Pregnancy in a non-communicating rudimentary horn of a unicornuate uterus

BACKGROUND

The non-communicating rudimentary horn of a unicornuate uterus is the rare result of abnormal development of the Müllerian ducts during embryogenesis.  Case description: We report a rare condition of a pregnancy of eight weeks of gestation in a non-communicating rudimentary horn of a unicornuate uterus, which was diagnosed without specific symptoms and treated through laparoscopy.

CONCLUSION

Early diagnosis and treatment are essential to prevent the high maternal risk of life-threatening bleeding complications. HIPPOKRATIA 2019, 23(2): 92-94.

Abstract OT1-11-01: The BRandO BiO registry – A multicenter regional registry for patients with primary breast and ovarian cancer with longitudinal biobanking and evaluation of epidemiological, life style and quality of life factors

Background:

Further progress in the treatment of breast cancer will likely come from contributions of molecular biology and immunologic approaches. The search for druggable molecular aberrations may enable treatment based on the molecular profile. A better identification of patients with a high risk of relapse facilitates the selection of these pts for clinical trials investigating early therapeutic molecular-based interventions.

Trial Design:

The BRandO BiO Registry is a multi-center regional registry to record clinical, epidemiological, and biological data from patients with newly diagnosed breast and ovarian cancer at the University of Ulm, Dept. of Gynecology and 19 affiliated network hospitals and practices in the Alb-Allgäu Bodensee region (outreach area of the Comprehensive Cancer Center Ulm). Longitudinal biobanking is included with collection of paraffin-embedded samples of the primary tumor as well as blood samples at first diagnosis, after 6 and 12 months and at first relapse to isolate and investigate cell-free and germline DNA. Epidemiological, life style and quality of life (QOL) questionnaires are collected at first diagnosis, after 12, 36 and 60 months. The follow up is planned for 10 years.

Eligibility criteria:

Patients with primary newly diagnosed untreated breast or ovarian cancer of ≥ 18 years are eligible; primary metastatic untreated disease is allowed. Exclusion criteria comprise severe neurological or psychiatric disorders interfering with the ability to give an informed consent, no consent for registration, storage and processing of the individual disease characteristics and bio samples, and any malignant tumor in the last 3 years (except in situ disease).

Specific aims:

To register the majority of patients with newly diagnosed breast or ovarian cancer in all BRandO-BiO participating centers of a well-defined geographical area. To assess clinical characteristics and outcome data (event-free survival, overall survival) of these patients. To evaluate the primary tumor of all patients for mutational (druggable) aberrations. Further to assess cell-free DNA in the serial blood samples at baseline, 6 and 12 months and correlate these results with clinical outcome data as well as tumor and patient characteristics to look for early markers predicting relapse. To perform a longitudinal assessment of the patients' sociodemographic factors, comorbidities, lifestyle and QOL factors by analyzing serial questionnaires collected at recruitment and at 12, 36 and 60 months.

Present accrual and target accrual:

The BRandO BiO Registry started January 2016 in the Dept. of Gynecology, University of Ulm and February 2017 at the network hospitals and practices. Until June 2018, 1180 patients with primary breast or ovarian cancer have been enrolled. The current adherence to serial blood testing and serial questionnaires is good with a return rate of 90%. A sample size of 3000 patients is planned.

Contact information:

Jens Huober, University of Ulm, Dept of Gynecology, Breast Center, jens.huober@uniklinik-ulm.de

Amelie de Gregorio, University of Ulm, Dept of Gynecology, Breast Center, Amelie.de Gregorio@uniklinik-ulm.de

Citation Format: Huober J, Nagel G, Rempen A, Schlicht E, Flock F, Fritz S, Thiel F, Wiesmüller L, Felderbaum R, Heilmann V, Bekes I, Fink V, Albrecht S, De Gregorio N, Tzschaschel M, Ernst K, Wolf C, Kuhn P, Friedl T, Janni W, De Gregorio A. The BRandO BiO registry – A multicenter regional registry for patients with primary breast and ovarian cancer with longitudinal biobanking and evaluation of epidemiological, life style and quality of life factors [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-11-01.

