Kininogen, esterase and kininase activities in human peripheral venous plasma and in plasma from the intervillous space of human placenta, before and during labor.

Kininogen, esterase and kininase activity were measured in the peripheral venous and intervillous placental plasma of women submitted to cesarean section and of women who delivered normally. Kininogen consumption occurred in the intervillous placental plasma during labor. Kininase activity increased in the intervillous placental plasma during labor and was considerably higher than in peripheral venous plasma. Esterase activity was high during labor and decreased after delivery.

Quantification of immunoglobulin A in chorioamniotic membrane of patients with premature rupture of membranes.

OBJECTIVE: The proposal was to study the presence of immunoglobulin A (IgA) in the chorioamniotic membrane of healthy postpartum women with premature rupture of the chorioamniotic membrane (PROM). METHOD: A single radial immunodiffusion technique was used to quantify the IgA in the chorioamniotic membrane tissues. RESULTS: The level of IgA was approximately 10 times higher in patients whose membranes had been ruptured for > 10 h (24.58 mg/dl). These results were compared with those of a previously published study where the mean of amount of IgA was 2.52 mg/dl in membranes of patients with rupture < 10 h. Our results show that IgA began to rise after 10-15 h following rupture. CONCLUSION: Although more studies need to be performed our data indicate that the increasing IgA in our patients after 10 h of latency probably represents the beginning of an ascending colonization of bacteria which could be the source of future infection.

Quantitation of immunoglobulin A in the human chorioamniotic membrane.

Thirty-eight chorioamniotic membranes were obtained from normal patients divided into three groups according to time of rupture. A protein extract was obtained by destruction and differential centrifugation and immunoglobulin A was measured by the method of Mancini. The authors demonstrated that it is possible to quantitate immunoglobulin A. No statistically significant differences were observed between groups.

Demonstration of the presence of IgA in the human chorioamniotic membrane.

The presence of IgA was detected by direct immunofluorescence techniques in the chorion and decidua of eight fragments of chorioamniotic membranes obtained near the rupture edge from eight normal patients. It is suggested that, similar to what occurs in other organic systems, a first barrier against infection of the amniotic chamber exists at this site.

A morphometric study of maternal smoking on apoptosis in the syncytiotrophoblast.

OBJECTIVES: To study syncytiotrophoblast apoptosis in the placenta of smoking and non-smoking pregnant women. METHODS: Twelve neonates, pregnancies and placentas were available for study. Eight mothers smoked during pregnancy and the remaining four were non-smokers used as control subjects. The main outcome measure was the apoptotic syncytiotrophoblast index for each group. Apoptosis was detected by immunohistochemistry using the TUNEL method and quantitatively measured using a Merz grid. The apoptotic syncytiotrophoblast index was calculated as the ratio of mean apoptotic labeling to percent terminal villus area using high-power field microscopy. RESULTS: Significant differences in apoptotic syncytiotrophoblast index were observed between the control group (15.06+/-3.72) and the smoker group (1.66+/-1.74) (P < 0.0001, Mann-Whitney test), but no differences were detected in clinical or morphometric data between groups. CONCLUSIONS: The human placental syncytiotrophoblast undergoes apoptosis and this process is associated with inhibition of apoptosis by the smoking habit. The same way as the presence of trophoblast apoptosis is associated with modifications of the maternal-fetal exchange, the inhibitory effect of the smoking habit on syncytiotrophoblast could be responsible for the poor prognosis of pregnancy in the presence of maternal smoking.

Hemangiosarcoma of the breast followed by term pregnancy.

AIMS AND BACKGROUND: Primary angiosarcoma of the breast is an unusual neoplasm which is generally associated with a dismal prognosis. Given the poor prognosis and the predominance in the third and fourth decades of life when fertility tends to decrease, reports of term pregnancies after treatment of this disease are rare. METHODS AND STUDY DESIGN: We report a case of angiosarcoma of the breast in a 17-year-old patient with a recurrent breast nodule treated by local surgery only. After three years of follow-up without evidence of disease recurrence she became pregnant. RESULTS: A girl weighing 2,430 g was delivered at 38 weeks and two days. The patient has been free of disease for five years now. CONCLUSIONS: Our experience of the present case shows the lack of full information about this tumor. Pregnancy does not seem to interfere negatively with the course of the disease.

