[Fetal development].
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Biomedical subjects
Publications and source records attributed to J F Roux.
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Plasma cholesterol, triglycerides, glycerol, and glucose concentrations were measured in term and postmature rabbits. The data show that the term and postmature mothers have significantly higher glycemia than their fetuses. However, triglyceride and cholesterol concentrations are lower in the postmature mother than in her fetus. Postmature fetuses are characterized by very high plasma triglyceride and cholesterol concentrations. The results demonstrate that postmaturity is accompanied by maternal and fetal lipid metabolic changes related to a decrease in the transfer of maternal fatty acids through the placenta and to a diminution in fetal liver glucose utilization. The postmature fetus is then in a relative state of fasting and must rely on its own supply of fuel (glycogen and lipids) to provide cells for growth and survival. The maternal metabolic changes can possibly be explained by a decreased utilization of maternal substrates by the fetus, the placenta becoming insufficient. The close interrelationship of fetal and maternal lipid metabolism with the activity of the placenta suggests that an accurate knowledge of the metabolic changes taking place in the fetus during alteration of the maternal environment is indispensable to the understanding of the short- and long-term effects of maternal disease on the fetus.
Fetuses from term and postmature rabbits were obtained and their livers incubated with palmitate-1-14C in room air. The net incorporation of the fatty acids into ketone bodies, lipids, and Co2 was measured at fixed and variable concentrations of cold glucose. Data from postmature liver show that lipid synthesis is decreased, 14CO2 production is increased, and ketone body formation is unchanged when compared with data from the term liver. The addition of cold glucose to a constant concentration of palmitate-1-14C causes a slight increase in lipid synthesis in thepostmature liver, in contrast to a decrease in the term liver. The experimental results indicate that liver lipid synthesis and glucose utilization are diminished in the postmature preparation. This suggests that the postmature fetal liver responds to the decreased availability of free fatty acid from the placenta and to the increasing hypoxia by metabolic adaptations resembling those observed during fasting and tissue hypoxia. These changes are somewhat similar to those observed in the neonate before the onset of breast-feeding. Fetal metabolism is, therefore, responsive to changes in placental transfer of fatty acids and to postmaturity.
The administration of prostaglandin vaginally to 15 pregnant patients in the first trimester caused abortion in 73% of the cases. Although other regimens have been reported to be effective and well tolerated, the single 3 mg. suppository of 15(S)-15-methyl prostaglandin F2 alpha (methyl ester) utilized in the present study was associated with a significant incidence of side effects and a relatively high failure rate. However, if an analogue or improved treatment regimen could be found which is more efficient, as well as more pleasant in its affects, the availability and the cost of early abortion would be improved with a concomitant effect on the incidence of late abortion and its complications.
The application of acupuncture anesthesia in obstetrics is discussed and reviewed. Of 14 patients delivered by cesarean section under acupuncture, 8 (57%) felt no pain, and 6 did not go through the entire procedure without other supplementary anesthesia. The failure and success rates are reviewed. It is suggested that the technique be evaluated further because with acupuncture the fetus and mother are completely protected from the secondary effects of general regional anesthesia.
Gonadotropin-injected pregnant rabbits were delivered by cesarean section near term (30 days after conception (term, 31 days) and 3 1/2 and 4 days post term. Lipid metabolism of the postterm and near-term fetus was compared. Fetal and placental uptake of radioactivity and rate of lipid entry into the fetus, as well as fetal and maternal plasma free fatty acid (FFA) specific activities (at equilibrium) were determined following a single maternal injection of [1-14C]palmitate (50 muCi) administered at cesarean section. Evidence of placental malfunction in the postterm period includes decreased placental uptake and transport of labeled FFA occurring while maternal and fetal FFA dynamics (half times) remain unchanged and a loss in "organization": The strong positive correlation (p less than 0.001) between placental uptake and transfer to the fetus at 30 days' gestation is lost 5 days later. A comparison of maternal and fetal plasma FFA specific activities indicates a substantial (62%) near-term fetal contribution to its own circulating FFA pool. Total plasma FFA is elevated in the postterm fetus concomitant with a decreasing maternal supply. A postterm fetus must therefore contribute lipid from its own reserves (probably liver) in excess of amounts attributed to a near-term fetus, i.e., greater than 62%.
A radiotelemetry system for the direct monitoring of fetal heart rate and intrauterine pressure during labor has been evaluated at 5 different institutions. A conventional fetal scalp electrode and a special intrauterine pressure sensor are connected to a radio transmitter placed on the patient's thigh. The receiver can be located up to 50 feet away from the transmitter and is either a self-contained monitor or a unit that converts a conventional fetal monitor to a telemetric one. The telemetry recordings are of similar quality to those obtained from conventional monitors. Telemetry allows for greater patient comfort and mobility as well as greater convenience to the clinical staff. Continuous data can be obtained from patients while they are ambulatory or sitting in a chair as well as while they are in bed.
Continuous recording of cervical dilatation during labor has been investigated in 13 pregnancies. The recordings were obtained with an ultrasonic cervimeter that continuously monitors cervical dilatation from the transit time of ultrasound signals between two piezoelectric crystals attached on the uterine cervix. A small spring-loaded clip allowed each crystal to be fixed on the rim of the cervical os. Clinical accuracy was +/- 0.6 cm. When the ultrasound recording of cervical dilatation is compared to the intrauterine pressure curve, it is characterized by a baseline and wave-shape curve of dilatation (DWP). The maximal amplitude component is called cervical maximal plasticity. The onset of the DWP is related to cervical resistivity, and the end of DWP reflects the relaxation time of cervical dilatation. The data show that as dilatation enters the active phase of labor, the plasticity, the resistivity, and the duration of relaxation of the cervix increase. These observations are discussed and related to the structural changes of the cervix during labor.
