Meta-Analysis of Selected Maternal and Fetal Factors for Perinatal ...

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BACKGROUND: In several developing countries, achieving Millennium Development Goal 4 is still off track. Multiple maternal and fetal risk factors were inconsistently attributed to the high perinatal mortality in developing countries. However, there was no meta-analysis that assessed the pooled effect of these factors on ...

BLOOD BIOMARKERS FOR EVALUATION OF PERINATAL ENCEPHALOPATHY

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Ernest Marshall Graham

2016-07-01

Full Text Available Recent research in identification of brain injury after trauma shows many possible blood biomarkers that may help identify the fetus and neonate with encephalopathy. Traumatic brain injury shares many common features with perinatal hypoxic-ischemic encephalopathy. Trauma has a hypoxic component, and one of the 1st physiologic consequences of moderate-severe traumatic brain injury is apnea. Trauma and hypoxia-ischemia initiate an excitotoxic cascade and free radical injury followed by the inflammatory cascade, producing injury in neurons, glial cells and white matter. Increased excitatory amino acids, lipid peroxidation products and alteration in microRNAs and inflammatory markers are common to both traumatic brain injury and perinatal encephalopathy. The blood-brain barrier is disrupted in both leading to egress of substances normally only found in the central nervous system. Brain exosomes may represent ideal biomarker containers, as RNA and protein transported within the vesicles are protected from enzymatic degradation. Evaluation of fetal or neonatal brain derived exosomes that cross the blood-brain barrier and circulate peripherally has been referred to as the liquid brain biopsy. A multiplex of serum biomarkers could improve upon the current imprecise methods of identifying fetal and neonatal brain injury such as fetal heart rate abnormalities, meconium, cord gases at delivery, and Apgar scores. Quantitative biomarker measurements of perinatal brain injury and recovery could lead to operative delivery only in the presence of significant fetal risk, triage to appropriate therapy after birth and measure the effectiveness of treatment.

Perinatal hypoxia increases susceptibility to high-altitude polycythemia and attendant pulmonary vascular dysfunction.

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Julian, Colleen Glyde; Gonzales, Marcelino; Rodriguez, Armando; Bellido, Diva; Salmon, Carlos Salinas; Ladenburger, Anne; Reardon, Lindsay; Vargas, Enrique; Moore, Lorna G

2015-08-15

Perinatal exposures exert a profound influence on physiological function, including developmental processes vital for efficient pulmonary gas transfer throughout the lifespan. We extend the concept of developmental programming to chronic mountain sickness (CMS), a debilitating syndrome marked by polycythemia, ventilatory impairment, and pulmonary hypertension that affects ∼10% of male high-altitude residents. We hypothesized that adverse perinatal oxygenation caused abnormalities of ventilatory and/or pulmonary vascular function that increased susceptibility to CMS in adulthood. Subjects were 67 male high-altitude (3,600-4,100 m) residents aged 18-25 yr with excessive erythrocytosis (EE, Hb concentration ≥18.3 g/dl), a preclinical form of CMS, and 66 controls identified from a community-based survey (n = 981). EE subjects not only had higher Hb concentrations and erythrocyte counts, but also lower alveolar ventilation, impaired pulmonary diffusion capacity, higher systolic pulmonary artery pressure, lower pulmonary artery acceleration time, and more frequent right ventricular hypertrophy, than controls. Compared with controls, EE subjects were more often born to mothers experiencing hypertensive complications of pregnancy and hypoxia during the perinatal period, with each increasing the risk of developing EE (odds ratio = 5.25, P = 0.05 and odds ratio = 6.44, P = 0.04, respectively) after other factors known to influence EE status were taken into account. Adverse perinatal oxygenation is associated with increased susceptibility to EE accompanied by modest abnormalities of the pulmonary circulation that are independent of increased blood viscosity. The association between perinatal hypoxia and EE may be due to disrupted alveolarization and microvascular development, leading to impaired gas exchange and/or pulmonary hypertension. Copyright © 2015 the American Physiological Society.

[The value of Doppler sonography in the detection of fetal hypoxia].

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Aranyosi, János; Zatik, János; Juhász, A Gábor; Fülesdi, Béla; Major, Tamás

2002-10-27

Doppler ultrasound has become a part of routine antenatal fetal surveillance during the past two decades. It provides insight into the utero-placental and fetal arterial, venous circulation non-invasively. Doppler examination has a key role in the detection of hypoxic risk since abnormal blood flow patterns can be demonstrated before the clinical manifestation of fetal disorder. Doppler velocimetry facilitates judgment in the diagnosis, monitoring fetal well-being during pregnancy and labor, scheduling antenatal tests and timing delivery. Authors review the effects of chronic and acute hypoxia on fetal hemodynamics. On the basis of the present knowledge and experience a brief summary is given about the role of Doppler velocimetry in the early detection of hypoxic fetal jeopardy during pregnancy and labor.

Fatores maternos e perinatais relacionados à macrossomia fetal Maternal and perinatal factors related to fetal macrosomia

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José Mauro Madi

2006-04-01

Full Text Available OBJETIVO: identificar fatores maternos e perinatais relacionados a fetos com peso igual ou maior do que 4.000 g no nascimento. MÉTODOS: estudo de corte transversal, de 411 casos consecutivos de macrossomia fetal, ocorridos no período de março de 1998 a março de 2005. Compararam-se os dados obtidos aos de 7.349 casos de fetos com peso entre 2.500 e 3.999 g ao nascimento, ocorridos no mesmo período. Foram analisadas variáveis maternas (idade, paridade, diabete melito, ocorrência de parto cesáreo, mecônio, desproporção feto-pélvica, principais indicações das cesáreas e perinatais (ocorrência de tocotraumatismo, índice de Apgar inferior a sete no 1º e 5º minuto, natimortalidade, neomortalidade precoce, necessidade de internação na Unidade de Tratamento Intensivo Neonatal. As avaliações estatísticas foram realizadas com o teste não paramétrico do chi2 com a correção de Yates e com o teste t de Student. Adotou-se o nível de significância de pPURPOSE: to identify maternal and perinatal factors related to neonates with birthweight >4,000 g. METHODS: cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight >2,500 and <3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications and perinatal variables (birth injury, <7 1-min and 5-min Apgar score, fetal and early neonatal mortality range, need of neonatal intensive care unit were analyzed. For statistical analysis the chi2 test with Yates correction and Student's t test were used with the level of significance set at 5%. RESULTS: FM was significantly associated with older mothers, more parous and <7 1-min Apgar score (p<0.05; OR=1.8; 95% CI: 1,4-2.5 and <7 5-min Apgar score (p<0,05; OR=2.3; 95% CI: 1

Potential Utility of Melatonin in Preeclampsia, Intrauterine Fetal Growth Retardation, and Perinatal Asphyxia.

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Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Reiter, Russel J; Gitto, Eloisa

2016-08-01

Reactive oxygen species play an important role in the pathogenesis of several diseases during gestation and the perinatal period. During pregnancy, increased oxygen demand augments the rate of production of free radicals. Oxidative stress is involved in pregnancy disorders including preeclampsia and intrauterine fetal growth retardation (IUGR). Moreover, increased levels of oxidative stress and reduced antioxidative capacities may contribute to the pathogenesis of perinatal asphyxia. Melatonin, an efficient antioxidant agent, diffuses through biological membranes easily and exerts pleiotropic actions on every cell and appears to be essential for successful gestation. This narrative review summarizes current knowledge concerning the role of melatonin in reducing complications during human pregnancy and in the perinatal period. Melatonin levels are altered in women with abnormally functioning placentae during preeclampsia and IUGR. Short-term melatonin therapy is highly effective and safe in reducing complications during pregnancy and in the perinatal period. Because melatonin has been shown to be safe for both mother and fetus, it could be an attractive therapy in pregnancy and is considered a promising neuroprotective agent in perinatal asphyxia. We believe that the use of melatonin treatment during the late fetal and early neonatal period might result in a wide range of health benefits, improved quality of life, and may help limit complications during the critical periods prior to, and shortly after, delivery. © The Author(s) 2015.

Umbilical blood flow ultrasound characteristics of perioperative fetal intrauterine hypoxia and their relationship with maternal and fetal oxidative stress injury

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Yu-Mei He

2017-05-01

Full Text Available Objective: To study the relationship between umbilical blood flow ultrasound characteristics of perioperative fetal intrauterine hypoxia and maternal as well as fetal oxidative stress injury. Methods: 108 puerperae giving birth in our hospital between May 2014 and October 2016 were selected and divided into normal pregnancy group with neonatal Apgar score >7 points and intrauterine hypoxia group with neonatal Apgar score ≤7 points, color Doppler diasonograph was used to determine umbilical blood flow ultrasound parameters, umbilical cord blood was collected to determine the levels of oxidative stress products, and the placenta was collected to determine the levels of oxidative stress products and related apoptosis molecules. Results: During 24–30 weeks, 31–36 weeks and 37–41 weeks of pregnancy, umbilical blood flow resistance index (RI, pulsatility index (PI and diastolic velocity/systolic velocity (S/D of intrauterine hypoxia group were significantly higher than those of normal pregnancy group (P<0.05; malondialdehyde (MDA, oxidized low-density lipoprotein (ox- LDL, 8-isoprostanes (8-iso, and heat shock protein 70 (HSP-70 levels in umbilical cord blood of intrauterine hypoxia group were significantly higher than those of normal pregnancy group (P<0.05, MDA, oxLDL, 8-ios, HSP-70, Fas, FasL and Bax levels in placenta tissue were significantly higher than those of normal pregnancy group (P<0.05, and Bcl-2 and XIAP levels were significantly lower than those of normal pregnancy group (P<0.05; RI, PI and S/ D were positively correlated with MDA, oxLDL, 8-ios and HSP-70 levels in umbilical cord blood and placenta tissue, positively correlated with Fas, FasL and Bax levels in placenta tissue, and negatively correlated with Bcl-2 and XIAP levels in placental tissue. Conclusions: The increased umbilical blood flow resistance and decreased flow volume of fetal intrauterine hypoxia are closely related to maternal, fetal and placental oxidative

Functional magnetic resonance imaging (fMRI) for fetal oxygenation during maternal hypoxia: initial results

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Wedegaertner, U.; Adam, G. [Abt. fuer Diagnostische und Interventionelle Radiologie, Klinik und Poliklinik fuer Radiologie, UKE Hamburg (Germany); Tchirikov, M.; Schroeder, H. [Abt. fuer experimentelle Gynaekologie der Universitaetsfrauenklinik, Klinik und Poliklinik fuer Frauenheilkunde, UKE, Hamburg (Germany); Koch, M. [Klinik und Poliklinik fuer Neurologie, UKE Hamburg (Germany)

2002-06-01

Purpose: To investigate the potential of fMRI to measure changes in fetal tissue oxygenation during acute maternal hypoxia in fetal lambs. Material and Methods: Two ewes carrying singleton fetuses (gestational age 125 and 131 days) underwent MR imaging under inhalation anesthesia. BOLD imaging of the fetal brain, liver and myocardium was performed during acute maternal hypoxia (oxygen replaced by N{sub 2}O). Maternal oxygen saturation and heart rate were monitored by a pulse-oxymeter attached to the maternal tongue. Results: Changes of fetal tissue oxygenation during maternal hypoxia were clearly visible with BOLD MRI. Signal intensity decreases were more distinct in liver and heart ({proportional_to}40%) from control than in the fetal brain ({proportional_to}10%). Conclusions: fMRI is a promising diagnostic tool to determine fetal tissue oxygenation and may open new opportunities in monitoring fetal well being in high risk pregnancies complicated by uteroplacentar insufficiency. Different signal changes in liver/heart and brain may reflect a centralization of the fetal blood flow. (orig.) [German] Ziel: Untersuchung des Potentiales der funktionellen MRT (BOLD) in der Darstellung von Veraenderungen in der Sauerstoffsaettigung fetaler Gewebe waehrend akuter materner Hypoxie bei fetalen Laemmern. Material und Methoden: Die MR-Untersuchung wurde an zwei Mutterschafen mit 125 und 131 Tage alten Feten in Inhalationsnarkose durchgefuehrt. Die BOLD Messungen von fetaler Leber, Myokard und Gehirn erfolgten waehrend einer akuten Hypoxiephase des Muttertieres, in der Sauerstoff durch N{sub 2}O ersetzt wurde. Die materne Sauerstoffsaettigung und Herzfrequenz wurde durch ein Pulsoxymeter ueberwacht. Ergebnisse: Aenderungen der fetalen Gewebsoxygenierung waehrend einer akuten Hypoxiephase der Mutter waren mit der BOLD-MR-Bildgebung deutlich darstellbar. In der fetalen Leber und dem Myokard zeigte sich ein staerkerer Signalabfall um ca. 40% von den Kontrollwerten als im fetalen

The success of cardiotocography in predicting perinatal outcome

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Alpaslan Kaban

2012-06-01

Full Text Available Objectives: The determination of the fetal condition duringlabor is important to minimize fetal death due to asphyxiaand the neurological sequelae of fetal hypoxia.This study evaluated the success of fetal cardiotocographyin predicting perinatal consequences.Materials and methods: This study enrolled 101 full-termpregnant women admitted for delivery to Vakif GurebaTraining and Research Hospital between October 2009and February 2010. Women were included if they wereaged 18-45 years and within 36-41 weeks of gestation.During a 20-min period of fetal monitoring, a change inFHR (fetal heart rate lasting for 15 s or two elevated runsof 15 beats was evaluated as a reactive NST (non-stresstest. The umbilical artery pH was used as the “gold standard”for assessing fetal asphyxia.Results: The mean age of the women included in thestudy was 27.82 ± 5.29 years, the average parity was1.09± 0.96. The pH was normal in 85 neonates, while 13 hadfetal asphyxia. No significant difference in umbilical cordblood pH, pO2, or pCO2 was observed between these twogroups (p = 0.497, p = 0.722, and p = 0.053, respectively.No significant difference in maternal age, parity, or birthweight was found between the group with fetal distressbased on CTG (cardiotocography and the normal group.Conclusion: Cardiotocography is an important test duringlabor for labor management, it is insufficient for predictingthe perinatal outcome. Therefore, labor should beevaluated on an individualized basis. J Clin Exp Invest2012; 3(2: 168-171

Evolving changes in fetal heart rate variability and brain injury after hypoxia-ischaemia in preterm fetal sheep.

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Yamaguchi, Kyohei; Lear, Christopher A; Beacom, Michael J; Ikeda, Tomoaki; Gunn, Alistair J; Bennet, Laura

2018-01-08

Fetal heart rate variability is a critical index of fetal wellbeing. Suppression of heart rate variability may provide prognostic information on the risk of hypoxic-ischaemic brain injury after birth. In the present study, we report the evolution of fetal heart rate variability after both mild and severe hypoxia-ischaemia. Both mild and severe hypoxia-ischaemia were associated with an initial, brief suppression of multiple measures of heart rate variability. This was followed by normal or increased levels of heart rate variability during the latent phase of injury. Severe hypoxia-ischaemia was subsequently associated with the prolonged suppression of measures of heart rate variability during the secondary phase of injury, which is the period of time when brain injury is no longer treatable. These findings suggest that a biphasic pattern of heart rate variability may be an early marker of brain injury when treatment or intervention is probably most effective. Hypoxia-ischaemia (HI) is a major contributor to preterm brain injury, although there are currently no reliable biomarkers for identifying infants who are at risk. We tested the hypothesis that fetal heart rate (FHR) and FHR variability (FHRV) would identify evolving brain injury after HI. Fetal sheep at 0.7 of gestation were subjected to either 15 (n = 10) or 25 min (n = 17) of complete umbilical cord occlusion or sham occlusion (n = 12). FHR and four measures of FHRV [short-term variation, long-term variation, standard deviation of normal to normal R-R intervals (SDNN), root mean square of successive differences) were assessed until 72 h after HI. All measures of FHRV were suppressed for the first 3-4 h in the 15 min group and 1-2 h in the 25 min group. Measures of FHRV recovered to control levels by 4 h in the 15 min group, whereas the 25 min group showed tachycardia and an increase in short-term variation and SDNN from 4 to 6 h after occlusion. The measures of FHRV then progressively

Fetal programming of neuropsychiatric disorders.

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Faa, Gavino; Manchia, Mirko; Pintus, Roberta; Gerosa, Clara; Marcialis, Maria Antonietta; Fanos, Vassilios

2016-09-01

Starting from the Developmental Origins of Health and Disease (DOHaD) hypotheses proposed by David Barker, namely fetal programming, in the past years, there is a growing evidence of the major role played by epigenetic factors during the intrauterine life and the perinatal period. Furthermore, it has been assessed that these factors can affect the health status in infancy and even in adulthood. In this review, we focus our attention on the fetal programming of the brain, analyzing the most recent literature concerning the epigenetic factors that can influence the development of neuropsychiatric disorders such as bipolar disorders, major depressive disorders, and schizophrenia. The perinatal epigenetic factors have been divided in two main groups: maternal factors and fetal factors. The maternal factors include diet, smoking, alcoholism, hypertension, malnutrition, trace elements, stress, diabetes, substance abuse, and exposure to environmental toxicants, while the fetal factors include hypoxia/asphyxia, placental insufficiency, prematurity, low birth weight, drugs administered to the mother or to the baby, and all factors causing intrauterine growth restriction. A better comprehension of the possible mechanisms underlying the pathogenesis of these diseases may help researchers and clinicians develop new diagnostic tools and treatments to offer these patients a tailored medical treatment strategy to improve their quality of life. Birth Defects Research (Part C) 108:207-223, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Morphological evaluation of the cerebral blood vessels in the late gestation fetal sheep following hypoxia in utero.

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Baburamani, Ana A; Lo, Camden; Castillo-Melendez, Margie; Walker, David W

2013-01-01

Hypoxia can significantly contribute to the development of permanent brain injury in the term neonate; however the response of cerebral blood vessels is not well understood. This study aimed to quantitatively measure vascular density and morphology using laminin immunohistochemistry as a marker of blood vessels, and determine the effects of a single, severe bout of hypoxia (umbilical cord occlusion, UCO) late in gestation on the developing cerebrovasculature in fetal sheep. At 124-126 days gestation singleton fetal sheep underwent surgery for implantation of catheters and placement of an inflatable cuff around the umbilical cord. A 10 min UCO or sham UCO (n=5) occurred at 132 days gestation. Fetal brains were collected at 24 h (n=5) or 48 h (n=4) after UCO for vascular density and morphology analysis of laminin immunohistochemistry. 48 h following a single, brief bout of severe hypoxia late in gestation decreased vascular density was seen in the caudate nucleus and no changes in vascular morphology occurred. However closer analysis revealed a significant shift in the frequency of smaller (≤10 μm) to larger (≤100 μm) perimeter blood vessels in periventricular and subcortical white matter. Close examination of the frequency distribution of vascular perimeter highlights that alterations in vascular morphology persist in the near term fetal brain for up to 48 h following a brief (10 min) hypoxia in white but not gray matter. These findings suggest that the near term brain may still be vulnerable to white matter injury following in utero hypoxia. Copyright © 2012 Elsevier Inc. All rights reserved.

Perinatal mortality and socio-spatial inequalities

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Eunice Francisca Martins

2013-09-01

Full Text Available OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4, coverage areas (5.3 to 49.4 and areas of risk (13.2 to 20.7. The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.

Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance.

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Nassr, Ahmed Abobakr; Abdelmagied, Ahmed M; Shazly, Sherif A M

2016-03-01

The objective of this meta-analysis is to assess the value of fetal cerebro-placental Doppler ratio (CPR) in predicting adverse perinatal outcome in pregnancies with fetal growth restriction (FGR). Three databases were used: MEDLINE, EMBASE (with online Ovid interface) and SCOPUS and studies from inception to April 2015 were included. Studies that reported perinatal outcomes of fetuses at risk of FGR or sonographically diagnosed FGR that were evaluated with CPR were considered eligible. Perinatal outcomes include cesarean section (CS) for fetal distress, APGAR scores at 5 min, neonatal complications and admission to neonatal intensive care unit (NICU). Pooled data were expressed as odds ratio (OR) and confidence intervals (CI), and the summary receiver operating characteristic (SROC) curve was used to illustrate the diagnostic accuracy of CPR. Seven studies were eligible (1428 fetuses). Fetuses with abnormal CPR were at higher risk of CS for fetal distress (OR=4.49, 95% CI [1.63, 12.42]), lower APGAR scores (OR=4.01, 95% CI [2.65, 6.08]), admission to NICU (OR=9.65, 95% CI [3.02, 30.85]), and neonatal complications (OR=11.00, 95% [3.64, 15.37]) than fetuses who had normal CPR. These risks were higher among studies that included fetuses diagnosed with FGR than fetuses at risk of FGR. Abnormal CPR had higher diagnostic accuracy for adverse perinatal outcomes among "sonographically diagnosed FGR" studies than "at risk of FGR" studies. Abnormal CPR is associated with substantial risk of adverse perinatal outcomes. The test seems to be particularly useful for follow up of fetuses with sonographically diagnosed FGR.

Causes and Mechanisms of Intrauterine Hypoxia and Its Impact on the Fetal Cardiovascular System: A Review

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Damian Hutter

2010-01-01

Full Text Available Until today the role of oxygen in the development of the fetus remains controversially discussed. It is still believed that lack of oxygen in utero might be responsible for some of the known congenital cardiovascular malformations. Over the last two decades detailed research has given us new insights and a better understanding of embryogenesis and fetal growth. But most importantly it has repeatedly demonstrated that oxygen only plays a minor role in the early intrauterine development. After organogenesis has taken place hypoxia becomes more important during the second and third trimester of pregnancy when fetal growth occurs. This review will briefly adress causes and mechanisms leading to intrauterine hypoxia and their impact on the fetal cardiovascular system.

Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects

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Hod, Moshe; Damm, Peter; Kaaja, Risto

2008-01-01

The objective of the study was a comparison of insulin aspart (IAsp) with human insulin (HI) in basal-bolus therapy with neutral protamine Hagedorn for fetal and perinatal outcomes of type 1 diabetes in pregnancy.......The objective of the study was a comparison of insulin aspart (IAsp) with human insulin (HI) in basal-bolus therapy with neutral protamine Hagedorn for fetal and perinatal outcomes of type 1 diabetes in pregnancy....

Cardiovascular function in term fetal sheep conceived, gestated and studied in the hypobaric hypoxia of the Andean altiplano.

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Herrera, Emilio A; Rojas, Rodrigo T; Krause, Bernardo J; Ebensperger, Germán; Reyes, Roberto V; Giussani, Dino A; Parer, Julian T; Llanos, Aníbal J

2016-03-01

High-altitude hypoxia causes intrauterine growth restriction and cardiovascular programming. However, adult humans and animals that have evolved at altitude show certain protection against the effects of chronic hypoxia. Whether the highland fetus shows similar protection against high altitude gestation is unclear. We tested the hypothesis that high-altitude fetal sheep have evolved cardiovascular compensatory mechanisms to withstand chronic hypoxia that are different from lowland sheep. We studied seven high-altitude (HA; 3600 m) and eight low-altitude (LA; 520 m) pregnant sheep at ∼90% gestation. Pregnant ewes and fetuses were instrumented for cardiovascular investigation. A three-period experimental protocol was performed in vivo: 30 min of basal, 1 h of acute superimposed hypoxia (∼10% O2) and 30 min of recovery. Further, we determined ex vivo fetal cerebral and femoral arterial function. HA pregnancy led to chronic fetal hypoxia, growth restriction and altered cardiovascular function. During acute superimposed hypoxia, LA fetuses redistributed blood flow favouring the brain, heart and adrenals, whereas HA fetuses showed a blunted cardiovascular response. Importantly, HA fetuses have a marked reduction in umbilical blood flow versus LA. Isolated cerebral arteries from HA fetuses showed a higher contractile capacity but a diminished response to catecholamines. In contrast, femoral arteries from HA fetuses showed decreased contractile capacity and increased adrenergic contractility. The blunting of the cardiovascular responses to hypoxia in fetuses raised in the Alto Andino may indicate a change in control strategy triggered by chronic hypoxia, switching towards compensatory mechanisms that are more cost-effective in terms of oxygen uptake. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

Perinatal intermittent hypoxia alters γ-aminobutyric acid: a receptor levels in rat cerebellum.

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Pae, Eung-Kwon; Yoon, Audrey J; Ahuja, Bhoomika; Lau, Gary W; Nguyen, Daniel D; Kim, Yong; Harper, Ronald M

2011-12-01

Perinatal hypoxia commonly causes brain injury in infants, but the time course and mechanisms underlying the preferential male injury are unclear. Intermittent hypoxia disturbs cerebellar γ-aminobutyric (GABA)-A receptor profiles during the perinatal period, possibly responding to transient excitatory processes associated with GABA(A) receptors. We examined whether hypoxic insults were particularly damaging to the male rodent cerebellum during a specific developmental time window. We evaluated cerebellar injury and GABA(A) receptor profiles following 5-h intermittent hypoxia (IH: 20.8% and 10.3% ambient oxygen, switched every 240s) or room-air control in groups of male and female rat pups on postnatal d 1-2, wk 1, or wk 3. The cerebella were harvested and compared between groups. The mRNA levels of GABA(A) receptors α6, normalized to a house-keeping gene GAPDH, and assessed using real-time reverse-transcriptase PCR assays were up-regulated by IH at wk 1, more extensively in male rats, with sex influencing the regulatory time-course. In contrast, GABA(A) α6 receptor protein expression levels, assessed using Western blot assays, reached a nadir at wk 1 in both male and female rats, possibly indicating involvement of a post-transcriptional mechanism. The extent of cerebellar damage and level of apoptosis, assessed by DNA fragmentation, were greatest in the wk 3 IH-exposed group. The findings suggest partial protection for female rats against early hypoxic insult in the cerebellum, and that down-regulation of GABA(A) receptors, rather than direct neural injury assessed by DNA fragmentation may modify cerebellar function, with potential later motor and other deficits. Copyright © 2011 ISDN. Published by Elsevier Ltd. All rights reserved.

Ultrasound assessment of the fetal biophysical profile: What does an radiologist need to know?

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Guimaraes Filho, Helio Antonio; Araujo Junior, Edward; Marcondes Machado Nardozza, Luciano; Linhares Dias da Costa, Lavoisier; Fernandes Moron, Antonio; Mattar, Rosiane

2008-01-01

Proposed by Frank Manning about 26 years ago, fetal biophysical profile has been incorporated to the propaedeutics of non-invasive fetal well being assessment in high-risk gestations. Despite the existence of other methods for assessing fetal vitality, as Doppler flowmetry, the biophysical profile continues to be important in estimating the risk of hypoxia and perinatal morbimortality for those fetuses. In the present article, the authors review the regulatory mechanisms of fetal biophysical activities, as well as physiological and pathological factors that interfere with them. The main objective of the study is to discuss the present and important aspects of the method, and the practical applications and interpretation of its findings, in order to help radiologists improve their knowledge in this specific area of fetal ultrasonography

Fetal growth and perinatal outcome of pregnancies continuing after threatened abortion.

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Das, A G; Gopalan, S; Dhaliwal, L K

1996-05-01

The present study was conducted with the aim to find out the effect of threatened abortion in the current pregnancy on the subsequent perinatal outcome and follow the growth pattern of the fetuses of such complicated pregnancies. The study group consisted of 55 women with threatened abortion and 55 women with normal pregnancies formed the control group. Most of the patients presented at 6-12 weeks' gestation. The fetal growth was monitored by both clinical as well as ultrasound (USG) parameters. The mean growth rates were almost identical throughout gestation. The mean values of each parameter of the study group were found lying with 95% confidence limit values of their control group. The apparent increased incidence of low lying placenta in early pregnancy probably contributed to threatened abortion. There was no significant difference in preterm delivery, low birth-weight and overall perinatal outcome.

Maternal and fetal Acid-base chemistry: a major determinant of perinatal outcome.

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Omo-Aghoja, L

2014-01-01

Very small changes in pH may significantly affect the function of various fetal organ systems, such as the central nervous system, and the cardiovascular system with associated fetal distress and poor Apgar score. Review of existing data on maternal-fetal acid-base balance in pregnancy highlight the factors that are associated with derangements of the acid-base status and the impact of the derangements on fetal outcome. Extensive search of electronic databases and manual search of journals for relevant literature on maternal and fetal acid chemistry, clinical studies and case studies were undertaken. There is a substantial reduction in the partial pressure of carbon dioxide (pCO2) in pregnancy. Adequate buffering prevents significant changes in maternal arterial pH. Normal fetal metabolism results in the production of acids which are buffered to maintain extracellular pH within a critical range. Fetal hypoxia can occur when maternal oxygenation is compromised, maternal perfusion of the placenta is reduced, or delivery of oxygenated blood from the placenta to the fetus is impeded. When adequate fetal oxygenation does not occur, metabolisms proceed along with an anaerobic pathway with production of organic acids, such as lactic acid. Accumulation of lactic acid can deplete the buffer system and result in metabolic acidosis with associated low fetal pH, fetal distress and poor Apgar score. There is a significant reduction in pCO2 in pregnancy. This change, however, does not result in a corresponding significant reduction in maternal arterial pH, because of adequate buffering. Very small changes in pH may cause significant derangement in fetal function and outcome.

Cardiac Restoration Stemming From the Placenta Tree: Insights From Fetal and Perinatal Cell Biology

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Sveva Bollini

2018-04-01

Full Text Available Efficient cardiac repair and ultimate regeneration still represents one of the main challenges of modern medicine. Indeed, cardiovascular disease can derive from independent conditions upsetting heart structure and performance: myocardial ischemia and infarction (MI, pharmacological cardiotoxicity, and congenital heart defects, just to name a few. All these disorders have profound consequences on cardiac tissue, inducing the onset of heart failure over time. Since the cure is currently represented by heart transplantation, which is extremely difficult due to the shortage of donors, much effort is being dedicated to developing innovative therapeutic strategies based on stem cell exploitation. Among the broad scenario of stem/progenitor cell subpopulations, fetal and perinatal sources, namely amniotic fluid and term placenta, have gained interest due to their peculiar regenerative capacity, high self-renewal capability, and ease of collection from clinical waste material. In this review, we will provide the state-of-the-art on fetal perinatal stem cells for cardiac repair and regeneration. We will discuss different pathological conditions and the main therapeutic strategies proposed, including cell transplantation, putative paracrine therapy, reprogramming, and tissue engineering approaches.

PP096. The effect of preterm placental calcification on uteroplacental blood flow, fetal growth and perinatal outcome in hypertension complicating pregnancy.

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Chen, K-H; Chen, L-R

2012-07-01

Placental calcification is often found in pregnancy at term and regarded as a physiological aging process. However, its earlier presence, before 36weeks' gestation (preterm placental calcification) may have an unusual pathological implication [1-3]. This prospective cohort study aims to examine the effect of preterm placental calcification on uteroplacental blood flow, fetal growth and perinatal death (including intrauterine fetal death and neonatal death) in hypertension complicating pregnancy. Monthly ultrasound was performed starting at 28weeks' gestation to establish the diagnosis of Grade III placental calcification, with measurement of fetal growth and uteroplacental blood flow by Doppler velocimetry on the umbilical vessels at 34weeks' gestation. Participants (n=105) were classified into Group A (n=44), a hypertensive study group with notable preterm placental calcification at 28-36weeks' gestation, and Group B (n=61), a hypertensive control group without notable preterm placental calcification prior to 36weeks' gestation. Women who smoked or drank alcohol during their pregnancies, had multifetal gestations, or major fetal congenital anomalies were all excluded. In addition to the measurement of S/D ratio, poor uteroplacental blood flow was confirmed by absent or reversed end-diastolic velocity (AREDV). Logistic regression analysis was used to estimate the risks of AREDV, poor fetal growth (IUGR) and perinatal death by calculating odds ratios (OR) and 95% confidence intervals (CI), adjusted by maternal age, body mass index, economic status, co-morbidities (e.g. diabetes, marked anemia and placenta previa), type of delivery, and parity. In Group A, there is significant higher mean S/D ratio (3.80 Vs 3.28), as well as higher incidences of AREDV (28.2% Vs 10.5%), IUGR (45.5% Vs 26.2%), and perinatal deaths (20.5% Vs 6.6%) than those in Group B (pgrowth and perinatal death. Being an ominous sign, it may precede poor uteroplacental blood flow, fetal growth and

Improvement of perinatal outcome in diabetic pregnant women.

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Szilagyi, A; Szabo, I

2001-01-01

Obstetrical and perinatal outcomes in newborns of diabetic pregnant women depend on metabolic control and fetal surveillance during pregnancy. The effects of fetal surveillance on perinatal mortality and morbidity was analyzed in diabetic pregnant women with appropriate glucose control in our regional center for diabetes and pregnancy. 480 deliveries complicated by frank or gestational diabetes occurred in our Department in the period of 1988-1999. Perinatal mortality and morbidity, prevalence of premature deliveries, methods of fetal surveillance, options for respiratory distress syndrome (RDS) profilaxis, cesarean section rate, timing of delivery and its indications and occurrence of malformations have been analyzed. It was found that malformation rate and perinatal mortality may be reduced to even lower level than that of in healthy pregnant women by appropriate glucose control and by using the latest methods of intrauterine fetal surveillance including cardiotocography (non stress test and oxytocin challenge test), doppler fetal artery velocimetry and fetal pulse oximetry. Timing of delivery was needed in 35% of the cases with IDDM and 15% of gestational diabetes due to chronic placental insufficiency. If labour induction was needed before the 38 weeks, amniocentesis was performed to test fetal lung maturity. Direct fetal glucocorticoid administration was used to enhance fetal lung maturation in 14 cases. C-section rate was slightly higher than that of in non diabetic pregnant women. Our perinatal morbidity data (macrosomia, hyperbilirubinemia, hypoglycemia, injuries, infections) are comparable with the data from the literature. Although perinatal mortality with the help of thorough fetal surveillance is even better in diabetic pregnant women than in non diabetic patients, future eye should be focused on factors affecting perinatal morbidity, because it is still higher than in newborns of healthy mothers.

Perinatal morbidity and mortality in early-onset fetal growth restriction : cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE)

NARCIS (Netherlands)

Lees, C.; Marlow, N.; Arabin, B.; Bilardo, C. M.; Brezinka, C.; Derks, J. B.; Duvekot, J.; Frusca, T.; Diemert, A.; Ferrazzi, E.; Ganzevoort, W.; Hecher, K.; Martinelli, P.; Ostermayer, E.; Papageorghiou, A. T.; Schlembach, D.; Schneider, K. T. M.; Thilaganathan, B.; Todros, T.; van Wassenaer-Leemhuis, A.; Valcamonico, A.; Visser, G. H. A.; Wolf, H.

2013-01-01

ObjectivesFew data exist for counseling and perinatal management of women after an antenatal diagnosis of early-onset fetal growth restriction. Yet, the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe

A comparison of blood and cerebrospinal fluid cytokines (IL-1β, IL-6, IL-18, TNF-α in neonates with perinatal hypoxia

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Darinka Šumanović-Glamuzina

2017-08-01

Full Text Available Perinatal hypoxia-ischemia is a specific and important pathological event in neonatal care practice. The data on relationship between the concentrations of cytokines in blood and cerebrospinal fluid (CSF and perinatal brain injury are scarce. The aim of this study is to evaluate changes in interleukin (IL-1β, IL-6, and IL-18 and tumor necrosis factor alpha (TNF-α levels in newborns with perinatal hypoxia (PNH. CSF and serum samples of 35 term and near-term (35-40 weeks newborns with PNH, at the age of 3-96 hours, were analyzed using enzyme-linked immunosorbent assay. Control group consisted of 25 non-asphyxic/non-hypoxic infants of the same age sampled for clinically suspected perinatal meningitis, but proven negative and healthy otherwise. The cytokine values in CSF and serum samples were determined in relation to initial hypoxic-ischemic encephalopathy (HIE staged according the Sarnat/Sarnat method, and compared with neurological outcome at 12 months of age estimated using Amiel-Tison procedure. The concentrations of IL-6 and TNF-α in serum of PNH patients were significantly higher compared to control group (p = 0.0407 and p = 0.023, respectively. No significant difference between average values of cytokines in relation to the stage of HIE was observed. Significantly higher levels of IL-6 and IL-18 corresponded to a mildly abnormal neurological outcome, while higher levels of IL-6 and TNF-α corresponded to a severely abnormal neurological outcome, at 12 months of age. Elevated serum levels of IL-6 and TNF-α better corresponded with hypoxia/ischemia compared to CSF values, within 96 hours of birth. Also, higher serum levels of IL-6, TNF-α, and IL-18 corresponded better with abnormal neurological outcome at 12 months of age, compared to CSF values.

Relationship between maternal hemoglobin and perinatal outcome

International Nuclear Information System (INIS)

Bakhtiar, U.J.; Khan, Y.; Nisar, R.

2007-01-01

To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)

Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome

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García-Díaz Lutgardo

2012-07-01

Full Text Available Abstract Background Giant placental chorioangiomas have been associated with a number of severe fetal complications and high perinatal mortality. Case presentation We report a case of giant chorioangioma with fetal hydrops, additionally complicated by severe anemia, mild cardiomegaly with hyperdinamic heart circulation and maternal mirror syndrome. Intrauterine blood transfusion and amniodrainage was performed at 29 weeks. Worsening of the fetal and maternal condition prompted us to proceed with delivery at 29 + 5 weeks. The newborn died 3 hours later due to pulmonary hypoplasia and hemodynamic failure. Maternal course was favourable, mirror syndrome resolved in the second day and the patient was discharged four days following delivery. Conclusions In the case described here, fetal condition got worse despite of the anemia correction and amniodrainage. Our outcome raises the issue whether additional intrauterine clinical intervention, as intersticial laser, should have been performed to stop further deterioration of the fetal condition when progressive severe hydrops develops.

NEUROSPECIFIC ENOLASE IN DIAGNOSTICS FOR PERINATAL DAMAGE TO THE CENTRAL NERVOUS SYSTEM IN PREMATURE INFANTS

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E.G. Novopol'tseva

2010-01-01

Full Text Available Neurospecific enolase is an endoenzyme of the central nervous system (CNS present in neurons of the brain and peripheral neuraltissue. This is currently the only known general marker of all differentiated neurons. The article illustrates the results of determining this enzyme in premature infants with fetal infections and assessment of their importance as a marker of damage to CNS in this group of children. A high level of neurospecific enolase in children with infectious and inflammatory diseases is not only the marker of damage to blood-brain barrier, but also reflects the nature of damage (hypoxia, intoxication, inflammation. This parameter in premature infants with various pathologies may serve as a degree of perinatal damage severity, and along with other parameters, determine the performed therapy tactics. Key words: neurospecific enolase, marker of CNS damage, perinatal damage, children. (Pediatric Pharmacology. – 2010; 7(3:66-70

Hipertiroidismo en gestación: Clínica, morbi-mortalidad materna, fetal y perinatal.

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Hermógenes Palacios Porras

1995-04-01

Full Text Available Objetivo: Determinar la prevalencia y características clínicas del hipertiroidismo en gestantes y definir la influencia de hipertiroidismo sobre la morbimortalidad materna, fetal y perinatal. Material y métodos: Se incluyeron 29 pacientes con diagnóstico de hipertiroidismo y gestación, que cumplieron los criterios de inclusión. Las pacientes fueron divididas en dos grupos, hipertiroidismo compensado durante toda o la mayor parte de la gestación (Grupo I, n=11 y con hipertiroidismo no compensado (Grupo II, n=18. Resultados: La prevalencia de hipertiroidismo y gestación fue de 0.03%. La enfermedad de Graves estuvo presente en el 96.5% de los casos; el 62% cursó con náuseas y vómitos y el 90% con bocio de 40 a 60 gramos. Comparando los grupos I y II, observamos en este último, una mayor frecuencia cardíaca y una menor ganancia de peso (p<0.001 y p<0.0002, respectivamente. Los productos del grupo II, tuvieron un mayor índice de prematuridad (5 de 7 y de bajo peso al nacer (p<0.0003; todos los abortos (4, óbitos (2 y malformaciones congénitas (2, se presentaron en este grupo. El tratamiento recibido fue metimazol a dosis variable (10 a 30 mg/día, no encontramos efectos deletéreos importantes atribuibles al tratamiento. Conclusiones: El hipertiroidismo mal controlado durante la gestación produce mayor morbimortalidad materna, fetal y perinatal. (Rev Med Hered 1995; 6: 107-114.

A randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring

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Santos Cristina

2010-10-01

Full Text Available Abstract Background Intrapartum fetal hypoxia remains an important cause of death and permanent handicap and in a significant proportion of cases there is evidence of suboptimal care related to fetal surveillance. Cardiotocographic (CTG monitoring remains the basis of intrapartum surveillance, but its interpretation by healthcare professionals lacks reproducibility and the technology has not been shown to improve clinically important outcomes. The addition of fetal electrocardiogram analysis has increased the potential to avoid adverse outcomes, but CTG interpretation remains its main weakness. A program for computerised analysis of intrapartum fetal signals, incorporating real-time alerts for healthcare professionals, has recently been developed. There is a need to determine whether this technology can result in better perinatal outcomes. Methods/design This is a multicentre randomised clinical trial. Inclusion criteria are: women aged ≥ 16 years, able to provide written informed consent, singleton pregnancies ≥ 36 weeks, cephalic presentation, no known major fetal malformations, in labour but excluding active second stage, planned for continuous CTG monitoring, and no known contra-indication for vaginal delivery. Eligible women will be randomised using a computer-generated randomisation sequence to one of the two arms: continuous computer analysis of fetal monitoring signals with real-time alerts (intervention arm or continuous CTG monitoring as previously performed (control arm. Electrocardiographic monitoring and fetal scalp blood sampling will be available in both arms. The primary outcome measure is the incidence of fetal metabolic acidosis (umbilical artery pH ecf > 12 mmol/L. Secondary outcome measures are: caesarean section and instrumental vaginal delivery rates, use of fetal blood sampling, 5-minute Apgar score Discussion This study will provide evidence of the impact of intrapartum monitoring with computer analysis and real

Autism spectrum disorders and fetal hypoxia in a population-based cohort: Accounting for missing exposures via Estimation-Maximization algorithm

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Yasui Yutaka

2011-01-01

Full Text Available Abstract Background Autism spectrum disorders (ASD are associated with complications of pregnancy that implicate fetal hypoxia (FH; the excess of ASD in male gender is poorly understood. We tested the hypothesis that risk of ASD is related to fetal hypoxia and investigated whether this effect is greater among males. Methods Provincial delivery records (PDR identified the cohort of all 218,890 singleton live births in the province of Alberta, Canada, between 01-01-98 and 12-31-04. These were followed-up for ASD via ICD-9 diagnostic codes assigned by physician billing until 03-31-08. Maternal and obstetric risk factors, including FH determined from blood tests of acidity (pH, were extracted from PDR. The binary FH status was missing in approximately half of subjects. Assuming that characteristics of mothers and pregnancies would be correlated with FH, we used an Estimation-Maximization algorithm to estimate HF-ASD association, allowing for both missing-at-random (MAR and specific not-missing-at-random (NMAR mechanisms. Results Data indicated that there was excess risk of ASD among males who were hypoxic at birth, not materially affected by adjustment for potential confounding due to birth year and socio-economic status: OR 1.13, 95%CI: 0.96, 1.33 (MAR assumption. Limiting analysis to full-term males, the adjusted OR under specific NMAR assumptions spanned 95%CI of 1.0 to 1.6. Conclusion Our results are consistent with a weak effect of fetal hypoxia on risk of ASD among males. E-M algorithm is an efficient and flexible tool for modeling missing data in the studied setting.

Ultrasound Imaging of Mouse Fetal Intracranial Hemorrhage Due to Ischemia/Reperfusion

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Kenichi Funamoto

2017-05-01

Full Text Available Despite vast improvement in perinatal care during the 30 years, the incidence rate of neonatal encephalopathy remains unchanged without any further Progress towards preventive strategies for the clinical impasse. Antenatal brain injury including fetal intracranial hemorrhage caused by ischemia/reperfusion is known as one of the primary triggers of neonatal injury. However, the mechanisms of antenatal brain injury are poorly understood unless better predictive models of the disease are developed. Here we show a mouse model for fetal intracranial hemorrhage in vivo developed to investigate the actual timing of hypoxia-ischemic events and their related mechanisms of injury. Intrauterine growth restriction mouse fetuses were exposed to ischemia/reperfusion cycles by occluding and opening the uterine and ovarian arteries in the mother. The presence and timing of fetal intracranial hemorrhage caused by the ischemia/reperfusion were measured with histological observation and ultrasound imaging. Protein-restricted diet increased the risk of fetal intracranial hemorrhage. The monitoring of fetal brains by ultrasound B-mode imaging clarified that cerebral hemorrhage in the fetal brain occurred after the second ischemic period. Three-dimensional ultrasound power Doppler imaging visualized the disappearance of main blood flows in the fetal brain. These indicate a breakdown of cerebrovascular autoregulation which causes the fetal intracranial hemorrhage. This study supports the fact that the ischemia/reperfusion triggers cerebral hemorrhage in the fetal brain. The present method enables us to noninvasively create the cerebral hemorrhage in a fetus without directly touching the body but with repeated occlusion and opening of the uterine and ovarian arteries in the mother.

Fetal Primary Cardiac Tumors During Perinatal Period

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Shi-Min Yuan

2017-06-01

Full Text Available Fetal primary cardiac tumors are rare, but they may cause complications, which are sometimes life threatening, including arrhythmias, hydrops fetalis, ventricular outflow/inflow obstruction, cardiac failure, and even sudden death. Among fetal primary cardiac tumors, rhabdomyomas are most common, followed by teratomas, fibromas, hemangiomas, and myxomas. Everolimus, a mammalian target of rapamycin inhibitor, has been reported to be an effective drug to cause tumor remission in three neonates with multiple cardiac rhabdomyomas. Neonatal cardiac surgery for the resection of primary cardiac tumors found by fetal echocardiography has been reported sporadically. However, open fetal surgery for pericardial teratoma resection, which was performed successfully via a fetal median sternotomy in one case report, could be a promising intervention to rescue these patients with large pericardial effusions. These recent achievements undoubtedly encourage further development in early management of fetal cardiac tumors. Owing to the rarity of fetal primary cardiac tumors, relevant information in terms of prenatal diagnosis, treatment, and prognosis remains to be clarified.

Fetal cerebral responses to ventilation and oxygenation in utero

International Nuclear Information System (INIS)

Gleason, C.A.; Jones, M.D. Jr.; Traystman, R.J.; Notter, R.H.

1988-01-01

Previous studies have shown that cerebral oxygen consumption (CMRO 2 ) increases by nearly 50% at birth. The perinatal factors responsible for this increase are unknown; however, one possibility is that fetal CMRO 2 is constrained by the normal intrauterine arterial Po 2 (Pa 0 2 ) of ∼20 mmHg. The authors investigated this possibility in seven near-term chronically instrumented fetal sheep (131-138 days gestation) in which they inserted vascular catheters and an endotracheal tube. After 1-3 days recovery, they measured cerebral blood flow (CBF) with radiolabeled microspheres and calculated CMRO 2 . Measurements were made in utero under three conditions for each fetus: (1) nonventilated control; (2) ventilation with 3% O 2 -5% CO 2 -92% N 2 ; and (3) ventilation with an inspired oxygen concentration sufficient to raise fetal Pa 0 2 to normal newborn levels. The results showed that increasing fetal arterial Po 2 to postnatal levels did not consistently increase CMRO 2 . CBF decreased as arterial O 2 content (Ca 0 2 ) rose, with an inverse hyperbolic response similar to that previously found to relate CBF to Ca 0 2 during fetal hypoxic hypoxia. This indicates that the normally low intrauterine Pa 0 2 does not intrinsically limit CMRO 2 and implies that the rapid increase in CMRO 2 at birth reflects the activation of specific cellular and physiological processes at (or near) this unique developmental event

Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

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Djelmis, J

1998-01-01

At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

Fetal brain damage following maternal carbon monoxide intoxication: an experimental study

Energy Technology Data Exchange (ETDEWEB)

Ginsberg, M D; Myers, R E

1974-01-01

Techniques of fetal monitoring, including fetal blood sampling in utero, were employed to study the physiological effects of acute maternal carbon monoxide intoxication on nine term-pregnant female rhesus monkeys exposed to 0.1 to 0.3% inspired carbon monoxide over 1 to 3 hr. The mothers tolerated carboxyhemoglobin levels exceeding 60% without clinical sequelae, whereas the fetuses promptly developed profound hypoxia upon exposure of the mothers to CO. The fetal COHb levels rose only gradually over 1 to 3 hr, and thus contributed only slightly to the development of early fetal hypoxia. The fetal hypoxia was associated with bradycardia, hypotension, and metabolic and respiratory acidosis. Severity of intrauterine hypoxia was closely correlated with the appearance of brain damage. Brain swelling associated with hemorrhagic necrosis of the cerebral hemispheres (severe brain damage) appeared only in fetuses whose arterial oxygen content was reduced below 1.0 ml/100 ml for at least 45 min during the maternal CO intoxication.

Intrauterine hypoxia: clinical consequences and therapeutic perspectives

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Thompson LP

2015-09-01

Full Text Available Loren P Thompson,1 Sarah Crimmins,1 Bhanu P Telugu,2 Shifa Turan1 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA; 2Department of Animal Sciences, University of Maryland, College Park, MD, USA Abstract: Intrauterine hypoxia is a significant clinical challenge in obstetrics that affects both the pregnant mother and fetus. Intrauterine hypoxia can occur in pregnant women living at high altitude and/or with cardiovascular disease. In addition, placental hypoxia can be generated by altered placental development and spiral artery remodeling leading to placental insufficiency and dysfunction. Both conditions can impact normal maternal cardiovascular homeostasis leading to preeclampsia and/or impair transfer of O2/nutrient supply resulting in fetal growth restriction. This review discusses the mechanisms underlying altered placental vessel remodeling, maternal and fetal consequences, patient management, and potential future therapies for improving these conditions. Keywords: fetal growth restriction, oxidative stress, extravillous trophoblast invasion, Doppler ultrasound, pulsatility index, preeclampsia 

Low vascularization of the nephrogenic zone of the fetal kidney suggests a major role for hypoxia in human nephrogenesis.

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Gerosa, C; Fanni, D; Faa, A; Van Eyken, P; Ravarino, A; Fanos, V; Faa, G

2017-09-01

CD31 reactivity is generally utilized as a marker of endothelial cells. CD31 immunoreactivity in the developing human kidney revealed that fetal glomerular capillary endothelial cells change their immunohistochemical phenotype during maturation. The aim of this study was to analyze CD31 reactivity in the fetal human kidney in the different stages of intrauterine development: We observed different distribution of CD31-reactive vascular progenitors in the different areas of the developing kidney. In particular, the nephrogenic zone and the renal capsule were characterized by a scarcity of CD31-reactive cells at all gestational ages. These data suggest the hypothesis that nephrogenesis does not need high oxygen levels and confirms a major role of hypoxia in nephrogenesis.

Fetal activity patterns in hypertensive pregnancies.

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Rayburn, W F

1982-01-01

This prospective investigation attempts to determine whether the maternal recording of perceived fetal motion is useful for fetal assessment in pregnancies complicated by hypertension. During a 21 month period, 124 patients whose pregnancies were complicated by either chronic or pregnancy-induced hypertension participated. The number of perceived movements per hour (24 +/- 11, mean +/- S.D.) and evidence for fetal inactivity (7 cases, 6%) did not vary significantly from a control group of normotensive pregnancies (p greater than 0.05). Fetal inactivity was predictive of an unfavorable perinatal outcome in 6 of 7 cases, including the three stillborn infants. No perinatal deaths occurred among the 117 hypertensive pregnancies with active fetuses, and the 6 cases with an unfavorable outcome were associated with mild intrauterine growth delay, prematurity, or acute changes such as placental abruption or umbilical cord accidents. Realizing these limitations, a record of fetal inactivity is worthwhile in managing the pregnancy complicated by hypertension.

Impact of Restricted Maternal Weight Gain on Fetal Growth and Perinatal Morbidity in Obese Women With Type 2 Diabetes

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Asbjörnsdóttir, Björg; Rasmussen, S.S.; Kelstrup, Louise

2013-01-01

OBJECTIVESince January 2008, obese women with type 2 diabetes were advised to gain 0-5 kg during pregnancy. The aim with this study was to evaluate fetal growth and perinatal morbidity in relation to gestational weight gain in these women.RESEARCH DESIGN AND METHODSA retrospective cohort comprised...... the records of 58 singleton pregnancies in obese women (BMI ≥30 kg/m(2)) with type 2 diabetes giving birth between 2008 and 2011. Birth weight was evaluated by SD z score to adjust for gestational age and sex.RESULTSSeventeen women (29%) gained ≤5 kg, and the remaining 41 gained >5 kg. The median (range...... with pregnancies with maternal weight gain >5 kg.CONCLUSIONIn this pilot study in obese women with type 2 diabetes, maternal gestational weight gain ≤5 kg was associated with a more proportionate birth weight and less perinatal morbidity....

A prospective observational study of early fetal growth velocity and its association with birth weight, gestational age at delivery, preeclampsia, and perinatal mortality

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Vasudeva, Akhila, E-mail: akhilavasudeva@gmail.com [Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State (India); Abraham, Anu Annie, E-mail: anuannieabraham@yahoo.com [Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State (India); Kamath, Asha, E-mail: aashakamat@gmail.com [Department of Community Medicine, Kasturba Medical College, Manipal, A Constituent College of Manipal University (India)

2013-08-15

Objectives: We aimed to measure early fetal growth velocity and to correlate this with the birth weight, gestational age at delivery, and with the incidence of adverse pregnancy outcomes specifically preeclampsia and perinatal mortality. Methods: A data based prospective observational study, wherein sonographic biometry data and specific pregnancy outcome related data were collected from pregnant women's records, starting soon after their first antenatal visit. Early fetal growth velocity was measured using BPD growth between 11 and 14 weeks scan and anomaly scan and standardizing this by Z scoring. Results: Out of 607 fetuses, 41 (6.7%) were slow growing, 531 (87.4%) normally growing, and 35 (5.7%) fast growing (Z scoring <10th{sup ,} 10–90th, and >90th percentiles respectively). As fetal growth velocity increased, the mean birth weight decreased from 2958.7 ± 388.9 (<10th centile), 2742.1 ± 576.6 (10–90th centile), to 2339.3 ± 729.4 (>90th centile); and gestational age at delivery decreased from 38.5 ± 1.3 (<10th centile), 37.5 ± 2.1 (10–90th centile), to 36.4 ± 2.2 (>90th centile), and both these trends were statistically significant (p < 0.001).Faster growing fetuses had a higher risk of preterm delivery(spontaneous + indicated) compared to other 2 groups [OR 4.42 (2.18,8.98)], and slower growing fetuses had a higher risk of postdated deliveries compared to other 2 groups [OR 3.042 (1.44, 6.45)].We found no significant association between early fetal growth velocity and incidence of small for gestational age at birth/low birth weight at term, preeclampsia, and perinatal mortality. Conclusions: Early fetal growth velocity between first and second trimesters, may be one of the important factors influencing ultimate birthweight and gestational age at delivery.

A prospective observational study of early fetal growth velocity and its association with birth weight, gestational age at delivery, preeclampsia, and perinatal mortality

International Nuclear Information System (INIS)

Vasudeva, Akhila; Abraham, Anu Annie; Kamath, Asha

2013-01-01

Objectives: We aimed to measure early fetal growth velocity and to correlate this with the birth weight, gestational age at delivery, and with the incidence of adverse pregnancy outcomes specifically preeclampsia and perinatal mortality. Methods: A data based prospective observational study, wherein sonographic biometry data and specific pregnancy outcome related data were collected from pregnant women's records, starting soon after their first antenatal visit. Early fetal growth velocity was measured using BPD growth between 11 and 14 weeks scan and anomaly scan and standardizing this by Z scoring. Results: Out of 607 fetuses, 41 (6.7%) were slow growing, 531 (87.4%) normally growing, and 35 (5.7%) fast growing (Z scoring <10th , 10–90th, and >90th percentiles respectively). As fetal growth velocity increased, the mean birth weight decreased from 2958.7 ± 388.9 (<10th centile), 2742.1 ± 576.6 (10–90th centile), to 2339.3 ± 729.4 (>90th centile); and gestational age at delivery decreased from 38.5 ± 1.3 (<10th centile), 37.5 ± 2.1 (10–90th centile), to 36.4 ± 2.2 (>90th centile), and both these trends were statistically significant (p < 0.001).Faster growing fetuses had a higher risk of preterm delivery(spontaneous + indicated) compared to other 2 groups [OR 4.42 (2.18,8.98)], and slower growing fetuses had a higher risk of postdated deliveries compared to other 2 groups [OR 3.042 (1.44, 6.45)].We found no significant association between early fetal growth velocity and incidence of small for gestational age at birth/low birth weight at term, preeclampsia, and perinatal mortality. Conclusions: Early fetal growth velocity between first and second trimesters, may be one of the important factors influencing ultimate birthweight and gestational age at delivery

Optimal fetal growth for the Caucasian singleton and assessment of appropriateness of fetal growth: an analysis of a total population perinatal database

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Lawrence David M

2005-05-01

Full Text Available Abstract Background The appropriateness of an individual's intra uterine growth is now considered an important determinant of both short and long term outcomes, yet currently used measures have several shortcomings. This study demonstrates a method of assessing appropriateness of intrauterine growth based on the estimation of each individual's optimal newborn dimensions from routinely available perinatal data. Appropriateness of growth can then be inferred from the ratio of the value of the observed dimension to that of the optimal dimension. Methods Fractional polynomial regression models including terms for non-pathological determinants of fetal size (gestational duration, fetal gender and maternal height, age and parity were used to predict birth weight, birth length and head circumference from a population without any major risk factors for sub-optimal intra-uterine growth. This population was selected from a total population of all singleton, Caucasian births in Western Australia 1998–2002. Births were excluded if the pregnancy was exposed to factors known to influence fetal growth pathologically. The values predicted by these models were treated as the optimal values, given infant gender, gestational age, maternal height, parity, and age. Results The selected sample (N = 62,746 comprised 60.5% of the total Caucasian singleton birth cohort. Equations are presented that predict optimal birth weight, birth length and head circumference given gestational duration, fetal gender, maternal height, age and parity. The best fitting models explained 40.5% of variance for birth weight, 32.2% for birth length, and 25.2% for head circumference at birth. Conclusion Proportion of optimal birth weight (length or head circumference provides a method of assessing appropriateness of intrauterine growth that is less dependent on the health of the reference population or the quality of their morphometric data than is percentile position on a birth weight

Obstetric interventions and perinatal asphyxia in growth retarded term infants

DEFF Research Database (Denmark)

Langhoff-Roos, J; Lindmark, G

1997-01-01

BACKGROUND: The monitoring of fetal growth during pregnancy is usually justified because of the increased perinatal risk of these babies. METHODS: In 1552 infants from the Scandinavian Small for Gestational Age Study the need for obstetric interventions, risk of fetal asphyxia and immediate...... neonatal outcome at term have been studied in relation to different types of fetal growth retardation, including sub-groups with low ponderal index or low amount of subcutaneous fat. RESULTS: The need for obstetric intervention indicated by suspected fetal asphyxia before or during labor was increased 3......-fold (6-8%) for growth retarded infants both in SGA infants in general and infants with asymmetric body proportions. The immediate perinatal outcome, however, was favorable with Apgar below 8 at 5 min in only 2% irrespective of the type of growth retardation, in spite of the fact that less than 25...

Dynamic FDG PET for assessing early effects of cerebral hypoxia and resuscitation in new-born pigs

International Nuclear Information System (INIS)

Lange, Charlotte de; Malinen, Eirik; Qu, Hong; Johnsrud, Kjersti; Skretting, Arne; Saugstad, Ola Didrik; Munkeby, Berit H.

2012-01-01

Changes in cerebral glucose metabolism may be an early prognostic indicator of perinatal hypoxic-ischaemic injury. In this study dynamic 18 F-FDG PET was used to evaluate cerebral glucose metabolism in piglets after global perinatal hypoxia and the impact of the resuscitation strategy using room air or hyperoxia. New-born piglets (n = 16) underwent 60 min of global hypoxia followed by 30 min of resuscitation with a fraction of inspired oxygen (FiO 2 ) of 0.21 or 1.0. Dynamic FDG PET, using a microPET system, was performed at baseline and repeated at the end of resuscitation under stabilized haemodynamic conditions. MRI at 3 T was performed for anatomic correlation. Global and regional cerebral metabolic rates of glucose (CMR gl ) were assessed by Patlak analysis for the two time-points and resuscitation groups. Global hypoxia was found to cause an immediate decrease in cerebral glucose metabolism from a baseline level (mean ± SD) of 21.2 ± 7.9 to 12.6 ± 4.7 μmol/min/100 g (p gl but no significant differences in global or regional CMR gl between the resuscitation groups were found. Dynamic FDG PET detected decreased cerebral glucose metabolism early after perinatal hypoxia in piglets. The decrease in CMR gl may indicate early changes of mild cerebral hypoxia-ischaemia. No significant effect of hyperoxic resuscitation on the degree of hypometabolism was found in this early phase after hypoxia. Cerebral FDG PET can provide new insights into mechanisms of perinatal hypoxic-ischaemic injury where early detection plays an important role in instituting therapy. (orig.)

N-Methyl-D-aspartate Receptor Excessive Activation Inhibited Fetal Rat Lung Development In Vivo and In Vitro

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Zhengchang Liao

2016-01-01

Full Text Available Background. Intrauterine hypoxia is a common cause of fetal growth and lung development restriction. Although N-methyl-D-aspartate receptors (NMDARs are distributed in the postnatal lung and play a role in lung injury, little is known about NMDAR’s expression and role in fetal lung development. Methods. Real-time PCR and western blotting analysis were performed to detect NMDARs between embryonic days (E 15.5 and E21.5 in fetal rat lungs. NMDAR antagonist MK-801’s influence on intrauterine hypoxia-induced retardation of fetal lung development was tested in vivo, and NMDA’s direct effect on fetal lung development was observed using fetal lung organ culture in vitro. Results. All seven NMDARs are expressed in fetal rat lungs. Intrauterine hypoxia upregulated NMDARs expression in fetal lungs and decreased fetal body weight, lung weight, lung-weight-to-body-weight ratio, and radial alveolar count, whereas MK-801 alleviated this damage in vivo. In vitro experiments showed that NMDA decreased saccular circumference and area per unit and downregulated thyroid transcription factor-1 and surfactant protein-C mRNA expression. Conclusions. The excessive activation of NMDARs contributed to hypoxia-induced fetal lung development retardation and appropriate blockade of NMDAR might be a novel therapeutic strategy for minimizing the negative outcomes of prenatal hypoxia on lung development.

Indications and technique of fetal magnetic resonance imaging

International Nuclear Information System (INIS)

Asenbaum, U.; Woitek, R.; Furtner, J.; Prayer, D.; Brugger, P.C.

2013-01-01

Evaluation and confirmation of fetal pathologies previously suspected or diagnosed with ultrasound. Ultrasound and magnetic resonance imaging (MRI). Technique for prenatal fetal examination. Fetal MRI is an established supplementary technique to prenatal ultrasound. Fetal MRI should only be used as an additional method in prenatal diagnostics and not for routine screening. Fetal MRI should only be performed in perinatal medicine centers after a previous level III ultrasound examination. (orig.) [de

Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

Science.gov (United States)

Rodin, Urelija; Filipović-Grčić, Boris; Đelmiš, Josip; Glivetić, Tatjana; Juras, Josip; Mustapić, Željka; Grizelj, Ruža

2015-01-01

Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks' (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment. PMID:26693484

Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

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Urelija Rodin

2015-01-01

Full Text Available Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM was reduced by 31%, fetal mortality (FM by 32%, and early neonatal mortality (ENM by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks gestational age (GA was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

Hemodynamic and metabolic correlates of perinatal white matter injury severity.

