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A 35 year old primigravida with a triplet pregnancy developed polyuria and epigastric pain in the 31st week of pregnancy. During that week, emergency cesarean section was performed due to evidence of liver disease and imminent fetal hypoxia. Three girls were delivered who were healthy apart from transient neonatal respiration distress syndrome. Following surgery, the mother developed HELLP syndrome with hemolysis, increased transaminases and thrombocytopenia. She also developed diabetes insipidus with daily urine outputs of up to 7000 ml and poor response to desmopressin. Both the HELLP syndrome and the diabetes insipidus resolved spontaneously within ten days. In pregnant patients with right upper quadrant pain, HELLP syndrome or acute fatty liver of pregnancy should be considered. The association of diabetes insipidus with acute fatty liver of pregnancy is an established, but rare phenomenon. As far as is known, this is the first report of a patient presenting with a combination of HELLP syndrome and diabetes insipidus. Patients with HELLP syndrome have a good prognosis, if the diagnosis is early and the pregnancy terminated at the right time. With close supervision further pregnancies are possible.

Size and shape of the bony pelvis are important factors determining the progress of labor and delivery. Clinical evaluation of the pelvis and sonographic examination of the fetal size are important tools for the planning of labor and in most cases allow to diagnose cephalopelvic disproportion. Pelvimetry by computed tomography (CT) and by magnetic resonance imaging (MRI) are exact and simple techniques with low or absent ionizing radiation. These new techniques offer distinct advantages over conventional X-ray pelvimetry. However, the value of the measurements of the pelvic dimensions in predicting labor outcome and in the diagnosis of cephalopelvic disproportion remains limited. Only if the pelvimetric data are combined with data on fetal dimensions obtained by ultrasound or by postpartum measurements, the efficacy of the examination in predicting the success of labor and identifying the presence or absence of cephalopelvic disproportion is increased. This combination therefore may confirm the diagnosis of cephalopelvic disproportion after operative delivery, which is important with respect to subsequent deliveries. Furthermore this method could play and important role in selecting patients with term breech presentation for possible vaginal delivery.

There is conflicting evidence on the influence of infections with Chlamydia trachomatis and Mycoplasma hominis on male and female infertility. We studied the prevalence of Chlamydia and Mycoplasma in male partners of 165 infertile couples. 25% of couples with tubal and/or andrological sources of infertility showed positive cultures for Chlamydia and/or Mycoplasma compared with 10% of couples with other causes of infertility. Our data suggest, that screening for Chlamydia and Mycoplasma in infertility patients may be of assistance.

We report on our experience with the induction of labour using 0.5 mg of prostaglandin E2 gel (Cerviprost, Organon) intracervically. Out of 43 cases, 27 were primiparae. Indication for induction was: 10 post-term pregnancies, 9 PROM's > 24h, 12 foetal and 11 maternal indications. Mean Bishop score before induction was 3.1 and 9 hours later or at the beginning of regular contractions 6.7. In 9 of the 43 cases induction was unsuccessful. There were 23 spontaneous vaginal deliveries, 6 forceps and 5 Caesarean sections. Uterine hyperstimulation was found in 6 cases, 5 of which occurred during the first 16 inductions, and only one was seen during the following 27. A possible reason may be unrecognised extra-amniotic application of the gel. Intracervical prostaglandin seems to be an appropriate method not only for cervical ripening but also for induction of labour in cases with a low Bishop score. Although side effects are rare, sufficient monitoring and control of mother and foetus are mandatory.

Of 149 laser laparoscopies 50 were performed for adnexal masses. Histological evaluation revealed benign cysts in 54%, endometrioma in 24% and other benign tumors in 14%. In 2 cases, a mucinous cyst was diagnosed, in 1 case a borderline ovarian tumor and in 1 case adenocarcinoma was found. There were no complications. 10% of the patients underwent secondary laparotomy. During the observation period, 6% of the patients required operation for recurrent disease. Low complication rate, little blood loss and a short hospital stay are advantages of laparoscopic surgery.

The aim of screening for infectious diseases in pregnancy is to identify subjects who are at risk of a specific infection, which lends itself to effective intervention. The value of routine screening is determined by the validity of the test and the prevalence of the disorder in the population. During pregnancy, serological screening for rubella, syphilis, toxoplasmosis, HIV, hepatitis B and bacteriological screening for asymptomatic bacteriuria and gonorrhea is recommended. The search for additional infections is reserved for patients presenting special risk factors or clinical symptoms.

Report about practical experience with concentration of high risk pregnancies in a regional center. It is better to transport the fetus in utero than to transport the neonate.

Cortical blindness without retinal changes is a rare complication in preeclampsia. We report two patients, both of whom developed cortical blindness one and two days post partum. In one of these patients, the blindness occurred following eclamptic seizure. In both patients the total blindness recovered fully after two and three days respectively following treatment for hypertension and cerebral edema. Spasm of small vessels in the occipital cortex is assumed to be the cause of this complication.

In a retrospective study of their autopsy cases the authors investigate the presence of lymphocytic infiltrations in the thyroids of 44 diabetics up to age 55 and compare these thyroids with 72 post-mortem controls. Size and number of the infiltrations were determined by a semiquantitative method on the histological slide. The non-diabetic controls and the non-insulin-dependent diabetics included 5 out of 72 (6.9%) and 3 out of 31 (9.7%) cases respectively with more than 10 infiltrations per 100 mm2 thyroid tissue. The insulin-dependent diabetics, however, showed significantly more, i.e. 5 out of 13 (38.5%) patients with more than 10 infiltrations per 100 mm2 tissue. All were asymptomatic with the exception of one young diabetic with clinical signs of hypothyroidism.

105 biopsies of nonpalpable breast lesions were performed because of suspect X-ray findings. 68 lesions were preoperatively marked under X-ray control, 37 under ultrasound control. Histological examination revealed invasive and in situ carcinomas in 8 and 13% of the cases, respectively. The sensitivity of X-ray mammograms was superior to ultrasound, whereas the predictive value of ultrasound in the presence of suspect findings was superior to x-ray examination. However, because of its low sensitivity, sonographic examination cannot be recommended as a screening procedure in the diagnosis of nonpalpable breast lesions.