Plasma levels of unconjugated estrogens in normal and diabetic pregnancies

Plasma ether-extractable estrogens were determined by radioimmunoassay which, based upon utilization of an antibody toestradiol-17β-hemisuccinate-bovine serum albumin, measured predominantly estradiol. Then 287 plasma samples from 215 normal pregnancies and 93 samples from 14 pregnant diabetic women were analyzed. The plasma estrogen (“estradiol”) concentrations found in the 14 diabetic patients fell within the range of levels observed in normal pregnant women at comparable periods of gestation. Serial plasma estrogen levels measured in one diabetic patient did not fall concomitantly with a decrease in urinary estriol/creatinine ratios determined simultaneously, suggesting that further evaluation is required before plasma estrogen assays may be accepted for clinical management.     

Basement membrane of the uterine cervix: Immunofluorescence characteristics of the collagen component in normal or atypical epithelium and invasive carcinoma

Frozen sections of the uterine cervix were processed by an indirect immunofluorescence technique using specific antisera against type I, III, and IV collagens (raised in rabbits). A continuous basement membrane (BM) was selectively stained using antibodies against type IV collagens beneath both squamous and columnar epithelia. In the case of atypical epithelium, the appearance of BM beneath the epithelia remains unchanged. In contrast, with invasive carcinomas, a more or less continuous band of unequal thickness, whose reactivity in the presence of antibodies to type IV collagen remains weak or moderate, is observed around the lobules of neoplastic cells. Thus, the unimpaired character of the basement membrane cannot be considered as the major criterion, to distinguish carcinoma in situ from invasive carcinoma of the uterine cervix.     

The ultrasound estimation of sex-related variations of intrauterine growth

The fetal ultrasound parameters of biparietal diameter, head circumference, abdominal circumference, and the product of crown-rump length and trunk area were estimated from serial measurements at 16 weeks' gestation to term in a sample of 96 pregnant European women. The slower rate of growth in the female fetus compared to that in the male fetus was statistically significant by 28 weeks' gestation, and this discrepancy increased toward term. This sex-related difference was reflected in the birth weight, head circumference, and crown-heel length of the newborn infant. The variation of intrauterine growth affected both head and abdomen equally as the head/abdominal circumference ratio did not differ significantly between the sexes throughout pregnancy and the neonatal ponderal indices were similar.     

Discussion

The interrelationship of sodium intake and blood pressure regulation during pregnancy is not clear. The effects of dietary sodium loading and restriction on plasma levels of catecholamines, mean arterial pressure, and vascular response to two pressor agents, Levophed and angiotensin II, were investigated in 49 chronically prepared primigravid rabbits. Sodium loading increased mean arterial pressure (p < 0.005), but did not alter the response to either pressor agent. Sodium restriction did not alter mean arterial pressure, but did increase plasma norepinephrine (p < 0.05) and epinephrine (p < 0.02). Negative correlations between plasma levels of norepinephrine and vascular response to infusions of both pressor agents were observed during sodium restriction, ?0.61 (p < 0.05) for angiotensin II, and ?0.74 (p < 0.05) for norepinephrine. A similar correlation of ?0.81 (p < 0.05) was observed for angiotensin II in control animals. Norepinephrine appears to play a significant role in blood pressure maintenance and vascular response in pregnancy. This role is enhanced during sodium restriction.     

Squamous cell neoplasms arising from ovarian benign cystic teratoma

Five cases of squamous cell carcinoma arising in benign cystic teratomas found in postmenopausal patients are presented. Exhaustive tissue sampling is necessary for the discovering of malignancy in this age group. Carcinogenesis is thought to be due to local factors. Carcinoma in situ of a bowenoid type was present in two cases, which suggests an epidermal origin; however, squamous clear-cell carcinoma similar to that of the respiratory tract was also found. Prognostic parameters are discussed attaching special importance to tumor stage and the presence of tumor emboli in capsular vessels.     

The correlation between colposcopic grading, directed punch biopsy, and conization.

In a study group of 102 patients in whom colposcopy examinations were done, a series of 67 selected biopsies and 47 cold-knife conizations were performed. All patients had suspicious or positive Papanicolaou smears. There was a 96 to 98 per cent correlation between the colposcopic findings, biopsies, and cone specimens.     

cis-Platinum-hexamethylmelamine therapy of advanced ovarian cancer

Thirteen patients with advanced, previously treated ovarian cancer were given cis-platinum and hexamethylmelamine combination chemotherapy. Only two partial responses of brief duration were obtained. Because of a low response rate and toxicity obtained, this combination was poor palliation for patients failing initial therapy.     

Preoperative dilatation of the first-trimester cervix: a comparison between Lamicel and 16,16-dimethyl-trans delta 2 prostaglandin E1 methyl ester pessaries

Both Lamicel and 16,16-dimethyl-trans delta 2 prostaglandin (PG) E1 methyl ester pessaries have recently been shown to be effective for cervical dilatation prior to first-trimester abortion. In the study described, the force required to dilate the cervix prior to vaginal termination of pregnancy was measured in three groups of patients--a control group, a group which received Lamicel , and a group which received 16,16-dimethyl-trans delta 2 PGE1 methyl ester pessaries. The total force required to dilate the cervix to 10 mm was significantly reduced in the treated groups, but there was no significant difference between the two treatment regimens. The use of Lamicel is associated with fewer side effects.     

