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Biomedical subjects

C B Coulam

Publications and source records attributed to C B Coulam.

At least 73 records · Page 4Linked to original sources
PubMed1994

Very early (24-56 days from last menstrual period) embryonic heart rate in normal pregnancies.

To determine embryonic heart rate in early gestations, 426 ultrasonographic examinations from 24 to 56 days from onset of last menstrual period (LMP) were studied. All pregnancies had a subsequent successful outcome. Transvaginal ultrasonography was performed using an Acuson 128 10XP with a 5 MHz probe. Embryonic heart rate was determined by M-mode. No embryonic heart rate was observed prior to 34 days of gestation from onset of LMP (n = 65). At 35 days, two of 13 (15%) pregnancies had cardiac activity, and by 36 days 16 of 19 (82%) pregnancies had cardiac activity. By day 37 from onset of LMP all pregnancies demonstrated embryonic cardiac activity. From days 34 to 56, mean embryonic heart rate rose from 94 to 166 beats/min. We conclude that embryonic cardiac activity is first apparent at day 34 and should be visible by day 37 in normal pregnancies.

Female↗
PubMed1994

Endocrine factors associated with recurrent spontaneous abortion.

The role of endocrine factors as a cause of recurrent spontaneous abortion is controversial. Diabetes mellitus and thyroid disease do not represent a significant risk factor for recurrent pregnancy loss. Luteal-phase defect has been questioned because there are no accurate methods for diagnosis and no convincing evidence of correction with treatment exists. The corpus luteum is an unusual endocrine gland, highly diverse in function and important for successful reproduction in all mammalian species. Much controversy exists about the luteal function in humans and how defects in luteal function affects reproduction. Disagreement has been due to lack of accurate diagnosis and controlled studies to determine whether correction of the luteal-phase defect is worthwhile when treating female reproductive problems. The donor egg recipient model from assisted reproductive technology programs has shown that corpus luteum function can be replaced by estrogen and progesterone administration. The mechanism by which these steroids stimulate a uterus to be receptive to implantation of the embryo is not known. Several proteins produced by the endometrium are candidate markers for uterine receptivity. Further work needs to be done to correlate these markers with subsequent pregnancy outcome. A noninvasive marker for uterine receptivity is ultrasonographic evaluation of the endometrium. Although the sensitivity of this test is high (100%), its specificity is low (only 20% to 60%).

Abortion, Habitual↗
PubMed1994

Use of lymphocyte platelet binding assay for detecting a preimplantation factor: a quantitative assay.

PROBLEM: To evaluate the ability of the lymphocyte/platelet binding assay to identify a preimplantation factor (PIF). METHOD: Percentages of binding of lymphocytes by platelets in the presence of sera from 30 known pregnant and 30 nonpregnant individuals were compared using a novel lymphocyte/platelet binding assay. The assay is performed using a combination of a heat inactivated sera with donor O+lymphocytes, activated complement and an antibody against CD2 (T11, Ortho Pharmaceuticals). RESULTS: In nonpregnant females (23.6 +/- 6.5%) and males (17.7 +/- 4.7%) the percentage of lymphocytes bound by platelets was significantly different from pregnant women (56.1 +/- 15.9%) (P < 0.0001). Serial sampling of blood in five women undergoing IVF/ET who had normal pregnancies showed the detection of PIF by 4 days after transfer. The lymphocyte/platelet binding assay was not influenced by hCG, progesterone and estradiol. The interassay and intrassay variabilities were < 3%. CONCLUSIONS: The lymphocyte/platelet binding assay is a simple, reproducible, specific and cost efficient assay for measurement of PIF. Application of this assay will provide investigative and diagnostic tools for identifying and monitoring early pregnancy events.

Biological Assay↗
PubMed1994

Immunotherapy with intravenous immunoglobulin for treatment of recurrent pregnancy loss: American experience.

