Congenital annular constrictions due to amniotic bands

Amniotic bands which become involved with fetal parts, especially the extremities, are produced by rupture of the amnion during pregnancy with the consequent union of the extra-embryonic mesoderm in fibrous strings. An infant with the amniotic band syndrome, in whom an annular constriction of the left leg and right hand was found, is described. He was treated successfully by multiple Z-plasties and a plaster cast to correct the clubfoot. The oedema of the leg persisted for 5 weeks and then subsided completely. The role of amniotic abnormalities in the production of congenital malformations is reappraised. The microscopic and histological investigation of the placenta and membranes should accompany every case of fetal malformation in abortuses, stillbirths, and affected newborn.

Estrogens in maternal plasma following intraamniotic injection of (3H)-dehydroepiandrosterone-sulfate in midpregnancy

In 4 patients with normal pregnancies between the 18th and 20th week of gestation (3H7alpha)-dehydroepiandrosterone-sulfate ([H]-DHEA-S) was injected intraamniotically. Maternal venous blood was drawn before and at regular intervals for 240 minutes after DHEA-injection. Thereafter, legal abortion was performed by intraamniotic instillation of prostaglandine. The conjugated steroids were hydrolyzed enzymatically and the total steroids were isolated and identified. The following labelled metabolites were determined quantitatively: Estriol (e3, estradiol-17beta (E2-17beta), estrone(E1), 16alpha-hydroxy-estrone, (16alpha-OH-DHEA), ALPHA4-androstenedione (AD) and testosterone (T). The maximal increase of all estrogen fractions in matermal plasma occurred 120-180min after intraamniotic injection of the precursor. The most prominent rise of the C18-steroids could be shown for estriol. 60-70% of all metabolites were C16-hydroxylated.

Inhibition of multiplication of parainfluenza 3 virus in prostaglandin-treated WISH cells

Influence of prostaglandins E2 (PGE2) and F2alpha (PGF 2alpha) on multiplication of myxovirus parainfluenza 3 was investigated. At concentrations of 0.01--1 mug/ml prostaglandins had no direct cytotoxic effects. PGE2 and PGF2alpha inhibited multiplication of parainfluenza 3 virus at concentrations 0.1--10 mug/ml. The inhibitory effect was most pronounced when the prostaglandins were added to medium for the whole period of virus multiplication (48 hours) while little or no effect was found when prostaglandins were added before virus inoculation or for 2 hours after infection. It is suggested that prostaglandins exert an inhibitory effect on the replication phase of the virus by influencing the growth of the WISH cells.

Coagulation changes during second-trimester abortion induced by intra-amniotic prostaglandin E2 and hypertonic solutions

The coagulation system was studied in twenty-seven patients undergoing second-trimester abortion induced by intra-amniotic prostaglandin (P.G.) E2 alone and in combination with a hypertonic solution of urea or glucose. Changes consistent with intravascular coagulation, namely a rise in fibrin degradation products and a fall in plasma-fibrinogen and platelet-count, were observed in those patients treated using P.G.E2 with hypertonic urea. Similar but less pronounced changes were found in the group treated using P.G.E2 with hypertonic glucose. In patients treated with P.G.E2 alone no changes suggestive of intravascular coagulation were detected. One patient treated using P.G.E2 with hypertonic urea who did not abort for 26 hours demonstrated changes indicative of a pronounced degree of disseminated intravascular coagulation. These findings show that when abortion is induced using P.G.E2 and a hypertonic solution, particularly hypertonic urea, disseminated intravascular coagulation can occur as a result of a hypertonic agent being used.

Clinical experience using intraamniotic prostaglandin F2alpha for midtrimester abortion in 600 patients

Six hundred consecutive patients received intraamniotic prostaglandin F2alpha to induce midtrimester abortion. The PGF2alpha was administered by a general population of gynecologists according to a standard protocol. The aim of the study was to observe whether results would be similar to those reported in various research studies. Of 600 abortions, 460 were complete, 140 were incomplete, and there were no abortion failures. Other parameters were also similar to previous research results, indicating that PGF2alpha can be an effective and safe means of inducing midtrimester abortion when administered by the practicing gynecologist.

