[Shoulder dystocia--a rare obstetrical complication]. / Schulterdystokie--seltene geburtshilfliche Komplikation.

Shoulder dystocia is an uncommon complication of delivery with a high neonatal morbidity rate. This review describes the use of the most important shoulder dystocia maneuvers and underlines the demand to perform a written description of all details of the management during delivery.

[Endothelial cell damage in pre-eclampsia]. / Endothelzellschäden bei Präeklampsie.

It was the aim of this paper to report on new estimations from the literature suggesting that vessel endothelial cell injury may be a very pathologic process in preeclamptic women. These reports relate to structural vessel endothelial cell damages in and outside of the placenta bed and in other body sides. Furthermore there are indirect estimations that indicate elevated plasma fibronectin concentration before preeclamptic symptoms becomes apparent, the activation of the coagulation cascade by damaged endothelium, the known reduced prostacyclin synthesis, an increased mitogenic activity and the occurrence of anti-endothelial cell antibodies in preeclamptic women, an increased number of circulating desquamated vessel endothelial cells in peripheral blood in patients with preeclampsia and an increased cytotoxic activity of preeclamptic serum against umbilical vein endothelial cells. These findings will be discussed.

[MgSO4 therapy in severe pre-eclampsia/eclampsia]. / MgSO4-Therapie schwerer Präeklampsien/Eklampsien.

Corresponding to the newer literature and based on good own experiences lasting for four decades magnesium sulfate is put out as anticonvulsive drug of first choice in cases of severe preeclampsia and eclampsia. Especially the dosage is explained in connection with the classic schemes of Pritchard and Zuspan, in which a high concentration of magnesium in serum situated in therapeutic range is aspired to without additional sedatives. As standard dose initially 4 g MgSO4, followed by 2 g/h intravenously (in severe cases in the first hours 3 g/h) for continuing serum level applied by infusion pump are recommended. Dihydralazine as most used drug shall be applied by a second pump. Besides some newer results about the effects of magnesium sulfate on mother and child are mentioned.

[Intrauterine growth retardation--CTG findings in pre-partum oxygen respiration and transcutaneous nerve stimulation]. / Intrauterine Wachstumsretardierung--CTG-Befunde bei präpartaler Sauerstoffatmung und transkutaner Nervenstimulation.

In 33 pregnant women with sonographic diagnosis intrauterine growth retardation (IUGR) 75 O2-mask respirations or, for a comparison, 63 transcutaneous electric paravertebral nerve stimulations (TENS) were carried out between 30 to 39 weeks of gestation. Before, during and after these measures the fetus was monitored by means of continuous CTG-registration. Both in the O2-inhalations and in the TENS the dominant CTG-changes were the rise of the acceleration frequency (in about 41% respectively 49% of the measures) and the increase of the fetal movements (in about 35% respectively 64% of the measures). In the case of some O2-respirations prognostically unfavourable CTG-changes occurred, like fetal tachycardia (in 9 experiments) and firstly occurring decelerations (in 8 experiments), Spikes not being taken into consideration. As those CTG-changes were also seen in some cases with TENS it is concluded that these findings were caused by retardation and that most probably O2-respiration cannot be charged with. Additionally a report is given on nuclearmedical measurements of the uteroplacental blood circulation and on determinations of the concentration of the serumal oxytocinase. The present study shows that by O2-respiration in connection with IUGR obviously no acute risk for the fetus exists which could be proved in the CTG. However it permits no conclusion on the therapeutic effect.

[Latzko-plasty for closing vesicovaginal fistulas]. / Die Latzko-Plastik zum Verschluss von Vesikovaginalfisteln.

It is reported on 68 Latzko-grafts in vesicovaginal fistulae. In 63 cases (92.6%) the closure was successful in the first session; 4 of the 5 failures were corrected with the same technique in the second session. The method is technically simple and little stressing for the patient. It is to be recommended particularly for the treatment of the typical posthysterectomy fistula. The shortening of the vaginal canal is insignificant also in young women.

[Estrogen metabolism and hormone substitution in the climacteric]. / Estrogenstoffwechsel und Hormonsubstitution im Klimakterium.

Report about the metabolism of estrogens in the postmenopausal period and the hormone replacement therapy. The indications and contraindications for the estrogen- and estrogen-progesterone-therapy were discussed. Osteoporosis in the aging women constitutes a major public health and socio-economic importance than the climacteric syndrome.

[Course and regulation of the menstrual cycle from Robert Schröder to the present]. / Ablauf und Regulation des mensuellen Zyklus seit Robert Schröder bis zur Gegenwart.

The fundamental histological findings about endometrial and ovarian changes during the menstrual cycle by Robert Schröder (1884-1959) are passed in review and some actual conceptions of the regulation of the ovarian cycle are cited. In addition, general findings of molecular processes during gonadotropin actions in follicular cells are described, e.g. activation and desensitization of adenylyl cyclase, the role of 3',5'-adenosinmonophosphate and down-regulation of gonadotropin receptors. In general, the progress in cycle research since the work of R. Schröder was done consists in the transition from the histological description of endometrial changes to recognition of intracellular events which have to be considered by gynaecologists.

[Preventive appendectomy--pro and con]. / Prophylaktische Appendektomie--Pro und Contra.

The pros and cons of incidental appendectomy on the occasion of gynecological laparotomies are discussed. It is possible to prevent the well known morbidity and mortality of appendicitis later on by removing the appendix. The rate of complications is elevated only insignificantly. Incidental appendectomy is proposed under special preconditions.

[The intrauterine device from today's perspective]. / Das Intrauterinpessar aus heutiger Sicht.

