[Significance of uterine contractions for adaptation of the newborn infant before cesarean section]. / Die Bedeutung der Wehentätigkeit für die Adaptation des Neugeborenen vor Sectio caesarea.

UNLABELLED: There are quite a few publications on the influence of labour on the adaptation of neonates after elective cesarean sections. Many authors recommend the induction of labor prior to the cesarean section. They found that this improves the adaptation of the infants. MATERIAL AND METHOD: All cesarean sections between 1991 and 1996 are recorded. Mature neonates (> 36 weeks of pregnancy) were evaluated separately from premature infants (< 36 weeks of pregnancy). As target-parameters we chose 1. the condition of the neonates (characterized by the Apgar-Score, the pH of the umbilical cord artery, and the requirement of artificial respiration). 2. the necessity of transfer to the neonatologic intensive care unit. Concerning these parameters, the immature neonates (> 36 weeks of pregnancy) were evaluated separately from the mature infants (< 36 weeks of pregnancy). In the latter group we finally evaluated the data of those who were not delivered by a cesarean section because of intrauterine fetal distress. RESULTS: The adaptation of the premature neonates was so closely related to the gestational age that all the other variables were of no statistically significant influence. Thus also the factor "labour" was of no influence. The results in the group of the mature infants were completely different. Between week 36 und 42 of pregnancy the gestational age was of no influence on the adaptation of the neonates. Statistically noticeable however was the influence of preoperative labour: The adaptation of infants delivered by cesarean-section after labour was remarkably worse than the adaptation of those who were delivered without labour prior to the operation. This statement is also correct when one rules out those infants who were delivered by a so called emergency cesarean section. When evaluating the group of neonates in which the cesarean section was not performed because of intrauterine fetal distress we could find no influence of preoperative labour on the adaptation of the infants. All other variables examined (e.g. maternal age, parity, duration of labour, method of anaesthesia, twin-pregnancy) were no factors of influence on the adaptation of the babies. CONCLUSION: From our results we cannot support the recommendation to induce labour prior to any elective cesarean section by infusion of oxytocin or to wait for the spontaneous onset of labour. There ist no reason to change our policy to perform an elective cesarean section as near as possible to term before the onset of labour.

[Twin pregnancy in uterus didelphys]. / Gemini-Gravidität bei Uterus didelphys.

A case of twin pregnancy in uterus didelphys is reported. This rare event is discussed from obstetric aspects as well as that of dizygotic twins.

Morphohistometric investigations in placentas of gestational diabetes.

Perinatal morbidity and mortality are increased in both overt and gestational diabetes. Since retardation of placental development has been documented in overt diabetes, we, thus, examined morphometrically the terminal villi of 26 patients with gestational diabetes in order to determine if there is an immaturity of placental development. Investigation of villous surface, degree of vascularization, and development of epithelial plates yielded values lying somewhere between those of non-diabetic patients and those of patients with overt diabetes. Only the surface areas of the vessels were reduced to levels lower than in overt diabetes. Our findings appear to explain the occasional development of acute placental insufficiency.

Morphohistometric investigations of placentas of diabetic patients in correlation to the metabolic adjustment of the disease.

In order to determination if an interdependence exists between the well-known maturational disturbances in placentas of diabetics and the quality of metabolic adjustment, a morphometric study covering 7,500 terminal villi of 50 placentas was performed. The diabetic mothers were divided into two groups according to satisfactory or unsatisfactory blood glucose values. Significant differences in placental retardation were observed between both diabetic groups and a normal control group. Although outcomes did not differ greatly between the two diabetic groups, macrosomia and the ratio of malformations in the newborns correlate with unsatisfactory metabolic management. Small-for-date babies, the need for early termination of pregnancy as well as pre-eclampsia are related to the severity and duration of the disease.

The development of the placental villus during normal pregnancy: morphometric data base.

The morphological structures of the terminal villus of the normal human placenta were evaluated morphometrically throughout pregnancy. The Videoplan (Kontron) system was used to measure a total of 6000 villi. The cross-sectional surface and circumference of the villus decrease continuously until the 28th week and remain stable thereafter. The cross-sectional surface, number, and circumference of villous vessels only increase until the 20th week. The relative degree of vascularization, however, increases further until 28th week together with a continuous decrease in villous size. Epithelial plates start to appear in the 18th to 20th week, and their development is essentially completed by the 28th week. According to the data presented, the development and differentiation of the placental villus are completed by the 28th week of gestation. Any further increase in nutritional capacity can only be provided by an increase in the number of villi and not their individual maturation. These results represent a morphometric data base for the quantification of retarded placental development in placental insufficiency.

[Pelviscopic tubal coagulation]. / Pelviskopische Tubenkoagulation.

1771 laparoscopic tubal sterilisations were analysed from 1972-1982 at the UFK Ulm. The control period extended to 1986. The median age was 35.2 years with a constant increase over the decade. The overall complication rate was 1.86%; however, laparotomy became necessary in only 0.39% of the cases. There was an increased risk of complications with the more difficult procedures and with simultaneous elective abortion, whereas no association with the number of preceding laparotomies was observed. The failure rate was 0.34% by the end of 1986.

