Control of prostaglandin induced uterine hyperactivity with intravenous ritodrine.

The prostaglandins, F2 alpha and E2, are in extensive local use for the induction of labor. The main concern with oral and vaginal administration is the difficulty in controlling rapidly progressing labor and uterine hyperactivity. Herein we present a case where intravenous ritodrine was given as soon as hyperactivity and fetal heart rate decelerations were detected. With this treatment, the hyperactivity was controlled, fetal heart rate returned to normal and labor progressed normally to the birth of a healthy infant.

Cervico-vaginal fistula and spontaneous mid-trimester abortion.

An unusual complication of spontaneous second trimester abortion which was unaided by external agents is presented. We found no similar case in the literature.

Huge mesenteric mucinous cystadenoma in normal pregnancy.

A 36-year-old woman required laparotomy early in the puerperium after a normal delivery because of the presence of a large abdominal cyst. At laparotomy, a large mucinous cystadenoma was found attached to the root of the ileal mesentery; the ovaries were normal. This is the third case of mesenteric cyst published in association with pregnancy, but the first with a mucinous pattern. Pathologic aspects, possible complications, and treatment are discussed.

Serum-specific antibodies for Chlamydia trachomatis in premature contractions.

A case-control study was undertaken to examine the possible morbidity associated with Chlamydia trachomatis in 28 pregnant women having idiopathic premature contractions, in 35 healthy preterm pregnant women, and in 43 healthy pregnant women at term. Serum C. trachomatis IgG- and IgA-specific antibodies were determined by the single serovar inclusion immunoperoxidase assay. There were no significant differences in the prevalence rate of elevated C. trachomatis IgG-specific antibodies (titer greater than or equal to 1:128) between pregnant women suffering from idiopathic premature contractions as compared with healthy preterm and term pregnant women (11%, 28%, and 26%, respectively). The known prevalence rate in a normal healthy population is 23%. The prevalence rate of elevated C. trachomatis IgA-specific antibodies (titer greater than or equal to 1:16) was significantly lower in the pregnant women with idiopathic premature contractions as compared with the healthy preterm and term pregnant women (0%, 20%, and 17%, respectively; p less than 0.002 and p less than 0.012). These findings do not support the assumption that C. trachomatis has a role in premature contractions.

Prenatal diagnosis of the pterygium syndrome.

We report two second trimester pregnancy terminations in the same woman following intrauterine ultrasonic findings of hydrops fetalis, polyhydramnios, lack of fetal movements, and short, fixed malformed limbs. One fetus also showed a cystic mass at the back of the head. Radiographic and anatomic studies of the fetuses demonstrated multiple pterygia, flexion contracture of multiple joints, abnormal facial appearance, cleft palate, pulmonary hypoplasia, and gracile bones. The cystic mass of the back of the head was found to be a cystic hygroma. These findings are consistent with the lethal variant of multiple pterygium syndrome. Early prenatal diagnosis of this condition is possible using ultrasonography.

Transperitoneal ovum migration in women with unilateral congenital ovarian absence.

A rare case of transperitoneal ovum migration resulting in an intra-uterine pregnancy is presented. A woman with left congenital ovarian absence and a surgically removed right oviduct, conceived following microsurgical repair of left tubal occlusion.

An unusually aggressive verrucose carcinoma of the uterine cervix.

An unusual case of Verrucose Carcinoma of the uterine cervix is described. The tumor characteristics, as well as its aggressively malignant potential nature are presented. The unique response to irradiation therapy is discussed, hence the great difficulty in treating the tumor and the importance of early diagnosis to achieve a good prognosis. The literature regarding this unique tumor is reviewed.

Subsequent pregnancy following labor of a very-low-birth-weight infant.

During a period of 5 years (1978-1982), 55 mothers with an average age of 27.5 +/- 5.4 years, delivered 59 infants, weighing less than 1500 g. These infants had a mean birth weight of 1160.5 +/- 263 g and a mean gestational age of 28.7 +/- 2.25 weeks (range 25-32 weeks). Subsequently 47 (79.6%) survived and 12 (20.4%) died. There was a statistical difference of both mean gestational age and of mean gestational weight between survivors or infants with neonatal death. Twenty two of 29 mothers who subsequently became pregnant, gave birth to liveborn infants, who subsequently survived (four pregnancies terminated in induced abortion). Mean gestational age was 37 +/- 3 weeks (range 32-41 weeks) (P less than 0.001) and a mean birth weight was 2753.2 +/- 570 g (range 1620-3600 g) (P less than 0.001. All the 22 infants subsequently born weighed more than 1501 g, 7 (31.8%) infants weighed 1501-2500 g and 15 (68.2%) more than 2500 g. Similar data were obtained from a control group of 615 mothers (chosen at random) who delivered a normal infant at term, 202 subsequently became pregnant and 176 gave birth to a normal infant at term. Mean gestational age was 39.54 +/- 1.24 weeks (P less than 0.001) and mean birth weight was 3299.3 +/- 412 g (P less than 0.001). (In the control group 10 pregnancies terminated in induced abortions). The above data could be used in advising for future pregnancy outcome in regard to women with premature births.

