THE FEATURES OF THE WOMEN'S SIMPATHOADRENAL SYSTEM FUNCTIONAL STATE WITH RISK OF EARLY PREGNANCY TERMINATION.

Preterm labor is an urgent medical-social and demographic issue at the present stage. A considerable number of factors affects the course of pregnancy and its outcome, their effect is realized at the level of the central nervous system through numerical metabolic interactions, where monoaminergic systems play an important role. Objective - to study the features of the sympathoadrenal system state by determining the excretion level of DOPHA, dopamine, norepinephrine and epinephrine in women's daily urine with different periods of abortion. 227 pregnant women who were admitted to the Kharkiv perinatal center have been examined, 190 of them had clinical signs of premature delivery in the gestation period of 23-36 weeks. Formation of clinical groups was carried out depending on the pregnancy term in the form of premature and timely delivery. Diagnosis of preterm labor was carried out in the presence of abdominal pain syndrome and structural changes in the cervix. Consequently, pregnancy compensatory and adaptive mechanisms are complex of neurohumoral process, which are realized through monoaminergic systems and a significant factor in its interruption is their destabilization. Reducing of sympathoadrenal system activity and reserve capacity in pregnant women may be a pathogenetic factor in the development of preterm labor. Therefore determination of the imbalance initial manifestations in the catecholamines exchange may possibly prevent the loss of pregnancy in the early stages.

Effects of supplemental oxygen on urinary 8-hydroxy-2'-deoxyguanosine levels in extremely low birth weight infants.

As the effects of supplementary oxygen on urinary excretion of 8-hydroxy-2'-deoxyguanosine (8-OHdG) are poorly understood, urinary 8-OHdG levels (ng/mg creatinine) were determined longitudinally on the postnatal day (PND) 1, 3, and 30 in 16 neonates with birth weight < 1000 g. No supplementary oxygen was required in 9 neonates during the first 24 h of life. Urinary 8-OHdG level on PND 1 was inversely correlated with birth weight in these 9 neonates (P = 0.0323) and was higher in four with birth weight < 750 g than five with birth weight > 750 g (41.0 ± 6.9 vs. 5.6 ± 2.7, respectively, P = 0.0200). Median urinary 8-OHdG on PND 1 of these 9 neonates was significantly lower than that of 7 neonates with oxygen (9.3 vs. 60.2, respectively), although there were no significant differences in clinical background, such as birth weight, between the two groups. Five of the 9 did not require supplemental oxygen at all during the first 30 days of life. Median urinary 8-OHdG levels were consistently significantly lower in the 5 neonates than in 11 neonates with oxygen transiently or persistently (9.3 vs. 54.6, 19.1 vs. 61.4, and 28.3 vs. 145 on PND 1, 3, and 30, respectively), although there were no differences in clinical background, such as birth weight, between the two groups. Urinary 8-OHdG on PND 30 was significantly positively correlated with supplemental oxygen dose on PND 30 (P < 0.0001), but not with birth weight in the 16 neonates. These results suggest that higher supplemental oxygen tension caused higher urinary 8-OHdG in this population.

Value of routine urine culture in the assessment of preterm labor.

OBJECTIVE: To assess the utility and expense of routine urine culture in women evaluated for preterm labor. STUDY DESIGN: A retrospective study of 1,429 patients evaluated for preterm labor over a calendar year. Patients evaluated for preterm labor were identified using the hospital's admissions database and then cross-referenced with the hospital microbiology laboratory's database to identify those who had urine cultures sent as part of their evaluation. The charts of patients with a positive urine culture were further reviewed to evaluate the diagnosis and outcome. RESULTS: Five hundred twelve urine cultures were sent for analysis of preterm labor, and 6 (1.2%) reported growth of > 100,000 colonies of a single bacterium. Of these 6 patients, 5 reported symptoms consistent with a urinary tract infection, while the 6th was asymptomatic. Fisher's exact test showed no clinical significance for a positive urine culture as a predictor of preterm delivery (P = .68). Sensitivity was 0.7% (95% CI, 0.0-4.3), and specificity was 98.6% (95% CI, 96.7-99.5). A cost difference of $29,676 existed between charges and reimbursements. A positive culture was not a significant risk factor for preterm delivery. The 1 patient who delivered preterm with a positive culture probably had cervical incompetence as the cause of preterm delivery. CONCLUSION: The routine use of urine cultures in the assessment of preterm labor is costly and adds little value to obtaining a diagnosis except in the presence of specific complaints at our institution. Urine culture identified a single patient with asymptomatic bacteriuria being evaluated for preterm labor, and she probably had another etiology for her advanced cervical examination.

[A study of the relationship among interleukin-8, cortisol and idiopathic preterm labor].

