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From 1917 to 1979, the maternal mortality in the Rheinische Landesfrauenklinik Wuppertal has been investigated on the basis of 136084 live births. From 1917 to 1921, it was 10.1% and decreased to 0.16% in the period from 1973 to 1979. The maternal mortality in association with caesarean section, which was 11.8% in the period from 1917 to 1921 with a frequency of caesarean sections of 2.5%, decreased to zero since 1973 with a frequency of 6.3%. A caesarean section preceded more than 50% of the deaths since 1962. Most of the decreased (24.4%) were in the group of 30-34 years of age and 48.3% aged more than 30 years. 51.5% were primiparas and 14.6% of the women were at least para 4's. From 1917 to 1936, infection was the main cause of maternal mortality with 39.6%; from 1957 to 1966, however, thrombo-embolism advanced to the leading cause with 27.3%. Since 1960, 4 of 35 deaths were anaesthetic deaths. During all the examined periods, non-specific reasons of maternal mortality were an important factor with more than 30%.

Torulopsis glabrata, a pathogenic yeast, causes a vulvovaginal mycosis in about 10% of all cases, whereas mostly candida albicans is identified. Yeasts of the genus Torulopsis seem to occur especially on healthy women, whereas in cases of the well-known risk factors the growth of Candida albicans is advanced. Torulopsidosis of the vagina commonly takes a mild course. The diagnosis is ensured only in cooperation with special laboratories. However, microscopic traps are absence of pseudomycelia and relatively small buds which contrast with the big buds of candida albicans. Although the clinical course is usually less heavy than in cases of candidosis, a six- to ten-day treatment with local imidazole or Polyene antimycotics is necessary to avoid recurrences. The fact that yeasts of the genus Torulopsis form no pseudomycelia is perhaps an explanation for the mostly mild course of illness on the one hand and for the weak response to cellwall-synthesis blocking antimycotics on the other hand.

After laparoscopic confirmation of adnexitis, a bacteriological examination was made of specimens taken from the small pelvis of 63 patients, with an average age of 26.4 years, at the Rheinischen Landesfrauenklinik (Gynecological Hospital) in Wuppertal. To this end, various aerobic and anaerobic optimal and selective culture media were used. The cultured germs were identified with API systems, other conventional methods, and by using gas chromatography. All bacilli were tested for their sensitivity to mezlocillin and metronidazole. In 40 cases (63.5%), it was possible to determine 1-10 bacilli from the inner genital tract. In most cases there was an aerobic/anaerobic mixed infection, with participation of streptococci, staphylococci, enteric bacteria, as well as peptococci, peptostreptococci and bacteroid types. Neisseria gonorrhoeae was only identified three times. In 23 cases (36.5%), it was not possible to determine bacilli in spite of definite inflammatory symptoms. Since, according to international literature, Chlamydia trachomatis was to be found on the inflamed tubes of roughly one third of cases of adnexitis, the presence of this bacillus is suspected even in the many bacteriologically negative cases in the author's own study. Only in one case of a monoinfection by Staphylococcus aureus did the combination of mezlocillin and metronidazole prove to be unsuitable. In 25% of the cases where the presence of bacilli was proved, metronidazole was even necessary, since bacilli of the Bacteroides fragilis and Bacteroides bivius and disiens groups were involved, all of which are capable of inactivating penicillins and cephalosporins by formation of a beta-lactamase.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients with a mycologically confirmed vaginal mycosis were treated either with one 100-mg vaginal ovule of clotrimazole each for 6 days, or with one 200-mg vaginal ovule of clotrimazole each for 3 days, or with one 500-mg vaginal ovule of clotrimazole for 1 day, the ovule having been supplied in a novel, acid formulation. 24, 48 and 72 h after the last dose, samples of secretion were taken from the fornix vaginae. The intravaginal secretion levels were determined semiquantitatively on the basis of the measured inhibition zones obtained with Candida albicans growth on agar plates, and the levels obtained with the different treatment regimens were compared. The vaginal secretion levels after a single 500-mg dose of the new formulation were higher, even after 3 days, than those measured in the 6-day treatment, while administration of 200 mg clotrimazole on 3 days resulted in no increase of the secretion levels over those seen in 6-day treatment with 100 mg.

A new method of transvaginal pudental block is described with a carbon dioxide jet-injector. During the second stage of labor and good anaelgesia of the perineum was obtained in 119 of 125 cases. No side-effects or complications were noted although the amount of local anaesthetic used was only 3 ml. for each side.

Before the beginning of radium therapy a vaginal yeast contamination of 9,7% was found of 113 patients with different genital carcinomas. However, the incidence of vaginal yeast contamination increased suddenly to 30,9% under the contac irradiation therapy with radium. The radiation effect of radium is not sufficient for a "selfsterilisation" of the radium-carrier in the case of yeast contamination. Therefore, a chemic desinfection of the radium-carriers is principly necessary. The significance of radium therapy with respect to vaginal yeast contamination is discussed and the recommendation is made that routine mycological supervision be carried out on all patients with gynaecological carcinomas and appropriate antimycotic therapy initiated where necessary.