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In pre-eclampsia hemodynamic alterations are characterized by a lack of plasma volume expansion and a raised peripheral vascular resistance. For the compensation of plasma volume deficit and to restitute blood fluidity the therapeutic use of plasma volume expanders (f.e. low molecular dextran) is recommended. Several groups (Goodlin et al., Cloeren et al., Heilmann et al., Seghal et al., Schröck) have demonstrated benefitial effects on fetal status and development in the course of hypervolemic hemodilution in preeclampsia. This therapeutic procedure presumes the continuous surveillance of maternal hemodynamics to early recognize heart insufficiency or fluid overload in the lungs. We use the noninvasive thoracic impedance cardiography for continuous monitoring of maternal heart performance. The effect of hypervolemic hemodilution on fetal circulation has not been quantitatively investigated yet. Meanwhile pulsed doppler ultrasonography offers the possibility of estimating quantitative changes on fetal blood flow. We used both noninvasive techniques--thoracic impedance cardiography and pulsed doppler imaging system--for the simultaneous evaluation of maternal and fetal hemodynamic parameters during hypervolemic hemodilution. This preliminary report summarizes the investigations in 5 patients with pre-eclampsia (mean arterial blood pressure greater than or equal to 103.3 mm Hg, hemoconcentration with elevated hematocrit levels greater than or equal to 38%). The patients received an infusion of 500 ml dextran 40 over a period of exactly 60 minutes. The simultaneous measurements of maternal and fetal cardiovascular parameters were performed in 15-minutes intervals during dextran application and 15 minutes (p 15), 30 minutes (p 30) and 60 minutes (p 60) after the end of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Using ultrasonic A- and B-scan equipment (Kretz-Technik), 80 pregnancies with chronic placental dysfunction were investigated: 34 cases with hypertension, 24 cases with diabetes and 22 cases with rhesus immunization. In addition to biparietal diameter (A-scan), the direct and transverse diameter, the circumference and the area were estimated on B-scan displays of the occipito-frontal plane and the largest cross-sectional plane of the abdomen. 15 parameters of fetal growth and body composition were compared with normal standards. The significance of the different methods in the diagnosis of fetal dysmaturity was demonstrated.

A case of hydramnion by congenital myotonic dystrophy is presented. By a 31 years old primipara typical causes of hydramnion as fetal malformations, immunologic or non-immunologic hydrops, diabetes mellitus or intrauterine infections could be excluded. Because of a severe fetal dystrophy with imminent asphyxia a caesarean section has been performed in the 35th. week of pregnancy. The newborn showed all clinical symptoms of congenital myotonic dystrophy and died after four weeks in a respiratory distress. A muscle biopsy of the m. quadriceps confirmed the diagnosis. EMG examination of the parents revealed a conductoring state of the mother. Possible causes of "idiopathic" hydramnion and possibilities of prenatal diagnosis of congenital myotonic dystrophy are discussed.

In attempt to estimate birth weight in utero several dimensions of fetal head and trunk cross-sections, obtained by ultrasonic A- and B-scan techniques (Kretz-Technik), were related to postnatal weights in 108 normal and abnormal pregnancies. Abdominal parameters showed better correlation with weights than did head parameters. Evaluations derived from mean diameter, circumference or area yielded more accurate estimations than those derived from single diameter. In addition, the combination of both head and abdomen measurements increased accuracy. The best results were obtained by planimetric determination of head and trunk cross-sectional areas. Using this method the standard error of estimates was 233 gm. as compared with 423 gm. employing biparietal diameter alone.

In 199 patients with female genital tract tumors the preoperative diagnosis recorded by palpation and ultrasound examination with the A and B apparatus of Kretz were compared with the microscopic findings at laparotomy. The sonographic description of the findings was accurate in 60% of the cases, largely correct in 33% of the cases and mostly erroneous in 7% of the cases. By palpation a correct diagnosis was made in 38% of the cases, largely correct diagnosis was established in 45% of the cases and a mostly erroneous diagnosis was made in 17% of the cases. With tumors up to 4 cm. in diameter, both methods were of approximately equal value. A prognosis as to the likely histology was not possible with the ultrasound technique. A prediction as to malignancy was possible in many cases. Only 4% of the homogenous tumors were malignant whereas 27% of the inhomogenous tumors were malignant tumors.

Breast sonography is a well-accepted diagnostic method. For differentiation between benign and malignant lesions quantified sonography is gaining increased importance. In addition to measurements of velocity, attenuation and elastic properties of tissue, analysis of blood flow by CW Doppler ultrasound plays an important role. Malignancies usually show increased vascularity and extremely disorder. The peripheral resistance is low due to numerous AV-shunts in malignant tissue. With high frequency CW Doppler ultrasound (8-10 MHz) these anatomical and physiological features can be outlined objectively. Frequency analysis of Doppler signals in breast malignancies shows high intensities corresponding to increased blood flow. But also a broadening of the systolic peak with flattening of systolic increase and diastolic decrease as well as high diastolic flow. The different blood flow directions of the vessels recorded by the ultrasonic Doppler beam also cause broadening of the frequency range. In combination with B-mode ultrasound this method provides information essential for the differentiation of malignancies.