Olav Lapaire - Academia.edu (original) (raw)
Papers by Olav Lapaire
Geburtshilfe Und Frauenheilkunde, Feb 1, 2008
ABSTRACT Objective: To compare the efficacy of vaginal misoprostol and dinoprostone gel for induc... more ABSTRACT Objective: To compare the efficacy of vaginal misoprostol and dinoprostone gel for induction of labor at term and to evaluate the predictive value of pre-assessed Bishop score and sonographic estimated cervical length. Methods: One hundred and seven patients were prospectively randomized to receive either 50 mu g misoprostol vaginally every 12 hours, or 2 mg of dinoprostone gel for nulliparae with an unfavorable cervix. 1 mg was given in case of multiparity or nulliparity with a Bishop score of > 5, according to the RCOG guidelines. Primary outcome was the achievement of vaginal delivery within 24 hours. Secondary outcome parameters included the induction to delivery interval, mode of delivery, drug related side effects, and the predictive value of the Bishop score and sonographic estimated cervical length. Results: The probability of delivering within 24 hours was more than threefold higher with misoprostol than with dinoprostone: odds ratio [OR]: 3.23; 95 percent confidence interval [CI]: 1.14-9.16, p: 0.03. In contrast, predictive values of both cervical parameters for delivery within 24 hours were not significant (Bishop score: [OR]: 1.28; [CI: 0.92-1.77], p: 0.14, cervical length: [OR]: 0.98; [CI: 0.92 - 1.03], p: 0.40). No difference was observed in the induction to delivery interval between both groups, and no correlation between cervical parameters and induction to delivery interval. Conclusion: Vaginal misoprostol is an effective, safe and cost-effective alternative to dinoprostone for cervical ripening and labor induction. The preinduced assessed cervical parameters showed poor predictive values for estimation of delivery within 24 hours and no correlation with the induction to delivery interval.
Archives of Gynecology and Obstetrics, Mar 12, 2008
Objective Postmenopausal hormone replacement therapy (HRT) is associated with an increase in brea... more Objective Postmenopausal hormone replacement therapy (HRT) is associated with an increase in breast cancer risk, which correlates to the duration of HRT use. We wanted to investigate a possible association between HRT use and the risk of a histologic subtype of breast cancer. Patients and methods From 1995 until 2004, 497 cases of primary ductal, lobular or ductulolobular breast cancer in postmenopausal women were diagnosed at the
Archives of Gynecology and Obstetrics, Apr 25, 2007
Objective To assess the impact of three-dimensional (3D) versus two-dimensional (2D) ultrasound (... more Objective To assess the impact of three-dimensional (3D) versus two-dimensional (2D) ultrasound (US) on maternalfetal bonding. Study design Prospective randomized pilot study among low risk women with singleton fetuses in the second and third trimester. Dependent on the randomization pattern, US was commenced either with 2D US or 3D US and the eVects were recorded with standardized questionnaires. Results Sixty patients were included. Although the quality of 2D US, assessed by the examinator, was superior to 3D US, maternal recognition was higher with 3-D US (P = 0.004). With 2D US, nulliparous patients had signiWcantly more diYculties visualizing the fetus, than multiparous (P = 0.03). However, the maternal preference of 3D US had no signiWcant impact on maternal-fetal bonding. Conclusion Ultrasound had no signiWcant eVect on maternal-fetal bonding. Three-dimensional images may facilitate recognition of the fetus, but 3D US did not have higher impact on maternal-fetal bonding. This Wnding may be a reason not to consider 3D ultrasound for routine scanning.
