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Biomedical subjects

I Gerhard

Publications and source records attributed to I Gerhard.

At least 73 records · Page 4Linked to original sources
PubMed1987

Influence of microbial colonization on sperm-mucus interaction in vivo and in vitro.

Two-hundred-and-thirty-three asymptomatic couples with a mean duration of infertility of 5 years were submitted to postcoital testing (PT) and to sperm penetration meter test (SPMT) and simultaneous microbial screening. Cervical swabs and semen specimens were collected for culture of Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, other potentially pathogenic and commensal aerobic and anaerobic bacteria, herpes simplex virus, vaginal swabs for Trichomonas vaginalis and yeasts. Results of microbial screening were analysed with regard to sperm penetration ability into wives' cervical mucus in vivo and in vitro, but no marked influence was revealed for most microorganisms. Samples of only one of the 233 couples proved to be completely sterile. The findings suggest that in asymptomatic patients microbial colonization is of minor importance for sperm-mucus interaction.

Adult↗
PubMed1987

Double-blind controlled trial of progesterone substitution in threatened abortion.

Between 1983 and 1984 a double-blind randomized study with progesterone substitution in threatened abortion was carried out. Fifty-six patients with vaginal bleeding during the first trimester of pregnancy, the internal cervical os being closed, were referred to the hospital. Twenty-five women (5th and 6th week of gestation) with positive serum concentrations of beta-hCG were admitted to the study without regard to sonogram results. In other 25 women (7th-10th week of pregnancy) and 6 women (greater than or equal to 11th week of pregnancy) fetal heart action and movement could be demonstrated by ultrasound. The patients were prescribed bed rest and vaginal suppositories twice daily, containing either 25 mg progesterone or only polyethylene glycol. The code was not broken until after completion of the study. Serial serum determinations of beta-hCG, estradiol-17 beta (E2), progesterone, and ultrasound were performed. Four patients had to be omitted from final analysis (two tubal pregnancies, one intrauterine infection, one sectio parva). Three of 26 patients progesterone (11%) and five of 26 patients with placebo (19%) had an abortion, which represented no significant difference. Frequency of abortion was increased in women more than 30 years old, in women with previous abortions and after ovulation induction. Progesterone treatment resulted in a significant elevation of serum progesterone concentrations (p less than 0.01), while beta-hCG and E2 were unchanged. The results of this study confirm that pregnancy outcome is favorable in women with bleeding and normal hormone concentrations without hormonal treatment and unfavorable in women with reduced beta-hCG and E2-concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Threatened↗
PubMed1986

Human placental lactogen and unconjugated estriol concentrations in twin pregnancy: monitoring of fetal development in intrauterine growth retardation and single intrauterine fetal death.

Human placental lactogen and unconjugated estriol concentrations in maternal serum were evaluated in 100 uneventful twin pregnancies, and these values were compared with those observed in 16 twin pregnancies associated with intrauterine growth retardation or single intrauterine fetal death. In pregnancies associated with intrauterine growth retardation (n = 8), human placental lactogen levels were at the lower limit of normal range for singleton pregnancies, whereas estriol levels were normal in most cases. When one of the fetuses had died before week 33 of pregnancy (n = 5), both human placental lactogen and estriol levels were low and they were almost at the levels in singleton pregnancy. When intrauterine fetal death occurred after week 36 of pregnancy (n = 3), both hormone levels remained normal until term. Thus human placental lactogen rather than estriol is a good indicator of intrauterine growth retardation in twin pregnancy. Both human placental lactogen and estriol are useful for the monitoring of the surviving fetus in the case of single intrauterine fetal death.

Adult↗
PubMed1986

Estrogen screening in evaluation of fetal outcome and infant's development.

