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PubMedDate not supplied

Perinatal listeriosis: report of an outbreak.

From April to August, 1981, 15 cases of perinatal listeriosis were seen in Halifax, Nova Scotia, Canada. Nine of the 15 mothers presented with 'flu-like' symptoms, 3 had symptoms of an upper respiratory infection and 2 a history of fever alone. During labor 11 mothers had fevers greater than 38 degrees C and 9 had stained amniotic fluid. Twelve delivered prematurely. Among the 15 infants the most common clinical features were perinatal depression, respiratory distress, fever, hematologic abnormalities and rash. There were 7 deaths (case fatality rate of 46.7%). A transplacental route of infection for the fetus was suggested by the signs of systemic illness in most mothers, the lack of positive maternal vaginal cultures and evidence of chorioamnionitis, premature labor, severe fetal disease and intrauterine death prior to membrane rupture. The delivery of healthy infants to two mothers who had received antepartum treatment for listeriosis suggests that earlier recognition and treatment of maternal disease will improve perinatal outcome.

Disease Outbreaks↗
PubMed1978

Models of congenital heart disease in fetal lambs.

Intracardiac flow patterns were chronically altered by partially obstructing left ventricular (LV) inflow or outflow in midgestational fetal lambs. Physiological measurements of the fetal circulation were made serially through indwelling catheters and the use of radioactive microspheres. With LV inflow obstruction, mean LV output (LVO) decreased to 30% of control (P less than 0.01). Within seven days, the LV/right ventricular (RV) weight ratio decreased to 70% of control (P less than 0.01), and the mean LV/RV chamber volume decreased to less than one-half of control (P less than 0.001), simulating an early form of the hypoplastic left heart syndrome. With LV outflow obstruction, mean LVO decreased to 64% of control (P less than 0.05). Mean LV/RV wall thickness doubled (P less than 0.0001) and mean LF/RV chamber volume decreased to less than one-half of control (P less than 0.0001). Within four to ten days after increasing LV afterload, a large increase in LV mass occurred, which was demonstrated by morphometric analysis to be due to hyperplasia of ventricular myocytes. LV chamber volume decreased somewhat, simulating moderately severe congenital aortic stenosis. Over the long term (30--36 days), the mean LV/RV weight ratio decreased and the LV chamber was nearly obliterated, simulating very severe congenital aortic stenosis. The results suggest that by varying preload and afterload in both ventricles of the fetus, various forms of congenital heart disease may be simulated.

Animals↗
PubMed1996

Prenatal ultrasonographic assessment of the ductus venosus: a review.

OBJECTIVE: To review current data pertaining to prenatal ultrasonography of the ductus venosus. DATA SOURCES: We identified English-language studies regarding prenatal ultrasonography and the fetal ductus venosus. The studies were obtained from a MEDLINE search for the period 1966 through March 1996. Additional sources were identified through cross-referencing. METHODS OF STUDY SELECTION: We reviewed all published reports, case studies, and articles regarding ultrasonographic morphology, physiology, and pathophysiology of the fetal ductus venosus. TABULATION, INTEGRATION, AND RESULTS: Knowledge of the function of the fetal ductus venosus in both normal and abnormal fetal conditions is increased by prenatal ultrasonographic data. Altered ductus venosus hemodynamics may be noted in various medical conditions that include fetal growth restriction, twin-twin transfusion, invasive diagnostic procedures (chorionic villus sampling and fetal blood sampling), fetal anemia and transfusion, complex cardiac structural anomalies, and cardiac arrhythmias. CONCLUSION: Blood flow velocity in the fetal ductus venosus reflects the pressure gradient between the umbilical vein and the cardiac atria. Knowledge of pathophysiologic hemodynamic changes of blood flow in this vessel obtainable by prenatal ultrasonography in conjunction with fetal disease may assist diagnosis and management.

Blood Flow Velocity↗
PubMed1979

An immunoradiometric assay for procoagulant factor VIII antigen: results in haemophilia, von Willebrand's disease and fetal plasma and serum.

An immunoradiometric assay (IRMA) has been developed based on the inhibitor which arose in a polytransfused severe haemophiliac. The two-site IRMA measures antigens closely associated with the procoagulant parts of the factor VIII complex, which are termed FVIIC antigens or FVIIICAG. FVIIICAG was present in normal plasma and also, at a slightly lower concentration, in normal serum. In 37 patients with haemophilia A, 36 had FVIIICAG levels of less than 10% of the normal plasma pool. In patients with von Willebrand's disease the levels of FVIIIC and FVIIICAG were in good agreement, both before and after treatment with cryoprecipitate or DDAVP. FVIIICAG was relatively stable in plasma at 37 degrees C and could also be detected in cord and fetal serum. The assay is of potential value for detecting reduced levels of factor VIII, for carrier detection and for the prenatal diagnosis of haemophilia.

