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To elucidate the involvement of MAO activity in rat pregnancy, female rats exhibiting at least 3 consecutive 4-day estrous cycles were used. The day of sperm-positive smears was designated as day 0 of pregnancy. The rats were sacrificed on day 2 of diestrus (diestrus-2) and days 7, 14 and 21 of gestation. The organs were collected and weighted, and mitochondrial fractions were prepared for MAO analysis with kynuramine dihydrobromide as substrate. Specific activity (pmol/mg of protein/min) in the ovary is significantly lower in rats on diestrus-2 (792 +/- 127) (mean +/- S.D.) than on day 14 (1,038 +/- 140) and day 21 (1,580 +/- 61) of pregnancy. However, the levels of MAO activity in the uterus of rats on diestrus-2 (899 +/- 266) is higher than on day 21 (570 +/- 80) of pregnancy. The MAO activity in the placenta on day 21 (644 +/- 82) was higher than day 14 (356 +/- 88) of pregnancy. Total MAO activity per organ (nmol/min) of ovary on day 21 (27.2 +/- 5.2) is higher than on diestrus-2 (8.7 +/- 3.0) and on day 14 (14.2 +/- 3.6). Our results suggest that MAO activity in rat reproductive organs such as uterus, ovary, and placenta might fluctuate significantly near term, in correlation with steroid levels, tissue catecholamine contents and so on, in order to maintain pregnancy.

Objective: The aim of this study was to evaluate the effect of ethanol and progesterone on the monoamine oxidase activity in cultured human term placental cells., Study Design: Human placental cells were prepared from normal human term placentas by enzymatic dispersion in Dulbecco's modified Eagle medium. The viability of placental cells prepared by our method was 90%, and the yield of placental cells was 0.6 x 10(6) cells per gram of wet placental tissue. Five milliliters of Dulbecco's modified Eagle medium containing 3 x 10(5) placental cells was plated in a 25 cm2 flask and cultured for 8 days in an incubator at 37 degrees C under an atmosphere of 5% carbon dioxide and 95% oxygen with a saturated humidity. During the culture period the culture medium was replenished every 2 days. A confluent monolayer condition was achieved after 8 days in culture. The cultured placental cells were treated with different concentrations of ethanol (0, 34.6, and 69.2 mmol/L) and progesterone (0, 16, and 32 mumol/L) on day 8 of culture for 48 hours. At the end of treatment placental cells from control and treated flasks were harvested for the analysis of monoamine oxidase activity by spectrophotometry. The effects of ethanol and progesterone on cultured placental cells were statistically analyzed by one-way analysis of variance followed by Duncan's multiple comparisons procedure., Results: A human placental cell culture system has been established from normal human term placentas. The monoamine oxidase activity in 8-day-cultured human term placental cells was significantly higher than that of freshly prepared placental cells. Ethanol concentrations at 34.6 and 69.2 mmol/L significantly increased and progesterone concentration at 32 mumol/L significantly decreased the monoamine oxidase activity., Conclusion: These results suggest that the cultured human term placental cells can be used to examine the in vitro effects of ethanol and progesterone on monoamine oxidase activity. However, the physiologic significance of progesterone's inhibitory effect and the stimulatory effect of ethanol monoamine oxidase activity in the in vivo system have yet to be further investigated.

Several advantages are apparent in the use of self-monitored or automatic ambulatory blood pressure monitoring by pregnant patients who appear to have borderline or mild hypertension. Home recordings, combined with conventional office measurements, can give a more accurate picture of the patient's dynamic blood pressure. Blood pressures are often lower outside the physician's office, probably because of the patient's increased awareness and decreased anxiety in other settings. When blood pressures are normal at home, the patient may be able to avoid antihypertensive therapy, antepartum hospitalization, and intervention during her pregnancy. Monitoring at home or work also provides a more thorough screening for preeclampsia, especially with patients who have chronic hypertension or other predisposing conditions.

Preeclampsia is a syndrome of unknown etiology characterized by the sequential development of facial and hand edema, hypertension, and proteinuria after the 20th week of gestation. Patients with preeclampsia may progress to a seizure-like state: The patient is then said to have eclampsia. The major goal of prenatal care is detecting the early onset of preeclampsia and to activate aggressive therapy to prevent severe complications either for the mother or the fetus. There currently are no specific forms of therapy to prevent the disease.

