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PubMedDate not supplied

Maternal serum transforming growth factor beta-2 in preeclampsia and eclampsia, a potential biomarker for the assessment of disease severity and fetal outcome.

OBJECTIVE: The emerging role of transforming growth factor beta in hypertension, kidney disease, and trophoblast differentiation promoted our interest in evaluating the clinical value of assaying maternal serum TGF-beta2 levels in pregnancies complicated by preeclampsia and eclampsia. We wished to determine these levels in relation to the severity of the disease, the degree of renal involvement, and fetal outcome. METHODS: A prospective study was carried out in 50 pregnant patients with preeclampsia (PE) and eclampsia and these women were compared to 20 pregnant normotensive controls. Preeclamptic patients were subdivided into 20 cases of mild PE, 20 cases of severe PE, and 10 cases of eclampsia. Maternal serum levels of TGF-beta2 were determined in all cases by enzyme immunoassay. Maternal serum creatinine and uric acid were measured, together with an assessment of fetal well being, using the Biophysical Profile Score. RESULTS: Maternal serum TGF-beta2 levels were significantly increased in cases of severe preeclampsia and eclampsia compared to controls. This increase was positively correlated with elevated levels of serum creatinine and uric acid, as well as poor biophysical profile scores (BPS), and low birth weight (LBW). CONCLUSION: Measurement of maternal serum TGF-beta2 levels in preeclampsia may be a useful biomarker for the assessment of the severity of disease and fetal outcome in PE.

Adult↗
PubMed1992

The effect of fetal age upon normal fetal laboratory values and venous pressure.

Eighty fetuses referred because of maternal alloimmunization or maternal infection underwent umbilical venipuncture and were found to be unaffected. Norms for hematologic, biochemical, and pressure measurements were constructed from 18 weeks until term. Total red blood cell (RBC) count (p less than .0001), hemoglobin (p less than .0001), white blood cell count (p less than .0001), and platelet count (p = .04) and volume (p less than .03) each rose with advancing gestation. The number of nucleated RBCs declined significantly (p less than .0001). Umbilical vein carbon dioxide pressure rose (p less than .009) and oxygen pressure declined (p = .005) with advancing gestation. Total protein and albumen rose (each p less than .0001). Aspartate aminotransferase (p less than .02), alanine transferase (p less than .0001), and gamma-glutamyl transpeptidase (p less than .0001) each rose with gestation, independent of any other measured value. The rise in lactic dehydrogenase with gestation was found to depend on pH (p = .0002) rather than gestational length. Paired maternal-fetal serum samples were obtained from an additional 50 abnormal fetuses; there was no significant relationship between mother and fetus for the concentrations of any of the studied enzymes. Umbilical vein pressure rose progressively with gestational age (p less than .004). These studies reveal new information on fetal development and provide a baseline from which to evaluate either fetal disease or the response to therapy.

Blood Cell Count↗
PubMed2005

Recent advances in fetal nucleic acids in maternal plasma.

The discovery of cell-free fetal DNA in maternal plasma in 1997 has opened up new possibilities for noninvasive prenatal diagnosis. Circulating fetal DNA molecules have been detected in maternal plasma from the first trimester onwards and can be robustly detected using a variety of molecular methods. This approach has been used for the prenatal investigation of sex-linked diseases, fetal RhD status, and prenatal exclusion of beta-thalassemia major. Recently, fetal RNA has also been found in maternal plasma. Such fetal RNA has been shown to originate from the placenta and to be remarkably stable. The use of microarray-based approaches has made it feasible to rapidly generate new circulating RNA markers. It is hoped that further developments in this field will make the routine and widespread practice of noninvasive nucleic acid-based prenatal diagnosis for common pregnancy-associated disorders feasible in the near future.

Chromosome Aberrations↗
PubMed1983

The feasibility of fetal echocardiography in the prediction of congenital heart disease.

The fetal heart has been studied echocardiographically in over 750 pregnancies between 16 weeks gestation and term. This has allowed description of normal fetal cardiac anatomy, the acquisition of measurement data for various cardiac structures and the detection of 16 cardiac malformations. In all the patients delivered so far and in which normality was predicted the neonatal heart was confirmed to be normal (640) except in 3 early cases where defects were overlooked. This promises to be a useful technique for the reliable prediction of structural cardiac anomaly prenatally.

Echocardiography↗
PubMedDate not supplied

Drug kinetics in pregnancy.

Any drug given to a pregnant woman must be considered as possibly harmful in the fetus, since all drugs administered to the mother cross the placental membrane, although at different rates. Important physiological changes occur in pregnancy, which may influence the kinetics of drugs. Differences in gastrointestinal function are likely to alter drug absorption rates in the stomach or gut. Ventilatory alterations modify pulmonary drug absorption or elimination. Important changes in haemodynamics and alterations in body water compartments influence drug distribution and elimination. Renal drug elimination is generally enhanced, whereas hepatic drug elimination may be modified in different ways. Computerised pharmacokinetic models representing the compartmental aspects of the fetal-maternal unit and fetal-maternal drug interrelationships may be used to predict kinetic consequences of fetal drug exposure. Such information may be a useful guide for the clinical use of drugs during pregnancy, particularly for treatment of fetal disease.

