Prevention and treatment of pregnancy-induced hypertension (preeclampsia) with progestogens.

Available data indicate that progesterone is able to treat pregnancy-induced hypertension (preeclampsia). Dydrogesterone and 17alpha-hydroxyprogesterone caproate might also be used for this purpose. Prevention of hypertensive disorders in preeclampsia also seems possible, but studies are needed to confirm this.

Values of certain clinical and biochemical tests for prediction of pre-eclampsia.

To evaluate different predictive tests for pre-eclampsia, either individually or in combination, we prospectively studied 100 primigravid females. Eighty-eight of the subjects continued the follow-up until delivery and 17 developed pre-eclampsia. Venous blood samples were take for determination of plasma fibronectin, and urine samples were taken for determination of microalbuminaria and calcium-creatinine ratio. Isometric handgrip exercise tests were also performed. Evaluation of predictive tests, as well as t and chi-squared statistical tests, were used for analysis of data. Pre-eclampsia developed in 19.3% of the patients studied. Pre-eclamptic and normotensive females showed significant differences in calcium-creatinine ratio and plasma fibronectin levels in both ( 14-24 weeks and 28-32 weeks) gestation periods (P <.0001). Plasma fibronectin had the best sensitivity, positive, and negative values in gestation period 14-24 weeks, whereas isometric handgrip exercise tests had the best specificity. These values improved for all the tests in the 28-32-week gestation period; even so, plasma fibronectin proved best of all. A combination of tests failed to improve the predictive ability of fibronectin alone. We conclude that plasma fibronectin is the best predictive test for pre-eclampsia.

An epidemiologic study of Papanicolaou smear data at Ain-Shams University hospitals.

This study is designed to find out the association between some risk factors for cancer cervix and the sensitivity and specificity of pap smear test. Data from the Cyto-Diagnostic Unit of Department of Obstetrics and Gynaecology Ain-Shams University are used. Women included in the study are those, who have had both cytology and directed biopsies irrespective of the cytology results. 757 women from 1981-1989 met that criteria and data for them are retrieved from computer files. It is found that there is association between age of women (P less than or equal to 0.05 for sensitivity and specificity), parity (P less than or equal to 0.05 for sensitivity, P greater than 0.05 for specificity), age at marriage (P less than 0.05 for sensitivity, P greater than 0.05 for specificity), and duration of marriage (p greater than 0.05 for sensitivity, P less than 0.05 for specificity), and the sensitivity and specificity of Papanicolaou smear.

Progesterone therapy in pregnancy induced hypertension therapeutic value and hormonal profile.

The study was carried on 25 primigravidae with severe pre-eclamptic toxaemia (PET) and 19 normal pregnancies as a control group. 15 cases of PET were treated by 600 mg. progesterone daily for variable duration between one and six weeks. Daily blood samples were assayed for progesterone, dihydroprogesterone, estriol, estradiol, placental lactogen and prolactin. Under progesterone therapy there was a significant decrease in both systolic and diastolic blood pressure, significant increase in urinary output, amelioration of the edema, slight reduction in weight gain, but no change in the proteinuria. Prolactin was the only hormone that showed significant rise in the group of PET when compared with normal pregnancy.

The cytology of the pouch of Douglas in polycystic ovarian disease.

Cul-de-sac aspiration was performed for cytologic sampling in 137 cases of polycystic ovaries treated by wedge resection. Fifty patients undergoing abdominal tubal ligations also underwent aspiration of the pouch of Douglas as a control group. The cytodifferential count in polycystic ovarian disease showed 30% to 40% mesothelial cells, 15% to 20% polymorphonuclear leukocytes, 15% to 20% lymphocytes, 10% to 15% squamous cells and 1% to 5% histiocytes. The corresponding count in the control group showed 15% to 20% mesothelial cells, 20% to 25% polymorphonuclear leukocytes, 15% to 20% lymphocytes, 10% to 15% squamous cells and 1% to 3% histiocytes. Cells exfoliated from the fimbrial end of the tube were encountered in most smears. Abnormal cells were diagnosed in seven cases of polycystic ovarian disease due to a coexistent neoplasm, i.e., two dermoid cysts, a carcinoid tumor, a hilus cell tumor, a simple serous cyst, a pseudomucinous cystadenoma and endometriosis of the ovary. All tumors were histologically diagnosed in the resected wedges of the ovaries.

Nucleic acids and protein changes in normal and pre-eclamptic placentae.

