Absorption and metabolism of oral progesterone

The absorption, metabolism, and clearance of progesterone from the peripheral circulation were investigated in five postmenopausal women after oral administration of 100 mg daily for five consecutive days. Maximal plasma concentrations of progesterone were observed within four hours after ingestion of the last dose, when the range (22.11-34.18 nmol/l; 696-1077 ng/100 ml) was comparable with that observed during the mid-luteal phase of the ovarian cycle. The surge in values lasted six hours, and progesterone concentrations remained raised for at least 96 hours. Of the three metabolites studied, the plasma concentrations of pregnanediol-3 alpha-glucuronide were most raised by treatment, the peak values ranging from 1097 nmol/l (54.9 microgram/100 ml) to over 2000 nmol/l (100 microgram/100 ml), which was the upper limit of the assay used. Concentrations of 17-hydroxyprogesterone were least raised, and the peak values ranged from 4.32 to 9.68 nmol/l (143-319 ng/100 ml). The plasma profile of 20 alpha-dihydroprogesterone most closely approximated that of progesterone, although the range of maximal values was lower (7.11-16.06 nmol/l; 228-514 ng/100 ml). Plasma concentrations of oestradiol were unchanged by giving progesterone. It is concluded that the increases in circulating concentrations of progesterone and the biologically active metabolite 20 alpha-dihydroprogesterone, and the duration of these increases, were sufficient to modulate the biochemistry of responsive tissues. Oral progesterone may thus have a therapeutic role, and this route of administration merits further investigation.

Disposition of all-trans- and 13-cis-retinoic acids and n-hydroxyethylretinamide in mice after intravenous administration

The disposition of 13-cis- and all- trans-retinoic acids and N-hydroxyethylretinamide has been studied in mice after an intravenous dose of 10 mg/kg. As determined by high-ressure liquid chromatography, serum levels of 13-cis-retinoic acid, in a distribution phase, decreased rapidly over a 30-min period. This was followed by an apparently exponential phase of elimination. N-Hydroxyethylretinamide had a distribution phase lasting for 1 hr followed by an exponential phase. All-trans-retinoic acid had a similar distribution phase, but this was followed by a nonexponential phase. Tissue levels of 13-cis-retinoic acid, although generally not as high as those in serum, decreased in a manner similar to that for serum. Levels of all-trans-retinoic acid in liver, kidney, lung, brain, and small intestine were generally higher than those of serum throughout the period of observation. At 8 hr after injection of the mice, relatively high levels of all-trans-retinoic acid remained in the brains, and detectable levels of 13-cis-retinoic acid persisted in the lungs. N-Hydroxyethylretinamide also persisted in tissues for long periods of time, with tissue levels generally higher than those in serum. At 18 hr after injection of mice, relatively high levels of this compound were found in the liver, kidneys, and testes.

Maternal perception of fetal motor activity

A technique using real-time ultrasound for comprehensive recording of fetal motor activity was used in 20 subjects in the third trimester of pregnancy. Maternal awareness of fetal movement correlated with the number of fetal parts contributing to the movement but not with maternal parity or obesity, gestational age, placental site, or duration of the fetal movement. Some subjects recorded fetal breathing, passive fetal displacement, and Braxton Hicks's contractions as fetal movement. Most of our subjects were consistent and accurate in their perception of major fetal movements, but a few were inconsistent and one was completely unaware of major fetal movements. These results suggest that kick counts kept by most mothers will be accurate. Low counts of fetal movement should be an indication for fetal monitoring by other means and not, unconfirmed, for intervention.

Plasma assay of fetal factors VIIIC and IX for prenatal diagnosis of haemophilia

Fetal blood unmixed with maternal blood or amniotic fluid was obtained by direct-vision fetoscopy in 22 consecutive cases at 15--22 weeks' gestation; the investigation was done either for prenatal diagnosis or before therapeutic abortion. Fetal plasma factors VIIIC and IX averaged 50 I.U./dl (S.D. 12.8) and 12.5 I.U./dl (S.D. 2.4), respectively. Two male fetuses at risk of haemophilia had normal factor VIIIC levels by these criteria, and both pregnancies ended in the birth of a normal boy. Five others gave 3 normal and 2 haemophilic results, which were confirmed in two of the three terminated pregnancies.

