Amniotic fluid U. urealyticum colonization: significance for maternal peripartal infections at term.

The aim of this study was to examine the relationship between maternal peripartal infectious morbidity and amniotic fluid colonization by U. urealyticum. Amniotic fluid specimens for bacterial and mycoplasmal cultures were obtained by aspiration at nonelective cesarean section from 98 pregnant women. Amniotic fluid cultures revealed micro-organisms in 70 (71%) parturients and U. urealyticum was the most frequently isolated species, detected in the specimens from 38 (39%) women. In the total study population, the prevalence of clinically defined infectious morbidity was 26%, including 8 (8%) patients with chorioamnionitis, 11 (11%) with endometritis, 5 (5%) with urinary tract infection, and 4 (4%) with wound infection. A significant association between the amniotic fluid U. urealyticum colonization and increased maternal peripartal infectious morbidity was observed (p < 0.0027; relative risk 4.1; 95% confidence limits 1.6 to 10.7). Amniotic fluids positive for U. urealyticum were significantly more often positive for other potentially pathogenic bacteria (p < 0.0024) and particularly for Bacteroides spp. (p < 0.0074). Our results support the existence of an association between amniotic fluid U. urealyticum invasion and maternal infectious morbidity. However, U. urealyticum was not usually isolated alone from amniotic fluids but combined with other pathogenic bacteria, the severity of infections were not enhanced when U. urealyticum was present and parturients with diagnosed infections managed well without specific antibiotic against U. urealyticum. Hence, it appears that the significance of U. urealyticum in maternal infections in this study population was mainly based on its interactions with other bacteria.

Intraumbilical oxytocin for management of retained placenta.

OBJECTIVE: The purpose of the study was to investigate the removal of a retained placenta. METHOD: Oxytocin was injected into the vein of the umbilical cord. A total of 109 patients with retention of the placenta were randomized into two groups. Active management of the third stage of labor was carried out by giving oxytocin 5 IU intravenously and ergometrine maleate 0.2 mg intramuscularly after delivery of the fetus. Group 1, which comprised 68 patients, was allocated to receive 50 IU oxytocin diluted in 10 ml 0.9% sodium chloride solution, and the 41 patients in group 2 were given 20 ml plasma expander (dextran 70) into the umbilical vein. RESULTS: Forty-nine cases (72%) in the oxytocin group and 22 cases (54%) in the dextran 70 group required manual removal of the retained placenta. No significant differences were found between group 1 (oxytocin) and group 2 (dextran 70). CONCLUSION: Our results indicate that intraumbilical vein injection of oxytocin is not effective for removal of a retained placenta.

Infection markers during labor at term.

Serum levels of C-reactive protein (CRP), white blood cell count (WBC), amniotic fluid white blood cells (Gram staining) and leukocyte esterase (LE) activity were measured serially and prospectively in 30 pregnant women in labor at term. Results were retrospectively compared with amniotic fluid bacterial culture results. Leukocyte esterase activity was measured by the dipstick test (Nephurtest) and an in vitro photometric method. Amniotic fluid samples were collected through an intrauterine transvaginal pressure catheter. The serial CRP and WBC levels from admission to the delivery and CRP levels from delivery to the first post partum day increased statistically significantly. Levels of both markers correlated significantly with duration of labor. Both amniotic white blood cells and leukocyte esterase activity increased during labor. Bacterial colonization of amniotic fluid was not clearly associated with amniotic LE-activity or leukocyte count as determinated by Gram stain. The tests evaluated cannot be regarded as reliable methods in distinguishing intra-amniotic infection during labor and vaginal delivery at term.

Psychosocial factors, female fertility and pregnancy: a prospective study--Part II: Pregnancy.

