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To evaluate which method, clinical, hormonal or sonographic, can be used as the best predictor of successul RU-486-induced abortions, 20 healthy women with fetal cardiac activity, between 6 and 9 weeks from the last menstrual period and desiring abortion, were studied. Fourteen women (70%) successfully aborted, and 6 (30%) failed to abort within 7 days following therapy. A small hematoma, seen as a localized detachment of the gestational sac, was observed in the decidua capsularis in women who aborted successfully. A significant decrease in plasma levels of estradiol and progesterone (p < 0.04) and significantly increased cortisol levels (p < 0.001) in the plasma of the 14 patients who aborted were noted by the 7th day following treatment. No significant changes were observed in the 6 nonaborting patients. In conclusion, the differences in the early sonographic findings may be helpful in the early prediction of successful RU-486 administration.

Nineteen women were treated with the gonadotropin-releasing hormone (GnRH) agonist buserelin in order to suppress the pituitary prior to gonadotropin treatment. Eight women were oligomenorrheic, 6 had polycystic ovarian disease (PCOD) and 5 women had normal cycles. Buserelin was administered for 3 weeks before ovarian stimulation, and the pituitary down-regulation was proven by provocative tests. Ovarian stimulation was then achieved by human menopausal gonadotropin (hMG) 2 ampules a day. Several abnormal responses to the combined buserelin/hMG treatment were noted in some patients. This included a sudden decrease in E2 level without LH surge (2 patients), induced follicular growth with buserelin instead of ovarian suppression (2 patients) and ovarian hyper-stimulation syndrome in 3 patients with PCOD. From this we conclude that although pituitary suppression can easily be achieved by GnRH analog administration, this does not ensure the prevention of unwanted responses. It is possible that the common denominator for these abnormal responses is that they are ovarian in origin, hence they occur in spite of pituitary down-regulation. Close monitoring of the suppression and stimulation stages will detect most cases of such failures. Furthermore it is possible that not all patients are suitable for the combined treatment of gonadotropin and GnRH agonist.

An investigation of possible seasonal patterns in ectopic tubal pregnancies was conducted. The computer data utilized were based on all ectopic pregnancies, abortions and deliveries (total pregnancies) recorded in the Department of Obstetrics and Gynecology at the Chaim Sheba Medical Center, Israel, between the years 1986 and 1989. Composite monthly cohorts of ectopic tubal pregnancies and total pregnancies were constructed for each month of the year, and the probability of an ectopic pregnancy was estimated. A statistically significant increase in the probability of conception rate resulted in ectopic pregnancies which occurred during winter and spring, especially in January to June. The probability of ectopic tubal pregnancies was low (0.50%) in September and high (1.81-1.42%) in December to January. When we studied primigravidae, the same seasonal pattern was observed. The findings of our study suggest, for the first time, that there is an association between meteorological and environmental factors, and ectopic pregnancies. These factors should be considered in the epidemiology of ectopic tubal pregnancies.

In order to determine whether there is a correlation between meteorological factors and the occurrence of hypertensive disorders, vaginal bleeding during pregnancy and premature rupture of the fetal membranes, we stratified all the patients hospitalized with such complications between the years 1984 and 1988 by the months of occurrence, weather, humidity and heat. During this period, there were 276 women hospitalized with exacerbation of hypertension and toxemia, 349 because of vaginal bleeding during pregnancy and 35 women following premature rupture of the fetal membrane between 30 and 33 weeks of gestation. The occurrence of pre-eclampsia and exacerbation of pregnancy-induced hypertension was significantly increased in the winter months (p less than 0.001).

A case of reinfection with the wild rubella virus in the 8th gestational week is reported. The patient had preexisting hemagglutination inhibition antibodies of low titer following immunization with rubella vaccine. Reinfection was accompanied by clinical symptoms and the presence of rubella-specific immunoglobulin M (IgM) of high titer. Following termination of pregnancy no rubella virus could be isolated from the fetal tissues and the fetal blood contained no specific IgM antibodies. These results should encourage the use of cordocentesis before decision on interruption of pregnancy.

In order to evaluate the effect of preventive corticosteroid on the occurrence of pruritus after epidural anesthesia with morphine, we studied 95 patients undergoing cesarean section. Thirty-seven patients (group I) were given 20 mg of bupivacaine 0.5 % for the operation and 2 mg of morphine hydrochloride with 50 mg of Ultracortene-H immediately after the operation and 24 h later, and 58 patients (group II) were given epidural bupivacaine during the operation and epidural morphine hydrochloride immediately after the operation and 24 h later without Ultracortene-H. Only 8.1 % of group I patients had pruritus after the injection compared to 20.6% in group II. We suggest that the addition of 50 mg Ultracortene-H to 2 mg epidural morphine analgesia after the operation might prevent severe forms of pruritus.

A case of parovarian serous tumor of borderline malignancy inadvertently found during cesarean section in a 27-year-old multigravida is reported. Seventeen months after diagnosis there is no clinical evidence of disease. The histologic appearance of the tumor was identical with that of tumors of ovarian origin, however, whether its biologic behavior is similar as well is not known.