In an unselected obstetric population of 869 women serial determinations of estriol in serum and urine were performed from the 28th week of pregnancy until delivery. Clinical management was based on ultrasound and nonstress/contraction stress tests only. Data on the development of the infants were available after 1 year in 759 cases (89%) and after 2 years in 661 cases (78%). Serum free estriol (E3) screening during weeks 28-34 of pregnancy revealed a significantly increased risk for reduced Apgar scores, growth retardation and postnatal complications in pregnancies with decreased levels (p less than 0.001). The development of the children was disturbed by a higher incidence of childhood diseases, retardation in speech and bowel and bladder control. The urinary estrogen determinations (UE) during this period of pregnancy showed only a vague connection with birth weight and Apgar scores (p less than 0.05) and no connection to the infant's development. Serial determinations of E3 after the 35th week of pregnancy increased the significance for all parameters tested. If the estrogen concentration was determined in the last 2 weeks before delivery, 50% of the SGA and 60% of the endangered cases could be diagnosed. After reduced E3 serial levels neurological sequelae, reduced body weight, retarded speech and late development of bowel and bladder control were significantly more frequent at age two than after normal E3 levels. The differences obtained by serial UE determinations were less evident. Considering cost-benefit-calculations, an E3 screening of every pregnant woman cannot recommended. In pregnancies at risk serial E3 determinations allow better prognostication of fetal well-being. In the case of reduced E3 values maximum post partum care should be made available for all newborns. Special support should be given to the early infant's development after reduced E3 values have been observed.

Apgar Score↗
PubMed1984

Predictive value of hormone determinations in the first half of pregnancy.

In a prospective randomized study serial hormone determinations (beta-hCG, HPL, P, 17-OHP, E2 and E3) were performed with 1125 pregnant women from the detection of pregnancy until delivery (n = 994) or abortion (n = 131). In 605 women carrying to term blood sampling started before the 16th wk of gestation, while 389 patients were admitted to hospital between the 16th and 20th wk of gestation. The first value of most of the hormone determinations at the time of diagnosis of pregnancy before the 16th wk was normal in more than 90% (beta-hCG 95%, P 94%, E3 94%, E2 92%, HPL 64%). In the case of women with abortion the first hormone determination was low in more than 50% (beta-hCG 51%, P 56%, E3 54%, E2 62%, HPL 62%). The predictive value was highest for beta-hCG (75%) and E2 (70%) and lowest for HPL (18%). In 249 women with threatened abortion blood samples were obtained at the first days of bleeding. At this time the highest sensitivity in detecting early abortions (before the 16th wk of pregnancy) was 82% for E2, followed by beta-hCG 74%, E3 65%, P 63%, 17-OHP 52% and HPL 34% (n = 112). In late abortion (after the 16th wk of pregnancy, n = 19) the sensitivity of all methods tested was below 40%. In the case of women with bleeding and continuation of pregnancy (n = 118) normal values were found in 95% by P, 94% by beta-hCG, 93% by HPL and E3, and 83% by 17-OHP respectively. Serial determinations in women with abortion revealed that in a normal population trophoblastic disorders with reduced beta-hCG concentrations were most common. Of the remaining patients with normal beta-hCG concentrations every third woman had low P or E2 values. The combined determination of all hormones allowed conclusions to be drawn on the cause of pregnancy failure. It could be established that prior to the 6th wk of pregnancy the determination of beta-hCG was most valuable. From the 7th wk onwards the measurement of E2 or E3 showed the highest sensitivity. Between the 11th and 14th wk of pregnancy the discriminating potency of all methods tested was equally high. After the 14th wk of pregnancy hormone determinations were of little diagnostic value.

17-alpha-Hydroxyprogesterone↗
PubMed1984

Hormone load tests in the first half of pregnancy--a diagnostic and therapeutic approach.

In view of still unsolved problems concerning disturbances in early pregnancy, the efficacy of various substances with regard to endocrine systems in the first trimester of pregnancy has been investigated. Seventy-five women, who had been referred to our hospital for an authorized termination of pregnancy during weeks 7-9 of gestation, and 6 women between weeks 10 and 16 of gestation volunteered to take part in the study. After single administration of the test substances, blood was drawn from an indwelling catheter with one group of patients at hourly intervals over an 8-hour period, while with all other patients this was done at 3-hourly intervals over a 24-hour period. In all samples beta-HCG, progesterone (P), estradiol-17 beta (E2), and 17 alpha-hydroxyprogesterone (17-OHP) were determined. The following substances were studied in detail: HCG, allylestrenol, 17-hydroxyprogesterone caproate, tamoxifene, R 5020, betamethasone, and dehydroepiandrosterone sulfate (DHAS). Two hundred and seventy-one women with imminent abortion were either treated with allylestrenol (n = 130) or simple clinotherapy and no medication (n = 141). One hundred and two women had a miscarriage, while 168 carried to term. The serum concentrations of beta-HCG, P, E2 and estriol (E3) were determined serially. Twelve women with a history of repeated miscarriages were treated with vaginal progesterone suppositories. Five of them experienced another miscarriage. The serum concentrations of beta-HCG and P were determined serially. It could be shown that diagnostics in early pregnancy have been complemented by assessment of the E2-increase after DHAS loading. Maternal serum concentrations were not affected by administration of HCG and various progestational agents including allylestrenol. Only in the case of parenteral or vaginal application of progesterone could increased serum concentrations of this hormone be demonstrated. Progesterone substitution in early pregnancy may, therefore, be chosen under special conditions as possible therapeutic procedure.