OBJECTIVE: To assess the effect of interleukin-8 and cortisol on the onset of idiopathic preterm labor (PL). METHODS: In 35 women with preterm labor and 17 controls, maternal serum and urine samples were collected. Interleukin-8 concentration was measured by enzyme-linked immunosorbant assay, serum cortisol level was measured by radioimmunoassay. RESULTS: The concentration of interleukin-8 in maternal serum and urine and cortisol in serum were significantly higher in PL group than those in the control [(0.26 +/- 0.13) microg/L vs (0.16 +/- 0.08) microg/L, (0.16 +/- 0.15) x 10(-2) g/mol Cr vs (0.04 +/- 0.02) x 10(-2) g/mol Cr, (765.83 +/- 408.55) microg/L vs (512.41 +/- 142.65) microg/L; P < 0.05, P < 0.01, P < 0.01, respectively]. A strong correlation was found ammong interleukin-8 and cortisol concentration in maternal serum in PL (r = 0.448; P < 0.05). CONCLUSIONS: There is a strong relationship between interleukin-8 and cortisol in the onset of preterm labor. Immune system and endocrine system might be involved in the mechanisms of idiopathic preterm labor.

Bacteriuria in pregnancy: a comparison of Bangladeshi and Caucasian women.

During a 5-year period all urine culture results from pregnant Caucasian and Bangladeshi women booked for confinement at the Royal London Hospital, London, UK, were reviewed to determine race-specific rates of bacteriuria. The results showed that the overall prevalence of bacteriuria in the Caucasian group was 6.3% compared to 2.0% for the Bangladeshi women. Caucasian women were found to be at significantly greater risk across all pregnancy outcome and history categories, with the greatest risk observed in grand multiparous women (RR: 4.7, 95% CI: 2.8-8.3). Pregnancies that resulted in preterm delivery showed a strong association of bacteriuria in Caucasian women which was not seen in the Bangladeshi women (RR: 4.4, 95% CI: 2.0-8.7). The data suggest that Caucasian women have a significantly higher prevalence of bacteriuria in pregnancy than their Bangladeshi neighbors. Differences in hygiene practices and clothing may explain the observed differences in the bacteriuria rates.

Microalbumin as a marker of premature delivery.

OBJECTIVE: To determine if microalbumin excretion can predict the development of premature delivery. METHODS: The possibility of predicting, early in pregnancy, the development of a preterm delivery using urinary albumin was investigated in 1422 nulliparous women recruited prospectively. A first morning urine sample was collected at three occasions during pregnancy (8-14, 15-24, 25-34 weeks' gestation) for the determination of urinary albumin excretion. RESULTS: No significant correlation was found between gestational age and urinary albumin (absolute concentration, albumin-creatinine ratio, or relative clearance of albumin) at either visit (r ranging from -0.043 to 0.036; P > .1). The incidence of preterm birth was similar for the first and fourth quartiles of the urinary albumin-creatine ratio for the second visit (5.8 and 5.7%, respectively). CONCLUSION: Urinary albumin is not a useful marker of preterm birth in a low-risk general population.

[Evaluation of the usefulness of enzymatic determination of estriol in urine and placental lactogen in serum of pregnant women with threatened preterm labor]. / Ocena przydatnosci oznaczania poziomu estriolu w moczu i laktogenu lozyskowego w surowicy krwi u ciezarnych z porodem przedwczesnym zagrazajacym.

The authors studied 60 pregnant women in the pregnancy period from 29-37 weeks with threatened preterm labor. The control group formed 40 healthy pregnant women in the same pregnancy period. In all pregnant women the values of oestriol in 24-hour urine and placental lactogen in the serum was measured. Statistically significantly lower values of placental lactogen were found in the serum of pregnant women with threatened preterm labor. The values of oestriol in 24-hour urine were also lower, but the differences were not statistically significant. In 40 pregnant women in the pregnancy period from 16 to 28 weeks with threatened in the serum is a useful method of monitoring of pregnancy with threatened preterm labor. Determination of oestriol was without any greater diagnostic significance in the case threatened preterm labor.

[Evaluation of usefulness of enzymatically determining estriol in urine and placental lactogen in serum of pregnant women with threatened preterm labor]. / Ocena przydatnosci oznaczania poziomu estriolu w moczu i laktogenu lozyskowego w surowicy krwi u ciezarnych z porodem niewczesnym zagrazajacym.

