[Weight discordance of the second twin: effect on perinatal morbidity and mortality. An 8-year analysis of 213 twin deliveries]. / Gewichtsdiskordanz des zweiten Zwillings: Einfluss auf perinatale Morbidität und Mortalität. Eine 8-Jahres-Analyse von 213 Zwillingsgeburten.

In this retrospective eight-years-study we examine factors to be considered responsible for higher perinatal mortality in twins, especially in twins with discordant body weight. As a main risk factor for this we find vaginal delivery, i.e. from a non-vertex position. Other additional reasons for the higher perinatal mortality of twins are prematurity (less than 34 weeks of gestation) and birthweight lower than 1500 grams. Early hospitalisation has a positive influence on that risk. The perinatal mortality in the second twin (6.7%) is twice as high as in the first twin. The highest perinatal mortality (17.6%), however, is in twins with discordant growth whereas the second twin had a higher birthweight at delivery (15% more than the first twin). In twins with discordant body weight cesarean section gives advantage to the second twin versus vaginal delivery from breech presentation.

[Blood pressure values in normal pregnancy]. / Blutdruckverhalten in der normalen Schwangerschaft.

In two studies independent from each other we examined the behaviour of arterial blood pressure in normal pregnancy. Study 1 was performed in exactly defined external conditions, study 2 in normal antenatal clinic. Especially in study 1 a distinct reduction of blood pressure could be proved. Towards the end of pregnancy there is a raise of blood pressure. Blood pressure is dependent on the position of the body. Havdarized examination conditions have to be claimed with respect to reproducibility and comparability of the values.

[Decrease in premature birth rate through consequent application of diagnostic and therapeutic standards in pregnancy monitoring]. / Senkung der Frühgeburtenrate durch konsequente Anwendung von Diagnostik- und Therapiestandards in der Schwangerenbetreuung.

All pregnant women living in the district of Suhl have been observed in our prenatal outpatient department. All gave birth in our department for obstetrics and gynaecology. This observation is made on the base of a standard. From 1981-1987 there were 5,657 pregnant women with singleton pregnancies. In this time the rate of premature birth was on an average of 4.7%. But, over the time there was a slope from 7.3 to 2.8%. Consecutively there was a decrease of 50% in perinatal mortality. The successful standards for observation of pregnant women used in our department have been discussed.

[Course and outcome of pregnancy in adolescents]. / Schwangerschaftsausgang und Schwangerschaftsverlauf bei Adoleszentinnen.

All pregnant women living in the district of Suhl were observed and delivered in our Department for Obstetrics and Gynaecology, County Hospital of Suhl. In a retrospective study, the course and outcome of 732 pregnancies in adolescents (less than or equal to 19 years) were analysed. In all women bearing to maturity, the course of delivery and the neonatal outcome were studied. All results were compared with those of an equal-sized group of women of 20-24 years of age. Out of the 732 adolescent pregnancies, nearly 62% gave birth; in 30% an artificial abortion was undertaken. In a subgroup of 179 adolescents aged less than 18 years, the rate of artificial abortion was 61.5%. Only 34% gave birth to a child. The course of pregnancy in adolescents was not more complicated as it was in older patients (comparison group). The rate of premature delivery was not increased and premature rupture of membranes was even rarer. During birth, there were no increased risks, the duration of birth being identical in both groups. In adolescents, there were a few more spontaneous deliveries. Body weights and neonatal conditions were the same as in the comparable group. Consequently, pregnancy in adolescents is not accompanied by increased risks for mother or child.

[Pelvimetry using computerized tomography. I. Theoretical and methodical fundamentals]. / Pelvimetrie mittels Computertomographie. Teil I: Theoretische und methodische Grundlagen.

The first part of our article deals with the basic aspects of using computed tomography in obstetrical pelvimetry. A macerated osseous female pelvis was used to measure the true conjugate, the transverse plane of the pelvic inlet, the interspinous line and the distance between the ischial tuberosities. The same pelvis was then examined computed tomographically. A lateral and a posterior-anterior scan, and a single scan through the iliac spines were performed. The results of the direct measurement agreed highly with the values achieved computed tomographically if the phantom was positioned exactly on the mid-line of the examination-table, if not, the true conjugate was elongated. Measurements of the superficial and the intravaginal radiation dose in patients demonstrated a significantly lower risk in computed tomography than in conventional x-ray methods. We recommend computed tomography in obstetrics as a safe, accurate and reliable method.

[Rectal examination during labor--tradition or compelling necessity?]. / Die rektale Untersuchung unter der Geburt--Tradition oder zwingende Notwendigkeit?

