PubMed · 5077902
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1972-09-23. Maternal deaths.. https://pubmed.ncbi.nlm.nih.gov/5077902/
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OBJECTIVE: To detect post mortem changes in fetal hematopoiesis consistent with infection from liver examination alone. STUDY DESIGN: We investigated the immunohistochemical expression of Glycophorin C, Neutrophilic elastase, and CD34, in the hepatic parenchyma from fetuses miscarried as a result of chorioamnionitis (caused by Chlamydia trachomatis) and correlated them with the equivalent from fetuses after voluntary abortion (gestational age: 16th, 20th, and 24th weeks). RESULTS: A statistically significant difference was found in the Neutrophilic elastase positive cells to the advantage of cases with chorioamnionitis over voluntary abortions (24th week: P=0.0001, t-test) and also at the level of total hematopoiesis (20th and 24th week: P=0.041 and 0.004, respectively, t-test). There was no quantitative difference between the two settings at the level of erythropoiesis in the three examined periods. CONCLUSIONS: Fetal infection can be diagnosed from the liver alone. After detection of changes in fetal hematopoiesis indicative of infection, examination of additional specimens of placenta and membranes will document the diagnosis of chorioamnionitis.
OBJECTIVES: To analyze the reproductive outcome before and after myomectomy in patients with subserous or intramural myomas, and to assess the factors influencing pregnancy rate after myomectomy. STUDY DESIGN: Out of 128 patients submitted to myomectomy, we considered eligible for this study only the 41 patients wishing to conceive after surgery and who did not present any plausible infertility factor, apart from the removed myomas. We have evaluated the pregnancy outcome prior to and following myomectomy, and analyzed the correlation between conception rate after surgery and patient's age at the time of the surgery, type of surgery, number and size of the myomas, location of the largest fibroid and previous pregnancies. RESULTS: Nineteen patients had been submitted to abdominal (group A) and 22 to laparoscopic myomectomy (group B). Prior to surgery, 28 pregnancies had occurred in 14 of the 41 patients, with a miscarriage rate of 57.1%. Following surgery 29 pregnancies occurred in 25 patients (60.9%), pregnancy rate being similar in both groups. The postoperative delivery rate was 86.2% whereas the miscarriage rate was reduced to 13.8% (P<0.001). Overall, 60% of deliveries were vaginal. No cases of ectopic pregnancy or uterine rupture occurred. Those patients who conceived after surgery were significantly younger (32.36+/-4.06 years versus 35.88+/-3.57 years; P=0.0073), and their removed myomas were significantly larger (5.80+/-2.69 cm versus 4.28+/-1.54 cm; P=0.0274). Furthermore, a multivariate analysis shows that, apart from age and diameter, the probability of conceiving after myomectomy is higher in case of intramural myomas (intramural versus subserosal: OR 12.382, 95% CI: 1.61-95.22) or laparoscopic surgery (laparoscopy versus laparotomy: OR 14.062, 95% CI: 1.40-141.15). CONCLUSIONS: Our results suggest that myomectomy significantly improves pregnancy outcome in patients with subserous or intramural fibroids, probably removing a plausible cause of altered uterine contractility or blood supply. The main determinants of pregnancy rate after surgery are patient age, diameter and intramural localization of the myomas and type of surgery.
OBJECTIVE: In this study, we sought to evaluate characteristics of couples with spontaneous conceptions after treatment with assisted reproductive technologies (ART). STUDY DESIGN: Data from 254 couples who underwent 1127 therapy cycles between November 1987 and February 1997, were analyzed. Chi-Square (chi(2)) test and Student's t-test were used. P<0.05 was considered significant. RESULTS: Spontaneous pregnancies occurred in 14% of all treated couples. Psychological counselling only was performed in 21% but was observed significantly more frequently among patients without later spontaneous conception. Ten percent of all treated couples applied for adoption. The miscarriage rate was significantly higher in the group of treatment dependent pregnancies compared to the group of patients with later spontaneous conception (27% versus 9%). The spontaneous conception rate differed significantly depending on women's age and normal semen analysis. CONCLUSION: Appearance of spontaneous conception after ART-procedures should be taken into account in the first patient's interview. Depending on women's age and andrological parameters, treatment-success will differ. The positive impact of psychological counselling for stress relief during and after therapy should also be noted, even though a statistically significant impact could not be demonstrated in the present study. Adoption should be discussed as an alternative to overcome infertility.