Autonomic influence on pregnancy outcome in IDDM.

We evaluated the autonomic influence on pregnancy outcome with prospective study of 100 consecutive pregnancies in women with insulin-dependent diabetes mellitus (IDDM). Tests of cardiovascular autonomic nervous function were performed at the beginning of each pregnancy, and two groups were formed. Group 1 was comprised of 23 pregnancies with autonomic dysfunction, and group 2 was comprised of 77 pregnancies with no abnormalities in cardiovascular tests. Elective abortion was later induced for medical reasons in two cases in group 1, and these women were excluded from the study. The groups were comparable with respect to age, duration of diabetes, and presence of nephropathy. Both groups also achieved comparable glycemic control during pregnancy. There were no significant differences between groups 1 and 2 in any specific pregnancy complication (spontaneous abortions, 5 vs. 3%; perinatal mortality, 10 vs. 1%; congenital malformations, 10 vs. 4%; respiratory distress syndrome, 5 vs. 8%; preeclampsia, 20 vs. 10%; maternal ketoacidosis, 4 vs. 0%; and maternal hypoglycemic accidents, 10 vs. 4%, respectively), but the frequency of pregnancies with at least one of the above complications was greater in group 1 (52 vs. 23%, P = 0.01). Stepwise logistic regression analysis showed the association between autonomic dysfunction and pregnancy outcome to be independent of high initial glycosylated hemoglobin levels, long duration of diabetes, and nephropathy. Maternal autonomic dysfunction seems to be associated with an increased frequency of overall pregnancy complications but does not significantly interfere with the achievement of tight metabolic control during pregnancy.

Immunohistochemical detection of human estrogen receptor with region D-specific antipeptide antibodies.

To study the possibility of using antipeptide antibodies for the immunohistochemical determination of human estrogen receptors (ER), three peptides corresponding to the putative major antigenic regions of the human ER (Met12-Leu26, or ERP1; Thr227-Gln267, or ERP2; Leu256-Gly275, or ERP3) were used to produce site-specific rabbit polyclonal antipeptide antisera. High titer antibodies were obtained against all the peptides used, as judged by time-resolved fluoroimmunoassay. The antibodies against region D (ERP3) specifically immunoprecipitated the ER proteins in vitro, as did the antiERP2 antibodies to a much smaller extent. With one of the region D-specific antibodies (antiERP3 Ab2) ER could also be immunohistochemically detected. When benign and malignant human breast and normal endometrial tissues were used, the immunohistochemical staining observed with these antipeptide antibodies correlated well with the staining obtained with an established method. Thus, the results reported here show that this part of region D in ER is a potential antigenic epitope for the production of site-specific antibodies against ER. Antipeptide antibodies produced against this region can be used to immunolocalize the ER in various normal and pathological human tissues.

Ultrasonic diagnosis of fetal life in early pregnancy.

Ultrasound methods for detecting fetal life during early pregnancy are reviewed. By using recently developed techniques, fetal heart function can be detected as early as the 44th to 45th day of amenorrhea. Fetal movements in the amniotic cavity can be visualized from the 10th week on. If no signs of fetal life can be detected by ultrasound examination by the 10th week, the pregnancy is in jeopardy. However, the prognosis is favorable in over 90% of those cases of threatened abortion in which fetal life has been confirmed by ultrasound.

Study of blighted ovum by ultrasonic and histopathologic methods.

The value of histopathologic examination was estimated in 60 abortions at 8 to 16 weeks' gestation. The diagnosis of blighted ovum had previously been made by careful ultrasonic examination. In the histopathologic examination of the villous tissue the criteria of pathologic or probably pathologic ovum were fulfilled in 55% of the cases. The evaluated retention time of the uterine contents was 1 week or more in 73%. The practical value of histopathologic and ultrasonic examination in the diagnosis of blighted ovum has been discussed.

Role of maternal prolactin in early pregnancy failure.

To study the significance of maternal prolactin (PRL) secretion in early pregnancy failures, intravenous thyrotropin-releasing hormone (TRH) stimulation tests were carried out in 39 women with normal or doomed early pregnancy, as verified by ultrasound examination, before the onset of clinical symptoms of abortion. The basal PRL levels did not differ between the women with normal early pregnancy (N = 15), blighted ovum (N = 13), or with missed abortion (N = 11). Thyrotropin-releasing hormone injection stimulated PRL secretion in all cases, but the response was smaller (P less than .01) in women with early pregnancy failure. It is concluded that PRL is not significant in the etiology or course of early pregnancy wastage and that its basal or stimulated measurement is of limited value in the prediction of pregnancy outcome.

