[Association of low 50 g glucose screening test in pregnancy and fetal retardation]. / Assoziation von niedrigem 50-g-Glukose-Screeningtest in der Schwangerschaft und fetaler Retardierung.

BACKGROUND: The connection between elevated blood sugar and macrosomia is sufficiently well known and studied. The following study, however, examines whether patients with lower blood sugar values--based on the result of the 50 g-glucose screening test--delivered smaller children than patients with normal blood sugar based on the current criteria of blood sugar levels. PATIENTS RESPECTIVELY AND METHODS: In this study, all patients were included who visited our Prenatal Counseling Center between September 21, 1994 and July 31, 1996. Not included were patients with one-hour values greater or equal to 140 mg/dl. For assessing the 50 g-screening tests, percentiles were used. Based on the tables of Voigt, children below the 10th percentile were considered to be growth retarded. The student's t-test and chi-square test were employed as statistical tests. RESULTS: Of the 1416 participating patients in the study, 868 fulfilled the aforementioned criteria. A significant statistical correlation was shown between the development of fetal retardation and nicotine consumption, weight gain, and maternal height. It was also shown that patients with a lower (< 93 mg/dl) 50 g-screening test more often delivered a retarded child than patients with a normal value (23% vs. 12%, p = 0.034). No significant connection was found between the screening test groups and the described influencing factors. The clinical outcome, measured by the Apgar-scores and the transferal rate, was statistically significantly worse with the retarded children. CONCLUSIONS: The maternal glucose metabolism influences the fetal growth not only with respect to macrosomia but also growth retardation. The growth curves that have been used until now wrongly do not take into consideration the maternal anthropometric data. In light of this, the former ought to be re-evaluated. The data of this study emphasize the necessity of need-adapted nutrition. Maybe also pregnant women with a growth retarded child need a dietary consultation.

Internal jugular vein thrombosis caused by resistance to activated protein C as a complication of ovarian hyperstimulation after in-vitro fertilization.

We present a case of a 24 year old woman who became pregnant (twins) after human menopausal gonadotrophin (HMG)-induced ovarian stimulation, in-vitro fertilization (IVF) and subsequent embryo transfer. She developed a right internal jugular vein thrombosis as a complication of severe ovarian hyperstimulation syndrome (OHSS) 28 days after embryo transfer. The thrombosis developed in spite of anticoagulation with low-dose heparin. Later a resistance to activated protein C (APC) or Dahlbäck disease was diagnosed. Due to a new test procedure (accelerin inactivation test), the diagnosis was possible even under anticoagulation treatment. The coincidence of hyperstimulation and internal jugular vein thrombosis with the concurrent diagnosis of resistance to APC has not been published previously. The benefit of general screening for resistance to APC before admission to the IVF programme should be weighed. Targeted selection of a group of high-risk women would therefore be made possible.

Recurrent benign Müllerian papilloma of the vagina. Immunohistological findings and histogenesis.

Vaginal papillomata are rare, particularly in children. The macroscopic appearance is suggestive of a botryoid rhabdomyosarcoma, which is more common in this age group. The histogenesis of these tumors is still controversial, the choices being mesonephric or Müllerian origin. In our case cytokeratins and intermediate filaments were looked for immunohistochemically. Squamous epithelium as well as the cylindrical epithelium expresses type I cytokeratins, an acidic polypeptide typical of cylindrical epithelium. A strong expression of EMA in both epithelial types and CEA staining of the cylindrical epithelium support the hypothesis that these papillomata derive from Müllerian epithelium. Recurrence as observed in our case has not been described before. Treatment involves the simple removal of the papilloma.