Intrauterine fetal death due to echovirus 11

In a case of intrauterine fetal death in the 29th week of gestation, echovirus 11 could be isolated from the umbilical cord of the fetus. The mother had no apparent signs of infection but serological evidence of current echovirus 11 infection. Enterovirus PCR performed on paraffin-embedded specimens of various tissues (myocardium, lung, liver and placenta) from the fetus yielded positive results in all cases. These findings, together with supporting serological and epidemiological findings--e.g. proven echovirus 11 infection 3 weeks before in the 18-month-old son of the woman--constituted strong evidence that echovirus 11 infection was responsible for the fetal death.

Insufficient remodelling of the uterine connective tissue in women with protracted labour

OBJECTIVE

To investigate the association between a slow progress of labour and insufficient remodelling of the uterine connective tissue.

DESIGN

An open comparative study.

SETTING

Danderyd Hospital, Department of Obstetrics and Gynaecology, referral centre.

SUBJECTS

Eleven women (study group) in oxytocin augmented labour but with an unripe cervix in whom vaginal delivery could not be accomplished and 12 women (normal labour group) in normally progressing spontaneous labour and a favourable cervix but who needed to be delivered by caesarean section due to signs of fetal distress.

INTERVENTIONS

At caesarean section tissue specimens were obtained from the fundus, the isthmus and the cervix uteri.

MAIN OUTCOME MEASURES

Collagen concentration and extractability, collagenolytic activity expressed as DNP-peptide hydrolytic activity and the concentrations of sulphated glycosaminoglycans (S-GAG) and hyaluronic acid (HA) in the tissue specimens.

RESULTS

Statistically significantly higher concentrations and lower extractability of collagen in the isthmus and the cervix uteri was found in women with slow progress of labour compared with those with normal labour.

CONCLUSIONS

An insufficient remodelling of the connective tissue in the cervix and isthmus uteri may contribute to slow progress of labour.

Proteoglycan metabolism in the connective tissue of pregnant and non-pregnant human cervix. An in vitro study

Profound changes occur in the cervix during pregnancy. In particular, the connective tissue is remodelled. To elucidate the mechanisms behind this process, the metabolism of cervical connective tissue was studied using tissue cultures. Cervical biopsies from non-pregnant and pregnant women were incubated with [35S]sulphate. The proteoglycans of the tissue specimens were purified by ion-exchange and gel chromatography and characterized by SDS/PAGE and by enzymic degradation. In the non-pregnant cervix, the incorporation of [35S]sulphate into the proteoglycans was linear for 48 h. During the first 6 h of incubation the accumulation of chiefly one small labelled proteoglycan (apparent Mr 110,000) substituted with dermatan sulphate was recorded. This is in accordance with the known proteoglycan composition of non-pregnant cervical tissue. In addition, small amounts of two larger radioactive dermatan/chondroitin sulphate proteoglycans (apparent Mr values 220,000 and greater than 500,000) were recorded. After longer periods of incubation the proportion of heparan sulphate proteoglycans increased considerably. The pregnant tissue showed a clearly different composition of labelled proteoglycans. An increased accumulation of the two larger dermatan/chondroitin sulphate proteoglycans was seen in addition to the dominant small dermatan sulphate proteoglycan of the non-pregnant cervix. The rate of accumulation of these two proteoglycans was about 3 times higher in the pregnant tissue, whereas that of the small dermatan sulphate proteoglycan was only increased 2-fold. The fact that the concentration of proteoglycans in the pregnant cervix is approximately one-half of that in the non-pregnant cervix indicates that the turnover of proteoglycans in pregnant cervical tissue is significantly increased. The major effect of this profound change of metabolism was a 50% decrease in proteoglycan content and a 2-fold increased proportion of a dermatan sulphate proteoglycan with an apparent Mr of 220,000.

Low field magnetic resonance imaging of the central nervous system in 15 children with autistic disorder

Fifteen children, 10 boys and 5 girls, with autistic disorder, were studied with low field magnetic resonance imaging (MRI). The age ranged from 2.7-13.1 years, with a mean of 8.3 years. All patients but one (who refused) had a normal CT scan of the C.N.S. The MRI investigation was performed during anaesthesia with a low field magnetic resonance imager. The cerebrum, cerebellum, and brain stem were examined. No pathological changes were found in any of the patients studied.