PROBLEM: Recurrent spontaneous abortion (RSA) is the cause of childlessness in 2-5% of reproducing couples. Immunological mechanisms have been proposed as an etiology in some cases of RSA. Various forms of immunotherapy have been attempted in individuals thought to have an immunologic mechanism associated with RSA. Intravenous immunoglobulin (IVIG) has been used in a pilot study to successfully treat women with RSA. METHOD: To evaluate the efficacy of IVIG in the prevention of RSA as prospective randomized, placebo-controlled clinical trial was undertaken. Women experiencing two or more consecutive RSAs receive either IVIG 500 mg/kg/month or placebo (albumin). RESULTS: To date 92 women have been enrolled in the study and 58 pregnancies have been achieved. The outcome of the 58 pregnancies include 20 deliveries, 9 ongoing pregnancies and 29 losses. Fourteen (49%) of the 29 pregnancy losses were blighted ova (empty gestational sacs) and 15 (51%) were intrauterine fetal deaths (IUFD's) occurring in the first trimester of pregnancy. Of 14 blighted ova, 8 were in women receiving IVIG and 6 were receiving placebo. Fifteen IUFD's occurred: 3 (20%) in women receiving IVIG and 12 (80%) placebo. Of 11 pregnancy losses occurring in women receiving IVIG, 8 (73%) were blighted ova and 3 (27%) were IUFD's. Eighteen losses occurred in women receiving placebo: 6 (33%) were blighted ova and 12 (67%) were IUFD's. CONCLUSIONS: These preliminary data suggest IVIG may be effective treatment for RSA. Analysis of data from the completed randomized placebo-controlled trial will test this suggestion.

Abortion, Habitual↗
PubMed1993

Serum progesterone and estradiol concentrations in the early diagnosis of ectopic pregnancy after in vitro fertilization-embryo transfer.

To determine if discriminatory P or E2 concentrations can be established for early diagnosis of EP after IVF, 282 pregnancies were studied 11, 13, 15, and 17 days after ET. Receiver-operator characteristic analysis of P and E2 indicated no clinically useful threshold value for EP. No significant differences in P or E2 was seen when intrauterine and extrauterine pregnancies or viable and nonviable pregnancies were compared. All EPs had P < 50 ng/mL and E2 < 500 pg/mL at 11 days after ET. Serum P and E2 cannot differentiate EPs from intrauterine pregnancies nor viable from nonviable pregnancies resulting from IVF.

Embryo Transfer↗
PubMed1993

Pregnancy after metroplasty for uterine anomalies.

OBJECTIVE: To clarify the relation between metroplasty for correction of uterine anomalies and subsequent pregnancy, we reviewed the charts of all patients for whom a diagnosis of bicornuate, septate, or didelphic uterus had been made between 1972 and 1982 and analyzed their obstetric outcomes. DESIGN: Of the 146 patients evaluated, 23 received a metroplasty procedure, and 123 patients did not have surgical intervention. Fifteen of the nonsurgical patients could be matched with 15 of the surgical patients by age, chief complaint, gravidity, and type of anomaly and therefore served as matched controls. RESULTS: The percentage of patients with living children after the diagnosis of uterine anomaly was 67% for the matched nonsurgical group and 73% for the patients who underwent metroplasty. The difference was not statistically significant. Although marked improvement in fetal salvage rates was noted when reproductive outcomes before and after metroplasty were compared, the obstetric outcome was similar to that of the control groups after the diagnosis was made and surgery deferred. CONCLUSION: The efficacy of metroplasty in the treatment of multiple pregnancy losses is thus being questioned.

Adult↗
PubMed1993

Colour Doppler ultrasound guidance for transcervical wire tuboplasty.

To evaluate the usefulness of high-resolution ultrasound with colour Doppler mapping system in performing transcervical wire tuboplasty, 13 infertile women with bilateral proximal tubal obstruction demonstrated by X-ray or colour Doppler ultrasound hysterosalpingography and chromoperturbation at laparoscopy were treated by transcervical wire tuboplasty utilizing colour Doppler mapping ultrasound guidance. A co-axial catheter was used to introduce a 0.016-in. flexible wire to the occluded portion. Transcervical wire catheterization was accomplished in 25 of 26 tubes (96%), resulting in patency in 24 of 25 tubes (96%). At the end of the procedure all patients had at least one tube patent (100%). Five (38%) women achieved pregnancies within 1 year after the procedure. High-resolution ultrasound with colour Doppler mapping system is an efficacious way to perform transcervical wire tuboplasty, avoiding the risk of radiation and allergic reaction.

Adult↗
PubMed1993

Early diagnosis of ectopic pregnancy using receiver-operator characteristic curves of serum progesterone concentrations.

