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Biomedical subjects

B Arabin

Publications and source records attributed to B Arabin.

At least 37 records · Page 2Linked to original sources
PubMed1997

Nicotine and caffeine. Influence on prenatal hemodynamics and behavior in early twin pregnancy.

OBJECTIVE: To evaluate the effect of nicotine and caffeine in early multiple pregnancies. STUDY DESIGN: Ten women with twin pregnancies volunteered to take part in the study. Five mothers smoking > 5 cigarettes/d were investigated before and after smoking. Five women were investigated before and after drinking coffee. Maternal hemodynamics, umbilical blood flow, fetal heart rate and twin behavior were longitudinally documented during a 30-minute session from 8 to 16 gestational weeks. Fetal behavior was analyzed from videotapes using a one-minute window. RESULTS: The mean increase in maternal heart rate after smoking was 10 bpm (P < .005). After drinking coffee, it was 8 bpm (P < .01). The pulsatility index of the umbilical artery showed a significant increase after smoking (P < .01). After coffee the increase was also significant (P < .05). Two of five behavioral parameters (swallowing and breathing) demonstrated significant changes after the consumption of coffee (P < .001). CONCLUSION: This pilot study demonstrated significant effects of nicotine and caffeine consumption on maternal and fetal hemodynamics. It seems worthwhile to study the influences of smoking and coffee consumption on early twin behavior in larger samples.

Adult↗
PubMed1996

The onset of inter-human contacts: longitudinal ultrasound observations in early twin pregnancies.

Twin pregnancies provide us with the opportunity to observe first reactions towards touch in utero, and this study illustrates the onset and development of these contacts. Forty women with twin pregnancies volunteered to take part in this study, 25 of whom (five monochorionic, 20 dichorionic pairs) fulfilled the inclusion criteria. Between 8 and 12 weeks' gestation, ultrasound examinations were performed transvaginally, and from 13 weeks onwards transabdominally, at weekly intervals. Ultrasound findings were recorded on videotapes and were analyzed retrospectively. The first contacts producing reactions in the co-twin were defined as primary contacts, which could be slow or fast arm/leg/head/body contacts. Primary contacts followed an action-reaction model, and usually lasted < 3 s. These contacts were initially slow and then became fast. The first reactions of the co-twin towards touch were observed at 65 postmenstrual days. Contacts of longer duration between both bodies including extremities, or contacts initiated by sucking movements towards the co-twin were defined as complex contacts and were observed from 85 and 92 post-menstrual days, respectively. Nearly all contacts occurred significantly earlier in monochorionic compared to dichorionic twins. Female/female pairs seemed to develop complex body contacts earlier than male/male pairs, but for the onset of other contacts we have not yet found significant differences between gender combinations.

Age of Onset↗
PubMed1996

Fetal death of one twin in a monochorionic pregnancy with twin-twin transfusion syndrome.

BACKGROUND: Twin-twin transfusion syndrome (TTTS) occurs in 5-30% of all monochorionic pregnancies. The mortality and morbidity rates are high and therapeutic options limited. CASE: TTTS in a monochorionic twin pregnancy was initially diagnosed by differences in amniotic fluid volume at 26 weeks. No signs of atrioventricular valve insufficiency or nonimmune hydrops fetalis were present in the recipient. Despite this, the recipient died in utero, whereupon the condition of the donor improved markedly. After spontaneous delivery at 30 weeks' gestation, coarctation of the umbilical cord at its insertion was observed in the recipient, probably secondary to severe torsion. CONCLUSION: Unexpected obstetric events may occur in already-complicated pregnancies that are not related to a specific condition, its diagnosis or its therapy.

Adult↗
PubMed1995

[Fetal macrosomy and hydramnios. Intrauterine symptoms of a combination of Sturge-Weber-Krabbe- and Klippel-Trenaunay syndrome].

