Blastomyces infestation of vagina, oral cavity, and rectum of young women, with particular reference to promiscuity (author's transl)]

Venereological patients (Group I, n = 210), intact women without any gynaecological disease (Group II, n = 125), pregnant women close to full term (Group III, n = 200), and women with vaginal fluor (Group IV, n = 380) were examined and compared for the occurrence of blastomyces, particularly Candida albicans (C. albicans), in the vagina, oral cavity, and rectum. The presence of C. albicans in vaginal secretion was established from 15.7 per cent of all probands in Group I, 12.0 per cent in Group II, 24.0 per cent in Group III, and 31.6 per cent in Group IV. The difference between Groups I and II was not significant. Promiscuity, consequently, did not seem to have major impact upon vaginal blastomyces infestation of young women. Probands with rectal infestation of C. albicans accounted for figures between 20.0 and 27.5 per cent in all four groups. Group I took first position in oral infestation of C. albicans, the figure being 64.8 per cent which was significantly above those recorded from all other groups, between 33.9 and 37.5 per cent. The correlations between rectal and vaginal occurrence of C. albicans are discussed.     

Correlation between second trimester maternal serum inhibin-A and human chorionic gonadotrophin for the prediction of pre-eclampsia

We aimed to investigate the relationship between inhibin-A and human chorionic gonadotrophin (hCG) concentrations in the second trimester in the same cohort of women and compare their screening efficiency for the subsequent development of pre-eclampsia. The main outcome measures were pre-eclampsia and pre-eclampsia requiring delivery before 37 weeks.We carried out a retrospective examination of inhibin-A and free beta-hCG levels taken between 15 and 19 weeks of gestation, from 685 women. The values were corrected for weight and gestation and presented as multiples of the median (MoM). Receiver operator characteristic (ROC) curves for the prediction of pre-eclampsia and pre-eclampsia requiring delivery before 37 weeks were created for both analytes alone and in combination. Based on this data the sensitivities for the prediction of pre-eclampsia using inhibin-A and hCG, alone and in combination were examined for a specificity of 90 per cent.Thirty-five (5.5 per cent) women developed pre-eclampsia, of whom 15 (2.7 per cent) required delivery before term as a result of pre-eclampsia. There was no correlation between inhibin-A and hCG for the whole population (r=0.08) but there was a significant correlation for women who subsequently developed pre-eclampsia (r=0.648) or preterm pre-eclampsia (r=0.84). For a specificity of 90 per cent the sensitivity using inhibin-A was significantly better than for hCG (48.6 per cent versus 31.4 per cent, P< 0.05). The results were similar for preterm pre-eclampsia (P< 0.05). The addition of hCG data to inhibin-A data did not improve the sensitivity for pre-eclampsia compared to inhibin-A alone (42.9 per cent versus 48.6 per cent, P< 0.20).Inhibin-A is a more sensitive marker for the subsequent development of pre-eclampsia than hCG. Addition of hCG data to inhibin-A did not improve the screening efficacy for pre-eclampsia suggesting that inhibin-A and hCG are markers of the same underlying pathological process.     

The natural history of macroscopic cysts in the breast.

Macroscopic cysts of the breast, defined as clinically apparent lesions, are common causes of masses in the breast. In a 14 year study of 4,207 patients, cysts in the breast were diagnosed by percutaneous aspiration in 286 women who had cysts on 561 occasions. These cysts accounted for the presenting problem in 4 per cent of 15,600 visits to the clinic. Patients with cysts were observed for a mean period of 70 months. The patient was aware of a mass 83 per cent of the time, but cysts were discovered in asymptomatic patients in 17 per cent. The majority of cysts (76 per cent) were in premenopausal women (mean age of 48 years), with peak occurrence between age 40 and 50 years. Only 5 per cent were in women who were more than 60 years of age, none of whom had concurrent or subsequent carcinoma. Cysts did not recur in 60 per cent of the patients. There were two to five recurrences in 36 per cent and more than five recurrences in 4 per cent. Patients with more than five recurrences were five years younger than the over-all group when the first cyst appeared and the events developed over a period of time ranging from 51 to 161 months (mean of 96 months) and appeared at intervals averaging 17 months. Only three patients who were postmenopausal had more than one cyst. Carcinoma occurred in three patients (1 per cent) diagnosed between three and five years after the first cyst was discovered. Macrocystic disease seems to be a condition of women who were perimenopausal. An association between these cysts and carcinoma has not been proved.     

