Oxytocin augmentation of dysfunctional labor: I. Clinical data

The effectiveness of a specific oxytocin dosage regimen and a specific computer-defined initial goal of contractile activity is compared to groups of similar nulliparous women managed by the same physicians who used their own choices of oxytocin therapy and electronic monitoring of the intrauterine pressure. The patients managed by a specific regimen and a computer-defined therapeutic goal had oxytocin stopped or the dosage reduced because of concerns with fetal distress or, less frequently, hypercontractility, had shorter intervals from the initiation of oxytocin to full dilatation, required smaller doses to accomplish cervical change, and received smaller maximum doses of oxytocin. The most significant factor determining these results was the rate of incrementation of the oxytocin dose.     

Treatment of premature labor with beta sympathomimetics: results with isoxsuprine

This prospective study presents a protocol for the treatment of premature labor with beta sympathomimetics and the results when isoxsuprine was used. Seventy-two patients from 25 to 36 weeks' gestation were treated. All patients were placed at bed rest, hydrated, and given parenteral sedation prior to the intravenous use of isoxsuprine. Treatment was continued via the intramuscular and oral routes until the thirty-seventh week of gestation. Three patients (4.2%) were delivered of infants during the initial infusion, and 15 (20.2%) were delivered of infants within 2 weeks after the onset of therapy. Forty-nine (68%) were delivered of infants after 37 weeks' gestation, and their infants weighed more than 2,500 grams. Maternal side effects were common, but none necessitated termination of therapy. There were six neonatal deaths, the causes of which were respiratory distress syndrome in two infants, necrotizing enterocolitis in one, group B streptococcal sepsis in one, congenital anomalies with sepsis in one, and multiple congenital anomalies in one.     

Etiology of infertility in monkeys with endometriosis: measurement of peritoneal fluid prostaglandins

To study the relationship between peritoneal fluid prostaglandins and infertility associated with endometriosis, we autografted endometrial or adipose tissue to the pelvic peritoneum in 21 monkeys. Peritoneal washings were collected prior to tissue transplantation and during a subsequent laparotomy performed for biopsy of the implants. Monkeys were mated and peritoneal washings were collected during three subsequent cycles. The content of prostaglandin F2 alpha (PGF2 alpha) in adipose tissue autografts was significantly less (p less than 0.05) than in endometrial tissue autografts. The PGF2 alpha concentration in peritoneal fluid increased significantly (p less than 0.05) only in monkeys that developed moderate or severe endometriosis. Prostaglandin E levels in tissue autografts or peritoneal fluid were similar in all animals. Infertility in monkeys with endometriosis was associated with luteinized unruptured follicles, luteal phase defects, and pelvic adhesions. Although PGF2 alpha concentrations in peritoneal washings obtained during these cycles were increased in comparison with those of ovulatory cycles, the difference was not significant. A relationship between spontaneous abortion and prostaglandin concentrations in peritoneal fluid was not established.     

Prospective study of angiotensin II response to positional change in pregnancy-induced hypertension

The response of endogenous angiotensin II levels to positional change, lateral to supine recumbency, was investigated in a prospective study of 55 primigravid patients during the last half of pregnancy. Blood samples were obtained in the lateral and supine recumbent positions. The mean supine angiotensin II level was significantly higher between 29 and 34 weeks' gestation in those patients destined to develop pregnancy-induced hypertension than in those who remained normotensive (P < 0.05). As gestation advanced, the mean per cent relative change of angiotensin II from the lateral to the supine position altered from negative to positive in those patients destined to develop pregnancy-induced hypertension, whereas it remained negative in those patients who remained normotensive. These findings are discussed in relation to pathophysiologic alterations in the development of pregnancy-induced hypertension.     

Prophylactic transfusion in sickle cell disease

This prospective study was designed to compare the relative efficacy of two antibiotic regimens for the treatment of operative site infections subsequent to pelvic operations. Patients with endomyoparametritis after delivery or pelvic cellulitis subsequent to hysterectomy were randomized to treatment with the combination of penicillin-gentamicin or the single agent cefoxitin. Seventeen of the 26 patients (65%) with endomyoparametritis who were treated with penicillin-gentamicin were cured by antibiotic therapy alone, in comparison to 15 of 23 (65%) patients treated with cefoxitin. Fifty-eight percent of the patients with pelvic cellulitis who were treated with penicillin-gentamicin responded favorably, in comparison to 50% of the patients treated with cefoxitin. None of these differences was statistically significant. In this study, neither antibiotic regimen provided satisfactory initial treatment for surgically induced soft tissue pelvic infection. Moreover, 11 of the 28 patients with treatment failures (40%) developed serious sequelae of their primary infection.     

Immunoreactive gonadotropin-releasing hormone level in maternal circulation throughout pregnancy

Immunoreactive gonadotropin-releasing hormone was quantitated in maternal blood. Circulating levels of gonadotropin-releasing hormone were found to be significantly higher during pregnancy than in nonpregnant cycling women. The highest concentrations of gonadotropin-releasing hormone immunoreactivity were observed in the first half of pregnancy with values at 20 to 42 weeks being significantly lower. A correlation with placental human chorionic gonadotropin-releasing hormone concentrations and maternal circulating gonadotropin-releasing hormone levels was noted. Four pregnancies that resulted in premature labor and/or delivery had very low circulating maternal gonadotropin-releasing hormone concentrations, possibly reflecting placental dysfunction in these cases.     