Archives of Gynecology and Obstetrics, Jul 26, 2006
Objective To prospectively assess the eVect of water birth on maternal and fetal outcomes in a se... more Objective To prospectively assess the eVect of water birth on maternal and fetal outcomes in a selected lowrisk collective of a tertiary obstetrical unit. Method In this prospective observational study, 513 patients of a low-risk collective, who requested a water birth, were studied during the years 1998-2002. Primary outcome measurements included the maternal and fetal parameters. Secondary outcome measurements comprised data on the incidence of water births in an interested, low-risk population in an academic hospital. Result All groups were similar in terms of demographic and obstetric data. SigniWcant diVerences were observed in maternal outcome parameters, which included the use of analgesia/anesthesia during labor, the duration of Wrst and second stages of labor, perineal tears and episiotomy rate. No diVerences were seen in all observed fetal outcome parameters including APGAR scores, arterial and venous pH, admission rate to neonatal intensive care unit and infection rate. Conclusion Water birth is a valuable and promising alternative to traditional delivery methods. The maternal and fetal outcomes were similar to traditional land births. However, currently there still exist some deWcits in the scientiWc evaluation of its safety. Therefore, the selection of a low-risk collective is essential to minimize the risks with the addition of strictly maintained guidelines and continuous intrapartum observation and fetal monitoring. Based on our results and the literature, water births are justiWable when certain criteria are met and risk factors are excluded.
Reproduktionsmedizin, Oct 1, 2002
ABSTRACT
We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe n... more We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss. A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally. Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential. Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.
Geburtshilfe Und Frauenheilkunde, Apr 14, 2015
Geburtshilfe Und Frauenheilkunde, Aug 1, 2011
Geburtshilfe Und Frauenheilkunde, Apr 14, 2015
Geburtshilfe Und Frauenheilkunde, Apr 14, 2015
Therapeutische Umschau, Nov 1, 2008
Der Gestationsdiabetes ist eine der schwerwiegendsten schwangerschafts-assoziierten Erkrankungen.... more Der Gestationsdiabetes ist eine der schwerwiegendsten schwangerschafts-assoziierten Erkrankungen. Die Inzidenz beträgt je nach Kollektiv und Screening Test bis zu 14%. Die ansteigende Rate in den letzten Jahren wurde hauptsächlich durch das ansteigende mütterliche Durchschnittsalter, sowie dem ansteigenden maternalen Body Mass Index bedingt. Aufgrund der hohen Inzidenz auch in der Schweiz und den Therapieoptionen ist ein universelles dem selektiven Screening vorzuziehen. In der vorliegenden Übersichtsarbeit werden die relevanten klinischen Aspekte diskutiert.
Therapeutische Umschau, Nov 1, 2006
Mit den technischen Entwicklungen erweiterten sich in den letzten Jahren die Einsatzmöglichkeiten... more Mit den technischen Entwicklungen erweiterten sich in den letzten Jahren die Einsatzmöglichkeiten des pränatalen Ultraschalls. So konnten in den 80er und 90er-Jahren zunehmend fetale Fehlbildungen diagnostiziert und spezifiziert werden. Die Untersuchung mit der sonographischen Nackentransparenzmessung in der 11. bis 14. Schwangerschaftswoche findet nunmehr als wichtiges pränatales Screening zur individuellen Risikoabschätzung für Chromosomenstörungen Eingang in die pränatale Medizin. Neben der standardisierten Untersuchungstechnik sollte größter Wert auf die ausführliche Information und Beratung der Schwangeren sowie auf die Qualitätssicherung gelegt werden. Durch die Verbesserung der individuellen Risikospezifizierung mittels Sonographie, biochemischen Markern und dem mütterlichen Alter können unnötige invasive Untersuchungen vermieden und ihre Zahl insgesamt deutlich reduziert werden. Ein Trend, der sich auch anhand des nicht-invasiven Nachweises des fetalen Rhesus D Status und mit dem Einsatz der Dopplersonographie im Management fetaler Anämien verfolgen lässt.
Frauenheilkunde Up2date, Aug 1, 2009
Zeitschrift Fur Geburtshilfe Und Neonatologie, Feb 1, 2011
We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe n... more We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss. A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally. Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential. Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.
