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A spectrophotometric method is presented for use during amnioscopy for the estimation of the colour of amniotic fluid. The application of five different filters was tested; and a ratio of the results obtained using filters with mean wave-lengths of 621 nm and 589 nm was found to be the most reliable parameter for the detection of green coloured amniotic fluid. Preliminary results are so promising that further examinations and a development of the method are indicated. Various improvements to the method are also discussed.

In order to evaluate the efficacy and acceptability of 15(S)-15-methyl-prostaglandin F2alpha (15-me-PGF2alpha) for pregnancy termination, we induced 30 abortions with single intra-amniotic injections of 2,5 mg of 15-me-PGF2alpha and 25 abortions with intra-muscular 15-me-PGF2alpha administered 200 mug initially and 300 mug every third hour until 30 hrs or abortion. Abortion occurred within 30 hrs in 97% of cases in the intra-amniotic group, with a mean abortion time of 17,6 hrs and in 80% in the intramuscular group, with a mean abortion time of 15.0 hrs. Neither parity nor gestational age was significantly related to the abortifacient efficacy of 15-me-PGF2alpha. No serious complications occurred. Vomiting (83-84%) and diarrhoea (23-92%) were the most common complaints. Uterine contractions were more painful if induction was effected with intra-amniotic rather than intramuscular injections. 15-me-PGF2alpha appears to be an effective and practicable abortifacient which can be used intra-amniotically or intramuscularly according to the ease of amniocentesis.

A 31 year old woman in whom subarachnoid and intracerebral haemorrhage occurred during the second trimester of pregnancy was sustained in intensive care with a respirator for 10 weeks. Computed tomography of the brain showed bilateral intraventricular haemorrhages. Because of drug resistant hypotonic episodes at 31 weeks' gestation caesarean section was performed, and a boy was delivered. The woman died of spontaneous cardiac arrest two days after caesarean section, and the boy showed normal development. Life support can be continued for several weeks in a modern intensive care unit after fatal insult to the brain even in a pregnant woman without affecting the fetus.

A method for the incorporation of spectrophotometry to amnioscopy for the colourmetric estimation of amniotic fluid is presented. The spectrum of light reflected from the object under examination was measured using narrow-band interference filters, and a siliceous PIN light diode as the detector. A graphical representation of the spectrum was obtained using an automatic recorder. The preliminary measurements were performed using papers of various colours, clear amniotic fluid and green fluid as well as two patients in late pregnancy who required amnioscopic investigation. Measurements have shown that the apparatus can reliably distinguish different colours from each other and the authors consider that the apparatus may be used in connection with amnioscopy in order to estimate the colour of the amniotic fluid. The possible future use and development of such a technique is discussed.

The iron stores of 32 healthy pregnant women were evaluated longitudinally during pregnancy and 6 months post partum by serum ferritin assay and by bone marrow iron content. Half of the women were receiving oral iron while the others were not given iron supplementation. Women receiving iron could maintain their iron stores throughout the pregnancy. By contrast, women without iron therapy had low serum ferritin values, pointing to the absence of iron stores during the last trimester, and 6 of these 16 women developed anemia. This was confirmed by estimation of the quantity of stainable iron in the bone marrow. In addition serum iron, transferrin and red cell MCV values indicated iron deficient erythropoesis. During a 6-month period after pregnancy the women receiving supplemental iron during pregnancy had a significant increase in their serum ferritin concentrations, indicating restoration of iron stores. Women not receiving iron during pregnancy had exhausted iron stores at term and serum ferritin values stayed low even at 6 months after delivery. If iron therapy was instituted after parturition, serum ferritin assays indicated restoration of iron stores within the ensuing 6 month. To prevent iron deficiency anemia during pregnancy supplemental iron is advisable for all pregnant women in our country.

