Transvaginal sonographic measurement of fetal kidneys in the first trimester of pregnancy.

Fetal renal size late in the first trimester of pregnancy was evaluated by transvaginal ultrasonography in 50 patients not at risk for congenital kidney disease and whose pregnancies resulted in a normal outcome. Both kidneys were reliably identified in all patients scanned at 12 weeks, 13 weeks, and 14 weeks, menstrual age. Kidney diameter measurements obtained in this study are presented for reference in evaluating patients in late first trimester whose fetuses are at risk for kidney abnormalities.

Laparoscopic unwinding of twisted ischemic hemorrhagic adnexum after in vitro fertilization.

We present a case where, for the first time, unwinding of ischemic hemorrhagic adnexum was performed successfully through the laparoscope without the need to operate. Aspiration of ovarian fluid before detorsion facilitates the procedure; follow-up showed spontaneous follicular growth. We conclude that laparoscopic detorsion of ischemic adnexum is feasible.

Addition of exogenous estrogens to improve cervical mucus following clomiphene citrate medication. Patient selection.

Medication with Clomiphene Citrate and its effects on the quality of cervical mucus and the addition of exogenous estrogens in order to suppress abnormal mucus secretion are controversial issues. We have prospectively studied a group of 19 anovulatory women who were treated with clomiphene citrate in order to characterize those patients most likely to respond to the addition of exogenous estrogens. On day 14 of the cycle, 17 beta estradiol and cervical score were measured and 1 mg estradiol benzoate was injected intramuscularly.

Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy.

A series of 201 cycles of ovarian hyperstimulation syndrome (OHSS) in 154 women were reviewed. Pregnancy occurred in 75 of 201 cycles. Twelve pregnant women (16%) presented with torsion of hyperstimulated ovary, but only 3 out of 126 patients (2.

Rubella-specific IgM in reinfection and risk to the fetus.

A case of reinfection with the wild rubella virus in the 8th gestational week is reported. The patient had preexisting hemagglutination inhibition antibodies of low titer following immunization with rubella vaccine. Reinfection was accompanied by clinical symptoms and the presence of rubella-specific immunoglobulin M (IgM) of high titer.

The association of pregnancy-induced hypertension and uterine malformations.

To evaluate the incidence of pregnancy-induced hypertension (PIH) in women with congenital uterine malformations, we examined the pregnancy complications of 67 women with uterine anomalies demonstrated by hysterosalpingography (HSG). The study group was compared with a control group of 130 women with normal-shaped uterus proven by HSG-matched for age, parity and presenting complaint. A significantly increased (p less than 0.

Prevention of a side effect of epidural morphine by epidural steroid administration in cesarean section.

In order to evaluate the effect of preventive corticosteroid on the occurrence of pruritus after epidural anesthesia with morphine, we studied 95 patients undergoing cesarean section. Thirty-seven patients (group I) were given 20 mg of bupivacaine 0.5% for the operation and 2 mg of morphine hydrochloride with 50 mg of Ultracortene-H immediately after the operation and 24 h later, and 58 patients (group II) were given epidural bupivacaine during the operation and epidural morphine hydrochloride immediately after the operation and 24 h later without Ultracortene-H.

Failure to improve ovarian response by combined gonadotropin-releasing hormone agonist and gonadotropin therapy.

Nineteen women were treated with the gonadotropin-releasing hormone (GnRH) agonist buserelin in order to suppress the pituitary prior to gonadotropin treatment. Eight women were oligomenorrheic, 6 had polycystic ovarian disease (PCOD) and 5 women had normal cycles. Buserelin was administered for 3 weeks before ovarian stimulation, and the pituitary down-regulation was proven by provocative tests.

Hot flushes during Gn-RH analogue administration despite normal serum oestradiol levels.

Five out of 6 normally-menstruating women who were treated with a potent gonadotropin-releasing hormone (Gn-RH) agonist in order to achieve medical hypophysectomy developed hot flushes despite having normal oestradiol (E2) levels. The Gn-RH agonist was administered subcutaneously for 6 days and then intranasally for a further 14 days. A dose of 2 mg of E2 benzoate was injected intramuscularly once a week for 2 consecutive weeks.

The role of gonadotropins in the etiology of ectopic pregnancy.

Our study indicates that the high rate of EP in MAP(+) patients, treated with hMG/hCG, is due to the fact that it is a selected group of infertile patients with probable additional underlying tubal disease. Absence of EP in MAP(-) patients indirectly support the theory that a mechanical factor is at work. It is, therefore, our opinion, that the cause of ectopic pregnancy lies in the patient and not in the drug (hMG/hCG).

Endocrinological basis of hot flushes.

Hot flushes are frequent among women during natural, surgical, or pharmacological menopause. The available data suggest the involvement of estrogens, progestins, catecholestrogens, catecholamines, dopamine, endorphins, prostaglandins, luteinizing hormone (LH) and luteinizing hormone-releasing hormone (LH-RH) in the pathogenesis of flushes. At present the estrogen withdrawal and pulsatile luteinizing hormone (LH) secretion theories are most commonly accepted for explaining the development of this symptom.

Programmed oocyte retrieval: clinical and biological effects of oral contraceptives administered before in vitro fertilization.

