Lillian Nordbø Berge

Dietary supplementation with l-arginine or placebo in women with pre-eclampsia

Background.  To investigate the effect of dietary intake of the NO‐donor l‐arginine on the diastolic blood pressure in women with pre‐eclampsia.

Addison's disease and pregnancy.

Five case reports are presented illustrating that pregnancy and Addisons disease are not incompatible, provided adequate substitution therapy is given.

Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team

Whether planned cesarean section is better than planned vaginal delivery for breech presentation at term (37–42 weeks) has been the subject of debate for some time. Apart from two small randomized controlled trials (1,2) from the early 1980s, the evidence on breech delivery was based on patient series and register studies, which have been considered to be of low scientific value. However, in October 2000 the randomized multicenter Term Breech Trial (TBT) was published in The Lancet (3), with a 3-month follow-up in 2002 (4). The study included 2083 deliveries from 121 obstetric departments in 26 countries. One Danish and one Finnish, but no Norwegian, obstetric departments took part in the study. The TBT concluded that planned cesarean section led to a significantly better perinatal outcome than planned vaginal delivery. The occurrence of maternal complications was similar for the two groups. Not surprisingly, the TBT ignited intense discussion among doctors, midwives and the public. Data from the Medical Birth Registry of Norway show a slight increase in the incidence of breech presentation among infants with a birthweight greater than 2499 g in the period 1981–98, and the incidence is 2.9% in 1998 (Fig. 1). In Norway, 40% of approximately 1500 annual term breech infants are currently delivered vaginally (Fig. 2). A change to routine use of cesarean section would have an unprecedented impact on clinical practice in Norway. The use of external cephalic version on the Norwegian population has not been studied previously. A review team was therefore assigned to review (5,25) all current literature on term breech deliveries as well as on external cephalic version, using predetermined standard literature review methodology.

Prenatal diagnosis of osteogenesis imperfecta

The lethal perinatal types (II A‐C) of osteogenesis imperfecta are reported to occur in approximately 1:55000 births. We here present three cases in three unrelated families, diagnosed by antenatal ultrasound within one year. A reliable diagnosis of the lethal perinatal type of osteogenesis imperfecta can be made by ultrasound examination during the second trimester, by identification of fractures of the long bones. The compression of the fetal head by the ultrasound probe and the low echogeneity of the cranium, should raise the suspicion of skeletal dysplasia, but is not diagnostic for osteogenesis imperfecta. The diagnosis is confirmed by postmortem examination including radiography and biochemical studies of cultivated fibroblasts from the fetus. Although rare, this lethal condition should be recognized when an ultrasound examination is performed, to prevent unnecessary obstetric intervention. In families with a previously affected fetus, prenatal diagnosis by first trimester transvaginal ultrasound investigation or chorionic villus sampling should be discussed.

Antenatal, neonatal and post neonatal deaths evaluated by medical audit : A population-based study in northern Norway - 1976 to 1997

BACKGROUND Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997. SUBJECTS AND METHODS Antenatal, neonatal and post neonatal deaths (n=472) at > or = 20 weeks of gestation have been evaluated. Data were collected from the Medical Birth Registry of Norway and from medical records. Pregnancy risk factors, mortality rates, causes of deaths, non-optimal care and avoidable deaths were recorded. RESULTS The death rate (all deaths per thousand total births) declined from 13.8 (1976-80) to 7.7 (1992-97), (p<0.001), due to a reduced death rate in preterms > or = 24 weeks (p<0.001) and in those between 500 and 1995 g (p<0.001). Antenatal deaths decreased (p<0.001) due to reduced intrapartum deaths (p<0.001). Prelabor deaths, unexpected intrauterine pre-hospitalization deaths included, did not change. Postnatal deaths declined (p=0.01) due to reduced early neonatal mortality (p=0.002). Deaths from malformations (p<0.001), fetal and neonatal infections (p=0.03) and placental disorders (p<0.001) declined. Non-optimal care (22.5% of deaths, 2.3%o of total births), avoidable deaths (13.1% of deaths, 1.3% of total births), and maternal neglect (7.5% of cases with non-optimal care, 0.6% of total births) did not change. Death during transport was rare (n=5), and no deaths occurred at maternity homes. Non-cohabitance, smoking and undiagnosed SGA new borns declined, and the level of education increased in the study population. CONCLUSION The improvement is due to a reduction in intrapartum deaths and early neonatal mortality in preterms. A constant high rate of unexpected intrauterine deaths in non-hospitalized patients is a challenge for antenatal health care providers.

Phagocytic cell activity in pre‐eclampsia

To compare the immune response in normal and pathological pregnancy, some functions of phagocytic cells were studied in 8 women with pre‐eclampsia and 7 healthy women matched for age and parity. Free oxygen radical activity determined by chemiluminescence (CL) of polymorphonuclear leukocytes (PMN) and monocytes (MN) during phagocytosis of preopsonized zymosan, and cell migration measured by tube migration of PMN were studied together during and after pregnancy. CL of MN decreased or remained unchanged during normal pregnancy, but a marked increase was observed in pre‐eclampsia. CL of PMN increased, too, in the pre‐eclamptic patients, but the difference was not significant. Tube migration was enhanced during pregnancy compared with baseline values, but the values were significantly lower in the pre‐eclamptic group. Immunoglobulins (Ig G, Ig M and Ig A) were studied in both groups. A decline in Ig G level from baseline to the 3rd trimester was observed in patients. The complement fractions C3 and C4 were not altered during pregnancy in any group. The study indicates a difference in behavior of phagocytic cells in normal vs. pre‐eclamptic pregnancy.

Pregnancy related changes in some cardiovascular risk factors

Background. Certain risk factors for development of ischemic heart disease are influenced by pregnancy related changes of female sex hormone levels.

Female sex hormones and platelet/endothelial cell interactions.

The effects of estradiol and progesterone added to the growth medium of human umbilical vein endothelial cells for 72 h on the formation and release of prostacyclin were investigated. The influence on collagen-induced platelet aggregation and on the platelet formation of thromboxane A2 following aggregation, of the growth medium collected before and after thrombin stimulation of the endothelial cells, was studied simultaneously. Under basal conditions, endothelial cells grown with progesterone released significantly less prostacyclin into the growth medium than did controls (p

Antenatal, neonatal and post neonatal deaths evaluated by medical audit

Background. Perinatal committees evaluate deaths by medical audit to improve antenatal and neonatal care. We report data from Troms County from 1976 to 1997.

The bleeding time in women: An influence of the sex hormones?

A sex difference in the bleeding time has been reported. To investigate the effects of the different sex hormones, the bleeding time (BT) and hemostatic factors related to it were measured in 209 healthy women: 50 pregnant, 113 menstruating and 46 post‐menopausal. The serum levels of estrogens, progesterone and testosterone were distributed as expected for the different groups. There were no significant differences in the BT between any of the groups. No correlations between the BT and female or male sex hormones were found. The findings indicate that although sex hormone mediated effects on platelet/endothelial cell interactions may exist, they do not become evident within the physiological variations in the BT of healthy women.