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We report on a 45-year-old patient who presented with a 7 cm palpable right breast mass which had been classified as a cyst by ultrasonography. Multiple aspiration cytologies revealed no evidence of malignancy. Repeat sonography in our institution showed a lesion at 1 o'clock, 1 cm deep, and 3-8 cm from the nipple. The lesion contained a solitary cystic component measuring 3.9 x 4.1 x 4.4 cm. A 3.1 x 2.6 x 2.5 cm solid, inhomogeneous mass with irregular margins was found at the lateral border of the cyst. This mass raised suspicion of an intracystic carcinoma. Histopathologic analysis of 5 high-speed biopsy tissue cores demonstrated an invasive large-cell ductal carcinoma (G2-3). Final histopathologic assessment subsequent to breast-preserving resection and axillary node dissection confirmed the initial diagnosis: keratinizing intracystic squamous cell carcinoma (G2-3, pT2, pN0 (0/15)). The search for a remote primary squamous cell carcinoma included a chest X-ray, cystoscopy, colposcopy and PAP smear, esophago-gastroscopy, ENT consultation (laryngoscopy), and did not reveal any extramammary cancer. The postoperative management consisted of a total of 6 cycles of chemotherapy (Cisplatinum 75 mg/m (2) BSA and Paclitaxel 175 mg/m (2) BSA every 21 days) and subsequent percutaneous radiotherapy. In accordance with published reports, the diagnostic and therapeutic management was analogous to that of adenocarcinoma of the breast. However, some authors recommend the same chemotherapy as used for squamous cell carcinomas of other organs. It remains difficult to make any statements regarding the adjuvant therapy and prognosis, since this type of tumor is so infrequent, especially as an intracystic lesion.

As a part of a prospective study of 20 patients with previous pelvic surgery, the efficacy of using a 2/3 mm dilatable STEP device (InnerDyne, Inc., Sunnyvale, USA) for the first insertion in the area below the left costal border was tested, using 2 or 3.3 mm minilaparoscopes (Storz). Despite the high incidence of periumbilical omental and bowel adhesions (55%), no complications were observed in any of the 20 patients with previous pelvic surgery. Herewith could be confirmed that the use of a minilaparoscope in the area below the left costal border represents in high risk patients a safe and minimally invasive method for preventing or reducing the number of trocar-related injuries during first trocar insertion. In combination with the use of 2/3 mm disposable STEP-trocars if clinically required an atraumatic dilation and safe insertion of reusable 5 mm, 10 mm or 12 mm trocars is enabled.

Objective: Because of their beneficial effects on atherosclerosis and cancer risk, isoflavones may be useful as a dietary alternative or supplement to postmenopausal hormone replacement therapy. Isoflavones belong to the most important phytoestrogens. They may have estrogenic and antiestrogenic effects. We examined this in a well-characterised primate model of the postmenopause., Material and Methods: Adult, surgically postmenopausal female macaques were treated with isoflavones, estradiol or placebo for 6 months. After 6 months of therapy histopathological, morphometrical, and immunohistochemical measurements of endometrium and mammary glands were performed., Results: 6 months of isoflavone-therapy did not induce proliferation or any other clinical important changes in endometrium and mammary tissue. Phytoestrogentherapy did not show estradiol comparable effects. We are discussing our results with the results of other studies, which are sometimes in contrast., Conclusions: Our results indicate that isoflavones do not have estrogenic effects in the tissues studied.

Objective: Maternal CA 125 levels are supposed to rise in pregnancies complicated by vaginal bleedings in dependence to the extent of decidual disruption which is directly related to the outcome of pregnancy., Material and Methods: The prognostic value of maternal CA 125 serum measurement was investigated in 239 women with a first trimester intact pregnancy, imminent, incomplete, complete or missed abortion., Results: 43.9% of the CA 125 serum levels were without normal range (> 20 U/ml). Mean CA 125 serum levels were higher in patients with incomplete (52.4 +/- 67.4 U/ml), complete (34.3 +/- 46.1 U/ml), and imminent abortion (33.0 +/- 45.8 U/ml) as compared with normal pregnancies (28.9 +/- 28.8 U/ml) and missed abortion (23.5 +/- 21.5 U/ml). CA 125 levels in first trimester pregnancies tended to be higher in patients with vaginal bleedings than in patients without bleeding (40.5 U/ml +/- 55.0 vs. 28.9 U/ml +/- 28.8; p = 0.65)., Conclusions: For clinical use CA 125 serum measurement is not relevant. First trimester CA 125 measurement can not serve as an accurate predictor of pregnancy outcome due to the wide overlap of ranges.

