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Numerous maternal (diabetes, preeclampsia) and fetal pathologies (uteroplacental dysfunction, hydrops, infection, congenital heart disease) can lead to cardiac dysfunction in the fetus. This includes increase of pre- and afterload, compression of the heart, myocardial damage, hypoxia and hyperglycemia. Beside already established methods like m-mode and pulse-waved Doppler, new promising technologies like tissue Doppler and speckle tracking are available for monitoring fetal cardiac function. Some of these new techniques have not been part of clinical routine yet because no validation has been performed so far and/or the technique is too time-consuming. Other technologies are currently being tested and only part of research projects. Innovations like speckle tracking that have its seeds in adult cardiology, are still limited because of the smallness of the fetal heart, the higher heart rate, fetal and maternal moving artefacts and finally because of a missing fetal ECG signal. Therefore their application should be performed critically.

Heart rate variability (HRV) reveals information on the functional state of the autonomic nervous system (ANS). This study was initiated to assess the physiological and maturational development of the ANS by comparing HRV data of a large number healthy foetus of different gestational ages from the 24(th) to the 42(nd) week.Cardiotocogram (CTG) recordings of HRV of 172 healthy foetus (24-42 weeks' gestation) were performed to establish normative data. Frequency domain HRV parameters were computed in three frequency bands.The gestational ages of the foetuses correlate with HRV. Lower gestational age in weeks showed lower frequency domain parameters than higher gestational age in weeks. The most significant differences were discerned for HRV parameters reflecting sympathetic activity in LF (low frequency) and VLF (very low frequency), due to the adrenergic system.Maturation of the ANS is accompanied by increasing HRV with a pronounced increase of sympathetic activity. These changes are measurable by CTG recordings with a computer algorithm which can calculate short-term variability on the basis of CTG data. Problems of the CTG signal, as shown before, were the parameters of the time domain, which could only be well detected by ECG or foetal magnetocardiography (FMCG).

Isolated fetal heart block is considered as an immunological disorder in the majority of cases. Mothers of affected fetuses often suffer from connective tissue disease (Sjögren syndrome or Lupus erythematodes). All of them test positive for anti-SS-A (anti Ro) and/or anti-SS-B (anti La) antibodies. Once established, third-degree congenital heart block is permanent and often requires a pacemaker.We report on a pregnancy in a mother with Sjögren syndrome which was complicated by the development of incomplete fetal heart block, diagnosed by pulsed wave Doppler echocardiography. We started oral dexamethasone treatment to reduce immune-mediated fetal cardiac damage and to prevent complications like hydrops fetalis.Detection of isolated fetal heart block is possible with pulsed Doppler sonography, but there are no clear recommendations for treatment.

Tissue Doppler imaging is a new ultrasound technique for the acquisition and analysis of myocardial velocity and deforming parameters in the human heart. In cardiology this innovative technique is used to identify ischemic regions and stunned areas after cardiac infarction and to diagnose dyssynchrony. In the last two years, our research group has been using this technique extensively on fetal hearts. It is possible to establish the fetal cardiac cycle clearly just by analyzing the typical courses of myocardial velocity curves. The quality of the curves is comparable to the results in adult cardiology. Consequently, many innovative analysis options can be acquired, e.g., the comparison of the kinetics of several myocardial regions in the cardiac cycle, the determination of pre- and post-systolic intervals (isovolumic contraction time, isovolumic relaxation time), the evaluation of diastolic function by analyzing the E(m) and A(m) waves and the detection of the atrial contraction. These parameters are currently used in cardiology for extended function analysis. Tissue Doppler imaging is the first step in parametric imaging of the fetal heart and consequently marks the beginning of a new era in fetal echocardiography.

