Publications by authors named "Mareike Möllers"

31 Publications

Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis.

Eur Heart J 2021 Oct 12. Epub 2021 Oct 12.

Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.

Aims: The aim of this study was to provide population-based data on maternal and neonatal complications and outcome in the pregnancies of women with congenital heart disease (CHD).

Methods And Results: Based on administrative data from one of the largest German Health Insurance Companies (BARMER GEK, ∼9 million members representative for Germany), all pregnancies in women with CHD between 2005 and 2018 were analysed. In addition, an age-matched non-CHD control group was included for comparison and the association between adult CHD (ACHD) and maternal or neonatal outcomes investigated. Overall, 7512 pregnancies occurred in 4015 women with CHD. The matched non-CHD control group included 6502 women with 11 225 pregnancies. Caesarean deliveries were more common in CHD patients (40.5% vs. 31.5% in the control group; P < 0.001). There was no excess mortality. Although the maternal complication rate was low in absolute terms, women with CHD had a significantly higher rate of stroke, heart failure and cardiac arrhythmias during pregnancy (P < 0.001 for all). Neonatal mortality was low but also significantly higher in the ACHD group (0.83% vs. 0.22%; P = 0.001) and neonates to CHD mothers had low/extremely low birth weight or extreme immaturity (<0.001) or required resuscitation and mechanical ventilation more often compared to non-CHD offspring (P < 0.001 for both). On multivariate logistic regression maternal defect complexity, arterial hypertension, heart failure, prior fertility treatment, and anticoagulation with vitamin K antagonists emerged as significant predictors of adverse neonatal outcome (P < 0.05 for all). Recurrence of CHD was 6.1 times higher in infants to ACHD mothers compared to controls (P < 0.0001).

Conclusions: This population-based study illustrates a reassuringly low maternal mortality rate in a highly developed healthcare system. Nevertheless, maternal morbidity and neonatal morbidity/mortality were significantly increased in women with ACHD and their offspring compared to non-ACHD controls highlighting the need of specialized care and pre-pregnancy counselling.
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http://dx.doi.org/10.1093/eurheartj/ehab571DOI Listing
October 2021

[Disinfection of transvaginal ultrasound probes-A current overview of methods and recommendations].

Gynakologe 2021 Jul 7:1-5. Epub 2021 Jul 7.

Bereich Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 Gebäude A1, 48149 Münster, Deutschland.

Disinfection of ultrasound probes, especially of transvaginal probes, has been under discussion during recent years and there have been several new regulations and recommendations as well as trends in the field of disinfection methods. This article provides a review and summary of the current state of knowledge.
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http://dx.doi.org/10.1007/s00129-021-04824-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261395PMC
July 2021

Correlation of first-trimester thymus size with chromosomal anomalies.

J Perinat Med 2021 Jun 10;49(5):604-613. Epub 2021 Feb 10.

Department of Obstetrics and Gynecology, University Hospital of Muenster, Muenster, Germany.

Objectives: The aim of this study was to investigate the correlation between fetal thymus size measured during first-trimester screening and chromosomal anomalies.

Methods: This study is a retrospective evaluation, in which the anterior-posterior diameter of the thymus in a midsagittal plane was measured in first-trimester ultrasound between 11 and 13 weeks of gestation in 168 fetuses with chromosomal anomalies (study group) and 593 healthy fetuses (control group). The included cases were subdivided into six groups: (1) trisomy 21, (2) trisomy 18, (3) trisomy 13, (4) Turner syndrome, (5) triploidy and (6) normal controls. Thymus size measurements were adjusted to the week of gestation, which was determined by ultrasound using crown-rump-length (CRL), by calculating a ratio between CRL and thymus size (CRL-thymus-ratio). Each study group was compared with the control group separately.

Results: Thymus size in fetuses affected by trisomy 18 or trisomy 13 was noticeably smaller compared to the control group (1.4 mm [1.3, 1.5] and 1.3 mm [1.2, 1.4] vs. 1.8 mm [1.6, 2.1]; all p<0.001; respectively). The thymus size of fetuses with trisomy 21 and Turner syndrome did not differ from healthy fetuses. Between the CRL-thymus-ratios of the separate study groups no statistically noticeable differences could be found.

Conclusions: Fetal thymus size appeared to be smaller in pregnancies affected by trisomy 18 and trisomy 13. The predictive value of fetal thymus size in first-trimester screening should be evaluated prospectively.
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http://dx.doi.org/10.1515/jpm-2020-0599DOI Listing
June 2021

Cervical elastography strain ratio and strain pattern for the prediction of a successful induction of labour.

J Perinat Med 2021 Feb 2;49(2):195-202. Epub 2020 Oct 2.

Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany.

Objectives: The aim of this study was to introduce cervical strain elastography to objectively assess the cervical tissue transformation process during induction of labour (IOL) and to evaluate the potential of cervical elastography as a predictor of successful IOL.

Methods: A total of 41 patients with full-term pregnancies elected for an IOL were included. Vaginal ultrasound with measurement of cervical length and elastography and assessment of the Bishop Score were performed before and 3 h after IOL. The measured parameters were correlated to the outcome of IOL and the time until delivery.

Results: We observed an association between the strain pattern and the value of the strain ratio 3 h after IOL and a successful IOL (p=0.0343 and p=0.0342, respectively) which can be well demonstrated by the results after 48 h. In our study population the cervical length and the Bishop Score did not prove to be relevant parameters for the prediction of a successful IOL.