100 years ago, on November 16, 1898, Ernst Wertheim performed the first radical abdominal hysterectomy for cervical cancer wearing his name. In this historical survey the life story of Wertheim is described involving morally questionable behaviours, misconceptions to radiation therapy, and problems regarding his obstetrical teaching. In context to the Wertheim-operation the vaginal radical hysterectomy developed by Schuchardt and Schauta and the radiation therapy of cervical cancer in the Wertheim-era are discussed.

Since TH1-cytokines compromise pregnancy and TH2-cytokines are produced at the maternal-fetal interface one can hypothesize that TH2-cytokines improve fetal survival. Cytotoxic T- or NK-cells are unable to recognize MHCI/II-negative trophoblast or become inactivated by HLA-G expression, respectively. Normal delivery at term might be assisted by a rapid reversal of the TH2 cytokine bias. Thus, the maternal immune state is most beneficial to reproductive fitness.

Objective: Dysfunction's of the thyroid gland are one of the most important endocrinological diseases. We report serum TSH levels in postmenopausal women before and during long-term hormone replacement therapy., Material and Methods: 107 postmenopausal patients participated in this study. Criteria for inclusion were: no known thyroid dysfunction and request for hormone replacement. Before starting therapy TSH serum levels were measured in each patient. If basal levels were within normal range TSH serum levels were reported over 4 years of hormone replacement therapy., Results: More than 10% of the postmenopausal women showed pathological TSH-levels without clinical symptoms requiring further diagnostic. During subsequent treatment cycles (4 years) serum TSH in euthyroid patients did not show significant changes. Women using hormone replacement therapy developed no new manifestation of thyroid disease., Conclusion: In euthyroid women using long-term hormone replacement therapy are no changes in thyroid function caused by hormone replacement therapy to expect.

In a prospective study 20 patients suffering from recurrent, therapy-refractory menorrhagias were pre-treated for endometrial ablation after exclusion of intrauterine abnormalities and histological pathology. Two injections of GnRH-analogues (3.75 mg leuprorelinacetate depot, Enantone Gyn, Takeda Pharma GmbH Aachen, Germany). Two weeks after the last injection a hysteroscopic surgery by roller-ball-techniques was performed in 10 patients and a balloon-thermocoagulation by Cavaterm-technique (Wallsten Medical, Morges, Schweiz) was performed in 10 patients. Both patients groups were comparable according to age and anamnesis. In a follow-up of 9 to 15 months we found about identical results. All 20 patients were satisfied with the treatment. The Cavaterm-coagulation is in comparison to the operative hysteroscopy a simple method for endometrial coagulation, and can also be used by an hysteroscopically inexperienced gynaecologists with simple technical equipment. In strict indication the Cavaterm-coagulation is a simple method of endometrial ablation in many patients.

Echinococcosis is a rare disease in central Europe. But with the increasing numbers of foreign citizens, this disease becomes more important in cases of cystic processes of unknown origin. It is still very difficult to achieve a diagnosis and a subsequent therapy, particularly in cases of multiple cysts, means a long lasting process containing certain risks. We report on a 20 years old female patient, suspected to have a severe inflammatory pelvic disease. We found multiple abdominal cysts, not originating from or involving ovaries, tubes, bowel, liver or kidneys. The serologic investigations proved our clinical suspicion on an echinococcosis. But neither serology nor clinical investigations could provide any indication on which kind of echinococcosis we found. We started a therapy with high doses of mebendazole to achieve a shrinkage of the multiple cysts to enable a surgery.

The management of an uterine perforation occurring during a D & C, in which a bleeding could not be stopped by coagulation per laparoscopiam is described. The closing of the bleeding injury in the uterus wall was performed by ENDO-UNIVERSAL-clip-instrument. The wound was closed and the bleeding stopped. The possibility to manage an uterine perforation with this simple method is reported and discussed.

