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Gynecology and Obstetrics

Six thousand active participants were assembled in Berlin during the XIth World Congress of Gynecology and Obstetrics. Their contribu- tions covered the entire field of our discipline: matemo-fetal medicine, gynecologic oncology and surgery, reproductive medicine, and endocri- nology. Emphasis was laid on the diseases of the female breast and these papers appear in a separate section of the book (B VII -X). The scientific program included 370 invited speakers for special lec- tures, various main theme sessions, around 100 seminars, and 45 film and video presentations. A total of 1566 free communications had al- ready been published in abstract form before the Congress convened (Archives of Gynecology, Vol. 237, pp. 1-405, 1985). The present volume contains 291 papers, representing special lectures, all main theme ses- sions, and seminars, from the contributions of speakers invited by the Scientific Program Committee and the key-chairmen of the XIth World Congress. Unfortunately, 78 speakers did not send their manuscripts by the deadline despite two extensions, so that we had to be content with around 80% of the contributions presented during the Congress.
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Table of Contents

A.- I History.- 1. Milestones in Gynecology and Obstetrics.- II Ethics.- 1. Biological and Phylogenetic Requirements of Medical Ethics.- 2. Ethics and Science in Drug Trials.- 3. Are Ethics Committees Really Necessary?.- III Primary Health Care Psychosomatics.- 1. The Health Needs and Problems of the Women of the World and the Inadequacy of the Present Health Care System.- 2. Meeting the Health Needs of Women Through Primary Health Care.- 3. Obstetrics and Gynaecology as a Component of Primary Health Care.- 4. Cultural and Moral Issues in Obstetrics and Gynecology.- 5. Women's Perspectives of Obstetrics and Gynaecology.- 6. New Trends in the Psychosomatic Approach to Obstetrics and Gynecology.- 7. Female Circumcision.- IV Terminology.- 1. The Effect of Manual and Computerised Questionnaires on the Quality and Quantity of Medical Information.- 2. Standardisation of Terminology: Introduction.- 3. Reproductive Age and Menstruation: Definition of Terms.- 4. Towards Less Ambiguous Definitions in Perinatal Surveillance.- V Reporting Scientific Results.- 1. Editors, Peers and the Process of Scientific Review.- 2. The Need for Collaborative Clinical Trials in Obstetrics and Gynaecology.- 3. How to Avoid Having Your Paper Published.- VI Manpower Development.- 1. The Challenge: The Relevance of Education in Obstetrics and Gynaecology to the Needs of Society.- 2. Possible Changes in Manpower Structure and Training in the United Kingdom.- 3. A European View of Manpower Development in Obstetrics and Gynecology.- 4. Current Views on Manpower Development in the U. S. A..- 5. Human Resources in Obstetrics and Gynecology in Latin America.- 6. Training in Obstetrics and Gynecology in the Federal Republic of Germany.- 7. Subspecialisation: Educational Implications.- PartB.- I Care for the Pregnant Woman.- 1. The Challenge to Obstetricians Gynecologists: To Meet the World Target of Health for All by the Year 2000.- 2. Obstetric Care at the Primary Health Care Level.- 3. Chronic and Temporary Exposure to Altitude: Effect on Fertility and Pregnancy Outcome.- 4. A Sociomedical Study of Working Women and Pregnancy.- 5. Exercise and Pregnancy: Maternal and Fetal Effects.- 6. Obstetric Problems in Developing Countries.- 7. Impact of Traditional Practices on Maternal and Child Care in Indonesia.