[Computer-assisted cardiotocography analysis within the scope of continuous electronic labor monitoring with simultaneous use of noninvasive and invasive methods of registration]. / Computergestützte CTG-Analyse im Rahmen einer kontinuierlichen elektronischen Geburtsüberwachung mit simultan durchgeführter noninvasiver und invasiver Registriermethode.

In frame of a simultaneously study with noninvasive and invasive registration technic by application of 2 fetal monitors with following computer aided CTG-analysis at 22 patients we found in relation to the quantitative CTG-parameters DF (fetal condition), D (dip area), BI (bradycardia index) as well as BR (bradycardia residuelle) in part distinct differences for the range of distribution in spite of missing statistical significance (p less than 0.05) which point to insecurity in trigger signals for the noninvasive method. As exceptionally dangerous turned out to be false trigger signals in range of medium-term heart rate changes in attendance to auto-correlation US-DOPPLER-technic. The noninvasive registration of labour pains impressed forcibly for some time about longer CTG-phases to be unsuitable for the exactly judgment of uterine activity (Montevideo-unit). In conclusion the noninvasive method in supervision of labour should be considered more critical than earlier particular under forensic points of view.

[Assessment of fetal growth using the humerus and femur in ultrasound fetometry]. / Die Beurteilung des fetalen Wachstums unter Einbeziehung von Humerus und Femur in die Ultraschallfetometrie.

In a prospective study process curves of fetal development were done for 1618 patients using humerus and femur with at least 5 ultrasound investigations per patient. These prenatal ultrasound values were divided in 7 groups and compared with the postnatal values of newborns to get a reliable statement. Typical curve processes have been demonstrated for low-profile development, mild and severe intrauterine growth-retardation, a macrosomy, and for a diabetic fetopathy. The following results have been gained from ultrasound values of prospective staging of fetal development. From 1618 cases 1263 cases (78.0%) have been staged exactly. 333 cases (20.6%) were not total exact. 22 cases (1.4%) have been evaluated wrong. From 121 cases of IUGR 95 cases (78.5%) have been staged correctly. Humerus and femur values are below the normal range in for IUGR group. 77 cases (62.1%) from the 124 macrosomal newborns have been detected right. Only 2 cases (4.9%) from the 41 cases of diabetic fetopathy have been evaluated lower. Humerus and femur values in severe macrosomia were over the normal range in contrast to the diabetic fetopathy. Our scheme for control of fetal development which use humerus and femur as additional parameters shows higher precision.

[Lymphogranulomatosis and pregnancy]. / Lymphogranulomatose und Schwangerschaft.

A long period of full remission after successfully treated Hodgkin's disease set more and more in our concern problems of pregnancy and parturition in these patients. There are no exact informations about an unfavourable influence of pregnancy on the course of Hodgkin's disease. Although in cases of severe disease the treatment of the mother goes first we will restrain from therapeutical activities in patients with favourable histology and missing B-symptoms. It is reported on 3 cases of Hodgkin's disease with succeeding pregnancy and delivery. The stage IV of Hodgkin's disease in one patient is apparently followed by an uncomplicated course of pregnancy and lack of recurrent disease.

[Possibilities of the diagnosis of abnormalities within the scope of basic obstetrical ultrasound examination]. / Die Möglichkeiten der Missbildungsdiagnostik im Rahmen der geburtshilflichen Ultraschall-Basis-Untersuchung.

The possibility to diagnose slight masked malformations increased in the last years both by improving technical ultrasonic equipment and progressive personal experience of the examiners. With regard to time and technique it is impossible to treat fully all possibilities of ultrasonics, because the time-patient-ratio would be to enormous, the malformation rate would be to low and not any malformation is followed by an obstetric consequence. Additionally most of the malformations can be diagnosed or excluded only in determined gestational weeks. Therefore we present as a compromise a checklist which guarantees as well as examination of 8-10 patients per hour as a detection of the most important malformations. Abnormalities like double monsters, hydrocephalus, anencephaly, microcephalus, posterior and anterior tumors, thoracal and abdominal cysts, micromely and amely should not escape. Smaller abdominal cysts caused by filled intestines are very frequent. Controlling these findings, like looking for defects of extremities e.g. dub-feet is impossible, but not necessary, too, because of the lacking antenatal consequences.

[Recommendation for a systematic solution of documenting findings in obstetrical and gynecologic ultrasound diagnosis]. / Vorschlag einer Systemlösung der Befunddokumentation für die geburtshilfliche und gynäkologische Ultraschalldiagnostik.

