[The effect of body position on uterine blood flow in the 3d trimester of pregnancy]. / Der Einfluss der Körperposition auf die uterine Durchblutung im 3. Schwangerschaftstrimenon.

Uterine vessels of 20 women with uncomplicated pregnancy between the 34th and 38th week of gestation were examined by means of Duplex sonography and a "simple" Doppler ultrasound device without sectional view and spectral analysis. Blood flow in several uterine vessels was recorded in various body positions: lying, sitting on a bench, standing, and - with some of the patients - in a position sitting on a so called "Variable Balance Chair". The relationship between the systolic and diastolic levels, as well as the shape of the Doppler curve, led to the Doppler parameters used. The Doppler parameters pointing to the best perfusion were found in the lying position, and sitting on the "Variable Balance Chair". Uterine perfusion seemed to be significantly decreased at the regular sitting, and in the standing position. Likewise, the shape of the Doppler curves indicated higher resistance in the blood vessels in the standing and the regular sitting position. The observations show that there are other factors that influence the momentary uterine perfusion besides uterine contractions. These results seem to be useful for the management of foetal growth retardation.

[Involution-induced changes in arterial uterine blood flow]. / Die involutionsbedingte arterielle uterine Blutstromänderung.

The change of resistance in the uterine arteries was studied in 20 patients showing a normal involution on five consecutive days. A uterine artery was examined by Doppler sonography, the Doppler profile evaluated, and the quotient, Fmean, resistance index, and pulsatility index were calculated from the systole and diastole. These parameters, which provided information on vascular resistance independently of the angle between the Doppler beam and the vessel, indicated a continuous increase during the puerperium; the differences in values for different days were significant. The changes in the Doppler profiles in the puerperial period pointed to an increasing vascular resistance. In one-half of the patients this was shown only by an increasing slope to the systolic peak, a sharp drop to early diastole, and a clear distinction between systole and diastole. In the other half of the patients the Doppler curves were like those found in pregnant patients with EPH gestosis. This indicated that the pathologic mechanisms leading to increased resistance in the uterine vessels were the same in both groups. One cause of this may be contraction and compression of the blood vessels, the other, and probably principal, cause was reduction of the vascular system due to histolysis, as in the puerperium, or insufficient development of the vascular system, as in EPH gestosis. That is to say, functional and morphological changes occur in both cases. No decrease in resistance in the uterine vascular bed was detected in cases of puerperial subinvolution of the uterus.

[Effect of atypical pathogen colonization on cervical priming in cervix insufficiency]. / Einfluss auf das cervikale Priming durch atypische Keimbesiedlung bei der Cervixinsuffizienz.

In a prospective study the cervical bacterial flora of pregnant women with insufficiency of the cervix is compared with the flora of asymptomatic pregnant women. It could be demonstrated, that in case of insufficiency of the cervix a different bacterial flora is found: in addition to the incidence of pathological bacterial groups, a shift of the physiological flora with Doederlein's bacilli to a mixed flora is observed. New findings in the cervical priming lead to the idea, that an atypical cervical flora could influence the cervical priming. The changing of the cervical environment is able to induce an increased production of prostaglandins with cervical dilatation of its structure. Regarding the different cervical flora in case of cervical insufficiency, the importance of the circular suture in the prophylactic management of premature delivery will be discussed. The results lead to the necessity of precise vaginal check-up and therapy of genital infections during pregnancy.

[Clinical experiences with intracervical prostaglandin E2 administration for labor induction]. / Klinische Erfahrungen mit intracervikaler Prostaglandin E2-Applikation zur Geburtseinleitung.

From January 1, 1986 to December 31, 1987, 119 patients among a total number of 2309 were recorded prospectively, who needed induction of labour for mixed indications (Group A), for a premature rupture of the membrane (Group B) or for medical indication (Group C). Independently of the ripe of cervix the results were significantly better in the multiparae than nulliparae respecting the success of induction, the duration of labour and the rate of Caesarean sections. 66.4% (n = 79) of all cases could be delivered within 24 hours after the first gel-application. Statistically significant differences in the partial collectives A, B, and C were seen only by unripe cervix (A = 60.0%, B = 71.4%, C = 30.0%). Repeated tries of inductions led to statistically significant more rates of Caesarean sections, fever during labour and prolonged course of labour. The rate of Caesarean sections and the fetal post-partum results comparing to the other remaining deliveries in 1986/87 were statistically not different. Side effects induced by Prostaglandins were only founded in two cases concerning nausea. Uterine hyperactivities with pathological CTG-patterns being resistant to treatment with beta-mimetics were found in one case. As severe complication the only case with particular rupture of uterus must be seen. Based on our experience the intracervical PGE2-application for induction of labour is not disadvantageous for mother and fetus, if there are certain indications and fixed criteria.

[Changes in uterine circulation in relation to body position in pregnancy]. / Anderung der uterinen Durchblutung in Abhängigkeit von der Körperposition während der Schwangerschaft.

The present paper reports on studies to determine the influence of body position on uterine blood flow. In ten pregnant patients (around the 35th week of gestation), over 700 measurements of systolic/diastolic action in the uterine vessels were made by Doppler sonography with the patients in various positions: lying down, standing, and sitting on the couch and the balance-variable chair; from the relationship between the systolic and diastolic levels conclusions were then drawn about the uterine blood flow in various body positions. It was found that it was best when the patient was lying down or sitting on the special chair without angling the hips; in contrast, diastole was lower in relation to systole with the patient standing and sitting on the examination couch. This means an increase in resistance or a reduction in blood flow. It appears reasonable to conclude that sitting on the balance-variable chair can be recommended to pregnant patients with signs of deficient fetal blood supply, in addition to bedrest, which is customarily advised. Apart from this, it is wise to use Doppler sonography to establish the body position in which uterine blood flow is best.