Gary S. Berger

Classification of Adnexal Adhesions: A Proposal and Evaluation of Its Prognostic Value *

A system of classification of adnexal disease is proposed. Hysterosalpingography is important to determine tubal patency (stage I) and to distinguish between the presence of rugae in early fillage of the ampullae (stage II) and their absence (stage III or IV). Diagnostic laparoscopy under general anesthesia with the double-puncture technique is recommended to inspect the ovaries thoroughly and to put adhesions on a stretch for evaluation of thin, avascular adhesions (A) and thick, vascularized adhesions (B). The extent of adnexal disease can be classified as stage I minimal if most or all of the ovarian surface is visible; stage II, over 50% of the ovary is visible; stage III, less than 50% of the ovary is visible; Stage IV, no ovarian surface is visible. Each adnexum should be described separately. The worst aspect of each adnexum should be described. The best adnexal classification should be used in describing the patient for purposes of comparing surgical treatments. Using this approach, the authors describe a gradient from stage I (best prognosis) to stage IV (poorest) in a personal series of 99 tuboplasties over a 10-year period.

Factors affecting intrauterine contraceptive device performance. I. Endometrial cavity length.

The relationship of endometrial cavity length to intrauterine contraceptive device (IUD) performance was evaluated in 319 patients wearing three types of devices. The rate of events, defined as pregnancy, expulsion, or medical removal, increased significantly when the length of the IUD was equal to, exceeded, or was shorter by two or more centimeters than the length of the endometrial cavity. Total uterine length was found to be a less accurate prognostic indicator of IUD performance than endometrial cavity length alone.

The Northwestern University Multihospital Twin Study. II. Mortality of first versus second twins.

The results of a multihospital study involving a total of 588 twin pairs born in Chicago in 1970-1975 are reported, with special respect to differences in mortality between first and second twins by time as well as by cause of death. Mortality was higher in second than in first twins and most commonly occurred after delivery and was the result of immaturity and of respiratory distress syndrome.

Contraceptive practice and tuboovarian abscess.

The hospital and operative records of 318 women with a discharge diagnosis of tuboovarian abscess (TOA) were reviewed to evaluate the possible relationship between contraceptive usage and the occurrence of TOA. A significantly higher (p < 0.10) proportion of the intrauterine contraceptive device (IUD) users had acute pelvic inflammatory disease and a significantly lower proportion (p < 0.10) compared to users of other contraceptive methods were surgically treated. The proportions of women with unilateral and bilateral TOAs were similar, regardless of the contraceptive method used. This was true whether diagnosis was based on physical examination alone or confirmed at operation.

The Relationship Between Congenital Defects and the Use of Exogenous Progestational “Contraceptive” Hormones During Pregnancy: A 20‐Year Review

This review of 20 years of medical literature on the occurrence of congenital defects among offspring of women who ingested “progestational” or contraceptive hormones during pregnancy emphasizes the need for additional studies with carefully selected control groups. Other problems encountered in interpreting the existing literature, including the use of imprecise definitions, confusing nomenclature and inadequate clinical information, are also discussed.

Analysis of retained placenta associated with saline abortion: Clinical considerations☆

Abstract In a series of 4,069 saline abortions, the incidence of retained placenta and the complications associated with this condition are described. The most frequent complication observed was hemorrhage. The incidence of complications rises progressively as the duration of retained placenta increases. The complication rate associated with surgical removal is less than the complication rate associated with placental retention beyond 2 hours after expulsion of the fetus. These data suggest that removal of the placenta appears warranted if it has not been delivered within 2 hours after delivery of the fetus.

Possible ovulatory deficiency after tubal ligation

Mean plasma progesterone levels measured in the midluteal phase of the menstrual cycle were lower in 8 women requesting reversal of prior tubal ligation than in 19 normal women (9 vs. 18 ng/ml; P < .05). Based on previous findings that such progesterone assays are good indexes of luteal function and that women with marginally decreased progesterone levels have conceived after treatment with clomiphene it is speculated that persistent infertility after tubal reanastomosis is due to a deficiency of ovarian function especially since pregnancy rates after sterilization reversal are lower than the tubal patency rates. Retrospective and prospective studies of plasma progesterone estrogens and gonadotropins in women who have been or are planning to be sterilized are underway to establish the incidence of ovarian hormonal dysfunction after sterilization by various methods. Establishment of the incidence of hormonal dysfunction after sterilization not only may facilitate management of patients desiring restoration of fertility but also may be relevant to reported observations of an apparent increased frequency of poststerilization menorrhagia which has been hypothesized as due to interruption of the ovarian blood supply two-thirds of which is transmitted via the tubal artery from the uterine cavity.

The evaluation of Regionalized Perinatal Health Care Programs

A survey, conducted in the summer of 1974, to determine the extent of regionalized perinatal care in the United States revealed 28 states to have programs in operation. Evaluation was a common concern of these programs. A model for the evaluation of Regionalized Perinatal Care Programs is presented here with the North Carolina program used as an example. Evaluation was mandated as an integral component of the program in North Carolina, and this model has been developed in response to that mandate.

Oxytocin administration, instillation-to-abortion time, and morbidity associated with saline instillation

Among 4,069 healthy gravidas undergoing saline abortion, patients administered intravenous oxytocin had a significantly shorter instillation-to-abortion time (median, 25.5 hours) than did patients not administered oxytocin (median 33.3 hours). The instillation-to-abortion time was independent of the rate of oxytocin administration, which ranged from 1 to 4 U. per hour (17 to 67 mU. per minute), but was associated with the time at which oxytocin infusion was begun. When oxytocin infusion was started within eight hours after instillation, a shortened time from instillation to abortion was observed. Although oxytocin augmentation may result in a lower proportion of patients being exposed to the risk of infection associated with prolonged intervals from instillation to abortion, this potential advantage appears counterbalanced by an increased incidence of clinical consumptive coagulopathy associated with instillation-to-abortion intervals of less than 24 hours.

A prospective, randomized study of oral contraceptives: The effect of study design on reported rates of symptoms

A study was undertaken to assess the effects of the study design (frequency and method of inquiry about the side effects) on the reporting of oral contraceptive (OC)-associated side effects. The study found that the one-contact-per-cycle schedule yielded consistently lower rates of side effects than the two-contact-per-cycle schedule. Also, asking subjects about the occurrence of specific symptoms led to the reporting of higher rates of side effects than those obtained by general inquiry. The study suggests that differences in the reported rates of side effects may be due in part to the manner in which the data were collected.