Antenatal assessment of fetal outcome in pregnant diabetics.

The predictive value of three parameters (amniotic fluid insulin and C-peptide, and HbA1) in prognosticating major neonatal symptomatology was investigated in 57 pregnancies of diabetic women. The prediction of a healthy neonate can be achieved with a 90% accuracy by measurement of the amniotic fluid insulin alone. The correct prognosis for a child with major neonatal problems due to maternal diabetes can be made with 70% certainty using the same method. All other parameters can be judged less valuable based on our results. By using more than one of those parameters mentioned, the prediction of a healthy child can be made more correctly with a certainty of almost 100%. The accuracy in predicting a child with major symptoms cannot be increased any further.

[Significance of hormones in the amniotic fluid. II. STH and corticoids]. / Die Bedeutung von Hormonen im Fruchtwasser. II. STH und Kortikoide.

We measured the concentrations of growth hormone and corticosteroids in the amniotic fluid of 50 pregnant diabetic women between the 33rd and 36th week of gestation. These values were compared with normal values obtained by amniocentesis in 275 healthy patients. In the amniotic fluid the concentration of growth hormone decreases during pregnancy. Between the 12th and 16th week we measured 50 ng/ml, whereas in the last four weeks we found 30 ng/ml. In the diabetic patient the amniotic fluid content of STH is lower; however, hyperinsulinaemia of the foetus does not further decrease the concentration of growth hormone. The corticosteroid concentration in the amniotic fluid increases from 10 ng/ml in the 4th month of pregnancy to 35 ng/ml at the end of pregnancy. In diabetic patients we found lower cortisol concentrations; the concentration decreased further in the case of major symptoms of diabetic foetopathy in the newborn. We believe that low corticoid concentration in the amniotic fluid of the diabetic mother may be responsible for the respiratory distress syndrome in the newborn.

Pregnancy induced hypertension complicated by thrombocytopenia, haemolysis and elevated liver enzymes (HELLP) syndrome. Renal biopsies and outcome.

Twelve patients are presented with the symptomatology of haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome). Only 3 patients experienced a progressive course; the rest did not differ from a group of 130 patients suffering from severe preeclampsia. There was no significant difference in the concentration of plasma fibrinogen, fibrinogen monomer complex and antithrombin III. Two patients were treated with heparin without improvement of the coagulation data or the severity of the disease. The subgrouping of very severe preeclampsia may be desirable, but it is felt that this group is insufficiently characterized by the symptomatology of HELLP. The evaluation of better criteria may allow identification of subgroups of preeclamptic patients with severe prognostic criteria.

[Significance of hormones in the amniotic fluid. 1. Insulin and C-peptide]. / Die Bedeutung von Hormonen im Fruchtwasser 1. Insulin und C-Peptid.

Samples of amniotic fluid of 275 healthy women were used to establish a standard profile of amniotic fluid insulin and C-peptide concentrations versus gestational age. The reasons for amniocentesis were: exclusion of chromosomal defects, rhesus immunisation, and determination of the L/S ratio. The concentrations of both peptides which were measured in the amniotic fluid in diabetics were compared with the normal profile. We found that long-term blood glucose control as estimated by the concentration of glycosylated haemoglobins in maternal blood is not well correlated with amniotic fluid insulin or C-peptide, respectively. In a few cases with poor metabolic control, we found normal insulin values, and vice versa. Since elevated insulin and C-Peptide levels in amniotic fluid correlate well with diabetic foetopathy, we conclude that measurement of both peptides provides a useful parameter in the management of a diabetic pregnancy.

[Glomerular proteinuria in pregnancy hypertension]. / Glomeruläre Proteinurie bei Schwangerschaftshochdruck.

In view of the lack of reliable diagnostic parameters for predicting pregnancy-induced hypertension (PIH) the aim of this study was to test the prognostic value of electrophoretic urinary protein patterns. Based on experience with this method in nephrology, molecular weight related polyacrylamide-gel-electrophoresis (PAGE) of urinary proteins was used to distinguish between the different kinds of renal lesions (glomerular, tubular, combination, extrarenal). The analysis was carried out in two independent groups: urines of 126 non-selected pregnant women (1st group) were analysed at regular intervals. By chance, none of them had a history of previous PIH or hypertension, nor any signs of impaired renal function before or during the present pregnancy. In a 2nd group 124 women after severe PIH (pd greater than or equal to 110 mm Hg) were examined in part using PAGE, postpartum renal biopsy and long-term clinical follow up (greater than or equal to 1 year after PIH). In 29/124 cases data for all mentioned parameters was collected. 24 women of the prepartum group developed an electrophoretic pattern characteristic of glomerular proteinuria, which was persistent once found. PIH appeared greater than or equal to 8 weeks after the appearance of this pathological pattern in 15/24 women of this subgroup; 5 of 9 remaining women developed PIH in a subsequent pregnancy. None of the 102 women with other protein patterns developed PIH. In the 2nd group a close relationship was found between the glomerular protein patterns 0.5 to 3 years after PIH, clinical long-term follow up and renal biopsies about 1 year after PIH.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cimetidine for preventing the adverse effects of aspiration during anaesthesia (author's transl)]. / Prophylaxe des Säure-Aspirationssyndroms mittels Cimetidin.

The aspiration of gastric contents into the bronchial tree is a serious complication in both anaesthetic practice and obstetrics. The main factor in the pathophysiology of this syndrome is the degree of acidity of the aspirated material. A reliable and effective way of preventing its occurrence is to raise the pH of the gastric secretion by administration of the histamine H2 antagonist cimetidine.

