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Rupture of the gravid uterus is a rare, life-threatening obstetric complication. Major symptoms are hypovolemic shock and abdominal pain during late pregnancy or after vaginal delivery. Immediate surgical therapy is required. We report a case of uterine rupture after vaginal delivery diagnosed by means of ultrasonography and computed tomography.
The antiphospholipid syndrome (APS) is associated with pregnancy morbidity and vascular thrombosis in the presence of circulating antiphospholipid (aPL) antibodies. Clinical manifestations of aPL antibodies represent a spectrum (asymptomatic, pregnancy events, vascular events, or both pregnancy and vascular events), and APS should not be considered a single disease with a predictable outcome. Patients with aPL antibodies are at increased risk of vascular thrombotic events during pregnancy, the postpartum period, and even during long-term follow-up after an APS-related pregnancy event. Therefore, the purpose of this paper is to review the relation between APS-related pregnancy morbidity and vascular thrombosis, and to address the importance of prophylactic therapy during and after APS pregnancies to prevent maternal thrombotic complications. During pregnancy, low-dose aspirin (LDA) should be considered for all patients with aPL antibodies and heparin should be added to LDA in patients fulfilling the Sapporo criteria for definite APS. During delivery, especially with caesarian section, periods without anticoagulation should be kept to an absolute minimum. Some data suggest that LDA might be effective against future non-gravid vascular thrombosis in patients with APS and a history of only pregnancy morbidity.
PURPOSE: To evaluate the relationships among gravidity, obesity, and non-insulin-dependent diabetes mellitus in Pima Indian women. SUBJECTS AND METHODS: Pima Indian women (n = 2,779) participating in a longitudinal epidemiologic study of diabetes were evaluated in both cross-sectional and longitudinal analyses. RESULTS: The prevalence of non-insulin-dependent diabetes was higher among women who had never been pregnant than among those who had been pregnant (age- and obesity-adjusted odds ratio = 2.0; 95% confidence interval = 1.5 to 2.7). Controlled for age and obesity, nondiabetic women who had never been pregnant had significantly higher fasting plasma glucose concentrations by 2% (P = 0.004), higher fasting serum insulin concentrations by 8% (P = 0.09), and higher 2-hour serum insulin concentrations by 10% (P = 0.07) than nondiabetic women who had been pregnant. Among 1,025 women observed for an average of 8 years, those who had not been pregnant by the baseline examination were at significantly higher risk for developing non-insulin-dependent diabetes before the age of 40 years (incidence rate ratio = 1.5; 95% confidence interval = 1.2 to 2.1), but that difference could be accounted for by a higher degree of obesity. CONCLUSIONS: We hypothesize that Pima Indian women who have a high risk for non-insulin-dependent diabetes develop obesity and hyperinsulinemia at an early age, and that may be responsible for decreased fertility because of associated changes in sex hormones.
Responses of the uterine vasculature and myometrium to uterine arterial infusions of local anesthetic agents were evaluated in chronically prepared conscious ewes between 86 and 141 days of gestation. Decreases in uterine blood flow (UBF) with increasing levels of anesthetic drugs were similar to those previously observed in nonpregnant ewes. A 25% decrease in UBF occurred at 7 micrograms of bupivacaine, 11.5 micrograms of 2-chloroprocaine, and 19.5 micrograms of lidocaine per milliliter of control UBF. Myometrial tonus did not change significantly except with bupivacaine where an increase occurred (P less than 0.001). These data indicate that local anesthetic agents may lower gravid UBF by a direct vascular effect and by stimulation of myometrial contractility. The possible clinical implications of these observations are discussed.
To test the applicability of equations for fetal weight estimations in a group of fetuses suspected of being large for gestational age, real-time ultrasound measurements of fetal biparietal diameters and abdominal circumferences were obtained for 34 fetuses of diabetic mothers. In the first phase of the study the accuracy in the prediction of weight was assessed with use of two known equations. In the second phase, biparietal diameter, abdominal circumference, and actual birth weight data of the 34 study fetuses were used as independent variables to determine the best-fitting equation for relating estimated fetal weight (EFW) to biparietal diameter (BPD) and abdominal circumference (AC); this equation is log (EFW) = 0.02597 AC + 0.2161 BPD - 0.1999 (AC X BPD2)/1000 + 1.2659. The standard deviation of differences is 322.26 gm and multiple R = 0.781. In the final phase the reliability of this equation was compared to those of Thurnau and Shepard in 34 additional fetuses of diabetic gravid women. The data suggest that in these fetuses suspected of being large for gestational age the weight estimates calculated at or near term may be enhanced if predictive equations are formulated specifically from the data for such fetuses.
