Assessment of fetal cerebral arterial and venous blood flow before and after vaginal delivery or Cesarean section.

OBJECTIVES: To compare perinatal intracranial arterial and venous blood velocity changes between healthy term neonates delivered vaginally or by Cesarean section and to correlate these changes with cord blood gases and pH values at birth. METHODS: The study involved 43 healthy term neonates who were delivered vaginally (n = 20) or by Cesarean section (n = 23). All fetuses/neonates were examined by Doppler ultrasound to obtain middle cerebral artery (MCA) and cerebral transverse sinus (Tsin) Doppler waveforms on three occasions (before delivery, and 1 h and 24 h after birth). Pulsatility index (PI) and peak systolic velocity (PSV) for MCA and Tsin were measured and compared between neonates who were delivered vaginally or by Cesarean section. Umbilical cord blood samples were analyzed for umbilical artery and vein pH, pO(2) and pCO(2) and values were correlated with MCA and Tsin Doppler indices. RESULTS: MCA-PI increased and MCA-PSV decreased at 1 h after birth, and Doppler measurements returned to predelivery values at 24 h after birth. Tsin Doppler measurements remained unchanged at 1 h and 24 h when compared to predelivery values in both the Cesarean and vaginal delivery groups. There was a negative correlation between Tsin-PI before birth and umbilical venous pH. There was a positive correlation between Tsin-PSV at 1 h after birth and umbilical vein pCO(2). CONCLUSIONS: Cerebral arterial blood velocity decreases immediately after birth and increases within 24 h, probably as part of neonatal adaptation. Cerebral venous blood velocity remains constant during the perinatal period and is likely to be regulated in a different and more complex manner than that of arterial blood velocity. Mode of delivery does not affect cerebral blood velocity.

Immunohistochemical staining of IGF-I, IGF-binding proteins-1 and -3, and transforming growth factor beta-3 in the umbilical cords of preeclamptic patients.

BACKGROUND: To detect the immunoreactivity of insulin-like growth factor-I, insulin-like growth factor-binding proteins-1 and -3 and transforming growth factor beta-3 in the umbilical cords of normal and preeclamptic patients. METHODS: Umbilical cords were obtained from 15 normal and 15 preeclamptic patients. Immunoreactivities were determined using either indirect immunofluorescence or immunoperoxidase techniques on formalin-fixed, paraffin-embedded sections. Staining intensity was graded by a semiquantitative scoring method. The results were compared by Mann-Whitney U-test. RESULTS: The umbilical cords were thinner and the vessels were hypoplastic in the preeclamptic group. Moderate staining intensity for insulin-like growth factor-I, insulin-like growth factor binding protein-1 and -3 and transforming growth factor-beta 3 was observed in normal patients. The preeclamptic group had mild and strong intensities for insulin-like growth factor-I and insulin-like growth factor binding protein-1, respectively, and intensity for insulin-like growth factor binding protein-3 did not change, but diffuse and increased intensity was observed for transforming growth factor-beta 3. CONCLUSION: Changes in the intensity of insulin-like growth factor-I and its major binding protein and the transformation of growth factor-beta 3 may play a role in the pathogenesis of preeclampsia by altering the structure and responsiveness of the umbilical cord.

Clomiphene citrate does not adversely affect endometrial leukemia inhibitory factor levels.

The aim of this study was to compare endometrial leukemia inhibitory factor (LIF) levels in spontaneous and clomiphene citrate (CC)-induced cycles of patients with unexplained infertility. The patients were followed in two consecutive cycles. Endometrial samples were obtained 7 days after ultrasonographic evidence that ovulation has occurred during the spontaneous cycle, then the patients were induced with CC from day 5 to day 9 during the subsequent cycle with 50 mg/day, and ovulation monitoring and endometrial biopsy were performed in the same manner. The samples were obtained using a Pipelle biopsy device without using local anesthesia, and kept in formaldehyde solution until the day of measurement. Then they were homogenized in phosphate buffered distilled water, and LIF levels were detected in the homogenized fluid by ELISA method. Endometrial LIF levels were 470 +/- 52 and 501 +/- 45 pg/1 gram wet tissue in spontaneous and CC-induced cycles respectively, revealing no significant difference. Ovulation induction with CC did not adversely affect endometrial LIF levels.