6,639 consecutive deliveries are followed up with respect to the course of puerperium. All these patients were examined during delivery vaginally. Febrile temperatures sub partu were to be stated in 1.1% and post partum in 2.0%. Subfebrile temperatures within the first 7 days of puerperium were to be seen in 7.0%, neonatal infections in 0.5%. The pro and contra of vaginal versus rectal investigation are discussed. The use of an emulsion containing chlorhexidine an antiseptic gliding substance is recommended for obstetrical examinations before and during labour.

[Left ventricular ejection time (LVET) in the course of pregnancy]. / Die linksventrikuläre Austreibungszeit (LVET) im Verlauf der Schwangerschaft.

In 101 normotensive healthy pregnant women, the left ventricular ejection time (LVET) was estimated. The examinations were performed in intervals of 14 days and 6 weeks after child-birth in left-side and in upright position. The LVET-values are closely frequency-related. Therefore the LVET-values were corrected with regression equations ascertained in 129 healthy non-pregnant women. The curve of the uncorrected LVET has a continuous shift downwards till to the end of pregnancy. However, after correction with the frequency the curve increases in the course of pregnancy till to the time of the 26th-30th week of pregnancy. After this time there is diminishing tendency. In orthostasis in upright position the curves have a similar shift but on a lower level. In the course of pregnancy the heart-frequency increases till to the 31st-35th week. After that it decreases slightly. It has to be assessed that the increase of the frequency-corrected LVET is related to the increasing loading with intravascular volume. On the other hand this increase can be the expression of the improved cardiac performance showing the adaptation to the increase charge of the cardiovascular system. The LVET is to be seen as a indirect destination value of the hearts contractility.

[Possibilities of obstetric pelvic diagnosis]. / Möglichkeiten der geburtshilflichen Beckendiagnostik.

The management of pelvic examination in the department of obstetrics and gynecology, county-hospital Suhl is pointed out. Discussion of all clinical and radiological facilities in the pelvic examination both in breech and in head presentation. The X-ray pelvimetry is recommended in case of suspicion of a contracted outlet of the pelvis and generally for planning the management in case of breech presentation after the exclusion of an indication for a primary caesarean section.

[Chlorhexidine as a vaginal antiseptic in obstetrics]. / Chlorhexidin als Antiseptikum bei der vaginalen Untersuchung in der Geburtshilfe.

The antimicrobial efficiency of a chlorhexidine containing emulsion which is used as gliding or antiseptic remedy is examined. The killer-time for germs within the suspension test as well as the testing in clinical use confirm the efficiency known from literature. The use of chlorhexidine containing emulsions serving as antiseptic gliding remedy is recommended.

[External version from breech position to head presentation near term]. / Die äussere Wendung aus Beckenendlage in Schädellage in Terminnähe.

The external version of fetus from breech into a head presentation is one of the methods to avoid maternal and fetal risk by Cesarean section and by vaginal delivery. As a supposition, we see a technique which is undangerous for mother and fetus. Our procedure corresponds in many points with a practice, which is published by B. Westin. The sober patient is positioned head down on the side of fetus small parts. Then an intravenous infusion is given over 30 min with 2 micrograms fenoterol (Partusisten)/min. The version is performed in many single and little steps. It needs time, a soft hand and the readiness of the Cesarean section. In 104 of 242 patients with breech presentation there was the indication with fulfilled suppositions for such a version. The success-rate was nearly 50%. In no case there was a complication. The rate of Cesarean section past turning was clearly reduced in contrary to breach presentation. The fetal outcome was clearly better. The version of breach presentation is recommended.

[Transcutaneous electrical nerve stimulation in the treatment of placental insufficiency. II. Results of treatment compared to special infusion treatment]. / Die transkutane elektrische Nervenstimulation zur Behandlung der Plazentainsuffizienz. II. Mitteilung: Ergebnisse der Behandlung im Vergleich mit einer speziellen Infusionsbehandlung.

Results of treatment of placental insufficiency by transcutaneous electric nerve stimulation (TNS) in 101 patients are demonstrated and compared with a treatment of a special infusion therapy. While TNS-therapy a significant rise of Fischer-Score was observed. In both groups the urinary estrogen excretion was increased.

[Effect of modified obstetrical neuroleptanalgesia on the duration of labor and uterine contractions]. / Der Einfluss einer modifizierten geburtshilflichen Neuroleptanalgesie auf Geburtsdauer und Wehentätigkeit.