Antigens↗
PubMed1988

Artificial instillation of amniotic fluid as a new technique for the diagnostic evaluation of cases of oligohydramnios.

In cases of severe oligohydramnios, sonographic diagnosis is hampered by poor visibility and by increased fetal flexion. Therefore, 74 artificial instillations of amniotic fluid were performed in 50 pregnancies by sonographic guidance. Fetal diseases included Potter's syndrome, obstructive uropathy, cystic kidneys (20 cases); Meckel's syndrome, C. de Lange syndrome, cytomegaly fetopathy (1 case each); VATER association (2 cases); triploidy (5 cases); severe intrauterine growth retardation (8 cases); and premature rupture of membranes (12 cases). By improved sonographic visibility and the observation of fetal behaviour (drinking, filling of stomach and bladder, voiding of bladder after artificial instillation of amniotic fluid), the fetal anatomy could be studied more accurately, malformations could be identified or excluded, and bladder function could be examined. Thus, differentiation between fetuses without functioning kidneys and those with severe intrauterine growth retardation becomes possible. Further, re-aspiration on the day following instillation permitted determination of the karyotype. Finally, the artificial instillation of amniotic fluid is a hazardous intervention (rupture of membranes, labour) and should be reserved only for a small number of selected cases with diagnostically unclear oligohydramnios. For these cases, it seems to be the method of choice permitting a variety of diagnostic information to be obtained.

Administration, Intravaginal↗
PubMed1995

Antepartum fetal surveillance.

In recent years the advances in prenatal diagnosis of fetal asphyxia have been dramatic and increasing at a remarkable pace. Now that a solid base of multivariable testing has been accepted as the method of choice for assessment of fetal health, the focus of clinical research has shifted towards identification of factors and signs that might predict not only risk of death and immediate morbid outcome but also the quality of life after delivery. The papers reviewed here outline the scope of the problem of cerebral palsy and offer clues as to how fetal disease may become manifest as child or adult sustained neurological injury. Concurrently, the advances in refinement of the testing methods are reviewed. Clearly a better understanding of the etiology, physiology, and range of fetal responses to asphyxia will be the key to effecting not only better survival rates but also a higher quality of survival.

Cerebral Palsy↗
PubMed1998

Immunolocalization of OV-6, a putative progenitor cell marker in human fetal and diseased pediatric liver.

The existence of progenitor (stem) cells in the human liver remains a matter of debate. In rodent models of hepatocarcinogenesis and injury, oval cells proliferate in the periportal regions of the portal tracts and are suggested to derive from a stem cell compartment, because they are capable of differentiating into hepatocytes or biliary epithelial cells. In this study, the rat oval cell marker, OV-6 has been used to investigate the hypothesis that there are stem cells present in fetal and pediatric human liver. The pattern of OV-6 expression was compared with the established adult biliary cell markers human epithelial antigen-125 (HEA-125) and cytokeratin-19 (CK-19). In normal pediatric liver (n = 7), bile ducts and ductules were immunostained with CK-19 and HEA-125, whereas OV-6 staining was consistently negative. In fetal tissue (n = 10), ductal plate cells, primitive bile ducts, and hepatoblasts were stained with CK-19 and HEA-125 although only some of the ductal plate cells and hepatoblasts were OV-6 positive. In biliary atresia (n = 6) and 1, anti-trypsin deficiency (1,AT) (n = 4), CK-19 and HEA-125 immunostained ductular proliferative cells that tended to form finely anastomosing ductules, whereas OV-6 staining was found more on discrete cells confined to portal tract margins. Additionally, in diseased liver, OV-6 was strongly positive in hepatocyte lobules with greatest intensity in the periseptal regions. This widespread hepatocyte OV-6 positivity suggests that the antibody may identify cells of a less differentiated phenotype (transitional hepatocytes) that have replaced the mature cells. Therefore, it is proposed that in human liver, OV-6 is recognizing cells with a progenitor stem cell-like phenotype with the capacity to differentiate into OV-6 positive ductular cells or lobular hepatocytes.

Adult↗
PubMed1986

Fetal heart rate characteristics that provide confidence in the diagnosis of fetal well-being.

Fetal heart rate monitoring was first used as a clinical tool for the assessment of fetal danger and well-being. In the past decade, basic research has demonstrated the physiologic events associated with most heart rate changes. This review has demonstrated that study and semiquantification of the five analyzable features of an FHR recording can provide a strong reassurance of fetal health. The method has not proven as predictable for defining fetal disease, so additional parameters are needed to define clearly the significance of an abnormal FHR tracing.

