Menstrual Dates Research Articles

Development of human palmar and digital flexion creases.

To determine the timing of the development of the various palmar and digital creases, we examined the hands of 100 human fetuses obtained after therapeutic abortion. The fetuses ranged in age from 7 to 19 fetal weeks, with age being established by menstrual period dates and ultrasound examination before termination. Our observations show that palmar and digital creases develop between 8 and 13 fetal weeks. Digital creases are well defined by 10 weeks; palmar creases are consistently seen by 13 weeks of gestation. The volar pads are present from 8 to 14 fetal weeks. A hand malformation or specific insult that occurs before the time of crease development and that alters the form or function of the fetal hand can cause secondary alterations increase patterns of the hand.

Determination by ultrafiltration of the fraction of unbound estradiol and its variation in peritoneal fluid during the menstrual cycle.

An ultrafiltration method employing a Centrifree filter for determining the unbound fraction of estradiol was studied. Centrifugation was performed under conditions similar to those in vivo. Good correlation was recognized between this method and the equilibrium dialysis. This method was employed to determine the unbound fraction of estradiol in the serum and the peritoneal fluid of 26 infertility patients classified according to their menstrual dates. The total estradiol and progesterone contents in the peritoneal fluid were high after ovulation. There was no significant difference in the percentage of unbound estradiol in the serum among various groups. In the peritoneal fluid, however, the percentage of unbound estradiol for the day 12-14 patients was 4.5 +/- 0.2% in contrast with 3.8 +/- 0.4% for the day 15-18 group (p less than 0.05) and 3.5 +/- 0.1% (p less than 0.05) for the day 19-28 group. Moreover, the fraction (4.5%) of unbound estradiol in the peritoneal fluid of a patient with luteinized unruptured follicle (LUF) syndrome was comparable with that of patients in the follicular phase. The difference between the percentage of unbound estradiol in the peritoneal fluid before and after ovulation is considered to be due to the transudation of follicular estradiol in the follicular phase and the exudation of estradiol from the corpus luteum into the peritoneal cavity in the luteal phase.

A prospective study to compare serum human placental lactogen and menstrual dates for determining gestational age

In a group of 575 healthy pregnant women with certain menstrual dates the estimation of the length of gestation from maternal serum human placental lactogen concentrations has been compared with gestational age calculated from the last menstrual period and ultrasonic measurements of the fetal biparietal diameter. In 412 of these patients labor started spontaneously, and the estimated dates of delivery determined by these three methods were also compared. In the range of 9 to 17 weeks of pregnancy, gestational age can be determined by human placental lactogen measurement to within 7 days (± 1 SD) which compares favorably with other methods. Regarding the prediction of the expected date of delivery, 88% were delivered within 2 weeks of the date predicted by last menstrual period, 82% within 2 weeks of the sonar date, and 80% by the date determined by human placental lactogen assessment. Prediction of delivery in a further group of 139 women with uncertain dates gave 73% within 2 weeks by sonar date and 69% within 2 weeks by human placental lactogen determination. We suggest human placental lactogen measurements should become part of routine antenatal care complementing rather than replacing the role of ultrasonic scanning. For those doctors and patients who wish to avoid more exposure to ultrasonic scanning than absolutely necessary, human placental lactogen estimates offer an alternative method for assessing the length of gestation.

Similarities of Negro and Caucasian fetal extremity lengths in the interval from 9 to 20 weeks of pregnancy

Foot, leg, and arm measurements were compared from 599 electively aborted fetuses of Negro and Caucasian women who had reliable menstrual dates and agreement between dates and uterine size. When compared by week, no significant racial differences were detected in the means of any of these measurements between 9 and 20 menstrual weeks of pregnancy. The combined, corrected data provided smoother curves than those previously published. The following formulas are recommended for weeks 9 to 20 of pregnancy, where W = weeks and F, L, and A are the foot, leg, and arm measurements in centimeters: W = 4.5261 + 11.937(F) − 4.4895(F2) + 0.71583(F3); W = 5.9957 + 5.7279(L) − 1.2246(L2) + 0.11880(L3); W = 5.4007 + 5.0305(A) − 0.93540(A2) + 0.079022(A3).

