Twins--results after changing the management in pregnancy and labor.

Retrospective analysis of the results of management in pregnancy and labor of 598 pregnancies during the period 1986-1990. The influence of prophylactic and therapeutic hospitalization related to the gestational age on the complication rate for premature labor, method of delivery, fetal outcome (APGAR-score, umbilical cord-pH, neonatal mortality) will be presented. There is a need for improvement in antenatal care and the management of delivery including liberal indication for prophylactic hospitalization and for delivery by caesarean section.

[Uses of vaginal pH measurement for prevention of premature labor. Results of a prospective study]. / Nutzen der vaginalen pH-Messung zur Frühgeburtsvermeidung. Ergebnisse einer prospektiven Studie.

UNLABELLED: The influence of the microflora of the vagina and cervix has been undervalued for the induction of premature birth. Examination of the microbiological problem by determination of the vaginal pH in combination with the microflora (Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum). Report of the outcome of 161 prospective, ad the beginning normal pregnancies in comparison of 200 primary hospitalized pregnancies with symptoms of imminent premature birth. CONCLUSION: The vaginal pH is a very useful parameter of screening for identification of disturbances of the microflora in practice. In cases of pathologic pH (> 4.5) it is possible by therapy to reduce the premature birth rate.

Perfusion of immobilized isolated nerve terminals as a model for the regulation of transmitter release: release of different, endogenous transmitters, repeated stimulation, and high time resolution.

To study the release of neurotransmitters, i.e., the recruitment of transmitters for release and the regulation of the release process, isolated nerve terminals (synaptosomes) of the rat forebrain were immobilized in Sephadex gel inside a perfusion chamber. In this way, the following were achieved: (a) A very limited pressure stress was exerted on the synaptosomes, so that these remained viable for long periods (greater than 30 min) inside the chamber and did not elute from the chamber, which allowed long-term experiments with repeated stimulations; (b) estimation of the release of various endogenous transmitters, both in a Ca(2+)-dependent (exocytotic) and Ca(2+)-independent manner; (c) a step-like stimulation with depolarizing agents (rise time, 3-4 s) and a high time resolution (600-ms sampling); and (d) negligible reuptake of transmitter into the terminals or extracellular breakdown. It is concluded that this perfusion setup helps to provide new insights in the presynaptic stimulus-secretion coupling, co-transmission, and the exo-endocytosis cycle.

Screening for toxoplasmosis in pregnant women: presentation of a screening programme in the former "East"-Germany, and the present status in Germany.

The results of the screening programme (including the examination of fetal IgM) in East-Germany, related to the efficiency of therapy (pyrimethamine/sulfonamid) of the fetal infection risk are presented. For comparison the results of a prospective study of toxoplasmosis in pregnancy (n = 1697) without therapy, and follow up of the connatal infected infants to the age of 9/10 years old are shown. Recommendations for the diagnostic and therapeutical management in Germany for the future are presented.

[Vaginal sonography in the diagnosis of premature rupture of fetal membranes]. / Vaginosonographie zur Diagnostik des vorzeitigen Blasensprunges.

68 patients have been examined by vaginal scanning one time in the second and third trimester of pregnancy. Chorion and amnion could be correctly identified in 89.7%. It was possible to recognize rupture of the membranes using a vaginal scan probe in 17 patients.

[Pregnancy after kidney transplantation. Report of 6 successful cases with multiple risk factors]. / Schwangerschaft nach Nierentransplantation. Ein Bericht über 6 erfolgreiche Verläufe bei multiplen Risikofaktoren.

The long-term course before, during and after successful pregnancy in six women 3 to 6 years after receiving CD-kidney transplants from dead donors is described. Multiple risk factors such as hypertension, considerable proteinuria, preceding rejection crises etc. have been taken into account. The analysis includes the observation of a pregnancy which began already in the 1st month after transplantation. With the exception of a patient with hydronephrosis, whose functional data remained normal, the transplants of all patients showed better functional data after delivery than before pregnancy (maximum period of observation: 5 years 3 months post delivery). The patients mainly received alternating prednisolone therapy. Immunosuppression was generally reduced in the second trimester and was temporarily increased above the maintenance dosage after delivery. All children were eutrophic at birth and developed normally without complications. Important factors leading to the good overall clinical result were intensive out-patient care and the cooperation between nephrologists, urologists, gynecologists and neonatalogists. Despite our very good experience with 6 pregnancies successfully carried to full term by women with kidney transplants, the risk for mother and child should only cautiously be estimated, taking into account the results of future larger studies.

Prenatal prophylaxis of hyaline membrane disease with prednisolone: advantages and disadvantages.

