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PubMed1981

Prospective randomized study of corticosteroids in the management of premature rupture of the membranes and the premature gestation.

A prospective randomized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted. Patients with chorioamnionitis, advanced labor, and fetal distress, as well as those with mature lecithin/sphingomyelin ratios and/or Gram stains positive for bacteria, were delivered immediately. The remaining patients were randomized. One group received betamethasone. Tocolytic agents were used in this group when necessary. After 48 hours all patients given corticosteroids (CS group) were delivered). The second group was managed expectantly (EM group) and were delivered only when spontaneous labor or infection occurred. A total of 160 patients were randomized, 80 in each group. Maternal outcome, including chorioamnionitis and cesarean section rates, was not different; however, the endometritis rate was significantly higher in the CS group (p less than 0.05). Neonatal outcome did not differ in mean birth weights, perinatal death rates, neonatal infections, or incidences of respiratory distress. The frequency of prolonged hospital stay (greater than 4 weeks) was higher in the neonates in the CS group (p less than 0.01). The conclusion is that corticosteroids and active management in patients with premature rupture of the membranes and premature gestations do not decrease the incidence of respiratory distress syndrome or perinatal mortality and may aggravate certain infectious complications.

Adolescent↗

PubMed1984

Simulation of a probable biologic action of decidual prolactin on fetal membranes.

As evidence continues to accumulate supporting a specific effect of prolactin on the permeability of reflected fetal membranes to tritiated water, no information on the role of decidual prolactin in this process is available. Simulation of in vivo events was conducted with the use of isolated membrane preparations of human amnion or chorioamnion with adherent decidua. In the presence of ovine prolactin in equal concentrations on both sides of human amnion, membrane permeability (cm X 10(-4) X sec-1) was reduced from 1.52 +/- 0.16 to 1.18 +/- 0.07 (mean +/- SEM) from the fetal to the maternal surface. Permeability in the opposite direction was significantly increased from 1.15 +/- 0.10 to 1.39 +/- 0.08. No osmotic effect of ovine prolactin was noted. With the use of chorioamnion with adherent decidua, permeability was significantly reduced from the maternal to the fetal surfaces only when ovine prolactin bathed the maternal surface. These in vitro results may suggest that the accumulation of decidual prolactin at the choriodecidual interface in vivo supports bulk water flow across fetal membrane from the amniotic to the maternal compartments.

Biological Transport↗

PubMed2001

Indomethacin tocolysis and intraventricular hemorrhage.

OBJECTIVE: To determine the association between indomethacin tocolysis and neonatal intraventricular hemorrhage. METHODS: Fifty-six preterm neonates with intraventricular hemorrhage were matched by gestational age with neonates (n = 224) without this morbidity. Maternal and neonatal charts were reviewed to ascertain the type of tocolytic exposure experienced by the neonate. Other maternal and neonatal demographic and outcome data were also abstracted. Results were analyzed using the Student t test, chi(2) analysis, and multivariable logistic regression. The number of studied subjects provided 80% power to determine if antenatal exposure to indomethacin was twice as likely among infants with intraventricular hemorrhage. RESULTS: Univariate analysis revealed that there were no significant differences between the study and control groups with respect to maternal age, parity, or betamethasone exposure. Infants with intraventricular hemorrhage were significantly more likely to be born at an earlier gestational age, a lower birth weight, after maternal chorioamnionitis, after vaginal delivery, and after exposure to either indomethacin alone or a combination of indomethacin and magnesium. Additionally, their neonatal course was significantly more likely to be complicated by sepsis and respiratory distress syndrome. In a multivariable logistic model, only gestational age, chorioamnionitis, vaginal delivery, and respiratory distress syndrome continued to be significantly associated with intraventricular hemorrhage. Indomethacin exposure, either as single-agent (adjusted odds ratio 1.3, 95% confidence interval 0.5, 3.3) or combination tocolytic therapy (adjusted odds ratio 2.0, 95% confidence interval 0.8, 4.8), was not significantly associated with intraventricular hemorrhage. CONCLUSION: Indomethacin tocolysis is not associated with an increased risk of intraventricular hemorrhage.

Adult↗

PubMed2003

Maternal and neonatal outcomes in patients with a prolonged second stage of labor.

