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Objectives Serum bile acid (BA) levels testing is used for the diagnosis of intrahepatic cholestasis of pregnancy (ICP). We aimed to determine the performance of routine liver tests in the evaluation of ICP. Methods A retrospective cohort study conducted at a university hospital, including all pregnant women who underwent serum BA levels testing due to suspected ICP during 2007–2019. Liver tests were performed in all women including: aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase (ALK), gamma-glutamyl transferase (GGT), and total bilirubin (TB). The optimal combination of laboratory values was determined by an algorithm developed in the Python programming language. Results Of 640 women who met the inclusion criteria, 22% (n = 142) were diagnosed with ICP (serum BA>10 μmol/L). A combined laboratory score of: (TB>11 μmol/L) or (ALK>255 U/L) or (GGT>32 U/L) or (AST>31 U/L), had a sensitivity of 94%, negative predictive value (NPV) of 97%, specificity of 50%, positive predictive value of 35%, and a negative likelihood ratio of 0.11 for the diagnosis of ICP. The AUC of the laboratory model alone was 0.72 (95% CI: 0.69–0.75). The addition of history of ICP to the suggested laboratory score resulted in a sensitivity of 97%, NPV of 98% and a negative likelihood ratio of 0.06. The AUC of the final model was 0.76 (95% CI: 0.72–0.79). Conclusions A combined laboratory score incorporating AST, GGT, ALK and TB was shown to reliably exclude the diagnosis of ICP. This may be particularly useful in settings with limited access to BA levels testing.

Objective History of prior preterm birth (PTB) represents one of the strongest risk factors for recurrent PTB. Nevertheless, whether the occurrence of PTB in multifetal gestation is associated with increased risk of PTB in subsequent pregnancies remains unclear. We aimed to determine the recurrence risk of PTB in a subsequent singleton pregnancy after a previous spontaneous preterm triplet delivery. Study design A retrospective matched case-control study. The study group comprised all women with spontaneous preterm trichorionic triplet delivery who had a subsequent singleton pregnancy during 2006–2017 at two university hospitals. A control group of women with spontaneous preterm dichorionic twin delivery and a subsequent singleton pregnancy, was established by matching, four-to-one, according to maternal age, parity, gestational age at delivery, and delivery year. Results Data from 170 women were analyzed, 34 with preterm triplet delivery and 136 matched control women with preterm twin delivery. Gestational age at the subsequent singleton delivery was higher in those with preterm triplet delivery than in those with preterm twin delivery (median 39 vs 38 weeks, P = 0.02). Women with prior triplet PTB had a significantly lower rate of recurrent PTB as compared with women with prior twin PTB (5.9 % vs. 25.0 %; OR [95 % CI]: 0.19 (0.04, 0.82), P = 0.02) with lower proportions of low-birth weight infants ( Conclusions The risk of recurrent PTB following spontaneous PTB in triplet pregnancy was low compared to preterm twin delivery. These data provide reassurance for those who experienced preterm triplet delivery and suggest the need for further studies to understand the mechanisms contributing to PTB in multifetal pregnancies.

OBJECTIVES To examine the outcomes of planned induction of labour versus spontaneous onset of labour among women using prophylactic-dose low-molecular weight heparin (LMWH) therapy. DESIGN Retrospective cohort study. SETTING University hospital. POPULATION Women receiving antepartum prophylactic LMWH therapy undergoing a trial of vaginal delivery. METHODS Charts from 2018-2019 were reviewed. MAIN OUTCOME MEASURES Duration of anticoagulation interruption and eligibility to receive neuraxial anaesthesia. RESULTS Data from 199 women were analysed; 78 (39.2%) were admitted following spontaneous onset of labour and 121 (60.8%) underwent planned induction of labour. Compared to women who underwent planned induction of labour, women who presented with spontaneous onset of labour had a shorter median admission-to-delivery interval (4.7 versus 29.3 hours, P

