[Induction of labour and pelvic score (author's transl)]. / Geburtseinleitung und Pelvic-Score.

Reported in this paper are 267 cases of induced labour with correlation to pelvic score in 213 pregnancies. Tocometrically controlled infusion of 10 IU oxytocin/500 ml is compared to conventional drip infusion of 6 IU oxytocin. The success of induction is closely related to pelvic score according to G. Martius. The rate of good success doubled by about ten points on the pelvic score, that is from 83 to 94 per cent. Good success was obtained in 69 per cent of those cases in which labour had been first induced by drip infusion of 6 IU oxytocin/500 ml and in 92 per cent of those cases in which 10 IU oxytocin/500 ml had been infused under tocometric control. Caesarean section was applied to 4.7 per cent of women in the first group and to 12.8 per cent in the second. Higher section rates and lower apgar values seemed to be correlated to indications for induced labour with tocometrically controlled oxytocin infusion. The results should be verified by comparable material.

[Is tocolytic treatment required for surgical closure of cervix? (author's transl)]. / Bedarf die Zerklage einer Tokolyse?

Reported in this paper are 211 cases of surgical closure of the cervix by McDonald's procedure. In 50 per cent of all cases, isthmocervical closure was performed for indications derived from case histories, and 68.2 per cent of the operations were performed in the fifth and sixth months of pregnancy. No postoperative complications were suffered by the mothers or children concerned. Average hospitalisation was 8.3 days for 111 pregnant women who required parallel tocolytic treatment or 5.6 days for 100 patients without complementary tocolysis. Perinatal mortality was 1.77 per cent in the first group, with 94.6 per cent of these women giving birth beyond the 36th week of pregnancy. -The outcome of pregnancy was evaluated, too, in the context of 77 patients in a comparable group with no tocolytic treatment. Both abortions and perinatal mortality accounted for 2.6 per cent each, with 94.8 per cent of these women giving birth beyond the 36th week of pregnancy. The effectiveness of surgical closure of the cervix with flanking tocolysis is discussed.

[Appendectomy in parallel with gynaecological laparotomy (author's transl)]. / Simultanappendektomie bei gynäkologischer Laparotomie.

An account is given in this paper of 102 cases of appendectomy in parellel with 193 gynaecological laparotomies (52.9 per cent), with reference being made to the small amount of associated complication, as borne out by literature data on larger groups of patients. Particular reference is made, in that context, to legal and clinical prerequisites and to counter-indictions. The authors' own pathohistological findings differed from figures around 90 per cent, as reported elsewhere, in that more or less conspicuous tissue peculiarities were recorded from only 37.5 per cent of all simultaneously removed appendices. That discrepancy in evaluation is discussed. With the relative increase in incidence and complication of senile appendicitis in mind, appendectomy in parallel with gynaecological laparotomy is recommended as a genuine prophylaxis, yet, with due consideration of all necessary conditions.

[Delivery of overweight infants]. / Zum Geburtsverlauf bei übergewichtigen Kindern.

Overweight was recorded from 9.6 per cent of 6155 infants born between 1976 and 1981. Birth weights were between 4000 g and 4499 g in 8.5 per cent of the newborns, between 4500 g and 4999 g in 0.9 per cent, and in excess of 5000 g in 0.2 per cent. Sixty-five newborns with birth weights above 4500 g were evaluated in greater detail. The male-female ratio was almost three to one. The average age of the mothers was 25.7 years. Fifty-nine children were born spontaneously, three by forceps, and three by caesarean section. The Apgar score was eight and more in 64 newborns. The case history of one postnatal death is described. Puerperal anaemia and involution disorders were quite frequent. Eighteen of the 65 mothers were overweight themselves. A dubious pathological result was obtained from oral glucose tolerance test, six weeks after childbirth. Clinical conclusions are drawn.

