Plasma prostanoids in pregnancy-induced hypertension

Summary. The concentrations of 13,14-dihydro-15-oxo-prostaglandin F_2α (PGFM), 6-oxo-prostaglandin F1_α,_a (6-oxo-PGF1_α) and thromboxane B₂ (T×B₂) were measured by radioimmunoassay in peripheral plasma from 183 pregnant women attending routine antenatal clinics. A total of 141 patients (47 nulliparous, 94 parous) remained normotensive and had uncomplicated pregnancies. The results from this group showed that there was no significant difference in the concentration of any metabolite in relation to parity or gestational age. The concentrations (pmol/1; means±SD) were PGFM 373±105, 6-oxo-PGF_1α 391±104 and T×B₂ 373±121. Nineteen patients (12 nulliparous, 7 parous) who had pregnancy-induced hypertension (PIH) by the time of sampling (three) or who subsequently developed the symptom (mean time from sampling to diagnosis 11 weeks, range 1–24 weeks) had significantly higher levels of 6-oxo-PGF_lα(574±216; P<0.0005, Student's test) and T×B₂ (603±268; P <0.0005). The concentrations in seven nulliparous patients with PIH and proteinuria were 656±276 for 6-oxo-PGF_3α and 754±228 pmol/1 for T×B₂.     

Primary dysmenorrhoea: the importance of both prostaglandins E2 and F2 alpha

Menstrual fluid was collected in a contraceptive diaphragm from 16 women with primary dysmenorrhoea and 12 matched control subjects without dysmenorrhoea. Prostaglandins F2 alpha (PGF2 alpha), E2 (PGE2) and 6-oxo-prostaglandin F1 alpha (6-oxo-PGF1 alpha) were extracted and measured using gas-chromatography: mass spectrometry (GC:MS). The concentrations of both PGF2 alpha and PGE2 were higher on days 1 and 2 in the dysmenorrhoea group than in the control group and the concentration of PGF2 alpha was higher on day 1 than on day 2 in the dysmenorrhoea group. The concentrations of 6-oxo-PGF1 alpha (the stable metabolite of PGI2) were low in both groups. These results confirm suggestions that PGF2 alpha is important in the aetiology of dysmenorrhoea and also indicate that PGE2 may be involved.     

Prostaglandin production and stimulation by angiotensin II in the isolated perfused human placental cotyledon

Levels of prostaglandins E and F2 alpha, thromboxane B2, and 6-oxo-prostaglandin F1 alpha were measured by radioimmunoassay in the maternal and fetal effluents of isolated human placental cotyledons perfused in vitro. All prostaglandins measured were released in greater amounts by the maternal side than by the fetal side of the perfused cotyledon although there were no consistent concentration gradients between the two sides. The approximate rank order of prostaglandin release into the maternal side was thromboxane B2 greater than prostaglandin F2 alpha congruent to prostaglandin E congruent to 6-oxo-prostaglandin F1 alpha, and that into the fetal side was thromboxane B2 congruent to prostaglandin F2 alpha congruent to prostaglandin E congruent to 6-oxo-prostaglandin F1 alpha. Injection of angiotensin II (0.5 microgram) into the fetal circulation stimulated prostaglandin E and 6-oxo-prostaglandin F1 alpha but not thromboxane B2 and prostaglandin F2 alpha release into the fetal circulation and had no effect on maternal release. Angiotensin II (0.5 microgram) had no effect on either side of the perfused cotyledon when injected into the maternal circulation. It is proposed that prostaglandin release into both maternal and fetal circulations may be flow-dependent and that the angiotensin II-stimulated release of prostaglandin E and 6-oxo-prostaglandin F1 alpha may serve to modulate the vasoactive actions of angiotensin II on the fetal vasculature.     

Plasma and amniotic fluid prostacyclin and thromboxane in mild pregnancy-induced hypertension

To study the involvement of 6 keto prostaglandin F1 alpha (6 keto PGF1 alpha) and thromboxane B2 (TxB2) in mild pregnancy-induced hypertension (PIH), we measured amniotic fluid and plasma concentration of these prostanoids by radioimmunoassay in PIH subjects and normotensive pregnant controls. The results suggest no difference in plasma or amniotic fluid 6 keto PGF1 alpha or plasma TxB2 in PIH and control subjects. The concentration of TxB2 (mean +/- SE) in amniotic fluid, however, were 189.5 +/- 27.7 for PIH and 107.4 +/- 9.7 for controls (P less than 0.05). This increase in vasoconstrictor TxB2 over vasodilator 6 keto PGF1 alpha may have implications in the hypertensive vascular response of mild PIH.     

