Showing papers in "Gynecologic and Obstetric Investigation in 1985"
TL;DR: It is suggested that these proteolytic activities of the stromal cells, together with the presence of blood-derived phagocytes, may account for endometrial clearance, since there are no lymphatic channels in the superficial endometrium.
Abstract: An ultrastructural review of the cyclic changes of endometrial surface and glandular epithelial cells, stromal cells and the stromal microvasculature is presented. Endometrial biopsies were collected from infertile patients with endometriosis or tubal dysfunction. During the proliferative phase, the ergastoplasm and Golgi apparatus of surface and glandular epithelial cells become well-developed, while increasing numbers of mitochondria are seen. In the early secretory phase, the postovulatory triad composed of glycogen accumulation, nuclear channel system and giant mitochondria is described and its functional significance is discussed. Premenstrual cellular involution due to enhanced lysosomal activity such as apoptosis and lysosomal wrapping is detailed. Before ovulation, the endometrial stromal cells are primarily involved in the secretion and remodelling of the extracellular connective tissue fibers and ground substance. After predecidual change, the stromal cells exhibit marked macropinocytotic and phagocytotic properties. We suggest that these proteolytic activities of the stromal cells, together with the presence of blood-derived phagocytes, may account for endometrial clearance, since there are no lymphatic channels in the superficial endometrium. According to this hypothesis, tissue fluid may be drained via the fenestrated (venous) endometrial blood capillaries.
93 citations
TL;DR: Blood coagulation and fibrinolysis variables have been studied in the normal puerperium in order to facilitate the decision to discontinue thrombosis prophylaxis after delivery, although simultaneously increased inhibitor capacity of both systems was present.
Abstract: Blood coagulation and fibrinolysis variables have been studied in the normal puerperium in order to facilitate the decision to discontinue thrombosis prophylaxis after delivery. 16 women were followed longitudinally from the 1st to the 6th week post partum. Factor VIII activity and related antigen, fibrinogen, fibrinopeptide A, antithrombin III, plas-minogen, tissue plasminogen activator (t-PA), fast inhibitor of t-PA, Α2-antiplasmin, uroki-nase inhibitors, fragment BΒ 15–42 and kallikrein inhibition were analyzed. Both blood coagulation and fibrinolysis were significantly increased during the first 2 weeks, although simultaneously increased inhibitor capacity of both systems was present. 3 weeks post partum, blood coagulation and fibrinolysis were generally normalized, although the inhibitors remained raised compared to nonpregnant controls throughout the observation period.
64 citations
TL;DR: The heavy coffee drinkers among the pregnant women had high rates of spontaneous abortion, chromosomal abnormality and congenital multi-anomalies, and the multiple socioeconomic variables might be more important than any direct effect of caffeine.
Abstract: We studied the effects of caffeine ingestion during pregnancy. A total number of 9,921 healthy pregnant women with a gestational age after 24 weeks were subjected to the study. The women who drank more than 5 cups of coffee per day had a high incidence of impending abortion, premature labor, and fetuses small for gestational age. The heavy coffee drinkers among the pregnant women had high rates of spontaneous abortion, chromosomal abnormality and congenital multi-anomalies. However, we would like to stress that the multiple socioeconomic variables might be more important than any direct effect of caffeine.
60 citations
TL;DR: The psychological effects of the medical investigation and surgical treatment of infertility were investigated and negative effects on sexual life were recorded in all individuals and were associated with the planning of intercourse.
Abstract: The psychological effects of the medical investigation and surgical treatment of infertility were investigated. For 2 years 30 women with a diagnosis of tubal damage and 29 men were followed with repeated interviews. Negative effects on sexual life were recorded in all individuals and were associated with the planning of intercourse. Semen analysis was psychologically difficult to half of the men and feelings of shame and degradation were common. Fear and anxiety were increased before reconstructive tubal surgery and postoperative depression was observed in 10 women. Most couples overestimated their chances of having a child and half of them expected pregnancy to occur within a few months. After 2 years the need for professional support and counseling had increased. The medical procedure has psychological side effects in the infertile couple and may provoke anxiety. The investigation should be comprehensive and short, and psychologically traumatic investigations like basal body temperature records should be used with caution. During the period of somatic investigation and treatment repeated discussions about the marital relationship and sexual life should be initiated and psychosocial counseling should be offered to all couples.
