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PubMed1985

Transplacental fetal hemorrhage after amniocentesis.

A retrospective survey of Winnipeg Rh laboratory data from January 1, 1981 to December 31, 1984 determined that, despite placental localization, 2.6% of 974 women having amniocenteses performed at 16 to 18 weeks' gestation for genetic reasons and 2.3% of 1215 women having amniocenteses performed between 32 and 38 weeks' gestation had fetal-maternal transplacental hemorrhages greater than or equal to 0.1 mL of fetal red cells due to placental trauma. In 1.6 and 1.8%, respectively, the fetal transplacental hemorrhages were greater than or equal to 1 mL. Four of 99 alloimmunized women undergoing 257 amniocenteses for determination of severity of fetal erythroblastosis had fetal transplacental hemorrhages all greater than 5 mL of fetal red cells. The 1.9% incidence of fetal transplacental hemorrhages after amniocentesis in alloimmunized women is 83% less than the 11.2% incidence that occurred in the authors' institution from February 1963 to December 1966. However, in three of the four women, there was a very rapid rise in Rh antibody titer and increased severity of Rh fetal disease. Only the alloimmunized woman who meets strict criteria, indicating that her fetus is at risk of fetal death, should be subjected to amniocentesis, and then only after careful placental localization by ultrasound. Because fetal transplacental hemorrhages occur after amniocentesis despite ultrasound placental localization, 300 micrograms of Rh immune globulin should be administered to all unimmunized Rh negative women after amniocentesis.

Amniocentesis↗
PubMed1979

[Juvenile, non-progressive muscular atrophy localized in the hand and forearm. Report of 16 cases (author's transl)].

Sixteen cases of juvenile, non-progressive muscular atrophy localized in the hand and forearm were seen at our neurology out-patient clinic for the past 8 years. The analyses of these 16 cases disclosed characteristic features as follows: 1) juvenile onset 2) male preponderance 3) unique distribution of muscular atrophy and weakness in the hand and forearm. 4) insidious onset, initial progressive period and subsequent non-progressive course 5) tendon reflexes of the arms are hypoactive in half of the cases 6) no pathological reflexes 7) cold paresis 8) no definite sensory disturbance 9) no cranial nerve involvement 10) neurogenic patterns on EMG According to these features, this clinical entity carrying good prognosis must be differentiated from several diseases associated with similar muscular atrophy of extremities, especially amyotrophic lateral sclerosis which is notorious as a fetal disease.

Adolescent↗
PubMed1993

Radiotelemetric fetal monitoring during and after open fetal operation.

Diagnosis and treatment of fetal disease processes has advanced dramatically, but the ability to monitor the fetus in utero remains rudimentary. Open fetal operation provides a unique opportunity to correct life-threatening fetal abnormalities, but it also places the fetus at risk. Continuous intraoperative and post-operative fetal electrocardiographic monitoring may decrease the risk by optimizing fetal and maternal perioperative management. We tested an implantable radiotelemetry device that allowed continuous intraoperative and postoperative fetal electrocardiographic and temperature monitoring. The radiotelemetry device was placed subcutaneously in four fetal sheep at 100 to 112 days' gestation (term equals 145 days). During and after the fetal operation, the monitor reliably and continuously transmitted the analog fetal electrocardiogram and temperature. We then tested a similar device during human fetal operations on both an acute and a chronic basis. The radiotelemetry device permits continuous and reliable fetal monitoring during and after fetal operation and we now consider it essential to the operation. Its use should facilitate optimal fetal and maternal management and improve survival of the fetus.

Animals↗
PubMed1994

Fetal congenital heart disease: diagnosis and management.

The most important papers address controversial aspects of fetal cardiology, for example, screening for congenital heart disease (CHD), the diagnosis and the accuracy of diagnosis, and the management of fetal tachycardias. There are some interesting additions to the literature although some conclusions require further evaluation.

Female↗
PubMed1998

Neonatal morbidities in gestational diabetes mellitus.

