The forms of vitamin B12 on the transcobalamins

Prolactin (PRL) secretion in the periparturitional period in patients undergoing labor and vaginal delivery follows a remarkable multiphasic pattern not found in patients who underwent elective cesarean section without labor. There is a highly significant decline in PRL levels during active labor which reaches a nadir about two hours prior to delivery. Immediately after delivery, a surge of PRL is noted, reaching peak levels within two hours post partum. Thereafter, PRL levels fall, reaching a second nadir about nine hours post partum, and this low level is maintained for nine to 24 hours after delivery. This multiphasic pattern of PRL secretion is not correlated with changes in serum concentrations of cortisol, progesterone, estradiol, or estrone. PRL levels in all pregnant patients at term were unaffected by the administration of synthetic narcotic analgesic agents, anesthesia, or the stress of operation. It is concluded that PRL secretion in the pregnant patient at term is unresponsive to usual stimuli and that the multiphasic pattern of PRL secretion uniquely found with labor and vaginal delivery may be associated with dopaminergic neuroendocrine processes during human parturition.     

Ultrastructure of the zymogenic-cell lineage in abomasal mucosa of adult cattle

In this study of 192 cases of post partum psychosis, the mean age of cases was 24.2 years. A past history of post partum psychosis was present in 16 cases (8.3%). As per the RDC categories, a majority of patients had unspecified functional psychosis and developed psychosis after the birth of first child. There was a positive correlation between the birth of female child and psychosis. The majority of cases developed psychosis within first 2 weeks after delivery. There were several other statistically significant differences when these cases were compared with non-puerperal, disease-matched controls.     

The onset of the ovarian cycle following calving

The onset of ovarian activity post partum was investigated by measuring progesterone concentrations in milk samples, in two dairy herds consisting of 118 cows with an average milk yield of 8340 kg FCM. Samples were taken three times a week till 50 days post partum. In 17 cows (14.4%) anoestrus occurred. The daily milk yield in this group was 2.65 kg FCM higher than the average yield in the group returning to oestrus before day 50 post partum. In cows returning to oestrus within 50 days post partum the first rise in progesterone was detected on average 27.6 days after calving. In first calvers (31.4 +/- 10.2) and in multiparous cows in the winter period (26.9 +/- 9.4) the onset of ovarian activity was delayed compared to start of ovarian activity in the summer period. In the first cycle only 28% of the cows had a normal luteal phase (12-17 days), 36% of the cows had a shortened luteal phase (less than 6 days), and 24% of the cows had a short luteal phase (6-11 days). In 12% of the cows the luteal phase was longer than 17 days. In the second cycle 56% of the cows had a normal luteal phase while 17% had a shortened luteal phase, and 17% had a short luteal phase. Pregnancy rates after first insemination in cows with a short dioestrus (10-25 days) were higher than in cows with a prolonged dioestrus (26-50 days). On the basis of these result it might be expected that postponing the first insemination until the second or even the third cycle in high-yielding cows will have only a marginal effect on the number of open days and a large effect on the number of inseminations per pregnancy.     

Elevation of oxytocin levels early post partum in women

BACKGROUND: The aim of this study was to determine plasma levels of oxytocin in women immediately after delivery. METHODS: Oxytocin was measured in 18 healthy women at 15 minute intervals after normal vaginal deliveries with healthy infants. The mothers had their infants put skin-to-skin on their chests immediately after birth. The infants stayed there up to two hours post partum. RESULTS: There were significant elevations of oxytocin 15, 30 and 45 minutes after delivery (p = 0.007, 0.02 and 0.02 respectively) when compared with average pre partum levels sampled approximately 7-15 minutes before partus. This elevation of oxytocin coincided with the expulsion of placenta. In most women this first elevation was followed by repeated elevations of oxytocin. Oxytocin levels returned to pre partum levels at 60 minutes post partum. CONCLUSIONS: Oxytocin is known to play a role in maternal bonding in animals. Earlier studies indicate that there is a sensitive period for bonding the first hour after giving birth even in women. Our study demonstrates a coincidence of this putative 'sensitive period' and high levels of oxytocin.     