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Art Riddle

Full Text Available Although the spectrum of perinatal white matter injury (WMI in preterm infants is shifting from cystic encephalomalacia to milder forms of WMI, the factors that contribute to this changing spectrum are unclear. We hypothesized that the variability in WMI quantified by immunohistochemical markers of inflammation could be correlated with the severity of impaired blood oxygen, glucose and lactate.We employed a preterm fetal sheep model of in utero moderate hypoxemia and global severe but not complete cerebral ischemia that reproduces the spectrum of human WMI. Since there is small but measurable residual brain blood flow during occlusion, we sought to determine if the metabolic state of the residual arterial blood was associated with severity of WMI. Near the conclusion of hypoxia-ischemia, we recorded cephalic arterial blood pressure, blood oxygen, glucose and lactate levels. To define the spectrum of WMI, an ordinal WMI rating scale was compared against an unbiased quantitative image analysis protocol that provided continuous histo-pathological outcome measures for astrogliosis and microgliosis derived from the entire white matter.A spectrum of WMI was observed that ranged from diffuse non-necrotic lesions to more severe injury that comprised discrete foci of microscopic or macroscopic necrosis. Residual arterial pressure, oxygen content and blood glucose displayed a significant inverse association with WMI and lactate concentrations were directly related. Elevated glucose levels were the most significantly associated with less severe WMI.Our results suggest that under conditions of hypoxemia and severe cephalic hypotension, WMI severity measured using unbiased immunohistochemical measurements correlated with several physiologic parameters, including glucose, which may be a useful marker of fetal response to hypoxia or provide protection against energy failure and more severe WMI.

The Beneficial Effects of Melatonin Administration Following Hypoxia-Ischemia in Preterm Fetal Sheep

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Tamara Yawno

2017-09-01

Full Text Available Melatonin (MLT is an endogenous hormone that controls circadian cycle. MLT has additional important properties that make it appealing as a neuroprotective agent—it is a potent anti-oxidant, with anti-apoptotic and anti-inflammatory properties. MLT is safe for administration during pregnancy or to the newborn after birth, and can reduce white matter brain injury under conditions of chronic fetal hypoxia. Accordingly, in the current study, we examined whether an intermediate dose of MLT could restore white matter brain development when administered after an acute hypoxic ischemic (HI insult in preterm fetal sheep. Fifteen fetal sheep at 95–98 days gestation were instrumented with femoral artery and vein catheters, and a silastic cuff placed around the umbilical cord. At 102 days gestation, the cuff was inflated, causing complete umbilical cord occlusion for 25 min in 10 fetuses, to induce acute severe HI. Five HI fetuses received intravenous MLT for 24 h beginning at 2 h after HI. The remaining five fetuses were administered saline alone. Ten days after HI, the fetal brain was collected from each animal and white and gray matter neuropathology assessed. HI caused a significant increase in apoptotic cell death (TUNEL+, activated microglia (Iba-1+, and oxidative stress (8-OHdG+ within the subventricular and subcortical white matter. HI reduced the total number of oligodendrocytes and CNPase+ myelin density. MLT administration following HI decreased apoptosis, inflammation and oxidative stress within the white matter. MLT had intermediate benefits for the developing white matter: it increased oligodendrocyte cell number within the periventricular white matter only, and improved CNPase+ myelin density within the subcortical but not the striatal white matter. MLT administration following HI was also associated with improved neuronal survival within the cortex. Neuropathology in preterm infants is complex and mediated by multiple mechanisms

Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement.

LENUS (Irish Health Repository)

Daly, Niamh

2011-09-05

OBJECTIVE: To examine the obstetric and perinatal outcomes of women presenting with reduced fetal movement (RFM) during the third trimester, specifically in relation to the diagnostic capacity of non-stress cardiotocography (CTG) used as the primary investigation in this clinical scenario. STUDY DESIGN: This was a retrospective population-based cohort study of pregnancy outcomes of all women ≥28 weeks\\' gestation with singleton pregnancies presenting during one calendar year with maternal perception of RFM, all of whom underwent CTG at presentation. Main outcome measures included: obstetric intervention (induction of labour, spontaneous vaginal delivery, operative vaginal delivery, emergency caesarean section), and perinatal outcome (subsequent perinatal death, low Apgar scores (<7(5)), neonatal resuscitation and NICU admission). RESULTS: In all, 524 women presented with RFM and a live fetus, representing 7% of the antenatal obstetric population; 284 women (54%) were nulliparous. The reassuring CTG group comprised 482 (92%) women in whom initial CTG was reassuring and 15 (3%) where a repeat tracing within 1h was reassuring. The non-reassuring\\/abnormal CTG group (n=27, 5%) either underwent emergency delivery or comprehensive serial fetal assessment; this group had significantly higher rates of emergency caesarean delivery, neonatal resuscitation and NICU admission; the incidence of small-for-gestational-age infants did not differ significantly. No perinatal death occurred in either group following CTG. CONCLUSION: Normal non-stress CTG is a reliable screening indicator of fetal wellbeing in women presenting with perception of RFM in the third trimester; abnormal pregnancy outcomes were more common when initial CTG was abnormal or persistently non-reassuring.

Growth assessment in diagnosis of Fetal Growth Restriction. Review.

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Albu, A R; Horhoianu, I A; Dumitrascu, M C; Horhoianu, V

2014-06-15

The assessment of fetal growth represents a fundamental step towards the identification of the true growth restricted fetus that is associated to important perinatal morbidity and mortality. The possible ways of detecting abnormal fetal growth are taken into consideration in this review and their strong and weak points are discussed. An important debate still remains about how to discriminate between the physiologically small fetus that does not require special surveillance and the truly growth restricted fetus who is predisposed to perinatal complications, even if its parameters are above the cut-off limits established. In this article, we present the clinical tools of fetal growth assessment: Symphyseal-Fundal Height (SFH) measurement, the fetal ultrasound parameters widely taken into consideration when discussing fetal growth: Abdominal Circumference (AC) and Estimated Fetal Weight (EFW); several types of growth charts and their characteristics: populational growth charts, standard growth charts, individualized growth charts, customized growth charts and growth trajectories.

Senescence and quiescence in adipose-derived stromal cells: Effects of human platelet lysate, fetal bovine serum and hypoxia.

Science.gov (United States)

Søndergaard, Rebekka Harary; Follin, Bjarke; Lund, Lisbeth Drozd; Juhl, Morten; Ekblond, Annette; Kastrup, Jens; Haack-Sørensen, Mandana

2017-01-01

Adipose-derived stromal cells (ASCs) are attractive sources for cell-based therapies. The hypoxic niche of ASCs in vivo implies that cells will benefit from hypoxia during in vitro expansion. Human platelet lysate (hPL) enhances ASC proliferation rates, compared with fetal bovine serum (FBS) at normoxia. However, the low proliferation rates of FBS-expanded ASCs could be signs of senescence or quiescence. We aimed to determine the effects of hypoxia and hPL on the expansion of ASCs and whether FBS-expanded ASCs are senescent or quiescent. ASCs expanded in FBS or hPL at normoxia or hypoxia until passage 7 (P7), or in FBS until P5 followed by culture in hPL until P7, were evaluated by proliferation rates, cell cycle analyses, gene expression and β-galactosidase activity. hPL at normoxia and hypoxia enhanced proliferation rates and expression of cyclins, and decreased G0/G1 fractions and expression of p21 and p27, compared with FBS. The shift from FBS to hPL enhanced cyclin levels, decreased p21 and p27 levels and tended to decrease G0/G1 fractions. Hypoxia does not add to the effect of hPL during ASC expansion with regard to proliferation, cell cycle regulation and expression of cyclins, p21 and p27. hPL rejuvenates FBS-expanded ASCs with regard to cell cycle regulation and expression of cyclins, p21 and p27. This indicates a reversible arrest. Therefore, we conclude that ASCs expanded until P7 are not senescent regardless of culture conditions. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief.

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Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline

2017-09-01

Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA's negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study's objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG. An online, retrospective survey was conducted with 161 women. Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses. Moderate levels of PTG were observed for "relating to others," "personal strengths" and "appreciation of life." "Positive reframing" was a significant predictor of PTG. Despite using mainly "adaptive" coping strategies, women's grief levels were high. "Adaptive" coping strategies such as, "positive reframing" are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women's experience, may be beneficial.

Fetal exposure to a diabetic intrauterine environment resulted in a failure of cord blood endothelial progenitor cell adaptation against chronic hypoxia

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Dincer UD

2014-12-01

Full Text Available U Deniz Dincer Department of Basic and Clinical Pharmacology, School of Medicine, Bezmialem Vakif University (BAVU, Fatih/Istanbul, Turkey Abstract: Gestational diabetes mellitus (GDM has long-term health consequences, and fetal exposure to a diabetic intrauterine environment increases cardiovascular risk for her adult offspring. Some part of this could be related to their endothelial progenitor cells (EPCs. Understanding the vessel-forming ability of human umbilical cord blood (HUCB-derived endothelial colony-forming cells (ECFCs against pathological stress such as GDM response to hypoxia could generate new therapeutic strategies. This study aims to investigate the role of chronic hypoxia in EPCs functional and vessel-forming ability in GDM subjects. Each ECFC was expressed in endothelial and pro-angiogenic specific markers, namely endothelial nitric oxide synthase (eNOS, platelet (PECAM-1 endothelial cell adhesion molecule 1, vascular endothelial-cadherin CdH5 (Ca-dependent cell adhesion molecule, vascular endothelial growth factor A, (VEGFA and insulin-like growth factor 1 (IGF1. Chronic hypoxia did not affect CdH5, but PECAM1 MRNA expressions were increased in control and GDM subjects. Control hypoxic and GDM normoxic VEGFA MRNA expressions and hypoxia-inducible factor 1-alpha (HIF1α protein expressions were significantly increased in HUCB ECFCs. GDM resulted in most failure of HUCB ECFC adaptation and eNOS protein expressions against chronic hypoxia. Chronic hypoxia resulted in an overall decline in HUCB ECFCs' proliferative ability due to reduction of clonogenic capacity and diminished vessel formation. Furthermore, GDM also resulted in most failure of cord blood ECFC adaptation against chronic hypoxic environment. Keywords: endothelial progenitor cells, gestational diabetes mellitus, chronic hypoxia, human cord blood

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder

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Imen Hadjkacem

Full Text Available Abstract Objective: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD by comparing them to their siblings without autistic disorders. Method: The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014. It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Results: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p = 0.03 and p = 0.042. In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases, long duration of delivery and prematurity (18% of cases for each factor, while postnatal factors were represented principally by respiratory infections (24%. As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others, as determinant variables for the genesis of ASD.

Perinatal outcome in relation to fetal sex in offspring to mothers with pre-gestational and gestational diabetes--a population-based study.

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Persson, M; Fadl, H

2014-09-01

The objective of the present study was to investigate if perinatal outcome differs with fetal sex in pregnancies with maternal Type 1 diabetes, Type 2 diabetes or gestational diabetes. This was a population-based cohort study, with data from the Medical Birth Registry in Sweden throughout the period 1998-2007. Singleton pregnancies with maternal Type 1 diabetes (n = 4092), Type 2 diabetes (n = 412) and gestational diabetes (n = 8602) were identified based on the International Classification of Diseases, 10th edition code. For comparison, 905 565 pregnancies without diabetes were included. The primary outcome was a composite outcome, consisting of any of the following diagnoses: perinatal mortality rate, major malformation, preterm delivery, acute respiratory disorders and neonatal hypoglycaemia. Logistic regression was used to obtain odds ratios for adverse outcomes in male offspring within the diabetic and reference cohorts, respectively. In pregnancies with diabetes, maternal characteristics did not differ with fetal sex, except for a higher rate of Caesarean delivery in male offspring of women with Type 1 diabetes. Male infants to mothers with Type 1 diabetes and gestational diabetes had significantly increased odds of respiratory disorders [adjusted odds ratio (confidence interval) Type 1 diabetes: 1.50 (1.12-2.02); gestational diabetes: 1.81 (1.27-2.57)]. Male infants to mothers with gestational diabetes also had significantly increased odds of major malformations [adjusted odds ratio: 1.44 (1.07-1.93)]. In offspring of mothers with Type 2 diabetes, odds ratios of most outcomes were higher in male infants; however, not significantly different from female infants. In pregnancies without diabetes, male infants had significantly higher odds of all adverse outcomes, except perinatal mortality rate. The risk of adverse perinatal outcome in offspring of mothers with Type 1 diabetes and gestational diabetes did not differ by sex, except for a higher risk in male

Effects of hypoxia on serum hepatic chemistries of Tibet chicken and ...

African Journals Online (AJOL)

Hypoxia is a major factor that affects the subsistence and development of multicellular organisms. Tibet chicken, as a unique native chicken breed in altiplano, shows genetic adaptation to hypoxia comparing with the breeds at the low altitude. In the present study, to explore effects of hypoxia on chicken fetal livers, eggs of ...

[Perinatal complications in patients with chronic renal insufficiency on hemodialysis].

Science.gov (United States)

Vázquez-Rodríguez, Juan Gustavo; del Angel-García, Guadalupe

2010-09-01

Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. To compare perinatal complications of patients with chronic renal insufficiency undergoing hemodialysis who become pregnant vs. the complications of women with chronic renal insufficiency not undergoing dialysis but who then require dialysis during gestation. Transversal and retrospective study that included three patients with chronic renal insufficiency on chronic hemodialysis who became pregnant (group A) and three patients with chronic renal insufficiency without hemodialysis at the time of conception but who required dialysis during gestation (group B). Perinatal results were compared. Statistical analysis was performed with measures of central tendency and dispersion and Student t-test. Group A had 25 sessions vs. group B with 29 hemodialysis sessions (p = 0.88). Maternal complications were anemia 100% (six cases), Cesarean delivery 83.3% (group A 2 cases vs. group B 2 cases), preeclampsia 50% (group A 2 cases vs. group B 1 case), uncontrolled hypertension 50% (group A 2 cases vs. group B 1 case), preterm delivery 50% (group A 2 cases vs. group B 1 case), transfusion 33.3% (group A 2 cases), polyhydramnios 33.3% (group A 1 case vs. group B 1 case) and abortion 16.6% (group A 1 case). Fetal complications included fetal loss 16.6% (group A 1 case), neonatal mortality 33.3% (group A 1 cases vs. group B 1 case), prematurity 50% (group A2 cases vs. group B 1 case), fetal distress 50% (group A 1 case vs. group B 2 cases), respiratory failure 33.3% (group A 2 cases) and fetal growth restriction 16.6% (group A 1 case). Frequency of perinatal complications is elevated in both groups.

Fetal Ascites and Second Trimester Maternal Hepatitis C Virus Infection

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Pei-Ying Ling

2006-09-01

Conclusion: Second trimester perinatal HCV infection with possible CMV coinfection associated with fetal ascites is a rare event. Fetal therapy resulting in a successful outcome has not been reported. Prompt fetal therapy with paracentesis in this case led to the delivery of a healthy term liveborn baby with anti-HCV seropositivity.

Developmental programming of cardiovascular disease by prenatal hypoxia.

Science.gov (United States)

Giussani, D A; Davidge, S T

2013-10-01

It is now recognized that the quality of the fetal environment during early development is important in programming cardiovascular health and disease in later life. Fetal hypoxia is one of the most common consequences of complicated pregnancies worldwide. However, in contrast to the extensive research effort on pregnancy affected by maternal nutrition or maternal stress, the contribution of pregnancy affected by fetal chronic hypoxia to developmental programming is only recently becoming delineated and established. This review discusses the increasing body of evidence supporting the programming of cardiac susceptibility to ischaemia and reperfusion (I/R) injury, of endothelial dysfunction in peripheral resistance circulations, and of indices of the metabolic syndrome in adult offspring of hypoxic pregnancy. An additional focus of the review is the identification of plausible mechanisms and the implementation of maternal and early life interventions to protect against adverse programming.

The World Health Organization Fetal Growth Charts

DEFF Research Database (Denmark)

Kiserud, Torvid; Piaggio, Gilda; Carroli, Guillermo

2017-01-01

BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable...... longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway...

Análise dos Testes de Vitalidade Fetal e dos Resultados Perinatais em Gestações de Alto Risco com Oligoidrâmnio Analysis of Fetal Well-being and Perinatal Outcome in the High-risk Pregnancies Complicated by Oligohydramnios

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Roseli Mieko Yamamoto Nomura

2002-07-01

Full Text Available Objetivos: analisar, em gestações de alto risco com diagnóstico de oligoidrâmnio, os resultados dos testes de avaliação da vitalidade fetal e os resultados perinatais. Métodos: foram selecionadas retrospectivamente 572 gestações de alto risco com diagnóstico de oligoidrâmnio, caracterizado por ILA inferior ou igual a 5,0 cm. Destas, 220 apresentavam diagnóstico de oligoidrâmnio grave (ILA Purpose: to evaluate, in the high-risk pregnancies with oligohydramnios, the assessment tools for fetal well-being and perinatal results. Methods: five hundred seventy-two high-risk pregnancies were retrospectively analyzed. All of them presented with oligohydramnios established by AFI <=5.0 cm. Severe oligohydramnios was detected in 220 cases (AFI<=3,0 cm. The fetal well-being tests included: antepartum cardiotocography, biophysical profile score (BPS and dopplervelocimetry of umbilical and middle cerebral arteries. Multiple gestation, fetal anomalies and premature rupture of membrane cases were excluded. Results: severe oligohydramnios was significantlly associated with abnormal and suspected cardiotocography results (23.2%, abnormal biophysical profile score (10.5%, abnormal results of middle cerebral artery dopplervelocimetry (54.5%, small for gestational age infants (32.7% and meconial amniotic fluid (27.9% when compared to pregnancies with AFI between 3.1 and 5.0 cm. This group presented: abnormal or suspected cardiotocography results (13.9%, abnormal biophysical profile score (4.3%, abnormal results of middle cerebral artery dopplervelocimetry (33.9%, small for gestational age infants (21.0% and meconial amniotic fluid (16.8%. Conclusion: the oligohydramnios severity in high-risk pregnancies allows to discriminate the cases that are related to adverse perinatal outcome.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder.

Science.gov (United States)

Hadjkacem, Imen; Ayadi, Héla; Turki, Mariem; Yaich, Sourour; Khemekhem, Khaoula; Walha, Adel; Cherif, Leila; Moalla, Yousr; Ghribi, Farhat

To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD) by comparing them to their siblings without autistic disorders. The present study is cross sectional and comparative. It was conducted over a period of three months (July-September 2014). It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p=0.03 and p=0.042). In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases), long duration of delivery and prematurity (18% of cases for each factor), while postnatal factors were represented principally by respiratory infections (24%). As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others), as determinant variables for the genesis of ASD. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Avaliação do bem-estar fetal pela dopplervelocimetria com mapeamento em cores Evaluation of fetal well-being through color doppler velocimetry

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Cleide Mara Mazzotti de Oliveira Franzin

1999-01-01

Full Text Available Objetivos: Avaliar a eficiência do exame dopplervelocimétrico no diagnóstico do bem-estar fetal. Metodologia: Foram analisadas 130 gestantes atendidas no Serviço de Ultra-Sonografia do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, entre a 28ª e a 42ª semana. Foram feitas correlações entre o Doppler das artérias umbilical, cerebral média e aorta abdominal fetal com os resultados perinatais adversos. As gestantes selecionadas para o estudo foram submetidas eletivamente ao parto cesáreo, no máximo quatro horas após o exame Doppler. Considerou-se como resultados perinatais adversos: índice de Apgar ao 5º minuto menor que sete, internação em unidade de terapia intensiva neonatal, retardo de crescimento intra-uterino, sofrimento fetal agudo, mortalidade perinatal, hipoglicemia, enterocolite necrosante e hemorragia cerebral. Os índices de impedância das artérias umbilical, cerebral média e aorta abdominal foram relacionados caso a caso com os resultados perinatais adversos. Resultados: a relação sístole/diástole da artéria umbilical apresentou maior sensibilidade (80,76% do que o índice de pulsatilidade e índice de resistência da artéria umbilical. O estudo Doppler da artéria umbilical apresentou melhor sensibilidade que o da artéria cerebral média e da aorta abdominal na detecção de resultados perinatais adversos. Conclusão: a dopplervelocimetria das artérias umbilical e cerebral média apresentou boa capacidade de avaliação do bem-estar fetal e associação significativa com resultados perinatais adversos.Purpose: to evaluate the accuracy of Doppler velocimetry in the diagnosis of fetal well-being. Methods: a total of 130 pregnant women assisted at the Ultrasound Unit of the Center for Integral Assistance of Women's Health, UNICAMP, between the 28th and 42nd gestational weeks was analyzed. The correlation between fetal umbilical and middle cerebral arteries, abdominal

Maternal and Fetal Acid-Base Chemistry: A Major Determinant of ...

African Journals Online (AJOL)

hanumantp

Very small changes in pH may significantly affect the function of various fetal organ systems, such ... and fetal acid chemistry, clinical studies and case studies were undertaken. There is a .... the challenges of diagnosis and treatment of fetal hypoxia. Maternal ...... Blumenthal I. Cerebral palsy – Medicolegal aspects. J R Soc.

Prenatal and perinatal striatal injury: a hypothetical cause of attention-deficit-hyperactivity disorder?

DEFF Research Database (Denmark)

Toft, P.B.

1999-01-01

, in children who have suffered perinatal adverse events. Evidence is presented to demonstrate that the composition of metabolites in the striatum is altered, primarily in the form of an elevated level of lactate, in human neonates who have suffered various perinatal disorders, such as germinal matrix...... hemorrhage, intrauterine growth retardation, and asphyxia. An elevated level of lactate suggests tissue hypoxia, which may interfere with the formation of frontostriatal circuits and may play a role in the pathogenesis of the behavioral disturbances observed in a proportion of children with a history...... of perinatal adverse events...

Effect of amnioinfusion for meconium stained amniotic fluid on perinatal outcome.

Science.gov (United States)

Ashfaq, F; Shah, A A

2004-06-01

To see the effect of amnioinfusion on perinatal outcome in cases of meconium staining of liquor. This study was conducted in department of Obstetrics and Gynaecology, unit 1, Jinnah Postgraduate Medical Centre, Karachi, from 1st January 1998 to 31st December 2000. Four hundred patients were included in this study, assigning 200 for amnioinfusion and 200 as control. All patients were matched in both the groups with respect to age, antenatal booking, parity, gestational age, stage of labour, colour of amniotic fluid and fetal birth weight. Both the groups were found to be comparable. The rate of Caesarean section was found to be 37% in amnioinfusion group, which collaborates with other international studies. The fetal outcome was better i.e. 91% alive and healthy, after amnioinfusion due to dilution of meconium stained amniotic fluid with physiological solutions. The perinatal outcome was recorded by Apgar score at 5 minutes. The perinatal morbidity and mortality both were significantly lowered and was found to be 6% as compared to 14% in control, which was also noticed by less number of admissions in nursery i.e. 12% and perinatal deaths. The incidence of meconium aspiration syndrome was found to be 56% in control and was reduced to 22% after amnioinfusion in the other arm of the study. These results are very encouraging and suggestion can be safely made that in future amnioinfusion will be the ideal method of preventing fetal distress due to meconium stained amniotic fluid.

Complete biallelic insulation at the H19/Igf2 imprinting control region position results in fetal growth retardation and perinatal lethality.

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Dong-Hoon Lee

2010-09-01

Full Text Available The H19/Igf2 imprinting control region (ICR functions as an insulator exclusively in the unmethylated maternal allele, where enhancer-blocking by CTCF protein prevents the interaction between the Igf2 promoter and the distant enhancers. DNA methylation inhibits CTCF binding in the paternal ICR allele. Two copies of the chicken β-globin insulator (ChβGI(2 are capable of substituting for the enhancer blocking function of the ICR. Insulation, however, now also occurs upon paternal inheritance, because unlike the H19 ICR, the (ChβGI(2 does not become methylated in fetal male germ cells. The (ChβGI(2 is a composite insulator, exhibiting enhancer blocking by CTCF and chromatin barrier functions by USF1 and VEZF1. We asked the question whether these barrier proteins protected the (ChβGI(2 sequences from methylation in the male germ line.We genetically dissected the ChβGI in the mouse by deleting the binding sites USF1 and VEZF1. The methylation of the mutant versus normal (ChβGI(2 significantly increased from 11% to 32% in perinatal male germ cells, suggesting that the barrier proteins did have a role in protecting the (ChβGI(2 from methylation in the male germ line. Contrary to the H19 ICR, however, the mutant (mChβGI(2 lacked the potential to attain full de novo methylation in the germ line and to maintain methylation in the paternal allele in the soma, where it consequently functioned as a biallelic insulator. Unexpectedly, a stricter enhancer blocking was achieved by CTCF alone than by a combination of the CTCF, USF1 and VEZF1 sites, illustrated by undetectable Igf2 expression upon paternal transmission.In this in vivo model, hypomethylation at the ICR position together with fetal growth retardation mimicked the human Silver-Russell syndrome. Importantly, late fetal/perinatal death occurred arguing that strict biallelic insulation at the H19/Igf2 ICR position is not tolerated in development.

Human fetal growth is constrained below optimal for perinatal survival

NARCIS (Netherlands)

Vasak, B.; Koenen, S. V.; Koster, M. P. H.; Hukkelhoven, C. W. P. M.; Franx, A.; Hanson, M. A.; Visser, GHA

ObjectiveThe use of fetal growth charts assumes that the optimal size at birth is at the 50(th) birth-weight centile, but interaction between maternal constraints on fetal growth and the risks associated with small and large fetal size at birth may indicate that this assumption is not valid for

Fetal outcome in emergency versus elective cesarean sections at ...

African Journals Online (AJOL)

Introduction: Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in ...

Perinatal Maternal Mental Health, Fetal Programming and Child Development

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Andrew J. Lewis

2015-11-01

Full Text Available Maternal mental disorders over pregnancy show a clear influence on child development. This review is focused on the possible mechanisms by which maternal mental disorders influence fetal development via programming effects. This field is complex since mental health symptoms during pregnancy vary in type, timing and severity and maternal psychological distress is often accompanied by higher rates of smoking, alcohol use, poor diet and lifestyle. Studies are now beginning to examine fetal programming mechanisms, originally identified within the DOHaD framework, to examine how maternal mental disorders impact fetal development. Such mechanisms include hormonal priming effects such as elevated maternal glucocorticoids, alteration of placental function and perfusion, and epigenetic mechanisms. To date, mostly high prevalence mental disorders such as depression and anxiety have been investigated, but few studies employ diagnostic measures, and there is very little research examining the impact of maternal mental disorders such as schizophrenia, bipolar disorder, eating disorders and personality disorders on fetal development. The next wave of longitudinal studies need to focus on specific hypotheses driven by plausible biological mechanisms for fetal programming and follow children for a sufficient period in order to examine the early manifestations of developmental vulnerability. Intervention studies can then be targeted to altering these mechanisms of intergenerational transmission once identified.

Perinatal Maternal Mental Health, Fetal Programming and Child Development.

Science.gov (United States)

Lewis, Andrew J; Austin, Emma; Knapp, Rebecca; Vaiano, Tina; Galbally, Megan

2015-11-26

Maternal mental disorders over pregnancy show a clear influence on child development. This review is focused on the possible mechanisms by which maternal mental disorders influence fetal development via programming effects. This field is complex since mental health symptoms during pregnancy vary in type, timing and severity and maternal psychological distress is often accompanied by higher rates of smoking, alcohol use, poor diet and lifestyle. Studies are now beginning to examine fetal programming mechanisms, originally identified within the DOHaD framework, to examine how maternal mental disorders impact fetal development. Such mechanisms include hormonal priming effects such as elevated maternal glucocorticoids, alteration of placental function and perfusion, and epigenetic mechanisms. To date, mostly high prevalence mental disorders such as depression and anxiety have been investigated, but few studies employ diagnostic measures, and there is very little research examining the impact of maternal mental disorders such as schizophrenia, bipolar disorder, eating disorders and personality disorders on fetal development. The next wave of longitudinal studies need to focus on specific hypotheses driven by plausible biological mechanisms for fetal programming and follow children for a sufficient period in order to examine the early manifestations of developmental vulnerability. Intervention studies can then be targeted to altering these mechanisms of intergenerational transmission once identified.

Cerebral Dysfunctions Related to Perinatal Organic Damage: Clinical-Neuropathologic Correlations.

Science.gov (United States)

Towbin, Abraham

1978-01-01

Recent neuropathology studies identify hypoxia as the main cause of perinatal cerebral damage. Cerebral lesions present at birth, with transition to chronic scar lesions, are correlated to mental retardation, cerebral palsy, epilepsy, and minimal brain dysfunction. Gestation age and severity of hypoxic exposure essentially determine the cerebral…

Umbilical nucleated red blood cell as a sign of fetal distress

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Torkestani F

2008-06-01

Full Text Available Background: The presence of increased numbers of nucleated red blood cell (NRBC in the umbilical cord blood has been associated with states of relative hypoxia. Nucleated red blood cell counts are a potentially useful tool in estimating the degree and timing of intrauterine hypoxia. This may have important implication in determining causality in case of compromised infant. Cord blood NRBC counts may be obtained noninvasively from an otherwise discarded specimen and analyzed by personnel on equipment readily available in most hospital laboratories. Since the aim of monitoring of fetal heart is early diagnosis of hypoxia, we studied the relationship between abnormal fetal heart rate with the number of nucleated red blood cells (NRBC in the umbilical cord blood.Methods: We performed this research at Hazrat Zeynab Hospital on 130 full-term newborns (65 cases of fetal distress and 65 normal cases between July 2005 and July 2006. The NRBC counts of newborns with abnormal fetal heart rate were compared with those of normal newborns and correlations with other parameters including Apgar score, hemoglobin level, condition of newborns in the first 24 hours of the birth and birth weight.Results: The mean NRBC count in the fetal distress group was 9.45 ± 8.75 and that of the normal group was 9.17 ± 8.76 per 100 white cells (p=0.89. The mean duration between diagnosis of fetal distress to birth was equal to 1.2± 0.77 hours. Furthermore, there was no meaningful correlation between number of NRBC and Apgar score, hemoglobin, birth weight and condition of newborns in the first 24 hours.Conclusion: If the fetus is born a short time after the diagnosis of distress with no risk factors for hypoxia, the NRBC count for cord blood is not elevated.

Trends and correlates of good perinatal outcomes in assisted reproductive technology.

Science.gov (United States)

Joshi, Nikhil; Kissin, Dmitry; Anderson, John E; Session, Donna; Macaluso, Maurizio; Jamieson, Denise J

2012-10-01

To estimate trends in good perinatal outcomes (singleton live births at term with birthweight more than 2,500 g) among live births after assisted reproductive technology in the United States from 2000 to 2008, and associated factors among singletons in 2008. Using retrospective cohort data from the National Assisted Reproductive Technology Surveillance System from 2000 to 2008, we calculated relative change and χ tests for trend in the proportion of good perinatal outcomes among assisted reproductive technology live births (n=444,909) and liveborn singletons (n=222,500). We conducted univariable analyses followed by multiple logistic regression to estimate the effects of various characteristics on the outcome among singletons born in 2008 after fresh, nondonor assisted reproductive technology cycles (n=20,780). The proportion of good perinatal outcomes among all liveborn neonates increased from 38.6% in 2000 to 42.5% in 2008, whereas it declined marginally among singletons from 83.6% to 83.4%. One previous birth, transfer of fewer than three embryos, and the presence of fewer than three fetal hearts on 6-week ultrasound examination were associated with good perinatal outcome among singletons. Non-Hispanic black race, tubal factor infertility, uterine factor infertility, ovulatory disorder, and 5-day embryo culture were associated with reduced odds for a good outcome. The strongest association was the presence of one fetal heart compared with more than two (adjusted odds ratio 2.43, 95% confidence interval 1.73-3.42). From 2000 to 2008, good perinatal outcomes increased among assisted reproductive technology live births. Among singleton live births, odds for good outcome were greatest with the presence of a single fetal heart and lowest in women of non-Hispanic black race. II.

STRIDER (Sildenafil TheRapy in dismal prognosis early onset fetal growth restriction)

DEFF Research Database (Denmark)

Pels, A; Kenny, L C; Alfirevic, Z

2017-01-01

randomised placebo-controlled trials have been launched. Women with a singleton pregnancy between 18 and 30 weeks with severe fetal growth restriction of likely placental origin, and where the likelihood of perinatal death/severe morbidity is estimated to be significant are included. Participants......BACKGROUND: Severe, early-onset fetal growth restriction due to placental insufficiency is associated with a high risk of perinatal mortality and morbidity with long-lasting sequelae. Placental insufficiency is the result of abnormal formation and function of the placenta with inadequate...... Restriction (STRIDER) collaboration is to evaluate the effectiveness of sildenafil versus placebo in achieving healthy perinatal survival through the conduct of randomised clinical trials and systematic review including individual patient data meta-analysis. METHODS: Five national/bi-national multicentre...

Dopplervelocimetria dos Compartimentos Arterial e Venoso da Circulação Fetal e Umbilical em Gestação de Alto-Risco: Análise dos Resultados Perinatais Dopplervelocimetry of the Arterial and Venous Compartments of the Fetal and Umbilical Circulation in High-Risk Pregnancy: Perinatal Results

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Joelma Queiroz Andrade

2002-01-01

ção do IPV do ducto venoso para o diagnóstico de acidemia foram: sensibilidade de 39,1; especificidade de 90,4; valor preditivo positivo de 60,0 e valor preditivo negativo de 80,2. Conclusão: a dopplervelocimetria permite avaliar a hemodinâmica fetal nas mais variadas situações e o estudo do ducto venoso constitui exame importante na avaliação das alterações hemodinâmicas decorrentes da hipoxia fetal.Purpose: to study the fetal hemodynamic profile in high-risk pregnancy and correlate it with perinatal results. Methods: transverse prospective study of 108 patients of the Obstetric Clinic of the Hospital das Clínicas, São Paulo University School of Medicine. The patients were evaluated at the Fetal Surveillance Unit, and Doppler examinations of umbilical, aorta, middle cerebral artery, inferior vena cava and ductus venosus were performed. The criteria for inclusion were patients whose delivery was in the next 24 hours after evaluation. Twin pregnancies and fetal malformations were excluded. Results: the hemodynamic implications in the fetal circulation were demonstrated by changes in the Doppler ultrasonographic results in the umbilical artery, aorta, middle cerebral artery, ductus venosus and in the inferior vena cava. The Doppler examinations were abnormal in the umbilical artery (25.9%, fetal aorta (24%, middle cerebral artery (34.2%, ductus venosus (18.2% and inferior vena cava (46,6%. Segments of the fetal circulation which best correlated with the perinatal results were the umbilical artery and the ductus venosus. The abnormal results in the umbilical artery were significantly associated with 1st minute Apgar score <7 in 42.8% and need of neonatal intensive care unit in 50% of the cases. The abnormal results in the ductus venosus Doppler ultrasonography showed statistical association with 1st minute Apgar score <7 (52.6%, 5th min Apgar <7 (15.7%, acidemia at birth (60%, need of neonatal intensive care unit (52.6% and neonatal death (21.1%. The predictive

Hypoxia induces dilated cardiomyopathy in the chick embryo: Mechanism, intervention, and long-term consequences

NARCIS (Netherlands)

A. Tintu (Andrei); E.V. Rouwet (Ellen); S. Verlohren (Stefan); J. Brinkmann (Joep); S. Ahmad (Shakil); F. Crispi (Fatima); M. van Bilsen (Marc); P. Carmeliet (Peter); A.C. Staff (Anne Cathrine); I. Cetin (Irene); E. Gratacos (Eduard); E. Hernandez-Andrade (Edgar); L. Hofstra (Leo); M. Jacobs (Michael); W.H. Lamers (Wouter); I. Morano (Ingo); E. Safak (Erdal); A. Ahmed (Asif); F. Noble (Ferdinand)

2009-01-01

textabstractBackground: Intrauterine growth restriction is associated with an increased future risk for developing cardiovascular diseases. Hypoxia in utero is a common clinical cause of fetal growth restriction. We have previously shown that chronic hypoxia alters cardiovascular development in

Hypoxia induces dilated cardiomyopathy in the chick embryo: mechanism, intervention, and long-term consequences

NARCIS (Netherlands)

Tintu, Andrei; Rouwet, Ellen; Verlohren, Stefan; Brinkmann, Joep; Ahmad, Shakil; Crispi, Fatima; van Bilsen, Marc; Carmeliet, Peter; Staff, Anne Cathrine; Tjwa, Marc; Cetin, Irene; Gratacos, Eduard; Hernandez-Andrade, Edgar; Hofstra, Leo; Jacobs, Michael; Lamers, Wouter H.; Morano, Ingo; Safak, Erdal; Ahmed, Asif; le Noble, Ferdinand

2009-01-01

BACKGROUND: Intrauterine growth restriction is associated with an increased future risk for developing cardiovascular diseases. Hypoxia in utero is a common clinical cause of fetal growth restriction. We have previously shown that chronic hypoxia alters cardiovascular development in chick embryos.

Recommendations for fetal echocardiography in twin pregnancy in 2016

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Leszczyńska Katarzyna

2016-01-01

Full Text Available Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.

Semi-automated analysis of EEG spikes in the preterm fetal sheep using wavelet analysis

International Nuclear Information System (INIS)

Walbran, A.C.; Unsworth, C.P.; Gunn, A.J.; Benett, L.

2010-01-01

Full text: Presentation Preference Oral Presentation Perinatal hypoxia plays a key role in the cause of brain injury in premature infants. Cerebral hypothermia commenced in the latent phase of evolving injury (first 6-8 h post hypoxic-ischemic insult) is the lead candidate for treatment however currently there is no means to identify which infants can benefit from treatment. Recent studies suggest that epileptiform transients in latent phase are predictive of neural outcome. To quantify this, an automated means of EEG analysis is required as EEG monitoring produces vast amounts of data which is timely to analyse manually. We have developed a semi-automated EEG spike detection method which employs a discretized version of the continuous wavelet transform (CWT). EEG data was obtained from a fetal sheep at approximately 0.7 of gestation. Fetal asphyxia was maintained for 25 min and the EEG recorded for 8 h before and after asphyxia. The CWT was calculated followed by the power of the wavelet transform coefficients. Areas of high power corresponded to spike waves so thresholding was employed to identify the spikes. The performance of the method was found have a good sensitivity and selectivity, thus demonstrating that this method is a simple, robust and potentially effective spike detection algorithm.

Impact of Oxidative Stress in Fetal Programming

OpenAIRE

Thompson, Loren P.; Al-Hasan, Yazan

2012-01-01

Intrauterine stress induces increased risk of adult disease through fetal programming mechanisms. Oxidative stress can be generated by several conditions, such as, prenatal hypoxia, maternal under- and overnutrition, and excessive glucocorticoid exposure. The role of oxidant molecules as signaling factors in fetal programming via epigenetic mechanisms is discussed. By linking oxidative stress with dysregulation of specific target genes, we may be able to develop therapeutic strategies that pr...

The importance of perinatal autopsy. Review of the literature and series of cases.

Science.gov (United States)

Şorop-Florea, Maria; Ciurea, Raluca Niculina; Ioana, Mihai; Stepan, Alex Emilian; Stoica, George Alin; Tănase, Florentina; Comănescu, Maria Cristina; Novac, Marius Bogdan; Drăgan, Ioana; Pătru, Ciprian LaurenŢiu; Drăguşin, Roxana Cristina; Zorilă, George Lucian; Cărbunaru, Ovidiu Marian; Oprescu, NuŢi Daniela; Ceauşu, Iuliana; Vlădăreanu, Simona; Tudorache, Ştefania; Iliescu, Dominic Gabriel

2017-01-01

Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians' over-appreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.

The use of non-invasive fetal electrocardiography in diagnosing second-degree fetal atrioventricular block.

Science.gov (United States)

Lakhno, Igor; Behar, Joachim A; Oster, Julien; Shulgin, Vyacheslav; Ostras, Oleksii; Andreotti, Fernando

2017-01-01

Complete atrioventricular block in fetuses is known to be mostly associated with autoimmune disease and can be irreversible if no steroids treatment is provided. Conventional methods used in clinical practice for diagnosing fetal arrhythmia are limited since they do not reflect the primary electrophysiological conduction processes that take place in the myocardium. The non-invasive fetal electrocardiogram has the potential to better support fetal arrhythmias diagnosis through the continuous analysis of the beat to beat variation of the fetal heart rate and morphological analysis of the PQRST complex. We present two retrospective case reports on which atrioventricular block diagnosis could have been supported by the non-invasive fetal electrocardiogram. The two cases comprised a 22-year-old pregnant woman with the gestational age of 31 weeks and a 25-year-old pregnant woman with the gestational age of 41 weeks. Both women were admitted to the Department of Maternal and Fetal Medicine at the Kyiv and Kharkiv municipal perinatal clinics. Patients were observed using standard fetal monitoring methods as well as the non-invasive fetal electrocardiogram. The non-invasive fetal electrocardiographic recordings were analyzed retrospectively, where it is possible to identify the presence of the atrioventricular block. This study demonstrates, for the first time, the feasibility of the non-invasive fetal electrocardiogram as a supplementary method to diagnose of the fetal atrioventricular block. Combined with current fetal monitoring techniques, non-invasive fetal electrocardiography could support clinical decisions.

Fetal growth disorders in twin gestations.

LENUS (Irish Health Repository)

Breathnach, Fionnuala M

2012-06-01

Twin growth is frequently mismatched. This review serves to explore the pathophysiologic mechanisms that underlie growth aberrations in twin gestations, the prenatal recognition of abnormal twin growth, and the critical importance of stratifying management of abnormal twin growth by chorionicity. Although poor in utero growth of both twins may reflect maternal factors resulting in global uteroplacental dysfunction, discordant twin growth may be attributed to differences in genetic potential between co-twins, placental dysfunction confined to one placenta only, or one placental territory within a shared placenta. In addition, twin-twin transfusion syndrome represents a distinct entity of which discordant growth is a common feature. Discordant growth is recognized as an independent risk factor for adverse perinatal outcome. Intertwin birth weight disparity of 18% or more should be considered to represent a discordance threshold, which serves as an independent risk factor for adverse perinatal outcome. At this cutoff, perinatal morbidity is found to increase both for the larger and the smaller twin within a discordant pair. There remains uncertainty surrounding the sonographic parameters that are most predictive of discordance. Although heightening of fetal surveillance in the face of discordant twin growth follows the principles applied to singleton gestations complicated by fetal growth restriction, the timing of intervention is largely influenced by chorionicity.

Plasma metabolite score correlates with Hypoxia time in a newly born piglet model for asphyxia

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Julia Kuligowski

2017-08-01

Full Text Available Hypoxic-ischemic encephalopathy (HIE secondary to perinatal asphyxia is a leading cause of mortality and acquired long-term neurologic co-morbidities in the neonate. The most successful intervention for the treatment of moderate to severe HIE is moderate whole body hypothermia initiated within 6 h from birth. The objective and prompt identification of infants who are at risk of developing moderate to severe HIE in the critical first hours still remains a challenge. This work proposes a metabolite score calculated based on the relative intensities of three metabolites (choline, 6,8-dihydroxypurine and hypoxanthine that showed maximum correlation with hypoxia time in a consolidated piglet model for neonatal hypoxia-ischemia. The metabolite score's performance as a biomarker for perinatal hypoxia and its usefulness for clinical grading and decision making have been assessed and compared to the performance of lactate which is currently considered the gold standard. For plasma samples withdrawn before and directly after a hypoxic insult, the metabolite score performed similar to lactate. However, it provided an enhanced predictive capacity at 2 h after resuscitation. The present study evidences the usefulness of the metabolite score for improving the early assessment of the severity of the hypoxic insult based on serial determinations in a minimally invasive biofluid. The applicability of the metabolite score for clinical diagnosis and patient stratification for hypothermia treatment has to be confirmed in multicenter trials involving newborns suffering from HIE. Keywords: Hypoxia, Perinatal asphyxia, Newborn, Metabolic biomarker, Neonatal piglet model, Liquid Chromatography – Time-of-Flight Mass Spectrometry (LC-TOF-MS

Low cerebral blood flow in hypotensive perinatal distress

International Nuclear Information System (INIS)

Lou, H.C.; Lassen, N.A.; Friis-Hansen, B.

1977-01-01

Hypoxic brain injury is the most important neurological problem in the neonatal period and accounts for more neurological deficits in children than any other lesion. The neurological deficits are notably mental retardation, epilepsy and cerebral palsy. The pathogenesis has hitherto been poorly understood. Arterial hypoxia has been taken as the obvious mechanism but this does not fully explain the patho-anatomical findings. In the present investigation we have examined the arterial blood pressure and the cerebral blood flow in eight infants a few hours after birth. The 133Xe clearance technique was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays a crucial role in the development of perinatal hypoxic brain injury. (author)

Outcomes in Continuing Pregnancies Diagnosed with a Severe Fetal Abnormality and Implication of Antenatal Neonatology Consultation: A 10-Year Retrospective Study.

Science.gov (United States)

Hostalery, Laura; Tosello, Barthélémy

2017-06-01

To describe a population choosing to continue their pregnancy despite a severe fetal abnormality and to evaluate the role of antenatal neonatology consultation in perinatal decision-making. A 10-year (2005-2015) retrospective descriptive study in a single Multidisciplinary Prenatal Diagnosis Center in South France. A series of pregnancies with severe fetal abnormalities were collected by a person outside the decision making process and/or the child's care. Thirty-nine pregnancies were included, among which 12 couples chose the perinatal palliative care. In total, there were 25 live births (10 later died, with median of survival of 52.5 h [16-943.5]); only five infants received a palliative care plan at birth. The choice to continue a pregnancy diagnosed with severe fetal pathology is on the rise in France. Treatment options point to standardize perinatal palliative care provided by trained perinatal professionals using standardized practices.

INTRAUTERINE FETAL DEATH CASES AT TERTIARY CENTER

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Babu Lal Bishnoi

2018-01-01

Full Text Available BACKGROUND Intrauterine fetal death is a tragic event for the parents and a great cause of stress for the caregiver. It is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with intrauterine fetal death. Aim and Objective- This was an Analytical study aimed to evaluate and understand the prevalence, socio-epidemiological and etiological factors of IUFD methodology should not be mixed with aims and objectives MATERIALS AND METHODS The study was carried out at March 2017 to June 2017 (4 months study which was conducted at Dr. S. N. Medical College, Jodhpur, Rajasthan. The details were entered in a preformed proforma. IUD is defined as fetal death beyond 20 weeks of gestation and/or birth weight >500g. The details of complaints at admission, obstetrics history, menstrual history, examination findings, per vaginal examination findings, mode and method of delivery and fetal outcomes and investigation reports were recorded. RESULTS A total of 227 intrauterine fetal deaths were reported amongst 6264 deliveries conducted during the study period. The incidence rate of intrauterine fetal death was 36/1000 live births. 192 (84.56% deliveries were unbooked and unsupervised and 133 (58.59% belonged to rural population and 126 (55.5% were preterm and 221 (97.55% were singleton pregnancy. Among the identifiable causes hypertensive disorders (24.22% and severe anemia (13.10% were most common followed by placental causes (9.97%. Congenital malformations were responsible for 12.39% and unidentifiable causes were 11.01%. Induction was done in 103 patients, 94 patients had spontaneous onset of labour and caesarean section was done in 30 patients. Incidence of intrauterine foetal demise gradually decreased as parity advanced. CONCLUSION Institutional deliveries should be promoted to prevent intrapartum fetal deaths. Decrease in the incidence of IUD would

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder

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Imen Hadjkacem

2016-11-01

Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others, as determinant variables for the genesis of ASD.

Perinatal Asphyxia: A Review from a Metabolomics Perspective

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Claudia Fattuoni

2015-04-01

Full Text Available Perinatal asphyxia is defined as an oxygen deprivation that occurs around the time of birth, and may be caused by several perinatal events. This medical condition affects some four million neonates worldwide per year, causing the death of one million subjects. In most cases, infants successfully recover from hypoxia episodes; however, some patients may develop HIE, leading to permanent neurological conditions or impairment of different organs and systems. Given its multifactor dependency, the timing, severity and outcome of this disease, mainly assessed through Sarnat staging, are of difficult evaluation. Moreover, although the latest newborn resuscitation guideline suggests the use of a 21% oxygen concentration or room air, such an approach is still under debate. Therefore, the pathological mechanism is still not clear and a golden standard treatment has yet to be defined. In this context, metabolomics, a new discipline that has described important perinatal issues over the last years, proved to be a useful tool for the monitoring, the assessment, and the identification of potential biomarkers associated with asphyxia events. This review covers metabolomics research on perinatal asphyxia condition, examining in detail the studies reported both on animal and human models.

Decreasing perinatal mortality in the Netherlands, 2000-2006: a record linkage study

OpenAIRE

Ravelli , Anita C J; Tromp , Miranda; Van Huis , Marian M; Steegers , Eric A P; Tamminga , Pieter; Eskes , Martine; Bonsel , Gouke J

2009-01-01

Abstract Background: The European PERISTAT-1 study showed that in 1999 perinatal mortality, especially fetal mortality, was substantially higher in the Netherlands when compared to other European countries. The aim of this study was to analyze the recent trend in Dutch perinatal mortality and the influence of risk factors. Methods: A nationwide retrospective cohort study of 1,246,440 singleton births in 2000-2006 in the Netherlands. The source data were available fro...

Hypoglycemia and the origin of hypoxia-induced reduction in human fetal growth.

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Stacy Zamudio

2010-01-01

Full Text Available The most well known reproductive consequence of residence at high altitude (HA >2700 m is reduction in fetal growth. Reduced fetoplacental oxygenation is an underlying cause of pregnancy pathologies, including intrauterine growth restriction and preeclampsia, which are more common at HA. Therefore, altitude is a natural experimental model to study the etiology of pregnancy pathophysiologies. We have shown that the proximate cause of decreased fetal growth is not reduced oxygen availability, delivery, or consumption. We therefore asked whether glucose, the primary substrate for fetal growth, might be decreased and/or whether altered fetoplacental glucose metabolism might account for reduced fetal growth at HA.Doppler and ultrasound were used to measure maternal uterine and fetal umbilical blood flows in 69 and 58 residents of 400 vs 3600 m. Arterial and venous blood samples from mother and fetus were collected at elective cesarean delivery and analyzed for glucose, lactate and insulin. Maternal delivery and fetal uptakes for oxygen and glucose were calculated.The maternal arterial - venous glucose concentration difference was greater at HA. However, umbilical venous and arterial glucose concentrations were markedly decreased, resulting in lower glucose delivery at 3600 m. Fetal glucose consumption was reduced by >28%, but strongly correlated with glucose delivery, highlighting the relevance of glucose concentration to fetal uptake. At altitude, fetal lactate levels were increased, insulin concentrations decreased, and the expression of GLUT1 glucose transporter protein in the placental basal membrane was reduced.Our results support that preferential anaerobic consumption of glucose by the placenta at high altitude spares oxygen for fetal use, but limits glucose availability for fetal growth. Thus reduced fetal growth at high altitude is associated with fetal hypoglycemia, hypoinsulinemia and a trend towards lactacidemia. Our data support that

MRI of normal and pathological fetal lung development

International Nuclear Information System (INIS)

Kasprian, Gregor; Balassy, Csilla; Brugger, Peter C.; Prayer, Daniela

2006-01-01

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

MRI of normal and pathological fetal lung development

Energy Technology Data Exchange (ETDEWEB)

Kasprian, Gregor [University Clinic of Radiodiagnostics, Medical University of Vienna (Austria)]. E-mail: gregor.kasprian@meduniwien.ac.at; Balassy, Csilla [University Clinic of Radiodiagnostics, Medical University of Vienna (Austria); Brugger, Peter C. [Center of Anatomy and Cell Biology, Medical University of Vienna (Austria); Prayer, Daniela [University Clinic of Radiodiagnostics, Medical University of Vienna (Austria)

2006-02-15

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.

NEUROGENETIC ASPECTS OF PERINATAL HYPOXIC-ISCHEMIC AFFECTIONS OF THE CENTRAL NERVOUS SYSTEM

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George A. Karkashadze

2016-01-01

Full Text Available Neurogenetics is a thriving young science greatly contributing to the generally accepted concept of the brain development in health and disease. Thereby; scientists are not only able to highlight new key points in traditional ideas about the origin of diseases; but also to completely rethink their view on the problem of pathology development. In particular; new data on neurogenetics of perinatal affections of the central nervous system (CNS has appeared. Genetic factors in varying degrees affect perinatal hypoxic-ischemic CNS affections. Prematurity determination stays the most studied among them. Nevertheless; there is increasing evidence of significant epigenetic regulations of neuro-expression caused by hypoxia; malnutrition of a pregnant woman; stress; smoking; alcohol; drugs that either directly pathologically affect the developing brain; or form a brain phenotype sensitive to a perinatal CNS affection. New data obliges to change the approaches to prevention of perinatal CNS affections.

Fetal cardiac remodeling in twin pregnancy conceived by assisted reproductive technology.

Science.gov (United States)

Valenzuela-Alcaraz, B; Cruz-Lemini, M; Rodríguez-López, M; Goncé, A; García-Otero, L; Ayuso, H; Sitges, M; Bijnens, B; Balasch, J; Gratacós, E; Crispi, F

2018-01-01

Recent data suggest that singleton fetuses conceived by assisted reproductive technology (ART) present cardiovascular remodeling that may persist postnatally. Twin pregnancies are more frequent in the ART population and are associated with increased adverse perinatal outcomes, such as hypertensive disorders, gestational diabetes and preterm birth. However, it is unknown whether cardiac remodeling is also present in twin pregnancies conceived by ART. Our aim was to assess the presence of fetal cardiac remodeling and dysfunction in twin pregnancies conceived by ART as compared with those conceived spontaneously (SC). This was a prospective cohort study including 50 dichorionic twin fetuses conceived by ART and 50 SC twin fetuses. The study protocol included collection of baseline/perinatal data and a fetal ultrasound examination at 28-30 weeks' gestation, including assessment of estimated fetal weight, fetoplacental Doppler and fetal echocardiography. Measurements of atrial area, atrial/heart ratio, ventricular sphericity index, free wall thickness, mitral and tricuspid annular plane systolic excursions, and systolic and early diastolic peak velocities were assessed. Multilevel analyses were used to compare perinatal and ultrasonographic parameters. Comparisons of echocardiographic variables were adjusted for parental age, paternal body mass index and incidence of pre-eclampsia. Compared with SC twins, ART twin fetuses showed significant cardiac changes, predominantly affecting the right heart, such as dilated atria (right atrial/heart area: 15.7 ± 3.1 vs 18.4 ± 3.2, P fetal cardiac programing in ART. These results open opportunities for early detection and intervention in infants conceived by ART. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Prenatal, perinatal and postnatal factors associated with autism spectrum disorder

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Imen Hadjkacem

2016-11-01

Full Text Available Objective: To identify prenatal, perinatal and postnatal risk factors in children with autism spectrum disorder (ASD by comparing them to their siblings without autistic disorders. Method: The present study is cross sectional and comparative. It was conducted over a period of three months (July–September 2014. It included 101 children: 50 ASD's children diagnosed according to DSM-5 criteria and 51 unaffected siblings. The severity of ASD was assessed by the CARS. Results: Our study revealed a higher prevalence of prenatal, perinatal and postnatal factors in children with ASD in comparison with unaffected siblings. It showed also a significant association between perinatal and postnatal factors and ASD (respectively p = 0.03 and p = 0.042. In this group, perinatal factors were mainly as type of suffering acute fetal (26% of cases, long duration of delivery and prematurity (18% of cases for each factor, while postnatal factors were represented principally by respiratory infections (24%. As for parental factors, no correlation was found between advanced age of parents at the moment of the conception and ASD. Likewise, no correlation was observed between the severity of ASD and different factors. After logistic regression, the risk factors retained for autism in the final model were: male gender, prenatal urinary tract infection, acute fetal distress, difficult labor and respiratory infection. Conclusions: The present survey confirms the high prevalence of prenatal, perinatal and postnatal factors in children with ASD and suggests the intervention of some of these factors (acute fetal distress and difficult labor, among others, as determinant variables for the genesis of ASD. Resumo: Objetivo: Identificar fatores de risco pré-natal, perinatal e pós-natal em crianças com transtorno do espectro do autismo (TEA ao compará-las a irmãos sem transtornos de autismo. Método: Este estudo é transversal e comparativo. Ele foi conduzido em um per

Impact of Oxidative Stress in Fetal Programming

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Loren P. Thompson

2012-01-01

Full Text Available Intrauterine stress induces increased risk of adult disease through fetal programming mechanisms. Oxidative stress can be generated by several conditions, such as, prenatal hypoxia, maternal under- and overnutrition, and excessive glucocorticoid exposure. The role of oxidant molecules as signaling factors in fetal programming via epigenetic mechanisms is discussed. By linking oxidative stress with dysregulation of specific target genes, we may be able to develop therapeutic strategies that protect against organ dysfunction in the programmed offspring.

Avaliação da vitalidade fetal e resultados perinatais em gestações após gastroplastia com derivação em Y de Roux Assessment of fetal vitality and perinatal results in pregnancies after gastroplasty with Roux-en-Y gastric bypass

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Roseli Mieko Yamamoto Nomura

2010-01-01

Full Text Available OBJETIVO: Analisar os resultados da avaliação da vitalidade fetal de gestações após gastroplastia com derivação em Y de Roux, verificando as complicações maternas e os resultados perinatais. MÉTODOS: No período de julho de 2001 a setembro de 2009, foram analisados, retrospectivamente, dados de prontuário de pacientes com gestação após gastroplastia com derivação em Y de Roux, acompanhadas em pré-natal especializado e cujo parto foi realizado na instituição. Foram analisados os exames de avaliação da vitalidade fetal (cardiotocografia, perfil biofísico fetal e dopplervelocimetria das artérias umbilicais realizada na semana anterior ao parto. As variáveis maternas investigadas foram: dados demográficos, complicações clínicas maternas, tipo de parto, complicações no parto e pós-parto, exames hematimétricos maternos e resultados perinatais. RESULTADOS: Trinta gestações após gastroplastia com derivação em Y de Roux foram identificadas e 24 delas foram submetidas à avaliação da vitalidade fetal. Todas as pacientes apresentaram resultados normais na cardiotocografia, no perfil biofísico fetal e na dopplervelocimetria das artérias umbilicais. Houve um caso de oligohidrâmnio. A principal complicação observada foi anemia materna (Hb OBJECTIVE: To study fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass'and verify maternal complications and perinatal results. METHODS: Hospital charts of all pregnancies after gastroplasty with Roux-en-Y gastric bypass were reviewed retrospectively. All cases followed at the specialized prenatal care that gave birth in this institution, between July 2001 and September 2009, were reviewed. The assessment of fetal vitality (cardiotocography, fetal biophysical profile and umbilical artery Doppler velocimetry performed in the last week before delivery were analyzed. The maternal variables investigated were: demographic data, maternal complications

Hypoxia inhibits hypertrophic differentiation and endochondral ossification in explanted tibiae.

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Jeroen C H Leijten

Full Text Available Hypertrophic differentiation of growth plate chondrocytes induces angiogenesis which alleviates hypoxia normally present in cartilage. In the current study, we aim to determine whether alleviation of hypoxia is merely a downstream effect of hypertrophic differentiation as previously described or whether alleviation of hypoxia and consequent changes in oxygen tension mediated signaling events also plays an active role in regulating the hypertrophic differentiation process itself.Fetal mouse tibiae (E17.5 explants were cultured up to 21 days under normoxic or hypoxic conditions (21% and 2.5% oxygen respectively. Tibiae were analyzed on growth kinetics, histology, gene expression and protein secretion.The oxygen level had a strong influence on the development of explanted fetal tibiae. Compared to hypoxia, normoxia increased the length of the tibiae, length of the hypertrophic zone, calcification of the cartilage and mRNA levels of hypertrophic differentiation-related genes e.g. MMP9, MMP13, RUNX2, COL10A1 and ALPL. Compared to normoxia, hypoxia increased the size of the cartilaginous epiphysis, length of the resting zone, calcification of the bone and mRNA levels of hyaline cartilage-related genes e.g. ACAN, COL2A1 and SOX9. Additionally, hypoxia enhanced the mRNA and protein expression of the secreted articular cartilage markers GREM1, FRZB and DKK1, which are able to inhibit hypertrophic differentiation.Collectively our data suggests that oxygen levels play an active role in the regulation of hypertrophic differentiation of hyaline chondrocytes. Normoxia stimulates hypertrophic differentiation evidenced by the expression of hypertrophic differentiation related genes. In contrast, hypoxia suppresses hypertrophic differentiation of chondrocytes, which might be at least partially explained by the induction of GREM1, FRZB and DKK1 expression.

Indicators of fetal and infant health outcomes

NARCIS (Netherlands)

Buitendijk, Simone; Zeitlin, Jennifer; Cuttini, Marina; Langhoff-Roos, Jens; Bottu, Jean

2003-01-01

OBJECTIVE: To assess the ability of the member states of the European Union to produce the indicators recommended by the PERISTAT project on perinatal health indicators and to provide an overview of fetal and infant health outcomes for these countries according to the information now available.

[Impact of hypoxia in different periods of prenatal ontogenesis on ECoG of rabbit fetus].

Science.gov (United States)

Guseĭnov, A G; Mamedov, Kh B

2012-10-01

Sensitivity of ECoG of sensorimotor cortex of 28-day rabbit foetus in different periods (prefetal and fetal) of embryogenesis to hypoxia impact was studied. In the foetus subjected to hypoxia during prefetal period (8-18th days) in the spectrum of the general activity the increase of slow waves, occupying little portion of the spectrum, is noticed, while the main delta-rhythm has more clear pattern. At the same time, hypoxia, undertaken in the fetal period (18-28th days) does not have significant effect on ECoG indexes. On the basis of our own and literature data one can propose tha high sensitivity of ECoG to oxygen deficiency is due to low stability of the brain cortex itself and subcortical white matter to hypoxic inpairement in early embriogenesis.

The protective effect of ursodeoxycholic acid in an in vitro model of the human fetal heart occurs via targeting cardiac fibroblasts.

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Schultz, Francisca; Hasan, Alveera; Alvarez-Laviada, Anita; Miragoli, Michele; Bhogal, Navneet; Wells, Sarah; Poulet, Claire; Chambers, Jenny; Williamson, Catherine; Gorelik, Julia

2016-01-01

Bile acids are elevated in the blood of women with intrahepatic cholestasis of pregnancy (ICP) and this may lead to fetal arrhythmia, fetal hypoxia and potentially fetal death in utero. The bile acid taurocholic acid (TC) causes abnormal calcium dynamics and contraction in neonatal rat cardiomyocytes. Ursodeoxycholic acid (UDCA), a drug clinically used to treat ICP, prevents adverse effects of TC. During development, the fetus is in a state of relative hypoxia. Although this is essential for the development of the heart and vasculature, resident fibroblasts can transiently differentiate into myofibroblasts and form gap junctions with cardiomyocytes in vitro, resulting in cardiomyocyte depolarization. We expanded on previously published work using an in vitro hypoxia model to investigate the differentiation of human fetal fibroblasts into myofibroblasts. Recent evidence shows that potassium channels are involved in maintaining the membrane potential of ventricular fibroblasts and that ATP-dependent potassium (KATP) channel subunits are expressed in cultured fibroblasts. KATP channels are a valuable target as they are thought to have a cardioprotective role during ischaemic and hypoxic conditions. We investigated whether UDCA could modulate fibroblast membrane potential. We established the isolation and culture of human fetal cardiomyocytes and fibroblasts to investigate the effect of hypoxia, TC and UDCA on human fetal cardiac cells. UDCA hyperpolarized myofibroblasts and prevented TC-induced depolarisation, possibly through the activation of KATP channels that are expressed in cultured fibroblasts. Also, similar to the rat model, UDCA can counteract TC-induced calcium abnormalities in human fetal cultures of cardiomyocytes and myofibroblasts. Under normoxic conditions, we found a higher number of myofibroblasts in cultures derived from human fetal hearts compared to cells isolated from neonatal rat hearts, indicating a possible increased number of myofibroblasts

Ethical issues in perinatal mental health research.

