bluuebunny/crossref_metadata_2025 huggingface dataset:
FETAL SYSTOLIC TIME INTERVALS IN LATE PREGNANCY EFFECT OF ATROPINE
Authors: Jenssen Helge
Published: December 2009

Abstract. Fetal systolic time intervals (FSTI) were derived from the externally recorded electrocardiogram and phonocardiogram in 74 women during late pregnancy. The FSTI of the first 43 patients were recorded as a control. In the others FSTI were registered before and after intravenous injection of atropine to the mother to increase the range of fetal heart rate. Two patients in the atropine group were excluded.

Correlation was found between the duration of the heart cycle (R‐R interval) and the mechanical systole (S1‐S2 interval) before and after atropine.

The amplitude of the initial part of the first heart sound (S1a) increased after atropine, when postatropine tachycardia evidenced significant placental transfer of the drug.

After atropine some fetuses showed initial bradycardia or bradycardia without following tachycardia. In such periods of bradycardia S1a amplitude was reduced.

During the initial period of postatropine tachycardia short periods of constant R‐R interval combined with varying S1a amplitude and S1‐S2 interval occurred. A close correlation was then present between S1a amplitude and S1‐S2 interval.

The time from electrical to mechanical start of ventricular systole was measured as the R‐S1 interval; it did not vary with heart rate in the control group or in the atropine group before atropine was given. Atropine shortened the R‐S1 interval; no correlation was found between shortening and tachycardia.

It is concluded that in the fetus, changes of FSTI can be observed from the externally recorded electrocardiogram and phonocardiogram. Signs of peripheral circulatory change after atropine were not found.

The changes observed after atropinization can be explained as a reduction of vagal tonic inhibition of cardiac chronotropism and inotropism. Atropine also may cause a decrease of mitral valve flow.
A NEW AND SENSITIVE METHOD FOR QUANTIFYING AND COMPARING THE BIOLOGICAL POTENCY OF VARIOUS ESTROGENS IN MAN
Authors: Damber Mats‐GÖRan , Sandström Bo , von Schoultz Bo , Stigbrand Torgny
Published: December 2009

Abstract. The serum level of an estrogen‐inducible plasma protein was followed by a radioimmunoassay in groups of women during treatment with various estrogens. After an initial increase, the mean value for the serum concentration was stable. The plateau level after six months of treatment was taken as a parameter of estrogenic potency. Eleven different hormonal preparations were compared and an estrogen index was constructed.
DETERMINATION OF TONICITY IN THE NON PREGNANT HUMAN UTERUS IN VIVO
Authors: Joelsson Ingemar , Lalos Othon
Published: December 2009

Abstract. The method hysterometry has been designed for the study of the effect upon the uterine muscle of pharmacologically active agents. Hysterometry has earlier been used on the pregnant uterus and is now described for the non‐pregnant situation. The capacity of the technique is exemplified with results achieved in a study of the effect of prostaglandin synthetase inhibitors and β‐receptor stimulating agents during dysmenorrhea.
Red cell 2.3‐diphosphoglycerate in pregnancy
Authors: Bille‐Brahe N. E. , Rorth M.
Published: December 2009

Abstract. In normal, primigravidae red cell 2.3‐diphosphoglycerate (2.3‐DPG) concentration was found to be increased significantly from the third month of pregnancy. The 2.3‐DPG concentration remained elevated throughout pregnancy. Increase in the 2.3‐DPG concentration leads to a decrease in the oxygen affinity of the maternal red cells. The combination of low pC02 and low oxygen affinity of the maternal blood facilitates the transport of oxygen as well as that of carbon dioxide across the placenta. The weight of the delivered children was not significantly correlated to the 2.3‐DPG changes, and no significant variation of the measured variables could be detected in 9 women with abnormal pregnancies.
Neurobehavioral response of infants after paracervical block during labour
Authors: Nesheim Britt‐Ingjerd , Lindbæk Ellen , Storm‐Mathisen Ingebjørg , Jenssen Helge
Published: December 2009

Abstract. 30 parturient women were randomized into a group receiving paracervical block (PCB) and a control group. The infants were tested by a neurobehavioral examination immediately after birth, after 3 hours and 3 days. The examiner was unaware of the obstetrical management of the patients. No clinically significant differences could be detected between the two groups. Arterial and venous pO2, pCO2 and pH from the umbilical cord showed no differences between the groups.
Body weight in parous women: Is there any alteration between successive pregnancies?
Authors: Beazley J. M. , Swinhoe J. R.
Published: December 2009

Abstract. In 50 women who had five successive pregnancies the difference was studied between the mean maternal weight at the 20th week of gestation and six weeks post partum. The difference changed from a weight loss to a weight gain in the fourth and fifth pregnancies. The maximum weight increment occurred between the end of the first pregnancy and the 20th week of the second, especially in obese multiparae.
The peroxidase content and the antibacterial activity of the amniotic fluid
Authors: Feingold Michael , Levin Samuel , Insler Vaclav
Published: December 2009

Abstract. A possible relationship between the antibacterial activity of amniotic fluid and its peroxidase content was examined. Antibacterial activity, assessed by counting colonies of S. aureus following 24 hour incubation, was present in 76 % of the samples studied. It was not related to gestational age. Peroxidase activity, assessed by the O‐dianisidine method, was not found in any of the amniotic fluid samples examined.
Emotional distress in morning‐after pill patients
Authors: Huggins George R. , Rosenfeld David L. , Rickels Karl , Garcia Celso‐Ramón , Fisher Ellen L.
Published: December 2009

