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[A critical review of hypothetical causes of EPH-gestosis].

The essential EPH-gestosis seems to have multiple aetiological factors and the disease develops already a long time before the appearance of the classical symptoms. The disturbed renal function is the main point among secondary pathological effects as the damaged placenta, the disseminated coagulation, the glomerular endotheliosis, the increased retention of water and sodium with increased arterial responsiveness. It may be that this reduced reversible renal function is of extra-renal origin. As predisposing factors were discussed the reduced uteroplacental circulation with the release of still unknown pressor substances or decreased inactivation of pressor amines, the uterorenal reflex mechanism, the disturbed homeostasis of the body fluids and the vegetativ-hypothalamic crisis etc. But other factors may also be participate on this disease as immunological and hormonal aspects, especially the renin-angiotensin-aldosteron-system and prostaglandins. To find out the aetiological factors we should examine the disease at the beginning in comparison with normal pregnancy. These factors must explain why the true EPH-gestosis appears mainly during the first pregnancy and frequently in twins and so on.

Aldosterone↗

[The frequency of cellular infiltration in fetal membranes and the umbilical cord and its dependence on the time of membrane rupture, transmission and EPH-gestosis].

The determination of the frequency of the histological severity of cellular, predominantly leukocytic infiltration in the fetal membranes and umbilical cord and its dependence upon the time of rupture of the membranes, the transmission, and the EPH gestosis yielded the following results: (1) Cellular infiltration of the decidua, the severity of which ranged from low to high, was observed in almost 90 percent of the placentae included in this investigation, with infiltration being not detected in only about 10 percent. (2) There was observed a continuous decrease in the frequency of low- and high-severity infiltration in the fetal membrane layers toward the choriodecidual space, so that high-severity infiltration of the amnion could be detected in about 3 percent only. (3) The percentages of infiltrates detected were roughly 13 percent in the umbilical vein wall and only 8 percent in the umbilical arterial walls. (4) Cellular infiltration of the umbilical vein may be observed significantly more frequently in those cases in which the time from the rupture of the membranes to the delivery of placenta is longer than three hours than in cases where this time is shorter than three hours. (5) In the case of transmission the frequency of cellular infiltration of the amnion and umbilical vein wall is significantly higher than in the cases of normal gestations. (6) High-severity forms of cellular infiltration of the umbilical vein and arteries are significantly more frequent in the case of EPH gestosis than low-severity forms. (7) The differences in frequency of cellular infiltration in fetal membrane layers and umbilical vessel walls not mentioned under (4) through (6) above are not significant for different times between the rupture of the membranes and the delivery of placenta, transmission, and EPH gestosis. (8) Hypoxidosis and chemotaxis due to acidification of the amniotic fluid rather than bacterial infection are considered to be the causes of cellular infiltration in the majority of cases of increases in time between the rupture of the membranes and the delivery of placenta, transmission, and EPH gestosis.

Extraembryonic Membranes↗

[The determination of human placental lactogen (HPL) for hormonal supervision in late pregnancy].

In the serum of 145 women between the 34th and 42nd weeks of pregnancy, 209 radioimmunological determinations of human placental lactogen were made, using the Pharmacia, Uppsala, Sweden, HCS Phadebas Test. Following the determination of normal HPL levels in late pregnancy, the HPL values of high-risk pregnancies were investigated in relation to normal values and compared with the clinical pattern. A satisfactory relation was found between low HPL levels and fetal growth retardation. To some extent the HPL data can also be used in monitoring severe EPH-gestosis and postmaturity. Light cases of gestosis and pregnancies involving Rh-incompatibility do not affect HPL production. The clinical findings regarding HPL levels should not be overestimated in attempting to diagnose placental insufficiency.

Erythroblastosis, Fetal↗

[Immunological relations between mother and child during pregnancy (author's transl)].

The relations between the maternal and foetal organisms during pregnancy are partly very complicated and remain inexplicable. Blastocyst, trophoblast, embryo and foetus have membrane antigens at a very early stage, and the immunocompetence of the foetus develops already during the second third of the pregnancy period. Many non-specific factors are involved in preventing the castingoff reaction of the foetal organism. The trophoblastic tissue is probably of central importance. The focal point of interest in trophoblast tissue research is probably the testing of the local action of HCG and HPL and perhaps also AFP, as well as the question whether cellular and nuclear fusions occur in the region of the syncytiotrophoblasts and the decidual base, or if leucocyte antibodies can block the HLA antigens or the trophoblastic surface.

Animals↗

An evaluation of preinduction scoring systems.

A double-blind clinical study of five preinduction scoring systems was undertaken to determine the accuracy of clinical usefulness of each system as applied to a diverse group of patients. When strictly applied, all five systems were found to be as accurate and useful as it was originally claimed they were. However, when applied without regard to each author's prerequisites, none of the five scoring systems was found to be reliable. A series of preinduction score modifiers is presented which, when applied to any of the preinduction scoring systems, will reliably predict the outcome of induction of labor, with a 50% induction failure rate in patients with lower third scores, a 10% failure for middle third scores, and essentially a 0% failure in the upper third scores.

Apgar Score↗

Correlation between morning urine estriol concentration and 24-hour estriol excretion.

In an attempt to circumvent the need for 24-hour urine collections for estriol analyses in assessment of fetal status, the possibility of using morning urine samples was investigated. Results indicate 1) good correlation between 24-hour estriol excretion and morning estriol concentration, and between corresponding E/C ratios, 2) similar morning and 24-hour estriol concentrations, 3) high dependence of estriol and creatinine excretion on 24-hour urine volume but not on morning volume, 4) larger variations in 24-hour than in morning urine volume, and 5) better consistency of values in morning than in 24-hour samples in pathologic pregnancy. The use of serial morning urine concentrations at least as an outpatient monitoring procedure is suggested.

Creatinine↗

[Creatinine during pregnancy (author's transl)].

Determination of the creatinine concentration of the amniotic fluid was undertaken between the 25th and 40th week of gestation in 114 patients. The normal serum creatinine level was simultaneously determined in 43 of these patients. The aim of this study was to examine whether this parameter of fetal renal function allows a conclusion to be drawn with respect to fetal maturity and the length of gestation. With increasing length of gestation a marked increase in the amniotic fluid and the maternal serum creatinine concentration was observed (p less than 0.01). The large scatter of the values made it impossible to relate any particular creatinine concentration to a certain week of gestation. However, if the concentration of creatinine in the amniotic fluid has reached a value of 2 mg% or more, a mature baby can be predicted in most cases. A tendency to raised levels of creatinine was seen in cases of EPH gestosis and latent diabetes mellitus. The determination of creatinine in the amniotic fluid can be recommended with certain reservations as an additional method to assess fetal maturity.

Amniotic Fluid↗