[Perinatal and neonatal mortality and morbidity in newborn infants up to 1,000 g]. / Perinatale und neonatale Mortalität und Morbidität bei Neugeborenen bis 1000 g.

World-wide intensive efforts have been made for more than 20 years to reduce the rate of preterm delivery, but so far without remarkable success. Preterm delivery accounts for 6-9% of all deliveries and very-low-birth-weight infants (< or = 1000 g) total up to about 60% of perinatal mortality. This study reports on a retrospective analysis of fetal outcome with 33 very-low-birth-weight-infants (< or = 1000 g) delivered at the Women's Hospital (University of Rostock) during the time from 1986 to 1992. The rate of early mortality was at 45.2%, survival rate was at 33% (n = 11). Caesarean section with preservation of fetal membranes proved to offer better results of fetal outcome than spontaneous delivery. Comparing the fetal outcome of all patients concerned, it became obvious that newborns whose mothers enjoyed intensive prenatal care had better chances than those newborns whose mothers came to hospital not before onset of preterm labour. From our experiences we conclude that intensive antenatal care with very early assessment of all possible risk factors for preterm labour is the prerequisite to reduce the rate of preterm delivery.

[Diagnosis of urinary tract infections in puerperium]. / Zur Diagnostik von Harnwegsinfektionen im Wochenbett.

Urinary tract infections (UTI) are the most frequent nosocomial infections of women during puerperium. Since, in these women, diagnostic accuracy is affected by lochial secretion, suprapubic urinary bladder puncture (SPB) is recommended. Between December 1989 and January 1993, we subjected 903 women to suprapubic urinary bladder puncture (SpBP) at the 4th or 5th day after delivery. A urine culture of SpBP was done in all cases. Semiquantitative leukocyte counts (n = 891) and nitrite test (n = 830) were done on mid-stream urine (MSU). Side by side with microbiological investigation for urinary tract pathogens via SpPB, MSU was performed in 246 cases immediately after SpPB had been carried out. Leukocyte counts were also estimated in SpBP urine samples. In 370 (41.1%) of 903 SpBP, one or more microorganisms were cultivated. Only 36 (4.0%) of 903 women showed UTI symptoms. Microorganisms were detectable via SpBP in only 26 (72.7%) of these 36 symptomatic patients. Vaginal-operative or secondary caesarean section are related to an increased UTI rate (p < 0.001). UTI were also significantly (p < 0.0001) more frequent in women subjected to catheterisation sub partu (54.5%) compared to no catheterism (24.4%). No significant differences between the number of leukocytes in MSU sediment and the SpBP findings were seen. Semiquantitative leukocyte counts in SpBP offered a significantly (p < 0.001) increased number of leukocytes in cases with microorganism detection in SpBP irrespective of MSU findings. These results justify the designation of uterine tract infection also in the absence of complaints as "infection" and not common "bacteriuria".(ABSTRACT TRUNCATED AT 250 WORDS)

[Is determination of C-reactive protein and haptoglobin in puerperium suitable for further therapeutic decisions?]. / Ist die Bestimmung von C-reaktivem Protein (CRP) und Haptoglobin (HPT) im Wochenbett für weitere therapeutische Entscheidungen geeignet?

A report is given on the levels of c-reactive protein (crp) and haptoglobin (hpt) of 168 puerperae at the second and fourth day post partum. All of the patients had a afebrile puerperium. We conclude that the value of crp (< 5 mg/l) is grown up during the puerperium. That ist why the sole analysis of crp is not to be a criteria for decision during the puerperium.