[Evolution promotes a minimal effect of fetal labor stress during birth]. / Die Evolution fordert ein Mindestmass an fetalem Wehen-Stress unter der Geburt.

Controlled labor-caused fetal stress during birth can be tolerated better than generally suspected. This is the result of a pilot study among 1000 term infants in which the postpartum development of neonate weight was evaluated as a simple parameter of adaptation to extrauterine life. I. The clinical relevance of postpartum weight development was demonstrated in newborns whose mothers had been hospitalized during pregnancy e.g. because of hyperemesis, diabetes or gestosis. Postpartum these newborns showed longer lasting and more extensive weight loss. II. On the contrary moderate fetal stress during labor results in less and shorter lasting weight loss of the newborn term infants born after a labor-period of 12 hours showed a weight loss greater than 5% of their birth weight. Only half as often as newborns after a shorter period of labor. Further parameters of stress like a 1 minute APGAR score up to 6 versus 1 minute APGAR between 8 and 10 or umbilical cord ph-values below and over 7.20 revealed the same tendency. Newborns with green amniotic fluid (as a sign of stress) during birth also had a lower weight loss (up to 2% of birth weight) twice as often as newborns without green amniotic fluid. A statistically significant relation was also seen between the way of delivery as another aspect of stress and postpartum weight: on the 5th day postpartum newborns delivered by cesarean section showed a weight below birth weight three times as often as babies delivered by vaginal-operation means. The evolutionary aspect of catecholamine-peak during birth as protection against labor-induced hypoxemia and as advancing factor of adaptation to extrauterine life makes the results of this study seem plausible. This topic deserves more clinical research.

[Climacteric symptoms: intensity, incidence and need for treatment. A study of 716 women between 40 and 70 years of age]. / Klimakterische Beschwerden: Stärke, Häufigkeit und Behandlungs-bedürftigkeit. Studie an 716 Frauen im Alter zwischen 40 und 70 Jahren.

Is treatment for climacteric complaints more often required because of the intensity or the frequency of problems? Which marked problems-according to the Menopause Rating Scale (MRS)-are considered to be worth treatment by the affected women? This was the topic of a study among more than 700 women aged 40 to 70 years. 1. Covering 10 items of complaint by the MRS there was a tendency towards higher incidence of frequency than incidence of intensity. With 24% respectively 15% severe joint- and muscle problems were mentioned in the first place followed by distinct lack of sexual desire with 16% respectively 10%. 2. The comparison of pre- and postmenopausal women showed differently experiences intensity respectively frequency for only some of the 10 items. 3. With time advancing after menopause (intervals of 5 years) only vaginal dryness was found to be an increasingly serious problem: 9%-15%-27%. 4. 3 out of 10 registered postmenopausal complaints were age-related: flushes/sweating, lack of sexual desire and vaginal dryness. 5. Relief of these complaints by estrogen substitution was exemplary experienced for distinct lack of sexual desire. Postmenopausal patients without estrogen-therapy complained of this problem almost twice as often as those receiving estrogen-therapy: 22% versus 12%. The results of this study facilitate special counselling on climacteric problems. The necessity of treatment for these complaints with regard to particular groups of symptoms is judged quite differently by the patients.

[Gerontologic aspects of postmenopausal measurement of bone density and prevention of osteoporosis]. / Gerontologische Aspekte bei postmenopausaler Knochendichtemessung und Osteoporoseprophylaxe.

I. Among 454 postmenopausal women to undergo bone mineral density (BMD) examination 7 out of 10 were aged 50 to 70 years. 1. 50 of patients older than 70 years had BMD examination because of being clinically suspicious of osteoporosis. 2. In this group of age 4 out of 10 women had BMD results of the lumbar spine below 0,8 gcm2. 3. Half of all women aged up to 50 years had a positive family history of osteoporosis. 4. Patients older than 60 years often underestimated their own risk of osteoporosis. 5. 50 of women up to the age of 50 and only one sixth of women older than 70 said they had very good to good knowledge of osteoporosis. 6. Resentments against estrogen substitution are rapidly growing with every decade of age. 7. Only one third of the women selected by BMD-indication were ready to accept longterm estrogen substitution to prevent osteoporosis. II. 4 out of 10 women had entered menopause maximally 8 years ago.1. Out of this group 6 of 10 patients were substituted with estrogen. 2. When menstruation had sisted more than 15 years ago the BMD examination indication, clinically suspicious of osteoporosis, rose immensely and made up for 50 of patients. 3. One third to one half of patients who had reached menopause more than 22 years ago showed pathological BMD results, which means they were at risk of fractures. 4. In this group only 1 in 10 women had a positive history of osteoporosis. III. Obese postmenopausal women (more than 25 of overweight according to Broca) had pathologic BMD results only half as often as postmenopausal women with normal weight. Summing it up these facts may be the basis of special counselling on the prevention of osteoporosis by estrogen substitution.

