Papers by Elisabeth Krampl
![Research paper thumbnail of [Screening of chromosome anomalies during the first trimester]](https://a.academia-assets.com/images/blank-paper.jpg)
Gynäkologisch-geburtshilfliche Rundschau, 2005
In view of today's knowledge, it is evident that a very efficient screening for chromosome an... more In view of today's knowledge, it is evident that a very efficient screening for chromosome anomalies can be carried out during the first trimester. Prospective studies of a total of 200,868 pregnancies-among them 871 fetuses with trisomy 21-have shown that measuring the nuchal transparency can identify 76.8% of fetuses with trisomy 21, with a false-positive rate of 4.2%. If the measurement of nuchal transparency is combined with that of the maternal serum concentrations of free human beta-choriogonadotropin and pregnancy-associated plasma A, the detection rate is 87.0% with a false-positive rate of 5% (prospective studies of altogether 44,630 pregnancies with 215 fetuses suffering from trisomy 21). At present, further signs of Down syndrome in the first trimester are being investigated, such as the missing fetal nasal bone, the maxilla and the blood flow pattern in the ductus venosus. Well-known signs of trisomy 13 and 18, which are already visible in the first trimester, are me...
Obstetrics & Gynecology, 2003
To investigate maternal cardiac function in twin pregnancy. METHODS: We conducted a cross-section... more To investigate maternal cardiac function in twin pregnancy. METHODS: We conducted a cross-sectional study of 119 pregnant women with twin pregnancies at 10-40 weeks' gestation. Two-dimensional and M-mode echocardiography of the left ventricle was performed in the left lateral decubitus position to assess left ventricular longitudinal and transverse systolic function. The measurements were compared with those obtained from 128 women with singleton pregnancies previously reported. RESULTS: In twin pregnancies, compared with singletons, maternal cardiac output was greater by 20% (P < .001), because of a greater stroke volume (15%, P < .001) and heart rate (3.5%; P ؍ .04). Furthermore, in women with twins there were greater left ventricular end-diastolic and left ventricular end-systolic dimensions, left ventricular mass (13.5%; P < .001), fractional shortening (3%; P ؍ .04), and ejection fraction (2.5%; P ؍ .04). Mean arterial pressure and global time to shortening in women with twins, compared with singletons, were less in the first trimester by approximately 2%, but after midpregnancy they increased progressively, so that at term the measurements were greater by 3% and 5.7%, respectively (P ؍ .03). Conversely, long axis shortening in women with twins, compared with singletons, was greater in the first trimester by approximately 6.5%, but at term it was 3% less (P ؍ .01). Twin pregnancies that subsequently developed preeclampsia had a hemodynamic profile similar to the rest of the twin population. CONCLUSION: Twin pregnancy is characterized by an even more hyperdynamic circulation than singleton pregnancy. Left ventricle longitudinal systolic function and mean arterial pressure are more abruptly affected after 20 weeks compared with singleton pregnancies.
Acta Obstetricia et Gynecologica Scandinavica, 2001
Zentralblatt Fur Gynakologie, 1997
Geburtsh Frauenheilk, 2007
Geburtsh Frauenheilk, 2007
Gynakol Geburtshilfl Rundsch, 2007
Geburtshilfe und Frauenheilkunde, 2002
Down's syndrome accounts for roughly one third of all causes of mental handicap. It has a pre... more Down's syndrome accounts for roughly one third of all causes of mental handicap. It has a prevalence of 0.2% of all pregnancies and, with the availability of prenatal diagnosis by chorionic villus sampling or amniocentesis, every obstetrician faces the challenge of counseling his patients about chromosomal abnormalities. Combining quantifiable fetal markers with the maternal age-related risk individualises the risk calculation and improves the detection rate of Down's syndrome. Thus, at a 5% false-positive rate, the detection rate is 30% for age-based screening (age cut-off of 37 years in Germany/Austria), and if the nuchal translucency measurement and maternal serum concentrations of free b-human chorionic gonadotrophin (hCG) and pregnancy associated plasma protein A (PAPP-A) are taken into account, the detection rate increases to about 90%. This information should be provided to every pregnant woman.
Geburtshilfe und Frauenheilkunde, 2007
Geburtshilfe und Frauenheilkunde, 2007
Gynecology and Obstetrics Urology, 1994
Many embryo transfers after in vitro fertilization may fail secondary to expulsion of the embryos... more Many embryo transfers after in vitro fertilization may fail secondary to expulsion of the embryos from the uterus. Approximately 5%–8% of resulting pregnancies after embryo transfer are ectopic. It was the aim of our study to find a technique to avoid ectopic pregnancies and to improve pregnancy rate. We used a two-component fibrin sealant which also contains a fibrinolysis inhibitor (aprotinin) in various concentrations. After gaining experience in mouse embryos we used it in human embryo transfer with great success. The results of a pilot study encouraged us to perform a prospective randomized study on 546 patients (270 with fibrin sealant, 276 conventional embryo transfers). There were 47 (17.03%) orthotopic pregnancies and 6 (2.17%) ectopic pregnancies in the control group, whereas there were 51 (18.89%) intrauterine and no ectopic pregnancies in the treatment group. The difference in ectopic pregnancies was statistically significant (p ‹ 0.05). Regarding aprotinin concentration, there was a trend towards better results with 100–150 kIU (28.5% clinical pregnancies) in comparison to 250–300 kIU (19.23%) or no aprotinin (20.41%) (not significant). Further improvements of the technique may raise the pregnancy rate when fibrin sealant is used. As was shown in our prospective randomized study, ectopic pregnancy may be completely avoided.
