Thanks to the statistics of the Arbeitsgemeinschaft Schweizerischer Frauenkliniken (Swiss Gynecological Clinics' Working Group) it has for the first time become possible to report on larger numbers of laparoscopies performed in Switzerland. In contrast to most international statistical records, data relating to this subject are gathered prospectively; there is no doubt that this improves the quality of the data. The authors report on a total of 18,186 laparoscopies performed in 1983/84/85, in 50% of the cases for sterilization. The various sterilization methods employed are discussed. As far as diagnostic laparoscopies are concerned, the indications and techniques are described. Serious intraoperative complications occurred in 15 cases, which corresponds to one serious complication in every 1,212 laparoscopies. Fortunately, not a single patient died as a direct result of the laparoscopy. The results are compared with those in the international literature. With regard to late-onset morbidity it is evident that there are more complications with the more complex procedure of diagnostic laparoscopy.

Between 1979 and 1985 a total of 8641 children were born at the gynecological clinic in Winterthur, 388 of them (4.5%) from breech presentation. All of these were evaluated with regard to external version, and conditions for an attempt at version were satisfied in 97 cases. The principal prerequisite was a gestational age of at least 37 weeks. External version was accomplished in 39 of the 97 cases (40.2%). Complications encountered were drops in fetal heart tone or bradycardias in 26 cases (26.8%); the attempt at version was abandoned for this reason in 22 cases. In one case premature detachment of the normally implanted placenta occurred 6 days after successful external version, and in one case an emergency cesarean section had to be performed owing to persistent bradycardia. In a further case intrauterine fetal death was established 18 hours after successful version on the basis of an absence of fetal movement, though no cause of death could be found. Among the 39 cases in which version was successful a cesarean section was only necessary in one (2.5%), as opposed to 21 in the 58 cases (36.2%) in which the attempt at version failed. Neonatal fetal condition (Apgar score and umbilical blood gas analysis) revealed that neonates born from vertex presentation are subject to very considerably less stress. The international literature is discussed and compared. It is found that there has been a change of trend from a tendency to reject external version in the 1970s to a majority favoring it in the 1980s.(ABSTRACT TRUNCATED AT 250 WORDS)

In 871 deliveries out of a total of 3980 effected during 1980-1982 at the Winterthur Gynaecological Hospital, we found it necessary to perform one or several microanalyses of blood (blood gas analyses) sub partu. Among these, we found retrospectively that in 22 cases the microanalysis of the blood gas had prevented us from performing caesarean section which would have seemed necessary if we had relied on the cardiotocographical findings alone. Micro-analysis of blood gas made it possible to exclude the presence of pre-acidosis or acidosis which would have made Caesarean section imperative; in all these cases, normal delivery via the vagina was achieved, and in no case did this result in severe acidosis. All newborn had a 5-minute Apgar score of 7 and higher. We can conclude from these results, therefore, that the indication for an immediate termination of delivery via Caesarean section should not depend solely on a pathological cardiotocogram; the final decision should be arrived at only after micro-analyses of blood gas have confirmed the presence of foetal pre-acidosis or acidosis.

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