bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal Beta‐Adreneceptor Blockade Reduces Fetal Tolerance to Asphyxia: A study in pregnant sheep
Authors: Kjellmer I. , Dagbjartsson A. , Hrbek A. , Karlsson K. , Rosén K. G.
Published: December 2009

Abstract. Maternal and fetal β1‐adrenoceptor blockade was induced in sheep by infusing i.v. 11 pregnant ewes with metoprolol in doses producing maternal plasma concentrations of metoprolol comparable to those obtained in clinical use. Ten other ewes and their fetuses served as controls. Under acute anaesthesia the fetus was exteriorized and subjected to two levels of controlled asphyxia by intermittent, complete obstruction of the maternal placental blood flow. Fetal haemodynamic reactions were assessed by measuring fetal heart rate, cardiac contractility, cardiac output and cerebral blood flow. The metabolic reactions were evaluated from blood gases, pH, lactate and hypoxanthine concentrations, while the electrophysiological status of the brain was evaluated from the somatosensory evoked EEG potentials (SEP). Already during the period of moderate asphyxia the P‐blocked fetuses demonstrated a blunted haemodynamic response, in comparison with the control fetuses, resulting in an accelerating lactic acidosis, signs of a breakdown of intra‐cellular energy‐rich phosphates and an impaired cerebral function. During the period of severe asphyxia, both groups of fetuses exhibited signs of extensive cerebral deterioration. During the ensuing recovery phase, 80% of the control fetuses regained their brain function, as assessed by SEP, whereas this was true for only 30% of the β1‐blocked fetuses. It is concluded that the ovine fetus relies heavily on greatly increased sympathoadrenal activity to adapt itself to asphyxia and that blockade of the fetal β1‐adrenoreceptors by maternal medication is a hazard to the potentially asphyctic fetus.
Acute Haemodynamic Effects of Pindolol During Pregnancy in Experimental Renal Hypertension
Authors: Lundgren Yen , Karlsson Kirsten , Ljungblad Ulf
Published: December 2009

Abstract.Clinical as well as experimental studies have demonstrated a 70% reduction in utero‐placental blood flow in pregnancies affected by Severe hypertension (13, 19). In pregnant renal hypertensive rats, propranolol administration causes a further 50% reduction in utero‐placental blood flow (16). The present study on renal hypertensive rats was performed in order to explore the acute effects on central haemodynamics and utero‐placental blood flow of the non‐selective P‐blocker pindolol, which also has an intrinsic P‐stimulatory effect. Renal hypertension was induced by partial clamping of both renal arteries in female Wistar rats 4 weeks before pregnancy. Some 2‐4 days before expected parturition, cardiac output was determined with the dye‐dilution technique and blood flow to the reproductive organs with the microsphere technique, both before and after acute pindolol administration. Mean arterial pressure and heart rate were recorded continuously during the experiment. After pindolol injection, mean arterial pressure fell by 22% due to a 38% reduction in total peripheral resistance. No significant changes in cardiac output, stroke volume or heart rate were found. Placental blood flow was significantly reduced, by 30%, whereas myometrial and ovarian blood flows were reduced by only 18 and 9%, respectively.

Thus, the reduction in blood supply to the reproductive organs in renal hypertensive rats after acute pindolol administration was most pronounced in the placenta. This reduction in placental flow was, however, only about half as pronounced as after propranolol, which lacks intrinsic β‐stimulatory effects. This may suggest that vasodilating β‐receptors may play an important role in the maternal placental vascular bed.
DOES CERVICAL RIPENING WITH PGE2 AFFECT SUBSEQUENT UTERINE ACTIVITY IN LABOUR?
Authors: Fenton David W. , Speedie Jenny , Duncan Sheila L. B.
Published: December 2009

Abstract. Uterine activity was measured quantitatively during subsequent labor after prostaglandin E2 gel (PGE2). Thirty primigravidae with a low Bishop score were included in this randomized double‐blind study. Fewer women who received PGE2 required subsequent surgical induction. The pattern of uterine activity was different. Cervical dilatation was achieved with less uterine activity in the PGE2 group, especially during the shorter latent phase.
ORAL CONTRACEPTIVES AND THE COBALAMIN (VITAMIN B12) METABOLISM
Authors: Hjelt K. , Brynskov J. , Hippe E. , Lundström P. , Munck O.
Published: December 2009

Abstract.The mean concentrations of serum (S)‐cobalamin (vitamin B12) and S‐unsaturated B12binding capacity (UBBC) were significantly decreased in 101 women (mean age: 30.4 years) taking oral contraceptives (OC) of the combination type, compared to 113 controls. OC users more frequently showed decreased concentrations of S‐cobalamin (<200 pmol/1) than did their controls. However, the incidence of particularly low concentrations (< 150 pmol/1) in OC users was not increased. To study a possible dose‐dependent effect, 27 women (mean age: 50.5 years) given high‐dose estrogen preparations (1‐4 mg estrogen) were compared with 31 controls. The two groups showed no difference with regard to S‐cobalamin, but the mean S‐ and plasma‐UBBC levels were significantly decreased in the high‐dose estrogen group. 12 OC users with decreased S‐cobalamin (<200 pmol/1), 9 OC users with normal S‐cobalamin and 10 controls were studied more intensively. The mean hemoglobin concentration was significantly decreased in those OC users having decreased S‐cobalamin. On the contrary, the absorption and excretion of radiolabel‐led cobalamin and the concentrations of erythrocyte‐folate, S‐iron and ‐transferrin did not show any difference between the groups, and all results were normal, by and large. No characteristic changes in plasma volume were found. It is concluded that routine measurement of S‐cobalamin in women taking OC is not justified.
EFFECTS OF ELECTRONIC FETAL MONITORING ON RATES OF EARLY NEONATAL DEATH, LOW APGAR SCORE, AND CESAREAN SECTION
Authors: Greenland Sander , Olsen JØRn , Rachootin Pamela , Pedersen Gunnar Thomsen
Published: December 2009

