Fenoterol depot and fenoterol in premature uterine contractions--a multicentric double-blind comparative study.

In a double-blind randomized study, the effect of a single dose of a fenoterol preparation with delayed release of active substance (designated as fenoterol depot) was compared with a fenoterol product with undelayed release of active substance (designated as fenoterol) in two groups respectively comprising 66 and 65 female patients with premature uterine contractions. The fenoterol depot was administered p.o. in a single total dose of 21 mg at the beginning of an investigation period of 360 minutes and the fenoterol was administered p.o. within 235 minutes in three identical consecutive doses resulting in a total dose of 22.5 mg. The increased uterine activity present at the beginning was markedly lowered by an initial intravenous infusion of Partusisten. After administration of the two oral preparations, the uterine contractions remained at the low level achieved. The fenoterol depot was slightly superior to fenoterol with regard to the reduction of the duration of contractions: the difference in the inhibition of the duration of the contraction between the two preparations was a maximum of 25.7% in favor of fenoterol depot. The frequency of uterine contraction was substantially reduced by both preparations, but to a greater extent by the depot form. The tocolytic efficacy and the tolerance were rated as "good" in 70% and 75% respectively with fenoterol depot and in 69% and in 71% respectively in the case of fenoterol. The maternal pulse rate remained at the level reached at the end of Partusisten infusion with the two preparation, and the blood pressure fluctuated slightly within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiotocographic changes in epidural analgesia with bupivacaine]. / Kardiotokographische Veränderungen bei Epiduralanalgesie mit Bupivacain.

During the first stage of labor in a large number of births, temporarily pathologic patterns become manifest in the cardiotocogram after epidural analgesia. Statistical comparisons showed a significant level of correlation (in the region of 1%) between pathologic heart rate pattern and a fall in blood pressure after the main epidural dose (in all cases, premedication was given before commencement of analgesia). This jeopardy to the fetus in the first 20-30 minutes after administration of the main dose, visible in the cardiotocogram, makes it imperative for the clinician to pay the utmost attention to all women in labor during this period, not just those regarded as risk patients. After 10-20 minutes, labor is intensified, and this can coincide with possible jeopardy to the fetus. As this change in the course of labor manifests itself inordinately strongly in the labor-frequency parameter, and since absolute intrauterine pressure did not represent a threat to life in any of the cases described here, the authors feel that monitoring of labor by external tocometry is sufficient for clinical needs.

The concentration of bupivacaine in fetal organs during obstetrical epidural analgesia.

The concentration of bupivacaine in organs of non-viable human fetuses after obstetrical epidural analgesia in customary doses was investigated. The concentrations were determined with a gas chromatograph. The material consisted of a fetus who died following termination in the 24th week of pregnancy three minutes after birth without spontaneous respiration. The other fetus was born maturely in the 40th pregnancy week with anencephaly who lived 20 minutes following initial spontaneous respiration. Most noteworthy were the increased concentrations in the liver indicating the important metabolic function of the liver for the metabolism of bupivacaine in the fetus. Further a very high pulmonary concentration was found in the mature fetus. Even though blood gases analysis were not performed we conclude that: the lung is the best perfused organ after birth and onset of spontaneous respiration because of the closure of the ductus arteriosus; because of the increasing agonal respiratory acidosis, bupivacaine accumulates in the lung, the organ from which the acidosis originates. Also, the ionized form the bupivacaine is unable to leave the intracellular space. For the clinical use of epidural analgesia during delivery, these results constitute an important indication for avoiding fetal acidosis before and during the action of such analgesia. This mandates strict and continuous fetal monitoring. Our results in agreement with other authors show that during fetal acidosis and simultaneous administration of bupivacaine the fetal distress may be potentiated by an accelerated transfer of the anesthetic agent into the fetal placental space. Under normal conditions one may assume that this technique of analgesia has a positive effect on the fetus because of the improved placental perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Amniocentesis under permanent ultrasonic control--advantages of a special procedure]. / Amniozentese unter permanenter Ultraschallsicht--Vorteile eines speziellen Verfahrens.

