Showing papers in "Obstetrical & Gynecological Survey in 1988"

An Improved Method for Prenatal Diagnosis of Genetic Diseases by Analysis of Amplified DNA Sequences: Application to Hemophilia A

Abstract: We report the development of a rapid nonradioactive technique for the genetic prediction of human disease and its diagnostic application to hemophilia A. This method is based on enzymatic amplification of short segments of human genes associated with inherited disorders. A novel feature of the procedure is the use of a heat-stable DNA polymerase, which allows the repeated rounds of DNA synthesis to proceed at 63 degrees C. The high sequence specificity of the amplification reaction at this elevated temperature permits restriction-site polymorphisms, contained in the amplified samples, to be analyzed by visual inspection of their digestion products on polyacrylamide gels. By means of this method, we have performed carrier detection and prenatal diagnosis of hemophilia in two families with use of the factor VIII intragenic polymorphisms identified by the restriction enzymes BclI and XbaI. Predictions can be made directly from chorionic villi, without previous DNA extraction, and fetal sex can be determined by amplification of sequences specific for the Y chromosome. Specific amplification of genomic sequences with heat-stable DNA polymerase is applicable to the diagnosis of a wide variety of inherited disorders. These include diseases diagnosed by restriction-site variation, such as Duchenne's muscular dystrophy and sickle cell anemia, those due to a collection of known mutations, such as beta-thalassemia, and those due to gene deletion, such as alpha-thalassemia.

Hip Fracture and the Use of Estrogens in Postmenopausal Women: The Framingham Study

Abstract: To assess the effect of postmenopausal use of estrogens on the subsequent risk of hip fracture, we performed a retrospective cohort study of 2873 women in the Framingham Heart Study Information obtained at routine biennial examinations about the use of estrogens, body weight, age at menopause, smoking, and alcohol consumption was used to evaluate the risk of hip fracture among postmenopausal women who received estrogens Hip fractures occurred in 179 postmenopausal women, at a rate that increased exponentially after the age of 50 The risk of fracture was inversely related to weight at all ages The relative risk of hip fracture in subjects who had taken estrogens at any time was 065 after adjustment for age and weight (95 percent confidence interval, 044 to 098) The adjusted relative risk in women who had taken estrogens within the previous two years was further reduced, to 034 (95 percent confidence interval, 012 to 098) Taking estrogens within four years of menopause also protected against fracture The number of women in each age group who took estrogens was insufficient for a definitive evaluation of risk, but recent use of estrogens appeared to be protective in women under the age of 65 (no fractures among those who took estrogens) and those 65 to 74 We cannot exclude some degree of selection bias among the women who received estrogen-replacement therapy Nevertheless, this large cohort study supports the hypothesis that postmenopausal use of estrogens protects against subsequent hip fracture in women

Cardiovascular mortality and noncontraceptive use of estrogen in women: Results from the lipid research clinics program follow-up study

Abstract: A cohort of 2270 white women, aged 40-69 years at baseline, were followed for an average of 8.5 years in the Lipid Research Clinics Program Follow-up Study. There were 44 deaths due to cardiovascular disease among the 1677 nonusers of estrogens and six cardiovascular disease deaths among the 593 estrogen users. The age-adjusted relative risk (RR) of cardiovascular disease deaths in users compared with nonusers was 0.34 (95% confidence limits 0.12 to 0.81). After multivariable adjustment for potential confounding factors (age, blood pressure, and smoking), the estimated RR for estrogen use was 0.37 (95% confidence limits 0.16 to 0.88). Analyses were done to explore whether these results could be due to selection bias for estrogen use. However, the prevalence of cardiovascular disease at baseline was slightly higher in estrogen users (12%) than in nonusers (10%); furthermore, the exclusion of all women with prevalent cardiovascular disease at baseline did not alter the apparent protective effect of estrogen use on cardiovascular disease mortality (RR = 0.42, 95% confidence limits 0.13 to 1.10). Additional analyses examining the complex association between estrogen use, lipoprotein levels, and cardiovascular disease mortality suggest that the protective effect of estrogen is substantially mediated through increased high-density lipoprotein levels.

