Prenatal diagnosis of urinary tract anomalies. The value of two ultrasound examinations.

OBJECTIVE: To determine when fetal urinary tract anomalies were detected by ultrasound screening during pregnancy and to discuss the possible consequences if only one early ultrasound examination is performed. DESIGN: A retrospective study of 47 cases where fetal urinary tract malformations were diagnosed in a two-stage screening program (17th and 32nd week of gestation) covering 22,310 women over ten years, 1982-91. SETTING: Ullevål University Hospital in Oslo which serves as a referral center for obstetric and neonatal diseases. RESULTS: Urinary tract anomalies were diagnosed in 0.18% of the pregnancies. Of these, 61.7% were found at the second routine ultrasound screening. The most difficult differential diagnoses were those of hydronephrosis without megaureter and a multicystic kidney. Hydronephrosis was found in 51% and a multicystic kidney in 21% of the cases. The tentative prenatal diagnoses were confirmed postnatally in 83% of the cases. Six of the fetuses had anomalies regarded as incompatible with postnatal life. These pregnancies were terminated, and the diagnoses verified by autopsy. Two other infants died perinatally, one of them as a result of the urinary tract anomalies. CONCLUSION: If only one ultrasound scanning had been performed in the 17th week, approximately two-thirds of the cases would not have been detected. Early intervention and follow-up after delivery would only have been performed if the infants had developed symptoms or complications related to the urinary tract anomalies.

[External cephalic version of breech presentation]. / Ytre vending av foster i seteleie.

External cephalic version of the breech presentation has long traditions. Earlier this was practised to improve the baby's prognosis. Today most breech presentations are delivered by Caesarean section, and external cephalic version of the breech presentation is done to reduce the number of Caesarean sections. External cephalic version of breech presentation reduces the total rate of Caesarean sections by 1-2%. If the breech deliveries are carefully selected at term, they become comparable with cephalic presentation, both in terms of mortality and morbidity. Although the complications associated with external cephalic version of the breech presentation are considered minimal they cannot be ruled out. Therefore systematic external cephalic version of the breech presentation should not be encouraged.

[Pregnancy and labor in HIV-positive women. Experiences from the Department of Obstetrics and Gynecology, Ullevål hospital]. / Svangerskap og fødsel hos HIV-positive kvinner. Erfaring fra Kvinneklinikken, Ullevål sykehus.

21 HIV positive women have given birth at Ullevål Hospital. Initially this category consisted of drug addicts infected by hypodermic needles, but in the last few years, most of the women were infected heterosexually. Maternity check-ups should be performed in cooperation with internists. Because of the danger of reduced immunity, test cultures should be taken from the cervix, and blood should be tested for antibodies against different viruses and toxoplasmosis. An ultrasound examination in addition to the one performed as a routine in Norway should be performed towards the end of the pregnancy, to monitor foetal growth. The average length of pregnancy was 39 weeks. Five infants were delivered by Caesarean section, while 16 infants were delivered vaginally. All the infants were in good condition after delivery, but the average length and weight were below normal.

[Emergency obstetrics]. / Akutt obstetrikk.

Sudden bleeding in the advanced stage of pregnancy is usually caused by abruptio placentae. Pre-eclampsia may develop rapidly into eclampsia and should lead to immediate hospitalization of the patient. A pregnant woman suffering from high blood pressure, headaches and epigastric pains, might be developing the life threatening HELLP syndrome. Sudden labour at term, either at home or in the ambulance, does not usually involve major complications. Hypothermia of the newborn baby should be avoided by drying it and placing it at the mother's breast. The umbilical chord is cut at the obstetrical department.

[Infections after cesarean section]. / Infeksjoner etter keisersnitt.

Post-operative infectious morbidity was recorded in 390 patients who delivered by Caesarean section. The patients were observed closely while in hospital. Upon leaving the hospital, each was given a questionnaire, which was answered by 350 (89.7%). 10% of the patients had experienced post-operative infections, the most frequent being infections of the urinary tract or of wounds. There was no significant difference in post-operative infectious morbidity in the case of elective as against emergency Caesarean section. This may have been due to the use of prophylactic antibiotics in many cases of emergency Caesarean section. Only 28.6% of the infections were diagnosed during hospitalization. Therefore, many infections following Caesarean section are diagnosed after the patient has been discharged from hospital.

[Ultrasonic examinations of pregnant women--ethical reflections]. / Ultralydundersøkelse av gravide--etiske betraktninger.

Foetal diagnostics has changed prenatal checkups beyond the point of no return. The practice of offering ultrasound screening involves great responsibility. Routine ultrasound screening requires a high level of competency. Four main ethical issues are discussed; life or death, malformations, the foetus as patient, and the feotus as donor. Other issues discussed are verifying the diagnosis of death, how to inform the parents, procedures in connection with pathological findings, procedures in connection with stillbirth, and the legal rights of the foetus, as well as three recommendations focussing on the above-mentioned issues. A forthcoming bill to the Storting is expected to draw public attention to these issues.

Changes in the use of intoxicants after onset of pregnancy.

