A study of the kinetics of cephapirin and cephalexin in pregnancy.

The kinetics of cephapirin and cephalexin were studied in 60 pregnant women after the administration of single 1 g doses of the antibiotics given by the intramuscular and oral route, respectively. Maternal serum, amniotic fluid and cord serum concentrations were measured at intervals after the dose by the agar diffusion method. The results showed that the mean peak concentration of cephalexin in maternal serum, after 1 hour, was significantly greater than that of cephapirin. Both antibiotics crossed the placenta barrier and reached levels in the amniotic fluid and cord serum adequate for the in vitro inhibition of pathogens involved in materno-foetal infections.

Carcinoembryonic antigen (CEA) in normal and pre-eclamptic pregnancies (values in maternal blood, amniotic fluid and umbilical cord blood).

Values of carcinoembryonic antigen (CEA) were measured by radioimmunoassay in 100 pregnant women divided into 4 groups. In group 1 (49 normal pregnancies) and 2 (17 pre-eclamptic pregnancies), the estimation of CEA was done in maternal vein blood, umbilical cord blood and in amniotic fluid. In group 3 (20 normal pregnancies) CEA was measured separately in blood of the two umbilical vessels as well as in maternal vein blood. In group 4 (14 pregnancies with small-for-date infants) CEA was estimated in umbilical cord blood. The values in amniotic fluid of normal and pre-eclamptic pregnancies were more than 20 times higher than in the other two compartments. A significant correlation was found between the amniotic fluid and umbilical cord blood values (r = 0.500; P < 0.05), as well as between the values in umbilical artery and vein (r = 0.792; P < 0.001). Thus, it is thought that CEA is transferred from the amniotic cavity to the umbilical cord while a part of CEA perhaps is produced by the placenta. Umbilical cord blood values of small-for-date fetuses do not differ significantly from the normal. On the contrary, significantly lower values were obtained in umbilical cord blood and in amniotic fluid of pre-eclamptic women as compared to the normal, but this finding is not useful clinically because of the large standard deviation.

Toxoplasma antibodies and spontaneous abortion.

One hundred and fifty-two women with spontaneous abortion were investigated by hemagglutination (HA) and immunofluorescence antibody (IFA) tests for toxoplasmosis. In 48 cases, quantitive immunoglobulin (Ig) studies and mouse inoculation with gestational material were performed. Positive toxoplasma antibody titers were observed in 62 cases (40.8%) using HA and in 52 cases (38.2%) using IFA. This prevalence was significantly higher than that observed in 80 normal women who served as controls. Toxoplasma gondii was isolated in two cases. No correlation was found between antibody titers and IgG, IgM or IgA levels. We conclude that toxoplasmosis should be considered as the cause of abortion when a patient's antibody titer exceeds 1:256.

Second-look laparoscopy in ovarian cancer.

Forty-six patients with epithelial ovarian cancer previously treated with surgery, chemotherapy or external radiation underwent second-look laparoscopy to evaluate management. Twenty of the patients had positive laparoscopic findings and were not subjected to further laparotomy. The frequency of positive findings was related to the stage of the disease. Laparoscopic examination revealed no evidence of cancer in the remaining 26 patients. Three of the patients in this group were found to have additional disease at subsequent laparotomy. The laparoscopic procedures were not associated with major complications. Although second-look laparoscopy cannot replace repeat laparotomy, it does have a role in the follow-up of patients with ovarian cancer.

Ectopic pregnancy: outcome of 152 cases.

