Biomedical subjects
Publications and source records attributed to G Reiffenstuhl.
6 infertile women with primary or secondary amenorrhoea or anovulation, who failed to ovulate after clomiphene and HMG/HCG treatment, underwent 11 treatment cycles with pulsatile GnRH therapy using a portable pump. Normal ovulation occurred in 9 out of 11 treatment cycles; the luteal phase was normal in 6 cycles. One woman conceived in the second treatment cycle.
Sonography in the 5th month of pregnancy--the pregnancy itself appearing intact--revealed an enormous myometric angiomatosis affecting the body of the uterus. Hence, the size of the uterus in the 17th week of pregnancy equalled the size usually attained in the 36th week only. Tendency to collapse and pulselessness as a consequence of excessive haemorrhages into the enormously dilated veins was observed. The myometrium displayed varying intensity and was permeated by blood vessels of different sizes up to 1 cm diameter. Because of the extremely dangerous tendency of the uterine wall to break, hysterectomy was performed. The histological specimen showed a diffuse cavernous myometric angiomatosis of the body of the uterus and of the isthmus uteri. We believe that this extreme reaction of the veins during pregnancy is caused by a specifically acting agent and by a special disposition of the veins in the uterus. So far, only two cases have been described in literature (Halban, case 1 Kaufmann).
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Perinatal mortality at Landesfrauenklinik Salzburg was recorded by annual analysis of 19,533 births for the period between 1972 and 1979. Differentiation of 374 perinatal deaths was undertaken by antepartum, intrapartum, and postpartum mortality as well as by weight groups above and below 2500 g. All 129 antepartum deaths were attributable to preclinical situations, since all cases concerned had been pregnancies with attention outside hospital and with stillbirths on first admission. All 45 intrapartum deaths were separately analysed by causes for the purpose of elucidating avoidable cases. Failures due to shortcomings in terms of personnel, equipment, and organisation were discussed for each year. Organisational consequences drawn from such evaluation are reported together with effects. Stepwise target-oriented re-organisation helped to reduce unpurified mortality from 24 to 7.7 per thousand (WHO) in the period under review, while purified perinatal mortality dropped from 12.5 to 1.0 per thousand.
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Premature labour is best treated in a special ward, the tocolysis ward. From 1972 to 1975 there were around 8% premature deliveries. During the first six months of 1976 there were still around 8% premature deliveries. During the second six months of 1976 the premature rate was lowered to 6% in the tocolysis ward. This is a decrease of the 25%.
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Perinatal mortality rate is an important parameter of the obstetrical efficacy. The analysis of case reports of 10 590 newborn infants results in the fact, that perinatal mortality could be decreased from 27,15% to 20,11%. Special interest is directed to subpartual mortality, being the proportion of entire mortality reflecting the quality of intrapartal supervision. Critical and precise single case analysis of subpartual deaths was performed in order to detect failures of the supervision system with consequential amelioration of perinatal care. Methods of intensive obstetrical care, introduced since 1973 such as ultrasonic diagnostic, screening for placental insufficiency, amniotic fluid diagnostics tocolysis, cardiotocography and micro-blood analysis, resulted in a significant raise of quality. Unselected perinatal mortality could be decreased by approximately 25%.
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