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

432 Pages·1985·14.448 MB·English
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Preview Archives of Gynecology: Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe

Archives of Gynecology Organ of the Deutsche Gesellschaft fUr Gynakologie und Geburtshilfe Since 1921 (Vol. 117) "Archiv fUr Gynako Copyright logie" has been the organ of the Deutsche Submission of a manuscript implies: that Gesellschaft fUr Gynakologie und Geburts the work described has not been published hilfe. Founded in 1870. Edited by K. Crede, before (except in the form of an abstract or A. Gusserow, E. Bumm, A. Doderlein, as part of a published lecture, review, or R. Meyer, C. Kaufmann, G. A. Wagner, and thesis); that it is not under consideration others. Vols. 1-114 (1920) published by for publication elsewhere; that its publica August Hirschwald, Berlin; Vols. 115-175 tion has been approved by all coauthors, if by Springer, Berlin; as of Vol. 176 (1948) by any, as well as by the responsible authori J. F. Bergmann, Munich. Published under ties at the institute where the work has the English title "Archives of Gynecology" been carried out; that, if and when the as of Vol. 226 (1978). manuscript is accepted for publication, the authors agree to automatic transfer of the copyright to the publisher; and that the manuscript will not be published else where in any language without the consent of the copyright holders. All articles published in this journal are protected by copyright, which covers the exclusive rights to reproduce and distri Manuscripts and inquiries may be addres bute the article (e.g., as offprints). as well as sed to: all translation rights. No material published in this journal may be reproduced photo graphically or stored on microfilm, in elec Prof. Dr. H. A. Hirsch tronic data bases, video disks, etc., without Universitats-Frauenklinik first obtaining written permission from the Schleichstrasse 4 publisher. D-7400 Ti.ibingen, FRG The use of general descriptive names, trade names, trademarks, etc., in this publica tion, even if not specifically identified, does Dr. F. E. Loeffler, F.R.C.S., F.R.C.O.G. not imply that these names are not protec St. Mary's Hospital ted by the relevant laws and regulations. Praed Street While the advice and information in this London W2, England journal is believed to be true and accurate at the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any er Prof. Dr. H. Ludwig rors or omissions that may be made. The Universitats-Frauenklinik publisher makes no warranty, express or Schanzenstrasse 46 implied, with respect to the material con CH-4031 aasel tained herein. Switzerland Special Regulations for Photocopies in the USA Prof. Dr. K.-H. 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Annual subscription rate: OM 532.00 plus carriage charges. Vol ume price: OM 266.00, single issue price: © Springer-Verlag Berlin Heidelberg 1985 Originally published by Springer-Verlag Berlin Heidelberg New York in 1985. 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

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