Conclusions: We demonstrated for the first time that the cervical elastography pattern after the first prostaglandine application can help predict the outcome of IOL.
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http://dx.doi.org/10.1515/jpm-2020-0189DOI Listing
February 2021

Fetal brain development in small-for-gestational age (SGA) fetuses and normal controls.

J Perinat Med 2020 Mar 3. Epub 2020 Mar 3.

Department of Obstetrics and Gynecology, University Hospital of Münster, 48149 Münster, Germany.

Objective To assess whether fetal brain structures routinely measured during the second and third trimester ultrasound scans, particularly the width of the cavum septi pellucidi (CSP), differ between fetuses small for gestational age (SGA), fetuses very small for gestational age (VSGA) and normal controls. Methods In this retrospective study, we examined standard ultrasound measurements of 116 VSGA, 131 SGA fetuses and 136 normal controls including the head circumference (HC), transversal diameter of the cerebellum (TCD), the sizes of the lateral ventricle (LV) and the cisterna magna (CM) from the second and third trimester ultrasound scans extracted from a clinical database. We measured the CSP in these archived ultrasound scans. The HC/CSP, HC/LV, HC/CM and HC/TCD ratios were calculated as relative values independent of the fetal size. Results The HC/CSP ratio differed notably between the controls and each of the other groups (VSGA P = 0.018 and SGA P = 0.017). No notable difference in the HC/CSP ratio between the VSGA and SGA groups could be found (P = 0.960). The HC/LV, HC/CM and HC/TCD ratios were similar in all the three groups. Conclusion Relative to HC, the CSP is larger in VSGA and SGA fetuses than in normal controls. However, there is no notable difference between VSGA and SGA fetuses, which might be an indicator for abnormal brain development in this group.
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http://dx.doi.org/10.1515/jpm-2019-0401DOI Listing
March 2020

Comparison of strain and dyssynchrony measurements in fetal two-dimensional speckle tracking echocardiography using Philips and TomTec.

J Perinat Med 2020 Mar;48(3):266-273

Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.

Background The aim of this study was to compare Philips and TomTec two-dimensional speckle tracking echocardiography (2D-STE) software measurements of strain and dyssynchrony values in healthy fetuses. Methods This was an explorative observational study in which the echocardiographic data of 93 healthy fetuses between the 20th and 38th week of gestation were determined from a four-chamber view using 2D speckle tracking. The global and segmental longitudinal strain values of both ventricles, inter-ventricular and left intra-ventricular dyssynchrony were analyzed using QLab version 10.8 (Philips Medical Systems, Andover, MA, USA) and TomTec-Arena version 2.30 (TomTec, Unterschleißheim, Germany). Results TomTec showed persistently lower values for all of the assessed strain and dyssynchrony variables. For all variables, the bias between vendors tended to increase with gestational age, though not to a significant extent. Left ventricular dyssynchrony and longitudinal strain within the mid segment of the septum correlated best between vendors; however, the limits of agreement were wide in both cases. None of the variables assessed in the two-chamber view compared well between QLAB and TomTec. Conclusion Speckle tracking software cannot be used interchangeably between vendors. Further investigations are necessary to standardize fetal 2D-STE.
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http://dx.doi.org/10.1515/jpm-2019-0424DOI Listing
March 2020

Influence of maternal HIV infection on fetal thymus size.

J Perinat Med 2019 Dec;48(1):67-73

Department of Obstetrics and Gynecology, University Hospital Münster, Albert-Schweitzer Campus 1, Gebäude A1, 48149 Münster, Germany.

Objective To reveal the effect of a maternal human immunodeficiency virus (HIV) infection on the fetal thymus size. Methods The sonographic fetal thymus size was measured retrospectively in 105 pregnancies with maternal HIV infection and in 615 uncomplicated singleton pregnancies. The anteroposterior thymic and the intrathoracic mediastinal diameter were determined in the three-vessel view and their quotient, the thymic-thoracic ratio (TT ratio), was calculated. The study group was subdivided into three groups by the maternal viral load on the date of ultrasound (<50 cop./mL, 50-1000 cop./mL, >1000 cop./mL). Furthermore, an association between prognostic factors of the HIV infection such as the lymphocyte count, CD4/CD8 ratio, HIV medication and the thymus size, was investigated using correlation analyses. Results Fetal thymus size in pregnancies of HIV-positive mothers showed to be noticeably larger than in uncomplicated pregnancies. The mean TT ratio in the HIV-positive group was 0.389 and in the control group 0.345 (P < 0.001). There was no association between any maternal HIV parameter or medication and the size of the thymus gland. Conclusion Maternal HIV infection was associated with an increased fetal thymus size. Further consequences of intrauterine HIV exposure for fetal outcome and the development of the immune system of HIV-exposed uninfected (HEU) infants must be discussed.
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http://dx.doi.org/10.1515/jpm-2019-0060DOI Listing
December 2019

Fetal adrenal gland size in gestational diabetes mellitus.

J Perinat Med 2019 Nov;47(9):941-946

Department of Gynecology and Obstetrics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.

