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PubMed1980

Sinusoidal fetal heart rate pattern.

The etiology of sinusoidal fetal heart rate (FHR) patterns is diverse and consequently they ave been associated with poor as well as normal fetal outcome. Four patients who demonstrated sinusoidal FHR patterns are reported, and the factors associated with these patterns and their effect on fetal outcome are discussed. Three of the babies were delivered by emergency cesarean section and were markedly depressed at birth. Two of the infants died and the third required prolong hospitalization. The fourth baby was delivered vaginally and had a normal outcome. The possible pathophysiology is discussed and recommendations are made for the management of this FHR pattern.

Acidosis↗
PubMed1989

Current perspectives in assessment of fetal pulmonary surfactant status with amniotic fluid.

In recent years, improvements in analytical methodology and clinical management of maternal-fetal diseases have altered the understanding of data from amniotic fluid analysis. Delays in phospholipid production or lung function are not currently reported in maternal diabetes. Fetal lung function following glucocorticoid therapy or premature membrane rupture is uncoupled from amniotic fluid phospholipid concentrations, which do not have the usual significance in these circumstances. Phosphatidylglycerol (PG) is present prior to the usual time it is detected by thin layer chromatography (TLC) methods, which vary in sensitivity for PG. Consequently, the significance of its "absence" is highly varied. These observations are discussed in light of the earlier methods and data, along with new perceptions of the functions of the individual phospholipids and apoproteins, the regulatory mechanism of surfactant production, and the relationship of amniotic fluid components to neonatal lung function.

Adult↗
PubMed1996

Aspects of fetal physiology from 18 to 37 weeks' gestation as assessed by blood sampling.

OBJECTIVE: To construct reference ranges for fetal pH, oxygen pressure (PO2), and hematologic and biochemical blood constituents, which can be used to analyze changes with gestation and differences with maternal values, thus elucidating some aspects of fetal biology and the effects of the maternal and placental environments. METHODS: We assayed venous pH, PO2, hematocrit, glucose, uric acid, urea, creatinine, total protein, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase, creatine kinase, triglycerides, and cholesterol concentrations in 157 fetuses and 134 mothers who underwent fetal blood sampling from 18 to 37 weeks' gestation. None of the fetuses was infected or had chromosomal, hematologic, or hormonal abnormalities. RESULTS: All the variables analyzed were similar in fetuses sampled at the placental cord insertion (n = 125) or at the intrahepatic vein (n = 32). Maternal and fetal concentrations of glucose (r = 0.79, P < .001), urea (r = 0.96, P < .001), creatinine (r = 0.83, P < .001), and uric acid (r = 0.94, P < .001) correlated significantly, and their differences exhibited significant changes: the maternal-fetal differences of glucose and urea increased, whereas those of uric acid and creatinine decreased with advancing gestation. Fetal pH and PO2 decreased with gestational age, whereas hematocrit increased, similar to what has been described previously. All of the other variables, with the exception of amylase and cholesterol, changed significantly during the investigated period of pregnancy. Gestational age explained at least 40% of the variance in values of fetal total protein, pseudocholinesterase, alanine aminotransferase, creatine kinase, and triglycerides, but only 3-25% of the variation in the remainder. Most enzymes were higher in the fetus than in the maternal circulation, and all except alkaline phosphatase increased with gestational age. The maternal-fetal glucose difference correlated significantly with hematocrit, pH, and PO2, independent of gestational age and independent of each other. CONCLUSION: With the exception of aspartate aminotransferase, all of the analyzed fetal variables were different from the maternal values, and most changed with gestational age. The mechanisms leading to these fetal specificities remain mostly uncertain, but the provision of reference ranges for several blood constituents may be useful in the differential diagnosis of fetal disease.

Adolescent↗
PubMed2006

Recurrent fetal hydrops due to mucopolysaccharidoses type VII.

Hydrops fetalis is associated with a wide range of abnormalities. In about 20% of cases of non-immune fetal hydrops, no cause is found despite investigations including routine post-mortem examination and enzyme studies may be indicated to detect an underlying metabolic storage disease. Fetal hydrops due to mucopolysaccharidosis type VII is very rare and a prenatal diagnosis is not usually made. We report a case of mucopolysaccharidosis type VII presenting as recurrent fetal hydrops and review the clinico-pathological features of this disorder.

Abdomen↗
PubMed1995

The predictive value of maternal serum testing for detection of fetal anemia in red blood cell alloimmunization.