The currently accepted definition of gestational diabetes mellitus (GDM) is rather broad. One might expect that fetal and neonatal complications that may occur in GDM pregnancy would be similar to those in pregestational diabetic pregnancy. Comparative evaluation of reported data on morbidity in GDM are often hampered by confounding variables (maternal age, parity, obesity) as well as the influence of factors such as ethnic origin, diagnostic criteria, and intervention during pregnancy. Recent observations indicate that GDM may be associated with increased incidence of fetal malformation and perinatal mortality. Such poor outcome is likely confined to a subset of GDM patients in whom diabetes was present but unrecognized before pregnancy. The most frequent and significant morbidity is fetal macrosomia, which in turn is associated with increased risk of birth injuries and asphyxia. In a nationwide study in Sweden (1991-1993) of a large series (n = 3.322) of treated GDM pregnancies, perinatal mortality rate was not increased; but the rate of preeclampsia was doubled, and the rate of emergency cesarean section was 1.6 times higher than in the background population. The rates of fetal macrosomia (> or = 4,500 g), asphyxia, and transient tachypnea were two to three times higher than normal Erb's palsy was 0.7 and 5% in vaginally delivered infants weighing < 4,500 and > or = 4,500 g, respectively. There is a clear need to define the various levels of glucose intolerance in the mother that may have an adverse effect on the offspring. Of equal importance is to standardize and systematize the criteria used to assess the significance of any such impact.

Diabetes, Gestational↗
PubMed2005

Pathophysiology of fetal microchimeric cells.

Microchimerism has been defined by the presence of a low number of circulating cells transferred from one individual to another. The transfer of microchimeric cells naturally takes place during pregnancy and occurs bi-directionally between the mother and fetus. Further, microchimerism can also be a result of blood transfusions and organ transplants. Microchimeric cells have been implicated in health and disease. Fetal microchimerism has been correlated with the hyporesponsiveness of the maternal immune system towards a fetal allograft and with the longevity of organ transplants. However, microchimeric cells have been implicated in the pathogenesis of autoimmune diseases including systemic sclerosis. In contrast, microchimeric cells were found to contribute to tissue repair. Much controversy exists around the role of microchimeric cells in the pathogenesis of certain diseases, and these cells in tissues may be a consequence rather than the cause of disease.

Animals↗
PubMed1975

Fetal haemoglobin in homozygous sickle cell disease.

Synthesis of fetal haemoglobin is prolonged in homozygous sickle cell disease. Its intracellular distribution is irregular and red cells containing high levels of Hb F enjoy greater protection from sickling and subsequent destruction. This relationship is reflected in a number of associations between Hb F level and the haematological and clinical parameters of the disease. High fetal haemoglobin levels are associated with more normal red cell survival, more normal oxygen affinity, and more normal red cell characteristics whereas clinically they are associated with less evidence of vessel obstruction, persistence of splenomegaly, more normal skeletal development and body habitus, and a generally more benign clinical course. Attempts to prolong Hb F synthesis might therefore be expected to lead to amelioration of the clinical features of the disease. The factors leading to persistence of Hb F synthesis is SS disease are largely unknown although they appear to be operative as early as the first three months of life.

Adolescent↗
PubMedDate not supplied

Congenital toxoplasmosis in twins: a case report.

We report a case of congenital toxoplasmosis in a twin pregnancy at 21 weeks of gestation. The complete antenatal investigation included ultrasound examination, cordocentesis and amniocentesis. The ultrasonographic evaluation showed a distinct morphological aspect confirmed by the fetal biological profile. The time lag between placental and fetal infection, or the immunological fetal responses could explain the varying stages of the fetal disease. This is another case which early demonstrates that there may exist a distinct clinical pattern in bichorial pregnancy with varying biological fetal responses. It underlines the importance of cordocentesis in the case of maternal toxoplasma seroconversion, enabling us to gather a maximum number of biological data for complete appreciation of the fetal status. The information obtained permits a precise adaptation of the medical decision.

Abortion, Induced↗
PubMed1977

Stimulation of human fetal lymphocytes by lipopolysaccharide B in culture.

