Comparative analytical evaluation of thyroid hormone levels in pregnancy and in women taking oral contraceptives: a study from an iodine deficient area.

Increase of serum thyroxine binding globulin (TBG) resulting from estrogen action may lead to problems in thyroid diagnostics. The aim of the present study was to define the most diagnostically reliable thyroid parameters in women exposed to differentially elevated estrogens. Sera of three groups of healthy women were analyzed: women taking no medicine (controls), those taking oral contraceptives and pregnant women (in weeks 16 or 32 of gestation). All women involved in the study lived in a moderately iodine-deficient geographical area. Thyroid stimulating hormone (TSH), TBG, total thyroxine (T4), total tri-iodothyronine (T3) and free T3 were determined and free T4 indices (total T4 x T3 uptake; total T4/thyroxine binding capacity (TBC); total T4/TBG) were calculated. Free T4 was measured simultaneously with a one-step T4-analog enzyme-linked immunosorbent assay (ELISA), a labeled T4 antibody radioimmunoassay (RIA), and a two-step microparticle enzyme immunoassay (MEIA). Estrogen-dependent differences were found in all investigated parameters; however, they remained in the reference interval for TSH, total T4 x T3 uptake, total T4/TBC,free T3 and free T4 MEIA. It was concluded that simultaneous estimations of free T4 and free T3 should follow a primary TSH measurement. The necessity of a distinct reference range has emerged for free thyroid hormones in midterm and late pregnancy as well as in the use of oral contraceptives, especially in iodine-deficient areas.

[Symptomless amniotic infection related to pregnancy outcome]. / Tünetmentes peteürfertözödés kapcsolata a szüléskimenetellel.

Placental histology in 984 pregnancies (758 term and 226 preterm) occurring during the years 1995 to 1998 was investigated and amniotic cavity cultures were taken during 918 cesarean sections. Histology revealed placental infection in 20.3% of placentas. Chorioamnionitis was confirmed in 119 out of 758 term pregnancies (15.7%) while in 81 out of 226 preterm pregnancies (35.8%); the difference is highly significant (chi 2 = 26.6, p < 0.01). Bacteriological culture resulted in bacterial growth in 19.7% of all cases (181/918), its frequency was significant higher in premature births (54/133, 40.3% chi 2 = 25.2, p < 0.01) as compared with pregnancies carried to term. Recovery of any organism from the amniotic cavity was strongly associated with chorioamnionitis confirmed by histology. Comparison of the rates of indicating placental infection found in this study and a study performed between 1981 and 1983, showed that the program aiming at detection and treatment of silent intrauterine infection has only partially been successful.

[Intrapartum administration of antibiotics in the prevention of neonatal Streptococcus B infections]. / Szülés alatt alkalmazott antibiotikus kezelés az újszülöttkori B csoportú Streptococcus fertözések megelözésére.

This study was performed prospectively. Between 1. January 1995 and 31 December 1997, a modification of the screening-based strategy protocol was implemented. Antenatal screening cultures for GBS were performed at approximately 30-32 weeks of gestation. The protocol recommends the use of antibiotic prophylaxis to GBS positive women with any of the obstetric risk factors for early-onset of GBS disease. Our regiment for prophylaxis for patients in labor was ampicillin 2 g. intravenously then 1 g. i.v. every 4 hours until delivery. Before this study had started (1984-1994), there were 149 serious neonatal GBS infection (149/15,040 pregnancy, among them were 97 premature infants. Thirty-one infants suffered from connatal sepsis. We observed 29 lethal infection. Between January 01, 1995, and December 31, 1997, 4150 women participated in this investigation. The incidence of positive group B Streptococcus cultures from the vaginal samples was 11.6% (481/4150). During the study period (3 years), serious GBS infection was detected in 46 infants (1.1%). There were 9 cases of neonatal sepsis (0.2%), two of them suffered lethal infections (0.05%). There was no late onset of GBS disease and lethal outcome in the last two years. Our investigations bears clinical importance because we confirmed that group B streptococcal colonization is an important risk factor for neonatal infection. The selective intrapartum chemoprophylaxis is a safe and effective intervention to prevent early-onset severe GBS disease.

[Use of Zatuchni-Andros score system on deliveries from breech presentation (author's transl)]. / Anwendung des Zatuchni-Andros-Score-Systems bei Beckenendlagengeburten.

The Zatuchni-Andros score was applied to assessment of deliveries from breech presentation, between January 5th, 1973, and December 31st, 1976. Frequency of caesarean section was 28.3 per cent and perinatal mortality 0.44 per cent in 247 deliveries on term. The authors' experience and results were compared with literature data and supported the conclusion that the Zatuchni-Andros score was a reliable instrument of decision-making on the obstetric method that should be used in cases of breech presentation.