Jørgen Falck Larsen

Normal fetal growth evaluated by longitudinal ultrasound examinations.

Fetal weight estimation was evaluated using the equations of Warsof, Shepard and Hadlock in 192 patients, less than 3 days before delivery. Warsofs and Hadlocks equations resulted in significantly better weight estimates compared to Shepards equation. No systematic error was found below 2500 g by use of Warsofs equation, whereas Shepards and Hadlockss equations resulted in significant over-estimation in the low weight group. In a study of 5 fetuses, of 27-38 weeks gestational age, the intra-observer variation was calculated to 4.6%, whereas the coefficient of variation among observer means was 2.9%. The mixed intra- and inter-observer coefficient of variation was 6.5%. Thirty-five low-risk, uncomplicated pregnancies with reliable last menstrual dates were investigated longitudinally with ultrasound measurements of fetal weight. Population growth curves of fetal weight, fetal femur length, abdominal circumference and biparietal diameter were constructed by weighted polynomial regression. After 27 weeks of gestational age the weight growth curve showed only insignificant non-linearity. Compared to a Danish growth curve based on birth weights, significant higher mean weight was found, especially before 31 weeks of gestational age. The 10th and 90th percentiles for the individual percentage deviation change was +/- 4.4% per 28 days.

Detection of small‐for‐gestational‐age fetuses by ultrasound screening in a high risk population: a randomized controlled study

Objective To assess the value of fetal weight estimation during routine third trimester ultrasound examinations for the identification of small‐for‐gestational‐age (SGA) fetuses, to promote active pregnancy management and so reduce perinatal morbidity.

Narrow intra-individual variation of maternal thyroid function in pregnancy based on a longitudinal study on 132 women

BACKGROUND Adaptive alterations in maternal physiology cause changes in thyroid hormone levels throughout pregnancy, and precise biochemical evaluation is thus highly dependent on gestation-specific reference intervals and expected intra-individual variation. OBJECTIVE The aim of the study was the assessment of the intra-individual variation as well as the longitudinal course of thyroid hormones during normal pregnancy and factors that influence the normal reference range for thyroid function. For this purpose, a longitudinal statistical model was applied. DESIGN In a cohort of 132 pregnant women, serial blood samples were obtained and ultrasound scans were performed throughout pregnancy. METHODS Serum levels of TSH, free and total thyroxine (T(4)), free and total triiodothyronine (T(3)) as well as autoantibodies against thyroid peroxidase and thyroglobulin were measured in 979 serum samples. RESULTS Intra-individual variations of thyroid hormone concentrations were smaller than inter-individual variations (individuality index range: 0.38-0.71). Maternal height was positively associated with free T(4) (FT(4)) (b=0.003; P=0.031) and pre-pregnancy body mass index with T(3) and free T(3) (b=0.017; <0.001 and b=0.007; P<0.001). Smoking was positively associated with T(4) and FT(4), but it was modulated by gestational age. Gestation-specific reference intervals for thyroid function variables from autoantibody-negative participants are presented. CONCLUSIONS In accordance with the data from nonpregnant adults, intra-individual variations of thyroid hormones were smaller than inter-individual variations also during pregnancy. In the evaluation of thyroid function in pregnancy, the individual longitudinal course of thyroid hormones rather than absolute values should be considered. We present a longitudinal model for the prediction of maternal thyroid function tests in pregnant women.

Comparison of urinary human follicle-stimulating hormone and human menopausal gonadotropin for ovarian stimulation in polycystic ovarian syndrome.

A randomized, double-blind, crossover study was carried out to compare purified urinary follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) for ovarian stimulation in polycystic ovarian syndrome (PCOS). Twelve patients were stimulated with FSH and hMG in three alternate cycles. FSH, luteinizing hormone (LH), estradiol, dihydroepiandrosterone sulphate, free and total testosterone, Δ 5 -androstenedione, sex hormone binding globulin, and ovarian volume were monitored during the stimulation. There was no difference between the dose of FSH and hMG necessary to induce preovulatory follicles in the individual patients. The mean increase of ovarian volume during stimulation with FSH and hMG was 120% and 129% respectively (no significant difference). Two patients became pregnant in the first cycle. Two other patients had delayed bleeding and positive serum-human chorionic gonadotropin. No significant difference was found in the endocrine changes during the two different stimulation methods. The LH/FSH ratio was normalized after a few days of treatment regardless of the type of stimulation. The size of the material does not permit a comparison of the efficacy of the two treatment schedules. Our clinical and ultrasonic observations do not support the theory that treatment of infertility in PCOS with FSH is more safe than with hMG.

