Stimulation by polypeptides of dehydroepiandrosterone sulphate synthesis in human fetal adrenal slices.

Slices of human fetal adrenal glands (obtained after abortion at 10-18 weeks of gestation) were superfused sequentially with buffer or with buffer incorporating human ACTH, synthetic ACTH (1-24), human GH, human chorionic gonadotrophin, alpha-melanocyte stimulating hormone, metenkephalin, ovine prolactin, beta-lipotrophic hormone or corticotrophin-like intermediate lobe peptide in concentrations from 10(-6) to 10(-9) mol/l. Changes in the concentration of dehydroepiandrosterone sulphate (DHAS) in the effluent in response to addition or removal of the polypeptides were measured by radioimmunoassay. Comparison of the quantity of DHAS in the effluent collected during superfusion (5h) with that present in the tissue initially indicated that synthesis of this conjugated steroid occurred during superfusion. Increases in the concentration of DHAS in the effluent were provoked by exposure of the tissue to all the polypeptides except corticotrophin-like intermediate lobe peptide. These effects were unlikely to be non-specific since incorporation of gonadotrophins, albumin or dextran into the superfusate did not stimulate corticosteroid synthesis from viable bovine adrenal tissue. It was concluded that a number of pituitary polypeptides have the potential to provoke androgen sulphate synthesis by the human fetal gland in early gestation. Consequently there may be no single fetal corticotrophin at this stage and androgen production may be regulated by a number of trophic factors.

Factors affecting the success of mid-trimester amniocentesis.

Of 298 women who had mid-trimester amniocentesis carried out in a single hospital unit in a 6-yr period, an increasing proportion were carried out for detection of neural tube defects. A clinical decision could be made following the first amniocentesis in 77% of cases. There were 16% where liquor was not obtained at the first attempt, and a further 7% where cell growth or biochemical testing was unsatisfactory. The outcome was influenced by the experience of the operator and timing of procedure. The success of the first procedure was 59% before 16 wk of gestation and 86% between 16 and 20 wk. The incidence of blood-staining of the liquor was higher with an anterior placenta (19%). Despite difficulties, the abortion rate (3.5%) does not appear to be higher than would be expected.

Use of ultrasound and hormone assays in the diagnosis, management, and outcome of twin pregnancy.

A study of 79 twin pregnancies was conducted between 1973 and 1976 with particular reference to the use of ultrasound and hormone analysis. There were 17 perinatal deaths, a perinatal mortality rate of 107 per 1000 deliveries. The contributing factors were antepartum anoxia (40%), prematurity (30%), congenital abnormalities (18%), and obstetric trauma (12%). During the period of study there was a complete change in the method of confirming twin pregnancies, ie, in 1973, 84% were confirmed by x-ray and in 1976, 86% by ultrasound. About 40% were diagnosed at 28 weeks' gestation or earlier. The ranges (mean +/- 2 SD) for human placental lactogen (hPL) and urinary estrogens have been established for twin pregnancy, and the value of these measurements in the antenatal management of twin gestations is discussed.