In vitro study of the effect of clonidine on human umbilical artery motility.

The umbilical-placental circulation is of vital importance for fetal survival and has a dominant effect on the cardiorespiratory physiology of the fetus. The mechanisms of regulation of umbilical vessels appear to differ from those regulating other vessels. Both clonidine and alpha-methyldopa have been used in the management of hypertensive complications of pregnancy. In contrast to alpha-methyldopa, clonidine does not require previous metabolization but acts directly on the receptors. The action of the two drugs on human umbilical artery was studied in vitro. Forty-eight human umbilical artery segments were dissected and perfused as follows: 9 segments with alpha-methyldopa, 10 with clonidine, 10 with yohimbine, 9 with alpha-methyldopa in combination with yohimbine, and 10 with pure Tyrode's solution. alpha-Methyldopa had a statistically significant vasoconstrictive effect starting at 40 min (p < 0.05) and this effect was blocked by yohimbine (p < 0.05). Clonidine had no vasoconstrictive effect. The present data for clonidine do not confirm the presence of alpha 2-adrenergic receptors in the umbilico-placental circulation which had been indicated by the action of methyldopa.

Action of alpha-methyldopa on human umbilical circulation in vitro.

To determine the possible effects of alpha-methyldopa on the motility of human umbilical artery, a total of 53 arterial segments were perfused with different concentrations of the drug as follows: 38 segments with 125, 250 and 500 ng/ml of the drug, 9 segments with 500 ng/ml alpha-methyldopa in combination with 10(-7) M yohimbine, and 6 segments with 10(-7) M yohimbine alone. alpha-Methyldopa had a vasoconstrictor effect at all doses employed, with a clear dose-effect correlation (p less than 0.01). The vasoconstrictor effect of 500 ng/ml alpha-methyldopa was fully inhibited in the presence of 10(-7) M yohimbine. These results suggest that alpha 2-adrenergic receptors are present in the umbilical circulation and that alpha-methyldopa may play a role in the control of this circulation.

Successful preservation of fertility subsequent to a complete pathologic response of a squamous cell carcinoma of the uterine cervix treated with primary systemic chemotherapy.

This is the first report about a successful pregnancy following treatment for advanced cervical cancer.

Prenatal diagnosis of fetal ovarian hyperstimulation.

A case of prenatal diagnosis of fetal ovarian hyperstimulation in a pregnancy of 35 weeks is reported. Two large cystic septate ovaries with no internal vegetations were observed in the fetal abdomen. The fetus was macrosomic and the remaining morphology was normal. Polyhydramnios and placental thickening were present, with no other macro- or microscopic alterations. The only significant maternal change detected was elevation of blood beta-human chorionic gonadotropin (beta-hCG) levels. Evaluation of the newborn confirmed the prenatal diagnosis, with progressive and spontaneous regression of fetal ovarian volume and of maternal serum beta-hCG occurring after delivery.

Chemotherapy in the treatment of locally advanced cervical cancer and pregnancy.

BACKGROUND: Carcinoma of the cervix is the most common malignant tumor associated with pregnancy. The initial stages and premalignant lesions apparently present the same prognosis in pregnant and nonpregnant women; however, there are limited data regarding outcome for locally advanced cervical cancer in pregnancy. CASE: A 26-year-old woman, gravida 4, para 3, at 14 weeks and 4 days' gestation, was diagnosed with a FIGO stage IIB squamous cell carcinoma of the cervix, treated by primary chemotherapy with cisplatin and bleomycin, until pregnancy resolution at 38 weeks. The newborn infant is currently 3 years old and presents no evidence of abnormalities in neuropsychomotor development. CONCLUSION: The present case demonstrates that chemotherapy was harmless for the child up to the present time. However, a longer follow-up is needed to determine the safe outcome of this child.