Showing papers on "Pregnancy published in 1977"

Morphological effects of chronic tracheal ligation and drainage in the fetal lamb lung.

Abstract: The relationship between lung liquid flow and fetal lung development has been studied at the cellular level using ultrastructural techniques. Continuous in utero tracheal ligation and drainage (over a period of 21-28 days) both result in malformations of the developing fetal lamb lung. Ligated lungs are larger, and drained lungs are smaller, than normal lungs at a similar gestational age. These changes are not merely due to altered lung liquid volume, but actual tissue growth thas been affected. Future alveolar wall thinning is enhanced in ligated lungs and inhibited in drained lungs, whilst the presence of differentiated alveolar type II cells (probably related to surfactant production) is decreased in ligated lungs and markedly enhanced in drained lungs. These results indicate the importance of fetal lung liquid in the regulation of pulmonary development in the fetus.

Adverse Effects on Offspring of Maternal Alcohol Abuse during Pregnancy

Abstract: To evaluate the risk of offspring of heavy drinking during pregnancy, we administered a questionnaire to 633 women at the first prenatal visit. Nutritional status, smoking, drug and alcohol use were determined. Women were classified into three groups: abstinent and rare drinkers; moderate drinkers; and heavy drinkers. After delivery, detailed pediatric, neurologic and developmental examinations were administered by a physician without prior knowledge of any history. Infants born to heavy drinkers had twice the risk of abnormality of those born to abstinent or moderate drinkers (P less than 0.001). Thirty-two per cent of infants born to heavy drinkers demonstrated congenital anomalies, as compared to 9 per cent in the abstinent and 14 per cent in the moderate group (P less than 0.001). Microcephaly and multiple congenital anomalies were much more frequent in this group (P less than 0.001). Heavy drinking during pregnancy increases the risk to offspring.

Progesterone and Maintenance of Pregnancy: is Progesterone Nature's Immunosuppressant?

Abstract: Progesterone derived either from the corpus luteum or the placenta, or both, has been shown to be essential for the maintenance of pregnancy in every species examined. The essential role of the corpus luteum was discovered by Frankel in 1903, and extracts of the corpus luteum were shown to be effective in maintaining pregnancy in rabbits by Allen and Corner about 30 years later. Many more,recent studies that utilized elegant immunologic and chemical techniques have further elaborated on the importance of progesterone for pregnancy maintenance. However, the functional role of progesterone remains unclear. The pioneering studies of Csapo led to the concept that progesterone dominance of the uterus suppresses uterine contractility until near the end of gestation. However, other effects of progesterone may be equally as important (for an extensive review of progesterone and pregnancy maintenance, see Reference I). More than 20 years ago, it was proposed2 that a '*barrier" exists between fetuses and both normal and sensitized mothers that prevents the mother from developing a state of transplantation immunity to the paternal histocompatibility antigens of the fetus. Much attention has been directed to the possibility that the trophoblast serves this function, simply because it represents the fetal cellular element that, to varying degrees in different species, has direct contact with maternal blood and tissue (decidua). The effectiveness of the placental barrier has been ascribed to nonantigenicity of trophoblastic cells,' secretion of fibrinoid or mucopolysaccharide by trophoblasts that masks histocompatibility antigens,4s5 and suppression of cellular and humoral immunity by trophoblastic hormones.6 Considering that pregnancy can be terminated by administration of heterolcgous antiplacental serum, on the one hand, and that interspecies matings have been successful, on the other, it seems obvious that a universal, highly efficient mechanism must prevent the immunologic destruction of the fetus. The idea that trophoblastic hormones may be important in mediating immunologic tolerance of pregnancy has gained considerable interest recently. Depression of maternal cellular immunity, particularly during the third trimester of human pregnancy, has been observed both in vivo7.8 and in vitro. Thymus-dependent lymphocytic proliferation measured after s t i m ~ l a t i o n ~ ~ ~ ~ with mitogens (phytohemagglutinin, PHA) or in mixed lymphocyte cultures (MLC)"*I2 is sup-

Neonatal-perinatal medicine: Diseases of the fetus and infant

Abstract: The field of neonatal-perinatal medicine the foetus pregnancy disorders and their impact on the foetus the delivery room provisions for neonatal care development and disorders of organ systems.

Non-invasive measurement of human fetal circulation using ultrasound: a new method.