Ectopic pregnancy is a common gynecological condition which usually presents with symptoms of acute abdomen. During the period 1976 to 1978, 152 cases of ectopic pregnancy were treated in our department. About one ectopic pregnancy was treated for every 100 infants delivered. Most of the cases were seen during summer time. Of the patients 43% were between 26 to 30 years of age. From their previous history, 47% reported one or more terminations of pregnancy and 33% recurrence of acute salpingitis. The majority of the ectopic pregnancies were located in the tube. Abdominal pregnancy was observed in three women, one of whom delivered, with the aid of laparotomy, a live infant. All the women reported pelvic pain, whereas shock appeared in only 23% of the cases. Culdocentesis gave false negative results in 14.15% of the cases. Preoperative diagnosis was based on laparoscopy in 28 cases. Dilatation and curettage (D and C) with endometrial biopsy disclosed decidual endometrium without chorionic villi in 37% and Arias-Stella cells in 68% of cases. Salpingectomy was performed in 52% of the cases, and plastic surgery of the tube in 16%.

Ovarian neoplasms and pregnancy.

Sixteen cases of benign cystic ovarian neoplasms (13 serous cystadenomas and 3 dermoids) were discovered among 5,616 pregnancies. The only serious complication was torsion of the ovary containing the tumor in one case.

Induction of abortion by intra-amniotic administration of prostaglandin F2 alpha in patients with intrauterine fetal death and missed abortion.

The use of intra-amniotic administration of Prostaglandin (PG) F2 alpha in the management of intrauterine fetal death and missed abortion is evaluated in a series of 30 patients. The patients were from 17 to 38 years of age with a median of 25 years. Parity ranged from 0 to three, and duration of gestation ranged from 16 to 37 weeks, with a median of 24 weeks. A single intra-amniotic dose of 40 mg PGF2 alpha was used under direct ultrasound vision. Induction was achieved in all cases. There were 28 complete, and two incomplete terminations. The mean treatment to completion interval for all patients was 5.3 hours. Side effects were minimal: we believe that PGF2 alpha can be safely administered intra-amniotically even with a dead fetus in the uterus and that it can lead to abortion with a minimum of discomfort and danger to the mother.

The use of 15-methylated derivative of prostaglandin F2a for the therapeutic termination of pregnancy and management of late fetal death.

The administration of 15-me-PGF 2a for the therapeutic termination of pregnancy and management of intrauterine death of the embryo during the second and third trimester of pregnancy was studied in 92 patients. Of these, 52 came because of intrauterine death with an average gestational age of 28.7 weeks while the rest came for therapeutic termination of pregnancy with an average gestational age of 21 weeks. Successful abortion was achieved in 90 patients. The mean abortion induction time was 7.3 hours for patients with intrauterine death and 12.6 hours for the patients who came for therapeutic termination. The results and complications of the intramuscular administration of the 15-me-PFG2a are analysed in the present work.

Evaluation of diagnostic fetoscopy.

The authors evaluate the efficacy and safety of fetoscopy on a series of 510 patients in which the procedure was carried out between the 18th and 20th week of gestation in order to obtain a suitable fetal blood sample for prenatal genetic diagnosis; the whole pregnancy could be completely followed up in them. The complication rate was low (1.7%) when the first attempt of fetoscopy was successful, but rose dramatically up to 17.9% on repeated attempts: however, they only amounted to 7.8% of all cases. The results of their study lead the authors to propose fetoscopy as a powerful, accurate and safe addition to the presently available diagnostic methods, provided it is performed by well trained fetoscopists, under aseptic conditions and local anaesthesia.

[Clindamycin levels in the cervical mucus after intramuscular administration of the drug (author's transl)]. / Le taux de clindamycine dans la glaire cervicale après injection intramusculaire.

Female genital tract is a major area of anaerobic infections. Clindamycin has been used as a highly active antibiotic against both gram positive and negative anaerobic pathogens including bacteroides fragilis. Concentration of clindamycin in cervical mucus has been tested in 30 women after administration of one single dose (600 mg) of the antibiotic intramuscularly. Antibiotic levels were tested by agar diffusion method employing a strain of alpha-hemolytic streptococcus. Levels of clindamycin in cervical mucus were found to be sufficient to inhibit "in vitro" a significant proportion of anaerobic bacteria present in cervical mucus.