Improved staining method for differentiating immature germ cells from white blood cells in human seminal fluid

A new staining method for differentiating WBCs from immature germ cells in seminal fluid has been studied. It is a combination of Bryan's sperm stain, which particulary stains the acrosomal cap of the spermatozoa and the spermatid, and Leishman's blood stain which stains the WBCs in the same way as found in blood smears. The peroxidase positive granules in the cytoplasm of the PMN leukocytes are seen clearly. Thus, it is possible to differentiate PMN leukocytes from non-separated spermatids when they are present in a common cytoplasm. The staining of acrosomal cap permits differentiation between spermatids and lymphocytes.

Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

OBJECTIVE

The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women.

DESIGN

Cross-sectional study.

SETTING

Patan Hospital, Kathmandu, Nepal.

SUBJECTS

A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis.

RESULTS

Overall mean values (+/-s.d.) of s-tHcy and s-MMA were 9.5 (+/-4.2) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=-0.30, P<0.001) and s-folate (r=-0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=-0.40, P<0.001), but not with s-folate.

CONCLUSIONS

Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women.

SPONSORSHIP

The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

High-risk childbirth practices in remote Nepal and their determinants

This study describes birth-related practices and their determinants among women in the Jumla district of Nepal. Data were derived from a household survey in 1996. Of 939 married women of reproductive age, 657 who had given birth to their last child during the previous five years were included in the analysis. Qualitative information was further obtained from traditional birth attendants (TBAs), mothers-in-law, community leaders and pregnant women. High-risk practices were common and related to local custom and lack of knowledge on the importance of cleanliness. Husband's level of education greater than fifth grade significantly reduced the high-risk practices in all stages of childbirth, independent of other socio-economic, biological and village variables.

Maternal hematological status and risk of low birth weight and preterm delivery in Nepal

BACKGROUND

Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant Nepali women.

METHODS

In a case-control study, 1400 pregnant women attending Patan Hospital, Kathmandu, Nepal for antenatal care and delivery in the period 1994 to 1996 were included. Women with twin pregnancies (n=15) and those delivering infants with congenital malformations (n=13) were excluded from the study. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight, gestation at delivery, Apgar score, mode of delivery, and perinatal death. Linear and logistic regression models were used to analyze data.

RESULTS

Severe anemia (hematocrit < or =24%) was associated with a significantly increased risk of low birth weight (<2500 g) and preterm delivery (<37 weeks gestation). High hematocrit values (> or =40%) did not increase the risk of low birth weight or preterm delivery. The risk of low Apgar score or operative deliveries was significantly increased in women with severe anemia in the first trimester. Teenagers, women with short height or low body mass index, and those belonging to the ethnic group Brahmins, had significantly higher risks of delivering low birth weight infants.

CONCLUSIONS

Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improvements in the nutritional status of young Nepali women could contribute to improved health among their infants.

Infant death rates and animal-shed delivery in remote rural areas of Nepal

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

Seasonal variation in risk of anemia among pregnant Nepali women

OBJECTIVE

We aimed to investigate whether there is any seasonal variation in risk of anemia among pregnant Nepali women.

METHODS

We studied the hematocrit values in pregnant women (n=5495) attending Patan Hospital, Kathmandu for the first antenatal visit in the 2-year period from January 1994 until December 1995. In a sub-sample of subjects (n=2706), additional information was obtained through interviews and clinical examinations. Logistic regression models were used to analyze data.

RESULTS

Mean hematocrit values recorded in the monsoon period were significantly lower than hematocrit values recorded in the winter. The prevalence of moderate (hematocrit 25-33%) and severe (hematocrit<25%) anemia was highest in September.

CONCLUSIONS

We found a clear seasonal variation in risk of anemia, which was associated with rainfall and temperature. The monsoon seems to be a period when interventions may give the most beneficial effects.

The prevalence of anemia in pregnant Nepali women--a study in Kathmandu

BACKGROUND

Anemia in pregnancy is associated with maternal and perinatal morbidity and mortality. The World Health Organization has suggested that where up-to-date information is not available, prevalence studies should be undertaken.

