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Using a discriminance analysis we investigated the interactions between parameters of the vaginal flora and subclinical infection regarding preterm birth. The prospective study includes 222 single pregnancies, 114 of them with preterm labour or premature rupture of the membranes (PROM). The analysis includes information of a vaginal/ cervical smear (total number of pathogenic germs, species and groups of pathogenic germs), vaginal pH, maternal white blood cell count (WBC), C-reactive protein (CRP) and temperature. A normal vaginal flora was found in only 19%. Pregnancies with preterm labour have a higher quantity of pathogenic germs, whereas there is no difference of the germ group distribution. Moreover, pregnancies with preterm labour and 2 or 3 pathogenic germs have a higher rate of preterm birth. The discriminance analysis shows that only the affiliation the risk group with preterm labour and the parameters CRP and WBC have a significant selectivity for consequent preterm birth, but not the parameters containing information of the vaginal flora. The same is valid for the group with preterm labour, where only the parameters PROM and WBC are able to select significantly for preterm birth.

We investigated 69 healthy women with normal pregnancy and delivery in order to establish normal values for the second trimester of gestation. In a cross-sectional study we measured the pulsatility index (PI), the maximal systolic velocity (V-MAX) and the mean velocity (V-MEAN) in the uterine arteries (UAA), the umbilical artery (UA), the fetal thoracic aorta (FTA) and the middle cerebral artery (MCA) from the 14th to the 24th week of gestation. A regression analysis shows a significant slope of the PI of UAA and UA (p < 0.01), whereas in contrast to the UA there is no significant difference of the median values of the UAA-PI from the 18th week of gestation. With progressive gestation V-MEAN of UAA increases more (p < 0.001) than V-MAX (p < 0.05) as a result of the increasing diastolic blood flow. In the UA there is also a significant rising trend of V-MAX and V-MEAN (p < 0.0001). No significant changes of the PI of FTA and MCA are seen, although there is a slight increasing trend. After the 20th week in the MCA a marked tendency to high PI-values is observed, whereas there is a change between different flowpatterns prior to the 20th week. V-MAX and V-MEAN of FTA increases significantly, but there is no change in the MCA. Our results for UAA and UA correspond to the known morphologic changes in the utero- and fetoplacental vessels in the second trimester and are comparable to other results. Particularly the physiology of the cerebral perfusion needs to be investigated more intensively. These normal values provide a good basis for early and complex assessment of a disturbed perfusion in the second trimester.

Ascending infections of the female genital tract as a cause of preterm birth have become major importance regarding the prevention of preterm birth. Measurements of the vaginal pH value are able to verify a alkalinisation of the vagina caused by a atypical vaginal flora. In a prospective study we measured the vaginal pH value using indicator paper and evaluated the results of a vaginal and cervical smear of 162 single pregnancies from 26 to 30 weeks of gestation. In contrast to normal pregnancies there is a relation between a pathological pH value > 4.5 and consequent preterm birth in pregnancies with preterm labour but also in pregnancies with other risk factors without symptoms of preterm labour.

The faulty origin of the left coronary artery from the pulmonary artery is with an incidence of 1:300,000 newborns a very rare heart defect. We report a case of a pregnancy with two intrauterine blood transfusions in the 30th and 32nd week of gestation because of Rh-incompatibility and fetal anaemia. Dopplersonographic and echocardiographic parameters were normal. In the 32nd week of gestation delivery was induced (birth weight 2240 g, cord pH value 7.35, Apgar-score 8/9/9). Under a therapy with respiration, blood exchange transfusion and cardiotonic drugs the newborn died in the second week. The autopsy showed a general immaturity, a haemosiderosis of spleen, liver and lungs, a marked cellular jaundice and signs of a multi-organ-failure. The sinus of the pulmonary valve was the origin of the left coronary artery. In case of a seriously impaired pumping action and after exclusion of other heart defects the Bland-White-Garland-Syndrome (BWGS) has to be considered. Although a prenatal diagnosis of BWGS is with high resolution-ultrasound possible, the early postnatal diagnosis seems to be more relevant.

In a prospective study we investigated 100 twin pregnancies in order to assess the predictive value of doppler-sonographic measurements regarding the pregnancy outcome. We used the pulsatility index of the uterine arteries, the umbilical artery, the fetal aorta thoracica and the fetal middle cerebral artery. The measurements were obtained at various gestational ages between 24 and 32 weeks. Significant differences between unselected twin pregnancies and normal single pregnancies were not found. Moreover, there is no relation between the severity of an impaired perfusion and an adverse outcome of the pregnancy. The prediction of fetal distress (hypoxia, preterm birth, poor fetal growth, acidosis, and disturbed neonatal adaption) with doppler-score has a sensitivity of 25% and a positive predictive value of 63%. From this rather insufficient result we conclude that doppler screening in unselected twin pregnancies hardly proves to be useful.