Ultrasonic findings in a women's clinic are very heterogeneous. In their totality they will be unmethodical very quick. Therefore we decided to organize four separate card indexes: 1. gynaecologic findings; 2. breast diagnostics; 3. supervision of pregnancy and look for fetal malformations; 4. single findings in pregnancy.--Each card index does not exceed 2000 to 3000 patients by appropriate actualization. A filing card for supervision of pregnancy and systemic detection of fetal malformations is created.

[Diversity of symptoms in uterine rupture]. / Vielfältigkeit der Symptome bei Uterusruptur.

We analyzed 5 cases of uterine rupture observed in our clinic in the last 8 years (= 0.36 per 1000 deliveries) because spontaneously appearing ruptures of a normal uterus often have symptoms which may mislead our efforts like amniotic fluid infusion or clotting defects. All our 5 cases were multiparous women, in 4 cases oxytocic drugs were applied and only in one case there was a histologic damage of the myometrium. In no case classic sharp pain and cessation of contractions could be observed, only in one case painful abdomen and tenderness of the uterus. On the other hand shock could be seen in every case, vaginal bleeding in 4 cases and alteration of fetal heart frequency in 3 of 4 cases with primary living fetus. The different symptoms may occur as to time in a variable sequence. Therefore the right diagnosis is made often very late. In accordance with the literature a digital control of the uterine cavity is proposed in every case of an acute event during childbirth, especially evidence of shock, also if another diagnosis than rupture of the uterus is more probable.

[Antepartal diagnosis of an acardius in a triplet pregnancy using ultrasound]. / Antepartale Diagnostik eines Acardius bei Drillingsschwangerschaft mittels Ultraschall.

In fetal anomalies we can follow the course by repeated ultrasound examinations and so decide the therapy. For collection of experience all rare cases should be published. Beginning in 25th gestational week we observed a triplet pregnancy, in which one fetus was a severe malformed acardius. Fetus I has been separated with an own placenta and was developing well. Fetus II had to supply the acardius with circulating blood and therefore it retarded beginning in the 28th week. Fetus III was the malformed acardius. Beginning in the 28th week it began to grow rapidly. Caused by this fact and an increasing hydramnios pregnancy was terminated by spontaneous delivery in 31th week. The normal fetus I (1320 g) survived. The retarded fetus II (830 g) died postnataly. The diagnosis of an acardius monster (triplet III, 2090 g) was confirmed by autopsy. Good collaboration with the pathologist is of great value, because he can show the clinician the degree of precision of his antenatal diagnosis.

[Diagnosis of extrauterine pregnancy with special reference to ultrasound diagnosis and abdominal pregnancy]. / Beitrag zur Diagnostik der Extrauteringravidität unter besonderer Berücksichtigung der Ultraschalldiagnostik und der Abdominalgravidität.

Extrauterine pregnancies scarcely achieve an advanced developmental stage and were rarely diagnosed preoperatively. Even the ultrasonic B scanning don't eliminate the difficulties in recognising the ectopic pregnancy. We can demonstrate this by means of 3 case. In one of them, a case of full term abdominal pregnancy with healthy fetus, we could diagnose this preoperatively.

Prenatal diagnosis of anterior duplication anomaly (dicephalus diauchenos) by ultrasonography.

A 29 year old gravida 3, para 1 was referred in the 32nd pregnancy week for ultrasonography when a twin pregnancy was suspected. We found a fetal duplication with two heads in parallel position, biparietal diameter 81 mm (Fig. 1), a joint thoracic cavity measuring 86 x 92 mm (Fig. 2), reduced amniotic liquid and decreased spontaneous movements. The pelvic radiogram confirmed our suspension of an anterior duplication anomaly and showed only two arms and two legs for both fetuses but brought no additional information. The amniofetography failed. The contrast media ended up in the joint peritoneal cavity of the fetuses (Fig. 3). Delivery was in the 36th week by Cesarean section. The weight of the conjoint twins (Fig. 4) was 3210 grams, length 43 cm, and head circumference of each was 32 cm. Both fetuses showed independent respiratory movements and both briefly cried. Death occurred after 12 hours. Fig. 5 shows remnants of a scapula and Fig. 6 demonstrates a stump like leg remanent. Our prenatal diagnosis of an anterior duplication was confirmed by the autopsy. After a prenatal diagnosis of a duplication anomaly we recommend Cesarean section in term pregnancies. Considerations when deciding on the management of the pregnancy should include survival chances following possible surgical separation. If the diagnosis if made before the 24th week termination of the pregnancy might be considered.