Cultures of Isopaque-Ficoll-isolated lymphocytes from three human sources were compared with respect to the effect of mitogens. The cell sources were maternal blood immediately after delivery, cord blood, and blood obtained by heart puncture of 10-20-week aborted fetuses. Lipopolysaccharide B (LPS) induced incorporation of tritiated thymidine, blastic transformation, and mitotic activity in cord and fetal, but not maternal, cells. The stimulation reached a maximum on days 4-8 of culture. It was stronger than the spontaneous transformation often displayed by fetal cells. If fetal cells spontaneously occurring in the blood of pregnant women were to react in a similar way, it should be possible to selectively stimulate the fetal cells with LPS. Such transformed fetal cells could then be isolated from cultures of maternal blood samples and used for antenatal diagnosis of fetal disease.

Cells, Cultured↗
PubMed2004

Non-iatrogenic pathology of the preterm infant.

Non-iatrogenic anatomical findings at autopsy provide insight into preterm infant physiology. The different patterns of lipid accumulation in the adrenal may correspond to long-term differences in stress response. Cardiac papillary muscle infarction occurs with asphyxia or shock and can explain myocardial dysfunction. Underdevelopment of preterm kidneys may correlate with susceptibility to renal disease and hypertension in adult life. Immaturity of the lung or immature responses to inflammation, rather than high oxygen concentrations or high ventilation pressures, may underlie chronic lung disease in premature infants. Hepatic extramedullary haematopoiesis is normal but, if excessive or abnormally persistent, can be an indicator of fetal disease. Hypertrophic somatostatin islet cells found with intra-uterine growth retardation may correlate with low serum insulin. Thymic involution may mark the degree of stress. Small thyroglobulin stores may limit the premature neonate's initiation of thermogenesis.

Adrenal Gland Diseases↗
PubMedDate not supplied

Haemodynamic evaluation of the first trimester fetus with special emphasis on venous return.

Knowledge of the fetal circulation is a prerequisite for understanding the physiological behaviour of the developing fetus. In this overview dealing with Colour and Power Doppler ultrasound findings in the first trimester of pregnancy and its pathophysiological background, we aim to report on the methodological aspects, normal blood flow waveform patterns, normal reference values for haemodynamic parameters and potential clinical applications for both arterial and venous flow information (umbilical artery, descending aorta, middle cerebral artery, umbilical vein, inferior vena cava, ductus venosus) and atrioventricular valves. Particular emphasis is devoted to the venous return to the heart. Alterations in venous waveforms, particularly in the ductus venosus, are correlated with the pathophysiology of some fetal diseases and are suggested as a promising tool for the screening of cardiac impairment and as an alternative method for fetal biophysical surveillance.

Arteries↗
PubMed1996

[The clinical value of fetal congenital heart disease diagnosed by color Doppler echocardiography].

OBJECTIVE: To investigate the clinical value of color Doppler echocardiography for the diagnosis of fetal congenital heart disease (CHD). METHODS: 368 cases of high risk fetuses of CHD, aged from 20-40 gestational weeks, were examined by color Doppler echocardiography with Acuson 128 x P/10 color Doppler flow imaging system. The prenatal echocardiographic diagnosis were confirmed by fetal autopsy and echocardiographic examine after birth as well as follow-up. RESULTS: 11 cases of fetal CHD were detected by prenatal echocardiography, of those, 5 cases of CHD were confirmed by fetal autopsy after induction of labor and 5 cases of CHD were confirmed by color Doppler echocardiography after birth, 1 case of false-positive and 1 case of false-negative. CONCLUSIONS: The study suggests that four-chamber view is an important view for detecting fetal CHD by echocardiography, but multiple views are necessary for diagnosis of fetal complex CHD. Color Doppler echocardiography lists as the first choice for prenatal diagnosis of fetal CHD.

Adult↗
PubMed1997

[Complete congenital atrioventricular block. Prenatal diagnosis and perinatal management].

