Estradiol metabolism in pregnant and nonpregnant women

After the intramuscular injection of tracer doses of estradiol-6,7-H³ to 1 nonpregnant and 4 pregnant women, the radioactivity present in the blood and various maternal and fetal tissues was determined, and the tritiated urinary excretion products were measured and identified. The levels of tritium in the fetal circulation were 50 to 75 per cent of those in comparable maternal blood, indicating that the steroid readily crosses the placental barrier. Approximately 2 hours after estradiol injection, the uterus and subcutaneous fat of the nonpregnant, but not of the pregnant, patients showed high levels of radioactivity. In the fetus, the pituitary possessed a higher tritium content than the blood, while the liver, gall bladder, and upper intestine showed high levels of radioactivity, suggesting hepatic clearance of estrogen from the fetal circulation.Three patients in whom pregnancy was of 15 weeks' or greater duration excreted a much smaller amount of the administered tritium as urinary metabolites than did the 12 weeks pregnant or nonpregnant patients. The latter 2 individuals excreted radioactivity principally as estrone, especially in the first 12 hours after injection. The 3 patients with further advanced pregnancies excreted large amounts of radioactive estriol and other more polar steroids with only small quantities of estrone, and continued to do so even after the ovaries, placenta, and fetus were removed. It is suggested that, between the twelfth and fifteenth weeks of pregnancy, adaptive changes take place in steroid metabolism by maternal tissues, resulting in enhanced conversion of estradiol to estriol.     

Fetal intracranial arterial hemodynamics assessed by color and pulsed Doppler ultrasound.

Fetal intracranial arterial velocimetries were serially performed on 31 pregnant women with regular menstrual cycle, at 28-40 weeks of gestation, using color and pulsed Doppler ultrasound. The change in fetal intracranial arterial hemodynamics was based on the calculation of resistance index (RI). There was no significant difference between the RI values in the anterior cerebral artery (ACA) and middle cerebral artery (MCA) from 28 weeks to term. The RI in the posterior cerebral artery (PCA) was significantly lower than that in the ACA and MCA, respectively, from 28 weeks to term (P less than 0.001). The PI values in both the ACA and MCA remained unchanged from 28 to 33 weeks, became significantly lower from 34 to 35 weeks (P less than 0.05), and the values were fairly constant thereafter. The RI seen in the PCA showed no significant change from 28 weeks to term. This color and pulsed Doppler ultrasound assessment of fetal intracranial arterial blood flow provides a useful foundation for elucidating normal intracranial hemodynamics and will aid in avoiding misinterpretations of the different intracranial arteries.     

Cutaneous anergy in pregnant and nonpregnant women with human immunodeficiency virus.

OBJECTIVE: To determine the prevalence of cutaneous anergy in pregnant and nonpregnant women who are seropositive for human immunodeficiency virus. METHODS AND MATERIALS: The medical records of 159 women seropositive for human immunodeficiency virus were reviewed. Demographic characteristics and tuberculin skin test results were abstracted from the chart. Tuberculin skin testing was performed by the Mantoux method (5 tuberculin units of purified protein derivative injected intradermally). Anergy testing was performed using any two of the three following antigens; tetanus toxoid, mumps, or Candida skin test antigen. A positive tuberculin test was defined as induration of 5 mm or more, and a positive test for the other antigens was defined as any amount of induration over the skin test area. Anergy was defined as any amount of induration to the other antigens. A CD4+T lymphocyte count was obtained at the time of skin testing. Continuous variables were analyzed using the Mann Whitney-U test. Categorical data were analyzed with the chi-square or Fisher's exact test as appropriate. A two-tailed P value < 0.05 was considered significant. RESULTS: There were 102 nonpregnant and 57 pregnant women who returned to have their skin test results read. There was no significant difference in the prevalence of positive, negative or anergic skin test results between groups. The CD4+T lymphocyte count (mean +/- standard deviation) in patients with anergic results was similar between pregnant (375 +/- 256/mm3) and nonpregnant (358 +/- 305/mm3) women (P = 0.64). CONCLUSION: The prevalence of cutaneous anergy is similar among pregnant and nonpregnant women seropositive for human immunodeficiency virus.     

Renal arterial blood flow velocity waveforms in pregnant women

Seventy-two continuous-wave Doppler ultrasonographic examinations were performed on nine nonpregnant and 56 normal pregnant women. The range of gestation was 6 to 40 weeks, and the objective was to record the renal arterial blood flow velocity waveform. Acceleration time and systolic per diastolic ratio of renal arterial blood flow velocity waveforms were assessed. Of 72 examinations, 68 recordings were made of the left renal artery (94.4%) and 28 of the right renal artery (38.9%), respectively. There was no correlation between acceleration time and systolic per diastolic ratio and gestational age, respectively, and no correlation between acceleration time and systolic per diastolic ratio, and caliceal diameter of the renal pelvis, respectively. Acceleration times of the left and right renal arteries were 47 +/- 11 and 40 +/- 8 msec in nonpregnant women and 62 +/- 23 and 62 +/- 23 msec in pregnant women, respectively. The left and right systolic per diastolic ratios were 3.1 +/- 0.7 and 2.9 +/- 0.5 in nonpregnant women and 2.8 +/- 0.6 and 2.6 +/- 0.5 in pregnant women, respectively. Therefore these data provide a foundation for the study of hydronephrosis, which may occur in pregnant women.     