METHODS

The distribution of hematocrit in 2280 pregnant women attending Patan Hospital, Kathmandu, for their first antenatal visit in a twelve month period, 1994-95, was studied. Anemia was defined as a hematocrit value < or =34% in the first and third trimesters, or < or =33% in the second trimester. Severe anemia was defined as a hematocrit value < or =24%. The prevalence of anemia and severe anemia, and associations with socio-demographic (age, ethnic group, living area, maternal and paternal education and occupation) and biological (height, body mass index, parity, gestation) variables were investigated.

RESULTS

The hematocrit values ranged from 11-49% with a mean value of 32.6% (s.d. 3.9). The prevalences of anemia and severe anemia were 62.2% and 3.6%, respectively. High prevalence of anemia was observed among teenagers, farmers, women of short height, the ethnic groups Lama/Sherpa/Tamang, and women married to industrial workers or illiterate men. Also, the risk of anemia increased with gestation. Work within the service professions, higher education and high body mass index, were associated with a lower risk of anemia.

CONCLUSIONS

A high prevalence of anemia among pregnant women in Kathmandu was observed. The hematocrit values were related to socio-demographic and biological factors. In order to plan focused and effective intervention, studies on the etiology of anemia among pregnant women in rural and urban areas of Nepal need to be carried out.

Anaemia in pregnancy: possible causes and risk factors in Nepali women

OBJECTIVE

The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women.

DESIGN

Case-control study.

SETTING

Patan Hospital, Kathmandu, Nepal.

SUBJECTS

A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54).

RESULTS

We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively.

CONCLUSIONS

In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care.

SPONSORSHIP

The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8

The effect of male occupational exposure in infertile couples in Norway

The objective of the study was to assess whether reduced semen quality in infertile couples is associated with occupational exposures known to be hazardous to fertility. Results of the first semen analysis were linked to occupational exposure data from a self-administered questionnaire. Reduced semen quality was found in men exposed to electromagnetic fields (odds ratio, 3.22; confidence interval, 1.46 to 7.09). A tendency toward reduced semen quality was seen in commuters (OR, 1.52; CI, 0.89 to 2.59), shift workers (OR, 1.46; CI, 0.89 to 2.40), and men exposed to heavy metals (OR, 1.47; CI, 0.76 to 2.87). In general, the impact of occupational exposure on semen quality in infertile couples in Norway seemed to be minor. However, occupational exposure mapping is still important in individual infertility investigations.

Secular trends in sperm variables for groups of men in fertile and infertile couples

OBJECTIVE

To assess possible secular trends in sperm variables in men according to previous or subsequent paternity.

DESIGN

A comparison of secular trends in sperm variables 1975-1994 in men under investigation for infertility in groups according to previous and subsequent paternity, based on data from the Medical Birth Registry of Norway.

SETTING

University hospital, Sperm laboratory and the Medical Birth Registry of Norway.

MATERIAL

Samples were obtained from: 1108 men who had fathered at least one child before the analysis. 1786 men who had at least one child after the analysis, and 2286 men with no children registered.

MAIN OUTCOME MEASURES

Sperm concentration, seminal fluid volume, total number of spermatozoa per ejaculate.

RESULTS

Analyzed by year of evaluation, men with no child registered had a significant secular decrease of sperm concentration, total number of sperms per ejaculate and seminal volume. The group with subsequent children had significant secular decrease of sperm concentration and total sperm count per ejaculate, while no significant changes were found for the group with previous children. Analyzed by year of birth, a significant decrease of sperm concentration and total sperm count was found for the group without and for the group with subsequent children.

CONCLUSION

The results are compatible with a cohort effect, exhibiting a trend of deteriorating sperm variables in consecutive birth cohorts.

[The P-pill for men--when will it be available?]

Although the development of a hormonal contraceptive for men has proved to be more of a challenge than oral contraception for women, several experimental prototypes already satisfy many of the criteria that must be met. Steroid regimes are more effective in Asians than in men of other ethnic backgrounds. They are inexpensive, and the effect is reversible.GnRH analogues are promising, but further research is needed and is being carried out. Androgens must be used as a supplement to all hormonal strategies in order to maintain normal sexual function. The impact of androgens on lipid metabolism and prostate physiology must be clarified. Lack of funding is the greatest barrier to further research and the development of a hormonal contraceptive for men.