In a retrospective study was investigated, whether a GnRH-analogue-pre-treatment has advantages during the hysteroscopic septum dissection in infertile and sterile patients with a uterus septus. The results show, that a GnRH-analogue-pre-treatment has no positive effect on intraoperative data (time of surgery, fluid deficit), the rate of complications, the postoperative anatomical results (residual septus) and the pregnancy rate. A GnRH-analogue-pre-treatment for a hysteroscopic septum dissection is not generally necessary. The surgery should be carried out in the proliferative phase of the menstrual cycle.

The transcervical endometrium ablation is more and more used for the treatment of therapy refractory bleeding disorders. Since in 70% of the patients, even with a postoperative amenorrhoea, a residual endometrium can be found a hormone replacement therapy should in any case include a sequential or continuous application of progestagen. For the prevention of a hematometra by using a hormone replacement therapy the cervix should be spared during endometrium ablation. With recurrent therapy-refractory bleeding disorders during hormone replacement therapy an indication for endometrium ablation can also be given. In these patients a postoperative amenorrhoea can be reached by a continuous hormone replacement therapy.

63 cases of adenomatous endometrial hyperplasia (1st-3rd degree) were diagnosed by hysteroscopy and D&C at the Department of Obstetrics and Gynaecology of the University of Greifswald from January 1991 to December 1994. In 40 patients with adenomatous hyperplasia (2nd-3rd degree) a hysterectomy was performed. 23 patients presenting with 1st degree hyperplasia were treated continuously with gestagenes for a period of 6 months. In those cases we performed a repeated diagnostic hysteroscopy and D&C to check the success of hormonal treatment. In 92.5% of tall cases the histological diagnoses of a lower degree adenomatous hyperplasia, cystic glandular hyperplasia or of a normal endometrium were made after hysterectomy. Only in one patient (2.5%) an endometrial carcinoma developed from an adenomatous hyperplasia (3rd degree). There was no progression to observe of adenomatous hyperplasia after hormonal therapy with gestagenes. We conclude that in those cases a hysterectomy has not necessarily to be carried out. However, in adenomatous hyperplasia of 3rd degree hysterectomy has to be the treatment of choice, because there is an increased risk of invasion.

The postoperative course of a not recognized perforation of the small bowel will be reported. The patient underwent a control-laparoscopy because of ovarian cancer following radical surgery and postoperative chemotherapy. Prevention possibilities with the use of the Minioptik (Storz) and Visiport (Auto Suture) are described.

The impaired glucose tolerance in pregnancy (IGT) represents an important fact in aetiopathogenesis of insulin dependent diabetes mellitus (IDDM) and non insulin dependent diabetes (NIDDM) as well as obesitas and cardiovascular diseases in context with fetal hyperinsulinism. Prospective studies of diabetic mothers newborns are difficult by reason of health controls in different outpatient departments. The aim of this review is to claim a general glucose screening in pregnancy looking on the development of newborns in later life. In present preventive prospects were not used to decrease the morbidity in diabetes, obesitas and cardiovascular diseases without gestational diabetes screening in pregnancy. The neonatal onset and late morbidity is dependent on the quality of maternal glycemia in pregnancy measured by means of glycosylated hemoglobin and insulin the amniotic fluid.

From February 1992 to December 1995 hysteroscopical myoma resections were performed in 70 patients suffering from recurrent bleeding disorders. In 24 cases of single myoma these were submucous with their largest portion located in the uterine wall. In all cases a pretreatment was performed with 2-3 injections of GnRH-analogues. The indication for resection must be proved critical in submucous myoma with their largest portion in the uterine wall, because a higher rate of complications is described. A simultaneous sonographical or laparoscopical control is necessary. In 2 cases of large myomas second resections were performed. The hysteroscopical resection of submucous myoma with their largest position in the uterine wall is a procedure for a surgeon with much experience in the field of operative hysteroscopy. In a follow up of 5 to 52 months a normal menstruation was reached in all patients. No intra- or postoperative complications were seen, no hysterectomy had to be performed until now. The resection of submucous myoma with their largest portion in the uterine wall is a surgery without a higher complication rate when carried out by an experienced surgeon.

