Annales chirurgiae et gynaecologiae. Supplementum最新文献

Intrauterine intravascular transfusion is the most effective way of correcting the fetal haemoglobin level in severe rhesus haemolytic disease. Fetal anaemia should be corrected as early as possible before the development of hydrops and ascites. When required, the transfusion can be repeated several times. We present in this publication our own experience in a severe rhesus isoimmunization case, where the fetal haemoglobin level was corrected by a successful transfusion in the intra-abdominal part of the fetal umbilical vein in the 31st week of pregnancy and the child was delivered a week later by cesarean section.

A severe case of ulcerative, herpetic infection of the vagina and uterine cervix simulating cancer is described.

Body weight, fasting blood glucose (GP) (BFG), serum immunoreactive insulin (IRI), serum growth hormone (GH) and serum glycosylated proteins were longitudinally followed in 2 groups of women during two years' oral contraception. One group (n = 10) received a combination of 0.030 mg ethinylestradiol and 0.150 mg levonorgestrel and the other (n = 10) a combination of 0.030 mg ethinylestradiol and 0.150 mg of desogestrel. There was a significant increase in BFG during the study and the values were still rising, when examined 2 months after discontinuation of the pill. Two subjects, reaching the level of 5.5 mmol/l showed normal pretreatment values, when investigated one year later. After 6 months' use of either preparation, GH significantly increased, remained on that level throughout the study and returned to the pretreatment level after discontinuation of the pill. Body weight, IRI and GPP did not change significantly during the study.

Body weight, systolic and diastolic blood pressure and plasma renin activity (PRA) were longitudinally followed in two groups of women during 2 years' oral contraception. One group (n = 10) received a combination of 0.150 mg levonorgestrel plus 0.030 mg ethinyloestradiol and the other (n = 10) a combination of 0.150 mg desogestrel plus 0.030 mg ethinyloestradiol. Three subjects discontinued the study due to relocation. No statistically significant changes occurred in any of the measured parameters.

Pancreatic phospholipase A2 in human serum during pregnancy is within the normal range. In the amniotic fluid, the amount of immunoreactive pancreatic phospholipase A2 increases from 1.3 microgram/l at 16 weeks to 2.9 micrograms/l near term, but does not correlate with PLA2-activity. Meconium-stained amniotic fluid had highly elevated pancreatic, but not kinetic, PLA2. The fetal pancreas and its high PLA2-content may contribute to the progressive increase in uterine activity during human pregnancy.

The concentrations of vasopressin in the amniotic fluid were measured in 40 patients. The pregnancies were complicated by diabetes, toxemia or imminent premature delivery and in one case by polyhydramnion. The gestation time varied from 33 to 41 weeks. In addition, we measured vasopressin concentrations after transabdominal drainage of fetal bladder in three cases with urethral obstruction. Detectable concentrations of vasopressin in the amniotic fluid were found in all but four of the 40 cases observed. The vasopressin concentrations varied from 0.21 to 1.81 pg/ml. There were no systematic differences in the values in relation to duration of gestation or disease present. The highest vasopressin concentration was observed in the patient with polyhydramnion. No detectable amount of vasopressin was found in the urine of the three fetuses examined. The results suggest that, in contrast to earlier studies, the placenta may be permeable to small amounts of vasopressin or may itself be an origin of this hormone. The maternal complications present seem to have no effect of the vasopressin concentrations in the amniotic fluid.

The value of a single serum free estriol (E3) measurement in the detection of intrauterine growth retardation (IUGR) was investigated. Among the group of 40 mothers later giving birth to a growth retarded baby, E3 was low, i.g. below the level of two lower standard deviations of the mean values, in 9 cases. In the control group of 50 mothers with appropriately grown newborns, none of the E3 values was low. In a group of 42 mothers with a low E3 level, only 10 gave birth to a growth retarded baby. Hence, the sensitivity of a single E3 measurement to detect IUGR is 38%, the specificity 61% and the predictive value 37%. E3 measurement is neither efficient nor accurate in the detection of IUGR.

Forty-five women with an unfavourable cervix (cervical score less than 3) and an obstetric indication for delivery were given intracervical prostaglandin E2 (PGE2) gel 0.5 mg/3 g to prime the uterine cervix. Twenty-one women (47%) went into labour after PGE2 gel application only. In 13 women (29%) the cervical score sufficiently improved within 12 hours and labour was successfully induced with intravenous oxytocin. The rate of adverse effects was notably: there were two uterine ruptures, the rate of cesarean sections was 33%, hypertonic uterine contractility 25%, premature rupture of membranes 16%, and neonatal asphyxia 21%. In our experience, cervical ripening with PGE2 gel, although efficient, may also bring about complications, which appear partly iatrogenic. Therefore, a critical evaluation of indications and the risk/benefit ratio is required.

Clinical and laboratory studies were performed in 18 hirsute women for evaluation of the efficacy of spironolactone (S) therapy. Each patient received S 100 mg daily. The grade of hirsutism was assessed using a semiquantitative scale of Ferriman and Gallwey. Total testosterone, androstendione, dehydroepiandrosterone sulphate and sexhormone binding globulin were measured before initiation and after six months of therapy. A clinical response was seen in 12 women. The total score of hirsutism in the whole patient group was decreased from 14.1 +/- 6.3 (mean +/- S.D.) to 11.8 +/- 6.4 (p less than 0.01). No changes were found in the hormonal values. The findings of the present study confirm the efficacy of S in decreasing the hair growth by mainly a peripheral mode of action.