Oxytocin and initiation of human parturition. III. Plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2 alpha in spontaneous and oxytocin-induced labor at term

The plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) were measured in serial samples collected during the first stage of spontaneous and oxytocin-induced labor in 17 and 15 women, respectively. Four women in late pregnancy served as control subjects, with serial samples collected at similar intervals as during labor. During spontaneous labor, mean plasma oxytocin levels were consistently raised over the levels observed 1 to 2 weeks before the onset of labor and were higher than the levels in the control patients (mean, 19.9 +/- 3.1 pg/ml) and the initial levels in the oxytocin-induced group of women (mean, 17.4 +/- 4.8 pg/ml). The mean plasma oxytocin levels during spontaneous labor (45 +/- 3.9 pg/ml) were similar to those observed during infusion of 4 to 6 mU/min of synthetic oxytocin (49.1 +/- 10.9 pg/ml). Plasma oxytocin levels increased progressively with stepwise increments of the infusion. Plasma PGFM levels also rose during labor, but, in contrast to the oxytocin levels which increased in early labor, plasma PGFM levels did not increase significantly until relatively late in labor, provided the membranes were intact. The state of the membranes had a marked influence on plasma PGFM; patients with spontaneous rupture of membranes had significantly increased PGFM levels when admitted early in labor or when membranes ruptured during labor. This increase in prostaglandin F2 alpha (PGF2 alpha) production does not by itself suffice to initiate labor, as evidenced by the failure of premature rupture of the membranes to initiate labor in a number of patients with elevated PGFM levels in whom labor was then induced with oxytocin. Conversely, oxytocin induction was successful only when PGFM levels increased during the infusion of oxytocin; in the absence of a rise in plasma PGFM, oxytocin induction failed. These data add support to the view that both oxytocin and PGF2 alpha are required for adequate stimulation of the human uterus during labor. In addition, the data suggest that oxytocin rather than PGF2 alpha may be the major stimulus that initiates labor, whereas PGF2 alpha appears responsible for the progress of labor.     

Prostaglandin F metabolite concentration as a prognostic factor in preterm labor

Concentration of the 13,14-dihydro,15 keto-metabolite of prostaglandin F2 alpha (PGFM) was measured in women being observed for preterm labor. The mean initial PGFM level was significantly higher in patients who delivered preterm (65.9 +/- 9.7 pg/mL; N = 14) than in patients not in preterm labor (32.1 +/- 4.3 pg/mL; N = 11; P less than .01). Plasma PGFM concentrations decreased significantly during ritodrine therapy only in successfully treated patients (P less than .05). All patients with initial PGFM concentrations greater than or equal to 55 pg/mL delivered preterm. Two of four patients not considered to be in preterm labor but who delivered prematurely (within five days of initial evaluation) had initial PGFM concentrations of greater than 55 pg/mL. Concentration determinations of PGFM might be a useful adjunct in identifying early preterm labor and in predicting success of tocolytic therapy.     

Abnormal concentrations of prostaglandins in amniotic fluid during delayed labour in multigravid patients

Concentrations of prostaglandins E (PGE), F2 alpha (PGF), 13,14-dihydro-15-keto prostaglandin F2 alpha (PGFM), 6-keto F1 alpha and thromboxane B2 were measured by specific radioimmunoassay in samples of amniotic fluid from 22 multigravid patients during labour. Normal labour in 10 patients was associated with a significant increase of PGE, PGF and PGFM with close correlation to cervical dilatation (P less than 0.05). In the 12 patients with clinically delayed labour, in the absence of cephalopelvic disproportion, there were significantly lower PGF (P less than 0.002) and PGFM (P less than 0.05) concentrations obtained while no differences were observed in the other prostanoids measured. Administration of oxytocin to the latter group to enhance labour did not have any effect on the concentrations of prostaglandins obtained in spite of an improvement in intrauterine pressures and accelerated progress of labour.     