In order to study the effect of gossypol on the monoamine oxidase (MAO) activity in pregnant rat organs, 20 day pregnant rats were sacrificed, and MAO activity/0.02 g tissue of several organs and total MAO activity/organ, were determined. The control group (n = 5) were injected with vehicle intramuscularly on the 17th, 18th and 19th day of pregnancy, and the gossypol treated group (n = 4) were injected with gossypol acetic acid (GAA) (25 mg/kg of body weight) intramuscularly on the 17th, 18th and 19th day and were decapitated on the 20th day of pregnancy. Maternal liver, uterus, placenta, and fetal liver were collected and examined. In placenta, total MAO activity/organ was significantly (p less than 0.05) lower in the GAA treated group than that in the control group. However, in maternal liver, uterus and fetal liver, there was no significant difference in total MAO activity/organ between the two groups. There was no significant difference in MAO activity/0.02 g tissue (specific activity), weight of organ, protein weight/organ and protein/g tissue between the two groups in maternal liver, uterus, placenta and fetal liver. These results suggest that, after intramuscular injection of GAA, total MAO activity/organ in the placenta of pregnant rats might decrease significantly.

Portable electronic and mechanical aneroid instruments for blood pressure self-monitoring are available, inexpensive, and reasonably accurate. Instructing the patient at risk for borderline, mild hypertension or chronic hypertension during pregnancy on self-monitoring of blood pressure has advantages. Combined with conventional office measurements, many daily recordings give an accurate picture of an individual's dynamic blood pressure. Lower blood pressures commonly found outside the office are likely attributable to an increased awareness, less anxiety, and attention by the patient to nonpharmacologic factors. Such persons may well avoid antihypertensive therapy or antepartum hospitalization. This information provides a strong incentive to undertake and adhere to an appropriate plan of treatment for those patients whose hypertension is confirmed by blood pressure self-monitoring technique. We consider blood pressure self-measurement to complement other reported monitoring techniques for active patient participation at home or in the work setting. It also permits an early evaluation of blood pressure alterations to rule out preeclampsia, especially in the pregnant patient with chronic essential hypertension.

Human placental explant was cultured, using fresh full term placenta delivered by elective cesarean section (n = 10), and monoamine oxidase (MAO) activity was measured in the tissue by the spectrophotometric method. Placentae were obtained from patients without complications in pregnancy. Chorionic villi 2 g was incubated for 3 hr under the 95% air-5% CO2 humidified condition at 37 degrees C. When progesterone was added in the media (100-500 micrograms/ml), MAO activities significantly decreased, compared with the control. The gossypol (100 micrograms/ml) treated group showed no inhibitory or stimulatory effects on MAO activities, compared with the control. However, progesterone (100-500 micrograms/ml) and gossypol (100 micrograms/ml) treated group showed the same value of MAO activities, compared with the control. Those results indicate that gossypol might block progesterone action which is inhibitory against MAO activity. The mechanism of pharmacological function of gossypol was discussed.

Protein synthesis of human placenta from cesarean section was analyzed by SDS gel electrophoresis using full term cell culture system. The qualitative pattern of cytoskeletal proteins before and after culture was also examined. After trypsinization, cytotrophoblasts were cultured for 20 days in the humidified incubator of 5% CO2 in 95% air. The confluency was obtained in 10 days after inoculation. The pattern of SDS-PAGE showed several protein bands including actin (43,000 Da) and desmin (55,000 Da) as major constituents of 12 and 20 day cultures. The significant differences between band appearances in samples before and after culturing were noted. The present results indicated that myosin may not be synthesized in high content, differing from previous observations. Cytoskeletal protein production seemed to be markedly enhanced in the cultured system.

The aim of the present experiments was to investigate a possible correlation between the occurrence of preeclampsia and the levels of norepinephrine in human myometrial biopsies obtained from the lower uterine segment at the time of cesarean section. Norepinephrine was measured directly by the technique of muscle CATS, and indirectly by measuring the effect of their release on the K(+)-induced force development of the myometrial strip. Two distinct types of force development depending on the level of endogenous norepinephrine were observed, but they were not correlated with the development of preeclampsia. This was confirmed by the absence of correlation between uterine norepinephrine levels and the occurrence of preeclampsia. Therefore, no correlation between myometrial catecholamine content and the development of preeclampsia could be demonstrated.

