Intrauterine devices in the immediate, early and late postabortion period

2146 cases of IUD insertions after hospitalization for abortion at a hospital in Chile were studied. In 1514 cases the IUDs were inserted immediately after abortion, in 430 cases between 1-5 days after the operation, and in 202 cases between 5-40 days after. It is concluded that immediate or early insertion results in a somewhat lower retention rate, but offers the advantage of making it possible to treat a greater number of patients, many of whom would not return later to have the IUD inserted. The incidence of removal for medical causes was very low and immediate insertion was found to be harmless. The medical causes of removal were the usual ones of bleeding, pain, and infection; the most frequent cause of interruption of use was expulsion, which tends to occur during the 1st few months of use and among younger women. The probability of failure due to pregnancy was somewhat higher than in the case of insertion during the intermenstrual period. Cases of voluntary removal tend to increase after prolonged use, and a study to analyze the actual reasons for this fact is necessary.     

Alterations in irregular and fractal heart rate behavior in growth restricted fetuses

OBJECTIVES: To determine whether irregularity, and short- and long-term fractal correlation reflecting smoothness of heart rate behavior are changed in intrauterine growth restricted fetuses. STUDY DESIGN: Fetal heart rate data of 192 normal fetuses and 86 intrauterine growth restricted fetuses between 31 and 42 weeks of gestation were studied. Approximate entropy to quantify irregularity, and short-term (< or =80 beats, alpha1) and long-term (>80 beats, alpha2) fractal scaling exponents to quantify the short- and long-term fractal correlation were calculated. RESULTS: In the intrauterine growth restricted fetuses, the approximate entropy was significantly lower (P<0.001). The alpha2 value was significantly higher (P=0.0001) than in the normal fetuses, which performed better (F=34.2, P<0.0001) than other heart rate variability indexes in differentiating the intrauterine growth restricted fetuses from the normal fetuses in stepwise discriminant analysis. CONCLUSIONS: Compared to normal fetuses, intrauterine growth restricted fetuses show a difference in that the irregularity of the fetal heart is decreased. A more apparent difference is that the long-term fractal correlation of the fetal heart is increased and the fetal heart is smoother in the long-term scale.     

Adenomyosis as a disorder of the early and late human reproductive period

Magnetic resonance imaging (MRI) allows the diagnosis of adenomyosis in vivo with a high sensitivity and specificity. Usually the diagnosis of adenomyosis is obtained from women in their fourth to fifth decade of life. However, recent data suggest that adenomyosis may develop much sooner in life, particularly in women with endometriosis. In order to test these suggestions, MRI of the uterus in 227 women with and without endometriosis was performed and the results were related to the age of the subjects (age groups: 17-24, 25-29, 30-34 and >34 years). The study revealed that the process of the development of adenomyosis, represented by an increased diameter of the dorsal junctional zone of the uterus as the imaging correlative of the invasion of basal endometrium into the junctional zone, had already commenced early in the third decade of life and progressed steadily during the fourth decade in women with endometriosis. Women without endometriosis showed almost no signs of adenomyosis up to the age of 34 years. Surprisingly, parallel in both groups of women, a marked increase in the incidence of adenomyosis could be observed beyond the age of 34 years, thus representing a common phenomenon in the age-related pathophysiological continuum of adenomyosis.     

Heart rate variation and movement incidence in growth-retarded fetuses: the significance of antenatal late heart rate decelerations

In 37 intrauterine growth-retarded fetuses, combined 1-hour recordings of fetal heart rate and body movements were made within 24 hours of elective cesarean section. Fetal body movements were recorded simultaneously by use of real-time ultrasound. The study group was divided into two subgroups, according to the presence (n = 29) or absence (n = 8) of antepartum late heart rate decelerations. Correlations were made with umbilical blood gas values obtained immediately after cesarean section. Baseline heart rate variation was reduced below the normal range in 88% of the intrauterine growth-retarded fetuses with decelerations but in only 37% of the group without decelerations. A reduction in fetal heart rate accelerations and body movements and an increase in mean heart rate also were observed only in the group with decelerations. Late heart rate decelerations were associated with low PO2 values in both umbilical artery and vein. It is concluded that in intrauterine growth-retarded fetuses reduced heart rate variation and movement incidence correlate with the presence of late heart rate decelerations before birth and with hypoxemia at birth.     

