Showing papers in "Acta Obstetricia et Gynecologica Scandinavica in 1979"

Lipid metabolic studies in oophorectomized women. effects of three different progestogens

Abstract: 10 oophorectomized women (ranging in age from 27-45 with a mean age of 34.5 and a standard deviation of 5.3) were given 3 different progestogens (norgestrel norethisterone and medroxyprogesterone) in treatment periods of 3 weeks duration immediately preceded by 3 weeks "wash out" periods. Venous blood samples were drawn before and after each treatment period. Free and total cholesterol triglycerides and phospholipids were determined in the 3 lipoprotein fractions; (VLDL) very low density lipoproteins (LDL) low density lipoproteins and (HDL) high density lipoproteins. Individual phosphatides were determined after thin layer chromatography. In addition the relative fatty acid composition of serum lecithin and cholesterol esters were assessed by gas-liquid chromatography. Both norethisterone and norgestrel caused a decrease in alpha-lipoprotein cholesterol. The relative fatty acid composition of serum lecithin revealed an increase of biochemical pathway 1 for liver lecithin synthesis on norgestrel and norethisterone but no major changes on medroxyprogesterone. With norgestrel an increase in serum-lycolecithin concomitant with a decrease in lecithin was observed while the 2 other progestogens did not induce any significant changes. From the present data it is suggested that the 19-norethisterone derivatives norethisterone and especially norgestrel have androgen-like influences on lipid metabolism. Medroxyprogesterone being a 17alpha-hydroxyprogesterone caused less changes and consequently less disturbance of lipid metabolism. (authors)

Pathophysiology of dysmenorrhea

Abstract: Mechanisms of possible pathophysiological importance in primary dysmenorrhea are discussed. Hyperactivity of the myometrium with accompanying uterine ischemia is considered to be of central importance in the causation of pain. Prostaglandins seem to be involved to a large extent in the development of the myometrial hyperactivity. Other mechanisms of possible importance such as ovarian hormones, cervical factors, vasopressin, nerves, and psychological factors can well act ultimately through prostaglandin release but an action directly on the myometrium and blood flow may also occur.

The aetiology and outcome of abruptio placentae

Abstract: A series of 193 cases of abruptio placentae in a hospital population of 35,217 is described. This is an incidence of 0.55%. In the series both age and parity, but not pre-eclampsia or anaemia, are significant associated factors. The recurrence rate of abruptio placentae was 5.6%. There were no maternal deaths and the perinatal mortality was 35%. Epidural analgesia does not abolish the pain of the abruptio placentae in spite of abolishing the pain of labour.

On improved outcome of twin pregnancies.

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.

Treatment of post‐menopausal hypercholerolaemia with estradiol

Abstract: Replacement therapy with estradiol valerate in 29 post-menopausal women reduced low-density lipoprotein (LDL) cholesterol concentrations by 22% and increased high-density lipoprotein (HDL) cholesterol by 21% after 12 months. Apart from a 67% increase of HDL-triglyceride estradiol had only a slight effect on the levels of lipoprotein triglycerides. Post-heparin plasma lipoprotein lipase (LPL) activity was significantly decreased in subjects with normal pre-treatment very-low-density lipoprotein (VLDL) triglyceride levels, and hepatic lipase (HL) activity was significantly decreased in the group as a whole. It is suggested that estradiol replacement therapy should be considered in climacteric women with high LDL-cholesterol or low HDL-cholesterol levels, or both.

Folic Acid Supplement and Intrauterine Growth

Abstract: The effect of a folic acid supplement on birth weight and placental weight in women delivering in the early summer in Denmark was investigated.Thirty-six women with normal pregnancy and expected delivery in the first half of June were selected consecutively. They were paired two and two, and allotted to two groups, one of which was supplied daily with 5 mg folic acid, and the second with tablets without folic acid, from the 23rd week of pregnancy. A significant correlation was found between erythrocyte folic acid and birth weight. The infants in the folic acid group were 12.7 per cent heavier than those in the control group (p < 0.01). A similar difference was found with regard to placental weight and the number of placental cells.

