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Biomedical subjects

M G Hull

Publications and source records attributed to M G Hull.

At least 127 records · Page 7Linked to original sources
PubMed1983

Oxytocin deficiency at delivery with epidural analgesia.

The effect of epidural analgesia on oxytocin release during the second stage of normal labour was studied by comparing 10 primigravidae who had epidurals with 10 control subjects who did not have epidurals. A significant increment in oxytocin between paired peripheral blood samples taken at the onset of full cervical dilatation and crowning of the fetal head was found in the control subjects but not in those with epidurals. Forceps delivery was required more often in the group with epidural analgesia and was associated with lower oxytocin levels at crowning. Since distension of the lower birth canal and stimulation of pelvic autonomic nerves leads to oxytocin release, and the need for forceps associated with epidurals can be reduced by oxytocin, these differences are attributed to the lumbar epidural block.

Adolescent↗
PubMed1982

Anovulatory and ovulatory infertility: results with simplified management.

A simplified scheme for the management of anovulatory and of ovulatory (usually called unexplained) infertility was evaluated in 244 women. Eighteen patients were excluded because of primary ovarian failure, 164 were treated for ovulatory failure, and 62 with ovulatory infertility remained untreated. Twenty-five patients had a properly validated negative postcoital test. In the remaining 201 patients the two-year conception rates were 96% in patients with amenorrhoea, 83% in those with oligomenorrhoea, 74% in those with luteal deficiency, and 88% in those with ovulatory infertility. Comparison with normal rates implied that amenorrhoea represents a pure form of ovulatory failure that is completely correctable whereas in other conditions unexplained factors also contribute to infertility though to a much smaller extent than was previously thought.

Adult↗
PubMed1982

The value of a single serum progesterone measurement in the midluteal phase as a criterion of a potentially fertile cycle ("ovulation") derived form treated and untreated conception cycles.

A single midluteal serum progesterone concentration was obtained in 212 untreated cycles in 113 infertile patients, including 138 cycles in 72 patients in whom tubal, seminal, and cervical causes of infertility had been excluded. There were 16 conception cycles in the latter group. In an extended study a total of 21 untreated singleton conception cycles have been observed with a mean progesterone value of 40.7 nmol/l (12.8 ng/ml), 95% confidence limits of 28 to 53 nmol/l (8.8 to 16.7 ng/ml), and a range of 27 to 53 nmol/l (8.5 to 16.7 ng/ml), which extended significantly above as well as below the conception range, indicating that there is an optimal range for fertility with both an upper and a lower limit. The lower limit is of greater practical importance; and, partly to allow for assay variation, we suggest it should be taken as 30 nmol/l (9.4 ng/ml). It provided a clinically reliable criterion of potential fertility ("ovulation") in related studies. Our findings in treated conception cycles suggest that a higher value may be needed after treatment with clomiphene or gonadotropins because of the contribution from other stimulated follicles.

Adult↗
PubMed1982

Prognostic value of the postcoital test: prospective study based on time-specific conception rates.

Time-specific conception rates were studied prospectively after a carefully validated post-coital test (PCT) in a consecutive series of 80 ovulatory women without any pelvic or seminal cause for their previous infertility. The PCT was performed on endocervical mucus collected 6-18 h after intercourse. The definition of a negative result, indicated by the absence of forward-moving sperm, depended on the finding being repeated in a second cycle and on the presence each time of fully developed mucus, indicated simply by its abundance, ductility and clarity. The time to conception was inversely related to the number of motile sperm seen. Simpler analysis showed a fivefold greater chance of conception associated with a positive compared with a negative PCT; after 2 years the cumulative conception rates were 84 and 16% respectively.

Adult↗
PubMed1981

Normal fertility in women with post-pill amenorrhoea.

After exclusion of primary ovarian failure and causes of infertility not due to contraception 48 patients with post-pill amenorrhoea (PPA) and 47 patients whose amenorrhoea did not follow oral contraception received treatment aimed at inducing ovulation. In the patients with PPA the cumulative conception rate was 91% at 12 months from the start of treatment and 98% at 24 months. 80% gave birth to a child by 18 months and 95% by 30 months. These rates were similar to those of the non-PPA group and to previously published normal rates. Hence PPA poses no serious threat to fertility, unlike the tubal damage that may result from use of an intrauterine device. Whatever their previous menstrual history women, especially the nulliparous, who are concerned about their future fertility should be recommended oral contraception in preference to an intrauterine device.

Amenorrhea↗
PubMed1981

Post-pill amenorrhea: a causal study.

The distribution of distinguishable disorders in 102 patients with post-pill amenorrhea has been compared with that in 166 other patients with secondary amenorrhea, including 123 patients who had never used oral conception. In the post-pill group there was a 13% to 21% excess of patients who had a functional disorder without any weight loss or psychological disturbance to account for it and who typically were estrogenized and demonstrated intact feedback systems by their ovulatory response to clomiphene (the so-called cycle initiation defect). This excess might be explained by biased selection of oral contraception, but it seems wiser to assume a causal relationship, which amounts to a true risk of post-pill amenorrhea in less than 1 per 1000 users. No risk was revealed of primary ovarian failure, hyperprolactinemia, or pituitary tumor.

