Mid-trimester Pregnancy Research Articles

Maternal hypertension and intrauterine fetal death in mid-pregnancy.

An analysis of the 156 pregnancies which terminated spontaneously between 16 and 27 weeks gestation, inclusive, indicated that in 41 patients where fetal death was the primary event, maternal arterial pressure was raised in early pregnancy when compared with matched groups of women whose pregnancies had a successful outcome. Blood pressure in the 14th week of pregnancy in women with fetal death was significantly higher than in women with other types of mid-trimester abortion. It is suggested that maternal hypertension predisposes to intrauterine fetal death in the mid-trimester of pregnancy as it does in the third trimester.

Plasma levels of 15(S)15-methyl-PGF 2α-methyl ester following vaginal administration for induction of abortion in women

A single suppository containing 3.0 mg 15(S)15-methyl-PGF 2α-methyl ester was administered vaginally in women to terminate mid-trimester pregnancy. Plasma levels of the drug (both methyl ester and free acid forms) were measured at different time intervals using deuterated carriers and gas chromatography-mass-spectrometry. 15(S)15-methyl-PGF 2α (sum of methyl ester + free acid) was found to have a mean value of 1166 pg/ml plasma at 3 hrs after administration of the suppository. The mean levels were subsequently found to be maintained in the range of 1000 pg/ml. Preliminary studies showed that unlike the successfully aborted women in those who did not abort within 30 hrs with this suppository, the plasma levels of the drug were not maintained for a sufficiently long time. The episodes of side effects, body surface area and the induction-abortion interval in relation to the plasma levels are discussed.

Pregnanolones, pregnenolone and progesterone in the human fetal tissues of early and midtrimester pregnancy

Endogenous tissue levels of progesterone (determined by radioimmunoassay), pregnenolone and 3α/β-hydroxy-5α/β-pregnan-20-ones (determined by gaschromatography and electron capture detection) were measured in different human fetal tissues of the 11th to the 24th week of pregnancy. Progesterone was the predominant unconjugated steroid in all samples. 3β-sulfoxy-5-pregnen-20-one was isolated in considerable amounts from most fetal organs. The saturated metabolites were present at different concentrations, demonstrating a differentiated distribution of ring-A-reductases and of sulfotransferases. The qualitative and quantitative distribution of the epimeric steroids may reflect hormonal action not only of progesterone but also of the so called metabolites.

46,XY/45,X mosaicism in an amniotic fluid cell culture: suppression of abnormal cell line after subcultivation.

An abnormal cell population, 45,X, appeared in 3 of 4 cell lines established from an amniotic fluid specimen obtained from a normal mid-trimester pregnancy. Two of the cell lines were subjected to repeated chromosome analyses until VII passage. The abnormal cells were suppressed after repeated trypsinisations; simultaneously, fibroblast-like cells outgrew the cultures, which were previously predominated by epithelial-like cells. Polyploidy was found in 0 to 12% of the cells, the highest level existing in the early passages. The question of whether chromosomally abnormal cells present in primary cultures and the early subcultures reflect the karyotype of the fetus is discussed.

Comparative Study of Interupting Methods for Mid Trimester Pregnancy

Comparative Study of Interupting Methods for Mid Trimester Pregnancy

The Effect of Intra-Amniotic Prostaglandin F2α on Anterior Pituitary Hormone Release During Midtrimester Abortion

The effect of intra-amniotic administration of prostaglandin F2alpha (PGF2alpha) on pituitary hormone release was studied in women undergoing midtrimester abortion. Serum prolactin (PRL), growth hormone (GH), thyrotropin (TSH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured prior to and at 15-minute intervals for 2 hours following intra-amniotic administration of 40 gm of urea alone, 20 mg of PGF2alpha and 40 gm of urea, or an equal volume of normal saline. Serum PRL levels were significantly higher at sampling times from 15 through 120 minutes when both PGF2alpha and urea were administered than after saline or urea alone. The elevation in serum GH following PGF2alpha and urea was not significantly greater than for urea alone. The GH response in the women receiving normal saline was significantly less than for the two groups of women receiving the abortifacients. These results indicate that the GH response was related to the stress effects of the abortifacients. There was no difference in the TSH, LH, and FSH responses for the three groups. These results suggest that PGF2alpha selectively causes pituitary release of PRL in women during midtrimester pregnancy.

