Archives of Gynecology: Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe

432 Pages·1985·14.448 MB·English

by  Prof. Dr. H. A. Hirsch, Dr. F. E. Loeffler F.R.C.S., F.R.C.O.G., Prof. Dr. H. Ludwig, Prof. Dr. K.-H. Wulf (auth.)

Archives of Gynecology
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01.13.01
Current concepts in the etiology and treatment of dysmenorrhea: Dawood, MY. Dept. Obstet. and Gyn.,
Univ. of Illinois, Chicago, IL, USA
Dysmenorrhea is either primary (when there is no visible pathology) or secondary (when a visible pathology
is present and responsible). Primary dysmenorrhea occurs with ovulatory cycles. Prevailing data indicate
that in primary dysmenorrhea there is abnormal and increased uterine activity during the menstrual phase
of the cycle, often of prostaglandins (PG). Preliminary evidence implicates changes in menstrual fluid
prostanoids and possibly increased release of circulating vasopressin in primary dysmenorrhea but sequen
tial measurements are needed. In secondary dysmenorrhea due to intrauterine device (IUD) use, the pain
is due to increased endometrial PG levels secondary to the inflammatory response induced by the IUD: The
role of PG in dysmenorrhea associated with endometriosis is unestablished. The treatment of choice for
primary dysmenorrhea is an effective nonsteroidal anti-inflammatory drug (NSAID) which inhibits cyclo
oxygenase and therefore PG biosynthesis. Likewise, the secondary dysmenhorrhea due to the IUD is
relieved with NSAID but other causes of secondary dysmenorrhea are best corrected by treating the
underlying pathology. Primary dysmenorrhea can also be relieved with oral contraceptive (OC) but this
should be prescribed only to patients who want the OC as a contraceptive. Both NSAID and OC will
suppress the menstrual fluid PG; the former inhibits cyclo-oxygenase while the latter suppresses endome
trial growth and development and thereby reduces the PG levels.
01.13.02
The clinical pharmacology of piroxicam: Guttadauria, M. Pfizer International, NY, USA
Piroxicam is the first of the oxicam class of nonsteroidal anti-inflammatory drugs. It is a potent inhibitor
of prostaglandin biosythesis via inhibition of cyclo-oxygenase. It is rapidly asorbed in humans with
significant blood levels within 1 or 2 hours and a serum half-life of about 50 hours allowing once daily
dosing. After chronic dosing with 20 mg, daily steady state plasma levels are usually achieved within 1 to
2 weeks. When given at a dose of 40 mg daily for 2 days followed by 20 mg daily, steady state plasma levels
are similar to those achieved with the 20mg daily dose. However, 75% of steady state is attained immedi
ately after the second 40 mg dose, a level achieved only after 8 days with the daily 20 mg dose. These
observations provide the rationale for the use of the 2 day 40 mg loading dose in acute conditions. A single
40 mg dose of piroxicam has been demonstrated to rapidly reduce uterine contractility in dysmenorrheic
women. Piroxicam (Feldene) has been available for the last 5 years for the treatment of a wide range of
acute musculoskeletal and chronic rheumatic conditions around the world. Extensive clinical trials in these
acute and chronic conditions demonstrate that Feldene is as affective as aspirin 3.5-5 gms daily and
indomethacin 75-150mg daily but better tolerated and that it is as effective and as well tolerated as
diclofenac 75-150mg daily and naproxen 500-1000mg daily.
01.13.03
A comparative crossover study of piroxicam versus mefenamic acid and diclofenac in France: Serfaty, D.
Hosp. Saint-Louis, Paris
Ninety-one patients with primary dysmenorrhea participated in this randomized comparative study. The
comparative agents were piroxicam versus either mefenamic acid or diclofenac. Patients were treated
during four menstrual cycles: the first two cycles they received either piroxicam or one of the two agents
against which it was being compared; the treatments were reversed during the third and fourth cycles. The
efficacy assessment was statistically in favour of piroxicam over both of the comparative drugs. The
toleration of all three drugs was good. The study made it obvious that piroxicam, an anti prostaglandin
NSAID (non-steroidal anti-inflammatory drug), is active in countering uterine contractility and conse
quently is efficacious in the treatment of primary dysmenorrhea.