Contraception prior to counselling for termination of pregnancy.

OBJECTIVE: This study investigates the methods of contraception used by women attending for pregnancy counselling at the time of an unintended pregnancy. METHOD: Women attending three pregnancy counselling clinics in Birmingham were asked to fill in a questionnaire which was designed to obtain demographic data and history of women's methods of contraception, prior to attending for termination of pregnancy. RESULTS: The contraceptive methods used most widely by women presenting for termination of pregnancy were the condom (n = 188; 43%) and the oral contraceptive pill (n = 96; 22%). A proportion of women did not use any contraception (n = 117; 27%). Women who had undergone a previous termination of pregnancy (32%) [corrected] had similar contraceptive patterns to those with no history of termination of pregnancy. Women aged 19 and under were less likely to be using contraception (non-users 30/90; 33%) compared with women aged 20 and over (non-users 82/324; 25%), but this difference was not statistically significant. Forty per cent (n = 31) of Afro-Caribbeans did not use any contraception; this was statistically significant when compared with the percentage of Caucasians not using contraception. Only 30% of those eligible had actually presented for post-coital emergency contraception. However, the uptake of emergency contraception was similar in the different age groups. CONCLUSION: Effective contraception is important in the prevention of unwanted pregnancies and, although it will not prevent all conceptions, it will contribute significantly to a reduction in unintended pregnancies. This study indicates that there is a need to consider and be sensitive to the different cultural needs of ethnic groups in the development and presentation of future contraceptives.     

Circulating immune complexes in sera of patients with gynecologic disorders

Sera from 211 women seen in the Department of Obstetrics and Gynecology at the New York Hospital were assayed for CIC by the Raji cell enzyme linked immunosorbent assay. Only 9 per cent of healthy women (two of 21), 6 per cent of pregnant women (two of 34), 2 per cent of women with benign tumors (one of 39) and 5 per cent of women with vaginal and cervical infection (two of 37) had detectable CIC. CIC was present in low concentrations when it was found. In marked contrast, 80 per cent of the patients with Condylomata acuminatum infection (eight of ten), 46 per cent with acute salpingitis (11 of 24) and 39 per cent with gynecologic malignant diseases (13 of 33) had CIC, usually at high levels. In a patient with salpingitis, CIC was shown to be 19S and 14S, dissociable at acid pH and capable of activating complement.     

Patient care before and after termination of pregnancy for neural tube defects

A retrospective study was designed to examine the perception of care in women who had experienced a second-trimester termination of pregnancy (TOP) for a neural tube defect. Women were identified over a 3-year period, 1983-1985. After appropriate consent, 166 women were visited at home between 4 weeks and 7 months post-TOP and interviewed by one experienced interviewer using a structured questionnaire with open and closed questions. The majority (137, 82 per cent) felt satisfied with the care received during screening, prenatal diagnosis, and during the TOP (126, 76 per cent). Patients were less satisfied (63, 38 per cent) with post-TOP care in hospital. On leaving hospital, the post-termination sequelae were mentioned to only 25 (15 per cent) patients, which left 135 (81 per cent) confused and bewildered by the post-partum reactions of their bodies, and by their strong emotions. After-care was perceived as unsatisfactory by 113 (68 per cent). One-quarter (42, 25 per cent) did not have, and were not invited for, a post-termination appointment and thus did not have an opportunity to ask questions or to discuss the fetus. Eighty-six (51.8 per cent) had no visit from any member of the primary health-care team, yet most would have appreciated such a visit. Suggestions for improved management are presented.     