Science.gov (United States)

Brandon, Anna R; Shivakumar, Geetha; Lee, Simon Craddock; Inrig, Stephen J; Sadler, John Z

2009-11-01

To review the background of current ethical standards for the conduct of perinatal mental health research and describe the ethical challenges in this research domain. Current literature reflects a growing sentiment in the scientific community that having no information regarding the impact of psychiatric treatment on the mother and developing fetus/infant poses dangers that may exceed the risks involved in research. However, without sufficient consensus across the scientific community, both regulatory bodies and perinatal researchers find themselves without a framework for decision making that satisfactorily limits the risks and facilitates the benefits of participation of pregnant and lactating women in clinical research. Psychiatric research in perinatal mental health is critically important as it enables clinicians and patients to participate in informed decision-making concerning treatment for psychiatric disorders. Specific areas of concern include fetal safety, maternal risk, the therapeutic misconception, commercial interests, forensic/legal issues, the informed consent process, and study design. Developing guidelines that address ethical challenges and include the views and concerns of multiple stakeholders could improve the access of perinatal women to the benefits of participation in mental health research in addition to providing evidence-based mental healthcare for this subpopulation.

Factors associated with and causes of perinatal mortality in northeastern Tanzania

DEFF Research Database (Denmark)

Schmiegelow, Christentze; Minja, Daniel; Oesterholt, Mayke

2012-01-01

, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key...... to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7....../26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly...

Growth assessment in diagnosis of Fetal Growth Restriction. Review

OpenAIRE

Albu, AR; Horhoianu, IA; Dumitrascu, MC; Horhoianu, V

2014-01-01

Abstract The assessment of fetal growth represents a fundamental step towards the identification of the true growth restricted fetus that is associated to important perinatal morbidity and mortality. The possible ways of detecting abnormal fetal growth are taken into consideration in this review and their strong and weak points are discussed. An important debate still remains about how to discriminate between the physiologically small fetus that does not require special surveillance and the t...

Fetal Echocardiography and Indications

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Melih Atahan Güven

2008-09-01

Full Text Available Congenital heart diseases are encountered in 0.8% of live births and are among the most frequently diagnosed malformations. At least half of these anomalies end up with death or require surgical interventions and are responsible for 30% of the perinatal mortality. Fetal echocardiography is the sum of knowledge, skill and orientation rather than knowing the embryologic details of the fetal heart. The purpose of fetal echocardiography is to document the presence of normal fetal cardiac anatomy and rhythm in high risk group and to define the anomaly and arrhythmia if present. A certain sequence should be followed during the evaluation of fetal heart. Sequential segmental analysis (SSA and basic definition terminology made it possible to determine a lot of complex cardiac anomalies during prenatal period. By the end of 1970’s, Shinebourne started using sequential segmental analysis for fetal cardiac evaluation and today, prenatal diagnosis of congenital heart disease is possible without any confusion. In this manner, whole fetal heart can be evaluated as the relation of three segments (atria, ventricles and the great arteries with each other, irrelevant of complexity of a possible cardiac anomaly. Presence of increased nuchal thickness during early gestation and abnormal four-chamber-view during ultrasonography by the obstetrician presents a clear indication for fetal echocardiography,however, one should keep in mind that 80-90% of the babies born with a congenital heart disease do not have a familial or maternal risk factor. In addition, it should be remembered that expectant mothers with diabetes mellitus pose an indication for fetal echocardiography.

Lipid peroxidation and antioxidant activity in patients in labor with nonreassuring fetal status.

Science.gov (United States)

Dede, F S; Guney, Yildiz; Dede, Hulya; Koca, Cemile; Dilbaz, Berna; Bilgihan, Ayse

2006-01-01

The aim of our study was to evaluate lipid peroxidation products and antioxidant enzyme activity in placental tissue and umbilical cord blood, as a marker for fetal hypoxia in patients in labor with nonreassuring fetal status. Umbilical cord arterial blood and placental tissue samples were collected from 24 patients with term pregnancies in labor and nonreassuring fetal heart rate (FHR) patterns (study) and 24 women with normal pregnancies in labor and normal FHR tracings (controls) for determination of malondialdehyde (MDA) as a marker for lipid peroxidation and superoxide dismutase (SOD) for the antioxidant activity. Measured values were compared statistically between two groups using independent samples t-test or Mann-Whitney U-test. The median 1min Apgar score was 8 (range 4-9) in the study group and 9 (range 8-10) in the control group, respectively (p 0.05). Placental MDA levels in patients with nonreassuring fetal status were found to be significantly elevated compared to the control group (12.14 nmol/g tissue versus 9.75 nmol/g tissue; p < 0.01). The placental SOD activity in the study group was significantly higher (p < 0.01) compared to controls (3.57 U/mg protein versus 2.63 U/mg protein). The umbilical cord blood MDA levels in the study group were higher than in normal pregnancies (4.99 nmol/mL, 3.88 nmol/mL; p < 0.05). The activity of SOD in umbilical cord blood was significantly higher (p < 0.001) in patients with nonreassuring fetal status when compared with the control group (11.62 versus 6.95 U/mL). Lipid peroxidation products and antioxidant functions were elevated in the umbilical cord blood and placenta of patients having nonreassuring FHR tracings during labor. These findings indicate that lipid peroxidation products in placenta and umbilical cord blood can be used as a possible marker for fetal hypoxia during labor and SOD levels may discriminate acute from chronic hypoxia. Further investigations are needed with large number of series to

Asma na gestação: efeitos na vitalidade fetal, complicações maternas e perinatais Asthma during pregnancy: effects on fetal well-being, and maternal and perinatal complications

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Renata Franco Pimentel Mendes

2013-04-01

impairment of fetal well-being, as well as the related maternal and perinatal complications. METHODS: A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteriawere as follows: singleton pregnancy; pregnantwomen diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28th week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. RESULTS: Of the total of 117 pregnant women with asthma, 41 (35.0% had intermittent, 33 (28.2% mild persistent, 21 (17.9% moderate persistent, and 22 (18.8% severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks, and birth weight averaged 3,056 g (SD 581 g. The fetal biophysical profile performed during the antepartum period (n = 90, 76.9% showed a normal result (8 or 10 in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n = 28 of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p < 0.001 different among the intermittent (4.9%, mild persistent (9.1%, moderate persistent (28.6%, and severe persistent (45.5% groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

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Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Perinatal pathology: practice suggestions for limited-resource settings.

Science.gov (United States)

Roberts, Drucilla J

2013-06-01

The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

Piracetam for fetal distress in labour.

Science.gov (United States)

Hofmeyr, G Justus; Kulier, Regina

2012-06-13

Piracetam is thought to promote the metabolism of brain cells when they are hypoxic. It has been used to prevent adverse effects of fetal distress. The objective of this review was to assess the effects of piracetam for suspected fetal distress in labour on method of delivery and perinatal morbidity. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012). Randomised trials of piracetam compared with placebo or no treatment for suspected fetal distress in labour. Both review authors assessed eligibility and trial quality. One study of 96 women was included. Piracetam compared with placebo was associated with a trend to reduced need for caesarean section (risk ratio 0.57, 95% confidence interval 0.32 to 1.03). There were no statistically significant differences between the piracetam and placebo group for neonatal morbidity (measured by neonatal respiratory distress) or Apgar score. There is not enough evidence to evaluate the use of piracetam for fetal distress in labour.

Ultrasonic character istics and clinical significance of umbilical cord blood flow in acute fetal distress

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Wei Dai, Yin Xu

2016-11-01

positively correlated with the umbilical artery RI, PI and S/D. Conclusions: The ultrasonic characteristics of umbilical cord blood flow in patients with acute fetal distress are increase of the resistance, reduction of blood flow, and significant reduction of ultrasonic parameters of RI, PI and S/D. The degree of hypoxia, oxidative stress, myocardial injury and brain injury can also be evaluated. 1. Introduction Acute fetal distress is one of the serious complications in perinatal period and it refers to acute hypoxia of the fetus in the womb. Its pathological

Acute and Chronic Fetal Anemia as a Result of Fetomaternal Hemorrhage

OpenAIRE

Singh, Paul; Swanson, Tara

2014-01-01

Introduction. Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management. Case. A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal ane...

Fetal growth velocity and body proportion in the assessment of growth.

Science.gov (United States)

Hiersch, Liran; Melamed, Nir

2018-02-01

Fetal growth restriction implies failure of a fetus to meet its growth potential and is associated with increased perinatal mortality and morbidity. Therefore, antenatal detection of fetal growth restriction is of major importance in an attempt to deliver improved clinical outcomes. The most commonly used approach towards screening for fetal growth restriction is by means of sonographic fetal weight estimation, to detect fetuses small for gestational age, defined by an estimated fetal weight <10th percentile for gestational age. However, the predictive accuracy of this approach is limited both by suboptimal detection rate (as it may overlook non-small-for-gestational-age growth-restricted fetuses) and by a high false-positive rate (as most small-for-gestational-age fetuses are not growth restricted). Here, we review 2 strategies that may improve the diagnostic accuracy of sonographic fetal biometry for fetal growth restriction. The first strategy involves serial ultrasound evaluations of fetal biometry. The information obtained through these serial assessments can be interpreted using several different approaches including fetal growth velocity, conditional percentiles, projection-based methods, and individualized growth assessment that can be viewed as mathematical techniques to quantify any decrease in estimated fetal weight percentile, a phenomenon that many care providers assess and monitor routinely in a qualitative manner. This strategy appears promising in high-risk pregnancies where it seems to improve the detection of growth-restricted fetuses at increased risk of adverse perinatal outcomes and, at the same time, decrease the risk of falsely diagnosing healthy constitutionally small-for-gestational-age fetuses as growth restricted. Further studies are needed to determine the utility of this strategy in low-risk pregnancies as well as to optimize its performance by determining the optimal timing and interval between exams. The second strategy refers to the

Effect of neonatal asphyxia on the impairment of the auditory pathway by recording auditory brainstem responses in newborn piglets: a new experimentation model to study the perinatal hypoxic-ischemic damage on the auditory system.

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Francisco Jose Alvarez

Full Text Available Hypoxia-ischemia (HI is a major perinatal problem that results in severe damage to the brain impairing the normal development of the auditory system. The purpose of the present study is to study the effect of perinatal asphyxia on the auditory pathway by recording auditory brain responses in a novel animal experimentation model in newborn piglets.Hypoxia-ischemia was induced to 1.3 day-old piglets by clamping 30 minutes both carotid arteries by vascular occluders and lowering the fraction of inspired oxygen. We compared the Auditory Brain Responses (ABRs of newborn piglets exposed to acute hypoxia/ischemia (n = 6 and a control group with no such exposure (n = 10. ABRs were recorded for both ears before the start of the experiment (baseline, after 30 minutes of HI injury, and every 30 minutes during 6 h after the HI injury.Auditory brain responses were altered during the hypoxic-ischemic insult but recovered 30-60 minutes later. Hypoxia/ischemia seemed to induce auditory functional damage by increasing I-V latencies and decreasing wave I, III and V amplitudes, although differences were not significant.The described experimental model of hypoxia-ischemia in newborn piglets may be useful for studying the effect of perinatal asphyxia on the impairment of the auditory pathway.

Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet).

Science.gov (United States)

Moon-Grady, Anita J; Baschat, Ahmet; Cass, Darrell; Choolani, Mahesh; Copel, Joshua A; Crombleholme, Timothy M; Deprest, Jan; Emery, Stephen P; Evans, Mark I; Luks, Francois I; Norton, Mary E; Ryan, Greg; Tsao, Kuojen; Welch, Ross; Harrison, Michael

2017-01-01

More than 3 decades ago, a small group of physicians and other practitioners active in what they called "fetal treatment" authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of fetal therapies with appropriate expertise, experience, and subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety. © 2017 S. Karger AG, Basel.

Mortalidade perinatal por sífilis congênita: indicador da qualidade da atenção à mulher e à criança Perinatal mortality due to congenital syphilis: a quality-of-care indicator for women's and children's healthcare

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Valéria Saraceni

2005-08-01

Full Text Available A sífilis permanece como causa importante de mortalidade perinatal no Município do Rio de Janeiro, Brasil, onde o presente estudo foi realizado utilizando os dados do Sistema de Informação de Mortalidade e das Fichas de Notificação e Investigação de Óbitos Fetais e Neonatais, obrigatórias para as maternidades municipais. Entre 1996 e 1998, a sífilis congênita foi responsável por 13,1% dos óbitos fetais e 6,5% dos neonatais nas maternidades municipais. Entre 1999 e 2002, os percentuais foram de 16,2% e 7,9%, respectivamente. Para o Município do Rio de Janeiro, de 1999 a 2002, os percentuais foram 5,4% e 2,2%, para óbitos fetais e neonatais. A taxa de mortalidade perinatal por sífilis congênita permanece estável no Município do Rio de Janeiro apesar dos esforços iniciados com as campanhas para eliminação do agravo em 1999 e 2000. Propomos a utilização da taxa de mortalidade perinatal por sífilis congênita como indicador de impacto das ações de controle e eliminação da sífilis congênita e sugerimos a utilização das fichas de notificação e investigação de óbitos fetais e neonatais para a vigilância de outros agravos evitáveis.Syphilis is a persistent cause of perinatal mortality in Rio de Janeiro, Brazil, where this study was performed using data from the mortality data system and investigational reports for fetal and neonatal deaths, mandatory in municipal maternity hospitals. From 1996 to 1998, 13.1% of fetal deaths and 6.5% of neonatal deaths in municipal maternity hospitals were due to congenital syphilis. From 1999 to 2002, the proportions were 16.2% and 7.9%, respectively. For the city of Rio de Janeiro as a whole from 1999 and 2002, the proportions were 5.4% of fetal deaths and 2.2% of neonatal deaths. The perinatal mortality rate due to congenital syphilis remains stable in Rio de Janeiro, despite efforts initiated with congenital syphilis elimination campaigns in 1999 and 2000. We propose that the

Continuity and change in mothers' narratives of perinatal hospice.

Science.gov (United States)

Lathrop, Anthony; VandeVusse, Leona

2011-01-01

(1) To broadly explore the experiences of women who chose to continue pregnancies affected by lethal fetal diagnoses and (2) to develop knowledge useful to nurses and other healthcare professionals who provide perinatal hospice (PH) care. Qualitative descriptive study using narrative analysis. Fifteen women who learned during their pregnancies of a lethal fetal diagnosis and chose to continue the affected pregnancies. Participants' stories of their PH experiences were recorded in face-to-face interviews. A qualitative approach using narrative analysis was used to identify themes and develop suggestions for care. The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes such as increased compassion, faith, and strength were frequently mentioned. Mothers described transient phases of highs and lows. Drawing personal meanings or life lessons was the main way mothers connected their experiences to their present lives. Mothers' descriptions of their experiences can enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses can help mothers experiencing loss by elucidating and reflecting their personal meanings.

MRI of fetal acquired brain lesions

International Nuclear Information System (INIS)

Prayer, Daniela; Brugger, Peter C.; Kasprian, Gregor; Witzani, Linde; Helmer, Hanns; Dietrich, Wolfgang; Eppel, Wolfgang; Langer, Martin

2006-01-01

Acquired fetal brain damage is suspected in cases of destruction of previously normally formed tissue, the primary cause of which is hypoxia. Fetal brain damage may occur as a consequence of acute or chronic maternal diseases, with acute diseases causing impairment of oxygen delivery to the fetal brain, and chronic diseases interfering with normal, placental development. Infections, metabolic diseases, feto-fetal transfusion syndrome, toxic agents, mechanical traumatic events, iatrogenic accidents, and space-occupying lesions may also qualify as pathologic conditions that initiate intrauterine brain damage. MR manifestations of acute fetal brain injury (such as hemorrhage or acute ischemic lesions) can easily be recognized, as they are hardly different from postnatal lesions. The availability of diffusion-weighted sequences enhances the sensitivity in recognizing acute ischemic lesions. Recent hemorrhages are usually readily depicted on T2 (*) sequences, where they display hypointense signals. Chronic fetal brain injury may be characterized by nonspecific changes that must be attributable to the presence of an acquired cerebral pathology. The workup in suspected acquired fetal brain injury also includes the assessment of extra-CNS organs that may be affected by an underlying pathology. Finally, the placenta, as the organ that mediates oxygen delivery from the maternal circulation to the fetus, must be examined on MR images

MRI of fetal acquired brain lesions

Energy Technology Data Exchange (ETDEWEB)

Prayer, Daniela [Department of Radiodiagnostics, Medical University of Vienna (Austria)]. E-mail: daniela.prayer@meduniwien.ac.at; Brugger, Peter C. [Center of Anatomy and Cell Biology, Medical University of Vienna (Austria); Kasprian, Gregor [Department of Radiodiagnostics, Medical University of Vienna (Austria); Witzani, Linde [Department of Radiodiagnostics, Medical University of Vienna (Austria); Helmer, Hanns [Department of Obstetrics and Gynecology, Medical University of Vienna (Austria); Dietrich, Wolfgang [Department of Neurosurgery, Medical University of Vienna (Austria); Eppel, Wolfgang [Department of Obstetrics and Gynecology, Medical University of Vienna (Austria); Langer, Martin [Department of Obstetrics and Gynecology, Medical University of Vienna (Austria)

2006-02-15

Acquired fetal brain damage is suspected in cases of destruction of previously normally formed tissue, the primary cause of which is hypoxia. Fetal brain damage may occur as a consequence of acute or chronic maternal diseases, with acute diseases causing impairment of oxygen delivery to the fetal brain, and chronic diseases interfering with normal, placental development. Infections, metabolic diseases, feto-fetal transfusion syndrome, toxic agents, mechanical traumatic events, iatrogenic accidents, and space-occupying lesions may also qualify as pathologic conditions that initiate intrauterine brain damage. MR manifestations of acute fetal brain injury (such as hemorrhage or acute ischemic lesions) can easily be recognized, as they are hardly different from postnatal lesions. The availability of diffusion-weighted sequences enhances the sensitivity in recognizing acute ischemic lesions. Recent hemorrhages are usually readily depicted on T2 (*) sequences, where they display hypointense signals. Chronic fetal brain injury may be characterized by nonspecific changes that must be attributable to the presence of an acquired cerebral pathology. The workup in suspected acquired fetal brain injury also includes the assessment of extra-CNS organs that may be affected by an underlying pathology. Finally, the placenta, as the organ that mediates oxygen delivery from the maternal circulation to the fetus, must be examined on MR images.

Chronic antepartum maternal hyperoxygenation in a case of severe fetal Ebstein's anomaly with circular shunt physiology

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Alisa Arunamata

2017-01-01

Full Text Available Perinatal mortality remains high among fetuses diagnosed with Ebstein's anomaly of the tricuspid valve. The subgroup of patients with pulmonary valve regurgitation is at particularly high risk. In the setting of pulmonary valve regurgitation, early constriction of the ductus arteriosus may be a novel perinatal management strategy to reduce systemic steal resulting from circular shunt physiology. We report the use of chronic antepartum maternal oxygen therapy for constriction of the fetal ductus arteriosus and modulation of fetal pulmonary vascular resistance in a late presentation of Ebstein's anomaly with severe tricuspid valve regurgitation, reversal of flow in the ductus arteriosus, and continuous pulmonary valve regurgitation.

Oligodramnia sem rotura das membranas amnióticas: resultados perinatais Oligohydramnios without premature rupture of membranes: perinatal outcomes

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José Mauro Madi

2005-02-01

Full Text Available OBJETIVO: avaliar os resultados perinatais em casos de oligodramnia sem rotura de membranas amnióticas. MÉTODOS: foram estudados retrospectivamente 51 casos consecutivos de oligodramnia (índice de líquido amniótico (ILA menor que 5 cm em nascimentos ocorridos no período de março de 1998 a setembro de 2001. Compararam-se os dados obtidos aos de 61 casos com quantidade intermediária e normal de líquido amniótico (ILA >5 cm. Analisaram-se variáveis maternas e neonatais, bem como taxas de mortalidade fetal, neonatal precoce e perinatal. As avaliações estatísticas foram realizadas mediante a aplicação do teste não paramétrico do c² com a correção de Yates, e do teste t de Student. Adotou-se o nível de significância de 5%. RESULTADOS: não houve diferença significante entre os grupos estudados, ao se analisar a ocorrência de síndrome hipertensiva, presença de mecônio, índice de Apgar inferior a sete no primeiro e quinto minuto, internação na unidade de tratamento intensivo neonatal e prematuridade. A oligodramnia associou-se significantemente ao tipo de parto (pPURPOSE: to evaluate perinatal outcomes in cases of oligohydramnios without premature rupture of membranes. METHODS: a total of 51 consecutive cases of oligohydramnios (amniotic fluid index, AFI 5. Maternal and neonatal variables, as well as fetal mortality, early neonatal, and perinatal mortality rates were analyzed. For statistical analysis the c² test with Yates correction and Student's t test were used with level of signicance set at 5%. RESULTS: there were no significant differences between groups when the presence of gestational hypertensive syndromes, meconium-stained amniotic fluid, 1- and 5-minute Apgar score, need of neonatal intensive center unit, and preterm birth were analyzed. Oligohydramnios was associated with the way of delivery (p<0.0002; RR=0.3, fetal distress (p<0.0004; RR=2.2 and fetal malformations (p<0.01; RR=5.4. Fetal malformation rates

Oxygen and oxidative stress in the perinatal period.

Science.gov (United States)

Torres-Cuevas, Isabel; Parra-Llorca, Anna; Sánchez-Illana, Angel; Nuñez-Ramiro, Antonio; Kuligowski, Julia; Cháfer-Pericás, Consuelo; Cernada, María; Escobar, Justo; Vento, Máximo

2017-08-01

Fetal life evolves in a hypoxic environment. Changes in the oxygen content in utero caused by conditions such as pre-eclampsia or type I diabetes or by oxygen supplementation to the mother lead to increased free radical production and correlate with perinatal outcomes. In the fetal-to-neonatal transition asphyxia is characterized by intermittent periods of hypoxia ischemia that may evolve to hypoxic ischemic encephalopathy associated with neurocognitive, motor, and neurosensorial impairment. Free radicals generated upon reoxygenation may notably increase brain damage. Hence, clinical trials have shown that the use of 100% oxygen given with positive pressure in the airways of the newborn infant during resuscitation causes more oxidative stress than using air, and increases mortality. Preterm infants are endowed with an immature lung and antioxidant system. Clinical stabilization of preterm infants after birth frequently requires positive pressure ventilation with a gas admixture that contains oxygen to achieve a normal heart rate and arterial oxygen saturation. In randomized controlled trials the use high oxygen concentrations (90% to 100%) has caused more oxidative stress and clinical complications that the use of lower oxygen concentrations (30-60%). A correlation between the amount of oxygen received during resuscitation and the level of biomarkers of oxidative stress and clinical outcomes was established. Thus, based on clinical outcomes and analytical results of oxidative stress biomarkers relevant changes were introduced in the resuscitation policies. However, it should be underscored that analysis of oxidative stress biomarkers in biofluids has only been used in experimental and clinical research but not in clinical routine. The complexity of the technical procedures, lack of automation, and cost of these determinations have hindered the routine use of biomarkers in the clinical setting. Overcoming these technical and economical difficulties constitutes a

Oxygen and oxidative stress in the perinatal period

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Isabel Torres-Cuevas

2017-08-01

Full Text Available Fetal life evolves in a hypoxic environment. Changes in the oxygen content in utero caused by conditions such as pre-eclampsia or type I diabetes or by oxygen supplementation to the mother lead to increased free radical production and correlate with perinatal outcomes.In the fetal-to-neonatal transition asphyxia is characterized by intermittent periods of hypoxia ischemia that may evolve to hypoxic ischemic encephalopathy associated with neurocognitive, motor, and neurosensorial impairment. Free radicals generated upon reoxygenation may notably increase brain damage. Hence, clinical trials have shown that the use of 100% oxygen given with positive pressure in the airways of the newborn infant during resuscitation causes more oxidative stress than using air, and increases mortality.Preterm infants are endowed with an immature lung and antioxidant system. Clinical stabilization of preterm infants after birth frequently requires positive pressure ventilation with a gas admixture that contains oxygen to achieve a normal heart rate and arterial oxygen saturation. In randomized controlled trials the use high oxygen concentrations (90% to 100% has caused more oxidative stress and clinical complications that the use of lower oxygen concentrations (30–60%. A correlation between the amount of oxygen received during resuscitation and the level of biomarkers of oxidative stress and clinical outcomes was established. Thus, based on clinical outcomes and analytical results of oxidative stress biomarkers relevant changes were introduced in the resuscitation policies. However, it should be underscored that analysis of oxidative stress biomarkers in biofluids has only been used in experimental and clinical research but not in clinical routine. The complexity of the technical procedures, lack of automation, and cost of these determinations have hindered the routine use of biomarkers in the clinical setting. Overcoming these technical and economical difficulties

Perinatal and maternal complications related to postterm delivery: A national register-based study, 1978-1993

DEFF Research Database (Denmark)

Olesen, Annette Wind; Westergaard, Jes G.; Olsen, Jørn

2003-01-01

OBJECTIVE: This study was undertaken to estimate the risk of fetal and maternal complications associated with postterm delivery in Denmark. STUDY DESIGN: A cross-sectional study that used records from the Danish Medical Birth Registry from 1978 to 1993 was performed. All women with registered...... to analyze data. RESULTS: The risk of perinatal and obstetric complications was high in postterm delivery compared with term delivery (adjusted odds ratios between 1.2 and 3.1). The risk of perinatal death was 1.33 (1.05-1.68). CONCLUSION: Postterm delivery was associated with significantly increased risks...... of perinatal and maternal complications in Denmark in the period from 1978 to 1993....

Indications and technique of fetal magnetic resonance imaging; Indikationen und Technik der fetalen Magnetresonanztomographie

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Asenbaum, U.; Woitek, R.; Furtner, J.; Prayer, D. [Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Brugger, P.C. [Medizinische Universitaet Wien, Zentrum fuer Anatomie und Zellbiologie, Wien (Austria)

2013-02-15

Evaluation and confirmation of fetal pathologies previously suspected or diagnosed with ultrasound. Ultrasound and magnetic resonance imaging (MRI). Technique for prenatal fetal examination. Fetal MRI is an established supplementary technique to prenatal ultrasound. Fetal MRI should only be used as an additional method in prenatal diagnostics and not for routine screening. Fetal MRI should only be performed in perinatal medicine centers after a previous level III ultrasound examination. (orig.) [German] Evaluierung und Bestaetigung von im praenatalen Ultraschall entdeckten Pathologien. Ultraschall und Magnetresonanztomographie. Praenatale Untersuchungsmethode. Die fetale MRT ist inzwischen als ergaenzende Methode zum praenatalen Ultraschall anerkannt. Die fetale MRT soll als additive Methode bei klinischer Relevanz, nicht jedoch als Routinescreeningverfahren waehrend der Schwangerschaft angewendet werden. Durchfuehrung ausschliesslich an einem Perinatalzentrum nach vorangegangenem Level-III-Ultraschall. (orig.)

Adrenocortical and Adipose Responses to High-Altitude-Induced, Long-Term Hypoxia in the Ovine Fetus

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Dean A. Myers

2012-01-01

Full Text Available By late gestation, the maturing hypothalamo-pituitary-adrenal (HPA axis aids the fetus in responding to stress. Hypoxia represents a significant threat to the fetus accompanying situations such as preeclampsia, smoking, high altitude, and preterm labor. We developed a model of high-altitude (3,820 m, long-term hypoxia (LTH in pregnant sheep. We describe the impact of LTH on the fetal HPA axis at the level of the hypothalamic paraventricular nucleus (PVN, anterior pituitary corticotrope, and adrenal cortex. At the PVN and anterior pituitary, the responses to LTH are consistent with hypoxia being a potent activator of the HPA axis and potentially maladaptive, while the adrenocortical response to LTH appears to be primarily adaptive. We discuss mechanisms involved in the delicate balance between these seemingly opposing responses that preserve the normal ontogenic rise in fetal plasma cortisol essential for organ maturation and in this species, birth. Further, we examine the response to, and ramifications of, an acute secondary stressor in the LTH fetus. We provide an integrative model on the potential role of adipose in modulating these responses to LTH. Integration of these adaptive responses to LTH plays a key role in promoting normal fetal growth and development under conditions of a chronic stress.

Technology use, cesarean section rates, and perinatal mortality at Danish maternity wards

DEFF Research Database (Denmark)

Lidegaard, O; Jensen, L M; Weber, Tom

1994-01-01

Fifty-eight Danish maternity units, managing 99% of Danish deliveries, participated in a cross sectional study to assess the relationship between use of birth-related technologies, cesarean section rates and perinatal mortality for births after 35 completed weeks of gestation. A regional technology...... index (0-10) was calculated for each maternity unit according to its use of ante and intra partum fetal heart rate monitoring (FHM), hormone analysis (human placental lactogen (HPL) and/or estriol (O3)), fetal blood samples (scalp-pH), intrauterine catheter and umbilical cord-pH. Maternity units using...

The effect of customization and use of a fetal growth standard on the association between birthweight percentile and adverse perinatal outcome.

Science.gov (United States)

Sovio, Ulla; Smith, Gordon C S

2018-02-01

It has been proposed that correction of offspring weight percentiles (customization) might improve the prediction of adverse pregnancy outcome; however, the approach is not accepted universally. A complication in the interpretation of the data is that the main method for calculation of customized percentiles uses a fetal growth standard, and multiple analyses have compared the results with birthweight-based standards. First, we aimed to determine whether women who deliver small-for-gestational-age infants using a customized standard differed from other women. Second, we aimed to compare the association between birthweight percentile and adverse outcome using 3 different methods for percentile calculation: (1) a noncustomized actual birthweight standard, (2) a noncustomized fetal growth standard, and (3) a fully customized fetal growth standard. We analyzed data from the Pregnancy Outcome Prediction study, a prospective cohort study of nulliparous women who delivered in Cambridge, UK, between 2008 and 2013. We used a composite adverse outcome, namely, perinatal morbidity or preeclampsia. Receiver operating characteristic curve analysis was used to compare the 3 methods of calculating birthweight percentiles in relation to the composite adverse outcome. We confirmed previous observations that delivering an infant who was small for gestational age (customized fetal growth standard but who was appropriate for gestational age with the use of a noncustomized actual birthweight standard was associated with higher rates of adverse outcomes. However, we also observed that the mothers of these infants were 3-4 times more likely to be obese and to deliver preterm. When we compared the risk of adverse outcome from logistic regression models that were fitted to the birthweight percentiles that were derived by each of the 3 predefined methods, the areas under the receiver operating characteristic curves were similar for all 3 methods: 0.56 (95% confidence interval, 0

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term.

OpenAIRE

Khalil, A; Thilaganathan, B

2017-01-01

Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is eme...

La mortalidad perinatal según 2 fuentes de información Perinatal mortality according to 2 information sources

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Adriana Freitas Ramírez

2008-08-01

Full Text Available Objetivo: Evaluar la diferencia en muertes perinatales (MP ocurridas en Cataluña y su evolución según 2 fuentes de información sanitaria. Métodos: Los datos proceden de la estadística de mortalidad (Departament de Salut e Institut d'Estadística de Catalunya y del Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBDAH del Servei Català de la Salut del período 2000-2003. Se describen las frecuencias totales de MP según si cumplen o no criterio legal de declaración. Resultados: La estadística de mortalidad registró un 27,2% menos de MP, un 44,77% menos de muertes fetales y un 13,5% más de muertes neonatales precoces que el CMBDAH. Estos porcentajes son menores considerando sólo los casos con criterios legales de declaración. Conclusión: Las diferencias de casos entre ambas fuentes están relacionadas con características del recién nacido: bajo peso al nacer, prematuridad y lugar en que se produjo. Los datos hospitalarios podrían mejorar la estadística de mortalidad perinatal.Objective: To evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain recorded in 2 health information systems, as well as trends in this phenomenon. Methods: Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics and the minimum data set (MDS for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting. Results: The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered. Conclusion: The differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal

[The woman at the termination of pregnancy for fetal anomalies: clinical case].

Science.gov (United States)

Baena-Antequera, Francisca; Jurado-García, Estefanía

2015-01-01

Within the assistance and support to coping with perinatal death, it must be considered that there is a group of women whose process has some features that give specific connotations. We talked about when the perinatal loss occurs due to a maternal decision to the presence of a fetal malformation. These cases today, thanks to advances in the techniques of control fetal development, are not uncommon. In their assistance, healthcare professionals should be aware that they often present a great sense of guilt and ambivalence between well-made decision and the hardness of having to come to it. A case of a pregnant woman undergoing a fetal fetolisis and care plan developed in her assistance for the induction of labor, delivery and immediate postpartum period is presented. This plan includes the problems of collaboration and the independent problems that are formulated according to the NANDA, NOC and NIC taxonomies. The implication for practice after studying this case leads to the duty to equally address the coping with a stillbirth, whether it was spontaneous or had it been determined by fetal malformation completion, giving parents the ability to view and contact with their child. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Causes of Acute Intranatal and Postnatal Hypoxia in Neonatal Infants

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S. A. Perepelitsa

2012-01-01

Full Text Available Objective: to study the causes of acute intranatal hypoxia and reveal a relationship of placental changes to respiratory failure (RF in newborn infants. Subjects and methods. The investigation included 252 neonates with the complicated course of an early neonatal period. Their gestational age was 26 weeks to 40 weeks, birth weight varied from 850 g to 4100 g. 95.3% of the newborn infants were born with a low Apgar score and RF, which required mechanical ventilation immediately after birth. The neonatal status was clinically evaluated; the values of blood gas composition and acid-base balance were recorded; the pathogen was discharged from the tracheobronchial tree; chest X-ray survey and placental morphological examination were performed. Results. The main cause of neonatal respiratory failure is chronic intrauterine hypoxia caused by placental inflammatory changes and fetal-placental blood circulatory disorders, which gives rise to preterm delivery, cerebral hemodynamic disorders, and neonatal amniotic fluid aspiration. Bacteriological examination of tracheobronchial aspirations showed that no microflora growth occured in the majority of the newborns acute intranatal hypoxia. Enterococcus faecalis and Staphylococcus epidermidis were isolated in 12.3% and 8.7%, respectively. Growth of в-hemolytic streptococcus was observed in 2.8% of cases. The rate of microbial association specific only for rate premature infants with neonatal respiratory distress syndrome (NRDS was 4.8%. Conclusion. Placental changes causing fetal-placental circulatory disorders were ascertained to be responsible for acute intranatal and postnatal neonatal hypoxia. Placental inflammatory changes occurred in the majority of cases, as confirmed by bacteriological examinations of neonatal infants. Isolation of the varying microbial flora in infants with RF to a greater extent is, indicative of the infectious process occurring in the maternal body. Key words: acute intranatal

A case of Hydrops fetalis due to Kell alloimmunization: A perinatal approach to a rare case

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Arzu Akdag

2012-03-01

Full Text Available Introduction: While the routine administration of Rhesus immunoglobulin has significantly reduced the incidence of this type of alloimmunization, maternal alloimmunization to other red cell antigens continues to contribute to perinatal morbidity and mortality. Although the Kell antigen is found on the red cells of only 9% of the population, attention has increasingly been focused on Kell antibodies. Case Report: We present a case of fetal hydrops who was sonographically detected at 30th week of pregnancy. Antenatal tests for evaluation of fetal condition clearly showed the critical level of hemolytic disease but the baby was delivered prematurely due to fetal distress. The combination of anemia, reticulocytopenia, hydrops fetalis, and positive indirect Coombs test suggested Kell isoimmunization. The baby was treated by exchange transfusion with the Kell-negative packed red cell succesfully, and was discharged on postnatal 30th day. Conclusion: Here we describe a case of hydrops fetalis caused by Kell alloimmunization that was determined in postnatal period, and thus we plan to discuss the perinatal approach to the Kell immunization.

Increased Umbilical Cord PAI-1 Levels in Placental Insufficiency Are Associated with Fetal Hypoxia and Angiogenesis

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Maxim D. Seferovic

2016-01-01

Full Text Available In intrauterine growth restriction (IUGR, a subset of pregnancies undergoes placental vascular dysregulation resulting in restricted blood flow and fetal hypoxemia. Altered transcription of hypoxic regulated plasminogen activator inhibitor 1 (PAI-1 has been associated with pregnancy complications and angiogenic regulation. Here we assessed circulating PAI-1 as an indicator of placental insufficiency. Venous umbilical PAI-1 of hypoxemic (VpO2 20 versus 35 mmHg, p<0.0001 placental insufficient pregnancies (resistance index 0.9 versus 0.63, p<0.05 (n=18 was compared to controls (n=12. PAI-1 was increased (~10-fold, p<0.001 and had a positive predictive ratio of 6.7. Further, PAI-1 levels correlated to blood oxygen (r=-0.68, p<0.0001. The plasma’s angiogenic potency measured in vitro was associated with umbilical cord blood PAI-1 levels (r=0.65, p<0.01. This association was attenuated by PAI-1 inhibiting antibody (p<0.001. The results demonstrate PAI-1 as a potential marker of placental insufficiency and identify its close association with pathological hypoxia and angiogenesis in a subset of growth restricted pregnancies.

Fetal Neuroprotection by Magnesium Sulfate: From Translational Research to Clinical Application

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Clément Chollat

2018-04-01

Full Text Available Despite improvements in perinatal care, preterm birth still occurs regularly and the associated brain injury and adverse neurological outcomes remain a persistent challenge. Antenatal magnesium sulfate administration is an intervention with demonstrated neuroprotective effects for preterm births before 32 weeks of gestation (WG. Owing to its biological properties, including its action as an N-methyl-d-aspartate receptor blocker and its anti-inflammatory effects, magnesium is a good candidate for neuroprotection. In hypoxia models, including hypoxia-ischemia, inflammation, and excitotoxicity in various species (mice, rats, pigs, magnesium sulfate preconditioning decreased the induced lesions’ sizes and inflammatory cytokine levels, prevented cell death, and improved long-term behavior. In humans, some observational studies have demonstrated reduced risks of cerebral palsy after antenatal magnesium sulfate therapy. Meta-analyses of five randomized controlled trials using magnesium sulfate as a neuroprotectant showed amelioration of cerebral palsy at 2 years. A meta-analysis of individual participant data from these trials showed an equally strong decrease in cerebral palsy and the combined risk of fetal/infant death and cerebral palsy at 2 years. The benefit remained similar regardless of gestational age, cause of prematurity, and total dose received. These data support the use of a minimal dose (e.g., 4 g loading dose ± 1 g/h maintenance dose over 12 h to avoid potential deleterious effects. Antenatal magnesium sulfate is now recommended by the World Health Organization and many pediatric and obstetrical societies, and it is requisite to maximize its administration among women at risk of preterm delivery before 32 WG.

Prolonged hypoxia modulates platelet activating factor receptor-mediated responses by fetal ovine pulmonary vascular smooth muscle cells.

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Renteria, Lissette S; Raj, J Usha; Ibe, Basil O

2010-12-01

Hypoxia augments PAF receptor (PAFr) binding and PAFr protein expression in venous SMC (SMC-PV). We compared effect of acute and prolonged hypoxia (pO(2)<40 torr) on PAFr-mediated responses in arterial SMC (SMC-PA) and SMC-PV. Cells were studied for 30 min (acute) or for 48 h (prolonged) hypoxia and compared to normoxic (pO(2) ~100 torr) conditions. PAF binding was quantified in fmol/10(6) cells (mean ± SEM). PAF binding in normoxia were SMC-PA, 5.2 ± 0.2 and in SMC-PV, 19.3 ± 1.1; values in acute hypoxia were SMC-PA, 7.7 ± 0.4 and in SMC-PV, 27.8 ± 1.7. Prolonged hypoxia produced 6-fold increase in binding in SMC-PA, but only 2-fold increase in SMC-PV, but binding in SMC-PV was still higher. Acute hypoxia augmented inositol phosphate release by 50% and 40% in SMC-PA and SMC-PV, respectively. During normoxia, PAFr mRNA expression by both cell types was similar, but expression in hypoxia by SMC-PA was greater. In SMC-PA, hypoxia and PAF augmented intracellular calcium flux. Re-exposure of cells to 30 min normoxia after 48 h hypoxia decreased binding by 45-60%, suggesting immediate down-regulation of hypoxia-induced PAFr-mediated effects. We speculate that re-oxygenation immediately reverses hypoxia effect probably due to oxygen tension-dependent reversibility of PAFr activation and suggest that exposure of the neonate to prolonged state of hypoxia will vilify oxygen exchange capacity of the neonatal lungs. Copyright © 2010 Elsevier Inc. All rights reserved.

[Can implementation of intensified perinatal survey be effective in improving the quality of perinatal care?].

Science.gov (United States)

Troszyński, Michał

2010-01-01

obligatory to conduct medical audit which is a form of specialistic supervision. It is probable that higher number of stillbirths and premature births may be caused by late start of perinatal care in pregnancy. In primary health care, insufficient objective parameters are investigated which lead to assessment of the quality of perinatal care. Correct filling up of the pregnancy chart could improve the quality of the management of prophylactic procedures leading to a fall in the number of premature births and stillbirths. This would also lead to a reduction of costs associated with life saving procedures and improving the quality of life in newborns with low and extremly low birth weight. 1. The survey of fetal and newborn perinatal mortality of fetuses and newborn should be the base for elaborating the perinatal care programme as well as the main source of data for medical audit. This is the instrument for evaluation of the three level perinatal care. It also serves to assess the effectivness of diagnostic and therapeutic recommendations and the programme of active prevention. 2. In order to obtain effectivness in functioning of the three step perinatal care within the framework of the National Health Programme the following steps are needed: - urgent elaboration of new or improved medical documentation which will become obligatory, - implementation of educational programmes and training of teachers. 3. Implementation of medical audit, carried out periodically at all three levels of perinatal care.

[Pregnancy in patients with renal transplantation: maternal and fetal morbidity].

Science.gov (United States)

Romero Arauz, Juan Fernando; Ayala Méndez, José Antonio; Jiménez Solís, Guillermo

2008-11-01

Preeclampsia is a multisystemic syndrome with unknown etiology and characterized by abnormal vascular placentation response. Patients with renal transplantation restore them fertility 10 months after the intervention. To evaluate incidence of preeclampsia and maternal-perinatal outcome in patients with renal transplantation. Comparative, observational and retrospective study performed in pregnant patients with renal transplantation, from December 1999 to April 2008 at Perinatology of Hypertensive Diseases Department of the Unidad Medica de Alta Especialidad de Ginecoobstetricia Luis Castelazo Ayala, IMSS. Davison' guide, descriptive statistic, and Fischer exact test were used. Thirty patients were analyzed, 27 cases satisfy Davison's recommended guidelines, and the rest did not achieve these criteria (p = 0.001). Preeclampsia occurred in 15 cases (50%), preterm delivery in 15 (50%), and fetal growth restriction in 6 (20%). Among the 11 patients with previous chronic hypertension, 8 developed superimposed preeclampsia (72%), and 9 had delivery before 37 weeks of gestation (82%). Malfunction of renal transplantation, before pregnancy, was associated with maternal and perinatal poor outcome (p = 0.006). There were no maternal deaths, but one perinatal (3%) Successful pregnancy is possible in patients with renal transplantation, however there is a high risk of preeclampsia, infection, and fetal growth restriction. Patients with renal transplantation must fulfill Davison's pre-pregnancy guidelines.

Perspectives of fetal dystocia in cattle and buffalo

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Govind Narayan Purohit

2012-04-01

Full Text Available We review the causes of fetal dystocia in cows and buffalo. Two fetal causes are distinct fetal oversize and fetal abnormalities. Fetal oversize is common in heifers, cows of beef cattle breeds, prolonged gestations, increased calf birth weight, male calves and perinatal fetal death with resultant emphysema. Fetal abnormalities include monsters, fetal diseases and fetal maldispositions, and it is difficult to deliver such fetuses because of their altered shape. Although monsters are rare in cattle, a large number of monstrosities have been reported in river buffalo; yet also here, overall incidence is low. Diseases of the fetus resulting in dystocia include hydrocephalus, ascites, anasarca and hydrothorax. The most common cause of dystocia in cattle seems to be fetal maldispositions, of which limb flexion and head deviation appear to be the most frequent. We provide a brief description of the management of dystocia from different causes in cattle and buffalo. A case analysis of 192 and 112 dystocia in cattle and buffalo, respectively, at our referral center revealed that dystocia is significantly higher (P<0.05 in first and second parity cows and buffalo, and that dystocia of fetal origin is common in cows (65.62% but less frequent (40.17% in buffalo. In buffalo, the single biggest cause of dystocia was uterine torsion (53.57%. Fetal survival was significantly (P<0.05 higher both in cows and buffalo when delivery was completed within 12 h of second stage of labor.

[Marital status and the severity of perinatal depression among pregnant women].

Science.gov (United States)

Podolska, Magdalena; Sipak-Szmigiel, Olimpia

2010-01-01

Cohabitation existing for ages in all human cultures is becoming more common since the 1960s due to complex changes in postmodern societies. These societies have made the phenomenon of cohabitation the object of adequate theoretical reflection. The aim of this work was to determine whether the marital status of pregnant women affects the severity of perinatal depression. We enrolled 117 gravida hospitalized in 2006 and 2007 at the Department of Maternal-Fetal Medicine, Pomeranian Medical University. The gestational age ranged from week 32 to 40. The clinical condition of each gravida was assessed during routine obstetric history taking. The Edinburgh Postnatal Depression Scale by Cox, Holden, and Sagovski was used as the screening test for perinatal depression. 1. The marital status of the gravida with emphasis on cohabitation is a significant correlate of perinatal depression and its risk. 2. Clinical examination should concentrate not only on the physical and medical condition but also on the psychosocial status of the patient as the predictor of perinatal depression. 3. All pregnant women living in informal partnerships should be offered psychological support.

Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? : a prospective observational study

OpenAIRE

Page, Ann-Sophie; Page, Geert; Dehaene, Isabelle; Roets, Ellen; Roelens, Kristien

2017-01-01

Objective: To investigate the potential clinical use of serial fetal CPR measurements during the last month of pregnancy for the prediction of adverse perinatal outcome in unselected low-risk pregnancies. Methods: A multicenter prospective observational cohort study in 315 consecutively recruited low-risk pregnancies. All eligible pregnancies underwent serial sonographic evaluation of fetal weight and Doppler indices at two week intervals, from 36 weeks gestation until delivery. Data were ...

Neuronal nitric oxide synthase inhibition prevents cerebral palsy following hypoxia-ischemia in fetal rabbits: comparison between JI-8 and 7-nitroindazole.

Science.gov (United States)

Yu, Lei; Derrick, Matthew; Ji, Haitao; Silverman, Richard B; Whitsett, Jennifer; Vásquez-Vivar, Jeannette; Tan, Sidhartha

2011-01-01

Cerebral palsy and death are serious consequences of perinatal hypoxia-ischemia (HI). Important concepts can now be tested using an animal model of cerebral palsy. We have previously shown that reactive oxygen and nitrogen species are produced in antenatal HI. A novel class of neuronal nitric oxide synthase (nNOS) inhibitors have been designed, and they ameliorate postnatal motor deficits when administered prior to the hypoxic-ischemic insult. This study asks how the new class of inhibitors, using JI-8 (K(i) for nNOS: 0.014 μM) as a representative, compare with the frequently used nNOS inhibitor 7-nitroindazole (7-NI; K(i): 0.09 ± 0.024 μM). A theoretical dose equivalent to 75 K(i) of JI-8 or equimolar 7-NI was administered to pregnant rabbit dams 30 min prior to and immediately after 40 min of uterine ischemia at 22 days gestation (70% term). JI-8 treatment resulted in a significant decrease in NOS activity (39%) in fetal brain homogenates acutely after HI, without affecting maternal blood pressure and heart rate. JI-8 treatment resulted in 33 normal kits, 2 moderately and 13 severely affected kits and 5 stillbirths, compared with 8 normal, 3 moderately affected and 5 severely affected kits and 10 stillbirths in the 7-NI group. In terms of neurobehavioral outcome, 7-NI was not different from saline treatment, while JI-8 was superior to saline and 7-NI in its protective effect (p JI-8 significantly improved the locomotion score over both saline and 7-NI scores. JI-8 was also significantly superior to saline in preserving smell, muscle tone and righting reflex function, but 7-NI did not show significant improvement. Furthermore, a 100-fold increase in the dose (15.75 μmol/kg) of 7-NI significantly decreased systolic blood pressure in the dam, while JI-8 did not. The new class of inhibitors such as JI-8 shows promise in the prevention of cerebral palsy and is superior to the previously more commonly used nNOS inhibitor. Copyright © 2011 S. Karger AG, Basel.

Fetal programming as a predictor of adult health or disease: the need to reevaluate fetal heart function.

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Miranda, Joana O; Ramalho, Carla; Henriques-Coelho, Tiago; Areias, José Carlos

2017-11-01

Epidemiologic and experimental evidence suggests that adverse stimuli during critical periods in utero permanently alters organ structure and function and may have persistent consequences for the long-term health of the offspring. Fetal hypoxia, maternal malnutrition, or ventricular overloading are among the major adverse conditions that can compromise cardiovascular development in early life. With the heart as a central organ in fetal adaptive mechanisms, a deeper understanding of the fetal cardiovascular physiology and of the echocardiographic tools to assess both normal and stressed pregnancies would give precious information on fetal well-being and hopefully may help in early identification of special risk groups for cardiovascular diseases later in life. Assessment of cardiac function in the fetus represents an additional challenge when comparing to children and adults, requiring advanced training and a critical approach to properly acquire and interpret functional parameters. This review summarizes the basic fetal cardiovascular physiology and the main differences from the mature postnatal circulation, provides an overview of the particularities of echocardiographic evaluation in the fetus, and finally proposes an integrated view of in utero programming of cardiovascular diseases later in life, highlighting priorities for future clinical research.

Early unexpected diagnosis of fetal life-limiting malformation; antenatal palliative care and parental decision.

Science.gov (United States)

Mariona, Federico; Burnett, Marianne; Zoma, Melody; Blake, Janice; Khouri, Hanna

2017-11-02

Conjoined twins are an infrequent occurrence in obstetric practice. Live-conjoined twins on a late preterm triplet pregnancy is an even rarer event. The objective of this study is to emphasize the critical importance of perinatal palliative care and non-directive parental counseling, informed decision making and respect for autonomy following full disclosure of findings, fetal life-limiting diagnosis, treatment alternatives, maternal-fetal potential complications, and most likely perinatal outcomes. Early surprise prenatal diagnosis, comprehensive parental counseling, palliative care, and perinatal care of a set of conjoined twins and a singleton. Cesarean delivery of a set of conjoined twins and a singleton at 34 weeks' gestation. Immediate neonatal death of the conjoined twins, intact survival, and discharge of the singleton. Review of the database on previously reported similar cases. It is very important to utilize simple and direct language for parents to understand the grave prognosis to the pregnancy. Care alternatives in view of the maternal physical risks and psychological impact of carrying a high order abnormal multiple pregnancy, along with the possible side effects on the singleton.

[Geographic distribution of perinatal mortality due to congenital malformations in Colombia, 1999-2008: An analysis of vital statistics data].

Science.gov (United States)

Misnaza, Sandra Patricia; Roncancio, Claudia Patricia; Peña, Isabel Cristina; Prieto, Franklin Edwin

2016-09-01

During 2012, 13% of the deaths worldwide in children under the age of 28 days were due to congenital malformations. In Colombia, congenital malformations are the second leading cause of infant mortality. Objective: To determine the geographical distribution of extended perinatal mortality due to congenital malformations in Colombia between 1999 and 2008. Materials and methods: We conducted a cross-sectional study. We revised all death certificates issued between 1999 and 2008. We defined perinatal mortality as fetal or non-fetal deaths within the first 28 days after delivery in children with body weight ≥500 grams, and congenital malformations according to ICD-10 diagnostic codes Q000 - Q999. The annual birth projection was used as the denominator. We defined high mortality areas due to congenital malformations as those in the 90th percentile. Results: We recorded 22,361 perinatal deaths due to congenital malformations. The following provinces exceeded the 90th perinatal mortality percentile: Antioquia, Caldas, Risaralda, Huila, Quindío, Bogotá, Valle del Cauca and Guainía. Among the municipalities, the highest perinatal mortality rates were found in Giraldo, Ciudad Bolívar, Riosucio, Liborina, Supía, Alejandría, Sopetrán, San Jerónimo, Santa Fe de Antioquia and Marmato (205.81 and 74.18 per 10.000 live births).The perinatal mortality rate due to malformations of the circulatory system was 28.1 per 10.000 live births, whereas the rates for central nervous system defects and chromosomal abnormalities were 13.7 and 7.0, respectively. The Andean region showed high perinatal mortality rates due to congenital malformations. There is an urgent need to identify possible risk factors of perinatal mortality and implement successive prevention programs in that particular region.

Fetal plasma erythropoietin concentration in severe growth retardation.

Science.gov (United States)

Snijders, R J; Abbas, A; Melby, O; Ireland, R M; Nicolaides, K H

1993-02-01

The aim of this study was to determine whether hypoxemia induces an increase in plasma erythropoietin concentration in human fetal life and, if so, whether this response stimulates fetal erythropoiesis. The plasma erythropoietin concentration in blood samples from 33 small-for-gestational-age fetuses at 26 to 38 weeks' gestation was measured. Measurements were compared with the reference range for gestation, and associations with PO2, pH, and erythroblast and erythrocyte counts were examined. The mean plasma erythropoietin concentration in the small-for-gestational-age fetuses was significantly increased, and the degree of increase was significantly associated both with fetal acidemia and, more strongly, with fetal erythroblastosis. Erythropoietin production in response to tissue hypoxia occurs from at least 26 weeks' gestation with measurable physiologic effects on erythropoiesis. Furthermore, more accurate assessment of tissue oxygenation may be obtained by measuring the erythroblast count rather than the blood pH.

Gestacional diabetes and perinatal morbimortality in Medellín, Colombia Diabetes mellitus durante la gestación y morbimortalidad perinatal

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Juan Nicolás Franco Baena

1996-02-01

Full Text Available Retrospective analysis of 166 pregnant women with gestational diabetes mellitus, at San Vicente de Paúl Hospital, Medellín, Colombia, evidenced inadequate registration of information and lack of clinical management protocols, despite the fact that this is a reference institution. Gestational diabetes mellitus (GDM was found in 81 patients (48.8%, non-insulin-dependent diabetes mellitus (NIDDM in 69 (41.5% and insulin-dependent diabetes mellitus (IDDM in 16 (9.6%. Perinatal morbidity rate was 52.2% (72 cases among the 138 in which information was available, distributed as follows: macrosomy (16 cases; 22.2%, acute fetal distress (15 cases; 20.8%, chronic fetal distress (10 cases; 13.9%, polyhydramnios (9 cases; 12.5%, hypoglycemia (8 cases; 11.1 % and delivery fetal trauma (6 cases; 8.3%. It was remarkable that the potentially preventable entities (macrosomy, acute and chronic fetal distress, polyhydramnios, fetal trauma and respiratory failure syndrome were more frequent in NIDDM and GDM groups, indicating an inadequate clinical management; fetal mortality was 3.6% (5 patients mostly associated to maternal hypertension. These results point out to the urgent need of establishing in this third level hospital an interdisciplinary management protocol of gestational diabetes, with apropriate registration of information and clear clinical guides

El análisis retrospectivo de 166 pacientes embarazadas y con diagnóstico de diabetes mellitus, atendidas en el Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, permite apreciar un registro inadecuado de la información, lo que le resta confiabilidad, y la carencia de protocolos apropiados de manejo. La diabetes gestacional (DMG se presentó en 81 pacientes (48.8%, seguida por la diabetes mellitus no insulino dependiente (DMNID (69 pacientes; 41.5% y por último la

Circulating docosahexaenoic acid levels are associated with fetal insulin sensitivity.

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Jin-Ping Zhao

Full Text Available Arachidonic acid (AA; C20∶4 n-6 and docosahexaenoic acid (DHA; C22∶6 n-3 are important long-chain polyunsaturated fatty acids (LC-PUFA in maintaining pancreatic beta-cell structure and function. Newborns of gestational diabetic mothers are more susceptible to the development of type 2 diabetes in adulthood. It is not known whether low circulating AA or DHA is involved in perinatally "programming" this susceptibility. This study aimed to assess whether circulating concentrations of AA, DHA and other fatty acids are associated with fetal insulin sensitivity or beta-cell function, and whether low circulating concentrations of AA or DHA are involved in compromised fetal insulin sensitivity in gestational diabetic pregnancies.In a prospective singleton pregnancy cohort, maternal (32-35 weeks gestation and cord plasma fatty acids were assessed in relation to surrogate indicators of fetal insulin sensitivity (cord plasma glucose-to-insulin ratio, proinsulin concentration and beta-cell function (proinsulin-to-insulin ratio in 108 mother-newborn pairs. Cord plasma DHA levels (in percentage of total fatty acids were lower comparing newborns of gestational diabetic (n = 24 vs. non-diabetic pregnancies (2.9% vs. 3.5%, P = 0.01. Adjusting for gestational age at blood sampling, lower cord plasma DHA levels were associated with lower fetal insulin sensitivity (lower glucose-to-insulin ratio, r = 0.20, P = 0.036; higher proinsulin concentration, r = -0.37, P <0.0001. The associations remained after adjustment for maternal and newborn characteristics. Cord plasma saturated fatty acids C18∶0 and C20∶0 were negatively correlated with fetal insulin sensitivity, but their levels were not different between gestational diabetic and non-diabetic pregnancies. Cord plasma AA levels were not correlated with fetal insulin sensitivity.Low circulating DHA levels are associated with compromised fetal insulin sensitivity, and may be involved in

Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction.

LENUS (Irish Health Repository)

Kennelly, M M

2012-02-01

Intrauterine fetal growth restriction (IUGR) is an important pregnancy complication associated with significant adverse clinical outcome, stillbirth, perinatal morbidity and cerebral palsy. To date, no uniformly accepted management protocol of Doppler surveillance that reduces mortality and cognitive morbidity has emerged. Aortic isthmus (AoI) evaluation has been proposed as a potential monitoring tool for IUGR fetuses. In this review, the current knowledge of the relationship between AoI Doppler velocimetry and preterm fetal growth restriction is reviewed. Relevant technical aspects and reproducibility data are reviewed as we discuss AoI Doppler and its place within the existing repertoire of Doppler assessments in placental insufficiency. The AoI is a link between the right and left ventricles which perfuse the lower and upper body, respectively. The clinical use of AoI waveforms for monitoring fetal deterioration in IUGR has been limited, but preliminary work suggests that abnormal AoI impedance indices are an intermediate step between placental insufficiency-hypoxemia and cardiac decompensation. Further prospective studies correlating AoI indices with arterial and venous Doppler indices and perinatal outcome are required before encorporating this index into clinical practice.

Evaluación de la mortalidad perinatal en mujeres autóctonas e inmigrantes: influencia de la exhaustividad y la calidad de los registros Perinatal mortality assessment in native and immigrant women: influence of exhaustiveness and quality of the registries

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Isabel Río Sánchez

2009-10-01

Full Text Available Objetivo: Realizar un análisis comparativo de la exhaustividad de los datos sobre mortalidad perinatal en la Comunitat Valenciana recogidos en el Instituto Nacional de Estadística (INE y en el Registro de Mortalidad Perinatal (RMPCV. Posteriormente, calcular y comparar la tasa de mortalidad perinatal (TMP y sus componentes en gestantes autóctonas e inmigrantes, tomando como referencia los casos notificados a ambos registros durante 2005 y 2006. Métodos: Se definieron los distintos tipos de mortalidad de acuerdo con los criterios establecidos por la OMS. La magnitud de la infradeclaración se analizó calculando las frecuencias y porcentajes de muertes infradeclaradas para el período 2005-2006. Se calcularon y compararon las diversas tasas entre mujeres autóctonas e inmigrantes de los cuatro grupos mayoritarios a partir de ambos registros, así como los intervalos de confianza del 95% para dichas tasas. Resultados: En el INE existe un importante subregistro de muertes fetales y neonatales. Además, constan neonatos fallecidos de madre extranjera con nacionalidad española asignada. Ambos factores distorsionan la proporción de muertes fetales y neonatales en inmigrantes, y provocan una infraestimación de la TMP y sus componentes en estos colectivos, pues las obtenidas a partir del RMPCV son muy superiores en las mujeres inmigrantes, en particular en las de Europa del Este y las subsaharianas, en comparación con las autóctonas. Conclusiones: En definitiva, nuestros resultados indican que ambos registros son complementarios, pero el RMPCV presenta una mayor exhaustividad y fiabilidad para el cálculo de tasas. Además, sugieren la necesidad de monitorizar la evolución de la TMP en la población inmigrante en España.Objective: To analyze the exhaustiveness and reliability of the data on perinatal mortality in two Spanish registries, namely, the National Statistics Institute and the Perinatal Mortality Registry of the Valencian Community

The association between a low cerebro-umbilical ratio at 30-34 weeks gestation, increased intrapartum operative intervention and adverse perinatal outcomes.

Science.gov (United States)

Twomey, Sarah; Flatley, Christopher; Kumar, Sailesh

2016-08-01

The aim of this study was to investigate the relationship between the cerebro-umbilical ratio (CUR), measured at 30-34 weeks, and adverse intrapartum and perinatal outcomes. This was a retrospective cross-sectional cohort study of women delivering at the Mater Mothers' Hospital in Brisbane, Australia. Fetal Doppler indices for 1224 singleton pregnancies were correlated with maternal demographics and intrapartum and perinatal outcomes. Only women who attempted vaginal delivery were included in the study. Infants delivered by emergency cesarean section for fetal compromise had the lowest median CUR, 1.65 (IQR 1.17-2.12), compared to any other delivery group. The proportion of infants with a CUR ≤1 who required emergency cesarean section for fetal compromise was 33.3% compared to 9.3% of infants with a CUR >1 (adjusted OR 6.92 (95% CI 2.04-25.75), p<0.001). However, the detection rate of CUR ≤1 as a predictor for emergency cesarean delivery for fetal compromise was poor (18.9%). Detection rates increased in cohorts of infants born within two weeks of the scan or with birth weights <10th centile or <5th centile. Additionally, a CUR ≤1 was associated with lower median birth weight, higher rates of admission to the neonatal critical care unit and increased neonatal mortality. This study suggests that a CUR ≤1, measured at 30-34 weeks, is associated with a greater risk of emergency cesarean delivery for fetal compromise and a number of other adverse perinatal outcomes. The association was strongest in low birth weight babies. Copyright © 2016. Published by Elsevier Ireland Ltd.

