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Building on a body of research which confirms that psychosocial factors have an important influence on health in general and on pregnancy outcomes in particular, we carried out a prospective study of pregnant women in Israel. We hypothesized that medical pregnancy and delivery outcomes are mediated by psychosocial coping resources and risks. Resources were defined as social ties, and risks as life events self-reported as stressful. The population studied included 233 women who responded to questionnaires after the second trimester of pregnancy. Medical data on the delivery were collected from hospital archives. The questionnaire measured biomedical risks, including general medical and obstetrical history, as well as health behaviours, social ties, and perceived stress. Pregnancy outcomes were classified according to medical measures of abnormalities in mother and child at birth. Our findings show that resources such as the variety of social ties (family, friends, neighbours and colleagues) interacted significantly with biomedical risk. It was found that low scores for social ties anticipated 3.6 times higher negative medical outcome in otherwise healthy women than in those with higher scores for social ties. The findings of the study are discussed in terms of their implications for relating to social competence as a determining element in health and health behaviour.

Objective: To determine whether various solutions commonly used in amnioinfusion during labor affect neonatal electrolyte and blood gas values., Methods: Amnioinfusion for thick meconium or severe variable fetal heart rate decelerations is used at our institution according to a standardized protocol. During alternating 3-week periods, the only solution made available for amnioinfusion was either normal saline or Ringer's lactate. Bolus volume, rate, and duration of infusion were determined by the individual physicians. At delivery, cord blood was collected for electrolyte and blood gas determination. These values were compared between the two solution groups and to a non-infused control group., Results: Complete data on neonatal electrolytes and blood gas values were available on 53 infusion patients (20 Ringer's lactate, 33 normal saline) and 39 non-infusion patients. Comparing infusion to non-infusion patients and those infused with Ringer's lactate to those with normal saline, we found no significant difference in demographics, neonatal outcome variables, duration of labor, neonatal electrolytes, and cord blood gas values. Infusion variables (bolus volume, infusion rate, hours infused, and total volume infused) did not differ between solutions. Total volume and hours of infusion were closely correlated with each other (r = 0.93, P < .001); both were correlated with neonatal chloride (r = 0.38 and r = 0.36, respectively; P < .005). No cases of hypernatremia or hyperchloremia were found in any of the groups. The type of solution used had no effect on the neonatal chloride trend., Conclusion: The use of both normal saline and Ringer's lactate for indicated amnioinfusion in labor appears to have no clinically significant effect on neonatal electrolytes.

Objective: The purpose of this study was to compare the diagnostic performance of ultrasonographic and digital examination of the cervix in the prediction of preterm delivery in patients presenting with preterm labor and intact membranes., Study Design: Endovaginal ultrasonography was performed in 59 patients admitted with preterm labor (20 to 35 weeks) and cervical dilatation of < 3 cm. Cervical parameters evaluated included endocervical length, the presence of funneling, funnel length, funnel width, cervical index ([Funnel length + 1]/Endocervical length), and cervical dilatation and effacement as determined by digital examination. Outcome variables were the occurrence of preterm delivery (< 36 weeks) and the admission-to-delivery interval., Results: The prevalence of preterm delivery was 37.3% (22/59). Receiver-operator characteristic curve and logistic regression analyses indicated a significant relationship between the occurrence of preterm delivery and ultrasonographic cervical parameters (p < 0.005 for each) but not with the results of digital examination of the cervix. Survival analysis demonstrated a shorter admission-to-delivery interval for patients with an abnormal cervical index or endocervical length (p < 0.005 for each)., Conclusions: Endovaginal ultrasonographic examination of the uterine cervix is more accurate than digital examination of the cervix in the assessment of the risk for preterm delivery in patients with preterm labor and intact membranes.

