[Antepartal maternal risks for shoulder dystocia. An analysis of 224 744 births spontanous and vaginal and after the 37th week of gestation born in Hessen (2002-2008)]. / Mütterliche antepartale Risiken einer Schulterdystokie. Eine Analyse der HEPE aus 224 744 reifen vaginalen Einlingsgeburten aus Schädellage der Jahre 2002-2008.

UNLABELLED: PATIENTS RESPECTIVELY AND METHODS: 224,744 vaginal and spontanous births >or= the 37 (th) week of gestation were analysed (2002-2008) to calculate the maternal risks for shoulder dystocia (obesity BMI >30, high maternal weight gain >15 kg during pregnancy, Diabetes mellitus, Diabetes of gestation, duration of pregnancy >or= 298 days, multiparity >1 partus). RESULTS: It could be demonstrated for the first time (Degree of evidence III B), that multiparity and the weight gain>15 kg elevate the rate of shoulder dystocia independant of the birth weight. At a birth weight below 4 000 g in addition to the multiparity and the weight gain the obesity BMI>30 elevate significant the rate of shoulder dystocia (Degree of Evidence III B). In the birth weight group >or=4,000 g Diabetes mellitus elevate the risk of shoulder dystocia in addition to multiparity and weight gain >15 kg (Degree of Evidence III B). Diabetes mellitus elevate the risk of shoulder dystocia only in combination with macrosomia >4 000 g. CONCLUSION: The pregnant woman should be informed about the statistically proved different maternal risk factors for a shoulder dystocia and a possible paresis of the Plexus brachialis in relation to the fetal birth weight. The sensitivity of 60% of the sonographic estimation of the fetal birth weight is to low and cannot be the only content of an information about this danger for the newborn.

[Maternal risks for newborn macrosomia, incidence of a shoulder dystocia and of damages of the plexus brachialis]. / Mütterliche Risiken für eine Makrosomie, Inzidenz von Schulterdystokie und Plexus-brachialis-Parese.

UNLABELLED: PATIENTS RESPECTIVELY AND METHODS: In the HEPE 619 242 births have been analysed (1990 - 2000) to calculate the incidence of a birthweight between 4000 and 4499 g and of a weight > or = 4500 g in relationship to maternal obesity, high maternal weight gain and of a duration of pregnancy more than 298 days. RESULTS: The risk of a macrosomia > or = 4500 g is in cases of obesity 3.4 times higher, in cases of obesity and prolongation of pregnancy 6.6 times higher and in the presence of all 3 risk factors 10 times higher. Data of the Frauenklinik Wiesbaden (HSK) (n = 6075 births) complete the results, because a correlation between macrosomia, shoulder dystocia and a damage to the plexus brachialis has been found. The incidence of a damage to the plexus brachialis is in case of a shoulder dystocia and a birth weight of < or = 4000 g 6.3%, at a birth weight between 4000-4499 g 25% and in newborns with a weight > or = 4500 g 40%. CONCLUSIONS: Because of the low sensitivity (60%) of the ultrasonic weight measurement the 3 maternal risk factors--if they exist--of a shoulder dystocia and of a damage of the plexus brachialis should be discussed with the pregnant woman to help her about the decision of an alternative cesarean section. Still one third of the newborns weigh more than 4000 g if all 3 maternal risk factors exist.

[Emergency cervix cerclage in amniotic sac prolapse--a realistic option for prolonging pregnancy]. / Notfallmässiger Muttermundverschluss bei Fruchtblasenprolaps--eine realistische Option zur Schwangerschaftsverlängerung.

BACKGROUND: We tried to evaluate, whether emergency operative closure of the cervix (EOCC) is a realistic option for prolongation of pregnancy in cases with early opening of the cervix and prolapse of the amniotic sac (PAS) into the vagina. PATIENTS AND METHODS: We report on 16 patients with PAS between 15 + 3 and 28 + 1 weeks of gestation and cervix dilatation between 2 and 8 cm. After antibiotic and tocolytic treatment we performed EOCC in 7 cases and EOCC + Cerclage in 9 cases. Pregnancy follow up and fetal outcome were analysed retrospectively. RESULTS: Mean gestational age at delivery was 33 + 1 weeks (9 cases > 32 + 0 weeks, 2 cases between 28 + 0 and 31 + 6 weeks, 3 cases between 25 + 0 and 27 + 6 weeks, 1 case with rupture of membranes during operation and immediate cesarean section at 28 + 1 weeks, 1 miscarriage at 23 + 3 weeks). Time between EOCC and delivery was between 0 and 146 days (mean 56.3 days), 14 fetuses survived healthy. The best results were obtained after EOCC + cerclage. CONCLUSION: If antibiotic and tocolytic treatment was successful in stopping local infection and contractions, EOCC is an acceptable and mostly successful procedure to prolong pregnancy.