Light and electron microscopy changes in the endometrium caused by the administration of a norgestimate-containing oral contraceptive (Cilest)

Endometrium morphology has been analysed by means of light microscopy, scanning and transmission microscopy in patients before and during treatment with a norgestimate containing low dose combined pill (Cilest). Endometrium biopsies were taken after 1 (N = 3), 2 (N = 3), 3 (N = 7), 5 (N = 1) and 6 (N = 4) OC cycles. Light microscopy of the endometrium obtained during the OC-free pretreatment cycles shows a regular secretory transformed endometrium. During the first OC cycles of Cilest treatment slight growth retardation of endometrial glands was observed. Endometrium after 3 to 6 OC cycles showed an increasing delay of the growth of endometrial glands in terms of an abortive secretion. Morphometric studies revealed a retardation of the development of endometrial glands and an "arrest of secretion". The degree of proliferation varied slightly; a general delay between the date of the menstrual cycle and endometrial dating was evident. Using scanning electron microscopy the endometrium presented mostly a regular surface corresponding to the midcycle or a late proliferative phase up to the early secretory phase. Infiltrative dysplasia or inflammatory changes as well as local proliferations could not be detected. In transmission electron microscopy with semi-thin and ultrathin slices, stroma, structure of glands and surface appeared to be normal. Furthermore, no time delay between the endometrium and the day of menstrual cycle was observed. During treatment with a norgestimate containing low dose combined pill, only slight changes of the endometrium in terms of a growth retardation of endometrial glands were seen in the first 6 treatment cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

A correlative morphologic study of human breast and endometrium in the menstrual cycle.

Seventy-five premenopausal women autopsied under medical examiner auspices were selected for a correlative study of breast and endometrial morphology proceeding through the menstrual cycle. Criteria for selection included adequate preservation of the endometrial and breast tissue, relatively even distribution of women by age (range 15-56), menstrual cycle date, and parity status. Hormonal therapy and disease states that might influence pituitary-ovarian cycling were reasons for exclusion from the study. Proliferative phase breast was characterized by small lobules with few terminal duct structures. Terminal duct epithelial mitoses were uncommon. Intralobular stroma was condensed and continuous with interlobular stroma. Secretory phase breasts were characterized by increasing size of lobules and number of terminal duct structures and duct epithelial basal vacuolization and mitoses. Intralobular stroma became increasingly loose and edematous. Stromal lymphocytic population increased toward the end of secretory phase. Perimenstrual breasts underwent lobular contraction with necrosis and sloughing of duct epithelium. There was a concomitant marked increase in lobular stromal lymphocytic infiltrate and metachromasia. These features heralded a return to the proliferative phase appearance. These marked cyclical changes have implications for routine pathologic diagnosis as well as for the newer noninvasive diagnostic techniques.

Dickinson's sign: Focal uterine softening in early pregnancy and its correlation with the placental site

Focal uterine softening, characteristic of early pregnancy, is usually known as Piskacek's or von Braun-Fernwald's sign but should be attributed to Robert Latou Dickinson, who first described it in 1982. The presence or absence of Dickinson's sign was carefully noted in 1040 pregnant patients seeking abortions. The weeks of gestation, location of uterine softening, and correlation with placental site were also studied. This sign reliably showed the placental site, hence its unequivocal presence nearly proves the presence of intrauterine pregnancy and precludes the existence of tubal pregnancy. It was present in most pregnancies between 6 and 11 menstrual weeks, and its presence after 14 weeks should make menstrual dates suspect or signal the possibility of a septate or bicornuate uterus.

Human fetal extremity lengths in the interval from 9 to 21 menstrual weeks of pregnancy

Fetal arm, leg, and foot lengths were freshly measured with vernier calipers on all fetuses aborted by me from 1975 to 1983. With the use of these measurements from the 575 patients with reliable menstrual or conception dates and uterine size in agreement (±2 weeks) with dates, statistical analyses were performed to determine the polynomial regressions of menstrual weeks of pregnancy for each extremity length. The data best fit the following formulas, where W represents weeks and F, L, and A are foot, leg, and arm lengths in centimeters: W = 3.03 + 17.4(F) − 10.8 (F2) + 3.36(F3) − 0.367(F4); W = 5.74 + 6.49(L) − 1.90(L2) + 0.305(L3) − 0.0161(L4); W = 5.19 + 5.65(A) − 1.45(A2) + 0.203(A3) − 0.00934(A4). Mean foot lengths at each week agreed well with those of Streeter, and when corrected for bias, all foot lengths were in near perfect agreement with his data.

