[Cerebral hemorrhage and periventricular leucomalacia in preterm neonates after intravenous tocolysis with fenoterol: results of postnatal ultrasound examination]. / Hirnblutungen und periventrikuläre Leukomalazie bei Frühgeborenen nach intravenöser Tokolyse mit Fenoterol: postnatale neurosonographische Untersuchungsergebnisse.

BACKGROUND: This study tested whether tocolysis with beta-adrenergic agonists (Fenoterol) had an effect on the frequency of cerebral lesions in preterm neonates. PATIENTS AND METHODS: Head ultrasound scans of preterm neonates who were born after long-term (> 24 h) tocolysis were compared with scans of preterm neonates without preceding tocolysis. The gestational and neonatal data were analyzed retrospectively. RESULTS: Preterm neonates after (n = 102) and without (n = 101) tocolysis were subdivided into three groups according to their gestational age (23 - 28 wk: n = 41; 29 - 33 wk: n = 66; 34 - 36 wk: n = 96). Within these groups, no significant differences were found with respect to birth weight, rate of cesarean section, or pulmonary morbidity. Preterm babies < 28 weeks of gestation from the control group had lower Apgar scores (after 1 and 5 minutes, respectively) and arterial umbilical cord pH values. Intravenous tocolysis did not lead to an increase in pseudocystic periventricular leucomalacia (PVL) or intracerebral hemorrhage (ICH) in any of the subgroups studies. However, cerebral lesions were found in preterm neonates after tocolysis who exhibited signs of infection (29 - 33 wk: PVL n = 2; 23 - 28 wk: ICH n = 1) and in preterm neonates without tocolysis who had undergone fetal hypoxia or abruptio placentae (29 - 33 wk: PVL n = 4; antenatal terminal vein bleeding n = 1; 23 - 28 wk: PVL n = 2; terminal vein bleeding n = 5; posterior cerebral artery bleeding n = 1). When compared to preterm neonates of 34 - 36 weeks of gestation, the risk of infection was increased 4-fold in neonates of 29 - 33 weeks of gestation (odds ratio 5.43, 1.10 - 26.83) and 10-fold in neonates of 23 - 28 weeks of gestation (odds ratio 20.50, 3.65 - 115.03). Chorioamnionitis also was a more common finding in preterm neonates < 28 weeks of gestation. CONCLUSION: Preterm neonates who were born after intravenous long-term (> 24 h) tocolysis with Fenoterol do not exhibit an increase in periventricular leucomalacia or intracranial hemorrhage. The occurrence of cerebral lesions in these patients merely depends on their degree of immaturity and on the presence or absence of perinatal infection. In preterm neonates without tocolysis, brain lesions are mainly associated with hypoxic events.

[Neonatal ultrasonographic cerebral findings: association with risk factor for cerebral palsy]. / Stellenwert der postnatalen Neurosonographie für die frühzeitige Erfassung und ursächliche Klärung der Zerebralparese.

BACKGROUND: Is it possible to identify patients with cerebral palsy (CP) with postnatal ultrasound scan? Which risk factors are associated with an increased risk of CP?. PATIENTS AND METHODS: The data of 37 children with CP, who were sonographically investigated during the first 24 hours of life were analyzed retrospectively. The data of 21 preterm infants with gestational age /= 33 wk and in 5/8 of the mature babies. The mature babies had prenatal brain atrophy or hypoxic-ischaemic cerebral lesions. Cytomegaly and encephalitis were detected in two babies. Immature babies >/= 33 wk showed prenatal porencephaly or encephalomalacia after asphyxia. Premature babies

[Effectiveness and tolerance of depot leuprorelin acetate for preoperative endometrium flattening before endometrial ablation. German Leuprorelin Study Group]. / Wirksamkeit und Verträglichkeit von Leuprorelinacetat-Depot zur präoperativen Endometriumabflachung vor Endometriumablation. Deutsche Leuprorelinstudiengruppe.

OBJECTIVE: In order to assess the efficacy and tolerability of leuprorelin acetate depot in pre-operative flattening of the endometrium prior to hysteroscopic endometrial ablation, 94 patients from eight centres were included in the per protocol analysis. MATERIAL AND PATIENTS: The patients included were pre- or peri-menopausal, had completed their family planning and had intractable uterine bleeding. The primary target criterion was the reduction in maximum endometrial thickness after two injections of leuprorelin acetate depot with an interval of four weeks between injections. Surgery took place two weeks after the second injection. RESULTS: Sufficient pre-treatment was achieved in 91.5% of the patients with > 50% decrease and/or a type 1 endometrium according to sonographic and/or endometrial atrophy (Score 11) according to the central histological evaluation. The endometrium was flattened by a mean of 4.0 +/- 4.1 mm. In terms of clinical response, amenorrhoea, hypomenorrhoea or normal menstruation were achieved after endometrial ablation. Hence 91.5% of patients benefited from the overall treatment after six weeks and still 83% after six months. The trial medication was well tolerated overall. The most common side-effect described was hot flushes which could be attributed to the deliberate oestrogen withdrawal. CONCLUSION: In view of the good study results, hormone-suppressive pretreatment of the endometrium can be recommended prior to elective ablation. Surgery should take place during the oestrogen-suppressed phase.

