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PubMed2002

Acute Trypanosoma cruzi infection in mouse induces infertility or placental parasite invasion and ischemic necrosis associated with massive fetal loss.

Pathogens may impair reproduction in association or not with congenital infections. We have investigated the effect of acute infection with Trypanosoma cruzi, the protozoan agent of Chagas' disease in Latin America, on reproduction of mice. Although mating of infected mice occurred at a normal rate, 80% of them did not become gravid. In the few gravid infected mice, implantation numbers were as in uninfected control mice, but 28% of fetuses resorbed. Such infertility and early fetal losses were significantly associated with high maternal parasitemia. The remaining fetuses presented with reduced weights and all died later in gestation or within 48 hours after birth. Several organs of these fetuses were infiltrated by polynuclear cells and presented ischemic necrosis but did not harbor T. cruzi parasites, discarding congenital infection as the cause of mortality. However, surprisingly, the deciduas were massively invaded by T. cruzi parasites, harboring 125-fold more amastigotes than the maternal heart or other placental tissues. Parasites were significantly more numerous in the placentas of dead fetuses. In addition, placentas contained inflammatory infiltrates and displayed ischemic necrosis, fibrin deposits, and vascular thromboses. These results show that acute T. cruzi infection totally impairs reproduction in mice through inducing infertility or fetal-neonatal losses in association with placental parasite invasion and ischemic necrosis.

Animals↗
PubMed2002

The incision of choice for pregnant women with appendicitis is through McBurney's point.

BACKGROUND: There is uncertainty over the optimal incision for gravid patients with appendicitis. METHODS: Data were collected retrospectively from January 1, 1995, through December 31, 2000, on 374 women of childbearing age who underwent appendectomies. Of these, 23 gravid patients were evaluated. RESULTS: Eighteen incisions were made over McBurney's point and five were created superior to McBurney's point. Patients in the third trimester of pregnancy all received incisions over McBurney's point. The appendix was located without difficulty in all 4 of the third trimester patients. The appendix was easily located in 94% of the incisions made through McBurney's point and 80% of the incisions made above McBurney's point. CONCLUSIONS: Our clinical experience indicates that the incision for the removal of the appendix in pregnant patients in all trimesters can be successfully made over McBurney's point.

Abdomen↗
PubMed1987

Pregnancy following minilaparotomy tubal sterilization--an update of an international data set.

Seventeen pregnancies were reported from an international tubal sterilization data set comprising 1,862 minilaparotomy cases between 1978 and 1984. Of these 17, seven (41.2%) were diagnosed as luteal phase pregnancies. Of the 10 pregnancies due to sterilization failure, one was an ectopic pregnancy which occurred much later (20 months poststerilization) than the intrauterine pregnancies (10 months or less). Poststerilization pregnancy risk was greater among gravid women (those undergoing sterilization at the time of abortion or soon after childbirth) than among non-gravid women (those undergoing interval sterilization). These findings are, in general, consistent with those of previous studies using a much larger data set of primarily laparoscopic sterilizations. Pregnancies occurred with every type of mechanical tubal occlusion techniques included for study (the tubal ring, the Rocket Clip, the Secuclip and the Filshie Clip), and a frequently reported reason for failure was incorrect placement of the device. No pregnancies occurred in women sterilized with the non-mechanical Pomeroy/modified Pomeroy techniques. Findings of this analysis suggest that in minilaparotomy sterilization, for the mechanical tubal occlusion techniques to be as effective as the Pomeroy/modified Pomeroy techniques, more care and skill are required for the operator.

Adult↗
PubMed2001

Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization.

