Asynchronous multiple birth. A report of five cases.

The feasibility of prolonging the delivery interval of the fetus or fetuses in multiple gestations after the preterm delivery of one fetus has been demonstrated. Five clinical reports and a literature review served as the database for this study. Pregnancy was extended in each of five patients with multiple gestations after the extreme preterm delivery of one fetus. Four of the six remaining infants survived. The literature reviewed shows successful survival in 42 of 52 (81%) such asynchronously delivered infants. Use of tocolytic therapy, broad-spectrum antibiotics and cerclage allows pregnancy extension when delivery occurs asynchronously in multiple gestations. The patient's strong desire and full understanding of the potential risks are mandatory before such an endeavor is attempted.

Experimental induction of a toxemia-like syndrome in the pregnant beagle.

A toxemia-like syndrome was induced in pregnant beagles by intraperitoneal inoculation of concentrates prepared from placentas of patients with preeclampsia-eclampsia and hydatidiform mole, which contained an agent, Hydatoxi lualba, that stained in a unique fashion with toluidine blue-O-. The pregnant dogs inoculated with either of these concentrates progressively developed hypertension, eyeground changes consistent with hypertensive retinopathy, proteinuria, disseminated intravascular coagulation, and hepatic dysfunction in addition to intrauterine growth retardation and intrauterine fetal death. Hepatic periportal hemorrhage and glomeruloendotheliosis, lesions usually seen in preeclampsia-eclampsia, were also noted to occur in pregnant beagles inoculated with these concentrates. A significant increased sensitivity to angiotensin II infusion was also noted. The toxemia-like syndrome did not develop in pregnant beagles when inoculated in a similar fashion with concentrates prepared from placentas from normal term pregnancies which were free of Hydatoxi lualba or in nonpregnant beagles inoculated with concentrates containing Hydatoxi lualba. Although the agent was not injected in pure form, the inoculation of concentrates containing Hydatoxi lualba appears to be required for the manifestation of the toxemia-like syndrome.

Observation of an organism found in patients with gestational trophoblastic disease and in patients with toxemia of pregnancy.

This is an initial descriptive report of observations of multiple forms of an organism found in patients with gestational trophoblastic disease and in patients with preeclampsia-eclampsia. The worm-like forms most frequently observed have an average length of 1.0 to 1.5 mm. Larva-like forms have an average length of 150 mu; primordial eggs and egg-like forms in developmental stages range from 7 to 43 mu in diameter; and sperm-like forms are 3.5 mu or slightly smaller in size. These forms have been observed in contact smears prepared from 3 ml samples of peripheral circulating blood from both groups of patients, from trophoblastic tumor tissue, from contact smears prepared from placentas of patients with preeclampsia-eclampsia, and from umbilical cord blood of infants delivered of patients with preeclampsia-eclampsia. The various forms of this organism share morphologic characteristics of several orders of helminths, i.e., hookworms, roundworms and tapeworms. The taxonomy of these forms has not yet been determined. Until the time of taxonomic classification, the various forms will be referred to as Hydatoxi lualba. We have experimental evidence that this organism has biologic activity in BALB/c mice and in beagle dogs.

Association of spontaneous fetal heart rate decelerations during antepartum nonstress testing and intrauterine growth retardation.

Two hundred one patients with high-risk pregnancy and 66 patients with term uncomplicated pregnancy underwent a nonstress test 7 days or less prior to delivery. The incidence of spontaneous fetal heart rate decelerations in the high-risk group was 5.5%. None of the fetuses in the normal group showed this finding. Among those infants presenting with spontaneous decelerations, there was an 18.2% mortality. Disturbances of intrauterine growth were found in 63.6% of cases. The possible metabolic mechanisms and clinical implications underlying this finding are discussed.

Effect of therapeutic levels of magnesium sulphate, methyldopa, hydralazine and phenobarbitone on normal term human trophoblast in vitro.

The development of a technique allowing prolonged culture in vitro of normal term human trophoblast facilitates examining what effects, if any, drugs commonly used in pregnancy may have on placental tissue. Dosages compatible with therapeutic blood levels of magnesium sulphate, methyldopa, hydralazine and phenobarbitone were tested individually in vitro on monolayer cultures of normal term trophoblast. Hydralazine and magnesium sulphate additions resulted in a 100 per cent loss of viability of trophoblast cells. Phenobarbitone caused an 8 per cent decrease in cell viability, while methyldopa caused only a 2 per cent decrease in cell viability.

Normal fetal growth despite persistent amniotic fluid leakage after genetic amniocentesis.