Abstract. Using data from the University Hospital in Odense, Denmark, we have studied the effects of electronic fetal monitoring on rates of early neonatal death (death of liveborn within first week of life), low five‐minute Apgar score (less than 7), and cesarean section. Approximately 22000 births occurring in 1974‐82 were studied, of which 13% were electronically monitored. Monitoring was significantly associated with an elevated cesarean rate in low‐risk labors and certain high‐risk labors, but appeared not to increase the cesarean rate in all high‐risk labors. In high‐risk labors, monitoring was associated with an approximate 40% reduction in rates of low Apgar score and early neonatal death, but neither reduction was statistically significant. The associations of monitoring with elevated cesarean rate declined significantly over the study period. These results accord closely with studies conducted in the United States, indicating that monitoring is of benefit in high‐risk labors, but leads to excessive cesarean deliveries in low‐risk labors. Our study additionally indicates that the effect of monitoring on the cesarean rate has been declining over time.
LIPOLYTIC ACTIVITY IN THE PLACENTAS OF CHRONICALLY DEPRIVED FETUSES
Authors: Biale Y.
Published: December 2009

Abstract.Intracellular lipolytic activity and lipoprotein lipase activity were determined in healthy human placental tissue, in placentas obtained from patients with severe pre‐eclampsia, and from cases of intra‐uterine growth retardation. The level of lipoprotein lipase, which is responsible for the transfer of fatty acids across membranes, was found to be much higher compared with the intracellular lipase and had increased further during pregnancy. Lipoprotein lipase activity was significantly greater in placentas of pre‐eclamptic women and in the placentas of intra‐uterine growth retarded fetuses. The intracellular lipolytic activity was significantly lower, however, than in controls. The levels of triglycerides and cholesterol were significantly higher in the cord blood of newbornes of women who had pre‐eclampsia and in the intra‐uterine growth retarded fetuses. The present study indicates that in situations causing fetal distress there are changes in the placenta leading to an increased supply of free fatty acids to the fetus. The role of lipids in fetal metabolism and their transfer across the placenta are poorly understood. The main precursor of fetal lipids in man is believed to be either carbohydrate (5) or maternal blood lipids (10). There is no evidence for the trans‐placental flow of intact triglycerides. The plasma free fatty acids (FFA) constitute the only lipid fraction known to cross the placenta and could supply a significant proportion of the fetal requirements (8, 19).
THE OUTCOME OF PREGNANCY AFTER THREATENED ABORTION
Authors: Hertz Jens B. , Heisterberg Lars
Published: December 2009

Abstract. A prospectively collected group of 93 pregnancies complicated by threatened abortion was carefully monitored throughout pregnancy, during birth and in the perinatal period, and any deviation from a completely uneventful course was registered. Comparison was made with a selected group of 282 non‐risk pregnant women. A significant association was found between threatened abortion and the overall number of complications in the second half of pregnancy requiring medical intervention and/or admission to hospital, impending pre‐term birth requiring betamimetics, pre‐term birth, retention of the placenta, birth weight below 2000 g, light‐for‐dates infants in case of pre‐term birth or birth weight below 2000 g, and hyperbilirubinemia in infants with birth weight below 2000 g. The incidences of perinatal mortality and congenital malformations did not differ significantly from those of the control group. Pregnancies complicated by threatened abortion constitute a risk group requiring careful obstetric and perinatal supervision and follow‐up.
INDUCTION OF LABOR
Authors: Andreasson B. , Bock Johannes E. , Larsen J.
Published: December 2009

Abstract. In a double‐blind randomized controlled study of 300 women, 150 primiparas and 150 multiparas, induction of labor by means of vaginal suppositories containing 3 mg prostaglandin E2 (PGE2) was compared with the conventional method of intranasal oxytocin and with a combined method of 3 mg PGE2 vaginal suppositories alternating with intranasal oxytocin. In the PGE2 group the intensity of delivery was significantly greater than in the oxytocin group, among both primiparas and multiparas and among the patients with ripe and unripe cervix. The efficiency of the combined treatment could no be evaluated because of the high intensity of delivery during the first 24 hours. There were no maternal side effects, and no significant difference in the frequencies of failed induction and cesarean section.
INTRA‐UTERINE PRESSURE IN DYSMENORRHEA
Authors: Lumsden M. A. , Baird D. T.
Published: December 2009

Abstract. Intra‐uterine pressure recordings in normal and dysmenorrheic women during the menstrual period were analysed regarding amplitude, duration, frequency and peak area of contractions and the resting pressure. The activity of the myometrium showed large between subject variability and no significant difference was found, between the two groups in amplitude and duration of contractions or their frequency. However, there was a consistent difference in peak area at the onset of the menses (p <0.01) and there was also a significant decrease in peak area during the menses in the group with dysmenorrhea, with maximum uterine work being performed on the day when the pain was at its worst. The contribution of the pattern of contractility to the etiology of dysmenorrhea is discussed.

Abnormal uterine activity as a cause of primary dysmenorrhea was first suggested in the 1930s and 1940s on the basis of intra‐uterine pressure recordings (Moir, 1936; Woodbury et al., 1947). Since then, intra‐uterine pressure has been measured in a number of studies using a micro‐balloon (Lundstrom et al., 1976; Bygdeman et al., 1979). With the introduction of the highly sensitive micro‐transducer catheter it has been possible to make accurate quantitative estimations (Akerlund et al., 1978; Ulmsten & Andersson, 1979) but, to our knowledge, no detailed analysis and quantification of intrauterine pressure recordings in primary dysmenorrhea has been reported.