Much is unknown about the effects of estrogen's on the mammary gland in postmenopausal women today. In a recent study of estrogenmonotherapy 28 adult, surgically postmenopausal female monkeys (Macaca fascicularis) were treated continuously with estradiol or were given only a diet (control group). After 6 months serum levels of estradiol and progesterone, morphometrical, histopathological and immunohistochemical measurements of the mammary gland were performed. In monkeys receiving estradiol the mammary epithel thickness and the mammary epithelial area (as percentage of total breast area) increased. Estradiol induced mammary gland hyperplasia, but we did not see any atypical hyperplasia. Estradiol and progesterone receptors staining in mammary ducts and lobuli increased (not significant). Estradiol induced a mammary gland proliferation (not significant) shown as increased staining for PCNA and Ki67.

In 11 patients with a cervical cancer stage IB a gasless laparoscopic pelvic lymph node dissection in combination with a vaginal radical Schauta-Amreich-hysterectomy was performed. The technique of the gasless lymph node dissection with the Laparolift (ORIGIN Medsystems, Menlo Park) is described. Because of the advantages of this technique (ability to use conventional and endoscopic instruments, perform irrigation and suction, dot with sponge sticks, change instruments quickly, prepare and remove lymph nodes without influence on visibility) it was possible to obtain a radicality (45 lymph nodes-median value) according to oncological standards for an abdominal radical Wertheim hysterectomy. If the radicality is equivalent to a Wertheim hysterectomy the combination of the radical vaginal Schauta-Amreich-hysterectomy and the gasless laparoscopic pelvic lymph node dissection offers a real alternative to the abdominal Wertheim hysterectomy because of low postoperative morbidity and quick mobilisation.

In 130 sterile women undergoing first look laparoscopy we found in 86.9% patent tubes. In this group in 34.5% an endometriosis was discovered. All patients with closed tubes had no signs of endometriosis. In a second look laparoscopy we found in 50% an endometriosis after microsurgery if the tubes were open. In this group we didn't also find an endometriosis if the tubes were closed. The frequency of endometriosis in women with laparoscopic sterilisation is 3.3%. After microsurgery in sterile women a second look laparoscopy seems to be very necessary to check the operation success and to exclude an endometriosis.

The use of a 1.2 mm microendoscope is compared to the conventional laparoscopy technique in this study. In 22 sterility patients and 23 patients suffering from chronic pelvic pain the high diagnostic value of the microendoscope is shown. Only in one case endometriosis (EEC I) is overseen. The diagnostic laparoscopy by the microendoscope is a new minimal invasive procedure which could be important as a screening method in future.

By means of laparoscopic supracervical and pelviscopic intrafascial hysterectomy (CISH) new minimally invasive hysterectomy methods for benign indications have been developed where the cervix or a portion of the cervix remain intact. The carcinoma risk is extremely small. Using the example of a large cervical myoma 25 years after a supracervical hysterectomy, the possibility of recurrent myomas is emphasized.

To find an answer whether the maternal serum concentration of immunoglobulins is influenced by intravenous treatment with polyvalent immunoglobulins and whether it can be used for therapy monitoring we evaluated data of 12 patients suffering from 2 to 5 previous recurrent abortions. The course of maternal serum immunoglobulins (IgG, IgM, IgA) was monitored before and after application of Venimmun. The average concentration of IgG, IgM and IgA before intravenous application in the 8th, 11th, 14th, 17th, 20th and 23rd week of gestation was always within the normal range. 11 of the 12 evaluated pregnant patients delivered healthy children on term. One of the 12 patients suffered an abortion in the 20th week of gestation. Our analysis supports the theory that in some cases of recurrent abortions the presumably absent blocking factors can be substituted by passive immunotherapy.

The characteristics of the tumor marker CASA (Cancer Associated Serum Antigen) during the menstrual cycle were analysed. We investigated whether hormonal influences in women and the score of this tumor marker ought to be considered. It could be demonstrated in regularly ovulating women that CASA is not influenced by physiological alterations of the hormonal status.

A case of ovarian venous thrombosis in the puerperal period after caesarean section (twin pregnancy) of a 14 year old patient is reported. After removal of the attacked vein, ovary, and fallopian tube antibiotics and heparin were given. The uterus could be maintained. The problems of diagnosis and treatment were discussed.

