Prospects of the laboratory diagnosis of intrauterine foetal distress.
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Abortion, Threatened↗
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[Importance of the determination of plasma chorionic somatomammotropin in high-risk pregnancy].
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Abortion, Threatened↗
[Effects on fetal and infant's development of intrauterine cytomegalovirus infection].
OBJECTIVE: To study the early effects of fetal development and remote sequalae of mental development of infants after intrauterine human cytomegalovirus (HCMV) infection. METHODS: Enzyme-linked immunoabsorbant assay (ELISA) were used for screening HCMV antibodies in the serum of 1419 pregnant women. HCMV DNA were examined by PCR in maternal blood, amniotic fluid and/ or umbilical blood for those with serum HCMV-IgM positive and some with HCMV negative. According to the results, group A (n = 53) included women with positive serum HCMV-IgM and HCMV DNA, and also positive HCMV DNA in amniotic fluid and/or umbilical blood: group B (n = 87) were women with positive serum HCMV-IgM and HCMV DNA but negative HCMV DNA in amniotic fluid and/or umbilical blood: group C (n = 34) served as control with all negative. The above 174 cases were carefully monitored for fetal development. Baley scales of infant development (BSID) were used to test both mental development index (MDI) and psychomotor development index (PDI) at 2-30 months after birth for babies in group A and C. RESULTS: The occurrences of fetal intrauterine death, congenital malformation, fetal growth retardation and neonatal asphyxia were significantly higher in group A than that in group B and C (P < 0.05) and the average birth weight and height were also significantly lower in group A (P < 0.05). The mental development of infants in group A were remarkably slower than that of group C (P < 0.01). CONCLUSION: Active HCMV intrauterine infection may cause congential infection, birth defects and mental retardation in childhood.
Adult↗
Human parvovirus B19: historical and clinical review.
Human parvovirus B19 has been associated with disease only for the past few years. First isolated from sera obtained for studies on hepatitis B in 1975, it was not until 1981 that infection with this small, single-stranded DNA virus was related to aplastic crisis associated with hemolytic anemia. A nonspecific viral prodrome, the occurrence in family members, and epidemics of aplastic crisis suggested the infectious etiology. Human parvovirus infection has since been associated with arthritis, erythema infectiosum (fifth disease), fetal death, and hydrops fetalis. Through the use of recently developed serologic tests, epidemics of erythema infectiosum and parvoviral infection have been related not only to aplastic crisis but also to intrauterine infection and hydrops; DNA hybridization studies have allowed the detection of viral DNA in serum and tissue extracts. Studies have been hampered by the lack of an ability to culture the virus, but this is now possible utilizing bone marrow culture and erythropoietin. This article is a historical and clinical review of human parvovirus infection and disease and considers potential questions regarding their consequences.
Anemia, Hemolytic↗
[Intrauterine rhesus diagnosis].
Although current recommendations for administration of Rh immune globulin have been extended to a variety of reproductive events, residual Rh prophylaxis problems persist. Recent advances in treating Rh-immunized pregnancies include: 1. Fetal blood group determination in first trimester pregnancy by chorionic villus sampling; 2. The severity of fetal haemolysis can be predicted only from invasive procedures, which are recommended, when maternal antibodies exceed 1:8. In the second trimester the only accurate method of assessing the severity of fetal anemia is by fetal blood sampling (cordocentesis). Interpretation of amniotic fluid by the Liley method is still valid for the third trimester of pregnancy; 3. Ultrasonographic evaluation of the fetus is the major adjunct for invasive procedures, but cannot reliably distinct mild from severe fetal disease; 4. Therapy should be initiated before the fetus is hydropic (i.e. Hb less than 5 g%). Survival rates above 90% have been reported by several authors giving transfusions by cordocentesis.
Erythroblastosis, Fetal↗
[Retarded fetal growth. Attempt at an etiological-pathogenetic and clinical classification].
The "small-for-dates" babies are not a single entity but a heterogenous group. The condition has been attributed to many possible causes and mechanisms that many induce "poor fetal growth" in utero. Poor intrauterine fetal growth (P.I.F.G.) has been recognized to occur in many circumstances, can begin at various stages of pregnancy and be caused by several different factors. It was assessed that a reduction in fetal growth support can produce irreversible quantitative and qualitative deficiencies in the organs of the fetus and these deficiencies can play a significant role in perinatal pathology. The recognition of these forms at the right time, the knowledge of the criteria for evaluating their severity and their evolution during intrauterine life would seem to be preferable. Therefore, it is essential to define the various forms of P.I.F.G. during pregnancy to give them names, to define the patterns of P.I.F.G., which are seen in various maternal and/or fetal diseases or conditions, so that they can easily be referred to and understood by everyone. That is the purpose of the proposed etiologic and clinical classification of P.I.F.G.
Abnormalities, Multiple↗
Relationship between amniotic fluid volume and maternal plasma volume expansion.