Management of term breech presentation: a protocol of external cephalic version and selective trial of labor

OBJECTIVE: The results of a program of external version and selective trial of labor for term breech presentation are reviewed. This is a follow-up to our 1987 report describing management of singleton, term breech presentations and expands our 16-year experience to 1180 cases. STUDY DESIGN: All term breech presentations cared for in 1985 through 1992 are reviewed and outcome contrasted with those predicted in our earlier report. During these 8 years a trial of external version was offered if a breech presentation was identified after 36 completed weeks' gestation and before active labor. The criteria for allowing a trial of labor are detailed. RESULTS: Four hundred sixty-four breech presentations were identified for review. Three hundred eighty-two (82%) were diagnosed before active labor. Of these, 344 (90%) underwent an attempt at external version, of which 174 (51%) were successful. The 290 breech presentations where version either was not attempted or was unsuccessful were stratified into three groups: cesarean section without labor (147), trial of labor with cesarean section (90), and trial of labor with vaginal delivery (53). The 174 cases where version was successful were stratified into two additional groups on the basis of the eventual route of delivery. Careful review of maternal and fetal variables indicates that a trial of labor in selected patients resulted in vaginal delivery in only 37% but was achieved without an increase in fetal or maternal mortality or morbidity. Surprisingly, 54 of the 174 cases where version was successful were ultimately delivered by cesarean section. This 31% rate of cesarean delivery is significantly higher than the 15% rate observed for all cases of term, singleton vertex presentation. A higher prevalence of cases complicated by failed progress in labor and failed induction contributed to the excess. CONCLUSION: External version is successful in 51% of cases of term breech presentation. With careful selection, cases where version has failed can be allowed to labor and be delivered vaginally. The incidence of cesarean section (31%) for those cases where version had been successful was surprisingly high, largely because of an increase in labor abnormalities and failed labor inductions.     

Obese patients in obstetrics

The results of two studies about the course of pregnancy and delivery in adipose women in our hospital are combined and discussed. We found a higher rate of EPH-gestosis in overweight patients. The frequency of Cesarean section was increased. Belated uterine involution post partum is more frequent in adipose women, also the occurrence of urinary tract infections. There is a significant increase in perinatal mortality, mainly due to an increase in still-born. Pneumonia due to aspiration and birth traumata occur more frequently as well and endanger the children.     

Follow-up of albumin excretion during pregnancy and post partum in type 1 diabetic patients in comparison with health pregnant probands

32 diabetic and 31 metabolic healthy pregnant women are studied to answer the following questions: Is there a difference in the albumin-excretion rate (AER) during the pregnancy in primary normoalbuminuric type 1 diabetics and non-diabetics? Is there a difference 6 months post partum between the 2 groups? The average age of the diabetics (D) is 28, of the non-diabetics (ND) 27 years; the diabetics suffer from diabetes mellitus 12.5 years. In the 16th week of pregnancy, we find a AER (D vs. ND) of 5.0 vs. 2.37 micrograms/min (not significant [n.s.]), creatinin in serum 0.77 vs. 0.75 mg/dl (p < 0.05), creatinin clearance 92.5 vs. 103.4 ml/min (n.s.). In the 28th and in the 34th to 38th week, there is no significant elevation of the AER compared to the 16th week; but there is a significant elevation in the diabetics vs. the non-diabetics. 6 months post partum, the AER (D vs. ND) are: 6.13 vs. 5.11 micrograms/min (n.s. vs. 16th week and D vs. ND); in each group one person is found with a positive microalbuminuria (MA): 48.2 micrograms/min (D) and 27.4 mg/min (ND). Another diabetic woman shows post partum an isolated higher value of creatinin in serum: 1.5 mg/dl (without MA). This parameter is post partum significant higher (0.97 [D], 0.96 [ND] mg/dl) than in the 16th week of pregnancy (0.77 [D], 0.75 [ND] mg/dl). The creatinin clearance decreases post partum (pp): 92.2 ml/min (pp) vs. 102.0 ml/min (28th week) in the diabetics (n.s.) and 80.6 ml/min (pp) vs. 111.0 ml/min (28th week) in the non-diabetics (p < 0.05). Concerning the studied renal parameters, there is a significant difference of the albumin-excretion rates during the pregnancy between preconceptional normoalbuminuric type 1 diabetic and non-diabetic women, but 6 months post partum, there is no significant difference. The diabetics show a significant increase of the creatinin in urine and in serum and no significant change of the creatinin clearance 6 months post partum.     

