bluuebunny/crossref_metadata_2025 huggingface dataset:
Transfer of Propranolol and Sotalol Across the Human Placenta
Authors: Erkkola R. , Lammintausta R. , Liukko P. , Anttila M.
Published: December 2009

Abstract.Eighty milligrams of propranolol or sotalol was administered orally to two groups of 8 parturients who were to undergo elective cesarean section. This was performed 3 hours after drug administration. The transplacental passage of both drugs was registered in each patient. The maternal concentration of propranolol was approximately four times that in the umbilical circulation, while the sotalol level in maternal circulation was twice that in the umbilical circulation. The administration of beta‐adrenoceptor antagonists caused a significant decrease in maternal plasma renin activity. After these doses of beta blockers, no difference in the plasma renin activity was found in the umbilical circulation, when compared with the previous normal values at cesarean section.
Penetration of lymecycline (tetracycline) into the tissues of the fallopian tube
Authors: Bergholm A.‐M. , Holm S. E. , Wiklund D.‐E.
Published: December 2009

Abstract. On the basis of a comparison of different methods used to determine the concentration of active lymecycline in Fallopian tube tissue, a method was adopted which allowed the determination of lymecycline in serosa and mucosa tissue of the Fallopian tube in 16 women undergoing hysterectomy. A difference in the concentration of active drug was found in serosa (>1.7 mg/kg tissue) and mucosa (>0.8 mg/kg tissue) in 16 patients on lymecycline therapy for 24 hours. These figures were fairly constant for the 7.5 hours following the administration. The figures are discussed in relation to the MIC values of the commonly found microorganisms in salpingitis.
The Tendency to Repeat Gestational Age and Birth Weight in Successive Births, Related to Perinatal Survival
Authors: Bakketeig Leiv S. , Hoffman Howard J.
Published: December 2009

Abstract. The risk of perinatal death was studied in relation to the tendency for mothers to carry their fetuses to similar gestational ages and birth weights in successive pregnancies. The data for this study are derived from all 635 140 births in Norway during a 10‐year period (1967‐76). The findings demonstrate that those babies that were born similar in age and size to their elder siblings ran the lowest risk of perinatal death. For example', the perinatal mortality rate (PMR) for second‐birth babies weighing between 2501 and 3000 g is 9.1 per 1 000 births if the first baby weighed 3000 grams or less. But the PMR is 50% higher, 13.3 per 1 000 births, when the first baby weighed between 3001 and 3 500 g. If the first baby weighed more than 3 500 g, then the PMR is 3 1/2 times greater, 32.1 per 1000 births.

In addition to gestational age and birth weight, the Medical Birth Registry of Norway also records measurements of crown‐heel length. The length data show that babies at greatest risk for perinatal mortality tend to be relative long and thin rather than symmetrically developed. For example, the PMR for second babies weighing between 2501 and 3000 grams who were disproportionately long (>46 cm) was 4.6 times greater than the PMR for the average length babies of the same birth weight. The investigation of cause‐specific mortality rates showed that most categories were increased for the higher risk babies. However, congenital malformation was the principal contributor to deaths of the relatively short babies. Conversely, placenta praevia, abruptio placentae, and complications of the umbilical cord were the principal contributors to the mortality of the relatively long babies. These results suggest that any deviation from the expected growth pattern for a fetus of a multiparoiis mother should raise concern about an increased risk for the remainder of her pregnancy and delivery.
Deep Vein Thrombosis During Pregnancy
Authors: Bergqvist A. , Bergqvist D. , Hallböök T.
Published: December 2009

Abstract. Seventeen women with thrombosis during pregnancy were studied prospectively. The deep venous thrombosis (DVT) was diagnosed objectively with phlebography, plethysmography and thermography. In many cases (13/17) the dominant symptom was diffuse pain in the lower abdomen and/or leg which in several cases caused a delay in the diagnosis. The traditionally typical thrombotic signs were often missing. Proximal thrombi were predominant (13/17) as were left‐sided ones (14/17). During pregnancy and lactation the patients were treated with heparin which, after the initial parenteral administration, was given subcutaneously by self‐administration.

In conclusion, DVT must be suspected and non‐invasive diagnostic tests be liberally performed in cases of uncharacteristic lateral and/or declive abdominal pain or leg pain during pregnancy. The DVT must always be objectively verified before treatment. In patients with pregnancy DVT there is no indication for early labor induction and the patients can be delivered by the normal vaginal route. It is recommended that patients with DVT during pregnancy should be treated with heparin subcutaneously which can be self‐administered. The post‐partum treatment may be continued for 2 − 3 months with heparin subcutaneously or per‐oral anticoagulants.
Intact fetal membranes
Authors: Ibrahim M. E. A. , Bou‐Resli M. N. , Al‐Zaid N. S. , Bishay L. F.
Published: December 2009

Abstract. Samples from different parts of the fetal membranes were examined by both light and transmission electron microscopy. Samples were obtained during elective ce‐sarean section after full‐term normal pregnancy. The results indicated that the different layers of the membranes had undergone ukrastructural changes varying according to the site from which the sample was taken. Samples taken from areas geometrically opposite to the placenta showed evidence of tension on the amniotic epithelium and disruption of the basement membrane. Samples taken from the area covering the internal os showed changes in the collagenous material. The implications of these findings are discussed.
Prostaglandin‐Oxytocin Induction of Mid ‐ Trimester Abortion complicated by Grand Mal‐Like Seizures
Authors: Sederberg‐Olsen Jesper , Olsen Carl Eli
Published: December 2009

