[Sialic acid, steroids and proteohormones in maternal, cord and retroplacental blood]. / Sialinsäure, Steroid- und Proteohormone im Venenblut der Mutter, im Nabelschnurblut des Neugeborenen und im Retroplazentarblut.

BACKGROUND: To study the storage of sialic acid in newborns reference concentrations for sialic acid were measured in maternal, retroplacental and cord blood and compared with the concentration of human placental lactogen (hPL) and estriol (E3). High serum concentrations of hPL and E3 in retroplacental blood indicate the synthesis of these products in the fetoplacental unit. The comparison of the serum concentrations give first informations for a possible role of the placenta as a place of production and storage of the investigated products. METHODS: The concentrations of sialic acid, hPL and unconjugated E3 were determined in maternal and retroplacental blood samples of 126 pregnant women (16-42 years old) between 28 and 42 weeks of gestation. 84 of these pregnant women had uncomplicated pregnancy with birth after 37 gestational weeks. Measurements of E3 and hPL were performed by solid phase radioimmunoassays. Concentrations of sialic acid were determined by HPLC (high performance liquid chromatography). RESULTS: Means and medians of the three parameters for both groups differentiate hardly. The retroplacental serum concentrations of hPL and E3 are increased significantly compared with maternal blood. The same trend was found for sialic acid without significance. The highest concentrations of E3 were found in the cord blood (298.2 +/- 138.0 ng/ml) (p < 0.01). On the other hand the lowest concentrations of sialic acid (36.1 +/- 19.6 mg/l) (p < 0.01) were estimated in cord blood samples. It was estimated a significant correlation between fetal and retroplacental concentrations of E3. Significant correlations (p < 0.01) were found for sialic acid between maternal and retroplacental blood on the one side and maternal and the cord blood on the other side. Significant increased mean sialic acid concentrations in retroplacental blood (x = 102.67 mg/l) were found in female newborns in comparison with male newborns (x = 80.58 mg/l). There were not significant differences between prematurity and term delivery. CONCLUSION: Increased sialic acid concentrations in retroplacental blood samples are a sign of sialic acid accumulation in the fetomaternal area aiming to induce the tolerance of fetal allotransplantat. There are no evidence for a take up of free sialic acid by fetus.

[Diagnosis and therapy of toxoplasmosis infections in pregnancy at the Rostock University Gynecologic Clinic 1986-1994]. / Diagnostik und Therapie von Toxoplasmoseinfektionen in der Schwangerschaft an der UFK Rostock 1986-1994.

Over a period of eight years, 61 patients with toxoplasmosis infection in pregnancy were examined retrospectively at women's hospital. Diagnosis of maternal infection was based on seroconversion, positive IgM, raising IgG--titers above twofold, and very high primary titers in SFT. In 20 patients (32.8%) diagnosis was found with seroconversion. In 15 patients (24.6%) the first examination revealed very high titers (SFT > or = 1:2000, KBR > or + 1:40)> Using a score, time of infection was grouped into: periconceptional (24.59%), 1st Trimester (34.43%) 2nd Trimester (31.14%), 3rd Trimester (4.92%), not specified (4.92%). The latency phase between first suspect titer and treatment did vary markedly. Duration of latency phase was longer than 6 weeks only in 10% and 20% of cases identified via seroconversion or very high titers respectively. Of all cases with different diagnostic attempts 73.9% were treated later than 6 weeks after the first suspect titer. Therapy was performed with either a combination of pyrimethamine-sulfadiacine or spiramycin monotherapy. In 18/53 newborns (33.9%) fetal infections were proven with IgM-detection post partum. Clinical evaluation was normal in 48 children (77.5%). 6 newborns (9.7%) had dilated cerebral ventricles; 3 (4.8%) had irregularly dense intracerebral structures, one newborn (1.6%) had intracerebral calcifications. Primary neurological check-up of the newborn was normal in 91.9%. 2 children (3.2%) had facial paralysis or reduced muscle tonus. In 2 newborns (3.2%) opthalmological examination of the fundus revealed signs of retino-chorioditis.

