Does thermal stress decrease uterine blood flow in hypertensive pregnancies?

The aim of the study was to determine the acute effects of thermal stress on maternal and fetal circulatory responses in normal and hypertensive patients. Therefore we studied 14 healthy pregnant women and 12 women with compromised pregnancies during short-term heat stress using color Doppler ultrasound in addition to conventional follow-up methods. The uterine vascular resistance increased significantly during the exposure in the high-risk pregnancy group without change in the control group. The results of the present study give strong support to our earlier studies that short-term heat stress seems to be safe in uncomplicated pregnancies but may be detrimental in high-risk pregnancies.

Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study.

BACKGROUND: Promising results have been reported from treatment with oral retinoids in patients with severe lichen sclerosus et atrophicus (LSA) of the vulva. OBJECTIVE: The aim of our study was to determine the efficacy of acitretin (20 to 30 mg/day) for 16 weeks in LSA. METHODS: Seventy-eight patients were enrolled into a multicenter, randomized, placebo-controlled, double-blind trial. The primary measure of efficacy was the "responder" rate based on the assessment of characteristic clinical features of LSA of the vulva (pruritus, burning, atrophy, hyperkeratosis, and secondary features such as erosions, ulcers, edema, or lichenification) and on the extent of the lesions. RESULTS: From the 46 patients eligible for efficacy analysis, a significantly higher number of responders was observed in the acitretin-treatment group (14 of 22 patients) as compared with the placebo-treatment group (6 of 24 patients). Typical retinoid adverse reactions were observed in all patients receiving active drug. CONCLUSION: Acitretin is effective in treating women with severe LSA of the vulva.

Association of steroid hormone receptor content and flow cytometric DNA ploidy in endometrial carcinoma.

Flow cytometric DNA ploidy and sex steroid hormone receptor activity was measured in 55 endometrial carcinomas. DNA ploidy was measured on paraffin-embedded specimens and ER and PR activity was measured using both biochemical and immunohistochemical assay. Association of these parameters was tested using logistic regression model. Diploid or near diploid DNA histogram was seen in 40 cases (72.7%). All Grade 1 tumours (n = 15) were diploid whereas 38.5% of Grade 2 (n = 27) and Grade 3 (n = 13) tumours were aneuploid (grade 1 vs Grade 2 and 3, P = 0.0031). The mean value of ER was 109 +/- 120 (SD) fmol/mg protein for diploid tumours and 48 +/- 50 fmol/mg protein for aneuploid tumours (P = 0.0093). The corresponding values for PR were 226 +/- 262 fmol/mg protein and 75 +/- 102 fmol/mg protein (P = 0.0073), respectively. In immunohistochemical assay the mean HSCORE of ER was 45 +/- 77 for diploid tumours and 27 +/- 48 for aneuploid tumours (P = 0.43). The corresponding values for PR were 32 +/- 55 and 22 +/- 56, respectively (P = 0.58). In logistic regression analysis cytosolic PR content was associated with DNA ploidy.

Hydatidiform mole in a 56-year-old woman.

We present a rare case of a hydatidiform mole that occurred in a 56-year old woman. The main symptom was prolonged vaginal bleeding, and the gynaecological examination revealed a markedly enlarged uterus. Sonography revealed a 9 x 15 cm large cystic tumour in the pelvis. At operation, a suspicion of trophoblastic disease was arosen. Serum human chorion gonadotropin was still markedly elevated on the fifth postoperative day. After removal of the uterus and adnexae the recovery and the 3-year follow-up have been uneventful.

Effects of short-term thermal stress on plasma catecholamine concentrations and plasma renin activity in pregnant and nonpregnant women.

OBJECTIVE: The purpose of this study was to find out whether the effects of thermal stress on plasma catecholamines and plasma renin activity are altered by pregnancy. STUDY DESIGN: Nonpregnant (n = 15) and pregnant (13 to 14 weeks, n = 23; 36 to 37 weeks, n = 23) healthy women were examined. Samples were taken before the exposure, in the heat chamber (70 degrees C), and during the recovery. The BMDP statistical software was used. RESULTS: The concentration of epinephrine in plasma increased significantly only in the nonpregnant group. The epinephrine concentrations in the pregnancy groups increased most in the subjects who felt discomfort during or after the exposure. Plasma norepinephrine concentrations increased without significant differences between the groups. Plasma renin activity increased in each group, but the increases were significantly lower in the pregnancy groups as compared with the nonpregnant group. CONCLUSIONS: Pregnancy does not alter the thermally induced increase in norepinephrine release. The adrenaline response is mostly dependent on the mental discomfort. The plasma renin activity response to thermal stress is blunted during pregnancy.

