The relation between fetal heart rate accelerations and fetal movements.

Fetal heart rate (FHR) accelerations associated with fetal movements is considered a sign of fetal well-being. Fetal movements as felt by the pregnant woman and visualized by real-time ultrasonography were correlated to FHR accelerations in 52 normal and high-risk pregnant women. All fetal movements felt by the mother or seen in the real-time ultrasonography were associated with large FHR accelerations (more than 15 beats per minute lasting 15 seconds or more) or small accelerations (fewer than 15 beats per minute). The large accelerations were associated with 78.6% of fetal movements felt by the mother and 99.6% of fetal movements seen by real-time ultrasonography. The small accelerations were associated with 52.9% of fetal movements felt by the mother and 82.4% of fetal movements seen by ultrasonography. Mothers felt 75.7% of fetal movements seen by real-time ultrasonography. It was concluded that fetal movements could be verified by existence of large accelerations on the FHR tracing.

Maternal-paternal histocompatibility: lack of association with habitual abortions.

Class I human leukocyte antigens (HLA-A, -B) and class II (HLA-DR) antigens were determined in 60 and 30 carefully selected couples with multiple abortions, respectively. The study group was compared with fertile couples with no history of abortion and with a control group consisting of randomly matched women and men from our laboratory cell panel. No significant deviation from the calculated control mating frequencies was observed in the group with habitual abortions. When the study and control couples were grouped by ethnic origin into Ashkenazim and non-Ashkenazim, the frequencies of shared HLA-A, -B, and -DR antigens were similar in both groups. These results do not confirm the observations of greater HLA compatibility between partners of aborting couples reported by other laboratories. Moreover, the results of an informative family in which the woman, after three consecutive spontaneous abortions, conceived and bore a healthy male infant genotypically HLA-identical to his mother are presented. Taken together, these results challenge the concept that compatibility in determinants of the major histocompatibility complex have a major role in habitual abortions.

Histoincompatibility in couples with unexplained infertility.

Class I human leukocyte antigens (HLA-A, -B) and class II (HLA-DR) antigens were determined in 18 carefully selected couples suffering from unexplained infertility and subsequently compared with 30 normal fertile couples with no history of secondary sterility and with a control group consisting of randomly matched women and men from our laboratory cell panel. No significant differences in the frequencies of HLA antigens were detected between infertile and control groups. The frequency of shared HLA-A, -B, and -DR antigens among members of the couples was similar in all the groups. Finally, the one-way mixed lymphocyte culture showed normal reactivity of both infertile parental pairs in all combinations tested.

Mixed lymphocyte reactivity nonresponsiveness in couples with multiple spontaneous abortions.

We have endeavored to ascertain the possible existence of deviant recognition of antigens controlled by the major histocompatibility complex by lymphocytes originating in couples with a history of multiple spontaneous abortions of unknown cause. Human leukocyte antigen (HLA) typing, as well as one-way mixed lymphocyte culture (MLC) tests, were performed on 33 couples with multiple spontaneous abortions and subsequently compared to 30 fertile couples with no abortion history. No significant differences in the frequency of HLA were detected between the fertile and infertile groups. The frequencies of shared HLA-A and -B antigens among members of the couples were similar in both groups. In 70% of the cases studied, the husbands revealed a depressed cellular response to their respective wives; whereas reactivity to cells from other women proved normal. However, the response of allogeneic controls to these infertile women was normal. This implies that women with multiple abortions are not poor stimulators. The specific one-way decrease in the MLC reactivity appeared to be mediated by female-derived suppressor mechanisms and may be considered as one of the causes of the interrupted development of pregnancy in vivo.

Cellular immunity in human milk.

The responses of human milk lymphocytes (MIL) to a variety of immunogenic stimuli were studied and compared to those of peripheral blood lymphocytes (PBL) from the milk donors. MIL showed a decreased proliferative response to mitogens and allogeneic leukocytes in vitro but displayed the ability to stimulate alloreactivity equivalent to PBL. Neither pretreatment with cell-free autologous milk nor co-cultured MIL were capable of suppressing the proliferative responses of PBL. Moreover, macrophages isolated from milk and pulsed with soluble antigen or allogeneic cells effectively induced proliferation by peripheral blood T cells whereas the response of milk nonadherent cells to antigen presented by peripheral macrophages was very low. MIL respond better to pathogenic enteric E. coli than PBL not as well as PBL to Yersinia enterocolitica. Treatment of MIL with monoclonal antibodies cytotoxic for T cells abolished their response to bacterial antigens. Application of an anti HLA class II antigen monoclonal antibody to mixed lymphocyte or lymphocyte-bacteria cultures resulted in substantial inhibition of the MIL response similarly to that of PBL. The relevance of these data to the immunological needs of the neonate are discussed.