Activities of 9 enzymes were determined biochemically in the endometrium. In Trial I (five women) 25 mg progesterone were injected i.m. on day 9 of the cycle; and endometrial biopsy taken 24 hours later was compared with endometrium from day 10 and day 21, taken in two untreated cycles from the same volunteers. Similarly, in Trial II (five women) 50 mg progesterone were injected on day 9, biopsy taken on day 11 and compared with days 11 and 21 from untreated cycles. The specific activites of lactate dehydrogenase, isocitrate dehydrogenase (ICDH), malate dehydrogenase, glutamate dehydrogenase, beta-glucuronidase, acid phosphatase (ACP) and alkaline phosphatase (AP) were significantly higher in the secretory phase. Twenty-five milligrams progesterone (after 24 hours) caused increases of some enzymes, significant only for AP. Fifty milligrams (after 48 hours) increased significantly the activity of ICDH and ACP. Biochemical changes, especially increase of ICDH, can be used for detection of the effect of progesterone on the endometrium.

Gall bladder volume was measured by ultrasound in eight patients with cholestasis of pregnancy, in 21 normal pregnant women and in 14 non-pregnant women, and at the same time serum cholic and chenodeoxycholic acid levels were estimated. The gall bladder volume was 60% larger in cholestasis than that in normal pregnancy and more than two times larger in normal pregnancy than in non-pregnant women. The serum cholic and chenodeoxycholic acid concentrations were significantly higher in cholestasis of pregnancy than those in normal pregnancy.

Operative results of stress urinary incontinence are discussed on the basis of a follow-up study made 3-5 years after the operation. The series consisted of 301 patients operated on during 1969-1971. The most significant anamnestic feature was the great number of multiparas: 67% of the patients had given birth to at least 4 children. The choice of the operative method was based on Green's urethrocystographic classification into type I and type II. The healing was complete or satisfactory in 85% of the total material. In the group operated on according to type I the outcome was good in 88%, while in the type II group it was good in 84%. Incontinence of degree I was cured in 89% of the cases, while patients of degree III in only 72%. If there was a significant urgency component observable in the incontinence symptoms preoperatively, a good outcome was only attained in 64%. In pure or dominant stress incontinence the corresponding outcome was 88%. Hysterectomy combined to the operation seemed to improve the results. Age, parity, duration of the incontinence symptoms, weight and changes of weight after the operation had no significant effect on the healing. The authors emphasize the importance of careful differential diagnosis based on the anamnesis and examinations in choosing the therapeutic method for incontinence patients.

Retrospective evaluation of 137 patients with advanced ovarian carcinoma was attempted 4-12 years after therapy. The operation was radical or almost radical in 56 cases (40.8%). Postoperative treatment consisted of single-drug (N = 53) or multi-drug cytotoxic chemotherapy (N = 53) and irradiation alone (N = 8) or together with cytotoxic chemotherapy (N = 53). Postoperative therapy of any kind was impossible in 23 cases. Nine patients were alive 5 years after therapy. Eight of them had had a clinical stage III (survival rate 7.7%) and one clinical stage IV malignancy (survival rate 3.0%). The extent of the operation was of major importance, 8 out of 9 survivors having undergone a radical operation, which also prolonged the life of the non-survivors. Single drug chemotherapy and combination chemotherapy yielded similar results, 4 and 5 survivors, and 21.1 and 19.6 months as the mean length of survival respectively. None of the patients on postoperative radiotherapy survived. Their mean survival period was 16.6 months. Radiotherapy as an additional measure did not produce any benefit. The prognosis was most favourable for patients with serous cystadenocarcinoma. A poor prognosis was typical of nulliparous women, suggesting that hormones may contribute to the clinical behaviour of this illness.

To simplify the clinical evaluation of the hypothalamic-pituitary-ovarian function, a 5-day treatment regimen of 100 mg clomiphene administered daily was tested on a group of 30 amenorrheic women (4 with primary amnenorrhea and 26 with secondary amenorrhea). Vaginal smears and serum follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol-17beta and progesterone levels were obtained prior to treatment and 5 and 12 days after treatment ended. According to her response to clomiphene, each patient was assigned to one of the four response categories established by Kjeld et al. (6). Based on clinical findings and changes in serum hormone levels, the patients' responses to clomiphene were categorized as "normal" (the patient ovulated), "partial" (the patient experienced menstrual bleeding without ovulation), "minimal" (rise in estradiol without menses), and "nil". Of the parameters studied, the patient's serum estradiol level was the most sensitive index of her response to clomiphene.

