ABSTRACT
OBJECTIVE: The aims of this investigation were to measure corticotropin-releasing hormone (CRH), corticotropin (ACTH) and cortisol before, during and after delivery searching for an endocrine intercorrelation of the hypothalamic-pituitary-adrenal (HPA) axis and to correlate these findings with obstetrical variables. METHODS: Blood was sampled from 50 women with singleton pregnancies at term without uterine contractions, during delivery (after full cervical dilatation) and on the 4th postnatal day. Hormones were measured by radioimmunoassay (RIA). The correlation between obstetric variables, sociodemographic and endocrine data were evaluated using the Spearman rank coefficient. Group comparisons for continuous variables were calculated using the Mann-Whitney U test and Kruskal-Wallis test. RESULTS: Maternal plasma ACTH and cortisol increased significantly during labor, declining toward the 4th postnatal day (p < 0.001) and showing a significant intercorrelation (p < 0.01). Compared to women without uterine contractions CRH rose during labor (p < 0.05) and decreased rapidly to the 4th postnatal day (p < 0.001). No correlations between CRH and ACTH or cortisol were observed. None of the obstetrical variables (parity, newborn's weight, duration of delivery) revealed any significant correlation with ACTH. Analgetic medication (pethidine hydrochloride) was not able to influence the endocrine response to labor stress. CONCLUSIONS: Stressful experience during childbirth has an impact on endocrine response. However, this is not fully evident along the HPA axis in a simple biological model with monocausal dependencies. This 'biological stress model' is not sensitive enough to detect different childbirth conditions and the hormones in the maternal compartment have partially fetal (placental) origin.
Subject(s)
Labor, Obstetric/physiology , Models, Biological , Stress, Physiological , Adrenocorticotropic Hormone/blood , Analgesia, Obstetrical , Birth Weight , Corticotropin-Releasing Hormone/blood , Female , Gestational Age , Humans , Hydrocortisone/blood , Parity , Postpartum Period , PregnancyABSTRACT
The influence on uterine contractility of inflammatory cytokines like interleukin-6 is widely unknown. We were able to demonstrate in 16 human myometrial strips obtained during caesarean section in the organ chamber a highly significant (P < 0.001) increase of the activity of uterine strips after addition of IL-6. This further emphasizes the importance of subclinical infections for the etiology of so called idiopathic preterm labour.
Subject(s)
Interleukin-6/pharmacology , Uterine Contraction/drug effects , Cesarean Section , Culture Techniques , Female , Humans , Infant, Newborn , Interleukin-6/physiology , Obstetric Labor, Premature/physiopathology , Pregnancy , Uterine Contraction/physiologyABSTRACT
The tumour and cytoskeleton protein tissue polypeptide antigen (TPA) was determined in maternal serum taken during the second stage of labour and on the 4th postpartum day. Pregnant women at term (weeks 38-42) served as a control group. TPA levels of women during parturition (median 169 U/l) were higher than those of the control group (median 108.5 U/l) and those of women on the 4th postpartum day (median 66.5 U/l); p < 0.0001 in each case. The correlation between duration of labour and TPA concentration was positive and significant (rs = 0.3; p = 0.03). A significant negative correlation was found between placental weight and maternal serum TPA levels during parturition (rs = -0.3; p = 0.03). The decline of TPA after delivery indicated a serum half-life for TPA of less than 4 days.
Subject(s)
Labor, Obstetric/immunology , Postpartum Period/immunology , Tissue Polypeptide Antigen/blood , Female , Half-Life , Humans , Male , Pregnancy , Reference ValuesABSTRACT
OBJECTIVE: To improve the accuracy and speed of diagnosis of an ectopic tubal pregnancy by means of blood flow analysis in the tubal arteries. We hypothesized that invasion of the trophoblast increases blood flow in the tubal artery involved in ectopic pregnancy. METHODS: In 394 patients, using an endovaginal triplex color Doppler ultrasonography system, we performed qualitative blood flow analysis in the tubal arteries on both sides. The percentage of the between-side difference in tubal blood flow was calculated. RESULTS: There was an increase in tubal blood flow on the ectopic pregnancy side, and the mean between-side difference in tubal blood flow was 20.45% in the ectopic pregnancy group. In the control groups, the between-side difference was 2.95% (t = 21.5, P < .00001). Using a cutoff point of 8% for the percentage of the between-side difference in tubal blood flow, the method had a sensitivity of 85% and a specificity of 96% for diagnosing an ectopic pregnancy. The percentage of the between-side difference in tubal blood flow was independent of gestational age (Pearson correlation coefficient 0.081). CONCLUSION: The advantages of this new method for diagnosing tubal pregnancy are early detection, noninvasivity, and immediate results.