In a prospective study in 40 patients the pretreatment for endometrial ablation with a gestagen (Orgametril 10 mg/die), danazol (600 mg/die) and an injection of a GnRH-analogon (Decapeptyl-Depot) was compared with a control group without pretreatment. The subjective estimation of the surgeon (endometrial thickness and depth of coagulation) showed a sufficient pretreatment in 90 % of all cases following danazol- and GnRH-analogon-pretreatment. In 90 % of the danazol- and GnRH-analogon pretreated group the histological findings showed also an atrophic or little proliferative endometrium. In a follow up of 6 months after endometrial ablation the highest amenorrhoea-rates were reached following danazol- and GnRH-analogon pretreatment. These two regimes should be used for the pretreatment for endometrial ablation.

First experiences after the introduction of LAVH with regard to intra- and postoperative parameters of quality in comparison with the classical abdominal and vaginal hysterectomies are shown. The main indications for LAVH were large myomas, previous pelvic surgery and adnexal mass. Intra- and postoperative complications, time of operation, uterine weight, estimated blood loss, the period of use of analgetics and discharge wishes of 40 patients after abdominal and 25 after vaginal hysterectomies were compared with the results of 30 patients after LAVH. Patients after abdominal hysterectomy need more and longer analgetics. The lowest perioperative morbidity we found in the LAVH group. In cases with enlarged uteri the high blood loss during the vaginal hysterectomy can be significantly reduced with LAVH. LAVH offers a new technique to convert a lot of abdominal hysterectomies with benign indications (large myomas, adhesions, adnexal mass) into vaginal hysterectomies.

A case of an extraperitoneal injury of the urinary bladder by an endoscopical sterilization of the fallopian tubes is reported. The occurrence of clinical symptoms in a temporary difference to operation makes diagnosis of this rare complication difficult.

The early pregnancy factor (EPF) seems to be very helpful in clinical applications such as early detection of pregnancy, differential diagnosis of failure of fertilization or implementation and prognosis of a fertilized ovum. Our purpose was to investigate the diagnostic value of single and serial measurement of EPF, especially in the differential diagnosis of abortion and extrauterine pregnancy. Women with a history of 6-16 weeks amenorrhoea with/without vaginal bleeding were included in the prospective study. The EPF-test system was carried out by means of the rosette inhibition method. EPF proved to be always positive in normal pregnant women and always negative in nonpregnant controls. In case of threatened abortion the prognosis was good, when the EPF values were positive, and poor when they became negative. Patients suffering from spontaneous and missed abortion mostly showed negative EPF-values. This was also true in ectopic pregnancies. The sensitivity and specificity of EPF-test system were 83%. The positive predictive value was observed to be 54% and the negative predictive value 95%. The EPF as an early embryonic signal may be a suitable parameter for the clinical use detecting pregnancy disturbances very early.

A case of a clomifen induced bilateral simultaneous tubal pregnancy after micro-surgical tubal operation is reported. Causes, diagnostics, therapy, and possible preventions are discussed on the basis of current literature.

13 months after a hysteroscopic endometrial ablation a haematometra was diagnosed in a 44 year-old women as a source of recurrent pelvic pain. The cause of the haematometra was a complete obliteration of the ostium cervicae internum. This long-term complication of the endometrial ablation shows that all patients should have a regular clinical and sonographical follow up after endometrial ablation.

The anamnesis, the preoperative diagnostics, the laparoscopic findings, and the therapeutic management are reported of 303 patients who underwent laparoscopy because of chronic pelvic pain during the years of 1989 and 1993. The most common laparoscopic diagnosis were adhesions of the bowel and omentum (34.7%), adhesions of the genital organs (24.1%) and endometriosis (19.8%). In 31.4% there were normal pelvic findings. In patients with a history of surgical or other gynecological procedures we found significantly more adhesions as compared to nontreated controls; the adhesions were predominantly confined to the bowel and rather than the gynecologic pelvis. PID-Patients had significantly more genital adhesions. The high frequency of surgical laparoscopies and therapeutic recommendations following a diagnostic laparoscopy emphasize the importance of a laparoscopic investigation in patients with chronic pelvic pain.

