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The hospital remuneration act, the call for minimum amount regulations and the necessities of the specialization education rules will lead to considerable changes in obstetrical care in Germany in the future. It will develop into a two-stage structure in which the level I care takes place in houses with more than 700 deliveries and the maximum care with more than 1,500 deliveries (perinatal centres).

Psychosocial stress is and has been under study in a plenty of epidemiological research done to further detect the mechanisms between risk factors and preterm birth, but the role of these possible risk factors is up to now not approved neither theoretically nor empirically. Associations calculated between those risk factors and preterm birth are highly inconsistent and with exceptions only moderate. Based on the data given by the BabyCare programme in a first analysis for the group of primiparae it will be analysed, which psychosocial risk factors are correlated with preterm birth and which of these can be judged as independent risk factors, as far as this can be ruled out by the sample-size given. The descriptive data analysis shows, that the frequency of psychosocial risk factors is varying as it can be expected by age and social stratification. The analytical analysis shows by the given sample-size that the variable "strong stress in the last 12 months before pregnancy" has the highest ODDS-Ratio, which is also almost significant. Unexpectedly there is no correlation between preterm birth and the frequency and characteristics of life-events in the last 12 months, nor between the stress index, nor between the frequency of psychosocial complaints. Weaker associations--further to be approved--are given with respect to work load and occupation, problems in partnership and emotional or social support as well as to unplanned pregnancy and "low social status". The risk-ratios of the psychosocial variables are altogether much lower than the ratios of the medical or behavioural risk factors. The analysis of preterm birth rates reveals, that "strong stress in the last 12 months before pregnancy" will especially raise the preterm birth rates of smokers by an additional factor of 1.5. The associations found have to be approved by raising sample-size by stratified analytical methods and additional research by follow-up or retrospective studies to finally find out the factors which arise in the subsequent time of pregnancy and might explain the higher risk of preterm birth in the group of women with "strong stress in the last 12 months before pregnancy".

In Germany the diagnosis of gestational diabetes is recognized in only 10% of the patients with gestational diabetes. Therefore 36000 pregnant patients per year are undiagnosed. The reason is an insufficient screening system which plans only the determination of the glukosuria at each prenatal visit. Several studies have shown the low sensitivity of glucosuria in the detection of gestational diabetes. The majority of the gynecologists are in the wrong certainty of having a healthy pregnant woman in front of themselves. Therefore a general screening with the 50 g-glucose screening test or the 75 g-oral glucose tolerance test is necessary. Own observations have shown an influence of the previous meal on the 50g-glucose screening test. Therefore we would prefer the one-step screening with a 75 g-oral glucose test. The costs of the one-step or two-step regimen are similar. Also a screening only of high risk pregnancies appears insufficient. Using an age below 25 years and a body-mass index below 25 kg/m 2 only 13.7% of our patients would not have to become screened. Of those 3.1% have a gestational diabetes. The considerations to offer the Screening as an individual health achievement, which has to be paid by the patients, does not justice to the importance of the illness. A general Screening, preferred as one-step screening should be offered to each pregnant women.

Das Zytomegalie-Virus ist angesichts seiner hohen Pravalenz das haufigste interuterin ubertragene Virus. Zur Diagnose der Zytomegalie-Virus-Infektion stehen mehren Moglichkeiten zur Verfugun, z. B. die Viruskultur aus verschiedenen Materialen und die DNA-Hy bridisierung. Die schnelle und zuerlassige Diagnostik ist die Bestimmung von Zytomegalie-Viral Antikorpern, naemlich quantitativer Nachweis von Zytomegalie-Virus-IgG-Antikorpern und qualitativer Nachweis von Zytomeglie-Virus Spezifischen IgM-Antikorpern. Der Nachweis von IgM Antikorpern oder der Anstieg des IgG-Antikorpers bei einer Serokonversion sind Zeichen der aktive Zytomegalie-Virus-Infektion, wonach diese Infektion gewertet werden kann. Um die Frage des Brauchbarkeit der methode fur den Zytomegalie-Virus-Antikorper-Nachweis zu beantworten und die Technik zum Nachweis von Zytomegalie-Virus-Antikorpern zu prufen, wurde in der Studie der Nachweis von Zytomegalie-Virus-IgG und IgM-Antikorpern aus filtergetrocknetem Blut, durchgefuhrt. Dabei wurde festgestellt, das diese Filterpapier-Technik zum Nachweis von Zytomegalie-Virus-Antikorpern durchfuhrbar ist.

