Kombinierte perizervikale und intramuskuläre Prostaglandin-Medikation zur Schwangerschaftsbeendigung im II. und III. Trimenon

In 64 patients with pathological pregnancies (missed abortion, molar pregnancy, intrauterine fetal death, fetal malformation, maternal disease) termination of pregnancy was induced by local application of PGE2 by means of a portio cap and subsequent intramuscular application of Sulproston. In 21 women 1,5 mg and in 43 2,25 mg PGE2 or more were used for cervical priming. In 21 cases expulsion of the fetus could be obtained during or shortly after the priming procedure. In the remaining 43 women Sulproston was administered on the following day with a starting dose of 200 mcg and 100 mcg subsequently at two hours intervals up to a total dose of 500 mcg. With the exception of 3 cases this led to the expulsion of the products of conception. In the remaining 3 patients abortion was obtained on the third day by additional Sulproston-application. The mean expulsion time was 6,3 +/- 2,1 hours, being significantly lower when the fetus was not alive compared to viable pregnancies. Side effects during the priming procedure were only observed in 3 cases; the total rate of side effects was 57,8% and the incidence of use of analgetics 51,5%. The softening effect of locally applied prostaglandins apparently adds in an advantageous manner to the strong contractile effects of Sulproston resulting in shorter expulsion intervals, lower total dosage of prostaglandins and a reduction of the incidence of side effects and the use of analgetics.

Elevated serum melatonin levels during human late pregnancy and labour

Melatonin (MLT) shows an influence on gonadal steroid genesis, and has soporific effects. Serum MLT levels were examined during late pregnancy and 4 days after delivery in 25 women. Circulating levels of melatonin were analysed as integrated values (areas under the curve [AUC]) over 24 hours, 5 to 2 days before and 4 days after delivery. Antepartum AUCs were significantly increased compared with postpartum AUCs. Additionally, MLT levels were measured every 2 hours in a subgroup of 11 women during spontaneous labour between 08.00 and 12.00 h at a time when physiological serum MLT levels were low. Increased MLT levels were determined and compared to MLT levels measured in a previous evaluation of the antepartum AUCs. Elevated serum MLT levels during late-pregnancy and labour may influence the concentration of receptors of gonadal steroids in the gravid uterus at term and the psychic perception of painful uterine contractions during labour.

Hypericin - The Facts About a Controversial Agent

Hypericin is a naturally occurring substance found in the common St. John's Wort (Hypericum species) and can also be synthesized from the anthraquinone derivative emodin. As the main component of Hypericum perforatum, it has traditionally been used throughout the history of folk medicine. In the last three decades, hypericin has also become the subject of intensive biochemical research and is proving to be a multifunctional agent in drug and medicinal applications. Recent studies report antidepressive, antineoplastic, antitumor and antiviral (human immunodeficiency and hepatitis C virus) activities of hypericin; intriguing information even if confirmation of data is incomplete and mechanisms of these activities still remain largely unexplained. In other contemporary studies, screening hypericin for inhibitory effects on various pharmaceutically important enzymes such as MAO (monoaminoxidase), PKC (protein kinase C), dopamine-beta-hydroxylase, reverse transcriptase, telomerase and CYP (cytochrome P450), has yielded results supporting therapeutic potential. Research of hypericin and its effect on GABA-activated (gamma amino butyric acid) currents and NMDA (N-methyl-D-aspartat) receptors also indicate the therapeutic potential of this substance whereby new insights in stroke research (apoplexy) are expected. Also in the relatively newly established fields of medical photochemistry and photobiology, intensive research reveals hypericin to be a promising novel therapeutic and diagnostic agent in treatment and detection of cancer (photodynamic activation of free radical production). Hypericin is not new to the research community, but it is achieving a new and promising status as an effective agent in medical diagnostic and therapeutic applications. New, although controversial data, over the recent years dictate further research, re-evaluation and discussion of this substance. Our up-to-date summary of hypericin, its activities and potentials, is aimed to contribute to this process.

