The physical characteristics and adaptations of women with twin pregnancies.
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Biomedical subjects
Publications and source records attributed to I MacGillivray.
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Maternal plasma levels of the trophoblast product, pregnancy-specific beta 1-glycoprotein (PS beta G), have been measured both in normal pregnancies and in pregnancies complicated by pre-eclampsia and/or fetal growth retardation. PS beta G levels correlate significantly with placental and fetal weight and fall below the normal range in about 60 per cent of all patients with fetal growth retardation. PS beta G measurements appear to give a considerably better indication of fetal size than measurements of either human placental lactogen (HPL) or plasma oestriol.
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Pregnancy-specific beta-glycoprotein (PSbetaG) is a major product of the trophoblast which has only recently been identified. Like human placental lactogen, the concentration of PSbetaG in maternal blood rises throughout pregnancy until about 34 weeks, thereafter tending to remain constant until term, with only a small day-to-day variation in individuals. The circulating maternal levels of PSbetaG between 34 weeks and term are about 200 mug/ml, 20 to 30 times greater than the levels of placental lactogen, thus allowing detection and measurement of PSbetaG by relatively simple techniques. The levels of PSbetaG are above the normal range in the majority of twin pregnancies. It is suggested that PSbetaG measurements may be useful in assessing placental function and may help in the detection of multiple pregnancies at an early stage of gestation.
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Mild preeclampsia, as defined by a rise in blood pressure to 140/90 mm Hg or more in the third trimester of pregnancy, does not affect the baby either in terms of increased perinatal mortality or a reduction in birth weight. Higher maternal weight gains are associated with greater birth weight of the babies in primigravidae, provided that proteinuria does not occur. Reduction of water retention by diuretic treatment does not lower the incidence of preeclampsia, does reduce the weight of the baby.
No differences were found at the 30th week of pregnancy in total body water, serum sodium, potassium, chloride and osmolality, plasma volume, total protein concentration, intravascular protein mass, serum albumin concentration, intravascular albumin mass, and urinary estriol and pregnanediol in 94 primigravidae who remained normotensive, 35 who developed mild preeclampsia, and 23 who developed severe preeclampsia (i.e. hypertension and significant proteinuria in the third trimester). In twin pregnancies no differences were found between 13 primigravidae who remained normotensive and nine who subsequently developed proteinuria and hypertension.
Whole blood was collected from five patients with severe pre-eclampsia, three with mild pre-eclampsia, and three with normal uneventful pregnancies. The red cells were separated and replaced. The plasma was stored until after the patients were delivered and on the sixth postpartum day they were autotransfused with plasma. This caused a rise in blood pressure in the patients with pre-eclampsia but an aliquot which was stored for six weeks and then retransfused into these patients did not cause any change in blood pressure. No blood pressure changes were found in the normal control subjects at six days or six weeks post partum. It is postulated that patients with pre-eclampsia develop altered vascular sensitivity to normal amounts of circulating pressor substance and that his sensitivity lasts for a week after delivery but not as long as six weeks.
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A 1200 calorie diet or cyclopenthiazide with potassium was given to two groups of 51 high weight gain primigravidae and baby weight and the incidence of pre-eclampsia were compared with those in a matched control group. There was no difference in the development of pre-eclampsia, but the weight of babies in the control group was higher than in the treated groups. The body fat was reduced in the diet group and the total body water in the diuretic group.
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