The plasma fibronectin concentration was abnormally elevated (greater than 400 micrograms/ml) in 16 of 17 normotensive gravid women who subsequently developed preeclampsia. Of this group, 13 had elevated levels detectable greater than or equal to 4 weeks before the onset of hypertension. Our results indicate that plasma fibronectin levels can be abnormally increased long before the onset of clinical symptoms and that abnormalities of this glycoprotein may be an early indication of this pathologic process.
Amrinone is a bipyridine derivative with positive inotropic and vasodilator properties. We investigated its effects on uterine and iliac artery blood flow, blood pressure, and heart rate in 10 acutely instrumented gravid baboons. Amrinone was compared with dopamine, infused systemically or regionally via the common iliac artery. When given intravenously at a constant rate of 40 micrograms/kg/min, amrinone produced a slight increase in iliac artery blood flow but did not significantly alter mean arterial pressure, heart rate, or uterine artery blood flow. Dopamine at an intravenous dose of 40 micrograms/kg/min produced a mean (+/- SD) 49.2% +/- 18.7% increase in mean arterial pressure (p less than 0.01) and a 84.2% +/- 56.1% increase in uterine vascular resistance (p less than 0.01), but caused no changes in heart rate, uterine artery blood flow, or iliac artery blood flow. Regional infusion of amrinone at the rate of 25 micrograms/kg/min produced a significant increase in iliac artery blood flow (p less than 0.01) without changing uterine artery blood flow, heart rate, or mean arterial pressure. Regional infusion of dopamine at concentrations of 2.5 to 25 micrograms/kg/min produced decreases in flow (p less than 0.01) and increases in resistance (p less than 0.01) in the uterine and iliac vascular beds. We conclude that amrinone dilates the vascular bed of the external iliac artery, but has no remarkable effect on the uterine vascular bed. Dopamine increases uterine vascular resistance and may impair uteroplacental perfusion.
Gravidic macromastia is a rare condition. Breast enlargement in pregnancy is influenced by several hormones, including ovarian steroids and somatotropic or lactogenic polypeptide hormone. Evaluation showed minimal reactive stromal and periductal fibrosis. The treatment is surgical.
Simultaneous maternal indirect blood pressure measurements, electronic fetal heart rate monitoring, and ultrasonographic biophysical profile testing were used to assess maternal-fetal homeostasis in gravid ewes during gestational days 127 to 134 (term 146), during a 72-hour fast, and during treatment with thromboxane synthetase inhibitors CGS13080 and CGS12970. Seventy-five percent of the ewes (12 of 16) developed clinical signs of ovine pregnancy-induced hypertension, including maternal hypertension and fetal depression. In three untreated hypertensive ewes, pregnancy was terminated by spontaneous premature delivery, and one maternal death occurred after an eclamptic seizure. All nine ewes treated with one of the two thromboxane synthetase inhibitors responded to therapy with decreases in blood pressure and resolution of fetal depression. These nine ewes completed gestation, and were delivered at term. These data indicate that therapy with thromboxane synthetase inhibitors in this animal model of preeclampsia results in profoundly beneficial effects and suggest that further studies of thromboxane synthetase inhibitors are warranted in preeclampsia.
There are 3 members of the multidrug-resistance gene family expressed in mouse. Only one of these, mdr 1b, and its gene product P-glycoprotein are induced to high levels in the mouse endometrium during pregnancy. It is shown here that P-glycoprotein in the gravid uterus is significantly larger (Mr 155,000) compared to P-glycoprotein encoded by mdr 1b in a murine multidrug-resistant cell line (Mr 140,000). However, both species co-migrate after enzymatic removal of N-linked sugars (Mr 125,000). These results demonstrate that differential glycosylation of the mdr 1b gene product contributes to molecular heterogeneity found in P-glycoprotein from normal and multidrug-resistant cells.
A case of a gravid uterus in an incisional hernia in the anterior abdominal wall of a 27-year-old Nigerian woman is presented. The patient developed an ulceration of the anterior abdominal wall necessitating prolonged hospitalization. She was delivered by emergency lower segment cesarean section at 35 weeks gestational age because of premature labor. The patient unfortunately died from primary postpartum hemorrhage.
Rupture of a pregnant uterus is a serious threat to the mother's life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.