Purpose: Uterine leiomyomata alone are an infrequent cause of infertility. We presumed that--since the smaller the uterine size at the time of myomectomy, the greater the chances of subsequent conception--diminishing the preoperative tumor size in infertile patients with large leiomyomata prior to myomectomy should be beneficial., Procedure: Decapeptyl (D-Trp6-LHRH) depot 3.2 mg was administered for a period of 3-6 months to 23 infertile women. No causes of infertility were found in these patients except for uterine leiomyomata. In 10 of the 23 patients conservative myomectomy was added to Decapeptyl treatment., Findings: Following Decapeptyl treatment an average decrease in uterine volume of 57% (range: 22%-86%) was observed in all patients. In ten of the 23 patients conservative myomectomy was added to Decapeptyl treatment resulting in a further 16% decrease in uterine volume. Uterine regrowth following Decapeptyl and myomectomy was found to be significantly lower (P < 0.01) when compared with cases treated with Decapeptyl alone. Five of the ten patients treated by Decapeptyl and myomectomy achieved successful pregnancies and delivered. Among the women treated with Decapeptyl without myomectomy, only one patient conceived., Conclusions: From these findings it may be concluded that combined GnRH and myomectomy is the treatment of choice for infertile women with large uterine leiomyomata.

Women members of the newly formed Ehlers-Danlos National Foundation (EDNF) were surveyed with a very detailed questionnaire with 50 questions concerning family history and inheritance, past medical history, and obstetric and gynecologic problems. They entailed the largest extant database on Ehlers-Danlos Syndrome (EDS) patients. The mean age of the 68 women who responded to the survey was 42 years; most had EDS types I, III, IV and unknown. Forty-three women had 138 pregnancies; 13 women never married. The stillbirth rate was 3.15% (3/95); the preterm delivery rate was 23.1% (22/95), and the spontaneous abortion rate was 28.9% (40/138). There was a cesarean delivery rate of 8.4%, with 14.7% having perinatal bleeding problems. One woman (EDS type IV) had congestive heart failure. Common gynecologic problems were recurrent anovulation (41.3%), recurrent vaginal infections (53%), abnormal cytologic smears (19%), sexual dysfunction (61%), irregular menses (28%), endometriosis (15.8%), vaginal dryness (25%) and a need for hysterectomy (19.1%). In this largest series of pregnancies with EDS, we found relatively high rates of abortion, preterm delivery, pregnancy-related bleeding and stillbirth. Women with EDS also seem to have high frequency of anovulation, vaginal infections, abnormal cytologic smears and dyspareunia.

To determine if there are any specific monitoring patterns associated with chromosomal abnormalities the intrapartum tracings of 17 postnatally diagnosed karyotypically abnormal infants were obtained. Controls were randomly selected from infants born on the same day at the same gestational age. The tracings from these two groups were independently evaluated. Comparison of the monitor interpretations showed: (1) the karyotypically abnormal group was more likely to have decreased or absent short- (p < 0.001) and long-term (p < 0.01) variability; (2) accelerations were more likely to be represented in the control group (p < 0.001); (3) no significant differences were found in the baseline heart rates or in the presence or frequency of mild, moderate, or severe variable or late decelerations. These findings may reflect underlying central nervous system abnormalities as opposed to uteroplacental insufficiency, but are not specific to karyotypically abnormal infants.

Objective: Our goal was to compare the value of amniotic fluid tests in the detection of microbial invasion of the amniotic cavity and in the relationship with the amniocentesis-to-delivery interval and neonatal complications in patients with preterm labor and intact membranes., Study Design: Amniotic fluid was retrieved by transabdominal amniocentesis from 120 patients with preterm labor and intact membranes. Fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. Amniotic fluid analysis included a Gram stain, white blood cell count, glucose and interleukin-6 determinations. Logistic regression and Cox's proportional hazards model were used for analysis., Results: (1) The prevalence of positive amniotic fluid cultures was 9.2% (11/120); (2) patients with microbial invasion had a shorter amniocentesis-to-delivery interval and a higher neonatal complications rate than patients with a negative culture; (3) the most sensitive test for the detection of microbial invasion of the amniotic cavity was amniotic fluid interleukin-6 determinations (cutoff 11.3 ng/ml) (sensitivity; for interleukin-6 100%, for glucose 81.8%, for white blood cell count 63.6%, and for Gram stain 63.6%; p < 0.05 for all comparisons); (4) the most specific test was the Gram stain of amniotic fluid (specificity: for Gram stain 99.1%, for white blood cell count 94.5%, for interleukin-6 82.6%, and for glucose 81.6%; p < 0.01 for all); (5) of all amniotic fluid tests, interleukin-6 determinations were the only ones that had significant relationship with the amniocentesis-to-delivery interval and neonatal complications., Conclusion: Interleukin-6 concentrations in amniotic fluid are better indicators of microbial invasion of the amniotic cavity, amniocentesis-to-delivery interval, and neonatal complications than the amniotic fluid Gram stain, glucose concentration, or white blood cell count.

