bluuebunny/crossref_metadata_2025 huggingface dataset:
Conservative Treatment of Uterine Arteriovenous Fistula
Authors: Forssman Lars , Lundberg Jan , Scherstén Tore
Published: December 2009

Abstract. A case of a uterine arteriovenous aneurysm in a 20‐year‐old woman is described. The patient's main symptom was copious uterine bleeding. The diagnostic difficulties are described and the importance of arteriography is emphasized. The aneurysm was occluded at laparotomy by introducing gel‐foam into the uterine artery. The patient subsequently became pregnant and after an uneventful pregnancy was delivered of a healthy child. Thus, this type of conservative treatment seems to offer a possible means of avoiding hysterectomy in young patients with this rare condition who wish to retain their fertility.
Serum Levels of 4‐Androstene‐3,17‐Dione in Menstruating and Postmenopausal Women
Authors: Brody S. , Carlström K. , Lagrelius A. , Lunell N.‐O. , Rosenborg L.
Published: December 2009

Abstract. A radioimmunoassay for serum 4‐androstene‐3, 17‐dione (A‐4) using anti‐4‐androstene‐3, 17‐dione‐11α‐hemisuccinate bovine serum albumin was applied to serum samples from 16 healthy, normally menstruating women in different phases of the menstrual cycle, from 36 healthy postmenopausal women and from 23 postmenopausal women with various bone mineral contents and endometrial conditions, undergoing an acute ACTH stimulation test. The values obtained in the normal subjects were consistent with those found in the literature. A‐4 levels were significantly higher at midcycle than in the follicular phase and were significantly lower in postmenopausal than in menstruating women. ACTH increased the levels of A‐4 significantly. However, no significant correlation was found between basal levels or the ACTH‐induced increments of A‐4 on the one hand and bone mineral content, endometrial condition and the patients' weight, age, or Broca's index on the other. This is in contrast to our previous finding of significant correlations between basal dehydroepiandrosterone sulfate and ACTH‐induced increments in dehydroepiandrosterone on the one hand and bone mineral content on the other in the same clinical material. We discuss whether the differences in correlations to bone mineral content between the two adre‐nocortical androgens may be due to a rather more complex origin of the steroid moiety of A‐4.
Carcinoid Tumor of the Uterine Cervix
Authors: Hariri J. , Rasmussen E. A. , Hage E.
Published: December 2009

Abstract. A case of welldifferentiated carcinoid in the uterine cervix in a 60‐year‐old white woman is presented, with histochemical and ultrastructural examinations. The patient was treated by hysterectomy and bilateral salpingo‐oophorectomy with pelvic lymph node dissection. No systemic endocrine manifestations were detected. The patient is alive and free from recurrence 11 months after detection of the tumor.
Legal Teenage Abortions in a Swedish Population in the 1970s
Authors: Larsson Jan , Svanberg Lars
Published: December 2009

Abstract. The number of teenage abortions increased sharply in the early 1970s but gradually decreased from 1975, in absolute numbers as well as in relation to population figures. Teenage abortions now constitute 15% of the total number of abortions. However, the percentage of teenage pregnancies that are terminated by legal abortion is constantly increasing. As the preservation of childbearing function is of paramount importance in teenagers, a low complication rate is essential. Complications occurred in 7% of the cases studied, and the effects of complications of legal abortion on the later obstetric history are discussed. In 14% of the cases a second pregnancy was also terminated artificially. The repeat abortion rate is discussed, with special reference to the contraceptive method used.
The Incompetent Cervix During Pregnancy Diagnosed by Ultrasound
Authors: Vaalamo P. , Kivikoski A.
Published: December 2009

Abstract. Ninety‐one pregnant patients in mid‐trimester were examined for suspected cervical incompetence using ultrasound. This diagnosis means that detached membranes at the internal os are bulging into a dilated cervical canal. In 13 cases cervical dilatation was found. These patients were operated on using McDonald's purse‐string suture. Only one of these patients had premature rupture of the membranes and was delivered at 35 weeks. In all other operated cases the pregnancy continued beyond 37 weeks. Ultrasound is an objective method of diagnosing incompetence of the cervix in pregnancy.
Factors Related to an Improved Outcome for Twins
Authors: Hartikainen‐Sorri Anna‐Liisa , Kauppila Antti , Tuimala Risto , Koivisto Maila
Published: December 2009

Abstract. We observed that perinatal mortality among the 220 twins born at our hospital in 1977–78 (3.6%) was significantly lower than for the 210 twins born in 1975–76 (11.0%). At the same time the frequency of postpartum asphyxia had decreased significantly. An analysis of factors related to the diagnosis and therapy revealed that during the later period both the diagnosis of twins and bed rest in hospital had been initiated significantly earlier than during the former period. The duration of pregnancy, length of stay in hospital, use of β‐adrenergic drugs or glucocorticoids, duration and type of delivery and birthweight of the infants were similar in both groups. Early diagnosis permits the greatest degree of readiness for both the mothers and the obstetrical and pediatric personnel in order to meet the possible complications commonly associated with a twin pregnancy and birth.
The Results of Cryosurgical Treatment in Young Women with Cervical Intra‐Epithelial Neoplasia
Authors: Hemmingsson Erik , Sténson Stig
Published: December 2009