Identification of the complement regulatory protein CD59 in human colostrum and milk

PROBLEM

Complement lytic activity has been demonstrated, and a potential for its activation is present in human colostrum and milk. This necessitates the presence of regulatory mechanisms protecting epithelial cells in the oropharynx and the gastrointestinal tract of the infant, the milk cellular elements, and bacteria colonizing the oropharynx and the gastrointestinal tract. Lactoferrin and C1 inhibitor have been attributed such a role. However, it is likely that additional protection against the cytolytic activity of the membrane attack complex is required. This has lead us to investigate the presence of the complement regulatory protein CD59 in human colostrum and milk, and to further characterize the source of secretion.

METHOD

Samples of human colostrum and milk were obtained from volunteers at different stages of lactation, and separated into fat, skim milk, and milk cellular elements by centrifugation. Normal human mammary gland tissues were obtained from patients undergoing biopsy for benign conditions. SDS-PAGE and Western blotting, and an immuno dot-blot assay were used to identify CD59 in human milk. Immunohistochemistry was performed on all tissue samples and cytospins of the milk cellular elements, using monoclonal antibodies to CD59.

RESULTS

CD59 was present in cell-free colostrum and milk as a 19-25 kDa glycoprotein. No variation in CD59 levels was detected between colostrum and milk. CD59 was present in great amounts in the cytoplasm and was highly expressed on the surface membrane on mammary gland acinar and ductal epithelial cells, while the milk cellular elements contained CD59 mainly in their cytoplasm.

CONCLUSION

The complement regulatory protein CD59 present in cell-free human colostrum and milk may exert its effects both in the mammary gland and in the oropharynx and gastrointestinal tract of the infant. The lobuloalveolar epithelial cells in the mammary gland are the likely source of secretion.

Evaluation of a rapid enzyme immunoassay for detection of genital colonization of group B streptococci in pregnant women: own experience and review

We have compared an enzyme immunoassay (ICON Step B, Hybritech) with cultures for demonstration of genital carriage of group B streptococci (GBS) in pregnant women, and studied the relationship between vaginal and rectal carriage of this organism. Pertinent literature has also been reviewed. Two hundred pregnant women at gestational week 17 were included. Swabs from the uterine cervix were tested for GBS by ICON Strep B immunoassay and ordinary cultures on blood agar. Additional swabs from the rectum were tested by cultures. The percentage of women with GBS in cervical secretions was 13.5% (27/200) by cultures and 4% (8/200) by the ICON Strep B immunoassay. The overall sensitivity of the immunoassay was 7.4%, and the specificity 96.5%. In conclusion, the sensitivity of rapid enzyme immunoassays is too low for accurate screening of GBS in the genital tract of pregnant women.

Identification of the complement regulatory proteins CD46, CD55, and CD59 in human fallopian tube, endometrium, and cervical mucosa and secretion

PROBLEM

Complement lytic activity has been demonstrated, and a potential for its activation is present in human cervical and tubal secretions and in the endometrium. This necessitates the presence of regulatory mechanisms for protection of the sperm and the implanting allogeneic conceptus in the female genital tract. Complement regulatory proteins demonstrated on sperm and in seminal fluid have been attributed such a role. It is however likely that additional protection is required for a successful conception and implantation to take place. This lead us to investigate the distribution of the complement regulatory factors in cervical mucus and mucosa, uterine endometrium, and fallopian tube.

METHOD

Endometrium and cervical mucosa were obtained from patients undergoing hysterectomy for benign conditions, and specimens were selected from different stages of the menstrual cycle. Fallopian tubes were obtained from patients submitted for sterilization, while cervical mucus was aspirated from volunteers undergoing gynecological examination. Immunohistochemistry was performed on all tissue samples, using monoclonal antibodies to membrane cofactor protein (MCP), decay accelerating factor (DAF), CD59 and complement receptor 1 (CR1). Western blot analysis was performed on cervical mucus under nonreducing conditions.