Routine screening for intrauterine growth retardation in Germany: low sensitivity and questionable benefit for diagnosed cases.

BACKGROUND: Antenatal screening for fetal growth retardation has proven effective in detecting at-risk pregnancies under study conditions. It is also widely believed to improve pregnancy outcomes. We assessed sensitivity of antenatal screening routines for intrauterine growth retardation under routine service conditions in Germany. We then compared pregnancy management and outcome in small for gestational age neonates with antenatally diagnosed growth retardation to neonates whose growth retardation had remained undetected. METHODS: Historical prospective study covering all 2378 singleton pregnancies with antenatal records delivered within a one-year period at a tertiary level maternity hospital in Germany. Antenatal records were linked with pregnancy outcome data. RESULTS: The sensitivity of screening routines based on ultrasound and non-systematic follow-up investigations was 32% as compared to 80-90% reported for ultrasound screening under study conditions. An antenatal diagnosis of intrauterine growth retardation was associated with a 5 times higher rate of preterm delivery (p<0.001), mainly as a consequence of medical interventions to avoid fetal compromise, when compared to new-borns with growth retardation not detected before delivery; admission rates to neonatal care unit were 3 times higher (p<0.001). The proportion of low Apgar scores and low cord pH, indicating fetal distress, was not significantly different in detected and undetected cases. CONCLUSION: Screening routines for intrauterine growth retardation currently used in Germany miss the majority of cases and do not contribute towards improved pregnancy outcome in detected cases. A benefit of elective preterm delivery in the management of suspected intrauterine growth retardation was not evident.

[Transabdominal chorionic villi and placental biopsy: rapid karyotyping in the 1st-3rd trimester of pregnancy]. / Transabdominale Chorionzotten-und Plazentabiopsie: Rasche Karyotypisierung im 1.-3. Trimenon der Schwangerschaft.

AIM: The diagnostic value and the complication rate of transabdominal chorionic villi and placental sampling was compared with standard amniocenteses. The method ist especially helpful in cases with conspicuous fetal sonographic findings. METHODS: The results of 475 biopsies were retrospectively compared with 983 amniocenteses and chorionic villi samplings (CVS). RESULTS: 64% of chorionic villi samplings (CVS) were performed in the first, 30% in the second and 6% in the third trimester. The indications were advanced maternal age (45%) and psychological problems (14%) in the first trimester and conspicuous maternal serum markers (11%) or fetal ultrasound anomalies (12%) in the second and third trimester, respectively. 10 out of 20 aneuploid cytogenetic results were found in fetuses with sonographic anomalies. In 4 cases we found confined placental mosaicism, which was clarified by means of amniocentesis and cordocentesis. We had 8 miscarriages in a total of 475 CVS procedures; 6 in 304 before the 15th week of gestation (1.97%). The natural abortion rate in this gestational age is about 1%, the CVS-related abortion rate therefore is near 1%. CONCLUSION: Transabdominal CVS is a low risk method for rapid karyotyping during the entire pregnancy.

[The macrosomic neonate: incidence, early morbidity and legal aspects. An analysis of the Hessia perinatal study]. / Das makrosome Neugeborene: Inzidenz, Frühmorbidität und rechtliche Aspekte. Eine Analyse der Hessischen Perinatalerhebung.

In the past 13 years in Hessian Hospitals there is an 20% increase of newborn with a birthweight range between 4000-4499 g and a 17% increase of newborns weigh more than 4499 g. The incidence in the first weight group increases from 7.8% to 9.3% and in the second weight group from 1.3% to 1.53%. Since 1990 the decrease in the incidence of obstetrics traumas in single macrosomic newborns in vertex presentation will be missed, although there was an decrease from 1982 to 1990. There is a statistically significant higher incidence of injuries in the weight group above 4499 g than in the both weight groups below 4500 g. In 13 years the rate of primary Caesarean section only increases in the weight group in the range from 2500 to 3399 g whereas the secondary Caesarean section rate rises in all 3 weight groups. The ratio of an acidosis (ph < 7.10) after vaginal delivery is not different between these 3 newborn groups. After secondary Caesarean section the mean acidosis rate of 5 years (1990-1994) is 2.3% in the normal weight group and 1.5% in the macrosomic newborns. There is no difference in the acidosis rate in the macrosomic newborn groups between vaginal an secondary abdominal delivery. In our opinion the data are no argument for a primary Caesarean section in the weight group above 4499 g. The higher rate of secondary caesarean section and the higher transfer rate of the macrosomic newborns with a birthweight above 4499 g into a neonatal unit represents an elevated perinatal risk. Therefore it will be recommended to send the pregnant women before the beginning of labour in a special obstetrics department in case of estimated birthweight higher than 4499 g according to sonographic examination.