DNA and RNA assayed in the placentae of three groups of pregnant women: normal second trimester (16-28), normal third trimester (28 weeks up to term) and in preeclampsia. The protein level in the placentae of the three groups was also assayed. The proteins, DNA and RNA all decreased after 28 weeks and up to term in normal pregnancy. In pre-eclampsia DNA and RNA showed a significant increase compared with cases of normal third trimester pregnancy. Whereas the proteins also showed an increased level, this was still less than its concentration during the second trimester of pregnancy. Protein/DNA and RNA/DNA ratios were calculated for the three groups. These ratios showed a gradual decrease during normal pregnancy from 16 weeks up to term, but with a sharper decrease in pre-eclampsia.

Ceruloplasmin and copper level in maternal and cord blood and in the placenta in normal pregnancy and in pre-eclampsia.

Copper and ceruloplasmin were assayed in maternal and cord blood sera and in the placenta of 10 women with normal pregnancies, in 10 patients mild and 10 with severe pre-eclampsia. Copper and ceruloplasmin levels were significantly elevated in the maternal blood of pre-eclamptic patients as compared with normal pregnant women. The placental and cord blood concentrations of copper and ceruloplasmin showed non-significant changes, which indicates that their increase in the maternal blood is not of placental origin.

Leucine aminopeptidase activity in maternal, cord blood and placenta of normal pregnancy and in pre-eclampsia.

1) Leucine aminopeptidase (LAP) was determined in maternal and fetal blood and in the placenta of mild and severe pre-eclamptic patients, then compared to the levels of normal pregnancy. 2) The enzyme activity increased significantly in severe pre-eclampsia as compared with the mild type and with normal pregnancy. 3) In mild pre-eclamptic patients LAP activity of maternal and cord blood did not increase significantly as compared with the normal cases but the placenta showed a slight decrease. 4) The enzyme level in cord blood did not increase markedly in pre-eclampsia.

Serum and Placental lactic dehydrogenase and alkaline phosphatase isoenzymes in normal pregnancy and in pre-eclampsia.

LDH isoenzymes and heat-stable alkaline phosphatase were studied in the serum and placental extract of 20 cases of pre-eclampsia and 10 normal pregnancies as a control. The starch-gel electrophoretic serum and placental isoenzymogram showed that LDH4 and LDH5 were the main isoenzymes in the placenta while LDH1 and LDH2 were the main isoenzymes in the serum in pre-eclampsia. The electrophoretic serum protein pattern in pre-eclamlobulins with decreased albumin fraction, while in the placenta, the albumin fraction was increased together with a decrease in the alpha-globulins. The electrophoretic pattern of serum alkaline phosphatase showed a main band of activity at the B-globulin zone in all cases of normal pregnancy and pre-eclampsia. In the placenta, two additional bands were detected.

Progesterone therapy in pre-eclamptic toxaemia.

Progesterone was the principal therapeutic agent used in 40 cases of pre-eclamptic toxaemia. It was also given to 10 normal pregnant women who served as a control group. A significant fall in both the systolic and diastolic blood pressures was observed in 80% of the toxaemic patients. In all cases there was a marked increase in the 24-hour urinary output with an apparent loss of weight. Serum uric acid showed a significant drop and the urea clearance values also improved. The serum sodium showed an apparent decline while the serum potassium did not show any marked variation. The serum uric acid, urea clearance, blood urea, serum sodium and serum potassium remained unchanged in the control group.

Alkaline phosphatase activity of polymorphonulcear leukocytes in relation to oral contraceptives.

PIP: 25 fertile women aged 25-36 with an average of 3 children were tested over 93 cycles to observe the effects of synthetic steroids on the neutrophil alkaline phosphatase. The women were using 3 different types of oral contraceptives: Anovlar, Lyndiol, and Enovid-E. 14 women using Anovlar were analyzed for 50 cycles and showed fluctuation in alkaline phosphatase activity with higher levels as compared to normal cycles before the use of Anovlar. 8 women receiving Lyndiol over 18 cycles indicated a low-rise, while 3 women on Enovid-E over 10 cycles showed a rise in alkaline phosphatase activity, but not as much as with the Anovlar. After a 5-cycle follow-up, 5 women who discontinued the pill showed a drop in alkaline scores. After pill discontinuation, there was a gradual return to the neutrophil alkaline phosphatase activity, but these levels did not indicate a correlation with the total leukocyte or absolute neutrophil count.^ieng