[Splenic lesions as a complication of pelviscopy]. / Milzverletzung als Komplikation einer gynäkologischen Pelviskopie.

Splenic lesions as a complication of pelviscopy. The induction of pneumoperitoneum for diagnostic pelviscopy caused a splenic lesion as a result of stretching and distorsion of perisplenic adhesions. It will be discussed forensic problems.

[Autopsy in peri- and neonatology--an essential step in quality control. Data on autopsy frequency in Saxony]. / Die Autopsie in der Peri- und Neonatologie--ein unverzichtbarer Schritt bei der Qualitätskontrolle. Erhebungen zur Sektionsfrequenz in Sachsen.

In the framework of a general quality assurance compaign the working group for peri- and neonatology at the General Medical Council of Saxony has investigated the frequency, conclusiveness and development of autopsies in Saxony between 1992 and 1997/98. There were observable different autopsy rates depending on the degree of neonate maturity. Thus, the autopsy rate of stillbirths having birth weights from 500 to 999 g amounted to 79.7%, and that of stillbirths above 1000 g birth weight to only 59.4%. The abduction rate of neonates dying before day 7 of life was 65.7%. It is remarkable that the abduction rates declines from 79.1 to 62.9% in all weight classes of premature and full-term neonates from 1992 to 1997. The possible reasons for the decline of autopsies and the problems emerging for quality assurance are discussed.

[pH-metry in vivo--use in obstetrics]. / pH-Metrie in vivo--Anwendung in der Geburtshilfe.

A new equipment and technique in order to analyse the pH in vivo will be presented. The special rod-shaped probe contains an ISFET pH sensor. There is pointed out a wide field of applications in the obstetrics.

[ISFET-pH recording probe for vaginal pH monitoring]. / ISFET-pH-Messsonde zur Kontrolle des vaginalen pH-Wertes.

The measurement of pH is increasingly being used as an additional or prophylactic diagnostic method in gynecology. In this paper a new measuring set-up for this purpose is described. The special rod-shaped probe contains an ISFET pH sensor and a miniaturized reference electrode. Initial experimental results of in vivo applications are discussed.

[Fetal intranatal tachycardia as an indicator to a connatal infection]. / Fetale intranatale Tachykardie als Hinweiszeichen auf eine konnatale Infektion.

By means of 80 cases of connatal infections a fetal tachycardia will be observed without distinct relation to a fetal distress in 51.3% (in comparing to a fetal tachycardia in 19.5% without infection). Concluding there is to state, that a typical pattern is an increase of fetal heart frequency without decelerations during labour. This shall be the reason, to diagnose an obstetrical and neonatological infection.

[The validity of parameters in neonatal diagnosis and fetal monitoring of breech deliveries. 1. Neonatal status after breech delivery]. / Untersuchungen zur Wertigkeit von Parametern der neonatalen Zustandsdiagnostik und der fetalen Uberwachung bei Geburten aus Beckenendlage. Teil 1: Zur neonatalen Kondition nach Becken- endlagengeburten.

By means of 522 singles in breech presentation the pH of umbilical artery (pH u. a.) and Apgar score in comparison to the mode of delivery, duration of pregnancy and weight of neonates have been analysed. The frequency of deliveries by cesarean section in breech presentation was 28.3%, the rate of preterms in these cases amounts to 14.6% and the perinatal mortality to 42.1%. The average value of pH u.a. after vaginal delivery (7.25) was significantly different to the value after cesarean section (7.28). 25% of the pH-values were below 7.20, 10% below 7.10. Mixed acidoses dominated, metabolic ones after vaginal and abdominal deliveries equalled each other. Vaginal deliveries were frequently followed by respiratory acidoses. In 81% of one-minute-Apgar and in 93% of five-minute-Apgar, the score was above 7. According to our experiences the only determination of the pH u.a. after breech deliveries is not sufficient, because of being at risk for the fetus it demands the measurement of the complete acid-base-status. A critical comparison of these data with the clinical status of the newborn is necessary.

[The validity of parameters in neonatal diagnosis and fetal monitoring of breech deliveries. 2. Problems in fetal monitoring in the breech position--a proposal for a standardized biochemical diagnosis]. / Untersuchungen zur Wertigkeit von Parametern der neonatalen Zustandsdiagnostik und der fetalen Uberwachung bei Geburten aus Beckenendlage. Teil 2: Probleme der intranatalen Uberwachung von Kindern in Beckenendlage--Vorschlag einer generellen biochemischen Zustandsdiagnostik.

By means of 149 fetal microblood samplings (FBA) from the breech in deliveries in breech presentation and by means of 64 cardiotocograms the validity of biochemical parameters and biophysical ones of fetal monitoring will be investigated. It takes an increased number of suspect or pathologic CTG into account in cases of breech presentation. By means of FBA it is possible to exclude or to confirm the supposed acidoses. By this the rate of operations during delivery can be reduced or the operation will be indicated respectively. A normal fetal pH resulting from the general biochemical monitoring does enlarge the obstetricians license when the fetus presents himself in advanced parturition in pelvic floor (hold back of breech during assisted spontaneous delivery). A pH less than 7.15 demands an immediate delivery. A prognosis of fetal outcome by means of FBA and CTG is not possible due to difficulties in calculation of the final stage of breech presentation. The difference between fetal pH measured in pelvic floor and pH in umbilical artery must be kept as small as possible and it might be regarded as criterion of the management of the delivery in breech presentation.

[An advantage of isthmo-cervical longitudinal incision in cesarean section of low-birth weight infants]. / Ein Pro dem isthmozervikalen Längsschnitt bei der Schnittentbindung untergewichtiger Kinder.

