Iodine status in neonates in Denmark: regional variations and dependency on maternal iodine supplementation.

Iodine status of 147 neonates born in five different regions of Denmark was evaluated in relation to the iodine content of breast milk and iodine supplementation taken by the mother. Approximately two-thirds of the women had not received iodine supplementation. They had low iodine concentrations in breast milk and urinary iodine concentrations of the neonates at day 5 were low. The median values (milk/urine) were 33.6/31.7 micrograms/l (Randers 22/26, Ringkøbing 29/16, Aalborg 36/31. Arhus 54/41 and Copenhagen 55/59 micrograms/l). Higher values were found in the group where tablets containing iodine had been taken (milk/urine: 57.0/61.0 micrograms/l). In general, the values are low compared with internationally recommended levels. We suggest that mothers without autoimmune thyroid disease should receive iodine supplementation in the form of vitamin/mineral tablets containing iodine (150 micrograms per tablet).

Iodine deficiency in pregnancy in Denmark. Regional variations and frequency of individual iodine supplementation.

Iodine requirements are increased during pregnancy and lactation and adequate iodine intake is important for normal brain development of the fetus/newborn child. The aim of the present study was to evaluate the extent to which this increase in iodine requirement is met in pregnant women living in various regions of Denmark. One hundred and fifty-two healthy pregnant women admitted to five different Danish departments of obstetrics participated in the study. Iodine status was evaluated by measurement of iodine in spot urine at day five after delivery and by careful history of the intake of iodine containing vitamin/mineral tablets. Approximately one third of the women had received tablets containing iodine. In women who had not received iodine supplementation urinary iodine was low with a median value of 39.7 micrograms/g creatinine (Aalborg 28, Randers 33, Ringkøbing 34, Arhus 43 and Copenhagen 62 micrograms/g creatinine). These values are far below internationally recommended levels. The consequences remain to be evaluated and no firm recommendations can be given. It seems reasonable, however, to recommend a high intake of food containing iodine (e.g. milk products) during pregnancy and lactation. Since nearly all the women took some kind of vitamin/mineral supplementation it could be considered to advocate intake of vitamin/mineral tablets containing iodine.

Reproductive outcome following two ectopic gestations: results after conservative surgery.

In an 11-year period, 106 women were treated for two ectopic pregnancies (EP). Thirty-one had been surgically sterilized by the second operation. Of the 75 women with at least one patent tube, 70 (93%) were followed up regarding pregnancy outcome, with a mean follow-up period of 4.5 years. Fifty women had had a desire for pregnancy after treatment for the second EP. Of these, 26 (52%) did not achieve any conception; 16 (32%) experienced at least one more EP, and 13 (26%) had at least one intrauterine pregnancy. There were a total of 46 pregnancies, of which 21 (46%) were ectopic and 16 (35%) were carried on term. When conservative surgical techniques had been performed at the first EP, the number of intrauterine pregnancies achieved after the second EP was doubled, and the risk for a third EP was not raised. There was found no statistical difference in laterality of the second EP when the first operation was conservative. It is concluded that women experiencing repeat EP have severely impaired future fertility, with a high risk of a third EP if they conceive.

Surviving child from tubal pregnancy.

A case report of a 1150 g child surviving from a tubal pregnancy in the 30th week of gestation, delivered by cesarean laparotomy, is described. A review of the literature disclosed nine other cases.

Third-trimester fetal death in triplet pregnancies.

During the last decade, 89 sets of triplets were born in Denmark with a gestational age of more than 25 completed weeks. Fifteen pregnancies (16.9%) were complicated by fetal death in the third trimester, with a total of 17 intrauterine deaths. Six neonatal deaths occurred, leaving 22 survivors among these 15 patients. Four triplet gestations were diagnosed as twins until delivery. Eight women conceived spontaneously, two gestations followed assisted fertilization and embryo transfer, and five women had had various forms of ovulation stimulation. The mean maternal age was 27.8 years (range 17-38). Seven women were parous and eight wer nulliparous. Maternal complications included hydramnios (three), preeclampsia/hypertension (three), and anemia (nine). All women delivered preterm. Of the 11 gestations diagnosed as triplets, fetal death was diagnosed at 32.2 +/- 2.9 weeks (mean +/- SD) and delivery occurred at 32.6 +/- 3.0 weeks. Nine of 11 women had cesarean deliveries. Continuation of pregnancy after fetal death could be considered in only three subjects. In eight women, obstetric reasons required immediate delivery. Fetal death was associated with monochorionic or dichorionic placentation, and growth retardation was a frequent complication before fetal death. Anencephaly of one fetus, umbilical cord problems in two, and severe hydrops in two were the only obvious causes of fetal death. Fetal death should not be the sole indication for delivery. In cases with severe prematurity and a stable intrauterine situation, frequent assessments of fetal well-being are recommended, with prompt delivery when indicated.

