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The aim of the study is to present biometrical data of the fetal lung measured in real-time sonography in mid-pregnancy. In 313 healthy fetuses of singleton pregnancies between the 15th and 30th week of gestation the fetal lung was measured in the horizontal, sagittal and frontal cross-sectional planes. In each plane the lung was measured in the following levels: clavicula, heart at the atrioventricular level (four chamber view) and diaphragm, as well as the lung length. During observation time all parameters showed a significant linear increase (r2 > 0.9; p < 0.001). Furthermore we found a high correlation between the same lung measurements collected in the different planes. The intraobserver variability was 3-8%. Such references of different planes could be helpful for differentiation of a small (hypoplasia) or a large lung (malformation).

The present study reports on 3 cases of cystic renal dysplasias of Potter II type with variable characteristics and different clinical symptoms. The prenatal sonography revealed multicystically altered kidneys in the 19th to 33 rd week of gestation. Amniotic fluid cells and fetale lymphocytes were investigated to exclude possible chromosomal disorders. In case one, a unilateral cystic renal dysplasia was diagnosed by sonography in the 19th week of gestation. The chromosome analysis revealed one additional and altered chromosome 22 (partial trisomy). In case two, a bilateral cystic renal disease with oligohydramnios was distinguished in week 21 of gestation. In both cases, the pregnancies underwent artificial abortions and the stillborn infants were subjected to post mortem examinations. The patho-anatomical examinations confirmed the results of prenatal diagnoses and the classification of the cystic renal alteration as renal dysplasia of Potter II type. In case two, extrarenal malformations were found additionally. In case three, sonography revealed a unilateral multicystic kidney. In this case, there had not been any clinical symptoms in the prenatal stage, neither originating from the affected organ nor from other disorders. After delivery at predicted day a unilateral nephrectomy was performed because of space-consuming growth inside the abdominal cavity.

To evaluate the use of serial measurement of cervical length and width of internal os by means of vaginal ultrasound 144 pregnant women were examined prospectively. We hypothesized, that cervical length and width of the internal os would be significantly different in normal patients and those with preterm labor or cervical incompetence. Predictive validity of suspicious findings indicating the occurrence of preterm labour and cervical incompetence in further course of pregnancy should be assessed. Anamnestic, sonographic and outcome data were analysed. To assess sensitivity, specifity, positive and negative predictive values, different values of cervical length and width of internal os between 20 and 27 weeks were analysed. Significant differences of cervical length and width of internal os in normal and pathologic pregnancies could be documented early in pregnancy course. By further investigation early suspicious findings indicating the developing pathology were found only for the subgroup with cervical incompetence. Sensitivity of vaginal ultrasound examination between 20 and 27 weeks indicating the whole pathologic collective was only 30%, whereas up to 55.5% of pregnancies complicated by cervical incompetence were detected. Specifity (up to 95%) and negative predictive value (90%) were high. The results show that cervical examination by vaginal ultrasound allows early detection of developing cervical incompetence. The high specifity and the high negative predictive value may be useful to exclude cervical incompetence in clinically unclear cases thus helping to avoid unnecessary therapeutical interventions.

Recently Ferencz et al. [6] using the datas of the Baltimore-Washington Infant Study found a predominance of double outlet righ ventricle and truncus arteriosus communis among the congenital heart diseases of newborns of diabetic mothers. This paper reports about the prenatal diagnosis of a truncus arteriosus communis Type I in a 23 year old pregnant with insulin-dependent diabetes mellitus (White B). The diagnosis was performed in the 25th week using Real-Time- and Color-Doppler-sonography. The important features in the prenatal differentialdiagnosis from a tetralogy of Fallot are explained. The optimal management of pregnancy, the delivery at a perinatal center with subsequent operative correcture could improve the prognosis of the newborn.

The application of high resolution ultrasound in the prenatal diagnosis enables a detailed differentation of the intracerebral structures in the fetus. In a period of 16 months (Jan. 1990-June 1991) we diagnosed at the "Center for prenatal diagnosis and therapy" at the Charité's Hospital in 14 fetuses among 1800 investigated plexus chorioideus cysts. A rapid karyotyping after cordocentesis was performed in 11 cases. In 3 of them a trisomy 18 could be detected. In one fetus having a normal karyotype we could find besides the cysts multiple structural anomalies. In these 4 cases the termination of pregnancy was performed. In the other 10 pregnancies we could observe a spontaneous regression of the plexus cysts. These results suggest that the prenatal diagnosis of plexus chorioideus cysts is a indication for cytogenetic evaluation in order to detect a trisomy 18.