OBJECTIVE: To determine risk factors for a prolonged second stage of labor and evaluate the maternal and neonatal outcomes of such pregnancies. METHODS: We reviewed all 7818 patients who delivered at the University of Illinois at Chicago from 1996 to 1999. Excluding nonvertex and multiple gestations, 6791 reached the second stage. Group 1 (n = 6259) consisted of patients with a second stage of 120 minutes or less; group 2, greater than 120 minutes (n = 532 [7.8%]); group 2A, 121-240 minutes (n = 384 [5.7%]); and group 2B, greater than 240 minutes (n = 148 [2.2%]). We compared pregnancy outcomes for these groups with respect to maternal and neonatal morbidity factors using chi(2), Student t, and Wilcoxon rank-sum tests (significance, P <.05). RESULTS: Vaginal delivery rates were 98.7% (group 1), 84.0% (group 2), 90.2% (group 2A), and 65.5% (group 2B). Group 2 had higher rates of perineal trauma, episiotomy usage, chorioamnionitis, postpartum hemorrhage, and operative vaginal delivery than group 1 (P <.001, all comparisons). Group 2B had higher rates of episiotomy usage, operative vaginal deliveries, and perineal trauma than group 2A (P <.001, all comparisons). The neonatal morbidity rates were similar for the three groups. Diabetes, preeclampsia (P <.023), macrosomia, nulliparity, chorioamnionitis, oxytocin usage, and labor induction were each independently associated with an increased risk of a prolonged second stage (all but preeclampsia, P <.001). CONCLUSION: A prolonged second stage is associated with a high rate of vaginal delivery, but a high rate of maternal, though not neonatal, morbidity was observed. Certain antenatal and intrapartum conditions are associated with a prolonged second stage of labor.

Adult↗

PubMed1997

Etiologic determinants of abruptio placentae.

OBJECTIVE: To quantify the roles of suspected sociodemographic, anthropometric, behavioral, and pathologic determinants in the etiology of abruptio placentae. METHODS: We performed a hospital-based cohort study of 36,875 nonreferred births between January 1978 and March 1989. Gestational age was based on menstrual dates confirmed (within 7 days) by early ultrasound. RESULTS: Parity, maternal education, pre-pregnancy weight, and the rate of net gestational weight gain did not have significant independent associations with abruption. Significant determinants included the following: severe small for gestational-age (SGA) birth (odds ratio [OR] 3.99; 95% confidence interval [CI] 2.75, 5.77), chorioamnionitis (OR 2.50; 95% CI 1.58, 3.98), prolonged rupture of membranes (OR 2.38; 95% CI 1.55, 3.65), preeclampsia (OR 2.05; 95% CI 1.39, 3.04), pregnancy-induced hypertension without albuminuria (OR 1.57; 95% CI 1.00, 2.46), pre-pregnancy hypertension (OR 1.77; 95% CI 1.05, 2.99), maternal age at least 35 years (OR 1.50; 95% CI 1.14, 2.01), unmarried status (OR 1.50; 95% CI 1.13, 1.98), cigarette smoking (OR 1.40; 95% CI 1.00, 1.97 for ten to 19 cigarettes per day and OR 1.13; 95% CI 0.81, 1.59 for at least 20 cigarettes per day), and male fetal gender (OR 1.38; 95% CI 1.12, 1.70). Removal of SGA from the regression model resulted in little change in the magnitude of the other associations. CONCLUSIONS: Severe fetal growth restriction, prolonged rupture of membranes, chorioamnionitis, hypertension (before pregnancy and pregnancy-induced), cigarette smoking, advanced maternal age, unmarried status, and male fetal gender are significant etiologic determinants of placental abruption. Non-SGA determinants appear to operate largely independently of their effects on fetal growth.

Abruptio Placentae↗

PubMed1997

The effect of instituting an elective labor epidural program on the operative delivery rate.

