Etiology of miscarriage in polycystic ovary syndrome.
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Abortion, Spontaneous↗
Biomedical subjects
R Homburg
Publications and source records attributed to R Homburg.
Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome.
Women with the polycystic ovary syndrome do not respond well to treatment with luteinising hormone releasing hormone. To determine whether this might be due to an underlying endocrine disturbance basal concentrations of luteinising hormone were measured in 54 infertile women treated with pulsatile luteinising hormone releasing hormone and concentrations at the time of maximum follicular growth were measured in 23 of the patients. Forty one patients ovulated. Forty one patients ovulated and 27 conceived, but nine pregnancies terminated within four weeks after ovulation. Basal luteinising hormone concentrations were significantly lower in those who conceived (12.4 (range 1.3-29.0) IU/l) than in those who did not (19.0 (3.5-50.0) IU/l) and in those whose pregnancy progressed (9.6 (1.3-29.0) IU/l) than in those with early loss of pregnancy (17.9 (7.0-29.0) IU/l). Concentrations at the time of maximum follicular growth were significantly lower in women who ovulated (9.4 (2.9-35.4) IU/l) than in those who did not (29.0 (7.0-50.0) IU/l) and in those who conceived (6.2 (2.9-8.5) IU/l) than in those who did not (17.9 (4.0-50.0) IU/l). These results indicate that high concentrations of luteinising hormone during the follicular phase in women with polycystic ovaries have a deleterious effect on rates of conception and may be a causal factor in early pregnancy loss.
Abortion, Spontaneous↗
Improved treatment for anovulation in polycystic ovarian disease utilizing the effect of progesterone on the inappropriate gonadotrophin release and clomiphene response.
The treatment of anovulatory, clomiphene-resistant patients with polycystic ovarian disease (PCOD) is difficult. Ten such women were given progesterone, 50 mg/day i.m. for 5 days to achieve luteal phase concentrations. Immediately following progesterone treatment, plasma concentrations of FSH were reduced in all patients (P = 0.001) and seven of the 10 had reduced plasma LH concentrations. Following the withdrawal bleeding these seven all became responsive to clomiphene as shown by ovulation, and three conceived after a single progesterone/clomiphene cycle. LH pulsatility, studied in five women over 4 h, before and immediately following progesterone treatment, showed a slowing of the pulse frequency (62 +/- 26 min to 105 +/- 51 min, P less than 0.05) and an increase in pulse amplitude (6 +/- 1.9 IU/l to 16.7 +/- 20 IU/l). The LH and FSH response to GnRH was blunted by progesterone. It would thus appear that progesterone modulates LH pulsatility and reduces pituitary sensitivity to GnRH, reducing LH levels and possibly inducing more FSH synthesis and storage, similar to its action in the normal ovulatory cycle. These changes provide a more favourable environment for ovulation induction by clomiphene and we suggest that short-term progesterone treatment may be utilized to improve the efficiency and results of clomiphene treatment in PCOD.
Anovulation↗
Growth hormone facilitates ovulation induction by gonadotrophins.
The addition of biosynthetic human growth hormone (GH) to treatment with human menopausal gonadotrophin (hMG) significantly augmented the ovarian response in four patients treated for in-vivo and three patients treated for in-vitro fertilization who had previously been resistant to hMG. The amount, duration of treatment and daily effective dose of hMG were all reduced by growth hormone. This action of growth hormone offers a new approach to ovulation induction.
Adult↗
Synergism of pulsatile LHRH therapy with oral clomiphene treatment.
Eighteen anovulatory patients who were resistant to induction of ovulation with clomiphene and with subcutaneous pulsatile LHRH were treated with these two agents given simultaneously. Twelve of the 14 patients with polycystic ovary syndrome, 1 patient with weight-related amenorrhea and 1 of 3 patients with intrinsic pituitary disease responded to the combined treatment. Serial determinations of serum gonadotropin concentrations showed that these remained unchanged by clomiphene treatment, suggesting a direct action on the ovary. For induction of ovulation for in vivo fertilization, the combination of oral clomiphene with subcutaneous pulsatile LHRH is worth trying before proceeding to intravenous LHRH or hMG therapy.
