Gerald G. Anderson

Diagnosis of the respiratory distress syndrome by amniocentesis

Abstract Studies on 302 amniocenteses show that changes in phospholipids in amniotic fluid (PLAF) reflect those in the lung of the developing fetus. A sudden increase in lecithin concentration after 35 weeks heralds maturity of the pulmonary alveolar lining when respiratory distress syndrome will not occur should the fetus then be born. Clinical interpretation is made on a thin-layer chromatogram by inspection; a lecithin spot clearly larger than that of sphingomyelin marked pulmonary maturity in the fetus.

Midtrimester abortion using intraamniotic prostaglandin F2α

Abstract Prostaglandin F 2α (PGF 2α ) was instilled intraamnniotically in varying amounts and at different intervals in 40 patients in the second trimester of pregnancy. Using an F prostaglandin radioimmunoassay as a clinical tool, a regimen was developed in which 40 mg of PGF 2α were instilled in a single injection. Of 35 patients so treated, 26 aborted completely and 9 partially. The results compare favorably with those reported with hypertonic saline. The mean treatment-abortion interval among the 26 patients who received the high dose was 22.3 hours. The side effect rate was low and acceptable, and no effect was noted on blood clotting mechanisms.

Comparative study of high-dose chorionic gonadotropin on the human and rat corpus luteum and effect of gonadotropin-releasing hormone on human luteal function.

Human chorionic gonadotropin (hCG) was administered to pseudopregnant rats with 4-day-old corpora lutea and to normal women on days 16 to 18 following onset of menses. In the rat serum progesterone levels fell by 90% within 8 hours as did unoccupied luteal luteinizing hormone (LH) receptors following treatment with hCG (100 IU). Total receptor number for LH, however, remained unchanged until after 12 hours. In the woman 20,000 or 40,000 IU of hCG given on day 16 and day 18 of the cycle did not reduce serum progesterone or serum estradiol levels although the serum hCG level was similar to that achieved in the rat. In fact, serum progesterone levels rose and the cycle length was extended by hCG treatment in the human. Conversely, treatment of the woman with gonadotropin-releasing hormone (GnRH, 500 microgram on day 16 and on day 18) caused an initial rapid rise, then a fall in serum progesterone levels and the cycle length was shortened. It was concluded that the human corpus luteum may be resistant to densensitization by hCG but possibly not to LH. However, the possibility cannot be excluded that GnRH may compromise luteal function through mechanisms independent of effects on pituitary gonadotropin secretion or action.

The induction of therapeutic abortion using intravenous prostaglandin F2α

Abstract Intravenous prostaglandin F 2α was given to 42 patients to induce abortion. The overall success rate was about 50% using 3 separate protocols in which the dosage varied between 25 and 200 μg/min and in which the duration of infusion varied from 6 to 24 hours. A high and unacceptable rate of side effects was associated with all dosage levels, but especially with the highest rate of infusion. There was no association of eventual abortion with duration of pregnancy, but there was a marked association with parity; multiparas aborted 2.5 times more frequently than primigravidas. It is concluded that intravenous prostaglandins given in accordance with the described protocols is not a clinical approach of terminating human pregnancy which offers any advantage over existing methods.

Hypertonic glucose infusion during labor. Maternal-fetal blood glucose relationships.

Abstract Maternal-fetal blood glucose relationships were studied in 32 patients in labor before and after an infusion of glucose. Maternal and fetal hyperglycemic responses to the infusion were not parallel. The fetal peak occurred 10 minutes after the maternal, and the fetal glucose levels declined more slowly. There was not a constant glucose gradient or ratio between the materal and fetal compartments. Evidence for placental transfer of glucose by facilitated diffusion is presented and glucose disappearance rates were calculated on mothers and fetuses. A more basic understanding of carbohydrate metabolism in normal and abnormal pregnancies is needed before new therapeutic regimens involving the use of glucose can be evaluated.

