Israel G. Gorodeski

The effect of placenta previa localization upon maternal and fetal-neonatal outcome.

The present study evaluated the association between maternal and fetal-neonatal outcome in women with placenta previa (PP) and the site of PP, i.e. low lying, marginal, partial or total. The study group was composed of 154 women (159 newborns) and the control group of 300 woman (305 newborns). Of the various parameters examined, the following 3 were associated with PP localization: advanced maternal age was associated with major types of PP, while focal accretion of the placenta and neonatal mortality in cases of vaginal delivery were associated with minor types of PP. No connection was found between antepartum, intrapartum or postpartum blood loss and any specific type of PP. A review of the literature and the results of the present study revealed that the use of the modern aggressive (conservative-active) management protocol in women with PP has resulted in a significant reduction in the maternal and perinatal complication rates, as well as a relative decrease in the importance of major types of PP and a relative increase of that of the minor types.

Recurrent placenta previa

Among a group of 33 135 women who delivered at Beilinson Medical Center, Israel, during the years 1968 to 1978, recurrent placenta previa occurred in 3.2% of the women, i.e., 6 times higher than the incidence of placenta previa in the general population (0.5%). Analysis of the data revealed that women over 36 yr of age with a history of placenta previa are at risk for recurrent placenta previa. Maternal and perinatal morbidity and mortality were similar in cases of single and recurrent placenta previa.

Effect of Single-Dose Progesterone Administration on Estradiol Receptor Levels in Normal Human Endometrium

The effects of single-dose progesterone administration on cytosolic and nuclear estradiol receptor levels (RCE2, RNE2) in normal human endometrium were studied in a group of 17 women and the results compared to 18 controls. In both groups, RCE2 and RNE2 levels were highest in the mid-cycle phase and lowest in the secretory phase. Although a wide range of values was found in both groups, the levels of RCE2 in the two groups did not differ significantly. It seems that in human endometrium a single progesterone injection does not significantly change RCE2 and RNE2 levels.

Placenta Previa with Focal Accretion

A series of eight women in whom a diagnosis of placenta previa with focal accretion was established, is presented. They were selected from a group of 153 women with placenta previa who delivered during the period 1968-77. The women with placenta previa accreta did not differ from those with placenta previa per se with respect to age, parity, obstetrical history, and antenatal, intrapartum or perinatal outcome. Three women delivered vaginally and five by cesarean section. Postpartum hemorrhage occurred in four of the women, three of whom were delivered vaginally. Of seven women who were managed conservatively, one required a hysterectomy to control bleeding. It is suggested that cases of placenta previa with focal accretion be managed conservatively.

Placenta previa - the identification of low- and high-risk subgroups

Among a group of 155 women with placenta previa (PP), two subgroups were identified: subgroup A consisted of 56 pregnancies (56 newborns) in women who had an asymptomatic antenatal course and who were delivered following a single episode of uterine bleeding; subgroup B consisted of 99 pregnancies (103 newborns) in women who had multiple antepartum bleeding episodes. The women in subgroup B were older, more parous, had more abortions and caesarean sections compared to those in subgroup A. Although the distribution of women in both subgroups with respect to the types of PP was similar, the prognosis in subgroup A was better with respect to various maternal and perinatal aspects. The recognition of low- and high-risk subgroups among women with PP may have practical implications for management protocols.

Abruption and premature separation of placenta previa

Abstract In a group of 431 patients who presented with 3rd trimester bleeding a diagnosis of abruption of placenta previa was established in 4, and a diagnosis of premature separation of placenta previa in 3. These obstetrical events were associated with severe maternal morbidity and one case of maternal mortality, high rate of cesarean section, prematurity, intrauterine growth retardation and high perinatal mortality rates. A review of the literature is presented and the entities of abruption and premature separation of placenta previa are defined.

Decreased Ratio of Total Progesterone to Total Estradiol Receptor Levels in Endometria of Women with Adult Dysfunctional Uterine Bleeding

Total estradiol and progesterone receptor levels (TRE2, TRP) were measured in endometria of women with adult dysfunctional uterine bleeding (n = 2) and compared to those of controls. The women in both groups were comparable with respect to age, history, light and electron microscopic endometrial morphology and dating; plasma levels of LH, FSH, estradiol and progesterone were similar in both groups. A wide range of TRE2 and TRP levels was measured in both groups; however, the levels of the ratio of TRP/TRE2 for each case were significantly lower in 18 of the 22 women with adult dysfunctional uterine bleeding and were in the range of the controls in the remaining 4. Possible explanations for these findings are presented.

Decreased induced retention of the progesterone receptor in the nuclear extract in human uterine leiomyoma in vivo.

Progesterone receptor (RP) levels were measured in the cytosol and in the 0.4 M KCl nuclear extract of human uterine leiomyoma, myometrium and endometrium; the synthetic progestin [3H]-R5020 was used as a ligand. The women were divided into groups A-D as follows: A, 7 women with no treatment; B, 7 women who received progesterone injection 1-3 h before tissue collection; C, 4 women who received conjugated estrogens 7-11 days before tissue collection; D, 5 women who received both conjugated estrogen and progesterone treatments. The following results were demonstrated: Total RP levels in the leiomyoma were significantly higher than the corresponding levels in the myometrium of the same uterus; after estrogen treatment these differences diminished. Leiomyoma challenged with progesterone expressed significantly lower RP levels in their nuclei than did the corresponding endometrium and myometrium. These results indicate the possibility of a defect of RP dynamics in human uterine leiomyoma.

Effect of progesterone injection on progesterone receptor levels and distribution in untreated and short-term Premarin-primed pre-menopausal and post-menopausal endometrium.

Cytosolic and nuclear progesterone receptors (RPC, RPN) were measured in post-menopausal endometria, using [3H]R5020 as the radioligand, and the findings compared with those in pre-menopausal endometria. Total RP levels (RPC + RPN) in post-menopausal endometria were low, i.e. less than 2000 fmol/mg DNA. A 7-11 day course of Premarin (conjugated equine oestrogen) treatment in post-menopausal subjects resulted in RP levels in 11818 +/- 3008 fmol/mg DNA, which were higher than those in proliferative, mid-cycle and Premarin-primed pre-menopausal endometria. Progesterone injection 1-3 h before tissue collection resulted in a change in the distribution of the RP in both premenopausal and post-menopausal Premarin-primed endometria and pre-menopausal proliferative and mid-cycle endometria. Following the progesterone injection RPN levels increased to 57 +/- 9% of the total as compared with 23 +/- 8% in endometrial samples from women who received no progesterone.

HORMONAL AND CYTOPATHOLOGICAL CHANGES IN VAGINAL AND CERVICAL SMEARS FROM WOMEN UNDERGOING CHEMOTHERAPY FOR EXTRAGENITAL MALIGNANT DISEASES

Abstract. The effects of various chemotherapeutic drugs on the squamous epithelium of the cervicovaginal tissues were investigated in a test group of 74 and a control group of 44 women with advanced extragenital malignancy. The cyto‐logical findings were as follows