[Results of postpartum Rhesus prophylaxis 1967 to 1990]. / Ergebnisse der postpartalen Rhesus Prophylaxe 1967 bis 1990.

INTRODUCTION: The aim of the study is to analyse the benefit of rh-prophylaxis at the Universitäts-Frauenklinik Köln from 1967 to 1990. MATERIAL AND METHOD: During that period 28,761 births, of whom 2602 were non-sensitized rh-negative mothers with a rh-positive child (9.04%), were assessed. 2223 mothers received rh-prophylaxis, in 379 cases rh-prophylaxis was omitted particularly within the first 4 years of the study period, due to a limited provision of anti-D immunoglobulines. From 1972 onwards postnatal rh-prophylaxis was omitted in only 3%. In 14.5% of the 379 women without rh-prophylaxis contamination of the maternal circulation system with HbF cells was confirmed by the Kleihauer-Betke-Test. In 98.4% of the cases rh-prophylaxis was performed postnatally within the first 72 hours. RESULTS: During the study period the initial dosage of IgG anti-D was set at 55 - 150 microgram i.v. (n = 217) and later increased to 150 - 250 microgram i.v. (n = 1109) and finally to 300 - 330 microgram i.m. (n = 897). After rh-prophylaxis presence of HbF cells in the maternal circulation was found in 5.5% of the mothers of group 1, in 2.1% of the second group and in 1.1% of the third group. In the group of mothers without rh-prophylaxis 69 had a second delivery and rh-sensitsation was found in 7.3% of these cases. Of 537 women having received rh-prophylaxis who delivered a second rh-positive child, 9 (1.7%) showed rh-sensitisation. of the 352 women with rh-incompatibility 8 (2.3%) had already been sentisized during their first pregnancy. CONCLUSIONS: The study confirms that postnatal application of anti-D immunoglobulins is effective to a great extent but does however not completely exclude rh-sensitisation. Furthermore, we recommend the additional prenatal rh-prophylaxis as introduced by the German maternity regulations since 1990.

[Results of transabdominal placental biopsy in the 2nd and 3d trimester]. / Ergebnisse der transabdominalen Plazentabiopsie im II. und III. Trimenon.

From August 1988 to October 1990, 115 transabdominal placental biopsies were performed in the second (68%) and third trimenon (32%). The main indication (80%) was the detection of pathological ultrasonographic findings (foetal malformation, growth retardation, oligohydramnios and polyhydramnios). The success rate of chorionic villus sampling (89%) was independent of the localisation of the placenta. A definite cytogenetic result was found in 83% of patients. By combination of placental biopsy and amniocentesis (n = 77) karyotyping was successful in 97% of pregnancies. Chromosomal abnormalities were observed in 15 (13%) cases (7 autosomal and 2 gonosomal aneuploidies, 1 unbalanced translocation, 1 autosomal deletion, 4 structural variants). The outcome of the pregnancies was substantially influenced by the indication for the procedure and by the cytogenetic result. Foetal and peri-/neonatal losses were found in 53% (3% spontaneous abortions) of patients with sonographic abnormalities (n = 92) and in 9% (abortion rate 4%) of pregnancies with regular findings (n = 23). The pregnancy loss rates were 37.7% and 5.9%, respectively. The results confirm the clinical significance of placental biopsy in the management of pregnancies with pathological ultrasonographic findings.

[Prenatal diagnosis of neural tube defects and clinical consequences]. / Pränatale Diagnostik von Neuralrohrdefekten und klinische Konsequenzen.

Today, ultrasound is the most important method for antenatal recognition of defects of the central nervous system. This article reports our 17 years experience in antenatal diagnosis and management of neural tube malformations. A total of 103 neural tube defects were diagnosed, including anencephaly (36), rachischisis (31), encephalocele (13), microcephaly (11), and hydrocephalus (35). Ultrasonic findings, clinical histories, and management are reviewed.

[Early ultrasonic diagnosis of thoracopagus]. / Frühe Ultraschalldiagnose des Thorakopagus.

Two cases of early ultrasonic diagnosis of conjoined twins (thoracopagi) in the 13th and 21th week of pregnancy, respectively, are reported. Heart and liver were fused in both and the upper gastrointestinal tract in one of the pairs. Once an ophalocele was seen. The most important ultrasonic criteria were close and fixed position of the twins to each other, ventral fusion of the thoracal and abdominal contours and detection of joint organs. Since hearts and livers were not paired, there was no chance of any successful therapy and on the parent's request, both pregnancies were terminated.