PIP: Currently, the most used IUD's are those containing copper and the ones containing progestins. The foreign body reaction to these IUDs leads to biochemical and biological changes in the uterus which affect ovum and sperm transport and the development of the blastocyst. Copper augments this foreign body reaction and has a cytotoxic effect on sperm and blastocyst. Progesterone causes atrophy of the glands, a pseudodecidual stroma reaction of the endometrium and a change in blastocyst metabolism preventing implantation. Indications for IUD are: 1) older women with completed families, 2) between desired pregnancies, 3) with contraindications for hormonal contraception, 4) low compliance (e.g. mental disorders). Patients should be carefully examined before insertion of a well-fitting IUD. Patient education must include the occurrence of cramplike pain after insertion; light bleeding for a few days; more bleeding at first and, possibly, subsequent menstruation. Patients should be encouraged to see their doctor with more severe pain, bleeding, or fever. IUD should not be inserted immediately following pregnancy or abortion; higher expulsion and/or pregnancy rates have been observed with this in various studies. Follow-up with sonography after insertion should be done the 1st 2 months, then every 6 months. Pregnancy rates for various IUD's in the 1st year of use are between 0.5 and 2.6/100 women. Side effects of IUD's are spontaneous expulsion (1.4-15.7/100 women) in 1st year, bleeding disorders, pain, adnexitis, uterus perforation and ectopic pregnancy. Various contraindications for IUDs are listed. Indications for removal are: desire for children, pregnancy with in-situ IUD, pathological bleeding over more than 3 cycles, severe pain which does not disappear with spasmolytic analgesics, and occurrence of salpingitis.^ieng

Fetal pulmonary maturity as determined by particle electrophoresis.

Particle electrophoresis has been used to investigate particles obtained from amniotic fluid. These particles are defined mainly as unilamellar and multilamellar liposomes by electron microscopy. A total of 172 samples of amniotic fluids from 132 pregnancies were included in this study. The electrophoretic results were compared to the total phospholipids and to neonatal outcomes in 42 cases. At least two kinds of particles from amniotic fluids with different electrophoretic mobilities (EPM) are evident. With a ratio of F greater than 1.0, the presence of electrophoretically faster particles was found to be associated with apparent fetal lung maturity. On the other hand when the ratio was F less than 1.0, this seems to indicate an immature fetal lung. Seventy-seven per cent of F values correspond to the total phospholipid content P regarding the prediction of fetal pulmonary maturity resp. immaturity. The correct prediction of fetal lung maturity was demonstrated in 42 patients delivered within 48 hours of amniotic fluid sampling. In 28 cases with a mature F value (greater than 1.0) the correct prediction of respiratory distress syndrome (RDS) was 100 per cent. Eight out of 14 patients with immature F values (less than 1.0) developed RDS. The F values were found to increase as pregnancy progressed. The electrophoretically differentiated amniotic fluid particles behave differently at low pH. Selection and electrophoretic measurement of particles were made in a subjective manner. This preliminary investigation suggests that the results correspond to those obtained by objective cell electrophoretic measurements.

[Serum HPL, total estrogen excretion and serum oxytocinase in intrauterine retardation. Results of 3 evaluation procedures]. / HPL im Serum, Gesamtöstrogenausscheidung und Serumoxytocinase bei intrauteriner Retardierung. Ergebnisse von 3 Auswertungsverfahren.

The purpose of this study was to check the value of the determinations of human placental lactogen (HPL), urinary total estrogens and oxytocinase in 40 patients with fetal growth retardation among 253 single pregnancies using 3 methods of interpretation. The false-positive (abnormal) error of HPL was 40.4%. The sensitivity of urinary total estrogens was 22,5%, and of oxytocinase 30,8%. Therefore the intrauterine growth retardation can be predicted only in about a quarter of cases showing low levels or atypical profiles of these both biochemical determinations. The results suggest that the practical value is limited for all three determinations.

[Therapy of pre-eclampsia and eclampsia]. / Therapie der Präeklampsie und Eklampsie.

1. From 1976 to 1980 858 patients with late gestoses were treated at the Department of Obstetrics and Gynecology of the Wilhelm-Pieck-University of Rostock (6,9% from 12.519 deliveries). 2. The principles of therapy with appropriate dosage of drugs are discussed in comparison to other countries. 3. The sedative-anticonvulsive therapy of severe preeclampsia is based mainly on magnesium sulfate used both in the USA and in our clinic, but seldom in Sweden. In England the basic principles of the sedative therapy are benzodiazepines. 4. In treatment of preeclampsia antihypertensive drugs are usually applied only above blood pressure values of 160/110 mmHg. 5. Hydralazine is preferred in our clinic like in the USA, in England methyldopa and beta-blocking agents. Diazoxide is said to be the drug of choice in acute hypertensive crisis. 6. Since many years in severe cases with hemoconcentration we prefer a short-term plasma volume expansion by hypertonic osmotically and oncotically active solutions. This osmoonco-therapy may be applied before or simultaneously with the administration of antihypertensive drugs. But there are controversies in this mode of treatment. 7. In our clinic the maternal mortality of 79 eclampsias was 2,25% from 1959 to 1980.

[Classification of gestoses (author's transl)]. / Zur Klassifikation der Gestosen Kurze Mitteilung.

Brief reference is made to classification of gestoses. For purposes of research, classification should be restricted to cases of "pregnancy-induced hypertension" which are, more or less, identical with cases of pre-eclampsia. Grouping by pathogenesis, as established by the two American Committees, is considered to be suitable for proper coverage of all cases of gestoses, say, for statistical records.