Biomedical subjects
Publications and source records attributed to M Blott.
Respiratory function was assessed serially in the first 16 months of life in an infant who was treated antenatally by thoracoamniotic shunting. Both compliance of the respiratory system and functional residual capacity were within the reference range constructed from healthy controls.
Two patients with severe oligohydramnios in the second trimester, one due to spontaneous membrane rupture at 18 weeks and the other, uteroplacental insufficiency from 22 weeks were prospectively followed. In both cases despite severe oligohydramnios fetal breathing movements persisted and although one infant delivered at 28 weeks developed respiratory distress syndrome and the second meconium aspiration syndrome neither had evidence of pulmonary hypoplasia. We conclude the presence of fetal breathing movements, despite oligohydramnios, may preserve lung growth, and may act as a predictor of favourable neonatal outcome.
The neonatal outcomes of 30 pregnancies that were complicated by premature and prolonged rupture of the membranes that had started in the second trimester of pregnancy, were reviewed. The neonatal mortality was 11 (36%), the main cause of death being pulmonary hypoplasia. Two infants died of sepsis, but these were the only proved episodes of maternal or fetal infection. Of the survivors, 27% developed compressive limb abnormalities, all of which responded to passive physiotherapy. Pulmonary hypoplasia was significantly associated with earlier onset of rupture of the membranes, and the absence of fetal breathing movements. Compressive limb abnormalities were significantly associated with longer periods of oligohydramnios. We conclude that premature rupture of the membranes, even with onset in the second trimester, may be associated with a favourable outcome and this may be predicted by the persistence of fetal breathing movements. We therefore, recommend expectant management of such pregnancies, but suggest elective delivery at 34 weeks to limit fetal exposure to uterine compression and minimise the risks of prematurity.
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Pleuroamniotic shunting was performed at 22-35 weeks' gestation in 11 fetuses with pleural effusions. Eight of the infants, born two to 16 weeks after shunting, had no evidence of pulmonary hypoplasia. Three died in the neonatal period; one because of pseudomonas septicemia, one because of pulmonary hypoplasia caused by an associated diaphragmatic hernia, and the third because of a major cardiac defect. Pleural effusions and their prenatal decompression offer an experimental human model for the study of the effect of intrathoracic compression on pulmonary development.
In 11 pregnancies complicated by oligohydramnios due to spontaneous rupture of the membranes in the second trimester of pregnancy fetal breathing movements were assessed regularly by ultrasonographic examinations. In the 6 cases in which fetal breathing movements were detected the babies were liveborn and there was no evidence of pulmonary hypoplasia or the other non-renal features of Potter's syndrome. In the other 5 cases there were no fetal breathing movements. 1 pregnancy was terminated electively, and 1 ended in an intrauterine death; the remaining 3 infants died in the neonatal period. All 5 cases showed necropsy evidence of pulmonary hypoplasia. These findings indicate that premature and prolonged rupture of membranes in the second trimester of pregnancy does not uniformly result in a poor prognosis. They suggest that fetal breathing movements could be used as a predictor of favourable neonatal outcome.
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