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1982

The hCG test: an approach to luteal insufficiency.

Corpus luteum insufficiency often constitutes the main cause of infertility. A corpus luteum test system has therefore been added to existing diagnostic methods. Eight days after the midcyclic LH surge 15 women suffering from infertility were administered i.m. injections of varying doses (5,000, 40,000 and 80,000 IU) of hCG. This was followed by multiple radio-immunological determinations of beta-hCG, 17 beta-estradiol, 17-hydroxyprogesterone and progesterone concentrations in peripheral serum over a period of 24 h. An identical test arrangement operating with physiologic saline was used for comparison with 5 primiparae. Beta-hCG concentrations in peripheral blood showed a dose-dependent increase following hCG injections. 17 beta-Estradiol displayed a diurnal concentration pattern. There was no significant difference, however, between the estradiol concentration following placebo or any of the hCG injections. In the case of progesterone and 17-hydroxyprogesterone a significant increase was found following the hCG injections. On the basis of multiple progesterone and 17-hydroxyprogesterone determinations good, moderate and lacking responses to hCG injections were determined. These were accompanied by normal or reduced basal values of progesterone. This fact may have important consequences for future diagnostics and therapy of sterility caused by luteal insufficiency.

Adult↗
PubMed1981

[Habitual abortion: diagnostics and therapy in gynaecological practice (author's transl)].

According to several literature surveys women with three consecutive and clinically ascertained spontaneous abortions appear to have without treatment an abortion risk of 50 to 60 per cent in the course of any further pregnancy. For improving prognostication various conditions leading to habitual abortions have to be clarified before the onset of a new pregnancy. Among our patients corpus luteum dysfunctions (35 per cent) and anomalies of the uterus (17 per cent) showed the highest frequency. Our patients also had an increased frequency of pathological spermiograms. Their influence on the incidence of habitual abortions remains, however, unclear. Infectious diseases and metabolic disorders (5 per cent) as well as chromosomal aberrations (6 per cent) appeared to be less frequent. Controversial views on the consequences of blood group incompatibilities of the spouses continue to exist. Conflict-oriented personalities of patients seem to play a major role. After evaluating the findings in literature pertaining to habitual abortions and on the basis of our own results (110 patients) diagnostic and therapeutic guidelines have been worked out. By employment of the individually required therapy 90 per cent of the patients with habitual abortions were able to successfully complete a further pregnancy.

Abortion, Habitual↗
PubMed1980

[Hormonal evaluation in multiple pregnancies (author's transl)].

Between 1974-1978 39 twins pregnancies and 1 triplet pregnancy were monitored by long term hormonal determinations in the serum and the urine. There was an incidence of premature labor of 90%, of pre-eclampsia of 28% and of bleeding 25%. The infants were at risk for prematurity in 58% and for increased perinatal mortality in 8%. The correlation between the total estrogen in the serum and total estrogen excretion in the urine was investigated. Serial determinations of HCG, HPL and progesterone were done in addition to estriol. All hormone levels were higher during the first half of a multiple pregnancy and the diagnosis of multiple pregnancy was suspected from these values. During the further course of the pregnancy none of these hormonal parameters in the serum was of any help in the early detection of fetal risk. In some cases the course of the estrogen excretion in the urine was a sign of placentae insufficiency.

Adult↗
PubMed1980

[Peculiarities of pregnancies in women in the fifth decade of life (author's transl)].

From 1974-1978, 101 women in the fifth decade of life were delivered. The course of the pregnancy was more often complicated by pre-eclampsia. Premature and dysmature deliveries were not more common than in younger women. The sex ratio was more in favor of females than usual. Despite shorter duration of labor and delivery the Apgar ratings at 1 and 5 minutes were less favorable in the new borns of older pregnant women. The infants required more often intubation and transfer to the pediatric hospital. The perinatal mortality was 4.2%. Down syndrome occured in 4.2% of the infants and abnormalities occured in 4.9%. Routine genetic amniocentesis and intensive pregnantal care should lower the fetal morbidity and mortality in these cases. Urinary total estrogen determinations are proposed as a parameter for the monitoring of the these risk cases besided ultra-sound and fetal monitoring.