01.13.04
Worldwide studies comparing piroxicam and naproxen: Plantema, F. St. Liduina Stichting, The Nether
lands
Results of double blind crossover studies performed in several countries around the world comparing the
efficacy and toleration of piroxicam and naproxen in the treatment of primary dysmenorrhea will be
presented. In one such study conducted in Sweden, 83 patients were treated for one menstrual cycle with
each drug for up to 5 days. Piroxicam was given in a dose of 40 mg once daily for the first 2 days followed
by 20mg once daily. Naproxen sodium 500mg was given twice daily for the entire treatment period. With
both agents treatment commenced at the onset of menstrual pain. There were no statistically significant
differences between the drugs for any of the efficacy parameters which included daily assessment of
menstrual pain intensity, effect of medication on pain, need for rescue analgesics and ability to perform
usual work. However, piroxicam was judged by patients to be overall the more effective drug in reducing
the symptoms of dysmenorrhea (p < 0.01 ). Patient preference was in favour of piroxicam. Both drugs were
well tolerated with no patient reporting serious side-effects or needing to discontinue medication due to
side-effects.
01.14.01
Maternal intake of bigbly refined carbohydrates and fetal growth: Yla-Outinen, A, Tuimala, R, Visala, T.
Inst. Clin. Sci., Univ. of Tampere, Finland
In order to study the association between fetal growth and maternal intake of different foodstuffs during
pregnancy, 739 non-diabetic parturients who had given birth to a singelton baby filled up a questionnaire
concerning their dietary habits during pregnancy. Mothers were divided into three groups according to the
birth weight of the infant: small-for-gestational age (SGA), average-for-gestational age (AGA) and large
for-gestational age (LGA) groups. Differences in the consumption of various foodstuffs between these
groups were further analysed by using multiple discriminant analysis. The mean number of warm meals
or sandwiches, or the frequency of most foodstuffs consumed during pregnancy seemed not to differ
between these three groups. However, the summarized variable of foodstuffs containing highly refined
carbohydrates (cookies, candies, free sugar etc.) presented weak but significant (p< 0.05) discriminative
power between these three groups with higher frequency of use in AGA and LGA groups. Our results thus
suggest an association between frequent use of highly refined carbohydrates and enhanced fetal growth.
01.14.02
Zinc and copper concentration in Egyptian women during normal and complicated pregnancy and its impact
on the newly born: Kandil, 0, Fabmy, A, El-sbeikba, Z, Fabim, M, Zaki, K. Dept. Obstet. and Gyn., Fac.
Med., Al-Azhar Univ., Cairo, Egypt
Serum zinc and copper were determined in 208 subjects including normal pregnancy, pre-eclampsia,
diabetic patients, and spontaneous first and second trimesters abortion, using the atomic absorption. A
control group of healthy non-pregnant premenstrual women was included for comparison. A gradual
significant decline of zinc in contrast to a significant rise in serum copper in all pregnant patients was found.
In spontaneous abortion serum zinc and copper levels were significantly lower when compared to normal
pregnancy. Parity significantly decreased serum zinc. Premature rupture of membranes caused a significant
decrease in maternal and neonatal zinc and maternal copper. Pre-term neonates had significantly lower
serum zinc accompanied by a significant decrease in birth weight.
01.14.03
Antepartum death of one twin: Lumme, R, Saarikoski, S. Dept. Clin. Sci., Univ., Tampere and Dept. Obstet.
and Gyn., Univ., Kuopio, Finland
Twenty-two cases with antepartum death of one twin were identified in 909 twin pregnancies treated in
Tampere Central Hospital during the years 1964-1980. Antenatal diagnosis was made in 16 cases. In six
delivery was immediate because of spontaneous labor. In three labors was likewise spontaneous but after
a time interval of one to 16 weeks between the diagnosis and delivery. In five labors was induced after
confirmation of the diagnosis. In two amniocentesis was performed. When pulmonary maturity was
confirmed delivery was carried out. The mode of delivery was Cesarean section in six mothers. The placenta
was monochorionic in 11 pregnancies and five stillborn fetuses had a velamentous insertion of the umbilical
cord. Five stillborn fetuses were delivered as a fetus papyraceus, 11 had severe and six no maceration. One
monochorionic co-twin of a fetus papyraceus had multiple structural defects, otherwise the neonatal
morbidity was not increased if the low gestational age averaging 34 weeks is taken in account. One co-twin
was lost because of immaturity. These results suggest that antepartum death of one twin is not an indication
for labor induction unless antenatal surveillance of the living co-twin is suggestive of fetal compromise.
01.14.04
The problem with magnesium therapy during pregnancy: Mund-Hoym, S, Schlebusch, H.* Univ.-Frauenklin.,
Koln, Univ.-Frauenklin., Bonn•
In a longitudinal study 220 measurements by atomic absorptions of plasma magnesium levels were made
in healthy, pregnant women. The results were as follows:
X S
< 8.-14. gestational weeks: 0.81 ± 0.05 mmol/1
15.-18. gestational weeks: 0.78 ± 0.05 mmolfl
±
19.-23. gestational weeks: 0.78 0.06 mmol/1
24.-27. gestational weeks: 0.79 ± 0.06 mmol/1
±
28.-31. gestational weeks: 0.78 0.06 mmol/1
32.-35. gestational weeks: 0.77 ± 0.06 mmol/1
36.-41. gestational weeks: 0.77 ± 0.06 mmol/1
These results indicate a significant lowering of plasma magnesium levels around the 15th week of pregnancy
after which a stabilisation is achieved. A broader range of magnesium variability is seen in the erythrocyte
intracellular magnesium measurements. In contrast, lower plasma levels were found in 145 samples of
women with pathologic pregnancy (diabetics and gestosis). The magnesium levels of diabetics were not
related to their serum glucose. These findings call into question which is the clinically relevant compartment
for magnesium measurement as well as the wisdom of widespread magnesium substitution as is currently
practiced in the Federal Republic of Germany.
