Abnormalities of early human development

Rapid karyotyping in ectopic pregnancies

The aim of this study was to determine the feasibility of karyotyping ectopic Fallopian tube pregnancies utilizing dividing cytotrophoblast cells. Villi from 78 ectopic conceptuses were processed by the direct chromosome technique and cytogenetic diagnosis was successful in 60 cases (76.9 per cent). The amount of villi obtained, as well as villus morphology, was correlated with cytogenetic success rate. Histological examination of the Fallopian tube was also carried out. A total of 47 cases were chromosomally abnormal (78.3 per cent), which is the highest frequency of cytogenetic abnormalities reported to date.

Ectopic pregnancy in adolescents: a clinical review for pediatricians

Pediatricians caring for sexually active female adolescents and young adults need to be aware of the history, symptoms, and signs of an ectopic pregnancy. A thorough history and physical examination, including the pelvic examination, as well as specific diagnostic tests such as repeated quantitative hCG measurements, and ultrasonography when indicated, are crucial to proper and early diagnosis of a nonruptured ectopic pregnancy manageable by laparoscopy. The key to early diagnosis is to include ectopic pregnancy in the differential diagnosis in any sexually active female patient who has abnormal vaginal bleeding or abdominal pain. With early diagnosis, close observation, and appropriate management, the outcome is more likely to be favorable, with minimal morbidity and risk of death.

Implications of delay in culturing for Campylobacter

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Congenital defect rates among spontaneous abortuses: twenty years of monitoring

A 20-year study of 1,124 spontaneously aborted embryos and fetuses found 214 (19.0%) to have a localized defect or identifiable syndrome. No clear trend of change over time was noted. The rate is compared with other studies of spontaneously aborted specimens and is approximately ten times higher than in newborns. Forty (3.6%) had neural tube defects and 30 (2.7%) had a clinically recognized chromosomal phenotype. Fifteen had Turner's phenotype, four trisomy 18, and 11 triploidy. Amniotic bands occurred in eight. Two had bilateral renal agenesis. Thirty had some form of facial cleft.

Histopathologic study of ampullary and isthmic tubal ectopic pregnancy

A histopathologic study of 84 ampullary and seven isthmic tubal ectopic pregnancies was conducted. In 52.2% of ampullary pregnancies, the gestations were found intraluminally, and in most of these cases (85.1%), the muscularis was preserved. In isthmic pregnancies, the gestations were usually found extraluminally or both intraluminally and extraluminally. The disruption of the tubal wall was more extensive in isthmic pregnancy. This study suggests that in isthmic pregnancy, the trophoblast penetrates the tubal wall relatively early. It appears that linear salpingostomy could be done for ampullary pregnancy without jeopardizing luminal integrity. Its use for isthmic pregnancy is still unclear.

Ectopic pregnancy in Aberdeen 1950-1985

The reported incidence of ectopic pregnancy in Aberdeen City and suburbs (1950-1985), using as denominators maternities, pregnancies and women aged 15-44 years, has increased threefold since 1970 to 6.4/1000 pregnancies. This increased incidence persisted after the exclusion of previously sterilized women. A total of 11,128 women were sterilized in Aberdeen City and suburbs between 1960 and 1982; 36 ectopic pregnancies occurred in this sterilized population. The prevalence of ectopic pregnancy was 3.55/1000 sterilizations. This did not alter significantly over the period of study despite changes in the method of sterilization. However, due to the increased popularity of sterilization, the proportion of ectopic pregnancies in women who had been sterilized increased from 0% in the 1950s to 21% in the quinquennium 1975-1979.

Cardiac malformations in spontaneous abortions

A detailed examination of 247 spontaneously aborted foetuses, under the age of 24 weeks gestation, showed 38 instances of cardiac malformation (15.4%). Very early specimens were not included. There was a bimodal relationship with maternal age and parity and a higher incidence in summer conceptions, but there was no apparent association with maternal blood groups. There were more male foetuses and they had proportionately more malformed hearts than the females. There was a marked inverse relationship with foetal age; in early foetuses, less than 25 mm, cardiac malformations were present in 68%. A wide variety of morphological abnormalities was encountered; these are listed. No cardiac malformations occurred in 72 threatened abortions which went to full-term delivery.

New concepts in the surgical management of tubal pregnancy and the consequent postoperative results