[Severe HELLP syndrome with temporary kidney and lung failure]. / Schweres HELLP-Syndrom mit passagerem Nieren-und Lungenversagen.

This report is on a severe case fo a HELLP-syndrome (H haemolysis, EL elevated liver enzymes, and LP low platelets). A 32-year old gravida developed severe preeclampsia with epigastric pain at 33 weeks' gestation. During a few hours post partum she showed disseminated intravascular coagulation (DIC) and required intensive care. The severe HELLP-syndrome was combined with a fast increasing acute respiratory distress syndrome (ARDS) and acute oligo-anuric renal failure. She was treated in the intensive-care unit for several days with artificial respiration, 10 acute haemodialyses, 4 plasma exchanges with fresh-frozen plasma and many blood and platelet transfusions. An early Caesarean section and treatment in the intensive care unit managed to turn the otherwise complicated progression of the disease. It is pointed out that plasma exchange with fresh-frozen plasma is a rarely employed treatment.

[Quality of prenatal data in the Hessian Perinatal Registry. A comparison with data from maternal health record and results of a pregnancy survey]. / Zur Qualität antepartaler Daten in der Hessischen Perinatalerhebung. Ein Vergleich mit Angaben im Mutterpass und Ergebnissen einer Schwangerenbefragung.

In the Federal State of Hesse, Germany, pregnancy and delivery related data are collected in a central perinatal registry called "Hessische Perinatalerhebung" (HEPE) since 1981, the objective being to enforce quality assurance and to contribute to a reduction in perinatal mortality and morbidity. The delivery unit compiles these data based on the antenatal record called "Mother Passport" and the actual delivery. In order to check on the quality of data, information on risk factors obtained from the perinatal register was compared to information from antenatal records and from a questionnaire administered to pregnant women prior to delivery. The study population comprised 1978 women who delivered at the maternity unit of the Municipal Hospital of Wiesbaden, the Dr. Horst Schmidt Kliniken, in 1990 and 1991. Comparison of the three data sources revealed substantial differences: Almost all risk factors were most frequently mentioned by the mothers themselves, less by the antenatal record and even less by the perinatal register. These differences were less pronounced for data on previous pregnancies and pre-existing disease and on abnormal positioning. Considerable differences were found in relation to pregnancy induced hypertension, intra-uterine growth retardation, incapacity of the cervix, preterm labour and bleeding. Risk factors related to the social environment and personal habits like psycho-social stress and smoking were found to be extremely under-reported in the antenatal records as well as in the perinatal register. The following factors could be identified as major reasons for the different risk profiles obtained from the various data sources: [1] Data loss through the transfer of data from the antenatal record to the record form of the perinatal register or to the computer, [2] selective recording of those risk factors considered by doctors to be particularly relevant, [3] missing definition of some risk factors and [4] recording of antenatal data for the perinatal register by the delivery unit after knowing the pregnancy outcome. Antenatal data in the perinatal register of Hessen are doubtful and should not be used uncritically for comparative studies and the assessment of relative risks. The extreme under-reporting of some risk factors may even lead to giving some interventions undue priority. In future, regular validity studies should become routine. A reduction of the data losses as well as a clear separation of antenatal data and delivery data could be achieved if antenatal data would be transferred from the doctor providing antenatal care direct to the perinatal register.

[Doppler sonographic flow measurements of the middle cerebral artery in end-diastolic zero flow in the umbilical arteries in relation to fetal outcome]. / Dopplersonographische Verlaufsmessungen der Arteria cerebri media bei enddiastolischem Nullflow in den Nabelarterien in Relation zum fetalen outcome.

