Thesis (Ph. D.)--University of Wisconsin--Madison, 1967. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

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To determine the current clinical practices of perinatologists regarding the management of premature rupture of membranes (PROM), 1,041 perinatologists were surveyed by multiple choice questionnaire with regard to induction of labor, use of antibiotics, tocolytic agents, and corticosteroids following uncomplicated PROM occurring between 19 and 36 weeks. The response rate was 51% (557/ 1,041). There was a consensus on expectant management of preterm PROM, except (1) where fetal lungs are found mature between 33 and 35 weeks gestation (51% induction vs. 44% expectant) and (2) at 19-22 weeks (71% undecided). During the expectant management the majority does not at any time use antibiotics, tocolytic agents, or corticosteroids. No uniform protocol has yet evolved for the management of preterm PROM, especially (1) between 33 and 35 weeks with mature fetal lungs, and (2) at 19-22 weeks gestation.

Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg / Background and objectives Prelabour rupture of the membranes (PROM) is a major obstetric problem affecting about 20% of pregnancies. Complications include preterm labour, ascending intrauterine and perinatal infections, and neonatal mortality. Standard guidelines are formulated and continually reviewed to improve the clinical management of PROM and to reduce poor perinatal outcomes associated with this condition. The objectives of this study, conducted using women in Johannesburg as a sample population, were: 1) to audit the implementation of the standard protocol on management of PROM, and 2) to determine the maternal and fetal outcomes of this condition. Methods A cross-sectional descriptive study was done on women admitted to the antenatal wards of Chris Hani Baragwanath Academic Hospital with PROM. Inclusion criteria were that PROM was the main reason for admission, gestation ≥24 weeks, and maternal age 18 years or more. Hospital clinical files were studied for obstetric and clinical characteristics, adherence by doctors to the management protocol, and final outcome including latency period, induction rate, mode of delivery, and neonatal outcome. Results Ninety-seven women participated in the study. Their mean age was 27.0 years, and 37 (38%) were nulliparous. Eighty-five (87%) had attended antenatal clinic. Twenty-nine (30%) were HIV-infected, 23 (79%) of them on highly active antiretroviral treatment. 6 The mean gestational age on admission was 32.8 weeks, with 78 (80%) women having preterm PROM at GA<37 weeks and 52 (54%) at GA <34 weeks. The most frequent methods of diagnosis were visual inspection in 77 (79%), speculum examination in 49 (51%) and ultrasound scan in 81 (84%) of the women. Antibiotics were given to 96 women (99%), and antenatal corticosteroids were used in all women <34 weeks pregnant. No cases of clinical chorioamnionitis were detected. The mean latency from PROM to delivery for women <37 weeks pregnant was 15 days, and for those <34 weeks, it was 19 days. Twenty-nine women (30%) required induction of labour, and 25 (25.8%) had caesarean sections. There were 12 perinatal deaths (with the exclusion of three late neonatal deaths), resulting from prematurity (n=4), congenital anomalies (n=2), neonatal jaundice (n=2), respiratory distress syndrome (n=2) and perinatal asphyxia / hypoxic ischaemic encephalopathy (n=2). There were no recorded cases of either neonatal or puerperal sepsis. Conclusion The study may have under-represented term PROM, so the findings are most applicable to preterm PROM. The condition was mostly managed appropriately within the local protocol, especially in terms of corticosteroid and antibiotic use. Overt or clinically evident chorioamnionitis was not detected. However, the perinatal mortality rate was high, and whatever the causes of perinatal death in this group, it is clear that PROM is a high-risk condition deserving of close clinical attention.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1995. / Includes bibliographical references (leaves 116-131). / Microfiche. / xvi, 131 leaves, bound ill. (some col.) 29 cm

Thesis (Ph. D.)--University of Wisconsin--Madison, 1956. / Typescript. Abstracted in Dissertation abstracts, v. 16 (1956) no. 11, p. 1994-1995. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 155-157).