Preinductive cervical ripening with PgE2 gel in term pregnant women with ultrasonically diagnosed intra-uterine growth-retarded fetuses

Intra-uterine growth retardation (IUGR), often combined with other pregnancy-related complications, constitutes a rather common indication for labor induction. The objective of this prospective study was to evaluate a strict intracervical application of 0.5 mg PgE2 in gel for cervical ripening and labor induction. Eighty term pregnant women with an ultrasonically diagnosed IUGR (less than -2 SD) and an unripe cervix were given PgE2-gel. The main indication for labor induction was IUGR, but 26 women had other complications. IUGR was verified at delivery in 50 women (study group), whereas 30 women (control group) gave birth to infants of normal birth weight (greater than -2 SD). The cervical ripening effect did not differ between the groups. In the study group, 19 nulliparous and 15 parous women out of 50 had a favorable cervix after 12 h and were delivered within 24 h of gel application. The corresponding result for the control group was 11 nulliparous and 8 parous women out of 30. Failed induction was registered in 2 and one woman respectively. On the other hand, the number of instrumental deliveries was greater in the study group, 11 caesarean sections (CS) and seven ventouses, compared with one CS and three ventouses in the control group (p less than 0.05). The frequency of operative deliveries for fetal distress (ODFD) was higher among the women with verified IUGR (14/50) than in the controls, where the corresponding figure was 3/30. No side effects were observed. We conclude that strict intracervical application of 0.5 mg PgE2 is a safe and effective method for cervical ripening and labor induction in women with IUGR.

Myometrial activity after local application of prostaglandin E2 for cervical ripening and term labor induction

Twelve pregnant women at term with unfavorable cervices (less than or equal to 5 points according to Bishop score) were given prostaglandin E2 for cervical priming and labor induction. Prostaglandin E2 was given in the following manner: 0.5 mg in gel strictly intracervically (n = 4), extraamniotically (n = 4), or prostaglandin E2 (4 mg) in gel vaginally (n = 4). The myometrial activity was registered over a period of 30 minutes before and at least 3 hours after gel application by means of an extraamniotic microtransducer catheter. After both extraamniotic and vaginal gel application, myometrial activity was significantly increased compared with intracervical application. All the women had favorable cervical states 6 hours after treatment and were delivered vaginally within 24 hours. All infants were delivered in good condition with 1-minute Apgar scores greater than 7. From these results we conclude that proper intracervical prostaglandin E2 gel application, in contrast to extraamniotic or vaginal application, induces cervical ripening without significant myometrial activity. Because careful intracervical application appears to avoid or minimize the risks of myometrial hyperstimulation, this technique should be considered particularly in women with unfavorable cervices and delicate fetuses.

Circulatory monitoring of children during anaesthesia in low-field magnetic resonance imaging

Anaesthesia for patients in a Magnetic Resonance Imaging (MRI) scanner provides some problems for the design of both the anaesthetic and the monitoring equipment. This report presents a technique for continuously displaying the heart rate during anaesthesia for children in an MRI scanner. The monitoring system used light to detect differences in skin capillary circulation, and the light was transferred to and from the patient via fiberoptic cables. After amplification, the signal was displayed "on line" on a cardioscope, thus continuously presenting heart rate and, in part, a qualitative view of the skin vascular resistance.

Epidemiological studies of geographic variations of cancer incidence in Sweden. Choice of variables and statistical units

The Swedish Cancer-Environment Registry has been used for studies of the parts of cancer incidences and of their variations between subpopulations, which, in a statistical sense, can be 'explained' by environmental variables. In previous studies the dependence of age-standardized incidences in municipalities (279 in Sweden) on population density, socio-economic variables, smoking habits and a variable for 'diagnostic intensity', assumed to allow for variations in under-diagnosing and under-reporting, was studied in, i.a., multiple-regression analyses. Due to intrinsic variation in potentially etiologic factors and in size, municipalities are less suitable as geographic units. Therefore a system was developed to build up, from parishes (about 2,600), pseudo-municipalities standardized with respect to size and some environmental variable(s), in the present study population density. This paper shows, for a number of cancer diseases and for total cancer, the superiority of pseudo-municipalities to municipalities with respect to power of explaining variation and, preliminarily, also incidence.

Fenfluramine treatment of twenty children with autism

The effects of fenfluramine were examined on 20 children with autism over a 48-week period utilizing a double-blind placebo-controlled crossover design. Blood and urine samples and psychological tests (Griffith's Developmental Scales and Real Life Rating Scale) were obtained at each crossover period. The only significant improvement was a decrease in abnormal motor behavior. We did not find any significant improvement in intellectual functioning or any correlation between good clinical response and low baseline serotonin levels or high baseline IQ. Serotonin decreased 53% after fenfluramine treatment and rebounded to a level 35% higher than baseline following a placebo period. Fenfluramine and the active metabolite norfenfluramine were determined in plasma samples.

