Biomedical subjects
R T Geirsson
Publications and source records attributed to R T Geirsson.
Audit of a screening service for fetal abnormalities using early ultrasound scanning and maternal serum alpha-fetoprotein estimation combined with selective detailed scanning.
The objective of the study was the evaluation of a screening service for fetal abnormality using early ultrasound scanning to date and establish viability of the pregnancy combined with maternal serum alpha-fetoprotein estimation at 16 weeks and thereafter selective detailed scanning at 18-20 weeks based on clinical indication. The study was designed to be retrospective, emphasizing the possibility of diagnosis. Early scans were performed by radiographers and radiologists, detailed ones by radiologists and obstetricians with subspecialty training in prenatal diagnosis. The study was carried out in the ultrasound department of a large University Hospital. The subjects studied were all cases of abnormality identified pre- or postnatally in women delivering in the hospital over 4 years and to whom the screening service applied. Information was obtained from ultrasound and maternity records, birth notifications, pathology and autopsy reports and a special needs register. Cases were classified as not detectable, potentially detectable and usually detectable. Major fetal anomalies numbered 255 (total deliveries 19,497), a prevalence of 1.3%; 130 (51%) were diagnosed by ultrasound with 64% before 24 weeks and 36% later. Eleven chromosomal anomalies (4%) were diagnosed by genetic methods and 114 (45%) anomalies were not diagnosed antenatally. The sensitivity of the program was 37% before 24 weeks. Chromosomal anomalies, lesions of the central nervous system and cardiac defects were most common, followed by lesions of the gastrointestinal and urinary tracts. A large proportion of the detected and detectable anomalies were lethal.(ABSTRACT TRUNCATED AT 250 WORDS)
Death rates from ischemic heart disease in women with a history of hypertension in pregnancy.
BACKGROUND: Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population-based study with a long follow-up time the potential association between hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated. METHODS: All 7543 case records at the main maternity hospital in Iceland during 1931-1947 were reviewed to identify women with hypertension in pregnancy, subdivided by parity and severity of disease into those with eclampsia, preeclampsia and hypertension alone. Information on those who had died was obtained from death certificates, supplemented by autopsy reports and hospital records. Death rates from IHD were compared to population data from public health and census reports during corresponding periods and between study groups. RESULTS: Of 374 hypertensive women 177 had died. The death rate was slightly higher among women with any hypertension in pregnancy than in the reference population (RR = 1.20; 95% CI 1.01-1.42). About half of the increase was attributed to excess mortality from IHD with a relative risk of dying of 1.47 (95% CI 1.05-2.02). The relative risk of dying from IHD was significantly higher among eclamptic women (RR = 2.61; 95% CI 1.11-6.12) and those with preeclampsia (RR = 1.90; 95% CI 1.02-3.52) than those with hypertension alone. Parous women at the index pregnancy had a twofold higher risk of dying from IHD than primigravid women (RR = 2.05; 95% CI 1.19-3.55; p = 0.01). CONCLUSION: There is an indication of increased death rates among women with a history of hypertension in pregnancy, where ischemic heart disease may be more common than in the general population.
Is genetic susceptibility for pre-eclampsia and eclampsia associated with implantation failure and fetal demise?
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Prenatal thoracocentesis may be lifesaving in congenital chylothorax.
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Renin gene restriction fragment length polymorphisms do not show linkage with preeclampsia and eclampsia.
OBJECTIVE: To investigate linkage between the renin gene restriction fragment length polymorphisms in families with a history of preeclampsia/eclampsia. METHODS: Nine Icelandic families with at least three affected females in two or three generations were investigated. DNA from lymphocytes was digested with the endonuclease restriction enzyme Bgl I and restriction fragments were transferred by Southern Blotting. Hybridisation was effected with the 32P-oligonucleotide-labeled diallelic genomic probe pHRnX 0.8. LOD scores were calculated by the Liped program for two forms of inheritance patterns. Affected sib pairs were analysed. RESULTS: Frequencies of the 9.0 kb and 5.0 kb alleles were 0.67 and 0.33, with no significant differences between affected females and spouses and combined LOD scores of -2 for recombination values of 3%. Allele sharing in affected sibs was not different from the expected random assortment. CONCLUSION: The linkage analysis provides evidence to exclude alteration of the renin gene in pregnancy as being directly responsible for the manifestations of preeclampsia or eclampsia in these families.
Falling population incidence of eclampsia. A case-control study of short term outcome.
BACKGROUND: Eclampsia remains a serious complication of pregnancy and childbirth and factors related to morbidity require continued evaluation. DESIGN: Retrospective case-control study on the incidence and outcome of eclampsia. SETTING: A defined total island population over 20 years. METHODS: All centrally collected birth registration returns in Iceland for the years 1972-1991 were reviewed to identify women with the diagnosis of eclampsia, selecting women delivering immediately before and after the eclamptic case as controls. Information from all places where women had delivered was obtained to ensure that no case was missed. Maternity records were reviewed to verify the diagnosis and obtain maternal and neonatal data. RESULTS: Forty women had eclampsia (0.046% of deliveries). The incidence diminished between the decades 1972-81 and 1982-91 (p < 0.05), as did the incidence of eclamptic convulsions before delivery. Eclamptic women were more often primiparous, younger and delivered earlier than controls. Preterm delivery and a low ponderal index were more common among offspring of the eclamptic mothers and the male/female ratio was lower. CONCLUSION: The incidence of eclampsia in the population is falling. Common features related to the condition were confirmed. Severe maternal illness is rare, but the babies often appear growth-retarded and are delivered preterm.
