A rapid, centrifugation-free radioimmunoassay specific for human chorionic gonadotropin using glass beads as solid phase.

A simple, specific, rapid, centrifugation-free solid phase RIA for hCG has been developed. Purified gamma-globulin isolated from antisera produced against hCG-beta in rabbits is covalently linked to glutaraldehyde-activated aminopropyl glass beads. The entire assay can be completed within 3 h at room temperature. The sensitivity (1 ng/ml), precision (intra- and interassay variabilities, less than 10% and less than 15%, respectively), and specificity (0.4% cross-reactivity with LH) are comparable to other methods. The hCG levels determined by the present method show good correlation with those obtained by another RIA and by radioreceptorassay. The present method also provides the basis for the development of similar rapid and sensitive assays of other hormones.

The fetal serum alpha-fetoprotein and its relationship to immunoglobulins and birth weight at term.

The distribution of values of alpha-fetoprotein (AFP) was analyzed in the cord blood of 350 newborns divided into groups according to whether their mothers were normal, preeclamptic, or smokers. In addition, fetal birth weight and fetal IgA and IgM at term were correlated with AFP. Cord serum AFP values showed a unimodal bell-shaped distribution in 269 normal newborns with a mean of 22.7 +/- 11.3 (SD) micrograms/ml. The cord sera of infants of preeclamptic mothers and of smoking mothers showed a similar mean and distribution. As previously observed, AFP was correlated inversely with birth weight. No correlation existed between AFP and fetal Ig levels.

Effect of glucocorticoids on fetal immunoglobulin production after premature rupture of membranes.

Cord blood IgA and IgM levels were measured in newborns of mothers with prematurely ruptured membranes (PRM) who had also received prenatal glucocorticoid treatment to accelerate fetal lung maturity. Previous data show that some newborns of mothers with PRM had elevated IgA and/or IgM levels. This increase was also found in the present glucocorticoid-treated group, indicating that glucocorticoid therapy did not appear to alter fetal humoral immune response at all.

Fetal and maternal humoral immune response to cytomegalovirus infection.

The relationship between cytomegalovirus titers and immunoglobulin (Ig) levels in 514 paired maternal-fetal sera at term was studied. Positive cytomegalovirus titers were found in 192 (37.4%) maternal sera and 138 (26.8%) fetal sera. Fetal sera with positive cytomegalovirus titers had decreased IgM levels, and maternal sera with positive cytomegalovirus titers had increased IgG levels. There was a negative correlation between cytomegalovirus titer level and IgM concentration in fetal serum and a positive correlation between cytomegalovirus titers levels and IgG concentration in maternal serum in individual samples. After removal of IgG from samples with cytomegalovirus positive titers by column chromatography, 17 maternal and 22 fetal sera remained cytomegalovirus positive.

Translocation of the Dalkon Shield into the broad ligament.

Perforation of the uterus is a serious complication in users of intrauterine devices for contraception. The incidence varies with the type of device. The perforation can occur in different parts of the uterine wall. Perforation into the broad ligament is rare; only 4 cases have been described. Two additional cases, both occurring with the Dalkon Shield, are reported here.

PIP: A serious complication following the insertion of an IUD is perforation of the uterus and translocation of the device into the abdominal cavity. Uterine perforation can be divided into "primary" ones, the most common, which are related to the insertion procedure, and "secondary" ones, which are caused by uterine contractions. A rare type of secondary perforation is to the broad ligament. Heretofore, only 4 such cases have been reported. 2 additional cases, occurring with the Dalkon shield, are reported here. Although the translocation of an IUD into the leaves of the broad ligament is rare, this complication should be considered whenever an IUD cannot be removed by pulling the strings. 2 possible complications--rupturing of the uterine vessels causing serious intraabdominal bleeding and infection, with potential danger of peritonitis and sepsis--could greatly endanger the patient's life. The 2 cases reported here were resolved satisfactorially.

Intrapartum uterine rupture.

The association between diethylstilbestrol (DES) exposure in utero and uterine malformations resulting in poor reproductive performance is well established. A case is presented of uterine rupture in a patient exposed to DES in utero who had no known predisposing factors for uterine rupture.

Fetal immunoglobulin production following prenatal glucocorticoid treatment.

