G. Helm

Cholestasis of Pregnancy: Clinical and Laboratory Studies

A prospective study was made of clinical symptoms, liver function and pregnancy prognosis in women with cholestasis of pregnancy (CP). We used several positive and negative criteria to allow a clinical definition of CP as itching limited to time of pregnancy with or without laboratory evidence of liver dysfunction. the incidence during 1971–74 was 1.5% (100/6798 women) and lower during 1980–82 (52/5 441 = 1.0%). One hundred consecutive pregnant women without itching were used as clinical controls. the incidence of CP showed a distinct seasonal variation, culminating in November. Women with CP had often had itching during previous pregnancies and during use of contraceptive pills and described anamnestically itching in mother and sisters. Laboratory data in CP were compared with reference intervals for healthy pregnant women. Serum enzyme levels were significantly increased for serum alkaline phosphatase, 5‐nucleotidase, aspartate aminotrans‐ferase and alanine aminotransferase in the second and especially in the third trimester. the enzyme distribution was often markedly skewed to the right, i.e. some patients reacted more than others. Most patients with cholestasis only had itching without pronounced abnormalities in laboratory data. This mild form of CP was associated with a good prognosis for both mother and child.

Vasoactive intestinal polypeptide nerves in the human female genital tract

VIP, a recently recognized neuropeptide, has been demonstrated by immunohistochemistry in nerves of the human female genital organs. Such nerves were most numerous in the isthmic part of the fallopian tube and in the cervix. They were found in smooth muscles, around blood vessels, and beneath the epithelium. Immunoreactive VIP nerve cell bodies were found in paracervical tissue, suggesting a local origin of genital VIP nerves. Besides the well-known adrenergic and cholinergic nerves, peptidergic nerves may constitute a new component in the autonomic nervous system.

Existence and coexistence of peptides in nerves of the mammalian ovary and oviduct demonstrated by immunocytochemistry

SummaryThe immunocytochemical distribution of substance P (SP), gastrin releasing peptide (GRP), vasoactive intestinal polypeptide (VIP), peptide histidine isoleucine (PHI), and neuropeptide Y (NPY) was studied in the ovary and the Fallopian tube (oviduct) of rats, guinea-pigs, cows, pigs and humans. Generally, the nerve supply was better developed in the oviduct than in the ovary. GRP fibers were most scarce in all tissues. Nerves containing SP were particularly numerous in the oviduct of rat and guinea-pig, supplying the muscular wall and blood vessels. VIP and PHI coexisted in dense plexuses of nerves, not only around blood vessels but also in the follicular wall and the interstitial gland of the ovary, as well as within the smooth muscle layers and subepithelially in the oviduct. The general distribution of NPY was similar, but these immunoreactive nerves were even more numerous. Sequential staining for dopamine-β-hydroxylase and NPY together with results of chemical sympathectomy with 6-hydroxydopamine suggested that NPY was stored in the noradrenergic sympathetic nerves.

Neurogenic relaxation mediated by vasoactive intestinal polypeptide (VIP) in the isthmus of the human fallopian tube

The smooth musculature of the Fallopian tube is important for normal ovum transport, fertilization and implantation. Little is known about the factors controlling the motor activity of the isthmic sphincter. Studies were performed on smooth muscle preparations from the human tube in vitro. Electrical field stimulation of the nerves in the isthmic region reduced the motor activity, particularly in the circular muscle. The response was unaffected by adrenergic and cholinergic antagonists, but blocked by tetrodotoxin, suggesting a neural involvement. Vasoactive intestinal polypeptide (VIP) was considered a likely candidate for the neural mediation of this response in view of the high density of VIP-containing nerve fibres in this region, and in view of the fact that exogenous VIP causes a marked reduction of the tubal motor activity. To test whether VIP might be the endogenous mediator of this effect, nerve stimulation was carried out in the presence of large amounts of exogenous VIP in order to occupy all VIP receptors; the motor inhibitory action of VIP was counteracted by vasopressin. Under these conditions, nerve stimulation failed to reduce isthmic motor activity. This was not due to vasopressin since reduction occurred in the presence of this peptide alone. The results suggest that VIP is responsible for the neurogenic inhibition of motor activity in the isthmus region of the human Fallopian tube.

