[Experiences with HELLP syndrome].

Between 1988 and 1991 thirty-nine pregnant women suffering from HELLP-Syndrome were treated in our hospital. A retrospective analysis of clinical course and of the changes in the relevant laboratory values was performed. The incidence of the HELLP-Syndrome at Freiburg University Hospital was 0.

[Prolongation of premature multiple pregnancy after abortion of one or more fetuses].

In four cases of one twin pregnancy and three triplet pregnancies, efforts were made to prolong the pregnancy after the death of one foetus between 15th and 26th weeks of gestation. Two patients had a history of spontaneous abortion, three patients had undergone infertility treatment. In a further three cases the membranes ruptured prematurely in association with severe disturbance of the vaginal flora.

[Fetomaternal transfusions in early pregnancy].

Fetomaternal bleeding is the major cause for rhesus immunization in pregnancy. This study evaluates the amount of fetomaternal bleeding in 345 pregnancies before 28th week of gestation. Fetomaternal bleeding was of clinical relevance (HbF greater than 0.

Fetal urinary tract obstructions: prenatal diagnosis--prenatal and postnatal therapy.

A retrospective study was conducted comprising 78 cases of fetal urinary tract obstructions diagnosed by ultrasound. Thirteen of the obstructions were subvesical and 65 supravesical. In only one fetus with a subvesical obstruction leading to megacystis was a puncture of the fetal bladder performed--in the 17th week of gestation--resulting in restitution of the bladder to its normal size.

[Fetomaternal transfusion in relation to mode of delivery. Comparison of data from the DFG multicenter study "Rhesus negative" (1965-70) with data from the Freiburg University Gynecologic Clinic (1989)].

Fetomaternal hemorrhage with transfusion of more than 10-25 ml fetal blood into the maternal circulation ("macrotransfusion") is one possible cause of the failure of combined pre- and postpartal anti-D prophylaxis. We analyzed the data from 391 patients who delivered at the UFK Freiburg in 1989. We evaluated the amount of fetomaternal bleeding in different modes of delivery.

[Refractory vomiting with cisplatin therapy. Prospective study with the serotonin receptor antagonist GR 38032F].

Emesis in chemotherapy containing Cisplatinum (DDP) is still a therapeutical dilemma. Emesis and nausea cause the cessation of a potential curative therapy in up to 10% of patients treated with DDP. We studied the antiemetic effectiveness of the selective Serotonin (5HT3)-receptor-antagonist Ondansetron (GR 38032F, Glaxo) in patients receiving high dose platinum chemotherapy.

[Oral contraceptive-induced liver tumors and pregnancy].

This paper reports on four pregnancies with maternal liver tumors induced by oral contraceptives. No increase in size and no rupture of these liver lesions were observed during the gestational and postpartum period. The toxic potentials of orally active sex steroids and the role of natural sex steroids are discussed.

[Systemic lupus erythematosus and pregnancy. Clinical aspects, serology and management].

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting the connective tissue of the skin and the vascular system. In about 90% of the cases, the first diagnosis is made in women of child-bearing age. We report on 11 pregnancies in 5 patients with SLE.

[The Arabin cerclage pessary--an alternative to surgical cerclage].

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix.

[Late morbidity following cesarean section--a neglected factor].

Based on the data of a questionnaire this study was designed to follow the obstetrical and gynecological history of 269 women who were delivered at our hospital by Caesarean section during 1960-1969. The Caesarean section group was compared with a control group of 229 women who were delivered spontaneously during the same period. Patients with cesarean sections had less children and more often they had been afraid of further deliveries.

The effect of acetylsalicylic acid and indomethacin on the catecholamine- and oxytocin-induced contractility and prostaglandin (6-keto-PGF1 alpha, PGF2 alpha)-production of human pregnant myometrial strips.

The effects of acetylsalicylic acid (ASA) and indomethacin (IND) on the epinephrine and oxytocin stimulated contractility and prostaglandin (6-keto-PGF1 alpha, PGF2 alpha) production of superfused myometrial strips from the pregnant human uterus at term are reported. Without preincubation in ASA or IND epinephrine dose-dependently (10 ng/ml to 1 microgram/ml) stimulated the contractility and significantly increased the PG-release of the myometrial strips. The epinephrine induced increase in contractility was correlated to a higher increase in PGF2a production and a decreased 6-keto-PGF1 alpha/PGF2 alpha ratio (5.

[The course of labor in very young and older pregnant patients].

The course of pregnancy and delivery and the fetal outcome were analyzed in 23 women aged less than 16 years and 151 women aged 42 years or more. Most of the adolescent mothers were delivered spontaneously without any major problems. In patients aged 42 years and more there was a higher rate of pregnancy complications due to predisposing risks and a high incidence of prolonged labour, correlated to an increased frequency of operative deliveries and in general more active obstetrical management.

Urinary protein patterns and EPH-gestosis.

In pregnancy a glomerular or mixed glomerular/tubular proteinuria in excess of 0.5 g/day was found in EPH-gestosis or preceding glomerular disease. A pure tubular proteinuria was not found in EPH-gestosis.

[Cervix ripening using drugs before oxytocin labor induction. Clinical study of a new prostaglandin E2 triacetin gel].

