[Severe fetal hemolytic disease. Evaluation and successful treatment by means of cordocentesis]. / Enfermedad hemolítica fetal severa. Evaluación y tratamiento exitoso mediante cordocéntesis.

Ultrasonically guided access to the fetal umbilical circulation offers an alternative to the standard management of the severe isoimmunized pregnancy. This technique allows fetal blood sampling, direct hematocrit analysis and intravascular transfusion. A severely Rh isoimmunized pregnancy is described in which five intrauterine transfusions of blood were given directly into the umbilical vein under ultrasound visualization. Technical aspects of the procedure and complications are discussed.

New insights on the mode of action of intrauterine contraceptive devices in women.

To gain a better understanding of the mechanism of action of intrauterine devices (IUDs), a search was made for ova in the genital tracts of 115 women using no contraception and of 56 women using IUDs, all of whom volunteered for study in conjunction with surgical sterilization. Ova were recovered from tubal flushings between 48 and 120 hours after the midcycle peak of luteinizing hormone in 39% of the IUD users compared with 56% of women in the control group (0.05 less than P less than 0.10). This suggests an action of the IUD before the ovum reaches the uterus. Eggs with a microscopic appearance consistent with fertilization were recovered from the fallopian tubes of half of the women using no contraception who had intercourse within the fertile period of the reproductive cycle and from whom ova were recovered. In contrast (P less than 0.01), no eggs with this appearance were recovered in IUD users who had intercourse within the fertile period. No ova were recovered from the body of the uterus of any of the IUD users. Fertilized ova are less likely to reach the uterine cavity containing an IUD. Thus, the principal mode of IUDs is by a method other than destruction of live embryos.

Endocrine response and ovum transport in women treated with D-Trp6-luteinizing hormone-releasing hormone in the postovulatory period.

Possible alterations in ovum transport during increased activity of the hypothalamic-pituitary-ovarian axis were investigated in women. D-Trp6-luteinizing hormone (LH)-releasing hormone, a synthetic peptide with potent gonadotropin-releasing activity, was used to induce a gonadotropin surge and stimulate ovarian steroid secretion in the postovulatory phase. The compound was administered intramuscularly or intravenously 24, 48, or 72 hours following the maximum preovulatory LH level in plasma in seven women. An immediate and pronounced gonadotropin surge accompanied by a moderate increase in the estradiol and progesterone level was obtained in all cases. Ova were recovered from the fallopian tubes in four of the seven women 24 hours following treatment. The rate of recovery and the location of ova within the genital tract indicate that the treatment and the resulting endocrine changes failed to accelerate migration of the ova toward the uterus. This observation, taken together with other negative findings previously reported, suggests that in comparison with other mammals transport of the ovum in the woman is relatively insensitive to endocrine changes occurring in the postovulatory phase.

Ovum transport in women treated with methyl ergonovine.

The location of ova in the genital tract was studied between 24 and 120 hours after the luteinizing hormone (LH) surge in 32 women who had been treated with methyl ergonovine in doses known to stimulate tubal contractility. Thirteen eggs were found in the fallopian tubes, between 48 and 120 hours after th LH peak, and no eggs were recovered from the endoemtrial cavity. No significant difference in tubal ovum recovery or in tubal segmental distribution of ova was found in comparison with these parameters in an untreated control group. These results indicate that stimulation of tubal contractility with methyl ergonovine does not accelerate ovum transport through the fallopian tubes in the human.

Effect of 15(S)-15-methyl prostaglandin F2alpha on human oviductal motility and ovum transport.

The effects of an intravenous infusion of 15(S)-15-methyl prostaglandin F2alpha (PGF2alpha) on oviductal motility and ovum transport were studied in women who were scheduled for elective tubal sterilization. Infusion rates of 0.38 microgram/kg/hour or higher caused an increase in oviductal motility in all patients. Lower infusion rates did not always cause a stimulation of motility. Low infusion rates generally caused an increase in the amplitude of contractions without any effect on basal oviductal tone. The higher infusion rates usually caused a large increase in basal tone as well as an increase in the amplitude of contractions. Ova were recovered from the oviducts of five patients who had received an intravenous infusion of 15(S)-15methyl PGF2alpha. The ova were recovered from the ampulla in three patients, from the ampullary-isthmic junction in one patient, and from the isthmus in one patient. Since one would expect to recover ova from the oviducts at similar times under normal circumstances, there was no evidence that this prostaglandin treatment caused an acceleration of ovum transport. These data support the conclusion that a PGF analog which stimulates oviductal motility does not necessarily also accelerate ovum transport in women.

Attempts to programme ovulation with exogenous oestrogens and LH-RH analogue.

