Due to better care and better knowledge pregnancies in paraplegic patients nowadays have a good prognosis. We report on 16 deliveries in 13 paraplegic or tetraplegic patients. To minimise the danger of possible further damage it is important to know about the special problems associated with pregnancies in paraplegic mothers. It is particularly important to know about the elevated risk of premature labour and the risk of autonomic hyperreflexia in lesions above D7. To prevent urogenital infections, patients should try to keep the genital region clean and try to empty the bladder as completely as possible. Intermittent catheterisation might be necessary. One should try to prevent decubital ulcers, and therefore an eventual anaemia (below 80%) should be corrected by transfusions. The patients should be instructed how uterine contractions can be palpated manually because sometimes perception of contractions in other ways is not possible. Repeated examinations of the cervix also help to prevent premature birth. Hospitalisation of the mother two to three weeks before the expected date of birth is suggested. If the lesion is higher than D7, symptoms of autonomic hyperreflexia (bradycardia and rise of blood pressure with the risk of cerebral haemorrhagia) are almost always present when labour starts. To prevent this possibly life-threatening complication, early application of epidural anaesthesia is suggested. There is no contraindication to spontaneous delivery. Vacuum extraction or forceps are necessary more frequently. In the post-partal period, prophylaxis of decubital ulcers is important. Breast feeding is not influenced.

We present a patient in the 30th week of gestation with adnexal torsion, which was treated by laparotomy with oophorectomy. After 2 days, we had to perform a cesarean section because of bowel obstruction. We discuss the diagnosis and treatment of adnexal torsion in pregnancy and compare laparoscopic management with laparotomy. By reviewing the literature, we evaluate the conservative therapy by detorsion employing Doppler sonography.

The last two hours of 342 intrapartum FHR records of high technical quality were evaluated visually with simple tools (compasses, caliper). All data were entered on punched cards (25 pro fetus) and analyzed using an IBM system 370/135. In 253 fetuses with an actual pH in the umbilical artery (UA) above 7.199 the oscillation frequency (OF) during the last 30 min. preceding delivery amounted to 9.5 +/- 4.5 (4615 minutes without decelerations or accelerations). The 5th percentile, the median and the 95th percentile were 2,9 and 18 per minute respectively. OF refers to the number of visually detectable turning points in baseline FHR. There exists a significant association (2 alpha less than 0.001) between the OF and the oscillation amplitude (OA) per minute: a reduction in OF is followed by a decrease in OA even in vigorous infants. In acidotic fetuses OF is decreased when compared with FHR minutes of equal OA in nonacidotic infants. However this becomes statistically significant only in fetuses with actual pH (UA) below 7.150 i.e. in fetuses with severe acidosis. These findings can explain why the loss of FHR variability as a single symptom may be misleading in individual cases.

Report on 114 terminations of pregnancy during the second and third trimester of pregnancy with a new prostaglandin E2 derivative "Sulprostone". In 84 cases legal therapeutic abortions were induced. In 30 women an abnormal pregnancy was terminated. "Sulprostone: is a prostaglandin with selective activity in the uterus. It can be administered parenterally or locally. 48 women received intravenous sulprostone, 35 patients had extraamniotic injections and 31 patients had extra-amniotic injections following an intramuscular injection for priming of the cervix the night before. In 103 women the pregnancy was terminated within the first 24 hours after the administration of sulprostone (90.3%). 8 patients (7.0 %) had a cervical dilatation over 2 cm. In 3 women no effect was noted. In 1 patient the prostaglandin application was stopped because of severe vomiting. The mean administration abortion interval was 12 hours and 54 minutes following extra amniotic application and 10 hours and 30 minutes with extra amniotic application and following intramuscular priming. In 5 patients the abortion was completed after the priming administration. More than 90% of the patient's required analgesia. There were 32.4% side effects of mild character. The results and the methods are described and compared to other methods.

ZusammenfassungEs wird über die Schwangerschaft einer 34jährigen IV Gravida/II Para berichtet, die in der 19. Woche mit der Ruptur eines rudimentären Horns bei Uterus bicornis unicollis endete. Es lag eine Placenta accreta vor. Zwei Jahre nach diesem Ereignis kam es zur Spontangeburt eines Knaben ohne Plazentainsertionsstörung. Anhand der Literatur wird auf die Möglichkeiten des Ultraschalls sowie der Serum-AFP-Bestimmung hingewiesen. AbstractA rare case of a pregnancy of a 34-year old IV gravida/II para is reported, which ended in the 19 th week with the rupture of a rudimentary horn of the uterus bicornis unicollis. Histopathological examination showed a placenta accreta. Two years after this event spontaneous birth of a boy resulted without any pathological findings of the placenta. Basing on the literature, the significant roles played by ultrasonic investigation as well as by serum-AFP-screening are pointed out.