[Changes in cervical fibronectin levels during pregnancy, labor and in the postpartum period]. / A cervix uteri fibronektin tartalmának változása terhességben, a szülés alatt és közvetlenül a szülés után.

The authors analysed the fibronectin content of the uterine cervix during pregnancy and delivery. The aim of their investigation was furnishing data to the biochemical changes during cervical maturation. The ripening of the uterine cervix during pregnancy is a result of complicated interactions between different macromolecules, where the fibronectin plays a key role. The quantitative determination of the extracellular matrix fibronectin is impossible because its extraction from tissues recently is not solved. Taking this fact in consideration the authors choose a semiquantitative method, being reliable indicator of changes in fibronectin content of uterine cervix. They took small pieces of materials from portio vaginalis uteri of 139 women being in postmenopause and premenopause, in different stages of pregnancy and parturition concerning directly after delivery. The slides were incubated, with rabbit-anti-human fibronectin-FITC. The evaluation of fluorescence happened with an Axiophot (Zeiss) microscope. Authors stated that the fibronectin content in the cervical extracellular matrix and in the cellular membrane of fibroblasts increases during the 1st trimester pregnancy. This increase can be shown in the 3rd trimester as well and it drops significantly during delivery. They could not found any relationship between the leucocyte invasion observed during delivery and the changes of cervical fibronectin content. These observations call our attention to the importance of fibronectin in cervical ripening respectively dilatation and the need of further examinations.

Changes in binding capacity of sialic acid-specific lectins in the connective tissue of the uterine cervix during its physiological maturation.

The authors obtained small pieces of materials from portio vaginalis uteri of women being in postmenopause and premenopause, in different stages of pregnancy and parturition respectively after delivery. Biochemical investigations of these specimens were performed to study the background of physiological ripening of the uterine cervix. They examined the changes in activity of sialidase which cleaves terminal sialic acids. Investigations were performed with the use of Triticum vulgaris (WGA) and Limulus polyphemus (LPA) agglutinins (lectins) marked with FITC. These lectins bind specifically to the sialic acids. The evaluation of the lectin linkage was carried out with fluorescence microscope. Separately was evaluated the fluorescence of different extracellular matrix elements concerning the whole fluorescence of connective tissue as well. It was stated that the number of WGA- and LPA-binding sites of the uterine cervix compared to the non-pregnant state increases predominantly in the 1st trimester pregnancy. In relation to the 1st trimester we described a slight reduction of LPA- and WGA-binding sites in the 3rd trimester. The most impressing changes of LPA- and WGA-binding sites we observed during parturition in the extracellular matrix. These results coincide with the author's previous experience whereas the sialidase activity increases significantly during parturition. These data support the assumption that the terminal sialic acids and the sialidase play certain role in human uterine cervix during the gestational process. Their role at the time of pregnancy and delivery however remains to be cleared.

Serum collagenase levels during pregnancy and parturition.

Recent studies have described the origin of the collagenase responsible for the degradation and loss of collagen during cervical ripening and dilatation to be polymorphonuclear leukocytes. In the present study the clinical feature of cervical dilatation was correlated to the serum levels of human granulocyte collagenase. The serum collagenase level was measured in 19 premenopausal women and in 181 pregnant women. In 15 of these pregnant women serum samples were obtained from the onset of labour to the active phase of labour at four different times. The collagenase concentrations remained low up to the 35th week of gestation (19.4 ng/ml) in comparison with the beginning of pregnancy. From the 35th week of gestation on we found a slight increase in collagenase in maternal serum. The maximum peak was reached during parturition at a cervical dilatation of 6-8 cm (71.2 ng/ml). The serum levels returned to non-pregnant values the first day following delivery. The results show that collagenases are critically involved in parturition.

[Sialidase activity in cervical connective tissue during cervix maturation and dilatation during labor]. / Szialidáz aktivitás alakulása a cervix uteri kötöszövetében a terhesség alatti érés és a szülés alatti dilatáció során.

The authors obtained small pieces of materials from portio vaginalis uteri of 122 women being in postmenopause and premenopause, in different stages of pregnancy and parturition concerning directly after delivery. Different biochemical investigations of these 30-200 mgs specimens were performed to study the physiological background of its ripening process. They examined the changes in activity of sialidase which cleaves terminal sialic acids. The authors performed these investigations with the use of Triticum vulgaris (WGA) and Limulus polyphemus (LPA) agglutinins (lectins) marked with FITC. The evaluation of the lectin linkage happened with fluorescence microscope. They evaluated the whole fluorescence of extracellular matrix but separately of different extracellular matrix elements as well. From their investigations was stated that the number of WGA and LPA binding sites of the uterine cervix increases predominantly in the 1st trimester pregnancy compared to the non-pregnant state. As compared to the 1st trimester they described a slight reduction of LPA- and WGA-binding sites in the 3rd trimester. The most impressing changes of LPA and WGA binding sites in the extracellular matrix were observed during parturition. These results coincide with the authors' previous experience whereas the sialidase activity increases significantly during parturition. These data support the assumption that the terminal sialic acids and the sialidase play a recently yet not cleared role in the ripening of the human uterine cervix during pregnancy and in dilatation at the time of parturition.

