Stoyan. depends on sex. In endemic areas goiter is more common in females than in. early and later toxaemia of pregnancy),

Transcription

1 Department of Endocrinology (Prof. Dr. v. Pentchev) nstitut for Specialisation and Perfection of Physicians (SUL) Sofia, Bulgaria THE NFLUENCE OF ENDEMC GOTER ON THE COURSE OF PREGNANCY, LABOUR AND PUERPERUM Stoyan By. Dokumov ABSTRACT The influence of endemic goiter on the course of pregnancy, labour and birth is still unsettled, the informations in the literature being scanty and incomplete. nvestigation into the course of pregnancy, labour and the puerperium on 2101 pregnant women from 4 different areas with different incidence of endemic goiter shows conclusively that endemic goiter has an unfavourable influence on the course of pregnancy, birth and the puerperium. The following conclusions are drawn: Endemic goiter brings about a greater incidence of complications in pregnancy (imminent abortions, early and later toxaemia of pregnancy), an increase in the number of prolonged labours and a decrease in the number of shortened labours, a higher incidence of birth complications (retention of placenta, retention of placental parts, postpartum uterine atony, lacerations of the soft genital tissues) and an increase in the complications of the puerperium. There is a wellknown difference in the incidence of endemic goiter which depends on sex. n endemic areas goiter is more common in females than in males. The onset in females coincides frequently with those periods of the sexual development in woman, which are characterized by a certain physiological fluctuation and instability of the sexual function. This indicates the close correlation existing between endemic goiter and the function of the female sexual glands. But while the effect of the hypo or hyperfunction of the thyroid on sexual and general development as well as on pregnancy, birth and the puerperium is well established, the effect of endemic goiter still remains unsettled and obscure. Since this question has been so seemed of interest. little investigated, a study of this problem

2 multie. MATERAL AND METHOD The course of pregnancy, labour and the puerperium of 2101 pregnant women, addmitted for child birth in the hospitals of 4 small towns with a different incidence of endemic goiter has been investigated with regard to the data of the case histories. Since the incidence of endemic goiter among schoolchildren reflects the distribution of thq endemic goiter among the whole population this has been taken as an index of the incidence of endemic goiter. 56 /o goiter among schoolchildren 429 primie and 360 multie, 53 /o goiter among schoolchildren 138 primie and 183 multie, 11 /o goiter among schoolchildren 267 primie and multie and Baltshik 0 %> goiter among schoolchildren primie and The data concerning goiter in schoolchildren are according to Pentschev et al. (1958). Almost all births for the years 1956, 1957 and 1958 in these towns are included, since on account of the free medical service in this country, a qualified obstetric service is available to all. Of the 2101 pregnant women addmitted, only 15 were discharged before parturition ( 7 primi e and 3 multie and 5 multie). n the study of the course of labour births by operation have not been taken into account (Levskygrad 5 primi e and 1 multie, 3 primie and 5 multie, 5 primi e and 3 multie and Baltshik 2 primie and 5 multie). RESULTS Pregnancy in women from areas with a high incidence of endemic goiter has a more complicated course as compared to pregnancy in women from areas with a low or without any endemic goiter. The danger of abortion (uterine con tractions, uterine bleeding) is considerably higher (Table 1). Early toxaemia of pregnancy as well as late toxaemia are frequently observed among women from areas with high endemic goiter (Table 2). But a correlation between the rate of incidence of endemic goiter and the different forms of the toxaemia of pregnancy cannot be established. Table 1. mminent Abortions. Pregnant women mminent abortions 56 /o 53 /o 11 /o 0 /o

3 Table 2. Early and Late Toxaemia of Pregnancy. Pregnant women Early toxaemia Late toxaemia 11 % Table 3. Course of Normal Labour. Shortened labour Prolonged labour 1 1 " ' Essential differences in the course of labour are also observed depending on the rate of incidence of endemic goiter. A normal birth has a duration of 1518 hours for primie and 1012 hours for multie (according to the data given by Stamatov (1956)). While in areas with a high incidence of endemic goiter the number of prolonged labours is high, in areas with a low incidence short labour occurs commonly (Table 3). Significant distinctions are also evident among the complications of birth: anomalies of the placental period (retention of placenta, retention of placental parts), postpartum uterine atony, lacerations of the soft genital tissues (Table 4). While the puerperium is uneventful in areas with a low incidence or on endemic goiter it tends to become complicated in areas with a high incidence. The difference in puerperal morbidity expressed as a febrile condition with a temperature over 38 C for more than 3 days is also evident (Table 5).

4 Table 4. Complications of Birth. (total number) Retention of placenta or placental parts Postpartum uterine atony Lacerations of the soft genital tissues / % Table 5. Puerperium. Febrile puerperium 11% S S DSCUSSON This study on the course of pregnancy, labour and the puerperium in women from areas with a different incidence of endemic goiter discloses some charac teristics which coincide with the difference in the incidence of endemic goiter. n this respect our observations coincide with that of Baksheev (1960) on the greater incidence of abortions in areas with a high endemic goiter. But they differ from his findings concerning the absence of any other distinctions between areas with endemic goiter and areas with low or no endemic goiter with regard to early and late toxaemia of pregnancy as well as with the course of labour and the puerperium. Our observations show an unfavourable influence on pregnancy, labour and the puerperium.

5 CONCLUSONS 1. Endemie goiter exerts an unfavourable influence on the course of pregnancy: the complications of pregnancy (imminent abortions, early and late toxaemia of pregnancy) are more frequent in areas with a high incidence of endemic goiter than in areas with a low incidence. 2. Endemic goiter has an unfavourable influence on the course of labour: the number of the prolonged labours increases in areas with a high incidence of endemic goiter while in areas with low or no endemic goiter short labours are more frequent; the complications of birth (retention of placenta, retention of placental parts, postpartum uterine atony, lacerations of the soft genital tissues) are more frequent in goiter endemic areas. 3. Endemic goiter has also an unfavourable influence on puerperium: the puer peral period has a more complicated course in areas with a high endemic goiter than in areas with no endemic goiter. REFERENCES Baksheev N. S.: Endemic goiter and pregnancy. Probi, endocrin. i hormonotherapii, 5 (1960) 98. Pentshev., Varbanov V'., Papazov G., Dishliev D. Se Staikov T.: Endemic goiter in Bulgaria after the data from the medical examinations of schoolchildren. Savremena med., 8 (1958) 3. Stamatov D.: Obstetrics. Nauka i skustvo, Sofia (1956). Received on March 9th, 1961.