In this paper we publish the results of a study in which daily recordings obtained from women suffering from primary dysmenorrhea were compared with those from a group of women with very similar menstrual patterns but with minimal or no symptoms.
A NEW VAGINAL ANTIFUNGAL AGENT – BUTOCONAZOLE NITRATE
Authors: Jacobson Jan B. , Hajman Aleksander J. , Wiese JØRgen , Gandrup Per , Forsström Sven
Published: December 2009

Abstract. The continuously increasing incidence of vulvo‐vaginal candidiasis necessitated a search for novel therapeutic modalities. Butoconazole nitrate (BN) a new imida‐zole, has been singled out for clinical studies since, in experimental vaginal candidiasis, it proved more effective than either miconazole nitrate (MN) or clotrimazole. One hundred and thirty volunteers with vaginal candidiasis, verified by wet mount and positive fungal culture, were randomly assigned to receive‐daily, for 6 days, either 1% BN (44 patients), or 2% BN (45 patients) vaginal cream or 2% MN (41 patients) vaginal cream. The patients were comparable regarding age (85% were 18–39 years of age), gravidi‐ty and parity. Twenty‐five per cent had a recent history of unsuccessfully treated fungal vaginitis. Eight days after completion of treatment, negative fungal cultures were found in 98% of the patients using 2% BN, in 91% of patients using 1% BN and in 83% using 2% MN. The recurrence rate of the disease was low; about 80% of patients using 1% and 2% BN and 68% of those using 2% MN were culture‐negative 30 days after conclusion of treatment. Rapid relief of clinical symptoms was experienced by patients in all three treatment groups. No significant side effects of the treatment were observed in any of the treatment groups.
INCREASED FREQUENCY OF CARCINOMA OF THE UTERINE CERVIX IN WOMEN MARRIED TO MEN WITH A PREVIOUS GONORRHEAL INFECTION
Authors: Furgyik Stefan
Published: December 2009

Abstract. An earlier investigation showed an increased frequency of squamous epithelial carcinoma of the cervix in women who had experienced gonorrhea, but that there was a long lag between the infection and diagnosis of the cervical malignancy. The present work is a retrospective study of cervical malignancy in women married to men who had had gonorrhea between 26 and 37 years previously. The women have been distributed into three groups: i) those who were married to their spouse at the time he had gonorrhea and who themselves became infected, ii) those who were married to their spouse at the time of his gonorrhea but who did not themselves become infected, iii) those who were not married to the man in question at the time of his gonorrhea and who do not recall having had had gonorrhea.

The incidence rates of cervical neoplasm were found to be: group i, 27.1%, group ii, 21.7%, and group iii, 13.7%. For all three groups the figures are significantly higher than in an age‐related control group drawn from the normal population.

The results of the investigation lead one to suspect that a carcinogenic agent had been transferred by sexual intercourse together with the gonorrhea and that the man was the bearer of this agent long after he had undergone treatment for his gonorrhea, but that not all the women so exposed had developed a cervical neoplasm.
SERUM LEVELS OF DEHYDROEPIANDROSTERONE SULPHATE AND TOTAL ESTRONE IN POSTMENOPAUSAL WOMEN WITH SPECIAL REGARD TO ‘NON‐ENDOCRINE’ OVARIAN CARCINOMA
Authors: Carlström Kjell , Lagrelius Anders , von Schoultz Bo
Published: December 2009

Abstract. Postmenopausal women with ‘non‐endocrine’ ovarian cancer have previously been reported to have elevated levels of estrogens, androstenedione and progesterone (1, 2, 3, 4). A contribution from the tumor‐affected ovary to the elevated steroid levels seems evident (1, 4), though the underlying mechanisms are obscure. After the menopause estrogens are normally formed by peripheral conversion of adrenal androgens, and ovarian function is of little significance. Tuimala et al (2) suggested conversion of adrenal precursors by the tumor tissue as an alternative explanation for the elevated estrogen levels in postmenopausal women with ovarian cancer. If this is so, the levels of adrenal androgens may be important. The weak androgen dehydroepiandrosterone sulphate (DHAS) is of an exclusive adrenal origin and is considered to be the best indicator of adrenal androgen secretion. In order to study a possible relationship between adrenal activity and postmenopausal ‘non‐endocrine’ ovarian cancer, we determined the peripheral serum levels of DHAS and total estrone in postmenopausal women with this disease and in strictly age‐matched healthy controls.
THE COURSE OF PREGNANCY FOLLOWING SPONTANEOUS ABORTION
Authors: Rud Bjarne , Klünder Kurt
Published: December 2009

Abstract. With the aim of being able to advise women concerning a recommended interval between spontaneous abortion and a new pregnancy, the course of 91 pregnancies following spontaneous abortion was studied. Nineteen women conceived within the first 12 weeks. There were no abortions, and 18 pregnancies proceeded normally. Thirty women conceived between 12 and 26 weeks, 29 pregnancies proceeded normally, and none aborted. Forty‐two women conceived later than 26 weeks after the abortion. Seven pregnancies terminated in abortion, and 30 proceeded normally. We found no reason to advise women to postpone a new conception after spontaneous abortion.
SEVERE FETAL DEFORMITIES ASSOCIATED WITH INGESTION OF EXCESSIVE ISONIAZID IN EARLY PREGNANCY
Authors: Lenke Roger R. , Turkel Susan Beckwitt , Monsen Rita
Published: December 2009