[Determination of reference ranges and effect of maternal and fetal factors on insulin and C-peptide level in umbilical cord blood]. / Die Ermittlung von Referenzbereichen und der Einfluss von mütterlichen und kindlichen Faktoren auf Insulin- und C-Peptidspiegel im Nabelschnurblut.

OBJECTIVE: The risks of pregnancy caused by maternal diabetes are well known. Patients with unrecognized gestational diabetes mellitus (GDM) represent a special problem. The aim of our study was to find out, whether the determination of insulin and C-peptide in cord blood serum offers a valuable tool for retrospective analysis. MATERIAL AND METHODS: In 600 paired serum samples from maternal venous blood and neonatal cord blood insulin and C-peptide were determined radioimmunologically. A reference group consisting of 338 mothers and their newborns was established by exclusion of all patients with known pregnancy complications. RESULTS: Positive correlations could be identified between fetal insulin and fetal C-peptide, as well as correlations of these parameters with birth weight and body length, with maternal values of insulin, C-peptide, body-mass index, weight, and weight gain during pregnancy respectively. Increased levels of cord serum insulin were found in complicated pregnancies as well as in patients with previous pregnancy losses, preterm deliveries or stillbirths. CONCLUSIONS: Cord serum insulin and C-peptide were found to be useful parameters for immediate postnatal identification of impaired glucose tolerance during the course of pregnancy.

[Neonatal percentile values for the GDR--1985. Correlation of body weight and length in newborn infants (calculation of birth weight/body length in cm. with reference to gestational age)]. / Neugeborenenperzentilwerte für die DDR--1985. Zur Korrelation von Gewicht und Länge bei Neugeborenen (Berechnung des Geburtsgewichtes/cm Körperlänge unter Berücksichtigung des Gestationsalters).

Taking account of the gestational age (28th to 42nd completed week of pregnancy) the sex-related ratio of birth weight to length (g/cm) for newborn infants is reported. This shows that observation of the correlation between birth weight and length with reference to gestational age makes a more accurate classification of newborn infants possible, rather than using a two dimensional classification (birth weight week of gestation).

[Neonatal percentile values for East Germany--1985. 3. On the correlation of body height and weight of the mother in a two-dimensional classification of newborn infants according to birth weight and gestational age]. / Neugeborenen-Perzentilwerte für die DDR--1985. 3. Mitteilung: Zur Berücksichtigung von Körperlänge und -gewicht der Mutter bei der zweidimensionalen Klassifikation der Neugeborenen nach Geburtsgewicht und Schwangerschaftsdauer.

There were published percentiles of birthweight in relation to bodyheight of the mother as well as in relation to bodyweight and parity, bodyheight and bodyweight of the mother for term range 37th to 41st week of pregnancy. They were calculated through median quantities. The dates again derive from the investigation of 51,570 single births in elected regions of GDR in 1984 and 1985. The length of pregnancy was stated in full weeks. It was determined on the base of three parameters (by Naegele method, by sonography, and by neonatal maturity judgment). Selected percentiles of birthweight regarding the above influencing factors, distributed into sex, were summarized for use in practice.

[Multicenter study of obstetrico-perinatologic quality control in the Rostock district. I. Comparative medical statistics]. / Multicenterstudie zur geburtshilflich-perinatologischen Qualitätskontrolle im Bezirk Rostock. I. Mitteilung: Vergleichende Medizinalstatistik.

Report about outcome-quality assessment in obstetrics and perinatology using an uniform check list for data collection in the district of Rostock. Various possibilities of outprint of the results in 1985 are demonstrated. For daily data collection in obstetrics a special book has been developed. The investigation concerns a data pool of more than 55,000 deliveries. Considering a trend of the results the following optimal criteria in obstetrics and perinatology are postulated: (table; see text) The check list of the Society of Perinatal Medicine of the GDR for obstetrical and neonatal data collection should be generally used. The soft ware for the computed data analyses has been developed by the "Rechenzentrum der Ernst-Moritz-Arndt-Universität Greifswald". Analysis and output of obstetrical and perinatological datas by means of a personal computer are prepared.

[The East German Twin Study l984/85. Report of selected aspects]. / DDR-Gemini-Studie 1984/85. Bericht über Teilaspekte.

Analysis of a multicentre study of the GDR in which 67 clinics with a total of 1,200 twin pairs participated over a scheduled period of 18 months. In the result a recommendation for the antenatal, intrapartal and neonatal care of gemini-pregnancy was prepared.

[Telemetric labor monitoring. Clinical aspects, cardiotocographic findings and acceptance of free mobilization in labor]. / Telemetrische Geburtsüberwachung. Klinische Aspekte, kardiotokographische Befunde und Akzeptanz der freien Mobilisation unter der Geburt.