Amniotic fluid acetylcholinesterase measurement in the prenatal diagnosis of open neural tube defects. Second report of the Collaborative Acetylcholinesterase Study

Seventeen centres from Australia, Britain, France, and the United States collaborated in a study to compare amniotic fluid acetylcholinesterase (AChE) determination by gel electrophoresis and amniotic fluid alpha-fetoprotein (AFP) measurement as diagnostic tests for open neural tube defects. The study was based on 32,642 women with singleton pregnancies (including 428 with open spina bifida and 238 with anencephaly) who had an amniocentesis at 13-24 weeks' gestation. The AChE test yielded a detection rate for open spina bifida of 99 per cent (95 per cent confidence interval 98-100 per cent), 98 per cent for anencephaly (95 per cent confidence interval 96-100 per cent), and a false-positive rate of 0.34 per cent (95 per cent confidence interval 0.28-0.40 per cent) excluding miscarriages, intrauterine death, and serious fetal abnormalities. The false-positive rate was 0.30 per cent among the 13 centres that used a specific AChE inhibitor in the test. Comparable rates for the AFP test were less favourable. (For example, the open spina bifida detection rate was 90 per cent and the false-positive rate was 0.46 per cent using the cut-off levels specified in the U.K. Collaborative AFP Study.) The AChE false-positive rate was lower in samples that were not bloodstained (0.16 per cent) than in those that were (2.4 per cent). It was higher in women who had an amniocentesis on account of a raised maternal serum AFP level (0.56 per cent) than in those who had one for other reasons (0.29 per cent). The best results were obtained by a combination of the two tests, an effective and economical policy being to perform the AFP measurement on all amniotic fluid samples and an AChE test on samples with AFP levels greater than or equal to 2.0 multiples of the normal median (about 5 per cent of all samples). Using this policy, the open spina bifida detection rate was 96 per cent and the false-positive rate was 0.14 per cent (0.06 per cent for samples that were not bloodstained and 1.2 per cent for those that were; 0.40 per cent for women with raised serum AFP levels and 0.09 per cent for other women). This policy offers a useful improvement to the prenatal diagnosis of open spina bifida.     

Childlessness in Andhra Pradesh, India: Treatment-seeking and consequences

Andhra Pradesh has a high incidence of childlessness, compared to the rest of India. This paper is based on a study that explored the psychosocial consequences of childlessness in Ranga Reddy district, Andhra Pradesh, India in 1998, and describes the extent and kinds of infertility treatment sought. Currently married women aged 20 years or more who had been married for at least three years with no live birth were included; the rate ofchildlessness was five per cent On average, they started allopathic treatment and visits to holy places after three years of not having a baby. A large majority sought allopathic treatment first, and only tried other sorts of treatment prayer, rituals and traditional treatments when this did not work or cost too much. About ten per cent had adopted children and others would consider it in future. For a minority of women, there was a risk of divorce and husbands marrying a second wife to have children. Two-thirds of the women experienced violence from their husbands; 13 per cent thought this was partly due to their childlessness. There is a clear need for infertility investigation and treatment to be included in the reproductive health programme in India, and for health workers to be trained to provide information, care and referrals.     

国产女用避孕套的临床有效性试验

目的 了解国产女用避孕套（阴道套）的临床避孕效果。方法 将６０３对育龄期志愿者夫妇随机分成两组,其中３０４例使用阴道套避孕（阴道套组）,２９９对使用阴茎套避孕（阴茎套组）。随访６个月,以生命表法统计、Ｌｏｇ ｒａｎｋ检验比较两组的妊娠率、因症停用率和其他原因停用率等。６０３对夫妇使用前后宫颈刮片和阴道脱落细胞检查均无异常。结果 ６个月的随访率,阴道套组和阴茎套组分别为９９．０１％和９９．６７％;两     

Prenatal diagnosis in advanced maternal age. Amniocentesis or CVS, a patient's choice or lack of information?