The role of maternal thyroid hormones on the development of the brushtail possum, Trichosurus vulpecula

Thyroxine (T4) is a vital hormone for the development of mammals. To determine the role of maternal thyroid hormones on organ development, methimazole, an inhibitor of T4, was first administered via a minipump to 13 mothers with pouch young between days 10 and 80 post partum for 28 days. Three young survived and 10 of the young died at 104.0 +/- 10.8 days post partum (mean, SEM). Methimazole was then administered for 28 days to 6 lactating adult possums with pouch young at day 20 post partum. The effects of this treatment on the maternal plasma concentrations of T4 were monitored and the development of the lung, kidney and brain of the young were examined at day 90 post partum. There was no difference in the morphology of the lung, kidney and brain of pouch young at day 90 post partum whose mothers were treated with methimazole or saline. Thus methimazole administered to lactating possums for a short period early in lactation can cause the demise of the young about day 100 post partum although the cause of death is unknown. It is possible that the development of the central nervous system or some other vital organ has been inhibited, this altered state not being apparent morphologically. Nevertheless the marsupial appears to be similar to the eutherian in its requirement for thyroxine for normal development. However whereas this requirement is apparent during fetal development and around the time of birth in eutherians thyroxine is of importance during pouch development in marsupials.     

Uterine activity in the multiparous patient

There were 149 parous patients with normal cervical dilatation patterns studied. The purpose was to quantitate and characterize uterine activity in a group of multiparous patients with normal labor using our present on-line method and to evaluate our method against pervious work done on uterine activity. A mean total of 5,299 uterine activity units (UAU) was required to progress from 4 cm. through delivery. In the patients receiving oxytocin 5,907 UAU were required and 4,498 UAU for those not receiving oxytocin. Of the total uterine work from 4 cm. to delivery, 49.4% was required to progress from 4 to 6 cm. 38.7% to progress from 6 to 10 cm., and 11.9% for the second stage. This study establishes in a quantitative way, using on-line methods, the patterns of uterine activity expended by the parous patient in normal labor and can be compared to previous off-line and manual evaluations. These data can be compared with the on-line observations previously made in a primiparous group, and will be fundamental to automated evaluations including definitions of abnormal labor.     

Severe preeclampsia remote from term: labor induction or elective cesarean delivery?

OBJECTIVES: The study's objectives were as follows: (1) to determine the rate of vaginal delivery after labor induction in severe preeclampsia remote from term and (2) to determine potential predictors of success. STUDY DESIGN: Retrospective chart review was conducted on live-born singleton pregnancies complicated by severe preeclampsia and delivered at 24 to 34 weeks' gestation from January 1, 1992, to December 31, 1996. Exclusion criteria included eclampsia, presence of labor or spontaneous rupture of membranes on admission, and complication of pregnancy by an ultrasonographically detected fetal congenital anomaly. Patients were divided into 3 groups: elective cesarean delivery without labor, cesarean delivery after labor induction, and vaginal delivery after labor induction. Statistical analyses included multiple logistic regression, the Student t test, the chi2 test, and the Mann-Whitney test. P 32 weeks' gestation. The most common indication for cesarean delivery after induction, in 50.7% of the cases, was nonreassuring fetal heart rate. The median Bishop score was significantly higher (3 vs 2, P =.004) and the total hospital stay was significantly shorter in the vaginal delivery after induction group than in the cesarean delivery after induction group. However, there were no significant differences between the 2 groups in use of cervical ripening agents, gestational age at delivery, birth weight, 5-minute Apgar score, or postpartum endometritis. After exclusion of cesarean deliveries performed for malpresentation, there was no statistically significant difference in classic incision rates between the elective cesarean delivery without labor and cesarean delivery after induction groups (13.6% vs 6.8%; P =.137). According to logistic regression analysis, only the Bishop score was significantly associated with a successful induction (odds ratio 1.38, 95% confidence interval 1.11-1.71). Gestational age reached marginal significance (odds ratio 1.30, 95% confidence interval 0.89-1.89). CONCLUSIONS: (1) Labor induction should be considered a reasonable option for patients with severe preeclampsia at 相似文献   