The purpose of the study was to evaluate the prophylaxis of hyaline membrane disease (HMD) with prenatal steroids from the viewpoint of neonatology. In 397 preterm infants of 27-35 week gestation the prenatal prophylaxis of HMD with prednisolone (200-300 mg over 48-72 h) significantly reduced the HMD morbidity and mortality rate (0-7th day of life), especially in newborns under 33-week gestation. HMD was not detected if a 48-h interval lay between the end of prednisolone application and birth. There was no influence on the severity and the lethality of HMD. The 29-day mortality rate in the prednisolone group (14.6%) corresponded more or less to that of the control group (16%). In the prednisolone group the increase in late mortality rate was due to a significantly higher number of late serious infections. The time interval between the rupture of the membranes and birth did not influence the infection rate and HMD frequency. At this time we cannot recommend a general prenatal glucocorticoid prophylaxis of HMD in cases of threatened preterm labor.

[The effectiveness of a general test for Toxoplasma gondii infection in pregnancy]. / Zur Effektivität einer generellen Testung auf Toxoplasma-Gondii-Infektion in der Schwangerschaft.

Primary toxoplasma gondii infection in pregnancy (6.7 per thousand pregnancies) is considered to be a potential danger to foetal development (congenital infections in 5.3 per thousand). This conclusion had been drawn from a prospective study into 1,697 pregnant women. It is a primary infection which can be detected only by means of specific diagnostic methods. - Pyrimethamine-sulphonamide treatment ,ist be considered as the optional for pregnant women, even by all accounts of side-effects. The risk of foetal infection has been reduced from 64 to 14 per cent by use of such treatment on cases of primary infection. - The results so far obtained from examination of congenitally infected children, aged between nine and ten years, are likely to justify the recommendation of general toxoplasma gondii testing and specific therapy for all cases of primary infection during pregnancy.

[Frequency of latent connatal Toxoplasma gondii infection in children and their development]. / Zur Häufigkeit und Entwicklung der Kinder mit latenter konnataler Toxoplasma gondii-Infektion.

The incidence and clinical symptoms of Toxoplasma gondii-primoinfection during pregnancy are ascertained basing on a prospective survey comprising 1,697 gravid women. The rate of the first infection during pregnancy was 7.6%, the connatal infection rate 5.6%, the premature birth rate in connatal infection 44%. In cases of connatal infection which were proved serologically with SFT and CFT, the development of the children was followed up to the age of 9 and 10 years.

[Use of prostaglandin F 2-alpha in placental period (author's transl)]. / Der Einsatz von Prostaglandin F2 alpha in der Nachgeburtsperiode.

Reported in this paper is the intravenous application of prostaglandin F 2-alpha in the placental period and in cases of severe postpartum haemorrhage. -- Intravenous infusion of per-minute amounts between 40 and 80 micrograms in cases of atonic haemorrhage or between 30 and 45 micrograms in the placental period, in general, produced uterine contraction and clearly reduced blood loss.

[Reproduction following kidney transplantation (author's transl)]. / Reproduktion nach Nierentransplantation.

Reported in this paper are the first two pregnancies and childbirths in the GDR following kidney transplantations. The point is made that pregnancy following kidney transplantation should remain to be a rare exception, though the courses were favourable in both cases described. Reference is made to most suitable forms of anticonception.

[Additional tocolysis via inhibition of prostaglandin synthetase with indometacin (author's transl)]. / Zusatztokolyse durch Prostaglandinsythetasehemmung mit Indometacin.

Indometacin was administered as additional tocolyticum in 42 women between the 27. and 36. week of pregnancy. Patients received indometacin oral, of a complete tocolysis could not be achieved by application of beta-sympathicomimetica. A complete tocolysis always could be achieved with a daily dose of 200 mg indometacin. The mean time of therapy was 7,5 days, the mean total dose 1100 mg.

[Induced abortion with intramuscular administration of 15(S)-15methyl-prostaglandin F 2 alpha]. / Abortusinduktion durch intramuskuläre Applikation von 15(S)-15-Methyl-Prostaglandin F 2 Alpha.

15(S)-15-methyl-prostaglandin F2alpha was administered by the intramuscular route in 10 patients between 12. and 18. weeks gestation. All these patients aborted within 20 hours, with mean induction-abortion intervall of 14,1 hours. 250 microgram 15(S)-15-methyl-prostaglandin F2alpha was administered 3 hourly. 8 patients had side effects, mainly nausea, vomiting and diarrhea.

PIP: 250 mcg 15(S)-15-methyl-prostaglandin F2alpha (PGF2alpha) was administered intramuscularly every 3 hours to 10 women between 12-18 weeks gestation. All aborted within 20 hours with a mean induction-abortion interval of 14.1 hours. 8 patients experienced side effects such as nausea, vomiting, and diarrhea. (author's modified)

[Experiences on the effectivity of prostaglandin F2alpha during labor after insufficient effect of oxytocin]. / Erfahrungen über die Effektivität von Prostaglandin F2alpha unter der Geburt nach unzureichender Oxytozinwirkung.