Quality Requirements for the early Fetal Ultrasound Assessment at 11-13+6 Weeks of Gestation (DEGUM Levels II and III)

The early fetal ultrasound assessment at 11 - 13(+6) weeks of gestation remains the cornerstone of care despite the progress in diagnosing fetal chromosomal defects using cell-free fetal DNA (cffDNA) from the maternal circulation. The measurement of nuchal translucency (NT) allows the risk calculation for the fetal trisomies 21, 18 and 13 but also gives information on those fetal chromosomal defects which are at present unable to be detected using cffDNA. Nuchal translucency is the only auditable parameter at 11 - 13(+6) weeks and gives thus information on the quality of the first trimester anomaly scan. In addition it gives indirect information on the risks for fetal defects and for cardiac anomalies. Also the chances for a healthy live baby can be estimated. As experience with first trimester anomaly scanning increases, and the resolution of the ultrasound equipment has increased substantially, more and more details of the fetal anatomy become accessible at the first trimester scan. Therefore fetal anatomical defects and complex anomalies have become amenable to examination in the first trimester. This guideline describes compulsory and optional parameters for investigation at the first trimester scan and outlines a structured method of examining a first trimester fetus at 11 - 13(+6) weeks of gestation.

Cranial and cerebral signs in the diagnosis of spina bifida between 18 and 22 weeks of gestation: a German multicentre study

OBJECTIVE

The aim of this article is to study secondary cranial signs in fetuses with spina bifida in a precisely defined screening period between 18 + 0 and 22 + 0 weeks of gestation.

METHOD

On the basis of retrospective analysis of 627 fetuses with spina bifida, the value of indirect cranial and cerebral markers was assessed by well-trained ultrasonographers in 13 different prenatal centres in accordance with the ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) guidelines on fetal neurosonography.

RESULTS

Open spina bifida was diagnosed in 98.9% of cases whereas 1.1% was closed spina bifida. Associated chromosomal abnormalities were found in 6.2%. The banana and lemon signs were evident in 97.1% and 88.6% of cases. Obliteration of the cisterna magna was seen in 96.7%. Cerebellar diameter, head circumference and biparietal diameter were below the 5th percentile in chromosomally normal fetuses in 72.5%, 69.7% and 52%, respectively. The width of the posterior horn of the lateral ventricle was above the 95th percentile in 57.7%. The secondary cranial and cerebral signs were dependent on fetal chromosome status and width of the posterior horn. Biparietal diameter was also dependent on the chromosome status with statistical significance p = 0.0068. Pregnancy was terminated in 89.6% of cases.

CONCLUSION

In standard measuring planes, lemon sign, banana sign and an inability to image the cistern magna are very reliable indirect ultrasound markers of spina bifida. © 2014 John Wiley & Sons, Ltd.

Does Non-Placement of a Drain in Breast Surgery Increase the Rate of Complications and Revisions?

Purpose: Although surgical therapy for breast cancer has become less radical, intrasurgical placement of drains and the use of compression bandages is still standard practice. However, evidence for the clinical benefit of wound drains is controversial, and use of drains is associated with increased pain and longer hospital stays. This raises the question whether, given the latest surgical techniques, wound drainage is still medically necessary. Material and Method: A retrospective analysis was done of patients with breast cancer treated surgically between January 2009 and April 2012 in the Breast Centre Hohenlohe (n = 573). Complication rates and revision following surgery with and without placement of wound drains were compared for patients who had breast-conserving surgery (n = 425) and patients who underwent mastectomy (n = 148). Results: The baseline characteristics (age, number of resected lymph nodes, numbers of patients who had sentinel lymph node resection, tumour characteristics, receptor status and affected side) were comparable for the investigated patient groups. The overall rate of complications was 4 %. There was no significant difference with regard to complication rates after surgery with and without placement of wound drains between the group of patients with breast-conserving surgery and the group of patients with mastectomy (p = 0.68 and p = 0.54, respectively). Conclusion: Our data indicate that non-placement of a wound drain does not influence complication or revision rates after breast-conserving surgery or mastectomy.

Feto-amniotic shunting -- experience of six centres

AIM

Foeto-amniotic shunting is an ultrasound-guided, therapeutic intervention for drainage of persistent intracavital fluid retention in severely affected foetuses with a high risk of mortality. In order to weigh up the comparatively high risk of intervention against the possible benefit, we evaluated the value of different indications, the complication rate and the time span of drains in situ.

PATIENTS AND METHODS

We made a survey of all level III ultrasound centres of German-speaking countries from 1993 to 2001. Six level III centres returned the questionnaire: forty-seven foeto-amniotic shunting procedures were performed in 30 foetuses [megacystis in 18 foetuses (three of these with urinary ascites), hydrothorax in eight foetuses, hydronephrosis in two foetuses, cystic adenomatoid malformation of the lung in one foetus, ovarian cyst in one foetus].