Sonographic diagnostics are increasingly brought forward into the first trimenon. Lately, more and more expert studies have been published on echocardiography in the context of the Nuchal Translucency (NT) screening (gestational age 11-14 weeks). The aim of this study has been to evaluate the feasibility of early echocardiography on the occasion of first trimenon screening in the context of routine operation.From February 2003 to March 2004, an echocardiography was prospectively sought in 130 assigned, unselected pregnant women during the first trimenon screening. Three doctors with different OGUM/DEGUM (Austrian and German societies for ultrasound in medicine) qualifications at our ward tried to represent the four-chamber view (4CV) and the outflow tracts (OFT), each via B-mode and color Doppler. The study conditions were "routine", in particular they were temporally limited. In case no sufficient visual representation was achievable with the transabdominal examination, transvaginal sonography was also used.Via B-mode, 4CV was indicated as successful in 86/130, and OFTs in 37/130. Via color Doppler, on the other hand, it was possible to sufficiently represent 4CV in 75/130 and OFTs in 87/130.In routine screening, early heart examination is a big challenge and in many cases even with good equipment no complete diagnostic echocardiography can be achieved. The utilisation of the color Doppler is helpful particularly for the representation of the outflow tracts.

To evaluate the potential diagnostic advantages of the contrast agent Levovist for signal enhancement of small adjoining fetal vessels and to study the effect of Levovist before and during acute fetal hypoxia on the fetal circulation and the fetal blood flow velocities.A prospective, randomized study was performed in 12 fetal sheep before and during acute fetal hypoxia produced by complete occlusion of the maternal common iliac artery. Two groups of animals were studied, comprising animals with (study group, n = 6) and without (control group, n = 6) Levovist. In the study group, Levovist was administered intravenously by a pump (modified IVAC P 4000, Schering, Berlin). Duration and intensity of signal enhancement were measured in the fetal aorta, the common carotid artery and the ophthalmic artery of both groups before and during hypoxia. Concurrently, fetal heart rates as well as systolic and diastolic blood flow velocities in all three vessels were recorded in both groups.The increased signal intensity of up to 15 dB in the study group resulted in improved differentiation and imaging quality of adjoining small fetal vessels when compared with the control group. Neither before nor during acute hypoxia, significant differences of the fetal heart rate and the systolic and diastolic blood flow velocities were observed between the two groups (p0.05). In the study group, no emboli were caused by Levovist in any fetal tissue or in the placenta.The contrast agent Levovist improves the detection and accuracy of monitoring flow velocities in small fetal vessels by increasing the intensity of the Doppler signal without affecting fetal heart rate or fetal blood flow velocities.

Most congenital cardiovascular malformations have their origins during early morphogenesis, and some forms of adult-onset cardiovascular disease also arise during embryonic development. Conotruncal heart defects comprise a major category of congenital heart disease and are found in children with a relative high frequency. These defects are associated with a high mortality risk in utero, and after postnatal surgical repair; embryologically they are linked with dextroposed aorta, which is an anomaly of the ventricular outflow tract with malalignment of the great arteries. The etiology and pathogenesis of dextroposed aorta is not known but is thought to be due to abnormal looping and/or incorrect "wedging" of the outflow tract (i.e., wedged positioning of the aorta between the atrioventricular valves) during early heart development. We have studied the morphology and visual development of the embryonic heart in an animal model of dextropsed aorta in a series of experiments to determine possible mechanisms for dextropositioning of the aorta. At this, we have employed besides established methods for analysis of anatomy and pathology (morphological studies, cardiac morphometry, histology, scanning electron microscopy and immunhistochemistry) also new imaging techniques (videocinephotography and time-lapse studies with a digital high-speed video camera, confocal and scanning electron microscopy, optical coherence tomography (OCT) and magnetic resonance microscopy (MRM) for 3D reconstruction of the heart) to achieve a better visualization of normal and pathological changes during heart development. The paper at hand summarizes the results of these studies.