Telemetric signal transmission represents a suitable technical concept for combining free mobilisation with continuous electronic monitoring of birth. The obstetric aspect of telemetric birth monitoring is discussed on the basis of a clinical-statistical analysis: a group of 127 women in labour (64 primigravidae and 63 multigravidae) were examined and the specific effect of mobilisation on obstetrically relevant parameters was analysed. The results show the advantages of this method of birth management. Freedom of decision as regards choice of posture during birth, better subjective control and less painful labour, better birth mechanics, more effective labour, shorter duration of birth, better heart-rate patterns, optimal exterior conditions and an active basic attitude of the woman in labour are the proven advantages of this method. The highly significant relationship between the degree of mobilisation and the duration of birth is emphasised as one of the most important results.

[The "long-term morbidity" computer program in perinatology. 1. Program introduction]. / Computer-Programm "Langzeit-Morbidität" in der Perinatologie 1. Mitteilung: Programmvorstellung.

Presentation of the Computer-programme for prospective analysis of morbidity of unselected children born in 1983 up to 1985 over a period of 10 years.

[Experiences with a mobile monitoring system for fetal and neonatal cardiotachometry]. / Erfahrungen mit einem mobilen Monitorsystem zur fetalen und neonatalen Kardiotachometrie.

A monitoring system for fetal and neonatal cardiotachometry which set up in own instrumentation at the Department of obstetrics of the Regional Hospital of Rostock. With aid of a wireless telemetric system is it possible to estimate the fetal condition before and during of caesarean section as well as at transfer of high risk neonates.

[Economic aspects of intensive care in obstetrics]. / Okonomische Aspekte der Intensivgeburtshilfe.

An intensive obstetric care unit has been established at investment costs of 646,167.--Mark which broke down into 220,248.--Mark for prepartum attention, 268,010.--Mark for intrapartum attention, and 157,909.--Mark for neonatal attention. Operational expenditures on equipment and services were found to amount to 144,052.--Mark per annum.--Specific outlays resulted from intensive obstetrics, as compared to conventional procedures. They varied between 48.--Mark and 96.--Mark per delivery, depending on annual numbers of deliveries and on the use of equipment quantitatively adapted to requirements. Individual costs for intrapartum attention varied by bedside equipment combinations and turnover of patients (n/labour bed/d) and were between 12.--Mark and 36.10 Mark.--Something between 2000 and 3000 births per annum, with patient turnovers between 1.5 and 2.0 per bed and die, was considered optimum. The cost of intensive obstetrics went up under such optimum conditions to something between 48.--Mark and 58.--Mark, with something between 14.80 Mark (BMT 504 biomonitor, Lineomat, FTS 101 foetal-function recorder) and 21.60 Mark (BMT 9141 biomonitor, Lineomat) being required for intrapartum monitoring of one birth.--Reduction in perinatal mortality, as compared to figures of conventional obstetrics and to cost factor between 519,168.--Mark and 627,328.--Mark for equipment and other hardware, yielded a benefit for 10,816 births of something between 46.9 and 167,5 million Mark.

Fetal risk in delivery with the Shute parallel forceps: analysis of 1,503 forceps deliveries.

A total of 1,503 vaginal deliveries with the Shute parallel forceps during a 10 year period are analyzed as to the risk of instrumental damage. In this series, 35 infants died intrapartum or neonatally. Eliminating all deaths from unrelated causes, three remain in which the forceps could possibly have been implicated. Investigation of these, however, revealed in each case the presence of other concomitant and potentially lethal factors, none of which could be completely ruled out as the primary cause of fetal death. Each of the three cases is discussed in detail. We conclude from our series that the Shute forceps is useful in the delivery of premature infants, but should be employed for this maneuver only by very experienced operators. In these cases, midforceps should be performed only for critical indications. The risk of damage with parallel forceps deliveries from the pelvic floor is minimal if decision for operation is based on cardiotocographic criteria, and under favorable degrees of oxygenation. In the delivery of the immature infants, the parallel forceps can, in fact, hardly be superseded by any other instrument because of its unique controlled protection of the fragile fetal head from even the pressures of the birth canal. Delivery with the Shute forceps can be performed effectively under pudendal block or local infiltration anesthesia.

[Histological changes in the placenta following tokolysis therapy (author's transl)]. / Histologische Veränderungen der Plazenta bei der Tokolysetherapie.

In 138 tokolytically treated cases of imminent abortion or premature birth the secundines were examined histologically and compared with 390 cases of pathological gravidities or births without tokolysis therapy. The frequency of occurrence of morphologically manifested circulatory disturbances following tokolysis therapy was equal to that in the untreated cases, the rate of ascendent infections was only slightly increased. In tokolytically treated placentas with the histological pattern of "dissociated disturbed maturation" and "Maturitias retarda" are prevailing. Thus in most cases sufficient supply of the fetus is possible and the critical phase of uteroplacental insufficiency with the danger of abortion or premature birth may be overcome. There were no hints at direct influences of tokolysis on placental morphology.