[Prognostic value of cardiotocography in pregnancy with pathologic Doppler findings]. / Prognostischer Wert der Kardiotokographie bei Schwangerschaften mit pathologischem Dopplerbefund.

Absent (absent-EDF) or reversed (RF) end-diastolic flow in Doppler velocimetry in the umbilical artery and fetal aorta indicates highly disturbed fetoplacental perfusion, which often occurs early in pregnancy. Perinatal mortality and morbidity is very high. In this situation it is not clear how long pregnancy can be continued to achieve better conditions for the preterm fetus. This study was performed to investigate the value of fetal heart rate recordings (FHR) in patients with absent EDF or RF as a parameter to determine the optimum time of delivery. 25 pregnancies with absent (n = 21) or reversed end-diastolic velocity (n = 4) were analysed. Gestational age was between 24 and 34 weeks. 17 children showed compensatory dilatation of the middle cerebral artery (68%). 15 (60%) were growth retarded, 8 of them below the 3% percentile, while 3 had normal weight. Maximum time interval until delivery was 18 days, median was 2 days. Five children died before, 2 during delivery. As none died after delivery, perinatal mortality was 28%. 4 of the survivers (22%) showed arterial acidosis. Only three children had completely normal fetal heart rate recordings on the day of diagnosis of absent EDF or RF. All others showed at least suspicious FHR (according to Hammacher), 8 of them (32%) even pathological FHR, including all children who died later. Early suspicious changes in FHR were the reduction in frequency and amplitude of oscillation, while decelerations occurred later. Additional unfavourable parameters in FHR were roundings of the oscillatory inversions as well as missing reactivity to fetal movements. Fetal heart rate monitoring is a reliable tool for determination of the optimum time of delivery in children with absent EDF or RF. The decision has to be made in relation to the gestational age. If possible, the fetus should be born before FHR becomes pathological. In this manner perinatal mortality and morbidity should be kept at a low level even in high-risk patients with absent EDF or RF.

-Glucose, insulin and C-peptide kinetics during tocolysis with oral fenoterol-. / Glukose-, Insulin- und C-Peptid-Kinetik unter Tokolyse mit oralem Fenoterol.

OBJECTIVE: The effect of oral fenoterol therapy (40 mg/day) on the kinetics of glucose, insulin and C-peptide during an oral glucose tolerance test (oGTT; 100 g glucose) was investigated in the third trimester. METHODS: 54 patients without tocolytic therapy (25 with a pathologic oGTT) were compared with 36 patients who received tocolytic therapy (18 patients with a pathologic oGTT). RESULTS: The patients with a normal or pathologic oGTT and with or without tocolytic therapy showed no significant differences in respect of the concentrations of glucose, insulin and C-peptide. During tocolytic therapy, an early increase in insulin was observed as well as slightly elevated C-peptide concentrations and a decreased C-peptide/insulin quotient.

[Fetal arrhythmias--new immunologic studies and results]. / Fetale Arrhythmien--Neue Immunologische Untersuchungen und Ergebnisse.

The etiology of fetal arrhythmias is still unknown. We therefore did a research for immunologic causes: antimyolemmal antibodies (AMLA) in mothers and umbilical cord serum resulting from secondary immunopathogenesis caused by myocarditis of the mother. Is there a correlation between immunological and clinical findings giving a possible explanation for fetal arrhythmias? In 21 cases mothers and umbilical cord serum was investigated for AMLA; 16 with fetal atrial premature beats, 4 with fetal tachycardia and 1 with fetal bradyarrhythmia. From 16 mothers with fetal atrial premature beats had 12 AMLA, from these were in 4 cases in the umbilical cord serum AMLA. In 4 cases of fetal tachycardia we found in 1 case AMLA in mothers and umbilical cord serum. In the other 3 cases accessory pathways have been the cause for tachycardia. From 19 healthy persons were found in 3 cases AMLA in mothers serum, umbilical cord serum was negative.

[Doppler ultrasound in monitoring twin pregnancies with early discordant growth]. / Dopplersonographie zur Uberwachung von Zwillingsschwangerschaften mit frühzeitigem diskordanten Wachstum.

Early growth retardation in one twin is complicated by a high fetal mortality and morbidity. It is often very difficult to determine the optimum time of delivery in regard to placental insufficiency and prematurity. We report of two cases in which doppler velocimetry was a helpful method in monitoring those pregnancies at high risk. A growth retardation of three weeks was found in one child of a twin pregnancy at 17 weeks of gestation. Doppler velocimetry at 23 weeks showed a reverse flow and centralisation and the child died at 27 weeks. The other twin then also developed pathologic flow patterns and had to be delivered by cesarean section. In the second patient, pregnancy could be continued in spite of a growth retardation of three weeks in one child at 15 weeks and an additional decrease in the growth rate of both children from 30 weeks onwards. Cesarean section had to be performed at 34 weeks because of premature rupture of membranes.

[Pregnancy follow-up of a twin pregnancy with acardius acephalus]. / Schwangerschaftsverlauf einer Geminigravidität mit Acardius acephalus.

Beginning with the 20th week of gestation a monoamniotic twin pregnancy with acardius acephalus was intensively observed by ultrasound and doppler ultrasound. The acardius only grew until the 24th week of gestation; the fetus underwent a normal development during the entire pregnancy. Doppler ultrasound showed low resistance indices in both umbilical arteries. During the 24th week of gestation the flow in the umbilical artery of the acardius could no longer be registered due to a cessation of development. A normal flow could be registered from the 28th week of gestation until the end of pregnancy in the umbilical artery, aorta fetalis and the art. cerebri med. of the fetus. During the 36th week of gestation the fetus died because of umbilical cord entanglement with the cord of the acardius.