[Abnormalities of the upper gastrointestinal tract diagnosed prenatally by ultrasound]. / Pränatal mittels Ultraschall diagnostizierte Missbildungen des oberen Gastrointestinaltraktes.

A hydramnion occurring during the second half of pregnancy may be due to atresias in the upper intestinal tract. Generally, one case of oesophageal atresia is likely to occur in every 2,500 births, often together with other malformations. Prenatal diagnosis of such atresias substantially improves prognosis for these children via optimal cooperation between the obstetrician and the paediatric surgeon. Characteristic features of oesophageal atresia in the sonographic image are, besides the hydramnion, the absence of visualisation of the stomach. Sonographic diagnosis of duodenal atresias is based on visualisation of the stomach, which is excessively filled with fluid, and of the portion of the small intestine located cranially of the stenosis. The patients treated by the author and presented here were successfully operated on via termination of birth and immediate surgery by the paediatric surgeon.

[Treatment of a prenatally diagnosed chylothorax]. / Behandlung des pränatal diagnostizierten fetalen Chylothorax.

A case of bilateral fetal chylothorax was diagnosed by ultra-second at 34 weeks gestation. The pregnancy had shown marked hydramnios. The ultrasound examination showed massive pleural effusions with marked compression of the both lungs a low diaphragm and a normal sized heart. After administration of Dexamethasone for pulmonary maturation a primary Caesarean section was done at 37 weeks pregnancy, the newborn was immediately intubated and the pleural effusions suctioned by bilateral pleural drainage. The lungs expanded satisfactorily, the drainage was removed 2 weeks later and the infant developed normally.

[Cervix and vaginal cytology in IUD prophylaxis]. / Zervix- und Vaginalzytologie unter IUD-Prophylaxe.

PIP: Local irritations in the areas of the ecto- and endocervix, and of the endometrium can be caused by IUDs. This results in a slight shift to inflammatory changes in smears. Among other findings are mature and also immature cells of indirect metaplasia from the transformation-zone area; well-preserved and also autolytically changed cylinder epithelium of the cervix mucosa and endometrium cells with similar changes. As a result of the appearance of hyperchromatic cells an occasional diagnosis of a conspicuous smear is reported. With extended retention of a properly seated IUD the above-mentioned changes are retrogressive insofar as they have been caused by the IUD. With persistent changes a histological clarification is recommended. There is no typical cytologic smear in an IUD wearer, i.e., the presence of an IUD cannot be concluded from the smear. In order to correctly classify the described cell changes, an accompanying record is required of the type and the duration of wear of an IUD.^ieng

[Bacteriological examination of amniotic fluid after intra-amnial tocometry sub partu (author's transl)]. / Bakteriologische Fruchtwasseruntersuchungen nach intra-amnialer Tokometrie sub partu.

Two sets of group of 50 women were examined and compared to find out if the introduction of continuous intra-uterine catheter during labour increased infection. Amniotic fluid was withdrawn from both groups and examined. Also a catheter was introduced into the amniotic sac of one group and after 2 and 5 hours amniotic fluid was also withdrawn from both groups and examined. Inhaled amniotic fluid from the infant was also withdrawn and bacteriologically examined both quantitatively and qualitatively. The examination proved that there was no significant increase in the infection of the test group and the control group. Also there were no complications observed on the mother and child after delivery.

[Intensive care in obstetrics and gynecology. Indications for transfer to the intensive care unit]. / Intensiv-Therapie in Geburtshilfe und Gynäkologie. Indikationen zur Verlegung auf Intensiv-Stationen

Between the years of 1969 and 1974, 68 patients were transferred from our Department of Obstetrics and Gynecology to the Intensive Care Unit. This figure represents 0,5% of all operative cases. 50% were high risk patients, previously under the care of our physicians. 11,8% occurred because of problems arising from latent diseases not previously diagnosed. The main reasons for transfer were septic shock, coagulopathy arising from abruptio placenta, placenta praevia, embolism and pneumonia. Interdepartmental cooperation is indispensable for correct diagnosis and a timely transfer.

[Cervix insufficiency]. / Die Zervix-Insuffizienz

Between 1965 and 1975, Shirodkar operations were performed on 144 patients (mean age 28,6 years). The most frequent diagnosis was incompetence of the internal cervical os, which accounted for 90% of the operations, the remaining 10% being prophylactic. Sutures were performed between the 14th and 16th week of gestation and 72,5% of these patients had normal births (mean gestation time 39 weeks). Without Shirodkar operation, out of 291 pregnancies studied, 26% resulted in normal birth; whilst with Shirodkar, 82% of 137 pregnancies were successfully delivered at term.

[Mortality of premature infants]. / Mortalität bei Frühgeborenen

Mortality of 908 immature births (newborn infants under 2501 g; stillbirths with crown-heel-lengths 35 cm plus) were studied and compared with a random selection of newborn infants with birth weights of at least 2500 g. Total mortality was 27,75%; 8,7% being stillbirths and 21,2% postnatal deaths; perinatal mortality was 26,98%. In mature groups a perinatal mortality of 0,64% was recorded. 90% of immature infants died within the first 3 days. In 30% of these cases cause of death was unknown, 30% died from immaturity, approx. 16% from apnoe and approx. 6% from cerebral haemorrhage.

[Legal abortions at the University-Gynecological Clinic Mannheim during 1971-1974]. / Interruptio an der Universitäts-Frauenklinik Mannheim in den Jahren 1971-1974

Between 1971 and 1974 142 legal abortions were performed. Methods used were determined by gestational age, size of the uterus and whether or not abortion in conjunction with sterilization was indicated. Dilatation and evacuation was employed in 46% of cases; in 8% of these sterilization was performed at a later date. A further 55% were treated by means of primary hysterectomy, 38% via the vaginal route, 17% via the abdominal route. Complications were observed in 4 cases (3 perforations, 1 post-operative haemorrhage, 1 case of endometritis). The complication rate was not higher than in non-pregnant women.

PIP: Legal pregnancy interruptions in 142 women, performed at the Frauenk linik Mannheim (University of Heidelberg) between 1971 and 1974 are reviewed. Methods included curettage (64 patients, with tubal steriliza tion in 11 cases) and hysterectomy (78 patients, including 54 vaginal hysterectomies and 24 abdominal approaches). Rivanol solution was used in 8 cases. Complications included uterine perforation (3 cases), hemorrhage (3 cases), endometritis (1 case), thrombophlebitis (1 case) and a catatonic crisis in 1 schizophrenic patient. The choice of techniques is briefly discussed.

[On the structural changes induced in adenomyosis uteri and endometriosis externa by hormonal therapy (author's transl)]. / Strukturwandlungen der Adenomyosis uteri und der Endometriosis externa unter dem Einfluss zugeführter Hormone

This study was undertaken to determine whether the hormonal sensitivity of the endometrium might be a measure of the effectiveness of hormonal therapy for adenomyosis and endometriosis. Accordingly, the effects of endogenous and exogenous hormones on the endometrium, adenomyosis, and endometriosis were correlated. The results revealed that, depending on where the ectopic endometrial tissue was located and on the type (duration and intensity) of hormonal treatment, the functional response of the endometriosis varied from that of the endometrium. The variations, however, can be predicted. The response of adenomyosis to hormonal stimulation was most like that of the endometrium. Endometriosis of the ovary often revealed an excessive response to stimulation, especially after gestagens. The other types of extrauterine foci of endometriosis, however, reacted only weakly to hormonal therapy. Important prognostic consequence for therapy can be drawn from the results.