[Analysis of 122 twin deliveries with special reference to morbidity and mortality of the second twin]. / Analyse von 122 Gemini-Entbindungen unter besonderer Berücksichtigung von Morbidität und Mortalität des zweiten Zwillings.

122 consecutive twin deliveries between 1986-1992 were analysed retrospectively under special consideration of morbidity and mortality of the second twin. 13.9% of the twin deliveries occurred before the 33rd week of gestation. The cesarean section rate amounted to 49.2%, the first twin was delivered in 5.7%, the second twin in 27%, by vaginal operative methods. Perinatal mortality of the first twin was 3.3%, of the second twin 6.6% (p < 0.01); thus resulting in an overall twin mortality rate of 4.9%. The acidosis-rate of 16.4% in the second twin was significantly above the 9.0% in the first twin. The vaginal operative mode delivery especially contributed to the impaired outcome of the second twin. There was no correlation between the morbidity of the second twin and the time interval between the two deliveries.

[Tocolysis with ethanol--effects on the ethanol content of the blood in the mother and neonate]. / Tokolyse mit Ethanol--Auswirkungen auf den Blutethanolgehalt von Mutter und Neugeborenem.

In 10 pregnant women infusions with fructose and ethanol have been performed during labour until delivery. Ethanol concentration in blood have been estimated during delivery and in the post partum period. A decrease of labour activity could be found already with ethanol blood level below 0.5 mg/g. Ethanol elimination in newborn was delayed about 30 per cent in comparison with their mothers. We couldn't observe any risk neither fetal nor maternal by ethanol infusion.

[East German percentile values for newborn infants--1985 relation of age, parity, body weight and height of the mother and the birth weight of newborn infants]. / Neugeborenen-Perzentilwerte für die DDR - 1985 Beziehungen zwischen Alter, Parität, Körpergewicht und -länge der Mutter und dem Geburtsgewicht der Neugeborenen.

Based on an analysis of very comprehensive data material multidimensional investigations on connections between age, parity, weight and height of mothers and birth weight of infants have been made. Maternal height as well as maternal weight have a considerable influence on birth weight of infants. At the same maternal height infant birth weight will rise in connection with the rise of maternal weight. Maternal age, parity and weight are correlated variables. The older a woman, the higher on average is not only her parity but at the same her weight, too. The rise of maternal weight per year in the statistic mean amounts to 401 g. Moreover, at the same age like primiparae second and subsequent parae are of higher weights so that partly maternal weight contains indirectly not only maternal age but also maternal parity. The following range of the influencing factors maternal height, weight, parity and age on birth weight can be given: 1. Height and weight as relatively equivalent factors, 2. parity and 3. age.

[Results of ultrasound brain studies in clinically normal newborn infants]. / Ergebnisse hirnsonografischer Untersuchungen bei klinisch unauffälligen Neugeborenen.

Ultrasound investigations demonstrating intracranial hemorrhages (periventricular intraventricular hemorrhage-PVH/IHV) were performed in 401 term newborns. Without consideration the mode of delivery incidence of intracranial hemorrhage was 4.7%. There were only subependymal hemorrhages grade 1 and 2. In case of vaginal-operative delivered children frequency of hemorrhage in forceps delivered babies was really lower than in vacuum extracted newborns.

[Treatment of fetal hemolytic disease using plasmapheresis]. / Therapie des Morbus haemolyticus fetalis mittels Plasmapherese.

Report about the therapy of severe Morbus haemolyticus fetalis in 15 pregnant women by plasmapheresis alone. Fetal survival rate was 67%. One of three children with hydrops fetalis survived. Plasmapheresis may be used in combination with intrauterine transfusion and improves treatment of Morbus haemolyticus fetalis.

[Results of prenatal amniotic fluid diagnosis in suspected hemolytic disease of newborn]. / Ergebnisse der pränatalen Fruchtwasserdiagnostik bei Verdacht auf Morbus haemolyticus fetalis.

