P. A. Järvinen

Serum Ferritin as a Measure of Iron Stores During and After Normal Pregnancy with and Without Iron Supplements

The iron stores of 32 healthy pregnant women were evaluated longitudinally during pregnancy and 6 months post partum by serum ferritin assay and by bone marrow iron content. Half of the women were receiving oral iron while the others were not given iron supplementation.

Conservative operative treatment of tubal pregnancy with postoperative daily hydrotubations.

Conservative surgery in the form of incision and resuture of the tube was used in the treatment of 43 tubal pregnancies. Rheomacrodex®‐Hydrocortisone®‐Chymotrypsin® solution was introduced into the patients abdominal cavity at operation to prevent the formation of adhesions. Using a little modified solution, daily hydrotubations via a Foley catheter placed in the uterine cavity were performed during the period in hospital. At the follow‐up examination 24 of the 32 patients subjected to salpingography had completely patent tubes There were 26 pregnancies (60%) within the follow‐up period of 4‐40 months. Six of the 10 patients with only one remaining tube became pregnant during the follow‐up period, and five children were born of these pregnancies. These patients had three extra‐uterine pregnancies. The study indicated that conservative extra‐uterine therapy combined with hydrotubation therapy to prevent adhesions gives better results than conservative therapy alone as reported previously.

Suppression of threatened premature labor by administration of cortisol and 17α-hydroxyprogesterone caproate: A comparison with ritodrine

A shift in progesterone-to-estradiol balance to estradiol dominance is assumed to be a prerequisite for regular uterine contractions. To antagonize this effect in premature labor 24 consecutive women were treated with intravenous cortisol for 3 days and with weekly intramuscular injections of 17 alpha-hydroxyprogesterone caproate (17 OHP-C). Twenty-four similar patients treated with ritodrine served as a reference group. The delivery was postponed by at least 1 week in 21 patients (87.5%) in the steroid treatment group and in 18 patients (75%) in the ritodrine group. The premature labor lasted for 5.1 +/- 0.4 hours (mean +/- SEM) with steroid therapy and for 2.2 +/- 0.3 hours with ritodrine. In singleton pregnancies the gestational length and birth weight of the newborn infants were greater in the steroid treatment group (N = 23, 39.1 +/- 0.3 weeks, 3,460 +/- 119 gm) than in the ritodrine group (N = 24, 37.7 +/- 0.4 weeks, 3,106 +/- 118 gm). Steroid treatment suppressed serum estradiol concentrations (maximally by 60%) and, to a lesser extent, testosterone, estriol, and progresterone levels (maximally by 30%).

Abortifacient efficiency of 15(S)15-methyl-prostaglandin F2α-methyl ester administered vaginally during early pregnancy

Forty early pregnancies (menses delay 13 - 27 days) were terminated by administering four vaginal suppositoreis each containing 1.0 or 1.5 mg of 15 (S) 15-methyl-prostaglandin F2alpha-methyl ester, one every third hour. In 14 cases serial measurementsof serum estradiol and progesterone were performed during and after therapy. Uterine contractions and bleeding started 1 - 17 hours after administration of the first suppository. Abortion was complete after one week in five women (13%), and after two weeks in 30 (75%). A curettage was performed on eight women, residual placental fragments were found in seven and pregnancy continued in one woman. Mild diarrhoea (65%) and vomiting (40%) were the major side-effects, despite premedication. Estradiol and progesterone levels fell progressively during the therapy. Self-administration of 4 or 6 mg of the methyl ester caused too low a rate of complete abortion for use in practice, but it may be a valuable and practical agent for preoperative dilation of the cervix.

Gall bladder volume and serum bile acids in cholestasis of pregnancy.

Summary. Gall bladder volume was measured by ultrasound in eight patients with cholestasis of pregnancy, in 21 normal pregnant women and in 14 non‐pregnant women, and at the same time serum cholic and nodeoxycholic acid levels were estimated. The gall bladder volume was 60% larger in cholestasis than that in normal pregnancy and more than two times larger in normal pregnancy than in non‐pregnant women. The serum cholic and chenodeoxycholic acid concentrations were significantly higher in cholestasis of pregnancy than those in normal pregnancy.