UNLABELLED Shoulder dystocia is defined as a standstill of delivery after the birth of the head and is attributed to an insufficient rotation of the shoulder. Risk factors include a history of prior macrosomia or shoulder dystocia, maternal obesity or excessive weight gain during pregnancy, maternal diabetes or postdate pregnancy and prolonged descent or midpelvic operative delivery. Neonatal morbidities associated with traumatic birth include fetal hypoxia with acidosis and permanent brachial plexus injury. THERAPY After the recognition of a shoulder dystocia a series of steps should be undertaken beginning with cutting or extending the episiotomy, McRobert's Manoeuvre, Wood's Manoeuvre and delivery of posterior arm. A tocolytic administered as a bolus or general anesthesia also may be needed. Documentation should include the exact time the dystocia was recognized by the midwife and/or obstetrician, the time at which intervention was started and a detailed operative report.

In a prospective study the spectrum of bacteriological organisms in the uterus was analysed within the first 3 days post partum. Smears were taken from the ectocervix and from the cavum uteri from 80 asymptomatic puerperae (70 had delivered spontaneously and 10 had had a vaginal-operative delivery). The smears were achieved using an endometrium catheter with a pilot cap. After the specialised sampling had been undertaken, in 47 of the 70 patients with spontaneous delivery and in 1 of the patients with operative delivery, no bacterial invasion was found in the cavum uteri. After prophylactic administration of antibiotics prenatally, bacterial organisms were found significantly less often (p < 0.05). On the other hand, intrauterine bacterial organisms were found significantly more frequently in patients who had had cervix priming with PGE2 and where foetal blood analysis had been performed sub partum (p < 0.05). Contrary to the smears from the cavum uteri, all ectocervical smears were positive. In 13 of 23 cases with positive proof of intrauterine bacterial organisms, a difference was found in the bacteriological spectrum compared with the parallel cervical smear taken. Further obstetrical factors play a role in influencing the bacterial invasion, however, there were no complications in any of the cases due to the smears being taken and no infections were observed during the rest of the lying-in period.

An new method of lung maturation during artificial placentation was evaluated during a series of 15 animal experiments in premature lambs (gestational age 125-132 days). Perfusion circuit with interposition of a membrane lung was connected with the umbilical vessels. Extracorporeal CO2-removal (ECCO2-R) and apneic oxygenation were provided during lung distension. The ultramicroscopic pattern approved a maturation of the lung during the procedure showing development of lamellar bodies and surfactant secretion into the alveolar space. The biochemical analysis of the tracheal fluid showed a significant increase of both PC and PG concentrations (3.225 +/- 1.112 mg/100g to 24.228 +/- 3.36 mg/100 g respectively 0.249 +/- 0.11 mg/100 g of 0.622 +/- 0.09 mg/100 g. The biophysical function of the lung was also improved as was shown by a significant increase of the statistical compliance. We conclude that artificial placentation and lung distension might be a new mode of prophylaxis for respiratory distress syndrome in critically immature babies.

BACKGROUND: Adequate administration of Rh immune globulin requires an accurate determination of the number of D-positive cells in the circulation of D-negative women. Although several tests have been described for the detection of fetomaternal hemorrhage, there is still a need for a rapid, simple, and clinically relevant screening test. STUDY DESIGN AND METHODS: Serial dilutions of a monoclonal anti-D were incubated with stock solutions (0.2 mL) of adult D-negative red cells in the absence or presence of various amounts of fetal D-positive cells (0.1, 0.2, 0.3, 0.4, and 0.5%). After incubation, the supernatants were tested against D-positive red cells by using the new, gel agglutination technique (GAT). After the GAT was adapted to detect D-positive cells at concentrations of > or = 0.2 percent, unselected postpartum samples from D-negative women (n = 420) who delivered D-positive infants were analyzed by both the new test and the Kleihauer-Betke test (KBT). RESULTS: Three of a total of 420 postpartum samples were positive (> or = 0.4% fetal cells), and 406 were negative in both tests. One had 0.5- percent fetal cells in the KBT and gave negative results in the GAT. The latter test was, however, performed after administration of Rh immune globulin. The KBT gave false-positive results in two cases, because of hereditary persistence of hemoglobin F, and the GAT gave a false-positive reaction in one case because of a maternal weak D variant. In the remaining seven cases, the KBT results were only weakly positive (0.2%) and could not be attributed solely to D positive red cells. CONCLUSION: The GAT is suited for routine screening. It provides rapid and specific detection of D-positive red cells at clinically relevant concentrations. The test may (rarely) yield false-negative results due to insufficient administration of Rh immune globulin before testing.