In 50 cases with an end-diastolic zero flow or reverse flow all antenatal and perinatal abnormalities have been recorded. The fetal outcome was registered. The percentage of highly dystrophic newborns (percentile less than 5) was 88%. The perinatal mortality counted up to 16% and the percentage of congenital malformations (including chromosomal anomalies) was 12%. A reverse flow was registered in 4 cases. The perinatal mortality of those cases with reverse flow was 100%. In approx. one-quarter of those pregnancies and in 50% of the perinatally deceased newborns, there were no pathological or suspicious changes in the antepartal and/or subpartal CTG-recordings. The Duplex sonographical diagnosis of an end-diastolic zero flow/reverse flow, has a highly positive predictive value, whereas its sensitivity is low. It can be regarded as a very helpful parameter in clinical diagnosis, particularly as it is independent of borderline values. The correct choice of the high-pass wall filter (50-100 Hz) is important.

We report on a case of a 22-year old primigravida with HELLP syndrome in association with blindness and cerebral sinus thrombosis. The diagnosis of the cerebral sinus thrombosis was based on MRI 1h after delivery. Immediate caesarean section and intensive care treatment led to a complete recovery of the patient.

The aim of this study was the validation of the minimal Resistance Index (min RI) measured by colour Doppler sonography as parameter of tumour neoangiogenesis. 107 patients with clinically or radiologically diagnosed breast tumour with a sonographically detectable lump had preoperative measurements and analysis of blood flow in the tumour area and in the healthy parenchyma of both breasts. The min RI was compared with histology, menopausal status and age. In all 107 patients blood flow could be measured in the tumour area and in 98% of the bilaterally investigated quadrants. Irrespective of tumour status the mean min RI was lower in the tumour area (0.62) than in the other quadrants of the affected (RI = 0.65, p = 0.002) or contralateral breast (RI = 0.65, p = 0.0003). The mean min RI of benign tumours was 0.60 (+/- 0.11 SD) and of malignant tumours 0.64 (+/- 0.11 SD), this difference was not significant (p = 0.07). Irrespective of tumour status postmenopausal patients had a higher mean min RI than premenopausal patients. This was true for the tumour area (RI = 0.64 vs 0.60, p = 0.11) and also for the quadrants (RI = 0.68 vs 0.62, p = 0.0002). In postmenopausal women there was a statistically significant correlation with age (r = 0.58, p = 0.0001). We conclude that the min RI is of no diagnostic relevance for the classification of breast tumours as benign or malignant.

In a group of 65 twin pregnancies the difference of perinatal findings and antepartal test results was evaluated in relation to amnionicity and chorionicity. Monochorionic placentation was found in 33% of the pregnancies. The rate of foetal malformation (11%), neuromuscular dysfunction (6%), perinatal mortality (11%) and duration of neonatal intensive care was increased in those cases. The most useful diagnostic tool was B-Mode-ultrasound (first detection and surveillance of multiple pregnancy, especially diagnosis of inter-twin growth discordancy). Non stress test and Doppler sonography were found to be of value as additional tests for detection of functional differences between both twins. There were no differences between findings in first and second twin as well as between findings in pregnancies with mono- or dichorionic placentation.

"Reverse Flow" as a Doppler sonographic finding indicates the appearance of retrograde blood flow in the diastolic part of the cardiac cycle. It has so far not been observed in uncomplicated pregnancies and seems to be an indicator of severe deterioration of the foetal condition. Several pathophysiological hypotheses are discussed in this paper on the basis of own results and the findings of other investigators.