Abstract. There is general agreement that pregnant women with active tuberculosis require immediate treatment with some combination of isoniazid (INH), ethambutol, rifampin or streptomycin. Other than the possibility of fetal ototoxicity from streptomycin none of these drugs in normal dosages has proved teratogenous to the human fetus (1). We therefore report here a possible association between fetal malformations and excessive early maternal ingestion of INH.
ANURIA COMPLICATING URETHROCYSTOPEXY
Authors: Kinn A‐C , Sjöberg B.
Published: December 2009

Abstract. The technique of correcting urinary stress incontinence by means of sutures attached in the perivaginal fascia and anchored to Cooper's ligament, as described by Burch (1) is probably better than the more common Marshall‐Marchetti‐Krantz procedure (2). In the latter technique the sutures are fixed to the periosteum of the symphysis pubis. Both methods aim to lift up the urethra, fix it to connective tissue and maintain it in elevated position. The Cooper's ligament technique advocated by Burch affords a technically simpler anchorage, as the periosteum often breaks down when the sutures are tied. Although the more lateral Burch approach reduces the risk of penetrating the urethral wall with the sutures, the risk of penetration into the bladder is increased. This paper deals with two patients referred to us because of complications caused by unsuitably placed sutures in a Burch operation.
RUPTURE OF THE UTERUS IN LABOR
Authors: Rahman J. , Al‐Sibai M. H. , Rahman M. S.
Published: December 2009

Abstract. Ninety‐six cases of ruptured uterus in labor treated in the University Teaching Hospitals, Benghazi, Libya between 1977 and 1980 are reported. An incidence of 1 in 585 deliveries remained unchanged during the period of study. Twenty uterine ruptures occurred in a previously scarred uterus. Rupture of the unscarred uterus is a more catastrophic event. There is a marked difference in both fetal and maternal outcome between the group with a previously scarred uterus and the group without a previous scar. The incidence and causes of uterine rupture in Libya differ greatly from those in developed countries. High parity is a frequent cause. Other common etiological factors were cephalopelvic disproportion, fetal malpresentation, oxytocin stimulation of labor and unwise obstetrical interference. The fetal wastage was high, a perinatal mortality of 75% being recorded, but 95% of the mothers were saved. Hysterectomy was commonly performed in this group. Repair of the uterus and sterilization should only be performed when the rupture is simple and transverse in the lower segment and without any sign of infection.
TORSION OF THE FALLOPIAN TUBE DURING PREGNANCY
Authors: Isager‐Sally L. , Weber T.
Published: December 2009

Abstract. We describe 3 cases of torsion of the Fallopian tube during pregnancy, caused by sactosalpinx, a cyst of the mesosalpinx, and an ovarian cyst. Other causes of torsion of the Fallopian tube are discussed. The difficulty of diagnosing this condition during pregnancy is emphasized.
PHEOCHROMOCYTOMA IN PREGNANCY
Authors: Stenström Gunnar , Swolin Kurt
Published: December 2009

Abstract. Three cases of pheochromocytoma diagnosed ante partum are reported. The first woman received phenoxybenzamine for 72 days until operation and the other 2 were given the drug for 2 and 3 days, respectively. Healthy infants were delivered by cesarean section followed by removal of the pheochromocytomas. The 29 cases reported in the literature of pheochromocytoma diagnosed ante partum and treated with α‐receptor blockade are reviewed with respect to results of treatment. It is concluded that pheochromocytoma diagnosed during the 1st trimester is probably besi managed by tumor resection as soon as possible. In order to avoid the risk of abortion during surgery in cases diagnosed in the 2nd trimester, the patient may well be brought to term under adequate treatment with an α‐recep‐tor blocking agent, when the infant is delivered by cesarean section followed by tumor removal. Third‐trimester cases should be managed in the same way.
EFFECT OF INTRAPERITONEAL INSTILLATION OF 32% DEXTRAN 70 ON POSTOPERATIVE ADHESION FORMATION AFTER TUBAL SURGERY
Authors: Larsson B. , Lalos O. , Marsk L. , Tronstad S‐E. , Bygdeman M. , Pehrson S. , Joelsson I.
Published: December 2009

Abstract. The intraperitoneal instillation of 32% dextran 70 (HyskonR, Pharmacia AB, Sweden) has previously been reported to prevent the formation of postoperative adhesions. Against this background, the present study was undertaken to evaluate the efficacy of HyskonR in counteracting peritoneal adhesions following tubal microsurgery. 105 infertile women were operated upon in a prospective, randomized, controlled, double‐blind, multicenter study. The intra‐ab‐dominal adhesions present from the beginning were classified by means of a standardized scoring scale and the extent of adhesions was again evaluated at follow‐up laparoscopy 4–10 weeks later. A reduction in the extent of the intra‐abdominal adhesions (statistically highly significant) was revealed in both the Hyskon group and the saline control group. The extent of adhesions in the Hyskon group was not lesser than in the saline group, however. The pregnancy rates in the two groups were also similar.
PERICARDIAL EFFUSION IN ADVANCED OVARIAN CARCINOMA
Authors: Lund Birthe
Published: December 2009

Abstract. The incidence of all categories of metastatic cancer to the heart is rising, as antineoplastic treatment results in longer survival. Malignant pericardial effusion in ovarian carcinoma has only been described at autopsy. In this report two cases of this condition diagnosed in vivo are presented, together with a review of the diagnosis and treatment of this complication of neoplastic disease.
THYROID HORMONES IN THE HUMAN PREGNANCY
Authors: Tolino A. , De Conciliis B. , Montemagno U.
Published: December 2009