57 citations
TL;DR: Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure.
Abstract: Amniotic fluid embolism is one of the least frequent complications of parturition, but the most dangerous of all. 38 cases of fatal amniotic fluid embolism were diagnosed in Sweden during the years 1951-1980, i.e. 1 case for every 83,000 live births. The proportion of amniotic fluid embolism in maternal mortality as a whole increased from 1.2 to 16.5% during this period. Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure. The main symptoms were cardiovascular shock with right heart strain, and hemorrhage with pathologic proteolysis. Four cases of presumed amniotic fluid embolism with survival of the patient were diagnosed during the years 1972-1980--a case fatality rate of 66% (4/12).
41 citations
TL;DR: A different response to the hormonal situation is suggested to explain the dissimilarities between the emetic and non-emetic pregnancy.
Abstract: Although nausea and vomiting in early pregnancy is extremely common, very little information on the cause and course of this disorder is available in the literature. A prospective laboratory and clinical study of 102 consecutive healthy pregnant women was undertaken to evaluate nausea and vomiting in relation to clinical data, serum electrolytes, creatinine, total protein and hemoglobin. Multigravidae suffered from emesis gravidarum at a higher rate than did primigravidae. The frequency of emesis was especially high in women with short intergestational intervals. During pregnancy there was a decline in systolic blood pressure only in non-emetic women. The diastolic blood pressure in late pregnancy was significantly higher in emetic women than in non-emetic subjects. All laboratory values were within normal ranges. However, major changes occurred during pregnancy but some alterations were noted only in the emetic pregnancy. A different response to the hormonal situation is suggested to explain the dissimilarities between the emetic and non-emetic pregnancy.
40 citations
TL;DR: Smoking habits of 597 pregnant women were investigated and Percentile birth weight proved to be decreased compared with the Amsterdam birth weight charts, which could be attributed largely to smoking in pregnancy.
Abstract: Smoking habits of 597 pregnant women were investigated; 48.6% of the women smoked during pregnancy. Percentile birth weight proved to be decreased compared with the Amsterdam birth weight charts. This
34 citations
TL;DR: 8 post-menopausal, post-oophrectomy and hysterectomy women had a 100-mg pure 17 beta-estradiol pellet installed in their subcutaneous abdominal tissue causing an up to 30-fold increase in plasma estradiol and a marked decrease in follicle-stimulating hormone levels.
Abstract: 8 post-menopausal, post-oophrectomy and hysterectomy women had a 100-mg pure 17 beta-estradiol pellet installed in their subcutaneous abdominal tissue. The pellet caused a marked systemic hormonal effect in these patients causing an up to 30-fold increase in plasma estradiol and a marked decrease in follicle-stimulating hormone levels. It showed a significant increase in plasma high density lipoprotein (HDL) and HDL to total cholesterol ratio levels, no change in plasma triglycerides and very low density lipoprotein levels and some decrease in total cholesterol and low density lipoprotein cholesterol concentrations. These results differ from the previously reported influence of synthetic hormonal preparations on the same plasma lipids and lipoproteins.
33 citations
TL;DR: The results show that the depression induced by operative stress on the NK cell function of parturients can be, at least partly, prevented by using epidural anesthesia.
Abstract: We studied the influence of elective cesarean section, under general and epidural anesthesia, on natural killer (NK) cell activity in 12 healthy parturients and in their newborns. The results of perip
28 citations
TL;DR: The present findings suggest a possible role of GABA in the function of human placenta.