Abstract: We combined two ultrasound techniques to develop a safe, non-invasive, transcutaneous method of observing the circulation in the umbilical arteries and vein in the fetus. The umbilical cord can be located by standard echo ultrasound procedures, and this information can be used to direct a Doppler ultrasound beam on to the vessels in the cord. The signals can be heard through audio headphones or recorded on a tape recorded and spectrum-analysed. The method was successful in each of 20 patients examined, whose pregnancies ranged from 12 to 40 weeks' gestational age, and was suitable for outpatient use. It should be useful in assessing such conditions as pre-eclampsia and intrauterine growth retardation.

Psychological changes accompanying pregnancy and motherhood.

Abstract: This study was an attempt to investigate some of the psychological changes that occur during first pregnancy and the early postpartum months. The major theoretical assumption was that pregnancy and early motherhood may be viewed as a series of developmental tasks, and that the way in which these are coped with will be predictive of adaptation to the maternal role. The aims of the study were (a) to identify the affective changes that occur in women during first pregnancy and to assess the extent to which pregnancy and motherhood are experienced as a period of psychological crisis; (b) to trace the development of maternal feeling; and (c) to assess the extent to which characteristics measured early in pregnancy are predictive of attitudes and adjustment to later stages of pregnancy and the degree to which these factors are themselves predictive of adaptation to parenthood. The sample consisted of 19 white, middle class primigravidas, with an age range of 22-33 years. Only women who had no previous gynecological or psychiatric difficulties and who were currently living with their husbands were accepted as Ss. Each woman was interviewed at each trimester of pregnancy, on the third postpartum day, and at 2 months postpartum. A follow up questionnaire was mailed at 7 months postpartum, The data obtained were derived from ratings of extensive interview schedules and a number of personality measures. Results indicated that although emotional upheaval and rapid change were characteristic of pregnancy, for some women a growing sense of adulthood, of fulfillment, and integration of a new maturational stage clearly co-existed with the emotional disequilibrium. Analysis of the interrelationship among characteristics shown in early pregnancy, adjustment to the pregnancy overall, and adaptation to parenthood indicated that the degree of personality integration achieved by early pregnancy was predictive of the extent to which psychological growth was experienced throughout pregnancy and early parenthood.

Moderate alcohol use during pregnancy and decreased infant birth weight.

Abstract: Maternal alcoholism during pregnancy may result in severe prenatal growth deficiency. In this prospective study, the relationship of moderate maternal alcohol consumption to infant birth weight is explored. Subjects were 263 paying members of a health maintenance organization who delivered single live children. Their alcohol consumption before pregnancy, and in early and late pregnancy, was estimated. In order to control for smoking, which is strongly related to both infant birth weight and maternal alcohol use, the sample was selected so that similar proportions of smokers were represented in both light and heavier drinkers. Multiple linear regression was employed. A regression equation was computed for each of the three periods in which drinking was estimated. Independent variables entered into the equation were maternal age, height, parity, daily cigarettes, alcohol use in the period, and gestational age and sex of child. The regression of birth weight on these variables revealed a significant relation...

Association of maternal systemic lupus erythematosus with congenital complete heart block.

Abstract: Infants born to mothers with disseminated lupus erythematosus occasionally have transient manifestations of the maternal disease. In six infants with congenital heart block born to mothers with systemic lupus erythematosus we postulated a causative relation. In one of the infants a post-mortem study of the conduction system suggested faulty embryonic development of the atrioventricular node with an abnormally thick annulus fibrosus and the effects of early inflammatory changes. Two of the infants had a cardiomyopathy and three, associated congenital heart disease.

Smoking: A Risk Factor for Spontaneous Abortion

Abstract: We compared cigarette smoking during pregnancy among 574 women who aborted spontaneously (cases) and 320 women with delivery after at least 28 weeks' gestation (controls). Log-linear analysis was used to test the hypothesis that smoking is associated with spontaneous abortion. Several potentially confounding variables — namely, age at last menstrual period and the number of previous pregnancies ending in spontaneous abortion, in induced abortion and in live birth — were controlled in the analysis. Women who had aborted spontaneously reported smoking during pregnancy more often than those with delivery after 28 weeks' gestation: 41 per cent of cases and 28 per cent of controls smoked. The odds ratio for the highly significant association with smoking was 1.8. The association did not vary with age or previous obstetric events. We conclude that smoking during pregnancy is a risk factor for spontaneous abortion. (N Engl J Med 297:793–796, 1977)

Backache in pregnancy

Abstract: Replies to a questionnaire showed that, amongst 180 women delivered in The London Hospital, 48% experienced backache during pregnancy; in one third of these it was severe. The prevalence of back pain increased with both increasing age and increasing parity, and it was difficult to separate the relative contributions of these two factors. No evidence was found of an association between backache during pregnancy and height, weight, 'obesity index', weight gain, or baby's weight. Analysis of aggravating and relieving factors indicates some differences between backache in the pregnant and 'mechanical' back pain in the non-pregnant. Slightly less backache was reported amongst patients attending antenatal physiotherapy classes but the figures do not provide clear evidence of any protective effect of this attendance.

