An integrated water resources management approach for the River Spree and its catchment.

In this paper a concept of an integrated water quality model for a river catchment area is presented. The main focus is directed to the development of a water quality module for rivers. Necessary simplifications for calculation of hydraulics and water quality will be explained. Furthermore, by first simulation results possible applications of the model are presented.

[Clinical experiences with intracervical prostaglandin E2 administration for labor induction]. / Klinische Erfahrungen mit intracervikaler Prostaglandin E2-Applikation zur Geburtseinleitung.

From January 1, 1986 to December 31, 1987, 119 patients among a total number of 2309 were recorded prospectively, who needed induction of labour for mixed indications (Group A), for a premature rupture of the membrane (Group B) or for medical indication (Group C). Independently of the ripe of cervix the results were significantly better in the multiparae than nulliparae respecting the success of induction, the duration of labour and the rate of Caesarean sections. 66.4% (n = 79) of all cases could be delivered within 24 hours after the first gel-application. Statistically significant differences in the partial collectives A, B, and C were seen only by unripe cervix (A = 60.0%, B = 71.4%, C = 30.0%). Repeated tries of inductions led to statistically significant more rates of Caesarean sections, fever during labour and prolonged course of labour. The rate of Caesarean sections and the fetal post-partum results comparing to the other remaining deliveries in 1986/87 were statistically not different. Side effects induced by Prostaglandins were only founded in two cases concerning nausea. Uterine hyperactivities with pathological CTG-patterns being resistant to treatment with beta-mimetics were found in one case. As severe complication the only case with particular rupture of uterus must be seen. Based on our experience the intracervical PGE2-application for induction of labour is not disadvantageous for mother and fetus, if there are certain indications and fixed criteria.

[Effect of risk factors on premature labor and neonatal condition following delivery]. / Der Einfluss von Risikofaktoren auf die Frühgeburtlichkeit und auf das kindliche Befinden nach der Geburt.

The influence of risk factors on the course of pregnancy in cases of preterm delivery, and on the mortality and morbidity of the premature infants, was investigated in a retrospective study. Data of 574 patients who bore children weighing under 2500 g between 1976 and 1986, and of a control group of 574 patients who gave birth during the same period to infants weighing over 2500 g were statistically analyzed. In the preterm population there was a significantly higher incidence of previous treatment for sterility, repeated miscarriages and prior preterm births. Smoking doubles the risk of preterm birth. Pathologic Apgar scores and acidosis morbidity were found significantly more frequently among mothers who smoked. The mortality and morbidity of the neonate depend on its birthweight and the duration of pregnancy. A considerably better prognosis may be expected if the infant weighs over 2000 g and is born after the 32nd week of gestation.

[Comparative studies of the venous system of the arm and leg before and after delivery]. / Vergleichende Untersuchungen am Venensystem des Armes und des Beines vor und nach Entbindung.

Venous occlusion plethysmographic measurements were performed on the legs of ten non-pregnant subjects on ten consecutive days, in order to demonstrate the reproducibility of this method. In the third trimester of gestation and on the seventh day post partum, venous occlusion plethysmographic studies and vein caliber measurements were performed on arms and legs of 20 patients. A significant reduction in leg vein diameter following delivery was found. There were no differences in the diameters of arm veins measured in the third trimester and post partum. The results of venous occlusion plethysmography, as an indicator of venous function, revealed no differences between the third trimester and post partum in either the arm or the leg. Since hormonal changes during gestation must affect the entire venous system, i.e., also the arms and legs, mechanical displacement of the blood drainage pathways by the gravid uterus is most probably responsible for the significant dilatation of leg veins in the third trimester. A displacement of the higher sections of the femoral vein was demonstrated by Doppler sonography. Increased distensibility of the veins in the third trimester, continuing post partum, is probably the measurable basis of the much higher incidence of varicosis among women who have had children. It appears possible to detect extreme dilatations of leg veins sonographically, and to counter the increased risk of thrombosis and perhaps also to reduce the risk of later varicosis by timely compression treatment.

[Changes in uterine circulation in relation to body position in pregnancy]. / Anderung der uterinen Durchblutung in Abhängigkeit von der Körperposition während der Schwangerschaft.

The present paper reports on studies to determine the influence of body position on uterine blood flow. In ten pregnant patients (around the 35th week of gestation), over 700 measurements of systolic/diastolic action in the uterine vessels were made by Doppler sonography with the patients in various positions: lying down, standing, and sitting on the couch and the balance-variable chair; from the relationship between the systolic and diastolic levels conclusions were then drawn about the uterine blood flow in various body positions. It was found that it was best when the patient was lying down or sitting on the special chair without angling the hips; in contrast, diastole was lower in relation to systole with the patient standing and sitting on the examination couch. This means an increase in resistance or a reduction in blood flow. It appears reasonable to conclude that sitting on the balance-variable chair can be recommended to pregnant patients with signs of deficient fetal blood supply, in addition to bedrest, which is customarily advised. Apart from this, it is wise to use Doppler sonography to establish the body position in which uterine blood flow is best.

[Doppler studies of arterial blood flow in the uterus during labor]. / Doppleruntersuchungen des arteriellen uterinen Flows während der Wehentätigkeit.

By the pulsed doppler method the arterial uterine blood velocity was studied in 19 patients with contractions before and during labour. It is shown, that uterine contractions reduce blood velocity significantly. Normally there is a low resistance in uterine arteries, so that the diastolic flow is nearly as high as the systolic flow. In uterine contractions the vascular resistance increases. Systolic flow is reduced slightly and diastolic flow severely or completely. But a complete zero-flow couldn't observed in any studied uterine contraction.

[Intensive supervision of labor with the help of the computor (author's transl)]. / Rechnergestützte Intensivüberwachung unter der Geburt.

A system of supervision which we developed was described. With this system it is possible to make on-line evaluations of the CTG and postpartal blood analyses from the cord blood via computors (AEG 60-10 and AEG 60-50). The computed parameters together with all obstetrical data collected during the pregnancy (results from ultrasonic tests, estrogen and HPL analyses, anamnestic data and additional "clinical findings") as well as off-line evaluated CTG findings made during the course of the pregnancy were scored. The CTG is evaluated on-line via the "cross correlation function" and can be produced in a wide variety of parameters at any time during labor. The complete system is demonstrated on the basis of an individual case analysis. The first statistical individual case analyses of deceleration in CTG were compared with the classical Hon and Caldeyro-Barcia method of calculation.