[The influence of premature rupture of the membranes on fetal lung maturity (author's transl)]. / Der Einfluss des vorzeitigen Blasensprunges auf die fetale Lungenreifung.

In 19 cases of premature rupture of the membranes between the 30th and 37th week of gestation amniotic fluid was collected immediately after rupture of the membranes and within 72 hours for surface tension measurement in the Wilhelmy-balance. The initial values predicted lung immaturity for the fetus in all cases. Surface activity of the amniotic fluid increased in 17 women, in 2 cases however there was no difference in the surface tension values 48 hours after rupture of the membranes. These two infants developed a respiratory distress syndrome (RDS), one of them died. The pulmonary function of all neonates could be predicted correctly on the basis of the surface tension measurement of the amniotic fluid samples collected before birth. The findings support the positive effect of premature rupture of the membranes on induction of pulmonary maturity in the newborn, which leads to a reduction of RDS frequency after premature rupture of the membranes.

[Caesarean section - morbidity of mother and child (author's transl)]. / Sectio Caesarea - Morbidität von Mutter und Kind.

In the years 1974, 1975, 1976, 1977 and 1978 641 cesarean sections were performed in the 1st Department of Gynecology and Obstetrics of the University of Vienna. All these were analysed in respect of diagnosis in each case as well as morbidity of mother and child. Especially the increase of the preventive indications in care of the child was shown. Vital and preventive indications were related to each other like 60,6% to 39,4%. The preventive indications were increasing. Obviously is this development by the childish indications, especially by children with extended legs. For this reason the vital indications concluded 69,1% in 1974, only 53,8% in 1978. In the same period the preventive indications increased from 30,9% to 46,2%. At the further indications we expect an addition of the diagnosis: st. p. sectio due to the general increasing of section-frequency, which causes the fact, that there will be more pregnant women who had been sectioned. Fever, parametritis and endometritis according to the morbidity of the mother contain 38%, by these and other complications a prolonged stationing more than two weeks is caused. The low Apgar-score of the newborns is due to the greater number of children below 2.500 g (at last: 19,18%). The perinatal mortality of the observed period was 3,06% by all cesarean sections; 12,8% belonged to the group with less than 2.500 g.

[Comparison of the surface tension of the amniotic fluid with the compliance of the respiratory system of the newborn (author's transl)]. / Die präpartale Oberflächenspannung des Fruchtwassers im Vergleich mit der postpartalen Compliance des respiratorischen Systems des Neugeborenen Eine kooperative Studie.

In 51 deliveries between the 27th and 41st week of gestation amniotic fluid was collected ante partum and surface tension measured with the Wilhelmy-balance. The values obtained was compared with the respiratory compliance of the newborns determined immediately post partum. A highly significant correlation (r = -0.83, p less than 0.001) was ascertained. This finding permits a precise prediction of the pulmonary function of the newborn, especially of the especially of the severity degree of a respiratory distress syndrome already by means of amniotic fluid analysis. The less significant correlation between surfactant activity in the amniotic fluid and gestational age (r = -0,48, p less than 0.01) permits the conclusion that pulmonary maturation represents a dynamic process depending upon a variety of known and unknown factors besides the duration of gestation. On the basis of the results of this study the intrauterine and extrauterine fetal risks associated with placental insufficiency can now be estimated more accurately.

[The inguino-vaginal fascial loop repair in women with relapsing urinary incontinence (author's transl)]. / Die inguino-vaginale Faszienschlinge zur Behebung der Rezidivinkontinenz.

This review comprises the results obtained over the past 20 years in the surgical treatment of incontinence by the method of Aldridge. The follow-up examination was carried out two years at least and 13 years at most after surgical intervention and consisted of case history evaluation, clinical assessment of urinary incontinence, as well as urodynamic investigation by cystometry and sphincterotonometry. Follow up was performed in 142 patients from the total number of 200 surgically treated cases. 84.5% of the patients showed good results, 7% were markedly improved, whilst 8.5% suffered recurrence of urinary incontinence. It must be taken into consideration that this kind of surgical intervention took place only after one or more operative failure for this indication. Hence, this method of surgical management can be recommended for the treatment of relapse of urinary incontinence.