BMC Pregnancy and Childbirth, Nov 5, 2019
Background: To better understand the profound multisystem changes in maternal physiology triggere... more Background: To better understand the profound multisystem changes in maternal physiology triggered by parturition, in particular in the underexplored neuronal system, by deploying a panel of pre-vs post-delivery maternal serum biomarkers, most notably the neuronal cytoskeleton constituent neurofilament light chain (NfL). This promising fluid biomarker is not only increasingly applied to investigate disease progression in numerous brain diseases, particularly in proteopathies, but also in detection of traumatic brain injury or monitoring neuroaxonal injury after ischemic stroke. Methods: The study was nested within a prospective cohort study of pregnant women at risk of developing preeclampsia at the University Hospital of Basel. Paired ante-and postpartum levels of progesterone, soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin (CT-proAVP), and NfL were measured in 56 women with complete clinical data. Results: Placental delivery significantly decreased all placental markers: progesterone 4.5-fold, PlGF 2.2-fold, and sFlt-1 1.7-fold. Copeptin and MR-proANP increased slightly (1.4-and 1.2-fold, respectively). Unexpectedly, NfL levels (median [interquartile range]) increased significantly post-partum: 49.4 (34.7-77.8) vs 27.7 (16.7-31.4) pg/ml (p < 0.0001). Antepartum NfL was the sole independent predictor of NfL peri-partum change; mode of delivery, duration of labor, clinical characteristics and other biomarkers were all unrelated. Antepartum NfL levels were themselves independently predicted only by maternal age. Conclusions: Parturition per se increases maternal serum NfL levels, suggesting a possible impact of parturition on maternal neuronal integrity.
Archives of Gynecology and Obstetrics, Dec 18, 2010
Introduction In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hy... more Introduction In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hyperemesis syndrome, which seems to be a rare paradoxical reaction in individuals with a particular predisposition, is characterized by cyclic severe nausea and vomiting in long-term cannabis users. While the symptoms are unresponsive to antiemetic drugs, compulsive hot baths result in a considerable symptom relief. Methods We report the first case of cannabinoid hyperemesis syndrome in pregnancy. A 26-year-old patient was admitted to our clinic in the 10th week of gestation. Conclusion Before undertaking time-consuming and expensive medical examinations to rule out other medical reasons for therapy-resistant hyperemesis in pregnancy, obstetricians should determine whether compulsive bathing or showering provides symptomatic relief and ask specific questions regarding possible/suspected cannabis consumption.
Geburtshilfe Und Frauenheilkunde, Feb 1, 2008
ABSTRACT Objective: To compare the efficacy of vaginal misoprostol and dinoprostone gel for induc... more ABSTRACT Objective: To compare the efficacy of vaginal misoprostol and dinoprostone gel for induction of labor at term and to evaluate the predictive value of pre-assessed Bishop score and sonographic estimated cervical length. Methods: One hundred and seven patients were prospectively randomized to receive either 50 mu g misoprostol vaginally every 12 hours, or 2 mg of dinoprostone gel for nulliparae with an unfavorable cervix. 1 mg was given in case of multiparity or nulliparity with a Bishop score of > 5, according to the RCOG guidelines. Primary outcome was the achievement of vaginal delivery within 24 hours. Secondary outcome parameters included the induction to delivery interval, mode of delivery, drug related side effects, and the predictive value of the Bishop score and sonographic estimated cervical length. Results: The probability of delivering within 24 hours was more than threefold higher with misoprostol than with dinoprostone: odds ratio [OR]: 3.23; 95 percent confidence interval [CI]: 1.14-9.16, p: 0.03. In contrast, predictive values of both cervical parameters for delivery within 24 hours were not significant (Bishop score: [OR]: 1.28; [CI: 0.92-1.77], p: 0.14, cervical length: [OR]: 0.98; [CI: 0.92 - 1.03], p: 0.40). No difference was observed in the induction to delivery interval between both groups, and no correlation between cervical parameters and induction to delivery interval. Conclusion: Vaginal misoprostol is an effective, safe and cost-effective alternative to dinoprostone for cervical ripening and labor induction. The preinduced assessed cervical parameters showed poor predictive values for estimation of delivery within 24 hours and no correlation with the induction to delivery interval.
