Placental isoferritin measured by a specific monoclonal antibody as a predictive marker for preterm contraction outcome.

The serum levels of placental isoferritin and normal ferritin in 25 women with preterm contractions (mean +/- SE gestational age 28.8 +/- 4.7 weeks) were compared with those in 14 control women with uncomplicated pregnancies (29.1 +/- 7.3 weeks). The serum concentration of placental isoferritin in women with preterm contractions (15.3 +/- 6.2 U/mL) was significantly lower than that in normal pregnant women (87.6 +/- 22.6 U/mL) (P = .005). The level of normal ferritin in women with preterm contractions (30.6 +/- 4.16 ng/ml) was lower than that in women with normal pregnancies (67 +/- 9.6 ng/mL) (P = .01); however, both were within the normal range. Serum placental isoferritin levels correlated with pregnancy outcome; low placental isoferritin (up to 10 U/mL) was a sensitive (71.5%) indicator of preterm labor. Low placental isoferritin had a positive predictive value of 59% and a negative predictive value of 71%. These results suggest that placental isoferritin may serve as a predictive marker for the prognosis of preterm contractions.

Placental isoferritin: a new serum marker in toxemia of pregnancy.

The serum concentrations of placental isoferritin and normal ferritin were determined in 20 patients with preeclamptic toxemia of pregnancy and were compared with the level measured in normal pregnant women at the third trimester and in labor at term. The mean serum concentration of placental isoferritin for the women with preeclamptic toxemia was found to be low: 7.5 +/- 23 U/ml compared with 81.6 +/- 89.3 U/ml in normal pregnancy during the third trimester and 54.8 +/- 53 U/ml in term delivery. In comparison, there was no significant difference in the serum levels of normal ferritin in both pregnant women with toxemia and in those without toxemia. These results suggest that placental isoferritin may be a useful marker for preeclamptic toxemia of pregnancy.

Total estradiol and progesterone receptor levels and DNA concentrations in human endometrium with nonuniform postovulatory delay of maturation.

Total estradiol and progesterone receptor levels and DNA concentrations were measured in endometria of four women with nonuniform postovulatory delayed maturation of the epithelium. All four women underwent curettage on Days 21 to 23 of their cycle. The results in these women were compared with results obtained from a control group of women with histologically normal cyclic endometrium. In three women with corpus luteum defect, total estradiol and progesterone receptor levels and DNA concentrations were in the range of midcycle or early secretory normal (control) endometria. In one patient with a normally functioning corpus luteum, the above parameters were similar to those found in the late secretory phase of controls. Summation of the results of the present study along with those previously reported in endometria of women, both with uniform and nonuniform delayed maturation, indicate the possibility of endometrial postacceptorial progesterone defect, which may either be secondary to corpus luteum defect or a result of primary endometrial defect.

Hereditary protein C deficiency during pregnancy.

Hereditary protein C, a primary hypercoagulable state, has not been previously associated with preeclamptic toxemia. A woman with previous preeclamptic toxemia and fetal deaths presented with recurrent deep vein thrombosis during her third pregnancy. Hereditary protein C was diagnosed but full heparinization followed by low-dose heparin failed to prevent preeclamptic toxemia.

Abolishment of the positive feedback mechanism: a criterion for temporary medical hypophysectomy by LH-RH agonist.

The hypothalamic pituitary axis was studied in patients with an abnormal pattern of gonadotropin release during chronic treatment with LH-RH agonist. Two patients had PCOD and the third demonstrated the early luteinization phenomenon. Following a well-defined gonadotropin rise with initiation of LH-RH treatment, no further response was noted. Stabilization of the LH:FSH ratio in PCOD patients was noted after 4 weeks of treatment. Administration of both native LH-RH (100 micrograms) and intravenous pulsatile LH-RH did not evoke any rise in LH. In addition to the above LH-RH challenges, the positive feedback was examined by administration of estradiol benzoate (EB). The study demonstrated that, although the pituitary did not respond to any LH-RH challenge, it may still respond by a rise in LH following EB administration. Both functions of the hypothalamic pituitary axis should be examined in order to determine the state of medical hypophysectomy.