OBJECTIVE: To evaluate labor outcome as well as maternal and neonatal morbidity before and after the initiation of elective labor epidural capability. METHODS: On October 1, 1993, a sudden change in military requirements mandated provision of elective labor epidural capability at our institution. Before this time, epidural provision had been primarily in response to urgent obstetrician requests. Pre-labor and labor characteristics and outcomes were reviewed for the year before this policy change (group 1, n = 373) and for the year after it (group 2, n = 421) in a population of nulliparous patients delivering singleton, vertex fetuses at 36-42 weeks' gestational age. In addition, the group of patients receiving labor epidurals before their ready availability (group 1E, n = 49) was compared with the group receiving them after ready availability (group 2E, n = 247). RESULTS: Maternal labor characteristics showed a slight (10 minutes on average) prolongation of the second stage of labor in group 2. The incidence of diagnosed chorioamnionitis was higher in group 2. Patients receiving epidurals in each time frame were analyzed to identify epidural-related findings, as opposed to findings associated with intrinsically more problematic labors. Epidural-related factors included the slightly prolonged second stage of labor, increased use of oxytocin, and a higher incidence of diagnosed chorioamnionitis. CONCLUSION: Our study demonstrated no increase in the rate of operative deliveries in a population that suddenly received access to on-request labor epidurals. We believe this option should be offered to parturients without making them feel that they must choose between comfort and safety.

Adult↗

PubMed2000

Tocolysis with advanced cervical dilatation.

OBJECTIVE: To assess the feasibility and potential benefit of delaying delivery in women with advanced preterm labor. METHODS: Two hundred fifty-seven gravidas with intact membranes and preterm labor at cervical dilatations of at least 3 cm were studied. Women were excluded if they had premature rupture of membranes, gestational age less than 24 or more than 35.9 weeks, complete cervical dilatation, severe hemorrhage, chorioamnionitis, and triplets or higher-order gestations. Management consisted of tocolysis with intravenous magnesium sulfate as the primary agent, antenatal steroids, antibiotics, and amniocentesis. The primary endpoint was delay to delivery interval. Statistical analyses by cervical dilatation were performed using the Pearson chi2 test and a nonparametric test of trend. RESULTS: Eighty-one percent of pregnancies were referrals in utero from outlying hospitals. Delivery was delayed 24 hours or longer in 74% and beyond 48 hours in 60% of cases. Among 229 women who delivered at our center, 21% remained undelivered after 1 week. Evaluating delay as a function of cervical dilatation, trend analysis found a highly significant inverse relationship (P < .001). Among women dilated 5 cm, 46% delivered beyond 48 hours. Among those dilated 6 cm or more, 19% delivered beyond 48 hours. Mild pulmonary edema developed in five percent, and all responded promptly to medical interventions. Chorioamnionitis developed in eight percent. CONCLUSION: Delaying delivery 24-48 hours to allow antenatal steroid use or other interventions is possible in women with advanced preterm labor.

Cervix Uteri↗

PubMedDate not supplied

Mechanisms, organisms and markers of infection in pregnancy.

Premature delivery is still a significant problem in Obstetrics. It has multiple causes, with around 50% thought due to infection. Of note infection as a pathogenesis is more likely in those pre-term births occurring <30 weeks gestation and is largely sub-clinical. Potential pathogens largely arise from the ascending route and from the endogenous vaginal flora, causing chorioamnionitis. Resultant morbidity from the release of endo+/exotoxins from such pathogens, the stimulation and production of inflammatory cytokine pathways, prostaglandins, metalloproteinases includes maternal sepsis (chorioamnionitis, septicaemia, post-partum endometritis), pre-term delivery (infant pre-maturity and its consequences, increased susceptibility to cerebral palsy and neonatal sepsis). As well, infection increases mortality due to fetal loss (extreme pre-maturity) as well as severe neonatal sepsis.

Biomarkers↗

PubMed1997

Risk of fetal infection from invasive procedures.

Recent technological advances have led to the development of several types of invasive procedures in the fetus principally for the diagnosis and management of fetal disorders. The risk of infection to the fetus related to these procedures needs evaluation. Although there are few reports of fetal infection, proper infection control procedures must be observed because the most common consequence of infection is fetal loss. Fetal blood sampling in the presence of chorioamnionitis is a risk factor that warrants prophylactic antibiotics. Conversely, clinical specimens taken from the fetus in the absence of chorioamnionitis are more likely to become contaminated with maternal skin flora, and a positive fetal blood culture is not necessarily significant. There is probably a small but finite risk of transmission of maternal viral infections such as human immunodeficiency virus, hepatitis B and C, cytomegalovirus and herpes simplex during invasive procedures. Obstetric departments undertaking invasive fetal diagnosis and treatment must have an adequate policy for infection control procedures.

Bacterial Infections↗

PubMed2000

Effects of intrauterine IL-6 and IL-8 on the expression of surfactant apoprotein mRNAs in the fetal rat lung.

