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Biomedical subjects

N J Secher

Publications and source records attributed to N J Secher.

At least 91 records · Page 5Linked to original sources
PubMed1990

A possible preventive effect of low-dose fish oil on early delivery and pre-eclampsia: indications from a 50-year-old controlled trial.

A preventive effect of dietary marine n-3 fatty acids on early delivery and toxaemia has recently been hypothesized. In only one published controlled trial fish oil has been given to pregnant women, namely in that conducted during 1938-9 in London by the People's League of Health with a dietary supplement containing vitamins, minerals, and halibut liver oil. Although it was of high quality and its findings are hitherto unexplained, neglect and misinterpretation of the trial seem to occur commonly in reviews. Of the 5644 women who were enrolled the 622 withdrawals were independent of treatment. Alternate allocation to treatment was used, producing two groups that were well balanced as to age and parity. The supplement was given from about week 20. The control group did not receive any supplement. Reductions of 20.4% (95% confidence interval 9-30%, P = 0.00083) and 31.5% (95% confidence interval 11-47%, P = 0.0047) were seen in odds of delivering before 40 weeks of gestation and pre-eclampsia respectively. No significant effects were seen on perinatal mortality, average birth weight, deliveries after 40 weeks, hypertension in the absence of oedema and proteinuria, duration of labour, sepsis or breast-feeding occurrence. Later controlled trials with vitamins or minerals given in the same amounts as in this trial have largely failed to show convincing effects as seen here. A controlled trial assessing the isolated effects of fish oil in pregnancy is warranted.

Birth Weight↗
PubMed1989

Fetal weight estimation in twin pregnancies.

In this study the fetal weight was estimated by ultrasound measurements of the biparietal (BPD) and abdominal diameters (AD) in 154 consecutive twin pregnancies. In 80 twins an attempt to estimate fetal weight was made 0-4 days before delivery (26% of all twins examined). In 84% (67 infants) it was possible to estimate the fetal weight using the formula (0.0108 X AD1.72 X BPD0.99). 60% of the birth weights deviated less than 10% from the estimated fetal weight and 83% deviated less than 15%. The prediction error was nearly constant, expressed as percent of actual weight in the different weight groups (8.5-9.8%). In 19 LGA infants, 69% of the birth weights deviated less than 10% from the estimated fetal weight and 70% deviated less than 15%.

Body Weight↗
PubMed1989

Intracervical 17 beta-oestradiol before induction of second-trimester abortion with a prostaglandin E1 analogue.

28 consecutive patients (17.5 weeks pregnant, range 15-21 weeks) referred for therapeutic termination of pregnancy were randomized for pretreatment overnight with either intracervical gel containing 50 mg 17 beta-oestradiol or placebo gel. The induction-abortion time with pessaries containing 16,16-dimethyl-trans-delta 2-prostaglandin E1 methyl ester was significantly reduced in the oestrogen group (median value of 11.5 versus 15 hours). The beneficial effect of oestradiol priming was primarily caused by a reduction of the number of women with high cervical resistance and prolonged induction-abortion time (90 percentiles of 15.5 and 34 hours). Thus, oestrogen pretreatment might reduce the cervical trauma due to the prostaglandins as well as the incidence of cervical incompetence in later pregnancies.

Abortifacient Agents↗
PubMed1989

Indications for tocolytic therapy: incidence of true preterm labor with uterine contractions as the sole deciding factor.

To evaluate the maximal impact tocolytic therapy could exert on preterm delivery rate, we conducted a retrospective study of all births that took place at Aarbus Kommune-hospital during a 2-year period when the only therapeutic regimen used in threatened preterm labor was bed rest. All singleton pregnancies that were delivered before the 35th week of gestation were included in the study. Eighty (1.2%) of 6454 deliveries fulfilled these criteria. Thirty-seven (46%) of the preterm pregnancies were associated with complications in which tocolytic therapy is contraindicated. Forty-three (54%) of the preterm deliveries occurred in women without pregnancy-related complications. Primary rupture of the membranes occurred in 19 (24%) women who therefore were not candidates for tocolytic therapy. Spontaneous contractions without contraindications for tocolytic therapy and with a cervical dilation less than 5 cm were present in 15 women only. In this group one infant had nonsuspected severe congenital malformations. Thus, only 14 (17.5%) of the preterm deliveries could have been prevented by tocolytic therapy. Tocolytic therapy other than bed rest was therefore indicated in only 0.2% of all deliveries.

Adult↗
PubMed1987

Estimation of fetal weight in the third trimester by ultrasound.

