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Ninety-five percent of the neonatal cases of bowel atresia result from jéjuno-ileal obstructions. Frequency is estimated from 1/3,000 to 1/5,000. We observed a case of small bowel volvulus secondary to jejunal atresia diagnosed at 35 weeks gestation. The ultrasound examination was performed due to decreased perception of active fetal movements. Fetal extraction was successful before perforation and meconial peritonitis.
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Intra-uterine and oral temperatures were recorded in 23 patients with fetal tachycardia during labour, as well as in 22 patients without fetal tachycardia. In the tachycardia group, the mean intra-uterine temperature was 38,83 degrees C, against 37,44 degrees C in the control group. The oral temperatures were 38,05 degrees C and 33,98 degrees C respectively. Furthermore, a high incidence of neonatal infections occurred in the tachycardia group--11 against 1 in the control group. To distinguish infection from other causes of fetal tachycardia, intra-uterine temperature measurements could be applied as a diagnostic aid.
Important factors in laparoscopic surgery during pregnancy are listed here: There is a risk of aspiration because of a hormonally induced decrease in lower esophageal sphincter tone and mechanical effects of a gravid uterus. Supine hypotensive syndrome because of aortocaval compression can be a major problem. Pneumoperitoneum during pregnancy results in more pronounced restrictive lung physiology. Avoid hypoxemia, hypotension, acidosis, hypoventilation, and hyperventilation. No anesthetic drugs have been proven to be teratogenic in humans. Surgery during pregnancy is associated with the delivery of low birth-weight, growth-restricted babies. Standard noninvasive monitoring could be sufficient for healthy parturients undergoing laparoscopic surgery. Fetal heart rate and uterine activity should be monitored pre- and postoperatively. Laparoscopic surgery during pregnancy is safe, has multiple advantages over open techniques, can be performed during all gestational ages, and does not require invasive or continuous fetal and uterine monitoring for routine cases; however, the anesthesiologist must be aware of the physiologic changes associated with pregnancy and the effects of positioning, and the consequences of CO2 pneumoperitoneum on the parturient and the fetus. Although no special monitoring is required in healthy parturients, each case must be assessed carefully, and invasive monitoring could be required in those patients with significant cardiovascular or pulmonary disease. Fetal heart rate should be assessed preoperatively and postoperatively. Surveillance with an external tocodynamometer should be instituted immediately preoperatively and postoperatively and tocolytic agents instituted if documented or perceived uterine activity is detected.
1. Neural transplantation is one promising approach for the treatment of Parkinson's disease. Fetal substantia nigra cells are a good source of dopamine, but in order to avoid ethical and immunological problems, adrenal medullary chromaffin cells have been investigated as an alternative source. 2. Grafted adrenal medullary chromaffin cells can provide dopamine as well as several neurotrophic factors that affect dopaminergic neurons in the brain. 3. We review experimental studies for application of neural transplantation techniques in Parkinson's disease, including immunological studies, cryopreservation, microvasculature, donor tissue, and direct gene delivery studies performed in our laboratory. Our clinical experience and new approach involving a polymer-encapsulated cell grafting procedure are also described.
A detailed retrospective analysis was made of the records of 486 preterm infants, who accounted for 5-1% of all births during 1973 and 1974. Whereas preterm delivery did not contribute to perinatal mortality in terms of stillbirth, it outweighed all other causes in terms of early neonatal deaths. Preterm birth was responsible for 85% of the early neonatal deaths not due to lethal congenital deformities. Early neonatal mortality rates were closely linked both to gestational age and birth weight and to the reason for preterm birth. Early neonatal mortality was high (97 per 1000) when preterm labour was spontaneous, whether or not associated with material or fetal disease or with multiple pregnancy, but low (27 per 1000) when preterm delivery was elective. Preventing spontaneous preterm labour would considerably reduce neonatal mortality in our community.
BACKGROUND: The detection of circulating nucleic acids has long been explored for the non-invasive diagnosis of a variety of clinical conditions. In earlier studies, detection of circulating DNA has been investigated for the detection of various forms of cancer. Metastasis and recurrence in certain cancer types have been associated with the presence of high levels of tumor-derived DNA in the circulation. In the case of pregnancies, detection of fetal DNA in maternal plasma is a useful tool for detecting and monitoring certain fetal diseases and pregnancy-associated complications. Similarly, levels of circulating DNA have been reported to be elevated in acute medical emergencies, including trauma and stroke, and have been explored as indicators of clinical severity. Apart from circulating DNA, much attention and effort have been put into the study of circulating RNA over the last few years. This area started from the detection of tumor-derived RNA in the plasma of cancer patients. Soon after that, detection of circulating fetal RNA in maternal plasma was described. Plasma RNA detection appears to be a promising approach for the development of gender- and polymorphism-independent fetal markers for prenatal diagnosis and monitoring. This development also opens up the possibility of non-invasive prenatal gene expression profiling by maternal blood analysis. Besides circulating DNA and RNA in plasma and serum, cell-free DNA in other body fluids, such as urine, has been detected in patients with different clinical conditions. Regardless of the sources of cell-free DNA for clinical use, the amount is frequently scarce. METHODS: Technical advancements in detecting free DNA have been made over the years. CONCLUSIONS: It is likely that further developments in the field of circulating nucleic acids will provide us with new diagnostic and monitoring possibilities over the next few years.