Abstract. A review is given of results from a 3–5‐year follow‐up of 105 young women treated with cryosurgery for a histopathologically verified dysplasia or carcinoma in situ of the uterine cervix. The recovery rate was 88%, with a slightly higher figure in the dysplasia group compared with that of carcinoma in situ. No invasive carcinoma was diagnosed and cases of treatment failure, all diagnosed within one year after cryosurgery, did not develop into a more severe form of neoplasia than previously. No recurrence has been noted so far and very few complications have been recorded. It is concluded that cryosurgery is an easy and effective method of treating cervical intra‐epithelial neoplasia in young women. We stress, however, the importance of correct histopathological diagnosis prior to therapy and that after treatment the status of the patient must be checked with vaginal smears over a long period of time.
Breast Carcinoma Met Astatic to the Vagina
Authors: Jacobs Allan J. , Deppe Gunter , Kessinger M. Anne , Newland James R.
Published: December 2009

Abstract. Breast carcinoma tends to follow a protracted course. By the time the patient succumbs to her disease, it is often widely metastatic (2). It is well recognized that the ovary is a frequent site of metastasis (3), but this tumor is also said to occur with some frequency in the uterus, retroperitoneal lymph nodes, peritoneum, and inguinal nodes (1). Vaginal occurrence of breast carcinoma is, on the other hand, extremely rare, with only one case described in detail in the literature (4). We describe here 3 other such cases and discuss the significance of our findings.
Use of Oral Oxytocics for Stimulation of Labor in Cases of Premature Rupture of the Membranes at Term
Authors: Westergaard J. G. , Lange A. P. , Pedersen G. Thomsen , Secher N. J.
Published: December 2009

Abstract.The efficacy of oral PGE2tablets and buccal demoxytocin (resoriblets) for the induction of labor in cases of premature rupture of the membranes (PROM) after the 37th week of gestation has been evaluated in a prospective, randomized investigation of 193 women. PGE2tablets (Pro‐stinR) were given to 109 parturients and demoxytocin resoriblets (SandopartR) to 84. The former were given in increasing doses from an initial 0.5 mg to a maximum of 1.5 mg every hour. The demoxytocin was administered at a constant dosage of 50 I.U. every 30 min.

The treatment was unsuccessful in 10 of the women treated with PGE2tablets and in 19 women receiving demoxytocin resoriblets. In addition, the treatment had to be discontinued in 5 women in the PGE2group due to gastrointestinal side effects. This gives a total success rate of 86.3% for treatment with PGE2against 77.4% in respect of demoxytocin. This difference is not significant.

No difference was observed between the two treatment groups as regards: the stimulation‐delivery interval, duration of the various stages of labor, efficacy in primiparae and multiparae, efficacy in patients with a high/low Bishop score.

A significantly higher frequency of gastro‐intestinal side effects was seen in those treated with PGE2(21.7%) as compared with demoxytocin (3.6%). The frequency of surgical intervention was 17% in the PGE2group and 10% in the demoxytocin group. In 4 cases where the stimulation was successful, cesarean section was carried out for reasons unrelated to the drug therapy.

Despite the fact that demoxytocin treatment results in fewer side effects than PGE2, the efficacy of the drug is not superior. Based on experience from previous investigations carried out in this department, where intravenous oxytocin was found to be clearly better than oral PGE2for the induction of labor in cases of PROM, intravenous oxytocin will remain the method of choice due to the shorter period of treatment, which must take priority.
Sickle Cell Diseases and Hormonal Contraception
Authors: Freie Harm M. Paul
Published: December 2009

Abstract. The available data on the use of oral contraceptive agents in patients with sickle cell diseases is reviewed. The attitude which considers sickle cell anemia to be a con‐tra‐indication to OC's cannot be supported on the basis of available evidence. On the contrary, there are a number of reports where favorable effects of steroids on ‘sickling’ have been described. It is concluded that modern low‐dose combined OC's are the method of choice for contraception in all patients carrying the HbS gene.
The Ability of Ultrasound to Determine the time for Harvesting Preovulatory Oocytes
Authors: Sundström P. , Persson P.‐H. , Liedholm P. , Wramsby H.
Published: December 2009

Abstract.To achieve fertilization in vitro, it would seem important to harvest the oocytes just before ovulation. Monitoring of follicular growth by repeated ultrasonic examinations has been suggested as a method for determining the time for harvesting preovulatory oocytes. To assess the usefulness of this new method, 90 women were studied in three groups. Two groups (N = 71) received ovarian stimulation with clomiphene citrate/hCG or hCG alone; one group (N = 19) was untreated. Each woman was examined with ultrasound 2–3 hours before the operation, performed on day 14 of the menstrual cycle. Blood samples for progesterone analyses were obtained from day 11 to 17 of the menstrual cycle to determine ovulation day. In the unstimulated group, the operation did not coincide with the day of the progesterone rise in any of the women and no preovulatory oocytes were found. In the stimulated women, progesterone rise and operation day coincided in 42%; preovulatory oocytes were obtained in 45% of the women. Follicles aspirated on the day of the progesterone rise were, on average, largest in diameter (20 mm, range 14–28 mm) and volume (3.3 ml, range 1 — 8 ml). When the follicles were ≥20 mm in diameter and the rise in progesterone occurred on the day of the operation, preovulatory oocytes were found in 63% of the women. If ultrasound failed to visualize follicles in an ovary, the chance of obtaining a preovulatory oocyte was 5.5%. False ultrasonic results were obtained in 29% of the women. In stimulated cycles, no improvement in the success rate of obtaining preovulatory oocytes would have been obtained if the operation day had been selected on the basis of one ultrasonic examination alone, compared with routine operation at midcycle. This lack of improvement was due to the wide range of the diameters of preovulatory follicles and to false results of the ultrasonic examinations. The investigation showed that the optimum time for harvesting fertilizable oocytes cannot be determined by ultrasound alone.
Insulin‐Induced Hypoglycemia in Pregnant Diabetics
Authors: Stangenberg Magnus , Persson Bengt , Stånge Lars , Carlström Kjell
Published: December 2009

