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Pregnancy zone protein and oral contraceptives
682
Correspondence
Fig. 1. Communicating
canal from pregnant horn
antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants, Pediatrics 50: 515. 1972.
to cervical
canal
(Fig. 1). The diameter of this canal was only 1 mm. and its walls were \ery rigid, so normal dilatation at labor was ver) unlikely and continuation of this pregnancy would probably have led to a dangerous .41x> in this patient
Twin pregnancy in double uterus To the Editors:
With great interest I have read the case of an unusual twin pregnancy in a double uterus, published by Drs. Zervoudakis, Lauersen, and Saary (AM. J. OBSTET. GYNECOL. 124: 659, 1976). In 1973, I was confronted with the following case. A 30-year-old woman, who had a normal pregnancy and delivery 10 years earlier, went to an abortion clinic in Amsterdam to have a pregnancy interruption carried out at 12 weeks’ amenorrhea. The existence of a uterine anomaly was not known beforehand, and it was not recognized at examination. With the use of local anesthesia, prior to a suction curettage, the uterus was sounded (unnecessary and dangerous). Perforation occurred, and the patient was sent to the University Hospital of Amsterdam. Here, with the use of general anesthesia, a careful suction curettage was done, but no fetal material was obtained. Inspection of the cervix revealed another canal which ended blindly after I % cm. This finding aroused suspicion that the patient might have a uterine anomaly, and a laparotomy was performed. Then the existence of a bicornuate uterus with the pregnancy in the right horn and a small perforation in the top of the left horn was noticed. But even then, with the guidance of the operator, it remained impossible to enter the pregnant horn via the only permeable cervical canal. Thus, it was decided to resect the pregnant horn and its tube. After this was carried out, at first no communication of the pregnant rudimentary right horn and the left horn or its cervical canal were found. At a microscopic examination, a very tiny communicating canal from the pregnant horn to the cervical canal of the left horn was found
of left horn.
situation. an anomaly
of the urinary
tract
was
present. e.g., absence of the right kidney. I wonder if such a very tiny communication between both horns was not also present in the extraordinar) case of Zervoudakis and his co-authors. Otherwise, thr pregnancy in the “blind” horn and especially the nonexistence of hematometra and hematosalpinx on that side remain a complete miracle to me. Ernst
W. Lomdmioot
Pregnancy zone protein and oral contraceptives To the Editors:
The extremely interesting paper by Dr. M. G. Damber and colleagues (AM.J. OBSTET. GYNECOL. 124: 289, 1975) demonstrates that increased amounts of the pregnancy zone protein (an cu,-globulin with a molecular weight of about 359,000) were detected in 59 per cent of a group of women receiving Ovral, compared to 9 1 per cent of a group receiving Norinyl- 1. In contrast, no rise was seen in any women using a progestogen-only product (Nor-Q.D.). Interpretation of these results is complicated by the fact that the authors state that Norinyl-1 contains 100 kg of mestranol per tablet, but the product internationally marketed under this name, to the best of rn?
Volume Number
127 6
knowledge, always contains 50 pg of mestranol. Therefore, if the study was a comparison of two products containing 50 pg of estrogen, then the highly sigthe Ovral and the nificant difference between Norinyl-I groups can only be due to the progestogen components. I’ have previously shown that norgestrel, but not norethindrone, antagonizes estrogen-induced changes in many plasma proteins. 1 would be grateful if this could be clarified. Michael Briggs Deakin Unwrsity Geelong 3220, .4 ustralia REFERENCE
1. Briggs, M. H.: Effects of oral progestogens on estrogeninduced changes in plasma proteins, J. Reprod. Med. 15: 100, 1975.
Reply to Dr. Briggs To the Editors: The two types of combined oral contraceptives that were used in the study on the pregnancy zone (PZ)
Correspondence
683
protein had the composition that was given in the paper. We are not very familiar with the various American synonyms for oral contraceptive, but we were told that the pill containing norethisterone, 1 mg., and mestranol, 0.1 mg., had the name of Norinyl 1 + 100. However, this pill was a brand in Sweden sold under the name of Conlunett. The study showed that the induction of PZ protein was significantly affected by the type and dosage of the drug. It seems likely that the “total estrogen effect” is of importance for the induction of PZ protein. and we agree completely with Dr. Briggs that the antiestrogenic effect of norgestrel in one of the combinations should be taken into consideration in this respect. Ma&G&-an Damber Bo zwn Srhoultz Torgny Stigbrand Departments of‘ Obstetrics and Gynecology and Physiological Chemistry University of t'muii S-901 87 UmeK, Sweden
Correspondence
Fig. 1. Communicating
canal from pregnant horn
antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants, Pediatrics 50: 515. 1972.
