Soluble tumor necrosis factor receptor II and soluble cell adhesion molecule 1 as markers of tumor necrosis factor-alpha release in preeclampsia.

Background: The purpose of this case-controlled study was to investigate whether plasma concentrations of TNF-receptors I and II and tumor necrosis factor-alpha-induced cell adhesion molecule 1 VCAM-1 could serve as more sensitive markers of tumor necrosis factor-alpha release in preeclamptic women than a direct measurement of circulating tumor necrosis factor-alpha.

Methods: Plasma concentrations of soluble tumor necrosis factor receptor I and II, immunoreactive tumor necrosis factor-a and soluble cell adhesion molecule VCAM-1 were determined in 21 patients with severe proteinuric preeclampsia (23-35 weeks' gestation) and 21 gestational age-matched normotensive controls by enzyme-linked immunoassays. Concentrations of bioactive tumor necrosis factor-alpha were assessed by the WEHI 164 bioassay.

Release of tumor necrosis factor-alpha and prostanoids in whole blood cultures after in vivo exposure to low-dose aspirin.

Background: The preventive effect of low-dose aspirin in cardiovascular disease is generally attributed to its antiplatelet action caused by differential inhibition of platelet cyclooxygenase-1. However, there is evidence that aspirin also affects release of inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha). It is not known whether this is caused by direct action on the cytokine pathway or indirectly through cyclooxygenase inhibition and altered prostanoid synthesis, or both.

Neonatal outcome of temporizing treatment in early-onset preeclampsia.

Objective: To assess the effect of prolongation of pregnancy on neonatal outcome by means of hemodynamic treatment in patients with early-onset preeclampsia.

Study Design: A retrospective case-controlled study of 222 liveborn infants of patients with early-onset (24--31 weeks) preeclampsia, who underwent temporizing hemodynamic treatment. Of the two control groups of liveborn preterm infants of non-preeclamptic mothers one group was matched with the study group for gestational age on admission (group I), one for gestational age at birth (group II).

Respiratory and metabolic responses to endurance cycle exercise in pregnant and postpartum women.

This study was designed to determine whether endurance cycling responses in pregnancy differ from those postpartum. We studied 16 women longitudinally at approximately 32 wk pregnancy and approximately 10 wk postpartum. We measured heart rate (HR), O2 uptake (VO2), CO2 output (VCO2), minute ventilation VE and plasma concentrations of substrates and of catecholamines at rest, during maximal testing, and during approximately 35-40 min of cycling at approximately 70-75% VO2peak.

Circulating bioactive tumor necrosis factor-alpha, tumor necrosis factor-alpha receptors, fibronectin, and tumor necrosis factor-alpha inducible cell adhesion molecule VCAM-1 in uncomplicated pregnancy.

Objectives: Our goal was to assess in a longitudinal study of uncomplicated pregnancy the course of maternal plasma concentrations of the bioactive cytokine tumor necrosis factor-alpha, the soluble tumor necrosis factor-alpha receptors sTNFRI and sTNFRII, the soluble cell adhesion molecule sVCAM-1, and circulating fibronectin.

Study Design: Blood was collected from 22 healthy pregnant women at 7 to 17, 18 to 22, 23 to 28, and 30 to 36 weeks' gestation and post partum. Plasma samples were measured by bioassay for bioactive tumor necrosis factor-alpha, by immunoassay for sTNFRI, sTNFRII, and VCAM-1, and by radial immunodiffusion for circulating fibronectin, and data were statistically analyzed.

Peak ventilatory responses during cycling and swimming in pregnant and nonpregnant women.

This study was designed to determine whether pregnancy affects peak O2 uptake (VO2peak) during swimming compared with cycling. We studied 11 women at 30-34 wk gestation and 8-12 wk postpartum. We measured heart rate (HR), O2 uptake (VO2), CO2 output (VCO2), minute ventilation (VE), and lactic acid concentration.

Tumor necrosis factor-alpha in response to endotoxin administration in the pregnant guinea pig.

Objective: Our purpose was to test the hypothesis that an intramuscular endotoxin challenge induces production of tumor necrosis factor-alpha in the pregnant guinea pig and to investigate some of the metabolic effects.