Responses of placental steroids, prostacyclin and thromboxane A2 to thermal stress during pregnancy.

The effect of heat stress on plasma prostacyclin and thromboxane A2 and serum estradiol, estriol and progesterone responses was studied in pregnant and non-pregnant women. Group I consisted of 15 healthy non-pregnant women, group II of 23 women 13-14 weeks pregnant, and group III of 23 women 36-37 weeks pregnant. Blood samples were taken before the heat stress, at the end of the stress (70 degrees C for 20 min) and 20 min and/or 45 min after the end of stress. The rectal temperature increased 0.3-0.4 degrees C. The concentration of progesterone did not change during the experiment but that of estradiol increased by 11% (P less than 0.005) in group II and by 10% (P less than 0.01) in group III after the end of the stress. Estriol increased only in group III (by 12%, P less than 0.005) after the end of the stress and the increase was higher as compared to group II (P less than 0.005). The metabolite of prostacyclin increased only in group III by 15% (P less than 0.05) during the heat stress. The metabolite of thromboxane A2 decreased in group II by 20% (P less than 0.005) at the end of the stress while there was no change in group III. The fetal heart rate reactivity remained unchanged and only few uterine contractions were recorded. The small changes found in the levels of prostanoids and placental steroids in response to heat stress do not seem to have any deleterious effects on fetal well-being. The slightly increased concentration of placental steroids may rather reflect changes in metabolism than an increase in uteroplacental blood flow.

Doppler flow measurement of uterine and umbilical arteries in heat stress during late pregnancy.

The effect of a moderate heat stress (20 minutes 70 degrees C) on uterine and umbilical artery blood flow was studied by continuous-wave Doppler ultrasound in 17 women 36 to 37 weeks pregnant. Maternal heart rate increased on average by 26 beats/minute. Maternal arterial blood pressure did not change during the heat stress but declined slightly immediately after. The fetal heart rate increased on average by 14 beats/minute by the end of the exposure. The variability of fetal heart rate was normal in each subject during the whole experiment and only one subject had a nonreactive tracing during the heat stress, which returned to normal during the recovery period. The ratio of the systolic to diastolic velocity in the uterine artery did not change significantly. Only two subjects had a marked increase in uterine artery vascular resistance; they had concomitantly a significant fall in the arterial blood pressure. Still, there was no change in umbilical artery blood flow. The fetuses of healthy pregnant women are not compromised during or after moderate thermal stress.

Effect of thermal stress on serum prolactin, cortisol and plasma arginine vasopressin concentration in the pregnant and non-pregnant state.

The thermal responses of serum prolactin, cortisol and plasma arginine vasopressin were studied on pregnant and non-pregnant women. Group I consisted of 15 healthy non-pregnant women, group II of 23 women 13-14 weeks pregnant and group III of 23 women 36-37 weeks pregnant. Blood samples were taken before the stress (21-23 degrees C), at the end of a 20 min stay in a heat chamber (70 degrees C, 15% relative humidity) and 20 min and 45 min after the stress (21-23 degrees C). The rectal temperature increased 0.3-0.4 degrees C. Serum concentration of prolactin increased from the pre-stress level by 82% in group I (NS), by 25% in group II (P less than 0.05) by the end of the stress but declined steadily in group III by 12% till the end of the recovery period (P less than 0.001). The cortisol concentration increased only in group II during the recovery period (54-72%, P less than 0.05). In this group the subjects who felt discomfort after the stress had higher cortisol levels already before the stress. Arginine vasopressin levels increased significantly only in group I by 17% (P less than 0.05) and there were no differences in the proportional changes between the groups. The response of prolactin to thermal stress seems to be abolished at late pregnancy while the responses of cortisol and arginine vasopressin are not influenced by pregnancy.