Release of multiple hormones by a direct action of lnterleukin-1 on pituitary cells

Abstract: Exposure to bacterial endotoxins has long been known to stimulate the release of anterior pituitary hormones; administration of endotoxin was at one time a common clinical test of anterior pituitary function. Endotoxin is a potent stimulus for production of the endogenous pyrogenic protein, interleukin-1 (IL-1), by macrophages and monocytes. The possibility that IL-1 has a direct effect on the secretion of hormones by rat pituitary cells in a monolayer culture was investigated. Recombinant human IL-1 beta stimulated the secretion of adrenocorticotropic hormone, luteinizing hormone, growth hormone, and thyroid-stimulating hormone. Increased hormone secretion into culture supernatants was found with IL-1 concentrations ranging from 10(-9) M to 10(-12) M. Prolactin secretion by the monolayers was inhibited by similar doses. These concentrations of IL-1 are within the range reported for IL-1 in serum, suggesting that IL-1 generated peripherally by mononuclear immune cells may act directly on anterior pituitary cells to modulate hormone secretion in vivo. Incubation of IL-1 solutions with antibody to IL-1 neutralized these actions. These pituitary effects of IL-1 suggest that this monokine may be an important regulator of the metabolic adaptations to infectious stressors.

Polycystic Ovaries A Common Finding in Normal Women

Abstract: The prevalence of polycystic ovaries (PCO) in normal women of reproductive age was determined by pelvic ultrasound scanning of 257 volunteers who considered themselves to be normal and who had not sought treatment for menstrual disturbances, infertility, or hirsutism. All women had completed a menstrual history questionnaire. 99 women were on oral contraceptives at the time of the study. Of the 158 subjects who were not on oral contraceptives 18% had irregular cycles. 116 (73%) women had normal ovaries and 36 (23%) had PCO. 5 women had multifollicular ovaries and 1 had small, unstimulated ovaries. Only 1 woman with normal ovaries had an irregular menstrual cycle. Of the women with PCO, 76% had irregular cycles, and 6 of the 8 with regular cycles were hirsute. Women with and those without PCO differed in distribution of serum LH concentrations although the median values were similar. 25% of women with PCO had LH concentrations which exceeded the upper limit of the normal range. Thus PCO are common in normal women. Some of these women may have clinical and biochemical markers of PCO, which suggest that PCO in women who consider themselves to be normal is part of the same clinical spectrum as the classic Stein-Leventhal syndrome.

The Marshall-Marchetti-Krantz procedure: a critical review.

Abstract: The success of the Marshall-Marchetti-Krantz procedure is reviewed in 56 articles that were predominantly retrospective analyses. The overall success rate was 86.1 per cent in 2712 cases, with 92.1 per cent in primary and 84.5 per cent in repeat procedures. An overall complication rate of 21.1 per cent was calculated. The frequency of osteitis pubis was 2.5 per cent. Lack of pre- or postoperative urodynamic evaluation in the selection of cases, loss of patients to follow-up in reported series, and the lack of long-term follow-up cases must be considered in appraising this retrospective review.

The growth discordant twin.

Abstract: The study of growth discordancy in twin gestation has gathered great momentum in recent years. Divergent intertwin growth is believed to be a direct result of the process of twinning and of the inability of the uterine environment to provide for the increased demand of multiple fetuses. The smaller twin faces increased risk of perinatal mortality and morbidity as well as reduced physical and mental development in later life. The advent of ultrasonography enabled a fairly accurate prediction of growth disparity. Although extensive investigative efforts have clarified many questions regarding divergent twin growth, the question how to manage such pregnancies remains to be answered. The present article is a review of the literature concerning the clinical aspects of growth discordant twins.

Induction and augmentation of labor: basis and methods for current practice.

