[The need, potential and unresolved issues of fertility preservation in the early stages of cervical cancer]

In the choice of a planned fertility preservation procedure for stage IA1 and IB1 cervical cancer, optimal oncological safety is the main focus of virtually all protocols. The surgeon should remove the appropriate proportion of the cervix for oncological safety, ensuring an adequate tumour-free surgical margin. However, some of the literature on fertility preservation, referring to histological parameters, still considers conisation with excellent fertility results to be optimal for the treatment of tumours with a diameter of 2 cm. With regard to fertility preservation in the case of radical trachelectomy versus simple conisation, we are aware of several ongoing studies, the results of which may provide an answer as to whether a more conservative surgical therapy for smaller tumours (less than 2 cm in diameter) represents an acceptable oncological safety.

Surgical treatment of lymph node metastases in stage IB cervical cancer. The laterally extended parametrectomy (LEP) procedure: experience with a 5 year follow-up

INTRODUCTION

In 2003, we published our preliminary experience with the use of an operative technique (laterally extended parametrectomy, the LEP procedure) without adjuvant therapy, in the treatment of 29 stage IB, cervical cancer patients with pelvic lymph node metastases. In our present paper, by an extended recruiting period, with a completed 5 year follow up, we studied the outcome of LEP operations, used with the same indications.

METHODS

In 70 out of 106 LEP-Wertheim operated patients, no adjuvant treatment was used. In 36 patients, where histology suggested tumor spread beyond the threshold of our surgery, adjuvant chemo-radiotherapy was advised. 5 year follow up was completed (without any patient lost for follow up) for the whole cohort of patients.

RESULTS

In 70 patients treated by LEP procedure alone, the overall 5-year survival was 91.4%. For those 36 patients, who were excluded due to disease spread above study criteria, 5 year survival was 44%. Complications in 10% of the cases necessitated a second operation. Apart from transient hyper continence and one case of permanent incontinence, no severe quality of life consequence of the operation was observed.

CONCLUSIONS

Our results suggest that in two-thirds of pelvic lymph node positive, stage IB cervical cancer cases surgery alone could provide equal or better survival (without the toxicity of chemo-radiotherapy), than any kind of multimodality treatment alternatives. LEP procedure should be considered a treatment option for stage IB cervical cancer patients with pelvic lymph node metastases.

Femoral artery embolism in patients undergoing a laterally extended parametrectomy (LEP) procedure

INTRODUCTION

Since 1993 an operative technique without adjuvant therapy (laterally extended parametrectomy, the LEP procedure) has been in use at our institution for the treatment of Stage IIB cervical cancer and for patients with pelvic lymph node metastases in Stages IA-IIA. Iliac/femoral artery embolic occlusion in the cohort of LEP operated patients was studied in an 11 years long period.

METHODS

The LEP-Wertheim procedure was used in 320 patients between 1994 and 2005. Embolic occlusion of the iliac and/or femoral arteries was detected in four out of 255 (1.6%) cases. Thrombectomy was done on one blood vessel in three cases, on both the deep and superficial femoral arteries in one case were executed to restore the vessel patency.

RESULTS

Three out of four patients following external iliac/femoral artery emboli removal healed up without any arterial occlusion-related symptoms. In one case preventive fasciotomy was needed to treat tumescence of the legs. This patient developed transient peroneal palsy, which necessitated the use of plantar support for one month and physiotherapy for one year for gait rehabilitation.

CONCLUSIONS

Embolus occlusion of the iliac/femoral artery during the LEP-Wertheim procedure was observed in 1.6% of cases. This complication has not been reported in the literature before in relation to radical surgery in cervical cancer. Operating teams using LEP operations should be aware of that risk, and should be prepared for treatment.

Preservation of fertility in reproductive-age women with the diagnosis of cancer

Over the past few decades the number of young, reproductive age cancer survivors has increased as a result of improved and less destructive cancer treatments. Certain types of cancers are predominantly diagnosed among reproductive age women and a small proportion of cancers originating in the reproductive tract are also detected in this age group. Treatment in the past used to be definitive and in most cases led to sterility. In recent years, improved medical treatments and more conservative surgical approaches have been introduced increasing the number of young survivors of cancer treatment. These less invasive treatments seem to be associated with similar survival rates and fertility can be preserved in most cases. This has led to studies evaluating the reproductive options of these women. Conservative surgical techniques, the use of chemotherapeutic agents with a reduced gonadotoxic side-effect profile, and the application of more focused radiation therapy are associated with maintenance of fertility. In addition, assisted reproductive technology (ART) has undergone tremendous improvements and now offers several alternatives to those who wish to maintain fertility before or even after cancer therapy. This review summarizes the fertility sparing medical and surgical as well as ART options that reproductive age women desiring to maintain fertility may utilize if they face cancer therapy.

