Pregnancy without ovarian function. A case report.

A 38-year-old nulliparous woman suffering from premature menopause was stimulated with oestradiol valerate in order to create an artificial endometrial cycle. Three oocytes were donated by a woman on an in vitro fertilisation cycle and were inseminated with the patient's husband's sperm. These were then transferred into the patient's uterus after the endometrium had been primed with progesterone to change it to the secretory phase. Pregnancy resulted and proceeded well. Gestation was terminated at the 34th week by caesarean section and 2 healthy boys and 1 girl were delivered.

The changes in fetal habituation patterns due to a decrease in inspired maternal oxygen.

Habituation is widely regarded as a basic form of learning. A fully functioning central nervous system is probably required for a normal habituation pattern. Habituation of the behavioural response to vibroacoustic stimulation was studied in 23 normal human fetuses whose gestational age was 36 or more weeks. Eighteen were tested whilst their mothers breathed either air or a 12% oxygen in nitrogen mixture. The test was repeated the following day with the order of the gases reversed. In addition five fetuses were tested while their mothers breathed air on both occasions. Of the 18 fetuses 17 had a normal habituation pattern when tested in air but only two had a normal pattern when their mothers breathed 12% O2. Four of the five fetuses tested both days in air had normal patterns on the second day. Altering the amount of inspired maternal O2 alters the fetal habituation pattern.

Fetal responses to vibrotactile stimulation, a possible predictor of fetal and neonatal outcome.

This study measured the antenatal fetal heart rate changes in response to a single vibrotactile stimulus. In a group of 11 normal patients, this resulted in a significant change in the fetal heart rate (P less than 0.001). Sixty-eight high risk patients were also tested. In the group of 25 patients whose fetuses showed no response to the stimulus, there were 4 stillbirths and 4 neonatal deaths; 23 of these 25 infants were small for gestational age (SGA) compared to only 15 of the 43 that showed a response to the stimulus. Fetal habituation to a repeated vibrotactile stimulus was measured in a control group of 40 patients who had a normal antepartum and intrapartum course and delivered infants in an optimal condition. The same was done in a study group of 48 patients who delivered infants that were SGA. These infants were assessed at 1 year of age by the Griffiths Mental Developmental Scale (GMDS). Infants that were SGA did not differ significantly from the control group. However, infants who had a normal antenatal habituation pattern had a significantly better performance (P less than 0.01) compared to infants who had an abnormal antenatal habituation pattern.

Absence of serum-stimulated lipase activity and altered lipid content in milk from a patient with type I hyperlipoproteinaemia.

We measured the serum-stimulated lipase activity, fatty acid content, and various biochemical parameters in the breast milk of a lactating mother suffering from familial lipoprotein lipase deficiency and of healthy control subjects. Serum-stimulated lipase activity was virtually undetectable in milk from our patient and the total fatty acid content was low. The fatty acid composition differed from normal showing a marked absolute and relative increase in the content of lauric (C12:0) and myristic (C14:0) fatty acids and considerably reduced levels of oleic (C18:1) and especially linoleic (C18:2) acids. Other fatty acid species showed lesser changes in concentration. Besides a reduced calcium concentration in the milk from our patient, other biochemical parameters were not significantly different from control subjects.

The assessment and significance of habituation to a repeated stimulus by the human fetus.

Habituation is the progressive decrease in response by an organism when it is stimulated repeatedly. This process is a basic form of learning and a normal pattern may be one indication of intact central nervous system function. This study assessed habituation of a behavioral response by the human fetus to repeated vibrotactile stimuli. Of the 40 normal fetuses studied 37 habituated after 10 to 50 stimuli. The gestational age at which the fetus first responded to the stimulus ranged from 22 to 30 weeks. Female fetuses responded 2 weeks earlier than males. The possible value of this assessment in obstetrical practice is presented.

Fetal habituation in high-risk pregnancies.

Habituation is a basic form of learning and probably requires an intact central nervous system. Habituation in the behavioural response to vibration in 40 normal human fetuses was compared with that in a group of high-risk pregnancies with an increased risk of fetal neurological damage. Highly significant differences in habituation patterns between the high-risk groups and normal control subjects were found. This test may offer a method of assessing the integrity of the fetal central nervous system.

Fetal movements and fetal outcome: a prospective study.

Two hundred sixty-four antenatal patients were monitored by maternal observation of fetal movements to predict fetal condition at birth. Abnormal fetal movements were significantly associated with fetal death as well as with poor fetal condition at birth. The sensitivity, specificity, and predictive value of monitoring abnormal fetal movements are presented. The mean weekly count decreased with advanced gestational age but not predictably so in each patient. Fetal outcome was studied prospectively in 138 patients with normal fetal movements and 23 patients with abnormal movements at term. Perinatal outcome was significantly poorer in the group with abnormal movements (P = .0015). Cognizance should be taken of patients reporting a decrease in fetal activity at term, as this may include fetal compromise.

Comparison of fetal movements and human placental lactogen as predictors of fetal outcome. A prospective study.

Maternal assessment of fetal movement and human placental lactogen (HPL) estimation were compared as predictors of fetal outcome in a prospective study of 135 antenatal patients. The sensitivity, predictive value and specificity for each test are presented. Abnormal fetal movements gave a better predictive index than abnormal HPL levels. The risk of poor fetal outcome is greatest when both parameters are abnormal.

Sheehan's syndrome followed by successful pregnancy: A case report.

Sheehan's syndrome is a complication of pregnancy rarely encountered in modern obstetric practice. The management of this condition involves substitution therapy of the hormones produced by the various endocrine glands under hypothalamic and pituitary control. There have been few reports on the occurrence of spontaneous pregnancy in patients with Sheehan's syndrome. This paper describes the investigation and management of a patient with long-standing panhypopituitarism. Hormone replacement therapy, and specifically induction of ovulation with human menopausal gonadatrophins, resulted in a successful outcome of pregnancy.

The use of human chorionic gonadotropin in recurrent abortion.

Important unresolved problems associated with recurrent abortion are aetiology, prognosis and management. This communication describes hormonal monitoring in pregnancy of groups of patients treated with human chorionic gonadotropin (HCG). The outcome is compared with that in an untreated normal group and an untreated group with recurrent abortions.

The accuracy of maternal observation of fetal movements.

The accuracy of maternal observation of fetal movements was assessed in 20 patients during the last trimester of pregnancy. The effect of factors such as smoking, obesity, education and gestational age were correlated with maternal observations to establish the accuracy of the latter.

Reversal of active labour. A case report.

The clinical course of primiparous patient who presented in premature labour at 31 weeks' gestation is described. Cervical dilatation was reversed from 9 cm and pregnancy continued for 6 days. The possible causes and mechanism are discussed and the implications are considered.

Haemodialysis in pregnancy. A case report.

A successful outcome of haemodialysis in a pregnant patient with chronic glomerulonephritis is reported. After a stable period of 9 years, pregnancy resulted in a definite deterioration of renal function. The importance of establishing biological maturity in preference to gestational maturity is stressed.