Apgar scores in low birth weight infants delivered vaginally and by cesarean section.

A retrospective investigation of 641 live infants weighing less than 2500 g showed that the frequency of a low Apgar score (less than or equal to 7, five minutes after birth) was significantly correlated to the birth weight of the infant and independent of the mode of delivery and the presentation of the fetus at birth.

Effects of electronic fetal monitoring on rates of early neonatal death, low Apgar score, and cesarean section.

Using data from the University Hospital in Odense, Denmark, we have studied the effects of electronic fetal monitoring on rates of early neonatal death (death of liveborn within first week of life), low five-minute Apgar score (less than 7), and cesarean section. Approximately 22 000 births occurring in 1974 - 82 were studied, of which 13% were electronically monitored. Monitoring was significantly associated with an elevated cesarean rate in low-risk labors and certain high-risk labors, but appeared not to increase the cesarean rate in all high-risk labors. In high-risk labors, monitoring was associated with an approximate 40% reduction in rates of low Apgar score and early neonatal death, but neither reduction was statistically significant. The associations of monitoring with elevated cesarean rate declined significantly over the study period. These results accord closely with studies conducted in the United States, indicating that monitoring is of benefit in high-risk labors, but leads to excessive cesarean deliveries in low-risk labors. Our study additionally indicates that the effect of monitoring on the cesarean rate has been declining over time.

Labor induction with prostaglandins.

Prostaglandins E2 and F2 alpha have been used for labor induction for more than 10 years. Many investigations have shown that these prostaglandins are effective, and within certain dosage schedules, safe oxytocics, even though the systemic administration is accompanied by side effects, mainly from the gastro-intestinal tract. Oral PGF2 appears to be the prostaglandin favored in recent years. It gives few side effects when administered in this manner. It is concluded from the present investigation and a study of the literature that oral PGE2 has certain advantages in comparison with other oxytocics for induction of labor at term, although it cannot entirely replace intravenous oxytocin. This, together with the relatively high cost of oral PGE2, will limit its use in the future for labor induction at term in normal cases.

Oral oxytocics for induction of labor. A randomized study of prostaglandin E2 tablets and demoxytocin resoriblets.

A randomized comparative study of 387 consecutive patients admitted for induction of labor was carried out using two orally administered oxytocics (prostaglandin E2 tablets (Prostin) or Demoxytocin resoriblets for buccal administration (Sandopart)), the results of which are reported here. One-hundred and twenty-three cases were suitable for primary amniotomy; of these 48 were given PGE2 tablets and 75 received demoxytocin resoriblets. In a further 264 cases, primary amniotomy was inadvisable and of these, 133 patients were allotted to the PGE2 treatment group and 131 to treatment with demoxytocin. A significantly higher success rate was observed (p less than 0.05) in the PGE2 group in cases where primary amniotomy had been carried out, as compared with the demoxytocin group. Parturition was successfully induced in 82.0% of the patients given PGE2 tablets, as against only 63.4% of those receiving demoxytocin following 2 days of stimulation without primary amniotomy. This difference is statistically significant at the 0.001 level, and presumably due to the highly significant difference (p less than 0.0001) between patients with a Bishop score of 5 or less, where induction was successful in 75.4% given PGE2 tablets, in contrast to a success rate of only 36.7% in patients receiving demoxytocin resoriblets. No difference was observed in the success rate between the two treatment groups when the Bishop score was 6 or more. No difference was recorded in the incidence of fetal distress, instrumental delivery or low Apgar score between the two treatment groups. However, a higher incidence of vomiting and diarrhea were observed in patients treated with PGE2 tablets (11%) as compared with those receiving demoxytocin (1.5%). There was no difference with regard to the induction-delivery time, nor to the different stages of labor between otherwise comparable treatment groups when the induction was successful. It is concluded in respect of induction of labor using orally administered oxytocics that PGE2 (tablets) are preferable to demoxytocin (resoriblets) as it is the more effective of the two.