Plasma oxytocin but not prostaglandin F2 alpha metabolite levels at cerclage may predict preterm delivery

Plasma oxytocin and prostaglandin F2 alpha metabolite (PGFM) concentrations were measured in 45 patients admitted for cerclage during the second trimester. Samples were collected before, 3 hours after, and 3 days after the Shirodkar procedure. Uterine activity was recorded by external tocography twice daily for 30 minutes. Twenty-eight women with uncomplicated pregnancy and commensurate gestational age served as controls. Cervical length, measured by ultrasonography, was significantly shorter before cerclage (36 +/- 2 mm) than after cerclage (43 +/- 2 mm) or compared with controls (48 +/- 1 mm). Bishop scores ranged from 3-6 (median 4) in the cerclage group and 0-1 (median 0) in controls. Fifteen cerclage patients and one control delivered preterm 5-22 weeks after the procedure. Initial plasma PGFM levels were significantly higher in cerclage patients than in controls. The cerclage procedure caused an immediate rise in plasma PGFM and a subsequent fall below initial levels to control values. Neither the initial levels of PGFM nor the increments 3 hours after cerclage correlated with the outcome of pregnancy. By contrast, plasma oxytocin levels before cerclage were significantly higher in patients who subsequently delivered preterm than in those who delivered at term. Cerclage resulted in a significant fall in plasma oxytocin at 3 hours in patients with preterm delivery, but after 3 days the oxytocin levels had returned to the precerclage values. Patients who had increased uterine contractions had significantly higher plasma oxytocin levels but lower PGFM levels than those without contractions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of fetal and maternal intravascular antipyrine infusion on maternal plasma prostaglandin concentrations in the pregnant sheep at 104 to 127 days' gestation

Antipyrine is commonly used to measure umbilical and uterine blood flow in the pregnant sheep. In the present experiment we investigated the effect of antipyrine on prostaglandin metabolism. Four pregnant ewes at 104 to 127 days' gestation were infused with either 1, 4, or 15 mg of antipyrine per minute via the fetal jugular vein. The 15 mg X min-1 dose was also infused into the maternal jugular vein in a fourth experiment. Prostaglandins in the uterine vein draining the pregnant horn were measured by radioimmunoassay and antipyrine by high-performance liquid chromatography. No change in the concentrations of either 13,14-dihydro-15-keto-prostaglandin F2 alpha or 6-keto-prostaglandin F1 alpha was observed with infusion of antipyrine at 1 mg X min-1. The 4 and 15 mg X min-1 infusion rates into the fetal jugular vein induced a significant decrease (p less than 0.05) in maternal uterine vein 13,14-dihydro-15-keto-prostaglandin F2 alpha plasma concentrations. These concentrations decreased from 669.3 +/- 161.3 pg X ml-1 (mean +/- SD) before infusion to 306.5 +/- 104.0 pg X ml-1 after 3 hours of infusion at 4 mg X min-1 and from 744.2 +/- 256.8 to 105.0 +/- 24.2 pg X ml-1 at 15 mg X min-1. Significant changes in maternal uterine vein plasma 6-keto-prostaglandin F1 alpha and the 6-keto-prostaglandin F1 alpha/13,14-dihydro-15-keto-prostaglandin F1 alpha ratio occurred only at the 15 mg X min-1 infusion of antipyrine into the fetal jugular vein (p less than 0.05). Maternal uterine vein 6-keto-prostaglandin F1 alpha fell from 86.0 +/- 31.6 to 37.0 +/- 11.5 pg X ml-1 and the 6-keto-prostaglandin F1 alpha/13,14-dihydro-15-keto-prostaglandin F2 alpha ratio rose from 0.14 +/- 0.10 to 0.35 +/- 0.10. We conclude that: antipyrine at doses currently used to measure uterine and umbilical blood flows inhibits 13,14-dihydro-15-keto-prostaglandin F2 alpha production and infusion rates of antipyrine less than 1 mg X min-1 probably do not affect maternal prostaglandin metabolism. We therefore recommend that if this method is to be used for measuring blood flow, antipyrine infusion rates should be less than 1 mg X min-1.     