- 8. The Midwife in the Rural Environment in Developing Countries.- 9. Socioeconomic Equity and Perinatal Health: Is There a Connection?.- II Nutrition in Pregnancy -Anemia in Pregnancy.- 1. Traditional Practices and Nutritional Taboos: Their Effect on the Health of Women and Children in Africa.- 2. Nutritional Anaemia in Developing Countries: Possible Solutions.- 3. A Rational Approach to the Problem of Anaemia in a Developing Country, Nigeria.- 4. The Problems of Anaemia in Pregnancy in Ghana: The Traditional Correlates.- 5. Anaemia in Pregnancy in the Guinea Savanna of Nigeria.- 6. Blood Transfusion During Pregnancy in Women with Sickle-Cell Disease.- 7. The Evaluation of a Nutrition Program During Pregnancy Among Poor Women in the United States.- 8. Anemia in Pregnancy.- 9. Immunological Stimulus and Response in Normal Pregnancy.- 10. Trace Elements: Zinc.- III Infectious Diseases During Pregnancy.- 1. The Role of Infectious Agents in Prematurity.- 2. The Association of Chlamydia trachomatis with Preterm Rupture of the Membranes and Perinatal Outcome.- IV Neonatal Tetanus.- 1. The Prevention of Neonatal Tetanus: A Global Review.- 2. A Primary Health Care Strategy for the Control of Neonatal Tetanus.- 3. Prevalence and Prevention of Neonatal Tetanus in Pakistan.- V Pregnancy Induced Hypertension.- 1. Preventive Measures in Pregnancy Hypertension.- 2. Hypertensive Disorders of Pregnancy.- 3. Problems of Indian Obstetricians in the Management of Pregnancy-Induced Hypertension.- VI Prematurity -Preterm Labor.- 1. Prematurity: Prevention and Obstetrical Management.- 2. Prediction of Preterm Birth.- 3. Stress Factors as a Cause of Preterm Labour.- 4. Preterm Deliveries in Working Women.- 5. Treatment of Preterm Labor with Betamimetics.- 6. Magnesium in Pregnancy.- 7. Tocolytic Therapy: Yes or No?.- 8. Dangers to Mother and Infant Caused by Premature Rupture of the Membranes.- 9. Premature Rupture of the Membranes in Cases of Premature Fetus: Indications for Lung Maturation Therapy and Prevention of Ascending Infection.- 10. Placentae Abruptio and Previa, by Age, Fetal Growth, and Outcome: A Closed Control Model for Research, Feedback, and Teaching MCM-46.- VII Surveillance of the Fetus by Means of New Technology.- 1. The Future of Technology in Obstetrics.- 2. The Role of Bioengineering in Evolving Appropriate Obstetric Technologies.- 3. Fetal Behavioral States and Their Relationship to Hypoxia.- 4. A New Generation of Fetal Monitoring.- 5. A Computerized Forecasting System to Predict Deliveries and Obstetric Admissions.- 6. Microcomputer Application in Fetal Monitoring.- 7. Interpretation of Fetal Heart Rate Patterns.- 8. Invasive Intrauterine Procedures 205.- 9. Neonatal Acid-Base Balance: Statistical Considerations.- 10. Medical Ultrasound: Bioeffects and the Safety Question.- 11. The Role of Ultrasound in Perinatology.- 12. A Fiber-Optic Transducer for the Measurement of Intrauterine Pressure.- 13. Fetal Monitoring in Labor.- 14. The Measurement and Recording of Perinatal Growth.- 15. New Technologies: Relevance for Maternity Care Programs.- 16. Computerizing the Obstetric Medical Record.- 17. The Significance of the Placenta in Monitoring Fetal State.- 18. Microcomputerized Automatic Fetal Heart Rate Monitoring as an External Method: Development of the Trendgram.- 19. Toward a More Rational Study of the Physiology of Pregnancy Using Contour Photography.- VIII Induction of Labor.- 1. Elective Induction of Labor: Indications and Benefits.- 2. Elective Induction of Labor: Uterine Contractility and Cervical Ripeness.- 3. Interruption of Pregnancy After the 24th Week of Gestation.- IX Labor.