After the quantitative, fully computerized evaluation of cardiotocography (CTG) after G.S. Dawes had yielded reliable results, an investigation was to be carried out to see whether a semiquantitative CTG analysis together with a CTG score (K. Hammacher) produced similarly useful results, too.The last 120 directly recorded intrapartum CTG minutes (HP 8040A, 80300A) of 393 vaginally delivered fetuses were evaluated by simple means (magnifying glass, dividers, Plexiglas sliding caliper). The number of turning points, the bandwidth and the mean frequency level were determined for each individual CTG minute. Further, all decelerations were registered numerically (start, end and depth of decelerations), both qualitatively (28 key positions) and quantitatively. The CTG score of Hammacher was programmed in Fortran IV and integrated as a subroutine into a larger software system.Score 4 was noted most frequently (35.4%) during the last 30 min ante partum. The score values 10, 11, 12, 14, 15, 16, 17 and 18 were not seen at all. On the basis of the 'percent distribution of points' of the three score components, it could be shown that the decelerations were numerically overrepresented in comparison with the two other factors. The rank correlation between the score value and the relevant blood pH of the umbilical artery was highly significant (p0.001). The scoring of the CTG rises perceptibly only above pH 7.15. The sensitivity of scoreor =4 is 87.2% for pH 7. 10 and 100% for pH 7.00.The interpretation of the cardiotocogram by means of the Hammacher score, which is based on a semiquantitative evaluation, yields clinically useful results. These may further be improved by changing the score structure. Beside the fully computerized analysis, the semiquantitative CTG analysis is able to finally determine the reliability of this monitoring method.

Small echogenic areas in the fetal heart are known as the golf ball phenomenon. These structures are considered by some to be a marker for chromosomal anomalies.To prospectively study the relationship of echogenic intracardiac structures and chromosomal aberrations.Over a 15 month period (6/96-9/97) 4500 unselected fetuses between 16-31 weeks were screened for malformations; in each case echogenic intracardiac structures were sought.In 77 cases (1.17%) single or multiple echogenic punctate intracardiac structures could be diagnosed. In 60 fetuses (78%) chromosome analysis was performed. Two (3.3%) had chromosomal abnormalities--trisomy 21 and 45.XO/46.XX.The golf ball phenomenon appears to be a normal variation in the development of the papillary muscle. This sign is usually easily to identify and if present, should lead to a more detailed screening for anomalies. In the case of other sonographic abnormalities, with advanced maternal age or with a positive triple test, a chromosomal analysis should be performed.

Routine ultrasound screening during pregnancy is being debated. The paper presents the aims of a three-step ultrasound screening during pregnancy care. These are exact dating of the pregnancy, detection and classification of multiple pregnancies and the detection of fetal malformations. In order to achieve these goals, we describe these three examinations. In the Cochrane Database, the efficiency of routine ultrasound screening during pregnancy is presented. Consequences of pregnancy care without routine ultrasound examinations are discussed.

Pulsed Doppler velocimetry of both fetal atrioventricular valves derived in the four-chamber-view were performed in 94 uncomplicated pregnancies between the 20th and the 40th week of gestation. The maximal velocities in early (E-peak) and late diastole (A-Peak) as well as the E/A Ratio were calculated for both tricuspid (TV) and mitral valves (MV). Normal ranges for the six measured parameters were constructed and correlated with gestational age. In the second half of pregnancy an increase of the E-wave for both valves was found (TV r = 0,59; MV r = 0,48) with higher values through the TV compared with the MV. In comparison the A-velocities showed a flat increase during the observation time (TV r = 0,32, MV r = 0,24). The E/A Ratio for both valves which is1 in the fetus showed an increase throughout pregnancy, mainly due to the increase of the E-wave in the observed period of time. These intracardiac Doppler flow measurements enable an insight into the physiology of fetal circulation. They give a basis for the analysis of blood flow under pathological conditions, like in congenital heart defects or in intrauterine growth retardation.

