We studied the cause of the low serum progesterone, 17 beta-estradiol, and 17-hydroxyprogesterone levels that occur in women with an ectopic pregnancy. Only women who had been amenorrheic for less than 8 weeks were studied in order to assess corpus luteum rather than placental biosynthesis of these steroids; each woman with an ectopic pregnancy was matched to a woman with a normal intrauterine pregnancy on the basis of serum intact hCG levels within 10% of one another to obviate the influence of different levels of this luteotropic hormone. Every woman with an ectopic pregnancy had lower serum progesterone, estradiol, and 17-hydroxyprogesterone levels than her matched normal pregnant pairmate (median values: progesterone, 27.9 vs. 83.5 mmol/L; estradiol, 0.36 vs. 1.79 nmol/L; 17-hydroxyprogesterone, 4.95 vs. 22.1 nmol/L, respectively; all P less than 0.002). The ratios of intact hCG, measured by immunoradiometric assay, to hCG, measured by a hCG beta-specific RIA, were similar in the two groups. Serum hCG bioactivity was assayed by measuring the ability of serum to stimulate testosterone secretion from mouse Leydig cells. The mean biological to intact immunological hCG ratios were 2.06 +/- 1.39 (+/- SD) for ectopic pregnancy and 1.91 +/- 0.81 for normal pregnancy (P greater than 0.05). The biological hCG to immunoreactive hCG beta ratios were 1.98 +/- 0.75 and 2.02 +/- 0.82, respectively. Serum hCG from both groups of women stimulated cAMP generation by testicular cells similarly. We conclude that the lower serum steroid levels in women with ectopic pregnancy cannot be explained by altered hCG bioactivity. The lower steroid levels may thus reflect a primary defect of the corpus luteum, absence of another stimulator of ovarian steroid biosynthesis, or more subtle alterations in hCG glycosylation which are important in vivo but not assessed by the in vitro bioassay.
Summary. Oxytocin was measured by a specific and sensitive radio‐immunoassay in plasma and amniotic fluid after extraction with Sep‐Pak cartridges in patients undergoing elective caesarean sections, normal labour and labour induced with oxytocin infusion or prostaglandins. In maternal plasma, levels of oxytocin correlated with the period of gestation; concentrations at term were significantly higher than in the first two trimesters. Maternal plasma levels of oxytocin before the onset of contractions were not significantly different from those at the onset of spontaneous labour or at full cervical dilatation. Levels of oxytocin in patients induced with oxytocin were not statistically different from levels observed in spontaneous labour. Amniotic fluid oxytocin levels were not significantly different between the groups either at the onset of labour or immediately before delivery. Umbilical arterio‐venous differences in oxytocin were present in all groups except the prostaglandin‐induced group. Increased prostaglandins associated with the onset of normal labour are probably not a consequence of changes in oxytocin concentrations.
Mobilization of arachidonic acid from glycerophospholipids and prostaglandin (PG) release from fetal membranes were studied in women with dysfunctional labor in the absence of cephalopelvic disproportion or fetal malposition. Using superfusion of intact amnion and chorion, we found a slight decrease in PGE and a more significant decrease in PGF release by the amniotic side of the fetal membrane obtained from women with dysfunctional labor compared to that in women with normal labor (PGE: normal labor, 2992 pg/cm2.h; dysfunctional labor, 1846 pg/cm2.h; P less than 0.05; PGF: normal labor, 662 pg/cm2.h; dysfunctional labor, 204 pg/cm2.h; P less than 0.02). Release of both prostanoids was significantly greater from the amniotic side in tissues obtained after labor compared to that in prelabor tissue. Analysis of arachidonic acid (by gas liquid chromatography) and phospholipid content (by two-dimensional thin layer chromatography) confirmed metabolic disposal of arachidonic acid from the amnion after the onset of labor. However, no difference in either phospholipid or phospholipase A2-releasable arachidonic acid of individual phospholipid classes was found in amnion tissue from women with normal and dysfunctional labor, suggesting similar activities of phospholipase A2 in these two groups. The finding of decreased free and phospholipase A2-releasable arachidonic acid of the total lipid extract of the amnion of women with dysfunctional labor could suggest further metabolic exhaustion of the substrate or failure of liberation of this fatty acid from glycerophospholipids by enzymes other than phospholipase A2, such as phospholipase C or diacyl and monoacylglycerolipases.
Short oral presentation abstracts Methods: A series of 15 consecutive women diagnosed with RTT and EMV with a PSV > 50 cm/sec. All underwent an ultrasound guided surgical removal under general anesthesia. The blood loss during the procedure was recorded. A second ultrasound to re-evaluate the vascularity within the myometrium was performed within 4 hours after the procedure. All patients were discharged within 24 hours and seen at follow-up within 2 months. Results: Five patients had RTT after a term delivery, 5 after a spontaneous first trimester miscarriage and 5 after first trimester termination of pregnancy elsewhere. The PSV in the area of EMV at diagnosis ranged from 53.1 to 152.6 cm/sec (mean 100.8 cm/sec). The estimated blood loss (EBL) at surgery ranged from 30 mL to 750 mL (mean 170 mL). After surgery the PSV in the myometrium dropped dramatically (range 0-35.2). The patient with the highest blood loss (750 mL) had a PSV of 104.9 cm/sec. The patient with the highest PSV (152.6 cm/sec) had an EBL of 200 mL. In all cases trophoblastic tissue was confirmed on histology. There were no postoperative complications and there was no need for repeat surgery for incomplete removal of RTT. Conclusions: Although surgical removal of RTT was uneventful in most cases, heavy bleeding has to be anticipated in case of high velocity flow in the myometrium underlying residual trophoblastic tissue. Doppler examination of the blood flow in the myometrium to detect EMV in women scheduled for surgical removal of RTT seems therefore clinically relevant. Accordingly, in cases of EMV, we advocate surgical removal of the residual tissue under ultrasound guidance by an experienced surgeon and in the presence of a fully informed anesthesist.
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