Calcium metabolism in diabetic mother,fetus, and newborn infant

Peripheral blood levels of the minerals and hormones involved in calcium homeostasis were measured in insulin-dependent diabetic patients at delivery, and in umbilical arterial and venous blood. The minerals were also measured in neonatal blood at 24 hours of age. Insulin-dependent diabetic patients at delivery have depressed serum levels of parathyroid hormone, although serum total and ionized calcium levels are not different from those of nondiabetic patients. Fetuses of diabetic mothers are hypocalcemic and have reduced parathyroid hormone levels. Infants of diabetic mothers demonstrate early neonatal hypocalcemia. No differences between diabetic and control patients could be demonstrated in terms of calcitonin or phosphorus levels, in either mother, fetus, or neonate.     

High-molecular weight dextran in human infertility surgery

The use of intraperitoneal 32% high-molecular weight dextran 70 (Hyskon, Pharmacia Inc.) has been reported to reduce the incidence of surgical adhesions in several species. The present study was undertaken to determine the effect of 32% dextran 70 in human females who underwent major abdominal infertility operations. Adhesions were quantitated by means of standardized objective criteria in 44 women in a prospective, randomized, double-blind study, and reevaluated at second-look laparoscopy approximately 6 weeks later. The mean change in the adhesion score for all patients in the 32% dextran 70 group (n = 23) was -2.57 units (i.e., clinically "improved") versus +2.41 units (i.e., clinically "worsened") in the control group (n = 21), p = 0.016. For the subgroup of patients who underwent lysis of adhesions, the 32% dextran 70 group (n = 17) improved significantly, whereas the control group (n = 12) tended not to improve with careful technique alone (-4.2 units versus +0.3 unit, p less than 0.05). These data indicate that 32% dextran 70 not only significantly reduces the formation of adhesions overall in human infertility operations, but also is highly effective in reducing the reformation of adhesions after lysis.     

Detrusor instability syndrome: The use of bladder retraining drills with and without anticholinergics

Ninety-two (24.6%) of 374 patients referred to our gynecologic urology unit were found to have instability of the detrusor muscle with no recognizable associated pathologic conditions: idiopathic detrusor instability. Thirty-nine (42.4%) of these 92 patients demonstrated the instability only after detrusor activation maneuvers such as coughing, heel bouncing, or positional changes. The cure rate among patients with both “spontaneous” and “provoked” contractions of the detrusor muscle was comparable to the cure rate among those whose bladder contractions were apparent only after detrusor activation maneuvers (p > 0.9). The success rate of bladder retraining drills (BRD) as the sole mode of therapy was not significantly different from that observed with BRD combined with anticholinergics (p > 0.6).     

Fluid weight uroflowmetry in women

This study evaluates fluid weight uroflowmetry as a screening technique for urogynecologic conditions. Sixty women with no known pathologic condition volunteered for the evaluation of normal uroflowmetric parameters and curve patterns. Forty were menstruating cyclically, and 20 were postmenopausal. The parameters studied included: (1) total voided volume, (2) flow time, (3) peak flow rate, and (4) time to peak flow rate. In addition, uroflowmetric tracings were classified according to their patterns of configuration into: (1) normal, (2) multiple peak, and (3) interrupted. The parameters studied showed no difference in the two normal groups. A wide range of values was observed. Neither age, parity, weight, height, nor menstrual cycle phase affected the data. Values obtained from patients with idiopathic instability of the detrusor muscle, sensory urgency, and stress urinary incontinence did not show differences or trends. Seventeen percent of the tracings of the normal population group showed either multiple peak or interrupted patterns. Patients with sensory urgency (p < 0.001) had a higher incidence of multiple peak and interrupted flow rate patterns.     

Interactions of the trophoblast and maternal tissues in three closely related primate species

The confluence of maternal and fetal tissues to form the placenta causes a wide variety of alterations in cells of both origins. Three closely related primate species were studied for similarities and differences in the interrelationships formed during various stages of placental development in the areas of implantation, decidualization, and trophoblastic involvement in the spiral arteries. Although certain similarities exist among the three species a surprising number of distinct differences were found to shed doubt on the common practice of assuming species-to-species similarity, particularly among primates.     

Technique of surgical sex reassignment for micropenis and allied conditions.

Although the etiology of micropenis is diverse, individuals who have in common a penile length of 2 cm. or less at birth do not function well as men. For this reason, during the last 18 years, 10 individuals with this problem were selected for surgical sex reassignment. The technique of the surgical procedure is described. The immediate results are considered to be cosmetically satisfactory, and the long-term results, as judged by two individuals who have been observed for 18 plus years seem to indicate that surgical sex reassignment is a useful procedure in selected patients with this disorder.     