The aim of the present study was determination of the complex character of hemodynamic disturbances in uteroplacental, fetoplacental and fetal vessels as well as their influence on the outcome of pregnancies suspected to have IUGR on ultrasound examination. A special form of Doppler scoring was implemented for documentation of the hemodynamic disturbances. Of 82 single pregnancies with sonographically suspected IUGR, 30 women gave birth to eutrophic babies whereas 52 mothers delivered hypotrophic newborns. However, 43 cases of the hypotrophic babies had birth weight below the 5th percentile. The median values of Doppler indices for those with eutrophic babies revealed no significant differences compared to normal collective. However, significantly elevated RI and PI values in both uterine arteries, the umbilical artery and fetal descending aorta of pregnancies which resulted in hypotrophic babies indicated hemodynamic disturbance. The umbilicoplacental and uteroplacental vasculature compartments were almost equal involved with a proportion of 39% or 30% respectively. Birth weight < or = 5th percentile was associated with a further increase of pathological values in this both vascular areas. Significant rang correlations between values of Doppler indices and clinical parameters indicated a direct association between perfusion disturbances and fetal outcome of the pregnancies studied. The present Doppler score, which is a summary of all separately evaluated examined blood vessels, is suitable for clinical implementation and showed a good correlation to the clinical parameters in our study. Therefore Doppler perfusion measurements should play an important role in the clarification of suspected fetal growth retardation.

Moles and coexisting living fetus are rare. Most cases are twin gestations. We report a case of a single placenta with focal hydatidiform mole of the placenta and a coexisting living fetus. The fetus with hypotrophy was born in the 34th weeks of gestation with a normal diploid female karyotype. The placenta showed a complex alteration of the non molar part with consecutive vascular hyperplasia. The differential diagnosis of molar pregnancies and coexistent living fetuses are discussed. Postpartal are cytogenetic examination of fetal tissue (skin biopsy) and both parts of the placenta, the molar and non molar, necessary. In each case should be a postpartal measurement of beta-HCG in serum of the mother to rule out a gestational trophoblastic disease.

The aim this study to compare perfusion parameters, measured by Doppler sonography, between normal pregnancies and pregnancies with symptoms of preterm labor. The patient collective comprised of 3 groups: 62 normal pregnancies (group 1), 23 preterm labor before tocolysis (group 2) and 114 preterm labor up to 48 hours under tocolysis (group 3). In each case pulsatility index was measured in the uterine artery on the placental side and non-placental side, umbilical artery, fetal descending aorta and middle cerebral artery. In the contrary to patients in group 1, patients in group 2 and 3 showed significantly elevated PI values in uterine artery placental side and non-placental side, respectively. The median of PI for both uterine arteries in both groups was significantly higher compared to that of group 1. However, 1/3 of patients with preterm labor showed pathologic uterine perfusion before or during tocolysis. The values of PI in umbilical artery, fetal descending aorta and middle cerebral artery did not reveal significant difference in all group. Nevertheless, 30% of pregnancies with preterm labor have pathological perfusion in the fetal descending aorta. We conclude that some patients with symptoms of preterm labor have pathological perfusion in uterine arteries and fetal descending aorta not induced by uterine contractions. We believe that the complex assessment of uterine perfusion should include the median PI value of both uterine arteries in order to have a reliable information. A short-term intravenous tocolysis with betamimetics does not seem to have a positive influence on the hemodynamic insufficiency.

The reproducibility of Doppler blood velocity profiles of the umbilical arteries within the umbilical cord is a special problem because of the difficult separation and extreme torsion of both vessels. Resistance-(RI) and pulsatility index (PI) have been assessed on two different locations immediately one after the other in 90 pregnancies with signs for premature labor, including 16 cases with premature rupture of membrane. For comparison the same measurements have been performed in 33 normal pregnancies. There was a significant correlation between the first and second assessment. However, the correlation coefficients of cases with premature labor are lower than in normal pregnancy. This underlines the necessity of at least two repeated measurements for these patients with signs of premature labor.

Based on the current view about disturbances of the feto-materno-placental unit we examined 37 women with suspected intrauterine fetal growth retardation and 12 women with threatened premature labor and looked for possibilities of antenatal therapeutic influence of nutritive, respiratory, endocrine and hemodynamic insufficiency. In a randomized study we can prove a normal increase of the distance between symphysis pubis and fundus as well, as the biparietal diameter not only following bedrest but also following bedrest with additional intravenous infusion of glucose respectively oral application of galactose. The high rate of hypotrophic babies is no argument against a positive influence on nutritive insufficiency, but the acquired retardation can not be compensated totally. Neither a positive influence on the endocrine insufficiency nor the moderate respiratory one could be found. As well by maternal transcutaneous nerval stimulation as by maternal oxygen inhalation an oral long-term tocolysis we can demonstrate a considerable improvement of the uteroplacental perfusion measured with isotopes. These positive aspects are basis for further investigations. An important supposition to a successful therapy remains an early diagnosis.

The authors are involved in a study in the field of nuclear medicine aimed at further clarifying the connection between premature delivery and placental insufficiency. They are particularly concerned with uteroplacental perfusion at the time when a trend is emerging toward premature birth, and with ways of treating this by exclusive therapy using betamimetics and/or additional maternal oxygen inhalation/additional maternal transcutaneous dorsal nerve stimulation (TNS). The significantly longer half-life periods of activity increase found at the time of hospitalization similar to pregnancies with intra-uterine fetal retardation, as compared with a normal control group, are interpreted as expressing a hemodynamic placental insufficiency and a risk of premature delivery. In contrast to exclusive betamimetic therapy, additional O2 inhalation/additional TNS significantly shorten the half-life period both in short-time and long-time tests. The better therapeutic effect on uteroplacental perfusion in cases of imminent premature delivery which is thus demonstrated can be seen also in an improved respiratory condition of the fetus as shown in a cardiotocogram. From a clinical point of view, the authors call attention to the clearly prolonged pregnancy periods regardless of the duration of gestation, at the time when a trend is emerging toward premature birth, as compared with exclusive betamimetic therapy, the duration of tocolysis/amount of betamimetic applied being the same.