Normal Term Pregnant Women Research Articles

Imbalance of serum T helper 1- and 2-type cytokines in preeclampsia and gestational hypertension

To investigate the changes in serum levels of Th1- (IL-2 and TNF-alpha) and Th2-type cytokines (IL-10) and the ratios of Th1/Th2 (IL-2/IL-10 and TNF-alpha/IL-10) in preeclampsia and in gestational hypertension. Levels of IL-2, IL-10 and TNF-alpha were determined with radioimmunoassay in serum samples from 22 women with preeclampsia, 15 women with gestational hypertension and 32 normal term pregnant women. The Th1/Th2 ratios were calculated accordingly. There were no significant differences in serum levels of IL-2, IL-10 and TNF-alpha (P>0.05 for all) among normal pregnancy, gestational hypertension and preeclampsia. The ratio of serum IL-2/IL-10 was significantly higher in preeclampsia than that in controls (P < 0.05), and the ratio of TNF-alpha/IL-10 significantly higher in patients with preeclampsia than that in either controls or gestational hypertension (P<0.025 for both). Alterations of serum cytokine balance with predominance of Th1 immunity were observed in preeclampsia. These associations may offer insight into the pathogenesis of preeclampsia.

Placental imbalance of Th1‐ and Th2‐type cytokines in preeclampsia

To characterize the changes in the level of T helper 1 (Th1)- [interleukin (IL)-2 and tumor necrosis factor (TNF)-alpha] and Th2-type cytokine (IL-10) and the ratios of Th1/Th2 (IL-2/IL-10 and TNF-alpha/IL-10) in placentae from women with preeclampsia and women with gestational hypertension. Placental levels of IL-2, TNF-alpha, and IL-10 were determined with radioimmunoassay and Th1/Th2 ratios (IL-2/IL-10 and TNF-alpha/IL-10) calculated in the placentae from 22 women with preeclampsia, 15 women with gestational hypertension, and 32 normal term pregnant women. Although preeclampsia had the trend of the increase in the placental levels of IL-2 and TNF-alpha and the trend of the decrease in placental IL-10, there were not significant difference in placental levels of IL-2, IL-10, and TNF-alpha among preeclampsia, gestational hypertension, and normal pregnancy (P > 0.05 for all). Placental ratios of IL-2/IL-10 and TNF-alpha/IL-10 were significantly higher in preeclampsia than in normal pregnancy (P = 0.035 and P = 0.005, respectively). No differences of Th1/Th2 ratios were found between preeclampsia and gestational hypertension and between gestational hypertension and normal pregnancy (P > 0.05 for all). Alterations of placental balances of cytokines with Th1 predominance were demonstrated in preeclampsia. These associations may offer insights into the pathogenesis of preeclampsia.

Placental imbalance of Th1- and Th2-type cytokines in preeclampsia

Objectives. To characterize the changes in the level of T helper 1 (Th1)- [interleukin (IL)-2 and tumor necrosis factor (TNF)-α] and Th2-type cytokine (IL-10) and the ratios of Th1/Th2 (IL-2/IL-10 and TNF-α/IL-10) in placentae from women with preeclampsia and women with gestational hypertension. Methods. Placental levels of IL-2, TNF-α, and IL-10 were determined with radioimmunoassay and Th1/Th2 ratios (IL-2/IL-10 and TNF-α/IL-10) calculated in the placentae from 22 women with preeclampsia, 15 women with gestational hypertension, and 32 normal term pregnant women. Results. Although preeclampsia had the trend of the increase in the placental levels of IL-2 and TNF-α and the trend of the decrease in placental IL-10, there were not significant difference in placental levels of IL-2, IL-10, and TNF-α among preeclampsia, gestational hypertension, and normal pregnancy (P > 0.05 for all). Placental ratios of IL-2/IL-10 and TNF-α/IL-10 were significantly higher in preeclampsia than in normal pregnancy (P = 0.035 and P = 0.005, respectively). No differences of Th1/Th2 ratios were found between preeclampsia and gestational hypertension and between gestational hypertension and normal pregnancy (P > 0.05 for all). Conclusions. Alterations of placental balances of cytokines with Th1 predominance were demonstrated in preeclampsia. These associations may offer insights into the pathogenesis of preeclampsia.

