Amniotic fluid cells in the second trimester of pregnancy.

The cell types of amniotic fluid in the second trimester of normal pregnancy are described and compared with the findings in the literature. Two hundred cell samples obtained by amniocentesis in pregnancies without known fetal neural tube or skin defects were studied. Anucleated and nucleated squamous epithelial cells of superficial and intermediate layers were found, as were macroforms of superficial cells. Parabasal cells were infrequent. Parabasallike cells were of amniotic origin. Other amniotic cell types, such as "balloon," or "goblet," cells, umbilical cord cells and hyperchromatic placental amniotic cells, were observed. Urothelial cells and nonepithelial cells, such as histiocytes and macrophages, were found. In several cases, "minicells" were seen; their different sites of origin are discussed.

[Menstrual disorders in athletes]. / Zyklusstörungen bei Sportlerinnen.

It is important to pay attention to bone metabolism in women long before the menopause. Irregular menstruation with anovulatory cycles or amenorrhoea persisting over several years have negative effects on bone formation and total bone mass already within a few years after menarche. They lead to a lack of oestradiol and are often associated with inadequate and unbalanced nutrition (e.g. lack of calcium and proteins). This results in severe impairment of bone formation and a net loss of bone mass. It is the duty of the doctors taking care of female athletes (as well as non-athletes) with irregular menstrual cycles or amenorrhoea to protect them against osteoporosis which may manifest itself 2-5 decades later. In the special case of female athletes a reduced bone mass is an important risk factor for stress fractures which can result in interruption or even in a premature termination of promising athletic careers. Athletes with retarded menarche, irregular menstrual cycles, or amenorrhoea must, therefore, be referred to a gynecologist for further diagnosis and treatment.

[Prenatal diagnosis after abortus imminens--further progress of pregnancy and peculiarity of amniotic cell cultivation (author's transl)]. / Pränatale Diagnostik nach Abortus imminens--weiterer Schwangerschaftsverlauf und Besonderheiten der Zellkultivierung.

Among 1600 pregnancies, in which amniocentesis for prenatal diagnosis had been performed, were 73 cases with previous threatened abortion. In none of these abortion occurred after amniocentesis. 56 children have been born so far. There is evidence for a slight but not statistically significant increase in the number of multifactoral anomalies in this group. This study supports former findings of a higher prematurity incidence after vaginal bleeding in early pregnancy. If amniocentesis took place after imminent abortion, brownish discoloured amniotic fluid has been withdrawn in 53%. This phenomenon probably results from transfer of blood substances from hematomata between uterine wall and amniotic sac. Cultivation of amniotic fluid cells may be impaired by those degradation products, prolonging the cultivation period for an average of 2 days. Special methodological modifications to enhance the success of amniotic fluid cell cultivation in those heavily contaminated specimens are discussed. There seems to be no interference with AFP-estimation. Fetoscopy vision may be impaired.

[Prenatal diagnosis of Gaucher's disease (author's transl)]. / Pränatale Diagnose der Gaucher-Krankheit.

Gaucher's disease type I was diagnosed prenatally in one case. Using radiomarked natural lipid substrate the enzyme defect was demonstrated in amniotic cells cultured after amniocentesis in the 16th week of pregnancy. Rest activity of cerebroside beta-glucosidase was around 6% of control activity. After termination of pregnancy in the 19th week the diagnosis was confirmed in the fetus by demonstration of lack of enzyme activity in fetal fibroblasts and liver tissue. Enzyme levels of cerebroside beta-glucosidase in blood leucocytes of the couple who decided on termination of the pathological pregnancy were found compatible with but no proving the heterozygote state of Gaucher's disease. In the future the enzyme defect of affected probands should be determined early and as precisely as possible.

Persistent infection of human fibroblasts by hepatitis A virus.

Infection of human embryo fibroblasts with hepatitis A virus (HAV), a picornavirus, leads to an inapparent, persistent infection; cultures can be passed serially with consistent recovery of the virus in the supernatant. All of the cells of a HAV carrier culture are infected and proliferate. Subcultivation under HAV-immune serum cannot achieve a cure or even a reduction in the number of infected cells in HAV carrier cultures. No interferon activity can be detected during HAV infection and persistence. Addition of exogenous interferon eliminates HAV infection in vitro. Persistence of HAV in vitro appears to contradict the clinical course of HAV infection in vivo. The system presented offers the possibility of evaluating the role of immunological injury of HAV-infected cells, an injury which may lead to damage of these cells and to elimination of HAV during an HAV infection in vivo.

[Amniotic infection syndrome after amniocentesis--a case report]. / Amnioninfektionssyndrom nach Amniozentese. Ein kasuistischer Beitrag.

A severe amniotic infection syndrome with a septic shock and a consumption coagulopathy is reported after an amniocentesis in second trimester. In literature, the risk of an amnionitis after amniocentesis amounts to 0.1%-0.4% and the risk of a severe maternal infection reaches 0.03%-0.19%. The available data show, that the clinical symptoms (rise in temperature, signs of septic shock) start 24-36 hours after the punction. The earlier treatment (evacuation of the uterus or - if necessary - hysterectomy) is accomplished, the more favourable will be the course of the disease with respect to septic shock and DIC. Determination of germs in each amniotic fluid seems to be of prognostic value; thus treatment can be started before infection becomes detrimental for the mother.

Amniotic fluid levels of 17 alpha-hydroxyprogesterone during human pregnancy: pre-natal diagnosis of congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

Levels of 17 alpha-hydroxyprogesterone were estimated by radioimmunoassay in 174 amniotic fluid specimens obtained from 162 normal pregnancies of 16-20 weeks gestation. Another 18 specimens from 11 normal pregnancies between 25-42 weeks gestation and 7 specimens from 7 women who each previously had given birth to a child affected with CAH were also studied. There was no sex difference in AF 17 alpha-OH-progesterone levels, nor any significant downward trend in concentrations throughout the observed gestation period. Among the 7 subjects with previous history of CAH offsprings, 4 demonstrated normal levels of AF 17 alpha-OH-progesterone and 3 significantly higher values. HLA-typing of the cultivated amniotic cells confirmed these 4 cases to be heterozygous for 21-hydroxylase deficiency. The three subjects with high AF 17 alpha-OH-progesterone levels delivered babies affected with CAH, although HLA-typing in one case was non-conclusive. The failure of HLA-typing in 1 case for a confirmatory diagnosis indicates that the prenatal diagnosis of CAH must continue to rest on joint endocrinological and genetical investigations.