Publications by authors named "Melanie Metz"

7 Publications

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Peripartum Covid-19 Pneumonia with Severe ARDS - A Case Report.

Z Geburtshilfe Neonatol 2021 04 19;225(2):183-187. Epub 2021 Apr 19.

Department of Gynecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany.

Introduction: SARS-CoV-2 is a novel coronavirus that was first isolated in Wuhan, China, and resulted in a rapidly spreading pandemic worldwide. Currently there is only limited evidence on the effect of COVID-19 on pregnant women.

Case: Here we present one of the first serious COVID-19 cases in pregnancy at term with subsequent delivery. Postpartum the mother required antibiotic and symptomatic treatment. She experienced acute worsening of symptoms and developed acute respiratory failure requiring endotracheal intubation and subsequently extracorporeal membrane oxygenation.

Conclusion: COVID-19 affects all medical disciplines, requiring interdisciplinary approaches and development of patient care regimes. Obstetricians should be aware and be prepared for the special needs of pregnant women with potential prenatal and postnatal issues. Ideally pregnant COVID-19 patients should be cared for at a tertiary perinatal center with experienced perinatologists and neonatologists.
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April 2021

Influence of Functional Groups on the Ene Reaction of Singlet Oxygen with 1,4-Cyclohexadienes.

Photochem Photobiol 2021 Mar 27. Epub 2021 Mar 27.

Department of Chemistry, University of Potsdam, Golm, Germany.

The photooxygenation of 1,4-cyclohexadienes has been studied with a special focus on regio- and stereoselectivities. In all examples, only the methyl-substituted double bond undergoes an ene reaction with singlet oxygen, to afford hydroperoxides in moderate to good yields. We explain the high regioselectivities by a "large-group effect" of the adjacent quaternary stereocenter. Nitriles decrease the reactivity of singlet oxygen, presumably by quenching, but can stabilize proposed per-epoxide intermediates by polar interactions resulting in different stereoselectivities. Spiro lactams and lactones show an interesting effect on regio- and stereoselectivities of the ene reactions. Thus, singlet oxygen attacks the double bond preferentially anti to the carbonyl group, affording only one regioisomeric hydroperoxide. If the reaction occurs from the opposite face, the other regioisomer is exclusively formed by severe electrostatic repulsion in a perepoxide intermediate. We explain this unusual behavior by the fixed geometry of spiro compounds and call it a "spiro effect" in singlet oxygen ene reactions.
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March 2021

Do we need a 200 μg misoprostol vaginal insert? A retrospective cohort study comparing the misoprostol vaginal insert to oral misoprostol.

J Obstet Gynaecol Res 2020 Jun 3;46(6):851-857. Epub 2020 May 3.

Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany.

Aim: The misoprostol vaginal insert (MVI) was reported to be more effective than dinoprostone but discussed critically because of high rates of fetal heart rate changes due to uterine tachysystole. The aim of this study was to investigate the outcome of induced labor using the MVI compared to off-label orally-administered misoprostol (OM).

Methods: Retrospective study including a total of 401 patients with singleton pregnancies in whom labor was induced at ≥36 0/7 gestational weeks with MVI (203) or OM (198). Primary outcomes were the time from induction to delivery, vaginal delivery in 24 h and the mode of delivery and the neonatal outcome.

Results: Median time until any delivery was 833 min (645-1278) for MVI and 1076.5 min (698-1686.3) for OM group; 83.7% of the patients in the MVI group gave birth within 24 h versus 63.6% in the OM group. The MVI group needed significantly less pre-delivery oxytocin (29%). Tachysystole (6.4%) and pathological CTG (30.5%) occurred at a significantly higher frequency in the MVI group. The cesarean section rate was significantly higher in the MVI group amounting to 21.7% versus 14.6% in the OM group (P < 0.05). Neonatal outcome did not differ between the groups.

Conclusion: The MVI might be an option if you are in need for an approved and faster method to induce labor. Although we observed a significantly higher rate of fetal heart rate changes and cesarean sections in the MVI group this did not affect the neonatal outcome.
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June 2020

Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin.

J Perinat Med 2018 Apr;46(3):299-307

Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Affiliate of Charité University, Berlin, Germany.

Background: Trial of labor after cesarean (TOLAC) is a viable option for safe delivery. In some cases cervical ripening and subsequent labor induction is necessary. However, the commonly used prostaglandins are not licensed in this subgroup of patients and are associated with an increased risk of uterine rupture.

Methods: This cohort study compares maternal and neonatal outcomes of TOLAC in women (n=82) requiring cervical ripening agents (osmotic dilator vs. prostaglandins). The initial Bishop scores (BSs) were 2 (0-5) and 3 (0-5) (osmotic dilator and prostaglandin group, respectively). In this retrospective analysis, Fisher's exact test, the Kruskal-Wallis rank sum test and Pearson's chi-squared test were utilized.

Results: Vaginal birth rate (including operative delivery) was 55% (18/33) in the osmotic dilator group vs. 51% (25/49) in the dinoprostone group (P 0.886). Between 97% and 92% (32/33 and 45/49) (100%, 100%) of neonates had an Apgar score of >8 after 1 min (5, 10 min, respectively). The time between administration of the agent and onset of labor was 36 and 17.1 h (mean, Dilapan-S® group, dinoprostone group, respectively). Time from onset of labor to delivery was similar in both groups with 4.4 and 4.9 h (mean, Dilapan-S® group, dinoprostone group, respectively). Patients receiving cervical ripening with Dilapan-S® required oxytocin in 97% (32/33) of cases. Some patients presented with spontaneous onset of labor, mostly in the dinoprostone group (24/49, 49%). Amniotomy was performed in 64% and 49% (21/33 and 24/49) of cases (Dilapan-S® group and dinoprostone group, respectively).