Changes in the connective tissue of corpus and cervix uteri during ripening and labour in term pregnancy

The composition of the connective tissue of human cervix and corpus uteri was studied in tissue specimens from seven nonpregnant women and 14 pregnant women, delivered at term by section, to examine spontaneous cervical ripening and labour-induced changes in both the uterine and the cervical connective tissue. The main finding in both the cervix and the corpus was a large (40-60%) decrease of the collagen concentration. The collagen extractability, obtained by pepsin digestion, was increased twofold, suggesting a change of the organization of the collagen fibrils. This reorganization process could also be demonstrated by a large increase of the collagenolytic activity demonstrated with an artificial DNP-peptide substrate. The concentrations of sulphated glycosaminoglycans was lower in pregnant women than in non-pregnant women. The results show that both the cervix and the corpus uteri contain substantial amounts of connective tissue components (collagen, sulphated glycosaminoglycans and hyaluronic acid) and that during ripening, reconstruction of the connective tissue components occurs in both sites. This indicates that the cervical state reflects that of the myometrium.

Changes in the connective tissue of corpus and cervix uteri during ripening and labour in term pregnancy

The composition of the connective tissue of human cervix and corpus uteri was studied in tissue specimens from seven nonpregnant women and 14 pregnant women, delivered at term by section, to examine spontaneous cervical ripening and labour-induced changes in both the uterine and the cervical connective tissue. The main finding in both the cervix and the corpus was a large (40-60%) decrease of the collagen concentration. The collagen extractability, obtained by pepsin digestion, was increased twofold, suggesting a change of the organization of the collagen fibrils. This reorganization process could also be demonstrated by a large increase of the collagenolytic activity demonstrated with an artificial DNP-peptide substrate. The concentrations of sulphated glycosaminoglycans was lower in pregnant women than in non-pregnant women. The results show that both the cervix and the corpus uteri contain substantial amounts of connective tissue components (collagen, sulphated glycosaminoglycans and hyaluronic acid) and that during ripening, reconstruction of the connective tissue components occurs in both sites. This indicates that the cervical state reflects that of the myometrium.

Intravenous infusion of 15 methyl-prostaglandin F2 alpha (Prostinfenem) in women with heavy post-partum hemorrhage

Post-partum hemorrhage is a serious complication in obstetric practice. The aim of this study was to investigate, in vivo, the effects of 15 methyl-prostaglandin F2 alpha (Prostinfenem, Upjohn, Sweden) on uterine activity and hemorrhage. Twenty-seven women were included in the study and, in accordance with our clinical routine, all were given oxytocin (10 IE Syntocinon) intramuscularly immediately after delivery. In cases of heavy bleeding and signs of uterine atony, ethylergometrine (0.2 mg Methergin) and oxytocin (40 i.e. Syntocinon in 500 ml, 5.5% glucose) were administered intravenously. If this therapy failed, the woman was given an intravenous infusion of 15-methyl-prostaglandin F2 alpha (0.25 mg Prostinfenom, in 500 ml, 5.5% glucose). Myometrial activity was quantitated in 5 women by a micro-transducer introduced into the uterine cavity. The treatment resulted in a contracted uterus and cessation of bleeding within 12.5 min (mean). The intra-uterine pressure registered a prompt effect regarding both amplitude and frequency of uterine contractions.

Cervical priming and labor induction with vaginal application of 3 mg PGE2 in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix

Sixty-one term pregnant women, 29 nulliparous (Group A) and 32 multiparous (Group B) with unfavorable cervix and premature rupture of the membranes (PROM) were given 3 mg PGE2 in suppository form for cervical ripening and labor induction. Five hours after starting the treatment, 12 women of the 29 in Group A and 21 of the 31 in Group B had a favorable cervix and established labor. The remaining 17 nulliparae and 11 multiparae still had an unfavorable cervix and were then given another PGE2 suppository. Until the next morning, i.e. within 24 h, 19 nulliparous and 22 multiparous women gave birth whereas a further 5 nulliparous women who now had favorable cervix but no uterine contractions were delivered after stimulation with intravenous oxytocin. The remaining undelivered women were given another PGE2 suppository. With or without additional oxytocin stimulation, all but 2 multiparous women could be delivered within a further 12 hours. The total number of instrumental deliveries in Group A was 2 caesarean sections due to disproportion (7%) and 5 ventouses. In Group B, 3 caesarean sections (9%) had to be carried out, one due to fetal distress and 2 due to failed induction. From the results of this study we conclude that vaginal application of 3 mg PGE2 in suppository form can be used to induce labor in patients with PROM and unripe cervix. However, when the results are compared with those obtained in previous studies after application of PGE2 in gel, the latter technique seems preferable.