Abstract: Medical control of labor is often necessary in modern obstetrics. The status of the cervix may dictate the method of induction and influence its success. Four milligrams of prostaglandin (PGE2) gel applied intravaginally has been shown to be a safe, efficacious, and extremely well-tolerated agent to promote cervical ripening. The patient should be monitored before and at least 4 hours after PGE2 gel application, since the incidence of uterine activity is high after this treatment and many of these pregnancies are at risk. The rare case of hyperstimulation may be treated with a tocolytic agent. The start of oxytocin may be individually tailored, but we do not recommend its use in less than 4 hours after gel insertion. Oxytocin should be used with great caution if the patient continues to have uterine activity from the PGE2 gel. Because, in part, the use of the PGE2 gel for cervical ripening is not approved by the Food and Drug Administration in the United States, it is prudent to discuss its use with the patient, document carefully, and use this medication only if there is clear indication. Protocols for the use of oxytocin currently used in many hospitals seem to be based on outdated pharmacologic data. Relatively new information on the pharmacology and clinical effects of oxytocin are reviewed to provide a rational approach to its clinical use in accordance with recently published guidelines from the American College of Obstetricians and Gynecologists (ACOG). The current data overwhelmingly indicate that oxytocin should be started at a low dose (0.5-1 mU/min) with a slow, arithmetical increase every 30 to 60 minutes. Previous reports of a high incidence of fetal distress, uterine dysfunction, and hyperstimulation in induced labor may be related to use of oxytocin at doses higher than currently appear appropriate. The risks of induction and augmentation can be reduced by careful patient selection and preparation. Oxytocin is safe and effective with expert medical management which provides careful monitoring, controlled infusion, persistence, and the knowledge of when to stop.

Leiomyomas in Pregnancy: Sonographic Study

Abstract: With ultrasound monitoring, analysis of the behavior of uterine leiomyomas (fibroids) and their impact on the course of pregnancy was undertaken in a group of 113 patients. Fibroid size changes were analyzed on the basis of trimesters. In the second trimester, smaller fibroids increased in size, whereas larger fibroids decreased in size. In the third trimester, a decrease in size was documented regardless of initial size. The most common patterns of echotexture were hypoechoic, heterogeneous, and echogenic rim. The development of a heterogeneous pattern or anechoic/cystic spaces on a follow-up study was accompanied in seven of ten patients by severe abdominal pain, compared with 12 cases of abdominal pain in 103 patients without such echotexture changes. Although the number of patients was small, the development of these patterns apparently indicates significant degeneration of the fibroid. Fibroids located in the lower uterine segment were accompanied by a higher frequency of cesarean section and retaine...

Ovarian Steroid Cell Tumors (Not Otherwise Specified): A Clinicopathological Analysis of 63 Cases

Abstract: :The clinical and pathological features of 63 steroid cell tumors, not otherwise specified, were reviewed. The patients ranged in age from 2'A to 80 years. The most common initial manifestation was virilization (41%); four patients had estrogenic manifestations, and four had hypercortisolemi

Placenta Creta and Placenta Praevia Creta

Abstract: The placental bed in placenta creta and placenta praevia creta was studied from pregnancy or immediate postpartum hysterectomy specimens. In all cases placental villi were seen in direct contact with myometrium, the sine qua non of placenta creta, but was focal in some cases. There was no apparent diminution of decidua parietalis or, in cases of focal accreta, of adjacent basalis. In all cases the extravillous trophoblast was mainly uninuclear or binuclear, in contrast to the placental bed syncytial giant cells seen in late normal placentation. There was an apparent proliferation of interstitial trophoblast at the junction of placenta with myometrium, but the density of interstitial trophoblast deeper in the myometrium was lower than it is in normal placentation. An unusual uteroplacental vasculature was seen in which physiological changes were present in large arteries of the radial/arcuate system deep in the myometrium, while there were also spiral arteries more superficially without physiological changes. These findings suggest that in placenta creta there is defective interaction between maternal tissues, particularly decidua, and migratory trophoblast in the early stages of placentation resulting in undue adherence of the placenta or penetration into the uterus coupled with the development of an abnormal uteroplacental circulation.

