Maternal serum inhibin A levels are a marker of a viable trophoblast in incomplete and complete miscarriage.

OBJECTIVE: From early gestation the human trophoblast secretes large amounts of inhibin A and activin A, and their measurement provides a value for predicting the outcome in women who become pregnant after assisted reproductive techniques. The aim of the study was to investigate the putative role of maternal serum inhibin A and activin A levels as markers of a viable trophoblast in women who miscarry. DESIGN: Controlled cross-sectional study. METHODS: One group consisted of 65 healthy pregnant women (controls), progressing to deliver a healthy singleton baby and another group consisted of 54 miscarriages (38 incomplete (27 non-viable, 11 anembryonic pregnancies) and 16 complete). Maternal blood samples were collected between 5 and 12 weeks of gestation. RESULTS: Serum human chorionic gonadotrophin concentrations in women with incomplete or complete miscarriages were significantly (both P<0.001) lower than in controls; activin A levels being lowest only in women with a complete miscarriage (P<0.001). On the other hand, inhibin A levels were significantly lower in incomplete or complete miscarriage than in controls (both P<0.0001). CONCLUSIONS: Maternal serum inhibin A, but not activin A, determination reflects the lack of a viable trophoblast in complete miscarriage.

Growth hormone secretion in premenopausal women before and after ovariectomy: effect of hormone replacement therapy.

OBJECTIVE: To evaluate the GH response to growth hormone-releasing hormone (GH-RH) stimulation in premenopausal women before and after ovariectomy and after 1 month of estrogen replacement therapy (ERT). PATIENTS: Ten women 42 to 49 years of age awaiting combined hysterectomy and ovariectomy for a variety of benign gynecological conditions. INTERVENTION: Endocrine status was determined by assay of basal levels of gonadotropins (LH, FSH), E2, P, and PRL. Stimulation with GH-RH was performed before and 8 to 10 days after ovariectomy, and after a month of ERT. RESULTS: A significant reduction in GH response to GH-RH was observed after ovariectomy. Estrogen replacement therapy restored GH response to presurgical levels. CONCLUSIONS: The results support the role of E2 in the stimulated secretion of GH and suggest that ERT increases pituitary stores of GH.

Simultaneous ovarian and intrauterine pregnancy: case report.

The simultaneous presence of an ovarian and a normal intrauterine pregnancy is a very rare condition. We report such a case seen as an ovarian cyst during gestation. It was immediately and successfully treated, thus allowing for the normal physiologic continuation of the gestation.

CA 125 and CA 19-9 in peritoneal, cyst and amniotic fluids.

The concentrations of the tumour markers CA 125 and CA 19-9 were determined in peritoneal, cyst and amniotic fluids, with particular attention being paid to certain reliability criteria of the assay methods. The antigens were measured in undiluted samples and after several dilutions. A recovery test was also performed and protein content evaluated. The results show high levels of CA 125 in all fluids; in descending order of concentration: amniotic (2376-3891 U ml-1), peritoneal (379-4040 U ml-1) and cyst fluid (124-466 U ml-1). Amniotic, peritoneal and cyst fluid concentrations of CA 19-9 were found to be 314-1008 U ml-1, 26.7-2182 U ml-1 and 226-2988 U ml-1, respectively. Recovery was between 80 and 100% for all fluids. CA 125 was easily assayable in all fluids, except amniotic and peritoneal which required dilution even of the samples which fell within the range of the standard curve before dilution. The presence of CA 125 and CA 19-9 in amniotic and cyst fluids emphasizes the non-specificity of these molecules and suggests caution in the interpretation of the results.

[Intrauterine rupture of ML Cu 250 device. Report of two cases]. / Rottura intrauterina dello IUD ML Cu 250.