Abstract. Mid‐trimester therapeutic abortion is performed routinely in several clinics by using a combination of intraamniotic instillation of prostaglandin F2α, followed by intravenous infusion of oxytocin in 5% glucose. In doses as low as 10 mU/min, oxytocin has an antidiuretic action. Two cases of grand mal‐like seizure in connection with this procedure of therapeutic abortion are reported and the background discussed.
Oral Oxytocics for Induction of Labor
Authors: Westergaard Jes G. , Lange Aksel P. , Pedersen Gunnar Thomsen , Secher Niels J.
Published: December 2009

Abstract.A randomized comparative study of 387 consecutive patients admitted for induction of labor was carried out using two orally administered oxytocics (prostaglandin E2tablets (ProstinR) or Demoxytocin resoriblets for buccal administration (SandopartR)), the results of which are reported here.

One‐hundred and twenty‐three cases were suitable for primary amniotomy; of these 48 were given PGE2tablets and 75 received demoxytocin resoriblets. In a further 264 cases, primary amniotomy was inadvisable and of these, 133 patients were allotted to the PGE2treatment group and 131 to treatment with demoxytocin.

A significantly higher success rate was observed (p <0.05) in the PGE2group in cases where primary amniotomy had been carried out, as compared with the demoxytocin group.

Parturition was successfully induced in 82.0% of the patients given PGE2tablets, as against only 63.4% of those receiving demoxytocin following 2 days of stimulation without primary amniotomy. This difference is statistically significant at the 0.001 level, and presumably due to the highly significant difference (p<0.0001) between patients with a Bishop score of 5 or less, where induction was successful in 75.4% given PGE2tablets, in contrast to a success rate of only 36.7% in patients receiving demoxytocin resoriblets. No difference was observed in the success rate between the two treatment groups when the Bishop score was 6 or more.

No difference was recorded in the incidence of fetal distress, instrumental delivery or low Apgar score between the two treatment groups. However, a higher incidence of vomiting and diarrhea were observed in patients treated with PGE2tablets (11%) as compared with those receiving demoxytocin (1.5%). There was no difference with regard to the induction‐delivery time, nor to the different stages of labor between otherwise comparable treatment groups when the induction was successful.

It is concluded in respect of induction of labor using orally administered oxytocics that PGE2(tablets) are preferable to demoxytocin (resoriblets) as it is the more effective of the two.
Supra Vaginal Uterine Amputation VS. Hysterectomy
Authors: Kilkku Pentti
Published: December 2009

Abstract. The author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 supra‐vaginal amputation patients, first preoperatively and then 6 weeks, 6 months and one year postoperatively. At 12 months the follow‐up percentage was 99.5 (211/212). This report concentrates on coital frequency and dyspareunia. In the statistical analysis, McNewar's test of symmetry and the Fisher exact test were used.

With respect to coital frequency, no statistically significant changes occurred between or within the two groups. Dyspareunia was relieved by either operation, but more so by supravaginal amputation. When dyspareunia was experienced deep within the pelvis, removal of the uterus by either method almost always resulted in disappearance of the symptom.
Higher Fibrinolytic Activity in Human Endometrium in Direct Contact with an Iud
Authors: Liedholm Percy , Srivastava Kartar , Wingerup Lars , Astedt Birger
Published: December 2009

Abstract. From 18 apparently healthy women wearing a copper‐IUD, endometrial biopsy specimens were obtained under hysteroscopic control, both from the site of the IUD and from a distant area. The fibrinolytic activity proved significantly higher in the former specimens than in the latter. The results provide a theoretical basis for the development of an IUD which releases a synthetic inhibitor of fibrinoly‐sis.
Levels of Ampicillin and Doxycycline in Human Oviduct Mucosa and Serum
Authors: Brihmer Christina , Brundin Jan
Published: December 2009

Abstract. A common treatment for salpingitis today includes ampicillin (AMPI) and doxycycline (DC), the former against Neisseria gonorrhoeae and the latter against Chla‐mydia trachomatis. The concentrations of doxycycline in oviduct mucosa were found about equal to that of serum and well above the minimum inhibitory concentrations (MIC's) for the bacteriae in question. The concentration of AMPI in the oviduct mucosa was only about 1/40 of that in serum, i.e. 1/10 of the MIC, which jeopardizes the effectivi‐ty of AMPI in the treatment of salpingitis.
Colpotomy Drainage of Pelvic Abscesses
Authors: Darling M. R. N. , Golan A. , Rubin A.
Published: December 2009

Abstract. Retrospectively the records of 155 patients with an acute pelvic abscess who were treated by colpotomy drainage were studied. The more aggressive management, i.e. surgery, is to be preferred and the vaginal approach gives good results. The complications and morbidity in this series were very low and the mortality less than 1%. The procedure itself is simple and requires no special skill or great experience.
Cellular Morphometric Analysis of the Postmenopausal Endometrium During Treatment with Percutaneous Estradiol‐17β with and Without Oral Gestagen
Authors: Hoist Juhani , Cajander Stefan , von Schoultz Bo
Published: December 2009