Abdominal Radical Trachelectomy During Pregnancy to Preserve Pregnancy and Fertility

BACKGROUND

For 10,000-40,000 women each year, cervical cancer complicates pregnancy. Current therapy usually terminates the pregnancy and results in the loss of future fertility. Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy for young women with cervical cancer.

CASES

We report five pregnancies complicated by cervical cancer treated by abdominal radical trachelectomy with preservation of the concurrent pregnancy and the birth of two healthy term infants.

CONCLUSION

Pregnancy complicated by concurrent cervical cancer can be managed with abdominal radical trachelectomy during pregnancy while preserving future fertility.

Laparoscopic abdominal radical trachelectomy

BACKGROUND

Radical trachelectomy is a fertility preserving alternative for young women with early stages of cervical cancer. Currently, a technique of abdominal radical approach is used in a few centres. With growing availability of laparoscopy, a novel technique of laparoscopic radical trachelectomy might be an alternative.

CASE

Presented is one case of laparoscopic pelvic lymphadenectomy with radical trachelectomy in young woman with IB cervical cancer. No intraoperative or postoperative complications occurred. Operation time reached 250 min, estimated blood loss was 250 ml. Limited follow-up of 9 months was uneventful and patient indicates normal menstrual pattern and satisfactory sexual intercourse.

CONCLUSION

Laparoscopic abdominal radical trachelectomy with pelvic lymphadenectomy might be an alternative technique in the treatment of early stages cervical cancer in patients who desire future pregnancy. The procedure is in principle identical to the standard abdominal radical hysterectomy. Centres practising laparoscopic radical hysterectomy can adopt the technique without any special surgical training.

[Abdominal radical trachelectomy--technique and experience]

OBJECTIVE

Discussion of current experiences with abdominal radical trachelectomy in the treatment of early stages of cervical cancer in fertile women.

DESIGN

Case-reports.

SETTING

Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.

METHODS

Presentation of 4 cases of abdominal radical trachelectomy and pelvic lymphadenectomy. Discussion with published data.

RESULTS

Three cases of open abdominal and one case of laparoscopic abdominal radical trachelectomies together with pelvic lymphadenectomies are presented. All procedures were indicated for cervical cancer stages IA2-IB1. Frozen section of pelvic nodes and a slice of upper margin of cervix revealed no metastasis or infiltration. In total 22-43 pelvic nodes were removed, being negative in all cases. Operative time ranged between 148 and 270 min. in laparotomy and 250 min. in laparoscopy. Blood loss reached 350-3500 ml. There were no intraoperative complications, postoperatively one case of bladder atony was treated by suprapubic drainage for 30 days, one case of ileus was managed pharmacologically. Vaginal suture healed properly in all cases. No complications occurred within limited follow-up of 1-5 months.

CONCLUSION

Abdominal radical trachelectomy with pelvic lymphadenectomy is a rational alternative in the treatment of stages IA2-IIA cervical cancer in women of fertile age. Standard radicality in parametria resection and easy incorporation into armamentarium of oncogynecological centers are main advantages of such approach. Laparotomy can be avoided using laparoscopy.

Abdominal radical trachelectomy: a fertility-preserving option for women with early cervical cancer

Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy or chemoradiation for young women with stage IA2 to IB cervical cancers. Thirty-three patients were offered this procedure. The mean age was 30.5 years (range 23-37). Three procedures were abandoned because of positive pelvic nodes (two patients) and involvement of the margin between the amputated cervix and uterine fundus (one patient). Of the remaining 30 patients, 10 had stage IA2 tumours, 15 had stage IB1 and 5 had stage IB2. During follow up of a median of 47 months (mean 32 months, range 14-75 months), no recurrences have been detected. A normal menstrual pattern resumed within eight weeks of surgery in all but two patients. Five patients attempted to conceive. Three women have fallen pregnant, resulting in one first trimester miscarriage and two caesarean section deliveries at term. Our experience suggests that abdominal radical trachelectomy provides a method of treating women with stage IA2 to IB cervical cancers with conservation of fertility without apparently compromising recurrence or survival rates. It appears to provide equivalent oncological safety to a standard Wertheim hysterectomy using a technique familiar to all practising gynaecologic oncologists.