Presence of a human chorionic gonadotropin--like substance in human sperm

An hCG-like material has been extracted from human sperm. These experiments were designed to characterize this material. Sperms of 10 volunteers were separated from seminal fluid, washed in PBS three times, and resuspended in 0.5 ml of the same buffer. Samples were pooled; cells were disrupted by sonication and extracted in alkaline buffer by constant agitation at 4 degrees C. The extract was ultracentrifuged at 4 degrees C. Supernate was lyophilized and reconstituted in 2 cc of distilled water. This material presented a dose-response curve parallel to those of IS2-hCG and CR119 in beta hCG RIA. When chromatographed in a Sephadex G-150 column the extract eluted within the hCG range and immunoreacted in the specific beta hCG RIA. When absorbed onto a concanavalin A--Sepharose column, all recovered immunoreactive material eluted after exposure to alpha-D-methylglucoside, indicating that it is a glycoprotein. The extract stimulated progesterone and testosterone secretion in porcine granulosa cells and decapsulated rat testis, respectively, indicating its biologic potency.     

Meclofenamate and prostaglandin E2 affect breathing movements independently of glucose concentrations in fetal sheep

Fetal breathing movements in sheep are stimulated by infusions of a prostaglandin synthetase inhibitor, meclofenamate; they are inhibited by prostaglandin E2. Recent studies suggest that these effects are mediated through changes in fetal plasma glucose concentrations. We infused into chronic fetal sheep preparations (1) glucose, (2) meclofenamate, and (3) prostaglandin E2, followed by prostaglandin E2 and glucose together. Infusions of glucose alone did not affect fetal breathing movements despite a significant twofold increase in glucose concentrations. During meclofenamate infusions, fetal breathing movements increased from 34.9% to 80.6% (p less than 0.005); glucose concentrations did not change. During prostaglandin E2 infusions, fetal breathing movements decreased from 36.5% to 4.1% (p less than 0.005) without any change in glucose concentrations; the addition of glucose did not alter the effects of prostaglandin E2 on fetal breathing movements. We conclude that fetal infusions of glucose in sheep do not affect fetal breathing movements and the effects on these breathing movements produced by meclofenamate and prostaglandin E2 are independent of the changes in plasma glucose concentrations.     

Temporal relationships of estrogen, progesterone, and luteinizing hormone levels to ovulation in women and infrahuman primates.

These studies were undertaken to ascertain the interval between the estrogen and LH peaks and ovulation in women, rhesus monkeys, and baboons. Estrogen, progesterone, and LH were measured by RIA. Ovulation was documented by visual examination of the ovaries, histology of the corpora lutea, and recovery of ova. The data for human subjects was based on a group of 23 normal women scheduled for surgical sterilization. Blood was drawn daily between 8:30 and 10:30 P.M. beginning on day 10 of the cycle. Surgery was performed 1 to 5 days after the LH peak. The hormonal findings were correlated with the histology of the corpus luteum. The mean interval from the estrogen peak to ovulation was 34 hours, the interval from the estrogen peak to the LH peak was 24 hours, and that from the LH peak to ovulation was 9 hours. In 46 rhesus monkey cycles and in 53 baboon cycles diagnostic serial laparoscopic examinations were initiated following the estrogen peak and repeated every 24 hours until ovulation was confirmed. The mean interval between the estrogen peak and ovulation was 34 hours in the monkey and 41 hours in the baboon. The intervals from the estrogen peaks to the LH peaks were 12 hours in the monkey and 23 hours in the baboon. The intervals from LH peak to ovulation were 22 hours in the monkey and 18 hours in the baboon. Plasma progesterone levels were significantly increased prior to the LH peak in all three species.     

Isolation of cytomegalovirus from the amniotic fluid during the third trimester

A case is presented in which cytomegalovirus was isolated from the amniotic fluid at 36 weeks' gestation in a pregnancy complicated by cytomegalovirus hepatitis at 10 weeks of gestation. Abnormalities noted in the newborn infant included an undescended testis, right equinovarus, and hypotonia. All cultures revealed cytomegalovirus. Subsequent immunoglobulin studies, chest x-ray film, and bone films were all normal.     

