[Disorders of liver function, thrombopenia and hemolysis in a special clinical form of hypertension in pregnancy (the so-called HELLP syndrome)]. / Leberfunktionsstörung, Thrombopenie und Hämolyse bei einer besonderen Verlaufsform der Schwangerschaftshypertonie (sog. HELLP-Syndrom).

The so called HELLP syndrome is a severe complication of pregnancy-induced hypertension, characterized by haemolysis (H), elevated liver enzymes (EL) and low platelet counts (LP). The data of 37 patients with a HELLP syndrome are presented. In addition to the clinical symptoms of pregnancy-induced hypertension, 21 patients suffered from abdominal pain and 5 patients from icterus. Thrombocytopenia, haemolysis and elevated liver enzymes were observed in every case. In 28 of the patients a Caesarean section was performed to prevent further deterioration of the disease. Three patients died post partum as a consequence of severe complications. In five pregnancies intrauterine deaths were observed. The results of this retrospective study confirm the great risk for both the mother and the foetus, if pregnancy-induced hypertension is complicated by a so called HELLP syndrome.

Relationship between serum prolactin concentration, vascular angiotensin sensitivity and arterial blood pressure during third trimester pregnancy.

Prolactin may play an important role in the pathogenesis of pregnancy-induced hypertension (PIH) and preeclampsia. In 105 normotensive nulliparous women at 28 to 32 weeks of gestation, the relationship between serum prolactin concentration (PRL) and blood pressure behaviour was examined under standardized conditions. Neither postural change from left lateral to supine recumbency nor the infusion of low doses of angiotensin-II-amide had an effect on PRL levels. Similar mean PRL levels were found in pregnant women with a low angiotensin pressor dose (ADP less than 10 ng x kg-1 x min-1) or "angiotensin sensitivity", a positive supine pressor response (delta pd greater than or equal to 20 mmHg) or an increased serum uric acid concentration (greater than 3.6 mg/dl), which are criteria for an increased risk of developing hypertensive complications. However, in the group of subjects with angiotensin sensitivity, a significant correlation was found (a) between PRL levels and the APD and (b) between PRL levels and diastolic blood pressure increase after 5 min of supine recumbency. These results may reflect diminished dopaminergic activity in the central nervous system, which could influence both blood pressure and prolactin secretion.

[Stomach cancer and pregnancy]. / Magenkarzinom und Schwangerschaft.

The symptoms of gastric carcinoma are nonspecific and uncharacteristic especially during the pregnancy. Two cases of gastric carcinoma in pregnancy are reported. In both cases the diagnosis of the malignoma was not made in an early stage. Therefore both women died within a short period after the delivery due to the metastasis of the gastric cancer. The newborns survived the complicated pregnancy and they were born spontaneously and by cesarean section. The reasons for the delayed diagnosis and the problems of this malignoma during a pregnancy are discussed based on the own observations and the published cases.

[Neurofibromatosis and pregnancy]. / Neurofibromatose und Schwangerschaft.

A case of neurofibromatosis (Recklinghausen's disease) in pregnancy in a 29-year-old patient is reported. The woman has had two uncomplicated pregnancies and deliveries. The lesions of the neurofibromatosis did not change during the course of the pregnancy. However, based on the few published cases it is necessary to pay attention to hypertension or an exacerbation of the neurofibromatosis.

[Local metronidazole and PVP-iodine prevention before abdominal and vaginal hysterectomy]. / Lokale Prophylaxe mit Metronidazol und PVP-Jod vor abdominaler und vaginaler Hysterektomie.

One day before abdominal or vaginal hysterectomy 37 patients received a vaginal suppository of (I) metronidazol (200 mg) (II) PVP-iodine or (III) a placebo. Microbiologic analysis was performed before application and three or four days post surgery. No differences between the three groups were observed regarding bacterial status and postoperative morbidity. Occurrence of postoperative infections did not decrease as a result of the local treatment and dosage as described.

[Lymphocyte subpopulations in gestosis]. / Lymphozytensubpopulationen bei Gestose.