THE FUNCTION OF THE ANTERIOR PITUITARY‐ADRENAL CORTEX AXIS IN HYPEREMESIS GRAVIDARUM

In order to study the function of the pituitary‐adrenal axis, serum ACTH and cortisol levels were estimated before and after insulin induced hypoglycaemia in nine women with hyperemesis gravidarum, seven women in normal early pregnancy and in eight non‐pregnant controls. Before hypoglycaemia, the basal ACTH level in the hyperemesis group (102.4±62.9 pg/ml) was higher than in normal early pregnancy (67.5±19.2 pg/ml; p<0.05) or in non‐pregnant controls (54.8±25.2 pg/ml; p<0.01). Correspondingly, the mean cortisol value in hyperemesis (0.47±0.16 μmol/1) was higher than in normal early pregnancy (0.39±0.10 μmol/1; p>0.05) or in non‐pregnant controls (0.32±0.13 μmol/1; p<0.01). After insulin the elevation of ACTH (p>0.05) and cortisol (p<0.01) was observed in every group. The level of ACTH and cortisol was highest in hyperemesis group. Our results do not support the idea that hypofunction of the pituitary‐adrenal axis contributes to the aetiology or pathogenesis of hyperemesis gravidarum. The high ACTH level might be evidence of the psychic instability of hyperemesis gravidarum patients.

Trimethoprim-Sulfonamide Combination Administered Orally and Intravaginally in the First Trimester of Pregnancy: Its Absorption into Serum and Transfer to Amniotic Fluid

Abstract. The absorption of trimethoprim‐sulfonamide combination into serum and transfer to the amniotic fluid after oral and intravaginal administration was studied on 134 patients undergoing legal abortion. The combination given orally as a single dose was absorbed rapidly: the peak levels of both trimethoprim and sulfamethoxazole in serum were reached within 4 hours. In amniotic fluid, the peak level of trimethoprim appeared within 14 hours and that of sulfamethoxazole within 10 hours. After a single intravaginal application of cream, the absorption of trimethoprim into serum and transfer to the amniotic fluid was smaller although measurable amounts could be demonstrated. After repeated intravaginal application during several days no accumulation of trimethoprim in serum or amniotic fluid could be detected.

Induction of abortion with intra-amniotic or intra-muscular 15(S)-15-methyl-prostaglandin F2α

In order to evaluate the efficacy and acceptability of 15(S)-15-methyl-prostaglandin F2alpha (15-me-PGF2alpha) for pregnancy termination, we induced 30 abortions with single intra-amniotic injections of 2,5 mg of 15-me-PGF2alpha and 25 abortions with intra-muscular 15-me-PGF2alpha administered 200 mug initially and 300 mug every third hour until 30 hrs or abortion. Abortion occurred within 30 hrs in 97% of cases in the intra-amniotic group, with a mean abortion time of 17,6 hrs and in 80% in the intramuscular group, with a mean abortion time of 15.0 hrs. Neither parity nor gestational age was significantly related to the abortifacient efficacy of 15-me-PGF2alpha. No serious complications occurred. Vomiting (83-84%) and diarrhoea (23-92%) were the most common complaints. Uterine contractions were more painful if induction was effected with intra-amniotic rather than intramuscular injections. 15-me-PGF2alpha appears to be an effective and practicable abortifacient which can be used intra-amniotically or intramuscularly according to the ease of amniocentesis.

Prevention of Intraperitoneal Adhesions by Dextran, Hydrocortisone and Chymotrypsin: An Experimental Study

Abstract. The purpose of an experimental study in guineapigs was to prevent adhesion formation in the intraabdominal space by simultaneous intraperitoneal infusion of hydrocortisone, dextran and chymotrypsin. An examination made three weeks after the operation revealed a highly significant (p>0.001) difference in favour of the dextran, dextran‐chymotrypsin and dextran‐chymotrypsin‐hydrocortisone groups when compared with the NaCl and control groups.

Intrauterine injection of prostaglandin F2α for termination of early pregnancy in out-patient

Prostaglandin F2alpha (PGF2alpha) administered as single intrauterine injection was used for termination of very early pregnancy in 34 outpatients. 12 patients were induced with 1.0 mg, 18 patients with 2.0 mg and 4 patients with 4.0 mg of PGF2alpha. After 2 weeks, abortion was complete in 58% induced with 1.0 mg, in 78% induced with 2.0 mg, and in all 4 patients induced with 4.0 mg. After 3 weeks, abortion was complete in 83% induced with 1.0 mg and in 100% induced with 2.0 mg. There was 1 failure, which occurred in the group treated by using 1.0 mg PGF2alpha. Immediate side-effects were kept at an acceptable level with a very mild premedication. No serious complications occurred but curettage was performed on 2 patients because of bleeding. Spontaneous menstruation started in the 1.0 mg group within an average of 33 days (range 25-61). The use of 2.0 mg PGF2alpha for the routine termination of very early pregnancy is recommedned.