Absent or reverse end-diastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress. We studied 74 fetuses with AREDFV with respect to the resistance index of the middle cerebral artery (MCA). The change in the resistance index of MCA was applied to the fetal outcome. The fetuses were retrospectively divided into 3 groups: 1) The fetuses in the first group did not show any changes in the course of observation of the MCA. 2) In the second group a drop followed by an increase in the resistance index of the MCA was confirmed. This is known in literature as "cerebral oedema". 3) The third group showed only a drop in the resistance index, described in literature as "brain-sparing-effect". The increase in the resistance index of the MCA points to a danger for the fetus, since the incidence of fetal acidosis, low birth weight, severe idiopathic respiratory distress syndrome in these fetuses was extremely high. In particular every second fetus in this group showed neurological complications. The change in the cerebral perfusion known as "cerebral oedema" which is extremely dangerous for the fetus has to be avoided.

[Prognostic value of Doppler flow measurement of the middle cerebral artery for morbidity of premature infants with null or negative flow in umbilical arteries]. / Die prognostische Bedeutung der Dopplerflussmessung der Arteria cerebri media für die Morbidität der Frühgeborenen mit Null- oder Negativflow der Nabelarterien.

We analysed 78 fetuses with absent or reverse endiastolic flow velocities (AREDFV) of the umbilical arteries with respect to fetal acidosis, resistance index of the middle cerebral artery (MCA) and abnormal neurological evaluations. A control group was matched for gestational age and normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed an increased incidence of fetal acidosis. The number of fetuses with abnormal neurological signs was significantly increased compared to the control group. Most of these fetuses (86%) showed abnormal blood flow velocity waveforms of the middle cerebral arteries called "brain-sparing effect". The combination of premature delivery in the 30th week of gestation, severe idiopathic respiratory distress syndrome, and a resistance index under the 10th percentile in the middle cerebral arteries seems to be a risk factor of the early neurological morbidity in fetus with AREDFV.

[Blood flow profile in the uterine artery. Correlation with placental morphology and clinico-obstetrical data within the scope of pre-eclampsia]. / Blutströmungsprofile der Arteria Uterina. Korrelation zur Plazentamorphologie und zu klinisch-geburtshilflichen Daten im Rahmen der Präeklampsie.

Within a group of preeclamptic women we found severe histologic placental pathology with functional relevance when both the uteroplacental and fetoplacental flow velocity waveforms showed elevated resistance indices. These pathological findings were a reduced decidual area, infarction and villus maturation failures with a high rate of intrauterine growth retardation, acidosis and premature delivery. In cases with normal flow velocity waveforms these pathologic findings were much rarer although the patients were preeclamptic, too.

[Fetal development in mild and severe pre-eclampsia: correlation with maternal laboratory parameters and Doppler ultrasound]. / Fetale Entwicklung bei der leichten und schweren Praeeklampsie: Korrelation zu mütterlichen Laborparametern und der Dopplersonographie.

During three and a half years we observed 83 single pregnancies all delivered by caesarean section. All of them had a mild (systolic blood pressure > 140, diastolic > 90 and proteinuria > 0.5 g/dl) or a severe preeclampsia (systolic blood pressure > 160, diastolic > 100 and proteinuria > 3.0 g/dl). We found significantly twice as many abnormal uteroplacental blood flow velocities in the severe preeclampsia group than in the mild one. These results draw us to the conclusion that possible pathological changing of the vessels is due to preeclampsia which does not need to correlate with a placental insufficiency and fetal growth retardation. An abnormal uteroplacental blood flow velocity connected with an abnormal umbilical blood flow velocity raises the fetal morbidity and the early childhood morbidity. Fetal outcome in mild compared to severe preeclampsia definitively shows a worse prognosis for those fetuses whose mother developed a prepartal severe preeclampsia. A distinctly increased rate of cerebral haemorrhages, abnormal neurological signs, acute respiratory distress syndromes and bronchopulmonary dysplasia was found. Finally we show an additional risk for fetal outcome in absent or reverse enddiastolic flow velocity (AREDFV) in the severe preeclampsia group. We observed in the AREDFV group with severe preeclampsia in comparison to a group of AREDFV without maternal preeclampsia more than twice as many cerebral haemorrhages, abnormal neurological signs and bronchopulmonary dysplasia.

[Incidence of birth injuries to newborn infants in relation to birth weight. An analysis of the Hessen perinatal study]. / Die Inzidenz von Geburtsverletzungen Neugeborener in Abhängigkeit des Geburtsgewichtes. Eine Analyse in der Hessischen Perinatalerhebung.

