Neonatal death after induced abortion

An obstetrical practice based at a university hospital in Jerusalem has studied the offspring of 9,894 women who were pregnant at least once during the years 1966 through 1968, and discovered that the neonatal mortality rate was 2 to 3 times higher in infants born to women who reported a previous induced abortion. Among the women studied, 7.2% reported at least 1 previous abortion; immigrants from South Africa tended to have the highest rate of abortion, whereas the lowest rate was observed in the Arab population. An inverse relationship was detected between a history of induced abortion and the following: the degree of religious observance; maternal age at the time of marriage; and maternal age at the time of past deliveries. A positive correlation was observed between a history of induced abortion and the present age of the mother; smoking; Caesarian section; bleeding during pregnancy; vomiting during pregnancy; and the use of medications during the 1st trimester of the present pregnancy. The women in this study delivered a total of 11,057 infants between 1966 and 1968; infants born to mothers who reported a previous induced abortion experienced a higher neonatal mortality rate and were more likely to be low birth-weight infants, when compared to the group of infants whose mothers did not report a previous induced abortion.     

A histologic study of the placentas of patients with saline- and prostaglandin-induced abortion

A comparative histologic study of plancentas aborted after infusion of hypertonic saline or prostaglandin F2alpha into the amniotic cavity toinduce abortion is presented. Five placentas from spontaneous abortions served as controls. Saline abortion produced edema of the membranes; congested,dilated, thrombotic blood vessels; and subchorionic necrosis. Prostaglandin did not produce edema, but created marked vasospasm as evidenced by thickened vessels without subchorionic necrosis. The absence of serious sepsis and defibrination in prostaglandin-induced abortions is probably related to the absence of tissue necrosis.     

Delayed delivery of surviving triplet after fetal reduction and spontaneous abortion

In multiple pregnancies, survival of remaining fetuses after premature death and delivery of one fetus is uncommon. We report a case of a triplet pregnancy that was reduced to twins at the 14th gestational week and then had preterm premature rupture of membranes and intrauterine fetal death of one twin at the 17th gestational week. To save the surviving fetus, delivery of the dead fetus and ligation of the umbilical cord at the cervical level were performed. We also performed McDonald cervical cerclage to keep the placenta of the dead fetus as well as that of the surviving one in the uterine cavity. After a series of aggressive procedures, including immediate administration of tocolytic agents, and antibiotic prophylaxis to prevent infection and preterm labor, the surviving fetus was delivered vaginally 73 days later due to intractable uterine contractions. After a 10-week hospital stay, the infant boy, weighing 2,500 g, was discharged without any sequelae. To our knowledge, this was the longest interval between deliveries in a triplet pregnancy reported in Taiwan. With adequate intensive management, a satisfactory outcome of the fetus and mother in such cases is possible.     

Iatrogenic secondary infertility caused by residual intrauterine fetal bone after midtrimester abortion

Eleven women with secondary infertility had ultrasonographic findings of intrauterine calcification. Infertility developed in all women after operative termination of midtrimester pregnancy. Dilation and curettage or hysteroscopic removal confirmed residual fetal bony fragments. The removal of these bony fragments was associated with therapeutic success for infertility.     

Pathological features of the placenta in fetal death

Few studies of the histopathological features of the placenta in cases of fetal death are available. We will describe the placental findings from 24 midtrimester spontaneous abortions and 54 stillborn infants of more than 28 weeks' gestation. In almost 100% of midtrimester abortions and in 48% of the placentas from stillborn infants of more than 28 weeks' gestation, chorioamnionitis, deciduitis, and/or villitis were present. Because of this very high percentage of lesions, which suggests an infectious causation, it is mandatory that studies be performed that might identify pathogens. One third of the stillborn infants of more than 28 weeks' gestation were associated with maternal complications (diabetes, preeclampsia, and urinary tract infection), in addition to placental fetal vasculopathy, ischemia, infarcts, and chorangiosis (villous capillary hyperplasia). We emphasize the use of the placenta for the recognition of maternal diabetes.     

Socioeconomic factors in relation to fetal growth in white infants

Over 1,200 white mothers who were delivered consecutively at this medical center were classified in four different socioeconomic classes according to family affluence and occupations of the heat of the household. The frequency of low-birth-weight infants was highest in the lowest socioeconomic class. The high incidence of LBW infants in the lowest socioeconiomic group was not affected by any significant increase in number of mothers with medical problems or medical complications of pregnancy; it was dependent on the large number of mothers who were involved in four specific practices, largely of their own choosing, including low-weight gains, cigarette smoking, use of certain drugs during pregnancy, and refraining from all prenatal care. Mothers in the four socioeconomic classes who were not involved with these four specific practices (smoking, etc.) and whose pregnancies were free of medical problems and complications had uniformly low incidences of LBW infants and the mean birth weights of their infants were uniformly high and not significantly different. Unfavorable outcome of pregnancy with respect to fetal growth in this study appeared to depend less directly on socioeconomic circumstances than on the four specific maternal practices listed above.     

