William N. Spellacy

Respiratory distress syndrome with mature lecithin/sphingomyelin ratios: Diabetes mellitus and low Apgar scores

A detailed study was made of 150 women delivered of their infants within 72 hours of an amniocentesis where the lecithin/sphingomyelin (L/S) ratio was 2.0 or greater. There were nine neonates with respiratory distress (6.0 per cent). There were two neonatal deaths, both due to severe congenital heart disease. A mature amniotic fluid L/S ratio predicts a newborn infant who will not have respiratory distress syndrome (RDS) in most pregnancies. There is a significantly increased risk of RDS in neonates with a mature L/S ratio if the mother has insulin-dependent diabetes or if there is a resulting low Apgar score. The method of delivery (cesarean section or vaginal) does not affect the frequency of RDS where the L/S ratio is 2.0 or more.

Fetal movements in response to sound stimulation

STUDIES OF FETAL MOVEMENT have suggested that its variations may be a useful index of fetal health.’ As in all testing, a dynamic evaluation in response to a stimulus is usually more sensitive than a static test. This study was designed to investigate the fetal movement responses to external sound stimuli. The results show that the fetus is affected by some external sounds and suggest, also, a possible dynamic fetal evaluation test. Sixty normal pregnant women in the third trimester volunteered for these studies, and they all signed informed consents approved by the University Committee on Human Experimentation. Each woman arri\,ed at the Perinatal Ultrasound Laboratory in a fasting state in the morning. They were placed at bed rest in a quiet room, and the fetus was observed continuously with a real-time ultrasound system (Seimens Vidoson 635 ST Ultrasound instrument). The fetal movements were visualized on a black-and-white television monitor by a trained ultrasonographer and recorded on a stripchart recorder with an event marker. Assessments were made for 5 continuous minutes at the control time and then at 5, 15, 30, and 60 minutes after the stimulus. The sound stimulus was generated by an audiometer (Zenith %A112A audiometer) applied to the maternal midline in the lower abdomen. 411 of the fetuses were in the vertex presentation. There were three subgroups in this study. The first group of 25 women served as the controls, and no sound stimulus was emitted through the system. The second subgroup of 10 women received a sound stimulus of 500 cps (110 db) for 1 minute. The third subgroup of 25 women received a stimulus of 2,000 cps (110 db) for 1 minute. The person who counted the fetal movements was unaware of the subgroup designation. After the studies tlatl been completed. the data \ve~-e placed on punch cards and analyzed with the aid of a computer. The means, standard deviations, and standard errors of the means were calculated. The postsound movements were compared to the control movements by means of Student’s t test. The probability values were taken from two-tailed tables, and only

Carbohydrate Metabolism In Male Infertility And Female Fertility-Control Patients

Carbohydrate metabolism in male infertility and female fertility con trol patients is reviewed. There is a general agreement among investiga tors that the reproductive capacity of men with diabetes mellitus is imparied. 3 common problems appear to be involved: semen quality impotence and inadequate ejaculation. These patients can often be helped and pregnancy established. Contraception and carbohydrate metabolism was reviewed with the following main topics: frequency of abnormal results types of women at great risk mechanism of action reversibility of change individual steroid effects (estrogens-progestogens) and clinical implications. The physician should utilize the high-risk historic data to identify the population who will require careful laboratory predrug evaluation and monitoring or another method of contraception.

Effects of blood or meconium on the determination of the amniotic fluid lecithin/sphingomyelin ratio

Increasing quantities of maternal and fetal serum were added to amniotic fluids with orignal high or low lecithin/sphingomyelin (L/S) ratios. It was found that serum contains an L/S ratio of approximately 1.31 to 1.46 and therefore its addition lowered high L/S ratios and raised low L/S ratios. The addition of meconium to amniotic fluid decreased the L/S ratio.

The effects of norgestrel on carbohydrate and lipid metabolism over one year.

Carbohydrate and lipid metabolism were studied with the use of a three-hour oral glucose tolerance test in 71 women before and after one year of daily oral norgestrel, 0.075 mg., treatment. There was no significant change in weight or fasting plasma triglyceride and cholesterol levels. There was a significant elevation of both the blood glucose and plasma insulin levels after one year of treatment. This was true for both the fasting and the glucose-stimulated values. Whereas all of the individual glucose tolerance curves at the pretreatment control test were normal by selection, 15.5 per cent of the curves were borderline abnormal to abnormal at the one-year test. The significance of these metabolic alterations is discussed.

