Spontaneous abortion among insulin-dependent diabetic women.

A prospective study was undertaken to evaluate the frequency of spontaneous abortion in clinically apparent pregnancies among insulin-dependent diabetic women evaluated prior to pregnancy. The study was done in 132 pregnancies occurring in 91 diabetic women. The spontaneous abortion rate was 30%; 70% of the pregnancies progressed beyond 20 weeks. The abortion rates for Classes B, C, D, and F through RT were 0%, 25%, 44%, and 22%, respectively. Initial serum levels of the beta-subunit of human chorionic gonadotropin above 6000 mIU were usually associated with favorable outcome while levels below 6000 mIU were not predictive of outcome. Data from this study suggest that the risk of spontaneous abortion among insulin-dependent diabetic women may be substantially higher than for the general population. Higher abortion rates were generally associated with more advanced White classification of diabetes. Age at diagnosis was the only factor which showed a significant contribution to the risk of abortion.

Effect of vasoactive intestinal polypeptide on uterine blood flow in pregnant ewes.

Vasoactive intestinal polypeptide has been localized in the uterine vasculature, uterine smooth muscle and the placenta of several species. Vasoactive intestinal polypeptide is a potent uterine vasodilator in nonpregnant sheep and also abolishes spontaneous uterine contractile activity, but the effects of this polypeptide on the uterine vasculature of the pregnant animal is currently unknown. The present experiments were performed in seven late-term pregnant sheep which were chronically catheterized to evaluate the uterine vascular effects of vasoactive intestinal polypeptide. An intra-arterial catheter was placed in a branch of the main uterine artery to allow administration of vasoactive intestinal polypeptide directly into the uterine vasculature. Uterine blood flow was continuously monitored via an electromagnetic flow transducer on both main uterine arteries. Vasoactive intestinal polypeptide infused at the rate of 1 to 30 micrograms/min produced dose-related reductions in uterine blood flow (33% +/- 9% at 30 micrograms/min). This decrease was due to a reduction in systemic arterial blood pressure, since calculated resistance in the uterine vasculature that received the vasoactive intestinal polypeptide did not change significantly. In addition, the contralateral uterine vasculature that did not receive direct intra-arterial infusions of vasoactive intestinal polypeptide showed identical changes. These data suggest that vasoactive intestinal polypeptide produces peripheral vasodilation at doses which have very little uterine effect locally. These data can be interpreted to mean either that high local endogenous production of vasoactive intestinal polypeptide prevents exogenously administered vasoactive intestinal polypeptide from exerting its vascular effects, or that vasoactive intestinal polypeptide is a very weak uterine vasodilator in pregnant ewes. The clarification of these possibilities will require further experimentation.

Effects of vasoactive polypeptides on the uterine vasculature.

Estrogen-induced increases in uterine blood flow appear to require de novo protein or polypeptide synthesis. In the present experiments a chronically catheterized nonpregnant sheep preparation was used to determine the uterine vascular effects of vasoactive intestinal polypeptide (VIP), neurotensin, and substance P. These effects were compared to those of bradykinin and the most potent vasodilator prostaglandin, prostacyclin. An intra-arterial catheter was placed in a branch of the main uterine artery to allow administration of the compounds directly into the uterine vasculature. Uterine blood flow was continuously monitored via an electromagnetic flow transducer on the maine uterine arteries. VIP, bradykinin, and prostacyclin were equally potent as vasodilators of the uterine vasculature, while neurotensin and substance P were totally devoid of vasoactivity. Unlike estradiol, bradykinin and VIP produced significant changes in systemic arterial pressure and heart rate, suggesting that these compounds may not have responsible for mediating the uterine vascular response observed after estrogen. However, VIP was a potent uterine vasodilator and was able to totally ablate uterine contractile activity, suggesting that this endogenously occurring polypeptide may be important in regulating uterine hemodynamics and contractile activity.

Changes in cervical compliance at parturition independent of uterine activity.

A new animal model has been developed to measure intrinsic changes of cerivcal compliance during spontaneous parturition or exposure to hormonal manipulation. Intermittent measurements of cervical compliance and continous measurements of uterine and cervical pressure were made during the last month of gestation of nine pregnant ewes. Cervical compliance increased abruptly and dramatically during spontanous and dexamethasone-induced parturition. Maternal progesterone supplementation at parturition inhibited uterine contractions but not the increase in cervical compliance, demonstrating the independence of the two events. The cervix was found to contract rhythmically and vigorously with a gradual decrease in activity as parturition approached.