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Previous perinatal trials using Doppler ultrasound have demonstrated a favorable correlation between abnormal blood flow spectra and feto-maternal problems. 33 patients with manifest placental unsufficiency were subject to daily transcutaneous nerve stimulation in a 2-week therapeutic course. 23 patients of the control group were treated by bed rest over 2 weeks. The patient group with transcutaneous nerve stimulation (TNS) showed significant improvement of the investigated blood flow parameters (A/B ratio) of the umbilical artery and fetal aorta (p less than 0.01). In the placebo group there were no significant alterations of blood flow parameters. The clinical findings (improved flow parameters and perinatal outcome) are not expected to yield any significant improvement when placental insufficiency is treated with bed rest alone.

A report about 12. gravid patients with a diminished uteroplacental flow is given. To increase their placental perfusion a transcutaneus lumbo-sacral electric nerve stimulation was performed. In all 12 cases a distinet increase war measured by the method of radioisotope placenta-perfusion. The mean values showed a high significant difference (p less than 0,001). The reasons for this results and the possibilities of this findings for the therapy of funcitonal placental insufficiency are discussed.

Morphine derivatives are the most frequently used analgetic substances in obstetrics today. Nevertheless, nausea, vomiting, weariness, and somnolence are common side effects of these drugs. Moreover opiates exhibit a depressive effect on ventilatory activity. As many studies have demonstrated tramadol, a new analgetic substance amongst the opiates does not show a depressive effect to such a high degree. In this prospective randomized trial we compared the efficacy as well as the safety of 100 mg tramadol and 100 mg pethidine in 40 women asking for pain relief during labour. The duration of labour was slightly but not statistical significantly shorter in the pethidine group. An analgetic effect could be observed in the pethidine as well as the tramadol group by both the pregnant women and the attending physician about 10 min after application lasting for about 2 hours. Concerning the side effects tramadol highly contrasted with pethidine. There were less cases of weariness and somnolence and the ventilatory frequency of the newborn babies tended to be higher than in the pethidine group. The serum levels of tramadol in umbilical and maternal veins demonstrated values of 0.83 +/- 0.15 (mean +/- SEM; quotient). The results of this study seem to establish an analgetic effect of tramadol similar to pethidine but with less side effects.

The influence of transcutaneous nerve stimulation (TNS) on the hormonal parameters of placental function (HPL and Estriol) in the serum of 39 patients between the 28th and 39th week of pregnancy was investigated. In this patients placental insufficiency was suspected because of low hormonal parameters or a diminished radioisotope placental perfusion test. During a hospitalization of 2 weeks these patients underwent a daily TNS-therapy for 2-3 hours. 2 or 3 hormonal values before these two-weeks therapy and 2 or 3 values after the therapy were compared. A significant difference (p less than 0.05; t-test) was found. HPL and Estriol mean values raised absolutely, but also in comparison to a group of patients of our clinic without placental insufficiency. A correlation between the onset of therapy at a certain week of gestation and it's effect could not be proved. The use of this riskless method as a therapy of placental insufficiency is recommended.

The course of delivery and labor, the post partum period and the postpartal condition of the newborn were reviewed in 315 obese patients with a bodyweight of 90 kg or more at delivery. The results were compared with those of a group of 315 patients with a body-weight of less than 90 kg, choosed by random and evaluated by statistic (t-test, x2-test). In the group of obese gravidae we found a significant higher rate of cases with induction of labor, protracted deliveries, breech presentation and operative deliveries. Also the rate of manual removal of the placenta, post partum uterine infections and disorders in the milk secretion was significant higher in this group. Post partum abnormal glucose tolerance tests ocurred abnormal more frequently in the obese patients. The weight of the infants of obese mothers was higher as in the control group. Significant higher were the perinatal mortality and the cases of fetal death in utero in the obese group compared to the non obese group.

Between 1. 6. 1972 and 31. 12. 1974 obese gravidae with a body weight of 90 kg or more were observed (7,6% of all patients in this period). This 315 patients were compared with a group of 315 patients with normal body weight chosen by random. The results of both groups were compared and evaluated by statistic (t-test, x2-test). A significant higher rate of Diabetes, latent Diabetes, EPH-Gestosis and cases of over-term deliveries were found in the group of obese patients.

37 gravid patients with diagnosed symptoms and signs of placental insufficiency underwent during 10 days a treatment of transcutaneous electric stimulation. Fetal CTG showed compared to the situation before treatment a distinct increase in the amplitude of the oscillation pattern and a rise in the number of accelerations, which means an improvement of the fetal situation. In 10 cases Fischer-Score went up from 7 to 10, in other 10 cases from 8 to 10.