Abstract. The effects of percutaneous estradiol‐17β 3 mg daily on the postmenopausal endometrium were quantified by morphometric analysis during 6 months of cyclic replacement therapy. A marked cellular response was recorded, together with increased serum levels of estradiol‐17β and a satisfactory therapeutic effect. Glandular epithelial cells and nuclei proved to be the most sensitive markers for the estrogenic effect, with profile areas increasing 80% and 65% respectively, whereas stromal cell nuclei showed a weaker response. In the women investigated, no correlation was found between individual cell growth and estrogen level. The increase in mean cellular profile areas was quite similar in women taking lynestrenol 5 mg daily for the last 10 days of each treatment cycle, as compared with those receiving unopposed estrogen. A 10‐day gestagen supplementation was found too short to reduce the estrogen‐induced growth.
Endometrial Ossification Associated with Repeated Abortions
Authors: Degani Shimon , Gonen Ron , De Vries Karl , Sharf Mordechai
Published: December 2009

Abstract. A patient with repeated abortions and a finding of endometrial ossification is reported. The etiology and pathogenesis of endometrial ossification are discussed.
Gastroschisis Diagnosed in Utero by Ultrasound
Authors: Björnståhl Herbert , Kullendorff Carl‐Magnus , Westgren Magnus
Published: December 2009

Abstract. During the last decade ultrasonography has been extensively used in prenatal diagnosis. Identification of fetal abnormalities can make it possible to improve obstetric and neonatal care. This is a report of a case of fetal gastroschisis diagnosed in the 32th week of gestation. As a result of the prenatal diagnosis of the malformation, the fetus was delivered by cesarean section and the pediatric surgeon could operate upon the infant immediately after birth.
Second‐Trimester Abortion by Extra‐Amniotic Instillation of Rivanol Combined with Intravenous Administration of Oxytocin or Prostaglandin F2α
Authors: Klinte Ingemar , Hamberger Lars , Wiqvist Nils
Published: December 2009

Abstract. Induction of second‐trimester abortion was studied by administration of the acridine derivative Rivanol in combination with an i.v. drip infusion of oxytocin or pros‐taglandin F2α (PG2α), alone or in combination. It was found that an early onset of the i.v. infusion was of major importance for the outcome. Administration of oxytocin in immediate connection with the Rivanol instillation proved more favorable than administration of PGF2α) or a combined oxytocin PGF2α drip, taking into consideration the induction‐abortion time as related to the side effects. A lag phase between the instillation of Rivanol and the start of i.v. infusion such as has earlier been frequently recommended seemed to be of no specific advantage, but caused both a prolonged induction‐abortion time and an increased incidence of infection.
Serum Estriol Level During Treatment with Betamethasone in the Last Trimester of Human Pregnancy
Authors: Kjer J. J. , Hess J.
Published: December 2009

Abstract. A comparison was made between betamethasone disodiumphosphate/betamethasone acetate (CelestonR) and betamethasone disodiumphosphate (CelestonaR) in antena‐tally prophylactic treatment of respiratory distress syndrome syndrome (RDS).

Altogether 65 pregnant women in the last trimester of pregnancy were treated with the first‐mentioned drug and 62 with the second. The RDS‐preventive effect was the same in the two groups. CelestonR has a much longer depressive effect on the level of plasma estriol than has CelestonaR. Use of this drug, betamethasone disodiumphosphate, is therefore recommended in the prophylaxis against RDS.
Tubal Surgery and Subsequent Artificial Insemination by Donor
Authors: Lauritsen J. G. , Vangsted P. , Pagel J. D. , Stamp J.
Published: December 2009

Abstract. The conception rate of 32 infertile women undergoing tubal microsurgery and subsequent artificial insemination by donor (AID) was compared with that of 71 women undergoing tubal microsurgery alone. The follow‐up period ranged from 1 to 6 12; years. Nine (28%) of the patients in the AID group conceived, resulting in 8 (89%) live births and 1 (11%) spontaneous abortion. In the normal semen group 42 (59%) of the patients conceived, resulting in 31 (74%) live births, 6 (14%) tubal pregnancies and 5 (12%) spontaneous abortions. In the AID group the following term pregnancy rates were achieved: 40% after bilateral lysis of periadnexal adhesions, 25% after fimbriolysis and 14% after salpingostomy. The corresponding figures in the group with normal semen analysis was 67%, 64% and 29%, respectively. It is concluded that patients who in addition to tubal microsurgery have been treated with AID for 9–12 menstrual cycles seem to have about a 50% poorer chance of achieving a term pregnancy compared with patients whose husbands have normal semen quality.
Incontinence Surgery in Female Motor Urge Incontinence
Authors: Meyhoff Hans‐Henrik , Walter Steen , Gerstenberg Thomas C. , Olesen Knud P. , Nordling Jørgen , Pedersen Poul H. , Hald Tage
Published: December 2009

Abstract. Conventional incontinence surgery was performed in 41 consecutive female patients despite the finding of motor urge incontinence. The patients were reinvestigated 6 months to more than 2 years after operation. Twenty‐eight of the patients also had the symptom stress incontinence. Seventeen patients had coexisting symptomatic genital prolapse and were operated on without prior pharmacological treatment. The remaining 24 patients were all resistant to parasympatholytic treatment. The choice of operative procedure was based on vaginal examination as well as bladder suspension defect as demonstrated on voiding‐colpo‐cysto‐urethrography. Subjective cure and improvement rate was 73%. At follow‐up, 30% of the patients had normal de‐trusor reflex control, and a significant improvement in urge incontinence as well as frequency of micturition and noc‐turia was observed.