Ovarian cancer in women given diethylstilboestrol in pregnancy: two case reports.

Two cases of ovarian cancer that developed many years after exposure to large dozes of diethylstilboestrol during pregnancy are reported. This paper is the first such cases reported.

Pregnancy with an artificial pacemaker.

Complete heart block in pregnancy is not a common encounter. The first case was reported in 1914 by Nanta and today some 100 cases are documented. Heart block may be congenital or acquired secondary to cardiac surgery, rheumatic heart disease, or infective disorders. Heart block, whether congenital or acquired, rarely creates any special obstetric problems. Today there is an increasing use of cardiac pacemakers in younger people and the first reported obstetric experience with a cardiac pacemaker implanted before pregnancy was by Shouse and Acker. This review will document the course and outcome of all reported pregnancies in women conceiving with an artificial pacemaker, and discuss complications and principles of management. We will also report our experience with a woman suffering from a complete heart block in whom an internal cardiac pacemaker was inserted before pregnancy.

Correlation between the endocrine profile of ovulation and the ultrasonically detected 'double contour' of the preovulatory follicle.

The exact prediction of ovulation is becoming more important in the management of infertile couples. The routine methods used to monitor ovulation are plasma levels of estradiol and luteinizing hormone, and ultrasonic scanning of graafian follicle diameter. Ovulation is known to occur at a wide range of follicular diameters and it cannot be used as a single predictor of ovulation. In a previous study we described the preovulatory double contour of the dominant follicle occurring a few hours before ovulation. The purpose of this study was to correlate this sign with the hormonal profile to determine whether it can be used as a single parameter in predicting ovulation. The results demonstrate a close relationship between the LH peak and the appearance of the double contour which can be used as a reliable predictor of impending ovulation.

Nodular malignant lymphoma presenting as bilateral adnexal masses.

A case of nodular malignant lymphoma, small cleaved cell in both ovaries, tubes and peritubal tissue is reported in a 55-year-old nulliparous woman with primary clinical symptoms of dyspnea and chest pain. The disease was first diagnosed at laparotomy. The patient was treated by bilateral adnexectomy and chemotherapy. This is the third case of adnexal small cleaved cell nodular lymphoma reported in the literature. Clinical and pathological aspects of this relatively rare pathological entity are reviewed.

Acute rupture of an ovarian pregnancy associated with a negative serum B-HCG.

A case of acute rupture of an ovarian pregnancy in which Beta Subunit of human chorionic gonadotropin was negative is presented. This is the first case known in the literature. Clinical and laboratory aspects of ovarian pregnancy are reviewed.

Management of gonadotrophin-induced cycles characterized by a significant discrepancy between oestrogen levels and dominant follicle size.

The incongruity between oestrogen elevation and immature follicles is one of the problems encountered during the induction of ovulation with gonadotrophins. This phenomenon is particularly pertinent in women with polycystic ovarian disease. Our work presents a regimen of treatment that was found helpful in overcoming this problem. It is based on a close ultrasonic assessment of the follicular growth, which also serves as the sole means for the decision of human chorionic gonadotrophin (HCG) administration (mature follicle range is 19-25 mm). Accordingly, the human menopausal gonadotrophin doses were individually adjusted and, if necessary, omitted in an effort to avoid excessive oestrogen elevation at the time of HCG administration. The resultant plateau or decline of oestrogen levels in our series do not interfere with ovulation. Seventeen conceptions occurred after 53 treatment cycles in 19 women.

Myotonic dystrophy and pregnancy: a review.

The previous reports of 20 women with myotonic dystrophy and pregnancy are reviewed, and a new case report added. Myotonic dystrophy is often unrecognized in early life due to vague symptoms, and is often first diagnosed during pregnancy which is known to worsen the main features of muscular weakness and myotonia. Complications of pregnancy and delivery are frequent and serious and should be known to all those dealing with pregnant women. A history of fetal wastage or a child suffering from symptoms of congenital myotonic dystrophy may be a clue to the diagnosis and these patients should be closely followed until safe delivery. The neonatologist should be involved as feeding and respiratory problems in the neonate may indicate that the infant is affected.

Fetal death in early pregnancy due to electric current.

Electric shock injuries in pregnant women are rare events. The uterus and amniotic fluid are thought to be excellent conductors of electric current which reaches the fetus causing cardiac arrest and fetal death. All cases except one reported in the literature occurred in the third trimester, and ended with the death of the fetus. We report a case of a woman struck by a high voltage electric current in the 13th week of her pregnancy, causing fetal death and abortion.