[Chorioangioma--sonographic diagnosis and clinical significance]. / Chorioangiom-sonographische Diagnose und klinische Bedeutung.

This paper presents two cases of large placental chorioangiomas associated with polyhydramnios, detected in the 25th and 27th week of pregnancy, respectively, using ultrasound. The tumors produced complex echo-pattern with transonic and echogenic areas. In the one case, the fetus, malformed by an omphalocele, was spontaneously aborted in the 25th week. In the other case, regular contractions, resistant to any therapy, and fetal asphyxia urged delivery by Caesarean section in the 27th week. The neonate died from pulmonal prematurity. The reported complications associated with large chorioangiomas and perinatal mortality up to 80%, according to the literature, underline the need for early sonographic diagnosis.

[Child development following severe intrauterine growth retardation--results of follow-up studies]. / Die kindliche Entwicklung nach schwerer intrauteriner Wachstumsretardierung--Ergebnisse von Follow-up-Studien.

94 prenatally severely dystrophic newborn (year of birth: 1970 to 1982) of the Department of Gynaecology of the University of Cologne were catamnestically investigated when they 2 to 12 years of age; follow-up examinations were performed by paediatricians, neurologists, EEG specialists and by test psychology. In more than one-half of the children followed up in this manner delays in early childhood development were seen; there were no conspicuous differences between the two groups (classified according to years of birth). On comparing the age brackets 1970-1975 and 1976-1982 about one-third of the children in both groups presented at follow-up clearly evident signs of retarded growth. In 32% of the children born between 1970 and 1975 mostly mild neurological deficits or slight impairments of nerve function were observed, whereas in the 1976-1982 group this figure was 26%. The incidence of cerebral pareses was 7% and 9%, respectively. Disturbances of fine motor response were most frequently seen. Mild to moderate EEG changes occurred in both patient groups at about the same rate of incidence (34% and 32% respectively); one child in each group presented with definitely pathological electroencephalographic findings. Pathological test psychology results were seen in 38% (1970-1975) and 21% (1976-1982) of the followed-up children; the tests employed were the Göttingen form reproduction test in children born between 1970 and 1975 and the Denver development test in the younger children born between 1976 and 1982.(ABSTRACT TRUNCATED AT 250 WORDS)

[Obstetric management in severe fetal growth retardation. Report of experiences based on 278 newborn infants with severe dystrophy 1970-1985]. / Geburtshilfliches Management bei schwerer fetaler Wachstumsretardierung. Ergebnisbericht anhand von 278 Neugeborenen mit schwerer Dystrophie der Jahrgänge 1970-1985.

The article discusses and reviews the obstetrical modalities in confirmed severe growth retardation and the effects exercised by marked dystrophy of newborn (less than or equal to 3rd percentile of weight) at the Department of Gynaecology of the University of Cologne between 1970 and 1985 on perinatal mortality, rate of asphyxiation and neonatal complications. In view of the optimal diagnostic possibilities available during the past decade, the examinations were subdivided into two groups (1970-1975 and 1976-1985). In severe foetal growth retardation-mainly confirmed sonographically-the proportion of primary Caesarean sections increased from 10% to 38%, whereas indication for inducing labour clearly dropped from 25% to 6%. The desired slight reduction in incidence of prenatally severely dystrophic newborn from 1.6% to 1.2% is regarded as the beginning of the effect of ultrasound screening during pregnancy. The higher perinatal mortality of the severely dystrophic newborn of the years 1976-1985 is explained by the increased incidence of dystrophic newborn who are considerably underweight (less than 1000 g) from 1.3% (1970-1985) to 10.4% (1976-1985). If perinatal mortality rate is corrected accordingly, perinatal mortality for both groups is about equal, namely, 3.3% and 3.2% respectively. Among the severely dystrophic newborn there were distinct differences on comparing the two groups in respect of the degree of maturity depending on the pregnancy period, and of the weight at birth. In 1970-75 85% of the dystrophic children were born after the 37th pregnancy week, i.e. mature-dystrophic, and only 15% showed in addition the signs of immaturity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and prognostic aspects of congenital hydrocephalus]. / Klinische und prognostische Aspekte des konnatalen Hydrocephalus.