A noninvasive technique in an animal model that consistently produces severe intrauterine growth retardation in the Sprague-Dawley rat is described. Maternal rats were exposed continuously to a hypoxic environment (9.5% oxygen) between days 10 and 22 of gestation. This oxygen concentration was marginal for the survival of the Sprague-Dawley rat fetus. The results demonstrate decreases of 61% in litter size, 36% in fetal body weight, and 23% in fetal brain weight. The effect of hypoxia was differentiated from that of a reduced voluntary food intake by the maternal rats occurring simultaneously during the period of hypoxic exposure.

The effect of a pharmacologic dose of estrogen on brain monoamine systems in the rat fetus was determined using a semiquantitative measure of histofluorescence. Pregnant rats received a subcutaneous injection of cottonseed oil alone or estradiol (E2) in cottonseed oil just before the monoamine systems began to develop. The fetuses were delivered abdominally and killed on day 22 of gestation. A study of four major monoamine areas of the brain with a glyoxilic acid preparation showed that intrauterine exposure to E2 has a significant effect on the monoamine organization of the fetal hypothalamus. No treatment effects were noted in the areas of locus coeruleus, substantia nigra and corpus striatum. The litter sizes of the E2-treated rats and the body weights of the fetuses were much lower than those of the control group. The effect of E2 on monoamine distribution in the fetal hypothalamus may explain the reported disturbances of reproductive function and sexual behavior seen after perinatal exposure to high doses of estrogen in humans.

Two cases of acute spontaneous rupture of uterine ovarian veins during the third trimester of pregnancy are reported. This condition has an obscure etiology and a relatively infrequent incidence and has been associated in the past with very high maternal and fetal mortality. The clinician is faced with both a puzzling diagnostic dilemma and a perplexing management scheme.

The natural course of signs and laboratory test findings indicative of bacterial vaginosis was followed in an observational noninterventive 6-month longitudinal study of 270 asymptomatic women. Only the minority of positive Gardnerella vaginalis cultures (5 of 33), wet mount clue cells (5 of 14), sniff tests (3 of 11), Papanicolaou smear clue cells (0 of 5), and discharge consistent with bacterial vaginosis (11 of 49) persisted in the absence of therapy. While these four laboratory parameters as well as chromatographic succinate/lactate ratios (performed only on the final visit) were abnormal significantly more often in patients with abnormal discharge than in those with normal discharge (p = 0.006, p less than 0.0001, p less than 0.0001, p = 0.0003, and p = 0.002, respectively), all were insensitive predictors of abnormal discharge with sensitivities ranging between 10.6% and 20.2% and abnormal test predictive values between 30.6% and 65.2%. We conclude that G. vaginalis represents indigenous flora in some normal women and that therapy is unwarranted for the incidental finding of a positive laboratory indicator of bacterial vaginosis in the patient without symptoms.

Plasma epinephrine and norepinephrine were measured throughout pregnancy in an ambulatory population of normal and untreated chronically hypertensive pregnant women. There was no significant difference between trimesters for plasma epinephrine, norepinephrine, or the ratio epinephrine/norepinephrine in either the normal or chronically hypertensive group. In the first trimester of pregnancy, women with chronic hypertension demonstrated a significantly higher plasma norepinephrine and a significantly lower epinephrine/norepinephrine ratio than normal women.

The lecithin/sphingomyelin ratio in amniotic fluid is a method of predicting fetal lung maturity. The L/H ratios in certain high risk pregnancies are poorly correlated with the shake test. The L/S ratios in drug addiction methadone pregnancies and diabetic pregnancies do not have a high degree of correlation with normal L/S ratios after 36 weeks of gestation and are often low.

A pregnant patient in the midtrimester of pregnancy was begun on a methadone detoxification program. The fetal neurobiologic response was monitored by serial amniotic fluid amines (epinephrine and norepinephrine). The detoxification program showed a marked fetal response of the adrenal gland (E) and sympathetic nervous system (NE) that was blunted when the methadone dose was increased. Detoxification during pregnancy is not recommended unless the fetus can be biochemically monitored.

Nine patients with prolonged, preterm premature rupture of the membranes (PROM) had associated abruptio placentae confirmed at delivery. Antepartum vaginal bleeding during the course of expectant management was the most common feature in the clinical course of the patients who developed abruptio placentae. Other clinical and laboratory findings suggesting the diagnosis were not present consistently. Retrospective analysis of all patients with prolonged, preterm PROM led to an estimated risk of 4% for the development of abruptio placentae during the course of expectant management of such patients. This risk estimate is three to eight times greater than that for the development of abruptio placentae in pregnancy generally. A high index of suspicion for abruptio placentae is appropriate when patients with prolonged, preterm PROM develop vaginal bleeding or any other suggestive clinical signs or symptoms of abruptio placentae during the course of expectant management.