2
01.14.05
Influence of the combination therapy P-stimulation + P-blockade on water and electrolyte balance during
1 1
tocolysis: Grospietsch, G, Engelmann, A, Kuhn, W. Dept. Obstet. and Gyn., Univ., Gottingen
The development of pulmonary edema during betamimetic tocolysis has a multifactorial origin. The
principal mechanism is water retention during medication. The combination of Fenoterol (F) and Meto
prolol (M) has been found to be useful during tocolysis because of its cardioprotective effects. This study
was undertaken to clarify the effects on kidney function of this combination. - Methods: Two groups of
patients were studied during 24 hr intravenous tocolysis and bed-rest. The F-group (n = 10) received
Fenoterol only and the F/M-group (n= 15) received the combination of Fenoterol with Metoprolol. Hgb,
Hct, Na, K, creatinine, osmolality, renin and aldosterone were determined in blood. Urinary output, Na,
K, creatinine and osmolality were also determined.-Results: In the F-group the well-known changes were
observed: decrease in urinary output, decline in Hgb, Hct, aldosterone and creatinine clearance as well as
an increase in renin. In contrast the M/F-group showed no change in the urinary output, Hgb, Hct,
creatinine clearance or renin. -Discussion: These results demonstrate that the reduction in kidney function
and influence on the water and electrolyte balance during betamimetic tocolytic therapy is for the most part
caused by a residual P-activity.
1
01.14.06
Cervical collagen concentration; A predictor oflabor delivery time: Ulmsten, U, Ekman, G, Uldbjerg, U. Dept.
Obstet. and Gyn., Malmo, Sweden and Pharmacol, Arhus, Denmark
Spontaneous cervical ripening at term is accompanied by biochemical changes in the cervical connective
tissue (1). The aim of the present study was to establish a possible relation between cervical collagen content
and cervical dilatation during labor and to find out if locally applied PGE induces a collagen break-down
2
in patients with unripe cervices similar to that seen in spontaneous ripening. - Material and methods:
Collagen and collagenase were quantitated (1) in cervical biopsies from three groups of patients: Group
A, 10 term pregnant women with favorable cervices and spontaneous labor; Group B, 12 term pregnant
women with unripe cervices given 0.5 mg PGE in gel intracervically for cervical ripening and labor
2
induction; Group C, 5 term pregnant women with unripe cervices and spontaneous labor. - Results:
Women in Group Chad longer cervical dilatation times (18 hours) compared to women in Group A (6.7
hours) and in Group B (5.0 hours) (p < 0.001). In line with that the cervical collagen concentration was
higher in Group C, 8.58 p.g/mg wet weight compared to 6.7 p.g/mg in Group A and 5.47 p.g/mg in Group
B (p < 0.001 ). The collagenolytic activity was also significantly higher in PGE -treated patients of Group
2
B (530 U/100mg) compared to women in Group A (380 U/100mg) (p < 0.05).-Conclusion: This study
provides clear evidence of a closed correlation between the biochemical composition of the cervix and the
clinical course of delivery. Local application of PG E seems to mimic spontaneous cervical ripening in both
2
clinical and biochemical terms.
(1) Uldbjerg, N. Am. J. Obstet. Gyn. 147, 662 (1983)
01.14.07
A new modality for treatment of threatened abortion (Solcoseryl) "A preliminary report": Khairy, M, Kandil,
0, Abdel Razik, M, El Gazzar, A. Benha Fac. Med., Cairo, Egypt
Fifty cases of first trimester threatened abortion manifested by vaginal bleeding with or without low
backache and for lower abdominal colics had been included in this study. These were randomly divided into
two groups after delicate clinical evaluation of the cervix and ultrasonic confirmation of viable gestation.
