bluuebunny/crossref_metadata_2025 huggingface dataset:
The site of placental attachment as a factor in the aetiology of breech presentation
Authors: Fianu Stefan , Václavinková Vlasta
Published: December 2009

Abstract. The frequency of cornu‐fundal implantation of the placenta in association with breech presentation was investigated in the following study. In a series of 124 women with breech presentation, and 125 women with cephalic presentation at or near term, the implantation site of the placenta was demonstrated by ultrasonography. It was found that with breech presentation the placenta was implanted in the cornual region in 72.6% of the cases, as compared with 4.8% in cephalic presentation. The placental implantation site may therefore have a determining effect upon the presentation of the foetus.
THE THERMOGENIC ACTIVITY OF EXOGENOUS E AND F PROSTAGLANDINS IN HUMANS
Authors: Dingfelder James R. , Brenner William E.
Published: December 2009

A basic understanding of the physiologic effects of the prostaglandins on the human reproductive system has been one of the diverse scientific interests of Professor Axel Ingelman‐Sundberg (19). Although the obvious clinical utility of these ubiqitous compounds directed early attention to their therapeutic aspects, more recently there has been renewed interest in the basic physiologic mechanisms of the prostaglandins in reproductive medicine. Undoubtedly, the work of Dr Ingelman‐Sundberg has stimulated many of his colleagues, students, and fellow scientists to pursue such basic studies in greater details.
The value of serum cystine aminopeptidase (cap), human chorionic somato‐mammotrophin (hcs), and urinary oestrogen assays for detecting intrauterine growth retardation
Authors: Rydén Gunnar
Published: December 2009

Abstract. The aim of the present study was to compare the usefulness of cystine aminopeptidase (CAP) and human chorionic somato‐mammotrophin (HCS) estimations in maternal serum and maternal urinary oestrogen excretion in predicting intra‐uterine growth retardation. The material consists of 43 patients who subsequently gave birth to infants with a birth weight less than 2 S.D. from the mean according to the gestational age. The patients were controlled with simultaneous analyses of CAP, HCS and urinary oestrogen assays every week from the 36th week of pregnancy. The patients have been compared with another group in which infants with normal birth weight and without signs of fetal distress were delivered. Intrauterine growth retardation (IGR) was predicted by low oestrogen levels in 58%, low HCS levels in 42% and low CAP levels in 35%. The difference between the biochemical tests was not statistically significant. IGR infants who developed fetal distress were predicted by oestrogen assays in 72%, by HCS assays in 62% and by CAP assays in 48%. If urinary oestrogen assays were combined with HCS assays this combination predicted IGR significantly better than oestrogen assays alone. The combination HCS‐CAP was as informative in this respect as urinary oestrogen assays alone. The results indicate that all methods tested are rather insensitive in predicting the total number of IGR infants. The capacity for predicting IGR infants with fetal distress is, however, rather high. For this purpose a combination of tests is preferable as no test fulfils the qualifications of being superior to the other. The combination oestrogens–HCS seems to be most suitable in this respect.
Antepartum administration of terbutaline and the incidence of hyaline membrane disease in preterm infants
Authors: Bergman B. , Hedner T.
Published: December 2009

Abstract. The incidence of hyaline membrane disease in 41 preterm infants born between January 1975 and January 1976 was investigated in a retrospective study. Terbutaline, a beta2‐receptor stimulating drug, had been administered to the women in order to arrest premature labour. In spite of the treatment 24 preterm infants were delivered. The incidence of HMD in this group was 1/24. In a group of 17 neonates whose mothers had received no such treatment the incidence of HMD was 5/17. Comparison between the two groups revealed a significantly lower incidence of HMD in the terbutaline treated group than in the controls (p<0.05). There were no significant differences in maternal age, gestational age, birth weight or Apgar score between the two groups. The lower incidence of HMD in the terbutaline treated group is suggested to reflect a rapidly induced release of pulmonary surfactants in the preterm infants. Evidence for a similar sequence of events has earlier been shown to occur in animals under standardized experimental conditions.
Therapeutic abortion: the 1975 report from ullevål hospital
Authors: Jerve Fritjof , Fylling Petter
Published: December 2009

Abstract. The results from a prospective study of 1228 therapeutic abortions (the 1975 material) are reported. First trimester pregnancies (1028 cases) were terminated by suction and curettage and second trimester pregnancies by prostaglandins (200 cases). The overall follow‐up (4–6 weeks after termination) was 94.3%. The incidence of perforation was 0.5% of the surgical terminations, none of which, however, resulted in any other complications. The mean incidence of re‐admission was 3.9%, the main causes being retained products or pelvic infection. The mean incidence of pelvic infection (salpingitis/parametritis) was 1.6%. The highest incidence of pelvic infection was found in early pregnancies (8 weeks) or nulliparous women (2.7%) and the lowest (1.5%) in the induction group.
On receptors for estrogens (e2) and androgens (dht) in human endometrial carcinoma and ovarian tumours
Authors: Friberg L. G. , Kullander S. , Persijn J. P. , Korsten C. B.
Published: December 2009