Dysmenorrhea during adolescence.

Abstract: Different aspects of the menstrual pattern including dysmenorrhea, premenstrual tension and working performance during menstruation was studied in three different investigations.The first study includes 5458 adolescent girls aged 10 to 20. The incidence of invariably painful menstruation was 7.2 per cent during the first gynecological year and 26 per cent five years later. A correlation was found between mothers and daughters for dysmenorrhea as well as for premenstrual tension.In a second study including 331 girls aged 13 to 20 years the overall absence from school due to pain was 23.4 per cent. The frequency of dysmenorrhea increased from 36 per cent to 56.5 per cent between 13-14 years and 17-20 years.Socio-medical aspects of menstrual pattern were studied in 865 adult women. Approximately 88 per cent had premenstrual tension and almost 45 per cent had menstrual pain. Thus the treatment of menstrual distress during adolescence is of great importance and the use of modern prostaglandin synthetase inhibi...

Spontaneous labor and elective induction--a prospective randomized study. I. Effects on mother and fetus.

Abstract: In a prospective randomized study spontaneous and oxytocin induced labor “for convenience” have been compared with respect to uterine activity, duration of labor, the condition of the fetus and the newborn infant. The study consists of 84 normal patients, of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II; 41 patients served as controls. No difference in maternal age, number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups. The following parameters were calculated: duration of labor, uterine activity, amount of bleeding in the third stage of labor, number of early and late decelerations as well as number of episodes of bradycardia in the CTG-recordings, birth weight, Apgar score one and five minutes post-delivery and blood gases in mother and child 60 seconds after delivery. No significant differences between the two groups were found. It is concluded that there are no increased risks t...

Fetal growth retardation associated with inadequate haemodilution in otherwise uncomplicated pregnancy

Abstract: The Hb level during pregnancy was followed in 113 non-anaemic women with uncomplicated pregnancy and birth weight of the baby above the 2.5th percentile. There was an inverse correlation close to statistical significance between the birth weight of the baby and the lowest Hb level reached during pregnancy as well as the Hb level in late pregnancy (38th week). A group of seven non-anaemic women with birth weight of the baby below the 2.5th percentile had a significantly higher (p

Effect of induction of general anesthesia for cesarean section on intervillous blood flow.

Abstract: Intervillous blood flow was measured by a new intravenous 133Xe method before and during induction of general anesthesia for cesarean section in 10 healthy mothers. The flow values showed a highly significant decrease (p < 0.001) (35 per cent on an average) at the time of anesthesia compared with the control values. The impairment was observed in all the cases. The role of the maternal changes in hemodynamic parameters and acid-base balance as a background of this decrease is discussed.

Acute deep vein thrombosis (dvt) after cesarean section

Abstract: In 169 consecutive women undergoing cesarean section, of which 90 were performed as an emergency and 79 electively, the frequency of deep vein thrombosis was evaluated with a non-invasive diagnostic technique - strain gauge plethysmography. Three patients developed thrombosis (1.8 per cent), all after acute surgery. No specific background factors were associated with the development of thrombosis. In 26 of the 79 patients (33 per cent), who were plethysmographed before operation, a biphasic venous emptying indicated venous outflow obstruction by the pregnant uterus.

Pregnancy complications following conization of the uterine cervix (i)

Abstract: The literature on the course of pregnancies following conization of the uterine cervix has been studied. It is demonstrated that an evaluation of the possible effect of conization upon subsequent pregnancy should be based upon a comparison of either pregnancies before and after conization or upon a comparison between pregnancies in women with a previous conization and in a control group of women without conization. In both cases the possible influence of conization can be evaluated only if the patient material is described as regards age, parity, number of previous pregnancies, smoking habits, etc., factors which may all influence the course of pregnancy. None of the previous publications have described the patient material sufficiently, and most studies have not tried to set up control groups. Due to these deficiencies we do not find it justified that conization leads to reduced fertility, increased frequency of spontaneous abortion, nor to increased perinatal mortality. An increased prematurity rate may not be rejected, however, but this point has not been adequately evaluated in the previous papers.

