ABSTRACT
INTRODUCTION: Mechanisms mediating preeclampsia (PE) are unclear. Endogenous digitalis-like factors (EDLFs) are sodium pump (SP) inhibitors implicated in essential hypertension, but not fully explored in PE. This study asks whether EDLFs are present and increased in PE and considers their source. METHODS: EDLF in sera and placentas from third trimester women with uncomplicated pregnancies or PE was assessed by a Rb(+) uptake assay. A digoxin antibody Fab fragment (Digibind) known to inactivate EDLFs was also used to assess EDLFs. RESULTS: PE serum caused significantly more SP inhibition than serum from uncomplicated pregnancies. This inhibition was concentration-dependent and reversed by Digibind. Serum from uncomplicated pregnancies showed no concentration-dependence or reversal with Digibind. Placental homogenates from control women showed little SP inhibition, but homogenates from PE women showed marked SP inhibition reversed by Digibind. CONCLUSION: These studies evidence EDLF in PE serum. Additionally, PE placentas have high EDLF and may represent a source.
Subject(s)
Cardenolides/antagonists & inhibitors , Immunoglobulin Fab Fragments/pharmacology , Myometrium/metabolism , Placenta/metabolism , Pre-Eclampsia/metabolism , Saponins/antagonists & inhibitors , Sodium-Potassium-Exchanging ATPase/metabolism , Blood Proteins/metabolism , Cardenolides/metabolism , Cells, Cultured , Dose-Response Relationship, Drug , Erythrocytes/drug effects , Erythrocytes/metabolism , Female , Humans , Hypertension, Pregnancy-Induced/drug therapy , Hypertension, Pregnancy-Induced/metabolism , In Vitro Techniques , Myometrium/drug effects , Pre-Eclampsia/drug therapy , Pregnancy , Pregnancy Trimester, Third/metabolism , Rubidium/pharmacokinetics , Saponins/metabolismABSTRACT
OBJECTIVE: The purpose of this study was to compare postoperative morbidity in patients who underwent cesarean delivery with and without elective appendectomy. STUDY DESIGN: Subjects who underwent cesarean delivery were assigned randomly by computer-generated randomization to either standard cesarean delivery or cesarean delivery with appendectomy. Primary variables that were measured were operative times and markers of morbidity. Secondary outcome was appendiceal pathologic condition. RESULTS: Ninety-three subjects whose condition required cesarean delivery from July 2002 to May 2006 were enrolled (control subjects, 48; active subjects, 45). Operative time in the study group was increased by 8.8 minutes (P < or = .028). Postoperative morbidity findings were similar. Pathologic evaluation revealed 9 abnormalities that included acute appendicitis in 2 patients. CONCLUSION: Elective appendectomy at the time of cesarean delivery does not increase inpatient morbidity. Consideration can be given safely to elective appendectomy at the time of cesarean delivery in selected cases, such as women with palpable fecaliths and/or an abnormal appearing appendix, a history of pelvic pain, endometriosis, or anticipated intraabdominal adhesions.