- 1. Childbirth in Different Positions: Psychological Effects on the Mother.- 2. The Optimum Birth Position - Vertical vs Horizontal: The Example of the Trobriand People, Papua New Guinea.- 3. The Mother's Response to Adopting Alternative Positions in Labour.- 4. Perinatal and Infantile Repercussions of Deliveries in the Squatting Position.- 5. Moldability of the Bony Pelvis During Labor and After Delivery.- 6. Prevention of Neglected Labour With and Without Hospital Facilities.- 7. The Diagnosis and Assessment of Patients in Neglected Labour.- 8. Management of Obstructed Labour and Uterine Rupture in the Multipara.- 9. Patterns of Normal and Abnormal Labour in Primiparae and Multiparae: Cervical Dilatation, Uterine Activity, Head Descent.- 10. Anxiety and Its Influence on the Course of Labour.- X Obstetrical Anesthesia.- 1. Systemic Analgesia in Obstetrics: Inhalation Analgesia.- 2. Regional Anaesthesia: The Fetus and the Neonate.- 3. Epidural Anaesthesia and Analgesia.- XI Cesarean Section.- 1. Rising Rates of Cesarean Section: Maternal and Perinatal Advantages.- 2. Rising Rates of Cesarean Sections: Maternal and Perinatal Disadvantages.- 3. The Rising Rates of Cesarean Section.- 4. Maternal Position During Cesarean Section: Influence on the Fetus.- 5. Use of Newer Antibiotics in Treatment of Infection After Cesarean Section.- XII Maternal and Perinatal Mortality.- 1. A Global Overview of Maternal and Perinatal Mortality and Morbidity.- 2. Social Trends in Maternal Mortality: The English Viewpoint.- 3. Thirty Years of Maternal Mortality in Massachusetts.- 4. Survey of Maternal Mortality in Japan.- 5. Maternal Mortality in Hungary.- 6. Government Statistics on Maternal Mortality in England and Wales.- 7. Maternal Mortality in Brazil.- 8. Social Factors in Maternal Mortality in Italy.- 9. Social Factors in Maternal Death in Japan.- 10. Hypertensive Pregnancy as a Cause of Maternal Mortality, Morbidity, and Metabolic Changes in Japan.- 11. Social Factors in Maternal Mortality in Malaysia.- 12. Maternal Mortality: Problems of Data Collection in Confidential Enquiries in a Developing Country.- 13. Perinatal Mortality and Morbidity: Variables and Influences.- 14. The Effects of a Woman Caregiver on Perinatal Morbidity in Guatemala: A Replication.- 15. Perinatal Death in Indonesian Obstetrics: Control for Pregnancy Care and Fetal Growth MCM-45.- XIII Puerperium.- 1. Use of Dopamine Agonists for Inhibition of Lactation.- 2. Stimulation of Lactation by Pharmacological Means.- 3. Management of Breast Engorgement and Puerperal Mastitis.- 4. Endocrinology of Normal and Defective Lactation: Clinical Implications.- C.- I Oncology -General Aspects.- 1. Detection, Early Diagnosis and Treatment of Gynecologic Malignancy.- 2. Advances in the Management of Gynecologic Malignancies.- 3. Pregnancy Proteins as Markers for Estrogenicity and Malignancy.- 4. The Murine Subrenal Capsule Assay.- II Oncology-Trophoblastic Tumors.- 1. The Role of Immunobiology in the Natural History of Hydatidiform Moles and Gestational Trophoblastic Tumors.- 2. Diagnosis and Treatment of Nonmetastatic Gestational Trophoblastic Tumors.- 3. The Diagnosis and Management of Partial and Complete Hydatidiform Moles.- 4. A Review of Trophoblastic Tumors in Diyarbakir Region, Turkey.- 5. Diagnosis and Treatment of Low-Risk Metastatic Gestational Trophoblastic Neoplasms.- 6. The Management of High-Risk Gestational Trophoblastic Tumours.- 7. Pathologic Findings in Hysterectomized Trophoblastic Neoplasms.- III Oncology -Vulva and Vagina.- 1. Human Papillomavirus Infections of the Vulva and Vagina.- 2. Oncology of Vulva and Vagina.- 3. Vulvar Dystrophies.