Abstract. Some human endometrial carcinomas contain receptors for estrogen (E2) and dihydrotestosteron (DHT). Analysis of 50 primary endometrial carcinomas by agar gel electrophoresis revealed a varying receptor pattern, absence of both receptors, sole presence of E2‐ or DHT‐receptor, or presence of both. Highly differentiated tumours often had receptors of both types (7/18) and poorly differentiated tumours most often lacked them (1/10). Primary tumours with metastases (Stages III‐IV) seldom had combined receptors, only in 2 cases out of 9. Growth of the tumour down in the cervical canal (Stage II) implied absence of combined receptors in all of the 13 cases studied. In 8 different ovarian tumours, presence of either E2‐ or DHT‐receptors was found in 6. The findings are discussed in relation to hormonal treatment of the disease.
Hypervitaminosis a in early human pregnancy and malformations of the central nervous system
Authors: Stånge Lars , Carlström Kjell , Eriksson Margareta
Published: December 2009

Abstract. A case of malformations of the fetal central nervous system following hypervitaminosis A in early pregnancy is reported. The mother was treated with 150000 IU vitamin A daily during gestation days 19 to 40. Determination of urinary oestriol carried out in the 42nd week of pregnancy revealed a very low excretion (4.2‐6.6 μmol/24 h). Induced delivery resulted in a microcephalic child who died after 18 min. The child had multiple malformations of the central nervous system and very small adrenal glands (1.5 g; normal 11±4g). The very low urinary oestriol excretion is well explained by the hypoplastic adrenals, which in turn can be related to insufficient ACTH stimulation, a condition similar to anencephaly. The malformations shown in the present case are considered to be related to the high doses of vitamin A given to the mother, and the authors wish to warn against uncritical use of high doses of vitamin A in women of childbearing age.
Intrauterine Death Due to Infection with Group B Streptococci
Authors: Bergqvist G. , Holmberg G. , And T. Rydner , Vaclavinkova V.
Published: December 2009

Abstract. During the 6‐year period 1970–1975 5 cases of late intrauterine death caused by group B streptococcal infection were seen in two obstetrical departments in the Stockholm area. During the same period 17638 infants were born in the two departments, and in 117 cases intrauterine death occurred. Hematogenous spread of the infection from the mother was the most likely cause in the 5 cases. This figure should be compared with a carrier rate of 15–20% in pregnant women in the Stockholm area.
Decreased Fetal Movements and Polyhydramnios
Authors: Sadovsky E. , Perlman M.
Published: December 2009

Abstract. It was previously demonstrated that in high‐risk pregnancies, pronounced reduction of fetal movements until cessation, with audible fetal heart sounds, indicates severe fetal distress and impending death. Immediate delivery is indicated provided the fetus is viable. Three instances of cessation of fetal movements associated with polyhydramnios are reported; the fetuses proved to have malformations lethal for the newborn infant. These cases of polyhydramnios with diminished fetal movements stress the importance of investigating fetal morphology in this condition. Antenatal diagnosis of congenital anomalies may influence decisions about intervening in cases of decreased fetal movements.
Rupture of the Spleen During Delivery
Authors: Christau Susanne , Klebe Joachim G.
Published: December 2009

Abstract. A case of traumatic rupture of a normal spleen in a complicated delivery is presented. The etiology of splenic rupture and therapeutic aspects of this unusual occurrence are discussed. It is pointed out that a violent expression of the fetus might be dangerous for the mother.
Treatment of Primary Dysmenorrhea with Prostaglandin Synthetase Inhibitors—a Promising Therapeutic Alternative
Authors: Lundström Viveca
Published: December 2009

Abstract. Three groups of patients with primary dysmenorrhea were treated with prostaglandin synthetase inhibitors. Thirty‐one women received indomethacin at a dose of 25 mg × 3‐4 per day usually starting one to two days before the onset of menstruation and 38 women received naproxen 250 mg × 3–4 per day usually starting on the first day of bleeding (open studies). Seventy‐one per cent of the patients experienced moderate or good relief of pain following indomethacin and 67% following naproxen. In a third series a double‐blind crossover study using the sodium salt of naproxen versus placebo in 26 patients showed that naproxen‐sodium was significantly more effective than the placebo (p<0.05). At the doses employed, the prostaglandin synthetase inhibitors were not associated with any side effects of major concern. The study indicates that this form of therapy offers an effective alternative in patients who for some reasons do not accept hormonal treatment.
Recording of Myometrial Activity in the Non‐Pregnant Human Uterus by a Micro‐Transducer Catheter
Authors: Åkerlund M. , Bengtsson L. Ph. , Ulmsten U.
Published: December 2009

Abstract. A micro‐transducer catheter was tested in vitro and in vivo for recording of myometrial activity in the non‐pregnant human uterus and was also compared with conventional fluid‐filled, open end catheters previously used for recording intra‐uterine pressures. The microtransducer catheter had a frequency response far above that of fluid‐filled, open end catheters. It was easily introduced through the uterine cervix and was never obstructed. Provided that the sensory surface of the microtransducer was kept from direct contact with the uterine wall by some special arrangement it gave recordings of the intra‐uterine pressure, that were practically identical with those obtained by an open end catheter.
Initiation of Voiding in Healthy Women and those with Stress Incontinence
Authors: Rud T. , Ulmsten U. , Andersson K. E.
Published: December 2009