Abstract: The concentration of gamma-aminobutyric acid (GABA), the activity of glutamate decarboxylase (GAD), and the presence of specific GABA receptor binding sites have been examined in human term placentas The estimated values of GABA concentration and GAD activity in the placenta were about 50 nmol/g tissue and 11 nmol/mg protein/h, respectively A remarkable density of high-affinity and specific GABA binding sites has also been demonstrated in membranes of the human term placenta These binding sites showed the properties of a GABAA receptor The present findings suggest a possible role of GABA in the function of human placenta
22 citations
TL;DR: It is concluded that pregnancy is much better tolerated in patients with bioprostheses and that in Patients with metal prostheses the risk is increased if the mother is older than 30 years, if time of replacement is more than 5 years or if there is a history of previous thromboembolism or gravidic heart failure.
Abstract: We studied 59 pregnancies in 48 female carriers of prosthetic heart valves. In 44 pregnancies the mother had a metal valve mostly with coumarin therapy and in 15 a bioprosthesis usually without hemato
TL;DR: Morphometric evaluation showed a statistically significant difference between RU-486-treated patients (2 X 100 mg) and controls, and a possible link between these morphological changes and the induction of prostaglandin synthesis by the antiprogesterone is suggested.
Abstract: An antiprogesterone (RU-486) was administered to women undergoing voluntary interruption of pregnancy. Five patients received 100 mg 12 h before surgical interruption, 5 others received 100 mg twice,
TL;DR: The presence of a continuous BM seems to be only a relative criterion in distinguishing between benign and malignant conditions.
Abstract: The occurrence and location of basement membranes (BM) and their constituents were studied in benign, inflammatory, dysplastic and malignant conditions of the uterine cervix by light and electron microscopy and by immunohistochemical analysis with antibodies against human laminin and type IV collagen. The normal squamous epithelium showed a thin subepithelial BM band, which was preserved in dysplasia. Severe inflammatory conditions affecting the epithelium caused disruption and fragmentation of the BM. Well-differentiated carcinomas were frequently surrounded by a BM, whereas anaplastic tumors had a disrupted and fragmented BM, and similar material was also seen in the tumor tissue itself. Thus the presence of a continuous BM seems to be only a relative criterion in distinguishing between benign and malignant conditions.
TL;DR: The results indicate that women with uterine hypocontractility during labor requiring oxytocin showed no rise in their plasma beta-EP and beta-LPH and a blunted cortisol rise during Oxytocin administration.
Abstract: beta-Endorphin (beta-EP), beta-lipotropin (beta-LPH) and cortisol plasma levels were measured during labor in 18 pregnant women. In 7 cases labor progressed spontaneously and in 11 cases oxytocin (5 mIU/min) was administered to stimulate uterine contractions. In control and oxytocin-treated subjects hourly blood samples were taken until delivery. In spontaneous labor all three hormones showed a progressive and significant increase until parturition. In oxytocin-treated patients, however, both beta-EP and beta-LPH remained constant until parturition. Cortisol levels in oxytocin-treated patients presented a significant increase but reached values significantly lower than in control patients. These results indicate that women with uterine hypocontractility during labor requiring oxytocin showed no rise in their plasma beta-EP and beta-LPH and a blunted cortisol rise during oxytocin administration.
TL;DR: The method is very well suited to clinical evaluation of placental blood flow and cannot be directly equated with fetal development as it is not its only determinant, and no other independent test to evaluate the radioisotopic study in terms of accuracy exists.
Abstract: The authors have evaluated placental blood flow using a non-invasive radioisotopic approach. The procedure involves the intravenous administration of 113mIn and the technique is a modified version of a previously reported method for a non-diffusive tracer kinetics analysis. The method is presented in detail and its performance is evaluated in 17 normal and 32 pathologic pregnancies (19 intrauterine growth retarded patients; 7 patients with iso-Rh immunization; 5 patients with gestational diabetes, and 1 pregnancy with extensive fetal malformation which was not included in any group). The normal pregnancies showed a flow index of 5.34 ± 1.64 (1 SD) units compared to the pathological pregnancies value of 2.73 ± 0.73 (1 SD) units (p < 0.001). The conclusions drawn are: (1) the method is very well suited to clinical evaluation of placental blood flow; (2) the evaluation of placental blood flow cannot be directly equated with fetal development as it is not its only determinant, and (3) no other independent test to evaluate the radioisotopic study in terms of accuracy exists.