Spontaneous labor onset, epidural anesthesia and prior cesarean for non-arrest disorders are strong predictors of successful vaginal birth after cesarean in women delivering a macrosomic fetus. Lower rates of successful vaginal birth after cesarean in association with increasing birthweight were previously reported. We aimed to determine the factors associated with successful trial of labor after cesarean (TOLAC) among primiparous women with fetal macrosomia. A retrospective cohort study conducted during 2005–2019 at two university hospitals, including all primiparous women delivering a singleton fetus weighing ≥ 4000 g, after cesarean delivery at their first delivery. A multivariate analysis was performed to evaluate the characteristics associated with TOLAC success (primary outcome). Of 551 primiparous women who met the inclusion criteria, 50.1% (n = 276) attempted a TOLAC and 174 (63.0%) successfully delivered vaginally. In a multivariate analysis, spontaneous onset of labor (aOR [95% CI] 3.68 (2.05, 6.61), P

Accurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs.Antenatal cases of suspected placenta accreta were collected prospectively in a single-site tertiary delivery center. Women with clinical signs of placenta accreta (placenta previa, number of previous cesarean deliveries and/or ultrasound suspicion of placenta accreta) were included. The diagnosis of accreta was confirmed surgically. The primary endpoint was the proportion of surgically-diagnosed placenta accreta among all suspected cases. Logistic regression modeling was performed to assess preoperative risk factors for placenta accreta. The risk score was tested on a receiver operator characteristic curve to identify subjects with placenta accreta and the optimum cut-point was chosen.Over nine years, 92 suspected accreta cases were identified from 46623 deliveries (0.2%). The diagnosis was confirmed at surgery in 52/92 cases (56%) and there were no maternal deaths. Blood transfusion requirements were greater in patients with placenta accreta versus patients without placenta accreta (median 7 [range 0-25, interquartile range 3-10] versus 0 [0-6, 0-2] units of blood, P0.0001). Area under the curve of the receiver operator characteristic curve was 0.846, with contribution from three variables (placenta previa, number of previous cesarean deliveries and ultrasound suspicion), each with a P value0.05. From the ROC curve a cut-point with 100% sensitivity and specificity 25% (95% CI 12.69%-41.20%) was achieved, compared with 86.6% sensitivity (95% CI 74.21%-94.41%) and 60.0% specificity (95% CI 43.33%-75.14%) using ultrasound alone.Combining diagnostic features associated with placenta accreta through mathematical modeling has better positive predictive value than ultrasound alone.

Apolipoprotein E (apoE4) and head trauma are important genetic and environmental risk factors for Alzheimer's disease. Furthermore, apoE4 increases both the acute and chronic consequences of head trauma. The latter are associated with the deposition of amyloid-beta, which is particularly elevated in apoE4 subjects. The short-term effects of head injury are associated with transiently increased metabolism of amyloid precursor protein (APP) and its secreted fragment, APPs. In the present study, we examined the possibility that the acute, short-term pathological effects of apoE4 following head trauma and the corresponding neuroprotective effects of apoE3 are related to isoform-specific effects of apoE on APP metabolism. Accordingly, male transgenic mice expressing human apoE3 or apoE4 on a null mouse apoE background and apoE-deficient and control mice were subjected to closed head injury (CHI). The resulting effects on brain APP, and on its secreted products, APPs and secreted product of the alpha-cleavage of APP (APPsalpha) were then determined 24 h following injury. Immunoblotting revealed no significant differences between the basal APP, APPs and APPsalpha levels of the hippocampus or the cortex of the control and the apoE3 and ApoE4 transgenic mice. The apoE-deficient mice also had similar cortical basal levels of APP and its metabolites, whereas their corresponding basal hippocampal APP and APPs levels were lower than those of the other groups. CHI lowered the hipppocampal APPs and APPsalpha levels of the apoE4 transgenic mice, whereas those of the apoE3 transgenic mice and of the control and apoE-deficient mice were not affected by this insult. In contrast, CHI raised the cortical APP and APPs levels of the apoE3 transgenic mice but had no significant effect on those of the other mice groups. These animal model findings suggest that the acute, short-term pathological effects of apoE4 following CHI and the corresponding neuroprotective effects of apoE3 may be mediated by their opposing effects on the expression and cleavage of cortical and hippocampal APP. Similar isoform-specific interactions between apoE and APP may play a role in the acute, short-term effects of head trauma in humans.

