Within the last 3 years a prospective study on 70 pregnant women suffering from hypotension was carried out. In all these patients the endocrine placental function was examined regularly by measuring the HPL and E3 level in the maternal serum (from the 16th week of pregnancy onwards). In order to get information on the uteroplacental perfusion rate, placental flow measurements using radioisotopes were carried out. Whereas the endocrine parameters revealed no abnormality, the results of the flow measurements were significantly low in more than 80%. In 30 out of the total of 70 patients no medication was given and after termination of pregnancy the fetal outcome was investigated. The neonates of this group were significantly smaller than normal, the rate of dystrophy was considerably high. The other 40 women were subjected to a drug regimen. Depending on pressure values and type of complaints they were given a crystal suspension of deoxycorticosterone trimethylacetate intramuscularly. In this group of patients the placental perfusion rate improved significantly after medication, the fetal outcome did not differ in comparison to cases with normotension. In the light of our study we suggest that a maternal blood pressure of 110/65 and below has to be treated not only because of maternal indication, but as well because of the fetus’ sake.
l Introduction \ The etiology of prematurity exhibits many heterogenous factors and circumstances before and during pregnancy. Several authors developed Systems to assess the risk of a pre-term delivery. These scoring Systems have been become necessary, because up to 30 factors have been considered to have an influence on prematurity. The purpose has been always to select high risk patients who require intensive prenatal care in order to eliminate or to compensate such risk factors. In particular the significance of one single factor is often found to be very different from another one. Thus it has been essential to characterize each factor with a certain number of risk points. On the other hand the combüia-. tion of some circumstances may magnify or diminish the calculated risk, which a mere addition of points does not represent. PAPIERNIK reported 1969 [14] his coefficient for a risk of a premature delivery based on results of own studies and literature. In a recent report [15] he could show a decrease of prematurity rate (without twins) in the area of CLAMART from 10.1 % (1973) to 3.9% (1977), assumably due to efforts of recognization of pre-term risk, followed by adequate therapeutic measures. SALING published 1972 his prematurity-dysmaturity-prevention program (PDP-program) [20] which is based mainly on present and previous obstetrical characteristics; social factors are listed under variable factors. This useful and valuable program, and the resulting experiences with it [6] induced us to establish a special outpatient clinic for intensive prenatal care on the model of SALING's PDP-outpatient clinic. Our experiences have been reported in previous papers [9,16]. Although it was possible to lower the prematurity rate [16], this special outpatient clinic concentrates on high risk patients in our hospital, so that it will be doubtful whether a fürther decrease of pre-term deliveries in the hospital's statistics will be within reach. Also FEDRICK [4]
A 27-year-old gravida 2 was hospitalized in the 37th week of pregnancy because of nausea, vomiting and upper abdominal pain. She had severe thrombocytopenia (600/microliter), haemolysis and markedly abnormal liver functions (bilirubin 7.4 mg/dl, GOT 512, GPT 650 and LDH 1772 U/l), indicating a probably immunologically induced syndrome (HELLP) of late pregnancy. After platelet infusion and antithrombin III substitution a slightly growth-retarded girl was delivered without complications by section because of threatened intrauterine asphyxia while the cervix was undilated. The maternal platelet count and the liver functions quickly returned to normal post-partum.
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