[Computer-assisted cardiotocography analysis within the scope of continuous electronic labor monitoring with simultaneous use of noninvasive and invasive methods of registration]. / Computergestützte CTG-Analyse im Rahmen einer kontinuierlichen elektronischen Geburtsüberwachung mit simultan durchgeführter noninvasiver und invasiver Registriermethode.

In frame of a simultaneously study with noninvasive and invasive registration technic by application of 2 fetal monitors with following computer aided CTG-analysis at 22 patients we found in relation to the quantitative CTG-parameters DF (fetal condition), D (dip area), BI (bradycardia index) as well as BR (bradycardia residuelle) in part distinct differences for the range of distribution in spite of missing statistical significance (p less than 0.05) which point to insecurity in trigger signals for the noninvasive method. As exceptionally dangerous turned out to be false trigger signals in range of medium-term heart rate changes in attendance to auto-correlation US-DOPPLER-technic. The noninvasive registration of labour pains impressed forcibly for some time about longer CTG-phases to be unsuitable for the exactly judgment of uterine activity (Montevideo-unit). In conclusion the noninvasive method in supervision of labour should be considered more critical than earlier particular under forensic points of view.

[Assisted spontaneous delivery vs. Bracht manual aid within the scope of vaginal delivery in breech presentation. Late morbidity in children 5-7 years of age]. / Assistierte Spontangeburt vs. Manualhilfe nach Bracht im Rahmen der vaginalen Geburt aus Beckenendlage. Spätmorbidität im Alter von 5-7 Jahren.

For judgment of late morbidity we investigated 52 children after vaginal delivery in breech presentation age from 5 to 7 years. This concerned 27 children after assisted spontaneous labour and 25 children after manual expression according to Bracht. All the children were mature and eutrophic and without neonatal distress after delivery. They were explored with help of an voluminous screening programme, concerning not only the intellectual development but also the psychomotoric capacity. The result was an very high intellectual conduct in frame of the test according to Raven (PR greater than 75). The difference in confrontation to the collective after manual expression according to Bracht was statistical significant (p less than 0.05). Neuropsychologic investigations according to Simernitzkaja demonstrated evident differences in disfavour to children after manual expression according to Bracht concerning the visual memory performance for symbols and letters. Further investigations referring to the graphomotoric accomplishment of one hand or both hands reinforced the opinion; that means the visual motoric totality performance in a narrowed sense or the psychomotoric performance in a enlarged sense was statistical significant poorer pronounced (p less than 0.05). The results underline the claim to estimate more critical the manual expression according to Bracht till now.

[The carnitine level of the umbilical cord blood in relation to the course of labor]. / Der Carnitinspiegel des Nabelschnurblutes in Abhängigkeit vom Geburtsverlauf.

Total and free carnitine were analyzed in cord blood of 24 newborn babies, with uncomplicated delivery, and 12 neonates with protacted labour. At birth, the mean neonatal carnitine value (total 33.7 +/- 10.1; free 23.5 +/- 7.5 mumol/l) was lower than the mean adult value (60.0 +/- 10.0 and 50.5 +/- 7.3, resp.). The carnitine values in the group with protracted labour increase slowly with duration of delivery. In our opinion carnitine values of neonates are not suitable for diagnosis of systemic carnitine deficiency syndrome.

[Computerized automatic analysis of the cardiotocogram (results of an international multicenter study]. / Rechenautomatische CTG-Analyse versus visuelle CTG-Analyse (Ergebnisse einer internationalen multizentrischen Studie).

