Identification of high-risk pregnancy by the routine measurement of pregnancy-specific beta 1-glycoprotein.

A prospective study of 1,040 women who underwent delivery during 1977 at St. Bartholomew's Hospital was undertaken to evaluate the role of measurement of maternal circulating pregnancy-specific beta 1-glycoprotein (SP1) in the detection of high-risk pregnancy. A comparison of the predictive value of this test was also made with a variety of clinical, ultrasonic, and biochemical variables in the detection of high-risk pregnancies. The best antenatal predictors of fetal risk were severe preeclampsia and depressed maternal serum levels of human placental lactogen and SP1. It is suggested that measurement of SP1 may provide valuable information on fetal compromise in late pregnancy.

Pregnancy specific beta 1 glycoprotein and chorionic gonadotrophin in early human pregnancy.

Venous blood samples were collected prospectively in ten menstrual cycles where conception occurred, and for several weeks thereafter, and the circulating concentrations of pregnancy specific beta 1 glycoprotein (SP1) and human chorionic gonadotrophin (HCG) determined using specific radioimmunoassays. The data were converted to logarithms and pooled and pooled using the day of the LH peak as zero time. The concentration profiles so obtained were remarkable similar and showed a rapid exponential increase in concentration during the very early stage of pregnancy. The doubling times were 2.4 days and 2.3 days for SP1 and HCG respectively and both proteins were initially secreted in approximately equivalent concentrations. However, some 30 days following the LH peak, the concentration profiles began to diverge, with SP1 levels continuing to rise whilst HCG concentrations showed the characteristic plateau at 8 and 10 weeks of gestation.

Fetal loss after implantation. A prospective study.

The incidence of post-implantation pregnancy loss in 197 women was determined prospectively. The diagnosis of pregnancy was based on the detection of human chorionic gonadotropin in the urine during the luteal phase of each menstrual cycle. There were 152 conceptions in the 623 cycles studied with a pregnancy loss rate of 43%. 14 of the pregnancies ended in clinically recognised spontaneous abortions and in 50 the sole evidence of pregnancy was an increased concentration of urinary hCG. The maximum conception rate achieved was 36% in the first cycle after removal of an intra uterine device.

Monitoring fibrinolytic activity in the cerebrospinal fluid after aneurysmal subarachnoid haemorrhage: a guide to the risk of rebleeding?

Serial assay of fibrin degradation products (FDPs) was used to monitor fibrinolytic activity in blood and cerebrospinal fluid (CSF) after subarachnoid haemorrhage (SAH) in 64 patients, 43 of whom had aneurysms. CSF levels fell rapidly from high initial values over a few days, thereafter more slowly to reach normal levels after one to six weeks. Probably only the later slow decline is a measure of fibrinolysis, which is obscured in the first few days by the cross antigenicity with FDP's of fibrinogen released by the bleed. After this phase of fibrinogen clearance, early attainment of normal FDP levels appears to be associated with a lower risk of rebleeding in cases of aneurysm. This phenomenon could be useful in deciding whether marginal cases should be treated surgically or conservatively.

Circulating levels of pregnancy specific beta 1 glycopretein in patients with testicular, bronchogenic and breast carcinomas.

Pregnancy specific beta 1 glycoprotein (SP1) was measured in plasma from patients with carcinoma of the breast (42 patients), lung (32 patients, and testis (9 patients). Elevated circulating levels of SP1 were detected in one patient from each group.

Circulating levels of pregnancy specific beta 1 glycoprotein in pregnancies complicated by diabetes mellitus.

Circulating levels of SP1 were measured in 20 insulin dependent diabetic women during the third trimester of pregnancy. With one exception, SP1 levels were between the 80 per cent confidence limits of the normal range. The exception was a patient who was delivered of a normal infant at 37 weeks but had consistently low levels of SP1 from 32 weeks until delivery, suggesting a specific defect in SP1 synthesis.

Identification and purification of a new protein from water-soluble extracts of human adrenal gland.

