[The "long-term morbidity" computer program in perinatology. 1. Program introduction]. / Computer-Programm "Langzeit-Morbidität" in der Perinatologie 1. Mitteilung: Programmvorstellung.

Presentation of the Computer-programme for prospective analysis of morbidity of unselected children born in 1983 up to 1985 over a period of 10 years.

[Possibilities in modification of the risk to the child in multiple pregnancy and labor]. / Uber die Beeinflussbarkeit des kindlichen Risikos bei Geminischwangerschaft und -geburt

A comparison of twin deliveries from 1966 to 1971 (140 = 1,23%) and from 1972 to 1974 (65 = 1,07%) indicates a decrease of the uncorrected perinatal mortality from 10,35% to 6,15% caused by early diagnosis, gestation prolonging measures, diagnosis of placental insufficiency and management of delivery. Concerning the first twin the decrease of perinatal mortality was more evident from 7,86% to 1,54% compared with the second twin from 12,86% to 10,77%. Nevertheless the following statement can be made: up to 1971 perinatal mortality was mainly a problem of prematurely born infants; it is changed now to a problem of antenatal mortality of small for date infants. Prematurely birth and mortality of twins may be well influenced by: 1. Early diagnosis. 2. Widely used hospitalisation, beginning from 28 th week of gestation. 3. Widely used cervix-cerclage and uterotocolysis. 4. Intensive antenatal care. 5. Intranatal intensive care of both infants (cardiotocography, blood gas analysis). 6. Limitation of the interval to 5 to 10 minutes. 7. Widened caesarean section indication (breech presentation, small for date infants).

Fetal risk in delivery with the Shute parallel forceps: analysis of 1,503 forceps deliveries.

A total of 1,503 vaginal deliveries with the Shute parallel forceps during a 10 year period are analyzed as to the risk of instrumental damage. In this series, 35 infants died intrapartum or neonatally. Eliminating all deaths from unrelated causes, three remain in which the forceps could possibly have been implicated. Investigation of these, however, revealed in each case the presence of other concomitant and potentially lethal factors, none of which could be completely ruled out as the primary cause of fetal death. Each of the three cases is discussed in detail. We conclude from our series that the Shute forceps is useful in the delivery of premature infants, but should be employed for this maneuver only by very experienced operators. In these cases, midforceps should be performed only for critical indications. The risk of damage with parallel forceps deliveries from the pelvic floor is minimal if decision for operation is based on cardiotocographic criteria, and under favorable degrees of oxygenation. In the delivery of the immature infants, the parallel forceps can, in fact, hardly be superseded by any other instrument because of its unique controlled protection of the fragile fetal head from even the pressures of the birth canal. Delivery with the Shute forceps can be performed effectively under pudendal block or local infiltration anesthesia.

[The East German Twin Study l984/85. Report of selected aspects]. / DDR-Gemini-Studie 1984/85. Bericht über Teilaspekte.

Analysis of a multicentre study of the GDR in which 67 clinics with a total of 1,200 twin pairs participated over a scheduled period of 18 months. In the result a recommendation for the antenatal, intrapartal and neonatal care of gemini-pregnancy was prepared.

[Isolated thrombotic omphalovasculitis with marginal insertion--a rare umbilical cord complication]. / Die isolierte Omphalovasculitis thrombotica bei marginaler Insertion-eine seltene Nabelschurkomplikation

Report about 2 cases of a rare umbilical cord complication, the isolated omphalovasculitis thrombotica with marginal insertion and about their effects at the feto-placentare unity. Reference is given to an eventual embolic cause of praenatal thrombosis. It will be recommended a regular histological examination of the marginal respectively velamentous insertion for clarification of unclearly fetal deaths.

[Economic aspects of intensive care in obstetrics]. / Okonomische Aspekte der Intensivgeburtshilfe.

