Biomedical subjects
Publications and source records attributed to M Thiery.
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.
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)
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.
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The contraceptive efficacy, tolerance, and safety of a new monophasic oral contraceptive that combines 75 mcg gestodene (delta-15- levonorgestrel) and 30 mcg ethinyl estradiol were studied in 75 women (944 cycles) currently at risk for pregnancy. 20 women were nulliparous. No woman became pregnant during the trial, nor were vital signs of body weight affected by the drug. Cycle control was excellent, with no bleeding irregularities in 92% of the cycles. Serious complications did not occur. The low incidence of side effects, e.g. headache (9%) and breast tenderness (8%), indicated that the gestodene combination was well-tolerated. In a subgroup of 10 women, no changes in routine laboratory tests could be demonstrated after 12 cycles of treatment.
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.
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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.
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.
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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.
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A simple and accurate method is described for rapid differentiation of surgical and nonsurgical pneumoperitoneum by measuring the partial pressure of oxygen in intraperitoneal air with a blood gas analyser. Results in five ventilated neonates in whom this distinction was not possible by clinical or radiographic means are presented.
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 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.
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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.