Fetal DNA in uterine vein blood

Citations from the Literature

phone follow-up was obtained for 61 patients at least 6 months after the procedure. The majority of patients requested endometrial ablation because of irregular heavy menses, and two patients presented with postmenopausal bleeding. Al1 patients had preoperative endometrial sampling that demonstrated benign endometrial histology. Five women had previous endometrial ablation with the Nd:YAG laser, with persistent bleeding. Eight patients had endometrial polyps and six had submucous fibroids that were resected at the time of hysteroscopic ablation. Results: The average operative time was 31.6 min, and an average of 304 ml of distending medium was absorbed during the procedure. Complications included one uterine perforation in a patient who had a previous Nd:YAG ablation, and one epidural anesthetic complication. At followup, 18 women (29.5%) reported amenorrhea, 16 (26.2%) reported spotting, 21 (34.4%) reported decreased menstrual flow, four (6.6%) had no change, and two (3.3%) noted increased flow. Subjectively, 49 patients (80.3%) reported a satisfactory outcome. Of the 12 who were not satisfied, seven underwent a repeat ablation with satisfactory results, four chose hysterectomy, and one elected not to have further therapy. Conclusion: Endometrial ablation with the rollerball electrode is a safe, excellent method of management in women with excessive menstrual flow and provides a tost-effective, minimally invasive altemative to hysterectomy. Laparoscopic oophorectomy: Compnrative study of ligatures, bipolnr coagulatioo, aod automatie stapling devices

Daniell JF; Kurtz BR; Lee J-Y 2222 Stare Street. Nashville, TN 37203, USA OBSTET GYNECOL 1992 8013 1 (325-328) Objective: We assessed laparoscopic oophorectomy using three techniques. Methods: From January 1989 to October 1991, 65 patients underwent laparoscopic oophorectomy using three techniques: bipolar coagulation, pretied ligature placement, and automatie stapling devices. The patients were aged 18-57 years and had the indications of pain, ovarian endometriosis, adhesions, unilateral blocked tubes, breast cancer, and recurrent benign ovarian cysts. The primary method of adnexal removal involved the automatie stapling device in 17, bipolar coagulation in 30, and pretied ligatures in 18. Results: Total anesthesia time ranged from 45-123 min, with means of 77 min for pretied ligatures, 84 min for bipolar coagulation, and 84 min for automatie stapling devices. Sixty-two patients were discharged within 23 h, two stayed two nights, and one stayed three nights. Rectus muscle bleeding and hematoma formation were the only complications in this series. Conclusion: Al1 three methods of laparoscopic oophorectomy are effective, with similar operative times and uniformly good results for the patients. Ureter injury during laparoscopy-assisted witb the endoscopic linear stapler

vagina1 hysterectomy

Woodland MB Department of Obstetrics/Gynecology, Pennsylvania Hospital, University of Pennsylvania. Philadelphia, PA 19107, USA

AM J OBSTET GYNECOL 1992 16713(756-757) Ureter injury is more common with abdominal hysterectomy

2 17

than vagina1 hysterectomy. Complications during laparoscopyassisted vagina1 hysterectomy cases have not been thoroughly studied. Two cases are presented that highlight urologie misadventures, specifically, ureteral injury, with the endoscopic linear stapler during laparoscopy-assisted vagina1 hysterectomy. Transverse traosperineal lower vagina

repair of rectovaginal

tìstulas in tbe

Wiskind AK; Thompson JD Emory University School of Medicine. Department of Gynecology/Obstetrics, 69 Butler Street. SE, Atlanta, GA 30303, USA