The pros and cons of the isthmo-cervical longitudinal incision of the uterus in order to deliver a very low birth weight infant are discussed. The advantages of the incomparably more careful taking out of the easily being injured fetus compensate disadvantages connected with this operative technique to a high degree.

[Once again: the perioperative antibiotic prophylaxis in cesarean section]. / Nochmals: Perioperative Antibiotikaprophylaxe beim Kaiserschnitt.

In continuation of our clinical observations on perioperative prophylaxis by application of Halospor and Gentamicin the dosage of Halospor has been reduced to 2 grams once only. According to our experiences in 98 cases of cesarean section we can recommend these advance: fever in 12.2% (21.2% without prophylaxis), secondary wound-healing in 2% (6.7%) and therapeutical antibiotics in 13.3%, Metronidazol as often as not (36.6%).

[Heart disease and pregnancy--results of consequent interdisciplinary management]. / Herzerkrankung und Schwangerschaft--Ergebnisse konsequenter interdisziplinärer Betreuung.

In this paper it has been published about the interdisciplinary cooperation during the treatment of 143 pregnant women having heart diseases. In spite of a partial centralisation this number only 0.46 per cent of all deliveries in a period of 16 years. 32.1 per cent of the cases are congenital heart diseases and 46.2 per cent acquired heart diseases. In the acquired heart diseases mitral failures prevailed. Pacemakers have to be applied preventively only in 6.3 per cent. NYHA-stages did not impair during pregnancy. Vaginal operative delivery is compulsory only in two of seven cases heart diseases indicated a cesarean section. Consequent early get-up in the puerperium is important in NYHA-stages I-III. Maternal mortality was 0. Perinatal mortality was 0.7% (one child died antenatally).

[Initial results of perioperative antibiotic premedication with halospor and gentamycin in cesarean section]. / Erste Ergebnisse der perioperativen Antibiotikaprophylaxe mit Halospor und Gentamycin beim Kaiserschnitt.

The perioperative application of antibiotics in prophylaxis of infections is disputed. In a preliminary prospective study the infections morbidity of 44 patients after caesarean section was determined to investigate the effect of short term prophylaxis with halospor and gentamycine. A control group of 104 patients remained without any antibiotic prophylaxis. The patients of the prophylaxis group showed a statistically significant reduction of postoperative infectious morbidity. The costs are equalized by reduction in therapeutic applications of antibiotics.

[Intrauterine retardation in cyanotic heart defect in pregnancy]. / Intrauterine Retardierung bei zyanotischem Herzvitium in der Schwangerschaft.

By means of own experiences with intrauterine growth retardation by cyanotic heart-failure there will be demanded the completion of the NYHA-classification with biochemical parameters of O2-supply and with intensive fetal monitoring.

["Intrauterine resuscitation" in the curved course of transcutaneous pO2 measurement in the fetus during labor. 2. Uterine contraction inhibition and contraction regulation]. / "Intrauterine Reanimation" im Kurvenverlauf der transkutanen pO2-Messung am Feten während der Geburt. 2. Mitteilung: Wehenhemmung und Wehenregulierung.

According to own investigations on the behaviour of transcutaneous pO2 measurement in cases of labour inhibition there will be stated: the normal oxygenation of the fetus cannot be improved. However, there is to state the value of labour coordination and inhibition by drugs in cases of threatening fetal hypoxia.

[Continuous transcutaneous oxygen measurement in the fetus--clinical study on the value of the procedure in the ejection period of labor]. / Kontinuierliche transkutane Sauerstoffmessung am Feten--Klinische Studie zur Wertigkeit des Verfahrens in der Austreibungsperiode der Geburt.

The behaviour of the fetal tcPO2 in the second stage of labour in a collective of normal deliveries is compared with deviating cases (neonatal distress/tcPO2 antenatal = 0, zero line/tcPO2--means normal--SD) and discussed. Regarding the tcPO2 as indicator of the peripheral circulation, it is suitable in the second stage of labour as additional parameter in diagnosis of the fetal condition. But just in this period the tcPO2 considerably depends on disturbances. That is why the interpretation of the tcPO2 graphs is to be performed very critically.

[Intrauterine resuscitation during measurement of the transcutaneous pO2 curve in the fetus during labor. I. Oxygen inhalation of the parturient patient]. / "Intrauterine Reanimation" im Kurvenverlauf der transkutanen pO2-Messung am Feten während der Geburt. I. Mitteilung: Sauerstoffatmung der Gebärenden.

Using the method of continuous transcutaneous PO2 determination in the fetus during normal labour there is possible to state the positive influence of O2-normoventilation by the parturient on the oxygenation of the fetus.

[Serum uric acid as a prognostic parameter in prenatal monitoring of gestoses]. / Die Harnsäure im Serum als prognostischer Parameter bei der präpartalen Uberwachung der Gestosen.

A correlation between gestosis and increase of serum uric acid level has been known for a longtime. From the 6th month of pregnancy we found significantly increased values in all hypertensive pregnant women. In the 7th and 8th month of pregnancy there was a high significant deviation in gestoses second degree (classification of the organisation gestosis). In the two last months of pregnancy all gestoses deviated high significantly from the uric acid level in serum of the normal collective. There is a correlation between pathologically increased mean uric acid values in the 9th and 10th lunar month and increased systolic and diastolic blood pressure values. The uric acid level in pregnant women with gestosis, whose illness or its consequences led to cesarean section, is significantly higher than in patients with normal delivery. In accordance with literature we could not find a limit above the fetus dies. In our opinion determination of plasma uric acid in late pregnant hypertensive women is one additional parameter calculating both maternal prognosis and fetal risk.