Precardiac venous blood flow, umbilical artery and aortal blood flow of 120 unselected patients has been investigated by means of Doppler ultrasound. Measuring a hepatic vein directly before entering the inferior vena cava we found a characteristic blood flow pattern with a moderate foreward flow during systole and a small foreward flow during early diastole and a very small reverse flow because of atrial contraction during late diastole. We found changes in this flow pattern with reduction of the mean velocity in cases of high risk pregnancies with intrauterine growth retardation. Comparing normally developed fetuses with growth-retarded fetuses and vaginal delivery or caesarean sections without fetal distress with caesarean sections because of fetal distress we found significant differences with lower mean velocities in the precardiac veins of the latters. Comparing the precardiac venous flow velocities with the umbilical artery flow velocities and the fetal descending aortal flow velocities we found similar results of statistical values predicting growth retardation and caesarean section because of fetal distress. We concluded that venous Doppler flow velocity analysis is also able to predict perinatal risks like intrauterine growth retardation or caesarean section because of fetal distress as good as flow velocimetry of the umbilical artery or the fetal aorta; if it is impossible to demonstrate the fetal descending aorta or the vena cava inferior sonographically correctly the investigation of the hepatic vein may give you more reliable Doppler values for your clinical management.

Fetal cardiac measurements derived in the five-chamber and the short-axis view were performed in uncomplicated pregnancies between the 20th and the 40th week of gestation. Using cine loop and zoom techniques, the diameters of the aortic and pulmonary valve were measured (n = 157) and the pulmonary trunk/aorta ratio calculated. Normal ranges for both parameters were constructed and correlated with gestational age. Both diameters showed a linear increase during gestation (aorta r = 0.87, pulmonary trunk r = 0.91). The mean pulmonary trunk/aorta ratio had a constant value of 1.25 and showed no changes throughout pregnancy. In 128 fetuses the heart width was further measured and the vessel diameters were presented in correlation to the heart width.

In 541 early pregnant women transvaginal sonography (TVS) was performed between 5th and 9th week of gestation. The correct gestational age was verified and information on normal development of the embryo was collected with this routine sonographic control. In one-third of 541 patients disturbances of the pregnancy were found directly or a TVS control was recommended. In 116 cases the gestational age, determined by calculating the period since the last menstruation, had to be corrected by sonographic results. In 12 women ectopic pregnancies without any symptoms were found. Only 47 women of 251 evaluated patients had no risk in pregnancy.

In a retrospective study the results of vagino- and colour flow Doppler sonography of 23 tubal pregnancies verified by surgery were documented. Due to the neovascularisation in the trophoblast tissue the vascular impedance was elevated in all cases. The mean value of all pulsatility indices was 0.85 +/- 0.2. The direct signs of tubal pregnancy were seen in only 20 cases with vaginosonography alone. The combination of vagino- and colour flow Doppler sonography offers the chance of an earlier detection (5th week of pregnancy) of a tubal pregnancy.

This study was performed to evaluate the time interval for Doppler ultrasound and sonographic diagnostic measurement at 267 patients during antenatal risk screening. Time for biometry, screening of malformation, Doppler ultrasound, documentation and discussion with the patients were measured. Although experienced colleagues used an standardized inquiry a mean time interval of 52 minutes were needed under optimal conditions. It is interesting to note that outstanding disturbance factors extend the examination time considerable. Many data must be calculated and recorded by the obstetrician. Several proposals are drawn up and discussed in this paper on the basis of this results. This study shows that high special knowledge and a large time expense is necessary to establish Doppler technology in the routine antenatal screening.

Embryonic cardiac activity was observed by means of transvaginal Doppler ultrasound in a period from the 28th through the 78th day after conception (p. c.). We were able to detect a correlation between the embryonic heart rate and the stage of pregnancy as well as a correlation to the crown-rump length. The maternal age did not seem to have any effect on the appearance of embryonic heart activity. The number of registered Doppler echoes did not yield information on embryonic heart development.