Study Design: Twelve randomly selected guinea pigs at 33 days' gestation with a sampling catheter in the carotid artery received an intramuscular injection of a solution of endotoxin isolated from Bacteroides fragilis (n = 6) or of solvent alone (n = 6). Plasma values of tumor necrosis factor-alpha, hematocrit, and 6-keto-prostaglandin F1 alpha were determined before and several hours after injection.

Fetal heart rate and uterine contractility during maternal exercise at term.

Objective: Our aim was to assess the physiologic response of human fetal heart rate and uterine contractility to moderately strenuous maternal exercise.

Study Design: We measured fetal heart rate and intrauterine pressure with the use of internal monitoring before, during, and after maternal exercise at a heart rate of 140 beats/min on a cycle ergometer in 30 term women admitted for elective induction of labor. The fetal heart rate tracings were assessed by three observers and were classified according to Fischer et al.

A comparison between the haemodynamic effects of oral nifedipine and intravenous dihydralazine in patients with severe pre-eclampsia.

Objective: To compare the effects of a single oral dose of nifedipine with those of intravenous dihydralazine on central haemodynamics in pregnant women with severe pre-eclampsia.

Design: A prospective comparative study.

Setting: The High Risk Obstetric Unit, University Hospital Rotterdam Dijkzigt, Rotterdam.

Maternal and perinatal complications in triplet compared with twin pregnancy.

Objective: To compare maternal and perinatal complications in triplet and twin pregnancies.

Study Design: Case-controlled study in the setting of a University Hospital. Each pregnancy of a consecutive series of 40 triplet pregnancies of 20 weeks or more was matched for parity and maternal age with two sets of twins delivered in the same year.

Anaerobic threshold and respiratory compensation in pregnant women.

In an effort to explore why CO2 output (VCO2) at peak exercise is lower during pregnancy than postpartum despite little change in the peak O2 uptake (VO2), we determined the VCO2/VO2 relationship during rapidly incremental exercise and estimated the anaerobic threshold (AT) and the respiratory compensation (RC) point. We measured heart rate, VO2, VCO2, and minute ventilation (VE) at rest and during cycle exercise tests with rapidly increasing exercise intensities until maximal effort in 33 volunteers at 16-, 25-, and 35-wk gestation and postpartum. Through modification of the V-slope method, we estimated the AT and RC point for each test by nonlinear regression analysis in a three-dimensional space (defined by VE, VO2, and VCO2) for a line assumed to have two breakpoints; we found a good fit for all tests.

Effect of low-dose aspirin during pregnancy on fibrinolytic variables before and after parturition.

Objective: We assessed the effects of a daily oral dose of 60 to 80 mg of aspirin from 12 weeks' gestation until delivery on fibrinolytic variables before and after parturition.

Study Design: In a prospective controlled study labor was electively induced in 24 patients, eight receiving low-dose aspirin and 16 controls. Levels were determined in maternal and cord plasma of tissue-type plasminogen activator antigen and activity, plasminogen activator inhibitor-1 antigen, plasminogen activator inhibitor activity, and plasminogen activator inhibitor-2 antigen.

Temporising management of severe pre-eclampsia with and without the HELLP syndrome.

Objective: To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre-eclampsia receiving temporising haemodynamic treatment does not depend on the presence or absence of the syndrome of haemolysis, elevated liver enzymes, and a low platelet count (HELLP).

Design: A case-controlled study.

Setting: High risk obstetric unit, University Hospital Rotterdam-Dijkzigt, Rotterdam.

Expectant management of twin pregnancy with single fetal death.

Objective: To evaluate the course and outcome of expectantly managed twin pregnancies with single fetal death in the second half of gestation.

Design: Case-controlled study of 29 consecutive pregnancies from 1973 to 1993, with sonographic evidence of a twin at 20 weeks gestation with antenatal demise later in pregnancy, matched for maternal parity with 58 twin pregnancies without fetal death and delivered in the same year as the index case. Outcome measures included the incidence of complications of pregnancy, gestational age and mode of delivery, placentation, and perinatal outcome.

Sensitivity of ovine myometrial tissue to various eicosanoids in vitro.