To evaluate the significance of progesterone and estradiol in human uterine activity during pregnancy and delivery the blood concentrations of these hormones were monitored weekly during the last trimester of pregnancy and at the onset of labour in 15 women, and before and 3 hours after the induction of term delivery in 83 parturients. Neither plasma concentrations of progesterone or estradiol nor the ratio of progesterone to estradiol changed significantly during the last trimester of pregnancy or at the onset of delivery. After the induction of delivery parturients with initial progesterone dominance (ratio of progesterone to estradiol higher than 5 before induction) demonstrated a significant fall in serum concentration of progesterone and in the ratio of progesterone to estradiol while estradiol concentration rose significantly. In estrogen dominant women (progesterone to estradiol ratio equal to or lower than 5) the serum concentration of progesterone and the ratio of progesterone to estradiol rose significantly during the 3 hours after the induction of delivery. Our results suggest that the peripheral blood levels of progesterone and estradiol do not correlate with the tissue biochemical changes which prepare the uterine cervix and myometrium for delivery. The observation that the ratio of progesterone to estradiol decreased in progesterone-dominant and increased in estrogen-dominant women stresses the importance of a well balanced equilibrium of these hormones for prostaglandin metabolism during human delivery.

The purpose of an experimental study in guineapigs was to prevent adhesion formation in the intra-abdominal space by simultaneous intraperitoneal infusion of hydrocortisone, dextran and chymotrypsin. An examination made three weeks after the operation revealed a highly significant (p less than 0.001) difference in favour of the dextran, dextran-chymotrypsin and dextran-chymotrypsin-hydrocortisone groups when compared with the NaC1 and control groups.

To evaluate the risks associated with gynaecologic operations on elderly patients (60 years or over) we performed this retrospective study of 573 operations. More than half the patients (53%) were operated on because of uterine prolapse. An abdominal operation was done in 33%, a vaginal approach in 59% and a combined abdominal and vaginal procedure in 9%. (he total amount of postoperative complications was 26% and higher after abdominal (36%) than vaginal operation (19%). Most complications were mild, e.g. fever (16%) and wound complications (4%). Five patients (0.87%) died within one month postoperatively, but only in two cases was death caused by postoperative complication itself, namely cardiac infarction and pulmonary embolism. It appears that our procedures based on co-operation between gynaecologist, internist and anaesthetist yield good results and that the chronologic age in itself is only seldom a contraindication to operative treatment.

A progesterone intrauterine device (IUD), Progestasert, was prescribed for 25 patients unable to use an ordinary non-hormonal IUD. Both the amount of menstrual bleeding and the discomfort was observed to decrease more often than increase during the period of use of the progesterone IUD. Hemoglobin, hematocrit and the serum iron levels either remained static or increased. Continuation rate was 76 per cent after one year. The authors consider Progestasert a suitable alternative to the ordinary non-hormonal IUD in women with dysmenorrhea or menorrhagia and those in whom a previous IUD had been associated with pain or increased menstruation.

A shift in progesterone-to-estradiol balance to estradiol dominance is assumed to be a prerequisite for regular uterine contractions. To antagonize this effect in premature labor 24 consecutive women were treated with intravenous cortisol for 3 days and with weekly intramuscular injections of 17 alpha-hydroxyprogesterone caproate (17 OHP-C). Twenty-four similar patients treated with ritodrine served as a reference group. The delivery was postponed by at least 1 week in 21 patients (87.5%) in the steroid treatment group and in 18 patients (75%) in the ritodrine group. The premature labor lasted for 5.1 +/- 0.4 hours (mean +/- SEM) with steroid therapy and for 2.2 +/- 0.3 hours with ritodrine. In singleton pregnancies the gestational length and birth weight of the newborn infants were greater in the steroid treatment group (N = 23, 39.1 +/- 0.3 weeks, 3,460 +/- 119 gm) than in the ritodrine group (N = 24, 37.7 +/- 0.4 weeks, 3,106 +/- 118 gm). Steroid treatment suppressed serum estradiol concentrations (maximally by 60%) and, to a lesser extent, testosterone, estriol, and progresterone levels (maximally by 30%).