To compare the antepartum and intrapartum course of Jewish and Arab great-grandmultiparas from central and peripheral areas in Israel to age-matched control multiparous women.Medical records of four groups of parturients were compared: great-grandmultiparas (paraor = 9) and multiparae (para 2-5) delivering at Nazareth E.M.M.S. hospital (mostly Arabs) and Hadassah-Ein-Kerem hospital in Jerusalem (mostly Jews). The control groups consisted of demographically and geographically matched multiparas. Data was collected on prenatal care received, antepartum complications, as well as the intrapartum complications traditionally associated with high parity (e.g. malpresentation, placental abnormalities, peripartum hemorrhage, shoulder dystocia). Neonatal records were also examined to determine any neonatal morbidity or mortality.There were 139 and 141 great-grandmultiparas in the Nazareth and the Jerusalem study groups, respectively (mean parity was 10.1 and 10.9, respectively), and 142 and 139 multiparas in the Nazareth and the Jerusalem control groups, respectively (mean parity was 2.9 and 2.5, respectively). The rate of physician visits during the prenatal period in the Nazareth and the Jerusalem study groups was 2.3 +/- 2.4 and 3.2 +/- 2.7, respectively (p=0.0041). This rate was significantly higher in the controls of both areas (4.0 +/- 3.0 and 4.9 +/- 2.9, respectively). There was no difference in the rate of nurse visits in all groups in all areas. Maternal and neonatal outcomes were similar in both study groups, and were also similar in the control groups, but perinatal mortality was higher in both great-grandmultiparous groups compared to the controls (11/280 and 2/281, respectively; p0.05).The differences in the intensity of prenatal care between these rural and urban areas did not affect the maternal outcomes of great-grandmultiparous pregnancies. In addition, there were no significant differences in maternal outcomes between great-grandmultiparas and multiparas in rural and urban areas although prenatal care was less intense in the former. However, increased incidence of perinatal mortality in the great-grandmultiparas may be due to factors unrelated to prenatal care intensity or quality.

The aim of this study was to determine placental thickness by ultrasound examination throughout pregnancy and establish the correlation of sonographically thick placenta with perinatal mortality and morbidity. Placental thickness was determined by routine sonographic examination throughout pregnancy in 561 normal singleton pregnancies. Thick placenta was determined as placenta that was above the 90th percentile. Gravidae between 20-22 weeks' gestation (n=193) and 32-34 weeks (n=73) were then divided into two groups according to placental thickness. The study group consisted of 44 gravidae with thick placenta. The control group included 151 gravidae with placental thickness between the 10th and 90th percentile. A comparison of perinatal mortality and morbidity rates as well as the incidence of small and large for gestational age neonates was conducted.A linear increase of placental thickness was found to correlate with gestational age throughout pregnancy. No statistical differences were observed between the two groups with regard to obstetrical variables such as maternal age, parity and gestational age at delivery. No correlation was found between placental thickness and maternal age or parity. The incidence of perinatal mortality was significantly higher among gravidae with thick placentae (6.82% versus 0.66 per cent, P=0.037, 95 per cent confidence interval 1.71-70.29). Birthweight at term was found to be above 4000 g in 20.45 per cent of the thick-placenta group as compared to 5.3 per cent in the control group (P=0.001, 95 per cent CI 2.08-13.85), and birthweight of less than 2500 g was found in 15. 9 per cent of the thick-placenta group as compared to 7.3 per cent in the control group (P=0.03, 95 per cent CI 1.11-8.14). The incidence of fetal anomalies was 9.1 per cent in the thick-placenta group and 3.97 per cent in the control group (not significant). Sonographically thick placenta is associated with increased perinatal risk with increased mortality related to fetal anomalies and higher rates of both small for gestational age and large for gestational age infants at term.

Post-term pregnancy is associated with increased perinatal mortality. In a retrospective study based on our post-term protocol from 1990 until May 1995 1,798 post-term pregnant women with reliable dating were evaluated for expectant management. A group of 2,633 pregnant women who delivered between 37 and 41 weeks during 1994 served as a control group. The perinatal mortality (0.56 per 1,000 vs. 0.75 per 1,000 in the control group) was similar in both groups. The incidence of induction of labor (7.45% vs. 7% in the control group), meconium of more than +1 (5.2% vs. 4% in the control group), shoulder dystocia (0.33% vs. 0.19%), high birthweight (4,500 g) (1% vs. 1%), and cesarean section rates (7.5% vs. 7% in the control group) were similar. However the fetal distress rates (11.6% vs 16%; P = .004), instrumental deliveries (10.1% vs. 13%, P = .002), and the rate of 5-minute Apgar score of less then 7 (1.1% vs. 5%, P = .000001) were found to be significantly lower in the post-date group than in the control group. We conclude that the expectant management and our intensive observation and follow-up in post-term is indicated for both mother and fetus.