Abstract. The self‐administered SCL‐90 test was utilized to collect emotional distress data on 120 female patients requesting morning‐after pill pregnancy interception. SCL prescores were significant in anxiety, guilt and depression factors. The 2‐week post‐treatment results showed a significant decrease in these factors. This test provides reliable measurement of emotional distress factors in gynecologic GYN patients. The results must be considered supportive for the use of DES interceptive therapy in spite of other clinical considerations relative to its safety.
Mental factors influencing recurrence of stress incontinence
Authors: öbrink A. , Fedor‐Freybergh P. , Hjelmkvist M. , Bunne G.
Published: December 2009

Abstract. At a recent follow‐up of 51 women operated on for stress incontinence, there was an astonishingly high discrepancy between symptoms claimed by the patients and signs found by the physician. To examine the influence of certain mental factors on the recurrence of stress incontinence, the patients in the above‐mentioned follow‐up were tested with the Eysenck Personality Inventory test and the Sabbatsberg Depression Self‐rating Scale test. The women with symptoms but no objective signs of stress incontinence showed a higher degree of both neuroticism and depression than the women of perfect health. Thus, in this group, it may be a question of aggravation of symptoms, which cannot be helped by a reoperation. Instead, these women might need psychiatric attention to relieve their psychosomatic symptoms.
Plasma medroxyprogesterone acetate levels following intramuscular or oral administration in patients with endometrial adenocarcinoma
Authors: Laatikainen T. , Nieminen U. , Adlercreutz H.
Published: December 2009

Abstract. The concentration of medroxyprogesterone acetate (MPA) in plasma samples taken 24 h after intramuscular or oral administration of 100 mg daily doses of the drug to patients with endometrial adenocarcinoma was measured by radioimmunoassay. In general, a plasma level of about 4 ng/ml was found 24 h after the dose, independent of the route of drug administration. However, in three of the patients to whom intramuscular MPA was given, considerably higher values were found. A maximal plasma level was achieved three hours after ingestion of 100 mg MPA. This was followed by a rapid decline to 20‐25% of the peak value after about 12 h. A rather small day‐to‐day intraindividual variation was found in daily blood samples taken just before administration of the next dose. However, considerable differences were found between individuals and it is concluded that this variation in plasma levels may be reflected in the clinical efficacy of the treatment. Thus further studies in which plasma values and clinical effectiveness are correlated seem to be indicated.
RIPENING OF THE CERVIX AND INDUCTION OF LABOR IN PATIENTS AT TERM BY SINGLE INTRACERVICAL APPLICATION OF PROSTAGLANDIN E2 IN VISCOUS GEL
Authors: Wingerup Lars , Andersson Karl‐Erik , Ulmsten Ulf
Published: December 2009

Abstract. Prostaglandin E2 (PGE2) suspended in a viscous gel was deposited intracervically to 115 patients at term with an unripe cervix. 45 of these patients were given a single dose of 1.0 mg PGE2, whereas the remaining 70 received only half that dose, i.e. 0.5 mg. Irrespective of dose <60 per cent of the patients were induced into labor and delivered without further stimulation within less than 24 hours. The mean induction delivery time was 10 hours. In the remaining patients a considerable ripening of the cervix was registered. Hypercontractility did occur in one patient given 1.0 mg PGE2, otherwise no maternal side effects were observed. There were no adverse effects on the fetuses. The number of instrumental deliveries was 19 per cent including 9 per cent cesarean sections.

It is concluded that locally applied PGE2‐gel can be used to produce ripening of the cervix and/or induce labor in patients at term with an unripe cervix. Since there was practically no difference in efficiency between the two doses but one case of hyperstimulation in patients given 1.0 mg PGE2, the smaller dose, i.e. 0.5 mg is recommended.
AN IMPROVED METHOD OF EPIDURAL ANALGESIA WITH REDUCED INSTRUMENTAL DELIVERY RATE
Authors: Matouskova A. , Dottori O. , Forssman L. , Victorin L.
Published: December 2009

Abstract. A detailed study on a modified technique of epidural analgesia (EDA) for pain relief in obstetrics has been performed. the aim of the modifications was to reduce the number of instrumental deliveries and at the same time to make the delivery a s smooth a s possible for the baby. This was achieved by the use of an anaesthetic with a favourable ratio between neonatal and maternal plasma levels (Bupivacaine) in low concentration (0.25 %). a special technique of injection enabled us to limit the extent of the blockade. An epidural catheter was inserted between L2 and L3 and moved upwards 20 cm into the epidural space. 8‐10 rnl of the solution was then injected after a test dose. the blockade was continued by the repeated injection of smaller doses. As judged by the skin anaesthetic zones and by obstetric examinations, the patient was gradually positioned, during labour, from supine to half‐sitting. the catheter was withdrawn at the end ofthc first stage of labour so that the lower sacral segments could be blocked. a group of 100 patients treated with the technique described was followed. the number of instrumental deliveries in the present series (15%) was significantly lower than in similar series reported in the literature. the group of 100 patients treated with modified EDA was also compared with 100 control patients who received only conventional treatment without EDA. There were no differences in the number of abnormal presentations. while the number of caesarean sections and cases of atonic post‐partum bleeding was insignificantly lower in the EDA group. the difference in the number of instrumental deliveries–although somewhat higher in the EDA group‐was not statistically significant. the total length of labour was prolonged in the EDA group but EDA was not necessarily responsible for this undesired effect. The clinical status of the babies was found to be better after EDA than in the control group, asjudged from Apgar score. Furthermore. fetal bradycardia was significantly reduced with EDA. It is concluded that EDA. a s used in this study, not only is a preferable way of achieving pain relief in the mother but also offers a means of facilitating the birth process for the infant. reducing the incidence of pre‐ and post‐natal asphyxia.
CONTINUOUS MINI‐INFUSION OF BUPIVACAINE INTO THE EPIDURAL SPACE DURING LABOR
Authors: Matouskova A. , Hanson B. , Rösmark U.
Published: December 2009

