Differential nitric oxide synthase activity in human platelets during normal pregnancy and pre-eclampsia.

1. Nitric oxide released from endothelial cells is a potent vasodilator that might play an important role in cardiovascular regulation during pregnancy. Platelets, like endothelial cells, contain a constitutive form of nitric oxide synthase. 2. The present study aimed to measure the activity of this nitric oxide-forming enzyme in normotensive pregnant and non-pregnant women, as well as in women who had developed pre-eclampsia. Nitric oxide synthase activity was measured in the platelets of 21 normotensive pregnant women, 16 non-pregnant women and seven pregnant women who had developed pre-eclampsia. 3. The nitric oxide synthase activity was significantly higher in normotensive pregnant women [36.8 +/- 2.7 pmol h-1 mg-1 of protein (mean +/- SEM), P < 0.001] than in non-pregnant control subjects (16.8 +/- 1.4 pmol h-1 mg-1 of protein) and in women with pre-eclampsia (24.5 +/- 2.1 pmol h-1 mg-1 of protein, P < 0.01). 4. These data suggest that nitric oxide synthesis is increased during normal pregnancy, possibly contributing to the vasodilatation associated with this condition. Nitric oxide generation, however, may be inappropriately low in pregnant women developing pre-eclampsia, thus leading to an enhanced vasoconstriction.

[Liver transplantation and pregnancy: 1994 perspectives]. / Transplantation hépatique et grossesse: perspectives en 1994.

The authors report a case of pregnancy in a 24-year-old, gravida-3, para-1 patient who had previously undergone liver transplantation for alveolar echinococcosis. Pregnancy and delivery were uneventful with no obstetrical or liver complications. Pregnancy seems to have little effect on liver transplants and rejection is seldom observed. Primary maternal complications are hypertension, preeclampsia, anemia and hyperbilirubinemia. Primary fetal complications include premature delivery and growth retardation. The mode of delivery depends on the obstetrical situation. Cyclosporin may be used during pregnancy. The risk of breastfeeding has not been clearly established. Pregnancy after liver transplantation is possible after 9 to 12 months but requires strict multidisciplinary surveillance. Barrier methods remain the preferred method of contraception for liver transplant patients.

Plasma/serum protein patterns in human fetuses and infants: a study by high-resolution two-dimensional polyacrylamide gel electrophoresis.

Plasma/serum proteins of fetal blood samples (N = 88) obtained under ultrasound guidance between the 18th and the 39th week of pregnancy, of blood samples collected from premature infants (N = 19), newborns at term (N = 20) and children of less than 5 years of age (N = 55) were analysed by high-resolution two-dimensional polyacrylamide gel electrophoresis. By comparison with adult 'reference' protein maps, tens of different proteins (and some of their genetic variants) were identified on the electrophoretograms. After the 18th week of gestation, albumin, transferrin, Factor B, glu- and lys-plasminogen, antithrombin III, Gc-globulin, alpha 1-antitrypsin, alpha 2-HS-glycoprotein, several apolipoproteins (apo A-I, A-II, A-IV, C-II, C-III, D, E, J), retinol-binding protein, transthyretin and alpha-fetoprotein could be observed. During intrauterine life, the size of the spots corresponding to alpha-fetoprotein progressively decreased, whereas the protein pattern globally showed an increase in the number and in the size of the spots. These modifications were particularly apparent in the regions of the electrophoretograms restricted to the heavy and light chains of IgG and to alpha 1-antichymotrypsin. In addition, we observed an unidentified fetal polypeptide characterized by an apparent molecular weight (M(r)) of 46 kDa (P46) and a pI of 5.0. P46 was present in all fetuses and all infants of less than 2 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Childbirth without fear in case of Von Willebrand's disease]. / Accouchement sans crainte en cas de maladie de von Willebrand.

