Wiggo Fischer-Rasmussen

Ginger treatment of hyperemesis gravidarum

Thirty women participated in a double-blind randomized cross-over trial of the efficacy of a natural product, the powdered root of ginger (Zingiber officinale), and placebo in hyperemesis gravidarum. Three patients had to be withdrawn. Each woman swallowed capsules containing either 250 mg ginger or lactose q.i.d. during the first 4 days of the treatment period. Interrupted by a 2 days wash-out period the alternative medication was given in the second 4-day period. The severity and relief of symptoms before and after each period were evaluated by two scoring systems. The scores were used for statistical analyses of possible differences. Subjectively assessed, 19 women (70.4%) stated preference to the period in which ginger, as was later disclosed, had been given (P = 0.003). More objectively assessed by relief scores a significantly greater relief of the symptoms was found after ginger treatment compared to placebo (P = 0.035). No side effects were observed. The possible mutagenic and antimutagenic characters of ginger reported in a study of E. coli have not been evaluated with respect to any significance in humans. Powdered root of ginger in daily doses of 1 g during 4 days was better than placebo in diminishing or eliminating the symptoms of hyperemesis gravidarum.

Serum concentrations of intact parathyroid hormone during late human pregnancy: a longitudinal study

In the present study an assay reactive with the intact PTH molecule supposed to be the biological active has been used for measurements in 10 normal pregnant women during the late pregnancy and post-partum. Simultaneously serum concentrations of ionized calcium, phosphate, magnesium and albumin were determined. Serum concentrations of intact PTH were low compared to non-pregnant levels, while concentrations of ionized calcium, phosphate, magnesium (corrected) were unaffected.

MATERNAL‐SERUM‐ALPHAFETOPROTEIN SCREENING FOR FETAL MALFORMATIONS IN 28062 PREGNANCIES

Abstract. From 1st March, 1980 and up to 29th February 1984 a multicenter serum α‐fetoprotein (S‐AFP) screening project was carried out for the detection of severe fetal malformations. S‐AFP was determined by a radio‐immunoas‐say in 28062 pregnant women between the 16th and 20th week of gestation. Patients with elevated S‐AFP values, e.g. above 95 percentile, were examined further with a second S‐AFP and by ultrasound scan. 244 amniocenteses (0.9%) were carried out to detect 62 malformations (21 anen‐cephalies, 14 spina bifidas, 2 encephaloceles, 7 omphaloceles, 5 gastroschises, 4 chromosome abnormalities and 9 other malformations). Fifteen of the 16 cases of spina bifida could not be verified by ultrasound scan, whereas all other malformations except chromosome abnormalities were confirmed by ultrasonography. Two cases of spina bifida and one case of skin‐covered encephalocele had normal S‐AFP concentrations and were therefore not detected. There were no definitive false‐positives, e.g. therapeutic abortion of a normal fetus. Our conclusion is that a nationwide S‐AFP screening should be recommended.

The benefit of external cephalic version with tocolysis as a routine procedure in late pregnancy

The effectiveness of external cephalic version with tocolysis when routinely used in the 37th week of gestation is reported. The procedure had earlier been ruled out in our department, was found effective in a prospective study, and afterwards settled as a routine. Among 1038 women with single breech presentation, 882 could be offered an attempt of external cephalic version during the period 1982-1988. Attempt of version was carried out in 316 women resulting in a vertex presentation at delivery in 100. The success rate on average was 35%. The estimated reduction of breech deliveries was 100/1038 = 9.6%. As the mean caesarean section rate in women with breech presentation was 81% during the period studied, the estimated reduction in the number of caesarean sections during those seven years was 81. Thus the total caesarean section rate (11.3%) was estimated to be reduced by 0.4%. No immediate serious complications were associated with the procedure. Two cases of intra-uterine fetal death occurred 2 and 5 weeks, respectively, after successful, uncomplicated version to vertex presentation. No obvious connection with the external cephalic version could be demonstrated. The effectiveness of version as a routine procedure is less than expected from reports of prospective trials of external cephalic version carried out by a few investigators, but the results may realistically illustrate what is achieved in the long term.

Stress urinary incontinence and posterior bladder suspension defects. Results of vaginal repair versus Burch colposuspension.

Vaginal repair has been recommended in cases of stress urinary incontinence and posterior bladder suspension defect diagnosed by colpocysto‐urethrography. Thirty‐eight women with stress urinary incontinence and posterior suspension defect have been treated. First, 19 women underwent a vaginal repair. In a second period, another 19 consecutive patients had a colposuspension a.m. Burch. The patients have been evaluated 6 months postoperatively and at a long‐term follow‐up. No significant difference was found postoperatively in the frequency of symptoms and signs of stress incontinence, either after 6 months or at the long‐term follow‐up. A significantly smaller frequency of genital prolapse was found in the colposuspension group at long‐term follow‐up. No side effects such as frequency, urgency or bacteriuria were evident in the group treated by colposuspension. With reservation to the non‐randomized allocation, it may be concluded that a radiographic distinction between anterior and posterior bladder suspension defects in choosing the surgical approach is unnecessary.

Relation of estriol in saliva to serum estriol during normal pregnancy

Abstract. As saliva is an easily accessible biological material, compared with 24‐hour urine and blood, the salivary concentration of estriol was studied from the 30th to the 41st week of gestation in 268 samples from 124 normal pregnancies. At the same time, venous blood samples were drawn and analyzed for total and unconjugated estriol. The mean values for the concentration of total estriol in saliva in the 30th and 41st weeks were 2.8 and 7.2 nmol/l respectively. The salivary estriol concentration appears to increase in perfect conformity with its serum concentration in the course of gestation. If estriol in saliva also reflects low serum values and an impaired function of the feto‐placental unit, analyses of the saliva may be applicable as a screening procedure in high‐risk pregnancies.