Resultado perinatal em mulheres portadoras de hipertensão arterial crônica: revisão integrativa da literatura Resultado perinatal en mujeres que sufren de hipertensión crónica: revisión integradora de la literatura Perinatal outcome in women suffering from chronic hypertension: literature integrative review

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Angelita José Henrique

2012-12-01

Full Text Available Objetivou-se identificar as principais complicações relativas à Hipertensão Arterial Crônica observadas em mulheres gestantes e conhecer a evolução nos padrões de riscos dos resultados perinatais em duas décadas. Realizou-se uma revisão integrativa da literatura com abrangência temporal entre os anos de 1990 e 2010, nas bases de dados LILACS, SciELO e MEDLINE. Entre os resultados, observou-se que gestantes hipertensas crônicas apresentaram pré-eclâmpsia sobreposta (20% a 78%, restrição do crescimento fetal (8,5% a 30,7%, prematuridade (32,4% a 86,4%, cesárea (69,2%, descolamento prematuro da placenta (3,75% a 8,4%, óbito fetal (9,5% a 27,2%, complicações cardiovasculares, renais e pulmonares maternas. Conclui-se que a associação entre hipertensão crônica e gestação mostra forte risco para complicações maternas e perinatais, principalmente quando associados à severidade e etiologia da hipertensão, não mostrando evolução no decorrer das duas décadas pesquisadas sobre o resultado perinatal.Objetivó-se identificar los patrones en la evolución del riesgo de resultados perinatales de las mujeres embarazadas con hipertensión crónica con el fin de comparar los resultados de la evolución del embarazo. Realizó-se una revisión integradora de la literatura, con lapso de tiempo entre los años 1990 y 2010, en las databases LILACS, SciELO y MEDLINE. En los resultados, fue observado que las mujeres embarazadas con hipertensión crónica apresentaran preeclampsia superpuesta (20% a 78%, restricción del crecimiento fetal (8,5% a 30,7%, prematuridad (32,4% a 86,4%, cesárea (69 2%, desprendimiento abrupto de la placenta (3,75% a 8,4%, muerte fetal (9,5% a 27,2%, complicaciones cardiovasculares, renales y pulmonares materna. Concluye-se que la asociación de hipertensión crónica y embarazo presenta riesgo importante para complicaciones maternas y perinatales, especialmente cuando se asocia con la gravedad y etiología de

Predictors of Cord Blood Leptin Level in Pregnancies Complicated With Preeclampsia, Fetal Growth Restriction and in Normal Pregnancies

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Nilgün Öztürk Doğan

2007-04-01

CONCLUSION: Regulation of cord blood leptin level is a complex process involving fetal gender and fetal anthropometric variables as well as cord blood cortisol, intrauterine growth and hypoxia. Leptin level is decreased in cases of placental insufficiency like IUGR but not in uncomplicated preeclampsia alone.

INCODE-DK 2014. Classification of cause of intrauterine fetal death – a new approach to perinatal audit

DEFF Research Database (Denmark)

Maroun, Lisa Leth; Ramsing, Mette; Olsen, Tina Elisabeth

on a national level as described in the national guideline for IUFD. Multidisciplinary perinatal audit is an important tool in the evaluation of stillbirth, however, the establishment of the C-IUFD has until now been hampered by the lack of a recommended classification system. Material and methods...... on the perinatal audit system in use as introduced by K. Vitting Andersen. The scheme is adapted to INCODE in main categories and allows grading and coding of C-IUFD. INCODE –DK and INCODE perinatal audittabel are available in an updated version of the IUFD guideline 2014, as well as in a separate excel file...... of the working group that the new audit scheme in combination with the new national classification system will improve the uniformity and quality of perinatal audits on a national level....

ADAPTAÇÃO TRANSCULTURAL E EVIDÊNCIAS DE VALIDAÇÃO DA PERINATAL GRIEF SCALE

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Gisele Ferreira Paris

2017-01-01

Full Text Available Objetivo : realizar la adaptación transcultural y validación de pruebas de la Perinatal Grief Scale para el portugués Brasil y Canadá francés. Metodo : estudio metodológico, con aplicación de Escala de Duelo Perinatal desde el conjunto de procedimientos de adaptación transcultural. La populación fue compuesta por todas las mujeres que tuvieron óbito fetal en el año de 2013 vecinas en el municipio de Maringá-Brasil y participantes del Centre d’Études et de Recherche en Intervention Familiale en la Université du Québec en Outaouais - Canadá. Resultados : la escala en las versiones en portugués y francés demostró para ser confiable en las dos poblaciones. Coeficiente alfa de Cronbach de la escala aplicada en Brasil fue de 0,93 y aplicada en Canadá fue 0.94. Versión portuguesa, cuatro elementos no correlacionan con la escala total. Conclusión : la Perinatal Grief Scale puede utilizarse para identificar el estado de duelo en mujeres que tenían la muerte fetal, en su versión de cada país.

Transfusão feto-fetal - sobrevivente policitémico

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Joana Dias

2016-02-01

Full Text Available Introdução: A Síndrome de transfusão feto-fetal (STFF é uma doença cardiovascular complexa que afeta gestações geuma doença cardiovascular complexa que afeta gestações gemelares monocoriónicas. As gestações complicadas pela STFF antes das 28 semanas estão associadas a um risco elevado de perda fetal, morte perinatal e sequelas nos sobreviventes. Caso Clínico: Primigesta, gestação gemelar, monocoriónica, biamniótica. Sinais ecográficos de STFF, pelo que realizou ablação por laser das anastomoses placentárias às 18 semanas. Cesariana às 33 semanas após diagnóstico de morte in útero do segundo gémeo. Recém-nascido com pletora evidente ao nascimento. Iniciou dificuldade respiratória na primeira hora de vida tendo iniciado ventilação não invasiva, apresentando também hipoglicemia e trombocitopenia. Necessidade de duas transfusões permuta parcial nas primeiras 12 horas de vida por hematócrito venoso de 70 %. Ecografias transfontanelares seriadas sem alterações. Conclusão: Apesar da melhoria do prognóstico perinatal da STFF após a introdução da ablação das anastomoses placentárias, a mortalidade e morbilidade perinatal permanecem elevadas.

Rna synthesis of perinatal female and male gametes

International Nuclear Information System (INIS)

Doering, R.; Hubaleck, K.

1980-01-01

Intensity curves of RNA synthesis in the perinatal phase of gametogenesis were established for rat fetuses and young rats by 3 H-uridine autoradiography. Gonads of male and female rat fetuses were studied on days 15 to 22 p.c. and gonads of young animals on days 1 to 7 p.n. The nuclear surface of the gametes was found to increase continuously. The number of silver grains was the same for male and female gametes up to the 18th day of fetal life, and the same applies to the silver grain density. The rate of RNA synthesis of male germ celles remained at a constant, low level throughout the study; in the female germ cells, a 10-fold increase in RNA synthesis was measured after the 19th day of fetal life. (orig./MG) [de

Perinatal changes in myocardial supply and flux of fatty acids, carbohydrates, and ketone bodies in lambs

NARCIS (Netherlands)

Bartelds, B; Gratama, JWC; Knoester, H; Takens, J; Smid, GB; Aarnoudse, JG; Heymans, HSA; Kuipers, JRG

No information is available on perinatal changes in myocardial metabolism in vivo. We measured myocardial supply and flux of fatty acids, carbohydrates, and ketone bodies in chronically instrumented fetal, newborn (1-4 days), and juvenile (7 wk) lambs, by measuring aorta-coronary sinus concentration

Perinatal exposure to diesel exhaust affects gene expression in mouse cerebrum

Energy Technology Data Exchange (ETDEWEB)

Tsukue, Naomi [Tokyo University of Science, Department of Hygiene Chemistry, Faculty of Pharmaceutical Sciences, Noda, Chiba (Japan); Japan Science and Technology Agency, Core Research for Evolutional Science and Technology, Kawaguchi, Saitama (Japan); Japan Automobile Research Institute, Health Effects Research Group, Energy and Environment Research Division, Tsukuba, Ibaraki (Japan); Watanabe, Manabu; Kumamoto, Takayuki; Takeda, Ken [Tokyo University of Science, Department of Hygiene Chemistry, Faculty of Pharmaceutical Sciences, Noda, Chiba (Japan); Japan Science and Technology Agency, Core Research for Evolutional Science and Technology, Kawaguchi, Saitama (Japan); Takano, Hirohisa [Japan Science and Technology Agency, Core Research for Evolutional Science and Technology, Kawaguchi, Saitama (Japan); National Institute for Environmental Studies, Pathophysiology Research Team, Tsukuba, Ibaraki (Japan)

2009-11-15

Many environmental toxins alter reproductive function and affect the central nervous system (CNS). Gonadal steroid hormones cause differentiation of neurons and affect brain function and behavior during the perinatal period, and the CNS is thought to be particularly susceptible to toxic insult during this period. It was, therefore, hypothesized that inhalation of diesel exhaust (DE) during the fetal or suckling period would disrupt the sexual differentiation of brain function in mice, and the effects of exposure to DE during the perinatal period on sexual differentiation related gene expression of the brain were investigated. In the fetal period exposure group, pregnant ICR mice were exposed to DE from 1.5 days post-coitum (dpc) until 16 dpc. In the neonatal period exposure group, dams and their offspring were exposed to DE from the day of birth [postnatal day (PND)-0] until PND-16. Then, the cerebrums of males and females at PND-2, -5, and -16 from both groups were analyzed for expression level of mRNA encoding stress-related proteins [cytochrome P450 1A1 (CYP1A1), heme oxygenase-1 (HO-1)] and steroid hormone receptors [estrogen receptor alpha (ER alpha), estrogen receptor beta (ER beta), androgen receptor (AR)]. Expression levels of ER alpha and ER beta mRNA were increased in the cerebrum of newborns in the DE exposure groups as well as mRNA for CYP1A1 and HO-1. Results indicate that perinatal exposure to DE during the critical period of sexual differentiation of the brain may affect endocrine function. (orig.)

Parvovirus infection: an immunohistochemical study using fetal and placental tissue.

Science.gov (United States)

Li, Jing Jing; Henwood, Tony; Van Hal, Sebastian; Charlton, Amanda

2015-01-01

Parvovirus B19 infection causes 5% to 15% of cases of nonimmune hydrops fetalis. The aim of our study was to evaluate the use of immunohistochemistry in diagnosing parvovirus infection in fetal and placental tissue during routine fetal and perinatal autopsies. Histology slides of 20 cases of confirmed parvovirus infection were reviewed, and immunohistochemistry was applied to selected blocks of fetal and placental tissue. Immunohistochemistry was positive in all 20 cases, and histologic viral inclusions were seen in 19 cases. Immunohistochemical staining was closely correlated with histology and was more sensitive than histology in detecting virally infected cells, especially in autolyzed tissue. All cases also had confirmatory evidence of parvovirus infection by polymerase chain reaction of fetal liver and positive maternal serology, where it was available. We conclude that parvovirus immunohistochemistry is a reliable method for diagnosing parvovirus infection, especially in autolyzed tissue where histologic assessment may be suboptimal.

[Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes].

Science.gov (United States)

Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos

2011-01-01

To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA) was used. The results were considered significant at panemia rate was higher in the coast (25.8%) and low forest (26.2%). Moderate/severe anemia rate in low forest was 2.6% and at the coast was 1.0%. In the highland, the highest rate of moderate/severe anemia was in the southern highlands (0.6%). The highest rate of erythrocytocis was found in the central highland (23.7%), 11.9% in the southern highland and 9.5% in the north highland. Severe anemia and erythrocytocis were associated with adverse perinatal outcomes. There are differences by Peruvian geographical region in anemia rates. In the central highlands were found the highest rates of erythrocytocis due to hypoxia effect in the high altitudes; however in the southern highlands, erythrocytocis was lower. Severe anemia and erythrocytosis were associated with increased adverse perinatal outcomes.

CORRELATION OF CEREBROPLACENTAL RATIO WITH PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

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Sajala Vimalraj

2016-07-01

Full Text Available BACKGROUND Doppler velocimetry is a non-invasive method of measuring changes in blood flow. (1,2,3 Randomised Control Trials (RCTs have shown that using Doppler indices in the management of Intrauterine Growth Restriction (IUGR cases leads to a significant reduction in perinatal mortality rate. Deterioration of various Doppler indices precedes abnormal Biophysical Profile (BPP by 1-2 weeks. (1,2,3,4 Umbilical artery indices only reflect the placental status. Fetal response to this increasing placental insufficiency can be deduced from studying the Cerebroplacental Ratio {CPR}, which gives us an idea of the fetal response to the placental status and is potentially more advantageous in predicting fetal outcome. OBJECTIVES To compare CPR in predicting fetal outcome with UA and MCA indices. MATERIALS AND METHODS Prospective cohort study of cases of IUGR - January 2013 to December 2013. 180 cases of clinically diagnosed IUGR were selected. Obstetric USG and Doppler was performed. The S/D ratio, RI, PR values were obtained and CPR calculated. All cases were managed as per the protocol then in place using U/A SD ratios for determining the timing & mode of termination RESULTS Of 180 cases of IUGR were selected most women were primigravidae, 20-34 years, and from low socio-economic status. (3 25 women (13.8% had oligohydramnios (AFI <5. Of these women, 24 had an abnormal CPR, 1 normal CPR. 47% with abnormal CPR had caesarean for fetal distress. Birth weight was <1.5 kg in 14.4% of patients all of whom were in the abnormal CPR group. 7.5% had an Apgar <7; all these babies were in the abnormal CPR group. 43.9% of babies from the abnormal CPR group needed resuscitation. 79% of the abnormal CPR group babies needed NICU admission. CONCLUSION Utilization of only UA and MCA indices may cause unnecessary early intervention in some cases. (1,5 CPR can help triage pregnancies in need of termination while prolonging those which are relatively stable so as to gain

Risk factors for perinatal mortality in an urban area of Southern Brazil, 1993

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Ana M. B. Menezes

Full Text Available INTRODUCTION: Although there was a considerable reduction in infant mortality in Pelotas, Rio Grande do Sul in the last decade, its perinatal causes were reduced only by 28%. The associated factors of these causes were analised. MATERIAL AND METHOD: All hospital births and perinatal deaths were assessed by daily visits to all the maternity hospitals in the city, throughout 1993 and including the first week of 1994. RESULTS: The perinatal mortality rate was 22.1 per thousand births. The multivariate analysis showed the following risk factors: low socioeconomic level, male sex and maternal age above 35 years . Among multigravidae women, the fetal mortality rate was significantly increased for mothers with a previously low birthweight and a previous stillbirth. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight. CONCLUSIONS: Main risk factors for perinatal mortality: low socioeconomic level, maternal age above 35 years and male sex. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight.

Prenatal diagnosis and perinatal management of congenital hydrocephalus using MRI

International Nuclear Information System (INIS)

Hamada, Hiromi; Koresawa, Mitsuhiko; Kubo, Takeshi

1990-01-01

We studied congenital hydrocephalus in 14 patients who were diagnosed prenatally. As a result, we obtained the following insights concerning the prenatal diagnosis by MRI (magnetic resonance imaging) and perinatal management of congenital hydrocephalus. Accurate diagnosis of congenital hydrocephalus was impossible prenatally by two-dimensional ultrasonography or computed tomography alone in some patients. MRI was useful for accurate prenatal diagnosis. Problem of MRI in prenatal diagnosis included deterioration of the image by fetal movements and safety concern over the fetus. The cause of hydrocephalus, complicated anomaly, cerebral cortical thickness, and gestational age must be considered in the perinatal management of congenital hydrocephalus. There appeared to be a chance of recovery to a certain extent from thinning of cerebral cortex by decompression in a patient in whom dilation of cerebral ventricles progressed rapidly. (author)

Placental responses to changes in the maternal environment determine fetal growth

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Kris Genelyn eDimasuay

2016-01-01

Full Text Available Placental responses to maternal perturbations are complex and remain poorly understood. Altered maternal environment during pregnancy such as hypoxia, stress, obesity, diabetes, toxins, altered nutrition, inflammation, and reduced utero-placental blood flow may influence fetal development, which can predispose to diseases later in life. The placenta being a metabolically active tissue responds to these perturbations by regulating the fetal supply of nutrients and oxygen and secretion of hormones into the maternal and fetal circulation. We have proposed that placental nutrient sensing integrates maternal and fetal nutritional cues with information from intrinsic nutrient sensing signaling pathways to balance fetal demand with the ability of the mother to support pregnancy by regulating maternal physiology, placental growth, and placental nutrient transport. Emerging evidence suggests that the nutrient-sensing signaling pathway mechanistic target of rapamycin (mTOR plays a central role in this process. Thus, placental nutrient sensing plays a critical role in modulating maternal-fetal resource allocation, thereby affecting fetal growth and the life-long health of the fetus.

[Fetal urology].

Science.gov (United States)

Jakobovits, Akos; Jakobovits, Antal

2009-06-14

Although it becomes vitally important only after birth, renal function already plays significant role in maintaining fetal metabolic equilibrium. The kidneys significantly contribute to production of amniotic fluid. Adequate amount of amniotic fluid is needed to stimulate the intrauterine fetal respiratory activity. Intrauterine breathing is essential for lung development. As a result, oligohydramnion is conducive to pulmonary hypoplasia. The latter may lead to neonatal demise soon after birth. In extrauterine life kidneys eliminate nitrogen containing metabolic byproducts. Inadequate renal function results therefore lethal uremia. Integrity of ureters and the urethra is essential for the maintenance of renal function. Retention of urine causes degeneration of the functional units of the kidneys and ensuing deterioration of renal function. Intrauterine kidney puncture or shunt procedure may delay this process in some cases. On the other hand, once renal function has been damaged, no therapy can restart it. Certain anomalies of renal excretory pathways may also be associated with other congenital abnormalities, making the therapeutic efforts pointless. Presence of these associated intrauterine defects makes early pregnancy termination a management alternative, as well as it affects favorably perinatal mortality rates.

Differences in perinatal and infant mortality in high-income countries

DEFF Research Database (Denmark)

Deb-Rinker, Paromita; León, Juan Andrés; Gilbert, Nicolas L.

2015-01-01

BACKGROUND: Variation in birth registration criteria may compromise international comparisons of fetal and infant mortality. We examined the effect of birth registration practices on fetal and infant mortality rates to determine whether observed differences in perinatal and infant mortality rates...... by gestational age and birth weight; gestational age-and birth weight-specific stillbirth rates; neonatal, post-neonatal, and cause-specific infant mortality. RESULTS: Proportion of live births ....02%), Canada (0.07%) and United States (0.08%). At 22-23 weeks, neonatal mortality rates were highest in Canada (892.2 per 1000 live births), Denmark (879.3) and Iceland (1000.0), moderately high in the United States (724.1), Finland (794.3) and Norway (739.0) and low in Sweden (561.2). Stillbirth:live birth...

Platelet-activating factor synthesis and receptor-mediated signaling are downregulated in ovine newborn lungs: relevance in postnatal pulmonary adaptation and persistent pulmonary hypertension of the newborn.

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Renteria, L S; Cruz, E; Ibe, B O

2013-12-01

Platelet-activating factor (PAF) is a phospholipid with a wide range of biological activities. We studied PAF metabolism and PAF receptor (PAFR) signaling in perinatal ovine lungs to understand PAF's role in transition of the perinatal pulmonary hemodynamics and pathophysiology of persistent pulmonary hypertension of the newborn. We hypothesized that downregulation of PAF synthesis with upregulation of PAF catabolism by acetylhydrolase (PAF-Ah) in the newborn lung is needed for fetus-to-newborn pulmonary adaptation. Studies were conducted on fetal and newborn lamb pulmonary arteries (PA), veins (PV) and smooth muscle cells (SMC). PAF metabolism, PAFR binding and cell proliferation were studied by cell culture; gene expression was studied by qPCR. Fetal lungs synthesized 60% more PAF than newborn lungs. Compared with the fetal PVs and SMCs, PAF-Ah activity in newborn was 40-60% greater. PAF-Ah mRNA expression in newborn vessels was different from the expression by fetal PA. PAF-Ah gene clone activity confirmed deletion of hypoxia-sensitive site. PAFR mRNA expression by the PVs and SMC-PV of the fetus and newborn was greater than by corresponding PAs and SMC-PA. Q-PCR study of PAFR expression by the SMC-PV of both groups was greater than SMC-PA. Fetal SMCs bound more PAF than the newborn SMCs. PAFR antagonist, CV-3988, inhibited PAFR binding and DNA synthesis by the fetal SMCs, but augmented binding and DNA synthesis by newborn cells. We show different PAF-PAFR mediated effects in perinatal lungs, suggesting both transcriptional and translational regulation of PAF-Ah and PAFR expression in the perinatal lamb lungs. These indicate that the downregulation of PAF-mediated effects postnatally protects against persistent pulmonary hypertension of the newborn.

Risk factors, organ weight deviation and associated anomalies in neural tube defects: A prospective fetal and perinatal autopsy series

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Asaranti Kar

2015-01-01

Full Text Available Introduction: Neural tube defects (NTD are a group of serious birth defects occurring due to defective closure of neural tube during embryonic development. It comprises of anencephaly, encephalocele and spina bifida. We conducted this prospective fetal autopsy series to study the rate and distribution of NTD, analyze the reproductive factors and risk factors, note any associated anomalies and evaluate the organ weights and their deviation from normal. Materials and Methods: This was a prospective study done over a period of 6 years from August, 2007 to July, 2013. All cases of NTDs delivered as abortion, still born and live born were included. The reproductive and risk factors like age, parity, multiple births, previous miscarriage, obesity, diabetes mellitus, socioeconomic status and use of folic acid during pregnancy were collected.Autopsy was performed according to Virchow′s technique. Detail external and internal examination were carried out to detect any associated anomalies. Gross and microscopic examination of organs were done. Results: Out of 210 cases of fetal and perinatal autopsy done, 72 (34.28% had NTD constituting 49 cases of anencephaly, 16 spina bifida and 7 cases of encephalocele. The mothers in these cases predominantly were within 25-29 years (P = 0.02 and primy (P = 0.01. Female sex was more commonly affected than males (M:F = 25:47, P = 0.0005 There was no history of folate use in majority of cases. Organ weight deviations were >2 standard deviation low in most of the cases. Most common associated anomalies were adrenal hypoplasia and thymic hyperplasia. Conclusion: The authors have made an attempt to study NTD cases in respect to maternal reproductive and risk factors and their association with NTD along with the organ weight deviation and associated anomalies. This so far in our knowledge is an innovative study which was not found in literature even after extensive search.

Caracterização sociodemográfica e resultados perinatais das gestações com diagnóstico ultrassonográfico de malformação fetal Socio demographic characteriation and perinatal outcome of pregnancies with ultrasonographic diagnosis of major fetal malformation in a referral centre

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Juliana Limeira de Araújo Moura Ramos

2009-01-01

Full Text Available OBJETIVO: Caracterizar, do ponto de vista sociodemográfico, e obter a evolução pós-natal, das gestantes com diagnóstico ultrassonográfico pré-natal de malformação fetal maior, atendidas no Setor de Medicina Fetal do Hospital das Clínicas (HC da Faculdade de Medicina da Universidade de São Paulo, entre 15/12/2005 e 15/12/2006. METHODS: Estudo descritivo com 335 gestantes entrevistadas após a obtenção do termo de consentimento pós-informado. Os dados pós-natais foram obtidos mediante contato até um mês após a data provável do parto. Foram excluídas aquelas que não aderiram e que não tiveram confirmação da malformação fetal. RESULTADOS: A idade materna média das gestantes foi de 27,1 anos; a cor da pele predominante parda (48,1%. Em relação à escolaridade, 57,8% das gestantes apresentavam grau de escolaridade igual ou inferior ao ensino médio completo. A renda salarial média foi de 3,1 salários mínimos. Quanto aos antecedentes de malformação fetal, 10,4% das gestantes o referiram. Dentre os casos de malformação atual, as do sistema nervoso central foram as mais prevalentes (28%, seguidas das malformações renais (9,2% e cardíacas (8,9%. Das gestantes submetidas à pesquisa do cariótipo fetal, 23,6% obtiveram resultados anormais. Em 311 casos (92,8%, o resultado da gestação foi obtido. Destes, 76,8% nasceram vivos; 25,7% evoluíram com óbito neonatal; 16,4% foram natimortos e em 6,3% houve interrupção da gestação. CONCLUSÃO: O presente estudo permitiu conhecer as características sociodemográficas e os resultados gestacionais de mulheres com diagnóstico de malformação fetal, o que poderá ser útil para o planejamento periconcepcional deste grupo de pacientes.OBJECTIVE: The purpose of this study is to describe the socio demographic profile and perinatal outcome of pregnant women with prenatal ultrasound diagnosis of major fetal malformation at the Hospital das Clínicas, Medical School, S�

eHealth as the Next-Generation Perinatal Care: An Overview of the Literature.

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van den Heuvel, Josephus Fm; Groenhof, T Katrien; Veerbeek, Jan Hw; van Solinge, Wouter W; Lely, A Titia; Franx, Arie; Bekker, Mireille N

2018-06-05

Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable

Trends in birth asphyxia, obstetric interventions and perinatal mortality among term singletons: a nationwide cohort study

NARCIS (Netherlands)

Ensing, Sabine; Abu-Hanna, Ameen; Schaaf, Jelle M.; Mol, Ben Willem J.; Ravelli, Anita C. J.

2015-01-01

The objective of the present study is to investigate trends in birth asphyxia and perinatal mortality in the Netherlands over the last decade. A nationwide cohort study among women with a term singleton pregnancy. We assessed trends in birth asphyxia in relation to obstetric interventions for fetal

Perinatal features of the RASopathies: Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome.

Science.gov (United States)

Myers, Angela; Bernstein, Jonathan A; Brennan, Marie-Luise; Curry, Cynthia; Esplin, Edward D; Fisher, Jamie; Homeyer, Margaret; Manning, Melanie A; Muller, Eric A; Niemi, Anna-Kaisa; Seaver, Laurie H; Hintz, Susan R; Hudgins, Louanne

2014-11-01

The RASopathies are a family of developmental disorders caused by heritable defects of the RAS/MAPK signaling pathway. While the postnatal presentation of this group of disorders is well known, the prenatal and neonatal findings are less widely recognized. We report on the perinatal presentation of 10 patients with Noonan syndrome (NS), nine with Cardiofaciocutaneous syndrome (CFCS) and three with Costello syndrome (CS), in conjunction with the results of a comprehensive literature review. The majority of perinatal findings in NS, CS, and CFCS are shared: polyhydramnios; prematurity; lymphatic dysplasia; macrosomia; relative macrocephaly; respiratory distress; hypotonia, as well as cardiac and renal anomalies. In contrast, fetal arrhythmia and neonatal hypoglycemia are relatively specific to CS. NS, CS, and CFCS should all be considered as a possible diagnosis in pregnancies with a normal karyotype and ultrasound findings of a RASopathy. Recognition of the common perinatal findings of these disorders should facilitate both their prenatal and neonatal diagnosis. © 2014 Wiley Periodicals, Inc.

Serum Uric Acid as a Predictor of Perinatal Outcome in Women with Pre-Eclampsia

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Jwan Muhammad Zangana

2018-03-01

Full Text Available Background and objectives: Pre-eclampsia is one of the medical complication of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Hyperuricemia is often associated with preeclampsia. The objective of this study was to assess serum uric acid in group of women with pre-eclampsia and to evaluate its diagnostic effect on perinatal outcome. Patients and methods: This is a hospital-based cross-sectional study conducted in Maternity Teaching Hospital in Erbil city, Iraq. Convenient sample size of 200 participants preeclamptic pregnant women with ≥ 34 weeks of gestation in different level of hypertension were included. After getting informed consent from participant who were diagnosed with pre-eclampsia (hypertension and proteinuria, all sociodemographic information was collected from 1st June 2017 to 19th January 2018. Blood samples were obtained to assess serum uric acid besides other investigation routinely done and fetal outcome (birth weight, gestational age, intrauterine death, Apgar score, admission to neonatal care unit, intrauterine growth restriction and early neonatal death was evaluated. Results: Serum uric acid was ≥ 6 mg/dL in 127 (63.5% among all pre-eclamptic women. There was positive significant association between means of serum uric acid at different levels of hypertension with p=0.000 in ANOVA and x2 test. This study revealed significant association between increased level of serum uric acid and bad fetal outcome (birth weight, gestational age, intrauterine death, Apgar score, admission to neonatal care unit, intrauterine growth restriction and early neonatal death and Apgar score in 1st minute. Conclusion: This study revealed significant raised level of serum uric acid among pre-eclamptic women and significant effect on fetal outcome and perinatal morbidity and mortality.

Fetal evaluation of spine dysraphism

International Nuclear Information System (INIS)

Bulas, Dorothy

2010-01-01

Spinal dysraphism or neural tube defects (NTD) encompass a heterogeneous group of congenital spinal anomalies that result from the defective closure of the neural tube early in gestation with anomalous development of the caudal cell mass. Advances in ultrasound and MRI have dramatically improved the diagnosis and therapy of spinal dysraphism and caudal spinal anomalies both prenatally and postnatally. Advances in prenatal US including high frequency linear transducers and three dimensional imaging can provide detailed information concerning spinal anomalies. MR imaging is a complementary tool that can further elucidate spine abnormalities as well as associated central nervous system and non-CNS anomalies. Recent studies have suggested that 3-D CT can help further assess fetal spine anomalies in the third trimester. With the advent of fetal therapy including surgery, accurate prenatal diagnosis of open and closed spinal dysraphism becomes critical in appropriate counselling and perinatal management. (orig.)

Fetal evaluation of spine dysraphism

Energy Technology Data Exchange (ETDEWEB)

Bulas, Dorothy [George Washington University Medical Center, Division of Diagnostic Imaging and Radiology, Children' s National Medical Center, Washington, DC (United States)

2010-06-15

Spinal dysraphism or neural tube defects (NTD) encompass a heterogeneous group of congenital spinal anomalies that result from the defective closure of the neural tube early in gestation with anomalous development of the caudal cell mass. Advances in ultrasound and MRI have dramatically improved the diagnosis and therapy of spinal dysraphism and caudal spinal anomalies both prenatally and postnatally. Advances in prenatal US including high frequency linear transducers and three dimensional imaging can provide detailed information concerning spinal anomalies. MR imaging is a complementary tool that can further elucidate spine abnormalities as well as associated central nervous system and non-CNS anomalies. Recent studies have suggested that 3-D CT can help further assess fetal spine anomalies in the third trimester. With the advent of fetal therapy including surgery, accurate prenatal diagnosis of open and closed spinal dysraphism becomes critical in appropriate counselling and perinatal management. (orig.)

2-Iminobiotin Superimposed on Hypothermia Protects Human Neuronal Cells from Hypoxia-Induced Cell Damage: An in Vitro Study

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Karina Zitta

2018-01-01

Full Text Available Perinatal asphyxia represents one of the major causes of neonatal morbidity and mortality. Hypothermia is currently the only established treatment for hypoxic-ischemic encephalopathy (HIE, but additional pharmacological strategies are being explored to further reduce the damage after perinatal asphyxia. The aim of this study was to evaluate whether 2-iminobiotin (2-IB superimposed on hypothermia has the potential to attenuate hypoxia-induced injury of neuronal cells. In vitro hypoxia was induced for 7 h in neuronal IMR-32 cell cultures. Afterwards, all cultures were subjected to 25 h of hypothermia (33.5°C, and incubated with vehicle or 2-IB (10, 30, 50, 100, and 300 ng/ml. Cell morphology was evaluated by brightfield microscopy. Cell damage was analyzed by LDH assays. Production of reactive oxygen species (ROS was measured using fluorometric assays. Western blotting for PARP, Caspase-3, and the phosphorylated forms of akt and erk1/2 was conducted. To evaluate early apoptotic events and signaling, cell protein was isolated 4 h post-hypoxia and human apoptosis proteome profiler arrays were performed. Twenty-five hour after the hypoxic insult, clear morphological signs of cell damage were visible and significant LDH release as well as ROS production were observed even under hypothermic conditions. Post-hypoxic application of 2-IB (10 and 30 ng/ml reduced the hypoxia-induced LDH release but not ROS production. Phosphorylation of erk1/2 was significantly increased after hypoxia, while phosphorylation of akt, protein expression of Caspase-3 and cleavage of PARP were only slightly increased. Addition of 2-IB did not affect any of the investigated proteins. Apoptosis proteome profiler arrays performed with cellular protein obtained 4 h after hypoxia revealed that post-hypoxic application of 2-IB resulted in a ≥ 25% down regulation of 10/35 apoptosis-related proteins: Bad, Bax, Bcl-2, cleaved Caspase-3, TRAILR1, TRAILR2, PON2, p21, p27, and phospho

Perinatal Autopsy Findings in a Case of De Novo Hypohidrotic Ectodermal Dysplasia.

Science.gov (United States)

Chikkannaiah, Panduranga; Nagaraju, Smitha; Kangle, Rajit; Gosavi, Mansi

2015-01-01

Ectodermal dysplasia are group of inherited disorders involving the developmental defects of ectodermal structures like hair, teeth, nails, sweat glands, and others. X-linked recessive inheritance is most common. Here we describe perinatal autopsy findings in a case of de novo ectodermal dysplasia in a female fetus. To the best of our knowledge, this is the first fetal autopsy description in a case of ectodermal dysplasia.

Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

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Piedrahíta-Gutiérrez, Dany Leandro

2016-07-01

Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

Screening for fetal growth restriction using fetal biometry combined with maternal biomarkers.

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Gaccioli, Francesca; Aye, Irving L M H; Sovio, Ulla; Charnock-Jones, D Stephen; Smith, Gordon C S

2018-02-01

Fetal growth restriction is a major determinant of perinatal morbidity and mortality. Screening for fetal growth restriction is a key element of prenatal care but it is recognized to be problematic. Screening using clinical risk assessment and targeting ultrasound to high-risk women is the standard of care in the United States and United Kingdom, but the approach is known to have low sensitivity. Systematic reviews of randomized controlled trials do not demonstrate any benefit from universal ultrasound screening for fetal growth restriction in the third trimester, but the evidence base is not strong. Implementation of universal ultrasound screening in low-risk women in France failed to reduce the risk of complications among small-for-gestational-age infants but did appear to cause iatrogenic harm to false positives. One strategy to making progress is to improve screening by developing more sensitive and specific tests with the key goal of differentiating between healthy small fetuses and those that are small through fetal growth restriction. As abnormal placentation is thought to be the major cause of fetal growth restriction, one approach is to combine fetal biometry with an indicator of placental dysfunction. In the past, these indicators were generally ultrasonic measurements, such as Doppler flow velocimetry of the uteroplacental circulation. However, another promising approach is to combine ultrasonic suspicion of small-for-gestational-age infant with a blood test indicating placental dysfunction. Thus far, much of the research on maternal serum biomarkers for fetal growth restriction has involved the secondary analysis of tests performed for other indications, such as fetal aneuploidies. An exemplar of this is pregnancy-associated plasma protein A. This blood test is performed primarily to assess the risk of Down syndrome, but women with low first-trimester levels are now serially scanned in later pregnancy due to associations with placental causes of

Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being.

Science.gov (United States)

Martis, Ruth; Emilia, Ova; Nurdiati, Detty S; Brown, Julie

2017-02-13

babies, very low-quality evidence). There were no clear differences for perinatal mortality (RR 0.88, 95% CI 0.34 to 2.25; 633 infants, very low-quality evidence). Neonatal seizures were reduced in the EFM group (RR 0.05, 95% CI 0.00 to 0.89; 633 infants, very low-quality evidence). Other important infant outcomes were not reported: mortality or serious morbidity (composite outcome), cerebral palsy or neurosensory disability. For maternal outcomes, women allocated to intermittent electronic fetal monitoring (EFM) (CTG) had higher rates of caesarean section for fetal distress (RR 2.92, 95% CI 1.78 to 4.80, 633 women, moderate-quality evidence) compared with women allocated to routine Pinard. There was no clear difference between groups in instrumental vaginal births (RR 1.46, 95% CI 0.86 to 2.49, low-quality evidence). Other outcomes were not reported (maternal mortality, instrumental vaginal birth for fetal distress and or acidosis, analgesia in labour, mobility or restriction during labour, and postnatal depression). Doppler ultrasonography with routine Pinard (two trials)There was no clear difference between groups in Apgar scores < seven at five minutes after birth (reported as < six in one of the trials) (average RR 0.76, 95% CI 0.20 to 2.87; two trials, 2598 babies, I 2 = 72%, very low-quality evidence); there was high heterogeneity for this outcome. There was no clear difference between groups for perinatal mortality (RR 0.69, 95% CI 0.09 to 5.40; 2597 infants, two studies, very low-quality evidence), or neonatal seizures (RR 0.05, 95% CI 0.00 to 0.91; 627 infants, one study, very low-quality evidence). Other important infant outcomes were not reported (cord blood acidosis, composite of mortality and serious morbidity, cerebral palsy, neurosensory disability). Only one study reported maternal outcomes. Women allocated to Doppler ultrasonography had higher rates of caesarean section for fetal distress compared with those allocated to routine Pinard (RR 2.71, 95% CI

WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component.

Science.gov (United States)

Merialdi, Mario; Widmer, Mariana; Gülmezoglu, Ahmet Metin; Abdel-Aleem, Hany; Bega, George; Benachi, Alexandra; Carroli, Guillermo; Cecatti, Jose Guilherme; Diemert, Anke; Gonzalez, Rogelio; Hecher, Kurt; Jensen, Lisa N; Johnsen, Synnøve L; Kiserud, Torvid; Kriplani, Alka; Lumbiganon, Pisake; Tabor, Ann; Talegawkar, Sameera A; Tshefu, Antoinette; Wojdyla, Daniel; Platt, Lawrence

2014-05-02

In 2006 WHO presented the infant and child growth charts suggested for universal application. However, major determinants for perinatal outcomes and postnatal growth are laid down during antenatal development. Accordingly, monitoring fetal growth in utero by ultrasonography is important both for clinical and scientific reasons. The currently used fetal growth references are derived mainly from North American and European population and may be inappropriate for international use, given possible variances in the growth rates of fetuses from different ethnic population groups. WHO has, therefore, made it a high priority to establish charts of optimal fetal growth that can be recommended worldwide. This is a multi-national study for the development of fetal growth standards for international application by assessing fetal growth in populations of different ethnic and geographic backgrounds. The study will select pregnant women of high-middle socioeconomic status with no obvious environmental constraints on growth (adequate nutritional status, non-smoking), and normal pregnancy history with no complications likely to affect fetal growth. The study will be conducted in centres from ten developing and industrialized countries: Argentina, Brazil, Democratic Republic of Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand. At each centre, 140 pregnant women will be recruited between 8 + 0 and 12 + 6 weeks of gestation. Subsequently, visits for fetal biometry will be scheduled at 14, 18, 24, 28, 32, 36, and 40 weeks (+/- 1 week) to be performed by trained ultrasonographers.The main outcome of the proposed study will be the development of fetal growth standards (either global or population specific) for international applications. The data from this study will be incorporated into obstetric practice and national health policies at country level in coordination with the activities presently conducted by WHO to implement the use of the Child Growth Standards.

Promoting antenatal steroid use for fetal maturation: results from the California Perinatal Quality Care Collaborative.

Science.gov (United States)

Wirtschafter, David D; Danielsen, Beate H; Main, Elliott K; Korst, Lisa M; Gregory, Kimberly D; Wertz, Andrew; Stevenson, David K; Gould, Jeffrey B

2006-05-01

The California Perinatal Quality Care Collaborative (CPQCC) was formed to seek perinatal care improvements by creating a confidential multi-institutional database to identify topics for quality improvement (QI). We aimed to evaluate this approach by assessing antenatal steroid administration before preterm (24 to 33 weeks of gestation) delivery. We hypothesized that mean performance would improve and the number of centers performing below the lowest quartile of the baseline year would decrease. In 1998, a statewide QI cycle targeting antenatal steroid use was announced, calling for the evaluation of the 1998 baseline data, dissemination of recommended interventions using member-developed educational materials, and presentations to California neonatologists in 1999-2000. Postintervention data were assessed for the year 2001 and publicly released in 2003. A total of 25 centers voluntarily participated in the intervention. Antenatal steroid administration rate increased from 76% of 1524 infants in 1998 to 86% of 1475 infants in 2001 (P < .001). In 2001, 23 of 25 hospitals exceeded the 1998 lower-quartile cutoff point of 69.3%. Regional collaborations represent an effective strategy for improving the quality of perinatal care.

Defining the residual risk of adverse perinatal outcome in growth restricted fetuses with normal umbilical artery blood flow.

LENUS (Irish Health Repository)

O'Dwyer, Vicky

2014-07-25

To determine the cause of adverse perinatal outcome in fetal growth restriction(FGR) where umbilical artery Doppler(UA) was normal, as identified from the Prospective Observational Trial to Optimize Pediatric Health(PORTO). We compared cases of adverse outcome where UA Doppler was normal and abnormal.

[Embryo-fetal diseases in multiple pregnancies].

Science.gov (United States)

Colla, F; Alba, E; Grio, R

2001-04-01

Embryo-fetal diseases are the consequence of prenatal (progenetic and metagenetic or environmental) and intranatal (of a traumatic, infective, toxic nature) pathological factors. In multiple pregnancies this complex etiopathogenesis also includes an altered didymous embriogenesis. This study aimed to evaluate the pathologies affecting the fetus in multiple pregnancy, a special biological situation leading to the potential onset of severe fetal and neonatal damage. The authors studied 205 patients with multiple pregnancies, including 199 bigeminal, 5 trigeminal and 1 quadrigeminal, admitted to the Department B of the Obstetrics and Gynecological Clinic of Turin University between 1989-1999. Possible embyro-fetal damage was examined using a chronological criterion: namely following the development of the multiple fetuses from the zygotic to the neonatal phase. Pregnancies were biamniotic bichorionic in 54% of cases, biamniotic monochorionic in 45% and monochorionic monoamniotic in 1%. There were a total of 154 (79.38%) premature births out of 194 and neonatal birth weight was always SGA (small for gestational age). 66.84% of newborns were LBW (<2500 g) and 7.14% were VLBW (<1500 g). Fetal mortality (2.29%) was higher than early neonatal mortality (1.53%). Perinatal mortality (3.82%) was three times higher than in all neonates from the same period (1.03%). The severe embryo-fetal and neonatal damage found in multiple pregnancies is a clinical reality that calls for adequate diagnostic and therapeutic measures, and above all specific medical and social prevention to limit maternal pathogenic risks.

Early fetal size and growth as predictors of adverse outcome

DEFF Research Database (Denmark)

Pedersen, Nina Gros; Figueras, Francesc; Wøjdemann, Karen R

2008-01-01

OBJECTIVE: To evaluate the association between fetal size and growth between the first and second trimesters and subsequent adverse pregnancy outcome. METHODS: A cohort was created of 7,642 singleton pregnancies cared for in three obstetric units associated with Copenhagen University. Data were...... obtained from ultrasound measurements at 11-14 weeks (crown-rump length, biparietal diameter) and 17-21 weeks (biparietal diameter). Fetal size was assessed by gestation-specific z scores, and fetal growth between the first and second trimester was calculated individually using conditional centiles....... The main outcome measures were preterm delivery, smallness for gestational age, and perinatal death. RESULTS: Slow growth of the biparietal diameter less than the 10th and less than the 2.5th conditional centiles between first and second trimesters occurred in 10.4% and 3.6% of the population, respectively...

Combining hypobaric hypoxia or hyperbaric oxygen postconditioning with memantine reduces neuroprotection in 7-day-old rat hypoxia-ischemia.

Science.gov (United States)

Gamdzyk, Marcin; Ziembowicz, Apolonia; Bratek, Ewelina; Salinska, Elzbieta

2016-10-01

Perinatal hypoxia-ischemia causes brain injury in neonates, but a fully successful treatment to prevent changes in the brain has yet to be developed. The aim of this study was to evaluate the effect of combining memantine treatment with HBO (2.5 ATA) or HH (0.47 ATA) on neonatal hypoxia-ischemia brain injury. 7-day old rats were subjected to hypoxia-ischemia (H-I) and treated with combination of memantine and HBO or HH. The brain damage was evaluated by examination of infarct area and the number of apoptotic cells in CA1 region of hippocampus. Additionally, the level of reactive oxygen species (ROS) was measured. Memantine, HBO or HH postconditioning applied at short time (1-6h) after H-I, and repeated for two subsequent days, resulted in significant neuroprotection. The reduction in ipsilateral hemisphere weight deficit and in the size of infarct area was observed 14days after H-I. A reduction in apoptosis and ROS level was also observed. Combining memantine with HBO or HH resulted in a loss of neuroprotection. Our results show that, combining HBO or HH postconditioning with memantine produce no additive increase in the neuroprotective effect. On the contrary, combining the treatments resulted in lower neuroprotection in comparison to the effects of memantine, HBO or HH alone. Copyright © 2016 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes

International Nuclear Information System (INIS)

Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold; Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela; Helmer, Hanns; Brugger, Peter C.

2011-01-01

Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)

Fetal MRI for prediction of neonatal mortality following preterm premature rupture of the fetal membranes

Energy Technology Data Exchange (ETDEWEB)

Messerschmidt, Agnes; Sauer, Alexandra; Pollak, Arnold [Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna (Austria); Pataraia, Anna; Kasprian, Gregor; Weber, Michael; Prayer, Daniela [Medical University of Vienna, Department of Radiology, Vienna (Austria); Helmer, Hanns [Medical University of Vienna, Department of Obstetrics and Maternal-Fetal Medicine, Vienna (Austria); Brugger, Peter C. [Medical University of Vienna, Center of Anatomy and Cell Biology, Vienna (Austria)

2011-11-15

Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). To evaluate the predictive value of MRI lung volumetrics after pPROM. Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM. (orig.)

Perinatal bisphenol A exposure and adult glucose homeostasis: identifying critical windows of exposure.

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Jingli Liu

Full Text Available Bisphenol A (BPA is a widespread endocrine-disrupting chemical used as the building block for polycarbonate plastics. Epidemiological evidence has correlated BPA exposure with higher risk of heart disease and type 2 diabetes. However, it remains unknown whether there are critical windows of susceptibility to BPA exposure on the development of dysglycemia. This study was an attempt to investigate the critical windows and the long-term consequences of perinatal exposure to BPA on glucose homeostasis. Pregnant mice were given either vehicle or BPA (100 µg/kg/day at different time of perinatal stage: 1 on days 1-6 of pregnancy (P1-P6, preimplantation exposure; 2 from day 6 of pregnancy until postnatal day (PND 0 (P6-PND0, fetal exposure; 3 from lactation until weaning (PND0-PND21, neonatal exposure; and 4 from day 6 of gestation until weaning (P6-PND21, fetal and neonatal exposure. At 3, 6 and 8 months of age, offspring in each group were challenged with glucose and insulin tolerance tests. Then islet morphometry and β-cell function were measured. The glucose homeostasis was impaired in P6-PND0 mice from 3 to 6 months of age, and this continued to 8 months in males, but not females. While in PND0-PND21 and P6-PND21 BPA-treated groups, only the 3-month-old male offspring developed glucose intolerance. Moreover, at the age of 3 months, perinatal exposure to BPA resulted in the increase of β-cell mass mainly due to the coordinate changes in cell replication, neogenesis, and apoptosis. The alterations of insulin secretion and insulin sensitivity, rather than β-cell mass, were consistent with the development of glucose intolerance. Our findings suggest that BPA may contribute to metabolic disorders relevant to glucose homeostasis and the effects of BPA were dose, sex, and time-dependent. Fetal development stage may be the critical window of susceptibility to BPA exposure.

Perinatal asphyxia: CNS development and deficits with delayed onset

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Mario eHerrera-Marschitz

2014-03-01

Full Text Available Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified.In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by over expression of sentinel proteins, such as poly(ADP-ribose polymerase-1 (PARP-1, competing for NAD+ during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat foetuses into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that it constitutes a lead for exploring compounds with similar or better pharmacological profiles.

Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies.

Science.gov (United States)

Sinkin, Joshua A; Craig, Wendy Y; Jones, Michael; Pinette, Michael G; Wax, Joseph R

2018-02-01

To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa. This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery ± 1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction. Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P = .039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P = .045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P = .012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P = .14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P = .21), and fetal or neonatal death (3.8% versus 0%; P = .11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P = .013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P = .036). Isolated confirmed velamentous cord insertion is associated

Prenatal diagnosis of fetal skeletal dysplasia with 3D CT

International Nuclear Information System (INIS)

Miyazaki, Osamu; Horiuchi, Tetsuya; Nishimura, Gen; Sago, Haruhiko; Hayashi, Satoshi; Kosaki, Rika

2012-01-01

Clinical use of 3D CT for fetal skeletal malformations is controversial. The purpose of this study was to evaluate the efficacy of fetal 3D CT using three protocols with different radiation doses and through comparing findings between fetal CT and conventional postnatal radiographic skeletal survey. Seventeen fetuses underwent CT for suspected skeletal dysplasia. A relay of three CT protocols with stepwise dose-reduction were used over the study period. The concordance between the CT diagnosis and the final diagnosis was assessed. Ninety-three radiological findings identifiable on radiographs were compared with CT. Fetal CT provided the correct diagnosis in all 17 fetuses, the detectability rate of cardinal findings was 93.5 %. In 59 % of the fetuses an US-based diagnosis was changed prenatally due to CT findings. The estimated fetal radiation dose in the final protocol was 3.4 mSv (50 %) of the initial protocol, and this dose reduction did not result in degraded image quality. The capability of fetal CT to delineate the skeleton was almost the same as that of postnatal skeletal survey. The perinatal management was altered due to these more specific CT findings, which aided in counseling and in the management of the pregnancy. (orig.)

Prenatal diagnosis of fetal skeletal dysplasia with 3D CT

Energy Technology Data Exchange (ETDEWEB)

Miyazaki, Osamu; Horiuchi, Tetsuya [National Center for Child Health and Development, Department of Radiology, Seatagaya-ku, Tokyo (Japan); Nishimura, Gen [Tokyo Metropolitan Children' s Medical Center, Department of Pediatric Imaging, Fuchu-shi, Tokyo (Japan); Sago, Haruhiko; Hayashi, Satoshi [National Center for Child Health and Development, Department of Perinatal Medicine and Maternal Care, Seatagaya-ku, Tokyo (Japan); Kosaki, Rika [National Center for Child Health and Development, Department of Strategic Medicine, Division of Clinical Genetics and Molecular Medicine, Seatagaya-ku, Tokyo (Japan)

2012-07-15

Clinical use of 3D CT for fetal skeletal malformations is controversial. The purpose of this study was to evaluate the efficacy of fetal 3D CT using three protocols with different radiation doses and through comparing findings between fetal CT and conventional postnatal radiographic skeletal survey. Seventeen fetuses underwent CT for suspected skeletal dysplasia. A relay of three CT protocols with stepwise dose-reduction were used over the study period. The concordance between the CT diagnosis and the final diagnosis was assessed. Ninety-three radiological findings identifiable on radiographs were compared with CT. Fetal CT provided the correct diagnosis in all 17 fetuses, the detectability rate of cardinal findings was 93.5 %. In 59 % of the fetuses an US-based diagnosis was changed prenatally due to CT findings. The estimated fetal radiation dose in the final protocol was 3.4 mSv (50 %) of the initial protocol, and this dose reduction did not result in degraded image quality. The capability of fetal CT to delineate the skeleton was almost the same as that of postnatal skeletal survey. The perinatal management was altered due to these more specific CT findings, which aided in counseling and in the management of the pregnancy. (orig.)

Hypoxia during pregnancy in rats leads to the changes of the cerebral white matter in adult offspring

International Nuclear Information System (INIS)

Wang, Lingxing; Cai, Ruowei; Lv, Guorong; Huang, Ziyang; Wang, Zhenhua

2010-01-01

The aim of the present study is to evaluate the effect of reduced fetal oxygen supply on cerebral white matter in the adult offspring and further assess its susceptibility to postnatal hypoxia and high-fat diet. Based on a 3 x 2 full factorial design consisting of three factors of maternal hypoxia, postnatal high-fat diet, and postnatal hypoxia, the ultrastructure of myelin, axon and capillaries were observed, and the expression of myelin basic protein (MBP), neurofilament-H+L(NF-H+L), and glial fibrillary acidic protein (GFAP) was analyzed in periventricular white matter of 16-month-old offspring. Demyelination, injured axon and damaged microvasculars were observed in maternal hypoxia offspring. The main effect of maternal hypoxia lead to decreased expression of MBP or NF-H+L, and increased expression of GFAP (all P < 0.05). Moreover, there was positive three-way interaction among maternal hypoxia, high-fat diet and postnatal hypoxia on MBP, NF-H+L or GFAP expression (all P < 0.05). In summary, our results indicated that maternal hypoxia during pregnancy in rats lead to changes of periventricular white matter in adult offspring, including demyelination, damaged axon and proliferated astroglia. This effect was amplified by high-fat diet and postnatal hypoxia.

Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors

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Ana Paula Pinho Matos

2018-05-01

Full Text Available Abstract Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.

Naturally conceived twins with monochorionic placentation have the highest risk of fetal loss

DEFF Research Database (Denmark)

Sperling, Lene; Kiil, C; Larsen, L U

2006-01-01

before 14 + 6 weeks' gestation in order to determine chorionicity. The fetal loss rate, the perinatal, neonatal and infant mortality rates and the frequency of very preterm labor were estimated for the different types of twin. RESULTS: Among the 495 pregnancies (421 DC and 74 MC) 229 (46%) were conceived...... the corresponding figures were 0% (0/10) and 0.4% (1/256). The odds ratio (OR) for very preterm birth-before 28 weeks' gestation-was 4.2 for MC twins compared to DC twins. The relative risk of fetal loss or death among DC twins was 20% of the risk for MC twins. CONCLUSION: The risk of fetal loss, very preterm...... that the maternal age was higher among the mothers of the AR twins....

Diabetes and perinatal mortality in twin pregnancies.

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Zhong-Cheng Luo

Full Text Available BACKGROUND: Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk "shift" may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths. This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth in twin pregnancies. METHODS: This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies. Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR of perinatal death accounting for twin cluster-level dependence. RESULTS: Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63] or with birth weight =2500 g [aHR 2.20 (1.55-3.13]. CONCLUSIONS: Diabetes in pregnancy appears to be "protective" against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes.

Perinatal stress and food allergy: a preliminary study on maternal reports.

Science.gov (United States)

Polloni, L; Ferruzza, E; Ronconi, L; Lazzarotto, F; Toniolo, A; Bonaguro, R; Muraro, A

2015-01-01

Maternal stress in fetal and early life has been associated with the development of respiratory allergies, but no studies exist about food allergy. Stressful events and the quality of caregiving provided, as they affect the emotional and physiologic regulation of the infant, could alter the hypothalamic-pituitary-adrenal and immune system, facilitating an increased allergic response. This study aimed to investigate the influence of perinatal stress, as perceived by mothers, on developing food allergy in childhood. A survey on pregnancy and the first three months after giving birth was submitted to 59 Italian mothers of at least one child suffering from severe food allergy and one completely healthy child, for a total of 118 children examined. The presence of stressful events and the quality of perinatal period for each child were assessed retrospectively. The food allergic children's data were compared to siblings' data through inferential statistics. The results showed a significantly higher number of stressful events occurred during patients' perinatal period, compared to siblings, in particular bereavements in pregnancy and parenting difficulties in postpartum. Mothers reported harder pregnancies and more stressful, harder, and, in general, worse postpartum when referring to their food-allergic children, in comparison with their siblings (p stress and perinatal psychosocial factors in the pathogenesis of food allergy; further studies are necessary to understand individual psychological impact and its relations with genetic and biological factors.

Ethical issues of perinatal human gene therapy.

Science.gov (United States)

Fletcher, J C; Richter, G

1996-01-01

This paper examines some key ethical issues raised by trials of human gene therapy in the perinatal period--i.e., in infants, young children, and the human fetus. It describes five resources in ethics for researchers' considerations prior to such trials: (1) the history of ethical debate about gene therapy, (2) a literature on the relevance of major ethical principles for clinical research, (3) a body of widely accepted norms and practices, (4) knowledge of paradigm cases, and (5) researchers' own professional integrity. The paper also examines ethical concerns that must be met prior to any trial: benefits to and safety of subjects, informed assent of children and informed parental permission, informed consent of pregnant women in fetal gene therapy, protection of privacy, and concerns about fairness in the selection of subjects. The paper criticizes the position that cases of fetal gene therapy should be restricted only to those where the pregnant woman has explicitly refused abortion. Additional topics include concerns about genetic enhancement and germ-line gene therapy.

Cerebral hypoxia and ischemia in preterm infants

Directory of Open Access Journals (Sweden)

Alberto Ravarino

2014-06-01

Full Text Available Premature birth is a major public health issue internationally affecting 13 million babies worldwide. Hypoxia and ischemia is probably the commonest type of acquired brain damage in preterm infants. The clinical manifestations of hypoxic-ischemic injury in survivors of premature birth include a spectrum of cerebral palsy and intellectual disabilities. Until recently, the extensive brain abnormalities in preterm neonates appeared to be related mostly to destructive processes that lead to substantial deletion of neurons, axons, and glia from necrotic lesions in the developing brain. Advances in neonatal care coincide with a growing body of evidence that the preterm gray and white matter frequently sustain less severe insults, where tissue destruction is the minor component. Periventricular leukomalacia (PVL is the major form of white matter injury and consists classically of focal necrotic lesions, with subsequent cyst formation, and a less severe but more diffuse injury to cerebral white mater, with prominent astrogliosis and microgliosis but without overt necrosis. With PVL a concomitant injury occurs to subplate neurons, located in the subcortical white matter. Severe hypoxic-ischemic insults that trigger significant white matter necrosis are accompanied by neuronal degeneration in cerebral gray and white matter. This review aims to illustrate signs of cerebral embryology of the second half of fetal life and correlate hypoxic-ischemic brain injury in the premature infant. This should help us better understand the symptoms early and late and facilitate new therapeutic strategies. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

Cumulative Effective Hölder Exponent Based Indicator for Real-Time Fetal Heartbeat Analysis during Labour

Science.gov (United States)

Struzik, Zbigniew R.; van Wijngaarden, Willem J.

We introduce a special purpose cumulative indicator, capturing in real time the cumulative deviation from the reference level of the exponent h (local roughness, Hölder exponent) of the fetal heartbeat during labour. We verify that the indicator applied to the variability component of the heartbeat coincides with the fetal outcome as determined by blood samples. The variability component is obtained from running real time decomposition of fetal heartbeat into independent components using an adaptation of an oversampled Haar wavelet transform. The particular filters used and resolutions applied are motivated by obstetricial insight/practice. The methodology described has the potential for real-time monitoring of the fetus during labour and for the prediction of the fetal outcome, allerting the attending staff in the case of (threatening) hypoxia.

Preclinical chorioamnionitis dysregulates CXCL1/CXCR2 signaling throughout the placental-fetal-brain axis.

Science.gov (United States)

Yellowhair, Tracylyn R; Noor, Shahani; Maxwell, Jessie R; Anstine, Christopher V; Oppong, Akosua Y; Robinson, Shenandoah; Milligan, Erin D; Jantzie, Lauren L

2018-03-01

In the United States, perinatal brain injury (PBI) is a major cause of infant mortality and childhood disability. For a large proportion of infants with PBI, central nervous system (CNS) injury begins in utero with inflammation (chorioamnionitis/CHORIO) and/or hypoxia-ischemia. While studies show CHORIO contributes to preterm CNS injury and is also a common independent risk factor for brain injury in term infants, the molecular mechanisms mediating inflammation in the placental-fetal-brain axis that result in PBI remain a gap in knowledge. The chemokine (C-X-C motif) ligand 1 (CXCL1), and its cognate receptor, CXCR2, have been clinically implicated in CHORIO and in mature CNS injury, although their specific role in PBI pathophysiology is poorly defined. Given CXCL1/CXCR2 signaling is essential to neural cell development and neutrophil recruitment, a key pathological hallmark of CHORIO, we hypothesized CHORIO would upregulate CXCL1/CXCR2 expression in the placenta and fetal circulation, concomitant with increased CXCL1/CXCR2 signaling in the developing brain, immune cell activation, neutrophilia, and microstructural PBI. On embryonic day 18 (E18), a laparotomy was performed in pregnant Sprague Dawley rats to induce CHORIO. Specifically, uterine arteries were occluded for 60min to induce placental transient systemic hypoxia-ischemia (TSHI), followed by intra-amniotic injection of lipopolysaccharide (LPS). Pups were born at E22. Placentae, serum and brain were collected along an extended time course from E19 to postnatal day (P)15 and analyzed using multiplex electrochemiluminescence (MECI), Western blot, qPCR, flow cytometry (FC) and diffusion tensor imaging (DTI). Results demonstrate that compared to sham, CHORIO increases placental CXCL1 and CXCR2 mRNA levels, concomitant with increased CXCR2 + neutrophils. Interestingly, pup serum CXCL1 expression in CHORIO parallels this increase, with sustained elevation through P15. Analyses of CHORIO brains reveal similarly

Mortalidad perinatal en el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago, Chile

OpenAIRE

Ovalle S,Alfredo; Kakarieka W,Elena; Díaz C,Marcela; García Huidobro M,Trinidad; Acuña M,María Jesús; Morong C,Carla; Abara C,Selim; Fuentes G,Ariel

2012-01-01

Objetivo: Conocer la mortalidad perinatal del parto prematuro y los factores de riesgo asociados, usando los datos perinatales clínicos, los resultados de laboratorio y los hallazgos patológicos del feto, neonato y placenta. Métodos: Estudio retrospectivo, cohorte de 407 nacimientos prematuros, únicos, entre 22.0 y 34.0 semanas de gestación. Se estudiaron las muertes fetales y neonatales hasta los 7 días de vida. Fallecieron 122 niños (64 muertes fetales y 58 neonatales), 78 tuvieron autopsia...

Pregnancy, obstetric, and perinatal health outcomes in eating disorders.

Science.gov (United States)

Linna, Milla S; Raevuori, Anu; Haukka, Jari; Suvisaari, Jaana M; Suokas, Jaana T; Gissler, Mika

2014-10-01

The purpose of this study was to assess pregnancy, obstetric, and perinatal health outcomes and complications in women with lifetime eating disorders. Female patients (n = 2257) who were treated at the Eating Disorder Clinic of Helsinki University Central Hospital from 1995-2010 were compared with unexposed women from the population (n = 9028). Register-based information on pregnancy, obstetric, and perinatal health outcomes and complications were acquired for all singleton births during the follow-up period among women with broad anorexia nervosa (AN; n = 302 births), broad bulimia nervosa (BN; n = 724), binge eating disorder (BED; n = 52), and unexposed women (n = 6319). Women with AN and BN gave birth to babies with lower birthweight compared with unexposed women, but the opposite was observed in women with BED. Maternal AN was related to anemia, slow fetal growth, premature contractions, short duration of the first stage of labor, very premature birth, small for gestational age, low birthweight, and perinatal death. Increased odds of premature contractions, resuscitation of the neonate, and very low Apgar score at 1 minute were observed in mothers with BN. BED was associated positively with maternal hypertension, long duration of the first and second stage of labor, and birth of large-for-gestational-age infants. Eating disorders appear to be associated with several adverse perinatal outcomes, particularly in offspring. We recommend close monitoring of pregnant women with either a past or current eating disorder. Attention should be paid to children who are born to these mothers. Copyright © 2014. Published by Elsevier Inc.

A placenta clinic approach to the diagnosis and management of fetal growth restriction.