Color Doppler flow as an indicator of trophoblastic activity in tubal pregnancies detected by transvaginal ultrasound.

OBJECTIVE: To evaluate the potential benefits of transvaginal color Doppler in the diagnostic evaluation of tubal pregnancies. METHODS: Fifty-two women with suspected tubal pregnancy were examined by transvaginal ultrasonography and color Doppler. Those with positive scans were referred for exploratory laparoscopy. The area of the tubal pregnancy was examined by color flow imaging and the resistance indexes (RIs) of the artery blood flows were calculated. The pulsatility indexes (PIs) of both uterine arteries were also measured and serum beta-hCG was quantitated. RESULTS: Tubal pregnancy was diagnosed by transvaginal ultrasonography in 38 of the patients. There were two false-negative and two false-positive results. Color flow in the trophoblastic tissue was detected in 50% of the tubal pregnancies, and the mean (+/- standard deviation) RI of the trophoblastic flows was 0.51 +/- 0.12. The RIs of the trophoblastic flows tended to decrease at higher beta-hCG levels, and 88.2% of the cases with detectable trophoblastic flow had beta-hCG above 800 mIU/mL. The average PI of the uterine arteries was 2.28 +/- 0.89. The PIs of the ipsilateral uterine arteries were significantly lower in the patients with trophoblastic flow than in those without it. CONCLUSION: By monitoring trophoblastic activity, color Doppler may differentiate between active and inactive disease and could assist in choosing the correct treatment.

Blood flow in benign ovarian tumors and normal ovaries during the follicular phase.

OBJECTIVE: To identify the Doppler flow characteristics of benign ovarian tumors, and to compare the variables involved with those of normal ovaries during the follicular phase. METHODS: Ninety-one women comprised the study group: 43 were recruited from patients undergoing surgical exploration because of adnexal masses, and the remaining 48 were asymptomatic volunteers with normal ovaries. The ovarian volume and morphology, location of the intratumoral and intraovarian arteries, pulsatility index (PI), resistance index (RI), peak systolic velocity, and minimum diastolic velocity were assessed with transvaginal color Doppler ultrasonography. We examined patients with adnexal tumors before surgery and asymptomatic volunteers during the follicular phase of their menstrual cycles. RESULTS: Arterial blood flow was detected in 49 (89%) of the 55 benign tumors and in 89 (94%) of the 95 normal ovaries. The PI was less than 1.0 in 80% of the benign tumors and 94% of the normal ovaries. The RI was less than 0.4 in 43% of the benign tumors and 25% of the normal ovaries. Blood flow exhibited a lower mean PI but a higher mean peak systolic velocity and minimum diastolic velocity value in benign tumors compared with normal ovaries. There were no differences in the Doppler characteristics of the benign tumors between the follicular and luteal phases. CONCLUSION: The blood flow in benign tumors and normal ovaries may have low PIs and RIs, even during the follicular phase. Therefore, low PIs and RIs alone should not be interpreted as pathognomonic signs of malignancy.

Intrauterine membranous cyst: a report of antenatal diagnosis and obstetric aspects in two cases.

A large, intrauterine membranous cyst originating from the subchorionic layer of the placenta was diagnosed by ultrasound in two pregnancies. The cyst was attached in both cases near the cord insertion. In one pregnancy this condition resulted in fetal growth retardation and diminution of umbilical circulation, but both of the deliveries were uncomplicated. This abnormality indicates careful monitoring of pregnancy and labor.

Blood velocity waveforms of the fetal aorta in normal and hypertensive pregnancies.