In corrosion casts of the left anterior descending coronary artery and its branches of higher order, the length, diameter, and number of branches were examined in 20 hearts, from 9 adults, 3 children, 4 new-born and 4 fetuses. We counted 5245 branches in total, thereof 147 branches in the corrosion casts of adult hearts were systematically analyzed, as were 46 branches of children's hearts, 55 branches of the new-born and 35 branches of the fetuses, respectively (left anterior descending coronary arteries and branches of 1st to 6th order). The length of the left coronary arteries and of their branches of 1st and 2nd order increases to almost the same degree as the linear measurements of the hearts. The left anterior descending coronary artery is about four times as long as the 1st order branches and these have twice the length of the 2nd order branches. These differences result from the divergent course of the branches. The results indicate that no significant increase in the number of the 1st to 3rd order branches of the coronary arteries occurs from birth to adulthood in human hearts. During the postnatal growth in human hearts there seems to be no remarkable neogenesis of coronary artery branches of greater diameter. Nearly all of them exist at birth and even in the late fetal period. Their length increases harmonically with the linear measurements of the heart and they become progressively separated. These findings parallel those obtained in a previous study in pigs.

We report on biometric measurements of the fetal heart with the TM-technique; these measurements were carried out between the 20th and 40th gestational week. The right and left endsystolic atrial and ventricular diameters were, measured, as well as the diameters of the large vessels, i.e. aorta and pulmonary artery; finally, the septal thickness was determined. Our measurements show a linear progression of the diameters in question, the right-left ratio of the atria and ventricles was close to one, so was the ratio between aorta and pulmonary artery. Our results are compared, as far as possible, to the literature.

160 woman patients in whom the course of pregnancy was uneventful or pathological (intrauterine growth retardation, percentile less than 5) were investigated at the Department of Obstetrics and Gynaecology of the University of Homburg/Saar between the 28th and 42nd week of pregnancy, using a newly developed cardiotocograph (HP M1350A Hewlett-Packard, Böblingen, FRG). By means of the kinetocardiotocogram (KCTG), fetal mobility (fetal movements of the whole body or of the extremities) was recorded simultaneously with the conventional recording of the fetal heart rate and uterine contractions. One of the aims in developing the KCTG was to record as far as possible all fetal movements synchronous to the recordings of heart rate and uterine contractions. To this end, the recording algorithm of the KCTG was adapted to the examination results obtained by two simultaneously operating ultrasound investigators. After the 28th week of pregnancy it was possible to record by the KCTG fetal "movement clusters" (combined body and limb movements) independent of the weight of the fetus and of amniotic fluid volume or positional anomalies, reliably and with good correlation with the results of the sonographic control investigations (r = 0.88-0.97). In cases of intrauterine growth retardation (percentile less than 5) a significantly reduced motility was observed on average as early as 13 days before delivery (p less than 0.005). It must be emphasized that, at this stage, most of the antenatal CTGs were normal. These findings indicate that KCTG can contribute to improved monitoring in high-risk pregnancies.

The paper is a practical approach to fetal echocardiography using real-time ultrasound. The normal sonoanatomy of the fetal heart is presented for the non-cardiologist. The basic cross-sectional views are explained as well as the systematic analysis of the different fetal heart structures. The main heart malformations are reviewed with a description of their appearance in prenatal real-time-ultrasound illustrated by some figures. The examination of the fetal heart could be easy learned, but the assessment and the differentiation of congenital heart defects are only possible by a systematic approach, experience and patience. The examination of the fetal heart should be therefore involved in the screening-ultrasound performed by the prenatal sonographer and suspicious findings has to be referred to a perinatal center.

This is a review based on a description of a standardized method (microdissection + SEM) for study of human and animal cardiac development. Two examples of the analytical approach are given. In the first one, concerning the establishment of contact between the aorta and the left ventricle, the previous assumptions for "vectorial bulbus rotation" are disproved by more precise observations of normal cardiac development. Aorta is not transferred into the left ventricle but is connected to it by means of a "conduit" (aortic vestibulum) delimited by the fusion of the conotruncus ridges. For the second example the multilevel-analysis of pathogenesis of conotruncus septum defects in Keeshond dogs was selected. At the organ level, hypoplasia of the right ventricle was diagnosed, accompanied by hypoplasia of conus cushions. Tissue-level analysis indicated that the major cause of these hypoplasias is a decreased relative volume of the myocardium. Further study at the cell level showed that the number of mesenchymal cells in certain parts of conotruncus cushions is also diminished. Combining these observations with what is known about the architecture of cell proliferation in the embryonic heart, allows to formulate a hypothesis on a selective lesion of the right proliferation center, as one of the main causes of the observed anomalies. Further progress towards the subcellular and molecular level will help to complete the pathway from a gene defect toward an organ defect.

