Evidence for the promoting role of the intra-uterine kinin release in the development of late hypertonic saline-induced abortion.

Blood plasma kininogen (K), kininases (KS), kallikrein (KK), prekallikrein (PKK), and PGF2a were estimated in the common circulation of pregnant women during late saline-induced abortion and also in retroplacental blood after foetus delivery. The results provide evidence for intra-uterine kinin release from circulating blood K by locally activated KK from the very beginning of abortion. The greatest kinin release coincided with the strongest KS activity decrease at the time of foetus delivery. The pre-abortive KS levels correlated directly with abortus duration. Uterine PG biosynthesis was activated, but appeared to be a secondary process.

PIP: Although human kininogen involvement in hormonal homeostasis during pregnancy and activation of full-term delivery has been documented, the role of intrauterine kinin release in saline-induced late abortion has not been explored. Thus, kinin-related components in the circulation of 53 women with second-trimester (16-27 weeks) hypertonic saline-induced abortions and 20 nonpregnant controls were investigated. Observed were increases in both inactive precursors such as kininogen (K) and prekallikrein (PKK) and the active enzymes kallikrein (KK) and kinases (KS). The prostaglandin (PG) F-2 alpha-KK level in abortion patients did not differ from that in controls. The period from saline instillation to delivery of the fetus (26.5 +or- 2.4 hours) was accompanied only by K and KS changes; these levels decreased simultaneously, reaching their lowest value at the time of fetal expulsion. A 6-fold increase of KK-like activity was detected at fetal expulsion. Thus, the greatest contractile activity of the uterus coincided with the highest concentrations of free kinins and their longest life-time in the systemic circulation. The duration of abortion was directly associated with KS activity level, suggesting that kinins can be used to estimate abortion duration. Tissue KK synthesized in human myometrium and endometrium is considered responsible for local intrauterine kinin release after saline instillation. Finally, a sharp PGF-2 alpha increase (3.6-fold in the systemic circulation and 33-fold in retroplacental blood) was observed at the time of fetal expulsion. The high myometrial contractile activity at the final stage of saline-induced abortion appears to be achieved through the combined effects of locally released kinins and kinin-stimulated prostaglandins.

[The significance of genital mycoplasmas in the etiology of puerperal endometritis]. / Znachenie genital'nykh mikoplazm v étiologii poslerodovogo éndometrita.

The rate of genital Mycoplasma isolation from the uterine cavity was studied in 147 puerperae (80 ones with a normal course of the puerperium and 67 with acute postpartum endometritis). Mycoplasma were isolated from the metroaspirate in 11.3% of puerperae in whom the postpartum period ran a normal course; M. urealyticum were found in 8.8% and M. hominis in 2.5% of cases. In endometritis Mycoplasma were isolated from the infection focus 2.5 times more often, i.e. from 28.4% of patients with postpartum endometritis (M. urealyticum were detected in 9.0% and M. hominis in 19.4% of cases). Mycoplasma were the sole agents of endometritis in 9.0% of patients. Hysteroscopic and morphologic studies helped verify the contribution of genital Mycoplasma to the development of acute postpartum endometritis in 19.4% of the patients. Therefore, virtually every fifth patient with postpartum endometritis was in need of purposeful antimycoplasma therapy with tetracycline.

[Analysis of lochial acid-base equilibrium in an uncomplicated course of the postpartum period and in endometritis]. / Analiz kislotno-osnovnogo sostoianiia likhii pri neoslozhnennom techenii poslerodovogo perioda i pri razvitii éndometrita.

Lochial acid-base status was analyzed in 45 puerperants in whom the postpartum period ran an uncomplicated course or was complicated by endometritis. The normal course of the puerperium is associated with the development of metabolic acidosis in the uterine cavity, and this acidosis is completely compensated for at the expense of gas alkalosis. In slight endometritis metabolic acidosis augments, and grave endometritis is associated with the development of marked acidosis at the expense of the development of tissue hypoxia in the presence of metabolic acidosis.

[Structural changes in the endometrium of puerperae with high risk of development of endometritis in the postpartum period]. / Strukturnye izmeneniia éndometriia u rodil'nits s vysokim riskom razvitiia éndometrita v poslerodovom periode.