Objective: We sought to evaluate the accuracy of ultrasonographic, obstetric, and neonatal diagnosis of a single umbilical artery., Study Design: We studied 17,777 consecutive singleton births from women who had undergone ultrasonographic examination at our hospital. A single umbilical artery was confirmed in 37 cases (0.2%) by two clinical methods or by pathologic assessment. Outcome of neonates with a single umbilical artery was compared with the outcome of neonates with either two or three vessel cords., Results: Ultrasonographic diagnosis had a 65% sensitivity and positive predictive value. Obstetricians and pediatricians failed to diagnose 24% and 16% of the cases, respectively. On average, neonates with a single umbilical artery weighed 320 gm less, were delivered 1 week earlier, and had lower Apgar scores than neonates with three vessel cords (p < 0.01 in each case.), Conclusion: Although early gestational age may account for some cases not diagnosed by ultrasonography, there is a little justification for missing the diagnosis after delivery. Greater emphasis on clinical examination of the umbilical cord is needed to identify neonates at risk of associated malformations.

Objective: To evaluate the effects of prostaglandin (PG) E2, given for induction of labor at term, on fetal breathing and body movements., Methods: Eighteen women with term pregnancies, mild gestational hypertension, intact membranes, and unripe cervices who were not in labor participated in this study. After a 60-minute baseline ultrasound examination of fetal chest and body movements, recorded on videotape, the patients were randomly assigned to either 3 mg intravaginal PGE2 tablets or controls (placebo intravaginal tablets). Following tablet insertion and a 3-hour observation time, a second 60-minute ultrasound recording of fetal movements was taped. The videotape recordings were interpreted according to the total amount of time occupied by fetal body movements and fetal breathing movements., Results: There was a total of 2180 minutes of ultrasound tape recordings, with 136.2 minutes of fetal body movements (6.2%) and 207.8 minutes of fetal breathing movements (9.5%). Mean (+/- standard deviation) observation times per patient before and after tablet insertion were 60.3 +/- 1.2 and 56.4 +/- 1.2 minutes for the PGE2 group and 60.1 +/- 1.3 and 60.4 +/- 1.1 minutes for the control group. Three hours after PGE2 insertion, there were significant decreases in the percentage of time occupied by body movements (7.8 +/- 3.1 versus 3.4 +/- 2.0%; P < .003) and breathing movements (10.6 +/- 8.6 versus 3.9 +/- 2.3%; P < .007). Three hours after tablet insertion, there were statistically significant decreases in the percentage of time occupied by body movements (P < .025) and breathing movements (P < .01) between the control and study groups., Conclusion: Induction of labor with intravaginal PGE2 tablets inhibits fetal body and breathing movements. The effects could be due to direct action on the fetus or indirect effects of PGE2 (through uterine contraction and/or endogenous PG).

Objective: The purpose of this study was to determine the prevalence and clinical significance of microbial invasion of the amniotic cavity in patients presenting with cervical dilatation in the midtrimester of pregnancy., Study Design: Amniocentesis for microbial studies was performed in women admitted with cervical dilatation > or = 2 cm, intact membranes, and without active labor between 14 and 24 weeks of gestation. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as for mycoplasmas. Gram stain was performed on all samples., Results: The prevalence of microbial invasion of the amniotic cavity was 51.5% (17/33). The most common microbial isolates were Ureaplasma urealyticum, Gardnerella vaginalis, Candida albicans, and Fusobacterium sp. All patients with microbial invasion of the amniotic cavity had complications. Patients who underwent cervical cerclage in the presence of a positive amniotic fluid culture had rupture of membranes, clinical chorioamnionitis, or pregnancy loss. On the other hand, the prognosis of patients with a negative amniotic fluid culture was better than that of patients with a positive culture. Of 16 patients with a negative amniotic culture, nine were delivered at > 34 weeks., Conclusions: (1) Microbial invasion of the amniotic cavity occurs frequently in women presenting with cervical dilatation in the midtrimester; (2) the microbiologic state of the amniotic cavity is an important prognostic factor for pregnancy outcome; (3) amniocentesis to determine the microbiologic characteristics of the amniotic cavity should be considered before a cerclage is placed in women presenting with cervical dilatation in the midtrimester.

