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Perinatal deaths due to EPH gestosis which occurred in Glasgow during 1970 were studied. There was a high frequency of perinatal deaths among babies born to primigravidae below the age of 20 years and to mothers with proteinuria. The majority of the deaths occurred in babies weighing less than or equal to 2,500 g. It is suggested that some of the deaths were avoidable and that a further reduction in perinatal mortality can still be achieved.
Between 1. 6. 1972 and 31. 12. 1974 obese gravidae with a body weight of 90 kg or more were observed (7,6% of all patients in this period). This 315 patients were compared with a group of 315 patients with normal body weight chosen by random. The results of both groups were compared and evaluated by statistic (t-test, x2-test). A significant higher rate of Diabetes, latent Diabetes, EPH-Gestosis and cases of over-term deliveries were found in the group of obese patients.
Myasthenia gravis in pregnancy is rare, and its occurence in conjunction with preeclampsia has not been previously described. A case report of preeclampsia in a myasthenic patient is described with recommendations for management. The authors conclude that magnesium is a contraindicated pharmacologic agent in a myasthenic patient.
Our experience with consumptive coagulopathy associated with preeclampsia at North Carolina Baptist Hospital is presented. All cases of recognized consumptive coagulopathy on the obstetric service from 1969 to 1975 are reviewed and the associated obstetric entities given. Two cases of consumptive coagulopathy complicating severe preeclampsia are presented. Consumptive coagulopathy occurred in 9.1% of eclamptic patients and in 2.6% of severe preeclamptic patients. No previous incidence figures were found in the literature.
As it is known, formation of the adenohypophysis in the human fetus takes place at early stages of ontogenesis. The objective of the present work was to find out whether the adenohypophysis, already at these early stages of development, was capable to response to changes in the environment, in this case to those in the mother's organism. Two groups of the human adenohypophyses obtained as a result of artificial abortion were studied: 1) from fetuses which developed under normal pregnancy; 2) from fetuses which developed under pathological pregnancy (toxemia in the first half of pregnancy). The method of quantitative cytospectrophotometric analysis of simple and conjugated proteins of a various nature were used. The data obtained indicated to early appearance of simple and conjugated proteins in the cells of the anterior lobe of the hypophysis of the human fetus and to their definite dynamics depending upon the course of pregnancy. It was established that at early stages of ontogenesis the adenohypophysis of the human fetus produces a certain reaction to changes in the environment, in particular, to changes occurring in the mother's organism.
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The maternal Serum concentrations of beta 1 SP 1, IgM and alpha 2-macroglobulin were determined in relation to the gestation age, using the simple radial immunodiffusion method in 102 non-pathologic pregnancies and 35 pregnancies involving risk factors. To assess the clinical relevance of these determinations, we examined to what extent the changes in concentration of beta 1 SP 1 IgM and alpha 2-macroglobulin would permit a prognostically useful conclusion on the placenta function and foetal condition. All patients with lowered beta 1 SP 1-serum concentrations were examined for their antepartua CTG-evaluation, as well as the type of termination of parturition. The normal distribution for beta 1 SP 1 showed a continuous rise in serum concentration up to the 37th pregnancy week. During the last 3 weeks, beta 1 SP 1 remained almost constant. For the cases with EPH-gestosis and placenta insufficiency, a beta 1 SP 1-concentration below the normal distribution level was found in the large majority of all cases. In diabetes mellitus during gravidity, twin gravidity and MHN, the determination of beta 1 SP 1 is not of any decisive prognostic significance. The maternal serum levels of IgM showed no significant differences when comparing normal pregnancy and risk pregnancy. The serum concentration of alpha 2-macroglobulin increased in both groups of patients with increasing gestation age. Of the three examined protein bodies, we consider beta 1 SP 1 to be a good, additional parameter for the assessment of the trophoblast function.