Probably the primary treatment in females with motor urge incontinence should be pharmacological. However, in patients with symptomatic genital prolapse as well as in patients with ineffective medical treatment, conventional incontinence surgery seems to be well indicated in the absence of neurological disease‐providing the patient has an associated bladder suspension defect.
Invasive Cervical Cancer in a Cytologically Screened Population
Authors: Bjerre Bengt , Johansson Sven
Published: December 2009

Abstract. In the community of Malmö, less than 10% of the 20‐69‐year‐old women had been examined cytologically in 1960. By 1970 this figure had increased to 74% and the incidence of invasive cervical cancer decreased by 48% of the incidence prior to cytologic screening. In spite of continued screening and rescreening, no further decrease occurred during the 1970s. In 131 cases, invasive cancer was diagnosed in women previously screened. The smears of 90 of these women had shown changes more than a year before the diagnosis, but 30 women refused examination or therapy. In 60 cases of mild‐moderate atypia, further examination consisted solely of a cytologic check‐up. We believe that a more active examination program, including colposcopy, in cases of cytologic atypia will be the most important step towards a further reduction in the frequency of invasive cervical cancer.
Physiotherapeutic Aspects of Urine Incontinence
Authors: Fischer Wolfgang
Published: December 2009

Abstract. Women suffering from urinary incontinence often lose proper control of their abdominal and pelvic floor muscles. A comprehensive program for differential diagnosis and therapy was therefore devised and tested. Briefing of patients on functional anatomy, application of a pulsating electric current, and exercises in respiration and mobility for the activation of pelvic floor muscles are major therapy elements. Groups of up to 30 start off by exchanging experiences of complaints, followed by exercises coached by an experienced physiotherapist. Beginners and advanced patients are grouped together and separated only for electrotherapy. Some 4‐6 weeks are required for treatment (four sessions weekly and 2 hours of attendance daily). Continence was restored by such treatment in 23 of 82 patients (28%), and 38 (46%) improved greatly. Best results were obtained from I° II° cases. Integration of physiotherapy with multistep therapy for urinary incontinence is described.
Cesarean Section and Intraoperative Surgical Complications
Authors: Nielsen Thorkild F. , Hökegård Klas‐Henry
Published: December 2009

Abstract. The incidence of surgical complications associated with cesarean section (CS) was studied prospectively in 1319 patients undergoing CS during the years 1978, 1979 and 1980 (18% of all deliveries). The overall complication rate was 11.6% (9.5% patients with minor complications and 2.1 % with major complications). The complication rate for emergency operations was 18.9% and for elective CS, 4.2%—a highly significant difference, (p <0.001). Six risk factors were associated with the occurrence of surgical complications in emergency cases: Station of the presenting part of the fetus in relation to the spinal plane (p <0.001), labor prior to surgery (p<0.001), low gestational age (<32 weeks) (p<0.001), rupture of fetal membranes (with labor) prior to surgery (p <0.01), previous CS (p <0.01), and skill of the operator (p<0.05). However, no such risk factors were found in the elective group. The clinical relevance of these findings is summarized in two conclusions. Firstly, the proportion of emergency operations needs to be reduced, either in favor of elective procedures, or by allowing more patients to give birth by the vaginal route. Secondly, emergency CS requires great skill on the part of the surgeon, and should therefore not be entrusted to young, inexperienced obstetricians.
The Plasma Concentration of Medroxyprogesterone Acetate and Ovarian Function During Treatment with Medroxyprogesterone Acetate in 5 and 10 mg Doses
Authors: Wikström Agneta , Green Britt , Johansson Elof D. B.
Published: December 2009

Abstract. Peripheral plasma levels of medroxyprogesterone acetate (MPA) were determined by radioimmunoassay in 5 women after oral administration of 5 and 10 mg medroxyprogesterone acetate daily. Peak levels of MPA in plasma were recorded within 1‐3 hours of taking the tablet, which indicates a rapid absorption from the gastro‐intestinal tract. The levels of medroxyprogesterone acetate 12 hours after taking of the 5 mg tablet‐remained constant throughout the 8 weeks of study. Peripheral plasma levels of estradiol and progesterone were determined throughout treatment. The estradiol levels indicated development of follicles in 7 out of 10 treatment months in the 5 mg group, and in 3 of the subjects treated with 10 mg MPA. The progesterone levels in those women treated with 5 mg MPA showed normal luteal concentration values in 2 out of 10 treatment months. No woman treated with 10 mg MPA had an increase in progesterone during the 21‐day period of treatment. The results obtained in this study suggest that 10 mg MPA daily will inhibit ovulation but 5 mg is not sufficient to inhibit ovulation in all women.
Non‐Specificity of Symptoms Related to Adenomyosis
Authors: Kilkku Pentti , Erkkola Risto , Grönroos Matti
Published: December 2009

Abstract. A total of 212 patients coming for removal of the uterus due to a benign condition were interviewed by the first authour before operation. Of these patients 28 had ade‐nomyosis, while 157 had neither adenomyosis nor external endometriosis; these two groups were compared with respect to duration of menstrual bleeding, dysmenorrhea, dyspareunia, urinary symptoms and sacral and lower abdominal pain. There were no inter‐group differences in the frequencies of these symptoms. It is concluded that although patients with adenomyosis have many symptoms, none specific to adenomyosis can be found.
Three Years of Experience After Post‐Abortal insertion of Nova‐T and Copper‐T‐200
Authors: Nielsen Niels Christian , Nygren Karl‐Gösta , Allonen Hannu
Published: December 2009

