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. Despite restricted therapeutic possibilities, safe and successful treatment of severe hypertension during pregnancy can best be performed with dihydralazine and diazoxide, which achieve their effect by reducing the peripheral vascular resistance. 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.

Antihypertensive Agents↗

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[Liver diseases complicating pregnancy].

Liver disease in pregnancy represents a broad spectrum of disorders. Most of the common forms of acute and chronic liver disease occur during pregnancy and often present special difficulties in diagnosis and management. In addition, there is a group of hepatic disorders unique to pregnancy, which also must be identified appropriately. Rapid institution of therapy is important in preventing the unfavorable perinatal outcome and maternal mortality. The changes in liver function related to gestation will be reviewed initially. The major forms of hepatic disease specifically associated to pregnancy will be then described and the obstetrical management as well as the therapeutic modalities proposed.

Adult↗

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[Prenatal diagnosis and obstetric management of a case of Klippel-Trenaunay-Weber syndrome].

A description is given of a case of Klippel-Trenaunay-Weber syndrome diagnosed by sonography in the 28th week of pregnancy. The ultrasound findings established in the course of pregnancy are presented. Whereas minor variants of this syndrome normally do not represent a birth hindrance, a cesarean section was indicated in the present case on the basis of the size of the deformation--especially at the hip--an in order to save the child.

Adult↗

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[Recklinghausen disease and pregnancy].

Morbus Recklinghausen is an autosomal dominant disease with a high rate of new mutations. Progression of the skin lesions and the development of severe preeclampsia are the most important complications during gestation. In the following paper three cases with Recklinghausen's disease in pregnancy are reported and the consequence of the complications as well as the importance of genetic counseling are discussed.

Adult↗

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[Prenatal ultrasonic diagnosis of a cystic abdominal tumor--liver cyst and its differential diagnosis].

A report is presented on the prenatal development of a solitary hepatic cyst in a fetus of the 39th week of pregnancy. Sonography revealed that nearly the entire abdomen was filled by a cyst that caused displacement of the stomach and intestine as well as elevation of the diaphragm. Abdominal distension necessitated delivery before term by cesarean section. The laparotomy subsequently performed because of increasing dyspnea of the newborn showed the left lobe of the liver to be the point of origin of a solitary hepatic cyst that could be removed in toto. Possibilities of post partum therapy are discussed in addition to obstetrical management. The incidence, localisation and size of solitary hepatic cysts as well as their differential diagnosis are also described.

Adult↗

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[Microflora of the birth canal and an intrauterine catheter system following use of polyvinylpyrrolidone iodine for subpartal disinfection of the vaginal mucosa].

Changes in the microflora of the birth canal as a result of application of polyvinylpyrrolidone iodine were examined. 58 women in labor were randomly selected and assigned to a PVP iodine prophylaxis- and to a control group. Germinal spectra from cervical smears at the beginning of birth and directly post partum (p.p.) were taken, and bacteriological specimens from the intra-uterine catheter system and the oral cavity of the neonatus were also determined. In the p.p. cervical smears of the PVP iodine prophylaxis group, Escherichia coli (p = 0.05) were found significantly less frequently. The germinal isolates of the tip and middle of the catheter produced an increased occurrence of Pseudomonas aeruginosa and Klebsiella oxytoca. The frequency of these germs could be reduced significantly by vaginal application of PVP iodine. The oral cavity smear of the neonatus which was taken at the same time as the post partum cervical smear showed an almost identical bacterial flora. A reduction of E. coli and other gram-negative bacilli were found in the PVP iodine group.

Bacteria↗

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[Pregnancy in adolescence].

The retrospective study compares the pregnancy, labour, lying-in period and the newborn of adolescents with corresponding data for a group of mothers aged 21 to 30. Both groups were the same size. Menarche had been 6-7 months earlier on average for the pregnant adolescents. Pregnancy was complicated in the teenage group by a markedly higher incidence of gestosis, greater frequency of pregnancy anaemia, and a tendency to deliver prematurely. Medical care during pregnancy was found to have been much more inadequate for this group. With onset of labour more often spontaneous, shorter labour, and the rate of spontaneous delivery increased, labour and delivery could be rated as free from complications and low-risk. There was no evidence that morbidity during the lying-in period was greater for the juveniles. The newborn was found to be at greater risk in the adolescent group, with perinatal mortality predominantly linked to the incidence of premature births.

Adolescent↗

PubMedDate not supplied

[Management of premature rupture of fetal membranes in obstetrical departments in Germany].

Since the treatment of premature ruptures of membranes is not only controversial in the German but also in the international literature, we performed a survey of all obstetrics departments in Germany. From a total of 843 hospitals, 444 questionnaires were returned for evaluation (52.7%). The purpose was to determine which diagnostic and therapeutic regimes are used and how these agree with the literature. In addition to questions on the type of hospital, birth rates with a percentage of premature births and applied diagnostic parameters, our special interest focused on therapy, particularly with regard to prophylactic antibiotic application, tocolytic treatment and lung maturity induction. Prophylactic antibiotics are used in 36.7% and prophylactic tocolytic therapy in 41.7% of the departments. Interestingly, lung maturity induction was performed in 93.5%, in part even before the 28th week of pregnancy, although the effect of this therapy has not yet been proven at a very early stage of gestation. Due to the different views in the literature and, in part, a lack of basic scientific data, it seems there is a preference for the procedure, in which the best personal experience has been made. Because premature ruptures of the membranes is responsible for 30-40% of premature births, it is urgently necessary to clarify this controversial problem by large multicenter studies so that the treatment of early premature ruptures of the amnion can be founded on a rational basis.

Antibiotic Prophylaxis↗