Abstract. Radio‐immunologic T3, T4, FT3, FT4, rT3, TBG and 17β‐estradiol were measured in women in the 2nd and 3rd trimester of pregnancy, during labor, and during the first 14 days of the puerperium. A group of women suffering with gestosis EPH were also investigated. Our data suggest that in women suffering with gestosis EPH and during labor in normal pregnancy there is a T3‐selective defect (low T3syndrome) in which the conversion route of T4 into T3 is inhibited while the conversion route of T4 into rT3 remains fully operative, resulting in low plasma levels of T3 and FT3 and normal levels of T4, normal or high levels of FT4 and high levels of reverse T3.
BEST CRITERION FOR THE ASSESSMENT OF EFFICACY OF TOCOLYSIS AND CHOICE OF MOST SUITABLE BETASYMPATHOMIMETIC
Authors: Gummerus M.
Published: December 2009

Abstract. Over a period of 10 years, 645 patients were treated with six different betasympathomimetics because of threatening premature labor during the 24–36 weeks of gestation. Some 603 comparable patients were analysed with various parameters to find the most suitable criterion for assessing the efficacy of tocolysis and the best tocolytic agent. Delivery after 37 completed weeks proved clinically a sufficient criterion of a succesful therapeutic outcome. The various scores did not essentially facilitate comparison of various tocolytics. The combination buphenin (DilaverR) + verapamil (IsoptinR) proved to be the most suitable medication.
THE EFFECT ON THE HUMAN UTERUS OF TWO NEWLY DEVELOPED COMPETITIVE INHIBITORS OF OXYTOCIN AND VASOPRESSIN
Authors: Åkerlund M. , Carlsson A. M. , Melin P. , Trojnar J.
Published: December 2009

Abstract. in order to develop inhibitors of vasopressin (VP) and oxytocin (OXY) action on uterine activity, 1‐deaminat‐ed vasotocin derivatives with modifications at positions 2, 4 and 8 were developed. Two of the most effective analogues in the rat, l‐deamino‐2‐D‐Tyr(OEt)‐4‐Val‐8‐Orn‐vasotocin (dE‐VVT) and l‐deamino‐2‐D‐Tyr(OEt)‐4‐Thr‐8‐Orn‐vaso‐tocin (dE‐TVT) were now tested on human nonpregnant myometrium obtained at hysterectomy in fertile age and on pregnant myometrial tissue obtained at elective cesarean section. the effect was compared with that of a previously synthesized analogue l‐deamino‐Tyr(OEt)‐oxytocin (dE‐OXY) which has already been tested in nonpregnant and pregnant women in vivo. Both of the new analogues competitively inhibited the action of the posterior pituitary hormones. on the nonpregnant uterus dE‐VVT was about five times and dE‐TVT almost twenty‐five times more potent than dE‐OXY in inhibiting the effects of VP. on pregnant myometrium, dE‐TVT inhibited oxytocin action about as effectively as a five‐fold stronger concentration of dE‐OXY, and dE‐VVT slightly less. A moderate agonistic effect of dE‐OXY on pregnant myometrium was found, whereas it was minimal with dE‐VVT and not detectable at all with dE‐TVT. It appears that these two analogues, particularly dE‐TVT, would be interesting for clinical testing both in dysmenorrhea, where increased VP secretion could be of etiological importance, and in premature labor where an increased myometrial concentration of OXY receptors has been demonstrated.
Contentsintroductioncurrent Concepts in the Etiology and Treatment of Primary Dysmenorrhea
Authors: Dawood M. Yusoff
Published: December 2009

Primary dysmenorrhea may affect as many as 40 percent of all adult women, temporarily disabling one‐tenth of them. The etiology of this condition may be related to excess production of prostaglandins by the endometrium following decline in progesterone levels consequent to corpus luteum regression. It is proposed that increased prostaglandin levels produce increased myometrial contractility and uterine ischemia and sensitization of pain fibers, resulting in pelvic pain.

Administration of nonsteroidal anti‐inflammatory agents which block the cyclooxygenase enzyme of the arachidonic acid cascade is an effective treatment for primary dysmenorrhea, as is oral contraceptive therapy. Criteria for an ideal prostaglandin synthetase inhibitor are described.
OVARIAN STEROID HORMONES
Authors: Bäckström Torbjörn , Bixo Mari , Hammarbäck Stefan
Published: December 2009

Abstract.Ovarian steroid hormones are frequently used in clinical practice. Postmenopausal replacement therapy and oral contraception are both based on the effects of the ovarian steroids. Mental side effects have often been reported, especially in relation to oral contraceptives. In that context it is of course of importance to collect knowledge about the influence ovarian steroid hormones have on the brain. The present review discusses the natural hormones estradiol and progesterone and some of their metabolites. Knowledge of the effects of synthetic estrogen and progestagen derivatives is very limited and will be mentioned only briefly.
CLASSIFICATION OF THE NONSTRESS TEST AND FETAL OUTCOME IN 1056 PREGNANCIES
Authors: Montan Sven , Olofsson Per , Solum Thore
Published: December 2009

Abstract. During a 2 1/2‐year period, 1056 pregnant women (1072 fetuses) were monitored with the nonstress test (NST) in the antenatal period. Testing time was 30 minutes. The NST was classified into one of four classes: normal, suspect pathological, slight pathological, and severe pathological. In 88.5% of the pregnancies, all NSTs were normal. Suspect, slight, or severe pathological NSTs occurred at least once in 8.1%, 2.1%, and 1.3% of the women respectively. All women with a severe pathological NST had high‐risk complications. Lethal malformations excluded, there were only two perinatal deaths among the tested women. In the four different classes, the frequencies of cesarean section were 11%, 17%, 41%, and 79%. One‐minute Apgar scores were <7 in 5%, 12%, 41%, and 64%. The need for referral to neonatal intensive care was 19%, 40%, 41%, and 93% respectively. A normal NST predicted normal fetal outcome in an excellent way, while the three pathological classes appeared to represent different degrees of impending fetal jeopardy.
TROPHOBLAST SAMPLES SUITABLE FOR LONG‐TERM CULTURE
Authors: Gustavii Björn , Edvall Heléne , Mineur Anita , Heim Sverre , Mandahl Nils , Kristoffersson Ulf , Mitelman Felix
Published: December 2009