RESULTS

The median gestational age at time of shunting was 23.5 (range 16 - 33) weeks, at time of delivery 35 (range 23 - 41) weeks. The median time span of drains in situ was 19 (range 0 - 170) days. Altogether 18 of 30 foetuses (60 %) had a benefit of foeto-amniotic shunting.

CONCLUSION

The best possible selection of pregnancies which might profit from foeto-amniotic shunting is required. The decisive criteria are the underlying defect as well as the severity and progression of the disorder.

Prenatal diagnosis in a family with severe type I plasminogen deficiency, ligneous conjunctivitis and congenital hydrocephalus

Severe type I plasminogen deficiency may cause severe ligneous conjunctivitis, a rare and unusual form of chronic pseudo-membranous conjunctivitis that usually starts in early infancy, but also pseudo-membranous lesions of other mucous membranes in the mouth, nasopharynx, trachea and female genital tract, and in rare cases congenital occlusive hydrocephalus. The index patient, the daughter of a consanguineous marriage, had suffered from severe ligneous conjunctivitis and had died from decompensated congenital hydrocephalus despite numerous shunt revisions. She was found to be homozygous for a non-sense mutation in exon 15 of the plasminogen gene (Trp597->Stop). In her next pregnancy, the mother asked for prenatal diagnosis of the plasminogen deficiency. Chorionic villus biopsy was performed at 12 weeks of gestation. DNA analysis of the plasminogen gene by PCR and single-strand conformation polymorphism (SSCP) revealed that the fetus exhibited an identical heterozygous band pattern as observed in the healthy mother. Therefore, the fetus was heterozygous for the Trp597->Stop mutation in plasminogen exon 15. In addition, the fetus was found to be male by cytogenetic analysis and by multiplex PCR analysis using two polymorphic X-chromosomal markers (DXS424, HPRT). These findings excluded the possibility of contamination by maternal DNA. It was concluded that the fetus was not at risk for ligneous conjunctivitis and its associated complications. After the birth of a healthy boy, plasminogen functional activity was shown to be 38 per cent. DNA analysis confirmed prenatal molecular genetic results.

Successful abdominal delivery in a woman with sonographic diagnosis of diffuse cavernous hemangioma of the uterus

Diffuse hemangioma of the pregnant uterus is a serious lesion. We report the first case of a successful cesarean section at term following expectant management of pregnancy in a patient with presumed isolated diffuse cavernous hemangioma of the uterus and protein S deficiency. The sonographic diagnosis and clinical management of this condition is described. The presented successful pregnancy underlines that, under close surveillance, consideration should be given to a conservative approach to this sonographic finding during pregnancy, as even an abdominal delivery does not imply hysterectomy inevitably.

The shape of the endometrium evaluated with three-dimensional ultrasound: an additional predictor of extrauterine pregnancy

The objective of this prospective follow-up study was to evaluate the potential utility of three-dimensional (3D) ultrasound to differentiate intrauterine from extrauterine gestations. Fifty-four pregnancies with a gestational age <10 weeks and with an intrauterine gestational sac <5 mm in diameter formed the study group. The configuration of the endometrium in the frontal plane of the uterus was correlated to eventual pregnancy outcome. After exclusion of three patients with a poor 3D-image quality the endometrial shape was asymmetrical with regard to the median longitudinal axis of the uterus in 84% of intrauterine pregnancies, whereas the endometrium showed a symmetry in the frontal plane in 90% of extrauterine pregnancies (P = 0.0000001). Intrauterine fluid accumulation may distort the uterine cavity, thus being responsible for false-positive as well as false-negative results. The evaluation of the endometrial shape in the frontal plane appears to be a useful additional means to distinguish intrauterine from extrauterine pregnancies, especially when a gestational sac is not clearly demonstrated with conventional ultrasound.

Fetal lung volumetry by three-dimensional ultrasound

The aim of this study was to establish a method for determination of fetal lung volume by three-dimensional ultrasound. The thoraces of a total of 113 fetuses (singleton pregnancies, 11-41 weeks of gestation without any signs of malformation or oligohydramnios) were examined by three-dimensional ultrasound. Volumetric evaluation of each lung was performed in each of three perpendicular planes (six measurements in total). There were significant differences in all three measurements between the left and right lungs. Especially in the second and third trimesters, measurement of the frontal and the sagittal planes was sometimes prevented by poor imaging conditions. The scan volume was always too small for fetuses above 34 weeks. With these problems considered, nomograms of fetal lung volume for the left and the right lung were calculated. Lung volumes in the present study showed good correlation with published autopsy findings. Three-dimensional ultrasonographic volumetry is a useful method for determining fetal lung volume and may have a role to play in the detection of pulmonary hypoplasia.