[The importance of a gynecological teenager consulting hour by the example of "First Love"]

There are worldwide deficits in sexual and contraceptive education of teenagers and the effects on their contraceptive behaviour. It is worthwhile to offer services tailored to the needs of adolescent girls. This can be demonstrated by the experience of 10 years work of 'First Love', a gynaecological out-patient department for teenagers at Rudolfstiftung Hospital, Vienna. Together with the girls and their partners, individual concepts for safe, responsible and satisfying sexuality are developed. A multidisciplinary team, easy access, the possibility of remaining anonymous and free-of-charge consultations are the major principles in this work. There are also a lot of preventive health care issues: as young girls experience their first gynaecological examination as painless and less embarrassing than expected, they will agree to routine check-ups in their future life.

A significant correlation between melatonin deficiency and endometrial cancer

Endometrial cancer is the most common pelvic genital cancer in women. Its incidence is increasing. Unlike the successful screening method for cervical cancer, there is no such equivalent procedure for the early diagnosis of endometrial cancer. Screening procedures currently being tested are too insensitive and nonspecific while diagnostics are either too complex or invasive. In Austria, a multicenter study was begun to search for parameters appropriate for a screening program. 138 women were selected based on anamnestic, serologic and cytologic risk factors. 68 women were diagnosed with endometrial cancer, 70 patients had abnormal bleeding. There were no significant differences in age and menopausal status. Secondary diseases including diabetes mellitus, hypertonia and adipositas were evenly distributed in both groups. In addition to the routine hormone analyses, we tested the patients' plasma for differences in melatonin levels. We found a significant correlation (p < 0.001) between melatonin plasma levels and the presence of endometrial cancer. The mean plasma melatonin value was 6.1 pg/ml in the cancer-positive group and 33.2 pg/ml in the cancer-negative control group resulting in a 6-fold difference between the two groups. We conclude that decreasing melatonin plasma levels may be an indicator of endometrial cancer and that this may therefore be used as a reliable screening parameter.

5-aminolevulinic acid-mediated photodynamic therapy of intraepithelial neoplasia and human papillomavirus of the uterine cervix--a new experimental approach

The aim of this study was to treat patients for ectocervical dysplasia [cervical intraepithelial neoplasia (CIN) grades 1 and 2] and associated human papilloma virus (HPV) infections with photodynamic therapy (PDT). In 20 patients, 5-aminolevulinic acid (5-ALA, 12% w/v) was applied topically with a cervical cap 8 h prior to illumination. A thermal light source (150 W halogen lamp) emitting a broadband red light (total energy: 100 J/cm2, fluence rate: 90 mW/cm2) was used for superficial illumination of the portio. In addition, an Nd:YAG pumped dye laser (652 nm) was used to illuminate the cervical canal (total energy: 50 J/cm2, fluence rate: 300 mW/cm2). Preliminary results of follow-ups at 1, 3, 6, and 9 months posttherapy showed a cytological improvement in the grading of the PAP smears in 19 patients and the eradication of cervical HPV in 80%. These results demonstrate that ectocervical dysplasia and associated HPV infections can be treated by PDT.

Antagonistic effects of combination photosensitization by hypericin, meso-tetrahydroxyphenylchlorin (mTHPC) and photofrin II on Staphylococcus aureus

Photodynamic therapy involves the application of a photosensitizer activated by visible light to generate cytotoxic reactive oxygen. In addition to clinical investigations, in vitro studies concerning photodynamic potency of sensitizers as well as quantification of illumination procedures are necessary. In our investigation, the objective was to evaluate not only the effects of photosensitizer and light on Gram-positive Staphylococcus aureus, but also to investigate possible synergistic or antagonistic effects of these sensitizers. Therefore, we used hypericin, Photofrin II, porfimer sodium and meso-tetrahydroxyphenylchlorin (mTHPC) alone, as well as in combination. Log-phase cells of S. aureus exhibited a marked sensitivity to white thermal light irradiation in the presence of Photofrin II and mTHPC. However, hypericin caused a rather stimulated growth expressed in increased optical density (OD) and increase of total cell count (TCC) of the culture. Combination sensitization of S. aureus by Photofrin II and mTHPC with hypericin likewise caused a stimulation of bacterial growth. No synergistic effects were obtained by combination of Photofrin II and mTHPC; photoresponse of S. aureus was rather decreased by using combined porphyrins. In comparison, TCC and colony-forming units (CFU) were suppressed in the presence of mTHPC after an illumination procedure as well as in dark reactions. These effects were also obtained in the combination photosensitization by mTHPC and Photofrin II. In the presence the of hypericin, photodynamic effects of mTHPC and Photofrin II were inhibited. It was finally concluded that hypericin in our model is not a proper sensitizer for combination photo-sensitization due to antagonistic effects on photodynamic activity of mTHPC and Photofrin II.

