Wolfgang Arzt

Assisted vaginal delivery versus caesarean section in breech presentation

Background.  The Term Breech Trial (TBT), a well‐known study conducted by Hannah and published in the Lancet, revealed a better outcome for neonates after primary caesarean section compared with attempted vaginal delivery. The aim of the present study was to determine whether the results of TBT have to be taken into account when counseling pregnant women in central Europe.

Easy sperm processing technique allowing exclusive accumulation and later usage of DNA-strandbreak-free spermatozoa

Sperm DNA fragmentation is increased in poor-quality semen samples and correlates with failed fertilization, impaired preimplantation development and reduced pregnancy outcome. Common sperm preparation techniques may reduce the percentage of strandbreak-positive spermatozoa, but, to date, there is no reliable approach to exclusively accumulate strandbreak-free spermatozoa. To analyse the efficiency of special sperm selection chambers (Zech-selectors made of glass or polyethylene) in terms of strandbreak reduction, 39 subfertile men were recruited and three probes (native, density gradient and Zech-selector) were used to check for strand breaks using the sperm chromatin dispersion test. The mean percentage of affected spermatozoa in the ejaculate was 15.8 ± 7.8% (range 5.0–42.1%). Density gradient did not significantly improve the quality of spermatozoa selected(14.2 ± 7.0%). However, glass chambers completely removed 90% spermatozoa showing strand breaks and polyethylene chambers removed 76%. Both types of Zech-selectors were equivalent in their efficiency, significantly reduced DNA damage (P < 0.001) and,with respect to this, performed better than density gradient centrifugation (P < 0.001). As far as is known, this is the first report ona sperm preparation technique concentrating spermatozoa unaffected in terms of DNA damage. The special chambers most probably select for sperm motility and/or maturity.

Secondary abdominal pregnancy with live birth

Dear Sir, Abdominal pregnancy is a rare and potentially life-threatening condition of which obstetricians and gynecologists must be aware. The maternal mortality risk is seven to eight times higher than in other ectopic pregnancies (1). We wish to call attention to the case of a 26-year-old woman with psychic disorder, who presented to the emergency room because of lower abdominal pain. A pregnancy of approximately 34 weeks was diagnosed. The quality of ultrasound was reduced because of oligohydramnion. Placenta previa was suspected. A cesarean section was performed on the third day after admission because of a decrease of the hemoglobin level, placenta previa and oligohydramnion. During surgery an abdominal pregnancy was detected. After delivering a female baby in good condition (birthweight 2,420 g), heavy bleeding from the placenta occurred. It could be managed by pressure on the intra-abdominal bleeding sites until the patient received volume replacement. After stabilization, the site was inspected and the placenta was found to be adherent on the posterior wall of the uterus, the bowel, the left tube and ovary and on the left pelvic wall. The whole placenta was removed, while hysterectomy and left adnexectomy were needed to stop the bleeding. The patient received a total of 19 units of blood. In spite of the massive blood loss, the woman recovered rapidly and could be transferred to psychiatry on the 12th day after surgery to continue antipsychotic therapy. The left tube was