An homogenate of human foetal adrenal gland was subjected to negative immunoabsorption by column chromatography using anti-whole human serum coupled to Sepharose 4B. Two peaks were eluted and used to immunize rabbits. The antisera produced were absorbed and tested for specificity by double immunodiffusion. Two antigens, which appeared to be specific to the adrenal gland, were identified having molecular weights of 25 000 and 65 000 as determined by gel filtration. The lower molecular weight antigen was isolated by physicochemical methods and found to be a protein. The amino acid composition is reported.

Fetal breathing movements and other tests of fetal wellbeing: a comparative evaluation.

Sixty pregnant women whose fetuses were considered to be at high risk were intensively studied with fetal and placental function tests. Fetal breathing movements were studied with real-time ultrasound and the amount of time spent breathing and the variability of the breath-to-breath interval were measured. A reduction in the amount of time the fetus spent making breathing movements and decreased variability were indicative of fetal compromise. When these results were compared with those of other tests of fetal wellbeing measurement of fetal breathing movements and ultrasound assessment of growth were more sensitive tests of fetal wellbeing than the biochemical measures (urinary oestrogen, human placental lactogen, pregnancy-specific beta-1-glycoprotein, and unconjugated oestriol concentrations) or fetal heart rate. The predictive value was highest with serum unconjugated oestriol but the results of other tests were similar. Study of fetal breathing movements or an ultrasonic assessment of growth may provide a better screening test for fetal compromise than biochemical estimations.

Placental protein 5 in fetal and maternal compartments.

Placental protein 5 is produced by the syncytiotrophoblast and secreted into the maternal peripheral circulation reaching levels of approximately 30 micrograms per litre in normal pregnancy at term. In the present study the distribution of PP5 was examined in maternal and fetal compartments in 13 patients at delivery.

Changes in the concentration of 5-methoxytryptophol in the circulation at different phases of the human menstrual cycle.

The pineal indole 5-methoxytryptophol (ML) has been shown to have an antigonadal activity when administered to experimental animals, but data on its normal pattern of secretion have been lacking. Using a new gas chromatography-mass spectrometry assay, the concentration of ML at various phases of the human menstrual cycle has been studied. Daily samples were obtained throughout the month from five women with a normal cycle and two women taking an oral contraceptive. In women with a normal cycle levels of ML were found to be significantly lower in the last third of their cycle; this change was not seen in women taking an oral contraceptive who had low levels throughout the month. The changes in concentration of ML did not correlate with the changes in concentration of gonadotrophins.

Maternal serum alpha-fetoprotein levels as an index of fetal risk.

In a prospective study on an obstetric population (1,059 cases) an association was found between elevated levels of maternal serum AFP at weeks 16 to 22 and the occurrence of premature labor or the need for emergency cesarean section in the third trimester. There was no association with other late fetal complications including perinatal death, perinatal asphyxia, and intrauterine growth retardation. The sensitivity of the test in respect of premature labor was 14 per cent but the high incidence of false-positive results reduces the practical value of the test.

Urinary excretion of factor VIII after renal transplantation.

The urinary excretion of factor-VIII-related antigen (VIIIRAg) was measured in 72 patients with kidney transplants and compared with that of two end-products of fibrin-fibrinogen lysis (fragments D and E) to assess their usefulness in monitoring the onset of rejection episodes. Specific and sensitive radioimmunoassays were used to measure the three proteins. Unconcentrated urine samples of 24-hour collections were obtained from 20 healthy subjects, 48 patients with stable transplants, and 24 patients with recent transplants serially followed up from the day of transplantation. Factor VIIIRAg and fragments E and D were not detectable in the urine from healthy subjects but were present in 39%, 60%, and 100% respectively of samples from patients with stable transplants. During 33 acute rejection episodes in 19 patients with recent transplants factor VIIIRAg and fragments E and D were significantly increased above the values observed in patients with stable transplants in 82%, 73%, and 64% of samples respectively; in patients with recent transplants showing no clinical sign of rejection increased excretion of these proteins was observed in 11%, 26%, and 22% of samples respectively. The presence of factor VIIIRAg in urine from patients with kidney allografts suggests that endothelial cell-factor VIII-platelet interactions might pay a key part in the pathogenesis of acute rejection. The results suggest that the assay of factor VIIIRAg in urine is more useful than assays of fragments D and E as a corroborative index of transplant rejection.