Science.gov (United States)

Kingdom, John C; Audette, Melanie C; Hobson, Sebastian R; Windrim, Rory C; Morgen, Eric

2018-02-01

Effective detection and management of fetal growth restriction is relevant to all obstetric care providers. Models of best practice to care for these patients and their families continue to evolve. Since much of the disease burden in fetal growth restriction originates in the placenta, the concept of a multidisciplinary placenta clinic program, managed primarily within a maternal-fetal medicine division, has gained popularity. In this context, fetal growth restriction is merely one of many placenta-related disorders that can benefit from an interdisciplinary approach, incorporating expertise from specialist perinatal ultrasound and magnetic resonance imaging, reproductive genetics, neonatal pediatrics, internal medicine subspecialties, perinatal pathology, and nursing. The accurate diagnosis and prognosis for women with fetal growth restriction is established by comprehensive clinical review and detailed sonographic evaluation of the fetus, combined with uterine artery Doppler and morphologic assessment of the placenta. Diagnostic accuracy for placenta-mediated fetal growth restriction may be enhanced by quantification of maternal serum biomarkers including placenta growth factor alone or combined with soluble fms-like tyrosine kinase-1. Uterine artery Doppler is typically abnormal in most instances of early-onset fetal growth restriction and is associated with coexistent preeclampsia and underlying maternal vascular malperfusion pathology of the placenta. By contrast, rare but potentially more serious underlying placental diagnoses, such as massive perivillous fibrinoid deposition, chronic histiocytic intervillositis, or fetal thrombotic vasculopathy, may be associated with normal uterine artery Doppler waveforms. Despite minor variations in placental size, shape, and cord insertion, placental function remains, largely normal in the general population. Consequently, morphologic assessment of the placenta is not currently incorporated into current screening

Perinatal programming of childhood asthma: early fetal size, growth trajectory during infancy, and childhood asthma outcomes.

Science.gov (United States)

Turner, Steve

2012-01-01

The "fetal origins hypothesis" or concept of "developmental programming" suggests that faltering fetal growth and subsequent catch-up growth are implicated in the aetiology of cardiovascular disease. Associations between reduced birth weight, rapid postnatal weight gain, and asthma suggest that there are fetal origins to respiratory disease. The present paper first summarises the literature relating birth weight and post natal growth trajectories to asthma outcomes. Second, issues regarding the interpretation of antenatal fetal ultrasound measurements are discussed. Finally, recent reports linking antenatal measurement and growth trajectory to early childhood asthma outcomes are discussed. Understanding the nature and timing of factors which influence antenatal growth may give important insight into the antecedents of early-onset asthma with implications for interventions.

Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure

NARCIS (Netherlands)

Khalil, Asma; Beune, Irene; Hecher, Kurt; Wynia, Klaske; Ganzevoort, Wessel; Reed, Keith; Lewi, Liesbeth; Oepkes, Dick; Gratacos, Eduardo; Thilaganathan, Basky; Gordijn, Sanne J.

2018-01-01

Twin pregnancies complicated by selective fetal growth restriction (sFGR) are associated with increased perinatal mortality and morbidity. Inconsistences in the diagnostic criteria for sFGR employed in existing studies hinder the ability to compare or combine their findings. It is therefore

Factores asociados a mortalidad perinatal en el hospital general de Chiapas, México Perinatal mortality associated factors in a general hospital of Chiapas, Mexico

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Leonor Rivera

2003-12-01

Full Text Available OBJETIVO: El objetivo del estudio es identificar factores socioeconómicos, gineco-obstétricos y del producto asociados a mortalidad perinatal. MÉTODOS: Se realizó un estudio de casos y controles pareado. Se consideró caso a los nacidos vivos o muertos que nacieron y fallecieron entre las 28 semanas de gestación a los 7 días de vida extrauterina. y control al producto nacido vivo entre las 28 semanas de gestación y los 7 días de vida extrauterina. Los datos se obtuvieron de los expedientes clínicos hospitalarios. Se estudiaron 99 casos y 197 controles. Se hizo un análisis estadístico utilizando Stata 6.0. RESULTADOS La media de edad de la madre fue de 24.82 años y del producto de 37.78 semanas de gestación. El promedio de peso del producto fue de 2,760 gramos. Los factores asociados a mortalidad perinatal fueron: ocupación del padre agricultor (RM ajustada 3,31; IC 95% 1,26-8,66; índice de riesgo obstétrico alto (RM ajustada 10,57; IC 95% 2,82-39,66, antecedente de cesárea (RM ajustada 2,75; IC 95% 1,37-5,51; cinco y más consultas prenatales (RM ajustada 4,43; IC 95% 1.86-10,54; producto pretérmino (RM ajustada 9,20; IC 95% 4,39-19,25. CONCLUSIONES: Los resultados muestran que es necesario implementar medidas de prevención y control que aseguren la identificación del riesgo en las mujeres embarazadas, con el fin de abatir la incidencia de mortalidad perinatal.OBJECTIVE: To identify socioeconomic, gynecological-obstetric and fetal factors associated with perinatal mortality. METHODS: A matched case-control study was carried out. Cases were newborns (born live or dead that were born and died between 28 weeks gestation and 7 days of life. Controls were live newborns between 28 weeks gestation and 7 days of life. A total of 99 cases and 197 controls were studied. Data were obtained from the corresponding medical charts. Statistical analysis was performed using Stata 6.0 software. RESULTS: Mean maternal age was 24.82 years and

Animal models for clinical and gestational diabetes: maternal and fetal outcomes.

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Kiss, Ana Ci; Lima, Paula Ho; Sinzato, Yuri K; Takaku, Mariana; Takeno, Marisa A; Rudge, Marilza Vc; Damasceno, Débora C

2009-10-19

Diabetes in pregnant women is associated with an increased risk of maternal and neonatal morbidity and remains a significant medical challenge. Diabetes during pregnancy may be divided into clinical diabetes and gestational diabetes. Experimental models are developed with the purpose of enhancing understanding of the pathophysiological mechanisms of diseases that affect humans. With regard to diabetes in pregnancy, experimental findings from models will lead to the development of treatment strategies to maintain a normal metabolic intrauterine milieu, improving perinatal development by preventing fetal growth restriction or macrosomia. Based on animal models of diabetes during pregnancy previously reported in the medical literature, the present study aimed to compare the impact of streptozotocin-induced severe (glycemia >300 mg/dl) and mild diabetes (glycemia between 120 and 300 mg/dl) on glycemia and maternal reproductive and fetal outcomes of Wistar rats to evaluate whether the animal model reproduces the maternal and perinatal results of clinical and gestational diabetes in humans. On day 5 of life, 96 female Wistar rats were assigned to three experimental groups: control (n = 16), severe (n = 50) and mild diabetes (n = 30). At day 90 of life, rats were mated. On day 21 of pregnancy, rats were killed and their uterine horns were exposed to count implantation and fetus numbers to determine pre- and post-implantation loss rates. The fetuses were classified according to their birth weight. Severe and mild diabetic dams showed different glycemic responses during pregnancy, impairing fetal glycemia and weight, confirming that maternal glycemia is directly associated with fetal development. Newborns from severe diabetic mothers presented growth restriction, but mild diabetic mothers were not associated with an increased rate of macrosomic fetuses. Experimental models of severe diabetes during pregnancy reproduced maternal and fetal outcomes of pregnant women

Animal models for clinical and gestational diabetes: maternal and fetal outcomes

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Kiss Ana CI

2009-10-01

Full Text Available Abstract Background Diabetes in pregnant women is associated with an increased risk of maternal and neonatal morbidity and remains a significant medical challenge. Diabetes during pregnancy may be divided into clinical diabetes and gestational diabetes. Experimental models are developed with the purpose of enhancing understanding of the pathophysiological mechanisms of diseases that affect humans. With regard to diabetes in pregnancy, experimental findings from models will lead to the development of treatment strategies to maintain a normal metabolic intrauterine milieu, improving perinatal development by preventing fetal growth restriction or macrosomia. Based on animal models of diabetes during pregnancy previously reported in the medical literature, the present study aimed to compare the impact of streptozotocin-induced severe (glycemia >300 mg/dl and mild diabetes (glycemia between 120 and 300 mg/dl on glycemia and maternal reproductive and fetal outcomes of Wistar rats to evaluate whether the animal model reproduces the maternal and perinatal results of clinical and gestational diabetes in humans. Methods On day 5 of life, 96 female Wistar rats were assigned to three experimental groups: control (n = 16, severe (n = 50 and mild diabetes (n = 30. At day 90 of life, rats were mated. On day 21 of pregnancy, rats were killed and their uterine horns were exposed to count implantation and fetus numbers to determine pre- and post-implantation loss rates. The fetuses were classified according to their birth weight. Results Severe and mild diabetic dams showed different glycemic responses during pregnancy, impairing fetal glycemia and weight, confirming that maternal glycemia is directly associated with fetal development. Newborns from severe diabetic mothers presented growth restriction, but mild diabetic mothers were not associated with an increased rate of macrosomic fetuses. Conclusion Experimental models of severe diabetes during pregnancy

Infertility, infertility treatment, and fetal growth restriction

DEFF Research Database (Denmark)

Zhu, Jin Liang; Obel, Carsten; Hammer Bech, Bodil

2007-01-01

mortality and SGA among infertile couples (treated and untreated), but the odds ratios (ORs) of perinatal mortality among infertile couples were attenuated after adjustment for maternal age and body mass index (1.32, 95% confidence interval [CI] 0.95-1.84 among untreated and 1.26, 95% CI 0.86-1.85 among......OBJECTIVE: To examine the association between infertility, with or without treatment, and fetal growth, as well as perinatal and infant mortality. METHODS: From the Danish National Birth Cohort (1997-2003), we identified 51,041 singletons born of fertile couples (time to pregnancy 12 months or less...... treated couples). The elevated risk of SGA among infertile couples persisted after adjustment for maternal age, parity, and smoking (OR 1.24, 95% CI 1.10-1.40 among untreated, and OR 1.40, 95% CI 1.23-1.60 among treated). The risk of SGA increased with time to pregnancy, and a longer time to pregnancy...

Perinatal Programming of Childhood Asthma: Early Fetal Size, Growth Trajectory during Infancy, and Childhood Asthma Outcomes

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Steve Turner

2012-01-01

Full Text Available The “fetal origins hypothesis” or concept of “developmental programming” suggests that faltering fetal growth and subsequent catch-up growth are implicated in the aetiology of cardiovascular disease. Associations between reduced birth weight, rapid postnatal weight gain, and asthma suggest that there are fetal origins to respiratory disease. The present paper first summarises the literature relating birth weight and post natal growth trajectories to asthma outcomes. Second, issues regarding the interpretation of antenatal fetal ultrasound measurements are discussed. Finally, recent reports linking antenatal measurement and growth trajectory to early childhood asthma outcomes are discussed. Understanding the nature and timing of factors which influence antenatal growth may give important insight into the antecedents of early-onset asthma with implications for interventions.

Percepção materna de movimentos fetais como método de avaliação da vitalidade fetal em gestantes diabéticas Maternal perception of fetal movements as a method to evaluate fetal condition in diabetic women

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Belmiro Gonçalves Pereira

1999-12-01

Full Text Available Objetivo: avaliar a acurácia da percepção materna dos movimentos fetais (PMMF na predição de alguns resultados perinatais em gestantes diabéticas. Métodos: análise retrospectiva de 209 gestantes diabéticas atendidas no Centro de Atenção Integral à Saúde da Mulher (CAISM, entre junho de 1988 e maio de 1996, que tinham registro de PMMF dentro dos três dias anteriores ao parto, monitorização eletrônica da freqüência cardíaca fetal intraparto, idade gestacional > ou = 30 semanas, avaliação do recém-nascido (RN e diagnóstico neonatal. O teste de PMMF foi considerado normal quando a mulher detectou um mínimo de 7 movimentos em 60 minutos. Resultados: a sensibilidade do teste foi de 23 e 29% para Apgar Purpose: to evaluate the accuracy of maternal perception of fetal movements (MPFM in diabetic pregnant women, using Apgar score at the 1st and 5th min of life, intrapartum fetal distress and neonatal hypoxia as parameters. Methods: two hundred and nine diabetic women evaluated at the High Risk Prenatal Care Clinic of the Women's Hospital (CAISM were analyzed retrospectively between June 1988 and May 1996. All patients had MPFM records within three days before delivery, fetal heart rate recordings during labor, gestational age greater than 30 weeks and a complete neonatal evaluation. MPFM was classified as normal if seven movements were recorded in 60 min. Results: the sensitivity of the test was 23 and 29% for Apgar score 7 at 5 min and neonatal hypoxia. Conclusions: MPFM is a useful test to identify diabetic women needing fetal evaluation with more complex techniques, given the high NPV, that indicates the capacity to separate the cases where the fetus is in good condition.

Lethal Congenital Malformations in Fetuses-Antenatal Ultrasound or Perinatal Autopsy.

Science.gov (United States)

Grover, Sumit; Garg, Bhavna; Sood, Neena; Arora, Kamaldeep

2017-06-01

Congenital malformations (CMF) are major causes of fetal demise which can be detected antenatally by Ultrasonography (USG). We studied 100 perinatal autopsies for CMF. Sensitivity of USG was determined and accuracy of USG with that of autopsy was compared. At Autopsy 134 individual CMF were seen in 40 cases. The sensitivity of USG in detecting major CMF was 54.47%. A complete agreement between autopsy and USG findings was seen in 13/40 (32.5%) and partial agreement in 17/40 (42.5%) fetuses while autopsy completely changed antenatal diagnosis in 10/40 (25%) fetuses. Major findings were added in all 17 fetuses with partial agreement. In 2 cases, CMF suspected on USG were not detected on autopsy due to fetal maceration. Autopsy significantly adds to the prenatal USG diagnosis and may help in predicting the probability of recurrence, and thus counseling the affected couple to prevent any such future event.

[Application of Epigenetics in Perinatal Nursing Care].

Science.gov (United States)

Chou, Hsueh-Fen; Kao, Chien-Huei; Gau, Meei-Ling

2017-04-01

Epigenetics is a field of biomedicine that expanded tremendously during the 1980s. Epigenetics is the study of heritable changes in gene expression independent of underlying DNA (DeoxyriboNucleic Acid) sequence, which not only affect this generation but will be passed to subsequent generations. Although conception is the critical moment for making decisions regarding gene mapping and fetal health, studies have shown that perinatal nursing care practices also affect the genetic remodeling processes and the subsequent health of the mother and her offspring. To optimize maternal-infant and the offspring health, it is important to ensure that the new mother get adequate nutrition, reduce stress levels, adopt gentle birth practices, facilitate exclusive breastfeeding, and avoid contacting toxic substances.

Ultrasonographic and clinical features of fetal cholelithiasis. Three case reports

International Nuclear Information System (INIS)

Agnifili, Alessio; Gola, Piersante; Marino, Maria; Verzaro, Roberto; Carducci, Giuseppe; Mancini, Ermanno; Rizzo, Franz Maria; Carducci, Augusto; Biasini, Giancarlo

1997-01-01

Fetal cholelithiasis was first diagnosed in 1983 and since then there have been only few reports about the presence of gallstones in the fetus. Maternal conditions, fetal or obstetrical predisposing risk factors have been proposed to have a causative role, by the pathogenesis of fetal gallstones remains unknown. Clinical sequelae of fetal gallstones are poorly understood as well as the role of fetal cholelithiasis in predisposing the adult to gallstones. They report on 3 patients whose cholelithiasis was diagnosed by obstetrical ultrasonography. Repeated ultrasound scans were performed in each patient until resolution of the US images. The goal of US was to correctly identify the number, size and US features of the material within the gallbladder. The presence of distal shadowing or comet-tail artifact was assess. Multiple, small echogenic foci without distal shadowing were recognized in the fetal gallbladder in their patients. In the third case echogenic foci disappeared during pregnancy. In all the cases, US showed no biliary tract abnormality, and neither the mothers nor the patients had clinical or laboratory findings consistent with liver or biliary diseases. The authors discuss a diagnostic protocol to detect and follow-up gallstones in the perinatal period by ultrasonography. In their experience, fetal cholelithiasis confirmed to be a self-limiting disease without complications and did not require any form of therapy. However a close follow-up is indicated in these patients until spontaneous resolution is demonstrated by US

Perinatal exposure to the fungicide prochloraz feminizes the male rat offspring

DEFF Research Database (Denmark)

Vinggaard, Anne; Christiansen, Sofie; Laier, Peter

2005-01-01

. Behavioral studies showed that the activity level and sweet preference of adult males were significantly increased. Overall these results strongly indicate that prochloraz feminizes the male offspring after perinatal exposure, and that these effects are due, at least in part, to diminished fetal...... of reproductive organs, affecting androgen-regulated gene expressions, and increasing luteinizing hormone (LH) levels. The purpose of this study was to investigate reproductive toxic effects after exposure during gestation and lactation to prochloraz alone and a mixture of five pesticides (deltamethrin...

Fetal QRS detection and heart rate estimation: a wavelet-based approach

International Nuclear Information System (INIS)

Almeida, Rute; Rocha, Ana Paula; Gonçalves, Hernâni; Bernardes, João

2014-01-01

Fetal heart rate monitoring is used for pregnancy surveillance in obstetric units all over the world but in spite of recent advances in analysis methods, there are still inherent technical limitations that bound its contribution to the improvement of perinatal indicators. In this work, a previously published wavelet transform based QRS detector, validated over standard electrocardiogram (ECG) databases, is adapted to fetal QRS detection over abdominal fetal ECG. Maternal ECG waves were first located using the original detector and afterwards a version with parameters adapted for fetal physiology was applied to detect fetal QRS, excluding signal singularities associated with maternal heartbeats. Single lead (SL) based marks were combined in a single annotator with post processing rules (SLR) from which fetal RR and fetal heart rate (FHR) measures can be computed. Data from PhysioNet with reference fetal QRS locations was considered for validation, with SLR outperforming SL including ICA based detections. The error in estimated FHR using SLR was lower than 20 bpm for more than 80% of the processed files. The median error in 1 min based FHR estimation was 0.13 bpm, with a correlation between reference and estimated FHR of 0.48, which increased to 0.73 when considering only records for which estimated FHR > 110 bpm. This allows us to conclude that the proposed methodology is able to provide a clinically useful estimation of the FHR. (paper)

Simultaneous use of intrapartum fetal pulse oximetry and amnioinfusion in meconium stained amniotic fluid.

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Halvax, László; Szabó, István; Vizer, Miklós; Csermely, Tamás; Ertl, Tibor

2002-09-10

Fetal pulse oximetry is a minimally invasive, simple technique which continuously helps to reflect in utero well-being. The presence of meconium in the amniotic fluid may be a clinical sign of fetal hypoxaemia. Amnioinfusion has a beneficial effect on the incidence of meconium aspiration syndrome (MAS), and the presence of meconium below the level of the vocal cords. We studied the impact of amnioinfusion combined with fetal pulse oximetry on the incidence of meconium aspiration syndrome and operative delivery. The retrospective analysis revealed that the presence of meconium below the level of vocal cords was significantly reduced. The frequency of cesarean section is decreased, however, it did not reach statistical significance. Fetal pulse oximetry may be used in combination with amnioinfusion and cardiotocography (CTG) to reduce the risk of meconium aspiration syndrome and the number of instrumental deliveries and improve perinatal outcome. Copyright 2002 Elsevier Science Ireland Ltd.

Transabdominal amnioinfusion for improving fetal outcomes after oligohydramnios secondary to preterm prelabour rupture of membranes before 26 weeks.

Science.gov (United States)

Van Teeffelen, Stijn; Pajkrt, Eva; Willekes, Christine; Van Kuijk, Sander M J; Mol, Ben Willem J

2013-08-03

Preterm prelabour rupture of membranes (PPROM) before 26 weeks can delay lung development and can cause pulmonary hypoplasia, as a result of oligohydramnios. Restoring the amniotic fluid volume by transabdominal amnioinfusion might prevent abnormal lung development and might have a protective effect for neurological complications, fetal deformities and neonatal sepsis. To assess the effectiveness of transabdominal amnioinfusion in improving perinatal outcome in women with oligohydramnios secondary to rupture of fetal membranes before 26 weeks. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013). All randomised controlled trials comparing transabdominal amnioinfusion with no transabdominal amnioinfusion. Cluster- or quasi-randomised trials were not eligible for inclusion. In cases where only an abstract was available, we attempted to find the full articles. Two review authors assessed trials for inclusion. No eligible trials were identified. There are no included studies. There is currently no evidence to evaluate the use of transabdominal amnioinfusion in women with oligohydramnios secondary to rupture of fetal membranes before 26 weeks for improving perinatal outcome. Further research examining the effects of this intervention is needed. Two randomised controlled trials are ongoing but final data have not yet been published.

Effects of Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) on Fetal Pulmonary Circulation: An Experimental Study in Fetal Lambs.

Science.gov (United States)

Sharma, Dyuti; Aubry, Estelle; Ouk, Thavarak; Houeijeh, Ali; Houfflin-Debarge, Véronique; Besson, Rémi; Deruelle, Philippe; Storme, Laurent

2017-07-16

Background: Persistent pulmonary hypertension of the newborn (PPHN) causes significant morbidity and mortality in neonates. n -3 Poly-unsaturated fatty acids have vasodilatory properties in the perinatal lung. We studied the circulatory effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in fetal sheep and in fetal pulmonary arterial rings. Methods: At 128 days of gestation, catheters were placed surgically in fetal systemic and pulmonary circulation, and a Doppler probe around the left pulmonary artery (LPA). Pulmonary arterial pressure and LPA flow were measured while infusing EPA or DHA for 120 min to the fetus, to compute pulmonary vascular resistance (PVR). The dose effects of EPA or DHA were studied in vascular rings pre-constricted with serotonin. Rings treated with EPA were separated into three groups: E+ (intact endothelium), E- (endothelium stripped) and LNA E+ (pretreatment of E+ rings with l-nitro-arginine). Results: EPA, but not DHA, induced a significant and prolonged 25% drop in PVR ( n = 8, p DHA resulted in only a mild relaxation at the highest concentration of DHA (300 µM) compared to E+. Conclusions: EPA induces a sustained pulmonary vasodilatation in fetal lambs. This effect is endothelium- and dose-dependent and involves nitric oxide (NO) production. We speculate that EPA supplementation may improve pulmonary circulation in clinical conditions with PPHN.

[Fetal programming as a cause of chronic diseases in adult life].

Science.gov (United States)

Seremak-Mrozikiewicz, Agnieszka; Barlik, Magdalena; Drews, Krzysztof

2014-01-01

Long-term adaptive changes occurring in a developing fetus in response to unstable in utero environmental conditions, which appear at a particular time (critical window), are called intrauterine or fetal programming. These adaptive changes are beneficial during the intrauterine period because they adapt the fetus to current needs, but may turn out to be harmful in the end and lead to development of chronic diseases in adult life. Fetal programming means the structural and functional changing of an organism, metabolism and function of some cells, tissues and systems, that occur even despite intrauterine limitations. Events of fetal life influence the determination of physiological patterns which may manifest as disease processes in the adulthood (Barker's hypothesis). Genetic and environmental factors (poor diet in pregnancy chronic intrauterine fetal hypoxia, the effects of xenobiotics and drugs, as well as hormonal disorders) influence the phenotype of a newborn and are involved in the intrauterine programming process. The effects of fetal programming may be passed along to the next generations via not fully understood pathways, which probably include epigenetic mechanisms. Most of the mechanisms underlying this process remain unclear and need to be elucidated.

Perinatal Changes of Cardiac Troponin-I in Normal and Intrauterine Growth-Restricted Pregnancies

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Nicoletta Iacovidou

2007-01-01

Full Text Available Intrauterine growth restriction (IUGR implies fetal hypoxia, resulting in blood flow redistribution and sparing of vital organs (brain, heart. Serum cardiac Troponin-I (cTnI, a well-established marker of myocardial ischaemia, was measured in 40 mothers prior to delivery, the doubly clamped umbilical cords (representing fetal state, and their 20 IUGR and 20 appropriate-for-gestational-age (AGA neonates on day 1 and 4 postpartum. At all time points, no differences in cTnI levels were observed between the AGA and IUGR groups. Strong positive correlations were documented between maternal and fetal/neonatal values (r≥.498, P≤.025 in all cases in the AGA and r≥.615, P≤.009 in all cases in the IUGR group. These results may indicate (a normal heart function, due to heart sparing, in the IUGR group (b potential crossing of the placental barrier by cTnI in both groups

Relevance of labor room fetal autopsy in increasing its acceptance.

Science.gov (United States)

Kumar, Manisha; Singh, Abha; Gupta, Usha; Anand, Rama; Thakur, Seema

2015-02-01

Fetal autopsy is included in the basic protocol of investigating a perinatal death, parental refusal is the main reason for its low rate. To increase acceptance of fetal autopsy and to provide better counselling to the couple regarding risk of recurrence in future pregnancies. All cases with antenatally diagnosed congenital anomaly resulting in stillbirth or termination before 20 weeks were offered fetal autopsy and it was performed in labor room itself by the fetal medicine specialist after consents. External and internal examination, photograph, infantogram and karyotyping were done, and relevant tissue was sent for histopathology. Correlation between the ultrasound and autopsy finding was done. Total 674 cases of antenatally detected major congenital anomaly were included in the study. Out of 403 cases of stillbirth and abortion, consent for autopsy was given in 312. Most common defect was cranio-vertebral defect followed by genitourinary anomaly. The autopsy finding correlated with USG findings fully in 63.5% cases, there were additional findings altering diagnosis in 24.7% cases, the diagnosis completely changed in 11.8% cases. Autopsy if done in labor room increases its acceptance by the couple. Additional findings on autopsy helped in reaching at diagnosis and counseling accordingly.

Diagnóstico precoce da restrição do crescimento fetal pela estimativa ultra-sonográfica do peso fetal Early diagnosis of intra-uterine growth restriction by ultrasonographic estimation of fetal weight

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Maria Marta Martins

2005-02-01

Full Text Available OBJETIVOS: Com a finalidade da atuação pré-natal oportuna e diminuição da morbiletalidade perinatal e tardia, este estudo se propôs a avaliar a evolução do peso fetal determinado pela ecografia entre a 25ª e 27ª semanas de gestação, estabelecer valores de corte de peso fetal úteis no diagnóstico do pequeno para esta época da gestação e propor modelo matemático para reconhecer a probabilidade de ocorrência de recém-nascido pequeno para a idade gestacional (PIG. MÉTODOS: Avaliaram-se 85 recém-nascidos, 35 pequenos e 50 adequados para a idade gestacional (AIG. As mães haviam feito o pré-natal no serviço, eram hígidas ou apresentavam hipertensão arterial crônica como única doença, sem história de vícios, fetos gemelares ou malformados. Todas realizaram exames ultra-sonográficos na 25ª e 27ª semanas para cálculo do peso fetal. RESULTADOS: O ganho de peso ecográfico fetal entre a 25ª e a 27ª semanas de gestação foi menor no grupo PIG havendo desaceleração do crescimento em relação ao grupo AIG. Os valores de corte de pesos ecográficos fetais foram de 775 gramas e 1015 gramas para a 25ª e 27ª semanas, respectivamente Obteve-se modelo matemático útil para quantificar a probabilidade de crescimento intra-uterino inadequado.OBJECTIVE: Aiming to reduce the perinatal and late morbidity and lethality through opportune prenatal intervention, this study proposed to sequentially evaluate the echographic fetal weight at the 25th and 27th weeks of gestation, establishing cut-off values for echographic fetal weight useful in the diagnosis of small-for-gestational-age at this gestation time, and developing a mathematical model able to recognize the probability of a newborn small-for- gestational-age. METHODS: Eighty-five newborns were evaluated, 35 small and 50 adequate for gestational age. The mothers who underwent prenatal care at our Instituition were healthy or presented chronic arterial hypertension as the only

A neonatal mouse model of intermittent hypoxia associated with features of apnea in premature infants.

Science.gov (United States)

Cai, Jun; Tuong, Chi Minh; Gozal, David

2011-09-15

A neonatal mouse model of intermittent hypoxia (IH) simulating the recurring hypoxia/reoxygenation episodes of apnea of prematurity (AOP) was developed. C57BL/6 P2 pups were culled for exposure to either intermittent hypoxia or intermittent air as control. The IH paradigms consisted of alternation cycles of 20.9% O2 and either 8.0% or 5.7% O2 every 120 or 140s for 6h a day during daylight hours from day 2 to day 10 postnatally, i.e., roughly equivalent to human brain development in the perinatal period. IH exposures elicited modest to severe decrease in oxygen saturation along with bradycardia in neonatal mice, which were severity-dependent. Hypomyelination in both central and peripheral nervous systems was observed despite the absence of visible growth retardation. The neonatal mouse model of IH in this study partially fulfills the current diagnostic criteria with features of AOP, and provides opportunities to reproduce in rodents some of the pathophysiological changes associated with this disorder, such as alterations in myelination. Copyright © 2011 Elsevier B.V. All rights reserved.

Performance of third-trimester combined screening model for prediction of adverse perinatal outcome.

Science.gov (United States)

Miranda, J; Triunfo, S; Rodriguez-Lopez, M; Sairanen, M; Kouru, H; Parra-Saavedra, M; Crovetto, F; Figueras, F; Crispi, F; Gratacós, E

2017-09-01

To explore the potential value of third-trimester combined screening for the prediction of adverse perinatal outcome (APO) in the general population and among small-for-gestational-age (SGA) fetuses. This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester evaluation (32 + 0 to 36 + 6 weeks' gestation). Maternal baseline characteristics, mean arterial blood pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently had an APO (n = 148) and in a control group without perinatal complications (n = 902). APO was defined as the occurrence of stillbirth, umbilical artery cord blood pH < 7.15, 5-min Apgar score < 7 or emergency operative delivery for fetal distress. Logistic regression models were developed for the prediction of APO in the general population and among SGA cases (defined as customized birth weight < 10 th centile). The prevalence of APO was 9.3% in the general population and 27.4% among SGA cases. In the general population, a combined screening model including a-priori risk (maternal characteristics), estimated fetal weight (EFW) centile, umbilical artery pulsatility index (UA-PI), estriol and PlGF achieved a detection rate for APO of 26% (area under receiver-operating characteristics curve (AUC), 0.59 (95% CI, 0.54-0.65)), at a 10% false-positive rate (FPR). Among SGA cases, a model including a-priori risk, EFW centile, UA-PI, cerebroplacental ratio, estriol and PlGF predicted 62% of APO (AUC, 0.86 (95% CI, 0.80-0.92)) at a FPR of 10%. The use of fetal ultrasound and maternal biochemical markers at 32-36 weeks provides a poor prediction of APO in the general population. Although it remains limited, the performance of the screening model is improved when applied to fetuses with suboptimal fetal growth. Copyright © 2016 ISUOG. Published by John Wiley & Sons

Mitochondria, Bioenergetics and Excitotoxicity: New Therapeutic Targets in Perinatal Brain Injury

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Bryan Leaw

2017-07-01

Full Text Available Injury to the fragile immature brain is implicated in the manifestation of long-term neurological disorders, including childhood disability such as cerebral palsy, learning disability and behavioral disorders. Advancements in perinatal practice and improved care mean the majority of infants suffering from perinatal brain injury will survive, with many subtle clinical symptoms going undiagnosed until later in life. Hypoxic-ischemia is the dominant cause of perinatal brain injury, and constitutes a significant socioeconomic burden to both developed and developing countries. Therapeutic hypothermia is the sole validated clinical intervention to perinatal asphyxia; however it is not always neuroprotective and its utility is limited to developed countries. There is an urgent need to better understand the molecular pathways underlying hypoxic-ischemic injury to identify new therapeutic targets in such a small but critical therapeutic window. Mitochondria are highly implicated following ischemic injury due to their roles as the powerhouse and main energy generators of the cell, as well as cell death processes. While the link between impaired mitochondrial bioenergetics and secondary energy failure following loss of high-energy phosphates is well established after hypoxia-ischemia (HI, there is emerging evidence that the roles of mitochondria in disease extend far beyond this. Indeed, mitochondrial turnover, including processes such as mitochondrial biogenesis, fusion, fission and mitophagy, affect recovery of neurons after injury and mitochondria are involved in the regulation of the innate immune response to inflammation. This review article will explore these mitochondrial pathways, and finally will summarize past and current efforts in targeting these pathways after hypoxic-ischemic injury, as a means of identifying new avenues for clinical intervention.

Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications

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Junichi Hasegawa

2006-03-01

Full Text Available In the maternal and child health statistics of Japan for 2003, perinatal deaths were most frequent in pregnant women with abnormalities of the placenta, umbilical cord, and fetal membrane. Despite advances in perinatal medicine, approximately 2% of low-risk pregnant women still require an emergency cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. In our previous studies, some abnormalities of the placenta and umbilical cord were associated with abnormalities of cord insertion. Furthermore, we reported that prenatal detection of velamentous cord insertion (VCI reduced the number of emergency cesarean sections in low-risk women. In this review, we describe the prenatal detection of abnormalities of umbilical cord insertion and the management of VCI based on our current clinical data.

Acute behavioral effects of intrapleural OK-432 (Picibanil) administration in preterm fetal sheep.

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Cowie, Rosalind V; Stone, Peter R; Parry, Emma; Jensen, Ellen C; Gunn, Alistair J; Bennet, Laura

2009-01-01

To develop a model to study the fetal effects of intrapleural infusion of OK-432 (Picibanil), a pleurodesis agent derived from killed Gram-positive streptococci. OK-432 (0.1 mg, n = 5), or normal saline (n = 5) were infused over 20 min into the pleural space of chronically instrumented preterm fetal sheep at 0.7 gestation. Fetal physiological parameters, including breathing and nuchal activity were monitored in utero from 6 h before infusion until 12 h afterward, and fetuses were killed after 7 days recovery. OK-432 was associated with transient suppression of fetal EEG activity, breathing and body movements from 3-6 h after infusion. Hypotension and hypoxia did not occur. At postmortem, local pleural adhesions were seen around the site of OK-432 infusion but not in saline treated fetuses. Intrapleural administration of OK-432 is associated with marked but transient fetal behavioral effects. This model will enable preclinical investigation of the neural and cardiovascular safety of OK-432 at a clinical relevant stage of development. Copyright 2009 S. Karger AG, Basel.

MR appearance of neonatal and fetal intervertebral disks

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Ho, P.S.P.; Yu, S.; Lynch, K.L.; Ho, K.C.; Haughton, V.M.

1987-01-01

The infant spine has a different MR appearance than the adult spine. The authors used MR and cryomicrotomy to study the spines of stillborn fetuses and infants during in the perinatal period. In the fetal spine, Sharpey fibers are incompletely developed, the nucleus and anulus are more distinctly differentiated, the nucleus contains a transverse structure not seen in the adult, notochordal cells are more prominent, and the vertebral bodies and neural arches are incompletely ossified. The spinal landmarks and their MR appearances will be illustrated. Variations, such as calcification of the nucleus pulposus, are illustrated

Fetal programming of the human brain: is there a link with insurgence of neurodegenerative disorders in adulthood?

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Faa, G; Marcialis, M A; Ravarino, A; Piras, M; Pintus, M C; Fanos, V

2014-01-01

In recent years, evidence is growing on the role played by gestational factors in shaping brain development and on the influence of intrauterine experiences on later development of neurodegenerative diseases including Parkinson's (PD) and Alzheimer's disease (AD). The nine months of intrauterine development and the first three years of postnatal life are appearing to be extremely critical for making connections among neurons and among neuronal and glial cells that will shape a lifetime of experience. Here, the multiple epigenetic factors acting during gestation - including maternal diet, malnutrition, stress, hypertension, maternal diabetes, fetal hypoxia, prematurity, low birth weight, prenatal infection, intrauterine growth restriction, drugs administered to the mother or to the baby - are reported, and their ability to modulate brain development, resulting in interindividual variability in the total neuronal and glial burden at birth is discussed. Data from recent literature suggest that prevention of neurodegeneration should be identified as the one method to halt the diffusion of neurodegenerative diseases. The "two hits" hypothesis, first introduced for PD and successfully applied to AD and other neurodegenerative human pathologies, should focus our attention on a peculiar period of our life: the intrauterine and perinatal periods. The first hit to our nervous system occurs early in life, determining a PD or AD imprinting to our brain that will condition our resistance or, alternatively, our susceptibility to develop a neurodegenerative disease later in life. In conclusion, how early life events contribute to late-life development of adult neurodegenerative diseases, including PD and AD, is emerging as a new fascinating research focus. This assumption implies that research on prevention of neurodegenerative diseases should center on events taking place early in life, during gestation and in the perinatal periods, thus presenting a new challenge to

Hidropesía fetal en una gestante con enfermedad hipertensiva grave. Presentación de un caso

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Maribel Rodríguez Matos

2013-09-01

Full Text Available La hidropesía fetal es un grave proceso de elevada mortalidad perinatal, de etiología multifactorial, caracterizado por un síndrome edematoso generalizado, con o sin acumulación de líquido en las cavidades serosas del organismo fetal. Se presenta un caso de hidropesía fetal no inmunológica en una paciente de sexo femenino, de color de piel blanca y de 20 años de edad con enfermedad hipertensiva grave, diagnosticada mediante ultrasonido, como estudio de bienestar fetal a las 35,1 semanas de gestación, cuando fue remitida desde su área de salud por presentar cifras de tensión arterial de 160/100 mmHg. A su llegada al cuerpo de guardia de ginecobstetricia del hospital Héroes del Baire de la Isla de la Juventud se constataron cifras de 140/90 mmHg, se presentaba asintomática, por lo que se ingresó para estudio y tratamiento. Teniendo en cuenta el examen físico y el resultado del ultrasonido obstétrico, se decidió la interrupción de embarazo por cesárea de urgencia. Se recibió un recién nacido pretérmino de aspecto malformado. Se decide la presentación del caso por lo poco común de esta patología asociada a una enfermedad hipertensiva grave lo que incrementa el riesgo perinatal.

Intrauterine intravascular transfusion for fetal haemolytic anaemia: the Western Australian experience.

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Newnham, J P; Phillips, J M; Stock, R

1992-11-16

To report the first four years' clinical experience with fetal intravascular blood transfusion for the treatment of fetal haemolytic anaemia in Western Australia. King Edward Memorial Hospital, Perth, which is the sole tertiary level perinatal centre in Western Australia with a referral base of approximately 25,000 pregnancies each year. Transfusion was by injection of packed cells from Rh-negative donors into the fetal umbilical vein near the site of insertion into the placenta. Fetal haemoglobin levels were measured before and after each transfusion. In most cases, the fetus was paralysed by intramuscular tubocurarine. Sixty intravenous transfusions were performed in 20 pregnancies. At the time of the initial transfusion, the mean haemoglobin level was 5.8 g/dL (range, 2.5-8.5 g/dL) and six fetuses had signs of hydrops. The case survival rate was 80% and the procedure survival rate was 93%. Three of the deaths occurred in the first five cases. Caesarean section was performed during two of the procedures, one because of bleeding from the cord puncture site and one because of tamponade of the umbilical vessels. Fetal intravascular transfusion is a highly effective treatment for fetal alloimmunisation and allows pregnancies to continue to term and to be delivered vaginally. However, the procedure may be difficult and requires a team approach with ready access to fetal monitoring and emergency caesarean section. Our results suggest that increasing experience of the team is a major factor in improved outcome.

Localised proton magnetic resonance spectroscopy of the brain after perinatal hypoxia: a preliminary report

International Nuclear Information System (INIS)

Chateil, J.F.; Quesson, B.; Thiaudiere, E.; Delalande, C.; Canioni, P.; Brun, M.; Diard, F.; Sarlangue, J.; Billeaud, C.

1999-01-01

Objectives. Perinatal hypoxic ischaemic injury is a significant cause of neurodevelopmental impairment. The aim of this study was to evaluate localised proton magnetic resonance spectroscopy ( 1 H-MRS) after birth asphyxia. Materials and methods. Thirty newborn infants suspected of having perinatal asphyxia (Apgar score 1 H-MRS was recorded in a single voxel, localised in white matter, using a STEAM sequence. Results. Image quality was good in 25 of 30 babies. 1 H-MRS was performed in 19 of 30 subjects, with adequate quality in 16. Choline, creatine/phosphocreatine and N-acetylaspartate peaks and peak-area ratios were analysed. Lactate was detected in four infants. The N-acetylaspartate/choline ratio was lower in infants with an impaired neurological outcome, but the difference was not statistically significant. Conclusions. This study suggests that 1 H-MRS may be useful for assessing cerebral metabolism in the neonate. A raised lactate level and decreased N-acetylaspartate/choline ratio may be predictive of a poor outcome. However, in our experience this method is limited by the difficulty in performing the examination during the first hours after birth in critically ill babies, the problems related to use of a monovoxel sequence, the dispersion of the ratios and the lack of determination of the absolute concentration of the metabolites. (orig.)

Acute and Chronic Fetal Anemia as a Result of Fetomaternal Hemorrhage

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Paul Singh

2014-01-01

Full Text Available Introduction. Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management. Case. A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal anemia such as right ventricular enlargement, diminished cerebral vascular resistance, and elevated middle cerebral artery end-diastolic velocity. On the other hand, signs of acute fetal decompensation such as deterioration of the fetal heart tracing, diminished biophysical score, decreased cord pH, and increased cord base deficit were noted. Following delivery, the neonate’s initial hemoglobin was 4.0 g/dL and the maternal KB ratio was 0.015 indicative of a significant fetomaternal hemorrhage. Discussion. One should consider FMH as part of the differential diagnosis for fetal or immediate neonatal anemia. We describe a unique case of FMH that demonstrated both acute and chronic clinical features. It is our hope that this case will assist practitioners in differentiating acute FMH that may require emergent delivery from chronic FMH which may be able to be expectantly managed.

Acute and chronic fetal anemia as a result of fetomaternal hemorrhage.

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Singh, Paul; Swanson, Tara

2014-01-01

Introduction. Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management. Case. A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal anemia such as right ventricular enlargement, diminished cerebral vascular resistance, and elevated middle cerebral artery end-diastolic velocity. On the other hand, signs of acute fetal decompensation such as deterioration of the fetal heart tracing, diminished biophysical score, decreased cord pH, and increased cord base deficit were noted. Following delivery, the neonate's initial hemoglobin was 4.0 g/dL and the maternal KB ratio was 0.015 indicative of a significant fetomaternal hemorrhage. Discussion. One should consider FMH as part of the differential diagnosis for fetal or immediate neonatal anemia. We describe a unique case of FMH that demonstrated both acute and chronic clinical features. It is our hope that this case will assist practitioners in differentiating acute FMH that may require emergent delivery from chronic FMH which may be able to be expectantly managed.

First and second trimester screening for fetal structural anomalies.

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Edwards, Lindsay; Hui, Lisa

2018-04-01

Fetal structural anomalies are found in up to 3% of all pregnancies and ultrasound-based screening has been an integral part of routine prenatal care for decades. The prenatal detection of fetal anomalies allows for optimal perinatal management, providing expectant parents with opportunities for additional imaging, genetic testing, and the provision of information regarding prognosis and management options. Approximately one-half of all major structural anomalies can now be detected in the first trimester, including acrania/anencephaly, abdominal wall defects, holoprosencephaly and cystic hygromata. Due to the ongoing development of some organ systems however, some anomalies will not be evident until later in the pregnancy. To this extent, the second trimester anatomy is recommended by professional societies as the standard investigation for the detection of fetal structural anomalies. The reported detection rates of structural anomalies vary according to the organ system being examined, and are also dependent upon factors such as the equipment settings and sonographer experience. Technological advances over the past two decades continue to support the role of ultrasound as the primary imaging modality in pregnancy, and the safety of ultrasound for the developing fetus is well established. With increasing capabilities and experience, detailed examination of the central nervous system and cardiovascular system is possible, with dedicated examinations such as the fetal neurosonogram and the fetal echocardiogram now widely performed in tertiary centers. Magnetic resonance imaging (MRI) is well recognized for its role in the assessment of fetal brain anomalies; other potential indications for fetal MRI include lung volume measurement (in cases of congenital diaphragmatic hernia), and pre-surgical planning prior to fetal spina bifida repair. When a major structural abnormality is detected prenatally, genetic testing with chromosomal microarray is recommended over

Disrupted PI3K p110δ Signaling Dysregulates Maternal Immune Cells and Increases Fetal Mortality In Mice

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Jens Kieckbusch

2015-12-01

Full Text Available Maternal immune cells are an integral part of reproduction, but how they might cause pregnancy complications remains elusive. Macrophages and their dual function in inflammation and tissue repair are thought to play key yet undefined roles. Altered perinatal growth underpins adult morbidity, and natural killer (NK cells may sustain fetal growth by establishing the placental blood supply. Using a mouse model of genetic inactivation of PI3K p110δ, a key intracellular signaling molecule in leukocytes, we show that p110δ regulates macrophage dynamics and NK-cell-mediated arterial remodeling. The uterus of dams with inactive p110δ had decreased IFN-γ and MHC class IIlow macrophages but enhanced IL-6. Poor vascular remodeling and a pro-inflammatory uterine milieu resulted in fetal death or growth retardation. Our results provide one mechanism that explains how imbalanced adaptations of maternal innate immune cells to gestation affect offspring well-being with consequence perinatally and possibly into adulthood.

Intrauterine Intervention for the Treatment of Fetal Growth Restriction.

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Spiroski, A-M; Oliver, M H; Harding, J E; Bloomfield, F H

2016-01-01

Fetal growth restriction (FGR) is associated with an increased incidence of fetal and neonatal death, and of neonatal morbidity. Babies born following FGR also are at risk of a range of postnatal complications, which may contribute to an increased incidence of disease later in life. There currently are no effective clinical interventions which improve perinatal survival, intrauterine growth and later outcomes of the FGR baby. Postnatal interventions aimed at promoting or accelerating growth in FGR babies to improve outcome, particularly neurodevelopmental outcomes, may further increase the risk of metabolic dysregulation and, therefore, the risk of developing chronic disease in adulthood. An intrauterine intervention to improve nutrition and growth in the FGR fetus may have the potential to decrease mortality and improve long-term outcomes by delaying preterm delivery and mitigating the need for and risks of accelerated postnatal growth.

Early neonatal deaths associated with perinatal asphyxia in infants ≥2500 g in Brazil,

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Maria Fernanda Branco de Almeida

Full Text Available Abstract Objective: To assess the annual burden of early neonatal deaths associated with perinatal asphyxia in infants weighing ≥2500 g in Brazil from 2005 to 2010. Methods: The population study enrolled all live births of infants with birth weight ≥2500 g and without malformations who died up to six days after birth with perinatal asphyxia, defined as intrauterine hypoxia, asphyxia at birth, or meconium aspiration syndrome. The cause of death was written in any field of the death certificate, according to International Classification of Diseases,10th Revision (P20.0, P21.0, and P24.0. An active search was performed in 27 Brazilian federative units. The chi-squared test for trend was applied to analyze early neonatal mortality ratios associated with perinatal asphyxia by study year. Results: A total of 10,675 infants weighing ≥2500 g without malformations died within six days after birth with perinatal asphyxia. Deaths occurred in the first 24 h after birth in 71% of the infants. Meconium aspiration syndrome was reported in 4076 (38% of these deaths. The asphyxia-specific early neonatal mortality ratio decreased from 0.81 in 2005 to 0.65 per 1000 live births in 2010 in Brazil (p < 0.001; the meconium aspiration syndrome-specific early neonatal mortality ratio remained between 0.20 and 0.29 per 1000 live births during the study period. Conclusions: Despite the decreasing rates in Brazil from 2005 to 2010, early neonatal mortality rates associated with perinatal asphyxia in infants in the better spectrum of birth weight and without congenital malformations are still high, and meconium aspiration syndrome plays a major role.

Immunity peculiarities of neonates in case of perinatal pathology

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О. S. Godovanets

2018-02-01

Full Text Available The immune system as one of the regulating systems of the body determined peculiarities of child adaptation after birth stipulating physiology of adaptation or perinatal pathology formation. Objective: to study peculiarities of immunological indices in case of neonates’ perinatal pathology to detect their role in pathogenesis and formation of diseases severity. Materials and methods. The group of term infants with clinical signs of perinatal pathology (173 individuals was examined. They were divided into two groups: group A included those with diagnosed severe forms of diseases (121 individuals, and group B included 52 infants with general moderate severity of perinatal pathology. The group of comparison included 82 newborns without substantial adaptive deviations after birth. IL1 and IL6 levels were examined by means of immunofluorescence method “Clonospectr” using the reagents produced by “ProCon”. Absolute and relative amount of СD2+-associated Т and NK-lymphocytes, СD14+-associated monocytes, СD15+-associated neutrophils, СD19+-associated В-lymphocytes and СD54+-associated ІСАМ-1 cells were determined by means of immunofluorescence method “Status” using the set of monoclonal and polyclonal antibodies produced by “Sorbent”. The data obtained were statistically processed with the application of applied programs package used for medical-biological studies “Statgraphics Centurion XVI.I” [2011] on the personal computer Pentium MMX CPU. Results. The results obtained were indicative of considerable changes in the immune system indices in newborns under conditions of birth stress and hypoxia. It has been found that a term newborn has a special different from that of adults biologically mediated state of immune system, that can determine both the development of physiological adaptation and under certain circumstances excessive reactions of systemic inflammation, autoimmune processes and destruction of tissues. One

Improving Perinatal Care in the Rural Regions Worldwide by Wireless Enabled Antepartum Fetal Monitoring: A Demonstration Project

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Roberto Tapia-Conyer

2015-01-01

Full Text Available Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27–29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n=74 or usual standard-of-care (n=79. Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%. Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.

Improving Perinatal Care in the Rural Regions Worldwide by Wireless Enabled Antepartum Fetal Monitoring: A Demonstration Project

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Tapia-Conyer, Roberto; Lyford, Shelley; Saucedo, Rodrigo; Casale, Michael; Gallardo, Hector; Becerra, Karen; Mack, Jonathan; Mujica, Ricardo; Estrada, Daniel; Sanchez, Antonio; Sabido, Ramon; Meier, Carlos; Smith, Joseph

2015-01-01

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27–29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services. PMID:25691900

The value of umbilical blood 2,3 diphosphoglycerate levels in the diagnosis of chronic fetal hypoxia.

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Zapadlo, M; Böswart, J; Petová, J; Hosková, K

1990-01-01

The authors assessed the levels of lactate and 2,3 diphosphoglycerate in the umbilical blood of 105 full-term neonates. A significant increase was found in the levels of 2,3 diphosphoglycerate in newborns of mothers with a history of imminent chronic intrauterine hypoxia. The lactate levels of these newborns were the same as in children of mothers without a history showing a risk of intrauterine hypoxia. The psychomotor development of newborns with increased levels of 2,3 diphosphoglycerate was significantly more altered than in those with normal levels in their first year of life.

Perinatal survival of a fetus with intestinal volvulus and intussusception: a case report and review of the literature.

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Ohuoba, Esohe; Fruhman, Gary; Olutoye, Oluyinka; Zacharias, Nikolaos

2013-10-01

Fetal intestinal volvulus is a rare life-threatening condition. Late diagnosis of volvulus contributes to high rate of morbidity and mortality. It has variable degrees of presentation and survival. Intrauterine volvulus may be complicated by intestinal atresia due to ischemic necrosis. To our knowledge, there are three reported cases of term fetal demise. We report a case of fetal intestinal volvulus with perinatal survival of the largest term infant described with this complication to date. The volvulus was associated with type 3A jejunal atresia and intestinal pathology was noted on prenatal ultrasound. The infant was born via urgent cesarean delivery at 37(6/7) weeks of gestation and underwent emergent exploratory laparotomy with resection of small bowel and primary end-to-end anastomosis. Intrauterine intestinal volvulus may be suspected on prenatal ultrasound but only definitively diagnosed postnatally. Signs of fetal distress and volvulus are rarely associated with reports of survival in the term fetus. We review reported cases of prenatally suspected volvulus in infants documented to survive past the neonatal period. As fetal volvulus and most intestinal atresias/stenoses manifest during the third trimester, we recommend that the limited fetal anatomical survey during growth ultrasounds at 32 to 36 weeks routinely include an assessment of the fetal bowel.

Metabolomics reveals metabolic alterations by intrauterine growth restriction in the fetal rabbit brain.

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Erwin van Vliet

Full Text Available Intrauterine Growth Restriction (IUGR due to placental insufficiency occurs in 5-10% of pregnancies and is a major risk factor for abnormal neurodevelopment. The perinatal diagnosis of IUGR related abnormal neurodevelopment represents a major challenge in fetal medicine. The development of clinical biomarkers is considered a promising approach, but requires the identification of biochemical/molecular alterations by IUGR in the fetal brain. This targeted metabolomics study in a rabbit IUGR model aimed to obtain mechanistic insight into the effects of IUGR on the fetal brain and identify metabolite candidates for biomarker development.At gestation day 25, IUGR was induced in two New Zealand rabbits by 40-50% uteroplacental vessel ligation in one horn and the contralateral horn was used as control. At day 30, fetuses were delivered by Cesarian section, weighed and brains collected for metabolomics analysis. Results showed that IUGR fetuses had a significantly lower birth and brain weight compared to controls. Metabolomics analysis using liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF-MS and database matching identified 78 metabolites. Comparison of metabolite intensities using a t-test demonstrated that 18 metabolites were significantly different between control and IUGR brain tissue, including neurotransmitters/peptides, amino acids, fatty acids, energy metabolism intermediates and oxidative stress metabolites. Principle component and hierarchical cluster analysis showed cluster formations that clearly separated control from IUGR brain tissue samples, revealing the potential to develop predictive biomarkers. Moreover birth weight and metabolite intensity correlations indicated that the extent of alterations was dependent on the severity of IUGR.IUGR leads to metabolic alterations in the fetal rabbit brain, involving neuronal viability, energy metabolism, amino acid levels, fatty acid profiles and oxidative stress

Antenatal maternal long-term hypoxia: acclimatization responses with altered gene expression in ovine fetal carotid arteries.

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Ravi Goyal

Full Text Available In humans and other species, long-term hypoxia (LTH during pregnancy can lead to intrauterine growth restriction with reduced body/brain weight, dysregulation of cerebral blood flow (CBF, and other problems. To identify the signal transduction pathways and critical molecules, which may be involved in acclimatization to high altitude LTH, we conducted microarray with advanced bioinformatic analysis on carotid arteries (CA from the normoxic near-term ovine fetus at sea-level and those acclimatized to high altitude for 110+ days during gestation. In response to LTH acclimatization, in fetal CA we identified mRNA from 38 genes upregulated >2 fold (P2-fold (P<0.05. The major genes with upregulated mRNA were SLC1A3, Insulin-like growth factor (IGF binding protein 3, IGF type 2 receptor, transforming growth factor (TGF Beta-3, and genes involved in the AKT and BCL2 signal transduction networks. Most genes with upregulated mRNA have a common motif for Pbx/Knotted homeobox in the promoter region, and Sox family binding sites in the 3' un translated region (UTR. Genes with downregulated mRNA included those involved in the P53 pathway and 5-lipoxygenase activating proteins. The promoter region of all genes with downregulated mRNA, had a common 49 bp region with a binding site for DOT6 and TOD6, components of the RPD3 histone deacetylase complex RPD3C(L. We also identified miRNA complementary to a number of the altered genes. Thus, the present study identified molecules in the ovine fetus, which may play a role in the acclimatization response to high-altitude associated LTH.

Perinatal development and adult blood pressure

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N. Ashton

2000-07-01

Full Text Available A growing body of evidence supports the concept of fetal programming in cardiovascular disease in man, which asserts that an insult experienced in utero exerts a long-term influence on cardiovascular function, leading to disease in adulthood. However, this hypothesis is not universally accepted, hence animal models may be of value in determining potential physiological mechanisms which could explain how fetal undernutrition results in cardiovascular disease in later life. This review describes two major animal models of cardiovascular programming, the in utero protein-restricted rat and the cross-fostered spontaneously hypertensive rat. In the former model, moderate maternal protein restriction during pregnancy induces an increase in offspring blood pressure of 20-30 mmHg. This hypertensive effect is mediated, in part, by fetal exposure to excess maternal glucocorticoids as a result of a deficiency in placental 11-ß hydroxysteroid dehydrogenase type 2. Furthermore, nephrogenesis is impaired in this model which, coupled with increased activity of the renin-angiotensin system, could also contribute to the greater blood pressure displayed by these animals. The second model discussed is the cross-fostered spontaneously hypertensive rat. Spontaneously hypertensive rats develop severe hypertension without external intervention; however, their adult blood pressure may be lowered by 20-30 mmHg by cross-fostering pups to a normotensive dam within the first two weeks of lactation. The mechanisms responsible for this antihypertensive effect are less clear, but may also involve altered renal function and down-regulation of the renin-angiotensin system. These two models clearly show that adult blood pressure is influenced by exposure to one of a number of stimuli during critical stages of perinatal development.

Fetal heart rate patterns at 20 to 24 weeks gestation as recorded by fetal electrocardiography

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Hofmeyr, F; Groenewald, CA; Nel, DG; Myers, MM; Fifer, WP; Signore, C; Hankins, GDV; Odendaal, HJ

2014-01-01

Introduction With advancing technology it has become possible to accurately record and assess fetal heart rate (FHR) patterns from gestations as early as 20 weeks. The aim of our study was to describe early patterns of FHR, as recorded by transabdominal fetal electrocardiogram according to the Dawes-Redman criteria. Accordingly, short-term variability, basal heart rate, accelerations and decelerations were quantified at 20-24 weeks gestation among women with uncomplicated pregnancies. Methods This study was conducted in a subset of participants enrolled in a large prospective pregnancy cohort study. Our final data set consisted of 281 recordings of women with good perinatal outcomes that had undergone fetal electrocardiographic assessment as part of the Safe Passage Study. Results The success rate of the recordings was 95.4%. The mean frequency of small and large accelerations was 0.5 and 0.1 per 10 minutes respectively and that of small and large decelerations 0.3 and 0.008 per 10 minutes respectively. The mean and basal heart rates were both equal to 148.0 bpm at a median gestation of 161 days. The mean short term variation was 6.2 (SD 1.4) milliseconds and mean minute range 35.1 (SD 7.1) milliseconds. Conclusion The 20 to 24 week fetus demonstrates FHR patterns with more accelerations and decelerations, as well as higher baseline variability than was anticipated. Information from this study provides an important foundation for further, more detailed, studies of early FHR patterns. PMID:23991757

Inactivation of Stac3 causes skeletal muscle defects and perinatal death in mice

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Reinholt, Brad Michael

2012-01-01

The Src homology 3 domain (SH3) and cysteine rich domain (C1) 3 (Stac3) gene is a novel gene copiously expressed in skeletal muscle. The objective of this research was to determine the role of Stac3 in development, specifically in skeletal muscle. We achieved this objective by evaluating the phenotypic effects of Stac3 gene inactivation on development in mice. At birth homozygous Stac3 null (Stac3-/-) mice died perinatally and remained in fetal position with limp limbs, but possessed otherwis...

From head to heart; : the effects of fetal growth restriction and preterm birth on the cerebral and systemic circulation

NARCIS (Netherlands)

Cohen, Emily

2017-01-01

Fetal growth restriction (FGR) is the condition where a fetus does not grow according to its genetic growth potential. It is estimated that 3-7% of pregnancies are complicated by FGR. FGR has been associated with many adverse outcomes, including an increased risk of perinatal and neonatal morbidity

Comparative analysis of perinatal outcome of spontaneous pregnancy reduction and multifetal pregnancy reduction in triplet pregnancies conceived after assisted reproductive technique

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Shilpa Bhandari

2016-01-01

Full Text Available INTRODUCTION: With the advent of assisted reproductive treatment options, the incidence of multiple pregnancies has increased. Although the need for elective single embryo transfer is emphasized time and again, its uniform applicability in practice is yet a distant goal. In view of the fact that triplet and higher order pregnancies are associated with significant fetomaternal complications, the fetal reduction is a commonly used option in such cases. This retrospective study aims to compare the perinatal outcome in patients with triplet gestation who have undergone spontaneous fetal reduction (SFR as against those in whom multifetal pregnancy reduction (MFPR was done. MATERIALS AND METHODS: In the present study, eighty patients with triplet gestation at 6 weeks were considered. The patients underwent SFR or MFPR at or before 12-13 weeks and were divided into two groups (34 and 46, respectively. RESULTS: Our study found no statistical difference in perinatal outcome between the SFR and MFPR groups in terms of average gestational age at delivery, abortion rate, preterm delivery rate, and birth weight. The study shows that the risk of aborting all fetuses after SFR is three times (odds ratio [OR] = 3.600, 95% confidence interval [CI] = 0.2794-46.388 that of MFPR in subsequent 2 weeks. There were more chances of loss of extra fetus in SFR (23.5% group than MFPR group (8.7% (OR = 3.889, 95% CI = 1.030-14.680. As neither group offers any significant benefit from preterm delivery, multiple pregnancies continue to be responsible for preterm delivery despite fetal reduction. CONCLUSION: There appears to be some advantages of MFPR in perinatal outcome when compared to SFR, especially if the latter happens at advanced gestation. Therefore, although it is advisable to wait for SFR to occur, in patients with triplet gestation at 11-12 weeks, MFPR is a viable option to be considered.

Utilidad de una prueba cualitativa para la detección de fibronectina fetal en secreción cervicovaginal como predictor de parto prematuro

OpenAIRE

L.R. López-Ocaña; F. Palacios-Torres; M.O. Coreño-Juárez; D.A. Obando-Izquierdo; E. Krug-Llamas; R.R. Villanueva-Romero; M. Rodríguez-Gutiérrez; Y.M. Gómez Alegre; M.L. Martínez Morgado

2015-01-01

La fibronectina fetal es una glucoproteína de la matriz extracelular que se localiza en la interfase materno-fetal de las membranas amnióticas, entre la decidua y el corion. Los niveles séricos de fibronectina fetal ≥ 50 ng/ml a partir de las 22 semanas de gestación más se han asociado con un riesgo de partos prematuros espontáneos. El parto prematuro es el nacimiento que se presenta antes de las 37 semanas de gestación, es multicausal, contribuye con un 70% de la mortalidad perinatal y su...

Algorithms for Computerized Fetal Heart Rate Diagnosis with Direct Reporting

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Kazuo Maeda

2015-06-01

Full Text Available Aims: Since pattern classification of fetal heart rate (FHR was subjective and enlarged interobserver difference, objective FHR analysis was achieved with computerized FHR diagnosis. Methods: The computer algorithm was composed of an experts’ knowledge system, including FHR analysis and FHR score calculation, and also of an objective artificial neural network system with software. In addition, a FHR frequency spectrum was studied to detect ominous sinusoidal FHR and the loss of baseline variability related to fetal brain damage. The algorithms were installed in a central-computerized automatic FHR monitoring system, which gave the diagnosis rapidly and directly to the attending doctor. Results: Clinically perinatal mortality decreased significantly and no cerebral palsy developed after introduction of the centralized system. Conclusion: The automatic multichannel FHR monitoring system improved the monitoring, increased the objectivity of FHR diagnosis and promoted clinical results.

Temporal trends of latency period and perinatal survival after very early preterm premature rupture of fetal membranes.

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González-Mesa, Ernesto; Herrera, José A; Urgal, Amaya; Lazarraga, Cristina; Benítez, María J; Gómez, Cristina

2012-08-01

This paper shows temporal trends of latency period and perinatal survival after preterm premature rupture of membranes at or before 28 weeks (very early PPROM). We have studied retrospectively medical records of all cases of very early PPROM attended in our Obstetric Department from January 1, 2000 to December 31, 2010. A total of 327 cases of very early PPROM were attended, representing 0.4 % of all deliveries, 3.68 % of all preterm births and 15 % of cases all of PPROM. The mean gestational age at delivery was 27 weeks (range 20-34). The mean duration of latency period for the total of 327 cases was 12.1 days (range 0-83, SD 13.3), with a clear trend to its increase from 2005 (p 2000-2010, perinatal deaths reached 30.6 % of all cases, with a clear trend to decrease as gestational age at diagnosis increased, and over the years of study. We have also found a high rate of obstetric complications and a high rate of cesarean deliveries. The upward trend in the duration of latency period in all groups over the years of study and the encouraging perinatal survival observed, even in previable PPROM, are incentives to follow expectant/conservative management in these cases.

[Are risk factors in prenatal and perinatal period important for develompent of schizophrenia?