RESULTS

MCP, DAF, and CD59 were found to be expressed in human endometrium and fallopian tube. No variation in expression was detected throughout the menstrual cycle. CR1 was not expressed. Soluble forms of DAF and CD59 were found to be present in cervical mucus.

CONCLUSION

The complement regulatory proteins MCP, DAF, and CD59 are expressed throughout the female genital tract, and may thus play an important role in protecting the traversing sperm and implanting blastocyst from complement mediated damage.

Cyclic variation in the expression of Fc gamma receptors in human endometrium

Cyclic variations of Fc gamma receptors (FcR) in human endometrium were studied in specimens from the fundal part, the lower part of the uterine cavity and from the endocervix obtained in the proliferative, ovulatory and early and late secretory phase. The three classes of FcR were studied using monoclonal antibodies (mAb) and indirect immunohistochemistry with avidin-biotin-peroxidase complexes. FcRI, FcRII and FcRIII were expressed on stomal cells throughout the cycle. In the late secretory phase some of the stromal cells had morphology comparable to predecidual cells. These cells express FcRIII only. FcRIII only were expressed on the glandular epithelium in all phases of the cycle. The endothelium was negative in the midcycle and positive early and late in the cycle for FcRI and FcRIII, although weak for FcRIII late in the cycle. FcRII was not expressed on the endothelium. Apparently the FcR activity in the endometrium does not vary during the menstrual cycle, except for small variation in the expression on the endothelium and the presence of FcRIII on positive predecidual cells. No differences in FcR expression were found in specimens taken from different parts of the uterine cavity.

Systemic and mucosal antibody responses to group B streptococci following immunization of the colonic-rectal mucosa

The cervico-vaginal mucosa is poorly designed for inducing a mucosal immune response, but it can effect such a response evoked at other mucosal sites. This study was undertaken to determine whether colonic-rectal immunization with group B streptococci (GBS) might induce a local cervico-vaginal immune response. Mice were immunized with either fragmented GBS rectally, whole GBS rectally, or whole GBS subcutaneously. Cholera toxin (CT) was used as an adjuvant for the rectal immunizations. Following colonic-rectal immunization with whole GBS, the mean anti-GBS IgA antibody level in vaginal secretions was 735 kU/ml, with individual values reaching 3480 kU/ml. Corresponding levels of IgA antibodies never exceeded 10 kU/ml in serum and intestinal secretions, or 90 kU/g in feces. In vaginal secretions IgA antibodies to GBS also constituted a much larger fraction of total IgA than in serum, intestinal secretions and feces. Immunizations with fragmented GBS produced much lower IgA responses. Anti-GBS IgA response at the inductive site in the colon-rectum was not significant, as opposed to a strong anti-CT IgA response. Except in serum, the anti-GBS IgG responses to colonic-rectal immunizations were generally low, or absent. The results may provide a basis for the development of mucosal vaccines against GBS-infection.

High serum ferritin post partum: an acute phase reaction

The purpose of the study was to examine the cause of the increased serum ferritin post-partum observed previously. B-hemoglobin, B-leucocytes, S-ferritin, erythrocyte protoporphyrin and S-orosomucoid were determined in the blood of 21 pregnant women in the 39th week of pregnancy, two to four days and six weeks after delivery. The S-ferritin was increased from 12.1 micrograms/l at the 39th week of pregnancy to 30.1 micrograms/l post-partum. The probable reason for this increment is an acute phase reaction since a rise in the concentration of S-orosomucoid and B-leucocytes were concurrently observed.

Demonstration of Fc gamma receptors in human endometrium

Cryostat sections of human endometrium bound sheep erythrocytes (E) sensitized with rabbit IgG antibody (A), (EA). Unsensitized E were not bound. Native, heat-aggregated IgG and Fc fragments of IgG inhibited the binding of EA, whereas IgM, IgA and F(ab')2 fragments of IgG did not. The data indicate the presence of receptors for the Fc part of IgG (FcR). Using immune complexes of horseradish peroxidase (HRP) and rabbit IgG antibodies to HRP and monoclonal antibodies (mAbs), FcR were located to the glandular epithelial and endothelial cells, macrophages and predecidual cells of the stroma. These structures were also stained by mAbs against all three FcR classes and a 40-kD low affinity placental FcR. Preliminary results indicate that the expression of FcR varies during different stages of the menstrual cycle. FcR in the endometrium may play a rôle in local immunoregulation necessary for nidation and development of the blastocyst.

