[Severe fetal hemolytic disease. Evaluation and successful treatment by means of cordocentesis]. / Enfermedad hemolítica fetal severa. Evaluación y tratamiento exitoso mediante cordocéntesis.

Ultrasonically guided access to the fetal umbilical circulation offers an alternative to the standard management of the severe isoimmunized pregnancy. This technique allows fetal blood sampling, direct hematocrit analysis and intravascular transfusion. A severely Rh isoimmunized pregnancy is described in which five intrauterine transfusions of blood were given directly into the umbilical vein under ultrasound visualization. Technical aspects of the procedure and complications are discussed.

New insights on the mode of action of intrauterine contraceptive devices in women.

To gain a better understanding of the mechanism of action of intrauterine devices (IUDs), a search was made for ova in the genital tracts of 115 women using no contraception and of 56 women using IUDs, all of whom volunteered for study in conjunction with surgical sterilization. Ova were recovered from tubal flushings between 48 and 120 hours after the midcycle peak of luteinizing hormone in 39% of the IUD users compared with 56% of women in the control group (0.05 less than P less than 0.10). This suggests an action of the IUD before the ovum reaches the uterus. Eggs with a microscopic appearance consistent with fertilization were recovered from the fallopian tubes of half of the women using no contraception who had intercourse within the fertile period of the reproductive cycle and from whom ova were recovered. In contrast (P less than 0.01), no eggs with this appearance were recovered in IUD users who had intercourse within the fertile period. No ova were recovered from the body of the uterus of any of the IUD users. Fertilized ova are less likely to reach the uterine cavity containing an IUD. Thus, the principal mode of IUDs is by a method other than destruction of live embryos.

[Human tubal contractility in vivo. Analysis of the reproducibility and iatrogenics of a method of study]. / Contractilidad tubaria humana in vivo. Análisis de la reproducibilidad y yatrogénia de una metódica de estudio

PIP: Techniques for the study of tubal motility in vivo can provide important basic information, but their safety and the potential risks to which patients are exposed must be considered. 30 patients were studied, of whom 10 left the program. They were in good health and good gynecological conditions for at least 6 months after retrieving the tubal devices. Temporary changes in the ovaric cycle were observed in 3 patients; these changes and possible endocrine alterations induced by surgery must be considered in planning studies. 1 patient became pregnant 4 months after sterilization. The method was used previously by Maia and, Coutinho, and findings are consistent with those of the earlier study. The amplitude of tubal contractions is generally within 0-10 mm Hg and occasionally 0-20. Spontaneous tubal activity is asynchronous, and may be the result of the local release of certain compounds, probably catecholamines. The findings may be limited to patients subjected to tubal ligature, but findings on other patients are similar.^ieng