NEUROPHYSICAL MATURATION IN IDM: EFFECT OF EARLY MATERNAL MANAGEMENT

Although diabetes in pregnancy is thought to delay maturation of fetuses, its effects on neurophysical maturation have not been examined, especially in regard to the time of initiation of diabetic management. We tested the hypothesis that the diabetic intrauterine environment will retard the rate of fetal neurophysical maturation and that institution of maternal metabolic control before 9 wks of pregnancy (early) will reduce the maturation delay. Gestation was assessed in 104 infants of insulin dependent diabetic mothers (IDM) followed prospectively and in 221 infants of non-diabetic mothers (non-IDM), by standard clinical exam (Ballard, J. et al, 1979). Both groups had reliable obstetrically confirmed menstrual dates. At all gestations neurophysical maturity was advanced by 0.6 weeks in IDM when compared with non-IDM (p=0.005). Early institution of diabetic management in pregnancy (n=76) vs later (n=28) was not associated with change in rate of maturation. In the IDM group there was no effect of race, sex, or tobacco, alcohol, or coffee consumption on maturation. Lack of clinical RDS was associated with accelerated neurophysical maturation (p<0.003). We conclude that the diabetic intrauterine environment has an accelerating rather than retarding effect on gestational neuro-physical maturation; early institution of diabetic management does not affect the rate of intrauterine maturation.

Inaccurate Gestational Dating and Maternal Serum Alpha‐Fetoprotein Screening

Abstract. The consequences of erroneous gestational dating on the efficiency of a maternal serum alpha‐fetoprotein (MS‐AFP) screening program has been studied in 1050 early pregnant women. The gestational age of each woman was independently estimated by means of menstrual dates as well as by ultrasonic measurements of the fetal crown‐rump length before the 15th week of gestation.Misinterpretation of the AFP‐test results because of incorrect gestational dating according to menstrual dates was observed in 5.4% of all women screened. 40% of the pregnant women with true “elevated” MS‐AFF values, according to ultrasonic dating, would have been misinterpreted as “normal” using menstrual dating. Incorrect menstrual dating was also found to account for 22% of all elevated MS‐AFP test results observed.Women who intend to take part in MS‐AFP screening programs should preferably have their gestational age determined be ultrasonography prior to blood sampling.

Intrauterine growth retardation risk detection for fetuses of unknown gestational age

A method of plotting growth rate of the biparietal diameter against the concurrent size of the biparietal diameter was used to assess risk of intrauterine growth retardation. The technique does not require knowledge of gestational age of the fetus. Therefore, it is uniquely useful for patients with unknown or uncertain menstrual dates who present relatively late in pregnancy when a reliable estimate of gestational age cannot be sonographically obtained. One hundred twenty-one patients were studied. Ninety-seven percent of the fetuses who demonstrated a normal rate of growth were either appropriate or large for gestational age by weight. Thirty-five percent of the fetuses who had a subnormal rate of growth of the biparietal diameter were intrauterine growth retarded by weight. The data presented support the use of this technique for assessing the risk for intrauterine growth retardation, when an accurate estimate of gestational age cannot be made.

Routine real-time scanning at the first hospital visit.

All patients presenting at one consultant booking antenatal clinic had a routine real-time ultrasonic scan. The purpose was to study the accuracy of the technique, the additional work involved and the clinical benefit. All scans were performed by one operator. The average time per scan was 6 min compared with 15 min for each B scan. When gestation assessed by scan differed from gestation assessed by menstrual dates or clinical examination, an independent assessment was made after birth. There was a marked decrease in utilization of B-scanning facilities. Routine real-time scanning at the first visit was a reliable method of assessing gestation in 94% of patients.

Prolactin production by luteal phase defect endometrium

The production of prolactin (PRL) by explants of late secretory endometrium obtained during normal cycles (n = 61) and that by similar explants obtained during luteal phase deficient (n = 17) cycles was compared. The amount of prolactin produced in vitro correlated with the degree of histologic decidualization in both normal and luteal phase defect endometria. However, samples of luteal phase defect endometrium produced significantly less prolactin (p < 0.01) than did control tissues of the same ideal menstrual dates. These data indicate that the amount of prolactin produced by late secretory endometrium in explant culture can be used as an additional criterion for the diagnosis of luteal phase defects and may also provide a method for evaluating the response of the endometrium to progesterone.

Respiratory distress associated with elective repeat cesarean section. A two-year experience in one medical community.

One hundred and forty-five elective repeat cesarean sections performed in one large medical community during a two-year period were studied. Ninety-nine of the patients had no prenatal test for determination of pulmonary or fetal maturity; 18 patients had an amniocentesis for L/S ratio. Only two infants were thought to be delivered prematurely, at 37 weeks gestational age. One of these infants had no respiratory distress. The other infant was delivered before the EDC by menstrual dates because a single ultrasound measurement performed one week before delivery suggested a "term fetus", and this infant had severe hyaline membrane disease. Six other infants had mild respiratory distress compatible with transient tachypnea or aspiration. In this medical community, one must question whether the risk of routine amniocentesis for L/S ratio before every elective repeat cesarean section might outweigh the potential benefits of the procedure.

