Intracardiac fibrin adhesive for selective fetocide in twin pregnancy: report of three cases.

Intracardiac fibrin adhesive was used for selective fetocide in three diamniotic twin pregnancies at 18-24 weeks' gestation (trisomy 21: n = 1; ultrasound evidence of major malformation: n = 2). Two of the three pregnancies were complicated by an intra-amniotic infection leading to pregnancy loss but one patient (with a monochorionic twin gestation) delivered a normal baby prematurely in the 31st week of pregnancy. The technique, complications and pregnancy outcomes are discussed.

[Infected ovarian vein thrombosis in infection with Ureaplasma urealyticum and Mycoplasma hominis after cesarean section]. / Septische Ovarialvenenthrombose bei Infektion mit Ureaplasma urealyticum und Mycoplasma hominis nach Sectio caesarea.

Puerperal ovarian vein thrombophlebitis (POVT) is a rare but severe complication of the post partum period. We report on a patient, who developed a POVT based on an infection with Ureaplasma urealyticum and Mycoplasma hominis. Problems of diagnostic procedures in cases of POVT and the role of ureaplasma and mycoplasma in infectious obstetric complications are discussed.

[Survey of the availability and utilization of Doppler ultrasound in German-speaking areas]. / Umfrage zur Verbreitung und Anwendung der Dopplersonographie im deutschsprachigen Raum.

The study was performed about the spread and usage of Doppler ultrasound measurements. Standardised questionnaires were sent to the obstetrical departments of 253 universities and teaching hospitals. 59% of the hospitals answered the questions. At the university departments, the method was used regularly. On the average twice the number of patients have been examined compared to the teaching hospitals. The obstetricians in the university departments were more experienced in safety determinations and quality control. Most of the university departments used their own norm curves. When measuring the resistance in the favoured vessels umbilical artery, middle cerebral artery and arcuate arteries, the resistance index (RI) was preferred to the pulsatility Index (PI) in both kinds of hospitals. The most severe pathological findings, zero and reverse flow, occurred with an incidence of more than 2% only in hospitals with less than 500 patients a year, indicating false positive results due to inexperienced physicians. Relevant software is not commercially available; therefore documentation and evaluation of the data was done manually in most of the departments. There are different opinions about the use of Doppler ultrasound as a screening test. However, Doppler ultrasound is seen as a valuable method for diagnosis of hypoxia especially in cases of intrauterine growth retardation and pregnancy-induced hypertension. In the year 2000 the method might be widely used in nearly every small hospital and even in offices. This development without adequate training of the obstetricians might result in a high incidence of false positive results.

[The effect of smoking on the resistance index of the umbilical artery and the middle cerebral artery]. / Einfluss des Rauchens auf den Resistance-Index in der Arteria umbilicalis und der Arteria cerebri media.

23 healthy smokers with uneventful singleton pregnancies underwent Doppler-flow measurements of the foetal umbilical artery and middle cerebral artery before and ten minutes after smoking one cigarette. In both arteries the resistance indices (RI) did not change significantly. Maternal mean arterial blood pressure and heart rate increased significantly after the smoking of the cigarette. Neither the group with an RI increase of greater than or equal to 5% in the foetal umbilical artery (n = 7) nor the group with an increase of the RI in the foetal umbilical artery and, at the same time, a decrease of the RI in the arteria cerebri media (n = 5), showed a significant difference concerning maternal haemodynamic parameters and the number of cigarettes smoked before and during pregnancy. The results suggest, that the smoking of one cigarette in uneventful pregnancy does not produce acute haemodynamic effects in the foetus.

[Doppler flow changes in maternal and fetal blood vessels before and during peridural anesthesia]. / Dopplerflussverhalten in mütterlichen und fetalen Gefässen vor und während Periduralanästhesie.

26 women with an uneventful singleton pregnancy near term underwent scheduled Caesarean section with lumbar epidural anaesthesia (PDA). Doppler-flow measurements of the foetal umbilical artery and the maternal hypogastric artery were taken before and after sympathicolysis was established. The mean arterial blood pressure was maintained unchanged between the measurements. Both measurements were performed by the same examiner. Three patients received additional general anaesthesia during the operation because of inadequate analgesia. The resistance index (RI) with PDA decreased significantly in 23 patients by a mean of 7.6% (p less than 0.05). The RI in those patients (n = 3) with inadequate analgesia increased by a mean of 27%. The physiologically reversed diastolic flow in the maternal hypogastric artery was mathematically taken into consideration by applying the quotient of the systolic flow and the diastolic reversed flow (V/R-quotient). The V/R-quotient increased with established sympathicolysis by more than 180% in all but one patient. The neonates' mean umbilical artery pH was 7.32 (7.27 to 7.41), the mean five minute Apgar score was 10 (8 to 10).

[Clinic interns, individual performance appraisal and obstetric quality assurance]. / Klinikinterne, individuelle Leistungserfassung und geburtshilfliche Qualitätssicherung.

Obstetrical management and fetal outcome were individually analysed annually from 1987 to 1990, using computerised equipment. The individual results were discussed anonymously with all colleagues, but every colleague knew his own results. Clinical methods and obstetrical management had not been changed during the investigation period. The number of high-risk pregnancies increased significantly, whereby the incidence of risk-related surgical interventions decreased at the same rate. The number of FBA and EDA increased significantly (p less than 0.001). The mean umbilical artery pH increased during the last four years from 7.27 to 7.30 (p less than 0.05), i.e. that each colleague achieved an improvement. The incidence of acidotic values in the umbilical artery decreased significantly (pH less than 7.20 from 13.2% to 7.1%, pH less than 7.10 from 3.6% to 1.2% p less than 0.01). The rate of caesarean section increased (p less than 0.05) and the number of vaginal operative deliveries did not change significantly. As early as one year after the introduction of the individual efficiency control, a significant improvement in obstetrical results could be demonstrated.