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PubMed2000

Detection of C-type natriuretic peptide in fetal circulation.

C-type natriuretic peptide (CNP) belongs to the natriuretic peptide family that plays an important role in the control of blood pressure, renal function and volume homeostasis. In contrast to the atrial natriuretic peptide and brain natriuretic peptide, CNP acts in an autocrine/paracrine fashion and is considered to be the endothelial component of the natriuretic peptide system. CNP has a high expression and tissue-specific regulation in reproductive organs. Using a radio-immunoassy for CNP-22 we measured for the first time CNP in fetal blood. Samples were taken by cordocentesis in a group of fetuses with rhesus isoimmunisation (10.74 +/- 2.81 pg/ml), fetuses with rhesus isoimmunisation after intravascular transfusion (10.03 +/- 4.01 pg/ml) and a group with structural anomalies (12.9 +/- 5.67 pg/ml). A group of healthy fetuses was used as controls (11.64 +/- 4.32 pg/ml). In contrast to ANP, the fetal CNP-plasma concentrations remain stable in the investigated fetal diseases and after volume load during intravascular transfusion. Moreover, fetal CNP-plasma levels are higher than previously measured maternal concentrations in normal pregnancies. Therefore, the fetus expresses CNP independently of the maternal circulation.

Blood Transfusion, Intrauterine↗
PubMed1996

Prenatal ultrasonographic assessment of the ductus arteriosus: a review.

OBJECTIVE: To review current data pertaining to prenatal ultrasonography of the ductus arteriosus. DATA SOURCES: We reviewed manuscripts published in the English language regarding prenatal ultrasonography and the fetal ductus arteriosus obtained from a MEDLINE search for 1966 onward. Additional sources were identified through cross-referencing. METHODS OF STUDY SELECTION: Data regarding morphology, physiology, pathophysiology of fetal disease, and hemodynamic changes after administration of various maternal medications and structural congenital anomalies of the ductus arteriosus were selected. DATA EXTRACTION AND SYNTHESIS: Knowledge of the function of the ductus arteriosus in both normal and abnormal fetal conditions is enhanced by prenatal ultrasonographic findings. Detailed analyses of ductus arteriosus hemodynamics are indicated in well-defined medical conditions, including maternal medication and established structural or functional fetal cardiac disease. CONCLUSION: The fetal ductus arteriosus is a vascular structure of major functional importance. Knowledge of physiologic hemodynamic changes of blood flow in this vessel obtained by prenatal ultrasonography in conjunction with increasing gestational age, maternal medication, fetal growth restriction, as well as the detection of structural anomalies, may assist in clinical management of complicated pregnancies.

Ductus Arteriosus↗
PubMedDate not supplied

Antenatal diagnosis of fetal cardiac abnormalities.

Utilizing fetal electrocardiography, ultrasound, M-mode and two dimensional echocardiography, fetal cardiac function, structure, and rhythm were studied in pregnancies with obstetrical risk factors. Risk factors for fetal cardiac abnormalities were defined to include: maternal diabetes, connective tissue disorders; Rh hemolytic disease; fetal cardiac arrhythmias, ascites of hydrops; intrauterine growth retardation; maternal drug or teratogen exposure and a family history of congenital heart disease. Representative cases are presented and include fetal findings, management and neonatal outcome.

Arrhythmias, Cardiac↗
PubMed2005

Sustained hematological consequences in the first week of neonatal life secondary to placental dysfunction.

OBJECTIVE: To evaluate the relationship between umbilical artery end diastolic velocity in growth restricted fetuses and neonatal hematologic parameters. STUDY DESIGN: Growth restricted fetuses were studied with ultrasound and Doppler evaluations. Neonates were analyzed in two groups based on umbilical artery Doppler status: positive end-diastolic velocities (PEDV) and absent or reversed end-diastolic velocities (AEDV). At birth and throughout the first week of life, groups were compared for anemia and thrombocytopenia; transfusion of red blood cells, platelets, and fresh frozen plasma; and intraventricular hemorrhage (IVH). RESULTS: Seventy-three neonates met inclusion criteria, 38 with PEDV, 35 with AEDV. Those with AEDV were delivered 3 weeks earlier, were 450 g smaller, had lower cord arterial pH values, and greater cord artery base deficits (p<0.05, respectively). AEDV neonates were twice as likely to be anemic and thrombocytopenic at birth and remain so during the first week, requiring more red blood cell and platelet transfusions. There was no difference in occurrence of severe IVH between groups. CONCLUSION: Hematological alterations associated with intrauterine growth restriction appear to continue into the first week of neonatal life. These are proportional to the degree of placental dysfunction and are predicted by fetal Doppler status. SUMMARY: Abnormal development of the placental vascular tree is the primary step in a cascade of fetal compromises leading to intrauterine growth restriction (IUGR). Doppler ultrasound evaluation of fetal and placental blood flows provides a non-invasive assessment of the fetal condition which reflects the impact of placental vascular abnormalities. The degree of placental dysfunction determines the severity of fetal disease, which can affect many fetal organ systems. In addition to disturbances in placental respiratory function, abnormal umbilical artery Doppler status is also indicative of hematologic abnormalities during fetal life and at birth. Neonates who had more severe placental dysfunction, as depicted by absent umbilical artery end diastolic velocity, were more likely to be anemic and thrombocytopenic at birth and remain so during the first week of life, and required more transfusions than those with positive end diastolic velocities. The severity of hematologic alterations during the first week of life in growth restricted neonates was proportional to and predicted by the antenatal umbilical artery end diastolic velocity Doppler status.