We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.

The effect of growth hormone addition to human menopausal gonadotrophin (HMG), after pituitary down-regulation, on granulosa cell function, in in-vitro fertilization (IVF) was evaluated. Growth hormone or placebo were added in a prospective, randomized and double-blind manner to an existing IVF stimulation protocol. Forty-two normal ovulatory women (< or = 38 years old) with mechanical factor infertility and normal male factor were included in the study. Gonadotrophin-releasing hormone agonist (GnRHa) was given from day 21 of the previous cycle until human chorionic gonadotrophin (HCG) administration. Follicular stimulation with HMG was started after pituitary down-regulation. Growth hormone 12 IU/day or placebo were administered on alternate days, beginning day 1 until day 7 of HMG treatment. Granulosa cell function was evaluated, in all patients, by follicular fluid levels of ovarian steroids and insulin-like growth factor-I (IGF-I). In 14 patients, chosen arbitrarily granulosa lutein cells were cultured in the presence and absence of additional HCG. Follicular fluid levels of oestradiol, progesterone, testosterone and IGF-I were similar in both growth hormone and placebo groups. Basal and post-HCG levels of oestradiol and progesterone did not differ significantly between the two groups of granulosa lutein cell cultures. We conclude that after pituitary down-regulation, in-vivo administration of growth hormone with HMG in young ovulatory women does not seem to affect granulosa cell function when compared to the administration of HMG alone.

SummaryPregnancies after repeated caesarean sections are often considered to have increased maternal and fetal risks because of the assumed fragility of the scarred uterus. A group of 103 pregnant women who had more than three uterine scars was studied and compared to 12l pregnant women who were delivered by a third caesarean section during the same period. The pregnancy outcome and complications during pregnancy, intra-operative and postoperative variables were studied. No statistical difference was found between the two groups. The complication rate is low even in repeated caesarean sections. Thus there is no place for an arbitrary limitation of the number of caesarean sections. Advice should be based on the apparent condition of the uterus during the last operation.

The forward angle differential cross sections of ( π + , π − ) reactions on the calcium isotopes to the double-isobaric-analog (DIAS) and ground states (GS) were measured between 25 and 65 MeV. These low-energy cross sections are up to an order of magnitude larger than those at resonance energies. The forward-angle excitation functions of 42 Ca, 44 Ca DIAS and 44 Ca GS transitions peak around 50 MeV. The 48 Ca DIAS cross section exhibits a minimum at about 50 MeV and that for the GS has a peak which is shifted to lower energy with a smaller cross section than that of the other nuclei. The observed behaviour is inconsistent with theoretical expectations.

Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders, characterized by a defect in the synthesis of collagen. The syndrome is subdivided into different clinical subtypes, the most hazardous of which is type IV, the vascular type. It can manifest itself in various complications such as rupture of arteries and hollow organs. The obstetrical manifestations are the risk of uterine rupture during labor, damage to the vagina and perineum, bleeding and rupture of blood vessels and colon during the puerperium.We describe a primigravida suffering from Ehlers-Danlos type IV who was followed and successfully delivered by a cesarean section at 36 weeks of gestation and made an uneventful recovery.Following a thorough literature review, it seems wise to perform early delivery by cesarean section for pregnant women suffering from Ehlers-Danlos type IV.

Recombinant activated factor VII (rFVIIa, NovoSeven) was used in three patients with massive obstetric hemorrhage due to placenta previa accreta, rupture of the uterus and pre-eclampsia with HELLP. Administration of the drug markedly decreased the bleeding and enabled control of the hemorrhage. rFVIIa seems to be an adjunctive hemostatic measure for the treatment of severe obstetric hemorrhage.

