Immunochemical purification and characterization of ovine alpha-fetoprotein.

Ovine alpha-fetoprotein was successfully isolated from fetal sheep serum by using rabbit anti-ovine alpha-fetoprotein linked to an agarose immunoadsorbent column. Antibody used in this affinity chromatography column was produced by immunizing a rabbit with highly purified alpha-fetoprotein-antibody complex to yield a monospecific antiserum to ovine alpha-fetoprotein. Following affinity chromatography, alpha-fetoprotein was further purified by preparative polyacrylamide disc gel electrophoresis ultimately yielding a 105-fold purification. The purified alpha-fetoprotein was homogeneous on analytical polyacrylamide disc gel electrophoresis. Ovine alpha-fetoprotein was found to be immunochemically related to human alpha-fetoprotein and to exhibit a molecular weight and amino acid composition similar to other mammalian alpha-fetoproteins.

Radioimmunoassay of ovine alpha-fetoprotein.

Highly purified ovine alpha-fetoprotein (AFP) was used both for radioisotope labelling and as the reference standard in the double antibody radioimmunoassay of ovine AFP. The sensitivity of the assay is 2 ng/ml which is about 8000 times more sensitive than radialimmunodiffusion assay. The assay is of sufficient sensitivity to quantitate AFP in normal adult sheep serum, pregnancy serum, amniotic fluid and fetal lamb serum.

Experiences with a fine stainless stell wire fetal scalp electrode.

A simple, economic stainless steel wire fetal scalp electrode is described. Its uneventful use over a 5-year period is reported in the light of several reports of complications arising from the application of both clip and spiral electrodes. The performance of 100 electrodes prepared under controlled conditions was analyzed in terms of both the quality of the rate trace produced and of problems experienced during application. Six electrodes were wasted during preliminary handling but of the 94 used in an attempted application to a fetal scalp, 88.3% were considered successful.

A rapid method for the purification and radioimmunoassay of human alpha-fetoprotein.

Human alpha-fetoprotein (AFP) was isolated from cord serum on an immunoadsorbent column obtained by covalently linking rabbit anti AFP to cyanogen bromide activated Sepharose. Bound AFP was eluted with 8 M urea with better than 50% recovery. The purified AFP was iodinated prior to its use in a double antibody radioimmunoassay. The purification and radioimmunoassay employ commercially available materials. A standard inhibition curve was obtained which allowed determination of AFP levels between 50 and 100 ng/ml in human serum. The assay was verified by measureing AFP levels in normal female serum, pregnancy serum, cord serum, hepatoma ascitic fluid and a standardized AFP solution.

A rapid radioimmunoassay for human alpha-fetoprotein.

Our previous double antibody radioimmunoassay for human AFP was run at 4 degrees C and required 48 h for completion. A method is described which permits the assay to be performed within 5 h due to an increased incubation temperature and the use of polyethylene glycol to precipitate the antigen-antibody complex. The modified radioimmunoassay was standardized against an international reference preparation of human AFP. Characteristics of this assay are discussed.

Psychosocial adjustment to unsuccessful IVF and GIFT treatment.

Twenty-one couples for whom in vitro fertilisation (IVF) or GIFT treatment failed were followed-up 15-30 months after treatment and compared with 20 couples for whom IVF had been successful. Current mental health status, quality of life and marital adjustment were assessed via standardised questionnaires. In addition, couples' experiences of IVF/GIFT treatment were explored via a semi-structured interview. Questionnaire results showed that unsuccessful IVF/GIFT recipients cannot be distinguished from general population norms. However, these couples reported more emotional distress relative to those whom treatment had worked and females in particular indicated a lower quality of life. Couples who had at least one child prior to IVF/GIFT treatment tended to show greater emotional distress at follow-up. Both groups gave similar accounts of the positive and negative aspects of IVF/GIFT treatment, but the unsuccessful group felt less supported by the IVF Unit staff and were less satisfied with the counseling they received. The data indicate that post-treatment counseling may be particularly important for facilitating positive reconstructions of the IVF experience when treatment is unsuccessful.