Abstract. Sixteen healthy women, and 13 with stress incontinence were investigated by simultaneous urethrocystometry during the initiation of voiding. In the healthy women, there was a decrease in the maximum intra‐urethral pressure immediately before micturition. A few seconds later (mean 3.0 sec), the intravesical pressure increased. As a result, the urethral closure pressure decreased to zero, and urine started to escape from the urethra. In the patients with stress in continence, three different ways of initiating micturition were observed. Five patients initiated voiding by the Valsalva manoeuvre, 3 mainly by decreasing the maximum urthral pressure, and 5 mainly in the same way as the healthy women. The results suggest that preoperative analysis of the micturition pattern by means of simultaneous urethrocystometry can be of value for the choice of operative procedure, and thereby make it possible to avoid or reduce postoperative retention of urine.
The Ethanol Gelation Test in Pregnancy
Authors: Eika C. , Arnesen H. , Godal H. C.
Published: December 2009

Abstract. Coagulation studies in 55 healthy pregnant women indicated that in spite of high coagulation activity, a positive ethanol gelation test for fibrin in plasma is not a normal feature of pregnancy. The four case reports presented stress the value of the ethanol test in monitoring treatment of thromboembolic disease in pregnancy.
Myometrial Activity and Endometrial Blood Flow in an Ectopic Pregnancy
Authors: Åkerlund Mats
Published: December 2009

Abstract. Myometrial activity and endometrial blood flow were recorded in a patient with uterine haemorrhage and lower abdominal pain, who turned out to have a tubal pregnancy. The uterine contractions had an amplitude sometimes exceeding 400 mmHg and a duration up to 3.5 min. Thus, strong uterine contractions can appear during pregnancy without the presence of a gestational sac within the uterus. This is contrary to the assumption that processes in the foetal membranes initiate the sequence of events leading to abortion or labour.
Impact of Fetal and Maternal Factors on the Normal Growth of the Biparietal Diameter
Authors: Persson P.‐H. , Grennert L. , Gennser G. , Kullander S.
Published: December 2009

Abstract. 9,846 BPD measurements made from the 20th gestational week to term were used to study the influence on the BPD growth of various maternal factors known to affect fetal size at birth. Also the covariation of the growth of BPD and fetal size at birth was studied. Cross‐sectional growth curves were constructed for each studied condition, and regressions were calculated for their difference from the normal curve. Maternal age, weight, height, and weight gain during pregnancy, and also parity were not found to affect the BPD growth; thus no difference from the normal growth curve could be found. Diseases during pregnancy, such as toxaemia, early bleeding, and infections, had no apparent effect on the BPD growth. The group of preterm delivered infants had a slow intrauterine growth rate from the 26th week. Throughout pregnancy, male infants had mean BPD values 1.7 % larger than female infants. The intrauterine growth pattern reflected fetal size at birth. The large fetuses (heavy, fat, and tall) had a faster growth rate from the 20th week on, and the regression lines on the difference from the normal mean pointed to a starting point of the deviation close to zero weeks. The short infants mirrored the tall infants; but for the negative weight variants (thin and light), the deviation from the normal mean increased towards term. Placental weight in relation to infant weight was of no significance for the intrauterine BPD growth.

The results suggest that neither maternal size nor caloric supply have much influence on the BPD development. Fetal size at birth is parallel to the intrauterine growth rate. The growth pattern for the large infants seemed to be determined from the beginning, whereas the infants of small weight were influenced by additional factors towards term. The results also imply that measurements of the BPD for the assessment of fetal age have to be done early in pregnancy lest the range of the BPD values of fetuses of different size should invalidate age determination.
Serum and amniotic fluid heat labile alkaline phosphatase and aminotransferases in association with meconium stained liquor: On their origin, distribution and clinical use
Authors: Thaler I. , Zinder O. , Abramovici H. , Brandes J. M.
Published: December 2009

Abstract. A method for detecting meconium in the amniotic fluid is described. Samples of maternal serum, cord serum and amniotic fluid were tested for alkaline phosphatase and transaminases activity in 32 healthy, term gravidas during labor in whom meconium stained amniotic fluid was found. The values obtained were compared to those of a control group consisting of 32 normal term pregnancies in whom the amniotic fluid was clear.

Mean alkaline phosphatase activity was significantly higher in the study group in all three compartments ‐ maternal, fetal and amniotic fluid.

A significant and positive correlation between levels of alkaline phosphatase in the amniotic fluid and in maternal serum was found in the study group. Alkaline phosphatase value of 550 IU/L or more in maternal serum was diagnostic and levels between 350–500 IU/L were highly suggestive for the presence of menconium in the amniotic fluid.

Mean levels of transaminases (SGOT and SGPT) were similar in the two groups and all were within normal range. The origin of alkaline phosphatase and the mode of transfer of the three enzymes are also discussed.

It is suggested that this method can also be used during the third trimester of pregnancy.
Minimal brain dysfunction in children born in breech presentation
Authors: Fianu Stefan , Joelsson Ingemar
Published: December 2009

Abstract. The influence of delivery in breech presentation on the occurrence of minimal brain dysfunction (MBD) has been studied. Parents of 8‐15 year old children were asked to account for behavioral and educational deficits and needs of their children from birth until the date of investigation. It was found that among prematurely delivered children, the frequency of MBD, defined as hyperkinesia and learning disability, amounted to about 20 per cent and was similarly distributed between children delivered in breech and in vertex presentation. Among term delivered children, however, the average frequency of hyperkinesia and learning disability amounted to 8 per cent; in children born in breech presentation it was 14 per cent, while in those born in vertex presentation the corresponding figure was 2 per cent. MBD was more common in boys (16 per cent) than in girls (12 per cent).
Infertility and cervical chlamydia trachomatis infections
Authors: Paavonen J. A. , Saikku P. , Vesterinen E. , Lehtovirta P.
Published: December 2009

