Prostaglandin Termination Of Pregnancy Research Articles

Maternal viral load and vertical transmission of HIV-1 in mid-trimester gestation.

It is now accepted that the majority of HIV-1 vertical transmissions occur in late gestation and at the time of delivery. However, there is wide variation in the prevalence rate of mid-trimester vertical transmission. We assessed the maternal HIV-1 RNA viral load and in utero transmission during mid-trimester gestation. Patients were enrolled when they decided to have their pregnancies terminated between 17 and 24 weeks of gestation. Prostaglandin-induced abortion with PGE1 analogue vaginal administration was carried out in all patients. Maternal plasma HIV-1 RNA viral load and plasma HIV-1 RNA (qualitative) from abortus heart blood were assessed. Amongst 41 HIV-1 seropositive pregnant women not receiving antiretroviral therapy plasma HIV-1 RNA was detected in the abortus heart blood from two women (4.9%; 95% confidence interval (CI), 0.6-16.5). Transmission occurred in one out of nine (11.1%; 95% CI, 0.3-48.2) with maternal viral load > or =100000 copies/ml versus one out of 32 (3.1%; 95% CI, 0.1-16.2) of those with <100000 copies/ml (P = 0.39). The frequency of HIV-1 vertical transmission during mid-trimester was approximately 5% as detected by plasma HIV-1 RNA (qualitative) method in the fetuses aborted from the prostaglandin termination of pregnancy. During mid-trimester gestation there was no correlation between high maternal viral load and vertical transmission.

Morphometry of the second trimester fetal brain. Comparison of ultrasonographic and post-mortem findings.

With the increasing use of ultrasound examination in the antenatal period the lack of morphological correlates has become a problem. This study was carried out in order to correct this deficiency. An antenatal real-time ultrasound scan of the fetal head was performed and measurements of the biparietal diameter, occipitofrontal diameter, head circumference and cerebral ventricle-to-hemisphere ratio were undertaken in 103 fetuses at 13-24 weeks gestation. After prostaglandin termination of pregnancy, the fetal brains were perfused in situ through the right carotid artery with 10% formal saline. Horizontal slices of the fetal head were cut, photographs were obtained and measurements of the same parameters as in the ultrasound examination were undertaken. There is a significant correlation (p less than 0.001) between the ultrasonographic and post-mortem measurements of all parameters. Also several anatomical structures of the fetal brain are now confidently identified in the antenatal ultrasound scan, using the anatomical preparations for comparison.

Characterisation of bombesin-like immunoreactivity in human fetal lung

A sensitive radioimmunoassay for bombesin-like immunoreactivity (BLI) was developed and utilised in conjunction with G50 gel chromatography and reverse-phase HPLC, to study the content and molecular characteristics of bombesin-like peptides in acid extracts of human fetal lung. The antiserum, (B5), is directed towards the C-terminal region of the bombesin molecule and cross-reacts 70% with synthetic porcine GRP and the synthetic GRP fragment, GRP (14–27). Specimens of lung were collected from fetuses of gestational ages 15–22 weeks, following prostaglandin termination of pregnancy. The tissue was extracted into 0.1 N HCl at 90°C. The mean BLI content was 50.2 pg/mg wet weight of tissue (range 15.5–136 pg/mg; n = 13). No correlation between gestational age and BLI content could be established. G50 gel chromatography of acid extracts, under dissociating conditions, revealed two peaks of BLI, one in the position of synthetic porcine GRP and the second, constituting greater than 90% of the immunoreactivity, eluting with synthetic amphibian bombesin. Reverse-phase ODS silica HPLC of this major G50 peak, utilising a methanol/trifluoroacetic acid gradient, indicated that this peptide was similar to the GRP C-terminal fragment, GRP (14–27). We have therefore (1) confirmed the presence and heterogeneity of BLI in human fetal lung, and (2) shown, for the first time, that the majority of this BLI more closely resembles a fragment of GRP than amphibian bombesin itself.

Distribution and characterisation of immunoreactive somatostatin in human gastrointestinal tract.