In order to accelerate fetal lung maturation 46 pregnant women were given either dexamethasone or betamethasone intramuscularly during 3 consecutive days during 29--36 weeks of gestation. At birth, the infants appeared to have intact humoral immune function in that they could produce normal amounts of immunoglobulins in utero, and 2 fetuses responded with increased synthesis of IgA or IgM following premature rupture of the membranes. The clinical course did not show any increased incidence of puerperal or neonatal illness attributable to intrauterine infection.

Fetal immune response following congenital toxoplasmosis.

Serum concentrations of IgA, its subgroups IgA1 and IgA2, IgM, IgG, and IgD were determined in a group of 14 mothers who contracted toxoplasmosis during pregnancy and their 14 offspring. Four newborns developed toxoplasmosis, 10 did not. The 4 infants with congenital toxoplasmosis had evidence of increased immunoglobulin synthesis in utero in sharp contrast to the 10 offspring of toxoplasmosis-infected mothers who failed to develop the disease. Three of these 4 affected children had elevated IgM levels; all 4 had significantly increased IgA values. The use of IgA subclass IgA1 and IgA2 was not helpful in distinguishing infants with congenital toxoplasmosis from unaffected infants. The present series is consistent with other studies from this laboratory, indicating that the fetal immune response to intrauterine infection may include IgA as well as IgM.

Amniotic fluid transfer of meperidine from maternal plasma in early pregnancy.

Concurrent samples of maternal plasma and amniotic fluid were collected from 40 subjects during the second trimester of pregnancy following a single intramuscular dose of meperidine (100 mg). Maternal meperidine plasma levels were highest in samples collected from 15 to 50 minutes after drug administration. Thereafter the level declined during the next 2 hours. Meperidine was not detected in amniotic fluid until 30 minutes after the intramuscular dose. We estimated that an apparent equilibrium was reached between plasma and amniotic fluid at 120 to 155 minutes after the drug was given to the mother. Normeperidine was not detected in either maternal plasma or amniotic fluid during the time course of this study.

Herpes simplex in the amniotic fluid of an unaffected fetus.

A woman with a 7-year history of herpes progenitalis was delivered by cesarean section after herpes simplex virus was isolated from the cervix 2 weeks prior to delivery. No overt signs of herpes progenitalis had been observed during this pregnancy. At amniocentesis done the day of delivery to assess fetal maturity, herpes simplex virus was isolated from the amniotic fluid. An unaffected infant was delivered; she remains healthy at 18 months of age. Immunoglobulin levels in fetal serum and amniotic fluid did not indicate fetal infection.

Correlation between maternal and fetal immunoglobulin E levels.

Immunoglobulin E (IgE) concentrations were measured in 157 paired samples of maternal-fetal sera. A correlation was found between maternal and fetal IgE levels, in contrast to earlier reports dealing with smaller series. The correlation is probably not due to placental transfer of maternal IgE but rather to genetic factors. The possible role of IgE in the fetal immune response is discussed.

Ultrastructural cytochemistry of monoamines in cultured human fetal sympathetic neurons.

The presence and storage of adrenergic neurotransmitter (monoamines) in cultured human fetal sympathetic neurons was investigated by chromate-dichromate cytochemistry, formaldehyde-induced fluorescence and potassium permanganate fixation. Monoamines were specifically identified in the neurons by the presence of an electron dense precipitate following cytochemical treatment. Reaction product was found in cell somas and processes in all chromate-dichromate treated cultures. The size range and morphology of the precipitate indicated a vesicular storage site within large dense core vesicles. Neurons fluoresced after treatment with formaldehyde vapors, further confirming the presence of monoamines. When potassium permanganate was employed as the fixative, occasional positive dense core vesicles were found but their frequency was greatly reduced from that seen in the chromate-dichromate treated cultures. These findings show that cultured human fetal sympathetic neurons retain an adrenergic phenotype during long-term serum-free culture. In addition, the storage site for the adrenergic neurotransmitter in the developing neuron is within large dense core vesicles. The lack of dense core vesicles in potassium permanganate fixed material is believed to be due to the depletion of monoamines during fixation.

Progesterone metabolism in cultured amniotic fluid cells.