Abstract. The results of 3 years of follow‐up of a randomized comparative study of 331 women who had an IUD inserted immediately after a first‐trimester legal abortion are presented. In one group of women, 172 Nova‐T were inserted and in another, 159 Copper‐T 200. There was no statistically significant difference between the two groups, though the pregnancy rate for Nova‐T was considerable lower than for Copper‐T 200. The overall performance of the IUD equals that in a larger material of more than 1 800 insertions, both post menstrual and post abortal, of which this study is a part.
Treatment of Pruritus Vulvae by Means of CO2 Laser
Authors: Ovadia Jardena , Levavi Hanoch , Edelstein Theodor
Published: December 2009

Abstract. Five women with intractable pruritus vulvae, in whom standard therapy had failed to cure the condition, were treated by CO2 laser beam application. Results at one year were good in one patient and excellent in four.
Local Application of PGE2 by Means of a Portio‐Adapter
Authors: Grünberger W. , Huber J. , Husslein P.
Published: December 2009

Abstract. In 206 pregnant women with unfavorable cervix, labor was induced by local application of 1.5 mg PGE2 by means of a portio‐adapter. In 70.4% labor was successfully induced after a single “PG‐cap”. An additional 11.6% went into labor after a second or third cap. In 14.1%, a sufficient priming of the cervix was obtained and amniotomy was performed. 3.9% had to be considered failures. The overall incidence of operative deliveries was 17%. Apgar scores and cord gases were within normal ranges. Internal tocography revealed a physiologic pattern of contractions with slightly elevated maximal pressures but normal baseline values. With local application of PG by means of a portio‐adapter the preparation of a gel mixture can be avoided and the exact anatomic location of the PG‐containg solution allows a withdrawal in case of hyperstimulation. From the results of this study it is concluded that local application of 1.5 mg PGE2 by means of a portio‐adapter is a safe and effective method of induction of labor.
Treatment and Prognosis of met Astatic Gestational Trophoblastic Disease
Authors: Punnonen R. , Hori A. , Okawada M. , Kudoh R.
Published: December 2009

Abstract. Three cases with metastasized choriocarcinoma are reported. The basic chemotherapeutic regimen was methotrexate and actinomycin D, combined with cyclo‐phosphamide or vinblastine. Surgery was used in the treatment of both primary and metastatic lesions. The chief indications for hysterectomy arise when chemotherapy has obviously failed. Thoracotomy was performed for a pulmonary metastasis and nephrectomy for a metastasis of the kidney. Craniotomy was performed to control the brain hemorrhage. Aggressive multidrug chemotherapy is considered necessary as the primary treatment for high‐risk cases of trophoblastic disease.
Does Glucose Administration Affect the Cerebral Response to Fetal Asphyxia?
Authors: Blomstrand Svante , Hrbek Antonin , Karlsson Kirsten , Kjellmer Ingemar , Lindecrantz Kaj , Olsson Torsten
Published: December 2009

Abstract. This study was designed to test whether the fetal brain has an increased resistance towards asphyxia at high levels of blood‐glucose, compared with low levels. 35 fetal sheep were exteriorized and investigated under general anesthesia. Cerebral blood flow (CBF) was estimated with the 133Xenon‐washout method. Cerebral uptake of oxygen, glucose, and lactate was measured. Somatosensory evoked potentials (SEP) were recorded. The fetuses were subjected to controlled asphyxia by ventilating the ewes with gasmixtures low in oxygen. The blood sugar levels of the fetuses were varied over a four‐fold range. During normal oxygenation of the fetus variations in the blood glucose concentration induced considerable changes in the cerebral glucose uptake, whereas CBF and oxygen uptake were unaffected. During asphyxia, hyperglycemia was associated with rapid development of acidosis and reduction in cerebral oxygen consumption together with deterioration of the neurophysiological characteristics of the brain. Far from being beneficial during asphyxia, fetal hyperglycemia appeared to reduce the tolerance of the fetal brain towards asphyxia. This report together with other evidence provides support for the view that extra glucose might be disadvantageous for the asphyxiated fetus.
Predictive Value of Antepartum Non‐Stress Test in Multiple Pregnancies
Authors: Lenstrup Carsten
Published: December 2009

Abstract. Twentyseven sets of twins in the last trimester of pregnancy underwent 122 antepartum nonstress tests (NST). The NSTs were evaluated by a cardiotocography score. The last test was performed less than one week antepartum. Fifty fetuses had a normal NST, 13 were smallforgestational age, but only one of these required intensive neonatal care. Four fetuses had one or more pathological NSTs; all 4 were SGA, and these required intensive neonatal care. The pathological variables in the cardiotocograms were reduced variability, absence of spontaneous accelerations, and (late) decelerations. There was no perinatal mortality. Pathological NST was associated with a statistically significantly increased rate of neonatal morbidity, reduced intrauterine growth and a low one minute Apgar score. For the evaluation of retarded intrauterine growth, the predictive value of a normal NST was 95.7%, and the predictive value of a pathological NST was 75.0%‐ The assessment of fetal wellbeing in multiple pregnancy by nonstressed antepartum cardiotocography is of clinical value and seems to be a better predictor of perinatal morbidity than are serial estriol analyses and serial biparietal diameter measurements.
The Effect of Estrogen Therapy on Somatic and Psychical Symptoms in Postmenopausal Women
Authors: Furuhjelm Mirjam , Karlgren Erva , Carlström Kjell
Published: December 2009

Abstract. The effect of oral estrogen replacement therapy upon somatic and psychical disturbances and sexuality was studied in a doubleblind investigation in 48 postmenopausal women using hormone preparations with two different levels of micronized estradiol‐17β (E2) as active estrogen component. The patients were treated for 8 months in four 2‐month periods with two preparations containing 1‐2 mg of E2 (TrisekvensR and EstrofemR), with one preparation containing 1‐4 mg of E2 (TrisekvensR forte) and with a placebo preparation. Investigations performed before and during treatment included general clinical chemical analysis, serum levels of FSH, LH and E2 and evaluation of the patients' somatic and psychical disturbances and sexuality.

