Lars Nylund

When does external cephalic version succeed

From 1984 to 1987, 300 pregnant women with fetal representations underwent an attempt at external cephalic version (ECV) during the last trimester. A consecutive analysis of factors associated with successful version was performed during this period. the final version rate after one or more attempts was 58%, being lower in nulliparous (39%) than in parous women (80%). Multivariate analyses (logistic regression) identified only three significant variables out of 16 with independent power to explain successful version. the overall most important factor was parity (p < 0.001), followed by fetal presentation (p < 0.001) and amount of amniotic fluid (p = 0.019).

Isradipine, a new calcium antagonist: effects on maternal and fetal hemodynamics.

To assess the effect of isradipine on blood pressure. and uteroplacental and fetal blood flows in pregnancy-induced hypertension, 41 women with a diastolic blood pressure ≥ 95 mm Hg were included in our study. Of these, 27 received isradipine 5 mg twice daily. Uteroplacental blood flow index was calculated from the activity-time curve of the very low radiation from the placenta after intravenous injection of 18.5 Hq indium-113m. Blood flow velocity was measured in the uterine and umbilical arteries, and fetal aorta, using the pulsed Doppler technique. Investigations were per-formed before and after 1 week of isradipine. A control group of 14 women was examined in the same way. The isradipine group showed a significant reduction in mean arterial pressure (from 117 to 112 mm Hg) whereas there was no change in the controls. Uteroplacental blood flow indices were similar before treatment in both groups and did not change during treatment. Furthermore, the pulsatility indices were the same in both groups at the first examination and also did not change. Isradipine had no adverse effects on the fetus. In conclusion, isradipine lowered blood pressure without altering uteroplacental or fetal blood flows.

Nordic in Vitro Fertilization Embryo Transfer (IVF/ET) Treatment Outcomes 1982–1989

In the four Nordic countries, Denmark, Finland, Norway and Sweden, data were compiled from altogether 30 in vitro fetilization (IVF) clinics regarding their treatment outcomes. Two small, recently established IVF clinics in Finland did not respond to the postal inquiry used for data collection. For each clinic, data were collected from the time they commenced activities until June 1989. Preliminary data for the latter half of 1989 was also gathered. The first IVF‐baby in this data set was born in Gothenburg in 1982. Seven years later, in December 1989, altogether 35 clinics in the four countries were in operation and 1,290 children had been born. The largest number of clinics, 12, was to be found in Sweden but the number of treatment cycles in relation to the population was highest in Norway with about 340 treatments per million inhabitants annually during 1988–89, with Sweden in second place: 190 treatments per million inhabitants. The ratio of private to public clinics was highest in Finland, where four out of ten clinics were privately run. A mean clinical pregnancy rate per embryo transfer of 20% was recorded and 85% were singleton pregnancies. Spontaneous abortions occurred in 25% and the ectopic pregnancy rate was 7% of all clinical pregnancies. The ‘take home baby rate’ for 1988–89 was 13% per embryo transfer. There were no major differences between the four countries.

Scheduled Intermittent Periods of in vitro Fertilization Treatments

Organization and results of an in vitro fertilization program at the Huddinge University Hospital are given from its beginning in August 1985: 6 months in advance a scheme is scheduled with 2 weeks open for treatment followed by free intervals of 3-4 weeks. Follicular development is stimulated with clomiphene citrate and hMG, and assessed by analyses of estradiol and LH in serum combined with ultrasound examinations. Following the administration of hCG, eggs are collected by transvesical aspiration guided by ultrasound. The ova are inseminated with about 50,000 motile spermatozoa, and cultured for 48 h. Up to four eggs are transferred transcervically to the uterine cavity. 158 egg pickups have been performed (August 1985 to December 1987) in 106 patients resulting in fourteen intrauterine and two ectopic pregnancies, biochemical pregnancies not counted. This protocol has restricted routine work load allowing these treatments to be part of the clinical routine. It has also allowed the application of research programs and thus optimized limited resources.

Utero-Placental Blood Flow and the Effect of β2-Adrenoceptor Stimulating Drugs

Abstract. The immediate effect of a β2‐adrenoceptor stimulating drug, salbutamol, on utero‐placental blood flow in the last trimester of pregnancy was evaluated in 16 women without uterine contractions, using a method applying 113‐m Indium and a computer‐linked gamma camera. Serial scintigrams over the placental site showed a 15 per cent increase in activity during a short salbutamol infusion, denoting an augmented blood pool in the intervillous space. At the end of a 25–30 min salbutamol infusion, a mean prolongation of the rise time of the isotope accumulation curve by 100 per cent could be calculated. A utero‐placental blood flow index derived from the ratio of the maximum activity and the rise time of the accumulation curve above the placenta showed a decrease ranging from 18 to 50 per cent. It is conceivable that this initial decrease would disappear during continued infusion, as has been shown to occur in the pregnant sheep model.

A scheduled in vitro fertilization program at Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden

embryos were transferred per patient. Twenty-four ongoing pregnancies have been established, for a pregnancy rate of 17.1%. Nine women have delivered, including two sets of twins. Of the 143 women undergoing laparoscopy for GIFT, 41 pregnancies have been established, resulting in a clinical pregnancy rate of 29%. Two ectopic pregnancies have occurred. Sixteen pregnancies have been delivered, including four sets of twins. Our 1987 pregnancy rate is 23% for IVF and 35% for GIFT. We are currently accepting 70 couples per month into our program. Embryo cryopreservation and gamete and embryo donation are options which are also available.