Clomiphene citrate does not affect the secretion of alpha3, alphaV and beta1 integrin molecules during the implantation window in patients with unexplained infertility.

BACKGROUND: The expression of integrin molecules on the endometrium suggests that certain integrins may participate in the cascade of molecular events leading to successful implantation. A prospective, controlled study was carried out to investigate the effect of clomiphene citrate (CC) on secretions of beta1, alpha3 and alphaV integrin molecules in the endometrium of patients with unexplained infertility during the implantation window. METHODS: A total of 40 endometrial samples was evaluated in both spontaneous (n = 13) and ensuing clomiphene-treated cycles (100 mg on days 5-9) and also from fertile women serving as controls (n = 14) during postovulatory 7th or 8th day of menstrual cycle. A semiquantitative grading system (H-score) was used to compare the immunohistochemical staining intensities. Endometrial thickness and serum oestradiol and progesterone concentrations were also measured on the day of sampling. RESULTS: Staining of alpha(v) but not beta1 and alpha3 integrins was significantly less intense in infertile cases than fertile control cases (1.42 +/- 0.12 versus 2.21 +/- 0.13 respectively, P = 0.012) and this was not restored to normal concentrations with treatment. CONCLUSIONS: Our study indicated that cc treatment significantly decreased the endometrial thickness and increased oestradiol and progesterone concentrations. However, secretion of alpha(v), beta1 and alpha3 integrin molecules, which might play a role in implantation, was not affected.

Assessment of the effectiveness of postmenopausal tibolone therapy on neural functions by measuring visual evoked potentials: a placebo-controlled study.

OBJECTIVE: To assess the effect of hormone replacement therapy on neural transmission in postmenopausal women using tibolone by a non-invasive, objective way. STUDY DESIGN: In a randomised, 3 cycle, placebo-controlled study, neurovisual transmission in optic pathways were evaluated by measuring visual evoked potentials (VEP). After neuroophtalmologic examination, eligible subjects were randomised into two groups. Treatment group (n=38) were given tibolone 2.5mg daily continuously for 3 months and control group (n=20) were treated with placebo. A baseline VEP measurement before the treatment and then at the end of first, second and third month were obtained by the EMG-evoked system in the Department of Neurology, University of Celal Bayar, Manisa, Turkey. RESULTS: Data from 31 women from treatment group and 16 from control group were available for evaluation. The mean P(100) latency values, which indicate the transition time period between the optic stimuli and electrical change recorded on the occipital area by the skin electrodes, have showed a significant decrease for the study group (from 100.39+/-0.58 to 97.90+/-0.65 ms, P<0.01) at the end of the first month of treatment according to the baseline values. This difference between two groups has remained constant during the study period. CONCLUSION: The change in latency measurements of VEP, reflecting the functional status in optic pathways from retina to occipital cortex were significantly different in the treatment group than in that of control. We concluded that a facilitating effect of tibolone was observed on neurovisual transmission.

Non-invasive evaluation of the adaptations of cardiac function in the neonatal period: a comparison of healthy infants delivered by vaginal route and caesarean section.

Postnatal adaptations of cardiac hemodynamics in infants born vaginally or by caesarean section may be different. These cardiac functions were evaluated by Doppler echocardiography to assess adaptation differences. Cardiac output, heart rate, stroke volume, mean arterial pressure, total systemic vascular resistance, ejection fraction, and ductus arteriosus diameter were determined and compared at 1, 24 and 72 h of life in 22 infants born vaginally (group 1) and 23 born by caesarean section (group 2). One hour after delivery, heart rate, mean blood pressure, and total systemic resistance were found to be higher in group 1 infants (P < 0.01, P < 0.05, P < 0.05 respectively). Stroke-volume measurements were significantly higher in group 2 (P < 0.05). The ejection fraction and cardiac output values were similar in both groups. At 24 and 72 h, no significant differences were observed in measurements of infants born vaginally or by caesarean section. We did not find a parameter negatively affecting healthy newborns in either mode of delivery. However, under pathological conditions affecting the cardiovascular system at 1 h of life, including perinatal infections and hypoxemia, a lower stroke volume, higher heart rate, higher mean blood pressure, and higher peripheral resistance may cause additional work load to the cardiovascular system in infants born vaginally.

