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Biomedical subjects

M Thiery

Publications and source records attributed to M Thiery.

At least 37 records · Page 2Linked to original sources

Social differences in low birthweight and preterm deliveries in twins.

The relationship between low social class and low birthweight or preterm deliveries is well established in singletons but not in twins. We present a study using all twin deliveries registered in Belgium in 1983 and in Aberdeen between 1951 and 1983. No significant relationship was found between social class and low birthweight, very low birthweight or preterm deliveries in the Belgian sample. In Aberdeen, we found significantly higher rates of low birthweight twins in low social classes. This increase of low birthweight twins in low social classes occurred in Aberdeen during the period 1951-1968, but not in the more recent data.

Belgium

[Cocaine and pain control in childbirth].

Without absolutely any pain, women can live through the whole process of birth-giving thanks to the discovery of cocaine (1860) and the work of surgeons and obstetricians, who invented a whole range of locoregional methods, and the chemists who delivered them safe substitutes for cocaine. It was, as a matter of fact, a long way to go, but the final result was surely worth the effort.

Anesthesia, Obstetrical

[Midwifery education in Ghent: a historical sketch].

In spite of the tremendous importance of the services of the midwife in past centuries, formal regulation of their office was delayed until the establishment of the Collegium Medicum Gandavense (1663). Formal instruction of Ghent midwives was belated even longer, the first school for midwives being established only in 1772. Two years later, the Castellania Auderburgensis started her own school for midwives, the Ecole Royale et Supérieure d'Accouchements. Thus, it was Ghent's unique privilege to possess two schools for midwives in the latter fourth of the 18th century, one supervised by the city's medical college, the other by the Castellania of the Oudburg. Due to the charisma of its teacher (the famous man-midwife J.B. Jacobs) and thanks to the fact that the jurisdiction of the Castellania comprised the greater part of the present-day provinces of East- and West-Flanders, the Ecole Royale became a tremendous success. Unfortunately, this school was short-lived: together with the Castellania it was suppressed by the French in 1795. The City School fared better. Indeed, its teacher (med. lic. Damman), by joining the Comité de Santé of the Département de l'Escaut could rescue the institution and bridge the gap between the suppression of the Collegium Medicum Gandavense (1795) and the foundation of the Ecole de Chirurgie by the French administration (1801). Both the Ecole de Chirurgie and the other French "medical" schools of Gent [Ecole de Médecine, de Chirurgie et de Pharmacie (1805-1806) and Ecole élémentaire de Médecine (1806-1817)] took care of the theoretical instruction of departmental midwives. Regretfully, the authorities did fail to make use of the opportunities granted by the French law and establish a "home for poor women" in their city. Had such been realized, midwives would have had a chance to obtain clinical training as well. For the latter we will have to wait another decade. Indeed, it was only at the end of his reign that king William I succeeded to persuade the local and provincial authorities of the dire necessity of establishing a maternity clinic with annexed school for midwives. The first Provincial Maternity Clinic was installed in 1828 in a building erected for this purpose at the Hoveniersdreef. Two years later, the medical students of the Ghent State University (founded by William I in 1817) were admitted to the school for clinical teaching, be it in separate quarters. Because the main purpose of the Maternity Clinic was the instruction of midwives, the medical faculty will be treated as "parente pauvre" for decades to come.(ABSTRACT TRUNCATED AT 400 WORDS)

Belgium

Influence of parity on plasma lipid levels.

Plasma levels of total cholesterol (TC), HDL cholesterol (HDLC) and LDL cholesterol (LDLC), triacylglycerols (TG) and apoprotein (apo) A-I, A-II and B were measured in 516 women in the early puerperium. Different lipid plasma values (TC: 5.98 +/- 1.17 mmol/l, LDLC: 3.79 +/- 1.12 mmol/l, apo B: 108 +/- 24 mg/dl) and ratios (LDLC/HDLC: 2.85 +/- 1.09) were significantly (p less than 0.02) lower after the first pregnancy (n = 209) than after five or more pregnancies (n = 15) (TC: 6.50 +/- 2.10 mmol/l, LDLC: 4.36 +/- 1.97 mmol/l, apo B 130 +/- 50 mg/dl, LDLC/HDLC: 3.44 +/- 0.89). The opposite was true for the HDLC/TC ratio which was significantly lower (p less than 0.02) after five or more pregnancies (20.0 +/- 3.5) than after the first pregnancy (24.1 +/- 6.6). We also found a significant correlation (p less than 0.02) between the TC, LDLC, apo B and LDLC/HDLC ratio levels and parity. Other factors which could interfere with lipid metabolism (diet, body/mass index smoking, physical activity, alcohol intake) were not different between the various parity groups. Hence, we could not find a reason for the lipid elevation after the subsequent pregnancies. Although the higher lipid levels in puerperium of multipara should indicate a higher risk for progression of atherosclerosis, we need more studies before to conclude that multiparity influences the risk for coronary heart disease.

Adolescent

The cesarean delivery rate can be safely reduced in a developing country.