Effects on the neonate of the induction of labor with prostaglandin F2α and oxytocin

Abstract Considerable investigative interest has been given to the oxytocin-like effect of the prostaglandins for the induction of labor. However, in depth studies on the effects on the neonate have not appeared in the literature. The present study was designed to evaluate the possible clinical and biochemical alterations in the neonate subsequent to the use of prostaglandin F 2α for the induction of labor in a double blind study with oxytocin. No significant differences between the two groups of infants could be identified by the methods used.

Fetal cephalic metabolism in sheep

Abstract A model to permit some studies of the intrauterine fetal cephalic metabolism in sheep has been developed. Using this model, we have demonstrated that there is fundamentally no change in fetal cephalic blood flow, fetal arterial oxygen tension, and CO 2 tension in the normal intrauterine fetus as compared with an exteriorized preparation. There does, however, seem to be a decrease in circulating blood glucose and an increase in pH in the recovered intrauterine fetal preparation. Calculations have been made of the cerebral oxygen consumption as well as glucose consumption, and it would appear that both oxygen and glucose consumption in the fetus are roughly equivalent to that in the adult.

Treatment of dysmenorrhea

Abstract A double blind comparative study between (1) Dialog and Edrisal and (2) Dialog and Darvon was carried out to determine the relative effectiveness of these three medications on several prominent symptoms of dysmenorrhea. The results of this comparison are discussed in detail.

Clinical Use of Prostaglandins in Reproduction

Because of the close association of prostaglandins with the reproductive tract of both males and females noted in the early years of basic research, it followed that the first clinical trials would involve reproductive processes. Bygdeman et al. (1967) were stimulated to begin a pilot study of the effects of intravenous prostaglandins on the human pregnant uterus by the work of von Euler and of Bergstrom and Samuelsson (1967), which had been proceeding in Stockholm for many years. Karim independently arrived at similar conclusions and began similar efforts because of his knowledge of native medical lore. He had observed that the umbilical cord of term Ugandan babies born in the bush was not tied after being cut. Investigating cord jelly for a vasoconstrictive substance, he isolated a compound which was later identified as prosta-glandin F2α. Further investigation revealed significant levels in the amniotic fluid, decidua, and peripheral blood of women in labor, but not before labor (Karim, 1968). After tolerance studies in nonpregnant females and males, initial clinical efforts were directed toward the induction of term labor. The observation that prostaglandins could, unlike oxytocin, stimulate the early pregnant uterus to contract led to investigations of its use as an abortifacient. Ramifications of information obtained from the above studies have stimulated early studies in contraception and male infertility. In 2 years, clinical research has moved from a stage of tentative studies in two laboratories to widespread clinical studies being carried out in centers throughout the world. This development occurred appropriately enough at a time when the Western world was shifting its attitude toward population control. Whether or not the prostaglandins themselves become valuable clinical tools, the current influx of able investigators into the field will greatly enhance our knowledge of reproductive physiology and suggest new clinical approaches for the control of fertility.

The effects of maternal hypoxemia on fetal and infant development

Pregnant women with cyanotic cardiac defects have a high percentage of abortuses and infants small for gestational age. The primary aim of this study was to determine the effect of maternal hypoxemia, as measured by arterial blood gas tensions, on fetal and placental development, neonatal adaptation, and subsequent growth and development. 19 women with right-to-left shunts were studied and 21 of the 30 pregnancies resulted in live births. 11 of these infants were small-for-dates, all born to women who had no surgery or only palliative surgery over 10 years ago. Mothers with total correction of these shunts delivered infants of normal size. Urinary estriol excretion during pregnancy was studied in 6 patients; low urinary estriol levels and low arterial blood oxygen tensions (PO2 < 60 mm Hg) were associated with low birth weight of the infants. Placental size was larger than expected on the basis of birth weight, Blood O2 affinity and red cell 2,3-diphosphoglycerate (DPG) were studied in 2 cyanotic women and in their infants at birth. Blood O2 affinity was significantly decreased and DPG markedly increased in both mothers; the same changes, although to a lesser degree, were observed in their infants, indicating intrauterine adaptation to hypoxia. The postnatal growth and development of all small infants have equalled or exceeded the normal standards.