OBJECTIVE: To describe our experience in prenatal diagnosis and perinatal management of congenital atrioventricular heart block, as well as pacemaker treatment in the neonate. MATERIAL AND METHODS: A total of 13 fetuses are included. The diagnosis of atrioventricular dissociation was established by Doppler heart rate sample in the right atrium to show the atrial activity while the sample in the Aorta reflected the ventricular heart rate. Gestational age at diagnosis, ventricular heart rates, autoimmune maternal pathology, maternal blood tests for autoantibodies antiRo+, congenital structural heart disease, fetal hydrops, maternal medical treatment, perinatal results and pacemaker neonatal implantation are described. RESULTS: Gestational age at diagnosis ranged between 22 and 32 (mean 27.6) weeks. Ventricular heart rates ranged between 32 to 80 (mean 54) beats/min. AntiRo+ antibodies were detected in 5 mothers, and clinical systemic lupus erythematosus was found in only one. Four had congenital heart disease (2 ventricular inversion and corrected TGA, 1 complete atrio-ventricular canal and 1 tricuspid atresia). Signs of heart failure and hydrops were detected in 9 fetuses. Treatment with beta-metasona and ritodrine was administered to 7 mothers when the ventricular heart rate dropped below 60 beats/min. Intrauterine fetal death occurred in 3 fetuses with structural congenital heart disease and hydrops. Delivery was performed by cesarean section in 8 preterm fetuses (one them a twins), 3 spontaneous deliveries at term and 3 stillbirth. Postnatal pacemaker implantation was carried out in 9 newborns (3 cases with unicameral temporal right ventricle electrode and 6 cases with permanent bicameral electrodes implanted through the subclavian vein and DDD pacemaker). Follow-up of the bicameral pacemaker group was satisfactory. CONCLUSION: Persistent fetal bradycardia is the first sign to diagnose prenatal complete atrioventricular heart block. Echocardiography asses fetal haemodynamic status and may detect signs of fetal deterioration. Hydrops and further drop in the ventricular heart rate warrant urgent cesarean section and pacemaker management of the newborn.

Female↗
PubMed1985

Sonographic measurements of the fetal spleen: clinical implications.

Normal values for fetal spleen dimensions are proposed, including longitudinal, coronal, and transverse diameters, the perimeter, and the estimated volume. Similar values were then obtained in cases of Rh-immunization and prolonged premature rupture of the membranes. A good correlation between amniotic fluid optical density and fetal spleen size was found. Only severely affected fetuses showed splenic values above the upper limit. Since sonographic examination can be regarded as a reliable method, nomograms can be useful in detecting growth disorders of the fetal spleen and thus provide a new complementary method to identify possible fetal diseases of genetic disorders.

Embryonic and Fetal Development↗
PubMed2002

Acute renal failure in leptospirosis in the black-sea region in Turkey.

Leptospirosis is an infectious disease caused by pathogenic leptospires and is characterized by a broad spectrum of clinical manifestations, varying from inappearent infection to fulminant, fetal disease. Eighty-five to 90% of leptospirosis infections are self-limiting. However, 5-10% of infection by L. interrogans can cause renal tubular damage, microvascular injury, acute renal failure (ARF), and interstitial nephritis. We studied 36 patients with leptospirosis. Twenty-seven (65%) cases of 36 patients had ARF. Fourteen (51%) had nonoliguric ARF. In thirteen (48%) oliguria appeared on the third or fourth days of hospitalization. Serum BUN, creatinine, serum bilirubine, ALT, AST, potassium and thrombocytopenia levels were higher in oliguric than nonoliguric patients (p < 0.05). However, serum sodium, CPK levels were not different between oliguric and nonoliguric groups (p > 0.05). Thirteen patients (48%) needed in renal replacement therapy (RRT). 8 of them were treated by hemodialysis (HD) alone and 5 patients by HD in combination with hemoperfusion. Twenty-five patients (92%) recovered completely after 3-5 weeks. Two patients (7.4%) who had severe hepatorenal and hemorrhagic syndromes, died. We concluded that till now leptospirosis is actual problem for nephrologist in the developing countries because of very high percentage of renal disease, with good prognosis in patients without multiorgan failure and early treatment.

Acute Kidney Injury↗