Abstract. Chorionic villi were obtained by a direct vision technique. Villi without vessels (38 cases) failed to grow in vitro, irrespective of the amount of tissue. Vascular villi with an estimated weight exceeding 5 mg (71 cases) grew in vitro—with two exceptions.
SUCCESSFUL ULTRASOUND‐GUIDED INTRAVASCULAR TRANSFUSION IN SEVERE FETAL ANEMIA WITHOUT BLOOD GROUP INCOMPABILITY
Authors: Bock J. E. , Bang J. , Trolle D. , Skjaeraasen J.
Published: December 2009

Abstract. A 26‐year‐old patient with chronic acquired pure red cell aplasia had given birth to two infants, both of which died from fetal hydrops and anemia. In her third pregnancy the fetus was diagnosed as being hydropic and anemic in the 24th gestational week. No blood group incompability could be demonstrated. Because of the low gestational age and presence of fetal ascites, intraperitoneal fetal blood transfusion was considered to be without effect, and three fetal in‐travascular transfusions were therefore performed in the 24th, 26th and 28th gestational weeks. The infant born in the 30th week, is in good health with a normal blood picture, 6 months later. Hydrops and fetal anemia has never been described as a complication of pregnancy in a patient with pure red cell aplasia and it is the first time that intra‐uterine intravascular fetal transfusion has been used other than for rhesus indication.
Concentrations of Steroid Receptors in Normal Human Endometrium in Relation to the Day of the Menstrual Cycle
Authors: Tamaya T. , Murakami T. , Okada H.
Published: December 2009

Concentrations of receptors for estrogen (ER), progestin (PR) and androgen (AR) were measured in the cytoplasm and nucleus of human endometrium, throughout the normal menstrual cycle. Endometrial cellular ER and PR levels gradually increased during the preovulatory and immediate postovulatory phases, remained constant at the maximal level during the mid‐secretory phase and gradually decreased to the lowest level at the end of the cycle. There was a difference between ER and PR nuclear levels in the mid‐secretory endometrium, where maximum levels of PR and low levels of ER were noted. This PR abundance indicates the necessity of progesterone action for implantation. During the menstrual cycle, AR sites did not change noticeably and far fewer were found than those of the other receptors. This finding indicates that androgen plays a less important role in female reproduction.
The Risk of Endometrial Neoplasia and Treatment with Estrogens and Estrogen ‐ Progestogen Combinations: First results of a cohort study after one to four completed years of observation
Authors: Persson Ingemar R. , Adami Hans‐Olov , Eklund Gunnar , Johansson Elof D.B. , Lindberg Bo S. , Lindgren Anders
Published: December 2009

This prescription‐based cohort investigation was undertaken in order to study whether climacteric estrogen treatment of women in a Swedish population might be associated with an increased risk of endometrial cancer, and whether added progestogens can afford any protection from developing estrogen‐related endometrial neoplasia. Some 23 000 women who had been prescribed estrogens were followed up regarding the outcome of neoplastic lesions of the endometrium. The results are based on an observation period of one to four completed years, corresponding to 89 000 person‐years. Among those cohort members exposed to estrogens alone, regardless of the duration, the relative risk of endometrial cancer was 1.3 (95% confidence interval 0.9 to 1.7). The inclusion of premalignant endometrial changes resulted in a significantly increased relative risk of 1.6(1.2–2.1). The relative risk estimates in association with estrogen – progestogen combinations were 0.6 (0.2–1.4) for endometrial cancer and 0.8 (0.4–1.5) when including premalignant lesions. These data indicated a possible protective effect of progestogens against the development of endometrial neoplasia. It was concluded that estrogens were – within an observation period of 4 years – associated with an increased risk of premalignant endometrial lesions.
Long‐Term Treatment with Combined Oral Contraceptives and Cigarette Smoking Associated with Impaired Activity of Tissue Plasminogen Activator
Authors: Kjaeldgaard Anders , Larsson Bertil
Published: December 2009

The fibrinolytic activity in vein walls (FAV) was determined by a semi‐quantitative fibrin slide technique in a group of 68 healthy middle‐aged women consisting of 22 healthy controls, 19 non‐smoking contraceptive pill users and 27 cigarette‐smoking non‐users. Significantly decreased FAV was demonstrated in pill users because of high frequency of low values among women using combined oral contraceptives (OC) for more than 5 years. Significantly lower FAV was also recorded in smoking non‐users, among whom low FAV values were found mainly in heavy smokers. However, no effect of OC usage for less than 5 years was observed, neither did smoking of less than 10 cigarettes daily influence FAV. Thus, the two well‐known risk groups with respect to circulatory diseases, long‐term contraceptive users and heavy smokers, included the vast majority of middle‐aged women with impaired plasminogen activator activity.
Fetal Cardiac Arrhythmia: Clinical outcome in 113 cases
Authors: Lingman GÖRan , Lundström Nils‐Rune , Marŝál Karel , Ohrlander Sten
Published: December 2009

