Zeitschrift fur Geburtshilfe und Perinatologie最新文献

During a relaxation bath, a 20-years old I-Para had an accident by submersion. In succession, both, mother and child, experienced irreparable cerebral injuries. While the counsel of prosecution pleads for manslaughter, forensic scientists and gynaecologists advise to discuss the inaccuracies in the law of midwife.

We conducted a retrospective examination of the data of 36 patients with congenital diaphragm defects detected at an early stage or even before birth. The course of pregnancy, pregnancy risks, prenatal findings, mode of delivery, clinical parameters, prenatal, perinatal and postnatal procedures, findings at surgery and surgical therapy were analyzed with respect to the patients' outcome. The following factors were seen to influence the prognosis: associated anomalies, prenatal diagnosis, maturity for age, weight, Apgar score, the size of the defect and the extent of the pulmonary hypoplasia (and--linked to this--the patient's cardiorespiratory condition prior to surgery), and possibly sex. The mortality of patients surviving until surgery became possible was 28%. Our standard procedure in case of diaphragm defects known before birth is primary intubation before the child's first spontaneous breath. We also consider the practice of delaying surgery until stabilization has been achieved and especially in the incubator on the ward the course of action with the fewest complications at present from the patient's point of view.

Primary hyperparathyroidism has to be accused to cause serious morbidity during pregnancy not only on the maternal, but also on the fetal side: the fetus is threatened by prematurity, dystrophy and an increased risk of stillbirth. Postpartually hypocalcaemia and tetany may be observed as the result of neonatal hypoparathyroidism caused by maternal and thus also fetal hypercalcaemia. We report the case of a 32-year-old pregnant woman suffering from a severe form of primary hyperparathyroidism caused by an adenoma of the parathyroidea. The tumor was removed in the 34. week of pregnancy. Six weeks later the patient delivered a healthy boy (birth weight 3450 g). A survey is given of the therapeutical procedures that should be arranged individually by interdisciplinary consulting depending on the degree of maternal disease and on the gestational age.

423 deliveries by breech presentation (1988-1992), delivered by vaginally or abdominally management, were analysed. 72 preterm (32nd to 36th gestational week) and 351 term labours were studied. In 239/423 (56.5%) cases neonates were delivered vaginally, in 54/423 (12.8%) and 130/423 (30.7%) cases primary or secondary cesarean section was necessary. In 120/423 (51.9%) cases of all primaparous spontaneously delivery were realized. There was no difference in early morbidity of vaginal und abdominal delivered neonates (pHNA, APGAR-Score, intracranially bleeding). Three intracranially bleedings (I degrees, II degrees, III degrees) observed in the vaginally delivery group (n = 239), were not the result of breech presentation or vaginally management. No correlation between vaginally management, acidosis and intracranially bleeding were observed. In patients presented with preterm labour (32nd to 36th gestational week) and/or fetal intrauterin growth retardation, cesarean section could be indicated. In postnatal sonographic screening of all neonates hip joint disorders were twice more frequently in female neonates (n = 51 vs. n = 26) without correlation to delivery mode. In conclusion, if certain personally and equipmently conditions are considered, vaginally delivery mode does not correlate to an increase of early neonatal morbidity.

Absent or reverse enddiastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress and adverse fetal outcome. We studied 68 fetuses with AREDFV with respect to abnormal neurological evaluation up to two years. A control group was matched for gestational age and had normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed increased abnormal neurological signs, compared with the control group (31% vs. 12%). Our results confirm the significance of AREDFV in growth retarded infants with respect to neurological development in early childhood.

In recent years the syndrome of hemolysis, elevated liver enzymes and low platelets (H-ELLP) has attracted increasing interest in obstetrics as a serious complication of pregnancy, either alone or in combination with the classical symptoms of EPH-gestosis or eclampsia. In 1993, we observed 3 cases of severe HELLP syndrome in a total of 1126 deliveries. We present the clinical characteristics and the laboratory findings in these cases. A common symptom was general malaise and upper abdominal discomfort or pain. All patients were delivered by cesarean section of healthy infants. We conclude that it is no longer sufficient to emphasize edema, proteinuria and hypertension, but that the signs and symptoms of the HELLP syndrome present a new and increasingly important challenge in obstetric practice.

Size and shape of the bony pelvis are important factors determining the progress of labor and delivery. Clinical evaluation of the pelvis and sonographic examination of the fetal size are important tools for the planning of labor and in most cases allow to diagnose cephalopelvic disproportion. Pelvimetry by computed tomography (CT) and by magnetic resonance imaging (MRI) are exact and simple techniques with low or absent ionizing radiation. These new techniques offer distinct advantages over conventional X-ray pelvimetry. However, the value of the measurements of the pelvic dimensions in predicting labor outcome and in the diagnosis of cephalopelvic disproportion remains limited. Only if the pelvimetric data are combined with data on fetal dimensions obtained by ultrasound or by postpartum measurements, the efficacy of the examination in predicting the success of labor and identifying the presence or absence of cephalopelvic disproportion is increased. This combination therefore may confirm the diagnosis of cephalopelvic disproportion after operative delivery, which is important with respect to subsequent deliveries. Furthermore this method could play and important role in selecting patients with term breech presentation for possible vaginal delivery.

Vulvar hematomas, resulting from obstetric traumata represent a rare complication. The author describes a respective case and gives a survey on literature regarding vulvar hematomas. The advantages and disadvantages of conservative and surgical treatment are discussed.

In a Study of 500 unselected women in childbed interested the incidence and risk factors of residual urine over 50 ml (RH), sonographically proven in the first days after birth. The incidence after vaginal birth was 17% and after C-section 13%, 7% and 1% suffered from a urinary tract infection respectively. The RH-phenomenon lasted approximately 3 days. Significant risk factors have been: vaginal-operative deliveries (forceps, Vacuum-Extraction) protracted deliveries (over 12 hours) protracted expulsion period (over 1 hour) longer expulsive periods (over 15 minutes) newborn head-circumference over 36 cm I-Parae with episiotomy -PDA had only an additive effect. The shown quantitative aspects make it easier to evaluate the risk and the exact sonographic search for residual urine in the days pp.