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Ambroz, P; Janoutová, J; Machaczka, O; Kovaľová, M; Pohlídalová, A; Vařechová, K; Košta, O; Tomášková, H; Šerý, O; Hosák, L; Janout, V

Schizophrenia is an important psychical disease of multifactorial origin and not yet clear etiology. In prenatal and perinatal period some potential risk factors for schizophrenia are taken into consideration. Case-control study of 815 subjects, 407 cases and 408 controls was performed in 2013 to 2015. In this study environmental and genetic risk factors were evaluated including potential risk factors of prenatal and perinatal period. Statistically important difference was found in child-birth done by cesarean section (p = 0.009) and in patients with schizophrenia were 15.7% complications in the course of childbirth (p < 0.001). Hypoxia, passed umbilical cord were the most frequent complications. In prenatal period premature childbirth, injury and psychical complications were the most frequent. On the other hand difference in weight and length of newborns, breast feeding and infection during pregnancy were found not statistically important. In this study statistically important diference were found in way of carrying childbirth and in some complications during pregnancy and delivery. Influence of infection during pregnancy and influence of weight and length of newborn were not demonstrated.

Impaired fetal blood gas status in polyhydramnios and its relation to raised amniotic pressure.

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Fisk, N M; Vaughan, J; Talbert, D

1994-01-01

A substantial proportion of perinatal losses in polyhydramnios occur as unexplained normally formed stillbirths. In order to investigate the relationship between fetal condition and raised amniotic pressure (AP), fetal blood gas and acid-base status were determined together with AP in 22 pregnancies with polyhydramnios. At fetal blood sampling, 8 (36%) had a venous pH value and 16 (73%) a pO2 value below the reference range. Both fetal pH and pO2 were significantly negatively correlated with the degree of elevation in AP (y = 7.43 - 0.036x, r = 0.56, p = 0.006, where y = pH and x = AP z score, and y = -1.6 - 0.48x, r = 0.54, p = 0.01, where y = pO2 z score, respectively). Although some of these fetuses were hydropic, had congenital anomalies, or were from multiple pregnancies, univariate and multiple logistic regression analyses indicated that the above associations could not be accounted for by these potentially confounding variables. This work suggests that abnormal fetal blood gas status in human pregnancies with poly-hydramnios is associated with elevated AP.

Fetal demise by umbilical cord around abdomen and stricture.

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Tan, Shun-Jen; Chen, Chi-Huang; Wu, Gwo-Jang; Chen, Wei-Hwa; Chang, Cheng-Chang

2010-01-01

Umbilical cord abnormalities are accepted as conditions associated with intrauterine fetal demise (IUFD), and umbilical cord stricture is most frequently encountered. In addition, although cord entanglement with multiple loops rarely increases the perinatal mortality, it is associated with a significant increase in variable kind of morbidity such as growth restriction. We describe a 27-year-old woman, with a missed abortion history at about 10 weeks' gestation in her first pregnancy, who presented to our outpatient department at 34 4/7 weeks of gestation due to decreased fetal activity during the preceding week. No fetal heart activity and blood flow had been detected by ultrasonography and pulsed-wave Doppler. A demised fetus with umbilical cord stricture and three loops around abdomen was delivered and was weighted 1,830 g that was below the tenth percentile for the gestational age. Either umbilical cord stricture or entanglement around the body can affect the development of the fetus and even be lethal. The former might play a more important role in this case. Their etiology and the sequence of the events are still undetermined, and additional evaluation such as autopsy and further research may be needed. In addition, counsel and frequent fetal surveillance should be done in patients with previous IUFD attributed to cord stricture during next pregnancy because of undetermined risk of recurrence.

Neonatal nucleated red blood cells in infants of overweight and obese mothers.

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Sheffer-Mimouni, Galit; Mimouni, Francis B; Dollberg, Shaul; Mandel, Dror; Deutsch, Varda; Littner, Yoav

2007-06-01

The perinatal outcome of the infant of obese mother is adversely affected and in theory, may involve fetal hypoxia. We hypothesized that an index of fetal hypoxia, the neonatal nucleated red blood cell (NRBC) count, is elevated in infants of overweight and obese mothers. Absolute NRBC counts taken during the first 12 hours of life in 41 infants of overweight and obese mothers were compared to 28 controls. Maternal body mass index and infant birthweight were significantly higher in the overweight and obese group (P cell and lymphocyte counts did not differ between groups. The absolute NRBC count was higher (P = 0.01), and the platelet count lower (P = 0.05) in infants of overweight and obese mothers than in controls. In stepwise regression analysis, the absolute NRBC count in infants of overweight and obese mothers remained significantly higher even after taking into account birthweight or gestational age and Apgar scores (P mothers have increased nucleated red blood cells at birth compared with controls. We speculate that even apparently healthy fetuses of overweight and obese mothers are exposed to a subtle hypoxemic environment.

EPIGENETIC RISK FACTORS OF FETAL SENSITIZATION TO ALLERGENS IN THE SYSTEM «MOTHER-FETUS-NEWBORN»

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L. A. Lityaeva

2017-01-01

Full Text Available A comparative study of the state of health of 110 women with allergopathology at the stage of pregnancy and their newborn children, with an assessment of the influence of factors burdening fetal fetal development and contributing to the implementation of allergopathology in the first months of life.Trigger factors of disturbances in the formation of the intestinal microbiota, immune system and congenital decrease in the resistance of the child's organism — gestosis (c2 = 5.2, p = 0.022, Feto-placental insufficiency (c2 = 6.2, p = 0.012, chronic intrauterine fetal hypoxia (c2 = 5.7, p = 0.017, due to the presence in a woman with an allergic disease of combined somatic pathology and pathology of the genitals, malnutrition and microecological status.Such women should be classified as a high-risk group for intrauterine fetal sensitization and taken from the first days of pregnancy for primary prevention of allergopathology already at the stage of intrauterine development of the fetus. 

Neuronal Damage Induced by Perinatal Asphyxia Is Attenuated by Postinjury Glutaredoxin-2 Administration

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Juan Ignacio Romero

2017-01-01

Full Text Available The general disruption of redox signaling following an ischemia-reperfusion episode has been proposed as a crucial component in neuronal death and consequently brain damage. Thioredoxin (Trx family proteins control redox reactions and ensure protein regulation via specific, oxidative posttranslational modifications as part of cellular signaling processes. Trx proteins function in the manifestation, progression, and recovery following hypoxic/ischemic damage. Here, we analyzed the neuroprotective effects of postinjury, exogenous administration of Grx2 and Trx1 in a neonatal hypoxia/ischemia model. P7 Sprague-Dawley rats were subjected to right common carotid ligation or sham surgery, followed by an exposure to nitrogen. 1 h later, animals were injected i.p. with saline solution, 10 mg/kg recombinant Grx2 or Trx1, and euthanized 72 h postinjury. Results showed that Grx2 administration, and to some extent Trx1, attenuated part of the neuronal damage associated with a perinatal hypoxic/ischemic damage, such as glutamate excitotoxicity, axonal integrity, and astrogliosis. Moreover, these treatments also prevented some of the consequences of the induced neural injury, such as the delay of neurobehavioral development. To our knowledge, this is the first study demonstrating neuroprotective effects of recombinant Trx proteins on the outcome of neonatal hypoxia/ischemia, implying clinical potential as neuroprotective agents that might counteract neonatal hypoxia/ischemia injury.

Neuronal Damage Induced by Perinatal Asphyxia Is Attenuated by Postinjury Glutaredoxin-2 Administration.

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Romero, Juan Ignacio; Holubiec, Mariana Inés; Tornatore, Tamara Logica; Rivière, Stéphanie; Hanschmann, Eva-Maria; Kölliker-Frers, Rodolfo Alberto; Tau, Julia; Blanco, Eduardo; Galeano, Pablo; Rodríguez de Fonseca, Fernando; Lillig, Christopher Horst; Capani, Francisco

2017-01-01

The general disruption of redox signaling following an ischemia-reperfusion episode has been proposed as a crucial component in neuronal death and consequently brain damage. Thioredoxin (Trx) family proteins control redox reactions and ensure protein regulation via specific, oxidative posttranslational modifications as part of cellular signaling processes. Trx proteins function in the manifestation, progression, and recovery following hypoxic/ischemic damage. Here, we analyzed the neuroprotective effects of postinjury, exogenous administration of Grx2 and Trx1 in a neonatal hypoxia/ischemia model. P7 Sprague-Dawley rats were subjected to right common carotid ligation or sham surgery, followed by an exposure to nitrogen. 1 h later, animals were injected i.p. with saline solution, 10 mg/kg recombinant Grx2 or Trx1, and euthanized 72 h postinjury. Results showed that Grx2 administration, and to some extent Trx1, attenuated part of the neuronal damage associated with a perinatal hypoxic/ischemic damage, such as glutamate excitotoxicity, axonal integrity, and astrogliosis. Moreover, these treatments also prevented some of the consequences of the induced neural injury, such as the delay of neurobehavioral development. To our knowledge, this is the first study demonstrating neuroprotective effects of recombinant Trx proteins on the outcome of neonatal hypoxia/ischemia, implying clinical potential as neuroprotective agents that might counteract neonatal hypoxia/ischemia injury.

Excessively delayed maternal reaction after their perception of decreased fetal movements in stillbirths: Population-based study in Japan.

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Koshida, Shigeki; Ono, Tetsuo; Tsuji, Shunichiro; Murakami, Takashi; Arima, Hisatomi; Takahashi, Kentaro

2017-12-01

Fetal movement is the most common method to evaluate fetal well-being. Furthermore, maternal perception of decreased fetal movements is associated with perinatal demise. Previously, we showed that perception of decreased fetal movements was the most common reason for mothers visiting the outpatient department among those who had stillbirths in our region. Further investigation of stillbirths with decreased fetal movements is essential to find a possible way of preventing stillbirth. To investigate maternal reaction time after their perceiving decreased fetal movements among stillbirths in our region of Japan. This is a population-based study of stillbirths in Shiga Prefecture, Japan conducted from 2007 to 2011. We sent a questionnaire to each obstetrician who had submitted the stillbirth certificate. We reviewed and evaluated the questionnaires returned from the obstetricians. There were 66 cases (35%) with decreased fetal movements among 188 stillbirths in Shiga during the study period. The number of maternal visits to outpatient department after perception of decreased fetal movements within 24h was only seven (11%) among 64 stillbirths diagnosed at outpatient department. We conclude that delayed maternal visit after perceiving decreased fetal movements is frequently observed in stillbirths. Promoting more thorough maternal education on fetal movements, including emphasizing earlier visitation after perceiving decreased fetal movements, may prevent stillbirths. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Asymptomatic bacteriuria in pregnancy: maternal and fetal complications.

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Grio, R; Porpiglia, M; Vetro, E; Uligini, R; Piacentino, R; Minì, D; Marchino, G L

1994-12-01

From an analysis of the data reported in the literature it is clear that pregnancy is a predisposing factor for urinary tract infection and that pregnant women with this pathology are exposed to dangerous risks which may influence maternal wellbeing and fetal prognosis. Authors do not concur on the specific risks to the mother and fetus, one reason being that the statistics reported to date reveal discrepancies relating to the presence of disorders prior to pregnancy and the environmental, working and socio-hygienic conditions of the populations studied. The apparently paradoxical finding of a higher incidence of perinatal problems in pregnant women with asymptomatic bacteriuria compared to manifest forms can be attributed to the fact that the latter are treated with adequate therapies whereas asymptomatic bacteriuria, which is difficult to diagnose, may persist throughout pregnancy. This underlines the importance of early diagnosis using a protocol which entails the execution of serial urine tests and urine cultures and adequate treatment of all cases of asymptomatic bacteriuria in order to reduce the incidence of urinary tract infections and materno-fetal complications. Non-treated asymptomatic bacteriuria in fact represents a considerable risk factor since it may lead to the onset of acute pyelonephritis in approximately 5% of pregnant women and may increase the risk of fetal mortality.

Hypoxia induces dilated cardiomyopathy in the chick embryo: mechanism, intervention, and long-term consequences.

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Andrei Tintu

Full Text Available Intrauterine growth restriction is associated with an increased future risk for developing cardiovascular diseases. Hypoxia in utero is a common clinical cause of fetal growth restriction. We have previously shown that chronic hypoxia alters cardiovascular development in chick embryos. The aim of this study was to further characterize cardiac disease in hypoxic chick embryos.Chick embryos were exposed to hypoxia and cardiac structure was examined by histological methods one day prior to hatching (E20 and at adulthood. Cardiac function was assessed in vivo by echocardiography and ex vivo by contractility measurements in isolated heart muscle bundles and isolated cardiomyocytes. Chick embryos were exposed to vascular endothelial growth factor (VEGF and its scavenger soluble VEGF receptor-1 (sFlt-1 to investigate the potential role of this hypoxia-regulated cytokine.Growth restricted hypoxic chick embryos showed cardiomyopathy as evidenced by left ventricular (LV dilatation, reduced ventricular wall mass and increased apoptosis. Hypoxic hearts displayed pump dysfunction with decreased LV ejection fractions, accompanied by signs of diastolic dysfunction. Cardiomyopathy caused by hypoxia persisted into adulthood. Hypoxic embryonic hearts showed increases in VEGF expression. Systemic administration of rhVEGF(165 to normoxic chick embryos resulted in LV dilatation and a dose-dependent loss of LV wall mass. Lowering VEGF levels in hypoxic embryonic chick hearts by systemic administration of sFlt-1 yielded an almost complete normalization of the phenotype.Our data show that hypoxia causes a decreased cardiac performance and cardiomyopathy in chick embryos, involving a significant VEGF-mediated component. This cardiomyopathy persists into adulthood.

SLC9B1 methylation predicts fetal intolerance of labor.

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Knight, Anna K; Conneely, Karen N; Kilaru, Varun; Cobb, Dawayland; Payne, Jennifer L; Meilman, Samantha; Corwin, Elizabeth J; Kaminsky, Zachary A; Dunlop, Anne L; Smith, Alicia K

2018-01-01

Fetal intolerance of labor is a common indication for delivery by Caesarean section. Diagnosis is based on the presence of category III fetal heart rate tracing, which is an abnormal heart tracing associated with increased likelihood of fetal hypoxia and metabolic acidemia. This study analyzed data from 177 unique women who, during their prenatal visits (7-15 weeks and/or 24-32 weeks) to Atlanta area prenatal care clinics, consented to provide blood samples for DNA methylation (HumanMethylation450 BeadChip) and gene expression (Human HT-12 v4 Expression BeadChip) analyses. We focused on 57 women aged 18-36 (mean 25.4), who had DNA methylation data available from their second prenatal visit. DNA methylation patterns at CpG sites across the genome were interrogated for associations with fetal intolerance of labor. Four CpG sites (P value intolerance of labor. DNA methylation and gene expression were negatively associated when examined longitudinally during pregnancy using a linear mixed-effects model. Positive predictive values of methylation of these four sites ranged from 0.80 to 0.89, while negative predictive values ranged from 0.91 to 0.92. The four CpG sites were also associated with fetal intolerance of labor in an independent cohort (the Johns Hopkins Prospective PPD cohort). Therefore, fetal intolerance of labor could be accurately predicted from maternal blood samples obtained between 24-32 weeks gestation. Fetal intolerance of labor may be accurately predicted from maternal blood samples obtained between 24-32 weeks gestation by assessing DNA methylation patterns of SLC9B1. The identification of pregnant women at elevated risk for fetal intolerance of labor may allow for the development of targeted treatments or management plans.

Placental Hypoxia During Early Pregnancy Causes Maternal Hypertension and Placental Insufficiency in the Hypoxic Guinea Pig Model.

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Thompson, Loren P; Pence, Laramie; Pinkas, Gerald; Song, Hong; Telugu, Bhanu P

2016-12-01

Chronic placental hypoxia is one of the root causes of placental insufficiencies that result in pre-eclampsia and maternal hypertension. Chronic hypoxia causes disruption of trophoblast (TB) development, invasion into maternal decidua, and remodeling of maternal spiral arteries. The pregnant guinea pig shares several characteristics with humans such as hemomonochorial placenta, villous subplacenta, deep TB invasion, and remodeling of maternal arteries, and is an ideal animal model to study placental development. We hypothesized that chronic placental hypoxia of the pregnant guinea pig inhibits TB invasion and alters spiral artery remodeling. Time-mated pregnant guinea pigs were exposed to either normoxia (NMX) or three levels of hypoxia (HPX: 16%, 12%, or 10.5% O 2 ) from 20 day gestation until midterm (39-40 days) or term (60-65 days). At term, HPX (10.5% O 2 ) increased maternal arterial blood pressure (HPX 57.9 ± 2.3 vs. NMX 40.4 ± 2.3, P < 0.001), decreased fetal weight by 16.1% (P < 0.05), and increased both absolute and relative placenta weights by 10.1% and 31.8%, respectively (P < 0.05). At midterm, there was a significant increase in TB proliferation in HPX placentas as confirmed by increased PCNA and KRT7 staining and elevated ESX1 (TB marker) gene expression (P < 0.05). Additionally, quantitative image analysis revealed decreased invasion of maternal blood vessels by TB cells. In summary, this animal model of placental HPX identifies several aspects of abnormal placental development, including increased TB proliferation and decreased migration and invasion of TBs into the spiral arteries, the consequences of which are associated with maternal hypertension and fetal growth restriction. © 2016 by the Society for the Study of Reproduction, Inc.

Maternal risk factors in fetal alcohol syndrome: provocative and permissive influences.

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Abel, E L; Hannigan, J H

1995-01-01

We present an hypothesis integrating epidemiological, clinical case, and basic biomedical research to explain why only relatively few women who drink alcohol during pregnancy give birth to children with alcohol-related birth defects (ARBDs), in particular, Fetal Alcohol Syndrome (FAS). We argue that specific sociobehavioral risk factors, e.g., low socioeconomic status, are permissive for FAS in that they provide the context for increased vulnerability. We illustrate how these permissive factors are related to biological factors, e.g., decreased antioxidant status, which in conjunction with alcohol, provoke FAS/ARBDs in vulnerable fetuses. We propose an integrative heuristic model hypothesizing that these permissive and provocative factors increase the likelihood of FAS/ARBDs because they potentiate two related mechanisms of alcohol-induced teratogenesis, specifically, maternal/fetal hypoxia and free radical formation.

Maternal and fetal outcome in pregnant and parturient women with cardiac disease

International Nuclear Information System (INIS)

Arif, S.; Baqar, S.; Arif, A.

2013-01-01

Objective: To study the maternal and fetal outcome in pregnant and parturient women with cardiac disease admitted in Armed Forces Institute of Cardiology Rawalpindi. Type of Study: Cross sectional descriptive study. Place and Duration: Armed Forces Institute of Cardiology Rawalpindi Jan 2008 to June 2008. Patients and Methods: All pregnant patients beyond 28 weeks gestation with cardiac disease diagnosed before pregnancy or during the index pregnancy admitted for delivery or with cardiac complications were included in the study. All neonates less than 2.5 kg were taken as low birth weight and deliveries between 28 and 37 weeks were considered preterm. Cardiac patients with pregnancy less than 28 weeks were excluded from the study. Results: Maternal mortality was 5% with 31% mortality in NYHA Class III and IV. Perinatal mortality was 9% and low birth weight babies were 17%.Perinatal mortality was 0% in NYHA Class I and II and 60% in NYHA class III and IV. There was no maternal mortality in booked patients. All patients who expired were unbooked. Conclusion: Functional cardiac status is the most important factor affecting maternal and perinatal outcome. Antenatal booking status of the patient is the next important factor. (author)

Gestational hypoxia induces preeclampsia-like symptoms via heightened endothelin-1 signaling in pregnant rats.

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Zhou, Jianjun; Xiao, Daliao; Hu, Yali; Wang, Zhiqun; Paradis, Alexandra; Mata-Greenwood, Eugenia; Zhang, Lubo

2013-09-01

Preeclampsia is a life-threatening pregnancy disorder. However, its pathogenesis remains unclear. We tested the hypothesis that gestational hypoxia induces preeclampsia-like symptoms via heightened endothelin-1 (ET-1) signaling. Time-dated pregnant and nonpregnant rats were divided into normoxic and hypoxic (10.5% O2 from the gestational day 6-21) groups. Chronic hypoxia had no significant effect on blood pressure or proteinuria in nonpregnant rats but significantly increased blood pressure on day 12 (systolic blood pressure, 111.7 ± 6.1 versus 138.5 ± 3.5 mm Hg; P=0.004) and day 20 (systolic blood pressure, 103.4 ± 4.6 versus 125.1 ± 6.1 mm Hg; P=0.02) in pregnant rats and urine protein (μg/μL)/creatinine (nmol/μL) ratio on day 20 (0.10 ± 0.01 versus 0.20 ± 0.04; P=0.04), as compared with the normoxic control group. This was accompanied with asymmetrical fetal growth restriction. Hypoxia resulted in impaired trophoblast invasion and uteroplacental vascular remodeling. In addition, plasma ET-1 levels, as well as the abundance of prepro-ET-1 mRNA, ET-1 type A receptor and angiotensin II type 1 receptor protein in the kidney and placenta were significantly increased in the chronic hypoxic group, as compared with the control animals. Treatment with the ET-1 type A receptor antagonist, BQ123, during the course of hypoxia exposure significantly attenuated the hypoxia-induced hypertension and other preeclampsia-like features. The results demonstrate that chronic hypoxia during gestation induces preeclamptic symptoms in pregnant rats via heightened ET-1 and ET-1 type A receptor-mediated signaling, providing a molecular mechanism linking gestational hypoxia and increased risk of preeclampsia.

Ecosystem impacts of hypoxia: thresholds of hypoxia and pathways to recovery

International Nuclear Information System (INIS)

Steckbauer, A; Duarte, C M; Vaquer-Sunyer, R; Carstensen, J; Conley, D J

2011-01-01

Coastal hypoxia is increasing in the global coastal zone, where it is recognized as a major threat to biota. Managerial efforts to prevent hypoxia and achieve recovery of ecosystems already affected by hypoxia are largely based on nutrient reduction plans. However, these managerial efforts need to be informed by predictions on the thresholds of hypoxia (i.e. the oxygen levels required to conserve biodiversity) as well as the timescales for the recovery of ecosystems already affected by hypoxia. The thresholds for hypoxia in coastal ecosystems are higher than previously thought and are not static, but regulated by local and global processes, being particularly sensitive to warming. The examination of recovery processes in a number of coastal areas managed for reducing nutrient inputs and, thus, hypoxia (Northern Adriatic; Black Sea; Baltic Sea; Delaware Bay; and Danish Coastal Areas) reveals that recovery timescales following the return to normal oxygen conditions are much longer than those of loss following the onset of hypoxia, and typically involve decadal timescales. The extended lag time for ecosystem recovery from hypoxia results in non-linear pathways of recovery due to hysteresis and the shift in baselines, affecting the oxygen thresholds for hypoxia through time.

Mortalidad perinatal en el Hospital Nacional Edgardo Rebagliati Martins

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Lizeth Diaz Ledesma

2003-07-01

Full Text Available Objetivo: Conocer la tasa de mortalidad perinatal en el Hospital Nacional Edgardo Rebagliati Martins y sus características. Materiales y Métodos: El estudio comprendió la revisión de todas las historias clínicas de gestantes portadoras de óbito fetal (mayor de 28 semanas de gestación o mayor de 1000gramos, de recién nacidos que fallecieron dentro de los primeros 7 días de vida y de sus madres durante el año 2000. Resultados: La tasa de mortalidad perinatal fue de 10.5 por mil nacidos vivos. La edad promedio materna fue de 31.6 años, + 5.9 y un rango entre 14 y 44 años. El 30.1% de partos correspondió a nulíparas, el 61.6% a multíparas y el 8.3% a gran multíparas. El promedio de visitas al control prenatal fue de 4.8 + 2.7. El 53.4% de las madres tuvo algún antecedente relacionado a mala historia obstétrica, siendo los más frecuentes historia de aborto previo (27.4%, cesárea anterior (13.7% y pre eclampsia (12.3%. Las causas asociadas a mortalidad perinatal fueron madres con pre eclampsia severa (38.4% y hemorragia en el tercer trimestre (15.1% y fetos con malformaciones congénitas severas (27.4%. La vía de parto fue abdominal en 68.5% y vaginal en 31.5%. Se tuvo 83.6% de gestaciones únicas y 16.4% de gestaciones múltiples. El peso de los productos fue 1985.2 + 945.8 gramos. El 61.6% de muertes perinatales correspondieron a prematuros. Conclusiones:La tasa de mortalidad neonatal en el HNERM durante el año 2000 fue de 10.5 por mil nacidos vivos y los factores relacionados a mortalidad perinatal fueron pre-eclampsia severa, malformaciones congénitas severas y hemorragias del tercer trimestre. ( Rev Med Hered 2003; 14: 117-121.

Retrospective comparison of perinatal outcomes following emergency cervical cerclage with or without prolapsed membranes.

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Steenhaut, Patricia; Hubinont, Corinne; Bernard, Pierre; Debiève, Frédéric

2017-06-01

To compare perinatal outcomes following emergency cerclage between patients with singleton pregnancies with prolapsed and non-prolapsed membranes. The present retrospective cohort study included data from women who underwent physical examination-indicated emergency cerclage at between 15 and 25 weeks of pregnancy at Saint Luc University Hospital, Brussels, Belgium, between January 1, 2000, and December 31, 2014. Outcomes were compared based on the presence of prolapsed or non-prolapsed membranes. The primary outcome measures were the duration of pregnancy at delivery and the interval between cerclage and delivery. Secondary outcomes included delivery weight, fetal or neonatal death, and neonatal morbidity, including neonatal intensive care unit admission. Data were included from 140 patients with cervical dilation of at least 1 cm; 85 women had non-prolapsed membranes and 55 women had prolapsed membranes. Among patients with non-prolapsed membranes, the mean duration of pregnancy at delivery was later (Pmembranes was associated with improved perinatal outcomes following emergency cerclage. © 2017 International Federation of Gynecology and Obstetrics.

Fetal programming and early identification of newborns at high risk of free radical-mediated diseases.

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Perrone, Serafina; Santacroce, Antonino; Picardi, Anna; Buonocore, Giuseppe

2016-05-08

Nowadays metabolic syndrome represents a real outbreak affecting society. Paradoxically, pediatricians must feel involved in fighting this condition because of the latest evidences of developmental origins of adult diseases. Fetal programming occurs when the normal fetal development is disrupted by an abnormal insult applied to a critical point in intrauterine life. Placenta assumes a pivotal role in programming the fetal experience in utero due to the adaptive changes in structure and function. Pregnancy complications such as diabetes, intrauterine growth restriction, pre-eclampsia, and hypoxia are associated with placental dysfunction and programming. Many experimental studies have been conducted to explain the phenotypic consequences of fetal-placental perturbations that predispose to the genesis of metabolic syndrome, obesity, diabetes, hyperinsulinemia, hypertension, and cardiovascular disease in adulthood. In recent years, elucidating the mechanisms involved in such kind of process has become the challenge of scientific research. Oxidative stress may be the general underlying mechanism that links altered placental function to fetal programming. Maternal diabetes, prenatal hypoxic/ischaemic events, inflammatory/infective insults are specific triggers for an acute increase in free radicals generation. Early identification of fetuses and newborns at high risk of oxidative damage may be crucial to decrease infant and adult morbidity.

Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability.

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Amanda T Langridge

Full Text Available BACKGROUND: As well as being highly comorbid conditions, autism spectrum disorders (ASD and intellectual disability (ID share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions. AIMS: To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children. METHODS: The study population comprised all live singleton births in Western Australia (WA between January 1984 and December 1999 (N = 383,153. Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes. RESULTS: In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR = 0.64, 95% CI: 0.43, 0.94; OR = 0.58, 95% CI: 0.34, 0.96, respectively. For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk. CONCLUSION: Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As

Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability.

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Langridge, Amanda T; Glasson, Emma J; Nassar, Natasha; Jacoby, Peter; Pennell, Craig; Hagan, Ronald; Bourke, Jenny; Leonard, Helen; Stanley, Fiona J

2013-01-01

As well as being highly comorbid conditions, autism spectrum disorders (ASD) and intellectual disability (ID) share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions. To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children. The study population comprised all live singleton births in Western Australia (WA) between January 1984 and December 1999 (N = 383,153). Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes. In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR = 0.64, 95% CI: 0.43, 0.94; OR = 0.58, 95% CI: 0.34, 0.96, respectively). For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk. Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As such, these findings highlight the importance of accounting for

The effects of corticotrophin-releasing factor and two antagonists on breathing movements in fetal sheep.

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Bennet, L; Johnston, B M; Vale, W W; Gluckman, P D

1990-01-01

1. The respiratory effects of corticotrophin-releasing factor (CRF) and the CRF antagonists alpha-helical CRF 9-41 (alpha hCRF) and [DPhe 12, Nle 21-38] rCRF (12-41) (DPhe CRF) have been studied in unanaesthetized fetal lambs of 125-140 days gestation. 2. CRF when given as a 10 micrograms bolus followed by a 5 micrograms h-1 infusion into a lateral cerebral ventricle caused prolonged continuous fetal breathing movements which were stimulated in both amplitude and frequency but which did not persist during hypoxia. 3. Lower doses of CRF (20 ng bolus followed by 10 ng h-1) increased the amplitude but not the frequency of fetal breathing movements which did not become continuous. 4. At higher doses (20 micrograms bolus followed by 10-15 micrograms h-1) CRF induced cerebral convulsions which were also associated with fetal breathing movements of increased amplitude and frequency. 5. The CRF antagonists alpha hCRF and DPhe CRF both inhibited fetal breathing movements and induced a prolonged apnoea which was resistant to the stimulatory effects of 5-6% hypercapnia. 6. We conclude that CRF stimulates breathing movements in the fetal lamb. The finding that administration of the CRF antagonists alone cause apnoea suggests that CRF may have a tonic role in the regulation of fetal breathing movements. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2348387

Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

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Vogel, J P; Souza, J P; Mori, R; Morisaki, N; Lumbiganon, P; Laopaiboon, M; Ortiz-Panozo, E; Hernandez, B; Pérez-Cuevas, R; Roy, M; Mittal, S; Cecatti, J G; Tunçalp, Ö; Gülmezoglu, A M

2014-03-01

We aimed to determine the prevalence and risks of late fetal deaths (LFDs) and early neonatal deaths (ENDs) in women with medical and obstetric complications. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS). A total of 359 participating facilities in 29 countries. A total of 308 392 singleton deliveries. We reported on perinatal indicators and determined risks of perinatal death in the presence of severe maternal complications (haemorrhagic, infectious, and hypertensive disorders, and other medical conditions). Fresh and macerated LFDs (defined as stillbirths ≥ 1000 g and/or ≥28 weeks of gestation) and ENDs. The LFD rate was 17.7 per 1000 births; 64.8% were fresh stillbirths. The END rate was 8.4 per 1000 liveborns; 67.1% occurred by day 3 of life. Maternal complications were present in 22.9, 27.7, and 21.2% [corrected] of macerated LFDs, fresh LFDs, and ENDs, respectively. The risks of all three perinatal mortality outcomes were significantly increased with placental abruption, ruptured uterus, systemic infections/sepsis, pre-eclampsia, eclampsia, and severe anaemia. Preventing intrapartum-related perinatal deaths requires a comprehensive approach to quality intrapartum care, beyond the provision of caesarean section. Early identification and management of women with complications could improve maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

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Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C S; Torabi, Rozbeh

2009-06-10

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most

Fetal inflammation associated with minimal acute morbidity in moderate/late preterm infants.

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Gisslen, Tate; Alvarez, Manuel; Wells, Casey; Soo, Man-Ting; Lambers, Donna S; Knox, Christine L; Meinzen-Derr, Jareen K; Chougnet, Claire A; Jobe, Alan H; Kallapur, Suhas G

2016-03-23

To determine whether exposure to acute chorioamnionitis and fetal inflammation caused short-term adverse outcomes. This is a prospective observational study: subjects were mothers delivering at 32-36 weeks gestation and their preterm infants at a large urban tertiary level III perinatal unit (N=477 infants). Placentae and fetal membranes were scored for acute histological chorioamnionitis based on the Redline criteria. Fetal inflammation was characterised by histological diagnosis of funisitis (umbilical cord inflammation), increased cord blood cytokines measured by ELISA, and activation of the inflammatory cells infiltrating the placenta and fetal membranes measured by immunohistology. Maternal and infant data were collected. Twenty-four per cent of 32-36-week infants were exposed to histological chorioamnionitis and 6.9% had funisitis. Immunostaining for leucocyte subsets showed selective infiltration of the placenta and fetal membranes with activated neutrophils and macrophages with chorioamnionitis. Interleukin (IL) 6, IL-8 and granulocyte colony-stimulating factor were selectively increased in the cord blood of preterm infants with funisitis. Compared with infants without chorioamnionitis, funisitis was associated with increased ventilation support during resuscitation (43.8% vs 15.4%) and more respiratory distress syndrome postnatally (27.3% vs 10.2%) in univariate analysis. However, these associations disappeared after adjusting for prematurity. Despite fetal exposure to funisitis, increased cord blood cytokines and activated placental inflammatory cells, we could not demonstrate neonatal morbidity specifically attributable to fetal inflammation after adjusting for gestational age in moderate and late preterm infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nonreassuring fetal heart rate patterns and nucleated red blood cells in term neonates.

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Kovalak, E Ebru; Dede, F Suat; Gelisen, Orhan; Dede, Hulya; Haberal, Ali

2011-05-01

The aim of this study was to evaluate the association between nonreassuring fetal heart rate patterns during labor and umbilical cord nucleated red blood cell counts. Nucleated red blood cell data was collected prospectively from 41 singleton term neonates presented with nonreassuring fetal heart rate patterns and/or meconium stained amniotic fluid during labor (study group) and from 45 term neonates without any evidence of nonreassuring fetal status (controls). Umbilical artery pH, blood gases and base excess were also determined to investigate the correlation between independent variables. The median nucleated red blood cells per 100 white blood cells were 13 (range 0-37) in the study group and 8 (range 0-21) in the control group. Stepwise regression analysis have identified meconium stained amniotic fluid (R(2) = 0.15, p patterns. Nucleated red blood cells in the cord blood of newborns were found to be elevated in patients with nonreassuring FHR patterns during labor. However, the wide range and the poor correlation of NRBC count with umbilical artery pH and blood gas values limit its clinical utility as a marker for fetal hypoxia.

Perinatal Asphyxia May Influence the Level of Beta-Amyloid (1-42 in Cerebrospinal Fluid: An Experimental Study on Newborn Pigs.

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Torkil Benterud

Full Text Available Total tau (T-tau, phosphorylated tau (p-Tau and Beta-Amyloid 1-42 (AB42 in Cerebrospinal Fluid (CSF are useful biomarkers in neurodegenerative diseases. The aim of the study was to investigate the role of these and other CSF biomarkers (T-tau, p-Tau, AB42, S100B and NSE, during hypoxia-reoxygenation in a newborn pig model.Thirty newborn pigs were included in a study of moderate or severe hypoxia. The moderate hypoxia group (n = 12 was exposed to global hypoxia (8% O2 until Base excess (BE reached -15 mmol/l. The pigs in the group exposed to severe hypoxia (n = 12 received 8% O2 until BE reached -20 mmol/l or mean Blood Pressure fell below 20 mm Hg, The control group (n = 6 was kept at room air. For all treatments, the CSF was collected at 9.5 hours after the intervention.The level of AB42 in CSF was significantly lower in the pigs exposed to severe hypoxia compared with the control group, 922(SD +/-445pg/ml versus. 1290(SD +/-143 pg/ml (p<0.05, respectively. Further, a non-significant reduction of AB42 was observed in the group exposed to moderate hypoxia T-tau and p-Tau revealed no significant differences between the intervention groups and the control group, however a significantly higher level of S100B was seen in the CSF of pigs receiving hypoxia in comparison to the level in the control group. Further on, there was a moderate negative correlation between the levels of AB42 and S100B in CSF, as well as a moderate negative correlation between Lactate in blood at end of hypoxia and AB42 in CSF.This is the first study to our knowledge that demonstrated a significant drop in AB42 in CSF after neonatal hypoxia. Whether or not this has an etiological basis for adult neurodegenerative disorders needs to be studied with additional experiments and epidemiological studies. AB42 and S100B are significantly changed in neonatal pigs subjected to hypoxia compared to controls and thus may be valuable biomarkers of perinatal asphyxia.

Immunoreactive erythropoietin concentrations in neonatal rats and the effects of hypoxia

International Nuclear Information System (INIS)

Clemons, G.K.; Fitzsimmons, S.L.; DeManincor, D.

1987-01-01

We attempted to find answers to what are the circulating, hepatic and renal erythropoietin (Ep) levels in normal rat neonates measured daily through the first three weeks of life and when they attain sexual maturity, how are these Ep levels altered by exposure to hypoxia, and whether can it be transferred to the nursing neonatal animals? Since we established earlier that in the fetal rat the liver is the main Ep producing tissue, we attempted to determine the age at which the switch from liver to kidney occurred in both the normal and the hypoxic neonatal rat. 2 figs

Correlation between the umbilical artery flow ultrasound parameters of intrauterine fetal distress and fetal ischemic hypoxic damage

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Hai-Ying Gu

2017-08-01

Full Text Available Objective: To study the correlation between the umbilical artery flow ultrasound parameters of intrauterine fetal distress and fetal ischemic hypoxic damage. Methods: A total of 158 puerperae who gave birth in our hospital between July 2016 and June 2017 were selected and divided into the intrauterine distress group (Apgar<7 points and normal pregnancy group (Apgar≥7 points according to the neonatal Apgar score, the umbilical artery flow ultrasound parameters at 24-30 weeks, 31-36 weeks and 37-41 weeks of gestation were determined, and the umbilical arterial blood gas parameters and oxidative stress molecule levels were determined. Results: At 24-30 weeks, 31-36 weeks and 37-41 weeks of gestation, umbilical arterial RI, PI and S/D of intrauterine distress group were significantly higher than those of normal pregnancy group; umbilical arterial pH and PaO2 of intrauterine distress group were significantly lower than those of normal pregnancy group and negatively correlated with RI, PI and S/D while PaCO2 and lactic acid levels were significantly higher than those of normal pregnancy group and positively correlated with RI, PI and S/D; SOD, GSH-px and CAT levels in umbilical artery of intrauterine distress group were significantly lower than those of normal pregnancy group and negatively correlated with RI, PI and S/D while MDA and 8-OHdG levels were significantly higher than those of normal pregnancy group and positively correlated with RI, PI and S/D. Conclusion: Umbilical artery flow ultrasound characteristics of intrauterine fetal distress are characterized by the increased resistance and decreased blood flow and are correlated with the degree of fetal hypoxia and oxidative stress.

Inactivation of maternal Hif-1α at mid-pregnancy causes placental defects and deficits in oxygen delivery to the fetal organs under hypoxic stress.

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Kenchegowda, Doreswamy; Natale, Bryony; Lemus, Maria A; Natale, David R; Fisher, Steven A

2017-02-15

A critical transition occurs near mid-gestation of mammalian pregnancy. Prior to this transition, low concentrations of oxygen (hypoxia) signaling through Hypoxia Inducible Factor (HIF) functions as a morphogen for the placenta and fetal organs. Subsequently, functional coupling of the placenta and fetal cardiovascular system for oxygen (O 2 ) transport is required to support the continued growth and development of the fetus. Here we tested the hypothesis that Hif-1α is required in maternal cells for placental morphogenesis and function. We used Tamoxifen-inducible Cre-Lox to inactivate Hif-1α in maternal tissues at E8.5 (MATcKO), and used ODD-Luciferase as a reporter of hypoxia in placenta and fetal tissues. MATcKO of Hif-1α reduced the number of uterine natural killer (uNK) cells and Tpbpa-positve trophoblast cells in the maternal decidua at E13.5 -15.5. There were dynamic changes in all three layers of E13.5-15.5 MATcKO placenta. Of note was the under-development of the labyrinth at E15.5 associated with reduced Ki67 and increased TUNEL staining consistent with reduced cell proliferation and increased apoptosis. Labyrinth defects were particularly evident in placentas connected to effectively HIF-1α heterozygous null embryos. MATcKO had no effect on basal ODD-Luciferase activity in fetal organs (heart, liver, brain) at any stage, but at E13.5-15.5 resulted in enhanced induction of the ODD-Luciferase hypoxia reporter when the dam's inspired O 2 was reduced to 8% for 4 hours. MATcKO also slowed the growth after E13.5 of fetuses that were effectively heterozygous for Hif-1α, with most being non-viable at E15.5. The hearts of these E15.5 fetuses were abnormal with reduction in size, thickened epicardium and mesenchymal septum. We conclude that maternal HIF-1α is required for placentation including recruitment of uNK and trophoblast cells into the maternal decidua and other trophoblast cell behaviors. The placental defects render the fetus vulnerable to O 2

Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing.

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Devane, Declan; Lalor, Joan G; Daly, Sean; McGuire, William; Cuthbert, Anna; Smith, Valerie

2017-01-26

The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register to 30 November 2016 and we planned to review the reference list of retrieved papers All randomised and quasi-randomised trials comparing admission CTG with intermittent auscultation of the FHR for pregnant women between 37 and 42 completed weeks of pregnancy and considered to be at low risk of intrapartum fetal hypoxia and of developing complications during labour. Two authors independently assessed trial eligibility and quality, and extracted data. Data were checked for accuracy. We included no new trials in this update. We included four trials involving more than 13,000 women which were conducted in the UK and Ireland and included women in labour. Three trials were funded by the hospitals where the trials took place and one trial was funded by the Scottish government. No declarations of interest were made in two trials; the remaining two trials did not mention declarations of interest. Overall, the studies were assessed as low risk of bias. Results reported in the 2012 review remain unchanged.Although not statistically significant using a strict P auscultation (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.00 to 1.44, 4 trials, 11,338 women, I² = 0%, moderate quality evidence). There was no clear difference in the average treatment effect across included trials between women allocated to admission CTG and women allocated to intermittent auscultation in instrumental vaginal birth (RR 1.10, 95% CI 0.95 to 1

FEATURES OF MEMORY IN CHILDREN OF PRESCHOOL AGE WITH CONSEQUENCES OF PERINATAL LESIONS OF THE CENTRAL NERVOUS SYSTEM

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T. S. Krivonogova

2014-01-01

Full Text Available The ability of memory was investigated in 524 children, aged 4 to 7; with remote consequences of perinatal damage of the central nervous system (CNS. A weak memory ability was detected in 42% of children with dysfunctions of the general and fine motility and in 59% of children with impaired speech. Severe gestosis, anemia in pregnancy (stage II and a delayed intrauterine fetal development were found to have a negative influence on memory shaping process.

Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study.

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Getiye, Yemisrach; Fantahun, Mesganaw

2017-07-26

perinatal mortality is the sum of still birth (fetal death) and early neonatal death (ENND) i.e. death of live newborn before the age of 7 completed days. Perinatal mortality accounts three fourth of the deaths of the neonatal period and is one of the major challenges for under-five mortality. Therefore this study was conducted to better understand the common and avoidable factors that affect perinatal mortality in Addis Ababa, Ethiopia. An unmatched case control study design using secondary data as a source of information was conducted. Cases were still births or early neonatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st January up to 30th February 2015. Epi-Info version 7.0 and SPSS Version 21 were used for data entry and analysis. Descriptive statistics, frequencies, proportions and diagrams were used to check the distribution of outcome variable and describe the study population. Logistic regression model was used to identify the important factors that are associated with perinatal mortality. A total of 1113(376 cases and 737 controls) maternal charts were reviewed. The mean age of the mothers for cases and controls were 26.47 ± 4.87 and 26.95 ± 4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the first time. Factors that are significantly associated with increased risk of perinatal mortality were birth interval less than 2 years, preterm delivery, anemia, congenital anomaly, previous history of early neonatal death and low birth weight. Use of partograph was also associated with decreased risk of perinatal mortality. From factors that are associated with perinatal mortality, some of them can be prevented with early investigation of pregnant mothers on their antenatal care follow. Appropriate labor follow-up and monitoring with regular use of partograph, immediate newborn care and interventions to delay

Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

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Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

2016-01-01

Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P cesarean section performed under general anesthesia (P cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are likely to undergo cesarean section may reduce the incidence of emergency cesarean sections and thus decrease fetal complications. PMID:27347286

Causes of death and associated conditions (Codac – a utilitarian approach to the classification of perinatal deaths

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Harrison Catherine

2009-06-01

Full Text Available Abstract A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD, although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies, two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy, a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal. For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions

Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

Science.gov (United States)

Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon CS; Torabi, Rozbeh

2009-01-01

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal). For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the

Localised proton magnetic resonance spectroscopy of the brain after perinatal hypoxia: a preliminary report

Energy Technology Data Exchange (ETDEWEB)

Chateil, J.F. [Service de Radiologie A, Hopital Pellegrin, Bordeaux (France)]|[Unite de Radiopediatrie, Hopital Pellegrin, Bordeaux (France); Quesson, B.; Thiaudiere, E.; Delalande, C.; Canioni, P. [Resonance Magnetique des Systemes Biologiques, CNRS, Bordeaux (France); Brun, M.; Diard, F. [Service de Radiologie A, Hopital Pellegrin, Bordeaux (France); Sarlangue, J.; Billeaud, C. [Service de Neonatalogie, Hopital Pellegrin, Bordeaux (France)

1999-03-01

Objectives. Perinatal hypoxic ischaemic injury is a significant cause of neurodevelopmental impairment. The aim of this study was to evaluate localised proton magnetic resonance spectroscopy ({sup 1}H-MRS) after birth asphyxia. Materials and methods. Thirty newborn infants suspected of having perinatal asphyxia (Apgar score < 3) were studied. The mean gestational age was 37 weeks, mean age at the MR examination was 18 days and mean weight was 2.9 kg. A 1.5-T unit was used for imaging and spectroscopy. None of the babies had mechanically assisted ventilation. No sedation was used. Axial T1-weighted and T2-weighted images were obtained. {sup 1}H-MRS was recorded in a single voxel, localised in white matter, using a STEAM sequence. Results. Image quality was good in 25 of 30 babies. {sup 1}H-MRS was performed in 19 of 30 subjects, with adequate quality in 16. Choline, creatine/phosphocreatine and N-acetylaspartate peaks and peak-area ratios were analysed. Lactate was detected in four infants. The N-acetylaspartate/choline ratio was lower in infants with an impaired neurological outcome, but the difference was not statistically significant. Conclusions. This study suggests that {sup 1}H-MRS may be useful for assessing cerebral metabolism in the neonate. A raised lactate level and decreased N-acetylaspartate/choline ratio may be predictive of a poor outcome. However, in our experience this method is limited by the difficulty in performing the examination during the first hours after birth in critically ill babies, the problems related to use of a monovoxel sequence, the dispersion of the ratios and the lack of determination of the absolute concentration of the metabolites. (orig.) With 3 figs., 2 tabs., 20 refs.

Placental fetal stem segmentation in a sequence of histology images

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Athavale, Prashant; Vese, Luminita A.

2012-02-01

Recent research in perinatal pathology argues that analyzing properties of the placenta may reveal important information on how certain diseases progress. One important property is the structure of the placental fetal stems. Analysis of the fetal stems in a placenta could be useful in the study and diagnosis of some diseases like autism. To study the fetal stem structure effectively, we need to automatically and accurately track fetal stems through a sequence of digitized hematoxylin and eosin (H&E) stained histology slides. There are many problems in successfully achieving this goal. A few of the problems are: large size of images, misalignment of the consecutive H&E slides, unpredictable inaccuracies of manual tracing, very complicated texture patterns of various tissue types without clear characteristics, just to name a few. In this paper we propose a novel algorithm to achieve automatic tracing of the fetal stem in a sequence of H&E images, based on an inaccurate manual segmentation of a fetal stem in one of the images. This algorithm combines global affine registration, local non-affine registration and a novel 'dynamic' version of the active contours model without edges. We first use global affine image registration of all the images based on displacement, scaling and rotation. This gives us approximate location of the corresponding fetal stem in the image that needs to be traced. We then use the affine registration algorithm "locally" near this location. At this point, we use a fast non-affine registration based on L2-similarity measure and diffusion regularization to get a better location of the fetal stem. Finally, we have to take into account inaccuracies in the initial tracing. This is achieved through a novel dynamic version of the active contours model without edges where the coefficients of the fitting terms are computed iteratively to ensure that we obtain a unique stem in the segmentation. The segmentation thus obtained can then be used as an

MATERNAL AND FETAL OUTCOME IN PRE-ECLAMPSIA AND ECLAMPSIA

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Sipra

2015-11-01

Full Text Available BACKGROUND Pre-Eclampsia and Eclampsia are the leading causes of maternal and perinatal morbidity and mortality worldwide. In developed countries, much lower incidences have been achieved through aggressive screening and management of Pre-Eclampsia. In developing countries like India, there is a wide gap in quality of health care in cities and rural area. The present study was done to evaluate the incidence of hypertensive disorders and maternal and fetal outcome in a tertiary care centre catering to poor people of Bihar, Bengal and neighboring country, Nepal. MATERIALS AND METHODS This is an observational descriptive study. After obtaining institutional ethical committee approval and informed consent from patients, all the patients presenting to our institution for delivery with Pre-Eclampsia and Eclampsia were included in the study. Socio-economic status, frequency of ANC, age, parity and period of gestation were recorded. Investigations included complete blood count, urinary protein, coagulation profile, liver function tests and kidney function tests. Mode of conduct of delivery and maternal and fetal outcome were thoroughly recorded and described. Data was presented in the form of n (%. RESULTS 64.28% cases with Pre-Eclampsia and 95.12% cases with Eclampsia were from low socio-economic status. 95.12% cases with Eclampsia and 67.5% cases with Pre-Eclampsia had no ANC throughout the pregnancy. Most of the patients were in the age group of 20-25 years. 86.11% cases with Eclampsia and 66.68% with Pre-Eclampsia were primigravida. Most of the patients presented with 37 weeks of gestation. 54.76% Pre-Eclampsia cases and 58.94% Eclampsia delivered by L.S.C.S. Pulmonary edema and acute renal failure were the most common complications. Maternal mortality was 25.60% in Eclampsia cases. The most common cause of maternal mortality was pulmonary edema. Incidence of IUD+ stillbirth was 16.66% in Pre-Eclampsia cases and 34.14% in Eclampsia cases. Overall

Analysis of hypoxia and hypoxia-like states through metabolite profiling.

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Julie E Gleason

Full Text Available In diverse organisms, adaptation to low oxygen (hypoxia is mediated through complex gene expression changes that can, in part, be mimicked by exposure to metals such as cobalt. Although much is known about the transcriptional response to hypoxia and cobalt, little is known about the all-important cell metabolism effects that trigger these responses.Herein we use a low molecular weight metabolome profiling approach to identify classes of metabolites in yeast cells that are altered as a consequence of hypoxia or cobalt exposures. Key findings on metabolites were followed-up by measuring expression of relevant proteins and enzyme activities. We find that both hypoxia and cobalt result in a loss of essential sterols and unsaturated fatty acids, but the basis for these changes are disparate. While hypoxia can affect a variety of enzymatic steps requiring oxygen and heme, cobalt specifically interferes with diiron-oxo enzymatic steps for sterol synthesis and fatty acid desaturation. In addition to diiron-oxo enzymes, cobalt but not hypoxia results in loss of labile 4Fe-4S dehydratases in the mitochondria, but has no effect on homologous 4Fe-4S dehydratases in the cytosol. Most striking, hypoxia but not cobalt affected cellular pools of amino acids. Amino acids such as aromatics were elevated whereas leucine and methionine, essential to the strain used here, dramatically decreased due to hypoxia induced down-regulation of amino acid permeases.These studies underscore the notion that cobalt targets a specific class of iron proteins and provide the first evidence for hypoxia effects on amino acid regulation. This research illustrates the power of metabolite profiling for uncovering new adaptations to environmental stress.

Non-nutritive sucking recorded in utero via fetal magnetography

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Popescu, E A; Popescu, M; Gustafson, K M; Wang, J; Barlow, S M

2008-01-01

Several studies in term and pre-term infants have investigated the rhythmic pattern of non-nutritive sucking (NNS) indicating correlations between the quantitative measures derived from sucking pressure variation and/or electromyographic (EMG) recordings and a range of factors that include age, perinatal stress and sequelae. In the human fetus, NNS has been reported from 13 weeks of gestation and has been studied using real-time Doppler ultrasonography exclusively. The present study indicates that NNS in fetus can be reliably recorded and quantified using non-invasive biomagnetic measurements that have been recently introduced as an investigational tool for the assessment of fetal neurophysiologic development. We show that source separation techniques, such as independent component analysis, applied to the high-resolution multichannel recordings allow the segregation of an explicit waveform that represents the biomagnetic equivalent of the ororhythmic sucking pressure variation or EMG signal recorded in infants. This enables the morphological study of NNS patterning over different temporal scales, from the global quantitative measures to the within burst fine structure characterization, in correlation with the fetal cardiac rhythm

Differential effects of concomitant use of vitamins C and E on trophoblast apoptosis and autophagy between normoxia and hypoxia-reoxygenation.

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Tai-Ho Hung

2010-08-01

Full Text Available Concomitant supplementation of vitamins C and E during pregnancy has been reportedly associated with low birth weight, the premature rupture of membranes and fetal loss or perinatal death in women at risk for preeclampsia; however, the cause is unknown. We surmise that hypoxia-reoxygenation (HR within the intervillous space due to abnormal placentation is the mechanism and hypothesize that concomitant administration of aforementioned vitamin antioxidants detrimentally affects trophoblast cells during HR.Using villous explants, concomitant administration of 50 microM of vitamins C and E was observed to reduce apoptotic and autophagic changes in the trophoblast layer at normoxia (8% oxygen but to cause more prominent apoptosis and autophagy during HR. Furthermore, increased levels of Bcl-2 and Bcl-xL in association with a decrease in the autophagy-related protein LC3-II were noted in cytotrophoblastic cells treated with vitamins C and E under standard culture conditions. In contrast, vitamin treatment decreased Bcl-2 and Bcl-xL as well as increased mitochondrial Bak and cytosolic LC3-II in cytotrophoblasts subjected to HR.Our results indicate that concomitant administration of vitamins C and E has differential effects on the changes of apoptosis, autophagy and the expression of Bcl-2 family of proteins in the trophoblasts between normoxia and HR. These changes may probably lead to the impairment of placental function and suboptimal growth of the fetus.

2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE) : A randomised trial

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Lees, Christoph C.; Marlow, Neil; Van Wassenaer-Leemhuis, Aleid; Arabin, Birgit; Bilardo, Caterina M.; Brezinka, Christoph; Calvert, Sandra; Derks, Jan B.; Diemert, Anke; Duvekot, Johannes J.; Ferrazzi, Enrico; Frusca, Tiziana; Ganzevoort, Wessel; Hecher, Kurt; Martinelli, Pasquale; Ostermayer, Eva; Papageorghiou, Aris T.; Schlembach, Dietmar; Schneider, K. T M; Thilaganathan, Baskaran; Todros, Tullia; Valcamonico, Adriana; Visser, Gerard H A; Wolf, Hans; Aktas, Ayse; Borgione, Silvia; Chaoui, Rabih; Cornette, Jerome M J; Diehl, Thilo; Van Eyck, Jim; Fratelli, Nicola; Van Haastert, Inge Lot; Lobmaier, Silvia; Lopriore, Enrico; Missfelder-Lobos, Hannah; Mansi, Giuseppina; Martelli, Paola; Maso, Gianpaolo; Maurer-Fellbaum, Ute; Van Charante, Nico Mensing; De Tollenaer, Susanne Mulder; Napolitano, Raffaele; Oberto, Manuela; Oepkes, Dick; Ogge, Giovanna; Van Der Post, Joris; Prefumo, Federico; Preston, Lucy; Raimondi, Francesco; Reiss, Irwin K M; Scheepers, H. C J; Schuit, Ewoud; Skabar, Aldo; Spaanderman, Marc; Weisglas-Kuperus, Nynke; Zimmermann, Andrea; Moore, Tamanna; Johnson, Samantha; Rigano, Serena

2015-01-01

Background: No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography

2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE) : a randomised trial

NARCIS (Netherlands)

Lees, Christoph C.; Marlow, Neil; van Wassenaer-Leemhuis, Aleid; Arabin, Birgit; Bilardo, Caterina M.; Brezinka, Christoph; Calvert, Sandra; Derks, Jan B.; Diemert, Anke; Duvekot, Johannes J.; Ferrazzi, Enrico; Frusca, Tiziana; Ganzevoort, Wessel; Hecher, Kurt; Martinelli, Pasquale; Ostermayer, Eva; Papageorghiou, Aris T.; Schlembach, Dietmar; Schneider, K. T. M.; Thilaganathan, Baskaran; Todros, Tullia; Valcamonico, Adriana; Visser, G. H. A.; Wolf, Hans

2015-01-01

Background No consensus exists for the best way to monitor and when to trigger delivery in mothers of babies with fetal growth restriction. We aimed to assess whether changes in the fetal ductus venosus Doppler waveform (DV) could be used as indications for delivery instead of cardiotocography

Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

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Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

2012-01-01

Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a

[Chorionicity and adverse perinatal outcome].

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Ferreira, Isabel; Laureano, Carla; Branco, Miguel; Nordeste, Ana; Fonseca, Margarida; Pinheiro, Adelaide; Silva, Maria Isabel; Almeida, Maria Céu

2005-01-01

Considering the highest rate of morbidity and mortality in diamniotic monochorionic twins, the authors evaluated and compared the adverse obstetric and perinatal outcome in twin pregnancies according to chorionicity. A retrospective study was conducted in all twin deliveries that occurred in the Obstetric Unit of Maternidade Bissaya-Barreto, for a period of tree years (from the 1st of January 1999 until the 31st of December 2001). From de 140 diamniotic twin pregnancies studied, we considered two groups according to the chorionicity: monochorionic and dichorionic. We compared multiple parameters as, epidemiologic data, adverse obstetric outcome, gestacional delivery age, type of delivery and the morbidity, the mortality and the follow-up of the newborn. The statistic tests used were the X2 and the t student. From the 140 twin pregnancies included in the study, 66% (92 cases) presented dichorionic placentation and 34% (48 cases) were monochorionic. In the group of monochorionic pregnancies, we observed highly difference related to pathology of amniotic fluid (14.5% vs 2.2%), discordant fetal growth (41.6% vs 22.8%) and rate of preterm delivery (66.6% vs 32.6%). Related to the newborn we verified that they had a lower average birth weight (1988g vs 2295g), a highly rate of weight discordancy (23% vs 15.3%), intraventricular haemorrhage (2.2% vs 0%) and IUGR (6.6% vs 1.6%), statistically significant in the monochorionic group. Also the perinatal mortality rate was significantly higher in the monochorionic pregnancies (93.7 per thousand vs 21.7 per thousand). The high rate of morbidity and mortality related to the monochorionic twin pregnancies, implies the need of a correct identification of the type of chorionicity and also a high standard of prenatal surveillance in prenatal specialised health centers.

Revisión Bibliográfica: Relación de la subunidad beta de gonadotropina corionica humana, testosterona libre y sexo fetal con el desarrollo de preeclampsia.

OpenAIRE

Francisco A. Yegüez M; Olivar C. Castejón; Marisol García de Yegüez

2007-01-01

La hipertensión arterial que complica al embarazo, constituye una patología compleja que comprende entidades clínicas como la preeclampsia (PE), eclampsia (E) y síndrome de HELLP. En su etiopatogenia se imbrican innumerables factores conducentes a disfunción endotelial que desencadena una cascada de manifestacionesclínicas que generan un gran impacto en la salud materno fetal: restricción del crecimiento fetal, parto prematuro y/o asfixia perinatal, abruptio placentae, hemorragias maternas in...

Prevention of hypoxic fetal complications in pregnant women with congenital heart disease and anemia

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Iu. Davydova

2016-06-01

Full Text Available The aim of the study is — to develop a strategy of prevention of hypoxic fetal abnormalities in pregnant women with congenital heart disease, heart failure and iron deficiency anemia. Materials and methods. The study included 86 pregnant women with CHD and NYHA II–III. 68 women in the third trimester of pregnancy is diagnosed anemia (group I, 18 pregnant women with CHD, NYHA II–III without anemia (II group, the control group consisted of 24 pregnant women without cardiac disease, with physiological pregnancy. All pregnant with information registration consent studied the concentration of ferritin, hemoglobin level, morphological study of the placenta. All pregnant women were assigned to iron supplements, oral iron (III hydroxide polymaltose complex (Maltofer when hemoglobin levels above 95 g/l and the expected delivery date more than 40 days of starting treatment. When the hemoglobin level below 95 g/l of intravenously administered iron (III hydroxide sucrose complex (Venofer followed by transfer to oral iron (III. Results. In groups of pregnant I and II did not have perinatal losses, births in gestation less than 28 weeks, with a score Apgar at birth of less than 4 points. Pregnant women with cyanotic heart defects and the need for early delivery in less than 37 weeks are not included in the study. Also, there is a correlation between the degree of severity of anemia in women with CHD with HF and prematurity, and the presence of IUGR child birth asphyxia able to varying degrees (respectively, r=0.8, r=0.75 and r=0.85. Conclusions. Formation of fetoplacental unit in women with CHD on a background of heart failure occurs with complications associated with the presence of tissue hypoxia, as well as the possible impact on the process of oxidative stress. The development of iron deficiency anemia in this group is an additional risk factor for placental dysfunction, which is confirmed by morphometric and morphological studies of placentas

When One Knows a Fetus Is Expected to Die: Palliative Care in the Context of Prenatal Diagnosis of Fetal Malformations.

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Rocha Catania, Taisa; Bernardes, Lisandra; Guerra Benute, Glaucia Rosana; Bento Cicaroni Gibeli, Maria Augusta; Bertolassi do Nascimento, Nathalia; Aparecida Barbosa, Tercilia Virginia; Jornada Krebs, Vera Lucia; Francisco, Rossana P V

2017-09-01

Fetal malformations occur in 2% of gestations and are the fifth most common cause of neonatal death in the world. In many cases, fetal malformations result in neonatal death or long stay in intensive care facilities. Families that continue the pregnancy in such a situation need to make choices and cope with an overwhelming number of potential issues. Palliative care starting at the prenatal period is a growing field that allows the entire family to prepare for this difficult situation. To perform a systematic review of published data on palliative care in the prenatal period. PubMed and the Cochrane Library were searched using the keywords ("perinatal" OR "prenatal" OR "fetal") AND "palliative care" and also ("perinatal" OR "prenatal" OR "fetal") AND "hospice." Studies focusing on the long-term impact of prenatal palliative care published up to December 2015 were used. Quantitative and qualitative studies. In total, 541 studies were retrieved; 29 articles met the inclusion criteria. Studies were organized into different categories according to the design or main focus. The majority of studies retrieved were reflexives or presented a narrative proposal on palliative care started in the prenatal period (45%). Clinical studies comprised 17% of all articles found. No studies were found on the long-term impact of prenatal palliative care. Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.

