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Plasma relaxin concentrations were measured hourly by radio immunoassay in 4 pregnant mares from 11 days before until 4 days after natural foaling. Pre-partum levels ranged from 4 to 7 ng/ml without any surge until the second stage of labour when they increased rapidly to about 11 ng/ml. In 3 of these mares, relaxin activity declined immediately after the expulsion of the placenta and was below detectable levels within 36 h. In the other mare relaxin activity did not fall until after the mechanical removal of the placenta 7 h after foaling. Eight mares were induced to foal by the administration of oxytocin. In 5 out of 6 mares induced with a single i.v. injection of 40 i.u. plasma relaxin increased following injection and peaked at 17 ng/ml shortly after foaling and expulsion of placenta. Activity then rapidly declined. In the 6th mare, which retained the placenta, relaxin activity did not decrease after foaling. Administration of more oxytocin to this mare after foaling resulted in a further increase in plasma relaxin activity, but oxytocin treatment of other mares after placental delivery failed to elicit a similar increase. In the 7th mare 2 i.v. injections of 40 i.u. oxytocin induced a relaxin concentration of 34 ng/ml whereas in the remaining mare one i.m. injection of 40 i.u. oxytocin led to a relaxin profile similar to that in naturally foaling mares. Oxytocin may therefore be responsible for the increased secretion rate of relaxin at foaling. These data support the concept that the placenta is the sole significant source of relaxin in the pregnant mare.
Twenty nine mares with retained fetal membranes were treated IV with an oxytocine infusion. Within two hours the placenta released in 24 mares (83%). Twenty six (90%) mares got pregnant during the same season.
OBJECTIVES: To describe sonographic findings associated with retained placental tissue in patients with secondary postpartum hemorrhage, and to compare these findings with those of women with a normal puerperium. METHODS: This was a prospective observational study of 79 women with secondary postpartum hemorrhage. Ultrasound examinations were performed on the day the patients presented with clinical symptoms and were scheduled for postpartum days 1, 3, 7, 14, 28 and 56, continuing until uterine surgical evacuation was performed or until the bleeding stopped. The maximum anteroposterior (AP) diameters of the uterus and uterine cavity were measured and morphological findings in the cavity were recorded. The findings were compared with previously published results from a normal population. RESULTS: The patients were divided into two groups. Group 1 (n = 18) underwent surgery and Group 2 (n = 61) was treated conservatively. Sonography revealed an echogenic mass in the uterine cavity in 17 patients from Group 1, and in 14 of these patients histology confirmed placental tissue. The AP diameter of the uterine cavity was above the 90(th) percentile in all but two of the 18 Group 1 patients. In 18 patients from Group 2 the cavity was empty and in 43 a mixed-echo pattern was found. The uterine cavity was wider compared with the controls, but the values largely overlapped. CONCLUSION: This report supports the opinion that the sonographic finding of an echogenic mass in the uterine cavity in women with secondary postpartum hemorrhage is associated with retained placental tissue.
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Two pregnant cows aborted 11 and 18 days after Mycoplasma agalactiae subsp bovis was inoculated into the amniotic fluids. The placentas were retained. The fetuses (approx 100 and 150 days of age) were decomposed; M agalactiae subsp bovis was recovered from several tissues of the fetuses, the placentas, and fetal fluids. The same organism was given by intraperitoneal injection to 2 other pregnant (130 and 180 days, respectively) cows. At necropsy of the latter 36 days later, placentitis was severe; M agalactiae subsp bovis was recovered from the placentas of both cows and from the fetus of 1 cow. Control cows given sterile mycoplasma cultural medium by intraamnion or intraperitoneal injection did not abort and were not infected. When first recovered from the bovine placenta and fetus, M agalactiae subsp bovis grew slowly in liquid medium and assumed bizarre colonial morphology on solidified medium. Colonies were small (0.1 to 0.5 mm) and dark and lacked halos, but they reacted specifically in the direct fluorescent antibody test with equine M agalactiae subsp bovis antiserum. After 1 or 2 subcultures, the isolates grew at a normal rate and displayed their usual colonial morphology.
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A sonographic evaluation of forty-six patients with suspected complications of unsafe induced abortion was performed prospectively. The sonographic features were correlated with surgical findings. Based on the sonographic findings, the patients were categorised into three groups. There was no clear association between the severity of sonographic or pathological findings and the time of presentation for ultrasound after the termination of pregnancy, but most of the patients presenting after 5 days belonged to groups II and III, i.e. had uterine complications with or without abdomino-pelvic complications. The commonest complication, sepsis, is variably expressed sonographically in all groups. Although, the sonographic appearances of sepsis are similar to those seen in pelvic inflammatory disease (PID), some features seen with post-abortal sepsis are peculiar. Apart from sepsis, other complications of abortion presented non-specific sonographic features. "Pseudouterus" appearance was demonstrated in one patient after hysterectomy. The likelihood of pre-operative diagnosis of uterine perforation is high when the presentation is early before the formation of complex echopatterns of sepsis or in the absence of free intraperitoneal gas from bowel perforation or gas-forming organism. Routing manual vacuum aspiration or therapeutic endometrial curettage is unnecessary where sonography shows no evidence of retained products post abortion.