Use of oral oxytocics for stimulation of labor in cases of premature rupture of the membranes at term. A randomized comparative study of prostaglandin E2 tablets and demoxytocin resoriblets.

The efficacy of oral PGE2 tablets and buccal demoxytocin (resoriblets) for the induction of labor in cases of premature rupture of the membranes (PROM) after the 37th week of gestation has been evaluated in a prospective, randomized investigation of 193 women. PGE2 tablets (Prostin) were given to 109 parturients and demoxytocin resoriblets (Sandopart) to 84. The former were given in increasing doses from an initial 0.5 mg to a maximum of 1.5 mg every hour. The demoxytocin was administered at a constant dosage of 50 I.U. every 30 min. The treatment was unsuccessful in 10 of the women treated with PGE2 tablets and in 19 women receiving demoxytocin resoriblets. In addition, the treatment had to be discontinued in 5 women in the PGE2 group due to gastrointestinal side effects. This gives a total success rate of 86.3% for treatment with PGE2 against 77.4% in respect of demoxytocin. This difference is not significant. No difference was observed between the two treatment groups as regards: the stimulation-delivery interval, duration of the various stages of labor, efficacy in primiparae and multiparae, efficacy in patients with a high/low Bishop score. A significantly higher frequency of gastro-intestinal side effects was seen in those treated with PGE2 (21.7%) as compared with demoxytocin (3.6%). The frequency of surgical intervention was 17% in the PGE2 group and 10% in the demoxytocin group. In 4 cases where the stimulation was successful, cesarean section was carried out for reasons unrelated to the drug therapy. Despite the fact that demoxytocin treatment results in fewer side effects than PGE2, the efficacy of the drug is not superior. Based on experience from previous investigations carried out in this department, where intravenous oxytocin was found to be clearly better than oral PGE2 for the induction of labor in cases of PROM, intravenous oxytocin will remain the method of choice due to the shorter period of treatment, which must take priority.

Stimulation of labor in cases of premature rupture of the membranes at or near term. A consecutive randomized study of prostaglandin E2-tablets and intravenous oxytocin.

Prostaglandin E2-tablets were compared to intravenous oxytocin for the stimulation of labor in 201 patients at or near term, with premature spontaneous rupture of the membranes without labor activity for 6 hours after the escape of fluid. The patients were randomly allocated; 99 were treated with PGE2-tablets (0.5-1.5 mg/hr) and 102 with intravenous oxytocin (7.5-45 mIU/min). The treatment was ineffective in the PGE2 group in 3 cases; these were treated successfully with intravenous oxytocin. In the oxytocin group, 3 patients were delivered by cesarean section for reasons not associated with the drug. A significant difference was found in the stimulation-delivery time, in favor of intravenous oxytocin. Although PGE2 tablets are a safe and convenient alternative to intravenous oxytocin, the investigation showed that intravenous oxytocin is preferable in cases of premature rupture of the membranes with more than 6 hours without labor activity.

Induction of labor with and without primary amniotomy. A randomized study of prostaglandin E2 tablets and intravenous oxytocin.

A comparative study of labor induction has been performed on 471 consecutive patients. Primary amniotomy was performed in 227 cases, and 103 of these patients were stimulated, 57 patients with PGE2 tablets and 46 with oxytocin. In the remaining 124 cases labor was induced within 4 hours without medical stimulation. Primary amniotomy was omitted in 244 cases, as the head was not engaged and the cervix was unripe. After random allocation to the treatment groups 125 patients received PGE2 tablets (ProstinR), and 119 patients received oxytocin intravenously. After 2 days of stimulation without primary amniotomy, delivery was induced in 83 per cent of the patients receiving PGE2 and in 84 per cent of the patients receiving oxytocin. All patients on whom primary amniotomy had been performed were delivered on the first day. There was no difference in the success rate between PGE2 and oxytocin treatments in patients with the same Bishop score. The performance of amniotomy at the beginning of induction led to a significantly lower total dose as well as a lower maximal dose of PGE2 and oxytocin. There was no difference in the duration of active labor in patients receiving PGE2 or oxytocin. There were no differences in the incidence of fetal distress and low Apgar scores between the different groups. No serious side effects occurred. Vomiting and diarrhea in 14 patients (8 per cent) receiving PGE2 was in contrast to 3 patients with these symptoms (2 per cent) in the oxytocin group. Oral administration of PGE2 is a convenient, effective and safe alternative to oxytocin for the induction of labor; however, PGE2 was not found superior to oxytocin in cases with a low Bishop score.