In 40 pregnant women in the pregnancy period from 16 to 28 weeks with threatened preterm labor diagnosed after clinical investigations and recording of cardiotocogram the values of oestriol in 24-hour urine and placental lactogen in the serum was measured. These values were compared to analogous determinations in a group 40 healthy women with similar duration of pregnancy. Statistically significantly lower values of placental lactogen were found in the serum of pregnant women with threatened preterm labor. The values of oestriol in 24-hour urine were also lower, but the differences were not statistically significant. In conclusion the authors state that enzymatically determined placental lactogen in the serum is a useful method of monitoring of pregnancy with threatened preterm labor. Determination of oestriol was without any greater diagnostic significance in the case of threatened preterm labor.

Urinary excretion of prostacyclin and thromboxane metabolites in threatened preterm labor: effect of indomethacin and nylidrin.

OBJECTIVE: We studied the role of smooth muscle-relaxing prostacyclin and its endogenous antagonist, thromboxane A2, in preterm labor by assessing the urinary output of the breakdown products of prostacyclin (6-keto-prostaglandin F1 alpha and 2,3-dinor-6-keto-prostaglandin F1 alpha) and those of thromboxane A2 (thromboxane B2, 2,3-dinor-thromboxane B2). STUDY DESIGN: Thirty-three women in preterm labor between 25 and 34 weeks of gestation were studied before, during, and after treatment with indomethacin (n = 16) or nylidrin (n = 17). Urinary prostanoid levels were determined by high-performance liquid chromatography followed by radioimmunoassay, and the excretion was expressed as nanograms of prostanoids per millimole of creatinine. Statistical analyses were done by paired and unpaired Student t test, by Spearman's correlation, and by Wilcoxon signed-rank test. RESULTS: Preterm labor was accompanied by a median 32% higher output of prostacyclin and thromboxane A2 metabolites as compared with those in 25 controls. At 8 hours after the start of treatment indomethacin induced maximal drops in 6-keto-prostaglandin F1 alpha (70%), in dinor-6-keto-prostaglandin F1 alpha (60%), in thromboxane B2 (85%), and in dinor-thromboxane B2 (95%) excretion. Within 1 week after the cessation of indomethacin, output of prostacyclin metabolites had recovered to pretreatment values, whereas output of thromboxane A2 metabolites was yet lower than the pretreatment value. Nylidrin induced no change in the output of prostacyclin and thromboxane A2 metabolites. CONCLUSION: Threatened preterm labor is associated with a rise in prostacyclin and thromboxane A2 synthesis. Indomethacin inhibits more thromboxane A2 than does prostacyclin synthesis. These findings may explain the fetal vascular changes during maternal indomethacin treatment.

The effect of magnesium sulfate infusion on systemic and renal prostacyclin production.

Recent in vitro studies have suggested that magnesium sulfate (MgSO4) infusions may increase prostacyclin production. We studied the effect of MgSO4 infusion on prostacyclin (PGI2) metabolite excretion in women with either pregnancy induced hypertension or preterm labor. Excretion of renal and systemic metabolites of PGI2 was measured prior to and following the start of MgSO4 infusion in the two groups. An increased in renal PGI2 metabolite preterm labor excretion was noted in the hypertension group but no change was noted in systemic PGI2 excretion in either group. These data fail to support a generalized, short term increase in endothelial cell PGI2 production as the basis for the beneficial effect of MgSO4.

Screening in pregnancy with unconjugated serum estriol compared with urinary estriol.

The diagnostic value of estriol determinations in high-risk pregnancies is frequently discussed in the literature. Estriol levels of urine and serum samples of 48 asymptomatic pregnant women were analyzed using direct radioimmunoassay. A correlation was found (r = 0.5997) between urine and serum samples, nevertheless the correlation was stronger (r = 0.8278) if 4 cases with extreme deviation were omitted. In these cases the serum estriol levels were high and the urine estriol levels were low. The outcome of the pregnancies was without any complication. Our observations suggest that determination of unconjugated serum estriol levels is more reliable in the monitoring of high-risk pregnancies, since they do not depend on renal and hepatic functions.

Rupture of fetal membranes and premature delivery associated with group B streptococci in urine of pregnant women.

68 of a group of 2745 consecutive pregnant women had group B streptococci in their urine. In this group primary rupture of the membranes and premature delivery occurred in 35% and 20% respectively. In women without group B streptococci 15% had primary rupture of the membranes and premature delivery occurred in 8.5%. Group B streptococcal sepsis occurred in five infants, all had mothers with positive urine culture. Women with group B streptococci in their urine seem to have a significantly increased risk of primary rupture of the fetal membranes and premature delivery.

Variations in urinary levels of free 6 beta-hydroxycortisol, cortisol, and estrogens in late pregnancy.