The patients were classified into three subgroups according to their pretreatment scores for mental distress and/or depression: severe (group I), moderate (group II), or no (group III) mental distress and/or depression. No significant differences between the three subgroups were found in pretreatment values from the general clinical chemical analysis or the hormone assays. Estrogen treatment significantly reduced S‐total cholesterol values in all three subgroups; otherwise no significant effects were revealed by the general clinical chemical analysis. During the period of optimal wellbeing, serum E2 levels corresponded to luteal phase values. The gonadotropin levels, although depressed by approx. 50%, were still within the postmenopausal range. There were no significant differences between the two subgroups in hormone levels obtained during optimal estrogen treatment. Twentyone patients had the best test results when treated with the larger dose (TrisekvensR forte) and 23 with the smaller dose (TrisekvensR and EstrofemR) and 4 during placebo treatment. The dose of estrogen did not significantly influence the hormone values found during optimal estrogen treatment. Vasomotoric and physical symptoms improved appreciably during estrogen treatment when compared with placebo or pretreatment scores. A certain placebo effect was noted for physical symptoms, which may be attributed to persisting effects of previous active estrogen treatment. The psychical symptoms too improved considerably during estrogen treatment, although placebo effects were also noted. In 10 patients, detrimental effects on psychical symptoms were observed during active estrogen treatment. Hormone analysis revealed very high E2 and low gonadotropin levels in these patients, which must therefore be considered as overtreated. In one patient with premenopausal depression periods and in 3 who surreptitiously took tranquillizers during the treatment period, no effects of estrogens upon the psychical symptoms were observed. The sexuality of the patients did not improve during estrogen treatment.

The authors stress the need to individuate the dosage in estrogen replacement therapy.
Cesarean Section and Maternal Mortality in Sweden 1973‐1979
Authors: Moldin Per , Hökegård Klas‐Henry , Nielsen Thorkild F.
Published: December 2009

Abstract. During the years 1973‐79, 704732 births took place in Sweden and 63 075 cesarean sections (CS) were performed. Within the study period there were 20 maternal deaths associated with delivery or puerperium. Thirteen of these patients were delivered by CS and 7 by the vaginal route. The hospital records of the 13 deaths associated with CS were closely analysed and it was found that 5 of the patients were critically ill before the beginning of surgery, and the CS per se was not responsible for these deaths. The 8 remaining maternal deaths gave a corrected (cesarean‐attributed) maternal mortality rate of 12.7/100000 cesarean deliveries. For vaginal deliveries the mortality rate was 1.1/100000 deliveries. Thus, the risk of maternal death from CS in Sweden was twelve times as high as that from vaginal parturition. All maternal deaths except one, associated with CS, occurred after emergency operation. No deaths were ascribable to anesthesia complications. The most common causes of death after CS were pulmonary embolism, amniotic fluid embolism, coagulopathy and peritonitis. Time trends in the causes of maternal death in Sweden are discussed.
Antithrombin III in Oral Contraceptive Users and During Normotensive Pregnancy
Authors: Weenink G. H. , Kahlé L. H. , Lamping R. J. , ten Cate J. W. , Treffers P. E.
Published: December 2009

Abstract. Plasma antithrombin III (AT III) was determined in four groups of subjects, by employing an automated chromogenic technique. In 25 women, discontinuing oral contraceptives led to a 9% elevation of AT III, while in 13 women AT III levels fell by 9% after starting with the pill. In 77 normotensive pregnant patients AT III levels were normal during the third trimester and did not differ from control values 6‐8 weeks after delivery. Women taking the pill at that time did not have lower AT III levels than those who did not. Furthermore, AT III levels in 414 oral contraceptive users were the same as in 572 controls, when random samples were taken during pill cycle and menstrual cycle. It is concluded that although synthetic estrogens do cause a decrease in AT III levels, this decrease is probably the result of estrogen‐induced hemodilution, which may also occur during the normal menstrual cycle. If low dose pills are thrombogenic, mass screening for AT III deficiency will not identify those at risk, with the exception of the rare cases of hereditary AT III deficiency.
Serum Urate as a Predictor of Fetal Outcome in Severe Pre‐Eclampsia
Authors: Sagen Norvald , Haram Kjell , Nilsen Stein Tore
Published: December 2009

Abstract. Maternal serum urate levels were studied in 50 normal pregnancies and 72 cases of severe pre‐eclampsia. Markedly elevated levels of serum urate were found in severe pre‐eclampsia, compared with normal pregnancy. In severe pre‐eclampsia significantly higher levels were found prior to parturition in cases of growth retardation and perinatal distress, compared with patients whose newborns were of normal size and condition. Particularly high serum urate levels were found early in the third trimester in cases of perinatal death. A slight but significant correlation was found between the weight centile of the newborn and the last maternal urate level before parturition. A rapidly rising urate level reliably predicted perinatal distress. The last maternal serum urate before parturition was correlated with the hemoglobin and erythrocyte volume fraction values in the same blood sample.
THE HEMOSTATIC EFFECT OF TRANEXAMIC ACID IN CONISATIO COLLI UTERI
Authors: Lundvall Finn , Nielsen Niels Christian
Published: December 2009

