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PubMed1976

Amniotic fluid tests for fetal maturity in normal and abnormal pregnancies.

Amniotic fluid creatinine, percentage of lipid-positive cells, and L/S ratio were determined on 285 samples from normal pregnancies and 222 samples from abnormal pregnancy states (Rh isoimmunization, diabetes, hypertensive disorders, intrauterine growth retardation, and hydramnios). In normal pregnancy the coefficient of correlation between true gestational age and estimated period of gestation (EPG) based on the three parameters was 0.94, in Rh isoimmunization 0.77, in diabetes 0.67, and in hypertensive disorders 0.59. In intrauterine growth retardation both the L/S ratio and creatinine were depressed, the coefficient was 0.61, and the EPG was consistently less than the true gestational age. The mean L/S ratio in pre-eclampsia was slightly below the normal mean and in diabetes the mean L/S ratio was also depressed. In 150 samples taken within 48 hours of delivery L/S ratios were accurate in assessing fetal pulmonary maturity although there was a 20 per cent incidence over all of false-immature values. There were no false-mature values except in diabetes (2/9).

Amniotic Fluid↗
PubMed1976

Recognition of the hydropic fetus by gray scale ultrasound.

The use of gray scale B mode provides more effective visualization for sonographic evaluation of fetal ascities. Two cases of severely Rh isoimmunized fetuses with hydrops and one fetus with hydrops secondary to chylous ascites are presented to show the ultrasonic features of diagnosis of fetal edema and ascities. Thus, ultrasonic evaluation in known cases of Rh isoimmunization or diabetes provides additional information on the status of the fetus in utero and rapid recognition of fetal hydrops. This additional information aids in the management of the pregnancy and in the determination of the time of delivery.

Adult↗
PubMed1990

[Flow in the umbilical cord in normal and high-risk pregnancies].

The author studied umbilical venous blood flow in 100 normal pregnant women and in 100 pregnant women with apparent delay in intrauterine growth (DIUG). At birth, it was shown that only 50 babies had DIUG and that the blood flow was low in 49. In the other 50 babies there was no DIUG and blood flow in the umbilical vein was normal in all of them. The same study was carried out in 50 pregnant women with fetal hypoxia due to placental pathology (32), hemorrhage in the third trimester (15) and Rh isoimmunization (3). This study showed that increased blood flow in the umbilical vein is an early and sure sign of hypoxia due to placental pathology, hemorrhage in the last three months of gestation or Rh isoimmunization. It was also ascertained that low umbilical venous blood flow is a bad prognostic sign because it indicates that the fetus receives an abnormally low quantity of originated blood from the placenta, as was the case of the fetus with DIUG or in the final stages of hypoxia, and that when this happens, the fetus is already incapable of controlling the compensatory circulatory mechanisms and is at imminent risk of cardiac damage.

Embryonic and Fetal Development↗
PubMed1984

Isoimmunization with anti-U antibody.

Isoimmunization with anti-U antibody is a rare but significant cause of hemolytic disease in black newborns. In this case report, an lgG antibody stimulated by fetomaternal transfusion produced a positive direct Coombs' test on cord blood but not neonatal hyperbilirubinemia. A review of the literature suggests the pathophysiology is similar to Rh isoimmunization. The anti-U antibody may develop as a result of pregnancy or blood transfusion in the 1.2 percent of American blacks who are at risk for developing the antibody. The principles of treatment employed in Rh isoimmunization can be successfully used in isoimmunization due to anti-U.

Adult↗
PubMed1980

[Surfactant lipoprotein concentration in amniotic fluid of abnormal pregnancies and premature deliveries (author's transl)].

As shown in our previous report surfactant lipoprotein concentration (SLPC) in amniotic fluid measured by sucrose density gradient centrifugation predicts accurately the risk of RDS. In this study SLPC estimations were made on 91 amniotic fluid samples from abnormal pregnancies, spontaneous premature deliveries and anencephalies. The results were as follows. SLPCs increased in placental insufficiency and severe preeclampsia, especially associated with SFD infant, on the other hand, SLPCs decreased in maternal diabetes (Class B), Rh-isoimmunization and anencephaly as compared with normal pregnancy. In most of premature deliveries SLPCs were higher than those of normal pregnancies except for RDS cases. Present evidence suggests that the maturation of fetal lung is accelerated in severe preeclampsia and placental insufficiency and is delayed in maternal diabetes (Class B), Rh-isoimmunization and anencephaly, and it is considered that in spontaneous premature delivery surfactant production in fetal lung is not accelerated but surfactant excretion from fetal lung into amniotic fluid is enhanced by effect of uterine relaxant such as isoxsuprine or terbutaline.

Adult↗
PubMed1976

Accurate amniotic fluid bilirubin analysis from the "bloody tap". A preliminary report.

The quantitation of bilirubin in amniotic fluid is of paramount importance in prognosticating the severity of Rh isoimmunization. Amniotic fluid contaminated by maternal blood can result in erroneous results when direct spectrophotemetric analysis is performed on such fluid. The technique and results of a one-step chloroform extraction performed on "bloody" amniotic fluid is presented. Results confirm that chloroform extraction yields more accurate clinical information in regard to Rh isoimmunized patients in whom a "bloody tap" is obtained.

Amniocentesis↗
PubMed1993

[Biochemical and hematometric effects of exchange transfusion in isoimmunized neonates].

