Zeitschrift für Geburtshilfe und Perinatologie
-
Treatment of severe hypertension in pregnancy, particularly in preeclampsia and eclampsia, is a great challenge to the obstetrician and requires prompt and expert management. Application of antihypertensive agents is limited during pregnancy because of possible side effects, particularly impairment of the fetal state. The following survey present a detailed discussion on the substances suitable for treating hypertensive emergencies in pregnancy and their side effects. ⋯ If the blood pressure cannot be adequately reduced with these substances, treatment can be continued with sodium nitroprusside. A critical discussion is presented in this connection on drugs such as clonidine and reserpine, which reduce pressure largely by central mechanisms and should no longer be applied in pregnant patients because of serious disadvantages. Consideration is also given to the special clinical problems associated with pheochromocytomas, and a concluding discussion deals with the perspectives of antihypertensive therapy in pregnancy.
-
Z Geburtshilfe Perinatol · Sep 1990
[Peridural anesthesia and method of delivery. Peridural anesthesia performed by the obstetrician].
In deliveries in epidural analgesia (PDA) there are more obstetrical operations than in deliveries without PDA. We have investigated the delivery mode in relation to the indication of epidural analgesia. If the PDA is done because of prolonged course of labour or because of suspicious fetal heart rate, about 40% of these women deliver spontaneously, in about 35% a cesarean is done, and in about 25% a forceps- or vacuum-extraction is done. ⋯ The increase of operative deliveries in PDA isn't found generally. Epidural analgesia managed by the obstetrician doesn't result in more complications by the method itself, the increase of operative deliveries is found even in clinics where the PDA is carried out by the anesthetist. The possible reasons are discussed.
-
Z Geburtshilfe Perinatol · May 1990
[Control of postoperative vaginal sonographic findings following Shirodkar cerclage].
Up to now postoperative control of the uterine cervix following cerclage was performed by bimanual palpation. Since clinical use of transvaginal sonography it is possible to get objective results about preoperative morphology of the cervix (exact cervical length, dilatation of the cervical canal and opening of internal and external os). Besides postoperative vaginal sonography following cerclage can ascertain lengthening and stabilization of the incompetent cervix and localize the ligature's position. 75 pregnant women between 15th and 30th week of gestation were examined using a 5-MHz vaginal sector scanner probe following Shirodkar cerclage to gain information about the residual cervical length and the distance from the surface of the ectocervix to the ligature's position within the anterior and posterior lip of the cervix. ⋯ This study showed that the actual positions of ligatures after cerclage operations varied very much. Unsatisfying position can be an explanation why some preterm deliveries can not be prevented. Therefore it is recommended to control the position of the cerclage ligation postoperatively using transvaginal sonography.
-
Z Geburtshilfe Perinatol · Mar 1990
[Hemodynamic adaptation during extracorporeal perfusion and arteriovenous extracorporeal CO2 removal].
During an animal study using five bastard dogs the hemodynamic relations during extracorporeal perfusion with an arteriovenous circuit and extracorporeal CO2 removal (ECCO2-R) were analyzed. We utilised a prototype circuit (Promed, West-Germany) which is by diminution and using silicon rubber adapted to the application in newborn. A silicon lung (Scimed, 0.8 m2, ECCO2-R) was used in the circuit. ⋯ We found a statistical significant correlation (r = 0.66) between the main arterial blood pressure and the extracorporeal blood flow. Further more there was a significant correlation between the arterial PCO2 and the blood flow through membrane lung (r = 0.81). In conclusion our animal experiments approved the possibility of hemodynamic adaptation to an arteriovenous circuit as well as effectiveness of CO2 removal via such circuit.
-
Z Geburtshilfe Perinatol · May 1989
Comparative Study[Vaginal sonography versus vaginal palpation: initial experiences in 120 pregnant patients with suspected cervix insufficiency].
In a clinical study a group of pregnant women with suspected cervical incompetence was examined by vaginal sonography. Aim of the investigation was to compare results of performed vaginal palpation with results of sonography. 120 pregnant women with cervical insufficiency between 16th and 33rd week of gestation were examined by a 5-MHz vaginal sectorscanner probe. After focussing sagittal projection of uterine cervix and lower uterine segment the cervical length and opening of the internal os were assessed prior to cerclage. ⋯ They complete results of cervical palpation and offer precise information concerning an intended cerclage. In case of suspected cervical incompetence continuous sonographical examination can supervise the development of the uterine cervix during pregnancy. In future the number of prophylactic cerclage-operations perhaps decreases by using the technique of transvaginal sonography.