Background The aim of this study was to compare the adrenal gland size of fetuses of women with gestational diabetes mellitus (GDM) with that of healthy control fetuses. Methods This prospective cross-sectional study included measurements of the adrenal gland size of 62 GDM fetuses (GDM group) and 370 normal controls (control group) between the 19th and 41st week of gestation. A standardized transversal plane was used to measure the total width and the medulla width. The cortex width and an adrenal gland ratio (total width/medulla width) were calculated from these data. Adrenal gland size measurements were adjusted to the week of gestation and compared between the two groups in a multivariable linear regression analysis. A variance decomposition metric was used to compare the relative importance of predictors of the different adrenal gland size measurements. Results For all the investigated parameters of the adrenal gland size, increased values were found in the case of GDM (P < 0.05), while adjusting for the week of gestation. GDM seems to have a greater impact on the size of the cortex than on the size of the medulla. Conclusion The fetal adrenal gland is enlarged in pregnancy complicated by GDM. The width of the cortex seems to be particularly affected.
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http://dx.doi.org/10.1515/jpm-2019-0146DOI Listing
November 2019

Procedure related risk of premature delivery and fetal growth reduction following amniocentesis, transcervical and transabdominal chorionic villus sampling: a retrospective study.

J Perinat Med 2019 Oct;47(8):811-816

Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany.

Background The aim of this study was to compare transabdominal and transcervical chorionic villus sampling (CVS) as well as amniocentesis (AC) with respect to their rates of premature delivery and fetal growth restriction. Methods We retrospectively evaluated the mentioned procedures of invasive prenatal testing performed in a single center between 2001 and 2016. Seven hundred and ninety-nine cases of AC and 719 cases of CVS were included, of which 400 were performed transvaginally. Only singleton pregnancies with a normal karyotype and delivery after 24 + 0 weeks of gestation were included. Fetal growth restriction was defined as birth weight below the 10th percentile. Premature delivery was defined as delivery before 37 + 0 weeks of gestation. Data were compared to a control group without an invasive procedure. Results The frequency of premature delivery was 8.5% after transabdominal CVS, 6.3% after transcervical CVS and 10.5% after AC as compared to 10.8% in the control group. The frequency of fetal growth restriction was 8.2% after transabdominal CVS 6.8% after transcervical CVS and 8.4% after AC as compared to 9.7% in the control group. Conclusion Our study supports that the three different methods of invasive prenatal testing do not lead to a higher risk of either premature delivery or fetal growth restriction when compared to controls. We found no difference in risk profile among the three techniques.
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http://dx.doi.org/10.1515/jpm-2019-0291DOI Listing
October 2019

Disinfection of Transvaginal Ultrasound Probes by Ultraviolet C - A clinical Evaluation of Automated and Manual Reprocessing Methods.

Ultraschall Med 2020 Dec 25;41(6):681-687. Epub 2019 Jun 25.

Department of Obstetrics and Gynecology, University Hospital Münster, Germany.

Purpose:  Since pathogens can be transmitted to patients via transvaginal ultrasound probes, it is of particular importance that cleaning and disinfection are performed adequately. This study was designed to do a qualitative comparison of a low-level disinfection technique with disinfectant-impregnated wipes and an automated disinfection technique using ultraviolet C radiation in a clinical setting.

Materials And Methods:  The transvaginal ultrasound probes used in two groups of 160 patients were compared in a prospective controlled study regarding the effectiveness of manual low-level disinfection (Mikrozid sensitive wipes) and automated disinfection using ultraviolet C radiation (Antigermix AS1). Microbiological samples were taken from the whole surface of the probe before and after the disinfection process.

Results:  Before disinfection, 98.75 % (316/320) of the samples showed bacterial contamination. After automated and manual disinfection, the contamination rates were 34.2 % (54/158, automated) and 40.5 % (64/158, disinfectant wipes) (p > 0.05). Pathogens with the potential to cause healthcare-associated infections, such as Enterococcus faecalis and Klebsiella pneumoniae, were removed completely by both techniques. Manual disinfection showed a lower contamination rate after disinfection of bacteria that usually belong to the vaginal, pharyngeal and skin flora (disinfectant wipes 10.6 %, 11/104, automated 32.5 %, 38/117) (p < 0.001).

Conclusion:  For the clinical routine, automated disinfection with ultraviolet C is a promising technique for transvaginal ultrasound probes because of the simple handling and time efficiency. In our study, this method was completely effective against nosocomial pathogens. However, the study didn't show any significant difference in terms of effectiveness compared to low-level wipe disinfection.
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http://dx.doi.org/10.1055/a-0874-1971DOI Listing
December 2020

Strain and dyssynchrony in fetuses with congenital heart disease compared to normal controls using speckle tracking echocardiography (STE).

J Perinat Med 2019 Aug;47(6):598-604

Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany.

Objective To compare myocardial strain and mechanical dyssynchrony in fetuses with congenital heart disease (CHD) to normal controls using speckle tracking echocardiography (STE). Methods In this comparative cross-sectional study 23 fetuses with CHD and 105 normal controls between 19 and 41 weeks of gestation were assessed with STE. The STE sample box was placed over the myocardium of both ventricles. The parameters of interest included the segmental strain of the left (LV-S) and right lateral ventricle wall (RV-S) and the global ventricular strain of both chambers (2C-S). In order to separately assess the LV, we placed the STE sample box over the myocardium of the LV. We calculated the strain of the LV lateral wall (LW-S), the septum (SEPT-S) and the global ventricular strain of the single LV (1C-S). Furthermore, we analyzed the differences in timing of negative peak myocardial strain between the LV and RV (two-chamber dyssynchrony, 2C-DYS) and also within the LV between the lateral wall and the septum (one-chamber dyssynchrony, 1C-DYS). Results The evaluation of strain and mechanical dyssynchrony was feasible in all cases. Compared to normal controls, fetuses with CHD showed lower segmental and global strain values and the extent of 2C-DYS and 1C-DYS was higher than in the healthy control group. Conclusion The deterioration of myocardial function in CHD can be measured with STE. The assessment of strain and dyssynchrony with STE may be useful for distinguishing fetuses with CHD from healthy fetuses.
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http://dx.doi.org/10.1515/jpm-2019-0073DOI Listing
August 2019

3D Ultrasound Evaluation of the Fetal Outer Ear: Novel Biometry Ratio and Comparison of Different Surface Display Modes.

