Premature Rupture of the MembranesEvaldson, George; Lagrelius, Anders; Winiarski, Jacek
doi: 10.3109/00016348009155416pmid: 7446003
The etiology of premature rupture of the membranes (PROM) has been investigated in 30 consecutive cases and 30 matched controls. The significance of several possible factors predisposing to this condition is discussed and the obstetric and pediatric outcome reviewed. Significantly increased frequencies of previous genital operations, cervical operations and lacerations were found in the PROM group, which also contained significantly more heavy smokers. The relation between the length of the PROM delivery time interval and the risks of prematurity and infection are discussed. Patients delivered > 24 hours after PROM had significantly more puerperal infections than those with a latent period of > 24 hours. Maternal fever was found to be an unreliable prognostic indicator. The incidence of puerperal infection amounted to 27 per cent in the PROM group. A 12 per cent incidence of proven neonatal septicaemia contributed to a high perinatal mortality rate (17.6 per cent).
Clinical and Ultrasonic Aspects in the Diagnosis and Follow‐Up of Patients with Early Pregnancy FailureJouppila, Pentti
doi: 10.3109/00016348009155418pmid: 7192472
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.
Alterations in the Electrocardiogram of the Fetal Lamb as a Sign of Fetal Asphyxia: A Comparison between the Scalp Lead and the Precordial LeadHökegård, K.‐H.; Rosén, K. G.
doi: 10.3109/00016348009155419pmid: 7446005
Progressive changes in the ST‐T period of the fetal electrocardiogram (FECG) were studied in 18 lamb fetuses, acutely exteriorized and subjected to graded hypoxia. The aim of the study was to compare the bipolar precordial lead (CR‐lead) with the unipolar scalp lead, and to correlate the alterations in the FECG to blood‐gas and acid‐base status. The scalp lead gave less information regarding fetal condition and was more difficult to interpret than the precordial lead. This might be one factor in the controversy regarding the significance of alterations in the FECG during asphyxia and labor, since the scalp lead is used mainly in clinical situations. Our previous results demonstrating progressive changes in the ST‐T period of the FECG during hypoxia in experimental animals and showing the same ECG changes in newborn human infants immediately after birth, were registered with the bipolar precordial lead. It is possible that a bipolar scalp lead might give more information regarding the fetal condition than the unipolar scalp lead mainly used in clinical practice.
Oxytocinase Activity in the Course of Continuous Lumbar Epidural AnalgesiaWieczorek, Eligiusz; Sobiech, Krzysztof A.
doi: 10.3109/00016348009155421pmid: 7446007
The oxytocinase activity in the blood serum, umbilical blood and homogenates from the placenta and umbilical cord was determined in 34 women in labor subjected to continuous lumbar epidural analgesia with 0.125 per cent bupivacaine and 1:800 000 epinephrine. The results obtained were subjected to statistical analysis and compared with a group of 30 patients in spontaneous labor without any drugs. Significantly higher oxytocinase activity was found in the women subjected to epidural analgesia. The increased oxytocinase activity was found to correlate with the duration of the first stage of labor. It is assumed that the increase in the oxytocinase activity in the course of continuous epidural analgesia is associated with diminished uterine contractions and is related to the effect of the particular anesthetic agent.
Ectopic Pregnancy and IUDs; incidence, Risk Rate and Predisposing FactorsMeirik, Olav; Nygren, Karl‐GÖSta
doi: 10.3109/00016348009155422pmid: 7446008
During a period of 4 years, 1974–77, in Uppsala county; Sweden, 203 women underwent surgery for ectopic pregnancy with histological proof of the diagnosis. For the female population of fertile age this corresponds to 0.11 ectopics per 100 women 15–44 years of age, or 1.08 per 100 notified pregnancies, or 1.53 per 100 births. Fifty‐five of the women with ectopic pregnancy were using an intrauterine device (IUD) (48 a copper‐bearing IUD and 7 some other type of device), and 6 women used a low dose progestogen contraceptive. For users of copper‐bearing IUDs the risk of an ectopic pregnancy was estimated to be 0.15 per 100 women years. When comparing this latter risk rate with the overall incidence rate of 0.11, it must be observed that the populations forming the denominator in these two rates differ with respect to some crucial characteristics. Nulliparity and predisposing factors were found statistically significantly more often in non‐IUD‐users with an ectopic pregnancy than in IUD‐users. Such predisposing factors may be less prevalent in IUD‐users, as in other populations. This may explain why ectopic pregnancy has been found to occur less frequently than theoretically expected among IUD‐users. The “ectopic preventing” capacity of the IUD may therefore be considerably lower than has been previously claimed.
Results in the Operative Treatment of Pelvic EndometriosisPuolakka, Jukka; Kauppila, Antti; Rönnberg, Lars
doi: 10.3109/00016348009155423pmid: 7446009
Two hundred and eight patients treated surgically for endometriosis were reviewed one to four years later. The incidence of endometriosis in this survey was 17 per cent of all gynecological laparotomies. After operation, 30 per cent of the patients were symptomless, 60 per cent estimated the alleviation as good or moderate, and only 10 per cent had no benefit from the operation. In the 32 cases where infertility was the main indication for operation and other factors affecting fertility were excluded, 20 pregnancies of 19 women were achieved after operation.
Urethral Pressure Profile at Pubococcygeal Repair for Stress IncontinenceÖbrink, A.; Bunne, G.
doi: 10.3109/00016348009155424pmid: 7192473
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.