Recombinant human erythropoietin in the treatment of postpartum anemia.

Postpartum maternal anemia (hemoglobin concentration below 10 g/dL) is a common problem in obstetrics. Human recombinant erythropoietin, which has been shown to correct the anemia of end-stage renal disease and eliminate the need for transfusions, was used in a comparative study of women with postpartum hemoglobin concentrations below 10 g/dL. Five daily doses of 4000 IU were given. Hematologic and clinical data were compared on days 5, 14, and 42 after therapy in the treated women and in untreated women. Both groups received the same iron and folic acid supplements. Significantly greater increases in reticulocytes, hemoglobin, and hematocrit were seen by day 5 for the treated subjects compared with controls. Ferritin levels were significantly lower in the therapy group than in controls. No differences were seen between the groups in the platelet counts or clinical characteristics. No negative side effects were observed. As in other studies in populations without renal disease, recombinant human erythropoietin enhanced endogenous erythropoiesis over and above the normal physiologic recovery rate.

Lack of associations between fetal and maternal serum-erythropoietin at birth.

Erythropoietin (EPO) is known to be the main regulator of erythropoiesis. We wanted to determine whether EPO production during pregnancy takes place independently in the mother and the fetus, and to identify the factors which set the EPO level. Endogenous EPO levels were determined in simultaneous samples from the umbilical vein, the umbilical artery and a maternal vein in 126 mother-child pairs and simultaneously from amniotic fluid (n = 14) in unselected births. Results were related to clinical and biochemical parameters of fetal well-being, mode of delivery, duration of labor, and infant parameters at birth. There was a weak correlation between maternal and fetal log EPO values (umbilical vein: r2 = 0.11; umbilical artery: r2 = 0.08), but a highly significant correlation between log EPO levels in the two umbilical vessels (r2 = 0.91) and between both umbilical blood and amniotic fluid (r2 = 0.41). Maternal EPO levels were lower than fetal levels in 76 cases, higher in 47, and nearly identical in 3. Increased fetal EPO levels were associated with clinical and biochemical indicators of fetal stress. These associations help to explain why EPO concentrations in fetal blood are independent of maternal levels and also indicate that EPO does not cross the placental barrier. These findings are discussed in the light of the animal experimental and in vitro evidence for placental transfer of EPO. Our data, and the work of others, make such a transfer in humans quite unlikely. This observation has therapeutical consequences for the treatment of maternal anemia with recombinant human EPO.

[Studies on the kinetics of nitrofurantoin (Nifurantin) in normal pregnancy, gestoses, pyelonephritis and labor (author's transl)]. / Untersuchungen zur Kinetik von Nitrofurantoin (Nifurantin) in der normalen Schwangerschaft, bei Gestosen, Pyelonephritis und unter der Geburt.

After oral administration of 300 mg of nitrofurantoin (Nifurantin) to various groups of pregnants, to women in labour and nonpregnant women the blood level and renal excretion of nitrofurantoin were investigated. We stated that gravidity, pyelonephritis and EPH-gestosis did not alter neither the renal excretion nor the blood level. In contrast to this during labour the renal elimination of nitrofurantoin was diminished and the blood concentration was enhanced. The biotransformation of nitrofurantoin seems not to be changed by pregnancy.

[The correlation of reduced amniotic fluid volume, placental maturity and morphologic placental changes in placental insufficiency]. / Uber den Zusammenhang zwischen einer reduzierten Fruchtwassermenge, der Plazentareife und den morphologischen Plazentaveränderungen bei der plazentaren Insuffizienz.

A reduced quantity of amniotic fluid is diagnosed semiquantitatively in 41 pregnant women in the 38th to 40th week of gestation. In 21 cases, the birth of a mature hypotrophic child below the 10th weight percentile is registered. Sonographically, the placentas of the mature eutrophic children significantly more frequently show a grade III maturity and the placentas of the mature hypotrophic children a grade II maturity. In contrast to the values found in the placentas of eutrophic children and in the placentas with grade III maturity, a significantly decreased villous vascularization is determined in the placentas of hypotrophic children and in placentas with grade II maturity. The area of attachment of the placenta is 301 cm2 for the eutrophic children and 222 cm2 for the hypotrophic children. All findings are discussed and compared with the relevant data of the pertinent literature.