Longitudinal observations of human chorionic gonadotropin in serum following surgery for ectopic pregnancy

In order to study the disappearance of human chorionic gonadotropin (hCG) in serum after surgery for ectopic pregnancy and to facilitate the postoperative follow-up of hCG decline serial hCG serum concentrations were analysed in 189 women with an uneventful postoperative course and in 4 patients with persistent trophoblast. A double logarithmic transformation of hCG concentrations resulted in a linear relationship of the individual hormonal decline versus the postoperative time (r2 = 0.990). The decrease of hCG levels was independent from the type of surgery or gestational age. The calculated half life of hCG steadily increased with rising time interval after surgery. A nomogram of hCG decrease was constructed using the regression lines of the individual sequential hormone concentrations. The nomogram enabled the detection of active residual trophoblast within one week after surgery before serious complications occur. Our scheme requires only three hCG tests to be performed before surgery, and on day 2 and 7.

Transvaginal ultrasonography of pelvic masses: evaluation of B-mode technique and Doppler ultrasonography

OBJECTIVE

The purpose of this study was to evaluate pelvic masses by B-mode and Doppler ultrasonography for identification of ovarian malignancies.

STUDY DESIGN

A previously described scoring system for pelvic masses was applied in 310 women, and the lesions were classified into four groups according to the ultrasonographic structure. Pulsatility index values of vessels within the tumor and the contralateral ovary and of both uterine arteries were determined.

RESULTS

A total of 259 masses were benign and 51 were malignant. The scoring system and classification into morphologic groups revealed similar sensitivity, specificity, and positive and negative predictive values. Intratumoral and opposite ovarian blood flow and ipsilateral and contralateral uterine blood flow did not differ in benign and malignant masses except in cases of benign lesions in postmenopausal women. In malignant lesions a lower pulsatility index (0.94 +/- 0.4) was measured than in benign lesions (1.06 +/- 0.4, p < 0.05), although a remarkable overlap was found.

CONCLUSION

The results suggest that further refinement of assessment of pelvic masses with Doppler ultrasonography is needed.

[Premature termination of pregnancy in the 2nd and 3rd trimester. Serial administration of 1 mg gemeprost vaginal suppositories versus intravenous sulproston]

Comparison of 1 mg Gemeprost-Vaginal Suppositories Serial Application versus Sulproston i.v.: Three different regimens for the termination of second and third trimester pregnancies by the use of prostaglandins (PG) were compared in a retrospective analysis. In group A (n = 16) terminations were attempted by continuous i.v. Infusion of Sulproston 9 hours after administration of a 3 mg-PGE2-vaginal tablet overnight. In group B (n = 22), i.v. Sulproston was started 2 hours after priming with 1 mg Gemeprost-vaginal suppositories. The outcome of these two regimens was compared with that of repeated administration of 1 mg Gemeprost-vaginal suppositories at 6-hourly intervals (group C, n = 25). In each group. If uterine contractions failed to appear after one day, the treatment was discontinued for a sleep rest over night and then resumed. Genetic disorders or fetal malformations were the most frequent reasons for termination. Patients with intrauterine fetal demise, rupture of the membranes, preterm labour or a ripe cervix (Bishop Score > 3) were excluded. Median time intervals from induction to abortion were 33 hours in group A and 23 hours in each Group B and C. The rate of fetal expulsions within 12, 24 and 36 hours in groups B and C were similar. Women of parity > or = 1 showed significantly shorter intervals than nulliparae in groups A and C. Only one woman (in group A) failed to expel after induction, in four other cases (in groups A and B) complications (local thrombophlebitis, bronchospasm) were noted. The serial administration of 1 mg Gemeprost-vaginal suppositories at 5-hourly intervals showed fewer side effects and seems to be as efficient as sulproston i.v. after cervical ripening.

Experience with laparoscopic assistance in vaginal hysterectomy

OBJECTIVE

To determine safety and usefulness of laparoscopy intended to convert an abdominal into a vaginal hysterectomy.

STUDY DESIGN

Forty-seven consecutive hysterectomies are retrospectively analyzed in which laparoscopy was used to accomplish a vaginal instead of an abdominal procedure which would have been performed without endoscopic surgery.

