[Premature labor in gestosis]. / Frühgeburtlichkeit bei Gestose.

796 pregnancies complicated by preeclampsia and 1,299 pregnancies without toxemia of the years 1981 to 1985 have been compared with regard to prematurity. Prematurity rates were 12.4 respectively 13.8 per cent, hypotrophy rates were 20 resp. 13 per cent, acidosis morbidity was 75 resp. 20 per cent and Apgar values below 8 were 63 resp. 24 per cent. Morbidity rate of respiratory distress syndrome was 8 resp. 12 per cent, of sepsis 2 resp. 7 per cent, intrauterine death rate 5 resp. 2 per cent, but survival rate overall was 93 resp. 90 per cent. Prematurity was influenced by severity of preeclampsia, time of onset and prenatal care. Prolongation of pregnancy by tocolysis is possible principally, but influenced in its effect by maternal and fetal symptoms and the necessity of termination of pregnancy by these factors.

[Hemodynamic placental insufficiency and its therapeutic modification in threatened premature labor]. / Hämodynamische Plazentainsuffizienz und ihre therapeutische Beeinflussung bei drohender Frühgeburt.

The authors are involved in a study in the field of nuclear medicine aimed at further clarifying the connection between premature delivery and placental insufficiency. They are particularly concerned with uteroplacental perfusion at the time when a trend is emerging toward premature birth, and with ways of treating this by exclusive therapy using betamimetics and/or additional maternal oxygen inhalation/additional maternal transcutaneous dorsal nerve stimulation (TNS). The significantly longer half-life periods of activity increase found at the time of hospitalization similar to pregnancies with intra-uterine fetal retardation, as compared with a normal control group, are interpreted as expressing a hemodynamic placental insufficiency and a risk of premature delivery. In contrast to exclusive betamimetic therapy, additional O2 inhalation/additional TNS significantly shorten the half-life period both in short-time and long-time tests. The better therapeutic effect on uteroplacental perfusion in cases of imminent premature delivery which is thus demonstrated can be seen also in an improved respiratory condition of the fetus as shown in a cardiotocogram. From a clinical point of view, the authors call attention to the clearly prolonged pregnancy periods regardless of the duration of gestation, at the time when a trend is emerging toward premature birth, as compared with exclusive betamimetic therapy, the duration of tocolysis/amount of betamimetic applied being the same.

[Therapeutic efforts and prenatal modification of selected disordered fetomaternal relations]. / Therapeutische Bemühungen um präpartale Beeinflussung ausgewählter gestörter fetomaternaler Beziehungen.

Based on the current view about disturbances of the feto-materno-placental unit we examined 37 women with suspected intrauterine fetal growth retardation and 12 women with threatened premature labor and looked for possibilities of antenatal therapeutic influence of nutritive, respiratory, endocrine and hemodynamic insufficiency. In a randomized study we can prove a normal increase of the distance between symphysis pubis and fundus as well, as the biparietal diameter not only following bedrest but also following bedrest with additional intravenous infusion of glucose respectively oral application of galactose. The high rate of hypotrophic babies is no argument against a positive influence on nutritive insufficiency, but the acquired retardation can not be compensated totally. Neither a positive influence on the endocrine insufficiency nor the moderate respiratory one could be found. As well by maternal transcutaneous nerval stimulation as by maternal oxygen inhalation an oral long-term tocolysis we can demonstrate a considerable improvement of the uteroplacental perfusion measured with isotopes. These positive aspects are basis for further investigations. An important supposition to a successful therapy remains an early diagnosis.

[Clinical value of various parameters in antenatal diagnosis of fetal hypotrophia (intrauterine retardation) (author's transl)]. / Zur klinischen Wertigkeit verschiedener Parameter bei der antenatalen Diagnostik der fetalen Hypotrophie.