Immunoreactive somatostatin (IRS) was measured in acid extracts of human gastrointestinal tissue. The highest levels were found in the duodenum, pancreas, jejunum and stomach with lower levels in the ileum and colon. In the antrum, pylorus, duodenum and pancreas the main peak of IRS (1.6K IRS) coeluted with synthetic somatostatin-14 on both gel filtration chromatography and HPLC. In the body of stomach, jejunum, ileum and colon, a large peak coeluting with synthetic somatostatin-28 (3.5K IRS) on both chromatographic systems was also identified, while minor peaks of IRS assigned molecular weights of 6000 (6K) and greater than 15 000 (15K) were seen in some extracts. The total IRS content and pattern of molecular forms were similar in tissues obtained from adults at surgery or rapid post mortem, and in tissue taken from human fetuses after prostaglandin termination of pregnancy. When tissues were divided into mucosal and muscle layers, greater than 90% of the IRS was in the mucosa with less than 10% in the muscle layer. In the muscle layer the IRS was almost entirely the 1.6K form in all tissues. Immunohistochemical studies showed the IRS in the mucosa to be localised in endocrine-type cells, while in the muscle layer the IRS is present in nerve fibres and neurones of the myenteric plexus. It is suggested that (1) different mechanisms may control the biosynthesis of somatostatin-14 and somatostatin-28 in mucosal cells in different parts of the gut, (2) different biosynthetic controls may operate in endocrine-like and neuronal cells in the same region of the gut.

Obliterative cholangitis due to cytomegalovirus: A possible precursor of paucity of intrahepatic bile ducts

A fetus at 24 weeks' gestation was found to have ascites and abdominal calcifications by ultrasonography. Pathologic examination after prostaglandin termination of pregnancy two weeks later revealed disseminated cytomegalovirus infection with inclusions in the lung, pancreas, kidney, and liver. A mononuclear inflammatory reaction was present in the portal areas of the liver and in the kidney, and gliosis was diffuse in the brain. The liver lesions were of greatest interest because most portal areas had no bile ducts. In other portal areas there was a combination of inclusions in epithelial cells of the few remaining interlobular ducts and intense duct-oriented inflammation. Thus, in fetuses surviving intrauterine cytomegalovirus infection, inflammatory destruction of intrahepatic bile ducts could manifest as chronic cholestasis and paucity of bile ducts later in infancy.

CONSEQUENCES OF ACUTE MYELOGENOUS LEUKEMIA IN EARLY PREGNANCY

Cytarabine and thioguanine therapy for acute myelomonocytic leukemia initiated in the tenth week of pregnancy (with the addition of vincristine and rubidomycin at 17 weeks) led to a short complete remission of the leukemia in a 24-year-old primigravida. This is the first case to be reported in which cytarabine was administered in the first trimester and a prostaglandin termination of pregnancy performed at 20 weeks produced an apparently normal fetus. A review of the literature suggests a slightly less than 50% chance of producing a live healthy baby if acute myelogenous leukemia is diagnosed in the first half of pregnancy, with materna mortality approaching 100% by six months postpartum. Current therapy may improve these figures.

548 PRENATAL DIAGNOSIS OF CONGENITAL ERYTHROPOIETIC ETIC PORPHYRIA

Congenital erythropoietic porphyria (CEP) is a rare disorder of porphyrin metabolism in which uroporphyrinogen I (Uro I) and coproporphyrinogen I are found in great excess in tissues and excreta. This autosomal recessive disorder has been atributed to a partial deficiency of Uro III cosynthetase activity in cells of erythroid origin and other tissues. Studies of fibroblast cultures from skin of a 2 year old boy with CEP revealed an accumulation of protoporphyrin after incubation with Δ-amino-levulinic acid, but no increase in Uro I. A pregnancy of the mother of the patient with CEP was monitored by amniocentesis at 16 weeks gestation. The amniotic fluid had a pink-brown discoloration, and extraction of the porphyrins revealed a marked increase in fluorescence in comparison with control fluids, with characteristic absorption and emission spectra. The presence of marked excess of Uro I was confirmed by thin layer chromatography. Prostaglandin termination of pregnancy 4 days later confirmed the presence of excess Uro I in fetal tissues. Although the diagnosis of CEP can be confirmed by demonstration of reduced Uro III cosynthetase activity in amniotic cell cultures, the marked derangement of Uro I formation is evident in amniotic fluid thereby facilitating prenatal diagnosis of this disorder. (Supported by NIH Grant GM 19100)