Antigen-presenting cells in human decidual tissue.

The responses of peripheral blood human T lymphocytes supported by decidual antigen-presenting cells (DAPCs) to a variety of immunogenic stimuli were studied and compared to those of T cells supported by peripheral blood antigen-presenting cells (PAPCs). Antigen-presenting cells were isolated from early normal decidual tissue or peripheral blood by elution with ethylenediamine tetraacetic acid of cells that after Ficoll-Paque separation bear receptors for all have bound to fibronectin. DAPCs pulsed with soluble or particulate antigens induced proliferation of T cells with an efficiency equivalent to PAPCs. Decidual tissue APCs also showed the ability to stimulate auto- and alloreactivity. Treatment with anti-human lymphocyte antigen (HLA) class II antibody and ultraviolet radiation resulted in substantial inhibition of the accessory cell function of DAPCs as well as of PAPCs. Bromodeoxyuridine and light treatment of alloreactive T cells generated in vitro was used to demonstrate that DAPCs primed with a synthetic polypeptide antigen (T,G)-A-L can stimulate only HLA class II-compatible T lymphocytes.

Human leukocyte antigens (HLA) class I and class II on sperm cells studied at the serological, cellular, and genomic levels.

The expression of human leukocyte antigens (HLA) on highly purified human ejaculated sperm cells was studied using the sensitive enzyme-linked immunosorbent assay (ELISA) technique and a wide panel of monoclonal antibodies to class I and class II HLA. In addition, the stimulatory capacity of these cells was tested in mixed cultures of lymphocytes and spermatozoa, and the levels of RNA homologous to the HLA class I and class II genes were determined. The results obtained using the ELISA indicate that the class I and class II HLA serologically defined antigens are weakly expressed on the cell surface of the mature spermatozoa. Highly purified sperm cells consistently stimulated heterologous lymphocytes but not when HLA-DR compatibility was observed between stimulator and responder. The proliferative response of lymphocytes induced by sperm cells was lower than the response obtained in a lymphocyte-lymphocyte combination, though the kinetics of the response were similar in both cases. In addition, it was found that spermatozoa contained RNA species homologous to HLA class II DR beta and DQ beta genes sequences but not to HLA class I sequences. The levels of these RNA species were significantly reduced after interferon stimulation. Lymphocytes that served as positive control were found to contain RNA complementary to both HLA class I and class II genes.

Postmenopausal pneumococcal tubo-ovarian abscess.

Streptococcus pneumoniae is an uncommon cause of infection in the female genital tract. An unusual case of postmenopausal pneumococcal tubo-ovarian abscess is presented. The pathogenesis of this infection probably entailed the ascent of bacteria from the vagina to the internal genitalia; there was no evidence of infection of the bloodstream or gastrointestinal tract.

Acute effect of prenatal pethidine administration on human fetal brain cyclic AMP levels and ornithine decarboxylase activity.

The acute effect of pethidine administration on cAMP levels and ornithine decarboxylase (ODC) activity of fetal human brain from mid trimester abortion was studied. Both activities remained at the low level up to 9 h after intravenous injection of the drug to the pregnant mother. Our data suggest that pethidine causes at least temporary alterations in the cAMP levels and ODC activity of the fetal developing brain.

Postpartum restoration of pregnancy-induced cholecystoparesis and prolonged intestinal transit time.

Pregnancy-induced cholecystoparesis and prolonged intestinal transit are well known, but their duration after delivery and any relation to the rapid decline of serum progesterone have not been studied in the early postpartum period. We studied gallbladder and small intestinal motor function in 10 women during the third trimester of pregnancy and in the second and fourth days postpartum, comparing the results to a control group of 8 women during the follicular phase of the menstrual cycle. Gallbladder motor function was evaluated by real-time ultrasonography and intestinal transit time was measured by the lactulose hydrogen breath test. Postpartum correction of gallbladder and intestinal motor function is early and is initially related to the fall of serum progesterone. Other as yet unknown mechanisms operate later to achieve normalization of gallbladder motor function.

