Zeitschrift fur Geburtshilfe und Perinatologie最新文献

In a two-centre prospective study 20 patients with a history of unsuccessful sterility treatment underwent immunization with paternal lymphocytes to improve the pregnancy rate in the subsequent therapeutic AIH or IVF/ET cycle. Unsuccessful sterility treatment was defined as no pregnancy after 8 properly monitored AIH cycles and at least one diagnostic IVF/ET or more than 3 IVF with transfer of 3 embryos. After successful immunization expressed by the induction of Fc-receptor blocking antibodies 10/20 patients became pregnant. Nine of these patients delivered healthy children, one patient experienced a first trimester abortion. A successful second pregnancy occurred in 6 of these patients. No significant correlation between the previous history and pregnancy success could be found, except a slight advantage for patients with a history other than tubal sterility. There were no differences in the anamnestic data as well as in the success rate between the two independent centres Göttingen and Leuven (10 patients each). These data suggest, that adjuvant immunotherapy might improve markedly the pregnancy rates in selected cases of sterility.

95 patients were investigated using Doppler ultrasound to evaluate its usefulness during the clinical management of patients with preterm labor, preterm rupture of membranes and incompetent cervix. Cases with additional pregnancy complications as preeclampsia or intrauterine growth retardation or infection of the amnion or the birth canal were excluded from our study. We examined the umbilical artery and the uterine arteries. Predicting preterm birth we found a sensitivity of 31.4% and a specificity of 70% for the former and a sensitivity of 34.3% and a specificity of 83.3% for the latter. As a result of our investigation we have to conclude that Doppler ultrasound is not able to predict sufficiently reliable preterm birth to use it in clinical management. Normal uterine blood flow in cases with preterm labor seems to indicate birth at term in a high degree.

In addition to the flowmetrie of aorta fetalis and a. umbilicalis, color flow mapping enables the examination of the renal and middle cerebral arteries in the assessment of the fetal blood circulation. The resistance and pulsatility-indices of aorta fetalis, umbilical artery, renal artery and middle cerebral artery were calculated in a prospective examination of a normal study group of 123 pregnant women. Moreover, ratios were established from the pulsatility-indices of renal artery and aorta fetalis, renal artery and umbilical artery, middle cerebral artery and aorta fetalis, middle cerebral artery and umbilical artery. By the use of these ratios, we hope to detect more reliably changes in the fetal blood circulation.

The rupture of visceral hamartomas in tuberous sclerosis (Pringle-Bourneville) is more likely in pregnancy because of the increased blood volume and can be followed by lifethreatening retroperitoneal hemorrhage. To avoid complications during delivery the vacuum extraction in epidural anesthesia is recommended. Preconceptional genetic counseling in this autosomal dominant disorder is obligatory.

The need for alternatives to amniocentesis, beset by 1% abortion rate, has been increasingly voiced over the past years and also includes the under 35 age group. However, the known age-dependent screening programs such as Alpha program according to Wald (1988) and the Dermalog Program according to Norgaard-Pederson (1990) only yield a detection rate of 50 or, at best, 70% (Müller, 1992) for this age group. We tried to improve this result by index calculation. Compared to the tested age-dependent screening programs the Ulm Index achieves a 25 to 40% higher detection rate (85%). For pregnant women beyond 35 years the detection rate of Down's syndrome can even be raised to 95-100% by a combination of the Alpha or Dermalog program with the Ulm Index, without entailling an increase in the rate of false-positive results.

26 days past an obstetric catheter epidural anesthesia a subdural haematoma right fronto-temporal was diagnosed and relieved by operation in a primipara of 19 years of age. Already several days after the delivery the patient was suffering recurrent headaches, at first misinterpreted as post-spinal headaches. Weeks later a cranial computer tomography lead to the right diagnosis. Although the occurrence of a subdural haematoma after catheter epidural anesthesia is extremely rare, untypical headaches following spinal, epidural or caudal procedures, should call your attention towards this complication. Because of the pressing mechanisms during childbearing, delivering mothers run the risk of a subdural haematoma.

