Women's attitudes towards management of breech presentation at term.

Current advice on the management of breech presentation at term is that all uncomplicated cases should be offered external cephalic version (ECV) or an elective caesarean section. Clinical experience suggests that ECV is currently not offered as widely as advised and that the majority are delivered electively by caesarean section. We present the results of a patient attitude survey of term breech deliveries in a university teaching hospital over 12 months. The results show that half of respondents were not offered ECV and that two-thirds of these women were not eligible for ECV, either having had a previous caesarean or breech presentation diagnosed in labour. One-third of women, potentially suitable for ECV, were not made aware of their options. The majority are offered elective caesarean section with a small minority (10%) opting for planned vaginal breech delivery.

Antibiotic treatment based on seminal cultures from asymptomatic male partners in in-vitro fertilization is unnecessary and may be detrimental.

We questioned the policy of routine microbiological culture of semen prior to in-vitro fertilization (IVF) with a view to prescribing antibiotics to reduce the risk of introducing seminal infection into the embryo culture system. An initial retrospective study examined serum microbiology reports of 449 couples undergoing IVF or gamete intra-Fallopian transfer (GIFT). In semen samples taking >/=1 days to reach the microbiology laboratory compared with same-day delivery there was increased frequency of significant culture of enterococci (27 versus 15%, P < 0.01). In samples taking >/=2 days there was increased frequency of significant culture of Gram-negative bacilli (31 versus 12%, P < 0.01) and of overall culture of other potentially pathogenic organisms (26 versus 14%, P < 0.01). We questioned diagnostic accuracy and relevance. Therefore, in a prospective study, semen and high vaginal swabs obtained on the day of oocyte collection were cultured from 100 couples having IVF or GIFT, of whom 52 male partners had been treated with antibiotics following positive pre-IVF semen culture. The presence of bacteria in semen samples used only for IVF (n = 90) did not reduce fertilization rates nor lead to infection of the embryo culture system. However, there was an increased incidence of significant culture of vaginal Gram-negative bacilli in patients with treated partners compared with untreated partners [15/52 (29%) versus 5/48 (10%), P < 0.05]. Thus antibiotic therapy in the male partner may increase the likelihood of inoculation of antibiotic-resistant pathogenic bacteria from the vagina into the embryo culture system during vaginal oocyte collection. In asymptomatic patients, microbiological screening of semen samples prior to IVF treatment and subsequent treatment with antibiotic therapy in those with positive cultures appears to be unnecessary and may be detrimental to IVF outcome.

Experience using preparations of follicle-stimulating hormone alone to stimulate the ovaries for assisted conception after pituitary desensitisation and simplified management of treatment.

The results are reported of 2,204 cycles of treatment started for in vitro fertilisation and embryo transfer or gamete intrafallopian transfer, during 5 years, 1990-1994, using only follicle-stimulating hormone (FSH) preparations to stimulate the ovaries following pituitary desensitisation, combined with greatly simplified scheduling and monitoring of treatment. The physiological principles underlying these choices are discussed. In all women under 40 years of age and men with normal sperm, the use of unpurified urinary FSH in 1990-1993 resulted in oocyte collection in 94% of cycles started, pregnancy in 29% and live births in 23%. Using highly purified urinary FSH (uFSH-HP; Metrodin HP) during 1994, the rate for oocyte collection was 97% and pregnancy 25% (birth rates not yet available). The difference compared with previous years was not significant. A study of 93 first cycles using uFSH-HP showed that the dosage required was usually (expressed as medians) 24 ampoules over 12 days (2 ampoules/day) resulting in 9 oocytes (range 2-36) of which 93% were mature and 64% resulted in cleaving embryos. The results are comparable with the best using human menopausal gonadotropin or unpurified FSH and classical detailed monitoring.

Ovarian hyperstimulation syndrome may be more likely if multiple pregnancy occurs following assisted conception.

Whereas modern assisted conception with such techniques as in vitro fertilisation now helps many subfertile couples to fulfill their ambition to have a child, it has not been without a price. The increased incidence of multiple pregnancies, with their attendant maternal and perinatal sequelae following assisted conception is well known, but perinatologists may be far less familiar with the Ovarian Hyperstimulation Syndrome (OHSS) which is the other major complication when controlled ovarian hyperstimulation is used during assisted conception treatment. Mild forms of OHSS are common and require no more than symptomatic treatment. Severe forms of OHSS are uncommon occurring in 0.6% to 14% of IVF cycles, but are nonetheless very important to identify as they may lead to thrombo-embolic disease, cardiorespiratory dysfunction, renal failure and even death [6]. This review considers whether OHSS may be related to multiple pregnancy by reviewing the available literature and local experience.

The interaction of benzodiazepines with thyrotropin-releasing hormone receptors on clonal pituitary cells.

1. Seven benzodiazepines were investigated for their ability to interact with receptors for thyrotropin-releasing hormone (TRH) on GH3 and GH4C1 pituitary tumour cells. 2. Midazolam and chlordiazepoxide were the most potent inhibitors of TRH-induced [3H]-inositol phosphate formation with Ki values in the low micromolar range. The antagonism was competitive in nature and was increased in potency at sub-physiological temperatures. 3. None of the agents examined antagonized bombesin-induced [3H]-inositol phosphate formation in GH4C1 cells. 4. While the ability of benzodiazepines to interact with the GABA receptor-chloride channel ionophore is markedly stereospecific, little difference was evident in the ability of (+)- and (-)-4-methylmidazolam (Ro 21-5656 and Ro 21-5657) to compete with TRH at its receptor. 5. Recently it has been suggested that, in contrast to phosphatidylinositol hydrolysis, the TRH-induced breakdown of phosphatidylinositol polyphosphates is transient in clonal pituitary cells. Addition of chlordiazepoxide to TRH-stimulated GH3 cells up to 60 min after initiating the reaction leads, however, to an immediate decline in the cellular content of inositol trisphosphate. This indicates that TRH-induced phosphatidylinositol 4,5-bisphosphate hydrolysis is not transient.

The role of androgens in the effect of diabetes mellitus on hepatic drug metabolism in the male rat.

Diabetes mellitus exerts a sex-dependent effect on hepatic drug metabolism in the rat and it has been suggested that this is due to a reduction in serum androgen levels. This study shows that the effect of diabetes is only seen in the presence of androgen and that testosterone can reverse the effect of diabetes on drug metabolism. Diabetes, however, does not consistently cause a reduction in serum testosterone. Diabetes and androgens, therefore, are postulated to interact in their effects on drug metabolism by action on a common mediator. It is suggested that this mediator is growth hormone, which is known to be affected by the androgens and insulin and to be involved in sex differences in drug metabolism in the rat.