Blood velocity waveforms were studied using a combination of real-time and Doppler ultrasonic equipment, a spectral analyzer, and on-line computer in the thoracic descending aorta of the human fetus. In 43 normal pregnancies (weeks 30 to 42) the median of mean velocity was 26.5 (24.1 to 27.9) cm/sec, that of the end-diastolic velocity 10.9 (7.9 to 13.4) cm/sec, the velocity acceleration 718.9 (620.3 to 844.1) cm/sec2, the resistance index 0.84 (0.80 to 0.89), and the pulsatility index was 2.49 (1.94 to 3.10). No differences in these values were observed in the fetuses of noncomplicated hypertensive pregnancies (N = 32), whereas the resistance index increased and the mean velocity and end-diastolic velocity decreased if fetal growth retardation was associated with maternal hypertension (N = 14). In the subgroup of fetal distress (N = 6), all of these parameters except velocity acceleration differed from the normal values, reflecting increased peripheral vascular resistance. This method may be of value in the follow-up of fetal well-being in risk pregnancies by giving an early sign of hemodynamic changes in developing hypoxia.

Early pregnancy failure: study by ultrasonic and hormonal methods.

The value of ultrasonic and hormonal methods [plasma human chorionic gonadotropin (hCG), estradiol (E2), and progesterone (P)] was examined in 188 patients exhibiting different forms of early pregnancy failure. A negative ultrasonic result in the detection of fetal life signs after 9 weeks' gestation signified an unsuccessful outcome for the pregnancy in 100% of cases. On the other hand, the ultrasonic demonstration of fetal life predicted delivery in 90% of cases despite symptoms of threatened abortion. Pathologic levels of hCG or P signified a later miscarriage in 93% of cases, and their combination correlated with a 100% failure rate. In the diagnosis of ectopic pregnancy the combined application of ultrasound and plasma hCG levels seemed to be very useful; however it appears that the detection of blighted ovum should be based on the ultrasonic scanning only. The results of the present study indicate that ultrasonic examination can be regarded as the basic diagnostic method in the evaluation of early pregnancy failure. The determination of plasma trophoblastic hormones (especially hCG) seems to add valuable information to the ultrasonic findings in the actual diagnosis and evaluation of the later course of pregnancy only until 9 weeks' gestation.

Correlation of human chorionic gonadotropin secretion in early pregnancy failure with size of gestational sac and placental histology.

The relationships between maternal plasma human chorionic gonadotropin (hCG) levels, the gestational sac diameter, and histopathologic findings in the placenta were studied in 99 cases of bleeding during the sixth to 15th weeks of pregnancy. In cases of threatened abortion with a successful outcome of pregnancy, the maternal hCG levels and gestational sac diameter were normal, the correlation being significant during weeks seven to ten. In cases of blighted ovum and missed abortion, both the hCG concentration and gestational sac diameter were usually normal during the sixth to eighth weeks of pregnancy. After the ninth week nearly all gestational sac diameters were under the normal range, whereas normal plasma hCG levels were detected occasionally until the 14th week in these doomed pregnancies. Villous structures were histologically normal in ten of the 31 cases of blighted ovum and missed abortion. However, only two of these ten cases showed normal hCG levels and only one had a normal gestational sac diameter immediately before abortion. The results suggest a correlation between the hCG secretion of the trophoblast and gestational sac diameter in cases of bleeding during the early weeks of pregnancy, both in successful and unsuccessful outcome. Normal hCG levels in maternal plasma and nonpathologic histologic findings in the placental tissue often appear to be present in cases of blighted ovum and missed abortion until the second trimester without any mutual correlation.

Maternal thromboxane, prostacyclin, and umbilical blood flow in humans.

The stable hydration products of the vasoconstrictory and proaggregatory thromboxane A2 and vasodilatory and antiaggregatory prostacyclin, ie, thromboxane B2 and 6-keto-prostaglandin F1a, respectively, were measured with radioimmunoassays from 67 women with normal pregnancy, preeclampsia, or other pregnancy complications with the determination of the blood flow in the umbilical vein with the ultrasound method. In addition, the maternal platelets' capacity to release thromboxane B2 was studied. No relation was seen between these prostanoids and the umbilical blood flow and/or pregnancy complications. Moreover, the concentrations of the prostanoids were similar in women with high (161.1 +/- 6.8 mL/minutes/kg of fetal weight, mean +/- SE, N = 33) and low (50.5 +/- 2.1 mL/minutes/kg, N = 34) umbilical flow. If thromboxane A2 and prostacyclin regulate the umbilical circulation in the human, they exert this effect locally in the fetoplacental unit, and the changes are not reflected by the levels of their metabolites in the maternal peripheral circulation.