Prematurity and Work in Pregnancy

Abstract: The frequency of low birth weight (less than or equal to 2500 g) and of preterm birth (less than 37 weeks) was studied in 22,761 single live births in relation to maternal employment, taking account of 11 nonoccupational confounding factors. There was some increase of low statistical significance in both types of prematurity in service and manufacturing sectors of industry. A substantial excess of preterm births was seen in women employed in food and beverage service (O/E = 1.29, p = 0.03) and psychiatric nursing (O/E = 2.47, p less than 0.01) and of low birth weight in food and beverage service (O/E = 1.30, p = 0.02), in chambermaids and cleaners (O/E = 1.42, p = 0.03), and in those employed in the manufacture of metal and electrical and certain other goods (O/E = 1.57, p less than 0.01). Heavy lifting and long hours of work were consistently related to both outcomes, changing shift work less consistently. Noise was associated with low birth weight in the health and manufacturing sectors. The findings of this study are unlikely to have resulted from subject or observer bias but the role of unidentified factors related to selection for work are difficult to assess.

Perinatal Cocaine and Methamphetamine Exposure: Maternal and Neonatal Correlates

Abstract: Maternal and neonatal growth, behavior, and physiologic organization were evaluated in 104 mother-infant pairs with positive results of urine toxicology screens. ANOVA comparison of cocaine, methamphetamine, and cocaine plus methamphetamine groups revealed no significant differences in perinatal variables. The Finnegan withdrawal scoring scheme demonstrated that all three groups of infants had altered neonatal behavioral patterns, characterized by abnormal sleep patterns, poor feeding, tremors, and hypertonia. Infants exposed to cocaine or methamphetamine or both were combined and compared with both narcotic-exposed and drug-free mother-infant pairs matched for known maternal risk factors. All drug-exposed groups had significantly higher rates of prematurity and intrauterine growth retardation and smaller head circumferences than did the drug-free comparison group. A significantly higher rate of placental hemorrhage occurred in the cocaine plus methamphetamine group. Stepwise multiple regression analysis assessed the independent contribution of maternal factors; cocaine or methamphetamine was adversely, negatively assoclated with gestational age, birth weight, length, and occipitofrontal circumference. The increased rate of prematurity, intrauterine growth retardation, and perinatal complications associated with perinatal exposure to cocaine or methamphetamine was greater than that predicted by coexisting risk factors and was consistent with the pharmacologic properties of these drugs.

Risk Factors Accounting for Racial Differences in the Rate of Premature Birth

Abstract: In a hospital-based cohort of 8903 black and white women, we investigated medical and socioeconomic risk factors that may explain the known increase in premature births among black women. Among the medical conditions examined, only the maternal hematocrit level (or some related factor) explained a substantial proportion (60 percent) of the increased rate of premature births to black women. Four economic, demographic, and behavioral predictors of prematurity were also examined: age less than 20 years, single marital status, receiving welfare support, and not having graduated from high school. The number of these socioeconomic risk factors occurring in a woman was strongly predictive of premature birth of her infant, regardless of the particular risk factors present. The presence of any one factor was associated with a moderate increase in the risk of prematurity (7.0 percent as compared with 4.6 percent with no risk factors present); the presence of two or more characteristics was associated with ...

Intra- and Inter-Observer Variability in the Assessment of Intrapartum Cardiotocograms

Abstract: The diagnostic value of a test depends on the variability of the test results and the accuracy of the test. The object of this investigation was to estimate the observer variability and the accuracy, when intrapartum CTGs were assessed by experienced obstetricians. Fifty CTGs were evaluated twice by four obstetricians. They were asked to identify the CTGs belonging to the compromised infants. They were told the criteria for a compromised infant and the incidence (one- third). Eleven (22%) of the CTGs were assessed in the same way of all the obstetricians in both evaluations. Between the obstetricians, the accuracy ranged from 50 to 66%. We conclude that the considerable observer variability found in this and other investigations must severely impair the clinical value of electronic fetal monitoring (EFM). The variability must be reduced before the “true” predictive value and the cost/benefit of EFM can be estimated.

