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Biomedical subjects

U Ekblad

Publications and source records attributed to U Ekblad.

At least 19 recordsLinked to original sources

Maternal weight, weight gain during pregnancy and pregnancy outcome.

OBJECTIVE: To evaluate the effects of abnormal maternal weight or weight gain on pregnancy outcome. METHOD: Records for 191 mothers with abnormal prepregnancy weight (> or = 20%) above, or under, ideal body weight for height) or weight gain > or = 20 kg, or < or = 5 kg during pregnancy were reviewed. The control group consisted of 166 mothers with normal prepregnancy weight and normal weight gain during pregnancy. Data on mothers and their infants were analyzed by one-way analysis of variance. RESULTS: Obese women and mothers with excessive weight gain during pregnancy had an increased incidence of induced labor (P < or = 0.05) and tendency for emergency cesarean sections during the delivery. Obese women had more large-for-date babies than controls (P < or = 0.05). Weight gain < or = 5 kg during pregnancy was most common in slightly obese women and did not carry any special obstetric or neonatal risk. Underweight women had a significant risk for delivering a small-for-data baby. CONCLUSION: Obese women and women with excessive weight gain during pregnancy need special follow-up and counseling during pregnancy and delivery. Underweight women may need prepregnancy nutritional counseling to guarantee normal fetal growth. In developed countries suboptimal weight gain (< or = 5 kg) during pregnancy seems not to need any medical intervention.

Adult

Aspirin dose-dependently reduces alcohol-induced birth defects and prostaglandin E levels in mice.

The purpose of the present study was threefold. The first purpose was to determine if aspirin (ASA) decreases alcohol-induced birth defects in mice in a dose-dependent fashion. The second purpose was to see if the antagonism of alcohol-induced birth defects afforded by ASA pretreatment was related to dose-dependent decreases in prostaglandin E (PGE) levels in uterine/embryo tissue. The third purpose was to determine if ASA pretreatment altered maternal blood alcohol level. In experiments 1 and 2, pregnant C57BL/6J mice were administered ASA (0, 18.75, 37.5, 75, 150, or 300 mg/kg) on gestation day 10. One hour following the subcutaneous injection of ASA, mice received alcohol (5.8 g/kg) or an isocaloric sucrose solution intragastrically. In experiment 1 the incidence of birth defects was assessed in fetuses delivered by caesarean section on gestation day 19. In experiment 2 uterine/embryo tissue samples were collected on gestation day 10 1 hr following alcohol intubation for subsequent PGE analysis. In experiment 3 blood samples were taken at five time points following alcohol intubation from separate groups of alcohol-treated pregnant mice pretreated with 150 mg/kg ASA or vehicle. The results from the three experiments indicated that 1) ASA dose-dependently reduced the frequency of alcohol-induced birth defects in fetuses examined at gestation day 19, (2) ASA decreased the levels of PGE in gestation day 10 uterine/embryo tissue in a similar dose-dependent fashion, and 3) ASA pretreatment did not significantly influence maternal blood alcohol levels. These results provide additional support for the hypothesis that PGs may play an important role in mediating the teratogenic actions of alcohol.

Abnormalities, Drug-Induced

Carcinoma of the stomach associated with the pregnancy: two case reports.

Two case reports on carcinoma of the stomach associated with pregnancy are presented. In both cases, the main symptoms were persisting hyperemesis, nausea and weight loss. Both mothers succumbed within a year after their pregnancy, but the infants born by Cesarean section are doing well. The diagnostic and therapeutic difficulties which are encountered when a carcinoma complicates a pregnancy are discussed.

Adenocarcinoma

Biological correlates of mental stress related to anticipated caesarean section.

The relationships between self-reported assessments of acute anxiety and several biochemical and physiological indicators of stress reaction were investigated in pregnant women at term in connection with spinal analgesia for caesarean section. Fear and apprehension were statistically significantly associated only with blood pressure and with an increase in heart rate from the previous day. The subjective estimate of the quality of the preoperative night's sleep was negatively associated with biochemical plasma and cerebrospinal fluid (CSF) measures of sympatho-adrenal activity. The previously reported negative correlation between body height and 5-hydroxyindoleacetic acid (5-HIAA, an indicator of serotonin metabolism) in lumbar CSF was confirmed. The concentration of 5-HIAA in CSF was positively correlated with the levels of other acidic monoamine metabolites and cortisol in CSF. It is concluded that hormone and monoamine metabolite measurements in CSF and plasma have only limited usefulness as quantitative indicators of the intensity of preoperative fear and anxiety.