OBJECTIVE: To determine prognostic factors for achieving a pregnancy with intrauterine insemination (IUI) and IVF. To compare the effectiveness and cost-effectiveness of IUI and IVF based on semen analysis results. DESIGN: Retrospective cohort study. SETTING: Academic university hospital-based infertility center. PATIENT(S): One thousand thirty-nine infertile couples undergoing 3,479 IUI cycles. Four hundred twenty-four infertile couples undergoing 551 IVF cycles. INTERVENTION(S): IUI and IVF treatment. MAIN OUTCOME MEASURE(S): Multiple logistic regression analysis was used to assess the significance of prognostic factors including a woman's age, gravidity, duration of infertility, diagnoses, use of ovulation induction, and sperm parameters for predicting the outcomes of clinical pregnancy and live birth rate after the first cycle of IUI and IVF. The relative effectiveness and cost-effectiveness of these treatments were then determined based on sperm count results. RESULT(S): Female age, gravidity, and use of ovulation induction were all independent factors in predicting pregnancy after IUI. The average total motile sperm count in the ejaculate was also an important factor, with a threshold value of 10 million. For IVF, only female age was an important predictor for both clinical and ongoing pregnancy. When the average total motile sperm count was under 10 million, IVF with ICSI was more cost-effective than IUI in our clinic. CONCLUSION(S): An average total motile sperm count of 10 million may be a useful threshold value for decisions about treating a couple with IUI or IVF.

Adult↗
PubMed2002

Effect of captivity in semi-natural enclosures on the reproductive endocrinology of female lizards.

Long-term captivity can result in abnormal behavior and physiology in many vertebrates. Here, we examine whether semi-natural, outdoor captive environments can offer a compromise, allowing much of the experimental control afforded by captivity, while providing the environmental conditions essential for normal behavior and physiology. We first determined plasma concentration of the sex steroid hormones progesterone, testosterone, and estradiol of free-ranging female striped plateau lizards (Sceloporus virgatus) throughout the reproductive season, and second, compared the results to those from conspecific females maintained in semi-natural outdoor enclosures. Among free-ranging females, levels of progesterone and estradiol were elevated during vitellogenesis, with an apparent surge in progesterone and testosterone occurring in association with ovulation. Following ovulation, estradiol fell to non-reproductive levels while progesterone remained elevated during the month-long period of gravidity. Long-term captivity in outdoor enclosures did not significantly affect progesterone or estradiol levels at any stage of the reproductive cycle, and did not affect testosterone levels during normal ovarian development and gravidity. However, (1) females with delayed oviposition in captivity had lower testosterone levels than free-ranging females with normal oviposition, and (2) when all females sampled were post-reproductive, captive females continued to have lower testosterone levels than free-ranging females. Thus, the endocrine response to captivity may be greater among post-reproductive females than among reproductive females. Our results are in marked contrast to many studies that show captivity can dramatically impair reproduction of female vertebrates.

Animals↗
PubMed2003

Seasonal variation in plasma catecholamines and adipose tissue lipolysis in adult female green sea turtles (Chelonia mydas).

We investigated three aspects of potential interrenal regulation of reproduction in female green sea turtles, Chelonia mydas. First, seasonal trends in plasma catecholamines were examined from female C. mydas at different stages of their reproductive cycles. Second, variation in catecholamine levels during a nesting season were analysed in relation to restraint time, and ecological variables such as nesting habitat, body size, and reproductive investment. Third, catecholamine and corticosterone (CORT) induced lipolysis was investigated with adipose tissue collected from gravid green turtles, using in vitro incubations. Plasma epinephrine (EPI) was lowest in non-vitellogenic (1.55 +/- 0.26 ng/ml) and post-breeding (1.57 +/- 0.22 ng/ml) females, and highest in courting females (2.87 +/- 0.28). Concentrations of norepinephrine (NE) and EPI were relatively constant throughout a nesting season, and not significantly related to restraint time, reproductive investment or nesting habitat. In vitro concentrations of CORT (>3 ng/ml) and NE (2 ng/ml) induced significant release of glycerol after 6h of incubation. Epinephrine tended to induce an antilipolytic affect at low concentrations (0.25 ng/ml) and a net lipolytic response at higher concentrations (>1 ng/ml). Our data suggest that EPI may play a role in regulating body condition during vitellogenesis, and maintaining energy stores during prolonged aphagia during courtship and nesting in female green sea turtles. Furthermore, we provide preliminary evidence that suggests that catecholamine production may be either down regulated or de-sensitised in gravid female C. mydas.

Adipose Tissue↗
PubMed2002

Changing attitudes toward mode of delivery and external cephalic version in breech presentations.

