Reproductive outcome of 32 patients with primary or secondary infertility and uterine pathology.

We did a retrospective study on 102 patients who had a laparoscopy and a hysteroscopy during investigations for primary or secondary infertility. 32 of the 102 patients had uterine pathology. Seven of them had septate uteri, eight had uterine synechiae, another six had uterine fibroids, four had a bicornuated uterus, while the remaining had either a combination of all or other uterine anomalies.

Laparoscopic management of ovarian tumors.

Background: Laparoscopy can be used with minimal operative morbidity to evaluate adnexal masses. We report our experience with the endoscopic approach to the diagnosis and treatment of ovarian tumors. In particular, we describe 11 patients who incidentally underwent laparoscopy and in whom the ovarian masses were found to be malignant.

[External fetal version from breech presentation to cephalic presentation: modifying factors, reliability and risks].

External cephalic version (ECV) was performed in 524 single pregnancies. The version was successful in 38.4%.

Cardiac and extracardiac complications in infants of diabetic mothers and their relation to parameters of carbohydrate metabolism.

Unlabelled: Despite the current improvement of diabetes care in pregnancy, neonatal complications are still more frequent than in the general population. Even in fetuses of well controlled diabetic mothers, myocardial hypertrophy can be demonstrated although it is not related to maternal metabolic control. The objective of this study was to determine perinatal complications and the course of myocardial hypertrophy in newborns who had been prenatally monitored and to relate the findings to neonatal parameters of carbohydrate metabolism.

[Diabetes screening in pregnant patients with different risk factors. Benefits, therapeutic success, consequences].

600 ethnically heterogeneous patients with various risk factors from outpatient obstetric clinic of the UFK Ulm were screened for gestational diabetes. Incidence with the 100 g oGTT was 21%, with fasting levels having the lowest prognostic value, and one hour levels having the best. After the diagnosis of gestational diabetes was established patients were counselled and put on diet, 7% received insulin additionally.

[Effects of new dental amalgam fillings in pregnancy on Hg concentration in mother and child. With consideration for possible interactions between amalgam and precious metals].

Amalgam-tooth fillings are suspected to be cause of many different diseases. With special consideration of the problem of newly made fillings, blood samples were taken from 45 affected pregnant women. After birth, newborns and placenta tissue were tested for Hg-contamination.

[Is a generalized amalgam ban justified? Studies of mothers and their newborn infants].

To measure the Hg-contamination from amalgam as well as other exposures to mothers and their newborns 185 women with tooth filling surfaces from 0 to 780 mm2 were examined. The Hg-values of mother and child at a time showed a highly significant correlation with a median value from 0.4 resp.

[Abnormal glucose tolerance and insulin resistance after diabetes in pregnancy].

Women with the diagnosis of gestational diabetes mellitus (GDM) are at a greater risk for developing diabetes in later life. This raises the question in which time span, to what extent and on which pathophysiological basis disorders of carbohydrate metabolism are to be expected post partum. Therefore 28 former gestational diabetes patients (GDM) were compared to 35 control patients, who had shown no irregularities in the oral glucose tolerance test during pregnancy.

[Metabolic acidosis in the 32nd week of pregnancy--uncontrolled diabetes in pregnancy, dehydration or sequela of tocolysis?].

We describe a case of keto- and lactic acidosis in a 22 year old, healthy woman hospitalized for preterm labor at week 32 of gestation. One former pregnancy was normal. Blood glucose level at admission was 115 mg/dl after 8 mg of betamethasone.

[Diagnostic value of continuous wave (cw) Doppler sonography in maternal diabetes mellitus].

Doppler studies of umbilical, uterine and arcuate artery velocity wave forms were performed in 40 insulin-dependent diabetic women in the first and second half of pregnancy. Using a continuous-wave Doppler device, the resistance index (RI) was calculated to determine the degree of vascular resistance in utero-placental and foeto-placental compartment. The 90th percentile was used to classify flow velocity profiles.

[The value of Doppler ultrasound studies of insulin-dependent diabetic patients].

Measurement of umbilical, uterine and arcuate velocity waveforms was used to study 40 pregnancies complicated by insulin dependent diabetes. Continuous wave doppler velocimetry was used to identify flow velocity profiles during the second and third trimester of pregnancy. Resistance index (RI) was calculated to evaluate waveforms.

[Spontaneous rupture of the liver in HELLP syndrome].

Spontaneous hepatic rupture in pregnancy is a rare, but dangerous complication of acute or progressing pre-eclampsia. Pain in the right upper quadrant is the most important clinical symptom and should prompt immediate laboratory evaluation (transaminase, coagulation profile, platelet count, red and white blood count). If the diagnosis of HELLP syndrome is confirmed, close supervision in an intensive care unit is mandatory.

