Anticoagulant therapy in the prevention of placental infarction and perinatal death.

Anticoagulant therapy was administered to 15 pregnant women whose prior pregnancies had been complicated by extensive placental infarctions, intrauterine growth retardation of the fetus, and/or stillbirths. With anticoagulant therapy, 15 live infants were born, none growth retarded, and no severe infarction of placentas was observed. Therapy resulted in no adverse reactions in either the mothers or the neonates.

Obstetric outcome in singleton pregnancies after assisted reproduction.

OBJECTIVE: To compare the obstetric outcome of singleton pregnancies after various procedures of assisted reproduction with a control group. METHODS: Maternal and perinatal outcome in 355 assisted-reproduction singleton pregnancies (study group) with a duration of 140 days or more were compared retrospectively with a control group matched for age and parity. All assisted-reproduction pregnancies resulted from treatment in one university hospital, and all control subjects delivered in the obstetric department of the same hospital. The controls consisted of 643 women, also with singleton pregnancies, who were matched for age and parity. RESULTS: In the study group, the frequencies of pregnancy-induced hypertension and placenta previa were increased. More patients in the study group were delivered by elective cesarean. Pregnancies after assisted reproduction were of shorter duration, with an increased incidence of preterm birth. Infants in the study group had a lower mean birth weight than did those in the control group and were more frequently referred to a neonatal care unit. CONCLUSION: Singleton pregnancies resulting from assisted reproduction represent obstetric risk cases, and the patients should be offered special attention during the pregnancy, which will probably be their only one.

Marital break-up among couples raising families by artificial insemination by donor.

The separation rate for Norwegian women who had given birth to children after artificial insemination by donor (AID, n = 227) was compared with the separation rate among all Norwegian women that met certain demographic criteria for equality (controls, n = 6,689). The criteria included identical year of maternal birth, similar age at marriage, and equally long period between marriage and birth of the first child. Mean duration of marriage at first delivery was 7.4 years, and mean age of the first child was 3.6 years at registration of the data. The incidence of marital break-up in the AID group was 1.8%, as compared with 3.0% to 3.7% in the control group. The difference is not significant (P approximately 0.15). The authors conclude that the separation rate in AID families does not differ significantly from the observed separation rate in a demographically matched population. The study highlights the importance of selecting a proper control group before statements of the magnitude of separations in AID families are made.

Effect of a combination of orphenadrine/paracetamol tablets ('Norgesic') on myalgia: a double-blind comparison with placebo in general practice.

The clinical efficacy and tolerability of a combination preparation ('Norgesic') of 35 mg orphenadrine plus 450 mg paracetamol was compared with that of placebo in a controlled double-blind, parallel group, 7-day study comprising 44 patients suffering from pain due to tension of the cervical and upper thoracic musculature. The patients were allocated at random into two homogeneous groups, stratified by sex and initial pain intensity. One group received the combination, the other placebo. The dosage used was 1 tablet 3-times daily. The effect of treatment of pain was assessed daily using a visual analogue scale. Despite the low dosage used, orphenadrine/paracetamol produced statistically significant pain relief from initial levels by and from the second day of the study. Comparison between the groups showed that the analgesic efficacy of the combination was significantly superior to that of placebo from the third day of treatment. These results confirm the efficacy of a combination of orphenadrine/paracetamol in patients suffering from myalgia nuchae.

Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study.

OBJECTIVE: To study the incidence and prevalence of juvenile chronic arthritis (JCA) in northern Norway. METHODS: Cases from the period 1985-1994 were retrospectively identified from the hospital files of the only pediatric department treating JCA in the study area. The European League Against Rheumatism (EULAR) criteria for JCA were used. RESULTS: The annual incidence of JCA was 22.6/100,000 children under 16 years of age. The incidence of oligoarticular JCA was 11.8, and the incidence of systemic JCA was 0.8/100,000. In the incidence group 25% were ANA positive, 14% developed uveitis and 42% of the tested patients were HLA-B27 positive. The point prevalence was 148.1/100,000. CONCLUSION: These incidence and prevalence data are higher than those reported in most other studies. The impact of genetic differences, cyclic variations and other factors in relation to the onset and course of JCA merit further investigation.

Duration of the latency period in preterm premature rupture of the membranes. Maternal and neonatal consequences of expectant management.