In an attempt to reduce the cesarean rate without adverse effect on outcome, new guidelines for the management of dystocia, previous cesarean delivery, fetal distress, and breech presentation were introduced in September 1984 in a provincial hospital in Zimbabwe, Africa. Comparison of the 2-year periods before and after September 1984 showed that the cesarean rate had dropped from 16.8 to 8.0%, the maternal mortality rate from 202 to 57 per 100,000 births, and the perinatal mortality rate from 71.9 to 56.2 per 1000 births. During the latter period, use of oxytocin increased from 3.4 to 17.4%. These findings suggest that the adoption of strict guidelines can lead to a decrease in the cesarean rate and an improvement in obstetric outcome.

Adolescent

Genetic and environmental variation in the birth weight of twins.

Two novel approaches to the analysis of twin data are illustrated with data from birth weight in twins. First, two possible covariates of birth weight are fitted to the data simultaneously, allowing for linear effects of these variables, and their correlation. Second, information on chorionicity is used to estimate the effects of chorion type on birth weight. The data were collected from a large sample of twins born in East Flanders, Belgium. Variation and covariation in twins were considered as a function of sex, chorionicity, maternal age, gestational age, and genotype. No evidence for sex differences in causes of variation was found. As expected, the largest source of variation in bith weight was associated with gestational age. Other common environmental influences were non-significant. Heritability was significant, constituting approximately 40% of variation not associated with maternal and gestational age. A small but significant effect of chorionicity was found, such that dichorionic twins show a greater similarity than monochorionic.

Birth Weight

Long-term experience with Multiload intrauterine devices.

This paper reports the joint experience of three investigators who used three types of the Multiload (ML) IUD (MLCu250 Short, MLCu250 Standard, and MLCu375) in 1987 consecutive insertions during which an experience of 56,005 woman-months of use was accumulated. The material was analyzed using the life-table method and complemented with a case by case investigation, the main purpose of the study being the specific analysis of IUD-related complications. The authors also evaluated return of fertility whenever a device was removed because of wish of pregnancy. Results indicate that serious IUD-related complications were rare, continuation rate high, and reversibility of fertility unaffected by the device.

Computer Simulation

[The levonorgestrel intrauterine device].

The levonorgestrel IUD offers a valuable improvement for women, who develop menorrhagia with conventional IUDs. However, since the levonorgestrel Nova-T induces amenorrhea and spotting in a substantial proportion of the patients, it is advisable, before insertion, to evaluate the acceptor's reaction to the "new" bleeding pattern induced by the steroid IUD.

Female

Organization of obstetrical care in Belgium.

Belgium, with its pluralistic health care system, has many small-sized maternity units staffed almost exclusively with obstetricians. The maternal and perinatal mortality and morbidity rates are still higher than in some of the neighboring countries. The new regulations with regard to the accreditation of maternity units might improve the figures. Other measures must be taken, however, to ensure that only low-risk patients are taken into small maternity units and that all high-risk cases and all those developing complications are cared for in large, well-equipped and well-staffed hospitals. Some form of peer review would also be beneficial.

Belgium

Frequency of cesarean deliveries in Belgium.

Belgium has not been spared the increase in the rates of cesarean section (CS) observed in other Western countries. In contrast with some of these countries, however, rate increases have been rather modest, both nationally and in most Belgian hospitals. Casuistic data suggest that the indications explaining the increase of CS rates in Belgium are by and large comparable to those pinpointed elsewhere. Ways to reduce rates of abdominal delivery are suggested.

Belgium

Clinical experience with an ethinyl estradiol-desogestrel oral contraceptive.

Desogestrel (150 micrograms), a potent progestogen virtually devoid of androgenic activity, was used in combination with 30 micrograms ethinyl estradiol as an oral contraceptive preparation (Marvelon). 219 women completed a total of 4074 cycles, and the use-effectiveness was 0.58 Pearl Units. Serious side effects were not observed. The drug-related discontinuation index was 12.8% in six months.

Adult

[The impact of a new strict obstetrical strategy on maternal mortality and obstetrical results].

In an attempt to reduce the caesarean section rate without an adverse effect on the obstetrical outcome, new guidelines for the management of dystocia, previous caesarean delivery, fetal distress, and breech presentation were introduced in September 1984 in a provincial hospital in Zimbabwe, Africa. Comparison of the two-year periods before and after September 1984 showed that the caesarean section rate had dropped from 16.8 to 8.0%, the maternal mortality rate from 2.0 to 0.5%, and the perinatal mortality rate from 71.9 to 56.2%. During the latter period use of oxytocin increased from 3.4 to 17.4%. These findings suggest that the adoption of strict guidelines can lead to a decrease of the caesarean section rate and an improvement of the obstetrical outcome in the absence of new technology.

Adult

[Historical aspects of pain relief during normal parturition].

Traditional methods used for the relief of pain during normal delivery are few and the medical literature remained silent on this topic up to the middle of the 19th century. Indeed, the first effective method was etherization, and it was introduced by Simpson (Edinburgh) in 1847. Obstetric inhalation analgesia was followed by many other methods the development of which was based on new discoveries in chemistry, pharmacology, physiology, and psychosomatic medicine. This paper reviews the milestones in the historical development of obstetric analgesia.

Analgesia