Abstract. Insulin (0.1 IU/kg bw) was injected intravenously in 9 pregnant diabetics in the last trimester of pregnancy. Maternal levels of blood glucose, estriol, human placental lactogen, blood pressure and pulse rate were measured and fetal heart rate (FHR) recorded. During hypoglycemia maternal blood pressure remained unchanged but maternal pulse rate tended to increase. Plasma levels of estriol and HPL remained unchanged. In 6 of the 9 patients there was a decrease in FHR variability during the hypoglycemic period. FHR variability increased after normalization of maternal blood glucose levels. The decrease in FHR variability could be a direct effect of glucopenia on the fetal heart.
Radiographic Findings in Cervix Uteri After Prostaglandin Abortion Induction
Authors: Kajanoja Pauli , Aantaa Kaarina
Published: December 2009

Abstract. Hysterography was performed on 173 nulliparous patients following termination of midtrimester pregnancy by intra‐amniotic prostaglandin F2α (PGF2α). In 21 hystero‐grams (12%) a pathologically wide internal os was found, compared with three out of one hundred routine hystero‐grams carried out for infertility examination. A deformed cervical canal with filling defects and synechiae was found in the hysterograms of 28 patients (16%). Only one of the 6 patients with ruptured cervix had a wide internal os. A lami‐naria tent was inserted more frequently into the cervix of patients whose internal os was of normal wide. The clinical picture of patients and the courses of abortion inductions did not differ in other respects in patients with normal vs. wide internal cervical os. This leads us to believed that there are two types of cervix: a rigid, hypoplastic cervix with high collagen content, which when exposed to the trauma of abortion induction leads to rupture, but not necessarily to incompetence, and a softer type of cervix, very muscular, which leads to wide internal os and incompetence.
Which Local Anesthetic is Best Suited for Paracervical Blocks?
Authors: Nesheim BrittIngjerd
Published: December 2009

Abstract. In a prospective, randomized study the duration and effectiveness of four different regimens of PCB were studied: Bupivacaine both with and without adrenalin, and chloroprocaine with and without adrenalin. The pain relief was immediate and almost complete in most patients in all four treatment groups. The duration of the effect of bupivacaine was the same whether adrenalin was added or not. The labors were significantly prolonged with adrenalin, however. The duration of the effect of chloroprocaine was substantially shorter than bupivacaine, but with this short‐lasting anesthetic the duration was prolonged by the addition of adrenalin. It is concluded that bupivacaine without the addition of adrenalin is the drug of choice for PCB.
Tranexamic Acid for the Treatment of Advanced Ovarian Carcinoma
Authors: Sigurdsson Kristjan , Johnsson John‐Erik , Tropé Claes
Published: December 2009

Abstract. In the present phase II trial, 26 heavily pretreated patients with advanced recurrent ovarian carcinoma were treated with tranexamic acid, 4 − 6 g per os daily for at least 3 months. Of these 26 patients, 3 had stage IIb, 21 stage III and 2 stage IV. Histologic examination revealed serous adenocarcinoma in 13, mucinous in 3, endometroid in 4, 1 anaplastic and 5 unspecified adenocancer. Twenty of the tumors were poorly differentiated and 5 highly‐moderately differentiated. No objective response was noted but all the highly‐moderately differentiated tumors showed a stable disease state with a median duration of 6 months (range 4 — 36 months). The patients with poorly differentiated tumors had a median survival of 4 months. Most of the patients had some form of gastro‐intestinal side effect. This investigation has shown that treatment with tranexamic acid was not particularly helpful in poorly differentiated cases in which modern combined chemotherapy already had failed. The effect in highly‐moderately differentiated cases needs further evaluation.
Practice and Patterns of Estrogen Treatment in Climacteric Women in a Swedish Population
Authors: Persson I. , Adami H. O. , Lindberg B. S. , Johansson E. D. B. , Manell P.
Published: December 2009

Abstract. A cohort of 23 233 women to whom estrogens had been prescribed and constituting a total material from a defined Swedish population was recruited for the purpose of conducting a prospective follow‐up study of endometrial cancer. Their exposure to estrogens was studied in detail by means of a comprehensive questionnaire, which was mailed to 735 randomly selected women from the cohort and answered by 89%. This paper describes the practice of estrogen prescribing in the population and the patterns of exposure of the cohort, as estimated from the sample. Our results indicated: restrictive usage of estrogens with a marked downward secular trend in the frequency of prescriptions; short duration of treatment and frequent temporary interruptions; predominant choice of estradiol valerate compounds; preference for cyclic administration and low‐strength tablets; acceptance of recommended dose levels; and adherence to a few, established indications for treatment. When compared with data from a large number of other epidemiological studies, the risk of endometrial cancer in this cohort is likely to be lower.
Intra‐Uterine Transfusions to the Rhesus‐Immunized Fetus in the Department of Obstetrics, National Hospital, Oslo 1968‐1979
Authors: Skjaeraasen Julie , Moe Narve
Published: December 2009

Abstract. During the years 1968‐79, 115 intra‐uterine transfusions (IUT) were performed in 71 severely Rhimmunized pregnant women at 26‐32 weeks' gestational age. Thirty‐five (approx. 50%) infants survived; 28 died in utero and 9 in the neonatal period. The selection of patients and technique is described. The amount of transfused blood in cord blood at birth is presented for the majority of liveborn infants.

