[Effect of high performance sports on female menstrual cycle exemplified by windsurfing]

Questionnaires were sent to all female members (n = 60) of the Austrian Funboard Association (funboard = the most athletic windsurfing class). They included questions about the menstrual cycle, physical capacity, libido and performance dependent on the particular cycle phase. There was no significant libido or capacity peak, neither for the windsurfers nor for a normal collective (n = 100); on the other hand there was an evident low during menstruation. A mean length of the menstrual cycle of 26.5 +/- 2.8 days and a bleeding time of 4.4 +/- 1.2 days were found, while metrorrhaghia and dysmenorrhea were less frequent than in the normal collective. One reason for these findings could be that physical activity reduces dysmenorrhea.

[Contraception in Austria]

952 sexual active women between 15 and 44 years were investigated for their contraceptive behaviour. In 42% the pill was the first choice followed by the condom in 16%. 18% of all sexual active women in this age group did not use any contraceptives. Therefore the rate of unplanned pregnancies was very high: 34% reported about such unplanned pregnancies in their history. The main sources for informations in contraception are the gynecologist and the partner, but not the parents or the newspapers. Nearly half of all women did not know how the pill really works and quite a lot has still the opinion that there are really harmful side effects of oral contraceptives.

[The course of atrial natriuretic peptide, aldosterone and antidiuretic hormone in normal pregnancy]

Atrial natriuretic peptide (ANP), consisting of 28 aminoacids, is a recently discovered cardiac hormone involved in blood-volume homeostasis. Pregnancy is associated with an increase in blood volume expansion, therefore an increase in ANP-concentration would have been expected. To test this hypothesis ANP, Aldosterone and Vasopressin, concentrations of 229 women with normal pregnancies at different gestational ages were measured and compared with values found in a non-pregnant control group of 24 women. Mean plasma ANP was increased during pregnancy, but significant differences were noted only after 36 weeks of gestation. Also plasma aldosterone increased significantly during pregnancy, whilst vasopressin levels showed no significant change compared to the non-pregnant group.

[Incidence of hyperandrogenemia]

Within two years 341 amenorrheic patients treated in our endocrinological outpatient department were listed up retrospectively in WHO-classification groups. In 30 patients a primary amenorrhea and in 311 patients a secondary amenorrhea could be registered. In 28.3% a hypothalamic pituitary disorder must be diagnosed, in 5.1% a hypergonadotropic profile was observed. Uterine amenorrhea was seen in 0.6%, a hyperprolactinemia in 6.1%. The hyperandrogenemia with an incidence of 42.1% is remarkable and should be included in the WHO-classification.

[Stimulation of prolactin secretion by vasoactive intestinal peptide]

Dopamine has already been recognized as an inhibiting factor of prolactin. On the other hand, the stimulators of prolactin are still judged diversely at the moment. In addition to hypothalamic TRH, serotonine as well as endogenous opiates and VIP are under discussion. The object of our studies was testing the function of VIP in directing prolactin secretion on three different groups of patients: 1. hyperprolactinaemic women of WHO-group VI; 2. patients who had undergone a TRH-test along with an endocrine check-up; 3. post partum in childbed. The determination was made from analyzing peripheral blood by radioimmunoassay. In 20 amenorrhoeic patients of WHO-group VI, their prolactin and VIP levels were determined between 8 and 10 a. m. Only 4 patients showed a VIP-concentration below 20 pg/ml (which represents the limit of detectability). The other 16 patients showed an increased concentration of VIP. In 15 cases there was an obvious correlation of VIP and prolactin concentrations according to the linear regression. In the course of a TRH-test to 20 and 40 minutes after initial blood examination prolactin and VIP were again determined. After 20 minutes all patients showed a threefold increase of the initial prolactin value. On the other hand, VIP increased in 3 cases only. Apart from all those patients who wanted to become pregnant, these three women--being postmenopausal--showed increased initial values already in the unstimulated condition. The third group of patients consisted of 26 women in childbed. Their prolactin and VIP were determined between the second and eight day post partum.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endocrine profile of patients with post-pill amenorrhea]

"Post-pill amenorrhea" is still a much-debated subject in gynecological endocrinology. The authors therefore studied the reproductive history and endocrinological parameters of 145 patients with the presumptive diagnosis of post-pill amenorrhea, seen in their department during the last two years; 166 cases of secondary amenorrhea served as a control group. The incidence of late menarche (20%), previous oligomenorrhea, and elevated androgen serum levels was high in both groups. There were no significant differences between the two collectives. These findings suggest that although oral contraceptives may have an unfavorable influence on the menstrual cycle, there is no causal relationship between such agents and the development of secondary amenorrhea. It seems that in many cases of presumptive post-pill amenorrhea the common condition of juvenile hyperandrogenemic ovarian insufficiency might be the underlying problem.