Ultrasound in Obstetrics and Gynecology, 2002
... growth. Diabetes 1991; 40: 61–5 22 Clapp JF 3rd, Seaward BL, Sleamaker RH, Hiser J. Maternal ... more ... growth. Diabetes 1991; 40: 61–5 22 Clapp JF 3rd, Seaward BL, Sleamaker RH, Hiser J. Maternal phys-iologic adaptations to early human pregnancy. ... altitude. Br J Obstet Gynaecol 2002 (in press) 29 Ali KZ, Burton GJ, Morad N, Ali ME. ...
Ultrasound in Obstetrics and Gynecology, 2001
Objective To investigate the feasibility and repeatability of nuchal translucency thickness measu... more Objective To investigate the feasibility and repeatability of nuchal translucency thickness measurement using threedimensional ultrasound. Methods Forty consecutive women with uncomplicated singleton pregnancies attending for Down syndrome screening at 11-14 weeks' gestation were included in this prospective crossover trial. Nuchal translucency thickness was measured using both two-dimensional and three-dimensional ultrasound. In each case two three-dimensional volumes were recorded and then examined by using the technique of planar reformatted sections. The initial plane of the first volume always contained a clear image of the nuchal region ('sagittal volume'), whilst the initial plane of the second volume was selected randomly regardless of fetal position ('random volume'). The repeatability of nuchal translucency measurement was examined by constructing a scatter diagram of the difference between the measurements plotted against the mean of two readings. Results Nuchal translucency measurements could be repeated in 38/40 (95%) sagittal volumes and 24/40 (60%) random volumes. The mean difference between two-dimensional measurements and those obtained by reslicing of sagittal three-dimensional volumes was-0.097 mm (95% limits of agreement from-0.481 to 0.675) and 0.225 mm (95% limits of agreement from-0.369 to 0.819) when random volumes were examined. Conclusions Reslicing of stored three-dimensional volumes can be used to replicate nuchal translucency measurements only when nuchal skin can also be clearly seen on two-dimensional ultrasound.
European Journal of Haematology, 2001
Objective: To investigate haemorheological changes during pregnancy in a Latin American populatio... more Objective: To investigate haemorheological changes during pregnancy in a Latin American population and compare to previously published data from Caucasian populations. Design: Cross-sectional study. Population: 75 pregnant women at 10-36 wk of gestation and 17 non-pregnant female controls in Lima, Peru. All the women and their ancestors for three generations were born and lived at sea level. Methods: Viscosity, haematocrit and plasma fibrinogen, albumin and total protein concentrations were determined in blood samples obtained after an overnight period of fasting. Results: At 10 wk of gestation, total protein concentration and plasma viscosity were above non-pregnant levels by about 15% and subsequently decreased linearly with gestation. Fibrinogen concentration was increased in the first trimester; it then decreased to a nadir at about 20 wk and subsequently increased. Albumin concentration decreased linearly with gestation. Haematocrit decreased from pre-pregnancy levels at 10 wk to a nadir at about 26 wk. Blood viscosity increased in the first trimester and then decreased with gestation to a nadir at about 26 wk. Conclusion: In the first trimester of pregnancy blood and plasma viscosity are increased and they subsequently fall with advancing gestation. Plasma viscosity reflects the changes in total protein concentration, and blood viscosity is dependent on the interplay of changes in plasma viscosity and haematocrit.
Clinica Chimica Acta, 2003
Background: High-altitude (HA) hypoxia leads to profound cardiovascular, respiratory and electrol... more Background: High-altitude (HA) hypoxia leads to profound cardiovascular, respiratory and electrolyte changes, and pregnancy at HA has been associated with increased incidence of preeclampsia and intrauterine growth restriction. Objective: To examine the effect of high altitude on maternal serum electrolytes and liver enzymes. Design: Cross-sectional study of 77 pregnant women at 6-40 weeks of gestation resident at HA (4370 m above sea level) and 80 at sea level (SL) and 13 and 15 nonpregnant women at each altitude, respectively. Serum electrolytes (sodium, potassium, calcium and phosphate), creatinine, bilirubin and liver enzymes (alkaline phosphatase (ALP), aspartate transaminase (AST) and gamma-glutamyl transferase (g-GT)) were measured. Results: Pregnancy at HA, compared to SL, was associated with higher serum osmolality (0.4%), sodium (0.7%), creatinine (14%) and phosphate (5%) concentrations and lower potassium (10%) concentration. Calcium and albumincorrected calcium concentrations were higher at HA compared to SL in nonpregnant women (8%), with no difference in pregnant women. AST, g-GT and ALP concentrations were not significantly different between HA and SL, neither in pregnant nor in nonpregnant women. AST and g-GT were lower in pregnant compared to nonpregnant women (30%) at HA, whereas the difference was not significant at SL. Total bilirubin concentrations were higher at HA compared to SL by about 25% both in pregnant and in nonpregnant women, the difference reaching statistical significance only in the pregnant group. Conclusions: Pregnancy at HA is associated with increased osmolality, sodium, creatinine, calcium, phosphate and total bilirubin concentrations. Liver enzyme activities are similar to SL.
