Prognostic value of repeated serum CA 125 measurements in first trimester pregnancy.

OBJECTIVE: To assess the diagnostic value of maternal CA 125 in patients with symptomatic first trimester pregnancy and to evaluate the prognostic significance of CA 125 versus beta-hCG in early pregnancies with intact fetal heartbeat, complicated by vaginal bleeding. STUDY DESIGN: Two prospective open-label studies with longitudinal follow-up in the second trial. SETTING: Academic Department of Obstetrics and Gynecology, University of Cologne. PATIENTS: Study 1: 168 patients presenting between gestational weeks 6 and 12 with: extrauterine pregnancy, 29; missed abortion, 50; incomplete spontaneous abortion, 38; imminent abortion, 33; and normal pregnancy (no history of endometriosis or ovarian mass), 18. Study 2: Fifty consecutive patients with vaginal bleeding during gestational weeks 6-12 all of whom having demostrable fetal heartbeat. Eighteen patients finally aborted whereas the remainder had normally continuing pregnancy until term. MAIN OUTCOME MEASURE: Study 1: Single serum determinations of CA 125 and beta-hCG were correlated with the different disorders observed. Study 2: Two sequential measurements of serum CA 125 and beta-hCG performed within a 5-7 days interval were related to the outcome of pregnancy as indicated by changes of the ultrasound presentation, miscarriage, future hospitalization, or delivery. RESULTS: Study 1: Patients with vaginal bleeding generally had higher median CA 125 values (38 IU/ml; range 1.3-540) compared to non-bleeding patients (17.8 IU/ml; range 1.0-157). No statistically significant differences in regard to median serum CA 125 levels between symptomatic and normal pregnancies occurred: normal pregnancy, 25.5 IU/ml (range 3.2-97); ectopic pregnancy, 26 IU/ml (range 1.3-157); missed abortion, 19.1IU/ml (range 1-242); threatened abortion, 48 IU/ml (range 5.2-540); spontaneous abortion, 40 IU/ml (range 5.4-442). Study 2: Initial CA 125 levels did not differ significantly between both groups of patients with 27/32 non-aborters and 13/18 aborters showing concentrations below 65 IU/ml. After 5-7 days, CA 125 in all patients who eventually aborted remained high or increased whereas non-aborters all had constantly low or steeply declining CA 125 measures. beta-hCG increased in all non-aborters but also in 13/18 aborters during the 5-7 day interval. CONCLUSION: Single serum measurements of CA 125 in symptomatic first trimester pregnant patients failed to discriminate spontaneous abortion, ectopic or normal pregnancies. However, sequential determinations of maternal CA 125 measurements appear to be a highly sensitive prognostic marker in patients with viable pregnancy at risk for abortion.

Sulbactam/ampicillin versus cefoxitin in the treatment of gynaecological infections: an antibiotic therapeutic study.

Seventy-six women with gynaecological infections such as endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis were treated with sulbactam/ampicillin (SBT/AMP) (50% of patients) or cefoxitin (CFN) (50% of patients) in a randomized, controlled study. The diagnosis was based on the history, clinical findings and microbiological culture findings. The disease was assumed to be of bacterial origin if leukocytosis was present with a left shift or if the causative organism was identified. Of the group of patients treated with SBT/AMP, 33 (87%) were cured and 4 (10.5%) showed improvement; 1 patient (2.5%) failed to respond to treatment. The equivalent figures for the CFN group were: 30 patients (79%) cured, 4 (10.5%) showed improvement and 4 (10.5%) failed to respond to treatment. The causative organism was eradicated in 29 (91%) patients in the SBT/AMP group and 20 (59%) patients in the CFN group. Reinfection occurred in 1 (3%) patient in the SBT/AMP group and 4 (12%) patients in the CFN group. The causative organism persisted in 1 (3%) patient in the SBT/AMP group and 4(12%) patients in the CFN group. The superiority of SBT/AMP in microbiological terms was statistically significant, but the superiority of SBT/AMP in terms of clinical efficacy was not. The combination of SBT and AMP was efficacious and well tolerated in the treatment of gynaecological infections. This combination offers the advantage of being effective against Streptococcus faecalis and beta-lactamase producing organisms.

[Premature rupture of fetal membranes: problems and obstetric management]. / Der vorzeitige Blasensprung: Problematik und geburtshilfliches Management.

The treatment of a premature rupture of the foetal membrane (prom) has up to now been a subject of controversy. Depending on the stage of gestation, the prompt birth ensuing as a result of prom, involves the risk of immaturity of the child. Conservative waiting by contrast, exposes mother and child to a potential risk of infection. The retrospective study presented, summarises the strategies for treating prom used at the Cologne University Department of Obstetrics and Gynaecology during the period from 1984 to 1989, and attempts to develop from these data proposals for the treatment of prom. With an increase in latency of over 24 hours between prom and delivery, the maternal and neonatal rate of infection also increased significantly. An effective result of a prophylaxis with antibiotics could only be shown in the reduction of incidence of infection in the mother. An effect on the neonatal rate of infection could not be seen. Inducing prepartually lung-maturity with glucocorticoides or ambroxol resulted in a significant decrease of the RDS-rate in new born children up to the 34th week of gestation. Beyond the 34th week of gestation, this effect could not be found. Whereas after completion of the 37th week of gestation, the preferred treatment used by doctors is allowing the shortest possible time of latency between prom and delivery, the expected pulmonary immaturity before the 34th week of gestation has to be treated by prolonging the pregnancy and inducing pulmonary maturity under antibiotic prophylaxis and at the same time controlling infection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical relevance and pathognomonic significance of Actinomycetes colonization of intra-uterine devices]. / Klinische Relevanz und pathognomonische Bedeutung der Aktinomyzetenbesiedlung von Intrauterinpessaren.

