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This study was performed to document for the first time peritoneal fluid volumes and steroid hormone levels in baboons with and without endometriosis. A laparoscopy was carried out in 19 female baboons (11 with a normal pelvis and 8 with histologically proven spontaneous minimal/mild endometriosis) during 64 cycles in the early luteal phase. Peritoneal fluid was measured and aspirated. The pelvis was examined for evidence of recent ovulation and endometriosis. Peritoneal fluid and serum were assayed for 17 beta-estradiol and progesterone. The mean volume of peritoneal fluid and its concentration of 17 beta-estradiol and progesterone were 2.6 ml, 679 pmol/l and 64 nmol/l, respectively. No differences were observed between animals with or without either endometriosis or luteinized unruptured follicle syndrome. The peritoneal fluid and serum steroid levels were comparable to those found in women. The results presented are similar to those obtained in women with endometriosis and this suggests that the baboon can be used for the study of this disease.

Deeply infiltrating endometriosis can be defined as endometriosis infiltrating deeper than 5 mm under the peritoneal surface. Type I is a conical lesion suggested to be caused by infiltration; type II is mainly caused by retraction of the bowel over the lesion; type III is the most severe lesion suggested to be caused by adenomyosis externa. Severe cases are clinically apparent by nodularities in the pouch of Douglas, whereas mild and subtle forms of deep endometriosis are easily missed. Clinical examination during menstruation and scrutiny at laparoscopy for indurations, followed, preferably, by CO2-laser-excision are the key features for diagnosis and treatment. It is important to realize that depth of infiltration and lateral spread cannot be evaluated by laparoscopic inspection but only during excision, that CA125 concentration but not ultrasound or nuclear magnetic resonance can be helpful in the diagnosis, and that in the most severe cases medical pretreatment is advocated. Results of excision, as evaluated by disappearance of pain in some 80% of women, by a cumulative pregnancy of some 70% and a low recurrence rate, are excellent. The peritoneal fluid is thought to play a key role in the physiopathology of deep endometriosis which is considered to be endometriosis which has escaped from the influence of the peritoneal fluid. This concept is clinically important for the medical treatment of endometriosis, which is suggested to shrink deep lesions and to bring them back under peritoneal fluid control. A model of endometriosis is proposed and discussed. Subtle lesions are considered a natural condition occurring intermittently in all women, whereas we question whether mild endometriosis is a disease. In some women endometriosis has an aggressive behavior and develops into cystic ovarian endometriosis or into deeply infiltrating endometriosis. In this model subtle and mild forms would be called "endometriosis," whereas deep and cystic ovarian forms could be called "endometriotic disease." It is stressed that deep and cystic ovarian endometriosis are two distinct entities, which is important for our understanding of endometriosis, for classification and for treatment of endometriosis.

To the best of our knowledge this is the first prospective study in nonhuman primates of proven fertility in the wild, which compares fertility between animals with spontaneous minimal endometriosis and those with a normal pelvis. During 7 months 13 female baboons were exposed to males and all pregnancies were terminated by hysterotomy. A diagnostic laparoscopy was performed to assess the presence of pelvic endometriosis at the end of the fertility trial. Sixty-one percent of the baboons became pregnant at least once and the cycle fecundity was 21%. No obvious difference was found between baboons with (n = 7) and without endometriosis (n = 6) in either pregnancy rate (57 and 67%, respectively) or cycle fecundity (18 and 24%, respectively). These data suggest that in baboons with spontaneous minimal endometriosis the cycle fecundity is not grossly reduced.