There has been a decrease in the incidence of obstetric traumas in single newborn in vertex presentation weighing more than 2.499 g between 1983 and 1992, in Hessian hospitals, the drop in incidence being from 0.70% to 0.33%. The rate of injuries depends on the birth weight. During the perinatal analysis period of 10 years the average rate of injuries is 0.47% in the birth weight range between 2.500-3.999 g, in the range between 4.000 and 4.499 g 1.61% and in the birth weight group above 4.499g 3.39%. These differences are statistically highly significant. During the ten years under report, 1.908 infant injuries at birth were recorded. 70% of these infants were in the 2.500-3.999 g range and only 6.7% in the weight group beyond 4.999 g. There are no comparable data in literature. The drop in the rate of injuries compared to 1983 is represented by a factor of 2.5 in the 2.500-3.999 g birth weight range, by 1.5 in the 4.000-4.499 g range and by 1.8 in the group over 4.999 g. We do not intend to artificially construct a connection, but during the report period there was an increase in the rate of Caesarean sections in cases of vertex presentation and single births, in all weight groups. If in any particular case the birth weight is estimated to be higher than 4.499 g according to sonographic examination, this does not imply that Caesarean section must be performed, since that would be associated with increased maternal morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Late neurologic morbidity of premature infants with intrauterine diagnosis of null- or negative flow of the umbilical arteries]. / Neurologische Spätmorbidität von Frühgeburten mit intrauterin diagnostiziertem Null- oder Negativflow der Nabelarterien.

Absent or reverse enddiastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress and adverse fetal outcome. We studied 68 fetuses with AREDFV with respect to abnormal neurological evaluation up to two years. A control group was matched for gestational age and had normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed increased abnormal neurological signs, compared with the control group (31% vs. 12%). Our results confirm the significance of AREDFV in growth retarded infants with respect to neurological development in early childhood.

CK-BB as indicator of prenatal brain-cell injury in fetuses with absent or reverse end-diastolic flow velocities of the umbilical arteries.

The purpose of this study is to determine the levels of brain type isoenzyme of creatine kinase (CK-BB) as a possible indicator of a pre-existing intrauterine brain-cell damage in cord blood sera of fetuses with preceding absent or reverse end-diastolic flow velocities of the umbilical arteries (AREDFV). CK-BB isoenzyme activities were determined in umbilical cord sera of 13 newborn infants with preceding AREDFV and in 14 fetuses with low end-diastolic flow velocities (LEDFV) of the umbilical arteries. 50 newborn infants with elective cesarean section and normal umbilical artery blood flow velocity waveforms were used as controls. Two-tailed Student's t-test and Fischer's exact test were used for statistical evaluation of the results. CK-BB isoenzyme activity did not depend on gestational age. Fetuses with AREDFV showed a significant increase in CK-BB values, whereas fetuses with LEDFV had CK-BB activities within the normal range of the controls. The elevated CK-BB values of the AREDFV group were not correlated with fetal acidosis at birth. Brain-cell injury with leakage of CK-BB isoenzyme might be present in fetuses with AREDFV even before (preterm) delivery.

[Analysis of perinatal mortality as an obstetric quality factor exemplified by the Hessian Perinatal Study 1981-1989]. / Analyse der perinatalen Mortalität als geburtshilflicher Leistungsparameter am Beispiel der hessischen Perinatalerhebung von 1981-1989.

In a retrospective study, the perinatal mortality between 1981 and 1989 in Hesse is analysed with the help of the Hessische Perinatalerhebung (Hessian Perinatal Study, HEPE). The frequencies of antepartum, subpartum, and neonatal death (< or = 7th day) are studied in relation to the birthweight of the newborn. For the first time in 1982, the neonatal mortality was below the rate of the stillborn foetuses. The subpartum mortality is remarkably low since 1985 (< 0.3%). The number of stillbirths with antepartum death is unchanged since 1985 and their relative amount increases as the neonatal mortality decreases further. The improvement in neonatal mortality concerns particularly the very low birthweight infants below 1500 g, and especially those below 1000 g. The survival of the born alive fetuses below 1000 g birthweight show an additional improvement, when they are born in a perinatal centre. The death of the stillborn babies occurs antepartum in 90% and concerns approx. 80% of fetuses with more than 1499 g and in nearly 50% fetuses weighing more than 2499 g. Lethal malformations are of no importance in antepartum mortality. An improvement in antepartum foetal losses seems to be possible in Hesse and could lead to a decrease in perinatal mortality to below 5% in the years to come.