AM J OBSTET GYNECOL 1992 167/3 (694-699) Objective: The management of a rectovaginal fistula is a significant challenge for the patient and the surgeon, with many acceptable surgical techniques for repair. The transverse transperineal repair is a method that preserves an intact externa1 anal sphincter, allows wide mobilization of recta1 and vagina1 tissues, and closes the fistula with at least live layers of tissue. We have used this technique in patients with rectovaginal lïstulas in the lower vagina for the past several years and recently reviewed our results. Study design: A chart review of 21 patients who had a transverse transperineal repair of a rectovaginal lïstula in the lower vagina in our institutions from 1983 to 1990 was performed. Results: Al1 patients had a satisfactory recovery with no recurrence of a fistula during a followup period ranging from 3 months to 8 years (mean 18 months). The series includes seven patients with Crohn’s disease and/or previous failed repairs. Conclusions: Our experience suggests this method provides excellent anatomie and physiologic results with minima1 morbidity.

PERINATOLOGY Fetal DNA in uterioe vein bloed Ganshirt-Ahlert D; Basak N; Aidynli K; Holzgreve W Department Obstetrics and Gynecology, Munster, DEU

University of Munster.

OBSTET GYNECOL 1992 80/4 (601-603) Objective: To investigate whether the ratio of fetal cells in the maternal circulation differs before and after the blood passes through the maternal lung. Methods: We performed polymerase chain reaction-based Y-sequence analysis of DNA derived from antecubital vein blood obtained before and 2 h after cesarean delivery, and from uterine vein blood obtained during cesarean of 14 women carrying male fetuses. Results: Fetal DNA was detected in 17 tested specimens and. as estimated by comparison with parallel dilution series, the fetal-maternal DNA ratio was 1:105 to 1:106. However, there was no signilïcant differente in the amount of Y-chromosomal DNA detectable between uterine vein blood and peripheral blood after polymerase chain reaction and Southern hybridization. In DNA derived from peripheral blood after delivery, the intensity of Y-specilïc fetal DNA sequences was also not signilïcantly increased. Conclusion: Our results argue against the often-stated hypothesis of different ratios of fetal to maternal DNA in the Int J Gynecol Obstet 41

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Citations front the Literature

uterine vein versus peripheral bloed, and indicate that even delivery does not seem to increase the flow of fetal cells into the matemal circulation. Tumor aecrosis factor-selectively stimulates prostaglandin F(2) production by macrophages in bumao term decidua

Norwitz ER; Lopez Bemal A; Starkey PM Vniversity of Oxford, Nuffield Dept. Obstetrics/Gynecology. John Radcliffe Hospital, Headington 0X3 9DV. GBR

AM J OBSTET GYNECOL 1992 167/3 (815-820) Objective: Our objective was to investigate the effect of tumor necrosis factor-on prostaglandin production by human term decidual cel1 subtypes in vitro. Study design: We measured the effect of tumor necrosis factor-on prostaglandins F(2), Ei, D2, F metabolite, and E metabolite production by decidual cells (n = 4) with radioimmunoassay. We used flow cytometry after labeling with an antibody to histocompatibility antigen DR, L243, which is spccitïc for macrophages in this tissue, to prepare pure populations of decidual macrophages (n = 3). Differences in prostaglandin output were analyzed by Wilcoxon and Rruskal-Wallis tests. Results: Tumor necrosis factorstimulated prostaglandin F(2) output by unfractionated decidual cells, without altering the output of any other prostaglandins. Tumor necrosis factor-( 10 nmolil) increased prostaglandin F(2) production from decidual macrophages (HLA-DR-positive cells) by about threefold: from a median of 727 (range 423-1226) to a median of 1974 (range of 1550-2201), fmoV106 cells per 18 h, as compared with a 1&fold increase from nonmacrophages from a median of 247 fmol/106 cells per 18 h (range 125-611) to a median of 340 fmol/106 cells per 18 h (range 201 to 505). Conclusion: Stimulation of decidual prostaglandin F(2) production by tumor necrosis factor-may be important in the etiology of spontaneous labor at term or preterm labor associated with infection. Prostaghdin Ds production by term buman decidua: Celkdar origins defioed using flow cytometry