The success following reconstructive tubal pregnancy can only be measured in terms of live births. Because the fallopian tube is not a simple conduit and has numerous complex functions, many women fail to conceive despite successful reconstructive surgery. The most effective way to prevent reocclusion or peritubal adhesion is to minimize tissue trauma. Magnification permits accurate excision and hemostasis. In this review, it has been demonstrated that tubal conservation is technically possible and safe. It is effective in increasing the number of live births postoperatively in women interested in fertility and does not increase the risk of the repaired tube for a repeat tubal gestation more than the uninvolved tube, although one of five subsequent pregnancies are again ectopic. They seem to occur equally as often in the contralateral tube as in the repaired tube. It has been shown that salpingotomy can restore tubal patency and maintain fertility. The second question was whether the number of viable pregnancies increase after conservative surgery. This question can be answered only if the repaired tube remains and the patient subsequently delivers at term. Such data have already demonstrated this outcome. Conservative operations in selected cases of tubal pregnancy seem feasible and safe and do not further impair tubal function. Because intrauterine pregnancy is more apt to occur than is repeat ectopic pregnancy, it seems logical that the involved tube should be saved whenever fertility is desired (Fig. 2). In unruptured isthmic pregnancy, Stangel and Gomel prefer segmental excision and end-to-end anastomosis during the same intervention. Gomel advocates segmental excision of the conceptus whether ruptured or not when the pregnancy is located in the isthmus or proximal half of the ampulla, and end-to-end anastomosis undertaken later as an elective procedure if necessary (Fig. 2). An ampullary gestation may be successfully treated by salpingotomy; and in the case of distal ampullary location, a tubal abortion may be performed (Fig. 2). When extensive destruction of the tube occurs, salpingectomy becomes necessary. In cases of early diagnosis of tubal gestation, conservative surgical management may be carried out via laparoscopy (Fig. 1).

Ectopic pregnancy and myoma uteri: teratogenic effects and maternal characteristics

Morphological data from 3,614 well-preserved human embryos derived from artificial termination of pregnancy were used to determine whether ectopic implantation or enlarged myomas could enhance the prevalence of localized malformations of the embryo. The frequency of malformed embryos was 11.6% among 43 recovered from ectopic pregnancies, 6.2% among 97 from myomatous pregnancies, and 3.3% among 3,474 from normally implanted pregnancies not complicated by myomas. Unilateral amelia in the ectopic cases and caudal dysplasia in the myoma cases were significantly increased. Both malformations were quite unusual in the control group. It is argued that spatial restrictions could be a teratogenic agent in human embryos. Mothers of both ectopic and myoma cases were on average much older than mothers of the control specimens, and those with myomas had a higher frequency of previous pregnancy wastages. Ectopic pregnancy was found to be associated with lowered parity, previous ectopic pregnancy, and maternal smoking and drinking. These associations are discussed and interpreted in relation to etiology of each of the two conditions.

A human embryo of 28 mm crown-rump length with cerebral, esophagotracheal and cardiovascular malformations

The following malformations were observed in a human embryo of 28 mm crown-rump length obtained at operation for tubal rupture in a case of extrauterine pregnancy: 1. Secondary anophthalmia with dysplasia and in part aplasia of the diencephalon. Rudiments of both eyes and eyestalklike proliferations within the diencephalon. No lenses and on the left side only a palpebral fissure. Hypoplasia of the right telencephalic hemisphere and of the right side of diencephalon, mesencephalon and proximal parts of the medulla oblongata. Pseudotumorous proliferations in the diencephalon, in the alar plate of the medulla oblongata (protruding into the fourth ventricle) and in the arachnoid. Hypoplasia of the right internal, middle, and external ear. Dysplasia and in part aplasia of facial osseous elements (cebocephalia). 2. Proximal esophageal atresia with distal tracheoesophageal fistula. 3. A Fallot's tetralogy with right-sided aortic arch and regressive right-sided ductus arteriosus, tricuspid atresia, hypoplasia of the right ventricle with excessive hypertrophy of its wall, and hypoplasia of the pulmonary trunk. Single left superior vena cava and abnormal, semicircular course of the stems of both coronary arteries.

Embryonic development in ectopic human pregnancy

Ectopic pregnancy in the fallopian tube occurs in about 1 in 50 human pregnancies. Maternal factors in the etiology of this condition have been well documented. There is less information available on the development of the embryo or fetus. To document this information morphological and cytogenetic data were obtained from pregnancies occurring in the fallopian tube. Analysis of the data showed that tubal implantation was associated with a high proportion of severely disorganized embryos. There was also a high incidence of maternal tubal disease. The importance of these factors and the etiology of ectopic pregnancy is discussed.

Prenatal epidemiology of spontaneous cleft lip and palate, open eyelid, and embryonic death in A/J mice

Nongenetic bases of variability in the frequencies of spontaneous cleft lip and palate (CLP), open eyelid (OL), and fetal resorption were searched for in A/J mouse litters of prenatal ages 17-21 days post-VP and parities 1-7. The malformation rates did not decrease with advancing fetal age, and hence prenatal elimination does not account for the lower rates seen in newborns. Multivariate analysis indicated that the frequencies of CLP and resorption were inversely related to maternal age and directly related to litter size, and that the frequency of OL was related, directly, only to litter size; but that none were associated with maternal weight, parity, and several other variables. Regarding uterine location, the frequency of CLP was higher at the ovarian and cervical sites, OL higher at the cervical site, and resorption lower at the ovarian site, than elesewhere. CLP was significantly commoner in females, and OL commoner in males; also, since the percentage of males increased with parity, the frequency of CLP in males relative to that in females decreased with parity, and that of OL increased. Malformed offspring weighed less than normal ones; and the sex with the lower frequency of CLP or OL had the greater weight reduction. The results are discussed in relation to the frequency of malformations in human fetuses and newborns.