Comparison of Magnesium and Methyldopa for the Control of Blood Pressure in Pregnancies Complicated with Hypertension

Objectives: Although magnesium is now the drug of choice for the prevention of eclamptic seizures only few studies have evaluated whether magnesium may reduce blood pressure in pregnancies complicated with hypertension. Methods: A total of 33 patients with pregnancy-induced hypertension were randomized to either magnesium or methyldopa treatment. Of these 16 received magnesium and 17 methyldopa. The treatment comprised a 48-hour magnesium infusion followed by oral magnesium tablets until 3 days after delivery or 250 mg methyldopa 4 times a day in a similar period. Results: Patients treated with magnesium had 1 day after inclusion a statistically significantly lower systolic blood pressure compared to the level in the methyldopa group (138.1 ± 11 vs. 147.6 ± 11 mm Hg; p < 0.05), but no difference was observed in diastolic blood pressure (92.0 ± 6.6 vs. 96.0 ± 10.1 mm Hg; NS). From the 5th day of inclusion and until delivery both systolic and diastolic blood pressure were significantly lower in the magnesium group (p < 0.05). Including all blood pressure measurements in a single analysis showed that both systolic (138 ± 13 vs. 148 ± 15 mm Hg; p < 0.0001) and diastolic (92 ± 10 vs. 94 ± 10 mm Hg; p < 0.05) blood pressure were lower in the magnesium group compared to the methyldopa group. There was no difference between the two groups regarding gestational age at delivery, birth weight, Apgar scores and pH in umbilical cord blood. Conclusion: This preliminary study demonstrates that magnesium treatment lowers blood pressure in pregnancies complicated with hypertension. The effect is without any adverse effect on maternal and neonatal well-being.

Plasma Oestrogens and the Fetal Outcome

Oestriol, oestrone, and oestradiol‐17β concentrations in plasma were studied in a series of “high risk” pregnancies. A gas chromatographic method of measurement was used. Plasma determinations have an advantage over urine determinations, because the collection of 24 h urine specimens is ledious and particularly liable to error. Low and subnormal plasma oestriol values were found to be correlated with the subsequent occurrence of fetal asphyxia or intrauterine death. Plasma oestriol values well within normal limits, or increasing, indicated that fetuses were not at risk of the more severe grades of asphyxia, or of intrauterine death. An exception was observed when the mothers had impaired renal function. Oestrogen clearance is reduced and, therefore, apparently normal values are not significant. Low oestrogen concentrations may not be significant when patients are on (halogenated) steroid therapy. Plasma oestrone and oestradiol‐17β values in the asphyxia group showed a similar pattern to those of oestriol, but gave no additional information. In the groups without asphyxia, especially oestradiol‐17β values lay low in the normal range with many subnormal values. In many of these cases, there was also the discrepancy that plasma oestriol values were normal, while urine oestriol values were subnormal. The plasma analysis will probably become a valuable guide to care in the obstetrical clinic.

Evaluation of a simple, non‐surgical concept for management of urinary incontinence (minimal care) in an open‐access, interdisciplinary incontinence clinic

Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open‐access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non‐surgical treatment with a limited consumption of resources (“minimal care”). This was a prospective observational study of 408 consecutive women examined and treated in the clinic. The main characteristics of the women were a high median age and a high prevalence of severe concomitant diseases with possible influence on lower urinary tract function. More than half of the patients had urge or mixed incontinence. Most of the patients were managed with conservative treatment. Fifteen percent were referred to in‐hospital treatment, with 5% to incontinence surgery. In total 44% felt cured or very much improved. Before and after treatment one third of the women completed quality‐of‐life questions and voiding charts, while 43% completed the pad tests. Quality of life improved significantly. Objectively leakage on pad test and voiding charts was significantly improved. The patients were in general very satisfied with clinics program. Almost one fourth of the women were followed up for 6 months after discharge. No significant deterioration in the subjective results were found compared to status at discharge. In conclusion, the results highlight the need for advice and treatment of patients with incontinence. The minimal care program and interdisciplinary structure in the incontinence clinic offer effective and low cost treatment for urinary incontinence. The open‐access, interdisciplinary incontinence clinic model is recommended. Neurourol. Urodynam. 18:9–17, 2000.

Emepronium Carrageenate: Clinical Effects and Urinary Excretion in Treatment of Female Urge Incontinence

Eighteen women (median age 54 years, 36-79) with urinary motor urge (n = 13) or sensory urge (n = 5) incontinence were treated for three 2-week periods with emepronium carrageenate (EC) (Cetiprin Novum) in daily doses of 500 and 1000 mg and placebo. Subjectively the women experienced an increased ability to control micturition, i.e. less urge, during EC treatment. Only mild and mainly anticholinergic side effects were recorded, most frequently dryness of the mouth. As regards side effects, the evaluation of objective effects were complicated by a tendency towards carry-over effect to placebo. Placebo in the first treatment periods were analysed solely; no effects of placebo could be demonstrated. Compared with the reference period, decreases in the total number of micturitions (approx. 20%) and in the number of urge incontinence episodes (approx. 75%) were seen. As compared with placebo, a significant increase (approx. 25%) in the average micturition volume could be demonstrated. The percentage urinary excretion of emepronium decreased with increasing oral intake and with advancing age. Probably, an initial daily dosage of 500 mg EC will do well in younger women (less than 50 years), whereas elder patients may need 1000 mg. Further dosage recommendations are given.