Nitric oxide synthesis is increased after dehydroepiandrosterone sulphate administration in term human pregnancy.

The purpose of this study was to evaluate the role of nitric oxide in the vasodilative effect of dehydroepiandrosterone sulphate (DHEA-S) in term pregnant women. Circulating nitrite, nitrate and oestradiol concentrations were measured on 10 normal full-term pregnant women before (-30 min) and after (10, 30, 60, 90 and 120 min) administration of a 200 mg i.v. dose of DHEA-S dissolved in 20 ml of 5% dextrose (DHEA-S group). Ten normal full-term pregnant women received 20 ml of 5% dextrose as controls (control group). Maternal blood pressure and heart rate were also recorded. The median oestradiol concentration increased significantly after the infusion in DHEA-S group (P < 0.001), whereas there was no significant change in plasma oestradiol in the control group. In the DHEA-S group, plasma circulating nitrate and nitrite increased significantly at 10 and 30 min after DHEA-S administration respectively (P < 0.05). In the control group, there was no change in plasma nitric oxide (NO) metabolites. No change was found in heart rate or mean arterial blood pressure in the control or DHEA-S groups. These results suggest there may be a link between increased NO and increased oestrogen after DHEA-S injection but their peak values did not coincide. Both may be associated with vasodilation in term pregnant women.

Serum magnesium levels in preterm labour in relation to socioeconomic status.

The present study revealed significantly lower levels of serum magnesium in patients with preterm labour without any apparent cause as compared to normal term pregnant women in labour. The values were also lower in women with low socioeconomic status, older age and consuming vegetarian diet. Hence, estimation of serum magnesium levels in pregnancy may be a useful parameter in preterm labour.

Hourly fetal urine production rate in the near-term fetus: is it really increased during fetal quiet sleep?

Fetal bladder volume and hourly fetal urine production (HFUPR) is calculated on the assumption that the fetal bladder is ellipsoid in shape. A recent validation study demonstrated a progressive overestimation at increasing bladder volumes. This may be due to changes in shape of the fetal bladder at increasing volumes. Two independent papers have shown increased HFUPR during fetal behavioural state 1F (S1F) when compared with S2F. The aim of the present study was to assess whether this increase of HFUPR during S1F, previously observed by others, could be the result of an error introduced by the method of volume calculation. A retrospective evaluation was performed in a series of 208 HFUPR measurements in 123 normal near term pregnant women attending a low-risk atenatal clinic. Adequate bladder filling in both states was identified in 43 recordings. Maximum fetal bladder volumes were greater (> 10 ml) during S1F in comparison to S2F in 56% of these recordings and HFUPR was significantly greater during S1F only in these cases. Bladder volumes are usually lower during S2F as a result of fetal voiding, which occurred in association with 22 of 36 transitions from S1F to S2F, and only 1 of 13 transitions from S2F to S1F (P < 0.001). When disregarding calculated bladder volumes in excess of 20 ml for the purpose of calculating HFUPR, eleven recordings remained. HFUPR calculated in this way was significantly lower in comparison to measurements where larger bladder volumes were included and no difference was observed between states. This implies that the differences observed are the result of the greater error in calculating bladder volumes and HFUPR during S1F, where volumes are usually greater and that calculation of fetal bladder volume should not be performed on the assumption that the bladder is ellipsoid in shape. Alternative techniques include limiting measurements to a maximum volume of approximately 20 ml, when the bladder is usually ellipsoid in shape or basing volume calculation on the surface area of a series of sagittal views as suggested by Hedriana and Moore [Hedriana HL, Moore TR. Ultrasonographic evaluation of human fetal urinary flow rate: accuracy of bladder volume estimations. Am J Obstet Gynecol 1994;170:1250-1254; Hedriana HL, Moore TR. Accuracy limits of ultrasonographic estimation of fetal urinary flow rate.

Study of interleukin-6 and tumor necrosis factor-alpha levels in maternal serum and amniotic fluid of patients with premature rupture of membranes.