Gravid Angiostrongylus cantonensis can utilize radiolabelled bicarbonate, orotate, uracil, uridine and cytidine but not cytosine, thymine and thymidine for the synthesis of RNA and DNA. In cell-free extracts of the worm, a phosphoribosyltransferase was shown to convert orotate to OMP and uracil to UMP. A similar reaction was not observed with cytosine and thymine. Uridine was readily phosphorylated by a kinase but a similar reaction for thymidine and deoxyuridine was not found. Cytidine could be phosphorylated by a kinase or be deaminated by a deaminase to uridine. No deaminase for cytosine was detected. There was also no phosphotransferase activity for pyrimidine nucleosides in the cytosolic or membrane fractions. Pyrimidine nucleosides were, in general, converted to the bases by a phosphorylase reaction but only uracil and thymine could form nucleosides in the reverse reaction. The activity of thymidylate synthetase was also measured. These results indicate that the nematode synthesizes pyrimidine nucleotides by de novo synthesis and by utilization of uridine and uracil and that cytosine and thymine nucleotides are formed mainly through UMP. The thymidylate synthetase reaction appears to be vital for the growth of the parasite.
Four cases of incarceration of the retroverted gravid uterus are described. Typical observations were: a rather low fundal height at vaginal examination, no detectable uterine cervix, and the fetal presenting part deeply impacted in the pelvic cavity. One spontaneous correction in the third trimester is described. In general a cesarean section under general anesthesia is indicated. Preoperative recognition of retroversion is important and may prevent intraoperative complications. Three cases showed micturition problems in the second trimester. All pregnant women with second trimester micturition problems should be examined for a possible retroverted uterus.
This communication reports the first use of a transmitter implanted into the abdominal cavity of a small pregnant rodent to simultaneously measure the heart rate, core body temperature and general locomotory activity with no apparent side effects to the animals. Using this method the heart rate of one female Mongolian gerbil (Meriones unguiculatus) decreased from a mean of 303 +/- 6 (SE) (beats per minute) during gravidity to a level of 248 +/- 3 (SE) (beats per minute) during lactation. At the same time, the core body temperature increased from 37.7 +/- 0.05 (SE) degrees C to 38.0 +/- 0.03 (SE) degrees C. During pregnancy the general locomotory activity of this female followed the normal nocturnal pattern for this species (i.e., greater activity during the dark period) but there was an overall reduction in activity to 85% of the nonpregnant state. The level of activity was further reduced during lactation to about 43% of the nonpregnant state. This was largely the result of less activity during the dark period so that activity in the dark period and light period became more or less equivalent.
1. All major classes of lipids were found in the young adults in brain (22 days post-infection) and gravid Angiostrongylus cantonensis in lung of rats (34 days post-infection) comprising approximately 60% of phospholipids, 30% of neutral lipids and the rest, glycolipids. 2. The relative composition of phospholipids were quite similar between worms from the two different habitats, with phosphatidylcholine predominating. The glycolipid profiles were also similar. 3. More neutral lipids in the worms from brain existed as cholesterol and cholesterol esters than those from the lung. More than 20% of the fatty acids in these lipids of the brain were found as C10-C14 acids while oleic acid was the main component in the lung worm.
The placental transfer, maternal tissue distribution and elimination of [14C]-nonoxynol-9 (25 mg/kg) were studied during the first 6 h in 15-day pregnant rats treated intravaginally. Blood concentrations of 14C reached a maximum of 2.0 +/- 0.06 micrograms/ml in 1 h, declining slowly in 3 h, and remaining steady thereafter. At 6 h, the highest levels of 14C were recorded in the maternal urinary bladder, followed by those in the liver, kidney, adrenal and thyroid. The maternal brain showed lowest uptake of 14C among all tissues examined. After 6 h, the 14C concentrations in the uterus or placenta were similar to that of maternal plasma, whereas the mean concentrations of 14C both in the amniotic fluid and fetus were approx. one-third of that of the maternal plasma. About 44% of the administered dose was absorbed from the vagina, and nearly 17% of the per vaginum applied radioactivity was recovered in the urine and feces over 6 h. The results show that nonoxynol-9 (N-9) is rapidly absorbed into the blood stream from the vagina of gravid rat and that the fetal uptake of 14C is much lower than that of the placenta.
A rare case of gravid uterine rupture secondary to motor vehicle accident trauma is presented. The case illustrates the serious risk to the fetus as well as the potential for maternal catastrophe with this condition. Normal physiological changes in pregnancy hinder the early diagnosis in many cases. A greater awareness of this entity along with prompt diagnosis, aggressive resuscitation, and surgical intervention will help reduce morbidity and mortality.