[Clinical and ultrasonic diagnosis of hematometra following curettage]. / Klinische und sonographische Diagnose einer Hämatometra nach Curettage.

By hands of a case report we describe our diagnostic management in a patient suffering from hematometra 3 months after legal abortion. Sonography plays an important role in such cases to detect and explain the symptoms "metrorrhagy and uterine cramps monthly connected with small inflammatory signs". For curing we did a probing of the uterine cavity to eliminate the residual blood coagulas. 3 months after curing the hematometra the patient was clinically and sonographically without bodily ailments. Hypotheses about etiology and treatment of this rare condition are reviewed.

[Twin pregnancy with fetal hydrocephalus]. / Zwillingsschwangerschaft mit einem fetalen Hydrozephalus.

There is a case report on twin pregnancy with fetal hydrocephalus, recognized in the 24th week of gestation. Course of pregnancy and management during labour are described. The peculiarity of our observation is for the constellation mother--healthy fetus--fetus with hydrocephalus. Taking care for the pregnant woman and the healthy fetus are most important.

[Fetal triploidy--diagnosis and sequelae]. / Fetale Triploidie--Diagnostik und Konsequenzen.

A pregnancy in the 22nd week of gestation with severe asymmetric retardation of growth without malformations by ultrasonography is described. A triploidy was found by prenatal cytogenetic investigation. Possible signs for triploidy in pregnancy and the necessary conclusions are discussed.

Doppler ultrasound examination of fetal renal arteries.

This study used color Doppler imaging to establish the normal values of the pulsatility index in the fetal renal arteries in a group of 304 uncomplicated singleton pregnancies. The measurements were taken between 26 and 42 weeks of gestation. The median was 2.79 (95% confidence interval: 2.72-2.86) for 26 weeks' gestation, and it then fell linearly to 1.96 (95% confidence interval: 1.92-2.00) at 40 weeks. Compared with values published so far in the literature, the range was clearly smaller. These normal values could be used as a basis for further investigations on these vessels.

[Correlation of the magnitude of fetal movement associated fetal heart rate accelerations, amplitude of "classical" accelerations and transcutaneous fetal oxygen partial pressure]. / Der Zusammenhang zwischen der Grösse kindsbewegungsassoziierter fetaler Herzfrequenzakzelerationen, der Amplitude "klassischer" Akzelerationen und dem transcutanen fetalen Sauerstoffpartialdruck.

An attempt is made to provide non-empirical evidence of the "classical" amplitude of sporadic fetal heart rate accelerations of 15 bpm. Sporadic, fetal movement associated fetal heart rate accelerations are generally regarded as an indication of fetal wellbeing. A minimal amplitude of 15 bpm with unknown duration of the associated fetal body movement seems to be a prerequisite to establish an unimpaired fetal condition as reliably as possible. Including the "classical" acceleration amplitude in a ratio from the acceleration amplitude and associated fetal body movement and comparison of these calculated values with a total of 3851 actual ration from acceleration amplitudes and durations of associated body movements of 175 normotrophic and 72 hypotrophic fetuses showed that only a hypothetical acceleration amplitude of 15 bpm yields ratios which correspond to the actual values of unimpaired fetuses. There is a significant positive correlation between the actual ration and the transcutaneous basal fetal partial pressure of oxygen during birth.

[Diagnosis of a Twin-Reversed-Arterial-Perfusion-Syndrome (TRAP) in the First Trimester of Pregnancy - Report on Two Cases]. / Diagnose eines Akardius-Akranius im ersten Trimenon der Schwangerschaft - Bericht von zwei Fällen.

