[Is there a relationship between hyperemesis gravidarum and hyperthyroidism?]. / Is er een relatie tussen hyperemesis gravidarum en hyperthyroidie?

UNLABELLED: This retrospective study evaluates the incidence and degree of thyroidal stimulation in patients with hyperemesis, and the correlation between thyroid function, the hCG level and the severity of the hyperemesis gravidarum. The role of antithyroidea is discussed in patients with a gestational hyperthyroidism. The degree of thyroid stimulation on the outcome of the pregnancy was studied. At admission hCG, TSH, FT4, FT3, TSI, anti-TPO and anti-Tg were determined. The severity of the hyperemesis gravidarum was evaluated by the degree of ketonuria, % weight loss, and the electrolytes and the liver function disorders. An ultrasound to confirm the gestational age and to exclude a multiple pregnancy or a trophoblastic disease was carried out. RESULTS: In a period of 1 January '91 to 31 January '94, 48 hyperemesis gravidarumpatients were admitted at the maternity. 22.9% of the hyperemesispatients had thyroid stimulation; 4 patients had a decreased TSH and an increased FT4 (group 2) and 7 patients had a decreased TSH, an increased FT4 and FT3 (group 3). The age of the mother, the parity and the gestational age at admission are comparable, and do not differ from the patients without thyroid disorders (group 1). Parameters, determining the severity of hyperemesis gravidarum, are not significantly different in the 3 groups. Treatment with antithyroidea in the group with proven hyperthyroidism (decreased TSH, increased FT4 and FT3) does not only lead to normalisation of the thyroid tests, but also to an improvement of the symptomatology. The gestational age at delivery and the birthweight of the babies are comparable in the 3 groups. CONCLUSION: In patients admitted with hyperemesis gravidarum, we found 23% of the women to present a thyroid stimulation. This hyperthyroidism differs from the auto-immune hyperthyroidism, i.e. the patients have no thyroid antibodies, no classic clinical signs of thyrothoxicosis. Probably, the absolute hCG concentration and its biological activity plays a crucial role in the thyroid stimulation. This degree of thyroid stimulation has no influence on the severity of the hyperemesis gravidarum, neither on the outcome of the pregnancy.

Singleton pregnancy after in vitro fertilization: expectations and outcome.

OBJECTIVE: To determine if singleton in vitro fertilization (IVF) pregnancies carry a higher risk for ante- and perinatal complications compared with naturally conceived pregnancies. METHODS: One hundred forty singleton pregnancies conceived by IVF and 140 matched control pregnancies conceived naturally were analyzed with respect to the incidence of antepartum complications and perinatal outcome. The study was conducted in a university hospital, and pregnancy and labor were managed according to a standardized protocol. RESULTS: Sixteen IVF pregnancies and two control pregnancies ended preterm (P < .01), resulting in the birth of infants with lower birth weight in the former group (P = .01). Except for placenta previa, which occurred four times in IVF pregnancies and not in the control group, no differences in antenatal events were found. Labor was more often induced in IVF pregnancies than in control pregnancies. Elective cesarean delivery for obstetric reasons was performed ten times in the IVF group and never in the controls (P < .01). However, once in labor, no differences in the rate of instrumental or cesarean delivery were found. There were eight minor congenital malformations in the IVF group and none in the control group (P < .01). CONCLUSION: Even when managed in a single center, IVF pregnancies carry a greater antenatal risk than matched controls. Once in labor, and managed in a similar fashion, the outcome does not differ from that of controls.

Epidural analgesia in active management of labor.

OBJECTIVES: To examine the determinants of epidural analgesia in the active management of labor. To examine the association of epidural with instrumental delivery and cesarean section. STUDY DESIGN: Observational study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A thousand consecutive nulliparous women at term, were assessed. RESULTS: Requests for epidural anesthesia were predominantly expressed at the time the patient was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caused labor to be subjectively more arduous. In induced labor, the same observation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when the incidence of operative delivery was adjusted for the use of oxytocin, the significance between patients with epidural versus the others abated. CONCLUSION: The use of oxytocin in active management of labor results in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.

Premature rupture of membranes at term in nulliparous women: a hazard?

One hundred five consecutive women with premature rupture of the membranes (PROM) at term were managed expectantly for at least 24 hours. Seventy-six went into spontaneous labor, of whom 38 were augmented with oxytocin. Twenty-nine had labor induced. Subjects who delivered during the same study interval after artificial rupture of the membranes served as controls. There were no statistically significant differences in the frequency of amnionitis, endometritis, cystitis, neonatal infection, low Apgar score, low cord arterial blood pH, instrumental delivery, or cesarean delivery. Morbidity was seen most often in induced labor whether or not the membranes were ruptured for a long time. It is concluded that expectant management of PROM at term does not increase perinatal morbidity.