Archives of Gynecology and Obstetrics, Mar 12, 2008
Objective Postmenopausal hormone replacement therapy (HRT) is associated with an increase in brea... more Objective Postmenopausal hormone replacement therapy (HRT) is associated with an increase in breast cancer risk, which correlates to the duration of HRT use. We wanted to investigate a possible association between HRT use and the risk of a histologic subtype of breast cancer. Patients and methods From 1995 until 2004, 497 cases of primary ductal, lobular or ductulolobular breast cancer in postmenopausal women were diagnosed at the
Archives of Gynecology and Obstetrics, Apr 25, 2007
Objective To assess the impact of three-dimensional (3D) versus two-dimensional (2D) ultrasound (... more Objective To assess the impact of three-dimensional (3D) versus two-dimensional (2D) ultrasound (US) on maternalfetal bonding. Study design Prospective randomized pilot study among low risk women with singleton fetuses in the second and third trimester. Dependent on the randomization pattern, US was commenced either with 2D US or 3D US and the eVects were recorded with standardized questionnaires. Results Sixty patients were included. Although the quality of 2D US, assessed by the examinator, was superior to 3D US, maternal recognition was higher with 3-D US (P = 0.004). With 2D US, nulliparous patients had signiWcantly more diYculties visualizing the fetus, than multiparous (P = 0.03). However, the maternal preference of 3D US had no signiWcant impact on maternal-fetal bonding. Conclusion Ultrasound had no signiWcant eVect on maternal-fetal bonding. Three-dimensional images may facilitate recognition of the fetus, but 3D US did not have higher impact on maternal-fetal bonding. This Wnding may be a reason not to consider 3D ultrasound for routine scanning.
Archives of Gynecology and Obstetrics, Jul 26, 2006
Objective To prospectively assess the eVect of water birth on maternal and fetal outcomes in a se... more Objective To prospectively assess the eVect of water birth on maternal and fetal outcomes in a selected lowrisk collective of a tertiary obstetrical unit. Method In this prospective observational study, 513 patients of a low-risk collective, who requested a water birth, were studied during the years 1998-2002. Primary outcome measurements included the maternal and fetal parameters. Secondary outcome measurements comprised data on the incidence of water births in an interested, low-risk population in an academic hospital. Result All groups were similar in terms of demographic and obstetric data. SigniWcant diVerences were observed in maternal outcome parameters, which included the use of analgesia/anesthesia during labor, the duration of Wrst and second stages of labor, perineal tears and episiotomy rate. No diVerences were seen in all observed fetal outcome parameters including APGAR scores, arterial and venous pH, admission rate to neonatal intensive care unit and infection rate. Conclusion Water birth is a valuable and promising alternative to traditional delivery methods. The maternal and fetal outcomes were similar to traditional land births. However, currently there still exist some deWcits in the scientiWc evaluation of its safety. Therefore, the selection of a low-risk collective is essential to minimize the risks with the addition of strictly maintained guidelines and continuous intrapartum observation and fetal monitoring. Based on our results and the literature, water births are justiWable when certain criteria are met and risk factors are excluded.
Reproduktionsmedizin, Oct 1, 2002
ABSTRACT
We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe n... more We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss. A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally. Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential. Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.
Geburtshilfe Und Frauenheilkunde, Apr 14, 2015
Geburtshilfe Und Frauenheilkunde, Aug 1, 2011
Geburtshilfe Und Frauenheilkunde, Apr 14, 2015
Geburtshilfe Und Frauenheilkunde, Apr 14, 2015
Therapeutische Umschau, Nov 1, 2008
Der Gestationsdiabetes ist eine der schwerwiegendsten schwangerschafts-assoziierten Erkrankungen.... more Der Gestationsdiabetes ist eine der schwerwiegendsten schwangerschafts-assoziierten Erkrankungen. Die Inzidenz beträgt je nach Kollektiv und Screening Test bis zu 14%. Die ansteigende Rate in den letzten Jahren wurde hauptsächlich durch das ansteigende mütterliche Durchschnittsalter, sowie dem ansteigenden maternalen Body Mass Index bedingt. Aufgrund der hohen Inzidenz auch in der Schweiz und den Therapieoptionen ist ein universelles dem selektiven Screening vorzuziehen. In der vorliegenden Übersichtsarbeit werden die relevanten klinischen Aspekte diskutiert.