Abstract. Two groups, each consisting of 20 parturients, were given a continuous infusion of 0.25 per cent bupivacaine into the epidural space for pain relief, after test and loading doses. the analgesic effect was registered during labor. After delivery the course of the catheters in the epidural space was investigated radiologically. in the first group long catheters (mean 16.5 cm from the skin surface) and in the second group short catheters (mean 10.5 cm) were used. the medial approach in the epidural space was varied between the first and second lumbar interspaces. the relationship between the position of the catheter tip and the degree of analgesia was also studied. in two mothers with fetus mortuus ante partum, the spread of a radiopaque dye solution was followed during labor. Through the force of gravity and the mothers position, the spread of solution covered three segments within 30 minutes.

It was concluded, that slow infusion of local anesthetic solution gives satisfactory pain relief if the catheter is inserted into the first lumbar interspace to a depth of 10–12 cm from the skin surface ending close to the Th12 level. Gradual raising of the mother from the supine to the semirecumbent position and regular change of sides during mini‐infusion is important for an even spread of the analgesic solution and analgesia.
CONTINUOUS MINI‐INFUSION OF BUPIVACAINE INTO THE EPIDURAL SPACE DURING LABOR
Authors: Matouskova A. , Hanson B.
Published: December 2009

Abstract. Mini‐infusion of 0.25 per cent bupivacaine plain into the epidural space was used in 16 healthy women for pain relief during labor. After a loading dose, continuous administration was ensured by using an automatic pump at an infusion rate of 5 or 8 ml per hour.

Maternal venous blood concentrations of bupivacaine were determined 20, 40, and 60 minutes after the loading dose. Further samples were taken hourly until delivery. Fetal blood concentrations were determined from fetal scalp blood during mini‐infusion, and from umbilical venous blood at delivery. Maternal blood levels averaged 206 ng/ml. the maximum concentration (604 ng/ml) did not exceed 30 per cent of the toxic level. the blood concentration of bupivacaine did not tend to increase during the course of continuous infusion. Tachyphylaxis could not be detected statistically. the fetal blood concentration during blockade averaged 58 ng/ml, giving a feto‐maternal ratio of 0.28. the neonatal‐maternal ratio, calculated from the umbilical venous blood, was 0.32. with a shift of the acid‐base status towards acidosis in the neonate, the ratio of bupivacaine slightly increased. Absence of maternal hypotension as well as absence of fetal heart irregularities during infusion may be attributed to the low and stable blood concentration of bupivacaine. the mean Apgar score was 9.5 at one minute and 9.9 at five minutes. the maternal arterial acid‐base balance at delivery was normal. the fetal acid‐base status at delivery showed wide variation, without any relation to the Apgar score or the total dose of bupivacaine. It is concluded that continuous mini‐infusion of bupivacaine by means of an automatic pump has advantages over intermittent administration.
OVULATION INHIBITION WITH A COMBINED ORAL CONTRACEPTIVE CONTAINING 20 μg ETHINYL ESTRADIOL AND 250 μg LEVONORGESTREL
Authors: Lunell Nils‐Olov , Carlström Kjell , Zador Göran
Published: December 2009

Abstract. In order to investigate the possible ovulation inhibitory effect of a new oral contraceptive containing a combination of 20 μg ethinyl estradiol and 250 μg levonorgestrel peripheral serum from five healthy women between 17 and 24 years were analysed for FSH, LH, estradiol 17‐β and progesterone. the measurements were carried out during a control cycle before the treatment, during two treatment cycles and during a subsequent control cycle. in addition, serum levels of ethinyl estradiol and norgestrel were determined during the treatment periods. Radioimmunological methods were utilized for all the measurements. in all five women studied there was a complete inhibition of ovulation during treatment as indicated by a lack of mid‐cycle LH peaks and by suppression of normal luteal phase levels of progesterone. Four out of the five women showed no biphasic estradiol pattern. During treatment the serum levels of levonorgestrel varied between 1 and 10 nmol/1 while the levels of ethinyl estradiol usually were below the limit of detection for the method used (below 85 pmol/1). Post‐treatment control cycles revealed a reestablishment of the ovulatory pattern in four of the five subjects.
PITUITARY RESPONSIVENESS TO LUTEINIZING HORMONE‐RELEASING HORMONE DURING TREATMENT WITH SUBDERMAL D‐NORGESTREL IMPLANTS IN WOMEN
Authors: Weiner E. , Nillius S. J. , Wide L. , Johansson E. D. B.
Published: December 2009

