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PubMed2000

Oral misoprostol for induction of labour with a viable fetus.

BACKGROUND: Misoprostol is a synthetic prostaglandin which has been used to induce labour. Oral use of the drug misoprostol may be convenient, but an overdose could cause uterine hyperstimulation and precipitate labour which may be life-threatening for both mother and fetus. OBJECTIVES: The objective of this review was to assess the effects of oral misoprostol used for labour induction in women with a viable fetus. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials of oral misoprostol versus any other method, placebo or no treatment given to women with a viable fetus for induction of labour. DATA COLLECTION AND ANALYSIS: The selection of trials and data extraction were undertaken by one reviewer and independently checked by two other reviewers. MAIN RESULTS: Five trials were included. In one placebo trial, oral misoprostol reduced the need for oxytocin infusion and shortened delivery time in women with prelabour rupture of membranes at term. In another trial, compared to vaginal prostaglandins, oral misoprostol reduced the need for oxytocin (relative risk 0.62, 95% confidence interval 0.47 to 0.82). Based on two trials, the caesarean section rate with oral misoprostol was 20. 2% (55/272) compared with 15.5% (42/270) for vaginal prostaglandins (relative risk 1.29, 95% confidence interval 0.90 to 1.86). Different doses (100 micrograms three hourly and 200 micrograms six hourly) were used in the two trials that compared oral with vaginal misoprostol. The caesarean section rate was 21.8% in the oral misoprostol group compared with 13.5% for vaginal misoprostol (relative risk 1.62, 95% confidence interval 0.85 to 3.09). The uterine hyperstimulation rate with oral misoprostol was 37.5% (36/96) compared with 28% (25/89) for vaginal misoprostol (relative risk 1.32, 95% confidence interval 0.86 to 2.04). There was significant heterogeneity between these two trials. REVIEWER'S CONCLUSIONS: Oral misoprostol may be an effective method for labour induction. However clinically effective oral regimens may have an unacceptably high incidence of uterine hyperstimulation and possibly uterine rupture.

Female↗
PubMed1994

Cardiac blood flow studies in fetuses with haemoglobin Bart's disease.

Blood flow across the atrioventricular valves and outflow tracts was measured in 55 normal fetuses and 32 fetuses with haemoglobin (Hb) Bart's disease between 18 and 26 weeks of gestation. The mean velocities remained unchanged in both normal and affected fetuses over the gestations studied. The volume flow across both atrioventricular valves and outflow tracts increased as the gestation advanced in both normal and affected fetuses, but was significantly higher in affected than in normal fetuses. The same magnitude of increased flow was found in both hydropic and non-hydropic fetuses with Hb Bart's disease. These findings suggest that fetuses with severe and long-standing anaemia have a remarkable cardiac compensatory mechanism for the maintenance of tissue oxygenation. In response to anaemia and circulatory loading, the cardiac chambers and outflow tracts enlarge proportionately up to twice the normal values. Because of this response and the operation of the Frank-Starling mechanism, the heart is able to maintain a normal mean velocity of propulsion and the net output is increased to two to three times that in normal fetuses. Hydropic changes in these anaemic fetuses appear unrelated to cardiac failure as cardiac failure is not observed at the time that hydropic changes develop.

Blood Flow Velocity↗
PubMed2002

Middle cerebral artery Doppler study in fetuses with homozygous alpha-thalassaemia-1 at 12-13 weeks of gestation.

OBJECTIVE: Fetuses affected by homozygous alpha-thalassaemia-1 are anaemic from the first trimester of pregnancy. We investigated middle cerebral artery Doppler velocimetry in these affected fetuses at 12-13 weeks of gestation to assess its use in predicting fetal anaemia. METHODS: Women referred for the prenatal diagnosis of homozygous alpha-thalassaemia-1 before 14 weeks of gestation were recruited. All fetuses underwent pulsed Doppler examinations following colour flow mapping at 12 or 13 weeks of gestation. Homozygous alpha-thalassaemia-1 was diagnosed by DNA or haemoglobin study. The middle cerebral artery Doppler indices were compared between the affected fetuses and fetuses unaffected by homozygous alpha-thalassaemia-1. RESULTS: Between 1998 and 2000, 80 eligible women were recruited. Of these, 19 fetuses were affected by homozygous alpha-thalassaemia-1. Two of them showed hydropic changes at the time of Doppler study. The affected fetuses had significantly higher middle cerebral artery peak systolic velocity (V(max)) (36% increase) and time-averaged maximum velocity (V(tamx)) (33% increase). CONCLUSION: The increase of cerebral blood flow in affected fetuses is consistent with our previous finding of an increased forward flow in the ductus venosus, cardiac dilatation and an increase of cardiac output to preferentially shunt more oxygenated blood to the brain as a compensatory mechanism. However, extensive overlap of the middle cerebral artery flow velocity values between affected and unaffected fetuses precludes its use in predicting anaemia at 12-13 weeks' gestation.