The effect of placenta previa localization upon maternal and fetal-neonatal outcome.

The present study evaluated the association between maternal and fetal-neonatal outcome in women with placenta previa (PP) and the site of PP, i.e. low lying, marginal, partial or total. The study group was composed of 154 women (159 newborns) and the control group of 300 woman (305 newborns). Of the various parameters examined, the following 3 were associated with PP localization: advanced maternal age was associated with major types of PP, while focal accretion of the placenta and neonatal mortality in cases of vaginal delivery were associated with minor types of PP. No connection was found between antepartum, intrapartum or postpartum blood loss and any specific type of PP. A review of the literature and the results of the present study revealed that the use of the modern aggressive (conservative-active) management protocol in women with PP has resulted in a significant reduction in the maternal and perinatal complication rates, as well as a relative decrease in the importance of major types of PP and a relative increase of that of the minor types.

Case report of two primary tumors: mullerian adenosarcoma and endometrial adenocarcinoma.

A rare case of two concomitant primary uterine neoplasmas in a 64-year-old patient who had received conjugated estrogens for the 3 preceding years is presented. Müllerian adenosarcoma, heterologous type, with stromal components suggestive of rhabdomyosarcoma, and adenocarcinoma of endometrium, were localized in different sites of the endometrium with no intermingling between them (combination tumor). The diagnostic and therapeutic problems are discussed.

Decreased ratio of total progesterone to total estradiol receptor levels in endometria of women with adult dysfunctional uterine bleeding.

Total estradiol and progesterone receptor levels (TRE2, TRP) were measured in endometria of women with adult dysfunctional uterine bleeding (n = 2) and compared to those of controls. The women in both groups were comparable with respect to age, history, light and electron microscopic endometrial morphology and dating; plasma levels of LH, FSH, estradiol and progesterone were similar in both groups. A wide range of TRE2 and TRP levels was measured in both groups; however, the levels of the ratio of TRP/TRE2 for each case were significantly lower in 18 of the 22 women with adult dysfunctional uterine bleeding and were in the range of the controls in the remaining 4. Possible explanations for these findings are presented.

Effect of single-dose progesterone administration on estradiol receptor levels in normal human endometrium.

The effects of single-dose progesterone administration on cytosolic and nuclear estradiol receptor levels (RCE2, RNE2) in normal human endometrium were studied in a group of 17 women and the results compared to 18 controls. In both groups, RCE2 and RNE2 levels were highest in the mid-cycle phase and lowest in the secretory phase. Although a wide range of values was found in both groups, the levels of RCE2 in the two groups did not differ significantly. It seems that in human endometrium a single progesterone injection does not significantly change RCE2 and RNE2 levels.

Urinary culture and morbidity in gynecological surgery.

Three hundred women undergoing gynecological surgery were evaluated as regards post-operative morbidity and its relationship to urinary tract infections. The incidence of pre-operative positive urine cultures was 6.3%. This was almost tripled post-operatively. Post operative morbidity was found in 39% of the cases with the highest rate following vaginal surgery. Urinary tract infection was thought to be the cause in 20% of the cases, wound infection in 42% and unknown among 36% of the cases. It was found that the pre- and post-operative urine cultures were poorly related to morbidity and it was particularly noted that 41% of patients who had positive post-operative cultures suffered no morbidity at all. It was concluded that the mere finding of positive post-operative urine cultures may not have accounted for the morbidity in some of the cases and the need for further search of the cause is discussed.

Menorrhagia associated with the wearing of IUD--the results of treatment with clomiphene citrate.

The influence of clomiphene citrate was tested in 206 women suffering from menorrhagia following the insertion of an intrauterine device (IUD). Eighty-three percent felt relief during the therapy, 10% did not benefit and 7% complained of a worsening of their symptoms. Among the women who felt an improvement, 85% responded to the 250 mg/cycle dosage, and 15% required the 350 mg/cycle dosage. Women with shortened menstrual cycles required the higher dose treatment, i.e. 350 mg, compared with women with normal cycles (36% vs. 28%, respectively). The influence of placebo was 6%. The hypothesis is raised that the mechanism of action of clomiphene citrate is the correction of the hormonal disturbances in the luteal phase of the cycle following insertion of the IUD.

