[Progress of labor and neonatal morbidity in primiparity with breech presentation]. / Der Geburtsverlauf und die neonatale Morbidität bei Erstgebärenden mit Beckenendlage.

Progress of labour in 100 consecutively delivered term ( > or = 37 weeks) primiparous breech births was analysed and correlated with fetal outcome according to different durations of first and second stages. All women had sonographic biometry prior to admission and epidural anaesthesia (PDA) early in established labour. Women with nonreassuring fetal heart rate tracings during any stage of labour were delivered by caesarean section, and were excluded. Birth weights were between 1980 g and 4090 g. There was no perinatal mortality, but eight neonates sustained birth associated trauma (6 Erb's palsies, two fractured long bones), all of which regressed spontaneously. Risk of neonatal trauma and of reduced Apgar scores was significantly associated with duration of the first stage but not of the second stage. It appears that short first stage duration (i.e. up to six hours) or a cervical dilatation rate of no less than 1 cm/h is associated with a very low risk of fetal trauma. In contrast, no upper limit of a second stage duration associated with low trauma risk could be seen in this group of parturients with effective continuous epidural anaesthesia. Assumptions regarding risks in primiparous labour progress for term breech labour may need to be reevaluated. The data presented are suitable for comparison with those from other centres and for metaanalyses.

[The HELPP syndrome--a severe complication of pre-eclampsia. A presentation of 19 cases from 1983 to 1990]. / Das HELLP-Syndrom--eine schwerwiegende Komplikation der Gestose. Eine Darstellung von 19 Fällen in der Zeit von 1983 bis 1990.

Between 1983 and 1990, HELLP syndrome was diagnosed in 19 of 201 patients with preeclampsia. In addition to the characteristic changes in laboratory values, severe edema and proteinuria were found in almost all cases. Upper abdominal pain was the most common subjective symptom and, together with a reduced thrombocyte count, was often a first sign of HELLP syndrome. In some cases blood pressure was only slightly increased. Maternal and infant morbidity were significantly increased. Premature termination of labor was usually necessary, in most cases due to maternal pathology. The incidence of intrauterine dystrophy and premature delivery far exceeded the norm. Early detection of HELLP syndrome is crucial, and interdisciplinary cooperation is a key factor in achieving this goal.

[Results following anterior levator-plasty]. / Ergebnisse nach vorderer Levatorplastik.

In this study we report about 172 patients who underwent modified anterior repair in the time from october 1983 up to april 1985 because of vaginal prolapse and/or incontinence. 125 patients could be examined clinically, in the middle 14.2 months after operation. In 64% the modified anterior repair was combined with a colporrhaphia anterior and hysterectomy, and in 20% a colporrhaphia posterior was made additionally. Dehiscence of the anterior vaginal wall occurred in 19.2%, severe pelvic infections in 8.8%. Because of bleeding complications a chirurgical intervention was necessary in 5.6%. A descent of the anterior vaginal wall was seen in 30.4%, 76.8% of the women developed a descent of the posterior vaginal wall, and 8% a stenosis of the vagina. Problems at sexual intercourse were frequent, followed by pain in the lower abdomen. The principle of the operation is presented including the changed anatomy. Many of the adverse effects can be understood and the necessity of prophylaxis of a descensus of posterior vaginal wall was described.

Fenoterol depot and fenoterol in premature uterine contractions--a multicentric double-blind comparative study.

In a double-blind randomized study, the effect of a single dose of a fenoterol preparation with delayed release of active substance (designated as fenoterol depot) was compared with a fenoterol product with undelayed release of active substance (designated as fenoterol) in two groups respectively comprising 66 and 65 female patients with premature uterine contractions. The fenoterol depot was administered p.o. in a single total dose of 21 mg at the beginning of an investigation period of 360 minutes and the fenoterol was administered p.o. within 235 minutes in three identical consecutive doses resulting in a total dose of 22.5 mg. The increased uterine activity present at the beginning was markedly lowered by an initial intravenous infusion of Partusisten. After administration of the two oral preparations, the uterine contractions remained at the low level achieved. The fenoterol depot was slightly superior to fenoterol with regard to the reduction of the duration of contractions: the difference in the inhibition of the duration of the contraction between the two preparations was a maximum of 25.7% in favor of fenoterol depot. The frequency of uterine contraction was substantially reduced by both preparations, but to a greater extent by the depot form. The tocolytic efficacy and the tolerance were rated as "good" in 70% and 75% respectively with fenoterol depot and in 69% and in 71% respectively in the case of fenoterol. The maternal pulse rate remained at the level reached at the end of Partusisten infusion with the two preparation, and the blood pressure fluctuated slightly within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prenatally diagnosed fetal hydrothorax]. / Pränatal diagnostizierter fetaler Hydrothorax.