Ninety-six women of advanced maternal age were interviewed about the way they obtained information on prenatal diagnosis and about how the decision was made as to what procedure was to be performed (transabdominal chorionic villus sampling (TA-CVS) or amniocentesis). In the CVS group, women visited their physician or midwife earlier in pregnancy (mean 7.1 weeks) than those in the amniocentesis group (mean 10.7 weeks). The availability of prenatal diagnosis was not mentioned during the first antenatal visit in 55 per cent of women from the amniocentesis group as opposed to 25 per cent from the TA-CVS group. Approximately 40 per cent of women eligible for prenatal diagnosis did not receive any information from the referring body prior to counselling at our centre. Only 29 per cent of women who underwent amniocentesis had actually chosen this procedure; 71 per cent were too late to undergo TA-CVS at 12 weeks. It is concluded that information to the patient must be improved in order to ensure early referral for prenatal diagnosis.     

Spontaneous abortion after amniocentesis in women with a history of spontaneous abortion

The incidence of spontaneous abortion after amniocentesis (19 to 28 weeks gestation) in women who have had previous spontaneous abortions is compared with the rate in women who have not had previous spontaneous abortions. The outcome of the pregnancy after amniocentesis and the previous history of spontaneous abortion is reported for 691 pregnancies. The rate of spontaneous abortion after amniocentesis was found to be significantly higher in women who had one or more previous spontaneous abortions, 12/238 (5 per cent), than in women who did not, 6/453 (1.3 per cent). In women who reported two or more previous spontaneous abortions, the rate was 7/81 (8.6 per cent). No statistically significant effect of maternal age or gravidity was detected. The incidence of spontaneous abortion after amniocentesis was greater in the three weeks following the procedure (three for each of the three weeks) than in the subsequent seven weeks (nine for seven weeks).     

Prenatal screening and diagnosis of neural tube defects in England and Wales in 1985

A survey was carried out to determine the effect of prenatal screening and therapeutic abortion on births in 1985 with anencephaly and spina bifida in England and Wales. Maternal serum alpha-fetoprotein tests were done on 399,288 women (60 per cent of pregnant women): 4 per cent were reported as being screen-positive and 1 per cent had an amniocentesis. An estimated 534 pregnancies associated with anencephaly were terminated and an estimated 445 pregnancies associated with spina bifida (but without anencephaly) were terminated. Most (63 per cent) of the anencephalic pregnancies were first suspected from an ultrasound examination; 57 per cent of the spina bifida pregnancies were first suspected from a positive maternal serum alpha-fetoprotein test, 35 per cent by ultrasound, and the remaining 8 per cent by other means. The birth prevalence of anencephaly declined by 94 per cent between 1964-1972 and 1985, but when the terminations of pregnancy on account of having a fetus with anencephaly are added to the births the decline in prevalence was only 50 per cent. The birth prevalence of spina bifida declined by 68 per cent over the same period but when the terminations were added to the births the decline in prevalence was only 32 per cent. Among births with anencephaly 66 per cent had had no screening or diagnostic tests in early pregnancy, but in those that did nearly all were positive--usually in twin pregnancies where one fetus was affected but not the other. Among births with spina bifida, 48 per cent had no tests and in those that did the results were mainly negative.(ABSTRACT TRUNCATED AT 250 WORDS)     

Group B streptococcal colonization and antibody status in lower socioeconomic parturient women.

This investigation was undertaken to determine the prevalence of group B streptococcal vaginal and throat colonization among lower socioeconomic pregnant women and the antibody concentration to the capsular polysaccharide antigen of type III group B streptococcus in their sera. Group B streptococci were recovered from 28.6 per cent of the 112 women studied; vaginal colonization was detected in 23.4 per cent, throat colonization in 4.7 per cent, and colonization at both sites in 0.9 per cent of the patients, respectively. Among these isolates of group B streptococci, serotypes III (39.5 per cent) and II (30.3 per cent) predominated. No differences were found between colonized and noncolonized women with respect to age, race, marital status, or parity. The majority of all women studied had low concentration of antibody in serum (less than 1.0 microgram per milliliter). However, women with isolation of type III group B streptococci from cultures at the time sera were collected had significantly higher concentrations than did women without group B streptococci from cultures at the time sera were collected had significantly higher concentrations than did women without group B streptococcal colonization.     