The authors report on a case where the Klippel-Trenaunay symptom complex was combined with a Sturge-Weber-Krabbe syndrome, which, however, was only noticeable during pregnancy by fetal macrosomy and hydramnios. The child was delivered on term by Caesarean section and presented no paediatric problems; however, during the first few years of its life mental retardation became clearly evident.

Adult↗
PubMed1995

From biochemical to biophysical placental function tests in fetal surveillance.

Radioimmunoassays of human placental lactogen and estriol levels in the maternal plasma, ultrasound biometry of the abdominal diameter (AD), pulsed Doppler measurements of uteroplacental arteries, the common carotid artery (CCA), and the umbilical artery (UA) and fetal heart rate monitoring were simultaneously performed in 219 risk pregnancies from 26 weeks' onward at regular intervals. The prognostic value of all tests to predict small for gestational age infants (SGA) and fetal distress was evaluated simultaneously. Receiver operator characteristic allowed the simultaneous comparison of all methods: The AD was most predictive for early detection of SGA, even more than uteroplacental blood flow. Fetal blood flow redistribution expressed as a ratio of the resistance index of CCA/UA was the most significant test for detection of fetal distress later in pregnancy, even more than antenatal cardiotocography. Considering cutoff levels used in clinical routine, the sensitivity and specificity of the fetal AD in detecting intrauterine growth retardation more than 28 days before birth, were 71 and 81%, respectively. Pulsed Doppler measurements of CCA/UA less than 7 days before the delivery had a sensitivity and specificity of 83 and 90%, respectively. Our results demonstrate the historical change in fetal surveillance within one study group: If accurate routine ultrasound is available, the use of biochemical placental function tests is not justified, a procedure that is already accepted in nearly all perinatal centers. Fetal cerebral versus umbilical blood flow measurements should be applied as a tool to measure fetal blood flow redistribution in small fetuses to predict most precisely the risk for poor outcome and perinatal hypoxia.

Estriol↗
PubMed1995

Correlation of surfactant phosphatidylcholine synthesis and 11 beta-hydroxysteroid dehydrogenase in the fetal lung.

Glucocorticosteroids (GCS) are prerequisite for the induction of surfactant synthesis in the fetal lung. The 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD) regulates the intracellular concentration of biologically active GCS. In this study we demonstrate the correlation of 11 beta-HSD activity and the GCS-induced surfactant phosphatidylcholine synthesis in organoid cultures of fetal rat lung. In the first series of experiments, [3H]corticosterone (CORT) or [3H]11-dehydrocorticosterone (11-DHC) were added to lung organoid cultures to test 11 beta-HSD activity. We found a low oxidative and a high reductive conversion indicating that in intact cells the equilibrium tends to biologically active GCS. However, in homogenized organoid cultures oxidative outweighed reductive activity. Secondly, the phosphatidylcholine synthesis of organoid cultures was enhanced by preincubation with GCS. CORT, as well as the hormonally inactive 11-DHC, increased the incorporation of [14C]choline into phosphatidylcholine. The effect of the latter was completely inhibited by glycyrrhetinic acid (inhibitor of 11 beta-HSD) indicating that it is caused by a previous conversion of 11-DHC into CORT via 11 beta-HSD. Thirdly, preincubation with GCS also altered 11 beta-HSD activity: dexamethasone or CORT both decreased the oxidative and increased the reductive activity in intact cells, indicating that glucocorticoids increase the rate of their own activation by positive feedback.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed1994

[Prenatal determination of lung maturity from amniotic fluid--indications and new methods].

