Trimester Of Normal Pregnancy Research Articles

An increase in catecholamines and metabolites in the amniotic fluid compartment from middle to late gestation

By means of a modified radioenzymatic assay, simultaneous determinations of the parent catecholamines, epinephrine (E), norepinephrine (NE), and dopamine (DA), and their deaminated metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC) and 3,4-dihydroxyphenylglycol (DOPEG), were made in amniotic fluid obtained during the second (N = 44) and third (N = 20) trimesters of normal pregnancies. Significant positive correlations were noted between gestational age and concentrations of E, NE, DA, DOPAC, and DOPEG in amniotic fluid. These findings provide evidence of progressive fetal adrenergic maturation through pregnancy. In addition, our data suggest a parallel maturational event in the central nervous and peripheral catecholamine systems of the fetus, since DOPAC and DOPEG are more representative of catecholamine neuronal activity in the brain.

The lack of significant change in plasma progesterone and estradiol-17 beta levels before the onset of human labor.

Maternal plasma levels of progesterone and estradiol-17 beta were measured weekly by radioimmunoassay in 15 healthy women during the last trimester of normal pregnancy. There was a large individual variation for both hormones. The mean concentrations rose slightly with advancing gestational age but the ratio of progesterone to estradiol did not change. It is apparent that the onset of spontaneous labor cannot be predicted by measuring the levels of progesterone and estradiol-17 beta in maternal peripheral plasma.

Fetal movement patterns in the first trimester of pregnancy.

Fetal movements were examined at various ages during the first trimester of pregnancy in 46 patients. Characteristic types and patterns of movement were found to relate to the age of the fetus. By 10 to 12 weeks, a full range of movements had developed and the movement patterns then closely resembled those normally found in the second and third trimesters of normal pregnancy.

The 24-hour excursion and diurnal rhythm of glucose, insulin, and C-peptide in normal pregnancy

A longitudinal study to quantitate the progressive effects of the second and third trimesters of normal pregnancy on the levels of plasma glucose, immunoreactive insulin (IRI), and C-peptide (C-P) at hourly intervals throughout the 24-hour “metabolic clock” was made. Identical studies were conducted in each subject at 6 to 11 weeks post partum and these data were used as nonpregnant control values. Data analyses were made to determine the role of meal-activity-sleep cycles as physiologic modifiers. A diurnal rhythm of plasma glucose, IRI, and C-P was demonstrated in all study periods. During meals anabolic values of plasma glucose (increments above the 24-hour mean) in response to meal intake were remarkably small, ranging between 30 and 35 mg/100 ml in the postpartum state, and were not significantly modified by pregnancy. The corresponding IRI levels were similarly small with a mean increase on only 31% in pregnancy. However, during the third but not the second trimester of pregnancy, the peak anabolic values for both plasma glucose and IRI were significantly (p < 0.05) increased and consequently the 2-hour postprandial glucose and IRI levels were significantly elevated after meal ingestion. When values were compared with those of the postpartum state, there was a progressive increase in the degree of catabolic excursion (decrease from 24-hour mean) of plasma glucose during sleeping hours from the second to third trimester of pregnancy. This resulted in a state of relative hypoglycemia, with significantly reduced fasting (8 a.m.) plasma glucose and 24-hour integrated glucose levels. This relative nocturnal hypoglycemia was associated with synchronous IRI values but without concomitant reduction of absolute IRI levels. Consequently, the fasting, premeal, and 24-hour IRI/glucose ratios were increased. Thus, basal insulin secretion is significantly augmented relative to levels of plasma glucose, but a quantitative increase in insulin secretion following food intake is relatively small during pregnancy. These observations together with the finding of a marked diurnal rhythm of plasma glucose and relative nocturnal hypoglycemia provide important insights for the formulation of guidelines for the timing, amount, and mode of delivery of exogenous insulin necessary for the management of diabetic patients during pregnancy.

Angiotensin-converting enzyme: Serum levels during normal pregnancy

ACE activity of the serum of 52 normal pregnant women was measured in vitro under conditions of substrate saturation with Hip-His-Leu as substrate. The product His-Leu was measured by fluorimetry after reaction with o-phthaldehyde. ACE activity (nmol/min/ml serum) was 30.6 +/- 7.8, 28.8 +/- 7.4, and 30.9 +/- 8.2 for the first, second, and third trimester of pregnancy, respectively. No statistically significant differences (p greater than 0.05) in ACE activity were detected among the three trimesters of normal pregnancy with either serum volume or serum protein as reference value. These values are within the range reported by Friedland and Silverstein13 for 51 male and seven female healthy blood bank donors. We conclude that the evolution of normal pregnancy does not significantly modify the levels of ACE in peripheral blood serum.