Multiple endometrial stromal nodules with sparse cysts and glands in the lung--a nodular variation of endometriosis that may mimic metastases of sarcoma

We report an unusual case of a nodular variation of pulmonary endometriosis. To our knowledge, there is no previous report on a morphological investigation of this entity. The etiology of this rare condition is still a matter of discussion. The well-circumscribed nodular mass is composed of cells identical to, or closely resembling, those of endometrial stroma containing sparse cysts and glands. Immunohistochemically, the cells showed an extensive co-expression of cytokeratin AE1/AE3 and vimentin and were highly positive for progesterone receptor (PRICA) and estrogen receptor (ERICA). Cells lining the cysts and glands as a monolayer were reactive for Ber-Ep4, cytokeratin Pan and cytokeratin AE1/AE3 and negative to all other markers used including PRICA and ERICA. The differential diagnosis of this entity included fibrous tumor of the pleura and metastatic low-grade-endometrial-stromal-sarcoma. The morphological findings are correlated with immunohistochemical studies and results of cell image analysis. This study details the clinicopathological features of the nodular variation of pulmonary endometriosis.

Does the in-vitro efficiency of meso-tetrahydroxy-phenyl-chlorin depend on pre-treatment of sensitizer?

The efficiency of a new photosensitizer of the second generation, meso-tetra-hydroxyphenyl-chlorin (mTHPC), which has a strong absorption at 652 nm, was investigated by oxygen consumption measurements and membrane integrity testing. The experiments proved a great increase in the efficiency of mTHPC after preincubation at 37 degrees C for 24 hours. From these findings it can be assumed that tumor cells can be treated in an optimal way with PDT after a longer delay following drug administration.

Clinical effect of meso-tetrahydroxyphenylchlorine based photodynamic therapy in recurrent carcinoma of the ovary: preliminary results

This article addresses the use of meso-tetrahydroxyphenylchlorin-based photodynamic therapy (m-THPC-PDT) to treat recurrent gynaecologic malignancies of the ovary. Photodynamic therapy is an experimental approach in the treatment of neoplasms and results indicate it is a highly tissue selective, relatively simple intervention with few side effects, therefore reducing the overall burden on the patient. Of the three patients involved in the initial study, two were treated solely with photodynamic therapy by laparoscopy, and one underwent additional palliative debulking surgery of metastatic tumours. After a post-operative period of more than two years all three women remained free of relapses.

[Sarcoma botryoides in the pediatric vagina--a soft tissue sarcoma with good prognosis]

Although rare, sarcoma botryoides of the vagina in infants is a highly aggressive soft tissue tumour. Former opinions suggesting exenterative surgery and radiation to improve the dismal outcome in these young children, are outdated. Due to balanced therapies (topical tumourectomy, chemotherapy and radiation adjusted to tumour stage) cure of these sarcomas may be expected dependent on tumour stage, localisation and response to chemotherapy. The rate of complete remissions has increased in recent years. We report on an eighteen-month old girl with complete remission of tumour stage IIA who had been treated according to the CWS 91 protocol. Diagnosis and treatment were performed in March 1994 at the age of six months. We observed the patient in complete remission for 8 months (till September 1995).

A new approach to cancer therapy due to appropriate uptake and retention kinetics of meta-tetrahydroxy-phenylchlorin in a human fibroblast cell line

Studies have shown that meta-tetrahydroxy-phenylchlorin is an efficient tumor targeting agent for laser photodynamic therapy. The effectiveness of this approach for cancer treatment depends on drug concentration, incubation time and extracellular protein. We studied uptake and retention kinetics of mTHPC in a human fibroblast cell line. Our results clearly demonstrate a difference in the amount of extracellular mTHPC at an incubation temperature of 37 degrees C compared to 20 degrees C and 4 degrees C. pH-values were always constant and not responsible for the increase. Furthermore, both absorption and fluorescence of mTHPC increase when incubated at normal human body temperature. Incubation of human fibroblast cells with mTHPC (10 micg/mL) showed that intracellular mTHPC increases in a linear manner reaching saturation after 24 hours and declining until 48 hours with concommitant increase of supernatant mTHPC. Therefore, we believe that tumor cells can be treated optimally with PDT following a delay > 24 hours after drug administration with a minimum of damage to surrounding normal tissues.