Intrauterine Growth Retardation: Prediction of Perinatal Distress by Doppler Ultrasound

Abstract: To investigate the ability of umbilical artery Doppler findings to identify true cases at risk of fetal distress among 51 pregnancies clinically judged to be compromised by intrauterine growth retardation (IUGR) Doppler data were related to pregnancy outcome, which was classified into three groups—group 1, healthy babies with normal placental function (16 fetuses), group 2, fetuses with definite signs of placental failure (30), and group 3, non-classifiable pregnancies (5). Group 2 was subdivided into 2A, placental failure with manifest perinatal distress (19), and 2B, placental failure without perinatal distress (11). All 19 compromised and distressed fetuses (group 2A) had extremely pathological Doppler findings, even several weeks before fetal distress became apparent by cardiotocography. The Doppler findings in the 11 small-for-dates fetuses without perinatal distress (group 2B) were inconsistently normal or slightly pathological. All 16 normal infants (group 1) had normal antenatal Doppler data. The Doppler technique thus allows accurate and early recognition of those fetuses who will become distressed perinatally. It also helps to identify which fetuses clinically suspected of IUGR have an adequate placental circulation.

Early Pregnancy Wastage: Relationship between Chorionic Vascularization and Embryonic Development

Abstract: The chorionic villous vascularization of 40 patients with first trimester spontaneous abortion was compared with that of 10 patients undergoing legal abortion (control group). The spontaneous abortion group was subdivided into a group with intrauterine embryonic death (n = 20) and a group with blighted ova (n = 20). Villous vascularization appeared unaffected after prolonged postmortem intrauterine retention. The incidence of vascularized villi was 89% in the control group, 26% in the group with embryonic death, and 9% in the group with blighted ova. In addition, the vascular density of vascularized villi was three to four times higher in the control group than in the two spontaneous abortion groups. The present study provides evidence that, in case of embryonic death and blighted ova, chorionic villous vascularization is deficient.

Stimulation of Ovarian Follicular Maturation with Pure Follicle-Stimulating Hormone in Women with Gonadotropin Deficiency

Abstract: According to the 2-cell theory, ovarian steroidogenesis requires the coordinate action of both FSH and LH. To evaluate the relative importance of these hormones in follicular maturation, a randomized cross-over study was performed in 10 women with complete gonadotropin deficiency (absence of pulsatile LH secretion and no LH response to LHRH). Five women were treated with highly purified FSH (LH bioactivity, 0.09%) and 3 months later with human menopausal gonadotropin (hMG; LH bioactivity, 65%), each given for 10 days at a daily dose of 225 IU FSH, im. The sequence was reversed in the other 5 women. hCG (5000 IU) was administered im 24 h after the last injection of FSH or hMG. Plasma estradiol (E2), estrone (E1), androstenedione (A), testosterone, LH, and FSH concentrations and urinary LH and FSH were measured daily by RIA. Ultrasonography was performed during each treatment and 2 days after each hCG injection. After FSH treatment, mean plasma and urinary FSH levels increased, mean plasma LH did not change, and urinary LH increased slightly but not significantly from 91 +/- 32 (SE) to 164 +/- 55 mIU/24 h (10(-3) IU/24 h). After hMG treatment, mean plasma and urinary LH and FSH levels increased accordingly. The mean basal plasma E2 [11 +/- 1 pg/mL (40 +/- 4 pmol/L)] and E1 [14 +/- 4 pg/mL (52 +/- 15 pmol/L)] levels increased after FSH treatment to 207 +/- 69 pg/mL (760 +/- 253 pmol/L) and 82 +/- 21 pg/mL (303 +/- 78 pmol/L), respectively (P less than 0.01), but plasma A did not change. In response to hMG, the mean plasma E2, E1, A, and testosterone levels increased more than during FSH treatment. Ultrasonography revealed multiple preovulatory follicles (greater than or equal to 16 mm) in 2 women after hMG and 1 woman after FSH treatment; therefore, hCG was not administered. In 3 women given FSH, hCG did not induce ovulation. hCG induced ovulation in 8 women given hMG and in 6 women given FSH, based on ultrasonography and plasma progesterone levels. Thus, in the presence of profound gonadotropin deficiency pharmacological doses of FSH, with minute LH contamination, are capable of stimulating ovarian follicular maturation, underlining the key role of FSH in folliculogenesis.

Prevention of preterm birth: new initiatives based on microbial-host interactions.

