Zeitschrift fur Geburtshilfe und Perinatologie最新文献

With regard to clinical diagnosis and prognosis, intrauterine infection continues to pose major problems for obstetricians. In recent years serum assay of CRP, an acute phase protein, has become firmly established in the obstetric management of premature rupture. We investigated the relationship between histologically confirmed chorioamnionitis and maternal and fetal inflammation parameters in 69 patients on the basis of inflammation of the membranes, placenta and cord occurring in histomorphologic stages. Our results show the C-reactive protein to be a sensitive and specific indicator of chorioamnionitis and closely correlated with both the histologic stage and the severity of the chorioamnionitis. We therefore advocate adoption of the histologic result as the "gold standard" for evaluating subclinical and clinically manifest forms of intrauterine infection.

Low birth weight infants are a heterogenous group of babies with medical risks that may vary according to gestational age. The degree of prematurity should be assessed using non-invasive valid methods. The purpose of this study was to assess the validity of four most commonly used methods for the assessment of gestational age in two groups of 60 appropriate for date pre-terms and 29 small for date babies. Our results support the use of prenatal assessment of gestational age by maternal history and early ultrasonography in afd-infants, the use of the examination of the anterior vascular capsule of the lens in afd and sfd infants and physical criteria rather than neurologic criteria when using the Ballard score.

Reference values for 26 plasma amino acids were determined by ion exchange chromatography in 29 healthy pregnant women (1st to 3rd trimenon). The results are given as P50 (P7-P93). In the course of pregnancy the concentrations of amino acids generally decrease. Threonine, however, shows a distinct, statistically significant increase. The interindividual concentration ranges are low and they show little change in the course of pregnancy. The data presented here are relevant for dietary treatment of metabolic disorders, e.g. maternal phenylketonuria in pregnants.

The syndrome of haemolysis, elevated liver enzymes and low platelet count (HELLP-Syndrome) is a severe form of preeclampsia and eclampsia. The clinical course is characterized by right upper quadrant and epigastric pain, hypertension, proteinuria and edema. Maternal and neonatal morbidity are high. The underlying cause for this pregnancy-related syndrome is still unclear. As soon as a reliable diagnosis is established handling of patients suffering from HELLP-Syndrome is ambivalent: Immediate termination of pregnancy, however, poses a problem at early gestational age. Therefore some authors have advocated a conservative management. At our department active management and delivery by Caesarean section as soon as possible has gained acceptance in the past 5 years. We report our experience with 23 patients over a 12 year period, and with 4 patients from the intensive care unit (N = 27). Mean gestational age was 33.5 weeks (+/- 4.8) and the mean birthweight was 1922.5 g (+/- 971.5). 19 patients were delivered by Caesarean section. Most complications were based on a delayed delivery and subsequent deterioration of maternal condition. Reduction of the time interval between establishment of diagnosis and termination of pregnancy (1980-1985-3 days; 1986-1992-12 hours) resulted in a better outcome. We recommend intensive laboratory screening and exact clinical examination since missed or delayed diagnosis as well as delayed delivery are life threatening for mother and child. Only prompt delivery yields an improvement of prognosis.

In order to estimate the influence of adaptational processes during pregnancy and post partum on micturition, uroflow-parameters (3) and residual urine were examined in 119 healthy women. Comparisons were made between women in the 1st, 2nd and 3rd trimester of pregnancy, women who were between 1 and 5 days post partum and nonpregnant, fertile women. Compared with the control group the mean flow was significantly lower during the 2. and 3. trimester. Time taken to achieve maximum flow was significantly higher after spontaneous delivery compared with the control group. During pregnancy and after delivery an increase in flow time could be shown. During the 3rd trimester time taken to achieve maximum flow was noticeably higher than in the other groups. Both mean and maximum flow were lower during pregnancy and after spontaneous delivery than in the control group. Residual urine increased mainly during the 1. trimester and showed the highest value after delivery. As all the investigated differences stayed within the standardized values, uroflowmetric investigations and ultrasonic residual urine estimation during pregnancy and after delivery are only necessary if suspicious symptoms on the part of the urinary tract exist.

A case of an HELLP-syndrome in the 32nd week of gestation with complete remission of pathological biochemical data and clinical symptomatic within five days is reported. Twenty days later a Caesarean section because of severe fetal growth retardation was performed. Because of this case it has to be discussed, if an "intermittent" HELLP-syndrome does really exist?