The clinical effect of uterine hyperflexion and cervical elongation in cases of pelviscopic hysterectomy

In a retrospective study of women who had undergone pelviscopic hysterectomies in the last 2 years, we focused on postoperative cyclic spotting. Preoperatively, a regular, cyclic menstruation and a premenopausal sexual hormone constellation were common to all patients. In the first group (n = 29), spotting occurred only in association with two uterine anatomical varieties: uterine hyperflexion and cervical elongation. The second group (n = 18), in which intraoperative internal electrocoagulation of the residual cervical envelope was performed, no spotting occurred despite the presence of uterine hyperflexion and cervical elongation. This procedure prevents the occurrence of postoperative spotting in cases of uterine anatomical varieties.

Pelvic promontory fixation of the vaginal vault in sixty-two patients with prolapse after hysterectomy

During a 20 year study period from 1969 to 1991, 62 patients underwent abdominal colpopexy between a prolapsed vaginal vault and the cartilage of the promontory. A simple surgical operation technique introduced in 1954 was modified and tested on these women. Hysterectomy, either transabdominal or vaginal, had previously been performed upon all of these patients. In some instances, short lyodura loops were used to suspend the vagina. In all operations, the suspension was covered with peritoneum of the lumbosacral area. Functional and cosmetic results were excellent and urinary stress incontinence could often be improved. It is suggested that this type of procedure is indicated in subtotal and total prolapse of the vagina after hysterectomy in patients who desire to preserve sexual function.

[Phthirus pubis as the cause of tubo-ovarian conglomerate tumor]

A case of an inflammatory tubo-ovarian tumour is presented. Histology and entomology identified the infectious agent as Phthirus pubis.

[Pelviscopic hysterectomy--a prospective comparative study of 40 cases]

We review to date 20 pelviscopic extirpations of the uterus. This new method of hysterectomy shows some advantages over the common vaginal hysterectomy. Anatomy of the supporting ligaments of the uterus remains the same, recovery from the operation goes quicker. Morbidity rate seems to be less than in the case of vaginal hysterectomy.

[Struma ovarii maligna]

Benign and malignant struma ovarii are very rare ovarian teratomas. Specific therapy guidelines should be established. A case of a malignant struma ovarii is presented and results of therapy discussed.

[Fetal death in multiple pregnancy--implications for obstetrics and literature review]

Due to routinely and skilled ultrasound examinations during pregnancy the diagnosis of a single intrauterine loss in twin pregnancy is increasingly found. This report demonstrates two cases of twin gestation complicated by the death of one fetus, presented as a fetus papyraceus. Supported by the recent literature, intensive observation and care leaded to spontaneous delivery near term of the healthy surviving twins. In such cases conservative obstetrical management is recommended.

[Computer-assisted patient management. Individual electronic data processing-assisted documentation in gynecology]

EDP-supported documentation of patients has become increasingly important over the last several years. Seven autonomous wards of the gynecological department of the Hospital Rudolfstiftung were equipped with a clinical documentation system. The integration of this new system into the infrastructure of the KIS (Krankenhausinformationssystem) was accomplished with the help of the MD-ADV. We also implemented one of the best-known statistical analyzing systems, SAS, so that we have simple possibilities for statistical calculation and graphical plots.

Influence of isradipine on the maternal and fetal cardiovascular system in hypertensive disorders in pregnancy

Nine pregnant women (aged 28.7 +/- 6.9 years) who had developed hypertension (blood pressure greater than 140/90 mm Hg) took part in an open pilot study with the new calcium antagonist isradipine. Dosage was started with 1.25 mg twice daily and was increased weekly to 2.5 mg and 5 mg twice daily until a diastolic blood pressure of less than or equal to 80 mm Hg was achieved. By the time of the last visit before term, blood pressure was significantly reduced to 129/79 mm Hg and heart rate had not altered. External cardiotocography indicated fetal well-being throughout the entire study. Doppler flow measurements showed no deterioration in A:B ratio, resistance index, and pulsatile index. All measurements in the newborn were within normal ranges. In conclusion, isradipine is a safe and effective drug for pregnant women and their fetuses in the management of hypertensive disorders in pregnancy.