An intensive obstetric care unit has been established at investment costs of 646,167.--Mark which broke down into 220,248.--Mark for prepartum attention, 268,010.--Mark for intrapartum attention, and 157,909.--Mark for neonatal attention. Operational expenditures on equipment and services were found to amount to 144,052.--Mark per annum.--Specific outlays resulted from intensive obstetrics, as compared to conventional procedures. They varied between 48.--Mark and 96.--Mark per delivery, depending on annual numbers of deliveries and on the use of equipment quantitatively adapted to requirements. Individual costs for intrapartum attention varied by bedside equipment combinations and turnover of patients (n/labour bed/d) and were between 12.--Mark and 36.10 Mark.--Something between 2000 and 3000 births per annum, with patient turnovers between 1.5 and 2.0 per bed and die, was considered optimum. The cost of intensive obstetrics went up under such optimum conditions to something between 48.--Mark and 58.--Mark, with something between 14.80 Mark (BMT 504 biomonitor, Lineomat, FTS 101 foetal-function recorder) and 21.60 Mark (BMT 9141 biomonitor, Lineomat) being required for intrapartum monitoring of one birth.--Reduction in perinatal mortality, as compared to figures of conventional obstetrics and to cost factor between 519,168.--Mark and 627,328.--Mark for equipment and other hardware, yielded a benefit for 10,816 births of something between 46.9 and 167,5 million Mark.

[Telemetric labor monitoring. Clinical aspects, cardiotocographic findings and acceptance of free mobilization in labor]. / Telemetrische Geburtsüberwachung. Klinische Aspekte, kardiotokographische Befunde und Akzeptanz der freien Mobilisation unter der Geburt.

Telemetric signal transmission represents a suitable technical concept for combining free mobilisation with continuous electronic monitoring of birth. The obstetric aspect of telemetric birth monitoring is discussed on the basis of a clinical-statistical analysis: a group of 127 women in labour (64 primigravidae and 63 multigravidae) were examined and the specific effect of mobilisation on obstetrically relevant parameters was analysed. The results show the advantages of this method of birth management. Freedom of decision as regards choice of posture during birth, better subjective control and less painful labour, better birth mechanics, more effective labour, shorter duration of birth, better heart-rate patterns, optimal exterior conditions and an active basic attitude of the woman in labour are the proven advantages of this method. The highly significant relationship between the degree of mobilisation and the duration of birth is emphasised as one of the most important results.

[Ambulatory tocography]. / Ambulante Tokographie

The value of the ambulant tocography was tested in 127 cases by ambulant tocograph T 500. The average frequency of uterine contractions was in 66 normal cases 0,5/30 min. This frequency of uterine contraction was higher in a group with anamnestic risk (1,1/30 min) and in patients with tocolytic medication (2,3/30 min). Nearly term all groups tended to higher frequency of uterine contractions. The ambulant tocography is a new method to completed the diagnostic.

[Methods of localization of chorioamnionitis and their clinical value]. / Lokalisationsformen der Chorioamnionitis und ihre klinische Wertigkeit

121 out of 390 placentas of mostly pathological deliveries and preganancies were cases of chorioamnionitis. Histological studies have been performed under topographical respects. Several localisations (dynamic phases) of ascending infection of the secundinae are being described and their clinical relevance is being assessed. 1)"Nomal secundinae" or "physiological leucocytosis at ruptured chorionic membranes": there are but a few cases (3 to 5%) of amniotic infection syndroms or morphological signs of an aspiration of infected amniotic fluid and fetal sepsis. 2) "Isolated leucocytosis of the vessels of the umbilical cord and the chorionic plate": it is mostly caused by a fetal hypoxia; relatively seldom it is the result of an infection (about 10%). 3) "Partial phlegmon of the secundinae" (phlegmon of the chorionic membrane with spreading to the periphery of the chorionic plate): about 30% amniotic infection syndrom or infected amniotic fluid (and fetal sepsis respectively. 4) "Subtotal phlegmon of the secundinae" (phlegmon of the chorionic membrane and the chorionic plate in part, spreading to the umbilical cord): about 50% amniotic infection syndrom or infected amniotic fluid (and fetal sepsis) respectively. 5) "Total phlegmon of the secundinae" : in the majority of cases (about 65%) signs of infection damage on mother and/or fetus are visible.