to cervical
canal
(Fig. 1). The diameter of this canal was only 1 mm. and its walls were \ery rigid, so normal dilatation at labor was ver) unlikely and continuation of this pregnancy would probably have led to a dangerous .41x> in this patient
Twin pregnancy in double uterus To the Editors:
With great interest I have read the case of an unusual twin pregnancy in a double uterus, published by Drs. Zervoudakis, Lauersen, and Saary (AM. J. OBSTET. GYNECOL. 124: 659, 1976). In 1973, I was confronted with the following case. A 30-year-old woman, who had a normal pregnancy and delivery 10 years earlier, went to an abortion clinic in Amsterdam to have a pregnancy interruption carried out at 12 weeks’ amenorrhea. The existence of a uterine anomaly was not known beforehand, and it was not recognized at examination. With the use of local anesthesia, prior to a suction curettage, the uterus was sounded (unnecessary and dangerous). Perforation occurred, and the patient was sent to the University Hospital of Amsterdam. Here, with the use of general anesthesia, a careful suction curettage was done, but no fetal material was obtained. Inspection of the cervix revealed another canal which ended blindly after I % cm. This finding aroused suspicion that the patient might have a uterine anomaly, and a laparotomy was performed. Then the existence of a bicornuate uterus with the pregnancy in the right horn and a small perforation in the top of the left horn was noticed. But even then, with the guidance of the operator, it remained impossible to enter the pregnant horn via the only permeable cervical canal. Thus, it was decided to resect the pregnant horn and its tube. After this was carried out, at first no communication of the pregnant rudimentary right horn and the left horn or its cervical canal were found. At a microscopic examination, a very tiny communicating canal from the pregnant horn to the cervical canal of the left horn was found
of left horn.
situation. an anomaly
of the urinary
tract
was
present. e.g., absence of the right kidney. I wonder if such a very tiny communication between both horns was not also present in the extraordinar) case of Zervoudakis and his co-authors. Otherwise, thr pregnancy in the “blind” horn and especially the nonexistence of hematometra and hematosalpinx on that side remain a complete miracle to me. Ernst
W. Lomdmioot
Pregnancy zone protein and oral contraceptives To the Editors:
The extremely interesting paper by Dr. M. G. Damber and colleagues (AM.J. OBSTET. GYNECOL. 124: 289, 1975) demonstrates that increased amounts of the pregnancy zone protein (an cu,-globulin with a molecular weight of about 359,000) were detected in 59 per cent of a group of women receiving Ovral, compared to 9 1 per cent of a group receiving Norinyl- 1. In contrast, no rise was seen in any women using a progestogen-only product (Nor-Q.D.). Interpretation of these results is complicated by the fact that the authors state that Norinyl-1 contains 100 kg of mestranol per tablet, but the product internationally marketed under this name, to the best of rn?
Volume Number
127 6
knowledge, always contains 50 pg of mestranol. Therefore, if the study was a comparison of two products containing 50 pg of estrogen, then the highly sigthe Ovral and the nificant difference between Norinyl-I groups can only be due to the progestogen components. I’ have previously shown that norgestrel, but not norethindrone, antagonizes estrogen-induced changes in many plasma proteins. 1 would be grateful if this could be clarified. Michael Briggs Deakin Unwrsity Geelong 3220, .4 ustralia REFERENCE
1. Briggs, M. H.: Effects of oral progestogens on estrogeninduced changes in plasma proteins, J. Reprod. Med. 15: 100, 1975.
Reply to Dr. Briggs To the Editors: The two types of combined oral contraceptives that were used in the study on the pregnancy zone (PZ)
Correspondence
683
protein had the composition that was given in the paper. We are not very familiar with the various American synonyms for oral contraceptive, but we were told that the pill containing norethisterone, 1 mg., and mestranol, 0.1 mg., had the name of Norinyl 1 + 100. However, this pill was a brand in Sweden sold under the name of Conlunett. The study showed that the induction of PZ protein was significantly affected by the type and dosage of the drug. It seems likely that the “total estrogen effect” is of importance for the induction of PZ protein. and we agree completely with Dr. Briggs that the antiestrogenic effect of norgestrel in one of the combinations should be taken into consideration in this respect. Ma&G&-an Damber Bo zwn Srhoultz Torgny Stigbrand Departments of‘ Obstetrics and Gynecology and Physiological Chemistry University of t'muii S-901 87 UmeK, Sweden