We have measured the absorbance of centrifuged amniotic fluids at 650 nm. and found reasonably good correlation between the absorbance and the L/S ratio. In 87 fluids studied, an absorbance of greater than 0.100 predicted correctly an L/S ratio of 2 or more in 98 per cent of the cases. When the absorbance was less than 0.100, 70 per cent of the fluids had an L/S ratio of less than 2.

This point of view encountered in the treatment of pregnancy-induced hypertension enumerates the most common problems encountered when treating the disease. These problems include: terminology, etiology and pathogenesis, known facts, failure to identify the patient, loss of life for mother and baby, complications, recognition of early disease, and treatment not uniform or individualized. The severe forms of the disease are preventable and should never occur, but once present they should yield a zero maternal mortality rate and a fetal salvage of greater than 90%. Proper therapy of severe disease is primarily the use of pharmacologic doses of magnesium sulfate given intravenously and the prevention of a cerebral vascular accident in the mother. Induction of labor and removal of the products of conception will cure the disease.

The role of subspecialties in obstetrics and gynecology was evaluated by a mail questionnaire to department chairpersons, members of the American Gynecological and Obstetrical Society, nonuniversity directors of obstetrics and gynecology residency programs, and others. Results from the questionnaire were evaluated by conventional statistical methods. The issues identified included subspecialties and the further development of our specialty in role modeling, enhanced education for both residents and students, and the recruitment of a higher-quality resident for our specialty. Additional issues included: Were subspecialties a mistake, and have they fragmented our specialty? Some of the results include the following: (1) More than 90% of respondents agree that subspecialties have helped in the development of obstetrics and gynecology. (2) The subspecialties have enhanced our image in medical schools (88%) and in the community hospitals (77%). (3) The education of medical students (73%) and of residents (86%) has been enhanced by the development of subspecialties. (4) As predicted, the subspecialties have fragmented our specialty (69%), but patient care has not suffered. (5) Disagreement is noted between chairpersons and other respondents that a higher-quality resident is going into subspecialties, but all agreed that the improved quality of residents was due to the development of subspecialties. (6) Only 10% of respondents wished subspecialties had never been developed as contrasted to 82% of all respondents who felt they were commendable. (7) If another subspecialty area is to be identified, more respondents prefer reproductive urology than the next two areas combined.

Serial plasma, amniotic fluid, and urine samples were analyzed for epinephrine (E) and norepinephrine (NE) in eight subjects during midtrimester abortion induced by intra-amniotic prostaglandin F2alpha (PGF2alpha). After PGF2alpha administration, plasma E increased and there was no change in plasma NE levels. Amniotic fluid levels of E and NE decreased initially. During the course of abortion the mean level of E in the amniotic fluid increased after fetal distress and decreased after fetal death, indicating that the midtrimester fetus of both E and NE increased following PGF2alpha. The observation that mean plasma levels and urinary excretion rate changes correlated better with the course of abortion and uterine contractility rather than with the time of PGF2alpha administration was consistent with the hypothesis that the catecholamine response may be due to the stress of labor rather than to the PGF2alpha per se.

In the pregnant rat, carbachol-induced phosphoinositol hydrolysis by myometrium at the placental attachment region progressively decreased toward term, whereas hydrolysis was relatively stable in the myometrium of the non-attachment region. Tritium-quinuclidinyl benzilate binding increased in the myometrium of non-attachment regions as pregnancy progressed. At placental attachment sites binding remained relatively stable until parturition when it increased. Apparently the myometrium associated with the placental attachment site is less sensitive to cholinergic influence during pregnancy compared with the non-attachment site when evaluated by muscarinic activation of phospholipase C or ligand binding.

The adrenergic innervation to the vasculature of the pregnant human uterus was studied by means of glyoxylic acid histofluorescence staining. Catecholamine fluorescent nerves are observed in the myometrium and walls of the vasculature in deep biopsies taken from the uterine isthmus and placental bed.

Forty-seven of 52 women with pregnancy-induced hypertension completed a protocol consisting of 4 gm of hydrocortisone given over 24 hours (1 gm every 8 hours). All patients' fetuses were less than 36 weeks' gestation and had an immature lecithin sphingomyelin ratio (less than 2). The hydrocortisone was given to reduce the incidence of respiratory distress syndrome. The admitting systolic blood pressure was 148.8 +/- 21.8 torr and diastolic was 105.6 +/- 18.9 torr. Blood pressure change was compared before, during, and after treatment. This study demonstrates no aggravating effect on maternal blood pressure even in severely hypertensive (blood pressure = 160/110 torr) patients.