Immunolocalization of transforming growth factor-beta 3 in pregnant human myometrium.

BACKGROUND: Transforming growth factor-beta 3 is a cytokine which is involved in cell growth regulation and differentiation, stimulation of extracellular matrix and modulation of immune responses. The goal of this study was to detect the presence of this cytokine in the myometrium of preterm and term, nonlaboring and laboring patients, and to measure serum levels of interleukin-1 beta (IL-1 beta), IL-6 and IL-8 before cesarean section. METHODS: In this prospective study, we obtained samples of myometrium from the lower uterine segment during elective and emergency cesarean sections (term non-laboring, n=8; term laboring, n=7; preterm non-laboring, n=3; and preterm laboring, n=19) and stained for transforming growth factor-beta 3. Blood was also sampled from the same patients to determine IL-1 beta, IL-6 and IL-8 levels. RESULTS: Different intensities of staining were detected in preterm laboring, term nonlaboring and term laboring groups, but there was no staining in preterm nonlaboring group. We also found a statistically significant difference in IL-6 levels between laboring and nonlaboring groups (p=0.028). CONCLUSION: Different intensities of TGF-beta 3 which appeared in different stages of myometrium made us consider that TGF-beta 3 might prepare myometrium to labor, and IL-6 was more important than the other interleukins in initiation of labor.

Effects of oestrogen replacement therapy on pattern reversal visual evoked potentials.

As a result of a regression in the ovarian functions, oestrogen level in circulation during the menopause drops to 1/50 of its value in the normal reproductive cycle. Excitatory oestrogen increases the sensitivity of the central nervous system to catecholamines by changing the opening frequency of voltage-related L-type calcium channels and augmenting the effect of glutamate; in addition it inhibits the formation of gamma-amino butyric acid (GABA) by the inhibition of glutamate decarboxylase enzyme. It is argued that oestrogen increases transmission in the optic pathways and that oestrogen is responsible for the shorter latency values and higher amplitudes of visual evoked potentials in women. We recorded the monocular pattern reversal visual evoked potentials (PRVEP) of both eyes of 54 post-menopausal women before treatment and of 30 of them after replacement therapy with Tibolon, and of 24 women receiving placebo treatment. The explicit values of P100 latency of right and left eyes before treatment were 98.8 +/- 3.5 and 99.0 +/- 3.3 ms, respectively. The explicit values of P100 latency of right and left eyes after placebo treatment were 98.6 +/- 3.7 and 98.8 +/- 4.0, respectively. The explicit values of P100 latency of right and left eyes after replacement treatment were 94.6 +/- 3.7 and 94.8 +/- 4.0, respectively. We found a statistically significant decrease in the mean PRVEP latencies and a statistically significant increase in mean amplitudes after replacement treatment (P < 0.001) compared with those before treatment and those after placebo treatment. We attributed the changes in PRVEP values after replacement treatment to the action of Tibolon, which acted as a natural sex steroid and speeded the visual transmission time via the widespread receptors in the central nervous system. It is concluded that PRVEP is an objective electrophysiological assessment method in evaluating the efficiency of hormone replacement therapy in post-menopausal women.

Sexual behaviour during pregnancy.

The effects of pregnancy on sexuality were studied in 158 pregnant women. They were surveyed by questionnaire about sociodemographic variables and sexual behaviour. Dyspareunia was common in our study group during pregnancy. Pregnancy had a negative effect on orgasmic quality. Dyspareunia and orgasmic quality influenced coital frequency. Coital frequency declined as the month of the pregnancy increased. Pregnancy is a potent influence on sexuality irrespective of an individual's conditioning.

