A new technique for reduction of prolapsed fetal membranes for emergency cervical cerclage

A new method to replace fetal membranes that have prolapsed through an incompetent cervix, which includes overfilling of the urinary bladder, was successful in four consecutive patients who presented with this clinical entity.

Use of the subcutaneous terbutaline pump for long-term tocolysis

Nine patients in preterm labor requiring long-term tocolysis were managed with subcutaneous terbutaline administered via a portable infusion pump. All had failed oral tocolytic therapy and were therefore faced with prolonged hospitalization. In this feasibility study, the patients were treated at home and monitored with portable tocodynamometers and home nursing visits. Uterine activity data were transmitted via telephone to the study center and terbutaline pump infusion rates were adjusted accordingly. Terbutaline pump therapy consisted of a combination of low-dose continuous basal infusion supplemented with intermittent high-dose boluses. Total daily drug dosage remained exceptionally low (less than 3 mg/24 hours). The mean gestational age at initiation of therapy was 29.6 +/- 3.7 weeks, and pregnancy was prolonged an average of 9.2 +/- 4.3 weeks. The minimum gestational age at delivery was 37.3 weeks. Patient tolerance was excellent and, in a total 394 patient-days of therapy, there were no significant complications. We conclude that the portable subcutaneous terbutaline pump may be a promising new method for long-term outpatient tocolysis in patients who cannot be maintained on oral therapy.

Failure to demonstrate decreased beta-adrenergic receptor concentration or decreased agonist efficacy in term or preterm human parturition

Iodine 125-labeled iodocyanopindolol, a radioactive beta-adrenergic antagonist, bound to particulate preparations of pregnant human myometrium in a manner compatible with binding to the beta-adrenergic receptor. Studies with a specific beta 2-antagonist, IPS 339, indicated that 72% of receptors present were of the beta 2-subtype. Quantitative studies of beta-receptor concentrations in myometrium from women at term indicated no change in receptor concentration during labor. Similarly, there was no difference in beta-receptor concentration in myometrium from women in labor or before labor between 28 and 34 weeks of gestation. Concentrations of the beta-receptor were not different at any stage of gestation assayed. Isoproterenol competition for iodocyanopindolol binding was used to examine efficacy of receptor agonist interactions in myometrium from women at term, in labor, or before labor and from women in preterm labor. There was no difference in high-affinity binding, an index of efficacy, in any of the groups examined.

The ultrastructure of the cells of Leydig in the white-crowned sparrow (Zonotrichia leucophrys gambelii) in relation to plasma levels of luteinizing hormone and testosterone

In male White-crowned Sparrows subjected to 20 h daily photoperiods there is an approximately 3-fold increase in the plasma concentration of luteinizing hormone (LH) on the first long day after which a quasi-stable level is maintained for at least 42 days. This increase is followed by an increase in numbers of cells of Leydig and an enhancement of their steroidogenic features, a decrease in transitional interstitial cells, and an increase in plasma level of testosterone. With the decline in plasma LH, as photorefractoriness develops, the steroidogenic features of the cells of Leydig undergo disorganization. For as yet unexplainable reasons the plasma levels of testosterone decline before the decrease in plasma LH and before the degeneration of the steroidogenic features of the cells of Leydig.