We report two cases of von Willebrand (type I) disease with vWF antigen levels of 21 and 25%, vWF ristocetin cofactor concentrations of 32 and 30%, and coagulation FVIII levels of 10 and 50% respectively. Template bleeding times were 20 and 11 minutes respectively. Both of these women exhibited a progressive and marked improvement of the vWF/FVIII complex during pregnancy. In the first, all parameters had completely normalized in the 37th week when a cesarean section was performed without hemorrhagic complications. The second case had borderline normal levels of the vWF/FVIII complex in the 37th week and underwent normal delivery in the 39th week. The improvement persisted for at least one week post-partum and in the first case values were still higher 10th weeks after delivery than they had been prior to the pregnancy. These observations and similar cases in the recent literature suggest that obstetrical operations and normal delivery are not associated with major blood losses in cases of moderately severe vWD of type I. These patients probably will not need vWF/FVIII concentrates for adequate hemostasis.

[Invasive fetal medicine: pros and cons]. / Médecine foetale invasive: le pour et le contre.

Many methods of ovular sampling now exist. They give us access to our second patient, the foetus, for the purpose of carrying out diagnoses and prognoses and of beginning treatment. These methods carry a risk for the foetus, and it is therefore to weigh up the indications carefully. In addition, some methods (embryoscopy, foetoscopy, skin and liver biopsies, foetal blood samples) have to be performed by experienced specialists in reference centers. These methods also raise numerous ethical problems, notably in view of the multiple diagnostic possibilities and the relatively limited therapeutic possibilities.

[Hematological parameters and prognosis in established or imminent HELLP syndrome. Apropos of 12 case reports]. / Paramètres hématologiques et pronostic dans le syndrome de HELLP établi ou imminent. A propos de 12 observations.

We describe the clinical and biological characteristics of 12 pregnant women with the HELLP syndrome as defined by Weinstein in 1982 (H for hemolysis, EL for elevated liver enzymes and LP for low platelet count). The data demonstrate that this syndrome is an obstetric emergency threatening the lives of both mother and child. However, if delivery is prompt the prognosis is good. The suspicion of gestosis requires a hematological assessment (complete blood count and close examination of blood film, evaluation of hemostasis) as an essential component in therapeutic decisions.

[Fertilization in vitro and embryo transfer]. / Fécondation in vitro et transfert d'embryons.

After a brief historical survey and review of the main Swiss centres engaged in medically assisted procreation, the indications for in vitro fertilization and embryo transfer (IVF-ET) are discussed. This technique offers the sterility specialist a new approach in allowing separate investigation of the two gametes and study of their interactions. This therapeutic approach to infertility is thus supplemented by biological data which may modify or highlight some of the etiologic aspects and promote new treatments. The techniques employed at our centre and the results obtained over the past four years are presented. Analysis of IVF pregnancies shows that the obstetric risks can be associated with the characteristics of the groups treated rather than with the IVF technique.

[Active management of labor. Preliminary results]. / Conduite active de l'accouchement. Résultats préliminaires.

Concerned by the raise in cesarean section rate we introduced a more active management of labor derived from the Dublin experience. This involved a more accurate diagnosis of labor, associated with early diagnosis and augmentation of nonprogressive labor by oxytocin. Two groups of patients who delivered before and after the method was applied were compared. Cesarean section rate fell from 29.6% to 21% (p less than 0.01) and the mean duration of labor was reduced by two hours in nulliparas (from 7 h to 5 h: p less than 0.0005) and by one hour 15 minutes in multiparas (from 4 h 15 min to 3 h: p less than 0.0005), without change in the number of forceps deliveries and the perinatal outcome. Our cesarean section rate remains high. This is largely due to the number of high-risk pregnancies (10% preterm deliveries), the percentage of nulliparas (49%) and the systematic abdominal delivery of breech in nulliparas.

[Lupus erythematosus, circulating anticoagulant and obstetric complications. Apropos of 2 cases]. / Lupus érythémateux, anticoagulant circulant et complications obstétricales. A propos de deux cas.

Systemic lupus erythematosus (SLE) is a disease occurring mostly in women in the childbearing age. We present two cases of pregnancy complicated one by SLE, the other by a "lupus-like" syndrome. In the first case, the fetus suffered from a complete heart block; in the second one, a lupus anticoagulant was discovered in the mother. These two cases are discussed by the light of the literature.