[Correlation between maternal hemoglobin levels and placental morphology and findings in newborn infants]. / Korrelation zwischen maternem Hämoglobingehalt und Plazentamorphologie sowie Befunden der Neugeborenen.

According to the criteria formulated by the WHO a hemoglobin concentration of 11 g/% represents an anaemia requiring treatment. 28 placentas of patients with hemoglobin concentrations of 7.2 to 10.9 g/% were examined morphometrically to detect possible disturbances of placental development. The patients had all delivered between the 37th and 41st week. Weight, hematocrit and HbA content of the newborn were correlated with the maternal hemoglobin content. There was no influence of maternal hemoglobin concentration on weight and size of the placenta, degree of vascularization and epithelial plates of the terminal villi. In patients with severe anaemia villous areas were smaller and villous vascular areas appeared larger than usual. The ratio of weight of the newborn to weight of the placenta was more commonly decreased in patients with anaemia. In some cases of severe anaemia fetal HbA values were elevated. All newborns with a hematocrit of 50 or more were delivered of mothers with haemoglobin concentrations of 9.5 g/% or less. The weight of all newborns in this study were above the 10th percentile. 7 of 9 newborns with a weight of 3,200 g or less were delivered of patients with a hemoglobin concentration of 9.5 g/% or less. These results indicate that placenta and fetal organ systems are able to compensate for the maternal anaemia without any major complications.

[Histometric case report of a placenta following intra-uterine therapy of rhesus incompatibility]. / Histometrische Kasuistik einer Plazenta nach intrauteriner Therapie einer Rhesus-Inkompatibilität.

In Rh-incompatibility the human placenta shows a prominent retardation of maturation. The placental insufficiency caused by these changes, combined with the existing hemolysis, represents an additional danger to the fetus. In a patient with severe Rh-incompatibility several Rh-negative blood transfusions were performed between the 26th and 30th weeks of gestation via sonographically guided puncture of the umbilical vein. Morphometric studies of the placenta were performed and the results compared with data already obtained from normal mature placentas and placentas from pregnancies complicated by Rh-incompatibility. Small terminal villi with a surface area identical to normal mature placentas were found. There was no improvement in vascularization when compared with other placentas from Rh-incompatible pregnancies. Nevertheless, isolated rebuilding of epithelial plates was found. The authors interpret these morphological phenomena as a "partial postmaturation" of the placenta as regards the development of the terminal villi. The absence of reproliferation of the villous vessels as well as the lack of any extensive regeneration of the epithelial plates could be due to the short time which elapsed between transfusion therapy and the inevitable indication for caesarean section. Intensive intrauterine therapy reduces the risk to the fetus due to immunologic complications, as well that due to placental insufficiency, as evidenced by the additional differentiation of villi.

Morphometric investigations of terminal villi of diabetic placentas in relation to the White classification of diabetes mellitus.

In this morphometric study, terminal villi of 22 placentas of maternal diabetes mellitus were compared with the results in terminal villi of 22 normal placentas. The results demonstrate that there is a distinct retardation in maturation, statistically significant with bigger cross sectional surfaces of the terminal villi, particularly, when classified in 3000 mu2-steps, the number of the villous vessels and number of epithelial plates. Only slightly decreased in diabetic placentas is the villous vessels cross sectional surface as well as the degree of vascularization. The correlation between the degree of histometric changes and the severity and duration of the disease was separately investigated (classification was done according to White). It could be shown, that the degree of morphologic changes in the terminal villi does not run strictly parallel to the severity and duration of diabetes. The retardation in maturation of the terminal villi increases from White group A to C. In White group D, which is the most severe stage of diabetes mellitus which we investigated, the values of measured parameters are close to the normal placentas. This observation is interpreted as a compensatory reaction of the fetal organ placenta to the reduction in utero placental blood flow in diabetes caused by the diabetic angiopathy.

[Functional morphometry of the villous surface of the mature human placenta]. / Funktionelle Morphometrie der Zottenoberfläche der reifen menschlichen Plazenta.

In 22 placentas of spontaneous delivered new-borns after a normal course of pregnancy and delivery the entire surface of resorption of the placenta was determined by means of multiple macroscopic and microscopic parameters. It could be demonstrated that the placental tissue is subject to a homogeneous shrinking process during the usual process of histologic preparation. The influences of fixation and histologic preparation are strongly marked. They have to be taken in consideration when the total villous surface is calculated. In the present study the distribution pattern of stem villi, immature villi and terminal villi in the total volume of villi was studied in representative histologic sections from the periphery of placentones. In this area also the content of intervillous fibrin and the quota of syncytial knots in the placental tissue was determined. Our average value for the total villous surface can serve as a standard for planned studies in placentas of high risk pregnancies.

[Vagino-cytological studies in prostitutes]. / Vaginalzytologische Untersuchugen an Prostituierten.