Placentas of small-for-dates infants: a small controlled series from Mexico City, Mexico

Thirty-five placentas of small-for-dates infants were compared with control placentas of normally grown infants. They were small by weight, area, and volume and tended to have a marginal cord insertion; marginal cord insertion was associated with a thick cord, and central insertion, with a thin cord. When the two groups were compared, the first showed increased fibrinoid deposits and atherosis, more severe fetal abnormalities, and abnormal nutrition in the mother, together with a high incidence of preeclampsia. In the mothers of both groups, peak diastolic blood pressure was lower than that in the control group; additional factors leading to a probable reduction in placental blood flow were different in the two groups.     

Subpopulations of lymphocytes in maternal peripheral blood during pregnancy

The fetus can be considered an allograft with up to one-half of its MHC antigens being potentially recognized by the mother as foreign. This study compares expression of OKT3, OKT4, OKT8, Kappa, Lambda and Ia antigens on lymphocytes in the peripheral blood of normal non-pregnant women, normal pregnant women, patients who are chronic spontaneous aborters and pregnant insulin-dependent diabetic women. Monoclonal antibodies and cytofluorometric analyses were used for these determinations. There were no significant differences (P = 0.01) between these groups for T-cell markers. A statistically significant (P = 0.001) increased ratio of cells bearing surface immunoglobulin to those expressing Ia antigen (K&L/Ia) was observed between normal non-pregnant controls and women with a history of chronic spontaneous abortion. It is concluded that T-lymphocytes in the peripheral blood do not demonstrate a phenotypic abnormality that would account for the non-rejection of the fetal allograft; however, women with chronic spontaneous abortion may have abnormal B-cell differentiation or T-cell activation that mediates chronic spontaneous abortion.     

Results of conservative management of premature rupture of the membranes

The maternal and fetal outcome of a conservative management protocol, at a tertiary care center, for premature rupture of membranes between 25 and 34 weeks' gestation was reviewed for the 2-year period 1980 to 1981. There were 139 patients with premature rupture of the membranes prior to 37 weeks' gestation, 47 with premature rupture of the membranes less than 24 hours prior to delivery, and 92 in whom premature rupture of the membranes occurred 24 hours or more before delivery. There was a significant difference in the incidence of chorioamnionitis and endometritis between patients in whom premature rupture of the membranes occurred 24 hours or more before delivery and patients in whom delivery took place within 24 hours (p < 0.001). However, neither proiongation of pregnancy with premature rupture of the membranes beyond 24 hours nor use of betamethasone was associated with any increase in maternal or neonatal infectious morbidity. Neonatal mortality was 3.3% and was related only to lower gestational age.     

The relationship between circulating catecholamines and ST waveform in the fetal lamb electrocardiogram during hypoxia

Previous studies from this laboratory have shown that changes in the ST waveform in the fetal electrocardiogram are a sign of fetal asphyxia. In the present study, seven chronically instrumented fetal lambs between 117 and 143 days' gestation were studied during 16 one-hour periods of maternally induced hypoxia. The aim was to test the hypothesis of a relationship between the concentration of circulating catecholamines and T-wave amplitude. The response to hypoxia was aged-dependent. Fetuses below 126 days of gestation did not react with electrocardiographic changes and output of epinephrine unless acidosis occurred. In more mature fetuses, hypoxia per se would induce a surge of epinephrine and changes in the ST waveform. Overall there was a strong correlation between the T/QRS ratio and the level of circulating epinephrine. During normoxia, epinephrine was undetectable (less than 0.1 nmol/L) in most fetuses; norepinephrine showed an increase at term. The analysis showed one fetus with chronic changes in the ST waveform (T/QRS ratio greater than 0.30) related to a marked increase in the plasma level of epinephrine in spite of normal blood gas values. These findings complement previous results in the acute and chronically instrumented fetal lamb and suggest that changes in the ST waveform expressed as T/QRS ratio identify a change to anaerobic myocardial metabolism mediated by beta-adrenergic stimulation.     

Cardiovascular alterations in severe pregnancy-induced hypertension: acute effects of intravenous magnesium sulfate

The central hemodynamic effects of intravenous magnesium sulfate were studied in five patients with severe pregnancy-induced hypertension. All five patients had a Swan-Ganz and a radial artery catheter placed prior to initiation of magnesium sulfate therapy. Four grams of magnesium sulfate was given over 15 minutes followed by a continuous infusion of 1.5 gm per hour. There was a 12.5% increase in cardiac index immediately after the infusion but cardiac index returned to pretherapy values by 15 minutes after infusion. The mean arterial pressure was significantly (p less than 0.01) decreased 30 minutes after the 4 gm loading dose but had returned to baseline values by 1 hour. There were no other significant changes in any of the hemodynamic or oxygen-related variables measured. Our data confirm previous hemodynamic studies in patients with severe pregnancy-induced hypertension indicating a hyperdynamic state with large fluctuations in systemic and pulmonary vascular resistances. In addition, magnesium sulfate has been shown to have a transient hypotensive effect on mean arterial pressure, related to bolus infusion, that is not present with continuous infusion.     

Postoperative cesarean section morbidity: A prospective study

During a 3-year period, 1,319 women delivered of their infants by cesarean section were prospectively studied to determine the type and rate of postcesarean complications and to identify risk factors which predispose to postoperative morbidity. The overall complication rate was 14.5% and the most common complication was infection (13.3%), in particular, endometritis (6.6%), urinary tract infection (3.1%), and wound infection (1.6%). A lower complication rate was seen in elective operations (4.7%) compared with emergency operations (24.2%). Four significant factors that predispose to postoperative morbidity were identified: duration of ruptured membranes prior to operation (p < 0.001), duration of labor prior to operation (p < 0.001), anemia (p < 0.01), and obesity (p < 0.01). Patients with a combination of risk factors had an increased complication rate, in some cases as high as 91%. The clinical relevance of these findings in trying to decide possible ways to reduce the complication rate by changing the delivery routines is discussed.