The examinations described here were made in order to answer the question - how often, in spite of suspicious CTG patterns during the second stage of labor, were the fetal blood tests normal, and a spontaneous delivery or a further propulsion of the presenting part could be expected? The data of 201 patients formed the statistical basis for this survey; these patients were delivered at the Department of Obstetrics in Berlin- Neuk olln Hospital during the period from September 1975 to September 1976. Each patient had a suspicious Hammacher Score (greater than or equal to 3 points) during the second stage of labor, and due to this, the fetal acid-base balance had been examined. The course of 201 labors was divided up into those where the CTG first necessitated a fetal blood analysis in the mid-pelvic plane (n = 159) and those where the FBA was not necessary before the fetus was on the pelvic floor (n = 42). It was shown that with an increase in CTG score points the proportion of pH levels less than or equal to 7.24 increased. The peak of frequency division was at 4 points. In this group however, there was only a pH level of less than or equal to 7.24 in 4.2% of the infants. Acidotic pH levels were only present after greater than or equal to 5 score points. Here it was not possible with the CTG score to give definite evidence about the real risk to the fetus in a single case.(ABSTRACT TRUNCATED AT 250 WORDS)

Although it has been documented in many studies that optimal monitoring of the fetus during labor is only achieved through a combination of cardiotocography (CTG) and fetal blood analysis, up to now no uniform guidelines exist as to when fetal blood analysis should be performed. Furthermore, there are still many obstetricians who decide on their delivery procedure entirely on the basis of CTG. We have therefore examined the question of how accurately intrauterine risk situations of the fetus can be recognized in individual cases by using the Hammacher score only from particular CTG patterns. The data from 407 patients formed the statistical basis. All these patients had been delivered between January and September 1979 at the Department of Obstetrics at the Women's Hospital in Berlin-Neukölln. In all cases, at least one fetal blood analysis had been performed on account of a suspicious CTG during the course of labor. All actual pH values were combined with the Hammacher score of the corresponding 30-min-interval, and in addition we recorded the CTG patterns seen. We observed that the CTG was at least suspicious (greater than or equal to 3 points) in 79,3%, while the fetal blood analyses performed immediately afterwards were normal in 78,1%; only in 11,7% it was reduced to 7,29-7,25 and in 10,2% it was less than or equal to 7,24 (incl. 3,9% less than or equal to 7,19). The probability that a high score was associated with a reduced pH increased from 2% at 0-2 points, to 26,3% at greater than or equal to 5 points.(ABSTRACT TRUNCATED AT 250 WORDS)

A diagnostic programme has been recommended for cardiotocography in pregnancy. It is designed to non-stress testing and includes the oxytocin exposure test for better assessment of both oscillations and accelerations, depending on foetal movement, without or following arousal stimulus. -- Up to 95 per cent of all findings are obtained from non-stress or negative oxytocin exposure tests which are highly dependable diagnostic indicators to sufficient oxygen supply to the foetus. A pathological oxytocin exposure result would call for differentiated selection of those frequency images which do support suspicion of hypoxia, but these account only to something between two and five per cent among all high-risk pregnancies under conditions of selective cardiotocography.

