ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsThe clinical effects of cigarette smoking during pregnancy include increased perinatal mortality, an unduly high incidence of “small-for-dates” babies, and a general tendency of fetal weight to be below average. Most studies of placentas from cigarette-smoking women have been concerned principally with the weight and gross characteristics of the organ, and there have been few reports of either the histological appearance or the fine structure of these placentas. The reported findings have been contradictory and have not yielded a consistent pattern of placental pathology in cigarette smokers. The authors report here a study of the morphological changes seen in the placentas of women who smoke during pregnancy.For the purpose of light microscopic examination, 100 placentas were collected, 72 from cigarette smokers and 28 from nonsmokers. Smokers were divided into three groups. Those smoking less than 11 cigarettes a day during pregnancy were classified as “light” smokers; those smoking 11 to 20 a day were considered to be “medium” smokers; and those smoking in excess of 20 cigarettes a day were regarded as “heavy” smokers.The mean placental weight in the smoking group was higher than that in the nonsmoking group, but the difference was not significant. The only significant difference between the two groups was in the lower fetoplacental weight ratio of the smoking group.The villi were of normal maturity in all cases examined, in both the smoking and nonsmoking groups. A focal villitis was present in two placentas (7.1 per cent) of the nonsmoking group and in eight (11 per cent) of the smoking group. Taking the smoking group as a whole, there was a significant decrease in the incidence of vasculosyncytial membranes and a significant increase in the incidence of villous cytotrophoblastic cells in these placentas, as compared with those from nonsmokers. The number of syncytial knots in the smoking group, however, did not differ from that found in the nonsmoking group. When the smoking group was broken up in terms of the number of cigarettes smoked, it was apparent that significant differences in morphological factors were confined to the heavy smokers, and it was solely the presence of this group that led to significant differences between the smoking group as a whole and the nonsmoking group.Within the fetal vasculature, an obliterative endarteritis was found in 64 per cent of the placentas from nonsmokers and in 76 per cent of those from smokers. There was no significant difference in either the extent or the severity of this vascular abnormality between the two groups of placentas. No abnormality of the basal plate or decidua was seen in any placenta, and there was only one instance of choriamnionitis which was found in the smoking group.Electron microscopy confirmed the presence of an excess of prominent cytotrophoblastic cells in nine of the 23 placentas in the smoking group. Most of the cytotrophoblastic cells in all the placentas were of the intermediate type (Fig. 1), with many mitochondria, prominent Golgi bodies, a few narrow cisternae of endoplasmic reticulum, a number of electron-dense membrane-limited droplets, and an abundance of free ribosomes. A mitotic figure was seen in one placenta. The cytotrophoblastic organelles had, for the most part, a fully normal appearance, but in three placentas the mitochondria showed some degree of swelling of the cristae, and in four others there was some dilation of the cisternae of rough endoplasmic reticulum. The limiting plasma membranes of the cytotrophoblastic cells were generally smooth, but in seven placentas they showed marked basal digitation and striking interdigitation with the adjacent syncytiotrophoblast.The villous syncytiotrophoblast had, in general, a regular outline, with a full complement of microvilli of normal appearance on the free surface. In 15 placentas, however, there were focal areas of variable extent in which there was a markedly complicated infolding of the surface plasma membrane with local loss of syncytial cytoplasm. In these foci, the microvilli were either lost or markedly reduced in number, and those remaining were bizarrely distorted or elongated. Areas of the syncytiotrophoblast showing this striking appearance were usually immediately adjacent to syncytiotrophoblast with a normal outline and non-deformed microvilli. In three placentas, the microvilli outside of the scalloped foci showed some degree of abnormality of form, with irregular budding, stunting, elongation, or forking. In occasional placentas there were tongue-like protrusions of syncytial cytoplasm into the intervillous space. Focal syncytial necrosis was seen in two placentas (Fig. 2), but even in these the extent of the necrosis was small, and the vast bulk of the syncytiotrophoblast appeared to be fully viable.No clear-cut correlation could be established between either the degree or the extent of the various syncytial abnormalities noted and the number of cigarettes smoked by the mother. It was observed, however, that the most marked changes in the villous syncytiotrophoblast occurred in three placentas from women who smoked heavily and gave birth to infants weighing less than 2500 g.In 20 of the placentas there was irregular thickening of the trophoblastic basement membrane. Collagen fibers were sometimes seen within the thickened membrane, as were electron-dense inclusions, thought to be remnants of the iron-calcium complexes normally found in early pregnancy. The stromal content of collagen fibers tended to be increased.The majority of the stromal fetal capillaries were small, but the endothelial cells were generally of normal contour. In six placentas, however, degenerative changes were seen in the endothelial cells.