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The objective of this study was to evaluate the use of transvaginal ultrasonography compared with a routine gynecological examination to check the location of an intrauterine contraceptive device (IUCD). Fifty-two women attending the antenatal cure unit at Lundby hospital for contraceptive guidance were included in the study. All women had an IUCD inserted at this visit and were examined bimanually and by speculum. The same examination was repeated and a transvaginal ultrasound scan was carried out at 1 week and then 3 months later. In 51 women, the threads of the device could be identified at the time of the gynecological examination and the IUCD was considered to be correctly positioned. In one woman, the threads could not be seen, but transvaginal ultrasonography confirmed that the position of the device was at the fundus of the uterus. Forty-eight women were judged by ultrasound examination to have the device optimally placed in the uterine cavity. In four women, although the IUCD was apparently correctly located according to the gynecological examination, the device was shown by ultrasonography to be misplaced.We suggest that transvaginal ultrasonography should replace the conventional gynecological examination as the best method of checking the location of an IUCD.

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Coagulation, fibrinolytic, kallikrein, and complement systems were studied in 20 patients with multiple trauma. Three of four patients with a trauma score less than 10 on hospital arrival died, compared to one of 16 with a score over 10. Five patients developed disseminated intravascular coagulation. Signs of activated cascade systems were evident in most patients on hospital arrival. Changes were not related to trauma score, but patients with an arterial pressure below 110 mm Hg had significantly lower levels of antithrombin III and alpha 2-antiplasmin than those with higher BP. This study confirms that the cascade systems are activated very soon after multiple trauma.

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The study evaluates the effect of conventional obstetric analgesia on 544 parturients and their newborn infants. The parturients' pain situation was evaluated with respect to both the effect of pain relief given, and the total pain experience in the first and second stage. This gave a more correct view of the parturients' pain situation and effectiveness of the analgesic procedures that if one or the other estimation was used separately. Nearly 20% of all parturients experienced good effect on low-back or suprapubic pain in the first stage. Severe to almost unbearable pain was experienced by about 60% of all parturients in the first stage as well as in the second stage. The duration of labor showed a strong positive correlation (p less than 0.0001) to the pain intensity in the first stage and a strong negative correlation (p less than 0.0001) to the degree of cervical dilation at admission. No adverse effects on the newborn infants were seen, apart from the well-known association between the drug--delivery interval and the slightly depressant effects of pethidine.

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In this prospective randomized study of pain relief in labor, the effect of transcutaneous electrical nerve stimulation (TNS) performed over both the low-back and suprapubic region was evaluated and compared with a control group not receiving TNS. Both high frequency and pulse train TNS were used. The study included 24 induced labors. In the TNS group, conventional methods were added when needed, while in the control group only conventional methods were used. Assessment of low-back and suprapubic pain was performed by the parturient each hour during the first stage. In the TNS group most of the parturients reported minimal or moderate low-back pain throughout labor, while parturients in the control group reported an increased intensity of low-back pain as labor progressed. The effect of suprapubic pain was insignificant in both groups. Neither TNS nor nitrous oxide-oxygen mixture and pethidine could reduce this pain component. Course of labor, uterine activity and fetal heart patterns were similar in the two groups. The neonates were evaluated with Apgar score, assays of blood samples from the umbilical vein including blood lactate, plasma hypoxanthine and blood gas, and neurobehavioral assessment on two occasions. All newborn infants were in good condition and no significant differences between the two groups could be demonstrated.

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A current density standard for current shapes used in transcutaneous electrical nerve stimulation (TNS) must be established in order to avoid harmful effects. This is especially important when stimulating near vital structures such as the fetal heart. In the absence of an applicable standard, a preliminary safety norm is proposed, based on clinical experience during delivery and experimental measurements in the female bladder. Current densities due to TNS not exceeding 0.5 microamperemeter/mm2 are safe for the fetal heart. A stimulator and electrodes fulfilling the safety criteria proposed in this study have been tested. A filter which suppresses the electrical disturbances occurring during TNS, thereby permitting recording of the fetal heart rate during birth, has also been tested. TNS was given over both the low-back and suprapubic region. Results of clinical tests of the equipment during 15 supervised births are reported. No adverse effect in the mother or newborn infant were observed.

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The study evaluated transcutaneous electrical nerve stimulation (TNS) for pain relief in labor, used in parallel with conventional methods. The investigation comprised 566 vaginally delivered women, 283 of whom were given TNS. Pain relief was evaluated with a questionnaire which the women answered shortly after delivery. With a statistical multivariate technique, it was concluded that TNS has a specific effect on pain localized to the back. Few women in either the TNS or the control group reported good relief of pain localized to the suprapubic region. Nitrous oxide-oxygen mixture was used less often in the TNS group than in the controls. Duration of labor and maternal blood loss were comparable in the two groups. The babies borne by primiparae in the TNS group tended to have better Apgar scores. Fewer babies of primiparae in the TNS group required observation for two days or more on the neonatal ward than was the case with the controls. However, the electrical stimulation could not be used optimally as it interfered with monitoring the fetal heart rate in half the cases. It is concluded that although TNS has a good effect on low-back pain and seems to have no negative effects on the mother or child, it is only a complement to conventional methods.

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The analgesic effect of transcutaneous electrical nerve stimulation (TNS) during delivery has been evaluated. The usual technique of TNS was modified to suit the specific needs of pain control during the whole course of delivery. Two pairs of electrodes were taped to the patient's back, one pair level with the spinal processes Th 10-L1 and the other with S2-S4, corresponding to the influx of pain during the first and second stages respectively. Stimulation was delivered as biphasic pulses at 60-80 Hz. A low-intensity stimulation was given continuously, and a high-intensity stimulation was initiated by the patient herself whenever pain increased. As a rule, stimulation via the thoracic electrodes was given throughout delivery and sacral stimulation added from the later part of the first stage. No complications with respect to mother or child have occured. Three hundred and forty-seven women have been treated, 47% of them considered the analgesia with TNS to be good or very good, 42% experienced a certain effect whil 11% considered that TNS made no difference. In view of the relatively good results and the absence of complications, the authors recommend the method as a primary pain relieving measure to which conventional methods can be added if necessary.

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