DNA↗
PubMed2005

Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome?

OBJECTIVES: Most obstetric clinics have a program for the identification of small-for-gestational age (SGA) fetuses because of the increased risk of fetal complications that they present. We have a structured model for the identification and follow-up of SGA pregnancies. We aimed to determine whether the recognition of SGA antepartum improves fetal outcome. METHODS: All pregnancies at Malmö University Hospital from 1990 to 1998 (n = 26 968) were reviewed. SGA fetuses identified prior to delivery (n = 681) were compared with those not identified (n = 573). Also, all pregnancies with SGA fetuses were compared with those appropriate-for-gestational age (AGA) (n = 24 585). The risk of serious fetal complications (hypoxic encephalopathy grade 2 or 3, intracranial hemorrhage, Apgar score <4 at 5 min, neonatal convulsions, umbilical pH <7.0, cerebral palsy, mental retardation, stillbirth, intrapartum or infant death) was assessed with cross-tabulation and logistic regression analysis, adjusted for gestational age and degree of SGA. RESULTS: When compared with SGA fetuses identified before delivery (54%), SGA fetuses not identified before delivery were characterized by a four-fold increased risk of adverse fetal outcome (odds ratio, 4.1; 95% CI, 2.5-6.8). Similarly, compared with AGA fetuses, SGA fetuses were associated with a four-fold increased risk of serious fetal complications. CONCLUSIONS: A structured antenatal surveillance program for fetuses identified as SGA results in a lower risk of adverse fetal outcome, compared with cases of SGA fetuses not identified antepartum.

Brain Damage, Chronic↗
PubMed2005

Fetal trunk and head volume in chromosomally abnormal fetuses at 11+0 to 13+6 weeks of gestation.

OBJECTIVE: To examine the pattern of growth in chromosomally abnormal fetuses at 11+0 to 13+6 weeks of gestation and compare the trunk and head volume to crown-rump length (CRL) in defining the growth deficit in such fetuses. METHODS: The fetal trunk and head volume was measured using three-dimensional (3D) ultrasound in 140 chromosomally abnormal fetuses at 11+0 to 13+6 (median 12) weeks of gestation, and the values were compared to 500 chromosomally normal fetuses. In each chromosomally abnormal fetus, the observed fetal trunk and head volume was subtracted from the expected mean (delta value) of the chromosomally normal fetuses of the same gestational age, and this difference was expressed as a percentage of the appropriate normal mean. The Mann-Whitney U-test was used to determine the significance of differences between the chromosomally normal and abnormal groups. RESULTS: In trisomy 21 (n=72) and Turner syndrome (n=14) fetuses, compared to chromosomally normal fetuses, the CRL for gestation was similar (P=0.335 and P=0.317, respectively), but the fetal trunk and head volume was about 10-15% lower (P<0.001 and P=0.004, respectively). In trisomy 18 (n=29), trisomy 13 (n=14) and triploidy (n=11), the deficit in volume was about 45% (P<0.001), whereas the deficit in CRL was less than 15% (P<0.001). CONCLUSIONS: In the quantification of the degree of early growth impairment in chromosomally abnormal fetuses, measurement of the fetal trunk and head volume using 3D ultrasound may be better than measurement of CRL.

Case-Control Studies↗
PubMed1989

Pathogenic properties of encephalomyocarditis virus isolates in swine fetuses.

The pathogenicity of 5 different encephalomyocarditis (EMC) virus isolates was investigated in swine fetuses following injection of each virus in utero. Laparotomies were performed on 3 pregnant sows in early mid-third (39-40 days) of gestation and on 5 sows in the late mid-third (70-72 days) of gestation, and groups of fetuses were inoculated with different viruses into the amniotic sacs. The uninoculated fetuses served as controls. Thirty-five (71.4%) of 49 infected and 1 of 26 control fetuses were grossly abnormal. Virus was recovered from 18 of 28 infected fetuses and 1 of 16 control fetuses examined. Antibody to EMC virus was detected in all of 14 fetuses infected at 70-72 days of gestation and examined 11-26 days post-infection. The fetal pathogenicity was different depending on the virus strains and the fetal age at the time of virus infection. The EMC ATCC-VR 129 virus was not pathogenic but NVSL-PR, MN-25 and MN-30 were highly pathogenic to the fetuses in both early and late mid-thirds of gestation, while NVSL-MDV was pathogenic to the fetus in early but not in late mid-third of gestation. Possible mechanisms for differences in the pathogenicity between the virus strains are discussed.