Intrauterine treatment of severe fetal erythroblastosis: intravascular transfusion with ultrasonic guidance.

Twenty intrauterine, intravascular transfusion were performed in six patients under ultrasound guidance, the earliest one in the 19th week of gestation. In all twenty attempts we were able to insert the needle into the umbilical vein, transfuse between 12 and 80 ml of packed red blood cells, and raise the hematocrit (HK) up to 57% maximally. In two cases the fetal hydrops and the ascites completely disappeared.

The development of the placental villus during normal pregnancy: morphometric data base.

The morphological structures of the terminal villus of the normal human placenta were evaluated morphometrically throughout pregnancy. The Videoplan (Kontron) system was used to measure a total of 6000 villi. The cross-sectional surface and circumference of the villus decrease continuously until the 28th week and remain stable thereafter.

[Perinatal problems in fetal macrosomy and its relation to maternal Hb A1C].

Although the frequency of macrosomic newborns decreased within the last years due to an intensive centralized care of women with diabetes mellitus, 175 new borns had a birth weight of more than 4,000 grams in 1986 (total number of deliveries 2,339). Within this collective increasing maternal as well as fetal risks and perinatal complications increased rapidly corresponding to the rising birth weight. When clinical parameters were related to maternal levels of HBA1C, which was determined immediately after delivery, a dependency of the height of glycolised hemoglobin was related to several perinatal problems e.

Morphohistometric investigations of placentas of diabetic patients in correlation to the metabolic adjustment of the disease.

In order to determination if an interdependence exists between the well-known maturational disturbances in placentas of diabetics and the quality of metabolic adjustment, a morphometric study covering 7,500 terminal villi of 50 placentas was performed. The diabetic mothers were divided into two groups according to satisfactory or unsatisfactory blood glucose values. Significant differences in placental retardation were observed between both diabetic groups and a normal control group.

Morphohistometric investigations in placentas of gestational diabetes.

Perinatal morbidity and mortality are increased in both overt and gestational diabetes. Since retardation of placental development has been documented in overt diabetes, we, thus, examined morphometrically the terminal villi of 26 patients with gestational diabetes in order to determine if there is an immaturity of placental development. Investigation of villous surface, degree of vascularization, and development of epithelial plates yielded values lying somewhere between those of non-diabetic patients and those of patients with overt diabetes.

[Pelviscopic tubal coagulation].

1771 laparoscopic tubal sterilisations were analysed from 1972-1982 at the UFK Ulm. The control period extended to 1986. The median age was 35.

[Correlation between maternal hemoglobin levels and placental morphology and findings in newborn infants].

According to the criteria formulated by the WHO a hemoglobin concentration of 11 g/% represents an anaemia requiring treatment. 28 placentas of patients with hemoglobin concentrations of 7.2 to 10.

[Histometric case report of a placenta following intra-uterine therapy of rhesus incompatibility].

In Rh-incompatibility the human placenta shows a prominent retardation of maturation. The placental insufficiency caused by these changes, combined with the existing hemolysis, represents an additional danger to the fetus. In a patient with severe Rh-incompatibility several Rh-negative blood transfusions were performed between the 26th and 30th weeks of gestation via sonographically guided puncture of the umbilical vein.

[Histometric studies of placental villi in Rh incompatibility].

The delay in maturation of placental terminal villi in cases of Rh-incompatibility has often been described. The terminal villi of sixteen placentas from pregnancies complicated by Rh-incompatibility histometric were studied. Twenty-two placentas of healthy mothers who had born healthy babies after normal pregnancies served as a control group.

Morphometric investigations of terminal villi of diabetic placentas in relation to the White classification of diabetes mellitus.

In this morphometric study, terminal villi of 22 placentas of maternal diabetes mellitus were compared with the results in terminal villi of 22 normal placentas. The results demonstrate that there is a distinct retardation in maturation, statistically significant with bigger cross sectional surfaces of the terminal villi, particularly, when classified in 3000 mu2-steps, the number of the villous vessels and number of epithelial plates. Only slightly decreased in diabetic placentas is the villous vessels cross sectional surface as well as the degree of vascularization.

[Histometric studies of placentones of the human placenta].

Regionally different structures of placental terminal villi in the placentones have been shown in earlier publications. In this study the earlier results should be tested by means of histometry. The earlier results could be proved.

[Functional morphometry of the villous surface of the mature human placenta].

In 22 placentas of spontaneous delivered new-borns after a normal course of pregnancy and delivery the entire surface of resorption of the placenta was determined by means of multiple macroscopic and microscopic parameters. It could be demonstrated that the placental tissue is subject to a homogeneous shrinking process during the usual process of histologic preparation. The influences of fixation and histologic preparation are strongly marked.