The relationship between peak velocity in the fetal descending aorta and hematocrit in rhesus isoimmunization.

OBJECTIVE: To correlate the peak velocity in the fetal descending aorta, as measured by pulsed Doppler ultrasound, with fetal hematocrit values assessed by funipuncture in pregnancies complicated by rhesus isoimmunization. METHODS: One hundred twelve consecutive funipunctures were performed on 33 rhesus-negative gravidas of 21-36 weeks' gestation (median 30). Doppler flow, corrected for angle, was measured on the fetal descending aorta with pulsed Doppler equipment immediately before funipuncture. Differences between observed peak velocities and the calculated gestational age-dependent upper confidence limits (delta peak velocities) were compared with corresponding differences between observed hematocrits and the calculated lower confidence limits (delta hematocrits), and a regression analysis on the above paired difference values was performed. In addition, the correlation coefficient between delta peak velocities and delta hematocrits was calculated for the first procedure per pregnancy only. RESULTS: The mean peak aortic velocity of anemic fetuses was higher than that of unaffected fetuses (P < .001); delta peak aortic velocities correlated negatively with delta hematocrits (r = -0.66, P < .001). The correlation coefficient between delta peak aortic velocities and delta hematocrits for the first procedure peer pregnancy only was r = -0.72 (P < .001). Prediction of fetal anemia by Doppler using gestational age-dependent 95% confidence limits was possible with positive and negative predictive values of 73 and 66%, respectively. CONCLUSION: Peak aortic velocity, a noninvasive assessment of fetal anemia, may be used as an additional test for monitoring pregnancies complicated by rhesus isoimmunization. However, the limited predictive capacity hampers its clinical usefulness.

[Breast metastasis in renal cell carcinoma]. / Brustmetastasierung bei Nierenzellkarzinomen.

The breast is an unusual site for metastatic extra-mammalian tumors, for instance for renal cell carcinoma. In the literature only few cases are reported. Our two cases show the possibility of different metastatic forms in hypernephroma after nephrectomy 5 and 6 years before.

[Outcome after artificial amniotic fluid instillation in early oligohydramnios]. / Outcome nach artifizieller Fruchtwasser-Instillation (AFI) bei früher Oligohydramnie.

We report on the foetal outcome of 50 pregnancies with severe oligohydramnios in the second and early third trimesters in which artificial fluid instillation (AFI) had been performed. Through the AFI, rapid diagnosis was possible or was made easier or additional malformations were detected or could be excluded. The AFI-associated risk was an induction of labour and a possible iatrogenic rupture of membranes in 3/50 cases. A total of 47 pregnancies could be evaluated to the end, 37 ended in intrauterine death, spontaneous abortion or, in case of a diagnosed lethal malformation, in induced abortion. Ten babies were born alive, but within a period of six months 6 of them died. From the total group, 4 children (8%) are alive and healthy. Survivors are from pregnancies with PROM, with severe IUGR or from the group of idiopathic oligohydramnios. Twenty-seven foetuses had structural, chromosomal or functional anomalies (urogenital, intestinal, heart, skeletal, central nervous, complex malformations). Our data demonstrate a poor prognosis in case of early oligohydramnios. AFI enables early and correct diagnosis. It provides a better basis for counselling and managing of these pregnancies. The risk of AFI with possible induction of labour and iatrogenic rupture of membranes has to be considered both in indication and counselling. However, the risk is limited with regard to the very poor prognosis even without invasive diagnosis.

[Effectiveness of local prostaglandin instillations in tubal pregnancy in relation to preoperative beta-HCG level]. / Wirksamkeit lokaler Prostaglandin-Instillationen bei Tubargraviditäten in Abhängigkeit vom präoperativen beta-HCG Verlauf.

33 patients with tubal pregnancy and beta-HCG level less than 2500 mIU/ml were treated with local, laparoscopic Prostaglandin-injection. Re-operation was not necessary and beta-HCG fell to undetectable levels in 73% (p = 0.05). Serial beta-HCG correlated poorly with outcome. In patients with an increasing beta-HCG success was limited to 55% (p = 0.59). In contrast patients with falling or stable beta-HCG values had success rates of 85.7% (p = 0.22) and 83.5% (p = 0.30) respectively. Our data suggests there may be a clinical advantage to the use of prostaglandin-injection for the conservative management of early ectopic pregnancy. However the utility of preoperative serial beta-HCG values in predicting success showed a trend, without reaching statistical significance.

[Comparison of biochemical and Doppler sonographic monitoring of high-risk pregnancies]. / Vergleich biochemischer und dopplersonographischer Uberwachung von Risikoschwangerschaften.

We performed in 113 patients at least three simultaneous determinations of serum-HPL and oestriol in 24-hour urine samples, as well as Doppler flow studies at the arcuate artery (AA), umbilical artery (UA), foetal aorta and internal carotid, because of suspicion of IUGR. The diagnostic value was studied with regard to IUGR, placental weight and mode of delivery. Concerning the detection of IUGR, the superiority of Doppler parameters (AA, UA) is shown. In the total number of patients, the rates for sensitivity and specificity for UA (78/91%) and AA (58/89%) exceed the hormone parameters. Oestriol, in particular, (13/63%) shows a marked difference, but even HPL (37/63%) cannot compete with respect to diagnostic value.