OBJECTIVE: Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection of fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and monocyte monolayer assay. STUDY DESIGN: Forty-seven serum samples from pregnant women with red blood cell antibodies associated with fetal anemia were analyzed at cordocentesis. Fetal blood was analyzed for hematocrit (corrected for gestational age) and antigen status. Fetal anemia was defined as a hematocrit value of < 2 SD from the mean value for gestational age. Fetuses were classified into three groups: Antigen positive with anemia (n = 19), antigen positive without anemia (n = 17), antigen negative (n = 11). Statistical methods included Kruskal-Wallis test, Newman-Keuls test, Spearman's rank correlation, and receiver-operator characteristic curves; p < 0.05 was considered significant. RESULTS: The median monocyte monolayer assay (phagocytosis, adherence, and association) did not differ among the three groups. Both maternal titers and Marsh scores were significantly higher in fetuses with anemia compared with the other two groups of fetuses (256 vs 64 vs 64, p < 0.001, and 86 vs 69 vs 64, p = 0.02, respectively). Both titer and Marsh score exhibited significant correlations with corrected fetal hematocrit (r = -0.70, p < 0.001; r = -0.63, p < 0.001, respectively). Comparison of the overall receiver-operator characteristic curves for titer and Marsh score revealed no statistical difference; however, a Marsh score of 57 was noted to have a superior specificity than a titer of 16 (p = 0.02). CONCLUSION: The maternal Marsh score can be performed in conjunction with standard indirect Coombs' titers to enhance the predictability of fetal anemia.

Coombs Test↗
PubMed2002

Prenatal diagnosis of congenital cytomegalovirus infection by detection of immunoglobulin M antibodies to the 70-kd heat shock protein in fetal serum.

OBJECTIVE: Antibodies to the 70-kd heat shock protein were evaluated as biomarkers for cytomegalovirus infection. STUDY DESIGN: Fetal sera that was obtained by cordocentesis at 22 to 25 weeks of gestation from 53 mothers with a confirmed primary cytomegalovirus infection and 28 mothers (control group) without cytomegalovirus infection who had been screened for Rh incompatibility, were assayed by enzyme-linked immunosorbent assay for immunoglobulin M and G anti-70-kd heat shock protein antibodies. RESULTS: Eighteen of 53 fetuses (34.0%) from cytomegalovirus-positive mothers were infected, which was determined by culture or polymerase chain reaction. Anti-70-kd heat shock protein immunoglobulin M was detected in 17 of 18 sera (94.4%) from cytomegalovirus-infected fetuses, in 3 of 35 sera (8.6%) from uninfected fetuses, and in 0 of 28 sera from the control group (P <.0001). The level of antibody reactivity was correlated positively with fetal disease. Anti-70-kd heat shock protein immunoglobulin G was detected in sera from 52 of 53 fetuses (98.1%) from cytomegalovirus-infected mothers. CONCLUSION: The anti-70-kd heat shock protein immunoglobulin M assay may be of value in the assessment of fetal cytomegalovirus infection in pregnant women with a primary cytomegalovirus infection.

Cytomegalovirus Infections↗
PubMed1994

First-trimester diagnosis of fetal congenital heart disease by transvaginal ultrasonography.

OBJECTIVE: To describe the feasibility of diagnosing fetal congenital heart defects by transvaginal ultrasonography during the first trimester of pregnancy. METHODS: Pregnant women presenting to the Ultrasonographic Unit at the Chaim Sheba Medical Center who had a diagnosis of fetal heart defects were reviewed retrospectively. Attention was paid to prenatal ultrasound studies, karyotype, and pathologic examinations. RESULTS: Using high-resolution transvaginal ultrasonography, we were able to detect fetal tachycardia (one case), ectopia cordis with ventricular septal defect (one case), atrioventricular septal defect (two cases), ventricular septal defect with persistent truncus arteriosus (one case), tetralogy of Fallot (two cases), and large right atrium with unguarded tricuspid valve (Uhl disease) (one case). Seven of these fetuses had normal karyotypes and all showed additional sonographic abnormalities, including septated cystic hygroma (three cases), hydrops (ascites and pericardial effusions) (two cases), omphalocele (one case), and bilateral agenesis of kidneys (one case). Only one fetus with an abnormal karyotype (45,XO) showed a combination of septated cystic hygroma with hydrops. CONCLUSIONS: High-resolution duplex Doppler transvaginal ultrasonography during the first trimester of pregnancy seems to be a useful diagnostic method for detecting some congenital heart diseases.

Abnormalities, Multiple↗
PubMed1986

Influence of monensin on fertility in rats.

