Zeitschrift fur Geburtshilfe und Perinatologie最新文献

Unlabelled: Mean actual pH-values in umbilical arterial (UA) and venous (UV) blood as well as mean AV-pH-differences (AVD-pH) were computed for individual Apgar-scores (1 min) in a sample of 10,580 term neonates, which were born vaginally from vertex position. The newborns of the study group showed all different kinds of cord entanglements (CE, N = 3430); neonates without CE were used as controls (N = 7144). In addition infants of the study group were attributed to two different birth weight-centile groups: < 25. and > 75. percentile.

Results: In the study group mean AVD-pH-values in individual Apgar-scores showed a significant (P < 10(-5)) increase when compared with controls. The numerical value of AVD-pH seems to be a function of the clinical condition of the newborn: maximum value (mean = 0.113) was reached at Apgar 7; increasing neonatal distress was accompanied by low AVD-pH-values. This phenomenon was due to a decrease of actual pH in UA-blood and an increase in UV-blood; the latter was statistically feasible (P = 0.025) only in neonates with Apgar 8. AVD-pH-values of neonates above the 75. weight-centile showed a different reaction-pattern in individual Apgar-scores when compared with infants below the 25. centile: They remain constant or are slightly increased. We concluded, that blood-flow reduction in the umbilical vessels leads to a flow-dependent improvement of fetal pCO2-excretion at the placental level, which counteracts the developing metabolic fetal acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

In a cross-sectional study of 211 patients with a normal pregnancy the distance of the symphysis was sonographically measured during pregnancy and normal values were evaluated. Physiologically a continuous widening of the symphysis was shown up to 3 mm an average. The sonographical sign of the damage of the symphysis was a deviation in widening and also a difference in height. The value of the sonographic examination is shown in 2 cases with damage of the symphysis and compared to the x-ray picture results.

Measurement of umbilical, uterine and arcuate velocity waveforms was used to study 40 pregnancies complicated by insulin dependent diabetes. Continuous wave doppler velocimetry was used to identify flow velocity profiles during the second and third trimester of pregnancy. Resistance index (RI) was calculated to evaluate waveforms. In most of the patients with fetal growth retardation and/or pregnancy induced hypertension an increase in vessel resistance was found in uterine and arcuate arteries as well as diastolic notching. In comparison to that fact White's classification showed no significant correlation to vascular resistance determined by doppler flow measurement. This study indicates that doppler ultrasound examination may have an adjunctive role in the surveillance of pregnancies complicated by diabetes.

In a clinical examination an attempt was made to confirm the aptitude of a commercially available immunoassay to detect amniotic fluid. Pure amniotic fluid gained by amniocentesis, not mixed with other secretions, was used. On examination using three different batches the sensitivity of this test amounted to 35/55 in all, or 64%. We came to the conclusion that the present test was not sufficiently reliable to prove or disprove the discharge of amniotic fluid. An explanation is needed especially regarding the role played by the forces which occur during contractions and the presence of cervical and vaginal secretions when fetal fibronectin is found to be present. The evidence of fetal fibronectin could possibly become more important as a predictor of imminent labour than as being proof of the admixture of amniotic fluid in cervical and vaginal secretions.

3799 women delivered by cesarean section at the Department of Obstetrics and Gynaecology of the University of Ulm between 1978 and 1988 were retrospectively divided into three groups, according to the urgency of cesarean section: group [1]: elective cesarean section (n = 1333), group [2]: urgent cesarean section (n = 2295), group [3]: emergency cesarean section (n = 171). Group [1] comprised the greatest risk in terms of maternal diseases, pregnancy complications and previous cesarean sections, group [2] the least. Intraoperative complications were seen more often in group [3] than in groups [1] and [2] and included a greater number of operations lasting more than 2 hours (group [3]: 2.3%, group [1] and [2]: < or = 0.5%), a higher incidence of severe blood loss and consequent need for blood transfusions, and of serious complications such as damage to adjacent organs and need for hysterectomy (group [3] 4.7%, groups [1] and [2]: 1.6%). In group [3] the rate of postoperative complications, especially of infections, was unexpectedly low (e.g. fever > 38 degrees C in group [1]: 8.6%, group [2]: 11.5%, and in group [3]: 9.9%). This was not only explainable by more frequent prophylactic use, in group [3], of antibiotics whose efficacy in reducing infections was demonstrated. Altogether five patients died, two deaths, both in group [2], were directly related to cesarean section. Between 1978 and 1988 an increasing incidence of low birth weight infants was found in all groups, with the highest rate in group [3].(ABSTRACT TRUNCATED AT 250 WORDS)