We have prospectively compared two regimens of suppression of the hypothalamic-pituitary-ovarian axis by oral contraceptives (OCs) for 15 or 30 days and two ovarian stimulation protocols. The latent phase, which represents a period of ovarian insensitivity, was prolonged and directly correlated to the duration of suppression. Thirty days' suppression, compared with 15 days', resulted in the cancellation of more cycles and a lower fertilization and pregnancy percentage.

Pregnancy outcome after unwinding of twisted ischaemic-haemorrhagic adnexa.

Six women who became pregnant after human menopausal gonadotrophin/human chorionic gonadotrophin (hMG/hCG) treatment regimens were operated on between 6 and 21 weeks gestation with an intra-operative diagnosis of twisted ischaemic-haemorrhagic adnexa. During operation unwinding of the adnexa was performed in all patients. Monitoring of the pregnancy before and after operation by ultrasonography was normal.

Pituitary and ovarian suppression rate after high dosage of gonadotropin-releasing hormone agonist.

Ten infertile menstruating women were treated with daily injections of gonadotropin-releasing hormone agonist (GnRH-a). The GnRH-a (Buserelin; Hoe 766, Hoechst-AG, Frankfurt/Main, West Germany) was administered subcutaneously (SC) from day 9 of the cycle for 6 days, and intranasally (1.2 mg) for 15 days.

Cortisol levels in human follicular fluid.

This study shows that cortisol levels in follicular fluids in stimulated cycles were correlated with oocyte maturity and in vitro fertilizability. The levels were significantly higher than the concentrations found in spontaneous cycles. Our findings suggest that the presence of cortisol in follicular fluid may play a role in follicular development and oocyte maturation.

Fatal disruption of a splenorenal shunt after multiple pregnancies.

A 39-year-old woman underwent a distal splenorenal shunt operation for bleeding esophageal varices due to liver cirrhosis. Following the operation she had 7 pregnancies at almost yearly intervals. At the term of the last pregnancy a disruption of the anastomotic site caused a fatal hemorrhage.

Intrauterine fetal death apparently due to Candida chorioamnionitis.

There is an increasing awareness of the association between Candida albicans chorioamnionitis and preterm labor. We present a case of intrauterine fetal death caused by Candida chorioamnionitis at the 21 weeks gestation in a patient with an intrauterine device (IUD).

Fetal intracranial anatomy in the first trimester of pregnancy: transvaginal ultrasonographic evaluation.

The normal values and ranges of fetal intracranial structures were studied by high resolution transvaginal ultrasonic scan at 12, 13 and at 14 weeks' gestation. The data including measurements of crown rump length (CRL), bi-parietal diameter (BPD), head circumference (HC), hemispheric width (HW), lateral ventricle width (LVW), LVW/HW ratio, thalamus and cerebellum may be useful in determining deviations from the normal and also in expanding the range of prenatal diagnoses of fetal structural abnormalities in early pregnancy.

Suppression with gonadotropin-releasing hormone analogues prior to stimulation with gonadotropins: comparison of three protocols.

This study compared three groups of patients treated with three different protocols of suppression of the pituitary-ovarian axis prior to and during gonadotropin stimulation for in vitro fertilization with a nonsuppressed control group. Patients treated with daily injections of DTRp6 (Decapeptyl 0.5 mg) or with a single injection of Decapeptyl depot (3.

Ovarian hyperstimulation syndrome due to exogenous gonadotropin administration.

During the last decade, 154 patients treated with human menopausal gonadotropin human chorionic gonadotropin developed hyperstimulation necessitating hospitalization in 201 cycles. Moderate ovarian hyperstimulation occurred in 116 of the patients and severe ovarian hyperstimulation in 34. Sixteen patients underwent operative procedures.

Repetitive ovarian response to gonadotropin stimulation in an in vitro fertilization program.

The temporal changes of estradiol levels in 19 women undergoing ovulation induction for in vitro fertilization (IVF) and embryo replacement were described by a mathematical model. The model was analyzed for differences between treatment cycles of an individual woman and between cycles of different women. This model was also used to evaluate the results of IVF treatment.

Collagen matrix influences the morphologic features and steroid secretion of human granulosa cells.

Steroid secretion and structure of granulosa cells on floating collagen gels were compared with those of cells grown on plastic. Granulosa cells from follicles of gonadotropin-treated women were plated either onto dishes coated with type I collagen or onto plastic dishes. Medium containing serum was removed after 24 hours, defined medium was added, and the gel was floated.

An increased initial follicle-stimulating hormone/luteinizing hormone ratio does not affect ovarian responses and the outcomes of in vitro fertilization.

The tenet that a combination of human follicle-stimulating hormone (hFSH)/human menopausal gonadotropin (hMG) improves follicular recruitment was assessed by randomly treating ovulatory women either with hFSH/hMG on days 3 and 4 of the cycle followed by two ampules of hMG daily or with a constant daily dose of 2 ampules of hMG. Estradiol (E2) levels on the day of human chorionic gonadotropin (hCG) and the mean number of mature, immature and atretic oocytes per cycle did not differ between the two groups. Likewise, fertilization, cleavage, and pregnancy rates were similar for the two treatments.