[Hepatitis B screening in pregnancy]

At the I. Department of Obstetrics and Gynecology, University of Vienna, between April 1, 1985 and September 30, maternity patients between 24 and 28 weeks of gestation had their blood tested for hepatitis B. Out of 167 patients screened for hepatitis B, three had a positive hepatitis B surface antigen test (1.8%), nineteen a positive anti-hepatitis BsAg test. Two patients were positive for anti-hepatitis BeAg (1.2%), one was positive for hepatitis-BeAg (0.6%). The presence of hepatitis BeAg conveys a higher infant attack rate. Yet even in the absence of the antigen and/or the presence of anti-hepatitis BeAg, infection may lead to a fatal outcome. Also, if the mother is a carrier, risk of acquiring the infection because of chronic exposure is present. Therefore the question and possible need for routine Hepatitis B-screening during pregnancy arises, not only in maternity patients at high risk for hepatitis B.

[Course of pregnancy of insulin-dependent diabetic patients 1978-1985 at the 1st Vienna University gynecologic clinic]

Perinatal mortality and morbidity in infants of diabetic mothers have declined continuously during the past decades, due to advances in prenatal care, obstetric management and intensive neonatal care. This retrospective study reports on complications during pregnancy and fetal outcome in those insulin-dependent-diabetic (IDDM) pregnancies admitted to our institution from 1978 to 1985. Age, weight, prepregnant weight and weight-gain of those patients are compared with normal uncomplicated pregnancies (of the same period). In the diabetic group we noticed a high incidence of abortion (30%) as well as a high frequency of previous stillbirths (19%). In the majority of cases delivery was achieved by the 38th week of gestation the mean birth weight and length being 3,144 g and 48.5 cm respectively. 22% of the cases were delivered by cesarean section. The diagnosis preeclampsia was made in 15 patients, in 4 cases we observed a placental insufficiency, 11 women presented with premature labor and there was one fetal death. 44 newborns (63.8%) had a birthweight between 2,500 g and 4,000 g, 15 infants were below 2,500 g (21.7%), 10 infants weighed more than 4,000 g (14.5%), 5 of them displayed cushingoid features. 3 cases were complicated by hypoglycemia, 3 infants were dystrophic at birth and there was one major congenital anomaly. The incidence of neonatal respiratory distress syndrome was extremely high, 12 milder cases could be managed without ventilation therapy, 4 severe cases had to be given full respiratory support.

[Simplified hamster ovum-sperm penetration test (HSPT) in routine sterility testing]

In 67 patients, in most of whom the spermiogram did not, a priori, furnish definitive proof of fertility, the hamster egg human sperm penetration test was performed as part of a screening programme for infertility therapy conducted from February 1984 to February 1985. Evaluation of the test was facilitated by identification of the decondensed spermatozoon head in the penetrated hamster egg with a simple fluorescein staining instead of the usual aceto-lacmoid staining. The penetration rate (= percentage proportion of the hamster ova liberated from the zona pellucida which are penetrated within 3 hours following incubation with 1 million motile spermatozoa) was evaluated statistically in comparison to the fertility criteria of the spermiogram (motility, density, pathoforms), in order to verify the existence of possible fertility disturbances due to inability to penetrate despite the motility of the spermatozoa. In 42 patients the diagnosis of infertility was confirmed by a penetration rate of less than 10%. In 17 patients fertility was conformed according to HSPT (penetration rate of over 20%), while in 7 patients fertility was in the lower normal range. In the light of the authors' findings fertility confirmed by the HSPT is a precondition of referral for extracorporeal insemination. In the light of the authors' findings intrauterine insemination appears advisable for women whose fertility is in the lower normal range according to HSPT.

[Significance and incidence of risk factors in pre- and dysmaturity]

Anamnestic and clinical data of 10 654 deliveries were related to premature and dysmature pregnancies. The aim of the study was to get a correlation between special data on the one hand and pre- and dysmaturity on the other hand. The risk of dysmaturity is the highest in gravidae with a gestosisscore of more than 4. The risk of prematurity is the highest in gravidae with bleedings during pregnancy. The most frequent symptom in prematurity was a high cervix-score. It occurred in the prematurity collective in 40.7%. In the dysmaturity collective occurred the abuse of nicotine in 32.9%. Some symptoms have a high prognostic value for a pathological pregnancy, but it was impossible to develop a high risk score following these data. An high specificity was connected with a low sensitivity and vice versa.

Maternal hyperventilation as a possible cause of fetal tachycardia sub partu. A clinical and experimental study

Examination of 28 agitated, hyperventilating patients with fetal tachycardia showed that the mothers were in a hyperventilation-related state of hypocapnia and alkalosis. The mean maternal pCO2 was 17.48 +/- 6.79 mm Hg, the pH 7.54 +/- 0.14, which caused a reflex spasm of the umbilical veins, fetal acidosis and fetal tachycardia. Additional experiments on sheep revealed a similar correlation between maternal hyperventilation, hypocapnia, respiratory alkalosis and fetal tachycardia while the flow volume of the uterus showed no change.

