Effect of beta-mimetic tocolysis on cervical ripening and plasma prostaglandin F2 alpha metabolite after endocervical application of prostaglandin E2.

To suppress uterine contractions during cervical ripening induced by prostaglandin E2 (PGE2) gel, beta-mimetic drugs were given orally 30 minutes before PGE2 application to 17 patients with unripe cervix. This prevented the increase in contraction frequency observed during the first four hours after PGE2 application in 17 controls. Nevertheless, cervical ripening proceeded at a similar rate and the clinical outcome was comparable in both groups. Prostaglandin E2 application caused a transient rise in plasma levels of the PGE2 alpha metabolite (13,14-dihydro-15-keto), which was not prevented by pretreatment with beta-mimetics. Patients with premature rupture of the membranes had higher initial plasma PGF2 alpha metabolite levels than those with intact membranes but cervical ripening proceeded with the same rate, and the effect of beta-mimetics was the same in both groups. Thus, cervical ripening induced by PGE2 does not depend on uterine contractions, and increased production of PGF2 alpha is unrelated to the ripening process. There was no difference between the three beta-mimetic agents in the present study.

Effective measures for the prevention of late abortions and premature births.

After a retrospective study, more than 70% of premature births have been caused by ascending infections. With the use of a specially concerted diagnostic and therapeutic prevention programme, a reduction of 30% in very low birthweight prematures (less than 1500 g) has been achieved in in-hospital care and of about 50% in outpatient care.

Prevention of habitual abortion and prematurity by early total occlusion of the external os uteri.

Repeated late abortions and high-risk, low-chance premature births are among the problems of obstetrics and perinatal medicine still to be solved. It seems that a solution is on its way, through the early total cervix occlusion (ETCO) performed by us - a solution for at least some of these highly problematic cases. The special advantage of this measure is considered to be the avoidance of an infection ascending to the cervix and to the lower egg-pole resulting in abortion or premature birth. Early total occlusion of the os uteri has been performed on 28 women; 22 have since been delivered of healthy infants. Whereas previously from these 28 patients with a total of 99 wanted pregnancies only 14 infants (14%) survived, the rate of success after the introduction of ETCO lies at about 80% (22 out of 28). From this a high success rate can be expected in the future in these difficult cases.

Efficient prematurity prevention is possible by pH-self measurement and immediate therapy of threatening ascending infection.

In two prospective investigations, the effectiveness of the self care programme for prematurity prevention, developed by Saling, was investigated. Pregnant women in Erfurt have been offered to perform self measurements of their vaginal pH by means of test gloves twice a week in order to screen for any disturbances in the vaginal milieu. The women were instructed to see their physician immediately, if abnormal pH > or = 4.7 or other risk factors were present, in order to get them confirmed and to start lactobacillus acidophilus therapy or in case of bacterial vaginosis to treat with clindamycin cream i. vag. Patients who were not interested in the programme served as a control group. Seventy-three out of 381 women in the intervention group have been identified as risk cases. Fifty-eight of them were treated with a lactobacillus preparation, and 24 with clindamycin cream, three patients refused to have any therapy. In this study, the prematurity rate was 8.1% in the self measurement/intervention group versus 12.3% in the control group (P < 0.05, n = 2341). 0.3% versus 3.3% of the neonates belonged to the group of very early prematures with a gestational age of <32 + 0 (P < 0.01). PROM was registered in 22.8% versus 30.8% (P < 0.001), respectively. Starting 1 March 2000, a similar statewide pH screening programme was initiated in order to reduce prematurity in the State of Thuringia. According to the study design, a significant decrease of prematurity was hypothetically expected for the second half of 2000. In Erfurt, an overall decrease of prematurity from 7.68 to 6.81% and a reduction of cases < or = 32 weeks from 3.22 to 2.39% was observed. Premature rupture of membranes was seen in 19 versus 0 pregnancies with early prematurity (n = 1600). Data from 16,276 women are available for the state of Thuringia. On this basis, a significant reduction of early prematurity from 1.58 to 0.99% was seen, respectively (P < 0.001). Comparing low birthweights a significant reduction of cases was achieved as well in all groups. On the basis of the data obtained we recommend the extension of the campaign in whole of Germany.

Correlation between transcutaneous pCO2 and the corresponding values of fetal blood--a study at a measuring temperature of 39 degrees C.