Abstract. To evaluate the inhibitory effect of tranexamic acid (AMCA) on increased fibrinolyctical activity in connection with conisatio colli uteri we have carried out a randomized, double‐blind study with patients operated upon partly with an open method of operation (80 patients) and partly with modified Sturmdorff sutures (150 patients). In connection with the open method the frequency of late bleeding decreased from. 17.5% to 2.5%, which is significant. The corresponding decrease in connection with the other method was from 10.7% to 4.1%. This material was not sufficiently large to verify significance. The side effects of the prophylactic treatment with AMCA were few.

The study indicates that AMCA affords good protection against late bleeding in conisatio colli uteri.
The Social and Gynecological Long‐Term Consequences of Tubal Sterilization
Authors: Børdahl P. E.
Published: December 2009

Abstract. The long‐term consequences and complications of tubal sterilization were studied. Six years after surgery, information was obtained from 208 of 216 women. Five had been pregnant. Eight had been bothered by their scars for 2 years or more. The majority reported improved conjugal relations and a positive impact on marriage. Eighty‐five percent had told others about the sterilization; the frankness was more common in the younger age groups. Although most women were satisfied, 6% would have preferred the sterilization undone. In 10% of the couples, at least one of the partners held that view. The most common cause for regret was the desire for more children, in most cases with a new spouse. Regret was not correlated to the woman's age, parity or social group. Regret was recorded with significant predominance when the sterilization had been suggested by a doctor at abortion application. In a controlled comparison between Pomeroy laparotomy and laparoscopic electro‐coagulation, no differences in postoperative bleeding patterns were found. The present study indicates that tubal sterilization is not a major cause of subsequent menstrual irregularities.
Computer‐Tomographic Evaluation of Gynecologic Tumors
Authors: Kormano Martti , Grönroos Matti
Published: December 2009

Abstract. The accuracy of contrast‐enhanced computer tomography (CT) of the pelvis in the detection, characterization and staging of known or suspected pelvic tumors was compared with clinical and operative findings in a prospective study of 79 patients (25 cervical carcinomas, 27 endo‐metrial carcinomas, 10 ovarian carcinomas, 4 vulval or vaginal carcinomas and 13 benign ovarian or uterine tumors). In cervical carcinoma, there was a tendency towards lower staging of the tumor, especially in stage IIa, which is not easily detected in CT. Even small tumors of the cervix and endometrium can be visualized by contrast enhancement, which clearly delineates heavily vascularized myometrium and less enhancing tumor tissue. The accuracy of CT in tumor detection, characterization and evaluation of spread was best in ovarian neoplasms, weakest in cervical carcinomas. The importance of proper CT technique is stressed.
Effect of danazol on thyroid function in postmenopausal women
Authors: Dymling John‐Fredrik , Jeppsson Sten , Rannevik Gunnar
Published: December 2009

Abstract. During treatment with danazol the serum concentration of thyroxin‐binding globulin (TBG) decreases. This effect is probably a direct effect on TBG production at the cellular level. In order to exclude an indirect effect on TBG production via the well known suppressing effect of danazol on serum estrogen concentrations, the following study was performed. Twelve healthy female volunteers, who were at least 3 years past the menopause and with serum‐estradiol levels below 100 pmol/l, were treated with danazol in dosages of 400, 600 or 800 mg daily. The concentrations of TBG, TSH, total thyroxin (T4), total triiodothyronine (T3) and free dialysable fractions of T4 and T3 were determined, before, and after 2 and 4 weeks of medications. The serum concentrations of TBG, total T4 and T3 decreased. The TSH concentration and the free dialysable fraction of T4 were essentially unaltered after 2 weeks but the TSH had decreased slightly and free T3 increased slightly after 4 weeks. The free dialysable fraction of T3 decreased transiently at 2 weeks. All the observations proved to be independent of the three dosages of danazol applied in this study. In conclusion, danazol treatment influences available tests of thyroid function by reducing the concentration of TBG. This is most probably a direct effect of the drug, and it is clearly independent of the effect on estrogen production. Clinically there is no evidence of a decreased effect of thyroid hormones on the target organs.
Oral Progesterone and Estrogen/Progestogen Therapy: Effects of natural and synthetic hormones on subfractions of HDL cholesterol and liver proteins
Authors: Ottosson Ulla‐Britt
Published: December 2009

The pharmacokinetics of progesterone after oral administration were investigated. After a single dose of 100 mg, serum concentrations of progesterone around 50–60 nM and of 20α‐hydroxy‐4‐pregnene‐3‐one around 5–6 nM were recorded within 1–4 hours and elevated levels persisted for 8–12 hours. There were only minor changes in 17α‐hydroxyprogesterone concentrations and serum levels of androstenedione and cortisol were unaffected. A significant conversion of circulating progesterone into deoxycorticosterone was demonstrated. During clinical treatment with oral progesterone the individual serum concentrations of this potent mineralocorticoid were closely correlated to the progesterone concentrations. This observation could be important as regards the etiology of certain clinical disorders characterized by fluid retention. According to competitive binding analyses there was no evidence that progesterone or medroxyprogesterone acetate could cause significant displacement of cortisol from corticosteroid‐binding globulin during clinical treatment.