TL;DR: The histopathological findings recorded during 1 year in 101 women undergoing surgery for palpable ovarian tumors were analyzed with respect to patient age, medical history and presenting symptoms to illustrate the diagnostic difficulties and the potential risk of neglecting surgery.
Abstract: The histopathological findings recorded during 1 year in 101 women undergoing surgery for palpable ovarian tumors were analyzed with respect to patient age, medical history and presenting symptoms. Almost half of the women (43%) were younger than 30 years and functional cysts or normal ovaries were found in 66 out of totally 101 women. During the following 2 years 18 of these women were subjected to further gynecological surgery and 17 women were infertile. While surgical treatment of functional cysts in young women may be deleterious, 3 cases of ovarian cancer illustrate the diagnostic difficulties and the potential risk of neglecting surgery.
TL;DR: Considering Ca2+ and cAMP as intracellular messengers in the control of uterine motility, the characterization of the different forms of PDE in pregnant human myometrium will be of importance in developing improved tocolytic therapy.
Abstract: Most of the cyclic nucleotide phosphodiesterase (PDE) activity of pregnant human myometrium was found in the soluble fraction. Chromatography of this fraction on DEAE-cellulose resolved two peaks of PDE activities. Peak I hydrolyzed both cAMP and cGMP and was activated by the Ca2+-calmodulin complex. Peak II, insensitive to this complex, hydrolyzed specifically cAMP. Sucrose gradient centrifugation of the soluble fraction resolved three peaks (A, B, C) of cAMP PDE activities, and only the first two peaks (A, B) were active towards cGMP. A subsequent sucrose gradient centrifugation of peak I, previously determined by DEAE-cellulose, allowed us to restore two peaks A and B identical to those directly obtained from the soluble fraction: peak A hydrolyzes both substrates, while peak B is specific to cGMP hydrolysis. For peak II, a single large cAMP PDE activity peak is generated. Considering Ca2+ and cAMP as intracellular messengers in the control of uterine motility, the characterization of the different forms of PDE in pregnant human myometrium will be of importance in developing improved tocolytic therapy.
TL;DR: The strikingly rapid growth of some GBS strains in amniotic fluid may represent yet another factor responsible for perinatal GBS infection of the human neonate.
Abstract: 4-hour in vitro growth curves of a type III group B streptococcus (GBS) and Escherichia coli were examined in sterile term human amniotic fluid specimens. Both bacterial strains pro
TL;DR: Thromboplastin activity in amniotic fluid from 39 patients pregnant in weeks 14-40 has been studied and no correlation to gestational age was found.
Abstract: Thromboplastin activity in amniotic fluid from 39 patients pregnant in weeks 14–40 has been studied. Amniotic fluid was obtained by amniocentesis. All fluids were fractionated and the activity studied in both supernatant and sediment in a highly specific and sensitive test system. All samples tested showed a very high thromboplastin activity. No correlation to gestational age was found. Amniotic samples from 19 of the patients were incubated with endotoxin. Endotoxin did not further increase the procoagulant activity.
TL;DR: The proportion of intact to degraded collagen after solubilization of about 86% of the collagen with pepsin in acetic acid did not change during pregnancy and delivery and there was no indication of a qualitative change of the remaining collagen.
Abstract: The concentration of collagen in the human uterine cervix decreases during pregnancy. This change contributes to the ripening process, which facilitates cervical dilatation during labor. It has been suggested that cervical collagen is partly degraded at term and after delivery. In order to evaluate this hypothesis we investigated the proportion of intact to degraded collagen after solubilization of about 86% of the collagen with pepsin in acetic acid. Total collagen was quantitated as hydroxyproline whereas intact collagen was estimated by SDS-gel electrophoresis. The proportion of intact collagen to total collagen did not change during pregnancy and delivery. Furthermore it was similar to that of intact standard collagen. Thus, even if the concentration of collagen is diminished during pregnancy as a result of increased collagenolytic activity, there is no indication of a qualitative change of the remaining collagen.
