[Tubal pregnancy following hysterectomy]. / Tubargravidität nach Hysterektomie.

A 41 year old woman had been submitted to a supravaginal uterine amputation in 1978 and to extirpation of the cervical stump in 1981. In 1982 she then developed a tubal pregnancy. - There have been only 30 reports regarding ectopic gestation diagnosed after previous complete hysterectomy in world literature since 1895. In 20 cases conception occurred some time before hysterectomy, in the remaining 10 cases, however, thereafter ("early" or respectively "late" type of extrauterine gestation, with regard to the date of hysterectomy). Probably ectopic pregnancy following complete hysterectomy could be diagnosed more often in the future, provided that the possibility of its manifestation is carefully taken into consideration.

Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia.

After delivery of a healthy female child from a mother suffering from acute lymphatic leukaemia (35th week of gestation) the placenta was examined by light and electron microscopy. Morphologically, the villi in this placenta from a case of maternal acute lymphatic leukaemia differed from those in a normal placenta in the following respects: 1. The frequent occurrence of fibrinoid deposits on the free surface of the syncytiotrophoblast and the pronounced formation of syncytial cytoplasmic protrusions. 2. Dilatation of syncytial rough endoplasmic reticulum, numerous syncytial knots and numerous autophagosomes. 3. An excessive number of villous cytotrophoblastic cells. 4. Thickening of the trophoblastic basement membrane. 5. Bulbous endothelial cells with cytoplasm in fetal capillaries. 6. Strands of basement membrane-like material within the villous stroma. 7. Phagocytosis of nucleus-containing cells by the syncytiotrophoblast. 8. Cells with an abundant number of microtubular bundles within the villous stroma. It is suggested that phagocytosis of nucleus-containing cells (tumour cells?) by the syncytium could play a role in the prevention of transplacental metastasis.

[Amniotic band syndrome as a cause of fetal malformations. Steroids not to be regarded as the cause]. / Amnionstrang-Syndrom als Ursache fetaler Missbildungen. Steroide nicht als Ursache anzusehen.

Term deliveries of babies with amniotic band syndrome (ABS) occur approximately at a rate of 1:5000 to 1:15,000 of all cases. The ABS can be found after obviously quite normal pregnancies as well as in cases with previous mechanical stimuli, such as amniocentesis or after attempted artificial termination of pregnancy by mechanically induced lesions.

[Particularly small foetus papyraceus after full pregnancy period (author's transl)]. / Besonders kleiner Fetus Papyraceus bei ausgetragener Schwangerschaft.

This is a report on an extremely small fetus papyraceus coinciding with an uncomplicated pregnancy, delivery and post-partum period of a healthy newborn; the blighted twin fetus was found quite unexpectedly after a careful inspection of the placenta and fetal membranes. Because of the possible complications following retention of blighted fetuses in utero it seems wise to us to put great emphasis on tedious examination of the afterbirth especially in all those uniparous women, in whom a multiple pregnancy had been suspected in earlier stages of gestation.

[Examination of placenta by light and electron microscope in a woman patient with renal transplant (author's transl)]. / Licht- und elektronenmikroskopische Untersuchungen der Plazenta von einer nierentransplantierten Patientin.

The placenta of a woman who had received a renal graft before she became pregnant was examined. The light- and electronmicroscopical results were as follows: 1. Enlargement of the granulated endoplamatic reticulum in the syncytium. 2. Increase of the syncytial knots. 3. Persistence of exceeding numbers of Langhans cells. These alterations coinciding with the immune suppressive therapy might play a role for the initiation of the growth retardation as observed in children of renal-grafted mothers.

[On the incidence of knots in the umbilical cord (author's transl)]. / Uber das Vorkommen von Nabelschnurknoten.

The mechanisms of the development of knots in the umbilical cord are described. The different types of knots are enumerated. The causative factors for the development of a knot in the umbilical cord are discussed. This paper is based on a statistical evaluation of the deliveries of the Maternity Hospital of the University of Bonn from 1967-1970. These data have been adopted from the Author's M.D. Thesis of 1972. At the end of the paper the comparative anatomy of the umbilical cord complications is discussed.

[Long-term cultures of trophoblast cells and mixed trophoblast cultures as a model for in-vitro studies (author's transl)]. / Langzeit-Trophoblastzellkulturen und gemischte Zellkulturen mit Trophoblastzellen als Modell zum in-vitro-Studium.