The aim of the study was to determine whether psychosocial factors have an influence on the progress and outcome of pregnancy and whether personality-related or stress factors are significant in this respect. One hundred and ninety-one nulliparas without a history of infertility were prospectively studied gynecologically and psychiatrically. Life changes and changes in stress factors were monitored throughout the study period and obstetric complications were registered. By the end of the study period 120 (63%) of the subjects had given birth, 38 (19%) had abortion, 22 (12%) did not conceive and the remaining 11 (6%) discontinued. Certain psychosocial factors (e.g. life changes, anxiety, subjectively estimated physically and mentally stressful work) were associated with complications of pregnancy. In the logistic regression analysis the psychosocial stress factors were more strongly associated with the outcome of pregnancy than the factors related to personality. Adjusting for the stress-buffering factors (personality, coping methods and social support) did not reduce the original association.

Puerperal endometritis after abdominal twin delivery.

The infectious complications of 122 consecutive abdominal twin deliveries over the period 1984-1989 were analyzed in a prospective clinical study, comparing them with 761 singleton abdominal deliveries over the period 1984-1986. The incidence of endometritis was nearly three-fold after twin deliveries and the incidence of abdominal wound infections nearly two-fold compared with singleton abdominal pregnancies (13.1/4.7% and 5.6/3.0%). The risk of amnionitis was increased ten-fold, 6 hours after rupture of the membranes in abdominal twin delivery, but no connection was found between amnionitis and endometritis, as in singleton abdominal deliveries. Multiple regression analysis indicated only two risk factors as regards puerperal endometritis after abdominal twin delivery: age under 25 years (odds ratio 6.9, 95% confidence limits 1.9-24.8), an association also seen in singleton abdominal deliveries, and a period of more than 6 hours from rupture of membranes to delivery (odds ratio 7.8, 95% confidence limits 2.1-28.5). Multiple pregnancy appears to be associated with an increased risk of endometritis. The etiological factors remain unknown, but a large placental bed and/or immunological factors may be implicated.

Phaeochromocytoma in pregnancy.

A case of phaeochromocytoma diagnosed and treated during pregnancy is presented. The diagnosis was made by the typical paroxysmal symptoms with high blood pressure and confirmed by elevated plasma and urine catecholamine levels and ultrasound. After a short-term blockade with alpha and beta adrenergic antagonists an almost 10 cm large tumour was successfully excised at caesarean section. The problems with treatment of phaeochromocytoma during pregnancy are also discussed.

Early pregnancy loss and exposure to 50-Hz magnetic fields.

The possibility of an association of early pregnancy loss (EPL) with residential exposure to ELF magnetic fields was investigated in a case-control study. Eighty-nine cases and 102 controls were obtained from the data of an earlier study aimed at investigating the occurrence of EPL in a group of women attempting to get pregnant. Magnetic-field exposure was characterized by measurements in residences. Strong magnetic fields were measured more often in case than in control residences. In an analysis based on fields measured at the front door, a cutoff score of 0.5 A/m (0.63 microT) resulted in an odds ratio of 5.1 (95% confidence interval 1.0-25). The results should be interpreted cautiously due to the small number of highly exposed subjects and other limitations of the data.

Puerperal CRP-levels after manual removal of the placenta.

Maternal serum C-reactive protein (CRP) values were determined daily during the postpartum period in 113 cases after manual removal of a totally retained placenta. 200 mothers with uncomplicated pregnancy and delivery served as controls. The mean CRP-level in the study group was significantly higher than in the control group on the first postpartum day, 47.17 mg/L (SD 31.62) vs 39.00 mg/L (SD 28.00) and on the second day, 53.06 mg/L (SD 33.95) vs 42.00 mg/L (SD 21.00), reaching similar levels on the third day. The increase of CRP-values on the second day was 12% in the retained placenta group and 7% in the control group. There was no correlation between CRP-values and body temperature, white blood cell count or erythrocyte sedimentation rate, but the CRP-level was lower after excessive blood loss and increased after blood transfusion. Being a marker of infection and tissue damage, the maternal CRP-level on the first and second postpartum day primarily reflects the events of parturition. CRP-levels are higher after manual removal of a totally retained placenta without an obvious explanation for this phenomenon, and this has to be taken into account when CRP is used for diagnosing postpartum infections.

Smoking does affect fecundity.