Risk factors in endometrial carcinoma with special reference to the use of estrogens.

Abstract: To determine the possible risk factors of endometrial carcinoma especially use of hormones a personal interview method was used in a case-control study. The cases were endometrial carcinoma patients from which 318 were interviewed. A total of 585 tentative controls were interviewed and 1 was matched with each case for age within 5 years for weight (within 10% of a weight for a certain height and age) and for social class. 282 pairs were formed. Percent of unmarried women was higher in the endometrial carcinoma group but not significantly so. In general the endometrial carcinoma patients were heavier than controls (mean weight of patients 73.7 kg; and mean weight of controls 66.4 kg); this was highly statistically significant. Relative risk of endometrial carcinoma among women with a history of breast cancer or uterine cancer in the relatives was 1.6 and 2 respectively; the uterine cancer risk was significant. Mean age at menarch among matched cases was higher than controls (P < .05). Mean age at menopause of cases was higher than controls (P < .05). Relative risk of endometrial carcinoma was 3 among those without pregnancies. Earlier gynecological disease or operations were not significant risk factors. Continuous medication (hormones excluded) increased risk if the medication was for diabetes (2.4) or heart (digitalis 1.9). Controls had used hormones with some gynecological indication significantly more often than cases. Matched cases had received hormones because of menstrual disorders significantly more often than controls but cases had not been curettaged more than controls. Therefore it is assumed that cases had more menstrual disorders than controls supporting the view of endogenous inbalance in hormonal status of endometrial carcinoma patients. Relative risk of endometrial carcinoma among estrogen users was .8 when restricted to pairs residing in the city of Turku. In this investigation no excess risk of endometrial cancer was found among estrogen users.

Acid-base balance during laparoscopy. The effects of intraperitoneal insufflation of carbon dioxide and nitrous oxide on acid-base balance during controlled ventilation.

Abstract: During laparoscopy the carbon dioxide used to achieve a pneumoperitoneum is absorbed from the peritoneal cavity into the blood. The object of the present study was to clarify certain aspects concerned with anesthetic and ventilatory techniques, mostly in connection with the comparison between the effects of insufflation of either carbon dioxide or nitrous oxide. Anesthesia included ventilation with a volume controlled ventilator in curarised patients. Respiratory volumes were calculated according to the patienťs body area. The results show a sharp rise in PaCO2 and a fall in pH after intraperitoneal insufflation with carbon dioxide, while no changes were observed when nitrous oxide was used. The clinical consequences of these Findings are discussed.

Improvement of defective lactation by using oral metoclopramide

Abstract: An attempt has been made to pharmacologically enhance PRL secretion to improve lactation. Twenty-one puerperal women with past history of defective lactation and PRL levels under the normal range were studied for 4 weeks postpartum. Eleven patients who received orally 20 mg a day of metoclopramide showed persistently elevated basal levels of serum PRL during the four weeks' observation period. These women also had a good milk production and their infants did not need supplements. Ten women receiving placebo, however, showed an abrupt decrease in basal PRL levels, and this decrease persisted despite the continuation of lactation. Simultaneously a decline in the milk yield was observed and by the 14th postdelivery day milk production was minimal. The administration of metoclopramide at this moment to this group of poor lactating mothers produced an increase in serum PRL levels which persisted for the rest of the study. Metoclopramide also augmented the milk production so that these women were able to contin...

Maternal alcohol and tobacco consumption and their association with nausea and vomiting during pregnancy.