OBJECTIVES: To compare the attitude of gravid women in breech presentation towards external cephalic version (ECV) and mode of delivery between 1995 and 2001. METHODS: A questionnaire on ECV and mode of delivery was distributed to women in the third trimester of pregnancy with breech presentation, attending our departmental clinic for a routine check-up once in 1995 and again in 2001 in order to analyze changing attitudes. RESULTS: One hundred fifty-four women completed the questionnaire in 1995 and 127 in 2001. There were no statistically significant differences between the groups in age, gestational age, gravidity, parity, or level of education. In 1995, more than half the women (52.7%) had heard of ECV and 53.8% were willing to consider it, whereas in 2001, 73.2% had heard of it but only 23.9% were willing to consider it. In both groups, the women who were familiar with ECV were more likely to work outside of the home, have a higher level of educated than the women who were not. The women who were willing to try ECV were more likely not to work outside of the home, to consider their pregnancy low risk, and to opt for vaginal delivery (vs. cesarean section) if ECV did not succeed. The percentage of women who would choose planned cesarean section if the presentation remained breech was significantly higher in 2001 (97%) than in 1995 (64.7%). CONCLUSIONS: Attitudes toward breech delivery have changed since 1995. More women are aware of the option of ECV but are less inclined to consider it. Planned cesarean section for breech presentation is the overwhelming choice of women in general, with a significant increase in 2001 compared with 1995.

Adult↗
PubMed2001

The effect of the acanthocephalan parasite Pomphorhynchus laevis on the lipid and glycogen content of its intermediate host Gammarus pulex.

Besides conspicuous changes in behaviour, manipulative parasites may also induce subtle physiological effects in the host that may also be favourable to the parasite. In particular, parasites may be able to influence the re-allocation of resources in their own favour. We studied the association between the presence of the acanthocephalan parasite, Pomphorhynchus laevis, and inter-individual variation in the lipid and glycogen content of its crustacean host, Gammarus pulex (Amphipoda). Infected gravid females had significantly lower lipid contents than uninfected females, but there was no difference in the lipid contents of non-gravid females and males that were infected with P. laevis. In contrast, we found that all individuals that were parasitised by P. laevis had significantly increased glycogen contents, independent of their sex and reproductive status. We discuss our results in relation to sex-related reproductive strategies of hosts, and the influence they may have on the level of conflict over energy allocation between the host and the parasite.

Acanthocephala↗
PubMed1997

Differentiation and ultrastructure of the paruterine organs and paruterine capsules, in the nematotaeniid cestode Nematotaenia dispar (Goeze, 1782) Lühe, 1910, a parasite of amphibians.

Three types of egg-protecting envelopes of parenchymatic, uterine and embryonic origin have been distinguished in the cyclophyllidean cestode Nematotaenia dispar (Goeze, 1782) Lühe, 1910, a type species for the genus Nematotaenia and the family Nematotaeniidae. The present paper deals with the parenchymatic envelopes, which originate from the modified medullary parenchyma and are represented in this species by the paruterine organs and paruterine capsules. In pregravid proglottids they are composed of clongated myocytons, myofibrils and membranous anucleate cellular processes, containing a large amount of lipid droplets and some calcareous corpuscle cells. These cellular elements (CE) are separated from each other by abundant extracellular matrix (ECM), which consists primarily of an electron lucent ground substance with fine filaments embedded in it. The paruterine capsules of gravid proglottids are surrounded from the outside by a typical medullary parenchyma and are lined by a layer of the connective tissue. The paruterine organs and paruterine capsules show similar ultrastructure. During their histogenesis, all cellular elements undergo extensive flattening, followed by cellular deterioration, with simultaneous reduction in CE/ECM ratio. In the late gravid segments, paruterine capsule walls are very thick and consist of membranous sheets with large amounts of lipid droplets, which cause the cytoplasmic sheets to bulge. Ultrastructure of various types of parenchymatic envelopes in representatives of different cyclophyllidean families, such as paruterine organs in Nematotaeniidae and Mesocestoididae, uterine and parenchymatic egg capsules in Anoplocephalidae (Linstowiinae and Inermicapsiferinae, respectively), is compared.

Animals↗
PubMed1997

Risk factors for recurrence of hemorrhagic endovasculitis of the placenta.

