Gynakologisch-geburtshilfliche Rundschau最新文献

The majority of all deliveries worldwide take place in the so-called developing world. Most recent epidemiological data have shown that the number of cases of type 2 diabetes mellitus and diabetes in pregnancy is steadily increasing worldwide. However, little is known about the prevalence of gestational diabetes in East Africa. Intrauterine exposure to the metabolic environment of maternal diabetes increases the risk of altered glucose homeostasis in the offspring, producing a higher prevalence of gestational diabetes mellitus in the next generation. Our preliminary results from an East African tertiary referral center show that in the year 2007 3.1% of all newborns had a birth weight of more than 4,000 g (mean 4,300 g, range 4,000- 5,600 g). During the same time period, the mean birth weight in the general population was only 3,046 g (range 600-3,200 g). Hence, personal experience in East Africa has convinced the authors that diabetes in pregnancy is grossly neglected. Besides infectious diseases like HIV/AIDS, the African continent is increasingly facing metabolic diseases such as type 2 diabetes mellitus and diabetes in pregnancy.

This article aims to describe the pathophysiology of glucose metabolism in newborns of mothers with diabetes in pregnancy, the clinical signs of diabetic fetopathy and hypoglycaemia of the newborn, clinical practical procedures of post-partum blood glucose measurement and definition of hypoglycaemia, as well as prophylaxis and treatment of postpartal hypoglycaemia. In studies, newborns have been described with possibly severe mental retardation in the first years of life after post-partum recurrent hypoglycaemia with or without symptoms. Therefore, it is indicated to measure blood glucose levels regularly on the first day of life. Finally a flowchart for the measurement of glucose and therapy in newborns is presented.

Several developments in the field of reproductive medicine intend to improve the efficiency of the treatment and to reduce the number of unwanted side effects. These advancements are among others the production of long-acting FSH, polar body biopsy and the identification of factors, which can optimize the implantation potential of the endometrium. Cryopreservation of ovarian tissue enables the maintenance of fertility in tumor patients.

The basis of the preventive medical management during pregnancy in Austria is the mother-child pass which documents all examinations serving to monitor the normal course of pregnancy. Progress during the last few years has shown that regular medical preventive check-ups during pregnancy demonstrably lead to a reduction of maternal and fetal morbidity and mortality. The aim of these preventive pregnancy check-ups is--in addition to the registration of high-risk pregnancies which need an intensified supervision--the earliest identification possible of pregnancy-induced diseases in order to be able to monitor and treat them adequately. In Austria, these medical check-ups during pregnancy are required for the mother to receive the full child care benefit also from the 21st month of life onwards. For this, 5 prenatal preventive check-ups are absolutely necessary. In addition, ultrasound examinations between the 18th and 22nd and between the 30th and 34th weeks of pregnancy are recommended. Any further tests, like ultrasonography during the 1st trimester, nuchal translucency screening, combined test, invasive diagnostics (amniocentesis, chorionic villus sampling) or the oral glucose tolerance test, are not part of the current concept of prevention according to the mother-child pass; however, they are an option in the case of certain indications or at the request of the expectant mother.

The phylloid tumor (PT, formerly called cystosarcoma phylloides) is a rare neoplasia of the female breast. Usually the PT is treated with breast-conserving surgery. In spite of progress in early diagnosis, PTs recur frequently--independently of tumor's degree of malignancy. Especially in cases of malignant PT, complete resection with tumor-free margins is seen as the only predictive marker for tumor recurrence or metastases. Benign PT is also often resected with wide tumor-free margins. Because of the tumor's occasionally enormous dimensions, this therapy concept makes breast-conserving surgery almost impossible. A simple enucleation of benign PT is an option to facilitate the preservation of breast tissue and a cosmetically satisfactory breast reconstruction. In the case of particularly large benign PT, enucleation even without wide margins prevents tumor recurrence.

So far, implantation is a poorly understood process, which involves several paradoxical cell-biological mechanisms. First, 50% of the embryo is paternal and immunologically foreign material, and second, both the endometrium and embryo are covered by epithelial tissue to prevent cellular fusion. The adhesion and invasion of the blastocyst require an accurate coordination of embryonic and endometrial physiology and the modulation of maternal immune tolerance. Endometrial function plays an important role in assisted reproduction. Pathologies such as fibroids, hydrosalpinges, endometriosis and the polycystic ovary syndrome have a significant negative impact on implantation but can be treated in most cases. Therapeutic strategies to improve endometrial and embryonic function in recurrent implantation disorders are however still controversially discussed.

The success rates of present-day chemotherapy have provoked a rising awareness with regard to the preservation of quality of life among successfully treated patients. Among other factors, quality of life also implies the capacity to procreate. Unfortunately, both in men and women chemotherapy often irreversibly destroys the production of gametes, thereby causing permanent infertility. By its long-standing experience with the cryopreservation of oocytes, zygotes and embryos, reproductive medicine may offer assistance to those patients. Whereas the storage of cryopreserved semen has now become standard in most institutions, the options for the preservation of fertility in women suffering of malignant disease are still limited. Although cryopreservation of non-fertilized oocytes or of pronuclear cells has been established, both the number of oocytes that can be collected within the short time interval between the first detection of the tumour and the initiation of chemotherapy and the modest developmental capacity per frozen/thawed oocyte markedly limit the option of ovarian hyperstimulation and assisted reproduction. Several successful deliveries of healthy infants have now proven the feasibility of ovarian tissue cryopreservation and later orthotopic transplantation after successful tumour therapy. Further refinement of the techniques involved, but also the formation of multidisciplinary networks are expected to offer a solution for young women struck by cancer but striving to survive and to lead a fulfilled life.