In an open randomized clinical study, 50 of 100 gravidae with a low Bishop score (less than or equal to 5) at term were treated with prostaglandin E2 (0.5 mg PGE2 in 2.5 ml Triacetin gel.

[Perinatal medical possibilities and limitations of the obstetrical center--an analysis of the causes of perinatal mortality 1982-1985].

Based on the analysis of 4,881 deliveries during 1982-1985 the perinatal statistical data of a regional perinatal center (level 3) are presented. There is high percentage of pregnancies at risk (57%), preterm deliveries (11%), and increasing incidence of multiple pregnancies (3%). The rate of spontaneous deliveries amounts to more than 70%, the frequency of cesarean sections reached a maximum of 19%.

[Monitoring of pregnancy in diabetes mellitus].

From 1970-1984 116 diabetic pregnant patients were monitored and delivered at the University Hospital of Freiburg, Department of Obstetrics and Gynaecology. The pregnant diabetics were managed and controlled by an interdisciplinary team of internists and obstetricians. For better control of the maternal metabolic status, the diabetic patients were admitted to the hospital three times during their pregnancy.

[Prognosis of pregnancy in diabetes mellitus].

From 1970-1984 116 pregnant diabetic patients were monitored and delivered at the University Hospital of Freiburg, Department of Obstetrics and Gynecology. During these 15 years, a decrease in maternal and fetal complications was observed. Today the risk of some complications in diabetic pregnancy is not greater than that of pregnancy in nondiabetic women.

[Interaction of sex steroids, prostaglandins (6-keto-PGF1 alpha, PGF2 alpha) and beta adrenergic agonists (adrenaline, fenoterol-Partusisten) in the human non-pregnant myometrium in vitro].

The in vitro effects of epinephrine and fenoterol (Partusisten) on contractility and prostaglandin (6-keto-PGF1 alpha, PGF2 alpha) production of human, non-pregnant myometrial strips dependent on the phase of the menstrual cycle and after pretreatment with estrogens and progesterone are reported. Superfusion of epinephrine (100 ng/ml) stimulated contractility and PG-synthesis of myometrial tissue from the proliferative phase of the cycle, whereas fenoterol (10 ng/ml) had only a little inhibitory effect. After pretreatment with conjugated estrogens (Presomen) the maximal epinephrine-stimulated contractions were correlated to a further increase in PGF2 alpha-synthesis even during fenoterol superfusion.

Clinical evaluation of endocervical prostaglandin E2-triacetin-gel for preinduction cervical softening in pregnant women at term.

In an open randomized clinical trial 100 pregnant women with low Bishop Scores at term were treated either with intracervical Prostaglandin (PG) E2 (0.5 mg in 2.5 ml triacetin-gel) 12 hours before labor induction with intravenous oxytocin or with oxytocin infusion alone.

Simultaneous investigations of maternal cardiac output and fetal blood flow during hypervolemic hemodilution in preeclampsia--preliminary observations.

In pre-eclampsia hemodynamic alterations are characterized by a lack of plasma volume expansion and a raised peripheral vascular resistance. For the compensation of plasma volume deficit and to restitute blood fluidity the therapeutic use of plasma volume expanders (f.e.

The effects of alpha- and beta-adrenergic stimulation on contractility and prostaglandin (prostaglandins E2 and F2 alpha and 6-keto-prostaglandin F1 alpha) production of pregnant human myometrial strips.

The effects of catecholamines and alpha- and beta-adrenergic agonists and antagonists on the spontaneous contractility of superfused pregnant human myometrial strips are reported. Prostaglandins (prostaglandins E2 and F2 alpha and 6-keto-prostaglandin F1 alpha) were analyzed in the effluent of the superfusion medium by specific radioimmunoassays. Both epinephrine and norepinephrine dose-dependently (10 ng/ml to 1 microgram/ml) stimulated the contractility of the myometrial strips and significantly increased the synthesis of all prostaglandins assayed.

[Value of antepartal cardiotocogram in risk pregnancies--comparative evaluation of the non-stress test and oxytocin stress test].

247 patients with risk of uteroplacental insufficiency were monitored by 434 oxytocin challenge tests (OCT) and non-stress-tests (NST). A non-reactive NST was found in 20% of the patients. Late decelerations in the OCT were observed in 19%.

Age-, cycle- and topographic dependency of human myometrial prostaglandin (6-keto-PGF1 alpha, PGF2 alpha)-synthesis in vitro.

Specimens of human myometrium (isthmus and fundus) freshly obtained at hysterectomy were immediately transferred in ice cold Tyrode solution and placed in superfusion chambers. Spontaneous contractions were recorded, the effluent of the myometrium was analyzed for PGF2 alpha and 6-keto-PGF1 alpha by use of specific radioimmunoassay systems. Dating of the menstrual cycle was achieved by histological evaluation of the endometrium.

Urinary protein patterns and preeclampsia.

A retrospective study of urinary protein patterns, as determined by SDS-PAA-disc-electrophoresis was performed in 107 patients in third trimester of pregnancy because of preeclampsia. The aim was to determine whether the protein patterns allow a differentiation between nephropathies associated with genuine toxaemia of pregnancy and those in which toxaemia was superimposed on preexisting renal glomerular or tubular disease. The magnitude and type of proteinuria was related to the mean arterial pressure (MAP).