Ambivalence towards parenthood among pregnant women and their men.

369 pregnant women and 345 expectant fathers visiting antenatal clinics were examined by a questionnaire concerning attitudes towards pregnancy and parenthood. Data were processed by factor analysis and the degree of agreement to important factors was estimated. Attitudes were dominated by two conflicting views: children mean existential satisfaction and children mean restriction of freedom for women as well as for men. There was a tendency to deny the items concerning the disadvantages of having children. An important factor in the women's as well as in the men's analysis was the importance of own parents as models in parenthood. The findings from this unselected population of pregnant women and their men are consistent with earlier in-depth interviews. It can be concluded that ambivalence should be regarded as a normal constituent of the adaptation to pregnancy and parenthood. Experiences of own parents play an important role in the transition to parenthood. An important task for the medical profession should be to inform about ambivalence as a normal phenomenon as it, left unaccepted, may cause unnecessary anxiety and feelings of guilt.

Decrease in serum concentration of 5 alpha-pregnane-3,20-dione prior to spontaneous labor.

Serum 5 alpha-pregnane-3,20-dione (5 alpha DHP) and progesterone (P) concentrations before spontaneous labor were studied in 13 women whose pregnancy and delivery were uncomplicated. Blood samples were drawn twice weekly from the 36th week of gestation up to the onset of spontaneous labor. P and 5 alpha DHP values were analysed by applying RIA methods. Mean serum 5 alpha DHP concentrations declined significantly during the last week of pregnancy, from 135 +/- 12 nmol/l 5 days prior to spontaneous labor, to 111 +/- 10 nmol/l on the day spontaneous labor started (p less than 0.005). No significant changes in progesterone concentration occurred during the observation period. These results suggest a change in 5 alpha DHP production preceding the onset of spontaneous labor.

Reduced mortality in cancer patients after administration of alkoxyglycerols.

A regression of tumor growth is observed when alkoxyglycerols are administered prior to radiation treatment of patients suffering from cancer of the uterine cervix. This regression is remarkably higher for patients below the age of 60 years than for those over 60. The regression has been demonstrated by a change in the quotient between the incidence of early and advanced stages.

Effect of intraperitoneal instillation of 32% dextran 70 on postoperative adhesion formation after tubal surgery.

The intraperitoneal instillation of 32% dextran 70 (HyskonR, Pharmacia AB, Sweden) has previously been reported to prevent the formation of postoperative adhesions. Against this background, the present study was undertaken to evaluate the efficacy of HyskonR in counteracting peritoneal adhesions following tubal microsurgery. 105 infertile women were operated upon in a prospective, randomized, controlled, double-blind, multicenter study. The intra-abdominal adhesions present from the beginning were classified by means of a standardized scoring scale and the extent of adhesions was again evaluated at follow-up laparoscopy 4-10 weeks later. A reduction in the extent of the intra-abdominal adhesions (statistically highly significant) was revealed in both the Hyskon group and the saline control group. The extent of adhesions in the Hyskon group was not lesser than in the saline group, however. The pregnancy rates in the two groups were also similar.

Prenatal diagnosis of conjoined twins (diprosopus) with myelomeningocele.

Conjoined twins (diprosopus) with a neural tube defect were diagnosed by ultrasound, alphafetoprotein and acetylcholinesterase in the 18th week of gestation.

Effect of the naturally occurring prostaglandins E2 and F2 alpha on the human myometrium in vivo during pregnancy.

Hysterometry has been used to evaluate the effect on the human myometrium in vivo during early pregnancy of the naturally occurring prostaglandins E2 and F2 alpha. The hystermetric technique is based upon the fact that mechanical distension of smooth muscle induces contraction. According to the analysis of the contractile responses, the effects of the agents have been determined quantitatively. The drug effects have been characterized by changes in myometrial response between registrations under basic conditions and during the infusion of the active agent, respectively. It was found that when these drugs were given in the doses usually employed in clinical practice, the effect on contractility of the PGF2 alpha compound was more pronounced than that of the PGE2. However, when describing the results on a microgram basis, the PGE2 was confirmed to be more potent than the PGF2 alpha by a factor of up to 7-8.

Maternal deaths related to abortions in Sweden, 1931-1980.