In 113 cases of fetal cardiac arrhythmia, i.e. 94 with supraventricular arrhythmia, 5 with atrioventricular block and 14 with ventricular arrhythmia, the clinical outcome was studied and compared with the general pregnant population. The arrhythmia group was afflicted with a significantly increased frequency of congenital malformations, 6.2% vs. 2.0%; fetal distress in labor, 20.4% vs. 13.5%; perinatal mortality, 3.5% vs. 0.7%; and neonatal mortality, 1.8% vs. 0.1%. In 4 cases, pharmacological cardiac treatment was needed in utero due to fetal heart failure. Fetuses with cardiac arrhythmia thus constitute an obstetric and pediatric high‐risk group that should be subjected to an intensified supervision to detect fetal heart failure or fetal distress. When indicated, these complications can be treated in utero.
The binding sites of the calcium antagonist [3H] PN 200110 in the human myometrium and myosalpinx
Authors: Kleinstein Jürgen , Betjemann Peter , Weidacher Anne
Published: December 2009

Calcium antagonists of the dihydropyridine type may prove to be an important adjunct to the therapy of premature labor due to their proven ability to inhibit uterine contractility. Specific binding sites for calcium blockers were concentrated in 45 000 × g membrane preparations of human myometrium and myosalpinx. Scatchard plot analysis of the binding of [3H] PN 200110, a benzoxadiazole‐substituted dihydropyridine derivate, revealed that the binding sites of myometrial membranes numbered between 500 and 700 fmoles/mg protein (Bmax) and had an affinity (KD) of 0.3±0.1 nmol/1. In myosalpingeal membrane preparations Bmaxwas between 250 and 300 fmoles/mg protein, with KD values of 0.9±0.1 nmol/1. Unlabelled calcium anta‐gonits displaced [3H] PN 200110 binding in the following order of potency ranking: nitrendipine±nifedipine±d‐cisdiltiazem >D‐600±tiapamil. The calcium channels were especially dense (796±186 fmoles/mg protein) in the myometrium of the dorsal uterine wall. The number of binding sites in the myosalpinx was greatest in the isthmus (242±23 fmoles/mg protein).
Reactivity of non‐stress tests and its relationship to outcome in infants born prior to the 33rd week of gestation
Authors: Malcus P. , Svenningsen N. , Westgren M.
Published: December 2009

In order to evaluate the significance of the non‐stress test (NST) in the immature fetus, 60 patients who gave birth between the 26th and 33rd week of gestation were studied. They were grouped according to reactivity of the last non‐stress test performed 24 hours prior to delivery. Twenty‐eight (47%) of the patients were reactive, 10 (17%) non‐reactive, and 22 (37%) non‐reactive with decelerations on the last NST. The one‐year mortality rates were significantly higher in those non‐reactive with decelerations (41%) and in those non‐reactive (30%), than in the reactive group (7%) (p<0.001, p<0.05). The results suggest that reactive non‐stress tests and those that are non‐reactive with decelerations predicted the fetal outcome similarly to the same findings in term pregnancies. Non‐reactive non‐stress tests without decelerations were associated with poor outcome in fetuses with a gestational age of more than 29 weeks. Conversely, in more immature fetuses, nonreactive patterns occurred in patients with favorable outcome. The clinical implications of these findings are discussed.
Menstrual Changes Associated with Progestogen‐Only Contraception
Authors: Fraser Ian S.
Published: December 2009

Unpredictable disturbance of the menstrual cycle is the major problem associated with use of all progestogenonly methods of contraception. This even occurs with those methods which do not usually suppress ovulation, but the disturbance is generally less severe with lower dosage systems. The commonest changes include amenorrhoea and irregular, scanty and infrequent bleeding, but may sometimes involve episodes of prolonged or frequent spotting or light bleeding. Heavy bleeding is rare. Although some abnormalities of endometrial vascular morphology and function have been identified, the mechanisms of abnormal bleeding are poorly understood. Management centres around effective pretreatment counselling and continued support at follow‐up. Sometimes a single course of oestrogen therapy may be helpful. This is safe and effective at stopping a particular episode of bleeding provided that an adequate duration of oestrogen effect is given (eg. an oral 2 to 3 week course or a single intramuscular injection). However, experienced investigators rarely use oestrogens and repeated courses are not recommended. There is clearly a major need for basic research in this area, and for the development of improved systems to minimise the problem.
Menopause, Developing Countries and the 21st Century
Authors: Diczfalusy Egon
Published: December 2009

According to the independent projections of the United Nations Population Division and of the World Bank, the global population (presently: 4.7 billion) will continue to grow until the year 2100 or 2150, when it is expected to stabilize at an approximate level of 11 billion. Ninety‐five per cent of this future growth will occur in developing countries, with an increasing number and proportion of women aged 45 and over; their number will exceed 700 million before the turn of the century.

The past decade, or two, witnessed a dramatic increase in life expectancy at birth, especially in developing country women, but little, if any, information is available about the menopause in those countries.

An urgent task of high priority is therefore to establish on a country‐to‐country basis the age distribution and sociocultural significance of the menopause and of the prevalence of various menopausal disorders, which to a huge extent will determine the health‐ and social service needs of individual developing countries. Furthermore, a rapid progress must be made in the diagnosis, prevention and treatment of osteoporosis, atherosclerotic cardiovascular disease, musculoskeletal disorders and senility.

It is suggested that the establishment of a Special Programme of Research by the World Health Organization on the problems of aging would significantly accelerate progress in this field.
Catheter‐Associated Bacteriuria: A Controlled Trial with the BardexR Urinary Drainage System
Authors: Klarskov Peter , Bischoff Niels , Bremmelgaard Annie , Hald Tage
Published: December 2009

In a randomized trial, the BardexR Urinary Drainage System was tested against a routine system consisting of a silicone‐coated 16F Latex Foley catheter and exchangeable 1 500 ml collecting bags. the Bardex system consists of an all‐silicone balloon catheter preconnected and sealed to the drainage tube with tape. the tube is united with a 2000 ml collecting bag via a vented drip chamber. It has an extremely hydrophilic coating (BN‐74) resembling the natural glycosaminoglycans lining the urothelium. This coating is intended to minimize urethral irritation and bacterial migration and also to cause slow release of water‐soluble antiseptics applied to the surface. in the present study, isobetadine 10% was applied prior to the insertion and reapplied daily after pulling gently on the catheter.