Effects of dihydralazine infusion on the fetoplacental blood flow and maternal prostanoids.

The hemodynamic effects of intravenously infused dihydralazine (incremental doses up to 125 micrograms per minute during 60 minutes) were studied in ten women with acute or superimposed severe preeclampsia. The intervillous and umbilical vein blood flow were measured before and during dihydralazine infusion with 133Xenon method and with a combination of real-time and Doppler ultrasonic equipment, respectively. Maternal blood pressure decreased and pulse rate increased during the infusion. Dihydralazine did not change the intervillous blood flow but it increased the blood flow in umbilical vein. No effect on the 6-ketoprostaglandin F1 alpha in maternal plasma and urine or thromboxane B2 in maternal serum was observed. The results indicate that dihydralazine affects the placental and fetal circulations differently.

Umbilical artery N-terminal peptide of proatrial natriuretic peptide in hypertensive pregnancies and fetal acidemia during labor.

OBJECTIVE: To assess the activity of the human fetal atrial natriuretic peptide system in hypertensive pregnancies with and without signs of increased fetal systemic venous pressure and in pregnancies complicated by fetal acidemia during labor. METHODS: Umbilical artery plasma N-terminal peptide of proatrial natriuretic peptide concentrations were measured in neonates by radioimmunoassay. The control group consisted of 50 neonates with uncomplicated gestation and labor. In group 1, there were 22 newborns of hypertensive pregnancies. Doppler ultrasonography showed abnormal umbilical artery blood velocity waveform in five cases and normal nonpulsatile umbilical vein blood velocity profile in every case. Group 2 consisted of five newborns of pregnancies complicated by maternal hypertensive disorder. Atrial pulsations in the umbilical vein and retrograde diastolic blood velocity pattern in the umbilical artery were detected in every case. Group 3 was composed of 27 newborns of uncomplicated pregnancies with fetal acidemia (pH 7.10 or less) during labor. RESULTS: In groups 1-3, N-terminal peptide of proatrial natriuretic peptide concentrations were higher (P <.001) than in the control group. In group 1, neonates with abnormal umbilical artery blood velocity pattern had higher N-terminal peptide of proatrial natriuretic peptide concentrations than neonates with normal umbilical artery Doppler findings (P <.006). N-terminal peptide of proatrial natriuretic peptide concentrations were higher in group 2 (P <.002) than in groups 1 and 3. CONCLUSIONS Maternal hypertensive disorder and fetal acidemia during labor stimulate fetal atrial natriuretic peptide production, which was greatest in fetuses with severe placental insufficiency and signs of congestive heart failure.

Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes.

OBJECTIVE: To evaluate fetal outcome and long-term impact of very early preterm premature rupture of membranes (PROM). METHODS: In a retrospective cohort study, 78 women with singleton pregnancies who delivered at the Oulu University Central Hospital between 1990 and 1996 and who had early PROM, between the 17th and 30th gestational weeks, were matched with 78 women with spontaneous preterm delivery during the same time (control group). The main outcome measures were maternal morbidity, interval from early PROM to delivery, perinatal and neonatal mortality rates and neonatal morbidity, need for primary and recurrent hospitalization and later pulmonary complications of the infants, and growth and neurologic findings at 1 year of corrected age. RESULTS: The perinatal mortality was 282 per 1000 births in the early PROM group and 256 per 1000 births in the control group. Histopathologically defined chorioamnionitis and puerperal infections were significantly more common in the early PROM group than in controls (51 versus 29%, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.3, 4.9 and 38 versus 22%, OR 2.3, 95% CI 1.1, 5.1, respectively). There were no differences in neonatal infections between groups. Pulmonary hypoplasia was detected more often in the early PROM group (in nine infants) compared with the control group (no infants). The duration of rehospitalization up to 1 year of age due to respiratory problems was a mean of 5 days in the early PROM group and a mean of 1 day in the control group (P = .01; 95% CI 0.9, 6.9). Symptomatic chronic lung disease at 1 year of age was detected more often in the early PROM group than in controls (22 versus 9%; OR 2.4, 95% CI 0.9, 6.5). CONCLUSION: Early PROM seems to be a major obstetric and neonatal problem with pulmonary ramifications extending beyond the neonatal period. However, most of these infants can be saved.

Ultrasonic evaluation of the Dandy-Walker syndrome.