Adult↗
PubMed1992

[Fetal surgery: for what purpose?].

Widespread use of prenatal ultrasonography allows accurate diagnosis of many fetal malformations. The natural history and pathophysiology of some fetal diseases will undoubtedly induce lethal issue. Prenatal ultrasounds allow to determine prognosis during the second trimester of pregnancy. Experimental model and clinical practice have shown that prenatal surgery could be proposed for some correctable malformations: congenital diaphragmatic hernia, cystic adenomatoid lung disease, sacrococcygeal teratoma, lower urinary tract obstruction. To purpose this fetal therapy, great attention has to be paid to maternal risk and her future fertility, keeping in mind the aim of such fetal surgery: a new hope for improved management of the fetus with life-threatening defect.

Congenital Abnormalities↗
PubMed1989

The antenatal blood gas and acid-base status of normal fetuses and hydropic fetuses with Bart hemoglobinopathy.

Funipuncture offers direct access to the fetal circulation. The blood gas and acid-base status of the fetus can be studied, and fetal hypoxia and acidosis can be diagnosed directly. To establish normal ranges of fetal blood gas and acid-base status, we analyzed umbilical venous blood samples obtained by funipuncture from 62 normal fetuses (20-35 weeks). These fetuses were studied because of suspected fetal diseases and were subsequently proved to be normal by the fetal blood examinations. Umbilical vein pH and pO2 decreased whereas pCO2 and bicarbonate increased with gestational age. The umbilical vein base excess did not correlate with gestational duration, but oxygen saturation tended to decrease with gestational age. Twenty hydropic fetuses with Bart hemoglobinopathy were also studied; they were found to be more acidotic, hypoxic, and hypercarbic than normal fetuses.

Acid-Base Equilibrium↗
PubMed2002

Intrathyroidal fetal microchimerism in Graves' disease.

During pregnancy, fetal cells are known to reach the maternal circulation and infiltrate a variety of tissues (fetal microchimerism). Although the presence of such cells has the potential to modulate the maternal immune response to both self antigens and fetal alloantigens, the degree of their influence remains unclear. The hyperthyroidism of Graves' disease frequently abates during pregnancy and exacerbates after childbearing. Thus, we have hypothesized that fetal cells in the maternal circulation and tissues may influence this decrescendo to crescendo pattern of autoimmune thyroid disease. Part of this hypothesis was tested using an ELISA-PCR for the detection of DNA for a male-specific gene, sex-determining region Y. The sensitivity of this assay was the equivalent of approximately 1 male cell among 10(5) female cells. We initially examined paraffin-embedded thyroid tissues and detected male cells in 4 of 20 female Graves' thyroid specimens, but not in 6 of 6 female adenoma specimens. Using frozen thyroid tissue specimens, an additional 6 of 7 Graves' disease samples demonstrated intrathyroidal fetal microchimerism, whereas 1 of 4 female samples with thyroid nodules showed male cells. The greater detection of the sex-determining region Y gene in frozen female thyroid tissues was probably due to DNA fragmentation in the paraffin-derived samples. In summary, we demonstrated that intrathyroidal fetal microchimerism was common and profound in female patients with Graves' disease. Thus, fetal male cells are valid candidates for modulating autoimmune thyroid disease in pregnancy and postpartum.

Adenoma↗
PubMed1999

Sequential segmental approach to fetal congenital heart disease.

The sequential segmental approach is now universally used in the diagnosis of congenital heart disease. Its utilization during fetal sonography has not been well described. In this review, we show how the fetal heart can be approached in a sequential segmental manner by using six basic sonographic views. The transverse view of the fetal upper abdomen is obtained to determine the arrangement of the abdominal organs, which, in most cases, provides the important clues to the determination of the atrial arrangement. The four-chamber view is obtained to evaluate the atrioventricular junctions. The views of the left and right ventricular outflow tracts are obtained to evaluate the ventriculoarterial junctions. The three-vessel view and the aortic arch view are obtained for the evaluation of the arrangement and size of the great arteries, which provides the additional clues to the diagnosis of the abnormalities involving the ventriculoarterial junctions and the great arteries. The standard protocol to acquire these six basic views is also introduced.

