Oligohydramnios sequence and renal tubular malformation associated with maternal enalapril use

Article Abstract:

Oligohydramnios, or a reduction in the normal amount of amniotic fluid, is associated with inadequate development of the fetal lungs. In one case, an infant with pulmonary hypoplasia died; the condition was apparently the result of oligohydramnios, which was first noted at 27 weeks of gestation by ultrasonography. A post-mortem examination of the infant revealed abnormal development of the tubules in the kidney. The mother had been taking enalapril for hypertension, or high blood pressure, associated with systemic lupus erythematosus. Enalapril and captopril, which are chemically different, reduce blood pressure by inhibiting angiotensin converting enzyme; they have been associated with oligohydramnios, fetal distress, and kidney dysfunction. A retrospective study of 22 pregnant women who took captopril and nine who took enalapril revealed a high rate of miscarriage, though gross malformations were not reported. The kidney tubule malformation observed in this case history may have been related to reduced blood flow caused by enalapril, or may have been a primary teratogenic effect, or birth defect, caused by enalapril; the mechanisms are not known. However, since alternative drugs for the control of hypertension have not been reported to have such adverse effects, clinicians should carefully consider whether to use angiotensin converting enzyme inhibitors for the treatment of pregnant patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, ACE inhibitors, Angiotensin converting enzyme inhibitors, Enalapril, Captopril

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Association of immunoreactive eosinophil major basic protein with placental septa and cysts

Article Abstract:

Pregnant women have elevated blood levels of the major basic protein of eosinophilic granules, which are storage compartments in eosinophils (a type of white blood cell). This protein has been found in the X cells of the placenta, the tissue that provides nourishment to the fetus. These X cells are located in the placental septa, wall-like structures that separate cavities, and cysts, sac-like structures. The number of septa and cysts vary with different placenta. The development of septa and cysts in the placenta is thought to be associated with the advancement of pregnancy and maturation of the fetus. The number of X cells, as reflected by the number of placental cysts and septa, should correlate with the blood levels of major basic protein. The relationship between the number of placental cysts and septa and blood levels of major basic protein was assessed. The results showed that blood levels of major basic protein correlated with the number of placental cysts, septa, and deposits of fibrin, a thin, white protein. The levels of major basic protein were not related to the placental weight. These findings suggest that major basic protein can serve as a marker for placental septa and cysts, and help in elucidating the function and role of X cells in the formation of placental cysts, septa, and fibrin deposits. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Fetus, Physiological aspects, Growth, Placenta, Pregnancy proteins, Cysts, Fetal development

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The accuracy of urinary luteinizing hormone testing in predicting ovulation

Article Abstract:

Successful conception can result when exact time of ovulation is known. Urinary luteinizing hormone (a hormone involved in stimulating ovulation) testing is used to predict the exact day of ovulation and is a useful tool for women trying to conceive. Knowing the exact time of ovulation is particularly helpful to women using artificial insemination to achieve pregnancy. Ovulation predictor kits test urine for peak values of luteinizing hormone to signal that ovulation is occurring. Transvaginal ultrasonography (using high frequency sound to visualize internal organs) was used to determine the exact time of ovarian follicle rupture which confirms ovulation. Luteinizing hormone surges were found to occur up to two days before ultrasonography could detect ovulation. The ovulation predictor test has a 90 percent reliability rate and is still the method of choice, especially when done twice a day. However, when pregnancy fails within three to six cycles of artificial insemination, the authors recommend ultrasonographic confirmation on the day of hormone surge.

Methods, Ultrasonics, Luteinizing hormone, Natural family planning, Ovulation

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