BJOG: An International Journal of Obstetrics and Gynaecology, 2004
Setting Two maternity units providing routine antenatal care: one at 4370 m above sea level (Cerr... more Setting Two maternity units providing routine antenatal care: one at 4370 m above sea level (Cerro de Pasco, Peru) and one at sea level (Lima, Peru). Population We examined 175 pregnant women at 5-41 weeks of gestation and 16 non-pregnant controls resident at high altitude and 132 pregnant women and 18 non-pregnant controls at sea level. Methods Two-dimensional and M-mode echocardiography of the left ventricle. Main outcome measures Maternal cardiac output and left ventricular longitudinal and transverse systolic function indices. Results Pregnancy at high altitude, compared with sea level, is associated with 11% lower birthweight and 31% lower maternal cardiac output, due to 15% lower stroke volume and 11% lower heart rate. The lower stroke volume was due to a lower preload and impaired longitudinal and transverse left ventricular systolic function. Mean arterial pressure was about 8% lower during pregnancy at high altitude versus sea level. Pregnant women at high altitude failed to expand their intravascular space to the same extent as the sea level group: cardiac output increased by 17%, left atrial diameter by 12% and end-diastolic diameter by 1% at high altitude versus 41%, 25% and 5%, respectively, at sea level. Conclusions Pregnancy at high altitude, compared with sea level, is characterised by lower cardiac output due to lower heart rate and lower stroke volume and reduced expansion of the maternal intravascular space compared with the non-pregnant state.
BJOG: An International Journal of Obstetrics and Gynaecology, 2001
Objective 1. To measure blood gases and minute ventilation in healthy women with normal pregnanci... more Objective 1. To measure blood gases and minute ventilation in healthy women with normal pregnancies, compare with non-pregnant women both at sea level and at high altitude; 2. to relate the results at altitude with duration of residence there. Design Cross-sectional study. Setting Antenatal clinics at sea level in Lima, Peru and at high altitude 4300m in Cerro de Pasco, Peru. Population A total of 304 normal pregnant women between 7 and 41 weeks of gestation were studied, including 112 who lived at sea level and 192 at high altitude (4300m). For comparison 38 non-pregnant women (19 at sea level and 19 at high altitude) were also studied. Methods Arterialised blood gases, haemoglobin, pulse oximetry and minute ventilation were measured once in each woman. Main outcome measures PO 2 , PCO 2 , pH, haemoglobin, oxygen saturation, arterial oxygen content and minute ventilation and their relationship to gestation. Results PO 2 , PCO 2 , bicarbonate, base excess and oxygen saturation were lower in pregnancies at high altitude compared with sea level; pH, haemoglobin, arterial oxygen content and minute ventilation were higher. At high altitude oxygen saturation and haemoglobin decreased towards term resulting in a fall in arterial oxygen content at the end of pregnancy. Women whose family had lived at high altitude for at least three generations maintained their oxygenation throughout pregnancy better than women whose family had lived there for less than three generations. Conclusions In pregnancy at high altitude maternal adaptation appeared adequate in the ®rst trimester but declined towards term. However, maternal oxygenation was maintained in those whose family had lived longest at high altitude suggesting a bene®cial adaptation to a hypoxic environment, occurring over generations.
BJOG: An International Journal of Obstetrics and Gynaecology, 2001
Objective To compare plasma glucose in pregnant women living at very high altitude; pregnant wome... more Objective To compare plasma glucose in pregnant women living at very high altitude; pregnant women living at sea level; non-pregnant women living at very high altitude; and non-pregnant women living at sea level. Design Cross-sectional study. Participants Ninety-four pregnant women attending for routine antenatal care at 8±42 weeks of gestation in Cerro de Pasco, Peru which is situated 4370 m above sea level; 122 pregnant women in Lima, which is at sea level; 22 non-pregnant women in Cerro de Pasco; and 31 non-pregnant women in Lima. Methods Plasma glucose concentrations were measured in samples obtained from the antecubital vein between 8 am and 10 am after an overnight period of fasting for at least 10 hours. Results Fasting plasma glucose was lower in women at high altitude than in those at sea level, and in both groups the level was lower in pregnant women than in non-pregnant controls. The body mass index was not signi®cantly different between all four groups, and it did not have a signi®cant independent contribution in explaining the variance in fasting plasma glucose. Conclusion Women native at high altitude have lower plasma glucose concentrations before and during pregnancy than those at sea level.
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Papers by Elisabeth Krampl