The seasonal incidence of 472 ectopic pregnancies in the years 1984-1993 in the Departments Obstetrics and Gynaecology Greifswald and Neubrandenburg were analysed. While the birth rate was decreasing in the third and fourth quarter of the year there was a low, no significant increase of ectopic pregnancies from 1.30% (April-June) to 1.75% (October-December). The monthly analysis did not show any significant differences. In the area Vorpommern/East-Mecklenburg climatic and meteorological factors do not seem to have an important influence on the incidence of ectopic pregnancies.

Antibodies against spermatozoa specific antigens may be produced in female as well in male subjects. There is some evidence that they are able to contribute to infertility in susceptible couples. Therefore, we studied these antibodies with regard to the diagnostics of infertility. It is shown that there is no significant enhancement in the serum levels of the antibodies in infertile female patients and their partners. The figures measured are comparable to those found in pregnant or in climacteric women. It is concluded that the determination of these antibodies does not contribute to an improved diagnostic of infertility.

Single measurements of HCG, progesterone and 17-hydroxyprogesterone in blood samples were carried out in 32 patients with tubal pregnancies, in 38 patients with spontaneous abortions and 28 women with normal intrauterine pregnancies from the 5th to the 7th week of pregnancy. Although all 3 parameters showed significant differences between normal and abnormal early pregnancies, no difference between abortions and tubal pregnancies could be shown. The additional measurement of serum-progesterone and 17-hydroxyprogesterone for clinical use can be avoided.

In a prospective study of 68 infertile patients the findings of hysterosalpingography and hysteroscopy have been compared. Hysterosalpingography showed in 3 cases false-negative results and in 10 cases false-positive results. Hysterosalpingography is especially limited for diagnostics of intrauterine adhesions. Hysteroscopy should be a necessary component of diagnostics of sterility, also in case of normal hysterosalpingographical findings.

Women suffering from menorrhagia during anticoagulation therapy are risk patients for surgery. The successful hysteroscopic treatment of 2 of these patients is described.

The incidence of intrauterine adhesions is higher than often suggested. The causes are in most of the cases forced intrauterine intervention; especially in post-gravid uterus. Infections as only cause are very rate. For the diagnostics the hysteroscopy is definitely superior to the hysterosalpingography and sonography. The classification of intrauterine adhesions should be carried out by hysteroscopy. The therapeutic method of choice is the intrauterine adhesiolysis by hysteroscopy. Only in severe cases the abdominal metroplasty is the method of last choice. Primary prevention is only possible through avoidance of forced intrauterine interventions, especially in post-gravid uterus. A second possibility is the early performance of control hysteroscopy after intrauterine interventions.

To evaluate the Laser-Doppler flowmeter (LD) as a diagnostic tool in microcirculatory alterations of gestosis, cutaneous circulation was measured in the forearm under basal conditions and during reactive hyperaemia by means of an MBF3D (Moor Instrument Ltd., Oxford) in 11 hypertonic and in 14 normotonic pregnant women (+/- proteinuria, +/- pathologic increase in body mass, 16-36 years old, 26-40th week of gestation) with the exception of systolic and diastolic blood pressure, all statistical and clinical criteria were identical in the two groups. There were, however, in the hypertonic patients significant reductions in most of the LD criteria (basal and maximal speed and concentration of erythrocytes, duration of reactive hyperaemia). Regardless of group assignment, there were negative correlations between erythrocytes speed on the one side (basal, maximal), and blood pressure an the other, in some instances also to the increase in body mass and to the APGAR score of newborns. These preliminary findings are considered on an expression of cutaneous vasoconstriction accompanying hypertension in pregnancy. Extensive validation of LD under these conditions seems promising.

At three patients who have been operated on because of completely different tumours (trophoblast tumour, endodermalsinus tumour of the right ovary and rhabdomyosarcoma as well as adrenal cortex carcinoma) pre-operatively the Early Pregnancy Factor (EPF) could in each case be shown in the serum with the help of the rosette inhibition test. In two cases the EPF already intra-operatively disappeared from the serum. In the third case it could be found until the second day after operation. Since that patient suffered from two histogenetically non-related malignant tumours it was not possible to trace whether the adrenal cortex carcinoma or the rhabdomyosarcoma have been the reason for the EPF-synthesis. The already intra-operative disappearance and the also during further post-operative controls unsuccessful proof of EPF in serum can indicate an opportunity for the early assessment of efficiency of the surgical treatment of tumours which develop EPF or which induce the EPF-synthesis.