[The role of surgical cerclage (cervicorrhaphy), performed in the non-pregnant woman, in the prevention of premature labor]. / A nem terhes állapotban végzett cerclage mütét (cervicorrhaphia) szerepe a koraszülések megelözésében.

The authors analyse the role of cerclage operation (cervicorrhaphy) performed before the pregnancy in the prevention of premature birth. They studied the obstetrical events of 76 patients underwent on cervicorrhaphy because of diagnosed cervical insufficiency. They performed the operation in the cases where according to the case history or clinical findings the cervical incompetence was proven. They stated that the cerclage operation performed before the pregnancy is an effective method in prevention of premature births based on cervical incompetency. The obstetrical case history plays an important role in the indication of cervicorrhaphy. The cerclage operation executed in non-pregnant state can prevent the premature delivery only in the following pregnancy. In spite of the operation during the next coming pregnancy it is advisable the pregnant patient to have as possible bed rest and exceeding care.

Glycosaminoglycans in cervical connective tissue during pregnancy and parturition.

OBJECTIVE: To investigate the content and distribution patterns of glycosaminoglycans in the human cervix during pregnancy and parturition. METHODS: We obtained a total of 87 specimens from nonpregnant and pregnant women. Biopsies (weight 50-200 mg) were taken from the posterior lip of the cervix. Hyaluronic acid, dermatan sulfate, chondroitin sulfates, and heparan sulfate were separated on a Dowex 1 x 2 column and identified. RESULTS: The total amount of glycosaminoglycans increased during pregnancy from 2800 to 5000 nmol/g dry weight. The highest values were observed at the onset of labor (7100 nmol/g dry weight), followed by a sharp decrease during parturition. The clinical features of cervical ripening and dilatation were also associated with remarkable changes in glycosaminoglycan patterns. CONCLUSION: Besides collagenolysis during pregnancy, the glycosaminoglycans are also important regulators of cervical function. The different clinical features of the human cervix are characterized not only by variation in the total glycosaminoglycan content but also by changes in the proportions of the different glycosaminoglycans.

[Surgical cerclage in the treatment of cervical incompetence during pregnancy (determining the legitimacy of the procedure)]. / Cerclage mütét a méhnyak-elégtelenség kezelésében terhesség során (a mütét jogosságának megítélése).

The authors studied the effectiveness of the cervical cerclage operation in the therapy of cervical insufficiency during the pregnancy. Two Hundred sixteen pregnant women took part in this trial in whose pregnancy the necessity of cerclage operation was not unequivocal. It means, that the therapeutical cerclage operation was not necessary, but the necessity of prophylactic cerclage operation was doubtful as well. From the randomized 216 cases they performed cerclage operation in 108 pregnancies and in 108 cases they did not perform it. In the respect of pregnancy care they did not make any difference between the two groups. The authors from their trial draw the conclusion, that in doubtful cases where the necessity of cervical cerclage operation is not unequivocal--e.g. at serious gestational case history--it is advisable to perform the operation. The danger of premature birth can be diminished in this way.

Origin of cervical collagenase during parturition.

Cervical biopsy specimens were obtained under standard conditions from the posterior lip of the uterine cervix in 105 patients. A significant increase of collagenase activity was observed during parturition as determined with an assay with iodine 125-labeled native triple-helical collagen type I as the substrate. The collagenase was not likely to originate from cervical fibroblasts because in situ hybridization failed to detect synthesis of the specific procollagenase messenger ribonucleic acid. However, migration of polymorphonuclear leukocytes into the cervical stroma occurred on onset of labor, and an antibody specific for human leukocyte collagenase that did not cross react with fibroblast collagenase revealed the presence of the enzyme in the granules of polymorphonuclear leukocytes and subsequently in the extracellular matrix of the cervix. Therefore it is likely that the cells critically involved in collagen degradation during cervical dilatation are not resident fibroblasts but rather polymorphonuclear leukocytes emigrating from blood vessels.

Collagenase activity in the human cervix uteri after prostaglandin E2 application during the first trimester.

Cervix biopsies were obtained during the first trimester from plurigravidae and primigravidae at various times after intracervical application of prostaglandin E2. The tissues were extracted with Ca(2+)-containing buffer, and collagenase activity was determined in these extracts using a solid phase assay in which triple helical 125I-labelled collagen was cleaved. Collagenase was detected in all samples but elevated activity was present only during a short temporal window after prostaglandin application. Maximal activity was observed 1 and 2 h after application of prostaglandin in multigravidae and 4 h in primigravidae. These data can explain why collagenase activity in cervical tissues after prostaglandin application had previously not been found. They indicate somewhat different mechanisms of cervical ripening in primigravide compared to multigravidae.

[A life-saving hemostatic procedure by ligation of the hypogastric artery in hemorrhage caused by cervix carcinoma]. / Cervix carcinomából eredö vérzés életmentö csillapítása az arteria hypogastrica lekötésével.

