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Objective: To determine the relation between cervical conization and preterm birth., Methods: All Danish women with singleton pregnancies who gave birth to their first infant in 1982 and second infant during the time period 1982-1987 were included in a register-based cohort study. Information on pregnancy outcome and cervical conization in 1977-1987 was obtained from the Medical Birth Register and the National Register of Hospital Discharges., Results: In a cohort of 14,233 women, 170 had cervical conization. Thirty-four had cervical conization before the first delivery, 62 between the first and the second, and 74 after the second delivery. Women with cervical conization had a significantly higher risk of preterm birth. In addition, women with subsequent cervical conization had a higher risk of preterm birth in previous pregnancies. However, the risk of preterm birth was higher in women with previous than with subsequent cervical conization., Conclusions: Cervical conization is correlated with preterm birth. Because women with subsequent cervical conization have an increased risk of preterm birth in preceding pregnancies, factors other than the surgical intervention may contribute to the significantly increased risk of preterm birth.

Background: Pushing in the second stage of labor can be forced or follow the spontaneous urge to bear down. Recent studies have shown that spontaneous pushing results in a longer second stage, fewer CTG changes, higher arterial pH and less damage to the birth canal., Method: Randomized trial of spontaneous vs. forced pushing in 350 primiparous women., Results: There was no difference between the randomized groups in duration of second stage of labor, umbilical arterial pH or damage to the birth canal. Of the women allotted to spontaneous pushing, 65.6% used the closed glottis technique for more than half the expulsive phase. When dividing the women into two groups according to the actual pushing technique used most, open or closed glottis, it turned out that women who used the open glottis technique had a shorter second stage of labor and gave birth to infants with lower birth weight., Conclusion: Recommending of spontaneous bearing down during the expulsive phase of labor did not result in a significant difference in duration of the second stage of labor, fetal arterial pH or less damage to the birth canal. Women who chose the open glottis technique had a shorter expulsive phase and gave birth to smaller infants than those who used the closed glottis technique.

The occurrence of prior cervical conization and the cervical microbial colonization was investigated in 38 women with idiopathic preterm labor, 35 women with preterm premature rupture of the membranes (PPROM) and 75 normal pregnant women at 26-34 weeks of gestation. Data were analyzed by Fisher's exact test (two-tailed). The frequency of prior cervical conization was significantly higher in PPROM patients compared to normal pregnant women (P < 0.001) and to patients in preterm labor (P < 0.01). Lactobacilli occurred with a lower frequency in patients with PPROM compared to patients in preterm labor (P < 0.05) and control patients (P = 0.0543)-and with a lower frequency in patients with prior cervical conization (P < 0.05). All other microorganisms occurred with the same frequencies in all groups. The absence of lactobacilli may indicate changes in the cervical flora, which could increase the risk of PPROM. Prior cervical conization may impair the antimicrobial defense-mechanisms in the cervix, which could facilitate ascending microbial colonization. This may lead to a release of prostaglandins and proteolytic enzymes and subsequently preterm labor and rupture of the membranes.

In regions where malaria is endemism, the disease is a recognised cause of complications of pregnancy such as spontaneous abortion, premature delivery, intrauterine growth retardation and foetal death. Malaria is seldom seen in pregnant women in Denmark but, during the past two years, the authors have treated four patients in the University Hospital in Copenhagen. These pregnancies were all successful but two of the mothers required emergency Caesarean section on account of threatening intrauterine asphyxia. The patients came relatively late for treatment which may be because not only the patients but also their practitioners were unaware that malaria can occur several years after exposure. Three out of the four patients had employed malaria prophylaxis. As resistance to malarial prophylactics in current use is increasing steadily, chemoprophylaxis should be supplemented by mechanical protection against malaria and insect repellents. As a rule, malaria is treated with chloroquine. In cases of Falciparum malaria in whom chloroquine resistance is suspected, treatment with mefloquine may be employed although this should only be employed in cases of dire necessity in pregnant patients during the first trimester. Severe cases should be treated with infusion of quinine. During pregnancy, benign malaria may run a violent course and pregnant women with malaria should be monitored in maternity departments and should be treated in cooperation with specialists in tropical medicine.

Case histories of three pregnant women with spinal cord lesions are presented. These otherwise healthy women are at increased risk for silent preterm labour and complicated urinary tract infections. Autonomous hyperreflexia may be severe and even life threatening. Prevention and treatment of autonomic hyperreflexia in these women require supervision and coordinated care by obstetricians and physicians with special interest in spinal cord lesions.

Investigations from abroad suggest that idiopathic preterm delivery may be due to ascent of microorganisms from the cervix. These may then colonize the decidua, foetal membranes and amniotic fluid and may thus precipitate preterm contractions or rupture of the membranes. In subclinical urogenital infections, antibiotic treatment appears, in some cases, to be capable of reducing the risk of preterm birth. In cases of treated premature delivery, antibiotic treatment may possibly prolong the pregnancy and prevent neonatal and puerperal infections. Further investigations are, however, recommended before introduction of routine antibiotic treatment in cases of threatened premature birth.

A case of preterm premature rupture of the membranes (PPROM) in the 31st week of gestation is reported. Initial cultures from the cervix and urine were without pathogenic microorganisms. After 8 days of prophylactic pivampicillin and metronidazol, culture from the cervix showed profuse growth of Group B Streptococci (GBS) and the patient developed symptoms of chorioamnionitis. Cesarean section was performed and the infant presented GBS-septicemia. In spite of continued treatment with pivampicillin, culture from the cervix on day 6 post partum still showed profuse growth of GBS. Prolonged prophylactic per oral administration of broad-spectrum antibiotics after PPROM may not always protect against infectious complications. Literature is reviewed, and it is discussed whether the applied regimen in some cases even may favour the occurrence of serious infections.

