[Free fat in amniotic fluid - a criterion for prenatal assessment of foetal maturity (author's transl)]. / Freies Fett im Fruchtwasser als Kriterium für die kindliche Reife.

Smears were made and stained with nile-blue sulphate following sedimentation of 235 amniotic fluid samples which had been obtained by amniocentesis. An assessment was made of the amount of free fat and of the various cell shapes involved. Free fat was found to occur in higher quantity in advanced pregnancy. These data were compared with postnatally estimated pregnancy age. The method proved to enable objective assessment of foetal maturity over the last weeks of pregnancy, and it seemed to be very useful in differentiating between hypotrophy and immaturity.

[Prenatal diagnosis of genetic defects to reduce infant mortality (author's transl)]. / Die pränatale Diagnostik genetischer Defekte als Beitrag zur Senkung der Säuglingssterflichkeit.

A total of 568 perinatal deaths occurred along with 25,111 childbirths, with 92 infants exhibiting malformations detrimental to life. The latter figure accounted for 16.2 per cent of all perinatal deaths or for 0.37 per cent of all childbirths. --Sixty per cent of the above malformations would have been detectable, had prenatal diagnosis been undertaken for the discovery of genetic defects. Every third malformation occurred along with a neural tube defect of which 93 per cent would have been detectable. Hydramnion in the course of pregnancy has proved to be the most specific indicator to malformation, and in 26 per cent of all pregnancies examined it was found to be present in concomitance with prenatally detectable malformations. Other data recordable in the context of pregnancy, including case history, hyperemesis, imminent abortion, gestosis, maternal infections, and exogenous noxae, were found to be unspecific and, consequently, not reliable for prenatal diagnosis. General ultrasonographic B-scan examination of all pregnant women would most probably help to detect 30 per cent of all malformations observed in this study, while prenatal detection of another eleven per cent seemed to be possible with less certainty. Such high rate of prenatal detection would help to reduce perinatal mortality by 6.7 per cent. Alpha-foetoprotein in maternal serum should be determined from all pregnant women, with the view to recording neural tube defects. Such step would be conducive to the detection of one third of all malformations. Further reduction of perinatal mortality and even more morbidity is thought to depend strongly on an expansion of indications for prenatal diagnosis.

[Importance of trisomy-20 mosaicism to prenatal diagnosis (author's transl)]. / Bedeutung des Trisomie-20-Mosaizismus in der pränatalen Diagnostik.

Trisomy-20 mosaicism was among the findings obtained from two prenatal diagnoses and is discussed in this paper. The pregnant women concerned decided to ask for termination of pregnancy. Eight instances of prenatally diagnosed trisomy-20 mosaicism and three cases of pseudomosaicism so far have been reported elsewhere in the literature. Six pregnancies were carried to full term, with phenotypically normal infants being delivered. Hence, prenatal diagnosis of trisomy-20 mosaicism alone does not seem to justify termination of pregnancy. Yet, abandonment of termination should be flanked by follow-up checks of the children delivered, in order to rule out subsequent manifestation of mental defects.

[Risk of infertility following foetography and amniofoetography (author's transl)]. / Infertilitätsrisiko nach Feto- und Amniofetographie.

Prenatal diagnosis was made of 297 women. Amniocentesis was performed on 220 women to set up an amnion cell culture and on 77 women (26 per cent) for foetography and amniofoetography. Abortion occurred to nine per cent of those women following intra-amniotic injection of contrast medium, while premature delivery occurred to another 28.6 per cent of the probands. Perinatal mortality accounted for 13 per cent. Amniocentesis for amnion cell culturing was following by abortion of 3.2 per cent of the probands and by premature delivery of 2.3 per cent, while perinatal mortality was but slightly increased, the rate being 2.3 per cent. The differences were statistically secured. Foetography and amniofoetography should be followed by prophylactic cerclage.

[Infertility--a risk factor in obstetrics (author's transl)]. / Infertilität--ein geburtshilflicher Risikofaktor.