A follow-up study of 'successful' IVF/GIFT couples: social-emotional well-being and adjustment to parenthood.

Twenty couples who conceived their babies by in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) were seen between 15 and 27 months postdelivery in order to evaluate social-emotional well-being and parental functioning. Emotional health and marital adjustment were assessed by standard questionnaires and compared with general population norms. Questionnaires measuring quality of life, parents' feelings about their babies and child-rearing attitudes were also administered. Scores from these were compared with those obtained from a group of parents who had conceived without medical assistance. Results indicated that IVF/GIFT parents were undifferentiated from the general population with respect to emotional health and marital adjustment. Also, relative to non-IVF parents, they gave higher positive ratings for their feelings about their babies and for one aspect of quality of life (feelings of freedom). Parenting attitudes for the two groups differed in only one respect, IVF/GIFT parents reported being more overprotective.

Maternal serum alpha-fetoprotein in abnormal pregnancies and during induced abortion.

Serial maternal serum alpha-fetoprotein (AFP) levels were determined by radioimmunoassay in patients with abnormal pregnancies and after saline-induced abortion. Results from patients presenting with mild or severe preeclampsia, fetal growth retardation and severe diabetes did not differ from the normal range. However, in patients with premature labor, the majority of AFP levels were significantly below the normal range, and peak AFP levels were achieved approximately one month earlier than normal. In patients whose pregnancies were terminated by abortion, the AFP levels exhibited a significant rise within a few hours after induction because of resorption of fetal elements into the maternal circulation.

Women with nausea and vomiting in pregnancy demonstrate worse health and are adversely affected by odours.

The objectives of this study were (1) to determine aversive stimuli that are related to nausea and vomiting in pregnancy (NVP); (2) to determine food and fluid intake in early pregnancy; and (3) to explore relationships between aversive stimuli and health measures. A total of 273 women in an antenatal setting completed a questionnaire survey, incorporating the Nausea and Vomiting in Pregnancy Instrument (NVPI); the General Health Questionnaire (GHQ); measures of perceived mood and illness; food and fluid intake; and open-ended questions relating to perceived aversive and helpful stimuli. Data was subjected to quantitative and qualitative analysis. A total of 57% of women reported aversive stimuli. Of these, the primary sense implicated was olfaction, with 72% reporting food smells. A number of women were affected by the odours of drinks (26%) and other products (31%). Women who were adversely affected by odours had higher severities of NVP, perceived illness and psychopathology scores on the GHQ. In conclusion, odour appears to be an important stimulus related to NVP, with perceived aversive smells related to the severity of nausea. Women severely affected by NVP demonstrated worse health. The role of olfaction in pregnancy and specifically in sufferers of severe NVP should be evaluated further.

Nitrous oxide transfer across the placenta and condition of the newborn at delivery.

Nitrous oxide transfer to the fetus was measured in 14 consecutive patients having a Caesarean section near term. Better babies, as assessed by birth weight and Apgar score at five minutes, were associated with better transfer of nitrous oxide. The correlation was probably attributable to differences in placental blood flow, although it is not possible to prove this.

A study of the obstetric performance of the adolescent Jamaican primigravida.

PIP: Obstetrical outcome of a series of 226 primigravid Jamaican teenagers, less than 16 years old, was evaluated. All of the study subjects delivered at the University Hospital, Kingston, Jamaica, and their obstetrical outcomes were compared with the outcomes of older primigravidas delivering at the same institution. Incidence of preeclampsia was lower among the teenagers (8.4%) vs. older patients (9.8%). Incidence of antepartum hemorrhage was .9% in the teenage group vs. 3% among the older women. Spontaneous premature rupture also occurred less frequently among the teenagers (1.8%) vs. the older women (2.4%). 15.5% of older women suffered from anemia and so did the same percentage of teenagers. Postpartum hemorrhage had a higher incidence among the teenagers (12.8%) compared with the older women (9.3%). A low operative delivery rate was associated with a low incidence of fetal distress and babies with good Apgar scores among the teenagers. This overall good obstetrical performance is attributed to better antenatal care among the teenage mothers.^ieng

Serum oestriol in normal pregnancy.

