Search

An analysis of 1863 cases in a comparative study of 5 immunologic pregnancy tests is presented. 724 of the 1863 urine specimens were specifically selected because of interfering substance in the specimen or because of a clinical state capable of causing such substances to be excreted. The specimens were subjected to 2 hemagglutination-inhibition tube tests (UCG - urine chorionic gonadotropin - and Pregnosticon) 2 latex agglutination-inhibition slide tests (Gravindex and Pregnosticon) and a direct latex agglutination slide test (DAP). Maximum accuracies based on correct test results in uncomplicated first trimester pregnancies and a control group of nonpregnant patients were 98.8% for Pregnosticon tube test 98.6% for the UCG test 96.7% for the Pregnosticon slide test 93.8% for the Gravindex test and 93.2% for the DAP test. These results demonstrate greater sensitivity of tube tests and therefore indicate that tube tests should be used for all patients having elective gynecologic surgery or curettage in the childbearing period. Of the 3 slide tests the Pregnosticon slide test gave the least number of false positive results. Most false positive or inconclusive latex agglutination-inhibition results were related to protein or blood in the urine specimens.

Sixteen patients have been subjected to hysteroscopy with the Silander hysteroscope. No contraindications were found and good visualization was possible. Bleeding from the endometrial surface presented no problem and the uterine cavity was easily distended with the saline-filled rubber balloon. No postoperative complications referrable to hysteroscopy were evident. Good correlation between hysteroscopic and operative findings were evident. Future investigations are underway to widen the usefulness of the hysteroscope and an attempt is being made to photograph the interior of the uterine cavity through this instrument. The future possible uses of this instrument were discussed and the plans of study outlined.

4 cases of adenocarcinoma of the endometrium were reported in young women. All were using and had used for periods of 4-12 years a sequential oral contraceptive, Oracon, manufactured by Mead Johnson Laboratories. Ethinyl estradiol and mestranol, the 3 methyl ether of ethinyl estradiol, are 25 times more potent than diethylstilbestrol, which has recently been implicated in the development of vaginal adenocarcinoma in female offspring of women treated during pregnancy with it. A study is now in progress to determine whether long-term use of Oracon produces premalignant changes in the endometrium. Doctors with patients on similar sequential contraceptives should watch for abnormal vaginal bleeding.

Some clinicians have hesitated to perform dilatation and evacuation (D & E) procedures at 13 weeks' gestation or later because D & Es are more difficult to perform safely than suction-curettage procedures. Moreover, many clinicians still believe all second-trimester abortion procedures should be performed in a hospital. To evaluate these concerns, we analyzed 24,664 abortion performed between 1973 and 1978 by four physicians associated with a large outpatient abortion facility; 3,711 (15%) of the abortions were second-trimester procedures. Dilatation and evacuation was associated with a lower rate of serious complications per 100 procedures (0.23) than instillation of either dinoprost (prostaglandin F2 alpha) (1.28) or hypertonic saline (2.26). In addition, D & E had lower rates for most other specific complications. We conclude that D & E, while requiring more operator skill than earlier suction-curettage procedures, can be learned by gynecologists familiar with suction-curettage, can be performed more safely than the alternative instillation procedures, and can be safely practiced in selected ambulatory settings.