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Obstretics
Sub specialities of Obstretics
Prenatal diagnostic
History and Science Prenatal diagnostics began to develop in the second half of the last century when researchers were able to visualize chromosomes. Hereditary factors, also called genes, are located on the chromosomes. It has only been known since 1956 that humans have 23 pairs of chromosomes in every cell of their body. As early as 1930, it was found that women who became pregnant over the age of 40 were slightly more likely to give birth to a child with what was then called "Mongolism." In 1959, a doctor came up with the idea of examining the chromosomes of people with this problem and found that they had 47 chromosomes instead of 46. The small chromosome number 21 is present three times in these individuals. Family History If you have a family member in your immediate or extended family with a disability, a hereditary disease, or a malformation, and you therefore fear that your child's risk is increased, it is important that you visit a genetic counseling center before pregnancy, if possible, and get well-informed information from a specially trained specialist. The Methods Chorionic villi biopsy-CVS-chorionic villi sampling from 10 weeks of pregnancy Two invasive examination procedures are available for diagnosis or to rule out changes in the genetic material of the fetus: the so-called amniocentesis and the chorionic villus sampling. The fertilized egg produces both the cells from which the child is formed and those from which the placenta develops. In early development, this placental tissue is called the chorion. The chorionic cells contain the same chromosomes and genetic information as those of the future child. As a result, chromosomes and certain hereditary factors can be examined in this tissue. The risk that CVS will cause an abortion is around 1%. The fact that CVS can be carried out a month earlier is perceived by many couples as an advantage over amniocentesis for psychological reasons. The First Trimester Screening Test - 11-14 Weeks of Gestation Another possible examination is the measurement of the so-called nuchal fold NT, neck edema, nuchal translucency. It is a non-invasive prenatal medical examination method. The measurement must be taken exactly between the 11th and before the end of the 14th week of pregnancy. The risk of a chromosomal change is calculated from the combination of the mother’s age, gestational age, the nuchal translucency measurement, her blood values hormone beta-HCG and protein free PAPP-A, and trisomies in previous pregnancies. The interaction of these three measurements reveals 90% of chromosomal disorders. In only 5 out of 100 cases you get a falsely abnormal result, which can then be further clarified with an amniotic fluid puncture. Amniocentesis AC - From 15 Weeks of Pregnancy ...but the trend is towards 16-17 weeks of pregnancy. The aim of amniocentesis is to obtain child cells from the amniotic fluid. These cells are then processed and examined for their chromosomes. In addition to the most common chromosomal abnormalities, such as Down syndrome and disorders of chromosomes 13 or 18, a variety of other diseases can now also be identified if you look specifically for them. The AC Technique: First, ultrasound is used to find the largest amniotic fluid deposit. Under ultrasound guidance, this area is then punctured with a thin needle through the abdominal wall. Approximately 20 ml of amniotic fluid is then removed through the cannula, the needle is pulled out again, and the puncture site is then treated with a plaster. The procedure only takes a few minutes. The risk of amniocentesis is the occurrence of contractions and/or bleeding. Miscarriage occurs in less than 1% 1:100-1:500 of all amniocenteses. The result of the amniocentesis is only available 10-14 days after the puncture. You can often get a quick test result after just 24 hours through fluorescence in situ hybridization analysis carried out at an additional cost. The Following Can Be Clarified in Detail: - Deviations from the normal number of chromosomes, which can, for example, indicate Down syndrome - Evidence of a congenital metabolic abnormality - Progressive muscular dystrophy - Rule out a neural tube defect - Fetal risk in the event of possible Rhesus factor incompatibility, lung maturity in the event of premature termination of the pregnancy
Nutrition
