Loss of one of the twins in the first trimester does not impair the development of the surviving fetus. In the second trimester however this even is associated with increased risk for the survivor as reflected by a high incidence of growth retardation, premature labor and perinatal mortality.

Siekmann et al., Maternal cardiac output and fetal blood flow in pre-eclampsia 59

Ultrasonic findings in 1317 operatively confirmed gynecological tumors were classified according to five degrees of homogeneity: I, clearly outlined solitary cysts; II, clearly outlined homogeneous tumors; III, poorly defined or slightly heterogeneous tumors; IV, marked heterogeneous tumors; V, completely heterogeneous tumors. In the different groups, the rates of malignancy were: I, 0.9%, II, 1.9%; III, 17%; IV, 58%; and V, 75%. In a further study 1082 patients with a negative or doubtful result of the physical examination were investigated using ultrasound. Abnormal findings in 126 cases were able to detect 8 carcinomas, 25 kystomas, and 63 other tumors.

No abstract

From 1970-1984 116 diabetic pregnant patients were monitored and delivered at the University Hospital of Freiburg, Department of Obstetrics and Gynaecology. The pregnant diabetics were managed and controlled by an interdisciplinary team of internists and obstetricians. For better control of the maternal metabolic status, the diabetic patients were admitted to the hospital three times during their pregnancy. Foetal monitoring was done by ultrasonography, hormone analyses and cardiotocography. In most cases foetal growth retardation and macrosomia were detected early via sonography. Decreased urinary excretion of total oestrogen was measured during late pregnancy in 13% of the diabetic patients. In cardiotocography a loss of foetal reactivity was observed in 11% of all non-stress tests (NST). In more than 50% of these cases, the total oestrogen excretion also decreased. In patients with normal oestrogen values, an abnormal NST was rarely observed. Abnormal oxytocin challenge tests (OCT) were recorded in 19% of the patients. Among these cases most of the patients with a non-reactive NST were found. In 85% of the patients with pathological changes in the OCT a Caesarean section had to be performed, and among these in all patients with a loss of foetal reactivity in the cardiotocogram. In correlation with the foetal outcome, loss of reactivity in the cardiotocogram has greater pathological relevance than deceleration with maintenance of reactivity. For an early recognition of imminent placental insufficiency, OCT proved to be the most sensitive parameter. The increased incidence of acute placental insufficiency in diabetics during delivery underlines the need for repeated stress tests during late pregnancy.