Amniotic fluid and maternal plasma volumes were estimated in high-risk obstetric patients suspected of being hypovolemic. Excluding cases of intrinsic maternal or fetal disease, there were good (P less than 0.001) correlations between maternal plasma volume expansion and amniotic fluid volume. In the presence of oligohydramnios, there is usually maternal hypovolemia, and vice versa. Oligohydramnios may often be corrected by vigorous maternal plasma volume expansion, which is sometimes indicated in the treatment of cases of fetal distress. It is presumed that only when maternal plasma volume expansion is normal, is uterine perfusion sufficient to provide amniotic fluid formation in normal amounts. The varying amounts of amniotic fluid seen in normal pregnancies at term probably reflect the varying fetal activities of swallowing and voiding.
Adult↗
Severe fetal cytomegalic inclusion disease after documented maternal reactivation of cytomegalovirus infection during pregnancy.
Recurrent cytomegalovirus infection during pregnancy is considered less dangerous for the fetus than primary infection. We present a case of severe fetal cytomegalic inclusion disease after maternal reactivation of cytomegalovirus during the first trimester of pregnancy. The possibility of such fetal injury is an argument for prenatal diagnosis in seropositive pregnant women when ultrasonographic findings suggest cytomegalovirus infection.
Adult↗
Xenografted fetal dorsal root ganglion, embryonic stem cell and adult neural stem cell survival following implantation into the adult vestibulocochlear nerve.
Sensorineural hearing loss is a disabling condition. In the post-embryonic and adult mammalian inner ear, the regeneration of auditory hair cells, spiral ganglion neurons or their axons does not occur naturally. This decrease in excitable neurons limits the success of auditory rehabilitation. Allografts and xenografts have shown promise in the treatment of a variety of neurological diseases. Fetal dorsal root ganglion (DRG) neurons can extend functional connections in the rat spinal cord. Embryonic stem cells (ES cells) and adult neural stem cells (ANSC) have the potential to differentiate into neurons. We have implanted embryonic days (E) 13-16 fetal mouse DRGs from transgenic mouse lines that express Enhanced Green Fluorescent Protein (EGFP) or lacZ reporter genes, EGFP-expressing ES cells or lacZ-expressing ANSC into the injured vestibulocochlear nerve of adult rats and guinea pigs. Survival of the implants was assessed 2 to 4 weeks postoperatively. For further evaluation of the differentiation of the implanted ES-cells, we double labeled with the mouse-specific neuronal antibody Thy 1.2. The rats implanted with EGFP- or lacZ-expressing DRGs showed labeled DRGs after sacrifice. In addition, EGFP-positive nerve fibers were seen growing within the proximal nerve. The results from the EGFP ES cells and lacZ ANSC revealed reporter-expressing cells at the site of injection in the vestibulocochlear nerve of the host rats and guinea pigs but also within the brain stem. Thy 1.2 profiles were seen among the EGFP ES cells within the 8th cranial nerve. The findings of this study indicate that the vestibulocochlear nerve of adult rats and guinea pigs will support xenotransplants of embryonic DRG, ES cells and ANSC. This may have future clinical applicability in recreating a neuronal conduit following neuronal injury between the inner ear and the central nervous system (CNS).
Animals↗
The detection of CMV in amniotic fluid and cervicovaginal smear samples by real-time PCR assay in prenatal diagnosis.
OBJECTIVE: There is no specific antiviral therapy or a vaccine, which could be safely administered to the pregnant women with primary human cytomegalovirus (CMV) infection. Therefore, prenatal diagnosis has a critical role in the management of pregnancy, complicated by this disease. In this study, we investigated the prevalence and clinical consequences of human CMV infection from cervicovaginal smear and amniotic fluid samples of pregnant women by using real-time polymerase chain reaction (RT-PCR) assay, in one of the Obstetrics and Gynecology outpatient clinics of Turkey. The identification of reliable prognostic markers of fetal disease remains the main purpose and a major challenge on this issue. METHODS: Two hundred and six samples, of which 135 were cervicovaginal smear and 71 were amniotic fluid, were enrolled in the study. The DNAs of the samples were extracted by using Roche Diagnostic (Roche, Germany) kit and amplifications of these DNAs were studied by using Light-Cycler system (Roche Germany) as being quantitative. Anti-CMV IgM antibodies in the samples were studied by both MEIA (Imx system, Abbot Laboratories, USA) and a commercial ELISA kit (Radim SPA, Italy) while anti-CMV IgG antibodies were studied by MEIA (Axsym system, Abbot Laboratories, USA). RESULTS: Human CMV DNA was found to be positive in 1.5% (2 in 135) of cervicovaginal smear and 1.4% (1 in 71) of amniotic fluid samples by RT-PCR. IgM and IgG were found to be negative in all of the cervicovaginal smear samples by both MEIA and ELISA, while IgG antibody was found to be positive in only one of the amniotic fluid samples by MEIA. CONCLUSION: With RT-PCR assay, we have found the prevalence of human CMV in pregnant women similar to epidemiologic reports, which have been described earlier. Whereas the fetus with positive amniotic fluid in favor of human CMV had an intrauterine growth restriction resulted in intrauterine exitus, no symptoms were observed in the infants of the other two pregnant women with positive RT-PCR results. The fact that the clinical consequence of the newborn whose amniotic fluid evaluation revealed human CMV infection by RT-PCR made us think that this molecular diagnosis method may be a reliable assay in prenatal diagnosis of this pathogen.
