Maternal and cord blood metal concentrations and low birth weight--a case-control study.

There has been speculation on the possible role of trace metals in contributing to the occurrence of low birth weight, but few data are available for most metals. Twenty-five women giving birth to infants weighing between 1500 and 2500 g (cases) and 50 women giving birth to infants weighing more than 2500 g (controls) were studied. The cases and controls were matched for age +/- 4 years), race, and socioeconomic status. Cord blood and maternal blood collected at delivery were analyzed by atomic absorption spectrophotometry for calcium, magnesium, copper, lead, and iron. Significant differences between the mean blood metal concentrations of the low birth weight and control groups were found for calcium (P less than 0.001) and iron (P less than 0.05) in the maternal blood samples and for calcium (P less than 0.001) and iron (P less than 0.01) in the cord blood samples. All concentrations were lower in the low-birth weight group except for the maternal iron level. No significant differences between the low birth weight and control groups were found for copper, lead, and magnesium in either maternal or cord blood.

Early intrauterine development: I. The rate of growth of Caucasian embryos and fetuses between the 6th and 20th weeks of gestation.

Liberalization of abortion laws in various countries and states of Europe and America has offered an opportunity for the study of the correlations between menstrual age and the rate of bodily development of human embryos and fetuses. In several institutions where local bylaws mandated the consent of the patients requesting therapeutic abortion to pathological investigation of the products of conception, various parameters of growth were measured systematically. These included crown-rump and foot lengths and body weight. The analysis of the data indicated that in the embryosic stages of development the rate of growth is substantially slower than it had been assumed previously. In the more advanced fetal stages of development the findings supported the validity of the long-established standard of Streeter. Since the current study has been based on apparently normal gestations of healthy women, whereas earlier data had rested, to a great extent, on spontaneously aborted and extopic embryon and fetuses, it seems evident that pathological specimens are not suitable for the purpose of establishing reliable standards of normal intrauterine growth rate. The present data support the suggestion, based on various experimental and clinical observations, that pathological gestations often result from abnormal ovulations that occur at times other than the mid-cycle and that such conceptions are frequently followed by a bleeding episode that simulates menstruation. It is likely that the inclusion of a high number of such cases biased the results of earlier investigations concerning embryonic growth rate on account of the frequent incidence of erroneous menstrual histories. The material available did not permit the extension of the investigation beyond the 20th week of gestation. It appears, however, that the average growth rate in the mid-trimester may be slower than the data adopted by the American Academy of Pediatrics would indicate. The possible causes of some phenomena observed in the course of the investigation, such as unexplained scatter of growth-rate patterns at all developmental stages and discrepancies among various literary data, have been discussed in some detail. While a tentative attempt has been made to correlate the investigated parameters of fetal growth with biparietal diameters of the head, a measurement accessible to direct assessment by sonography during pregnancy, the necessity of improving these standards through a prospective study has been emphasized.

Early intrauterine development: II. The rate of growth in Black and Central American populations between 10 and 20 weeks' gestation.

The application of the growth-rate standards, extablished for Caucasian embryos and fetuses in a previous report, to Black and Central American racial groups has been investigated. Comparison between menstrual age and crown-to-rump length indicated differences in the 10 to 15 weeks' gestation range. However, growth rates for the same groups were practically identical between the 15th and 20th weeks of pregnancy. This finding suggests that the actual rate of growth is closely similar in the respective ethnic groups and that apparent discrepancies reflect erroneous, or purposefully false, menstrual histories rather than dissimilar growth patterns. Largely identical rates of development were suggested by the crown-rump length to foot length to body weight interrelations among the various racial groups. A moderate, but rather predictable, deviation from the earlier established standards was noted in the crown-rump length versus foot length ratios of Black American fetuses, providing the only exception to what appears to be a practically identical rate of growth for the investigated ethnic groups in the first half of gestation. The evaluation of the results was extended to involve the effect of educational and social factors on currently available data of embryonic and fetal growth. It is suggested that heretofore unconsidered factors may affect the validity of widely quoted standards of intrauterine growth.

A diagnostic device for stress incontinence.

Many methods of evaluating anatomic deformity of the urethrovesical angle are available. A new diagnostic device has been developed to determine the degree of rotation of the urethral axis, thus differentiating between type I and type II deformities causing stress incontinence. Preliminary study in 62 patients indicates that the instrument is accurate, simple, and easily interpreted. The device also has the advantage of being easily constructed, disposable, and inexpensive.

Purification and characterization of a sperm-coating antigen from human seminal plasma.

A sperm-coating antigen has been purified from human seminal plasma by a combination of fractionation methods including ammonium sulfate precipitation, Sephadex G-100 gel filtration, and diethylaminoethyl cellulose ion-exchange chromatography. The purified antigen was demonstrated to be immunologically identical sperm-coating antigen, not derived from blood serum but having immunologically cross-relating antigens in milk and saliva, and a glycoprotein with a molecular weight of approximately 33,000. The purpose of purifying this antigen was discussed.

Spinal cord tumors during pregnancy.

The diagnosis of and therapy for spinal cord tumors occurring during pregnancy are discussed. A case of pilocytic astrocytoma, not reported previously in the literature, is presented.

Copper intrauterine devices--a review of the literature.

PIP: The characteristics of the copper IUD are reviewed by tracing the development of the device, discussing its mechanism of action, evaluating possible systemic effects of copper, and summarizing the clinical data of the copper-7 IUD.^ieng

Experimental design for the surgical relocation of the ovary into the vaginal fornix.