A predominantly unilateral hydrothorax in an unborn child was diagnosed by sonography during the 34th gestational week. Because of a pathologic cardiotocogram it was necessary to make a primary caesarean section one day later. The premature baby was intubated immediately and the pleural discharge was removed. Later developmental of the child was uneventful. The hydrothorax was interpreted as a partial factor of a hydrops fetalis. Controlling the fetal pleural discharge by ultrasound examination and regular cardiotocogram a caesarean section should be done between the 34th and 36th week of pregnancy.

[Clinical aspects of premature rupture of the membranes]. / Klinik des vorzeitigen Blasensprungs.

In this study all deliveries with premature rupture of the membranes (VBS) between 1978 and the midst of 1981 were compared and statistically analysed using a control collective, which consisted of the sum of the respective following delivery. A premature rupture of the membranes was found in 18.1 per cent. We observed a VBS more often in case of increasing age of the mother and significantly more often for primiparae. An infection of the urinary tract seemed to increase the risk of an VBS. The latent period is longer, if the VBS occurred in the early pregnancy. There was no difference between both groups according to the course of birth, the frequency of KPDA, the pressing period and the period of dilatation. Complications with the umbilical cord could not be found more often in the collective of premature rupture of the membranes than in the control group. The umbilical cord prolapse even was rarer in case of premature rupture of the membranes. Difficulties in adaptation and the respiratory distress syndrome could be found significantly more often in the group of VBS, according to the higher rate of premature children in this collective. The possible stimulating effect of the VBS on the induction of the fetal lung maturity was reserved by the higher rate of neonatal infections in case of longer latent periods. We found the amnion infection syndrome in 2.1 per cent if the latent period was less than 24 hours, 10.7 per cent if it was longer than 48 hours and more than 15 per cent if it was 72 hours and more.(ABSTRACT TRUNCATED AT 250 WORDS)

[Suprapubic urinary diversion following gynecologic operations]. / Die suprapubische Harnableitung nach gynäkologischen Operationen.

In a prospective study the results of postoperative urinary discharge by suprapubic catheterisation (SC) are compared with those of transurethral catheterisation (TC) in a randomised collective of gynaecological patients after vaginal hysterectomy with front (resp. front and back) plastic. During November 1979 and September 1980 157 patients were examined, 88 patients by suprapubic catheterisation and 69 by transurethral catheterisation, with random distribution. Additionally, 430 other patients with suprapubic aspiration after vaginal hysterectomy with front and/or back plastic performed between September 1980 and October 1982 were examined retrospectively especially under the aspect of possible complications. The advantages of suprapubic urinary discharge are shown in the significantly reduced rate of primary infections. 20.5 per cent of infections are opposed to 67.1 per cent in the comparative group with TC. Spontaneous miction was possible in the SC group two days earlier than in the group of TC (5.2 days opposed to 7.35 days). Additional drug treatment for restitution of the bladder function was more often necessary for patients with TC, although the results with 43.5 per cent against 29.5 per cent in the SC collective are not significant. The number of renewed catheterisations after removal of the catheter was higher by 27 per cent in the group of patients with SC. Subjective complaints were stated by patients with TC in 66.7 per cent against 18.2 per cent of women with SC. This result is significant. In the TC collective there were significantly more patients with leucocyturia (88.5 per cent against 48.7 per cent). Antibiotic treatment of an urinary tract infection with typical symptoms was necessary in 35.8 per cent for patients with TC and in 14.1 per cent for women with SC.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malaria relapse in the puerperium]. / Malaria-Rezidive im Wochenbett.

During the last six years we observed four malaria relapses shortly after delivery. In three cases the relapse occurred subsequent to Caesarean section, and in one case shortly after normal uncomplicated delivery. Case histories revealed that these women had previously stayed in the tropical or subtropical zones. The longest period without relapse was five years, the shortest interval four months. In all cases, microscopic examination revealed a relapse of Malaria tertiana. All the patients were cured within a short time by administration of chloroquine; the clinical signs disappeared. If, in fever of unknown origin, malaria is suspected, diagnosis and therapy will be an easy matter. Good anamnesis will provide a pointer to appropriate therapeutic action.

[Experiences with ambulatory delivery]. / Erfahrungen mit der ambulanten Geburt.