Advocates of the so-called "free hand technique" in amniocentesis argue against permanent sonographic control as follows: "Free hand technique" is the only method enabling vertical guiding of the puncture needle between abdominal wall and amniotic cavity, and hence to cover the shortest distance with the lowest risk of traumatisation. "Free hand technique" is the only method permitting sensitive guiding of the needle in amniocentesis, since the puncturing doctor can use both hands without requiring one hand for sonographic examination. Amniocentesis under permanent sonographic control is claimed to raise serious problems in guaranteeing the necessary sterility. The authors present a modification of the puncture method with permanent sonographic control. This does away with all of the above arguments against permanent sonographic control, whereas all of its obvious advantages are retained (greater safety, less risk of injury). The method employs a fixation scaffolding and an aiming groove for routine sector scanning (Figures 1 and 2). The entire system is covered in a sterile manner by a pasted-on foil sheeting after having introduced the sonographic contact gel. The only contact medium for the skin is a disinfecting agent enabling satisfactory imaging (Figure 4). This method offers the following advantages over the methods using conventional puncture soundheads: Better possibility of disinfection. No rigid guiding of needle, and hence correction can be effected even during puncture. Adjacent levels can be observed by free displacement of scanner and needle. Modifiable puncture angle in respect of skin and uterus. The fixation scaffolding does away with the need for an assistant, and enables tremor-free fixation of the scanner during puncture.(ABSTRACT TRUNCATED AT 250 WORDS)

[Extremely high alpha-fetoprotein levels in a puncture specimen with few cells following amniocentesis and interpretation by sonography]. / Extrem hoher Alpha-Fetoproteinspiegel in einem zellarmen Punktat nach Amniozentese und Klärung durch Sonographie.

We report on a prenatal diagnosis with high alpha-fetoprotein level and a positive acetylcholinesterase activity in a presumptive amniotic fluid. Ultrasonographic examinations revealed a hydropic fetus with a nuchal cystic hygroma. Chromosome analysis of the aborted foetus ascertained the suspected Turner syndrome. The highly elevated alpha-fetoprotein concentration and the positive acetylcholinesterase activity as well as the absence of the cells in the fluid make it clear, that the punctate originated from a cystic hygroma. Other cases from the literature are discussed.

[Gynecologic endosonography: initial experiences]. / Gynäkologische Endosonographie: erste Erfahrungen.

Basing on our research work in hysteroscopy, we used recently developed small endosonographic sounds for intrauterine and later vaginal approach, for the first time in 1981. We call this method endosonography. The equipment used so far is described, the procedure explained, and the efficacy of this new technique demonstrated via several endosonograms. The advantage to transabdominal sonography is the close contact of the ultrasound transducer with the organ to be examined. This enables the use of high frequencies with correspondingly good resolution. Finally, our own experience is discussed.

Concentrations of aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, and cortisone determined simultaneously in human amniotic fluid throughout gestation.

Corticosteroids (CS) are essential for fetal organ maturation; yet, knowledge of endogeneous CS and precursor levels throughout fetal life is limited. Therefore, unconjugated aldosterone (Aldo), corticosterone (B), 11-deoxycorticosterone (DOC), progesterone (P), 17 alpha-hydroxyprogesterone (17-OHP), 11-deoxycortisol (S), cortisol (F), and cortisone (E) were simultaneously determined by RIA after automated Sephadex LH-20 chromatography in 70 control samples of amniotic fluid (AF) obtained at all gestational ages between 14-42 weeks. Levels of the progestins P and 17-OHP slowly increased from means (+/- SE) of 14.7 +/- 2.8 and 1.63 +/- 0.21 ng/ml, respectively, in early gestation to maximum levels of 32.4 +/- 3.5 and 3.80 +/- 0.74 ng/ml at 36-38 weeks (P less than 0.005), then dropped significantly (P less than 0.01) to 19.2 +/- 2.2 and 1.58 +/- 0.22 ng/ml at term. All CS levels except E rose very markedly by 3- to 12-fold (P less than 0.0001) from the weeks 14-16 (DOC, 0.44 +/- 0.08; B, 1.49 +/- 0.23; Aldo, 0.043 +/- 0.012; S, 0.51 +/- 0.10; F, 5.96 +/- 0.93 ng/ml) until the 36-38th weeks (DOC, 3.50 +/- 0.66; B, 4.60 +/- 0.78; Aldo, 0.530 +/- 0.109; S, 6.00 +/- 0.75; F, 60.8 +/- 8.9 ng/ml). Term levels were significantly reduced (P less than 0.01) in the less active CS DOC (0.51 +/- 0.07 ng/ml), B (2.35 +/- 0.35 ng/ml), and S (1.14 +/- 0.14 ng/ml), whereas those of the biologically most potent CS Aldo and F declined less markedly (0.272 +/- 0.053 and 23.0 +/- 0.75 ng/ml, respectively, at 39-42 weeks). Levels of the inactive glucocorticoid E rose from 8.83 +/- 1.08 ng/ml at 14-16 weeks to 16.8 +/- 2.6 ng/ml at 31-35 weeks (P less than 0.01), then remained rather constant around 11.5 ng/ml until term. It is concluded that after the 25th week, large amounts of biologically active CS are available in AF which probably directly induce the final epithelial maturation of fetal lungs and intestinal tract.

