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The possibility of using first trimester maternal serum human chorionic gonadotrophin (HCG) profiles to predict fetal growth retardation (FGR) was tested in 236 women with singleton pregnancies obtained after in-vitro fertilization (IVF). Pregnancies were monitored by serial analysis (two or more) of serum HCG at at least 48 h intervals. Serum was obtained between the 13th and the 35th day after conception (i.e. on the day of IVF). Early miscarriage occurred in 23.7% and FGR in 10.9% of pregnancies. Serum HCG profiles were higher than the 90th and lower than the 10th percentile in 12.3% and 19.5% of the cases respectively. FGR was significantly more frequent in women with serum HCG profiles lower than the 10th percentile than in women with normal profiles (45.5% versus 7.2%; P < 0.001), with a relative risk of 6.5 (95% confidence interval 2.7-15.6). FGR rates were similar in women with normal and high profiles of serum HCG. Pre-eclampsia and premature delivery rates were similar in women with normal and abnormal profiles of serum HCG. First trimester serum HCG should be further investigated as a potential marker of FGR. [ABSTRACT FROM AUTHOR]

Preeclampsia remains an important cause of maternal and neonatal mortality and morbidity. Delivery is always the appropriate therapy for the mother but may be responsible for neonatal adverse outcomes, particularly when it occurs at less than < 34 weeks’ gestation. In women with severe preeclampsia at < 34 weeks expectant management to improve neonatal mortality and morbidity may be performed under close monitoring of both the mother and the fetus. Any severe condition of the mother (HELLP syndrome, abruptio placenate, eclampsia) or the fetus (abnormal fetal heart rate) should lead to prompt delivery. In women with mild preeclampsia, expectant management should be performed until 38 weeks gestation. [Copyright &y& Elsevier]

Objective: To describe a patient with primary amenorrhea revealing an occult progesterone-secreting ovarian tumor., Design: Case report., Setting: University medical center., Patient(s): A 20-year-old woman with primary amenorrhea., Intervention(s): Investigations to identify the source of progesterone secretion., Main Outcome Measure(s): Discovery of an occult progesterone-secreting ovarian tumor., Result(s): Initial ovarian ultrasonography did not show any abnormal mass. Catheterization of ovarian veins suggested a right ovarian source of progesterone. After long-term follow-up, a right ovarian tumor became apparent and was surgically removed. After surgery, progesterone levels decreased and normal ovulatory cycles resumed. Pathologic and immunohistochemical analysis showed a Leydig cell tumor expressing cytochrome P450 side-chain cleavage and 3ss-hydroxysteroïd dehydrogenase enzymes, which are involved in progesterone biosynthesis, whereas P45017alpha-hydroxylase was not expressed, explaining the absence of hyperandrogenemia. Before surgery, two LH pulses were detected during a 6-hour study period and a lack of ovarian response to pulsatile GnRH administration., Conclusion: This is the first case of isolated progesterone secretion by an occult ovarian Leydig cell tumor and a novel etiology of primary amenorrhea. The results also suggest that sustained progesterone can exert an inhibitory effect on gonadotropin secretion at both hypothalamic and pituitary levels.

We report one case of severe Candida glabrata chorioamnionitis and septicemy occurring in a twin pregnancies achieved by in vitro fertilization techniques which resulted in pregnancy loss after preterm rupture of the membrane at 22 weeks of gestation despite a treatment with amphotericin B.

Objective: To compare oocyte and embryo quality in women with Polycystic Ovary Syndrome (PCOS) and in women with normal ovulation., Patients and Methods: Forty women with PCOS underwent a total of 67 In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) cycles. The control group consisted of women, of the same age, who underwent IVF (for tubal infertility) or ICSI (for male factor infertility) in the same period., Results: The average number of oocytes recovered was higher in the PCOS group (12,1) than in the control group (9.6) as was the rate of immature oocytes (13.8% vs 5.8%; respectively). The fertilization rate was lower in PCOS patients (52% vs 61% in the controls). The cleavage rates, embryo morphology and pregnancy rates were similar in both groups., Discussion and Conclusions: Although more oocytes were recovered from PCOS patients, the number of good quality embryos, suitable for transfer or freezing was similar in the two groups as less of the oocytes were mature and the fertilization rate was lower in the PCOS group. IVF or ICSI (according to the indication) are therefore efficient in PCOS patients.

Longer survival after anticancer treatment has lead to concern about the long-term adverse effects. Altered fertility is of particular importance. Before sterilizing treatment, three non-exclusive methods can be proposed to preserve female fertility: in vitro fertilization followed by cryopreservation of embryos, cryopreservation of mature ovocytes, cryopreservation of ovarian tissue. The method or methods chosen will depend on the age of the patient, here marital status, the urgency of the treatment, and the type of disease. Embryo cryopreservation is a routine practice in medically assisted reproduction centers, while cryopreservation of mature ovocytes and ovarian tissue is still in the experimental phase. It is known however that mature ovocytes can be used after cryopreservation. Cyropreservation of ovarian tissue is a more difficult problem. To date, there have not been any pregnancies or births after freezing-thawing of human ovarian tissue. This tissue could be used in two ways: autograft and in vitro folliculo-ovocyte maturation. Despite the uncertainty concerning use, women cryopreservation of ovarian tissue quite well.

Objective: Evaluate of the usefulness of manual rotation of occipito-posterior or transverse presentation., Design: One year retrospective study (1991)., Setting: Maternity hospital, Clinique Universitaire Baudelocque., Subjects: All patients during labour having a spontaneous (n = 160) or a manual rotation (n = 368) of an occipito-posterior or occipitotransverse presentation. The manual rotation could be indicated for a fetal distress, a protracted first stage of labour or prophylactically., Intervention: Manual rotation as described by Tarnier, was performed at least at 7 cm cervical dilatation., Main Outcome Measures: Success rate of manual rotation, cesarean section rate, maternal, fetal and neonatal complications.