Abstract. It has previously been reported that subdermal implants containing d‐norgestrel inhibit ovulation through blockage of the positive feedback action of estrogen on luteinizing hormone (LH) release. in this study 100 μg of LH‐releasing hormone (LRH) were injected intravenously to test the pituitary reserve capacity for gonadotrophin secretion in three women with three 40 mg d‐norgestrel rods implanted subdermally for more than one year. the gonadotrophin release to LRH varied and seemed related to the ovarian steroid concentrations at the time of the LRH infusion in a manner similar to that seen during the normal menstrual cycle. It is concluded that low plasma levels of d‐norgestrel do not inhibit the pituitary responsiveness to LRH. the results indicate that the blocking action of the gestagen on the positive feedback of estradiol on LH release occurs at the hypothalamus or higher CNS centers.
FERTILITY REGULATION USING “TRIPHASIC” ADMINISTRATION OF ETHINYL ESTRADIOL AND LEVONORGESTREL IN COMPARISON WITH THE 30 PLUS 150 μg FIXED DOSE REGIME
Authors: Zador Göran
Published: December 2009

Abstract. A new generation of combined oral contraceptive containing staggering amounts of ethinyl estradiol and levonorgestrel (SH B 264 AB) was compared in a randomized multicentre trial with a well established low dose combined pill composed of 30 μg ethinyl estradiol plus 150 μg levonorgestrel (Neovletta®) in a total of 489 women over 2,777 cycles. the trial was planned to run for six consecutive months at three clinics in Sweden (296 women) whereas the remaining 193 volunteers were enrolled from clinics in Great Britain and Germany. the case report forms were designed in a fashion to permit evaluation of the two formulations with regard to their overall reliability and acceptability in terms of cycle control. No pregnancy occurred during the observation period. Out of the total number of patients approximately 90% completed the six months treatment period on both combinations. Bleeding irregularities, such as spotting and/or breakthrough bleeding occurred more frequently on Neovletta® compared with SH B 264 AB (15.7% versus 10.1% of women) although the total hormone intake is considerably lower using the triphasic formulation. Missed withdrawal bleeding was reported in 2.3% of the total cycles on the fixed combination and in 0.9% of the total cycles on the triphasic regime. of the 72 (14.7%) women, 36 on each drug, who did not complete the six months of treatment, 44 discontinued for medical reasons. the discontinuation rate for medical reasons, the most common of which was spotting, was 8% for both formulations. From the present study it can be concluded that the new triphasic formulation is just as safe as Neovletta®, but it seems to be superior to the fixed 30 μg ethinyl estradiol plus 150 μg levonorgestrel‐pill in terms of a lower incidence of bleeding irregularities.
DEMOGRAPHIC TECHNIQUES IN DESCRIBING CONTRACEPTIVE USE APPLIED ON THE SITUATION IN SWEDEN
Authors: Meirik O. , Nygren K. G. , Smed B.
Published: December 2009

Abstract. The authors suggest expressing the amount of use of contraceptives in a female population in the same terms as used to denote the occurrence of births, with one year of contraceptive use regarded as an event in the same sense as a birth. If the prevalence of contraceptives in a population can be expressed in the same terms as other events associated with reproduction, such as births and abortions, it may help to clarify the relationships between these events. Applying the method used to calculate the total fertility and abortion rates on the use of oral contraceptives and intrauterine devices in Sweden in 1975, they noted 1.8 deliveries, 0.6 legal abortions and seven years' use of oral contraceptives and six years' use of intrauterine device per women.
EFFECTS OF THE PROSTAGLANDINS ON THE UTERUS
Authors: Bygdeman Marc , Bremme Katarina , Gillespie Arnold , Lundström Viveca
Published: December 2009

Abstract. The effect of intravenous and intrauterine administration of PGE1 or PGE2 and PGF2α as well as oral administration of PGE2 on the sensitivity and reactivity of the nonpregnant human uterus was studied. With the use of the flaccid microballoon technique or a micro transducer catheter, uterine recordings were made at frequent intervals throughout the menstrual cycle. Independently of the route of administration and of the phase of the cycle, treatment with PGF2α invariably resulted in stimulation of uterine motility. A high sensitivity to PGF2α was noted during the late secretory phase both in normal and dysmenorrheic women.

A marked decrease in sensitivity to both PGE2 and PGF2α administered by the intrauterine route was observed in the periovulatory phase. Inhibition of uterine contractility by PGE2 following both intrauterine and oral administration was noted during active menstrual bleeding in normal as well as in dysmenorrheic women.

These findings suggest that endogenous prostaglandins may play a role in the regulation of the normal uterine motility during the menstrual cycle and that the main reason for the abnormal contractility pattern seen in dysmenorrheic women during menstrual bleeding is an increased PGF2α/PGE2 ratio.
STANDARD TREATMENT OF DYSMENORRHEA WITH SPECIAL REFERENCE TO TREATMENT WITH SPASMOLYTICS AND HORMONES
Authors: Osler Mogens
Published: December 2009

Abstract. A survey of the methods of treatment used in dysmenorrhea is given. Special importance is focused on most frequently used methods of treatment in recent years, e. g. treatment with spasmolytics and hormones. The spasmolytics are by no means effective in all cases in treatment of dysmenorrhea and undesirable side‐effects are of frequent occurrence. When oral contraceptives became available it was found that they represented an effective remedy for dysmenorrhea. Whether the Pill should be used for treatment of dysmenorrhea must depend on whether there is also a desire of contraception or not. It is not unusual that women with severe dysmenorrhea have to abandon oral contraceptives because of side‐effects or possible risks of this treatment. There is a need for alternative treatment, and the new effective prostaglandin synthetase inhibitors may meet this need.
TREATING DYSMENORRHEA WITH ANTI‐INFLAMMATORY AGENTS
Authors: Sande Hans A. , Salvesen Turid , Izu Allen
Published: December 2009

Abstract. In a double‐blind trial with naproxen sodium 32 patients (15 in the naproxen sodium and 17 in the placebo group) completed the study during three consecutive menstrual cycles.

