Oddmund Koller

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.

High Hemoglobin Levels During Pregnancy and Fetal Risk

In a series of 24 apparently uncomplicated pregnancies with small‐for‐dates newborn at or below the tenth percentile, 15 women had hemoglobin (Hb) levels 2 SD above the mean value of normal distribution in late pregnancy. Among these 15 was the only case with intrauterine death of unknown cause. In a series of 15 cases with intrauterine fetal death of unknown cause, before start of labor 10 had Hb levels 2 SD above the mean, while in a series of 16 cases of late abortion where the fetus was alive until labor started, only one had a Hb level 2 SD above the mean. In three cases with serial Hb estimations, the levels were 2 SD above the mean one week or more before intrauterine fetal death. Two of these cases also had been observed during a successful pregnancy in which the Hb levels were within normal limits. It is concluded that high Hb levels during pregnancy may indicate a fetus at risk. High viscosity of the mothers blood may impede the uteroplacental circulation, causing placental infarction, growth retardation and ultimately fetal death.

Haemoconcentration in severe pre‐eclampsia

Summary. The last maternal haemoglobin (Hb) concentration before delivery was related to the perinatal outcome in 87 non‐anaemic women suffering from severe pre‐eclampsia. Abnormally high Hb concentrations were found in most women with evidence of placental dysfunction. An inverse correlation was found between the centile weight of the newborn and the maternal Hb. Significantly higher Hb levels were found in pregnancies complicated by fetal growth retardation and perinatal distress compared with those in pregnancies with good outcomes. Particularly high levels were found in pregnancies that ended in perinatal deaths. The hypothesis is put forward that raised haemoconcentration during severe pre‐eclampsia causes increased maternal blood viscosity which predisposes to placental pathology and initiates a vicious circle.

Carcinoma of the endometrium in Norway 1957-1960 with special reference to treatment results.

Abstract The total cases of endometrial carcinoma in Norway from 1957 through 1960 has been presented. The series comprises 634 cases, of which 404 were treated in the Norwegian Radium Hospital and 230 in other hospitals. The anatomic extent of the disease, as decided by international staging and by depth of infiltration of the uterine wall, increases with increasing age, concomitant with a decreasing survival rate. The undifferentiated carcinomas seem to have a poorer prognosis than the highly differentiated tumors. In Stage I patients operation seems to be superior to radiation treatment, with survival rates of 84.1 per cent and 63.5 per cent, respectively. Postoperative radiation following adequate operation in Stage I seems to be of doubtful value. The most striking trend in this series is the increasing mortality with increasing age, even if corrected for natural mortality. The most attractive hypothesis to explain the age-dependent mortality is the lack of steroid (gestagen) in older age groups.

Late Sequelae of Induced Abortion in Primigravidae: The Outcome of the Subsequent Pregnancies

Abstract. In a retrospective study a group of 137 women with legal abortion in their first pregnancy was compared with a group of 133 women with spontaneous abortion (before 28 weeks) and a group of 129 women who had a delivery (beyond 28 weeks) in their first pregnancy. Three cases of ectopic pregnancy were recorded in the second pregnancy in the legal abortion group, none in the other groups. The delivery group showed the best reproductive performance, while the spontaneous abortion group had the highest frequency of early abortion and the induced abortion group the highest frequency of late spontaneous abortion and premature delivery, and in addition a trend towards earlier spontaneous onset of labour in their second pregnancy. There was a conspicuous decline of the reproductive performance in the third and fourth pregnancy of the induced abortion group and a highly significant increase of the rate of late abortion, compared with the overall rate of late abortion in the department. The induced abortion group showed an increased rate of spontaneous primary and premature rupture of the membranes and also a definite trend towards lower weight of the newborn, especially beyond 41 weeks of pregnancy. There was a close correlation between induced abortion in girls below 17 years of age on the one hand and repeated abortion and/or unmarried state in the second pregnancy on the other. A significant correlation was revealed between early menarche and legal abortion in the first pregnancy and also between early menarche and unmarried state in the first pregnancy as found in a random series of 250 first pregnant women.

The Predictive Value of Total Estriol; HPL and HB on Perinatal Outcome in Severe Pre-Eclampsia

Abstract. The prognostic value of total maternal plasma estriol, human placental lactogen (HPL) and hemoglobin (Hb) with regard to perinatal outcome was compared in 74 cases of severe preeclampsia. No combination of the tests predicted all cases of fetal and newborn pathology. HPL was the most reliable single test in cases of intrauterine growth retardation, while Hb was the best predictor of severe fetal pathology and perinatal distress. In cases of severe fetal and neonatal pathology, the prognostic value of the combination of HPL and Hb was more reliable than the combination of all the three tests.

GYNAECOLOGICAL CANCER IN FEMALES BELOW 20 YEARS OF AGE IN NORWAY DURING THE YEARS 1953–1973

During this period (until July 1973) 7 1 new cases were recorded by the Cancer Registry of Norway. The incidence (new cases per year per 100 000 population ) below 5 years of age was only about 1 pro mille and in the age group 1519 only about 1 per cent of the incidence found in the age groups above 60. In addition 6 cases of malignant pelvic tumours of possible gynaecological origin were recorded in the age group 04 and 4 cases of mammary cancer in the age group 15-19. The total number of tumours is thus 81. Originating in vulva, vagina and uterus were 12, in the ovary 55. There were 4 cases of chorion-epitheliorna, all in the age group 15-19. None of the 16 cases below 10 years of age survived more than 1 year and 5 months , even if 8 of the cases were localized. The survival rate 10-19 years of age is 55 per cent with an observation time from 4 months to 20 years, an average of 8 years and 5 months. 22 of the cases have been followed for more than 5 years, and of those 16 were localized. One 13 years old patient irradiated unilaterally because of dysgerminoma had a normal puberty and delivered 19 years old a healthy son. One other case treated at 14 years of age indicates that radiation of the total pelvis in tumour doses is not incompatible with complete sexual function in later life.

OPERATION TECHNIQUE IN SURGICAL TREATMENT OF VULVAR CANCER

The treatment of choice of cancer of the vulva is surgical, and the best results are reported after so-called radical surgery. The term radical implies a wide vdvectomy and a thorough dissection of both the superficial and the deep inguinal nodes. It has been stated that adequate surgery should also include removal of the pelvic nodes, but most authors consider this procedure only to be indicated in a small number of patients. The great majority of the patients with vulvar cancer are old and there are frequently relative co~itraindications against surgery. Modern preoperative preparation, anaesthesia, blood transfusions, electrolyte therapy, and antibiotics have greatly increased the safety of radical surgery in patients of high age groups. It is a general experience that these patients can tolerate quite extensive surgery provided the postoperative course is smooth and early ambulation possible. The most frequent postoperative complication in patients treated with radical surgery for vulvar cancer is interference with the primary healing of the wound. There are 3 main causes for ths . 1. Because of the wide excision of the vulva, primary closure may be impossible or associated with too much tension of the skin and subsequent sloughing. 2. Undermining of the skin during groin dissection may result in ischaemic necrosis. 3. A frequent and troublesome complication in the inguinal area is the accumulation of serous, mainly lymphatic fluid. This prevents the contact between the skin flap and the underlying tissue which is necessary for primary healing to take place.