759 amniotic fluid samples have been examined spectrophotometrically according to Liley and chemically for bilirubin from 286 patients with suspicion of morbus haemolyticus fetalis. The results obtained, gave the following findings for the procedure of Liley: sensitivity 75.0 per cent, specivity 96.5 per cent, accuracy 85.3 per cent, predictive value of positive test 95.6 per cent and predictive value of negative test 79.1 per cent and for the chemical test respectively: 88.2 per cent, 81.7 per cent, 85.0 per cent, 83.0 per cent and 87.2 per cent. A pathological delta E value is suspect of a serious erythroblastosis. But a serious morbus haemolyticus fetalis may be excluded with higher likelihood by concentration of bilirubin chemically determined below the pathological range then by correlated values of delta E. Finally we conclude that two different methods for amniotic fluid diagnostic are of higher predictability.

[Report of experiences in 20 years use of intrauterine fetal transfusion in severe Rh-induced hemolytic disease of newborn]. / Erfahrungsbericht über 20 Jahre der Anwendung der intrauterinen fetalen Transfusion bei schwerem Rh-bedingten Morbus haemolyticus fetalis.

136 intrauterine transfusions in 90 fetuses between the 25th and 34th gestational week with severe hemolytic disease because of Rh-incompatibility have been performed after a prenatal step by step diagnostic in the years 1967 till 1986. The reason of the immunization was mistransfusion or omitted immune prophylaxis in 25 cases. 25 from 67 live born children died. There were 23 still births. 34 from 43 fetuses without hydrops survived, but only 8 from 47 fetuses with hydrops. The survival rate over all was 46.7 per cent.

[Fetomaternal macrotransfusion with severe fetal anemia]. / Fetomaternale Makrotransfusion mit schwerer fetaler Anämie.

A fetomaternal macrotransfusion endangers fetal life. This report describes a fetomaternal macrotransfusion of about 300 ml blood. Ante partum and intra partum monitoring showed a mild fetal tachycardia. After spontaneous delivery the newborn was severe anemic and has a mild hepatosplenomegaly and edema. The diagnosis of fetomaternal macrotransfusion was made by Kleihauer-Betke-Test with maternal blood.

[A case of intrauterine fetal retardation with polycythemia in a patient with a pacemaker]. / Ein Fall von intrauteriner fetaler Retardierung mit Polyzythämie bei einer Patientin mit Pacemaker.

A case of intrauterine fetal growth retardation with polycythemia is reported on a newborn whose mother was treated five years before pregnancy by an artificial external fixed-rate pacemaker because of complete atrioventricular block with right bundle-branch block and Adams-Stokes syndrome. Obviously fixed-rate pacemaker does not meet all necessities of pregnancy. Therefore in young women who wish to have children only demand pacemaker with programmable frequency are supposed to be used. They may be better for the requirements of systemic and uterine circulation in pregnancy.

[Comparison between ketamine, propanidid, and etomidate in general anaesthesia for caesarean section (author's transl)]. / Die Ketaminnarkoseeinleitung bei Sectio caesarea im Vergleich zur Propanidid- oder Etomidateeinleitung.

Propanidid, etomidate, and ketamine were compared for their effects on maternal acid-base balance and circulation as well as on postnatal general condition and acid-base balance of the newborn, on the basis of 44 women in advanced pregnancy to whom caesarean section was applied in general anaesthesia. The probands had not been deliberately selected beforehand. Results obtained from the three above anaesthetics were compared with one another as well as with parameters recorded from spontaneously delivered newborns without any medication. One of the anaesthetics produced sufficiently deep anaesthesia in all patients, and no signs of central depression were recordable from the newborns. The parameters of acid-base balance, following propanidid and etomidate anaesthesia, revealed respiratory acidosis in the newborns immediately after delivery by caesarean section. Their pH values were lower than those recorded in the context of ketamine anaesthesia or spontaneous delivery without any medication. Both values returned to normal within 30 minutes from delivery. The one-minute and five-minute Apgar scores were below those of spontaneous deliveries, at the beginning, but eventually reached normal levels. All the three anaesthetics were found to be suitable for introduction of general anaesthesia for caesarean section on account of high-rate enzymatic degradation and, consequently, absence of foetal depression. Resulting oxygen supply is higher, as compared to spontaneous delivery. Early indication and short-time introduction and delivery, thus possible, have often proved to be important to the newborn's condition.