Monensin was given orally to female rats at two dose levels (1.75 and 3.50 mg/kg body weight) over the period of 9-17 days of pregnancy where organogenesis of fetuses occur. The dams were killed on the nineteenth day of gestation and their fetuses were subjected to morphological, visceral and skeletal examination. The small dose of monensin increased the number of resorbed and dead fetuses and induced marked retardation in growth of viable fetuses, but visceral or skeletal defects in these fetuses were not seen. Large doses produced fetal resorption in all dams and no viable fetuses were delivered. Prolonged oral administration of monensin in male rats for 60 successive days at two dose levels, decreased the conception rate in non-treated females (mated with treated males) to 33.3% and 0% for the small and large doses, respectively. Both doses markedly decreased the weights of testicles, epididymides and seminal vesicles. The small dose of monensin caused oligospermia, whereas the large dose induced azospermia. Both doses decreased the activity of spermatogenic epithelium and caused degeneration in germ cells after histopathological examination of the testicles. It is concluded that monensin given during pregnancy to female rats is fetotoxic and when administered chronically to male rats, causes damage to the reproductive organs. The delayed effects of this drug are especially prominent.

Abnormalities, Drug-Induced↗
PubMed1989

Fetal research.

This article reviews some of the significant contributions of fetal research and fetal tissue research over the past 20 years. The benefits of fetal research include the development of vaccines, advances in prenatal diagnosis, detection of malformations, assessment of safe and effective medications, and the development of in utero surgical therapies. Fetal tissue research benefits vaccine development, assessment of risk factors and toxicity levels in drug production, development of cell lines, and provides a source of fetal cells for ongoing transplantation trials. Together, fetal research and fetal tissue research offer tremendous potential for the treatment of the fetus, neonate, and adult.

Cell Line↗
PubMedDate not supplied

Renal tubular damage in fetuses with intrauterine growth retardation.

Fetal hypoxemia is one of the most frequent causes of intrauterine growth retardation (IUGR). In chronic fetal hypoxia, peripheral blood flow and blood flow to the kidneys is reduced to maintain heart, brain and adrenal perfusion, the 'brain-sparing effect'. In kidneys the cells of the proximal tubules seem to be most sensitive to hypoxia caused by reduced blood flow. Damage to the cells of the proximal tubules can be easily diagnosed by urinary levels of N-acetyl-beta-D-glucosaminidase (NAG), an enzyme present in high concentrations in these cells. The aim of the present study was to define the levels of NAG in the amniotic fluid, to diagnose damage to the cells of the proximal renal tubules in fetuses, and to correlate them with a detectable brain-sparing effect. The study was conducted on a total of 55 pregnancies: 9 pregnancies were complicated by IUGR, and the remaining 46 normal pregnancies formed the control group. Higher levels of NAG were detected in the amniotic fluid from the IUGR-complicated pregnancies (p < 0.025). In particular, fetuses with IUGR had high levels of NAG in the amniotic fluid in 8 of 9 cases (+ 2 SD compared with controls), while 1 had normal concentrations. In the 8 cases with high concentrations of NAG in the amniotic fluid, velocimetric Doppler study documented a brain-sparing effect, which was not present in the 1 fetus with normal NAG levels. In conclusion, high levels of NAG in the amniotic fluid may identify in uterus fetuses with renal damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylglucosaminidase↗
PubMed1977

[A critical analysis of the present state of recognizing the fetal hazard in pregnancy, via hormonal determinations (author's transl)].

The experience published in medical literature on the pregnancy hormones HPL and estrogens, is subjected to a critical review. The reported studies are examined in detail, first of all, with regard to the performance of the pregnancy hormones in fetal risk situations, taking certain pregnancy complications into account. The ranking of these paremeters in arriving at obstetric decisions in fetal emergency situations, is then described. This is followed by an assessment of the importance of the pregnancy hormones as prognostic parameters for forecasting fetal hazard in cases where pregnancy appears to have taken an uneventful courese, basing on few results available to date. All findings indicate that biochemical monitoring during pregnancy contributes toward individualization of the obstetric decisions.

Estrogens↗
PubMed1987

Fetal death following antepartum fetal heart rate testing: a review of 65 cases.

The nonstress test (NST) remains in widespread use for antepartum fetal surveillance. Our institutional experience with 14,028 patients and 38,645 tests over eight years reveals a fetal death rate of 2.6 per 1000 within seven days of a reactive NST. The autopsy findings of 53 fetal deaths are presented. The most common findings, in descending order of frequency, were meconium aspiration, perinatal infection, and abnormal umbilical cord position. These findings support changes we have made in our antepartum assessment protocols.

Female↗