A method to estimate the intrauterine fetal weight by use of ultrasound measurements of the fetal biparietal diameter (BPD) and the abdominal diameter (AD) is presented. From a consecutive series of single pregnancies the 238 pregnancies (3% of the hospital population) with ultrasound measurements obtained within 4 days before delivery were used in the estimation of birth weight. In addition, the estimated formula was applied on a test material consisting of 100 similarly selected pregnancies from the same hospital. To evaluate the expected selection effects, the birth weight for gestational age in the study group was compared with birth weight for gestational age in the total population. The weight could be estimated as 0.0351 X AD1.65 X BPD0.69 X exp(0.00196 X gestational age). Thus, the actual birth weight was within 83-120% of the estimated weight (95% prediction limits), with a residual coefficient of variation of about 9%. The gestational age could be omitted without major influence on the weight prediction. When applying the formula on the test material, 70% of the actual weights deviated less than 10% from the estimated fetal weight, but a tendency towards a slight overestimation of the weight for light for gestational age infants was found.

Birth Weight↗
PubMed1987

A randomized study of fetal abdominal diameter and fetal weight estimation for detection of light-for-gestation infants in low-risk pregnancies.

A total of 2771 pregnant women with gestational age estimated by ultrasound measurement of the fetal biparietal diameter (BPD) before the 22nd week of gestation were re-examined by ultrasound in the 32nd and 37th week of pregnancy at which time the fetal BPD and abdominal diameter (AD) were measured. An additional examination was performed at 34 weeks if the fetal weight in the 32nd week was estimated to be less than 95% of the expected mean weight. Light-for-gestational age (LGA) was suspected if the estimated birth-weight was less than 85% of the expected mean birthweight. This applied to 186 uncomplicated pregnancies in which there was no clinical suspicion of poor intrauterine growth. These pregnancies were randomly allocated to a treatment group (AD and estimated weight reported) or to a control group (AD and estimated weight withheld). Induction of labour was significantly more common in the treatment group (41%) than in the control group (15%). No statistically significant difference was found in the use of instrumental vaginal delivery or caesarean section. There was a suggestion of marginal benefit in terms of neonatal morbidity but this was not statistically significant.

Abdomen↗
PubMed1987

Growth retardation in preterm infants.

This paper combines earlier results on the relation between birthweight and gestational age, and the relation between fetal weight and ultrasound measurements of the fetal biparietal diameter (BPD) and mean abdominal diameter (AD) to investigate whether preterm infants (viewed as a group) are smaller than unborn fetuses of the same gestational age. The birthweight distribution for each sex at 223 and 258 days gestation was derived from the birthweight-for-gestational age charts based on 3888 newborn infants. The sex-specific intrauterine weight distribution was estimated from ultrasound measurement of the fetal BPD and AD performed on randomly selected fetuses of gestational age 223 and 258 days. The birthweights were lower than the intrauterine weights, especially early in pregnancy and for female infants. Thus, the 10th birthweight centile for girls at day 223 corresponds to the 4th centile of the 'true' intrauterine weight, and the 'true' intrauterine 10th centile corresponds to the 25th centile birthweight at day 223.

Birth Weight↗
PubMed1987

On the evaluation of routine ultrasound screening in the third trimester for detection of light for gestational age (LGA) infants.

Based upon 2194 consecutive pregnancies with known gestational age, formulas for weight deviation predicted in the 32nd and 37th gestational week were estimated by multiple linear regression on the measurements of the abdominal diameter (AD) and the biparietal diameter (BPD) of the first 64% of the pregnancies. The usefulness of the screening was evaluated on the remaining 36%. An attempt to diagnose light for gestational age (LGA) infants resulted in either a low sensitivity or a low predictive value of a positive test. The late third trimester screening was more sensitive than the early, indicating LGA as a late phenomenon in pregnancy. Knowing the result from the late scanning, the result from the early scanning contributed almost no further information about whether the infant would be LGA at birth. Basic epidemiological characteristics of other comparable investigations on high-risk pregnancies and non selected pregnancies are presented.

Birth Weight↗
PubMed1986

Intake of marine fat, rich in (n-3)-polyunsaturated fatty acids, may increase birthweight by prolonging gestation.

Birthweights in the Faroe Islands are among the highest in the world. Compared with Denmark, the average birthweight of liveborn singleton infants of primiparous mothers is 194 g higher, and a substantial part of this difference seems to be attributable to longer gestation. Prostaglandins play an important part in the timing of parturition in human beings. Dietary (n-3)-polyunsaturated fatty acids (PUFA) in high amounts influence endogenous prostaglandin metabolism. Owing to the large consumption of marine fat, the average intake of (n-3)-PUFA in the Faroes by far exceeds that in Denmark. The hypothesis proposed is that dietary (n-3)-PUFA in high amounts prolong gestation in human beings by interfering with uterine production of prostaglandins, possibly by inhibiting the production of dienoic prostaglandins, primarily PGF2 alpha and PGE2, which are mediators of uterine contractions and cervical ripening.