Deaths related to abortion accounted for 20% of all maternal mortality in Sweden during the period 1931-80. The risk of dying as a consequence of abortion, per 100,000 pregnancies, declined with a factor of 160 during the study period. Three main reasons for the improvement are discussed. The introduction of antibiotics reduced mortality due to illegal abortions, but during the 1950s and 1960s sepsis and air embolism resulting from illegal abortion still accounted for the bulk of the abortional mortality. Liberal legislation and abortional practice subsequently eliminated illegal abortions, and resulted in a more accurate and favorable statistical distribution of abortions by pregnancy week. This together with new technology reduced the legal abortions mortality rate to one-fiftieth over the last 30 years even though the number of legal abortions increased 7-fold.

The decline in maternal mortality in Sweden, 1931-1980.

Maternal mortality in Sweden has declined steeply over the past 50 years. The reasons for this gratifying trend have been analysed. A decreasing incidence of complications during pregnancy and delivery, together with a lower case fatality rate from complications have been found to account for the major part of the reduction in maternal mortality in Sweden. This has been achieved by improvements in obstetrical and antenatal care, by the introduction of antibiotics and blood transfusion, and by a favorable shift to more appropriate ages for reproduction.

Effect of pharmacologically active agents upon the human myometrium in vivo. Theoretical and technical aspects.

Smooth muscle is capable of contracting in response to mechanical distension. Even though the structural basis for this phenomenon is not completely clear, a method has been designed by which the contractile response to mechanical distension of the human uterine muscle can be determined in vivo. The distension is enforced sinusoidally within the frequency range 0.006-1 Hz, by filling and emptying a rubber balloon introduced into the uterine cavity. A tonometric index of the myometrium is defined using Hook's law after the approximate evaluation of a contratile modulus and the tangential stress and strain in the innermost layer of the uterine wall. The regression lines of tonometric indices upon frequency are determined and intercepts of the equations for basic conditions are compared with those obtained during the administration of pharmacologically active agents. In a pilot study, this system, now modified for the evaluation of drug effects during early pregnancy, has been tested and found reliable.

Cardiotocographic distortion of fetal heart rate variability. Theoretical considerations and exemplification by computerized simulation.

The error arising when evaluating FHR variability on CTG curves is demonstrated. Visual estimation is based on the appreciation of oscillation amplitude (O.A.) which is necessarily dependent on basic heart frequency and the changes therein. It reflects variability in a distorted way--the distortion can be as great as 33% even when the basic heart frequency remains within the normal range of 120-160 beats per minute.

Amniotic fluid embolism in Sweden, 1951-1980.

Amniotic fluid embolism is one of the least frequent complications of parturition, but the most dangerous of all. 38 cases of fatal amniotic fluid embolism were diagnosed in Sweden during the years 1951-1980, i.e. 1 case for every 83,000 live births. The proportion of amniotic fluid embolism in maternal mortality as a whole increased from 1.2 to 16.5% during this period. Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure. The main symptoms were cardiovascular shock with right heart strain, and hemorrhage with pathologic proteolysis. Four cases of presumed amniotic fluid embolism with survival of the patient were diagnosed during the years 1972-1980--a case fatality rate of 66% (4/12).

Utero-placental blood flow and the effect of beta 2-adrenoceptor stimulating drugs.

The immediate effect of a beta 2-adrenoceptor stimulating drug, salbutamol, on utero-placental blood flow in the last trimester of pregnancy was evaluated in 16 women without uterine contractions, using a method applying 113-m Indium and a computer-linked gamma camera. Serial scintigrams over the placental site showed a 15 per cent increase in activity during a short salbutamol infusion, denoting an augmented blood pool in the intervillous space. At the end of a 25--30 min salbutamol infusion, a mean prolongation of the rise time of the isotope accumulation curve by 100 per cent could be calculated. A utero-placental blood flow index derived from the ratio of the maximum activity and the rise time of the accumulation curve above the placenta showed a decrease ranging from 18 to 50 per cent. It is conceivable that this initial decrease would disappear during continued infusion, as has been shown to occur in the pregnant sheep model.

Adjunctive radiation therapy in the management of stage I cancer of the endometrium.

