title: [Accumulation of two different hydroxyethyl starch preparations in the placenta after hemodilution in patients with fetal intrauterine growth retardation or pregnancy hypertension].
abstract: In a prospective clinical study the safety of two hydroxyethylstarch preparations (HES steril 10%, Fresenius AG, Oberursel = HES-A; Haemufusin, Kabi-Pfrimmer, Erlangen = HES-B) were assessed. In 60 patients with fetal growth retardation and/or gestational hypertension, hematocrit, aPTT, factor VIIIR: Ag, fibrinogen, uric acid, cord blood hemoglobin, hematocrit, pH-value and the fetal/maternal hydroxyethylstarch concentration before and after eight (HES-B) or nine (HES-A) days of treatment were monitored. 500 ml HES-A (n = 36) or HES-B (n = 24) together with the same volume electrolyte solution, were infused daily. Both substances lowered significantly the maternal and fetal hematocrit. Histopathological changes of placenta (trophoblast cells and stroma) taking place after the infusion of HES-A or HES-B were depicted by light microscopy. Administration of HES-A or HES-B was associated with lower values of factor VIIIR: Ag and a prolongation of aPTT, but only HES-B demonstrated a significant effect (31% vs. 12%, p less than 0.01). We observed in 4 (16.7%) cases severe uterine bleeding complications and one woman (4.2%) with abruptio placentae in the group HES-B. Light microscopy shows vacuoled trophoblast and stroma cells after HES infusions. The marked vacuolisation of the placenta after HES-B is due to differences in the physicochemical characteristics of HES-A and HES-B. For this reason, we prefer to administer HES-A in the dilution treatment of patients with placental insufficiency.
authors.affiliation: Abteilung Gynäkologie und Geburtshilfe, Stadtkrankenhaus Rüsselsheim.
authors.forename: L
authors.initials: L
authors.lastname: Heilmann
authors.forename: E
authors.initials: E
authors.lastname: Lorch
authors.forename: B
authors.initials: B
authors.lastname: Hojnacki
authors.forename: H
authors.initials: H
authors.lastname: Müntefering
authors.forename: H
authors.initials: H
authors.lastname: Förster
mesh_terms: D000293:Adolescent; D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology* / Q000628:therapy*; D006438:Hemodilution / Q000379:methods*; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics*; D007231:Infant, Newborn; D010920:Placenta / Q000187:drug effects* / Q000473:pathology*; D011225:Pre-Eclampsia / Q000473:pathology* / Q000628:therapy*; D011247:Pregnancy; D012307:Risk Factors; D014327:Trophoblasts / Q000187:drug effects / Q000473:pathology; D014592:Uterine Hemorrhage / Q000473:pathology
chemical_list: D006895:Hydroxyethyl Starch Derivatives
vernacular_title: Die Speicherung von zwei unterschiedlichen Hydroxyäthylstärke-Präparaten in der Plazenta nach Hämodilution bei Patientinnen mit fetaler Mangelentwicklung oder Schwangerschaftshochdruck.