The objective was to assess the usefulness of serum progesterone concentrations in the differentiation of intra-uterine (viable and non-viable) and extra-uterine pregnancies. Progesterone concentrations were prospectively measured at 4, 5 and 6 weeks gestation in 338 pregnancies which resulted in 242 viable births, 81 abortions and 15 ectopic pregnancies. Progesterone threshold analysis was performed using receiver-operator characteristic curves. The progesterone threshold value for ectopic pregnancy at 4 weeks was 5 ng/ml, at 5 weeks 10 ng/ml and at 6 weeks 20 ng/ml. A significant difference was observed between all intra-uterine versus ectopic pregnancies (P = 0.0005), but not between viable versus non-viable intra-uterine pregnancies (P = 0.37). The differences were most clearly defined at 4 weeks and decreased with increasing gestation. We conclude that serum progesterone and gestational age taken together can differentiate intra-uterine from extra-uterine pregnancies with a very high sensitivity and specificity at 4 weeks gestation, a time when ectopic pregnancies are not evident on ultrasound examination.

Abortion, Spontaneous↗
PubMed1993

Current status of immunologic recurrent pregnancy loss.

Normal mammalian pregnancy is confronted with a great number of self (autoimmune) and foreign (alloimmune) antigens that modulate the immune system of the mother. When maternal immune response is affected, recurrent pregnancy loss can result. Recurrent pregnancy loss affects 2% to 5% of reproducing couples. Half of these failures can be explained by genetic, hormonal, infectious, and anatomic factors. Eighty percent of the unexplained failures are proposed to have an immunologic cause. HLA typing, mixed lymphocytotoxic antibody tests, mixed lymphocyte culture reactions, lupus anticoagulant tests, and antiphospholipid antibody determination are methods used to study and differentiate between auto- and alloimmune response. Experimental therapies, including leukocyte immunization, seminal plasma suppositories, intravenous immunoglobulin, aspirin and prednisone, and heparin, have been tried to manage this condition. Results of randomized placebo-controlled clinical trials will aid in the choice of treatment for recurrent pregnancy loss. New assays to diagnose auto- and alloimmune factors in recurrent pregnancy loss are being investigated.

Abortion, Habitual↗
PubMed1992

Prevalence of out-of-phase endometrial biopsy specimens.

OBJECTIVE: We attempted to determine the prevalence of out-of-phase endometrial biopsy specimens among fertile and infertile women and women with recurrent pregnancy loss, histologic dating of biopsies was compared with four reference points for expected ovulation. These reference points included last menstrual period, next menstrual period, luteinizing hormone testing, and ultrasonographic documentation of ovulation. STUDY DESIGN: Four hundred eighty-five endometrial biopsies were performed 7 days after documented ovulation-based ultrasonographic evidence for follicle collapse. The histologic dating was referenced to the last menstrual period, next menstrual period, and ultrasonographic documentation of ovulation. One hundred thirty-two of these women also performed urinary luteinizing hormone surge testing before ovulation and serum progesterone determinations. A comparison of the prevalence of out-of-phase biopsy specimens among groups was determined with the chi 2 test and Fisher's exact test. RESULTS: The prevalence of out-of-phase endometrial biopsy specimens ranged from 42% when last menstrual period was used to 26% with next menstrual period, to 21% with luteinizing hormone testing, and to 4% with ultrasonographic documentation of ovulation. Serum progesterone values among women with a diagnosis of out-of-phase biopsy specimens by any of the reference dates progesterone were similar to those with in-phase biopsy specimens. CONCLUSION: The accuracy of histologic endometrial dating was best determined by ultrasonographic monitoring rather than by last menstrual period, next menstrual period, or luteinizing hormone testing in infertile populations and in those with recurrent pregnancy loss. Additionally, because no significant difference in out-of-phase biopsy specimens exists between fertile and infertile patients and recurrent pregnancy loss, those with the role of this procedure is called into question.

Abortion, Habitual↗
PubMed1992

Mechanism of recurrent spontaneous abortion. I. Ultrasonographic findings.