111 pregnancies complicated with premature rupture of the membranes (PROM) at a gestational age between 20 and 34 weeks, were observed prospectively with expectant management. Median duration of the latency period was 7 (0-109) days. The duration of the latency period was inversely related to the gestational age at PROM. Intra-uterine death ensued in 9.9% of the pregnancies. Clinical chorioamnionitis ensued in 12.6% of the pregnancies. Eight (7.6%) neonates developed sepsis. None of the babies died as a consequence of sepsis alone. Of the 43 (41.0%) neonates who developed idiopathic respiratory distress syndrome (IRDS), 8 (7.6%) babies died. The perinatal mortality rate was 18.6%. The study seems to justify the expectant management of PROM pregnancies of less than 34 weeks of gestation.

Pregnancy outcome in renal allograft recipients: influence of ciclosporin A.

The outcome of 35 pregnancies in 26 renal allograft recipients is reported. Twenty-four pregnancies in patients treated with prednisolone and azathioprine resulted in 22 live-born infants (one twin pregnancy) and 3 induced abortions on medical indications. Three of the deliveries were preterm, and one of the infants had a birth weight below the 2.5th percentile. Ten patients (11 pregnancies) were treated with ciclosporin A (CsA). These women delivered 5 infants (3 preterm deliveries of whom the birth weight of one infant was below the 5th percentile) and underwent 3 induced (medical indications) and 3 spontaneous abortions. Mean birth weight in the CsA treated group was 2464 g (range 1790-2930 g), and their gestational age varied from 232 to 271 days. No foetal malformations were observed in the two groups. The results may indicate a harmful effect of CsA on pregnancy outcome.

The intravenous infusion of prostaglandin F2alpha in the management of intrauterine death of the fetus.

Prostaglandin F2alpha (PGF2alpha) was given intravenously in the treatment of 16 cases of intrauterine death. Delivery was achieved without complications or side effects in 15 out of the 16 patients. A posterior cervical rupture occurred in one patient treated with cervical dilatation and PGF2alpha-infusion.

Amniotic fluid and serum lactic dehydrogenase in intrauterine death of the foetus.

Total lactic dehydrogenase (LDH) activity in amniotic fluid was determined in 17 cases of intrauterine death of the foetus. All values were above the normal range. In 7 cases with known duration of foetal death the values of LDH tended to increase with the interval between foetal death and amniotic fluid sampling. Serum LDH was significantly higher in cases of foetal death compared to normal pregnancies.

[Determination of birth date by early ultrasonography]. / Bestemmelse av fødselstermin ved tidlig ultralydundersøkelse.

Ultrasound examination has become an indispensable tool in antenatal care. In cases with intrauterine growth retardation, post-term pregnancy and when deciding elective delivery, knowledge about gestational age is essential. However, criticism has been raised against its routine use to determine gestational age. Ultrasound is subject to a certain degree of variation, as is determination of gestational age on the basis of the last menstrual period. Variation is less by ultrasound, which therefore reduces the number of "post-term" pregnancies. The consequences of post-term pregnancy are discussed.

In vitro perfusion studies of single umbilical artery cords: the vasoactive effects of serotonin.

BACKGROUND: To investigate the vascular resistance and the vasoactive effects of serotonin in arteries from single umbilical artery (SUA) cords. METHODS: The preparations were sampled from 10 patients with SUA cords. The control group (n=20) was matched according to gestational age, birth weight percentile, blood pressure and proteinuria. The arterial segments were perfused in vitro employing a constant perfusion rate and measuring alterations in perfusion pressure. Following an initial test with serotonin 10(-7) M the drug was administrated in stepwise increasing concentrations from 10(-10) to 10(-5) M. RESULTS: The vascular resistance was significantly reduced in the SUA group compared to the control group (p<0.01). In about half of the preparations in both groups serotonin 10(-7) M induced a transient pressure decrease followed by a larger pressure increase. The remaining arteries showed a monophasic pressure increase. The maximum constrictory response calculated in percent of the prestimulatory perfusion pressure was significantly increased (p<0.01) in the SUA compared to the control group, but non-significantly increased (p=0.073) when calculated in absolute values (mmHg). CONCLUSIONS: Arteries in SUA cords display reduced vascular resistance compared to arteries from normal cords in in vitro perfused preparations. The response pattern to serotonin was not altered, but the constrictory response might be increased in arteries from SUA cords.