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsThe histochemical examination of a placenta obtained from a stillbirth, which occurred 3 days after the mother had received a total-dose infusion of iron dextran (at 32 weeks of gestation), revealed large amounts of hemosiderin in the trophoblast. This is in contrast to a study of iron-deficient patients, treated with total-dose infusion of iron dextran, which shows no resulting increase of stainable iron in the placenta. Further studies were made to assess in more detail the effect on placental iron of infusions of iron dextran given at different stages of pregnancy. In addition to histochemical examination of the placenta, the two forms of storage iron, hemosiderin and ferritin, were estimated respectively as the water-insoluble and water-soluble fractions of the non-heme iron. The results of these studies are given in the present report.Observations were made on placentas obtained in an uncontrolled manner at various intervals after total-dose infusion and after varying doses of iron dextran. The latter was infused over 6 hours in either 5 per cent dextrose or in normal saline. Control placentas were obtained from women delivered at full term who had not been anemic during pregnancy and had not received parenteral iron.The interval between the infusion and the onset of delivery varied greatly. One patient was delivered the same day, and several others went into labor within 10 days; but in most cases, the infusion was given more than 3 weeks before delivery.The most striking changes were in the placenta associated with the stillbirth, in which almost every villus contained large amounts of Prussian blue-positive material in the trophoblast or immediately beneath it (Fig. 1). No other placenta showed so much iron, but in those obtained at 4 days and at 6 days, there was still a large amount of similarly distributed Prussian blue material in the villi. In placentas obtained at 8 days or longer after the infusion, the findings were the same as in the controls, namely, occasional specks of Prussian blue-positive material found mainly in the stroma of the villi. There was virtually none in the trophoblast itself.In the study of water-insoluble non-heme iron (hemosiderin), a total of 35 duplicate analyses of homogenates were made, with a range of values from 6 to 108 mg of iron per 100 g dry weight (0.108 to 2.94 mmol). The largest difference between duplicates was 12 per cent, but in 30 cases the difference was less than 6 per cent. The mean of the duplicates was therefore taken.In 11 controls, the placental hemosiderin iron ranged from 4.2 to 12 mg per 100 g dry weight (0.076 to 0.216 mmol). In 26 specimens obtained after iron dextran infusion, the placental hemosiderin ranged from control levels up to 128 mg (2.30 mmol) per 100 g dry weight. The highest values were found in placentas obtained within 2 weeks of the infusion. Much lower concentrations occurred in placentas collected between 3 and 20 weeks after the infusion. The high concentrations found within 2 weeks of infusion were, however, quite variable. Two placentas were obtained 4 days after infusion, two at 6 days, and two at 12 days. There were large deficiencies in hemosiderin within each of these pairs. In two of the pairs, the differences could be related to differences in the dose of iron dextran, but the remaining pair came from a twin pregnancy and were therefore exposed to the same maternal blood level.All but two of the highest hemosiderin concentrations were associated with the largest doses of iron dextran, but they were also cases in which the placentas were obtained within 14 days of infusion. In cases with longer intervals between infusion and delivery (the majority), the placental iron concentrations did not vary with the dose of iron dextran.The water-soluble non-heme iron was determined in 17 treated cases. No estimation was made in any of the controls, but the results after treatment fell into two groups. In three of six cases with increased concentrations of hemosiderin iron, the ferratin iron was higher than in the remaining 14 cases. In most of the latter, the concentrations of hemosiderin iron were within the control range.In some patients, the maternal serum iron was measured at the time of delivery. The concentrations were high in most of these, due to the presence of circulating irondextran.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