Apgar Score↗
PubMed1990

Model study of placental water transfer and causes of fetal water disease in sheep.

The purpose of the computer simulation was to use experimentally measured parameters of placental water transfer to compute conceptual water acquisition during the last third of ovine pregnancy and to evaluate the possible role of each of these parameters in the pathophysiology of polyhydramnios. Total conceptual water at birth was almost insensitive to the value of the placental filtration coefficient. It was more sensitive to fetal and maternal placental blood flows, the concentrations of actively transported or metabolically produced solutes in fetal plasma (bicarbonate, fructose, alpha-amino acids, urea, lactate), and the hydrostatic pressure difference across the placental barrier. It was quite sensitive to the NaCl reflection coefficient and permeability. We conclude that the actively transported or produced solutes in fetal plasma constitute a primary driving force. The opposing diffusion gradient of NaCl, and to a much lesser extent that of glucose, are essential to restrain the process. The causes of polyhydramnios in this species are, in order of probability, an increase in the placental diffusion permeability of NaCl, a decrease in the placental reflection coefficient for NaCl, or an increase in the concentration of an osmotically effective solute in fetal plasma, by active transport or metabolic production.

Animals↗
PubMed2006

Teratomas of the neck and mediastinum in children.

This retrospective study reviews a series of teratomas of the neck and mediastinum aiming at defining the features of these particular locations. We recorded prenatal diagnosis, perinatal management, clinical and radiologic features, pathology, surgical strategies and results in cervical and mediastinal teratomas treated over the last 10 years. During this period we treated 66 children with teratoma of which 11 (6 male and 5 female) had cervicomediastinal locations. Five babies had cervical teratomas extended into the anterior mediastinum in two cases. Prenatal diagnosis was made in three (two with polyhydramnios). Four babies were born by C-section and only one had a successful EXIT procedure. The diagnosis was confirmed by imaging and increased AFP. Surgical treatment involved total tumor removal and in one case subsequent removal of lymph node metastases. All children survived except one in whom airway could not be cleared at birth. Two children bear mild hypothyroidism. During the same period six patients aged 0-17 years were treated for mediastinal teratoma. Only one was prenatally diagnosed and only two had some dyspnea. Removal was performed either by median sternotomy, thoracotomy, or thoracoscopy. They all survive and are free of disease. Teratomas of the neck may cause fetal disease and unmanageable neonatal airway obstruction. Prenatal diagnosis and planned multidisciplinary management are mandatory at birth. In contrast, only some mediastinal tumors cause respiratory embarrassment. Although benign, these tumors are sometimes immature and may metastasize to regional lymph nodes. Total surgical removal is curative. Thyroid insufficiency may be present at birth in cervical teratomas and may be aggravated by surgery.

Adolescent↗
PubMed1999

Evolution and long term outcome in cases with fetal diagnosis of congenital heart disease: Italian multicentre study. Fetal Cardiology Study Group of the Italian Society of Pediatric Cardiology.

OBJECTIVES: To analyse the evolution and outcome in utero and after birth of infants with a fetal diagnosis of congenital heart disease. DESIGN: Inclusion criteria were the fetal diagnosis of congenital heart disease, confirmed postnatally or postmortem, and a complete follow up in utero and after birth. SETTING: 20 centres operating prenatal echocardiographic screening. PATIENTS: 847 cases were included in the study. Gestational age at diagnosis ranged from 15-39 weeks; in 370 cases (43.7%) the diagnosis was made before 24 weeks' gestation. RESULTS: 245/847 cases (28.9%) were terminated during pregnancy, 227 following early diagnosis; 128/245 cases (52. 2%) had associated anomalies and 117/245 (47.8%) had serious congenital heart disease. Of the remaining 602 cases that continued the pregnancy, 72 (11.9%) died in utero, 259 (43%) died postnatally (83 after surgery or invasive procedures), and 271 infants (45%) survived and presently range in age from 18 months to 13 years old. The mortality rate was higher in cases with associated extracardiac or chromosomal anomalies (68% and 74% of cases continuing pregnancy, respectively), and in cases with heart failure and complex cardiac defects. CONCLUSIONS: The data confirm a relevant fetal and postnatal loss in cases with complex congenital heart disease, and major clinical use of prenatal diagnosis in the management of ductus dependent anomalies. Negative prognostic factors for the outcome were associated anomalies and heart failure.

Abortion, Therapeutic↗