Radical hysterectomy for cervical carcinoma in pregnant women--a case of decidua mimicking metastatic carcinoma in pelvic lymph nodes

Intraoperative histology is commonly used to guide the treatment of women with carcinoma of the cervix. We present a case where frozen section of the pelvic lymph nodes from a pregnant woman was suggestive of metastatic cervical carcinoma but final histology showed only decidual change.

[Initial experience in exenteration interventions in the pelvis]

OBJECTIVE

Discussion of experiences with pelvic exenterations.

DESIGN

Case-report.

SETTING

Department of Obstetrics and Gynecology, Department of Urology, Department of Surgery, Department of Pathology, Department of Clinical Oncology, General Teaching Hospital and Ist Medical Faculty of the Charles University, Prague, Czech Republic.

METHODS

Presentation of 4 cases of pelvic exenterations. Discussion with published data.

RESULTS

Altogether four cases of pelvic exenterations are presented, one case of supralevator total exenteration for recurrent cervical cancer, one case of infralevator total exenteration for recurrent vaginal cancer, one case of supralevator anterior exenteration in the treatment of locally advanced cancer of urinary bladder, and one case of supralevator posterior exenteration for recurrent vaginal cancer.

Laterally extended parametrectomy (LEP), the technique for radical pelvic side wall dissection: Feasibility, technique and results

A new surgical method was introduced for the treatment of Ib lymph node positive and IIb cervical cancer patients. The lateral resection plane corresponds to the true pelvic side wall, the plane represented by the internal obturator muscle, the linea arcuata, and the piriformis muscle with the convergent branches of the sacral plexus. The LEP procedure overcomes the limitations of the standard class III-IV radical hysterectomy, which leaves in situ the gluteal superior, inferior and pudendal nodes, thus improving local control and survival.

Laterally extended parametrectomy (LEP), the technique for radical pelvic side wall dissection: Feasibility, technique and results

A new surgical method was introduced for the treatment of Ib lymph node positive and IIb cervical cancer patients. The lateral resection plane corresponds to the true pelvic side wall, the plane represented by the internal obturator muscle, the linea arcuata, and the piriformis muscle with the convergent branches of the sacral plexus. The LEP procedure overcomes the limitations of the standard class III-IV radical hysterectomy, which leaves in situ the gluteal superior, inferior and pudendal nodes, thus improving local control and survival.

Early Experiences with Combined Treatment (Surgery and Brachytherapy) of Gynecological Recurrences Infiltrating the Pelvic Wall

Neither the surgical nor the radiotherapeutic treatment of gynecological recurrences infiltrating the pelvic wall can be curative alone. The treatment of this group of patients is possible with the CORT (Combined Operative and Radiotherapeutic Treatment) method. As maximal as possible resection of the malignancy is done for patients having no distant metastases and the brachytherapy guiding tubes are implanted into the tumour bed on the pelvic wall. The brachytherapy is carried out postoperatively. An accurate analysis cannot be done because of the short follow up and the few cases. The authors do believe that the survival results of this poor prognostic group may improve by means of this method after proper selection of patients.

[Successful outcome of an intrauterine twin pregnancy combined with ectopic pregnancy]

Authors present a case of twin intrauterine pregnancy combined with ectopic pregnancy. The simultaneous pregnancies occurred after the use of clomiphene citrate. In this case viable intrauterine twin gestation was observed by vaginal ultrasound examination, the simultaneous ectopic pregnancy was observed by laparotomy. Right salpingectomy was performed. The intrauterine twin pregnancy continued normally to the 35th week of pregnancy, finished with normal vaginal delivery. The healthy twin boys weighed 2650 g and 2070 g left the hospital in a good general condition on the 5th past delivery day. Authors discuss the etiology, the mode of diagnosis and the therapy of this rare condition.

[Merkel cell tumor]

Merkel cell cancer is a rare carcinoma arising from the neuroendocrin cells of the skin. The diagnosis is based on the clinical behaviour, histopathologic and ultrastructural findings and immunohistochemical results. An unusual case of Merkel cell carcinoma is presented. Mass from the umbiculus and a right inguinal lymph node was excised in a 63-year-old female. The histologic features of a typical, primitive small cell tumor combined with the immunohistochemical evaluations established the diagnosis. Rare polynuclear giant cells were focally present in our case. Patient was treated with combination of chemotherapy (Cisplatin, Etoposid) and radiotherapy. Control examinations showed complete respond. One year later metastasis developed. Resection of all known metastasis were performed. Two months after the laparotomy she died of metastatic disease. The autopsy did not reveal any other primary tumor. The capricious nature of the clinical course and the differences between this tumor and other carcinomas is emphasized.