One hundred fifty-two patients with stage I, grades 2 and 3 adenocarcinoma of the endometrium, treated in 1972 and 1973 at the Radiumhemmet, are presented. Two uterine packings followed at 4 to 6 weeks by total abdominal hysterectomy and bilateral salpingo-oophorectomy resulted in a 5-year survival of 89%, whereas patients treated primarily with surgery followed by vaginal cylinder irradiation demonstrated 90% survival. Patients in both groups received whole pelvis irradiation postoperatively for deep myometrial invasion (more than 50% invasion by viable tumor). Patients treated with radiation therapy alone had 57% survival. Optimal results in poorly differentiated (grade 3) carcinoma of the endometrium were achieved with preoperative packings (90% survival); only 12% of the patients required external radiation therapy postoperatively.

Effect of salbutamol on the non-pregnant human uterus in vivo. A hysterometric study in dysmenorrheic women.

Uterine tonicity has been determined by means of hysterometry on the first day of menstruation in 5 women with severe primary dysmenorrhea. The effect of intravenous infusion of salbutamol in a dose of 10 microgram/min was evaluated. The results indicate that this beta 2-receptor stimulating agent is capable of eliciting a marked decrease in uterine tonicity in dysmenorrheic women. The diminished uterine tonicity was closely associated with pain relief.

Uterine tonicity in proliferative and secretory phases of the menstrual cycle.

Hysterometry, a method for the quantitative evaluation of drug effect on the myometrium, has now been applied in a study of the changes in uterine tonicity during the menstrual cycle. Six nulli-gravidae women with regular menstrual periods and normal gynecological examination findings, were studied. Hysterometry was performed in the midproliferative, ovulatory, and midsecretory periods of the cycle and on the first day of menstruation. Uterine tonicity was found to be higher during the proliferative compared with the secretory phase. The change in uterine tonicity was correlated with a change in the quotient of concentration of estradiol and progesterone in serum (E2/P).

Effect of an oral contraceptive on uterine tonicity in women with primary dysmenorrhea.

Hysterometry, a method for quantitative evaluation of the effect of pharmacologically active agents on the myometrium, has been applied to determine the effect of an oral contraceptive on uterine tonicity. Hysterometry was performed on the first day of each of two consecutive menstrual periods in 5 dysmenorrheic women. During the second cycle the women were given ethinylestradiol 50 microgram and lynestrenol 1 mg per day for 22 days. After the intake of this oral contraceptive, uterine tonicity decreased in all women, the decrease being accompanied by relief of dysmenorrheic pain.

PIP: The study objective was to determine uterine tonicity quantitatively by hysterometry--a method for quantitative evaluation of the effect of pharmacologically active agents on the myometrium--during menstruation in dysmenorrheic women, with special regard to the effect of an oral contraceptive (OC). 5 volunteers with severe primary dysmenorrhea were studied. The age range of these nulligravida was 17-25 years. All had normal menstrual periods and normal findings on gynecological examination. Hysterometry was performed on the 1st day of each of 2 consecutive menstrual periods, the 1st occurring after a non-medicated cycle and the 2nd after the use of an OC, ethinylestradiol 50 mc + lynestrenol 1 mg. Medication was started on the 5th day of the menstruation period and lasted 22 days. The women were instructed to register any side effects of the medication as well as the effect on the menstrual pain. All the women had severe menstrual pain before the treatment with OC. After the treatment daily for 22 days, 2 women had no pain at all and 3 only mild pain during the 1st day of the menstruation. Hysterometry on the 1st day of dysmenorrheic menstruation resulted in tonicity values (intercepts) between 110 and 217, mean 158. Hysterometry on the 1st day of bleeding after treatment with the OC resulted in tonicity values between 91 and 167, mean 117. There was almost a significant differences between the untreated and treated situations. The women who had the most marked decrease in uterine tonicity had no menstrual pain after the treatment; women who had the least decrease had mild menstrual pain during the 1st day of menstruation.

Determination of tonicity in the non pregnant human uterus in vivo.

The method hysterometry has been designed for the study of the effect upon the uterine muscle of pharmacologically active agents. Hysterometry has earlier been used on the pregnant uterus and is now described for the non-pregnant situation. The capacity of the technique is exemplified with results achieved in a study of the effect of prostaglandin synthetase inhibitors and beta-receptor stimulating agents during dysmenorrhea.