355. Hormonal and clinical studies in patients undergoing termination of mid-trimester pregnancy with different abortifacients

355. Hormonal and clinical studies in patients undergoing termination of mid-trimester pregnancy with different abortifacients

356. Effect of a single vaginal 15(S)15-methyl-PGF 2α-methyl ester suppository as abortifacient for mid-trimester pregnancy on serum hormone levels

356. Effect of a single vaginal 15(S)15-methyl-PGF 2α-methyl ester suppository as abortifacient for mid-trimester pregnancy on serum hormone levels

Hyperosmolar urea for elective midtrimester abortion: Experience in 1,913 cases

Intra-amniotic hyperosmolar urea (59.7 per cent) augmented by intravenous oxytocin (332 mμ per minute), prostaglandin F2α (20 mg.), prostaglandin F2α (10 mg.), or prostaglandin F2α (5 mg.) was utilized for 1,913 patients requesting elective midtrimester abortion. Injection-abortion intervals ranging from 13.70 to 21.49 hours were achieved with failure rates of 0.7 to 6.7 per cent. Despite frequent pre-existing medical conditions, the complication rate compared favorably with those of other methods for terminating midtrimester pregnancy such as saline amnioinfusion or dilatation and evacuation.

581 ENRICHMENT OF HUMAN F-CELLS IN FETAL-MATERNAL BLOOD MIXTURES

Recovery of fetus-origin red cells from maternal venous blood could facilitate diagnosis of fetal hemoglobinopathies by the single cell immunodiffusion method, using specific antibodies to Hb variants. Among 40 Black American women in mid-trimester pregnancy who presented for termination of pregnancy, and who had a Hb A phenotype by electrophoresis, the blood of 9 contained an occasional Hb S-cell. In only these 9 cases were S-cells found in the amniotic fluid. This finding prompted development of an F-cell enrichment procedure, assuming a majority of cells which migrate into maternal circulation from the midtrimester fetus contain Hb F. F-cells in term cord blood and from adults with Hb A, AS, or S were more resistant than A-cells or S-cells to hypotonic stress equivalent to 0.45 gm% NaCl. Cells were also subjected to sequential treatment by low Na and differential centrifugation in a molten agar gradient (45C). This yielded a cell fraction in which F-cells in blood of adults were changed from 6% to 48% and in cord blood from 48% to 90%, whereas centrifugation alone on the latter achieved 74% F-cells. Preliminary observations on enrichment of maternal blood in midtrimester pregnancy are equally promising.

186 DEVELOPMENTAL CHARACTERISTICS OF HUMAN F-CELLS

The total quantity of fetal hemoglobin (Hb F) is subject to developmental, humoral, pathological and genetic variables. The developmental and humoral mechanisms which effect changes in Hb F might be further clarified by comparing the dynamics of F-cell number and quantities of Hb F/F-cell. Changes in relative numbers of F-cells and A-cells and quantities of Hb F/F-cell and Hb A/A-cell were measured by single cell immunodiffusion, using fluorescein-conjugated anti-Hb F and anti-Hb A, in term cord blood, 3-month old children, and nonpregnant and pregnant adults. Over the indicated developmental interval relative A-cell number and mean Hb A/A-cell increased 1.71 and 1.40, respectively. In contrast relative F-cell number and mean Hb F/F-cell declined 26.23 and 1.32 fold, respectively. In the female at midtrimester pregnancy A-cell number and Hb A/A-cell increased 1.07 (NS) and 1.01 (NS) fold, respectively, whereas these same parameters for F-cells increased 2.96 and 1.14 fold. It is concluded that within the detection range of the immunodiffusion technique both the mean intracellular quantity of Hb F and the F-cell frequency show decrease during late development, but at dissimilar rates. Presumably humoral signals in midtrimester pregnancy promote disproportionate increases in both F-cell frequency and detectable Hb F/F-cell.