A total of 2198 mothers were interviewed at the 20th week of pregnancy and their smoking habits before pregnancy and the time from discontinuation of contraception to the beginning of the pregnancy were registered. This information was used to investigate whether smoking affects conception delay; i.e., fecundity and a multifactorial analysis were used. The longer the conception delay, the more significant was the deleterious effect of even light smoking, the odds ratio shifting from 1.1 at 6 months to 3.2 at 18 months. The effect of smoking on fecundity seemed to be mostly dose-dependent. In mothers becoming successfully pregnant in 12 months, both maternal and paternal smoking increased the risk of conception delay (OR 1.5 and 1.3), and the effect was potentiated by increasing age (OR 2.3 and 1.6). In addition to smoking, previous recurrent spontaneous abortions were also associated with fecundity.

Risk factors for fever, endometritis and wound infection after abdominal delivery.

Risk factors for postoperative fever, endometritis and wound infection were analyzed in 761 consecutive cesarean sections. Postoperative fever was observed in 12%, endometritis in 4.7% and wound infection in 3% of cases. The relative risk for postoperative fever was increased in cases with postoperative hematoma (relative risk = 16.0), in cases with blood loss over 500 g (relative risk = 1.8) and if the duration of labor exceeded 6 h (relative risk = 1.9). The only significant risk factors for endometritis were amnionitis (relative risk = 8.7), postoperative hematoma (relative risk = 5.0) and age under 24 years (relative risk = 3.0). Wound infections were less frequent in cases with previous cesarean sections (relative risk = 0.15) and after elective cesarean sections (relative risk = 0.22), but duration of operation over 1 h (relative risk = 2.8), induction of labor (relative risk = 3.2) and puerperal endometritis (relative risk = 7.9) increased the risk of wound infection. By elimination of amnionitis and postoperative hematomas the rate of endometritis would have diminished only from 4.7% to 3.8%, a percentage equally unacceptable; diagnostics and prevention should be directed to young patients undergoing caesarean section. Besides technical procedures prevention of endometritis is important for the prevention of wound infection. In hospitals with low postcesarean infectious morbidity antibiotic prophylaxis seems to be unwarranted.

C-reactive protein (CRP) levels after normal and complicated caesarean section.

Serum CRP level was measured in mothers after uncomplicated vaginal and after both uncomplicated and complicated abdominal deliveries. A rapid rise was observed after vaginal delivery, and after abdominal delivery the change was slower but more intense. Postoperative endometritis was detected quite accurately (with cut off level 90 mg/l) with sensitivity of 100% and specificity of 81%. Endometritis and postoperative haematoma could not be distinguished from each other with CRP. The causes of variation of CRP level after vaginal and abdominal delivery are discussed.

Cigarette smoking and semen quality in men of reproductive age.

The effect of cigarette smoking on conventional semen parameters was studied in voluntary men of reproductive age (n = 190). Special attention was focused on sperm motility and its quantitative and qualitative change in vitro during the observation period. The sperm output war normal in both smokers (n = 54) and non-smokers (n = 110), but semen volume was smaller (p less than 0.03) in heavy smokers (greater than 16 cigarettes/day) than non-smokers. In sperm morphology there was no difference between study groups. The only clear difference between men with different smoking habits was in the percentual change in the sperm motility during 24 hours. At the time of first examination, the sperm motility was better (p less than 0.02) in heavy smokers than those who smoked less than 16 cigarettes per day and the motility decreased more rapidly (p less than 0.007) in heavy smokers than non-smokers. The objectively measured initial mean velocities of the whole sperm population and of the progressive spermatozoa were slightly higher in subgroup of smokers than in non-smokers. The rapid decrease in the survival spermatozoa in smokers may be uneconomical and harmful in respect of fertility.