Although fetal lung maturity determination is carried out more and more rarely in the German-speaking area, a reliable information about the degree of lung maturity is still very important in the care of high-risk pregnancies. The side effects and costs of a postpartal surfactant administration can be avoided if lung maturity is proved. Indications for determination of fetal lung maturity are the threatening preterm delivery and the premature rupture of membranes before the 34th week of gestation and uncertain gestational age. Furthermore, in preeclampsia resp. in diabetes mellitus, which is difficult to control, premature delivery may be necessary. To improve lung maturity testing we introduce a new "sequence scheme" containing three lung maturity tests which are easy to carry out (in the following sequence: Amniostat-FLM ultrasensitive, counting of the lamellar bodies in amniotic fluid, surfactant/albumin ratio with TDx-FLM). The principle of this scheme is, that if any of these three tests indicates lung maturity, the sequence is terminated and no further test is performed. Only if all three tests indicated immaturity, the child was at risk for RDS. In 87 amniotic fluid samples with 7 RDS-cases, we achieved high predictive values for lung maturity (specificity 90%, sensitivity 100%, predictive value of positive test 47%, predictive value of negative test 100%). In 62% only one test was needed for lung maturity determination. It is possible to use other combinations in such a scheme (e.g. the L/S ratio). This might lead to equal or perhaps better results. An advantage of this suggested "sequence scheme" is that it can be performed in any clinic.

Amniocentesis↗
PubMed1993

Evaluation of the fetal assessment score in pregnancies at risk for intrauterine hypoxia.

OBJECTIVE: Our purpose was to define the diagnostic value of a new fetal assessment score that is based on each of the components of the Apgar score. STUDY DESIGN: A fetal assessment score was established to study the main fetal vital functions: (1) cardiovascular (heart rate, color of the skin in the Apgar score), now based on fetal heart rate patterns and Doppler assessment of fetal blood flow redistribution, (2) fetal respiratory (quality of breathing in the Apgar score), now based on Doppler assessment of uteroplacental perfusion, and (3) neuromuscular function (tone and reflexes in the Apgar score), now based on fetal tone and response to external stimuli. The fetal assessment score was used in the study of 110 postdate pregnancies and 103 small-for-gestational-age infants and was compared with the traditional biophysical profile score in the prediction of perinatal outcome. RESULTS: There were significant associations between both the fetal assessment score and the biophysical profile score with fetal distress that necessitated operative delivery, low Apgar scores, and low umbilical cord arterial blood pH. However, receiver-operator characteristic plots demonstrated that the fetal assessment score was superior to the biophysical profile score in predicting fetal distress and low Apgar values particularly in the small-for-gestational-age infants. The best single parameters in predicting fetal distress were the amniotic fluid volume in the biophysical profile score and fetal heart rate patterns and pulsed Doppler measurements in the new score. CONCLUSION: A fetal Apgar score in which respiration is assessed by placental perfusion rather than chest movements and in which skin color is assessed by centralization of fetal blood flow may be better than the traditional biophysical profile score in predicting fetal hypoxic compromise.

Apgar Score↗
PubMed1993

[Systematic antepartum fetal evaluation ("Safe"). A concept for diagnosis of fetal function in threatened hypoxia].

TARGET: The significant aim of the study was to prove whether it makes sense to apply the classical approach of diagnostic procedures to the fetus. PATIENTS AND METHODS: In a group of a total of 534 singleton pregnancies we examined the value of various biochemical and biophysical tests for detecting the risk of perinatal hypoxia. The sequence and combination of the most decisive tests was considered as well as the different approach within the observation period. RESULTS: Maternal laboratory findings like HPL and E3 were significantly less predictive of growth disturbance and compromise than any biophysical test. A small fetal abdomen detected by ultrasound ("observation") is up to now the earliest and most reliable predictor of foetal growth disturbance, followed by Doppler measurements of the uteroplacental circulation ("examination of the chronic respiratory function"). Examination of the foetal heart-circulatory function with pulsed Doppler and the foetal cardiac frequency (CTG) are the procedures of choice to determine the risk of perinatal hypoxia following pre-selection of foetuses, which are too old or too thin. In these patients, additional stress tests have neither medical nor a diagnostic advantage compared to the published function tests. Amongst the variety of biophysical tests, the Apgar score ("fetal Apgar score") was superior to all other tests in predicting prenatal or perinatal hypoxia and might even prevent invasive procedures. CONCLUSION: The sequence from non-invasive biophysical tests, including the fetal Apgar score, to invasive procedures is recommended for screening and follow-up of preselected pregnancies at risk for perinatal hypoxia. This approach might be applied to other risk groups and will hopefully be supplemented by new noninvasive diagnostic tools allowing early prognosis and prevention of fetal and neonatal disease.