Intra-uterine transfusions to the Rhesus-immunized fetus in the Department of Obstetrics, National Hospital, Oslo 1968-1979. The fetal prognosis by intra-uterine transfusions in relation to amniotic fluid blood pigment index.

During the years 1968-79, 115 intra-uterine transfusions (IUT) were performed in 71 severely Rh-immunized 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 m mu less than 0.3, a survival rate of 83% was registered compared with 36% and 0% in groups with values 0.3-0.6 and greater than 0.6, respectively.

Social conditions of children born after artificial insemination by donor.

Few objective data are available concerning the social conditions of children born after artificial insemination by donor (AID). We have studied 341 consecutive AID children born of 261 women during a 13-year period. Data from hospital archives were compared with information from the National Register of Norway. The parameters studied included age-relations of parents and offspring, sex- and age-relations between siblings as well as the divorce rate in AID families. Median maternal age at birth of the first AID child was 30 years. Forty-three percent of AID children were born in families that already had children or that later obtained an additional child; the majority of these siblings were conceived by AID. Mean age difference between the closest related AID siblings was three years. Six of the 261 AID families were split by divorce during the study period. The results only reflect such information as can currently be obtained with maintenance of the promise of secrecy.

Outcome of pregnancies in diabetic mothers in Norway 1967-1976.

A total of 1035 births to diabetic mothers were registered in Norway during the 10-year period 1967-1976. Perinatal mortality (from 16 weeks of gestation until 7 days after birth) decreased from 177.4 per 1000 births in 1967-68 to 60.7 in 1975-1976; for the total population the figures were 24.1 and 18.4. During the same period the duration of gestation increased from 35.5 weeks in 1967-1968 to 37.0 weeks in 1975-1976. The numbers of small and large infants decreased: in 1967-1968 53.3% weighed 2500-4000 grams, in 1975-1976 70.7%. Moreover, more births took place in university clinics and regional hospitals, 38.7% in 1967-1968 and 77.1% in 1975-1976. Malformations were 50% more common in children of diabetics. Cardiovascular and nervous system malformations accounted for this increase, being 5 times more frequent than in the general population.

Retinal hemorrhages in the preterm neonate. A prospective randomized study comparing the occurrence of hemorrhages after spontaneous versus forceps delivery.

The incidence and magnitude of retinal hemorrhages (RH) in a group of 23 preterm infants (29-35 weeks) born spontaneously in vertex presentation have been compared with those of 23 others (28-35 weeks) born by gentle extraction with small forceps. Distribution to the groups was random. The overall frequency of RH in both groups together was low, 6%, with no statistically significant difference between the groups. No fundi with severe (grade III) hemorrhages were seen. Both the incidence and magnitude of RH were less in the preterm neonates when compared with previously reported figures in term infants born spontaneously or with forceps extraction. The study provides further evidence in support of the hypothesis that fetal head compression with venous congestion is the main cause of RH in the newborn.

Effects of betamethasone on plasma levels of estriol, cortisol and HCS in late pregnancy.

The effect of a single dose of betamethasone on the maternal plasma concentration of estriol and cortisol was studied. The concentration of estriol decreased rapidly. A maximal suppression of about 70 per cent was seen after 6-24 hours. A similar influence on the maternal plasma concentration of cortisol was observed. HCS (human chorionic somatomammotropin) was not influenced by betamethasone. These facts have to be taken into consideration after treatment with synthetic corticosteroids in high risk pregnancies.

Mutagenicity testing of amniotic fluid from diabetic women, with special reference to their smoking habits.

Amniotic fluid from 16 diabetic and 78 healthy women at term was tested for capacity to cause mutations in Salmonella typhimurium bacterial tester strain TA98 (Ames test). Diabetes as well as heavy smoking increased the mutagenic activity of amniotic fluid. The difference between groups of diabetics and controls was significant in both nonsmokers and women who had smoked more than 5 cigarettes the last 48 h before delivery. It seems plausible that metabolic disturbances, perhaps enhanced by a lowered oxygenation, in some instances could produce mutagenic compounds. Mutagenic activity in amniotic fluid may be one of the factors underlying the increased incidence of congenital malformations in the offspring of diabetic women. Early mutations could cause such developmental errors in the embryos, and possibly also in future generations by damage to germ cells. Heavy smoking alone also caused an increase in mutagenic activity in term amniotic fluid. Our findings reflected an enhancing effect of smoking in diabetes. A pregnant diabetic woman who smoked would thus further endanger her already jeopardized pregnancy.