Animals↗
PubMedDate not supplied

Outcome of intermittent tachyarrhythmias in the fetus.

Persistent fetal tachycardias are known to have an adverse effect on fetal outcome. The outcomes of intermittent fetal tachyarrhythmias over a 12-year period at a tertiary fetal cardiology center were studied. Main outcome criteria included control of arrhythmia and death during the prenatal or postnatal period. A total of 28 fetuses had an intermittent tachyarrhythmia: 4 had intermittent atrial flutter and 24 had supraventricular tachycardia. At the time of presentation 14 fetuses were hydropic, and in 5 of the 14 an arrhythmia had not been noted prior to referral. Of the 28 fetuses, 23 were treated by drug administration to the mother. Control of arrhythmia was achieved in 10 of 11 (91%) nonhydropic fetuses and 8 of 12 (67%) hydropic fetuses, with resolution of hydrops in four cases. In the overall group there was one intrauterine death, two neonatal deaths, and one infant death, all of which occurred in the hydropic group. The arrhythmia recurred postnatally in 11 of 23 (48%) fetuses. We conclude that intermittent tachyarrhythmias may have a deleterious effect on the fetus with a significant risk of death pre- or postnatally. The fetus with nonimmune hydrops should be evaluated for a cardiac cause. Maternal antiarrhythmic therapy is indicated for intermittent fetal tachyarrhythmias. There is a high risk of recurrence of the arrhythmia during infancy, particularly if hydrops was documented during the prenatal period or if Wolff-Parkinson-White syndrome is diagnosed. Fetal echocardiography is a useful tool for diagnosis and for monitoring the progress of the fetus.

Anti-Arrhythmia Agents↗
PubMed1988

Discordant accelerated pulmonary maturation after adrenocorticotropic hormone-induced labor in twin sheep fetuses.

To examine the role of parturition on lung maturation in sheep, we studied parameters of lung development in singleton fetuses treated with pulsatile adrenocorticotropic hormone or saline solution from day 127 or twin pregnancies in which one fetus only received pulsatile adrenocorticotropic hormone from day 127 until labor occurred. These parameters were compared with those of term fetuses (145 days). Pulsatile adrenocorticotropic hormone provoked labor in a mean (+/- SEM) of 102.6 +/- 6.6 and 181.0 +/- 18.0 hours in single and twin pregnancies, respectively. Adrenal/body weight ratios increased similarly in adrenocorticotropic hormone-treated single and twin fetuses at delivery, and basal cortisol levels were two- to threefold higher prepartum in adrenocorticotropic hormone-treated fetuses. Little change in plasma cortisol levels occurred in singletons treated with saline solution or in twins not infused with adrenocorticotropic hormone. The lung weight/body weight was not altered in any group. Lung distensibility and stability were doubled to term values in fetuses treated with pulsatile adrenocorticotropic hormone compared with controls and untreated twins. Mean lavage phosphatidylcholine levels rose from 0.07 to 0.11 mg/gm in saline solution-treated or untreated fetuses to 0.20 to 0.23 mg/gm in pulsatile adrenocorticotropic hormone-treated singletons or twins, compared with 0.63 mg/gm at term. Phosphatidylcholine production increased from 0.51 dpm/gm/hr in saline solution-treated fetuses to 0.73 and 0.89 dpm/gm/hr in the single and twin pulsatile adrenocorticotropic hormone-infused fetuses, respectively; phosphatidylcholine production was 0.62 dpm/gm/hr in the noninfused twin. Lungs of twins treated with pulsatile adrenocorticotropic hormone were morphologically more mature than those of untreated twins. We conclude that fetal endocrine responses to exogenous adrenocorticotropic hormone, rather than the stimuli associated with labor per se, are responsible for lung maturation in the fetal sheep.

Adrenocorticotropic Hormone↗
PubMed1983

Effect of increased substrate availability on fatty acid synthesis in the growth retarded fetus.