Serial measurements of serum oestriol (E3) were made in 56 normal pregnancies from 10 to 40 weeks gestation using a radioreceptor assay. Several parameters of the assay and its intrapatient variability were examined. The mean curve for pregnancy E3 levels and limits of normal variation have been identified and compared with those of other series. A positive correlation was found to exist between infant birth weight and the last E3 value in normal pregnancies prior to the onset of labour. Advantages of serum E3 assays over urinary E3 determinations are discussed.

Obesity and urinary incontinence in women.

In a series of 368 incontinent women who presented to our urodynamic clinic for assessment, 232 (63%) were diagnosed as having genuine stress incontinence, and 136 (27%) as having detrusor instability. Obesity (greater than 20% more than average weight for height and age) was significantly more common in women with genuine stress incontinence and detrusor instability than in the normal population. In those with detrusor instability the body mass index was found to increase with age and parity. In women with genuine stress incontinence the body mass index increased with age and the number of previous incontinence operations; it was higher in nulliparous than in parous women. There was no significant difference between obese and nonobese women in any of the urodynamic variables measured in the two incontinence groups.

Selection of an antibody-free population of spermatozoa from semen samples of men suffering from immunological infertility.

Ejaculates from infertile men with significant levels of antisperm antibodies were processed in vitro, in an attempt to prepare sub-populations of antibody-free spermatozoa. Semen samples were processed on a discontinuous Percoll gradient and the resultant sperm preparation was treated with immunobeads. Selection of antibody-free spermatozoa was achieved: less than 10% of the resulting spermatozoa showed binding to immunobeads after treatment in all cases investigated. The overnight survival of these antibody-free spermatozoa was comparable to, or better than, that of the untreated antibody-coated sample obtained from the Percoll gradient. The fertility potential of these treated spermatozoa is currently under investigation.

Psychological health in early pregnancy: relationship with nausea and vomiting.

The psychological health of women in early pregnancy was investigated in a sample of 273 women (mean gestational age 12.8 weeks, SD=2.8) using the General Health Questionnaire (GHQ) and mood and illness perception visual analogue scales, and compared with the prevalence and severity of nausea and vomiting as measured using the Nausea and Vomiting in Pregnancy Instrument (NVPI). Using a cut-off of 4/5 for the GHQ, 50.5% of pregnant women were found to have potential psychiatric problems. However, perceived mental health and physical illness was significantly better than anticipated. The severity of nausea and vomiting correlated independently with GHQ subscales for somatic symptoms, social dysfunction, anxiety/insomnia and severe depression. The contradiction between high GHQ scored and high perceived wellbeing might be explained through cognitive processing. Nausea and vomiting in early pregnancy is associated with psychiatric morbidity. The causal relationship between the two conditions has not been established.

Development of an instrument to measure nausea and vomiting in pregnancy.

Severity of nausea, retching and vomiting was determined using a newly developed nausea and vomiting in pregnancy instrument (NVPI) in two groups of pregnant women at two gestational time periods. Participants at Time 1 (approximately gestational week 9), completed a postal questionnaire (N = 643) and those at Time 2 (approximately 13 weeks) completed the instrument at the clinic (N = 284). The three scale items forming the instrument had acceptable internal reliability (Time 1 alpha = 0.76; Time 2 alpha = 0.82). It was noted that approximately 60% of women did not vomit, approximately 30% experienced no retching, but 30-40% experienced nausea either all the time or more than once a day. The instrument may prove to be useful as a research tool to study nausea and vomiting in pregnancy.

The prevalence of domestic violence in pregnant women.

OBJECTIVE: To determine the prevalence of domestic violence in a population of pregnant women. DESIGN: Questionnaire survey. SETTING: Antenatal booking clinic in a north of England hospital. POPULATION: Five hundred consecutive women were included. METHODS: Anonymous confidential questionnaire to women who were not accompanied by their partners. MAIN OUTCOME MEASURES: Disclosure of a past history of physical, emotional or sexual abuse. RESULTS: Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26-30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity. CONCLUSIONS: The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.