Biomedical subjects
Publications and source records attributed to J J Amy.
We describe a strategy used in this case to detect congenital toxoplasmosis early in pregnancy. Combination of chorionic villus sampling and early amniocentesis with an in vitro cell culture technique makes prenatal diagnosis of congenital toxoplasmosis possible from the end of the first trimester of pregnancy.
Tocolytics were administered in 66 consecutive women in uncomplicated preterm labour with intact fetal membranes (53 singleton and 13 twin pregnancies). C-reactive protein (CRP), a marker of infection, was determined daily and used retrospectively to investigate the role of subclinical infection in preterm labour and to predict the efficacy of tocolysis and the development of a clinical perinatal infection. CRP was also determined in 66 women in uncomplicated labour at term (53 singleton and 13 twin pregnancies). The placenta was examined for histological evidence of infection in all patients who were delivered before 36 weeks (n = 21) and in all women in the control group (n = 66). Elevated CRP levels were more often found in patients who were refractory to tocolysis, suggesting an underlying infectious morbidity. Placental infection was found in 62% of the preterm delivery group and in 12% of the control group. There was an association between elevated CRP levels and histological evidence of placental infection. However, confounding factors such as urinary tract infections limit the usefulness of the CRP test. Because CRP cannot predict clinical perinatal infection accurately, its clinical relevance is very limited.
Until now, it was assumed that primary prevention of congenital toxoplasmosis was possible by means of specific hygienic measures. A prospective survey of pregnant women was made at a hospital in Brussels over the period 1979-1986 to assess the impact of such a prevention program. In the first study period (1979-1982), when no prophylactic measures were taught, 2986 consecutive women demonstrated a seroconversion rate of 1.43% among the nonimmunized subjects; 1.07% of the seropositive patients had high antibody levels in their first serum sample. In the second study period (1983-1986), all 3563 patients were instructed to adopt prophylactic measures. The seroconversion rate in seronegative patients and the percentage of patients with high initial antibody level were 0.95 and 1.26%, respectively. Although the percentage of seroconversion was reduced by 34% in the second study period, this difference did not attain significance. These results indicate that the impact of a primary prevention program aimed at reducing congenital toxoplasmosis is limited.
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Open-ended vasectomy was performed on one-hundred men. Sixty-three of them showed up for follow-up six months later. Spontaneous recanalisation had occurred in two. Sperm granuloma without orchialgia was found in 14 out of 59 men (23.9%). Twenty-one out of the 63 thought their sex life had improved, while 40 thought it was unchanged; only one man mentioned pain during intercourse since vasectomy.
Although most authors do not recommend prenatal puncture of a unilateral single cystic renal mass, in case the contralateral kidney is normal and there is sufficient amniotic fluid, this case report shows that the procedure, which can be done very carefully under ultrasonic guidance, can be helpful in establishing the presumed diagnosis.
Two cases are presented illustrating the potential danger of abnormal placentation. Placenta accreta is frequently associated with placenta praevia and/or a history of previous caesarean section. As there are no obvious specific symptoms before or during delivery, one should consider the possibility of this anomaly in the third stage of labour when manual removal of the placenta is very arduous. The treatment of choice is immediate abdominal hysterectomy, for this is followed by the lowest maternal mortality. If abnormal placentation is suspected, one should be prepared to deal with it as necessitated, including the possible performance of an emergency caesarean hysterectomy.
Ureaplasma urealyticum is a common inhabitant of the lower genital tract of women. It is unclear whether or not the microorganism plays a role in provoking spontaneous abortion. Reported is a U urealyticum infection of placenta and amniotic fluid in an immunologically competent host resulting in abruptio placentae and spontaneous abortion during the second trimester of pregnancy. U urealyticum was isolated from peripheral maternal blood twice. Immunologic alterations, namely a transiently reversed OKT4/OKT8 rate and a decrease in immunoglobulin G levels, were detected in the patient. U urealyticum must be considered as a pathogen able to interfere with normal fetal development.
A prospective survey of antenatal patients was made at a hospital in Brussels over the period 1979-1982 to assess the incidence of congenital toxoplasmosis. Of 2986 patients assessed, 1403 (47%) had no toxoplasma antibodies and were at risk. The susceptible population was assessed every 6 weeks and 20 of these women (1.4%) seroconverted during pregnancy. Ten of the seroconverters had a therapeutic abortion; of the remaining 10 two gave birth to congenitally infected infants. Of the 1583 (53%) patients with a positive serology for toxoplasmosis initially, 17 (1.1%) had high antibody titres indicating that the infection could have taken place early in pregnancy. Nine infants born to these women were followed at our hospital and two of them were affected.
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Vaginal suppositories containing 20 mg prostaglanding E2, administered at 2-5h intervals, are very effective in interrupting second-trimester pregnancy and in inducing labor in case of death in utero. However, side effects are common and make the treatment unpleasant to most patients. Premedication with an maintenance of a potent anti-emetic (e.g. haloperidol) and an anti-diarrheic (e.g. loperamide) considerably reduce the frequency and severity of these side effects.
A gel containing 0.5 mg prostaglandin E2 (PGE2) was extra-amniotically instilled 90 clinically normal gravidae at term, for ripening of the cervix before elective induction of labor by amniotomy and intravenous PGE2. An acceptable increase in the Bishop score was noted to have occurred in 87/90 women, when assessed eight hours after administration of the gel; 14 of these women were then in established labor, which progressed uneventfully. Four of the 90 subjects required cesarean section for cephalopelvic disproportion. No adverse maternal or fetal effects of the procedure were detected under careful clinical, electronic and biochemical monitoring. However, epidural anesthesia adversely influenced the acid-base equilibrium of the fetus.
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In 100 clinically-normal women, labor was induced at term by low amniotomy and PGE2. The drug was administered by either the oral or the oromucosal route, the same incremental dose scheme (initial dose of 0.5 mg; hourly increment of 0.5 mg until adequate uterine stimulation or a maximum single dose of 3.0 mg) being applied. Both routes of administration had comparable efficacy and were equally safe. The incidence of abnormal monitoring findings (uterine hypertonus, transient bradycardia and dips II during the first stage; late decelerations, progressive and transient bradycardia during the second stage of labor) and of low Apgar scores were similar. Acid-base and lactate-pyruvate equilibria in mother and fetus were not influenced by the route of drug administration in parous women. In nulliparae treated with PGE2 by the oromucosal route, higher values were found for the fetal-maternal difference in excess lactate than in those given oral PGE2; however, this is probably of little clinical importance.