[Automatic tocography using the Cardiff infusion system under cardiotocographic control with the fetal monitor BMT 504]. / Automatische Wehenmittelgabe durch das Cardiff-Infusionssystem unter kardiotokographischer Kontrolle mit dem Fetalmonitor BMT 504

Clinical results of the induction of labour by means of the Cardiff-equipment. The fetal monitor BMT-504 (VEB Kombinat Mebgerätewerk Zwönitz) has been used as cardiotocographic control unit. Labour has been induced with oxytocin (n = 38) or methyloxytocin (n = 30). 50 deliveries, which where induced by means of intravenous oxytocin infusion enables to be comparate the results. Using the automatic infusion the average induction-delivery interval was 4 hours 14 minutes, the average dosage of tocergic drugs was 2 IW oxytocin or 20 mug methyloxytocin. Using oxytocin for labour induction we found an increase in obstetric operative frequency caused by fetal distress. There where an increase in basal tone of uterine activity in this patients. Therefore we recommend methyloxytocin for the labour induction of high risk pregnancies. The safety factors, which are incorporated in the Cardiff-equipment have many advantages in obstetrical routine work, to determine fetal distress at an earlier stage. The results presented show that with this automatic infusion system labour can induced with even greater efficiency and safety. The equipment is very useful in accordance to the continuous increasing number of planned deliveries.

[Histological changes in the placenta following tokolysis therapy (author's transl)]. / Histologische Veränderungen der Plazenta bei der Tokolysetherapie.

In 138 tokolytically treated cases of imminent abortion or premature birth the secundines were examined histologically and compared with 390 cases of pathological gravidities or births without tokolysis therapy. The frequency of occurrence of morphologically manifested circulatory disturbances following tokolysis therapy was equal to that in the untreated cases, the rate of ascendent infections was only slightly increased. In tokolytically treated placentas with the histological pattern of "dissociated disturbed maturation" and "Maturitias retarda" are prevailing. Thus in most cases sufficient supply of the fetus is possible and the critical phase of uteroplacental insufficiency with the danger of abortion or premature birth may be overcome. There were no hints at direct influences of tokolysis on placental morphology.

[Cerebral hemorrhage and periventricular leucomalacia in preterm neonates after intravenous tocolysis with fenoterol: results of postnatal ultrasound examination]. / Hirnblutungen und periventrikuläre Leukomalazie bei Frühgeborenen nach intravenöser Tokolyse mit Fenoterol: postnatale neurosonographische Untersuchungsergebnisse.

BACKGROUND: This study tested whether tocolysis with beta-adrenergic agonists (Fenoterol) had an effect on the frequency of cerebral lesions in preterm neonates. PATIENTS AND METHODS: Head ultrasound scans of preterm neonates who were born after long-term (> 24 h) tocolysis were compared with scans of preterm neonates without preceding tocolysis. The gestational and neonatal data were analyzed retrospectively. RESULTS: Preterm neonates after (n = 102) and without (n = 101) tocolysis were subdivided into three groups according to their gestational age (23 - 28 wk: n = 41; 29 - 33 wk: n = 66; 34 - 36 wk: n = 96). Within these groups, no significant differences were found with respect to birth weight, rate of cesarean section, or pulmonary morbidity. Preterm babies < 28 weeks of gestation from the control group had lower Apgar scores (after 1 and 5 minutes, respectively) and arterial umbilical cord pH values. Intravenous tocolysis did not lead to an increase in pseudocystic periventricular leucomalacia (PVL) or intracerebral hemorrhage (ICH) in any of the subgroups studies. However, cerebral lesions were found in preterm neonates after tocolysis who exhibited signs of infection (29 - 33 wk: PVL n = 2; 23 - 28 wk: ICH n = 1) and in preterm neonates without tocolysis who had undergone fetal hypoxia or abruptio placentae (29 - 33 wk: PVL n = 4; antenatal terminal vein bleeding n = 1; 23 - 28 wk: PVL n = 2; terminal vein bleeding n = 5; posterior cerebral artery bleeding n = 1). When compared to preterm neonates of 34 - 36 weeks of gestation, the risk of infection was increased 4-fold in neonates of 29 - 33 weeks of gestation (odds ratio 5.43, 1.10 - 26.83) and 10-fold in neonates of 23 - 28 weeks of gestation (odds ratio 20.50, 3.65 - 115.03). Chorioamnionitis also was a more common finding in preterm neonates < 28 weeks of gestation. CONCLUSION: Preterm neonates who were born after intravenous long-term (> 24 h) tocolysis with Fenoterol do not exhibit an increase in periventricular leucomalacia or intracranial hemorrhage. The occurrence of cerebral lesions in these patients merely depends on their degree of immaturity and on the presence or absence of perinatal infection. In preterm neonates without tocolysis, brain lesions are mainly associated with hypoxic events.

