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Biomedical subjects

B Warkentin

Publications and source records attributed to B Warkentin.

25 records · Page 2Linked to original sources

[Fetal causes of the onset of labour. A kybernetic model (author's transl)].

The question of initiation of labour is not yet solved. A fetal fixing of the date would be ingenious. On the one hand the fet is endangered by prematurity, on the other hand by placental insufficiency in postmaturity. Fetuses with comparatively lighter placenta remain in average shorter in utero until spontaneous initiation of labour than those with comparatively heavier placenta. This fact leads to the assumption of a relative placental insufficiency as a determining factor of the onset of labour. A further inquiry demonstrates, that babies born after premature termination of pregnancy about the term - either by induction of labour or by primary sectio caesarea - are heavier and longer than those born after spontaneous labour. This leads to the assumption of a prenatal weight loss of the infant before spontaneous initiation of labour. This weight loss is caused by diminution of water content and relative placental insufficiency. This relative placental insufficiency also leads to a diminution of amniotic fluid, which is swallowed by the "hungry" fet in a greater amount. Altogether a diminution of uterine volume is resulting, which is accomplished by a diminution of uterine wall tension. The coordination of uterine activity, which precedes delivery, is combined with the ripening of the cervix. The ripening of the cervix also leads to a retraction of myometrium and thus to a further diminution of uterine wall tension. It is concluded, that a diminution of uterine volume, causes by fetal weight loss and diminution of amniotic fluid, leads to a reduction of uterine wall tension, which is supported by the ripening of the cervix. This reduction of uterine wall tension is the precondition of the increasing coordination of activity, which precedes delivery.

Amniotic Fluid↗

[Dilatation of the os uteri in various types of amniotic rupture and in induction of labor (author's transl)].

Basing on the "partial dilatation" ("Teileröffnungszeiten" (W. Wolf), ie the time in which the os uteri opens from a certain size to its full potential, the process of openning of the os uteri was compared between various types of rupture of the amnion and in programmed induction of labor. Both in the case of primiparas and pluriparas, opening is fastest after early rupture of the amnion, followed by premature amniotic opening and opening at induction of labor. Opening is slowest in the case of timely rupture of the amnion. However, the differences in the opening process between induction of labor and premature amniotic rupture on the one hand, and between induction of labor and timely amniotic rupture on the other, are not significant. The differences in opening following spontaneous onset of labor are attributed to the individual varying circumstances relating to the mechanism of birth. In regard to the temporal course of birth, neither the mother nor the child is subjected to an increased stress of labor resulting from induction of labor.

Female↗

[The ratio birth-weight, placental weight and the term of delivery. A contribution to the problem of a relative placental insufficiency in late pregnancy (author's transl)].

It is suggested, that a relative placental insufficiency in late pregnancy is one of the releasing factors of childbirth. Under this assumption 1027 deliveries in term pregnancy (266th-294th day of pregnancy) were inquired on the interrelationship between the ratio brith-weight: placental-weight and the duration of pregnancy. The average birth-weight increases slighly but significantly with the duration of pregnancy just as the average placental-weight. The average ratio birth-weight: placental-weight decreases significantly: The more unfavorable the ratio birth-weight: placental-weight is, the shorter remains the fetus in utero. This underlines the assumption of a relative placental insufficiency as one of the releasing factors of childbirth.

Birth Weight↗

[Uterine activity under tocolysis through a beta-sympathomimetic (author's transl)].

The actual mechanism of tocolytic effect of beta-mimetics is not yet known. While they are able to stop labour, the effect in vitro on myometral filaments is very different. In contrast to this, the socalled Ca++ -antagonists have an excellent relaxing effect on myometrium in vitro, but they are clinically ineffective. To clear up the mechanism of tocolysis, the uterine activity under tocolytic therapy was observed by external tocography. Whereas in normal pregnancy the portion of Braxton-Hicks-contractions and phases of inactivity--equivalent to the intervals of labour -- increases and the portion of Alvarez waves decreases, under tocolysis these changes are not to be found for a long time. The portion of Braxton-Hicks-contractions and phases of inactivity together is smaller than in normal pregnancy. The proportion of Braxton-Hicks-contractions to phases of inactivity corresponds well to normal pregnancy. The changes of uterine activity in normal pregnancy are explained as a process of increasing coordination. The tocolytic effect is regarded as a disturbance of this process.

Adrenergic beta-Agonists↗

[Prenatal weight loss in the infant (author's transl)].

Hillemanns and coworkers established, that infants born after induced labor were heavier, on the average, than those from a control group; who were born after spontaneous labor. Since it was postulated, that a weight loss preceded the onset of spontaneous labor, the birth weight and length of 444 infants born after induced labor and 70 infants born via a primary cesarean section was compared with a control group of 1,028 uncomplicated births via spontaneous labor. Thirty seven post term infants were also included in the study. The birth weight and length of infants after induced labor or delivered by primary cesarean section significantly higher than those in the control group. The post term infants were also significantly longer, but their weight was not significantly lower, than that in the control group. The major differences could not be accounted for by varying periods of gestation nor could they be accounted for by the special conditions of induced labor or cesarean section. Therefore, the only possibility remaining is that a weight loss precedes spontaneous labor. This may possibly be explained by the reduction in the relative water content which begins before birth and continues through the newborn period or by a relative placenta insufficiency. The infant weight loss and loss of amniotic fluid after the thirtyeighth week of pregnancy refutes the theory, that birth is induced by a stretching of the uterine wall. The possibility is discussed, that the onset of labor is influenced by a corresponding relief from tension such as that, which occurs following a premature rupture of the fetal membranes.

Birth Weight↗

[Uterine activity in late pregnancy (author's transl)].

In late pregnancy three different dinks of uterine activity can be observed by external tocography: Alvarez-waves, Braxton-Hicks-contractions and phases of inactivity equivalent to the intervals of labour. Contractions and phases of inactivity increases on to delivery, while the portion of Alvarez-waves decreases. Braxton-Hicks-contractions and phases of inactivity are opposed to the uncoordinated Alvarex-waves as coordinated activity. Accordingly these changes are explained as a process of increasing coordination of uterine activity, which finally ends in delivery.

Adolescent↗

[Ovarian cancer in a monocygotic twin pair (Author's transl)].

We report on a female monocygotic twin pair, where the two women fell ill of an adenocarcinoma of the ovaries almost simultaneously. The paramesonephric epithelium of the coelom is discussed as origin for the disease. The concordance of the disease in the same environment points to the genetic factors is being more important in the development of the disease. Nevertheless a clearcut hereditary troit can not be defined at this time.

Adenocarcinoma↗