Changes in postprandial release patterns of gastrointestinal hormones in late pregnancy and the early postpartum period

Intestinal transit time increases and gastrointestinal incretin effect is reported to decrease in pregnancy. The release patterns of gastrointestinal hormones related to these functions were studied in eight women before and after ingestion of a standardized meal at 32-34 weeks gestation and at 4 days postpartum. Basal plasma motilin and the integrated meal response of motilin, pancreatic polypeptide (PP) and gastric inhibitory polypeptide (GIP) were significantly lower in pregnancy than postpartum. The meal-induced rise of somatostatin and vasoactive intestinal polypeptide (VIP) was, however, absent in late pregnancy; whereas the somatostatin response recovered postpartum, and the plasma VIP concentrations stabilized at significantly higher levels postpartum without any meal response. Basal and meal-induced plasma insulin were significantly higher in pregnancy.     

Changes in postprandial release patterns of gastrointestinal hormones in late pregnancy and the early postpartum period

Summary. Intestinal transit time increases and gastrointestinal incretin effect is reported to decrease in pregnancy. The release patterns of gastrointestinal hormones related to these functions were studied in eight women before and after ingestion of a standardized meal at 32–34 weeks gestation and at 4 days postpartum. Basal plasma motilin and the integrated meal response of motilin, pancreatic polypeptide (PP) and gastric inhibitory polypeptide (GIP) were significantly lower in pregnancy than postpartum. The meal-induced rise of somatostatin and vasoactive intestinal polypeptide (VIP) was, however, absent in late pregnancy; whereas the somatostatin response recovered postpartum, and the plasma VIP concentrations stabilized at significantly higher levels postpartum without any meal response. Basal and meal-induced plasma insulin were significantly higher in pregnancy.     

Insulin sensitivity in late gestation and early postpartum period: the role of circulating maternal adipokines

Objective.?Early postpartum period is characterised by a dramatic decrease in insulin resistance and significant metabolic alterations. The aims of this study were to determine the changes in circulating maternal concentrations of total adiponectin, adiponectin multimers, leptin and resistin before and after the delivery and to explore their relationship with insulin sensitivity.

Methods.?Twenty-seven normal pregnant women at term were included in this longitudinal study. Blood samples were taken before and 4 days after elective caesarean section. Total adiponectin, adiponectin multimers, leptin, resistin, glucose, insulin and prolactin were measured in maternal serum. Adiponectin multimers were measured before and after the delivery in eight women.

Results.?(1) The mean maternal serum total adiponectin concentration was significantly higher before than after delivery while the relative distribution of circulating maternal adiponectin multimers did not change after delivery; (2) the median maternal serum concentration of leptin was significantly higher in the antepartum than in the postpartum period; (3) the median maternal serum resistin concentration was comparable before and after delivery; (4) multiple linear regression analysis revealed that antepartum insulin sensitivity was associated with maternal low body mass index, and low glucose concentrations in glucose challenge test, as well as with maternal age and increased leptin concentrations. Postpartum insulin sensitivity was associated with decreased circulating resistin concentrations.

Conclusions.?Despite increase in insulin sensitivity, early postpartum period is characterised by a decrease in maternal circulating total adiponectin and by steady concentrations of resistin and adiponectin multimers compared to the late third trimester.     

Cardiorespiratory response of heart transplantation recipients to exercise in the early postoperative period.

