Prolactin and thyrotropin responses to thyrotropin-releasing hormone during the peripartal period

To investigate the changes in pituitary responsiveness to hypothalamic releasing hormones during the periparturitional period, women undergoing labor and vaginal delivery were stimulated with thyrotropin-releasing hormone. The percentage of incremental changes in prolactin and thyroid-stimulating hormone were significantly lower in pregnant women at term than in nonpregnant control subjects. Evidence of augmented release of prolactin was disclosed after the onset of active labor. The percent increases in prolactin and thyroid-stimulating hormone were significantly higher at 24 hours post partum than at term. Administration of thyrotropin-releasing hormone to the gravid patient in active labor caused a brisk response in fetal thyroid-stimulating hormone, although the increase in fetal prolactin remained low. These findings suggest that the changes in serum triiodothyronine (T3) significantly influence the release of prolactin and thyroid-stimulating hormone in response to thyrotropin-releasing hormone during the periparturitional period.     

Prolactin synthesis and release during pregnancy and puerperium

Prolactin (PRL) synthesis and its release following thyrotropin-releasing hormone (TRH) administration during pregnancy and puerperium was studied in 45 women. Mean baseline E2 increased from 1,900 +/- 384 (SEM) pg/ml in the first trimester to 3,520 +/- 849 in the second trimester (P less than 0.05) and 43,057 +/- 5,765 pg/ml in the third trimester (P less than 0.001) of pregnancy. Mean baseline progesterone increased from 27.6 +/- 3.2 ng/ml in the first trimester to 41.9 +/- 6.6 in the second trimester (P less than 0.01) and 109.3 +/- 11.2 ng/ml in the third trimester (P less than 0.001) of pregnancy. Ten days after delivery, mean E2 dropped to 13 +/- 2.9 pg/ml and progesterone dropped to 0.56 +/- 0.07 ng/ml in the lactating women; in the nonlactating women, mean E2 level was 100 +/- 44 pg/ml and mean progesterone was 0.63 +/- 0.09 ng/ml. Baseline PRL increased from 27 +/- 15 ng/ml in the third trimester (P less than 0.002). The increased synthesis of PRL with increasing gestation was thought to be due to the stimulatory effects of E2 and progesterone, resulting in hyperplasia of the lactotrophs. In response to TRH, PRL demonstrated a significant increase from the first trimester to the second, with no further increase in the third. Therefore, it appears that the PRL reserve increases only during the first and second trimesters of pregnancy. Ten days after delivery, baseline PRL in response to TRH decreased to levels found in the first and second trimesters. However, the lactating women released less PRL than the nonlactating subjects (P less than 0.01), since PRL is released with each lactating episode which in turn probably reduces the PRL reserve.     

Prolactin secretion during pregnancy and puerperium: response to metoclopramide and interactions with placental hormones

Prolactin (PRL) response to an intravenous administration of metoclopramide (10 mg) was examined during normal pregnancy and puerperium. Basal PRL and the metoclopramide-induced increase of PRL increased gradually during pregnancy. This was paralleled by serum estradiol, estriol, and progesterone levels. A positive correlation between serum progesterone and metoclopramide-induced PRL concentrations was found at week 36 of pregnancy. In lactating women, metoclopramide always induced higher increases of PRL than did suckling stimulation on the seventh day postpartum. The PRL responses to suckling and metoclopramide were significantly correlated with each other, but no correlation was found between placental steroid levels throughout pregnancy, PRL levels after parturition, and total milk production during seven days postpartum.     

Acute massive pulmonary embolism treated with streptokinase during labor and the early puerperium

Acute massive pulmonary embolism occluding 60-70% of the pulmonary circulation occurred in a young primipara during the 28th week of pregnancy. She was critically ill despite 40 h of heparin infusion and thrombolytic therapy with streptokinase was initiated. After a 10-h infusion she went into labor and streptokinase treatment was stopped. One hour later she gave birth spontaneously to a preterm infant in footling breech delivery. The infant did well neonatally. Streptokinase infusion was recommenced 8 h after delivery. Because of increasing blood loss on the second day after delivery, streptokinase was withdrawn after a total treatment time of 29 h. Total hemorrhage amounted to 8.9 litres. Serial perfusion lung scans showed complete resolution of the emboli and normal lung function was restored.     