[Documentation of the surgical report with graphic statistical data analysis--a simplification of daily routine work]

A data collection system on microcomputer connected with an automatic medical report system for operations, was developed to facilitate both medical report as well as documentation. Linking different commercial software products by use of a Pascal programme, we were able to speed up daily routine work as well as establish efficient graphical statistics of patient data.

Vaginal agenesis and congenital adrenal hyperplasia. Psychosocial sequelae of diagnosis and neovagina formation

Eleven patients with Mayer-Rokitansky-Küster syndrome (MRK) and 7 patients with adrenogenital syndrome (CVAH) were interviewed and tested pre- and postoperatively. MRK subjects were operated on with a modified Vecchietti procedure, CVAH subjects underwent genitoplastic and clitoroplastic operation. Psychosocial sequelae of and coping with malformation and treatment were assessed with semistructured interviews and the Giessen test. Anatomical and functional results of the vaginoplastic operation were excellent, and sexual satisfaction correlated with coping. 7/11 MRK patients were capable of good to fair adaptation to the malformation, whereas CVAH patients suffered severe distortions of body image. The malformation caused narcissistic damage in all cases. Circumstances of diagnosis, prevailing defense mechanism and consequences for counselling are discussed.

[Initial experiences with a levonorgestrel-ethinyl estradiol combination for interception]

Several authors have reported on reliable postcoital contraception, using an estrogen/gestagen combination. These studies in more than a hundred women showed, that the unprotected intercourse in less than 50% took place around ovulation. Pregnancy rates from 0.7 to 2.6% were observed. From October 1987 to July 88, 50 women after unprotected intercourse around ovulation were included in our study. From one to 44 hours after intercourse, 0.5 mg levonorgestrel + 0.1 mg ethinylestradiol (Tetragynon) were administered orally. The same dose was repeated 12 hours later. Cervical secretion, LH- and E2 and P-serum levels at the time of the first administration were determined and side effects and bleeding patterns were registered. In one third of the women, we observed slight side effects. The bleeding resulted 5 to 29 days after the first tablet administration. Shortened menstruation cycles were seen more often than prolonged cycles. Bleeding duration was only slightly prolonged. Two pregnancies occurred - both women vomited immediately after the first medication and disregarded the order to visit our department again as quickly as possible. Tetragynon is not appropriate for regular contraception and should only be used in emergency situations.

[Treatment of tubal pregnancy with prostaglandins: a multicenter study]

In this prospective multi-centre-study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2 alpha and systemic PG E2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PG, the method proved to be successful in 81%; 21 patients (19%) required surgical intervention later. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalisation was significantly reduced in the PG group compared to the patients treated by primary operation (3 +/- 1 versus 6 +/- 2 days). In the PG-group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. Four subsequent intrauterine pregnancies in the PG-group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (less than 2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility.

Effect of beta-receptor blockers on uterine contractility in a puerperal model

beta-receptor blockers are increasingly used in the treatment of pregnancy-induced hypertension. Hitherto an oxytocic effect on the myometrium could not be excluded. We investigated the effect of 0.8 resp 1.6 mg pindolol on uterine activity in a double blind study in comparison with a placebo group, using a puerperal model. A "paradoxical" decline in uterine activity could be demonstrated, speaking in favor of a further propagation of beta-blockers in obstetric practice.

[Influence of pindolol on maternal cardiovascular parameters and contractility of the puerperal uterus]

In the present study the influence of beta-receptor blockers on uterine activity was examined. In the postpartum period of 16 enrollees blood pressure, heart frequency, contraction frequency, basal tone, contraction intensity as well as the Montevideo Units were recorded at intervals of 10 minutes during and after infusion of 0.8 resp. 1.6 mg pindolol. Pindolol with its inherent intrinsic sympathomimetic activity led to the well known decrease of blood pressure but did not increase uterine activity.

[Hormonal status in patients with Mayer-Rokitansky-Küster syndrome]

A characteristic and comparatively frequent malformation of the female genital tract is the congenital absence of the vagina and a rudimentary uterus, known as Mayer-Rokitansky-Küster syndrome. Since we employ the modified surgical technique according to Vecchetti we have a relatively large incidence of patients with this syndrome. Thus, a total of 15 patients were hospitalised for a thorough endocrinological examination including a GnRH test with 2 bolus injections of GnRH, TRH-test, the determination of testosterone, DHEAS, androstendione and gonadotropin as well as prolactin fluctuation over a 4-hour period. The values of 4 patients without any endocrinological disorder served as control group. 2 of the 15 patients showed an increase in androgenic hormones; 8 patients a slight hyperprolactinaemia disclosed by the TRH test. The gonadotropin fluctuation in all patients was restricted and the stimulation of the pituitary gland with GnRH bolus injections was diminished. The naloxone test led to a significant increase in peripheral gonadotropins. It remains to be determined whether this endocrinological disorder is the cause or the outcome of the rudimentary inner genitals.