RATIONALE: Although tricyclic antidepressants (TCAs) have gained wide acceptance for use in the treatment of depression in pregnant women, their pharmacokinetics during pregnancy have been poorly characterized. The aim of the present study was to investigate the transplacental transfer of amitriptyline (AMI) and its main active metabolite nortriptyline (NOR) in isolated perfused human placenta. METHODS: Nine term human placentae were obtained immediately after delivery with maternal consent and a 2-h non-recirculating perfusion of a single placental cotyledon was performed. AMI (200 ng/ml) and NOR (150 ng/ml), with antipyrine as a reference compound, were added to the maternal reservoir and their appearance to the fetal circulation was followed for 2 h. AMI and NOR concentrations were measured by high performance liquid chromatography (HPLC) and antipyrine concentrations spectrophotometrically. RESULTS: The mean (SD) transplacental transfers (TPT(SS)%) for AMI and NOR were 8.2 (2.3)% and 6.5 (1.8)%, respectively, calculated as the ratio between the steady-state concentrations in fetal venous and maternal arterial sides. The TPTs of AMI and NOR were 81% and 62% of the freely diffusable antipyrine. The absolute fraction of the dose that crossed the placenta (TPT(A)) was moderately, but significantly higher for AMI (7.7%) than for NOR (5.7%) (P=0.037). In all perfusions, steady state at the fetal side was reached by 30 min for AMI and by 50 min for NOR in the fetal side. The viability of the placentae was retained during the 2-h perfusion, as evidenced by unchanged pH of the perfusate and by stable perfusion pressures in fetal artery and stable antipyrine transfer. CONCLUSIONS: Both AMI and NOR cross the human placenta. However, the fetal exposure with NOR may be somewhat smaller compared with AMI, probably due to the higher lipophilicity of AMI.
A prospective study was carried out based on 117 first trimester legally induced abortions. Abdominal ultrasound examination was performed immediately after aspiration. The predictive value of an empty uterus at ultrasound examination was 97.3%. The rate of retained tissue was not reduced compared to studies where peroperative ultrasound was not used.
OBJECTIVE: The objective of this article is to describe the MR imaging appearances of retained products of conception. CONCLUSION: Retained products of conception appear on MR imaging as an intracavitary uterine soft-tissue mass with variable amounts of enhancing tissue and variable degrees of myometrial thinning and obliteration of the junctional zone. These findings should not be misinterpreted as indicating gestational trophoblastic disease, particularly in the setting of a postpartum patient with a normal or minimally elevated beta-human chorionic gonadotropin level. MR imaging may also be helpful in showing anatomic variants that hinder successful instrumentation of the uterine cavity in patients with suspected retained products of conception.
OBJECTIVE: To evaluate the role of transvaginal color Doppler ultrasonography in the management of first-trimester spontaneous abortion, clinically thought to be complete. STUDY DESIGN: A prospective interventional non-randomized study was performed in a tertiary care University hospital. Sixty-two women with suspected first-trimester spontaneous abortion, clinically thought to be complete were included in the study. All women were evaluated on admission by transvaginal color Doppler ultrasonography. The amount of blood flow within the myometrium or in the endometrium-myometrium interface was assessed. Those women with suspected retained tissue on color Doppler were scheduled to undergo dilatation and curettage (D&C). Those patients with no suspected retained tissue on color Doppler were scheduled for expectant management. RESULTS: Eighteen women had suspected retained tissue and 44 women did not. A total of 16 out of 18 (88.9%) patients had retained trophoblastic tissue confirmed on histopathologic analysis. There were two false negative cases. Outcome of all patients managed expectantly was optimal with no complications. CONCLUSIONS: Transvaginal color Doppler ultrasonography is useful to detect or to rule out the presence of retained trophoblastic tissue after first-trimester spontaneous abortion and to select patients for expectant management.
Fetal membrane retention is one of the most common problems in Holstein cattle after parturition. To investigate mechanisms involved, the following parameters were studied in the peri-parturition period: plasmatic concentrations of estradiol-17beta (E2) and PGFM (PGF2alpha metabolite), activity of antioxidant enzymes (superoxide dismutase-SOD, catalase-CAT and glutathione peroxidase-GSH-Px), thiobarbituric acid reagent substances (TBAR) concentrations and fatty acid composition of the placentae. E2 at parturition in the NPR group (control cows, n = 10) was higher than in PR cows (placental retention, n = 10) (P < 0.05). Activity of SOD in fetal tissue of NPR animals was higher than that of the PR group. In contrast, there was no difference between the two groups in activity of GSH-Px and CAT and the TBAR content of placental tissues. PR maternal tissues had proportionally more arachidonic and linoleic acid than tissues from NPR cows. Therefore, a complex of sequential events may cause placenta retention, starting with an unbalance of antioxidant capacity of the placenta, followed by a decrease in production of estrogen, which leads to the accumulation of arachidonic and linoleic acid in placental tissues.
Poly(ADP-ribose) polymerase (PARP) is the enzyme which utilises NAD to synthesise poly(ADP-ribose) polymers. This process appears in response to DNA lesions. Oxidative stress, which might be involved in bovine placental retention, is the reason for oxidative DNA injury. In this mini-review, the relationship between PARP activity and bovine placental retention is discussed. The results of our experiments on PARP activity in placental tissues showed that the enzyme of 113 kDa and its cleavage products were present in retained as well as released fetal membranes. Western blotting technique showed different intensities in the staining of bands which might suggest different activities of the enzyme.