Combined intrauterine and extrauterine gestations: a review.

In a review of the world's literature on combined intrauterine and extrauterine pregnancies, 589 cases, including five cases currently reported from the Sloane Hospital for Women, were documented. Analysis of the literature revealed abdominal pain to be the most frequent presenting symptom. A combination of signs and symptoms, including abdominal pain, adnexal mass, peritoneal irritation, and an enlarged uterus, was the most significant finding in support of a presumptive diagnosis of combined gestations. At the Sloane Hospital for Women, the occurrence of both pelvic inflammatory disease and combined pregnancy is approximately three times the reported world incidence. This proportionate increase in both disease states may support a potential etiologic association between pelvic inflammatory disease and simultaneous intrauterine and extrauterine gestations.

Significance of amniotic fluid corticosteroid levels in human pregnancies.

Retrospective analysis of 103 samples of amniotic fluid was performed. Twenty-four samples were obtained prior to midtrimester abortion, 31 were from patients who delivered spontaneously, 14 were from patients in whom labor was induced, and the remaining samples were obtained from patients who were delivered by cesarean section. In all normal pregnancies, there was a rising trend in corticosteroid levels in amniotic fluid as the gestation advanced. This was less marked in abnormal pregnancies. There is a suggestive fetal role in initiation of normal spontaneous labor, as reflected by a significant increase in amniotic fluid corticosteroid levels, in patients immediately prior to vaginal delivery as opposed to abdominal delivery. There was a significant correlation between the birthweight of babies born vaginally with the amniotic fluid corticosteroid levels, as compared to the weight of babies born by cesarean section.

PIP: Corticosteroid levels in amniotic fluid in patients delivered spontaneously, by labor induction, or by Caesarean section, in relation to the onset of labor, were studied. Amniotic fluid was obtained from 103 women in several stages of gestation. 24 samples were obtained prior to midtrimester abortion, 31 from patients who delivered spontaneously, 1 from patients in whom labor was induced, and 34 from patients delivered by elective Caesarean section. Details of the chemical technique used are given. This fluorometric method measured free unconjugated corticosteroid in the amniotic fluid. The method was shown to be specific for 11-hydroxy-corticosteroids. It was found that cortisol and corticosterone constitute about 90% of the total corticosteroids in the amniotic fluid. The amount of corticosterone was 3.5 times the level of cortisol. There was a rising trend in the level of corticosteroids in the amniotic fluid just prior to the onset of normal spontaneous vaginal delivery. In the Caesarean section group no rising trend of the level of corticosteroids in the amniotic fluid was found. There was a highly significant correlation (p less than .01) between birth weights of babies born spontaneously and the amniotic fluid concentration of corticosteroids. The higher the birth weight the greater the corticosteroid level in the amniotic fluid. This correlation was not found in babies born by Caesarean section. Results suggest that amniotic fluid corticosteroids may denote the maturity of the fetus and may be related to the onset of parturition in humans. The maternal contribution to amniotic fluid corticosteroids has not been ascertained.