Subject(s)
Fallopian Tubes/blood supply , Pregnancy, Tubal/diagnostic imaging , Ultrasonography, Prenatal , Adolescent , Adult , Analysis of Variance , Arteries/diagnostic imaging , Fallopian Tubes/diagnostic imaging , Female , Humans , Middle Aged , Pregnancy , Regional Blood Flow , Sensitivity and Specificity , Time Factors , Vascular ResistanceABSTRACT
Ectopic pregnancy is not recognized in 5523% of all cases using state-of-the-art diagnostic procedures. In this study, blood flow in tubal arteries was measured using a transvaginal duplex Doppler ultrasonography system. A 3.5 MHz Doppler transducer coupled to a 5 MHz imaging transvaginal sector probe was used to depict flow characteristics in the tubal branch of the uterine artery. This was performed in 102 patients. There was a significant increase in the blood flow on the tubal gestation side (p < 0.0001; z = -4.08). This between-side difference was determined using qualitative frequency shift analysis. The mean reduction in the resistance index on the side with the ectopic pregnancy as compared to the contralateral side was 15.6%. These changes appear to be due to trophoblast invasion. Between-side differences showed no dependence on gestational age (between gestational weeks 4 and 12 postmenstruation). We compared these data with those from three control groups ('early viable intrauterine pregnancy', 'early intrauterine pregnancy failure', 'non-gravid state'). In all these control groups, the impedance to flow, expressed as 'resistance index', showed no significant between-side difference. All control groups had significantly higher mean resistance index values than the ectopic pregnancy side, but did not differ from the contralateral side of the ectopic pregnancy group. The advantages of this new method in diagnosing ectopic pregnancy are early detection, non-invasivity, and immediate results.
Subject(s)
Endometrial Neoplasms/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Precancerous Conditions/diagnostic imaging , Uterine Neoplasms/diagnostic imaging , Endometrial Neoplasms/prevention & control , Female , Humans , Ovarian Neoplasms/prevention & control , Precancerous Conditions/prevention & control , Ultrasonography , Uterine Neoplasms/prevention & controlSubject(s)
HIV Seropositivity/immunology , Pregnancy Complications, Infectious/immunology , Biopterins/analogs & derivatives , Biopterins/urine , CD4-CD8 Ratio , Female , Fetal Growth Retardation/immunology , HIV Seropositivity/congenital , Humans , Infant, Newborn , Neopterin , Pregnancy , Pregnancy Outcome , Substance Abuse, Intravenous/complicationsSubject(s)
Nafronyl/pharmacology , Uterine Contraction/drug effects , Culture Techniques , Female , Humans , PregnancySubject(s)
Dinoprost/administration & dosage , Fallopian Tubes/blood supply , Laparoscopy , Pregnancy, Tubal/diagnostic imaging , Blood Flow Velocity/drug effects , Blood Flow Velocity/physiology , Female , Humans , Injections, Intralesional , Pregnancy , Pregnancy, Tubal/drug therapy , UltrasonographySubject(s)
Condylomata Acuminata/therapy , Interferon-alpha/administration & dosage , Laser Therapy , Papillomaviridae , Tumor Virus Infections/therapy , Vulvar Neoplasms/therapy , Aged , Combined Modality Therapy , Female , Humans , Injections, Subcutaneous , Interferon alpha-2 , Recombinant ProteinsSubject(s)
Fetal Blood/cytology , Leukocyte Count , Maternal-Fetal Exchange/physiology , Platelet Count , Pre-Eclampsia/blood , Adult , Female , Granulocytes , Humans , Infant, Newborn , Pregnancy , Syndrome , Thrombocytopenia/bloodABSTRACT
3 cases of severe discordant malformations diagnosed by ultrasound (anencephaly, myelomeningocele, prune belly-syndrome) in multiple pregnancies have been described. Operations have been given up consciously.