This study summarizes the experiences with ambulant delivery in the St. Elisabeth Hospital in Cologne between 1979 and October 1982. The ambulant deliveries during this period were compared with a control group of normal vaginal births in the hospital. There were 211 women in each group. Questionnaires were sent to those women who had ambulant births, and the answers formed an important part of this study. Of all the intended ambulant births, 18.5% had to be refused because of possible complications. The results of the study show that the risks during birth for mother and child in both groups, were identical, and any complications arising were wide and various. In our opinion the main risk is the "Icterus neonatorum". The number of peridural anaesthesia was significantly lower in the ambulant delivery group. From the questionnaires we had a clearly positive reaction to ambulant delivery. For the newborn infant there is a decisive risk, so that ambulant delivery should only be used as an alternative in order to avoid home delivery.

[Comparative monitoring of pre-ejection-period and transcutaneously measured pO2 in neonatal period (author's transl)]. / Vergleichende Untersuchung von Pre-ejection period und transkutan gemessener Sauerstoffspannung in der Neugeborenenperiode.

UNLABELLED: Pre-ejection period (PEP) and transcutaneous measured pO2 (tc pO2) were monitored simultaneously with the beat-to-beat ECG in 55 cases of unselected neonates. In addition body weight, acid-base-status and body temperature were registered 11 neonates were monitored immediately post partum, the others at various times until 9 days after delivery. RESULTS: The mean value of PEP after delivery is 63,3 msec. There is a negative correlation between neonatal heart rate and Pre-ejection-period. Increases of body temperature leads to a decrease of the PEP and vice versa. There are no direct significant alterations in PEP in connection with changes in neonatal tc pO2. Only when tc pO2-values beyond 20 mmHg were registered in distressed neonates PEP shortened significantly. PEP shortened also in periods of neonatal crying PEP is not correlated to birth weight or the actual neonatal weight when measurement of PEP and tc pO2 was performed.

[The pre-ejection-period of the human fetal heart: patterns of change during labour and heart-frequency alterations (author's transl)]. / Die Pre-Ejection-Period (PEP) des menschlichen fetalen Herzens: Anderungen in der Wehe und bei verschiedenen Dezelerationsmustern.

UNLABELLED: The Pre-ejection period (PEP) of the cardiac cycle, fetal heart rate, and uterine contractions were monitored in a series of 115 unselected fetus sub partu. PEP was detected by a new on-line technique using EKG and DKG. This method permits a continuous registration of PEP patterns simultaneously with the fetal CTG. Any change in PEP was related to fetal status and fetal heart rate patterns. RESULTS: Absolute PEP was prolonged and relative PEP (PEP/cardiac cycle) did not alter during decelerations due to a fetal head compression. The absolute PEP and the relative PEP were prolonged (rarely relative PEP was shortened) during alterations of fetal heart rate patterns based on the alteration in hemodynamics of fetal circulation. A first increase of the PEP was followed by a second increase of the PEP during severe variable decelerations conducting to a secondary chemoreceptor-reflex caused of fetal hypoxemia and acidosis; the duration between the two prolongation peaks of the PEP is directly correlated of fetal blood oxygenation: hypoxemia decreases this duration. These changes are essentially independent of heart rate and therefore PEP can be considered as an independent parameter for fetal assessment.

[Comparative study of pre-ejection period and trans-cutaneously measured pO2 sub partu (author's transl)]. / Vergleichende Untersuchungen von Pre-ejection-period und transkutan gemessener Sauerstoffspannung unter der Geburt.

UNLABELLED: Transcutaneously measured pO2 (tc pO2), Pre-ejection-period (PEP) fetal heart rate (FHR) and intrauterine pressure were registered simultaneously in 5 cases of fetuses having umbilical cord complications. In addition a punctual measurement of acid-base-status was performed during intra partal registration and after delivery. RESULTS: In each fetus there is a relative correlation of basic PEP and basic tc pO2. An almost parallel pattern of PEP and tc pO2 occurred during uterine contractions, while both parameters are strictly correlated. There is always a prolongation of the PEP and a rise in tc pO2 of the fetal scalp during deceleration and uterine contractions. PEP changes due to a decrease of preload and increase of afterload of the fetal heart, the relative better oxygenation of the fetal scalp during uterine contractions and decelerations due to a redistribution of circulating blood volume caused by a selective peripheral vasoconstriction.

[The pre-ejection-period of the humen fetal heart: significance of base-line alterations in perinatal period]. / Die Pre-Ejection-Period des menschlichen fetalen Herzens: Bedeutung der Base-Line-Schwankung in der Perinatalperiode.