Nutrition principles during pregnacy Contrary to popular belief that during pregnancy you have to “eat for two”, your energy needs actually only increase slightly. The average energy requirement is therefore 2000-2200 kcal per day, in the last few weeks 2200-2500 kcal per day. The best way to eat is to eat five to six small meals throughout the day. The diet consists of three main nutrients: carbohydrates eg sugar, bread, potatoes, proteins eg meat, vegetables and fats eg butter, sausage. A pregnant woman has different nutritional needs. To ensure an uninterrupted pregnancy, the diet must be adapted to these nutritional needs. Liquids Drink 1-2 liters of liquid per day, preferably in the form of unsweetened drinks, e.g. drinking/mineral water or fruit/herbal tea. Caffeine passes through the placenta into the baby's bloodstream and causes a deterioration in the supply of oxygen and nutrients. Therefore, drink caffeinated beverages coffee, black/green tea, ice tea, cola drinks and energy drinks in moderation. However, you can enjoy two cups of coffee or tea a day without any problems. Vegetable/ Fruits Enjoy at least five portions of vegetables, salad and fruit every day. If you eat these foods raw, cooked and in many different colors, you will support a good supply of vitamins, minerals, secondary plant substances and dietary fiber. Cereal Products Starchy foods such as rice, pasta, bread and potatoes are part of every main meal. The amount depends mainly on how much exercise you do. Meat/ Fish/ Poultry/ Eggs Meat, fish, poultry, pulses and eggs supplement your diet with high-quality protein. The development of the child requires protein. As the mother's blood volume increases and the child's blood must be produced, you need around 30 mg of iron daily twice as much as non-pregnant menstruating women. A regular intake of meat and eggs helps to cover the increased need for iron. Other sources of iron include whole grains, legumes and green vegetables. Dairy Products Milk and dairy products provide not only protein but also calcium. Include four portions of milk 2 dl, yogurt 1 cup, quark/cottage cheese 200g or cheese 30-60g in your diet every day. Since the fetus's skeleton and teeth need to be built up, considerable amounts of calcium are needed during pregnancy 1200g calcium per day. Carbohydrates Whole grain products are particularly good for carbohydrates, as they have a high fiber content and can therefore prevent or relieve constipation caused by pregnancy. It is also important to drink plenty of fluids so that the fiber can swell and thus speed up digestion. Protein Since protein is needed to build body substance, the protein requirement is increased during pregnancy. From the 4th month onwards, a protein intake of 1.3 g of protein per kg of body weight is recommended. A combination of animal and plant protein is good, as animal protein is of higher quality than plant protein, but usually has a high fat content. Fat The need for fat is not increased during pregnancy. However, care should be taken to ensure a sufficient intake of linoleic acid, which is mainly found in vegetable oils. Reducing animal fats also has a positive effect on elevated blood lipid levels. Nutritional Supplements Basically, taking a vitamin and mineral supplement is never a substitute for a healthy, balanced diet. During pregnancy, folic acid and iron are particularly important. A general recommendation cannot be made, as it depends on your eating habits. Here are the most important trace elements and vitamins for you: - Calcium : Milk, yoghurt, soft cheese, hard cheese, almonds, kale, raw calcium-rich mineral water - Iron: Meat veal, beef, pork, lentils, wholemeal bread, oat flakes, chicken egg egg yolk, dark green vegetables - Magnesium: Sunflower seeds, red beans, dark chocolate, oat flakes, whole grain pasta, whole grain products - Folic acid: Wheat germ, white beans, spinach, kale, liver max. 1-2 servings per month - Vitamin B6: Potatoes, lentils, brewer's yeast, trout, spinach - Vitamin C: Peppers, raw Kale, cooked, broccoli, steamed Strawberries, oranges Folic Acid The vitamin folic acid is of fundamental importance for the most elementary life processes, especially for cell division. Without folic acid, there is no cell proliferation. If the folic acid intake is too low, there is a risk of embryonic malformations, especially spinal cord defects. Folic acid is particularly important in the prevention of neural tube defects e.g. spina bifida. An additional dose of folic acid can reduce