Tocolysis in advanced preterm labor: impact on neonatal outcome.

Chart review of 73 patients with 3.5 cm or more dilation, intact membranes, and regular contractions at less than 36 weeks. Forty-four (group A) received tocolysis with magnesium sulfate, and 13 of the 44 also received indomethacin. Twenty-nine (group B) received no tocolysis. Obstetric and neonatal outcomes were compared. Demographic factors and admission gestational age, cervical dilation, effacement, and uterine activity were similar. Twenty-one of the 44 in group A versus 3 of 29 in group B had delivery delayed by more than 48 hours (p = 0.002). Group A had a lower incidence of severe respiratory distress syndrome; 4 of 48 babies in group A versus 9 of 32 in group B (p = 0.04; RR = 0.47; confidence interval [CI], 0.2, 1.0). Tocolysis in advanced preterm labor delays delivery by more than 48 hours in 50% of patients. The neonatal benefits of aggressive tocolysis in cases with advanced cervical dilation may outweigh the potential maternal risks of tocolysis, particularly in the setting of extreme prematurity. Delay in delivery enabling steroid enhancement of pulmonary maturity reduces the severity of respiratory distress syndrome.

Coagulopathy associated with dilatation and evacuation for intrauterine fetal death.

Dilatation and evacuation was reported recently to be a safe and effective method for the treatment of intrauterine fetal death. The current authors have treated ten cases of intrauterine fetal death with dilatation and evacuation. Five patients (50%) developed coagulopathy, one of whom also developed endometritis. Patients who developed coagulopathy were significantly older than those who did not. Previous pregnancy also was associated with the development of coagulopathy. Five of six multigravidas developed coagulopathy, whereas none of the four primigravidas developed this complication. Other factors that may have contributed to the development of coagulopathy are discussed. The authors conclude that dilatation and evacuation for midtrimester intrauterine fetal death may not be as safe as has been reported.

Uptake of intact nucleoside monophosphates by Bdellovibrio bacteriovorus 109J.

The degraded nucleic acids and ribosomes of its prey cell provide Bdellovibrio bacteriovorus 109J with a source of ribonucleoside monophosphates and deoxyribonucleoside monophosphates for biosynthesis and respiration. We demonstrate that bdellovibrios, in contrast to almost all other bacteria, take up these nucleoside monophosphates into the cell in an intact, phosphorylated form. In this way they are able to assimilate more effectively the cellular contents of their prey. Studies with UMP and dTMP demonstrate that they are transported and accumulated against a concentration gradient, achieving internal levels at least 10 times the external levels. Treatment of the bdellovibrios with azide or carbonyl cyanide m-chlorophenylhydrazone eliminates their ability to either transport or maintain accumulated UMP and suggests the presence of a freely reversible exchange mechanism. There are at least two separate classes of transport systems for nucleoside monophosphates, each exhibiting partial specificity for either ribonucleoside monophosphates or deoxyribonucleoside monophosphates. Kinetic analyses of UMP transport in different developmental stages of strain 109J indicate that each stage expresses a single, saturable uptake system with a distinct apparent substrate affinity constant (Kt) of 104 microM in attack phase cells and 35 microM in prematurely released growth phase filaments. The capacity for transport of UMP by the growth phase filaments was 2.4 times that of the attack phase cells. These data, in addition to the apparent lack of environmental control of UMP transport capacity in attack phase cells, suggest that there are two transport systems for UMP in bdellovibrios and that the high-affinity, high-capacity growth phase system is developmentally regulated.

Ruptured appendix after elective abortion. A case report.

Abdominal pain and fever after an uncomplicated elective abortion usually point to incomplete abortion and endometritis. We treated a woman for acute suppurative appendicitis one week after such an abortion. When fever, nausea, vomiting and pain are not relieved by the standard doses of medication, acute appendicitis must be added to the usual gynecologic differential diagnoses.

Insertion of the laparoscopic Trocar without the use of carbon dioxide gas.

Nine-hundred-and-fourteen patients have undergone the single puncture Falope Ring laparoscopic tubal ligations in a community hospital without prior insufflation of carbon dioxide gas. Anesthesia time averaged 10.5 minutes, surgical procedure time averaged 8.1 minutes. The patients left the hospital in satisfactory condition in the afternoon of the procedure. The only complication was a failed ligation (0.1%). Two-week follow-up showed no untoward complications. Omission of carbon dioxide insufflation before Trocar insertion lowers complications such as nausea, emesis, and post-operative pain. Also, anesthesia and surgical times are reduced. None of the patients required intubation during anesthesia.