Acetaminophen pharmacokinetics: comparison between pregnant and nonpregnant women

Acetaminophen is the most commonly taken drug during pregnancy, but knowledge about its absorption and disposition is lacking. Six healthy women volunteered to ingest a standard 1000 mg dose at 36 weeks' gestation and 6 weeks post partum. Mean maternal serum concentrations of acetaminophen were consistently less than but not significantly different from the postpartum values. The mean half-life of acetaminophen during pregnancy (3.7 hours) was not significantly different from the nonpregnant value (3.1 hours). The maximum plasma concentration occurred at 0.8 hours and was 20.8 +/- 6.9 micrograms/ml during pregnancy and 23.7 +/- 6.0 micrograms/ml in the nonpregnant state. The absorption, metabolism, and renal clearance of acetaminophen were unchanged. The decrease in the mean area under the curve during pregnancy may be explained by the increase in volume of distribution of acetaminophen. Potentially hepatotoxic metabolites were not measurable in the maternal serum. We conclude that the absorption and disposition of acetaminophen, when used in a standard oral dose, are not affected by pregnancy.     

The prevalence of autoantibodies in pregnant and nonpregnant women

The frequency of autoantibodies during pregnancy was studied. Sera from 136 women (84 pregnant and 52 nonpregnant) were tested for antibodies directed against nuclear antigens, smooth muscle antigens, gastric parietal cells, mitochondria, and striated muscle by indirect immunofluorescent microscopy. Rheumatoid factor was measured by a latex agglutination test, and thyroid microsomal and thyroglobulin antibodies were measured by a hemagglutination assay. Immunofluorescence assays were considered positive if antibodies were detected at a serum dilution of 1:20. All positive samples were retested at increasing dilutions until immunofluorescence or agglutination could not be detected. The control population consisted of 52 normal, healthy, ovulatory, and nonpregnant women. The study population consisted of 84 pregnant women, none of whom had a known autoimmune disorder. The mean ages of the two groups were 32 and 26 years, respectively. The frequency of autoantibody detection was not significantly different in comparing the study (46.2) and control groups (40.5). The results did not support the hypothesis that pregnancy has an effect on the induction or suppression of autoantibody production. Previous studies that suggested differences may have been influenced by the lack of a control group.     

Continuous-wave Doppler ultrasound and decreased amniotic fluid volume in pregnant women with intact or ruptured membranes

The cause(s) of decreased amniotic fluid in the absence of fetal anomalies and intrauterine growth retardation is not clear. A prospective study was performed to evaluate umbilical and uterine artery Doppler velocimetric results in pregnancies complicated by decreased amniotic fluid. Three medically high-risk groups were studied: women with (1) normal fluid and intact membranes, (2) decreased fluid and intact membranes, and (3) decreased fluid and ruptured membranes. The decreased fluid/intact membranes group had a significantly increased incidence of abnormal uterine artery waveforms (diastolic notching or absence of end-diastolic velocity); however, uterine systolic/diastolic ratios were not significantly different. The umbilical systolic/diastolic ratios were marginally higher in the intact membranes/decreased fluid group when compared with the ruptured membranes group. This study suggests that problems with maternal blood supply to the placenta may be related to decreased amniotic fluid when membranes are intact.     

Comparison of cerebral blood flow velocity as measured in preeclamptic, healthy pregnant, and nonpregnant women by transcranial Doppler sonography.

AIM: To test the hypothesis that the middle cerebral artery blood flow velocity (MCAV) is altered in preeclamptic pregnant women as compared with healthy pregnant and nonpregnant women. METHODS: Preeclamptic (n = 21) and healthy pregnant (n = 17) as well as healthy nonpregnant (n = 29) women underwent transcranial Doppler MCAV measurements. The mean MCAV values were compared between the different groups. Anova combined with Bonferroni correction was used for statistical analysis. RESULTS: The MCAV was significantly higher in nonpregnant women (mean +/- SE 73.0 +/- 2.12 cm/s) as compared with healthy pregnant women (67.0 +/- 1.8 cm/s, p = 0.0356). Preeclamptic women showed significantly higher MCAV values (83.5 +/- 2.1 cm/s) as compared with nonpregnant females (73.0 +/- 2.12 cm/s, p = 0.0014). Similar to nonpregnant women, healthy pregnant women showed lower MCAV values (67.0 +/- 1.8 cm/s) as compared with preeclamptic women (83.5 +/- 2.1 cm/s, p = 0.001). After Bonferroni correction the MCAV values in patients suffering from preeclampsia were still statistically significantly higher as compared with the two other groups. CONCLUSIONS: We detected increased resting MCAV values in pregnant women with preeclampsia. In our opinion, this finding refers to arteriolar dilation of the resistance vessels of the brain. Further studies are needed to prove altered vasoreactivity responses of the brain resistance arterioles in preeclampsia.     

