Zeitschrift fur Geburtshilfe und Perinatologie最新文献

Magnesium is commonly used in the therapy and prevention of preterm labor. Therefore the differences of the concentrations of magnesium and its antagonist calcium were measured in the human myometrium to examine the interaction of labour and ionic changes. The ionic concentration in the myometrium of 37 patients without labour are determined and the values are compared to the data of 26 patients in active labour. Women of the first group without labour had a magnesium concentration of mean = 4.1 mmol/kg wet weight and a calcium concentration of mean = 2.9 mmol/kg wet weight. Women of the second group with active labour have a significantly lower (p < 0.01) magnesium concentration (mean = 3.5 mmol/kg wet weight). However, the calcium level (mean = 2.7 mmol/kg wet weight) does not show significant differences. These results indicate that the decrease of magnesium plays an important role in the physiology of parturition. A low magnesium concentration in the myometrium might have a considerable influence on premature labour in the third trimester of pregnancy. Therefore a prophylactic application of magnesium seems to be useful.

During a clinical study 70 women in labour were monitored with fetal pulse oximetry. The oxisensor (FS 10) was positioned between fetal cheek and the uterine wall at a cervical dilatation of 2 cm or more. The advantage of the method is its minimal invasive character and the continuous monitoring of oxygen saturation. The pulse oximeter (N 400, Nellcor) had been blinded for the investigation following criteria met by FDA, so that the investigator could not read the saturation values. Preliminary results of more than 120 hours of monitoring intervals of 10 seconds show the following saturation values (median): 55% under normal CTG (10. perc. 36%, 90. perc. 73%), 42% during episodes of variable decelerations (10. perc. 22%, 90. perc. 63%), 53% during episodes of early decelerations (10. perc. 39%, 90. perc. 74%). Due to pathological fetal heart rate patterns 42 fetal blood analysis were performed. Because of these spectrophotometric saturation measurements (ABL 330, OSM 3, Radiometer) the deviation of the two methods could be calculated. The values of pulse oximetry were 5% higher than those of spectrophotometry. Correlation of both methods was r = 0.64.

Precardiac venous blood flow, umbilical artery and aortal blood flow of 120 unselected patients has been investigated by means of Doppler ultrasound. Measuring a hepatic vein directly before entering the inferior vena cava we found a characteristic blood flow pattern with a moderate foreward flow during systole and a small foreward flow during early diastole and a very small reverse flow because of atrial contraction during late diastole. We found changes in this flow pattern with reduction of the mean velocity in cases of high risk pregnancies with intrauterine growth retardation. Comparing normally developed fetuses with growth-retarded fetuses and vaginal delivery or caesarean sections without fetal distress with caesarean sections because of fetal distress we found significant differences with lower mean velocities in the precardiac veins of the latters. Comparing the precardiac venous flow velocities with the umbilical artery flow velocities and the fetal descending aortal flow velocities we found similar results of statistical values predicting growth retardation and caesarean section because of fetal distress. We concluded that venous Doppler flow velocity analysis is also able to predict perinatal risks like intrauterine growth retardation or caesarean section because of fetal distress as good as flow velocimetry of the umbilical artery or the fetal aorta; if it is impossible to demonstrate the fetal descending aorta or the vena cava inferior sonographically correctly the investigation of the hepatic vein may give you more reliable Doppler values for your clinical management.

Subclinical intrauterine infection is one of the causes of preterm birth. Adjuvant antibiotic treatment can improve the prolongative effects of tocolysis in patients with preterm labour. This study was conducted to evaluate the effectiveness of screening for infection and of antibiotic treatment in reducing postpartal infectious complications in patients with so called idiopathic preterm labour being treated with tocolysis intravenously. At the time of admission, we obtained cervical swabs of 138 patients for bacteriological investigation. 23 of the 37 patients with pathologic cervical colonisation were treated with antibiotics in addition to tocolysis. In women in preterm labour with pathologic cervical microbial colonisation, the frequencies of infectious complications in the puerperium were markedly increased compared to women without cervical colonisation. Adjuvant antibiotic therapy during pregnancy significantly reduced such complications. Additional antibiotic treatment of patients in idiopathic preterm labour with indicators of silent intrauterine infection seems beneficial not only for prolongation of gestation, but also for the reduction of postpartal infectious morbidity.

Reflectance pulse oximetry is a new method to monitor the fetus during labour in order to get a better assessment of the fetus's condition than by CTG interpretation alone. In this study the method is investigated with regard to its prognostic value concerning fetal outcome and complications possibly due to its application: Increased uterine bleeding, umbilical cord complications, amniotic infection syndrome. Arterial oxygen saturation was continuously recorded during labour in a total of 122 patients with a gestational age between 37 and 42 weeks and correlated to the umbilical cord-pH post partum and, if available, to intrapartum fetal blood gas analysis. 30% seems to be a threshold value below which oxygen saturation should not drop for a longer period of time. A post partum pH < 7.2 can be expected in more than 50% of the cases in which the saturation remains below this value for more than ten minutes. The application of the fetal pulse oximeter sensor did not affect maternal or fetal morbidity.