Adolescent↗
PubMed1979

Fetal breathing movements and other tests of fetal wellbeing: a comparative evaluation.

Sixty pregnant women whose fetuses were considered to be at high risk were intensively studied with fetal and placental function tests. Fetal breathing movements were studied with real-time ultrasound and the amount of time spent breathing and the variability of the breath-to-breath interval were measured. A reduction in the amount of time the fetus spent making breathing movements and decreased variability were indicative of fetal compromise. When these results were compared with those of other tests of fetal wellbeing measurement of fetal breathing movements and ultrasound assessment of growth were more sensitive tests of fetal wellbeing than the biochemical measures (urinary oestrogen, human placental lactogen, pregnancy-specific beta-1-glycoprotein, and unconjugated oestriol concentrations) or fetal heart rate. The predictive value was highest with serum unconjugated oestriol but the results of other tests were similar. Study of fetal breathing movements or an ultrasonic assessment of growth may provide a better screening test for fetal compromise than biochemical estimations.

Estriol↗
PubMed1979

Investigation and treatment of amenorrhoea resulting in normal fertility.

A simple scheme of investigation and treatment to restore fertility in amenorrhoeic women is described. Fifty-nine patients with amenorrhoea not due to primary ovarian failure were treated variously as appropriate, mainly with clomiphene (25), bromocriptine (15), or human menopausal gonadotrophins (12), and six by diet to increase their weight. All ovulated, and by the end of the study 55 (93%) had conceived, 42 (71%) had delivered at least one surviving child, and five others (8%) were pregnant and awaiting delivery. Conception rates were 49% within two cycles of treatment and 66% within three cycles; using life-table method to standardise the cumulative conception rates by correcting for patients who did not continue as long as others in the study, the expected conception rate was 79% in six cycles, 94% in 12 cycles, and 98% after 16 cycles. The multiple pregnancy rate was 13% and abortion rate 22%. Delivery rate (for a viable baby) were 48% within 11 months of starting treatment and 53% within one year; expected rates were 76% in 18 months and 97% in two years. The results show that a relatively simple scheme of classifying amenorrhoeic disorders endocrinologically followed by treatment directed at inducing ovulation allows amenorrhoeic women without primary ovarian failure to achieve conception and delivery rates equal to those in normal women.

Adult↗
PubMed1979

Serum prolactin concentrations related to copper or inert intrauterine devices (IUDs) in women.

A report that serum prolactin concentrations were almost doubled by the use of copper IUDs led us to study the effect of both copper and inert IUDs. We studied 105 normal women in whom all other prolactinergic factors had been excluded; 25 of them were using copper IUDs, 25 were using inert IUDs and there were 55 controls. No differences were found in the mean prolactin levels between these groups (4.3, 4.5 and 4.3 microgram/l, respectively). We conclude that copper and inert IUDs do not affect prolactin secretion.

Adult↗
PubMed1979

Plasma unconjugated oestriol and unconjugated oestradiol-17 beta in late pregnancy: individual fluctuation of concentrations from day to day and every 10 minutes.

Plasma unconjugated oestriol (E3) and unconjugated oestradiol-17 beta (E2) were determined by radioimmunoassay. In ten normal women in their last month of pregnancy the individual fluctuation of E3 concentrations (mean of the coefficients of variation, CV) from day to day (over 5 days) was 15.6% (range 6.4--26.2%). The individual fluctuation of E2 determined in eight of these women was 16.9 (10.4--25.5) %. In six of the same women who had blood samples collected every 10 min (for 3 h) the individual fluctuation of E3 concentrations was 13.8 (7.0--25.1) %, and of E2 was 16.1 (11.3--26.0) %. The degree of fluctuation of E3 in individuals was in proportion to the mean concentration, unlike E2, suggesting that in clinical practice individual changes in E3 values would be as easy to interpret at low levels as at high levels. The finding that concentrations of plasma unconjugated E3 fluctuate in individuals no more than for E2 or than reported for total E3, and less than reported for 24-h urinary oestrogens, lends practical support to the theoretical preference for the assay of plasma unconjugated E3 to assess fetoplacental function.

Adult↗
PubMed1979

The relation between plasma unconjugated oestriol and cystine aminopeptidase concentrations and uterine contractions.

The relation between maternal plasma unconjugated oestriol (E3) concentrations and uterine activity was investigated by very frequent, carefully timed determinations of E3 during synchronously recorded uterine contractions in six normal subjects. There was an initial rise (10 to 50 per cent above the mean) in E3 levels reaching a peak coincident with the contraction peak (range 20 seconds before to 15 seconds after) followed by a fall of similar magnitude below the mean reaching a nadir about 80 seconds (range 60 to 105 seconds) after the contraction peak. Although the pattern of E3 fluctuation was most marked in labour the overall degree of variation was no greater than at other times. Cystine aminopeptidase (CAP) concentrations in the same serum samples showed no significant correlation with uterine contractions. The reasons for, and practical applications of, the E3 results are discussed.

Adult↗