To study the change and clinical significance of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels in the maternal serum and amniotic fluid of pregnant women with chorioamnionitis and with premature rupture of membranes. Twenty-six normal-term pregnant women formed the control group, and forty-six pregnant women with premature rupture of membranes were enrolled for the study. Maternal serum and amniotic fluid IL-6 and TNF-alpha levels were measured using a sensitive radioimmunoassay and enzyme-linked immunosorbent assay (ELISA); chorioamnionitis was diagnosed by fetal membrane pathology. The maternal serum IL-6 levels and amniotic fluid IL-6 and TNF-alpha levels were higher than those of the control (P < 0.01). There was a significant relationship between maternal serum IL-6 and maternal serum and amniotic fluid IL-6 and TNF-alpha with the time of the premature rupture of membranes, i.e. the longer the time, the higher the maternal serum and amniotic fluid IL-6 and TNF-alpha. There were 12 patients with chorioamnionitis in premature rupture of membranes and their maternal serum and amniotic fluid IL-6 and TNF-alpha levels were higher than that of non-chorioamnionitis patients (P < 0.01-0.05). IL-6 and TNF-alpha levels in maternal and amniotic fluids are a valuable index in identification of the chorioamnionitis in patients with premature rupture of membranes.

Role of nitric oxide in the regulation of vascular tone in pressurized and perfused resistance myometrial arteries from term pregnant women

Objective: Our purpose was to evaluate flow-induced responses, myogenic tone, and norepinephrine-induced constriction in myometrial resistance arteries from normal term pregnant women and the role that nitric oxide and prostanoids may play in these responses. Study Design: Arteries (approximately 200 μm, n = 14, at 40 mm Hg) were dissected from myometrial biopsy specimens from women undergoing cesarean section and then were mounted in a pressure arteriograph. Responses to intraluminal flow, pressure, and a constrictor agonist (norepinephrine 10 −6 mol/L) were studied in the absence and presence of Nω-nitro- l-arginine methyl ester ( n = 7) or indomethacin ( n = 5). Myogenic and norepinephrine-induced tone were calculated after the determination of artery diameter in the absence of extracellular calcium. Results: Arteries developed myogenic tone (80 mm Hg) that was not modulated by nitric oxide or prostanoid release, whereas norepinephrine-induced tone was significantly enhanced by the nitric oxide inhibitor. An increase in intraluminal flow led to dilatation in physiologic salt solution and indomethacin, but to constriction in the presence of Nω-nitro- l-arginine methyl ester (percent increase in diameter at flow rate of 184.6 μl/min, 24% ± 8% in physiologic salt solution and 20% ± 4% in the presence of indomethacin versus –27% ± 12% in Nω-nitro- l-arginine methyl ester alone and –21% ± 10% in indomethacin and Nω-nitro- l-arginine methyl ester, respectively, analysis of variance, p < 0.05). Conclusions: Flow-induced shear stress is a physiologic modulator of vascular tone in myometrial arteries from pregnant women. Nitric oxide, but not prostanoids, mediates this response and also blunts norepinephrine constriction. Nitric oxide may play a fundamental role in the maintenance of adequate blood supply to the fetus during human pregnancy.

Diurnal variations in resting-active cycles in full-term fetal heart rate changes.

To elucidate the mechanism of the resting-active cycles (RAC) of fetal heart rates (FHR), in the resting and non-resting phases (RP and NRP), 24-h FHR recordings were made on 16 normal full-term pregnant women. RP, NRP, RAC-1 (NRP-NRP cycle), and RAC-2 (RP-RP cycle) were defined based on the criteria of Nijhuis et al. Frequency distributions were plotted separately for the entire 24-h period as well as for the day-time (07:00-21:00 h) and night-time (21:00-07:00 h), and were compared using Kolmogorov-Smirnov two-sample tests. The mean durations (+/- S.D.) (min) of RP, NRP, RAC-1, and RAC-2 were 22.7 +/- 11.2, 67.3 +/- 47.2, 90.0 +/- 47.6, and 89.9 +/- 48.6 during 24-h periods, 20.1 +/- 7.7, 68.3 +/- 52.3, 88.6 +/- 53.1, and 88.4 +/- 53.0 during the day-time, and 25.4 +/- 13.2, 66.2 +/- 41.2, 91.4 +/- 41.0, and 91.5 +/- 43.4 during the night-time. Length of RP was the only factor significantly different during the day and night (P < 0.05). We propose that there are different mechanisms controlling RP and NRP.