Ectopic pregnancy: current clinical trends.

During the 16 year period ending in November, 1978, 191 cases of ectopic pregnancy were managed at the University of Virginia Hospital. The overall incidence was 1/126 deliveries but during the last 3 years of the study the incidence was 1/60 deliveries. Only 56 patients have had a subsequent conception. Thirteen have had a recurrent ectopic implantation. Only 36 women (23.7% of those available for follow-up) have had subsequent term pregnancies. Ectopic pregnancy continues to be a major gynecologic problem and the potential for subsequent fertility is poor.     

Treatment of genital herpes simplex virus infection with photodynamic inactivation.

A double-blind randomized study to evaluate the effect of proflavine in the treatment of genital herpesvirus infection was conducted. One hundred fifty-seven women were studied, of whom 75 were treated with proflavine (treated women) and 82 were treated with placebo (control group). There were 62 women with primary disease and 95 with recurrent infection. Under the conditions by which this study was conducted, there was no apparent difference in the time of healing of lesions, development of recurrences, or virus isolation following treatment in the proflavine-treated and control groups.     

Perioperative cephalosporin prophylaxis in cesarean section: effect on endometritis in the high-risk patient.

A total of 120 patients who were to be delivered by cesarean section and who were at high risk of postoperative infection received three doses of either cefamandole, cephalothin or placebo perioperatively. Maternal serum levels for both antibiotics were in the therapeutic range. Although both drugs reduced the incidence of febrile morbidity and endometritis, only cefamandole significantly reduced the fever index. Risk factors for postoperative infections were the presence of ruptured membranes, labor, and internal fetal monitoring. Cefamandole beneficially influenced all risk factors while cephalothin was able to reduce only the risk of ruptured membranes. When a new method for obtaining endometrial tissue was utilized, 50% of cultures were negative. There was no difference in the organisms isolated from patients with and without endometritis.     

Water-borne contamination of intrauterine pressure transducers.

Internal intrapartum fetal monitoring has been implicated as a source of maternal and fetal sepsis. We report water-borne contamination of a component of the intrauterine pressure transducer and suggest that this may be a potential source of nosocomial infection.     

Risk factors for prematurity and premature rupture of membranes: A prospective study of the vaginal flora in pregnancy

Prematurity remains a major cause of perinatal mortality in the United States. Some research has indicated that infectious agents play a role in either initiating preterm labor, causing premature rupture of the membranes, or preventing tocolysis. This study attempted to determine if the presence of various vaginal pathogens in early pregnancy was associated with the subsequent development of premature rupture of membranes or preterm labor. We found that among 233 evaluable patients those with Trichomonas vaninalis were significantly more likely to have premature rupture of the membranes (p < 0.03), and those with Bacteroides sp. were more likely to be delivered of their infants before 37 weeks (p < 0.03) and to have infants weighing less than 2500 gm (p < 0.05). Those with Ureaplasma urealyticum more frequently began preterm labor (p < 0.05). Preterm premature rupture of the membranes was found significantly more often among patients with Bacteroides sp. Stepwise multiple logistic regression analysis indicated that those associations were not related to the number of previous abortions, deliveries, or preterm deliveries or to maternal age. We conclude that microbiologic screening in early pregnancy may aid in the assessment of patient risk for preterm delivery.     

Fetal heart rate monitoring in premature infants weighing 1,500 grams or less

Continuous monitoring tracings of fetal heart rate in 61 infants with birth weights of 1,500 grams or less were analyzed and related to newborn outcome. Reassuring heart rate patterns or good baseline variability correlated well with a normal unbilical artery pH. Fetal heart rate patterns and baseline variability were not related in a predictive way to central nervous system hemorrhage, respiratory distress syndrome, or neonatal death. Early intervention and operative delivery in cases demonstrating abnormal fetal heart rate patterns may have influenced the outcome in these infants. Fetal heart rate patterns can play an important role in the intrapartum assessment of the condition of the very-low-birth-weight infant and may be used to select those infants requiring prompt operative intervention and vigorous neonatal resuscitation.     