OBJECTIVE: The purpose of this study was to investigate the effect of interleukin-6 (IL-6) and interleukin-8 (IL-8), whose concentrations are elevated with chorioamnionitis, on the expression of surfactant apoprotein mRNAs in fetal rat lung. STUDY DESIGN: We employed an animal model in which we were able to administer substances continuously into the cavity between the fetal membranes and endometrium using a miniosmotic pump. Lipopolysaccharide (LPS), IL-6, or IL-8 was administered to timed pregnant rats for 3 days (day 16-19), and fetal lung expression of surfactant apoprotein mRNAs for SP (surfactant apoprotein)-A, SP-B, and SP-C was evaluated by Northern blot hybridization. RESULTS: Continuous administration of LPS increased the expression of each surfactant apoprotein mRNA, but the expression of mRNAs was not dose-dependent. On the other hand, continuous IL-6 or IL-8 administration increased the expression of each surfactant apoprotein mRNA in a dose-dependent manner. CONCLUSION: Fetal lung maturation may be promoted by either IL-6 or IL-8 produced in response to chorioamnionitis.

Animals↗

PubMed2001

Effect of reactive oxygen species on fetal lung maturation.

OBJECTIVES: Fetal lung maturation in preterm infants with chorioamnionitis is known to be accelerated. However, the molecular basis of this pathological acceleration has not been elucidated. We investigated whether reactive oxygen species play a role in the acceleration of fetal lung maturation. STUDY DESIGN: On the 16th day of gestation, xanthine (1mM) and xanthine oxidase solution (0.1-100mU/ml) were injected into the intrauterine cavity of pregnant rats. On the 19th day of gestation, we examined the expression of the mRNA of surfactant associated proteins A, B and C (sp-A, sp-B and sp-C) by reverse transcription-polymerase chain reaction. RESULTS: sp-A, sp-B and sp-C mRNAs were observed in lung tissue from fetal rats stimulated by xanthine-xanthine oxidase in contrast to the control. CONCLUSION: Reactive oxygen species in amniotic fluid might be an important factor in accelerated fetal lung maturation associated with chorioamnionitis in the rat experimental model.

Animals↗

PubMed1996

Inflammation of the lungs, umbilical cord and placenta associated with meconium passage in utero. Review of 123 autopsied cases.

It is uncertain how often the passage of meconium in utero is a response to some event causing fetal distress as opposed to being simply the physiologic functioning of a maturing intestinal tract. The extent to which meconium may produce injury or inflammation in pulmonary and placental tissues after intrauterine exposure is also unclear. This study was a retrospective review of 123 cases, 79 stillborn and 44 liveborn less than one month of age, autopsied at The Johns Hopkins Hospital, and showing histologic evidence of intrauterine meconium exposure by aspirated meconium or meconium macrophages in placental tissues. Of 55 cases with pulmonary inflammation, 13 (24%) had fetal pneumonia, 5 (9%) had postnatal bronchopneumonia, and 37 (67%) had inflammation secondary to meconium aspiration. There was inflammation of the umbilical cord in 31 (41%) of the 75 cases with available slides, 11 (15%) had funisitis associated with chorioamnionitis and 18 (58%) were secondary to meconium exposure. There were 19 cases with focal injury of cord vessels from meconium, two of which had cord ulceration. Inflammation of the membranes and chorionic plate was present in 24 (33%) of the 72 cases where it could be assessed, and was due to chorioamnionitis in 11 (46%) and to meconium in 13 (54%). In general, meconium-related inflammations was much less severe in the membranes than in the cord. There were 67 (54%) cases with definite or probable evidence of fetal distress. In 38 (48%) stillborns no cause of fetal death in utero was identified and in 18 (41%) liveborns there was no known prenatal problem. The results support the concept that meconium passage in utero may occur either as a response to fetal distress or as a physiologic process. Inflammation in the lung and placental tissues, and vascular injury in the umbilical cord may arise secondary to in utero exposure to meconium.

Female↗

PubMed2006

[Emergency thoraco amniotic shunting in cases with compressive pleural effusion with hydrops: A retrospective study of 60 cases].