PIP: The effect of cigarette smoking on conventional semen parameters was studied in voluntary men of reproductive age (n=190). Special attention was focused on sperm motility and its quantitative and qualitative change in vitro during the observation period. The sperm output was normal in both smokers (n=54) and nonsmokers (n=110), but semen volume was smaller (p 0.03) in heavy smokers ( 16 cigarettes/day) than nonsmokers. In sperm morphology there was no difference between study groups. The only clear difference between men with different smoking habits was in the % of change in sperm motility during 24 hours. At the time of 1st examination, sperm motility was better (p 0.02) in heavy smokers than those who smoked less than 16 cigarettes/day and the motility decreased more rapidly (p 0.007) in heavy smokers than nonsmokers. The objectively measured initial mean velocities of the entire sperm population and of the progressive spermatozoa were slightly higher in the subgroup of smokers than in that of nonsmokers. The rapid decrease in the survival spermatozoa in smokers may not be economical and may infact be harmful with regard to fertility.

Malignant fibrous histiocytoma of the vulva.

Malignant fibrous histiocytoma is a sarcoma that usually occurs in the extremities of elderly patients. Primary sarcomas of the vulva are extreme rarities. The most common vulvar sarcoma is leiomyosarcoma. Only two case reports on malignant fibrous histiocytoma in vulva have previously been published. It is a malignant tumor capable of metastasizing by hematogenous and lymphatic routes. The therapy of choice is radical surgery.

Acute effects of dihydralazine mesylate, furosemide, and metoprolol on maternal hemodynamics in pregnancy-induced hypertension.

The intervillous blood flow and other maternal hemodynamic parameters were assessed in 40 mothers with pregnancy-induced hypertension in late pregnancy before and after hypotensive treatment. Furosemide caused a significant decrease in the intervillous blood flow, whereas the effects of dihydralazine and metoprolol were both negative and positive, that is, more individual and diverse. These changes in the intervillous blood flow did not have any correlation with the changes in other maternal hemodynamic parameters. The importance of placental hemodynamic studies in the evaluation of hypotensive drugs is stressed.

Clinical assessment of the pelvic cavity and outlet.

A clinical assessment of the pelvic midplane (or cavity) and the pelvic outlet was made in 1,286 singleton pregnancies with a cephalic presentation of the fetus. 43 cases (3.4%) of pelvic contraction were excluded. The mothers were divided into two groups: those with an adequate pelvis and those with a borderline pelvis (18.6%). Those with a borderline pelvis were further subdivided into three categories: those with a borderline outlet, those with a borderline midplane and those with a borderline midplane and outlet. With a funnel pelvis the incidence of occiput posterior positions and vacuum extractions was three times as high and the duration of the first and the second stages of labor slightly longer when compared with those who had a normal pelvis. A borderline midplane seemed least harmful type with lower incidences of caesarean section and vacuum extraction, and a first stage of normal duration. Although birthweight had an effect on the duration of the first stage of labor in women with an ample pelvis, this was not the case with a borderline pelvis. The assessment of fetal weight therefore seems unnecessary in with a borderline midplane or outlet. With a borderline midpelvis and outlet the course of labor seemed normal in most cases. Clinical assessment of the midpelvis and the pelvic outlet seems to be the best method of measuring pelvic capacity.

Left-sided hydrothorax in connection with severe pre-eclampsia. Case reports.

Four cases of left-sided pleural hydrothorax in connection with severe pre-eclampsia are reported. In addition an increased formation of ascitic fluid was observed in the patients. A long-lasting bed rest in the left lateral recumbent position preceded the discovery of the roentgenologically verified pleural changes. Hypoproteinemia caused by the excretion of large amounts of protein in the urine seems to be a partial etiological factor aggravated by the renal retention of sodium and water. Pleural transudate disappeared spontaneously within two weeks from the delivery. In such cases, immediate diagnostic procedures, e.g. the exclusion of tuberculosis, are unnecessary. The authors think that the phenomenon is common in similar cases but usually remains undiagnosed.

Intrapartum rupture of uterus diagnosed by ultrasound: a case report.

A case of ruptured uterine scar of a previous cesarean section diagnosed by ultrasound is presented. Because of the severity of the complication and the great variation of symptoms in connection with it, the authors encourage the use of ultrasound screening in the detection of this rare, but often catastrophic complication.