Transabdominal cerclage for fetal wastage due to cervical incompetence.

From 1978-1986, nine transabdominal cervicoisthmic cerclage procedures were performed on eight patients at the University of California, San Francisco. In six of the patients, the decision to perform the procedure was based on failed transvaginal cerclages. In five of these six cases, the cervix had deep traumatic defects. In the remaining two patients, the cervix was extremely short. Before the procedure, the eight patients had 25 pregnancies lasting beyond the first trimester, with 20 fetal losses (fetal salvage rate 20%). After the transabdominal procedure, the eight patients had 13 pregnancies resulting in eight term births, three premature births (at approximately 36 weeks' gestation), and two fetal losses (salvage rate 85%). All infants were delivered by cesarean section. The transabdominal cerclage may increase the fetal salvage rate in selected women when poor obstetric outcome is related to failed transvaginal cerclage and/or an anatomically defective cervix.

Evaluation of a preterm birth prevention program: preliminary report.

A clinical study to determine the effectiveness of a program for prevention of preterm birth was conducted at the University of California, San Francisco. The program included scoring and assigning the patients according to their risk of having spontaneous preterm labor and delivery. Patients were instructed in self-detection of the early signs of preterm labor, and those at high risk were followed weekly in a special clinic. A second aspect of the program included intensive in-service education of the obstetric staff. The data indicate that during the year under review a significant decrease in the incidence of preterm delivery has occurred. It is suggested that the preterm birth prevention program may have been instrumental in reducing the preterm delivery rate by enabling early and effective long-term tocolytic therapy.

A modified technique for semen collection by electroejaculation in the domestic cat.

A method was developed for collecting feline semen by electroejaculation combined with the use of a urethral catheter. The catheter facilitated handling the small volumes of semen for laboratory analysis. In 14 cats, semen volumes ranged from 0.019 to 0.284 ml (mean 0.076) and spermatozoa counts of ejaculates collected in the catheter ranged from 0.32 to 49.60 x 10(6) (mean 11.64 x 10(6)). Nine individuals were evaluated for retrograde ejaculation by quantitation of spermatozoa in pre-ejaculation and post-ejaculation urine samples. No spermatozoa were detected in pre-ejaculation samples but post-ejaculation urine samples contained from 0 to 11.88 x 10(6) (mean 4.55 x 10(6)) spermatozoa. The antegrade portion of the ejaculate contained from 6.3 to 100% (mean 59.1%) of the total number of spermatozoa ejaculated.

Fertilization rate and early embryonic loss in Brahman crossbred heifers.

The fertilization rate and incidence of embryonic loss in virgin Brahman crossbred heifers between d 3 and 35 postinsemination (d 0 = first day of estrus) were determined. One hundred fifty-five virgin heifers, maintained in a dry lot, received approximately 22 Mcal.head-1.d-1 and were allotted to one of three groups (d 3, 16 or 35) according to body weight at the time of estrous detection. Seven empty ruptured zona pellucidae (ERZP) were recovered from five heifers in the d 3 group. It was impossible to determine whether the ERZP originated from fertilized or unfertilized ova and whether they were ovulated at the estrus immediately preceding or during a previous cycle. Consequently, the fertilization rate (d 3) was calculated to be 80 or 93% depending upon whether the ERZP were included or deleted from the calculations, respectively. Because of the large number of ERZP recovered, a second study was conducted with an additional 21 virgin Brahman crossbred heifers from which ova were recovered on d 3 postinsemination. The results of the two studies were similar. The percentage of heifers with an embryo on d 16 was 78 (10% had degenerating embryos and 12% no embryos), and the percentage pregnant at d 35 was 72. The conclusions suggested from this study depend upon the classification of the ERZP. If the ERZP are designated as ova ovulated during a previous cycle or ova damage in the collection process and are deleted from the calculations, the fertilization rate is high (93%), and embryonic loss apparently occurs between d 3 and 35 (P less than .95). However, if the ERZP are classified as ova ovulated at the immediately preceding estrus, unavailable for further embryonic development, and are included in the calculations, the fertilization rate is comparatively low (80%). In the latter case, the primary loss of potential embryos occurs before d 3, and the loss after d 3 is negligible (P greater than .05).

Quantitative study of the decussating optic axons in the pony, cow, sheep, and pig.

A quantitative study of optic axons in the optic tracts of several species was performed to determine the number and percentage of optic axons that decussate. Animals were prepared by unilateral ocular enucleation, and light microscopic techniques were employed to count the fibers. The mean number of fibers projecting from a single eye was 732,119 for the pony, 1,041,739 for the cow, 534,755 for the sheep, and 442,629 for the pig. The mean degree of crossover at the chiasm was 80.8% in ponies, 82.9% in cattle, 88.9% in sheep, and 87.8% in pigs.

Validity of indications for transabdominal cervicoisthmic cerclage for cervical incompetence.

OBJECTIVE: Our purpose was to review the indications for transabdominal cervicoisthmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. STUDY DESIGN: A retrospective review of transabdominal cerclage patients at one institution from 1978 to 1994, analysis of the indications for the transabdominal rather than the vaginal approach, and evaluation of fetal outcomes was performed. RESULTS: Twenty-three patients underwent 24 transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 14 patients and anatomic unsuitability for transvaginal cerclage in nine. Of the latter, five were a result of diethylstilbestrol exposure and four a result of cervical surgery. All patients were successfully delivered of one or more live babies (total 28, including two sets of twins). Two losses occurred, one after rupture of membranes at 21 weeks on the second pregnancy after cerclage placement and one intraoperative loss with herniation of the membranes. The live birth rate was 93%, compared with 18% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. Complications included blood loss requiring transfusion (four patients), although none of these occurred in the last 12 patients. CONCLUSION: We conclude that all the patients had a history compatible with incompetent cervix requiring a cerclage, and none were suitable candidates for a vaginal cerclage. We further conclude that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with a minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.