Delivery of the overweight woman. Analysis of 115 patients

OBJECTIVE: Our purpose was to assess the effect of weight gain during pregnancy on labor and delivery. Abnormal pregnancies were excluded from the study to avoid interaction with the management of labor. POPULATION AND METHODS: A retrospective monocentric case-control study was carried out. We analysed 115 pregnancies delivered in our institution between June 1994 and November 1994. The course of labor was studied in 2 groups of patients: a group of overweight patients and a control group. RESULTS: In the overweight patients, the frequency of induction of labor (25%) and of obstetrical analgesia (82%) was significantly higher than in the control group (respectively 7% and 64%), as well as the average duration of labour and the average duration of the rupture of the membranes. The rate of cesarean section was higher in the overweight patient group (16.7%) than in the control group (3.7%). The difference was not significant because of the small number of patients. CONCLUSION: These results show a more frequent requirement of induction of labour, analgesia, and cesarean section in overweight patients. This led us to propose a multidisciplinary management of overweight patients to minimize these different obstetrical risks during labor.     

Comparison of misoprostol and ricinus oil meal for cervical ripening and labor induction

OBJECTIVE: To compare the safety and efficacy of intravaginal prostaglandin E1, misoprostol with ricinus oil meal for labor induction. METHODS: Sixty patients with an indication for induction of labor were randomly assigned to two groups (30 cases each) induction with misoprotol, 50 micrograms intra-vaginally every 3 hours until active labor, or with that ricinus oil meal was taken. RESULTS: The time from start of induction to vaginal delivery was significantly shorter in the misoprostol group (12.2 vs 18.1, P < 0.05), and fewer patients in the misoprostol group required oxytocin augmentation (10.0% vs 40.0%, P < 0.05). The mean change in the Bishop score was significantly higher in those receiving misoprostol (5.5 vs 3.1, P < 0.05). Uterine tachysystole occurred more frequently in patients in the misoprostol group (16.7%) than in the ricinus oil meal group (3.0%). No significant differences were noted in the mode of delivery and patients of successful labor induction. CONCLUSIONS: Vaginally administered misoprostol is an effective agent for the cervical ripening and induction of labor.     

Postoperative vomiting: drug prevention and therapy with established agents in the child

OBJECTIVES: To study the characteristics of the labour course and perinatal prognosis in cases of fetal persistent occiput-transverse position (POTP) and persistent occiput-posterior position (POPP). METHODS: All the cases, delivered with POTP and POPP in or hospital from Nov, 1995 to July 1996 were analyzed retrospectively. RESULTS: In abnormal fetal occipital position group, the following indices were significantly higher than those of normal group: fetal macrosomia, uterine inertia, and duration of each labour course. The speed of descending of presentation was obviously slower. The incidence of abnormal labour course was markedly increased. The rate of operative delivery was significantly higher. The total rate of operative delivery was 82.81% in the POTP group, and 92.31% in the POPP group. The incidence fetal hypoxia and neonatal asphyxia was markedly high in the abnormal occiput group. CONCLUSIONS: The POTP and POPP are major cases of dystocia. If management is unsuitable, perinatal prognosis will be poor.     