[Experience with urinary conduit procedures]

Between 1989 and 1993, 32 urinary conduit procedures were carried out at the Department of Gynaecological Oncology, National Institute of Oncology Budapest. Of these, 26 patients with pelvic tumour underwent total or anterior pelvic exenteration. The urinary conduit operation was performed in associated with radical hysterectomy due 2 vesico-urinary fistula in 2 patients, and as a palliative procedure in 4 instances (bladder fistula 2, bladder fistula and ureter occlusion 1 and bilateral ureteric obstruction 1). Mean age of the patients was 46, range 20-73 years. 23 patients underwent bladder replacement with "Bricker pouch" or ileal conduit, mostly in the first 2 years, and as a palliative procedure. Kock pouch was constructed in 3 and an Indiana pouch in 6 women. There was no intraoperative mortality. 3 patients died in the postoperative period, none of them due to complication of the urinary diversion procedure. Postoperative bleeding occurred in one ileal conduit that ceased spontaneously and in one Indiana pouch that required reoperation. Haematuria was a common finding in the first 3 to 5 days following surgery. Urinary leakage in the abdominal cavity lasting for 7 to 10 days postoperatively occurred in almost all instances in those who underwent a Bricker pouch. This did not require surgical intervention. 3 patients with Bricker pouch experienced pyelonephritis. Continent pouches are emptied by self-catheterization, 6-8 times daily. There were no other early complications. Techniques of urinary diversion are discussed.

Vascular injuries in the surgical management of gynaecological malignancies

From 1989 to 1991 we performed 184 radical gynaecological interventions. In the vast majority of the cases lymph node dissection was part of the procedure. Thirteen out of the 184 patients suffered vascular injury, accounting 7% complication rate. The sites of the injured vessels included the external iliac artery in four patients, the vena cava in three, the external iliac vein in five and the femoral vein in one patient. All of them were primarily sutured; no prosthesis or venous patch was needed. In four cases postoperative complications occurred in relation to vascular surgery: two deep thrombosis of the femoral vein and two occlusions of the external iliac artery. The latter two patients had permanent sequelae, i.e. difficulties in walking. Our study suggests that vascular injuries represent an utmost important intraoperative risk in the course of lymph node dissection in gynaecological malignancies. Thus, gynaecological surgeons performing radical operations must be prepared to deal with the problem.

Perioperative complications of 116 radical hysterectomies and pelvic node dissections

Perioperative morbidity and mortality were studied in 116 patients who underwent radical hysterectomy and lymph node dissection. Type II radical hysterectomy was performed in two, type III in 97, type IV in 12 and type V in five patients, and the perioperative morbidity was assessed accordingly. Because of the short follow-up time the late sequelae could not be evaluated. There was no operative death. Haemorrhage was the most common complication and it was more frequent and serious in type IV and V classes. Prolonged bladder atony was also frequent, particularly in type IV radical hysterectomy. The infection rate was comparable. One patient developed ureteric fistula, and one woman had ureteric stricture. Lymphocyst formation, nerve damage, lymphoedema and thromboembolic disease were rarely encountered and there was no bowel obstruction. Injury to the great vessels was a major problem. It appears that the rate of complications in this study is acceptable and comparable with or favourable to other reported series. In spite of this, every effort should be made to reduce the operative morbidity as far as possible.

Stage I endometrial carcinoma: treatment of nonoperable patients with intracavitary radiation therapy alone

From 1976 to 1981, 171 patients with stage I endometrial adenocarcinoma (FIGO, 1971) underwent intracavitary radiotherapy alone because of medical contraindications to surgery and external-beam irradiation. The mean age of patients was 71 years, with the majority of patients being in the age group of 70-79 years. The intracavitary therapy consisted of intrauterine insertions of radium implants in three consecutive courses according to the packing method of Heyman. The estimated dose delivered to point A and to point B was 80 and 20 Gy (3500-7000 mg-hr; mean, 5500 mg-hr), respectively. The corrected 5-year survival rate for stage Ia was 76% and for stage Ib 72%. Grade had a profound effect on survival; corrected 5-year survival for G1 was 77%, for G2 68%, and for G3 53%, respectively. The total failure rate was 24% (40/171). Most of the recurrences occurred in the pelvis (35/171): uterus, 22; vagina, 9; rectum, 2; and bladder, 1. One patient had both vaginal and uterine failure and five had distant metastases (four abdominal and one pulmonary). No difference was seen in the failure rates of stage Ia and stage Ib patients. No major complications (necessitating hospital care or delay of treatment) were seen. Our findings suggest that for patients with stage I endometrial cancer who are unfit for surgery, intracavitary low-dose-rate radiation therapy alone is an effective alternative treatment with a low risk of complications.