Continuous transcutaneous monitoring of fetal carbon dioxide partial pressure (tcpCO2) may become an important new method for investigating the physiology and pathophysiology of the fetus during labor, as well as an additional tool for fetal surveillance. In order to contribute to the standardization of this newly developed method, we measured tcpCO2 during labor in 105 fetuses. We then compared the transcutaneous pCO2 with the pCO2 of fetal blood gas analysis; the correlation between these two parameters was significant. The relationship between transcutaneous pCO2 and the pH from fetal scalp blood is described, as is the influence of the stage of labor on the correlation between transcutaneous monitoring and blood samples. tcpCO2 during labor appears to be a helpful additional tool, especially in fetuses with pathologic heart rate patterns in whom multiple fetal blood gas analysis would otherwise be necessary.

The influence of maternal oxygen administration on the fetus.

During the last few years opinions have been divided on the advantages and disadvantages of oxygen administration in pregnancy and during labor. We review the present knowledge regarding the influence of maternal oxygen inhalation on the fetus. We conclude that the fetus may benefit from oxygen therapy during pregnancy and labor.

Small for gestational age twins: a retrospective analysis of clinical and acid-base status immediately after delivery.

In a retrospective study on 86 twins born between 1971 and 1990, the clinical and acidity status of small for gestational age twins in cases of uncomplicated labor was analysed and compared with the status of appropriate for gestational age twins. No difference was observed in Apgar score and umbilical blood pH between growth retarded and normal twins. The single fact of growth retardation without other factors of risk during labor has no influence on clinical status of small for gestational age twins.

Postterm pregnancy: computer analysis of the antepartum fetal heart rate patterns.

The purpose of this study was to establish reference ranges for numerical fetal heart rate (FHR) data in postterm pregnancy and to compare them with the patterns of fetuses under undisturbed condition at term. FHR was analysed on-line by Sonicaid Computer System 8000. A statistically significant decrease in the number of accelerations and decrease of variation in postterm pregnancy was observed. The duration of high variation (high episodes) in the 42nd week of gestation was statistically lower than in the pregnancy at term. These observations should be taken into account by clinicians in the interpretation of FHR records in postterm pregnancy.

Effect of the vibratory acoustic stimulation on fetal heart rate patterns of premature fetuses.

The purpose of this study was to examine the heart rate patterns before and after a standardized external vibratory acoustic stimulation in a group of 24 healthy premature fetuses at 32-35 weeks gestational age. FHR was analysed on line by Sonicaid Computer System 8000. A significant increase in the number of accelerations and an increase of variation after stimulus were observed. All other FHR patterns such as baseline, high and low episodes did not change significantly.

[Home delivery or hospital delivery--a statement free of ideologies]. / Hausgeburt oder Klinikentbindung - eine ideologiefreie Stellungnahme.

Due to the progress in obstetrics during the past 20 years hospital deliveries are becoming considerable less risk for mother and child if compared with prior times. On the other hand, individual emotional needs of mother and child are supposed to be relatively more attainable at home deliveries. From the movement to deliver at home obstetrician should learn how to achieve an emotional atmosphere during hospital delivery. Finally we may suggest as a compromise between home and hospital deliveries, out patient management of the same.

[Efficient prevention of prematurity - the Thuringian model]. / Effiziente Frühgeburtenvermeidung - Das Thüringer Modell.

In two prospective projects, the effectiveness of the self-care programme for prematurity prevention developed by Saling was prevented. Pregnant women in Erfurt were shown how to perform self-measurements of their vaginal pH by means of test gloves twice a week in order to screen for any disturbances in the vaginal millieu. The women were instructed to see their physician immediately, if abnormal values (ph > or = 4.7) or other risk factors were present, in order to start Lactobacillus acidophilus therapy or, in cases of bacterial vaginosis, treatment with intravaginal clindamycin cream. Patients who were not interested in the programme, served as a control group. 73 out of 381 women in the intervention group were identified as risk cases. In this study, the prematurity rate was 8.1% in the self-measurement/intervention group versus 12.3% in the control group (p < 0.05, n = 2,341); 0.3 versus 3.3% of the neonates belonged to the group of very early prematures with a gestational age of <32 + 0 weeks (p < 0.01). Starting on March 1, 2000, a similar statewide pH screening programme was initiated in order to reduce prematurity in the State of Thuringia. According to the study design, a significant decrease in prematurity was hypothetically expected for the second half of 2000. Data from 16,276 women are available. On this basis, a significant reduction of early prematurity from 1.58 to 0.99% was seen (p < 0.001). Comparing low birth weights, a significant reduction of cases was also achieved in all groups. On the basis of data obtained, we recommend that the campaign should be extended to the whole of Germany. This recommendation is also supported by the observation that after the campaign had been discontinued the prematurity rates monitored in 2002 were as high as they had been prior to the introduction of the statewide programme.