Mats Ahlgren

Ectopic pregnancy and antibodies to Chlamydia trachomatis.

Ectopic pregnancy is one of the most serious sequelae to acute salpingitis. Chlamydia trachomatis seems to be the most common etiologic agent of acute salpingitis. In the present study, we tested whether women with ectopic pregnancy had serologic evidence of a current or past chlamydial infection. Sixty-five percent of the women with ectopic pregnancy had IgG serum antibodies to C. trachomatis, and 21% of women pregnant in utero had such antibodies. Eleven percent of women with infertile husbands, 42% of women with cervicitis, and 69% of women with salpingitis had IgG serum antibodies to C. trachomatis. In women with ectopic pregnancy, there was a correlation between the occurrence of IgG antibodies and a history of salpingitis or gross evidence of a previous tubal inflammation. We conclude that previous chlamydial salpingitis may be a major etiologic factor leading to ectopic pregnancy.

Sperm Transport to and Survival in the Human Fallopian Tube

A review is given on sperm migration to and sperm survival within the human Fallopian tube. Sperm migration from the external os can be very fast. The survival time of spermatozoa in the oviduct has been demonstrated to be 85 h. Spermatozoa normally enter the abdominal cavity through the open fimbriated end. Laterally closed oviducts retain spermatozoa resulting in a larger number of spermatozoa than in the normal oviduct, where the number of sperm at the site of fertilization is very low. The morphology of spermatozoa reaching the ampulla of the oviduct is mostly normal, which seems to be based on the correlation between normal morphology and good motility. Spermatozoa within the abdominal cavity do not cause antibody formation of any importance for the fertility of the woman.

Outcome of Pregnancy After Clomiphene Therapy

Abstract. Of 159 pregnancies conceived after clomiphene therapy, 141 ended in childbirth, including seven sets of twins. There was a probable increase in the number of infants born with major malformations. These were exclusively to women who had not previously borne a normal infant. The incidence of malformed infants compares well with that published after gonadotropin therapy. The possibly higher incidence of malformations seen after drug‐induced ovulation would therefore seem to be due to the underlying subfertility state and thus not a direct drug effect.

Acute massive pulmonary embolism treated with streptokinase during labor and the early puerperium.

Acute massive pulmonary embolism occluding 60‐70% of the pulmonary circulation occurred in a young primipara during the 28th week of pregnancy. She was critically ill despite 40 h of heparin infusion and thrombolytic therapy with streptokinase was initiated. After a 10‐h infusion she went into labor and streptokinase treatment was stopped. One hour later she gave birth spontaneously to a preterm infant in footling breech delivery. The infant did well neonatally. Streptokinase infusion was recommenced 8 h after delivery. Because of increasing blood loss on the second day after delivery, streptokinase was withdrawn after a total treatment time of 29 h. Total hemorrhage amounted to 8.9 litres. Serial perfusion lung scans showed complete resolution of the emboli and normal lung function was restored.

Endometrial Destruction by Hyperthermia — a Possible Treatment of Menorrhagia: An experimental study

Background. Treatment of menorrhagia by heat‐destruction of the endometrium, intended to be an alternative to hysterectomy, was investigated in an experimental study. Method. A specially designed catheter (Cavatermtm) with a silicone balloon containing a self‐regulating heating element is inserted into the uterus, filled with glycine to a pressure of around 180 mmHg and heated to about 75°C. We investigated the treatment effect in vitro in five extirpated uteri (series A) and in vivo in three patients treated peroperatively just before hysterectomy, temperatures being monitored in the surrounding tissues (series B). In both series we monitored the following variables: heating‐power, balloon‐pressure, temperature of the heating element (around 85d`gC) and the temperatures at five locations from top to bottom of the balloon surface.

Endometrial Thermal Coagulation – Degree of Uterine Fibrosis Predicts Treatment Outcome

Objective: To study the uterine cavity after thermal endometrial destruction for the treatment of menorrhagia by means of a balloon catheter, the CavatermTM system. To relate the appearance of the uterine cavity to the outcome of the treatment. Methods: Fifty-one of the first 60 women treated with balloon endometrial destruction were examined with hysteroscopy and saline infusion sonography 11–28 months after treatment. Results: Patients with minimal or no bleeding after thermal endometrial destruction had more uterine fibrosis than patients bleeding more. Conclusion: The greater the degree of fibrosis of the uterine cavity after balloon endometrial destruction by thermal coagulation, the better the effect on menorrhagia.