A hundred twenty full term newborns infants (RN) with ABO or Rh isoimmunization who were submitted to exchange transfusion (ET) because hyperbilirubinemia have been studied and with the procedure were demonstrated: 1. Increase the levels of serum sodium in 2.8% in the RN of ABO group and 3.2% in the RN of Rh group with a recurrence of the original values prior to the procedure within three hours post-ET. 2. The levels of serum sodium equal or superior to 180 mEq/L (mmol/L) in the donor's blood led to hypernatremia after the ET, with a recurrence of the original values prior to the procedures within three hours post-ET. 3. The levels of serum potassium of the RN decreased (-7.7% in the ABO group and -5.47% in the Rh group) with a recurrence of the normal values in the control of six hours post-ET in the ABO group and one of 12 hours in the Rh group. 4. The levels of total calcium in the controls haven't been significantly altered up to 24 hours post-ET. 5. Regarding the pH, in spite of having used blood with low levels compared to those expected for fresh blood, the RN for this experiment maintained the acid-base balance within normal range. In relation to the hematimetric values, the ET: 1. Increase both hemoglobin (Hb) and hematocrit (Hto) values in both groups (increase of 5.6% in Hb and 6% in Hto in the ABO group and increase of 9.2% in Hb and 6.1% in Hto in the Rh group), right after the ET, with a reduction in the control posterior to that. 2. The values of Hb and Hto were always inferior in the RN in the Rh group. Therefore, it has been shown the high intensity of the hemolysis in this group.

ABO Blood-Group System↗
PubMedDate not supplied

[Prevention of maternal RhD isoimmunization with anti-D gamma isoimmunization].

OBJECTIVE: To report our experience in preventing RhD maternal isoimmunization by using anti-D gamma globulin among Rh-negative women. MATERIAL AND METHODS: Between 1982 and 1995, immunologic and hematologic data were collected from all Rh-negative women seen at Mexico's National Perinatology Institute. Women at risk of Rh isoimmunization were given a prophylactic dose of 150 micrograms of anti-D gamma globulin. RESULTS: A total of 4,857 Rh-negative women were seen during the study period (4.85% of the total population of women seen at the Institute), 629 (13.0%) of whom developed RhD isoimmunization; 542 (86.2%) of these women were already isoimmunized when first seen at our Institute. Twenty-two women (3.5%) developed isoimmunization even after receiving a proper dose of anti-D gamma globulin. Prophylaxis was given to 2,605 women (53.6%); 2,039 received a single dose, and 475 two doses. Prophylaxis failed in 22 cases; four were women with multiple pregnancy and 18 developed obstetric pathologic conditions. CONCLUSIONS: The use of anti-D gamma globulin resulted in a reduction of maternal Rh isoimmunization to less than one case per 1,000 women. Failures to prevent isoimmunization were associated to additional obstetric conditions and to lack of adherence to prevention guidelines.

Female↗
PubMed1978

[The determination of plasma and urinary estetrol (E4) for assessing fetal and neonatal prognosis (author's transl)].

As estetrol (E4) is believed to be the steroid most likely to wholly dependent on fetal origin, we developed a radiommunoassay for unconjugated and conjugated E4 (E4-U and E4-G) and investigated plasma and urinary levels serially throughout the second half of pregnancy to establish their validity by means of monitoring or screening tests to assess fetal well-being. E4 exhibits a remarkable increase during the latter half of pregnancy. At term, the mean E4-U level in maternal peripheral plasma was 0.67 +/- 0.33 ng/ml, a five fold increase from that at 28 weeks; E4-G was 4.57 +/- 2.84 ng/ml, showing a four fold increase; and E4-G levels in maternal urine were 1.68 +/- 0.96 mg/day, showing a three fold increase from that at 28 weeks. E4-U and E4-G levels showed no diurnal change. The coefficient of the correlation between plasma E4-U and E4-G was 0.699, which is satisfactory, but no correlation was found between urinary and plasma E4 levels. A significant correlation was shown between maternal and umbilical E4-U (r=0.820) and E4-G (r=0.608). No relationships between E4 levels and birth weight were detected. Pre-eclampsia, Rh-isoimmunization and diabetes mellitus are common complications of pregnancy which may cause latent fetal distress. Prenatal fetal assessment was performed by serial daily evaluations of these E4 values. In pre-eclampsia resulting in a small full term baby, E4 levels were mostly below normal mean values or failed to show an increased pattern. In addition, the E4 levels decreased in one case of neonatal death. In Rh-isoimmunization, plasma E4-G levels were lower in the group affected severely by the hemolytic desease. In a patient with diabetes mellitus delivered of a healthy baby, E4 levels were within the range of a normal pregnancy. In order to evaluate fetal and placental reserve capacities as well as feto-placental function, the dehydroepiandrosterone sulfate (DHA-S) loading test was performed by loading selected subjects with 50 mg of DHA-S, then serially measuring the E4 in the maternal plasma and urine. Intravenous infusion of 50 mg of DHA-S was completed in 60 minutes. A rapid and sharp increase of plasma E4 was observed, reaching maximal concentrations at 120 minutes in normal pregnancies. However, urinary levels showed patterns similar to those reported for estriol (E3). In some abnormal pregnancies, no increased or delayed patterns were observed in plasma E4-G levels, while the serial levels remained within the normal range. This possibly suggests that in these pregnancies, fetal functions had been inhibited or had reached their limit. It is concluded that the simultaneous determinations of serial E4 levels accompanied by the DHA-S loading test may be of value in assessing fetal well-being and reserve capacity and may therefore improve fetal and neonatal prognosis in abnormal pregnancies.

Dehydroepiandrosterone↗