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Actual situation of sonographic diagnostics stresses the performance of screening investigations in each trimester of pregnancy. Recommended periods are the 10th, 20th and 32nd week of gestation. The major intention of the programme consists of the assessment of abortions, fetal malformations and fetal growth retardation. The efficiency of the screening in the detection of clinically latent pathology attains 15, 0.5, and 4.5 per cent, respectively, in each trimester.

Besides characteristic morphological differences, carcinomas of the breast show remarkable changes of vascularity, which are essential for their enhanced metabolism. High-frequency CW Doppler allows to investigate normal and pathological vascularisation in the breast. In our basic study we examined 200 patients, 37 with breast malignancies (6 non-palpable lesions). 33 of the carcinomas showed pathological vascularisation. In an extended examination procedure we investigated also normal breast vascularisation and compared it with blood flow in lesions. We developed therefrom an easy and rational method which allows physiological blood flow measurements as well as a differentiation of breast lesions within a few minutes' time.

Breast ultrasound has mainly been used for differentiation of cystic and solid lesions. With high resolution technique, which was introduced several years ago, early cancers can now be detected by ultrasound. In this study, 1016 women were examined within 3 months. Mammography was used independently. According to the expected prevalence, 4 nonpalpable carcinomas were detected by sonography. The study proves that high-quality ultrasound equipment allows a primary detection of subclinical breast cancers. In premenopausal patients the sensitivity of mammography is reduced. Therefore, ultrasound should be used complementary to mammography in this age group. Widespread use is not possible due to a deficiency in experienced staff. However, in experienced centres, ultrasound could be used as a supplement to mammographic screening to prove if breast cancer mortality in premenopausal women can be reduced.

After a largely inconspicuous pregnancy, a 31-year old primipara suffered from a status epilepticus in the third trimenon. The convulsions could not be terminated by emergency medical services, resulting in aspiration of gastric contents. Assuming eclampsia, an emergency caesarean section was performed immediately in a central hospital. Postoperatively, a pathological pattern of tendon reflexes was noticed. A CT scan revealed subarachnoid haemorrhage. The causal aneurysm of the right A. pericallosa was clipped subsequently. Eclampsia is the leading cause of epileptic seizures during pregnancy. However, a different aetiology should always be considered, especially if medical history does not reveal symptoms of pre-eclampsia.

The obstetrician's expectations of anaesthetists are high and include a high level of competence at a specialist level, experience of the delivery room, a calm but fast and ordered way of working, a tactful and enquiring approach and the ability to work in an interdisciplinary environment. In the area of organisation the obstetrician and the anaesthetist should, through optimal cooperation, have a good understanding of the procedural plan to ensure the safety of mother and child. This includes working in close proximity, regular joint consultations and early preinterventional contact with the pregnant patient in order to inform them of the anaesthetic options and their inherent risks. Despite the undoubted successes resulting from the cooperation between obstetricians and anaesthetists, as shown by the reduction in mother and child mortality rates, the current structured and medical circumstances are not optimal and should motivate both disciplines towards improved joint care.

The amount of amniotic fluid was determined semiquantitatively in 600 pregnancies between the 12th and 41st week of gestation. Pregnancies at risk were excluded. The largest amniotic fluid area was measured sonographically in two dimensions. The mean plus/minus standard deviations are correlated with gestational age. A diagram has been prepared. Our results show good correlation with values from invasive quantitative examinations of amniotic fluid amount. However, our procedure is easy to perform and without hazard for the pregnancy, since it is non-invasive.

31 triplet pregnancies (DG), treated during 1975-1989, were analysed retrospectively. 13 DG (D10) were registered up to the end of the 10th week of pregnancy, 16 (DG) (D16) were intact between the 11th and the 16th gestational week. 3 DG resulted from the reduction of high grade multiple pregnancies. 18 DG (62%) of the initial 29 DG had previously been treated for sterility. The spontaneous foetal loss (DF) in group D10, including the perinatal mortality, amounted to 26% (10 of 39 DF). In one case of this group, a previously vital DF died. In another case, a partial bi-phasic abortion occurred followed by a premature birth of the surviving 3rd DF. The mortality rate in group D16, including the perinatal mortality (4 DF), was 25% (12 of 48 DF). 30 DG were still intact after the 16th week of pregnancy. 2 DG (7%) suffered from EPH-gestosis. In 4 DG (13%) a foeto-foetal transfusion syndrome occurred. 5 DF (6%) had some of the serious malformations. 27 DG were completed. 7 DG (26%) ended before the 32nd gestational week. In 13 DG (48%), a Caesarean section was performed. The perinatal mortality amounted to 11% (9 of the 81 DF) including all the births from the 25th gestational week upwards. On comparing these results with the data in the literature, a significant improvement in the prognosis of DG in recent years can be observed. This is due to the progress in antenatal and neonatal care.

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix. The bowl-shaped pessary is inserted with the curvature upwards and the cervix is fixed in the central opening of the cerclage pessary. Thus a constriction, reconfiguration, and elongation of the incompetent cervix is obtained as evidenced by ultrasonography. The only side effect of the pessary treatment is an increase in cervical secretion and subsequent vaginal discharge. No infectious complications occurred. In 92% of the treated gravidae the cerclage pessary could be removed after the 36th week of gestation. Cerclage pessary can be recommended as a favourable alternative to surgical procedures as prophylactic or therapeutic approach, reducing surgical treatment significantly to less than 0.5%.

We report on the prenatal diagnosis of a Pena-Shokeir syndrome sporadic case of the 27th week of pregnancy. Typical sonographical features are polyhydramnios, hypoplasia of lungs, foetal akinesia, reduced length of proximal and distal extremities and a striking discrepancy between biparietal and abdominal diameter. Differential diagnosis of polyhydramnios caused by foetal neuromuscular disorders is discussed.