Administration, Oral↗
Bleeding esophageal varices in pregnancy. A report of two cases.
Hemorrhage from esophageal varices during pregnancy in women with cirrhosis is a rare occurrence with a high mortality rate. Two such women, previously treated surgically for bleeding varices, one with additional sclerotherapy, had massive hemorrhages at 35 weeks necessitating cesarean section for fetal distress. Both neonates were healthy. One woman died one week postpartum. Pregnancy does not appear detrimental to the maternal prognosis despite the theoretical probability of raised portal pressure. About 70% of those with demonstrable varices will bleed during pregnancy; the overall mortality rate is 20%. Endoscopy and sclerotherapy before and in early pregnancy may help reduce the mortality rate. An awareness of the possibility of unpredictable bleeding and of the available treatments in a pregnant woman with esophageal varices is essential.
Adult↗
Endocrine studies of the ovulatory disturbances in Wilson's disease (hepatolenticular degeneration).
Women with Wilson's disease may have severe oligomenorrhea or amenorrhea whose cause is unknown. The endocrine profile of four such cases was investigated by measuring basal values and the response to dynamic tests of hypothalamic, pituitary, thyroid, and adrenal function, which all proved normal. Ovarian function was disturbed, as witnessed by low estradiol, high total testosterone (T) levels with normal free T, and mildly elevated androstenedione. An interference of ovarian follicular aromatase activity possibly due to copper intoxication could explain these findings as the cause of the ovulatory disturbances of Wilson's disease.
Adolescent↗
An infant with multiple deformations born to a myasthenic mother.
An infant with multiple deformations born to a mother with untreated myasthenia gravis presented with arthrogryposis multiplex, craniofacial dysmorphism, kyphoscoliosis of the thoraco-lumbar spine, severe hypotonia, absence of the sucking reflex, and other neurological deficits. The neurological state of the infant supported the diagnosis of congenital myasthenia gravis, but the negative Tensilon test and the lack of clinical improvement after prolonged Mestinon treatment ruled out this diagnosis. We believe that the multiple deformations and reduced fetal movements are related to the maternal myasthenic environment associated with mild polyhydramnion.
Abnormalities, Multiple↗
Rib fractures as a cause of immediate neonatal tachypnoea.
Two macroscopic term neonates are described who presented with uncomplicated tachypnoea immediately following vaginal delivery. The tachypnoea was not associated with lung injury, metabolic, endocrine or cardio-respiratory disease but with multiple unilateral posterior rib fractures. The neonatologist should be aware that neonatal tachypnoea immediately after vaginal term delivery, especially in macrosomic infants, may be caused by the pain of fractured ribs. The diagnosis can be made only by careful inspection of the ribs on chest X-ray.
Female↗
An examination of the relationship between fetal movements and infant motor activity.
Fifty-one patients recorded fetal movement counts for several weeks, 29 while hospitalized for complications of pregnancy (group 1) and 22 with normal pregnancies and ambulant (group 2). The motor activity of group 1 neonates was examined 24-72 hours following delivery, using a partial Brazelton neonatal assessment scale. Group 2 infants were examined at age 10-12 months, using a method specially designed for this study to assess motor activity. No significant correlation was found between the mean number of fetal movements and the motor activity of neonates, versus those of one-year-old infants. These findings suggest that fetal movements are most probably influenced by numerous factors differing from those influencing the motor activity of the neonate and infant.
Delivery, Obstetric↗
Neonatal factor XIII deficiency.
We describe a patient diagnosed in the neonatal period as having factor XIII deficiency who presented with persistent umbilical bleeding. Factor XIII deficiency is the only coagulation factor deficiency that cannot be detected by classical hemostatic tests, and a rapid diagnosis is vital during the first decade of life. A newborn presenting with persistent umbilical stump bleeding should be screened for factor XIII deficiency when routine coagulation tests prove normal.
Blood Coagulation Tests↗
Oxytocin-stressed and unstressed cardiotocograms for the prediction of fetal compromise.