There were no significant differences between the two groups in physical characteristics, obstetric/gynecological histories, including the character of dysmenorrhea, and pretreatment pain intensity scores (p = 0.7).

The women were prescribed two tablets (550 mg) at the first sign of menstrual pain and one tablet (275 mg) thereafter every six hours as required.

When the scores for pain relief were tallied for the three treatment cycles, the naproxen sodium group averaged 13.7 ± 0.65 SE, while the placebo group averaged 8.8 ± 0.95 SE out of a possible maximal relief score of 18. The difference between the two groups was statistically significant at p‐value of 0.0004. Few patients reported side‐effects.
Clinical fetal monitoring: The usage and relationship to trends in cesarean delivery and perinatal mortality
Authors: Paul Richard H. , Gauthier Robert J. , Quilligan Edward J.
Published: December 2009

During the six years 1970‐1975, 62 266 deliveries occurred at Women's Hospital, Los Angeles County—University of Southern California Medical Center. Of these patients, 18 106 (29 per cent) were monitored, with an incidence of 18 per cent in 1970 which rose to 35 per cent in 1975. The patients were divided into monitored and un‐monitored groups for comparison of cesarean section rates and various aspects of perinatal mortality. The overall cesarean section rate was 9.6 per cent with 2 830 cesareans performed in monitored patients (16 per cent) and 3 124 in those unmonitored, a 7 per cent incidence including repeat cesarean. The cesarean rate remained remarkably stable over the 6‐year study period even though the monitoring incidence nearly doubled. From 1970 to 1975, the intrapartum death rate fell progressively in contrast to the incidence of antepartum fetal deaths, which remained unchanged. Overall, 50 per cent survival rate was achieved in the birth weight range of 1 200 grams. A particular group of perinatal patients who apparently benefited from intrapartum monitoring were those liveborns with birth weights of 1 500 grams or less. Over the study period, the neonatal mortality in monitored patients declined, whereas mortality in the neonates which were not monitored during labor remained high.
Selective versus routine intrapartum monitoring: Comparison of effects on perinatal outcome
Authors: Ballas S. , Hornstein E. , Jaffa A. J. , Toaff R.
Published: December 2009

This study compares perinatal results of 7 604 deliveries in two successive years (1976‐1977) in which no policy changes occurred other than a four‐fold increase in electronic intrapartum monitoring.

In the first year 15.4 per cent of births were monitored selectively. In the second year all births were monitored, with the exception of patients admitted at an advanced stage of labor and elective cesarean section. The results show no significant improvement either in intrapartum or in early neonatal mortality rates. The same results obtained in cesarean section rate and in instrumental deliveries. The only positive result is a significant reduction of low Apgar scores in the unselected monitoring group (1977). The low morbidity is considered to be a result not only of increased monitoring, but also of active management of labor, of a short duration of labor and of intensive neonatal care.
Studies in normal pregnancy: III. Fatty acid composition of serum phosphoglycerides and cholesterol esters
Authors: Skryten A. , Johnso P. , Gustafson A.
Published: December 2009

Metabolic and hormonal influences on liver lipid synthesis are reflected in the relative fatty acid composition of serum lecithin. Thus, a sucessive decrease in essential fatty acids (EFA), i.e. n‐6 fatty acids, during pregnancy would indicate an incipient EFA deficiency at the time of delivery. Furthermore, reciprocal changes in linoleic and arachidonic acids during the 1st trimester with an increase in arachidonic acid would suggest an enhancement of the Greenbeg Pathway (Pathway II) in lecithin synthesis presumably caused by estrogen influence. During the 2nd and 3rd trimester, reciprocal changes in lecithin content of palmitic and stearic acids are similar to changes appearing under cholestasis.

It is furthermore suggested that variations in the utilization of linoleic acid in cholesterol esters (expressed as cholesterol ester 18:2/lecithin 18:2) might reflect changes in plasma cholesterol esterification by the enzyme lecithin‐cholesterol‐acyl‐transferase (LCAT). Then, in late pregnancy, in relation to a subclinical cholestatic liver engagement, LCAT activity would increase as judged from this ratio as well as the increased linoleic acid in cholesterol esters.
Study of ampicillin levels in maternal serum, umbilical cord serum and amniotic fluid following administration of pivampicillin
Authors: Jordheim Odd , Hagen Åse Gerd
Published: December 2009

Premature rupture of the membrane is often followed by intrauterine infections. Antibiotic prophylaxis is recommended, but the effect has been debatable.

Thirty pregnant women received pivampicillin 350 mg 4 times daily. The ampicillin levels in amniotic fluid and in the serum of the fetus and of the mother were determined and related to pivampicillin dose and time after administration.

In the amniotic fluid the average concentration was 3.4 μg/ml, which is considered therapeutic. In maternal and fetal serum the ampicillin concentrations were low and took an almost parallel course. To obtain the same ratio between ampicillin serum levels and MIC (minimum inhibitory concentration) in the pregnant as in the non‐pregnant subject, a double dosage should be used.
Emotional stress in childbirth and its modification by variations in obstetric management: Epidural analgesia and stress in labor
Authors: Buchan Peter C.
Published: December 2009

Emotional stress before, during and after labor was measured in 20 primigravidae by serial estimation of plasma 11‐hydroxycoricosteroids and by stress assessment interviews.

