Persistent fetal heart rate hypovariability: a presenting clinical sign of histologic chorioamnionitis at term gestation.

Chorioamnionitis (CA) is asymptomatic in a large fraction of the cases. Here, we report a case of a 39 weeks' gestation infant, with persistent fetal heart rate hypovariability as the only prenatal clinical sign in histologic CA.

Equilibration between breast surface and ambient temperature by liquid crystal thermography.

Controversy surrounds the need for a waiting period (equilibration, or cooling period) before obtaining a breast thermogram. Temperature differences between an intrinsic lesion (carcinoma) and the overlying skin are said to be amplified by cooling of the skin. Some investigators have found no qualitative difference between thermographic evaluations done 3-15 minutes after the patient disrobes; others assert that tests done within this period are invalid. We evaluated nine ovulatory women thermographically twice during a menstrual cycle (proliferative and secretory phases) to ascertain the significance of such a waiting period and to investigate when thermal equilibrium is achieved with the environment. Breast thermograms were obtained with a cholesteric liquid crystal contact plate at 1-minute intervals for a 20-minute period following exposure of the breast to a room temperature of 72 F (22 C). A significant drop in breast skin temperature was found to occur during the first 15 minutes before equilibrium takes place; this finding suggests that a waiting period is necessary for accurate evaluation.

Heterotopic pregnancy: discovery of ectopic pregnancy after elective abortion.

We report a case of combined intrauterine and tubal pregnancy in a 23-year-old woman. The patient came to the emergency department complaining of lower abdominal pain after having had an elective abortion 2 weeks earlier. Her physician had done pelvic ultrasonography, noting an intrauterine pregnancy before the abortion. Our working diagnosis in the emergency department was retained products of conception versus postabortion endometritis. Pelvic ultrasonography in the emergency department revealed an ectopic pregnancy without evidence of retained products of conception, and the patient had a right salpingotomy with removal of the ectopic fetus without complications.

Low-dose prostaglandin E2 analogue for cervical dilatation prior to pregnancy termination.

The trauma of mechanical cervical dilatation preceding abortion is directly related to the degree of cervical resistance. Prostaglandins may reduce cervical rigidity but are accompanied by undesirable side effects. Our aims were to ascertain if a low-dose (10 mg) analogue (9-deoxo-16, 16 dimethyl-9-methylene PGE2) is effective and well tolerated and, if so, to try to determine the possible mechanism by which it works. To this end, we studied 39 women with gestational ages ranging from 7 to 19 weeks who were given a single vaginal suppository 1 to 4 hours before suction curettage. In addition to demographic data on age, gravidity, parity, and previous abortions, we determined progesterone, human chorionic gonadotropin and prostaglandin plasma levels. This low-dose prostaglandin E2 analogue was found to be effective in achieving cervical dilatation and softening with minimal side effects (mild nausea in one patient only). Mean cervical dilatation achieved was 7.8 +/- 2.3 mm. Softening was apparent and facilitated additional instrumental dilatation when required. No correlation was found between drug effectiveness and gravidity, gestational age, or duration of action. There was no detectable trend with regard to baseline progesterone or human chorionic gonadotropin levels. This suggested a specific sensitivity to the local effect by the drug, apparently unrelated to dosage.

PIP: The trauma of mechanical cervical dilatation preceding abortion is directly related to the degree of cervical resistance. Prostaglandins (PGs) may reduce cervical regidity but are accompanied by undesirable side effects. The aims of this study were to ascertain if a low dose (10 mg) analogue (9-deoxo-16,16 dimethyl-9-methylene PGE2) is effective and well tolerated and, if so, to try to determine the possible mechanism by which it works. To this end, there were 39 women studied withgestational ages ranging from 7-19 weeks who were given a single vaginal suppository 1-4 hours before suction curettage. In addition to demographic data on age, gravidity, parity, and previous abortion, the authors determined progesterone, human chorionic gonadotropin (hCG) and PG plasma levels. This low dose PGE2 analogue was found to be effective in achieving cervical dilatation and softening with minimal side effects (mild nausea in only 1 patient). Mean cervical dilatation was achieved 7.8 +or- 2.3 mm. Softening was apparent and facilitated additional instrumental dilatation when required. No correlation was found between drug effectiveness and gravidity, gestational age, or duration of action. There was no detectable trend with regard to baseline progesterone or hCG. This suggested a specific sensitivity to the local effect by the drug, apparently unrelated to dosage.

Temporal variations of temperature of the breast by cholesteric liquid crystal contact plate thermography.

Thermography of the breast is considered by some to be a risk marker for the presence of abnormalities of the breast. Circadian variations in the temperature of the skin of normal and cancerous breasts have been documented. A temporal study was undertaken to verify whether or not thermograms obtained at different hours of the day are sufficiently similar to be clinically useful. Eleven healthy women underwent four serial thermographic evaluations each at three to four hour intervals. Significant differences were observed between the early morning results and subsequent evaluations. Reproducible thermograms were obtained for all studies done from 12 noon onward. This is a possible indication that the timing of thermographic examinations has to be standardized to ensure that reliable comparisons are being made.