Twelve women, 11 with hirsutism and one with alopecia areata, were treated with low-dose spironolactone (50 mg daily) from the 4th until the 22nd cycle day over 12 consecutive menstrual cycles. Eight hirsute women observed a favorable effect on hirsutism in 3 to 8 months, and hair loss ceased in the one patient with alopecia areata. No significant side effects occurred. Low-dose spironolactone decreased the concentration of total and free testosterone and elevated the concentration of prolactin on the 10th cycle day, while LH, FSH, estradiol, progesterone, DHEAS, SHBG, and cortisol levels remained unchanged. The plasma aldosterone concentration increased significantly during the treatment, although serum potassium and sodium concentrations remained unchanged. Low-dose spironolactone is, thus, safe and effective in the treatment of hirsutism. It seems to be useful as an initial or alternative treatment.

A total of 215 infertile patients with endometriosis verified at least laparoscopically were treated between 1977 and 1982 by conservative surgery alone (N = 90), or with danazol, 600 mg daily and most often for 6 months, either alone (N = 59) or postoperatively (N = 44), or by laparoscopic electrocautery of endometriotic foci (N = 18). The mean age and duration of infertility were about the same in all groups. The disease was mild in the electrocoagulated group, moderate in the groups treated either exclusively surgically or with danazol, and most severe among the patients who received danazol following surgery. The uncorrected pregnancy rate after conservative surgery was 43% and the mean interval until conception was 11.7 months. After 6 months' danazol treatment the uncorrected pregnancy rate was 56% and the mean interval until conception was significantly (p less than 0.02) shorter, 6.7 months. Conservative surgery followed by danazol treatment for 6 months resulted in fewer pregnancies (pregnancy rate 32%) but the mean interval until conception was about the same (6.9 months) as after danazol therapy alone. After laparoscopic electrocautery the pregnancy rate was only 17%. In view of these results, we recommend that for infertile patients with mild or moderate endometriosis the recommended treatment should be medical, e.g., danazol 600 mg daily for 6 months.

The beta-2-microglobulin concentrations in 127 aminotic fluid samples, obtained during weeks 32-42 of normal pregnancies (n = 58) and complicated pregnancies (n = 69), were measured and correlated with gestational weeks, amniotic fluid creatinine concentrations and L/S ratios. A significant (p less than 0.001) decrease of beta-2-microglobulin concentration occurred from week 32 to 34 of normal pregnancies, after which the beta-2-microglobulin level was unchanged. There were no significant correlations between beta-2-microglobulin concentrations and amniotic fluid creatinine concentrations of LK/S ratios. The beta-2-microglobulin content was elevated in samples obtained from diabetic and toxemic pregnancies. Measurement of beta-2-microglobulin in amniotic fluid seems to be of limited value for determining fetal age, but it may be useful in estimating fetal renal maturity.

Forty early pregnancies (menses delay 13 - 27 days) were terminated by administering four vaginal suppositoreis each containing 1.0 or 1.5 mg of 15 (S) 15-methyl-prostaglandin F2alpha-methyl ester, one every third hour. In 14 cases serial measurementsof serum estradiol and progesterone were performed during and after therapy. Uterine contractions and bleeding started 1 - 17 hours after administration of the first suppository. Abortion was complete after one week in five women (13%), and after two weeks in 30 (75%). A curettage was performed on eight women, residual placental fragments were found in seven and pregnancy continued in one woman. Mild diarrhoea (65%) and vomiting (40%) were the major side-effects, despite premedication. Estradiol and progesterone levels fell progressively during the therapy. Self-administration of 4 or 6 mg of the methyl ester caused too low a rate of complete abortion for use in practice, but it may be a valuable and practical agent for preoperative dilation of the cervix.

In a series of 71 ectopic pregnancies ten were associated with the use of an intrauterine device (IUD) and three with the use of low dose progestogen contraception. For comparison a series of 800 legal abortions were studied and in 20 of these cases pregnancy originated while an IUD was in utero and in 13 during the use of low dose contraceptive pills. When using the above-mentioned contraceptive methods the possibilities of an ectopic pregnancy should be taken into consideration.

15-me-PGF2alpha was administered as single intrauterine injection for interruption of very early pregnancy in 30 out-patients. After 2 weeks, abortion was complete in 60% induced with 125 or 200 mug and 80% induced with 300 mug. After 3 weeks, abortion was complete in 90% induced with 125 mug, in 70% induced with 200 mug and in 100% induced with 300 mug. One failure occurred in patients treated with 200 mug and 2 curettages were performed because of incompleteness of abortion. No serious complications occurred. Compared with our previous results it appears that 15-me-PGF2alpha is as effective as natural PGF2alpha in inducing abortions during very early pregnancy but causes somewhat fewer side-effects.