Forty female patients aged 31 to 85 years completed the study. in the Bardex group of patients, bacteriuria developed in none by the third day of catheterization and in 5% by the fourth day. in the Foley group, the bacteriuria rate was significantly higher, with 35% on the third day (p<0.01) and 45% on the fourth day (p<0.02).

No difference between the two drainage systems was found concerning incontinence beside the catheter, urethral pain or burning, meatal reddishness or urethral discharge. No conclusion regarding the advantages or disadvantages of the BN‐74 coating and the isobetadine application can be drawn from the present study.
Evidence of Specific Benzodiazepine Binding to Myometrial Membrane Preparations From Human Pregnant Uterus
Authors: Fioretti P. , Melis G. B. , Gambacciani M. , Galbani P. , Ronca‐Testoni S.
Published: December 2009

The muscle relaxant effect of benzodiazepines (BDZ) is widely held to be mediated at central as well as at peripheral level. in this study we report that crude membrane preparations from the myometrium of pregnant women possess binding sites for [3H]‐RO 5–4864, specific ligand for the peripheral type of BDZ receptor. Scatchard analysis shows a high affinity binding site (KD= 3.1±1.2 nM) and a class of low affinity binding sites (KD>30 nM). Displacement experiments show that various BDZ are differently effective in inhibiting [3H]‐RO 5–4864 binding: RO 5–4864 > diazepam > flunitrazepam > lorazepam > chlordiazepoxide. in conclusion, these data seem to demonstrate that human myometrium possesses specific binding sites of “peripheral type” for BDZ. It may be suggested that these binding sites are involved in mediating the myometrial relaxant effect exerted by BDZ. Thus, peripherally active BDZ could be used as tocolytic agents, avoiding BDZ central effects.
Single‐Dose Intravenous Tinidazole Prophylaxis in Abdominal Hysterectomy
Authors: Evaldson G. R. , Lindgren S. , Malmborg A S. , Nord C. E.
Published: December 2009

In 100 patients undergoing abdominal hysterectomy, a double‐blind study was undertaken to evaluate the efficacy of prophylactic tinidazole treatment in diminishing the postoperative infection rate. the patients treated received a single dose of 1 600 mg tinidazole i.v. during 2 h preoperatively. One patient each from the placebo and treatment groups was excluded since the operations was ultimately not hysterectomy. the two groups of women, 49 in each, were comparable with regard to age, previous obstetrical and gynecological history, and reason for hysterectomy. Significant infectious complications (pelvic cellulitis, vaginal cuff abscess, pelvic abscess) were observed in 9 (18.4%) of the 49 placebo patients, but in only 3 (6.1%) of the 49 tinidazole‐treated patients. Mild or mode rate wound infections were found in 2 patients of each group (4%). Urinary tract infections were found in 10 placebo (20.4%) and 12 tinidazole‐treated patients (24.5%). Among patients developing cuff abscesses, Bacteroides was the most frequently isolated anaerobic genus, B. bivius being the predominant species, while bacteria of enteric origin such as Escherichia coli and Streptococcus faecalis were the most common aerobic isolates.

The results of the present study indicate that an intravenous preoperative single‐dose tinidazole prophylaxis might reduce the risk of major pelvic infection following hysterectomy, the causative microorganisms usually being a mixture of aerobic and anaerobic bacteria.
Does Position and Size of Corpus Luteum Have Any Effect on Nausea of Pregnancy?
Authors: Samsioe Göran , Crona Nils , Enk Lennart , Järnfelt‐Samsioe Ann
Published: December 2009

It is a puzzling fact that emesis might occur in one pregnancy, whereas other pregnancies in the same woman could be either free or again associated with nausea. Pregnancy‐associated hormones are believed to cause nausea, possibly through effects mediated via the liver. in 43 women who applied for a legal abortion in early pregnancy the occurrence of nausea was recorded and the position and size of the corpus luteums were measured by means of ultrasound. It was found that emesis was associated with corpus luteum located predominantly on the right side, while the non‐emetic pregnancy often had a left‐sided corpus luteum. It is suggested that the venous drainage, which differs between the right and the left side, may be responsible for the fact that the same woman can either suffer from or be free from nausea during pregnancy. Ovarian vein insufficiency, being more common in multigravidity, may also explain why nausea is more common in multigravidae.
Treatment of Abscesses in the Vulva: Conventional Open Treatment Versus Primary Suture Under Antibiotic Cover
Authors: Larsen Torben , Larsen Peter Nørgaard , Christophersen Sten , Moesgaard Flemming , Nielsen Mogens Lykkegaard
Published: December 2009

Seventy patients were treated for a subcutaneous abscess in the vulva. in 35 consecutive patients the abscess was treated conventionally with deroofing of the abscess and wet dressings. in the other 35 consecutive patients the abscess was treated by incision, curettage and primary suture under antibiotic cover with a single dose of clindamycin. in the conventionally treated group the median stay in hospital was 7 days and the median healing time 18 days. in the group treated by primary suture the median stay in hospital was 2 days and the median healing time 7 days (P<0.0001). Recurrence of abscess was observed in one patient in each group. No other complications were observed in either group. It is concluded that vulvar abscesses may be treated safely and advantageously by primary suture under antibiotic cover.