The Solcoseryl group included 25 cases and were treated with 10mls. of Solcoseryl in 500mls. of 25%
glucose i. v. slowly daily with bed rest. The control group included 25 cases and were advised to get bed
rest and only given 500ccs. of 25% glucose i. v. slowly daily. The pregnancy continuation rate for the
Solcoseryl group was 80% in comparison to 52% in the control group which was statistically significant
(p < 0.05). Among the continued pregnancies, there was no increased risk of congenital anomalies nor
intra-uterine growth retardation in either group. Unlike the control group, there were no pre-term deliv
eries reported in the Solcoseryl group. As a continuation for our successful trials in treatment of IUGR
with Solcoseryl, also possible promising results are developing in threatened abortion treatment.
01.14.08
Extraperitoneal Cesarean section-a mode of coexistence with transperitoneal approach: Zaczek, T, Skr\!t,
A, Piela, A. Dept. Obstet. and Gyn., District Hosp., Rzeszow, Poland
Extraperitoneal Cesarean section (ESC) has been previously presented as alternative to transperitoneal
Cesarean section (TSC). In this report we purposely relinquished stereotype comparison of ESC and TSC
to present our own system of Cesarean section procedure with "built in" extraperitoneal technic. In this
system, based on pre-operative and intraoperative selection of patients to ESC, during a 4-year period a
total of 1640 Cesarean sections (1162 primary and 478 secondary) were performed. Pre-operative selection
disqualified 538 (32.8%) patients due to: 1. indications for immediate delivery (56), 2. need of abdominal
cavity inspection/operation (61), 3. poorly developed low uterine segment (96), 4. unavailability ofpersonel
trained in extrap eritoneal technic. In this group of patients "elective TSC" was performed. Remaining 1102
(67.2%) patients were qualified to trial of ESC, thus 933 ESC were managed without opening of peritoneal
cavity while 66 operations resulted in little peritoneal entry (fenestration). In 103 cases extraperitoneal
3
technic was abandoned because of failure of access to Bogros space or unintentional wide peritoneal entry,
which resulted in "enforced TSC". The presented mode of coexistence of ESC and TSC, similar to
well-known system of vaginal/abdominal approach in hysterectomy may enable understanding of ESC as
adjunct procedure to TSC and facilitate wider clinical proliferation of this much discussed procedure.
01.14.09
Effects of labor on serum glycoprotein; Comparison with those of gynecological operation: Hashimoto, S,
Harada, T, Terada, S, Akasofu, K, Nishida, E. Dept. Obstet. and Gyn., Kanazawa Univ., Kanazawa,
Japan
In order to investigate the effects of labor on serum glycoprotein fractions, the concentrations of 40 serum
protein components were measured during the period of late gestation, labor and puerperium. Sera were
sampled in series from the period oflate gestation to the 30th postpartum day. The concentrations of serum
glycoproteins slightly changed during labor. And after delivery several glycoprotein fractions increased
remarkably, and some of the other protein fractions decreased. The serum protein fractions which increas
ed after delivery included a -acid glycoprotein, haptoglobin, a -antichymotrypsin, C-reactive protein, and
1 1
9.5S-acglycoprotein. Conversely serum concentrations of a2-AP-glycoprotein and IX2-HS-glycoprotein
decreased after delivery. In addition, serum protein fractions, IX 1-antitrypsin, ceruloplasmin, immunoglobu
lin M, did not show any significant change during early puerperium. The effects on serum glycoproteins
of labor were compared with those of gynecological operation. The changing patterns of 20 glycoprotein
components after delivery were very similar to those of gynecological operation. These changing patterns
were classified into three groups, increased, decreased and unchanged patterns. The effects on glycoproteins
of labor were also compared with those of estrogen administration.
01.14.10
Semi-quantitative evaluation of the intrapartum variable deceleration of FHR pattern and its association with
umbilical cord blood gas analysis: Nishida, T, Chen, S, Koike, S, Mori, H, Kigawa, T. Dept. Obstet. and
Gyn., Oita Med. Coli., Oita, Japan
Variable deceleration of FHR pattern was semi-quantitatively evaluated to establish the diagnostic value
of variable deceleration for fetal distress. FHR charts of 55 normal deliveries by direct monitoring were
analysed and SDA (Sum of Dip Area) was calculated using following equation: SDA = 'E duration of dip
(sec.) x depth of dip (bpm.) and correlation between SDA and umbilical cord blood gas analysis was
obtained. Significant correlation was observed between SDA of the last one hour of delivery and cord blood
gas data. PHua: r= -0.524 (p< 0.005), P0 ua: r= -0.332 (p< 0.05); BEua: r= -0.461 (p<0.005), PHuv:
2
r= -0.336 (p<0.02); P0 uv: r= -0.468 (p<0.005), BEuv: r= -0.47 (p<0.005). In 14 cases which
2
showed prolonged variable deceleration (PVD), significant correlation was observed between SDA of PVD
and PH of umbilical venous blood (UV): PHuv = 7.425-0.000774 SDA (r= -0.756, p<0.005), whereas
in 17 cases with severe variable deceleration (SVD) no significant correlation was seen between the SDA
of SVD and the PH of UV. These results suggest that SDA value is helpful for evaluation of variable
deceleration during labor.