Histomorphometric changes of the skin in rats in relation to age

Histomorphometric evolution of skin was studied using 74 Wistar rats aged from 2 days to 34 months. Epidermal and dermal thickness, as well as surface density of collagen bundles in the superficial dermis was investigated by image analysis. Average epidermal thickness decreases progressively up to the 4th week, than it remains almost constant. Dermal thickness has a biphasic evolution. It increases rapidly during the first 3 weeks (+166%). This increase is followed by an important decrease (-55%), than dermal thickness increases again and reaches at the age of 1 year 5 times its value at birth. That thickness persists up to the end of life. Surface density of collagen bundles follows the rate of increase of dermal thickness, but variations are less important. Total increase of surface density of dermal collagen bundles between birth and the end of life corresponds to 56% of the initial value.     

Morphological change of lipids in the vaginal epithelium after intrauterine fetal death (lipid test)

The authors studied the lipid content of the vaginal epithelium of gravida in whom intrauterine fetal death had occurred. Fifteen gravida in the 6th to 10th month of gestation were examined and an unusual, inconsistent with the respective gestation term increase in the intra- and extra-cellular lipid content of the vaginal epithelium demonstrated. This is related to a decrease in the amount of estrogen hormones secreted by the placenta. A cytochemical 'lipid test' based on the above findings has been developed by the authors for the diagnosis of intrauterine fetal death during the second half of pregnancy.     

Placental transporter activity and expression in relation to fetal growth

The question of whether there are causative or compensatory changes in placental transport physiology affecting fetal growth is considered. Reductions in uterine and umbilical blood flow in growth retardation will reduce maternofetal exchange of lipophilic solutes, such as O2 and CO2, but will not have a major effect on the transfer of hydrophilic solutes. These solutes are transferred across the placenta by paracellular diffusion, transporter protein-mediated transport and endocytosis-exocytosis. Neither paracellular diffusion nor endocytosis-exocytosis has been investigated in relation to fetal growth. The weight of evidence is that there is no change in the activity and expression of the syncytiotrophoblast GI UTI glucose transporter in fetal growth retardation. However, there is strong evidence that the activity of the system A amino acid transporter, per milligram of placental membrane protein, is altered in relation to fetal growth, but in a complex manner. There is also some weaker evidence that the activity of the Na(+)-H+ exchanger, per milligram of placental membrane protein, is directly related to birth-weight. There are no data for other solute transporters; a considerable amount of work still remains to be done in order to understand the relationship between placental function and fetal growth rate.     

Small bowel injury in gastroschisis: relation to fetal presentation

The study presented here attempts to assess the cost savings attributable to having an on-site corporate medical clinic. For a period of 4 months, employees using the clinic were surveyed regarding: (1) whether they would have used an outside doctor if the corporate medical department clinic were not available, and (2) how many days per year they estimated that they came to work because there was an on-site medical center when they would otherwise have stayed at home. The results indicated that, on average, employees who used the facility saved 3.3 days of absenteeism. That total cost savings was calculated to be $499,212 per year. In addition, 69% of employees indicated that they would have sought attention elsewhere, suggesting that the presence of an on-site medical center does not induce demand. The findings concerning the hidden savings brought about by an on-site medical center are also discussed.     

Morphological and biochemical changes in the myocardium after sudden death from ischemic heart disease

The myocardium was examined in 44 persons who had suddenly died of ischemic heart disease, in 37 who had died of injury, and in 28 who had died of alcohol poisoning. Those with ischemic heart disease had foci of necrosis of the muscle fibers, severe disturbances in microcirculation, changes in the activity of certain myocardial enzymes and in the content of lipids in the myocardium. Biochemical changes similar to these in many respects were revealed in individuals who had died of alcohol poisoning, in view of which alcohol poisoning may be a factor conducive to sudden death in ischemic heart disease.     