Serum dehydroepiandrosterone and cortisol concentration in the maternal-fetoplacental hormonal system in elective caesarean section and spontaneous vaginal delivery in the 28th to 36th and 40th weeks of pregnancy

The authors compared the serum DHAS and cortisol level in 53 vaginal deliveries with those of 21 caesarean sections prior to the onset of labour at the 28th to 36th weeks. They also compared 18 vaginal deliveries with 16 elective caesarean sections at the 40th week. The serum hormone concentrations were measured in the maternal vein, the umbilical vein and the umbilical artery. The results indicate that the serum DHAS and cortisol level was higher after vaginal delivery than after caesarean section in the maternal vein, umbilical vein and umbilical artery at the 28th to 36th and also at the 40th week. The authors suggest that, although the role of the fetal adrenal cortex is not so definitive as in the case of some species in the onset of labour, it may be presumed that the increase in adrenal cortical activity cannot be explained exclusively by maternal stress.

[Prospective study of K-cell activity in patients with malignant gynecologic tumors. Effect of radiation therapy]

K cell activity was measured in the enzyme-like kinetic model of cytotoxicity against O, Rh (D) positive erythrocytes in 127 patients with carcinoma of the uterine cervix, 55 with carcinoma of the corpus uteri and 30 with malignant tumors of the ovary. The control groups included 62 healthy age matched women and 39 patients with benign tumor of the ovary. The cytotoxic activity was measured in a number of cases before any treatment and after irradiation and surgery in patients with cervical and endometrial cancer. The target cells were obtained from the same donor. ADCC activity of cervical and ovarian tumor patients enhanced depends on the stage of the disease. K cell activity of endometrial carcinoma patients was similar to the controls. ADCC activity of patients with carcinoma of the uterine cervix was increased, with carcinoma of the uterine corpus was indicated an increasing tendency following irradiation. There was connection with the dose of the irradiation and K cell activity. On the contrary, operation did not influence ADCC activity.

Quantitative comparison of serum steroid and peptide hormone concentrations in male and female fetuses in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy

There are a great deal of data concerning the role of testosterone in the formation of the sex of the fetus. The synthesis of the testosterone is influenced by the hypophysis and the fetoplacental unit. In this study the authors conferred the progesterone, DHAS, cortisol, oestradiol, oestriol, prolactin and HPL levels of male and female newborns in the maternal vein and in the umbilical vein and artery in the 28th-32th weeks (31 parturients, 15 male and 16 female fetuses), in the 33rd-36th weeks (43 parturients, 20 male and 23 female fetuses) and in the 40th week (34 parturients, 11 male and 23 female fetuses) of pregnancy. The determination of serum hormone concentration was carried out with the RIA method in 2084 samples. There was no significant difference between the serum hormone concentrations of the male and female sex in the 28th-40th weeks of pregnancy. They assume that in the 28th-40th weeks there is no difference in the activity of steroid and peptide hormone secretion caused by the sex of the fetus.

Serum DHAS in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy

The authors measured the serum levels of dehydroepiandrosterone sulfate (DHAS) in the maternal vein (MV), the umbilical vein (UV) and the umbilical artery (UA) during the 28th-36th weeks of pregnancy (n = 74) and in the 40th week (n = 34), to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found: (1) The DHAS concentration increased significantly in MV, up to twice the concentration from the 28th-32nd weeks to the 33rd-36th weeks (p less than 0.01). From the 33rd-36th weeks to the 40th week it decreased significantly to one third of this value (p less than 0.01). DHAS levels revealed a decreasing tendency in the UA and UV serum from the 28th-32nd weeks to the 33rd-36th weeks, and there was a tendency to rise from the 33rd-36th weeks to the 40th week. (2) The serum DHAS values were found to be higher than in the MV, the UA-UV difference was not significant; however, the 'UA/UV X 100' value remained higher than 100% during the 28th-40th weeks. (3) The MV DHAS value showed slight correlation with the UV and UA DHAS concentration (r = 0.2951, p less than 0.01, n = 106; r = 0.2930, p less than 0.01, n = 100). There was a close correlation between the UV and UA serum DHAS levels (r = 0.8432, p less than 0.01, n = 98). The authors consider that the adrenal activity increases independently of the maternal adrenal cortex at term.