Each of 20 gilts (principals) from a commercial swine herd free of antibody for porcine parvovirus (PPV) was exposed intranasally and orally to PPV at the onset of gestation. The gilts were killed and necropsied 22 +/- 1 days later to determine the effect of the virus on their embryos. An equal number of gilts (controls of the same status, from the same herd, and bred to the same boars, were treated similarly except for exposure to PPV. The following data were obtained at necropsy and from subsequent laboratory tests. Principals had 223 corpora lutea (8 to 16/gilt) and 203 embryos (6 to 16/litter). Porcine parvovirus-infected embryos (1 to 9/litter) were detected in 12 (60 per cent) of the 20 litters. Of the 203 embryos of principals, 169 were alive and 34 were dead and in various stages of decomposition and resorption. Both virus and viral antigen were detected in 7 of the live embryos (1, 1, 2, and 3 in 4 litters) and in 32 of the dead embryos. With 1 exception, infected live embryos were next to infected dead littermates in the uterus suggesting the beginning of intrauterine spread of the virus. Controls had 234 corpora lutea (9 to 15/gilt) and 217 embryos (9 to 14/litter). None of their embryos were infected with PPV and all but 3 were alive.
AIMS/HYPOTHESIS: Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than those of the National Diabetes Data Group (NDDG) that have been in use since 1979. We sought to determine the extent to which infants of women meeting only the ADA criteria for GDM are at increased risk of neonatal complications. MATERIALS AND METHODS: In a multiethnic cohort of 45,245 women who did not meet the NDDG criteria and were not treated for GDM, we conducted nested case-control studies of three complications of GDM that occurred in their infants: macrosomia (birthweight >4,500 g, n = 494); hypoglycaemia (plasma glucose <2.2 mmo/l, n = 488); and hyperbilirubinaemia (serum bilirubin > or =342 micromol/l (20 mg/dl), n = 578). We compared prenatal glucose levels of the mothers of these infants and mothers of 884 control infants. RESULTS: Women with GDM by ADA criteria only (two or more glucose values exceeding the threshold) had an increased risk of having an infant with macrosomia (odds ratio OR = 3.40, 95% CI = 1.55-7.43), hypoglycaemia (OR = 2.61, 95% CI = 0.99-6.92) or hyperbilirubinaemia (OR = 2.22, 95% CI = 0.98-5.04). Glucose levels 1 h after the 100-g glucose challenge that exceeded the ADA threshold were particularly strongly associated with each complication. CONCLUSIONS/INTERPRETATION: These results lend support to the ADA recommendations and highlight the importance of the 1-h glucose measurement in a diagnostic test for GDM.
A very rare case of a sustained fetal ventricular arrythmia in the form of bigeminy, trigeminy, and quadrigeminy during labor is described. The rhythm distrubance failed to respond to sedatives and narcotics but was successfuly reverted to sinus rhythm following the administration of intravenous propranolol to the mother. The significance and possible mechanism of the arrhythmia is discussed.
Spectral analysis of the fetal heart rate and intrauterine pressure was done with data obtained during labor for 24 patients delivered of their infants in an obstetric intensive care unit. The patients were grouped according to clinical assessment of labor and neonatal outcome as normal (11), abnormal/premature (4), and prolonged labor/cesarean section (9). A comparison among groups of spectral density functions and of coherence functions and phase angles failed to reveal consistent features that could be used to distinguish between groups. However, an analysis of the variance (integrated spectrum) and the mean of the base-line component of the fetal heart rate showed that the values for the normal and abnormal/premature groups could be distinguished from the background population. It is suggested that a study of the joint statistics of the variance and the mean may lead to the development of a diagnostic aid to the early detection of incipient fetal distress.
Appearance of a repetitive late deceleration pattern following oxytocin-induced uterine contractions in the prepartum patient may indicate fetal compromise, while absence of this finding may reflect fetal well-being. In this study, 72 patients at risk for intrauterine asphyxia underwent 81 satisfactory oxytocin challenge tests. Eight tests in seven patients were interpreted as positive; 72, as negative; and one, as suspicious. In 64 patients with negative tests, no fetal deaths or neonatal asphyxial depressions were observed. One patient developed intrapartum fetal distress with late decelerations 8 days after a negative test and was delivered by cesarean section. The positive test appears to correlate meaningfully with other clinical parameters reflecting intrauterine compromise.
Despite all the information about AFP presented, a great deal still needs to be discovered especially in pregnancy. Geographical and racial differences remain to be elucidated. Similarly, differences in obstetric population in Helsinki and Baltimore, for example, are only now being studied. Sex differences may exist; Lardinois and associates195 cited a higher level of AFP in male than female fetuses. The important questions that need to be answered are whether AFP assays can help improve the other half of prenatal care- that directed to the fetus- and whether the AFP model can help enhance our understanding of the similarities and differences of fetal and cancer cells.