The study emphasizes that the outcome of IUT is entirely dependent on the degree of hemolysis at the time of the initial IUT. Among 30 patients with an amniotic fluid optical density difference at 450 mμ <0.3, a survival rate of 83% was registered compared with 36% and 0% in groups with values 0.3‐0.6 and >0.6, respectively
Premature Labor and Coincident Acute Appendicitis not Resolved by Betamimetic but Surgical Treatment
Authors: Herczeg J. , Kovács L. , Keserü T.
Published: December 2009

Abstract. Three cases one of them fatal of betamimet‐ic “resistant” premature labor with coincident acute appendicitis are presented. These case histories support the opinion held by the authors that in the recent era of widespread use of betamimetics, during the second and third trimester, appendicitis can be concealed by increased uterine contractility which could be secondary to the intra‐abdominal inflammatory process or triggered by genuine premature motor activity of the myometrium. We consider that the obstetrician should revise his decision regarding betamimet‐ic treatment on the basis of continuous observation. There is a clinical message in these cases which should be incorporated into the decision‐making process: if a patient presents herself with premature labor, betamimetics should not be given before the diagnosis has been established.
The Influence of Dose‐Delivery time Interval on Neonatal Plasma Pethidine Levels
Authors: Moreland Terence A. , Brice John E. H. , Mohamdee Omar , Walker Colin H. M.
Published: December 2009

Abstract. Plasma pethidine levels were determined by RIA during the first 24h of life in 126 neonates whose mothers had received a single intramuscular dose of 100‐150 mg pethidine HC1 0.25 to 19.5 h before delivery.

The mean (geometric) maternal and cord venous plasma pethidine concentration and the neonatal capillary plasma levels at 0.5, 1.5 and 12‐24 h expressed per unit dose were 125, 98, 71, 59 and 23 ng/ml per mg/kg respectively. The mean (±S.E.M.) cord: maternal plasma concentration ratio was 0.741±0.036 (n = 40). The ratio was significantly correlated with the dose‐delivery interval, r = 0.42, p>0.01.

The pethidine concentration in cord and in neonatal capillary plasma was significantly correlated to the weight related dose, r = 0.25 to 0.48, p=0.01.

Cord venous levels of pethidine rose rapidly after drug administration but neonatal capillary levels increased slowly to reach peak levels at 2 to 5 h before declining over the next 15 to 18 h.

The maternal plasma pethidine half‐life, 5.59 h was considerably shorter than that observed in the newborn, 15.94 h.
Laparoscopy in Female Infertility
Authors: Nordenskjöld Fredrik , Ahlgren Mats
Published: December 2009

Abstract.Laparoscopy for the investigation of infertility was performed in 433 women. The rate of pathologic findings was 70%. No fewer than 55% of patients with no history of gynecologic disease and normal hysterosalpingo‐graphy (HSG) were found to have pathologic findings. When comparing the patency of the Fallopian tubes at HSG and laparoscopy the overall agreement was 71 %. Sixty‐eight of the patients with no other cause for infertility had the abdominal tubal ostia catheterized at laparoscopy. In 20 of these, small adhesions that could interfere with ovum pickup were found and divided. The pregnancy rate in this group was 70%, which is significantly higher than the pregnancy rate of 44% in 59 otherwise normal patients who did not have their tubes catheterized. The subsequent pregnancy rate for patients with different findings at laparoscopy is described. The role of HSG compared with laparoscopy is discussed. It is concluded that laparoscopy should be performed in all patients of female infertility, with the exception of those who have bilateral hydrosalpinges without patency on HSG. These patients are offered laparotomy for salpingo‐stomy without laparoscopy. The catheterization of the Fallopian tubes at laparoscopy is a new method to find an easily treatable cause of infertility.
Absence of Dynein Arms in Endometrial Cilia: Cause of Infertility?
Authors: Pedersen Henning
Published: December 2009

Abstract. Since the demonstration of a total lack of dynein arms in immobile human spermatozoa (2, 10) there has been considerable interest in the investigation of the ciliary substructure in nasal mucosa cilia in patients with chronic sinusitis and bronchial symptoms. Since 3 out of the 4 patients described above with immobile spermatozoa had situs inversus of the thoracic organs, it was thought that the basic defect in Kar‐tagener's syndrome might be a similar substructural ciliary defect. This hypothesis seemed to be confirmed by the demonstration of a lack of dynein arms in nasal mucosa cilia in such patients (9).
Unstressed Antepartum Cardiotocography in the Management of Pregnancies Complicated by Intrauterine Growth Retardation
Authors: Varma T. R.
Published: December 2009

Abstract. A study of antenatal cardiotocographs (CTG) in 250 patients with fetal growth retardation showed that non‐reactive tracings were associated with a significant increase in operative deliveries for fetal distress in labour, a high perinatal mortality rate, and fetal anomalies, and a low Apgar score of the infant, both at one and five minutes after delivery. A “ten‐point” scoring system was used to evaluate the CTG tracing. A score of 6 or less was associated with a significantly higher perinatal morbidity and mortality rate compared with those who had a score of 7 or more (p<0.01).
Lethal Fetal Renal Malignant Tumor
Authors: Heimer Gun , Victor Arne
Published: December 2009

Abstract. A peak in the occurrence of cancer early in life strongly suggests that the neoplasm has its origins during intra‐uterine development (4). Nevertheless, malignant tumors that cause death to the fetus prena‐tally seem to be very rare.