Abstract: Although little is known about factors influencing its occurrence nausea and vomiting during pregnancy (NV) has been associated with favorable pregnancy outcome. In order to learn more about the association of maternal alcohol and tobacco comsumption with nausea and vomiting during pregnancy information on NVP in 210 patients at a west coast health maintenance organization was obtained. Smoking and alcohol consumption before and during pregnancy were also estimated in 2 personal interviews during gestation. 72% of the subjects had NVP in the first 4 months of pregnancy. Smokers had significantly less NVP than nonsmokers (52% in contrast to 79%). NVP in smokers was negatively associated with alcohol consumption before and during pregnancy; the stronger relation being for alcohol reported in the 6 months prior to pregnancy. 46% of smokers drinking more than 1/2 fluid ounce of absolute alcohol daily in this period reported NVP; 68% of smokers drinking less had NVP. For nonsmokers there was no relation between alcohol use in any period and NVP. The risk of NVP associated with pre-pregnancy drinking was not related to any change in alcohol consumption after conception. The results suggest an interaction between NVP smoking and reported alcohol consumption. The association of favorable pregnancy outcome with NVP may be because women who experience it are less likely to be regular drinkers and smokers.

Effects of the prostaglandins on the uterus. Prostaglandins and uterine contractility.

Abstract: The effect of intravenous and intrauterine administration of PGE1 or PGE2 and PGF2 alpha as well as oral administration of PGE2 on the sensitivity and reactivity of the nonpregnant human uterus was studied. With the use of the flaccid microballoon technique or a micro transducer catheter, uterine recordings were made at frequent intervals throughout the menstrual cycle. Independently of the route of administration and of the phase of the cycle, treatment with PGF2 alpha invariably resulted in stimulation of uterine motility. A high sensitivity to PGF2 alpha was noted during the late secretory phase both in normal and dysmenorrheic women. A marked decrease in sensitivity to both PGE2 and PGF2 alpha administered by the intrauterine route was observed in the periovulatory phase. Inhibition of uterine contractility by PGE2 following both intrauterine and oral administration was noted during active menstrual bleeding in normal as well as in dysmenorrheic women. These findings suggest that endogenous prostaglandins may play a role in the regulation of the normal uterine motility during the menstrual cycle and that the main reason for the abnormal contractility pattern seen in dysmenorrheic women during menstrual bleeding is an increased PGF2 alpha/PGE2 ratio.

Segmental Epidural Analgesia in Labour: Related to the Progress of Labour, Fetal Malposition and Instrumental Delivery

Abstract: The effect of low-dose continuous segmental epidural analgesia given during the first stage of labour on the progress of labour, the frequency of fetal malpositions and the rate of vacuum extractions was studied prospectively in 100 parturients (epidural group). The results were compared with 100 parturients given none or conventional analgesia (control group). The results showed that in the primiparous epidural group the progress of labour before analgesia was induced was significantly slower than in the control group. After the block, however, the subsequent course of the labour was of equal duration in both groups. The durations of the second stages of labour did not differ significantly between the groups. The differences in fetal malpositions at delivery were statistically insignificant. Nor did the rate of vacuum extractions, 8% in the primiparous and 0% in the multiparous epidural group, differ statistically from the corresponding rate in the control groups. The results signify a normal progress an...

Ripening of the cervix and induction of labor in patients at term by single intracervical application of prostaglandin E2 in viscous gel.

Abstract: Prostaglandin E2 (PGE2) suspended in a viscous gel was deposited intracervically to 115 patients at term with an unripe cervix. 45 of these patients were given a single dose of 1.0 mg PGE2, whereas the remaining 70 received only half that dose, i.e. 0.5 mg. Irrespective of dose greater than 60 per cent of the patients were induced into labor and delivered without further stimulation within less than 24 hours. The mean induction delivery time was 10 hours. In the remaining patients a considerable ripening of the cervix was registered. Hypercontractility did occur in one patient given 1.0 mg PGE2, otherwise no maternal side effects were observed. There were no adverse effects on the fetuses. The number of instrumental deliveries was 19 per cent including 9 per cent cesarean sections. It is concluded that locally applied PGE2-gel can be used to produce ripening of the cervix and/or induce labor in patients at term with an unripe cervix. Since there was practically no difference in efficiency between the two doses but one case of hyperstimulation in patients given 1.0 mg PGE2, the smaller dose, i.e. 0.5 mg is recommended.