By means of an international multicentre study (SU, Socialist Republic of Poland, Socialist Republic of Czechoslovakia, GDR) 403 patients with computerized CTG-analysis and 393 patients with visual CTG-analysis in labour were investigated in relation to course of labour and neonatal outcome. The following results were fixed: The computerized CTG-analysis by help of the equipment "robotron-NATALI" is equal the statement of high qualified perinatologists. The computerized CTG-analysis led significantly more frequently in various stages of labour to the diagnosis "prepathological" CTG-pattern (warn signs) in relation to visual CTG-analysis with a significantly higher rate of fetal pH-measurements. That means, that the sensitivity of this method is greater. The safety in frame of electronic supervision of labour is improved. The number of "acut-tocolysis" in various stages of labour for both collectives wasn't significantly too. The rate of caesarean section and the rate of operative vaginally deliveries (forceps, vacuum-extraction) showed in both collectives no significantly differences. The neonatal morbidity (APGAR score, pHUA) matured analogous results in the collective with and without computerized CTG-analysis. A decline of "acidotic" morbidity in the collective with computerized CTG-analysis wasn't mentioned. One stillbirth was found in the collective with visual CTG-analysis. In spite of that computerized CTG-analysis showed no better results in perinatological centres in relation to visual CTG-analysis this method is the basis for very important perinatological aims how computer controlled infusion in connection with termination of labour as well as computer steered tocolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lymphogranulomatosis and pregnancy]. / Lymphogranulomatose und Schwangerschaft.

A long period of full remission after successfully treated Hodgkin's disease set more and more in our concern problems of pregnancy and parturition in these patients. There are no exact informations about an unfavourable influence of pregnancy on the course of Hodgkin's disease. Although in cases of severe disease the treatment of the mother goes first we will restrain from therapeutical activities in patients with favourable histology and missing B-symptoms. It is reported on 3 cases of Hodgkin's disease with succeeding pregnancy and delivery. The stage IV of Hodgkin's disease in one patient is apparently followed by an uncomplicated course of pregnancy and lack of recurrent disease.

[Effect of obstetrical manipulations on the prostaglandin content of the uterus]. / Der Einflu geburtshilflicher Manipulationen auf den uterinen Prostaglandingehalt.

It is reported about the concentration of PG F2 alpha, PG E2, TxB2 and 6-keto-PG F1 alpha in amniotic fluid after obstetrical manipulations without rupture of amniotic membranes. Only digital distension of the cervix was followed by a rise of PG F2 alpha values. On the other side there was no increase in PG-concentration after application of a transabdominal catheter or after amniotomy.

[Neonatal risk in early manifested maternal diabetes]. / Das neonatale Risiko bei frühmanifestiertem mütterlichem Diabetes.

Neonatal risk in 172 women with early manifested maternal diabetes mellitus (manifestation less than or equal to 18 years) has been estimated in an analysis of 10 years. We found a tendency towards an increased rate of mortality and malformations, but there are no statistic significant differences compared with the White B group as well as with the C/D-group of late manifestation. An increased risk of morbidity (rate of fetopathy , immaturity, disturbed adaptation) could be demonstrated, but it exists also in the newborns of diabetic mothers of the White group B. Using the recent literature the causes have been discussed and conclusions have been made.

[Diversity of symptoms in uterine rupture]. / Vielfältigkeit der Symptome bei Uterusruptur.

We analyzed 5 cases of uterine rupture observed in our clinic in the last 8 years (= 0.36 per 1000 deliveries) because spontaneously appearing ruptures of a normal uterus often have symptoms which may mislead our efforts like amniotic fluid infusion or clotting defects. All our 5 cases were multiparous women, in 4 cases oxytocic drugs were applied and only in one case there was a histologic damage of the myometrium. In no case classic sharp pain and cessation of contractions could be observed, only in one case painful abdomen and tenderness of the uterus. On the other hand shock could be seen in every case, vaginal bleeding in 4 cases and alteration of fetal heart frequency in 3 of 4 cases with primary living fetus. The different symptoms may occur as to time in a variable sequence. Therefore the right diagnosis is made often very late. In accordance with the literature a digital control of the uterine cavity is proposed in every case of an acute event during childbirth, especially evidence of shock, also if another diagnosis than rupture of the uterus is more probable.

