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A prospective study was carried out with the participation of 60 pregnant women to elucidate the question if a unilateral antibiotic-prophylaxis is also indicated for a primary caesarean section. With the help of a random-list two collectives were formed with 30 pregnant women each. After delivery of the child one collective was given 4 g Mezlocillin (Baypen) i.v., the other collective did not receive an antibiotic. We analyzed the postoperative period of storage, postoperative fever, postoperative quality of healing, endometritis, urinary tract infection and the necessity of a postoperative antibiotic therapy. In addition we investigated swabs of the ear of the newborn, swabs from the cervix of the mother and blood culture of umbilical vein. Significantly less postoperative disorder of healing could be observed in the prophylaxis collective. All other investigated parameters did not show any significant differences in both collectives. Also there were no significant differences of infections in both collectives, therefore there is no indication for an antibiotic prophylaxis at a primary caesarean section.

The placentas of ninety-six pregnancies supervised by measurements of human placental lactogen (HPL) were examined. The histometrically determined placental villous surface and the degree of maturation of the villous tissue were compared to HPL-values in late pregnancy and to the weight of the newborn. The production of HPL is dependent on the extent of the syncytiotrophoblast surface area and, in addition, is modulated by the grade of differentiation of the chorionic epithelium. Placental villi with abnormalities of maturation apparently synthesize more HPL than villi of normal maturation.

Bei der Beratung einer HIV-seropositiven Schwangeren ist das mutterliche Schicksal infolge der Beeinflussung der HIV-Infektion durch die Schwangerschaft und die Rate der transplazentaren Infektion des Kindes zu bedenken. Es wird auf die Schwierigkeiten der Diagnose der HIV-Infektion beim Neugeborenen hingewiesen. Heute wird eine Ubertragungsrate von etwa 30% auf den Feten angenommen. Als beeinflussende Faktoren fur das Ubertragungsrisiko werden der mutterliche immunologische Status, die Zeitspanne seit der Erstinfektion der Mutter, der Geburtsmodus und das Stillen angesehen.

In the present study we tried to find out relationships between lung maturation-assessable by aid of lecithin concentrations in amniotic fluid-and fetal thyreoid gland function. In 256 pregnant women amniocentesis was done after 31/0 weeks of gestation, and concentrations of thyroxin, of reverse triiodothyronine and lecithins were measured. While thyroxin and lecithin concentrations proved not to be correlated, the rT3 and lecithin concentrations showed significant correlation (2 p less than 0.001). The curves measured were interpreted as signs of maturity of various organs (lung, thyreoid gland). We found out, that clinical value of measuring thyreoid gland hormones in relation to diagnosis of fetal maturation is of less importance.

Between May and October 1984 in the Department of Obstetrics of the Frauenklinik Berlin-Neukölln, 147 blood samples were taken from 106 women who were pregnant or already in labor. The purpose was to determine the concentration of the elastase of the polymorphonuclear leukocytes. Towards the end of pregnancy (from the beginning of the 28th gestational week till birth of the child), the range of 66 ng/ml-122 ng/ml with a median of 92 ng/ml was considered normal. It was shown that the concentration of elastase in the plasma of pregnant women is affected neither by the increasing gestational age nor by such pregnancy-associated diseases as the following: fetal hypotrophy, cervix insufficiency, premature onset of labor, or gestational diabetes. In addition, the elastase concentration in pregnant women who had had a premature rupture of the membranes was determined. The values were compared with other clinical and laboratory infection parameters, such as temperature, the total number of leukocytes as well as the number of rod-shaped leukocytes, and the duration of the opening of the membranes. The results indicated that under 135 ng/ml, there is most likely no infection present. Elastase concentrations between 135 ng/ml and 180 ng/ml lie in the pre-pathological range, concentrations above 180 ng/ml nearly always indicate the presence of an infection.

When counselling an HIV-seropositive pregnant woman, one must consider both the fate of the mother in relation to pregnancy-induced effects on the HIV infection and the development rate of the transplacental infection to the child. The difficulties in correctly diagnosing HIV infection in the newborn are discussed; it is estimated that in about 30% of cases the fetus becomes infected. Factors which may influence the risk of infection to the child are the mother's immunological status, the time interval since the mother was first infected, the mode of delivery, and breastfeeding.

Transfer of information by cyclic AMP (cAMP) is an important principle of hormonal regulation. The endocrine and metabolic changes during pregnancy may result from a changed cAMP metabolism. At the beginning of systematic investigations on this complex of problems we determined the cAMP content in 111 samples of amniotic fluid from 104 pregnant women without risk symptoms between the eleventh and fortieth week of pregnancy. Up to the 20th week of pregnancy the cAMP content of the amniotic fluid remains constant (5 - 15pmol/ml) and subsequently rises (40th week: 19 - 35pmol/ml). We compared the cAMP content of 27 amniotic fluid samples from 22 risk pregnancies with the normal range which was established in this way. Higher levels of cAMP were measured in the amniotic fluid of women with hypertonic toxemia of pregnancy, gestational diabetes and intrauterine malnutrition - especially in relation to the birth weight. The various possible interpretations for this behavior must be clarified by further investigations.

Fetal heart rate monitoring traces showing sinusoidal pattern associated with a feto-maternal macrotransfusion of about 200 ml blood are described.

The samples of amniotic fluid from 55 transabdominal amniocenteses were examined with a simple spectrophotometric test for the predictive value on the risk of respiratory distress syndrome. There was a highly significant correlation between the lecithin content and the optical density of the amniotic fluid at 650 nm (r = 0.065 at p0.001). No infant with an extinction threshold value of less than 0.15 had neonatal respiratory distress syndrome.

Die WHO-Empfehlung, in der Schwangerschaft die Glukosetoleranz mit 75 g Glukose zu testen und die gleichen Beurteilungskriterien wie auserhalb der Schwangerschaft zu verwenden [1], sind umstritten. Ziel dieser Arbeit waren die Analyse und der Vergleich der Blutzuckerverlaufe eines Risikokollektivs mit den WHO-Kriterien.

Stimulation of the surfactant production in foetal lung cells by thyroxine has been shown in experiments on animals. In humans, too, thyroxine instilled intra-amnially should increase lung maturity. Therefore, amniotic fluid samples were taken from 22 women before the 35th week of gestation before instilling 500 micrograms levothyroxine and then during labour, and blood samples were taken half an hour and also 24 hours after instillation of thyroxine into the amniotic fluid and during labour. The concentration of thyroxine, triiodinethyronine and reversed triiodinethyronine were measured radioimmunologically in the amniotic fluid samples and blood samples, and the lecithin concentration was also determined enzymatically in the amniotic fluid samples. The occurrence of cases of membrane syndrome in the examined group, and the foetal heart rate were subsequently determined after thyroxine had been administered. The results showed that the foetus resorbed the thyroxine administered intra-amnially and--in a manner typical of foetal metabolism--converted it by preference to rT3. The thyroxine dosage leads to only a temporary increase in foetal thyroid gland hormones. The thyroxine given intra-amnially is not absorbed in considerable amounts by the mother. The lecithin content of the amniotic fluid was significantly increased after a dose of thyroxine, possibly a reversible increase. The membrane syndrome rate laid below the expected number; in 5 of the 22 cases a foetal tachycardia was observed about 2 days after thyroxine administration.