Six cases of ovarian hemorrhage secondary to anticoagulant therapy are described. Cardiac valvular prostheses required the use of oral anticoagulants in four patients in this series; the other two suffered a pulmonary infarction secondary to thromboembolism and required sustained anticoagulant therapy. Pertinent data from 28 other case reports are reviewed. Awareness of this syndrome during child-bearing years, early recognition, and aggressive management should prevent a fatal outcome.

Urinary amines were measured in 122 drug-addiction pregnancies. The profile of the patient indicates that 86 per cent were black and had a total of 2.98 pregnancies and 1.97 living children. She made 5.4 prenatal visits to our special drug-abuse prenatal clinic. The 208 antepartum 24 hour urine determinations indicated a mean excretion of epinephrine to be 28 +/- 1.6 mug which rises to 60 mug on the first day post partum. These values indicate increased adrenal gland activity and are more than six times greater than seen in normal pregnancy. The antepartum mean 24 hour urine excretion of norepinephrine is 49.7 +/- 2.6 mug which does not change on the first postpartum day. The antepartum norepinephrine values are 50 per cent higher than seen in normal pregnancy. Drug-addiction pregnancy in patients who are well controlled on methadone have markedly increased adrenal gland activity as evidence by increased levels of epinephrine. The sympathetic nervous system activity as evidenced by urinary norepinephrine is only slightly increased. Drug addiction alters the normal homeostatic mechanisms of pregnancy.

Amniotic fluid from different gestational age patients was partitioned into neutral, acidic and basic fractions. The organic acids were trimethylsilylated and analyzed by glass capillary gas chromatography-mass spectrometry. A marked difference in the level of hippuric acid was observed between samples from early (15-22 weeks) and late (30-38.5 weeks) pregnancy. This difference probably reflects the degree of maturity in the fetal liver and kidney. The procedures establish amniotic fluid profiles of substances of varying gestational age and should be useful in determining alterations caused by diseases.

Eight smokers and seven nonsmokers between the ages of 20 and 38 years were studied. None of these patients was pregnant. Three smokers and two nonsmokers were not taking oral contraceptives, as contrasted by three nonsmokers and four smokers taking oral contraceptives. Results approached statistical significance for urinary norepinephrine (p = 0.15) and epinephrine (p = 0.07) when the groups were compared. The values for nonsmoking/noncontraception tended to be low but, unexpectedly, the values for smoking/contraception also were low. When the smoking subjects (six of seven) stopped there was a significant decline in norepinephrine (p = 0.02) and the epinephrine decline approached significance (p = 0.08). The study does not show any synergistic effect of oral contraceptives and smoking but demonstrates that the smoker can diminish stimulation of the adrenal gland (epinephrine) and sympathetic nervous system (norepinephrine) if she will stop smoking.

Hydrocarbons of the human ovary and Fallopian tube have been studied by temperature-programmed gas chromatography. The major compounds present are a series of n-alkanes (C16 to C40), with the addition of iso and anteiso hydrocarbons. The human ovary and Fallopian tube hydrocarbons did not show significant changes during the menstrual cycle.

Fetomaternal hemorrhage can result from different types of trauma and may be followed by fetal anemia, fetal death, or isoimmunization. We prospectively studied the frequency and volume of fetomaternal hemorrhage, fetal well-being, abruptio placentae, and fetal outcome in 32 pregnant patients suffering recent trauma. Fetomaternal hemorrhage occurred in nine of 32 trauma patients (28%) with a mean volume of 16 ml +/- 14.3(SD). There was a statistically significant difference in the frequency and mean volume of fetomaternal hemorrhage in this group over that in gestational-age-matched controls. Neither the nature of the trauma nor the gestational age was related to the frequency or volume of fetomaternal hemorrhage. The outcome in three of the nine trauma patients who sustained fetomaternal hemorrhage was poor; fetal anemia, paroxysmal atrial tachycardia, and fetal death occurred in each one. Maternal trauma remains a significant cause of maternal and fetal morbidity and death, and the use of the Kleihauer-Betke analysis is indicated to identify fetomaternal hemorrhage. Rh-immune globulin therapy should be given to Rh-negative patients with fetomaternal hemorrhage.