Postpartum blues: relationship between not-protein bound steroid hormones in plasma and postpartum mood changes.

The relationship between non-bound steroid hormone levels in plasma and the occurrence of postpartum mood changes was investigated in 26 newly delivered mothers throughout the first 5 days postpartum. Studies with saliva samples had reported higher concentrations of 17 beta-estradiol and progesterone on the days of symptoms in women experiencing postpartum blues. As there had been a controversy as to how far saliva concentrations reflect free hormone levels in plasma, free hormone levels of 17 beta-estradiol and progesterone were determined in plasma using ultrafiltration. No significant difference concerning free hormone levels could be found between women with and without postpartum blues.

Post partum blues: depressive disease or pseudoneurasthenic syndrome.

Depressive mood disorders following childbirth can be quantified with self-rating and observer-rating scales. During two months, in the period from November 1989 to March 1990, women admitted to the obstetric unit of the University of Würzburg were examined on days 3 and 5 post-partum with the Hamilton Psychiatric Rating Scale for Depression, the Montgomery-Asberg-Depression-Rating-Scale and the Befindlichkeits-Scale by von Zerssen. Results reveal that during the early puerperium, scores on these scales rarely reach the same severity as in major depressive disorder. The clinical picture is no different from emotional-hyperaesthetic hyposthenia following other kinds of physical illness such as endocrine disorders.

[Malignant germ cell tumor in XY gonadal dysgenesis (Swyer syndrome)]. / Maligner Keimzelltumor bei XY-Gonadendysgenesie (Swyer-Syndrom).

UNLABELLED: Case of a 20-year-old patient with severe abdominal pain, right adnexal mass, positive beta-HCG titre and free fluid in the abdominal cavity, as diagnosed by ultrasound. Laparotomy resulted in a ruptured ovarian tumour (chorionic carcinoma). Despite chemotherapy, the tumour developed fulminant metastases with a follow-up of 3 months. FINAL DIAGNOSIS: Gonadal dysgenesis, XY female type (Swyer-Syndrome).

Hysteroscopy for gamete intrafallopian transfer (GIFT).

Gamete intrafallopian transfer (GIFT) is performed currently using laparoscopy. We report on a pilot-study from 1.1.1987 to 31.12.1987 and from 1.5.1988 to 30.4.1989, in which we used hysteroscopy instead of laparoscopy for the GIFT-procedure. The entering conditions were: unexplained (idiopathic) infertility, failure of previous treatments, proven fertilization capability of the gametes in at least one IVF attempt, and request of the married couple to dispense with laparoscopy during GIFT procedure. Hysteroscopic GIFT was initially performed on hysterectomy specimens, using the Chorionoskop. Continuous flow CO2 through the fallopian tubes did not result in loss of gametes. Twenty-four treatment cycles were performed in 16 patients. In 19 cycles, gametes were transferred into one tube, and in two cycles they were transferred into both tubes. Four of 16 women conceived: one patient delivered at term, three pregnancies ended in a first trimester abortion. These results demonstrate that the hysteroscopic approach to intrafallopian gamete transfer can be successful. However, the technique is demanding and requires extensive training. We conclude that further improvements of hysteroscopic GIFT are needed.

[The effect of maternal dexamethasone treatment after the 12th week of pregnancy on fetal genital development in adrenogenital syndrome with 21-hydroxylase deficiency]. / Effekt einer mütterlichen Dexamethasonbehandlung nach der 12. Schwangerschaftswoche auf die fetale Genitalentwicklung bei adrenogenitalem Syndrom (AGS) mit 21-Hydroxylase-Defekt.

Prenatal treatment with dexamethasone starting with gestation week 5 has been proposed to prevent virilization of female fetuses with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. We report dexamethasone treatment in a mother during her third pregnancy; this treatment could not be started before the 12th week of gestation. The second child (index case) had a simple virilizing 21-hydroxylase deficiency CAH and Prader IV genitalia. Because after amniocentesis a normal female karyotype and HLA identity with the index case were found, the dexamethasone treatment (3 x 0.5 mg/die) was continued until delivery.-In contrast to patients with salt-wasting CAH, the 17-alpha-hydroxyprogesterone level in the amniotic fluid was within the normal range. Decreased maternal plasma and urine estriol concentrations, as well as the plasma cortisol values, demonstrated adequate suppression of the fetal and maternal adrenal gland. No side effects were found in the mother as a result of the dexamethasone treatment. The newborn had virilization of the external genitalia according to Prader III but without hypertrophy of the clitoris. The degree of rugated scrotum was less marked in relation to the index case and the sinus urogenitalis was more distally shifted. Thus, surgery on the clitoris could be avoided. The conditions for further surgery (vaginoplasty) could probably be improved. Therefore, dexamethasone treatment of a mother with a female CAH fetus due to 21-hydroxylase deficiency seems to be justified starting at the 12th week of gestation. However, the optimal beginning of therapy is in early pregnancy.