TL;DR: Liberal legislation and abortional practice subsequently eliminated illegal abortions, and resulted in a more accurate and favorable statistical distribution of abortions by pregnancy week, which reduced the legal abortions mortality rate to one-fiftieth over the last 30 years even though the number of legal abortions increased 7-fold.
Abstract: Deaths related to abortion accounted for 20% of all maternal mortality in Sweden during the period 1931–80. The risk of dying as a consequence of abortion, per 100,000 pregnancies, declined with a fac
TL;DR: Results indicate that neither aspirin nor acetaminophen in the doses given alter either total menstrual loss or the pattern of loss during the first 3 menstrual days, however, both preparations were found to be more effective than placebo in reducing pain of cramps.
Abstract: 90 women participated in a 4-month study. During the first 2 periods, they took no pain relievers whatsoever; during their last 2 periods they took 2 X 325 mg aspirin, acetaminophen or an identically packaged placebo every 4 h to total 8 tablets during the first 24 h of their periods beginning with spotting. For statistical analysis, periods 1 and 2 were combined and averaged, then compared with periods 3 and 4 combined and averaged. Total menstrual loss in grams, number of days of flow, and pain of cramps and headaches were analyzed by MANOVA for each of the three treatment groups. An ANOVA for each of these variables as well as for daily menstrual loss for the first 3 menstrual days was also performed. The MANOVA for all variables by the three treatment groups failed to show any significant differences. Similarly, ANOVAs for the individual variables failed to indicate significant differences except for the variable pain of cramps (p = 0.0072). The Duncan's Multiple Range Test for pain of cramps showed that the average pain for the placebo group was higher than for either the aspirin or the acetaminophen group, although the means for these two groups were not significantly different. These results indicate that neither aspirin nor acetaminophen in the doses given alter either total menstrual loss or the pattern of loss during the first 3 menstrual days. However, both preparations were found to be more effective than placebo in reducing pain of cramps.
TL;DR: Receptors for estrogens, progesterone and androgens were assayed in 6 specimens of normal vulvar tissue and in 9 specimens of carcinomatous Vulvar tissue.
Abstract: Receptors for estrogens, progesterone and androgens were assayed in 6 specimens of normal vulvar tissue and in 9 specimens of carcinomatous vulvar tissue. These receptors were not always present in all specimens examined. In both normal and carcinomatous tissues receptor concentration was highly variable. Malignant tissues did not show significant changes in values compared to normal tissue.
TL;DR: The results showed that the growth of the fetal kidney correlates well with that of the abdomen and could be an additional parameter for the detection of intrauterine growth retardation.
Abstract: We present a method for measuring the size of the fetal kidney by real-time ultrasound. We examined 241 normal pregnancies and 27 pregnancies with intrauterine growth retardation by this method. The cross-sectional area of the kidney (KA) increases linearly from 20 weeks to term whereas the relative size of the kidney to the abdomen (KA/AA ratio) remains constant during this period. Growth-retarded fetuses had significantly smaller KA values than normal fetuses but their KA/AA ratios were generally in the normal range. The results showed that the growth of the fetal kidney correlates well with that of the abdomen and could be an additional parameter for the detection of intrauterine growth retardation.
TL;DR: It is concluded that, due to its prominent tocolytic effect, nifedipine can be used as a simple pharmacologic test to identify patients suffering from severe primary dysmenorrhea and indicates a subsequent way to treat the disorder.