Prostacyclin and thromboxane A2 in umbilical circulation in relation to preeclampsia

In the present study, metabolites of prostacyclin (PGI2) and thromboxane A2 (TxA2), 6-oxoprostaglandin F1 alpha (PGF1 alpha) and thromboxane B2 (TxB2) in the umbilical circulation were determined. Also the baseline and substrate stimulated synthesis and release of these compounds in the umbilical vessels were measured. Umbilical serum 6-oxo-PGF1 alpha levels were significantly higher while no consistent pattern was found for TxB2. The 6-oxo-PGF1 alpha levels in the umbilical artery (UA) were revealed to be significantly lower in preeclamptic patients (PRC) while TxB2 levels were higher. These levels in the umbilical veins (UV) showed no difference. The base line release of 6-oxo-PGF1 alpha and TxB2 from UA and UV showed no statistical difference. With a saturating dose of sodium arachidonate (A . A), both UA and UV tissue showed marked enhancement in the release of the two, in which 6-oxo-PGF1 alpha from UV was significantly higher than that from UA while TxB2 was without statistical difference. Between normal subjects and PRC, there was no difference in the base line release of 6-oxo-PGF1 alpha from UA, while TxB2 was higher in PRC. Substrate A . A did not enhance the release of 6-oxo-PGF1 alpha in the PRC, but the mean TxB2 release tended to increase both in the control and PRC. Present data indicate that the impaired metabolism, especially that of TxA2, and an imbalance between PGI2 and TxA2 may be involved in the development of PRC.     

Prostacyclin/thromboxane early changes in pregnancies that are complicated by preeclampsia

OBJECTIVE: The purpose of this study was to examine 6-keto-prostaglandin F(1)(alpha) and thromboxane B(2) plasma levels throughout normotensive and preeclamptic pregnancies and to analyze the predictive values of these quantifications for the detection of preeclampsia during the second trimester of pregnancy. STUDY DESIGN: Blood samples were collected from 30 healthy, nonpregnant women and at 4-week intervals from a cohort of nulliparous women who were recruited before 16 weeks of gestation. Preeclampsia developed in 26 patients; 52 normotensive control subjects were matched from the same cohort. The 6-keto-prostaglandin F(1)(alpha) and thromboxane B(2) were assayed by radioimmunoassay. Trends were compared between pregnancy groups and with the nonpregnant women. Predictive values were determined with the second-trimester assessments. RESULTS: The 6-keto-prostaglandin F(1)(alpha)/thromboxane B(2) ratio decreased throughout pregnancy in women with preeclampsia; there were no significant changes in normotensive women. We found higher thromboxane B(2) levels within the group with preeclampsia during the first gestational trimester (preeclampsia, 188 +/- 17 pg/mL; control, 119 +/- 4.8 pg/mL [mean +/- SEM]; P =.001). During the third trimester, patients with preeclampsia had lower 6-keto-prostaglandin F(1)(alpha) levels than did control subjects (preeclampsia, 191 +/- 9.8 pg/mL; control, 288 +/- 10 pg/mL; P =.001). The 6-keto-prostaglandin F(1)(alpha)/thromboxane B(2) ratio was suitable to calculate predictive values; the best cutoff point and time interval were 3.0 and 22 to 26 weeks of gestation, respectively. Sensitivity, specificity, and positive and negative predictive values were 88%, 97%, 69%, and 99%, respectively; the odds ratio was 14.6 (95% CI, 6.9-30.4). CONCLUSION: The prostacyclin/thromboxane ratio favored vasoconstriction early in gestation in women in whom preeclampsia developed. A 6-keto-prostaglandin F(1)(alpha)/thromboxane B(2) ratio of 相似文献   

Prostaglandin E2, F2 alpha,6-keto-prostaglandin F1 alpha and thromboxane B2 in the placenta of normotensive women and women with pregnancy induced hypertension

Prostaglandin E2 (PGE2), Prostaglandin F2 alpha (PGF2 alpha),6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane B2 (TXB2) were measured with radioimmunoassay in placentae of 18 normotensive and 22 moderate or severe PIH gravidae. The content of PGE2 and PGF2 alpha did not change significantly in placentae of PIH patients suggesting that PGE2 and PGF2 alpha in placenta were not important in causing PIH. The content of placental 6-keto-PGF1 alpha also showed no significant difference, while TXB2 levels were significantly higher in PIH patients. The 6-keto-PGF1 alpha/TXB2 in PIH patients was remarkably lower than in normotensive women. These results indicate that an increase in TXB2 level and thus a decrease in the ratio of 6-keto-PGF1 alpha to TXB2 of placenta may be a pathogenetic factor in PIH.     