Retrospective evaluation of percental frequency of pathological data gained by prepartual monitoring in pregnancies at risk of 180 small for gestational age infants and 130 eutrophic ones at term (postnatal classification). Parameters of interest were continuous maternal gain of weight, monthly progress of the size of the uterus, continuous ultrasomic cephalometria, maternal urinary estriol and serum heat stable alkaline phosphatase as well as amnioscopia and cardiotokographia with and without oxytocin challenge test. -- It seems that there is a significant better prediction of fetal retardation with the help of common clinical methods as well as with ultrasonic and that they are superior to the examined biochemical, cardiotocographical and amnioscopical parameters. With regard to possible additional disturbances of the fetoplacental unit--especially of respiratory placental function--in suspected intrauterine retardation the complete monitoring program should be taken.

[Mode of delivery, postnatal condition and neonatal outcome in preterm infants]. / Art der Geburtsbeendigung, Zustandsdiagnostik und kindlicher Ausgang bei Frühgeburt.

There were under examination 578 preterm infants of two groups--28. up to 31. and 32. up to 36. week of gestation--after birth of vertex as well as breech prevention. Postnatal condition and neonatal outcome were put into relation to the mode of delivery. We compared Apgar-Score (one and five minute value), morbidity on respiratory distress syndrom as well as rate of survival and neonatal mortality in spontaneous delivery with and without episiotomia, with specula delivery, Shute-forceps and vacuum extraction of vertex presentation as well as with breech presentation after vaginal delivery and primary Caesarean section. In respect of the management of the second stage of labour it is our opinion that prophylactic additional measures in preterm delivery of vertex presentation after 32 weeks of gestation are not necessary and that this question should be examined in a larger study of much more cases. But we were able to demonstrate that up to 32. week of gestation well-timed episiotomia of optimal size is necessary. Our good experiences in breech presentation between 31. and 35. week of gestation treated by obligate Caesarean section have to prove true in future.

[Relationships between the macroscopic placentary condition and postnatal state of underweight neonates. A contribution to the correlational pathology of the placenta (author's transl)]. / Beziehungen zwischen markroskopischen Plazentabefunden und postnatalem Austand untergewichtiger Neugeborener.

Results of macroscopic examinations of placentae, which were obtained under routine clinical conditions for a total of 615 underweight neonates, were checked for their capability of a respiratory distress syndrome, and perinatal mortality. Evidence was obtained for a (partially statistically significant) trend showing that, within individual gestatory age groups and for equal weights of babies, premature infants born in the period up to and including the thirty-fifth week of gestation and having relatively low placental weights premature babies born during the thirty-sixth week of pregnancy, and hypotrophic babies born at term and showing a relatively heigh weight of the placenta are particularly exposed to a number of dangers in the further postnatal course of life. The clinical importance of these results to attending neonatologists is pointed out. Other conditions. such as the form of attachment of the umbilical cord of the nature of allantochorial vasculature, were not found to be closely related to the parameters studied in this investigation.

[Macroscopically determined placentary conditions in the case of underweight neonates (author's transl)]. / Makroskopische Plazentabefunde bei untergewichtigen Neugeborenen.

The placentary conditions (weight of placenta, placenta/infant weight index, kind of attachment of the umbilical cord and allantochorial vasculature) of underweight neonates (eutrophic premature infants and hypotrophic babies born at term), which were macroscopically determined under routine clinical conditions, are compared with those of eutrophic babies born at term after clinically and anamnestically normal pregnancies. Significantly lower weights of placenta and significantly higher placenta/infant weight indices of underweight neonates must be differently assessed for prematurely born babies and hypotrophic infants born at term. The significant increase in the case of underweight neonates of the disperse type of allantochorial vasculature does not suggest any significant relations to either lower weights of placenta or lower weights of newborn infants within the individual classification groups. There is no increase in the number of marginal-velamentous attachments of umbilical cords in the case of underweight neonates. Also, reference is made to the limited importance of macroscopically determined placentary conditions to individual cases.

[The reaction of chorion epitheliums of human placentae to beta-sympathocomimetics (author's transl)]. / Das Verhalten des Chorionepithels menschlicher Plazenten nach Gabe von beta-Sympathicomimetika

The enzyme histochemical response of chorionic epithelium after treatment with Dilatel has been examined on 50 placentae of classified eutrophic premature and full-term births. In relation to the degree of damage to trophoblasts at the start of treatment and to dosage the response is mobilisation and further differentiation of Langhans cells and their transformation into mature plasmodium. The relevance of these results for metabolic transport and hormonal synthesis in the feto- maternal metabolic barrier and for the chance of therapeutic effects on insufficiency of the placenta is discussed.