Abstract: The calcium antagonist, nifedipine, was used to identify patients with primary dysmenorrhea caused by myometrial hyperactivity. Twelve patients with severe primary dysmenorrhea received an oral loading dose of 30 mg nifedipine on the first day of menstruation. Nine patients reported prompt relief of the menstrual cramps (within 15–60 min). In 3 patients no pain relief was obtained. In 2 of these subjects, subsequent laparoscopy revealed obvious signs of endometriosis and previous pelvic inflammatory disease as the cause of these patients pain. Moreover, intrauterine pressure recording with microtransducers displayed normal uterine activity in these patients. It is concluded that, due to its prominent tocolytic effect, nifedipine can be used as a simple pharmacologic test to identify patients suffering from severe primary dysmenorrhea. In addition it indicates a subsequent way to treat the disorder.
TL;DR: ABO blood group of patients with malignant trophoblastic disease can be an important prognostic factor in the diagnosis and treatment of the trophoplastic disease, if a large number of cases are compiled by many investigators.
Abstract: ABO blood group was analyzed in 70 patients with hydatidiform mole and 53 patients with malignant trophoblastic disease. 319 healthy pregnant women served as controls. The distribution of ABO blood gr
TL;DR: Maternal serum TPA concentrations did not change during abortion or parturition and the mixed umbilical blood concentration of TPA equaled that in the mother's serum just after parturitions, and the correlation between placenta weight and maternal TPA levels was significant.
Abstract: The tumor antigen and cytoskeleton protein tissue polypeptide antigen (TPA) have been determined in maternal serum throughout pregnancy. TPA levels in serum from pregnant women (n = 70) were not different from those in nonpregnant women (n = 61) until pregnancy week 28, from which time levels increased until parturition. Duplex pregnancies (n = 7) had higher serum TPA concentrations than simplex pregnancies, which was significant in pregnancy weeks 28 (p < 0.014) and 32 (p = 0.05). Maternal serum TPA concentrations did not change during abortion or parturition and the mixed umbilical blood concentration of TPA equaled that in the mother’s serum just after parturition. The correlation between placenta weight and maternal serum TPA levels was significant (p = 0.025). The decline of TPA after labor indicated a t½ for serum TPA of 7.5 days.
TL;DR: 92 preeclamptic women with unfavorable cervical states were treated with intracervical application of prostaglandin E2 (PGE2) in gel for cervical priming and/or labor induction.
Abstract: 92 preeclamptic women with unfavorable cervical states were treated with intracervical application of prostaglandin E2 (PGE2) in gel for cervical priming and/or labor induction.
TL;DR: In human endometrium a single progesterone injection does not significantly change RCE2 and RNE2 levels, and although a wide range of values was found in both groups, the levels of R CE2 in the two groups did not differ significantly.
Abstract: The effects of single-dose progesterone administration on cytosolic and nuclear estradiol receptor levels (RCE2, RNE2) in normal human endometrium were studied in a group of 17 women and the results compared to 18 controls. In both groups, RCE2 and RNE2 levels were highest in the mid-cycle phase and lowest in the secretory phase. Although a wide range of values was found in both groups, the levels of RCE2 in the two groups did not differ significantly. It seems that in human endometrium a single progesterone injection does not significantly change RCE2 and RNE2 levels.
TL;DR: It is suggested that the mild PRL stimulation observed be mediated by the known brain serotoninergic activation induced by the drug, fenfluramine at the low doses used does not seem to exert antidopaminergic action.
Abstract: The effects of two different doses (40 and 80 mg orally) of fenfluramine on serum prolactin (PRL) levels have been evaluated in healthy and hyperprolactinemic women and compared with those of the potent dopamine antagonist sulpiride (100 mg i.m.). The lower fenfluramine dose resulted in a significant PRL rise in healthy women (n = 16) but not in hyperprolactinemics (n = 14). A dose-response effect was shown between 40 and 80 mg in control subjects (n = 7); in 4 hyperprolactinemics the higher dose also failed to increase PRL levels. Sulpiride resulted in a much greater PRL response. Since fenfluramine at the low doses used does not seem to exert antidopaminergic action, it is suggested that the mild PRL stimulation observed be mediated by the known brain serotoninergic activation induced by the drug.