An increased incidence of neonatal jaundice has been observed in babies born to mothers who were treated with different drugs before or during delivery. In this review literature data on such drugs are collected which are under suspicion to produce increased levels of bilirubin in the newborn infant. Despite numerous attempts to show significant effects of these drugs on neonatal hyperbilirubinaemia most of them give contradictory results. Nevertheless, agents that stimulate uterine motility (oxytocin) as well as drugs that inhibit uterine motility (ritodrine) may have an icterogenic effect. Possible mechanisms of their actions are described. Thus, even if there is some association between drugs given prenatally and jaundice developing postnatally, no practical consequences arise except in such cases where additional risk factors may increase the danger of bilirubin encephalopathies in jaundiced infants.

Prostaglandin E2 is often used for induction of labour. A procedure appropriate for obstetrical condition of the cervix uteri is recommended. 1,472 births with a medical indication were induced in a multicenter-study. With a bishopscore < 5 prostaglandin E2 gel intracervical and with a score between 5 and 8 vaginal tablets were used for induction. Appropriate for the condition of cervix it was allowed to continue the induction. With a bishopscore > 8 an infusion of oxytocin was given. The fetal outcome was evaluated appropriate for the condition of cervix before and during induction of labour. The APGAR-score one minute post partum was < 8 in 10.8 per cent of all neonates. This part was near the same in the gel- and in the tablet group (p > 5%). By continuation of induction, the part with pathological findings was at all times not in relation to the different groups of cervical condition. It's the same by APGAR-scores 5 and 10 minutes after delivery. The acidotic morbidity at all was 10.7%. Also in this connection it was only an unimportant (p > 5%) increasing to observe then the induction was continued. There is no relation between the different groups of cervical condition and the acidotic morbidity. Under observation of mother and child the to cervical condition appropriated used method of induction of labour does not expect a bad neonatal outcome. The longer the cervix is unripen, the higher is the rate of delivery by caesarean section. The exploitation of the possibilities of induction by drugs can be recommended.

As biochemical markers for early diagnosis of disturbed pregnancies the placental proteins have been found special interest. It is suggested that measuring the serum concentration of placental proteins may have prognostic value in predicting the course of pregnancy. Furthermore, the activity of decidual tissue as well as the state of the menstrual cycle can be monitored. In this a review is given comprising the characteristics and possible clinical applications of these proteins, especially with respect to placental protein 12 (PP12), placental protein 14 (PP14) and the pregnancy associated plasma protein A (PAPP-A).

In development of endometriosis immunological phenomenons are discussed. In women with endometriosis specific antibodies are demonstrated and it is worth to speculate that there takes place de novo-expression of specific antigens. It is also possible, that changes in humoral immunity in endometriosis are secondary to deficient cellular mechanisms.

From 1983 to 1990 15 metroplasties were carried out at the Department of Obstetrics and Gynecology Greifswald. 11 of these operations were combined with a microsurgical tubal operation. For the diagnostics of uterus malformation and tubal damage as many methods as possible (hysterosalpingography, laparoscopy with chromotubation, hysteroscopy and sonography) should be used. A postoperative life birth rate of 62.5% shows that an operative correction of uterus malformation and tubal damage in one session is justified. Metroplasty is also indicated at primary tubal sterility with simultaneous uterus malformation. A caesarean section is not primarily indicated after metroplasty.

Because tramadol does not exhibit an depressive effect on ventilatory activity it is often be used in the obstetrical analgesia, at most in form of an intramuscularly injection. In a prospective study on at all 49 women under labour the clinical effect of the noninvasive rectal application of Tramadol, Pethidin, and Denaverin has been compared. The first dosage was 100 mg of all substances. Around the half of the women said that analgetic effect was good or very good. On only every fifth it was sufficient or not enough. The effect was at near the same in all treatment groups. Because of a low incidence of maternal side effects, the absence of side effects on the newborn, and near the same results on the analgetic effect of parenteral application in other studies, tramadol suppositories can be recommended for obstetrical analgesia.