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Biomedical subjects

G Pardi

Publications and source records attributed to G Pardi.

At least 145 records · Page 8Linked to original sources
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Fetal amino acids in normal pregnancies and in pregnancies complicated by intrauterine growth retardation.

Plasma amino acid concentrations were measured in normal (AGA) and intrauterine growth retarded (IUGR) percutaneous umbilical blood sampling (PUBS) performed for prenatal diagnosis or at elective cesarean section. IUGR fetuses present significantly lower concentrations of most amino acids, with a significant reduction of the umbilical veno-arterial difference for total alpha-amino nitrogen. These findings are present early in growth retarded fetuses and may be potentially responsible for the growth retardation.

Amino Acids↗
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Uterine Doppler velocimetry and placental hypoxic-ischemic lesion in pregnancies with fetal intrauterine growth restriction.

We tested the hypothesis that Doppler velocimetry of the ascending uterine arteries (Ut.DV) in cases of fetal intrauterine growth restriction (IUGR) can reflect the presence of hypoxic-ischaemic lesions of the placenta, and whether this prediction is affected by the maternal blood pressure status.Ut.DV was obtained within 7 days of delivery in 90 consecutive pregnancies with IUGR and in 37 uneventful control pregnancies. Abnormal Ut.DV was defined as an average of a (left and right systolic)/diastolic ratio >2.6 and diastolic notching. After delivery, pathological studies were performed with attention paid to macroscopic and microscopic evidence of hypoxic or ischaemic placental lesions related to uteroplacental vascular pathological features. In patients with IUGR, the total rate of placental lesions was significantly higher in the presence of abnormal Ut.DV compared to the presence of normal Ut.DV (relative risk, 6.35; 95 per cent confidence interval=5.2-7.3). The rate and the severity of these lesions was not significantly different between normotensive and hypertensive pregnancies (87 versus 93 per cent;P =0.2). When Ut.DV was normal, the rate of placental lesions was similar between IUGR cases and control pregnancies (14 versus 8 per cent;P =0.69). The perinatal outcome was not significantly different in any of the normotensive and the hypertensive pregnancies with growth-restricted fetuses and abnormal Ut.DV.The presence of abnormal Doppler velocimetry of the uterine arteries in pregnancies with fetal intrauterine growth restriction is may be in fact an important indicator of hypoxic or ischaemic placental lesions. This abnormal Doppler velocimetry is independent of the maternal blood pressure status.

Blood Pressure↗
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A multiple infusion start time (MIST) protocol for stable isotope studies of fetal blood.

A new approach utilizing multiple infusion start times for two stable isotopes of leucine was applied to seven pregnancies in order to assess equilibration times for isotopic studies when a single fetal blood sample is available. Two infusates, one containing l -[1-(13)C]-leucine and the other l -[5,5,5-D3]-leucine, were given as a primed constant infusion in the maternal circulation at fetal blood sampling (FBS). In five patients l -[1-(13)C]-leucine infusion was started at time zero (T(0)) whereas l -[5,5,5-D3]-leucine infusion began 30 min later, and both were continued until the umbilical sample was obtained at 149.7+/-8.8 min. In order to assure non-steady state conditions, in two patients the first infusion started at T(0)and the second 17 and 6 min before FBS was performed at 115 and 154 min, respectively. The fetal/maternal ratio for l -[5,5,5-D3]-leucine over the fetal/maternal ratio for l -[1-(13)C]-leucine was 0.98+/-0.03, indicating steady state conditions for both infusions for the first six patients. In the last patient the ratio was 0.51, indicative of non-steady state conditions for the shortest infusion time. Our results show that a single fetal sample can provide data for fetal amino acid enrichments reflecting multiple time points. Leucine steady state is achieved 20 min after a primed continuous infusion both in the maternal and fetal circulations.

Blood Glucose↗
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Percutaneous umbilical blood sampling: indication changes and procedure loss rate in a nine years' experience.

