Borenstein R

Intravenous albumin for the prevention of severe ovarian hyperstimulation syndrome in an in vitro fertilization program : a prospective, randomized, placebo-controlled study

OBJECTIVE To evaluate the efficacy of i.v. administration of human albumin solution for the prevention of severe ovarian hyperstimulation syndrome (OHSS). DESIGN A prospective, randomized, placebo-controlled study comparing the effects of i.v. administration of human albumin solution versus sodium chloride 0.9% solution at the time of oocyte retrieval with patients undergoing IVF-ET who are at high risk for the development of severe OHSS. SETTING Specialized assisted reproduction unit. PATIENTS Thirty-one patients undergoing IVF-ET who had serum E2 levels of 1,906 pg/mL (> 7,000 pmol/L) and multiple follicular development on the day of hCG administration. INTERVENTIONS After hCG administration, patients were randomized to receive i.v., either 50 g of human albumin diluted in 500 mL of sodium chloride 0.9% or 500 mL of sodium chloride 0.9% at the time of oocyte retrieval. MAIN OUTCOME MEASURES Ovarian size as measured by pelvic ultrasonography, development of ascites, serum E2 concentrations during the luteal phase, and results of the IVF-ET cycles. RESULTS Although no patient who had received human albumin solution developed severe OHSS, there were four such cases in the control group. All four were hospitalized with marked ascites and ovarian enlargement. There were no significant differences between the two groups comparing serum E2 levels on the day of hCG administration and during the luteal phase, the number of oocytes retrieved, fertilization, and pregnancy rates. CONCLUSIONS Our preliminary results suggest that the administration of human albumin solution may help to prevent the development of severe OHSS in high-risk patients. Further research is needed to assess the potential of this novel approach.

Severe ovarian hyperstimulation syndrome: a reevaluated therapeutic approach

During the 10 years 1978 to 1987, 33 patients were hospitalized because of moderate and severe ovarian hyperstimulation syndrome (OHSS) in 39 treatment cycles. Twenty-five treatment cycles ended in moderate OHSS (group A), 7 had severe OHSS without a significant amount of ascites (group B1), and 7 had severe OHSS with ascites (group B2). Groups A and B1 received intravascular volume expander, electrolytes replacement, and indomethacin up to 300 mg/day. The patients in group B2 had significant clinical and biochemical improvement after abdominal paracentesis. Urinary output and creatinine clearance improved significantly, and a decrease in hematocrit, blood osmolarity, and weight reduction were achieved. A strategy for treatment of OHSS based on consecutive ultrasonographic examination, clinical and biochemical evaluation, and abdominal paracentesis in severe OHSS with clinically significant ascites is suggested.

Prevention of premature labor by 17α-hydroxyprogesterone caproate

Abstract Eighty pregnant women at high risk of giving birth prematurely were divided randomly into two groups. Treatment with either 17α-hydroxyprogesterone caproate, 250 mg by intramuscular injection once a week, or a placebo was given in a double-blind fashion. Imminent premature labor occurred in 29.0% of the treated group and in 59.4% of the control group (p

HORMONAL PROFILES FOLLOWING CLOMIPHENE CITRATE THERAPY IN CONCEPTION AND NONCONCEPTION CYCLES

The hormonal profiles following clomiphene citrate (CC) administration during a single cycle were compared in infertile women who conceived and in those who did not. Of 41 treated patients, ovulation was assumed to have occurred in 28 and was confirmed by clinical pregnancy in five. In the 28 women who presumably ovulated, two distinct patterns of hormonal secretion were observed. A normal response was exhibited by 17 patients (including the five who became pregnant). The other 11 patients exhibited an abnormal response, characterized by significantly higher luteinizing hormone (LH)/follicle‐stimulating hormone (FSH) ratios than in the normal response group from day 9 until the occurrence of the LH peak (days 9 and 10, P > 0.05; days 11 and 12, P > 0.001), and significantly higher oestradiol (E2) levels throughout the cycle (P > 0.01). In addition, in comparison with the normal response group their LH levels during the follicular phase were significantly higher (P > 0‐05) but their LH peaks at ovulation were significantly lower (P > 0.02). Moreover, their progesterone levels, in contrast to those in the normal response group, began to increase prior to the LH peak and remained high during the early and mid‐luteal phases. None of the women who exhibited this abnormal gonadotrophin response to CC therapy achieved a clinical pregnancy. Exposure to high LH levels in the follicular phase following CC therapy seems to reduce the rate of fertilization and/or to contribute to early embryonic loss.