In a randomized double-blind study, 1048 women received pudendal block (PDB) at vaginal delivery, using three different local anesthetics: mepivacaine 1% plain, mepivacaine 1% with epinephrine, and bupivacaine 0.25% plain. The PDB was given transvaginally in doses of 8 ml X 2. Mepivacaine - epinephrine was found to be more effective than the other local anesthetics. Loss of bearing down reflex after PDB was found in 31.2% of the mothers and most commonly when mepivacaine - epinephrine was used. Inhibition of labor was slightly more pronounced with mepivacaine - epinephrine. The different durations of the local anesthetics did not affect the analgetic effect in clinical use. It is concluded that as the adverse effects on labor are quite common, PDB should not be given as a routine before delivery, but may be offered liberally when pain in the pudendal area is a main part of the pain of childbirth.

During the second pregnancy of 56 Swedish women resulting in a term birth, energy intake and physical activity were measured for 3 days at weeks 17 and 33. The values were related to maternal lean body mass, pregnancy weight gain, maternal fat accretion and infant birthweight by multiple linear regression analyses. A significant regression coefficient was found for energy intake at week 17 on maternal fat accretion. Energy intake was not significantly correlated with infant birthweight, not even when physical activity and maternal lean body mass were taken into account. Thus in a well-nourished Swedish population, energy intake is positively related to maternal fat accretion but not to the birthweight of term infants.

A case of acute myocardial infarction (AMI) in late pregnancy is reported. The prognosis for pregnant women with AMI and the mode of delivery is discussed. A woman with recent myocardial infarction does not seem to benefit from parturition by Cesarean section but should rather have an assisted vaginal delivery with regional anesthesia.

The relations between some hereditary and environmental factors and the variation in infant birth weight were estimated by multiple linear regression analyses on a sample of 276 Scandinavian single term pregnancies. Gestational age explained 10.9%, fetal factors (maternal and paternal birth weights and fetal sex) 7.9%, maternal factors (parity, pre-pregnancy weight and height) 5.5% and external factors (adjusted weight gain and smoking) 5.8% of the variation in infant birth weight. It is concluded that maternal and paternal birth weights are rather poor predictors of infant birth weight. Together they explain only 5.6% of the variation in infant birth weight at term.

The interrelations between three placental hormones (oestradiol, progesterone and hPL), maternal glucose metabolism, maternal anthropometry and fetal growth were studied in a sample of 52 carefully selected pregnant women. A relation was found between infant birthweight and both fasting blood glucose and t1/2 of glucose of an intravenous glucose tolerance test at week 37 of pregnancy. The serum concentrations of the placental hormones were not significantly related to the glucose variables. The correlation between birthweight and the maternal levels of hPL in late pregnancy (r = 0.60) persisted when fasting blood glucose and t1/2 of glucose were taken into account. Maternal fat mass was found to explain more of the variation in basal insulin levels around week 37 than did the placental hormones.

In order to simplify the operative technique and lower the postoperative complication rate, 354 healthy primigravidae were treated with a vaginal suppository containing 1 mg of 15-methyl-prostaglandin F2 alpha 12 hours prior to vacuum aspiration abortion in the first trimester. The mean cervical diameter found at the operation was 8.5 mm and in 38% of the women no further mechanical dilatation of the cervix was needed. The amount of bleeding during the operation was low (mean 30 ml, max. 300 ml). No perforations of the uterus or cervical lacerations occurred at operation. Side effects of the prostaglandin such as vomiting, diarrhea and lower abdominal pain occurred in 80% of the women and must be regarded as disturbing to the patient and seem to require that the women be hospitalized. The incidence of genital infection following the abortion was found to be 6.2%. In 8.2% of the women, the postoperative bleeding persisted for more than 14 days. It is concluded that if the frequency of side effects can be lowered by using new analogues of prostaglandins, pretreatment with vaginal suppositories may be recommended before vacuum-aspiration at legal abortion in the first trimester.

An intravenous glucose tolerance test (IVGTT) with serum insulin determinations was performed at week 37 of pregnancy in 52 healthy primiparae, selected to provide an increased variation in infant birth weight. A significant relationship was found between infant birth weight and both fasting blood glucose and t1/2 of glucose. Infant skinfold thickness, however, was not correlated independently to any of the parameters of the IVGTT. There was a significant correlation between maternal lean body mass and glucose metabolism, but this could not fully explain the relation between lean body mass and infant birth weight. Maternal fat mass was not significantly correlated to infant birth weight, though it was correlated with serum insulin levels. In the investigated population, fasting blood glucose, t1/2 of glucose, and maternal lean body mass accounted for 27% of the variation in infant birth weight.

Maternal fat stores and fat accretion during pregnancy were estimated from body weight and skinfold thicknesses and by the factorial method in a sample of 56 Swedish women in their second pregnancies who gave birth to singletons at term. Prepregnancy lean body mass, and not fat mass, were strongly correlated with infant birthweight. Total weight gain was significantly correlated with infant birthweight. A wide range of maternal fat accretion during pregnancy was observed, and the amount of fat accumulated was related to the total weight gain. In spite of this, maternal fat accretion during pregnancy was found to have little bearing on the infant birthweight at term.