Value of sonography in early diagnosis of ectopic pregnancy was investigated in a retrospective study. Frequency and value of different sonographic findings were analysed in 192 patients, who received laparotomy for ectopic pregnancy. In 171 patients (89%), the absence of an intrauterine sac in conjunction with a positive serum pregnancy test was the most reliable sign for ectopic pregnancy. A complex or cystic adnexal mass was found in 66 cases (32%). Hematocele or the presence of fluid in the cul-de-sac was observed in 61 patients (34%). Since an adnexal mass and retrouterine fluid or hematocele are rare sonographic findings in early ectopic pregnancy, the absence of an intrauterine sac in conjunction with a positive serum pregnancy test are of greatest significance. But correct diagnosis based on this sign is only possible considering the following conditions: 1. Evidence of pregnancy (beta-HCG in serum). 2. Gestational age more than 5 weeks. 3. Exclusion of intrauterine abortion .4. Consideration of differential diagnosis of pseudo-gestational sac and coexistence of an intra- and extrauterine pregnancy.
In a comparative study on 484 pregnant women the influence of different modifications of the examination by continuous wave (cw)--Doppler was tested. The aim was to improve the detection rate of foetal growth retardation (IUGR): 1. Among different definitions of normal ranges the mathematical "smoothing" of normal values by regression analysis improves the results. 2. Of the most commonly used flow indices the A/B ratio is more reliable than the resistance and the pulsatility index. 3. Comparing the results of one to three examinations of the same patient in the course of pregnancy the relation of sensitivity to specificity is best after two examinations. 4. On evaluating the examinations of the umbilical arteries and the arcuate arteries, an intolerably false positive rate was found in the evaluation of arcuate arteries by cw Doppler.
We investigated on the basis of 14,498 singleton births between the completed 24th and 42nd week of pregnancy, the dependence of the Apgar index after one minute and of the actual pH in the umbilical artery on two clinical variables 1. the duration of gestation and 2. the degree of intrauterine growth retardation. To determine the latter, each of the 14498 infant weights was transformed arithmetically to a percentile, i.e. a figure between 0 and 100. It was shown that the duration of pregnancy has a significant effect on increasing foetal acidity, which is greater (nonlinear correlation), the more immature the baby is. The influence of intrauterine growth retardation is slight but demonstrable in mature neonates and with adequate clinical management. In premature infants, especially in very small premature babies, intrauterine growth retardation becomes a major risk factor: increasing hypotrophy leads to a probably exponential rise of the acidity figures as well as to an increase in the percentage of low and very low Apgar scores. Hypertrophic premature babies and hypertrophic mature neonates are also subject to an increased risk. The effects mentioned above, of clinical maturity and intrauterine nutrient and oxygen supply on the unborn baby, result in a numerical continuity in the behaviour of the parameters: there are no abrupt alterations. This suggests, that the conventional definitions of hypotrophy or hypertrophy should be reconsidered. Furthermore, the data allow the conclusion, that prematurity and dysmaturity are two important variables thus suggesting an individual (i.e. non-schematic) obstetric procedure in premature deliveries.