[Neonatal percentile values for East Germany--1985. 3. On the correlation of body height and weight of the mother in a two-dimensional classification of newborn infants according to birth weight and gestational age]. / Neugeborenen-Perzentilwerte für die DDR--1985. 3. Mitteilung: Zur Berücksichtigung von Körperlänge und -gewicht der Mutter bei der zweidimensionalen Klassifikation der Neugeborenen nach Geburtsgewicht und Schwangerschaftsdauer.

There were published percentiles of birthweight in relation to bodyheight of the mother as well as in relation to bodyweight and parity, bodyheight and bodyweight of the mother for term range 37th to 41st week of pregnancy. They were calculated through median quantities. The dates again derive from the investigation of 51,570 single births in elected regions of GDR in 1984 and 1985. The length of pregnancy was stated in full weeks. It was determined on the base of three parameters (by Naegele method, by sonography, and by neonatal maturity judgment). Selected percentiles of birthweight regarding the above influencing factors, distributed into sex, were summarized for use in practice.

[Experiences with a mobile monitoring system for fetal and neonatal cardiotachometry]. / Erfahrungen mit einem mobilen Monitorsystem zur fetalen und neonatalen Kardiotachometrie.

A monitoring system for fetal and neonatal cardiotachometry which set up in own instrumentation at the Department of obstetrics of the Regional Hospital of Rostock. With aid of a wireless telemetric system is it possible to estimate the fetal condition before and during of caesarean section as well as at transfer of high risk neonates.

[Comparative studies of the value of impulse-reception methods of prenatal cardiotocography]. / Vergleichende Untersuchungen zur Frage der Wertigkeit der Impulsaufnahmeverfahren der vorgeburtlichen Kardiotokographie

102 pregnant womens have been controlled by means of the various three methods of the antenatal CTG (phonocardiography, ultrasonography and indirect fetal ECG) between the 22th to 41th week. The registered time for each method was ten minutes. Between the 27th to 33th week of the pregnancy the ultrasonography gives the best results. The phonocardiography gives after the 32th week, especially after the 37th week, increasing technical unobjectionable tachograms. There was a good tachografic performans between the 22th to 27th week and after the 35th week by means of indirect fetal ECG. Between the 27th and 34th week this method refuses. The interpretation of indirect fetal ECG or phonocardiotocography, if they are possible, shows clear advantages in antenatal diagnostic of fetal condition.

