Clifford C. Hayslip

Amniotic fluid infection as determined by transabdominal amniocentesis in patients with intact membranes in premature labor

The rate of microbial infection of amniotic fluid among patients in premature labor with intact membranes and the effect of this condition on perinatal morbidity and mortality are not known. Two study this question, specimens of amniotic fluid were collected by transabdominal amniocentesis from 31 patients in premature labor with intact membranes. Microorganisms were isolated from 25% (8/31) of the specimens; 87% (7/8) of these mothers underwent delivery within 48 hours of amniocentesis, and 75% (6/8) of positive culture were from mothers who were never febrile. Perinatal morbidity was significantly greater among mothers with positive amniotic fluid cultures, as evidenced by earlier gestational age at delivery (31 vs. 36 weeks), lower newborn weight (1,740 vs. 2,613 grams), and longer hospitalization (39 vs. 9 days). A few simple, commonly available laboratory tests (amniotic fluid Gram stain, lactic dehydrogenase levels, and white blood cell count) appear to be useful in making a rapid diagnosis. The data suggest that the presence of microorganisms in the amniotic fluid of afebrile patients in premature labor with intact membranes represents an infectious process rather than an innocuous condition and raises questions with regard to current obstetric trends in the management of premature labor. The routine evaluation of similar patients by transabdominal amniocentesis is not recommended unless prospective studies can demonstrate a decrease in perinatal morbidity and mortality with this approach.

The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction

We investigated the value of a screening program for postpartum thyroiditis in a heterogeneous American population and used serum antithyroid antibodies to identify postpartum women at risk. Blood was drawn from 1034 consecutive women on their second postpartum day and tested for antimicrosomal and antithyroglobulin antibodies by hemagglutination. Seventy-two women (7.0%) were seropositive for antimicrosomal antibodies, but only seven (0.7%) had antithyroglobulin antibodies. There was a significant difference in the racial prevalence of antimicrosomal antibodies, with seropositivity in 52 of 588 white women (8.8%) versus nine of 367 black women (2.5%; p less than 0.001). Thirty-four of 51 (67%) antimicrosomal seropositive women followed at least 6 months post partum developed biochemical thyroid dysfunction and 20 of these patients required treatment for hypothyroidism. The mean (+/- SEM) serum thyroxine and thyrotropin levels in these patients before treatment were 3.0 +/- 0.3 micrograms/dl (normal 6.1 to 12.3 micrograms/dl) and 77 +/- 17 mU/L (normal 0.3 to 4.0 mU/L), respectively. Psychologic interviews revealed a significant increase in impaired concentration, carelessness, depression, and total complaints when patients with postpartum hypothyroidism were compared with postpartum euthyroid women. Medical evidence now suggests that postpartum thyroiditis is a common event and causes significant symptoms in women who develop hypothyroidism. Therefore, we propose that serum antimicrosomal antibody testing of postpartum women provides a feasible cost-effective screening method of identifying women likely to suffer from this disease.

Hysteroscopic cannulation and lavage in the treatment of proximal tubal occlusion

In two patients with apparent PTO, as diagnosed by HSG and laparoscopy, tubal patency was restored by hysteroscopic cannulation of the tubal ostia, followed by direct lavage. Tubal resection and reanastomosis/reimplantation may not be necessary for all patients with apparent PTO.

The cystic fibrosis transmembrane regulator gene is expressed in the human endocervix throughout the menstrual cycle

OBJECTIVE To measure cystic fibrosis transmembrane regulator (CFTR) gene expression in cervical secretions during the menstrual cycle. DESIGN Prospective, descriptive clinical study. PATIENTS Thirteen healthy women with ovulatory menstrual cycles. INTERVENTIONS Endocervical cells and secretions were obtained by cytobrushings during the midfollicular, midcycle, and luteal phases. The cells were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR) for CFTR and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene expression. MAIN OUTCOME MEASURES Detection of CFTR gene expression and a quantitative comparison of the levels of CFTR to GAPDH gene expression. RESULTS All endocervical samples exhibited some degree of CFTR gene expression throughout the menstrual cycle; however, the levels of expression were variable. Cystic fibrosis transmembrane regulator gene expression did not correlate with E2 or P levels. CONCLUSION The production of copious cervical secretions at the time of ovulation in part may be because of the transport of sodium and water across endocervical cell membranes as a result of E2-stimulated CFTR mRNA and protein. Although cervical mucus becomes thick and scant during the luteal phase, CFTR gene expression is present in these secretions.

Globulin-Enriched Protein Supplements Shorten the Pre-Compaction Mitotic Interval and Promote Hatching of Murine Embryos

PROBLEM: To determine whether Synthetic Serum Substitute (SSS), which contains human globulins in addition to Human Serum Albumin (HSA), is superior to HSA alone as a protein supplement for embryo culture.

Characterization of Peripheral Blood and Peritoneal Fluid Mononuclear Cell Subsets in Fertile and Infertile Women

Mononuclear cell subpopulations from the peripheral blood (PB) and peritoneal fluid (PF) of fertile and infertile women were quantified by flow cytometry using a double-staining monoclonal antibody technique. No differences in the percentage distribution of mononuclear cells between fertile and infertile women were demonstrated when either the PB constituents or the PF components were compared to one another. When the mononuclear cell composition in the PB was compared with that in the PF however, the percentage of PF-activated T cells and monocytes was increased in both fertile and infertile women as opposed to that in the PB, while there was a decrease in T helper cells (fertile and infertile women) and natural killer cells (fertile women and infertile women with endometriosis). Even though shifts do exist in the immunocytes of PF from fertile and infertile women, evidence is lacking that the PF is an immunologic mediator of infertility.

Multiple Autoantigenic Determinants in Thyroid Autoimmunity

Autoantibodies directed against thyroglobulin (Tg), microsomes (Mic) and the TSH receptor (TSH-R) are well recognised in thyroid autoimnunity. Both Tg and Mic antibodies are found in Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) while Mic antibodies are strongly associated with post-partum thyroiditis (PPT). However in subacute granulomatous thyroiditis (SAT) and subacute lymphocytic or “silent” thyroiditis (ST), these antibodies are infrequent, transient and of low titre (Hay, 1985).