Different biochemical composition of connective tissue in continent and stress incontinent women

The collagen content in biopsies from skin and ligamentum rotundum of 7 women with a long history of stress incontinence was compared with that of continent controls. The collagen was extracted with 0.5 M acetic acid, followed by digestion with pepsin and quantitated as hydroxyproline. The skin of stress incontinent women contained 40% less collagen than that of continent women. The findings for ligamentum rotundum were similar. These results suggest a deteriorated connective tissue in stress-incontinent women and cast new light on the etiology of the disease.

Cervical collagen: an important regulator of cervical function in term labor

This study provides the first clear evidence of a close correlation between the biochemical composition of the cervix and the clinical course of delivery in terms of cervical dilatation. Cervical biopsy specimens were obtained from three groups of patients: Group A, ten women with favorable cervix and spontaneous labor; group B, 12 women with unfavorable cervix given 0.5 mg prostaglandin E2 in gel intracervically for cervical priming and induction of labor; and group C, five women with unfavorable cervix and spontaneous labor. Cervical dilatation time was significantly longer (18 hours) for women in group C compared with women in group A (6.7 hours) and in group B (5.0 hours; P less than .001). The total amount of cervical collagen was significantly higher in women in group C at 8.58 micrograms/mg compared with 6.7 micrograms/mg in women in group A and 5.47 micrograms/mg in prostaglandin E2-treated women in group B. The amount of nonextractable collagen also was significantly higher in women in group C, 23.6% compared with 11.3% in group A, and 12.4% in group B (P less than .01). The collagenolytic activity was significantly increased in cervical biopsy specimens from prostaglandin E2 gel-treated patients--520 U/100 mg wet weight compared with 380 U/100 mg wet weight in untreated patients in group A (P less than .05). From these results it is concluded that cervical collagen is an important regulator of cervical function in late pregnancy and term labor; that prostaglandin E2 is involved in cervical priming, initiation, and progress of term labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of labor in postterm pregnant women

We have studied the outcome of labor induction in 145 postterm pregnant women in whom gestational age was properly assessed by ultrasound scanning. The induction techniques were adapted to the cervical states of the patients. Seventy-five patients (32 nulliparous and 43 multiparous) with favorable cervical states were successfully induced with intravenous oxytocin. In this group the frequency of Caesarean section was 2%. Seventy patients (45 nulliparous and 25 multiparous) with unripe cervices received 0.5 mg PGE2 in viscous gel intracervically to prime the cervix and to induce labor; 38 (52%) were induced into labor after a single PGE2-gel application whereas 26 (48%) needed labor augmentation with intravenous oxytocin after PGE2-gel obtained cervical ripening. In 6 of the 20 patients the cervix did not ripen and the PGE2-gel application had then to be repeated. The frequency of cesarean sections was 11%. In 5 out of the 145 patients (4%) the fetuses had signs of intrauterine growth retardation (IUGR) as assessed by ultrasound scanning, and postmaturity as verified by pediatric examination at delivery. All these fetuses belonged to nulliparous women with unripe cervices and all had to be delivered instrumentally (3 by cesarean section and 2 by ventouse) indicating the fragility of these children. If postterm pregnancy is complicated by an unfavorable cervical state intracervical application of PGE2-gel seems to be an efficient method to prime the cervix and to induce labor. In most patients an uncomplicated vaginal delivery can be achieved by this procedure. However, nulliparous women with unfavorable cervices and signs of IUGR constitute a high risk group of patients at labor induction.

