Zeitschrift fur Geburtshilfe und Perinatologie最新文献

The introduction of surfactant in the therapy of respiratory distress syndrome (RDS) reduced mortality and long term complications in very premature infants. Nevertheless, the obstetric management influences critically the outcome. In a prospective study of 116 premature infants with RDS treated with natural surfactant preparations after birth, mortality was significantly reduced by antepartum corticosteroid therapy suggesting a synergistic effect of corticosteroids and surfactant on the immature lung. It is assumed that a preventive administration of surfactant immediately after birth would benefit neonates at risk for RDS more than a delayed surfactant replacement after the development of RDS. But without a reliable assessment of fetal lung maturity before birth more than 50% of our premature infants with birth weights less than 1500 g would be exposed to surfactant unnecessarily. It is important that fetal asphyxia is avoided. Acquired respiratory distress syndrome occur even in premature infants after shock or meconium aspiration and may respond poorly to surfactant replacement. This is also the case in lung hypoplasia or perinatal infection, where the combined efforts of obstetricians and neonatologists are needed to attain better results.

We performed a study in dopplersonography of the A. umbilicalis in pregnant women, who had either an untreated or a with Pholedrin longo (alpha receptor stimulating substance) treated hypotension. These study groups were compared with patients who had a normal blood pressure. In patients with hypotension we found higher values of the qualitative flow indices than women with normotension reflecting a low uterine perfusion. In the group with therapy of hypotension we could analyse a normalisation of the values without decrease of uteroplacental perfusion. These findings show, that hypotension is a high risk in pregnancy which we have to care for.

Goal: This retrospective clinical study was performed to analyze the relationship between the time course of an emergency Cesarean Section and the structural, logistic and circadian aspects of the clinical environment.

Methods: Statistical analysis was based on architectural and structural data from 132 Departments of Obstetrics in the region of Northrhine-Westfalia, Germany. Hospitals were compared in four groups of equal size defined by the number of deliveries per year. Data were available on 207 emergency C-Sections from 66 participating hospitals. The time of the day of each delivery was rounded to full hours.

Results: The size of the hospital was a highly significant predictor (p < 0.001) of the time elapsing between decision making and delivery (DD-interval) and of the preparation time required prior to the start of the operation: With increasing number of yearly deliveries the DD interval decreased from 31 minutes (SD = 15) to 19 minutes (SD = 7) with respective set-up times of 26 minutes (SD = 15) and 15 minutes (SD = 7) respectively. The time of the day had a significant influence on both variables (p < 0.05) with emergency C-Sections being slowest between 1:00 a.m. and 7:00 a.m. The mean time intervals observed may serve as a reference for the individual hospital situation: A preparation time of 15 minutes, time from start of surgery until delivery of 4 minutes and a DD interval of 19 minutes.

Conclusions: The data presented in this study underline the importance of the immediate availability of a complete emergency team consisting of midwife, obstetrician, anesthesiologist, OR nursing staff and pediatrician. While not necessarily arguing in favor of a concentration of obstetrical practice in specialized centers, the following recommendations might be worth considering for any given clinical setting: 1. Immediate availability of a complete team is essential, especially during the night. 2. Well defined steps of urgency in agreement between all disciplines involved improve communication and save time. 3. The emergency C-Section in the delivery room may be a worthwhile alternative in the individual case. 4. Flexibility in the decision making process may increase efficiency. 5. Practice drills may help to identify weaknesses in the interaction and coordination of the team. 6. A functional hospital architecture is important to avoid unnecessary and uncontrollable delays. 7. Adequate training programs for the obstetrical team are essential with special emphasis on the early diagnosis of fetal distress and maternal complications.

Cervical insufficiency is a frequent complication particularly in case of multiple pregnancy and is often considered to be an indication for cerclage operation. We performed a vaginosonographic monitoring prospectively in 35 cases with multiple pregnancy in order to diagnose cervical insufficiency early and to perform cerclage operation when indicated. The results were compared with a group of 41 patients with multiple pregnancy who received prophylactic cerclage in other hospitals. No significant difference occurred concerning the duration of the pregnancy. In patients without prophylactic cerclage the frequency of preterm contractions was significantly lower, the frequency of premature rupture of membranes, however, was higher. Our results confirm the hypothesis that the application of a prophylactic cerclage does not improve fetal outcome in case of multiple pregnancy. Vaginosonographic as a single monitoring procedure seems to sufficient for the early diagnosis of cervical insufficiency.

Meanwhile the attendance of fathers in the labour room is common. From 1. 7. 90-15. 10. 91 510 German fathers were interviewed before and 45' after labour. In comparison a smaller number (n = 56) of fathers were questioned who had decided not to attend. The evaluated data was split in the following three categories: 1. pre-post comparison; 2. "participants" and "non-participants" comparison; 3. special problems. The most mentioned reason for participation (over 85%) was the positive influence on the women. More then 70% of the attendants even wanted to support their wives during complicated delivery and surgical interventions. Approximately 5% of the fathers attending a clinic delivery would then prefer a home delivery because they more or less felt as a substitute to medical personnel. Non participants evidently were anxious due to missing preparation and information about the parturition. Sometimes the women desired no participation of their partners. About 23% of the men decided to attend labour just before birth. Practical recommendations are given and the change in the point of view of the fathers during course of labour is presented in this paper.

A case of primary hyperparathyroidism in late pregnancy is described. After an initial conservative treatment surgery was performed in the 35th week of gestation. The further course of the pregnancy was uneventful, the newborn showed a normal development.

Routine ultrasound during pregnancy is also performed for the detection of fetal malformations. This retrospective study comprises 31 children treated for urinary tract infection within 19 months postnatally. The charts of the young patients were evaluated how often a dilatation of the upper urinary tract (more than 3 cm in diameter) was observed already during pregnancy. In 18 patients (58%) the dilatation was detected antenatally and was missed in 13 (42%). Reasons of the low sensitivity may include low technical standard of the sonographic equipment and limited skill of the investigators.

In a case report of severe placental insufficiency in the HELLP-Syndrome with diastolic reverse flow in aorta and umbilical artery, the changes of flow in the renal artery and middle cerebral artery were demonstrated. A preferential perfusion of fetal brain at the expense of fetal kidneys was shown during fetal hypoxia.

A new equipment and technique in order to analyse the pH in vivo will be presented. The special rod-shaped probe contains an ISFET pH sensor. There is pointed out a wide field of applications in the obstetrics.

The etiology of fetal arrhythmias is still unknown. We therefore did a research for immunologic causes: antimyolemmal antibodies (AMLA) in mothers and umbilical cord serum resulting from secondary immunopathogenesis caused by myocarditis of the mother. Is there a correlation between immunological and clinical findings giving a possible explanation for fetal arrhythmias? In 21 cases mothers and umbilical cord serum was investigated for AMLA; 16 with fetal atrial premature beats, 4 with fetal tachycardia and 1 with fetal bradyarrhythmia. From 16 mothers with fetal atrial premature beats had 12 AMLA, from these were in 4 cases in the umbilical cord serum AMLA. In 4 cases of fetal tachycardia we found in 1 case AMLA in mothers and umbilical cord serum. In the other 3 cases accessory pathways have been the cause for tachycardia. From 19 healthy persons were found in 3 cases AMLA in mothers serum, umbilical cord serum was negative.