Ontogeny of peptide-containing neurones in human gut—an immunocytochemical study

Neurons containing enkephalin, substance P (SP), vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), galanin, calcitonin gene-related peptide (CGRP), peptide histidine isoleucine (PHI) or gastrin-releasing peptide (GRP) are known to occur in the human intestinal tract. The knowledge of the ontogeny of these neurones is, however, limited. Intestinal specimens from 24 human foetuses with gestational ages varying between 8 and 40 weeks were examined by immunocytochemistry. No peptide-containing neurones could be detected before the 14th week of gestation after which a rapid development was seen. Generally, peptide immunoreactivity was first noted in the myenteric ganglia and somewhat later in the other layers of the intestinal wall. There was no major difference between the peptides studied or between different parts of the intestinal tract with respect to time of appearance.

Relaxation of human female genital sphincters by the neuropeptide vasoactive intestinal polypeptide

Vasoactive intestinal polypeptide (VIP), a recently recognized neuropeptide with a putative transmitter function, has been demonstrated in nerves in the female genital tract. The highest density is in the smooth, muscle of the isthmus of the fallopian tubes and of the uterine cervix. The motor effect of VIP has been tested in vitro of smooth muscle from the isthmus and the uterine cervix. Both preparations responded to VIP with a concentration-dependent reduction in motor activity.

Female sex steroid concentrations in the ampullary and isthmic regions of the human fallopian tube and their relationship to plasma concentrations during the menstrual cycle.

The concentrations of estradiol-17 beta (E2) and progesterone (P) were measured in the ampullary and isthmic portions of the fallopian tube of nonpregnant menstruating women and the cyclic fluctuations were related to the concentrations of these hormones in plasma. The steroid concentrations were determined by radioimmunoassays. There was no significant difference in the isthmic and ampullary concentrations of either steroid in any of the menstrual phases. The mean value for E2 was highest in the ovulatory phase and for P during the luteal phase. The tissue (per gm)/plasma (per ml) ratio for the steroid concentrations was above unity in all measurements. The ratio for E2 was highest (isthmus:12, ampulla:8) in the follicular phase and for P (isthmus:26, ampulla:18) during ovulation. Since these highest ratios were attained when plasma steroid concentrations were relatively low they were interpreted as reflections of a maximal receptor contribution.

Electron microscopic and pharmacologic evidence for a functional adrenergic innervation of the smooth musculature in the human fallopian tube

Triple fixation for electron microscopy of the isthmic region of the human Fallopian tube distinguished adrenergic nerve terminals through their content of synaptic vesicles with a diameter of 50-60 nm. Non-vascular adrenergic nerves were found both outside and within smooth muscle bundles. Adrenergic varicosities, partly devoid of their Schwann cell ensheathing, frequently approached the smooth muscle cells within a distance of about 200 nm, and sometimes as close as 60-100 nm. These close contacts often occupied a considerable area of the naked varicosity. Electrical field stimulation of adrenergic nerves in the isthmic smooth muscle preparations in vitro induced an alpha-receptor mediated, frequency-dependent contractile response. The results show that the sympathetic nerves in the human Fallopian tube are able to exert a motor control of its smooth musculature, and may thus be involved in local functions essential for the normal fertilization process.

Seventeen Week Pregnancy IN a Rudimentary Uterine Horn Revealed at Routine Ultrasonography

Pregnancy in a rudimentary horn of a bicornuate uterus is a rare and often fatal event. A case is presented of such a pregnancy detected in the second trimester routine ultrasonographic examination.

Reference Values for Serum Components in Pregnant Women

Abstract. Reference values have been collected for 11 chemical blood serum components during the three trimesters of pregnancy in 100 healthy pregnant women. The results used for reference intervals are presented as 2.5, 50 and 97.5 percentiles. Especially regarding S‐Albumin, S‐Alkaline phosphatase and S‐5′‐Nucleotidase the changes were most pronounced during the third trimester. S‐Gammaglutamyltransferase did not change significantly during pregnancy. For S‐Aspartate aminotransferase and S‐Alanine aminotransferase there were no significant changes in the mean values during the three different trimester periods. In the third trimester the frequency distribution of the enzymes became skewed to the right, i.e. in some women the enzyme activities increased noticeably more than in others. S‐Na showed a significant decrease even during the first trimester and this lowering was slightly more pronounced during the second and third trimesters. S‐Ca decreased in parallel with S‐Albumin concentration. The changes in S‐CaAlbumincorrected were distinctly smaller than those in S‐CaTotal. Throughout pregnancy, S‐K, S‐Bilirubin and S‐Thymol turbitidy test values did not deviate from nonpregnant levels.