Placental morphology in relation to umbilical artery blood velocity waveforms.

The association between umbilical artery flow velocity waveforms, placental morphology and arterial vascular pattern was investigated in 30 pregnant women at risk for intra-uterine growth retardation. The blood velocity waveform was assessed in the umbilical arteries with pulsed Doppler ultrasound. Placentas from fetuses with an end-diastolic zero flow were small and thick with an extrachorial configuration, marginal cord insertion, magistral or mixed allantochorial vessel pattern and few cotyledons. The incidence and the extension of gross lesions were slightly increased in these placentas compared to placentas from fetuses with a normal S/D ratio (peak systolic velocity/minimum diastolic velocity). Placentas from fetuses with an increased S/D ratio (greater than +2SD) were large and thin with a high maximum diameter/maximum thickness ratio. Heavily smoking mothers were overrepresented in the group, with an increased S/D ratio and corresponding SGA infants. End-diastolic zero flow in the umbilical artery was strongly correlated with placental developmental abnormalities.

Chorioamnionitis in relation to gestational outcome in a Swedish population.

In a histopathological study, from a homogeneous Swedish population with a better than average socio-economic standard, placentas from 161 singleton infants small for gestational age (SGA) and 322 singleton infants appropriate for gestational age (AGA) were examined for the presence of inflammation in the placental parenchymal membranes, cord and decidua. Acute chorioamnionitis including funiculitis was found in 13.4% of the total material, in 17% of term AGA-infants (GA, greater than or equal to 38 weeks), in 13% of preterm AGA-infants (less than or equal to 37 weeks) and in 6.8% of SGA-infants (p less than 0.001, compared to term AGA). Acute chorioamnionitis was correlated to vaginal delivery (p less than 0.01), rupture of the membranes greater than 24 hours (p less than 0.01), nulliparity (p less than 0.05) and amniocentesis (RR = 1.7). In nulliparous, chorioamnionitis was related to duration of labor greater than 16 hours (p less than 0.01). Streptococcal (p less than 0.01) and anaerobic vaginal infections (p less than 0.05) were also related to chorioamnionitis. Of 17 infants with sepsis, 6 had chorioamnionitis (p less than 0.05). Decidual inflammation was chronic in type and found in 4.5% of the placentas and was not related to chorioamnionitis, but to parity (p less than 0.05) and term AGA-infants (p less than 0.001).

Placental lesions and maternal hemoglobin levels. A comparative investigation.

A high maternal hemoglobin level during pregnancy has been correlated to a low birth weight and a low placental weight, but has not been investigated in relation to placental factors. In 330 consecutive deliveries, placental lesions, birth weight and placental weight were studied in a multiple regression analysis in relation to maternal hemoglobin concentration, taking into consideration possible confounding factors such as smoking, hypertensive disorders, weight gain, primiparity, gestational age and sex. A high maternal hemoglobin concentration (greater than 130 g/l) was correlated with a low birth weight, acute infarcts and syncytial knots. Intervillous thrombosis was more common in non-smokers and multiparous women, increasing in incidence as gestational age advanced. Infarcts and microscopic perivillous fibrin were correlated with hypertension. Microscopic perivillous fibrin was slightly associated with a high hemoglobin level (greater than 130 g/l) in a bivariate analysis. These findings may indicate that a high maternal hemoglobin level impairs the uteroplacental circulation.

Placental villitis and intrauterine growth retardation in a Swedish population.

Villitis was studied in placentas from 445 singleton infants from an ethnically homogeneous population with a good socioeconomic standard. There were 161 infants small for gestational age (SGA) and 284 appropriate for gestational age (AGA). Villitis was found in 12 SGA-placentas (7.5 per cent) and 8 AGA placentas (2.8 per cent) (p less than 0.05). The degree of villitis was also related to growth retardation (p less than 0.05). Except for one placenta with villitis due to CMV infection, the cause of villitis could not be determined. No association was found with various studied factors such as hypertension, pre-eclampsia, smoking or maternal pyrexia during pregnancy.

Influence of progesterone on the sodium and potassium concentrations of rat uterine fluid investigated by microdialysis.