Velopharyngeal incompetence (VPI) has been associated with neuromuscular disorders. Only 4 patients with myotonic dystrophy (MD) who underwent pharyngeal flap elevation for VPI have been reported in the literature. In 3 patients, surgery preceded the diagnosis of MD. Cardiorespiratory complications characterized the postoperative period of 3 patients. The authors present 3 patients with VPI and an established diagnosis of MD (by molecular genetics) who underwent pharyngeal flap elevation. The operation resulted in a major improvement in speech in all patients, although some relapse was noted later in 1 patient. Contrary to previous reports, none had peri- or postoperative cardiorespiratory complications. MD, although an uncommon etiology, should be considered in cases of late-onset VPI. Owing to differences between the authors' findings and previous reports, additional studies are needed before final conclusions can be reached regarding the benefit and safety of pharyngeal flap surgery in MD patients. At present, MD should not be considered a contraindication for this procedure, although close perioperative monitoring is indicated.

Although the current literature attests to the merits of a trial of labor in the patient with a prior cesarean section, some controversies remain. For example, can women with two or more sections be allowed a trial of labor and can patients who undergo a trial of labor receive oxytocin or prostaglandins for induction? Also, do certain indications for previous cesarean section such as relative cephalopelvic disproportion/failure to progress or the diagnosis of breech or twins in the present pregnancy constitute an indication for elective repeat cesarean delivery? These questions along with some other controversies are discussed in the light of newly accumulated data in the English literature and our own experience over the last decade in a major university-based tertiary medical center.

Pregnancies achieved by assisted reproduction were considered to carry an increased risk for spontaneous abortion, and ectopic and heterotopic pregnancies. In order to examine the validity of this hypothesis we compared the outcomes of spontaneous pregnancies and assisted reproduction pregnancies using the published reports in the world literature during the last decade. We also studied the outcome of 53,928 in vitro fertilization (IVF) pregnancies reported during the years 1985-91. The reported loss rates in spontaneous pregnancies (abortions and ectopic pregnancies) compared to pregnancies achieved by assisted reproduction were 19% and 30%, respectively. The differences in loss rates between spontaneous and assisted reproduction pregnancies are not completely understood and may originate from predisposing factors such as tubal disease, uterine disorders, corpus luteum dysfunction, and endometriosis that are more frequent in patients suffering from infertility. Increasing maternal age correlates with a higher risk of fetal chromosomal anomalies which results in an increased rate of abortions.

We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.

The effect of growth hormone addition to human menopausal gonadotrophin (HMG), after pituitary down-regulation, on granulosa cell function, in in-vitro fertilization (IVF) was evaluated. Growth hormone or placebo were added in a prospective, randomized and double-blind manner to an existing IVF stimulation protocol. Forty-two normal ovulatory women (or = 38 years old) with mechanical factor infertility and normal male factor were included in the study. Gonadotrophin-releasing hormone agonist (GnRHa) was given from day 21 of the previous cycle until human chorionic gonadotrophin (HCG) administration. Follicular stimulation with HMG was started after pituitary down-regulation. Growth hormone 12 IU/day or placebo were administered on alternate days, beginning day 1 until day 7 of HMG treatment. Granulosa cell function was evaluated, in all patients, by follicular fluid levels of ovarian steroids and insulin-like growth factor-I (IGF-I). In 14 patients, chosen arbitrarily granulosa lutein cells were cultured in the presence and absence of additional HCG. Follicular fluid levels of oestradiol, progesterone, testosterone and IGF-I were similar in both growth hormone and placebo groups. Basal and post-HCG levels of oestradiol and progesterone did not differ significantly between the two groups of granulosa lutein cell cultures. We conclude that after pituitary down-regulation, in-vivo administration of growth hormone with HMG in young ovulatory women does not seem to affect granulosa cell function when compared to the administration of HMG alone.

It is commonly accepted that cesarean section is the preferred mode of delivery of triplets. The present study was performed to evaluate maternal complications and neonatal outcome in 21 women operated on by a transverse lower segment incision as compared to 8 parturients who underwent surgery by a longitudinal uterine incision. There was no significant difference in mean gestational age at delivery, mean weight of the newborns, Apgar scores, perinatal mortality rates, or intraoperative or postpartum hemorrhage incidence between the two groups. Thus, a transverse lower segment uterine incision should be used in triplet deliveries to increase the chances of a normal vaginal delivery in the future.

