Aksel P. Lange

Can Pregnancy-Associated Plasma Protein A (Papp-A) Predict the Outcome of Pregnancy in Women with Threatened Abortion and Confirmed Fetal Viability?

Depressed pregnancy‐associated plasma protein A (PAPP‐A) concentrations have been found in patients with threatened abortion, often weeks before spontaneous abortion while the fetus was still alive. In order to extend these findings we have developed a highly sensitive PAPP‐A radio‐immunoassay and have established a reference range in early pregnancy for PAPP‐A between week 7 and week 20 of pregnancy, based on blood samples from 240 pregnant women. The gestational age was determined by ultrasound.

Hysterectomy in Danish women: Weight-related factors, psychologic factors, and life-style variables**

Objective To assess weight-related risk factors, psychologic factors, and life-styles of importance for hysterectomy performed for benign conditions. Methods In a prevalence study, 2301 Danish women aged 30, 40, 50, or 60 years were selected at random in 1982, and self-report questionnaires were collected from 77%. Information about weight and dieting history, life-style, psychologic factors, gynecologic history, and social background were recorded. Weight, height, and plasma lipids were measured. In an incidence study, the cohort was followed during 1982–1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used to analyze the data. Results In the prevalence study, weight cycling (recurrent weight loss and weight gain of more than 5 kg) was associated with hysterectomy for benign disease (odds ratio 1.77, 95% confidence interval [CI] 1.05–2.99) by multivariate analysis independent of overweight, smoking, psychologic factors, social factors, and gynecologic characteristics. In the incidence study, all the weight-related factors except slimming diets were significant risk factors for hysterectomy performed recently for benign disease in women under age 50. In the multivariate analysis, weight cycling was the only significant weight-related factor (relative risk 2.49, 95% CI 1.10–5.60), explaining the relation between hysterectomy and psychologic factors. Coffee, tea, alcohol, smoking, and plasma lipids were not related to hysterectomy in either study. Conclusion Weight cycling might be an important risk factor for premenopausal hysterectomy performed for benign conditions. Whether weight cycling causes menstrual irregularities and leiomyomas, these results give us a better understanding of the pathways to hysterectomy.

Prostaglandins as abortifacients in Denmark.

Within the last few years intra-amniotic (i.a.) instillation of prostaglandin F2 alpha (PGF2 alpha) has become the predominant method of second-trimester abortion in Denmark. The method is employed by nearly all the gynecological departments, where approximately 500 such procedures are carried out annually. Our own investigations have demonstrated that it is necessary to be somewhat restrictive in the administration of supplementary intravenous infusion of oxytocin. It is pointed out, illustrated by four case histories, that there is a potential risk of greater or smaller quantities of i.a. PGF2 alpha accidentally passing during the procedure to the circulation of the patient. This may result in circulatory collapse, among other things, possibly as a result of acute pulmonary hypertension. A number of safety measures are suggested to minimize this risk and to ensure effective treatment should such complications occur.

Smoking habits and maternal serum a‐fetoprotein levels during the second trimester of pregnancy

Summary. In a prospective study the influence of cigarette smoking on maternal serum a‐fetoprotein levels at 16 weeks gestation was examined. Significantly higher levels were found in 120 smokers compared with 138 non‐smokers (median 54.0 and 44.3 μg/1 respectively, P<0.001). No difference in maternal body weight between the two groups could account for the results. The possibility of smoking‐induced increased permeability of the placental barrier is discussed.

elevated Maternal Serum Alpha-fetoprotein Caused by Midtrimester Amniocentesis : a Prognostic Factor

In a prospective investigation, 247 patients underwent ultrasonically guided midtrimester amniocentesis. Maternal serum alpha-fetoprotein (AFP) was measured before and after the procedure. In 229 patients, preamniocentesis AFP exceeded 19 micrograms/liter. Forty-eight (21.0%) of these displayed a significant elevation of AFP induced by the procedure, indicating fetal-maternal bleeding. This event was correlated with anterior placental location (P less than .025) and was followed by a significantly reduced mean fetal birth weight (3143 versus 3385 g, P less than .05). In addition, a nonsignificant (.10 less than P less than .20) doubling of the risk of giving birth to a child small for gestational age was observed. These findings suggest that amniocentesis represents a potential hazard to the fetus. The implications in relation to the widening indications for amniocentesis are discussed.

Serum Levels of Human Placental Lactogen During and After Prenatal Dexamethasone Therapy

Thirteen pregnant women were treated with 4 mg dexamethasone intramuscularly, three times daily, for seven days during the last trimester of pregnancy, in order to prevent the respiratory distress syndrome (RDS) in the neonate. Determination of human placental lactogen (HPL) was made daily during the treatment and at intervals of 2–3 days afterwards. No changes in HPL were seen during the treatment. One week after the treatment had been stopped, a statistically significant decrease in HPL was observed (p<0.01). The levels returned to normal during the following week. It is presumed, that the observed decrease in HPL may be regarded as a result of a direct depression of placental function caused by the dexamethasone therapy.

Pregnancy in a Non‐Communicating, Rudimentary Uterine Horn with a Successful Outcome

Developmental anomalies in the Milllerian ducts are well known. The incidence of uterine malformations has been calculated to 1:1500 (6). They can give rise to problems such as infertility and dysmenorrhea, as well as obstetrical complications (5 ) . Pregnancy in a non-communicating rudimentary horn of a bicornuate uterus will almost invariably be fatal to the fetus and also result in a considerable risk to the pregnant woman. Less than 5% of the reported cases have been correctly diagnosed preoperatively

Prediction of the time of delivery by means of ultrasonic scanning between the 20th and 30th weeks of pregnancy

Abstract. Ultrasonic scanning, with measurement of the biparietal diameter, during the 20th and 30th weeks of pregnancy, has been carried out on 738 women with an uncomplicated pregnancy and spontaneous delivery of a healthy child, weighing more than 2 500 g. The time of delivery was thereafter calculated by means of a reference curve.

Comparison of Extra-Amniotic Administration of PGF2α, 0.9 Per Cent Saline, and 20 Per Cent Saline Followed by Oxytocin for Therapeutic Abortion

Abstract. 168 patients between 1Oth and 18th week of pregnancy admitted to hospital for legal abortion were treated accordingly to three different protocols.