Joseph R. Leiberman

Personality and social resources in immediate and continued stress resistance among women.

In this study we investigated the immediate and continued impact on women of a major stressful event, the outcome of pregnancy, and the mitigating effect of self-esteem and intimacy with their spouse on their reactions. Few other studies have investigated initial reactions to crisis events. Ninety-nine Israeli women who experienced either normal delivery or pregnancy complications were interviewed at the time of the event and 3 months later. High self-esteem was found to limit feelings of depression at both times. Intimacy with spouse limited depression at the event, but not at follow-up. High self-esteem was seen as always being exploitable by women who possessed it, whereas the benefit of intimacy with spouse was seen as being dependent on situational demands and environmental constraints. Cross-cultural implications were presented.

Satisfaction with social support during crisis: Intimacy and self-esteem as critical determinants.

Satisfaction with social support was studied longitudinally in a group of 113 Israeli women following the outcome of both normal and medically complicated pregnancies. Greater intimacy with spouse and with friends were found to be related to greater satisfaction with support received during this crisis period. Intimate ties contributed to satisfaction with support independent of self-esteem, social network parameters, and type of pregnancy outcome. Social network parameters and pregnancy outcome were not found to be related to satisfaction with support. Among women low in self-esteem, greater intimacy with family was found to be related to lower satisfaction with support if the women lacked intimate ties with spouse or a friend. The findings were discussed in light of clinical and social psychological theories regarding reaction to aid.

Human preterm birth is associated with systemic and local changes in progesterone/17β-estradiol ratios

OBJECTIVE The purpose of this study was to determine whether human preterm birth is associated with changes in 17 beta-estradiol and progesterone concentrations in maternal plasma and amniotic fluid. STUDY DESIGN Forty healthy women in preterm labor with singleton pregnancies and intact membranes at 32 to 36 weeks of gestation who underwent amniocentesis for evaluation of the microbiologic status of the amniotic cavity were classified into the following two groups: 20 women who were delivered within 1 week from the amniocentesis (preterm delivery group) and 20 who were delivered at term (term delivery group). Maternal plasma and amniotic fluid concentrations of progesterone and 17 beta-estradiol were measured with sensitive and specific commercially available radioimmunoassay kits. RESULTS The median amniotic fluid concentration of 17 beta-estradiol was significantly higher in women delivered prematurely than in those who were delivered at term (1.5 ng/ml vs 0.9 ng/ml, p = 0.0001). Moreover, the median plasma 17 beta-estradiol concentration was also significantly higher in the preterm delivery group than in the term group (14.1 ng/ml vs 6.9 ng/ml, p = 0.022). In contrast, no significant difference was found in amniotic fluid and plasma concentrations of progesterone between these two groups (24.5 ng/ml vs 27.5 ng/ml and 132.0 ng/ml vs 107.5 ng/ml, respectively). The median amniotic fluid progesterone/17 beta-estradiol ratio was significantly lower in the preterm delivery group than in those delivered at term (18.4 vs 33.6, respectively, p = 0.0017). Moreover, the median plasma progesterone/17 beta-estradiol ratio was also significantly lower in the preterm delivery group than in the term group (9.8 vs 17.0, respectively, p = 0.016). CONCLUSION Human preterm birth is associated with significantly lower progesterone/17 beta-estradiol ratios than those of women with preterm labor delivered at term.

The relationship between bacterial vaginosis and preterm birth. A review.

Bacterial vaginosis is currently the most prevalent form of vaginal infection of reproductive age women. The etiology of bacterial vaginosis has not yet been defined. However, clear criteria for diagnosis and treatment have been established in the absence as well as in presence of pregnancy. Recent data show an association between bacterial vaginosis and preterm labor and delivery. This review outlines the role of bacterial vaginosis in preterm birth and other pregnancy complications.

Intraamniotic infection in patients with preterm labor and twin pregnancies

Background. Microbial invasion of the amniotic cavity plays a major role in the pathogenesis of preterm labor and delivery in singleton pregnancy. Nevertheless, this association is not well established among patients with multiple gestations. The purpose of our study was to explore the role of intraamniotic infection in the setting of twin pregnancies.

Polyhydramnios is an independent risk factor for perinatal mortality and intrapartum morbidity in preterm delivery.