3,4-Dihydroxyphenylacetic Acid

Perspectives on the pathophysiology of fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is a major known cause of fetal malformations and mental retardation. Prevention/intervention of FAS can only be achieved with identification of the mechanisms by which alcohol induces birth defects. The purpose of this paper is to discuss the data on possible mechanisms of FAS, and to give a number of suggestions for future research areas.

Acetaldehyde

Large atypical polyps of the vagina during pregnancy with concomitant human papilloma virus infection.

A 25-yr-old primigravid patient with large atypical fibroepithelial polyps of the vagina is presented. The tumors necessitated interruption of the pregnancy by cesarean section at 34 wks. After delivery the tumors were excised, and the patient has been symptom-free for 12 months. There was an intercurrent human papilloma virus (HPV) infection in the vaginal epithelium. The nature of rare atypical vaginal fibroepithelial polyps is discussed on the basis of the literature. These lesions are clinically benign and are curable by simple excision, although histologically they resemble sarcomas.

Adult

Ritodrine infusion at term: effects on maternal and fetal prostacyclin, thromboxane and prostaglandin precursor fatty acids.

A prospective randomized study was performed to investigate the effect of a short-term ritodrine infusion on the concentrations of maternal and fetal prostaglandins and their precursor fatty acids. Mothers gave birth by an elective cesarean section at term, and either ritodrine (study group) or physiological saline (controls) was infused 2 h prior to the operation. Ritodrine decreased the levels of thromboxane A2 significantly in the mother, while the concentration of prostacyclin remained unchanged. In the umbilical arterial plasma concentrations of prostacyclin or thromboxane A2 there were no differences between ritodrine-treated and control subjects. Ritodrine had no effect on the prostaglandin precursor fatty acids and other fatty acids of plasma phospholipids of the mother or her fetus. It is concluded that ritodrine may suppress the maternal prostaglandin production, but has no effect on the levels of vasoactive prostaglandins or their precursor fatty acids in the fetus.

6-Ketoprostaglandin F1 alpha

The effect of acute hypoxia on prostaglandin release in perfused human fetal placenta.

The release of prostaglandin E2 and F2 alpha, thromboxane B2 and 6-keto-prostaglandin F1 alpha was measured in isolated human placental cotyledons perfused under high- and low-oxygen conditions. Also the effect of reoxygenation on prostaglandin production was studied. During the high-oxygen period, prostaglandin E2 accounted for 44% and 6-keto-prostaglandin F1 alpha for 28% of all prostaglandin release, and the rank order of prostaglandin release was E2 greater than 6-keto-prostaglandin F1 alpha greater than thromboxane B2 greater than prostaglandin F2 alpha. Hypoxia had no significant effect on quantitative prostaglandin release, but the ratio of prostaglandin E2 to prostaglandin F2 alpha was significantly increased. After the hypoxic period during reoxygenation the release of 6-keto-prostaglandin F1 alpha was significantly decreased, as was the ratio of 6-keto-prostaglandin F1 alpha to thromboxane B2. Also the ratio of the vasodilating prostaglandins (E2, 6-keto-prostaglandin F1 alpha) to the vasoconstricting prostaglandins (thromboxane B2, prostaglandin F2 alpha) was decreased during reoxygenation period. With the constant flow rate, the perfusion pressure increased during hypoxia in six and was unchanged in three preparations. The results indicate that changes in the tissue oxygenation in the placenta affect prostaglandin release in the fetal placental circulation. This may also have circulatory consequences.

Aerobiosis

Effect of antepartum ritodrine on the cardiorespiratory status of the newborn after elective cesarean section.

Heart rate (HR), heart rate variability (HRV), respiratory rate (RR) and transcutaneous PO2 and CO2 of 12 infants born by elective cesarean section were monitored during the first postnatal hour in order to evaluate the effect of the beta-mimetic tocolytic drug ritodrine. Six of the mothers received ritodrine by infusion and the other 6 physiological saline during the 2 h prepartum. The Apgar scores of the treatment group were higher (p less than 0.05) but there was a significant increase in RR (p less than 0.05) during the first hour in these babies. Arterial blood pressure (BP) was lower in the group whose mothers had received ritodrine (p less than 0.05) but there was no difference in pulse pressure. Transcutaneous pressure of CO2 (PtcCO2) of the controls decreased during the first hour (p less than 0.05). Transcutaneous pressure of O2 (PtcO2) increased during the first postnatal hour (p less than 0.01) when both groups were examined together. HR of both groups was relatively high and HRV low.

Carbon Dioxide

The effect of a short-term ritodrine treatment on the concentration of beta-adrenergic receptors in human myometrium.

The concentration of beta-adrenoceptors in human myometrium has been studied of women giving birth by elective cesarean section at term. Eight of the woman were treated with intravenous ritodrine two hours prior to the operation. In the control group seven women received physiological saline with the same infusion rate as ritodrine in the study group. The concentration of beta-receptors in the myometrium of the lower uterine segment was determined with radioligand binding assay. Ritodrine treatment decreased the available beta-receptors significantly.

