Immunologic and biochemical factors in hyperemesis gravidarum with or without hyperthyroxinemia.

OBJECTIVE: This study was set up to investigate the relationship between immune process and high levels of human chorionic gonadotropin-beta (betahCG) in hyperemesis patients with or without hyperthyroxinemia. METHODS: betahCG, immune parameters and thyroid related hormones were assayed in hyperemesis patients and in controls. RESULTS: Mean serum betahCG, fT4 and TSH levels were significantly higher in hyperemesis patients than in controls (p<0. 01, p<0.01, p<0.05, respectively). Further, immune parameters regarding IgG, IgM, C3, C4 and lymphocyte count were significantly higher in patients than in controls (p<0.05, p<0.01, p<0.01, p<0.05, p<0.01, respectively). In hyperemesis patients with hyperthyroxinemia, mean serum betahCG, IgG and IgM were significantly higher than in hyperemesis women without hyperthyroxinemia (p<0.001, p<0.05, p<0.05, respectively). BetahCG was positively correlated with fT4 (r = 0.45, p<0.05), with lymphocyte count (r = 0.47, p<0.01), with IgM (r = 0.38, p<0.05) and with C3 (r = 0.40, p<0.05) in hyperemesis patients. A negative correlation between betahCG and TSH (r = -0.43, p<0.05) was noted in the hyperemesis group. Free T4 showed a positive association to IgM (r = 0.49, p<0.01), to IgG (r = 0.40, p<0.05), to lymphocyte count (r = 0.45, p<0.05). CONCLUSION: Immunologic activity in pregnancy may have an effect or role on the stimulatory mechanism of betahCG in hyperemesis patients with or without hyperthyroxinemia.

Prophylaxis of the occurrence of hyperbilirubinemia in relation to maternal oxytocin infusion with steroid treatment.

This study was carried out to investigate the steroid prevention on the occurrence and the severity of red blood cell destruction by the effect of oxytocin usage for labor induction. Venous cord blood was collected from the pregnancies who had oxytocin-induced or augmented labors (20), oxytocin-infused deliveries with steroid use (20), deliveries without oxytocin use (20) and cesarean sections (20). Evaluation of the data showed significant increase in serum bilirubin level, serum lactic dehydrogenase activity, erythrocyte fragility and reticulocyte count (p < 0.0083), and a significant decrease in hemoglobulin concentration, packed red cell volume fraction (p < 0.01) in groups with labor induction or augmentation with oxytocin in comparison to deliveries with oxytocin plus steroid use and the two other methods of delivery. Moreover, with regard to the above data, no significant difference was observed between the deliveries other than oxytocin-only use. Mean corpuscular volume in the oxytocin group was apparently (not significant) higher than the steroid group. The results of this study suggest that the use of 16 mg dexamethasone 21-phosphate at the beginning of the induction or augmentation of labor with oxytocin, followed by an additional 4-mg dose 4 h later intravenously, is advantageous for the prevention of erythrocyte destruction.

Cervicovaginal washing prolactin assay in prediction of preterm delivery.

