Christina Somell

Catecholamine metabolites in amniotic fluid as indicators of intrauterine stress.

The catecholamine metabolites HMPG and VMA have been determined in samples of amniotic fluid in 38 uncomplicated pregnancies, seven cases of IUGR, and six cases of diabetes. A successive increase of HMPG and VMA was found toward the end of the pregnancy. HMPG and particularly the HMPG/VMA ratio were significantly higher in the amniotic fluid of the growth-retarded fetuses than in the uncomplicated cases. No significant difference was found between the diabetic and uncomplicated cases.

Termination of early human pregnancy with Epostane

Fifty-six healthy women, with a gestational length of less than 49 days from the last menstrual period, who requested termination of pregnancy were treated with Epostane, a progesterone synthesis inhibitor. Epostane, which competitively inhibits the 3 beta-hydroxy steroid dehydrogenase enzyme system, was given in the dose 200 mg X 4 for seven days. Physical examination, routine laboratory screening and determination of hCG, progesterone, estradiol and cortisol was performed on days 0, 7 and 14. The treatment resulted in 84% complete abortions (90% among women completing therapy). Two women experienced vaginal bleeding only, while 7 were non-responders. Among subjective side effects nausea dominated totally and was also the reason for discontinuation in 4 cases. The average length of bleeding among women with complete abortions was 10.7 days and the decrease in hemoglobin and hematocrit was very slight. Routine laboratory values remained within the normal range. Cortisol levels were elevated on day 7 compared to days 0 and 14, but all single values were within the normal limits.

Reproductive hormones during termination of early pregnancy with mifepristone.

Thirteen women received a single oral dose of 600 mg mifepristone (RU486; Roussel-Uclaf, Paris, France) on day 0 to induce first-trimester abortion. Eleven women had a complete abortion, and 2 had a continuing pregnancy and were considered as failures. Plasma levels of human chorionic gonadotropin (hCG) increased from day 0 in all women, but dropped sharply after day 3 in women with successfully induced abortion. In these women, the levels of progesterone, 17 alpha-hydroxyprogesterone and estradiol-17 beta increased from day 0 to day 1 and then dropped. In the 2 failed inductions, the steroid levels remained virtually unchanged. In the complete abortions, the main prostaglandin F2 alpha metabolite, 15-keto-13,14-dihydro-PGF2 alpha, increased to a significant peak at day 6 followed by a significant fall to day 14. These findings supports a direct effect of mifepristone on the decidua, initiating prostaglandin synthesis. It is also suggested that there is a luteolytic effect of prostaglandin F2 alpha, as the levels of corpus luteum steroids started to fall before the drop in hCG.

Induction of abortion in early pregnancy with mifepristone.

Seventy women requesting first trimester abortion and with amenorrhea of less than 42 days were treated with a single 600-mg dose of mifepristone. Mifepristone is a synthetic 19-norsteroid with strong progesterone receptor antagonist properties. Complete abortion was achieved in 56 women (80%), 2 women (3%) had an incomplete abortion and 12 women (17%) had a continuing pregnancy. No relationship between rate of success and gestational age could be demonstrated. There was no serious side effects and the treatment was favorably received by the women concerned. It is concluded that this treatment is a safe and very acceptable alternative to vacuum aspiration for termination of early pregnancy.

Induction of abortion in early pregnancy with mifepristone in conjunction with gemeprost

This study was performed to investigate the efficacy of oral mifepristone and vaginal gemeprost for termination of early pregnancy. Eighty women requesting first trimester abortion and with amenorrhea of less than 56 days were included. Gestational age was confirmed with ultrasonography. Mifepristone was administered as a single 600 mg dose followed after 48 hours by a vaginal pessary containing 1 mg gemeprost. One woman did not return for gemeprost and later had a vacuum aspiration performed. There was complete abortion in all remaining women. No serious side effects were registered and the number of women requiring opioid analgesia was low (8%). The conclusion is that this treatment is a genuine alternative to vacuum aspiration but medical supervision is necessary for some time after gemeprost administration.

Cervical dilatation with meteneprost vaginal suppositories in first trimester abortion.

Forty nulliparous women were treated with vaginal suppositories containing Meteneprost (9-deoxo-16, 16-dimethyl-9-methylene PGE2) (Upjohn Co.) 10 mg or placebo prior to termination of first trimester pregnancy in a double-blind study. The suppository was inserted three hours before vacuum aspiration. The cervical diameter as measured by the size of the largest Hegar dilatator inserted without resistance was significantly larger in women treated with Meteneprost. The operative blood loss was also reduced in the Meteneprost group.

Dilatation of the Cervix by Oral PGE2 Before First-Trimester Termination of Pregnancy

Abstract. Twentyfour patients—all primigravidae with an especially narrow, rigid cervix were given PGE2 tablets or placebo tablets in order to prime the cervix before first trimester termination of pregnancy. 1.5 mg PGE2 or placebo tablets were administered hourly for 12 hours on the day before vacuum aspiration. The diameter of the cervix was measured by means of a Hegar dilator prior to administering the tablets and also before the vacuum aspiration the following day. The plasma level of 15‐keto‐13,14‐dihydro‐PGF2α was determined before the treatment and again before the vacuum aspiration. All the 12 patients treated with PGE2 tablets had an average change in cervix diameter of 2 mm, whereas in the placebo group the average change was 0.58 mm.

Priming and Induction of Labor with Oral PGE2 in Patients with Low Bishop Score

Abstract. Oral prostaglandin in hourly doses of 0.5 mg PGE2 was given to 58 patients with an initial Bishop score of five or less, for two 12‐hour periods in order to prime the cervix. After priming, the patients were induced with oral PGE2; 90% of these patients were delivered. In a control group comprising 59 patients induced with oxytocin, the delivery rate was only 51%.

Diagnosis in Utero of Congenital Hydrocephalus by Sonography and Computerized Tomography

Abstract. Four patients with suspected fetal hydrocephalus in utero were examined by means of sonography and computerized tomography (CT). The diagnosis was confirmed in 3 cases, while the fourth was found to be normal. The mean radiation dose absorbed by the maternal ovaries was estimated by phantom measurements.

Rhythmic changes in estriol excretion during pregnancy

Different biologic rhythms with effect on one and the same parameter may cause a complicated signal pattern in which no regularity can be visually identified. In this study an autocorrelation function approach, well established in the interpretation of electroencephalograms, was shown to be applicable also in the interpretation of processes with few points of observation. This technique, used on the excretion of estriol in urine, reveals several rhythms with wavelengths between 6 and 72 hours. Interference between these signals may explain the irregular visual appearance of plots of subsequent estriol determinations and the considerable rise and fall of urinary estriol excretion during pregnancy. The presence of two independent sources of the rhythms is suggested. It is concluded that the complicated and individual rhythmic changes in urinary excretion of estriol results in a low diagnostic specificity for fetoplacental malfunction of this component.