RESUMEN
OBJECTIVE: To compare direct intra-amniotic injection of betamethasone and thyroxine (T4) with maternal treatment and controls for accelerating pulmonary surfactant production. METHODS: Twelve pregnant monkeys (Macaca mulatta) on gestational day 125 (term 165 +/- 10 days) had surfactant protein A and B concentrations measured in amniotic fluid. In four controls, normal saline was injected into the amniotic fluid; four others (intra-amniotic) received intra-amniotic betamethasone (1 mg) and T4 (60 microg); and in four others (maternal), the dam was given betamethasone (12 mg) intramuscularly, repeated in 24 hours, plus TRH (400 microg) intravenously, repeated every 6 hours for 24 hours. Seventy-two hours after the initial amniocentesis, a hysterotomy was performed and fetal tissue and amniotic fluid harvested for determination of surfactant protein A and B concentrations and immunohistochemical staining for surfactant protein A. RESULTS: Amniotic fluid surfactant protein A was higher with intra-amniotic injection than with maternal treatment (P <.04) or controls (P =.07). Amniotic fluid surfactant protein B was higher in the intra-amniotic group than in controls (P =.06). Immunohistochemical staining for surfactant protein A in the lung tissue was increased in the intra-amniotic group compared with controls (0.145 +/- 0.01 versus 0.097 +/- 0.001, percent positive staining for surfactant protein A cells per lung tissue cells; P <.03). Birth weight was greater in the intra-amniotic group compared with the maternal group (P <.03) although not different from the controls. Finally, gut motility and the presence of formed meconium were increased in the intra-amniotic group compared with the other groups (P <.05). CONCLUSION: Intra-amniotic injection of betamethasone and T4 enhanced lung (and possibly intestinal) maturation of the preterm rhesus fetal monkey compared with maternal injections.
Asunto(s)
Líquido Amniótico/química , Betametasona/farmacología , Glicoproteínas/biosíntesis , Precursores de Proteínas/biosíntesis , Proteolípidos/biosíntesis , Surfactantes Pulmonares/biosíntesis , Tiroxina/farmacología , Animales , Betametasona/administración & dosificación , Femenino , Inmunohistoquímica , Inyecciones , Macaca mulatta , Embarazo , Proteínas Asociadas a Surfactante Pulmonar , Tiroxina/administración & dosificaciónRESUMEN
OBJECTIVE: The aim of this study was to characterize the increases of salivary estriol concentrations before the onset of labor at term. STUDY DESIGN: Salivary estriol concentrations were measured in weekly patient-collected samples by means of a sensitive (mean +/- SD threshold, 0.025 +/- 0.001 ng/mL; coefficient of variation, 3.8%) direct enzyme immunoassay in a microtiter plate format. The salivary estriol concentrations in 16 healthy pregnant women were characterized from 30 weeks' gestation until the time of parturition and delivery. Samples were stored frozen at collection and analyzed in batches after delivery. RESULTS: The median salivary estriol concentration profile revealed a nonlinear rise beginning from 30 weeks' gestation (0.89 ng/mL) until term (2.70 ng/mL, an increase of 201%). At 35 weeks' gestation the salivary estriol concentration median value increased sharply (positive inflection point, 50%-93% increase) at a demarcation between a slower increase during early pregnancy and a more rapid increase during late pregnancy. This positive inflection point associated with a late pregnancy increase characterized subgroups of pregnancies according to the lengths of gestation as follows: early term (delivered at <38 weeks 1 day's gestation), middle term (delivered at 38 weeks 1 day-40 weeks' gestation), and late term (delivered at >40 weeks' gestation). Five weeks before delivery the mean (+/-SEM) rate of rise in salivary estriol concentration was 0.50 +/- 0.13 ng/mL per week to 0.84 +/- 0.26 ng/mL per week in the early term group. The increase in rate for the middle term group was 0.32 +/- 0.06 ng/mL per week to 0.37 +/- 0.26 ng/mL per week, whereas in the late term group the rate of salivary estriol concentration rise was 0.37 +/- 0.03 ng/mL per week to -0.03 +/- 0.25 ng/mL per week. CONCLUSION: These data demonstrate in normal pregnancies (1) that a direct, nonradiometric measure of salivary estriol concentration can be used to monitor the late pregnancy increase in estriol production, (2) that 35 weeks' gestation marks a positive inflection point of the onset of increased estriol production, and (3) that the late pregnancy rise in salivary estriol concentration shows distinct patterns that tend to be characteristic of the length of pregnancy. These data support the concept that the rate of increase of estriol production is related to the timing of the onset of labor.