The Twin-Reversed-Arterial-Perfusion-Syndrome (TRAP) is a rare complication of monocygotic multiple pregnancies. It is associated with a high perinatal mortality. One twin (recipient or acardius) is perfused by the other (donour) on the basis of vascular anastomoses. Several possible therapies have been suggested. One of them is the endoscopic laser coagulation of the umbilical artery. The success of this method seems to depend on an early diagnosis of TRAP in the first trimester, when no secondary complications are to be expected. We report the diagnosis of two cases of TRAP in the 12th gestational week by transvaginal ultrasound combined with colour and pulsed Doppler. The latter facilitates the differentiation of TRAP from other pathologic conditions or malformations as well as a detailed description of the blood flow in TRAP.

[Application possibilities of an automatic image analyzer ("Quantimet 720") in bone histomorphometry]. / Untersuchungen zur Einsatzfähigkeit eines automatischen Bildanalysegerätes ("Quantimet 720") in der Knochenhistomorphometrie.

By the way of proofing of the preventive estrogen effect on the ovariectomy osteoporosis in rats the authors collected experiences in measuring of two histomorphometric parameters "trabecular bone volume" and "trabecular bone surface" with the automatic image analyser Quantimet 720. This method demands thin bone polishes or cuts, a very rich in contrast and selective colouring. The measurement with this device spares time and gives reliable results for "trabecular bone volume", but less reliable values for "trabecular bone surface".

[Ultrasonographic differential diagnosis of imminent abortion (author's transl)]. / Zur ultrasonographischen Differentialdiagnose des Abortus imminens.

Two-hundred patients, hospitalised for imminent abortion in the sixth to 16th weeks of pregnancy, underwent 294 ultrasonic compound B scans. Gravidity was found to be intact in 68 per cent of all cases, but 13.6 per cent of these ended in abortion prior to the 28th week of pregnancy. Four hydatiform moles and 17 missed abortions were reliably diagnosed. Ultrasonography, even without grey-scale equipment, may be of greatest usefulness for differential diagnosis between intact early pregnancy, missed abortion, blighted ovum, and hydatiform mole, when used by an experienced specialist in close cooperation with the clinical practitioner.

[Use of ultrasound in presurgical differential diagnosis of gynaecological tumours (author's translation)]. / Präoperative Differentialdiagnose von gynäkologischen Tumoren durch Ultraschall.

Ultrasonographic bistable compound A-B scanning was used in presurgical examinations of 53 gynaecological tumour patients. Ultrasonographic diagnosis proved to be superior to palpation for its better characterisation of the tumour by size, location, shape, consistency, and general description. It provided safe presurgical information in 23 per cent of those cases in which palpation had failed to yield satisfactory findings. -Tumours were correctly described by ultrasonography in 63 per cent of all cases, largely accurately in 28 per cent, and largely inaccurately in nine per cent. -Interpretation of typical ultrasonograms and of those likely to give problems in differential diagnosis as well as their proper integration with the overall clinical approach are discussed.

[Ultrasonographic detection and clinical importance of placental migration (author's transl)]. / Ultrasonographischer Nachweis und klinische Bedeutung der Plazentamigration.

Pathological insertions were diagnosed in 66 of 4, 804 ultrasonic placentograms, beginning with the 13th week of pregnancy. Placental migration, that is displacement towards the fundus of the uterus of the caudal adge of the placenta, was followed up by consecutive checks. Pathological placenta locations were recorded in 4.1 per cent of all cases, up to the 20th week of pregnancy, was found to emanate from migration in the majority of all cases. The process of placental migration usually takes place up to the 30th week of pregnancy and is completed by the 35th week. If pathological insertions were diagnosed after the 20th week f pregnancy, migration was found to take place with much lower incidence. Methodical problems relating to ultrasonographic representation are discussed together with clinical consequences.

[Correlation between reduced amniotic fluid volume and Doppler spectra of fetal blood vessels at term]. / Zusammenhang zwischen verminderter Fruchtwassermenge und Dopplerspektren fetaler Gefässe am Termin.

