[Uncomplicated obstetric injury as a risk factor for anal incontinence? Objective assessment of manometric measurements]. / Die unkomplizierte Geburtsverletzung als Risikofaktor analer Inkontinenz? Objektivierung durch manometrische Messungen.

The proximity of the anorectal sphincter apparatus and the vagina is a risk factor for faecal incontinence in women. To study the impact of the first delivery on anorectal continence, we evaluated 74 primiparae (41 women with midline episiotomy and 33 women with either intact perineum or Grade I tear only) and compared them to a control group of 18 nulliparous women. All subjects were examined by anorectal manometry and asked to complete a standardized questionnaire. Fourteen women of the primiparae group (eight patients with episiotomy, six pats. with intact perineum) had experienced incontinence of flatus, and 6 patients (8%, one pat. (3%) with intact perineum) had occasional incontinence of liquid or solid stool in the first weeks following delivery. We detected amongst those women who underwent episiotomy a significantly decreased maximum squeeze pressure and in women with an intact perineum a significantly decreased resting anal pressure. In all primiparae the anal canal length was significantly less when compared with control group. Even when the anal sphincter appears intact, the trauma of delivery causes detectable changes in the results of anorectal manometry, indicating a need for evaluation of the continence status at postpartum examination.

[Doppler ultrasound of uterine and fetoplacental circulation: placental laterality, normal values and reference curves]. / Dopplersonographie des utero- und fetoplazentaren Kreislaufs: Plazentalateralität, Normalwerte und Referenzkurven.

AIM: Doppler ultrasound assessment of blood flow velocity waveforms from the maternal and fetal sides of the placenta in normal pregnancies, taking into consideration placental location, in order to establish normal values and reference curves. METHOD: A cross sectional study of uneventful singleton pregnancies with gestational ages from 18 to 41 weeks and later on healthy newborns was performed by continuous-wave-Doppler ultrasound. Doppler flow signals from the uterine artery or the corresponding ascending branch and the umbilical arteries were analysed using the resistance index RI. The RI-values from the uterine circulation were classified according to the proximity of the placenta. Normal values and reference curves were established on the basis of centiles. RESULTS: After consideration of exclusion criteria, 757 pregnancies remained for evaluation. The resistance index reference curves of the uterine circulation were dependent on placental location, with proximal RI-values being lower, but with nearly constant course during the second half of pregnancy. In contrast, the umbilical artery RI-values were higher but showed a continuous decrease. CONCLUSION: In the second half of pregnancy, down stream flow resistance of the uterine circulation is very low and nearly constant but depends on placental location. The fetoplacental circulation shows high flow resistances which decrease with increasing gestational age. These reference curves are comparable with others where placental location is taken into consideration.

Fetal sex determination by high resolution ultrasound in early pregnancy.

OBJECTIVE: Fetal sex determination by ultrasound, and its medical and ethical implications, has been predominantly discussed in mid and late gestation. The development of high resolution ultrasound equipment has provided the possibility of detailed visualization of the fetus in early pregnancy. The present prospective study investigates the feasibility and accuracy of fetal sex determination by transabdominal ultrasound in early pregnancy. METHODS: Sonographic determination of fetal sex was attempted prospectively prior to genetic amniocentesis in 173 fetuses from 11 to 16 weeks of gestation. The result of ultrasound examination was compared with the karyotype obtained from amniotic fluid cells. RESULTS: Sonographic sex determination was feasible in 80.3% of cases, and all these determinations proved to be correct. There was no difference in the identification rate between male (n=87) and female (n=86) sex. Fetal sex determination was also feasible and correct in all four sets of twins and in the one set of quadruplets. CONCLUSION: Fetal sex assignment in the late first and early second trimester can be useful in pregnancies at risk for severe sex-linked diseases, in fetal disorders involving the genitalia, and in the individual identification of multiple fetuses. Prenatal sex assignment in early pregnancy implicates also far-reaching ethical problems because of the potential risk of sex-selected abortion.

Circulatory Doppler parameters in fetal hypoxaemia.

A 32-year-old pregnant woman (gravida 1, para 0) was delivered at 27 weeks of gestation by elective Caesarean section because of regular fetal heart rate (FHR) decelerations. Doppler ultrasound assessment of the middle cerebral artery (MCA) and the ductus venosus (DV) showed pathological results, whereas the umbilical artery waveforms were normal. Blood gas analysis of the umbilical cord obtained at Caesarean section indicated fetal hypoxaemia. The discrepancy between abnormal Doppler findings in the central circulation and normal Doppler in the umbilical artery suggests that a detailed Doppler assessment may be necessary in order to clarify abnormal FHR tracings.

[Doppler sonography of the ductus venosus in high risk pregnancies at 23 and 26 weeks]. / Dopplersonographie des Ductus venosus bei Hochrisikoschwangerschaften zwischen 23 und 26 Wochen.

Ductus venosus blood flow was assessed in 3 high-risk pregnancies, which were terminated at 23 to 26 weeks' gestation because of HELLP-syndrome. The fetuses were extremely growth-retarded and showed diastolic reverse flow in the umbilical artery. In all cases the ductus venosus flow pattern was abnormal and finally showed loss of blood flow during atrial contraction. This finding suggests that the fetal central venous pressure is pathologically increased and may be interpreted as a sign of threatening cardiovascular decompensation.