Fetal Diagn Ther 2019 29;46(3):200-206. Epub 2019 Mar 29.

Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany.

Background: The examination of the fetal ear is a promising but still challenging approach in prenatal diagnosis.

Objectives: This study investigated a novel ear length/width ratio based on anatomical landmarks. Additionally, we compared different 3D ultrasound surface rendering modes regarding their potential to depict detailed structures of the outer ear.

Method: We measured both the ear length and width of 118 fetal ears from 20 to 40 weeks of gestation to establish a length/width ratio. Additionally, we rendered the volumes in three different surface display modes and one adapted light position. Each image was scored regarding the visibility of distinct structures of the ear relief and indicator scores were evaluated for each mode.

Results: The median of the length/width ratio was 1.9 with a slight decline over the gestational period. The overall visibility of the ear structures differed noticeably between the four surface display modes (p < 0.001). The post hoc comparison showed that the display mode "TrueVue" resulted in the highest indicator scores.

Conclusion: The length/width ratio based on anatomical landmarks of the ear could prospectively be used as a marker in syndrome detection. The study showed a superiority of the surface display mode "TrueVue" for examination of the detailed ear structures.
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http://dx.doi.org/10.1159/000497145DOI Listing
February 2020

Evaluation of Cervical Elastography Strain Pattern to Predict Preterm Birth.

Ultraschall Med 2020 Aug 25;41(4):397-403. Epub 2019 Mar 25.

Department of Obstetrics and Gynecology, University-Hospital Münster, Germany.

Purpose:  To evaluate cervical elastography strain pattern as a predictive marker for spontaneous preterm delivery (SPTD).

Materials And Methods:  In this case-control study cervical length (CL) and elastographic data (strain ratio, elastography index, strain pattern score) were acquired from 335 pregnant women (20th - 34th week of gestation) by transvaginal ultrasound. Data of 50 preterm deliveries were compared with 285 normal controls. Strain ratio and elastography index were calculated by placing two regions of interest (ROIs) in parallel on the anterior cervical lip. The strain ratio was determined by dividing the higher strain value by the lower one. The elastography index was defined as the maximum of the strain ratio curve. Elastographic images were assigned a new established strain pattern (SP) score between 0 and 2 according to the distribution of strain induced by compression.

Results:  Elastography index, SP score and CL differed between preterm and normal pregnancies (1.61 vs. 1.27, p < 0.001; SP score value of "2": n = 31 (62 %) vs. n = 36 (12.6 %), p < 0.001; CL 30.7 vs. 41.0 mm, p < 0.001; respectively). The elastography index and SP score were associated with a higher predictive potential than CL measurement alone (AUC 0.8059 (area under the curve); AUC 0.7716; AUC 0.7631; respectively). A combination of all parameters proved more predictive than any single parameter (AUC 0.8987; respectively).

Conclusion:  Higher elastography index and SP scores were correlated with an elevated risk of SPTD and are superior to CL measurement as a predictive marker. A combination of these parameters could be used as a "Cervical Index" for the prediction of SPTD.
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http://dx.doi.org/10.1055/a-0865-1711DOI Listing
August 2020

Comparison of Longitudinal and Apical Foetal Speckle Tracking Echocardiography Using Tissue Motion Annular Displacement and Segmental Longitudinal Strain.

Ultrasound Med Biol 2019 01 25;45(1):233-245. Epub 2018 Oct 25.

Department of Obstetrics and Gynecology, University Hospital Münster, Münster, Germany.

The aim of our prospective pilot study with exploratory analysis was to compare longitudinal and apical foetal speckle tracking echocardiography (STE) using tissue motion annular displacement (TMAD) and segmental longitudinal strain (SLS). We compared two different STE quantification tools in a longitudinal and apical four-chamber view in 57 normal foetuses between 20 and 40 wk of gestation. Myocardial mechanical dyssynchrony and strain were assessed using offline quantification software (QLab Version 10.3, Philips Medical Systems, Andover, MA, USA). We compared the dyssynchrony measurements with TMAD and SLS in longitudinal and apical four-chamber views. Furthermore, we examined the segmental strain values of both ventricles with SLS and compared the differences between longitudinal and apical measurements. Dyssynchrony measurements with TMAD and SLS and strain measurements with SLS were feasible in all cases. In the apical view, the dyssynchrony measurements with TMAD were systematically greater than those achieved with SLS (p < 0.001). For the longitudinal view, no differences were observed between tools (p = 0.153). The application of SLS provided similar results for dyssynchrony in both views (intra-class correlation coefficient [ICC] = 0.281, p = 0.623), but the strain measurements in the left and right ventricles differed significantly between views (ICC = -0.082, p = 0.011, and ICC = -0.061, p = 0.024, respectively). For TMAD, we found large differences in the dyssynchrony values between longitudinal and apical assessment (ICC = -0.060, p = 0.03). Furthermore, TMAD exhibited reduced accuracy in the system's automatic tracking algorithm, limiting the data quality. The dyssynchrony assessment is affected less by the foetal position in SLS than in TMAD. The strain readings in SLS varied depending on the view in which they were assessed. The application of TMAD cannot be recommended for foetal STE.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2018.09.013DOI Listing
January 2019

New Method for Assessment of Levator Avulsion Injury: A Comparative Elastography Study.