Absorption↗
PubMed2003

Rapid prenatal diagnosis of X-linked chronic granulomatous disease using a denaturing high-performance liquid chromatography (DHPLC) system.

OBJECTIVE: To describe a family on whom it was possible to perform a rapid prenatal diagnosis for chronic granulomatous disease (CGD) using a denaturing high-performance liquid chromatography (DHPLC) system. METHODS: For a family whose first-born, a boy, suffered from X-linked chronic granulomatous disease, fetal DNA was obtained from an ongoing pregnancy by amniocentesis early in the second trimester. Denaturing high-performance liquid chromatography and direct sequencing were used to attempt to detect the previously identified X-linked chronic granulomatous disease mutation. RESULTS: Our studies predicted that the fetus in question was not likely to be affected by chronic granulomatous disease, which was demonstrated to be correct at birth. CONCLUSIONS: Here, we introduce a molecular diagnostic tool (DHPLC) for an effective and exact prenatal diagnosis of normality for the second-born child, as determined from amniocentesis during the second trimester.

Amniocentesis↗
PubMed1983

Correlation of real-time ultrasonic placental grading with amniotic fluid lecithin/sphingomyelin ratio.

Placental grading with real-time ultrasound was performed on 235 patients who underwent amniocentesis for determination of the lecithin/sphingomyelin (L/S) ratio between 31 and 44 weeks' gestation. Grades I, II, and III placentas were encountered in 88, 72, and 75 patients, respectively. Forty-eight percent of Grade I, 69% of Grade II, and 92% of Grade III placentas had mature L/S ratios (L/S greater than or equal to 2.0). All of the 52 patients with a Grade III placenta who underwent repeat cesarean section at term gestation had mature L/S ratios. However, 37% of the pregnancies complicated by maternal or fetal disease, with Grade III placentas, had immature L/S ratios. The gestational age of these six patients ranged from 34 to 37 weeks. These results suggest that a Grade III placenta in normal term gestation has a good correlation with fetal pulmonary maturity as predicted by the amniotic fluid L/S ratio.

Amniocentesis↗
PubMed1991

Possible causes linking asphyxia, thick meconium and respiratory distress.

The cause of fetal distress and neonatal respiratory distress (RD) in association with meconium-stained liquor is not always clear. To clarify this, a prospective study was undertaken in a tertiary referral maternity hospital for 1 year. In all infants born after meconium-stained liquor who developed RD, evidence was sought for 1) fetal distress (from the cardiotocograph (CTG), the cord blood pH, the Apgar score and the asphyxial complications in the neonate) 2) causes of fetal distress (including maternal risk factors, fetal infection and fetal malnutrition) 3) causes of respiratory distress (including meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN) and infection). Of 4,026 livebirths, 717 (17.8%) had meconium-stained liquor and 44 term and 5 preterm infants developed RD. In the 44 term infants, there was frequent evidence of fetal distress possibly caused by previously unrecognized factors such as fetal malnutrition with reduced neonatal skinfold thickness in 35% triceps and 41% subscapular measurements, and histological chorioamnionitis (CA) in 74%. The cause for respiratory distress was identified in only 48% of infants, and included clinical evidence of PPHN (41%), MAS (16%) and infection (2%). However in preterm infants, 80% had definite or suspected infection. The findings indicate that fetal distress is common in infants who develop respiratory distress after meconium-stained liquor. A role for histological CA and reduced nutrition in the fetus, as factors contributing to the vulnerability of the term infant to intrapartum fetal distress, is suggested.

Apgar Score↗
PubMed2003

Abnormal cardiac function in fetuses with increased nuchal translucency.

OBJECTIVE: To evaluate cardiac function in structurally and chromosomally normal fetuses with increased nuchal translucency (NT). METHODS: Forty-two structurally and chromosomally normal fetuses with increased NT at 11-14 weeks of gestation underwent fetal echocardiographic examination at 20-23 weeks. Fifty fetuses with normal NT values were considered as controls. Pulmonary and aortic peak velocity and time to peak velocities were measured as indices of ventricular systolic function. The ratios between the E-wave and A-wave (E/A) and the ratios between the E-wave and time velocity integral (E/TVI) at the level of both atrioventricular valves were evaluated as indices of ventricular diastolic function. RESULTS: In fetuses with increased NT the E/A ratios were significantly decreased when compared to control fetuses at the level of both the mitral (0.52 +/- 0.09 vs. 0.60 +/- 0.10, P = 0.0002) and tricuspid (0.51 +/- 0.09 vs. 0.61 +/- 0.09, P < 0.0001) valves. Similar results were found for the E/TVI ratios (mitral valve 4.79 +/- 1.03 vs. 5.63 +/- 1.23, P = 0.0007 and tricuspid valve 4.40 +/- 0.88 vs. 5.19 +/- 0.82, P < 0.0001). No significant relationship was found between the degree of NT and the abnormalities in Doppler indices. There were no significant differences in Doppler systolic indices. CONCLUSION: Structurally and chromosomally normal fetuses with increased NT have low E/A and E/TVI ratios at 20-23 weeks of gestation. These findings might indicate cardiac diastolic dysfunction.

Blood Flow Velocity↗