OBJECTIVES: To study perinatal outcome following thoraco-amniotic shunting for fetal pleural effusions with hydrops. MATERIALS AND METHODS: Retrospective study (1984-2004) to evaluate a policy of emergency thracoamniotic shunting in hydropic fetuses with suspected chylothorax, on the basis of the rationale that mediastinal compression could lead to acute fetal distress. RESULTS: Shunting was performed immediately following diagnosis, and was successful in all 60 cases attempted. There were 7 pregnancy terminations, 10 in utero deaths, and 43 live births, of which 7 children died in the neonatal period and 36 survived (33 without sequels). Among the liveborn, 26 were delivered preterm (72%), of which 7 (19%) had preterm premature rupture of membranes and 4 (11%) had chorioamnionitis. Perinatal death (24/60, 40%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (10 cases). All 36 survivors had chylothorax, 33 of which were primary, and 3 were secondary to right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome. CONCLUSION: Following shunting, pleural effusion with hydrops has survival rate >50%, but still have a high rate of morbidity and mortality.

Amniotic Fluid↗

PubMed1998

The frequency of extramembranous placement of intrauterine pressure catheters.

Objective: To determine, and confirm, the frequency of extramembranous placement of intrauterine pressure catheters.Methods: It is estimated that 15% of all deliveries in the United States (600,000 deliveries/year) receive intrauterine pressure catheters (IUPCs). This study quantifies the frequency of inadvertently placing IUPCs between the chorioamnionic membranes and the myometrium. An attempt was made to aspirate amniotic fluid during placement. If amniotic fluid was obtained, the catheter was considered to be within the amniotic cavity. If amniotic fluid was not obtained but the catheter appeared to be clinically working (possibly extramembranous), normal clinical management was continued until just before the catheter was removed. At that time, 2 mL of indigo carmine was injected. The chorioamnionic membrane was examined to confirm the location of dye (intraamnionic vs extramembranous).Results: Approximately 40 Koala (Clinical Innovations, Inc.) and 40 Intran Plus catheters (Utah Medical Products, Inc.) were placed. In 70% of all first insertions, amniotic fluid was not obtained. When multiple attempts (2-5) were made, amniotic fluid was obtained. There was no statistically significant difference between IUPC brands. Dye confirmed extramembraneous placement.Conclusions: IUPCs are frequently (inadvertently) placed extramembraneous. Upon first insertion it is possible that as many as 30% of IUPCs do not go into the amniotic space. If fluid is not obtained upon placement, a different location should be tried since if amniotic fluid is visualized in the catheter the percentage of intraamnionic placement increases. Adverse results of artefactual waveforms, placental perforation, and abruption with or without amnioinfusion can occur when IUPCs are placed extramembraneous.

Journal Article↗

PubMed2003

Role of cytokines and other inflammatory mediators.

In spite of impressive advances in biochemistry and molecular biology, it has not yet been possible to fit the individual biochemical components of cervical ripening and dilatation to a uniform clinical moiety or to uncover any regulatory mechanisms. The production of interleukin-8 by activated fibroblasts and macrophages plays a key role in cervical ripening, since this cytokine induces chemotaxis, activation, and degranulation of neutrophilic granulocytes with the consequent release of various proteases, including collagenase. In addition, the extravasation of neutrophilic granulocytes is mediated-as in the early stage of an acute inflammatory reaction-by a brief increase in adhesiveness of vascular endothelium. This is known to be modulated by the cytokine-induced increase in the expression of endothelial adhesion molecules. Furthermore, an increase in pro-inflammatory cytokine and proteinase concentrations in preterm delivery seems to occur at earlier stages of cervical dilatation than in term delivery. It is also well known that in patients with chorioamnionitis, the levels of pro-inflammatory cytokines are elevated in amniotic fluid, maternal serum, cervical secretion, placenta, and other compartments of the placento-maternal unit, and are associated with preterm uterine contractions. We have demonstrated for the first time that cytokine concentrations in the lower uterine segment in patients with chorioamnionitis are strongly elevated. We conclude from our data that increased concentrations of pro-inflammatory cytokines may also play a pivotal role in cervical softening and dilatation during chorioamniotic infection. Our data agree with the hypothesis of Liggins who stated nearly 20 years ago that cervical ripening may be an inflammatory reaction, which leads to increased prostaglandin synthesis, preterm labour and finally to preterm delivery.

Cell Adhesion Molecules↗

PubMed2003

Induction of labour with a favourable cervix and/or pre-labour rupture of membranes.