Abstract. Of the 51 women examined for infertility, 19.6 per cent were found Chl. trachomatis culture‐positive. This differs, although not significantly, from the 9 per cent isolation rate among our general gynecological outpatients. The results suggest that Chl. trachomatis should be considered in women with unexplained infertility.
PREGNANCY AND DELIVERY AFTER CONIZATION OF THE CERVIX
Authors: Grönroos M. , Liukko P. , Kilkku P. , Punnonen R.
Published: December 2009

Abstract. Of 327 patients who had undergone conization of the cervix in 1968‐74 in the Department of Obstetrics and Gynecology, Turku University Central Hospital, 249 replied to a questionnaire. Eighty‐nine of these had had total of 112 pregnancies after conization. Conization had only minimal influence on the pregnancies and none on the deliveries. Over 90 per cent of the newborns delivered were full term and without anomalies. The incidence of spontaneous abortions also did not differ from normal.
Amniotic Fluid Phospholipid Concentrations in Pregnancies with Pre‐Eclampsia and/or Intrauterine Growth‐Retardation of the Fetus
Authors: Skjæraasen Julie
Published: December 2009

Abstract. Amniotic fluid lecithin/sphingomyelin (L/S) ratios were examined in 74 samples from 65 patients with preeclampsia. The median values were comparable to those obtained in a reference series up to 36 weeks of gestation, whereas the median values after 37 weeks of gestation were found to be significantly smaller in the preeclamptic group (p<0.01).

According to the present results a L/S ratio 2 would in fact guarantee no development of respiratory distress syndrome (RDS) in the infants of preeclamptic mothers. On the contrary L/S ratios s 1.6 may be of limited predictive value in these women since only Vy of the children developed RDS. When preeclampsia was combined with intrauterine growth‐retardation of the fetus, RDS was found to be less apt to develop.

In 21 samples of amniotic fluid from 13 women with idiopathic intrauterine growth‐retardation of the fetus the L/S ratios were significantly below those in the reference series (p<0.05). No case of RDS was observed.
Fetal Breathing Movements and Maternal Exercise
Authors: Marsál Karel , Löfgren Olof , Gennser Gerhard
Published: December 2009

Abstract. Earlier statements that fetal breathing movements (FBM) are sensitive to changes in the fetal homeostasis prompted the study of the effect of maternal exercise on FBM and fetal heart rate. Forty women in the last trimester of gestation were subjected to a work load (80 W) for 5 min on a bed ergometer cycle; in 30 of them FBM were recorded by A‐mode ultrasound, and in 10, the fetal heart rate was monitored by continuous ultrasound. Maternal blood pressure, pulse rate, blood pH and pCO2, and transcutaneous pO2 were also followed. The FBM showed a transient marked increase in incidence immediately after the end of the exercise. No changes in basal level or in baseline variability of the fetal heart rate were found in the recovery period after work. Some possible causes of the observed FBM alterations are discussed. The findings imply that, after this particular form of stress, FBM are a more sensitive indicator of the physiological state of the fetus than the fetal heart rate.
PLATELET FUNCTION, COAGULATION AND FIBRINOLYSIS DURING TERMINATION OF MISSED ABORTION AND MISSED LABOR BY PGF2α AND OXYTOCIN
Authors: Briel R. C. , Kunz S. , Kidess E.
Published: December 2009

Abstract. In cases of missed abortion and missed labor, labor was induced by PGF2α i.a., i.v. and by oxytocin infusion. Platelet function (methods of Born and Breddin), the coagulation system and fibrinolysis have been studied within the three groups.

Using PGF2α i.v., the initially increased platelet aggregation showed a tendency to become normal. There was no manifestation of activation of the coagulation system. Fibrinolytic activity showed a slight increase during PGF2α i.v.

No essential changes in platelet function, coagulation and fibrinolytic system were found after i.a. injection of PGF2α.

When inducing labor by oxytocin i.v., both the coagulation and the fibrinolytic system were slightly activated and platelet aggregation increased.

The results and their clinical importance for hemostasis as well as therapeutic consequences are discussed.
ARTERIOGRAPHY AND CHEMOTHERAPY IN LOCALIZED TROPHOBLASTIC DISEASE, BY MEANS OF LOCAL‐ (PELVIC‐) INTRAARTERIAL INFUSION
Authors: Goldman Jack A. , Peleg Dan , Agmon Moshe , Shapiro Gerald
Published: December 2009

Abstract. In spite of considerable progress in systemic chemotherapy in malignant throphoblastic disease, there remains a small group of patients who fail to respond to this type of therapy. Here the trophoblastic process may be localized by means of an arteriography, and treated by a local, intraarterial infusion of cytotoxic compounds in high concentration. The latter makes possible the treatment of processes localized in essential organs which are hard to remove, as well as in young women wishing to preserve their reproductive capacity.

