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The paper presents data on prenatal human development studied by non-invasive sonography. Furthermore clinical application of prenatal diagnostic procedures and their possibilities in the future are discussed. These facts are the basis of ethical judgement in prenatal medicine.

A malnourished, captive, young adult (weight-11 kg, carapace length-25 cm), female snapping turtle (Chelydra serpentina) was presented for examination and treatment of malnutrition and multiple carapace necroses. Because treatment was unsuccessful, the animal was euthanatized and necropsied. The main necropsy observations showed the presence of a 9 cm greyish-white/yellow, soft, fleshy to fatlike mass involving the right ovary near the oviduct opening and multiple similar, pea-to-walnut sized masses involving both ovaries. Microscopic examination of formalin fixed, hematoxylin and eosin and silver stained tissue sections revealed the masses to be composed of primordial germ cells arranged in a pattern morphologically compatible with dysgerminoma as described in women and other mammals. Very rarely have ovarian neoplasms been reported in turtles or other reptiles. This is the first neoplasm described in the snapping turtle ovary and the first dysgerminoma reported in reptilians. A tabulation of previously documented ovarian neoplasia in reptiles and a comparison of this cancer to those occurring in women will be discussed.

Although cytomegalovirus (CMV) can be fatal to patients with the acquired immunodeficiency syndrome (AIDS), it usually causes few, if any, symptoms. The virus has an affinity for the alimentary tract, especially the ileum and right colon. CMV infections of the gut are often erosive, resulting in enterocolitis, hemorrhage, or intestinal perforation. Inflammatory mass formation is rare. Kaposi's sarcoma and lymphoma are established causes of bowel obstruction in patients with AIDS. This report describes a case of ileocecal obstruction due to a discrete CMV-induced pseudotumor in a patient with AIDS.

We examined morphologically the placenta in 15 cases of a "vanishing-twin" phenomenon of early pregnancy sonographically confirmed. In 10 of these cases remnants of an additional gestation product could be identified with ample variation in their conservation. These ranged between macerated, but clearly identifiable foetal residues and morphologically regular, empty gestational sacs, all being localised at the placental margin or within the amniotic tissue sheets. The chorionic villi of the surviving twins were normally developed. There was no evidence of any correlation between the developmental status of the vanished twin and any therapeutical intervention, age of the mother or number of initial gestational products. In 3 cases, an intrauterine foetal reduction by foetocide had been performed. In these instances, rather well-developed remnants of the additional fetuses could be found. Since in all cases a pluri-chorionic placenta was present, it is possible, that the vanishing twin phenomenon may be held responsible for an eventual blood group incompatibility during subsequent pregnancies.

Transvaginal sonographic imaging of the fetal brain performed in the second and third trimester of pregnancy is presented. By this technique coronal and sagittal sections of the central nervous system can be obtained which are similar to those performed via cranial sonography postnatally.

In multiple pregnancy, an intense supervision of the fetal condition is indicated during pregnancy and delivery. With the aid of a recently developed actocardiograph originally described by Maeda, it is possible to monitor the fetal heart rate (FHR) and fetal movements (FM) of twins simultaneously on one tracing by 2 external Doppler transducers. Additional methods (stimulation, real-time and Doppler ultrasound) were tested in combination with the equipment. In addition, FHR tracings of triplets were registered during delivery simultaneously with FM and contractions. First patterns of "twin behaviour" are described. It may be concluded that this way of recording is of definite practical and potential scientific value.

We report on three cases of acardia, all of which had to be classified as acardius anceps. The degree of cardiac malformation ranged between a completely missing heart and a malrotation of a relatively well-developed heart. One fetus showed an intermediate form of cardiac malformation with a hypoplastic cor triloculare. Our findings suggest that the defect in cardiac development may take place at different times in early embryogenesis, resulting in differing degrees of cardiac malformation.

A study on actual trends in obstetric analgesia and anaesthesia was conducted on data received from 385 German departments of obstetrics with a total of 267441 deliveries. On the basis of these extensive data quantitative results could be obtained about analgesic procedures for spontaneous deliveries, operative-vaginal deliveries, Caesarean sections and in cases of foetal or maternal risks. The type of analgesics and local anaesthetics used, their side effects and complications were recorded. In addition the cooperation and interaction between obstetricians and anesthesiologists in practising and monitoring obstetrical analgesia and anaesthesia are described.

Gigantomastia complicating pregnancy is rare and of unknown etiology. Medical treatment does not lead to a lasting improvement. We favour surgical treatment, involving plastic reconstructive aspects.