In a retrospective pilot study the weight development of 791 neonates in the first five postpartal days was related to clinical and social data relevant for the course of pregnancy. I. Pregnancy Course 1. For a variety of reasons, neonates of mothers hospitalized for more than two weeks during pregnancy had regained their birthweight by the 5th postpartal day significantly less often than infants of non-hospitalized women (7% versus 27%). 2. In newborns whose mothers had suffered from hyperemesis gravidarum weight loss in the first five postpartal days was seen twice as often as in the rest of the group (67% versus 33%). 3. Postpartal weight loss of infants from gestotic mothers tended to be higher and of longer duration compared to the remainder of the group. 4. The same phenomenon was seen in diabetic pregnancies. 5. Neonates from smoking mothers had a significantly lower postpartal weight loss and had regained their birthweight by the 5th postpartal day much more often (35% versus 23). II. Social data 1. Newborns from mothers aged up to 18 years reached their birthweight by the 5th postpartal day only half as often as infants whose mothers were aged between 18 and 35 (13% versus 26%). Even if preterm babies were excluded, this trend remained. 2. Distinct postpartal weight loss occurred much more often in infants of multiparous mothers (3 and more children) compared to the rest of the study group (29% versus 18%). 3. Somewhat surprisingly, newborns of mothers from islamic countries regained their birthweight earlier than neonates of German mothers.(ABSTRACT TRUNCATED AT 250 WORDS)

An analysis was performed of 5187 intra-amniotically measured labor pressure curves in 40 births with spontaneous labour (20 primiparae and 20 multiparae) and 40 births births in which labor was induced with oxytocin (20 primiparae and 20 multiparae). The dilatation of the os uteri was divided into three phases--Phase 1, dilatation of the cervix to 2 cm; Phase 2, dilatation of the cervix from 2 to 4 cm, and Phase 3, dilatation from 4 cm onwards until complete. During the active phase, from 2 cm until dilatation of the os uteri was complete, no differences were observed between induced and spontaneous labor with regard to frequency and amplitude of contractions. In the induced-labor cases, the parameters for uterine activity, maximum contraction and dilatation speed were higher in all three phases of labor, and those for total duration of labor lower than in the spontaneous labor cases. The contraction/dilatation speed is an important parameter for monitoring the effect of drug-induced stimulation of labor. In the latency phase in spontaneous labor, more contractions were observed in multiparae than in primiparae. This fact which should be reason enough to intensify monitoring of both mother and fetus during this phase. In light of these results it would appear advisable, in the absence of progress in labor, to make a clear distinction between the goals of cervical maturity and promotion of uterine activity, and to institute different drug therapy accordingly.

In Austria the prevalence of listeriosis is 2.6 cases per million inhabitants yearly, hence rather rarely the cause of spontaneous abortion or premature birth. On the other hand, Listeria monocytogenes is found in 1% of the asymptomatic population as a component of stool flora. Since the cause of premature labour contractions remains unclear in about half of all cases, we examined 29 listeria strains for their ability to cause myometrial contraction by direct contact using an in-vitro uterine strip-model. Seven of nine L. monocytogenes strains were able to cause contractions; contractions were not inducible by an nonhaemolytic mutane (SLCC 53, avirulent) nor by a rough strain (SLCC 5779, only slightly virulent). Three of six L. ivanovii isolates also exhibited the ability to induce contractions. None of the apathogenic species (L. innocua, L. seeligeri, L. welshimeri, L. grayi and L. murrayi) was capable of activating contractions in our in-vitro model. Only L. monocytogenes and L. ivanovii cause conjunctivitis after being dropped in rabbit's eyes (positive Anton Test). The influence of listeria on uterine activity as found in our in-vitro model thus correlates with the classical pathogenicity test. We consider these in-vitro results as an additional argument to oppose the presence of L. monocytogenes in ready-to-eat foods.

The four-chamber view and the visualization of the root of the left and right ventricular outflow tracts has been proposed as a screening method for the detection of congenital heart disease in the fetus. In order to study the diagnostical value of the method we investigated 1600 fetuses between the 17th and 40th gestational week without anamnestic risk for congenital heart disease with this screening method in a two years' period. We found 33 fetuses to have an abnormality either in the four-chamber view or in the ventricular outflow tracts. The sensitivity of the method in the detection of congenital heart disease was found to be 81%, the specificity 99% and the positive predictive value 88%. Women at high risk for congenital heart disease in the fetus should still undergo a more detailed echocardiographic examination to maximize the sensitivity in the detection of structural heart defects. Nevertheless, the described screening procedure is an effective and feasible method to detect fetuses with severe congenital heart disease, whose prognosis may be improved by the delivery in a perinatological center.