Amount and distribution pattern of soluble fibrin monomer complexes during the early puerperium.

Soluble fibrin monomer complexes (SFMC) were determined in 12 patients following delivery, 2, 4, 6 days and 3 months post partum. Quantitative gel filtration (1 per cent agarose) of the beta-alanine-precipitated plasma samples yielded the relative (per cent of the total fibrinogen content) and absolute (milligrams per 100 ml. of plasma) amount of SFMC. During the early puerperium the amount of SFMC remained essentially constant, with average postpartum values of 6.3 +/- 1.2 per cent and 27.6 +/- 9.1 mg. per 100 ml. (mean and standard deviation). Three months after delivery the level of SFMC was significantly (p less than 0.001) decreased (3.3 +/- 1.3 per cent and 8.4 +/- 3.4 mg. per 100 ml.). The quantitative estimation of SFMC in the early puerperium as presented in this study indicates that a state of hypercoagulability can be evaluated by measuring the thrombin-mediated catabolic products of fibrinogen.     

Glucose tolerance tests in the early puerperium

Eight cases of a newly described type of vaginitis are reported. In many respects, this vaginitis resembles atrophic vaginitis, although it appears in women with normal estrogen levels. Its etiology is as yet undetermined. With or without treatment, the disease runs a protracted course. Thus far, intravaginal applications of preparations containing a corticosteroid have proved to be the most effective treatment.     

Sensitivity to activated protein C in patients with deep vein thrombosis during early puerperium period

BACKGROUND: In this study, we used an endogenous thrombin potential (ETP)-based assay to examine the response to activated protein C (APC) during early puerperium of 6 Japanese patients of deep vein thrombosis (DVT) and pulmonary embolism (PE) without a history of familial thrombophilia or antiphospholipid syndrome. METHODS: The patient group comprised 6 Japanese women diagnosed for DVT or PE at Hamamatsu University School of Medicine, between July 1997 and April 2000. The control group comprised 30 healthy Japanese women in early puerperium. APC-sensitivity ratio (APC-sr), complete blood count (CBC), and other coagulant variables (thrombin-antithrombin-complex (TAT) and fibrin/fibrinogen-degration product (FDP)-D-dimer levels) were determined. RESULTS: Mean APC-sr was 2.0 +/- 0.3 in the control group and significantly higher (3.3 +/- 1.0) in the patient group (P < 0.05). The FDP-D-dimer level was significantly higher in the patient group than in the control group, but there was no significant difference in the TAT complex level. CONCLUSIONS: We conclude that sensitivity to APC is reduced in patients with DVT or PE during early puerperium. Although further clinical studies are needed to confirm, it appears that sensitivity to APC detected by ETP-based assay could become a useful marker to estimate the occurrence of DVT or PE.     

Phenytoin kinetics during pregnancy and the puerperium

During pregnancy changes in maternal physiology and plasma composition may alter drug binding and dose requirements. We have measured plasma unbound and total phenytoin, and saliva concentrations at intervals in 11 pregnant epileptics. Plasma albumin concentrations were also measured in pregnant and non-pregnant women. Saliva phenytoin correlated closely with the plasma unbound concentrations (r = 0.98). The saliva:plasma (S:P) ratio, reflecting the free fraction, was variable during pregnancy but tended to increase to maximal values at delivery and return to non-pregnant values within 2-8 weeks thereafter. Plasma albumin concentrations correlated poorly with phenytoin binding. Binding in umbilical cord plasma appeared higher than that in maternal plasma and total fetal concentrations correlated closely with maternal plasma concentrations at delivery. No ill effects of phenytoin were detected in the newborn infant. During the third trimester phenytoin dose increments were necessary to maintain therapeutic concentrations. After delivery maternal saliva phenytoin concentrations rose, and dose reductions were necessary to avoid clinical symptoms of toxicity. It is therefore appropriate to monitor saliva phenytoin concentrations regularly both during pregnancy and the puerperium.     

Neurologic disorders during pregnancy and the puerperium

This article focuses on epilepsies, autoimmune diseases such as multiple sclerosis and myasthenia, serious problems associated with stroke and pseudotumor cerebri, and some common problems such as headaches and the carpal tunnel syndrome, examining the effects of pregnancy and the puerperium on these disorders and the influence of these disorders on pregnancy.