J Ultrasound Med 2019 May 12;38(5):1301-1307. Epub 2018 Sep 12.

Department of Obstetrics and Gynaecology, University Hospital Münster, Münster, Germany.

Objective: The aim of this study was to introduce elastography as a new method for sonographic assessment of postpartum pelvic floor trauma.

Methods: We examined 86 postpartum primiparous women, of whom 43 had undergone primary caesarean section (group_CS) and 43 vaginal delivery (group_VD). In a puborectal-symphysis plane, B-mode and elastographic ultrasonography were used to evaluate pelvic floor trauma. The strain value of left and right puborectal muscle was assessed close to the symphysis (Trauma_Elastography). The strain ratio maximum of this measurement was stored (Trauma_Index).

Results: The elastographic evaluation revealed more trauma-suspicious lesions than the B-mode investigation (60.5% versus 39.5%; P < .001). The median Trauma_Index was higher in group_VD compared to group_CS (1.63 versus 1.18; P < .001).

Conclusion: Sonographic elastography assessment in a new examination plane shows postpartum trauma of the pelvic floor in women after vaginal delivery. This new method may help to identify women with a higher risk of postpartum pelvic floor disorders.
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http://dx.doi.org/10.1002/jum.14810DOI Listing
May 2019

Fetal brain development in diabetic pregnancies and normal controls.

J Perinat Med 2018 Sep;46(7):797-803

Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.

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http://dx.doi.org/10.1515/jpm-2017-0341DOI Listing
September 2018

Foetal thymus size in pregnancies after assisted reproductive technologies.

Arch Gynecol Obstet 2018 08 20;298(2):329-336. Epub 2018 Jun 20.

Department of Gynecology and Obstetrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.

Purpose: The aim of our study was to compare thymus sizes in foetuses conceived using assisted reproductive technologies (ART) to those conceived naturally (control group).

Methods: Sonographic foetal thymus size was assessed retrospectively in 162 pregnancies conceived using ART and in 774 pregnancies conceived naturally. The anteroposterior thymic and the intrathoracic mediastinal diameter were measured to calculate the thymic-thoracic ratio (TT-ratio). The ART cases were subdivided into two groups: (1) intracytoplasmic sperm injection (ICSI; n = 109) and (2) in vitro fertilisation (IVF; n = 53).

Results: The TT-ratio was smaller in pregnancies conceived using ART (p < 0.001). In both ART subgroups (ICSI and IVF), the TT-ratio was lower compared to the control group (p < 0.001). However, no difference between the two subgroups could be detected (p = 0.203).

Conclusions: Our data show reduced thymus size in foetuses conceived using ART compared to controls. These findings indicate that the use of ART may lead to certain deviations in organogenesis.
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http://dx.doi.org/10.1007/s00404-018-4795-4DOI Listing
August 2018

Quantification of fetal myocardial function in pregnant women with diabetic diseases and in normal controls using speckle tracking echocardiography (STE).

J Perinat Med 2018 Dec;47(1):68-76

University Hospital Münster, Clinic of Obstetrics and Gynecology, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.

Background The purpose of our study was to quantify the fetal myocardial function in pregnant women with diabetic diseases (FDM) and in normal controls (FC) using speckle tracking echocardiography (STE). Methods In this prospective study, the myocardial strain and dyssynchrony were analyzed using STE in a transversal four-chamber view in 180 fetuses (53 FDM, 127 FC) between 19 and 39 weeks of gestation. The measurements of the global and segmental longitudinal strain of both chambers (2C) and of the single left chamber (1C) were executed offline via QLab 10.5 (Philips Medical Systems, Andover, MA, USA). We assessed dyssynchrony as the time difference between peaks in strain in the mid segments of both chambers (interventricular dyssynchrony, 2C_DYS) and of the single left chamber (intraventricular dyssynchrony, 1C_DYS). Results Measurements were feasible with a high median frame rate of 199 frames/s (1st quartile: 174, 3rd quartile: 199). The global and segmental myocardial longitudinal strain of 2C and 1C were decreased and 2C_DYS and 1C_DYS were increased in pregnancies with diabetes compared to normal controls. Conclusion Our study demonstrates that fetal hearts affected by maternal diabetes mellitus (DM) show low myocardial strain values and high interventricular dyssynchrony. Two-chamber interventricular dyssynchrony has the potential to become a diagnostic marker for DM.
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http://dx.doi.org/10.1515/jpm-2018-0031DOI Listing
December 2018

High prevalence of MRSA and multi-resistant gram-negative bacteria in refugees admitted to the hospital-But no hint of transmission.

PLoS One 2018 31;13(5):e0198103. Epub 2018 May 31.

Institute of Hygiene, University Hospital Münster, Münster, Germany.

With high numbers of refugees arriving in Europe uncertainty exists as to whether multidrug-resistant organisms are imported into the healthcare system. In our study, we identified 383 refugee-inpatients admitted to the University Hospital Münster, Germany between September 2015 and September 2016. For this patient cohort screening for Methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MDR-GNB) and Vancomycin-resistant enterococci (VRE) was recommended in our institution. Until May 2016 pre-emptive isolation was applied to all refugee-inpatients until the exclusion of these multidrug-resistant organisms. MRSA were found in 34 refugee-patients (9.8%), MDR-GNB in 25 refugee-patients (12.9%) and VRE in none of the refugee patients. We did not find any strains carrying carbapenemases. Whole genome sequencing (WGS) data demonstrated that the respective isolates were genetically heterogeneous and revealed no transmission of refugee-patient isolates to other patients. We therefore omitted pre-emptive isolation as an infection control measure for this group of patients. Furthermore, molecular typing did not show evidence for nosocomial transmission from refugee-patients to other patients. Standard hygiene measures successfully prevented the transmission of refugee-patient isolates to other patients and as a result introduction into the healthcare system. This underlines that any multidrug-resistant organisms present within this cohort are not of any extraordinary concern for health systems.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198103PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978789PMC
November 2018

Adrenal gland size in growth restricted fetuses.