Sonographic measurements of multifetal pregnancy for dating and growth are considered identical to singleton pregnancies until the second trimester. Observations in 57 patients having triplets or more, who were referred for first trimester multifetal pregnancy reduction, suggest considerable size variability both within an individual pregnancy and among pregnancies of the same gestational ages (GAs). These data are unique because the GAs are precisely known, because the pregnancies were established by assisted reproductive technology. We observed a greater standard deviation at 12 and 13 weeks of GA. We also observed significant interfetal variation within an individual pregnancy. Because multifetal pregnancy reduction was performed, follow-up of any given fetus to term was not possible. We conclude that for high-order multiple gestations: (1) interfetal size variability begins much earlier than often stated; (2) differences in the degree of variability can be observed among different pregnancies of the same gestational age and within the same pregnancy, and (3) there is a trend for increasing variability with increasing gestational age.

Fifty four women with repeated unsuccessful in vitro fertilization (IVF) cycles due to inadequate ovarian response to stimulation with human menopausal gonadotropins (hMG) participated in this study. They were randomized to receive either gonadotropin releasing hormone agonist (GNRHa), Buserelin, prior to and during induction of ovulation by hMG (Group I--long protocol), or GnRHa starting on the first day of the cycle together with induction of ovulation by hMG (Group II--short protocol). Mean follicular phase serum luteinizing hormone (LH) and progesterone (P) levels were significantly lower in Group I than in Group II (P less than 0.01). Cancellation rate was significantly lower in Group I than in Group II (P less than 0.01). The long GNRHa protocol resulted in statistically significant lower cancellation rates, more oocytes per pickup (OPU), more embryos transferred per patient, and a higher pregnancy rate. Significantly more hMG ampoules and more treatments days were required in the long GNRHa protocol. Our data demonstrate that the use of GNRHa prior to and during ovarian stimulation with hMG offers a very good alternative for patients with repetitive unsuccessful IVF cycles due to inadequate response.

Transient hip osteoporosis is a benign, process mainly affecting men. A 31-year-old woman in the 31st week of pregnancy was diagnosed as having the disorder. Impairment of venous flow associated with pregnancy might have been the cause of the osteoporosis and superficial thrombophlebitis.

We performed chorionic villus samplings (CVS) in 795 cases in the first trimester during a 13-month period. Of these 35 were found to have a blighted ovum or missed abortion prior to the procedure. Nineteen women consented to have CVS. Ultrasonographic and cytogenetic findings in these 19 pregnancies were correlated. Expected gestational age was determined by last menstrual period. Observed gestational age was determined by crown rump length (CRL) (12 pregnancies) or gestational sac (GS) (7 pregnancies without fetal pole). The differences in days between the estimated and observed gestational ages was determined for each pregnancy. In all 19 CVS samples cytogenetic diagnosis documented aneuploidy. Ten cases had chromosome abnormalities virtually always lethal in the embryonic period (group I). Nine pregnancies had defects with moderate potential for fetal viability (group II). Gestations with low viability potential (group I) had estimated minus observed gestational age discrepancies (23.4 +/- 8.3 days) significantly greater than gestations with moderate viability potential (group II) (8.9 +/- 4.3 days) (P less than .001). The absence of a fetal pole was more common in group I. CVS in pregnancies with missed abortion or blighted ovum is feasible and has a high likelihood of documenting aneuploidy. Furthermore, the more severe the anomaly the more likely there will be very early fetal demise or intrauterine growth retardation.