Cystadenofibroma of the ovary: A clinicopathologic study of 34 cases and comparison with serous cystadenoma

The clinicopathologic features of 34 cystadenofibromas were analyzed and compared to those of 39 serous cystadenomas. The clinical features of the patients with cystadenofibromas were similar to those of the patients with cystadenoma. Pathologic features showed the following differences: Papillary projections of cystadenofibromas consisted of short, broad, firm structures which were frequently hyalinized. Those of cystadenomas were slender, delicate and friable showing less frequent hyalinization. Epithelial elements in both tumors were similar to those seen in a variety of neoplasms of müllerian derivation. However, while all the cystadenofibromas were histologically unequivocally benign, 6 cystadenomas showed epithelial tufting, 5 mitoses and atypia each, and 3 of these were diagnosed as borderline malignant. Characteristic histologic findings in the cystadenofibromas established beyond doubt their origin from germinal epithelium and underlying stroma, whereas in some of the other ovarian tumors of müllerian derivation, the cellular origin often remains conjectural at best. We concluded that ovarian cystadenofibroma is more common than generally believed and that is of an entirely benign nature, necessitating only conservative surgical therapy. The characteristic pathologic features of this neoplasm justify its separate listing in the group of müllerian ovarian tumors of surface epithelial and ovarian stromal origin.

Isolated tubal torsion : clinical and ultrasonographic correlation

A 13 year old girl developed sudden onset of left lower abdominal pain 30 hours prior to arrival. She previously had enjoyed perfect health, and menarche had occurred 3 months before the current episode. Family history was unremarkable, and no history of previous abdominal pain was elicited. After the onset of left abdominal pain, the pain assumed a colicky nature accompanied by nausea and vomiting. No urinary symptoms were encountered, and the patients temperature was normal. On examination, an ill-appearing girl with slight tachycardia of 92 beats per minute was encountered. Tanner pubertal development of grade III was assigned. The abdomen was soft to palpation, and no outright signs of peritoneal irritation were elicited, although some voluntary guarding in the left lower quadrant was noticed. On pelvic examination per rectum, labia and

Experiences with Danazol (an antigonadotropin) in the treatment of infertility

Abstract An antigonadotropic agent, Danazol, was used in the management of 48 patients with either primary or secondary sterility. All patients were infertile for 3 or more years before Danazol was employed. In Group 1, 11 of 21 had proved endometriosis histologically; the rest had suspected endometriosis by history and examination. In the second group of 27, no reason for infertility was found. A dose of 200 mg. was given orally for 100 days to all patients, but, in the group with endometriosis, the dosage was increased to 400 mg. in 3 and 800 mg. in 5 in order to induce abatement of severe pelvic discompfort. None conceived while on therapy while about 40 per cent did conceive within 4 months after discontinuation of the drug.

Constriction of the Umbilical Cord by an Amniotic Band After Midtrimester Amniocentesis

Abstract. Constriction of the umbilical cord by an amniotic band after previous midtrimester amniocentesis is an extremely rare entity. A case report of fetal asphyxia caused by partial occlusion of the umbilical cord by an amniotic band is presented. Clinical and experimental evidence strongly suggests that the pathogenesis of this defect is related to early rupture of the membranes during gestation with subsequent encirclement and ligation of fetal umbilical cord, or extremities. In this case, formation of the amniotic band caused by midtrimester amniocentesis is strongly suggested. Obstetricians should be aware of this hazardous complication during pregnancy and labor in women who had had a midtrimester amniocentesis.

The obstetrical management of patients with immunologic thrombocytopenic purpura

Pregnant women with immunologic thrombocytopenic purpura (ITP) run the risk of complications during pregnancy and labor, mainly due to the possibility of hemorrhage. Antibodies pass through the placenta, causing a transient, but dangerous thrombocytopenia in the fetus and infant. Four women with ITP, having five deliveries, are presented, showing that the modern treatment of these patients includes corticosteroids during pregnancy, thrombocyte transfusion during labor, and splenectomy before or after the pregnancy in selected cases. Cesarean section is not indicated for the disease per se, and fetal scalp blood sampling for thrombocyte count during labor is not necessary. The newborn needs immediate, careful control and, if necessary, thrombocyte transfusion and even steroids. Prolonged follow‐up of the infants is necessary.

Hydrops Fetalis Caused by Maternal Indomethacin Treatment

Abstract. Hydrops fetalis was diagnosed in one of two twins, while the other suffered from cardiac failure. Indomethacin, administered to the mother to arrest premature labor, seemed to be the predisposing factor resulting in the hydrops fetalis. The possible relationship between intrauterine closure of the ductus arteriosus and the pathogenesis of hydrops fetalis is discussed.