Unlabelled: The influence of the microflora of the vagina and cervix has been undervalued for the induction of premature birth. Examination of the microbiological problem by determination of the vaginal pH in combination with the microflora (Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum). Report of the outcome of 161 prospective, ad the beginning normal pregnancies in comparison of 200 primary hospitalized pregnancies with symptoms of imminent premature birth.

Conclusion: The vaginal pH is a very useful parameter of screening for identification of disturbances of the microflora in practice. In cases of pathologic pH (> 4.5) it is possible by therapy to reduce the premature birth rate.

33 patients with tubal pregnancy and beta-HCG level less than 2500 mIU/ml were treated with local, laparoscopic Prostaglandin-injection. Re-operation was not necessary and beta-HCG fell to undetectable levels in 73% (p = 0.05). Serial beta-HCG correlated poorly with outcome. In patients with an increasing beta-HCG success was limited to 55% (p = 0.59). In contrast patients with falling or stable beta-HCG values had success rates of 85.7% (p = 0.22) and 83.5% (p = 0.30) respectively. Our data suggests there may be a clinical advantage to the use of prostaglandin-injection for the conservative management of early ectopic pregnancy. However the utility of preoperative serial beta-HCG values in predicting success showed a trend, without reaching statistical significance.

The three-dimensional media structure of the umbilical arteries in their various functional states has up to now been object of numerous investigations, which are predominantly based on light-microscopic findings and have come to extremely differing results. For that reason the electron microscope method with an optically higher resolution was chosen for this thesis. In total, 20 umbilical cords were recovered, and in each case one of the two umbilical cord arteries was kept in a condition of non-contraction by means of perfusion fixation immediately after the omphalotomy. After the necessary preparation longitudinal, diagonal and cross-sections of both non-contracted and fully contracted umbilical arteries as well as of the folds of Hoboken, which occur in the arteries postnatally, were investigated by the scanning electron microscope. During this examination the following findings were made: The media in the wide umbilical cord artery consists of two layers. The outer layer accounts for some three quarters of the wall and is composed of lamellae of parallel muscle fibres which surround the vessel alternatively in gently rising and falling thread-like turns. The inner layer accounts for the remaining quarter and also consists of lamellae the thread-like turns of which, however, run at a much higher pitch. Exactly subendothelial, a very thin layer of irregularly arranged fibres with longitudinal main direction can be clearly identified. The folds of Hoboken are caused by local media contraction in the course of which the outer media restructures itself, thus being the main carrier of the fold.(ABSTRACT TRUNCATED AT 250 WORDS)

50 Patients weighing between 45 and 114 kg underwent standardized computed tomography of the pelvis. Fat compartments from inside and outside of the small pelvis were assessed quantitatively by means of tracing the fat tissue borders and planimetry. Fat compartments within the small pelvis showed a rather weak correlation with body weight and the so called Rohrer-Index as a weight/height-Index, correlations with the latter being slightly better. From the fat compartments within the single levels the functional reduction of birth channel diameters caused by fat tissue was calculated for. The weight/height-index dependent increase of space demand within the birth channel was rather pronounced at the pelvic brim becoming slighter when reaching mid-pelvis or even pelvic outlet. Hence, the common assumption can no longer be maintained, that adiposity necessarily causes soft tissue dystokia due to larger fat compartments within the small pelvis.