The sonographic equivalent of the morphological changes of the ovaries in the physiologic menstrual cycle is the periodic evidence of cystic or solid ovarian structures. The selection of the follicle destined for ovulation occurs from a number of many small antral follicles. The initial polymicro follicular reaction the timing of selection differentiates the follicular phase in the selection and in the maturation phase. The selection phase is the limiting temporal part of the cycle. The maturation occurs usually in a unifollicular manner. The daily growth of the dominant follicle (maturation rate) is in most cases not constant. Usually an intraindividual or inter-individual variability of the maturation rate of a mean 2.5 mm per day is present. Preovulatory a non significant delay in the maturation occurs. The sonographic prediction of ovulation is indirect and determined by the timing of selection, the size of the selected follicle, the maturation rate and the size of the preovulatory follicle. The diameter of the dominant preovulatory follicle is 23.1 +/- 2.8 mm. In individual cases solid structures in the preovulatory follicle are recognized which probably correspond to the cumulus oophorus. The corpus luteum structure is significantly larger than the preovulatory follicle with a size of 28.1 +/- 6.7 mm. Corpus luteum cysts can persist until the maturation phase of the next menstrual cycle. The shift from corpus luteum to dominant follicle of the next menstrual cycle can occur alternating between ovaries or homolaterally .

We retrospectively analyzed 95 intact twin pregnancies (GG) only diagnosed by sonography during the period 1977-1987: 48 GG were registered up to the 10th week of pregnancy (G 10), 90 between the 11th and the 16th week of pregnancy inclusive (G 16). In the group G 10, this spontaneous fetal loss, including the perinatal mortality amounted to 10.9% (10 of 92) twins (GF). In 5 cases from this group, a previously vital twin was lost before the 10th week. The loss in group G 16, including the perinatal mortality, was 9.7% (17 of 176 twins GF). An early or late abortion occurred in 6 cases (6.8%) and dies perinatally in this group. 82 GG were carried out to full term. 38 women (46.3%) had premature births, 12 pregnancies (12.6%) ended before the 34th week of pregnancy. The perinatal mortality rate amounted to 3.0% (5 GF), 4 (2.3%) of 172 GF had serious malformations. In 6 GG (7.4%) the weight of the twins differed more than 25%.

In 18 cycles of 16 patients the morphological changes following stimulation by human gonadotrophin were followed by ultra-sonography and radio-immunoassays of 17 beta-estradiol and progesterone (HMG). In 9 of 18 cycles hyperstimulation with more than 3 follicles on the day of chorionic gonadotrophin administration were found. When the human menopausal gonadotrophin treatment (HCG) results in the maturation of more than 10 follicles per ovary the estradiol level reaches more than 2000 pg/ml. In 4 of 8 cycles the administration of HCG triggered the hyperstimulation syndrome. In 5 of 18 cycles pregnancy was induced after a follicle of at least 17 mm diameter was found independant of the number and size of concommitant follicles. Because of the high incidence of HMG hyperstimulation ultra-sonographic prediction of a multiple pregnancy is of no practical value. In 6 of 10 treated cycles without success the deformation or unclear margins of the predominant follicle suggested an insufficient stimulation with HMG. For the monitoring of follicular maturation ultrasonography is superior to estradiol determination since only a large number of follicles showed correlation to elevated estradiol levels.

At 1188 patients we investigated the value of sonography of the breast in the detection of malignancies. We used 2 automatic multitransducer water-bath scanners, at first the 3 MH Octoson, then System 1, a dedicated 4 MH water-bath breast scanner which allows for compound and simple scans in any scanning plane. The sensitivity for detection of 63 malignancies was 87%. Other pathologies were 18 fibroadenomas, 160 cysts, 6 abscesses, 2 fatty necroses, 2 papillomas, 9 prostheses, one of them broken. The difficulties associated with differential diagnosis in breast sonography are discussed in detail.

Die pranatale sonographische Diagnose von Bauchwanddefekten und Stenosen des Intestinaltraktes ist heute mit wenigen Ausnahmen wahrend der Screening-Untersuchung in der 20. SSW moglich. In einer retrospektiven Studie werden 56 Fehlbiktungen in diesem Bereich untersucht, die im Zeitraum von 1973-1985 an der Universitats-Frauenklinik Freiburg sonographisch diagnostiziert wurden. Neben sonographischen Diagnosekriterien wurden Atiologie, Haufigkeit und Prognosefaktoren. Schwangerschafts- und Gcburtsverlauf sowie postpartales Management beschrieben. Die direkte sonographische Erkennungsquote in diesem Bereich ist von zunachst 26% auf 91% angestiegen. Die schlechteste Prognose hatten Kinder mit Zwerchfellhernien und Omphalozelen, die beste Prognose Kinder mit Stenosen im Duodenalund Dunndarmbereich. Today prenatal Sonographic diagnosis of abdominal defects and stenoses of the intestine is possible without few exceptions during general Screening in the 20th week of gestation. In a retrospektive study. 56 malformations in this area were investigated, which had been diagnosed at the University Hospital Freiburg during 1973 and 1985. Besides the criteria of Sonographic diagnosis the etiology, incidence, prognostic factors, the course of pregnancy and delivery and the postpartal management are described. The rate of direct Sonographic diagnosis in this area has increased from 26% up to 91%. The worst prognosis was found in infants with diaphragmatic hernias and exomphalos, whereas infants with Stenosis of duodenum and small intestine had the best prognosis.