[Amniotic sheet: the innocent amniotic band]. / Amnionseglet: det uskyldige amnionbånd.

An intrauterine amniotic band may be a benign condition provided sonography reveals that it does not adhere to the foetus and a free edge of the band can be demonstrated. Nevertheless, frequent sonographic control is recommended until the band has disappeared.

Heterotopic pregnancy. The first case with an IUD in situ.

The first reported case of simultaneous tubal and intrauterine pregnancy in a women with an IUD in situ is presented. The incidence of combined pregnancies is estimated as 1 to 2 pr. 10,000 gestations. The risk of IUD using women for becoming combined tubal and intrauterine pregnant is calculated as 1:6,000,000 women years of use.

PIP: The first reported case of simultaneous tubal and intrauterine pregnancy in a woman with an IUD is situ is presented. The incidence of combined pregnancies is estimated as 1 to 2/10.000 gestations. The risk of IUD users to have combined tubal and intrauterine pregnancy is calculated is 1/6,000,000 women years of use. A 32-year old patient, gravida 3, para 2 was admitted because of threatened miscarriage in the first trimester. she had been wearing an IUD for 2 1/2 years. Her symptoms were vaginal bleeding and abdominal pain. Pelvic examination showed an enlarged uterus consistent with a pregnancy of 12 weeks' gestation. A vacuum extraction was performed revealing a Copper-T IUD and intrauterine gestation. In the following days she experienced recurrent abdominal cramps and her physical condition did not improve. The red cell sedimentation test remained slightly elevated. 19 days after the evacuation she still had vaginal bleeding and the pregnancy test was still positive. Pelvic examination now disclosed a right, tender adnexal mass the size of a fist. By laparotomy a ruptured right-sided tubal pregnancy was found surrounded by an organized hematoma containing the right ovary. A right salpingo-oophorectomy was performed after microscopic proof of the existence of tubal pregnancy. The patient with combined pregnancy usually presents symptoms that do not facilitate the diagnosis of this specific disease. The diagnosis may be secured by careful pelvic examination, serial ultra-sound scanning, or eventually laparoscopy.

Long-term prognosis of pregnancies in women with intrauterine hematomas.

To evaluate the long-term significance of intrauterine hematomas in patients with threatened abortion, 380 women with a living fetus of more than 8 weeks were studied. On ultrasound, intrauterine hematomas, defined as an echo-poor subchorionic collection, were found in 86 women. Two hundred ninety-four patients without hematomas served as controls. The rate of miscarriage was significantly increased in the study group (22.1 versus 8.2%; P less than .05). Patients discharged from the initial hospitalization without aborting still had a higher abortion risk than controls (16.3 versus 5.6%; P less than .05). Second-trimester debut of symptoms was followed more often by preterm delivery. Thus, patients with intrauterine hematomas continue to be a high-risk group for the remainder of their pregnancies.

Successful hemisterilization in a patient with uterus didelphus.

Women with uterine malformations frequently present with reproductive impairment. This case addresses the opposite problem, a woman with uterus didelphus who conceived with ease. Following three consecutive cesarean sections in the left uterine horn, she was offered sterilization for medical reasons, but refused on religious grounds. As a compromise, she accepted unilateral tubal closure in order to force future pregnancies to the right uterine horn. She has now had three pregnancies with two cesarean sections on that side.

[In vitro fertilization and embryo transfer at the community hospital in Arhus]. / In vitro fertilisation og embryotransferering ved Arhus Kommunehospital.

Treatment of tubal infertility with in vitro fertilization and embryo transfer (IVF-ET) was introduced in the gynaecological/obstetric department of Arhus Municipal Hospital in February 1988. The principles of treatment are described. During the first ten months, 305 therapeutic cycles were carried out and clinical pregnancy occurred in 20.2% of the cycli after transfer of pre-embryos.

Second trimester chorioamniotic separation and amniocentesis.