Induction of labor with intravenous oxytocin or vaginal PGE2 suppositories. A randomized study

Thirty-eight term pregnant women with a moderately unfavorable cervix (cervical score 4-5 p.) were randomly given intravenous oxytocin (Group A) or 3 mg PGE2 as a vaginal suppository (Group B) for labor induction. Eight out of 19 in Group A and 17 out of 19 in Group B gave birth vaginally within 24 h. The remaining 11 women in Group A had still an unfavorable cervix after 24 h. They were then given 3 mg PGE2 as a vaginal suppository and all but one had given birth vaginally without complications within 24 h. In Group B only 2 were still undelivered after 24 h. Both had a favorable cervix and were delivered vaginally within 12 h after intravenous infusion of oxytocin. The number of instrumental deliveries in Group A was one cesarean section and two vacuum extractions and in Group B three vacuum extractions. One woman in Group B reported nausea and vomiting and in one had strong uterine contractions in the second stage of labor. Otherwise no side effects were registered. All babies were born in good condition with Apgar scores greater than or equal to 7. In conclusion, vaginal application of 3 mg PGE2 as a suppository seems to be more effective than intravenous infusion of oxytocin for labor induction in women with half-ripened cervices, i.e. cervical scores of 4-5 p.

The effect of terodiline treatment in women with motor urge incontinence. Results from a double-blind study and long-term treatment

The effects of terodiline were evaluated in 24 women with genuine motor urge incontinence: Twelve patients participated in a double-blind crossover study and 12 in a subsequent long-term study. All patients were investigated by simultaneous urethrocystometry before and after treatment. During the controlled study the subjects were treated with placebo or 37.5 mg of terodiline daily for two 3-week periods. The long-term study covered a period from 6 months to 3 years. A significantly higher increase in both bladder volume at urinary leakage (from 170 to 270 ml, p less than 0.001) and bladder capacity (from 320 to 390 ml, p less than 0.01) was registered after terodiline treatment compared to placebo. In the long-term study the effects on these parameters were still more pronounced with an increase in bladder volume at leakage (from 180 to 300 ml, p less than 0.001) and in bladder capacity (from 290 to 430 ml, p less than 0.0001). Subjective improvement with terodiline treatment was reported by all but two patients in the double-blind study and by all in the long-term study. Side effects such as dryness of the mouth were reported by four patients receiving terodiline in the double-blind study and by six in the long-term study. No patient discontinued the treatment. Terodiline seems to be a promising alternative for treatment of motor urge incontinence in women.

Fetal circulation 60 to 80 minutes after vaginal prostaglandin E2 in pregnant women at term

We combined real-time B-mode ultrasonography with a 2 MHz pulsed Doppler technique to record blood flow in the fetal descending aorta and in the intra-abdominal part of the umbilical vein in 14 pregnant women at term. The blood flow was studied before and after instillation into the vagina of either 4 mg prostaglandin E2 (PGE2) gel or placebo gel. The PGE2 gel was significantly more effective in cervical priming and labor induction than the placebo gel. After instillation of the gel neither group showed a change in the fetal volume blood flow or in the aortic blood velocity waveform. We conclude that the instillation of 4 mg of PGE2 gel does not affect fetal hemodynamics at term.

Intracervical versus intravaginal PGE2 for induction of labor at term in patients with an unfavorable cervix

In a randomized double-blind study we evaluated the effects on cervical ripening and labor induction of 0.5 mg PGE2 in gel given intracervically and 2.0 mg PGE2 given as a vaginal suppository. All patients were at term with unfavorable cervical scores. The indications for induction were toxemia, diabetes mellitus, Rh-immunization, or intrauterine growth retardation. Significantly better results for both cervical priming and labor induction were obtained after intracervical PGE2-gel application than after treatment with placebo or vaginal suppositories. Eleven out of 19 patients (58%) were delivered within 24 h after intracervical PGE2-gel compared to two out of 19 patients given placebo (p less than 0.01). In patients not delivered 24 h after the start of treatment, the mean cervical score had changed from 3.7 to 6.0 (p less than 0.05) after PGE2-gel application compared to a change from 3.9 to 4.3 after placebo treatment (n.s.). The outcome after treatment with PGE2 suppositories did not differ significantly from that with placebo treatment. In a subsequent study 25 patients were given 0.5 mg PGE2-gel intracervically. The results were consistent with those obtained in patients receiving PGE2-gel intracervically in the double-blind study. Few side effects were noted. No patient complained of gastro-intestinal discomfort but increased myometrial activity was observed in two patients; one after placebo and the other after active intracervical PGE2-gel treatment. The hyperactivity was readily countered with the beta 2-agonist, terbutaline. All infants were born in good condition with Apgar scores of 7 or more within 5 min. At pediatric examinations at 1 week and at 6 months of age all children seemed healthy.