[Cardiotokography, obstetrical decission, and perinatological results]. / Kardiotokographie, geburtsmedizinische Entscheidung und perinatologische Ergebnisse

For clinical use we divide the cardiotocographic parameters in 4 groups with the following percentages for antenatal or intranatal period. Normal criterias (antenatal: 80%; intranatal: 40%) Warn symptoms (antenatal: 5%; intranatal: 10%) Umbilico-placental circulatory disturbances (antenatal: 6%; intranatal: 45%) Signs of hypoxia (antenatal: 9%; intranatal: 5%). Variable decelerations are typically for disturbances in the umbilico-placental circulation. The clinical reasons are as well cord compressions as uterine hyperactivity or supine hypotensive syndrom. A prospective management of labor is possible only by means of CTG. The fetal death during labor is avoidable. The number of fetal micro-blood-samplings was reduced (in our hospital 10%) and the feto-maternal relationship was included. The operative frequency is the result of objective obstetrical decisions. We have before and after introduction of fetal monitoring a constant frequency of caesarean sectio of about 3%. A rise in operative frequency simultaneously with the beginning of fetal monitoring is due by a high operative activity in cases of umbilico-placental circulatory disturbances. The rate of neurological findings in newborn infants can be decreased. This result is not valid in preterm or small for date infants.

[Injury hazards in deliveries using the Shute forceps (analysis of 1016 forceps deliveries)]. / Zur Frage des Schädigungsrisikos bei Entbindungen durch Shute-Forceps. (Analyse von 1016 Forcepsentbindungen).

Report about 1016 deliveries by means of the parallel forceps (W. B. Shute). This group contains pathologic-anatomical results of 30 stillbirthes or died newborns. Accordingly to the classification in subarachnoidal, subependymal or subdural hämorrhage there are only in two cases signs of obstetrical brain damage. The hypoxia is the most important reason of intracraniale haemorrhage. In order to an objektive indication, without progredient signs of fetal hypoxia the extraction by means of parallel forceps is not dangerous. We have used the instrument for extraction as well term as preterm infants with good results.

[Determination of reference ranges and effect of maternal and fetal factors on insulin and C-peptide level in umbilical cord blood]. / Die Ermittlung von Referenzbereichen und der Einfluss von mütterlichen und kindlichen Faktoren auf Insulin- und C-Peptidspiegel im Nabelschnurblut.

OBJECTIVE: The risks of pregnancy caused by maternal diabetes are well known. Patients with unrecognized gestational diabetes mellitus (GDM) represent a special problem. The aim of our study was to find out, whether the determination of insulin and C-peptide in cord blood serum offers a valuable tool for retrospective analysis. MATERIAL AND METHODS: In 600 paired serum samples from maternal venous blood and neonatal cord blood insulin and C-peptide were determined radioimmunologically. A reference group consisting of 338 mothers and their newborns was established by exclusion of all patients with known pregnancy complications. RESULTS: Positive correlations could be identified between fetal insulin and fetal C-peptide, as well as correlations of these parameters with birth weight and body length, with maternal values of insulin, C-peptide, body-mass index, weight, and weight gain during pregnancy respectively. Increased levels of cord serum insulin were found in complicated pregnancies as well as in patients with previous pregnancy losses, preterm deliveries or stillbirths. CONCLUSIONS: Cord serum insulin and C-peptide were found to be useful parameters for immediate postnatal identification of impaired glucose tolerance during the course of pregnancy.

[Neonatal ultrasonographic cerebral findings: association with risk factor for cerebral palsy]. / Stellenwert der postnatalen Neurosonographie für die frühzeitige Erfassung und ursächliche Klärung der Zerebralparese.

BACKGROUND: Is it possible to identify patients with cerebral palsy (CP) with postnatal ultrasound scan? Which risk factors are associated with an increased risk of CP?. PATIENTS AND METHODS: The data of 37 children with CP, who were sonographically investigated during the first 24 hours of life were analyzed retrospectively. The data of 21 preterm infants with gestational age /= 33 wk and in 5/8 of the mature babies. The mature babies had prenatal brain atrophy or hypoxic-ischaemic cerebral lesions. Cytomegaly and encephalitis were detected in two babies. Immature babies >/= 33 wk showed prenatal porencephaly or encephalomalacia after asphyxia. Premature babies