Pregnancy outcome in Norway after Chernobyl

Pregnancy outcome has been studied in terms of legal abortions, early spontaneous abortions and total number of pregnancies (in an ad hoc study covering 6 counties) as well as various perinatal health problems (on the basis of routinely recorded data for epidemiological surveillance from the Medical Birth Registry of Norway). Apparently, no effects were observed in terms of an increased occurrence of legal abortions, while spontaneous abortions increased from 7.2% of all pregnancies during the last 12 months before the accident to 8.3% after the accident [corrected]. At the same time, the total number of pregnancies somewhat decreased. Based on monthly measurements in each municipality of external and internal (food-based) doses, dose-response associations were assessed for a number of perinatal health problems. No associations were observed.

[Pregnancy outcome in some Norwegian counties before and after the Chernobyl accident]

The outcome of pregnancies in six countries in Norway has been studied during 12 months prior and subsequent to the Chernobyl accident. The accident took place in a period with an annual increase of births of approximately 3%. However, the year after the accident a decrease of 0.7% was observed with particularly low numbers during February--April 1987. Concomitantly, the miscarriage fraction of all pregnancies increased by 16.3% and particularly during November 1986--January 1987. The same pattern was found when observations from Haukeland Hospital were analyzed separately. When the time of conception was taken into consideration we found that conceptions during the period May--July 1986 ended more often as miscarriages. We have no explanation of the observations. The external radiation exposure seems too small to have produced these effects. The internal radiation from food may have played a role. People may also have changed their food intake, using less vegetables, due to fear of these being polluted by radioactive fallout.

Outcome of pregnancy in one Norwegian county 3 years prior to and 3 years subsequent to the Chernobyl accident

Pregnancy outcome was studied in a county in Norway 3 years prior to and 3 years subsequent to the Chernobyl nuclear plant accident on 26th April 1986. More detailed analyses have been performed for the 12 months prior to and subsequent to the accident. A significant increase in the spontaneous abortion rate the first year after the accident was followed by a slight decrease during the second and third years, but figures were still higher than the period prior to the accident. The rate of legal abortions was unchanged. During the entire observation period the number of births increased continuously, with the exception of a decrease in the last 2 months of 1986 and the first month of 1987. A higher incidence of spontaneous abortions was found for pregnancies conceived during the first 3 months after the accident. This increase in the spontaneous abortion rate is noteworthy, and more especially its long-term persistence, which cannot be the result of external radiation. The internal radiation from food polluted by radioactive fallout is a possible explanation. Changes in nutrition in order to avoid polluted food may also be of importance.

Human chorionic gonadotropin in cord blood and peripheral maternal blood in singleton and twin pregnancies at delivery

The influence of fetal sex on human chorionic gonadotropin (hCG) in cord and peripheral maternal blood was studied at delivery in 57 twin and 66 singleton uncomplicated pregnancies. In twin pregnancies the hCG levels were about twice as high in female-female and in female-male vis-à-vis male-male combinations in both maternal and cord blood. In singleton pregnancies the hCG levels were significantly higher in maternal and in cord blood in cases of female vis-à-vis male infants. The ratio of maternal hCG/placental weight was also highest in the twin pregnancies when one or both infants were female. This suggests a "female effect", possibly genetically based.

