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About one in five women may be carrying Candida in their vagina, but only about one-third will actually develop the symptoms of yeast infection. This was the conclusion of researchers who tested 612 women for Candida using a rapid diagnostic test. Twenty-one percent of the Candida species isolated were resistant to the antifungal drug fluconazole.

In vitro fertilization (IVF) results in a higher risk of premature birth and infant mortality even in single-fetus pregnancies and even after adjusting for other factors. This was the conclusion of a study that compared IVF pregnancies with spontaneously conceived pregnancies.

Byline: Marc Dhont, Paul De Sutter, Gunther Ruyssinck, Guy Martens, Andries Bekaert Keywords: Assisted reproduction; in vitro fertilization; intracytoplasmic sperm injection; pregnancy; perinatal outcome Abstract: Objective: We conducted a case-control study of all pregnancies obtained with assisted reproduction technology in the Dutch-speaking part of Belgium from 1992 until 1997 to investigate differences in peripartum obstetric events and the perinatal outcome. Study Design: Three thousand fifty-seven singleton and 1241 twin pregnancies were studied. About 90% of pregnancies resulted from in vitro fertilization; the remainder resulted from intracytoplasmic sperm injection. Control subjects were selected from a regional register and were matched for maternal age, parity, fetal sex, plurality, and date of delivery. The main outcome measures were duration of gestation, birth weight, perinatal death, perinatal morbidity, incidence of congenital malformations, and incidence of cesarean delivery. Results: Odds ratios and 95% confidence intervals were 2.6 (1.4-4.8) for perinatal mortality, 3.5 (2.2-5.7) for birth before 33 weeks of gestation, and 1.7 (1.5-1.9) for cesarean delivery in singleton pregnancies that resulted after in vitro fertilization. Twin pregnancies obtained with in vitro fertilization, on the contrary, were similar for all outcome measures, except for the incidence of cesarean delivery (odds ratio, 1.4; 95% confidence interval, 1.2-1.7) compared with spontaneously conceived twin pregnancies. Conclusion: The perinatal outcome of singleton pregnancies obtained with in vitro fertilization is significantly worse than that of spontaneously conceived pregnancies, mainly because of the increased rate of preterm birth. The outcome of twin pregnancies obtained with in vitro fertilization is comparable with that of normally conceived twins. For both singleton and twin pregnancies obtained with in vitro fertilization, the incidence of cesarean delivery is increased. (Am J Obstet Gynecol 1999;181:688-95.) Author Affiliation: Ghent and Brussels, Belgium Article History: Received 30 October 1998; Revised 30 March 1999; Accepted 9 April 1999 Article Note: (footnote) [star] From the Department of Obstetrics and Gynecologya and the Department of Medical Informatics,b University Hospital, Ghent; and the Study Centre for Perinatal Epidemiology, Brussels.c , [star][star] Reprint requests: Marc Dhont, MD, PhD, De Pintelaan 185, UZ-Ghent, B-9000 Ghent, Belgium., a 0002-9378/99 $8.00 + 0 6/1/99127

Detection of a heartbeat in a fetus is an early indication of a viable pregnancy. Recent advances have improved the ability to detect and measure fetal heartbeats at even sooner. It has been reported that fetal heart rates normally are around 100 beats per minute at five weeks which gradually increases with time. On the other hand, abnormally slow rates have been associated with fetal death. Fetal heart rates were monitored between the fifth and 12th week of pregnancy in 170 pregnancies to establish normal development and to see if abnormally slow heart rates correlated with adverse outcomes of pregnancy. Results showed that 29 of the pregnancies ended in a miscarriage before the 12th week. Heartbeats were detected as early as five weeks three days of pregnancy and were always detected by the first day of the seventh week in normal pregnancies. In all instances where a heartbeat was not detected by six weeks one day, the pregnancy ended in miscarriage. In the normal pregnancies fetal heart rate increased from an average of 82 beats per minute during the fifth week to 156 beats per minute the ninth week. In cases where miscarriage occurred, but a heart rate was detected at some point, the rates never exceeded 100 beats per minute and a gradual decline in heart rate was detected in 10 cases. In fact, a gradual decline in heart rate was always indicative of miscarriage. A single measurement of abnormally low fetal heart rate was not a good predictor of outcome. These results suggest that fetal heart rates in normal pregnancies increase significantly between the fifth and ninth week of pregnancy and are always detectable by the beginning of the seventh week. A single observation of an abnormally slow heart rate does indicate a higher likelihood of adverse outcome, but is not a useful indicator for screening purposes. (Consumer Summary produced by Reliance Medical Information, Inc.)

The first report of the occurrence of hypogonadotropic hypogonadism associated with the Johnson-McMilllin syndrome (JMS) in a female patient is presented. A correct diagnosis of the condition is the foundation for proper genetic counseling and reproductive management in patients.

Byline: Tom Coetsier, Marc Dhont Author Affiliation: University Infertility Centre, University Hospital, De Pintelaan 185, 9000 Gent, Belgium