The results of unstressed and oxytocin-stressed cardiotocograms recorded in 222 high-risk pregnancies within 48 h of delivery were compared with signs of fetal distress in labour and Apgar scores. Thirty-nine (18%) developed a late deceleration pattern in labour and 18 newborn (8%) had Apgar scores of less than 7 at 1 min. A direct comparison of the predictive value of unstressed and stressed cardiotocograms, using Fisher's exact test, showed a very significant difference in favour of the stressed cardiotocogram for the prediction of both fetal compromise and fetal well-being. The exclusion, or very selective use, of the oxytocin-stressed cardiotocogram and reliance on the unstressed cardiotocogram for the antepartum investigation of high-risk pregnancies sacrifices accuracy for convenience.
Adolescent↗
Clinical evaluation of fetal movements.
Fetal movement was examined in 200 pregnancies to establish normal patterns, influencing factors, possible clinical value and practical application. The mean number of movements per hour was 26 in hospitalized and 40 in ambulatory patients. These values remained fairly steady throughout pregnancy except for a significant decrease in the week preceding labor. Individual variations were large. The number of movements was uninfluenced by parity and fetal sex but was lower for small-for-gestational-age babies, in mothers suffering from both hypertension and diabetes and in mothers treated with diazepam. Fetal movement count may be used as a parameter of fetal well-being.
Body Weight↗
Management of patients with a live fetus and cessation of fetal movements.
Sixty-seven patients with a history of no fetal movements for at least 12 hours and a live fetus were managed according to a fixed protocol. Twelve of these patients were found to have meconium-stained amniotic fluid and/or abnormal unstressed or oxytocin-stressed cardiotocograms; all of them were delivered within 24 hours of a live infant. The remaining 55 patients had no meconium and normal unstressed and stressed cardiotocograms, and their pregnancy, was allowed to continue. All felt fetal movements again and were delivered of live babies one to ten weeks later.
Amniotic Fluid↗
Hormonal responses to nasal application of synthetic gonadotropin-releasing hormone in amenorrheic patients pretreated with gonadotropins.
Synthetic gonadotropin-releasing hormone (GnRH) in the form of nasal drops was self-administered by five amenorrheic patients in an attempt to assess its therapeutic value in anovulatory infertility. After follicular maturation had been induced with human menopausal gonadotropins (HMG), a total daily dose of 7.5 mg of GnRH in the form of nasal drops was self-administered at 2-hour intervals for 6 hours on 3 consecutive days. In four patients, plasma luteinizing hormone (LH) levels were significantly elevated over a period of at least 8 hours. In three of these patients, in addition, there was a definite upward shift in the basal body temperature (BBT) curve, and uterine bleeding occurred 6 to 9 days after the first dose of GnRH. In the fourth patient, ovulation was induced as indicated by a biphasic BBT curve, a plasma progesterone level of 13 ng/ml, and a luteal phase of 15 days. In the remaining patient, there was a borderline LH response and no clinical response. It is concluded that GnRH, in the form of nasal drops, is effective in eliciting and maintaining elevated plasma LH levels in patients in whom follicular maturation has been induced with HMG. By obtaining ovulatory LH levels, such a regimen can lead to ovulation. In addition intranasal self-administration of GnRH is convenient and may provide an alternative route of administration for long-term therapy with this hormone.
Administration, Intranasal↗
[Acute renal failure with hemolytic crisis as a complication of septic abortion].
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Abortion, Septic↗
Detection of fetal risk in postmaturity.
Ninety-seven postmature pregnancies were monitored by amnioscopy or amniocentesis (to determine presence or absence of meconium), oxytocin challenge tests (OCT), 24-hour urinary oestriol estimations and fetal movement counts. The colour of the amniotic fluid and the result of the OCT predicted almost all cases of fetal distress in labour and infants with low Apgar scores. Oestriol estimations and fetal movement counts predicted fetal distress only when combined with other positive tests. Of 50 patients with no abnormal test results, 49 had uneventful labours. The Caesarean section rate was not above average and all babies were liveborn.
Adolescent↗
Perforation of the urinary bladder by the laparoscope.
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Adult↗