The course of epilepsy during pregnancy: a study of 78 cases

We have compared frequency and severity of epileptic seizures during pregnancy with the 9 months prior to pregnancy in 66 patients with a total of 78 pregnancies. Data on total number of seizures and major seizures are analysed separately. No statistically significant differences between frequency before and during pregnancy were found. Cases with seizures before pregnancy tended to have seizures during pregnancy, but there was no association between occurrence of seizures prior to pregnancy and increased frequency during pregnancy. There was no evidence that seizures became more severe during pregnancy. No relationship was found between type of epilepsy and change in seizure frequency during pregnancy. The data suggest that our therapeutic interventions may have influenced seizure frequency in at most a minority of cases. Serum concentrations of the anti-epileptic drugs were monitored regularly during pregnancy. Only data on patients on constant drug dosages and, therefore, presumedly with the mildest seizure disorders were analysed. In the majority of cases there was a decrease in drug levels during pregnancy. Most cases tolerated this decrease without an increase in seizure frequency. On the other hand, most cases with increased frequency also had decreased drug levels.

Some fetal and pregnancy parameters in Nepal

In Patan Hospital, Kathmandu, 4600 single live births were analysed concerning birth weight in relation to gestational age. At term, the median birth weight of females was 2900 g and of males 3010 g. Compared with Norwegian newborns, the birthweights of Nepali babies were lower for all corresponding gestational lengths. The differences increased with gestational age. Fundal height was lower in Nepali than in Norwegian pregnant women for all periods of pregnancy. An increase in the differences between Norwegian and Nepali women was also noted. Hematocrit values of Nepali women who did not take supplementary iron, correspond well to findings in Norwegian women without iron supplementation. Only a slight degree of hemoconcentration was noted towards term. For Norwegian women with iron supplementation the hematocrit values were much higher, with a tendency towards hemoconcentration near term. In Nepal the average woman probably has small iron stores, and without iron supplementation the hematocrit values will remain low throughout the pregnancy. The high altitude does not seem to cause hemoconcentration in pregnancy to a greater extent than at lower altitude. Hemoconcentration is therefore not a major causative factor of the lower birth weights.

Microflora of cervical and vaginal secretion in women using copper- and norgestrel-releasing IUCDs

In 90 women with a norgestrel-releasing IUCD inserted and 50 women having a copper releasing IUCD, culturing of cervical and vaginal secretion was performed prior to, and 3 and 12 months after insertion of the IUCD. There were no significant changes in the cervical or vaginal microflora, and no significant differences between the groups. According to these findings, locally released progestogens from an IUCD do not affect the microflora of the vagina or of the cervix.

Repeat ectopic pregnancy. A twenty-year hospital survey

Seventy-two patients with repeat ectopic pregnancy including 3 women with three ectopic pregnancies each during the period 1965 to 1984 were studied. In the same period there was a total of 842 ectopic pregnancies, giving a repeat ectopic pregnancy incidence of 9.4%. In the last decade the incidence of repeat ectopic pregnancy was 10.4%, and in the first decade it was 7.0% (p less than 0.025). None of the women used an intra-uterine contraceptive device, among those with repeat ectopic pregnancy in the first decade, vis-à-vis 17 (30.4%) in the last decade. A history of infertility was common among the patients with repeat ectopic pregnancy. Between the two events there was a total of 17 deliveries in 13 patients. Four out of 24 potentially fertile women completed full-term pregnancies following their second ectopic pregnancy.

Fertility following ectopic pregnancy with special reference to previous use of an intra-uterine contraceptive device (IUCD)

A group of 304 women operated on for ectopic pregnancy were followed up with respect to subsequent reproductive performance. The group was distributed into current users, earlier users and non-users of an intra-uterine contraceptive device (IUCD). Pelvic inflammatory disease (PID) and infertility were more common among non IUCD users. Reproductive performance was statistically significantly better in ever-users of an IUCD than in never-users. The proportions of women wishing to become pregnant and who later gave birth to a live baby in the three groups were 69.2%, 61.4% and 38.0% respectively.

Prolapse of an ovarian tumor during labor

A case of prolapsed tumor after home delivery is reported. At first a puerperal inversion of the uterus was suspected. At operation a dermoid ovarian tumor was found to be prolapsed through the vaginal fornix.