Lymphocyte subsets from peripheral venous blood of 11 patients with preeclampsia were enumerated by monoclonal antibodies and compared to the values of 10 normal term pregnant women. All women were in their last trimester of pregnancy. The number of B and T cells was similar in both groups. In the preeclampsia group, more helper T cells could be shown, whereas the number of suppressor T cells was reduced. Thus, the helper/suppressor ratio was increased from 2.01 in normal pregnancies to 3.97 in preeclamptic patients. In two patients with a true-positive angiotensin stress test similar changes as in preeclampsia could be seen. In only one out of five patients with preeclampsia the helper/suppressor ratio returned to normal values four to five weeks after delivery.

[Effect of oxytocin on renin activity and aldosterone concentration in plasma as well as blood pressure in late pregnancy and early puerperium]. / Wirkungen von Oxytozin auf Reninaktivität und Aldosteronkonzentration im Plasma sowie den Blutdruck in der Spätschwangerschaft und im frühen Wochenbett.

The effects of a low-dose oxytocin infusion on blood pressure during late pregnancy and early puerperium are unclear, and its effects on the renin-aldosterone axis are unknown. The present investigation was performed in 24 pregnant subjects at term and in 14 women within five days after vaginal delivery, 10 and 7 of these subjects serving as controls (5% laevulose being infused without oxytocin). A slight but significant decrease of plasma renin activity was found during oxytocin infusion antepartum as well as postpartum. The decrease of aldosterone concentration in plasma was also significant during late pregnancy, but not during the puerperium. An increase of diastolic blood pressure was only observed antepartum. In summary, however, the changes of blood pressure, renin and aldosterone described in the perinatal period in normotensive subjects were small and without clinical importance.

The value of the mean arterial blood pressure in the second trimester (MAP-2 value) as a predictor of pregnancy-induced hypertension and preeclampsia. A preliminary report.

In 200 healthy nulliparous women the mean arterial blood pressure in the second trimester (MAP-2 value) was calculated. 85 women (42 %) had a MAP-2 value of greater than or equal to 90 mmHg (positive test result), but only 27 women (32 %) developed a hypertensive complication. Conversely, 113 of the 115 (98 %) women with a negative test result (MAP-2 value less than 90 mmHg) remained normotensive. Only two women of this group (2 %) later showed a mild pregnancy-induced hypertension. Thus, the MAP-2 value has a high sensitivity (93 %) and a high predictive value of negative test results (98 %). On the other hand, there is a high rate of false-positive results (68 %) and thus a low predictive value of positive test results (32 %). It is concluded that the MAP-2 value is a simple method for selecting pregnant women who should be examined with other more specific predictive tests. Alternatively, weekly measurements of blood pressure are recommended for early diagnosis of hypertensive disorders of late pregnancy in all women with a MAP-2 value of 90 mmHg or more.

Inhibition of the renin--aldosterone axis and of prolactin secretion during pregnancy by L-dopa.

Recently, interactions between dopaminergic mechanisms and aldosterone secretion were described in non-pregnant subjects. The present study examined the effect of 1000 mg of L-dopa by mouth on plasma renin activity (PRA), and the concentrations of plasma aldosterone (PA) and prolactin (PRL) during normal pregnancy. Under basal conditions, there was a clear decrease of PRA, PA and PRL 60 min after oral intake of L-dopa in seven subjects; a further decrease was observed during the following 45 min, resulting in a total decrease of 41 (PRA), 44 (PA) and 56 (PRL) % of the respective arithmetic mean of the basal values. However, the response of PA to isopressor angiotensin II infusions was comparable before and shortly after treatment with L-dopa in 16 pregnant subjects. The decreased activity of the renin-aldosterone axis after administration of L-dopa may be attributed to an accumulation of dopamine and catecholamines in the brain, resulting in a diminution of sympathetic outflow from the central nervous system. The simultaneous and comparable changes of both PRA and PA after L-dopa treatment, as well as the reversibility of aldosterone suppression by infusion of angiotensin II, suggest that the inhibition of aldosterone secretion by L-dopa is mediated by a decrease of renin release.

