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This report describes aggregate time trend effects of advancing gestational age on circulating maternal concentrations of 17beta-estradiol (E2), estriol (E3), dehydroepiandrosterone (D), dehydroepiandrosterone sulfate (D-S), delta 5-androstenediol (delta 5 diol), delta 4-androstenedione (delta 4 A), testosterone (T), and dihydrotestosterone (DHT) in a sequential series of 155 blood samples obtained from 19 normal pregnant women ranging from 26-40 weeks gestational age. Only E2, E3, and D-S show aggregate time trend effects. Log (E2) plots as a linear positive sloping curve from 26-40 weeks. Log (E3) plots as a positive sloping curve that is significantly steeper than log (E2) (P less than 0.05). Log (D-S) plots into a negative sloping curve which mirrors the pattern for log (E2) but cannot be statistically associated with log (E2) except for the opposite sign of their slopes, which are both significantly different from a zero slope (P less than 0.05). delta 4 A, T, DHT, delta 5 diol, and D show no aggregate time trends; however wide, comoving undulations for delta 4 A, T, DHT, and delta 5 diol between 26-28 and 38-40 weeks are confirmed in time by comparison of log mean plots and in magnitude by regressing the C19 steroids on one another. D shows virtually no association with the other C19 steroids. All C19 steroids, except for T, circulate at nonpregnant concentrations, implying that there is little placental secretion of these steroids into the maternal circulation.
The effect of a large dose (1000 mg) of iv cortisol-hemisuccinate on circulating steroid concentrations in five women, 28--34 weeks, gestational age, is reported. Maternal concentrations of estriol, 16 alpha-hydroxyprogesterone, 17 alpha-hydroxyprogesterone, progesterone, 20 alpha-dihydroprogesterone, delta 5-pregnenolone, delta 5-pregnenolone sulfate, dehydroepiandrosterone sulfate, and cortisol were measured by RIA before and at 8 and 12 h after iv cortisol infusions at 0 and 8 h. Data were evaluated by repeated measure analysis of variance. Estriol and 17 alpha-hydroxyprogesterone suppressed initially (P less than 0.05) and suppressed further with retreatment and increased treatment time (P less than 0.05). Dehydroepiandrosterone sulfate and progesterone suppressed initially (P less than 0.05) but did not suppress further with retreatment and increased treatment time (P greater than 0.05). delta 5-Pregnenolone and delta5-pregnenolone sulfate increased initially (P less than 0.05) but did not increase further (P greater than 0.05). Concentrations of 16 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone were unchanged by cortisol infusion initially (P greater than 0.1) and with retreatment and increased treatment time (P greater than 0.1).
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The plasma concentration of pregnancy-associated plasma protein A (PAPP-A) was measured in 34 women during the last 10 weeks of pregnancy. From 30 to 36 weeks the concentration of this protein increased steadily. Thereafter the concentration of PAPP-A rose more steeply, the highest amounts being found in early labour. The concentration of PAPP-A in peripheral venous blood and in the uterine vein was much the same. It was less in the retroplacental blood and a great deal less in the peritoneal fluid. The day-to-day variation was small; the coefficient of variation at 38 weeks was only 7.3 per cent. After delivery, the concentration of PAPP-A fell more slowly than other placental proteins and steroids, the average half-life being 51 hours. Although there is no doubt that PAPP-A is a product of the syncytiotrophoblast, our findings suggest that it is not simply secreted by the chorionic villi directly into the intervillous space but makes its way into the maternal circulation by a more circuitous route.
A 28-year-old woman with acute myeloblastic leukaemia was effectively treated with cytosine arabinoside and 6-thioguanine during the third trimester of pregnancy and a complete remission achieved. A normal infant was delivered at term. The patient survived for 27 months and the baby is now 2 1/2 years old with normal physical and mental development. The literature on management of acute non-lymphocytic leukaemia during the second and third trimester of pregnancy is reviewed and it is concluded that effective combination chemotherapy improves fetal survival.
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Fetal movements (FM) were measured using a real-time B-scan method in 50 women in the third trimester. One hundred ninety-five observations were made. The number of FM per 20-minute observation period was similar in normal, diabetic, and hypertensive pregnancies and in patients with placenta previa, but was significantly lower in patients with Rh isoimmunization and an affected fetus. The number of FM did not vary with gestational age, mode of delivery, or birth weight and was significantly increased in patients either with a reactive nonstress test (NST) or in the presence of fetal breathing movements (FBM). Fetal movements were absent before delivery in 4 patients: In 3, the fetus died in utero and in the other a positive contraction stress test (CST) was observed. Conversely, in 2 other fetuses who died in utero, FM were observed during the last examination before death. In both, the cause of fetal death was related to an acute change. No relationship between FM and neonatal death was observed. These data suggest FM monitoring may be helpful in evaluating antepartum fetal condition.
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The responses of plasma insulin and the C-peptide of proinsulin, glucose, lactate, free fatty acids (FFA), glycerol, D-beta-hydroxybutyrate and alanine to a beta2-adrenergic agonist (salbutamol) were determined in 5 patients during the last trimester of pregnancy before labor. Salbutamol was given as an infusion in the same dosage as is used to inhibit uterine contractions in cases of premature labor and in obstetric emergencies. The influsion of salbutamol was given for 45 min, accompanied by repeated sampling of arterial blood. All patients developed moderate tachycardia and exhibited metabolic effects following salbutamol infusion, implying marked increases in plasma levels of insulin, C-peptide, glucose and lactate. An increased rate of lipolysis was evident from the rises of FFA, glycerol and D-beta-hydroxybutyrate. Plasma levels of alanine declined, possibly due to stimulation of gluconeogenesis. It is unlikely that these acute maternal metabolic changes would have significant adverse effects on the fetus.
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