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This randomized controlled blind prospective study is undertaken to evaluate the safety and efficacy of Seprafilm™—a novel bioresorbable membrane of chemically modified hyaluronic acid and carboxymethylcellulose—in prevention and reduction of postoperative endometrial and endocervical synechiae formation after general suction evacuation or curettage for incomplete, missed, and recurrent abortion. In total, 150 patients with incomplete or missed abortion participated in the clinical study. The study population was divided into two main groups. In the treatment (Seprafilm™) group (n=50), application of Seprafilm™ membrane in the endometrial cavity and the cervical canal was used after the suction evacuation and/or the curettage. In the control group (n=100), nothing was inserted in the uterus. Both groups were divided into two subgroups: patients who had no previous suction or curettage, (with no previous D&C) (n=88), and patients who had at least one previous suction or curettage (with one or more previous D&C) (n=62). In the treatment (Seprafilm™) group, 32 patients had no previous D&C and 18 patients had one or more previous D&C. In the control group, 56 patients had no previous D&C and 44 patients had one or more previous D&C. Further fertility was estimated by pregnancy success in all groups. Endometrial synechiae formation was evaluated with the use of hysterosalpingography (HSG) in patients of all groups without pregnancy success 8 months after the intervention. Registering any adverse reaction and performing ultrasound controls assessed the safety of Seprafilm™ use. From the subgroup with no previous D&C, all 32 patients (100%) who received Seprafilm™ had a pregnancy in the following 8 months; in the controls, pregnancy occurred only in 54%. It was also demonstrated with hysterosalpingography (HSG) that patients with one or more previous interventions and no pregnancy 8 months later were adhesion free in 90% of the patients where Seprafilm™ was used, and only 50% in the untreated group. The membrane was tested on the endometrial area of the uterus and did not produce any adverse reaction. Ultrasound controls did not show any abnormal echoes. Intrauterine insertion of Seprafilm™ is safe, prevents the appearance of endocervical adhesions or endometrial synechiae after curettage, and reduces the area of the endometrial cavity occupied by them in a large percent of cases. It also seems that its use improves the possibility of a new pregnancy and fertility. © 2001 Wiley Periodicals, Inc. J Biomed Mater Res (Appl Biomater) 63: 10–14, 2002

Breast milk samples were collected from 112 mothers who resided in southwest Greece during the years 1995-1997. The following chemicals, which were present in some of the milk samples, were quantified by gas chromatography: residues of lindane (i.e., α-hexa-chlorocyclohexane [BHC], (β-BHC, γ-BHC), δ-BHC, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p-DDE), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDD, and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p/p'-DDT). With the assistance of a qualified dietitian, the mothers also completed a 7-d food-frequency questionnaire and provided additional personal information (e.g., educational level, profession, previous or present residence, use of pesticides, treatment of dermal scabies). Concentrations of γ-BHC (i.e., lindane) were present in 57.1 % of the samples (mean concentration = 0.58 μg/l [whole milk], range = nondetectable to 10.86 μg/l). Concentrations of α-BHC, β-BHC, δ-BHC, p,p'-DDD, and p,p'-DDT were detected in 16%, 39.3%, 11.6%, 41%, and 55.3% of the samples, respectively. Moreover, p,p'-DDE, which was detected in all samples, ranged from 0.33 to 278 μg/l. Typically, the amounts of γ-BHC and Σ-DDTs in breast milk were below the established acceptable daily intake value. Nonetheless, 3 of the 112 samples contained concentrations of Σ-DDT derivatives that exceeded the acceptable daily intake value established by the World Health Organisation in 1987. Concentrations of insecticides in breast milk were affected by dietary habits. Some women who consumed 7 (or more) portions of fresh vegetables per week had γ-BHC concentrations in whole milk that exceeded 0.15 μg/l (odds ratio = 1.23 [95% confidence interval = 1.05, 1.44]; p = .006). The concentrations of DDT derivatives were associated with the portions of fish, chicken, fruits, milk, and potatoes consumed each week.

The purpose of this study was to determine the relationship between combined fetal biophysical activities, oligohydramnios, and fetal acid-base status at the time of testing. In a prospective study of 101 patients undergoing cesarean section before the onset of labor, a fetal biophysical profile was performed within 3 h before the cesarean section. Different combinations of fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) and oligohydramnios were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetal acidemia was defined as umbilical arterial blood pH <7.20. The group of fetuses with reactive nonstress test (NST) and/or fetal breathing present had significantly higher pH, pO2, bicarbonate, and base excess and significantly lower pCO2 levels compared with fetuses who had nonreactive NST, absent fetal breathing, and compromised or absent body movements and tone. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. There was a significant relationship between oligohydramnios and fetal acidemia. Seven of 15 (46.6%) fetuses with oligohydramnios were acidemic and 7 of 15 (46.6%) acidemic fetuses had oligohydramnios (P = 0.0008). Fetuses with compromised or absent movements and tone had the highest incidence of acidemia (10 of 11 or 91%) and oligohydramnios (4 or 11 or 36%). The presence of oligohydramnios was associated with increased frequency of acidemia in every combination of biophysical activities. However, when all biophysical activities were absent, the frequency of acidemia was 100% regardless of the presence or absence of oligohydramnios. In conclusion, progressive loss of fetal biophysical activities is associated with increasing frequency and severity of fetal acidemia and oligohydramnios.