Thermal conductivity of uterine tissue in vitro

Thermotherapy of the uterus has emerged as an alternative to hysterectomy in the treatment of menorrhagia, from whence it follows that the thermal properties of uterine tissue have become of importance. This study presents measurements of the thermal conductivity and the water content of uterine tissue in vitro. A steady-state thermal conductivity apparatus, based on the comparison of test samples with a material with known thermal conductivity, is described. Measurements were conducted on tissue samples from eleven patients, directly after hysterectomy. Samples with and without endometrium, as well as coagulated samples, were examined. The thermal conductivity of myometrial tissue was found to be 0.536 +/- 0.012 W m(-1) K(-1) (mean +/- 1 SD) and the corresponding water content was 81.2 +/- 1.5% (mean +/- 1 SD). Measurements on samples with both endometrium and myometrium showed similar thermal conductivity (0.542 +/- 0.008 W m(-1) K(-1), mean +/- 1 SD) and water content (81.6 +/- 0.7%, mean +/- 1 SD). It was also indicated that coagulation causes dehydration, resulting in a lower thermal conductivity.

Risk factors in ectopic pregnancy Results of a population-based case-control study

In a population‐based case‐control study, possible risk factors for ectopic pregnancy were compared in 119 patients with ectopic pregnancy and in 119 age‐matched controls with intra‐uterine pregnancy from each of the following categories: deliveries, spontaneous abortions and induced abortions. The following factors were found significantly more often in cases of ectopic pregnancy: a history of earlier ectopic pregnancy, a history of salpingitis, a history of earlier operation on the Fallopian tubes, a history of infertility, and a pregnancy that had occurred in spite of an intra‐uterine contraceptive device. A history of appendectomy was also found significantly more often among the cases. There was no significant correlation between ectopic pregnancy and a history of no earlier pregnancy, earlier deliveries, earlier spontaneous or induced abortions or a history of other gynecological operations and increased risk of ectopic pregnancy. One or more of the risk factors were found in 76.5% of cases and 23% of controls.

Laparoscopy in Female Infertility: Diagnosis and prognosis for subsequent pregnancy

Abstract. Laparoscopy for the investigation of infertility was performed in 433 women. The rate of pathologic findings was 70%. No fewer than 55% of patients with no history of gynecologic disease and normal hysterosalpingo‐graphy (HSG) were found to have pathologic findings. When comparing the patency of the Fallopian tubes at HSG and laparoscopy the overall agreement was 71 %. Sixty‐eight of the patients with no other cause for infertility had the abdominal tubal ostia catheterized at laparoscopy. In 20 of these, small adhesions that could interfere with ovum pickup were found and divided. The pregnancy rate in this group was 70%, which is significantly higher than the pregnancy rate of 44% in 59 otherwise normal patients who did not have their tubes catheterized. The subsequent pregnancy rate for patients with different findings at laparoscopy is described. The role of HSG compared with laparoscopy is discussed. It is concluded that laparoscopy should be performed in all patients of female infertility, with the exception of those who have bilateral hydrosalpinges without patency on HSG. These patients are offered laparotomy for salpingo‐stomy without laparoscopy. The catheterization of the Fallopian tubes at laparoscopy is a new method to find an easily treatable cause of infertility.

A sensitive urine pregnancy test as an aid in the diagnosis of ectopic pregnancy

A highly sensitive 2-hour tube test for the detection of human chorionic gonadotropin (hCG) in urine was compared with the more resource-demanding radioimmunoassay for hCG in serum as an aid in the diagnosis of ectopic pregnancy. In a first series of 107 patients with the possibility of ectopic pregnancy, the urine test was positive in 31 patients, including all 15 patients shown to have an ectopic pregnancy. In a second series of 113 consecutive patients with ectopic pregnancy, the highly sensitive test was performed in 94 patients. It was positive in 90 (96%). The median time of amenorrhea at diagnosis was 7 weeks, and only 15 patients suffered a rupture of the fallopian tube. A highly sensitive urinary test for hCG is recommended as a screening method for patients giving even the smallest indication of ectopic pregnancy.