Clinical risk identification for preterm delivery, the major cause of perinatal morbidity and mortality, remains problematic. To test the hypothesis that a provocative test for uterine contractility at the beginning of the third trimester would reliably identify patients destined to be delivered before and at term, we designed the mammary stimulation test. Uterine contractions in response to nipple stimulation at a mean of 28.6 weeks' gestation, were evaluated in 94 gravid patients at risk for preterm delivery. The mammary stimulation test, the results of which were not used for clinical management, was positive in 50% of patients tested and had a sensitivity of 84% and a positive predictive value of 34% (chi 2 = 11.15, p less than 0.01). Ninety-four percent of patients predicted to be delivered at term actually were delivered at term (negative predictive value). Furthermore, no patients with a negative mammary stimulation test were delivered within 1 month of testing or were delivered of infants weighing less than 2000 gm. Discriminant analysis indicated that the mammary stimulation test provided information beyond that available from clinical risk factors alone. A cost analysis suggested that the use of the mammary stimulation test could reduce the cost of ambulatory uterine activity monitoring by nearly 50%. If these findings can be validated in additional samples, the mammary stimulation test may be useful in prematurity prevention programs.

Artificial ripening of the unfavorable cervix was attempted in 48 women using intracervical prostaglandin (PG) E2 gel applied by a cannula and in 70 others by a newly designed double balloon device (Atad Ripener Device). In the first group (phase A), application of PGE2 gel by intracervical cannula resulted in a mean increase of 3 points in the Bishop score and a mean instillation-to-delivery time of 34.2 hours. The study of labor induction by the double balloon device was carried out in two parts. One (phase B) consisted of a double-blind randomized controlled study in which, through the double balloon device, ten women received PGE2 gel and another ten were given placebo gel. There was no significant difference in the increase of Bishop score between the two groups (5.8 points in the treatment group and 6.0 in the placebo-controlled group). Ninety percent of women in both groups delivered vaginally with a mean of 20.8 hours after device insertion. The third phase of the study consisted of an open trial of inserting the double balloon device alone without PGE2, and inflating the balloons in 50 patients. A mean increase of 4.4 points in the Bishop score was noted in these women. These findings suggest that the use of the double balloon device for ripening of the unfavorable cervix is an effective and well-tolerated method of labor induction.

Six patients with poor ovarian response to menotropin after pretreatment with a gonadotropin-releasing hormone analog exhibited improved ovarian responsiveness when metoclopramide was added on days 3, 5, and 7 of the cycle. This was evidenced by a higher number of leading follicles (4.4 versus 0.6), a higher mean of maximal serum 17 beta-estradiol levels (560 versus 178 pg/mL), a shorter duration of menotropin treatment (7 versus 11 days), and fewer ampules of menotropin used (20 versus 37 ampules/cycle) in metoclopramide-treated cycles as compared with control cycles, respectively. Serum prolactin levels reached a maximum of 172 ng/mL within 1 hour after metoclopramide administration and declined to normal range within 6 hours. These results suggest that intermittent increased prolactin secretion may augment ovarian response to gonadotropins.

Postpartum abdominal apoplexy is a rare obstetric complication that is associated with a very high maternal mortality rate. We report a patient with a low risk pregnancy and spontaneous vaginal delivery, who at 17 h post partum went into shock secondary to rupture of the splenic artery. She recovered following splenectomy and transfusion of 10 units of blood. This is the seventh documented case of splenic artery rupture in the postpartum period. Four of the seven patients survived. The cases are reviewed and the clinical presentation, pathogenesis and treatment are discussed.

Fluids were collected from 136 ovarian follicles of 35 women undergoing in vitro fertilization and embryo transfer (IVF-ET). Fifteen women (76 follicles) received oral contraceptive pills (OCs) prior to ovulation induction. All women received human menopausal gonadotropins (hMG) for ovulation induction and in all cases follicular aspiration was performed 32 to 34 hours after an injection of human chorionic gonadotropin (hCG). The concentrations of follicular-stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), and 17 beta-estradiol (E2) in the follicular fluids (FF) were measured by radioimmunoassay (RIA). FSH concentration in the FF of the OCs group (15 women, 76 follicles) was significantly lower (2.1 mIU/mL) as compared to the FSH (15.9 mIU/mL) in the FF of the control group (20 women, 60 follicles). The LH FF concentrations after hCG injection were similar in the two groups. The E2/P ratio in the OCs group (9.6) was significantly lower than the E2/P ratio in the control group (20.6). OCs given to patients before induction of ovulation with hMG results in lower E2/P ratios and lower FSH concentration in the FF.

