[Correlation of cotinine level in amniotic fluid, umbilical artery blood and maternal blood]. / Korrelation des Cotininspiegels in Fruchtwasser, Nabelarterienblut und mütterlichem Blut.

The aim of the present study was to determine the correlation of cotinine levels in amniotic fluid and in fetal and corresponding maternal blood samples. Amniotic fluid samples (N = 130) were taken during second trimester amniocentesis, umbilical artery blood samples (N = 75) at birth, both together with corresponding maternal blood samples. Self-reported smokers showed maternal serum cotinine levels > 15 ng/ml in 93%, self-reported nonsmokers levels < 15 ng/ml in 89%. Correlation of corresponding values for cotinine was 0.81-0.92. Cotinine values were increased in fetal blood and amniotic fluid in comparison to maternal serum levels. Despite the fact that pathophysiology is not fully understood, an accumulation of nicotine and its metabolites both in the fetus and in the amniotic fluid appears to be evident.

[Premature separation of the placenta--clinical findings and fetal monitoring]. / Vorzeitige Plazentalösung--klinische Befunde und fetale Uberwachungsmethoden.

In a study group of 41 pregnant women of postpartally confirmed placental abruption, the prognostic value of clinical and diagnostic findings was investigated. The incidence of placental abruption was 1.4% of all deliveries within a three-year interval. 51% of patients showed vaginal bleeding before delivery. Retroplacental haematoma was found in 49% of cases ultrasonographically. A total of 75% had a pathological CTG test. More than 95% of these findings occurred within 3 days before delivery. Abnormal Doppler flow findings in foetal vessels more than 3 days before delivery were seen in 62% of cases. In the last three days before delivery, 86% were abnormal. Preterm delivery before 37 weeks of gestation was registered in 82% of patients. Perinatal mortality amounted to 12%. The rate of severely dystrophic newborn was 30%. Even in cases with lack of the clinical and/or sonographical findings, the possibility of placental abruption should be considered, if an acute deterioration of cardiotocographic or Doppler-sonographic findings.

[Doppler ultrasound of fetal blood vessels--optimizing the diagnostic value by a combined diagram]. / Doppler-Sonographie der fetalen Gefässe--Optimierung der Aussagekraft durch ein Kombinationsdiagramm.

The dopplersonographic data of 1926 pregnant women in the 3. trimester of pregnancy was used to evaluate a graphic system for the analysis of A/B-ratio in fetal vessels (pulsed wave duplex system; descending aorta and umbilical arteries). The basis of the newly developed combination diagram were dopplersonographic standard values (single cut off and pregnancy duration related percentiles). One of the results was the fact, that the combined measurement and analysis of both fetal vessels increased the positive predictive value compared to single measurements. The value of dopplersonographic examinations in the aorta was slightly better than those in the umbilical arteries. The combined diagram showed a marked improvement in graphicness, especially in follow-up cases, and a partial improvement in statistical values.

[Pathologic Doppler flow findings and cardiotocography results]. / Pathologische Doppler-Flow-Befunde und kardiotokographische Ergebnisse.

Of 1950 pregnant patients (2870 Doppler ultrasound measurements) we observed, in a study group with highly abnormal Doppler-flow findings (n = 66, Feb. 1990), a correlation of Doppler flow and FHR-recordings. Among these 66 patients we retained 60 (91%) in the hospital. They had at least 2 FHR-recordings a day. The results of Doppler flow measurements in the fetal aorta and umbilical artery correlated well with diagnosis of IUGR. The comparison of the overall results of both fetal vessels did not indicate any significant difference. In 21% of all patients with highly abnormal Doppler flow findings, was no abnormal FHR record until delivery. 26% already showed an abnormal non-stress test before the first pathological Doppler assessment, in 44% abnormal FHR-recordings were observed later than the first abnormal Doppler flow finding in the course of pregnancy. The median interval was 13.5 days in cases with increased Doppler flow parameters but with detectable end-diastolic blood flow and was reduced to 8 days in cases with absent end-diastolic blood flow. In 9% of all cases, abnormal results were found with both methods on the same day. In 32% we observed a reproducible notch in Doppler flow velocimetry of uteroplacental vessels. The rate of congenital malformations was 14%. Thus abnormal Doppler flow signals can be estimated as "early" prognostic criterias for a compromised fetus at risk.