[Effect of the mode of delivery on the newborn infant with gastroschisis. With data from the Styrian Malformation Register]. / Die Auswirkungen des Geburtsmodus auf Neugeborene mit Gastroschisis. Mit Daten des Steirischen Fehlbildungsregisters.

OBJECTIVE: Our purpose was to investigate the influence of the mode of delivery on the outcome of children with gastroschisis. METHODS: 38 children were born and treated at the University Hospital of Graz between 1977 and 1995. The perinatal and surgical data were analyzed retrospectively. Furthermore, we compared the prevalence of gastroschisis in Styria to international data. RESULTS: The mode of delivery did not influence the fetal outcome. The higher rate of acidosis and shorter interval from rupture of the membranes to delivery in cases of cesarean section may be attributable to the obstetric decision for an operative delivery. The prevalence of gastroschisis is high as compared to European data. CONCLUSIONS: Our data and the majority of publications do not show a benefit of cesarean section for children with gastroschisis. A randomized prospective trial is still lacking to end controversies.

Contrast sonography for inconclusive findings on routine sonography.

OBJECTIVES: We conducted a pilot study in 20 women with sonographically suspect endometria, to assess the value of contrast sonography and patient acceptance of this procedure. METHODS: Saline solution 4-20 ml was injected into the uterine cavity using an embryo transfer catheter, followed by hysteroscopy in 19 cases and hysterectomy in one case. RESULTS: A polyp was diagnosed in 12 patients, a submucous myoma in one patient, a proliferated endometrium in five patients and a placental polyp in one patient. A sonographic irregular structure was diagnosed in one patient which turned out to be coagula on hysteroscopy and histology. The procedure was well accepted by all patients. The diagnosis found by contrast sonography agreed in all cases with that found by hysteroscopy. CONCLUSION: Our results show that contrast sonography is an easy, quick and inexpensive procedure which increases the diagnostic value of vaginal sonography. The indications for contrast sonography are based on inconclusive sonographic findings, especially if polyps or submucous myoma are suspected.

[The triple test scenario for Styria. With data of the Styria Abnormalities Register]. / Triple-Test-Szenario für die Steiermark. Mit Daten des Steirischen Fehlbildungsregisters.

OBJECTIVE: The aim of the study was to clarify by a cost-effectiveness analysis, if a triple-marker screening for trisomy 21 (triple test) should be established in Austria. METHODS: The published triple-test results of the last years were combined with the data of the Styrian Malformation Register covering the years 1985-1992. The cost-effectiveness analysis was based on total costs of prenatal diagnosis, costs per fetus diagnosed as affected, the number of affected fetuses detected, and the number of procedure-related losses. RESULTS: If low costs are given priority, the triple test should be offered to women 35 years of age or older. If a high detection rate is given top priority, the test should be offered to all pregnant women. CONCLUSION: The results suggest that the present policy of maternal age screening in Austria should be replaced by maternal serum screening.

[Pregnancy termination after prenatal diagnosis--data of the Styrian malformation register (1985-1992)]. / Schwangerschaftsabbruch nach Pränataler Diagnostik--Daten des Steirischen Fehlbildungsregisters (1985-1992).

3098 embryos, fetuses or newborns with congenital anomalies were registered in the period from 1985 to 1992 by the Styrian Malformation Register (prevalence 2.88%) the common screening tool for prenatal diagnosis is sonography. About 1/2 of all pregnant women aged 35 or more took advantage of karyotyping offered to this group of patients. Altogether 4004 fetal karyotypes were performed, leading to 89 terminations of pregnancy. A total of 181 terminations of pregnancy following prenatal diagnosis of congenital anomalies were recorded by the Styrian Malformation Register. The annual rate of terminations of pregnancy did not change over the years (5.3-6.7%). About 2/3 of severe congenital anomalies were missed or diagnosed too late in pregnancy. A comparison of our data with those of EUROCAT, the central malformation register of Europe, showed that hydrocephalus was terminated significantly more frequently in the EUROCAT data, but the difference in other congenital anomalies was less marked. It follows that prenatal diagnosis in Austria and all over Europe is subject to equal social demands and medical standards. The study highlights, furthermore, the need for specialist doctors to receive standardized high-quality training in prenatal diagnosis in Austria.