J Perinat Med 2018 Oct;46(8):900-904

Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.

Objective To compare the adrenal gland size of fetal growth restricted (FGR) and normal control fetuses. Study design In this prospective study the adrenal gland size of 63 FGR fetuses and 343 normal controls was measured between 20 and 41 weeks of gestation. The total width and the medulla width were measured in a new standardized transversal plane. The cortex width and a calculated ratio of the total and medulla width (adrenal gland ratio) were compared between both groups. Results The mean cortex width and the adrenal gland ratio in FGR fetuses were higher in comparison to the controls (P<0.001; P=0.036, respectively). The cortex width correlated positively with the gestational age (control group: P<0.001; FGR group: P=0.089) whilst the adrenal gland ratio showed no association with the gestational age (control group: P=0.153; FGR group: P=0.314). Conclusion The adrenal gland cortex width and the adrenal gland ratio were increased in FGR fetuses compared to normal fetuses.
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http://dx.doi.org/10.1515/jpm-2017-0339DOI Listing
October 2018

Assessment of the Fetal Cerebral Artery: Importance of Doppler Preset Settings.

J Ultrasound Med 2018 Mar 6;37(3):621-628. Epub 2017 Sep 6.

Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.

Objectives: The Doppler assessment of the middle cerebral artery (MCA) has a central role in the monitoring of high-risk pregnancies. The objective of this study was to investigate the importance of Doppler preset settings for measurement of the peak systolic velocity (PSV) and pulsatility index (PI) of the MCA.

Methods: The PI and PSV of the MCA were determined prospectively in 350 healthy fetuses between 19 and 42 weeks of pregnancy. The first measurement of the MCA (MCA.S) was performed with the conventional settings and the second (MCA.O) with an optimized setting of the maximum achievable frame rate. For the MCA.O measurement, the width of the B-mode image and the color Doppler window were adjusted as narrowly as possible. In addition, the MCA was shown in optimized high-definition zoom. Resulting values were compared with commonly used reference values.

Results: The PSV and PI values and frame rates of the MCA.O setting were noticeably greater than those of the MCA.S setting (P < .001 for all). For both settings, the PSV and PI values were increased compared to common reference values.

Conclusions: The assessment of the MCA with the optimized Doppler default setting yielded increased PSV and PI values compared to the commonly used measurement technique. Moreover, the resulting median curves differed from the established median reference curves. Therefore, an updated standardization for measuring the MCA should be set out, and current reference values should be adjusted.
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http://dx.doi.org/10.1002/jum.14378DOI Listing
March 2018

Assessment of strain and dyssynchrony in normal fetuses using speckle tracking echocardiography - comparison of three different ultrasound probes.

J Perinat Med 2018 Nov;46(9):960-967

Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany.

Objective: To evaluate segmental left (LV-S) and right (RV-S) ventricular strain as well as longitudinal mechanical myocardial dyssynchrony as a time difference between peaks in strain of both ventricles in fetuses (two-chamber-dyssynchrony, 2C-DYS) using speckle tracking echocardiography (STE). The aim of our study was to evaluate the influence of data acquisition on the results of STE measurement using different ultrasound probes.

Methods: We prospectively recorded cardiac cycles of four-chamber views of 56 normal fetuses with three different ultrasound probes and analyzed them offline with speckle tracking imaging software. Furthermore, we looked at a possible influence of heartbeat variability (beat-to-beat variability).

Results: The evaluation of the parameters was feasible with all three probes in 53 cases. There was no influence of heartbeat variability and no noticeable differences in 2C-DYS, LV-S and RV-S in all cases and for all three probes determined.

Conclusion: Assessment of strain and dyssynchrony using STE with three different probes is comparable. Further research is needed to validate dyssynchrony as a predictor for fetal outcome.
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http://dx.doi.org/10.1515/jpm-2017-0113DOI Listing
November 2018

Prevalence of Multidrug Resistant Bacteria in Refugees: A Prospective Case Control Study in an Obstetric Cohort.

Z Geburtshilfe Neonatol 2017 06 30;221(3):132-136. Epub 2017 Jun 30.

Gynecology and Obstetrics, University Hospital Münster, Münster.

To determine the prevalence of multidrug resistant (MDR) bacteria in a cohort of pregnant refugee women. In a prospective case control study, surveillance cultures for MDR bacteria (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], MDR Gram-negative bacteria [MRGN]) were analysed between October 2015 and June 2016 from a cohort of 50 pregnant refugee women and 50 resident controls in the obstetric unit of a German tertiary referral hospital. Prevalence of MRSA was noticeably higher among refugee women compared to residents (6 vs. 0%). In addition, a trend towards a higher prevalence of VRE and MDR Gram-negative bacteria in refugees was shown (1.8 vs. 0%). Due to the higher prevalence of MDR bacteria, surveillance cultures are justified in order to prevent nosocomial spread of MDR bacteria.
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http://dx.doi.org/10.1055/s-0043-102579DOI Listing
June 2017

Assessment of cervical elastography strain pattern and its association with preterm birth.

