Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women.

We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal (NM) therapy for preventing urinary tract infection (UTI) in postmenopausal women with recurrent UTI. Over a period of 9 months, 86 women received an estriol-containing vaginal pessary (0.5 mg estriol) twice weekly, and 85 women received NM (100 mg) once daily. We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM (P=.0003). Twenty-eight women (32.6%) who received estriol had no episodes of UTI versus 41 women (48.2%) in the NM group. There was a significant increase in the number of superficial cells in women who received estriol, whereas in the NM group, no such changes occurred. However, there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol. Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women.

Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis.

To compare and assess ingestion of yogurt that contained live Lactobacillus acidophilus with pasteurized yogurt as prophylaxis for recurrent bacterial vaginosis (BV) and candidal vaginitis, we designed a crossover trial during which patients were examined monthly for candidal infection and BV while they were receiving either a pasteurized yogurt or a yogurt that contained live L acidophilus. Forty-six patients in 2 groups of 23 were randomly assigned to each of the study groups. At least 28 (61%) participated during the first 4 months of the study. Seven patients completed the entire study protocol. We concluded that daily ingestion of 150 mL of yogurt, enriched with live L acidophilus, was associated with an increased prevalence of colonization of the rectum and vagina by the bacteria, and this ingestion of yogurt may have reduced episodes of BV.

Delivery of the very low birthweight breech: what is the best way for the baby?

A retrospective analysis was done to determine whether vaginally vs. cesarean section-born breech infants in the very low birthweight range are at increased risk for morbidity and mortality. Eighty-three viable singleton breech infants weighing 700-1,600 g, who were delivered in our medical center during the period 1980 through 1993, were followed for up to 5 years of age. Analysis of data after correction for weight, gestational age and other confounding variables such as antepartum complications revealed that survival rates in the 700-1,000 g group were similar in both routes of delivery. In the 1,001-1,600 g group, survival rate was 60.9% after vaginal delivery, as compared to 100% after cesarean section (P < 0.01). No difference was demonstrated in long-term outcome between the vaginal and cesarean groups, although the population was too small to draw statistical conclusions. Considering the limitation of such a retrospective analysis, our data identified a trend that supports prophylactic cesarean section in cases of pre-term breech infants weighing 1,000-1,600 g.

Factors associated with withdrawal bleeding after administration of oral dydrogesterone or medroxyprogesterone acetate in women with secondary amenorrhea.

The effectiveness of two treatment regiments in inducing withdrawal bleeding in secondary amenorrhea was compared and correlated with the endometrial thickness and endogenous E2 and progesterone concentrations. A prospective, randomized and double-blind study was designed at the Outpatient Clinic of Reproductive Endocrinology, Central Emek Hospital, Afula, Israel. Seventy-seven premenopausal women with oligomenorrhea or amenorrhea, 48 of whom qualified for the study, underwent a 5-day course of either medroxyprogesterone acetate (MPA) 5 mg b.i.d. or dydrogesterone (DG) 10 mg b.i.d. Endogenous pretreatment values of E2 and progesterone and endometrial thickness (by transvaginal ultrasonography) were correlated with the bleeding response. Withdrawal bleeding occurred in 93% of women taking either MPA or DG. Side effects occurred similarly among the groups. Lipid concentrations were unchanged. Endogenous E2 and progesterone were limited predictive value for withdrawal bleeding. Endometrial thickness as measured by transvaginal sonography correlated significantly with the bleeding response.

A random single Doppler study of the umbilical artery in the evaluation of pregnancies complicated by diabetes.

To evaluate a random single Doppler study of the systolic to diastolic ratio of the umbilical artery as a predictor of perinatal outcome in diabetic pregnancies, a prospective double-blind study was performed in 92 diabetic pregnant women between 28 and 40 weeks of gestation. Main outcome measures were perinatal outcome: group A, normal outcome; group B, poor outcome. The sensitivity and specificity of the Doppler studies as a predictor of poor perinatal outcome were 39% and 92%, respectively. The positive and negative predictive values were 54% and 86%, respectively. Our results suggest that the systolic to diastolic ratio of the umbilical artery offers no advantage over other well-established tests in the management of diabetic pregnancies.

Intraamniotic infection with Candida albicans successfully treated with transcervical amnioinfusion of amphotericin.

We present a case in which a pregnant woman was seen at 27 weeks' gestation with premature rupture of membranes and intraamniotic infection with Candida albicans, which was treated with transcervical amnioinfusion of amphotericin B. After 7 days of treatment spontaneous vaginal labor developed. A female newborn of 1030 gm was delivered. The infant was normal and did well.