- 4. The Relationship of Vulvar Dystrophies to Invasive Squamous Cell Carcinoma of the Vulva.- 5. Microcarcinoma of the Vulva: Does it Exist?.- 6. Early Invasive Vulvar Cancer.- 7. The Midline Incision in the Operative Treatment of Vulvar Cancer.- IV Oncology -Cervix.- 1. The New Colposcopic Nomenclature.- 2 Clinical Colposcopy: Indications, Management, and Video Presentation.- 3. Pitfalls in Colposcopic Diagnosis.- 4. The Role of Colposcopy in Screening Programmes for Cancer of the Cervix: Global Experience.- 5. Present Status of the Relation Between Human Papillomavirus and Dysplasia and Carcinoma of the Cervix.- 6. Clinical Aspects of Human Papilloma Virus Infection.- 7. Genital Warts and Cervical Cancer: A Colposcopic Index for Differentiating Benign Papillomaviral Infection from High-Grade Intraepithelial Neoplasia.- 8. Colposcopy of Intraepithelial Neoplasia: Cervix, Vagina, and Vulva.- 9. Screening Program for Cancer of the Cervix.- 10. Global Experience with Screening Programs for Cancer of the Cervix.- 11. Colposcopy of Invasive Cancer.- 12. Pretreatment Evaluation of Patients with Cervical Intraepithelial Neoplasia.- 13. Morphology of Dysplasia.- 14. Control of Carcinoma of the Cervix: Role of Mathematical Model.- 15. Screening Programme for Cervical Cancer and Public Education.- 16. Results of 10 Years' Mass Cytological Screening for Cervical Carcinoma and Its Precursors.- 17. Laser Evaporation and Laser Conization.- 18. Destruction of Cervical Intraepithelial Neoplasia at 100oC Using the Semm "Cold" Coagulator.- 19. Cryosurgery in the Management of Cervical Intraepithelial Neoplasia.- 20. The Efficacy of Electrocoagulation Diathermy in Eradicating Precancerous Lesions of the Cervix.- 21. Conization vs Destructive Methods in the Treatment of Cervical Intraepithelial Neoplasia.- 22. Clinical Staging of Cervical Carcinoma: A Critical Study.- 23. Ultraradical Surgery for Uterine Cervical Cancer.- V Oncology -Endometrium 467.- 1. Precancerous Endometrial Lesions.- 2. CO2 Hysteroscopy in Diagnosis of Uterine Cancer.- 3. Distinguishing Atypical Endometrial Hyperplasia from Well-Differentiated Carcinoma.- 4. Management of Precancerous Lesions of the Endometrium.- 5. Receptors and Hormone Dependency of Cancer Cell Proliferation.- 6. Receptors and the Prevention of Endometrial Cancer.- 7. Influence of Steroid Receptor Content on Prognosis of Early Stage Endometrial Carcinoma.- 8. Prognostic Factors and Their Therapeutic Implications in Endometrial Carcinoma.- VI Oncology -Ovary.- 1. Pathology of Borderline Tumors of the Ovary.- 2. Early Detection of Malignant Ovarian Neoplasms Through Echography.- 3. Management of Borderline Tumors of the Ovary.- 4. Management of Borderline Ovarian Tumors in Japan.- 5. Practicability and Experience of Volm's Rapid Incubation Test in Tumor Resistance Testing of Ovarian Cancer.- 6. The Application of Chemosensitivity Studies in Predicting Clinical Responses.- 7. Surgery in Ovarian Carcinoma: Indications, Techniques, and Results.- 8. Experience with Pelvic Evisceration.- 9. Radical Surgery in Cervical and Ovarian Cancer.- 10. Ultraradical Surgery in Advanced Carcinoma of the Ovary.- 11. Cyclophosphamide and Cisplatin vs Hexamethylmelamine,Cyclophosphamide, Doxorubicin, Cisplatin in Combination as Initial Chemotherapy for Stage III and IV Ovarian Carcinoma.- VII Breast-Benign Breast Tumors.- 1. The Gynecologist and the Breast.- 2. Epidemiology of Benign Breast Diseases.- 3. Pathology of Benign Breast Disease.- 4. Benign and Proliferative Lesions Associated with Breast Cancer.- 5. Carcinoma Lobulare in Situ of the Breast.- 6. In Situ Intraductal Carcinoma of the Breast.