Progesterone: its role in the central nervous system as a facilitator and inhibitor of sexual behavior and gonadotropin release.

Abstract: When the action of a hormone on a tissue is studied, the biochemical condition of the tissue or substrate prior to administration of the hormone should always be considered. Diverse factors, such as genetic sex, nutritional state, temperature, time of day, and season of year, may influence the substrate. Only when these and other factors are controlled for can one be sure that experimental samples begin from a relatively homogeneous baseline, and only in this way can one accurately assess the effects of a hormone on this baseline. Extraordinary emphasis on this stricture is required for progesterone and its actions on neural and genital tissues. This is so because the effects of progesterone are very much dependent on the previous, concurrent, and subsequent influences of estrogenic hormones on target tissue substrates. These temporal factors determine whether progesterone will facilitate or inhibit estrogen-dependent processes. In this paper, we will first describe, at a molar level, the interaction of progesterone with estrogen-sensitive neural tissues that regulate the expression of female sexual behavior and the release of gonadotropic hormones. Later, we will discuss, at a biochemical level, possible mechanisms by which progesterone can exert both facilitatory and inhibitory influences on sexual behavior and gonadotropin release. This section will include data on estrogen and progesterone uptake and on possible mediation of progesterone effects by neurotransmitters. Also included in this discussion will be a comparison between the inhibitory actions of progesterone and those of synthetic antiestrogens on estrogen-dependent neural processes. To conclude, we will suggest that progesterone-sensitive neural systems operate with a precision that is attributable more to interneuronal channeling of information to or from estrogen-sensitive areas than to intranuclear programming of biochemical events.

Thrombocytopenia in pregnancy

Abstract: Obstetricians frequently diagnose thrombocytopenia in pregnant women because platelet counts are included with automated complete blood cell counts obtained during routine prenatal screening (1). Although most U.S. health care providers are trained using U.S. Conventional Units, most scientists, journals, and countries use Système International (SI) units. The laboratory results reported in U.S. Conventional Units can be converted to SI Units or vice versa by using a conversion factor. Given the conversion factor is 1.0, when converting from 103/mL to 109/L the platelet “count” does not seemingly change. Thrombocytopenia, defined as a platelet count of less than 1503 109/L, is common and occurs in 7–12% of pregnancies at the time of delivery (2, 3). Thrombocytopenia can result from a variety of physiologic or pathologic conditions, several of which are unique to pregnancy. Some causes of thrombocytopenia are serious medical disorders that have the potential for maternal and fetal morbidity. In contrast, other conditions, such as gestational thrombocytopenia, are benign and pose no maternal or fetal risks. Because of the increased recognition of maternal and fetal thrombocytopenia, there are numerous controversies about obstetric management of this condition. Clinicians must weigh the risks of maternal and fetal bleeding complications against the costs and morbidity of diagnostic tests and invasive interventions. This Practice Bulletin is a targeted revision to reflect limited changes to information about new estimates for thrombocytopenia in pregnancy and the risk of recurrence of fetal–neonatal alloimmune thrombocytopenia in subsequent pregnancies, and to provide new information on the level of thrombocytopenia that permits regional anesthesia.

Iron stores in pregnancy.

Abstract: Summary. Serum ferritin concentration has been measured during the course of pregnancy in 154 women. There was a rapid decrease in iron stores during early pregnancy irrespective of any iron therapy. Oral iron did, however, prevent the stores reaching iron deficient levels during the second half of pregnancy. The results suggest that maternal erythroid activity starts early in pregnancy and may exhaust the iron stores before the fetal demands for iron can be met.

Antiluteolytic effect of the conceptus and of PGE2 in ewes.