The radioimmunoassay of placental protein 5 and circulating levels in maternal blood in the third trimester of normal pregnancy

A radioimmunoassay has been developed for placental protein 5 (PP5), a product of the human placenta. Circulating concentrations of PP5 were measured in the third trimester of normal pregnancy in 400 women. Concentrations of PP5 showed a skewed distribution and rose progressively to reach a plateau in the last four weeks of pregnancy. The development of this assay will permit studies on the potential clinical application of maternal PP5 levels during normal and abnormal pregnancy.

Biochemical changes of normal pregnancy and puerperium in Lagos, Nigeria.

A cross-sectional study is presented of biochemical changes in the third trimester of normal pregnancy and puerperium during the wet season in the tropical climate of Lagos, Nigeria. These changes are less marked in first than in subsequent pregnancies, and although qualitatively similar, in some respects they differ from those observed in the temperate climatic zone. The indications are that quantitative differences may exist which could be relevant to the management of pregnancy in the tropics.

CELL‐MEDIATED IMMUNITY IN PREGNANT PATIENTS WITH AND WITHOUT A PREVIOUS HISTORY OF SPONTANEOUS ABORTIONS

The percentage of T-cells was studied in pregnant patients with a previous history of spontaneous abortions, in patients without such a history and in nonpregnant controls. The percentage of T-cells remained unaltered during the three trimesters of normal pregnancy. In patients with a previous history of spontaneous abortions, the T-cell percentages were lower in the second and third trimesters than in non-pregnant controls, but the values did not differ statistically from corresponding values in those patients with no previous history of spontaneous abortion (normal pregnancy). The phytohaemagglutinin (PHA)-induced transformation of lymphocytes was depressed in the second and third trimesters of both patients with a normal pregnancy and those with a previous history of spontaneous abortions. Thus, while the percentage of T-cells remained unaltered during pregnancy, their response to PHA falls in the second and third trimesters.

CONCENTRATIONS OF PREGNANCY-SPECIFIC β1-GLYCOPROTEIN IN MATERNAL BLOOD IN NORMAL PREGNANCY AND IN INTRAUTERINE GROWTH RETARDATION

A radioimmunoassay has been developed for pregnancy-specific β1-glycoprotein (S.P.1), a product of the human placenta. Circulating concentrations of S.P.1 were measured in 153 women in the third trimester of normal pregnancy and in 27 women who delivered children with birth-weight below the 10th centile of the normal range—i.e., with intrauterine growth retardation (I.U.G.R.). Concentrations of S.P.1 showed a skewed distribution and rose progressively to reach a plateau in the last four weeks of pregnancy. In over 70% of women with I.U.G.R. of the fetus, concentrations of S.P.1 were low. Measurement of serum-S.P.1 may provide a new index of fetal wellbeing.

Coagulation studies in toxemia of pregnancy with special reference to the platelet aggregation and serum lipids

Disseminated intravascular coagulation has been suggested as a cause or an important secondary mechanism in toxemia of pregnancy. In order to clarify this evidence platlet count, aggregation, FDP, and serum lipids were studied on 30 normal pregnant women and 18 women with severe toxemia of pregnancy.The following results were obtained:1. The platelet count decreased slightly in severe toxemia of pregnancy as compared with the third trimester of normal pregnancy.2. In severe toxemia of pregnancy, the rate of platelet aggregation induced by ADP was lower than of normal pregnancy.3. In one case with abruptio placentae, platelet aggregation rate had fallen considerably at the time of hemorrhagic shock.4. FDP and serum lipids levels showed a marked increase in severe toxemia of pregnancy than in third trimester of normal pregnancy.