01.14.11
Studies on prostanoids in streptozotocin-induced diabetic pregnancy in the rat: Katon, K, Matsumoto, T,
Sugiyama, Y. Dept. Obstet. and Gyn., Mie Univ., School Med., Mie, Japan
It has been reported that prostacyclin (PGI2), in contract to thromboxane A2 (TxA2), play an important
part in the maintenance of the blood flow. In this study we measured 6-keto-PGF to and TxB2, metabolites
of these prostanoids, in tissues of the pregnant rats with diabetes mellitus induced by streptozotocin to
elucidate the relationship between fetal growth and prostanoids. Maternal aorta, placenta, fetal lung and
liver in the STZ treated pregnant rats were collected on days 20 of pregnancy. PGI activity was evaluated
2
as inhibition of collagen-induced platelet aggregation according to the bioassay proposed by Okuma. The
concentration of 6-keto-PGF to and TxB2 in tissues were measured by RIA after extraction and silicic acid
chromatographic procedures according to the modified Jaffe's method. PGI formation from the aorta in
2
the STZ treated pregnant group was 0.44 ± 0.15nmolfmg wet tissuefh which tended to be lower than in
±
the normal pregnant group. The prostanoid levels in the placenta were; 6-keto-PGF to• 205.9 38.9 pgfmg
protein; and TxB2, 105.3 ± 24.0 pg/mg protein in the STZ treated pregnant group. These were significantly
lower than those of the normal pregnant group. These results suggest that fetoplacental blood flow may
be disturbed when a diabetic mother is not favorably controlled, and this may eventually lead to a delay
in fetal growth.
01.14.12
Luteolytic effects of the uterus in the pregnant rat: Nanjo, K, Kato, H, Noma, F, Wataki, K, Torigoe, T. Dept.
Obstet. and Gyn., Yamaguchi Univ., School Med., Kogushi, Ube, Japan
It has been reported that the pituitary or the uterus exerts the luteolytic effect in pregnant rats (Endocrino
logy 111, 2020, 1982; 112, 1678, 1983). The present study was designed to show when and how the uterus
could influence the luteal function. S-D pregnant rats were laparotomized on day 7 of pregnancy, and the
number of conceptuses was adjusted to one by aspirating all but one conceptus (Asp-group). The rats were
divided into five subgroups and the non-gravid part of the uterus, except that contained a single conceptus,
4
was removed on day 7, 8, 9, 10, or 12 of pregnancy (Hyst-group). Serum progesterone levels were
significantly increased after day 15 in the D7-Hyst- and D8-Hyst groups as much well as those normally
observed in the intact pregnant rats with full conceptuses, whereas there were no such rises in serum
progesterone levels in rats whose uterus was removed after day 9. Interestingly, hypophysectomy in the
Asp-group on day 12 of pregnancy induced significant increases in serum progesterone levels after day 15
of pregnancy. Daily treatment with estradiol plus placentalluteotrophins (in a form of day-12 pregnant rat
serum) between day 12-17 of pregnancy did not show any differences in the changes of serum progesterone
levels between the Asp-group and the D7-Hyst group, which indicated that there would not be any essential
differences in the nature of the CL between these two groups. It was concluded that the presence of the
uterus between day 7-9 of pregnancy induced the luteolysis after day 12, probably mediated through the
pituitary.
01.14.13
Immunohistochemical study of fetal and maternal endocrine pancreas in streptozotocin-induced diabetic rats:
Tanaka, Y, Toyoda, N, Murata, K, Yamamoto, T, Sugiyama, Y. Dept. Obstet. and Gyn., Mie Univ., School
Med., Mie, Japan
It has been suggested that functional changes of maternal endocrine pancreas could play important roles
in the fetal growth as well as her own metabolism during pregnancy. In order to clarify the structural
changes of endocrine pancreas induced by pregnant status complicated diabetes mellitus, we investigated
the distribution of A, B and D cells in the islets of Langerhans in normal and streptozotocin (STZ)-induced
diabetic pregnant rats. STZ-induced diabetic female Sprague-Dawley (SD) rats were mated with normal
male SD rats. After decapitation on day 20 of pregnancy, maternal and fetal pancreas were obtained and
fixed immediately in Bouin's solution and embedded in paraffin for light microscopic examination. Stern
berger's PAP method was employed for the detection of A, B and D cells in the islets. Both in normal and
diabetic states, islets of Langerhans increased in size and number of its component cells during pregnancy,
although B cell numbers were remarkably reduced by STZ administration in nonpregnant state. A and D
cell numbers were greater in the diabetic rats than in the normal rats both in pregnant and nonpregnant
states. However, they had no remarkable changes during pregnancy. Fetal B cell numbers were somewhat
greater in normal rats than in diabetic rats. Fetal D cell numbers were slightly greater in diabetic rats than
in normal rats. Fetal A cell numbers had no significant difference between the two groups. These findings
suggest that not only normal but also diabetic islets of Langerhans can adapt themselves to metabolic
changes induced by. pregnancy.