Effect of estradiol and progesterone on human chorionic gonadotropin secretion in vitro

Many of the substances known to control the secretion of pituitary gonadotropins also modulate the secretion of human chorionic gonadotropin (hCG) by the placenta. In order to study the effect of estrogens and progestins on hCG secretion, term placental explants were cultured in culture media for 144 hours. During the culture period, hCG secretion increased after 48 hours, and a fortyfold increase was observed after 144 hours (p less than 0.001). Compared to concentrations of hCG in control cultures, secretion of hCG was markedly suppressed in the presence of progesterone 2.25 X 10(-5)M (p less than 0.001), a concentration similar to that found in term placental tissue (1.7 +/- 0.2 micrograms/gm of tissue). Suppression of hCG by progesterone occurred in a dose-response manner (r = -0.9100, p less than 0.01). Estradiol, an important steroid modulator of pituitary gonadotropins, did not significantly suppress the secretion of hCG, except in pharmacologic concentrations (10(-4)M), and physiologic concentrations of estradiol had no effect on the suppression of hCG by progesterone. These results suggest that the mechanism by which progesterone suppresses the secretion of hCG differs from the manner in which steroids modulate the secretion of pituitary gonadotropins.     

Intra-amniotic bacterial colonization in premature labor

Bacterial culturing was performed on amniotic fluid obtained by transabdominal amniocentesis from 33 patients with singleton pregnancies who were in idiopathic premature labor with intact membranes prior to the thirty-fifth week of gestation. Bacteria were isolated in seven patients (21.2%). The patients who were at highest risk for intra-amniotic colonization were those who had two or more clinical parameters suspicious for intra-amniotic infection in a pregnancy prior to the thirtieth week. Anaerobic bacteria were isolated from all seven patients. Only one patient had mixed aerotolerance isolates. Anaerobic that were classified as significant pathogens were isolated in four patients. Three patients had isolates that grew on primary plates, and the rest were recovered only from broth. The greatest impact of intra-amniotic bacterial colonization in premature labor with intact membranes on perinatal outcome is expressed in extreme prematurity and appears to be a function of the pathogenicity and concentration of the offending organism(s).     

Accuracy of serum human chorionic gonadotropin concentrations and ultrasonic fetal measurements in determining gestational age

Prior to 60 days' gestation, the maternal serum concentration of human chorionic gonadotropin (hCG) can predict the estimated date of confinement, but later in pregnancy, hCG concentrations vary widely. The current study was performed to compare the accuracy of hCG measurements with other determinants of gestational age. Fifteen patients in whom gestational age was documented were monitored prospectively throughout pregnancy. One to two determinations of hCG (beta subunit) were obtained during the first 60 days. Then, ultrasonographic measurements of crown-rump length were obtained between 8 and 16 weeks' gestation and two measurements of biparietal diameter were performed between 18 and 32 weeks. These results were compared to actual dates of gestation. The mean (+/- SD) difference between gestational age predicted by single measurements of hCG and actual gestational age was 3.2 +/- 2.5 days (r = 0.94, p less than 0.0001), which compared favorably with estimates by crown-rump measurements (6.7 +/- 6.5 days) and measurements of biparietal diameter (6.3 +/- 5.3 days). These results demonstrate that hCG measurements during the first 60 days accurately predict gestational age and complement ultrasonic determinations of gestational age used later in pregnancy.     

Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors.

In a case-control study of matched pairs, the risk of acute pelvic inflammatory disease (PID) was 4.4 times higher in intrauterine contraceptive device (IUD) users than in nonusers (p less than 0.001). Of approximately 500,000 cases of acute PID occurring annually in the United States, an estimated 110,000 are attributable to IUD's, costing over forty-four million dollars per year. PID was attributable to the IUD in 77 per cent of IUD users. No particular type of IUD was implicated. The relative risk of acute PID in IUD users over nonusers was higher in nulligravid women than in previously pregnant women and was directly related to socioeconomic status (SES), but the total annual risk of PID in IUD users appear inversely related to SES. IUD use significantly increased the risk of nongonococcal PID. Fever occurred in 13 (21 per cent) of 61 IUD users and 59 (41 per cent) of 143 nonusers (p less than 0.025). Among women with nongonococcal PID, and adnexal mass greater than or equal to 6 cm. was noted in 14 (40 per cent) of 35 IUD users and in only 12 (15 per cent) of 78 nonusers (p less than 0.01). An increased risk of gonococcal PID was found among non-Caucasians and women not using contraception, while the risk of nongonococcal PID was increased among women with a past history of gonorrhea. Oral contraceptive use may protect women with gonorrhea from developing PID. Menstruation precipitates the onset of symptoms of gonococcal PID.