Magnar Ulstein

Ultrasonic measurement of human fetal blood flow

Pulsed Doppler technique was combined with real-time B-mode ultrasonography for non-invasive measurement of human fetal blood flow in utero. The fetal vessel, e.g. aorta or umbilical vein, was identified in the real-time image and the real-time transducer put parallel to the vessel. The 2 MHz pulsed Doppler transducer insonated the vessel at a known angle, as the transducers were firmly attached to each other at an angle of 52 degrees. The Doppler instrument processed the Doppler shift signals and estimated the mean and maximum blood velocity. For calculation of blood flow, fetal vessel diameter must be measured. Three ultrasonic techniques (real-time B-mode, TM-mode, Time-distance recording) were applied for diameter measurements. The accuracy of the real-time B-mode technique was tested in vitro on 8 glass tubes with various diameters; the ultrasonically measured diameter was within +/- 0.4 mm of the diameter measured with vernier calipers. The reproducibility of diameter measurement was tested in vivo; the standard deviation of the difference between measurement was 0.15 mm for the fetal aorta and 0.20 mm for the umbilical vein. Fetal blood flow was measured in 38 normal late pregnancies. Blood flow in the thoracic part of the descending fetal aorta ws 185 ml min-1 kg-1 when based on mean blood velocity, and 261 ml min-1 kg-1 when based on maximum blood velocity. In the intra-abdominal part of the umbilical vein the mean blood flow was 115 ml min-1 kg-1.

Effective contraception with the levonorgestrel-releasing intrauterine device: 12-month report of a European multicenter study

The use-effectiveness of an intrauterine contraceptive device releasing 20 mcg of levonorgestrel daily (Lng-IUD), and of a Nova T copper-releasing IUD, were studied in a randomized, comparative multicenter trial. The Lng-IUD was inserted in 1821, and the Nova T in 937 women. The 12-month net pregnancy rate with the Lng-IUD (0.1 per hundred women) was significantly lower than that with the Nova T (0.9 per hundred). Removal rates for menstrual problems and/or pain were similar for the two methods (net rates 7.5 and 8.7, respectively). The 12-month continuation rates were 82.2 for the Nova T and 79.7 for the Lng-IUD. The reduction of the bleeding led to oligomenorrhea and amenorrhea in users of the Lng-IUD; the removal rate for these reasons was 1.4. The removal rate for hormonal side effects with the Lng-IUD was 2.4. Blood hemoglobin concentrations increased among users of the Lng-IUD and decreased among users of the Nova T. The results show that the Lng-IUD was a highly effective contraceptive method which reduced menstrual bleeding. It is a promising alternative for women desiring a highly effective method for long-term use.

Maternal hematological status and risk of low birth weight and preterm delivery in Nepal

Background. Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant Nepali women.

Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered

Objective: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women.Design: Cross-sectional study.Setting: Patan Hospital, Kathmandu, Nepal.Subjects: A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994–1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis.Results: Overall mean values (±s.d.) of s-tHcy and s-MMA were 9.5 (±4.2) µmol/l and 0.39 (±0.32) µmol/l, respectively. Elevated s-tHcy (>7.5 µmol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 µmol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (≤4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=−0.30, P<0.001) and s-folate (r=−0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=−0.40, P<0.001), but not with s-folate.Conclusions: Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women.Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.European Journal of Clinical Nutrition (2001) 55, 856–864

Anaemia in pregnancy: possible causes and risk factors in Nepali women

Objective: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women.Design: Case-control study.Setting: Patan Hospital, Kathmandu, Nepal.Subjects: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994–1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25–33% (n=254), and severely anaemic, Hct<25% (n=54).Results: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively.Conclusions: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care.Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.European Journal of Clinical Nutrition (2000) 54, 3–8

Human chorionic gonadotropin and testosterone in normal and preeclamptic pregnancies in relation to fetal sex.