Animals↗
PubMed1986

Controlled trial of ultrasound screening for light for gestational age (LGA) infants in late pregnancy.

The study included 3311 pregnant women: 1570 in the screened group and 1741 in the unscreened group. In the screened group, ultrasound was offered routinely in the 32nd and 37th week of pregnancy, at which time the fetal biparietal diameter (BPD) and the abdominal mean diameter (AD) were measured. If, after the first ultrasound examination, the estimated weight was less than 85% of the expected mean birthweight, a finding of light for gestational age (LGA) was suspected and the ultrasound examination was repeated in the 34th week. In the screened group 6.5% of the women were at risk at the final ultrasound examination (the sensitivity was 38%) and the predictive values of abnormal and normal weight deviation were 60% and 93%, with a specificity of 97% and a relative risk of 9. Ultrasound was offered to the unscreened group only in cases of clinical concern (23% of the women). In the unscreened group 34% of the 158 LGA infants had ultrasound performed before delivery because of clinical concern. By including pregnancies induced before ultrasound could be performed, 45% of the LGA infants in the unscreened group were suspected before delivery. No significant difference between the rate of induction, instrumental deliveries and caesarean sections was found between the two groups. No benefit in terms of decreased incidence of infants with low Apgar score and acidosis was achieved.

Clinical Trials as Topic↗
PubMed1986

Birthweight-for-gestational age charts based on early ultrasound estimation of gestational age.

Birthweight-for-gestational age charts were based on the analysis of 3888 consecutive births in which the gestational age was estimated by measuring the fetal biparietal diameter before the 20th week of gestation. The data showed, in contrast to previous studies, a linear relation between gestational age and birthweight without inflection after term. The regression parameters showed a strongly significant difference between girls and boys. Thus, boys were 1.5% heavier than girls at 190 days gestation and 3.6% heavier at 300 days gestation. The linearity in the birthweight-for-gestational age charts could be due to the more reliable gestational age based on early ultrasound.

Birth Weight↗
PubMed1985

High maternal serum alpha-fetoprotein and low birthweight. A study concerning possible correlation between maternal weight, smoking, and serum alpha-fetoprotein and subsequent birthweight and gestational age.

Maternal serum alpha-fetoprotein (AFP) levels between 15 and 19 weeks gestation were studied in relation to birthweight, gestational age, maternal weight, and daily cigarette consumption in 1739 pregnancies. All infants were born after the 28th week of gestation and all were without neural tube defects. Gestational age was estimated by early measurement of the fetal biparietal diameter. High maternal serum AFP, low maternal weight, and the number of cigarettes smoked per day were found to correlate with low birthweight, but not with gestational age. By testing the influence of the individual parameters on the subsequent birthweight, no significant correlation was found between the AFP levels and birthweight. Low birthweight was mainly a result of cigarette smoking and low maternal weight. Screening for AFP in the second trimester, therefore, seems to be of no value in predicting low birthweight when maternal weight is taken into consideration.

Adult↗
PubMed1985

Normal growth of the fetal biparietal diameter and the abdominal diameter in a longitudinal study. An evaluation of the two parameters in predicting fetal weight.

Normal growth curves of the fetal biparietal diameter (BPD) and abdominal diameter (AD) were measured by ultrasound in 41 normal pregnant women who had had regular menstruation with a known last menstrual period. The women were studied longitudinally from the 13th - 14th week of gestation and thereafter every 2-4 weeks until spontaneous onset of labor. The BPD curve proved to be uniform, with a deviation of 4.7 days (1 SD) before the 21st week. A 3rd-degree polynomial was found to be adequate to describe the results for BPD and AD. The value of longitudinal studies is emphasized by the fact that by using the same curve with individual plateaus rather than a common curve, as most often reported in the literature, it is possible to reduce the variance for BPD and AD by 54% and 40% respectively. There was a difference of up to 7 days for the mean BPD value prior to the 24th week of gestation between the present results and previously published normal curves collected in cross-sectional investigations. When calculating the mean fetal weight on the basis of measuring the BPD and AD, we found a linear correlation between the estimated fetal weight in the 3rd trimester and the duration of pregnancy (r = 0.99, p less than 0.001). The mean percentual difference in weight between the estimated and the actual weight was 1.2% +/- 10.5% (1 SD), which is acceptable for routine clinical use.

Abdomen↗