The authors report about the prenatal diagnosis of 34 cases of fetuses with a single umbilical artery (SUA) observed at the Perinatal Center of Charité. Between January 1989 and June 1991 the SUA has been associated with some adverse perinatal events, such as low birth weight (35%), congenital malformations (35%), perinatal mortality (11%) and placental alterations (76%). The incidence was not higher in girls than in boys. We did not find any chromosomal anomalies in our cases. An accurate ultrasonographic examination of the SUA in the 16th to 20th week is very important. The prognosis of the newborn could be improved by efficient diagnosis and optimum management of pregnancy and of delivery at a perinatal center.

Fetal and neonatal teratoma is rare, but it is the most common tumor of the fetus and meonate. We report seven cases with fetal sacrococcygeal teratoma and two cases with craniocervical teratoma. The diagnosis, further management of pregnancy and birth are described and compared with recent literature. While craniocervical teratoma is associated with very poor prognosis, there are sacrococcygeal teratoma with good survival rate and postoperative good functional results. Very important is prolongation of pregnancy near to term.

The paper is a practical approach to fetal echocardiography using real-time ultrasound. The normal sonoanatomy of the fetal heart is presented for the non-cardiologist. The basic cross-sectional views are explained as well as the systematic analysis of the different fetal heart structures. The main heart malformations are reviewed with a description of their appearance in prenatal real-time-ultrasound illustrated by some figures. The examination of the fetal heart could be easy learned, but the assessment and the differentiation of congenital heart defects are only possible by a systematic approach, experience and patience. The examination of the fetal heart should be therefore involved in the screening-ultrasound performed by the prenatal sonographer and suspicious findings has to be referred to a perinatal center.

The paper is a review of cardiac arrhythmias, as the most common cardiological symptom in the fetus. After exposing the basic knowledge of fetal pathophysiology necessary for the better und understanding of cardiac rhythm disturbances in the fetus, the classification of fetal arrhythmias is presented. The possibilities of modern diagnosis and differential diagnosis, such us the fetal ECG, the control of the heart rate patterns and the sonography are discussed. The usefulness of the real-time-directed and color-coded M-Mode-echocardiography in the diagnosis and classification of arrhythmias are emphasized as well as the significance of the intracardiac Doppler and simultaneous Doppler recordings in the inferior vena cava and aorta. The indications, ways and drugs used in the intrauterine therapy of arrhythmias are presented. The differentiated management related to the diagnosis is described, after reporting about our own experience with 261 fetuses with arrhythmias (27 tachycardias, 21 bradycardias and 213 ectopic beats).

The humanus amorphus or acardiac twin is a very rare anomaly found only in monocygotic multiple pregnancies. In 8 twin pregnancies observed from 1977 to 1988 at the Charité-Hospital the findings of perinatal imaging diagnostics (sonography, amniofetrography, postnatal radiography) have been presented. For the prenatal diagnosis, especially for continuous prenatal control in these high-risk pregnancies, sonography seems to be the suitable method. However, an exact classification and morphological description of such monstrosities will be possible only by postnatal radiography (eventually in combination with a transumbilical angiography). Six ouf of eight cases were classified as an acephalous type, and two as an acardius anceps fetus.

Blood flow velocity waveforms were recorded between the 20th and 40th week of gestation from the umbilical and fetal aorta (n = 230 each) in 130 uncomplicated pregnancies. The S/D ratio, the Resistance Index (RI) and the Pulsatility Index (PI) were calculated. In the umbilical artery the indices showed a significant decrease in the observation interval. In the fetal aorta we could not register any significant change of these indices. All values are presented as reference curves. The importance of the Doppler assessment of the circulation in these vessels for the management of high-risk pregnancy is emphasized.

Using pulsed Doppler, blood flow in the cerebral arteries was measured to assess the fetal central circulation. The Pulsatility-Index (PI) was calculated as a qualitative parameter of flow velocity waveforms. In 418 normal singleton pregnancies we performed 558 measurements between the 27th and 40th week of gestation to get normal range values of the PI. The curve shows a small decrease in the observed interval. In cases of an intrauterine hypoxia the resistance of the central vessels decrease to render the distribution of the fetal blood volume. The result of this is a centralisation of the fetal circulation. 131 high risk pregnancies were investigated and in 21 cases such a centralisation was registered. The fetal outcome of these fetuses was significantly worse compared with fetuses having a normal central flow resistance. We found for example a higher rate of caesarean sections because of fetal distress when the Pulsatility-Index was below the 5th percentile. The sensitivity of the method in prediction caesarean section for fetal distress was 59.3%, the specifity 95.3%.