OBJECTIVE The aim of the present study was to evaluate the effects of fetal gender on serum human chorionic gonadotropin (hCG) and testosterone in normotensive and preeclamptic pregnancies. METHODS The study consisted of 137 women with singleton pregnancies in the third trimester. Seventy‐three pregnancies were uncomplicated; among those were 35 male and 38 female fetuses. Sixty‐four pregnancies were complicated by preeclampsia; among those were 33 male and 31 female fetuses. Human chorionic gonadotropin and total testosterone were measured in maternal peripheral blood. RESULTS In male‐bearing pregnancies, maternal hCG and testosterone serum levels were significantly higher in preeclamptic than normotensive mothers (P < .001). In female‐bearing pregnancies, testosterone levels were significantly higher in preeclamptic than normotensive mothers (P < .001), whereas the hCG levels were not significantly different. Male‐bearing preeclamptic women had significantly higher testosterone levels than female‐bearing preeclamptic women (P < .02), whereas the hCG levels were not significantly different. In uncomplicated pregnancies the hCG levels were significantly higher in female‐bearing than in male‐bearing mothers (P < .005), whereas the testosterone levels were not significantly different. CONCLUSION In preeclamptic pregnancies with male fetuses, the maternal serum hCG levels were significantly higher than in uncomplicated pregnancies. Total testosterone levels were significantly higher in pregnancies with either gender and significantly higher in male‐bearing than in female‐bearing pregnancies. This may indicate an androgen influence on the pathophysiologic mechanism of preeclampsia.

Identification of the Complement Regulatory Proteins CD46, CD55, and CD59 in Human Fallopian Tube, Endometrium, and Cervical Mucosa and Secretion

PROBLEM: Complement lytic activity has been demonstrated, and a potential for its activation is present in human cervical and tubal secretions and in the endometrium. This necessitates the presence of regulatory mechanisms for protection of the sperm and the implanting allogeneic conceptus in the female genital tract. Complement regulatory proteins demonstrated on sperm and in seminal fluid have been attributed such a role. It is however likely that additional protection is required for a successful conception and implantation to take place. This lead us to investigate the distribution of the complement regulatory factors in cervical mucus and mucosa, uterine endometrium, and fallopian tube.

Fetal growth retardation associated with inadequate haemodilution in otherwise uncomplicated pregnancy

Abstract. The Hb level during pregnancy was followed in 113 non‐anaemic women with uncomplicated pregnancy and birth weight of the baby above the 2.5th percentile. There was an inverse correlation close to statistical significance between the birth weight of the baby and the lowest Hb level reached during pregnancy as well as the Hb level in late pregnancy (38th week). A group of seven non‐anaemic women with birth weight of the baby below the 2.5th percentile had a significantly higher (p<0.001) Hb level in late pregnancy than the normal group. Four of these cases had a statistically significant higher Hb level already in the second trimester. Trends in the reproductive history, complaints in the present pregnancy as well as results of hormone assays and the condition of the baby indicated that the seven cases represented a pathological group with fetal growth retardation. None of the women in the two groups were treated with diuretics. All had iron supplementation in high doses.

Sperm Penetration of Cervical Mucus as a Criterion of Male Fertility

Semen samples were examined from 51 fertile men, and from the male partners in 283 infertile marriages. In addition to routine analysis, they were tested for sperm penetration through ovulatory cervical mucus, using the method of Kremer with slight modifications. Comparison of the 2 groups in regard to semen properties showed statistically significant differences between the means for density, percentage of living, motile and abnormal spermatozoa, for motility degree, and for sperm penetration. No significant difference between the means was found for volume, content of fructose and acid phosphatase in the seminal plasma. In the entire series a moderate correlation was found between sperm penetration and percentage of motile spermatozoa, motility degree, density, percentage of living and percentage of abnormal spermatozoa. A low correlation was found between sperm penetration and volume, content of fructose or acid phosphatase in seminal plasma. The variance of sperm penetration due to regression of the other semen properties was only 43%. Sperm penetration had the highest discriminant function coefficient of the tested semen properties. Semen samples from fertile men had high penetration values although other semen properties were sometimes pathological. The sperm penetration test is a most valuable supplement to routine semen analysis for male fertility estimation.

Fertility of Donors at Heterologous Insemination

Seminal properties in relation to fertility were studied in 14 semen donors, used for heterologous inseminations in 178 women. There were 100 conceptions. Fertility of the donors was statistically significantly related to the in vitro penetration and duration of motility of spermatozoa in cervical mucus.