An attempt was made to programme ovulation in women on a predetermined day of the menstrual cycle by treatment used to induce ovulation in anovulatory sterility. At laparotomy for elective sterilization the ovaries were observed to assess the occurrence of ruptured follicles and ovulation. Histological analysis of ovaries and endometrium was performed, and ova were recovered from some women. Several regimens were tested but ovulation seldom occurred as planned. Clomiphene citrate, human chorionic gonadotrophin (HCG), synthetic luteinizing hormone releasing hormone (LH-RH), and ethinyloestradiol were ineffective. Human menopausal gonadotrophin followed by HCG was more effective, but multiple ovulations occurred. When one single injection of a potent long-acting LH-RH analogue was given on day 13 of the cycle to 10 women pretreated with ethinyloestradiol signs of recent ovulation were observed on day 15 in seven and on day 16 in two.

Effect of oxytocin on the contractility of the human oviduct in vivo.

PIP: The effects of oxytocin, administered by either rapid or slow iv injection, on fallopian tube contractility were studies. Single iv doses were shown to consistently induce several contractions with a mean intensity of 10 mm Hg and hypertonia of varying duration. The oxytocin-induced bursts were synchronous in both tubes while normal spontaneous contractions are asynchronous. The tubes showed a high sensitivity to even small doses of oxytocin. The minimum does (threshold dose) of oxytocin eliciting tubal response in the patients was 250 mU. The intensity and duration of oxytocin-induced contractions were dose-dependent with the maximal responses obtained with oxytocin doses of 5 IU or less. The highest sensitivity was during the proliferative stage of the ovarian cycle. Continuous iv infusions of oxytocin ranging from 20 to 40 mU/minute increased tubal activity during administration. It was determined that the sensitivity of the human fallopian tube to oxytocin was higher than that of the nongravid uterus and lower than that of the mammary gland during lactation.^ieng

Further experience with quingestanol acetate as a postcoital oral contraceptive.

PIP: The experiences of 4 clinical research groups, 1 each in Mexico, Peru, Chile, and Argentina, using quingestanol acetate as a postcoital oral contraceptive is described. 2702 patients accumulated 18,531 cycles of postcoital therapy. In Mexico with a 800 mcg dose, the pregnancy rate was .6. In Chile and Peru at a dose of 750 mcg, pregnancy rates were over 20. Differences in selection of patients may account for part of the difference.^ieng

Effect of contraception on lactation.

PIP: A study of the effects of IUD and hormonal contraceptives, both oral and injectable, on lactation is reported. The duration of lactation in 696 multiparous healthy women under contraceptive therapy was compared with the women's own previous duration of lactation when no contraception was used. In users of Lippes loop and injectable progestogens (in medroxyprogesterone acetate, DMPA) median duration of lactation (MDL) was significantly longer, even whem DMPA was injected immediately post partum, than in the controls. The MDL of Control Group B, which excluded those patients who had spontaneously stopped lactating within 30 days after delivery, was 5.3 months. The MDL in patients receiving DMPA 30 days after delivery was 9.3 months, and it was 6.7 months in those receiving DMPA immediately post partum. The MDL in patients with IUD was 7.7 months. When oral estrogen containing quinestrol and oral sequential steroidal contraceptives were given, MDL was significantly shorter than in control lactations. In the 2 groups of patients receiving the combination of quinestrol (Q1) and quingestronol acetate (Q2) orally, one a month, the MDL was 2.5 months respectively. The data indicate that compounds containing estrogens in the doses employed in this study should not be used as contraceptive therapy by nursing mothers.^ieng

[Human tubal contractility in vivo. Analysis of the reproducibility and iatrogenics of a method of study]. / Contractilidad tubaria humana in vivo. Análisis de la reproducibilidad y yatrogénia de una metódica de estudio

PIP: Techniques for the study of tubal motility in vivo can provide important basic information, but their safety and the potential risks to which patients are exposed must be considered. 30 patients were studied, of whom 10 left the program. They were in good health and good gynecological conditions for at least 6 months after retrieving the tubal devices. Temporary changes in the ovaric cycle were observed in 3 patients; these changes and possible endocrine alterations induced by surgery must be considered in planning studies. 1 patient became pregnant 4 months after sterilization. The method was used previously by Maia and, Coutinho, and findings are consistent with those of the earlier study. The amplitude of tubal contractions is generally within 0-10 mm Hg and occasionally 0-20. Spontaneous tubal activity is asynchronous, and may be the result of the local release of certain compounds, probably catecholamines. The findings may be limited to patients subjected to tubal ligature, but findings on other patients are similar.^ieng