Background: The reported incidence of neonatal acidosis varies++ significantly in different obstetrical departments. We wanted to investigate to which extend neonatal acidosis is depended on maternal respiration patterns during the third stage of labor.

Methods: Maternal arterial blood gas analysis was performed in 101 term pregnancies. Fetal acid-base parameters from arterial and venous umbilical blood were assessed simultaneously. SPEARMAN rank correlation (rs) was used to investigate the statistical relationship of maternal and fetal blood gas parameters and pH-values. Moreover a computer model was developed to describe the influence of maternal respiration on neonatal acidotic risk figures.

Results: A highly significant correlation was established between corresponding variables in maternal arterial blood and in venous umbilical blood (rs > or = 0.500, 2P < 0.001). These correlations were not as striking when comparing maternal parameters with corresponding variables in arterial umbilical blood. The partial oxygen pressure in arterial and venous umbilical blood did not show any correlation with the variables of the maternal acid-base status. In the computerized simulation model mild maternal hyperventilation during the third stage of labor decreased the risk of neonatal acidosis (pH, UA < 7.100%) by approximately 25% without evidence of lack of fetal oxygen supply.

Conclusions: A mild maternal hyperventilation synchronized with uterine contractions during the third stage of labor in combination with rapid breathing when delivering the fetal head has a favourable influence on the neonatal acid-base balance. In this study there is no indication that such an obstetrical management results merely in a laboratory artifact, because according to our data there was indeed no indication of compromised fetal oxygen supply. Routine fetal blood sampling also from venous umbilical blood appears to be useful in differentiating between combined feto-maternal and isolated fetal variations in actual pH-values.

From August 1992 to August 1993 we used the Prematurity Prevention Programme at 50 Pat. (23 + 1 to 34 + 0 pregnancy week) with premature labour or with a premature rupture of membranes. The results tally for the most part with the results in the literature. The combination of a positive bacteriological cut, of a positive identification of fibronectin and of a CRP-value > or = 2.0 mg/dl indicate and advanced degree of symptoms of premature birth through infection. With the examinations of the Prematurity Prevention Programme we have a simple technical and systematic programme for assessment symptoms of premature birth. The clinical use of this programme is a good help at the medical care of high risk patients.

Accumulating evidence indicates an association between intraamniotic infection and raising concentrations of amniotic cytokines, resulting in preterm labor and preterm rupture of fetal membranes, because these cytokines are able to stimulate prostaglandin biosynthesis. Therefore the purpose of our study was to investigate if quantitative determination of Il-1 beta, Il-6, Il-8 and TNF-a in amniotic fluid may be a practicable method to diagnose intraamniotic infection. Since invasive amniocentesis doesn't allow repeated cytokine detection, in case of preterm rupture of fetal membranes, amniotic fluid also was obtained by placing a sterile gauze and cotton pad into the women's vagina, absorbing draining amniotic fluid for cytokine detection. Our results clearly indicate that Il-1 beta and TNF-a are not detectable in normal pregnancy, while Il-6 and Il-8 are produced in low, but constant levels. In contrast, in amniotic fluid of patients with intraamniotic infection high amounts of Il-6 and Il-8 were found, while Il-1 beta and TNF-a bioactivity became measurable, indicating that biosynthesis was activated. These results demonstrate, that infection associated cytokines detectable in amniotic fluid are highly sensitive markers for intraamniotic infection. In case of preterm rupture of fetal membranes recovery of amniotic fluid from a vaginal pad allows monitoring of cytokine bioactivity in daily intervals to control success of antibiotic treatment.

The aim of this study was to extend the medical knowledge of the prenatal expectations and wishes of pregnant women with respect to themselves, their partners and the maternity ward selected for the approaching birth, and also of the anxieties arising in this connection. In summary, our study shows that the desire to experience birth in the most natural, undisturbed and unmanipulated form possible is reiterated frequently, but is relativized by the intense need to be reassured of the safety of the unborn child. Fears experienced before the birth were focused accordingly on the condition of the child, although 25% of the women questioned acknowledged a marked fear of helplessness and failure. The obstetric team were expected to offer, as far as possible, the continuous personal supervision of a doctor and a midwife who were prepared to allow the patient the responsibility of being involved in obstetric decisions.

A study was performed in order to find a suitable ultrasonographic method of determining amniotic fluid volumes. Volumes were measured in 398 gravidae with no fetal or maternal pathology. The Depot V method described by Chamberlain et al. and Phelan et al.'s four-quadrant method were used to perform the measurements. Normal-value curves were prepared from the results. The reproducibility of the two methods was also verified. The results of the study showed that the normal-value curve derived from the four-quadrant method was in very good agreement with the results of the quantitative indicator dilution methods described by Queenan et al., which also indicated a marked decrease in volume after GW 34. It may be concluded from this that the four-quadrant method produces representative figures for the actual volume of amniotic fluid. A further distinctive feature of the four-quadrant methods is its very good reproducibility. The decrease in the fluid volume towards the end of gestation could not be demonstrated by the Depot V method. The four-quadrant method may therefore be regarded as a suitable semi-quantitative ultrasonographic method of determining the amniotic fluid volume.