Problems with condoms -- a population-based study among Finnish men and women.

OBJECTIVE: This study evaluates men's and women's opinions of condom use and problems with it in real life. METHODS: Random samples of men and women, aged 18-50 years, were drawn from the Finnish Population Register and were mailed a questionnaire on family planning. Response rates were 36% for men (706) and 58% for women (1136). Respondents were asked e.g. about condom use, whether they had had problems with it and why they used condoms. Moreover they were asked if they had received advice on how to use condoms. RESULTS: Among both men and women 87% had at some time used condoms. Of all men 37% and of women 34% reported that they had at some time had a failure with condom use; among both men and women one in four had experienced condom breakage. The use of condoms with the main purpose of preventing sexually transmitted diseases was somewhat low. The proportion of respondents having received advice on condom use was greater among younger men and women. CONCLUSION: A patient with problems in condom use is not uncommon in consultations in primary health care, and thus personnel working there hold a key position in promoting condom use. The role of school health care should be assured to offer basic sexual and reproductive counselling to every generation.     

The risk and efficacy of chorionic villus sampling in multiple gestations.

Chorionic villus sampling (CVS) in the first trimester of pregnancy provides a safe and effective method for the early prenatal diagnosis of cytogenetic abnormalities in multiple gestations. In this multicentre study involving 126 twin and 2 triplet gestations primarily at risk because of advanced maternal age, the overall success rate of obtaining an adequate villus sample from each fetus was 99.2 per cent. For women of advanced maternal age, the rate of combined losses of chromosomally normal fetuses due to spontaneous abortion, stillbirths, and neonatal deaths was 5.0 per cent, compared with a 4.0 per cent total loss rate following CVS in singleton pregnancies derived from the same population (Rhoads et al., 1989). There was a 100 per cent success rate in obtaining a cytogenetic analysis; a cytogenetic abnormality was present in five of the multiple gestations (3.9 per cent) and involved seven fetuses (2.7 per cent). There were no diagnostic errors and no cases of normal cytogenetic diagnosis followed by the birth of a cytogenetically abnormal newborn. Based on cases of XX/XY admixture, cell contamination derived either from maternal decidua or the other twin occurred in 6 of 256 samples (2.3 per cent), giving an overall estimate of the frequency of cell contamination of 4.6 per cent; these cases did not present a diagnostic problem. However, there were two cases (0.8 per cent) in which the fetal sex was incorrect, due either to complete maternal cell contamination or to the possibility that in error one twin was sampled twice.     

国产女用避孕套的临床可接受性试验

24对已婚夫妇、234次性生活使用国产女用避孕套（简称阴道套），以询问表的形式进行可接受性评估。从总结性询问表分析结果显示，78．3％的夫妇认为阴道套可以接受，并是一种好的避孕器具；91．3％认为使用方便；65．2％认为使用阴道套的性快感与平时一样或增强；但与阴茎套相比，仅35．3％更喜欢阴道套。研究还从征募的前12对与后12对夫妇以及每对前5次与后5次应用时对阴道套进行对照评估。试验结果提示，如果阴道套上市，有一定比例的育龄夫妇愿选用阴道套作为避孕方法；作为一种新的避孕器具，阴道套有一个被人们逐渐认识和接受的过程。     

