Lennart Jacobson

Side‐Effects Of An Oral Contraceptive With Particular Attention To Mental Symptoms And Sexual Adaptation

Questionaires covering personality psychiatric and gynecologic symptoms were administered to 344 women in March 1966. 281 of the patients who had received Anovlar from a Lund clinic in 1964 responded. To determine whether oral contraceptives evoke neurotic symptoms the data were analysed with respect to social parameters duration of use of the pill reasons for discontinuing previous psychiatric symptoms. Age parity marital state and social class had no effect on incidence of psychiatric side effects. Premenstrual tension was improved in 70.9%. Sexual adaptation was increased in 45.3% usually because of security but decreased in 26.0% concomitant with a loss of libido. 69.4% of women discontinuing the pill claimed they experienced psychiatric symptoms or weight gain. The most frequent psychiatric symptoms noted by 48.6% marked in 17% were tiredness irritability sensitivity and depression. Increased psychiatric symptoms were correlated highly with overweight emotional problems during early pregnancy prior use of psychoactive drugs prior psychiatric symptoms and duration of use of oral contraceptives. The authors suggest that these women by given oral contraceptives with caution.

Transcutaneous Monitoring of PO2 in Different Skin Areas in the Neonate and in the Scalp of the Fetus During Labor-Methodological and Physiological Observations

Abstract. The reliability and physiological significance of continuous non‐invasive PO2 recording by means of skin electrodes was studied by comparing simultaneous tracings from different skin areas in a series of 40 newboms with normal labor and birth.

INTERPRETATIVE ASPECTS ON THE ACID‐BASE COMPOSITION AND ITS VARIATION IN FETAL SCALP BLOOD AND MATERNAL BLOOD DURING LABOUR

Different acid‐base parameters determined in human fetal scalp blood during normal labour have been studied. In evaluating changes in fetal blood acid‐base components during labour changes in corresponding components in the maternal blood must be considered. A tentative model of the maternal‐fetal acid‐base interaction under normal conditions is presented.

Intravascular Coagulation in Pregnancy-Treatment with Heparin

Abstract. Two pregnant women with a history of miscarriages or premature labour are described. In the 25‐27th week of pregnancy routine examinations showed high levels of FDP in serum. Subsequent extensive coagulation studies revealed a positive ethanol gelation test, low levels of fibrinogen, plasminogen, α2‐macroglobulin and P&P and high level of AHF related protein for the stage of pregnancy, i.e. findings in dicating abnormal proteolysis with activation of the coagulation and fibrinolytic system. Continuous intravenous heparin treatment caused the coagulation system to return to normal throughout the rest of pregnancy. Both women gave birth to healthy babies without any complications. But the placenta showed numerous infarcts. The heparin treatment may have prevented later development of placental dysfunction.

The Interrelationship Between Maternal and Foetal Acid-Base Balance During Normal Labour

From comparative studies of the acid-base balance in maternal and foetal blood during labour, utilizing the Saling technique (1962), the following results were obtained. All cases were obstetrically and clinically normal as regards both mother and child. The means of the individual differences of both Base Excess (B.E.) and PCO, d u e s between m a t e d blood {CapBary TCS veil as venous), foetal blood from the presenting part, and umbilical cord blood, were calculated in 20 cases. The different blood samples were collected in close succession just before and after delivery respectively. The results indicate that foetal blood obtained by this technique reflects very well the situation in the superior part of the foetal circulation as regards the metabolic component (B.E.) of the acid-base status but not as regards PCO,, probably because of local haemodynamic factors in the skin. In 30 cases the maternal and foetal acid-base status was recorded intermittently during the course of labour. On the average, the initial metabolic acidosis of the mother (B. E. values ranging from -1.0 to -6.5 meq./l) increased 1.5 meq./l during the first stage and 3.0 meq./l during the shorter second stage. In the foetal blood the figures were 0 and 2.0 meq./l respectively. It would seem that this increase of the metabolic acidosis is closely allied to the muscular work of labour, and thus primarily maternal in origin. The correlations between simultaneous samples of maternal and foetal blood, irrespective of the stage of labour, were significant concerning B.E. (corr. coeff. 0.62; P < 0.001) and also pH (corr.coeff. 053; P < 0.001) but not concerning PCO, (corr.coeff. 0.26).

SIDE-EFFECTS OF AN ORAL CONTRACEPTIVE WITH PARTICULAR ATTENTION TO MENTAL SYMPTOMS AND SEXUAL ADAPTATION:

Brief summary’ A sample of 344 women, who had Anovlar prescribed in 1964, was investigated by a mailed questionnaire in March, 1966. The main emphasis of the questionnaire was placed upon a survey of possible emotional changes in connection with the use of the ovulation inhibitor. Questions were also included about previous psychiatric problems or insufficiencies as well as about somatic and gynaecological changes. About 17 per cent of the material reported an increase of psychiatric symptoms during the treatment. The most frequent symptoms reported were an increase of tiredness, irritability, sensitivity, and feeling of depression. Women with a high number of symptoms were found to have discontinued the contraceptive medication significantly earlier. They also reported to a significantly greater extent previous psychiatric symptoms. No significant relations were found between psychiatric symptoms on the one hand and parity, age, and social group on the other. About 45 per cent of the women reported improved sexual adaptation during the use of the oral contraceptive. The cause of improvement in 90 per cent was stated to be an increased feeling of security. 26 per cent of the material reported impaired sexual adaptation, the majority of these stating a decrease of libido. Women who reported an increase of psychiatric symptoms, also stated an impaired sexual adaptation, i.e. a decrease of libido, to a significantly greater extent.

Some Aspects on the Foetal-Maternal Acid-Base and Electrolyte Balance During Labour

During normal labour, the PC02 level in the maternal blood is very much below normal, which aids hydrogen ion elimination from the foetus. The effect of this mechanisms is, however, partly counteracted by the gradual development of a metabolic acidosis in the maternal blood which secondarily leads to an increasing metabolic acidosis in the foetal blood. Thus children are normally born with such an acidosis, and although this may show a rather wide variation in degree it is, in the individual case, closely related to the maternal situation. This has been shown before, by us and others. The result of induced changes of the maternal acid-base status has been studied in two series of normal cases. Alkalizing treatment was given during the first stage of labour by intravenous administration either of a hyperosmolar sodium bicarbonate solution or of THAMsolution (in amounts averaging 100-110 meq.). In both series, the treatment resulted in a significant reduction of the level of metabolic acidosis in the maternal as well as in the foetal blood. The foetal blood was sampled by the Saling technique. The effect was temporary (1-2 hours), as is to be expected in a non-steady state with progressing maternal metabolic acidosis. The degree of metabolic acidosis at the end of labour was, however, still lower in both series than in a non-treated control group. The effect of the treatment on the foetal blood appeared more rapidly in the THAM series than in the sodium bicarbonate series. As is to be expected, the treatment also affected the electrolyte balance. After sodium bicarbonate treatment, the sodium concentra-