The anticipation of epidural analgesia and internal fetal monitoring was a significant source of emotional stress to women awaiting induction of labor, despite explanation and attempted reassurance.

During labor epidural analgesia reduced stress by abolishing pain, so eliminating the progressive rise in 11‐hydroxycorticosteroids normally seen throughout labor. Epidural analgesia does not, however, block the potential for the adrenocortical response to stress and the physical work, emotional stress and surgical trauma of delivery stimulate a considerable output of 11‐hydroxycorticosteroids.
Neurogenic bladder
Authors: Walter Steen , Olesen Knud P. , Nordling Jørgen , Andersen Jens T. , Meyhoff Hans H. , Hald Tage
Published: December 2009

A survey of the innervation of the bladder and urethra is presented. Based on the defects of innervation the main types of neurogenic bladder disorders are classified and described. The principal diagnostic procedures, cystometry and sphincter‐electromyography, are reviewed in detail. The findings at voiding cysto‐urethrography are depicted.

It is important to be able to distinguish between voiding disorders of non‐neurogenic and neurogenic origin.

The specific treatment of the various types of neurogenic disorders of the lower urinary tract is described.
A minor complication of cryosurgery occlusion of the cervical canal
Authors: Thormann L. , Schantz A.
Published: December 2009

In a series of 145 patients who underwent cryosurgery of the cervix uteri, six cases (4 per cent) were found with occlusion of the cervical canal. The patients complained of constant pains resembling labor. Inspection of the cervix uteri showed necrosis covering the orificium externum uteri. On removal of the necrotic area there was a discharge of watery fluid. The patients were then free of pain.
Serum Lactic Acid Dehydrogenase and Isoenzymes During Pregnancy and Labor
Authors: Makkonen Maija , Penttilä Ilkka M. , Castrén Olli
Published: December 2009

Total serum lactic acid dehydrogenase activity (LDH) and the levels of LDH isoenzymes were investigated in 14 women during early pregnancy (8–16th week), in 28 women during late pregnancy (29–37th week), in 73 at term (38–42nd week) and in 27 during labor (38–42nd week). LDH activity was found to be elevated in severe pre‐eclampsia and in chronic hypertensive women during pregnancy, as well as during normal and dysfunctional labor. No change was established in total serum LDH during normal pregnancy.

LDH 1 was increased during late pregnancy and at term. In severe pre‐eclampsia and during normal labor it was decreased. LDH 2 was also decreased in severe pre‐eclampsia and during dysfunctional labor. LDH 3 was decreased during late pregnancy but increased in severe pre‐eclampsia. No change was observed in LDH 4 during pregnancy, or in labor. LDH 5 was increased in normal and dysfunctional labor.
Serum Levels of Human Placental Lactogen During and After Prenatal Dexamethasone Therapy
Authors: Lange Aksel P. , Anthonsen Henning
Published: December 2009

Thirteen pregnant women were treated with 4 mg dexamethasone intramuscularly, three times daily, for seven days during the last trimester of pregnancy, in order to prevent the respiratory distress syndrome (RDS) in the neonate. Determination of human placental lactogen (HPL) was made daily during the treatment and at intervals of 2–3 days afterwards. No changes in HPL were seen during the treatment. One week after the treatment had been stopped, a statistically significant decrease in HPL was observed (p<0.01). The levels returned to normal during the following week. It is presumed, that the observed decrease in HPL may be regarded as a result of a direct depression of placental function caused by the dexamethasone therapy.

The implications of this finding for the fetus are not clear, but in cases of placental insufficiency, glucocorticoid treatment should not be employed.
An Analysis of the Intensity and Quality of Gynecological Pain
Authors: Newton J. R. , Reading A. E.
Published: December 2009

It is evident that the pain experience varies qualitatively as well as in intensity. A number of methods to assess both the intensity and quality of pain have been reported. This paper presents the results of a card sort method of pain assessment in the measurement of gynecological pain, which provides a score from 1 to 4 for 10 pain qualities. Factor analysis has identified 3 main clusters or pain dimensions: sensations, reaction and a tiring/duration dimension.

Comparative data is presented on 5 main pain types using this method: dysmenorrhea, IUD related pain, IUD insertion pain, postoperative pain and post‐partum pain. A total of 232 patients were assessed. The results permit comparisons between pain types for both intensity as well as quality. This distinction may have implications for pain management. Thus although dysmenorrhea and IUD related pain were similar in terms of sensations, dysmenorrhea was rated significantly higher in terms of the reaction component. Similarly, both IUD insertion pain and post‐partum pain received high reaction scores. The implications of such a score profile are discussed. Thus, these scores may result from the unexpected nature of the pain sensations rather than their high intensity. In which case inclusion of psychological preparation may have been of benefit. Similarly with pelvic pain of unknown organic origin, substantial relief may be provided by focussing on the reaction component, where this is elevated, and removing the worry surrounding the sensations.
Intraepithelial Neoplasia and Carcinoma in the Vaginal Vault
Authors: Henriksen Helen Marie
Published: December 2009

An 11‐year biopsy material from the vagina is presented. The indication for taking the 370 vaginal biopsies was abnormal cytology, polyps, or suspicion of tumor tissue. The material was found to include 10 cases of intraepithelial neoplasia, viz. 4 primary, 6 secondary, and 2 late cases of secondary invasive carcinoma. The interval between the primary and secondary diagnosis ranged from 7 months to 19 years. It is concluded that the risk of secondary changes in the vaginal mucosa is slight, but cytological follow‐up is recommended.
Maternal and Fetal Metabolic Responses to Ritodrine in the Sheep
Authors: Siimes Anja S.I. , Creasy Robert K.
Published: December 2009

Ritodrine hydrochloride was infused intravenously for 60 minutes into pregnant ewes or for 29 minutes into fetal lambs, during the last third of gestation. The maternal and fetal acid‐base balance and carbohydrate status was determined prior to, during, and after the ritodrine infusions. Ritodrine was also infused into pregnant sheep in labor until no further inhibition of uterine activity could be achieved. In these studies, acid‐base balance was frequently assessed.