Echocardiography↗
PubMed2005

[Fetal programming--the intrauterine origin of adult morbidity].

Many epidemiological studies have demonstrated an association between low birth weight and the subsequent development of hypertension, insulin resistance, type 2 diabetes and cardiovascular disease. This association appears to be independent of classic lifestyle risk factors such as smoking, overweight, social class, alcohol consumption and lack of exercise, which are additive to the effect. The association holds for the full range of birth weights, including those within the normal range. In addition, it was suggested that faster postnatal catch-up growth may also predict later risk of cardiovascular disease. 'Fetal programming' has been proposed as a mechanism underlying the link related to low birth weight, rapid neonatal growth and adult disease. The fetal programming hypothesis suggests that the intrauterine environment during critical periods of organogenesis and tissue growth may permanently alter organ structure and function in an epigenetic manner. Indeed, evidence from both human and animal studies suggests that diseases of adult life are induced by the fetal environment. This review describes epidemiological and physiological evidence that the programming phenomenon is a major factor in determining later life diseases. Better management of pregnancy in the present will have long term wide-scale effects on the health of our society.

Cardiovascular Diseases↗
PubMed1993

[Analysis of platelet-activating factor and its effect on the lung].

One of the lipid mediators, platelet-activating factor (PAF), is reported to be involved in a variety of biological phenomena including not only harmful reactions such as allergy or inflammation, but also physiological phenomena like nerve cell differentiation, sperm mobilization, ovulation, implantation, parturition etc. We reviewed the methods of detecting PAF in biological fluids and the effects of PAF on fetal lung maturation and pulmonary diseases. Fetal lung has a capacity to produce PAF and this autacoid is involved in glycogen breakdown to furnish both glycerol backbone, such as dihydroxyacetone phosphate and glycerol-3-phosphate, and the fatty acids utilized to synthesize pulmonary surfactant. PAF also enhances secretion of pulmonary surfactant. However, PAF causes eosinophil recruitment to the lung, activation of eosinophil and neutrophil, bronchoconstriction, and lung edema, and increases bronchial hyperreactivity. All are characteristics of the pathophysiology of bronchial asthma. We examined PAF acetylhydrolase activity in plasma from patients with bronchial asthma, and found the activity was significantly lower in severe cases than that in mild or moderate cases. Ketotifen had no effect on this enzymatic activity. Evaluating PAF acetylhydrolase activity may help determine the severity of bronchial asthma. PAF is also involved in chronic lung disorders of newborns, such as bronchopulmonary dysplasia. We treated a 3-month-old child with frequent pulmonary problems who was made a diagnosis of bronchopulmonary dysplasia during neonatal period. After administration of Ketotifen for one and a half months, his clinical symptoms improved dramatically.

Animals↗
PubMed1993

Early diagnosis of fetal congenital heart disease by transvaginal echocardiography.

Fetal echocardiography was performed using a high-frequency vaginal ultrasound probe in 114 singleton pregnancies between 11 and 16 weeks of gestation. The four-chamber view with both atria, atrioventricular valves and ventricles as well as the origin and double-crossing of aorta and pulmonary trunk could always be demonstrated from the 13th week onwards. In 12 of 13 cases, cardiac malformations were diagnosed in the first trimester. Only in one case was transabdominal echocardiography necessary at 20 weeks to make the diagnosis. In several cases, however, additional malformations were overlooked, in particular anomalies of the great arteries, such as coarctation of the aorta. Therefore, the accuracy of second-trimester transabdominal echocardiography is markedly higher. Because of the lower diagnostic accuracy, the high costs of equipment and the high training demanded of the examiner, first-trimester transvaginal echocardiography should be restricted to the high-risk fetus, i.e.: (1) Cases with other fetal anomalies very often associated with cardiac defects, such as nuchal edema and hygroma, non-immune hydrops, omphalocele, situs, inversus, or persisting arrythmia; (2) High-risk families with one or more first-degree relatives with cardiac defects are either inherited by Mendelian rules alone, or as part of a rare syndrome; and (3) In pregestational diabetes of the mother.Thus, many severe cardiac defects can be detected or excluded in the first trimester, reducing maternal anxiety. In these high-risk cases, second-trimester echocardiography using the transabdominal route should always be performed because of its distinctly higher diagnostic accuracy.

Journal Article↗
PubMed1989

Cordocentesis: role in assessment of fetal condition.

Cordocentesis for prenatal diagnosis has allowed extensive progress in our knowledge of human fetal physiology. It is now being used to guide obstetric management of acquired fetal diseases (e.g., timing of delivery and intrauterine therapy). The most established indications are blood disorders (e.g., fetal anemia and thrombocytopenia) and further investigation of potentially correctable fetal malformation, but it is being used increasingly in placental insufficiency (e.g., fetal hypoxia and hypoglycemia).

Female↗