OBJECTIVE: To assess the potential for recurrence of placental hemorrhagic endovasculitis and to identify clinical or pathologic cofactors that might influence recurrence of this lesion or subsequent pregnancy outcome. METHODS: Ninety-seven women with a placenta affected by hemorrhagic endovasculitis, who also had at least one placenta referred to the Michigan Placental Tissue Registry from a subsequent pregnancy, were identified from 10,531 referrals between 1978 and 1988. Histologic slides from 209 placentas and clinical data from 211 infants (two sets of twins) from initial (first) and subsequent referrals were analyzed. Placentas were graded for the presence, extent, and severity of hemorrhagic endovasculitis and chronic villitis of unknown etiology; for placental lesions indicative of hypertensive maternal vessel disease; and for intravascular nucleated erythrocytes and chorionic thrombi. Maternal data included age, gravidity, number of previous losses, and history of toxemia or hypertension. All data were analyzed for significance using chi2 and t tests. Outcome assessment was based on recurrence of hemorrhagic endovasculitis and infant viability with the second referral. RESULTS: With first referrals, 80 of 98 infants (81.6%) were stillborn. Among second referrals, 26 of 98 infants (26.5%) were stillborn. Hemorrhagic endovasculitis recurred in 28 second placentas (28.9%); of these, 18 infants (64.3%) were stillborn. Higher rates of recurrence were found with progressively higher first-referral chronic villitis severity scores (P < .02), higher hypertensive placental lesion scores (P < .001), and first referrals with a history of toxemia or hypertension (P < .02). Recurrence of hemorrhagic endovasculitis was higher in patients with two or more of these factors in first referrals (P < .001). Subsequent stillbirth was more frequent with progressively higher first-referral hypertensive placental lesion scores (P < .01) and in first placentas with two or more risk factors (P = .064). Hemorrhagic endovasculitis severity scores, intravascular nucleated erythrocytes, and chorionic thrombi were associated with stillbirth in index pregnancies only. Maternal age, gravidity, or history of prior losses were not predictive. CONCLUSIONS: Placental hemorrhagic endovasculitis is associated with pregnancy loss and can recur in some patients. Interrelations among placental hemorrhagic endovasculitis, chronic villitis, maternal hypertension, and adverse outcomes in subsequent pregnancies are apparent. This information may be useful in patient counseling.

Adolescent↗
PubMed1995

Laparoscopic cholecystectomy during pregnancy.

BACKGROUND: Cholecystectomy represents the second most common nonobstetric operation during pregnancy. Published guidelines for laparoscopic cholecystectomy (LC) have considered it to be contraindicated in the gravid patient. Several cases of successful LCs in the gravid patient have been reported recently. This study reviews LC during pregnancy in my series and compares this experience with the published literature. METHODS: Five LCs were performed during pregnancy out of 380 cases between May 1990 and November 1994. Forty-one cases were retrieved via MEDLINE search. RESULTS: Three patients were in their second trimester (14, 17, and 22 weeks), and two patients were in the third trimester (27.5 and 28 weeks) in my series. The open technique was used in one patient. Intraoperative cholangiography was not performed. No maternal or fetal morbidity occurred. Forty-one cases have been reported in the literature. Four patients were operated on during the first trimester, 35 during the second trimester, and two during the third trimester (range, 3 to 31 weeks) without fetal loss or maternal morbidity. Cholangiography was performed in 15 cases. Tocolytic agents were used in five of 46 patients. CONCLUSIONS: Although additional clinical data are required, laparoscopic cholecystectomy is safe during pregnancy when undertaken by the skilled laparoscopic surgeon.

Adult↗
PubMed2001

Effect of subclinical uterine infection on cervical and uterine involution, estrous activity and fertility in postpartum buffaloes.

