Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity inpatients with preterm labor and intact membranes

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Full blood gas and obstetric data were available for 16060 newborns. Of these, 15073 (94%) had a 5-min Apgar score I 7. The median umbilical artery values, with 2.5 percentile values in parentheses, were pH 7.26 (7.101, PCO, 52 mmHg (74), base excess - 4 mEq - L’ ( - ll), and PO, 17 mmHg (6). Although the distributions were skewed, the mean f 2 SDS were similar to these values. Data for these babies were further analyzed by method of delivery, gestational age, presentation, and presence of thick meconium. Although the means were significantly different in all groups, the differences between groups were relatively small. Conclusion: A wide range of acid-base values were found in babies with normal Apgar scores, defining the ‘physiologic acidemia’ of the normal vigorous newborn. Estimation of fetal lung volume using enhanced 3-dimensional ultrasound: A new method and first result D’Arcy T.J.; Hughes SW.; Chiu W.S.C.; Clark T.; Milner A.D.; Saunders J.; Maxwell D. GBR BR. J. OBSTET. GYNAECOL. 1996 103/10 (1015-10201 Objective: To measure fetal lung volume using a computer based, enhanced, 3-dimensional ultrasound imaging system. Design: An observational study. Setting: The Fetal Medicine Unit at Guys Hospital, London. Participants: Twenty healthy women with a singleton pregnancy between 24 and 36 weeks of gestation were scanned on one occasion during pregnancy using an ultrasound based 3-dimensional imaging system. All delivered at term with weights above the 10th centile for gestation. Results: Total lung volume increased exponentially with gestational age. Right lung volume measured consistently greater than left lung volume. Conclusions: The use of this new enhanced 3-dimensional imaging system allows for estimations of fetal lung volume. Preliminary data confirm that fetal lung volume, measured by a computerised 3-dimensional ultrasound imaging system increased exponentially with gestational age. The use of this system has obvious application in the further study of lung growth in utero and possible clinical application in disease states where fetal lung growth may be impaired. Decreased transferrin andincreased transferrln saturation in sera of women with preeclampsia: implications for oxidative stress Hubel CA.; Kozlov A.V.; Kagan V.E.; Evans R.W.; Davidge S.T.; McLaughlin M.K.; Roberts J.M. USA AM. J. OBSTET. GYNECOL. 1996 175/31(692-700) Objective: The concerted iron-binding antioxidant activity of transferrin and ceruloplasmin decreases with increasing transferrin saturation by iron. We examined interactions between serum iron and iron-binding capacity and concentrations of the lipid peroxidation metabolite malondialdehyde in normal and preeclamptic pregnancies. We also asked if the release of iron from free hemoglobin by lipid hydroperoxides is a potential mechanism to increase transferrin saturation in preeclampsia. Study design: Predelivety and 24-48-h post-

of Gynecology

C? Obstetrics

56 (1997) 213-223

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partum venous blood was collected from 19 women with uncomplicated pregnancies and 17 with preeclampsia. Serum iron, iron binding capacity, and malondialdehyde were measured. In a subset of predelivery samples electron paramagnetic resonance spectroscopy was used to determine diferric transferrin, total transferrin, and ceruloplasmin concentrations and to examine interactions of an organic hydroperoxide with hemoglobin and transferrin. Results: Antepartum serum iron concentrations were 46% greater, percent saturation of iron binding capacity was 98% greater, and malondialdehyde 50% grcatcr, whereas total iron binding capacity was 14% lower, in women with preeclampsia. By 48 h post-partum group differences between these variables other than total iron-binding capacity were not observed. Electron paramagnetic resonance spectroscopy confirmed antepartum differences and that total iron-binding capacity and percent saturation were equivalent to total transferrin and the ratio diferric transferrin/total transferrin, respectively. Antepartum concentrations of ceruloplasmin were not different. Antepartum malondialdehyde concentrations correlated positively with percent transferrin saturation and negatively with unsaturated iron binding capacity (apotransferrin). Electron paramagnetic resonance spectroscopy demonstrated that the release of iron from free hemoglobin by lipid hydroperoxides in serum is a potential mechanism to increase transferrin saturation. Conclusion: Increased transferrin saturation and decreased unsaturated iron binding capacity in preeclampsia may occur consequent to oxidative stress and then further promote oxidative stress by decreasing serum antioxidant buffering against redox-active iron. Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity inpatients with preterm labor and intact membranes Rizzo G.; Capponi A.; Rinaldo D.; Tedeschi D.; Arduini D.; Romanini C. ITA AM. J. OBSTET. GYNECOL. 1996 175/4 I (812-8171 Objective: The objectives of this study were to determine whether cytokine levels in cervical secretions were increased in the presence of microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes and to relate concentrations to cytokine levels in amniotic fluid, cervicovaginal microflora, and the presence of chorioamnionitis. Study design: Cervical secretions were sampled immediately before amniocentesis in 92 patients admitted for preterm labor with singleton pregnancies and intact membranes. Am niotic fluid was cultured and the following cytokines were measured in amniotic fluid and cervical secretions: interleukin-lbeta, interleukin-1 receptor antagonist, tumor necrosis factor-alpha, and interleukind. The cervicovaginal microflora and placentas (n = 42) were also analyzed. Results: A total of 19.56% (18/92) of the amniotic fluid cultures had positive results. All the cytokines tested showed significantly higher levels in cervical secretions in the presence of intraamniotic infection. There were significant relationships between the concentrations of interleukin-6 and interleukin-1 receptor

