Maternal somatostatin levels and their correlation with infant birth weight

190

Citationsfrom

the Literature

each stage rose progressively throughout the remainder of pregnancy at an average rate of 2% per lunar month. It peaked in the thirty-seventh week and remained significantly elevated 7 weeks postpartum. However, when the data were corrected for the additional requirement imposed by pregnancy weight gain, net efficiency was increased in both groups throughout pregnancy. These data support three conclusions. First, the efficacy of low-to moderate-intensity treadmill exercise in physically active women is improved in early pregnancy. Second, this increased efficiency is masked later in pregnancy by the effects of weight gain. Third, the degree of efficiency is enhanced throughout pregnancy in women who continue a regular exercise regimen at or above a basic conditioning level. Nifedipine pharmacokinetics during preterm labor tocolysis Ferguson JE II; Schutz T; Pershe R; Stevenson DK; Blaschke T Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University School of Medicine, Stanford, CA, USA

AM J OBSTET GYNECOL 1989,161/6 I(1485-1490) Nifedipine, a calcium entry blocker, has known relaxing effects of the myometrium. Thirteen women in preterm labor received nifedipine for tocolysis. Blood samples obtained serially during treatment and at the time of delivery were assayed for maternal and neonatal nifedipine concentrations. The peak concentration of nifedipine during sublingual therapy ranged from 23.4 to 197.9 ng/ml and reflected substantial interpatient variability. The mean (f SD) measurable trough value in patients who received 20 mg of nifedipine orally every 6 hours was 7.2 f 5.5 ng/ml. The maternal mean half-life of nifedipine was 81 min (range 49 to 137 minutes). At delivery, neonatal nifedipine levels were nondetectable in 6 of the 11 neonates available for study; in 5, values ranged from 29.5 to 1.8 ng/ml. From these results, we conclude that both sublingual and oral nifedipine treatment results in variable but usually measurable maternal plasma concentrations and that placental transfer of nifedipine occurs. induction of Iabour after fetal death: A randomized controlled trIaIof two prostaglandin regimens Kanhai HHH; Keirse MJNC Department of Obstetrics, Gynaecology and Reproduction, Leiden University, University Hospital, Rijnsburgerweg IO, 2333 AA Leiden, NLD

BR J OBSTET GYNAECOL 1989,96/12 (1400-1404) A total of 85 women with antepartum fetal death between 14 and 42 weeks gestation was randomly assigned to one of two regimens of intravenous infusion of the prostaglandin analogue ldphenoxy-17, 18, 19, 20-tetranor-PGE-methylsulphonamide (sulprostone) for inducing labour. Women received either 1 pg/min until delivery or the commonly recommended treatment of 1500 pg in 8 h followed by another, identical course of treatment if delivery did not occur within 24 h. The 1 pg/min dose schedule used half the amount of prostaglandin and resulted in statistically significantly fewer gastrointestinal side-effects compared with the conventional treatment. All women were delivered vaginally and there were no differences Int J Gynecol Obstet 33

in induction-to-delivery intervals between the two treatments. Sulprostone infused at a rate of 1 pg/min resulted in a 50% chance of being delivered within 12 h and a 90% chance of being delivered within 24 h, with an overall frequency of side effects of 20%. Protective effect of breast feeding against infection Howie PW; Forsyth JS; Ogston SA; Clark A; Du V; Florey C Ninewells Hospital, Medical School, Dundee DDI 9SY, GBR

BR MED J 1990,300/6716 (11-16) Objective: To assess the relations between breast feeding and infant illness in the first two years of life with particular reference to gastrointestinal disease. Design: Prospective observational study of mothers and babies followed up for 24 months after birth. Setting: Community setting in Dundee. Patients: 750 pairs of mothers and infants, 76 of whom were excluded because the babies were preterm (less than 38 weeks), low birth weight (less than 2500 g), or treated in special care for more than 48 hours. Of the remaining cohort of 674, 618 were followed up for two years. Interventions: Detailed observations of infant feeding and illness were made at two weeks, and one, two, three, four, five, six, nine, 12, 15, 18, 21, and 24 months by health visitors. Main outcome measure: The prevalence of gastrointestinal disease in infants during follow up. Results: After confounding variables were corrected for babies who were breast fed for 13 weeks or more (227) had significantly less gastrointestinal illness than those who were bottle fed from birth (267) at ages O-13 weeks (p < 0.01; 95% confidence interval for reduction in incidence 6.6% to 16.8%), 14-26 weeks (p < O.Ol), 27-39 weeks (p < 0.05), and 40-52 weeks (p < 0.05). This reduction in illness was found whether or not supplements were introduced before 13 weeks, was maintained beyond the period of breast feeding itself, and was accompanied by a reduction in the rate of hospital admission. By contrast, babies who were breast fed for less than 13 weeks (180) had rates of gastrointestinal illness similar to those observed in bottle fed babies. Smaller reductions in the rates of respiratory illness were observed at ages O-13 and 40-52 weeks (p < 0.5) in babies who were breast fed for more than 13 weeks. There was no consistent protective effect of breast feeding against ear, eye, mouth, or skin infections, infantile colic, eczema, or nappy rash. Conclusion: Breast feeding during the first 13 weeks of life confers protection against gastrointestinal illness that persists beyond the period of breast feeding itself. Maternal somatostatin levels and their correlation with infant birth weight Widstrom A-M; Matthiesen A-S; Winberg J; Uvnas-Moberg K Department of Paediatrics, Karolinska Hospital. Box 60500, S104 01 Stockholm, S WE

