Women attending our Department for a first-trimester abortion were examined for the presence of Mobiluncus species. C. trachomatis or clue cells in vaginal discharge in an attempt to identify risk groups for development of pelvic inflammatory disease (PID) after first-trimester abortion. A correlation was found between the presence of Mobiluncus and clue cells in vaginal discharge and the incidence of PID after first-trimester abortions. These women were also older than those in whom C. trachomatis was identified. Our study indicates that screening for C. trachomatis and clue cells in vaginal discharge will identify two different risk groups for developing PID after first-trimester abortion.

No abstract

In a prospective clinical investigation of 2,144 deliveries, we elucidate the indications for episiotomy and how different methods of anesthesia affect the frequency of episiotomy and the perineal problems after episiotomy compared with those after spontaneous perineal laceration. We found a significantly higher infection rate (p < 0.001) and a longer healing period in the episiotomy group. These differences remain even if only primigravida or the indication, imminent perineal laceration, is studied. The results indicate that many women will unnecessarily suffer after an episiotomy. The patient’s subjective problems are significantly increased, both immediately and at the 3-month postoperative follow-up.

A double-blind study of treatment for bacterial vaginosis (BV), using metronidazole tablets 500 mg 3 times daily for 10 days versus placebo in the same regimen, was performed on 42 outpatients with irregular bleeding episodes or discharge attending a gynecological clinic. All patients had motile rods in wet smears in addition to fulfilling the criteria for BV. Treatment gave a cure rate of 76% versus 5 % in the placebo group. Mobiluncus sp. was identified in 81 % of these cases before treatment, in 8% of the cured patients and in 50% of those not initially cured at follow-up. Repeated treatments, once or twice, resulted in a 100% cure rate. A 6-month follow-up was carried out on 39 of the 42 patients. There were 7 relapses after 6 months giving a cure rate of 82%. After successful treatment all bleeding disturbances disappeared. We conclude that it is important to treat BV in patients with symptoms other than malodorous discharge.

Objective: To assess the ability of measuring total maternal plasma fibronectin in predicting the risk of developing preeclampsia. Method: In a cohort of 657 initially normotensive pregnant nulliparous women blood samples were collected at 26, 30 and 34 weeks of gestation. After delivery 3 groups were selected for measurement of total plasma fibronectin. The first group comprised 24 women who developed preeclampsia; the second 21 women who developed gestational hypertension, and the third 89 age-matched controls who remained normotensive. Results: In women who developed preeclampsia the fibronectin levels were higher at 26 (p < 0.01), 30 (p < 0.001) and 34 weeks of gestation (p < 0.001) than in pregnant controls. In the general population of pregnant nulliparous women the estimated risk of subsequent preeclampsia correlated with the fibronectin level at each measurement. In women with fibronectin levels within the 25th percentile at the 26th week of gestation, the risk was ≤1.9% and within the 90th percentile ≥6.2%. The change in fibronectin levels between 26 and 34 weeks of gestation was the only variable that remained statistically associated with preeclampsia (p = 0.0002) in multivariate analysis. In this model the risk figures for the corresponding percentiles were ≤1.0 and ≥5.8%, respectively. Conclusion: Longitudinal assessment of the change in total fibronectin levels predicted preeclampsia slightly better than cross-sectional analysis of fibronectin at any gestational age. Nevertheless, measurement of total fibronectin in maternal plasma could not be proven to be a useful clinical predictor for preeclampsia in a general obstetric population of nulliparous women.

No abstract

The incidence of hyaline membrane disease in 41 preterm infants born between January 1975 and January 1976 was investigated in a retrospective study. Terbutaline, a beta2-receptor stimulating drug, had been administered to the women in order to arrest premature labour. In spite of the treatment 24 preterm infants were delivered. The incidence of HMD in this group was 1/24. In a group of 17 neonates whose mothers had received no such treatment the incidence of HMD was 5/17. Comparison between the two groups revealed a significantly lower incidence of HMD in the terbutaline treated group than in the controls (p less than 0.05). There were no significant differences in maternal age, gestational age, birth weight or Apgar score between the two groups. The lower incidence of HMD in the terbutaline treated group is suggested to reflect a rapidly induced release of pulmonary surfactants in the preterm infants. Evidence for a similar sequence of events has earlier been shown to occur in animals under standardized experimental conditions.

The respiratory performance was studied after intraperitoneal administration of the adenosine agonists N⁶-phenyl-isopropyl-adenosine (PIA) and adenosine- 5-ethylcarboxamide to preterm (gestational age 29–30 days) newborn halothane-anesthetized rabbits. Both agonists induced marked hypo ventilation and irregular breathing by decreases in the breathing frequency as well as the tidal volume. Expiratory time was markedly prolonged, resulting in a decrease in the respiratory duty cycle (inspiratory time/total cycle duration). Analysis using the occluded-breath technique revealed that the adenosine analogues altered the time setting of the expiratory (inspiratory) neuronal circuits and lowered the inspiratory off-switch level, while inspiratory drive and the bulbopontine setting of the inspiratory phase were unaltered. The ventilatory response to CO₂ was blunted after both adenosine analogues studied. Theophylline almost completely reversed the hypoventilation and irregular breathing seen after PIA injection. It is concluded that activation of central nervous adenosine receptors induced a marked respiratory depression in the preterm rabbit. Furthermore, our data imply that an overactivity of central adenosine mechanisms may have a pathophysiological significance for the irregular breathing or apnea of prematurity sometimes seen in the human neonate.