The levels of free amino acids in maternal and umbilical venous serum and in amniotic fluid were determined in 7 patients with normal pregnancy, 11 with intrahepatic cholestasis of pregnancy, 4 with pre-eclampsia and 9 with rhesus incompatibility. In maternal venous serum there were only small differences in the amino acid concentrations in complicated pregnancies when compared with normal subjects, and the only statistically significant difference was a lowered level of histidine in intrahepatic cholestasis. In umbilical venous serum, as in amniotic fluid, the amino acid concentrations were generally elevated in intrahepatic cholestasis of pregnancy and generally decreased in rhesus incompatibility when compared with control values, and in amniotic fluid the concentration of 13 amino acids was significantly higher in intrahepatic cholestasis than in normal pregnancy. Thus, the placental amino acid transfer seems to be increased in intrahepatic cholestasis of pregnancy and slightly decreased in rhesus incompatibility, and changes in the placental transfer system are parallel for most amino acids.

The 15-methyl analogue of PGF2alpha was administered intramuscularly between 23 and 36 weeks of gestation, to induce labour in 11 mothers with intrauterine fetal death and two with anencephaly. All were delivered within 20 hours (mean 7 hours). The mean dose of 15-me-PGF2alpha was 400 mug (range 100 to 700) given by a mean of 3-1 (range 1 to 7) injections. Diarrhoea was the most frequent side-effect.

The levels of free amino acids in amniotic fluid were determined in twenty patients with normal pregnancy, five with intrahepatic cholestasis of pregnancy, twelve with pre-eclampsia, and four with rhesus incompatibility. In pre-eclampsia there was no significant change in the amino acid composition of the amniotic fluid. In recurrent intrahepatic cholestasis the concentration of 15 out of the 22 amino acids studied was significantly higher than normal and the mean concentration of 4 others was more than 20 per cent above normal without this being statistically significant. In rhesus incompatibility there was a significant decrease in the concentration of 13 amino acids, and a decrease of more than 20 per cent in the mean concentration of 5 others.

Twenty patients, mostly with severe endometriosis and infertility, were treated with danazol 600 mg daily for six months. Clinical investigation and laboratory tests were done monthly. During treatment most clinical findings and symptoms of endometriosis disappeared within 2 to 3 months, but rectocervical induration and rectocervical pain decreased more slowly. During the 10 months follow-up after discontinuation of danazol, dysmenorrhoea recurred most commonly of all symptoms, but not to the same degree as before treatment and the patients were mainly satisfied. Gonadotrophin and prolactin levels did not alter significantly during treatment. Serum oestradiol and progesterone values were low during the danazol course. Testosterone values increased because of cross-reaction with danazol metabolites in the testosterone assay. Serum transaminase, creatinine, haemoglobin and blood platelet concentrations increased on average, but the changes were reversible. Three conceptions occurred during the period of study.

In order to study the function of the pituitary-adrenal axis, serum ACTH and cortisol levels were estimated before and after insulin induced hypoglycaemia in nine women with hyperemesis gravidarum, seven women in normal early pregnancy and in eight non-pregnant controls. Before hypoglycaemia, the basal ACTH level in the hyperemesis group (102-4+/-62-9 pg/ml) was higher than in normal early pregnancy (67-5+/-19-2 pg/ml; p less than 0-05) or in non-pregnant controls (54-8+/-25-2 pg/ml; less than 0-01). Correspondingly, the mean cortisol value in hyperemesis (0-47+/-0-16 mumol/l) was higher than in normal early pregnancy (0-39+/-0-10 mumol/l; p greater than 0-05) or in non-pregnant controls (0-32+/-0-13 mumol/l; p less than 0-01). After insulin the elevation of ACTH (p greater than 0-05) and cortisol (p less than 0-01) was observed in every group. The level of ACTH and cortisol was highest in hyperemesis group. Our results do not support the idea that hypofunction of the pituitary-adrenal axis contributes to the aetiology or pathogenesis of hyperemesis gravidarum. The high ACTH level might be evidence of the psychia instability of hyperemesis gravidarum patients.