PIP: The first case involved a 32-year old nullipara who had had a first trimester abortion by curettage. 2 years after receiving a ML Cu 250 IUD, she requested removal of the IUD but the procedure was done in a incomplete fashion: 1 of the arms of the device broke off and stayed in the uterine cavity. Its position was visualized by echography centrally at the fundus, and it was removed during hysteroscopy under general anesthesia. The second case was a 38-year old patient which 2 previous pregnancies ended in eutocia. She wanted removal of a ML Cu 250 IUD 3 years after its insertion. Partial removal was also effected in this case: an arm of the indented crown remained in the cavity, breaking off at the point of insertion over the central filament. Ecography did not visualize clearly the location of the fragment. Intracavitary maneuvers and subsequently curettage under general anesthesia were performed without success. Hysteroscopy under general anesthesia finally localized the fragment deeply embedded in the endometrium, provoking a virus reaction over the left lateral wall. After attempts at removal with endoscopy, Pean pincers were introduced and fragmented the distal are of the IUD. There have been reports of rupture of IUDs: 1 case of Lippes Loop, 1 case of Cu-7, 1 case of Majzlin spring, and 4 cases of ML Cu 250. Radiological visualization of a fragment is impossible, as the crown is not radiopaque. Hysteroscopy is the intervention of choice in order to avoid inappropriate surgical maneuvers.^ieng

[Induced abortion. Epidemiological study after eight years of enforcement of Law 194]. / Interruzione volontaria della gravidanza. Rilevazioni epidemiologiche a otto anni dall'entrata in vigore della legge 194.

PIP: The authors describe a study of induced abortions performed at the obstetric and gynecological university clinic in Siena, Italy, during the period 6/1/84-5/31/86, contrasting data with the experience of the first two years (6/1/78-5/31/80) of existence of law no. 194 introduced in 1978. The law legalized abortion--until then considered a social wound on society--thus making abortions more easily quantifiable from an epidemiological point of view. Since that initial period the socio- sanitary reality has changed substantially, i.e., a national progressive increase in the number of abortions was followed by a downward trend that has persisted since then, due to greater openness toward the use of contraceptive methods, in the mass media. A correct evaluation of the number of abortions cannot be obtained due to continued secret abortions. The study reflects the national trend, since during the first period, 2171 induced abortions were performed versus 1450 during the second period (a 13.14% decrease). Questionnaires asked patients about their age, geographic origin, occupation, marital status, week of pregnancy, possible previously induced abortions, length of stay in the hospital, and birth control method used at the time of induced abortion. The most significant variations in the parameters studied for the two periods demonstrated reduced waiting periods before an induced abortion operation was performed (during early pregnancy), a reduced number of requests by patients living in remote areas of the province, reduced time spent as inpatient in the clinic, and an increased percentage of women with previously induced abortions. The number of women preferring a certain type of birth control method during the two periods is comparable, except a slight increase was noted for those using IUD. It is concluded that there are still large lacunae in the area of abortion prevention in Italy, e.g., coitus interruptus is still widely practiced.^ieng

Prolactin secretion after surgery or bromocriptine treatment of prolactinoma.

In prolactinoma patients, the unresponsiveness of prolactin (PRL) to dynamic tests with thyrotropin-releasing hormone (TRH) or dopamine agonist or antagonist drugs suggests that the disease is caused by the failure of central dopaminergic inhibition. The absence of PRL secretory response to dopamine or TRH in prolactinoma patients also may be an effect of the disease. Twenty-six women diagnosed by dynamic tests and radiologic examination as having PRL-secreting adenoma were treated surgically (15) or with bromocriptine (11) and their condition was evaluated one to three years later by TRH, nomifensine, and domperidone tests. Basal PRL levels decreased after surgery and bromocriptine treatment. At the time of the follow-up study, PRL levels were elevated in six of the 15 surgically treated patients and in six of the 11 treated with bromocriptine. Thyrotropin-releasing hormone, nomifensine, and domperidone produced standard PRL responses in normoprolactinemic patients but not in hyperprolactinemic patients. These results indicate that the alteration of TRH or dopaminergic receptors in the regulation of PRL secretion in prolactinoma is related to the disease and disappears when the tumor is removed or treated successfully with bromocriptine.

Critical review of dilatation and curettage in the diagnosis of malignant pathology of the endometrium.

The authors take into account all the Dilatation and Curettage done in the Obstetric and Gynaecological Clinic of the University of Siena during the past ten years, on hospitalized patients affected by postmenopausal uterine bleeding (PMB). Endometrial cancer resulted in 14.3% of the cases, in 41.4% of the cases the histological finding showed benign pathology of the endometrium, in 26.5% it was not possible to remove sufficient tissue from the uterine cavity for a diagnostic interpretation. In 14.6% of the cases, the diagnostic method showed premalignant or other than benign tissue. In the light of these results and considering the frequent complication which arise from this operative technique, the patients' stress, the high cost and the relatively low diagnostic reliability, the authors conclude that the routine use of this method is quite often excessive. The authors recommend, for the diagnosis of endometrial pathology, hysteroscopy associated with specific endometrial biopsy, undoubtedly the most up-to-date and less expensive technique, more acceptable to the patient and more sure than Dilatation and Curettage.