Complications of cerclage

Abstract: The published results of cervical cerclage are almost invariably good and there is little mention of complications. Forty per cent of 52 pregnancies, with 38 early “prophylactic” and 14 late “thera...

Prostaglandin synthetase inhibitors and dysmenorrhea. A survey and personal clinical experience.

Abstract: . A survey of earlier published studies on treatment of dysmenorrhea with prostaglandin synthetase inhibitors is given and personal clinical experiences are presented. The time when treatment should start in relation to the onset of bleeding is also discussed. A survey of studies published in English and Scandinavian literature yielded 532 patients. Pain relief was experienced in 64 to 100 per cent of the patients in these studies. The incidence of side-effects has generally been low but in a few studies a high incidence was reported. In the current study 34 patients with primary dysmenorrhea completed the double-blind, placebo controlled study on naproxen. The patients were treated for two cycles, 16 with naproxen and 18 with placebo. The mean relief score indicated a “slight to good” pain relief in the naproxen group and “no alleviation” in the placebo group. The difference is statistically significant (p = 0.003). Supplementary medication was much more used in the placebo group compared to the naproxen group (p = 0.01). In the placebo group no change whatsoever was demonstrated in alleviation of interference with every-day life, whereas there was a statistically significant improvement in the naproxen group. No major side-effect was registered. Thus none of the subjects withdrew from the study.

Socioeconomic Implications of Dysmenorrhea

Abstract: Dysmenorrhea constitutes only a small fraction of the causes of absence from work among women of childbearing age. Nevertheless, every second woman in two Norwegian industrial companies experienced pain during menstruation and one in three had to stay in bed at least one day per month. Many women attend their jobs in spite of reduced capacity for work during periods of discomfort. The consequence for work output and hence economy may be impossible to estimate. Socially the perimenstrual period has a negative effect on many women. Poor results at examinations, greater risk of being injured and a tendency to commit offences seem to cluster at this time. The social implications of dysmenorrhea may be as important as the econonic ones.

Ripening of the cervix by intracervical application of PGE2-gel before termination of pregnancy with dilatation and evacuation

Abstract: In a randomized double-blind study a viscous gel, containing 0.25 mg prostaglandin E2 (PGE2-gel) or without prostaglandin (placebo gel), was applied intracervically in twenty-two nulliparous patients just before termination of early pregnancy by dilatation and evacuation (D & E). Within twelve hours a marked ripening of the cervix was found in all the eleven patients receiving PGE2-gel. Thus, a significant change in cervical dilatation from mean 5.4 mm to mean 10.7 mm occurred. Furthermore, a considerable softening of the cervix was registered. In the eleven patients receiving placebo gel, no significant changes in cervical dilatation or consistency were found. The subsequent D & E was easily performed in all patients treated with PGE2-gel. However, in three of the patients given placebo gel, D & E was difficult to carry out because of an unfavorable cervical state. To eliminate or decrease myometrial activity the calcium antagonist nifedipine was given orally to eight patients at application and five hours after application of 0.25 mg PGE2-gel. None of the patients recognized uterine contractions. However, also in these patients significant changes in cervical consistency and dilatation occurred within twelve hours. No side effects of the treatment were observed. It is concluded, that a preoperative, intracervical single application of 0.25 mg PGE2 seems to be useful to ripen the unfavorable cervix before subsequent termination of early pregnancy by D & E.

Prostaglandin synthetase inhibitors. Drugs which affect arachidonic acid metabolism.