Ovarian pregnancy associated with the intra-uterine contraceptive device. A survey of two decades

Records of 25 cases of ovarian pregnancy in the period 1965 to 1984 were reviewed. Seventeen cases (68%), had an IUCD in situ, and 15 of these had occurred during the last decade. The ratio of ovarian pregnancy to all ectopic pregnancies was 1:13 in the IUCD group versus 1:78 in the non-IUCD group (p less than 0.025). In contrast to patients with tubal pregnancies, those with ovarian pregnancy very seldom have a history of pelvic inflammatory disease (PID), infertility, or earlier pelvic operations. Subsequent fertility is good compared with patients with tubal pregnancies, for patients both with and without IUCD.

Fistula between the urinary bladder and an ovarian dermoid tumor

A 30 year old woman presented with symptoms of bladder stone. At operation, in addition to a big bladder stone, a fistula from the bladder to an ovarian dermoid tumor, was found. The cause of the fistula formation remains obscure.

Serum concentrations of vitamin D metabolites in vitamin D supplemented pregnant women. A longitudinal study

The serum concentrations of the vitamin D metabolites 25-OHD, 1,25-(OH)2D, 24,25-(OH)2D and 25,26-(OH)2D, and of vitamin D binding protein (DBP), were determined longitudinally in 22 vitamin D supplemented pregnant women, and in 17 age-matched non-pregnant women studied during the summer. The pregnant women had higher 25-OHD and 1,25-(OH)2D, similar 24,25-(OH)2D, and lower 25,26-(OH)2D concentrations than the non-pregnant group. The relative concentrations of 24,25-(OH)2D and 25,26-(OH)2D (expressed as the molar ratio of these metabolites to 25-OHD) were lower during pregnancy. The DBP levels were increased in pregnancy, but the calculated free fraction (i.e. not bound to DBP) of the hormonal form of vitamin D, 1,25-(OH)2D, was still persistently higher in the pregnant than in the non-pregnant women. The study suggests that a daily vitamin D supplement of 400 IU satisfies the vitamin D requirement of pregnant women living in a cool climate with limited sun exposure. The increased absolute and relative concentration of 1,25-(OH)2D and decreased relative levels of 24,25-(OH)2D and 25,26-(OH)2D further suggest that the increased intestinal calcium and phosphate absorption, which is known to occur during pregnancy, is at least partially mediated by the vitamin D endocrine system.

Critical evaluation of methods for electron microscopy of cervical mucus

The ultrastructure of cervical mucus has been studied by scanning (SEM) and transmission (TEM) electron microscopy. The images differ according to the methods used for preparation; different patterns were found in the same sample when the freeze-drying and critical point-drying methods were used for SEM. When using TEM, the specimen appeared more homogeneous, with fine fibrils and granules. This accords with the theory that the cervical mucus consists of a randomly entangled fibrillar network. Electron microscopy of cervical mucus requires preparation procedures which involve considerable risk of creating artefacts. In our experience the TEM technique produces fewer artefacts and therefore gives pictures more true to the in vivo situation.

25-Hydroxyvitamin D and 1,25-dihydroxyvitamin D of D2 and D3 origin in maternal and umbilical cord serum after vitamin D2 supplementation in human pregnancy

Serum concentrations of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D [1,25-(OH)2D] of vitamin D2 and D3 origin were determined separately in 10 women before vitamin intake in early pregnancy, and repeated in maternal and cord serum obtained at delivery after 20 to 30 wk of vitamin D2 supplementation in a dose of 400 IU/day. Before supplementation 25-OHD2 and 1,25-(OH)D2D2 were present in just traceable or nondetectable concentrations, but the levels increased in all to a mean +/- 1 SD of 7.3 +/- 3.7 ng/ml and 37.2 +/- 18.1 pg/ml, respectively (p less than 0.0025), by the time of delivery. At delivery the total 25-OHD and 1,25-(OH)2D levels were always lower in the cord than in the maternal serum (30.7 +/- 14.2 versus 20.1 +/- 9.1 ng/ml, and 90.1 +/- 31.2 versus 37.3 +/- 11.6 pg/ml, p less than 0.0025). The paired concentrations of 25-OHD were closely related (r = 0.89, p less than 0.0005), while the association for 1,25-(OH)2D was not statistically significant (r = 0.53, p less than .01). The 25-OHD of D2 and D3 origin accounted for a similar proportion of the total 25-OHD in the maternal and cord serum (ratio of 25-OHD2 to 25-OHD3: 0.40 +/- 0.28 versus 0.45 +/- 0.29, p = NS), as did the respective 1,25-(OH)2D metabolites [ratio of 1,25-(OH)2D2 to 1,25-(OH)2D3: 0.73 +/- 0.35 versus 0.90 +/- 0.50, p = NS].(ABSTRACT TRUNCATED AT 250 WORDS)