Amniotic fluid cells obtained by amnicentesis at 16-20 weeks' gestation were grown in culture until a confluent monolayer of cell had been formed. Radiolabeled pregnenolone, progesterone and 20 alpha-dihydroprogesterone were added to the cell cultures; steroid metabolites which formed after 24 and 48 hours of incubation were identified. Incubation of the cell cultures with pregnenolone-3H resulted in the formation of progesterone, 17alpha-progesterone and 20 alpha-dihydroprogesterone. A significant amount of progesterone was identified after incubating the cell cultures with 20 alpha-dihydroprogesterone. The results indicate that 3 beta-ol-dehydrogenase, 17 alpha-hydroxylase and 20 alpha-hydroxysteroid dehydrogenase enzymes are present in cultured amniotic fluid cells obtained at 16-20 weeks' gestation.

Amniotic fluid levels of alpha-fetoprotein and other proteins in a case of Turner's syndrome of the fetus.

A 34-year-old primigravida underwent genetic amniocentesis at 20 weeks gestation and the fetus was diagnosed as having Turner's syndrome. The concentration of alpha-fetoprotein in amniotic fluid was greatly elevated. Normal concentrations of amniotic fluid total protein, albumin and immunoglobulin indicated that the elevated level of alpha-fetoprotein was not the result of leakage through a hygroma, which has been previously suggested without supporting data in cases of Turner's syndrome of the fetus.

Rupture of the uterus after midtrimester prostaglandin abortion.

A case is reported of rupture of the uterus after intraamniotic injection of prostaglandin F2 alpha followed by intravenous oxytocin. The literature is reviewed and the management discussed.

PIP: A 34-year old Puerto Rican woman gravida 8, para 5, abortions 1, miscarriage 1, living children 4 admitted to the New York Hospital-Cornell Medical Center for prostaglandin abortion had a delayed diagnosis of rupture of the left uterine artery. The delay in diagnosis was attributed to the intraligamentous and retroperitoneal location of the hematoma. The bleeding was controlled by performing a supracervical hysterectomy and ligation of the left hypogastric artery. The patient recovered uneventfully. Rupture of the uterus is a less common occurence than cervical lacerations, which occur in 1% to 2% of 2nd trimester abortions and most frequently among young primigravidas. Uterine rupture occurs mostly in multiparous women and does not appear to be prevented by laminaria tents. Uterine rupture at term following oxytocin induction has been related with multiparous patients. Uterine rupture has also ben observed following induction of midtrimester abortion with intraamniotic hypertonic saline or prostaglandin analogs, and the dilatation and evacuation method. Of 12 documented cases of uterine ruptures after saline/prostaglandin-induced abortion, 11 necessitated hysterectomy and 2 patients died from blood loss. Management of oxytocin and prostaglandin-induced abortion is briefly discussed.

[Experiences with Antigon-F for intrauterine contraception]. / Erfaringer med antigon-F til intrauterin kontraception.

PIP: The Antigon F IUD was inserted in 884 patients and the results were compared with those from 910 Ypsilon and 939 Copper-T insertions. Among the Antigon F patients, the pregnancy rate was .88, the expulsion rate was 5.1, the rate of removal due to side effects was 9.1, and the continuation rate was 79.8/100 woman-years. Among the Ypsilon users, the pregnancy rate was 1.8, the expulsion rate 1.9, and rate of removal due to side effects was 3.57, and the continuation rate was 88.4/100 woman-years. No perforations were caused by the Antigon F or Ypsilon. The results of a 3 year study of 969 multiparae and 40 nulliparae who used the Antigon F, and 290 women who had the Antigon F inserted after abortion are reported. For multiparae, the rate of pregnancy was 1.6, the expulsion rate was 6.7, the removal rate due to side effects was 16.7, and the continuation rate was 63.9/100 woman-years. There were no pregnancies among the nulliparae, with a 24.4 expulsion rate, a 7.3 removal rate due to side effects, and a continuation rate of 63.4/100 woman-years. Among the postabortion insertion patients the pregnancy rate was 1.5, the expulsion rate was 7.8, the rate of removal because of side effects was 15.4, and the continuation rate was 67.2/100 woman-years. This IUD is particularly suited for preventing uterine adhesions.^ieng