Effect of Dehydroepiandrosterone Sulfate on Maternal Cardiac Function in Term Pregnancy

To search for possible effect of dehydroepiandrosterone sulfate (DHAS) on maternal cardiac function in term pregnancy, impedance cardiographic assessments were made on 15 normal full-term pregnant women before and 5, 10, 15, 20, 25, and 30 minutes after the administration of a 200 mg intravenous dose of DHAS in 20 mL of 5% dextrose. The cardiac output, stroke volume, heart rate, and mean arterial pressure were recorded. Maternal cardiac output increased from baseline by 20% (p < 0.05) after 15 minutes and the mean increase in stroke volume was 25% (p < 0.05) after 15 minutes. No change was found in heart rate or mean arterial blood pressure. DHAS induces a significant increase in both maternal stroke volume and cardiac output without change in heart rate or mean arterial pressure, which suggests a possible increase in cardiac contractility in term pregnancy.

Changes in serum free thyroxine, free tri-iodothyronine and thyroid stimulating hormone reference intervals in normal term pregnant women

SummaryQuantitation of serum free thyroxine (free T4) and free tri-iodothyronine (free T3) concentrations in pregnancy should theoretically avoid such confounding factors as low serum albumin, pregnancy changes in non-esterified fatty acids, and changes in thyroid binding globulin. The purpose of this study was to establish reference intervals for serum free T4 and T3, and thyroid stimulating hormone (TSH) in 120 healthy pregnant women during the third trimester, using assays unaffected by these factors. Reference intervals were determined as the central 95th centile confidence interval using non-parametric rank number analysis. Serum free T4 and T3 reference intervals both decreased, and the serum TSH reference interval increased when compared with non-pregnant levels. These changes are physiological, and show the importance of using pregnancy specific reference intervals for serum free T3 and T4 and TSH measurement when assessing thyroid function in the pregnant patient.

Effect of dehydroepiandrosterone sulfate on uterine artery flow velocity waveforms in term pregnancy

To investigate the interrelation between estrogen synthesis by the fetoplacental unit and uteroplacental hemodynamics in term pregnancy. Transvaginal color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were made on ten normal full-term pregnant women before and 3, 5, 10, 30, and 60 minutes after the administration of a 200-mg intravenous dose of dehydroepiandrosterone sulfate (DHAS) in 20 mL of 5% dextrose. Ten normal full-term pregnant women received 20 mL of 5% dextrose as controls. The pulsatility index (PI) values for the uterine artery, heart rate, and mean arterial pressure were recorded. Plasma estradiol (E2) was measured before and 10 minutes after the infusion. In the DHAS group, uterine artery PI decreased from baseline by 26% (P < .05) after 5 minutes, and the mean reduction was 36% (P < .05) after 10 minutes and 15% (P < .05) after 30 minutes. The PI returned to the baseline value 60 minutes later. In the control group, there was no change in uterine artery PI. No change was found in heart rate or mean arterial blood pressure in the control or DHAS groups. The mean plasma E2 increased from 22.3 +/- 6.6 to 56.2 +/- 24.1 ng/mL (P < .05) 10 minutes after the infusion in DHAS subjects, whereas there was no significant change in plasma E2 in the controls. Dehydroepiandrosterone sulfate induces a significant decrease in the uterine artery PI, which suggests a possible decrease in uterine vascular impedance in term pregnancy.

Hematologic Status of Newborn Infants of Mother with Pregancy-induced Hypertension

To evaluate the effects of pregnancy-induced hypertension (PIH) to the iron status of fetuses, umbilical cord blood of 35 newborn infants borne by PIH mothers and of 37 normal term infants delivered at Yeungnam University Hospital from September 1, 1993 to September 30, 1994, were studied. The serum hemoglobin concentration of women with PIH was significantly higher than normal full-term pregnant women. There was no significant difference in serum hemoglobin concetration between women with PIH and normal full-term pregnant women and their newborn infants. There was no significant difference in serum hemoglobin concentration beween infants of women with PIH and normal full-term infants. The serum iron concentration of newborn infants of women with PIH was higher and the serum ferritin concentration of newborn infants of women with PIH was lower than normal full-term infants, but there were no significant difference between the two groups. The serum total iron-binding capactity and unsaturated iron-binding capacity of infants of women with PIH were significantly higher than normal full-term infants. The newborn infants of PIH women seemed that they might have occult depletion of iron store and need meticulous follow up during early neonatal period.

