M. Sharf

Patterns of growth of uterine leiomyomas during pregnancy. A prospective longitudinal study

Summary. In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3–8 weeks. Each patient had hetween 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 4 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.

Early spontaneous rupture of the post myomectomy gravid uterus

Rupture of a pregnant uterus is a serious threat to the mothers life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.

Ultrasonographic and clinical correlates of menotropin versus sequential clomiphene citrate: menotropin therapy for induction of ovulation

Forty-six women remaining infertile with clomiphene citrate (CC) with or without human chorionic gonadotropin (hCG) were treated by either human menopausal gonadotropin (hMG, 44 cycles) or CC + hMG (33 cycles) and monitored by serum estradiol (E2) and ultrasonography. Ovarian hyperstimulation syndrome (OHS) and pregnancy outcome were compared in both regimens. In the presence of dominant follicles (greater than or equal to 18 mm) alone or with a single secondary follicle (14 to 16 mm) at hCG administration, OHS did not develop. A significant increase in OHS was noted when three or more secondary follicles were observed. Overall pregnancy rates were similar in both regimens but significantly higher when hCG was injected before rather than after the E2 peak. The results suggest secondary follicles rather than dominant follicles are a valuable sign of possible OHS development; and CC + hMG should be considered in CC-failure patients.

Lipid and Lipoprotein Levels following Pure Estradiol Implantation in Post-Menopausal Women

8 post-menopausal, post-oophrectomy and hysterectomy women had a 100-mg pure 17 beta-estradiol pellet installed in their subcutaneous abdominal tissue. The pellet caused a marked systemic hormonal effect in these patients causing an up to 30-fold increase in plasma estradiol and a marked decrease in follicle-stimulating hormone levels. It showed a significant increase in plasma high density lipoprotein (HDL) and HDL to total cholesterol ratio levels, no change in plasma triglycerides and very low density lipoprotein levels and some decrease in total cholesterol and low density lipoprotein cholesterol concentrations. These results differ from the previously reported influence of synthetic hormonal preparations on the same plasma lipids and lipoproteins.

USE OF PROPRANOLOL IN DYSFUNCTIONAL LABOUR

Labour pains associated with fear and anxiety increase the blood level of catecholamines. This in turn causes dysfunctional labour due to the weak uterine contractions which follow stimulation of uterine adrenergic beta receptors. Intravenous propranolol was administered to ten primigravidae with typical dysfunctional labour. This was shortly followed by normal uterine activity and delivery without any significant maternal or fetal complications. To the best of our knowledge this is the first attempt to treat dysfunctional labour by the intravenous administration of a beta‐blocking agent, and our preliminary results are encouraging.

Intrauterine diagnosis and control of fetal ventricular arrhythmia during labor

A very rare case of a sustained fetal ventricular arrythmia in the form of bigeminy, trigeminy, and quadrigeminy during labor is described. The rhythm distrubance failed to respond to sedatives and narcotics but was successfuly reverted to sinus rhythm following the administration of intravenous propranolol to the mother. The significance and possible mechanism of the arrhythmia is discussed.

The Association between Mid-Sleep Waking Episodes and Hot Flushes in Post-Menopausal Women

Nine post-menopausal women were studied for 2 consecutive nights in a sleep laboratory in order to investigate the possible relationship between hot flushes and sleep disturbance. The sleep structure in this group was not substantially different from that expected in this age group. All of the patients experienced mid-sleep waking episodes and hot flushes, with an average of 4.5 for the former and 2 for the latter. Only half of the waking episodes were found to be associated with hot flush. Even when the two were associated, in the majority of the cases the waking episode preceded the temperature rise. It is thus concluded that there is more than one mechanism responsible for mid-sleep awakenings in post-menopausal women, that the discomfort caused by the hot flush is certainly not an important etiologic factor in these disturbances, and that a common central disturbance is probably responsible for both events in most instances.

Electromyogram of Pelvic Floor Muscles in Genital Prolapse

In order to elucidate the pathophysiological mechanisms of genital prolapse, an electromyographic (E.M.G.) survey of the perineal muscles is presented. Fifty women with genital prolapses and stress incontinence, plus 10 women as a control group, were examined. The results pointed to a primary neurogenic lesion in 50% of cases with a denervation pattern in extreme cases. Our hypothesis is that the muscular deficiency in genital prolapse is secondary to a neurogenic lesion. Operations were performed on 31 women, subsequently re‐examined electromyographically. In those cases with severe denervation, the surgical results were poor and relapse occurred. It is suggested that the E.M.G. can be a preoperative prognostic test, as well as a tool in evaluation of conservative treatment in genital prolapse.

Endometrial Ossification Associated with Repeated Abortions

Abstract. A patient with repeated abortions and a finding of endometrial ossification is reported. The etiology and pathogenesis of endometrial ossification are discussed.

Assessment of fetal lung maturity by a microviscosimeter.

A new method of rapid antenatal assessment of fetal lung maturity was evaluated in relation to the newborn outcome and two other accepted test. This method is based on fluorescence depolarization (FD) technique. The special instrumentation required for this method (the Microviscosimeter) was found to be simple and easy to handle even to nonprofessional personnel. Analysis of 47 samples of amniotic fluid received within 48 hours of delivery demonstrated that lung maturity threshold may be related to a numeric value (P value) measured by this technique. With a P value of less than 0.320 respiratory distress syndrome (RDS) is unlikely to develop. With a P value greater than 0.340, chances for RDS, usually severe, are high. With a P value of less than 0.340 but greater than 0.320, RDS may or may not develop. This method did not prove to be more reliable then the determination of L/S ratio by thin layer chromatography, but its advantage is that it supplies the results in less then an hour. The FD technique proved to be more reliable then the commonly used foam stability test.