[Doppler ultrasound of the middle cerebral artery: pre-final normalization of cerebrovascular circulation?]. / Dopplersonographie der fetalen Arteria cerebri media: Präfinale Normalisierung des zerebralen Blutflusses?

We report on the circulatory changes of a severely growth-retarded fetus at 26 weeks of gestation with intrauterine death after 6 days of observation and a birth weight of 480 g. On admission the fetus already showed signs of circulatory centralisation; furthermore, we found pulsation in the umbilical vein and diastolic reverse flow in the umbilical artery. During the days of observation this reverse flow increased and the compensatory phase of fetal circulatory centralisation was followed on the last day by a phase of circulatory decompensation with an apparently normal middle cerebral artery waveform, mimicking preterminal normalisation of fetal cerebral blood flow.

[Psammoma bodies in cytological vaginal smears in metastatic ovarian carcinoma]. / Psammomkörperchen im zytologischen Vaginalabstrich bei metastasierendem Ovarialkarzinom.

The case of a 37-year old patient with ovarian cancer stage FIGO IV and vaginal metastasis is reported. The vaginal smear showed psammoma bodies, which are rarely found. The value of the diagnosis "psammoma bodies" is discussed, via a review of the literature.

[Development of a plastic capillary tube for Saling fetal blood analysis. Evaluation of pH-metry with standard references]. / Entwicklung einer Kunststoffkapillar für die Fetalblutanalyse nach Saling. Prüfung der pH-Metrie auf Vergleichbarkeit.

In order to avoid mouth suction and danger of glass breakage during collection and to avoid mixing of the sample with a piece of wire and an external magnet immediately after collection, an unbreakable plastic capillary tube was designed with increased heparin coating and surface and reduced diffusion distance. For assessing agreement between pH measurements of blood samples obtained with the new plastic capillary tube and a commercial glass capillary tube, umbilical blood pH-values of 41 births were analyzed simultaneously by both methods. The mean difference between paired pH-values, the corresponding 95%-confidence interval and the true limits of agreement were calculated. The pH-values obtained with the plastic capillary tube are systematically lower, with a mean pH decrease of 0.009 units, and there is an additional random variation with a standard deviation of 0.009 pH units. The true limits of agreement: [-0.031, 0.013] represent the interval of the worst expected pH difference. The increased heparin availability in the plastic capillary tube may be the reason for the systematic pH deviation of -0.009 units. However this difference does not seem to be clinically relevant and the statistical evaluation shows a sufficiently good agreement between the pH measurements.

[Hydrocephalus in one twin after massive reverse flow in the umbilical artery in the 2nd trimester]. / Hydrozephalus eines Zwillings nach massivem Rückstrom in der Nabelarterie im 2. Trimenon.

The case of a twin pregnancy with severe diastolic reverse flow in the umbilical artery of one of the twins at 23 weeks' gestation is reported. After delivery at 29 weeks' gestation, a congenital internal hydrocephalus was diagnosed in this twin. The most probable aetiology is an intrauterine periventricular haemorrhage. The severe diastolic reverse flow in the umbilical artery seems to represent a highly pathological flow pattern of prefinal degree, possibly leading to cerebral defects. The pathophysiology of the Doppler findings and the pathogenesis of the internal hydrocephalus are discussed.

Proteases of polymorphonuclear neutrophils: influence of different salts and buffers on pericellular lysis.

Polymorphonuclear neutrophils (PMN) contain neutral proteases which are cytochemically detectable on blood smears. The activity of these proteases can be visualized by pericellular lysis, i.e. through a disk like degradation of plasma and erythrocytes around centrally located neutrophils. This degradation is inhibited by protease inhibitors in a concentration-dependent manner. Striking differences in halo formation were found depending on the type of buffer and salt used and change of temperature. A halo formation was obtained in Tris-HCl buffer, pH 7.5 without salt, at room temperature (22 degrees C), and with short incubation periods (30 min). Borate buffer, pH 8.5, showed a comparable halo formation only at 37 degrees C, after addition of salts, and after longer incubation times (180 min). When different alkali chlorides were used, halo size increased with molecular mass. Optimum halo size was achieved at a concentration of 250 mM. Addition of MgCl2 and CaCl2 (250 mM) resulted in a small halo formation at 22 degrees C, but inhibited halo formation at 37 degrees C. The present study shows that the pericellular lysis caused around neutrophils by the release of proteases is affected by a complex interaction of salts, temperature, buffers and thermodynamic aspects, all of which should be evaluated carefully in these kinds of experiments.

[Removal of HPV infection of the portio vaginalis by laser therapy of scalpel conization]. / Zur Sanierung der HPV-Infektion der Portio vaginalis durch Laser-Therapie oder Messerkonisation.

Between May 1988 and December 1990, 855 patients were submitted to HPV-hybridisation. HPV 16/18 (10.4%) was detected more frequently (p = 0.0024) than HPV 31/33/35 (6.1%) and was more often associated with cervical intraepithelial neoplasia--CIN--III degrees (p = 0.0014). 42 patients with CIN were examined after treatment with cold-knife conization. PAP-smear, colposcopy and HPV-hybridisation were performed. None of the patients showed signs of CIN after treatment. Only one patient showed an HPV persistence. In three of 7 patients treated with laser conization and four of 12 patients treated with laser vaporization, examination after treatment showed signs of CIN. In 6 cases, an HPV persistence was detected. With regard to results of other authors, cold-knife conization is the most effective treatment of HPV infection of the cervix uteri.