[Smoking and pregnancy]. / Rauchen und Schwangerschaft.

The medical consultation during pregnancy should include information about smoking and side-stream smoking. More than half of the fetuses are more or less exposed to harmful substances passing the placenta due to smoking of the mother or smoking persons in the direct environment. The danger due to side-stream smoking have to be considered more during the consultation. It is known that toxic substances are concentrated higher in the side-stream smoke than in the main-stream smoke. Due to enzyme induction, smokers can metabolize toxic substances faster than non-smokers or side-stream smokers. Already before a planned pregnancy, it should be pointed out that tobacco smoke contains numerous teratogenic substances which double the risk of fetal malformations. A high consumption of cigarettes induces an increased risk of abortion. An insufficient perfusion of the uterus and the placenta causes an O2-debt with an increased risk for malformations such as schistasis or an increased rate of premature birth. The increased CO content of the maternal blood reduces the O2 transport capacity since CO has an about 200 times greater affinity to hemoglobin than O2. These and other topics of the consultation for pregnant women are important in the interest of the fetus.

[Disorders of bladder emptying after labor. Study of 511 puerperal patients regarding the incidence and risk of residual urine post partum]. / Harnblasenentleerungsstörungen nach der Geburt. Studie an 511 Wöchnerinnen zur Inzidenz und Risikoabwägung von Restharn post partum.

In a Study of 500 unselected women in childbed interested the incidence and risk factors of residual urine over 50 ml (RH), sonographically proven in the first days after birth. The incidence after vaginal birth was 17% and after C-section 13%, 7% and 1% suffered from a urinary tract infection respectively. The RH-phenomenon lasted approximately 3 days. Significant risk factors have been: vaginal-operative deliveries (forceps, Vacuum-Extraction) protracted deliveries (over 12 hours) protracted expulsion period (over 1 hour) longer expulsive periods (over 15 minutes) newborn head-circumference over 36 cm I-Parae with episiotomy -PDA had only an additive effect. The shown quantitative aspects make it easier to evaluate the risk and the exact sonographic search for residual urine in the days pp.

[Is moderate labor stress for newborn infants an advantage? Pilot study of postpartum weight gain of 791 newborn infants]. / Ist Geburtsstress in Massen für Neugeborene von Vorteil? Pilotstudie zur postpartalen Gewichtsentwicklung bei 791 Neugeborenen.

Neonatal weight development in the first 5 postpartal days is favourably affected by intrapartal stress factors. 1. Pathological CTS during delivery were registered for every 8th infant. Slight postpartal weight loss occurred twice as often in this group, compared with the other newborns. The incidence of distinct weight decrease was the same in both groups. On the 5th postpartal day, almost double the number of infants with pathological CTG had either reached or exceeded their birth weight, compared to the normal CTG group. 2. Green amniotic fluid coincided with slight weight loss in double the number of affected children, compared to the rest of the study group. 3. Slight postpartal weight loss was seen more often in neonates with umbilical cord-pH values of up to 7.20 than in infants with pH values exceeding 7.20. Distinct postpartal weight loss was, however, not more frequent in the former group. 4. The birth mode of the 791 newborn was as follows: 16% Caesarean section, 7% vaginal forceps delivery, and 77% spontaneous birth. On the 5th postpartal day 11% of the forceps-delivery infants, 17% of the spontaneous births and 30% of the neonates delivered by Caesarean section had not regained their birth weight. 5. PDA on vaginal delivery was applied to one-third of the women. Slight postpartal weight loss was seen twice as often in these infants, compared to the others. In conclusion, the study reflected, that intrapartal stress aids transition to extrauterine life via "catecholamine peaks". Our current birth monitoring methods may therefore require revalidation with regard to set pathologic limits, using the adaptation parameter of neonatal weight development.

[Labor stress and postpartum neonatal weight development]. / Geburtsstress und postpartale Neugeborenen-Gewichtsentwicklung.

55 years ago the term "stress" was defined as a general reaction pattern which, in moderation, is not only unharmful but even has a vital function. Does this also apply to intrapartal fetal stress? The results from a retrospective pilot study including 791 mature newborns without major disorders are presented to stimulate discussion and possibly give rise to prospective studies. 1. Newborns from primigravidas with labour spanning more than 12 hours incurred postpartal weight loss in excess of 5% of their birthweight only half as often as infants with shorter delivery periods. In other words, a longer expulsion phase tended to be correlated with lower postpartal weight loss in neonates. 2. As expected, the 1-minute-Apgar score was no statistically valid predictive parameter for the adaptation phase in the first 5 postpartal days of newborns. Infants with 1-minute Apgar scores of up to 6 had reached their birth-weight on the 5th postpartal day rather more often than those with better 1-minute Apgar scores. 3. In the group of mature newborns involving premature rupture of the membranes a marked gain on birthweight up to the 5th postpartal day was seen only half as often as in the group with rupture of membranes at term. 4. Weight loss of only slight proportions was seen in newborns admitted to the pediatric hospital because of suspected intra-amniotic infection half as often, compared to the other infants who also reached their birthweight faster than those with suspected intra-amniotic infection. 5. Oxytocin administered to aid labour had a positive effect on postpartal weight development.(ABSTRACT TRUNCATED AT 250 WORDS)