The diagnostic value of pharmacodynamic tests in the hyperprolactinaemic syndrome.

Patterns of prolactin (PRL) secretion were studied in a group of 18 hyperprolactinaemic patients with galactorrhoea and menstrual disorders and in a control group of thirty-two women in the early puerperium (24 h after a normal delivery) following provocative (TRH and Chlorpromazine) and suppressive (L-Dopa and bromocriptine) stimuli. Five out of the eighteen hyperprolactinaemic patients tested had radiological evidence of a pituitary tumour, and two were treated surgically. The early puerperium patients with elevated basal PRL levels (100--700 ng/ml) demonstrated a significant PRL response to the various treatments. On the other hand, in the hyperprolactinaemic group, an impaired PRL response to TRH, Chlorpromazine and L-Dopa was noted in patients with basal PRL levels higher than 30 ng/ml, whereas bromocriptine suppressed effectively PRL levels in all the hyperprolactinaemic patients tested irrespective of their basal PRL concentrations. The ratio between the fall in PRL concentrations (as percent of the baseline) after L-Dopa administration (delta%L) versus the PRL decrement after bromocriptine treatment (delta%B) was calculated. In the early puerperium group with normal pituitary prolactin secreting cells this ratio was equal to 0.8. In the hyperprolactinaemic group, the five patients with radiological evidence of a pituitary tumour had significantly lower ratios ranging from 0.2 to 0.57. These data suggest that in terms of prolactin release, prolactin producing tumour cells are intrinsically refractory to hypo thalamic dopaminergic signals. The calculation of individual delta%L/delta%B ratios may serve, therefore, as a valuable indicator for early detection of autonomous pituitary prolactin secreting cells and for evaluation of the extent of the pituitary lesion.

Histocompatibility antigens, mixed lymphocyte reactivity and severe preeclampsia in Israel.

In the present study we have attempted to ascertain the possible existence of an association between antigens of the major histocompatibility complex (MHC) and development of severe preeclampsia (PE). HLA-A, B, C, DR antigens as well as reactivity in one-way mixed lymphocyte culture (MLC) were studied in 40 couples with severe PE, and subsequently compared to 30 normal fertile control couples. No significant differences in the frequencies of HLA antigens were detected between PE and control couples. The frequency of shared HLA-A, B and DR antigens among members of the couples was similar in both groups. The one-way MLC showed normal reactivity of both parental pairs in all combinations tested. Consequent to our data we are unable to support the suggestion that the MHC affects the susceptibility to develop severe PE.

Ranking risk factors for perinatal mortality. Analysis of a nation-wide study.

This paper analyses data from the Israeli nationwide perinatal census, with the aim of revealing the possible causes of perinatal death, and to assess the effects of risk factors, using a logistic regression analysis. The analysis provided an estimate of the net effect of each characteristic independently, thus identifying high-risk pregnancies that should be monitored with greater intensity. Five variables were found to have a significant effect on perinatal death. Among these, in order of decreasing risk: fetal presentation, maternal diseases complicating pregnancy, number of fetuses, ethnic origin, and maternal age. Other variables such as parity, standard of hospital, the mother's country of birth and domiciliary circumstances, did not significantly affect perinatal mortality.

Gonadotrophin release in ovariectomized patients. I. Suppression by clomiphene or low doses of ethinyl oestradiol.

Administration of clomiphene citrate (150 mg/day) for 5 days to twenty-four ovariectomized patients and seven normal female patients evoked a significant release of FSH and LH in the normal control group and suppressed the gonadotrophin secretion in the castrated patients. A similar suppressive effect on gonadotrophin secretion was noted in eight ovariectomized patients treated for 10 days with low doses (50 microgram/day) of ethinyl oestradiol. It is suggested that in the ovariectomized hypoestrogenic patients, clomiphene acted as an oestrogen, suppressing by a negative feedback action gonadotrophin release in a way similar to ethinyl oestradiol. In the normal control group with an adequate steroid environment, clomiphene acted (probably at the hypothalamic level) as an oestrogen antagonist and stimulated gonadotrophin secretion. In view of our findings, it seems as if the ability of anovulatory patients to respond to clomiphene treatment by increased gonadotrophin secretion depends upon the absolute concentration of the compound in the different organs and by the quantitative relation of clomiphene to the endogenous oestrogens.