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PubMed1975

[The influence on the outcome of pregnancies of sociologic and medical changes during 1963--1972. II. Special section: prenatal dystrophy, diabetogenic fetal disease, the impact of previous miscarriages and twins (author's transl)].

Analysis of 16 486 obstetric and neonatal case histories of the years 1963--1972. 30.7% of all neonates of Austrian (A) mothers showed one or more signs of placentar insufficiency. Pronounced prenatal dystrophy (p.d.) occurs in similar numbers in women with or without EPH gestosis, but has other important causes as well. In p.d. excentric umbilical cord insertion is more common than in neonates without dystrophy (56.4 : 52.4). Very young mothers often have neonates with p.d. During the ten year period p.d. increased considerably until 1967. After that it decreased slightly but not to the numbers at the start. These changes in frequency apply to all maternal age groups equally. Pronounced and highgrade p.d. in foreign workers' (f.w.) children is significantly more common than with A mothers (p 0.0001). Cushing's syndrome as a symptom of fetal disease due to diabetes has become rarer by over 50% owing to more intensive preventive measures; at the same time still-births of those weighing 4000 g or more have disappeared. The frequency of Cushing's syndrome rises according to the age of the mother from 0.8% to 3.5%. In Austrian mothers the number of previous abortions has decreased during these 10 years, just as has the number of births. The chances of actual pregnancies are the worse the higher the number of previous abortions. In f.w. mothers previous artificial abortions are far more numerous, but the outcome of pregnancy does not deteriorate with an increase in previous abortions. In A mothers the effects of previous premature or still births are the same as after abortions but much more pronounced. The percentage of normal births following premature births has fallen somewhat in A mothers during the ten year period, also after one miscarriage from 86% to 71%, probably owing to effective prevention of late abortions. Of 173 pairs of twins the first-born was heavier than the second in 71 instances. It is confirmed that the second twin is still-born almost twice as often as the first-born and this in twins of whom the second is heavier than the first. 11% of individual twins weith more than 3000 g and 28% between 2501 and 3000 g. The heavier the twins the lower the average age of the mother (from 30.8 to 26.6). The mothers whose first twin weighs more than 2500 g, the second less, appear to be younger than those with an inverse ratio (27.6 : 30.7).

Abortion, Spontaneous↗
PubMed1996

[Cordocentesis for prenatal diagnosis of fetal diseases].

For the purpose of prenatal diagnosis, 30 fetal blood samplings were performed in 30 pregnant women from 19 to 36 gestational weeks. The samples were taken with a 22-gauge needle guided by ultrasound. Twenty-five cordocenteses were succeeded at the first attempt. A second attempt was needed in other 5 cases. The duration of procedure was less than 15 minutes in 83.3% cases. 1-6 ml fetal blood was obtained for each case. No lethal complication occured in our series. It is believed that cordocentesis could be a useful tool for prenatal diagnosis, and the intrahepatic-vein sampling is a preferable alternative choice if cordocentesis fails.

Cordocentesis↗
PubMed2006

Exercise in the prevention and treatment of maternal-fetal disease: a review of the literature.

Evidence-based guidelines indicate that regular prenatal exercise is an important component of a healthy pregnancy. In addition to maintaining physical fitness, exercise may be beneficial in preventing or treating maternal-fetal diseases. Women who are the most physically active have the lowest prevalence of gestational diabetes (GDM), and prevention of GDM may decrease the incidence of obesity and type 2 diabetes in both mother and offspring. However, few studies have investigated the effectiveness of exercise in delaying or preventing GDM in at-risk women, and exercise prescriptions that optimize outcomes for women with GDM are lacking. Physically active women are also less likely to develop pre-eclampsia, and we have proposed the following 4 mechanisms that may explain this protective effect: enhanced placental growth and vascularity, reduced oxidative stress, reduced inflammation, and correction of disease-related endothelial dysfunction. Exercise may also prevent reproductive complications associated with maternal obesity. Obesity increases the risk of infertility and miscarriage, and weight loss programs that incorporate diet and exercise are a cost-effective fertility treatment that may also reduce the probability of obesity-related complications during pregnancy. Regular exercise following conception may prevent excessive gestational weight gain and reduce post-partum weight retention.

Algorithms↗
PubMed2001

Animal models of fetal renal disease.

Fetal models of urinary tract disease have been used for many years and have provided unique and important insights into the pathophysiology of these conditions. This review will summarize the principal model systems used and the current directions of investigation. These models (including rabbit, opossum, sheep and recently swine) have demonstrated that in utero obstruction of the urinary tract alters renal growth, differentiation and produces stereotypical patterns of tissue response, particularly fibrosis. New molecular understanding of these processes has identified specific mechanisms that may be key elements in the development of renal dysfunction due to obstruction. These factors include the renin-angiotensin system (RAS) and its interaction with TGF-beta in altering growth regulation and tissue fibrosis. These factors offer the prospect of clinical utility as markers of disease progression as well as pharmacologic therapy. Gene knockout systems have opened a new horizon of molecular models of congenital obstructive uropathy with insights into the role of the RAS in particular. It remains to be defined how closely these knockouts represent the human conditions they resemble. Continued application of fetal models of urinary obstruction, integrating large animal and knockout systems offers promise for improved diagnosis and treatment in these challenging conditions.

Animals↗