The present case describes a female fetus stillborn at 24 weeks of gestation with a fast‐growing malignant tumor in the right kidney. On reviewing the literature we have not been able to find a similar case.
Postpartum Perforation of the Colon due to Endometriosis
Authors: Floberg J. , Bäckdahl M. , Silferswärd C. , Thomassen P. A.
Published: December 2009

Abstract. A case is reported of a ruptured endometriotic lesion following childbirth. Immediately after her second delivery, the 34 year‐old parturient developed acute abdominal pain. At operation a ruptured left‐sided ovarian abscess with a fistula to the colon was found. Endometriosis was present in the ovarian wall and the adjacent colon. Endometriosis as a cause of acute abdominal pain during pregnancy should be kept in mind.
Who Declines from Antenatal Serum α‐Fetoprotein Screening and Why?
Authors: Berne‐Fromell Kerstin , Josefson Gunilla , Kjessler Berndt
Published: December 2009

Abstract. One hundred women who declined a voluntary α‐fetoprotein screening test during early pregnancy and one hundred women who accepted the test were investigated by means of semistructured interviews with particular reference to background factors which could have influenced upon the decision making. Those who declined were, as expected, overrepresented among those opposed to legal abortion and they often showed an ambivalent or negative attitude towards prenatal diagnosis as such. These women were also more frequently legally married and active members of various religious denominations. Otherwise there were no socioeconomic, psychologic or other background factors specially associated with women who declined. The paramount individual reason given for abstaining from the test was the feeling that the test was ‘unreliable’. The personal ethical attitude, together with the current reputation of the test in society, seem to be major factors affecting the rate of participation in an AFP‐screening program.
Breast Stimulation Test in Fetal Surveillance
Authors: Erkkola R. , Rintala H. , Grönroos M.
Published: December 2009

Abstract. The usefulness of breast stimulation to elicit uterine contractions as a contraction stress test in fetal surveillance in high‐risk pregnancies was investigated. The test was successful in fulfilling the criteria of contraction stress testing in 48 out of 76 mothers (62%). Success rates were not affected by the duration of pregnancy after 36 weeks. Nor did parity have any significant effect. The results of the breast stimulation test (BST) correlated well with the preceding non‐stress test. Only one positive BST was detected in this population. In this case the late decelerations were present even during labor the next day. BST seems to be a practicable tool, in preference to the oxytocin challenge test, for fetal surveillance.
Pregnancy in a Young Woman with Hypergonadotropic “Ovarian Failure”
Authors: Voigt SØRen
Published: December 2009

Abstract. A case of pregnancy in a 20‐year‐old woman with hypergonadotropism and streak gonads is presented, illustrating the difficulties of diagnosing premature ovarian failure.
Fetal Heart Rate Response to a Controlled Sound Stimulus After Propranolol Administration to the Mother
Authors: Jensen Odd Harald
Published: December 2009

Abstract. The fetal heart rate response to a controlled sound stimulus was recorded in 36 pregnant women before and after a maternal peroral dose of either 80 mg propranolol, or placebo. The sound stimulation was repeated 60 minutes, 120 minutes and 180 minutes after the drug administration. The fetal heart rate response to sound was significantly depressed by this moderate dose of propranolol. The sound stimulation method is found to reflect sensitively the immediate influence of propranolol on the fetus.
Maternal Hemoglobin Concentration is Closely Related to Birth Weight in Normal Pregnancies
Authors: Sagen Norvald , Nilsen Stein Tore , Kim Hyun Chan , Bergsjø Per , Roller Oddmund
Published: December 2009

Abstract. Maternal Hb levels during the third trimester were studied in relation to certain maternal and fetal parameters in 877 apparently normal pregnancies. Low Hb levels at term were closely associated with increased frequency of newborns in the heavy weight‐for‐date group. Conversely, high maternal Hb levels were closely associated with an increased frequency of newborns in the light weight‐for‐date group. The maternal Hb levels both in the early third trimester and at term were significantly higher in mothers of small‐for‐date newborns than in those with newborns of normal weight. In both groups the maternal Hb levels increased significantly during the third trimester of pregnancy. High maternal Hb levels both early and late in the third trimester of pregnancy should be a matter of concern rather than of reassurance.
Uterine Rupture as a Complication of Second‐Trimester Abortion when Using Prostaglandin F2α Together with other Oxytocic Agents
Authors: Malmström H. , Hemmingsson E.
Published: December 2009

Abstract. A case of uterine rupture is presented following induction of second‐trimester abortion using oxytocin and prostaglandin F2α. A brief review of the literature is given and etiological factors and diagnostic features are discussed.
Genetic Counselling for Trisomy 20 Mosaicism in Amniotic Fluid Cell Cultures
Authors: Nisani Rachel , Chemke Juan , Rappaport Sara , Felsenburg Tamar
Published: December 2009

Abstract. Trisomy 20 mosaicism in amniotic fluid cell cultures has an obscure origin and significance. In only a few cases has the mosaicism been confirmed in fetal tissues, but never in neonatal tissues. There is some indication that the trisomic cells might originate from epithelial cells deriving from the urinary tract. A review of 20 demonstrated cases reveals that no consistent malformation pattern is associated with this finding. Since it is questionable whether the presence of this mosaicism in amniocentesis can be regarded as a manifestation of abnormal fetal development, we suggest that it does not justify interruption of pregnancy. Postnatal cytogenetic studies and follow‐up are indicated in these infants.
Pregnancy‐Specific β1Glycoprotein, SP1 in Maternal Serum During Uncomplicated Single Pregnancies
Authors: Tamsen L. , Inganäs M. , Johansson S. G. O. , Kjessler B. , von Schoultz B.
Published: December 2009

