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Biomedical subjects

P Thomassen

Publications and source records attributed to P Thomassen.

At least 19 recordsLinked to original sources
PubMed1999

The changing panorama of late fetal death in Sweden between 1984 and 1991.

BACKGROUND: During the last decade there has been a significant reduction in early neonatal mortality. The rate of late fetal death, however, has not changed significantly despite improvements in antenatal care. This study evaluated the years 1984 and 1991 as to possible changes in well known risk factors for late fetal death. METHODS: We studied all single births during 1984 and 1991 recorded in the Swedish Medical Birth Register. In 1984, there were 94,270 births; of these, 381 were late fetal deaths. In 1991, there were 124,201 births and 464 late fetal deaths. The risk factors analyzed included maternal age, parity, smoking, birth weight, birth weight deviation, plurality, hypertension, diabetes, placental complications and previous late fetal death. Some of these variables were assessed in a cohort design and others in a case-control design. RESULTS: The small reduction in the late fetal death rate between 1984 and 1991 (4.0/1000 vs. 3.7/1000 births) may be explained by changes in maternal age and parity. However, it seems more likely that changes have occurred in the various risk factors, but the net result did not affect the late fetal death rate. Although the number of mothers who smoked decreased from 30% to 24%, this habit increased as a risk factor, especially when it was >=10 cig/day (odds ratio 1.24 vs. 1.97). Infants <2500g showed a significant decrease in the risk of late fetal death. No significant change in the latter risk was found among infants small for gestational age. CONCLUSIONS: Demographic changes may entirely explain the small decrease in late fetal death rate between 1984 and 1991. Despite all the improvements in the care of pregnant women between these years, the net gain, in terms of a decreasing number of late fetal deaths, is small, which most likely is due to shifts in the fetal death risks between the risk factors. Further significant decreases in the number of late fetal deaths may be difficult to obtain through improvements in the Maternal Health Care Service.

Adolescent↗
PubMed1998

Neonatal risk factors for retinopathy of prematurity--a population-based study.

PURPOSE: The aim of the study was to evaluate possible neonatal risk factors for retinopathy of prematurity (ROP) in a population-based group of preterm, very low birth weight, infants. METHOD: The main study group included 202 single-born infants with a birth weight of 1500 grams or less. A group of 57 twins were also described. Selected risk factors were extracted from the neonatal records. RESULTS: Univariate analysis revealed an association between ROP and respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), septicaemia, intraventricular bleeding, and the use of ventilator as well as continuous positive airway pressure. In a stepwise logistic regression analysis, however, only gestational age at birth, birth weight and BPD were significantly associated with ROP. CONCLUSION: Prematurity per se remains the strongest risk factor for ROP.

Birth Weight↗
PubMed1998

Breast-feeding, pain and infection.

A syndrome of deep pain in the breast during and immediately after lactation has been ascribed to an infection with Candida albicans. A series of 20 patients with deep pain, another 20 with superficial infection and 20 healthy women were compared with respect to the growth of bacteria and fungi. C. albicans was found twice as often in the milk of women with superficial lesions compared to those with deep pain. Bacteria were often found on the nipple and in the milk of those complaining of deep pain. Thus, if the deep pain syndrome is caused by microbes, this study points to a pathogenic role of bacteria rather than fungi.

Adult↗
PubMed1997

Ovarian vein thrombosis with symptoms prior to term--a case report.

A case with ovarian vein thrombosis before delivery is presented. C-reactive protein exceeded 200 mg/l, and the patient was treated for a suspected infection before the true diagnosis was revealed by CT. After aggressive anti-coagulant therapy, a follow-up CT showed complete remission.

Adult↗
PubMed1997

Obstetric outcome in 100 women with severe anxiety over childbirth.

BACKGROUND: Extreme fear of delivery with request of cesarean section is a problem. The obstetric outcome in women given psychological and obstetric support is described. METHODS: Women, consecutively referred to the Psychosomatic outpatient clinic because of fear of delivery (n = 100), were compared to a matched reference group (n = 100). RESULTS: The women in the study group had higher frequency of psychic problems than the references. The majority, 68 of the women (68%) initially requested cesarean section (CS). After individualized psychological and obstetrical support, 38 of these women agreed to vaginal delivery (38%) and 30 had an elective CS (30%). In the end another 13 (13%) women had a CS for obstetric or mixed reasons. Complication rate was low and similar in the groups. The 57 women who eventually had a vaginal delivery (57%) showed an obstetric outcome similar to the reference group. They had a higher frequency of induction of labor (p = 0.02). and of epidural and pudendal blocks for pain relief (p = 0.002 and 0.05 respectively). They had shorter labor time (p = 0.05). The cost of the psychological therapy was well compensated for by the savings due to the reduction in the number of CS. CONCLUSIONS: Psychosomatic support for women with severe fear of delivery resulted in a 50% reduction of CS for psychosocial indications and vaginal deliveries similar to a reference group. The cost of psychosomatic support was less than savings due to fewer cesarean sections.

Adult↗
PubMed1996

Maternal risk factors for retinopathy of prematurity--a population-based study.

BACKGROUND: The aim of the study was to investigate maternal risk factors for retinopathy of prematurity (ROP) and also to describe risk factors for prematurity per se in our population. DESIGN: A retrospective, population-based study. MATERIAL AND METHODS: The study group included the mothers (identified with the help of a National Birth Register) of 202 single-born preterm infants with a birth weight of 1500 grams or less, from a previous population-based study. From the same register we also received information on 307 mothers of full term pregnancies for description of risk factors for preterm birth. Data from antenatal clinics, labor rooms and neonatal units were studied. RESULTS: Univariate analysis of maternal risk factors for ROP revealed a few positive findings. In a further logistic multiple regression analysis, apart from gestational age at birth and birth weight, only essential hypertension prior to pregnancy was a predicting risk factor (odds/ ratio 8.36, 95% confidence interval 1.62-43.0). CONCLUSIONS: Prematurity per se remains the strongest risk factor for ROP.

