The relation of maternal body build to pregnancy outcome was studied in a prospectively collected one year cohort of singleton pregnancies in Northern Finland. Of the 9015 women, 11.0 per cent were thin (body mass index < 19) and 3.9 per cent obese (body mass 1 3 0 ) .Maternal thinness was most common among young nulliparous women who smoked and obesity among multiparous women of advanced age and lower educational status. Maternal thinness marginally increased the risk of pre-term delivery but had no other relation to the course of labour. It was also associated with the number of small for gestational age and low birth weight babies, whose morbidity was minor compared with similar babies of obese women. Obesity was associated with an increased risk of hypertensive and diabetic disturbances and complications of the course of labour. It was also associated with more macrosomic, large for dates babies and marginally with the number of babies who were transferred to the neonatal intensive care unit after birth.
Objective To study the effect of daily treatment with 50 mg of aspirin (ASA) on the hypertensive pregnancy complications and on the production prostacyclin (PGI2) and thromboxane A2 (TxA2) in high risk pregnant women and their infants. Design Placebo controlled prospective study. Setting Departments of Obstetrics and Gynaecology, University of Helsinki, University of Oulu and Central Hospital of Middle Finland, Finland. Subjects Two hundred and eight pregnant women with pre‐existing hypertension or a history of severe preeclampsia in their previous pregnancy. Prostanoids were studied in a subgroup of 18 women. Interventions The women were randomised to receive ASA (50 mg/day, n= 103) or placebo (n= 105) from the mean of 15 weeks gestational age to delivery. The exacerbation of pre‐existing hypertension or the appearance of hypertension in previously normotensive women, the appearance of proteinuria and fetal growth were the main end points, but some other clinical characteristics were also recorded. Urinary excretion of PGI2 and TxA2 metabolites by mothers and infants and their production in umbilical arteries in vitro were also studied. Results Two women (one in both groups) had miscarriages, and one pregnancy was terminated for fetal anencephaly (ASA group). In addition, seven women discontinued the treatment due to urticaria (two women in ASA group), increased activity of aspartate amino tranferase in serum (one woman in both groups), or increased bleeding time (one woman in ASA group, two women in placebo group), and one woman in the placebo group was lost from follow‐up. Thus the end points could be assessed in 97 women taking ASA and 100 women taking placebo. ASA did not diminish the rate of the rise of blood pressure without (12 vs 14, respectively) or with proteinuria (9 vs 11), but fetal haemodynamic disturbances as assessed by Doppler equipment (1/44 vs 6/45 women studied, P= 0.05) and need for treatment in neonatal intensive care unit (10 vs 21, P= 0.04) were more rare in ASA group. ASA tended to increase the birthweight of the newborn (3348 ± 707 g vs 3170 ± 665 g, mean ± SD, P= 0.07), but two perinatal deaths occurred in ASA group. ASA prolonged the bleeding time of the mother (435 s, 210–998 s (geometric mean, range) vs 349 s, 210–690 s, P= 0.02), but caused no extra blood loss during delivery, nor affected neonatal hemostasis. In a subgroup of mothers (ASA, n = 10; placebo, n = 8), ASA inhibited more than 90% of platelet TxA2‐production, and caused a 65 to 80% decrease in the urinary excretion of TxA2 metabolites, but no decrease in the urinary excretion of PGI2 metabolites. Conclusions ASA did not prevent the rise of maternal hypertension, but improved fetal haemodynamic performance and reduced the need of intensive neonatal care. It inhibited strongly maternal thromboxane A2 but not PGI2 production and thus shifted the balance between PGI2/TxA2 to the dominance of the vasodilatory, anti‐aggregatory side.
An open, randomized, multicenter study was carried out to compare two oral contraceptives as regards their therapeutic efficacy in androgenization symptoms such as acne, seborrhea and hirsutism in women. The preparations used were the combination of 2 mg cyproterone acetate (CPA) with 0.035 mg ethinyl estradiol (EE) (Diane 35, Schering AG, Berlin-West) and 0.150 mg desogestrel (DG) with 0.03 mg ethinyl estradiol (Marvelon, Organon, Oss, The Netherlands). The duration of therapy was 9 months. The combination of CPA-EE was used by 83 patients for 658 cycles and the combination of DG-EE by 79 women for 618 cycles. No pregnancy occurred under either therapy. Both preparations are well tolerated. However, some side-effects, such as reduced libido, nervousness and breast tenderness, were observed more frequently (p less than 0.05) in the DG-EE group than among the users of the CPA-EE combination. The therapeutic outcome was better in the CPA-EE group, especially in cases of facial acne (p less than 0.05). Seborrheic symptoms also responded better to the CPA-EE therapy. The results show that the CPA-EE combination is superior to the DG-EE combination in the treatment of acne and seborrhoea.
Twenty-four cases with antepartal fetal death of one twin are reported. Of the stillborn fetuses 5 were delivered as a fetus papyraceus, 13 had severe and 6 no maceration. The cesarean section rate was 25%. The placenta was monochorionic in 12 cases. Structural defects were found in one monochorionic co-twin of a fetus papyraceus. Otherwise the neonatal morbidity of the liveborn co-twins was not increased if the low gestational age averaging 34 weeks, was taken into account. No manifestations of defective hemostasis were observed in the mothers.
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