Asphyxia Neonatorum↗
PubMed1993

Registration of fetal behaviour in multiple pregnancy.

Multiple pregnancies require intensive monitoring of the fetal condition, in particular during the last months of pregnancy. Recording fetal behaviour offers a possibility of investigating the neuromotor development, in twin pregnancies even behavioural patterns of fetuses of the same gestational age and "environment" may be compared. In 25 primarily uncomplicated twin pregnancies we simultaneously recorded antepartum FHR and FM patterns in twins younger than 36 completed gestational weeks over a period of at least one hour via a new device for simultaneous registration of FM and FHR in twin pregnancies. According to our longitudinal observations we have defined a special terminology for comparing the behaviour of twins considering gestational age, differences of FHR or FM patterns and the continuity of these patterns throughout gestation. To our opinion this will open a new field not only for clinical diagnostics in complicated twin pregnancies but also for developmental research of the possible impact on the further neurological development of multiple fetuses. Human behaviour in its early stage may be compared considering even "interfetal communication".

Embryonic and Fetal Development↗
PubMed1992

Comparison of the prognostic value of pulsed Doppler blood flow parameters to predict SGA and fetal distress.

A total of 219 women with complicated pregnancies had Doppler assessment of uteroplacental arteries, the umbilical artery, the fetal common carotid artery and the descending thoracic aorta to determine the prognostic value of Doppler examinations to predict the birth of a small-for-gestational-age (SGA) infant with or without fetal distress. Preliminary reproducibility studies showed that the resistance index, pulsatility index and intensity weighted flow velocity had the lowest coefficients of variation. Data on the systolic/diastolic ratio and mean blood flow volume were, therefore, not considered for further evaluation. Measurements were classified according to the time interval of the examination to the delivery of the baby according to the following groupings: 0-14 days, 15-28 days and 29-42 days. For evaluation of the SGA fetus complicated by fetal distress, only measurements within 2 weeks of delivery were analyzed. Significant differences were calculated by considering the area below the receiver operator characteristic (ROC) curves. Only Doppler studies of the uteroplacental arteries (mainly resistance index) were predictive of the later development of the SGA fetus. All fetal parameters showed an increasing improvement in the predictive capacity for an SGA infant, the closer the measurements were made to the time of delivery. This improvement was not observed for uteroplacental vessels. The resistance index of the uteroplacental vessels was significantly higher in SGA pregnancies complicated by fetal distress compared to SGA pregnancies alone. However, ROC analysis revealed that fetal Doppler velocimetry was more strongly related to fetal distress than SGA only. The single best fetal parameter was the mean velocity in the fetal descending thoracic aorta but the velocity ratio of the fetal common carotid artery over the fetal descending thoracic aorta had the highest predictive capacity for the SGA pregnancy complicated by fetal distress.

Journal Article↗
PubMed1992

Actocardiotocographic monitoring of triplets during vaginal delivery.

A case is reported in which fetal monitoring during vaginal delivery of triplets was performed with the MT 430 actocardiotocograph. This method provides optimal monitoring of multiple pregnancies because the fetal heart rate tracings of three fetuses, together with recordings of fetal movements and uterine contractions, can be visualized on one display.

Adult↗
PubMed1992

[Cephalic index: a neglected parameter of standard fetal biometry].