La vitamine A et ses dérivés actifs (les rétinoïdes) sont des molécules essentielles à la vie et ce dès la période embryonnaire. Molécules de choix dans de nombreuses applications thérapeutiques, notamment dans les domaines de la dermatologie et de l’ophtalmologie, elles sont le plus couramment utilisées pour leurs propriétés pro-cicatrisantes. Malgré cette utilisation courante en clinique, les mécanismes cellulaires et moléculaires permettant aux rétinoïdes de promouvoir un processus de cicatrisation restent encore mal connus. Afin de mieux appréhender ces mécanismes, mais aussi afin d’élargir leur utilisation clinique à la rupture prématurée des membranes (RPM), je me suis intéressée aux propriétés pro-cicatrisantes de l’atRA (l’un des dérivés actifs de la vitamine A) sur les membranes fœtales. Alors que l’amnios et le chorion sont physiologiquement incapables d’initier un processus de cicatrisation suite à une lésion, nos résultats démontrent un effet positif de l’atRA sur la migration des cellules épithéliales amniotiques (amniocytes primaires), conduisant ainsi à une potentialisation de la cicatrisation de plus de 80% in vitro. Ce travail, complété par une analyse transcriptomique réalisée sur des membranes fœtales et des amniocytes primaires traités ou non à l’atRA, a permis d’identifier de nombreux gènes régulés par l’atRA au sein de l’amnios et des amniocytes. Parmi ces gènes, je me suis intéressée à un membre de la famille des lysyl oxydases, LOXL4, qui joue un rôle clé dans la dynamique de la matrice extracellulaire en régulant la réticulation du collagène. Une étude de régulation transcriptionnelle associée à de la promotologie ont tout d’abord permis de montrer que l’atRA induisait l’expression du gène LOXL4 de manière directe. Puis, l’inhibition de la protéine LOXL4 lors de tests de blessure (par le β-aminopropionitrile et par un siARN spécifique) nous a permis de démontrer que l’effet pro-cicatrisant de l’atRA était médié, au moins en partie, par la rétino-induction deLOXL4. Ces nouveaux éléments apportés par ce travail dans la compréhension des mécanismes moléculaires utilisés par l’atRA afin de promouvoir la cicatrisation permettent d’envisager son utilisation future dans la prise en charge clinique des ruptures prématurées. / Vitamin A and its active derivates (retinoids) are essential molecules for life from the embryonic development to the adulthood. Because of these numerous functions and especially because of their pro-healing properties, they are commonly used in clinic in dermatology and ophthalmology in particular. Despite this routine clinical use, the molecular and cellular mechanisms used by retinoids to promote a healing process remain unclear. To better understand these mechanisms, but also to expand its clinical use to the premature rupture of fetal membranes (PROM), we looked to pro-healing properties of atRA (active derivative of vitamin A) on the human fetal membranes. While amnion and chorion are unable to initiate a physiological process of healing after injury, our results demonstrate a positive effect of atRA on the migration of primary amniocytes, leading to an healing improvement of up to 80% in vitro. This work, completed by a transcriptomic analysis performed on fetal membranes and primary amniocytes treated or not with atRA, allowed the identification of many genes regulated by atRA within the amnion and the amniocytes. Among these genes, we looked to a member of the lysyl oxidase family, LOXL4, which plays a key role in the dynamic of the extracellular matrix by regulating collagen crosslinking. First, transcription and promotology experiments have shown that atRA strongly induced the expression of LOXL4 in a direct manner. Then, the inhibition of the LOXL4 protein in scratch assay experiments (using β-aminopropionitrile or a specific siRNA) allowed us to demonstrate that the pro-healing effect of atRA was mediated, at least in part, by the retinoid-induction of this gene. Besides providing new elements to understand how atRA exerts their pro-healing properties, this work proposes atRA as a promising candidate to improve the clinical management of premature rupture of the fetal membranes by promoting re-epithelialization of the amnion.

Corticosterone in foetal tissues after injection of the mother with ¹⁴C-corticosterone was determined by acetylation. with ³H-acetic anhydride and crystallization to constant specific activity. The corticosterone content of whole foetal tissue varied between gestational days 13 and 17 from 641 to 300 ng/g respectively. The specific activity of foetal hormone recovered remained essentially constant; after a 15-minute pulse this was as much as one-fourth that of maternal hormone. However, placenta, head and liver showed distinctly different patterns of metabolism, which changed greatly during this time in head and liver, with a decrease in the conversion of corticosterone to 11-dehydrocorticosterone and a rise in foetal liver 113-hydroxysteroid:NADP oxidoreductase activity. This mitochondrial enzyme, Km=33yM, pH optimum 6, which reduces the 11-dehydro metabolite to the biologically active 116-OH compound, increased sharply, raising the relative amount of the latter in foetal tissues from 15 to 91% during this period. One day after removal of maternal adrenals, foetal corticosterone was normal and maternal levels close to normal, indicating ability of foetal adrenals to function. Maternal hormone, however, crossed to the foetus readily and it was considered most likely that, normally, the maternal source predominates. Regardless of origin, foetal or maternal, however, the hormone is maintained in different foetal tissues in a distinct and different manner. / Medicine, Faculty of / Biochemistry and Molecular Biology, Department of / Graduate

Evolution of the terrestrial egg of amniotes (reptiles, birds, and mammals) is often considered to be one of the most significant events in vertebrate history. Presence of an eggshell, fetal membranes, and a sizeable yolk allowed this egg to develop on land and hatch out well-developed, terrestrial offspring. For centuries, morphologically-based studies have provided valuable information about the eggs of amniotes and the embryos that develop from them. This review explores the history of such investigations, as a contribution to this special issue of Journal of Morphology, titled Developmental Morphology and Evolution of Amniote Eggs and Embryos. Anatomically-based investigations are surveyed from the ancient Greeks through the Scientific Revolution, followed by the 19th and early 20th centuries, with a focus on major findings of historical figures who have contributed significantly to our knowledge. Recent research on various aspects of amniote eggs is summarized, including gastrulation, egg shape and eggshell morphology, eggs of Mesozoic dinosaurs, sauropsid yolk sacs, squamate placentation, embryogenesis, and the phylotypic phase of embryonic development. As documented in this review, studies on amniote eggs and embryos have relied heavily on morphological approaches in order to answer functional and evolutionary questions.