[Premature rupture of fetal membranes at term: an indication for induced labor with prostaglandins?]. / Vorzeitiger Blasensprung am Termin: Eine Indikation zur Geburtseinleitung mit Prostaglandinen?

Premature rupture of membranes (PROM) at term is thought to be related to an increased infection risk for mother and child. A prospective study was conducted to evaluate the efficacy of prostaglandins for induction of labour in 433 cases of PROM presenting after 35 completed weeks of gestation. Intracervical gel or vaginal pessaries were given in dependence on the Bishop-score. Course of delivery and fetal outcome were analysed. In 57.3% single application was sufficient to induce the delivery. Only 1.8% of cases did not respond. 21% of patients were delivered within six hours of the first application and 89.6% during the first 24 hours. The rate of cesarean section was 15.5%. Fetal distress caused by uterine hyperstimulation was observed in 9.9% and required intrapartum tocolysis. A fetal acidosis (pH < 7.15) was present in 4.1%. The neonatal infective morbidity was 0.4%. Severe maternal complications were not observed. We conclude that use of prostaglandins for induction of labour in case of PROM at term seems to be a recommendable measure. In primiparous women or in the presence of an unfavorable cervix-score shorter duration to delivery diminishes the risk of fetal infection.

Polyploidies in abortion material decrease with maternal age.

Among 639 spontaneous abortions between the 8th and 14th week of gestation 342 (53.5%) revealed an abnormal karyotype. While the rate of trisomies distinctly increased with advancing maternal age, a decrease in the rate of 45,X conceptuses and polyploidies was observed among abortions from older women. The overall relation of XXXX:XXYY among the tetraploidies was 14:11 and that of XXX:XXY:XYY among the triploidies was 26:36:1. However, when the latter was related to maternal age, a reversal of the XXX:XXY ratio of 1:2 in the younger to 2:1 in the older age groups became evident. Furthermore a decrease in the rate of "paternally" derived partial hydatidiform moles was found among the triploid abortion specimens from older women. From these observations we conclude that digyny plays a major role in the origin of triploidy in the increased maternal age groups, while diandry related to immaturity of oocytes and impairment of oocyte cortical function is more frequent in triploid abortions from younger women.

Genetic amniocentesis in twin pregnancies: results of a multicenter study of 529 cases.

To evaluate the risk of abortion after genetic amniocentesis in twin pregnancies, a retrospective study of 15 centers was performed. The spontaneous abortion rate up to 20 completed weeks of gestation was 2.3%; the abortion rate up to 28 completed weeks, as defined by WHO, was 3.7%. The abortion rate could not be correlated either with the number of needle insertions or with the type of marker dye used. There was also no correlation between the abortion rate and the gestational age at which amniocentesis was performed. A significant association was shown between congenital intestinal obstructions and the application of methylene blue intra-amniotically as a marker dye. Considering the increased natural loss rate in multiple gestations, amniocentesis in twin pregnancies seems to be a safe and reliable technique.

Clinical diagnosis of partial duplication 7q.

We report on two sibs with partial dup (7q), a retarded 9-month-old boy and an aborted fetus of 17 weeks' gestational age. Besides minor anomalies, the boy had frontal bossing, macrocephaly with hydrocephaly, a high forehead, and a large fontanelle. GTG banded chromosomes showed a 14p+ abnormality. Because his mother carries a balanced, de novo translocation with a breakpoint in band 7q33, the boy has a duplication of the distal portion of band 7q33 and the segment 7q34----qter. Our findings suggest that the phenotype in terminal duplications of 7q may, in some patients, be recognized clinically.

[Risk of infection in premature infants with premature rupture of fetal membranes in correlation to respiratory distress syndrome]. / Infektionsrisiko bei Frühgeburten mit vorzeitigem Blasensprung in Korrelation zum Atemnotsyndrom.

The spectrum of infective agents in 58 preterm deliveries with premature rupture of the membranes (PROM) is examinated by assessment of bacteriological swabs. In the earliest weeks of gestation all children had severe RDS. Nearly 40% of the detected pathogens belonged to the non pathogenic vaginal flora. E. coli, Streptococcus species, Klebsiella and Candida were predominant in the group of facultative pathogenic infective agents. There is an enlarged colonization in maternal swabs after greater than 24 h. In nearly 80% of the children with severe RDS pathogens could be detected. Ascending infection is followed more often by severe RDS. In case of premature labor refractory to tocolytic therapy or slight vaginal bleeding, cervical swabs should be taken. Pathological findings must be treated by local antiseptic agents or antibiotic therapy. If there are any signs of intrauterine infection the pregnancy must be terminated to avert damage from the newborn.

[Bacteriologic studies in premature rupture of fetal membranes and correlation with the clinical aspects of chorioamnionitis and the amnion infection syndrome]. / Bakteriologische Untersuchungen bei vorzeitigem Blasensprung und Korrelation zur Klinik von Chorioamniotitis und Amnioninfektionssyndrom.

One of the major complications following premature rupture of the membranes (PROM) is ascending infection. In this aspect the bacteria of the vaginal flora play a major part. Bacterial spectra of a group with PROM and another control group with punctual rupture of the membranes are comparatively analysed. This analysis is based on swabs taken from vagina and newborns. Data are interpreted in correlation to clinical picture of chorioamnionitis and amnion infection syndrome (AIS). Twelve newborns clinical suspected to have a neonatal infection are retrospectively judged. In the group with pregnant women with PROM potential pathological germs such as group B streptococci and E. coli are found more often, whereas physiological flora, specially Lactobacillus species, are clearly reduced. In newborns with AIS even germs can be detected, which so far have seemed to be more apathogenic, such as Gardnerella vaginalis. Bacteriological findings are discussed in connection with clinical parameters, specially group B streptococci are looked at more precisely. In newborns with AIS microbiological results are demonstrated including course of pregnancy and delivery. For the management of PROM alternatives are shown and advice for prophylaxis is given.

[Bacteriologic studies of the amniotic fluid following amniocentesis]. / Bakteriologische Fruchtwasseruntersuchungen nach Amniozentese.

After transabdominal amniocentesis puncture needles and samples of amniotic fluid were microbiologically examined. The antibacterial activity of the amniotic fluid after inoculation of different germs was compared. Positive microbiological results were found in 43 of total 573 puncture needles, but there were germs of the skin flora in 40 cases. Five amniotic fluid samples out of total 424 were contaminated, whereby skin commensals were detected in four samples. The bacteriostatic activity against the examined germs was individually. Complete growth inhibition over 24 hours was observed in cultures with coagulase-negative Staphylococcus, Staph. aureus and E. coli, a less growth inhibition over nearly 10 hours for Pseudomonas aeruginosa. The growth of Strep. faecalis was not suppressed. As result of the frequent observation of skin commensals in amniocentesis puncture needles and amniotic fluid samples clear lines for the performance of the amniocentesis on antiseptic condition basis and for the diagnostic and therapeutic procedure in case of positive microbiological findings were recommended.