10 patients with clinical signs for necrotising enterocolitis (NEC) underwent doppler sonography of the superior mesenteric artery. Five of them, who proved to suffer from NEC, sonographically showed elevated systolic velocity and diminished resistance index. The other 5 patients with negative laboratory findings and negative abdominal plain film showed normal flow patterns in the superior mesenteric artery. We therefore believe, that color doppler sonography can improve the diagnostic workup of newborns suspicious of NEC.

The objective of the present study was to determine the toxic trace element status of 51 healthy Austrian women and their newborn babies. Lead, mercury and cadmium content of early breast milk, blood and urine were measured post partum by atomic absorption spectrophotometry. None of the toxic trace elements could be found in elevated concentrations; the content of mercury and cadmium in milk was below limits of detection. Mean lead concentration in breast milk was 35.8 (SD:15.0) micrograms/l. Whole blood content of lead was 37.0 (SD:12.7) micrograms/l in mothers and 26.3 (SD:11.6) in newborns. High blood concentrations of mercury were found both in mothers (4.46 micrograms/l, SD:1.95) and in umbilical cord blood (5.58 micrograms/l, SD:2.33). The corresponding values for cadmium were 0.44 (SD:0.4) micrograms/l and 0.08 (SD:0.16) micrograms/l. Urine excretion of the elements assayed was normal. Significant correlations between maternal and neonatal blood toxic mineral levels could be demonstrated in lead (p < 0.001).

Problem: Actual pH-measurements, which are used worldwide for quality control in obstetrics, give no information about the extent of metabolic and respiratory pathways involved in the synthesis of H(+)-ions. Therefore we looked for a new method to quantify the de novo-synthesis of H(+)-ions due to both pathways and to correlate them with the clinical condition of the newborn.

Methods: Using pH-, pCO2 (mmHg)- (and pO2 (mmHg)) measurements in umbilical blood (artery (UA), vein (UV)) of 8882 newborns, which were delivered vaginally in vertex position without cord-entanglements and without major malformations, the pHqu40 (metabolic pathway) and the pHnm (non-metabolic pathway) were computed. Thus both components of fetal acidosis could be determined together with actual pH in one unity i.e. H(+)-ion-concentration (nmol/l). By introduction of a reference-point, which denotes the mean actual pH- (7.373) and the mean pCO2- (36.4 mmHg) value in umbilical venous blood of 599 Apgar 10-babies it is possible to compute the mean de novo-synthesis of H(+)-ions in different clinical neonatal conditions (Apgar-score 1 min).

Results: In the case of slightly depressed neonates (Apgar 7-10) the respiratory acidosis dominates the metabolic one. In moderately asphyxiated newborns (Apgar 4-6) both components are equally involved. In severe fetal asphyxia (Apgar 0-3) both components can probably be determined by extrapolation: the metabolic component seems to be dominant. The computed mean actual pH-value in babies scoring Apgar 0 amounts to approximately 7.100 +/- 0.075.

Conclusions: The diagnostic range of Apgar-scoring and pH-measurements is not congruent: newborns with actual pH-values in UA-blood between 6,7 and approximately 7,1 do show Apgar-scores (1 min) of 0 or 1 without a possibility to further differentiate the degree of asphyxia by clinical criteria. This means, that actual pH-measurements are of high clinical importance in severely asphyxiated newborns. They should not be abandoned. The intercorrelation of some variables of the fetal acid-base-balance is demonstrated in 738 newborns sharing Apgar-scores of 8 after one minute. The diagnostic potential of acid-base-variables in UV-blood as a mirror of placental function is outlined.

The pressure exerted on the fetal head during the second stage of labor was continuously measured in 42 spontaneous deliveries with a new instrument. The pressure values were correlated to various obstetric variables. Typically, the head pressure remained elevated beyond the end of the uterine contraction in primiparae, whereas it decreased simultaneously with the amniotic pressure in multiparae. On the average, the head pressure was higher in primiparae indicating, together with the longer lasting bearing down period, a higher resistance of the birth canal. Deliveries with pudendal block or peridural analgesia showed no differences, but these two groups differed in other factors which might have influenced the results. Infusion of oxytocin during the course of labor was associated with higher head pressure values that could not be deduced from the hormone administration per se, but from a higher resistance of the birth canal. Maternal age did not influence the head pressure. Within physiological limits, the head pressure was independent from the size of the child and the maternal pelvis.