Abstract: Preterm delivery remains a preeminent problem in reproductive and pediatric care worldwide. Recent data suggest that cervicovaginal microflora and/or the inflammatory response they engender produce factors which can cause or predispose to preterm labor and rupture of membranes. Microorganisms mediating such processes may not be "recognized pathogens" and are often considered normal flora. These microorganisms may act singly, additively, or synergistically with host factors released during an induced inflammatory response. Quantitative, as well as qualitative aspects of cervicovaginal microflora may be important. Multiple cervicovaginal microorganisms produce IgA protease, neuraminidase, and mucinase which may facilitate passage of these and other agents past cervical barriers and into the lower uterine segment. Multiple microflora also produce phospholipases A2 and C, each of which can locally augment production of eicosanoids within the uterus which are important in cervical ripening and labor. Similar microflora produce various proteases, including collagenase, which can focally weaken the amniochorion and predispose to premature rupture of membranes and cervical ripening. Intrauterine microorganisms induce inflammatory reaction and may engender local release of similar proteases, phospholipases, as well as platelet-activating factor (PAF) and lymphokines which can also initiate or further potentiate labor-inducing mechanisms. Recognition of microbe-induced pathogenesis of some cases of preterm birth offers the hope of specific treatment and prophylaxis. In recent studies, administration of erythromycin and tocolytic agents was associated with an improved outcome in selected women with preterm labor. Further microbiological and clinical studies are ongoing. "Just why so many gravidas go into labor prematurely and hence give birth to infants who often are unable to cope with extrauterine conditions is one of the great unsolved problems of obstetrics."

The impact of obesity and chronic hyperinsulinemia on gonadotropin release and gonadal steroid secretion in the polycystic ovary syndrome

Abstract: We investigated whether obesity was a marker for a neuroendocrinologically distinct form of the polycystic ovary syndrome (PCO). Further, since women with PCO have significantly higher basal and/or glucose-stimulated plasma insulin levels, we also examined the effects of chronic hyperinsulinemia on gonadotropin and gonadal steroid secretion. Ten obese women (nine with acanthosis nigricans) and five nonobese women (one with acanthosis nigricans) with PCO as well as seven obese and six nonobese women of comparable age and weight in the midfollicular phase of their cycles were studied. Pulsatile gonadotropin release was determined for 6-24 h as well as gonadotroph sensitivity to GnRH (10 micrograms, iv). The obese PCO women had significantly increased basal and glucose-stimulated plasma insulin levels compared to the other groups, the nonobese PCO and the obese normal women had similar insulin levels, and the nonobese normal women had the lowest insulin levels. All four groups had similar plasma estradiol levels. Both the obese and the nonobese PCO women had similar and significantly higher mean plasma LH levels, LH pulse amplitude, and integrated LH responses to GnRH compared to values in both normal groups (P less than 0.01 to P less than 0.001); the obese PCO women did not differ from the nonobese PCO women. The mean LH pulse frequencies per 6 h were similar in the four groups. FSH secretion did not differ significantly in the four groups. The levels of the putative gonadal feedback steroids, plasma total and non-sex hormone-binding globulin-bound testosterone, non-sex hormone-binding globulin-bound estradiol, and estrone, were similar in both PCO groups and were significantly higher than those in both normal groups (all P less than 0.001). The only independent effect of obesity was on plasma androstenedione levels and the androstenedione to estrone ratio, both of which were significantly higher in PCO women than normal women (P less than 0.01 to P less than 0.001), but significantly lower in the obese (PCO and normal) women than in nonobese (PCO and normal) women (P less than 0.05). These findings suggest that 1) the impact, if any, of obesity in PCO is not reflected in discernible changes in gonadotropin release or in the gonadal steroid feedback environment; and 2) insulin does not have a major role in the perpetuation of PCO, since obese and nonobese PCO women had similar reproductive hormone levels despite significantly different degrees of hyperinsulinemia.

