Biomedical subjects
Publications and source records attributed to L L Cederqvist.
The association between diethylstilbestrol (DES) exposure in utero and uterine malformations resulting in poor reproductive performance is well established. A case is presented of uterine rupture in a patient exposed to DES in utero who had no known predisposing factors for uterine rupture.
The relationship between cytomegalovirus titers and immunoglobulin (Ig) levels in 514 paired maternal-fetal sera at term was studied. Positive cytomegalovirus titers were found in 192 (37.4%) maternal sera and 138 (26.8%) fetal sera. Fetal sera with positive cytomegalovirus titers had decreased IgM levels, and maternal sera with positive cytomegalovirus titers had increased IgG levels. There was a negative correlation between cytomegalovirus titer level and IgM concentration in fetal serum and a positive correlation between cytomegalovirus titers levels and IgG concentration in maternal serum in individual samples. After removal of IgG from samples with cytomegalovirus positive titers by column chromatography, 17 maternal and 22 fetal sera remained cytomegalovirus positive.
The effect of smoking on the fetal and maternal humoral immune parameters was evaluated in cord and maternal blood, collected at delivery from 163 mothers who smoked and 130 mothers who did not smoke, and their offspring. There was no difference in time of gestation between the two groups, but the mean birth weight of the offspring of mothers who smoked was decreased, as previously observed. There were higher levels of IgA (p less than 0.01), IgM (p less than 0.001), and IgG (p less than 0.001) in cord sera of children of mothers who smoked than in the offspring of mothers who did not smoke. Mothers themselves who smoked had higher levels of IgM (p less than 0.001) and IgG (p less than 0.001), but not IgA, as compared to control mothers who did not smoke. Since cord IgA and IgM are produced by the fetus, these results could be interpreted as being due to either a higher incidence of infection in utero or metabolic differences in the children of mothers who smoke. Either of these possibilities may explain the increased frequency of postpartum endometritis, increased incidence of fetal distress, and the characteristic of meconium-stained amniotic fluid in mothers who smoke.
Immunoglobulin E (IgE) concentrations were measured in 157 paired samples of maternal-fetal sera. A correlation was found between maternal and fetal IgE levels, in contrast to earlier reports dealing with smaller series. The correlation is probably not due to placental transfer of maternal IgE but rather to genetic factors. The possible role of IgE in the fetal immune response is discussed.
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The H-Y (male) antigen is phylogenetically conserved among vertebrate species, including the species man. Previous studies have indicated the presence of a "soluble" H-Y antigen in male serum and culture fluids of male cells. We examined over 50 samples of amniotic fluid from male and female fetuses to determine if H-Y typing could be correlated with the sex of the fetus. Samples of amniotic fluid were tested to inhibit the reactivity of monoclonal antibodies in a standard H-Y assay with protein A sheep red blood cells. We found that amniotic fluids from male fetuses inhibited 40% of the reactivity and that amniotic fluids from female fetuses inhibited 0.5% of reactivity. We could also correctly identify the sex of 90% of male fetuses and 100% of female fetuses. We have not yet identified the exact nature of the inhibiting antigen(s) in the amniotic fluids, but our results clearly indicate the feasibility of fetal H-Y typing.
The distribution of values of alpha-fetoprotein (AFP) was analyzed in the cord blood of 350 newborns divided into groups according to whether their mothers were normal, preeclamptic, or smokers. In addition, fetal birth weight and fetal IgA and IgM at term were correlated with AFP. Cord serum AFP values showed a unimodal bell-shaped distribution in 269 normal newborns with a mean of 22.7 +/- 11.3 (SD) micrograms/ml. The cord sera of infants of preeclamptic mothers and of smoking mothers showed a similar mean and distribution. As previously observed, AFP was correlated inversely with birth weight. No correlation existed between AFP and fetal Ig levels.
Seventeen patients during the third trimester of pregnancy with associated immune complex disease and/or immune complex state and their infants' cord blood were investigated for the presence of immune complexes. In comparing maternal levels of immune complex in normal third-trimester pregnancies to the study group, no statistical significant difference was noted. However, levels in cord blood were significantly lower (p less than 0.0025) than levels in paired maternal samples, but were found to correlate significantly (p less than 0.002). On the basis of the immunochemical analysis of selected pairs, the conclusion is that IgG-containing immune complexes may be responsible for this observed correlation and may represent the normal physiologic situation of pregnancy, whereas IgM-containing immune complexes may represent pathologic, and, therefore, abnormal, states. The suggestion is that the presence of such IgM-containing immune complexes may become predictive of fetoplacental compromise.
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Disagreement as to whether Ig levels are high, low, or normal at different ages in different groups of trisomic children has interfered with defining the associated immunodeficiency state. Fetal Ig production was assessed by measuring cord blood IgM and IgA of five trisomy 21, 97 normal, and 37 control newborns with other birth defects. Trisomic infants showed significantly lower values. Cord blood IgG values showed no differences between groups when corrected for fetal blood weight. The data indicate that children with trisomy 21 have an impaired humoral immune response to utero.
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The recent Food and Drug Administration's approval of prostaglandin E2 (PGE2) vaginal suppositories provides the clinician with a technique for the immediate management of missed abortion and intrauterine fetal death (IUFD). During a 4-year period at our institution, 78 of 80 patients with gestations ranging from 13 to 42 weeks had pregnancy successfully terminated with PGE2 suppositories with a dose schedule of 20 mg every 2 hours. The mean interval from induction to delivery of the fetus was 8.9 hours. Fifty percent of the patients spontaneously expelled the placenta; active intervention to remove the placenta within 2 hours of delivery of the fetus is recommended to avoid excessive vaginal bleeding. The most frequently encountered side effect was a temperature elevation, which was managed by less frequent administration of the prostaglandin. Gastrointestinal side effects were minimized by premedication with antidiarrheal and antiemetic agents, which also were administered during the induction period when indicated by the patient's symptoms. A concomitant oxytocin infusion was utilized in 38 patients. In gestations of less than 24 weeks the oxytocin was administered via intravenous drip at a rate of 10 U/hour. In the case of a patient with IUFD and a gestation of 24 weeks or more, oxytocin should be administered only with a constant-rate infusion pump starting at a dose schedule of 1 mU/minute with careful titration of the dose against the monitored uterine activity. The availability of the vaginal PGE2 suppositories for missed abortion and IUFD makes it important for the clinician to fully acquaint himself with the drug, its administration, effects, and side effects.
A woman with a 7-year history of herpes progenitalis was delivered by cesarean section after herpes simplex virus was isolated from the cervix 2 weeks prior to delivery. No overt signs of herpes progenitalis had been observed during this pregnancy. At amniocentesis done the day of delivery to assess fetal maturity, herpes simplex virus was isolated from the amniotic fluid. An unaffected infant was delivered; she remains healthy at 18 months of age. Immunoglobulin levels in fetal serum and amniotic fluid did not indicate fetal infection.
A simple, specific, rapid, centrifugation-free solid phase RIA for hCG has been developed. Purified gamma-globulin isolated from antisera produced against hCG-beta in rabbits is covalently linked to glutaraldehyde-activated aminopropyl glass beads. The entire assay can be completed within 3 h at room temperature. The sensitivity (1 ng/ml), precision (intra- and interassay variabilities, less than 10% and less than 15%, respectively), and specificity (0.4% cross-reactivity with LH) are comparable to other methods. The hCG levels determined by the present method show good correlation with those obtained by another RIA and by radioreceptorassay. The present method also provides the basis for the development of similar rapid and sensitive assays of other hormones.
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