Trophoblast cell-cultures provide a much promising model for qualitative and quantitative in-vitro-examinations of immunological, morphological and biochemical items. In the present paper an attempt has been made to analyze the light-microscopically identificable morphological modifications of the cultured cells under standardized culture-conditions in a temporary order. Furthermore, a number of single cases is presented in which mixed cultures of trophoblast cells with heterologous cells of embryonic origin and with cells derived from adult malignoma were tried.

[Fetomaternal immune reaction in normal and pathologic pregnancies]. / Feto-maternale Immunreaktion bei normal und pathologisch verlaufenen Schwangerschaften.

Pregnancy-specific diseases such as pre-eclampsia/eclampsia and intrauterine growth retardation do certainly influence the feto-maternal immunological links; this effect may be primary or secondary. In vitro methods to measure quantitatively the maternal cellular immune response and its sensitivity to humeral serum factors are discussed. Trophoblast cells grown in macro- and microcultures under standardized conditions were exposed to the cytotoxic effect of a suspension of maternal lymphocytes derived from peripheral venous blood; the concentration of lymphocytes was titrated. In a second titration series we tested the influence of maternal serum on the lymphocytotoxic effect; trophoblast and lymphocyte cell numbers were kept constant. The results give some evidence that in the absence of maternal serum the lymphocytotoxicity is diminished in cases with poor fetal growth or with pre-eclampsia/eclampsia, if compared with the conditions found in cases of normal term pregnancies. If, however, maternal serum was present, the known anticytotoxic effect of the serum became only evident in the normal term controls, whereas the cytotoxicity increased with rising serum concentrations in cultures derived from cases with intrauterine growth retardation or pre-eclampsia/eclampsia. One possible explanation would be the presence of cytotoxic serum factors in those cases. In the discussion the different aspects of feto-maternal immune relationship in healthy subjects are analysed and an attempt is made to correlate the findings of different authors. It is most likely that the maternal immune responses (directed specifically and non-specifically against fetal antigens) do vary continuously in pregnancy.

[Immunological relations between mother and child during pregnancy (author's transl)]. / Immunologische Beziehungen zwischen Mutter und Kind während der Schwangerschaft.

The relations between the maternal and foetal organisms during pregnancy are partly very complicated and remain inexplicable. Blastocyst, trophoblast, embryo and foetus have membrane antigens at a very early stage, and the immunocompetence of the foetus develops already during the second third of the pregnancy period. Many non-specific factors are involved in preventing the castingoff reaction of the foetal organism. The trophoblastic tissue is probably of central importance. The focal point of interest in trophoblast tissue research is probably the testing of the local action of HCG and HPL and perhaps also AFP, as well as the question whether cellular and nuclear fusions occur in the region of the syncytiotrophoblasts and the decidual base, or if leucocyte antibodies can block the HLA antigens or the trophoblastic surface.

Low thymic weight in small-for-dates babies.

The thymic weights of 20 growth-retarded babies dying at or about birth were found to be less than normal for their birth weights. It is suggested that small-for-dates babies that survive may be immunodeficient as are children who suffer from extrauterine malnutrition.

[The history of breast feeding]. / Zur Geschichte des Stillens

The significance of breastfeeding, as considered millenniums ago, has been handed down by numerous contemporary reports and illustrations. The woman who suckles her baby has even since held an exceptional position in social life. In this essay the author describes the breastfeeding customs of far ancient people such as Egyptians, Greek, Romans and Indians. As a conclusion one might say that even today breastfeeding did not lose its importance for the relation between mother and child. It is an encouraging matter of fact that--unmindful of their emancipation--many "modern" mothers retain the breastfeeding habit. What would happen if breastfeeding was generally discredited, if mothers from all different countries would abandom breastfeeding in order to adopt bottle-feeding their children? Undoubtedly, that would not only cause a notable increase of the risks for the children's survival--which are due to many secondary factors--but, furthermore, it would mean an important expenditure for the budget for national economy which cannot be justified.

[Infant nutrition in West Africa]. / Säuglingsernährung in Westafrika

The breastfeeding-customs of Westafrican tribes are described. Details are given about the duration of the suckling-period, about the nourishment of the baby after breastfeeding has been reduced and about the application of indigenous lactogenic substances. The relations between mother and child as well as the relations between wife and husband during the suckling-period are illustrated; the dangers of a precocious weaning from breastfeeding and the dangers due to the application of wrongly prepared bottle-milk are discussed.