Is the heat dissipating ability enhanced during pregnancy?

The effect of short-term heat stress on rectal and skin temperatures was measured in three groups: group I consisted of 15 non-pregnant, healthy women; group II of 23 women 13-14 weeks pregnant; and group III of 23 women 36-37 weeks pregnant. Rectal and skin temperatures were recorded every 5 min during a resting period (20 min, 21-23 degrees C) followed by thermal stress (20 min, 70 degrees C) and a recovery period (45 min, 21-23 degrees C). The rectal temperature decreased significantly in each group at the beginning of the stress. The total increase from pre-stress levels to the end of the heat stress was from 37.1 to 37.5 degrees C in group I, 37.2 to 37.6 degrees C in group II and 37.0 to 37.3 degrees C in group III (P less than 0.05). During the recovery period, the rectal temperature was significantly lower in the late-pregnancy group as compared to non-pregnant subjects. The skin temperature increased from the resting period to the end of the stress from 34.0 to 39.1 degrees C in group I, from 33.7 to 39.3 degrees C in group II and from 33.5 to 39.0 degrees C in group III (P less than 0.001). During the recovery period, the skin temperature declined significantly faster, and to lower levels in the late-pregnancy group as compared to both other groups. We conclude that the heat-dissipating ability is slightly enhanced during late pregnancy.

Haemodynamic response to moderate thermal stress in pregnancy.

The effect of a moderate heat stress on cardiovascular responses was studied: group I consisted of 15 healthy non-pregnant women, group II of 23 women 13-14 weeks pregnant and group III of 23 women 36-37 weeks pregnant. Heart rate, stroke volume, cardiac output, arterial blood pressure and peripheral vascular resistance were recorded every 5-10 minutes during a resting period (20 min, 21-23 degrees C) followed by heat stress (20 min, 70 degrees C, 15% relative humidity) and a recovery period (45 min, 21--23 degrees C). The rectal temperature increased 0.3-0.4 degrees C in each group during thermal stress. The heart rate before stress was highest in the advanced pregnancy group but increased almost identically in each group by 36--37 beats per minute during stress and approached starting values during recovery. There were no major changes in stroke volume during the experiment in any group nor were there any differences between the three groups. Arterial blood pressure did not change significantly in any group during the experiment; the differences between the groups were minimal. Peripheral vascular resistance began to fall at the start of the thermal stress and returned to prestress levels at the end of the recovery period. There were no differences between the groups in proportional changes of peripheral resistance. We conclude that pregnancy does not alter the cardiovascular responses to moderate thermal stress.

The effect of short-term heat stress on uterine contractility, fetal heart rate and fetal movements at late pregnancy.

The effects of short-term, moderate heat stress (20 min, 70 degrees C) on uterine contractility, fetal heart rate and fetal movements were investigated in 23 healthy subjects 36 to 37 weeks pregnant. The thermal stress caused minimal uterine contractility in five subjects but did not induce labor. Fetal heart rate increased from 146 beats per minute to a maximum of 157 beats per minute (P less than 0.05) by 10 min after termination of thermal stress. Fetal movements increased from 2.3 per minute to 4.9 per minute 35 minutes after heat stress (P less than 0.05). Throughout the experiment fetal heart rate variability remained normal but in four cases the tracings were temporarily non-reactive during or after the heat stress. The newborn infants were all in good condition at delivery which, generally, took place at the estimated time of delivery. The results suggest that moderate thermal stress does not induce regular uterine contractility nor is it harmful to the fetus at late pregnancy.

Acute urinary bladder tamponade with hypovolemic shock due to placenta percreta with bladder invasion. Case report.

A rare case with residual tissue of placenta previa invading posterior parts of the bladder as placenta percreta complicated by massive late hematuria with hypovolemic shock two months after gynecologic-obstetric operation is presented. The patient was finally treated by emergency bladder resection. If a grand multipara with a history of hysterotomies, such as cesarean sections, presents lower abdominal pain involving hematuria during pregnancy, placental invasion of the bladder may be suspected. The primary treatment by hysterectomy should be complemented by bladder resection. This placental type may have high steroidogenesis.