Conclusions: This pilot study examines the application of an osmotic dilator for cervical ripening to promote vaginal delivery in women who previously delivered via cesarean section. In our experience, the osmotic dilator gives obstetricians a chance to perform induction of labor in these women.
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April 2018

Development and Validation of a Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Post Partum.

Geburtshilfe Frauenheilkd 2017 Apr;77(4):358-365

Beckenbodenzentrum Charité, Klinik für Gynäkologie CBF, Berlin, Germany.

The aim of this study was to develop and validate a questionnaire for the assessment of pelvic floor disorders, their symptoms and risk factors in pregnancy and after birth including symptom course, severity and impact on quality of life. The validated German pelvic floor questionnaire was modified and a new risk factor domain developed. The questionnaire was initially completed by 233 nulliparous women in the third trimester of pregnancy and at six weeks (n = 148) and one year (n = 120) post partum. Full pyschometric testing was performed. The clinical course of symptoms and the influence of risk factors were analysed. Study participants had a median age of 31 (19-46) years. 63 % had spontaneous vaginal deliveries, 15 % operative vaginal deliveries and 22 % were delivered by caesarean section. Content validity: Missing answers never exceeded 4 %. Construct validity: The questionnaire distinguished significantly between women who reported bothersome symptoms and those who did not. Reliability: Cronbach's alpha values exceeded 0.7 for bladder, bowel and support function, and 0.65 for sexual function. The test-retest analysis showed moderate to almost complete concordance. The intraclass coefficients for domain scores (between 0.732 and 0.818) were in acceptable to optimal range. Reactivity: The questionnaire was able to track changes significantly with good effect size for each domain. Risk factors for pelvic floor symptoms included familial predisposition, maternal age over 35 years, BMI above 25, nicotine abuse, subjective inability to voluntarily contract the pelvic floor musculature and postpartum wound pain. This pelvic floor questionnaire proved to be valid, reliable and reactive for the assessment of pelvic floor disorders, their risk factors, incidence and impact on quality of life during pregnancy and post partum. The questionnaire can be utilised to assess the course of symptoms and treatment effects using a scoring system.
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April 2017

Valsalva versus straining: There is a distinct difference in resulting bladder neck and puborectalis muscle position.

Neurourol Urodyn 2017 Sep 31;36(7):1860-1866. Epub 2017 Jan 31.

Department of Gynaecology, Pelvic Floor Centre, Charité Universitätsmedizin Berlin, Berlin, Germany.

Aims: To assess the effects of the Valsalva manoeuvre versus straining on bladder neck (BN) and puborectalis muscle (PR) position, BN stiffness and pelvic floor muscle (PFM) activation in urinary incontinent women and healthy continent controls.

Methods: We recruited 17 continent and 85 incontinent women. A Microtip transducer measured urethral and vesical/abdominal pressures. A surface EMG electrode attached to a sponge was placed vaginally at the pelvic floor level. BN and PR movements were assessed with perineal ultrasound. Stiffness was calculated as the increase in vesical pressure per descent of BN and PR during manoeuvres. Women were standing and asked to perform a Valsalva against a closed mouth and glottis and thereafter to relax the PFM and strain as if defecating. To demonstrate a difference of 5 mm in PR descent between Valsalva and straining with a power of 80% and α = 0.05, 24 women were necessary.

Results: During Valsalva, 71% of continent and 76% of incontinent women demonstrated PFM activation, whereas during straining significantly fewer women activated the PFM (29% and 32%, respectively). During straining, BN and PR muscle descent was significantly greater and stiffness was lower than during Valsalva in both incontinent and continent women.

Conclusion: Valsalva and straining are different tasks with different PFM activation patterns. The PF is stiffer with Valsalva resulting in better BN support whereas straining leads to more PR and BN descent. These terms should not be used interchangeably and women have to be instructed carefully to allow appropriate interpretation of data.
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September 2017

Population pharmacokinetics of high-dose etoposide in children receiving different conditioning regimens.

Anticancer Drugs 2002 Jan;13(1):101-10

Department of Pediatric Hematology and Oncology, University Hospital Münster, 48129 Münster, Germany.

Pharmacokinetics after high-dose (HD) etoposide (Eto) (40 mg/kg i.v. once as 4-h infusion, one patient 20 mg/kg i.v. as 4-h infusion, for 3 consecutive days) were studied in 31 children and young adults (age 0.8-23.7 years, median: 8.0 years) undergoing bone marrow transplantation after different conditioning regimens. Blood samples were collected until 97 h after the end of infusion. The population analysis of the first part of data (112 samples/21 patients, well documented) served to establish the pharmacokinetic model. The same data combined with the second part of data (50 samples/10 patients, 'intention to treat') then served to calculate the final population model. Data were best described by a three-compartment model with t1/2alpha = 0.28 h +/- 3.2%, t1/2beta = 3.6 h +/- 16.9% and t1/2gamma = 44.2 h +/- 56.5%, respectively (mean(geom) +/- CV(geom)). Clearance (CL) was 15.5 ml/min/m2 +/- 30.6% (mean(geom) +/- CV(geom)) and thus at the lower range of data reported in the literature. The fraction of unbound Eto (fu) was 7.0% (4.3-11.9%) [median (range)], with high intra-individual variability. An increase in f(u) with increasing total Eto was observed. The question of a principally lower Eto CL in children, as compared to adults, after HD treatment remains open.
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January 2002