[Early development of a child following rabies of the mother during pregnancy (author's transl)]. / Frühkindliche Entwicklung nach manifester rabies in der Schwangerschaft

A case of rabies in a pregnant woman who spontaneously delivered a premature baby before dying is presented. Although not vaccinated the baby did not develop rabies. The possibility of displacental transmission of rabies in humans is judged as highly improbable on the basis of findings in other publications and in the case presented here.

[Ectopic pregnancy near term (case-report) (author's transl)]. / Die Abdominalgravidität in Terminnähe (Fallbericht)

Description of a case of ectopic pregnancy during the last 3 months with a living, malformed and underdeveloped neonate. Possible treatment is discussed: where as in our case there is a secondary ectopic pregnancy (i.e.a pregnancy started primarily in the tube and still in vascular contact with it but secondarily ectopic) removal of placenta following ligation of the main vessels arising from the tube is possible and recommended. In the much rarer primary ectopic pregnancy with primary nidus in the abdomen, removal of the placenta is dangerous and not advised because of the danger of diffuse hemorrhage.

The significance of the time interval in twin delivery.

In order to evaluate the influence of the time interval on the second twin in twin deliveries, we have used more precise criteria than have been used in the literature to date. In the period from July 1, 1970 to December 31, 1974, 35 twin deliveries in our hospital were analyzed, in which both twins fulfilled the following criteria: 1. vertex presentation 2. vaginal deliveries 3. birth weight above 2000 g. We analyzed various parameters in the clinical and acidity score of the second twin alone as well as in comparison to the first twin. The following points of view were considered: 1. The more sensitive aspect of morbidity was utilized by including the assessment of the state of the newborn rather than just mortality. 2. Since Caesarean sections in twins are often performed for a fetal indication, short time intervals between the birth of both infants correlate intrinsically with a higher risk for the second twin. Therefore we considered only vaginal deliveries in order to exclude this intrinsic correlation. 3. By excluding infants below a birth weight of 2000 g, the influence of the low birth weight of the second twin was eliminated. 4. The frequently occurring positional anomalies of the second twin will deteriorate the conditions independent of the time interval. therefore we have considered only births from vertex presentations. A comparison of the acidity state demonstrated that the actual pH values in the umbilical artery blood of these second twins (Fig. 1) decrease statistically significantly with increasing time intervals. this is also true for metabolic acidity (pHqu40). The differences of the actual pH values (Fig. 2) and the pHqu40 values between the first and second twin decreases significantly also with an increasing time interval. Our results indicate that obstetricians, according to the clinical conditions, should accomplish the birth of the second twin as soon as possible after the birth of the first twin.

[Neonatal asphyxia immediately following birth due to thyreoglossal cyst blocking the larynx (author's transl)]. / Erstickungstod eines Neugeborenen unmittelbar post partum durch Kehlkopfeingang verlegende Thyreoglossuszyste

Report on death from asphyxia immediately after birth of a child with obstruction of the larynx by a cyst of thyreoglossus. When intubation of an asphyctic neonate is attempted and a diagnosis of an obstructing cyst is made the following measures should be taken: Immediate aspiration of the contents of the cyst or without canula under laryngoscopic control. Attempt at intubation. If unsuccessful, emergency tracheostomy, although burdened with a high morbidity in neonates. If this cannot be done quickly, then--in addition to other measures--an infusion should be given through a catheter in the umbilical vein to counteract acidosis and hypercapnia.

[Tocolysis for external version of breech presentation close to term (authors transl)]. / Die anwendung der tokolyse bei der äusseren wendung der beckenendlage in terminnähe

The external version of breech presentation into vertex presentation with tocolysis near term is now the best method to avoid the disadvantages of a breech presentation for mother and child. In 30 out of 37 cases external version using Partusisten was possible. 26 patients with previous breech presentation were, after version, delivered of a healthy child. Except for one transitory slight hemorrhage there were no incidents. This method should be carried out only in a department having facilities for cardiotocography and emergency Caesarian section. It appears that a cause of failur of the external version with tocolysis near term is the breech presentation with extended legs.