Clinical data of 24 patients with congenital hydrocephalus are presented. 13 children died within the first 7 months of life; the average period of survival was 2 months. Associated malformations of the CNS or other organs, severely raised intracranial pressure in utero, and postnatal complications involving the CNS indicated a poor prognosis. The follow-up of the 11 surviving children showed severe neurologic sequelae and drug resistent epilepsy in 2 of them. Three others had neural tube defects and associated paraplegia. The 6 remaining children had mild or moderate cerebral palsy or were moderately mentally retarded. If possible, birth should not be induced before 36 weeks of gestation, and the hydrocephalus should be shunted soon after birth. Satisfactory results can be obtained in about one half of surviving patients by early shunting of congenital hydrocephalus.

[Risks in pregnancy after kidney transplantation]. / Risiken der Schwangerschaft nach Nierentransplantation.

Two women had four supervised pregnancies after renal transplantation. A striking feature was that the children had fetal growth retardation which led to premature termination of pregnancy by section. Likely causes of the growth retardation are, in the first instance, long-term treatment with corticosteroids and increased incidence of toxaemia. There is no evidence for a significant rise in the risk of teratogenicity for the embryo by the immunosuppressive treatment. However, an increased mutagenicity risk must remain a possibility in view of the one case of Turner's syndrome. Close interdisciplinary control of mother and child makes it possible to reduce risks to a reasonable level in case of pregnancy after renal transplantation.

[Prenatal diagnosis of fetal meconium peritonitis, therapy and clinical course. With a contribution to the differential diagnosis of fetal ascites]. / Pränatale Diagnose einer fetalen Mekonium-peritonitis, Therapie und Verlauf.

We report on the prenatal diagnosis of a case of foetal meconium peritonitis pursuant to colon perforation in the 34th week of gestation. A sonographic examination of the foetus showed ascites, dense zones around the peritoneum and intestine, hepatosplenomegaly and hydroceles, as well as a slight hydramnios. The foetal abdomen was punctured under ultrasonographic control, and ascitic fluid was withdrawn. It was sterile but included granulocytes, leucocytes, epidermal epithelial cells and lanugo hairs, thereby confirming the diagnosis. The bilirubin concentration was very high, and the protein content was also increased. An amniofoetography gave a clear picture of the small intestine and showed a calcified zone in the upper left abdomen. A Caesarean section was performed prior to term, and the prenatal diagnosis was confirmed. After surgical correction the infant has developed satisfactorily up to the present age of 15 months, even though mucoviscidosis was diagnosed at the age of 5 months. In addition to ascites due to meconium peritonitis, several other types of foetal ascites are discussed.

[Outcome of pregnancy following amniocentesis in the prenatal diagnosis of genetic birth defects]. / Schwangerschaftsausgang nach Amniozentese zur pränatalen Diagnostik genetisch bedingter Defekte.

From 1973 to 1982, genetic amniocenteses were performed in 2548 women with singleton pregnancies. Of the cases done up to the end of 1979 the outcome of the pregnancy is on record in 1163 of 1232 cases. Of the cases done from 1980 to 1982 the outcome up to three weeks after the amniocentesis is known in all cases. The final outcome of the pregnancy is known in 25% of these cases. The over-all abortion rate due to the amniocentesis was 0.5%. In the first group, the abortion rate was 0.8% for ultrasound guided amniocenteses and 2.9% for blind punctures. The fetal loss rate from abortion and stillbirth was 3.5%. The abortion rate was correlated to the maternal age, threatened abortions prior to the amniocentesis, the placental site and the technique of puncture. Because of pathological findings, the pregnancy was terminated in 3.2% of the cases. The majority of the amniocenteses was performed between the 16. and 18. week of gestation. Repeat punctures were required in 1.9% of the women. The incidence of discoloration of the amniotic fluid was 2.0%. The rate of frankly blood stained fluid was 2.2%. The frequency of minimally blood stained fluid was 3.2%. Blood stained samples of amniotic fluid were significantly more often obtained with larger canulas , blind punctures and in cases with anterior placentas. A feto-maternal transmission of red blood cells was detected in 10 of 699 tested cases (1.4%). Serious maternal complications or fetal injuries did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of the ovulation date in women with disturbed cervical factor by means of sonographic measurement of follicular growth, hormonal parameters and basal body temperature]. / Bestimmung des Ovulationstermines bei Frauen mit gestörtem Cervixfaktor mittels sonographischer Messung des Follikelwachstums, hormoneller parameter und Basaltemperatur.