Antenatal and postnatal ultrasonic findings of a case of cystic dilatation of the fourth cerebral ventricle (the Dandy-Walker syndrome) are presented. The triangular enlargement of the ventricle visualized ultrasonically was associated with mild widening of the lateral ventricles, and the finding was established postnatally by computer-assisted x-ray tomography.

Placental thromboxane and prostacyclin in the regulation of placental blood flow.

To study the significance of placental thromboxane A2 and prostacyclin in the regulation of placental blood flow, intervillous blood flow was measured using a 133Xenon method from 39 women zero to two days before delivery and compared it with the placental production of thromboxane A2 and prostacyclin as measured with a superfusion method postpartum. The placental production of thromboxane B2 (a metabolite of thromboxane A2; 4.5 +/- 1.3 ng/minute per gram dry weight of tissue; mean +/- SD) and that of 6-keto-prostaglandin F1 alpha (a metabolite of prostacyclin; 0.64 +/- 0.27 ng/minute per gram) did not correlate significantly with intervillous blood flow (153.1 +/- 108.0 mL/minute per 100 mL; r = -0.308 and 0.245, respectively), whereas the thromboxane B2/6-keto-prostaglandin F1 alpha ratio (8.53 +/- 4.3) was inversely related to intervillous blood flow (r = -0.419; P less than .01). In the women with intervillous blood flow below the normal mean (less than 130 mL/minute per 100 mL; N = 20) placental thromboxane B2 production (5.1 + 1.2 ng/minute per gram) was higher (P less than .005) and that of 6-keto-prostaglandin F1 alpha (0.54 +/- 0.23 ng/minute per gram) lower (P less than .02) than those in women with intervillous blood flow above 130 mL/minute per 100 mL (thromboxane B2 4.01 +/- 1.0 and 6-keto-prostaglandin F1 alpha 0.75 +/- 0.27 ng/minute per gram; N = 19). These results suggest that placental thromboxane A2 and prostacyclin may be factors in the regulation of intervillous blood flow and that their balance of production is more important than the presence of either agent alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of the ovarian follicle by ultrasound in ovulation induction.

Ultrasonic monitoring of ovarian follicles and estimation of serum estradiol were carried out in 12 patients with clomiphene therapy, in 5 patients with gonadotropin therapy, and in 7 normal controls. The average diameter of preovulatory follicles in normal controls was 12,8 mm; in ovulation induction groups it was 2 to 4 mm greater. The level of serum estradiol was also higher in ovulation induction groups than in normal controls. The combined use of these two methods is recommended: ultrasonic monitoring to minimize the risk of multiple pregnancies and estrogen level monitoring to minimize the risk of hyperstimulation. Ultrasound is also safe and practical in following the size of hyperstimulated ovaries.

Transvaginal salpingosonography for the assessment of tubal patency in infertile women: methodological and clinical experiences.

OBJECTIVE: To evaluate the advantages and accuracy of transvaginal salpingosonography in the assessment of tubal patency with regards to laparoscopic chromopertubation. SETTING: Infertility policlinic of the hospital. DESIGN: Thirty-one women suffering from infertility were examined with transvaginal salpingosonography using air and saline as a contrast medium. The results were compared with those obtained with laparoscopic chromopertubation. RESULTS: Altogether 61 fallopian tubes were examined with both transvaginal salpingosonography and laparoscopic chromopertubation. Concordance was 85%. Of the tubes investigated by transvaginal salpingosonography, 45 were found to be patent and 16 were found to be occluded. In chromopertubation, 50 of 61 tubes were patent and 11 were occluded. Bilateral tubal patency was found by transvaginal salpingosonography in 17 cases and by laparoscopy in 22 cases. Unilateral tubal patency was found in 11 and 6 cases, respectively. Bilateral occlusion was found in three cases using either technique. CONCLUSION: Transvaginal salpingosonography with the combination of air and saline is a low-cost, reliable, safe, and comfortable examination method. It can be used for the primary investigation of infertility on an outpatient basis.

Copper allergy and copper IUD.

Epicutaneous tests with copper, nickel and cobalt were performed in 37 patients using copper IUD who had shown side-effects to the IUD. None of them was allergic to copper; four were allergic to nickel and one to cobalt. Metal allergy was not considered to be the cause of the side-effects in any of the patients.