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Background: Estrogen and progesterone immunoregulate the genital environment by expression of cytokines and growth factors., Objective: To investigate the pattern of expression of T-helper cytokines during the ovarian cycle compared with women with chronic anovulation resistant to clomiphene citrate., Hypothesis: Expression of T-helper cytokines in women with chronic anovulation may be different from the pattern in women with a normal ovarian cycle., Methods: We evaluated 31 infertile women having laparoscopy for evaluation of tubal patency and evidence of ovulation in two groups during (a) the luteal phase (17 women) and (b) the follicular phase (14 women). A third group was composed of 14 women with polycystic ovarian syndrome, but they were resistant to clomiphene citrate for induction of ovulation and had laparoscopic ovarian cautery. Peritoneal fluid was collected during laparoscopy. Estimation of T-helper cytokine interleukin (IL)-2, tumor necrosis factor (TNF)-alpha, IL-4 and IL-6 in serum, peritoneal fluid and culture of the peritoneal mononuclear cells was performed by ELISA. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, estradiol and progesterone were evaluated by the Vidas Parametric System., Results: The LH : FSH ratio was significantly higher in the women with polycystic ovaries than in the ovulatory groups. IL-2 and IFN-gamma were more highly expressed in the follicular phase but the T-helper 2 cytokines IL-4 and IL-6 predominated in the luteal phase, serum, peritoneal fluid and culture of the peritoneal mononuclear cells. From the follicular to the mid-luteal phase, IL-6 increased three to fivefold in the serum and peritoneal fluid, but there was low expression with anovulation., Conclusions: The peritoneal fluid levels of IL-4 and IL-6 are higher in the luteal phase. Low IL-6 levels in chronic anovulation may be a marker of resistance to clomiphene citrate.

Background: There are suggestions that T helper 1 cytokines may be detrimental to early pregnancy and T helper 2 cytokines protective of the pregnancy. Their role in preeclamptic pregnancy, labor and puerperium, is not clear., Materials and Methods: Twenty-eight preeclamptic women and their matched controls were evaluated, at the Departments of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University and Maternity Hospital, Kuwait. Outcome measures evaluated were serum levels of TNF alpha and interleukin-4 at 12, 24, 36 weeks of gestation, advanced labor and at 1 hour and daily postpartum until they were undetectable, using ELISA technique., Results: T helper cytokines showed higher serum levels in preeclampsia than normotensive pregnancy (p < 0.01, 0.01), in established labor (p < 0.05) and at 1 hour postpartum (p < 0.01 for IL-4) and p < 0.02 for TNF alpha. There was significant increase of IL-4 between 12 to 24 weeks in normal pregnancy compared to preeclampsia (p < 0.001) but not for TNF alpha. By 24 hours postpartum, IL-4 was still detectable in eight parturients compared to one patient with detectable TNF alpha (p < 0.04). Detectable IL-4 levels after 24 hours postpartum were associated with intrauterine growth retardation (p < 0.03)., Conclusion: IL-4 has a dichotomous role in pregnancy. Normotensive pregnancy is associated with high increase in IL-4 in the first half of the pregnancy, but in the second half of pregnancy and puerperium, high levels of IL-4 are associated with preeclampsia.

Background: Hypertension in pregnancy is associated with increased maternal and fetal morbidity and mortality. The aim of this prospective study was to evaluate the obstetric outcome of patients with pregnancy induced hypertension (PIH) that delivered at the Maternity Hospital Kuwait within a period of six months and evaluate the economic implications of present management strategies., Methods: This was a comparative study with age and parity, as matching variables, in 224 pregnant hypertensive women and 224 normotensive controls., Results: During the study period, the incidence of PIH was 4.9 percent. They were more associated with diabetes mellitus and multiple pregnancy than controls (p < 0.02). About 43 percent of the hypertensive parturients used antihypertensive therapy. More of them had induction of labor (p < 0.001), preterm delivery (p < 0.0002) and cesarean section (p < 0.001), and babies with low birthweight (p < 0.01). In the linear regression analysis, hypertension in pregnancy gave rise to more hospitalisation, intrauterine growth retardation and operative deliveries than the normotensive controls. The perinatal mortality was higher (p < 0.001)., Conclusion: Despite the economic expenditure of about five times more for hypertensive women in pregnancy than in controls, both obstetric and neonatal outcome, are still significantly worse in the former. This study therefore advocates more research into the prevention, prediction and management, including neonatal care, of hypertensive disorders of pregnancy.

Objectives: To investigate the association between menopause and lipoproteins and the effect of hormone replacement therapy (HRT)., Methods: Total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were estimated in 50 postmenopausal women and 25 ovulating women who served as controls. The lipoprotein estimations were repeated after 1 year of therapy with natural estrogen-norgestrel combination., Results: More postmenopausal women than younger women had lipoprotein values in the high-risk status (P <0.001). There were no significant changes in lipoprotein levels (P >0.05) after HRT. Women with a body mass index below 26 kg/m2 had a significant reduction in their lipoprotein risk status (P <0.01)., Conclusion: There was no demonstrably clear effect of the estrogen-progestin combination on lipoprotein levels, probably because of other compounding variables such as obesity, lack of exercise and the type of progestin used.

Sera from pregnant and nonpregnant women were analyzed for thiocyanate. Serum thiocyanate concentration was higher in Nigerians compared with Caucasians and was significantly higher also in pregnancy. Hypoalbuminemia and dietary consumption of cyanogenic substances in pregnancy probably contributed to the higher thiocyanate levels. This may have a possible significant bearing on the fetal well-being, particularly fetal birthweight.

Of 13,500 deliveries in a 6-year period, 326 cases of antepartum hemorrhage (2.4%) were encountered. Fifty-six (0.42%) of these patients had abruptio placentae while 130 (0.96%) had placenta previa. An inverse ratio of placenta previa and abruption placentae was observed in this study, which may be due to a racial difference--probably a result of the late onset of preeclampsia among Nigerians. A high perinatal mortality of 643/1000, influenced mainly by the high prematurity rate, was observed; cesarean section resulted in the lowest perinatal mortality (154/1000). There was one maternal death, giving a maternal mortality rate of 18/1000.

Five hundred sixty grandmultiparous women were interviewed as to their contraceptive awareness, desirability and use in the three major hospitals in Benin City, Nigeria, between October 1, 1980 and September, 1981. Their parity ranged from 5 to 14 with a mean of 6.7. There was high level of awareness of contraceptive availability and usefulness (65%), but low level of practice (27.1%). The main causes of the low practice level included opposition from husband and other relatives, complications of previous methods used and the desire to have a large family. Oral contraceptives were the preferred method, followed by intrauterine devices. Educational attainment had a positive relationship to acceptance of contraceptive practice. We believe that with more concerted effort at family planning counseling, the community will be rid of the hazards and menace of grandmultiparity.

Induced adolescent abortion is a major cause of maternal and gynecologic death in the University of Benin Teaching Hospital, where 244 out of 349 such cases seen from January 1, 1974 to December 31, 1979 were reviewed. Ignorance and lack of contraceptive facilities were contributory factors. To deal with this problem that has been pervasive throughout Nigeria for the past decade, the authors advocate sex education, systematic dissemination of information for planned and conscientious parenthood as well as free availability of alternative methods of contraception. Interruption of early pregnancy should be an essential component of a national family planning program.