[The villous trophoblast in placentae of premature births (author's transl)]. / Der Zottentrophoblast in den Plazenten Frühgeborener (Eine enzymhistochemische Studie)

Enzyme histochemical behavier (cryostat-and semi-thin slice techniques) of the villous epithelium of 109 "genuine" premature birth permits evaluation of a qualitative disturbance of trophoblasts. It is characterised by an increase of pre-degenerative plasmodium and multilocular emergence of highly differentiated or degenerated Langhans cells which lack the potential for plasmodial transformation and thus for regeneration of trophoblasts. The importance of such changes for metabolic competence and hormone synthesis and the link between prematurity and insuficiency of the placenta are discussed.

[Chorionic epithelium in the resorption-villi of placentas of hypotrophic term-born infants. Morphology in chronic placental insufficiency]. / Das Chorionepithel in Resorptionszotten von Plazenten hypotropher Termgeborener. Ein Beitrag zur Morphologie bei chronischer Plazentainsuffizienz

The chorionic epithel of 61 placentas of hypotrophic term-born (small for date) with or without the sign of dysmaturity will be compared with the chorionic epithel of 25 placentas of eutrophic term-borns after clinical and anamnestic normal pregnancy or enzym-incubated Cryostat- and semi-thin-slides. Different degrees of predegenerative plasmoditrophoblast by proliferation or persistence high differentiated and degenerated Langhanscells are signs of disturbed regeneration processes in chorionic epithel by chronical fetal malnutrition. This functional- morphological disturbance of villous trophoblast low-weighted newborns will be evaluated as a morphological correlat by chronical insufficiency of placenta. The possible connections with functional capacity of chorionic epithel will be discussed.

[Results of cytological and histological studies on the uterine cervix after long-term intake of hormonal contraceptive agents]. / Ergebnisse zytologischer und histologischer Untersuchungen der Cervix uteri nach längerer Einnahme hormonaler Kontrazeptiva

Cytologic examinations with 880 women having constantly used oral contraceptives from one to eight years show no agglomeration of epithelial atypias if the primary status was clearly in the negative. Among 669 histologically sure atypias of cervix uteri the part of women using oral contraceptives for at least one year is significantly lower in carcinoma in situ as well as in early invasive carcinoma. The differences in dysplasia are not significant. The results are also discussed with regard to the efficiency of permanent control examinations before and during the use of oral contraceptions. The demand of a further intensification of cytodiagnostic is derived from these examinations.

PIP: Studies of the cervical cytological effects of oral contraceptives are reported. Precontraception cytology (all clearly Group 1 or 2) in 880 women was compared with cytological findings after 1-8 year (average 2.4 years) of continuous use of Ovosiston or Non-Ovlon, and with those of a control group of 479 women of similar age. In addition, 669 women with cervical pathology (dysplasia, preinvastive and invasive carcinoma) were questioned on previous use of hormonal contraception for at least 1 year. No evidence could be found that hormonal contraception fostered cytological atypias if initial findings were negative. The proportion of women with cervical pathology who had taken hormonal contraceptives was significantly smaller than their proportion in the ambulatory patient population. These results are discussed in relation to the need for prospective studies of the effects of oral contraceptives.

[Brenner tumors]. / Uber Brenner-Tumoren des Ovars

It will be reported about 33 cases of Brenner-tumors, observed between 1932 to 1974. Symptomatic, therapy, progress, morphology of these tumors as well as their coincidence with other pathological changes on genitals will be demonstrated. A short casuistic description of 3 cases with proliferating and 1 case of malignant Brenner-tumor will be given. In the discussion, it will be informed about the frequency, age, diagnostic and prognostic problems of proliferating and malignant tumors. The problem of hormonal activity of some of Brenner-tumors and finally the modern views over histogenesis will be considered and discussed.