Therapeutische Umschau, Nov 1, 2006
Mit den technischen Entwicklungen erweiterten sich in den letzten Jahren die Einsatzmöglichkeiten... more Mit den technischen Entwicklungen erweiterten sich in den letzten Jahren die Einsatzmöglichkeiten des pränatalen Ultraschalls. So konnten in den 80er und 90er-Jahren zunehmend fetale Fehlbildungen diagnostiziert und spezifiziert werden. Die Untersuchung mit der sonographischen Nackentransparenzmessung in der 11. bis 14. Schwangerschaftswoche findet nunmehr als wichtiges pränatales Screening zur individuellen Risikoabschätzung für Chromosomenstörungen Eingang in die pränatale Medizin. Neben der standardisierten Untersuchungstechnik sollte größter Wert auf die ausführliche Information und Beratung der Schwangeren sowie auf die Qualitätssicherung gelegt werden. Durch die Verbesserung der individuellen Risikospezifizierung mittels Sonographie, biochemischen Markern und dem mütterlichen Alter können unnötige invasive Untersuchungen vermieden und ihre Zahl insgesamt deutlich reduziert werden. Ein Trend, der sich auch anhand des nicht-invasiven Nachweises des fetalen Rhesus D Status und mit dem Einsatz der Dopplersonographie im Management fetaler Anämien verfolgen lässt.
Frauenheilkunde Up2date, Aug 1, 2009
Zeitschrift Fur Geburtshilfe Und Neonatologie, Feb 1, 2011
We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe n... more We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss. A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally. Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential. Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.
BMC Pregnancy and Childbirth, Nov 5, 2019
Background: To better understand the profound multisystem changes in maternal physiology triggere... more Background: To better understand the profound multisystem changes in maternal physiology triggered by parturition, in particular in the underexplored neuronal system, by deploying a panel of pre-vs post-delivery maternal serum biomarkers, most notably the neuronal cytoskeleton constituent neurofilament light chain (NfL). This promising fluid biomarker is not only increasingly applied to investigate disease progression in numerous brain diseases, particularly in proteopathies, but also in detection of traumatic brain injury or monitoring neuroaxonal injury after ischemic stroke. Methods: The study was nested within a prospective cohort study of pregnant women at risk of developing preeclampsia at the University Hospital of Basel. Paired ante-and postpartum levels of progesterone, soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin (CT-proAVP), and NfL were measured in 56 women with complete clinical data. Results: Placental delivery significantly decreased all placental markers: progesterone 4.5-fold, PlGF 2.2-fold, and sFlt-1 1.7-fold. Copeptin and MR-proANP increased slightly (1.4-and 1.2-fold, respectively). Unexpectedly, NfL levels (median [interquartile range]) increased significantly post-partum: 49.4 (34.7-77.8) vs 27.7 (16.7-31.4) pg/ml (p < 0.0001). Antepartum NfL was the sole independent predictor of NfL peri-partum change; mode of delivery, duration of labor, clinical characteristics and other biomarkers were all unrelated. Antepartum NfL levels were themselves independently predicted only by maternal age. Conclusions: Parturition per se increases maternal serum NfL levels, suggesting a possible impact of parturition on maternal neuronal integrity.
Archives of Gynecology and Obstetrics, Dec 18, 2010
Introduction In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hy... more Introduction In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hyperemesis syndrome, which seems to be a rare paradoxical reaction in individuals with a particular predisposition, is characterized by cyclic severe nausea and vomiting in long-term cannabis users. While the symptoms are unresponsive to antiemetic drugs, compulsive hot baths result in a considerable symptom relief. Methods We report the first case of cannabinoid hyperemesis syndrome in pregnancy. A 26-year-old patient was admitted to our clinic in the 10th week of gestation. Conclusion Before undertaking time-consuming and expensive medical examinations to rule out other medical reasons for therapy-resistant hyperemesis in pregnancy, obstetricians should determine whether compulsive bathing or showering provides symptomatic relief and ask specific questions regarding possible/suspected cannabis consumption.