Abstract. Pregnancy‐specific β1‐glycoprotein (SP1) levels in uncomplicated single pregnancies were measured by radio‐immunoassay from the time of ovulation until the 8th week of pregnancy in 129 blood samples from 78 women. SP1 was detectable in all samples examined from 34 days after the last menstrual period (LMP), and thereafter the SP1 level increased rapidly with time and 38 to 40 days after LMP the geometric mean SP1 concentration was 90 μg/l. From pregnancy weeks 8 to 41, SP1 levels were measured by nephelo‐metry in 1 255 blood samples from 1 255 women. A 95% reference range was established using logarithmic transformation. There was a steady increase in the SP1 concentration until the last month of pregnancy, in which a tendency to level off was seen, the geometric mean levels ranging from 149 to 170 mg/1. The day‐to‐day variation was studied during 5 consecutive days in 10 women. No significant variation was found. The diurnal variation was studied in blood samples taken every 4th hour during a 24‐hour period form 10 women. A significant decrease was found at midnight and at 4 a.m. The elimination rate of SP1 from serum was studied in 10 women following labor. Elimination was non‐linear and the time taken for SP1 to decrease to 50% ranged from 24 to 50 hours.

No correlation was found between the concentration of SP1 and parity, maternal age, or the sex of the infant. The SP1 concentration was significantly lower in heavier women (> 70 kg) than in lighter women (≤ 70 kg). In some weeks of late pregnancy the SP1 level showed a correlation to placen‐tal weight and birth weight of the infant.
Prenatal Diagnosis of Two Cases of Gastroschisis Following α‐Fetoprotein (AFP) Screening
Authors: Holmgren Gösta , Sigurd Jörgen
Published: December 2009

Abstract.Two cases of gastroschisis were diagnosed antena‐tally following maternal serum AFP screening in mid‐trimester of the pregnancy, using ultrasonography, amnio‐graphy and amniocentesis. The AFP screening program detected 4 congenital malformations but missed 4 malformations due to false negative AFP serum values.
Circulating Immune Complexes and Hypertension in Pregnancy
Authors: Wohlert M. , Selling J. , Pedersen E. B. , Johannesen P. , Kristensen S. , Lauritsen J. G. , Rasmussen A. B.
Published: December 2009

Abstract. Eighteen patients with preeclampsia, 10 patients with essential and 9 with transient hypertension during pregnancy, were investigated regarding circulating immune complexes by a Clqbinding assay and a PEG precipitation assay. The women were studied during pregnancy, 2 and 5 days after childbirth, and also 3 and 6 months afterwards. The frequency of circulating immune complexes was not significantly increased in any of the groups when compared with that in 18 normotensive pregnant control subjects and 19 nonpregnant controls. Thus Clqbinding and PEG‐precipitable immune complexes are a feature neither of normal pregnancy, nor of pregnancy complicated by hypertension or preeclampsia.
Dilatation of the Cervix by Oral PGE2 Before First‐Trimester Termination of Pregnancy
Authors: Somell C. , älund A. , Kindahl H. , Larsson B.
Published: December 2009

Abstract. Twentyfour patients—all primigravidae with an especially narrow, rigid cervix were given PGE2 tablets or placebo tablets in order to prime the cervix before first trimester termination of pregnancy. 1.5 mg PGE2 or placebo tablets were administered hourly for 12 hours on the day before vacuum aspiration. The diameter of the cervix was measured by means of a Hegar dilator prior to administering the tablets and also before the vacuum aspiration the following day. The plasma level of 15‐keto‐13,14‐dihydro‐PGF2α was determined before the treatment and again before the vacuum aspiration. All the 12 patients treated with PGE2 tablets had an average change in cervix diameter of 2 mm, whereas in the placebo group the average change was 0.58 mm.
11C‐Methionine Kinetics in Pregnant Rhesus Monkeys Studied by Positron Emission Tomography: A New Approach to Feto‐Maternal Metabolism
Authors: Berglund Lars , Halldin Christer , Lilja Anders , Lindberg Bo S. , Låndqvist Hans , Långström Bengt , Malmborg Petter , Nägren Kjell , Stälnacke Carl‐GÖRan
Published: December 2009

Abstract. By use of Positron Emission Tomography (PET), dynamic studies of the metabolism within the fetomaternal unit can be performed using various tracers. Many compounds like amino acids, carbohydrates, fatty acids and drugs can be labelled with 11C and used as tracers.

11C‐labelled L‐ or D‐methinonine was injected intravenously into pregnant Rhesus monkeys. The distribution of the radioactivity in maternal muscles, aorta, placenta and the liver of the fetus was quantitively estimated as a function of time. Simultaneously blood, urine and amniotic fluid samples were analysed for 11C‐activity. The distribution of 11C between the high and the low molecular fraction of plasma (MW>5000) was studied after gel filtration.