[Comparative blood coagulation studies in PGF2a- and 15-methyl-PGF2a-induced therapeutic abortion]. / Vergleichende Gerinnungsuntersuchungen bei PGF2a- und 15-Methyl-PGF2a-induzierten therapeutischen Abortus.

In 15 pregnant women of the first trimenon of gravidity an interruption was performed by means of extra-amnial application of PGF2a and in 10 pregnant women by means of i. m. application of 15-methyl-PGF2a. Bleeding time, recalcification time, number of thrombocytes, heat fibrin, and thrombocyte adhesiveness were determined before, during and after treatment. Statistically significant changes could be observed during bleeding time, heat fibrin, and thrombocyte number. The investigations of coagulation, however, did not reveal any considerable impairment of the coagulation system, thus confirming the positive evaluation of prostaglandines used for therapeutic induction of abortion.

PIP: Abortion was performed during the first trimester in 15 pregnant women by means of extraamnial application of PGF2alpha and in 10 pregnant women by means of an intramuscular application of 15-methyl-PGF2alpha. Bleeding time, recalcification time, number of thrombocyte adhesiveness were determined before, during, and after treatment. Statistically significant changes could be observed during bleeding time, heat fibrin, and thrombocyte number. The investigations of coagulation, however, did not reveal any considerable impairment of the coagulation system, thus confirming the positive evaluation of PGs used for therapeutic induction of abortion. (Authors' modified)

[Causes of clavicular fracture in newborns (author's transl)]. / Zu Ursachen der Klavikulafraktur bei Neugeborenen.

Accumulation of clavicular fractures among newborns on the authors' ward is reported, with reference to 1978. Twenty clavicular fractures were recorded from 1.6 per cent of all newborns, in the above period under review. They were related to cephalic presentations and to the upper shoulder in 90 percent. They were closely correlated to high birth weight. Positioning of the women concerned and medical supervision of delivery seemed to be of causative importance.

[Gynecologic geriatric surgery at the University Gynecological Clinic Rostock during 1960--1974]. / Gynäkologische Altersoperationen an der Universitäts-Frauenklinik Rostock in den Jahren 1960 bis 1974.

There is reported about 2279 gynaecological operations at women, aged 60 years and more, in a period from 1960 to 1974, divided into three 5-years-groups. The part of geriatric operations increased from 5,3% to 7,0% of all operations. The division into high risk-groups took place after points given by Loskant. 41,1% of all patients where classified into group III. Group IV has the highest postoperative mortality rate (5,3%). The postoperative mortality rate altogether was 2,2%. In the years from 1960 to 1974 it decreased from 2,6% to 1,9%. 25,1% of the surgical operations where carried out abdominaly. The high part of vaginal operations comes off by placing curettages into the analysis. Under that aspect must be seen the postoperative mortality rate 7,1% at abdominal and 0,7% at vaginal operations. In the main point indications for operation were malignant tumours (37,3%), haemorrhages (25,4%), benign tumours (17,6%), and position variations of the genitals (10,6%).

[Paroxysmal supraventricular tachycardia in the delivery room]. / Paroxysmale supraventrikuläre Tachykardie im Kreisssaal.

In case of tachycardia the whole clinical picture should be taken into consideration. After exclusion of other kinds of shock also in the delivery room it should be thought of the rare cardiogenic shock caused by paroxismal supraventricular tachycardia. Stimulation of nervus vagus and/or drugs have good success.

[Possibilities and limitations of aspiration curettage]. / Moznosti a hranice aspiracní kyretáze.