Trial of labor in patients with a previous lower uterine vertical cesarean section

OBJECTIVE: Our purpose was to determine the efficacy and safety of a trial of labor in patients previously delivered at least once by a lower uterine vertical cesarean section. STUDY DESIGN: A retrospective review was performed at a single tertiary perinatal center, The University of Florida Health Science Center, Jacksonville. The medical records of all patients with a previous low vertical cesarean section who underwent a trial of labor during a 72-month period from January 1988 until December 1993 were reviewed. The medical records of the next two patients who did not have a prior uterine incision admitted to labor and delivery after the index case served as the controls. The duration and outcome of labor, including mode of delivery, maternal and perinatal morbidity, and birth trauma were evaluated. RESULTS: Of 77 patients with a previous low vertical cesarean incision, 11 (14.3%) had a repeat operation compared with 14 of 154 patients (9.0%) in the no previous cesarean section group (not significant). No differences were noted in the incidences of operative vaginal deliveries or prolonged duration of the first or second stages of labor, or in the rate or maximum dose of oxytocin infusion between the two groups. One patient in the previous cesarean section group had uterine rupture. The incidence of umbilical artery pH < or = 7.20 was similar. No difference in the number of infants with 1- or 5-minute Apgar scores < or = 7 was noted. CONCLUSION: A trial of labor in women with previous low vertical cesarean sections results in an acceptable rate of vaginal delivery and appears safe for both mother and fetus.     

Lactose handling by women with lactose malabsorption is improved during pregnancy

OBJECTIVE: To evaluate lactose handling among women in late pregnancy and post partum to determine whether lactose handling is altered in pregnancy. DESIGN: Prospective study of lactose intolerance among pregnant women with and without lactose malabsorption. SETTING: Gastroenterology service of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal. PATIENTS: Thirty-three pregnant women, of whom 18 had lactose malabsorption, 12 did not and 3 were excluded. OUTCOME MEASURES: Lactose breath hydrogen (BH2) concentration after ingestion of lactose or lactulose; comparison before and after delivery of area under the curve (AUC) for lactose, oral-cecal transit time (OCTT) for lactulose, lactose-BH2-derived transit time and estimated dietary lactose consumption. RESULTS: After weaning (at a median time of 9 months after delivery), 28 of the women returned for follow-up. Of the 12 who could absorb lactose before delivery, 4 could no longer absorb lactose. Of the other 16 women, lactose intolerance worsened in 12, remained the same in 2 and improved in 2. The AUC was greater (p < 0.005), the maximal BH2 concentration was higher (p = 0.004) and the number of women whose BH2 concentration peaked was fewer (p < 0.025) post partum than before delivery. The women's symptoms during and after lactose BH2 tests were also greater post partum. The OCTT (based on the lactulose BH2 test) was shorter post partum (p = 0.001). Transit time derived from lactose BH2 tests was also shorter, but not significantly so. The OCTT was not inversely correlated with the change in AUC before and after delivery, but the lactose-BH2-derived transit time was inversely correlated. Pregnant women consumed more lactose before delivery than afterward (p < 0.004). CONCLUSIONS: Women with lactose malabsorption handle lactose better than usual in late pregnancy. Slow intestinal transit and bacterial adaptation to increased lactose intake may be primarily responsible.     

