Danish study results suggest non-informed consent leading to delayed hormonal contraceptive insertion among women with high thyroid function
Gynaecologists are under pressure to admit more women to hospital early for treatment because of a rise in stillbirths, a new study has found.
A review of three years of data by Danish researchers suggested that women who have high levels of hormone signals known as TSH, or TSH-2, in their system when they are pregnant have a higher risk of stillbirths. In women who do not have high levels of these hormones, the risk of stillbirth falls significantly.
In another area of research, the Danish Society of Obstetrics and Gynaecology has estimated that a rise in the incidence of stillbirths could be attributed to new guidelines for treating pregnant women with non-invasive gynaecological ultrasound.
This involves a brief ultrasound where the gynaecologist knows the ideal rhythm for implants to release hormones. Currently, when patients have symptoms of the HRT (hormone replacement therapy) pill, this leads to delays in application of hormones to prevent another pregnancy occurring, until the daily hormone dose is escalated. But some gynaecologists in the new guidelines believe this practice risks them adding more pills to patients’ pill regimes to compensate for too little dosage being administered in the early stages of pregnancy.
The study, led by Professor Ole Bremke of the University of Copenhagen, concluded that many gynaecologists do not fully explain to their patients that their HRT dosage should not be increased until the first two to three weeks of a pregnancy, when they should also work on creating ideal hormone pathways for pregnancy protection against infection, miscarriage and stillbirth. The team reviewed the Norwegian National Birth Register (NGBR) from 2006 to 2014 for non-hormonal contraceptive insertion procedures involving ultrasound in pregnant women, regardless of levels of thyroid hormone signals.
According to the study, there was a significant rise from one per cent in 2006 to 2.2% in 2013, in the rate of high levels of HRT signals. There were nearly 130,000 procedures from 2006 to 2013, with nearly one in 20 having some form of TSH-2 levels, and almost a one in 12 stillbirths after the first term. In menopausal women, less than 1% of uterine ultrasounds have HRT signals, but women with a high amount of TSH-2 levels had a 2.3% stillbirth rate, compared with just 1.7% in the low-sensitivity group.
Prof Bremke: “Our evidence suggests that women with high levels of hormone signals before pregnancy and during pregnancy carry a higher risk of stillbirth, and that gynaecologists with ultrasound experience, commonly referred to as ob-gyns, face a special need for ongoing training for appropriate patient preparation for insertion of a hormonal contraceptive, allowing them to inform their patients about the ongoing need for carefully planned distribution of hormonal HRT at the time of pregnancy.”