the risk of this disease by 60-75%. Since the neural tube is already closed in the 6th to 8th week, it is recommended that the intake of folic acid be increased before conception in planned pregnancies. Kale, Brussels sprouts, cauliflower, spinach and egg yolk are particularly rich in folic acid. Additional medicinal support is also possible. Since folic acid is only present in small amounts in food and is easily destroyed during preparation, the 800 micrograms that pregnant women should consume daily are rarely reached. Vitamin B The need for B vitamins is usually slightly increased. Whole grain products, milk, brewer's yeast, fish, meat and some vegetables are particularly recommended. Vitamin A / Beta-carotene Although the need for vitamin A is slightly increased, too much of this vitamin can lead to deformities in the infant. The recommended daily intake is 0.8 mg. There is no risk of overdose when consuming provitamin A beta-carotene. This occurs in all yellow-orange vegetables, especially carrots. Provitamin A is also found in abundance in spinach, fennel, leeks, broccoli, chicory and chard. Iron The need for iron is increased during pregnancy because the fetus also needs iron to build up the blood pigment. Although iron absorption is increased during pregnancy and menstrual blood is eliminated, many women develop iron deficiency anemia in late pregnancy. Animal products are particularly rich in iron. Iodine There is an increased need for iodine during pregnancy. The salt intake should be 6-8g per day, which corresponds to our general eating habits. However, the use of iodized table salt can only cover part of the requirement during pregnancy, which is why an additional 150µg of iodide should be consumed, provided there is no thyroid disease. This can be covered by regularly eating sea fish such as cod and plaice twice a week. If this is not possible, iodine can be taken medicinally throughout the pregnancy
Travel recommendation during pregnancy
Being pregnant and traveling are not mutually exclusive. On the contrary! A trip can be particularly beautiful during pregnancy. The time between the 4th and 7th month of pregnancy is particularly good for taking a trip that you have always wanted to do, but which will no longer be so easy with the child. A trip as a couple also offers you and your partner the opportunity to spend some intensive time together, to be close and there just for each other - before your child is born and with it many changes and new things will come into your life. Destination and precautions However, long and strenuous journeys are not recommended, especially in the first three months risk of miscarriage and the last two months mother's immobility and uncertainty about the actual date of birth. Drive a car As a pregnant woman, you can still drive without any problems. However, there are a few aspects that you should pay special attention to. If you pay attention to the signs of your body, you will notice that very long journeys and trips in high temperatures are not good for you. Heat build-up and thrombosis - caused by sitting in a hunched position for too long - are two things you can avoid if you avoid driving for too long. If it is unavoidable, take frequent breaks to relax and stretch your legs. During the journey or flight, it is important to make sure that you move and stretch your legs every 30 to 60 minutes to avoid the risk of a blood clot forming. Seat belts can also be used during pregnancy without any concerns. They are designed to keep the pregnant woman safely in the seat during sudden braking. At the same time, the child in the womb is not constricted and therefore does not suffer any harm. However, it is important that you always buckle yourself in correctly. This means: the diagonal shoulder belt should be between your chest and above your baby, and the lap belt should be as far below your stomach as possible and not above the baby. Fly Neither the cabin pressure nor the radiation at high altitudes are so high that they pose a danger to you or your baby. Air travel is not a problem, especially in the first half of pregnancy. Due to the sometimes uncertain due date, long air travel is not advisable towards the end of the pregnancy, as contractions could start on the plane or abroad. There are generally no concerns about traveling during pregnancy. A trip offers the opportunity to be alone with your partner, to sleep in and to mentally prepare for the upcoming time as a family.
