E. Saling

Neues Vorgehen zur Untersuchung des Kindes unter der Geburt

ZusammenfassungEs wird ein neues Vorgehen zur Untersuchung des Kindes unter der Geburt beschrieben. In kleinsten Blutproben, die aus der hyperämisierten Haut des vorangehenden Teiles gewonnen werden, erfolgen vorzugsweise Blutgasanalysen und Untersuchungen des Säurebasenhaushaltes. Die Durchführung zahlreicher anderer Labor-Mikromethoden ist möglich. Für die Forschung eröffnen diese Untersuchungen einen weiten Einblick in die intrauterine Physiologie und Pathophysiologie. Für die Klinik ergibt sich durch den Einsatz von Mikro-Schnellmethoden die Möglichkeit einer neuartigen Überwachung des Kindes unter der Geburt.

First magnetoencephalographic recordings of the brain activity of a human fetus.

Summary. Using a one‐channel neuromagnetometer adjusted to a special site on the mothers abdomen, we succeeded in recording prenatally, for the first time, human fetal brain activity in late pregnancy. It was possible to record both the fetal auditory‐evoked neuromagnetic field and to detect fetal brain activity by analysis of the frequency spectrum. Such measurements may soon prove valuable for the non‐invasive investigation of human brain function.

Fetal distress and the condition of the newborn using cardiotocography and fetal blood analysis during labour

Summary. The efficacy of electronic fetal monitoring combined with fetal blood analysis during labour in identifying fetal distress was investigated in a retrospective study. Operative delivery for fetal distress diagnosed during labour was performed in 9% of 2659 deliveries. All had continuous fetal heart rate monitoring and 22% had a fetal scalp blood analysis. Operative delivery had been performed in 53% of the infants who were acidotic at birth (umbilical artery pH <7.20) and in 46% of those with a low modified Apgar score (<7). These results show that the use of continuous fetal heart rate monitoring and fetal scalp blood sampling detects fetal distress without resulting in a high rate of operative delivery.

Effect of Oral Zinc Application during Pregnancy

The beneficial effects of the oral application of zinc aspartate in pregnancy is investigated in a randomly selected study group of 179 patients and a control group of 345 patients. This study confirms the prophylactic effectiveness of zinc replacement in reducing the overall complication rate for both mother and fetus and in particular for large-for-date and small-for-date infants. The therapy is well tolerated and accepted by the patients and causes no side effects. The results are in line with those of other working groups reporting on zinc as an important element with protective effects on fetal growth and development in pregnancy.

Obstetrical Characteristics of a Loss of End-Diastolic Velocities in the Fetal Aorta and/or Umbilical Artery Using Doppler Ultrasound

In 30 of 137 high-risk pregnancies we observed absent end-diastolic velocities indicating a high downstream impedance, which could be proved by histomorphological findings of the placenta. On the average the loss of end-diastolic velocities occurred 2-3 days before suspicious and nearly 8 days before pathological cardiotocographic findings. The perinatal mortality was high when absent velocities had been observed before the 32nd week, a cesarean section was obligatory in all but 1 case. All fetuses were growth-retarded. In 9 cases we were able to determine the ratio of blood flow volume in the common carotid arteries to that of the fetal aorta. The values were significantly increased as compared to values of undisturbed pregnancies, demonstrating a redistribution of fetal blood in favor of cerebral circulation.

Quantitative relationships between pain intensities during labor and beta-endorphin and cortisol concentrations in plasma. Decline of the hormone concentrations in the early postpartum period

In 38 women with uncomplicated vaginal delivery at term, the different pain intensities during spontaneous labor were correlated to the plasma beta-endorphin and cortisol concentrations simultaneously examined. The pain intensities subjectively assessed were numerically categorized. The women in labor categorized to pain intensities 0 to III were in comparable stages of cervical dilatation. The hormone concentrations were measured by means of radioimmunoassay. The lowest hormone levels were found after abolition of pains of labor by epidural anesthesia: beta-endorphin 42 pg/ml, cortisol 318 ng/ml (mean values). The hormone concentrations rose progressively with increasing intensities of labor pain. The highest concentrations were observed in the first few minutes after delivery i.e. immediately after cessation of the extreme pains of expulsive labor: beta-endorphin 118 pg/ml, cortisol 449 ng/ml. Statistically significant, positive correlations were calculated between beta-endorphin and cortisol concentrations in plasma and the self-reported pain intensities (p less than 0.001 and p less than 0.01 resp.). Thus, highly elevated beta-endorphin levels in plasma do not abolish pain, probably they modulate it. Within the first four hours postpartum the concentrations of the two stress-stimulated hormones dropped rapidly. The endorphin level fell from 118 pg/ml immediately after delivery to 38 pg/ml in the above mentioned period, the cortisol level from 449 ng/ml to 302 ng/ml. One to three days after delivery the beta-endorphin and cortisol concentrations in maternal plasma were largely normalized, this means they then approximately corresponded to the values being found in nonpregnant women under normal conditions.

