Multiple pregnancy and fetal abnormalities in association with oral contraceptive usage.

1,000 multiple births were examined in relation to maternal exposure to an oral contraceptive before conception. There was a significantly higher rate of monozygotic twinning among pregnancies which took place within 6 months of cessation of the contraceptive. In the monozygotic group there was a significant increase in the incidence of congenital abnormalities (P less than 0.01) when conception occurred within 3 months of cessation of the contraceptive.

PIP: Retrospective questionnaires were completed by mothers of multiple births in order to examine oral contraceptive (OC) usage in association with the incidence of multiple births, zygosity, and the presence of congenital abnormalities. The questionnaire was distributed nationwide to 2000 members of the Australian Multiple Birth Association seeking data in relation to biological aspects of twinning, including maternal and paternal ages, parity, sex and ages of all children in the family, and diseases, deformities and illnesses including stillbirths and deceased members of the family. Parents were requested to identify whether times were the same or of different sex and whether they considered them to be identical or not identical. In relation to each set of twins in the family, the mother was requested to supply retrospective details about OC use before conception and the elapsed interval between cessation of use and conception. At the time of this report, 1006 responses had been received; 1000 were included in the analysis. National statistics in Australia were examined for all births and both monozygous and dizygous multiple births from 1950-1972. The statistics demonstrated a marked decrease in the percentage of dizygotic twin births in Australia and also an increase in the proportion of monozygotic twins. A regression analysis on this data was highly significant for both the increase in monozygotic twinning rates and the decrease in dizygotic twinning rates. The ratios of monozygotic to dizygotic twins (MZ:DZ ratio) in relation to cessation of use of OCs in 3-monthly intervals was compared with that found in non-OC users. The MZ:DZ ratio of 128:273 (32%) among non-OC users was as expected. In OC users, there was a higher than expected rate of monozygotic twinning among conceptions which occurred within 6 months of cessation of OC use. This was particularly noticeable in the 1st month, where the MZ:DZ ratio was 40:42, almost 1:1. After 6 month cessation of OCs, the rate was more consistent with the rate expected. The proportion of congenital abnormalities among dizygotic twins appeared to be fairly constant both in the OC and non-OC user groups; the minor variations were not statistically significant. In the monozygotic group, the incidence of abnormalities was increased in the group where the mother had conceived within 6 months of cessation of the OC. If the child was conceived in the first 3 months, and particularly in the 1st month after stopping OC use, the increase in the rate of congenital abnormalities was highly significant.

Fifth day fits: a syndrome of neonatal convulsions.

A new syndrome of neonatal convulsions is described. Ninety cases were documented from one maternity hospital between 1973 and 1977. The appearance of this syndrome increased the annual incidence of neonatal convulsions from fewer than 3 to more than 16 per 1000 live births. Fits began on about the fifth day in apparently healthy babies. Investigations and therapeutic trials have not shown the cause. There were no deaths and all babies were discharged from hospital apparently well. The term fifth day fits is suggested with criteria for this diagnosis.

Artificial insemination with donor semen.

Fifty-three consecutive couples requesting artificial insemination with donor semen are presented. Insemination was carried out with fresh semen. Forty-three proven pregnancies were achieved with a mean of 3-4 treatment cycles per pregnancy. Psychological and legal aspects relating to this method of treatment are discussed.

PIP: 53 couples referred for artificial insemination with donor semen are presented and psychological and legal aspects discussed. 50 males were suffering from azoospermia or oligospermia and 3 were suffering from ejaculatory problems. All patients requested insemination in preference to adoption. Of 45 patients who continued treatment, 36 conceived. There were 43 proven pregnancies resulting in 29 live births and 5 first trimester abortions. 9 patients are at present more than 20 weeks' pregnant. Patients were required to meet certain psychological criteria before they were accepted for treatment. The husband and wife must have complete acceptance of the situation of the infertility and be willing to accept the child as being born to the marriage. The marriage must be stable and with good communication. In all cases, the parents were able to accept the child as their own. There are several legal questions that need clarification, the most important being that such a child is the legitimate issue of the parties to the marriage. The physician must protect himself with a consent form signed by both members of the marriage before conducting an insemination.

Evaluation of the Gravigard intrauterine copper contraceptive device.

PIP: The plastic intrauterine device is now being used as a carrier to hold the contraceptive agent (copper in this case) in the uterus. The action of copper as a contraceptive agent is thought to be due to an alteration in intrauterine environment thus preventing implantation and causing rapid loss or destruction of the fertilized ova. Studies show that such local use of copper appears to be safe over long-term use, and no changes in cervical cytology or endometrial histology and no evidence of tumor production due to copper have been seen. Presented here is a study of 127 women using a Gravigard (Copper 7) IUD. The patients ranged from 18 to 42 years old, and 33 (26%) were nulliparous. Insertion was easy in 111 (87%), there were minor problems in 10 (8%), and difficulties in 6 (4.7%). The majority of patients had no immediate postinsertion pain or problems, but 11 (9%) did complain of uterine cramps or symptoms of faintness or nausea. 3 patients were lost to follow-up, and the remaining 124 women were followed over a total of 1089 woman-months. 7 patients (5.5%) expelled the Gravigard, 3 (2.4%) became pregnant, and 10 (7.9%) had their IUDs removed for medical reasons.^ieng