[Dynamic surface tension measurements and L/S-ratio in amniotic fluid before birth in comparison with the respiratory compliance of the newborns immediately after parturition (author's transl)]. / Ein Vergleich von physikalischen und chemischen Surfactantparametern kurz vor der Geburt im Fruchtwasser mit der Compliance des respiratorischen Systems der Neugeborenen unmittelbar post partum. Eine kooperative Studie.

In 65 pregnant women between 27th and 42nd gestational week amniotic fluid was collected on average of 4,2 hours before birth and its amount of surfactant determined by means of the dynamic surface tension measurement in the Wilhelmy-balance and the L/S-ratio. These values were compared to the respiratory compliance of the newborns after birth. The respiratory compliance was measured by means of the airway occlusion technique. So far the measurement of dynamic surface tension has made it possible to predict the lungmaturity and the incidence of RDS. Our study for the first time describes a quantitative relationship between the surface tension of the amniotic fluid and the surface tension of the lungs in form of the respiratory compliance. The surface tension, measured by the Wilhelmy-balance, was better correlated (r = -0.85) than the L/S-ration (r = 0,58) with the respiratory compliance of the newborns. The surface tension measurement allows therefore a better prediction of the severity of the RDS than the determination of the L/S-ratio. This can be explained by the fact that the surface tension measurement in the amniotic fluid represents the total effect of SAM (Surface active material) while the L/S-ratio represents only about 60% of SAM. On the other hand the L/S-ratio gave a better correlation to the general maturity of the fetus than the surface tension; therefore we consider that the L/S-ratio is partially influenced by the lungmaturity and partially by gestational age of the fetus.

[The frequency and importance of gynaecological screening in older women (author's transl)]. / Häufigkeit, Wertigkeit und Notwendigkeit gynäkologischer Vorsorgemedizin bei der alten Frau.

A report is given on the incidence of doubtful and positive smears from the uterine cervix in women aged more than 60 years. Although the total number of smears of this age group represented only 10% of the total number of 39.325 smears examined at the 1st Department of Obstetrics and Gynaecology of Vienna University a doubtful smear was found in 24 (11.7%) out of a total of 205 patients and positive cervical smear in 50 (18.2%) out of a total of 177 patients. The high rate of incidence of cervical carcinoma in this age group is also reflected by the official population satistics in Austria. In our 74 patients with positive or doubtful smears 46 cases of invasive cancer were found. In view of these facts it is emphatically stressed that the age group of older women should be considered just as important as the younger age group and equally encouraged to present themselves for regular gynaecological examination.

[Comparison between lecithin-sphingomyelin-ratio and surface tension of amniotic fluid with regard to the prediction of fetal lung maturity (author's transl)]. / Vergleich zwischen Lezithin-Sphingomyelin-Ratio und Oberflächenspannung des Fruchtwassers zur Vorhersage der plumonalen Symptomatik des Neugeborenen.

Report on 127 children, who were born within 72 hours after determination of fetal lung maturity by means of measuring the surface tension of amniotic fluid with the Wilhelmy balance and analysis of the L/S-ratio. The predictive accuracy of the physical method was 91.3%, of the chemical method 92.1% and of both methods combined 96.8%. The correlation of the two methods by mean of a correlation-ellipse was high significant. However, by comparing the values obtained after different duration of gestation it was shown that the L/S-ratio predicted a mature child on the average one week earlier than the surface tension.

The effect of premature rupture of the membranes on the surface activity of amniotic fluid and on the pulmonary function of the newborn.

In 30 patients with rupture of the membranes at 29 to 37 weeks gestation amniotic fluid was collected immediately and within 72 h. The concentration of lung surfactant was estimated by surface tension measurements in the Wilhelmy-balance. In 19 cases the results of the first surface tension measurement predicted lung immaturity, in 17 of these surfactant concentration increased, the last surface tension measurement being consistent with complete pulmonary maturation. None of these infants developed RDS. However, the two newborn infants, in whom serial surface tension measurements had shown no increase of surfactant concentration developed symptoms of RDS. In 11 patients with apparently mature surfactant values immediately after membrane rupture, further amniotic fluid surface tension measurements showed an increase in the concentration of surface active material. The respiratory compliance was measured in 11 healthy neonates and in the two newborn with RDS. The results reflected those of surfactant concentration obtained in amniotic fluid. Premature rupture of the membranes would seem to constitute a stimulus for fetal lung maturation.