In this study, we evaluated the cardiorespiratory function of orthotopic heart transplantation (OHT) recipients during exercise. Seventeen male OHT recipients, ranging in age from 22 to 60 years, participated in this study 47 +/- 21 days after surgery. The control group consisted of 17 sedentary healthy men. Breath-by-breath measurement of cardiorespiratory function was obtained during the incremental exercise of leg cycling. At peak exercise, the oxygen (O2) uptake (16.5 +/- 3.3 vs 33.9 +/- 8.2 mL.kg-1.min-1), work rate (82 +/- 19 vs 169 +/- 42 watts), heart rate (HR), O2 pulse, and blood lactate level of the OHT recipients were significantly lower than the respective values of the control group. At the ventilatory threshold, the OHT group also showed a significantly lower O2 uptake (10.7 +/- 1.6 vs 18.3 +/- 5.1 mL.kg-1.min-1), work rate (39 +/- 12 vs 89 +/- 33 watts), HR, O2 pulse, ventilatory equivalent for O2, and ventilatory equivalent for carbon dioxide. The OHT recipients showed a high resting HR (97 +/- 7 beats/min) and a low peak HR (123 +/- 14 beats/min) during exercise, and their HR continued to increase for 1 to 3 minutes after cessation of exercise. Our data revealed a low level of cardiorespiratory endurance in OHT recipients during the early postoperative stage. A multidisciplinary cardiac rehabilitation program should be considered to enhance physical functional capacity and quality of life, and promote return to work.     

Characterization of the reduced heart rate variation in growth-retarded fetuses

Summary. Fetal heart rate (FHR) variation has been studied by computerized numerical analysis in 20 growth-retarded fetuses and 20 normal fetuses matched for gestational age. FHR variation was significantly reduced in the 14 growth-retarded fetuses where there was clinical evidence of associated pathology. Rest - activity cycles were assessed by changes in FHR variation and fetal movements. The growth-retarded fetuses with reduced FHR variation showed the same pattern of rest and activity as normal fetuses but the changes in FHR variation were of lower amplitude. This was observed even in the subgroup of six fetuses with the lowest FHR variation. Thus the unreactive FHR patterns associated with growth retardation do not arise because the fetus spends less time in activity.     

Bleeding in early and late pregnancy

Vaginal bleeding during pregnancy is always a cause for concern, for both the woman and her doctor. As the pregnancy advances, the clinical significance of the bleeding increases. It may, in addition to threatening the pregnancy, eventually also cause maternal morbidity and even mortality. The woman should be reassured about the well-being of the fetus or fully informed as to the possible complications. As soon as the fetus is viable or nearly viable, it is very important to pinpoint the optimal time of delivery. Valuable gestational age will be lost by doing an unnecessarily early delivery; on the other hand, a severe haemorrhage may cause fetal death if distress is not detected in time. All related factors have to be evaluated carefully, in order to make the best possible decision about the management of the pregnancy.     

Fetal movement and acceleration behavior in hypertension in pregnancy

Under standardized conditions, 26 pregnant women with pregnancy-related hypertension of different degrees were submitted to cardiogram-synchronous recording of fetal body and respiratory movements. The gestational age was between the completed 34th and 38th weeks. Of the 26 fetuses of the risk group, 20 were normotrophic and 6 hypotrophic. 40 normotrophic unimpaired fetuses of the same gestational age served as a control group. The average duration of the examination period was 70 minutes. The fetal movement and acceleration behaviours did not differ between the normotrophic fetuses of the risk group and those of the control group. The hypotrophic fetuses from the risk group, however, had significantly lower fetal body and respiratory activities than the normotrophic fetuses from this group. The same holds true for the degrees of heart rate activity. It can be concluded that pregnancy-related hypertension as the only pregnancy complication does not have a measurable influence on fetal movement and acceleration behaviours. This is true for both treated and untreated pregnancy-related hypertensions. The severity of pregnancy-related hypertension is not primarily reflected in changes of fetal movement and acceleration behaviours, either. This means that the parameters presented are not suited to prognosticate the effects of pregnancy-related hypertension on the fetus a priori. The situation becomes quite different if in addition to pregnancy-related hypertension some intrauterine fetal growth retardation develops. In this case, the fetus indicates its impairment by increasingly impaired movement and heart rate activities as a consequence of chronic oxygen deficiency.