Ultrasound measurement of fetal limb bones

A study was made of 41 patients with known menstrual dates in whom the duration of gestation, as determined by physical examination and ultrasound scan, corresponded with those dates. Examination of the fetal limb lengths was done every 1 to 3 weeks, starting at 8 weeks' gestation. A Kretz Combison 100 ultrasound sector scanner with a 2.5 MHz transducer (velocity = 1,540 meters per second) was used. A freeze frame was used when the full bone length was visualized, and then electronic calipers were employed to measure its full length. Serial measurements of the humerus and femur and the radius-ulna and tibia-fibula complexes were made. The values were expressed as means ± 2 standard deviations for each week of gestation. The growth of the fetal limb bones was linear from 12 through 22 weeks' gestation, but the various bones appeared to grow at different rates. The femur was the first to be well defined and the easiest to measure with reproducibility. All of the limb bone lengths correlate with gestational age and may serve as indicators of skeletal dysplasia. A patient who was delivered of an infant affected with diastrophic dwarfism syndrome was diagnosed at 16 weeks' gestation to have a fetus affected with this problem. Two other patients whose pregnancies were at risk for skeletal dysplasias were correctly diagnosed to be normal.

PREMATURITY

Perinatal epidemiologists no longer speak much of "prematurity". Instead the World Health Organization recommends that infants born before 37 completed weeks of gestation should be designated "preterm" and those of birthweight less than 2500 g "low birthweight". Both definitions have obvious drawbacks--the former because menstrual dates are often unknown or unreliable, the latter because it does not separate preterm from small-for-gestational-age infants. Whatever the classification of these small infants there is no dispute about their high mortality and morbidity; in the United Kingdom they account for over two-thirds of first-week deaths.

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Fourteen women under age 19 were evaluated and treated for ectopic pregnancy at the Regional Medical Center, Memphis. These women were screened according to a protocol involving use of quantitative beta-human chorionic gonadotropin (βhCG) and serum progesterone levels. All patients were in the first trimester of pregnancy, with a mean gestational age of 8.5 weeks based on menstrual dating. Ten patients denied knowing that they were pregnant prior to this evaluation. Because of the patients symptoms and clinical signs, nine patients underwent diagnostic laparoscopy at the time of initial evaluation. Of these, seven underwent either salpingectomy or salpingostomy for a raptured ectopic pregnancy or ectopic > 3 cm in greatest dimension. Two patients were successfully treated without surgery. Five patients were discharged after their initial evaluation and were identified only by abnormal values on serial determinations of βhCG and progesterone. One required salpingostomy, and the other four were successfully treated with methotrexate. Ectopic pregnancies identified at an early gestational age and prior to rupture are amenable to conservative treatment with methotrexate or laproscopic surgery. Patients who were identified by the protocol and not by clinical signs and symptoms were more likely to be candidates for conservative therapy.

The prediction of delivery date by ultrasonic measurement of fetal crown-rump length.

The ultrasonic measurement of the fetal crown-rump lenght (CRL) in early pregnancy was utilized to predict the date of delivery in 220 patients with reliable menstrucal histories and in 186 patients with unreliable menstrual dates who began labour spontaneously; Ninety-five per cent and 96.2 per cent respectively were delivered within 12 days of the predicted date. The CRL was found to be better than biparietal diameter measurements (p greater than 0.001) and as good as a reliable menstrual history (p greater than 0.5) in predicting the time fo spontaneous onset of labour.

Nonspecific date of last menstrual period: An indication of poor reproductive outcome

Socially disadvantaged women whose medical records whowed they reported nonspecific last menstrual period dates at the first prenatal visit had a disproportionately high incidence of complications in reproduction. The complications included an increased likelihood of delivery by cesarean section and lighter, more immature infants. Nonspecific last menstrual periods were also associated with indicators of increased risk available early in pregnancy. The increased number of complications among disadvantaged women with nonspecific last menstrual period dates was not explained by prenatal vaginal bleeding or irregular menstrual periods. A possible explanation for the association appeared to be the social circumstances. Mothers who reported nonspecific last menstrual period dates tended to be mothers with more disadvantaged social circumstances. These circumstances have been found to be associated with poor reproductive outcome.

Fetal growth and placental function in patients with placenta praevia.

SummaryFetal growth was assessed by serial ultrasound cephalometry in 150 patients with uncomplicated placenta praevia and certain menstrual dates who were treated expectantly. Placental function was assessed by serial 24‐hour total maternal urinary oestrogen assays. There were 24 (16 per cent) small‐for‐dates infants, more accurately predicted by serial cephalometry than by serial maternal urinary oestrogen assays. There was good correlation between fetal growth and the number of episodes of bleeding in pregnancy.