Norwitz ER; Starkey PM; Lopez Bemal A c/o Vniversity of Oxford, Nuffield Dept. of Obstetr./Gynecol., John Radcliffe Hospital. Oxford 0X3 9DV, GBR

OBSTET GYNECOL 1992 80/3 1 (440-445) Objective: To measure prostaglandin (PG) Dz output by human decidua at term and to identify the cel1 population(s) responsible for its production. Methods: Decidual cel1 suspensions were prepared enzymatically and the cells were labeled with either of two monoclonal antibodies: F10/89/4, which recognizes the leukocyte common antigen (CD45), or L243, which labels HLA-DR and is specitïc for macrophages in this tissue. Cells were sorted on a Couher EPICS 541 flow cytometer. Prostaglandin levels were measured by radioimmunoassay. Results: Human decidua is an important intrauterine source of PGD, at term. Twenty-nine percent (median) of decidual cells were CD45-positive and 12% were HLA-DR-positive; sorted cel1 populations were 95% pure. Prostaglandin D, output (fmoVlO6 cells per 3 h) by bone marrowderived (CD45-positive) cells was significantly higher than that by non-bone marrow-derived cells: median 63 (range 35-67) Int J Gynecol Obstet 41

versus 20 (13-21), respectively; HLA-DR-positive cells (macrophages) had the highest PGDs production rate (186, range 97-288 fmoY106 cells per 3 h). Under basal conditions, PGDs production by unsorted term decidual cells was not influenced by labor. Conclusion: Bone marrow-derived cells (macrophages) are the major source of decidual PGD2 at term. Further studies are required to investigate the possible role of PG production by human decidual macrophages in the mechanism of term and/or preterm labor.

UhsonograpbicaUy abnormalities

detectable mukers

of fetal ckromosomal

Nicolaides KH, Snijders RJM; Gosden CM; Berry C; Campbell S Harris Birthright Research Centre, Fetal Medicine, King’s College Hospital, Denmark HZ, London SE5 8RX, GBR

LANCET 1992 34018821(704-707) Screening for fetal chromosomal abnormahties on the basis of matemal age has not resulted in a substantial fa11in the proportion of infants bom with an abnormal karyotype: Most fetuses with major chromosomal abnormalities have defects that can be recognised on detailed ultrasonographic examination. Therefore, provided the cardinal signs of each chromosomal syndrome are recognised, it is possible that screening by ultrasound examination could have a greater impact. We karyotyped 2086 fetuses after ultrasonographic examination had revealed fetal malformations, growth retardation, or both. Chromosomal abnormalities were detected in 301 (14%) cases and were more common among fetuses with multisystem malfonnations (29%) than among those with isolated defects (2%). The commonest chromosomal abnormality was trisomy 18, followed by trisomy 21, triploidy, Tumer’s syndrome, unbalanced chromosomal rearrangements, and trisomy 13, trisomy 18 was associated with strawberry-shaped head, choroid plexus cysts, facial cleft, micrognathia, heart defects, exomphalos, malformations of hands and feet, and growth retardation. In trisomy 21, the associated defects were subtle and included nuchal oedema, macroglossia, atrioventricular septal defects, mild hydronephrosis, clinodactyly, and sandal gap. The frequency of autosomal abnormalities increased with matemal age, but if fetal karyotyping had been restricted to mothers older than 35 years, large proportions of chromosomally abnormal fetuses would not have been diagnosed prenatally (64-97%). Our findings provide guidelines as to which defects to search for in screening studies for the detection of chromosomal abnormalities.

Effects of exposure to benzodiazepine during fetal life Bergman U; Rosa FW, Baum C; Wiholm BE; Faich GA PACT, St. Davidi, PA, USA

LANCET 1992 340/8821 (694-696) Dysmorphism and mental retardation have been reported in 7 Swedish children bom of mothers who had taken high doses of benzodiazepines regularly during pregnancy. To explore this