Normal patterns of fetal activity in the third trimester

The incidence and frequency of fetal respiratory movements (FRM) and fetal trunk movements (FTM) were measured in 21 normal pregnancies between 28 and 39 weeks gestation. Fetal activity was assessed with a real-time ultrasound scanner and all observed movements were punched directly onto computer tape. Recordings were made for one hour in three over a 24 hour period, providing a total of 168 hours for analysis. The overall mean percentage incidence of FRM was 31 per cent at a mean breathing rate of 43 breaths/minute. The mean percentage incidence of FRM during the day (0800-1759 hours) was 37 per cent. The overall mean percentage incidence of FTM was 18 per cent with a mean of 29 moves per 30 minute observation period. The mean percentage incidence of FTM during the day (0800-1759 hours) was 16 per cent. There was a well-defined circadian variation in fetal activity with FRM peaking between 1900 and 2200 hours, and FTM between 2200 and 0100 hours. There was considerable variation in the amount of FRM and FTM recorded from hour to hour. Total fetal activity rarely fell below 10 per cent in any one recording period and this measurement may be a more useful clinical test of fetal well-being than FRM or FTM alone.

Progestogen modification of endometrial histology in menopasual women

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Sampling pure fetal blood by fetoscopy in second trimester of pregnancy

A technique for fetal blood-sampling in the second trimester of pregnancy (between 16 and 22 weeks' gestation) combining fetoscopy with real-time ultrasound was used in 48 attempts at fetal blood-sampling. Specimens containing fetal red cells with or without amniotic fluid or maternal blood, and adequate for diagnosing haemoglobinopathies, were obtained in 45 of the 48 fetoscopies. Sampling was successful in all 18 patients with a posterior placenta, and in 27 of the 30 with an anterior placenta. In 22 of the last 27 consecutive fetoscopies pure fetal blood was taken; the placenta was anterior in 16 and posterior in six. Out of 17 cases sampled between 18 and 22 weeks' gestation pure fetal blood was obtained in 16. The volume of the samples varied from 50 to 500 microliter. The ability to obtain pure fetal blood consistently even when the placenta is anterior will increase knowledge of fetal physiology and the scope of prenatal diagnosis.

Comparison between subjective and ultrasound assessments of fetal movement

Forty pregnant women participated in a study to compare subjective with ultrasound assessments of fetal movements. A real-time ultrasound scanner was used. Movements were recorded for 45 minutes in all cases. There was a significant positive correlation between the number of movements recorded by the two methods, but the 95% confidence limits were wide and no correlation was found in those patients who recorded fewer than 20 movements in the study period. Thus "false-positive" information may be obtained from purely subjective data, and in patients reporting low "kick counts" fetal activity should be assessed from real-time ultrasound recordings.

[Alkylation of delta 6-octalone-1]

In connection with the synthesis of shwarone (II), a sesquiterpinoid with interesting pharmacological properties, some results on the alkylation in the 9-position of the model substance delta6-octalone-1 (VI) are reported. Methylation, especially if carried out in polar aprotic solvents, gives mainly the trans derivative, this being the type needed for synthesis of compound (II); alkylation with allylbromides and propargyl gives mainly the cis isomer.

Early prenatal diagnosis of neural-tube defects by ultrasound-guided fetoscopy

In three fetuses with neural-tube defects (N.T.D.s) the lesions were clearly seen by fetoscopy in the second trimester. In a fourth fetus, in which the diagnosis of N.T.D. was suspected because of raised amniotic-fluid alpha-fetoprotein, spina bifida was excluded by fetoscopic examination and a normal baby was delivered at term. Ultrasound-guided fetoscopy has a place in the diagnosis of N.T.D.s when the results of other investigations are conflicting or inconclusive, and may be useful in assessing the severity of a lesion.