[Microbiological screening and postoperative course in patients undergoing first trimester abortion]. / Screening microbiologico e decorso postoperatorio in pazienti sottoposte a I.V.G.

PIP: Pelvic infections are a serious and widespread gynecological disease, often leading to sterility. Procedures like evacuation of the products of conception by vacuum suction are known to facilitate their appearance. 300 patients were examined the same day of the abortion (first trimester); before the hysterosuction a vaginal tampon was taken from the cervix and from the posterior fornix. The patients were invited to come back for an exam in two weeks and to refer to the clinic for any problem before then. A wet mount, aerobic and anaerobic cultures in several media and Gram stains were used to identify the pathogens. 40.3% of the tampons were positive for pathogens, mostly staphilococci (52%), but also Candida, alfa and beta hemolytic Streptococci, Proteus, E. Coli, Trichomonas. 5 patients had serious complications that required hospital admission. Only 128 patients showed up for the postoperative control; of these, 14 presented with symptoms of pelvic infection. Since pelvic infections are the most frequent complication after induced abortion, and considering the larege number of women who carry vaginal pathogens, the Authors strongly recommend a guided antibiotic profilaxis before the hysterosuction operation.^ieng

[Various aspects of dopaminergic function in patients with prolactin-secreting hypophyseal adenoma]. / Vari aspetti della funzione dopaminergica in pazienti affetti da adenoma ipofisario PRL-secernente.

Controversial data have been published in these last years on the dopaminergic tonus of tubero infundibular (TIDA) neurons in hyperprolactinemic subjects. Some authors retain that L-Dopa (LD) stimulation test after pretreatment with Carbidopa (CD), a dopa decarboxylase inhibitor substance, may reveal the presence of a central Dopamine (DA) defect in patient with prolactinoma. To elucidate the reason of so different activity of DA central tonus in subjects with prolactinoma, the effects of Nomifensine (NOM), an indirect DA agonist, DOM, Carbidopa/L-Dopa (CD/LD) and LD, were studied in 26 prolactinoma patients, (basal Prl levels 50 to 280 ng/ml). The patients (24-39 years) were characterized by secondary amenorrhea with sella turcica enlargement at hypocicloidal polytomography. The NOM administration resulted unable to reduce Prl plasma levels in all the patients. On the basis of Prl response to CD/LD administration the patients were subdivided in two groups: group A, which showed a significant decrease of Prl plasma levels and group B, who did not show any significant change. LD test induced a significant Prl decrease in all patients with more evident response in these of group A. DOM administration induced a Prl rise in patients of group A, but failed to change significantly Prl levels in group B subjects. These results confirming the high validity of NOM inhibiting test in the diagnosis of tumoural hyperprolactinemic states, reveal contradictory responses to CD/LD, LD and DOM, with sustain the existence of 2 sub-group of Prolactinomas: with or without a maintained DA central tonus supporting the possibility of different etiopathogenetical factors in inducing a tumoural hyperprolactinemic states.

[Radioimmunologic assay of PRL, E2 and prosterone, before and after pregnancy termination by metergoline and sulpiride]. / Dosaggio radioimmunologico di PRL, E2, P dopo interruzione di gravidanza in relazione con il trattamento con metergolina e sulpiride.

PIP: The authors have assayed plasma prolactin, estradiol, and progesterone in 30 women undergoing voluntary termination of pregnancy by vacuum aspiration under general anesthesia, in order to study in more detail, the correlations between PRL and sexual steroid hormones during the 1st trimester of pregnancy. Results obtained in the various plasma samples taken at intervals until 5 hours following vacuum curettage show a marked increase in PRL in the control group, from 80 to 3000 ng/ml, with a progressive decrease at the 5th hour. A much slighter increase was found in patients treated with Metergoline, compared to that of the former group, with an increase from 90 to 180 ng/ml, while in those patients treated with Sulpiride, the maximum increase ranges between 160-340 ng/ml. The plasma level of E2 decreased significantly and progressively after the sample taken at 30 minutes, with a similar pattern in the 3 groups. The plasma progesterone concentrations showed a similar patern in the groups treated with Metergoline and Sulpiride, with a progessive decrease in comparison with basal levels. On the contrary, the increase was found in the control groups, in comparison with basal values, in samples taken at 30 minutes, with a slow, progressive decrease in subsequent samples. It can be concluded from these results that the stress caused by vacuum curettage under anesthesia causes a stronger stimulation of PRL than the inhibition of this hormone caused by the fall of E2 and P concentrations; the inhibitory effect of Metergoline on PRL did not completely annul the effect of anesthesia and vacuum curettage on PRL production. While E2 shows a progressive decrease compared to basal values, with a similar behavior in all 3 groups, P, which decreases in the 2 groups that have undergone pharmacological treatment, shows a peak increase in the sample taken at 30 minutes. THe significance of this observation is not yet clear, and will be the subject of further study. (author's modified)^ieng