Numerous papers on the high incidence of precancerous lesions of the uterine cervix in prostitutes have been published mainly in Anglo-American literature. The reported data were compared with those of prostitutes in a South German city. In a retrospective study on 239 prostitutes and a control group of 502 patients of the same age distribution the data regarding the vaginal flora and the obtained cytologic groups (modified Papanicolaou classification "M unchner Nomenklatur ") were compared. The prostitutes showed a higher rate of cocci in otherwise "comparably clean" smears. The incidence of trichomonas vaginalis was five times higher among the prostitutes. In contradiction to American and British publication there was no higher incidence of smears pointing to precancerous lesions among the prostitutes. It seems that the characteristic "low socioeconomic status" does not apply to prostitutes in our region.

[Complete and incomplete removal of precancerous conditions by conization]. / Vollständige und unvollständige Entfernung von Präkanzerosen durch Konisation.

673 patients with cervical lesions ranging from mild dysplasia to microcarcinoma have been treated by cone biopsy. There was a complete removal of the premalignant or malignant tissue in 70% of the cases, depending on the degree of severity of the lesion. In 42% of the cases (166 patients) in which hysterectomy was performed for incomplete conisation, no rests of the epithelial lesion could be found. Therefore it is recommended to follow these patients by means of cytology and colposcopy without immediate hysterectomy, especially in women who desire further pregnancies. Among 28 patients followed in this way there was recurrency only in 2 cases. In spite of "complete" conisation there were rests of cancerous tissue in 11 of 66 cases. The latter results show the necessity of a consequent follow-up also for these patients.

[Morphologic findings in the placenta in intrauterine fetal growth retardation]. / Morphologische Plazentabefunde bei intrauteriner fetaler Mangelentwicklung.

The placentas of 105 small-for-dates infants and 190 newborns of normal birth weight were investigated morphologically. Each of these two groups consists of premature newborns and mature newborns. Macroscopic and microscopic data were evaluated by means of a so called data bank. --The weight and the area of attachment were determined. The histologic findings were classified in two groups: 1. Disturbances of placental maturation, 2. Morphologic changes in consequence of reduced uteroplacental blood flow. A marked increase of hypoplastic placentas was found among immature and mature small-for-dates infants. Retarded placental maturity was found more frequently among mature small-for-dates infants then among prematures. Among these, placentas with signs of a reduced uteroplacental perfusion were found more frequently. --It is assumed that the pathogenetic course is different in placentas of premature and mature small-for-dates infants.

[Diagnostic and therapeutic management of breast cysts]. / Diagnostisches und therapeutisches Vorgehen bei Mammazysten.

In a study of 144 patients with cystic dysplasia of the breast diagnostic and therapeutic accuracy of palpation, mammography, aspiration cytology and pneumocystography was investigated. Only in 9.7% of the cases a surgical biopsy was necessary. In more than 90% of the cases biopsy was not performed; instead of this follow up with palpation, mammography and aspiration cytology up to 11 months was done. No breast cancer was overlooked, three of four proliferating dysplasias were detected. In 21% a local cystic recidive occurred which again was punctured. In contrary to surgical biopsy follow up of cystic dysplasias is not complicated by scars and their diagnostic problems. No complications were seen.

[Morphometric placental investigations in EPH-gestosis (pre-eclampsia) (author's transl)]. / Morphometrische Placentaberfunde bei EPH-Gestose.

Morphometric data of 19 placenta after EPH-gestosis of pregnancy are compared with data of placenta of uncomplicated pregnancies. No statistically significant differences were found concerning the area of attachment of the placentas, the amount of fibrin deposits in the intervillous space and the amount of syncytial knots of the terminal villi. The areas of the cross section as well as the circumferences of the resorption villi were increased in the placentas of pre-eclampsia of pregnancy. The number of capillaries per villus was the same in both groups. The diameters of the vessels however were smaller in the gestosis group. Also a decrease of the degree of vascularisation of the villi was found. The number and length of epithelial plates and their quota of the circumference of the villi were markedly diminished in the EPH-gestosis group. These morphologic findings are signs of retarded maturation (differentiation) of the resorption villi. The results explain the ineffectiveness of therapeutic attempts in many cases of pre-eclampsia.

[The placental polyp, a cause of late puerperal hemorrhage (author's transl)]. / Der Placentarpolyp als Ursache der Spätwochenbettsblutung.

9.062 deliveries took place from 1975 to 1979 at the Department of Obstetrics and Gynecology, University of Ulm. In 33 patients (0,36%) a curettage had to be performed because of late puerperal hemorrhage. Clinically mostly a placental polyp was suspected. In 10 cases (0,11%) histologic examination revealed trophoblastic tissue, in 17 cases (0,19%) decidua only and in 6 cases (0,066%) endometrium of different stages of proliferation. No correlation could be found between the mode of delivery or the placental stage and the occurrence of late puerperal hemorrhages. Also no correlation could be demonstrated between the bleedings and the number of earlier pregnancies, former curettings or uterine surgery for malformations. Comparison with earlier reports in the literature shows that the rate of late puerperal hemorrhages can be diminished by an active procedure during the placental stage. It must be pointed out that in all cases in which placental tissue can not be demonstrated histologically the term "placental polyp" should be avoided and be replaced by the term "decidual polyp".