Maternal serum levels of placental proteins after in vitro fertilisation and their implications for prenatal screening.

OBJECTIVES: To determine whether the serum levels of pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta(1)-glycoprotein (SP1), placental lactogen (hPL) and human chorionic gonadotrophin (hCG) are different in pregnancies obtained after in vitro fertilisation (IVF) and embryo transfer (ET) in comparison to spontaneous pregnancies. Assessment of the need to establish normal medians for biochemical trisomy screening in IVF pregnancies. METHODS: The population comprised 96 IVF-ET pregnancies, of which 79 came from fresh gonadotrophin-stimulated cycles and 17 from embryo transfers without gonadotrophin stimulation (natural cycle IVF, frozen embryo transfers), and 156 spontaneous pregnancies. A single blood sample was obtained between 7 + 0 and 16 + 3 weeks. PAPP-A, SP1, hPL and hCG were quantified and the levels compared between gonadotrophin-stimulated IVF, steroid-only- or non-stimulated IVF, and controls with respect to gestational age using non-parametric statistical analysis. RESULTS: PAPP-A and hPL levels were reduced after stimulated IVF in early gestation (before 10 pregnancy weeks); SP1 followed the same trend without reaching statistical significance. hCG tended to be increased after IVF treatment including non-gonadotrophin-stimulation cycles, and also beyond 10 pregnancy weeks. CONCLUSION: Reduced PAPP-A with increased hCG yields an increased risk in screening for foetal trisomy 21. We confirm recently published observations but do not recommend the establishment of normal medians for IVF pregnancies since the extent of the deviations is varying according to the different stimulation protocols and dosages of gonadotrophins used.

Rabbit oviduct mucosa healing after accidental transmucosal suture passage.

The purpose of this study is to show by SEM the characteristics of mucosal healing related to the presence of intraluminal sutures of nylon (nonabsorbable) or dexon (absorbable) in the rabbit oviduct. Altogether, 30 animals with anastomosis in the isthmus were killed 2, 4, 8, or 12 weeks after the operation. Tubular structures or pieces of thread partially or completely covered by the epithelium were found n 36.8% of these cases. Independently of the suture material used, already 2 weeks after surgery, the thread was covered by an epithelium composed mostly of squamous cells and some rare ciliated cells. At 4 weeks, the proportion of ciliated cells was increased. Regions with the usual cellular morphology and repartition of the different cellular types were also observed. However, at 8 and 12 weeks, islets of atypical squamous cells persisted in areas of transmucosal passage of the suture material. At 12 weeks, the dexon suture was not yet completely absorbed.

Antisperm antibodies and in vitro fertilization failure.

A new enzyme-linked immunosorbent assay (ELISA)-based test (Zer, Jerusalem) has allowed us to show the presence of antisperm antibodies (1:32 to 1:64) in the blood of 14 (33%) of 32 patients undergoing in vitro fertilization and embryo transfer (IVF-ET) under gonadotropin stimulation. Observation of the morphology of fertilization in eight patients with and seven patients without antisperm antibodies has shown a significant association (P less than or equal to 0.025, Fisher exact probability test) among the cumulus/corona coagulation, the absence of fertilization, and the presence of these antibodies. Cumulus/oocyte complex washing and/or enzymatic cumulus removal are considered as elective interventions in the case of antisperm immunity. Each patient entering an IVF-ET program should have the antisperm antibody assay performed as a preliminary screening.

Systematic pH-measurements in the umbilical artery: causes and predictive value of neonatal acidosis.

Subpartal and neonatal blood gas analyses have attracted increasing interest during the past 20 years. Different studies have been carried out to investigate the causes and immediate consequences of perinatal acidosis. It was the aim of this study to examine the long term outcome of acidotic-born babies. During 16 consecutive months all deliveries in the Obstetric Department of the Centre Hospitalier Universitaire Vaudois (CHUV) were investigated with regard to incidence and causes of a perinatal acidosis (pHa.umb. less than 7.15). The psycho-motor development of all acidotic newborns was followed up for an average of 15 months. Out of 1922 deliveries a blood sample was available in all but 11 cases (0.57%). Seven newborns were excluded from the study on the assumption that their acidosis and outcome might be related to the underlying condition (congenital malformation and infection, extreme prematurity) rather than perinatal events. From the remaining 1904 deliveries 6.4% (N = 121) had a pHa.umb. less than 7.15 (Tab. I). The incidence of certain perinatal factors was compared in the acidotic and the non acidotic groups (Tab. II). The percentage of acidotic newborns is significantly higher in primipareae, in deliveries done on peridural analgesia in cord complications and premature rupture of the membranes, and in forceps deliveries. No difference could be found with regard to multiple pregnancies, meconiumstained amniotic fluid, cesarean sections, prematurity of 28-37 weeks, and sex. The relationship between CTG score and pHa.umb. is summarized in Tab. III.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of uterine rupture due to interstitial pregnancy of 22 weeks duration (author's transl)]. / A propos d'un cas de rupture utérine sur grossesse interstitielle de 22 semaines.

This paper describes a very rare case of uterine rupture on an interstitial pregnancy of 22 weeks. The etiopathological hypothesis, the diagnostic difficulties, the evolution as well as the conservative surgical treatment are discussed with a review of the literature.

Abscess formation of a Gartner's duct cyst with cervical communication in a case of bicornuate uterus associated with an ipsilateral renal agenesis.

One case of abscess formation of a Gartner's duct cyst communicating with the cervix of a bicornuate uterus is presented in a case of ipsilateral renal agenesis. The embryonic origin and the incidence of associated genital and urologic malformations are discussed. Marsupialization is recommended as an adequate method of treatment.

[Immediate reconstructive surgery in the treatment of ectopic pregnancy (author's transl)]. / Chirurgie restauratrice d'emblée dans le traitement des grossesses extra-utérines.

In cases of non ruptured tubal ectopic pregnancy, the first results of immediate reconstructive surgery demonstrate the need to give up classical salpingectomy, and the possibility of avoiding a second laparotomy. The technique used in this series of six unruptured ectopic pregnancies of the ampulla consisted in a subserous enucleation-excision of the ectopic ovum with end-to-end anastomosis on a polyethylene wire, followed by early hydrotubations. Hysterosalpingographic controls performed 3 months after the operation showed in all six cases bilateral passage and peritoneal spill of the contrast medium. Three patients have at the time of writing intrauterine pregnancy (16, 22 and 33 weeks old). Thus the anatomical integrity of the fallopian tubes could be restored in every case, as early as the emergency laparotomy for suspicion of unruptured ectopic pregnancy confirmed by laparoscopy. No early or late postoperative complications occurred in this series.