Fetal active and quiet periods of behavioral activity were determined at 28 and 32 weeks' and 36 to 40 weeks' gestational age in insulin-dependent diabetic pregnancies and in normal pregnancies resulting in infants with weights appropriate for gestational age. Fetal active and quiet periods were based on observations of fetal movements and long-term fetal heart rate variability. The number of fetal active-quiet periods, the average duration of fetal quiet periods, and the average duration of fetal active periods were the three parameters evaluated. In the normal pregnancy groups, with increasing fetal gestational age from 28 to 32 weeks to 36 to 40 weeks there was an increase in the length of the active and quiet periods with fewer active-quiet cycles per hour. The fetuses of the diabetic women had findings similar to those of the normal group at 28 to 32 weeks; these findings were essentially unchanged at 36 to 40 weeks. These findings suggest delayed development of the active-quiet cycles in these diabetic pregnancies.

Heart rate variability and fetal movement were used to classify active and quiet fetal periods. Fetuses at 28 to 30 weeks and at 38 to 40 weeks' gestation were compared. A period of fetal movement with increased variability of heart beat was classified as active and one with the absence of movement and diminished fetal heart beat was classified as quiet. The results demonstrated significant differences both in the number of active-quiet cycles per hour and in the length of the active periods. These findings suggest that analogs of fetal behavioral states may be present before birth and have cyclic patterns, and that the time spent in each fetal period is longer in older fetuses.

Spectral analysis of spontaneous fluctuations in human fetal movement revealed strong oscillations at frequencies between 0.24 and 0.90 cycle per minute, which are much higher than those of the cyclic alternation of quiet and active states in the fetus and neonate. Oscillations at frequencies up to 2.88 cycles per minute were also detected, but they were usually much weaker. The prominent peaks in the fetal movement spectra are in the frequency range of recently reported neonatal motor rhythms, and indicate the existence of a cyclic process controlling spontaneous motor output that oscillates near one cycle per minute and begins to function in utero.

Cyclic patterns of active and quiet fetal activity were evaluated in 36 clinically normal gravidas between 27 and 42 weeks of gestation. All infants were subsequently delivered between 37 and 42 weeks of gestation, were clinically normal and of appropriate weight for gestational age. Active-quiet cycles occurred less frequently and were of longer duration with increasing gestational age. Regression analysis of the number of active-quiet cycles with gestational age yielded a correlation coefficient of 0.52 (p less than 0.01). The similarity of fetal active-quiet cycles and active and quiet sleep cycles observed after birth is noted.

Five hundred ninety-one oocytes were laparoscopically recovered in 93 consecutive stimulated cycles. Fifty-three of the 591 oocytes were collected from the cul-de-sac in 39 cycles. The cul-de-sac-originated oocytes had fertilization and cleavage rates of 72 and 79%, respectively; these rates were similar to those achieved in oocytes originating from follicles. A significant decrease in the fertilization rate of cul-de-sac-originated oocytes was noticed in oocytes collected from the cul-de-sac 60 minutes or more after the beginning of the procedure. Oocytes collected from the cul-de-sac yielded 21% of the embryos transferred in cycles where some of the oocytes were recovered from the cul-de-sac. These findings indicate that repeated aspirations of the cul-de-sac may increase the number of embryos transferred.

It is essential to ascertain that women who had an IUD inserted at some time have indeed had the device removed. It is also important to ensure that the whole IUD was removed and that no parts were left in the uterine cavity. This is especially true in cases of infertility and should be ascertained before invasive investigations such as hysterosalpingography or laparoscopy commence. An accurate history and ultrasonography can easily rule out a forgotten or fragmented IUD, thereby preventing considerable unnecessary suffering and expense.