PIP: Since aspiration curettage is increasingly common, we undertook a study aimed at comparing the histological suitability of samples acquired by this method to conventional curettage methods. Both types of curettage were performed on 123 women aged 23-76. Before undergoing aspiration curettage, women received 50 mg. Pethidine and .01 mg. Atropine/kg. body weight. Anesthetics for conventional curettage were hexabarbitol and nitrous oxide. Histological reports on samples acquired by both methods of curettage were identical in ale 15 cases of breakthrough bleeding, in all 6 patients with hypermenorrhea, in both patients on whom the procedure was done for diagnostic purposes, and in 18 of 21 cases of long-term bleeding. 47 of 63 women with post-menopausal bleeding had identical findings in both samples; 9 of these women had significant findings in the conventionally obtained sample only and 7 in the aspirated sample only. Of 16 cases of cervical polyps detected in the conventional curettage samples, only 3 were simultaneously discovered in the aspirated samples. 5 cases of uterine cancer were simultaneously detected in both samples. Aspiration curettage dectected cervical cancer in one case where conventional caurettage did not, but one case of cervical cancer in conjunction with polyps was not detected by aspiration curettage. Thus, except in cases where cervical polyps are suspected the diagnostic and therapeutic utility of aspiration curettage is high. An advantage of aspiration curettage is that it need not be done under general anesthesia and may be done on an out-patient basis. This reduces surgical risks to the patient and promotes the efficient utilization of hospital facilities.^ieng

[Acute fatty liver of pregnancy and subsequent pregnancy]. / Akute Schwangerschaftsfettleber und nachfolgende Gravidität.

Report on a second para, aged 25 years, with acute fatty degeneration of her liver in the 35th gestational week of a twin pregnancy. Treatment was successful. After an interval of 2 years she conceived again. This pregnancy was without complications. A healthy child was born in the 39th gestational week.

[Blood coagulation tests in prostaglandin F-2alpha induced and a one-time mechanically induced therapeutic abortion]. / Gerinnungsuntersuchungen bei Prostaglandin-F2alpha- und einzeitig mechanisch induzierten therapeutischen Abortus

PIP: Blood coagulation parameters were studied in 36 women after induced abortion. Abortion was induced in 17 patients by extraamniotic application of prostaglandin F2alpha and in 19 by vacuum aspiration. Bleeding and clotting time, platelet count, heat-fibrin levels, and platelet adhesiveness were measured before abortion and 4 and 8 hours after beginning of PGF2alpha administration, 2 hous after expulsion of the conception product, and 24 hours after the 1st measurement. Heat-fibrin levels increased significantly during prostaglandin administration. Platelet adhesiveness increased significantly 2 hours after expulsion and remained significantly higher 24 hours later. No significant differences between the 2 methods with respect to blood coagulation were observed. This suggests a positive estimation of first trimester abortion using prostaglandin F2alpha.^ieng

[The action of prostaglandin E2-induced pains on the metabolic and clotting systems of mother and child during birth (author's transl)]. / Die Einwirkung von Prostaglandin E2-induzierten Wehen auf das Stoffwechsel- und Gerinnungssystem von Mutter und Kind intra partum

11 pregnancies at term were terminated by dilatation of the uterine cervix, low amniotomy, and by intravenous administration of PGE2. The average infusion time was 4 hours 20 minutes, and the average total dose of PGE2 amounted to 0.2 mg. Parameters of acid-base changes, carbohydrate and energic state changes, gas metabolism, and changes in coagulation and fibrinolysis in mother and in fetus were analysed during labor and after birth. Labor activity and fetal cardiac action were monitored cardiotocographically. Checked against 50 uncomplicated spontaneous deliveries, we have found no disadvantageous changes in the parameters investigated.

[Cold preservation of human sperm]. / Zur Kältekonservierung menschlichen spermas. Ein technisch neues Verfahren

The authors report the development and investigation of a new technique for freezing and storage of human spermatozoa. Utilizing isolated container of different kind the average rate of freezing was between 1,3 grd/min and 14 grd/min in the sphere from 5 degrees C to--10 degrees C and between 2,9 grd/min to 55 grd/min in the sphere from--10 degrees C to--60 degrees C. The technical expense was low. Semen specime were provided by 33 andrological patients. A total of 53 samples of human semen were frozen and stored for periods of time up to 25 days. The authors used the cryoprotective medium from Behrman and Sawada. The best results were obtained in the mode of freezing at 2,8 grd/min respectively 12 grd/min in ejaculates of original motility about 80%. The recovery of motility and fertilizability of spermatozoa was 50% of original motility, in cases of oligospermia only 34%. The results of this new technique of freezing and storage of human spermatozoa are similar to other new reports in literature.