01.14.14
Leukotriene D found in experimental amniotic fluid embolism: Azegami, M, Mori, N. Dept. Obstet. and
4
Gyn., Miyazaki Med. Coli., Miyazaki, Japan
The mechanism of amniotic fluid embolism (AFE) is still unknown. Steiner and Lushbaugh have emphasiz
ed the importance of anaphylactoid reaction. In anaphylactic shock, slow reacting substance (SRS) was
found and thought to be an important mediator. Recently, SRS has been identified as a member of newly
discovered group of substances, leukotrienes (L Ts), and has been shown to consist of L TC4, LTD4 and
LTE4• The purpose of this study is to examine an occurrence of L Ts in the lungs of experimental AFE
models as possible inducers of the symptoms in AFE. The adjusted human amniotic fluid was injected into
marginal ear vein of rabbits (amniotic fluid group). Control group was injected with saline. Extract from
lungs of the amniotic fluid group showed biological activities like L Ts on guinea pig ileums with the
concentration of 42 ± 8.5ng(g (n=10) of LTD4, and the contraction was reversed with FPL55712,
selective LTs inhibitor, at low concentration of 10-6M. Reversed phase high performance liquid chroma
tography of samples from the amniotic fluid group indicated the presence of a peak cochromatographing
with synthetic LTD (n=10). However, the control group showed neither biological activities nor peaks
4
of L Ts. The results suggested the possibility that L Ts contribute to the clinical and pathophysiological
features of AFE.
01.14.15
Study on experimental intracranial hemorrhage and cerebral blood vessel structure in rat newborns: Kawai,
N, Yamaguchi, S, Nishijima, S, Koshino, T, Murooka, H. Dept. Obstet. and Gyn., First Hosp. of Nippon
Med. School, Japan
Purpose: Intracranial hemorrhage in neonates is considered to be mainly due to the immaturity in fetuses
with fetal hypoxia. Therefore, we tried to study the cause of this disease from the aspect of its cerebral blood
vessel structure and to make use of the results in clinical practice.-Method: The rat newborns were divided
into following four groups. Group 1: rat newborns 22 days of gestation (term rat newborns); Group 2: rat
newborns 22 days of gestation with IUGR; Group 3: premature rat newborns 19 days of gestation; Group
4: premature rat newborns 17 days of gestation. Indian ink or latex was injected into the jugular vein or
umbilical vein of rat newborns in each group, and then each group was divided into nonhypoxia group and
hypoxia group. And, the occurrence of intracranial hemorrhage and the cerebral blood vessel structure
were observed on each sample of rat newborns with binocular magnifier. - Results: (1) ICH was not
observed in rat newborns 22 days of gestation, rat newborns 22 days of gestation with IUGR or rat
newborns 19 days of gestation. (2) In rat newborns 17 days of gestation, ICH was frequently observed in
5
the hypoxia group. At this stage, the undevelopment of the circle of Willis was observed in the cerebral
blood vessel structure. As a result, it was suggested that ICH is associated with the immaturity of cerebral
blood vessels. It is, therefore, considered to be most important for the prevention of neonatal intracranial
hemorrhage that the pregnancy should be maintained until full term of gestation.
01.14.16
A study of the mechanism regulating the onset of labor: the interaction of rat amniotic membrane and fetal
lung in the synthesis of prostaglandin E2: Furuya, K, Yoshida, T, Fukui, Y. Nihon Univ. School Med.
Tokuyama, T. Tokuyama Clin. Fujimoto, J. Fujimoto Clin., Tokyo, Japan
Prostaglandin E2 (PGE2) is found in high concentration in the amniotic fluid in late pregnancy and thought
to have various biological activities. However, the site of synthesis and the regulatory mechanism of PGE
2
in the amniotic fluid are not yet fully understood. Therefore, we attempted to elucidate the fetal membrane
activities in synthesizing PGE under the influence of other fetal organs, such as, lung, liver and kidney.
2
The fetal membranes, fetal lung, liver and kidney were obtained from Wistar strain rats. The fetal
membranes were cultured in 5% C0 in air for 24 hours followed by an additional24 hours of incubation
2
with fetal organs. The supernatant was evaluated by RIA to determine the PGE synthesis. The cultures
2
of the fetal membranes for 24 hours showed a decrease of PGE2• However, addition of the other fetal
tissues to the culture followed by a further 24 hours of culture showed an increase ofPGE2• It is concluded
that fetal tissues are making a contribution to the PGE synthesis by fetal membranes.