Fetal movements and ultrasound: Effect of maternal intravenous glucose administration

Fetal movements were directly visualized with a real-time ultrasound unit, and they were recorded after the random intravenous administration of either glucose or saline solution to the mother. A significant increase in fetal activity was seen 1 hour after the administration of glucose.

Distribution of cytoplasmic estrogen and progesterone receptors in human endometrium

Unoccupied estrogen receptors and progesterone receptors were measured in the cytoplasm of five sections along the length of endometrium obtained from noncancerous, premenopausal hysterectomy specimens. The concentrations of the two receptors were measured with tritiated estradiol or R5020 (a synthetic progestin), the latter two having been purified by high-pressure liquid chromatography, and were found to be highest in the fundus and lowest in the cervix. Progesterone receptor levels, ranging from 50 to 3,500 fmoles of R5020 bound per milligram of protein, were generally much higher in each section of the endometrium than estrogen receptor levels, which ranged from 0 to 500 fmoles of estradiol bound per milligram of protein. Near ovulation it seemed that the distribution profiles of both receptors became very steep, with more than a tenfold difference in the receptor levels being found between the fundus and the cervix. Receptor levels measured in endometrial samples obtained by curettage or aspiration should be interpreted with caution.

The acute effects of ritodrine infusion on maternal metabolism: Measurements of levels of glucose, insulin, glucagon, triglycerides, cholesterol, placental lactogen, and chorionic gonadotropin

Twenty-nine women in premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) treatment group. Thirteen serial blood samples were drawn during the first 12 hours of therapy by intravenous drug infusion and they were analyzed for a variety of metabolic substances. There was a significant increase in the blood glucose level in the ritodrine group after one hour and this persisted for the 12 hours of intravenous drug treatment. Plasma insulin levels similarly did not increase in the placebo but significantly rose in the ritodrine group by 30 minutes, peaked at 2 1/2 hours, and remained elevated throughout the infusion. There were no significant differences between levels of plasma glucagon, cholesterol triglyceride, human placental lactogen, or human chorionic gonadotropin in the two treatment groups. Ritodrine caused significant maternal and fetal tachycardia. Its use in women with carbohydrate abnormalities should be monitored carefully. The increased glucose levels may lead to an increased fetal weight.

Pituitary and ovarian responsiveness to a graded gonadotropin releasing factor stimulation test in women using a low-estrogen or a regular type of oral contraceptive☆

47 volunteer women were investigated to assess hypothalamic-pititary-ovarian functions under different types of contraception. 20 women were on mechanical contraception; 17 were on SOC (standard oral contraception) with 50 mg of estrogen; 10 were on LEOC (low-estrogen oral contraceptive) with 35 mg of ethnyl estradiol. Measurement of basal blood levels of LH (luteinizing hormone), FSH (follicle stimulating hormone), prolactin, estradiol progesterone, testosterone, and dihydrotestosterone were made. Lower concentrations were found in the SOC group. In addition, intravenous gonadotropin-releasing factor (GNRF) was administered in increasing quantities, and the same blood analyses repeated. The SOC group had a significantly suppressed response for both LHand FSH. The LEOC group had no suppression of FSH response, and LH response was suppressed only after maximal GNRF stimulation. These results suggest that pituitary gonadotropin suppression is dose-related, and that the low-estrogen type of oral contraceptives have potentially fewer adverse effects.

Norgestrel and carbohydrate-lipid metabolism: Glucose, insulin and triglyceride changes during six months time of use

Abstract The metabolic effects of the daily oral administration of 0.075 mg of Norgestrel were studied in 89 women utilizing a prospective research design. Three-hour oral glucose tolerance tests were performed before and after six months of drug usage and both blood glucose and plasma insulin levels were measured. In addition, fasting plasma triglyceride concentrations were measured. It was found that the use of the steroid was associated with significant elevations of both glucose and insulin. In addition, there was a significant increase in the mean weight during the six months and this was positively correlated with the altered carbohydrate metabolic parameters. Approximately 10% of “normal” glucose tolerance tests deteriorated to either “borderline abnormal” or “abnormal” types. There was a significant decrease in the fasting triglyceride levels during the six months and this was unrelated to the circulating insulin changes. These data are discussed as a prelude to the “mini-pill” era and as an aid to further understanding of the carbohydrate and lipid metabolic effects of steroid contraceptives.