On the influence of prostaglandin F2alpha-induced labor at term on the metabolism and coagulation of mother and fetus.

11 pregnancies at term were terminated by dilatation of the uterine cervix, low amniotomy, and by intravenous administration of PGF2alpha. The average infusion time was 3 hours 55 minutes, and the average total dose of PGF2alpha amounted to 2.0 mg. Parameters of acid-base changes, carbohydrate and energic state changes, gas metabolism, and changes in coagulation and fibrinolysis in mother and in fetus were analyzed during labor and after birth. Labor activity and fetal cardiac action were monitored cardiotocographically. Checked against 50 uncomplicated spontaneous deliveries, we found no disadvantageous changes in the parameters investigated.

[Blood gas analysis in surgical geriatric gynecology]. / Blutgasanalysen in der operativen geriatrischen Gynäkologie

At 36 women ranging in age from 60 to 87 years, who received general anaesthesia for gynaecological operations, pO2 and acid-base-status were controlled before and two hours after operation and on the 1st and 3rd postoperative days. At these geriatric patients the results showed mean values of pO2 in relation to the age and normal parameters of the acid-base status. Comparing the abdominal and vaginal operations no significant differences could be found. The comparison between patients aged 60 to 69 years and these over 70 years showed only small but clinically insignificant differences of base excess. These beneficial results are the consequences of a successful, complications avoiding pre- and postoperative treatment.

[Influence of labor induced by prostaglandins on the metabolism and blood coagulation system of the mother and child during labor]. / Einfluss prostaglandininduzierter Wehen auf den Stoffwechsel und das Gerinnungssystem von Mutter und Kind unter der Geburt

22 pregnancies at term were terminated by dilatation of the uterine cervix, low amniotomy, and by intravenous administration of PGF2alpha or PGE2. The average infusion time was 4 hours 10 minutes, and the average total dose of PGF2alpha amounted to 2,0 mg and of PGE2 0,2 mg. Parameters of acid-base changes, carbohydrate and energic state changes, gas metabolism, and changes in coagulation and fibrinolysis in mother and in fetus were analyzed during labor and after birth. Labor activity and fetal cardiac action were monitored cardiotocographically. Checked against 50, and for the coagulation 12 uncomplicated spontaneous deliveries, we have found no disadvantageous changes in the parameters investigated.

[Intravenous administration of prostaglandin F2alpha or prostaglandin E2 in labor pain induction in fetal death]. / Intravenöse Applikation von Prostaglandin F2alpha oder Prostaglandin E2 zur Weheninduktion bei intrauterinem Fruchttod

PIP: Successful treatment of intrauterine fetal death by intravenous administration of (PGF2alpha) prostaglandin F2alpha in 20 patients (gestational age 22-40 weeks) and of PGE2 in 6 patients (gestational age 24-36 weeks) is reported. Infusion of 5-20 mcg PGF2alpha/minute and of 0.5-2.0 mcg PGE2/minute resulted in regular uterine contractions within the first 2 hours. The average dosage of PGF2alpha was 7.06 mg in cephalic presentations (infusion time=7 hours, 2 minutes) and 23.4 mg in anomalous presentations (infusion time=16 hours, 54 minutes). The average dose of PGE2 was 1.17 mg (infusion time=9 hours, 23 minutes). Coagulation investigations were performed before, during, and after PG infusion. These investigations suggest that the coagulation potential of patients with intratuerine fetal death by intravenous PG administration is not influenced to any extent. Few undesirable side effects were seen using this PG. We consider that the intravenous PG application for the induction of labor in intrauterine fetal death is a useful method because of the effectiveness and few undersirable side effects. (author's)^ieng