Postabortal insertion of IUD

Advances in Contraception - During 1983, 823 first trimester therapeutic abortions were performed at the University Hospital of Trondheim, Norway. Of these patients, 229 had an IUD inserted at the...     

Long QT syndrome KCNH2 mutation with sequential fetal and maternal sudden death

We report a case of a woman who experienced intrauterine fetal death at full term pregnancy, and then died suddenly soon after learning about the death of her fetus. At autopsy, previously undiagnosed neurofibromatosis and an adrenal gland pheochromocytoma were discovered in the mother. Genetic screening also revealed a novel KCNH2mutation in both fetus and mother indicating type 2 congenital long-QT syndrome (LQTS). A catecholamine surge was suspected as the precipitating event of fetal cardiac arrhythmia and sudden fetal death, while the addition of emotional stress provoked a lethal cardiac event in the mother. This case illustrates the potential for lethal interactions between two occult diseases (pheochromocytoma, LQTS).     

Ultrasonically guided retrieval of occult IUD in early pregnancy.

The risk of spontaneous abortion and intra-uterine infections in pregnancies associated with an intra-uterine conceptive device (IUD) is well documented. There is a general agreement regarding the desirability of removing the IUD as soon as the pregnancy is diagnosed. When the string is not visible, the proper management is controversial. This study reports the successful retrieval of occult IUD in early pregnancy under ultrasonic guidance in 8 out of 9 women. In the one case where we failed to remove the IUD, the women chose to terminate the pregnancy by legal abortion. Seven women completed their pregnancy, while one experienced a spontaneous abortion. We consider the removal of the occult IUD in pregnancy under ultrasonic guidance to be a useful procedure.     

Correlation between prenatal ultrasound and autopsy findings: A study of second-trimester abortions.

OBJECTIVE: To evaluate discrepancies between sonographic and autopsy findings following termination of pregnancy (TOP) in the second trimester. METHODS: This retrospective report is based on 288 consecutive second-trimester abortions carried out because of fetal malformations diagnosed by ultrasound examination at a tertiary referral center. The correlation between the results from the ultrasound and autopsy examinations was evaluated. RESULTS: Autopsy was performed in 274 cases. In 160 of the 274 pregnancies (58.4%) there was full agreement between the two examination methods. Findings detected by autopsy (in addition to those leading to termination) were not observed by ultrasonography in 86 (31.4%) of the pregnancies; of the 64 malformations that occurred, 30 (46.9%) were judged as 'detectable'. In 27 (9.9%) pregnancies, observations made by ultrasound (in addition to those leading to termination) were not confirmed at autopsy. In one pregnancy, postmortem radiology examination-but not autopsy-confirmed the ultrasound observations. No pregnancies were terminated because of false positive ultrasound observations. The correlation between ultrasound and autopsy findings was evaluated by three investigators; the inter-rater agreement was high (kappa = 0.85). CONCLUSION: Discrepancies between ultrasound and autopsy findings were observed in about 40% of the pregnancies. These discrepancies confirm the need for autopsy following TOP.     

Induced abortion: Chlamydia trachomatis and postabortal complications. A cost benefit analysis

The overall prevalence of Chlamydia trachomatis among 873 abortion-seeking women was 9.3% during 1985. Significantly higher age-specific prevalences of C. trachomatis occurred among younger women (p less than 0.001). None of 17 women treated for C. trachomatis before the abortion was carried out, was readmitted to the hospital. Of 64 Chlamydia-positive women, who commenced treatment within the first 2 weeks after the abortion was carried out, 14.1% were readmitted to the hospital, compared with 5.7% of Chlamydia-negative women (p less than 0.02). Postabortal salpingitis was verified at readmission among 10.9% of Chlamydia-positive women and 3.2% of Chlamydia-negative women (p less than 0.01). An analysis of screening of all abortion-seeking women is estimated to be worthwhile when the prevalence of C. trachomatis exceeds 4.3%. We recommend screening for Chlamydia trachomatis of all abortion-seeking women, 30 years or younger, at the pre-abortion visit, provided that treatment can be completed before the abortion is carried out.     

Hysterosalpingography: value in estimating tubal function, and risk of infectious complications

A prospective study of 80 patients referred for hysterosalpingography (HSG). In 74 patients HSG was performed as part of an infertility investigation. Samples taken from the cervix were cultured for N. gonorrhoeae, Chl. trachomatis and M. hominis. Serum specimens were examined for antibodies against Chl. trachomatis and M. hominis. Two of our patients (2,5%) developed clinical signs of pelvic inflammatory disease following the procedure. Both had negative cultures for pathogenic microbes. The value of pre-HSG microbial culturing seemed negligible. Most patients had antibodies against Chl. trachomatis and M. hominis. Occlusion in one or both tubes was seen in 22 patients while possible pelvic adhesions were found in 15. It is concluded that HSG seems to have a relatively high risk of infectious complications, and we propose to do laparoscopy with chromopertubation as the primary step for evaluation of tubal function in infertile women.     

Organochlorine pesticides and polychlorinated biphenyls in maternal adipose tissue,blood, milk,and cord blood from mothers and their infants living in Norway

Samples of maternal blood, milk, and umbilical cord blood were collected from mothers and their infants at Ullevål University Hospital in Oslo, Norway. All the mothers had lived in Oslo during the last two years. Of the Norwegian mothers, 16 were delivered by Caesarean operation, and samples of subcutaneous fat tissues were collected. Hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs),p,p-DDE,p,p-DDT, and dieldrin were found in 157, 135, 168, 22, and 12, respectively, of the 168 samples analyzed, while , and -hexachlorocyclohexane (HCH) were found in 93 and 26, respectively, of the 152 samples analyzed for these compounds. In the samples obtained from the Norwegian mothers and infants, PCBs andp,p-DDE were the major contaminants present. In contrast, only traces of PCBs were found in six immigrant samples, which, however, contained 4–6 times higher levels ofp,p-DDE plusp,p-DDT than the corresponding Norwegian samples. Of the HCH isomers, the -HCH was the predominant isomer present. Two to three times significantly higherp,p-DDE and PCBs levels were found in maternal serum than cord serum. No significant differences were found between the organochlorine residue levels in subcutaneous fat and milk fat. A significant positive linear correlation was found between the levels ofp,p-DDE and PCBs in maternal serum and in milk fat, and between the levels ofp,p-DDE in maternal serum and cord serum from Norwegian mothers giving birth normally.Significantly higher PCBs andp,p-DDE residues were found in the maternal and cord serum samples obtained after Caesarean operation than after normal delivery, while no other such differences were found in the milk samples 5 days post partum.The results demonstrate that organochlorines are transferred from mother to fetus and newborn babies through the placenta and milk and that human milk is a good indicator in monitoring human beings and their environment for organochlorine contamination. Possible toxicological implications of the present results are discussed.     

A prospective randomized study of induction of labor

In a prospective randomized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant. The study consists of 166 normal patients at full term. No significant differences between the two groups were found, and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus. It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy.     

Cervical dilatation with Lamicel in first trimester therapeutic abortion

Preoperative treatment with Lamicel tent for first trimester therapeutic abortion was evaluated in an open randomized trial and compared with no treatment. Measured by the lowest Hegar moved through the internal os without resistance, the Lamicel group had significantly higher cervical dilatation than the control group (8.2 mm vs. 5.8 mm; P less than 0.001). One perforation was observed in the Lamicel (n = 270) group compared to six in the control group (n = 359) (not significant). There was no difference between the groups in the frequency of readmissions to the hospital. During one year of clinical experience with pretreatment of elective abortion with Lamicel per- and postoperative complication rates were not reduced.