Stem cells donation
Stem Cell Reserve For Life Since the founding of cell biology, scientists have been searching for the one “stem cell” as the cell of origin of all organs. The therapeutic use of stem cells is already a medical reality for a wide range of diseases. For about 20 years now, it has been possible in several countries to store stem cells from umbilical cord blood for later medical applications for one's own child or to donate the cells to a public blood bank. Umbilical Cord Blood The advantages of these young stem cells can be seen in particular in their high vitality and proliferation capacity. Basically, there are two different ways of storing stem cells from umbilical cord blood: - Storage for your own child in a private cord blood bank autologous - A donation to one of the six public blood banks allogeneic Umbilical cord blood is characterized by a relatively high concentration of blood stem cells, a fact that is based on the switch of fetal hematopoiesis from the liver to the bone marrow. During the first umbilical cord blood transplant in 1988, a five-year-old boy with Fanconi anemia in Paris received the umbilical cord blood of his younger sister. The first public umbilical cord blood bank was founded in New York in 1991. There are now more than 50 different diseases that have been treated with stem cell transplants. These include hematological diseases leukemia, chronic anemia, lymphoma, congenital immune deficiencies, severe metabolic disorders, and advanced stages of rheumatic diseases. The cells obtained are not infinitely expandable stem cells in the true sense of the word. Rather, they are precursor cells of the leukocytic, erythrocytic, and thrombocytic series. Cord Blood Donation Technique Obtaining umbilical cord blood is very simple. After the baby's umbilical cord is cut, the umbilical cord blood is collected in a solution containing sugar and citrate using a sterile collection set. There are two different techniques: 1. The umbilical vein is punctured while the placenta is still in utero. 2. After the birth of the placenta, the blood is collected outside the delivery room in a designated laboratory unit. In this case, the volume yield is often lower due to the postpartum collapse of the placenta. There are no health risks for mother or child with either technique. Using a second puncture needle included in the collection kit, the collection volume can be increased by an additional puncture. Since the donation takes place after the child's umbilical cord is cut, the cord blood preparation belongs to the mother from a legal point of view. Umbilical cord blood is collected from healthy newborns after delivery. Genetic or acquired diseases of the lymphohematopoietic system must be ruled out. Likewise, umbilical cord blood should not be donated in cases of severe hematological, immunological, or infectious diseases or in cases of significant malformations or underweight <1500 g of the newborn. Testing of the maternal blood for anti-HIV, anti-HCV, HBsAg hepatitis B surface antigen, and TPHA Treponema pallidum hemagglutination assay must be negative, and the mother's CMV status is documented. Public Cord Blood Banks There are now over 40 public cord blood banks worldwide. Around half of the products stored are in banks that are part of the international Netcord network. Until two years ago, most of the products were transplanted into children. The latest figures show that almost half of the cord blood products are now used in adults. Commercial Cord Blood Banks The basic idea is to store the umbilical cord blood as "life insurance" for the newborn in case it becomes ill during its lifetime. There is an uncontrolled proliferation of more than 100 profit-oriented companies worldwide, which apparently store around two million preparations. The probability that a child will need its own cord blood donation is very low and is given as 1:2700 or 1:1400. In addition, many hematological diseases in childhood are associated with genetic changes that are already present in the stem cells of the cord blood donation. Contrary to the guidelines of the German Medical Association, some commercial cord blood banks accept lower volumes and cell counts for storage. Many expert bodies condemn the policy of commercial cord blood banking for the reasons mentioned above. In the UK, the Royal College of Obstetricians and Gynecologists has spoken out against the routine, commercial collection of cord blood, as the scientific basis for such a practice is currently insufficient. The Italian government banned the establishment of commercial cord blood banks in 2002. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, the Canadian Society of Gynecology and Obstetrics, and the French National Ethics Committee for Health and Life Sciences also condemn commercial cord blood banking. One of the reasons for the rejection is that reserve cells can be obtained from the patient's own bone marrow for future regenerative purposes. Private storage is therefore not recommended, but not expressly prohibited either. What is more important is objective information from independent experts, which is unfortunately not offered by commercial operators of stem cell banks. Economic Aspects Commercial cord blood banks store cord blood donations for a fee, which is usually paid by the parents. There are no costs for parents to store the cord blood in a public cord blood bank. These costs are borne by the cord blood bank and amount to around 1,500 euros for the initial processing, excluding staff and storage logistics. Blood stem cells from cord blood are a valuable alternative to stem cells from bone marrow and peripheral blood. This also applies to adult patients for whom no unrelated or related donor is available. Transplants after reduced-dose conditioning or the use of two cord blood units could be promising treatment strategies for elderly and frail patients who would otherwise not be candidates for stem cell transplantation.