The maternal or fetal infusion of ritodrine resulted in no major changes in maternal or fetal acid‐base balance during the periods of study. Lactate and pyruvate concentrations in mother and fetus rose during the infusion. The lactate/pyruvate ratio remained stable, suggesting an increase in both aerobic and anaerobic glycolysis. Maternal glucose concentrations were significantly elevated after one hour of the ritodrine infusions to the ewes, but minimally elevated in the fetus. Fructose concentrations were unchanged. The possible role as fetal fuels of increased metabolic products of glycolysis caused by beta‐adrenergic stimulation is discussed.
Transvaginal Fetoscopy in Anterior Placentas
Authors: Gustavii Björn , Cordesius Eric
Published: December 2009

When the placenta is located anteriorly, fetoscopy by the abdominal route may be impracticable. An alternative route, i.e., insertion of the fetoscope through the anterior vaginal fornix, was used in 31 women in midpregnancy. Twenty‐six of the women had been admitted for therapeutic abortion; the remaining five, for diagnosis. The insertion of the instrument was uncomplicated in all 31 women. In three of the five diagnostic cases, the disease at risk was excluded. The three women continued their pregnancies, and two of them went on to term without complications. The third woman had intermittent leakage of amniotic fluid. At 33 weeks she was delivered of a normal infant (birthweight 2 150 g). Transvaginal fetoscopy may be considered when an anterior placenta has an extension so broad that the abdominal approach is unfeasible.
Contraceptive Habits in Women between Thirty and Fifty years of age: A Comparison of Two Periods, 1967–69 and 1972–74
Authors: Bostofte E. , Berg O.
Published: December 2009

The use of contraception by women 30–50 years of age is presented. The material was composed of participants in the prophylactic investigations for cancer colli uteri in the southern part of Storstrøms County, which was first performed in the period 1967–69 and secondly in 1972–74. A total of 17 028 women were examined, of whom 8 234 participated in both surveys. A comparison of the two periods of investigation revealed a significant increase (p>0.01) in the utilization of contraception and in shifting to more effective methods. This improvement was attributed to the increased amount of information about contraceptive methods which was made available in the country. It was observed that a remarkably large percentage of the women did not use contraception, 24.9 per cent among those 30–34 years of age, 26.9 per cent among those 35–39 years of age, 40.7 per cent among those 40–44 years of age and 57.2 per cent among those 45–49 years of age. Analysis of the influence of socioeconomic conditions showed that women of the lowest social stratum, with slight education and low income, made up a large proportion of those who abstained from contraception. The number of pregnancies was found to play a role in the use of contraception. An expansion of the distribution of information about contraception to the public is recommended, as well as a possible economic subsidy to the socially disadvantaged for procurement of contraceptives.
The Impact of Cytological Screening on the Incidence of Invasive Cervical Cancer
Authors: Helm G. , Johnsson J.‐E. , Lindberg L.‐G.
Published: December 2009

A cytological screening program for the early detection and prevention of cervical cancer was started in the county of Malmöhus, southern Sweden in 1967.

The incidence of invasive cervical cancer among women properly attending the screening program has been reduced over the 10 years to about one quarter of the incidence before the initiation of the program.

Figures calculated from the whole female population, however, did not indicate a significant decrease in incidence. Adequate individual follow‐up combined with computerized administrative programs and population registers seem to be necessary whenever the effects of a mass screening program are evaluated.
Incorrect Diagnosis of Placental Insufficiency in a Patient with Pre‐Eclampsia
Authors: Axelsson Ove , Weiner Erik
Published: December 2009

A case of pre‐eclampsia is described where suspicion of placental insufficiency arose due to low estriol levels and a positive oxytocin challenge test (OCT). The cause, however, of these findings was later proven to be strictly fetal. It is concluded that low estriol levels and a positive OCT may be caused by a decreased placental capacity but specific tests of placental function, as for instance estimations of HPL in plasma and/or a DHAS‐test, should be used to verify or rule out a suspicion of placental insufficiency.
Massive Extraperitoneal Bleeding—A Rare Complication of Amniocentesis
Authors: Goldman Jack A. , Peleg Dan
Published: December 2009

Amniocentesis is a widely used procedure, infrequently associated with complications. A patient in the 16th week of pregnancy is described, in whom amniocentesis for the purpose of genetic counselling was complicated by severe extraperitoneal bleeding into the abdominal wall, necessitating the surgical evacuation of a large hematoma. The bleeding most probably resulted from the accidental puncture of the right deep epigastric artery.
Treatment of Advanced Ovarian Cancer with Fibrinolytic Inhibitor (Tranexamic Acid)
Authors: Soma H. , Sashida T. , Yoshida M. , Miyashita T. , Nakamura A.
Published: December 2009

