No abstract

Objectives-To examine the deportation of trophoblast cells into the maternal blood in pre-eclamptic (gestational proteinuric hypertension) and normal pregnancy. Design-The monoclonal anti-cytokeratin antibody JMB2 was used in the APAAP technique to label trophoblast cells in cell smears of uterine vein blood obtained at caesarean section. Subjects-10 women with proteinuric pre-eclampsia requiring caesarean section, 10 pregnant women requiring elective caesarean section for reasons other than pre-eclampsia and five control women who had never been pregnant. Results-Three populations of trophoblast cells were identified; two mononuclear cytotrophoblast types with diameters varying from 11-14 pm and 19-25 Krn respectively, and multinucleated syncytiotrophoblast cells varying in size from 23-88 pm. Women with prc-eclampsia had more trophoblast cells in uterine vein blood than were found in pregnant women without pre-eclampsia. There was no correlation between the numbers of trophoblast cells and the stage of gestation or severity of the pre-eclampsia, although an acute maternal or fetal event necessitating delivery was associated with increased deportation of trophoblast. Mononuclear cytotrophoblast cells were detected in the peripheral blood of only 1 of 5 pre-eclamptic patients, despite their presence in the uterine vein blood of all 5 women. Conclusions-Trophoblast deportation is increased in pre-eclarnptic pregnancy, with both cytotrophoblast and syncytiotrophoblast present in the uterine vein blood, but there is no correlation with the seventy of the disease. In some cases cytotrophoblast may also enter the peripheral circulation.Pre-eclampsia, otherwise known as gestational proteinuric hypertension (GPH), is a syndrome that develops during pregnancy, labour or the early puerperium. It is recognised that the maternal and fetal clinical symptoms and signs are secondary manifestations of the disease, but Harris Birthright Pre-eclampsia Research Unit, Nuffield Department of Obstetrics 81 Gynaerology, John Radcliffe Hospital, Oxford OX3 9DU S. CHUA Clinicul Reseurch Fellow T. WILKINS Senior MLSO 1. SARGENT Lecturer C . REDMAN Clinical Reader

Objective To analyse activation of maternal peripheral blood leukocytes by flow cytometric measureDesign Case-control study.Setting High risk pregnancy service in a regional centre. Materialments of intracellular free-ionised calcium of lymphocytes, granulocytes and monocytes, separately.Samples from 10 women with pre-eclampsia, 10 appropriately-matched women with normal pregnancy, nine multigravid normal women at mid-gestation selected as being least likely to demonstrate any tendencies towards pre-eclampsia, and 1 1 healthy nonpregnant women of reproductive age were studied.Methods Using flow cytometry, intracellular free ionised calcium ([Ca2+],) was estimated by loading the cells with Fluo-3 and measuring the changes in fluorescence intensity induced by free ionised calcium. After the basal levels were measured, the response of phagocytes to stimulation with n-formylmethionyl-leucyl-phenylalanine (fMLP) was determined. Main outcome measures Basal [Ca2+], of peripheral blood leukocytes.Results Median basal [Ca?+], was significantly increased in all three subsets of leukocytes-lymphocytes, granulocytes and monocytes in pre-eclampsia-compared with the three control groups. Samples from both groups of women with normal pregnancy did not differ from those from nonpregnant women. The peak responses of monocytes to stimulation with 10 nmol fMLP were greater in samples from pre-eclamptic women, giving evidence of priming.Conclusions Peripheral blood leukocytes are activated in pre-eclampsia in terms of basal changes in the intracellular second messenger-free ionised calcium. Peripheral blood monocytes are primed to give greater responses after stimulation with fMLP.

No abstract