[Postpartum neonatal weight increase in relation to the course of pregnancy (retrospective study of 791 newborn infants)]. / Postpartale Neugeborenen-Gewichtsentwicklung vom Schwangerschaftsverlauf mitgeprägt (Retrospektive Studie an 791 Neugeborenen).

In a retrospective pilot study the weight development of 791 neonates in the first five postpartal days was related to clinical and social data relevant for the course of pregnancy. I. Pregnancy Course 1. For a variety of reasons, neonates of mothers hospitalized for more than two weeks during pregnancy had regained their birthweight by the 5th postpartal day significantly less often than infants of non-hospitalized women (7% versus 27%). 2. In newborns whose mothers had suffered from hyperemesis gravidarum weight loss in the first five postpartal days was seen twice as often as in the rest of the group (67% versus 33%). 3. Postpartal weight loss of infants from gestotic mothers tended to be higher and of longer duration compared to the remainder of the group. 4. The same phenomenon was seen in diabetic pregnancies. 5. Neonates from smoking mothers had a significantly lower postpartal weight loss and had regained their birthweight by the 5th postpartal day much more often (35% versus 23). II. Social data 1. Newborns from mothers aged up to 18 years reached their birthweight by the 5th postpartal day only half as often as infants whose mothers were aged between 18 and 35 (13% versus 26%). Even if preterm babies were excluded, this trend remained. 2. Distinct postpartal weight loss occurred much more often in infants of multiparous mothers (3 and more children) compared to the rest of the study group (29% versus 18%). 3. Somewhat surprisingly, newborns of mothers from islamic countries regained their birthweight earlier than neonates of German mothers.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychosocial aspects of sexuality in the elderly woman]. / Psychosoziale Aspekte der Alterssexualität der Frau.

In the doctor's office, counseling in matters of sexuality in the aged is rare, and scientific data are sparse. Speculative literature is of little use. Normative ideas from earlier decades need to be checked for their present-day validity. Sexuality as a learning process and form of communication is relatively constant, so that few generalizations are possible. A widely accepted theory is that of non-use, which means in analogy to the mental faculties in aging a steady decline of sexual functions. The possibilities for sexual activity in age are impaired not only by illness and the side effects of drugs; rather, the difference in life expectancy in men and women is also becoming ever more relevant. Thus, today, 1/7 of the 70-75 men are widowed compared with 50% of the women of the same age--three times as many. By the year 2000, 15% of the population will be aged 85 or older. The expected ratio of women to men is 2:1. Elderly women suffer from depression that lasts for weeks about three times as often as men. Possible consequences in the sexual area should be considered.

[Perinatal aspects of 520 twin deliveries between 1965-87 at the Ulm University Gynecologic Clinic]. / Perinatale Aspekte bei 520 Zwillingsgeburten zwischen 1965-87 an der UFK-Ulm.

1. Birth induction in twin pregnancies was substantially reduced to 6% in last few years (1984-87) as opposed to 21% between 1975 and 1980. 2. Premature rupture of the membrane increased in the last years. At a rate of 33% is occurred nearly twice as often as with singletons (18%). A waiting policy increasingly adopted in such cases resulted in 21% of the twin group and 9% of the singleton group being born as late as 48 hours and beyond after membrane rupture. 3. The frequency of Caesarean sections performed in twin pregnancies rose dramatically over the last 22 years: 16%, 36%, 43%, 45%. With singletons, the tendency is reverse: 6%, 22%, 15%, 9%. One of the reasons why Caesarean sections are so markedly on the increase is that the frequency of immaturity in twins is steadily rising. In the past two decades the percentage of second twins less than 2500 grams birth weight rose from 35% to 71%. 4. Labour duration exceeding 12 hours increased from 8% to 21%. The same applies to the expulsion time of the first twin which rose on average from 10 to 21 minutes. 5. Manual delivery of the placenta remained at a steady rate of 25%, compared to 10% after singleton deliveries. 6. Hospitalization time exceeding two weeks decreased in the study period from 33% to 5%. 7. The perinatal mortality rate of twins could be halved in the period from 1965 to 1987, to less than 4%. The frequency of Caesarean sections, on the other hand, increased threefold to 48% now.(ABSTRACT TRUNCATED AT 250 WORDS)