Jens Wessel

Frequency of denial of pregnancy: results and epidemiological significance of a 1‐year prospective study in Berlin

Background.  There has been an increasing number of reports on denial of pregnancy. However, only very few studies have involved a large number of patients. To date, no reliable calculation of this conditions general frequency, also from an epidemiological perspective, has been available.

Elevation of interleukin‐6 levels in cervical secretions as a predictor of preterm delivery

Background. The objective of this study was to evaluate the predictive value of interleukin‐6 (IL‐6) in cervical secretions for preterm delivery before 34+0 gestational weeks in patients with preterm labor.

Frequency and significance of preterm delivery in twin pregnancies.

Objective: We investigated the frequency of preterm delivery and its influence on the neonatal outcome in twin pregnancies at a perinatal center. Are there differences in the course of twin pregnancies with preterm or term delivery? Method: A retrospective investigation was carried out at the Department of Obstetrics on 502 twin pregnancies and deliveries between 1978 and 1993. Pregnancy history and clinical parameters were compared among preterm (<37+0 weeks) and term deliveries. Result: Median duration of all twin pregnancies was 36+3 weeks of gestation. In the preterm group, preterm labor was more frequent, both, the first and the second neonate had lower birth weight and were more often admitted to the neonatal intensive care unit (NICU) where they stayed longer than full‐term neonates needing intensive care. Perinatal deaths occurred only in the preterm group. Conclusions: The incidence of preterm delivery is significantly elevated in twin pregnancies and consequently the incidence of low‐ and very‐low‐birth‐weight‐infants and perinatal mortality. Preterm delivery is the main reason why twin pregnancies are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs.

Denial of pregnancy - characteristics of women at risk

Background. Denial of pregnancy is a womans subjective lack of awareness of being pregnant. Denial throughout most of gestation or until delivery may be associated with significant risks for both mother and fetus. We wanted to investigate if maternal characteristics were useful in order to identify women at risk. Methods. A 1‐year prospective study was performed to recruit all women with denied pregnancies in Berlin, Germany. Maternal parameters were analysed and sociodemographic variables were compared with the regional birth register. Results. Sixty‐five women were recruited. Maternal age was between 15 and 44 years (median 27 years). Only 21 women had never been pregnant before. A large majority (83%) had a close partner. Three women had a psychiatric diagnosis of schizophrenia, and only one a current abuse of analgesics/tranquilizer. Conclusions. The group of women with denied pregnancy was heterogeneous, and a clear‐cut typology of a ‘pregnancy denier’ could not be established.

Pregnancy and delivery in a patient with mutilating dystrophic epidermolysis bullosa (Hallopeau-Siemens type)

Background Epidermolysis bullosa dystrophica of the mutilating Hallopeau-Siemens type is a rare inherited skin disease. Those afflicted have blisters and pronounced scarring of skin and mucous membranes after minor trauma. Pregnancies are very rare in affected women. Case A 24-year-old woman, gravida 1, with a severe form of the Hallopeau-Siemens type was monitored closely during pregnancy. The patient spontaneously delivered a healthy female neonate at term. Episiotomy wound healing was uncomplicated. Seven months later, she returned in her second pregnancy, which was complicated by mild anemia and polyhydramnios from possible gestational-onset diabetes mellitus. Again, vaginal delivery of a healthy neonate was performed at term. We did not observe pregnancyinduced exacerbations of the skin disease. Conclusion Women with epidermolysis bullosa dystrophica of the Hallopeau-Siemens type may decide to have children after careful evaluation of the degree of impairment and a thorough explanation of the risks associated with pregnancy and delivery. Close monitoring of the pregnant patient is important. Vaginal delivery should be the first choice. Breast-feeding is difficult, but not contraindicated.

Cyclic menstruation-like bleeding during denied pregnancy. Is there a particular hormonal cause?

Objective. To investigate whether particular hormonal patterns could explain the persistence of cyclic menstruation-like bleeding during denied pregnancies. Methods. Hormone measurements were performed immediately after delivery in a total of 28 subjects with denied pregnancies. The results were studied in three patient subgroups: subjects with any cyclic bleeding during pregnancy (n = 22), subjects with cyclic bleeding during pregnancy until the delivery date (n = 7) and subjects with amenorrhea (n = 6). These data were compared with those of a control group (n = 126). In some of the women who reported cyclic bleeding, hormone assessments were also done once the lactation period ended. Results. For estradiol, free estriol and progesterone, no more than two values in each group were outside the 95% confidence interval of the control group. Several results for prolactin were remarkably lower. The findings for human chorionic gonadotropin, free testosterone, dehydroepiandrosterone sulfate, α-fetoprotein and thyroid-stimulating hormone were almost all within the 95% confidence interval. In seven subjects, abnormal results were obtained for the gondaotropin-releasing hormone/thyrotropin-releasing hormone test and the metoclopramid test after delivery and lactation. All of these subjects showed signs of corpus luteum insufficiency. In five subjects, evidence of hyperprolactinemia was found. Conclusion. Results revealed that hormonal patterns assessed immediately after delivery do not provide any causal explanation for the cyclic menstruation-like bleeding that occurs during denied pregnancies. Hormone assessments performed after the lactation period, i.e. during a normal menstrual cycle, showed a number of abnormalities. However, a causal relationship could not be drawn.

Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

BackgroundThe aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs.MethodsWe used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries.The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed.ResultsThe method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated.ConclusionUsing this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.