2
01.14.17
Effects of pregnancy and hormone treatments on the pressor response to angiotensin ll in the conscious rat:
Nakamura, T, Matsui, K, Ito, M, Yoshimura, T, Maeyama, M. Dept. Obstet. and Gyn., Kumamoto Univ.
Med. School, Kumamoto, Japan
The increased refractoriness to the pressor effects of angiotensin II (A-II) that accompanies normal human
pregnancy is lost rapidly following delivery. This finding prompts us to speculate that hormones of placental
origin which are rapidly cleared from plasma immediately postpartum may be responsible for the normal
pregnancy-associated refractoriness to the pressor effects of A-11. Based on this observation, a comparison
was made between the pressor responses to A-II in conscious rats during different stages of the pregnancy,
the castrated rats following estrogen and progesterone treatment and the rats after human chorionic
gonadotropin (hCG) treatment. The rats were placed in the restricted cage and blood pressure was
measured with the polygraph by cannulation of the femoral artery. Pregnancy was fo).lnd to diminish the
pressor response to A-II as well as human. Progesterone treatment also diminished the pressor response
to A-II as compared to the castrated (control) rats. However, no evidence for an effect of estrogen on the
pressor response to A-II was found. Furthermore, hCG induced the elevation of endogenous progesterone
level which was followed by the remarkable decrease of the pressor response to A-II. From these observa
tions, we suggest that the refractoriness to the pressor effect of infused A-II which characterizes normal
pregnancy may be mediated, at least in part, by the action of progesterone.
01.14.18
Plasma immunoreactive P-endorphin in early puerperium and during breast-feeding: Tulenheimo, A, Laatikai
nen, T. Dept. I Obstet. and Gyn., Helsinki Univ. Centr. Hosp., Helsinki, Finland
Changes in the plasma concentration of immunoreactive P-endorphin + P-lipotropin (P-ELI) were studied
in early puerperium and during breast-feeding. In five women in whom spontaneous labor had begun at
38 to 40 weeks of gestation, the mean level of P-ELI decreased from 282pgfml at the time of delivery to
72pgfml at 10min, 51 pg/ml at 30 min, and 19pg/ml at 60 min after the delivery of the newborn. The mean
level of P-ELI was still higher during the first 6 days of puerperium (23.4 ± 3.8 pg/ml) than was found in
nonpregnant healthy women (12.4 ± 0.8pgfml, p<O.Ol) suggesting that endorphin secretion from the
maternal hypophysis remains increased in the early puerperium. The effect of suckling stimulus on plasma
concentration of P-ELI was studied in five additional women for three to six days after delivery when breast
feeding had already been established. The mean concentration of P-ELI, 33.4pgfml, at the beginning of
breast-feeding, did not differ statistically significantly from those during or after the breast-feeding being
31.4, 32.2, 26.8, and 30.3 pg/mllO, 30, 60, and 120 min respectively, after the start of breast-feeding. Thus
we were not able to demonstrate any effect of the suckling stimulus on the maternal endorphin secretion.
The rapid withdrawal of endorphins from the maternal circulation after delivery might, however, predis
pose the development of various psychic symptoms common in the early puerperium.
01.14.19
Gastrointestinal regulatory peptides in human lactation: Haukland, H H (1), Holst, N (1), Jenssen, T G (2),
Burhol, P G (2), Jorde, R (2), Maltau, J M (1), Haug, E (3). (1) Dept. Obstet. and Gyn. and (2) Dept. Intern.
Med. Labor. Gastroent., lnst. Clin. Med., Univ., Troms0, Norway; (3) Hormone Labor., Aker Hosp.,
Oslo, Norway
The circulating levels of prolactin (PRL), vasoactive intestinal polypeptide (VIP), somatostatin (SRIH),
cholecystokinin (CCK), pancreatic polypeptide (PP), insulin, motilin and blood-glucose were measured in
nine nursing women 27 to 40 days after delivery, to establish the possible role of some gastrointestinal
regulatory peptides in human lactation. During the last 20 minutes of lactation a significant (p < 0.05)
6
increase in serum PRL was observed concomittantly with a significant decrease in plasma SRIH levels
(p < 0.05 at 20 min and p < 0.01 at 30 min). There was a highly significant inverse correlation between the
mean plasma concentrations of PRL and SRIH during the first 30 minutes of lactation (r = -0.996,
p< 0.001). This suggests a physiological role for SRIH in the hormonal control ofPRL secretion in human
lactation. PP increased significantly (p < 0.01) during nursing, possibly due to cephalic-vagal mechanisms.
There were no significant changes in the other gastrointestinal regulatory peptides studied.