Low target birth weight or growth retardation? Umbilical Doppler flow velocity waveforms and histometric analysis of fetoplacental vascular tree.

OBJECTIVE: The placental vascular architecture of small-for-gestational-age fetuses seems to have an impact on the flow patterns in the umbilical arteries. STUDY DESIGN: Blood flow velocity waveforms of the umbilical arteries were measured by Doppler ultrasonography in nine small-for-gestational-age fetuses with elevated systolic/diastolic ratios of the umbilical arteries, seven small-for-gestational-age fetuses with normal flow patterns, and 14 appropriate-for-gestational-age fetuses with normal flow patterns. After delivery histomorphometric placental investigations were performed. RESULTS: Reduced end-diastolic flow velocities were significantly associated with both a reduction of vascularization within the terminal villi and adverse diffusion conditions, indicating insufficient functional maturity. The perfusion and diffusion capacity of small-for-gestational-age placentas with normal umbilical artery flow velocity waveforms was similar or even slightly better compared with the appropriate-for-gestational-age control values. CONCLUSION: These data suggest that Doppler flow velocimetry in the umbilical arteries is predictive of a vascular lesion within the placentas of small-for-gestational-age fetuses.

[Effect of birth interval on the rate of cesarean section for the second twin after vaginal delivery of the first twin]. / Einfluss des Geburtsintervalls auf die Sectiorate am zweiten Zwilling nach vaginaler Geburt des führenden Zwillings.

Cesarean section for delivery of the second twin after successful vaginal delivery of the first twin is an infrequent and unusual occurrence. But this management of twin delivery has increased during the last years. A series of 371 pairs of twins born between 1978 and 1991 were reviewed. 12 second twins (3.2%) were delivered by cesarean section after vaginal delivery of the first twin. The initial 20 minutes the main indications were fetal distress and prolapsed umbilical cord. Beyond the first 20 minutes malpresentations were more frequent. In this group we have seen a better fetal outcome. An influence of the interdelivery time on the cesarean section rate of the second twin was not noted. No significant differences were seen for neonatal morbidity for all 197 vaginal delivered second twins with increasing interval.

[Brain-specific creatine kinase (CKBB) in umbilical cord blood. A prognostic parameter in chronic intrauterine hypoxia?]. / Die hirnspezifische Kreatinkinase (CKBB) in der Nabelschnur. Ein Prognoseparameter bei chronischer intrauteriner Hypoxie?

Elevated levels of brain type creatine isoenzyme (CKBB) have been demonstrated in serum after brain cell injury in neonates. A hypoxic lesion of the membrane permeability of the CKBB rich brain cells may lead to an increased enzyme leakage into the serum. As an increased release from the fetal brain as a result of intermittent compression and decompression of the fetal head during labour and after rupture of membranes may occur without hypoxic damage, only pregnancies which were terminates by cesarean section were studied. No mother went into first stage of labour and no rupture of membranes occurred. Three study groups were defined. The control group (elective cesarean section for breech presentation) showed CKBB enzyme activities below 15 U/l. A group with emergency cesarean sections had low CKBB values too, despite acidotic pH-values (pH < 7.20) at birth. The third group included fetuses which were delivered by cesarean section because of a pathological fetal heart rate tracing and intrauterine growth retardation. 6 out of 40 umbilical cord sera in this group showed elevated CKBB enzyme activities. If there was an additional fetal acidosis an increased neurological morbidity and neonatal mortality was seen.

[Spontaneous abortion after vaginal hemorrhage in intact early pregnancy--an etiologic analysis]. / Spontanaborte nach vaginaler Blutung bei intakter Frühgravidität--Eine Ursachenanalyse.

283 patients with vaginal bleeding before a gestational age of 16 weeks and positive foetal heart action were followed up by mean of ultrasound examination until termination of pregnancy. 18 pregnancies (7.5%) ended in spontaneous abortion. 44.4% of these abortions showed histological parameters of an infection, and in 16.6%, a sub-chorionic haematoma was diagnosed. In one case only a chromosomal anomaly (triploidy), was found. In 25 percent of the abortions, there was no evidence of histological abnormality. Since it could be demonstrated, that a bacteriological infection a possible cause of live abortions before 16 weeks of pregnancy, it could be concluded, that it might be possible to reduce live abortions by bacteriological examinations of the cervix and vagina followed by specific antibiotic treatment. If vaginal bleeding stopped during follow-up, the pregnancy outcome was normal.