[Diagnosis of extrauterine pregnancy with special reference to ultrasound diagnosis and abdominal pregnancy]. / Beitrag zur Diagnostik der Extrauteringravidität unter besonderer Berücksichtigung der Ultraschalldiagnostik und der Abdominalgravidität.

Extrauterine pregnancies scarcely achieve an advanced developmental stage and were rarely diagnosed preoperatively. Even the ultrasonic B scanning don't eliminate the difficulties in recognising the ectopic pregnancy. We can demonstrate this by means of 3 case. In one of them, a case of full term abdominal pregnancy with healthy fetus, we could diagnose this preoperatively.

[Progesterone and unconjugated estriol in amniotic fluid and serum in diabetic patients during induction of labor]. / Progesteron und unkonjugiertes Ostriol im Fruchtwasser und Serum bei der vorzeitigen Geburtseinleitung von Diabetikerinnen.

Progesterone and unconjugated estriol are radioimmunologically estimated in 42 diabetic patients in amniotic fluid and serum during last weeks of pregnancy and in the course of oxytocin-induced parturition. As unconjugated estriol rises in progressing weeks of pregnancy progesterone remains unchanged in both investigated fluids. The quotient progesterone unconjugated estriol correlates with affection to labour. There is no statistically significant change in both steroid hormones during induced labour.

[Gestation in early onset diabetes mellitus]. / Gestation bei frühmanifestem Diabetes mellitus.

Report about the gestation of 172 diabetic patients with manifestation of disturbance of carbohydrate metabolism in childhood or adolescence (Group White C and D early manifestation) based on a ten years experience. Relating to age of menarche, behaviour of menstrual cycle and course of pregnancy no significant difference could be found in comparison to 454 other diabetic patients delivered in the same clinic. Only the frequency of obstetrics operations of more than 50 per cent was higher significantly.

[Endogenous prostaglandins and steroid hormones in premature labor induction in diabetic patients]. / Endogene Prostaglandine und Steroidhormone bei der vorzeitigen Geburtseinleitung von Diabetikerinnen.

Prostaglandins E and F2 alpha as well as two steroid hormones, progesterone and unconjugated oestriol, were measured in amniotic fluid of 30 diabetics. The prostaglandin levels of all patients went up with significance after the os uteri had clearly opened. No rise in prostaglandin levels was recordable from induction of labour without opening of the os uteri. High primary prostaglandin levels, prior to induction of labour, and low progesterone/oestriol quotients were observed along with short-time courses of parturition. On the other hand, low prostaglandin values prior to induction of labour and slow rise during induction were recordable from protracted courses of labour.

[Budd-Chiari syndrome following intake of oral contraceptives (author's transl)]. / Budd-Chiari-Syndrom nach Einnahume von Ovulationshemmern.

Described in this paper are three cases of Budd-Chiari syndrome in young women who had taken oral contraceptives. Not more than 30 cases maximum so far have been reported in international literature, in the context of Budd-Chiari syndrome related to oral contraceptives. However, oral contraceptives have been increasingly considered to cause to disease, over the past ten years.

[Priming with intracervically administered prostaglandin F2 alpha before abortion]. / Priming mittels Prostaglandin F2 alpha intrazervikal vor Interruptiones.

75 Patients were treated with Prostaglandin-F2 alpha-gel intracervical to ripe the cervix prior to first trimester abortion. In all patients we get the wanted effect with Prostaglandin-gel. Priming of the cervix seemed to be especially needed with PG-gel in young patients with first pregnancy.

Investigations of hormones during early abortion induced by prostaglandin F2alpha and 15(S)-methyl-PGF2alpha.

