A relevant number of MA is present in fetuses with 'normal' NT. More than half will be detected by FTAS/FTFE. As consequence, one should discuss a concept in which also in fetuses with 'normal' NT, FTAS/FTFE should be offered. This concept can also be justified from an ethical point of view, which focuses on the principles of nonmaleficence, justice and respect for autonomy of the pregnant woman.

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3O r i g i n a l a r b e i t Zusammenfassung Der artikel spürt den subtilen Veränderungen nach, die bei Patienten, die mit tiefer Hirnstimulation behandelt werden, möglicherweise beobachtet werden können. Dabei sollen im rückgriff auf Konzeptionen zur narrativen identität mittels einer möglichst genauen beschreibung und analyse der Selbstwahrnehmung der Patienten sowie der Wahrnehmung ihres Umfelds die Änderungen im praktischen Selbstverhältnis untersucht werden, u. a. am beispiel technomorpher Metaphern, die von den Patienten in ihren Selbstbeschreibungen verwendet werden. Ziel ist es, die Neuartigkeit und das Spezifische der neurotechnologien -über die bisherigen Untersuchungen hinaus -hinsichtlich des Umgangs mit sich selbst herauszuarbeiten und greifbar zu machen. abschließend werden auf basis der analyse der Patienten-narrationen die entsprechenden normativen implikationen für eine ethische bewertung des einsatzes von neurotechnologien benannt.Schlüsselwörter tiefe Hirnstimulation · narrative identität · PatientenSelbstbeschreibung · neuroethik · technisierung · Phänomenologische anthropologie Narrative identity and therapy with 'brain pacemaker' Reflections on the integration of patients' self-descriptions in the ethical assessment of deep brain stimulation ethik Med (2010) 22:303-315 Der artikel entstand im rahmen des vom bMbF geförderten Freiburger bernstein Focus: neurotechnology (bFnt).O. Müller () · U. bittner institut für ethik und geschichte der Medizin an der albert-ludwigs-Abstract Definition of the problem the article goes into the matter of subtle changes, which can be noticed by patients being treated by deep brain stimulation. Arguments Thereby it is looked on alterations of the patients' practical self-relation by taking recourse to the conception of narrative identity. this shall be done via detailed description and analysis of both the patients' perception of themselves and of their environment, i.e. through the example of technomorph metaphors used by the patients in their self-descriptions. Conclusion The goal to achieve is to work out the novelty and the specifics of neurotechnologies-beyond current examinations-regarding the patients' behaviour towards themselves. Concluding normative implications for an ethical evaluation of neurotechnological usage are shown basing on the analysis of the patients' narrations.

ObjectiveTo identify patients at very high risk for adverse pregnancy outcome (APO) at the 20- to 23-week scan and to assess the effectiveness of Aspirin (ASS) and low molecular weight heparin (LMWH) starting after this examination.Patients and methodsBy applying an algorithm based on multivariate logistic regression analysis using the parameters maternal age, parity, body mass index (BMI), mean pulsatility index of both uterine arteries (meanPI), presence of uni- or bilateral notch, and depth of notch (mean notch index (meanNI), we retrospectively calculated the individual risk for APO of 21,302 singleton pregnancies. We isolated a subgroup of 426 patients with the highest calculated probability for APO (cpAPO > 27.8 %). 147 had been treated with ASS; 73 with LMWH, 15 patients with a combination of ASS and LMWH, and 191 patients had not received anticoagulants.ResultsAdministration of ASS starting after 20 gestational weeks in comparison to non-treated patients significantly reduced the frequency of intrauterine/neonatal death (IUD/NND), preeclampsia <33 weeks (PE < 33), and preterm delivery <33 weeks (PD < 33), while the frequency of IUGR showed a tendency to be elevated (P = 0.061). The subgroup of high-risk patients treated with LMWH was characterised by a higher a priori risk for APO and showed no significant reduction of any form of APO but an increased frequency of PE.ConclusionIndividual assessment of risk for APO by applying a simple algorithm based on biometrical/biographical as well as sonographic parameters may serve as basis for drug intervention studies. The administration of ASS in high-risk patients starting after 20 gestational weeks reduced the frequency of most of the severe forms of adverse pregnancy outcome in high-risk patients. A complication-reducing effect of LMWH starting after 20 weeks of gestation in patients could not be proven. From an ethical point of view, it may not be justified any more to preclude high-risk patients from administration of ASS or to perform studies of ASS against placebo.

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