Preston P. Williams

Pregnancy and systemic lupus erythematosus

Eleven patients with 18 pregnancies occurring during the course of systemic lupus erythematosus (SLE) were reviewed. Ten had long-standing lupus glomerulonephritis and a single patient developed glomerulonephritis during pregnancy. Patients were divided into those without (Group A) and those with (Group B) clinical evidence of renal disease or active SLE at conception. In Group A there were 10 pregnancies in five patients; all pregnancies were uncomplicated, except for mild superimposed pre-eclampsia in two, and all resulted in term delivery. Eight pregnancies in six patients occurred in Group B; four pregnancies were complicated by severe (2) or mild (1) superimposed pre-eclampsia and the onset of glomerulonephritis (1), resulting in three premature deliveries and a spontaneous abortion. The remaining four pregnancies were uncomplicated but resulted in one term delivery, one elective abortion, and two spontaneous abortions. None of the patients developed either renal failure or a rapidly progressive course following pregnancy.

Treatment of advanced epithelial ovarian carcinoma in pregnancy with cisplatin-based chemotherapy

Malignant ovarian neoplasms associated with pregnancy are uncommon, and the majority of these are Stage I. While adjuvant chemotherapy for germ cell tumors during pregnancy has been reported, only one previous report exists on the use of cisplatin-based chemotherapy for epithelial ovarian carcinomas during pregnancy. A patient with Stage III cystadenocarcinoma of the ovary treated during pregnancy with five courses of dose-intensive cisplatin and cyclophosphamide is presented. No adverse fetal effects secondary to cisplatin-based chemotherapy were noted. A review of the literature is presented.

Serum arachidonic acid levels in normal and preeclamptic pregnancies

Fifteen serum samples from 11 women with preeclampsia and 19 samples from 10 normal third-trimester pregnancies were analyzed for total nonesterified fatty acids and total nonesterified arachidonic acid. The percentages of arachidonic acid in nonesterified fatty acids, in phospholipids, in triglycerides, and in cholesterol esters were also measured in each sample. The same analyses were done on serum from six samples of cord blood from each group. Cord blood sera from preeclamptic and normal pregnancies had much less total nonesterified fatty acids than the corresponding maternal sera but had much higher percentages of arachidonic acid in each of the major lipid categories. The maternal phospholipids and cholesterol esters had higher proportions of arachidonic acid in preeclampsia than in normal pregnancy. Samples from placentas of preeclamptic pregnancies had significantly lower proportions of arachidonic acid in the nonesterified fatty acids and triglycerides than normal placentas. These findings suggest a decreased availability of arachidonic acid in the fetal circulation which may result in decreased production of prostacyclin in preeclampsia.

Endometrial aspiration in fertility control: A report of 500 cases☆

Outpatient endometrial aspiration was offered to patients who suspected that they were pregnant, but were within 5 to 21 days after failure of expected menstruation and had a uterus of normal size on pelvic examination. This is a report of 500 consecutive cases treated between September, 1973, and April, 1975. Histologic examination of the aspirated tissue was obtained on all 500 cases (100 per cent). Follow-up examination and urine pregnancy was obtained on 407 patients (81.4 per cent). Histologic evidence of pregnancy was obtained in 323 patients (64.6 per cent). Complications were limited to five infections (1 per cent), only one of which led to hospitalization of the patient, and failure to completely evacuate the pregnant uterus in 39 patients (12.1 per cetn of the 323 pregnant). Thirty-four of these had the uterus emptied by a second outpatient procedure and five patients were hospitalized to complete their abortion.

Workshop on Hysteroscopic Sterilization

A workshop on hysteroscopic sterilization held on June 22-24 1973 under the sponsorship of the Program for Applied Research on Fertility Regulation University of Minnesota is reported. 54 scientists from 9 countries discussed the potential of hysteroscopic techniques as a simple effective and acceptable means of elective sterilization for women. The development of instruments from the urologic endoscope to the modern 2- to 4-mm hysteroscope was discussed. Electrical and thermal aspects of high-frequency electrocautery as they apply to hysteroscopy were examined. The criteria for a satisfactory hysteroscope were listed. A technically superb review film of hysteroscopic techniques in experimental animals was shown. A 35% solution of dextran in water was favored for providing uterine distention adequate for visualization without excessive pressure or trauma to the cervix or endometrium. The Machida Wolf and Lindemann-Storz hysteroscopes were compared as were various media. Drawbacks of classic hysteroscopic methods were discussed. The participants recommended that standardization of methods be a priority of research.