Net fluid flux and transmural hydrostatic hydraulic conductance (Lp) were measured in the rat ileum during postnatal ontogeny, utilizing a refined in vitro, capillary-perfused (non-isolated) preparation for free-flow studies. Volume absorption at low transmural pressure gradient (1-2 cmH2O) was 0.99 +/- 0.22 ml/g wet weight.hr in the mature ileum and 1.55 +/- 0.42 ml/g wwt.hr in the differentiating intestine. Hydrostatic hydraulic conductance of the mature ileum was 0.76 microliter/cm2.cm H2O.hr, indicating that normal hydrostatic pressure gradients are not important for modulation of intestinal absorption. In contrast, Lp was 3.82 microliter/cm2.cmH2O.hr in the differentiating ileu, suggesting a significant contribution of pressure-dependent solvent drag to isotonic solute absorption.

ITP is the most common autoimmune disease during pregnancy. Whereas the maternal risk due to the extreme thrombocytopenia can be calculated, the risk to the foetus is difficult to predict. As there is no correlation between maternal and foetal platelet count, no generalisations can be made as to the preferable method of delivery. The methods of treatment with special reference to pregnancy and the various procedures necessary during delivery are discussed.

375 german departments of obstetrics with a total of 258,348 deliveries answered a questionnaire on the actual standards in obstetrical management for the prevention of neonatal respiratory distress syndrome. On the basis of these extensive data, results could be obtained about the time and the regimen of therapy as well as antenatal diagnostics of lung maturity. Furthermore the results document the treatment of high risk pregnancies like multiple pregnancies, diabetes mellitus, gestosis and PROM.

Twenty-eight hours after CO2 insufflation and curettage in a 26 year old, haemolysis, jaundice and anuria developed. As an ectopic pregnancy was also suspected, a diagnostic laparoscopy was done and was followed by a hysterectomy and left salpingo-oophorectomy before Clostridium perfringens was grown on culture. The survival of the patient despite clostridial infection is probably due to immediate surgical treatment and intensive post-operative care.

Two cases of atypical implantation are presented in order to illustrate the difference between interstitial and intramural pregnancy. Ultrasonography can provide a method of early diagnosis of heterotypic sitting before the occurrence of clinical symptoms. In cases where complications already occurred, sonography can be used to confirm the clinical diagnosis.

Antithyroid drugs can pass the placenta, in contrast to thyroid hormones. Therefore, their application in pregnancy carries the potential risks of teratogenic effects and foetal hypothyroidism. The actual danger to the foetus, however, is controversial. The history of a hyperthyroid patient treated with carbimazole and referred for termination of pregnancy in the 8th week of gestation gave rise to review the literature in order to elucidate the foetal risks. Data of 278 pregnant women treated with imidazole derivatives (group I) and 192 women, who received thiouracil derivatives (group II) during pregnancy, were found in the literature. The rates of foetal malformations and foetal goitre in group I were 3.6% and 3.2%, respectively. In group II the corresponding rates were 3.6% for foetal malformation and 7.8% for foetal goitre. From these figures we conclude that antithyroid therapy in pregnancy does not warrant termination of pregnancy for foetal reasons if there is meticulous control of maternal thyroid metabolism.

Between October 1st 1983 and January 31st 1986 we diagnosed various anomalies on 116 foetuses at the Department of Obstetrics and Gynaecology, Klinikum Grosshadern, Munich. In 103 cases we made a correct diagnosis. This group of patients included 45 non-viable foetuses. Severe anomalies of the foetal central nervous system and lethal dwarfism were diagnosed correctly. On the other hand, antenatal diagnosis of bilateral nonfunctional kidneys and non-correctable cardiac malformations poses problems. We feel that in the case of a definitive prenatal diagnosis of an anomaly for which there is no known medical treatment and which is not compatible with life, the decision as to further procedure should be made at this stage. Before 24 weeks gestation, termination of pregnancy on foetal grounds should be discussed with the parents. Thereafter, preterm labour is preferable to the dangers of obstructed labour at term and should be conducted without foetal monitoring.

The case of a 28-year old patient with a rare complication of an extensive endometriosis externa is described. A spontaneous pneumothorax occurred on 3 occasions corresponding each time with the start of the menstrual period. The various hypotheses on the aetiology and treatment of this rare condition are reviewed. To date only 65 patients with this interesting clinical entity have been recorded.

In a sample of 18 children aging one day to eighteen years 21 percutaneous nephrostomies and 27 antegrade pyelographies were performed using sonography and fluoroscopy. Thirteen patients had both nephrostomy and pyelography and 5 had only pyelography. Three of 13 patients needed bilateral nephrostomies. The results indicate that the combination of percutaneous nephrostomy and antegrade pyelography is helpful in diagnosis and treatment of various obstructive disorders of the urinary tract especially in the newborn period.