Both when 11C‐L‐ and D‐methionine were given, the radioactivity rapidly crossed the placenta and was accumulated in the fetal liver. In the 11C‐L‐methionine experiments, about 70 per cent of the radioactivity in plasma was found in the high molecular fraction one hour after injection. A greater part of 11C‐D‐compared to 11C‐L‐activity was excreted in the urine.
Abnormally Elevated Pregnancy Specific β1 Glycoprotein (SP1β) with Very low Placental Lactogen (hPL) Concentrations in a Pregnancy with Satisfactory Outcome
Authors: Pledger D. R. , McEwan Helen P.
Published: December 2009

Abstract. Pregnancies with very low maternal serum concentrations of placental function monitors, yet resulting in a normal outcome, have been reported occasionally before (4, 6). We report here a case in which maternal serum placental lactogen (hPL) concentratïons were very low, urinary estrogen output assessed by estrogen/creatinine ratio was satisfactory, but maternal serum pregnancy specific β1 glycoprotein (SP1β) concentrations were grossly elevated. Ultrasound findings suggested impairment of growth. The outcome of the pregnancy was satisfactory, although the baby, apparently of 38‐40 weeks' gestation, developed mild respiratory distress.
Normoprolactinemic Galactorrhea in a Fertile Woman with a Copper Intra‐Uterine Device (Copper IUD)
Authors: Giampietro Ottavio , Ramacciotti Carla , Moggi Giorgio
Published: December 2009

Abstract. We report a case of galactorrhea in a normopro‐lactinemic fertile woman (30 years old) wearing a copper intrauterine device (Gravigard). The Gravigard was first inserted in July 1977. In February 1979 our patient noted spontaneous galactorrhea, mainly on the left, but it was also present on the right, after breast pressure. X‐ray film of the sella turcica, visual‐field examination, thyroid function and basal prolactin levels were all within normal limits. In May 1979 the Gravigard was withdrawn and milk loss stopped finally in December 1979. In March 1980 the IUD was replaced; after only 3 days, mild spontaneous lactation again ensued, on the right side. The patient never took drugs which might have occasioned a prolactin rise. Possible explanations for this unusual phenomenon are discussed.
Cytomegalovirus (CMV) and Rubella Virus Infection During Pregnancy
Authors: Haukenes G. , Finne P. H. , Bertnes E. , Ørstavik I. , Tjøtta E. , Haneberg B. , Aarseth P.
Published: December 2009

Abstract. Two blood samples, one in the first and one in the third trimester, were collected from 2014 pregnant women. Serological tests for CMV and rubella antibodies were performed in the paired samples. Seroconversion by the CF test for CMV antibodies was demonstrated in 15 women. However, seroconversion also by the IF test was found in only one of these. A rise in titer during pregnancy by the CF test was found in 16 woman. None of these specimens contained specific IgM. High CMV‐CF antibody titer (>128) in the first serum sample was found in 28 women, but none of the sera contained specific IgM. It is concluded that no single serological test can serve at present as a screening test for the diagnosis of CMV infection during pregnancy. In children thought to be at risk contracting congenital CMV infection, no case with CNS malfunction that could be attributed to a congenital CMV infection could be demonstrated at the age of 7‐8 years. One case of seroconversion in the examination for rubella antibodies was found. The infant of this mother showed no clinical signs of rubella infection.
The Effect of Infused Prostaglandin F2α on Plasma Antidiuretic Hormone and Renin Activity in Early Human Pregnancy
Authors: Punnonen R. , Kilkku P. , Viinamäki O. , Lammintausta R.
Published: December 2009

Abstract. The effect of infused prostaglandin F2α plasma antidiuretic hormone and renin activity in early pregnancy was investigated in eight women. After infusion for one and three hours (infusion speed 50 μg/min) the PRA had decreased significantly. During the same time the blood pressure also showed a decreasing tendency. No changes were found in plasma vasopressin concentration.
Vasopressin and Prostaglandins in Premenstrual Pain and Primary Dysmenorrhea
Authors: Strömberg P. , Åkerlund M. , Forsling M. L. , Granström E. , Kindahl H.
Published: December 2009

Abstract. Both vasopressin and PGF2alpha are effective uterine stimulants in the non‐pregnant human uterus, especially around the onset of menstruation. In order to clarify the relationship of these hormones to menstrual pain, plasma concentrations of vasopressin and two prostaglandin metabolites (lS‐keto‐B.H‐dihydro‐PGF2alpha and 11‐ketotetranor PGF metabolites) were measured in serial blood samples taken premenstrually and during menstruation. Five women with premenstrual pain gave 7‐9 blood samples at intervals of 30 minutes on the day preceding the onset of menstruation. From 5 women with severe primary dysmenorrhea a corresponding series of blood samples were taken during the first day of menstruation. Two groups of 5 women with no symptoms served as controls, either premenstrually or during menstruation. In the women with premenstrual pain the vasopressin concentrations were significantly higher than in the corresponding control group. Even higher and markedly fluctuating vasopressin levels were found in the women with dysmenorrhea who, in general, had more intense pain than the women with premenstrual symptoms. In the group with dysmenorrhea there was also a significant rise in plasma concentration of the PG metabolites. No such increase was seen in the group with premenstrual pain. It is concluded that the pathophysiology of premenstrual pain could imply increased vasopressin secretion. The more severe pain in primary dysmenorrhea seems to be the result of a combined effect of vasopressin and PGF2alpha
β‐Adrenoceptor Function of Leukocytes in Pregnant Women Treated with Terbutaline for Preterm Labor
Authors: Berg Göran , Andersson Rolf G.G. , Rydén Gunnar
Published: December 2009