The prenatal detection of congenital heart disease is rather seldom, compared with other fetal malformations. The paper considers the necessity of the development of fetal echocardiography and presents therefore an introduction for the prenatal sonographer. The fetal cardiac characteristics are first analysed, before considering the possibilities and frontiers of the investigation. The different available sonographic methods like the real-time, M-mode, pulsed Doppler and color Doppler are discussed and the importance of each one is emphasized. The indications for fetal echocardiography are further enumerated, as well as the possible consequences resulting from the diagnosis of a heart abnormality. Because of the sophisticated ultrasound devices needed for a precise diagnosis as well as the optimal postnatal care, suspected fetuses have to be referred to centers specialised in perinatal medicine.

Doppler echocardiography was used for the prenatal diagnosis of a double outlet right ventricle and coarctation of the aorta in the 30th week of pregnancy. Heart failure with intrauterine death was observed during blood flow measurements. End-diastolic loss of flow velocity in the umbilical artery and fetal aorta occurred first and was followed by total loss of flow in both vessels, although ineffective contractions of the heart were recorded for a further three minutes. We conclude that a lock of end-diastolic flow velocity in the aorta may not only be due to strong placental resistance but can also be caused by a heart defect of by impaired cardiac function. The four-chamber-view approach makes an accurate prenatal diagnosis of severe congenital heart defects possible.

Using the results of 2,130 assessments with pulsed wave Doppler-ultrasound we established an indication catalogue which reflect the availability in cases of high specificity of the method. The paper shows the modus of fetal monitoring by inclusion of the other obstetrical investigations in consequence of the Doppler-assessment and the frequency of repetition of it.

The Doppler sonography enable as a new non-invasive procedure the assessment of the uteroplacental circulation. 209 blood flow measurements (pulsed wave Doppler) were recorded between the 20th and 40th weeks of gestation from the arcuate arteries in 130 women with uncomplicated pregnancy. The S/D Ratio, the Resistance Index (RI) and the Pulsatility Index (PI) were calculated. These Indices show throughout the observation time persisting low values which reflect the optimal uteroplacental circulation in a system with low downstream impedance. We found that the S/D Ratio and the RI are appropriate parameters in the qualitative analysis of the uteroplacental perfusion. On the other side we could demonstrate that the PI depends on the maternal heart rate which explains the high variability of the values. Therefore is the PI not appropriate for the impedance measurements in uteroplacental vessels.

In prenatal diagnosis besides radiographic methods there is a growing trend towards the use of invasive diagnostic techniques. These techniques have proved to be suitable for early detection of genetically determined conditions, diseases, and malformations of different origin. Invasive examination techniques were applied to 1.104 cases of prenatal diagnosis at Humboldt-University, Berlin, School of Medicine (Charité), Department of Gynaecology and Obstetrics, from January 1st, 1985, up to September 30th, 1987. In this paper importance and possible applications of these methods have been reported.

Reported in this paper are twelve cases of ventral schistasis transferred for cooperative prenatal assessment, diagnosis, and therapy to the Berlin Charité Hospital of Gynaecology and Obstetrics in 1985 and 1986. Concomitant malformations were recorded from eight in ten omphaloceles. Three of these children were delivered on full term by spontaneous parturition or caesarean section. They were surgically treated immediately after birth. Gastroschisis was recorded from two pregnancies with ventral schistasis. No generally valid recommendation can be given for approach to ventral schistasis. The approach should rather be interdisciplinary and should be preceded by careful diagnosis. Parents should be involved in decision-making.

From 1971 to 1974 in the Department of Gynecology and Obstetrics of the Humboldt-University of Berlin we monitored 1132 fetuses. The extent of the analysed groups runs to 306 to 632 cases, according to the completeness of the investigations and documentation. We have compared our CTG-findings with those of other authors. We found relationships between the risk factors and the CTG findings: for low weight fetuses more frequent Dip I, for maternal vitium cordis more frequent fetal tachycardia, for meconium stained liquor more frequent smooth baseline (silent) for EPH-gestosis (toxemia) more frequent Dip II (late deceleration) and variable deceleration. The relationships between the risk factors and the CTG findings are loose and not suitable to verify the great differences in frequency of the CTG pattern, published in the literature. We believe, that these differences are caused by different definitions and subjective interpretation of the CTG.