Amniotic Fluid↗
A discussion of some statistical methods for separating within-pair associations from associations among all twins in research on fetal origins of disease.
Twin data can be used to gain insights into the origin of associations between factors arising in fetal life and the risk of later disease. This is because twin data afford an opportunity to conduct paired analyses that take the influence of shared factors into account. When an association that is present in an unpaired analysis is present also in a paired analysis, there is evidence that the causal pathway linking the fetal factor and the disease may have a fetal origin. If the association disappears in the paired analysis, there is evidence that it may have has arisen from a shared source such as the mother. The relevant factors include diet and socio-economic status. There are several statistical approaches to this. The simplest involves comparing, say, a coefficient from a regression of an outcome on a fetal factor for all subjects in a twin sample, with the coefficient obtained from regressing the within-pair difference in the outcome on the within-pair difference in the fetal factor. Alternative approaches involve simultaneously estimating regression parameters for between- and within-pair components. These approaches permit similar inferences about whether the association is due to individual (fetal) or shared (maternal) factors, and are valid in the circumstances that non-shared factors missing from the regression model do not influence the regression estimates.
Birth Weight↗
Perlman syndrome--a cause of enlarged, hyperechogenic kidneys.
Perlman syndrome is a rare overgrowth syndrome, thought to be inherited in the autosomal recessive fashion. We describe the sonographic features in two cases, and review the literature.
Diagnosis, Differential↗
Decreased fetal activity and fetal heart rate changes after amniocentesis complicated by fetal hemorrhage.
A case is described in which amniocentesis caused placental injury, abruptic placenta, and fetal hemorrhage which caused fetal distress. This was primarily manifested by reduction of fetal movements and later by fetal heart rate deceleration. Emergency cesarean section was performed of monitoring the fetus after amniocentesis by assessment of fetal movements is stressed.
Adult↗
MRI of normal and pathological fetal lung development.
Normal fetal lung development is a complex process influenced by mechanical and many biochemical factors. In addition to ultrasound, fetal magnetic resonance imaging (MRI) constitutes a new method to investigate this process in vivo during the second and third trimester. The techniques of MRI volumetry, assessment of signal intensities, and MRI spectroscopy of the fetal lung have been used to analyze this process and have already been applied clinically to identify abnormal fetal lung growth. Particularly in conditions such as oligohydramnios and congenital diaphragmatic hernia (CDH), pulmonary hypoplasia may be the cause of neonatal death. A precise diagnosis and quantification of compromised fetal lung development may improve post- and perinatal management. The main events in fetal lung development are reviewed and MR volumetric data from 106 normal fetuses, as well as different examples of pathological lung growth, are provided.
Female↗
Perinatal outcome of paroxysmal tachycardia of the newborn with onset in utero. Report of 2 cases; review of the literature and a discussion of a clinical approach to fetal tachycardia.
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Cesarean Section↗
Perinatal asphyxia, causes, detection and neurologic sequelae.
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Animals↗
Palliative care in the fetus and newborn.
The changing environment in neonatology and perinatology has led to the examination of issues surrounding palliative care. Newborn palliative care should be considered in three general areas: (1) Neonates at the limits of viability. As advances in technology and outcomes become available, it is the responsibility of the health-care community and society to reach a consensus regarding the limits of viability. (2) Neonates with lethal congenital anomalies. When appropriate, and diagnosis and prognosis are certain, why should a family be deprived the opportunity to choose palliative care for the unborn child? (3) Neonates not responsive to aggressive medical management where continuing therapy may prolong suffering and postpone death. The question 'Are you doing for the neonate or to the neonate?' should be asked. These complex issues, along with best interest issues, site, mode and timing of delivery, and the development of palliative care are the subject of this manuscript.
Congenital Abnormalities↗
Intrapartum fetoscopy: technique and indications.
The present article summarizes six years of experience with intrapartum visualization of the uterus and its contents (fetus, umbilical cord, placenta and amniotic fluid). The choledochofiberscope, previously sterilized in 96% alcohol was introduced into the amniotic cavity via the cervical canal after spontaneous or artificial rupture of the membranes. The following abnormalities were diagnosed with high accuracy: umbilical cord complications (28 cases), placental pathology (36 cases), dehiscence of the uterine scar (2 cases), fetal dysmaturity (19 cases), congenital anomalies (15 cases). No fetal or maternal complications of fetoscopy were noted. Intrapartum fetoscopy can provide the obstetrician with important information in selected cases. Potential uses of intrapartum fetoscopy are discussed.
Congenital Abnormalities↗