[Readiness for breast-feeding--A psychosocial problem (author's transl)]. / Die Stillbereitschaft--ein psychosoziales Problem.

Frequency and duration of breast-feeding of mothers were evaluated at the Gynaecological Hospital of Wilhelm-Pieck-Universität Rostock, GDR, in 1975 and 1977. Readiness for breast-feeding was found to go on declining, over the period under review.--The incidence of breast-feeding differed significantly by occupational backgrounds. Frequency and duration of breast-feeding undertaken by women with university and technical school education as well as by teachers, nurses, and medical laboratory assistants or female medical orderlies were higher with significance than records obtained from shop-floor and agricultural workers, clerical staff, and housewives.--Prolongation of maternity leave alone obviously did not stimulate breast-feeding, but more attention should be given to psychological moments, individual briefing on aspects relating to breast-feeding offered to mothers by medical personnel, early attempts of breast-feeding with mothers still in the delivery room and fathers present, and intensive guidance on breast-feeding at maternity wards.

[Experience obtained from intra-uterine foetal transfusion to cope with severe rhesus-caused haemolytic disease of foetus - ten-year report (author's transl)]. / Erfahrungen mit der intrauterinen fetalen Transfusion bei schwerem Rh-bedingtem Morbus haemolyticus fetalis. Ein 10-Jahres-Bericht.

Sixty-three intra-uterine transfusions were applied to 44 foetuses with foetohaemolytic disease, in Rostock, between 1967 and 1976. Patients were selected for treatment by means of stepwise prenatal diagnosis. Details of that selection are described together with the technique of intra-uterine transfusion, with reference being made also to risks and complications. The survival rate of children, following intra-uterine transfusion, accounted for 41 per cent. The survival rate of non-hydropic foetuses was 76 per cent and thus much beyond that of hydropic foetuses of whom only 19 per cent survived. While the incidence of severe foetohaemolytic disease due to blood-group incompatibility is on a declining trend, intra-uterine foetal transfusion should be maintained as a possible therapy for certain cases.

[Postnatal primary therapy of Morbus haemolyticus neonatorum in prematurely born infants, following intra-uterine foetal transfusion (author's transl)]. / Postnatale Primärtherapie Frühgeborener nach intrauteriner fetaler Transfusion bei schwerem Morbus haemolyticus neonatorum.

Intra-uterine foetal transfusion was applied in 63 instances to 44 patients with severe Rh incompatibility in the authors' hospital, between 1967 and 1976. Eighteen of 29 live-born children survived the neonatal period (41 per cent). - Nineteen live-born children with most severe M. h. n. received substitutions of O (d)-erythrocytes, immediately after birth. Ten children with moderate M. h. n. received exchange transfusions in a premature-birth ward not until four hours on average had elapsed from birth. - Comparison between the two groups would provide little consistent information on the effectiveness of such primary therapy, because of difference in severity. - The conclusion drawn by the authors is that the rare cases of severe M. h. n. should be transferred for treatment to a national therapeutic centre where adequate personnel and equipment are available for optimum intra-uterine or early postnatal treatment.

[The effects of Pavulon (pancuronium bromide) on maternal circulation and metabolism as well as on fetal metabolism and postnatal condition at Caesarean section (author's transl)]. / Der Einfluss von Pavulon (Pancuroniumbromid) auf den Kreislauf und Stoffwechselparameter von Mutter und Kind bei Sectio caesarea.