Fetal heart rate characteristics during the 8 hours prior to delivery have been studied in 200 patients in whom the fetus had evidence of a metabolic acidosis at delivery, and compared to those in 200 patients in whom the fetus had a normal acid-base at delivery. Baseline fetal heart rate moderate bradycardia and tachycardia, decreased baseline variability, and decreased fetal heart rate accelerations are predictors of intrapartum fetal hypoxia with metabolic acidosis. Marked patterns of total decelerations and late decelerations are predictive of intrapartum fetal hypoxia with metabolic acidosis. The probability of fetal metabolic acidosis in the presence of a marked pattern of total decelerations is 25%, and with late decelerations it is 48%, in a population of high-risk pregnancies.
Six hundred seventy-nine postdate study patients surveyed with a contraction stress test (CST) protocol had no perinatal deaths and no greater morbidity than that found in a 500-patient normal term control population. However, the postdate study did have a significantly increased risk of intrapartum fetal distress, meconium-stained amniotic fluid, macrosomia, and cesarean section for both failed progress of labor and fetal distress. Among the postdate study group there was a high incidence of patients with abnormal CST results (39%); these patients with abnormal CST results were at increased risk for subsequent intrapartum fetal distress. Seventy-five percent of the postdate study patients entered labor spontaneously and delivery was elected because of abnormal CST results in only 5.4%. The data presented here support the use of contraction stress testing for primary surveillance of the prolonged pregnancy and they suggest that only one in 20 patients past 42 weeks' gestation will require intervention for fetal indications with this approach.
In animal experiments, it has been shown that tracheal occlusion counteracts the pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH). Successful clinical implementation requires a reliable, reversible, and atraumatic technique of occluding the fetal trachea. With this clinical goal in mind, the authors evaluated the following three methods of tracheal occlusion in a fetal lamb CDH model: (1) an occluded foam-cuffed endotracheal tube, (2) a foam-cuffed endotracheal tube with a magnetically controlled flow valve, and (3) a tracheal insert constructed of a water-impermeable, expandable, polymeric foam, which is placed by a translaryngeal approach. The foam-cuffed endotracheal tube did not provide consistently reliable fetal tracheal occlusion. Although the magnetically triggered flow valve functioned well, it was not necessary to open the valve in utero (to prevent overdistension of the lungs), and the presence of the valve contributed to several occlusive failures. In contrast, the foam insert was easy to position and to remove from the trachea, while providing reliable tracheal occlusion for several weeks with consequent enlarged fetal lungs, increased lung fluid volumes, complete reduction of abdominal viscera, and improved pulmonary gas exchange after birth. Bronchoscopic evaluation of the foam-occluded neonatal tracheas showed little or no tracheal damage, which was confirmed during necropsy by gross and histological examination. Translaryngeal placement of a compressible, water-impermeable polymeric foam appears to be a simple and safe technique to achieve fetal tracheal occlusion.
Echogenic foci within the fetal heart have been reported in association with cardiac tumors and chromosomal abnormalities. They have been observed also as a normal variant of cardiac development. The goal of this study was to analyze the frequency, distribution and natural history of echogenic foci within the fetal heart. A total of 1139 patients referred for targeted ultrasound were studied. Patients with positive findings (presence of the echogenic foci) were referred for serial fetal echocardiographic examinations at 26-28 weeks and 34-36 weeks of pregnancy. Neonatal follow-up examinations were performed within the first 3 months of life in 27 cases. Ventricular echogenic foci were seen in 3.6% of fetuses. The locations of the echogenic foci were as follows: left ventricle, 92.8%; right ventricle, 4.8%; both ventricles, 2.4%. All fetuses had a normal karyotype. Echogenic foci remained present in all infants who underwent echocardiographic examination within the first 3 months of life. Echogenic intracardiac foci probably represent a normal variant of the development of papillary muscles and chordae tendinae.
During a 2 1/2-year period, 1 056 pregnant women (1 072 fetuses) were monitored with the nonstress test (NST) in the antenatal period. Testing time was 30 minutes. The NST was classified into one of four classes: normal, suspect pathological, slight pathological, and severe pathological. In 88.5% of the pregnancies, all NSTs were normal. Suspect, slight, or severe pathological NSTs occurred at least once in 8.1%, 2.1%, and 1.3% of the women respectively. All women with a severe pathological NST had high-risk complications. Lethal malformations excluded, there were only two perinatal deaths among the tested women. In the four different classes, the frequencies of cesarean section were 11%, 17%, 41%, and 79%. One-minute Apgar scores were less than 7 in 5%, 12%, 41%, and 64%. The need for referral to neonatal intensive care was 19%, 40%, 41%, and 93% respectively. A normal NST predicted normal fetal outcome in an excellent way, while the three pathological classes appeared to represent different degrees of impending fetal jeopardy.