The Urethral Plug: A New Treatment Modality for Genuine Urinary Stress Incontinence in Women

A new modality, the urethral plug, was used to treat 22 women with genuine urinary stress incontinence. The plug is made of thermoplastic elastomer (Kraton G), and consists of a meatal plate, a soft stalk and 1 or 2 spheres along the stalk. The spheres were located according to the result of the urethral pressure profile. The midpoint of the proximal sphere was placed at the bladder neck and the distal sphere was placed just above the maximum urethral pressure point. At voiding the plug was removed and afterwards a new plug was inserted. The plug with 2 spheres was tested in week 1 (period 1) and the plug with only the distal sphere was tested in week 2 (period 2). A total of 22 patients completed period 1. Eight patients did not complete period 2, mostly due to either unchanged incontinence during period 1 or a repeated loss of the plug with 1 sphere. In periods 1 and 2, 73 and 79% of the patients were subjectively and objectively continent or improved. A total of 14 patients completed both periods. Eight patients preferred the plug with 2 spheres, 1 preferred the other plug and 5 had no preference. The side effects were few. This preliminary study shows that the urethral plug seems to be a promising alternative treatment for female genuine urinary stress incontinence.

Complications and problems in transvaginal sector scan-guided follicle aspiration

Complications and problems in the first 181 transvaginal sector scan-guided follicle aspirations in a recently established in vitro fertilization (IVF) unit were studied. No major complications occurred and, in only 3% of patients, it appeared impossible to aspirate the follicles because of method-related problems (i.e., localization of ovaries too high above the vaginal top and/or ovaries too mobile). The method is easily mastered and the oocyte yield of this method is already high, even though it is early in the learning phase of the procedure. The mean duration of the procedure decreased from more than 30 minutes to less than 20 minutes in the first 7 months after the introduction of this technique in the IVF program. The authors believe this method soon will be the choice for follicle aspiration in all major IVF programs.

Ultrastructure of a Granulosa Cell Tumour

Abstract. The fine structure of a hormonal active granulosa cell tumour is described. The greater part of the tumour consisted of a cell type resembling the granulosa cell of the normal follicle. It contained many Golgi elements but was poor in smooth and rough endoplasmic reticulum. Another type of cell was found in the proximity of strands of connective tissue. The second type had large amounts of smooth endoplasmic reticulum and lipid droplets. This type is probably the thecal element and its ultrastructure indicates that it represents the endocrine active part of the tumour.

Isolation and culture of human endometrial cells

1Herlev Hospital, Department of Obstetrics and Gynaecology, University of Copenhagen, DK 2730 Herlev, Denmark; Chromosome Laboratory, Section of Clinical Genetics, Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK 2100 Copenhagen, Denmark; Frederiksberg Hospital, Department of Obstetrics and Gynaecology, University of Copenhagen, DK 2000 Frederiksberg, Denmark; ^Department of Obstetrics and Gynaecology, University of Göteborg, Sahlgrenska University Hospital, Sweden; and 5Herlev Hospital, Department of Pathology, University of Copenhagen, DK 2730 Herlev, Denmark

Induction of labour with prostaglandin F2α in missed abortion, fetus mortuus, and anencephalia

Abstract Seven patients presenting missed abortions, six with intrauterine death of the fetus and missed labour, and four with anencephalic fetuses have been treated with intravenous prostaglandin F 2α to terminate the pregnancies. The drug has been effective in all cases and the mean induction-termination interval has been eight to twelve hours (if one case is excluded in which the induction was started with a drug concentration of 15 g/ml instead of the usual 50 g/ml). The technique seems to be reliable, safe and rapid.

TREATMENT OF HYPERPROLACTINEMIC LUTEAL INSUFFICIENCY WITH BROMOCRIPTINE

Abstract. Twelve patients with infertility and insufficient luteal function were studied during a control cycle, and during a cycle when 2.5 mg of bromocriptine was given twice daily. Serum levels of prolactin, progesterone, estradiol‐17‐β, FSH and LH were determined during both cycles. Endometrial biopsies were taken from most patients during the late luteal phase.