[Scanning electron microscopic studies of the umbilical arteries and veins of newborn infants of smoking mothers]. / Osservazioni in microscopia elettronica a scansione dell'intima di arterie e vene ombelicali di neonati da madri fumatrici.

We have examined the umbilical cord of ten newborn children of nonsmoking (five) and of smoking (five) mothers (10-20 cigarettes/day). The patients chosen for the study resulted "normal" before and during pregnancy. Immediately after delivery the umbilical cords were tied (to avoid collapse) and cut about 10 cm from the placenta. Umbilical cords were submitted to pressure-perfusion-fixation according to Kjelsen and Thomsen (7). Three randomly chosen specimens for SEM were cut and postfixation was performed in 1% buffered osmium tetroxide (pH 7.4) and after dehydration, were submitted to critical point drying (CO2), coated with gold palladium (sputtering technique), and observed by means of a Super ISI Mini SEM at 7,5 Kv. Luminal surfaces of umbilical arteries and veins from non-smoking mothers revealed a regular endothelial layer all over the surface. Large disendothelialised areas were instead found not only in arteries (1) but also in veins from newborn children of smoking mothers.

[Epidemiological and clinical aspects of voluntary interruption of pregnancy 2 years after passing of Law 194]. / Aspetti epidemiologici e clinici della interruzione volontaria di gravidanza a due anni dall'approvazione della Legge 194.

PIP: Abortion has been legal in Italy since June 1978. At the Obstetrical and Gynecological Clinic of the University of Siena a doctor is assisted by a psychologist and by a social worker, who deal mostly with adolescents; all patients are given a brochure with information on the procedure and with detailed instructions for the postabortum period. Abortion is commonly carried out by vacuum aspiration and under total anesthesia in 98% of cases. 2171 abortions were done from June 1978 to June 1980; the 1st year there were 1138 abortions and 1107 live births; the second year there were 1133 abortions and 1190 live births. 30% of patients came from districts outside of the Siena region, 32.2% of patients were housewives and 15.29% students. Most abortions were done between the 9-10th gestational week because of the shortage of medical personnel at the clinic. All ages were more or less equally represented, with a slight majority of patients in the age group 25-35; minors were only 2.67% of all patients in the 1st year, but the percentage doubled in the 2nd year. In 86.87% of cases hospitalization was only 1 day. 10.78% of patients had had previous abortions; 68.17% of patients were married. 65.45% of women did not use any type of contraception, and 23.44% used coitus interruptus, or 88.89% of women without effective contraception. There were 35 cases of complications, or a rate of 1.61%, 2 requiring laparotomy and 1 requiring hysterectomy. From these data it seems obvious to conclude that many women use abortion as a fertility control method and information on birth control methods and family planning education are sorely lacking.^ieng

[Correlation between blood concentrations of E2, P, T, A and HCS in induction of abortion in trimester II and ultrasonic monitoring]. / Correlazione tra le concentrazioni plasmatiche di E2, P, T, H, HCS nell'induzione dell'aborto al ii trimestre e monitoraggio ultrasonico.

PIP: The authors studied plasma HCS, estradiol (E2), progesterone (P), testosterone (T), and androgen (A) changes in 8 cases of therapeutic abortion by intraamniotic injection of prostaglandin F2 alpha (PGF2alpha). During abortion, the mean plasma concentrations of A and T did not change considerably, while mean plasma concentrations of HCS, E2, and P showed a progressive fall correlated to PGF2alpha dosages used to induce abortion. During the induction of abortion, monitoring by ultrasound showed no correlation between fetal movements, fetal distress, and fetal death. (author's modified)^ieng