Asunto(s)
Estriol/biosíntesis , Trabajo de Parto/metabolismo , Saliva/metabolismo , Adulto , Estriol/análisis , Femenino , Edad Gestacional , Humanos , Cinética , Trabajo de Parto Inducido , Embarazo , Saliva/químicaRESUMEN
BACKGROUND: Infants delivered by vacuum extraction or other operative techniques may be more likely to sustain major injuries than those delivered spontaneously, but the extent of the risk is unknown. METHODS: From a California data base, we identified 583,340 live-born singleton infants born to nulliparous women between 1992 and 1994 and weighing between 2500 and 4000 g. One third of the infants were delivered by operative techniques. We evaluated the relation between the mode of delivery and morbidity in the infants. RESULTS: Intracranial hemorrhage occurred in 1 of 860 infants delivered by vacuum extraction, 1 of 664 delivered with the use of forceps, 1 of 907 delivered by cesarean section during labor, 1 of 2750 delivered by cesarean section with no labor, and 1 of 1900 delivered spontaneously. As compared with the infants delivered spontaneously, those delivered by vacuum extraction had a significantly higher rate of subdural or cerebral hemorrhage (odds ratio, 2.7; 95 percent confidence interval, 1.9 to 3.9), as did the infants delivered with the use of forceps (odds ratio, 3.4; 95 percent confidence interval, 1.9 to 5.9) or cesarean section during labor (odds ratio, 2.5; 95 percent confidence interval, 1.8 to 3.4), but the rate of subdural or cerebral hemorrhage associated with vacuum extraction did not differ significantly from that associated with forceps use (odds ratio for the comparison with vacuum extraction, 1.2; 95 percent confidence interval, 0.7 to 2.2) or cesarean section during labor (odds ratio, 0.9; 95 percent confidence interval, 0.6 to 1.4). CONCLUSIONS: The rate of intracranial hemorrhage is higher among infants delivered by vacuum extraction, forceps, or cesarean section during labor than among infants delivered spontaneously, but the rate among infants delivered by cesarean section before labor is not higher, suggesting that the common risk factor for hemorrhage is abnormal labor.
Asunto(s)
Traumatismos del Nacimiento/etiología , Parto Obstétrico/efectos adversos , Hemorragia Intracraneal Traumática/etiología , Traumatismos del Nacimiento/epidemiología , California/epidemiología , Cesárea/efectos adversos , Parto Obstétrico/métodos , Distocia/complicaciones , Extracción Obstétrica/efectos adversos , Femenino , Humanos , Recién Nacido , Hemorragia Intracraneal Traumática/epidemiología , Masculino , Paridad , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Extracción Obstétrica por Aspiración/efectos adversosRESUMEN
OBJECTIVE: To investigate whether intramembranous absorption occurs in the rhesus monkey and its role in amniotic fluid (AF) volume regulation as a possible model for the human fetus. MATERIALS AND METHODS: We studied five chronically catheterized rhesus monkey fetuses (Macaca mulatta) at 126 +/- 1 (standard error) days' gestation (term approximately 165 days) with ligated esophagi and catheterized tracheae. Samples (0.5 mL each) of fetal and maternal blood and amniotic and lung fluid were collected at 0, 15, 30, 60, 120, 180, and 240 minutes after injection of 0.1 mCi (3 mL) of technetium-99m (Tc-99m) into the amniotic cavity. RESULTS: In spite of esophageal ligation, there was a rapid absorption of the Tc-99m into the fetal circulation within 15 minutes of injection. The maternal Tc-99m activity increased in parallel to fetal activity but remained lower. The fetal lung fluid Tc-99m activity increased more slowly but was equivalent to the fetal circulating level by 4 hours. CONCLUSIONS: These results suggest that intramembranous absorption occurs and may play an important role in rhesus AF volume regulation and composition. Furthermore, this animal model, which closely resembles the human, may provide valuable insight into abnormalities of human AF volume regulation.
Asunto(s)
Líquido Amniótico/fisiología , Membranas Extraembrionarias/fisiología , Macaca mulatta/fisiología , Preñez/fisiología , Animales , Femenino , EmbarazoRESUMEN
OBJECTIVE: This study examined the movement of the soluble ion technetium Tc 99m across the ovine placenta and intramembranous pathway. STUDY DESIGN: Nineteen fetal sheep at 131 +/- 1 (SE) days' gestation were studied. After a 1-hour control period technetium Tc 99m was injected into either a fetal vein (n = 7), the amniotic cavity (n = 5), or a maternal vein (n = 5). Maternal and fetal blood, fetal urine, and amniotic and allantoic fluid were sampled during the control period and for 8 hours after the injection. Fetal urine was drained externally throughout the experiment. In five animals technetium Tc 99m was injected intraamniotically after the fetus was killed with air emboli and sampled as described. RESULTS: Intrafetally injected technetium Tc 99m rapidly crossed the placenta; then it entered and was concentrated in the amniotic cavity. Intraamniotically injected technetium Tc 99m rapidly entered into the fetal circulation. The maternally injected technetium Tc 99m rapidly crossed the placenta into the fetus, suggesting a half-time for placental exchange of < 50 minutes. The technetium Tc 99m injected into the dead fetus group demonstrated significantly less maternal absorption than in the live fetus group. CONCLUSIONS: The soluble ion technetium Tc 99m demonstrated a much more rapid movement in both directions across the ovine placenta then previously demonstrated for the smaller ion sodium. Technetium Tc 99m rapidly crossed the intramembranous pathway bidirectionally, suggesting a high permeability of the intramembranous pathway. Minimal maternal absorption of technetium Tc 99m in the dead fetus group suggests little transmembranous absorption by the mother.