Arachidonic acid and other free fatty acid changes during abortion induced by prostaglandin F2α

Serum free fatty acids (FFA's) were measured after intra-amniotic injection of prostaglandin F2α (PGF2α) for the induction of abortion in eight healthy women in the midtrimester of pregnancy. The total FFA levels increased in all cases during the period between PGF2α administration and abortion. This lipolysis most likely is secondary to the effect of the catecholamines as indicated by the temporal relationship between increased plasma and urine catecholamine and serum FFA levels. The percentage of arachidonic acid in the total amount of FFA's decreased after administration of PGF2α. This proportional decrease in arachidonic acid (p < 0.05) may be due to selective utilization for the production of endogenous prostaglandins.

Testosterone and dihydrotestosterone in maternal and cord blood and in amniotic fluid

Maternal and umbilical arterial and venous plasma and amniotic fluid testosterone (T) and dihydrotestosterone (DHT) were measured by radioimmunoassay. Maternal plasma T was 690 ± 80 pg. per milliliter (mean ± S.E.) in early pregnancy (<20 weeks) and increased significantly (p = 0.002) to 1,095 ± 177 pg. per milliliter in late pregnancy (>20 weeks). DHT was 113.0 ± 18.8 pg. per milliliter in early pregnancy and 179.8 ± 30.5 pg. per milliliter in late pregnancy. Both umbilical arterial (UA) and umbilical venous (UV) plasma T were significantly higher in 11 male infants (UA T = 135.6 ± 16.5 pg. per milliliter; UV T = 227.5 ± 40.8 pg. per milliliter) than in 12 female infants (UA T = 92.1 ± 9.7 pg. per milliliter; UV T = 89.6 ± 12.6 pg. per milliliter) (p = <0.05 and <0.005, respectively). UV DHT and UA DHT showed no significant difference between male and female neonates. In midtrimester pregnancy, amniotic fluid T (AFT) was 165.2 ± 15.4 pg. per milliliter in pregnancies with a male fetus and was significantly higher (p = <0.001) than in pregnancies with a female fetus (mean ±S.E. = 27.6±2.6 pg. per milliliter). In late pregnancy, AFT levels were similar to those of early pregnancy, but a considerable overlap in AFT between fetuses of both sexes was observed. DHT was not detectable in amniotic fluid. The results suggest the potential value of AFT for determining fetal sex in midtrimester pregnancy and confirm that maternal T and DHT increase during pregnancy and that cord T levels reflect fetal gonadal androgen synthesis.

Steroid Sulfatase Deficiency

Placental steroid sulfatase deficiency is a genetic disorder only recently reported in the medical literature. Most documented cases of placental sulfatase deficiency have been marked by delay in onset of labor, lack of cervical dilatation, and relative refractoriness of oxytocic agents and amniotomy. We have studied the placenta, cultured fibroblasts, and amniotic fluid cells from an affected patient. The activities of estrone sulfatase, pregnenolone sulfatase, dehydroepiandrosterone sulfatase, and arylsulfatase C in the placenta from the patient were severely deficient. Arylsulfatases A and B were present at levels within the normal range for this tissue. Fibroblast dehydroepiandrosterone sulfatase activity was virtually absent in the patient's cells and present at normal levels in individuals with a variety of lysosomal disorders. It would thus appear that the mutation responsible for steroid sulfatase deficiency is genetically and biochemically distinct from those involved in the lysosomal sulfatase deficiency states. The cell culture studies further suggest that the defect is a generalized one which should be detectable in midtrimester of pregnancy and may have phenotypic consequences in later postnatal life.

Second trimester abortion: single dose intra-amniotic injection of prostaglandin F 2α with intravenous oxytocin augmentation

One hundred-sixty mid-trimester pregnancies were terminated by intra-amniotic injection of Prostaglandin F 2α with concomitant intravenous oxytocin. Only four of 77 nulliparas and one of 83 multiparas required a second prostaglandin injection. Mean injection-abortion interval was 22.8 hours, and 17.0 hours respectively. This difference between groups was statistically significant. Four nulliparas sustained uterine trauma, a high incidence suggesting that this method may be ill-advised in these women. Because of the predictable short injection-abortion interval in the multipara, this method can be combined conveniently with surgical sterilization.

