On the complication risk of early amniocentesis versus standard amniocentesis.

In the last 6 years early amniocentesis for the prenatal diagnosis of chromosome aberrations has been established in many centers worldwide, but knowledge about the gynecological safety of the procedure is sparse. From 1990 to 1995 at the Evangelisches Krankenhaus Oberhausen (Germany) 3,277 early amniocenteses (between weeks 11 and 14) and 1,808 standard amniocenteses were performed in low-risk indication groups (advanced maternal age and anxiety). A complete follow-up including reports of fetal outcome was obtained in 4,444 cases (87.5%). A pregnancy age-related abortion rate was determined with a slightly higher rate of abortions up to week 28 of gestation in early amniocentesis. The total abortion rate up to week 28 after the procedure for cases with complete follow-up was 2% in early amniocentesis. Compared to standard amniocentesis performed under the same clinical conditions with an abortion rate of 1.3%, there is no statistical difference between early and standard amniocentesis (p = 0.0971). Hip and foot dislocations (22 cases) and pulmonary distress syndromes (8 newborns) showed no significant correlation with the gestational week. Given the high normal background rate of spontaneous abortions in the early period of pregnancy without an invasive procedure, early amniocentesis can be considered as a safe alternative to chorionic villus sampling and standard amniocentesis.

[Early amniocentesis between the 12th-14th week of pregnancy. Clinical experiences with 1,100 cases]. / Die Frühamniozentese zwischen der 12.-14. SSW. Klinische Erfahrungen bei 1100 Fällen.

Information is presented on 1100 early amniocenteses between the 12th and 14th week of gestation, performed at the Evangelisches Krankenhaus Oberhausen over a two year period. In all cases, a sufficient amount of amniotic fluid was obtained. In 99.7%, the cytogenetic diagnosis was successful. In 2.6% (29 patients), an aberrant karyotype was found. The time of cultivation was in the same range as can be observed in standard amniocentesis. The AFP-median measurements correlate with other studies. The spontaneous abortion rate was 0.3%. We conclude, that early amniocentesis can be performed safely and successfully by an experienced surgeon between the 12th to 14th week of gestation.

[Unusual course of metastatic cancer of the uterine cervix]. / Ungewöhnlicher Verlauf eines metastasierenden Karzinoms der Cervix uteri.

The following report describes the case history of a 40-year-old woman suffering from a squamous carcinoma of the cervix uteri stage IV with predominantly cutaneous metastases. After a combined treatment of local radiotherapy and polychemotherapy with cisplatinum, bleomycin and methotrexate, a complete remission of the disease has been achieved. Six months later, however, a local recurrence of the tumor in the cervix uteri was diagnosed. As the patient showed no evidence of metastases, a radical hysterectomy was then performed. While the chemotherapy was continued over longer time intervals, the patient lived for a further five months in good health and without any recurrence of the disease. More than one year after treatment was started, the patient died suddenly of uncontrollable cerebral metastases. Considering the unfavourable prognosis and the satisfactory quality of the patient's life after therapy, the course of treatment undertaken appears to have been justifiable.