PIP: The influence of clomiphene citrate was tested in 206 women suffering from menorrhagia following IUD insertion. 83% felt relief during the therapy, 10% did not benefit, and 7% complained of a worsening of their symptoms. Among the women who felt improvement, 85% responded to the 250 mg/cycle dosage and 15% required the 350 mg/cycle dosage. Women with shortened menstrual cycles required higher dosage as compared to those women with normal cycles (36% vs 28%). The influence of the placebo was 6%. The hypothesis is raised that the mechanism of action of clomiphene citrate is the correction of the hormonal disturbances in the luteal phase of the cycle following IUD insertion.

Placenta previa. The ultrasonographic placental localization and its influence on the mode of delivery.

In a group of 168 patients who presented with third-trimester bleeding, ultrasonographic placental localization did not provide either positive or negative false results concerning the placental site. In a group of 47 patients for whom an ultrasonographic diagnosis of placenta previa was established, an erroneous typing was done in 4 (8.5%). Of these four, one (2.1%) underwent an elective cesarean section instead of being allowed a vaginal trial of labor.

Placenta previa with focal accretion.

A series of eight women in whom a diagnosis of placenta previa with focal accretion was established, is presented. They were selected from a group of 153 women with placenta previa who delivered during the period 1968-77. The women with placenta previa accreta did not differ from those with placenta previa per se with respect to age, parity, obstetrical history, and antenatal, intrapartum or perinatal outcome. Three women delivered vaginally and five by cesarean section. Postpartum hemorrhage occurred in four of the women, three of whom were delivered vaginally. Of seven women who were managed conservatively, one required a hysterectomy to control bleeding. It is suggested that cases of placenta previa with focal accretion be managed conservatively.

Reevaluation of the pH, ferning and nile blue sulphate staining methods in pregnant women with premature rupture of the fetal membranes.

The accuracy rates of 3 diagnostic methods, namely pH determination, fern test and nile blue sulphate (NBS) staining, in the evaluation of women with prolonged premature rupture of fetal membranes (PRM), were investigated in a prospective study. Two hundred and sixty-two women, divided into control and test groups, were examined. A total of 1725 tests were performed. The results indicate that these tests have high inaccuracy rates which increase progressively when more than one hour has elapsed since the rupture of the membranes, and become unreliable after 24 hours. It is concluded that in cases of prolonged PRM these tests provide no better diagnostic information than that obtained by clinical evaluation.

Recurrent placenta previa.

Among a group of 33 135 women who delivered at Beilinson Medical Center, Israel, during the years 1968 to 1978, recurrent placenta previa occurred in 3.2% of the women, i.e., 6 times higher than the incidence of placenta previa in the general population (0.5%). Analysis of the data revealed that women over 36 yr of age with a history of placenta previa are at risk for recurrent placenta previa. Maternal and perinatal morbidity and mortality were similar in cases of single and recurrent placenta previa.

Ovarian teratoma with peritoneal gliomatosis and elevated serum alpha-fetoprotein.

An adolescent girl, had a grade 1 immature teratoma combined with a rare manifestation of glial peritoneal implants of grade 0. A unilateral salpingo-oophorectomy was performed. Alpha-fetoprotein levels, which were elevated before the operation, returned to normal. The patient has been symptom-free for more than three years after the surgical treatment. Repeated normal assays for alpha-fetoproteins can serve as a guide to a projected favorable course. The World Health Organization grading of the teratoma is listed and pertinent medical literature is briefly discussed.

Cysts of the female external genitalia in the newborn infant.

Nineteen cases of cysts of the external female genitalia were diagnosed over a two-year period, giving an incidence of six per 1,000 female infants. The embryology, morphology, and differential diagnosis are discussed. No treatment was given and follow-up at two months of age revealed complete resolution of the cysts, thereby establishing their benign course in the newborn period.