J Perinat Med 2017 Nov;45(8):925-932

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Objective: The aim of the study was to assess the cervical strain pattern by an ultrasound elastography cervix examination and to determine its association with preterm delivery.

Methods: In this study, 30 cases resulting in preterm birth and 30 gestational age-matched controls were included. A vaginal ultrasound examination with cervical length and elastography measurement was performed. We calculated four strain ratios (SR1-SR4) of the regions of interest (ROIs) arranged in pairs in four different positions on the anterior cervical lip. The strain ratios were correlated to the outcome of spontaneous preterm delivery. The inter-observer and intra-observer variability of the strain measurement was evaluated.

Results: We observed an association between the value of the strain ratio that was calculated from the ROIs placed side by side in the middle of the anterior lip (SR4), and preterm delivery (P<0.001). The predictive values of cervical length and SR4 were comparable (AUC 0.7394; AUC 0.8322, respectively). The combination of cervical length and SR4 was superior in predicting preterm delivery compared to both parameters alone (AUC 0.8789). The inter-observer and intra-observer variability of data acquisition and measurement was excellent.

Conclusions: Our study assesses the cervical elastography strain pattern and shows a correlation to a spontaneous preterm birth.
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http://dx.doi.org/10.1515/jpm-2016-0375DOI Listing
November 2017

Fetal thymus size in pregnant women with diabetic diseases.

J Perinat Med 2017 Jul;45(5):595-601

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Aim: The aim of our study was to assess fetal thymus size in diabetic pregnancies compared with normal pregnancies.

Methods: Sonographic fetal thymus size was retrospectively assessed in 161 pregnancies with maternal diabetes and in 161 uncomplicated pregnancies matched by gestational age. The anteroposterior thymic and the intrathoracic mediastinal diameter were measured and the quotient was calculated [thymic-thoracic ratio (TT-ratio)]. In addition, we defined the quotient of the anteroposterior thymic diameter and the head circumference as thymus-head ratio (TH-ratio). The maternal diabetes cases were subdivided into three groups: (1) diet-controlled gestational diabetes, (2) insulin-dependent gestational diabetes and (3) preexisting maternal diabetes.

Results: TT-ratio and TH-ratio were smaller in pregnancies with maternal diabetes (P<0.001 and P<0.001, respectively). In all three maternal diabetes subgroups, the TT-ratio and the TH-ratio were lower compared with the control group (P<0.001 for each group).

Conclusions: Reduced fetal thymus size seems to be associated with diabetic pregnancy. We introduce fetal thymus size as a new potential prognostic parameter for maternal diabetes.
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http://dx.doi.org/10.1515/jpm-2016-0400DOI Listing
July 2017

Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE).

J Perinat Med 2017 Oct;45(7):821-827

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Purpose: To evaluate longitudinal mechanical dyssynchrony in normally grown fetuses by speckle tracking echocardiography (STE) and to compare longitudinal mechanical dyssynchrony in fetal growth restriction (FGR) with normal controls.

Materials And Methods: A prospective study was performed on 30 FGR and 62 normally grown fetuses, including 30 controls matched by gestational age, using STE and a transversal four-chamber view. Data analysis was carried out with a high frame rate of about 175 frames/s. Dyssynchrony was analyzed offline with QLab 9 (Philips Medical Systems, Andover, MA, USA) as time differences between peaks in strain of both ventricles and the septum. Inter- and intraventricular and intraseptal dyssynchrony were obtained and inter- and intraobserver reliability was analyzed.

Results: Longitudinal mechanical dyssynchrony was feasible in all cases, with high inter- and intraobserver reliability. Levels of inter- and intraventricular dyssynchrony were higher in the FGR than in the control group.

Conclusion: Speckle tracking echocardiography (STE) is a reliable technique for cardiac function assessment in the fetal heart. Interventricular dyssynchrony could be a potential parameter for early detection of subclinical myocardial dysfunction before other parameters demand intervention. The future clinical role of longitudinal mechanical dyssynchrony needs to be verified in larger studies and with a technique customized for prenatal echocardiography.
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http://dx.doi.org/10.1515/jpm-2016-0280DOI Listing
October 2017

Thorax-to-head ratio and defect diameter-to-head ratio in giant omphaloceles as predictor for fetal outcome.

Arch Gynecol Obstet 2017 Feb 11;295(2):325-330. Epub 2016 Nov 11.

Department of Obstetrics and Gynecology, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.

Purpose: To investigate the relationship between the thorax diameter and defect diameter of giant omphaloceles as a predictor for fetal outcome.

Methods: In a retrospective study, 17 fetuses with isolated giant omphaloceles were included for evaluation. The anterior-posterior thorax diameter and the defect diameter were measured from ultrasound images. For analysis, the thorax-to-head ratio (T/HC), the defect diameter-to-head ratio (DD/HC), and the quotient of the defect diameter and the thorax diameter (DD/T) were calculated. The days of ventilation (t ), the duration until hospital discharge (t ), and the type of treatment were recorded as outcome parameters.

Results: No relationship was found between the calculated ratios (T/HC, DD/HC, or DD/T) and neither t (r = -0.418, p = 0.095; r = -0.153, p = 0.556; and r = -0.023, p = 0.929; respectively) nor t (r = -0.391, p = 0.121; r = 0.041, p = 0.875; and r = 0.121, p = 0.645, respectively). The type of postnatal treatment was not associated with the three calculated ratios or t (r = 0.155, p = 0.553; r = 0.019, p = 0.942; and r = 0.012, p = 0.965; r = -0.009, p = 0.973, respectively). In 53% of cases, t was delayed due to additional and independent postnatal complications.