[Cardiotoxic effect of the tocolytic agent fenoterol (partusisten) in the neonate (author's transl)]. / Kardiotoxische Wirkung des Tokolytikums Fenoterol (Partusisten).

Forty-two children of mothers treated with beta-adrenergic drugs were investigated cardiologically during a period of 3 1/2 years. Eleven neonates were seen to suffer from severe toxic myocardiopathy associated with heart failure. The mothers had in part been given excessive fenoterol doses for 13 weeks on the average. One child died of regressive myocardial alterations as confirmed by autopsy. Suspicion of toxic myocardiopathy was suggested in another 16 children. Related to the very large number of mothers treated with tocolytic agents, fenoterol-induced myocardiopathy so far appears to be rare. In agreement with other reports, however, our observations suggest the possibility of severe, even perilous myocardial damage. Therefore, the indication and dosage of fenoterol should be subjected to more rigid criteria than so far applied.

[A device for transcutaneous measurement of arterial blood pressure (author's transl)]. / Ein Verfahren zur transkutanen, arteriellen Blutdruckmessung.

A new method is presented of measuring arterial blood pressure by differential evaluation of the pressure over an artery and the tissue pressure by piezo-electric effects. Advantages and problems of this method, the accuracy of which is similar to invasive techniques, are demonstrated.

[immunoglobulins in amniotic fluid in normal pregnancy and fetal malformation (author's transl)]. / Immunoglobuline im Fruchtwasser bei normaler Schwangerschaft und fötaler Missbildung.

In 20 cases of normal pregnancy and 9 cases of foetal monstrosities the immunoglobulins G, A, M and albumin C3C and alpha 2MG were determined in the amniotic fluid. In neural tube defects the IgG, IgA and albumin concentrations were clearly above those found in normal pregnancies. IgM was not found in any of the cases, whereas alpha 2MG occurred in two cases of foetal monstrosity. There was no difference in C3C concentrations of both groups.

Ultrastructural morphometric investigations on human platelets after long-term ingestion of oral contraceptives.

Platelets from healthy females, who were taking oral contraceptives over a long period of time, were investigated by ultrastructural morphometry. The size, shape, relative volumes, numerical and surface densities of the platelets and their organelles were measured. In 'long-term pill users' the platelets showed a significant increase in the area of section profile. Further changes as, for example, increased volume of platelet granules, reduced number of mitochondria, decreased volume and surface of the open canalicular system, and increased surface of the dense tubular system are to be noted.

PIP: Ultrastructural morphometry was used to measure the size, shape, relative volumes, and numerical and surface densities of platelets and their organelles from 10 longterm (up to 5 years) oral contraceptive (OC) users. Platelet materials from 14 non-OC users were also examined as a basis for comparison. The value for the area of section profile was 27% larger in OC users than in controls and the volume density of granules was 24% larger. The length of the platelet major axis, the axial ratio, and the boundary length of platelet profile did not differ significantly between the 2 groups. The surface density of granules was 2.743 mcgm2/mcgm3 in cases compared with 2.313 mcgm2/mcgm3 in controls. The numerical density of mitochondria was 46% smaller in OC users and the surface density of the dense tubular system was 97% larger. Overall, these finding suggest deviations in form and structure of platelets in OC users as well as an increase in platelet volume. It is recommended that morphology be correlated to an altered storage and transport function in platelet in OC users.

[Treatment of colitis ulcerosa during pregnancy (author's transl)]. / Behandlung der colitis ulcerosa während der Schwangerschaft.

Aggressive pharmacotherapeutic and surgical measures are often contra-indicated in the treatment of colitis ulcerosa in pregnancy. Especially in the sensitive embryonal development phase, the use of antibiotics, anti-inflammatory drugs, chemotherapeutics and ACTH is considered questionable. The subtotal colectomies and ileostomies often demanded in toxically dramatic colitides place a considerable burden on mother and foetus. A conservative therapeutic regimen, which has been successfully used in more than 80 patients with inflammatory intestinal diseases, was modified to suit the requirements of pregnancy. This is a combination therapy involving parenteral feeding, food which can be absorbed by the intestinal walls, and a suitably adapted pharmacotherapy. In one case of a severe toxic relapse of colitis ulcerosa during early pregnancy, remission was achieved in a patient while fully maintaining the pregnancy.

[Biochemical and coagulation-physiology examinations before and after amniocentesis in early pregnancy]. / Biochemische und gerinnungsphysiologische Untersuchungen vor und nach Amniozentese in der Frühschwangerschaft.

In 46 women the alpha1-fetoprotein content, the soluble fibrin monomer complexes (LFMK), and the coagulation status were determined in the maternal serum at the beginning of the second trimester before and after amniocentesis. Increases of AFP by more than 100% of the original level pointed to fetomaternal microtransfusion, the quantity of which was calculated by means of a formula. Overall coagulation tests did not show any change after the puncture. A moderate LFMK increase was seen (p less than 0.05), which, however, was not clearly correlated with the AFP increase.

[Experiences with an antimycotic tampon in the treatment of saccharomycetic vaginal infection]. / Erfahrungen mit antimykotisch präparierten Tampons bei der Behandlung des vaginalen Hefepilz-Befalls.

Antimycotic (miconazole) medicated tampons were used for treatment in 53 patients with vaginal saccharomycetic infections as evidenced by hanging drop and on culture. A short term 2 1/2 day treatment with 5 tampons showed a success rate of 92.5%. The fast relief of symptoms like discharge, itching and burning is an improvement of the medicated tampon treatment. The new medicated tampons are considered as improvement of local vaginal treatment.