The sensitivity of sheep myometrial tissue to prostaglandin F2 alpha (PGE2 alpha), PGE2, the thromboxane analog U-44069, and leukotrienes C4 (LTC4) and LTD4 was investigated in a superfusion system. Tissues were obtained from eight oophorectomized ewes, with or without pretreatment with estradiol-17 beta. After equilibration, spontaneous activity was abolished by adding indomethacin to the superfusion fluid.

Hypertensive disorders in twin pregnancy.

Objective: To compare the incidence and severity of pregnancy-induced hypertensive disorders in twin pregnancy and in singleton gestation.

Study Design: Case-control study in the setting of a University Hospital. Each pregnancy of a consecutive series of 187 twin pregnancies attending the antenatal clinic and booked before a gestational age of 24 weeks was matched for maternal age, parity, and gestational age at delivery with a singleton pregnancy delivered in the same year.

Effects of labor and delivery on fibrinolysis.

Because timing of sampling is crucial in an investigation of the effects of labor and delivery on fibrinolysis we conducted a study of fibrinolytic markers in plasma of 10 healthy multiparous women in whom labor was induced, which allowed standardization of sampling times in relation to the course of labor and delivery. Blood samples were taken 5 min before the start of oxytocin infusion, at full cervical dilatation, and within 5 min after delivery of the placenta. A sample of mixed free flowing cord blood was obtained after delivery with the placenta in situ.

Effects of estrogen treatment and inhibition of prostanoid synthesis on myometrial activity and gap junction formation in the oophorectomized ewe.

The objective was to elucidate the functional relationship between estradiol-induced changes in myometrial activity, uterine prostanoid synthesis, and gap junction formation in vivo. The study design was as follows. The effects of inhibition of prostanoid synthesis with naproxen on formation of gap junctions and coordination of electrical and mechanical myometrial activity induced by estradiol-17 beta were investigated in 6 chronically instrumented oophorectomized ewes.

Perinatal results of hemodynamic and conservative temporizing treatment in severe pre-eclampsia.

Objective: To evaluate maternal and perinatal outcome of hemodynamic temporizing management in severe pre-eclampsia.

Design: Study group of 57 pre-eclamptic women, gestational age 35 weeks or less, treated with plasma volume expansion and vasodilatation under invasive hemodynamic monitoring, retrospectively matched with a control group treated in another center without volume expansion and invasive monitoring.

Results: In both groups pregnancy was prolonged with 10-11 days.

Ultrasound assessment of cervical dynamics during the first stage of labor.

Objective: Assessment of cervical dynamics during the first stage of labor by a combination of ultrasound cervimetry and intrauterine tocography.

Methods: Sixty-two parturients were divided into four groups: nulliparous women in spontaneous (n = 9) or oxytocin-induced labor (n = 26), parous women in spontaneous (n = 11) or oxytocin-induced labor (n = 16). Intrauterine pressure and cervical dilatation were continuously recorded and assessed by off-line computer analysis.

Perinatal listeriosis in a Dutch woman returning from holiday in France.

A case is reported of perinatal infection and fetal death due to Listeria monocytogenes serotype 4B in a 28-weeks pregnant woman, who had spent her holiday in an area in France where an epidemic outbreak of listeriosis had occurred. Sero- and phage-typing combined with sensitive DNA-typing demonstrated that the Listeria was identical to the strain responsible for the outbreak in France. Although listeriosis appears to be an uncommon cause of perinatal infection, practicing obstetricians should be aware of the possibility.

Low-dose aspirin in pregnancy: changes in patterns of prescription in The Netherlands.

Objective: To describe patterns of prescription in the Netherlands of low-dose aspirin in pregnancy.

Design: Anonymous written inquiry in 1989 and 1991.

Subjects: Gynecologists in the Netherlands (619 in 1989 and 618 in 1991), practicing in training and non-training hospitals.

Endotoxin-induced fetal growth retardation in the pregnant guinea pig.

Objectives: Our purpose was to test the hypothesis that bacterial endotoxin may reduce fetal growth and to assess some of the pathophysiologic mechanisms of such an effect.

Study Design: Two randomly selected groups of nine guinea pigs at 30 days' gestation were treated with a solution of endotoxin isolated from Bacteroides fragilis or with solvent alone. Antibody titers, glucose, triglycerides, and 6-keto-prostaglandin F1 alpha were determined in maternal or fetal blood samples.