Zeitschrift für Geburtshilfe und Neonatologie
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Z Geburtshilfe Neonatol · Aug 2018
Review Comparative Study[Maternal Deaths Worldwide Falling - But Commonly Preventable].
According to data from the WHO, maternal mortality ratio has dropped worldwide by 44% between 1990 and 2015, yet more than 300,000 mothers still die annually, about 99% of them in the developing countries. In some developed countries the incidence of maternal deaths has even increased during the past 2 decades. The leading causes of direct maternal deaths are haemorrhage (nearly 3-quarters from postpartum haemorrhage), pulmonary embolism including amniotic fluid embolism, and hypertensive disorders of pregnancy; the leading cause of indirect maternal deaths is cardiac disease of the mother. ⋯ The UK Confidential Enquiries into Maternal Deaths and Morbidity are internationally recognized as the 'gold standard' in maternal mortality surveillance. Considering the 11 studies from different developed countries, nearly 50% of direct maternal deaths (range: 26-75%) are potentially preventable, most often those due to postpartum haemorrhage and hypertensive disorders of pregnancy, and the fewest of all due to amniotic fluid embolisms. The crucial point is to learn from failures leading to maternal deaths: each obstetric unit should scrutinise if and where the need for improvement exists to prevent severe maternal morbidity and mortality.
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Z Geburtshilfe Neonatol · Jun 2016
Review Practice Guideline[Pharmacological Thromboprophylaxis during Pregnancy and the Puerperium: Recommendations from Current Guidelines and their Critical Comparison].
Venous thromboembolism (VTE) is one of the leading causes of maternal deaths worldwide. Due to the increasing number of pregnant women with risk factors, the incidence of VTE has risen over the past decades. Mortality and morbidity of VTE are potentially preventable, since more than two-thirds of these women have identifiable risk factors and may benefit from appropriate thromboprophylaxis. ⋯ At the onset of labour, in case of any vaginal bleeding, prior to scheduled labour induction or at least 12 h before an elective caesarean section, antenatal LMWH prophylaxis should be discontinued. LMWH prophylaxis can be continued 4-6 h after vaginal delivery and 6-12 h after caesarean delivery when women do not have an increased risk of haemorrhage. Current guidelines recommend weight-based LMWH.
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Z Geburtshilfe Neonatol · Dec 2015
Review[High-Flow Nasal Cannulae (HFNC) in Neonates: A Survey of Current Practice in Level 1 Perinatal Centres in the German State of North Rhine-Westphalia].
High-flow nasal cannulae (HFNC) is a kind of non-invasive respiratory support. In recent years, its application has gained increasing popularity for treating neonates with respiratory failure. Within this study, neonatologists employed at high level perinatal centres within the region of North Rhine-Westphalia, Germany were interviewed. We evaluated their personal experience as well as the underlying indication for using HFNC. ⋯ The application of the HFNC system is increasing for specific neonatal indications, thereby increasing the data for the evaluation of effectivity and safety. Nevertheless, detailed investigations of the appropriate flow rate settings are still lacking.
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Z Geburtshilfe Neonatol · Oct 2013
Review[Active management of the third stage of labour (AMTSL) - the end of a 50 years-dogma?].
Post-partum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Since more than 50 years AMTSL has been proposed for the prevention of PPH and is still recommended in current guidelines. The 3 key components of AMTSL are the prophylactic administration of oxytocin, clamping and cutting of the umbilical cord immediately after delivery of the baby and controlled cord traction. ⋯ Uterine massage after delivery of the placenta, placental cord drainage and umbilical vein injection of uterotonics after delivery of the baby as part of AMTSL are not evidence-based methods. It has taken 50 years since AMTSL was first described for it to become clear that prophylactic oxytocin is the most important and the only evidence-based component of AMTSL. Future guidelines and textbooks should consider these new -findings.
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Z Geburtshilfe Neonatol · Jun 2012
Review[Speckle tracking--a new ultrasound tool for the assessment of fetal myocardial function].
Speckle tracking is a new ultrasound tool to assess 2D ventricular global and segmental myocardial velocity and deformation (strain, strain rate). Multiple factors such as fetal motion, high heart rates, low blood pressure, small size of the heart, physiological cardiac translation, filling and maturational changes of myocardium, polyhydramnion, maternal obesity and aortic pulsation can degrade the image quality and result in artifacts and measurement errors which may have an impact on the final analysis. Therefore deformation indices such as strain and strain rate offer a quantitative technique for the estimation of global and segmental myocardial function and contractility. ⋯ Nevertheless, the time and training necessary to acquire high-quality video clips limit the implementation of speckle tracking into clinical routine. It is not yet clear whether this new technique will identify subclinical myocardial impairment earlier than with current techniques or allow for better discrimination between healthy fetuses and fetuses with congenital heart disease. The clinical use of speckle tracking will have to be demonstrated in larger groups of complicated pregnancies.