Our experience is limited to one case of a young woman with chorioadenoma destruens in the uterus, resistant to systemic chemotherapy, yet sucessfully treated with pelvic, intraarterial infusion of cytotoxics.
ENHANCEMENT OF THE AMYLASE‐CREATININE CLEARANCE RATIO IN PREGNANCY
Authors: Naeije R. , Neuray F. , Van Melsen A. , Delcourt A.
Published: December 2009

Abstract. The renal clearance of amylase, expressed as a proportion of simultaneous creatinine clearance (Cam/‐Ccr), was determined in 131 women in various stages of pregnancy. No abnormal serum levels of amylase were found. A moderate but significant increase in Cam/Ccr occurred during the last 15 weeks of pregnancy. Possible causes for this change were investigated in smaller groups of subjects. No increase in rapidly cleared isoamylase could be detected. No modification in renal tubular handling of protein could be evidenced, as assessed by measurements of the renal clearance of β2 microglobulin, expressed as a proportion of simultaneous creatinine clearance. An increased glomerular permeability to amylase probably accounts for elevated Cam/Ccr in pregnancy.
On Improved Outcome of Twin Pregnancies
Authors: Persson Håkan , Grennert Lars , Gennser Gerhard , Kullander Stig
Published: December 2009

Abstract. During the past four years, an attempt has been made in MalmO to reduce the frequency of preterm termination of twin pregnancies. For this purpose, the entire pregnant population of this medium‐sized city was subjected to general ultrasonic screening in the second trimester. This detected 88 per cent of the twin pregnancies. The screening had a methodological error of 2 per cent. Eightysix of the women with twin pregnancy were subjected to bedrest in hospital for more than two weeks in the second half of gestation. The incidences of twins born with birth weight below 1500 g and of twins light‐for‐gestational‐age were reduced compared with those a decade earlier. Also the group of twins born before the 37th week decreased, and the perinatal mortality rate fell to the same level as in singleton pregnancies. Early detection of twin pregnancies followed by rest for the pregnant women seems to contribute to an improved outcome of these gestations.
Perinatal death due to abruptio placentae in an african city
Authors: Naeye Richard L. , Tafari Nebiat , Marboe Charles C.
Published: December 2009

Abstract. Abruptio placentae was a common cause of perinatal death in Addis Ababa, Ethiopia in 1974–1975 with a frequency of 5.5/1000 births. The disorder had its peak frequency at term. No abnormalities were found in the placentas to explain the placental abruptions but there were other clues to their genesis. There was a strong association of the fatal abruptions with severe poverty in the mothers. These poor mothers were both undernourished and malnourished during pregnancy. Their fetuses and neonates who died had multiple evidences of undernutrition including a relative undergrowth of adrenals, spleens and livers and a relative acceleration of lung maturation. These findings support observations in more prosperous nations that poor nutrition of the gravida may have an important role in the genesis of abruptio placentae.
Some adverse effects of copper—iud
Authors: Cullberg Göran , Larsson Bertil
Published: December 2009

Abstract. Perforations and extraction problems in some 30 700 women wearing a copper intrauterine device (Cu‐IUD), either a Cu‐7 or Cu‐T have been studied. Perforations were very rare. Judging from the literature and the present investigation, in cases of perforation the Cu‐7‐IUD has a tendency to penetrate the uterine wall and the Cu‐T‐IUD the cervical wall. Retracted and detached strings were observed somewhat more often in women wearing Cu‐7‐IUD's. The number of such cases was, however, not large enough to warrant a statistical comparison. The cause of retention, investigative procedures and recommendations in the removal of lodged Cu‐IUD's are discussed.
CONTINUOUS MINI‐INFUSION OF BUPIVACAINE INTO THE EPIDURAL SPACE DURING LABOR
Authors: Matouskova A. , Hanson B. , Elmén H.
Published: December 2009

Abstract. Obstetric analgesia was accomplished by segmental continuous blockade in 225 women. the technique involved automatic pump infusion of 0.25 per cent bupivacaine solution into the epidural space at a rate of 5 ml per hour after initial doses of 2 and 5 ml bupivacaine. If the analgesia was insufficient one or two single injections of 5 ml of bupivacaine were added. Statistical evaluation of the results could be carried out for 218 women, 158 of whom were nulliparae and 60 multiparae. Fully satisfactory analgesia was achieved in 96 per cent of the nulliparae and 88 per cent of the multiparae in the first stage of labor. in the second stage of labor 46 per cent of the mothers were given pudendal blockade to maintain satisfactory analgesia.

The positioning of the patient in the first stage of labor from supine to semirecumbent was of importance to spread the analgesic agent caudally, to the sacral nerve roots, and to control the pain due to stretching of the vagina and perineum. in the total material 17 per cent of the neonates were delivered by vacuum extraction. When the infusion into the epidural space was started in early labor, the incidence of vacuum extraction was 9 per cent, as compared with 38 per cent when it was started at 6 cm cervical dilatation or later (p:<0.01). 9.8 per cent of the neonates were delivered by cesarean section. Fetal head malposition occurred in 8.7 per cent. a drop in blood pressure was noted in 7 per cent of the women. the condition of the newborn was unaffected by the analgesia. the mini‐infusion system minimized the risk for infection. the danger in case of accidental intravascular injection was reduced, due to slowly administered bupivacaine. At the maternity department this technique has created a positive attitude towards epidural blockade, as mid‐wives and doctors have found it safe and easy.
PLASMA LEVELS OF ACTIVE INGREDIENTS AFTER SINGLE AND REPEATED ADMINISTRATION OF A NEW ORAL CONTRACEPTIVE CONTAINING 2 MG OF CYPROTERONE ACETATE AND 50 μg OF ETHINYL ESTRADIOL (DIANE®) TO FIVE YOUNG WOMEN
Authors: Düsterberg B. , Hümpel M. , Wendt H.
Published: December 2009

