Zeitschrift für Geburtshilfe und Neonatologie
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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.
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Z Geburtshilfe Neonatol · Oct 2011
Case Reports[Myocardial infarction in the 34th week of gestation: case report].
Acute myocardial infarction during pregnancy is a rare event that is often associated with a very high maternal mortality, estimated to be from 19 to 37%. During the last decades the incidence of myocardial infarction during pregnancy has increased. The main contributing factor could be a higher prevalence of the metabolic syndrome. ⋯ Based on an elevation of ischaemic heart markers and continuous non-specific thoracic pain we performed a primary Cesarean section. In the coronary angiography procedure that followed, a thrombotic occlusion of the ramus diagonalis was diagnosed. We here describe the differential diagnosis as well as the problems associated with diagnosing myocardial infarction in the third trimester of pregnancy.
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Z Geburtshilfe Neonatol · Aug 2011
Review[Respiratory disorders in preterm and term neonates: an update on diagnostics and therapy].
Respiratory disorders remain a major problem in postnatal adaptation. In term neonates, an increased incidence of the risk for transient tachypnoea of the neonate has been observed during the past decade, most likely secondary to an increased usage of primary Caesarean section. The disorder is mainly caused by a delayed resorption of foetal lung fluid. ⋯ The most relevant long-term sequelae, bronchopulmonary dysplasia, is currently being observed in about 15% of preterms with less than 32 weeks of gestation and is associated with severe pulmonary and extrapulmonary consequences. Due to the overall improvement in perinatal care, respiratory disorders still remain a major problem in pulmonary adaptation. However, mortality secondary to neonatal lung failure has been decreased substantially by the improvements in the whole field of perinatal medicine.
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Z Geburtshilfe Neonatol · Jun 2011
The clinical significance of base excess (BEB) and base excess in the extracellular fluid compartment (BEEcf) with and without correction to real oxygen saturation of haemoglobin.
Besides actual pH, base excess [ctH (+)(B) (mmol/l)] is of major importance since it is meant to reflect lactate acidosis due to foetal hypoxia; In vivo BE (B) is not independent from pCO (2). Independence is achieved by using the extended extracellular fluid (Ecf) for dilution of haemoglobin (cHb (B)) thus reducing cHb (B) to cHb (B)/3 (in the foetus to cHb (B)/4). Correction of ctH (+)(B) from the normally low foetal oxygen saturation by reoxygenation of Hb increases ctH (+)(B), resulting in 4 different variables: ctH (+)(B,act) (=BE (B)), ctH (+)(Ecf,act) (standard BE), ctH (+)(B,ox.) and ctH (+)(Ecf,ox). 3 questions arise: (i) which variable is most appropriate for perinatal acid-base studies? (ii) are there clinical advantages for using BE when compared with actual pH (UA), and (iii) what are the thresholds of the BE parameters? ⋯ Actual pH (cH (+)) offers the closest correlation with 2 essential clinical parameters: FHF and Apgar scores; the advantages of ctH (+)(B) and ctH (+)(Ecf), are not self-evident; if determination of the metabolic component becomes necessary standard BE, (ctH (+)(Ecf)) should be used with correction to 100% oxygen saturation (ctH (+)(Ecf,ox.)) of haemoglobin (HbF), because this quantity (after pH (UA)) correlates best with clinical indices. However if the 'correction' is omitted the difference seems clinically irrelevant.