The aim of this study was to determine, whether foetuses with reduced amniotic fluid in other-wise uncomplicated pregnancies at term show signs of redistribution of blood flow analogous to foetuses with intrauterine growth retardation. In 33 pregnancies > or = 37 gestational weeks with the largest pocket of amniotic fluid < 2 cm, flow velocity waveforms were recorded for the umbilical artery, middle cerebral artery and renal artery and compared with those of foetuses of the same gestational age and normal amniotic fluid volume. No difference was found in the resistance index (umbilical artery and middle cerebral artery), the pulsatility index (renal artery), or for the cerebral-placental ratio between these two collectives. We conclude, that Doppler examination of foetal vessels does not help to clarify the phenomenon of decreasing amniotic fluid volume during the final period of gestation. We suggest, that the decrease is not caused by renovascular changes, but has intra- or extrarenal causes.

[Classification of subpartal fetal heart rate oscillations by tcpO2 measurement]. / Klassifizierung subpartualer FHF-Oszillationen durch tcpO2-Messung.

There is no uniform opinion on the clinical value of FHR variability. It is possible to study connections between FHR variability and fetal oxygen tension by means of tcpO2 measurement. 856 episodes from 64 tcpO2 CTGs with more than 2 300 single characteristics were used for analysis. 31% of the fetuses examined exhibited signs of intrauterine growth retardation. The frequency of variability revealed a statistically significant correlation with oxygen tension (p less than 0,001). In hypotrophic fetuses the amplitude of variability was significantly correlated with oxygen tension (p less than 0,001). Silent and narrowly undulatory oscillations reached the significantly lowest oxygen tension values of 11,8 mmHg (1,6 kPa) and 15,2 mmHg (2,03 kPa), respectively, as compared to 20,5 mmHg (2,73 kPa) and 24,2 mmHg (3,23 kPa) for undulatory and saltatory oscillations, respectively. The control group of eutrophic fetuses revealed an inversely proportional, statistically significant behaviour of the amplitude of variability and fetal oxygen tension (p less than 0,001). Classification by means of tcpO2 limits (less than or equal to 11 mmHg = hypoxemic and greater than or equal to 12 mmHg = non hypoxemic) confirmed the traditional classification of the amplitude of variability in fetal growth retardation.

[Fetal hyperechogenic and cystic pulmonary masses: sonographic findings, antenatal management and outcome of 12 cases]. / Echogene und zystische Veränderungen in der fetalen Lunge: sonographische Befunde, pränatales Management und Outcome von zwölf Feten.

OBJECTIVE: Presentation of prenatal findings and postnatal outcome of cases with echogenic or cystic lesions of the lungs. Discussion of the prenatal diagnostic and clinical management. PATIENTS AND METHODS: Retrospective analysis of the antenatal sonographic findings, the management and outcome of 12 cases of fetal chest masses. RESULTS: The postnatal findings included cystic adenomatoid malformation of the lungs (CAML) (nine cases) and lung sequestration (LS) (one case). Five fetuses were observed up to term. Two of them underwent postnatal surgery and three fetuses revealed an antenatal decrease of the lesion. None of these surviving fetuses developed hydrops, but in three of them a mediastinal shift was seen. The other fetuses did not survive (termination of pregnancy: six cases, spontaneous fetal loss: one case). Four of them had bilateral solid lesions, hydrops or additional malformations. CONCLUSIONS: 1. Ultrasound evaluation of chest masses is useful in diagnosing of the type and the extent of the lesion, recognition of secondary alterations and exclusion of additional malformations. 2. Termination of pregnancy should be recommended in cases of hydrops that develops early in gestation, bilateral lesions with expected unfavourable outcome or life-threatening additional malformations. 3. Mediastinal shift does not seem to predict a poor perinatal outcome. 4. Spontaneous decrease of the size of the lesion is associated with a favourable outcome.