ber die Mglichkeit des Einsatzes einer Herz-Lungenmaschine bei Neugeborenen

ZusammenfassungBei einzelnen asphyktischen Neugeborenen versagt selbst das wirksamste Behandlungsverfahren, die endotracheale O2-Wechseldruckbeatmung. Die Ursachen sind: hochgradige Aspiration, intrauterin erworbene Pneumonien, hochgradige Unreife des Lungengewebes bei Frühgeburten und Mißbildungen. Bei diesen Kindern empfiehlt sich der Einsatz einer Herz-Lungenmaschine. Während der künstlichen Arterialisierung des Blutes kann ein Teil der vorliegenden Störungen durch eine gezielte Behandlung beseitigt werden. Für den Einsatz einer Herz-Lungenmaschine bietet das Neugeborene gegenüber dem Erwachsenen sogar gewisse Vorteile: 1. Über die Nabelschnurgefäße ist ein Zugang zum zentralen Kreislauf ohne operativen Eingriff möglich. 2. Durch das Vorhandensein großer Gefäßkurzschlüsse kann bei Druckdifferenzen ein Volumenausgleich erfolgen. In Zukunft wird es möglich sein, durch Entnahme kleiner Blutproben am Feten schon unter der Geburt alle für den Einsatz der Herz-Lungenmaschine erforderlichen Untersuchungen durchzuführen. Eine einfache, für Neugeborene entwickelte Apparatur wird kurz beschrieben.

A simple, efficient and inexpensive program for preventing prematurity

Abstract Prevention of prematurity and of low birth weight is – because of the associated increased risk of mortality and morbidity – one of the most urgent tasks of perinatal medicine. Whereas the rate of prematures all over the world does not vary very much (5–10 %), the rate of infants born with low birth weight lies between 3.6% and 10% in the industrial countries and between 9.8% and 43% in the developing countries, where the main cause of low birth weight is intrauterine malnutrition. As there are different causes for prematurity and low birth weight, but also because various countries have different resources and have therefore to set their priorities differently, there is no global solution. The situation in each country must be considered individually. However, as far as basic means are available for the majority – such as basic health care, monitoring the nutritional state of the mothers and acting to prevent infectious diseases (malaria in particular can cause prematurity) – determined prevention of prematurity should take the form of screening and the treatment of disturbances of the vaginal milieu or genital infections. This policy can be recommended because one of the most important avoidable causes of prematurity is ascending genital infection (mostly combined with bacterial vaginosis), which very frequently starts with a disturbance of the vaginal milieu and then often takes its course asymptomatically. Regular screening for signs of such a disturbance using vaginal pH-measurements (and if necessary further diagnostics and therapy) makes possible the detection of an “early marker” to prevent prematurity in an effective and inexpensive way. Our prematurity-prevention-program, which has been successful for many years, is based on an anamnestic assessment of prematurity risk, the early detection of warning signs (including regular measurement of the vaginal pH) and, if necessary, the appropriate therapeutic measures. In cases of disturbance of the vaginal milieu, the latter consists of a therapy with lactobacillus preparations or in a combination of lactobacillus preparation with an acidifying therapy which may lead to earlier normalization of the vaginal milieu. In cases of bacterial vaginosis local therapy, for example with metronidazol or clindamycin, is undertaken, and in other infections specific treatment. It is encouraging to note that particularly the rate of the very small prematures is reduced when pregnant patients take part in our self-care- program, measuring their own vaginal pH-value twice a week, and also searching for any other warning signs. In this way in our collective the rate of very small low birth weight infants could be reduced from 7.8% in the immediate previous pregnancy to 1.3 %. In a prospective study performed in Erfurt the rate of very early premature births (< 32 + 0 gw) amounted to only 0.3% in contrast to 3.3% in a control group who had not taken part in the self-care activity. According to a differentiated classification of the control group the success of the self-care activity was even clearer: In patients who did not take part because their doctors did not support the self-care activity, the rate of very early premature births amounted to 4.1 %. In patients who did not take part in the self-care activity, but who were in the care of doctors who were interested and had taken part in the prevention-program, the rate was 2.2 %; in the group with active participation in the self-care activity it was only 0.3 %. To date measurement of the vaginal pH-value was performed intravaginally using either indicator strips or pH-measuring test gloves. A short time ago we developed a panty liner coated with an indicator strip, which enables reading of the pH-value by just checking the indicator on the panty liner. First results with this panty liner are very promising.

Fetal pulse oximetry during labor: issues and recommendations for clinical use.

Several centers are investigating the possible benefits arising from the introduction of pulse oximetry into intensive fetal monitoring during labor and delivery. 50 cases with abnormal cardiotocograms interesting under different clinical aspects were selected from 2000 cases from different countries which were additionally monitored by pulse oximetry. We have drawn the following conclusions with the help of now 36 years of experience with FBA: if fetal pulse oximetry is used in every case of abnormal cardiotocogram and SpO2-values, defined as normal are present, FBA and numerous operative interventions can be eliminated in a considerable number (more than one half) of cases. In cases with reduced SpO2-values as well as lengthy SpO2-registration gaps (limits of acceptability are described) it is urgently advised to use FBA for differential diagnosis so that even in these cases unnecessary operative interventions can be avoided.

Simultaneous Assessment of Blood Flow Velocity Waveforms in Uteroplacental Vessels, the Umbilical Artery, the Fetal Aorta and the Fetal Common Carotid Artery

We investigated simultaneously blood flow velocity waveforms of uteroplacental vessels, the umbilical artery, the fetal aorta and the fetal common carotid artery. In pregnancies with intrauterine growth retardation or preeclampsia we found low diastolic velocities in uteroplacental vessels, the umbilical artery and the fetal aorta and high diastolic velocities in the common carotid artery. Abnormal waveforms of the common carotid artery were most effective in predicting fetal compromise and might be a valuable clinical tool for the supervision and therapy of high-risk pregnancies in the future.