In 16 women undergoing IVF-ET, with more than four embryos available, two transfers were performed (24 hr apart), instead of one. The pregnancy rate was 25%, as compared with a pregnancy rate of 6.2% in 16 women having fewer than four embryos available and in whom one conventional transfer was performed. Since in our IVF-ET program, we do not freeze the extra embryos available, the purpose of the double transfer was to use all the embryos available and to improve the chances of finding the "implantation window" open. It is our feeling that multiple transfers may be beneficial to improve the pregnancy rate in an IVF-ET program without freezing facilities. However, a larger controlled clinical trial is necessary, in order to establish the advantages of multiple transfers in terms of pregnancy rate in comparison with the potential disadvantages.

In 7 second trimester pregnancies ultrasound (US) demonstrated cystic hygroma colli (CHC); amniocentesis was performed in 6 patients. In the 7th patient, because of oligohydramnios, the fluid for karyotype was aspirated from the CHC. Five pregnancies had been referred secondary to abnormalities on US and 2 others because of low maternal serum alpha-fetoprotein (MSAFP). Four karyotypes were abnormal (45,X;47,XX+21; 47,XY+21; 46,XX/45,X), and 3 had normal karyotypes. Amniotic fluid alpha-fetoprotein (AFAFP) was normal in 4 pregnancies and low in 2 (0.09 MOM, 0.41 MOM). Of 2 pregnancies with trisomy 21 one had been referred for low MSAFP. In 2 pregnancies with normal karyotypes, US findings at early gestational age (14-17 weeks) of small, nonseptated, bilateral CHC disappeared during pregnancy; these women delivered normal, term babies. Most prenatally diagnosed CHC are not in fetuses with Turner syndrome. With a normal karyotype and CHC as the only finding on early US in utero, normal neonatal survival is possible. AFAFP is not elevated in pregnancies with CHC. If AFAFP is elevated with a positive acetylcholinesterase, such results may suggest that the CHC was inadvertently aspirated.

Cimetidine (Tagamet, Smith Klein, Brussels, Belgium) the histamine receptor type 2 blocker, has been suggested as a possible treatment of hirsutism. In a prospective randomized controlled trial, cimetidine 1.5 gm a day was given for 3 months to 12 moderately or severely hirsute women, while 8 other women were randomized to serve as a control group. There was no significant change in the hair growth rate in either group as measured by two assessment methods. This finding suggests that cimetidine, given in the recommended dose for a period of 3 months, does not have a beneficial effect on hirsutism.

The temporal organization (nonrandomness) of fetal heart rate (FHR), fetal movement, and their association was evaluated in 20 normal pregnancies at 20 to 22 or 28 to 30 weeks of gestation with the use of external electronic fetal monitoring and statistical analysis with the runs test. At 20 to 22 weeks, significant clustering was found in one of 10 pregnancies for FHR change, two of 10 pregnancies for fetal movement, and one of 10 pregnancies for FHR changes associated with fetal movement. At 28 to 30 weeks, significant clustering was found in eight of 10 pregnancies for FHR change, eight of 10 pregnancies for fetal movement, and all 10 pregnancies of FHR change associated with fetal movement. There was significantly more clustering of FHR change, fetal movement, and FHR change associated with fetal movement at 28 to 30 weeks of gestation than at 20 to 22 weeks of gestation. Clustering of FHR changes was highly correlated with clustering of fetal movement.

One hundred midtrimester pregnancy terminations were successfully induced with continuous extraovular infusion of prostaglandin F2 alpha (PGF2 alpha). The solution was infused into the extraovular space with a newly developed double-balloon catheter. The mean instillation abortion time was 12.9 h. Abortion was completed in 48% of the patients within 12 h, in 80% within 18 h, and in 96% within 24 h. The mean total dose of PGF2 alpha instilled was 12.4 mg/patient. Only four patients aborted after 24 h from the insertion of the catheter and instillation of the PGF2 alpha. Side effects were few. Thirteen patients (13%) had nausea and vomiting, and 14 (14%) had transient pyrexia (above 38 C). No major complications occurred. It appears that this method has a high success rate, good patient tolerance, and an acceptable safety factor with few minor side effects.