Currently used techniques to measure the chemical composition of the rat uterine fluid are accompanied by interference with the physiology of the uterus, and the sampling procedure creates a methodological problem as the amount of uterine fluid is small. The aim of the present study was to investigate the utility of a new in vivo technique, microdialysis. A microdialysis probe, which functions as an 'artificial blood vessel' was implanted into the uterine lumen and perfused with a Ringer solution. This perfusion technique makes it possible to study ions and other components in the uterine fluid without withdrawal of any liquid. Compared to previous techniques it offers the advantage of continuous monitoring of the chemical composition of the uterine fluid over time. The sodium and potassium concentrations in the uterine fluid of 10 rats were monitored during oestrous. After 1-2 h of baseline perfusion an intramuscular injection of progesterone was given. The mean sodium concentration was 124.9 +/- 2.4 mEq/l before and increased in all 10 rats to 133.9 +/- 2.3 mEq/l (p less than 0.001) after injection. The mean potassium concentration was 22.3 +/- 2.4 mEq/l before and decreased to 17.9 +/- 2.1 mEq/l (p less than 0.001) after injection. This study proves the validity and applicability of microdialysis to the monitoring of chemicals in uterine fluid and especially to follow dynamic changes.

Relationship between placental shape, cord insertion, lobes and gestational outcome.

Singleton placentas from 330 consecutive births were examined for size, shape, cord insertion, allanto-chorial vascular pattern and lobes. These factors were considered regarding possible interactions and correlation to pregnancy and perinatal outcome. Marginal cord insertion was correlated to extrachorial and bilobate placenta and to magistral wr mixed allanto-chorial vascular pattern. A paucity of lobes (less than 15) was associated with extrachorial placenta, marginal cord insertion, pre-eclampsia, gestational age less than 38 weeks and small for gestational age infants. The common denominator for abnormal configuration and marginal cord insertion seemed to be the paucity of lobes.

A prospective study of Chlamydia trachomatis infection following legal abortion.

In a prospective study, 288 women were tested for Chlamydia trachomatis (CT) in the cervix prior to legal abortion. In the control group (n = 259), CT culturing was carried out only when postoperative infection was suspected. CT was isolated in 14.2% of asymptomatic women. These patients were treated preoperatively with Doxycycline. In this group, no cases of postoperative infection were detected. Among those cases where CT was not detected, 4.9% contracted the infection, while in the control group the rate of infection was 9.7%. In the control group all the infections due to CT gave late symptoms after the operation (1-4 weeks).

PIP: 500 women under age 25 and undergoing therapeutic abortion between September 1983 and September 1984 were included in this study designed to evaluate whether preoperative Doxycycline treatment given to carriers of "Chlamydia trachomatis" (CT) could reduce the postoperative infections. The patients were randomly distributed into 2 groups. Specimens were taken from the cervix of the patients in group A (n=228) for culture and direct immunofluorescent staining (DFA). In group B (n=259) only a clinical examination was performed. CT culturing (iodine staining) was carried out postoperatively only when signs of infection were found. When a patient in either group A or B showed signs of infection preoperatively, she was excluded from the study. The operation was performed as a vacuum aspiration prior to the 12th week of gestation (9). After the 12th week, a 2-stage procedure was performed with extra- or intra-amniotic instillation of prostaglandin followed by exeresis of the cavum uteri. All cases of postoperative genital infection appearing within 1 month after the abortion were registered. To establish the diagnosis of postoperative PID, a bimanual examination revealing palpation tenderness over the uterus and tubes was required. In group A, 41 of 288 women were CT carriers by any or all diagnostic methods (14.2%). In 32 cases, both culture and DFA revealed the presence of CT. All 41 women received preoperative Doxycycline treatment. None developed a postoperative infection. Among the 247 women with nondetectable CT, 14 developed a postoperative infection (4.9%). In group B, 25 of 259 women (9.7%) contracted a postoperative infection. In 8 of these women, CT was isolated. On dividing the postoperative infections into 2 groups, those with symptoms appearing within 3-4 days after the abortion and those with later symptoms, 9 of the 14 infections were early in group A and 13 of 25 infections were early in group B. With preoperative Doxycycline treatment of CT carriers, the rate of late infections was reduced from 4.6% to 1.7%. Of the infected patients in group B, 4 suffered from salpingitis -- all with a late onset.