Prostaglandins in the fetal circulation following maternal ingestion of a prostaglandin synthetase inhibitor during mid-pregnancy

To assess the possible effect upon the fetus of maternal ingestion of the prostaglandin synthetase inhibitor, mefenamic acid, taken during mid-pregnancy (15-22 weeks) to prevent spontaneous abortion, samples of fetal blood were collected at fetoscopy from 13 treated and 14 untreated control cases. Mefenamic acid levels in the fetus were 32-54% of those in the mothers in the treated group, while prostaglandins E2 (PGE2), 6-oxo-PGF1 alpha and PGFM were all slightly but not significantly lower in those patients given 500 mg mefenamic acid 40-180 min prior to sampling than in untreated controls. Results indicate that the prostaglandin synthetase inhibitor crosses the placenta at this early gestation and may possibly suppress fetal prostaglandin production.     

Amniotic fluid 6-keto-prostaglandin F1 alpha and thromboxane B2 during labor

Production of the antiaggregatory and vasodilatory prostacyclin (prostaglandin I2) and the proaggregatory and vasoconstrictory thromboxane A2 during human labor was studied by measuring serial concentrations of the stable metabolites of these prostanoids, 6-keto-prostaglandin F1 alpha and thromboxane B2, respectively, in the amniotic fluid of 43 parturients whose labor was induced by amniotomy. The concentration of 6-keto-prostaglandin F1 alpha at amniotomy in 28 healthy parturients (92.7 +/- 12.1 pg/ml, mean +/- SE) was higher (p less than 0.02) than that in 15 preeclamptic women (48.6 +/- 5.5 pg/ml). The concentration of thromboxane B2 at amniotomy was 292.4 +/- 56.1 pg/ml, with no difference between the healthy and preeclamptic parturients. Both prostanoid levels rose consistently during labor, reaching peak levels when the cervix was fully dilated, but this rise started only after the established uterine contractility. Epidural anesthesia and paracervical blockade had no effect on 6-keto-prostaglandin F1 alpha and thromboxane B2 in the amniotic fluid, whereas oxytocin infusion was accompanied by reduced levels of thromboxane B2. The rise in amniotic fluid 6-keto-prostaglandin F1 alpha was reduced at every stage of labor in the preeclamptic women (n = 15), and its maximal increase (112.4 +/- 28.3 pg/ml) was smaller (p less than 0.005) than in the healthy women (n = 28, 240.8 +/- 21.4 pg/ml). The ratio of 6-keto-prostaglandin F1 alpha to thromboxane B2 also shifted to thromboxane B2 dominance in the preeclamptic parturients. It is concluded that a relative prostacyclin deficiency deteriorates in preeclamptic women during labor.     

A combined technic of artificial abortion in midtrimester of pregnancy

Abortion was induced by extraovular placement of rubber catheter -- the abortifacient efficacy of which was augmented by serial intramusclar administration of a small dose of 15 methyl analogue of prostaglandin F2 alpha -- among 75 consecutive physically healthy gravidas over a 3-month period beginning in March 1978. 96% of the patients aborted successfully within 40 hours by the effect of the combined treatment with extraovular catheter and intramuscular 15 methyl analogue of prostalandin F2 alpha. The mean induction-abortion interval was 24.15 hours, with a range of 5-39 hours. The procedure was found to be comparatively safe with no untoward complications such as hemorrhage or uterine rupture. Cervical injuries occurring in 2 nulliparous women of 16-20 weeks' gestational age were the only complications. There was no excessive blood loss in these patients, and the cervical tears were sutured promptly. There was no difficulty in inserting the catheter in the patients who were 13-15 weeks pregnant. The mean abortion time for the 18 nulliparous women did not differ significant from the mean abortion time for the 57 parous women. 50% of the parous women aborted within 24 hours, but only 41% of the nulliparous women did so within that period. It is demonstrated that utilization of the catheter method combined with intramuscular administration of a small dose of 15 methyl analogue of prostaglandin F2 alpha every 3 hours is promising.     

