Hypothesis on the role of sub-clinical bacteria of the endometrium (bacteria endometrialis) in gynaecological and obstetric enigmas

Unexplained infertility, recurrent abortion, dysfunctional uterine bleeding, pelvic pain, premenstrual syndrome, premature labour, placental insufficiency and pre-eclampsia are examples of common obstetric and gynaecological problems that frequently defy adequate explanation. Bacterial vaginosis, a non-inflammatory condition, is associated with premature labour, but antibiotics administered topically provide less effective prophylaxis than those administered orally. This would indicate that bacterial vaginosis might be a marker for significant genital tract bacteria, but some pathology is dependent on micro-organisms ascending out of reach of topical antibiotics. The author was led to consider the hypothesis that micro-organisms, possibly those associated with bacterial vaginosis, surreptitiously inhabit the uterine cavity (bacteria endometrialis) where they are culprits of some common gynaecological and obstetric enigmas. The objective of this review is to provide an initial theoretical examination of this hypothesis. Bacteria in the endometrium have been associated with infertility. Antiphospholipids have been linked to recurrent miscarriage and pre-eclampsia and with infections including Mycoplasma. Pre-eclampsia might be explained by an exaggerated host response to intrauterine micro-organisms or bacterial toxins. The hypothesis that one common factor, bacteria endometrialis, could provide a plausible explanation for a variety of obstetric and gynaecological mysteries is particularly intriguing. There is sufficient evidence to justify further investigation.

Late luteal phase dydrogesterone in combination with clomiphene or tamoxifen in the treatment of infertility associated with irregular and infrequent menstruation: enhancing patient compliance

This pilot study was undertaken to determine whether dydrogesterone administered in the late luteal phase might have a potential benefit for infertility associated with irregular and infrequent menstruation. Between April 1994 and February 1995, 54 normo-prolactinaemic women received either tamoxifen, if there was evidence of polycystic ovaries and/or increased luteinizing hormone (LH) secretion, or clomiphene together with dydrogesterone 10 mg twice daily on days 21-26 of the menstrual cycle. A total of 23 women (42.6%) conceived (10.7% per cycle). In 192 non-conception cycles the average cycle length was 29.6 days; 182 cycles (94.8%) were 34 days or less. Patients found the rapid onset of regular menstruation to be encouraging and compliance was excellent. Controlled studies are indicated to determine whether the addition of dydrogesterone to oral ovarian stimulation is beneficial.

Cerebral function monitor studies in neonates

Cerebral function monitor (CFM) recordings were obtained from 107 neonates, considered by pediatricians to be neurologically normal on discharge from hospital. Maturational changes in sleep patterns for the tracings over the conceptional age range 30 to 43 weeks were quantified and the resulting EEG measures analyzed statistically. When tracings obtained from neonates of less than three weeks chronological age were considered, significant correlations were found with the weight of the neonate at the time of the recording. For tracings of premature neonates obtained at the mean chronological age of six weeks a relationship was found between EEG measures and Apgar scores. These results are discussed in relation to the mature neonatal EEG, and it is suggested that the CFM provides a simple additional method of assessment.

Carcinosarcoma of the fallopian tube: a case report and review of the literature

A patient with a carcinosarcoma of the Fallopian tube is presented. She is the first reported from the United Kingdom and the 23rd in the literature. The clinical and pathological features, pathogenesis and management are discussed.

Intrapartum fetal monitoring with the cerebral function monitor

We report a trial of the technical feasibility of monitoring the state of the fetal brain during labour using the Cerebral Function Monitor (CFM). This device was developed for long-term monitoring of the electroencephalogram (EEG). A tripolar scalp electrode allows removal of the fetal electrocardiograph (ECG) from the fetal EEG. Technically satisfactory recordings were obtained from 15 fetuses during labour for periods of up to 6 1/2 hours before delivery. There were alterations of CFM trace with fetal distress and also during general anesthesia for Caesarean section.