Zeitschrift fur Geburtshilfe und Perinatologie最新文献

In a quarter of our Doppler investigations differences between the S/D-ratios of the arteries of one umbilical cord were more than 20%. In these cases one Doppler value was decided to be normal and the other to be pathological. In cases with two pathological values most caesarean sections because of fetal distress had to be performed and most SGA babies were born. There were relatively more caesarean sections and SGA babies in cases with one normal value and one pathological value than in cases with two normal Doppler values. Sensitivity and specificity of perinatal risks like intrauterine growth retardation or caesarean section because of fetal distress were different depending on which Doppler value was used to calculate these statistical parameters. Taking always the better values compared to the worse ones we found as greatest difference 20.0% for sensitivities and 24.1% for specificities. Taking the means of the better and the worse Doppler values we found as greatest difference 5.6% for sensitivities and 8.7% for specificities compared to the cases with two identical Doppler results. To decide whether the fetus is jeopardized and to describe the nutritional function of the placenta correctly by means of Doppler ultrasound of the umbilical artery we conclude that in some cases the investigation of both arteries is important to avoid false positive or false negative results.

Digital Image Intensifier Radiography (DIR) as well as Nuclear Magnetic Resonance Tomography (NMR) using an especially developed imaging routine for pelvimetry are suitable tools for the assessment of the anatomical conditions when mechanical problems are supposed to occur during birth (cephalopelvic disproportion, breech presentation). A concept for an optimised evaluation procedure of these imaging techniques has been developed, including: a more elaborate measuring protocol, easily and precisely executable due to appropriate software packages being implemented in the diagnostic units, calculation of obstetrically relevant parameters not deriving immediately from the imaging procedures. This is possible by means of multiple regression analysis of a data base from 467 evaluated female pelvis computed tomograms, calculation of intrapelvic soft tissue place requirements by means of correlative analysis of female computed tomograms and weight-/height-index, empirical determination of cut off values in borderline pelvi-fetometric constellations evaluating 190 births by means of logistic regression of the according pelvic-fetometric data. The calculations necessary to obtain all these parameters are implemented in a software package which also contains an algorithm for the general characterisation of an individual pelvis. Thus, a rather sophisticated knowledge base for pelvic assessment becomes easily accessible.

A prospective study analyses the course of pregnancy and the delivery of 315 women suffering from hypertension during their pregnancy. The perinatal state of the child is analysed as to the prevailing kind of hypertension. Gravidae suffering from gestation and chronical hypertensions, resp. (three forth of all kinds) delivered at birth term an eutrophic child. The proportion of spontaneous deliveries, acidosis morbidity, and of Apgar score was in correspondence with the average of all deliveries per annum without hypertension. The perinatal mortality among all kinds of hypertension was 1.6% caused only by children from gravidae suffering from preeclampsia and chronical nephropathy (corresponding to a quarter of all kinds). In comparison with gestation hypertension, chronical hypertension and the annual average of all deliveries, such gravidae prematurely delivered hypotrophic children of high acidosis morbidity and a worse Apgar score. Gravidae suffering from preeclampsia had an 80% abdominal delivery frequency. The prognosis of the child is made worse by appearance and severity of proteinuria.

This study was designed to answer three questions: 1. Is there a change in systolic blood pressure, diastolic blood pressure and heart rate during pregnancy? 2. Are there alterations of these parameters during standing? 3. Is there a relationship between mean arterial blood pressure and heart rate at rest and during standing? In a randomized study 161 clinically healthy pregnant women between 8th and 41st week of pregnancy were tested with a modified orthostatic test over defined time periods during pregnancy. Systolic and diastolic blood pressure and heart rate were registered in one minute intervals over a 30 minute period with an automatic Dinamap measuring device. This period was subdivided in a 10 minutes lying period, 10 minutes standing period followed by a 10 minutes lying period. There was a marked increase in systolic and diastolic blood pressure at rest with the beginning of the 34th week of gestation (p < 0.05 and p < 0.01). Despite this, maternal heart rate continued to rise over the whole course of pregnancy (p < 0.01). Furthermore, women with a fall in heart rate on standing were only seen in late pregnancy. Finally, pregnant women with a low mean arterial blood pressure (< or = 85 mmHg) did not experience a fall in blood pressure on standing more frequently than normal controls (> 85 mmHg). We conclude that a fall in blood pressure on standing is not dependent on blood pressure at rest during pregnancy.

The case report is about an infant suffering from coumarin embryopathy and coumarin syndrome after its mother underwent phenprocoumon treatment (Marcumar, Falithrom) during pregnancy (until 26th week of gestation). Interestingly, a hearing disorder was diagnosed, which had never been described in context with this substance. The coumarin derivatives warfarin, acenocoumarol and phenoprocoumon were compared with regards to spontaneous abortion rate, perinatal mortality and teratogenic risk. Eye anomalies or malformations seem to appear only under warfarin treatment, whereas CNS-malformations are more frequent under phenprocoumon. As a consequence, phenprocoumon treatment of fertile women seems rather doubtful. Upon discovery of a pregnancy under coumarin treatment, vitamin K should immediately be substituted in order to minimize the risk of anomalies and malformation.