Fetal Stress and Programming of Hypoxic/Ischemic-Sensitive Phenotype in the Neonatal Brain: Mechanisms and Possible Interventions

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Li, Yong; Gonzalez, Pablo; Zhang, Lubo

2012-01-01

Growing evidence of epidemiological, clinical and experimental studies has clearly shown a close link between adverse in utero environment and the increased risk of neurological, psychological and psychiatric disorders in later life. Fetal stresses, such as hypoxia, malnutrition, and fetal exposure to nicotine, alcohol, cocaine and glucocorticoids may directly or indirectly act at cellular and molecular levels to alter the brain development and result in programming of heightened brain vulnerability to hypoxic-ischemic encephalopathy and the development of neurological diseases in the postnatal life. The underlying mechanisms are not well understood. However, glucocorticoids may play a crucial role in epigenetic programming of neurological disorders of fetal origins. This review summarizes the recent studies about the effects of fetal stress on the abnormal brain development, focusing on the cellular, molecular and epigenetic mechanisms and highlighting the central effects of glucocorticoids on programming of hypoxicischemic-sensitive phenotype in the neonatal brain, which may enhance the understanding of brain pathophysiology resulting from fetal stress and help explore potential targets of timely diagnosis, prevention and intervention in neonatal hypoxic-ischemic encephalopathy and other for brain disorders. PMID:22627492

Fetal stress and programming of hypoxic/ischemic-sensitive phenotype in the neonatal brain: mechanisms and possible interventions.

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Li, Yong; Gonzalez, Pablo; Zhang, Lubo

2012-08-01

Growing evidence of epidemiological, clinical and experimental studies has clearly shown a close link between adverse in utero environment and the increased risk of neurological, psychological and psychiatric disorders in later life. Fetal stresses, such as hypoxia, malnutrition, and fetal exposure to nicotine, alcohol, cocaine and glucocorticoids may directly or indirectly act at cellular and molecular levels to alter the brain development and result in programming of heightened brain vulnerability to hypoxic-ischemic encephalopathy and the development of neurological diseases in the postnatal life. The underlying mechanisms are not well understood. However, glucocorticoids may play a crucial role in epigenetic programming of neurological disorders of fetal origins. This review summarizes the recent studies about the effects of fetal stress on the abnormal brain development, focusing on the cellular, molecular and epigenetic mechanisms and highlighting the central effects of glucocorticoids on programming of hypoxic-ischemic-sensitive phenotype in the neonatal brain, which may enhance the understanding of brain pathophysiology resulting from fetal stress and help explore potential targets of timely diagnosis, prevention and intervention in neonatal hypoxic-ischemic encephalopathy and other brain disorders. Copyright © 2012 Elsevier Ltd. All rights reserved.

Diagnostic value of perinatal autopsies: analysis of 486 cases.

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Neşe, Nalan; Bülbül, Yeşim

2018-02-23

Autopsy is a beneficial procedure to determine the cause of death and the frequency of anomalies in perinatal losses. Even in the event of an autopsy not providing any additional information, completion of the procedure confirming the clinical diagnoses gives reassurance to both clinicians and parents. Here we present a 15-year archival study based on findings of perinatal autopsies. Four hundred and eighty-six cases from our archive were reviewed and according to the findings they were divided into three subcategories; (1) miscarriages (MCF); (2) fetuses terminated (FTA) for vital anomalies detected by prenatal ultrasonography; (3) premature or term newborns died within first month of life (neonates: NN). Autopsies were documented and classified according to week/age of cases, anomalies and causes of abortion or death. Two hundred and twenty-six of 486 cases (46.5%) were in MCF group while 227 (46.7%) and 33 (6.8%) were of them in FTA and NN groups, respectively. In FTA group, the most frequent anomaly detected was neural tube defects. In NN group, prematurity related complications were the most common cause of death. The autopsy process was found valuable in 39.7% of all cases. We suggest that autopsy procedure is diagnostically valuable even in situations when there is USG findings that are confirming FTAs or there is no important major fetal or placental anomaly detected in MCFs.

Is Fetal Growth Restriction Associated with a More Severe Maternal Phenotype in the Setting of Early Onset Pre-Eclampsia? A Retrospective Study

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Weiler, Jane; Tong, Stephen; Palmer, Kirsten R.

2011-01-01

Background Both pre-eclampsia and fetal growth restriction are thought to result from abnormal placental implantation in early pregnancy. Consistent with this shared pathophysiology, it is not uncommon to see growth restriction further confound the course of pre-eclampsia and vice versa. It has been previously suggested that superimposed growth restriction is associated with a more severe pre-eclamptic phenotype, however this has not been a consistent finding. Therefore, we set out to determine whether the presence of fetal growth restriction among women with severe early-onset pre-eclampsia was associated with more severe maternal disease compared to those without a growth-restricted fetus. Methods and Findings We undertook a retrospective cohort study of women presenting to a tertiary hospital with severe early-onset pre-eclampsia (restriction. However, no significant difference was seen in relation to the severity of pre-eclampsia between those with or without a growth-restricted baby. The presence of concomitant growth restriction was however associated with a significantly increased risk of stillbirth (p = 0.003) and total perinatal mortality (p = 0.02). Conclusions The presence of fetal growth restriction among women with severe early-onset pre-eclampsia is not associated with increased severity of maternal disease. However the incidence of stillbirth and perinatal death is significantly increased in this sub-population. PMID:22046419

Perinatal postmortems: what is important to parents and how do they decide?

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Breeze, Andrew C G; Statham, Helen; Hackett, Gerald A; Jessop, Flora A; Lees, Christoph C

2012-03-01

Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby's body. Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby. © 2012, Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc.

Anaemia of pregnancy, perinatal outcomes and children's developmental vulnerability: a whole-of-population study.

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Smithers, Lisa G; Gialamas, Angela; Scheil, Wendy; Brinkman, Sally; Lynch, John W

2014-09-01

There is limited longitudinal data from high-income countries on the sequelae of anaemia during pregnancy. The aim of this study is to examine whether anaemia of pregnancy is associated with adverse perinatal outcomes and with children's developmental vulnerability. We conducted a population-based study to link routinely collected government administrative data that involved all live births in the state of South Australia 1999-2005 (n = 124 061) and a subset for whom developmental data were collected during a national census of children attending their first year of school in 2009 (n = 13 654). Perinatal outcomes were recorded by midwives using a validated, standardised form. Development was recorded by schoolteachers using the Australian Early Development Index (AEDI). Children in the lowest 10% of AEDI scores are indicative of developmental vulnerability. There were 8764/124 061 (7.1%) cases of anaemia. After adjustment for a range of potentially confounding factors, anaemia of pregnancy was associated with a higher risk of fetal distress [incident rate ratio (IRR) 1.20 [95% CI 1.13, 1.27

More similar than you think: Frog metamorphosis as a model of human perinatal endocrinology.

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Buchholz, Daniel R

2015-12-15

Hormonal control of development during the human perinatal period is critically important and complex with multiple hormones regulating fetal growth, brain development, and organ maturation in preparation for birth. Genetic and environmental perturbations of such hormonal control may cause irreversible morphological and physiological impairments and may also predispose individuals to diseases of adulthood, including diabetes and cardiovascular disease. Endocrine and molecular mechanisms that regulate perinatal development and that underlie the connections between early life events and adult diseases are not well elucidated. Such mechanisms are difficult to study in uterus-enclosed mammalian embryos because of confounding maternal effects. To elucidate mechanisms of developmental endocrinology in the perinatal period, Xenopus laevis the African clawed frog is a valuable vertebrate model. Frogs and humans have identical hormones which peak at birth and metamorphosis, have conserved hormone receptors and mechanisms of gene regulation, and have comparable roles for hormones in many target organs. Study of molecular and endocrine mechanisms of hormone-dependent development in frogs is advantageous because an extended free-living larval period followed by metamorphosis (1) is independent of maternal endocrine influence, (2) exhibits dramatic yet conserved developmental effects induced by thyroid and glucocorticoid hormones, and (3) begins at a developmental stage with naturally undetectable hormone levels, thereby facilitating endocrine manipulation and interpretation of results. This review highlights the utility of frog metamorphosis to elucidate molecular and endocrine actions, hormone interactions, and endocrine disruption, especially with respect to thyroid hormone. Knowledge from the frog model is expected to provide fundamental insights to aid medical understanding of endocrine disease, stress, and endocrine disruption affecting the perinatal period in humans

FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

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Lakshmi

2015-03-01

Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

Hypoxia Room

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Federal Laboratory Consortium — The Hypoxia Room is a 8x8x8 ft. clear vinyl plastic and aluminum frame construction enclosure located within USAREIM laboratory 028. The Hypoxia Room (manufactured...

The effect of fertility treatment on adverse perinatal outcomes in women aged at least 40 years.

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Harlev, Avi; Walfisch, Asnat; Oran, Eynan; Har-Vardi, Iris; Friger, Michael; Lunenfeld, Eitan; Levitas, Eliahu

2018-01-01

To compare perinatal outcomes between spontaneous conception and assisted reproductive technologies (ART) among patients of advanced maternal age. The present retrospective study included data from singleton pregnancies of women aged at least 40 years who delivered between January 1, 1991, and December 31, 2013, at Soroka University Medical Center, Beer Sheva, Israel. Demographic, obstetric, and perinatal data were compared between pregnancies conceived with ART (in vitro fertilization [IVF] or ovulation induction) and those conceived spontaneously. Multiple regression models were used to define independent predictors of adverse outcomes. A total of 8244 singleton pregnancies were included; 229 (2.8%) following IVF, 86 (1.0%) following ovulation induction, and 7929 (96.2%) were spontaneous. Preterm delivery (P<0.001), fetal growth restriction (FGR) (P<0.001), and cesarean delivery (P<0.001) demonstrated linear associations with the conception mode; the highest rates for each were observed for IVF, with decreased rates for ovulation induction and spontaneous conception. The incidence of gestational diabetes and hypertensive disorders were highest among pregnancies following ART. No association was observed between conception mode and perinatal mortality. Multivariate logistic regression demonstrated that IVF was independently associated with increased odds of preterm delivery (P<0.001) and FGR (P=0.027) compared with spontaneous conception. Among patients of advanced maternal age, ART were independently associated with increased FGR and preterm delivery rates compared with spontaneous pregnancies; perinatal mortality was comparable. © 2017 International Federation of Gynecology and Obstetrics.

Life shortening and carcinogenesis in mice irradiated at the perinatal period with gamma rays

International Nuclear Information System (INIS)

Sasaki, S.; Kasuga, T.

1986-01-01

This study elucidates the life-span radiation effects in mice irradiated at the perinatal period in comparison to mice irradiated at the young adult period. B6C3F 1 female mice were irradiated at 17 days of prenatal age, at 0 days of postnatal age, or as young adults at 15 weeks of age with 190, 380, or 570 rads of 137 Cs gamma rays. Mice irradiated at the late fetal period showed dose-dependent life shortening of somewhat lesser magnitude than that seen after neonatal or young adult irradiation. Mice exposed at the late fetal period were highly susceptible to induction of pituitary tumors for which the latent period was the longest of all induced neoplasms. Incidence of lung tumors in mice irradiated at the late fetal period with 190 and 380 rads was higher than in controls. Malignant lymphomas of the lymphocytic type developed in excess, after a short latent period, in mice irradiated fetally with the highest dose; susceptibility of prenatally exposed mice was lower than that of early postnatally exposed mice. Liver tumors developed more frequently in mice irradiated in utero than in controls; susceptibility to induction of this type of neoplasm was highest at the neonatal period. In general, carcinogenic response of mice exposed at the late fetal period resembled that of neonatally exposed mice but was quite different from that of young adult mice. Mice exposed as young adults have no, or low, susceptibility to induction of pituitary, lung, and liver tumors; and a higher susceptibility to induction of myeloid leukemias and Harderian gland tumors. 19 refs., 4 figs., 3 tabs

Pregnancy continuation and organizational religious activity following prenatal diagnosis of a lethal fetal defect are associated with improved psychological outcome.

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Cope, Heidi; Garrett, Melanie E; Gregory, Simon; Ashley-Koch, Allison

2015-08-01

The aim of the article is to examine the psychological impact, specifically symptoms of grief, post-traumatic stress and depression, in women and men who either terminated or continued a pregnancy following prenatal diagnosis of a lethal fetal defect. This project investigated a diagnostically homogeneous group composed of 158 women and 109 men who lost a pregnancy to anencephaly, a lethal neural tube defect. Participants completed the Perinatal Grief Scale, Impact of Event Scale - Revised and Beck Depression Inventory-II, which measure symptoms of grief, post-traumatic stress and depression, respectively. Demographics, religiosity and pregnancy choices were also collected. Gender-specific analysis of variance was performed for instrument total scores and subscales. Women who terminated reported significantly more despair (p = 0.02), avoidance (p = 0.008) and depression (p = 0.04) than women who continued the pregnancy. Organizational religious activity was associated with a reduction in grief (Perinatal Grief Scale subscales) in both women (p = 0.02, p = 0.04 and p = 0.03) and men (p = 0.047). There appears to be a psychological benefit to women to continue the pregnancy following a lethal fetal diagnosis. Following a lethal fetal diagnosis, the risks and benefits, including psychological effects, of termination and continuation of pregnancy should be discussed in detail with an effort to be as nondirective as possible. © 2015 John Wiley & Sons, Ltd.

Centralização de fluxo sanguíneo fetal: comparação entre os índices diagnósticos Brain-sparing effect: comparison of diagnostic indices

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Cleide Mara Mazzotti de Oliveira Franzin

2010-01-01

Full Text Available OBJETIVO: descrever os resultados perinatais adversos em pacientes com centralização de fluxo sanguíneo fetal, utilizando a relação entre os índices de pulsatilidade das artérias cerebral média e umbilical (IPACM/IPAU e entre os índices de resistência das artérias cerebral média e umbilical (IRACM/IRAU, assim como comparar os dois índices diagnósticos. MÉTODOS: foram incluídas 151 gestantes com diagnóstico de centralização de fluxo sanguíneo atendidas na maternidade da Universidade Estadual de Campinas, cujo parto ocorreu até 15 dias após o diagnóstico ultrassonográfico. Foram considerados como resultados perinatais adversos: índice de Apgar inferior a sete no quinto minuto, internação em UTI neonatal, concepto pequeno para a idade gestacional, sofrimento fetal agudo, mortalidade perinatal, hipoglicemia, policitemia, enterocolite necrosante, hemorragia cerebral, hemorragia pulmonar, anemia, septicemia, doença de membrana hialina, síndromes convulsivas, síndrome de hiper-reflexia e insuficiência renal. As frequências dos resultados perinatais adversos (RPA para as relações cérebro-placentária foram comparadas utilizando-se o teste exato de Fisher ou o do χ2 de Pearson, considerando-se como estatisticamente significativo o nível de 5%. Os resultados perinatais adversos foram avaliados de acordo com a idade gestacional, utilizando-se o teste de tendência de Cochrane-Armitage. RESULTADOS: os resultados perinatais adversos para o grupo em que os dois índices apresentaram-se alterados constatou que 62,5% dos recém-natos necessitaram de internação em UTI, conceptos pequenos para a idade gestacional (PIG ocorreram em 75,2%, sofrimento fetal agudo em 35,3%, hipoglicemia em 84,4%, policitemia em 8,3%, enterocolite necrosante em 4,2% e hemorragia cerebral em 2,1%. Constatou-se associação significativa das relações IPACM/IPAU e IRACM/IRAU, no decorrer da idade gestacional, para necessidade de cuidados

Effect of Young Maternal Age on Obstetric and Perinatal Outcomes: Results from the Tertiary Center in Turkey

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Oya Demirci

2016-06-01

Full Text Available Background: Young maternal age is variously defined in studies of its effect on obstetrics and perinatal outcomes. Also, pregnancy has been reported as the leading cause of death in adolescent girls in low- and middle-income countries. Aims: The aim of the study was to evaluate whether young maternal age was associated with an increased risk of obstetrics and perinatal adverse outcomes. Study Design: Case-control study. Methods: This case-control study was derived from a database of the medical records between January 2008 and December 2012. In the present study, 1374 teenage pregnancy and 1294 adult pregnancy cases were included. After restriction of analyses to singleton primiparous women, 1282 teenage pregnancy and 735 adult pregnancy cases were analyzed. Maternal age was separated into three groups: 15 and less, 16-19, and 20-34 years. Adjusted odds ratios (ORs were derived through logistic regression models for the potential confounding factors. Results: Adolescents aged 15 years and younger had higher risks of preterm delivery, early preterm delivery, intrauterine fetal death and neonatal death compared with women aged 20 to 34 years after adjustment for confounding factors. In addition, both groups of adolescents had higher risks for anemia and episiotomy and lower risk of cesarean delivery. The rates of preeclampsia, gestational diabetes, chronic diseases, intrauterine growth restriction (IUGR were higher in the adult group. Conclusion: Younger maternal age was correlated with increased risks of preterm delivery, fetal and neonatal death and anemia.

Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal.

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Manandhar, S R; Manandhar, D S; Adhikari, D; Shrestha, J; Rai, C; Rana, H; Paudel, M

2015-01-01

Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International. Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 . There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities. Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to

Human erythropoietin response to hypocapnic hypoxia, normocapnic hypoxia, and hypocapnic normoxia

DEFF Research Database (Denmark)

Klausen, T; Christensen, H; Hansen, J M

1996-01-01

exposed to 2 h each of hypocapnic hypoxia, normocapnic hypoxia, hypocapnic normoxia, and normal breathing of room air (control experiment). During the control experiment, serum-EPO showed significant variations (ANOVA P = 0.047) with a 15% increase in mean values. The serum-EPO measured in the other...... (10% Co2 with 10% O2) to the hypoxic gas mixture. This elicited an increased ventilation, unaltered arterial pH and haemoglobin oxygen affinity, a lower degree of hypoxia than during hypocapnic hypoxia, and no significant changes in serum-EPO (ANOVA P > 0.05). Hypocapnic normoxia, produced...

The role of magnetic resonance imaging in fetal intervention and management

International Nuclear Information System (INIS)

Fink, A.M.

2002-01-01

Full text: The purpose of this poster is to illustrate the ability of magnetic resonance imaging (MRI) to provide detailed anatomical information in the assessment of fetal anomalies, and the role this information plays in planning maternal and fetal management and treatment. Between November 1999 and June 2001, 41 fetal MRI examinations were performed on 34 patients at the Royal Children's Hospital. The patients were referred for further imaging by neonatologists and paediatric specialists, who had been consulted following an anomaly being detected on routine obstetric ultrasound. Gestational age ranged between 19 and 36 weeks, with a mean gestational age on presentation of 23.5 weeks. All the patients were scanned with high-resolution single shot fast spin echo (SSFSE) T2 weighted sequences, in multiple planes, using a 1.5 Tesla GE LX Echo-speed magnet. Fetal MRI confirmed the diagnosis in 10 cases, added to the ultrasound diagnosis or confirmed a differential diagnosis in 11 cases, and altered the diagnosis in 9 cases (of which 4 were shown to be normal variants). MRI was able to make the diagnosis in 1 case (cervical teratoma), and guided perinatal intervention in 4 cases (1 cervical teratoma, 1 sacrococcygeal teratoma, 1 vein of Galen aneurysm, and 1 case of conjoint twins). In all of the cases to date, MR imaging has provided useful information, particularly in the area of parental counselling, and for practitioners providing fetal management options. While ultrasound remains the screening modality of choice for fetal imaging, the introduction of ultra-fast imaging sequences has dramatically improved the ability of MRI to evaluate fetal anomalies. MRI, with its excellent soft tissue contrast, large field of view, and multiplanar capabilities, frequently provides invaluable additional and complementary information to ultrasound. This is proving particularly useful in the pre-natal management and counselling, the planning of antenatal and peripartum

[Maternal-placental interactions and fetal programming].

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Kadyrov, M; Moser, G; Rath, W; Kweider, N; Wruck, C J; Pufe, T; Huppertz, B

2013-06-01

Pregnancy-related complications not only represent a risk for maternal and fetal morbidity and mortality, but are also a risk for several diseases later in life. Many epidemiological studies have shown clear associations between an adverse intrauterine environment and an increased risk of diabetes, hypertension, cardiovascular disease, depression, obesity, and other chronic diseases in the adult. Some of these syndromes could be prevented by avoiding adverse stimuli or insults including psychological stress during pregnancy, intake of drugs, insufficient diet and substandard working conditions. Hence, all of these stimuli have the potential to alter health later in life. The placenta plays a key role in regulating the nutrient supply to the fetus and producing hormones that control the fetal as well as the maternal metabolism. Thus, any factor or stimulus that alters the function of the hormone producing placental trophoblast will provoke critical alterations of placental function and hence could induce programming of the fetus. The factors that change placental development may interfere with nutrient and oxygen supply to the fetus. This may be achieved by a direct disturbance of the placental barrier or more indirectly by, e. g., disturbing trophoblast invasion. For both path-ways, the respective pathologies are known: while preeclampsia is caused by alterations of the villous trophoblast, intra-uterine growth restriction is caused by insufficient invasion of the extravillous trophoblast. In both cases the effect can be undernutrition and/or fetal hypoxia, both of which adversely affect organ development, especially of brain and heart. However, the mechanisms responsible for disturbances of trophoblast differentiation and function remain elusive. © Georg Thieme Verlag KG Stuttgart · New York.

Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes

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Angadi Rajasab Nilofer

2012-01-01

Full Text Available Background: Gestational diabetes mellitus (GDM is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. The complications associated with GDM can be prevented by early recognition, intense monitoring and proper treatment. Aims: The present study was done to screen the high-risk pregnancy group for GDM, to find the incidence of abnormal results on screening and to correlate the abnormal results with the maternal and fetal outcomes. The study was done in a tertiary care hospital and teaching institute. It was a prospective cohort study. Materials and Methods: Selective screening for GDM was done in 150 pregnant women with high-risk factors. Screening was done with 50 g glucose challenge test (GCT after 18 weeks, and if GCT was negative then the test was repeated after 28 weeks of pregnancy. The patients who were having an abnormal GCT were subjected to 100 g oral glucose tolerance test (OGTT. All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. The period of study was from April 2008 to March 2009. Results: 7.3% of study population was OGCT positive. 6% of the study population was OGTT positive. Age >25 years, obesity, family history of DM, and past history of GDM were the risk factors significantly associated with GDM. One newborn had hypoglycemia and one had hyperbilirubinemia. The fetal and maternal outcome in GDM patients was good in our study due to early diagnosis and intervention. Conclusion: Women with GDM are at an increased risk for adverse obstetric and perinatal outcome. The increased morbidity in GDM is preventable by meticulous antenatal care.

Prenatal diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center Diagnóstico pré-natal e evolução perinatal de 38 casos de hérnia diafragmática congênita: 8 anos de experiência de um serviço terciário brasileiro

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Rodrigo Ruano

2006-06-01

Full Text Available PURPOSE: To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks.Thirty (79% cases had a left diaphragmatic defect and 8 (21% had a right lesion. Associated structural malformations were observed in 21 (55% cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45% cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.OBJETIVO: Avaliar os resultados neonatais dos

Bone health in children and adolescents with perinatal HIV infection

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Puthanakit, Thanyawee; Siberry, George K

2013-01-01

The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood. PMID:23782476

Disturbances of perinatal carbohydrate metabolism in rats exposed to methylmercury in utero

Energy Technology Data Exchange (ETDEWEB)

Snell, K; Ashby, S L; Barton, S J

1977-12-01

Pregnant rats were given a single subcutaneous injection of methylmercuric chloride (at 4 or 8 mg/kg) on the ninth day of gestation. Fetal (2 days prenatal), newborn and postnatal (6 days post partum) animals from the methylmercury-treated mothers were investigated with respect to parameters of carbohydrate metabolism. In the absence of any physical abnormalities, fetal rats exposed to methylmercury in utero showed diminished concentrations of plasma glucose and liver glycogen concentrations and a lower hepatic glucose-6-phosphatase activity compared to control animals. Newborn rats from the methylmercury-treated mothers showed an impairment in glycogen mobilization in the first hours of extra-uterine life which was accompanied by a severe and protracted hypoglycemic response. Postnatal rats exposed to methylmercury in utero exhibited higher liver glycogen concentration and decreased body weights compared to control rats. The results point to a derangement of perinatal carbohydrate metabolism in the offspring of pregnant rats exposed briefly to low doses of methylmercury during gestation (''metabolic teratogenesis''). The postnatal hypoglycemic episode in exposed rats may contribute to the pathogenesis of the neurological disturbances revealed by these animals in later life.

Anti-E Alloimmunization: A Rare Cause of Severe Fetal Hemolytic Disease Resulting in Pregnancy Loss

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An-Shine Chao

2009-01-01

Full Text Available We report a case of severe intrauterine hemolysis caused by sole anti-E alloimmunization. A 36-year-old multipara woman presented with hydrops fetalis at 27 weeks of gestation. She had a history of previous neonatal death. In this pregnancy, she was found to have very high titer of anti-E antibody. Ultrasonography detected marked skin edema, cardiomegaly, hepatosplenomegaly, pleural effusion, ascites, placentomegaly, and polyhydramnios. The Doppler peak systolic velocity in the middle cerebral artery was 0.8 m/s, indicating severe fetal anemia. Multiple intrauterine transfusions for the anemic fetus were administered. However, persistent severe fetal anemia and placentomegaly caused poor neonatal death and mirror syndrome in the mother. Uncommon red blood cell alloimmunization has to be watched for early in any population, especially in a woman with a history of unexplained perinatal loss.

The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

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Walsh, Joseph C.; Lebedev, Artem; Aten, Edward; Madsen, Kathleen; Marciano, Liane

2014-01-01

I. Introduction II. The Clinical Importance of Tumor Hypoxia A. Pathophysiology of hypoxia B. Hypoxia's negative impact on the effectiveness of curative treatment 1. Hypoxic tumors accumulate and propagate cancer stem cells 2. Hypoxia reduces the effectiveness of radiotherapy 3. Hypoxia increases metastasis risk and reduces the effectiveness of surgery 4. Hypoxic tumors are resistant to the effects of chemotherapy and chemoradiation C. Hypoxia is prognostic for poor patient outcomes III. Diagnosis of Tumor Hypoxia A. Direct methods 1. Oxygen electrode—direct pO2 measurement most used in cancer research 2. Phosphorescence quenching—alternative direct pO2 measurement 3. Electron paramagnetic resonance 4. 19F-magnetic resonance spectroscopy 5. Overhauser-enhanced MRI B. Endogenous markers of hypoxia 1. Hypoxia-inducible factor-1α 2. Carbonic anhydrase IX 3. Glucose transporter 1 4. Osteopontin 5. A combined IHC panel of protein markers for hypoxia 6. Comet assay C. Physiologic methods 1. Near-infrared spectroscopy/tomography—widely used for pulse oximetry 2. Photoacoustic tomography 3. Contrast-enhanced color duplex sonography 4. MRI-based measurements 5. Blood oxygen level-dependent MRI 6. Pimonidazole 7. EF5 (pentafluorinated etanidazole) 8. Hypoxia PET imaging—physiologic hypoxia measurement providing tomographic information a. 18F-fluoromisonidazole b. 18F-fluoroazomycinarabinofuranoside c. 18F-EF5 (pentafluorinated etanidazole) d. 18F-flortanidazole e. Copper (II) (diacetyl-bis (N4-methylthiosemicarbazone)) f. 18F-FDG imaging of hypoxia IV. Modifying Hypoxia to Improve Therapeutic Outcomes A. Use of hypoxia information in radiation therapy planning B. Use of hypoxia assessment for selection of patients responsive to nimorazole C. Use of hypoxia assessment for selection of patients responsive to tirapazamine D. Use of hypoxia assessment for selection of patients

Hypoxia and hypoxia mimetics decrease aquaporin 5 (AQP5 expression through both hypoxia inducible factor-1α and proteasome-mediated pathways.

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Jitesh D Kawedia

Full Text Available The alveolar epithelium plays a central role in gas exchange and fluid transport, and is therefore critical for normal lung function. Since the bulk of water flux across this epithelium depends on the membrane water channel Aquaporin 5 (AQP5, we asked whether hypoxia had any effect on AQP5 expression. We show that hypoxia causes a significant (70% decrease in AQP5 expression in the lungs of mice exposed to hypoxia. Hypoxia and the hypoxia mimetic, cobalt, also caused similar decreases in AQP5 mRNA and protein expression in the mouse lung epithelial cell line MLE-12. The action of hypoxia and cobalt on AQP5 transcription was demonstrated by directly quantifying heternonuclear RNA by real-time PCR. Dominant negative mutants of Hypoxia Inducible Factor (HIF-1α and HIF-1α siRNA blocked the action of cobalt, showing that HIF-1α is a key component in this mechanism. The proteasome inhibitors, lactacystin or proteasome inhibitor-III completely abolished the effect of hypoxia and cobalt both at the protein and mRNA level indicating that the proteasome pathway is probably involved not only for the stability of HIF-1α protein, but for the stability of unidentified transcription factors that regulate AQP5 transcription. These studies reveal a potentially important physiological mechanism linking hypoxic stress and membrane water channels.

Hypoxia and Hypoxia Mimetics Decrease Aquaporin 5 (AQP5) Expression through Both Hypoxia Inducible Factor-1α and Proteasome-Mediated Pathways

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Kawedia, Jitesh D.; Yang, Fan; Sartor, Maureen A.; Gozal, David; Czyzyk-Krzeska, Maria; Menon, Anil G.

2013-01-01

The alveolar epithelium plays a central role in gas exchange and fluid transport, and is therefore critical for normal lung function. Since the bulk of water flux across this epithelium depends on the membrane water channel Aquaporin 5 (AQP5), we asked whether hypoxia had any effect on AQP5 expression. We show that hypoxia causes a significant (70%) decrease in AQP5 expression in the lungs of mice exposed to hypoxia. Hypoxia and the hypoxia mimetic, cobalt, also caused similar decreases in AQP5 mRNA and protein expression in the mouse lung epithelial cell line MLE-12. The action of hypoxia and cobalt on AQP5 transcription was demonstrated by directly quantifying heternonuclear RNA by real-time PCR. Dominant negative mutants of Hypoxia Inducible Factor (HIF-1α) and HIF-1α siRNA blocked the action of cobalt, showing that HIF-1α is a key component in this mechanism. The proteasome inhibitors, lactacystin or proteasome inhibitor-III completely abolished the effect of hypoxia and cobalt both at the protein and mRNA level indicating that the proteasome pathway is probably involved not only for the stability of HIF-1α protein, but for the stability of unidentified transcription factors that regulate AQP5 transcription. These studies reveal a potentially important physiological mechanism linking hypoxic stress and membrane water channels. PMID:23469202

GABA accumulating neurons are relatively resistant to chronic hypoxia in vitro: An autoradiographic study

International Nuclear Information System (INIS)

Sher, P.K.; Hu, S.

1990-01-01

Whether there is preferential loss of certain types of nerve cells or specific cellular functions after hypoxic or ischemic insults remains unclear. To evaluate this phenomenon in vitro, the vulnerability of GABAergic neurons to hypoxia was investigated both quantitatively and with autoradiography. Immature neuronal cortical cultures obtained from fetal mice were subjected to chronic hypoxia (5% O2) for 24 h or 48 h and then returned to the normoxic condition for 48 h. The shorter hypoxic exposure resulted in significantly reduced numbers of neurons in comparison to the longer exposure and also to controls (29% and 26%, respectively; p less than 0.001). LDH efflux, a reliable indicator of cell damage, also was higher after the shorter exposure insult. Nevertheless, in these same 24 h hypoxic cultures there was prominent sparing of those neurons which accumulate GABA: by 48 h of recovery GABAergic neurons constituted 29.3 +/- 2.0% of the remaining neuronal population in comparison to 11.6 +/- 0.6 and 14.4 +/- 0.8% for controls and 48 h hypoxia, respectively; (p less than 0.001). Although total GABA uptake per neuron was significantly decreased after both types of insult, there was a concomitant increase in glial GABA uptake (i.e., that which could be displaced by beta-alanine). These observations suggest that certain GABAergic cortical neurons are relatively more resistant to chronic hypoxia than the general neuronal population and that depression of overall neuronal GABA uptake may be associated with enhanced glial GABA uptake

Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester

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Vesna Livrinova

2018-06-01

CONCLUSION: There is a significant difference in unfavourable outcome in the cases with PAPP-A under 0.4 Mom, particular in the group, with a PAPP-A value under 0.2 MoM. The patients delivered with SC with the main indications in utero hypoxia, growth restriction and elevated blood pressure had PAPP-A between 0.3-0.4 MoM. The patients with intrauterine fetal death and placental abruption in the most of the cases have PAPP-A value under 0.2 MoM. There is a need to be aware in these pregnancies to achieve the preventions of adverse outcome, to decrease perinatal morbidity and mortality.

Prenatal hypoxia induces increased cardiac contractility on a background of decreased capillary density

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Ousley Victoria

2009-01-01

Full Text Available Abstract Background Chronic hypoxia in utero (CHU is one of the most common insults to fetal development and may be associated with poor cardiac recovery from ischaemia-reperfusion injury, yet the effects on normal cardiac mechanical performance are poorly understood. Methods Pregnant female wistar rats were exposed to hypoxia (12% oxygen, balance nitrogen for days 10–20 of pregnancy. Pups were born into normal room air and weaned normally. At 10 weeks of age, hearts were excised under anaesthesia and underwent retrograde 'Langendorff' perfusion. Mechanical performance was measured at constant filling pressure (100 cm H2O with intraventricular balloon. Left ventricular free wall was dissected away and capillary density estimated following alkaline phosphatase staining. Expression of SERCA2a and Nitric Oxide Synthases (NOS proteins were estimated by immunoblotting. Results CHU significantly increased body mass (P in utero. Conclusion These data offer potential mechanisms for poor recovery following ischaemia, including decreased coronary flow reserve and impaired angiogenesis with subsequent detrimental effects of post-natal cardiac performance.

Fetal cardiac function in late-onset intrauterine growth restriction vs small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler.

Science.gov (United States)

Pérez-Cruz, M; Cruz-Lemini, M; Fernández, M T; Parra, J A; Bartrons, J; Gómez-Roig, M D; Crispi, F; Gratacós, E

2015-10-01

Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and mean uterine artery (UtA) pulsatility index (PI) can predict a subgroup of fetuses with poor perinatal outcome; however, the association of these criteria with fetal cardiac structure and function is unknown. Our aim was to determine the presence and severity of signs indicating cardiac dysfunction in small fetuses, classified as intrauterine growth-restricted (IUGR) or small-for-gestational age (SGA), according to EFW, CPR and UtA-PI. A cohort of 209 late-onset small fetuses that were delivered > 34 weeks of gestation was divided in two categories: SGA (n = 59) if EFW was between the 3(rd) and 9(th) centiles with normal CPR and UtA-PI; and IUGR (n = 150) if EFW was  95(th) centile. The small population was compared with 150 appropriately grown fetuses (controls). Fetal cardiac morphometry and function were assessed by echocardiography using two-dimensional M-mode, conventional and tissue Doppler. Compared with controls, both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index ± SD: controls, 1.8 ± 0.3; SGA, 1.5 ± 0.2; and IUGR, 1.6 ± 0.3; P < 0.01) and showed signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (mean ± SD: controls, 8.2 ± 1.1; SGA, 7.4 ± 1.2; and IUGR, 6.9 ± 1.1; P < 0.001) and increased left myocardial performance index (mean ± SD: controls, 0.45 ± 0.14; SGA, 0.51 ± 0.08; and IUGR, 0.57 ± 0.1; P < 0.001). Despite a perinatal outcome comparable to that of normal fetuses, the population of so-defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not 'constitutionally small' and that further research is needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Concurrent determination of bisphenol A pharmacokinetics in maternal and fetal rhesus monkeys

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Patterson, Tucker A. [Division of Neurotoxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Twaddle, Nathan C. [Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Roegge, Cindy S. [Division of Neurotoxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Callicott, Ralph J. [U.S. Food and Drug Administration and Priority One Services Corp, Jefferson, AR 72079 (United States); Fisher, Jeffrey W. [Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States); Doerge, Daniel R., E-mail: daniel.doerge@fda.hhs.gov [Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079 (United States)

2013-02-15

Bisphenol A (BPA) is an important industrial chemical used as the monomer for polycarbonate plastic and in epoxy resins for food can liners. Worldwide biomonitoring studies consistently find a high prevalence of BPA conjugates in urine (> 90%) in amounts consistent with aggregate exposure at levels below 1 μg/kg bw/d. The current study used LC/MS/MS to measure concurrently the pharmacokinetics of aglycone (active) and conjugated (inactive) deuterated BPA (d6) in maternal and fetal rhesus monkey serum, amniotic fluid, and placenta following intravenous injection in the dam (100 μg/kg bw). Internal exposures of the fetus to aglycone d6-BPA (serum AUC) were attenuated by maternal, placental, and fetal Phase II metabolism to less than half that in the dam. Levels of aglycone and conjugated d6-BPA measured in whole placenta were consistent with a role in metabolic detoxification. The monotonic elimination of aglycone d6-BPA from the fetal compartment accompanied by persistent conjugate levels provides further evidence arguing against the hypothesis that BPA conjugates are selectively deconjugated by either the placenta or fetus. These results also provide benchmarks to guide the interpretation of human cord blood, amniotic fluid, and placenta sampling and measurement strategies as a basis for estimating fetal exposures to BPA. This study in a non-human primate model provides additional pharmacokinetic data for use in PBPK modeling of perinatal exposures to BPA from food contact, medical devices, and other environmental sources. - Highlights: ► Maternal, placental, and fetal Phase II metabolism attenuate fetal exposure to BPA. ► Serum AUC for aglycone BPA in fetal monkeys is less than half of that in the dam. ► BPA profiles in monkey fetus rule out selective deconjugation and accumulation. ► BPA levels in monkey placenta are similar to other metabolically active tissues. ► Some published human cord blood data for BPA are inconsistent with these measurements.

Ultrasonographic fetal growth charts: an informatic approach by quantitative analysis of the impact of ethnicity on diagnoses based on a preliminary report on Salentinian population.

Science.gov (United States)

Tinelli, Andrea; Bochicchio, Mario Alessandro; Vaira, Lucia; Malvasi, Antonio

2014-01-01

Clear guidance on fetal growth assessment is important because of the strong links between growth restriction or macrosomia and adverse perinatal outcome in order to reduce associated morbidity and mortality. Fetal growth curves are extensively adopted to track fetal sizes from the early phases of pregnancy up to delivery. In the literature, a large variety of reference charts are reported but they are mostly up to five decades old. Furthermore, they do not address several variables and factors (e.g., ethnicity, foods, lifestyle, smoke, and physiological and pathological variables), which are very important for a correct evaluation of the fetal well-being. Therefore, currently adopted fetal growth charts are inadequate to support the melting pot of ethnic groups and lifestyles of our society. Customized fetal growth charts are needed to provide an accurate fetal assessment and to avoid unnecessary obstetric interventions at the time of delivery. Starting from the development of a growth chart purposely built for a specific population, in the paper, authors quantify and analyse the impact of the adoption of wrong growth charts on fetal diagnoses. These results come from a preliminary evaluation of a new open service developed to produce personalized growth charts for specific ethnicity, lifestyle, and other parameters.

Relationship between vitamin D during perinatal development and health.

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Kaludjerovic, Jovana; Vieth, Reinhold

2010-01-01

Vitamin D deficiency is a highly prevalent condition that is present in 40% to 80% of pregnant women. There is emerging evidence that vitamin D deficiency may be a risk modifying factor for many chronic diseases, including osteomalacia, rickets, multiple sclerosis, schizophrenia, heart disease, type 1 diabetes, and cancer. Heightened susceptibility to these diseases may originate in early life during the development of tissue structure and function. It is suspected that biologic mechanisms can "memorize" the metabolic effects of early nutritional environment through fetal and neonatal imprinting. Inadequate vitamin D nutrition during perinatal life may establish a poor foundation that may produce long-term threats to human health. This review summarizes the risks of vitamin D deficiency for human health and provides the current vitamin D recommendations for mothers and their newborns. Copyright © 2010 American College of Nurse-Midwives. Published by Elsevier Inc. All rights reserved.

False Labor at Term in Singleton Pregnancies: Discharge After a Standardized Assessment and Perinatal Outcomes.

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Nelson, David B; McIntire, Donald D; Leveno, Kenneth J

2017-07-01

To evaluate perinatal outcomes in women sent home with a diagnosis of false labor at term and assess the time interval to return for delivery. This was a prospective observational cohort study of women at 37 0/7 to 41 6/7 weeks of gestation without pre-existing medical complications who presented to our hospital-based triage unit with symptoms of labor and underwent a standardized evaluation. Women diagnosed as having false labor with a live singleton fetus in cephalic presentation without a prior cesarean delivery and sent home were compared with a group of similar women diagnosed to be in spontaneous labor. Women with hypertension, diabetes, and known fetal malformations were excluded. Using a perinatal composite outcome of respiratory insufficiency, intraventricular hemorrhage, culture-proven sepsis, Apgar score 3 or less at 5 minutes, phototherapy, and perinatal death, we tested the noninferiority of being sent home compared with being admitted for labor. The relationship of cervical dilatation to the time interval from discharge home to delivery was also analyzed. Between October 2012 and March 2016, a total of 3,949 women met inclusion criteria and were diagnosed with false labor, discharged, and returned to deliver, whereas 2,592 similar women were admitted in early labor. The mean interval from discharge to return was 4.9 days. Cesarean delivery rates were not different between the study groups-11% for both (P=.69), and the perinatal composite outcome rates were not significantly different between those sent home and those admitted-3.2% compared with 3.1% (P=.79). Women with more advanced cervical dilatation at discharge returned and delivered significantly earlier than those with less dilatation regardless of parity. Discharge with false labor at term after a standardized assessment in a triage unit was not associated with increased rates of adverse perinatal composite outcomes or cesarean delivery. The time interval to return for delivery was

The role of hypoxia inducible factor 1 (HIF-1) in hypoxia induced apoptosis

NARCIS (Netherlands)

Greijer, A.E.; Wall, E. van der

2004-01-01

Apoptosis can be induced in response to hypoxia. The severity of hypoxia determines whether cells become apoptotic or adapt to hypoxia and survive. A hypoxic environment devoid of nutrients prevents the cell undergoing energy dependent apoptosis and cells become necrotic. Apoptosis regulatory

Bioethics in the evaluation of the fetal central nervous system in third world countries: applying Rotary International’s four way test

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Pablo Emilio Hernández-Rojas

2018-05-01

Full Text Available Evaluation of fetal central nervous system (CNS can be performed with invasive and non-invasive tests but, the implementation of any of both present ethical dilemmas in the prenatal obstetrical management and perinatal therapy. Severely sick fetuses are usually aborted, and such practice is hazardous in third world countries, especially in current times with worldwide spread of Zika virus infection. Rotary International’s four way test give the practitioners a guideline to perform a moral and ethical medical pattern in order to respect the woman and her fetus rights, beneficence and autonomy. Bioethical guidelines in case of an adverse fetal CNS diagnosis is proposed based in this Rotarian moral model.

Role of hypoxia and hypoxia inducible factor in physiological and pathological conditions

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Mozhgan Jahani

2017-11-01

Full Text Available Introduction: Organisms are exposed to oxygen deprivation (Hypoxia in various physiological and pathological conditions. There are different conserve evolutionary responses to counterview with this stress that primary transcriptional response to stress related to hypoxia is interceded by hypoxia-inducible factor (HIF-1 in mammals. This factor can regulate different genes that have essential roles in adaptation to this condition. In this review, the role of this factor in physiological and pathological conditions under hypoxic condition has been evaluated after examining structural features and regulation characteristics of HIF-1. Methods: First, articles related to the keywords of hypoxia and HIF-1 (from 1991-2016 were searched from valid databases such as Springer Link, Google Scholar, PubMed and Science direct. Then, the articles correlated with hypoxia, HIF-1 and their roles in physiological and pathological conditions (120 articles were searched and just 64 articles were selected for this study. Result: According to studies, there are different genes in cells and organs that can be regulated by HIF-1. Activation of genes expression by this protein occurs through its linkage to cis-acting of 50 base pair hypoxia response element (HRE region located in their promotor and enhancer. Depending on circumstances, activation of these genes can be beneficial or harmful. Conclusion: Activation of different genes in hypoxia by HIF-1 has different effects on physiological and pathological conditions. Therefore, HIF-1, as a hypoxia-inducible factor in hypoxic conditions, plays an essential role in the adaptation of cells and organs to changes related to the presence of oxygen.

Fetal well-being: nonimaging assessment and the biophysical profile.

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Jackson, G M; Forouzan, I; Cohen, A W

1991-01-01

All of the testing methods described above are very good at predicting continued fetal health when test results are reassuring. Each test also suffers from a very poor ability to predict compromise when results are abnormal. Thus, the primary value of antepartum fetal monitoring is in identifying those pregnancies that do not require immediate intervention and may be allowed to continue. Certainly, all pregnant women (regardless of risk status) should monitor fetal movement as part of their fetal surveillance. For patients at risk, a variety of testing schemes are available using combinations of the NST, CST and BPP. There are several reasons for using the NST as the primary testing method for those at risk. Even a small antenatal testing area can accommodate three or four FHR monitors, and a single antenatal testing nurse can perform several NSTs at a time. Because the BPP requires an ultrasound machine and a trained technician to perform, and because only one BPP can be done at a time, many obstetricians who do their own in-office fetal testing are unable to adopt BPP testing as their primary means of surveillance. Additionally, it is more economical to use the NST than the BPP for first-line testing. Assuming charges of $150 and $300 for the NST and BPP, respectively, and assuming that 20% of NSTs are nonreactive and require a BPP for second-line testing, the weekly cost of testing 100 patients is $21,000 for the NST and $37,500 for the BPP. This increase-in-testing cost must be balanced against the small improvement in perinatal mortality rates achieved with the use of the BPP. Because it must be performed in a hospital setting and takes an average of 90 minutes to complete, the CST is more expensive and time-consuming than either the NST or BPP and it is less frequently used as the primary method of fetal testing. In the past the CST was the most commonly used secondary test after a nonreactive NST, but use of the BPP in this situation has now become

Diagnosis of Fetal Anomaly and the Increased Maternal Psychological Toll Associated with Pregnancy Termination.

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Coleman, Priscilla K

2015-01-01

Approximately 4% of U.S. abortions occur in desired pregnancies, with many resulting from fetal anomalies. The majority of terminations occur in the second trimester; however in recent years first-trimester ultrasound measurement for nuchal translucency, calculation of risk based on maternal age, and biochemistry at 11-14 weeks gestation, have resulted in earlier prenatal diagnoses for chromosomal abnormalities. First trimester ultrasound can also now lead to diagnoses of major structural abnormalities including anecephaly, ventral wall defects, and limb abnormalities. The American College of Medical Genetics released recommendations underscoring the crucial importance of ethical counseling and substantive communication with parents facing a prenatal diagnosis of fetal anomaly. Unfortunately, the inability of health care providers to understand and empathize with the ardent desire of some parents to refuse termination is likely to be a large factor in the common practice of professionals attempting to steer expectant parents toward termination. Perinatal hospice is family-centered, comprehensive, and integrative in nature. The care provided by perinatal hospice units is delivered by an interdisciplinary team of obstetricians, pediatricians, nurses, social workers and chaplains in 130 locations throughout the U.S. Support is offered from diagnosis until death and beyond with time for "bonding, loving, and losing." "Hospice care is an interactive, and at times intense, form of care. Rather than simply 'letting nature take its course,' this approach empowers the family to take control of some of the consequences of their unfortunate situation." A primary focus of perinatal hospice is on fear reduction. Parents facing the death of an infant often fear isolation and abandonment in addition to worrying about their child experiencing pain. Parents are assured that they will be cared for and supported throughout this entire chapter of their lives, as their babies are kept

Review: Neuroinflammation in intrauterine growth restriction.

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Wixey, Julie A; Chand, Kirat K; Colditz, Paul B; Bjorkman, S Tracey

2017-06-01

Disruption to the maternal environment during pregnancy from events such as hypoxia, stress, toxins, inflammation, and reduced placental blood flow can affect fetal development. Intrauterine growth restriction (IUGR) is commonly caused by chronic placental insufficiency, interrupting supply of oxygen and nutrients to the fetus resulting in abnormal fetal growth. IUGR is a major cause of perinatal morbidity and mortality, occurring in approximately 5-10% of pregnancies. The fetal brain is particularly vulnerable in IUGR and there is an increased risk of long-term neurological disorders including cerebral palsy, epilepsy, learning difficulties, behavioural difficulties and psychiatric diagnoses. Few studies have focused on how growth restriction interferes with normal brain development in the IUGR neonate but recent studies in growth restricted animal models demonstrate increased neuroinflammation. This review describes the role of neuroinflammation in the progression of brain injury in growth restricted neonates. Identifying the mediators responsible for alterations in brain development in the IUGR infant is key to prevention and treatment of brain injury in these infants. Copyright © 2016 Elsevier Ltd. All rights reserved.

Introduction and overview. Perinatal carcinogenesis: growing a node for epidemiology, risk management, and animal studies

International Nuclear Information System (INIS)

Anderson, Lucy M.

2004-01-01

Perinatal carcinogenesis as a cross-disciplinary concern is the subject of this special issue of Toxicology and Applied Pharmacology, which consists of a total of eight reviews or commentaries in the areas of epidemiology, risk assessment, and animal models. Some of the conclusions from these articles, and the Questions and Answers section that follows most of them, are summarized here. There is adequate reason to suspect that perinatal exposures contribute to human cancer risk, both childhood cancers, and those appearing later in life. The latter type of risk may actually be quantitatively the more important, and involve a wide range of types of effects, but has received only limited attention. With regard to childhood cancers, fetal irradiation and diethylstilbestrol exposure are known etiological agents, and it is likely, but not yet certain, there are additional external causes of a portion of these. Some current focal points of interest here include nitroso compounds, DNA topoisomerase inhibitors, viruses, anti-AIDS drugs, and endocrine disruptors. Regulatory agencies must rely heavily on animal data for estimation of human risk due to perinatal exposures to chemicals, and the quantity and quality of these data presently available for this purpose are greatly limiting. Correctly designed conventional animal studies with suspect chemicals are still needed. Furthermore, genetically engineered mouse models for childhood cancers, especially medulloblastoma, have become available, and could be used for screening of candidate causative agents for this cancer type, and for better understanding of gene-environment interactions

Clinical application of maternal serum HPL and INS levels determination for fetal health monitoring during perinatal period

International Nuclear Information System (INIS)

Xiang Xu; Tian Ying; Li Baoping; Luo Pengxiang; Wang Hong; Zhang Su'e; Chen Qiaozhi; Wang Xiaohua

2007-01-01

Objective: To investigate the possible applicability of maternal serum human placental lactogen (HPL) and insulin levels determination for fetal health monitoring. Methods: Maternal serum HPL and insulin levels were determined with RIA in (1) 70 pregnant women clinically diagnosed as with gestational diabetes (2) 66 pregnant women with hypertension and (3) 110 normal pregnant women as controls. Results: Serum HPL and insulin levels in the women with gestational diabetes were significantly higher than those in the controls (P 0.05). Conclusion: Detection of abnormally high or low levels of serum HPL and insulin in pregnant women suggested presence of maternal diseases which might affect fetal development (over weight or growth restriction). This approach was much more sensitive than conventional sonographic examination of fetus. (authors)

Perinatal tuberculosis: a diagnostic challenge

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Edna Lúcia S. de Souza

Full Text Available Despite the high prevalence of tuberculosis in adults and children, the congenital and perinatal forms of tuberculosis are rare. In Brazil, there has been only one published case of congenital tuberculosis and two cases of the perinatal form of this disease. We report a case of perinatal tuberculosis presenting with pneumonia. Alcohol-acid-resistant bacilli were found in the gastric lavage. Diagnosis of this disease presentation requires a high index of suspicion.

Midtrimester preterm prelabour rupture of membranes (PPROM): expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL - III trial).

Science.gov (United States)

van Teeffelen, Augustinus S P; van der Ham, David P; Willekes, Christine; Al Nasiry, Salwan; Nijhuis, Jan G; van Kuijk, Sander; Schuyt, Ewoud; Mulder, Twan L M; Franssen, Maureen T M; Oepkes, Dick; Jansen, Fenna A R; Woiski, Mallory D; Bekker, Mireille N; Bax, Caroline J; Porath, Martina M; de Laat, Monique W M; Mol, Ben W; Pajkrt, Eva

2014-04-04

Babies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome. Women with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05). This study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure. NTR3492 Dutch Trial Register (http://www.trialregister.nl).

Brain susceptibility to oxidative stress in the perinatal period.

Science.gov (United States)

Perrone, Serafina; Tataranno, Luisa M; Stazzoni, Gemma; Ramenghi, Luca; Buonocore, Giuseppe

2015-11-01

Oxidative stress (OS) occurs at birth in all newborns as a consequence of the hyperoxic challenge due to the transition from the hypoxic intrauterine environment to extrauterine life. Free radical (FRs) sources such as inflammation, hyperoxia, hypoxia, ischaemia-reperfusion, neutrophil and macrophage activation, glutamate and free iron release, all increases the OS during the perinatal period. Newborns, and particularly preterm infants, have reduced antioxidant defences and are not able to counteract the harmful effects of FRs. Energy metabolism is central to life because cells cannot exist without an adequate supply of ATP. Due to its growth, the mammalian brain can be considered as a steady-state system in which ATP production matches ATP utilisation. The developing brain is particularly sensitive to any disturbances in energy generation, and even a short-term interruption can lead to long-lasting and irreversible damage. Whenever energy failure develops, brain damage can occur. Accumulating evidence indicates that OS is implicated in the pathogenesis of many neurological diseases, such as intraventricular haemorrhage, hypoxic-ischaemic encephalopathy and epilepsy.

Shared effects of genetic and intrauterine and perinatal environment on the development of metabolic syndrome.

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Patricia M Vuguin

Full Text Available Genetic and environmental factors, including the in utero environment, contribute to Metabolic Syndrome. Exposure to high fat diet exposure in utero and lactation increases incidence of Metabolic Syndrome in offspring. Using GLUT4 heterozygous (G4+/- mice, genetically predisposed to Type 2 Diabetes Mellitus, and wild-type littermates we demonstrate genotype specific differences to high fat in utero and lactation. High fat in utero and lactation increased adiposity and impaired insulin and glucose tolerance in both genotypes. High fat wild type offspring had increased serum glucose and PAI-1 levels and decreased adiponectin at 6 wks of age compared to control wild type. High fat G4+/- offspring had increased systolic blood pressure at 13 wks of age compared to all other groups. Potential fetal origins of adult Metabolic Syndrome were investigated. Regardless of genotype, high fat in utero decreased fetal weight and crown rump length at embryonic day 18.5 compared to control. Hepatic expression of genes involved in glycolysis, gluconeogenesis, oxidative stress and inflammation were increased with high fat in utero. Fetal serum glucose levels were decreased in high fat G4+/- compared to high fat wild type fetuses. High fat G4+/-, but not high fat wild type fetuses, had increased levels of serum cytokines (IFN-γ, MCP-1, RANTES and M-CSF compared to control. This data demonstrates that high fat during pregnancy and lactation increases Metabolic Syndrome male offspring and that heterozygous deletion of GLUT4 augments susceptibility to increased systolic blood pressure. Fetal adaptations to high fat in utero that may predispose to Metabolic Syndrome in adulthood include changes in fetal hepatic gene expression and alterations in circulating cytokines. These results suggest that the interaction between in utero-perinatal environment and genotype plays a critical role in the developmental origin of health and disease.

Resultados maternos e perinatais em gestantes portadoras de leucemia Maternal and perinatal outcomes in pregnant women with leukemia

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Roseli Mieko Yamamoto Nomura

2011-08-01

grupo de gestantes com LMC, verificou-se a ocorrência de anemia em quatro casos (44,4% e plaquetopenia em um (11,1%. Quanto aos resultados perinatais, nas gestações complicadas pela leucemia aguda, a média da idade gestacional no parto foi de 32 semanas (desvio padrão - DP=4,4 e a média do peso do recém-nascido foi 1476 g (DP=657 g. Houve 2 (40,0% óbitos perinatais (um fetal e um neonatal. Nas gestações complicadas pela LMC, a média da idade gestacional no parto foi de 37,6 semanas (DP=1,1 e a média do peso do recém-nascido foi 2870 g (DP=516 g; não houve morte perinatal e nenhuma anomalia fetal foi detectada. CONCLUSÕES: É elevada a morbidade materna e fetal nas gestações complicadas pela leucemia aguda; enquanto que, nas complicadas pela LMC, o prognóstico materno e fetal parece ser mais favorável, com maior facilidade no manejo das complicações.PURPOSE: To describe the maternal and perinatal outcomes of pregnant women diagnosed with leukemia who were followed up for prenatal care and delivery at a university hospital. METHODS: A retrospective study of the period from 2001 to 2011, which included 16 pregnant women with a diagnosis of leukemia followed by antenatal care specialists in hematological diseases and pregnancy. For acute leukemia diagnosed after the first trimester, the recommendation was to perform chemotherapy despite the current pregnancy. For chronic leukemia, patients who were controlled in hematological terms were maintained without medication during pregnancy, or chemotherapy was introduced after the first trimester. We analyzed the maternal and perinatal outcome. RESULTS: Acute lymphoblastic leukemia (ALL was diagnosed in five cases (31.3%, acute myeloid leukemia (AML in two cases (12.5% and chronic myeloid leukemia (CML in nine cases (56.3%. Of the cases of acute leukemia, two (28.6% were diagnosed in the first trimester, two (28.6% in the second and three (42.9% in the third. Two patients with ALL diagnosed in the first

Avaliação da Vitalidade Fetal em Gestantes Diabéticas: Análise dos Resultados Neonatais Fetal Surveillance in Pregnancies Complicated by Diabetes: Analysis of Neonatal Outcome

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Roseli Mieko Yamamoto

2000-10-01

intensive care in 17% and neonatal death in 8%. Conclusions: the fetal well-being examinations correlated with adverse perinatal outcome, showing the need for fetal surveillance in diabetic pregnant women.

Advancing perinatal patient safety through application of safety science principles using health IT.

Science.gov (United States)

Webb, Jennifer; Sorensen, Asta; Sommerness, Samantha; Lasater, Beth; Mistry, Kamila; Kahwati, Leila

2017-12-19

The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes. Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D units standardized care processes through use of electronic health record (EHR)-based order sets and use of smart pumps and other technology to improve medication safety. Units also standardized EHR documentation, particularly related to electronic fetal monitoring (EFM) and shoulder dystocia. Cognitive aids and tools were integrated into EHR and care workflows to create independent checks such as checklists, risk assessments, and communication handoff tools. Units also used data from EHRs to monitor processes of care to learn from defects. Units experienced several challenges incorporating health IT, including obtaining organization approval, working with their busy IT departments, and retrieving standardized data from health IT systems. Use of health IT played an integral part in the planning and implementation of SPPC for participating L&D units. Use of health IT is an encouraging approach for incorporating safety science principles into care to improve perinatal safety and should be incorporated

Radioimmunoassay of erythropoietin and its potential in the diagnosis of fetal hypoxia

International Nuclear Information System (INIS)

Fingerova, H.

1993-01-01

Radioimmunoassay (RIA) for erythropoietin (EPO) in the serum and amniotic fluid was set up, based on donated rabbit antibody and a commercial tracer. EPO levels obtained by means of the RIA correlated well with the results obtained by means of ELISA or a commercial RIA kit. Retrospective evaluations of EPO levels in umbilical cord serum and amniotic fluid samples obtained during 171 vaginal or Cesarean section deliveries have shown that already in the course of spontaneous vaginal delivery a moderate increase of EPO in umbilical cord serum can be detected. The marked increase of EPO levels in both cord serum and amniotic fluid was always observed in relation to a severe fetal distress. (author) 3 figs., 3 refs

Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents' experiences.

Science.gov (United States)

Aiyelaagbe, Esther; Scott, Rebecca E; Holmes, Victoria; Lane, Emma; Heazell, Alexander E P

2017-10-01

Understanding parents' experience of care is essential to develop high-quality perinatal bereavement services. This study aimed at developing a questionnaire to identify parents' needs and record their experience of care. The patient experience questionnaire was developed by professionals and parents, and piloted in a tertiary maternity unit. Responses were received from 58 parents. Sensitivity and kindness of staff and time spent with their baby were ranked as 'very important' by 95% of parents. Care in these areas largely met their needs (90%), although 5% of respondents stated that partners could have been more involved. Between 8% and 15% of respondents did not feel that language used at the diagnosis of fetal death was sensitive, clear and unambiguous. Parents did not always receive written information about their care (5%) or post-mortem (13%). Analysis of bereaved parents' responses identified areas for improvement including greater involvement of partners and a need for timely information. Impact statement What is already known on this subject?: Good quality bereavement care after perinatal death reduces the negative emotional, psychological and social effects for parents. Description of parents' experiences is a potential means to improve the quality of perinatal bereavement care. What do the results of this study add?: Parents' needs and experiences of care after perinatal death were recorded using a patient-experience questionnaire designed by a multi-professional team and parents. Staff behaviour, particularly sensitivity and kindness was highly valued by parents. Giving both verbal and written information could be improved. Training is needed for professionals, particularly those who come into contact with bereaved parents less frequently. What are the implications of these findings for clinical practice and/or further research?: Description of parents' priorities and views can be used to identify areas for improvement in perinatal bereavement care

Ageing and cardiorespiratory response to hypoxia.

Science.gov (United States)

Lhuissier, François J; Canouï-Poitrine, Florence; Richalet, Jean-Paul

2012-11-01

The risk of severe altitude-induced diseases is related to ventilatory and cardiac responses to hypoxia and is dependent on sex, age and exercise training status. However, it remains unclear how ageing modifies these physiological adaptations to hypoxia. We assessed the physiological responses to hypoxia with ageing through a cross-sectional 20 year study including 4675 subjects (2789 men, 1886 women; 14-85 years old) and a longitudinal study including 30 subjects explored at a mean 10.4 year interval. The influence of sex, training status and menopause was evaluated. The hypoxia-induced desaturation and the ventilatory and cardiac responses to hypoxia at rest and exercise were measured. In men, ventilatory response to hypoxia increased (P ageing. Cardiac response to hypoxia was blunted with ageing in both sexes (P ageing. These adaptive responses were less pronounced or absent in post-menopausal women (P ageing in men while cardiac response is blunted with ageing in both sexes. Training aggravates desaturation at exercise in hypoxia, improves the ventilatory response and limits the ageing-induced blunting of cardiac response to hypoxia. Training limits the negative effects of menopause in cardiorespiratory adaptations to hypoxia.

Survey of the Definition of Fetal Viability and the Availability, Indications, and Decision Making Processes for Post-Viability Termination of Pregnancy for Fetal Abnormalities and Health Conditions in Canada.

Science.gov (United States)

Hull, Danna; Davies, Gregory; Armour, Christine M

2016-06-01

The purpose of this study was to explore the definition of fetal viability and the availability, indications, and decision making processes for post-viability termination of pregnancy for fetal abnormalities and health conditions in Canada. An online survey of members of the Canadian Association of Genetic Counsellors, the Canadian College of Medical Geneticists, and the Canadian Society for Maternal-Fetal Medicine who provide direct counselling to, or management of, prenatal patients in Canada (total sample size 815). Results of this study showed that the majority of respondents indicated that their centre will offer post-viability termination of pregnancy (98/123; 80 %). Sixty-seven percent (68/101) of respondents reported the definition of fetal viability to be 24 weeks' gestation. Most respondents reported that a collaborative decision making process was used to determine if post-viability termination of pregnancy would be offered (136/170; 80 %). For conditions presumed to be lethal/likely lethal, the majority of respondents would "sometimes" or "always" offer post-viability termination of pregnancy, whereas for conditions presumed to have a mild effect, the majority of respondents would "rarely" or "never" offer post-viability termination of pregnancy. Ninety percent (77/86) of respondents reported that perinatal hospice is offered as an alternative to termination of pregnancy. In conclusion, this study suggests that although post-viability termination is available in many provinces in Canada, variation in the definition of fetal viability and indications appear to exist. While these variations may lead to unequal access to post-viability termination of pregnancy across Canada, they might also represent the complexity of the decision making process and the importance of examining individual factors to ensure that the most appropriate decision is made in each case.