Sinusoidal fetal heart rate pattern (FHR) is regarded by most authors as signifying a compromised fetus. In most cases, this is secondary to fetal anemia of different causes, usually Rh isoimmunization, more rarely to fetomaternal transfusion, bleeding vasa previa, placental chorioangioma, or traumatic amniocentesis. A case is described which to our knowledge is the first reported of a sinusoidal FHR pattern occurring in the relatively anemic donor twin in a case of the twin to twin transfusion syndrome. The importance of separate antepartum biophysical evaluation of each member of a twin pregnancy is emphasized.

The effect of estradiol valerate and allylestrenol on the endometrial transformation of five hypergonadotropic hypogonadic women was evaluated. Estradiol valerate was administered throughout the whole induced cycle (28 days), while allylestrenol was added during the second half of the cycle. Endometrial biopsies were performed during allylestrenol treatment and were evaluated histologically. Samples of endometrium were also subjected to one-dimensional SDS electrophoresis. Of ten biopsies performed, only one was interpreted to be in-phase, while the others were dated proliferative (4 biopsies) or showed abortive or out-of-phase secretory transformation. The highest mean serum progesterone level, detected under allylestrenol treatment, was 1.5 ng/ml. Protein electrophoresis demonstrated relative sequential changes in the protein patterns of the 115 kDa and 150 kDa protein bands. It is concluded that allylestrenol, although having gestagen properties, may not be efficient for the induction of an adequate secretory transformation of human endometrium in the absence of ovaries.

We report a 54-year-old postmenopausal woman with a leiomyoma which on an ultrasound scan and on computed tomography (CT) had cystic areas and extensive necrosis suggesting sarcomatous change.

A 41-year-old woman with advanced abdominal adenocarcinoma presented at term pregnancy. The tumor was presented as previa and obstructed the delivery. A cesarean section was performed and a healthy child was born. At surgery diffuse metastatic disease was detected throughout the pelvis and abdomen and was partially resected. Combined chemotherapy consisting of cis-platinum, adriamycin and cytoxan was administered for 5 months. At second-look laparotomy no residual disease was found. We present an unusual presentation of metastatic abdominal undifferentiated carcinoma treated as ovarian cancer.

Fibromuscular dysplasia is an arteriopathy of unknown etiology that affects the intermediate-size branches of the aorta. Partial occlusion of these arteries may result in neurologic symptoms when carotid arteries are affected, and impaired liver or kidney function when their blood supply is compromised. Pregnancy and delivery in women who are diagnosed as having fibromuscular dysplasia may be associated with disease-related complications such as ischemic attacks. We report the course of a pregnancy and delivery in a patient with carotid artery fibromuscular dysplasia and suggest steps for general obstetric management and contraception in patients suffering from fibromuscular dysplasia.

Human decidual antigen presenting cells (DAPCs) exposed to fetal cells in vitro induce generation of suppressor T cells among a population of peripheral blood lymphocytes. Human lymphocyte antigen (HLA)-class II positive antigen presenting cells were isolated from early normal human decidual tissue and from peripheral blood (PAPCs) by adhering Ficoll-Pa-que separated cell suspensions to fibronectin. In contrast to PAPCs, DAPCs pulsed with fetal antigens induced a radio-sensitive, Leu 1,2-positive T suppressor cell population. A nylon wool adherent B cell population is required during the in vitro induction of the suppressor cells. These suppressor cells impair primary mitogen and mixed lymphocyte culture (MLC) responses, generation of anti-trinitrophe-nyl (TNP) cytotoxic T lymphocytes, and antibody response of autologous and allogeneic lymphocytes. Only intact viable embryonic cells can effectively confer upon DAPCs the ability to induce T suppressor cells. The T suppressor cell induction by DAPCs primed with fetal antigens is restricted by the major histocompatibility complex. Our results show that the HLA-DR molecules are the most prominent restriction elements.

Fibromuscular dysplasia is an arteriopathy of unknown etiology that affects the intermediate-size branches of the aorta. Partial occlusion of these arteries may result in neurologic symptoms when carotid arteries are affected, and impaired liver or kidney function when their blood supply is compromised. Pregnancy and delivery in women who are diagnosed as having fibromuscular dysplasia may be associated with disease-related complications such as ischemic attacks. We report the course of a pregnancy and delivery in a patient with carotid artery fibromuscular dysplasia and suggest steps for general obstetric management and contraception in patients suffering from fibromuscular dysplasia.