Objective: The risks of a high intraabdominal pressure during laparoscopy are poorly documented. These aspects were studied in a relevant nonhuman primate model, the baboon (Papio anubis, Papio cynocephalus)., Study Design: The animals used were to be killed at the completion of a vaccine project. They were anesthetized and intubated but allowed to breathe spontaneously. In group 1 (n = 10) a fixed intraabdominal pressure (between 10 and 35 cm H2O [7 and 26 mm Hg]) was applied over 30 minutes. In group 2 (n = 7) the intraabdominal pressure was increased up to a maximum of 105 cm H2O (77 mm Hg). Blood vessels of the parietal peritoneum and omentum were systematically opened from 30 cm H2O (22 mm Hg) onward. Respiration and pulse rate were measured regularly, and the degree of respiratory distress was assessed. After death of the baboons a necropsy was carried out immediately to study the degree of lung atelectasis., Results: In group 1 the respiration rate increased and the heart rate decreased. At an intraabdominal pressure of > or = 30 cm H2O (22 mm Hg) moderate respiratory distress was seen after 20 minutes. In group 2 one animal had a bilateral pneumothorax at a pressure of 60 cm H2O (44 mm Hg) and died at 90 cm H2O (66 mm Hg). Severe respiratory distress was observed in the other six animals. Severe lung atelectasis was present in only one of the five primates with moderate respiratory distress of group 1 and in all baboons of group 2., Conclusion: An increase of intraabdominal pressure up to 105 cm H2O (77 mm Hg) combined with intraabdominal blood vessel injury is not lethal in most baboons.

To document the spontaneous evolution of endometriosis, a repeat laparoscopy was performed in 11 baboons after 10 and/or 12 months. The mean number of endometriotic lesions had increased significantly after 10 months (P less than 0.02) because of a high proportion of new lesions (82%). These implants were mainly subtle (67%) and localized on the uterine peritoneum (58%). Progression of endometriosis did not go beyond revised AFS stage I. Additionally, repeat laparoscopy in 10 baboons with an initially normal pelvis showed an endometriosis incidence of 70% after 10 to 12 months. Remodeling of the lesions was apparent in both groups after 12 months. These results suggest that endometriosis is moderately progressive in the baboon. It is possible that multiple laparoscopies could favor the development of endometriosis.

The histopathology of spontaneous endometriosis was studied on 20 pelvic implants biopsied at laparoscopy in 15 healthy baboons. Endometriosis was confirmed by histopathology in 10 of these animals (66%). Typical (n = 3) and subtle (n = 13) endometriotic lesions were confirmed by histopathology in 100 and 61%, respectively. Suspected disease-bearing lesions (n = 4) were confirmed in 50%. Implants could be classified as active (n = 5), inactive (n = 3), atrophic (n = 2) or stromal endometriosis (n = 3). The histological findings for typical and subtle implants were similar to those reported in humans.

A fetus developed extreme supraventricular tachycardia (210/min) after intravenous hexoprenaline 10 micrograms was administered to the mother for intrapartum fetal distress. Urgent caesarean section resulted in the birth of a male baby with a reduced Apgar score; the infant survived after being ventilated for 24 hours.

The prevalence of spontaneous endometriosis was investigated by laparoscopy in 52 baboons (Papio anubis and Papio cynocephalus) of proven fertility. Clinical endometriosis was diagnosed in 9 (17%) and 4 (8%) baboons with or without a previous hysterotomy, respectively. Endometriosis was confirmed by histology in 75% of these animals. The 37 endometriotic lesions were classified as typical (13%), subtle (57%), or suspicious (30%); and the percentage of histological confirmation was 100%, 61%, and 50%, respectively. Lesions were found on the uterosacral ligaments and in Douglas' pouch (46%), on the uterine peritoneum and the uterovesical fold (38%), and on uterine-omental adhesions (11%). Only 5% of the lesions were localized on the ovarian ligament, whereas ovarian endometriosis was not found. This study for the first time demonstrates that spontaneous endometriosis occurs in healthy baboons with proven fertility. It also shows that the laparoscopic appearances, the histological aspect, and the localization of the pelvic lesions are comparable to those found in women. We therefore conclude that the baboon is a good animal model for the study of endometriosis.

Two hundred newborns delivered after decelerative antenatal fetal heart rate tracings were divided retrospectively into two groups, one that was small for gestational age (SGA) and another that was appropriately grown for gestational age (AGA). Analysis of the tests showed a lower prevalence of good long term variability in the SGA group when compared with the AGA group. In addition, fetal heart rate accelerations occurred less frequently in the SGA group, even in the presence of good long term variability.