Eliminating Perinatal HIV Transmission

Centers for Disease Control (CDC) Podcasts

In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.

[Fetal and neonatal mortality from 22 weeks of amenorrhea in the Loire area].

Science.gov (United States)

Branger, B; Beringue, F; Nomballais, M F; Bouderlique, C; Brossier, J P; Savagner, C; Seguin, G; Boog, G; Rozé, J C

1999-07-01

The Pays de Loire has a low perinatal mortality indicators among French regions but this could be due to under-notification. To explore this hypothesis we undertook a survey in order to identify all fetal and neonatal deaths occurring at a gestionnal age of 22 weeks or more. We also tried to examine and analyze the causes of death. All maternity (26) and neonatal wards (5) in the region took part in the survey in 1995. Clinicians were asked to fill out a questionnaire for all deaths occurring from gestational age (GA) 22 weeks and/or concerning a birthweight of a least 500 g. Only perinatal deaths related to parents living in the Pays de Loire were included in the study. Two hundred and sixty seven perinatal deaths were identified out of a total 29,440 births (9.1 /1000). Eighty three (2.8 /1000) were termination of pregnancy for medical reasons, of which 82% were motivated by chromosomic illness. Ninety-nine stillbirths fell (3.4 /1000) into two GA periods: 24 to 27 weeks (20%) and 38 to 41 weeks (2%). The cause of stillbirths remained unknown in 50% of cases despite a post-mortem examination rate of 87%. There were 29 deaths (1 /1000) in the immediate per and post-partum, 40% of which occurred at GA 22 to 25 weeks. Another 38% occurred at GA 36 to 40 weeks and these were related to undectected malformations or infections. Neonatal and intensive care units reported 56 neonatal deaths (1.9 /1000). GA was under 33 weeks for 44% of them. Deaths were caused by usual complications of severe prematurity, neurologic diseases and malformations. Thirty-two percent of total deaths were not notified to the French Authority: 25% of deaths for termination of pregnancy for medical reasons and 7% for stillbirths and per and post partum deaths. This survey suggests that the Pays de Loire perinatal mortality indicators remained low compared with other French regions, even after adjustment for this under notification. This casts doubts on the validity of perinatal mortality

Transfusão intra-uterina em fetos afetados pela doença hemolítica perinatal grave: um estudo descritivo Intrauterine transfusion in fetuses affected by severe perinatal hemolytic disease: a descriptive study

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Dorival Antônio Vitorello

1998-04-01

Full Text Available Objetivo: analisar 54 transfusões intravasculares intra-uterinas (TIVs, ressaltando complicações do procedimento e morbimortalidade perinatal. Material e Métodos: fetos submetidos a TIVs na Clínica Materno-Fetal e Maternidade Carmela Dutra (Florianópolis, SC, entre janeiro de 1992 e agosto de 1997, foram incluídos no estudo. As características das gestantes, dados relativos ao procedimento e ao recém-nascido foram tabulados para análise e apresentados de forma descritiva, utilizando-se percentagem, média, desvio padrão, mediana, variação e risco relativo (RR com intervalo de confiança de 95% (IC conforme apropriado. Resultados: foram realizadas 50 TIVs e quatro ex-sangüíneo transfusões em 21 fetos. Houve quatro óbitos (20%, três dos quais (75% ocorridos em fetos hidrópicos. A idade gestacional média quando da primeira transfusão foi de 29,1 semanas. A concentração média de hemoglobina foi de 5,69 mg/dl. A taxa de mortalidade decorrente do procedimento foi de 7,4%. A idade gestacional média ao nascimento foi 33,9 semanas e o peso médio foi 2.437 gramas. Sessenta e cinco por cento dos recém-nascidos receberam ex-sangüíneo transfusão complementar. Conclusão: a taxa de mortalidade por procedimento (7,4% foi semelhante à relatada na literatura mundial. A taxa de mortalidade perinatal (20% foi mais elevada do que a relatada na literatura estrangeira, mas inferior à relatada em estudo conduzido no Brasil, no qual a prevalência de fetos hidrópicos foi semelhante.Objective: to report 54 intrauterine intravascular transfusions (IITs, describing procedure related complications and associated perinatal morbidity and mortality. Methods: fetuses undergoing IITs at Clínica Materno-Fetal and Maternidade Carmela Dutra, Florianópolis, SC, between January 1992 and August 1997 were included in the study. Patients demographics, procedure and newborn related data were tabulated for analysis and presented in descriptive form

Pimonidazole: a novel hypoxia marker for complementary study of tumor hypoxia and tumor biology

International Nuclear Information System (INIS)

Varia, Mahesh A.; Kennedy, Andrew S.; Calkins-Adams, Dennise P.; Rinker, Lillian; Novotny, Debra; Fowler, Wesley C.; Raleigh, James A.

1997-01-01

Purpose/Objectives: Tumor hypoxia appears to be associated with treatment resistance and with gene expression that may lead to hypoxia-mediated selection of tumor cells as a source for cell growth and metastases. The objective of this study was to develop complementary techniques of hypoxia detection with molecular markers of cell proliferation and metastases in order to investigate the role of tumor hypoxia in tumor biology. Materials and Methods: Pimonidazole is a 2-nitroimidazole which is reductively-activated and becomes covalently bound to thiol-containing proteins only in hypoxic cells. These adducts can be detected using immunohistochemistry, enzyme linked immunosorbent assay or flow cytometry as a measure of hypoxia in tumors. Quantitative immunohistochemical analysis has been completed for five patients with squamous cell carcinoma of the cervix who were given pimonidazole hydrochloride (0.5 g/m 2 intravenously) followed by cervical biopsies 24 hours later. Informed consent was obtained according to a protocol approved by the Institutional Review Board. A minimum of 3 random biopsies were obtained from the tumors and at least four sections examined from each biopsy site. Formalin fixed, paraffin embedded tissue sections were immunostained for pimonidazole binding using a mouse monoclonal antibody. Commercially available monoclonal antibodies were used to detect cell proliferation markers MIB-1 (Ki-67) and to detect vascular endothelial growth factor (VEGF) in tumor cells in contiguous sections. The extent of immunostaining was expressed as the percent of immunostained to total tumor cells as determined by Chalkley point counting. Results: No clinical toxicities were associated with pimonidazole infusion. Immunostaining with pimonidazole antibody was observed in all patients indicating the presence of tumor hypoxia. Qualitatively there is little or no overlap between the areas of hypoxia and proliferation. Quantitative data tabulated below show the

Protective Effects of Fetal Zone Steroids Are Comparable to Estradiol in Hyperoxia-Induced Cell Death of Immature Glia.

Science.gov (United States)

Hübner, Stephanie; Sunny, Donna E; Pöhlke, Christine; Ruhnau, Johanna; Vogelgesang, Antje; Reich, Bettina; Heckmann, Matthias

2017-05-01

Impaired neurodevelopment in preterm infants is caused by prematurity itself; however, hypoxia/ischemia, inflammation, and hyperoxia contribute to the extent of impairment. Because preterm birth is accompanied by a dramatic decrease in 17β-estradiol (E2) and progesterone, preliminary clinical studies have been carried out to substitute these steroids in preterm infants; however, they failed to confirm significantly improved neurologic outcomes. We therefore hypothesized that the persistently high postnatal production of fetal zone steroids [mainly dehydroepiandrosterone (DHEA)] until term could interfere with E2-mediated protection. We investigated whether E2 could reduce hyperoxia-mediated apoptosis in three immature glial cell types and detected the involved receptors. Thereafter, we investigated protection by the fetal zone steroids DHEA, 16α-hydroxy-DHEA, and androstenediol. For DHEA, the involved receptors were evaluated. We examined aromatases, which convert fetal zone steroids into more estrogenic compounds. Finally, cotreatment was compared against single hormone treatment to investigate synergism. In all cell types, E2 and fetal zone steroids resulted in significant dose-dependent protection, whereas the mediating receptors differed. The neuroprotection by fetal zone steroids highly depended on the cell type-specific expression of aromatases, the receptor repertoire, and the potency of the fetal zone steroids toward these receptors. No synergism in fetal zone steroid and E2 cotreatment was detected in two of three cell types. Therefore, E2 supplementation may not be beneficial with respect to neuroprotection because fetal zone steroids circulate in persistently high concentrations until term in preterm infants. Hence, a refined experimental model for preterm infants is required to investigate potential treatments. Copyright © 2017 Endocrine Society.

Migraine induced by hypoxia

DEFF Research Database (Denmark)

Arngrim, Nanna; Schytz, Henrik Winther; Britze, Josefine

2016-01-01

in the visual cortex were measured by proton magnetic resonance spectroscopy. The circumference of cranial arteries was measured by 3 T high-resolution magnetic resonance angiography. Hypoxia induced migraine-like attacks in eight patients compared to one patient after sham (P = 0.039), aura in three...... and possible aura in 4 of 15 patients. Hypoxia did not change glutamate concentration in the visual cortex compared to sham, but increased lactate concentration (P = 0.028) and circumference of the cranial arteries (P ... suggests that hypoxia may provoke migraine headache and aura symptoms in some patients. The mechanisms behind the migraine-inducing effect of hypoxia should be further investigated....

Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India

Science.gov (United States)

Jain, Rajesh; Davey, Sanjeev; Davey, Anuradha; Raghav, Santosh K.; Singh, Jai V.

2016-01-01

Background: Gestational diabetes mellitus (GDM) is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014) after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P 1 in every case). Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001). Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study. PMID:27186155

Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India

Directory of Open Access Journals (Sweden)

Rajesh Jain

2016-01-01

Full Text Available Background: Gestational diabetes mellitus (GDM is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014 after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P 1 in every case. Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001. Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study.

Early cerebral hemodynamic, metabolic and histological changes in hypoxic-ischemic fetal lambs during postnatal life

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Carmen eRey-Santano

2011-09-01

Full Text Available The hemodynamic, metabolic and biochemical changes produce during transition from fetal to neonatal life could be aggravated if asphyctic event occur during fetal life. The aim of the study was to examine the regional cerebral blood flow (RCBF, histological changes, and cerebral brain metabolism in preterm lambs, and to analyze the role of oxidative stress for the first hours of postnatal life following severe fetal asphyxia. 18 chronically instrumented fetal lambs were assigned to: hypoxic-ischemic group, following fetal asphyxia animals were delivered and maintained on intermittent-positive-pressure-ventilation for 3 hours, and non-injured animals that were managed similarly to the previous group and used as control group. During hypoxic-ischemic insult, injured group developed acidosis, hypoxia, hypercapnia, latacidaemia and tachycardia in comparison to control group, without hypotension. Intermittent-positive-pressure-ventilation transiently improved gas exchange and cardiovascular parameters. After HI injury and during ventilation-support, the increased RCBF in inner zones was maintained for hypoxic-ischemic group, but cortical flow did not exhibit differences compared to the control group. Also, the increase of TUNEL positive cells (apoptosis and antioxidant enzymes, and decrease of ATP reserves was significantly higher in the brain regions where the RCBF were not increased.In conclusion, early metabolic, histological and hemodynamic changes involved in brain damage have been intensively investigated and reported in premature asphyctic lambs for the first 3 hours of postnatal life. Those changes have been described in human neonates, so our model could be useful to test the security and the effectiveness of different neuroprotective or ventilatory strategies when are applied in the first hours after fetal hypoxic-ischemic injury.

The World Health Organization fetal growth charts: concept, findings, interpretation, and application.

Science.gov (United States)

Kiserud, Torvid; Benachi, Alexandra; Hecher, Kurt; Perez, Rogelio González; Carvalho, José; Piaggio, Gilda; Platt, Lawrence D

2018-02-01

Ultrasound biometry is an important clinical tool for the identification, monitoring, and management of fetal growth restriction and development of macrosomia. This is even truer in populations in which perinatal morbidity and mortality rates are high, which is a reason that much effort is put onto making the technique available everywhere, including low-income societies. Until recently, however, commonly used reference ranges were based on single populations largely from industrialized countries. Thus, the World Health Organization prioritized the establishment of fetal growth charts for international use. New fetal growth charts for common fetal measurements and estimated fetal weight were based on a longitudinal study of 1387 low-risk pregnant women from 10 countries (Argentina, Brazil, Democratic Republic of Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) that provided 8203 sets of ultrasound measurements. The participants were characterized by median age 28 years, 58% nulliparous, normal body mass index, with no socioeconomic or nutritional constraints (median caloric intake, 1840 calories/day), and had the ability to attend the ultrasound sessions, thus essentially representing urban populations. Median gestational age at birth was 39 weeks, and birthweight was 3300 g, both with significant differences among countries. Quantile regression was used to establish the fetal growth charts, which also made it possible to demonstrate a number of features of fetal growth that previously were not well appreciated or unknown: (1) There was an asymmetric distribution of estimated fetal weight in the population. During early second trimester, the distribution was wider among fetuses 50th percentile. (2) Although fetal sex, maternal factors (height, weight, age, and parity), and country had significant influence on fetal weight (1-4.5% each), their effect was graded across the percentiles. For example, the positive effect of maternal height on fetal

Cerebral (31)P magnetic resonance spectroscopy and systemic acid-base balance during hypoxia in fetal sheep.

NARCIS (Netherlands)

Cappellen van Walsum, A.M. van; Rijpkema, M.J.P.; Heerschap, A.; Oeseburg, B.; Nijhuis, J.G.; Jongsma, H.W.

2003-01-01

The purpose of this study was to investigate cerebral energy metabolism and acid-base homeostasis during impaired oxygen supply in fetal sheep. Systemic acid-base balance was correlated with the sequence in changes of cerebral phosphorus metabolite ratios and intracellular pH. Phosphorus magnetic

Adiponectin supplementation in pregnant mice prevents the adverse effects of maternal obesity on placental function and fetal growth.

Science.gov (United States)

Aye, Irving L M H; Rosario, Fredrick J; Powell, Theresa L; Jansson, Thomas

2015-10-13

Mothers with obesity or gestational diabetes mellitus have low circulating levels of adiponectin (ADN) and frequently deliver large babies with increased fat mass, who are susceptible to perinatal complications and to development of metabolic syndrome later in life. It is currently unknown if the inverse correlation between maternal ADN and fetal growth reflects a cause-and-effect relationship. We tested the hypothesis that ADN supplementation in obese pregnant dams improves maternal insulin sensitivity, restores normal placental insulin/mechanistic target of rapamycin complex 1 (mTORC1) signaling and nutrient transport, and prevents fetal overgrowth. Compared with dams on a control diet, female C57BL/6J mice fed an obesogenic diet before mating and throughout gestation had increased fasting serum leptin, insulin, and C-peptide, and reduced high-molecular-weight ADN at embryonic day (E) 18.5. Placental insulin and mTORC1 signaling was activated, peroxisome proliferator-activated receptor-α (PPARα) phosphorylation was reduced, placental transport of glucose and amino acids in vivo was increased, and fetal weights were 29% higher in obese dams. Maternal ADN infusion in obese dams from E14.5 to E18.5 normalized maternal insulin sensitivity, placental insulin/mTORC1 and PPARα signaling, nutrient transport, and fetal growth without affecting maternal fat mass. Using a mouse model with striking similarities to obese pregnant women, we demonstrate that ADN functions as an endocrine link between maternal adipose tissue and fetal growth by regulating placental function. Importantly, maternal ADN supplementation reversed the adverse effects of maternal obesity on placental function and fetal growth. Improving maternal ADN levels may serve as an effective intervention strategy to prevent fetal overgrowth caused by maternal obesity.

Hypoxia and the anticoagulants dalteparin and acetylsalicylic acid affect human placental amino acid transport.

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Marc-Jens Kleppa

Full Text Available BACKGROUND: Anticoagulants, e.g. low-molecular weight heparins (LMWHs and acetylsalicylic acid (ASA are prescribed to women at risk for pregnancy complications that are associated with impaired placentation and placental hypoxia. Beyond their role as anticoagulants these compounds exhibit direct effects on trophoblast but their impact on placental function is unknown. The amino acid transport systems A and L, which preferably transfer essential amino acids, are well-described models to study placental nutrient transport. We aimed to examine the effect of hypoxia, LMWHs and ASA on the activity of the placental amino acid transport systems A and L and associated signalling mechanisms. METHODS: The uptake of C14-MeAIB (system A or H3-leucin (system L was investigated after incubation of primary villous fragments isolated from term placentas. Villous tissue was incubated at 2% O2 (hypoxia, 8% O2 and standard culture conditions (21% O2 or at 2% O2 and 21% O2 with dalteparin or ASA. Activation of the JAK/STAT or mTOR signalling pathways was determined by Western analysis of total and phosphorylated STAT3 or Raptor. RESULTS: Hypoxia decreased system A mediated MeAIB uptake and increased system L mediated leucine uptake compared to standard culture conditions (21% O2. This was accompanied by an impairment of STAT3 and a stimulation of Raptor signalling. System L activity increased at 8% O2. Dalteparin treatment reduced system A and system L activity under normoxic conditions and ASA (1 mM decreased system A and L transporter activity under normoxic and hypoxic conditions. CONCLUSIONS: Our data underline the dependency of placental function on oxygen supply. LMWHs and ASA are not able to reverse the effects of hypoxia on placental amino acid transport. These findings and the uncovering of the signalling mechanisms in more detail will help to understand the impact of LMWHs and ASA on placental function and fetal growth.

MiRNA-486 regulates angiogenic activity and survival of mesenchymal stem cells under hypoxia through modulating Akt signal

Energy Technology Data Exchange (ETDEWEB)

Shi, Xue-Feng [High Altitude Medicine of Ministry of Chinese Education and Research Center for High Altitude Medicine, Qinghai University, Xining 810001 (China); Department of Experimental Hematology, Beijing Institute of Radiation Medicine, Beijing 100850 (China); Department of Respiration, Qinghai Provincial People' s Hospital, Xining (China); Wang, Hua; Xiao, Feng-Jun [Department of Experimental Hematology, Beijing Institute of Radiation Medicine, Beijing 100850 (China); Yin, Yue [Department of Experimental Hematology, Beijing Institute of Radiation Medicine, Beijing 100850 (China); Department of Hematology, Peking University First Hospital, Beijing (China); Xu, Qin-Qin [High Altitude Medicine of Ministry of Chinese Education and Research Center for High Altitude Medicine, Qinghai University, Xining 810001 (China); Department of Experimental Hematology, Beijing Institute of Radiation Medicine, Beijing 100850 (China); Ge, Ri-Li, E-mail: geriligao@hotmail.com [High Altitude Medicine of Ministry of Chinese Education and Research Center for High Altitude Medicine, Qinghai University, Xining 810001 (China); Wang, Li-Sheng, E-mail: wangls@bmi.ac.cn [Department of Experimental Hematology, Beijing Institute of Radiation Medicine, Beijing 100850 (China)

2016-02-12

MicroRNA-486 (miR-486) was first identified from human fetal liver cDNA library and validated as a regulator of hematopoiesis. Its roles in regulating the biological function of bone marrow-derived mesnechymal stem cells (BM-MSCs) under hypoxia have not been explored yet. In this study, we demonstrated that exposure to hypoxia upregulates miR-486 expression in BM-MSCs. Lentivirus-mediated overexpression of miR-486 resulted in increase of hepatocyte growth factor (HGF) and vascular endothelial growth factor(VEGF) in both mRNA and protein levels. MiR-486 expression also promotes proliferation and reduces apoptosis of BM-MSCs. Whereas MiR-486 knockdown downregulated the secretion of HGF and VEGF and induced apoptosis of BM-MSCs. Furthermore, PTEN-PI3K/AKT signaling was validated to be involved in changes of BM-MSC biological functions regulated by miR-486. These results suggested that MiR-486 mediated the hypoxia-induced angiogenic activity and promoted the proliferation and survival of BM-MSCs through regulating PTEN-PI3K/AKT signaling. These findings might provide a novel understanding of effective therapeutic strategy for hypoxic-ischemic diseases. - Highlights: • miR-486 is a hypoxia-induced miRNA. • miR-486 regulates the secretion of HGF and VEGF, promotes proliferation, and inhibits apoptosis of BM-MSCs. • miR-486 enhances PI3K/AKT activity signaling by targeting PTEN molecule.

The value of predicting restriction of fetal growth and compromise of its wellbeing: Systematic quantitative overviews (meta-analysis) of test accuracy literature.

Science.gov (United States)

Morris, Rachel K; Khan, Khalid S; Coomarasamy, Aravinthan; Robson, Stephen C; Kleijnen, Jos

2007-03-08

Restriction of fetal growth and compromise of fetal wellbeing remain significant causes of perinatal death and childhood disability. At present, there is a lack of scientific consensus about the best strategies for predicting these conditions before birth. Therefore, there is uncertainty about the best management of pregnant women who might have a growth restricted baby. This is likely to be due to a dearth of clear collated information from individual research studies drawn from different sources on this subject. A series of systematic reviews and meta-analyses will be undertaken to determine, among pregnant women, the accuracy of various tests to predict and/or diagnose fetal growth restriction and compromise of fetal wellbeing. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate), exploration of heterogeneity and publication bias. The project will collate and synthesise the available evidence regarding the value of the tests for predicting restriction of fetal growth and compromise of fetal wellbeing. The systematic overviews will assess the quality of the available evidence, estimate the magnitude of potential benefits, identify those tests with good predictive value and help formulate practice recommendations.

Overexpression of Hypoxia-Inducible Factor-1α Exacerbates Endothelial Barrier Dysfunction Induced by Hypoxia

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Pei Wang

2013-09-01

Full Text Available Background/Aims: The mechanisms involved in endothelial barrier dysfunction induced by hypoxia are incompletely understood. There is debate about the role of hypoxia-inducible factor-1α (HIF-1α in endothelial barrier disruption. The aim of this study was to investigate the effect of genetic overexpression of HIF-1α on barrier function and the underlying mechanisms in hypoxic endothelial cells. Methods: The plasmid pcDNA3.1/V5-His-HIF-1α was stably transfected into human endothelial cells. The cells were exposed to normoxia or hypoxia. The mRNA and protein expressions of HIF-1α were detected by RT-PCR and Western blot respectively. The barrier function was assessed by measuring the transendothelial electrical resistance (TER. The Western blot analysis was used to determine the protein expression of glucose transporter-1 (GLUT-1, zonular occludens-1 (ZO-1, occludin, and myosin light chain kinase (MLCK in endothelial cells. The mRNA expression of proinflammatory cytokines was detected by qRT-PCR. Results: Genetic overexpression of HIF-1α significantly increased the mRNA and protein expression of HIF-1α in endothelial cells. The overexpression of HIF-1α enhanced the hypoxia-induced increase of HIF-1α and GLUT-1 protein expression. HIF-1α overexpression not only exacerbated hypoxia-induced endothelial barrier dysfunction but also augmented hypoxia-induced up-regulation of MLCK protein expression. HIF-1α overexpression also enhanced IL-1β, IL-6 and TNF-α mRNA expression. Conclusion: We provide evidence that genetic overexpression of HIF-1α aggravates the hypoxia-induced endothelial barrier dysfunction via enhancing the up-regulation of MLCK protein expression caused by hypoxia, suggesting a potential role for HIF-1α in the pathogenesis of endothelial barrier dysfunction in hypoxia.

TRATAMIENTO POR FETOSCOPIA DEL SÍNDROME DE TRANSFUSIÓN FETO FETAL EN CLÍNICA ALEMANA DE SANTIAGO

OpenAIRE

Yamamoto C,Masami; Astudillo D,Julio; Pedraza S,Daniel; Muñoz S,Hernán; Insunza F,Álvaro; Fleiderman D,José; Riveros K,Rodrigo

2009-01-01

Antecedentes: El síndrome de transfusión feto fetal (STFF) afecta el 15% de los gemelares monocoriales y tiene una mortalidad de 90% cuando se diagnostica antes de las 26 semanas. Objetivo: Evaluar el resultado perinatal mediante fotocoagulación con láser porfetoscopia, de las anastomosis vasculares placentarias en pacientes con STFF. Método: Fotocoagulación láser por fetoscopia de 18 casos de SFF tratados en Clínica Alemana de Santiago entre los años 2005-2008. Resultados: 72,8% de los embar...

Management of Very Early-onset Fetal Growth Restriction: Results from 92 Consecutive Cases.

Science.gov (United States)

Hoellen, Friederike; Beckmann, Annika; Banz-Jansen, Constanze; Weichert, Jan; Rody, Achim; Bohlmann, Michael K

2016-01-01

To evaluate management of early-onset intrauterine growth restriction (IUGR) and to define outcome according to obstetric setting. During an 11-year period (2000-2011), data of patients presenting with IUGR and preterm delivery of less than 30 weeks of gestation at a tertiary perinatal center were retrospectively reviewed. A total of 92 pregnancies were investigated. Delivery was indicated for fetal reasons in 38 out of 92 patients. Sixteen children of our cohort died within one year post partum, out of which eight had suffered from severe early-onset IUGR causing iatrogenic preterm delivery. Concerning the fetal outcome, gestational age at delivery and antenatal exposure to corticosteroids were found to be crucial. In some cases, respiratory distress syndrome prophylaxis and a "wait and see" approach to management in favor of a prolongation of the pregnancy might be favorable. Randomized prospective trials in early-onset IUGR with threatened preterm deliveries are needed in order to define guidelines for an individually tailored management of early-onset preterm infants. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Fetal echocardiography

International Nuclear Information System (INIS)

Chaubal, Nitin G.; Chaubal, Jyoti

2009-01-01

USG performed with a high-end machine, using a good cine-loop facility is extremely helpful in the diagnosis of fetal cardiac anomalies. In fetal echocardiography, the four-chamber view and the outflow-tract view are used to diagnose cardiac anomalies. The most important objective during a targeted anomaly scan is to identify those cases that need a dedicated fetal echocardiogram. Associated truncal and chromosomal anomalies need to be identified. This review shows how fetal echocardiography, apart from identifying structural defects in the fetal heart, can be used to look at rhythm abnormalities and other functional aspects of the fetal heart

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

Science.gov (United States)

Markin, Rayna D; Zilcha-Mano, Sigal

2018-03-01

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Fetal magnetic resonance: technique applications and normal fetal anatomy

International Nuclear Information System (INIS)

Martin, C.; Darnell, A.; Duran, C.; Mellado, F.; Corona, M

2003-01-01

Ultrasonography is the preferred diagnostic imaging technique for intrauterine fetal examination. Nevertheless, circumstances sometimes dictate the use of other techniques in order to analyze fetal structures. The advent of ultra rapid magnetic resonance (MR) sequencing has led to the possibility of doing MR fetal studies, since images are obtained in an extradordiarily short time and are not affected by either maternal or fetal movements. It does not employ ionizing radiations, it provides high-contrast images and it can obtain such images in any plane of space without being influenced by either the child bearer's physical characteristics of fetal position. MR provides good quality images of most fetal organs. It is extremely useful in analysing distinct structures, as well as permitting an evaluation of cervical structures, lungs, diaphragms, intra-abdominal and retroperitoneal structures, and fetal extremities. It can also provide useful information regarding the placenta,umbilical cord, amniotic fluid and uterus. The objective of this work is to describe MR technique as applied to intrauterine fetal examination, and to illustrate normal fetal anatomy as manifested by MR and its applications. (Author) 42 refs

Peroxisome proliferator-activated receptor ligands regulate lipid content, metabolism, and composition in fetal lungs of diabetic rats.

Science.gov (United States)

Kurtz, M; Capobianco, E; Careaga, V; Martinez, N; Mazzucco, M B; Maier, M; Jawerbaum, A

2014-03-01

Maternal diabetes impairs fetal lung development. Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors relevant in lipid homeostasis and lung development. This study aims to evaluate the effect of in vivo activation of PPARs on lipid homeostasis in fetal lungs of diabetic rats. To this end, we studied lipid concentrations, expression of lipid metabolizing enzymes and fatty acid composition in fetal lungs of control and diabetic rats i) after injections of the fetuses with Leukotriene B4 (LTB4, PPARα ligand) or 15deoxyΔ(12,14)prostaglandin J2 (15dPGJ2, PPARγ ligand) and ii) fed during pregnancy with 6% olive oil- or 6% safflower oil-supplemented diets, enriched with PPAR ligands were studied. Maternal diabetes increased triglyceride concentrations and decreased expression of lipid-oxidizing enzymes in fetal lungs of diabetic rats, an expression further decreased by LTB4 and partially restored by 15dPGJ2 in lungs of male fetuses in the diabetic group. In lungs of female fetuses in the diabetic group, maternal diets enriched with olive oil increased triglyceride concentrations and fatty acid synthase expression, while those enriched with safflower oil increased triglyceride concentrations and fatty acid transporter expression. Both olive oil- and safflower oil-supplemented diets decreased cholesterol and cholesteryl ester concentrations and increased the expression of the reverse cholesterol transporter ATP-binding cassette A1 in fetal lungs of female fetuses of diabetic rats. In fetal lungs of control and diabetic rats, the proportion of polyunsaturated fatty acids increased with the maternal diets enriched with olive and safflower oils. Our results revealed important changes in lipid metabolism in fetal lungs of diabetic rats, and in the ability of PPAR ligands to modulate the composition of lipid species relevant in the lung during the perinatal period.

Hypoxia targeting copper complexes

International Nuclear Information System (INIS)

Dearling, J.L.

1998-11-01

The importance and incidence of tumour hypoxia, its measurement and current treatments available, including pharmacological and radiopharmacological methods of targeting hypoxia, are discussed. A variety of in vitro and in vivo methods for imposing hypoxia have been developed and are reviewed. Copper, its chemistry, biochemistry and radiochemistry, the potential for use of copper radionuclides and its use to date in this field is considered with particular reference to the thiosemicarbazones. Their biological activity, metal chelation, in vitro and in vivo studies of their radiocopper complexes and the potential for their use as hypoxia targeting radiopharmaceuticals is described. The reduction of the copper(II) complex to copper(l), its pivotal importance in their biological behaviour, and the potential for manipulation of this to effect hypoxia selectivity are described. An in vitro method for assessing the hypoxia selectivity of radiopharmaceuticals is reported. The rapid deoxygenation and high viability of a mammalian cell culture in this system is discussed and factors which may affect the cellular uptake of a radiopharmaceutical are described. The design, synthesis and complexation with copper and radiocopper of a range of bis(thiosemicarbazones) is reported. Synthesis of these compounds is simple giving high yields of pure products. The characteristics of the radiocopper complexes ( 64 Cu) including lipophilicity and redox activity are reported (reduction potentials in the range -0.314 - -0.590 V). High cellular uptakes of the radiocopper complexes of the ligands, in hypoxic and normoxic EMT6 and CHO320 cells, were observed. Extremes of selectivity are shown ranging from the hypoxia selective 64 Cu(II)ATSM to normoxic cell selective 64 Cu(II)GTS. The selectivities observed are compared with the physico chemical characteristics of the complexes. A good correlation exists between selectivity of the complex and its Cu(II)/Cu(I) reduction potential, with hypoxia

L-Citrulline Supplementation Enhances Fetal Growth and Protein Synthesis in Rats with Intrauterine Growth Restriction.

Science.gov (United States)

Bourdon, Aurélie; Parnet, Patricia; Nowak, Christel; Tran, Nhat-Thang; Winer, Norbert; Darmaun, Dominique

2016-03-01

Intrauterine growth restriction (IUGR) results from either maternal undernutrition or impaired placental blood flow, exposing offspring to increased perinatal mortality and a higher risk of metabolic syndrome and cardiovascular disease during adulthood. l-Citrulline is a precursor of l-arginine and nitric oxide (NO), which regulates placental blood flow. Moreover, l-citrulline stimulates protein synthesis in other models of undernutrition. The aim of the study was to determine whether l-citrulline supplementation would enhance fetal growth in a model of IUGR induced by maternal dietary protein restriction. Pregnant rats were fed either a control (20% protein) or a low-protein (LP; 4% protein) diet. LP dams were randomly allocated to drink tap water either as such or supplemented with l-citrulline (2 g · kg(-1) · d(-1)), an isonitrogenous amount of l-arginine, or nonessential l-amino acids (NEAAs). On day 21 of gestation, dams received a 2-h infusion of l-[1-(13)C]-valine until fetuses were extracted by cesarean delivery. Isotope enrichments were measured in free amino acids and fetal muscle, liver, and placenta protein by GC-mass spectrometry. Fetal weight was ∼29% lower in the LP group (3.82 ± 0.06 g) than in the control group (5.41 ± 0.10 g) (P growth in a model of IUGR, and the effect may be mediated by enhanced fetal muscle protein synthesis and/or increased NO production. © 2016 American Society for Nutrition.

Analysis of fetal movements by Doppler actocardiogram and fetal B-mode imaging.

Science.gov (United States)

Maeda, K; Tatsumura, M; Utsu, M

1999-12-01

We have presented that fetal surveillance may be enhanced by use of the fetal actocardiogram and by computerized processing of fetal motion as well as fetal B-mode ultrasound imaging. Ultrasonic Doppler fetal actogram is a sensitive and objective method for detecting and recording fetal movements. Computer processing of the actograph output signals enables powerful, detailed, and convenient analysis of fetal physiologic phenomena. The actocardiogram is a useful measurement tool not only in fetal behavioral studies but also in evaluation of fetal well-being. It reduces false-positive, nonreactive NST and false-positive sinusoidal FHR pattern. It is a valuable tool to predict fetal distress. The results of intrapartum fetal monitoring are further improved by the antepartum application of the actocardiogram. Quantified fetal motion analysis is a useful, objective evaluation of the embryo and fetus. This method allows monitoring of changes in fetal movement, as well as frequency, amplitude, and duration. Furthermore, quantification of fetal motion enables evaluation of fetal behavior states and how these states relate to other measurements, such as changes in FHR. Numeric analysis of both fetal actogram and fetal motion from B-mode images is a promising application in the correlation of fetal activity or behavior with other fetal physiologic measurements.

Early brain development toward shaping of human mind: an integrative psychoneurodevelopmental model in prenatal and perinatal medicine.

Science.gov (United States)

Hruby, Radovan; Maas, Lili M; Fedor-Freybergh, P G

2013-01-01

The article introduces an integrative psychoneurodevelopmental model of complex human brain and mind development based on the latest findings in prenatal and perinatal medicine in terms of integrative neuroscience. The human brain development is extraordinarily complex set of events and could be influenced by a lot of factors. It is supported by new insights into the early neuro-ontogenic processes with the help of structural 3D magnetic resonance imaging or diffusion tensor imaging of fetal human brain. Various factors and targets for neural development including birth weight variability, fetal and early-life programming, fetal neurobehavioral states and fetal behavioral responses to various stimuli and others are discussed. Molecular biology reveals increasing sets of genes families as well as transcription and neurotropic factors together with critical epigenetic mechanisms to be deeply employed in the crucial neurodevelopmental events. Another field of critical importance is psychoimmuno-neuroendocrinology. Various effects of glucocorticoids as well as other hormones, prenatal stress and fetal HPA axis modulation are thought to be of special importance for brain development. The early postnatal period is characterized by the next intense shaping of complex competences, induced mainly by the very unique mother - newborn´s interactions and bonding. All these mechanisms serve to shape individual human mind with complex abilities and neurobehavioral strategies. Continuous research elucidating these special competences of human fetus and newborn/child supports integrative neuroscientific approach to involve various scientific disciplines for the next progress in human brain and mind research, and opens new scientific challenges and philosophic attitudes. New findings and approaches in this field could establish new methods in science, in primary prevention and treatment strategies, and markedly contribute to the development of modern integrative and personalized

Intact fetal ovarian cord formation promotes mouse oocyte survival and development

Directory of Open Access Journals (Sweden)

Pera Renee

2010-01-01

Full Text Available Abstract Background Female reproductive potential, or the ability to propagate life, is limited in mammals with the majority of oocytes lost before birth. In mice, surviving perinatal oocytes are enclosed in ovarian follicles for subsequent oocyte development and function in the adult. Before birth, fetal germ cells of both sexes develop in clusters, or germline cysts, in the undifferentiated gonad. Upon sex determination of the fetal gonad, germ cell cysts become organized into testicular or ovarian cord-like structures and begin to interact with gonadal somatic cells. Although germline cysts and testicular cords are required for spermatogenesis, the role of cyst and ovarian cord formation in mammalian oocyte development and female fertility has not been determined. Results Here, we examine whether intact fetal ovarian germ and somatic cell cord structures are required for oocyte development using mouse gonad re-aggregation and transplantation to disrupt gonadal organization. We observed that germ cells from disrupted female gonad prior to embryonic day e13.5 completed prophase I of meiosis but did not survive following transplantation. Furthermore, re-aggregated ovaries from e13.5 to e15.5 developed with a reduced number of oocytes. Oocyte loss occurred before follicle formation and was associated with an absence of ovarian cord structure and ovary disorganization. However, disrupted ovaries from e16.5 or later were resistant to the re-aggregation impairment and supported robust oocyte survival and development in follicles. Conclusions Thus, we demonstrate a critical window of oocyte development from e13.5 to e16.5 in the intact fetal mouse ovary, corresponding to the establishment of ovarian cord structure, which promotes oocyte interaction with neighboring ovarian somatic granulosa cells before birth and imparts oocytes with competence to survive and develop in follicles. Because germline cyst and ovarian cord structures are conserved in the

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

Directory of Open Access Journals (Sweden)

van Diem Mariet Th

2012-07-01

Full Text Available Abstract Background Perinatal (mortality audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF, the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%, ‘internal cooperation’ (17%, ‘practice organization’ (26%, ‘training and education’ (10%, and ‘medical performance’ (27%. Valued aspects of the audit meetings were: the multidisciplinary character (13%, the collective and non-judgmental search for substandard factors (21%, the perception of safety (13%, the motivation to reflect on one’s own professional performance (5%, and the inherent postgraduate education (10%. Conclusion

THE COMPARISON OF SLOVENIAN AND EUROPEAN PERINATAL DATA OR AS MORE BACK WE LOOK FURTHER INTO THE FUTURE WE WILL SEE

Directory of Open Access Journals (Sweden)

Živa Novak

2018-02-01

Full Text Available Background: Slovenian perinatal results are compared with European results: sometimes they are in the higher, sometimes in the lower range. Analysing trends and comparisons with other countries helps in planning changes in organisation and function so we are prepared for future challenges. Introduction of new technologies demands appropriate answers to challenges, including ethical ones. Methods: We compared perinatal results in Slovenia from 1987 to 1996, the PERISTAT project results from the year 2000 and the EURO-PERISTAT project with 2004 perinatal results including the Slovenian. Results: Some of the more prominent Slovenian perinatal results are shown. Cesarean section rate is the lowest among 26 countries in Europe. Deliveries after artificial reproductive techniques are second most frequent. Teenage pregnancies are very rare. Seemingly high maternal mortality mirrors also strict recording and cross checking with other data bases. Relatively high stillbirth rate may reflect the fact that all induced labours for fetal malformations are recorded. Conclusions: In Slovenia we do have tools for quality collection of perinatal results which should be used and audited. To have comparable results inside Slovenia, definitions should be written at http://www.obgyn-si.org/. When changing delivery record markers of prenatal care should be added – they could be easily obtained from maternity booklets (electronic or paper. In maternity booklet there is a place to write about grand dad prostate cancer; let us replace it with risk factors for preterm delivery (medical history and cervical length, 12 weeks screening for preeclampsia and intrauterine growth restriction (ultrasonic and biochemi- cal markers, gestational diabetes and obesity (body mass index, waist – hips ratio and hypothyroidism; let us leave some free space for the future screening tests. Known and proven efficient management (e.g. progesterone for recurrent preterm delivery prevention

Signaling hypoxia by hypoxia-inducible factor protein hydroxylases: a historical overview and future perspectives

Science.gov (United States)

Bishop, Tammie; Ratcliffe, Peter J

2014-01-01

By the early 1900s, the close matching of oxygen supply with demand was recognized to be a fundamental requirement for physiological function, and multiple adaptive responses to environment hypoxia had been described. Nevertheless, the widespread operation of mechanisms that directly sense and respond to levels of oxygen in animal cells was not appreciated for most of the twentieth century with investigators generally stressing the regulatory importance of metabolic products. Work over the last 25 years has overturned that paradigm. It has revealed the existence of a set of “oxygen-sensing” 2-oxoglutarate dependent dioxygenases that catalyze the hydroxylation of specific amino acid residues and thereby control the stability and activity of hypoxia-inducible factor. The hypoxia-inducible factor hydroxylase pathway regulates a massive transcriptional cascade that is operative in essentially all animal cells. It transduces a wide range of responses to hypoxia, extending well beyond the classical boundaries of hypoxia physiology. Here we review the discovery and elucidation of these pathways, and consider the opportunities and challenges that have been brought into focus by the findings, including new implications for the integrated physiology of hypoxia and therapeutic approaches to ischemic/hypoxic disease. PMID:27774477

Intrapartum fetal heart rate profiles with and without fetal asphyxia.

Science.gov (United States)

Low, J A; Pancham, S R; Worthington, D N

1977-04-01

Fetal heart rate profiles for periods up to 12 hours prior to delivery have been reviewed in 515 patients with a fetus at risk. Mechanisms other than fetal asphyxia will cause fetal heart rate decelerations, and fetal asphyxia may in some instances develop in the absence of total or late decelerations. However, an increasing incidence of total decelerations and late decelerations and particularly a marked pattern of total decelerations and late decelerations are of value in the prediction of fetal asphyxia. Fetal heart rate deceleration patterns can predict the probability of fetal asphyxia at the time of initial intervention, while a progression of fetal heart rate deceleration patterns in the individual fetus can be of assistance in the subsequent scheduling of serial acid-base assessments during labor.

Fetal gene therapy: recent advances and current challenges.

Science.gov (United States)

Mattar, Citra N; Choolani, Mahesh; Biswas, Arijit; Waddington, Simon N; Chan, Jerry K Y

2011-10-01

Fetal gene therapy (FGT) can potentially be applied to perinatally lethal monogenic diseases for rescuing clinically severe phenotypes, increasing the probability of intact neurological and other key functions at birth, or inducing immune tolerance to a transgenic protein to facilitate readministration of the vector/protein postnatally. As the field is still at an experimental stage, there are several important considerations regarding the practicality and the ethics of FGT. Here, through a review of FGT studies, the authors discuss the role and applications of FGT, the progress made with animal models that simulate human development, possible adverse effects in the recipient fetus and the mother and factors that affect clinical translation. Although there are valid safety and ethical concerns, the authors argue that there may soon be enough convincing evidence from non-human primate models to take the next step towards clinical trials in the near future. © 2011 Informa UK, Ltd.

Tumor Hypoxia: Causative Mechanisms, Microregional Heterogeneities, and the Role of Tissue-Based Hypoxia Markers.

Science.gov (United States)

Vaupel, Peter; Mayer, Arnulf

Tumor hypoxia is a hallmark of solid malignant tumor growth, profoundly influences malignant progression and contributes to the development of therapeutic resistance. Pathogenesis of tumor hypoxia is multifactorial, with contributions from both acute and chronic factors. Spatial distribution of hypoxia within tumors is markedly heterogeneous and often changes over time, e.g., during a course of radiotherapy. Substantial changes in the oxygenation status can occur within the distance of a few cell layers, explaining the inability of currently used molecular imaging techniques to adequately assess this crucial trait. Due to the possible importance of tumor hypoxia for clinical decision-making, there is a great demand for molecular tools which may provide the necessary resolution down to the single cell level. Exogenous and endogenous markers of tumor hypoxia have been investigated for this purpose. Their potential use may be greatly enhanced by multiparametric in situ methods in experimental and human tumor tissue.

Hypoxia, Oxidative Stress and Fat

Directory of Open Access Journals (Sweden)

Nikolaus Netzer

2015-06-01

Full Text Available Metabolic disturbances in white adipose tissue in obese individuals contribute to the pathogenesis of insulin resistance and the development of type 2 diabetes mellitus. Impaired insulin action in adipocytes is associated with elevated lipolysis and increased free fatty acids leading to ectopic fat deposition in liver and skeletal muscle. Chronic adipose tissue hypoxia has been suggested to be part of pathomechanisms causing dysfunction of adipocytes. Hypoxia can provoke oxidative stress in human and animal adipocytes and reduce the production of beneficial adipokines, such as adiponectin. However, time-dose responses to hypoxia relativize the effects of hypoxic stress. Long-term exposure of fat cells to hypoxia can lead to the production of beneficial substances such as leptin. Knowledge of time-dose responses of hypoxia on white adipose tissue and the time course of generation of oxidative stress in adipocytes is still scarce. This paper reviews the potential links between adipose tissue hypoxia, oxidative stress, mitochondrial dysfunction, and low-grade inflammation caused by adipocyte hypertrophy, macrophage infiltration and production of inflammatory mediators.

Midtrimester preterm prelabour rupture of membranes (PPROM): expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL – III trial)

Science.gov (United States)

2014-01-01

Background Babies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome. Methods/Design Women with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. Intervention: random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05). Discussion This study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure. Trial registration NTR3492 Dutch Trial Register (http://www.trialregister.nl). PMID:24708702

Perinatal grief in Latino parents.

Science.gov (United States)

Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

2010-01-01

Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

Maternal and perinatal outcomes in pregnancies with multiple sclerosis: a case-control study.

Science.gov (United States)

Yalcin, Serenat Eris; Yalcin, Yakup; Yavuz, And; Akkurt, Mehmet Ozgur; Sezik, Mekin

2017-05-24

To assess whether maternal multiple sclerosis (MS) is associated with adverse pregnancy outcomes by determining the clinical course of disease during pregnancy and postpartum throughout a 10-year-period in a single tertiary center. We conducted a case-control study that included pregnancies with a definitive diagnosis of MS (n=43), matched with 100 healthy pregnant women with similar characteristics. Maternal and perinatal data were retrieved from hospital files. Groups were compared with the Mann-Whitney and χ2 tests. Logistic regression models were constructed to determine independent effects. Maternal demographic and baseline laboratory data were similar across the groups. Rates of preterm delivery, fetal growth restriction, preeclampsia, gestational diabetes, stillbirth, cesarean delivery, congenital malformation, and 5-min Apgar score were comparable (P>0.05 for all). General anesthesia during cesarean delivery (96% vs. 39%, P=0.002), urinary tract infection (UTI) (12% vs. 3%, P=0.04), low 1-min Apgar score (21% vs. 9%, P=0.04), and nonbreastfeeding (33% vs. 2%, P=0.001) were more frequent in women with MS. The low 1-min Apgar score and breastfeeding rates were independent of general anesthesia and UTI in regression models. MS during pregnancy was not associated with adverse maternal and perinatal outcomes except UTI, low 1-min Apgar scores, and decreased breastfeeding rates.

Perinatal safety: from concept to nursing practice.

Science.gov (United States)

Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.

Perinatal Safety: From Concept to Nursing Practice

Science.gov (United States)

Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

Perinatal risk factors for neonatal encephalopathy: an unmatched case-control study.

Science.gov (United States)

Tann, Cally J; Nakakeeto, Margaret; Willey, Barbara A; Sewegaba, Margaret; Webb, Emily L; Oke, Ibby; Mutuuza, Emmanuel Derek; Peebles, Donald; Musoke, Margaret; Harris, Kathryn A; Sebire, Neil J; Klein, Nigel; Kurinczuk, Jennifer J; Elliott, Alison M; Robertson, Nicola J

2018-05-01

Neonatal encephalopathy (NE) is the third leading cause of child mortality. Preclinical studies suggest infection and inflammation can sensitise or precondition the newborn brain to injury. This study examined perinatal risks factor for NE in Uganda. Unmatched case-control study. Mulago National Referral Hospital, Kampala, Uganda. 210 term infants with NE and 409 unaffected term infants as controls were recruited over 13 months. Data were collected on preconception, antepartum and intrapartum exposures. Blood culture, species-specific bacterial real-time PCR, C reactive protein and placental histology for chorioamnionitis and funisitis identified maternal and early newborn infection and inflammation. Multivariable logistic regression examined associations with NE. Neonatal bacteraemia (adjusted OR (aOR) 8.67 (95% CI 1.51 to 49.74), n=315) and histological funisitis (aOR 11.80 (95% CI 2.19 to 63.45), n=162) but not chorioamnionitis (aOR 3.20 (95% CI 0.66 to 15.52), n=162) were independent risk factors for NE. Among encephalopathic infants, neonatal case fatality was not significantly higher when exposed to early neonatal bacteraemia (OR 1.65 (95% CI 0.62 to 4.39), n=208). Intrapartum antibiotic use did not improve neonatal survival (p=0.826). After regression analysis, other identified perinatal risk factors (n=619) included hypertension in pregnancy (aOR 3.77), male infant (aOR 2.51), non-cephalic presentation (aOR 5.74), lack of fetal monitoring (aOR 2.75), augmentation (aOR 2.23), obstructed labour (aOR 3.8) and an acute intrapartum event (aOR 8.74). Perinatal infection and inflammation are independent risk factors for NE in this low-resource setting, supporting a role in the aetiological pathway of term brain injury. Intrapartum antibiotic administration did not mitigate against adverse outcomes. The importance of intrapartum risk factors in this sub-Saharan African setting is highlighted. © Article author(s) (or their employer(s) unless otherwise stated in the

Eliminating Perinatal HIV Transmission

Centers for Disease Control (CDC) Podcasts

2012-11-26

In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

Perinatal risk factors for strabismus

DEFF Research Database (Denmark)

Torp-Pedersen, Tobias; Boyd, Heather A; Poulsen, Gry

2010-01-01

Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype.......Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype....

The effect of fetal sex on customized fetal growth charts.

Science.gov (United States)

Rizzo, Giuseppe; Prefumo, Federico; Ferrazzi, Enrico; Zanardini, Cristina; Di Martino, Daniela; Boito, Simona; Aiello, Elisa; Ghi, Tullio

2016-12-01

To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for parental characteristics, race, and parity Methods: In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low-risk singleton pregnancies between 16 and 40 weeks of gestation were considered. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Quantile regression was used to examine the impact of fetal sex across the biometric percentiles of the fetal measurements considered together with parents' height, weight, parity, and race. Fetal gender resulted to be a significant covariate for BDP, HC, and AC with higher values for male fetuses (p ≤ 0.0009). Minimal differences were found among sexes for FL. Parity, maternal race, paternal height and maternal height, and weight resulted significantly related to the fetal biometric parameters considered independently from fetal gender. In this study, we constructed customized biometric growth charts for fetal sex, parental, and obstetrical characteristics using quantile regression. The use of gender-specific charts offers the advantage to define individualized normal ranges of fetal biometric parameters at each specific centile. This approach may improve the antenatal identification of abnormal fetal growth.

Association of hypoproteinemia in preeclampsia with maternal and perinatal outcomes: A retrospective analysis of high-risk women

Directory of Open Access Journals (Sweden)

Hongbo Chen

2016-01-01

Full Text Available Background: The aim of this study was to evaluate maternal and perinatal outcomes in preeclampsia (PE, according to the value of albumin. Materials and Methods: Preeclamptic women were retrospectively divided into mild hypoproteinemia (MHP, n = 220 and severe hypoproteinemia (SHP, n = 79 PE according to the value of albumin. The maternal and perinatal outcomes were evaluated in both groups. Results: Two hundred and ninety-nine single pregnancies complicated by PE were included in this study. Gestational age at delivery was earlier in SHP than MHP (P < 0.01. Severe hypertension, abnormal liver function, abnormal renal function, ascites, and abruption occurred more frequently in SHP than in MHP (P< 0.01, 0.03, <0.01, 0.01, and 0.04, respectively. Women in SHP had a higher rate of cesarean section than those in MHP (P = 0.04. Fetal growth restriction infants were more frequent in SHP than in MHP (P < 0.01. The occupancy rate of the Neonatal Intensive Care Unit was higher in SHP than in MHP (P < 0.01. Conclusion: SHP PE is associated with a higher risk of adverse pregnancy outcome than MHP PE, deserving closer surveillance during pregnancy.

Selective vulnerability in brain hypoxia

DEFF Research Database (Denmark)

Cervos-Navarro, J.; Diemer, Nils Henrik

1991-01-01

Neuropathology, selective vulnerability, brain hypoxia, vascular factors, excitotoxicity, ion homeostasis......Neuropathology, selective vulnerability, brain hypoxia, vascular factors, excitotoxicity, ion homeostasis...

Elsevier Trophoblast Research Award Lecture: Searching for an early pregnancy 3-D morphometric ultrasound marker to predict fetal growth restriction.

Science.gov (United States)

Collins, S L; Stevenson, G N; Noble, J A; Impey, L

2013-03-01

Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality, even in term babies. An effective screening test to identify pregnancies at risk of FGR, leading to increased antenatal surveillance with timely delivery, could decrease perinatal mortality and morbidity. Placental volume, measured with commercially available packages and a novel, semi-automated technique, has been shown to predict small for gestational age babies. Placental morphology measured in 2-D in the second trimester and ex-vivo post delivery, correlates with FGR. This has also been investigated using 2-D estimates of diameter and site of cord insertion obtained using the Virtual Organ Computer-aided AnaLysis (VOCAL) software. Data is presented describing a pilot study of a novel 3-D method for defining compactness of placental shape. We prospectively recruited women with a singleton pregnancy and BMI of Elsevier Ltd. All rights reserved.

Developmental Hypoxia Has Negligible Effects on Long-Term Hypoxia Tolerance and Aerobic Metabolism of Atlantic Salmon (Salmo salar).

Science.gov (United States)

Wood, Andrew T; Clark, Timothy D; Andrewartha, Sarah J; Elliott, Nicholas G; Frappell, Peter B

Exposure to developmental hypoxia can have long-term impacts on the physiological performance of fish because of irreversible plasticity. Wild and captive-reared Atlantic salmon (Salmo salar) can be exposed to hypoxic conditions during development and continue to experience fluctuating oxygen levels as juveniles and adults. Here, we examine whether developmental hypoxia impacts subsequent hypoxia tolerance and aerobic performance of Atlantic salmon. Individuals at 8°C were exposed to 50% (hypoxia) or 100% (normoxia) dissolved oxygen (DO) saturation (as percent of air saturation) from fertilization for ∼100 d (800 degree days) and then raised in normoxic conditions for a further 15 mo. At 18 mo after fertilization, aerobic scope was calculated in normoxia (100% DO) and acute (18 h) hypoxia (50% DO) from the difference between the minimum and maximum oxygen consumption rates ([Formula: see text] and [Formula: see text], respectively) at 10°C. Hypoxia tolerance was determined as the DO at which loss of equilibrium (LOE) occurred in a constantly decreasing DO environment. There was no difference in [Formula: see text], [Formula: see text], or aerobic scope between fish raised in hypoxia or normoxia. There was some evidence that hypoxia tolerance was lower (higher DO at LOE) in hypoxia-raised fish compared with those raised in normoxia, but the magnitude of the effect was small (12.52% DO vs. 11.73% DO at LOE). Acute hypoxia significantly reduced aerobic scope by reducing [Formula: see text], while [Formula: see text] remained unchanged. Interestingly, acute hypoxia uncovered individual-level relationships between DO at LOE and [Formula: see text], [Formula: see text], and aerobic scope. We discuss our findings in the context of developmental trajectories and the role of aerobic performance in hypoxia tolerance.

A novel LabVIEW-based multi-channel non-invasive abdominal maternal-fetal electrocardiogram signal generator.

Science.gov (United States)

Martinek, Radek; Kelnar, Michal; Koudelka, Petr; Vanus, Jan; Bilik, Petr; Janku, Petr; Nazeran, Homer; Zidek, Jan

2016-02-01

This paper describes the design, construction, and testing of a multi-channel fetal electrocardiogram (fECG) signal generator based on LabVIEW. Special attention is paid to the fetal heart development in relation to the fetus' anatomy, physiology, and pathology. The non-invasive signal generator enables many parameters to be set, including fetal heart rate (FHR), maternal heart rate (MHR), gestational age (GA), fECG interferences (biological and technical artifacts), as well as other fECG signal characteristics. Furthermore, based on the change in the FHR and in the T wave-to-QRS complex ratio (T/QRS), the generator enables manifestations of hypoxic states (hypoxemia, hypoxia, and asphyxia) to be monitored while complying with clinical recommendations for classifications in cardiotocography (CTG) and fECG ST segment analysis (STAN). The generator can also produce synthetic signals with defined properties for 6 input leads (4 abdominal and 2 thoracic). Such signals are well suited to the testing of new and existing methods of fECG processing and are effective in suppressing maternal ECG while non-invasively monitoring abdominal fECG. They may also contribute to the development of a new diagnostic method, which may be referred to as non-invasive trans-abdominal CTG +  STAN. The functional prototype is based on virtual instrumentation using the LabVIEW developmental environment and its associated data acquisition measurement cards (DAQmx). The generator also makes it possible to create synthetic signals and measure actual fetal and maternal ECGs by means of bioelectrodes.

Perinatal death audits in a peri-urban hospital in Kampala, Uganda ...

African Journals Online (AJOL)

Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya ...

Proteinuria in preeclampsia: Not essential to diagnosis but related to disease severity and fetal outcomes.

Science.gov (United States)

Dong, Xin; Gou, Wenli; Li, Chunfang; Wu, Min; Han, Zhen; Li, Xuelan; Chen, Qi

2017-04-01

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality globally and proteinuria can be one of the cardinal features of this disease. However, studies about the association of the amount of proteinuria and the severity of preeclampsia, and perinatal outcomes are limited. Data on 239 women with preeclampsia were retrospectively collected from a university teaching hospital from September 2011 to June 2013 and analysed. Data included all clinical parameters and proteinuria in a 24h urine collection. In cases of severe preeclampsia, significantly fewer patients had proteinuria levels 0.3g/L, but there was no difference in cases of severe preeclampsia when proteinuria levels were >0.3g/L. Furthermore, when proteinuria levels were >0.3g/L, the frequency of severe preeclampsia in each group was significantly higher than the frequency of mild pre-eclampsia cases. Time of onset was significantly earlier in patients with proteinuria >3g/L in a 24h urine collection, but time between the onset of preeclampsia and delivery was not correlated with the amount of proteinuria. The birth weight was significantly lower in patients with proteinuria >3g/L. The incidence of fetal growth restriction or stillbirth was significantly higher in patients with proteinuria >5g/L. Our data demonstrate that the amount of proteinuria is not associated with the severe of preeclampsia, once proteinuria is detected, but is related to the severity of preeclampsia. The adverse fetal outcomes appear to be the function of prematurity rather than proteinuria itself. Copyright © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

Fetal MRI; Fetales MRT

Energy Technology Data Exchange (ETDEWEB)

Blondin, D. [Inst. fuer Diagn. Radiologie, Uniklinikum Duesseldorf (Germany); Turowski, B. [Inst. fuer Diagn. Radiologie, Neuroradiologie, Uniklinikum Duesseldorf (Germany); Schaper, J. [Inst. fuer Diagn. Radiologie, Kinderradiologie, Uniklinikum Duesseldorf (Germany)

2007-02-15

Ultrasonography is the method of choice for prenatal malformation screening, but it does not always provide sufficient information for correct diagnosis or adequate abnormality evaluation. Fetal MRI is increasingly being used to complete sonographic findings. It was initially used for evaluation of cerebral abnormalities but is increasingly being applied to other fetal areas. In vivo investigation of fetal brain maturation has been enhanced by MRI. An adequate analysis of fetal chest and abdomen can be achieved with fast T2-, T1-weighted and diffusion-weighted imaging (DWI). The advantages include the great field of view and the excellent soft tissue contrast. This allows correct diagnosis of congenital diaphragmatic hernia and evaluation of the consequences on pulmonary growth. Other pulmonary malformations, such as cystic adenomatoid malformation, sequestration and brochogenic cysts, can also be easily identified. Renal position can be quickly determined using DWI sequences and renal agenesia can be easily diagnosed with only one sequence. Prenatal MRI is virtually as effective as postnatal examination, dispenses with transport of a potentially very ill newborn, and provides logistic advantages. Therefore, prenatal MRI is useful for adequate postnatal treatment of newborns with malformations. (orig.)

MRI of perinatal brain injury

Energy Technology Data Exchange (ETDEWEB)

Rutherford, Mary; Allsop, Joanna [Imperial College, Robert Steiner MR Unit, Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Martinez Biarge, Miriam [La Paz University Hospital, Dept of Neonatology, Madrid (Spain); Counsell, Serena [Imperial College, Robert Steiner MR Unit, Neonatal Medicine, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Cowan, Frances [Imperial College, Dept of Paediatrics, Hammersmith Hospital, London (United Kingdom)

2010-06-15

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

MRI of perinatal brain injury

International Nuclear Information System (INIS)

Rutherford, Mary; Allsop, Joanna; Martinez Biarge, Miriam; Counsell, Serena; Cowan, Frances

2010-01-01

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

Perinatal loss and neurological abnormalities among children of the atomic bomb. Nagasaki and Hiroshima revisited, 1949 to 1989

International Nuclear Information System (INIS)

Yamazaki, J.N.; Schull, W.J.

1990-01-01

Studies of the survivors of the atomic bombing of Hiroshima and Nagasaki who were exposed to ionizing radiation in utero have demonstrated a significant increase in perinatal loss and the vulnerability of the developing fetal brain to injury. These studies have also helped to define the stages in the development of the human brain that are particularly susceptible to radiation-related damage. Exposure at critical junctures in development increases the risk of mental retardation, small head size, subsequent seizures, and poor performance on conventional tests of intelligence and in school. The most critical period, 8 through 15 weeks after fertilization, corresponds to that time in development when neuronal production increases and migration of immature neurons to their cortical sites of function occurs. The epidemiologic data are, however, too sparse to settle unequivocally the nature of the dose-response function and, in particular, whether there is or is not a threshold to damage. If a threshold does exist, it appears to be in the 0.10- to 0.20-Gy fetal-dose range in this vulnerable gestational period

Áreas de alta mortalidad perinatal debida a anomalías congénitas: análisis de estadísticas vitales, Colombia, 1999-2008

Directory of Open Access Journals (Sweden)

Sandra Patricia Misnaza

2016-09-01

Full Text Available Introducción. Durante 2012, las anomalías congénitas fueron la causa de 13 % de las muertes en menores de 28 días a nivel mundial y, en Colombia constituyeron la segunda causa de mortalidad infantil. Objetivo. Determinar la distribución geográfica de la mortalidad perinatal por anomalías congénitas en Colombia entre 1999 y 2008. Materiales y métodos. Se hizo un estudio descriptivo revisando los certificados de defunción de Colombia. La muerte perinatal se definió como muerte fetal y no fetal en niños con un peso de 500 g o más y 28 o menos días de edad, y las anomalías congénitas, como causa básica de la muerte (Clasificación Internacional de Enfermedades - CIE10: Q000 a Q999. La proyección nacional de nacimientos se tomó como el denominador de las tasas específicas. Se calcularon los percentiles para analizar las áreas de alta mortalidad (percentil de 90 o más. Resultados. Se encontraron 22.361 muertes perinatales por anomalías congénitas. Antioquia, Caldas, Risaralda, Huila, Quindío, Bogotá, Valle del Cauca y Guainía superaron, en promedio, el percentil 90 durante los diez años de estudio. Los municipios con mayores tasas de mortalidad fueron: Giraldo, Ciudad Bolívar, Riosucio, Liborina, Supía, Alejandría, Sopetrán, San Jerónimo, Santa Fe de Antioquia y Marmato, en donde oscilaron entre 205,81 y 74,18 por 10.000 nacimientos. Las tasas de mortalidad perinatal por 10.000 nacidos vivos fueron de 28,1 para el grupo de malformaciones del sistema circulatorio; de 13,7 para anomalías del sistema nervioso central, y de 7,0 para anomalías cromosómicas. Conclusión. La alta mortalidad perinatal por anomalías congénitas en la región andina requiere acciones urgentes de investigación sobre los posibles riesgos y medidas de prevención.

Laser ablation of posterior urethral valves by fetal cystoscopy.