Anticonvulsant drug therapy in human pregnancy: effects on serum concentrations of vitamin D metabolites in maternal and cord blood

Serum concentrations of the main vitamin D metabolites and of calcium, phosphate, and alkaline phosphatase were determined in each of the three trimesters of pregnancy and in simultaneously obtained maternal and cord blood at delivery in 22 epileptic women treated with diphenylhydantoin or carbamazepine alone or with a combination with one other drug. The results were compared with similarly obtained data from 22 normal pregnancies. Women in both groups received supplements of 400 IU vitamin D3 per day. All the women had 25-hydroxyvitamin D levels within the normal range for healthy adults (greater than 12 ng/ml) throughout pregnancy. The epileptic women had, however, significantly (p less than 0.05) lower median 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and higher median 25,26-dihydroxyvitamin D values than the reference group. The 24,25-dihydroxyvitamin D concentrations did not differ significantly, but the median ratio of 24,25-dihydroxyvitamin D to 25-hydroxyvitamin D was higher in the epileptic women at the end of pregnancy (p = 0.05). The respective differences in cord serum concentrations reflected those of the mothers at delivery. Serum calcium tended to be lower during epileptic pregnancy, but none were hypocalcemic. The alkaline phosphatase and phosphate values did not consistently differ from those of the reference women. The median alkaline phosphatase level of cord serum was slightly higher in the epileptic group, but the calcium and phosphate levels were similar to the reference values. The various biochemical parameters of the carbamazepine-treated women tended to be intermediate between those of the healthy and diphenylhydantoin-treated groups. Antiepileptic drug therapy appears to affect vitamin D metabolism and calcium homeostasis during pregnancy. The derangements may not be of major clinical significance, however, in vitamin D-supplemented and normally functioning women on long-term low-dose therapy.

Serum concentrations of vitamin D metabolites in maternal and umbilical cord blood of Libyan and Norwegian women

The serum concentrations of the vitamin D metabolites 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D) and 24,25-dihydroxyvitamin D (24,25-(OH)2D), and vitamin D binding protein, calcium, phosphate and alkaline phosphatase were determined in 19 grand multiparous Libyan women at delivery, and in the umbilical cord blood of 14 of their babies. The results were compared with similarly collected data from 22 vitamin D-supplemented Norwegian mother-infant pairs. The median 25-OHD and 24,25-(OH)2D concentrations were significantly lower for the Libyan group (maternal 25-OHD: 34 vs 112 nmol/l; cord 25-OHD: 20 vs 76 nmol/l; maternal 24,25-(OH)2D: 0.6 vs 4.1 nmol/l; cord 24,25-(OH)2D: 0.4 vs 2.7 nmol/l, P less than 0.001 for all differences). In both groups the 25-OHD and 24,25-(OH)2D levels in maternal as well as in cord blood were closely associated (P less than 0.001). The median 1,25-(OH)2D level was similar for the two maternal groups (198 vs 194 pmol/l), but slightly lower for the Libyan than for the Norwegian cord samples (80 vs 93 pmol/l, P = 0.04). A calculated free 1,25-(OH)2D concentration (not bound to vitamin D binding protein) did not differ between the two maternal or cord groups. Calcium and phosphate concentrations were similar for the respective maternal and cord samples, while the median alkaline phosphatase level of cord blood was slightly higher for the Libyan group (P = 0.04). The results suggest that calcium and phosphate homoeostasis of pregnant women and their fetuses can be maintained despite wide variations in vitamin D supply and numerous repeated pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)