A sample of 416 pregnant women were interviewed with emphasis on their use of alcohol, tobacco, and legally prescribed and illegal drugs before and after onset of pregnancy. The results indicate a significant reduction in alcohol consumption, tobacco smoking and the use of legally prescribed and illegal drugs in connection with the pregnancy. There was no correlation between socio-economic level and use of intoxicants. There was a correlation, however, between the use of intoxicants by the pregnant women and the use of such substances by other significant persons in their environment.

The excretion of zopiclone into breast milk.

1. The excretion of zopiclone into breast milk was studied in 12 lactating women in the early postpartum period following the oral administration of a single zopiclone tablet (7.5 mg). 2. The milk/plasma AUC ratio of zopiclone was 0.51 +/- 0.09 (mean +/- s.d.). Individual mean milk/plasma concentration ratios of zopiclone showed significant interindividual variation (range 0.41-0.70). 3. A comparison of pharmacokinetic parameters in the postpartum women with those reported previously in non-pregnant women, showed significantly higher Cmax values in the lactating mothers; tmax occurred later in milk than in maternal plasma. 4. Assuming a daily milk intake of 0.15 l kg-1 and 100% absorption the average infant dose of zopiclone in milk would be 1.4% of the weight adjusted dose ingested by the mother.

Ampicillin in breast milk during puerperal infections.

Low concentrations of ampicillin were found in colostrum/breast milk from 6 mothers treated with pivampicillin 1.05 to 2.1 g daily during the first to eighth day postpartum in the maternity ward. It was calculated that the breast-fed infant could theoretically receive 0.05-0.37% of the dose/kg given to the mother. It is concluded that direct exposure of the breast-fed infant suckling from a mother under treatment with ampicillin or pivampicillin seems to be minimal.

Ripening of the cervix with prostaglandin E2-gel. A randomized study with a new ready-to-use compound of triacetin-prostaglandin-E2-gel.

A randomized study with a group of patients treated with a new ready-to-use triacetin-prostaglandin E2-gel compared to a non-treated group was conducted. The gel-treated group showed a distinct difference in cervical score after 12 h and ten patients were delivered during this period without further induction attempt compared to none in the control group. There was a significantly lower need for oxytocin stimulation in the treated group (P less than 0.0005), but there was no difference in the cesarean section rate or instrumental delivery rate. No side-effects were seen. This new gel seems effective and safe.

Plasma lactoferrin measured by an enzyme-linked immunosorbent assay (ELISA). Measurements on adult and infant plasma.

The lactoferrin content of human plasma has been measured by an enzyme-linked immunosorbent assay. In cord blood the level was 0.02-0.3 mg/l, corresponding to 3-44 X 10-(10) mol/l lactoferrin; in plasma 5 d post partum the level had not changed. In adults the level was 0.02-0.2 in 29 out of 30 plasma samples and above 1 mg/l in 1 sample. Similar results were obtained with EDTA, citrate or heparin as anti-coagulant.

A prospective randomized study of induction of labor.

In a prospective randomized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant. The study consists of 166 normal patients at full term. No significant differences between the two groups were found, and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus. It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy.

High potential for breast feeding among mothers giving birth to pre-term infants.

PIP: An investigation was conducted to compare duration of lactation in mothers giving birth to preterm infants vis-a-vis mothers giving birth to healthy full-term infants. A written questionnaire was mailed to all Norwegian women whose preterm infants were admitted to the Neonatal Unit, Department of Pediatrics, Ulleval Hospital over the 1978-80 period. The same questionnaire was mailed to an equal number of Norwegian women who gave birth to healthy full-term infants at the Ulleval Hospital. The control group consisted of the 1st mothers with uncomplicated full-term vaginal deliveries on the same days as the preterm deliveries. There were 155 mothers in each group. There were 100 completed questionnaires from the preterm group and 108 from the full-term group. Significantly more women who gave birth at term were able to breastfeed their infants completely at discharge from the nursery, compared with women who gave birth to preterm infants, whereas more of the preterm mothers partly breastfed their infants. In the preterm group no correlation was found between duration of breastfeeding and the infants' birth weight or between duration of breastfeeding and gestational age. Although a higher potential for breastfeeding existed in the full-term group, a high percentage of the preterm mothers succeeded in breastfeeding. Of the preterm infants, 61% were breastfed (wholly or in part) for 3 months, 45% for 6 months, and 21% for 9 months. The corresponding figures for full-term infants were 83%, 59%, and 38%. The figures for duration of breastfeeding among mothers giving birth to healthy full-term infants in the present investigation were significantly higher than in similar investigations performed during 1976-1977. A high potential for breastfeeding existed in women giving birth to preterm infants referred to the Neonatal Unit. This may be taken as biological evidence for human milk as a physiological basis for nutrition of preterm infants. The separation trauma after admission of a preterm infant to a neonatal care unit does not necessarily impair the mother's ability to breastfeed, and it may be more important that attitudes and practical routines in nurseries and neonatal care units support these women in sustaining lactation.^ieng