Search

From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16%) foetuses, discordant growth occurred in 7 (39%) pregnancies. 41 (73%) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.

The amount of amniotic fluid was determined semiquantitatively in 600 pregnancies between the 12th and 41st week of gestation. Pregnancies at risk were excluded. The largest amniotic fluid area was measured sonographically in two dimensions. The mean plus/minus standard deviations are correlated with gestational age. A diagram has been prepared. Our results show good correlation with values from invasive quantitative examinations of amniotic fluid amount. However, our procedure is easy to perform and without hazard for the pregnancy, since it is non-invasive.

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. Criteria for differential diagnosis and practical suggestions are presented.

31 triplet pregnancies (DG), treated during 1975-1989, were analysed retrospectively. 13 DG (D10) were registered up to the end of the 10th week of pregnancy, 16 (DG) (D16) were intact between the 11th and the 16th gestational week. 3 DG resulted from the reduction of high grade multiple pregnancies. 18 DG (62%) of the initial 29 DG had previously been treated for sterility. The spontaneous foetal loss (DF) in group D10, including the perinatal mortality, amounted to 26% (10 of 39 DF). In one case of this group, a previously vital DF died. In another case, a partial bi-phasic abortion occurred followed by a premature birth of the surviving 3rd DF. The mortality rate in group D16, including the perinatal mortality (4 DF), was 25% (12 of 48 DF). 30 DG were still intact after the 16th week of pregnancy. 2 DG (7%) suffered from EPH-gestosis. In 4 DG (13%) a foeto-foetal transfusion syndrome occurred. 5 DF (6%) had some of the serious malformations. 27 DG were completed. 7 DG (26%) ended before the 32nd gestational week. In 13 DG (48%), a Caesarean section was performed. The perinatal mortality amounted to 11% (9 of the 81 DF) including all the births from the 25th gestational week upwards. On comparing these results with the data in the literature, a significant improvement in the prognosis of DG in recent years can be observed. This is due to the progress in antenatal and neonatal care.

We report on the prenatal diagnosis of a Pena-Shokeir syndrome sporadic case of the 27th week of pregnancy. Typical sonographical features are polyhydramnios, hypoplasia of lungs, foetal akinesia, reduced length of proximal and distal extremities and a striking discrepancy between biparietal and abdominal diameter. Differential diagnosis of polyhydramnios caused by foetal neuromuscular disorders is discussed.

We retrospectively analyzed 95 intact twin pregnancies (GG) only diagnosed by sonography during the period 1977-1987: 48 GG were registered up to the 10th week of pregnancy (G 10), 90 between the 11th and the 16th week of pregnancy inclusive (G 16). In the group G 10, this spontaneous fetal loss, including the perinatal mortality amounted to 10.9% (10 of 92) twins (GF). In 5 cases from this group, a previously vital twin was lost before the 10th week. The loss in group G 16, including the perinatal mortality, was 9.7% (17 of 176 twins GF). An early or late abortion occurred in 6 cases (6.8%) and dies perinatally in this group. 82 GG were carried out to full term. 38 women (46.3%) had premature births, 12 pregnancies (12.6%) ended before the 34th week of pregnancy. The perinatal mortality rate amounted to 3.0% (5 GF), 4 (2.3%) of 172 GF had serious malformations. In 6 GG (7.4%) the weight of the twins differed more than 25%.

Today prenatal sonographic diagnosis of abdominal defects and stenoses of the intestine is possible without few exceptions during general screening in the 20th week of gestation. In a retrospective study, 56 malformations in this area were investigated, which had been diagnosed at the University Hospital Freiburg during 1973 and 1985. Besides the criteria of sonographic diagnosis the etiology, incidence, prognostic factors, the course of pregnancy and delivery and the postpartal management are described. The rate of direct sonographic diagnosis in this area has increased from 26% up to 91%. The worst prognosis was found in infants with diaphragmatic hernias and exomphalos, whereas infants with stenosis of duodenum and small intestine had the best prognosis.

After exercising on a trampoline, a 29-year-old primigravidae in the 16th week of gestation was admitted to our hospital with the clinical signs of premature ablatio placentae and acute coagulation disturbances with disseminated intravascular coagulation and uncontrolled secondary hyperfibrinolysis. The coagulation disturbance was stabilized by conservative therapy (Substitution with fresh-frozen-plasma (ffp), whole blood and low-dose heparin treatment without having to terminate the pregnancy by evacuation of the uterus. An appropriate antifibrinolytic treatment was not performed in this case. The continuous controls of fibrinmonomeres and reptilase time indicate the possibility of a persisting latent coagulation disturbance after the acute phase. Thus, the necessity of a low-dose heparin therapy after an acute coagulation disturbance becomes evident.