After translocation into the vaginal vault while attached to a pedicle consisting of the infundibulo-pelvic ligament, the ovary was found to maintain its function in laboratory primates. In the majority of the baboons the ovulatory pattern returned within a few weeks after the surgical procedure. The only significant complication was a transitory, and self-limited, infection which was evident on inspection and on the biopsy specimens, but caused no clinical symptoms. By comparing the surgical outcome in two primate species, namely Papio Cynocephalus and Macaca Arctoides, it could be deduced that the Homo Sapiens would be a more suitable experimental model than either of the laboratory primates used in this research. Because there are potentially effective methods for reducing the likelihood of postoperative infection in the relocated ovary, the experience gained by this new method suggests the possibility that it could be utilized in the future for the purpose of collecting ova for in vitro fertilization in carefully selected, and otherwise untreatable, cases of female sterility.

The effect of antibody against a purified sperm-coating antigen on human sperm.

A purified fraction of human seminal plasma containing a sperm-coating antigen and two minor contaminants was used to immunize rabbits by intravenous route. An antiserum containing only the antibody against the sperm-coating antigen as examined by immunoelectrophoresis was obtained from one rabbit. The effect of this antiserum on human sperm was examined by sperm-immobilization and sperm-agglutination tests. The results revealed that the antibody against the purified sperm-coating antigen was incapable of immobilzing or agglutinating human sperm. This indicates that the purified sperm-coating antigen is unlikely to be useful as an antifertility antigen for immunologic fertility control.

Vitamin levels in low-birth-weight newborn infants and their mothers.

The cord blood of 50 normal-birth-weight neonates (more than 2,500 grams) and 50 low-birth-weight neonates (less than 2,500 grams) and the respective mother's blood were analyzed for folate, vitamin B6, riboflavin, nicotinate, pantothenate, thiamin, biotin, vitamin B12, vitamin A, and beta-carotene concentrations at parturition. No mothers had received supplemental vitamin intake. Except for vitamin A and beta-carotene, maternal vitamin levels were lower than those of neonates in all instances. Vitamin levels in the blood of low-birth-weight neonates were the same of those of normal-birth-weight infants except for significantly lower folate, vitamin B12, and pantothenate levels.

Plasma concentrations of calcium, chromium, copper, iron, magnesium, and zinc in maternal and cord blood and their relationship to low birth weight.

A study of the relationship between low birth weight and concentrations of six metals in maternal and cord plasma was conducted. Maternal and cord blood were collected at delivery. Cases and controls were matched for maternal age (+/- 3 yr), race, parity, socioeconomic status, and smoking habits and the sex of the neonate. Plasma concentrations of calcium, copper, magnesium, and zinc were determined by flame atomic absorption spectrophotometry; plasma chromium and iron concentrations were determined by flameless atomic absorption techniques. Mean maternal plasma concentrations were significantly lower in the low-birth-weight group than in the controls for iron (p = 0.012) and calcium (p = 0.007). Mean cord plasma concentrations were also significantly lower for calcium (p = 0.037). There were no statistically significant differences between the low- and normal-birth-weight groups for the maternal or cord chromium, copper, magnesium, and zinc concentrations or for the cord iron concentrations. It is probably true that many factors, acting additively or synergistically, can produce low birth weight, and that low birth weight acts only as a marker for a number of biologic insults. The results of this study suggest that nutrient metals may be one of these factors.

Fetal risk in hyperextension of the fetal head in breech presentation.

An evaluation of the possible etiologic factors in hyperextension of the fetal head in breech presentation and a discussion of management are presented. Our seven cases plus a review of the literature led to the conclusion that hyperextension of the aftercoming head is a dangerous malpresentation that should not be underestimated. For this reason, we strongly suggest an x-ray of all breech presentations in early labor, not only to evaluate pelvic adequacy but also to determine the attitude of the head. In persistent hyperextension, cesarean section is the management of choice.

Comparison of sterilization by tubal ligation and hysterectomy.

A comparison was made between sterilization by hysterectomy and by tubal ligation at the time of cesarean section and as an interval procedure. All operations were done at one institution and, essentially, by the same physician population, allowing for promotion within the residency program. The major deterrent to hysterectomy was the associated high incidence of necessary blood transfusion. However, a hysterectomy does offer the benefits of a permanent and completely effective procedure and the removal of an organ which ultimately may be the source of other problems. If another pathologic condition exists, making ultimate hysterectomy likely, it is the procedure of choice for sterilization, avoiding risks, costs, and the inconvenience of another operation. Methods of elective sterilization must be individualized. If the patient is appraised of the increased risk of hysterectomy and desires this more definitive procedure on the basis of informed consent, the incidence of complications is not prohibitive. These should not deter the well trained surgeon but should mandate use of all available skills, intensive evaluation of the patient, and concerned recognition of the potential adverse consequences.

Vaginal transposition of the ovary in primates (Papio cynocephalus and Macaca arctoides).

Experimental data indicate that the time and mechanism of ovulation play a significant role in some cases of infertility and in a broad range of reproductive abnormalities. In order to establish a new experimental model for the study of these phenomena in primates, transposition of the ovary from the pelvis into the vaginal fornix was attempted in 2 species of monkeys: (a) Macaca Arctoides and (b) Papio Cynocephalus. Particularly in the latter species, ovarian relocation into the anterior and the posterior vaginal fornices proved feasible. Most ovaries continued functioning in their new location during the 2-5 months of the follow-up, despite macroscopic and microscopic evidence of infection. Post mortem examination of one of the experimental animals several years after the surgical procedure revealed the presence of an intact functioning ovary still in close contact with the vaginal fornix.