EARLY HUM DEV 1989,20/3-4 (165-174) Samples of blood were obtained from 52 primiparous breast-feeding women 4 days post partum. Thirty-six of the mothers were still breast-feeding 3-4 months later and had further blood samples taken. Somatostatin levels were analyzed by radioimmunoassay. A highly significant rank correlation (P = 0.0001) between average somatostatin levels on the two occasions was established, although somatostatin levels

Citations from the Literature recorded 3-4 months post partum were significantly higher than those found 4 days post partum (P < 0.01). Furthermore, somatostatin levels obtained 4 days and 3-4 months post partum were inversely related to the birth weight of their children (P = 0.006 and P = 0.03). The significant negative correlation between somatostatin levels recorded 4 days post partum and birth weight of the infants persisted only when non-smokers were investigated. A strong positive correlation between infant birth weight and weight of placenta was found (P = 0.0801) and a negative correlation (P = 0.04) between somatostatin levels and placental weight. A stepwise regression was performed to explain the importance of somatostatin levels in birth weight. Somatostatin levels and smoking had an almost equal influence on the variation in birth weight (* 10%). It is suggested that low maternal somatostatin levels are related to an efficient storage of nutrients in the fetoplacental unit, thereby leading to a high birth weight. Selective reduction of multifetal pregnancies

Wapner RJ; Davis GH; Johnson A; Weinblatt VJ; Fischer RL; Jackson LG; Chervenak FA; McCullough LB Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, IO25 Walnut Street, Philadelphia, PA 19107, USA LANCET 1990,335/8681 (90-93) Selective reduction was carried out in 46 multifetal pregnancies by means of potassium chloride injection into the pericardial region of the fetus. There were three indications for the procedure: to improve perinatal outcome and to increase the likelihood that a term infant would be born in a multifetal pregnancy (34 women); to allow the birth of a healthy infant without the birth of a congenitally abnormal coexisting fetus (8 women); and to preserve a singleton pregnancy when the woman would otherwise have the whole pregnancy terminated (4 women). Of the 80 fetuses left after reduction 75 (94%) have survived. In 3 cases ultrasound scanning showed cardiac activity in the injected fetus 20-30 min after the initial injection despite 2 min of asystole immediately after the injection; repeated injection, carried out the same day, led to fetal death in all 3 cases. Selective reduction of multifetal pregnancies for the three indications described is an ethically justifiable option for the management of multifetal pregnancy, to which there are no public policy obstacles. Survival in children with perinataily immunodeficiency virus type 1 infection

acquired

human

Scott GB; Hutto C; Makuch RW; Mastrucci MT; O’Connor T; Mitchell CD; Trapido EJ; Parks WP Department of Pediatrics, University of Miami School of Medicine, P.O. Box 016960, Miami, FL 33101, USA NEW ENGL J MED 1989,321/26 (1791-1796) We describe our experience at Jackson Memorial Hospital in Miami, Florida, with 172 children who were given diagnoses of perinatally acquired infection with human immunodeficiency virus type 1 (HIV-l). The 146 mothers of the children acquired HIV-l through heterosexual contact (69 percent), intravenous drug use (30 percent) or blood transfusion (1 per-

I91

cent). The children presented with sympatomatic disease at a median age of eight months; only 21 percent presented after the age of two years. The most common first manifestations of disease were lymphoid interstitial pneumonia (in 17 percent), encephalopathy (in 12 percent), recurrent bacterial infections (in 10 percent), and candida esophagitis (in 8 percent), for which the median survival times from diagnosis were 72, 11, 50, and 12 months, respectively. Nine percent of the children had Pneumocystis carinii pneumonia at a median age of five months and had a median survival of only one month. The median surival for all 172 children was 38 months from the time of diagnosis. Mortality as highest in the first year of life (17 percent), and by proportial-hazard analysis the probability of long-term survival is low. In multivariate analyses, early age at diagnosis and the first identifiable pattern of clinical disease were found to be independently related to survival. We conclude that children with perinatally acquired HIV-l infection have a very poor prognosis and that most become symptomatic before one year of age. Early diagnosis is important, since there is only a short interval in which to initiate prophylactic or anti-viral treatment before progressive disease begins.

PERINATOLOGICAL RESEARCH Esterase activity in second-and third-trimester amniotic fluid: An indicator of chorioamnionitis

Hoskins IA; Katz J; Ordorica SA; Young BK Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Medical Center, 450 First Ave., USA AM J OBSTET GYNECOL 1989, 161/6 I(1543-1545) Accurate and rapid diagnosis of chorioamnionitis poses a major diagnostic dilemma. We previously reported that leukocyte esterase activity in amniotic fluid, as measured by dipstick assay, could be used as an aid in the diagnosis of chorioamnionitis. This study examines the effectiveness of an in vitro spectrophotometric assay of esterase activity in amniotic fluid. We define baseline levels of esterase activity in uninfected amniotic fluid and demonstrate a quantitative increase when infection is present. Fifty-seven amniotic fluid samples obtained at second-and third-trimester amniocenteses were divided into three parts, one for culture and two for a comparison of esterase activities by the dipstick and this spectrophotometric methods. In study, the spectrophotometric assay, because of its higher specificity and sensitivity in the determination of elevated esterase activity, was shown to be more reliable for predicting chorioamnionitis than either the dipstick or culture method. High glucose levels decrease proliferation fetal cells from placenta

of cultured human

Nelson DM; Curran EM Department of Obstetrics and Gynecology, Washington University School of Medicine, Jewish Hospital, 216 S. Kingshighway, St. Louis, USA AM J OBSTET GYNECOL 1989, 16116 1(1553-1558) We used the placenta as a source of undifferentiated cells to Int J Gynecol Obstet 33