Peritoneal fluid prostaglandins in endometriosis, tubal disorders, and unexplained infertility

To elucidate the roles of prostaglandins in peritoneal fluid and sex steroids in patients with endometriosis (N = 29), tubal disorders (N = 15), and unexplained infertility (N = 13), assays were performed using 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) (a metabolite of prostacyclin), thromboxane B2 (a metabolite of thromboxane A2), estradiol, and progesterone. Women with normal pelvic anatomy (N = 25) served as controls. Peritoneal fluid 6-keto-PGF1 alpha concentrations in patients with endometriosis (742 +/- 104 pg/ml, mean +/- SE), tubal disorders (987 +/- 211 pg/ml), and unexplained infertility (1659 +/- 770 pg/ml) were higher than those in the control women (515 +/- 77 pg/ml). The thromboxane B2 levels in the peritoneal fluid in endometriosis (554 +/- 73 pg/ml), tubal disorders (614 +/- 107 pg/ml), and unexplained infertility (668 +/- 161 pg/ml) were higher than the levels in the control subjects (333 +/- 23 pg/ml). There was no relationship between 6-keto-PGF1 alpha/thromboxane B2 in peritoneal fluid and day of menstrual cycle. The concentrations of estradiol and progesterone were normal in all patient groups and were not related to the 6-keto-PGF1 alpha and thromboxane B2 levels. The authors suggest that these prostanoids, which may contribute to infertility, may originate mainly from the peritoneum as a result of irritation by endometriotic implants, tubal adhesions, and scarring.     

Urinary 6-keto-prostaglandin F1 alpha during ovulation induction

To elucidate the role of the vasodilatory prostacyclin (PGI2) in human ovulation, urinary samples were collected from spontaneously ovulating women (n = 8) and from those undergoing ovulation induction with clomiphene (seven women, 9 cycles) and human gonadotropins (five women, 11 cycles). The samples were assayed for 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), a breakdown product of PGI2, employing high-pressure liquid chromatography and radioimmunoassay. The urinary 6-keto-PGF1 alpha was not consistently related to the menstrual cycle day at collection, the occurrence of spontaneous (n = 8) or induced (n = 11) ovulation, or the simultaneous concentration of estradiol in plasma. However, its concentrations both before and after the approximated time of ovulation during clomiphene (41.6 +/- 6.7 and 52.7 +/- 7.9 pmol/mmol creatinine, before/after, mean +/- standard error) or gonadotropin treatment (49.0 +/- 5.8 and 48.1 +/- 6.8 pmol/mmol creatinine) were higher (P less than 0.01) than those in spontaneously ovulating women (26.4 +/- 3.8 and 20.5 +/- 3.0 pmol/mmol creatinine, respectively). Multiple ovarian follicles, as assessed ultrasonographically, developed during four courses of the treatments with gonadotropins, and in three of them the urinary 6-keto-PGF1 alpha was high. The data suggest that treatment with clomiphene and gonadotropin is accompanied by increased production of PGI2, perhaps in the ovaries and/or in the kidneys. This may perhaps play a role in the etiopathogenesis of ovarian hyperstimulation syndrome.     

Induction of midtrimester abortion by the combined method of continuous extravovular infusion of prostaglandin F2alpha and intracervical laminaria tents.

Midtrimester abortion was successfully induced in 55 of 60 patients with continuous extraovular infusion of prostaglandin F2alpha (PGF2alpha) following the insertion of intracervical laminaria tents. Intravenous oxytocin was also used in 38 (63%) of the 60 patients. The mean induction-abortion time (IAT) was 11.72 hours +/- 1.06 SD). Abortion was completed in 40% within 8 hours, 80% within 16 hours, and 93% within 24 hours. The mean total dose of PGF2alpha was 41.9 mg. There was no significant difference in IAT between the parous patients (13.40 hours +/- 1.90 SD) and the nulliparous patients (10.41 hours +/- 1.13 SD). There was no apparent correlation between IAT and the stages of gestation (12 to 22 weeks). The five patients who failed to abort within 24 to 36 hours underwent uterine evacuation, which was easily accomplished because there was a marked degree of cervical dilatation. Side effects and complications of the technique were few. Endometritis occurred in three patients, two of whom had had intrauterine devices in situ until just prior to the procedure. It appears that this method has a high success rate, an acceptable safety factor, good patient tolerance, and relatively few side effects.     

