Ilan E. Timor-Tritsch

Heterotopic pregnancy after ovulation induction and assisted reproductive technologies : a literature review from 1971 to 1993

OBJECTIVE To review and analyze records on heterotopic pregnancy occurring after ovulation induction and assisted reproductive technologies. DATA IDENTIFICATION Case reports in the English literature related to the topic were identified through a computerized bibliography search up to December 1993. CONCLUSIONS The incidence of heterotopic pregnancies increased in recent years because of the escalating use of new reproductive technologies in infertile patients and has stabilized at approximately 1:100 pregnancies with these procedures. The main reasons for development of such a condition in these patients are past tubal or pelvic disease and multiple ovulations or multiple ET. Progress has been made in diagnosis of heterotopic pregnancy during the last two decades, mainly because of development of ultrasonographic techniques, especially transvaginal ultrasonography. Treatment of heterotopic pregnancy should be prompt to avoid maternal morbidity and mortality from extensive intraperitoneal bleeding. No increased intrauterine fetal mortality due to hemoperitoneum has been proven in the present review, except in advanced cornual pregnancies. More experience is needed for application of new treatment modalities such as salpingocentesis, which are used successfully for ectopic pregnancy, in treatment of heterotopic pregnancy. With early diagnosis and skillful treatment, the outcome of the intrauterine pregnancy is favorable and its survival rate should increase in the future.

Changes in uterine blood flow during human pregnancy.

A transvaginal duplex Doppler ultrasonography system was used to measure blood flow characteristics in the ascending uterine artery before and during pregnancy. The system uses a 5 MHz Doppler transducer coupled to a 6.5 MHz imaging probe. There was a steady increase in volume flow rate in the left ascending uterine artery from a mean of 94.5 ml/min before pregnancy to a mean of 342 ml/min in late gestation (reflecting a 3.5-fold increase). With the assumption of equal flow on both uterine arteries, the fraction of the cardiac output that is distributed to these vessels was calculated to be 3.5% in early pregnancy and to reach 12% near term. The mean diameter of this vessel in the nonpregnant state was 1.6 mm, increasing to 3.7 mm toward term. The resistance to flow, expressed as the peak systolic to end-diastolic flow velocity ratio, declined from a mean of 5.3 in the nonpregnant state to a mean of 2.3 near term. These changes reflect the perpetual growth and development of the uteroplacental circulation, which provides the metabolic demands of the growing fetus throughout gestation.

EFFECT OF ACUTE HYPOXIA ON HUMAN FETAL HEART RATE

Abstract. The fetal heart rate response to acute hypoxemia was observed during an accidental drop in oxygen concentration inspired by the mother in labor. There was a marked increase in FHR variability in the early stage of hypoxia and also during the recovery phase. While an increase in fetal heart variability is generally considered to be a normal physiological event, it may also indicate a state of fetal hypoxemia associated with an intact fetal circulation, and should be treated with caution during labor.

Sinusoidal pattern together with signs of moderate fetal hypoxia associated with a true knot of cord.

The fetal heart rate pattern of a dying fetus due to tightening of a true knot of cord is presented. Sinusoidal pattern was electronically recorded along wih bradycardia--tachycardia. The importance of the sinusoidal pattern is discussed. It seems to imply fetal compromise if observed together with other signs of moderate fetal distress.

Postmenopausal Tubo-Ovarian Abscess

Tubo‐ovarian abscess in postmenopausal women is a distinct and rare entity. the disease is usually diagnosed on the operating table and its high rate of postoperative complications and mortality commands special attention. by presenting our experience with four cases of tubo‐ovarian abscess in postmenopausal women, we would like to re‐emphasize the importance of including this disease in the differential diagnosis of the surgeon and the gynecologist. Early laparotomy is essential to reduce morbidity and mortality.

An Epidemic-Like Appearance of Congenital Cystic Hygroma

Abstract. Five fetuses with cystic hyroma were diagnosed in our department during a period of 5 months. Four of them were identified by an ultrasonic examination. No common causative factor was found to explain the appearance of such a rare anomaly in 5 cases over a very short period of time.

Tubal Pregnancy Treated by Salpingectomy Using Operative Culdoscopy

Abstract. A case of unruptured Ampullary pregnancy in the 7th postmenstrual week is presented, which was diagnosed and treated at the same time by operative culdoscopy. The indication and advantages of this method are discussed.

High-Frequency Transvaginal Scanning of the Uterus

Transvaginal sonography (TVS) is a relatively new sonographic technique to image pelvic structures. The transvaginal approach permits the use of probes operating at higher frequencies, which can be placed close to the pelvic organs. The axial and lateral resolutions and the determination of image quality are improved compared to the resolution obtained by conventional 3.5-MHz abdominal transducers. The higher resolution is obtained somewhat at the expense of depth of field. However, most of the relevant anatomy for transvaginal imaging is within 7 to 9 cm of the vaginal fornices. It is sometimes possible to increase the transducer frequency to 7 MHz while attenuation and depth of field are still acceptable in order to image somewhat closer structures.1

Intrauterine Fetal Arrhythmia: Atrial Premature Beats

A case of antepartum fetal arrhythmia is reported. The diagnosis of atrial premature beats was confirmed during labor by simultaneous recording of fetal heart rate and fetal electrocardiogram. The possibility of fetal distress during labor was excluded by fetal heart rate and acid‐base monitoring. The difficulty of reaching a definitive antepartum diagnosis of the arrhythmia and its significance in relation to fetal well‐being are discussed.