Uterine relaxation responses to calcitonin gene-related peptide and calcitonin gene-related peptide receptors decreased during labor in rats

OBJECTIVES: Our purpose was to investigate (1) whether uterine relaxation responses to calcitonin gene-related peptide are differentially regulated during pregnancy and labor, (2) the involvement of nitric oxide in smooth muscle relaxant action of calcitonin gene-related peptide in the rat uterus, (3) whether receptors for calcitonin gene-related peptide are expressed in rat uterus, and if so (4) whether the concentrations of these receptors are differently regulated during pregnancy and labor. STUDY DESIGN: Rats were killed on day 18 of gestation, at the time of spontaneous labor, or postpartum day 2. The uteri were removed for in vitro contractility measurements, nitric oxide production, and calcitonin gene-related peptide receptor binding assay. RESULTS: (1) Calcitonin gene-related peptide induced a dose-dependent relaxation in spontaneously contracting uterine strips from pregnant rats on day 18 of gestation; (2) the relaxation effects of calcitonin gene-related peptide on the uterus were decreased during spontaneous delivery at term and post partum compared with that during pregnancy; (3) calcitonin gene-related peptide-induced relaxation was inhibited by pretreatment of the uterine tissue with a calcitonin gene-related peptide receptor antagonist, calcitonin gene-related peptide(8-37); (4) nitric oxide synthesis inhibitor (N(G)-nitro-L-arginine methyl ester) and soluble guanylate cyclase inhibitor (LY83583) significantly decreased calcitonin gene-related peptide-induced relaxation of the rat uterus during pregnancy; (5) calcitonin gene-related peptide increased the uterine nitric oxide production in pregnant rats, and this increase was obliterated in the presence of calcitonin gene-related peptide(8-37); and (6) calcitonin gene-related peptide receptors are present in rat uterus, and the concentration of these receptors dramatically increases during pregnancy and decreases during labor at term. CONCLUSIONS: Calcitonin gene-related peptide inhibits uterine spontaneous contractions in rats during pregnancy but not during labor and post partum. The inhibitory effects of calcitonin gene-related peptide on uterine contractility appear to be modulated, at least in part, by the activation of nitric oxide generation in the rat uterus. Changes in calcitonin gene-related peptide receptors could contribute to the changes in calcitonin gene-related peptide-mediated uterine relaxation during pregnancy and labor.     

Measurement of medullation in wool and mohair using an Optical Fibre Diameter Analyser

OBJECTIVE: Our purpose was to determine whether the continuation of antibiotics postoperatively after cesarean section in patients whose labors were complicated by chorioamnionitis would reduce the incidence of endometritis. STUDY DESIGN: Patients with a clinical diagnosis of chorioamnionitis treated with ampicillin during labor and who required cesarean delivery for obstetric indications received preoperative intravenous clindamycin and gentamicin and were randomized into 2 groups. Group 1 received no scheduled postoperative antibiotics and group 2 continued to receive clindamycin 900 mg every 8 hours and gentamicin 1.5 mg/kg every 8 hours until afebrile for a minimum of 24 hours (temperature 相似文献   

Long-term effects of perindopril on metabolic parameters and the heart in the spontaneously hypertensive/NIH-corpulent rat with non-insulin-dependent diabetes mellitus and hypertension