Immunochemical characterization and serum concentrations of pregnancy-associated serum proteins in mice.

The glycoprotein structure of two pregnancy-associated murine proteins, alpha 1-PAMP and alpha 2-PAMP, was analysed by using concanavalin A (Con A) affinity electrophoresis: alpha 1-PAMP was completely precipitated by free Con A, whereas alpha 2-PAMP showed heterogeneity. The isoelectric points of alpha 1-PAMP and alpha 2-PAMP were determined at 4.2 and 4.0 respectively by using crossed immunoelectrofocusing. The alpha 2-PAMP was detectable only in the serum of pregnant mice and fetuses. Maternal serum concentrations increased from Day 8 of pregnancy, remained at high values between Days 14 and 18, and could not be detected by 2 days post partum.

Reference values for six enzymes in plasma from newborns and women at delivery.

We have determined the distribution in cord blood from healthy newborns of six enzymes: creatine kinase, lactate dehydrogenase, aspartate and alanine aminotransferase, alkaline phosphatase and gamma-glutamyltransferase. The concentration of enzymes were determined according to the methods recommended by the Scandinavian Committee on Enzymes. The distribution of isoenzymes and of enzymes in blood from women at delivery was investigated also. All distributions were positively skewed. The upper reference limits of cord blood exceeded those found in mother blood by a factor of eight for gamma-glutamyltransferase, and for lactate dehydrogenase and creatine kinase by a factor of two.

Effect of pregnancy zone protein on leucocyte migration inhibition, lymphoycte transformation and rosette formation by lymphocytes.

Pregnancy zone protein from pregnancy serum and control preparations from male serum were tested in lymphocyte transformation tests, in a system for rosette formation by T and B lymphocytes and in leucocyte migration inhibition tests using PPD-induced inhibition. PZ-protein preparations caused a dose dependent inhibition of lymphocyte transformation after stimulation with PHA, PPD and MLC. Inhibition was most pronounced in the PHA-system. In the rosette tests there was a tendency for T lymphocytes to bind fewer SRBC after incubation with PZ-protein while no effect on B rosettes was observed. In contrast, PPD-induced inhibition of leucocyte migration was abrogated effectively by PZ-protein, but not by corresponding fractions from male serum.

Changes in serum lipids during treatment with norgestrel, oestradiol-valerate and cycloprogynon.

The serum concentrations of triglycerides, cholesterol, and free glycerol were determined in 23 climacteric women, before and after the administration of three different steroid drugs. Each drug was given within a period of 12 weeks (3 cycles). Period I: Norgestrel, 0.5 mg daily from the 12th to 21st day of each cycle. Period II: Oestradiol-valerate (Progynon) 2 mg daily from the 2nd to 21st day of each cycle. Period III: Oestradiol-valerate 2 mg from the 1st to 11th day followed by oestradiol-valerate 2 mg+0.5 mg dl-norgestresl from day 12 to 21 of each cycle (Cycloprogynon). A significant decrease in triglycerides was observed following the administration of norgestrel and Cycloprogynon, whereas oestradiol-valerate had no effect on the triglyceride levels. On the other hand, oestradiol-valerate, following a period of norgestrel, produced an increase in serum cholesterol levels.

