Carbohydrate pathways of the endometrium: Effects on ovular growth

From these data, it can be said that the metabolism of carbohydrates and proteins is deranged in patients with the history of sterility and repeated abortions or congenital malformations. In these cases, all other conditions which could account for sterility or abortion were found to be in order.The abnormal histochemical changes, the alterations in the Krebs citric acid cycle, the decreased secretion of glucose-6-phosphatase and alkaline phosphatase together with the inability of the tissue to synthesize amino acids to RNA and DNA and hence on to the various enzymes needed in the carbohydrate metabolism probably indicate that the endometrial tissue in these patients was not carrying on the process of glycolysis or glycogenesis in a satisfactory manner.This may be due to (1) lack of estrogen and progesterone due to pituitary or ovarian failure, (2) anatomic, structural, and physiologic abnormality of the uterus and/or endometrium, (3) poor blood supply due to capillary disease, (4) a combination of all three factors. Any one of these factors may affect the amount of glucose and oxygen delivered to this tissue. In some instances these abnormal changes can be corrected by the proper use of the ovarian steroids.     

Hormones in human pregnancy. IV. Plasma progesterone.

The plasma concentration of progesterone (P) has been measured by radioimmunoassay in maternal peripheral vein (M.P.V.) at early pregnancy and in M.P.V. umbilical artery (U.A.) and umbilical vein (U.V.) at term pregnancy. In early preganacy marked hour-to-hour fluctuation of plasma progesterone was noted. At term pregnancy plasma P levels of U.V. were higher than those of U.A. and the umbilical venous arterial differences of plasma P did not differ between male and femal fetuses. Administration of hydrocortisone and ACTH to patients scheduled to undergo cesarean section had no effect on M.P.V., U.A., and U.V. plasma P concentration. On the basis of the differences between U.V. and U.A. plasma P concentrations and reported umbilical flow it was estimated that the secretion rate of P into the fetal circulation is approximately 23 mg. per 24 hr. and would amount to approximately 10 per cent of the reported total daily production rate of P at term pregnancy. The fraction of P which is unbound to the plasma proteins was estimeated by equilibrium dialysis at 37 degrees C. The per cent unbound P in M.P.V. plasma of pregnant patients at term was not different from that of nonpregnant patients but was 40 per cent lower than that in umbilical cord plasma (P LESS THAN 0.01), and the ratio between the concentrations of unbound P and estradiol in M.P.V. increased as pregnancy progressed. Plasma P in re-eclamptic patients who subsequently sustained intrauterine fetal death had no value in assessing placental function.     

Diagnosis of ovular infection associated with premature rupture of the membranes

Premature breaking of the membranes carries with it a serious risk of immediate or delayed ovular infection which compromises the prognosis. No diagnostic test with an acceptable error level was available to reduce the morbidity and mortality, in particular prior to 37 weeks of amenorrhea. The oligoamnios which accompanies the rupture increases the accuracy of the tocokinetic diagnosis, thus permitting a new and rigorous treatment in function of the stage of the pregnancy and the possibility of artificially inducing labor.     

Prenatal diagnosis of neural tube defects. IV. Maternal serum alpha-fetoprotein screening

The maternal serum alpha-fetoprotein (AFP) in 6161 women in routine pregnancy [2771 in a hospital obstetric clinic (group 1) and 3390 in private practices (group 2)] was studied. Group 1 studies enabled the delineation of the normal range of serum AFP, whereas group 2 represented a true screening experience. In group 2, 39 (2.5%) of 1566 women at 16 to 18 weeks' gestation had raised (2.5 times the median or more) serum AFP. Of these 39 women, 3 (7.8%) had neural tube defects (NTDs), 6 (15.4%) had multiple pregnancies, 1 (2.6%) had congenital nephrosis, 7 (17.9%) had spontaneous abortions, 7 (17.9%) had miscellaneous associated factors, and 15 (38.5%) had raised serum AFP for no obvious reason. Only 16 (1%) women had "unnecessary" amniocenteses. None of these aborted subsequently. Analysis of the combined data showed that NTDs were detectable in 87.5% of patients-all 6 with anencephaly and 1 of 2 with spina bifida (1 spina bifida lesion closed); multiple pregnancy was determined in 45% (18/40 cases), and spontaneous abortion ensued in 14.5%. In group 1 a raised serum AFP was associated with a host of complications in 77.3% of the women. Low AFP values had associated complications in 72.2% of cases. Maternal serum AFP screening represents another potentially important tool for early detection of high-risk pregnancy.     