A report is given about the efficacy of prostaglandin F2alpha for induction of labour after inefficient application of oxytocininfusion. In all cases induction of labour was indicated or labour should be supported. 80 of the 104 women with weak labour finally delivered on vaginal way. Only 9 of 24 caesarean sections were performed by reason of weak labour in spite of application of prostaglandin F2alpha. There was no influence on the state of the newborns, this was the result of postnatal judgment by Apgar-score.

PIP: Prostaglandin F-2 alpha was applied intrapartum in 104 women who (1) had indications for induction of labor (32 of them had premature rupture of the amniotic sac) and (2) had already received ineffective infusions of oxytocin. 80 women (77%) had vaginal deliveries; 24 had to have caesarean sections. Of these 24, however, only 9 were without strong obstetric indications for caesarean section (such as fetal heartbeat, fetal acidity, or intrapartum fever). 75 of the subjects were primiparae; the age range was 16-43. The prostaglandin was in a solution of 10-15 mcg/ml; the infusion rate was 5-22.5 mcg/minute. The mean time from infusion to birth was 180 minutes; mean time from 5-cm cervical dilation to birth was 114 minutes (cervical dilation was 2-3 cm at the beginning of prostaglandin application). No harmful effect on the state of the newborn was observed, as Apgar pH scores were similar to those of children born after spontaneous labor.

[Clinical problems of premature labor. 2. Therapy of threatening and actual premature labor]. / Die klinische Problematik der Frühgeburt. 2. Therapie der drohenden und der in Gang gekommenen Frühgeburt

The therapy of imminent prematurity needs specific treatment of the respective illness. Moreover there are three fundamental measures: 1. To appease the patients and to applicate sedatives. 2. To carry out tokolysis with medicamentes. 3. To carry out cerclage operation in order to close the uterine mouth. These possibilities must be combined in various ways dependent from the success in every individual case. These measures also are suit in prophylaxis, for example in disorders of former pregnancies. All schemes of therapy adapted to the individual case. The dosis must be determined from the effect of therapy. A particular view point must be the hospitalisation between 28. and 32. week of pregnancy in cases of twins or placenta previa. Also in cases of early rupture of amnion prolongation of pregnancy must be aspired.

[Prevention of neonatal respiratory distress syndrome through the administration of prednisolone in the fetal period]. / Prophylaxe des neonatalen Atemnotsyndroms durch Prednisolongabe in der Fetalperiode

The clinical effectiveness of antenatal prednisolone medication (prednisolone hemisuccinate) for the prophylaxis of idiopathic respiratory distress syndrome (IRDS) was studied in 114 premature infants with a gestational age between 28 and 36 weeks. There was a statistically significant difference (chi2 - test, p less than 0,01) between the frequency of IRDS in this group and in another one consisting of 137 premature babies with a nearly identical distribution of gestational age, whose mothers did not get prednisolone before delivery. It could be shown that the time interval between medical induction and delivery should not exceed 2 weeks, since the effect decreases with time. At present prednisolone medication during the fetal period may serve as useful prophylactic measure for IRDS in cases of premature birth. As there are a lot of contraindication against prednisolone and as we do know very much about side effects, it seems necessary to seek for other, less dangerous inductors.

[Indications and findings in the electronic monitoring of the fetus during birth]. / Indikationsstellung und Befunde bei der elektronischen fetalen Uberwachung unter der Geburt

From 1971 to 1974 in the Department of Gynecology and Obstetrics of the Humboldt-University of Berlin we monitored 1132 fetuses. The extent of the analysed groups runs to 306 to 632 cases, according to the completeness of the investigations and documentation. We have compared our CTG-findings with those of other authors. We found relationships between the risk factors and the CTG findings: for low weight fetuses more frequent Dip I, for maternal vitium cordis more frequent fetal tachycardia, for meconium stained liquor more frequent smooth baseline (silent) for EPH-gestosis (toxemia) more frequent Dip II (late deceleration) and variable deceleration. The relationships between the risk factors and the CTG findings are loose and not suitable to verify the great differences in frequency of the CTG pattern, published in the literature. We believe, that these differences are caused by different definitions and subjective interpretation of the CTG.

[Influence of electronic monitoring of the fetus on the frequency of surgery and on the status of the newborn infant]. / Einfluss der elektronischen fetalen Uberwachung auf die Operationsfrequenz und den Zustand der Neugeborenen

In the years from 1971 to 1974 the rate of fetal monitoring of high risk deliveries rose from 3.0% to 23.7%. In this time our clinic become a center of high risk pregnancies (reproductive failure and prematurity). By this way we could not show a decrease of the perinatal and intranatal mortality. The increase of caesarean sections from 3.0% (1968) to 6.0% (1974) was caused by the increasing of high risk patients. Fetal monitoring is not a cause for rising of operative frequency. By means of fetal monitoring the Apgar score of the newborns from mothers with severe diseases is not significant worse than from newborns of mothers with more easy diseases.