Biomedical subjects
Publications and source records attributed to H Bellée.
By means of 80 cases of connatal infections a fetal tachycardia will be observed without distinct relation to a fetal distress in 51.3% (in comparing to a fetal tachycardia in 19.5% without infection). Concluding there is to state, that a typical pattern is an increase of fetal heart frequency without decelerations during labour. This shall be the reason, to diagnose an obstetrical and neonatological infection.
By means of 522 singles in breech presentation the pH of umbilical artery (pH u. a.) and Apgar score in comparison to the mode of delivery, duration of pregnancy and weight of neonates have been analysed. The frequency of deliveries by cesarean section in breech presentation was 28.3%, the rate of preterms in these cases amounts to 14.6% and the perinatal mortality to 42.1%. The average value of pH u.a. after vaginal delivery (7.25) was significantly different to the value after cesarean section (7.28). 25% of the pH-values were below 7.20, 10% below 7.10. Mixed acidoses dominated, metabolic ones after vaginal and abdominal deliveries equalled each other. Vaginal deliveries were frequently followed by respiratory acidoses. In 81% of one-minute-Apgar and in 93% of five-minute-Apgar, the score was above 7. According to our experiences the only determination of the pH u.a. after breech deliveries is not sufficient, because of being at risk for the fetus it demands the measurement of the complete acid-base-status. A critical comparison of these data with the clinical status of the newborn is necessary.
By means of 149 fetal microblood samplings (FBA) from the breech in deliveries in breech presentation and by means of 64 cardiotocograms the validity of biochemical parameters and biophysical ones of fetal monitoring will be investigated. It takes an increased number of suspect or pathologic CTG into account in cases of breech presentation. By means of FBA it is possible to exclude or to confirm the supposed acidoses. By this the rate of operations during delivery can be reduced or the operation will be indicated respectively. A normal fetal pH resulting from the general biochemical monitoring does enlarge the obstetricians license when the fetus presents himself in advanced parturition in pelvic floor (hold back of breech during assisted spontaneous delivery). A pH less than 7.15 demands an immediate delivery. A prognosis of fetal outcome by means of FBA and CTG is not possible due to difficulties in calculation of the final stage of breech presentation. The difference between fetal pH measured in pelvic floor and pH in umbilical artery must be kept as small as possible and it might be regarded as criterion of the management of the delivery in breech presentation.
In continuation of our clinical observations on perioperative prophylaxis by application of Halospor and Gentamicin the dosage of Halospor has been reduced to 2 grams once only. According to our experiences in 98 cases of cesarean section we can recommend these advance: fever in 12.2% (21.2% without prophylaxis), secondary wound-healing in 2% (6.7%) and therapeutical antibiotics in 13.3%, Metronidazol as often as not (36.6%).
The pros and cons of the isthmo-cervical longitudinal incision of the uterus in order to deliver a very low birth weight infant are discussed. The advantages of the incomparably more careful taking out of the easily being injured fetus compensate disadvantages connected with this operative technique to a high degree.
In this paper it has been published about the interdisciplinary cooperation during the treatment of 143 pregnant women having heart diseases. In spite of a partial centralisation this number only 0.46 per cent of all deliveries in a period of 16 years. 32.1 per cent of the cases are congenital heart diseases and 46.2 per cent acquired heart diseases. In the acquired heart diseases mitral failures prevailed. Pacemakers have to be applied preventively only in 6.3 per cent. NYHA-stages did not impair during pregnancy. Vaginal operative delivery is compulsory only in two of seven cases heart diseases indicated a cesarean section. Consequent early get-up in the puerperium is important in NYHA-stages I-III. Maternal mortality was 0. Perinatal mortality was 0.7% (one child died antenatally).
The perioperative application of antibiotics in prophylaxis of infections is disputed. In a preliminary prospective study the infections morbidity of 44 patients after caesarean section was determined to investigate the effect of short term prophylaxis with halospor and gentamycine. A control group of 104 patients remained without any antibiotic prophylaxis. The patients of the prophylaxis group showed a statistically significant reduction of postoperative infectious morbidity. The costs are equalized by reduction in therapeutic applications of antibiotics.
According to own investigations on the behaviour of transcutaneous pO2 measurement in cases of labour inhibition there will be stated: the normal oxygenation of the fetus cannot be improved. However, there is to state the value of labour coordination and inhibition by drugs in cases of threatening fetal hypoxia.
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By means of own experiences with intrauterine growth retardation by cyanotic heart-failure there will be demanded the completion of the NYHA-classification with biochemical parameters of O2-supply and with intensive fetal monitoring.
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The behaviour of the fetal tcPO2 in the second stage of labour in a collective of normal deliveries is compared with deviating cases (neonatal distress/tcPO2 antenatal = 0, zero line/tcPO2--means normal--SD) and discussed. Regarding the tcPO2 as indicator of the peripheral circulation, it is suitable in the second stage of labour as additional parameter in diagnosis of the fetal condition. But just in this period the tcPO2 considerably depends on disturbances. That is why the interpretation of the tcPO2 graphs is to be performed very critically.
Using the method of continuous transcutaneous PO2 determination in the fetus during normal labour there is possible to state the positive influence of O2-normoventilation by the parturient on the oxygenation of the fetus.
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A correlation between gestosis and increase of serum uric acid level has been known for a longtime. From the 6th month of pregnancy we found significantly increased values in all hypertensive pregnant women. In the 7th and 8th month of pregnancy there was a high significant deviation in gestoses second degree (classification of the organisation gestosis). In the two last months of pregnancy all gestoses deviated high significantly from the uric acid level in serum of the normal collective. There is a correlation between pathologically increased mean uric acid values in the 9th and 10th lunar month and increased systolic and diastolic blood pressure values. The uric acid level in pregnant women with gestosis, whose illness or its consequences led to cesarean section, is significantly higher than in patients with normal delivery. In accordance with literature we could not find a limit above the fetus dies. In our opinion determination of plasma uric acid in late pregnant hypertensive women is one additional parameter calculating both maternal prognosis and fetal risk.
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A radioimmunoassay without chromatography was used for the determination of plasma aldosterone in pregnancy. The mean values (+/- S.D.) of aldosterone concentration increased consistently from 23.2 +/- 5.3 ng/100 ml (n = 14) during the first trimester to 37.2 +/- 10.6 ng/100 ml (n = 17) during the second trimester and 64.0 +/- 18.8 ng/100 ml (n = 29) during the third trimester of pregnancy. The highest values were found at delivery (71.9 +/- 14.2 ng/100 ml; n = 21) and in the cord plasma of newborns (83.4 +/- 14.9 ng/100 ml; n = 21). Significantly lower plasma aldosterone values were found in the plasma of pre-eclamptic women during the third trimester of pregnancy (41.9 +/- 21.3 ng/100 ml; n = 11).