[Initial experience with a minidose of methotrexate in the management of unruptured ectopic pregnancy]. / Experiencia inicial con un esquema de minidosis única de metotrexate para el manejo de embarazo ectópico no roto.

Methotrexate has been used in the conservative management of ectopic pregnancy with good results. Due to its great afinity for the trophoblast it was decided to try unique doses of 50 mg i.m. independently of the body surface. Fifteen patients were studied with ectopic pregnancy by ultrasound and hCG in series that didn't require confirmatory laparoscopy. The ectopic pregnancies broken and/or decompensated were discarded. Average gestational age was 6.1 weeks; the maximal dimention of the sacs was 36.8 mm average; the values for hCG average were 6440 mU/ml and the maximal time of negativization was 52 days. One patient required laparoscopy and salpingostomy, lineal, for inminent rupture 24 hour after methotrexate, the other 14 presented with complete remission. There were no colateral effects. From the 15 patients, in 6 tubal permeability was confirmed by laparoscopy or HSG, being positive in 6 patients, it has not been evaluated, two patients with resolved pregnancy, and other on course (two of them with one salpinx). The proposed management seems to be useful in ectopic pregnancy with success, equivalent to surgical management, and other programs of medical management, with out side effects and with greater easiness of administration.

[Catheterization of the tubal ostium using hysteroscopy under laparoscopic guidance]. / Cateterización del ostium tubario bajo guía histeroscópica con control laparoscópico.

It is considered that one out of five couples present a transitory problem of infertility during their reproductive life and the most frequent cause is the tubarian pathology; from these, the proximal obstruction occupies between 25 and 30% of the cases. Unfortunatelly, the conventional method use to study tubarian patency such as histerosalpingography or the direct observation by laparoscopy and selective chromotubation, frequently do not allow to differentiate between an insufficient filling of the tubes, tubarian spasm or a true mechanical obstruction. There are certain selective tubarian cannulation techniques, for example, the catheterism with hysteroscopic guidance which is extremely usefull in the diagnosis of tubarian patency or in the confirmation of partial or total proximal tubal disease. The procedure permits to diagnosticate precisely the tubarian obstruction and also if it is due to the presence of a true pathology or simply functional, or secondary to a tubarian spasm; besides it also works as a therapeutic procedure since in the first case permits the lysis of laxe adherencies and the removal of the amorfus material that obstructs the tube and permits the catheterization. The present study determines the utility of catheterization of the tubarian ostium by hysteroscopy with laparoscopic control using the Novy (Cook, Ob/ Gyn) catheter in patients with infertility problems due to proximal obstruction of one or both of the fallopian tubes, to confirm or discard the presence of a pathological obstruction. The results are evaluated in terms of tubarian permeability and the pregnancy rate after the procedure.

[Prenatal diagnosis in 350 amniocenteses]. / Diagnóstico prenatal en 350 amniocentesis.

Between march 1988 and march 1991, 350 amniocenteses were performed as a part of the prenatal diagnosis program at the Instituto Nacional de Perinatología. Cytogenetic diagnosis was obtained in 348 cases (99.4%). A total of ten abnormal fetal karyotypes (2.9%) were detected: Down's syndrome, (5) Edwards' syndrome, (2) Turner's syndrome, (1) Klinefelter's syndrome (1) and chromosomal instability. (1) In addition, one carrier of a Robertsonian translocation, two balanced carriers of reciprocal translocations and three cases of true mosaicism, were also detected. In the group of patients studied for indications other than risk of chromosomopathy, one female fetus affected by congenital adrenal hyperplasia, was observed. There were two miscarriages, resulting in a post-procedural fetal loss of 0.57%.

[Usefulness of intraperitoneal transfusion under direct ultrasound guidance]. / Utilidad de la transfusión intraperitoneal bajo guía ultrasonográfica directa.

Experience with intraperitoneal blood transfusion, using ultrasonographic guide, in 24 patients with severe isoimmunization to Rh factor, is reported. A total of 57 procedures, were done from 24 weeks of gestation. In 66.6% two or more transfusions were done in the same product. There were 71% of alive newborns and in 29% of the cases it was not possible to improve perinatal survival. The analysis of these results were correlated with antecedents: presence of hydrops, gestational age at the time of resolving pregnancy, and main disease status. The usefulness of intraperitoneal transfusion, is commented upon, and new perspectives, as intravascular transfusion in cases with severe hydrops, are considered.

[Unexplained sterility. Treatment with superovulation and intrauterine insemination]. / Esterilidad inexplicable. Tratamiento con superovulación e inseminación intrauterina.

Fifty couples with unexplainable sterility, were selected for study. They were treated following a uniform treatment protocol, consisting in inducin superovulation by human menopausic gonadotropins hormones, followed by intrauterine insemination with husband's fresh semen. One hundred and thirty six cycles of treatment, were obtained; 15 pregnancies were achieved, corresponding to 30% of the total of couples, and to 11% of amount of treatment cycles. These figures were similar to other author's, and similar to the ones obtained by intrauterine gametes transference. It is concluded that this a new alternative of treatment that may be used before IGT, or in places where there is not such methodology.