Nili-Ravi buffaloes (n=29) that calved normally between August and November and did not develop any clinical reproductive disorder after calving were studied for the incidence of sub-clinical bacterial infection of the uterus and its effects on postpartum reproductive efficiency. The incidence of subclinical uterine infection was 24% (7/29). Involution of the cervix and uterus was slower (P < 0.01) in the infected group than in the normal group (45.6 vs 31.1 days and 46.3 vs 35.8 days), respectively. The mean diameters of cervix and gravid horn on Day 12 post partum and on completion of involution did not differ between buffaloes of the two groups. However, the rate of involution of the cervix and the gravid horn was lower in buffaloes of the infected group (2.2 vs. 2.7 mm/day and 2.6 vs. 3.2 mm/day). The mean interval to first post partum ovulation was similar in buffaloes in the infected (35.5 days) and the normal group (33.8 days). The life span of corpus luteum formed after first ovulation was shorter (11 days) in buffaloes of both groups than that of a normal estrous cycle (15 to 17 days). The incidence of silent ovulation was apparently higher in buffaloes of the infected group (83 vs. 60%) but the difference was not significant. For the first four months after calving, the mean interval to first postpartum estrus was longer in buffaloes of the infected group (73.0 vs. 47.7 days; P < 0.01). Similarly, the average service period was longer in buffaloes of the infected group (91.0 vs. 64.8 days; P < 0.05). The overall pregnancy rate for the first four months after calving did not differ between buffaloes of the two groups. We conclude that subclinical bacterial infection of the postpartum uterus delays the cervical and uterine involution which can, in turn, delay the occurrence of first postpartum estrus and prolong the service period in buffaloes.

Animals↗
PubMed2004

Variant surface antigen-specific IgG and protection against clinical consequences of pregnancy-associated Plasmodium falciparum malaria.

BACKGROUND: Pregnancy-associated malaria caused by Plasmodium falciparum adherence to chondroitin sulfate A in the placental intervillous space is a major cause of low birthweight and maternal anaemia in areas of endemic P falciparum transmission. Adhesion-blocking antibodies that specifically recognise parasite-encoded variant surface antigens (VSA) are associated with resistance to pregnancy-associated malaria. We looked for a possible relation between VSA-specific antibody concentrations, placental infection, and protection from low birthweight and maternal anaemia. METHODS: We used flow cytometry to measure VSA-specific IgG concentrations in plasma samples taken during child birth from 477 Kenyan women selected from a cohort of 910 women on the basis of HIV-1 status, gravidity, and placental histology. We measured VSA expressed by one placental P falciparum isolate and two isolates selected or not selected for chondroitin sulfate A adhesiveness in-vitro. FINDINGS: Concentrations of plasma IgG specific for VSA, expressed by chondroitin sulfate A-adhering parasites (VSA in pregnancy-associated malaria or vsa-pam), increased with gravidity and were associated with placental histological findings. Women with chronic pregnancy-associated malaria and low or absent VSA-PAM-specific IgG had lower haemoglobin values (reduced by 17 g/L; 95% CI 8.1-25.2) and delivered smaller babies (birthweight reduced by 0.26 kg; 0.10-0.55) than did corresponding women with high VSA-PAM-specific IgG. No such relation was shown for concentrations of IgG with specificity for non-pregnancy-associated malaria VSA. INTERPRETATION: VSA-PAM-specific IgG protects against low birthweight and maternal anaemia. Our data indicate an important mechanism of clinical protection against malaria and raise hope for the clinical effectiveness of a potential VSA-based vaccine against pregnancy-associated malaria.

Animals↗
PubMedDate not supplied

Prevalence of low-back pain in Lesotho mothers.

OBJECTIVES: To identify factors that strongly affect the presence of severe low-back pain in mothers living in the Maseru District of Lesotho, to find out whether there is any truth to the widespread belief that rural mothers are more vulnerable to severe low-back pain than their urban counteTparts, and to identify influential factors that are strongly associated with each other. METHODS: A random sample of 4001 mothers was collected from the Maseru District of Lesotho in September 1994 by using sampling techniques of stratification and proportional allocation with respect to size. The following 10 explanatory variables of study were used: intensive farm work, gravidity (number of births plus abortions), residential area, heavy weight lifting, the literacy status of the mother, strenuous manual labor, the availability of basic health services, the income status of the mother, cooking method at home, and breast-feeding. The dependent variable of study was the presence or absence of severe low-back pain. Discriminant and log-linear analyses were done to analyze the data collected. Discriminant analysis was done by using the presence or absence of severe low-back pain as a classifying variable and the 10 explanatory variables that affect the classifying variable. Log-linear analysis was also done by using the same data with 9 of the 11 variables of study. RESULTS: A total of 405 (10.12%) of the 4001 mothers in the study had severe low-back pain at the time of data collection, 513 (12.82%) had moderate low-back pain, and 1422 (35.54%) had mild low-back pain. A total of 319 (78.77%) of the 405 mothers with severe low-back pain were poor, illiterate, and from rural communities. Results from discriminant analysis revealed that the presence of severe low-back pain was strongly affected by intensive farm work, the residential area of the mother, and gravidity of the mother in a decreasing order of strength and led to results similar to those obtained from discriminant analysis. The study also showed that rural mothers and their children were more disadvantaged than their urban counterparts with regard to basic health services. CONCLUSION: Recommendations were made to the Ministry of Health and Social Welfare of Lesotho to improve the provision of basic health services, including health education on the importance of chiropractors to the community.