The endometrium of 72 puerperae referred to a high-risk group in respect of developing infectious complications was examined on days 3-18 of the puerperium. The periods of epithelialization and regeneration onset in abnormal course of the puerperium were detected, and the morphologic criteria of these processes specified. In cases with cesarean sections these processes started 2-3 days later than after spontaneous delivery. Bacteriologic examination of the uterine cavity contents is an indirect test for the detection of an infection; the final diagnosis may be made only after a comprehensive assessment of the endometrial status.

[Clinical-morphological parallels in postpartum endometritis]. / Kliniko-morfologicheskie paralleli pri poslerodovom éndometrite.

Clinicomorphologic parallels were studied in 45 puerperants with postpartum endometritis. This condition was histologically confirmed in 42 of the 45 patients with its clinical symptoms (in 100% of patients with the grave, in 95% with the medium-severity, and in 83% of those with the benign form of the disease). The authors came to the conclusion that the severity of postpartum endometritis was directly dependent on the extent and depth of the uterine wall involvement in the inflammatory process. By the end of treatment the morphologic signs of inflammation persisted in 40% of patients even without clinical signs of endometritis. Such women should be referred to a group at high risk of developing chronic endometritis.

[Partial separation of sutures of the uterus after cesarean section (diagnosis and treatment tactics)]. / Chastichnoe raskhozhdenie shvov na matke posle kesareva secheniia (diagnostika i taktika lecheniia).

Echography supplemented by hysteroscopy helped detect signs of partial separation of the sutures on the uterus in 12 of 33 patients with grave endometritis following cesarean section. Therapeutic policy in such cases should be based on rational etiotropic antibiotic therapy and active local treatment of the involved focus (surgical treatment of the uterine cavity walls, drainage of the uterus, local multicomponent ointments with a hydrophilic base). The treatment helped preserve the uterus and resulted in complete cure in 11 of the 12 cases.

[The importance of cytological study of lochia in assessing uterine function in the puerperal period]. / Znachenie tsitologicheskogo issledovaniia lokhii v otsenke sostoianiia matki v poslerodovom periode.

Cytologic analysis of lochia in 118 puerperae helped distinguish 5 types of cytograms. A normal postpartum period is characterized by a gradual transition from an inflammatory to regenerative type. Subinvolution of the uterus is associated with a prolonged persistence of the inflammatory regenerative type, this pointing to deceleration of endometrium purification processes. The inflammatory, degenerative-inflammatory, and necrotic cytogram types were characteristic of endometritis of varying severity. The necrotic cytogram type was found the most prognostically unfavorable.

[Diagnostic value of lochial pH, pCO2,and pO2 in puerperal endometritis]. / Diagnosticheskoe znachenie opredeleniia pH, pCO2 i pO2 lokhii pri poslerodovom endimetrite.

A new method has been developed for rapid diagnosis of puerperial endometritis, based on measurements of lochial pH, pCO2, and pO2. Endometritis development is associated with acidosis in the uterine cavity (pH 6.8-7.2), elevation of pCO2 to make 40-70 mm Hg, and reduction of pO2 to make 40-80 mm Hg. The degree of these shifts is in direct relationship with the inflammatory process severity. The method is simple, almost noninvasive, and quite reliable.

[Diagnostic value of Doppler ultrasonography in the evaluation of the status of uterine blood flow in puerperium]. / Diagnosticheskoe znachenie dopplerometrii v otsenke sostoianiia matochnogo krovotoka v poslerodovom periode.

A study of 118 puerperants+ revealed that Doppler metry objectively evaluated the artery blood flow in the postpartum uterus. There was a progressive increase in uterine vascular resistance in the uncomplicated postpartum period following spontaneous labour, whereas there was a reduction in peripheral resistance in the endometritis-complicated period, which caused a rise in the end-diastolic blood flow. Postpartum uterine blood flow following cesarean section displayed low peripheral resistance in the presence or absence of an inflammatory process.

[Substantiation of active surgical tactics for patients with puerperal endometritis]. / Obosnovanie aktivnoi khirurgicheskoi taktiki vedeniia bol'nykh s poslerodovy éndometritom.