Maternal serum type III procollagen peptide (P-III-P) and 7S domain of type IV collagen (7S) as indicators of placental damage caused by severe toxemia of pregnancy

Summary Using immunohistochemical techniques, we studied the localization of type III and IV collagen in normal and toxemic placentae at term. We measured the maternal serum levels of type III procollagen peptide, and type IV collagen 7S domain in nonpregnant women, normal term pregnant women, and cases with toxemia of pregnancy. The immunohistochemical studies revealed that type III collagen exists in the connective tissues of the villus core, and type IV collagen in the basement membrane of trophoblast cells and fetal vascular elements. Even in normal looking toxemic placentae, the amount of types III and IV collagen appeared to be increased compared with that in normal placentae. However, the amount of types III and IV collagen appeared to be decreased in the necrotic chorionic villi of severe toxemia. Measurement of the collagen-related substances showed that the levels in toxemic pregnancy, especially when severe were elevated compared with those in normal pregnancy. In toxemic pregnancy, the incidence of IUGR in the group with elevated P-III-P levels increased significantly, and increased further when both P-III-P and 7S levels were high. Our data support our hypothesis that P-III-P and 7S in maternal serum flow out from necrotized chorionic villi into the intervillus space, and that these measurements are significant indicators of placental damage caused by severe toxemia of pregnancy.

Serum folate levels in normal full-term pregnant Chinese women.

Serum folate levels were determined by a radio-isotopic assay method and then analysed in 253 normal full-term pregnant women. None of them had received any hematonic during their whole pregnancy period. Their mean age was 27.72 years and the mean pregnancy duration was 39.50 weeks. Mean hemoglobin concentration in these normally pregnant women was 12.54 g%. Mean serum folate was 8.57 ng/ml. In this study, 7.51% (19 out of the 253) of the normally pregnant women had a folate level less than 3 ng/ml, and only 2 of them had clinical anemia (Hb less than 11 g%), and one of them also had serum ferritin less than 12 ng/ml. Thus pure folic acid deficiency anemia in pregnant women may be very rare in Chinese. Neither multiparity, age, nor gravida number played any role in the occurrence of folate deficiency. There would appear to be a slight positive relationship between folate levels and hemoglobin concentration in pregnant Chinese women.

2-Chlororocaine for local perineal infiltration

Lidocaine was recently found to rapidly cross the placenta and result in considerable fetal exposure after local infiltration of the perineum for episiotomy. For this reason, a more appropriate agent for local perineal infiltration might be a drug with rapid metabolism and inactive metabolites. 2-Chloroprocaine, an ester-linked local anesthetic agent, is available but is not commonly used for this procedure. The purpose of this study was to evaluate the placental transfer of 2-chloroprocaine after local perineal infiltration. The drug was administered to 17 normal term pregnant women for episiotomy. After local perineal infiltration, the levels of 2-chloroprocaine and/or its metabolite, chloroaminobenzoic acid, were quantitated in maternal and neonatal plasma or urine. The pharmacologic data indicated that 2-chloroprocaine was nondetectable at delivery in maternal and umbilical cord vein; one patient had trace levels in the cord. Chloroprocaine was not detectable in neonatal plasma, but chloroaminobenzoic acid was detectable in both maternal and cord vein plasma. Mean levels of chloroaminobenzoic acid in maternal plasma at delivery were 1.04 +/- 0.32 micrograms/ml, and mean levels in cord vein were 0.35 +/- 0.54 micrograms/ml. Clinically, 2-chloroprocaine provided good analgesia. These results indicate that very little, if any pharmacologically active drug, reaches the fetus after local perineal infiltration with 2-chloroprocaine. Therefore 2-chloroprocaine appears to be preferable to lidocaine when used for local perineal infiltration.