Two women not only lost relatively large amounts of amniotic fluid immediately following genetic amniocentesis, but continued to lose fluid for the remainder of their pregnancies. Periodic ultrasonographic assessment confirmed normal fetal growth and presence of some amniotic fluid. Both women were delivered at term of normal offspring who showed no evidence of fetal deformations. Although amnionitis is a risk, cautious surveillance may permit continuation of pregnancies complicated by copious or persistent amniotic fluid leakage following genetic amniocentesis.

An analysis of maternal transport within a suburban metropolitan region.

Data on 185 infants transported for perinatal and/or neonatal care from suburban metropolitan hospitals were analyzed. Following birth, 100 infants were transferred from community hospitals. A total of 85 infants were transported in utero and delivered at a tertiary (Level III) perinatal center. Survival rate was 90% for infants transported in utero contrasted with 81% for the infant transports. This difference was not significant. When hospitalization cost and length of stay were used as an index of morbidity, there was a significant difference between the two groups. The mean hospitalization cost of survivors was $6,473 for in utero transports compared to $12,208 for infant transports (p less than 0.005). The mean length of stay for in utero transports was 19 days contrasted to 27 days for infant transports (p less than 0.05). The findings of this study indicate that in utero transports resulted in reduced morbidity for infants of high-risk pregnancies.

Morphologic characteristics of the normal term human trophoblast maintained in prolonged in vitro cultures.

The development of a new technique for prolonged in vitro culture of normal human term trophoblast without stromal growth has facilitated the study of the morphologic characteristics of trophoblast in culture. Cytotrophoblast (epithelioid) cells were observed along with subsequent formation of syncytiotrophoblast in vitro. Hormonal assessment of hPL production has confirmed the viability and biologic specificity of the tissue. The morphologic characteristics of normal human term trophoblast maintained in vitro include projections, circular growths and syncytial sprouts. Growth patterns of trophoblast in vitro were similar to those described in vivo.

Observations of trophoblast from normal and pre-eclamptic pregnancies cultured for prolonged periods.

Trophoblastic cells from normal and pre-eclamptic pregnancies have been cultured for prolonged periods of time in vitro. The growth characteristics, morphology and hormone production in vitro were similar in both. These results suggest that given a comparable environment in vitro, trophoblast from both normal and pre-eclamptic pregnancies does not behave differently. It is suggested, therefore, that the changes classically described in placentae from pre-eclamptic pregnancies are probably secondary to maternal disease rather than a reflection of an altered trophoblast.

Time-lapse study of normal human trophoblast in vitro.

Time-lapse photographic observations of normal human trophoblast in vitro were made possible through the development of a new technique that allows for prolonged trophoblast culturing without stromal growth. Y body fluorescence and determinations of human placental lactogen (hPL) were used to confirm the specificity and viability of the cells in culture. Epithelioid cells (cytotrophoblast) with agranular cytoplasm, binucleated moderately granulated cells, and multinucleated heavily granulated syncytial masses were observed. The cytotrophoblast was observed in mitosis, whereas the syncytium showed strand formation and reabsorption, along with mass movement of cells at time of confluency. This technique should stimulate a renewed interest in the in vitro studies of normal human trophoblast.

Reduced urinary estriol levels with erythromycin therapy.

Several pharmacologic agents are known to interfere with urinary estriol levels in pregnancy. This report implicates erythromycin as yet another agent responsible for such interference.

Effect of maternal glucose load on fetal activity.

The effect of a MGL upon fetal activity has been studied in 39 normal and 54 high-risk pregnant patients between 30 and 42 weeks' gestation. The perinatal morbidity and mortality rates were significantly lower in the group showing an increase in fetal activity following a MGL. It is suggested that this may be useful for identifying the fetus at risk.

Fetal heart rate responses to fetal movements.

A classification of fetal heart rate (FHR) responses to fetal movements is based on the study of 210 hours of antepartum cardiotocographic tracings in clinically normal pregnant patients between 30 and 42 weeks gestation. The physiological mechanism underlying the FHR responses to fetal movement are discussed.

Effects of spontaneous and artificial membrane rupture in labour upon fetal heart rate.

This study reports the effects of spontaneous rupture of membranes and artificial rupture of membranes on fetal heart rate patterns during labour in 87 normal and 25 complicated pregnancies. The incidence of early deceleration patterns following membrane rupture was 6.25 per cent during the first 15 minutes and 1.78 per cent after 45 minutes, regardless of whether the pregnancy was normal or complicated. It is concluded that rupture of membranes does not significantly increase the incidence of early deceleration patterns. However, the occurrence of other heart rate alterations such as late decelerations, loss of beat-to-beat variability, changes in base line and tachycardia, need to be investigated further in larger collaborative studies.