Abstract. Peripheral plasma from five young women was analyzed for cyproterone acetate and ethinyl estradiol during a period of 96 hours duration after single oral intake of a coated tablet of DIANE® (2 mg of cyproterone acetate+50 μg of ethinyl estradiol), and during a treatment cycle of 21 days during which the formulation was given daily. Radioimmunoassays were utilized for quantifications. a maximum concentration of 11.0 ± 3.4 ng of cyproterone acetate/ml plasma was found 1.6 ± 0.6 hours after a single administration of DIANE®. Postmaximal disposition took place in two phases with half‐lives of 1.9 ± 0.6 hours and 2.2 ± 0.2 days. the maximum level of 0.08 ± 0.03 ng of ethinyl estradiol/ml plasma was found 1.6 ± 0.6 hours after such single administration. Following commencement of a daily oral intake of DIANE® a steady state was reached by the 5th to 8th days, during which 24 hours after each dose cyproterone acetate concentrations were found to be 2.4 ± 0.7 times higher than at the corresponding time after a single administration. Accordingly, after the first third of the 21 day treatment cycle an almost constant plasma level was reached indicating an equilibrium of intake and elimination. Except for a change in the mean terminal half life after multiple dosing, there was evidently no change in the kinetics of cyproterone acetate. No pointers to an accumulation of ethinyl estradiol upon daily administration of DIANE® could be found.
THE ROLE OF HORMONES IN THE ETIOLOGY OF BREAST AND ENDOMETRIAL CANCER
Authors: Gambrell R. Don
Published: December 2009

Abstract. Despite many years of extensive investigation, there has been neither a clear‐cut pattern of hormonal production nor milieu found in women with breast cancer. Estrogen replacement therapy for menopause does not significantly increase the risk of breast cancer and one study indicated that estrogen users have a lower incidence of breast cancer than that observed in untreated women. Some studies have shown that the mortality rate from breast cancer is lower in estrogen‐treated postmenopausal women. Only one investigator has found any significantly increased risk of breast cancer in oral contraceptive users. in that report, increased duration of birth control pill use decreased the risk of breast carcinoma. Several studies were unable to find an increased risk of breast cancer from oral contraceptives while one investigation observed a lower incidence in birth control pill users than that expected. the mortality from carcinoma of the breast in oral contraceptive users was lower than in non‐users, most likely due to earlier detection. Although some retrospective studies have indicated that estrogen use increases the risk of endometrial cancer, a prospective investigation found only an insignificant increase. Progestogens afford some protection from cancer in estrogen‐treated postmenopausal women. the incidence of endometrial adenocarcinoma is lower than that observed in untreated postmenopausal women. Combination oral contraceptives are protective against developing adenocarcinoma of the endometrium but sequential birth control pills may afford less protection.
THE EFFECT OF INHIBITORS OF PROSTAGLANDIN SYNTHESIS IN PRIMARY DYSMENORRHEA STUDIED WITH HYSTEROMETRY
Authors: Joelsson Ingemar , Lalos Othon
Published: December 2009

Abstract. The technique called hysterometry has been used for the quantitative evaluation of effect of naproxen sodium and naproxen on myometrial tension in vivo during dysmenorrhea. It was observed that “uterine tonicity” ‐ the datum arrived at after hysterometric recording ‐ decreased significantly during naproxen medication in comparison with placebo treatment. Decrease in uterine tonicity was well correlated with relief of pain.
Epidemiological aspects of toxoplasma infections among women in norway
Authors: Stray‐Pedersen Babill , Lorentzen‐Styr Anne‐Marie
Published: December 2009

In order to elucidate some of the epidemiological factors involved in the acquisition of Toxoplasma infections in Norway, 196 women were requested to answer a series of questions in their post‐natal periods. Of these women, 27 had recently been infected with T. gondii, 84 had old infections, and 85 were non‐infected.

The answers given indicated that frequent intake of raw meat and frequent travelling abroad, especially to countries with high infection risks, were of great significance for the contamination among adults. Living in rural districts appeared to represent a predisposing factor for the acquisition at younger ages. Contacts with animals, especially cats, were not shown to increase the infection risk.

With special reference to the results obtained, a list of instructions to sero‐negative pregnant women is proposed in order to prevent congenital toxoplasmosis in the Scandinavian countries.
Combined estrogen and progestogen for the menopause
Authors: Mugglestone C. J. , Swinhoe J. R. , Craft I. L.
Published: December 2009

A single‐blind pilot study using combined estrogen and progestogen therapy was undertaken in 25 patients for a period of six months in an attempt to evaluate symptomatic control, the acceptability or otherwise of bleeding patterns, and the effect on endometrial pathology.

Two different progestogens were employed, i.e. norgestrel and norethisterone acetate, and each was given in combination with estradiol valerate in a cyclical and a continuous regime.

Symptomatic control was good in all groups, but there was a mild recrudescence of some symptoms during the tablet‐free interval in the cyclical groups. Regular withdrawal bleeding was reported in almost all cases receiving cyclical therapy, and unscheduled bleeding was noted in those on continuous regimes.

Endometrial hyperplasia did not occur following treatment in any of the groups, and there was a return to the normal histology in two patients in whom hyperplasia existed prior to treatment. These results support the view that endometrial hyperplasia is least likely to occur if progestogens are adminstered in combination with estrogens.