Long term survival and severe rebleeding after variceal sclerotherapy

Of 197 consecutive patients with cirrhosis admitted because of bleeding from esophageal varices, 133 were included in a prospective study of elective sclerotherapy. We evaluated the incidence of extensive rebleeding and mortality rate. The period of study was 54 months and the mean follow-up period was 21 months. Forty-one patients had severe rebleeding and a majority of the episodes occurred during the first year. Only four patients had more than five sessions of sclerosis when rebleeding occurred. The probability rate for patients to be free of severe rebleeding after 48 months, according to Pugh's classification, was 88 per cent for those with grade A, 50 percent for grade B and 43 percent for grade C. The over-all mortality rate was 38.8 per cent (53 patients), with the highest rate noted during the first year. The mortality rate of patients with severe rebleeding was much higher than that of those who did not rebleed. Kaplan-Meier survival analysis at four years was 52 per cent, and survival rates in relation to Pugh's classification were 73 per cent for A, 53 per cent for B and 34 per cent for C. Differences between the three groups were statistically significant. Therefore, because of the high mortality rate associated with patients with cirrhosis and extensive rebleeding during the first year, it is important to achieve, as soon as possible, eradication of esophageal varices.     

Antigonadotropin (danazol) in the treatment of endometriosis. Evaluation of posttreatment fertility and three-year follow-up data

Ninety-nine women who completed danazol treatment for endometriosis proved by operation were re-evaluated clinically an average of 37 months later. The recurrence of symptoms was reported by 39 per cent and pelvic findings suggestive of endometriosis were noted in 33 per cent. An average time interval between the end of treatment and the recurrence was 15 months for the entire group. However, 31 women who conceived subsequent to treatment had a much lower recurrence rate of the disease (15 per cent) and a much longer average time until the recurrence (31 months). Of 84 infertile women who desired pregnancy after treatment, 39 conceived, for a pregnancy rate of 46.4 per cent. However, when patients with absolute sterility due to other causes were excluded, the corrected pregnancy rate was 72.2 per cent. The majority of conceptions (23) occurred within the first six months after discontinuation of danazol and a total of 30 occurred within the first year. Four second- and third-trimester intrauterine fetal deaths were observed among women who conceived within the first three cycles after discontinuation of the drug.     

Psychological reactions experienced by pregnant women with an elevated serum alpha-fetoprotein level

Repeated semistructured interviews with 66 singleton-pregnant women disclosed that when they were notified that they had an elevated serum AFP level, 47 per cent reacted with panic, 35 per cent with reasonable concern, and 18 per cent with denial. Three days later, these proportions had changed to 14, 21, and 65 per cent, respectively. On the latter occasion an interviewer judged that 74 per cent of the women were severely or considerably anxious about fetal malformations.

Twenty-five women who required extended investigation did not experience more strain during this period than women for whom one control serum assay sufficed. After completion of the total investigation 56 of the women did not regret that they had undergone the serum AFP test.

The present findings show that being informed about abnormal serum AFP test results induces immediate and severe though temporary emotional distress that can be alleviated by adequate medical information and reasonable psychological support.     

Safe motherhood perspectives and social support for primigravidae women in Lusaka, Zambia

The safe motherhood goals of being attended by a skilled attendant at birth have not been met in Zambia. Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study was conducted to explore low-risk Zambian primigravidae's preparation for pregnancy including contraceptive use, content of antenatal care, preparation for childbirth and the extent of social support. Two hundred and ninety nine healthy primigravidae, who attended the antenatal clinic at the University Teaching Hospital (UTH), Lusaka, Zambia, were interviewed using a structured interview guide. The women's mean age was 20.7 years; 41% were adolescents. The adolescent group had significantly less years of education (p < 0.0000). In total, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy. Sixty three per cent of the women had made their first antenatal visit during the second trimester. There had been no antenatal preparation of the women for parturition and their parenting role. Eighty five per cent of the pregnant women had identified a social support person to assist them during pregnancy and after childbirth. The results suggest that preparation for parenthood had a low priority as part of the antenatal care. We recommend that as part of the integrated reproductive health approach, parenthood classes should be organised and social support network should be utilised and involved in the care.