Adult↗
PubMed1979

Comparison between tamoxifen and clomiphene therapy in women with anovulation.

Forty-eight women with various types of menstrual disorder were treated with tamoxifen: 30 of them ovulated as judged by serum progesterone concentrations and the basal body temperature (BBT) record. Serial determinations of serum FSH, LH, prolactin, and estradiol-17 beta showed that tamoxifen acts primarily on the hypothalamic-pituitary axis. Before or after the tamoxifen treatment cycles, 30 women received clomiphene. The ovulation rate in women with primary and secondary amenorrhea was similar, while women with oligomenorrhea tended to be more responsive to tamoxifen than to clomiphene. There was no difference between the drugs in the duration of the luteal phases nor in the pregnancy rate. The side effects during treatment with clomiphene were pronounced than during tamoxifen therapy.

Adolescent↗
PubMed1979

[Hormone analyses and ultrasound examinations in high-risk early weeks of pregnancy (author's transl)].

The serum concentrations of HCG, HPL, progesterone and oestriol and ultrasonic findings were compared with one another in 42 women with normal pregnancy course, 51 women with haemorrhages and abortion and 27 women with haemorrhages and delivery on time. Correct diagnosis was most frequently possible with the help of ultrasound examination. However, it was possible to improve the accuracy of the diagnosis before the twelfth week of pregnancy by means of hormone analysis. If the hormone concentrations were normal, whereas ultrasound findings were either negative or not clear, intact pregnancy could be assumed. HCG and progesterone determination possessed the advantage of being reliably measurable even before cessation of menstrual bleeding. From the eighth to ninth weeks of pregnancy, determinations of HPL were also suitable for assessing endocrinal functions. After the twelfth week of pregnancy, the pregnancy conditions could be judged most safely by the ultrasound method.

Abortion, Spontaneous↗
PubMed1979

[Serial determination of hormones in pregnancies following induction of ovulation with clomiphene and gonadotropins (author's transl)].

The HCG, HPL, progesterone and oestriol levels in the serum were determined in 33 pregnancies following induction of ovulation with clomiphene and in 7 pregnancies following induction of ovulation with gonadotropins. During these pregnancies bleeding, premature labour and toxaemia occurred more often in women who became pregnant after induction of ovulation with clomiphene. The progesterone and oestriol levels were increased up to the 12th week of gestation, whereas the HCG and HPL levels remained normal. After induction of ovulation with gonadotropins the progesterone levels remained elevated until the 19th week of gestation whereas the levels of HCG and HPL and oestriol remained normal. The course of the pregnancy in a patient who had Meigs-syndrome after treatment with gonadotropins was presented. Our results show that the hormonal evaluation of pregnancies after induction of ovulation is best accomplished during the first three months by HCG and HPL titres and during the second half of the pregnancy according to the same criteria as in other pregnancies.

Adult↗
PubMed1978

[The value of determinations of human chorionic gonatrophin, human placental lactogen, progesterone and oestriol in women with threatened abortion (author's transl)].

During the antenatal care of 604 women 1629 blood samples for hormonal tests were collected. The values in 417 women with normal pregnancies were used to establish a normal curve with 99% tolerance for the serum concentrations of human chorionic gonatrophin (HCG), human placental lactogen (HPL), progesterone and oestriol. Of the 604 women 187 had bleeding during the first half of the pregnancy. Of these 187 women 57 carried the pregnancy to term and 130 had a miscarriage. Women with the symptoms of threatened abortion who carried the pregnancy to term had normal serum hormone values. The HCG values in this group were higher than normal at the time of bleeding. In 90% of the women with threatened abortion who miscarried prior to 16 weeks gestation (N = 87) and in all patients with a missed abortion (N = 16) 1 or more serum hormone concentrations were below normal. Women with early pregnancy bleeding and late abortion between 17 and 28 weeks (N = 27) showed 1 or more low hormone concentration in only 25% of the cases. Our findings show that the quantitative determination of HCG and progesterone give the most valuable tests for the evaluation of the endocrine system in the first trimester of pregnancy. In the second trimester HCG determinations are of value only in trophoblast disease. To a lesser degree determination of HPL and oestriol are of prognostic value in the second trimester of the pregnancy.

Abortion, Threatened↗