Antibody testing and counseling of dental patients at risk for human immunodeficiency virus (HIV) infection and associated clinical findings.

Two hundred six dental patients were tested between 1985 and 1987 for antibodies to human immunodeficiency virus (HIV) when a review of their medical histories revealed a high risk for infection. Serologic results are correlated with soft tissue and osseous findings recorded during routine head and neck and radiographic examination. Counseling recommendations for use in association with testing are outlined. A more active role for the dentist as a preventive agent is advocated to combat the spread of acquired immunodeficiency syndrome (AIDS).

[Thrombocytopenia in pregnancy]. / Thrombozytopenie in der Schwangerschaft.

The rare occurrence of thrombocytopenia in pregnancy is reported. Our own procedure in pregnancy and delivery is described in detail. The differential diagnostic considerations are emphasized. The present situation with regard to therapy is discussed with reference to the available literature.

[Management of twin pregnancies currently--a prospective study]. / Betreuung der Zwillingsschwangerschaften unter heutigen Aspekten--eine prospektive Untersuchung.

On the basis of our own earlier studies, the progress of 80 twin pregnancies is followed in a prospective investigation. Early diagnosis makes possible numerous measures for prevention of premature birth--the central problem of twin pregnancies. A cerclage was carried out in 51 cases (63.75%). Tocolytics were administered only in demonstrated uterine contractions. 54 women with a twin pregnancy (= 67.5%) reached the 37th week of pregnancy. A surgical termination of labor was necessary in 51.9% of twin pregnancies, and the frequency of cesarian section was 33.75%. Only 17.5% of the twins were under the critical weight limit of 2000 g. The perinatal mortality is 3.75%. Five out of the six babies who died weighed less than 2000 g. Finally, the individual points of our intensive care program for twin pregnancies are discussed in detail taking the recent literature into consideration.

[Spontaneous cecal perforation following cesarean section]. / Spontane Zökumperforation nach Sectio caesarea.

A very rare complication after cesarean section is reported. The spontaneous cecal perforation observed caused an acute abdomen. The re-laparotomy required clarified the situation and led to the correct therapy. The various possibilities by which this clinical picture may arise are dealt with on the basis of the available literature. Extreme overstretching of the cecum is evidently the decisive etiological factor.

[Severe fetal hemorrhage from a vas aberrans after amniotomy within the scope of labor induction]. / Starke kindliche Blutung aus einem Vas aberrans nach Amniotomie im Rahmen einer Geburtseinleitung.

Case report about a complication of amniotomy to be seen very seldom. An injury of a vas aberrans within the induction of labour was the cause of a fetal bleeding which indicated a cesarean section because of a pathologic cardiotocogramme. The further development of the newborn was undisturbed after primary resuscitation and fractionated blood transfusions. Incidence and meaning of pathologic insertions of the umbilical cord are represented.

[Management of labor after previous cesarean section]. / Geburtsleitung nach vorausgegangenem Kaiserschnitt.

Knowledge of the recent literature and evaluation of 210 deliveries in our own hospital are intended to help to provide an assessment of delivery management after prior cesarean section. In 56.6% of the cases, resection was chosen as the mode of delivery after cesarean section. The primary resection rate was 29.5% and the secondary rate 27.1%. Protracted labour is the main indication (around 60%) for secondary resection. Secondary resection is subject of a high maternal morbidity. The overall rate of uterine ruptures in the patients (1.4%) corresponds to the international level. 43.4% of the patients were delivered vaginally, 15.4% of these by vacuum extraction. An individualized procedure is necessary and to be aimed for in view of the problems discussed. The conclusions emphasize the main points of the procedure in management and delivery of pregnant women with a cesarean section in the case history.

[Management and monitoring of multiple pregnancies (author's transl)]. / Uberwachung und Betreuung der Mehrlingsschwangerschaften.

The fetal prognosis in multiple pregnancies can be improved by a multifaceted antenatal program which includes early diagnosis prior to 28 weeks gestation, follow-up of multiple pregnancies in the high risk antenatal clinic, early discontinuation of work, treatment of pre-eclampsia, bed rest in hospital between 28 and 33 weeks and sometimes cerclage, prophylactic and therapeutic administration of labour inhibiting drugs, speedy delivery of the second twin and immediate pediatric care. Bed rest and administration of labour inhibiting drugs are the most important points of this program. With this combination, the utero-placental perfusion can be improved. The gestation can be prolonged and the incidence of small weight neonates and the incidence of the perinatal mortality can be reduced. Since even a large antenatal clinic only cares for a small number of multiple pregnancies, a multicentre study to determine the optimal management of multiple pregnancies is urgently required. Multiple pregnancies had too little attention in modern perinatal medicine and deserve all our attention for an improvement of their outcome.

[Deliveries in foreign women (author's transl)]. / Entbindungen bei Ausländerinnen

The question is to be answered whether the delivery in foreign women has in any case to be valued as riskful birth. The development of deliveries in 1941 foreign women from 1968-1973 is therefore analysed and compared with 9009 deliveries in German women. The share of deliveries in foreign women increased from 3% in 1968 to 32% in 1973. Wifes from Turkey and Jugoslavia are prevailing (68,1% and 19,5%). A significant moving of parity to a higher number of children can be noticed in foreign women. The incidence of operative deliveries in foreign women amounting to 12,5% was 5% lower than in German women. The incidence of sectio amounted to 9.4% in German women and to 7.5% in foreign women. The rate of premature births in foreign women figured up to 9,5% surpassed the rate of premature births in German women by 1%. The comparison of uncleared as well as of cleared perinatal mortality did not show any statistically significant difference. Merely the mortality of sectio-children amounting to 6.9% was significantly higher in foreign women than in German women with 3.7% - owing to the accumulation of vital indications in caesarean sections. Authors come to the conclusion that based on their material examined deliveries in foreign women cannot be juged as riskful births. Particularities in foreign deliveries are specially indicated.

[Changes in indication for caesarean section analysis of 1241 caesarean sections (author's transl)]. / Wandel in der Sektio-Indikationsstellung: Eine Analyse von 1241 Schnittentbindungen

On the basis of a large schema of indications (tab. 1, 2) 1241 Caesarean sections during 1966-1973 are analysed. The following points can be summarized: 1) The percentage rose from 6.4% (1966) to 10.75% (1973) (Fig. 1). 2) The percentage of Caesarean sections decided on for the sake of the child rose from 54% (1966/67) to 63.9 (1972/73) (tab. 3). 3) Vital indications fell due to increasingly preventive obstetrics from 71.7% (1966) to between 30% and 41.3% (1973) (tab. 4). 4) Perinatal mortality of 1258 children delivered by Caesarean section was 4.05% (tab. 5). Of Children delivered surgically for vital indications 6.1% died, of those delivered surgically for preventive indications only 0.9% died in the perinatal period (tab. 6). 5) This shift from the vital towards preventive indication is particularly pronounced for repeated Caesarean section (tab. 7) and for breech presentation (tab. 8). 6) Maternal mortality after Caesarean section reached 3.2%, after spontaneous delivery only 0.16%. This great difference in the maternal risk between those treated with Caesarean section and those with spontaneous delivery emphasizes the need for indications for Caesarean section which are critical, conscious of the responsibility and not too generous.