Ca-DTPA-induced fetal death and malformation in mice

Increased fetal mortality and congenital malformation were induced in mice by Ca-DTPA, a chelate widely used for the removal of internally deposited plutonium in human beings. Mated C57BL/Do female mice were given five daily injections of 720-2,880 mumol/kg Ca-DTPA during early, mid, or late gestation. Damage probably occurred as a result of the depletion by Ca-DTPA of zinc and manganese, trace elements essential to growth and development. By extension, it seems likely that Ca-DTPA could damage human fetuses. A much safer chelate, Zn-DTPA, is recommended for the treatment of accidental plutonium contamination.     

Indication of medical abortion in cases of fetal abnormalities diagnosed in utero

OBJECTIVE: To search the novel gene related to human hepatoma. METHODS: Northern blot analysis was used to isolate from EST (expressed sequence tags) clones a cDNA fragment differentially expressed in hepatocellular carcinoma versus its surrounding noncancerous hepatic tissue. Human fetal liver cDNA library was screened with EST fragment probe. RESULTS: Northern blot analysis showed that EST clone F9391 expressed at high level in all the 6 hepatocellular carcinoma samples but low level in the surrounding noncancerous hepatic tissues and 2 normal liver tissues. In further screening of human fetal liver cDNA library, we obtained a positive clone named FL6. Nucleotide sequencing indicated that FL6 contained 1464 base pairs and the matched DNA sequence was not found in the gene data bases (EMBL 96.6). Northern blot analysis of various fetus tissues with FL6 probe showed a high level expression in lung, small intestine, skin and placenta, middle level expression in liver, stomach, colon and muscle but low level expression in brain, thyroid, thymus, heart, kidney, pancreas and bladder. CONCLUSION: The results suggested that FL6 gene related to cell proliferation and may play an important role in the process of oncogenesis.     

Adipocere--problems in estimating the length of time since death

Establishing the length of time since death is particularly difficult in corpses showing advanced autolysis. One sign of advanced decay is the formation of adipocere. In this state bodies show evidence of a partly wax-like and partly pasty condition. Continued storage ultimately results, among other things, in further decomposition due to the action of micro-organisms from the surrounding area-even if this is chronologically delayed. An exception is provided by the formation of adipocere under air-tight conditions. Initially, autolysis and heterolysis also occur, involving the release of fatty acids. As a result of the subsequent hydrogenation of the fats under the influence of bacterial enzymes, the unsaturated fatty acids are partially converted into saturated fatty acids. As the fatty acids clearly have a bactericidal effect, further bacterial decomposition is stopped at this early adipocere stage. Additional micro-organisms from outside can no longer penetrate when this hermetic seal is in place. In addition, the lack of calcium (e.g. from water or moist earth) can be a reason for the fact that further adipocere development, leading to wax-like hardening of the fat, is arrested. Thus the condition of the body can remain constantly preserved over many years and it no longer allows a reliable estimate to be made of the period of time since death.     

Real time imaging of calcium-induced localized proteolytic activity after axotomy and its relation to growth cone formation

The emergence of a neuronal growth cone from a transected axon is a necessary step in the sequence of events that leads to successful regeneration. Yet, the molecular mechanisms underlying its formation after axotomy are unknown. In this study, we show by real time imaging of the free intracellular Ca2+ concentration, of proteolytic activity, and of growth cone formation that the activation of localized and transient Ca2+-dependent proteolysis is a necessary step in the cascade of events that leads to growth cone formation. Inhibition of this proteolytic activity by calpeptin, a calpain inhibitor, abolishes growth cone formation. We suggest that calpain plays a central role in the reorganization of the axon's cytoskeleton during its transition from a stable differentiated structure into a dynamically extending growth cone.     

Aging changes of the optic nerve head in relation to open angle glaucoma

AIMS: To determine the age related changes in optic nerve head structure in a group of normal subjects and assess the significance of any changes in relation to those found in open angle glaucoma. METHODS: A group of 88 white volunteers and friends and spouses of patients with a normal visual field and normal intraocular pressure was studied. Two different imaging and measurement devices were used (computer assisted planimetry and scanning laser ophthalmoscopy), and the results from each were compared. Measurements were made of the optic disc, optic cup, and neuroretinal rim areas, and the vertical optic disc diameter and cup/disc diameter ratio. RESULTS: Neuroretinal rim area declined at the rate of between 0.28% and 0.39% per year. Vertical optic cup diameter and optic cup area increased with age. The mean cup/disc diameter ratio increased by about 0.1 between the ages of 30 and 70 years. CONCLUSIONS: Age related changes are significant and measurable, and should be taken into account when assessing the glaucoma suspect, and when estimating the rate of progression of glaucomatous optic neuropathy in patients with established disease.