The effects of ritodrine on prostaglandin metabolite concentrations in the blood of pregnant baboons

To investigate the relationship between beta sympathomimetic drugs and prostaglandins, we measured prostaglandin metabolites in the plasma of pregnant baboons that were given the drug ritodrine. Animals were at a mean gestation of 120 days, which is equivalent to 27 weeks in women. Ritodrine was infused i.v. at a rate of 23 micrograms/min or 80 micrograms/min for 4 h. Plasma concentrations of 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM), 11-deoxy-13,14-dihydro-15-keto-11,16-cyclo-prostaglandin E2 (PGEM-11), and 6-keto-prostaglandin-F1 alpha (6-keto-PGF1 alpha) were determined as indicators of the precursors, prostaglandin F2 alpha, prostaglandin E2, and prostacyclin (PGI2), respectively. At the 23 micrograms/min ritodrine infusion rate plasma levels of 6-keto-PGF1 alpha were decreased by 51% (+/- 15%) in the animals receiving the drug (p less than 0.005) whereas corresponding levels in control animals did not differ significantly from pre-infusion levels. At the 80 micrograms/min ritodrine infusion rate, the plasma levels of 6-keto-PGF1 alpha decreased by 66% (+/- 18%) compared with pre-infusion levels (p less than 0.001) but again the levels in control animals were not changed significantly. Plasma levels of PGFM and PGEM-11 in animals during ritodrine treatment did not differ significantly from baseline values.     

妊娠高血压综合征患者血浆止凝血分子标志物水平变化的意义

目的探讨妊娠高血压综合征(妊高征)患者血浆止凝血分子标志物水平变化的意义.方法对45例妊高征孕妇(妊高征组,其中轻度20例、中度15例、重度10例)及20例正常孕妇(正常妊娠组)分娩前后的血浆止凝血分子标志物进行检测.其中,采用酶联免疫吸附试验(ELISA)检测两组孕妇分娩前后的P-选择素、凝血酶原片段1+2(F1+2)、D-二聚体、纤溶酶抗纤溶酶复合物(PAP);采用发色底物法检测两组孕妇分娩前后的抗凝血酶活性.结果 (1)P-选择素妊高征组中、重度孕妇分娩前分别为(66±24)μg/L、(80±30)μg/L,正常妊娠组为(49±15)μg/L,两组比较,差异有显著性(P<0.05).分娩后妊高征组重度孕妇为(65±34)μg/L,正常妊娠组为(40±12)μg/L,两组比较,差异有显著性(P<0.05).(2)F1+2妊高征组轻、中、重度孕妇分娩前分别为(2.2±0.2)nmol/L、(2.3±0.4)nmol/L、(2.2±0.2)nmol/L,均明显高于正常妊娠组的(1.2±0.3)nmol/L,两组比较,差异有显著性(P<0.05).(3)D-二聚体妊高征组轻、中、重度孕妇分别为(0.7±0.1)mg/L、(0.7±0.3)mg/L、(0.8±0.2)mg/L,正常妊娠组为(0.4±0.1)mg/L,妊高征组显著高于正常妊娠组(P<0.05),且妊高征组重度孕妇D-二聚体水平高于中度及轻度孕妇.(4)PAP妊高征组轻、中、重度孕妇分娩前分别为(0.7±0.4)mg/L、(0.8±0.4)mg/L、(0.8±0.4)mg/L,均高于正常妊娠组的(0.7±0.3)mg/L(P<0.05),且妊高征组轻、中、重孕妇PAP的升高水平与疾病的严重程度呈正相关(P<0.05).两组孕妇分娩后PAP水平比较,差异无显著性(P>0.05).(5)抗凝血酶活性正常妊娠组为(108±17)%,而在妊高征组则显著降低,其中重度孕妇为(44±37)%、中度孕妇为(64±25)%、轻度孕妇为(83±39)%,两组比较,差异有极显著性(P<0.01).妊高征组中、重度孕妇又显著低于轻度孕妇(P<0.01).结论 P-选择素及 F1+2可用于高危妊娠的筛查,D-二聚体可作为妊高征孕妇早期DIC的监测,抗凝血酶活性是反映妊高征疾病严重程度的有效指标.以上这些止凝血分子标志物可作为妊高征患者血栓前状态的监测指标.