A 9 years' experience with percutaneous umbilical blood sampling (PUBS) has been appraised. A total number of 1,272 procedures have been performed in our institution between 1986 and 1994; 861 before the 24th week of gestation and 411 after 24 weeks. The indications for PUBS changed throughout these years because of the rapid evolution of molecular biology and because of the fact that certain conditions can now be diagnosed at earlier stages of gestation by chorionic villi sampling and amniocentesis. Sampling at a later gestational age reflected changes in indications. PUBS loss rate has been calculated for 482 fetuses less than 24 weeks, retrospectively found to be negative for the suspected condition and has been related to gestational age, duration of the procedure and number of needle insertions. Total procedure-related loss rate was 2.3%: 1.6% intrauterine fetal deaths within 48 h of the procedure and 0.7% spontaneous abortions in the 2 weeks following the procedure. Gestational age at the time of the procedure and duration of the procedure were significantly related to fetal losses within 48 h.

Abortion, Spontaneous↗
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[Testing for HIV infection in pregnant women at the obstetric centers in Italy].

BACKGROUND: To assess antenatal HIV testing policy implemented in Italian obstetric centres. METHODS: Cross-sectional study, Site and Participants: Italian obstetric centres. INTERVENTION: structured postal questionnaire. Out-comes: policies and practices of antenatal HIV testing in Italian obstetric centres. RESULTS: A total of 213 centres, accounting for a total of 167.927 deliveries/year (30% of the Italian number of deliveries) filed out the questionnaire. Of these, 45% reported having a policy on HIV antenatal testing. Having a policy on antenatal testing is associated to the number of observed HIV-positive women. HIV testing is offered to all women in 89% of centres, included in routine antenatal tests in 67%, with an opt out (57.5%) or on opt in (10.5%) on request. HIV testing is performed at the initial clinic visit in 78% of centres; it is offered routinely to male partners in 7.5% of centres. Amongst centres which observed HIV-positive pregnant women, 47% reported zidovudine is not available as a measure of HIV vertical transmission prevention. CONCLUSIONS: In Italy, HIV testing seems to be routinely included in management of pregnancy, although the practices of offering the test seem not always appropriate and the availability of measures for reducing the risk of vertical transmission not adequate. Specific guidelines should be issued in order to implement and to uniform universal antenatal HIV testing, and to optimize the management of infected women.

Adolescent↗
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Cigarette smoking in pregnancy: relationship to perinatal outcomes in six Italian centres.

In this study the relationship of maternal smoking in pregnancy to low birth weight, fetal growth retardation, preterm delivery, and perinatal deaths has been investigated in a sample of 36,544 women with their single newborns, from 6 Italian centers (Triese, Milan, Parma, Rome, Naples, Bari), where a multicenter survey of perinatal preventive medicine (MPPI) was carried out, between 1973 and 1979, with the financial support of the Consiglio Nazionale dell Ricerche. The proportions of babies weighing 2500 g or less, and of babies with birth weight, head circumference or crown-heel length below the 10th centile were similar among nonsmokers and "stopped" smoker mothers, while they increased with increasing smoking levels. As regards head circumference and crown-heel length below the 10th centile, odds ratios are essentially the same before and after adjustment for age, parity, and socioeconomic class (about 1.5 for "1-10CGT" and up to 2.5 for "11+CGT"). Only slight increases have been observed in the odds ratios concerning low birthweight below the 10th centile (about 1.5 for "1-10CGT" and up to 3.5 for "11+CGT") after adjusting for the socioeconomic demographic variables (i.e. mainly removing the favourable effect of high socioeconomic class or low parity, which more frequently characterize smoker mothers). Owing to the lower smokers' frequencies, cigarette smoking estimated attributable risks concerning low birth weight and "small for dates" babies in the MPPI centres (between 4% and 19%) are considerably lower than those estimated in studies carried out in the US or Canada. Data analyzed in the present study do not indicate any relationship between maternal smoking and preterm delivery or perinatal deaths.

Behavior↗
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Smoking habit in pregnancy and sociodemographic background in six Italian centres.