The Pre-ejection period of the cardiac cycle, fetal heart rate and uterine contractions were monitored in a series of 115 unselected fetus sub partu. A new one-line technique permits a continuous registration of PEP patterns simultaneously with the CTG. Any change in base-line of the PEP war related to heart rate, acid-base-status and gestational age. The average value of PEP in fetus was 72,93 +/- 7,9 msec. The base-line of PEP increased paralelly with gestational age of fetus and decreased rapidly beyond normal values after the 41. week of gestation. Within normal values alterations in base-line of the PEP were negativly correlated to alterations in base-line of the heart rate. Abnormal high and low base-lines of the PEP were observed in fetal acidosis, hypoxemia, and in uteroplacental insufficiency. The prolonging or shortening of the PEP base-line seems to signalize an acute injury of the utero-feto-placental unit in perinatal period.

[A new treatment for the on-line-registration of the pre-ejection-period of the human fetal heart simultaneously with the CTG (author's transl)]. / Ein neues Verfahren zur on-line-Registrierung der Pre-ejection-period des menschlichen fetalen Herzens parallel zum CTG.

A new noninvasive on-line technique for measuring the pre-jection-period (PEP) sub partu is described. It permits a continous registration of PEP patterns simultaneously with the fetal CTG.

[Acute reduction of uterine blood flow and fetal heart rate changes in pregnant sheep near term].

Five merino sheep near term were used for acute preparations to investigate the influence of basal uterine blood flow (UBF), basal fetal oxygenation and basal fetal heart rate (FHR) on FHR changes elicited by acute reduction of UBF. The ewes were anaesthesized with pentobarbital and Alloferin was given for relaxation. Ventilation was maintained via a tracheal tube by a Starling pump. Maternal heart rate, arterial pressure and intrauterine pressure as well as fetal heart rate and umbilical artery pressure were recorded continously. Initially blood flow was recorded by cuff flow meter sequentially in both uterine arteries for a short time in order to determine total UBF and the ratio of flows. During the UBF reduction sequence flow was recorded in the artery of the gravid horn continously and measurement was corrected according to the initial ratio of flows in both arteries, presuming that this ratio would remain constant throughout the course of the experiment. Repetitive and progressive acute reduction of UBF (approximately 25%, 50% and 100% from basal UBF value) was achieved three times, lasting 120 sec each and each approximatly 12 min apart, by flow meter controlled partial or total occlusion of the aorta abdominalis of the ewe with a balloon catheter inserted into the aorta. (In some cases the lateral abdominal section was left open and the aorta was compressed manually). Before, 90 sec after the beginning and 10 min after the end of UBF reduction blood samples were taken from the fetal catheters (Fig. 3). In two preparations this sequence was repeated once after complete recovery of FHR.

[Comparison of serum lipid concentrations in umbilical artery, umbilical vein and maternal vein blood (author's transl)]. / Vergleichende Lipiduntersuchungen in den Seren von mütterlichem Blut, von Nabelarterien- sowie Nabelvenenblut zur Frage des Zusammenhanges zwischen mütterlichem und fetalem Lipidstoffwechsel

Maternal serum lipids and lipids in umbilical artery and umbilical vein blood were examined immediately after delivery in order to relate maternal and fetal lipid metabolism. Total lipids, phospholipids, triglycerides, total cholesterol, cholesterol esters and free cholesterol were determined. The comparison of arterial and venous umbilical lipid levels showed a significantly higher concentration of phospholipids in the umbilical vein, indicating an enhanced flux of phospholipids from the placenta to the fetus. A positive correlation is established for the amounts of total lipids (p less than 0,05), triglycerides (p less than 0,01), phospholipids (p less than 0,05) and free cholesterol (p less than 0,005) between maternal and umbilical vein blood. It is suggested that free cholesterol passes the placental barrier unchanged. The other correlations are discussed as the expression of a factor influencing simultaneously the maternal and fetal lipid metabolism.

[Possibilities and limits of the intrauterine reanimation (author's transl)]. / Möglichkeiten und Grenzen der intrauterinen Reanimation

Intrauterine reanimation means the removal of acute maternal or fetal distress. Beside of maternal shock (traumatic, hoaemorrhagic, supine hypotension syndrome) all acute distress situation are seen during labour. The therapeutical possibilities and premises on the one side, the limits and dangers on the other are discussed. There are the change of position in bed, infusion of low molecular dextrane, O2- breathing, buffering of the mother, infusion of vasodilatators and beta-stimulators to the mother. The main therapeutical principle for intrauterine reanimation are change of side position and beta-stimulator therapy in case of disturbances in feto-maternal respiration because of an acute utero-placental insufficiency or a cord complication. As to an own patient group with intrauterine reanimation with the beta-stimulator "Partusisten" in 174 deliveries with cardiotocographic signs of fetal distress in the first stage of labour there is shown that threatened fetal distress because of uterine hyperactivity and cord complication is successfully treated by tocolysis. In case of chronic placental insufficiency there is no therapeutical success by intra partum tocolysis in 30%.