Breast carcinoma metastatic to uterine leiomyoma.
A case report of a woman with a history of breast carcinoma who presented with metastatic infiltration of uterine leiomyoma is described. The previously published literature on the subject is reviewed.
Angiotensinogen: a candidate gene involved in preeclampsia?
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A low male/female sex ratio in offspring of women with a family history of pre-eclampsia and eclampsia.
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Comparison of actual and ultrasound estimated second trimester gestational length in in-vitro fertilized pregnancies.
OBJECTIVE: To compare actual and calculated gestational age in pregnancies conceived by in-vitro fertilisation. METHODS: In 36 healthy women conceiving by in-vitro fertilisation an equation described for use in a Nordic population was used for calculating gestational age from the biparietal diameter and femur length at a routine 18-19 week scan. This was compared to actual gestational length estimated from the day between oocyte retrieval and embryo transfer. RESULTS: The mean difference amounted to -0.86 days with a standard deviation of 2.86 days, a range of -5 to +6 days and a 95% confidence interval -0.11 to 1.83 (t = 1.806, df = 35, p = 0.8). Correlation between the two methods was highly significant. CONCLUSION: The equation used allows prediction of term with sufficient accuracy for general use in our population.
Relation of antiphospholipid antibody and placental bed inflammatory vascular changes to the outcome of pregnancy in successive pregnancies of 2 women with systemic lupus erythematosus.
Histological changes in biopsies from the placental and placental bed in 2 successive pregnancies of 2 women with systemic lupus erythematosus and antiphospholipid antibodies were studied. In one of the first 2 pregnancies vasculitis was found in the spiral arteries of the placental bed biopsy, while the other showed perivascular inflammatory infiltration and deciduitis. This was associated with poor pregnancy outcome and elevated antiphospholipid antibodies (aPL). In the subsequent 2 pregnancies prednisolone treatment was tailored to suppress the aPL titer with markedly decreased inflammatory changes and no evidence of vasculitis in the spiral arteries of the placental bed was found. This was associated with a normal pregnancy outcome. A causal relationship between aPL and inflammatory vascular changes in the placental bed as well as a beneficial effect of the corticosteroid treatment in those two women in suggested.
Ultrasound instead of last menstrual period as the basis of gestational age assignment.
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Certain dates may not provide a reliable estimate of gestational age.
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Re.: Nielsen GL, Nielsen PH. Results of oral glucose tolerance test performed following birth of a baby with birthweight above 4500 gr.
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Genetic and familial predisposition to eclampsia and pre-eclampsia in a defined population.
Familial predisposition and patterns of genetic inheritance of eclampsia and pre-eclampsia were investigated through three or four generations in 94 families from the homogenous island population of Iceland. The families descended from index women delivered in the years 1931-47 and who had either eclampsia (n = 38) or severe pre-eclampsia (n = 69). Inheritance was followed both through sons and daughters. The prevalence of pre-eclampsia and eclampsia in daughters was significantly higher (23%) than that in daughters-in-law (10%). No difference was noted in the prevalence of these diseases by whether the daughter was born of an eclamptic or pre-eclamptic mother or whether she was a first or later born daughter. There was a non-significantly higher occurrence of pre-eclampsia among grand-daughters than in grand-daughters-in-law. No difference was seen by whether grand-daughters descended through sons or daughters. With increasing numbers of affected daughters or grand-daughters the probability rose of finding more affected women in a family. Hypotheses of single recessive and dominant gene inheritance were compared and maximum likelihood estimates for gene frequency obtained. For a single recessive gene model this was 0.31 reflecting a population prevalence of 9.6%, whereas a dominant model with incomplete penetrance gave 0.14 at 48% gene penetrance, corresponding to a population prevalence of 0.9% homozygous expression of severe disease and 11% heterozygous expression of milder disease. Either genetic model could fit the data.
Prostaglandins: a key factor in human labor.
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Lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis in women requesting induced abortion and in their sexual partners.
The prevalence and patterns of gonococcal and chlamydial infection were investigated in a prospective microbiological study on 3,395 women requesting abortion and the sexual partners of culture positive women (organism identified). Neisseria gonorrhoeae was found in only 1.8% of 3,395 women during the whole study period of 7 years, but Chlamydia trachomatis in 13.5% of 1,635 women in the last 3 years. Women with positive cultures were significantly younger (p less than 0.001), and more frequently single (p less than 0.001) than those with negative cultures. Single women had more partners (mean 1.5) than those in an established relationship (mean 1.1). Almost all women with gonorrhea were single. Of the males, 62.7% were examined, of whom 47.3% had positive cultures. Twenty per cent of culture positive males had gonorrhea. A high prevalence of positive cultures in the males was only found where chlamydial cultures had been positive in the female. All women and men with positive culture results received antibiotic treatment before or after the abortion procedure. The incidence of laparoscopically verified post-abortion salpingitis was low, at 0.57%, while a clinical diagnosis of endometritis was made in 3.3%. Routine pre-operative microbial screening for Chlamydiae trachomatis should be considered for all women requesting abortion. Tracing and screening for chlamydial and gonorrheal infection of sexual partners of culture-positive women is necessary as a preventive measure.