A patient with inoperable advanced ovarian cancer with metastases and ascites who had received several courses of radiotherapy and chemotherapy is presented. On her 6th admission, therapy with the fibrinolytic inhibitor tranexamic acid was followed by arrest of ascites and tumor growth; then at exploratory laparotomy, examination of tumor cells revealed encapsulation of fibrinoid substance and proliferation of connective tissue. The patient, still receiving tranexamic acid, is now free from noteworthy symptoms.
Radioimmunoassay of Serum Bile Acids in Normal Pregnancy and in Recurrent Cholestasis of Pregnancy
Authors: Samuelson Kickan , Thomassen Peter A.
Published: December 2009

Radioimmunoassay has been used to quantitate the conjugates of cholic and chenodeoxycholic acid in venous blood from women in different stages of normal pregnancy and in patients with recurrent intrahepatic cholestasis of pregnancy (RCP). The levels of cholic and chenodeoxycholic acid were shown to be within normal limits throughout uncomplicated pregnancy, and elevated in RCP. Because of RIAs simplicity and reliability, it is suggested that this method can be used to detect and follow the course of RCP and to assess the possible influence of treatment, e.g. diet.
Radioimmunoassay of hCG as an Early Diagnosis of Cerebral Metastases in Choriocarcinoma Patients
Authors: Soma H. , Takayama M. , Tokoro K. , Kikuchi T. , Kikuchi K. , Saegusa H.
Published: December 2009

To determine the early cerebral involvement of choriocarcinoma, the following studies were employed. By comparing hCG titers in measurements of serum and cerebrospinal fluid (CSF) hCG‐β through radioimmunoassay (RIA), serum/CSF ratios of titers were calculated in patients with normal pregnancies and in those with trophoblastic neoplasia. In normal pregnancies, the mean ratio of serum/CSF hCG was more than 45.5±6.0 (mean±SEM):1. In neoplasia without metastases to the brain, the ratio was more than 41.0:1. However, 2 patients with cerebral choriocarcinoma showed low ratios of 23.0:1 and 20.9:1, respectively. This suggests that determination of the β‐hCG concentration ratio of serum to CSF using RIA might give a more reliable evaluation for the early detection of choriocarcinoma metastasized to the brain.
Endometrial Effect of Oral Estriol Treatment in Postmenopausal Women
Authors: Englund D. E. , Johansson E. D. B.
Published: December 2009

Estriol is a weak estrogen with a claimed specific action on the epithelium in cervix uteri and vagina and with no or limited ability to induce endometrial proliferation. In a previous pharmacokinetic study we have shown elevated estriol levels for only 2–3 hours after oral administration of the drug. The present study was performed to test if estriol, when given orally in daily divided doses to postmenopausal women, has any effect on the endometrium. Twenty postmenopausal women who had no vaginal bleeding in response to lynestrenol (Orgametil(R) 5 mg × 2 × V) were treated with 6 mg estriol a day (Ovesterin(R) 2 mg × 3), divided into three doses, for 2 up to 3.5 months. When lynestrenol (5 mg × 2 × V) was given following the estriol treatment periods, 12 women out of 20 experienced a vaginal bleeding and one reported spotting. Endometrial biopsies in ten of those women who had a bleeding were examined histologically. The endometrium was atrophic in four women, proliferative in two, slightly hyperplastic in one and showed signs of weak hormonal activity in one. Two women had secretory endometrium. It is concluded that estriol, administered in a way that gives prolonged elevation of the blood levels, is able to produce the same effect on the endometrium as other estrogens.
The Influence of Adrenalectomy on the Biomechanical Properties of Collagenous Structures of Rats in the Post‐Partum Phase
Authors: Oxlund Hans , Rundgren Åke , Viidik Andrus
Published: December 2009

Pregnancy influences the functional properties of both genital and extragenital connective tissues. The sex hormones induce a major part of these changes but also corticosteroids may play a role, as their concentration is elevated during pregnancy and early post‐partum. The biomechanical properties of the pubic symphysis, muscle tendon and skin of intact and adrenalectomized rats during the first ten days of the post‐partum phase were investigated. For the pubic symphysis and the muscle tendon of the intact animals there was a decrease of the stiffness in the early post‐partum phase followed by a restoration. For the adrenalectomized animals there was no such initial decrease, which indicates that relaxation during pregnancy had been less pronounced. However, the strength of muscle tendons from the adrenalectomized animals was markedly decreased during the post‐partum phase. The stiffness of the skin from the intact animals was increased in the early post‐partum period. This increase was also found in adrenalectomized animals, but here the strength and stiffness were not only restored to the intact level but became further reduced during the post‐partum period. It seems therefore that the adrenal glands not only participate in the development of adaptive changes during pregnancy, but also play a role in the stabilization of extragenital connective tissues in the post‐partum phase.
Antenatal Ultrasonic Diagnosis of Complete Urethral Obstruction in the Fetus
Authors: Katz Z. , Lancet M. , Kassif R. , Chemke M. J.
Published: December 2009

A case of ante‐natal diagnosis of complete obstruction of the urethra is reported. By repeated ultrasonic B‐scans a distended bladder filling the abdominal cavity could be seen, and a hydroureter was demonstrated. By early diagnosis of this condition, which is incompatible with life, a decision to terminate pregnancy can be made.
Hormone Treatment of Stromal Endometriosis
Authors: Brøns Jens , Jensen Lene Kieler , Rasmussen Jan
Published: December 2009

A report of two cases of recurrent stromal endometriosis, both the patients having positive estrogen receptors in the tumor tissue. They were first treated with tamoxifen, which failed to halt growth of the tumor. After a month's subsequent treatment with progesterone the tumor regressed and the patients' condition improved.