RESULTS

In four patients the operation had to be converted to laparotomy due to difficult access (n = 3) or heavy bleeding (n = 1). Operation time declined during the study period, thus highlighting the importance of experience with laparoscopic technics. Major complications such as injuries of adjacent organs or delayed haemorrhage requiring a second intervention were not encountered.

CONCLUSIONS

Laparoscopy in hysterectomy seems to be a valuable method to avoid laparotomy. In the future, guidelines to determine the route of surgery are to be established which include those conditions in which laparoscopy in addition to vaginal hysterectomy implies a benefit for the patient.

[Meckel-Gruber syndrome]

The lethal Meckel-Gruber-Syndrome can be diagnosed prenatally during ultrasound screening between 16 and 20 weeks of pregnancy. Two case reports of Meckel-Gruber-Syndrome are given, which demonstrate the importance of a reliable ultrasound examination. The results supply the basis for an adequate counseling of the patient with the option of pregnancy termination in case of the lethal syndrome.

[Color Doppler sonography of peripheral and cerebral fetal vessels in comparison as prognostic criterion in predicting intrauterine distress]

Doppler sonography of the fetal descending aorta, renal artery, middle cerebral artery and umbilical artery in a population of 74 fetuses with a abdominal circumference below the fifth percentile of the reference limits were done. All fetuses were free from structural and chromosomal abnormalities. The pulsatility- and the resistance indices as well as the ratios between these indices from peripheral and cerebral vessels were calculated and correlated to the fetal distress. The measurement of the pulsatility index of the middle cerebral artery provided the best results in predicting the development of fetal distress. Better results were achieved by the use of ratios of pulsatility-indices of various vessels than by the examination of the vessels alone. Our results suggest the usefulness of the examination of the middle cerebral artery and their ratios compared to the renal artery.

Color flow mapping of the middle cerebral artery in 23 hydrocephalic fetuses

Color flow mapping was performed on 23 fetuses with hydrocephaly. The measurements on the middle cerebral artery posed no problem. We found end-diastolic frequencies in all cases. The pulsatility-indices were raised in only 4 cases. Color Doppler sonography gave no extra information about diagnosis or prognosis.

[Introduction of laparoscopic surgery in extrauterine pregnancy]

Top evaluate laparoscopic surgery in extrauterine pregnancy, the period from 1990-1993 was analysed, and the first 44 operations including only one laparoscopy (2%), were compared with the following 70 operations with 60 laparoscopic procedures (86%). Except for a younger mean gestational age in the second interval, both groups showed no differences in the history and preoperative findings. During the second period, however, the intraoperative blood loss was smaller and the rate of conservative procedures was higher. Operation times and complication rates were not different. But in laparoscopy, duration of the procedure significantly decreased with advancing experience. Postoperative hospital stay was half as long in the second group. Subsequent procedures were necessary in 3% of 61 laparoscopies due to adhesion ileus and persistent trophoblast, respectively. Persistent pregnancy was seen in 2% of 42 conservative laparoscopies. Laparotomy due to failed laparoscopy was done in 2 of 63 patients (3%) with bleeding complications. Laparoscopy in the hand of the experienced surgeon is a suitable method to treat ectopic pregnancy and allows also organ preservation.

[Transvaginal ultrasound of the endometrium in postmenopause]

We checked on the validation of vaginal ultrasound parameters to detect endometrial neoplasma by apposing the histological and sonographical data of 232 patients with postmenopausal bleeding. An endometrial height of more than 4 mm proved a good preliminary fact to screen for pathological findings (sensitivity: 94.9% for endometrial cancer and 84% for benign and malignant neoplastic lesions). The low specificity (53%) of this threshold value can be increased by including morphological parameters like inhomogeneous structure, irregular demarcation and lack of an endometrial middle echo. When screening postmenopausal women by transvaginal sonography these must be taken into account particularly with younger patients whose menopause occurred only recently. Until the age of sixty, respectively until 5 years after menopause, 50 to 70% endometrial proliferation must be taken into account causing an endometrial height of more than 4 mm in ultrasound. Therefore, before starting invasive diagnostics, one should confirm the postmenopausal state of asymptomatic patients without additional sonographical criteria and exclude other reasons for endometrial proliferation.