Discriminant Analysis↗
PubMed1998

A promoter mutation in the tumor necrosis factor alpha gene is not associated with preeclampsia.

Preeclampsia is associated with increased plasma concentrations of tumor necrosis factor alpha (TNF alpha) and TNF receptors. A mutation in the promoter region of the TNF alpha gene (TNF T2) has been described which is associated with increased transcription of the gene. Due to the familial predisposition of preeclampsia, we hypothesized that this promoter mutation in the TNF alpha gene may contribute to the genetic etiology of preeclampsia. Our objective was to determine the allele frequency of this mutation in a population with well-characterized preeclampsia and with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome as compared with normotensive controls. DNA was extracted from blood of 131 women with severe preeclampsia, 75 women with HELLP syndrome, and 41 normotensive gravid controls. Genotypes were determined using the polymerase chain reaction (PCR), allele-specific restriction with Nco1, and agarose gel electrophoresis. Results were analyzed with a chi 2 contingency table. No significant differences were found between patients with severe preeclampsia, HELLP syndrome, normotensive gravid controls, and previously published allele frequencies. The frequency of the TNF T2 allele is not increased in patients with preeclampsia or HELLP syndrome. Therefore, this promoter mutation is probably not a major genetic cause of preeclampsia. As more genes are cloned, sequenced and localized, this will enable investigators to take this 'candidate gene approach' to investigate potential genetic causes of preeclampsia.

Female↗
PubMed1980

Appendicitis during pregnancy.

We report the case of a 26-year-old gravid patient with acute appendicitis at 24 weeks gestation. Emergency appendectomy was performed with no post-operative sequelae to the mother or to the fetus. The patient delivered a viable infant vaginally at term. Alteration in the gravid patient of the classic signs and symptoms of acute appendicitis is detailed. Complications of delay in diagnosis and of negative laparotomy are discussed.

Adult↗
PubMed1987

Volume homeostasis during pregnancy in the rat.

This article reviews alterations in volume and sodium handling during rat pregnancy, noting similarities and contrasts to events in human gestation. Gravid rodents undergo extracellular and plasma volume increases of 50% to 70%, and these changes accompany a marked cumulative sodium retention shared by both dam and fetuses. Pregnancy alters several factors, with opposing effects on renal salt handling; however, mechanisms by which gestational sodium accumulation and volume expansion are achieved remain obscure. Furthermore, despite substantial increases in absolute blood volume, considerable uncertainty exists as to how this volume is sensed, particularly during the final gestational week when a rapid increase in volume is associated with decreases in peripheral resistance and BP. Attempts to assess "effective" intravascular volume by measuring responses to intravenous (IV) or oral sodium loading or to chronic mineralocorticoid administration indicate that pregnant and nonpregnant rats respond similarly, suggesting that such animals sense their volume as normal. In contrast, when salt-restricted, gravid rats fail to expand their plasma volume normally; this relative hypovolemia activates mechanisms leading to free water retention and pathologic hyponatremia, responses not observed in virgin animals.

Animals↗
PubMed2002

Humoral immune response to Dipylidium caninum infection of stray dogs in Taiwan.

Two kinds of homogeneous proglottid, mature and gravid, of Dipylidium caninum were used as the antigens for immunodiagnosis of canine dipylidiosis in stray dogs in Tainan, Taiwan. The ELISA was performed on 30 serum samples; 24 from dipylidiosis, four from ancylostomosis and two from toxocariosis. The ELISA have specificity and sensitive of 100 and 50% for mature proglottid extract, and 75 and 100%, respectively, for gravid proglottid extract. EITB technique showed two major peptide bands of 94.8 and 97.9kDa were recognized in the sera pool of infected dogs.

Animals↗