In 23 women from the fertility clinic with disturbed cervical factor and ovulatory cycles, the BBT was carried out, FSH, LH, progesterone and E2 were assayed and the follicular maturation was determined sonographically. The hormonal assays and ultrasound investigations were performed as a rule at 1-2 day intervals. The follicles were measured three dimensionally. At the time of ovulation, the mean diameter averaged 23 mm. There was a very good correlation between the various methods for determining the date of ovulation. Since the cervical factor could not be used for date determination in the patient group investigated, the immediately available result of the ultrasonographic investigation proved to be especially valuable. It was possible to attain a pregnancy in four cases.

[Sonographic demonstration of the fetal extremities in the mid-trimester (author's transl)]. / Die sonographische Darstellung der fetalen Extremitäten in mittleren Trimenon.

In 251 pregnancies fetal extremities were systematically examined by means of an ultrasound sector scanner between the 12th and 28th week of gestation. The procedure is demonstrated by typical pictures. The long tubular bones, hands and feet were visualized regularly, and differentiation of radius and ulna or tibia and fibular was possible. Studies took between 5 and 25 minutes. In all cases the length of the diaphyses was determined, resulting normal growth tables and rate of growth curves. Between the 12th and 28th week, the humerus grows from 9 to 51 mm., the radius from 7 to 46 mm., the femur from 10 to 55 mm., and the tibia from 8 to 48 mm. Sonographic depiction of fingers and clavicles was also quite successful. For best results, examinations were done between the 16th and 20th week. In three fetuses later aborted, sonographic and direct (after preparation) measurements of bone length for the diaphysis differed by no more than 4%. The study shows that visualization of the extremities regularly succeeds in the mid-trimester. A multitude of localized or systemic limb malformations may be recognized. In cases with known predisposition to malformations a regular ultrasonic checkup should be performed, thus extending the scope of prenatal diagnosis.

[The use of determining the sound intensity of diagnostic ultrasonic equipment in obstetrics (author's transl)]. / Zur Bedeutung der Intensitätsmessung diagnostischer Ultraschallgeräte für die Geburtshilfe.

The possible risks when using help energy ultrasound have resulted in worldwide "standard committees" establishing guiding values for the sound intensity which must not be exceeded by diagnostic equipment, 100 mW/cm2 are commonly accepted. The intensity level can be measured with a special very small microphone. The highest values occur at distances of near field length (also "standard working distance") or in the focal point. For measurements of sound intensities of different equipment (Real-time-scanner, Compound-scanner, Encephalographs, Doppler-unit) we used a sonic microphone which was calibrated by the "Physikalische Technische Bundesanstalt" (Physical-Technical Federal Institute). The measurements were carried out in water and correspond approximately to the value in human tissue. Using focusing transducers the sound intensity was much higher than without focusing transducers. Working with such a modern transducer and an old compound-scanner the measurement gave approximately 300 milliwatt per square centimeter. The results show that focusing trasducers cannot be used without a great deal of forethought.

The use of ultrasound in the diagnosis of pelvic pathology.

At the Universitäts-Frauenklinik Köln (Cologne) 515 patients with gynecological symptoms underwent 597 clinical and ultrasound examinations; 224 patients had a subsequent laparotomy which offered means of checking the clinical and ultrasound findings. There was full agreement between ultrasound and clinical examination in 80%, partial agreement in 9%, and no agreement in 11%. Ultrasound provided information not gained by clinical means in 12%. In those patients subjected to operation clinical examination provided correct and complete diagnoses in 70% of patients, partially correct diagnoses in 19%, and wrong diagnoses in 11%. Ultrasound, however, provided correct diagnoses in 78%, partially correct diagnoses in 14%, and wrong diagnoses in only 8%. The results of ultrasound and clinical findings tallied in 51%, in 38% the ultrasonogram provided more precise information than palpation, and in 11% the clinical findings were more revealing than ultrasound examination. Additional valuable information was provided by 13% of ultrasonograms. Ultrasonography was not a precise predictor of malignancy.

[Amniocentesis in prenatal diagnosis of genetic disorders in twin pregnancies (author's transl)]. / Zur Amniozentese in der pränatalen Diagnostik bei Zwillingsschwangerschaften.

In 14 twin pregnancies amniocentesis was performed for prenatal detection of genetic disorders. The indications, technique of amniocentesis under control of ultrasound, results and the outcome of pregnancies were described. In all cases with two amniotic-sacs a separate amniocentesis was possible. The prenatal diagnosis was always proved after delivery.