The assessment of luteal blood flow in pregnant and non-pregnant women by transvaginal color Doppler

Transvaginal color Doppler of luteal flow was performed on 58 patients with normal early pregnancy before artificial abortion, 73 patients with proven ectopic pregnancy and 75 non-gravid patients in luteal part of menstrual cycle. The equipment used were Aloka Color Doppler SSD-350 and SSD-680 with a 5 MHz transvaginal probe. Obtained color flow from ovarian tissue was explored with pulsed Doppler and the Pourcelot resistance index was calculated. Typical luteal low-impedance flow was detected in 82.8% cases of early pregnancy, 80.8% cases of ectopic pregnancy and 69.3% cases of non-pregnant women. The lowest resistance index (RI = 0.42 +/- 9.12) of luteal flow was found in cases of non-pregnant women, and the highest resistance index (RI = 0.53 +/- 0.09) was obtained in cases of early normotopic pregnancy. RI in cases of ectopic pregnancy was 0.48 +/- 0.07. Statistical analysis has shown significantly different RI in each of 3 groups of patients (P greater than 0.001). Corpus luteum was seen as early as a few days after ovulation in non-pregnant women and was present until about the 11th week of amenorrhea in pregnant women. In 86.4% patients with proven ectopic pregnancy, luteal flow was detected on the same side as the ectopic pregnancy. Our results have shown different RI value of corpus luteum flow in different groups of patients. Such findings could help to exclude pregnancy, specially with non-specific B-mode ultrasound features. Corpus luteum flow could be used as a guide for searching for ectopic pregnancy.     

彩色多普勒超声评价反复种植失败患者子宫动脉血流特点研究

目的 探讨反复种植失败（recurrent implantation failure,RIF）患者子宫动脉血流及其相关因素的特点。方法 选取2012年3月至2013 年8月于烟台毓璜顶医院生殖医学科因输卵管因素行体外受精-胚胎移植（in vitro fertilization- embryo transfer,IVF－ET）治疗的RIF患者（RIF组,n=40）为研究对象;同期IVF－ET治疗首次助孕成功的患者（首次IVF助孕成功组,n=40）,首次IVF－ET助孕治疗失败患者（首次IVF助孕失败组,n=40）为对照组,进行回顾性分析。于注射人绒毛膜促性腺激素（human chorionic gonadotropin,HCG）日行经阴道彩色多普勒超声检查,测量子宫动脉搏动指数（uterine artery pulsatility index,UAPI）、子宫内膜厚度,并同时测定血雌二醇及孕酮值。比较三组间相关指标的差异。结果 RIF组患者UAPI 3.3±0.4,显著高于同期IVF-ET治疗首次助孕成功组2.3±0.5及失败组UAPI 2.4±0.4,差异有统计学意义（P<0.05）,而IVF-ET治疗首次助孕成功组与失败组相比,差异无统计学意义（P＞0.05）。3组间的子宫内膜厚度、雌二醇及孕酮值差异无统计学意义（P>0.05）。结论 HCG日测定UAPI有助于评价子宫内膜容受性,预测种植率。     

Pelvic organ support in nulliparous pregnant and nonpregnant women: a case control study

OBJECTIVE: Our purpose was to compare pelvic organ support in nulliparous pregnant and nonpregnant women at a single institution. STUDY DESIGN: This was a case-control study. Pregnant patients and nonpregnant control subjects were matched according to age and race. Subjects underwent pelvic organ support evaluation by use of the pelvic organ prolapse quantification (POPQ) examination as part of routine prenatal or gynecologic care.The Pearson chi(2) statistic was used for statistical analysis, with a P value of 5% set for significance. RESULTS: A total of 21 pregnant and 21 nonpregnant nulliparous women between the ages of 18 and 29 years were included. All patients in the nonpregnant group had a POPQ stage of 0 or 1, whereas 47.6% of the pregnant subjects had POPQ stage 2 (P <.001). Individual components of the POPQ examination were compared. Significant differences were noted for points Aa and Ba, Ap and Bp, and PB and TVL. CONCLUSIONS: In nulliparous women, pregnancy is associated with increased POPQ stage compared with nonpregnant control subjects.