The effects of pancuronium bromide (Pavulon) on maternal circulation and metabolism as well as on fetal metabolism and postnatal conditions were studied in 13 women in late pregnancy (between gestational weeks 33 and 40) requiring Caesarean section in general anaesthesia. A comparison with results of 50 spontaneous deliveries without analgetics was performed. The average dosage of 4 mg did not effect the maternal blood pressure, fetal muscle tonus and cardiorespiratory adaption of the newborn. According to general anaesthesia we found in acid-base status a pH decrease with respiratory acidosis in comparison with spontaneous deliveries without anaesthetics, but pH and pCO2 were normalized 30 min after delivery. On the contrary, the oxygen tension were higher as at delivery as 30 min after delivery by Caesarean section. Although 1 minute Apgar score was lower than after spontaneous delivery the heart rate and frequency of ventilation were normal in every time and in the following minutes Apgar score was 7 to 10, too. An effect of pancuronium bromide to maternal or fetal carbohydrate metabolism could not be found. The less side effects on maternal cardiovascular system and the missing influence in postnatal condition recommand pancuronium bromide as a suitable relaxant in obstetrical anaesthesia, too.

[Postnatal monitoring of the newborn infant with cardiotachography. II. Significance of cardiotachography for diagnosis of existing conditions in the newborn infant]. / Die postnatale Uberwachung des Neugeborenen durch Kardiotachographie. II. Wertigkeit der Kardiotachographie für die aktuelle Zustandsdiagnostik des Neugeborenen.

Eighty-five cardiotachograms of newborns aged between 34 and 42 weeks of gestation were studied. Fifty newborns were delivered spontaneously. In seventeen cases caesarean sections were used and in eighteen cases vacuum extractions. Cardiotachograms were recorded continuously throughout the immediate postnatal period until the stabilisation of the heart rate. Cardiotachograms were divided into three typical groups based on their cours of heart rate and fluctuation. The relation between these groups and the methods and duration of delivery and the condition of newborns were discussed. We found a correlation between the pathological cardiotachograms (tachycardiac and bradycardiac type of cardiotachogram) and long expulsion time, existent history of intrauterine disorder and low Apgar score. No relationship could be established between pathological cardiotachograms and the method of delivery.

[Postnatal monitoring of the newborn infant using cardiotachography. 1. Normal cardiotachogram in the newborn]. / Die postnatale Uberwachung des Neugeborenen durch Kardiotachoraphie. I. Das normale Kardiotachogramm des Neugeborenen.

Cardiotachograms in a group of 30 vigorous newborns have permitted the study of the typical signs of the regulatory mechanism of neonatal circulation during the first minutes of life. Immediately after birth neonatal heart rate rise to a peak heart rate of 177 bpm at the age of two minutes. Thereupon neonatal heart rate falls gradually and reaches a stabil level in the 13. minute after delivery. In the phase of gradually fall in neonatal heart rate many brief episodes of cardiac deceleration ("spikes") were observed.

[Normal standards for birth weight and birth length of newborns in the DDR]. / Standarwerte für Geburtsgewichte und Geburtslängen von Neugeborenen in der DDR.

Normal anthropometric standards of birth weight and birth length are presented for newborn boys and girls in the GDR between 28 and 44 weeks' gestational age. Newborns with uncertain duration of gestation, multiple births, malformations and stillbirths have been excluded. It is directed to necessity of regional standards.

[Studies on the modification of puerperal lactation using methylergobrevin]. / Untersuchungen über die Beeinflussung der puerperalen Laktation durch Methylergobrevin.

During the first 6 days after delivery the daily amount of mild secretion was measured in 300 nursing puerperae who had been treated with 0,2 mg of Methylergobrevin per day in combination with 100 IU Oxytocin. The milk let-down was compared with that of 300 untreated puerperae nursing under the same conditions. A significantly smaller milk let-down was found in treated old primiparae over 30 years, multiparae between 19-30 years and puerperae after premature delivery. In puerperae desiring to nurse their babies the routine post-partum treatment with Methylergobrevin should always be combined with Oxytocin. In women who had a premature delivery and in old primiparae a postpartum treatment with Methylergobrevin should be avoided.