Hypercortisolism in patients with functional hypothalamic amenorrhea

Abstract: Hypercortisolism was found in patients with functional hypothalamic amenorrhea (HA) in preliminary short term studies conducted during the morning hours (0800-1100 h). This observation prompted us to characterize the circadian and pulsatile patterns of serum cortisol and LH levels at 15-min intervals for 24 h in 10 women with functional HA and in 7 normal women during the early follicular phase of their cycles. The mean integrated 24-h serum cortisol levels (area under the curve) were significantly (P less than 0.01) higher in the HA patients than in normal women. The mean cortisol levels in the HA patients were elevated (P less than 0.005) compared to those in the normal women during the daytime hours (0800-1600 h), but not during the evening (1600-2400 h) and sleeping hours (2400-0800 h). This selective hypercortisolism during the waking period of the day was almost entirely related to increased duration and amplitude of secretory episodes (peak area) rather than a change in pulse frequency. The serum cortisol increments in response to a noon meal that occurred in normal women were markedly impaired (P less than 0.01) in the HA patients. Compared with that in the normal women, mean LH pulse frequency was reduced by 30% in the HA patients. The 24-h mean LH levels and mean LH pulse amplitude were not significantly different from those in the normal women. However, among the HA patients there were marked individual differences in LH pulse frequency and amplitude, with prolonged interpulse quiescent periods, indicative of dysfunction of the hypothalamic GnRH pulse generator. We conclude that neuroendocrine activation of the ACTH-adrenal axis and inhibition of the GnRH pulse generator in women are associated with HA. Further, spontaneous resumption of normal cyclicity occurred in the majority (8 of 10) of the HA patients with no medical treatment, suggesting that this syndrome is a reversible hypothalamic disorder of a functional nature.

Inhibition of Uterine Contractions of Premature Labour with an Oxytocin Analogue: Results from a Pilot Study

Abstract: A competitive inhibitor of the action of oxytocin on the uterus, 1-deamino-2-D-Tyr-(OEt)-4-Thr-8-Orn-oxytocin, was studied for the first time in 13 patients with established, uncomplicated premature labour. Intravenous infusion of 10-100 micrograms/min of the analogue was given for 1-10 h and the effect was monitored by external cardiotocography. In all women an inhibition of uterine activity was observed, and in the majority of patients infused with 25 micrograms/min and a total dose of about 5 mg or more of the drug total inhibition of uterine contractions was achieved. There were no effects on the maternal and fetal pulse rates, nor were there any other side-effects. The results of this preliminary study support the concept of an increased concentration of uterine oxytocin receptors being aetiologically important in uncomplicated premature labour. They also suggest that the present oxytocin antagonist could be an interesting therapeutic alternative in the condition, primarily because of the marked selectivity of its effect.

Colposcopic manifestations of cervical and vaginal infections.

Abstract: We analyzed the associations of colposcopic features with cervical and vaginal pathogens and with clinical diagnoses in randomly selected women attending a clinic for sexually transmitted diseases. Logistic regression models were used to adjust for coinfections. Significant associations (P less than 0.01) were found for endocervical mucopus with C. trachomatis, N. gonorrhoeae, and herpes simplex virus (HSV); ulcers/necrotic areas with HSV; "strawberry cervix" with T. vaginalis; increased surface vascularity with HSV; hypertropic cervicitis with C. trachomatis; and immature metaplasia with C. trachomatis and cytomegalovirus. Koilocytosis on cervical cytology was significantly associated with an atypical transformation zone on colposcopy, as well as with satellite lesions. The presence of leukoplakia and ectocervical asperities were also associated with koilocytosis. Awareness of these associations is important for colposcopists to identify patients who need specific microbiologic studies. Although colposcopy is generally used to evaluate patients selected because of abnormal cytology, our study suggests that colposcopic examination could be a useful adjunct to cytology in screening for a variety of cervical and vaginal infections.