Surface-active fractions similar to the biochemical constituents of the pulmonary surfactant system can be isolated from human amniotic fluid and lung tissue from week 10 of gestation through term. Amniotic fluid yielded 10 mg. per 100 ml. surface-active material at 10 to 28 weeks' gestation and 330 mg. per 100 ml. at term. Fetal lung at 10 weeks of gestation gave 1,233 mg. per 100 ml. and 1,670 mg. per 100 ml. at 4 days after birth. The constituent PC of these surface-active fractions from amniotic fluid and lung contained in excess of 60 per cent palmitoyl residues. PC associated with the surface-active fraction accounted for no more than 15 per cent of the total amniotic fluid concentration of this compound. Minimum surface tensions obtained with these preparations from amniotic fluid ranged from 2.5 dynes per centimeter at 33 weeks to 8.3 dynes per centimeter at 40 weeks. At 14 to 28 weeks, the surface-active fraction from lung gave a minimum surface tension of 18.1 dynes per centimeter and 7.0 dynes per centimeter by 4 days after birth. These findings are consistent with the observation that an increase in the activity or concentration of the fetal lung surfactant system takes place in the last 4 weeks of gestation. Some constituents of this system, or their derivatives which have possibly been altered as a result of biochemical changes, are found in amniotic fluid. We infer that the majority of PC in amniotic fluid is not directly associated with the biochemical constituents of the fetal lung surfactant system.
A 3beta-hydroxysteroid dehydrogenase (3betaHSD) was demonstrated in term human fetal membranes (chorion and amnion) with both dehydroepiandrosterone (3beta-hydroxy-5-androsten-17-one) and pregnenolone (3beta-hydroxy-5-pregnen-20-one as substrates, and the subcellular distribution substrate and nucleotide specificity of the enzyme was studied. In both membranes the microsomal fraction (particles which sedimented at 105,000 g after 90 min) had the highest specific activity. The chorion was more active than the amnion but the enzyme in both tissues had similar substrate and nucleotide specificity. NAD was the preferred cofactor, and pregnenolone was a better substrate than dehydroepiandrosterone in the presence of NAD. However, with NADP as cofactor both steroids were equally good substrates. When the 3beta-hydroxysteroid dehydrogenase activity of chorion microsomes was compared with that of placental microsomes, the specific activities were found to be of the same order of magnitude, and the substrate, nucleotide specificity and steroid binding properties were almost identical.
In addition to the 10 HBs Ag subtypes already described, 2 new subtypes were defined by using the q determinant. Exceptions to the rule generally accepted were found in that the q determinant was only lacking in HBs Ag/adw4. These exceptions occurred in adw and adr categories. These 2 new subtypes are adw q positive and adr q negative. Out of 98 HBs Ag/adw4 from silent carries and patients from different parts of the world, mainly from France (79), 6 were found q positive. 3 out of these 6 cases came from Montpellier (South of France) and another 3 from Germany. The 92 other cases were found q negative. Further studies will be necessary to better know the location of this new subtype adw4 q positive, but it seems to be present only in certain parts of Europe. Out of 86 HBs Ag/adr from silent carriers from Asia (58), Oceania (17), France (10, most of them contaminated in Asia) and Réunion (1), 10 were found q negative. All these 10 cases were detected in Oceania, 2 out of 2 in carriers from New Caledonia and 8 out of 13 from French Polynesia. The new subtype adr q negative seems localized in Melanesia and Polynesia and absent from Asia. These 2 new markers of hepatitis B virus will allow better epidemiological and geographical studies.
A simple, accurate, and practical device was designed for detecting the woman at risk for postpartum emotional disorder (PED). Women attending the Sainte-Justine prenatal clinic were requested to complete a 19-item "yes/no" type of questionnaire. Each patient was classified for presence or absence of PED according to preestablished criteria. The responses of the patients classified as having emotional disorders were compared to the "normal" group. Thirteen percent developed PED. Six items showed predictive value: 1) admission of often feeling unloved by husband; 2) admission of feeling that pregnancy is undesired; 3) past history of postpartum depression; 4) being single or separated; 5) admission of marital problems; 6) admission that pregnancy was unplanned. The presentation of these items as part of a routine patient prenatal history questionnaire would constitute a means of identifying the woman at risk to develop PED and preventive measures could be taken.
An electronic system for the detection of uterine contractions by impedance measurement was evaluated in 30 subjects during the first stage of labor. The advantage of the system was patient comfort and ease of application of the recording electrodes. Simultaneous recordings of uterine contraction activity with conventional extra- or intra-uterine recording systems were made. The available evidence from this study indicated that 82 to 84% of the uterine contractions were accurately detected and that the onset and end of each uterine contraction is a reliable parameter of impedance measurement.
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Prostaglandins F2alpha and E2 and oxytocin were used to induce labor in 101 patients at risks. The data show that the three drugs are efficient labor inducers. The success rate of induction is the highest in primiparous patients receiving oral prostaglandin E2. Uterine contractility patterns and base line are similar with all drugs. The relaxation phase of the uterine contraction is skewed consistently in each investigated labor. This suggests an unequal relaxation time for the uterine fibers. It is concluded that prostaglandins E2 and F2alpha and oxytocin are safe drugs for induction of labor if monitoring is used in order to avoid an overdose of the medication. The three drugs must be synergistic because of their identical action on the uterine muscle.
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