Initiation of human parturition. IV. Demonstration of phospholipase A2 in the lysosomes of human fetal membranes.

In this study we sought to define the subcellular localization of phospholipase A2 in human fetal membranes. Others have postulated a role for decidual lysosomes in the initiation of human parturition. We hypothesized that if phospholipase A2 were localized within lysosomes of fetal membranes the accelerated expression of the activity of this enzyme could be prevented until such time as the metabolic events of parturition begin. At parturition a perturbation of the lysosomal membrane within the chorio-amnion could result in an increased release of free arachidonic acid through an accelerated activity of phospholipase A2. The results of this study suggest that at least a portion of phospholipase A2 in the chorion laeve and amnion is localized in the lysosomal fraction.     

Antenatal diagnosis of renal anomalies with ultrasound. IV. Bilateral multicystic kidney disease

Bilateral multicystic kidney disease is a congenital disorder that is fatal in the newborn period. A series of nine cases of bilateral multicystic kidney disease diagnosed prenatally by ultrasound is presented. Ultrasound criteria necessary for the diagnosis are bilateral multicystic kidneys, loss of renal architecture, nonvisualization of the fetal bladder, and absence of amniotic fluid. Seven of the nine cases had autopsy confirmation of the diagnosis. Three cases had other associated congenital anomalies. Precise prenatal diagnosis may allow patients the option of elective abortion or may prevent unnecessary obstetric intervention. We propose that a reliable diagnosis can be made with prenatal ultrasound.     

Prenatal diagnosis of complex abnormality syndromes. A case report

Two cases of complex and serious fetal malformations are presented, which have only been diagnosed in a relatively late stage of pregnancy. In both cases unspecific difficulties had already arisen during ultrasound screening, but they were not considered to be of any vital importance. The problems of diagnosing malformations by ultrasound and the serious consecutive consequences are discussed.     

Parental decisions following the prenatal diagnosis of sex chromosome abnormalities

OBJECTIVE: To report parental decisions regarding pregnancy termination following the prenatal diagnosis of a sex chromosome abnormality (SCA) in the fetus. METHODS: Retrospective collection of data from records of 61 families receiving genetic counseling after prenatal diagnosis of a sex chromosome abnormality in the fetus in the Division of Medical Genetics, University Hospital of Geneva during the time period 1980-2001. RESULTS: Among 61 couples with a prenatal diagnosis of a sex chromosome abnormality (SCA), 44 couples (72.1%) decided to terminate pregnancy. Pregnancy termination rates were 100, 73.9, 70, 50 and 42.9% for Turner syndrome, Klinefelter syndrome, 47,XXX females, 47,XYY males, and mosaic cases, respectively. In all 11 cases with a fetal abnormality seen on ultrasound, pregnancy was terminated. Termination rates were higher among couples with a higher mean number of previous children. Maternal age and year of test did not influence parental decisions. CONCLUSIONS: Parental decision to terminate a pregnancy for a fetus with a SCA varied by type of sex chromosome abnormality, by presence of fetal ultrasound anomalies, and by the mean number of previous children.     

The Northwestern University multihospital twin study: IV. Duration of gestation according to fetal sex

Recently MacGillivray has observed that the average duration of male twin gestations is shorter than that of either female twin or male/female twin gestations. The data from 562 twin gestations from the Northwestern University multihospital twin study were used to test this observation. Male twin gestations were slightly but significantly shorter than other twin gestations as measured by pediatric examination (p < 0.005). Approaching significance at the 0.05 level were findings that male twin gestations were shorter than other twin gestations when measured by dates, and that the male twins were slightly shorter and lighter than other twins. No significant differences were found between male/female twin gestations and female twin gestations. No relationship could be found between twin sex combinations and a variety of maternal and obstetric factors. Taken together, the results suggest that male twin gestations differ in some distinctive biologic sense from other twin gestations.