Female

Intracervical prostaglandin E2 gel for cervical ripening.

Forty-five women with an unfavourable cervix (cervical score less than 3) and an obstetric indication for delivery were given intracervical prostaglandin E2 (PGE2) gel 0.5 mg/3 g to prime the uterine cervix. Twenty-one women (47%) went into labour after PGE2 gel application only. In 13 women (29%) the cervical score sufficiently improved within 12 hours and labour was successfully induced with intravenous oxytocin. The rate of adverse effects was notably: there were two uterine ruptures, the rate of cesarean sections was 33%, hypertonic uterine contractility 25%, premature rupture of membranes 16%, and neonatal asphyxia 21%. In our experience, cervical ripening with PGE2 gel, although efficient, may also bring about complications, which appear partly iatrogenic. Therefore, a critical evaluation of indications and the risk/benefit ratio is required.

Cervix Uteri

HELLP syndrome.

HELLP syndrome is a triad of hemolysis, elevated liver enzymes and low platelet count during pregnancy and it is proposed to be a sign of severe preeclampsia. We present two mothers with this life-threatening condition. In the first case, the syndrome appeared after a twin delivery at 34 weeks of pregnancy. The mother required 10 days of intensive care with blood and thrombocyte transfusions. Both she and the infants survived. In the second case, the mother had all classic signs of severe preeclampsia at the 27 week of pregnancy. After 3 days' intensive care, a cesarean section was performed and both the mother and the child survived.

Adult

The effect of oxytocin and betamimetic stimulation on prostaglandin release in perfused human fetal placenta.

The existing data on prostaglandins indicate that they are involved in human parturition and regulation of fetoplacental blood flow. The interference of endogenous and exogenous oxytocin and prostaglandins and, on the other hand, betamimetics, which are commonly used during pregnancy, in the regulation of these phenomena is poorly understood. The production of prostaglandins by fetal placental cotyledons was studied using an in vitro perfusion technique. Isolated cotyledons were perfused without (control) or with oxytocin (200 pg/ml, 2000 pg/ml) or the betasympathomimetic drug ritodrine (10 micrograms/ml, 50 micrograms/ml). The release of prostaglandin F2 alpha (PGF2 alpha), prostaglandin E2 (PGE2), 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane B2 (TxB2) was measured by radioimmunoassay. The release of prostaglandins was also studied during a recovery period after the drug infusion. Oxytocin at a concentration of 200 pg/ml significantly decreased the release of PGF2 alpha. A higher concentration of oxytocin did not cause any changes in prostaglandin production. During ritodrine infusion the perfusion pressure was decreased, but the addition of ritodrine to the perfusion medium had no effect on prostaglandin release. During the recovery period, after ritodrine infusion, the release of PGF2 alpha was significantly decreased. It is suggested that oxytocin at the physiological concentration may protect the fetus from adverse effects of PGF2 alpha before labor in decreasing the release of PGF2 alpha, yet this small decrease in formation of PGF2 alpha is obviously of minor clinical importance because the perfusion pressure remained constant. Ritodrine had no effect on prostaglandin release and so the decrease in the perfusion pressure is probably the result of beta 2-receptor stimulation.

6-Ketoprostaglandin F1 alpha

Serum prostaglandin precursors after vaginal examination and amniotomy.

The effect of vaginal or cervical examination during pregnancy upon the levels of circulating prostaglandin precursors and other free fatty acids was investigated. Of 31 mothers coming to elective induction of labor, a plain vaginal examination was performed in 9 cases, the cervix was penetrated by a finger and the membranes were slightly swept off the uterine wall in 10 cases and an amniotomy was performed in 12 cases. The blood samples were collected before and 5 minutes after the procedure. No changes were observed in prostaglandin precursors or in other free fatty acid levels. Also the precursors/other fatty acids ratio was unchanged. The demonstrated changes in circulating prostaglandin levels after these procedures are not reflected in the circulating precursor levels.

Amnion

Composition of free fatty acids at the end of pregnancy and inducibility of labor.

The concentrations of free fatty acids which included prostaglandin precursors were investigated in a group of 54 healthy women coming to elective induction of labor. There were no differences between the concentrations of the fatty acids when the mothers were divided in two groups according to whether induction was successful or not. There were slightly more mothers with successful induction, who had the total prostaglandin precursor level above average than among mothers with unsuccessful induction (p less than 0.05). The rates of false positives or false negatives were so high, however, that this determination can not be clinically used in predicting the outcome of labor induction.

Arachidonic Acids