AbstractsImpaired neonatal leukocyte function has been demonstrated by several investigators. Previous studies have reported abnormal oxidative metabolic and functional activities of polymorphonuclear leukocytes from infected neonates, as well as from healthy newborn infants. The results of these studies are discordant, and the potential role of the method of delivery on neutrophil function of healthy, uninfected newborn infants has not been studied. The present study was designed to evaluate the effect of various methods of delivery on neutrophil function of the newborn.Thirty-five newborn infants were included in the study. Cord blood was obtained from 15 (38 to 43 weeks of gestation) delivered vaginally after 11 hours of labor, from 5 (40 to 43 weeks of gestation) delivered by cesarean section after 10 to 14 hours of labor, and from 15 (38 to 41 weeks of gestation) delivered by cesarean section without labor. Sixty milliliters of blood were obtained also from 12 postpartum women one hour after delivery to assess the effect of delivery method on maternal cell function. Each time neonatal cord blood or maternal blood was obtained, leukocytes were isolated from 80 ml of venous blood from each of 35 healthy adult volunteers who were used as control subjects.There were no significant differences in maternal age or duration of gestation among the three groups. The mean duration of labor was 7.5 hours in the vaginal group and 12 hours in the cesarean section group with labor.White blood cell function was assessed immediately after blood was obtained and the polymorphonuclear leukocytes were separated. The cell counts x 103per mm3of neonates delivered by cesarean section without labor (8.6 ± 1.0) and of adult control subjects (7.0 ± 0.4) were significantly (P < 0.01) lower than those of neonates delivered by cesarean section with labor (14.8 ± 0.9) or vaginally (14.2 ± 1.0) (Fig. 1). The absolute polymorphonuclear leukocyte counts of neonates delivered by cesar ean section without labor (3.5 ± 0.8) and of adult control subjects (4.0 ± 0.4) were significantly (P < 0.001) lower than those of neonates delivered vaginally (7.2 ± 0.6) or by cesarean section with labor (7.4 ± 0.5).The resting oxygen consumption of polymorphonuclear leukocytes isolated from neonates delivered vaginally or by cesarean section with labor was lower than that of polymorphonuclear leukocytes from neonates delivered by cesarean section without labor or from adult control subjects. The mean stimulated oxygen consumption of polymorphonuclear leukocytes from neonates delivered by cesarean section with labor (7.2 ± 0.9) or vaginally (7.6 ± 1.1) was significantly (P < 0.005 and P < 0.001, respectively) lower than that from neonates delivered by cesarean section without labor (16.5 ± 1.6) and from adult control subjects (15.2 ± 1.0).In the resting state, hexose monophosphate shunt levels of the polymorphonuclear leukocytes from neonates delivered vaginally or by cesarean section with labor were not significantly different from levels of neonates delivered by cesarean section without labor or from those of control subjects.The unstimulated dye reduction levels were similar in all groups. The reduction of nitroblue tetrazolium dye by zymosan-stimulated polymorphonuclear leukocytes isolated from neonates delivered by cesarean section with labor (0.353 ± 0.03) or vaginally was significantly (P <0.05) lower than levels of polymorphonuclear leukocytes isolated from cord blood of neonates delivered by cesarean section without labor (0.416 ± 0.01) and from those of control subjects (0.417 ±0.01).There were no significant differences among the groups of postpartum women with regard to zymosan-stimulated or resting hexose monophosphate shunt activity, nitroblue tetrozolium dye reduction, or oxygen consumption when compared to adult control subjects.

ISSN:0029-7828    

出版商:OVID    

年代:1983

数据来源: OVID