An active surgical tactics for managing patients (uterine wash and its cavity content vacuum aspiration) was applied in 34 patients with postnatal endometritis. Echography and hysteroscopy demonstrated that in 28 of 34 patients, the endometritis developed in the presence of pathological involvements into the uterine cavity, which made the use of surgical endometrial treatment justifiable. In addition, the surgical treatment substantially decreased the bacterial dissemination of the content in the uterine cavity. The proposed procedure enabled uterine extirpation to be avoided in 5 of 6 patients with partial suture inadequacy.

[Genital Mycoplasma as a risk factor of obstetric and perinatal pathology]. / Genital'nye mikoplazmy kak faktor riska razvitiia akusherskoi i perinatal'noi patologii.

The paper gives the results of the study into genital Mycoplasma in 1,200 females and 254 newborns and provides strong evidence for the fact that there is a relationship between the Mycoplasma carriage and the inflammatory urogenital processes. It also shows that M. hominis and Ur. urealyticum may persist in the endometrium of females suffering from isthmo-cervical insufficiency. Genital Mycoplasma have been found to play an etiological role in intrauterine infection in premature neonates and in inflammatory processes (endometritis, wound infection following cesarean section) in parturients.

[Artificial late abortion for medical genetic indications]. / Iskusstvennoe preryvanie beremennosti v pozdnie sroki po mediko-geneticheskim pokazaniiam.

Late abortions have been induced for genetic indications in 96 women using intra-amniotic administration of 20% sodium chloride or Enzaprost. The results were compared within this group and with a control group of 90 women whose pregnancies were terminated for other indications at similar dates and with the same agents. The use of 20% sodium chloride was associated with significantly higher blood loss and greater lengths of abortions. Patterns and rates of complications were comparable in both groups. These data suggest a utility of 20% sodium chloride and, especially Enzaprost, in late pregnancy termination for genetic indications.

[The importance of echography and hysteroscopy in the diagnosis and basis of a rational therapy for intrauterine pathology after labor]. / Znachenie ékhografii i gisteroskopii v diagnostike i obosnovanii ratsional'noi terapii vnutrimatochnoi patologii posle rodov.

Echography with hysteroscopy has been employed in 40 mothers with a complicated postpartum period. Ultrasound diagnosis of intrauterine disease is technically simple, noninvasive and efficient in measurement of the uterus and identification of abnormal inclusions in the uterine cavity. Hysteroscopy allows characterization of the abnormal intrauterine inclusions and evaluation of the endometrium. In addition, hysteroscopy enables additional diagnostic and therapeutic procedures. This study resulted in a protocol of postpartum examination of patients using echographic and hysteroscopic diagnostic methods.

[Artificial termination of pregnancy in late periods]. / Iskusstvennoe preryvanie beremennosti v pozdnie sroki.

PIP: Literature data on current methods of induced abortion during the 2nd trimester are reviewed with special emphasis on the use of intraamniotic administration of hypertonic saline solution. A 20% saline is injected during amniocentesis either intra-abdominally or through the vagina; the optimum time period for pregnancy termination is 21-23 weeks of gestation. In the majority of patients, miscarriage occurs within 24-36 hours. The incidence of complications after administration of 20% saline ranges from 1.7-2.18%. Complications include hypernatremia, hemolysis, anuria, coma, seizures, incomplete abortion, hemorrhage, and inflammatory pelvic disease. Contraindications for pregnancy termination using hypertonic saline include cardiovascular diseases, central nervous system diseases, kidney diseases, late pregnancy toxemias, presence of postoperative cicatrix on the uterus, and placenta previa. The mechanism of abortifacient action of hypertonic saline may be associated with stimulation of the synthesis of endogenous prostaglandins (PG). The findings that PG can stimulate uterine contractions prompted clinical trials of PG as abortifacient agents. Longterm iv administration of PGF2 alpha and PGE during 2nd trimester was found to be associated with serious complications (nausea, vomiting, diarrhea, phlebitis at the site of vein puncture). For this reason, the method of iv administration of PG was abandoned. Intra-amniotic administration of PGF2 alpha (40-50 mg) was shown to induce abortion in 82-91% of the patients within 48 hours after injection. The incidence of hemorrhage and rupture of the cervix uteri after PG administration was significantly greater than that after saline injection. The intramuscular and vaginal administration of synthetic PG alone or in combination with Laminaria was shown to provide the most effective and safe method of induced abortion during the 2nd trimester.^ieng