Disorders of carbohydrate metabolism in pregnancy are often associated with macrosome newborns. There are two methods with different approach for retrospective diagnosis of gestational diabetes (GDM): 1. maternal postnatal oral glucose tolerance test (ppoGTT), 2. determination of cord blood insulin for detection of fetal hyperinsulinism. The presented study deals with the question how often macrosomia is correlated with pathologic cord blood insulin respectively pathologic ppoGTT and if both methods select identical collectives. Cord blood insulin was determined by RIA in 154 newborns with birth weight over the 90th percentile (threshold 15 microU/ml). On the 2nd day p.p. oGTT was performed in 80 women without prenatal diagnosis of GDM (threshold 95, 165, 145, 125 mg%). 37/154 (24%) newborns showed pathologic insulin values. 24/80 (30%) women had pathologic ppoGTT. In 30% of the cases pathologic results of cord blood insulin and ppoGTT selected different collectives: 17/66 pathologic ppoGTT with normal insulin values, 7/14 normal ppoGTT with pathologic insulin values. The only use of ppoGTT would fail in 50% of cases of GDM with proved fetal hyperinsulinism. The determination of cord blood insulin offers the opportunity of direct diagnostics on the child in contrast to maternal ppoGTT. For retrospective diagnosis of macrosomia due to disorders of carbohydrate metabolism determination of cord blood insulin should be given preference to oGTT in puerperium.

A preselected cluster of births (12351-4719 = 7632 = n) which was divided into 3 groups (delivery between 28-32 gestational weeks, 33-37 gestational weeks and > 37 gestational weeks) has been correlated with six major weather situations of the four meteorologically defined seasons. The correlation was made with the date of birth and with one day as well as two days before. The duration of pregnancy was longer by an average of 0.45 weeks (i.e. 3 days) when the major weather situation did not change for more than 8 days. The group with delivery 28-32 weeks is more sensitive to meteorological influences than the group with delivery 33-37 weeks. During cyclonic as well as during anticyclonic atmospheric drifts the groups 28-33 wks and 33-37 wks have been statistically over-represented. As far as the season is concerned over-representation is found in autumn. We conclude that pregnancies at risk of premature delivery should be followed up in short intervals during cyclonic and anticyclonic atmospheric drifts especially during the autumn season.

The recurrence risk of HELLP-syndrome is reported to be between 2.6% and 24%. But yet, there are no accurate case reports about this topic available. In a retrospective study, 25 patients, which had suffered from a pre partum HELLP-syndrome, were interviewed about possible subsequent pregnancies. In 7 patients 8 pregnancies were found, which began between 5 and 55 months after the HELLP-syndrome. No recurrence of a HELLP-syndrome was observed in these 7 patients. Although in 71% a hypertension had been present during the HELLP-syndrome, only 1 patient had an elevated blood pressure in the subsequent pregnancy. Whilst all of the patients with HELLP-syndrome had been delivered by cesarean section, 50% of the patients were delivered vaginally in the subsequent pregnancy. There was no evidence of maternal or neonatal complications related to HELLP-syndrome. Nevertheless, even if the recurrence risk seems to be low, pregnancies after HELLP syndrome should be observed carefully.

Doppler-sonography was performed in 16 newborns with prenatally diagnosed unilateral cystic renal malformation. 11 babies with multicystic dysplastic kidneys showed doppler-sonographically reduced systolic flow velocities and elevated resistive index (RI) [RI = 90-100%] or lack of obtainable perfusion signals. 4 of them had to undergo nephrectomy, the other asymptomatic patients could be managed conservatively, spontaneous regression could be observed. 5 other infants suffering from cystic nephroma, severe ureteropelvic junction obstruction, hudge bleeding of the adrenal gland and hydronephrosis due to ectopic ureter, having been prenatally presented as "cystic renal malformations", initially showed normal systolic flow velocities within renal parenchyma and only slightly elevated RI (mean = 83%). By this they could be differentiated from multicystic kidney dysplasia. We therefore propose to use doppler-sonography for differential diagnosis of prenatally assumed cystic kidney malformations.

In this prospective randomised study the effects of antenatal treatment with a low dose betamethasone (2 mg/1 day)-L-carnitine (4 g/5 days) combination were compared with those of a high dose betamethasone, given alone (8 mg/2 days) on the prevention of respiratory distress syndrome (RDS) and mortality in preterm infants. One-hundred women entering the trial gave birth to 109 liveborn infants, 55 in the betamethasone group (A), 54 in the betamethasone-L-carnitine combination group (B). Eight of the 55 (14.5%) infants in group A developed RDS, four of the 54 (7.3%) in group B, which was significantly more (p < 0.05), although in group B the betamethasone dose was dramatically reduced. The mortality also was significantly lower after treatment with a betamethasone-L-carnitine combination compared to betamethasone alone (4 of 55 infants or 7.3% in group A versus 1 of 54 infants or 1.8% in group B, p < 0.05). The present results demonstrate that in combination with L-carnitine, the betamethasone dose is markedly reducible with a concomitant significant reduction of the incidence of RDS and mortality of premature newborns.