Functional and fibrinogen receptor studies in platelets in pre-eclamptic toxaemia of pregnancy.

It is believed that platelets play a key role in the production of pre-eclamptic toxaemia and toxaemia of pregnancy. Toxaemia of pregnancy is described as a condition of chronic DIC where there is thrombocytopenia as well as raised fibrin degradation products. Since fibrinogen receptors are involved in the final stage of the platelet aggregation reaction, we wanted to investigate the platelet receptors for fibrinogen in normal and abnormal pregnancy. Thirty-six normal pregnant women (12 in their 2nd trimester, 24 in their 3rd trimester), 24 pregnant pre-eclamptic toxaemia cases and 16 non-pregnant controls were included in the present study. All patients with pre-eclamptic toxaemia had oedema, proteinuria and hypertension. Flow cytometric study of platelets was undertaken utilizing fluorescein isothiocyanate (FITC)-labelled anti-human fibrinogen antibody in unstimulated and ADP-stimulated (final concentration 0.02 M) platelets. The intensity of platelet fluorescence was classified into three groups and expressed in arbitrary units. The results indicate that there are a higher number of stimulated platelets expressing fibrinogen receptors in the circulation of patients with pre-eclampsia. Thus, it is possible to hypothesize that platelets showing increased fibrinogen receptors aggregate and form microthrombi in smaller vessels in women with pre-eclamptic toxaemia.

Experience with intrauterine transfusions for severe Rh alloimmunization in a developing country.

This study reports our experience with 67 intrauterine transfusions (IUTs) carried out for 27 cases of severe Rh alloimmunization, which could be useful to other developing countries with similar situations. Most of the mothers were from sections of India other than Mumbai, their socioeconomic status was low, and they were referred during the second or third trimester. The mean gestation age at first IUT was 27+/-2.9 weeks and maternal anti-D titer ranged from 1:32 to 1:512. Ultrasonography (USG) was normal in eight cases, but showed minimal or gross ascites in 8 and 11 cases, respectively. The mean +/- SD hematocrit (HCT) in three groups defined by USG was 23.5+/-1.7, 15.9+/-4, and 12+/-5.9, respectively. Amniotic fluid analysis, which proved to be an important investigation, indicated IUT in eight cases having normal USG. Six cases were severely anemic (Hb deficit >7 g/dl). By fetal cell staining, the percentage of the donor's red cells in the fetal circulation was determined. Besides Hb, blood group, direct antiglobulin test, and mean cell volume, this parameter was also useful in assessing efficacy of IUT and the need for an exchange transfusion after birth. Of 11 fetuses having gross ascites, eight and one each from the remaining two groups, were stillborn. One death may be procedure related. Two neonates died due to hemorrhagic disorder and prematurity. The overall survival rate was 55.6%. Late referral, severe Rh alloimmunization, volume overload, delay in IUT because of nonavailability of blood and use of nonirradiated blood could be the reasons for the poor outcome. Strategies for improving results are discussed.

Foetal growth parameters--clinical versus ultrasonographic.

The study was conducted in 2831 pregnant women with no diagnosed complication at the time of registration to obtain normal foetal growth pattern for clinical and ultrasonographic parameters. Normal values for maternal weight, fundal height and abdominal girth for clinical and biparietal diameter, abdominal circumferences and femoral length for ultrasonographic parameters are presented. Clinical and ultrasonographic parameters were compared for their efficacy in prediction of low birth weight. Neither clinical nor ultrasonographic parameters were found to be satisfactory in identifying the foetus at risk of low birth weight. It has been found that clinical parameters for routine monitoring are as effective as ultrasonographic parameters and have the added advantage of being easily replicable at the peripheral level of health care.

Second trimester pregnancy termination using extra-amniotic ethacridine lactate.

OBJECTIVE: To investigate the efficacy of ethacridine lactate by the extra-amniotic route for second trimester pregnancy termination and its associated complications. DESIGN: Retrospective study of women undergoing second trimester termination, over 3 1/2 years, with extra-amniotic ethacridine alone, or extra-amniotic ethacridine supplemented later by extra-amniotic 15-methyl prostaglandin F2 alpha. SETTING: Teaching hospital in Bombay. PATIENTS: 315 consecutive women undergoing late abortions with extra-amniotic ethacridine. Demographic features were similar in the two groups. INTERVENTIONS: In group 1, 207 women had 150 ml of 0.1% ethacridine lactate injected slowly into the extra-amniotic space. In group 2, 108 women had the initial injection supplemented 6 h later by an extra-amniotic injection of 250 micrograms (1 ml) of 15-methyl prostaglandin F2 alpha. MAIN OUTCOME MEASURES: The occurrence of abortion following the induction procedure. The development of complications such as haemorrhage, infection, or injury to the uterus or cervix. RESULTS: The method was successful in 191 women (92%) in group 1 and in 106 (98%) in group 2. The median induction-abortion intervals were 35 and 19 h, respectively (Mann-Whitney U test, P less than 0.001). The corrected complication rate was less than 10% (30 women), with unplanned uterine evacuation in 6% (20), haemorrhage in 1% (4), and pelvic infection in 4% (14). CONCLUSION: The use of extra-amniotic ethacridine lactate provides an effective and safe treatment method for second trimester legal abortion. The induction-abortion interval can be appreciably reduced by supplementary prostaglandin.

