[Psychological adjustment to abortion for genetic indications in the 2d trimester]. / Die psychische Verarbeitung eines Schwangerschaftsabbruchs aus genetischer Indikation im zweiten Trimenon.

Based on a questionnaire analysis of 41 women after termination of pregnancy for genetic indications in the second trimester of pregnancy the predominant feelings in the different stages of the coping process were identified. Whereas during the hospitalization period helplessness and anger were the predominant emotions, later sadness prevailed. At the time of the abortion itself loneliness was one of the main complaints. This situation could probably be improved if more often the partners were present during the period of abortion induction. About 54% of the women indicated that a prenatal diagnosis in the first trimester would have improved their coping problems. It remains to be seen whether CVS in the first trimester will be of benefit in this respect. Even though there are methodological limitations in a retrospective questionnaire study our results clearly underline the necessity of special psychologic support which can probably partly be provided by a psychologist who is available in our prenatal program.

[Monitoring of cardiac output during use of bupivacaine 0.75% by ventriculography (99mTC)]. / Die Uberwachung der Herzleistung bei Anwendung von Bupivacain 0.75% mit Hilfe der Ventrikulographie (99mTC).

Fifteen patients undergoing orthopaedic surgery on the lower limbs were give continuous epidural anaesthesia with bupivacaine 0.75%. It was looked after changes in heart frequency, beat volume and changes in heart rhythm. Changes in cardiac output were investigated by ventriculography with 99mTC during 4 periods--10 min before and 10, 20 and 30 min after epidural blockade--the cardiac output was measured by a computer mathematically. Each patient received 2 mg/kg body weight of bupivacaine 0.75%. Besides the observation of blood pressure, heart rate and electrocardiogram the venous plasma levels of bupivacaine were measured up to 60 min after blockade. The results showed no changed in cardiac output. Except for one case with bradycardia--which could be treated with atropine--no changes in heart frequency occurred. Tachy- or bradycardia was not seen at all. Besides rare respiratory sinus arrhythmia no arrhythmia could be detected. The venous plasma levels of bupivacaine increased after 30 min up to 0.81 microgram/ml. The highest concentration measured was 1.45 microgram/ml 10 min after injection of bupivacaine. According to the results of the study the following statement can be given: Following bupivacaine 0.75% (2 mg/kg) given epidurally no changes in cardiac output, no changes in beat frequency, no pathological changes in cardiac rhythm and no specific cardiac toxicity related to bupivacaine 0.75% could be found in this study.