Studies carried out in foreign countries (US and UK, mainly) indicate that maternal characteristics, such as age, parity, social class, and prenatal care, are related to child's growth, mortality, and morbidity, as well as to cigarette smoking. These characteristics may act as confounding variables in the analysis of the effects of maternal smoking on babies in fetal and neonatal periods. Until now there has been a lack of information on the subject, because even the most recent available data concern women over age 14 regardless of obstetric history. This paper deals with smoking habits, before and during pregnancy, of 37,664 women included in a multicenter survey of perinatal preventive medicine (MPPI), which was performed in 6 Italian centres (Trieste, Milan, Parma, Rome, Naples, Bari) between 1973 and 1979, with the financial support of the Italian National Research Council. The results of the MPPI and other surveys are compared and the association between maternal smoking habits and sociodemographic background is investigated by multiple correspondence analysis. As to Italy, unlike UK and US, in the 1970s women of high social status show the highest prevalence of the smoking habit. Moreover, in pregnancy, the large majority gives up smoking, or at least reduces it, mainly in high socioeconomic levels, so that the proportion of pregnant women who keep on smoking over 10 cigaretts per day is very low (0.5-3.8%) and poorly related to sociodemographic factors. Therefore, it seems unlikely that these may exert serious confounding effects on the relationships between smoking in pregnancy and perinatal outcome.

Age Factors↗
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[Sampling fetal blood from the umbilical cord under echographic guidance].

The performance of 465 sonographically guided percutaneous umbilical blood samplings and its use in the management of diagnostic problems in the second and third trimester of pregnancy are described. The method has been employed in the prenatal assessment of 423 patients (357 procedures in the second trimester and 108 in the third trimester). Pure fetal blood was obtained in all third trimester samplings whilst in the second trimester in 4 cases (1.1%) fetal blood could not be obtained at the first procedure and in 9 cases (2.6%) contamination with maternal blood or amniotic fluid was observed. Data analysis confirm how this simple and rapid procedure offers access to the fetal circulation for diagnostic and therapeutic purposes.

Blood Specimen Collection↗
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[Evaluation of the fetal risk after echo-guided blood sampling from the umbilical cord in the 2d trimester of pregnancy].

Fetal risk related to cordocentesis has been analyzed on a series of 222 ultrasound-guided fetal blood samplings for prenatal diagnosis of fetal diseases during the second trimester of pregnancy. Affected and malformed fetuses were excluded. Seven intrauterine deaths (3.2%) and 2 spontaneous abortions (0.9%) were observed. These figures proved higher than those observed in non-homogeneous series which consider the second and third trimester altogether. The fetal risk was significantly correlated with gestational age (less than 18 weeks 7.6% vs greater than 18 weeks 0.7% p = .02) and duration of the procedure (greater than 10'11.4% vs = less than 10'0.9% p = .0029). The number of abdominal insertions resulted in different death rates (greater than 1 ins. = 6.5% vs 1 ins. = 1.4%). It is likely that different developmental, anatomical and neurovegetative mechanism play a significant role in the risk rate found in the second trimester cordocentesis. These findings and the specific risk factors observed within the different technical conditions reported, must be taken into consideration for prenatal counseling.

Abortion, Spontaneous↗
PubMedDate not supplied

[Prenatal diagnosis of congenital toxoplasmosis].

Primary Toxoplasmosis is devoid of any consequences in the mother in most cases, while the fetus can suffer serious damages following transplacental passage of the parasite. This is probably due to its limited immunocompetence. 440 women have been seen for suspected primary infection during pregnancy: clinical and serological parameters excluded infection in 62% of the cases. In 168 cases primary infection was likely and they underwent therapy with Spiramycin 3 grams per day to prevent placental and fetal colonization: 53 cases were elected for invasive prenatal diagnosis. Amniotic fluid was obtained by amniocentesis and fetal blood by ultrasound guided cordocentesis and by fetoscopy: the samples were analyzed for specific anti Toxoplasma IgM and sent for isolation of the parasite. Diagnosis of fetal infection was made in 4 cases: 3 cases had specific IgM in cord blood, 1 case showed intracranial calcifications by ultrasound screening. Fetal infection rate is thus below 10% and prenatal diagnosis avoids unjustified interruption of pregnancies complicated by maternal toxoplasmic infection.

Adult↗