[Diagnosis and therapy of gynecologic diseases in girls]

Problems arising the examination and treatment of children with gynaecological disorders are described. Over a period of 8 years 1300 newborn to 15 year-old girls were given a gynaecological check-up at the outpatient department for infants and juveniles at the 1st Department of Obstetrics and Gynaecology of the University of Vienna. The average age of the young patients was 7.6 years. The most frequent condition diagnosed was vulvovaginitis (43%), followed by pathological vaginal bleeding (13%), vulval disorders (7%) and suspicion of intravaginal foreign body (5%); about twenty additional disorders were diagnosed. Absolute and extended indications for Gynaecological and vaginoscopic examination, as well as therapeutic recommendations are enumerated.

[Effect of low birth weight on menstruation and sex behavior in adulthood]

We report the results of a follow-up study of women, who had low birth weight, and their later gynecological development concerning menarche, menstrual cycle, menstrual complaints, sexual activity and fertility. 50 women with a mean age of 22 years have been divided into three groups (13 women had a birth weight below 1.500 g, 17 women were within the range of 1.500 g and 2.000 g and 20 women between 2.001 and 2.500 g). Considering the parameters menarche, sexual activity and fertility no differences among those three groups were found. Comparing all three groups of low-birth-weight newborns significant differences could be shown in menstrual cycle and menstrual complaints.

[Surgical gynecologic interventions in 1 to 15-year-old girls]

1200 girls, aged between newborn to fifteen years, came to our outpatient department of children and adolescent gynecology, during the last seven years. 86 children (7%) had to be hospitalized. In the 86 young patients 111 operations were necessary; 36 operations had to be performed at the vulva, 33 at or through vagina and 42 intraabdominal. As expected the girls with operative interventions were older than the mean age of all our patients. Also juridical and psychological problems are discussed.

[Comparison between prostaglandin E2 gel and oxytocin in medically indicated labor induction]

The use of prostaglandins (PG) increasingly replaces the "classical" method of induction of labour by means of oxytocin and amniotomy, the last-named method being associated, especially in women with an unripe cervix, with side effects like prolonged labour and a higher rate of obstetric surgery. In this study the point of interest was whether prostaglandins offer any advantages over the classical method in respect of efficacy and maternal and foetal tolerance. 99 patients subdivided into primiparae and multiparae were randomly assigned to group A or B. In group A labour was induced with 1 mg resp. 2 mg PGE2 intravaginally at an interval of 6 hours. In group B the method of induction consisted of intravenous oxytocin and amniotomy. The success rate of induction was almost equal in both groups. However, in those patients where PGE2 induction did not succeed and who could not be delivered within 12 hours the cervical score was significantly improved in comparison to the oxytocin group. Based on the experience reported in the literature, one might speculate that an increased dosage could still improve the results of vaginally administered PGE2 gel.

[Pregnancy and labor in 12 to 14-year-old girls]

This retrospective study reports on the course of pregnancy and delivery in 12- to 14-year old girls during a period of 8 years. At the time of delivery 44 mothers (0.3%) out of 13,178 had not finished their 15th year; this adolescent primiparae were compared to a group of equal size including primiparae between 20 and 30 years of age. Whereas other studies report a higher risk of several pregnancy-related complications, our investigation mainly found a higher percentage of premature deliveries (13.6%). A significantly shorter duration of pregnancy resulted in lower birth weights in the adolescent group. Furthermore we noted a higher frequency of pyelitis gravidarum in this group. Operative delivery had to be performed in 9.1% of the cases (3 X cesarean sections, 1 X forceps), compared to 13.6% in the control group (3 X cesarean sections, 3 X forceps). In the adolescent group no other obstetric complications occurred; whereas a higher incidence of puerperal infections (endometritis) was noted. 26 adolescent mothers were foreigners of southern European descendence; in only 8 cases the putative father was notified; a third of the young mothers decided to enter their child in the state adoption program.