Amniotic fluid infection as determined by transabdominal amniocentesis in patients with intact membranes in premature labor

The rate of microbial infection of amniotic fluid among patients in premature labor with intact membranes and the effect of this condition on perinatal morbidity and mortality are not known. To study this question, specimens of amniotic fluid were collected by transabdominal amniocentesis from 31 patients in premature labor with intact membranes. Microorganisms were isolated from 25% (8/31) of the specimens; 87% (7/8) of these mothers underwent delivery within 48 hours of amniocentesis, and 75% (6/8) of positive cultures were from mothers who never febrile. Perinatal morbidity was significantly greater among mothers with positive amniotic fluid cultures, as evidenced by earlier gestational age at delivery (31 vs. 36 weeks), lower newborn weight (1,704 vs. 2,613 grams), and longer hospitalization (39 vs. 9 days). A few simple, commonly available laboratory tests (amniotic fluid Gram stain, lactic dehydrogenase levels, and white blood cell count) appear to be useful in making a rapid diagnosis. The data suggest that the presence of microorganisms in the amniotic fluid of afebrile patients in premature labor with intact membranes represents an infectious process rather than an innocuous condition and raises questions with regard to current obstetric trends in the management of premature labor. The routine evaluation of similar patients by transabdominal amniocentesis is not recommended unless prospective studies can demonstrate a decrease in perinatal morbidity and mortality with this approach.     

The Parkland Memorial Hospital protocol for treatment of eclampsia: Evaluation of 245 cases

Since 1955, a standardized treatment regimen has been used to manage 245 cases of eclampsia at Parkland Memorial Hospital. Magnesium sulfate alone effectively controlled convulsions in the great majority of cases. The only maternal death among the 245 cases reemphasizes the risk of respiratory arrest that is inherent in the administration of magnesium sulfate when given in large doses intravenously. Hydralazine to lower the diastolic blood pressure somewhat, when it was 110 mm Hg or higher, prevented intracranial hemorrhage. Avoidance of diuretics and hyperosmotic agents and limitation of fluid intake were not associated with severe renal failure. Pulmonary edema was rare. Vaginal delivery was achieved in the majority of cases. Oxytocin often proved effective for initiating and maintaining labor even remote from term. The results obtained with this regimen justify its continued clinical application.     

Ontogeny of human fetal plasma progesterone, deoxycorticosterone, and deoxycorticosterone sulfate

The concentrations of progesterone, deoxycorticosterone (DOC), and deoxycorticosterone sulfate (DOC-SO4) were determined in mixed umbilical cord plasma of abortuses and newborn infants delivered between 18 and 42 weeks' gestation. A wide range of values among individual samples was found for progesterone (224 to 2,152 ng/ml), DOC (1.6 to 10.4 ng/ml), and DOC-SO4 (17 to 154 ng/ml). Levels of progesterone and DOC in mixed umbilical cord plasma were not correlated; those of DOC and DOC-SO4 were positively correlated significantly (r = 0.3945, P less than 0.001). Whereas the mean plasma levels of DOC were similar throughout gestation, significant variation, as a function of gestational age, was found for progesterone and DOC-SO4, with levels of these steroids generally being higher near term than earlier in gestation. The administration of glucocorticosteroids to the mother resulted in a significant decrease (p less than 0.001) in plasma concentrations of DOC and DOC-SO4 in the newborn infant; levels of progesterone in umbilical cord plasma were not affected by maternal glucocorticosteroid treatment. These results suggest that the fetal adrenal glands play a direct, or possibly an indirect, role in the production of the DOC and DOC-SO4 that is present in the fetal compartment. In addition, since fetal plasma levels of progesterone are quite high throughout gestation, the potential exists for circulating progesterone to serve as a precursor for adrenal and extra-adrenal production of DOC and DOC-SO4.     

Prolactin in normal pregnancy: relationship of maternal, fetal, and amniotic fluid levels.

Serum prolactin was measured simultaneously by a homologous radioimmunoassay in 92 parturients and their offspring at term, and in maternal serum and amniotic fluid during various stages of normal pregnancy. Serum levels of 208 +/- 8 ng. per millilter were found in maternal blood; the corresponding levels in the cord serum were 354 +/- 14 ng. per milliliter. Prolactin levels in amniotic fluid were found to be 2- to 10-fold higher than the corresponding levels of the mothers. The possible source of the amniotic fluid prolactin molecule, which is identical with the human pituitary molecule, is discussed.     

Experimental amniotic fluid embolism in rabbits

An experimental model to study the entity “amniotic fluid embolism” in conscious animals is described. The results of the study indicate that the intravenous infusion of autologous amniotic fluid in conscious rabbits is innocuous, and hence the term “amniotic fluid embolism” in rabbits is probably a misnomer. The results of this study allows the authors to postulate a mechanism for this entity that is consistent with both the clinical findings and the frequency of this syndrome.     

The relationship of maternal antibody levels to post-cesarean section endometritis

One hundred eight pneumococal polysaccharide antibody levels were determined by radioimmunoassay preoperatively in 18 patients who underwent elective repeat cesarean section. Eight patients developed post-cesarean section endometritis, and 10 did not. The endometritis group did not vary significantly from the noninfected group in preoperative hematocrit, social status, number of previous pregnancies, maternal and newborn weights, length of operation, and Apgar scores. Mean antibody levels in the endometritis group were significantly lower than those in the control group (49 versus 103 ng/ml; p < 0.05). Mean antibody levels for the six serotypes in the endometritis group were significantly lower than those in the control group (p < 0.05). This study indicated that a healthy maternal immune system may play an important role in preventing post-cesarean section morbidity. Pneumococcal polysaccharide antibody levels may be used in pregnancy to assess the risk for post-cesarean section infections.