218

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antagonist in amniotic fluid and cervical secretions. A conccntration of interleukin-6 in cervical secretions > 410 pg/ml had a sensitivity of 66.8% and a specificity of 90.5% and a relative risk of 7.7 for intraamniotic infection, higher than the other cytokines tested. There were no relationships between the presence of bacterial vaginosis and cervicovaginal pathogens and cervical cytokine levels. In the presence of chorioamnionitis, cervical concentrations of interleukin-6 and interleukin-1 receptor antagonist were significantly increased in spite of negative amniotic fluid culture results. Conclusion: The measurement of interleukin-6 in cervical secretion? may help to non-invasively identify intraamniotic infection among pregnancies with preterm labor and intact membranes. The clinical efficacy of oral tocolytic Rust O.A.; Bofill J.A.; Arriola R.M.; J.C.

therapy Andrew

M.E.;

Morrison

USA

AM. J. OBSTET. GYNECOL. 1996 175/4 I (838-842) Objective: Our purposewas to determine whether maintenance oral tocolytic therapy after preterm labor stabilization decreases uterine activity, reduces the rate of recurrent preterm labor and subsequent preterm birth, or improves neonatal outcome. Study design: Women with documented idiopathic pretenn labor stabilized with acute tocolytic therapy were randomized to three groups: placebo, terbutaline 5 mg, or magnesium chloride 128 mg, all given orally every 4 h. Patients and providers were blinded to group assignment. All subjects were enrolled in a comprehensive system of preterm birth prevention that included preterm labor education, weekly clinic visits, home uterine contraction assessment, daily phone contact, and 24-h perinatal nurse access. Results: Of the 248 patients who were randomized, 39 were delivered before discharge and four were lost to follow-up, leaving 205 for final analysis: 68 placebo, 72 terbutaline, and 65 magnesium. The terbutaline group had significantly more side effects than the placebo group did. All groups had otherwise similar perinatal outcomes when confounding variables were controlled for. Overall, the three groups had a preterm birth rate < 37 weeks of 55.6% delivery, < 34 weeks of 15.6%, a 20.4% rate of newborn intensive care unit admission, and a mean neonatal length of stay of 6.3 days. Conclusions: Maintenance oral tocolytic therapy did not decrease uterine activity, reduce the rate of recurrent preterm labor or preterm birth, or improve perinatal outcome. Overall improvement in perinatal outcome may be achieved with a comprehensive program of preterm birth prevention without the use of maintenance oral tocolytic therapy.

FERTILITY

AND STERILITY

The effect of peritoneal fluid from patients on human sperm function in vitro Aeby T.C.; Huang T.; Nakayama R.T.

with endometriosis

USA

AM. J. OBSTET. GYNECOL. 1996 174/6 (1779-1785) Objective: Our purpose was to evaluate the effect of peritoneal fluid from women with endometriosis on sperm motility

of Gynecology

& Obstehics

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and function in an in vitro model. Study design: Peritoneal fluid was collected at laparoscopy from patients with and without endometriosis. Human donor sperm was diluted with this fluid, and its effect on sperm function and motility was measured with the zona-free hamster egg sperm penetration assay and computer-assisted semen analysis. Results: The mean number of eggs penetrated by the sperm mixed with peritoneal fluid from patients with endometriosis was significantly fewer than the number penetrated by the sperm mixed with fluid from control patients (22.9 + 5.31 vs. 44.4 f 4.96, P < 0.01, Student’s t-test, n = 20). When evaluated by computer-assisted semen analysis, sperm mixed with peritoneal fluid from patients with endometriosis showed a significant decrease in mean swimming velocity compared with sperm mixed with peritoneal fluid from control patients (54.0 + 1.77 vs. 59.2 + 1.05, P = 0.02, Student’s t-test, n = 20). A significant increase in the fraction of sperm swimming at slower velocities was also found. A trend toward a positive correlation between eggs penetrated and sperm velocity was seen, but statistical significance was not achieved (correlation coefficient, r= 0.4392, I’ = 0.053, n = 20). Conclusion: These data suggest that substances found in the peritoneal fluid of patients with endometriosis could contribute to infertility through impairment of both sperm function and motion kinematics.

Peritoneal fluid from women with moderate or severe endometriosis inhibits sperm motility: the role of seminal fluid components Oral E.; Arici A.; Olive D.L.; Huszar G. :gTIL. STERIL. 1996 66/S (787-792) Objective: To examine the mechanism of sperm motility inhibition by peritoneal fluid (PF) from women with endometriosis. Design: Prospective, randomized study. Setting: University-based andrology laboratory. Patients: Women with and without endometriosis. Interventions: Fresh semen or Percoll-purified sperm fractions were combined with PF from women with endometriosis (n = 20), from fertile women without endometriosis (n = lo), or with physiological saline. Main outcome measure: Sperm motility parameters were determined with computer-assisted semen analysis. Data were evaluated by the analysis of variance and the Student’s t-test. Results: Peritoneal fluid from women with minimal or mild endometriosis did not inhibit sperm motility in semen. Peritoneal fluid from women with moderate or scvcre cndomctriosis caused approximately 40%, 50%, and 80% declines in sperm motility and in percent progressive motile sperm, after 4, 7, and 24 h, respectively. Sperm velocity was inhibited by approximately 30% and 60% after 7 and 24 h, respectively. However, in the Percoll-purified sperm fractions the same PF did not inhibit sperm motility within the 4-7-h time frame, and only a 17-42% inhibition occurred after the overnight incubation. Sperm velocity was not affected. Conclusion: Cellular components of seminal fluid appear to mediate the inhibitory action of PF. Assuming that the leukocyte components of semen and PF are common, the cell-mediated inhibi-