Microbiological investigations were carried out on 524 intrauterine pessaries (IUP) from 488 patients. All patients underwent a gynecological examination on the occasion of IUP extraction. An actinomycete colonization of the extracted IUPs could be detected by culture in 8% of the cases. Actinomyces israelii was cultured most frequently. The raised detection of anaerobic bacteria in the endocervix of patients with actinomycin detection constitutes a potential danger for these women with regard to the development of genital actinomycosis. In addition, the clinical parameters document a higher susceptibility of these patients to ascending genital infections. The infectious morbidity is significantly raised.

[Child development following severe intrauterine growth retardation--results of follow-up studies]. / Die kindliche Entwicklung nach schwerer intrauteriner Wachstumsretardierung--Ergebnisse von Follow-up-Studien.

94 prenatally severely dystrophic newborn (year of birth: 1970 to 1982) of the Department of Gynaecology of the University of Cologne were catamnestically investigated when they 2 to 12 years of age; follow-up examinations were performed by paediatricians, neurologists, EEG specialists and by test psychology. In more than one-half of the children followed up in this manner delays in early childhood development were seen; there were no conspicuous differences between the two groups (classified according to years of birth). On comparing the age brackets 1970-1975 and 1976-1982 about one-third of the children in both groups presented at follow-up clearly evident signs of retarded growth. In 32% of the children born between 1970 and 1975 mostly mild neurological deficits or slight impairments of nerve function were observed, whereas in the 1976-1982 group this figure was 26%. The incidence of cerebral pareses was 7% and 9%, respectively. Disturbances of fine motor response were most frequently seen. Mild to moderate EEG changes occurred in both patient groups at about the same rate of incidence (34% and 32% respectively); one child in each group presented with definitely pathological electroencephalographic findings. Pathological test psychology results were seen in 38% (1970-1975) and 21% (1976-1982) of the followed-up children; the tests employed were the Göttingen form reproduction test in children born between 1970 and 1975 and the Denver development test in the younger children born between 1976 and 1982.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and pathomorphologic studies of the precancerous significance and prognostic assessment of epithelial changes in the vulva]. / Klinische und pathomorphologische Untersuchungen zur präkanzerösen Bedeutung und prognostischen Wertung epithelialer Vulvaveränderungen.

For an observation period of 19 years the authors compiled the relevant clinical and pathomorphological data of patients of the Department of Gynaecology of the University of Cologne to assess the epithelial alterations in the vulva. Particular attention was given to the simultaneous or earlier presence of other genital carcinomas and of genital precancerous growths, especially to the high coincidence rate of malignant and premalignant lesions of the cervix uteri. Metric measurements were performed on histological section preparations to determine the extent and dimensions of microinvasions, i.e. of microcarcinomas. Histological examination of the epithelial alterations adjacent to invasive vulvar carcinomas revealed a carcinoma in situ in only 35% of the cases, in contrast to the situation at the cervix uteri. No definite answer can as yet be given to the question of the concrete risk of malignant degeneration of the carcinoma in situ of the vulva.

Sulbactam/ampicillin versus cefoxitin in the treatment of obstetric and gynaecological infections.

Preliminary results of a randomised trial comparing parenteral sulbactam 1g plus ampicillin 2g every 8 hours and cefoxitin 2g every 8 hours in 75 patients with gynaecological infection are reported. Clinical and bacteriological cure were achieved in 87% and 91% of patients treated with sulbactam/ampicillin compared with 83% and 59% treated with cefoxitin. Both treatments were well tolerated.

[Determination of the ovulation date in women with disturbed cervical factor by means of sonographic measurement of follicular growth, hormonal parameters and basal body temperature]. / Bestimmung des Ovulationstermines bei Frauen mit gestörtem Cervixfaktor mittels sonographischer Messung des Follikelwachstums, hormoneller parameter und Basaltemperatur.

In 23 women from the fertility clinic with disturbed cervical factor and ovulatory cycles, the BBT was carried out, FSH, LH, progesterone and E2 were assayed and the follicular maturation was determined sonographically. The hormonal assays and ultrasound investigations were performed as a rule at 1-2 day intervals. The follicles were measured three dimensionally. At the time of ovulation, the mean diameter averaged 23 mm. There was a very good correlation between the various methods for determining the date of ovulation. Since the cervical factor could not be used for date determination in the patient group investigated, the immediately available result of the ultrasonographic investigation proved to be especially valuable. It was possible to attain a pregnancy in four cases.