The integrity of cervical collagen during pregnancy and labor

The concentration of collagen in the human uterine cervix decreases during pregnancy. This change contributes to the ripening process, which facilitates cervical dilatation during labor. It has been suggested that cervical collagen is partly degraded at term and after delivery. In order to evaluate this hypothesis we investigated the proportion of intact to degraded collagen after solubilization of about 86% of the collagen with pepsin in acetic acid. Total collagen was quantitated as hydroxyproline whereas intact collagen was estimated by SDS-gel electrophoresis. The proportion of intact collagen to total collagen did not change during pregnancy and delivery. Furthermore it was similar to that of intact standard collagen. Thus, even if the concentration of collagen is diminished during pregnancy as a result of increased collagenolytic activity, there is no indication of a qualitative change of the remaining collagen.

Proteoglycans from cultures of fibroblast from the human uterine cervix

A small dermatan sulphate proteoglycan has been isolated from the human uterine cervix. The concentration of this proteoglycan has been shown to decrease during pregnancy. To study the mechanism behind this change fibroblasts from the human uterine cervix were established in culture. Their synthesis and secretion of proteoglycans were investigated by incubating the monolayer with 35SO4 and (3H) leucine for 48 h. Two dermatan sulphate proteoglycans and one heparan sulphate proteoglycan were isolated from the medium. The cell layer contained the same proteoglycans although in different proportions. The major dermatan sulphate proteoglycan accounting for 55% of the total macromolecular 35S was small with a molecular weight (MW) of 100,000 daltons. The side chains were calculated to be approximately 1-3 per protein core and included more than 50% iduronic acid containing disaccharides. This small dermatan sulphate proteoglycan is very similar to that isolated from the intact human uterine cervix. However, when cells were established in culture an additional larger dermatan sulphate proteoglycan with an MW of 400,000 daltons was synthesized. This proteoglycan was substituted for 4-8 polysaccharide side chains rich in glucuronic acid. 24% of the total macromolecular 35S were found in this proteoglycan.

Cervical priming and/or induction by intracervical application of PGE2-gel in term patients with preeclampsia and unfavorable cervical states

92 preeclamptic women with unfavorable cervical states were treated with intracervical application of prostaglandin E2 (PGE2) in gel for cervical priming and/or labor induction. 55 (60%) were delivered after a single PGE2-gel application. In 27 (29%) the cervical state was improved after 24 h and labor could be induced by oxytocin infusion. Thus, 89% of the women were delivered within 48 h after a single PGE2-gel application. In 10 women (11%) a second PGE2-gel application had to be done before oxytocin infusion. The frequency of cesarean sections was low (5%). No case of uterine hypertonus was seen. No gastrointestinal side effects were observed. All newborn infants had an apgar score at 5 min of more than 7 and were in good condition.

Intravaginal versus intracervical application of prostaglandin E2 in viscous gel for cervical priming and induction of labor at term in patients with an unfavorable cervical state

Sixty term pregnant women with unripe cervix were randomly given either 0.5 mg of prostaglandin E2 (PGE2) in 2 ml of gel intracervically or 4 mg of PGE2 in 3 ml of gel intravaginally to prime the cervix and/or to induce labor. In patients with a highly unfavorable cervix (cervical score less than or equal to 3), the intracervical application was significantly more effective than the intravaginal. In patients with a more favorable cervical state (cervical score 4 or 5), the two routes of application were equipotent. Gastrointestinal side effects were registered after intravaginal but not after intracervical application. Myometrial activity was significantly more increased after intravaginal than after intracervical gel application. All children were born in good condition with an Apgar score greater than 7 within 5 minutes.

Ripening of the human uterine cervix related to changes in collagen, glycosaminoglycans, and collagenolytic activity

Connective tissue in biopsy specimens taken from the lower part of the uterine cervix in 40 pregnant women at various gestational ages was compared to that in similar biopsy specimens from 15 nonpregnant women. The concentrations of collagen, sulfated glycosaminoglycans, and hyaluronic acid decreased during pregnancy. At the gestational age of 10 weeks, the collagen concentration was 70%, and at term 30%, of that in the nonpregnant cervix. After delivery, no further decrease was observed. The extractability of collagen increased during pregnancy, as well as during labor. Also, the water concentration increased. An increase in the collagenolytic activity was observed with advancing gestational age. The 2,4-dinitrophenyl-Pro-Gln-Gly-Ile-Ala-Gly-Gin-D-Arg hydrolytic activity (collagenase) and the concentration of leukocyte elastase increased gradually by a factor of 10. The physiologic importance of the collagen was also demonstrated, since the cervical dilatation time during spontaneous labor was long in women with high concentrations of collagen and short in women with low concentrations of collagen.