The effects of natural and synthetic hormones upon subfractions of high density lipoprotein (HDL) cholesterol and liver proteins were followed in postmenopausal women during replacement therapy with various estrogen ‐ progestogen combinations. The total serum cholesterol level was significantly reduced during treatment with all estrogen regimens. The concentrations of HDL cholesterol, HDL2 cholesterol, apolipoprotein A I and A II were increased in a dose‐dependent pattern during unopposed estrogen therapy. The potency of 10 μg of ethinyl estradiol was estimated to be equivalent to 3–4 mg of estradiol valerate. Estrogen effects were significantly reversed by levonorgestrel 250 pg and also by medroxyprogesterone acetate 10 μg. During treatment with natural progesterone, no changes were recorded in HDL cholesterol or its subfractions. As compared with the lipoproteins, pregnancy zone protein and sex hormone binding globulin (SHBG) were found to be more sensitive to the alkylated than to the non‐alkylated estrogen. Both levonorgestrel and medroxyprogesterone acetate clearly reduced SHBG levels after 3 months, whereas micronized progesterone had no such effect. While tamoxifen counteracted the therapeutic and metabolic effects of estrogen the sequential addition of estriol had no apparent influence. Unopposed estrogen treatment enhanced liver lecithin synthesis along pathway 1, i.e. reduced the amount of stearic acid and increased the amount of palmitic acid. The effects were dose‐dependent and no qualitative differences between ethinyl estradiol and estradiol valerate were recorded.
Disposition of the Adrenergic Blocker Metoprolol in the Late‐Pregnant Woman, the Amniotic Fluid, the Cord Blood and the Neonate
Authors: Lindeberg S. , Sandstriöm B. , Lundborg P. , Regårdh C.‐G.
Published: December 2009

Abstract. Pharmacokinetic studies on the concentration of the beta1‐blocker metoprolol have been performed in maternal plasma, amniotic fluid, breast milk and the plasma of the newborn. The concentration of metoprolol in maternal plasma exceeded that in the amniotic fluid intially, but not later on. The quotient between the metoprolol concentration in the maternal venous blood and the mixed cord blood at the time of parturition is at about 1. In the maternal plasma the metoprolol concentration decreases rapidly after the latest dose, probably because of an increased clearance rate. Blood levels of metoprolol during the first postnatal hours increase almost fourfold and are generally followed by a decrease over the next 15 hours. Active metabolites of metoprolol (alfa‐OH‐metoprolol and O‐demethyl‐metoprolol) are found in the urine of the newborn. The breast milk concentration of metoprolol is three times as high as in the maternal plasma but the suckling newborn will only show very low or unmeasurable plasma levels between consecutive breast feeding periods, in the majority of cases.
ADVANCED EXTRA‐UTERINE PREGNANCY
Authors: Golan A. , Sandbank O. , Andronikou A. , Rubin A.
Published: December 2009

Abstract. Forty‐three cases of advanced extra‐uterine pregnancy of more than 34 weeks' gestation, seen and treated at Baragwanath Hospital between 1966 and 1978, are reviewed. The incidence in our unit was 1 per 6389 deliveries. Abdominal pain and vaginal bleeding were the most common complaints. Simple vaginal examination is of great help in establishing the diagnosis, while the abdominal signs are found to be disappointing in this respect. The oxytocin test is a helpful diagnostic aid and various radiographic methods, such as plain X‐ray abdomen, hysterosalpingography and ultrasonography have their merits. The placenta, although attached to rather critical areas in the majority of patients, was removed safely without damage to neighboring structures in 93% of the cases. Four patients, however, required hysterectomy. There were two maternal deaths. Of the 18 babies born alive, only 8 survived. All the surviving infants had congenital anomalies but only 5 had problematic defects.
ABRUPTIO PLACENTAE AND DISSEMINATED INTRAVASCULAR COAGULATION
Authors: Gilabert J. , Estelles A. , Aznar J. , Galbis M.
Published: December 2009

Abstract. Several parameters of hemostasis have been studied in 19 patients suffering from abruptio placentae. In 10 of them severe hemostatic alterations were detected and in 5, disseminated intravascular coagulation was observed. The patients were divided into four groups according to the severity of their clinical picture. The degree of placental separation was related to the severity and course of the clinical history and to the alterations in hemostasis detected at the most critical clinical moment. The analytical parameters were evaluated after extraction of the thromboplastic material. A good correlation was observed between the severity of the clinical picture and the degree of placental separation and the greatest analytical alteration, especially with cross‐linked soluble fibrin monomer complexes (SFMC). In 9 of the 19 patients who showed analytical and/or clinical alterations, an improvement was detected in these alterations after evacuation of the uterus.
AN ACARDIAC ACEPHALIC ANOMALY DETECTED ON SONOGRAPHY
Authors: Wexler S. , Baruch A. , Ekshtein N. , Libal Y. , Yedwab G. , Ornoy A.
Published: December 2009

Abstract. A rare anomaly of acardiac fetus is presented in which the diagnosis was made by ultrasonography, in the 20th week of pregnancy. This is, to our knowledge, the first report of such a phenomenon in the literature.

This anomaly is said to have an incidence of one in 34 600 births (1) and is possible only in multiple pregnancies, mostly in twins (4). This is the eleventh reported case in a triplet pregnancy.