OBJECTIVE: Our purpose was to determine the utility of cervicovaginal washing prolactin assay in prediction of preterm birth in women without rupture of membranes. METHODS: Sixty-six women with normal singleton pregnancy were submitted to cervicovaginal washing and serum prolactin assays. The latency period to delivery and gestational age at admission and at delivery were also recorded. According to uterine contractions and obstetrical history regarding the previous preterm delivery, the pregnant women were divided into 4 groups: 18 symptomatic (group 1) and 15 asymptomatic (group 2) pregnancies who had previously had preterm delivery, and 18 symptomatic (group 3) and 15 asymptomatic (group 4) pregnancies without a history of prior preterm delivery were enrolled in the study. RESULTS: The cervicovaginal washing prolactin concentrations were significantly higher in groups 1 and 3 than in group 4 (P < 0.0083). With respect to the latency period to delivery and the birth weeks, groups 2 and 4 were significantly higher than groups 1 and 3 (F < 0.0001). In the evaluation of the whole group, a significant negative correlation was observed both between cervicovaginal washing prolactin concentrations and the lapsed times to delivery, and the gestational ages at delivery. The finding of a cervicovaginal washing prolactin value exceeding 50 ng/ml in the 12 days preceding preterm delivery had sensitivity, specificity, positive and negative predictive values of 65%, 95%, 86%, and 81%, respectively. CONCLUSIONS: A cervicovaginal washing prolactin value more than 50 ng/ml precedes preterm delivery within 12 days at > 29 weeks. The easy application, the good feasibility, the success in identifying pregnancies at risk for preterm labor, and the cost effectiveness suggests cervicovaginal washing prolactin assay as a biochemical marker for preterm delivery.

Estrogen dermatitis.

The aim of the present study was to evaluate the estrogen dermatitis of women who have chronic skin disorders with exacerbations or premenstrual dermatitis in a cyclic pattern. Twenty-three women exhibiting skin disorders of pruritus, urticaria, eczema, papulovesicular eruption, hirsutism-acne with hyperpigmentation (hirsutism and/or its related disorders such as acne) and 18 healthy control subjects were included in the study. Sensitivity to estrogen was described in 14 of 23 women. Of the 14 estrogen sensitive women, nine had a premenstrual flare of their skin lesions and five had a chronic dermatitis with exacerbations. In the evaluation of endocrine profile, mean serum testosterone and LH levels of the patient group were significantly higher than controls (2.814 +/- 0.839 vs. 1.561 +/- 0.645 nm/l, P < 0.001; 10.843 +/- 2.538 vs. 4.539 +/- 1.215 IU/l, P < 0.0001). The LH/FSH ratio of the patient group was also significantly higher than controls (1.765 +/- 0.329 vs. 0.810 +/- 0.0116, P < 0.0001). Mean serum progesterone level of the patient group was significantly lower than the control group (0.499 +/- 0.201 vs. 0.977 +/- 0.396 ng/ml, P < 0.001). Hyperandrogenism and anovulation were the two more common outcomes in the patient group. Skin lesions of estrogen sensitive women were all cured with the administration of tamoxifen 20 mg daily for 7 days premenstrually.

Hyperthyroidism in hyperemesis gravidarum.

OBJECTIVE: To evaluate the hormonal and hematologic parameters of 24 patients with hyperemesis gravidarum without evidence of thyroid disease compared with matched controls. METHODS: Twenty-four pregnant women with hyperemesis and 20 control subjects were included in this study. A prospective comparison of hormonal milieu of hCG and thyroid function was performed. RESULTS: Mean serum hCG, fT3, and fT4 levels of patients were significantly higher than those of controls (P < 0.007), while there was no statistically significant difference in terms of TSH. Serum hCG correlated negatively with TSH and positively with fT3 and fT4 in the patient group (r = 0.66, r = 0.70, r = 0.85; P < 0.05, respectively), while there was no relationship between hCG and thyroid functions in controls (r < 0.25). The lymphocyte count of patients was significantly higher than that of controls (P < 0.007), while there were no statistically significant differences in the overall white blood count and the granulocyte count (P > 0.007). The lymphocyte count correlated positively with serum hCG, fT4 and fT3, and negatively with TSH in the patient group (r = 0.73, r = 0.72, r = 0.64 and r = -0.63; P < 0.05, respectively), while there was no relationship between lymphocyte count and serum hCG, fT4, fT3 and TSH in controls (r < 0.25). CONCLUSIONS: Maternal immune recognition of the conceptus and immune response, hypothetically, may be related to the high level of hCG and/or fT4. Patients who have hyperthyroidism in early pregnancy should be assessed for transient hyperthyroidism as it relates to hyperemesis gravidarum.