The spontaneously hypertensive/NIH-corpulent (SHR/N-cp) rat is a genetic model that exhibits both non-insulin-dependent diabetes mellitus (NIDDM) and hypertension. To determine the impact of long-term treatment with the long-acting angiotensin-converting enzyme (ACE) inhibitor perindopril (PE) on the glucose metabolism, lipid levels, and heart in this model, studies were performed in three groups of SHR/N-cp rats maintained on a diet containing 54% carbohydrate with 18% sucrose and 36% starch. One group of obese rats received PE (0.5 to 1.0 mg/kg body weight/d) for 3 to 4 months, a second group of obese rats received no treatment, and a third group of lean rats were used as controls. The mean systolic blood pressure (SBP) increased gradually in both untreated obese and lean rats, with lean animals showing slightly higher levels compared with untreated obese rats. By contrast, SBP was reduced to normal levels in PE-treated obese rats throughout the treatment period. Compared with lean rats, obese rats showed significantly higher body weight and fasting serum levels of glucose, insulin, total cholesterol (TC), and triglyceride (TG). However, no significant differences were observed in these metabolic parameters between PE-treated and untreated obese rats. Plasma renin activity measured at the end of the treatment period was significantly higher in PE-treated rats compared with untreated obese and untreated lean rats. The mean heart weight and left ventricular weight, expressed in absolute terms or indexed to body weight, were significantly lower in PE-treated versus untreated obese and untreated lean rats. To further determine whether glucose metabolism is directly affected by PE treatment, in vitro glycogen synthesis was evaluated in isolated soleus muscles obtained from three additional groups of animals. The basal rate of muscle glycogen synthesis was significantly lower in obese compared with lean rats (P < .05), but did not differ between PE-treated and untreated obese rats. Maximal insulin-stimulated glycogen synthesis increased threefold in PE-treated obese rats, but this increase did not differ from the increases observed in untreated obese and lean rats. In conclusion, the present study shows that long-term PE treatment in obese SHR/N-cp rats with NIDDM and hypertension effectively controlled systemic arterial pressure and resulted in a significant reduction in left ventricular weight. However, these favorable effects of PE were not associated with significant improvement in glucose tolerance, hyperinsulinemia, and hyperlipidemia in this model. PE also had no direct stimulatory effects on either basal or insulin-mediated glycogen synthesis in the isolated soleus muscle of obese rats, perhaps because of the severe insulin-resistant state of the animals. Our results support the clinical observations that antihypertensive therapy with ACE inhibitors has neutral effects on glucose metabolism and insulin sensitivity in patients with combined hypertension and NIDDM.     

Importance of abnormal fetal presentation of twins during labor and delivery

Utilizing the 18 year material of two institutions, the author investigated the effect of fetal lie and presentation on the labor and delivery process. Out of 541 pairs of twins, in 299 instances (55.27%) at least one of the fetuses occupied a transverse lie or presented by the breech. In the remaining 242 pairs (44.73%), both fetuses presented by the vertex. In association with premature labor, out of 239 sets of twins, in 134 instances (56.07%), the presentation of at least one of the twins was abnormal. The same phenomenon occurred in 165 out of 302 pairs (54.63%) when labor set in at term. The percentual frequency of abnormal presentations appeared to be positively related to maternal age and parity. In connection with abnormal presentations, there was an increase in the rate of cesarean sections (38.13% versus 13.21%) and that of low Apgar scores (18.18% versus 9.3%), as compared to those cases where both fetuses presented by the vertex. Of all cases of perinatal mortality, 57.76% involved twin pairs with abnormal presentation versus 42.24% for cases where both fetuses presented by the vertex.     

TRH stimulation as an attempt at demonstration of the induction and involution of prolactin-secreting pituitary cells in pregnancy and puerperium and in pathological hyperprolactinemia

The present paper discusses the relationship between functional hypertrophia or hyperplasia of the prolactin secreting cells in the pituitary and actual pituitary prolactin reserves in pregnant and post partum women. 35 randomly selected post partum patients from the 3rd to 12th day p.p. and 14 women in their 11th to 14th weeks of pregnancy volunteered to undergo a standard TRH-test. The control group consisted of 60 normoprolactinemic patients. Eleven pathologically hyperprolactinemic patients were compared to the normoprolactinemic and physiologically hyperprolactinemic groups. In all cases, plasma prolactin showed a linear decrease from the 3rd to 12th days post partum. The TRH induced increase became correspondingly greater as the basal prolactin levels decreased, i.e. an inverse relationship between these two parameters was seen. The TRH-induced increase was also always greater than the increase caused by suckling. A connection between prolactin and parity was not found. The inverse relationship between basal prolactin levels and the actual reserves which could be released by TRH stimulation can be explained in that there are two regulatory systems for prolactin. The estrogens stimulate basal prolactin and inhibit prolactin reserves. The actual prolactin reserve is, on the one hand, directly dependent on the degree of endogenous neurohormonal stimulation and, on the other hand, indirectly dependent on the endogenous estrogens through a feedback mechanism. The TRH-stimulation test is not suitable for determining a functional hypertrophia or hyperplasia of lactotropic pituitary cells.