[Programmed delivery].
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Biomedical subjects
Publications and source records attributed to E Reinold.
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All high-risk gravidae with regard to prematurity and dysmaturity (PDP programme) were collected over a time-limited period. More than two thirds (n = 72) of these women were submitted to intensive care (PDP group); one third (n = 33) (control group) refused intensive care. Furthermore, socio-economic factors were taken into consideration in this study and appropriate classification into 4 groups was undertaken. Gravidae of a higher social class were more often willing to undergo intensive care than gravidae of a lower class. In the PDP group 75% of the gravidae were delivered after the end of the 36th gestational week and 51% of the gravidae in the control group. A similar relationship was found in regard to the birth weight of the newborn infants: in the PDP group 74.4% of the babies weighed over 2500 g at birth in contrast to the respective figure of 42.9% in the control group. However, this socio-economic study shows that the results of intensive care are much more successful in women from a lower social stata than in women from a higher social class.
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A report is presented of 319 unselected patients investigated by the method of plate thermography according to Tricoire, which is a comparatively new method in the diagnosis of breast cancer. 281 cases were additionally examined by mammography and those cases in whom malignancy was suspected underwent further cytological and histological investigation. The results of plate thermography and mammography are compared. The high degree of diagnostic accuracy achieved in the present series of cases by the use of plate thermography indicates that this procedure is not only a valable adjunct in the diagnosis of breast cancer but, moreover, seems to be recommendable as a screening method.
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According to Saling's Prematurity-Dysmaturity-Prevention Program (PDP-Program) all high-risk pregnancies in a time limited period were collected (n = 105). From these a group of 72 gravidae (PDP-group) were controlled by an intensive care-staff, a group of 33 gravidae (controll group) refused an intensive care. The initial situation of both groups was very similar. In the PDP-group 3 quarters of the gravidae delivered after the 36th week of gestation, in the control group the half of gravidae. In the PDP-group 1 quarter of the newborn infants had a birth-weight of less than 2 500 g, in the control group the half. The condition of the newborn infants were similar.
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The value of plate thermography in the determination of placental localization was investigated in 120 cases, and compared with the results obtained by the ultrasonic B-Scan method. The duration of pregnancy in these cases ranged from 15 to 37 weeks. The results of plate thermography corresponded with ultrasonic localization in 94 cases (78.3%), but the placenta was incorrectly localized by plate thermography in 26 patients. The highest degree of correspondence was observed in the group of anterior wall placentae, the localisation of the placenta by plate thermography being correct in 52 out of 62 cases. The group of posterior wall placentae showed the lowest rate or correspondence, plate thermography giving the correct localization in only 32 out of 45 cases. Hence, plate thermography does not appear to be of sufficient accuracy for clinical use or scientific investigations. Furthermore, no accurate determination of placental surface area and placental thickness is possible with plate thermography. For all these reasons it may be concluded that this method is greatly inferior to the ultrasonic B-Scan method in respect to placental localization.
In the years 1960-1972 an increase of the frequency in the surgical closure of the incompetent cervix is observed. Primarily a cerclage, described by Shirodkar, in a modification of McDonald was used; a closure, described by Szendi was performed very rare. An exact explication of the pregnancy of 304 patients from the last 6 years shows, that in 87% the operation was successful, in 13% the pregnancy ended as an abortion. The purpose is to reach a time for a delivery of a child alive if possible mature. From 269 newborn infants 22,3% had a birthweight of less than 2500 g and 79,6% more than 2500 g; 1,1% were stillborn. The increase of the frequency we deduce on the one hand in an enlarged indication for a surgical closure and on the other hand in an improved intensive care during pregnancy, especially in high risk patients.
A case of an ectopic pregnancy is reported, which was diagnosed by ultrasonic-scan-technique. The echogramm had shown beside an enlarged uterus on the left side of the patient, a cystic structure on the right side; inside this cystic a fetus with spontaneous movements could be observed. The immediate following surgical intervention verified the ultrasonic diagnosis, the fetus showed spontaneous as well as by touching induced movements up to 30 minutes.
During the period 1969--1973, a total of 7933 deliveries was carried out at the First University Clinic of Obstetrics and Gynaecology in Vienna. Of these, 328 deliveries were breech presentations and 260 were single-born. The frequency of Caesarean sections in the case of breech presentations was 16,6%, i.e. about four times higher than the average frequency of Caesarean sections in relation to the overall number of obstetric patients of our clinic. The high frequency of premature deliveries in breech presentation (18,46%) is reflected in the perinatal mortality rate; 5,67% of all children born in breech position died sub or post partum. The net perinatal mortality rate was 1,15%.
EPH gestosis and placental insufficiency sui generis are cause of fetal hazards. Clinical symptomatology and anamnesis indicate different tests to detect pathological conditions for the fetus. HPL, HCG, urinary estriol, measuring the placental flow-rate, ultrasonic diagnosis as all other usual examinations during pregnancy were carried out. In EPH gestosis a reduction of all placental functions was found like as for thrombocytes and fibrinogen. Placental insufficiency showed an even greater reduction of placental function, only thrombocytes and fibrinogen remained constant. Weight and length of the newborn were according the pathological placental function reduced. Morphology of the placenta could proof the results of the previous done tests.