Perinatal progesterone in maternal-fetoplacental system during mature and premature deliveries

The role of the maternal-fetoplacental hormonal system in the maintenance of pregnancy and in the onset of labor was studied by measuring the serum progesterone level in the maternal vein, the umbilical vein and artery at term (n = 34) and in the case of premature births (n = 74). Our results show: 1) During the 28th-40th weeks the serum progesterone concentration in the umbilical vein is greater than in the maternal vein (p less than 0.01) and in the umbilical artery (p less than 0.01), and greater in the umbilical artery then in the maternal vein (p less than 0.01). 2) No correlation was found between the serum progesterone concentration in the maternal and fetal vessels, whereas a close correlation was found between the serum concentration in the umbilical vein and artery. 3) The progesterone concentration of the maternal serum increased during the 28th-40th weeks, but increased only during 28th-36th week in the umbilical vein and artery and fell significantly by the 40th week. From this it appears that the maternal and the fetal progesterone concentrations are interdependent. The progesterone concentration of the umbilical vessels falls before term but it is not an essential factor in the onset of labor.

K cell activity is low in newborn infants

K cell activity of 18 mature, healthy newborns was measured against O,Rh(D)-positive erythrocytes, sensitized by anti-D antibodies, in cord and venous blood (later obtained 3-4 days after delivery). 53 healthy women served as controls. Activity was determined as a function of target cell number in the enzyme-like kinetic model of cytotoxicity. It was low in cord blood, increased in venous blood by days 3-4 but it did not reach the level of adults. While cytotoxic activity of male infants increased significantly from birth to the 3rd-4th day of life, it did not change in female infants. No correlation was found between the weight and K cell activity of newborns.

The use of pregnancy serum to obtain trophoblastic cell cultures

A method for obtaining trophoblastic cell cultures from first-trimester human placental villi is described. The essential feature of the method is the use of serum from a pregnant woman in the culture medium. Using this technique, pure cultures of trophoblastic cells are produced in 88 per cent of cases.

Change of serum HPL level in maternal vein, umbilical cord vein and artery in mature and premature labour

The authors examined the possible role of HPL in the onset of labour. The HPL level of the maternal vein, the umbilical cord vein and artery was compared in vaginal mature (n = 16) and premature (n = 52) deliveries. The HPL concentration was also examined in mature (n = 18) and premature (n = 18) deliveries performed by caesarean section prior to the onset of labour. The results showed that: the serum HPL level in the maternal vein, the umbilical cord vein and artery was lower during the 33rd-36th and the 40th weeks in cases of vaginal delivery compared to elective caesarean section; The artery/vein ratio decreases during labour (A/V X 100 value), indicating that HPL metabolism in the fetus decreases during regular labour pains; The onset of premature labour and delivery was associated with lower HPL levels compared to normal pregnancy. The authors assume that the lower HPL level found in cases of vaginal delivery may be due to reduced placental perfusion, but they do not exclude the possible association of lower HPL concentrations in cases of premature delivery.

Decreased killer cell activity in preeclampsia

Anti-D antibody-dependent cellular cytotoxicity of peripheral blood mononuclear cells was measured against O, Rh (D)-positive erythrocytes in 20 healthy pregnant women (chosen from all trimesters), and in 16 toxemic patients; it was then compared to the cytotoxic activities of 20 women 3 months after parturition and to that of 42 nonpregnant women. The application of an enzyme-like kinetic model for measurement of maximal cytotoxic function has permitted sensitive determination of the K cell function. It was found that during normal pregnancy maternal K cell activity did not change, whereas it was significantly decreased in preeclampsia.

K-cell activity is enhanced intrapartum

The cytotoxic activity of killer (K)-cells was measured against O Rh(D)-positive human erythrocytes sensitized by anti-D antibodies, in 14 women during normal labor and compared with the K-cell activity of 20 pregnant women (in the 37-40th week of pregnancy) and 42 non-pregnant female controls. K-cell activity was determined by the enzyme-like kinetic cytotoxic model, which measured the maximum of killing capacity. Cytotoxic activity was found to be significantly higher intrapartum. Data are compatible with the possibility that immunologic mechanism(s) are contributing to the onset of parturition.