Adult↗
PubMed1995

Sixty-six cases of intrauterine fetal death. A prospective study with an extensive test protocol.

BACKGROUND: A prospective study was performed to elucidate the etiology of intrauterine fetal death and to evaluate diagnostic procedures. METHODS: Sixty-six stillbirth cases with a gestational age of more than 25 complete weeks were studied, using an extensive test protocol. The validity of the cause of death was classified as certain, probable, possible and unexplained. The extent to which the diagnostic measures had been performed was classified: patients in whom none or only a few tests were performed, patients partially tested and patients completely tested. RESULTS: The cause of death was certain in 57%, probable in 20%, and possible in 11% of the cases. In only 12% of the cases did the cause of death remain entirely unexplained. The principal causes of IUFD were infections, including premature rupture of the membranes (15%), anomalies (11%), preeclampsia-associated conditions (9%) and intrauterine growth retardation of unknown etiology (8%). In this series, less well-known conditions, such as circulating maternal autoantibodies and feto-maternal transfusion, also appeared to play an important role in causing intra-uterine fetal death. CONCLUSIONS: An extensive and relevant test protocol provides information as to the cause of death in the majority of cases. Future protocols should include tests for autoimmune antibodies and feto-maternal transfusion.

Blood Coagulation Disorders↗
PubMed1994

[A 4-year retrospective study of neonatal outcome on preterm premature rupture of the membranes].

During a four year period, 60 patients with premature rupture of membranes (PROM) met the inclusion criteria of having a single living fetus with gestational age between 25 to 36 weeks and more than 24 hours between PROM and delivery were admitted in Karolinska Hospital, Sweden. These cases were reviewed retrospectively. Five neonates died postnatally and the total survival rate was 91.7%. Three of them had major malformations and one died of hyaline membrane disease with 29 weeks of gestational age. In only one case the immediate cause of death was due to infection. The present protocol of expectant treatment for PROM in this hospital tends to be a minimum of unnecessary intervention for obtaining a high survival rate.

Female↗
PubMed1992

Prenatal diagnosis of distal arthrogryposis type I by ultrasonography.

Two consecutive pregnancies in a woman with initially undiagnosed type I distal arthrogryposis (DA) are reported. A prenatal diagnosis of the condition was made by ultrasound in the 17th week of gestation in one of the pregnancies, whereas in the subsequent pregnancy the disorder was excluded as early as 13 weeks' gestation. The diagnoses were verified at birth. The feasibility of prenatal diagnosis of DA type I in the second trimester is thus confirmed and its possibility in the late first trimester is suggested.

Adult↗
PubMed1992

Allo-immunization during pregnancy. Clinical results from 1983 to 1989 in a Scandinavian university hospital.

From 1983 to 1989, 147,068 pregnancies were analyzed for allo-immunization against erythrocyte antigens. Approximately half of the cases were due to immunization against factor D and the others were due to allo-immunization against other antigens (K, c, E, etc.). In 61 cases exchange transfusion of the newborn was needed and in 115 cases diagnostic amniocentesis was done during pregnancy. Intrauterine transfusions were performed in 10 cases. Fetal and neonatal mortality was 4% in these moderate to severe cases, all due to immunization against D. Immunization against D was due to failure to give immunoglobulin anti-D in about 2/3 of the cases. Systematic prophylactic treatment with anti-D during pregnancy would probably not be cost-effective in this population.

Amniocentesis↗
PubMed1991

Six cases of massive feto-maternal bleeding causing intra-uterine fetal death.

Six patients in whom intra-uterine fetal death (IUFD) near term resulted from massive feto-maternal hemorrhage are reported. Two of the mothers were Rh-negative, which necessitated the administration of large volumes of anti-D. In order to detect such patients, the Kleihauer-Betke test should be performed in all cases of IUFD of unknown etiology.

Adult↗
PubMed1990

[Preventive antibiotics in emergency cesarean section. A prospective comparison of benzylpenicillin and ampicillin plus cloxacillin].

Emergency cesarean section, especially when performed more than ten hours after rupture of the membranes, involves a high risk of postoperative infection. Different antibiotic regimens have been shown to reduce these infections substantially. In this prospective study a combination of ampicilling (2 g) plus kloxacillin (2 g) given as a single-dose infusion directly after division of the cord reduced the post-operative infection rate to 13% in a group of high-risk emergency cesarean section cases. Benzylpenicillin only (2 g) was less efficient. No side-effects were observed, and this prophylaxis may have certain advantages over cephalosporins, especially with respect to enterococcus-induced endometritis.

Ampicillin↗
PubMed1990

Screening for brucellosis in pregnant women.

During a period of 6 months, 537 pregnant women from a rural area in Saudi Arabia were tested serologically for brucellosis. Of the 513 women who were tested routinely, 18 were found to have a positive titre (3.5%). Of 24 patients in whom the test was carried out because of symptoms suggestive of brucellosis, all were positive. Thirty of the 42 positive cases had titres exceeding 1:160. The incidence of abortion among pregnant women with Brucella titres less than 1:160 was 7.7% contrasting with 17.6% among those with titres above 1:160 (P less than 0.04). This observation calls for further study of the incidence of brucellosis in pregnant women in infected areas, and the connection between elevated Brucella titre and abortion.

Abortion, Spontaneous↗