OBJECTIVE To investigate the clinical significance of polyhydramnios as a predictor of perinatal death and intrapartum morbidity in patients with preterm delivery. STUDY DESIGN The study population consisted of 4211 patients with singleton gestation, intact membranes and preterm delivery (< 37 weeks). Two groups were identified and compared according to the sonographic assessment of the amniotic fluid volume: increased and normal amniotic fluid. Analyses were conducted for the entire cohort as well as for the cohort excluding from each group all cases with congenital malformations. Logistic regression was used to assess the unique contribution of polyhydramnios to mortality and morbidity in the presence of other known risk factors. RESULTS The prevalence of polyhydramnios among women who delivered preterm was 5% (210/4211) including and 3.7% (142/3818) excluding the cases of congenital malformations, respectively. Polyhydramnios was associated with a higher rate of diabetes, large for gestational age neonates, fetal malpresentation at delivery, previous perinatal death and with a lower Apgar score at 1 and 5 min. Polyhydramnios was an independent predictor of perinatal mortality and intrapartum morbidity. When adjusted for well recognized risk factors for perinatal mortality and intrapartum morbidity (e.g. diabetes, severe pregnancy induced hypertension, multiparity, congenital malformation, previous perinatal death, low gestational age at delivery), the presence of polyhydramnios significantly increased the rate of perinatal mortality (odds ratio (OR) 5.8; 95% confidence interval (CI) 3.68-9.11) and of intrapartum morbidity (OR 2.8; 95% CI 1.94-4.03). CONCLUSION In the setting of preterm delivery, polyhydramnios is an independent risk factor for perinatal mortality and intrapartum complications even in the absence of congenital malformation and other conditions traditionally associated with increased perinatal mortality and morbidity.

Uterine artery estrogen receptors in the nonpregnant and pregnant guinea pig

Uterine artery, heart, and aorta or carotid specimens of nonpregnant, midpregnant, and term pregnant guinea pigs were examined for estrogen receptors by immunocytochemical methods. Estrogen receptors were found in the nuclei of cells in the endothelial, muscle, and adventitia layers of the uterine artery wall. The concentration of estrogen receptors was slightly higher in nonpregnant and term pregnant animals than in midpregnancy. No estrogen receptors were found in the heart, aorta, or carotid specimens of all animals. These results confirm the uterine artery as a target organ of estrogen action that would eventually lead to arterial functional adaptation in different biologic periods.

Maternal plasma and amniotic fluid 17 beta-estradiol, progesterone and cortisol concentrations in women with successfully and unsuccessfully treated preterm labor.

Maternal plasma and amniotic fluid (AF) were obtained for measurement of 17β-estradiol, progesterone and cortisol concentrations from 40 patients with preterm labor and intact membranes at 28–32 weeks of gestation: 20 delivered preterm and the remaining 20 patients responded to tocolytic treatment and delivered at term. Maternal plasma and AF concentrations of these hormones were measured with specific commercially available radioimmunoassay kits. Maternal plasma and AF 17β-estradiol concentrations were significantly higher in women who delivered preterm than in those who delivered at term, 8.0 ng/ml vs 3.5 ng/ml and 0.85 ng/ml vs. 0.6 ng/ml, respectively. No significant differences were found between groups in maternal plasma and AF progesterone concentrations. Maternal plasma cortisol concentrations were higher in the preterm delivery group than in the term group (235 ng/ml vs. 55 ng/m1, respectively). No significant differences were found in AF cortisol concentrations between groups.

Estrogen and progesterone receptors in the uterine artery of rats during and after pregnancy

Changes in the level of estrogen and progesterone receptors in the uterine artery of the rat were studied during pregnancy in order to evaluate the estrogen dependency of this artery. The weight of the uterine artery and its content of estrogen and progesterone receptors were measured. The steroid receptor content was also measured in the uterus and aorta as the tissues of these organs are estrogen-responsive and non-responsive, respectively. The uterine artery weight increased more than fourfold up to the middle of pregnancy and towards the end of pregnancy increased even further. The increase in weight was parallel to the increase in the level of plasma 17 beta-estradiol. During pregnancy a dramatic increase was detected in the number of uterine artery estrogen receptors. The estrogen receptor level was highest at term pregnancy, and following birth decreased to a low value. The level of progesterone receptors in the uterine artery increased modestly, though significantly, during pregnancy, and rose steeply at puerperium. No meaningful changes were seen in the aorta. The changes in estrogen and progesterone receptor levels in the rat uterine artery wall during and after pregnancy may suggest estrogen dependency of this tissue.

Successful treatment of preterm labour by eradication of Ureaplasma urealyticum with erythromycin

SummaryUreaplasma urealyticum was detected in the amniotic cavity of a woman with premature contractions at 32 weeks of pregnancy. Treatment with Erythromycin base was instituted for a period of ten days. Amniotic fluid analysis performed 48 hours after discontinuation of antibiotic treatment revealed sterile amniotic fluid. The pregnancy continued uneventfully until 39 weeks.