From 1.1.1990 to 15.3.1991, in 1074 women between the 13th and 40th weeks of pregnancy, the biparietal diameter (BIP), fronto-occipital diameter (FOD) and kephalic index (KI = BIP/FOD) were measured. The median of the kephalic index varied between 0.81 and 0.84 during different pregnancy weeks, with a range between 0.67 and 1.00. Correction to normokephaly (KI = 0.84) produced differences of up to 10 mm to measured values of BIP. We believe it necessary to determine the kephalic index in each kephalometry and to correct the measured value of BIP at least in those cases where the measured kephalic index differs significantly from normokephaly (KI = 0.84).

Female↗
PubMed1992

An attempt to quantify characteristics of behavioral states.

In order to describe fetal behavior in detail, 44 pregnant women were examined longitudinally between 34/0 to 42/0 gestational weeks; the traces of 38 fetuses were included for further analysis. We used two ultrasound scanners and an actocardiography and registered the number and duration of fetal head, trunk, limb, breathing, and eye movements (FEM) as well as the fetal heart rate (FHR). Data were recorded on polygraphic tracings and analyzed off-line via a 1-minute moving window. Percentile ranges were calculated throughout the observation period. Four primary behavioral states were analyzed according to Nijhuis et al. but state 3F could be neglected in our data. FHR variability, slow and rapid FEM, and the number of movements were most significant in differentiating between states 1F, 2F, and 4F. By considering percentile values of single parameters, the differentiation of states, a computer analysis, and the recognition of compromised fetuses might be facilitated.

Behavior↗
PubMed1992

Relationship of utero- and fetoplacental blood flow velocity wave forms with pathomorphological placental findings.

Pulsed Doppler examinations were performed in 143 risk pregnancies. The resistance index (RI) values of the uteroplacental vessels and umbilical artery on the last examination before delivery were correlated to specific patterns of morphological placental findings. The sensitivity and specificity of Doppler blood flow velocity wave forms to predict placental disease as well as the significant relationships were calculated. Impaired uteroplacental perfusion is correlated with: disturbances in growth, such as reduced weight and reduced basal area (p < 0.005, p < 0.05); disturbances in villous maturation, such as prematurity or a reduction in intermediate sized villi (p < 0.05, p < 0.01), and circulation disorders, such as acute or chronic infarcts (p < 0.05), villous fibrosis (p < 0.005) or microfibrin deposits (p < 0.05). Villous immaturity was not correlated to either pathological utero- or fetoplacental blood flow. Except for acute infarcts, all these findings as well as endangiopathy of truncal arteries are also combined with high RI values in umbilical arteries (p < 0.005) possibly reflecting the 'down-stream impedance' of the fetoplacental circulation.

Blood Flow Velocity↗
PubMed1992

Prediction of RDS by amniotic fluid analysis: a comparison of the prognostic value of traditional and recent methods.

The determination of lecithin or even more the lecithin/sphingomyelin (L/S) ratio in amniotic fluid are both well established in the prediction of neonatal RDS. The immunological measurement of phosphatidylglycerol (PG) and the determination of the surfactant/albumin (S/A) ratio by fluorescence polarization (TDx FLMR) have recently been introduced for the detection of fetal lung maturity. In order to compare traditional versus recent methods L/S ratio and PG determination by one dimensional thin-layer chromatography, enzymatic analysis of lecithin, immunological determination of PG by Amniostat-FLMR and the fluorescence polarization of S/A-ratio by the TDx FLMR were all performed in 141 amniotic fluid samples of 122 patients. Only one out of 72 samples was false negative in the enzymatic lecithin determination (sensitivity 88%). All other methods have a sensitivity and a negative predictive value of 100%. The positive predictive values and the specificity varied between 22%-50% and 58%-87% respectively. The false positive rate, which is high for all methods, is lowest for the L/S ratio. This study demonstrates, that the recent methods are reasonable alternatives in all cases with a positive test. In clinical practice they have the advantage, that the result can be obtained in 15 minutes. If the test is predictive for lung immaturity the L/S ratio should be performed in addition to decrease the false positive rate before any clinical decision is made.

Albumins↗