Enhancement of the antigenic activity and virulence of the vaccine strain E of Rickettsia prow azeki by passages in cell culture

Changes in the biological properties of the vaccine strain E of Rickettsia prowazeki occurred upon cultivation of A1 (human amnion) cells infected with this strain. In the course of passages of these cells the antigenic activity and virulence of the rickettsia increased. The changes were observed in 10 out of 22 cell cultures examined: in 6 cultures there was an increase in the antigenic activity and in 4 both in the antigenic activity and in virulence. The time of the occurrence of these changes in the rickettsial populations varied from 12-18 to 53-102 days of passage of the infected cells.

Disappearance of prostaglandins F2alpha and 15-methyl F2alpha from amniotic fluid as measured by radiommunoassay

A sensitive and relatively specific radioimmunoassay for 15 (S) 15 methyl prostaglandin F2alpha was used to determine the levels of the drug in amniotic fluid after it had been injected intra-amniotically for termination of second trimester pregnancy. The disappearance of the free acid (tham salt) and methyl ester of the prostaglandin analogue were similar. The results of this preliminary study suggest that the drug rapidly equilibrates in the fluid and this followed by a slow removal from the amniotic sac. A comparison with a similar study with PGF2Alpha revealed that the analogue had a longer half-life in the amniotic fluid.

Intranuclear inclusions in shope fibroma virus infected cells

The presence of nuclear inclusions consisting of accumulated filamentous material has been observed in Shope fibroma virus infected cells, analogously to what has been demonstrated in other poxvirus infected cells.

The current status of prostaglandins as abortifacients

The present use and potential uses of prostaglandins as abortifacients are summarized. Pertinent history, chemistry, prostaglandins' possible role in physiologic and pathologic processes and pharmacologic actions are discussed. The results of natural prostaglandins and their analogues by systemic and intrauterine administration for the purposes of postcoital contraception, menstrual regulation, first- and second-trimester abortion, preoperative dilation of the cervix, and delivery of patients with death in utero are presented. The only approved method of induction of abortion with prostaglandins, prostaglandin F2alpha by the intra-amniotic route for the induction of midtrimester abortion, is evaluated and compared to other methods of midtrimester abortion. It was concluded that: (1) the present use of prostaglandins is an important addition to the obstetrician's armamentarium, (2) more effective and/or convenient methods that are useful in patients over a wider gestational age appear to have been defined, and (3) the routine use of prostaglandins for postcoital contraception, menstrual regulation, and first-trimester abortion will require the development of analogues that are more specific as to their abortifacient actions than the natural prostaglandins and/or the development of improved delivery systems.

Host resistance to intraamniotic infection

In this review the mechanisms whereby amniotic fluid serves to protect the fetus from microbial disease have considered. It appears from the data reviewed that the principal mode of antibacterial action of amniotic fluid is bacteriostasis. Thus, the host is able to cope with a small number of organisms introduced into the amniotic cavity; however when the amniotic fluid is grossly contaminated the host resistance capacity of the amniotic fluid may be overwhelmed. This may be understood best by the quantitative description of disease theroized by Theobald Smith (94). Smith suggested that disease was a function of the number of organisms with which a host is initially infected multiplied by the virulence of the organism. The effects of the number and virulence of the organism in producing disease is lessened by the host's resistance capacity. This concept of disease is summarized by the equation: Disease equals (number) (virulence)/resistance. Although these parameters do not possess numeric values, it is possible to see at least conceptually their interplay with respect to intrauterine infection. For example, the number of organisms reaching the amniotic fluid may be increased by various modes, namely maternal viremia or bacteremia; premature rupture of the fetal membranes, antenatal vaginal examination and possibly intrauterine fetal monitoring. While these circumstances may result in increased rate of infection, some reports conversely indicate that minimal bacterial contamination in the amniotic fluid is not an extraordinary occurrence and may not result in any maternal or fetal complication (73,74). The intrinsic host resistance capacity of the amniotic fluid likewise represents an important part of the Smith equation for disease. We have found that amniotic fluids may vary in antibacterial efficacy from almost no inhibitory activity to profound bactericidal activity (90). Obviously, the likelihood of the production of disease by an equivalent inoculum of a particular organism would be quite different depending upon the intrinsic inhibitory capacity of the amniotic fluid. The measurement of the inhibitory capacity of amniotic fluid holds some promise for enabling a physician to determine which patients may be at special risk of intrauterine infection.