Definitions are offered for the concepts of sterility and infertility. The notion of infertility is expanded to cover not only habitual abortions (three or more miscarriages) but, as well, deliveries of defective children. --Five-hundred and fifty-five pregnancies so far have occurred to 240 infertile probands, among them 78 with habitual abortions and 162 with damaged children. Only one in ten of those pregnancies resulted in clinically intact live birth. --Abortion was the result of 95 per cent of all pregnancies of the women with habitual abortion. The same applied to 25 per cent of all pregnancies of the above women with defective children (e.g. Down's syndrome, neural tube defects, diaphragmatic hernia, hydrocephalus, and progressive muscular dystrophy). A damaged child was born in more than 50 per cent of the latter pregnancy cases. --The number of children born by 162 women has been 181, with only 96 of them alive. The causality relationship between abortion and birth of defective children is discussed. --Infertile women should be given special attention, before conception takes place, and they should be kept under intensive care to the end of pregnancy.

[Significance of after care in asymptomatic pregnancy bacteriuria and pyelonephritis gravidarum]. / Die Bedeutung der Nachsorge bei asymptomatischer Schwangerschaftsbakteriurie und Pyelonephritis gravidarum.

In the period from 1974 to 1976 3465 deliveries were performed in the "Landesfrauenklinik". During pregnancies there were started 10,7% urological and nephrological complications with the asymptomatic bacteriuria were predominating at a rate of 6,1%. --Considering the high rate of chronic complications in all types of urinary tract infections, long-term dispensary care should be postulated.

[Fetography and amniography in prenatal diagnosis of genetic disorders]. / Die Fetographie und Amniographie in der pränatalen Diagnostik genetischer Defektel

68 patients were transfered to the prenatal diagnosis. Both the alpa-fetorotein-estimation and the fetography or amniography were performed in 13 patients. The indication for fetography is the exclusion of neural tube defects and other serious visible defects. The amniography can especially carried out in the prenatal diagnosis of defects of intestinal tract. A program is proposed to the prenatal detection of neural tube defects: 1. Examination of all of the pregnacies with ultra sonic B scan. 2. At suspicions ultra sonic B scan and after birth of a child with neural tube defect alpha-fetoproteinestimation at the 16th week of pregnancy and fetography at the 24th week of pregnancy.

[Course of pregnancy and labor after prenatal diagnosis of genetic defects and abnormalities]. / Schwangerschaftsverlauf und Geburt nach pränataler Diagnostik genetischer Defekte und Missbildungen.

138 patients were referred to us to prenatal diagnosis of genetic defects. Only in 120 patients the diagnostic procedures could also be carried out. In 75% the amniocentesis was performed to establish the amnion cell culture and in 22.5% for analysis of alphafetoprotein and for performance of fetography. In 4.2% a genetic indication for interruption was found by the prenatal diagnosis. Among the 61 terminated pregnancies a premature delivery occurred in 13.1%. The operating frequency of delivery was 16.2% and the perinatal mortality was 1.6%.

[Organization of prenatal diagnosis of genetic defects]. / Zur organisation der pränatalen Diagnostik genetischer Defekte

The prenatal detection of genetic defects can make concrete predictions on definite diseases that are to be expected. In the indication catalogue of the prenatal diagnosis from the amniotic fluid the chromosomal anomalies are predominant. The basis and the potential consequences of the prenatal diagnosis are surgical treatments and highly differentiated methods which may have consequences on the fetus and on the pregnant woman. Therefore the structure of a prenatal diagnostics centre must to a great extent observe the "Nihil nocere". The most important functions in the prenatal diagnostics are incumbent on the surgical gynaecologist. His duties are the indication and the carrying-out of the surgical treatments and measures for the prenatal diagnostics under consideration of the risks existing. The gynaecologist has either further to care for the pregnancy as a risk pregnancy or at corresponding indication to interrupt it even after the 12th week of pregnancy. On these grounds it is recommended to build up a prenatal diagnostic centre in a gynaecological hospital.

PIP: The prenatal detection of genetic defects can make concrete predictions on definite diseases that are to be expected. In the indication catalogue of prenatal diagnosis from amniotic fluid the chromosomal anomalies are predominant. The basis and the potential consequences of the prenatal diagnosis are surgical treatments and highly differentiated methods which may have consequences on the fetus and on the pregnant woman. Therefore the structure of a prenatal diagnostics center must to a great extent observe the "Nihil nocere." The most important functions in the prenatal diagnostics center are incubent on the surgical gynaecologist. His/her duties are to indicate and carry out the surgical treatment and measures for the prenatal diagnoses under consideration in view of the existing risks. The gynaecologist must then treat the pregnancy as a risk pregnancy or interrupt it even after the 12th week of gestation. On these grounds it is recommended that a prenatal diagnostic center in a gynaecological hospital be expanded.