T.K.A.B. Eskes

A randomized comparison of oxytocin, sulprostone and placebo in the management of the third stage of labour

Objective— To compare the effect on post partum bloodloss of the postpartum prophylactic administration of oxytocin or sulprostone in low risk women having an expectant management of the third stage.

Quantitative evaluation of fetal heart rate patterns

Abstract Beat-to-beat arrhythmias of fetal heart action can be hardly analysed with ordinary paper tape recordings of the fetal tachogram. This problem can be circumvented by the use of automatic processing methods by which the irregularity can be quantified and different types of irregularity can be diagnosed. Two patients are discussed. The tentative diagnosis in the first case was wandering pacemaker, and in the second one sino-atrial block.

(Patho)physiological implications of chronic dietary sodium restriction during pregnancy; a longitudinal prospective randomized study

Objective— To study the possible pathophysiological implications of long continued dietary sodium restriction in pregnancy.

Dietary sodium restriction during pregnancy; a historical review.

This article reviews the major milestones in obstetric research in the past 90 years, which have lead to the wide-spread use of salt restriction during pregnancy. Possibly the most ardent advocate of the view that salt plays a crucial role in eclampsia was De Snoo (1877-1949), a Dutch obstetrician. However, despite many enthusiastic clinical reports, no convincing evidence has ever been produced that salt restriction helps in the prevention of hypertension during pregnancy.

Atrial natriuretic peptide and atrial size during normal pregnancy

Summary. Plasma atrial natriuretic peptide (ANP), right and left atrial areas and the diameter of the left atrium were studied serially during normal pregnancy and at 6 weeks post partum in 21 nulliparous women. Concentrations of ANP in plasma were significantly elevated during mid‐pregnancy. Thereafter ANP levels were not significantly different from those at 6 weeks after delivery. All atrial measurements were significantly increased in the third trimester of pregnancy, but none was significantly correlated with the plasma ANP concentrations. This might point at an altered mechanism of ANP secretion, which may be part of a physiological adaptive process to sustain the hypervolaemia of pregnancy.

Disturbed reproductive performance in extreme folic acid deficient golden hamsters

We studied the effects of folic acid-deficient diets on maternal red blood cell folate level and reproductive performance in golden hamsters (Mesocricetus auratus, Waterhouse). Animals on the same day of oestrous cycle were put together and finally divided into three groups. Each group comprised at least 12 mature female hamsters. The animals were given three different diets, which were commenced before mating. The feeding regimens comprised a standard diet (group 1), or a folic acid-deficient diet which started either 2 weeks (group 2) or 16 weeks (group 3) prior to mating. The regimens were continued until sacrifice of the animals on day 9 of pregnancy. Pregnancy was realized by caging a male with a selected female during the night of ovulation. Just prior to sacrifice, blood samples were drawn to measure maternal folic acid levels in red blood cells. The pregnant uteri were removed and the embryonic sacs were carefully dissected away from the uterus. The number of sacs per pregnant animal was noted. Extreme folic acid deficiencies were confirmed in the pregnant golden hamsters on a folic acid-deficient diet which started 16 weeks prior to mating as compared to those on a standard diet and on a folic acid-deficient diet which started 2 weeks prior to mating. This deficiency appears to interfere with normal reproductive performance. It caused early embryonic loss several days after mating and resulted, finally, in restoration of the oestrous cycle.

CA-125 levels in cervical mucus during the menstrual cycle *

OBJECTIVE To determine CA-125 levels in cervical mucus (CM) during the menstrual cycle and their relationship to gonadal steroids and ovulation. DESIGN Prospective study. SETTING Two academic tertiary referral centers. PARTICIPANTS Thirteen women with a normal fertility work-up. INTERVENTIONS CA-125 and protein concentrations were measured in CM aspirated from the endocervical canal on alternate days in the early follicular and luteal phases and on a daily basis during the periovulatory period. Results were correlated with hormonal determinations, serum CA-125 levels, and ultrasound examination. RESULTS Twenty ovulatory nonconceptional cycles were analyzed. Although the mean (+/- SD) concentration of CA-125 in CM (173,900 +/- 128,900 arbitrary U/mL) appeared relatively constant along the cycle, a large variation among the different samples was observed, ranging from 9,000 to 830,000 arbitrary U/mL. No clear trend could be detected as related to hormonal changes and ovulation. However, when the mucus CA-125 concentration was multiplied by the total volume of the correspondent sample, a clear periovulatory increase of total CA-125 levels was found. This was further supported by a similar trend showed by the calculated CA-125:protein concentration ratio. CONCLUSIONS CA-125 is present in CM in high concentrations that vary widely along the cycle. Although no cyclical variation in CA-125 concentration could be determined, there was an apparent increase of total CA-125 levels parallel to the augmented mucus production during the periovulatory period. This further suggests a possible involvement of this glycoprotein in the secretory process of endocervical glands.

Infusion of diazoxide in severe hypertension during pregnancy

Eight patients with severe pre-eclampsia or eclampsia were treated with diazoxide. The drug was administered on 3 occasions as a bolus injection (300 mg within 10 sec) and on 8 occasions as an infusion (15 mg/min, total amount 5 mg/kg body weight). The hypotensive effect at 30 and 60 min (stable hypotensive effect) and at 7 h (long-term effect) were the same with both modes of administration. The maximal decrease in blood pressure was reached in 5 min after bolus injection, compared to 25 min with the infusion. If diazoxide is used in severe pre-eclampsia and eclampsia, it should be administered preferably by the infusion method, because this results in a more gradual decline in blood pressure. Furthermore, the administration can easily be interrupted in cases of an exaggerated drop in blood pressure.

Is there influence of smoking on the mutagenicity of follicular fluid

The mutagenicity of follicular fluid was examined in 24 patients, 12 smoking and 12 nonsmoking, who were treated in an in vitro fertilization program. The Salmonella microsome assay was used. It was found that the mutagenicity of follicular fluid was not influenced by the number of cigarettes smoked. Urine samples of smoking in vitro fertilization (IVF) patients however showed a dose-dependent elevation of the mutagenicity.

Pressure in the hydrocephalic fetal head during the first stage of labor

Intraamniotic pressure was studied in the 30th week of amenorrhea in relationship with fetal intracranial pressure with open-tip catheters. The fetus had a severe hydrocephalus (echoscopy 16 cm) due to a teratologic malformation of the cerebrum. Clinically nonoperative treatment was indicated. Intracranial pressure (X) was invariably higher than intraamniotic pressure (Y) between contractions: Y = 2.04 + 0.54 X, and during contractions: Y = 5.30 + 0.55 X. There was no definite relationship between intrauterine and intracranial pressure, and the fetal tachogram. A definite relationship was established with the supine position of the patient and decelerations in the fetal tachogram. It is suggested that when fetal cardiac decelerations are seen during the first stage of labor it seems advisable to look for factors such as umbilical cord compression and decrease of materno-placental perfusion rather than fetal head compression.