Human reproduction
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Comparative Study
Relationship between protein concentrations in embryological fluids and maternal serum and yolk sac size during human early pregnancy.
Coelomic fluid (n = 57), amniotic fluid (n = 61) and maternal serum (n = 81) were obtained from normal pregnancies between 7.7 and 13.9 weeks and assayed for total protein, alpha-fetoprotein (alpha FP), albumin and pre-albumin. The mean concentration of total protein in matched samples was 18 times higher in maternal serum than in the coelomic fluid and 54 times higher in the coelomic fluid than in amniotic fluid. The concentrations of total protein, albumin and pre-albumin decreased and that of alpha FP increased in maternal serum with advancing gestation. ⋯ Before 11 weeks gestation, significant correlation was only found between yolk sac volume and coelomic fluid concentration of pre-albumin as evaluated by both electrophoresis and immunonephelometry. These results suggest that during the first trimester of normal pregnancy, the placental metabolism and transfer rate of proteins is not directly influenced by the concentrations of protein in the maternal circulation and that the transfer of proteins through the amniotic membrane is limited. These results also indicate that during that period the secondary yolk sac may contribute to the protein content of the exocoelomic cavity, and that the embryo and its yolk sac and subsequently the fetus are the main source of the proteins present in the amniotic fluid.
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In this prospective study among 208 high-risk patients with suspected ectopic pregnancy, the diagnostic value of transvaginal sonography and serum human chorionic gonadotrophin (HCG) measurements were analysed in detail. The absence of an intra-uterine gestational sac obviously was the most constant sonographic finding among patients with ectopic pregnancy (n = 89), with a very high sensitivity (0.99) but a low specificity (0.41). The application of different HCG cut-off levels improved specificity to 1.00 for values exceeding 4500 IU/l. ⋯ The additional effect of HCG values on these results was minor. The low HCG cut-off levels advocated in recent studies are questioned by the results of our analysis: whereas the combined use of sonography and HCG measurements is shown to be of great benefit, the limitations are also documented, underlining the need for re-evaluation at intervals of patients with low HCG values. The question of which cut-off level should be used in practice, however, hinges on a difficult choice between a certain specificity and clinical utility.
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Mifepristone (RU 486) is an antiprogestin which interacts with progesterone at the receptor level. Administration of mifepristone immediately after ovulation does not upset the menstrual cycle. However, the maturation and function of the endometrium is inhibited and uterine contractility is changed. ⋯ On the basis of the time of the LH peak, it was retrospectively calculated that in 124 cycles at least one act of intercourse occurred during the period 3 days before to 1 day after ovulation. The probability of pregnancy in this period of the menstrual cycle is thus 0.008. The women did not complain of any treatment-related side-effects apart from slight bleeding for 2-3 days starting a few days after the day of treatment in 35% of the cycles.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
The temporal relationship between vaginal fluid volumes obtained with the Rovumeter vaginal aspirator and the fertile phase of the cycle.
Recent trends in family planning demonstrate an increasing interest in natural methods of birth regulation. In their present form, however, these methods are highly subjective and individualistic. ⋯ Results show that in all cycles tested, it is possible using the Rovumeter aspirator to detect the beginning of the fertile phase by rapidly increasing volumes of CVF; this volume reaches a peak approximately 1 day before ovulation detected by ultrasound and demonstrates an abrupt fall after ovulation and the onset of the infertile phase. From the results of this pilot study, we believe that, by the use of suitable algorithms and larger studies, it should be possible to develop a CVF volume method which could be offered as an objective alternative method for users of natural family planning and programmes.