Premature rupture of membranes (PROM) occurs in 8% of term deliveries. In this situation labour induction with prostaglandins, compared with expectant management, results in a reduced risk of chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. The use of prostaglandin is associated with an increased rate of diarrhoea and use of analgesia/anaesthesia. Compared with oxytocin, prostaglandin induction results in a lower rate of epidural use and internal fetal heart rate monitoring but a greater risk of chorioamnionitis, nausea, vomiting, more vaginal examinations, neonatal antibiotic therapy, NICU admission and neonatal infection. Women should be informed of the risks and benefits of each method of induction.Misoprostol is gaining increasing interest as an alternative induction agent. It appears to be an effective method of labour induction with term PROM. Further research is needed to identify the preferred dosage, route and interval of administration, and to assess uncommon maternal and neonatal outcomes. There has been limited research on the use of prostaglandins, including misoprostol, for induction of labour with a favourable cervix and intact membranes. Compared with intravenous oxytocin (with and without amniotomy), labour induction using vaginal prostaglandins in women with a favourable cervix (with and without PROM) results in a higher rate of vaginal delivery within 24 hours and increased maternal satisfaction. In women with a favourable cervix, artificial rupture of membranes followed by oral misoprostol has similar time to vaginal delivery compared with artificial rupture of membranes followed by oxytocin. Further research with prostaglandins, including misoprostol, is needed to evaluate other maternal and neonatal outcomes in women being induced with a favourable cervix. No form of prostaglandin induction in women with PROM or favourable cervix has proven clearly superior to oxytocin infusion.

Administration, Intravaginal↗

PubMed2004

Mechanical failure of human fetal membrane tissues.

Mechanical integrity of the chorioamnion membrane, and the component chorion and amnion layers, was assessed with biaxial puncture testing. Fetal membranes were obtained from term placentas following labored natural delivery or scheduled cesarean section. Preterm specimens were obtained from deliveries prior to 37 weeks gestation. Dividing and peripheral membranes were obtained from multiple gestation pregnancies. Specimens were gripped between parallel plates with circular openings and loaded with an instrumented, hand-held blunt probe until rupture occurred. Peak force was recorded and rupture sites were examined. Defects in multi-layered membranes differed in both size and shape in the individual layers. Compared with chorion and whole chorioamnion, amnion was more mechanically sensitive to different obstetrical conditions. Amnion varied in response at different physical locations within the same patient. Membrane and component puncture force data were used to calculate biaxial failure strength. Membrane stresses arising from amniotic fluid pressure were computed as a function of gestational age, and compared to membrane strength to examine the criterion for membrane failure in vivo. Possible mechanical conditions for preterm membrane rupture were examined.

Amnion↗

PubMed2001

Immunoprotection of gonads and genital tracts in human embryos and fetuses: immunohistochemical study.

PROBLEM: The immune protection of genital organs in embryogenesis has not been sufficiently studied. The purpose of this study was to investigate the development of the secretory immune system (SIS) in the gonads and genital tracts of human embryos and fetuses. MATERIALS AND METHODS: Developing gonads at different stages and genital tracts from 18 embryos and 39 fetuses in the first to third trimester of gestation were analyzed for presence of different component of SIS: secretory component (SC), joining (J) chain. IgA, IgM, IgG, macrophages, and subsets of lymphocytes. The material was divided into two groups: cases not subjected to foreign antigenic effects (group I, n = 31) and those under antigenic attack (chorioamnionitis, group II, n = 26). RESULTS: In embryos and fetuses of group I, SC, J chain, and IgG were seen in the epithelium of mesonephric and paramesonephric ducts, proliferating coelomic epithelium, epithelium of the uterine tubes and uterus, epithelium of the vas deferens, epididymis, and rete testis. IgA and IgM appeared in 6-week-old embryos. J chain, IgA, IgM, and IgG, but not SC, were found in the primary oocytes and oogonia, spermatogonia. and interstitial cells. An abundance of macrophages was seen in 4-week-old embryos. T and B lymphocytes first appeared in 6-7-week-old embryos. In embryos and fetuses of group II, reactivity of immunoglobulins (Igs) decreased until they disappeared altogether. CONCLUSIONS: Components of SIS were seen in genital organs in 4-5-week-old embryos and were present during the whole intrauterine period. We suggest the presence of two forms of immune protection of fetal genital organs. One form contains SC, J chain, and Igs and is present in the genital tract epithelium. The second form contains only J chain and Igs and is present in germ cells of gonads. The loss of Igs in cases with chorioamnionitis reflects the functional participation of the SIS of genital organs in response to antigen attack.

Antigens, CD↗