Conclusion: Thorax diameter or defect diameter of giant omphaloceles is not predictive for fetal outcome. The perinatal care of these abdominal wall defects still remains a multidisciplinary challenge, but the outcome of giant omphaloceles is favorable at experienced centers.
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http://dx.doi.org/10.1007/s00404-016-4236-1DOI Listing
February 2017

Fetal loss following invasive prenatal testing: a comparison of transabdominal chorionic villus sampling, transcervical chorionic villus sampling and amniocentesis.

J Perinat Med 2017 Feb;45(2):193-198

Objective: The aim of this study was to compare transabdominal chorionic villus sampling, transcervical chorionic villus sampling and amniocentesis with respect to their total fetal loss rates.

Methods: We retrospectively evaluated procedures of invasive prenatal testing performed during a 14-year period (2001-2014) including 936 amniocentesis procedures and 1051 chorionic villus samplings, of which 405 cases were executed transabdominally and 646 transcervically. Only singleton pregnancies before 24 weeks and 0 days of gestation where the pregnancy outcome was known were included. Fetal loss was defined as an abortion occurring either before 24 weeks and 0 days of gestation or <2 weeks after the procedure.

Results: The total fetal loss rates were determined to be 1.73% for transabdominal chorionic villus sampling, 2.01% for transcervical chorionic villus sampling and 1.18% for amniocentesis. No statistically noticeable differences between the total fetal loss rates of all three procedures were found (P=0.399).

Conclusion: Our study has shown that chorionic villus sampling (either transabdominal or transcervical) and amniocentesis are equal methods for invasive prenatal testing with respect to their abortion risk.
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http://dx.doi.org/10.1515/jpm-2015-0434DOI Listing
February 2017

3D Ultrasound Evaluation of the Fetal Ear - Comparison of an xMatrix Probe with a Conventional Mechanical Probe.

Ultraschall Med 2017 Oct 3;38(5):508-514. Epub 2015 Nov 3.

Department of Obstetrics and Gynecology, University Hospital Münster, Germany.

 New 3 D technologies like xMatrix probes promise superiority over conventional mechanical probes and may allow a more detailed and time-saving prenatal diagnosis. In a comparison study we evaluate fetal ears. The aim of our study was to compare the following aspects of both techniques: (1) ultrasound detail resolution, (2) raw data acquisition time (AT) and (3) influence of covariates.  3 D raw data volumes of the fetal ear were collected with the V6 - 2 (V6) and with the xMatrix (X6) probe and were stored after offline customization to a single picture. Two observers scored these images independently. Furthermore, the 3 D raw data acquisition time (AT) was recorded. Concordance between observers, maternal age, body mass index (BMI), weeks of gestation and location of the placenta were evaluated.  Data volumes of 103 patients were analyzed. The X6 detected anatomic structures like the scapha (p = 0.0146), fossa triangularis (p = 0.0075) and cymba conchae (p = 0.0025) more often. The mean AT of the X6 was shorter compared to the V6 (p < 0.0001). A placenta location in the scanning field increased the AT only for the V6 (p < 0.01). Concordance between observers was higher for the X6 in most cases. Detailed structures were less visible at the end of pregnancy for both devices.  The comparison study demonstrated clear advantages of the new xMatrix technology concerning an advanced and fast examination of detailed structures like the fetal ear. The importance of 3 D assessment in cases of fetal ear anomaly should be proven in further studies.
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http://dx.doi.org/10.1055/s-0041-108567DOI Listing
October 2017

Assessment of first-trimester thymus size and correlation with maternal diseases and fetal outcome.

Acta Obstet Gynecol Scand 2016 Feb 17;95(2):210-6. Epub 2015 Nov 17.

Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany.

Introduction: We investigated the reliability of fetal thymus measurement during first-trimester screening, and associated fetal thymus size with crown-rump length, maternal diseases and fetal outcome.

Material And Methods: In a retrospective cohort of 971 normal singleton first-trimester fetuses, we measured the anterior-posterior diameter of the thymus in a midsagittal plane in 767 fetuses. The intra-observer and inter-observer reliabilities were tested by intra-class correlation coefficient. We correlated thymus size with fetal crown-rump length, and investigated its association with maternal diseases (diabetes mellitus, rheumatic disorders, hypertension and coagulation disorders) and fetal outcome (small for gestational age, preterm birth and umbilical artery pH) using regression analyses.

Results: The intra-observer and inter-observer reliabilities of fetal thymus measurement were excellent (intra-class correlation coefficient 0.926, 95% CI 0.745-0.981 and 0.945, 95% CI 0.886-0.993, respectively). A linear relationship was found between crown-rump length and thymus size (β = 0.023, p = 0.001). Pregnancies affected by maternal diabetes had a decreased fetal thymus size (β = -0.209, p = 0.001), whereas in pregnancies affected by maternal rheumatic disease the thymus size was increased (β = 0.285, p < 0.001). Fetal thymus size was not associated with maternal hypertension or maternal coagulation disorders. There was a positive association between preterm birth and fetal thymus size (p < 0.001).

Conclusion: Measurement of first-trimester thymus size is reliable. Fetal thymus size has a linear correlation with crown-rump length. Maternal diabetes, rheumatic disease and preterm birth appear to have an association with fetal thymus size.
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http://dx.doi.org/10.1111/aogs.12790DOI Listing
February 2016
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