Exogenous estrogen therapy concurrent with clomiphene citrate--lack of effect on serum sex hormone levels and endometrial thickness.

The antiestrogenic action of clomiphene citrate (CC) is claimed to have an adverse effect on the development of the secretory endometrium. This effect can be assessed: (1) sonographically by measuring endometrial thickness, and (2) by serum hormone levels. The aim of this study was to evaluate whether administering ethinyl estradiol (EE) during CC treatment has any effect on endometrial thickness and/or hormone levels. Seventeen patients were treated with CC for one cycle and with CC plus EE in an adjacent cycle either before or after. The patients were followed by daily assessment of endometrial thickness, follicular growth and serum estradiol levels as well as midluteal prolactin and progesterone levels. We did not find any significant difference in either endometrial thickness, estradiol level, midluteal prolactin or progesterone levels between the two treatment protocols. We conclude that exogenous EE, in the dosage used in this study, does not overcome CC-induced alterations in endometrial thickness.

External cephalic version at term--using tocolysis.

Fifty-five patients with non-vertex presentation at 37 to 40 weeks' gestation were evaluated to determine which factors were associated with a successful external cephalic version (ECV). Maternal parity, obesity, amniotic fluid volume, placental location, type of breech and position of fetal spine were analyzed. Only amniotic fluid volume and fetal weight were significantly associated with a successful version (p < 0.05), 40/55 (73%) were successfully converted, 36/55 (65%) were vertex at delivery, and 32/55 (58%) delivered vaginally. Version attempts were successful in six out of eight patients who had undergone a previous cesarean section. Two out of six of the successful version patients went on to have vaginal birth after cesarean section. We conclude that although ECV is a reasonable alternative in the management of pathological presentation near term it should be performed only when there is sufficient amniotic fluid volume.

Management of functional ovarian cysts after induction of ovulation. A randomized prospective study.

To investigate the need for hormonal treatment in patients with functional ovarian cysts after induction of ovulation, a randomized prospective study was performed. Fifty-four patients who were found to have ovarian cysts after induction of ovulation were randomly assigned to two groups: a) Treatment with estrogen/progesterone. b) Expectant management. The main outcome measure was resolution of ovarian cysts. There was no significant difference between the groups. We conclude that hormonal treatment is not necessary in cases with functional ovarian cysts after induction of ovulation.

Pregnancy following GnRH agonist therapy of uterine leiomyoma obstructing a single fallopian tube.

Several studies have shown that gonadotrophin-releasing hormone analogue (GnRHa) offers a promising medical approach in the treatment of uterine leiomyomas. Medical management is very important especially when fertility is desired. We report on a case with mechanical infertility, in which the right tube was obstructed by cornual myoma and the left tube was resected due to a ruptured ectopic pregnancy. The myoma was reduced in size by GnRHa treatment and the patient subsequently conceived.

The effect of ejaculatory frequency on semen characteristics of normozoospermic and oligozoospermic men from an infertile population.

The characteristics were examined of 87 consecutive semen samples obtained from participants of an intra-uterine insemination (IUI) programme. The population investigated comprised 65 normozoospermic, 13 moderately oligozoospermic and nine severely oligozoospermic individuals. The samples were produced after 4 days abstinence for the first IUI and after a further day of abstinence for the second IUI. Semen volume, sperm concentration, total sperm count and total motile sperm count for the whole population decreased significantly between the first and second samples. The characteristics of the second sample were significantly decreased only for the normozoospermic group.

Duplex Doppler ultrasound in the evaluation of pregnancies complicated by pregnancy-induced hypertension.

Umbilical artery velocimetry using pulsed Doppler technique was carried out in 49 pregnancies complicated by pregnancy-induced hypertension (PIH). Outcome of the pregnancies was evaluated after delivery. We found the systolic to diastolic ratio of the umbilical artery to be highly sensitive and specific in predicting abnormal outcome in pregnancies complicated by PIH. In our opinion, the pulsed Doppler technique can be a useful adjunct to other methods for evaluation of fetal well-being in patients with PIH.

Aortic valve replacement during pregnancy. A case report and review of the literature.

Aortic stenosis (AS) is an uncommon complication during pregnancy, but when it occurs it results in significant maternal and fetal morbidity and mortality. We present a gravida with severe AS in which aortic valve replacement was performed in the 3rd trimester of her pregnancy. She had severe AS with mild aortic regurgitation and severe congestive heart failure. Fetal heart rate and uterine activity were monitored and recorded during the operation. The pregnancy was carried uneventfully to term and the patient was delivered of a healthy baby. The literature is reviewed and recommendations are made for the management of AS during pregnancy.