Combined pregnancy: the Mount Sinai experience.

Nine recent cases of coexisting intra- and extrauterine pregnancy at The Mount Sinai Medical Center are presented. The myriad of clinical presentations is exemplified in the postabortal, endometriosis, posttreatment; ovulation induction, and routine "rule-out ectopic" situations. A brief review of the literature follows detailing historical reports of diagnostic inaccuracy and delayed diagnosis. Several studies are cited supporting the difficulty of correctly diagnosing heterotopic pregnancy as well as factors which may predispose to it. The advantages and pitfalls of ultrasonography are mentioned as well as recommendations for early laparoscopic intervention when clinical history and ultrasound are suggestive. Caution is advised in those infertility patients who may undergo "routine" curettage at laparoscopy for ectopic pregnancy and thus, be at risk for inadvertent termination of an otherwise salvageable intrauterine pregnancy. This report further supports several other reviews in noting that the incidence of combined pregnancy may be much greater than formerly appreciated.

Post-conceptional induction of menses with a single vaginal suppository of (15S)-15-methyl prostaglandin F2 alpha methyl ester.

The induction of post-conceptional menses needs a technically simple method which would avoid instrumentation of the uterus. One possible method investigated in this study is the abortifacient effect of a single dose long-acting vaginal suppository containing 3.0 mg of (15S)-15-methyl prostaglandin F2 alpha methyl ester. Pregnancy was terminated successfully in 13 of the 14 subjects. Two successful patients required curettage for prolonged bleeding and retained products of conception. Prolonged vaginal bleeding and the uncertainty of endpoints with particular reference to human chorionic gonadotropin (HCG) constitute the major problem with this non-invasive method, and are discussed in the light of the data obtained.

PIP: The clinical characteristics and applicability of vaginal administration of a single suppository of (15S)-15-methyl prostaglandin F2alpha (PGF2alpha) methyl ester in postconceptional induction of menses was evaluated in 14 healthy women who were no more than 7 weeks pregnant and desired pregnancy termination. Each suppository contained 3.0 mg of 15S-15-methyl PGF2alpha methyl ester in a 2.2 gm base of Witepsol E-76-A. Blood samples were collected at 0, 4, 8, and 10 hours and again at the 14th day follow-up visit for analysis of serum chorionic gonadotropin (HCG) levels using the Beta subunit radioimmunoassay as described by Vaitukaitis et.al. and serum progesterone levels using the radioimmunoassay method of Kirton et.al. Pregnancy termination was successful in all but 1 patient. Vaginal bleeding persisted for at least 14 days in 8 cases; 2 of these patients necessitated curettage at 4 weeks and 9 weeks after the procedure. The failed case was an obese woman whose pregnancy persisted. HCG levels declined below the arbitrary limit of 1 I.U./ml within 2 weeks after therapy in 36% of the cases. Plasma progesterone levels declined below the baseline level of 5 ng/ml within 2 weeks. A wide range of values was observed at 4 and 8 hours. The 1 failure case had an initial value of 72 pg/ml at 4 and 8 hours; all cases with undetectable levels at 8 hours had initial values over 138 pg/ml. In patients with prolonged bleeding, serum HCG and progesterone showed a significantly slower decline than in patients with an uneventful abortion. Diarrhea occurred in 86% of the cases and vomiting in 36%. The study illustrates the effectiveness of administration of 1 vaginal suppository containing 3.0 mg of PGF2alpha methyl ester in 1st trimester abortion. However, the bleeding and gastrointestinal side effects associated with this method preclude its widespread use.

A comparison between vaginal prostaglandin E2 suppositories and intrauterine extra-amniotic prostaglandins in the management of fetal death in utero.

This retrospective study was undertaken to compare the efficacy, side effects, and complications of prostaglandin E2 (PGE2) given as a vaginal suppository with those of PGE2 administered via the intrauterine extra-amniotic route to induce labor after fetal death. The induction-to-delivery intervals were comparable, with 9.2 +/- 3.94 hours and 8.6 +/-4.49 hours, respectively. However, the mean total amount of PGE2 administered was much less via the intrauterine extra-amniotic route (1.8 milligrams) than by the vaginal suppository (45.2 mg). There was a 100% success rate in the patients treated by the intrauterine extra-amniotic route, but only a 91.3% success rate in those patients treated via the vaginal route. The side effects (vomiting, diarrhea, fever) and the complications (incomplete abortion, uterine rupture, oxytocin augmentation) occurred more frequently with the use of PGE2 as a vaginal suppository. The vaginal route of administration of PGE2 is somewhat more convenient, but the intrauterine extra-amniotic route may offer a higher degree of efficacy and safety with fewer side effects in the management of fetal death in utero.

Meiosis in Coprinus VII. The prekaryogamy S-phase and the postkaryogamy DNA replication in C. lagopus.

The kinetics of incorporation of 32P into DNA have unequivocally shown that the premeiotic S-phase in Coprinus lagopus occurs before the onset of karyogamy. It takes 8 h under the control conditions (25 degrees C with a 16 h light-8 h dark regime) but only 6 h under the arrest-release conditions. An important discovery in this study is that the initiation of premeiotic DNA replication is subject to an arrest by restrictive conditions (35 degrees C under a continuous light regime) whereas that of the mitotic replication is not. Once initiated, meiotic DNA replication can continue even under the restrictive conditions. Incorporation of 32P into DNA at pachytene is quite extensive. These replications are considered to be repair replications.