There were no obvious differences between the effects of the two progestogens.
Perinatal asphyxia in spite of a normal cardiotocogram and a normal acid base state at the time of delivery
Authors: Weber T.
Published: December 2009

The labor preceding delivery of a depressed neonate with normal acid base status is described. Cardiotocographic (CTG) monitoring was used during the 5.5 hours of active labor. Continuous tissue pH determination was performed during the last 100 minutes of labor. Although the CTG pattern was normal all the time, tissue pH declined to 7.02 one hour before delivery, but reached normal values thereafter. The depression of the neonate could only be explained by the episode of acidosis one hour before delivery.
Skin Blood Flow in Normal Pregnancy Measured by Venous Occlusion Plethysmography of the Hand
Authors: Myhrman Per , Jansson Inge , Lundgren Yen
Published: December 2009

Total hand blood flow was measured by venous occlusion plethysmography in 14 healthy primigravid women. Consecutive measurements were made from the 15th week of pregnancy until term and after delivery. During pregnancy the mean hand blood flow, measured under standard resting conditions with the subjects supine, increased progressively from 7.7 in early pregnancy to 28.9 ml/100 ml/min at term. Simultaneously the peripheral vascular resistance decreased from 19.3 to 3.3 PRU100. When examined at 6–16 weeks after delivery hand blood flow and peripheral resistance were not yet returned to normal.
Fetal Systolic Time Intervals After Paracervical Block During Labor
Authors: Jenssen Helge
Published: December 2009

Fetal systolic time intervals (FSTI) were recorded every 10th second (s) during uterine contractions in 25 parturients in the first stage of labor before and after paracervical block (PCB). Twentytwo patients had good or excellent relief of pain. The newborn infants were not depressed.

After PCB the duration of the R – R and S1 – S2 intervals increased. A close correlation was found between the R – R and S1 – S2 intervals, both before and after PCB, and during early decelerations recorded before and after PCB. The S1 – S2 interval was prolonged after PCB, even after correction for the heart rate.

The R – S1 interval and the amplitude of the first part of the first heart sound (S1a) also increased after PCB.

The FSTI showed a conspicuous cyclic variation during uterine contraction. The S1a amplitude decreased after the peak of contraction, the others increased simultaneously.

The results contradict the assertion that PCB causes fetal hypoxia or reduction of the maternal placental circulation.

A centralization of the fetal circulation, possibly combined with a direct effect of local anesthetic on the fetal heart, would explain the changes found after PCB.

The cyclic variation of the parameters during uterine contraction is probably caused by a transfer of blood between the placenta and fetus. The changes of myometrial dynamics after PCB, as shown by the alteration of the phases of the amniotic pressure curve, are compatible with this transfer of blood.
A comparison of the Three Methods for External Fetal Cardiography
Authors: Solum Thore
Published: December 2009

Phonocardiography, abdominal electrocardiography and ultrasound cardiography are the three methods for external fetal cardiography. In the present study the methods have been compared regarding the quality of the graphs. The patients (163) were between the 34th and the 40th week of gestation. Graphs with less than 15 per cent failure or artifacts were found in 23.4 per cent for phonocardiography, 55.2 per cent for abdominal electrocardiography and 85.9 per cent for ultrasound cardiography. It could be shown that the number of successful abdominal electrocardiograms was higher with advancing gestational age. The quality of the phonocardiograms was influenced adversely by an anterior placenta. No obvious influence of a thick abdominal wall on external cardiography could be demonstrated.
Abruptio Placentae—Treatment with the Fibrinolytic Inhibitor Tranexamic Acid
Authors: Svanberg Lars , Åstedt Birger , Nilsson Inga Marie
Published: December 2009

Abruptio placentae is known to have a bad prognosis for the fetus. Pathologic proteolysis, e.g. a pathologic activation of the coagulation mechanism and/or the fibrinolytic system is known to be a common complication in such cases. Analysis of the coagulation factors and components of the fibrinolytic system in the acute stage of 14 cases confirmed the earlier finding of mainly an activation of the fibrinolytic system, which argues for the use of a specific fibrinolytic inhibitor. 73 consecutive cases of abruptio placentae were treated with tranexamic acid in the acute stage, 67 of the patients were immediately delivered by cesarean section. The remaining six patients were in early gestational age and were treated for a prolonged period. The perinatal mortality of the entire group was only 8 per cent and the maternal mortality nil. None of the cases were complicated by hemorrhagic diathesis or thromboses. We believe that routine immediate treatment with tranexamic acid can reduce the perinatal mortality in cases of abruptio placentae.
Continuous Fetal Scalp Tissue pH Monitoring During Labor: An Analysis of 152 Consecutive Cases
Authors: Weber Tom
Published: December 2009

Continuous Scalp Tissue pH Monitoring was Performed in 152 Consecutive Cases. The success rate was 53 per cent. The average duration of pH monitoring was 151 minutes (range 0‐609 minutes). A good correlation was found between tissue pH at delivery and blood pH in the umbilical artery (r = 0.78) and vein (r = 0.67). In no case with normal tissue pH (more than 7.20) and abnormal CTG was the Apgar score less than 8 one minute after delivery. A normal tissue pH almost always means that the fetus is not asphyxiated, but a low tissue pH reading may be caused by other factors than acidosis of the fetus. Continuous pH monitoring during labor remains a research method.
Steroid 16α‐Hydroxylase from Human Fetal Liver; Inhibition by Steroids
Authors: Sano Yumiko , Shibusawa Haru , Yoshida Nobutaka , Sekiba Kaoru , Okinaga Shoichi , Arai Kiyoshi
Published: December 2009