A double-blind investigation into the effects of ritodrine on uterine blood flow during the third trimester of pregnancy

The object of this double-blind crossover study was to investigate the effect of a beta-mimetic agent-ritodrine-administered intravenously at increasing infusion rates on uterine blood flow and the maternal cardiovascular system during the third trimester of normal pregnancies and pregnancies complicated by intrauterine growth retardation and/or hypertension. Uterine blood flow, maternal arterial blood pressure, maternal and fetal heart rate, and uterine activity were simultaneously recorded throughout the study. In normal pregnancies the changes in different parameters during ritodrine and placebo administration were slight. In the "pathologic" pregnancies there was a highly significant increase in maternal heart rate, differential blood pressure, and uterine blood flow during ritodrine administration. The differences in response to ritodrine and placebo were statistically significant in this later group. This study demonstrates increased sensitivity of the maternal cardiovascular system to this beta-mimetic agent in certain categories of high-risk pregnancies and possibily an increase in uteroplacental blood flow.

Alpha-fetoprotein concentration in amniotic fluid during the last trimester in normal pregnancies and in pregnancies with severe fetal abnormalities.

The concentration of alpha-fetoprotein (AFP) in the amniotic fluid was studied during the last trimester of pregnancy. 129 samples of amniotic fluid were collected by transabdominal amniocentesis in 94 pregnant women. Only women with uncomplicated pregnancies giving birth to normal infants at term were included. The 90% reference interval was calculated and a distinct decrease in the amniotic fluid AFP concentration was found during the last trimester. An AFP concentration above the 90% reference interval was found in 8 out of 10 cases of anencephaly. Normal AFP concentration was found in a case of congenital heart disease with severe oedema, and a low concentration was found in a case of Down's syndrome (Trisomy 21).

Plasma beta-melanocyte-stimulating hormone levels in pregnancy.

SummaryPlasma β‐melanocyte‐stimulating hormone (β‐MSH) levels were measured by radioimmunoassay in 10 women during the last trimester of normal pregnancy and in 21 women 40 to 95 days after delivery. It is concluded that β‐MSH cannot account for the increased circulating melanocyte‐stimulating activity that has previously been found in pregnancy when bioassays were used.

Ultrastructural development of the human decidua

The ultrastructure of the human decidua in all three trimesters of normal pregnancy, in the tube in a case of ectopic pregnancy, and in hydatidiform mole is described. By Day 25 of the menstrual cycle, most of the ultrastructural characteristics associated with pregnancy have begun to appear. The morphologic manifestations of cellular activity in the true decidua are maximal by Day 70 of pregnancy. By Day 100, ultrastructural evidence of metabolic activity begins to decline. During the first 100 days of pregnancy, the ultrastructure of the stroma in the decidua capsularis is virtually identical with that in the decidua parietalis. Later in pregnancy, a material very similar to both basal lamina (basement membrane) and fibrinoid appears to be elaborated by the stromal cells. The decidual reaction in early tubal pregnancy is ultrastructurally indistinguishable from that in uterine pregnancy. The endometrial epithelial responses in normal uterine and tubal pregnancies also are similar. The reaction (Arias-Stella) appears to reflect hyperstimulation rather than degeneration and is further exaggerated in cases of hydatidiform mole. Previously undescribed ultrastructural features of the endometrial epithelium in the presence of a mole include intramitochondrial crystals and oval electron-rare intranuclear bodies with a fine fibrillar structure. Similar juxtanucleolar bodies are found in association with certain viral diseases.

Amniotic fluid oestriol concentration during the last trimester of pregnancy. I. Normal pregnancy.

Abstract. The concentration of oestriol in the amniotic fluid during the last trimester of normal pregnancy was studied. by transabdominal amniocentesis in 98 pregnant women 144 samples of amniotic fluid were collected. Only women with uncomplicated pregnancies, giving birth to normal infants at term, were included. the results and conclusions were as follows: 1) a calculation of mean levels and upper and lower 95 % probabiliy limits was done for each gestational week in the last trimester. 2) Based on this a smooth curve, indicating the normal concentration area of amniotic fluid oestriol, was drawn. 3) the amniotic fluid oestriol concentration showed little variation before the 33rd gestational week (mean 86‐145 μg/l). During the subsequent period the concentration increased to a mean between 559‐881 μg/l and a lower limit between 294 and 464 μg/l at term (38—&lt; 42 weeks). 4) Between the amniotic fluid oestriol concentration and the urinary oestriol excretion there was a highly significant correlation. Likewise, serial analyses of amniotic fluid and urinary oestriol showed the same increasing tendency during gestation. 5) Between the amniotic fluid oestriol concentration on the one hand and the infant's birth weight or sex or the weight of the placenta on the other hand there was no significant correlation. 6) Our method is suitable for clinical use, and on the basis of the normal concentration area described we intend to judge the clinical significance of the amniotic fluid oestriol assay as a measure of foetal well‐being.

