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Ectopic pregnancy is not recognized in 5523% of all cases using state-of-the-art diagnostic procedures. In this study, blood flow in tubal arteries was measured using a transvaginal duplex Doppler ultrasonography system. A 3.5 MHz Doppler transducer coupled to a 5 MHz imaging transvaginal sector probe was used to depict flow characteristics in the tubal branch of the uterine artery. This was performed in 102 patients. There was a significant increase in the blood flow on the tubal gestation side (p < 0.0001; z = -4.08). This between-side difference was determined using qualitative frequency shift analysis. The mean reduction in the resistance index on the side with the ectopic pregnancy as compared to the contralateral side was 15.6%. These changes appear to be due to trophoblast invasion. Between-side differences showed no dependence on gestational age (between gestational weeks 4 and 12 postmenstruation). We compared these data with those from three control groups ('early viable intrauterine pregnancy', 'early intrauterine pregnancy failure', 'non-gravid state'). In all these control groups, the impedance to flow, expressed as 'resistance index', showed no significant between-side difference. All control groups had significantly higher mean resistance index values than the ectopic pregnancy side, but did not differ from the contralateral side of the ectopic pregnancy group. The advantages of this new method in diagnosing ectopic pregnancy are early detection, non-invasivity, and immediate results.

Objective: The aims of this investigation were to measure corticotropin-releasing hormone (CRH), corticotropin (ACTH) and cortisol before, during and after delivery searching for an endocrine intercorrelation of the hypothalamic-pituitary-adrenal (HPA) axis and to correlate these findings with obstetrical variables. Methods: Blood was sampled from 50 women with singleton pregnancies at term without uterine contractions, during delivery (after full cervical dilatation) and on the 4th postnatal day. Hormones were measured by radioimmunoassay (RIA). The correlation between obstetric variables, sociodemographic and endocrine data were evaluated using the Spearman rank coefficient. Group comparisons for continuous variables were calculated using the Mann-Whitney U test and Kruskal-Wallis test. Results: Maternal plasma ACTH and cortisol increased significantly during labor, declining toward the 4th postnatal day (p < 0.001) and showing a significant intercorrelation (p < 0.01). Compared to women without uterine contractions CRH rose during labor (p < 0.05) and decreased rapidly to the 4th postnatal day (p < 0.001). No correlations between CRH and ACTH or cortisol were observed. None of the obstetrical variables (parity, newborn’s weight, duration of delivery) revealed any significant correlation with ACTH. Analgetic medication (pethidine hydrochloride) was not able to influence the endocrine response to labor stress. Conclusions: Stressful experience during childbirth has an impact on endocrine response. However, this is not fully evident along the HPA axis in a simple biological model with monocausal dependencies. This ‘biological stress model’ is not sensitive enough to detect different childbirth conditions and the hormones in the maternal compartment have partially fetal (placental) origin.

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The tumour and cytoskeleton protein tissue polypeptide antigen (TPA) was determined in maternal serum taken during the second stage of labour and on the 4th postpartum day. Pregnant women at term (weeks 38–42) served as a control group. TPA levels of women during parturition (median 169 U/l) were higher than those of the control group (median 108.5 U/l) and those of women on the 4th postpartum day (median 66.5 U/l); p < 0.0001 in each case. The correlation between duration of labour and TPA concentration was positive and significant (r_s = 0.3; p = 0.03). A significant negative correlation was found between placental weight and maternal serum TPA levels during parturition (rs = ––0.3; p = 0.03). The decline of TPA after delivery indicated a serum half-life for TPA of less than 4 days.