[Antepartum and intrapartum cardiotocographic changes in pregnant women with diabetes mellitus]

In 69 insulin-dependent diabetic patients antepartal as well as intrapartal CTG's were evaluated retrospectively according to Fischer and Hammacher scores, revealing a marked decrease or a lack of decelerations together with a limitation of the oscillation amplitudes in the antepartal CTG. These show a marked increase during the last weeks of pregnancy. Intrapartal decelerations similar to variable dips are far more frequent. The same alterations, though less marked, are in part also found in latent diabetics. Owing to the small number of patients, and to a lack of literature in this field, no definitive conclusion can be drawn yet. Thus, prospective studies will still have to be carried out on a larger scale.

[Amniotic fluid cytology and foetal lung maturity--a comparison with the dynamic surface tension measurement of the amniotic fluid for predicting foetal lung maturity]

79 samples of amniotic fluid in 69 pregnancies between 29-40 weeks of gestation were examined for foetal lung maturity (dynamic surface tension) and general maturity (Nile Blue cytological test). Both parameters were compared with the pulmonary maturity of the newborn post partum in 24 cases born within 72 hours after the last amniotic fluid examination. In 49 cases the Nile Blue cytological test showed mature values, in 24 cases immature - and in 6 cases borderline values. The dynamic surface tension measurement showed 55 mature, 19 immature and 5 borderline results. These findings show an earlier maturation of the foetal lung compared with the foetal sebaceous glands. Between 36 and 40 weeks of gestation we found a significant (p less than 0.01) correlation between the two methods. Between 32 and 35 weeks of gestation, the significance was less (p less than 0.05) and between 29 and 31 weeks of gestation no correlation could be found. The Nile Blue cytological test for lipid cells is easy to perform, requires less than 1 ml amniotic fluid and is not influenced by blood and meconium and shows no false positive results. Immature findings with the Nile Blue cytological test should be confirmed by other lung maturity tests, like LS-ratio or amniotic dynamic tension measurement. Therefore we can recommend this simple method for the screening of foetal lung maturity as well.

[Real time ultrasound in routine breast diagnosis]

Ultrasound examination of the breast is used in three indications: the premenstrual syndrome, the examination of cyst and the short-time control of high-risk patients. The differential main point is the diagnosis of cysts, which may save the patient from "blind" puncture. In this field, ultrasound is more competent than mammography; furthermore, the oedematous changes occurring before the onset of menstruation can be easily seen with sonography. For the early detection of cancer of the breast, ultrasound is merely additional but its diagnostic value is bound to rise with progressing development.

[Premature rupture of membranes, fetal outcome, management of delivery (author's transl)]

In 764 gravides from totally 1738 women, which delivered 1977 in our hospital, happened a premature rupture of membranes. 319 patients had a spontaneous (SPR), 454 an artificial premature rupture of membranes (APR). Comparing the number of complications, the perinatal situation and the maternal behaviour, so you will find a significant difference between SPR and APR. The fetal outcome of the children, born after APR was better then born after SPR. The same is valuable as for the operative management of delivery. The perinatal morbidity after APR was nearly equal to the situation after normal rupture of membranes. Therefore you can see, that the bad experiences are more valuable for the SPR.

[The influence of beta-mimetics on foetal pulmonary maturing (author's transl)]

Amniocentesis was carried out in 99 patients between the 31st to the 32nd gestational week in order to determine lung maturity. We subdivided the patients into 5 groups 11 women were treated with Hexoprenaline, 12 with Ritodrine, 26 with Dexamethason for acceleration of lung maturity, 23 with Dexamethason and beta-mimetics and 27 women were controls. A significant rise of surfactant factor measured by surface tension by means of the Wilhelmy-balance could be demonstrated in the two groups receiving glucocorticoids, whereas in the other groups the rise of surfactant factor corresponded with the usual increase due to age of gestation. But concerning the incidence and intensity of RDS and intensity, the best results were observed in the group with Dexamethason only. Increase of surfactant factor and incidence of RDS in groups with tocolytics and in the controls were similar, therefore we conclude, that beta-mimetics do not have an influence on lung maturity. A relatively high incidence of mild RDS-cases in the group of Dexamethason combined with tocolytics should be a warning to use both drugs routinely together.

[The cardiotocogram in a woman's emotional experience: aid to more pleasurable experience of delivery or technological bugbear? (author's transl)]

Immediately after delivery 80 women were asked about her impression of cardiotocography (CTG) during labor. 97% of the primigravidae (PGR) and 83% of the plurigravidae (PLG) believed, that every delivery should be observated by CTG. Only 3% of the PRG an 14% of PLG found it necessary only in complicated delivery. Unnecessary was the fetal heart rate observation found in 3% of the PLG, but not in one case of PRG. Very important for the psychological situation of women under birth is the information about the use of CTG. Our results show the great agreement of the patients about this perinatal observation method.