In early pregnancy up the 7th week of pregnancy PGF2alpha was infused and 15(S)-methyl-PGF2alpha was applied i. m. to induce menstruation in 20 or 19 cases, respectively. In the tested form of application 15(S)-methyl-PGF2alpha is effective in 89 per cent of the cases and in 74 per cent complete abortion was achieved. PGF2alpha produced bleeding in 80 per cent only and complete abortion in 55 per cent. The differences in these two groups were not statistically significant. The steroid hormones estradiol and progesterone decrease in a successful application of PGs for induction of abortion and reach a value of 75 per cent at the onset of bleeding. The LH concentration in plasma becomes smaller too. In some cases there is a temporary increase in hormones shortly after starting treatment. The results could indicate that the considerable decrease in hormones before the onset of bleeding might be caused by an alteration of the corpus luteum, which is effective during early pregnancy.

PIP: Investigations of hormones during early abortion induced by prostaglandin F2 alpha (PGF2a) and 15(s)-methyl-PGF2a are reported. Up to the 7th week of pregnancy PGF2a was infused (total of 50 mg) and 15(S)-methyl-PGF2a was applied im (3-4 injections of 250 mcg each) to induce menstruation in 20, and 19 cases, respectively. 15(S)-methyl-PGF2a was effective in 89% of the cases and in 74% complete abortion was achieved. Blood levels of estradiol and progesterone decreased in successful applications of PGs for introduction of abortion and reached a value of 75% at the onset of bleeding. Plasma luteinizing hormone decreased also. In some cases there was a termporary increase in hormones shortly after starting treatment. These results suggest that the considerable decrease in hormones before the onset of bleeding might be caused by an alteration of the corpus luteum, which is effective during early pregnancy.

[Intravenous induction of labor with prostaglandins F2alpha]. / Intravenöse Geburtseinleitung mit Prostaglandin F2alpha.

Report on 60 patients with induction of labour by intravenous infusion of prostaglandin F2alpha. The high rate of success (95%) was attributed to some favourable factors. Side effects were minimal. Moreover no effects on the metabolism were observed. During labour a electronical and biochemical supervision is neccessary.

[Optimal labor induction using PG F2alpha in diabetes mellitus]. / Zur optimalen Geburtseinleitung bei Diabetes mellitus mit PG F2alpha.

By means of the COMPLEX-Method an optimisation problem based on biological data was solved. The optimal PG F2a-velocity of infusion in starting labour of diabetic patients was determined under the condition of the shortest possible duration of birth.

[Influence of labor induction using Prostin F2alpha on the cardiovascular system of the fetus]. / Einfluss von Geburtseinleitungen mit Prostin F2alpha auf das Herz-Kreislaufsystem des Feten

Conform to its reaction, prostin F2alpha is a useful medicament above all in order to initiate risky deliveries having a state of unripe cervix. We have estimated the labor pains and the fetal state, which did not give proofs for any negative influence by prostin F2alpha in 60 initiations of labor. An intensive supervision system is absolutely necessary.

PIP: 60 normal and endangered pregnancies were induced into labor by administering prostin F2 alpha iv in a dose of 2.5 mcg/minute (7.5 mg in 500 ml of 5% infusion of glucose). Fetal heartbeat was measured every 20 minutes using cardiotocography. Pathological uterine contractions were not found to be dependent on the dosage, although doses exceeding 20 mcg/minute were thought dangerous. The labor activity was dependent on the dosage variations, so that the extent of the metabolized prostaglandin-dehydrogenase widely varied. These factors varied with the individual, necessitating electronic supervision of any alterations. No negative influence of this preparation on the fetus or of increase in labor pain was noted.

[Induction of labor with prostaglandin F 2 alpha in diabetes mellitus]. / Zur Geburtseinleitung mit Prostaglandin F2alpha bei Diabetes mellitus

At 15 diabetic patients of the 36. to 40. week of pregnancy labour was induced by Prostaglandin F2alpha-infusion. The sure effect on uterus activity is characterized by prompt dilatation of the cervix. A disadvangeous influence could not be observed on blood circulation and digestive system both of the diabetic patient and fetus respectively newborn.