[Induced labor with prostaglandins: 0.5 mg PGE2 intracervical gel versus 3 mg PGE2 vaginal tablet]

For the induction of labour prostaglandin (PG) E2 has been recommended either as intracervical gel (0.5 mg) or as vaginal tablet (3 mg) depending on the Bishop score of the cervix. A prospective trial was conducted in 79, mainly postterm, pregnancies (59 with a Bishop score < 5), in whom either PG-E2 tablet or gel was given randomly without respect to the cervical score. In addition, 51 inductions in primiparous women (44 with a Bishop score < 5) were analysed retrospectively. In pregnancies with a Bishop score < 5 the rate of successful inductions, duration of labour or incidence of neonatal acidosis was not different in both groups. Similar results were obtained in the prospective trial for inductions with a cervical score > 4. These data suggest the lack of superiority of the intracervical over the vaginal route of PG-E2 administration for the induction of labour.

-Chronic tubo-ovarian abscess with vaginal fistula after vaginal hysterectomy: combined laparoscopic-vaginal therapy-

A chronic tuboovarian abscess with vaginal fistula occurring after vaginal hysterectomy was removed laparoscopically. The fistula was closed by a combined laparoscopic-vaginal procedure. A complete cure was achieved without complications.

[Laparoscopic removal of dermoid cysts]

Benign dermoid cysts between 1.5 and 6 cm in diameter were laparoscopically removed in 9 premenopausal women. Cystectomy was performed in eight patients, and unilateral oophorectomy in one. Surgical and postoperative complications were not observed. Chemical peritonitis due to the dermoid contents can be avoided, provided, careful lavage of the peritoneal cavity is performed.

[Normal values of color Doppler ultrasound in pregnancy]

In addition to the flowmetrie of aorta fetalis and a. umbilicalis, color flow mapping enables the examination of the renal and middle cerebral arteries in the assessment of the fetal blood circulation. The resistance and pulsatility-indices of aorta fetalis, umbilical artery, renal artery and middle cerebral artery were calculated in a prospective examination of a normal study group of 123 pregnant women. Moreover, ratios were established from the pulsatility-indices of renal artery and aorta fetalis, renal artery and umbilical artery, middle cerebral artery and aorta fetalis, middle cerebral artery and umbilical artery. By the use of these ratios, we hope to detect more reliably changes in the fetal blood circulation.

[Pressure on the fetal head in vacuum extraction]

The pressure exerted on the foetal head was continuously measured with a specially designed instrument in 4 children delivered by vacuum extraction because of arrested delivery. The results were compared with the values obtained in spontaneous deliveries. Lower head pressure values were found in the vacuum group, with a head pressure to amniotic pressure ratio < 1 (normal > 1) before application of the cup. During extraction the head pressure exceeded the intraamniotic pressure. Normal progress of labour requires not only sufficient intrauterine pressure but also an adequate pressure transmission to the presenting part that must widen the birth canal. A prolonged course of labour may therefore be associated with increased pressure values due to elevated resistance of the birth canal as well as with decreased pressure values due to insufficient transmission of pressure. Hence, the load of the foetal head during uterine contraction cannot be determined from the duration of birth.

[Brain sparing autoregulation of fetal circulation in HELLP syndrome--demonstrated by Doppler ultrasound findings]

In a case report of severe placental insufficiency in the HELLP-Syndrome with diastolic reverse flow in aorta and umbilical artery, the changes of flow in the renal artery and middle cerebral artery were demonstrated. A preferential perfusion of fetal brain at the expense of fetal kidneys was shown during fetal hypoxia.

[Stress on the head of the fetus in spontaneous labor in relation to perinatal factors]

The pressure exerted on the fetal head during the second stage of labor was continuously measured in 42 spontaneous deliveries with a new instrument. The pressure values were correlated to various obstetric variables. Typically, the head pressure remained elevated beyond the end of the uterine contraction in primiparae, whereas it decreased simultaneously with the amniotic pressure in multiparae. On the average, the head pressure was higher in primiparae indicating, together with the longer lasting bearing down period, a higher resistance of the birth canal. Deliveries with pudendal block or peridural analgesia showed no differences, but these two groups differed in other factors which might have influenced the results. Infusion of oxytocin during the course of labor was associated with higher head pressure values that could not be deduced from the hormone administration per se, but from a higher resistance of the birth canal. Maternal age did not influence the head pressure. Within physiological limits, the head pressure was independent from the size of the child and the maternal pelvis.

[Cordocentesis and pH determination sub partu in suspicious cardiotocogram]

Two courses of labor with growth-retarded fetuses are reported, during which cordocentesis was performed because of abnormal fetal heart rate patterns along with a closed cervix. Analysis of umbilical venous blood revealed a normal pH in both cases thus avoiding cesarean section.