Serum ferritin, folate and cobalamin levels and their correlation with anemia in normal full-term pregnant women

Serum ferritin, folate, cobalamin and hemoglobin concentrations were determined by radioimmunoassay, radioisotopic assay, radioassay and an automated hematology analyser respectively, and then analysed in 221 normal full-term pregnant women in order to evaluate the incidence and the prevalence of nutritional anemia in pregnancy. None of them had received any hematonic during their pregnancy. Their mean age was 27.68 years and the mean duration of pregnancy was 39.51 weeks. Twenty-three (10.41%) of these previously non-anemic pregnant women had clinical anemia after full-term pregnancy. Of the 23 women, 11 (47.83%) had iron-deficiency anemia, with serum ferritin less than 12 μg/l; another 11 women had some degree of iron depletion, with serum ferritin less than 20 μg/l. So in 22 of the 23 anemic women (95.65%) the cause of anemia may correlate to iron depletion. The remaining one had folate-deficiency anemia. No pure cobalamin deficiency anemia was found in this study. Among the 198 non-anemic normal full-term pregnant women, 92 (46.46%) had iron depletion (serum ferritin < 20 μg/l), of whom 35 (17.68%) had severe iron deficiency, with serum ferritin less than 12 μg/l. Another 3 had folate deficiency and 3 had cobalamin deficiency. By including all the anemic and non-anemic pregnant women, 114 (51.58%) of them had some degree of iron depletion. In other words, pregnancy can produce a considerable degree of iron depletion in more than half of the previously non-anemic women.

Serum ferritin levels and their significance in normal full-term pregnant women

Serum ferritin levels were determined by radioimmunoassay (RIA) method and then analysed in 240 normal full-term pregnant women. Their hemoglobin concentrations were found to be normal in the first trimester. None of them had received any hematonic during their whole pregnancy period. Their mean age was 27.7 years and the mean pregnancy duration was 39.5 weeks. Mean hemoglobin concentration in these normal pregnant women was 12.6 g%. Mean serum ferritin was 23.1 ng/ml. It was significantly lower than the mean value of the normal non-pregnant women of the same age. In this study, we found that even normal pregnant women, 15.42% (37 out of the 240) had subclinical iron deficiency and 12.92% (31 out of the 240) of the previously normal pregnant women had clinical anemia during their term of pregnancy. Multiparity was found to be a factor in the prevalence of iron deficiency but age and gravida number played no role in the occurrence of iron deficiency anemia.

T-cell subsets in patients with preeclampsia

Peripheral blood mononuclear cells from patients with preeclampsia were enumerated by means of monoclonal anti-T-cell antibodies. The percentage of total T cells was significantly decreased in this group of patients, as compared with normal term pregnant women. The low proportion of T cells was due to a proportional reduction in both helper and suppressor T cells; therefore, the ratio of helper to suppressor T cells was not different from that in normal pregnant women. There was no correlation between the degree of reduction in percentage of T cells and severity of the disease. The absolute numbers of T cells were slightly, but not significantly, decreased. Our findings support previous evidence of reduced, not increased, immune reactivity in preeclampsia.

294. Effect of a diuretic on urinary excretion of estrogens in pregnant woman

To investigate the interrelation between estrogen synthesis by the fetoplacental unit and uteroplacental hemodynamics in term pregnancy.Transvaginal color Doppler flow imaging and pulsed Doppler ultrasonographic assessments were made on ten normal full-term pregnant women before and 3, 5,10, 30, and 60 minutes after the administration of a 200-mg intravenous dose of dehydroepiandrosterone sulfate (DHAS) in 20 mL of 5% dextrose. Ten normal full-term pregnant women received 20 mL of 5% dextrose as controls. The pulsatility index (PI) values for the uterine artery, heart rate, and mean arterial pressure were recorded. Plasma estradiol (E2) was measured before and 10 minutes after the infusion.in the DHAS group, uterine artery PI decreased from baseline by 26% (P < .05) after 5 minutes, and the mean reduction was 36% (P < .05) after 10 minutes and 15% (P < .05) after 30 minutes. The PI returned to the baseline value 60 minutes later. in the control group, there was no change in uterine artery PI. No change was found in heart rate or mean arterial blood pressure in the control or DHAS groups. The mean plasma E2 increased from 22.3 ± 6.6 to 56.2 ± 24.1 ng/mL (P < .05) 10 minutes after the infusion in DHAS subjects, whereas there was no significant change in plasma E2 in the controls.Dehydroepiandrosterone sulfate induces a significant decrease in the uterine artery PI, which suggests a possible decrease in uterine vascular impedance in term pregnancy.