- 7. The Treatment of Benign Breast Disease.- VIII Breast -Early Diagnosis and Prognostic Factors of Breast Cancer.- 1. The Natural History of Breast Cancer: Mammographic Diagnosis.- 2. Early Diagnosis of Breast Carcinoma.- 3. Prognostic Factors of Breast Cancer Detected on Screening by Mammography.- 4. Immunologie Diagnostic Evaluation of High-Risk Groups for Breast Cancer.- 5. Prognostic Factors in Primary Breast Cancer.- 6. Diet and Breast Cancer: Causation and Therapy.- 7. Contraceptive Steroids and the Risk of Breast Cancer.- 8. Imbalance in Endogenous Steroids and the Risk of Breast Cancer.- 9. Estrogen-Regulated Proteins Secreted by Breast Cancer Cells: The Growth-Associated 52K Protein.- IX Breast -Conservative Treatment of Breast Cancer.- 1. New Therapeutic Modalities for Breast Cancer: Conservative Treatment.- 2. Conservative Treatment of Breast Cancer: 10-Year Follow-up in the Milan Clinical Trial.- 3. Limitations of Conservative Treatment of Early Breast Cancer.- X Breast -Modified Surgery and Treatment Modalities.- 1. New Therapeutic Modalities for Breast Cancer: Quadrantectomy/Axillectomy and Radical Mastectomy with Immediate Reconstruction.- 2. The Influence of Pathologic Features on Clinical Outcome of Breast Cancer Patients Treated by Primary Radiation Therapy.- 3. New Therapeutic Methods in the Treatment of Breast Cancer: Preoperative Chemotherapy and Modified Surgery.- 4. Adjuvant Chemotherapy of Breast Cancer: The Milan Cancer Institute Trials.- XI Trends in Gynecologic Surgery.- 1. Advances, Anatomical Observations, Complications and Special Precautions in Vaginal Surgery, with Particular Reference to Hysterectomy.- 2. Advances in Surgical Techniques Reported During the Congress.- 3. Controversy in the Indication for Elective Hysterectomy.- 4. Vaginal Hysterectomy.- 5. Indication for Elective Abdominal Hysterectomy.- 6. Immediate Reconstructive Surgery in Ectopic Pregnancy.- 7. Management of Postoperative Infection.- 8. Prevention and Treatment of Postoperative Ileus.- 9. Techniques to Decrease Morbidity in the Obese Patient.- 10. Spinal Anesthesia.- XII Pelviscopic Surgery.- 1. The Importance of Endoscopic Surgery.- 2. The Value of Pelviscopic Surgery in Japan.- 3. Pelviscopic Treatment of Tubal Pregnancy.- 4. The Influence of Pelviscopy on the Population of India.- 5. The Diagnosis and Management of Uterine Anomalies with Endoscopy.- 6. Replacement of Laparotomy by Pelviscopy.- 7. Surgical Pelviscopy.- 8. Yield and Dissemination of Pelviscopic Surgery in the U.S.A..- 9. The Importance of Pelviscopic Surgery in Endometriosis and Ectopic Pregnancies.- XIII Surgery in Urinary Incontinence.- 1. The Diagnosis of Stress Incontinence.- 2. Modern Surgical Techniques in the Treatment of Urinary Incontinence and Fistulas.- 3. Preoperative Workup for Urinary Incontinence.- 4. Psychologic and Sexual Effects of Neovagina Formation.- 5. Operative Techniques in Urinary Stress Incontinence.- XIV Inflammatory Diseases in Gynecology.- 1. Herpes Genitalis Infection of the Vulva and Vagina.- 2. Epidemiology of Pelvic Inflammatory Disease.- 3. Management of Septic Shock, Shock Lung, and Disseminated Intravascular Coagulation.- 4. Prophylactic Antibiotics in Obstetrics and Gynecology.- XV Endometriosis.- 1. Pharmacologic Treatment of Endometriosis.- 2. Studies Utilizing a Luteinizing Hormone-Releasing Hormone Agonist in the Therapy of Endometriosis.- D.- I Human Reproduction and Infertility.- 1. Endocrinology and Infertility: Medical Aspects.- 2. Tuberculosis and Infertility in Azarbaijan, Iran.- 3. Psychogenic Sterility.- 4. Immunological Influences on Fertility.- 5. Some Observations on Subclinical Abortion.