The urinary excretion of 6 beta-hydroxycortisol (6 beta-OHF), free cortisol, and estriol was studied at 4-hourly intervals in 9 subjects between the 36th and 38th week of pregnancy. The ratio of 6 beta-OHF to creatinine showed a significant diurnal rhythm with a 40% fall from a peak at 06.00-10.00 h to a trough at 22.00-02.00 h. There was a significant positive correlation between the excretion of 6 beta-OHF and free cortisol. Estrogen excretion showed no diurnal variation. No increase was observed in the 6 beta-OHF:creatinine ratio in early morning urine samples from 5 subjects followed daily prior to the onset of spontaneous labour at term. Normal nonpregnant females were also found to excrete significant quantities of 6 beta-OHF. These findings suggest that the clinical significance of 6 beta-OHF levels measured in a single void sample of urine has to be reassessed in the face of such a marked diurnal variation.

[Changes in estriol excretion in the urine and kidney function during Partusisten infusion]. / Die Veränderungen der Ostriolausscheidung im Harn und der Nierenfunktion während Partusisten-Infusion.

In a random controlled trial the effects of a betamimetic infusion (Fenoterol 2 micrograms/min) on the estriol excretion and the renal function were analysed in 30 patients in the 28.-34. weeks of pregnancy. It was stated that the estriol excretion in urine during the Partusisten infusion significant decreases (from 663 micrograms/2 h to 376 micrograms/2 h, i.e. to 56%). The diuresis and the creatinine-clearance showed a significant diminishing too (from 218 ml/2 h to 154 ml/2 h and from 131 ml/min to 88 ml/min). The decrease of estriol excretion is caused on the one hand by the diminution of GFR, on the other by a direct effect of betamimetics on the kidney. From the results obtained in this study the following consequences can be drawn: 1. The determination of urinary estriol during tocolytic treatment is not a suitable method for the monitoring the fetoplacental unit. 2. Applying the tocolysis in an infusion a possible reduction of water intake and a strict control of water balance is of great importance. 3. The betamimetic therapy in patients having an impaired renal function can be applied only with great precaution.

6 beta-Hydroxycortisol levels in maternal urine of pregnancies complicated by prematurity.

Maternal urinary 6 beta-hydroxycortisol (6 beta-OHF) and creatinine levels were measured in 28 patients with singleton pregnancies admitted in apparent premature labor and in 17 women with singleton pregnancies delivered at term. Urine specimens were collected immediately after admission but prior to the initiation of active clinical intervention and management. Fourteen patients in true premature labor who were spontaneously delivered less than 24 hours after admission had significantly elevated 6 beta-OHF levels (1,144 +/- 210 ng/ml) compared to levels in 14 patients in false premature labor who were delivered more than 48 hours after admission (544 +/- 88 ng/ml). The mean ratio of 6 beta-OHF to creatinine was also elevated in patients in true premature labor (184.5) compared to ratios in patients delivered more than 48 hours after admission and in women in labor at or near term (range 123.4 to 128.6). The absolute levels of creatinine in all groups did not differ significantly, suggesting that the excretion of 6 beta-OHF proceeds independently of any change in renal function. Only in patients in the true premature labor group were 6 beta-OHF levels correlated with creatinine levels. However, in urine obtained within 24 hours prior to premature delivery, 6 beta-OHF levels did not appear to be related to the presence or absence of neonatal respiratory distress syndrome. It is concluded that measurement of 6 beta-OHF may provide an objective criterion for directing tocolytic therapy to those patients in true premature labor.

[Prevention of respiratory distress syndrome prior to delivery using steroids]. / Steroidprophylaxe des Atemnotsyndroms vor der Geburt.

Dexamethason in a total dose of 15 mg was given in 125 cases of premature labour 48 hours before delivery to prevent the development of respiration distress syndrome. Clinically, the incidence of RDS was 14,5% (18 cases) in the treated group, while in the control group it was 27,7% (32 cases out of 119). Owing to RDS two prematures died in the treated group, and 14 in the control one. Steroid prophylaxis was applied prenatally with 69 pregnant women at term who were predisposed to give birth to infants developing RDS (retardation, diabetes mellitus, elective section caesareas, etc.). Five neonates developed RDS and one died of hyaline membrane disease. The authors studied the effect of steroids on carbohydrate metabolism and total oestrogen excretion in the urine. From profile examinations of blood sugar it was concluded that no pathological alterations take place in maternal carbohydrate metabolism due to intravenous or intermittent prolonged administration of Dexamethason. After one single large dose (15 mg) of Dexamethason a reduction of 30-40% was noted in total oestrogen excretion. Return to the initial value was noted on the 11th-12th day. No appreciable changes were observed with prolonged intermittently given Dexamethason. On the basis of their observations the authors consider that steroid therapy applied during labour is efficient in preventing neonatal RDS.