OBJECTIVES: Our objective was to study the mechanisms of early pregnancy loss with ultrasonographic findings in pregnancies that terminated in repeat abortion in women with recurrent spontaneous abortion compared with patients with spontaneous abortion with no previous spontaneous abortion and with women with recurrent spontaneous abortion who had viable pregnancies. STUDY DESIGN: A prospective, unselected study of 83 pregnancies followed from 4 to 12 weeks of gestation. Weekly transvaginal ultrasonography.among 43 pregnancies terminating in abortion were compared with 40 pregnancies ending in live birth with the Fisher exact test with a p value of significance assigned at less than 0.05. RESULT: A significant difference in the presence of fetal heart activity was observed at 6 weeks +/- 5 days among women who subsequently aborted when recurrent spontaneous abortions were compared with no history of abortion (55% and 14%, p less than 0.02). Fetal pole size was small in 86% of pregnancies lost after fetal heart activity. CONCLUSION: Ultrasonographic examination at 6 weeks can diagnose impending abortion with a sensitivity of 85%, specificity of 93%, positive predictive value of 92%, and negative predictive value of 87% among women with recurrent spontaneous abortion.

Abortion, Habitual↗
PubMed1992

Immunologic tests in the evaluation of reproductive disorders: a critical review.

OBJECTIVE: The purpose of this study was to evaluate the clinical usefulness of immunologic assays proposed to assist in the diagnosis of alloimmune causes of recurrent spontaneous abortion. STUDY DESIGN: Human leukocyte antigen typing, maternal antipaternal lymphocytotoxic antibody testing, and mixed lymphocyte culture assays were performed on 609 couples with recurrent spontaneous abortion, 92 infertile couples, and 43 fertile couples. The frequency of HLA antigen sharing and the presence of lymphocytotoxic antibodies and mixed lymphocyte culture inhibitors was compared among the populations. RESULTS: Sharing of two or more HLA-A, HLA-B, HLA-C, or HLA-DR antigens was observed in 41% (252/609) couples with recurrent spontaneous abortion and in 34% (31/92) with infertility compared with 63% (27/43) of fertile couples. The frequency of lymphocytotoxic antibodies to paternal cells was significantly greater in the fertile population (27/143, 63%) (p < 0.0001) than in couples with recurrent spontaneous abortion (160/609, 26%) and in infertile couples (7/92, 8%). Mixed lymphocyte culture inhibitors were also more prevalent in sera from fertile women (19/43, 44%) compared with those with recurrent spontaneous abortion (122/609, 20%) and infertile women (4/92, 4%). CONCLUSION: Human leukocyte antigen sharing does not predict pregnancy outcome, and the presence of lymphocytotoxic antibodies and mixed lymphocyte culture inhibitors is a function of the number and duration of pregnancies. More sensitive and specific assays are needed to identify alloimmunologic causes of reproductive disorders.

Abortion, Habitual↗
PubMed1992

Color Doppler ultrasonography assessment of tubal patency: a comparison study with traditional techniques.

OBJECTIVE: To compare the results of color Doppler ultrasonic hysterosalpingography (color US-HSG) and x-ray-HSG with chromoperturbation at the time of laparoscopy. DESIGN: Open, uncontrolled study of women seeking evaluation for infertility from August 1989 to July 1991. SETTING: Clinical environment. PATIENTS: Two hundred thirty-eight infertile women. INTERVENTION: Saline was administered transcervically during transvaginal color Doppler sonography in 238 women. Traditional x-ray-HSG was performed in 89 women. Laparoscopy with chromoperturbation was done in 121 women. Forty-nine women had all three procedures performed. MAIN OUTCOME MEASURES: The frequency of diagnosis of bilateral tubal patency, bilateral tubal occlusion, and unilateral tubal patency after color US-HSG and x-ray-HSG was compared with chromoperturbation. The diagnostic efficacy of color US-HSG and x-ray-HSG was compared with chromoperturbation. RESULTS: Correlation between color US-HSG and x-ray findings with chromoperturbation occurred in 81% versus 60% (P = 0.0008) of all women studied. In 49 women who had all three procedures performed, color US-HSG results correlated with chromoperturbation more often than x-ray-HSG (82% versus 57%, P = 0.0152). CONCLUSION: Color US-HSG is an alternative technique to x-ray-HSG in diagnosing tubal occlusion as a cause of infertility.

Fallopian Tube Patency Tests↗