The effect of betamethasone versus dexamethasone on fetal biophysical parameters.

BACKGROUND: Clinical observations suggest that betamethasone reduces maternal perception of fetal movements and short term variability, but that this dose not occur after treatment with dexamethasone. OBJECTIVES: To compare the effect of betamethasone and dexamethasone on fetal biophysical parameters. METHODS: In a randomized, prospective, double blind study, 20 courses of betamethasone and 20 courses of dexamethasone were given in random sequence to patients with imminent preterm labor. During the first 32h after initiation of treatment, fetal movements were counted by the mothers and recorded by ultrasound, and a nonstress test was performed. RESULTS: Betamethasone induced a significant decrease in fetal movements as perceived by the mother and observed by ultrasound. Fetal breathing movements also decreased. Dexamethasone did not change fetal body movements. Neither drug changed the short term variability. CONCLUSIONS: Unlike betamethasone, dexamethasone does not induce a decrease in fetal movements. Dexamethasone might, therefore, be preferred for enhancement of lung maturation in imminent preterm labor.

Female urinary stress incontinence--does it have familial prevalence?

OBJECTIVE: Many factors have been suggested to contribute to the development of urinary stress incontinence in women. One of the suggested factors has been attributed to a genetic defect in the connective tissue in such patients. The purpose of this study was to evaluate the prevalence of urinary stress incontinence among relatives of patients with urinary stress incontinence. STUDY DESIGN: The prevalence of urinary stress incontinence among first-degree relatives was investigated in 259 females with urinary stress incontinence. A control group comprising 165 women without micturition disorders was randomly selected from our gynecologic outpatient clinic. The two groups were matched according to age, parity, maximal birth weight, and percentage of first-degree relatives on whom information was obtained. RESULTS: Data from 780 first-degree relatives in the study group and 474 in the control group were evaluated. We found that there was an overall prevalence of 20.3% (178/780) first-degree relatives in the study group compared with 7.8% (37/474) in the relatives of the control group (p<0.05). Among the mothers we found the prevalence of urinary stress incontinence to be 34.9% (71/203) in the study group compared with 12.7% (19/149) of mothers in the control group (p<0.005). Among the sisters in the study group the prevalence of urinary stress incontinence was 19.9% (73/367) compared with 6.8% (15/220) of sisters in the control group (p<0.005). Among the daughters we found the prevalence in the study group (6.7%) to be twice as high as in the control group (2.9%), but the difference did not reach statistical significance. CONCLUSIONS: The results of this study indicated a three-fold prevalence of urinary stress incontinence among first-degree relatives of female patients with urinary stress incontinence. This finding may support the theory of a genetic factor in the cause of urinary stress incontinence.

Gas embolism complicating obstetric or gynecologic procedures. Case reports and review of the literature.

Gas embolism is a rare life-threatening complication of obstetric or gynecologic procedures, arising as a result of gas bubbles being introduced into the circulation via severed blood vessels. Extensive brain damage and acute cardiovascular collapse will lead to a fatal outcome. A favourable outcome depends on early diagnosis and prompt treatment. Hyperbaric oxygenation, which reduces bubble size and increases the supply of oxygen to hypoxic tissues, is the definitive treatment for gas embolism. We report four cases of gas embolism complicating obstetric or gynecologic procedures which were treated at the Israel Naval Medical Institute followed by an updated review of the literature.

[Hyperbaric oxygen for hydrogen sulfide poisoning].

Hydrogen sulfide (H2S) is a toxic gas produced in decaying substances containing organic sulfur. Exposure to the gas causes severe disturbances in the central nervous and respiratory systems. The mechanism of toxicity is disruption of the electron transport chain in mitochondria, resulting in intracellular hypoxia. Treatment of H2S poisoning includes mechanical ventilation with 100% oxygen and immediate administration of sodium nitrate. Treatment with hyperbaric oxygen (HBO) has been studied in animal models, and has also been used in a number of patients. However, the clinical effectiveness of this mode of therapy has not been clearly proven. Having recently treated a case of H2S poisoning, we suggest HBO to reduce mortality.

Prostaglandin for enhancing bladder function after vaginal surgery. Does it work?

Fifty women underwent vaginal hysterectomy with or without anterior and posterior colporrhaphy. After the operations the women were allocated randomly to one of three groups. One group (17 patients) received daily vaginal suppositories of 10 mg of prostaglandin E2. The second group (15) received a daily intravesical solution of 50 micrograms of prostaglandin F2 alpha dissolved in 100 mL of normal saline. The third group (18) received a daily instillation of 100 mL of saline and served as the control group. The postvoiding residual urinary volume was checked daily through a suprapubic catheter, which was removed once the residual volume was less than 50 mL. The prostaglandin did not shorten the time required for postoperative bladder drainage. The rates of febrile morbidity and hospital stay were the same in all three groups. Since most of the women in the study voided spontaneously within three days, the "sit and wait" approach seems reasonable in such patients, and prophylactic treatment to enhance bladder function after vaginal operations does not seem justified.