Ligation of the hypogastric arteries may be a lifesaving procedure for patients with intractable hemorrhage from pelvic viscera. This is especially true in the field of obstetrics and gynecology in which hemorrhage remains a major cause of mortality. Authors ligated both hypogastric arteries to control intractable hemorrhage in an advanced case of cervical carcinoma. It is emphasized that the technique of hypogastric artery ligation should be practised by all gynecologists.

Interruption of pregnancy by cervical rivanol predilatation.

Experience obtained in 1361 cases of first trimester pregnancy interruption with cervical Rivanol predilatation is reported. Rivanol-induced predilatation of the cervical canal prior to interruption was found to be an efficient procedure. The dilating effect of Rivanol could not be enhanced by i.m. administration of 5 IU oxytocin. After the interruption of more advanced pregnancies a higher degree of dilatation of the cervix was observed. The necessity of further dilatation prior to vacuum aspiration is, in the majority of cases, not higher than 2-2.5 H, which is insignificant on the softened cervix. The immediate complications of medical induction and interruption were infrequent and not severe. Thus, cervical predilatation with Rivanol prior to vacuum aspiration is a recommendable method of pregnancy interruption, worthy of widespread application.

Early complications of first trimester interruption of pregnancies with rivanol predilatation.

The early complications of the non-invasive interruption of 1361 first trimester pregnancies induced by Rivanol predilatation were studied. For this purpose the patients were called back for follow-up examination 6 weeks after the operation. The number of patients reporting at the control examination was 769. The number of febrile complications of genital origin was low. Slight postoperative bleeding exceeded the amount of normal menstruation only in 4.9% of the patients and, in general, it did not last longer than 7 days. The same applied to abdominal and lumbar complaints. The proportion of early complications was lower than after interruptions with the D + VA and D + C methods. The first menstruation after the operation did not differ from the earlier menstruation pattern of the particular patient in 75.9% of the cases. This also showed that the use of Rivanol did not involve lasting and severe damage to the endometrium.

Examination of gestations and deliveries subsequent to rivanol-induced interruption of first trimester pregnancies.

The pregnancies and deliveries of 550 parturient women were studied. The women previously had undergone interruption of pregnancy induced by Rivanol predilatation of the cervical canal. As controls served the data of 557 pregnancies and deliveries in which the pregnant women had formerly undergone invasive interruption of pregnancy. In addition the data of further 531 women were studied whose last delivery occurred before term or of a small for dates baby. The examinations showed that the necessitating cerclage occurrence of cervical incompetence was significantly lower in pregnancies following non-invasive interruption than after those following invasive interruption. There were no differences in the start and course of delivery and in the number of complications that could be traced back to the method of interruption. There was no difference in the intactness, site of adherence, separation and gross structure of the placenta. The condition of neonates at delivery was similar in the two groups. On the other hand, in the group of invasive interruptions the proportion of neonates that needed medical treatment was higher. An important observation was that after non-invasive interruption the proportion of preterm and small for dates births was significantly lower. These findings may be important in everyday practice.

"Menstrual induction" with Sulproston.

The PGE2-analogue Sulproston (16-phenoxy-omega-17,18,19,20-tetranor-PGE2-mythylsulfonylamide) was administered to 200 medically and gynecologically normal women who were 17 +/- 0.4 days beyond their expected menstrual period and who had a positive pregnancy test. The intramuscular impact dose (500 micrograms repeated after 4 hours) caused an immediate tonic uterine contraction which compromised the estradiol 17 beta, progesterone and chorionic gonadotropin production within the fetoplacental unit, and thereby allowed the evolution of cyclic uterine activity, cervical dilatation and tissue expulsion. Pregnancy termination was complete in 92% of women, 5.5% required surgical curettage and 2.5% were given a second Sulproston treatment 2-3 weeks after the first to remove retained tissue from the uterus. The medical induction of menstruation was preferred by 83% of the women who had previously experienced surgical termination of pregnancy. Normal menstruation resumed in all women after 36 +/- 0.9 days. The majority of 42 women questioned found Sulproston a satisfactory, safe, simple and effective drug regimen for "menstrual induction".

International cooperation to collect obstetric data.

Reported are preliminary results of an international collection of data initiated by FIGO. Data of 33.000 deliveries in 19 countries, five countries each in South America, Africa, and Asia and four in Europe provided a good basis for comparison and called attention to shortcomings in each individual country and to the need for more progress in obstetric treatment. - Sociological and demographic items in a questionnaire bring into focus the importance of both family planning and sexual education. - The authors consider this data collection a preliminary study for modernisation of Tauffer Statistics.

Menstrual regulation by mean of endometrial aspiration.

The results of menstrual regulation performed in 181 cases of supposed pregnancy are described. In 166 cases (92%) pregnancy could be interrupted without dilatation of the os uteri and only in 15 cases (8%) was it necessary to dilate the cervical canal by 8.5--9.0 H units. The majority of pregnancies was interrupted by means of vacuum aspiration and only in 15 cases was curettage performed because of a supposed residue. In the postoperative period slight blood discharge occurred in 2 cases and in 1 case the choriodecidual residue had to be removed by curettage one week after vacuum aspiration. The advantage of the method are particularly remarkable in the interruption of the first pregnancy since it can be carried out without an injury to the cervical canal.