ABSTRACT
The presence of elevated titres of anticardiolipin antibodies (ACA) and antihistone antibodies (AHA) in the blood serum is considered as one of serious reasons of repeated pregnancy losses. According to some reports, heparin significantly improves live birth rates in these cases. The aim of the work is an evaluation of the results of the heparin therapy in pregnant women with elevated titres of ACA and/or AHA in blood and bad obstetric anamnesis, or after sterility treatment. Our material consisted of three groups: the first one was composed of 25 ACA- and/or AHA-seropositive pregnant women 30.0 +/- 4.1 years old with 1-5 early miscarriages in past, the second one of six seropositive patients 31.3 +/- 2.8 years old, actually pregnant after the treatment of unexplained sterility (two of them after assisted reproduction) and, finally, in the third group were placed five pregnant ACA- and AHA-seronegative pregnant women 30.8 +/- 2.2 years old with 2-4 abortions of unexplained etiology in past. The ACA IgA, IgM and IgG and AHA IgG levels in blood sera were determined by ELISA. As a positive titre ACA in the class IgA was considered > 7 APL/ml, in the class IgM > 4 MPL/ml, IgG > 7 GPL/ml and in case of AHA IgG > 25 GPL/ml. The patients were treated by heparin 7500-30,000 units daily during all the pregnancy under the control of kaolin-kephalin time. In the first group, where 53 pregnancies from 56 were miscarried (94.6%), after the heparin therapy in 10 women 9 pregnancies of 11 (81.8%) were terminated by live birth (p < 0.001). One of the patients died three days after cesarean section because of myocardial infarction, probably due to sudden stopping of heparin. In the second group three women after heparin treatment delivered live babies, but three untreated aborted. In the last group only two women treated by heparin delivered live babies and three, despite treatment, miscarried. It should be concluded, that heparin therapy in ACA- and/or AHA-positive pregnant women might be a recommended therapeutic method. In cases of antiphospholipid syndrome a special precaution should be undertaken, when stopping the heparin. It seems, that double assay of ACA and AHA in patients with conception troubles might be usefull.
Subject(s)
Abortion, Threatened/prevention & control , Antibodies, Anticardiolipin/immunology , Antiphospholipid Syndrome/drug therapy , Fibrinolytic Agents/therapeutic use , Heparin/therapeutic use , Histones/immunology , Abortion, Threatened/immunology , Adult , Antibodies/immunology , Female , Humans , PregnancyABSTRACT
Authors analysed results of prenatal treatment of 68 cases of fetal haemolytic disease in the Department of Obstetrics and Gynaecology in Bytom in the years 1994-1999. We evaluated a clinic value of umbilical vessels punctures and intrauterine intra-vessel transfusions as a basic methods of treatment of this disease. In the analysis we took into consideration frequency of complications, character of complications and condition of neonates. The most important in the treatment of fetal haemolytic disease are early diagnostics and treatment procedures performed in the appropriate prepared Centres.
Subject(s)
Anemia, Hemolytic/therapy , Blood Transfusion/methods , Fetal Diseases/therapy , Anemia, Hemolytic/diagnosis , Female , Fetal Diseases/diagnosis , Humans , Infant, Newborn , Pregnancy , Prenatal DiagnosisABSTRACT
The technical performance and results of selective salpingography (SGS) in 28 infertile women with proximal tubal occlusion (PTO) are presented. In 50 cases of PTO, diagnosed first by hysterosalpingography (HSG) and/or laparoscopy, 14 oviducts (28%) were patent during initial HSG using the baloon catheter tightly filling the internal cervical orificium and from remaining 36 tubes 27 (75%) were successfully recanalized by SGS. Three patients after successful SGS became pregnant. One of the pregnancies was ectopic. The SGS should be widely accepted in diagnosing and treatment of PTO as a cheap, simple, noninvasive and very effective method.
Subject(s)
Fallopian Tube Diseases/diagnostic imaging , Hysterosalpingography/methods , Adult , Catheterization , Fallopian Tube Diseases/complications , Fallopian Tube Diseases/therapy , Female , Humans , Infertility, Female/etiology , Pregnancy , Pregnancy OutcomeABSTRACT
Till the end of March 1998 first seven trials of MESA-ICSI (microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection) in the Ist Chair and Clinics of Obstetrics and Gynecology of the Silesian Medical Academy in Bytom were performed in cooperation with an urologist from the IInd Chair and Clinics of Urology in Zabrze in couples suffering from sterility caused by obstructive azoospermia. In all the cases both contraindications and conditions of MESA-ICSI were respected. Fertilization rate of the MII oocytes was on average 62% and cleavage rate of the fertilized oocytes 76.9%. After embryo transfer at least two pregnancies occurred, from them one is ongoing well. The result of the last procedure is not known yet. The data obtained permit to conclude, that MESA-ICSI makes a real chance to possess their own children by couples with sterility caused by obstructive azoospermia.
