David M. Serr

Randomized management of the second nonvertex twin: Vaginal delivery or cesarean section

Sixty twin deliveries after the thirty-fifth gestational week with vertex-breech and vertex-transverse presentations were managed according to a randomization protocol. Thirty-three parturient women (21 vertex-breech and 12 vertex-transverse presentations) were allocated for vaginal delivery and 27 for cesarean section (18 vertex-breech and nine vertex-transverse). Six pairs of twins in the vaginal delivery group were delivered in a different mode than requested by the protocol (two women underwent cesarean section; in four cases the second twin spontaneously changed to vertex presentation). There were no significant differences between 1- and 5-minute Apgar scores and incidence of neonatal morbidity between the second-born twins in both study groups. Firstborn twins had higher 1-minute Apgar scores than the second-born infants irrespective of route of delivery (p less than 0.05). No case of birth trauma or neonatal death was recorded. Maternal febrile morbidity was significantly higher in the cesarean section group than in the vaginal delivery group (40.7% versus 11.1%, p less than 0.05). These results suggest that in twins with vertex-breech or vertex-transverse presentations after the thirty-fifth week of gestational age the neonatal outcome of the second twin was not significantly influenced by the route of delivery.

Cumulative conception rates following gonadotropin therapy

During the years 1963 to 1978, 515 patients were treated with HMG. They were divided into two groups depending upon the absence (Group I) or presence (Group II) of distinct endogenous estrogen activity. Group II patients were referred after failure of clomiphene therapy. None of the patients had mechanical or male infertility factors. The cumulative pregnancy rate (life table method) in Group I patients after six cycles of treatment was 91.2%. In 77 patients from Group I, further treatment was given for a second pregnancy after the first gonadotropin conception. In this group, the cumulative conception rate was 93.6% after eight cycles of treatment. In Group II the cumulative conception rate was 50% after 12 cycles of treatment. In both groups, the results were better in patients who were less than 35 years of age than those who were 35 or more when treated.

Abortion rate in pregnancies following ovulation induced by human menopausal gonadotropin/human chorionic gonadotropin*

Despite the high incidence of fetal loss following gonadotropin therapy, the etiologic factors that contribute to this loss remain unknown. In 203 women who conceived following gonadotropin therapy, the abortion rate was 28.5%. However, in 84 women who conceived a second time, also with gonadotropin treatment, the abortion rate was 11.9%. Second- and third-degree hyperstimulation of the ovary are accompanied by a 50% abortion rate, and the occurrence of abortion is more frequent in the first pregnancy. The contribution of multiple pregnancy, maternal age, and number of gonadotropin treatment cycles are also evaluated and discussed.

Prospective follow-up of patients with hydatidiform mole.

Of 74 Jewish patients with histologically confirmed hydatidiform mole (HM), 37 (50%) were referred to the hospital after the 15th week of pregnancy. In only 5.4% was HM the referral diagnosis. A correct diagnosis prior to uterine evacuation was made in only 29 (39.2%), and this was mainly when the uterus was normal or larger than expected for gestational age. The percentage with urinary human chorionic gonadotropin hemagglutination inhibition titers below 100,000 U/liter was significantly smaller in those with a smaller uterus as compared with those with a uterus of normal size or larger than expected. The incidence of persistent trophoblastic disease (PTD) following HM without the use of prophylactic chemotherapy was 12.2%. Patients with a large-for-date uterus had a greater potential for this outcome. AH patients with PTD responded well to treatment, which consisted mainly of chemotherapy, and remained free of disease after therapy was completed.

RECORDING OF ELECTRICAL ACTIVITY FROM THE HUMAN CERVIX

In vitro studies of the electrical activity of the human uterus have not shown any clear difference between the corpus and cervix uteri. Attempts to record bio-electrical activity in vivo have been few. There would be obvious advantages in correlating the results of such studies with the physiology of human reproduction (Larks et al., 1957; Goto and Csapo, 1959; Goto et aI., 1959). Recording biopotentials from single muscle fibres or muscle strips in vitro and from muscular tissue in vivo requires different techniques (Jacobson et al., 1939; Liesse, 1946). This paper deals with the development of suitable techniques for recording electrical activity from the cervix of the human uterus in vivo and presents preliminary observations.

Cell-mediated immunity in patients with endometrial adenocarcinoma.

Abstract The leukocyte migration inhibition test (LMIT) was used in eight patients with endometrial adenocarcinoma in order to evaluate the presence of a cell-mediated immune response to a soluble tumor extract. In three of four patients with tumor confined to the uterine cavity the LMIT was initially positive. Six to nine months after therapy a repeated LMIT was found to be negative. A negative LMIT was found in the other four patients with tumor extending beyond the uterine cavity. Negative assays were obtained when a homologous tumor extract with a positive autologous reaction was tested against leukocytes from two patients with extended disease. The possible significance of these findings is briefly discussed.

The Influence of Endometrial Preparation Protocols on Embryo Implantation in Human Cryopreservation Treatment

In promoting successful implantation of embryos following in vitro fertilization (IVF) and embryo transfer, there is always a dilemma as to what is more important, uterine environment1 or qualities of the embryo itself.2 Pregnancies following IVF treatment have been described previously in spontaneous cycles, stimulated cycles, and in egg donation program, using exogenous substitutional hormone therapy. In this study in order to evaluate the importance of the uterine environment, three protocols for uterine preparation prior to embryo replacement were compared while transferring frozen thawed embryos.

Acute abdominal condition caused by retrograde bleeding in a postmenopausal patient on estrogen-progestogen therapy

Retrograde blood flow in menstruating women has been described recently. The acute event seems to be asymptomatic. Reported here is a case of an acute abdominal condition due to cervical obstruction and retrograde bleeding in a postmenopausal patient treated with estrogen-progestogen therapy.