On the basis of our own experience and the literature the risk of acidosis, which corresponds to the risk of asphyxia, during vaginal delivery of breech presentations is examined. Compared with delivery of vertex presentation it is 3-10 times greater. The risk of acidosis does not depend on the duration of pregnancy and only a little on the parity of the mother. Even with carefully selective indication for primary Caesarean section it cannot be reduced below the high level. Typically there is acute compression of the cord at the end of the first or later stages of labor. Even with intensive intra-partum care it cannot safely be predicted with sufficient certainty. As a criterion of the efficiency of modern obstetrics the impact of acidosis in umbilical blood and its increase in breech presentation is discussed. Only systematic Caesaren section before or early in labor will lower the risk to that of vertex presentation. This is done and recommended by the authors. Links between acdosis in umbilical blood and permanent cerebral damage are probable but by no means certain and their importance in unknown. Selective indication for Caesarean section which has to be made generously, represents an acceptable alternative.

A study about continuous intrauterine pO2-measurement of the human fetus sub partu. It is reported about a continuous intrauterine unbloody pO2-measurement of the human fetus sub partu. There was found a good correlation in different cardiotocographic patterns between labour, fetal heart frequency and pO2-registration.

A group of 29 patients who had premature labour contractions were chosen to take part in this study. All were cardiovascularly healthy. Their performance during a step climbing exercise was examined in relationship to a Fenoterol-tocolysis (30-60 mg/day) and to the amount of exercise. The fetal heart rate showed no pathological changes following the exercise, as compared to the preexercise values. An external tocometry showed the uterine activity also to be uninfluenced.

The results from animal experimental research have shown that the infusion of dextran 40 increased the uterine blood flow mainly by decreasing the vascular resistance and by this improving the oxygen supply to the fetus. Dextran 40 given in a dosage of 50 ml/min within 10 minutes to 11 pregnant women during parturition showed that the fetal blood PO2 increased if the PO2 before infusion was low and decreased if the PO2 before infusion was high. Therefore the question enhanced if the reduced maternal oxygen capacity results in a reduction of fetal PO2 (tcPo2) too. After informed consent 10 healthy pregnant women at term with a normal pregnancy got an infusion of 500 ml dextran 40 during 30 minutes. The following maternal parameters were measured: heart rate, mean arterial blood pressure, intrauterine pressure and transcutaneous carbon dioxide tension (tcPCO2). Maternal microrheological parameters before and after infusion of dextran 40 were estimated as following: plasma viscosity, erythrocyte aggregation, serum osmolality, colloid osmotic pressure, hemoglobin and haematocrit. The mothers were laying in the side position and their ventilation was controlled by tcPco2 (Dräger, Lübeck). The following fetal parameters were registered: basal fetal heart rate, transcutaneous fetal oxygen partial pressure (tcPo2) and the umbilical cord blood gases. After rupture of the fetal membranes and at a cervix dilatation of about 5-7 cm a tcPo2 electrode (Dräger, Lübeck) was fixed at the fetal scalp with an acrylate glue (Histoacryl) and by this fetal tcPo2 and its "flow" registered.(ABSTRACT TRUNCATED AT 250 WORDS)

A pain free period during the first stage of labor is made possible by paracervical block anaesthesia. The extent of risks for the fetus using this method of anaesthesia is measured by different means. Changes of the fetal heart rate after paracervical block must be regarded as a complication. During the period of ten years paracervical block anaesthesia was performed in 10.041 cases in our hospital (Landesfraunklinik Wuppertal). The analysis of all cardiotocograms taken shows changes of the fetal heart rate after paracervical block in 11,3%. Carbostesin with adrenalin (0.5%) was used, 5 ml were injected on each side. Motility disturbances of the uterus and the vena cava-syndrome are clinically evident because of the various reasons for bradycardy. ECG analysis detects a suppression of the sinus-atrial node as a stimulator. During the period of bradycardy after paracervical block Caesarian section is not indicated. A conservative attitude is justified with the patient in a lateral position. Disturbances of uterine motility and long periods of bradycardy call for intrauterine resuscitation with the application of Partusisten (Th 1165) under constant control of maternal circulation. If there are other reasons for a Caesarian section an improvement of the fetal heart rate--as shown in the cardiotocogram--should be achieved in any case.