Ian Craft

HUMAN PREGNANCY FOLLOWING OOCYTE AND SPERM TRANSFER TO THE UTERUS

Abstract In 31 infertile patients, ovulation was induced with clomiphene citrate and oocytes were captured by laparoscopy 36 hours after injection of chorionic gonadotropin (hCG). The oocyte was incubated in tissue culture medium for 6 hours, sperm was added, and culture was continued for 1 further hour. The oocyte was then transferred directly into the uterus in 20 μl of fluid containing 10 000-20 000 sperm. In 14 patients (45%) β-hCG levels in urine indicated trophoblastic activity, and 2 patients have continuing intrauterine pregnancies.

The use of prostaglandin pessaries prior to vaginal termination.

Prosaglandin F2alpha 100 mg pessaries were inserted on 2 occasions within 24 hours of vaginal termination of pregnancy in an attempt to facilitate the subsequent operative procedure. Some degree of cervical dilatation occurred in 8 out of the 10 subjects studied but in only multiparous patients was it of sufficient degree to make evacuation easier. Side effects of uterine cramps, a flushed sensation; and the presence of diarrhea were relatively common. Disadvantages of prostaglandin F2a pessaries for use in vaginal termination of pre.g.nancy (e.g., large amounts are needed to induce cervical dilatation; cervical trauma is affected by parity status, no local specific ccervical softening action) preclude its clinical use.

Ovum Retention in the Human

Two cases of ovum retention occurring in postovulatory follicles are described. The ova were recovered at laparoscopy by aspiration of decompressed ovulatory follicles, one during a natural cycle and the other following a programmed clomiphene/human chorionic gonadotropin cycle. Each patient had a normal luteal phase with an increased progesterone level indicative of ovulation. The implications of these findings and their relevance to human fertility studies are discussed.

Materno-Fetal Cephradine Transfer in Pregnancy

Cephradine, a semisynthetic cephalosporin, has widespread use. There is, however, a paucity of data on the transfer of this antibiotic in pregnancy. Studies were undertaken after an intravenous dose of 2 g of cephradine was given in two elective situations: (i) therapeutic abortion in the first trimester and (ii) elective cesarean section in late pregnancy. Blood and tissue levels of cephradine obtained showed that the antibiotic is rapidly transferred to the feto-placental unit throughout pregnancy after intravenous administration to the mother.

Variations in Plasma Steroid and Prostaglandin Concentrations During Human Pregnancy

Abstract. Radioimmunoassay of sex steroids and prostaglandins was performed on plasma obtained from 10 uncomplicated primigravid subjects at a stated time of the day at varying stages of gestation. Prostaglandin E2 (PGE2), prostaglandin F2α (PGF2α), oestrone and oestriol concentrations reached a peak a few weeks before term and then declined. Progesterone, 17‐hydroxyprogesterone and oestradiol increased during pregnancy particularly after 32 weeks. In two normal patients repeated blood samples were taken throughout the day at weekly intervals in late pregnancy for sex steroid assays to evaluate the variation of concentrations with the time of sampling and the significance of changes in mean concentrations of different steroids with approaching parturition. Marked variability was found in the levels of different steroids during the day. Plasma oestriol values were lowest at 8.00 a.m. in one patient sampled frequently. A marked decrease in oestriol, oestrone, oestradiol and 17‐hydroxyprogesterone was found in one patient prior to the onset of spontaneous labour. In another subject there was no decrease in concentrations of oestrogens or progestogens prior to induction of labour at term.

Simple direct radioimmunoassay of the F prostaglandins

Abstract A simplified and accurate method of determining the F prostaglandins in 0.1 ml of serum without previous extraction is described. The procedure involves addition of anti-prostaglandin F2α to serum followed by tritiated prostaglandin, equilibration for 4 hours, removal of unbound prostaglandin with dextran-coated charcoal and subsequent liquid scintillation counting of the supernatant. The mean ± S.D. concentration of prostaglandin F2α in the serum of 15 healthy men was 90 ± 33 pg/ml and in 20 women 108 ± 43 pg/ml.

Intra-amniotic prostaglandin F2α and urea for abortion

A particular concern of gynecologists is the increased incidence of spontaneous midtrimester abortion following vaginal termination, especially in primigravid women between 10-14 weeks gestation. Intraamniotic prostaglandins (PG) have been reported to be particularly effective, but abortion is not guaranteed to occur within 24 hours after a single injection and repetition of therapy or intravenous oxytocin may be required to complete the process. A new method, intraamniotic PGE2 (10 mg) combined with urea (80 g) has been tested in a small group (n=5) of primigravid women aged 17-22 and with gestational size of 17-20 weeks. PGE2 alone was administered in another group (n=5) with similar age, parity, and gestation. The combined regimen had a significantly shorter mean time to abortion (8 hours 2 minutes) compared to the PG alone therapy (22 hours, 14 minutes) (t=2.731, p0.05). Abortion was complete in the combined regimen but was incomplete in the PG alone regimen.

Selective induction of labour following administration of an oral prostaglandin E2 0.5 mg tablet hourly.

Abstract Induction of labour was performed on 20 patients with favourable induction features by amniotomy and administration of a fixed dose of 0.5 mg of prostaglandin E2 (PGE2) hourly. Effective uterine action resulted in a mean time to delivery of 6 hrs 57 mins in primagravid patients and 4 hrs 40 mins in multigravid subjects. In two patients an intravenous oxytocin infusion was used to assist labour. There were no significant maternal or fetal side effects.

Intra-amniotic urea and prostaglandin E2 for abortion. A clinical study to determine the efficacy of using a variable prostaglandin dosage

Abstract Intra-amniotic urea 80 g combined with either prostaglandin E 2 5 mg or 10 mg was injected in two groups of patients to induce mid-trimester abortion. Abortion invariably resulted within 24 hours with both schedules used. The mean injection-abortion interval was not significantly shorter in those receiving the higher dose of prostaglandins. There were fewer gastrointestinal side effects in those receiving the lower dosage. This combined technique has some advantages over other methods used for a single initiating procedure only is required and nursing involvement is minimal.

Facilitation of suction termination using extra-amniotic prostaglandins in gel.

Extra-amniotic prostaglandin E2 (PGE2) suspended in a slow release gel (Tylose) was instilled in 35 patients prior to a planned surgical termination in an attempt to dilate the cervix, minimize cervical trauma, and reduce the possible risk of cervical trauma, and reduce the possible risk of cervical incompetence and its sequelae. Dilatation occurred in all patients to a minimum of 8 mm and 74% aborted before surgical evacuation performed 6 to 24 hours after injection. No serious side effects occurred. Extra-amniotic PGE2 in gel should be considered as a primary procedure when the cervix is obviously immature on examination. If the cervix is found to be tight and unyielding at surgical dilatation, the latter procedure should be dicontinued and PGE2 in gel injected.