- 6. New Aspects in Psychosomatic Guidance of Childless Couples.- 7. Pregnancy Proteins in Preovulatory Follicular Fluid and Endometrium in Relation to Early Events of Human Reproduction.- 8. Use and Abuse of Research on Human Embryos.- 9. The Ethics Artificial Insemination by Donor and in Vitro Fertilisation.- 10. The Role of Cryopreservation in a Programme of in Vitro Fertilization.- 11. Advances in Human Reproduction.- 12. Assessment of Spermatozoal Motility.- 13. Antibodies to Spermatozoa Relevant to Infertility and Purification of the Corresponding Antigens.- 14. Effect of (D-Trp6-Pro9-NEt)-LHRH on Testicular Function and Sperm Morphology in Adult Male Rhesus Monkeys.- 15. The Humoral Immune System in the Female Genital Tract.- II Family Planning.- 1. The Challenge: World Needs and Priorities in Research in Human Reproduction.- 2. New Developments in Methods of Birth Control.- 3. New Developments in Methods of Male Fertility Regulation.- 4. New Developments in Oral, Injectable, and Implantable Contraceptives, Vaginal Rings, and Intrauterine Devices.- 5. Implementation of Family Planning in Rural Areas.- 6. Implementation of Population Control and Family Planning in a Developed Country.- 7. Clinical and Histomorphological Remarks on Treatment with a New Triphasic Estroprogestinic Formulation, Delta-15 Levonorgestrel (Gestodene).- III Adolescence.- 1. Reproductive Physiology of Youth.- 2. Endocrinological Aspects of Normal Puberty.- 3. Characteristics of Cyclic Disorders During Puberty and Adolescence: High-LH-Low-PRL Hyperandrogenism in Puberty.- 4. Epics in the Life of Women: Physical Aspects of Adolescence.- 5. Adolescent Reproductive Health: Contraceptive Service Delivery.- 6. Psychological and Reproductive Aspects of Adolescence.- IV Menopause.- 1. Pathology of Premenopausal and Postmenopausal Women.- 2. Estrogen-Progestogen Therapy After the Menopause.- 3. Postmenopausal Hormone Therapy.- 4. Androgen Metabolism in the Perimenarcheal Period.- 5. Alternatives to Hormone Therapy.- V Endocrinologic Research.- 1. Regulation of Follicular Maturation in Primates: A Perspective.- 2. Development of Follicular and Luteal Function in Adolescence.- 3. Is Cell-to-Cell Communication Between Thy-1+ and Ia+ Cells in the Ovarian Follicle Necessary for Ovulation?.- 4. The Luteal Phase Following Induced Ovulation.- 5. Role of Central Mechanisms in Polycystic Ovary Syndrome.- 6. Ovarian Oxytocin and Luteolysis.- 7. Luteal Phase Deficiency as a Cause of Infertility.- 8. Intraovarian Control of Human Luteal Function.- 9. Local Inhibitors of Progesterone Secretion.- 10. Hypothalamic Disorders in Hyperprolactinaemia: The Place of GnRH Treatment.- 11. Comparative Effects of Bromocriptine and the Other Dopamine Agonists.- 12. Natural History of Hyperprolactinaemia.- 13. Hypothalamic Pituitary Maturation.- 14. Human Chorionic Gonadotropin Releasing Hormone.- 15. Neural Control of Gonadotropin Secretion: Interactions of Sex Steroids with Brain Opioids.- 16. Ovulation Induction with Pulsatile GnRH.- 17. Control Mechanism of Follicle-Stimulating Hormone Secretion.- 18. Gonadotropin-Releasing Hormone as an Ovulation-Inducing Agent: Regulation of Plasminogen Activator Activity.- 19. Identification of and Possible Role for an Ovarian FSH Receptor Binding Inhibitor.- 20. Advances in HCG Research.- 21. Placental Protein and Hormone Measurements in the Diagnosis of Early Pregnancy Failure.- 22. Placental Hormone and Protein Measurements During Conception Cycles and Early Pregnancy.- 23. Exercise and Endocrine Changes.- Epilogue The Congress Message: Facing the Challenge.

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