PIP: This study investigated the efficacy of ethacridine lactate by the extraamniotic route during 2nd trimester pregnancy termination as well as its associated complications. This retrospective study of 315 women undergoing 2nd trimester terminations over a 3 1/2 year period was based at a teaching hospital in Bombay. Patients received either extraamniotic ethacridine alone or supplemented later with extraamniotic 15-methyl- prostaglandin F2alpha (PGF2alpha). Women were divided into 2 groups--in group 1, 207 women received 150 ml of 0.1% ethacridine lactate injected slowly into the extraamniotic space; in group 2, 108 women had the initial injection supplemented 6 hours later by an extraamniotic injection of 250 mcg (1 ml) of 15-methyl-PGF2alpha. Outcome measures which were evaluated were the occurrence of abortion following the induction procedure and the development of complications such as hemorrhage, infection, and injury to the cervix or uterus. The method was successful in 191 women (92%) in group 1 and in 106 (98%) in group 2. The mean induction-abortion intervals were 35 and 19 hours, respectively (Mann-Whitney U test, p0.001). The corrected complication rate was 10% (30 women), with unplanned uterine evacuation in 6% (20), hemorrhage in 1% (4), and pelvic infection in 4% (14). The authors conclude that the use of extraamniotic ethacridine lactate provides an effective and safe treatment method for 2nd trimester legal abortion. The induction-abortion interval can be appreciably reduced by supplementary PGs.

Anti-convulsant therapy in eclampsia.

Seventy four patients presented with eclampsia at N.W.M. Hospital. Bombay. Among the patients with eclampsia, 64.9% were primis, 29.7% were gravida II-IV and 5.4% were grand multis. As many as 40.5% patients were less than 20 years of age, while 2.7% were over 30 years of age. 48.7% had antepartum convulsions, 40.5% had intrapartum convulsions, while 8 patients convulsed in the postpartum period. Besides standard management of eclamptic patients, 3 protocols of anticonvulsant therapy were utilised. 27% were managed with diphenyl hydantoin sodium, 43% with magnesium sulphate, and 30% by combination of diazepam and pentazocine. The maternal and perinatal outcome was evaluated. Control of convulsions was superior with magnesium sulphate while perinatal outcome was best with diphenyl hydantoin.

Effect of pregnancy plasma, neuraminidase and sialic acid on phytohemagglutinin-induced human lymphocyte response.

The effect of human pregnancy plasma on phytohemagglutinin-(PHA-)induced blastogenesis of lymphocytes from unrelated donors was studied in relation to the sialic acid (N-acetyl-neuraminic acid) content of the plasma. The total sialic acid levels in plasma were found to be elevated during pregnancy as compared with plasma from non-pregnant, normally menstruating control groups (p less than 0.001) and to increase with advancing gestation, reaching peak values in the post-partum period (1-14 days). On the other hand, pregnancy plasma at a concentration of 15% caused a significant suppression of lymphocyte proliferation (p less than 0.05 to p less than 0.001, depending on the stage of gestation). The maximum effect was observed with plasma obtained during the third trimester of pregnancy. The immunosuppressive activity was not detectable after parturition. It was further observed that desialation of both pregnancy and control plasma with neuraminidase diminished lymphocyte response to PHA (p less than 0.05). Addition of free sialic acid (0.1-1.0 mumol/ml) or treatment of the cells with neuraminidase (0.06-1.0 IU/ml) had no effect on lymphocyte transformation under assay conditions. These findings support the hypothesis that an immunosuppressive environment provided by pregnancy plasma could be one of the mechanisms protecting the antigenically alien fetus from maternal immunologic attack. The sialic acid content of maternal plasma did not appear to play a role in the immunosuppressive property of maternal plasma. On the contrary, the presence of plasma-bound sialic acid in the culture medium was found to be necessary for normal lymphocyte reactivity.