Abstract: Drugs may alter prostaglandin production by acting on the various pathways of arachidonic acid metabolism. The liberation of arachidonic acid from membrane-bound phospholipids, induced by the enzyme phospholipase A2, may be inhibited by mepacrine and the steroidal anti-inflammatory agents. The bio-transformation of the free arachidonic acid, by the enzyme cyclooxygenase, to the unstable endoperoxide intermediates is inhibited by non-steroidal anti-inflammatory agents. Thus, the generation of all the prostaglandin products is prevented. This action can explain the anti-inflammatory, analgesic, antipyretic actions as well as the ulcerogenic properties of these aspirin-like compounds. An alternative metabolic pathway of arachidonic acid, via the lipoxygenase system, can be inhibited by an acetylenic analogue and a newer compound, phenidone. The unstable endoperoxide intermediates can be transformed by blood platelets into the pro-aggregating products, thromboxanes. This pathway can be selectively inhibited by a variety of experimental compounds. Prostacyclin, a potent vasodilator and inhibitor of platelet aggregation is the major product of endoperoxide transformation in blood vessels. Its formation can be inhibited by lipid peroxides. Selective actions on one or more steps in arachidonic acid metabolism can lead to a different profile of the products subsequently generated. Such a diversion of biosynthetic pathways may be an underlying mechanism in certain pathological conditions, perhaps even in dysmenorrhea.

A New and Sensitive Method for Quantifying and Comparing the Biological Potency of Various Estrogens in Man

Abstract: The serum level of an estrogen-inducible plasma protein was followed by a radioimmunoassay in groups of women during treatment with various estrogens. After an initial increase, the mean value for the serum concentration was stable. The plateau level after six months of treatment was taken as a parameter of estrogenic potency. Eleven different hormonal preparations were compared and an estrogen index was constructed.

The immunodepressive effect of human glucoproteins and their possible role in the nonrejection process during pregnancy

Abstract: Human chorionic gonadotrophin (HCG) and human chorionic somatomammotrophin (HCS) were shown to suppress the proliferative T and B cell response induced by different mitogens in human and mouse lymphocytes. Thyroid stimulating hormone (TSH), sharing the alphachain subunit with HCG was devoid of effect suggesting that the immunosuppressive entity is localized within the beta-chain subunit. Human growth hormone (HGH) which is partly biologically cross-reactive with HCS did not impair mitogen responsiveness.HCG was also able to inhibit the differentiation of cells since the induction of antibody-formation was depressed. Expression of plaque forming cells was also reduced by addition of HCG directly in the PFC assay possibly reflecting the anti-complementary effect of this hormone, since cell mediated lysis of target cells by Con A activated lymphocytes, which is not complement-dependent, was unaffected by adding HCG in the assay system.

Duration of Labour with Spontaneous Onset

Abstract: Among 2242 women with spontaneous onset of labour, the median duration of labour for those delivered vaginally was 8 1/4 hours in para 0, 5 1/2 hours in para 1 and 4 3/4 hours in para 2+ mothers. In the parity groups 0, 1 and 2+ 90% had delivered within 16 1/4 hours, 10 1/2 hours and 10 3/4 hours, respectively, while 10% of para 0 labours lasted less than 4 hours, 10% of para 1 labours less than 2 1/4 hours and finally 10% of para 2+ labours less than 2 hours. In the first stage of labour the latent phase (cervical dilatation less than 4 cm), was nearly 2.5 times as long as the active phase (cervical dilatation 4-10 cm). The second stage (cervical dilatation 10 cm-birth) had a median duration of 16 min in para 0 and approximately 10 min in para 1+ mothers. The length of the latent and active phases and the second stage for para 1+ mothers was 60-70% of that of para 0 mothers. In individual mothers there were weak correlations between the length of the phases and stages. For example, the length of the latent phase appeared to be a relatively poor predictor of the length of the active phase of labour. However, selection bias may have weakened these correlations somewhat.