Abstract: SUMMARY The responses of pregnant and nonpregnant ewes on day 13 post-estrus to a dose of prostaglandin (PG)F2a known to be luteolytic in nonpregnant ewes were compared (experi- ment I). Either 270 /ag PGF2~ THAM salt (eight nonmated and 11 mated ewes) or saline (eight nonmated and 10 mated ewes) was injected into the largest follicle on each ovary bearing a corpus luteum. Jugular plasma sam- ples taken just prior to surgery and 4, 8, 12, 16, 20, 24, 28, 32 and 36 hr after injection were analyzed for progesterone, estradiol-1713 and luteinizing hormone (LH) by radioimmuno- assay. Treatment with PGF2a shortened the estrous cycle by 1.5 days in nonmated ewes and mated ewes without embryos (P<.05). Mated ewes with embryos did not return to estrus. The linear regression of progesterone over time varied with treatment (P<.01), pregnancy status (P<.01) and treatment x pregnancy status (P<.09). Progesterone did not reach as low a level (1.3 vs .4 ng/ml; P<.05) in pregnant as in nonmated ewes. Both LH and estradiol- 17/3 increased in treated ewes after progesterone had decreased to approximately 50% of pre- treatment levels; the increase in estradiol was transient in the pregnant ewes. The pattern of LH did not differ with pregnancy status. It is concluded that pregnancy overcame the luteo- lytic effects of PGF2c~ (i.e., had an antiluteo- lytic effect). Experiment II was designed to ascertain whether PGE 2 has antiluteolytic properties. A catheter was inserted into each uterine horn that was ipsilateral to a corpus luteum in nonmated ewes on day 11 postestrus. Intrauter- ine injections of 0, 300, 600 or 900/agof PGE2 were begun on the morning of day 12 and continued every 8 hr until estrus or day 20. Jugular plasma samples were taken just before the first injection and every 24 hr thereafter in all ewes and at .25, .5, 1, 2, 4 and 8 hr from several ewes in each group and were assayed for progesterone. The estrous cycle was lengthened and the decline in progesterone delayed by 2 days by PGE2 (P<.05). Frequent samples on day 12 did not differ in progesterone levels among treatments or over time. Prostaglandin E 2 had antiluteolytic activity in ewes but no in vivo steroidogenic effect was observed. (Key Words: Ewe, Corpus Luteum, PGF2c~, PGE2, Antiluteolytic Factors, Early Preg- nancy.) 1 Division of Animal and Veterinary Science. Sup- ported by NICHD Contract No. 69-2215 and Hatch Project 224 (NE-72). We thank the Upjohn Company and Drs. James Lauderdale and John E. Pike

The Guinea-Pig Placenta

Abstract: 1. Introduction.- 2. Historical Survey.- 3. Development of the Guinea-Pig Placenta.- 3.1. Breeding and Age Determination.- 3.2. Early Development and Formal Genesis.- 3.3. Morphogenesis.- 4. Rough Structure of the Mature Placenta.- 5. Vascular Supply of the Mature Placenta.- 5.1. Maternal Arterial Blood Supply.- 5.2. Maternal Venous Drainage.- 5.3. Fetal Arterial Blood Supply.- 5.4. Fetal Venous Drainage.- 5.5. Intralobar Circulatory Conditions.- 6. Ultrastructure and Functional Morphology.- 6.1. Physiological, Technical and Morphometrical Data.- 6.1.1. Physiological Data and Perfusion Technique.- 6.1.2. Influence of Fixation on the Structure of the Placenta.- 6.1.3. Morphometry of the Main Placenta.- 6.2. Ultrastructural and Histochemical Development of the Main Placenta.- 6.2.1. 6th to 14th Day.- 6.2.2. 15th to 20th Day.- 6.2.3. 21st to 35th Day.- 6.2.4. 36th to 50th Day.- 6.3. Functional Morphology of the Different Regions in the Mature Main Placenta.- 6.3.1. Interlobium.- 6.3.2. Transitional Zone.- 6.3.3. Periphery of the Lobe.- 6.3.4. Middle of the Lobe.- 6.3.5. Centre of the Lobe.- 6.4. Subplacenta and Junctional Zone.- 6.4.1. Development and Regression of the Subplacenta.- 6.4.2. Functional Significance.- 6.5. Yolk Sac and Margin of the Placenta.- 6.5.1. Section 1 of the Yolk Sac.- 6.5.2. Section 2 of the Yolk Sac.- 6.5.3. Section 3 of the Yolk Sac.- 6.5.4. Section 4 of the Yolk Sac.- 6.5.5. Section 5 of the Yolk Sac.- 7. Possibilities of Comparison with the Human Placenta.- Acknowledgements.- 8. References.- 9. Subject Index.