[Legal abortion in the county of Funen in relation to the liberalized Danish legislation]. / Abortus provocatus legalis i Fyns amt i relation til den liberaliserede lovgivning

PIP: An analysis is presented of the effect of the liberalized Danish abortion law on the relative frequency of births, sterilizations, and legal, and other abortions in the county of Funen for the years 1969-1974. The number of illegal abortions did not decrease with the liberalized legislation, while the number of legal abortions rose 225% between 1969-1974. The number of births in this time period remained stable. Abortions in the under-18 year age group remained constant, and the over-38 year age group showed a slight decrease. The length of the gestational period at the time of the abortion has been decreasing and would decrease even further if the waiting period due to overcrowded facilities did not necessitate waiting several weeks. Fewer complications in patients undergoing abortion are credited to the use of the vacuum extractor in less advanced pregnancies and prostaglandins in the more advanced ones. Sterilization in conjunction with abortion has become much less frequent, while sterilization without abortion has increased greatly, most markedly in men. 5.2% of the women having abortions in Funen county had had more than 1 induced abortion. The great increase in the number of abortions performed has more than doubled the case load of the county's gynecological department, which now only performs about 25% of the abortions in the county.^ieng

Correlation between human chorionic somatomammotropin and placental weight.

Human chorionic somatomammotropin concentration in serum (S-HCS) during the latter half of pregnancy was measured by radioimmunoassay and correlated to the placental weight, in two groups of normal, healthy, pregnant women. In one group, 228 samples from 47 women were examined, which gives a longitudinal series. In the other group, single samples from each of 346 pregnant women were examined, which gives a cross-sectional series. Both groups were randomized on the basis of a prospective selection. The mean values of S-HCS in each week of gestation were almost identical in the two groups, showing a steady increase until 37-38 weeks and a subsequent decrease. In the longitudinal series there was a positive correlation between the S-HCS and placental weight after 37 weeks' gestation, but not before that time. Before 37 weeks gestation the ratio S-HCS/placental weight was significantly higher with small placentae than with large placentae. This difference between small and large placentae disappeared after 37 weeks. These results point to the existence of some regulatory mechanism tending to keep the S-HCS concentration within certain limits, independent of placental weight. This mechanism appears to be lost after 37 weeks of gestation when the S-HCS concentration starts to correlate with placental weight.

Serum lipids during oestradiol-valerate/norgestrel treatment of menopausal women. Double-blind study of a sequential preparation.

Thirty-three women aged 38-56 years, all with menopausal complaints, were treated after randomization during three cycles either with oestradiolvalerate/norgestrel suquential therapy or a placebo and then during three cycles with the opposite drug. Serum cholesterol, triglycerides, glycerol as well as plasma FFA and lipoprotein electrophoresis were studied before the institution of treatment, after each cycle, and 4 weeks after the intake of the last tablet. During the treatment period the triglyceride level was significantly lower than during the placebo period, whereas no changes occurred in other parameters. The decrease was at a maximum after 8 weeks' treatment; 4 weeks after the discontinuation of treatment the levels were as before its institution. It cannot be decided whether the decrease was due to the natural oestrogen or to the gestagen.

PIP: Serum lipids during estradiol-valerate/norgestrel treatment of 33 menopausal women are reported. The women aged 38-56 years, all with menopausal complaints, were treated after randomization during 3 cycles with either estradiol-valerate/norgestrel sequential therapy or a placebo and then during 3 cycles with the opposite drug. Cholesterol, triglycerides, glycerol, free fatty acids and lipoprotein electrophoresis were studied before treatment, after each cycle and 4 weeks after the intake of the last tablet. Markedly lower triglyceride levels were seen during the treatment period than during the placebo period. A correlation analysis revealed a positive correlation between the difference in mean triglyceride value during the placebo and treatment period and the mean value during the placebo period (r equals .84, p less than .01). The triglyceride levels were lower after 8 weeks of treatment than after 4 weeks (p. less than .01). It is not known whether the decrease was due to the natural estrogen or to the gestagen. 4 weeks after the discontinuation of treatment the levels corresponded to pretreatment levels. No marked changes occurred in the other paratmeters.