The literature concerning the value of the "small neuroleptanalgesia" for obstetrical pain-relieve is in dispute. Our experiences are based on the single application of 0.05 mg Fentanyl and 2.5 mg Droperidol on the presupposition of a well--proportionate labour activity with a cervix dilatation of at least 2-4 cm. Sporadically we reinject Fentanyl once more or exceptionally Droperidol, too. Among 308 primigravidae and 189 multigravidae with continuously directed application of Oxytocine the duration of the delivery was shortened distinctly compared with the control group without "small neuroleptanalgesia" but with the same tocergic treatment. After the application of the "small neuroleptanalgesia" the labour--intensity is unchanged, exceptionally a very short lessening in the immediate phase after injection. The method is innocuous for the mother, for the fetus and for the new-born. It is effective and practicable under all circumstances. The method of the "small neuroleptanalgesia" is recommended.

[Pregnancy monitoring with the Westin gravidogram. II. Symphysis-fundus measurement and the cervix score]. / Schwangerenbetreuung mit dem Gravidogramm nach Westin. II. Mitteilung: Symphysen-Fundus-Mass und Zervixscore.

In 830 healthy pregnant women with delivery after the 37th week and parturation of a new-born normal for date (NFD) the Symphysis-Fundus-Measurement (SFM) was established and a standard curve was constructed. The curve is a nearly identic one with that given by the Swedish author Westin. There are significant deviations from the standard curve in patients with large for dates fetuses (LFD) and in those with small for dates fetuses (SFD). For LFD the difference is to make ensure statistically in the 24th and for SFD in the 31th week of pregnancy. Both parameters leave the +/- 1s--Standard-deviation in the 33th week of pregnancy. The +/- 2 s--Standard-deviation is not to be passed over. In twin-pregnancies the +/- 2 s--Standard-deviation is crossed after the 18th week of pregnancy. In obese pregnant women the SFM is to be seen significantly over that of pregnancies with normal body-weight. In conclusion we believe, that by consideration of the +/- 1 s--Standard-deviation and of the values for obese women in the curve of the SFM the distinctive sensitivity for detection of SFD-pregnancies is to be improved. By assessment of the registered dates of 308 Nulligravidae and 260 Multigravidae showing an undisturbed progress of pregnancy and a term--delivery the Westin--Score of the cervix uteri and its underlying single parameters have been ascertained and graphically recorded. The values concerning the Multiparae are a bit higher positioned than those of the Nulliparae. The inclination of both curves are otherwise similar.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transcutaneous electric nerve stimulation in the treatment of placental insufficiency. 1. Methodologic principle and set of instruments]. / Die transkutane elektrische Nervenstimulation zur Behandlung der Plazentainsuffizienz. 1. Mitteilung: Methodenprinzip und Gerätekombination.

Presentation of a set of generators for the transcutaneous electric nerve stimulation serving the treatment of placental insufficiency. First experiences confirm the proper practibility of the method in the variant of our generator set.

[Experiences with the portable tocograph Toki P2]. / Erfahrungen mit dem tragbaren Tokograph "Toki-P2".

Demonstration of a new tocograph which is portable and easy to operate. In more than 3500 examinations it registered excellent tocograms. It's wide use could improve the diagnostic and well-timed therapy of premature labour.

[Gynecologic geriatric surgery at the University Gynecological Clinic Rostock during 1960--1974]. / Gynäkologische Altersoperationen an der Universitäts-Frauenklinik Rostock in den Jahren 1960 bis 1974.

There is reported about 2279 gynaecological operations at women, aged 60 years and more, in a period from 1960 to 1974, divided into three 5-years-groups. The part of geriatric operations increased from 5,3% to 7,0% of all operations. The division into high risk-groups took place after points given by Loskant. 41,1% of all patients where classified into group III. Group IV has the highest postoperative mortality rate (5,3%). The postoperative mortality rate altogether was 2,2%. In the years from 1960 to 1974 it decreased from 2,6% to 1,9%. 25,1% of the surgical operations where carried out abdominaly. The high part of vaginal operations comes off by placing curettages into the analysis. Under that aspect must be seen the postoperative mortality rate 7,1% at abdominal and 0,7% at vaginal operations. In the main point indications for operation were malignant tumours (37,3%), haemorrhages (25,4%), benign tumours (17,6%), and position variations of the genitals (10,6%).

[Clinical experience with Hammacher's "CTG score"]. / Klinische Erfahrungen mit dem "CTG-Score" nach Hammacher.

The cardiotocograms of 340 pregnant women which are recorded ante partum and intra partum were analysed by the score of Hammacher. This score is representative for the intra partum period. We found a direct relation between variations of CTG and the Apgar-score of newborn. In the ante partum period only in pathological score this correlation can be observed.

[Production of obstetrical reports using a computer]. / Erstellung geburtshilflicher Berichte mittels Computer

A rational method of production of medical reports in obstetrics is reported. The basis of this method is the approved computer guided system (DOKUMEDA) in clinics of radiology. Advantages and disadvantages of using are discussed.