Reported in this paper is a case of premature termination of pregnancy in the 29th week because of sonographically diagnosed multiple malformations of the fetus. Holoprosencephaly, omphalocele, polyspleny syndrome, double-outlet right ventricle, and several skeletal malformations were established by pathologico-anatomic investigations. Possible correlation between these malformations are discussed in some details.

In the years from 1971 to 1974 the rate of fetal monitoring of high risk deliveries rose from 3.0% to 23.7%. In this time our clinic become a center of high risk pregnancies (reproductive failure and prematurity). By this way we could not show a decrease of the perinatal and intranatal mortality. The increase of caesarean sections from 3.0% (1968) to 6.0% (1974) was caused by the increasing of high risk patients. Fetal monitoring is not a cause for rising of operative frequency. By means of fetal monitoring the Apgar score of the newborns from mothers with severe diseases is not significant worse than from newborns of mothers with more easy diseases.

Intra-uterine exchange transfusion was performed on a patient in the 30th week of gestational age for Morbus haemolyticus fetalis. The indication for intra-uterine intervention resulted from spectrophotometric investigation of amniotic fluid which had revealed Zone III according to Liley as well as incipient hydropic development and development of ascites. The pregnancy had to be terminated for pathological CTG, four days after therapy. Postnatal neonatological intensive therapy included two exchange transfusions, before the child was dismissed in clinically intact condition.

Beta-adrenergics have recently come in the focus of clinical, physiological, and pharmacological research. The side-effects of tocolytically active substances are under thorough study at present. The authors checked the laboratory values recorded from 45 patients in pregnancy. Electrocardiographic follow-up checks were also conducted, with the view to establishing the effects of Dilatol and Partusisten on both the electrolyte balance and myocardium.--The results are described and discussed, and conclusions are suggested.

The validity of the modern methods of fetal monitoring to decide for the indication of urgent obstetric operations. The reliability of the modern supervision of the fetus is studied in cases of doubtful fetal heart action. Up to the present day we have no method for the exact estimation of the degree of a damage to the fetus. In such a precarious situation we should use all available methods for the diagnosis of the fetal condition, because the results of only one of the methods offer insufficient evidence. By means of the literature the alterations in the ECG of the dying fetus are interpreted in comparison to artefacts. In cases of doubtful fetal heart action we recommend in addition to the clinical findings to record the fetal ECG, to controll the actual fetal pH and attempt an investigation by ultrasonic.

The cardiotocographic findings recorded from 146 expulsions were analysed and related to the condition of the newborns. Melchior's cardiotocographic distribution diagram proposed for the expulsion period, 1973, is checked for its applicability.

Early detection of fetal malformations has become possible owing to the availability of highly advanced ultrasound systems. Majority of malformations, 30 per cent, has been recordable from urinary system. This system is early of access for the examiner, so that even sophisticated diagnosis of malformation is possible. High accuracy diagnosis has been increasingly helpful in forecasting pregnancy prognosis. Hence, with adequate perinatological management, it will be possible to influence on perinatal morbidity and mortality positively. 70 fetuses with malformations of kidneys and to urinary system have been observed in the context of this study. An assessment was made of diagnostic efficiency, postpartum development and long-range prognosis. Recommendations are derived from the above mentioned findings for perinatological approach in cases of diagnosed malformations of kidneys and the other urinary system.

The measurement of fetal and maternal blood flow velocities by Doppler-ultrasound is the first noninvasive method of studying utero-feto-placental haemodynamics. The pulsed Doppler is used by many observers to diagnose variations in the tissue resistance in certain clinical situations. The Doppler-ultrasound get the main importance in cases of intrauterine growth retardation, pregnancy induced hypertension, pregnancies in combination with diabetes mellitus and in cases of intrauterine hypoxia. This paper gives an overview about the clinical range of Doppler-velocimetry-investigations.

The paper gives an overview of the application in obstetrics of Doppler-ultrasound for blood flow measurements. Both usual methods, the continuous-wave and the pulsed Doppler are compared, including the safety aspects of the investigation. The advantages and disadvantages of quantitative and qualitative analysis of the Doppler spectrum are discussed and the necessary terms as Pulse Repetition Frequency (PRF), High Pass Filter (HPF), sample volume, aliasing and Doppler spectrum explained. The vessels of interest and the clinical importance they reflect are demonstrated. The importance of this new non-invasive mean in the assessment of utero-feto-placental haemodynamics is underlined.