Abstract.The correlation between cyclic AMP (cAMP) production in myometrial tissue and that in leukocytes was studied in 21 women delivered by cesarean section for obstetrical reasons. After in vitro β‐adrenoceptor stimulation, cAMP production in myometrial tissue was found to be closely correlated with that in leukocytes (r = 0.96). Using cAMP production in leukocytes as an indicator of the state of the β receptor function in myometrium, 18 women treated with terbutaline for preterm labor were studied. Repeat analyses of cAMP production were made in leukocytes before, during and after treatment. The results showed a significant reduction in cAMP production 3‐5 hours and 1‐2 days after terbutaline infusion. The cAMP values remained low during infusion. In women orally treated with terbutaline, a slight reduction in cAMP production was found after the first dose, but there was no significant reduction after 1‐14 days of treatment. After cessation of terbutaline treatment, cAMP production remained low during the following 3 days, but after 5‐8 days an increase was found in 7 out of 9 patients. It is suggested that a desensiti‐zation of the β‐adrenoceptor system in leukocytes appears after β‐adrenoceptor agonist treatment in high doses and that measurement of cAMP production reflects the state of desensitization of the β‐adrenoceptors in myometrial cells too.
The Outcome of a Uniform Program for Alpha‐Fetoprotein Screening in Early Pregnancy in Seven Regions in Sweden
Authors: Schnittger Agneta , Kjessler Berndt
Published: December 2009

Abstract. In 1979—1980 a multicenter study on serum alpha‐fetoprotein (S‐AFP) screening for detection of fetal neural‐tube and abdominal wall defects (NTD/AWD) was carried out in seven different regions in Sweden. A total of 22991 pregnant women, attending 84 public antenatal clinics, were offered an AFP test between their 15th and 18th completed gestational weeks. The average participation rate was 80.8%. The AFP assays were performed by five hospital laboratories, using the same commercially available assay method. In 19704 women screened, all with known pregnancy outcome, 17/22 fetuses affected by open NTD and 6/8 fetuses having AWD, gave S‐AFP levels exceeding 2 MOM. One placental haemangioma was recognized. Controlsampling was undertaken in 10.5% of the women. Amniocentesis was performed in 1.1% of all women screened with no false negative test results. However, three apparently normal fetuses were aborted at the parents request due to AFP levels in amniotic fluid exceeding 3 MoM.

Thus, AFP screening in women at low risk enables detection of 3/4 of fetuses affected by NTD/AWD. A program with higher efficiency would be obtained by more accurate gestational dating by ultrasonography, by complementary diagnostic methods such as neurospecific acetylcholinesterase in amniotic fluid, by a reduction of the work‐load by shifting the action limit to 3 MOM and by continous appropriate training of the medical staff.
Regional Variations in Test Results Obtained Within a Uniform Program for Alpha‐Fetoprotein Screening in Early Pregnancy
Authors: Schnittger Agneta
Published: December 2009

Abstract. Alpha‐fetoprotein screening in large scale use implies certain practical consequences in obstetric practice as e.g. performance of a number of control assays in maternal serum (MS‐AFP), amniocentesis and ultrasonic examinations. Considerable regional differences were observed in the incidences of control assays (5.0‐10.5 per cent) and amniocenteses (0.2‐1.9) per cent when a “uniform” AFP‐screening program was run in seven scattered hospital regions in Sweden. The AFP assays were routinely performed by five hospital laboratories using the same commercially available assay method (Phadebas AFP PRIST). A total of 18030 singleton pregnant women were analyzed in their 15th to 17th gestational week.

No significant differences were found between the regional distributions of MS‐AFP levels. By pooling the results, generally valid median (MS‐AFP) values, using this assay method, were determined for each relevant gestational week.

The individual AFP‐test results were expressed in multiples of the normal median value (MOM) for singleton pregnancies of the same gestational age. There were no significant differences observed between the regional distributions of test results expressed in MOM‐values either.

Thus, the variations in regional incidences of diagnostic follow‐up procedures found in the present study seemed to depend on the local obstetricians personal attitude and experience. The efficiency of the general screening program may well be significantly improved by employment of a more strictly standardized protocol for diagnostic follow‐up procedures.
Treatment of vaginal endometriosis with danazol
Authors: Koskimies Aarne I. , Meyer Bengt , Widholm Olof
Published: December 2009

Abstract. Six infertile patients with vaginal endometriosis were treated with danazol at 600 mg daily for 6 months. Three patients had previously undergone surgery for pelvic endometriosis. After 4 months of danazol treatment there was a clear reduction in the size and number of the lesions in all the patients. At the end of the treatment 4 patients still had small lesions, which showed histological evidence of regressive changes. Four women became pregnant within 6 months of the termination of therapy.
Pregnancy rates following various therapy modes for endometriosis in infertile patients
Authors: Rönnberg Lars , Järvinen Pentti A.
Published: December 2009

Abstract. A total of 215 infertile patients with endometrio‐sis verified at least laparoscopically were treated between 1977 and 1982 by conservative surgery alone (N = 90), or with danazol, 600 mg daily and most often for 6 months, either alone (N = 59) or postoperatively (N = 44), or by lapa‐roscopic electrocautery of endometriotic foci (N = 18). The mean age and duration of infertility were about the same in all groups. The disease was mild in the electrocoagulated group, moderate in the groups treated either exclusively surgically or with danazol, and most severe among the patients who received danazol following surgery. The uncorrected pregnancy rate after conservative surgery was 43% and the mean interval until conception was 11.7 months. After 6 months' danazol treatment the uncorrected pregnancy rate was 56% and the mean interval until conception was significantly (p<0.02) shorter, 6.7 months. Conservative surgery followed by danazol treatment for 6 months resulted in fewer pregnancies (pregnancy rate 32%) but the mean interval until conception was about the same (6.9 months) as after danazol therapy alone. After laparoscopic electrocautery the pregnancy rate was only 17%. In view of these results, we recommend that for infertile patients with mild or moderate endometriosis the recommended treatment should be medical, e.g., danazol 600 mg daily for 6 months.