[Surface properties of serum in case of premature onset of labour (author's transl)]. / Oberflächeneigenschaften des Serums bei vorzeitigem Wehenbeginn.

Fifty-eight pregnant women with premature onset of labour were compared to 149 women with normal course of pregnancy. Surface activity of the serum in the former group was found to be higher than that in the latter. The information obtained from determining the hysteresis curve of the serum by means of Wilhelmy's balance was much more complete than that recordable from surface tension with 20 per cent surface expansion (gamma minimum). An analysis was made, at the same time, of those serum parameters with highest surface activity, such as free fatty acids and lecithin. Their growth in concentration was found to coincide with onset of labour proper rather than with a condition in which the organism simply exhibited a trend towards premature labour. Hence, measurement of serum surface tension proved to be the more sensitive parameter by which to predict forthcoming premature labour. The actual cause underlying such behaviour so far has remained unelucidated, since an extremely sophisticated process has to be assumed to take place on the serum surface. These studies, consequently, have not been completed. They are likely, however, to provide some preliminary hints on quite peculiar serum changes in concomitance with premature labour or with the trend to it.

[Etiology of RDS in infants weighing more than 2500 g (author's transl)]. / Atiologische Faktoren des RDS bei Kindern über 2500 g.

Between 1974 to 1977, 7005 infants were born live at the I. University Clinic of Obstetrics and Gynecology, Vienna. 55 of these infants weighed at birth more than 2500g and developed RDS (Respiratory Distress Syndrome) as a result of which 16 died. All infants showing either malformations, icterus gravis (malignant jaundice) or infants delivered by insulin dependent diabetic mothers were excluded. The remaining 48 infants were compared with two control groups selected at random. The mortality rate for infants with RDS weighing more than 2500g (29,1%) was identical with those weighing less than 2500g (28,7%). The significant finding in the RDS group was the high incidence of primiparae, mothers with abnormal obstetrical histories, imminent abortion, cerclage operations and EPH gestoses. On three women in this group extragenital surgery which was performed during pregnancy appeared noteworthy. Time of labor, prolonged delivery time or surgical interference at time of birth did however not seem to make any difference. The RDS group showed in the 1 minute as well as in the 5 minute Apgar-Value distinctly worse results, whereby the missing recuperation after 5 minutes is typical and prognostically unfavourable for RDS. Of decisive importance for the development of RDS in infants weighing more than 2500g was birth induction before the end of the biological term.

[The significance of primary radiotherapy in cervical carcinoma in older women]. / Zur Bedeutung der primären Strahlentherapie des Zervixkariznoms älterere Frauen.

In spite of the increasing interest in geriatric-operative therapy primary irradiation therapy still has its important place in the treatment of cervical cancer in cases of higher age. About every third patient with cervical cancer belongs to the age group over 60 years, which is more or less excluded from operative therapy. The advantage of irradiation therapy is to be seen in the low post-therapeutic mortality and the remarkable survival and healing rates.

[Premature rupture of the membranes and RDS incidence in prematures (author's transl)]. / Der Einfluss des vorzeitigen Blasensprunges auf die RDS-Frequez der Frühgebroenen.

In the years 1974, 1975 and 1976 495 children were born alive with a birthweight less than 2500 g in the Ist Department of Gynecology and Obstetrics of the University of Vienna. We selected all cases with dystrophy or factors, which were a disposal for RDS, so we got a rest of 188 prematures with a weight from 1000 g to 2500 g. For these children we checked the influence of time of rupture of the membranes (ROM) before delivery to the incidence of RDS. We found a lower incidence of RDS of the newborns when duration of ROM exceeded the time of 12 hours. This fact was statistically significant in the class of premature newborns with a weight of 1500 g to 2000 g. The similar trend was found in 119 dystrophic newborns with a weight between 1000 g to 2500 g, although there was no statistical significance. No influence of duration of labor on the incidence of RDS neither in selected premature nor dystrophic newborns was found.