On ultrasound, we saw 12 women with a pathological amount of chorioamniotic separation (CAS) in the second trimester. Six were examined before amniocentesis and five were scanned for unsafe dates. In one patient CAS was diagnosed the day after amniocentesis. All women were asymptomatic. Despite CAS, amniocentesis was performed in six patients. The five others served as controls. The overall pregnancy outcome was favorable. Nine delivered living term babys. One patient, with brownish discolored amniotic fluid on amniocentesis, presented with fetus mortuus in week 28. One patient delivered preterm in week 32. In the control group one woman aborted shortly after diagnosis. In no case did the CAS increase after amniocentesis. In conclusion it appears safe to perform amniocentesis in women with asymptomatic CAS, although we recommend not to pass the needle through the separated membranes.

Primary hepatic pregnancy.

Abdominal pregnancies are a small fraction of ectopic pregnancies. They usually implant on the peritoneal surface after partial disruption of the initial implantation site in the tubes. The pelvic cavity is the preferential site, but they have been reported from all over the peritoneal cavity. In the present case the pregnancy was situated on the surface of the right liver lobe. Abdominal pregnancies usually present with acute hemoperitoneum and the pre-operative diagnosis is extremely difficult. The possible role of IUDs as an etiological factor is briefly discussed.

Tubal pregnancy causing haematoma in intra-uterine pregnancy diagnosed by ultrasound; a case report.

Combined intra- and extra-uterine gestations have been increasingly reported during the last few decades. Patients with a history of prior pelvic inflammatory disease and/or ovulation induction before pregnancy are thought to have greater risk for heterotopic gestations. We present a case of tubal pregnancy causing haematoma formation through the tube thus threatening a simultaneous intra-uterine pregnancy demonstrated by ultrasound scanning. The validity of serial ultrasound scannings is emphasized, and attention must be given for mutual heterotopic pregnancies by patients at risk.

Urinary iodine excretion is low and serum thyroglobulin high in pregnant women in parts of Denmark.

In the Randers area of Denmark urinary iodine excretion (which reflects iodine intake) was found to be much lower than recommended intake levels, both in women in late pregnancy [52(23-118) micrograms iodine/g creatinine, median, range, n = 20] and in non-pregnant controls [42(23-71), n = 20]. Serum thyroglobulin which is high in iodine deficiency was 32.5 micrograms/l (median) (range 10.5-78.0) in the control women and considerably higher in the pregnant women [67.0 micrograms/l (9.0-385)]. This increase was probably due to the extra iodine requirement of pregnancy which was not satisfied with an adequate increase in iodine intake. The results may suggest that pregnant women in this area should receive iodine supplementation and that a general program of iodine supplementation should be considered.

Fetal cardiac function in response to long-term maternal terbutalin treatment.

To evaluate whether long-term human fetal exposure to beta 2-adrenergic receptor agonists elicit alterations in the human fetal heart, a fetal echocardiographic examination was performed in 9 fetuses between the 24th and 35th week of gestation (median 28 weeks) and 9 age-matched controls. Examinations were performed during long-term tocolytic terbutalin treatment. Drug dosages varied between 7.5 and 20.0 mg/day (median 10.0 mg/day) and treatment durations prior to examination varied between 14 and 60 days (median 25 days). No significant differences were noted between the exposed fetuses and their controls as regards FHR, left ventricular dimensions, interventricular septal thickness, left ventricular contractility (fractional shortening) and the derived left ventricular stroke volume. Despite the limited number of subjects it is believed that long-term terbutalin exposure does not have any untoward major fetal left ventricular consequences.

Acute effects of maternal smoking on human fetal heart function.

M-mode echocardiography was used to evaluate fetal heart function following maternal smoking in 21 healthy smoking pregnant women between 24 and 39 weeks of uneventful gestation. Prior to smoking one cigarette (nicotine content 1.7 mg), a fetal M-mode echocardiographic examination was performed and repeated 5 and 10 min after maternal smoking. Maternal heart rate and systolic blood pressure increased 8.7% and 15.0%, respectively, immediately after smoking, while diastolic blood pressure remained unchanged. Fetal heart rate increased 4.3% and left ventricular diastolic and systolic diameters decreased 4.5% and 15.0%, respectively. No changes in right ventricular dimensions, ventricular ejection times, ventricular wall thickness or septal thickness were observed. Fractional shortening, mean velocity of fractional shortening, stroke volume and cardiac output of the left ventricle also remained unchanged subsequent to smoking. Thus, maternal smoking of one cigarette seems to elicit only a transitory acceleration in fetal heart rate without concomitant significant changes in fetal heart function.