Effect of Gestational Age on Fetal and Intervillous Blood Gas and Acid-Base Values in Human Pregnancy

Abstract: Intervillous, umbilical venous and umbilical arterial blood samples were obtained by cordocentesis or fetoscopically from 200 pregnancies at 16–38 weeks gestation. The fetuses were either not affected

Life Expectancy in Down Syndrome

Abstract: This study is part of a collaborative effort between the Division of Vital Statistics, Ministry of Health, Province of British Columbia and the Department of Medical Genetics, University of British Columbia. Permission to use the provincial vital and health records was conditional on the strict observance of the oath of secrecy regarding the nonstatistical information contained in the records. To develop life expectancy data for Down syndrome, we studied 1341 patients with Down syndrome identified by the British Columbia Health Survellance Registry from more than one million consecutive live births from 1952–1981 inclusive. Our results indicate that life expectancy is much better than generally believed. For patients with Down syndrome with congenital heart anomalies, survival to age 1 year is 76.3%; to age 5, 61.8%; to age 10, 57.1%; to age 20, 53.1%; and to age 30, 49.9%. For patients with Down syndrome without congenital heart anomalies, survival to the same ages is 90.7%; 87.2%, 84.9%, 81.9%, and 79.2%, respectively. Survival for these patients without congenital heart defects is still significantly lower than that for a comparison group of mentally retarded persons without congenital heart defects.

Verrucous carcinoma of the female genital tract: a review.

Abstract: The 102 cases of verrucous carcinoma of the female genital tract reported in the world literature have been reviewed. The difficulties in diagnosis of this tumor are discussed; correct diagnosis is heavily dependent on close collaboration between clinician and pathologist, and the provision to the latter of a sufficiently large biopsy specimen. Effective management requires surgical resection, which may at times need to be radical. Radiotherapy and chemotherapy are of doubtful value.

Peripheral placental separation: a review.

Abstract: Marginal placental bleeding is a distinct entity, marked (usually) by minor degrees of vaginal bleeding and significantly associated with premature labor and premature rupture of the membranes. Pathologically it is characterized by an adherent marginal placental hematoma, which shows varying degrees of film deposition and leukocytic infiltration depending on the age of the clot. Marginal placental bleeding may occur only once or be repeated many times. It usually is not fatal to mother or fetus per se. The chief clinical significance of the marginal placental bleed is its tendency to be confused with placenta previa. The perinatal mortality associated with perpheral placental separation is largely that of prematurity.

Advanced extrauterine pregnancy: description of 38 cases with literature survey.

Abstract: An analysis is presented of 38 patients with advanced extrauterine pregnancy First three typical cases are described that emphasize the marked differentiation of clinical symptoms which these patients present to the doctor The first patient was referred for induction because of a suspected intrauterine death The second patient presented an intraligamentous pregnancy with a living fetus In the third case, the patient was admitted to hospital after 32 weeks of pregnancy because of a persistent oblique lie At 34 weeks, a normal living fetus was born In all three cases, ultrasound examination was able to visualize the separate uterus A literature survey is given with special attention to the specific "clinic" and the problems concerning diagnosis and treatment It is obvious that sonography is the most important diagnostic technique at present The decision to remove the placenta by means of a laparotomy is brought up for discussion

Rhabdomyosarcoma of the Uterine Cervix: Sarcoma Botryoides

Abstract: Twenty-one cases of sarcoma botryoides of the uterine cervix, including four previously unreported cases, are reviewed. The age of the patients ranged from 5 months to 48 years, with a peak incidence in the group aged 14 to 18 years. Eighty percent of the patients are alive, with a mean follow-up period of 68 months. Seventy-five percent of the patients had Group I disease, of whom 88% are alive. Eleven of 14 patients (79%) receiving vincristine and dactinomycin based chemotherapy are alive. There were five patients with recurrent disease (24%) of whom two (40%) are alive. The prognosis for cervical sarcoma botryoides is similar to that of other female genital tract embryonal rhabdomyosarcomas. Primary therapy should consist of vincristine and dactinomycin based chemotherapy. Surgery should be guided by the response to initial chemotherapy and should attempt to conserve the function of the bladder, rectum, vagina, and ovaries.

Splenosis: report of a case and review of the literature.

Abstract: Splenosis is the autotransplantation of splenic tissue that usually follows traumatic rupture of the spleen These splenic implants may be located anywhere within the peritoneal cavity Although a relatively rare entity, when present these implants may mimic endometriosis or even metastatic carcinoma As splenosis may compensate in part for the asplenic state, it is recommended that these splenic implants not be removed It is important to correctly diagnose this condition to avoid unnecessary therapy Diagnosis and management are discussed as well as a review of the literature