[The value of a single determination of serum uric acid concentration in the early diagnosis of hypertensive disorders in pregnancy (author's transl)]. / Die Aussagekraft einer einmaligen Bestimmung der Harnsäurekonzentration im Serum zur Früherfassung der hypertensiven Schwangerschaftskomplikationen.

In 200 healthy, normotensive nulliparous women, a single determination of serum uric acid concentration was done between weeks 28-32 of gestation in order to identify a possible increased risk of developing hypertensive complications. If serum concentrations higher than 3.6 mg/dl were considered as increased ("positive test"), women who developed toxaemia of late pregnancy (proteinuric hypertension), had a significantly elevated mean serum uric acid concentration already at the beginning of the third trimester (p less than 0.01). The incidence of toxaemia and hypertensive disease without proteinuria was significantly higher in the group of women with an elevated uric acid value (p less than 0.001). Only 9% of pregnant women with a "negative test" ultimately developed a mild form of a hypertensive complication. Conversely, 74% of the patients with a "positive test" remained normotensive. Thus, the predictive value of a "positive test" is low (26%) and that of a "negative test" relatively high (91%).

Effect of angiotensin infusion during pregnancy on fetal heart rate and on fetal activity.

The angiotensin sensitivity test is of value in predicting patients at increased risk of pregnancy-induced hypertension and preeclampsia. Studies on the effects of angiotensin II on uterine blood flow in various species showed contradicting results. In the present study, 15 pregnant women were monitored by cardiotocography before, during and after an infusion of angiotensin II-amide (maximal infusion rates 6.3--23.2 ng . kg-1. min-1). No remarkable changes in fetal heart rate, oscillatory frequency and amplitude, as well as in the number of accelerations and fetal movements could be observed. It may be concluded from these results that the fetal condition is not compromised by an angiotensin sensitivity test.

[Significance of blood pressure and body weight in the early diagnosis of gestosis. Preliminary report]. / Bedeutung des Blutdruck- und Gewichtsverhaltens bei der Frühdiagnose der Gestose Ein vorläufiger Bericht.

Mean weight gain is higher in gestosis than in normal pregnancy. On the other hand, many patients with gestosis had an insignificant increase in body weight. Therefore, the weight gain in pregnancy does not have a predictive value concerning the later risk of developing gestosis. The supine pressor test ("roll-over test") and the determination of mean arterial pressure during weeks 18 to 26 of gestation (MAP-II-value) are simple and appropriate methods for early diagnosis of gestosis. By using the supine pressor test or by determination of the MAP-II-value, 73% or over 90%, respectively, of all subjects with later gestosis could be recognized before the onset of first clinical symptoms of the disease (n = 108). As both methods frequently show false-positive results, a high percentage of pregnant women needs intensive care during the last trimester. In order to select further women with increased risk of gestosis, it is proposed to calculate the MAP-II-value first and to determine the supine pressor response at least in those primigravidae with a MAP-II-value of 90 mmHg or more.

The value of the angiotensin sensitivity test in the early diagnosis of hypertensive disorders in pregnancy.

Normal pregnant women are resistant to the pressor effect of intravenously administered angiotensin II (AII), but women who are destined to develop hypertensive complications in pregnancy show an increased sensitivity to AII several weeks before the onset of the first clinical symptoms. In 231 normotensive nulliparous women (age 25 +/- 5 years), an angiotensin sensitivity test (AST) was performed between weeks 28 and 32 of gestation. If an effective angiotensin pressor dose (APD) of less than 10 ng . kg-1 . min-1, is considered to be a positive test result, 58 subjects had a positive AST and 173 had a negative AST. Twenty-six of 34 women who ultimately developed pregnancy-induced hypertension (PIH) or preeclampsia had a positive test, and the diagnosis was made early. Each of the eight pregnant subjects with a false negative test developed only a mild form of the hypertensive disorder. In this series, 11 women had a premature onset of labor; eight of them also had an APD of less than 10 ng . kg-1 . min-1. The study confirms the high predictive value of negative test results. Therefore, the AST can be used as an appropriate method for identifying women who are destined to develop hypertensive complications in pregnancy. However, because of the low practicability of the test, it may not be recommended as a screening method in routine prenatal care.