Infertility due to tubal obstruction with special reference to chlamydial and gonococcal infections

This study was conducted on 334 infertile women attending the out patient clinic of Kasr El-Aini Maternity Hospital. Out of them, 150 women with tubal cause of infertility were selected for laboratory investigations. Another 50 women attending the out patient clinic for contraception were taken as a control group. Serum and cervical mucus samples from both patients and control women were examined for the presence of antichlamydial IgG and IgA antibodies using the enzyme linked immunosorbant assay [ELISA] technique. Also, cervical mucus specimens from both patients and control women and peritoneal fluid samples from patients were cultured for Neisseria gonorrhoeae on modified New York City [MNYC] medium and chocolate agar. The study revealed 4 fold increase in the incidence of antichlamydial antibodies in tubal infertility women than in control group. It was found that serum IgG and IgA antibodies to Chlamydia trachomatis were usually correlated to cervical mucus IgG and IgA respectively. Also, no significant statistical difference between the presence of serum IgG and cervical mucus IgA were found. Tubal obstruction due to tuberculous salpingitis represented 4% of the patients included in this study. Neisseria gonorrhoeae were isolated from cervical secretions of only one patient and one woman in the control group, and could not be isolated from all peritoneal fluid specimens

Prevalence of chlamydial and gonococcal infections in infertile Egyptian women with tubal factor

This work was carried out to study the prevalence of chlamydial and gonococcal infections among 150 Egyptian infertile women having tubal factor as the only or the major contributing factor for infertility. Another 50 normal women were studied as a control group. Seropositive and cervical mucus positive antichlamydial IgG and IgA antibodies were found to be significantly higher in the study group when compared with corresponding ones in controls. The incidence of seropositive cases was higher among secondary infertile patients. The seropositivity was most prevalent in women aged 26 to 30 years in the study group. No significant difference was found between symptomatology of seropositive patients and control women. As regards the signs, it was found that 89% of patients having adnexal mass[es] were seropositive versus zero in controls at p <0.0001. 60.98% of patients having chronic cervicitis were seropositive compared with 5.56% in controls at p <0.0001. 72.41% of patients having purulent cervical discharge had antibodies versus 20% in controls, at p <0.02. Considering laparoscopic findings, it was found that 33.6% of patients with peritubal adhesions and all patients with frozen pelvis were seropositive. Antichlamydial antibodies were next prevalent in patients with hydrosalpinx [27%], cornual blook [26.7%] and then patients with terminal phimosis [18.5%]. Neisseria gonorrhea was isolated only from cervical secretions of patients in 0.67% of cases as gonococci are hard to find in this later stage. This study suggested that subclinical chlamydial salpingitis is an important cause of tubal infertility in Egyptian women. The presence of adnexal mass[es], chronic cervicitis or purulent cervical discharge may improve the ability to detect antichlamydial infections. A serological test for chlamydia trachomatis is recommended to be done as a routine part of infertility investigations

Significance of human chorionic gondotrophin value in tubal pregnancy

The study has been conducted on 20 conclusive cases, surgically proved to be tubal pregnancy, to detect whether serum B-HCG can predict site of rupture of tubal pregnancy, their ages ranged between 21 and 35 years and their parity ranged from nullipara to five parities. The gestational age at operation averaged 59.9 +/- 12.08 days. Out of 20 cases, 13 cases were ruptured [65%] while only 7 cases [35%] were unruptured. The mean serum B-HCG for ruptured tubal pregnancy was much higher than that of unruptured tubal cases. The mean levels were 528.8 +/- 303.8 and 222.4 +/- 51.5 mul/ml, respectively. Those planning for conservative or chemotherapeutic management of tubal pregnancy, an arbitrary serum HCG value of 280 mul/ml can be used as cut off limit for integrity of tubal pregnancy

Study of bacterial colonization of the cervix in pre-term rupture of the membranes

The aim of this study was to correlate bacterial colonization of the cervix with aerobic, facultative anacrobic and anacrobic micro organisms to premature rupture of the membranes. The study was conducted on sixty pregnant women attending the emergency delivery unit in Kasr El-Aini Hospital. The study revealed that lactobacilli seem to have a productive role against colonization by potential pathogenic anacrobes which would have a stimulating or precipitating rupture of the membranes