01.14.20
Evaluation of serum P-hCG and sonograms in ectopic pregnancy in comparison with abnormal intrauterine
pregnancy: SOderqvist, G, Lundstrom, V, Marsk, L. Dept. Obstet. and Gyn., Karolinska Hosp., Stockholm,
Sweden
Two hundred and two early abnormal pregnancies were evaluated with clinical data and P-hCG in serum
as well as ultrasound examination. Final diagnosis of ectopic pregnancy was obtained in 54 cases, continu
ing intrauterine pregnancy in 26 cases and spontaneous abortion in 82 cases. No definite diagnosis of
complete spontaneous abortion or early tubal pregnancy could be made in the remaining 40 cases, in which
the diagnosis of a pregnancy was based on a P-hCG assay in serum. Rapid clinical improvement concomi
tant with a falling P-hCG to low levels did not indicate laparoscopy or dilatation and evacuation. The
majority of cases with ectopic pregnancy had P-hCG levels below 6000 IU /1 and ultrasound was then of
uncertain value. The appearance of an adnexal mass on ultrasound strengthened the suspicion of ectopic
pregnancy in nine cases. Rapidly increasing P-hCG in serum with the existence of an intrauterine sac above
the P-hCG level 6000 IU/1 verified an ongoing intrauterine pregnancy. However, the major diagnostical
problems are between missed abortion and ectopic pregnancy where rapidly falling P-hCG in serum more
likely indicates a complete spontaneous abortion. The appearance of an intrauterine sac in cases with
P-hCG in the range below 6000 IU/1 indicated missed abortion in eight cases while no ectopic pregnancy
presented this sign.
01.14.21
Microchemical measurement of phosphates in amniotic fluid (AF): Relationship to antibacterial activity:
Tomblin, J, Larsen, B, Charles, D. Dept. Obstet. and Gyn., Marshall Univ. School Med., Huntington,
USA
In vitro addition of phosphate to term AF of healthy women diminishes the activity of an antibacterial
factor responsible for suppressing the growth of E. coli, providing presumptive evidence of the presence
of phosphate-sensitive antibacterial factor. Investigation of the role of endogenous phosphates in regulat
ing such activity would be facilitated by a simple and reliable procedure requiring minimal sample.
Therefore, adaptation of the malachite green complexometric assay (Clin. Chern. Acta. 14, 361, 1966) for
determination of inorganic and organic phosphate in AF was undertaken, and phosphate in these samples
correlated with bacterial growth inhibiting activity. Growth inhibition was determined by viable plate
counts of E. coli ATCC 33908 in AF. 104 washed bacteria were placed in 1 ml of AF and incubated at 36° C
for 24 hours. Phosphate was determined by absorbance at 600 nm after combining the sample with
malachite green-ammonium molybdate color reagent. Lipid phosphates were extracted with organic sol
vents. Trichloroacetic acid was used to precipitate protein and nucleic acid phosphates. Wet ashing
liberated organically bound phosphate from the samples. The malachite green method was found to be as
accurate as, and more sensitive than the Fiske-Subbarow method. We analyzed 23 AF samples for
phosphates and antibacterial activity. Free phosphate was the most abundant form of phosphate in AF,
but its concentration only weakly correlated with bacterial growth. It is concluded that phosphate is only
indirectly related to growth inhibition and that additional factors may be involved in the antibacterial
effect.
01.14.22
Mother-to-infant transmission of Chlamydia trachomatis in perinatal period: Yasuda, J, Yamamoto, T,
Kanao, M, Okada, H. Dept. Obstet. and Gyn., Kyoto Prefect. Univ. Med., Kyoto, Japan
Chlamydia trachoma tis is recognized as one of the common etiologic agents of STD. Its true incidence is
difficult to quantify, since chlamydial infections are not formally reported. The infections may progress to
more severe diseases such as endometritis, salpingitis and PID, and it may be transmitted to newborn
infants, resulting in neonatal conjunctivitis and respiratory infections. The transmission rate of chlamydia
from infected mother to infants has not been precisely studied, but is assumed to be approximately 50%.
This paper aimed to study the incidence of chlamydial infection in Japanese women and transmission from
mother to newborn infants. The infection of chlamydia was diagnosed through the demonstration of
chlamydial inclusions within McCoy cells stained by Giemsa, and immunofluorescent antibody technic.
Clinical specimens were obtained from the cervix, conjunctiva and pharyngeal swabs. The incidence of
infection of pregnant women (36-40 WG) before delivery was 4.9% (8/161), whereas 32.4% in STD clinic.
Three infants delivered from the infected women (8) were diagnosed to have chilimydial infection in the
conjunctiva. The transmission rate from infected mother to newborn infant at delivery was 37.5%. Perina
tal care of infected women is significantly important.
7