Circadian rhythms of serum and urinary estrogens in pregnancy.

Diurnal variations in serum unconjugated estradiol-17β (SE2), serum total estriol (SE3), total urinary estrogens (UE), and UE/creatinine ratios (E/C) were determined on samples obtained at 4-hr intervals from 22 women in the third trimester of normal pregnancy. Analysis of variance indicated significant variations in SE2 (p < 0.001), UE (p < 0.01), and E/C (p < 0.05). Multiple comparison of means showed maximum values at 12 pm to be significantly greater than minimum values at 12 am (p < 0.01). The SE3 rhythm was less marked with individual daytime (8 am–12 pm–4 pm) means significantly greater (p < 0.001) than those at nighttime (8 pm–12 am–4 am). It is proposed that this rhythm reflects changes in availability of estrogen precursors known to be secreted rhythmically by the maternal adrenal.

Serum Levels of Total Protein, Albumin and Globulin in Woman with Hyperemesis Gravidarum

Background: Hyperemesis gravidarum is a severe type of vomiting in pregnancy which has significant effect on the health of mother and fetus. During this period various metabolic and endocrine changes occur in maternal body. Objectives: The present study has been designed to observe the serum total protein, albumin and globulin in women with hyperemesis gravidarum. Method: For this purpose 6o women with age ranging from 20 to 40 years were selected. The women with hyperemesis gravidarum were taken as case and Non pregnant nulliparous women &amp; normal pregnant women during the first trimester of normal pregnancy were taken as control group. Each group consisted of 20 women. The total protein and albumin levels were measured in all study populations against the blank at wavelength of 530 nm and 620 nm in a colorimeter. Results: The serum total protein and albumin levels were significantly (p &lt; 0.001) higher in hyperemesis gravidarum and normal pregnant women during first trimester compared to control non pregnant nulliparous women. Conclusion: Therefore the result of the present study reveals that higher levels of total protein, albumin and globulin in hyperemesis gravidarum in comparison to non pregnant nulliparous &amp; normal pregnant women due to increase thyroid hormones and also increases thyroxine - binding globulins. Key words: Serum Total Protein; Serum Albumin; Serum Globulin; Hyperemesis Gravidarum DOI: 10.3329/jdmc.v19i1.6254 J Dhaka Med Coll. 2010; 19(1) : 58-60.

Protein and human chorionic gonadotrophin in amniotic fluid in the third trimester of normal pregnancy.

Protein and human chorionic gonadotrophin in amniotic fluid in the third trimester of normal pregnancy.

Serum "Angiotensinase activity" and female steroidal hormones.

Angiotensinase activity was measured in the third trimester of normal pregnancy (15) and preeclampsia (6) in women taking taking contraceptive pills (Oracon) (21) in males who also took these pills (3) and in serum and uterine tissue from pregnant and nonpregnant rabbits serving as controls. The findings of decreased angiotensin II amide survival and increased alpha-L-aspartyl-beta-naphthylamide hydrolysis in women during the third trimester of normal pregnancy suggests a possible relationship between serum angiotensinase activity and female steroidal hormones. Confirmatory evidence was provided by similar results with the latter substrate in women receiving contraceptive pills. Synthetic estrogen but not progestogen induced increased serum naphthylamidase activity in male volunteers. Starch gel electrophoresis was similar in normal women pregnant women and women on contraceptives in the patterns of proteins and this enzyme activity. Electrophoretic studies of enzyme activity in serum and uterine tissue extracts were not demonstrated in the electrophoresis studies and increased enzyme activity in human subjects could not be correlated with plasma renin activity blood pressure or liver cell damage it seems likely that the increased aspartic naphthylamidase hydrolysis is part of a nonspecific naphthylamidase increase induced by estrogens.(Authors modified)

Determination of diamine oxidase activity in normal human blood serum.

The method with 14C-putrescine as the substrate for routine measurement of serum (plasma) diamine oxidase (histaminase) during pregnancy, and mola hydatidosa (chorionepitelioma) has been modified. The optimal experimental conditions for determination of diamine oxidase (DAO) activity in normal human blood serum are given. Normal range for serum DAO is 0 to 20 mU/1. The majority, however, grouped around 4 mU/1, i.e., about 1/500 of the serum DAO activity in the last trimester of normal pregnancy.