Vaclav Insler

Psychogenic infertility, neuroticism and the feminine role: A methodological inquiry

Abstract A group of 25 psychogenically infertile women and a group of 25 women who in the past were mechanically infertile but underwent corrective tuboplastic surgery, participated in a study regarding psychological difficulties associated with psychogenic infertility. They were tested on (a) the neuroticism scale of the EPI, (b) an original Objective Social Perception Inventory, and (c) the Lakin Projective Test. The results showed that the psychogenically infertile group did not differ from the control group on the neuroticism scale, but showed greater difficulties in at least three dimensions of the feminine role on the two other tests. These difficulties were pronounced on both the overt and covert levels of perception. Methodological issues pertaining to research in this area are discussed.

Clinical Evaluation of Fetal Movements

Fetal movement was examined in 200 pregnancies to establish normal patterns, influencing factors, possible clinical value and practical application. The mean number of movements per hour was 26 in hospitalized and 40 in ambulatory patients. These values remained fairly steady throughout pregnancy except for a significant decrease in the week preceding labor. Individual variations were large. The number of movements was uninfluenced by parity and fetal sex but was lower for small‐for‐gestational‐age babies, in mothers suffering from both hypertension and diabetes and in mothers treated with diazepam. Fetal movement count may be used as a parameter of fetal well‐being.

Sperm Storage in the Human Cervix: A Quantitative Study *

Twenty-five women scheduled for hysterectomy for nonmalignant disease participated in the study. Sperm storage in endocervical crypts was examined in three groups of patients: nine women pretreated with estrogen and inseminated with normal semen, nine women pretreated with gestagen and inseminated with normal semen, and seven women pretreated with estrogen and inseminated with abnormal semen. The number of crypts containing spermatozoa (colonized crypts) and the sperm density per crypt were examined in serially sectioned cervices. In estrogen-pretreated cervices both the percentage of colonized crypts and the sperm density were significantly higher than in gestagen-pretreated cervices. Large and giant crypts proved to be the main storage facility for spermatozoa. The localization of crypts along the endocervical canal did not influence sperm storage. The quality of semen appeared to be of critical importance to sperm storage. The percentage of colonized crypts and sperm density were severly reduced in patients inseminated with abnormal semen.

DETECTION OF FETAL RISK IN POSTMATURITY

Ninety‐seven postmature pregnancies were monitored by amnioscopy or amniocentesis (to determine presence or absence of meconium), oxytocin challenge tests (OCT), 24‐hour urinary oestriol estimations and fetal movement counts. The colour of the amniotic fluid and the result of the OCT predicted almost all cases of fetal distress in labour and infants with low Apgar scores. Oestriol estimations and fetal movement counts predicted fetal distress only when combined with other positive tests. Of 50 patients with no abnormal test results, 49 had uneventful labours. The Caesarean section rate was not above average and all babies were Iiveborn.

The evaluation and treatment of cervical mucus diseases leading to infertility.

There are a whole array of cervical mucus changes typical for a number of inflammatory or neoplastic diseases of the uterine cervix. Moreover, certain changes in the nature of cervical secretion may occur in diseases of other parts of the genital tract (for instance cancer of the Fallopian tube). The aim of this report is to discuss one specific aspect of cervical pathology, namely the changes of endocervical epithelium and its secretion related to impaired fertility.

The Effect of Missed Abortion and Spontaneous Abortion on the Fate of Subsequent Pregnancies

Abstract. Sixtytwo patients with spontaneous abortion and 58 with missed abortion were all promptly treated with curettage. The reproductive performance and the subsequent fertility of both groups during a five year period before and after the abotion were compared. To our surprise, no significant differences were found between the two groups.

Loss of Beat‐to‐Beat Variability and a Negative Oxytocin Challenge Test: an Ominous Prognostic Sign

The reputation of the predictive accuracy of a negative oxytocin challenge test (OCT) has been somewhat tarnished by recent sporadic reports of intrauterine fetal death relatively soon after a negative OCT. We have analyzed probable causes and the possibilities of reducing to a minimum “false‐negative” results of the OCT. In particular, several of these reports did not lake into account the loss of baseline fetal heart rate (FHR) variability recorded during the OCT and, in the absence of late decelerations, the OCT was interpreted as negative. We suggest that recordings showing a loss of baseline beat‐to‐beat FHR variability and a negative OCT illustrate a complete inability of the fetus to react to any stimulus and that, in these cases, a negative OCT should in no way be reassuring, but rather a warning sign of severe fetal compromise. Two cases are presented to illustrate this phenomenon.

Haemodialysis in Acute Renal Failure Following Hyperemesis Gravidarum

Summary: Acute renal failure due to hyperemesis gravidarum in a 27‐year‐old woman is described. Prompt haemodialysis led eventually to full recovery of the mother and vaginal delivery of a viable infant. Immediate intensive care with haemodialysis is mandatory if pregnancy is complicated by acute renal failure, in order to protect the fetus from the uraemic environment.

The Effect of Cervical Encerclarge on Uterine Dimensions

Observation of women who underwent cerclage of the uterine cervix in pregnancy indicated that during the first 24 hours after operation a marked increase of the uterine size takes place.

The Relation Between Apgar Score and Subsequent Developmental Functioning

A randomly selected sample of 252 infants aged 5‐18 months was evaluated through medical and developmental examinations. Developmental achievement scores and factors such as management of delivery and fetal distress were studied in relation to Apgar scores. Low‐Apgar‐score infants aged 5‐8 months achieved consistently lower scores on all developmental fields. High‐Apgar‐score infants at younger and older ages did not differ on their achievement scores. Low Apgar score was much more frequent in infants delivered by vacuum extraction than in those delivered spontaneously, with forceps or by cesarian section. The frequency of low Apgar score was higher when fetal distress occurred.