The 16α‐hydroxylase system in fetal liver which used dehydroepiandrosterone (DHA) or pregnenolone as substrate, was apparently inhibited by various endogenous and synthetic steroids: DHA, pregnenolone, their sulfates, androstenediol, androstenetriol, estrone, estradiol‐17β, ethynylestradiol and chlormadinone‐acetate. The inhibition constants (Ki) towards DHA were as follows; pregnenolone 22 μM, DHA‐sulfate 13 μM, pregnenolone‐sulfate 21 μM, androstenediol 16 μM, androstenetriol 53 μM, estrone 32 μM, estradiol‐17β 75 μM, ethynylestradiol 22 μM and chlormadinone‐acetate 27 μM. The Ki values towards pregnenolone were DHA 6.3 μM, DHA‐sulfate 8.3 μM, pregnenolone‐sulfate 3.9 μM, androstenediol 8.7 μM, androstenetriol 14.7 μM, estradiol‐17β 15.4 μM and ethynylestradiol 16.0 μM, respectively. The reaction products, 16αOH‐DHA and 16αOH‐pregnenolone, showed little inhibitory effect upon the 16α‐hydroxylase.
The Effects of Estrogens and Gestagens on the Urethral Pressure Profile in Urinary Continent and Stress Incontinent Women
Authors: Rud T.
Published: December 2009

The present investigation was performed to study the urodynamic effects of hormones on the lower urinary tract in women. Twenty‐four stress incontinent and 6 continent women were randomly given E2 and E3 orally in doses of 4–8 mg per day for 3 weeks. Another group of 8 women were given a single i.m. injection of 1000 mg gestagen.

All the women were examined with simultaneous urethro‐cystometry, including urethral pressure profile measurement, before and after treatment. After estrogen treatment the transmission of intraabdominal pressure to the urethra increased. Furthermore, there was a significant increase in maximum urethral pressure and urethral length at rest. After gestagen treatment no significant changes of the recorded parameters were observed.
Clinical and Ultrasonic Aspects in the Diagnosis and Follow‐Up of Patients with Early Pregnancy Failure
Authors: Jouppila Pentti
Published: December 2009

The value of some central clinical and ultrasonic findings at the time of threatened abortion was examined in 525 patients in the 6th—20th weeks. The outcome of the pregnancy was delivery in 45 per cent of all the cases. A duration of the first bleeding of 3 days or more predicted abortion significantly more often than did a shorter bleeding episode. A positive detection of fetal life signs by ultrasound signified a successful outcome for the pregnancy in 87 per cent of the patients. The anamnestic duration of pregnancy often seemed to deviate from the real weeks, requiring correction by ultrasonic methods. Forty‐eight per cent of the cases with various pathologic forms of early pregnancy were evacuated on the basis of ultrasonic findings without waiting for the unavoidable spontaneous abortion. The later course of the pregnancies with a successful outcome revealed an 8 per cent frequency of premature deliveries, signifying careful observation of the patients in this respect. The relatively high frequency of perinatal mortality (3.4 per cent) seemed to be associated with the prematurity.
Urethral Pressure Profile at Pubococcygeal Repair for Stress Incontinence
Authors: Öbrink A. , Bunne G.
Published: December 2009

The influence of pubococcygeal repair on the urethral pressure profile as well as the cure rate, technical operative results and side‐effects have been studied in 16 severely stress‐incontinent patients. The patients were followed during the first postoperative year in order to detect the possible long‐term effects of devascularization, denervation and scarring on the urethral tone. Examination, using simultaneous urethrocystometry with recording of the urethral pressure profile at rest was undertaken preoperatively, 3 months postoperatively and one year postoperatively. Urethral functional length was not affected by the surgery. Urethral closure pressure was slightly reduced 3 months postoperatively and did not recover completely within the first postoperative year. Such a reduction in urethral pressure probably reflects damage to the urethral tissue due to devascularization and denervation. Its main clinical importance concerns cases of severe stress incontinence with a very low initial closure pressure in the urethra. Here, vaginal surgery may jeopardize the success of an otherwise technically irreproachably performed operation. On the whole, pubococcygeal repair is effective in achieving continence, although the side‐effects call for careful selection of patients.
Response of Endometrioid Ovarian Carcinoma in Nude Mice to the Combination of Vincristine Sulphate and Cyclophosphamide
Authors: Bjondahl K. , Grönroos M. , Klemi P. , Möttönen M.
Published: December 2009

The effect of a combination treatment with vincristine sulphate and cyclophosphamide to endometrioid ovarian carcinoma grown in nude mice hosts was studied by histopathological, ultrastructural and biochemical methods.

The first course of treatment had little or no effect. After the second and third courses, however, the growth of the tumors was suppressed as evidenced by increased necrosis and decreased weight of tumors. The total volume of the mitochondria decreased but there was no change in the nucleo‐cytoplasmic ratio and other ultrastructural features. In the DNA and RNA contents a decreasing trend was found.

No complete remission was observed during the treatment. However, in two treated animals, kept for a longer observation period, the tumors regressed completely and no new tumor growths were found. In the control animals, the tumors grew progressively and the histology was identical to that in the patient. However, the frequency of mitoses was slightly higher in the transplanted tumor than in the primary tumor.
Endometrioid Carcinoma in an Operation Scar
Authors: Madsen Hans , Hansen Peer , Andersen Ole Peter
Published: December 2009

A case of primary endometrioid carcinoma in endometriosis in an operation scar is described.