The specific activity of placental enzymes with a regulatory function in the pathways of glycolysis, gluconeogenesis, NADPH generation and fatty acid synthesis decrease during gestation in the rat. Similar decreases occur in the activity of enzymes of the human placenta when compared between early gestation and term, with the exception of the activity of enzymes related to gluconeogenesis which tend to increase as gestation advances. In term placentas from pregnancies complicated by preeclamptic toxemia, enzyme activities were significantly lower than those in placentas from normal pregnancies, irrespective of whether the baby was of normal weight or small-for-date. This indicates an accelerated decline in placental metabolic function in toxemia. In contrast, in placentas from nontoxemic pregnancies with small-for-date babies the enzyme activities were significantly higher than those in normal term placentas. It is suggested that the decrease in placental enzyme activity, which is associated with placental growth during the course of normal gestation, is retarded in nontoxemic pregnancies with small-for-date babies, apparently due to the arrested aging of the placenta.
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Alterations in corneal indentation pulse (CIP) amplitudes and pulse volume recordings (PVR) on the limbs were demonstrated in pregnant women, indicating that significant changes occur in the peripheral blood circulation during pregnancy. The PVR measured at week 30-36 of gestation demonstrated a significant increase when recorded on the forearm and index finger. In the eye an increase in CIP amplitudes was found early in pregnancy. From week 20 on, however, a steady decrease occurred, until the CIP amplitudes at term averaged about 1/3 of the values from normal, non-pregnant women. Similar changes, although less pronounced, were demonstrated in the ocular blood circulation during oral contraceptive treatment and, to some extent, during menstruation. Intake of gestagens and diaethyl-stilboestrol did not alter the CIP amplitudes.
Few studies of the histopathological features of the placenta in cases of fetal death are available. We will describe the placental findings from 24 midtrimester spontaneous abortions and 54 stillborn infants of more than 28 weeks' gestation. In almost 100% of midtrimester abortions and in 48% of the placentas from stillborn infants of more than 28 weeks' gestation, chorioamnionitis, deciduitis, and/or villitis were present. Because of this very high percentage of lesions, which suggests an infectious causation, it is mandatory that studies be performed that might identify pathogens. One third of the stillborn infants of more than 28 weeks' gestation were associated with maternal complications (diabetes, preeclampsia, and urinary tract infection), in addition to placental fetal vasculopathy, ischemia, infarcts, and chorangiosis (villous capillary hyperplasia). We emphasize the use of the placenta for the recognition of maternal diabetes.
The immunologic relation between mother and fetus has become of interest to those concerned with reproductive physiology. One method to assay this type of relation is to determine the immunologic response to HLA antigens expressed by the fetus which are of paternal origin. Although 20 to 50% of multiparous women develop lymphocytotoxic antibodies during pregnancy, the effect of these antibodies on gestation or the fetus has not been established. In a prospective study, 23 patients at the time of spontaneous abortion had negative cytotoxic antibodies. Of 129 obstetric patients followed with antibody screening over a 6 to 7 month period until delivery, 28 developed positive lymphocytotoxic antibodies (22%). These 28 patients with cytotoxic antibodies delivered male infants by a ratio of 4 to 3, and 11 patients (39.3%) had complications during the gestation. The responsiveness to the paternal histocompatibility antigens is valuable information for furthering the understanding of the fetal-maternal relation.
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166 Women were investigated after 26 weeks of pregnancy, divided into 4 groups (normal pregnancy, after urinary tract infection, with cystopyelitis and with toxemia). Renography is a very sensitive method. Only 6,6% women had bilateraly normal function. Unilateral pathology was detected more often on the right side (17,6% versus 2,9%) and the damage was on the right side also more intensive (30% versus 8%), and present as early as in the 7. to 8. month of pregnancy. The damage of the secretion phase of the renogram in pregnancy is mostly sequal of the disturbed drainage following compression of the ureter trough varicosal veins and the pregnant uterus.
Mild preeclampsia, as defined by a rise in blood pressure to 140/90 mm Hg or more in the third trimester of pregnancy, does not affect the baby either in terms of increased perinatal mortality or a reduction in birth weight. Higher maternal weight gains are associated with greater birth weight of the babies in primigravidae, provided that proteinuria does not occur. Reduction of water retention by diuretic treatment does not lower the incidence of preeclampsia, does reduce the weight of the baby.