Primary genital non-Hodgkin lymphoma.

Although genital lymphoma either being an initial manifestation of occult nodal disease or secondary involvement is not uncommon, extranodal lymphoma originating primarily from the genitalia is quite rare. Here, we report a new case of primary genital lymphoma involving the uterus and ovaries, but not the Fallopian tubes. We also wish to emphasize that misdiagnosis of genital lymphoma, either clinically or histologically can occur.

Ovarian pregnancy; relationship to an intrauterine device.

Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted within the ovary. The incidence is 0.5 to 3% of all ectopic gestations. In contrast to patients with tubal pregnancies, traditional risk factors, such as pelvic inflammatory disease and prior surgical procedure upon the pelvis, may not play a role in the aetiology. In the 2 cases reported here, it seems that using an intrauterine contraceptive device was an important factor.

PIP: The etiology of primary ovarian pregnancy is unknown, although an IUD is frequently implicated. This paper presents two cases of primary ovarian pregnancy diagnosed at Dokuz Eylul University in Izmir, Turkey, in 1995 and discusses the pathogenesis in relation to the IUD. In the first case, the woman had used a copper-releasing IUD for 3 years and had had it removed 1 month before presentation. The second woman had been using a Lippes Loop device for 16 years. Ovarian pregnancy was diagnosed only after pathologic examination of the specimen. Both pregnancies were located within the corpus luteum, suggesting that fertilization and nidation occurred at the ovulation site. Although the IUD protects against ectopic pregnancy in the first 24 months of use, the risk increases over time as the reversible foreign-body histologic changes associated with IUD use become established in the Fallopian tube. The preoperative diagnosis of primary ovarian pregnancy is very difficult. It should be kept in mind, however, that ovarian pregnancy is more frequent in ectopic pregnancies associated with IUD use.

Value of intraplacental villous artery Doppler measurements in severe preeclampsia.

Blood flow velocity waveforms were recorded by color Doppler ultrasound from intraplacental villous and umbilical arteries in 20 normal and 23 severe preeclamptic pregnancies. The results of the resistance index measurements in intraplacental villous arteries were 0.51 +/- 0.037 and 0.55 +/- 0.052 in healthy controls and preeclamptics respectively, which was not significantly different. Resistance indices showed a decrease through the umbilical cord from fetus to placenta in both groups. We also noted that Doppler examination of the umbilical cord might be an early indicator of fetal compromise. Detectable intraplacental villous flows were in normal limits even in patients with abnormally high umbilical resistance indices and failure to detect villous artery color Doppler flow signals is probably associated with fetal compromise. We conclude that Doppler measurements from the intraplacental arteries cannot be used in clinical management of patients with severe preeclampsia.

Umbilical coiling index: is it a marker for the foetus at risk?

The aim of this study was to determine the relationship between the number of coils in the umbilical cord and perinatal outcome. The umbilical cords and delivery records of 147 liveborn neonates were prospectively studied. The umbilical coiling index (UCI) of each cord was calculated by dividing the total number of complete umbilical vascular coils by the umbilical cord length. Subjects with UCIs below the 10th percentile, above the 90th percentile, and between the 10th and 90th percentiles were defined as hypocoiled, hypercoiled, and normocoiled, respectively. Several different parameters were used to measure neonatal outcome. The mean UCI was 0.20 +/- 10 (SD). No relationship was noted between UCI and maternal age, gravidity, parity, oligohydramnios, or birth weight. When we compared the hypocoiled group (n = 30) with the normocoiled group (n = 87), we detected a statistically significantly higher incidence of meconium staining, interventional delivery, apgar scores, fetal blood pH and intrapartum fetal heart rate disturbances. As a result, we concluded that the UCI has a strong relationship with perinatal outcome and may be used antenatally as a marker for identifying the fetus at risk.