The effect of prostaglandin F2alpha on the placental progesterone level in midtrimester abortion

A gas chromatograph method has been used for the determination of placental progesterone levels in 14 patients aborted at midtrimester by intra-amniotic instillation of prostaglandin F1alpha, also from a control group (five patients) aborted surgically by dilatation and suction. The results showed that the mean %/- S.E. of placental progesterone in the prostaglandin group was 1.45 mug +/- 0.09 per 1 Gm. of placental tissue, whereas the mean +/- S.E. of the placental progesterone in the surgically aborted group was 5.22 +/- 0.31 mug per 1 Gm. of placental tissue. The difference between the two groups was significant: P EQUALS 0.0001. This low level of placental progesterone in the prostaglandin abortion group could explain the sharp decline of the progesterone levels in the peripheral blood during abortion by intra-amniotic instillation of prostaglandin F2alpha, as observed by our group1, 2 and others.3(-5)

The distribution within the placenta, myometrium, and decidua of 24Na-labelled hypertonic saline solution following intra-amniotic or extra-amniotic injection

24Na-labelled hypertonic saline solution was injected into the uterus by the intra-amniotic or the extra-amniotic route, and six hours later determinations were made of the 24Na content of the placenta, myometrium, and decidua. The tissue specimens were obtained by subtotal hysterectomy. The activity of 24Na proved to be high in the decidua and in the fetal part of the placenta, but low in the myometrium. During labour, large amounts of prostaglandins have been found in the decidua, but little or none in the placenta. The present findings therefore lend further support to the assumption that hypertonic saline solution provokes abortion by inducing release of lysosomal phospholipase A2 into the cytoplasm of damaged decidual cells, resulting in prostaglandin synthesis and liberation.

Laminaria augmentation of intra-amniotic PGF2 for midtrimester pregnancy termination

In our hands, intra-amniotic PGF2alpha 40 mg for midtrimester pregnancy termination had a mean infusion to abortion interval of 29.4 hr. However, pretreatment of 230 patients with laminaria tents inserted 14-18 hr before PGF2alpha infusion resulted in a dramatically reduced time to abortion (14.3 hr mean) with a low incidence of gastrointestinal and other side effects. Laminaria tents inserted at the same time as PGF2alpha infusion in 26 patients also resulted in reduced time to abortion (18.6 hr mean). In the laminaria pretreated group, the infusion to abortion interval was indirectly related to the number of laminaria inserted and not to the nulliparous or parous state. Although we have made significant strides in shortening the abortion interval in the hospital, retained placentae and blood loss persist as problems related to the use of prostaglandin for abortion.

Prostaglandin E2 on the electroencephalogram

Present study was prompted by the report from another center on the occasional occurrence of convulsions and abnormal electroencephalogram (E.E.G.) patterns in women aborted with intra-amniotic prostaglandin F2alpha (PGF2alpha). Fifty four subjects were investigated by means of an E.E.G. taken before and after initiation of PGE2 administration. They included pregnant and non-pregnant patients, nearly half (23) of whom were known epileptics. One seizure was observed during PG administration in a man with daily psychomotor attacks who had not taken his anticonvulsants on the day the test was performed. PGE2 caused no alteration of the E.E.G. in subjects with a normal control tracing; in those with an abnormal E.E.G., a deterioration was seen in one and an improvement in three. It is concluded that PGE2 is not epileptogenic at doses required for termination of pregnancy.