Cortisol levels in amniotic fluid in prostaglandin F2α-induced midtrimester abortion

Cortisol concentrations in amniotic fluid and maternal plasma were determined by a competitive protein-binding assay in 14 patients in the midtrimester of pregnancy before and after intra-amniotic administration of prostaglandin F2α. Samples were obtained at three-hour intervals until abortion or until the fetal heartbeat ceased. The mean plasma levels of cortisol increased from 324 ± 173 ng. per milliliter at hour 0 to 524 ± 272 ng. per milliliter at 6 hours (the peak elevated value). In amniotic fluid, the mean levels of cortisol increased from 4.71 ± 2.5 ng. per milliliter to a maximum at 9 hours of 10.24 ± 2.5 ng. per milliliter. We concluded that at 16 to 20 weeks' gestation the fetoplacental unit is capable of responding to prostaglandin F2α instillation by increased levels of cortisol in the amniotic fluid.

The incompetent cervix and accelerated fetal lung maturation

The incompetent cervix is an infrequent but identifiable cause of late midtrimester pregnancy loss. The early diagnosis and surgical treatment of these patients have resulted in successful outcomes in 70 to 80 per cent of patients treated. However, this closure of the cervix may be only partially successful, in that the pregnancy may continue beyond the age of fetal viability, but the fetus may be born prematurely. There are no reports in the literature of the neonatal respiratory status of these infants delivered between 24 and 33 weeks of gestation. Nineteen preterm infants of less than 34 weeks' gestation were born to mothers with an incompetent cervix. The incidence of the respiratory distress syndrome was significantly less in infants of mothers with an incompetent cervix than in control infants of similar gestation (p < 0.001). The incomplete cervix appears to be related to maternal or fetal conditions which result in accelerated fetal lung maturation.

Immunologic and biologic activity of oxytocin in midtrimester pregnancy

Immunologic and biologic activity of oxytocin (OT) were studied by simultaneous monitoring of plasma OT measured by radioimmunoassay (RIA) and uterine contractility measured by recording of intrauterine pressures during the step-up rate of infusion of synthetic OT. The results in 11 patients with midtrimester pregnancy and step-up increase of OT infusion by 20 mU. showed a positive correlation of the increase of plasma OT and uterine contractility only at the plasma OT levels of 20 to 60 muU. per milliliter and only with hypertonic contractility but no correlation at plasma levels below and above this range. The lack of correlation of "dose and response" either prior to OT infusion or during low or very high rate of infusion suggests that other factors than merely the quantity of plasma OT are involved in determining the degree of uterine response.

Intraamniotic and Intramuscular Administration of 15‐Methyl Prostaglandin F2α for Midtrimester Abortion

Two series of midtrimester abortion inductions are compared. In one series of 68 cases of midtrimester pregnancies (12-24 weeks), legal abortion was induced by one intraamniotic injection of 2.5 mg 15-methyl prostaglandin F 2alpha. Fetus was expelled in 67 cases (98.5%) after a mean time of 18.4 hours. One case with duplex failed to abort (1.5%). Abortion was complete in 54% of the aborted cases. In the second series of 93 cases abortion was induced by intramuscular injection of 300 microgram 15-methyl PGF 2alpha every third hour (the first dose was 200 microgram) during 30 hours. Fetus was expelled in 79 cases (85%) after a mean time of 16.7 hours. Failure occurred in 14 cases (15%). Abortion was complete in 57% of the aborted cases. Side effects (vomiting and diarrhea) were more frequent in the intramuscular series and very inconvenient to many of the patients. Excessive bleeding occurred more often in the intraamniotic series. A small rupture of the cervix was noted once (primigravida) in the intramuscular group. It is concluded that the intramuscular way of administration is a simple method of second trimester pregnancy termination with small bleedings but that otherwise it is inferior to the intraamniotic route.

Fetal blood sampling in midtrimester pregnancies

Sonographically directed placental aspiration has been investigated as a method for obtaining fetal erythrocytes. The technique is generally successful and the fetal red cells are generally usable for the prenatal diagnosis of the hemoglobinopathies.