The purpose of this study was to test the hypothesis that increased substrate (glucose) availability will enhance fatty acid synthesis in the growth retarded rat fetus. At 17 days of gestation, 19 time-dated pregnant rats had one uterine artery ligated, leading to growth retardation (IUGR) in the fetuses located on the uterine horn supplied by the ligated artery. The uterine artery of the opposite uterine horn was left untouched, resulting in appropriately grown fetuses, which served as controls. At 21 days of gestation the animals were infused with either 20% dextrose or 0.9% saline via a maternal jugular vein catheter for 4 hr. Fetal organ fatty acid synthesis was measured by maternal 3H2O injection. In the growth retarded saline infused fetus, specific activity for 3H (representing rate of fatty acid synthesis) was significantly lower in fetal liver, lung and carcass. Dextrose infusion resulted in increased fatty acid synthesis in both control and IUGR fetuses in all tissues cited above. The specific activity in glucose infused IUGR fetal organs equalled that of saline infused control fetuses. The data indicate that maternal glucose infusion resulted in an increased rate of fatty acid synthesis, in IUGR fetuses; consequently, the deficit in fatty acid synthesis in the IUGR fetus (compared to appropriately grown control fetuses) was abolished.

Animals↗
PubMed1988

Prenatal diagnosis and management in fetuses with cystic hygromata colli.

We report on 45 fetuses with prenatally diagnosed bilateral cystic hygromata colli by ultrasound. Two of the 45 cases involved a twin pregnancy with only one fetus showing hygromata colli. In 2 cases there was only isolated hygromata colli. The other 43 cases showed the signs of non-immune hydrops fetalis. The cytogenetic findings were: 9 fetuses with Turner syndrome, 1 fetus with Turner mosaicism, 1 fetus with trisomy 18, 6 fetuses with trisomy 21, 12 fetuses with normal karyotype, and 16 fetuses with a failed chromosome culture. In fetuses with Turner syndrome and normal karyotype the sonographic findings were similar: massive bilateral hygromata colli, substantial fluid accumulations in skin and body cavities, oligohydramnios and intra-uterine growth retardation. In the cases with trisomy 21, the relative size of the hygromata colli was smaller. Intra-uterine growth retardation and oligohydramnios were not observed. The sole survivor of our group (elective pregnancy interruption: 30 cases; intra-uterine death: 14 cases) (karyotype: 46,XY) presented sonographically with massive ascites, a moderate cystic hygroma, and appropriate fetal development, and a normal amniotic fluid quantity. These findings are analysed in order to provide recommendations for prenatal diagnosis, prenatal management and genetic counselling of the couples concerned.

Adult↗
PubMed1995

Peak velocity of the outflow tract of the aorta: correlations with acid base status and oxygenation of the growth-retarded fetus.

OBJECTIVE: To correlate the peak velocities of the aortic outflow tract of growth-retarded fetuses with fetal acid base status and oxygenation measured in utero. METHODS: Thirty-one growth-retarded fetuses with abnormal umbilical pulsatility index (PI) measurements underwent fetal blood sampling. Blood pH, carbon dioxide pressure (PCO2), oxygen pressure (PO2), oxygen saturation, lactate concentration, and hemoglobin concentration were measured. Using color Doppler equipment, we measured the peak velocities of the outflow tract of the aorta, pulmonary artery, and ductus arteriosus before fetal blood sampling. RESULTS: The peak velocities measured in the outflow tract of the aorta, pulmonary artery, and ductus were significantly lower in growth-retarded fetuses than in 140 normal fetuses of comparable weight. The correlation observed between pulmonic and aortic peak velocities was significant (r = 0.84), as was that between pulmonic and ductal peak velocities (r = 0.74). Growth-retarded fetuses with abnormal aortic peak velocities had significantly lower values of PO2, oxygen content and pH, and had higher lactate concentration and PCO2 than did growth-retarded fetuses with normal peak velocities. Estimated fetal weight and umbilical PI (mean +/- standard deviation) were not significantly different in these two groups. Moreover, significant direct correlations were found between proximal aortic peak velocities and lactate concentrations (correlation coefficient 0.71, P < .0001) and O2 content (P < .02, r = 0.42). CONCLUSION: For growth-retarded fetuses, Doppler peak velocity in these vessels is significantly lower than in normal fetuses of comparable weight. Aortic, pulmonic, and ductal peak velocity correlated significantly. Growth-retarded fetuses with abnormally low peak velocity in the outflow tract of the aorta have a higher risk of acidemia and hypoxia than those with normal velocities.

Aorta↗
PubMed1996

Cerebellar Doppler velocimetry in the appropriate- and small-for-gestational-age fetus.

OBJECTIVE: To compare superior cerebellar artery flow velocity waveforms in the appropriate-for-gestational-age (AGA) and the small-for-gestational-age (SGA) fetus. METHODS: Superior cerebellar artery velocity waveforms were obtained prospectively from 172 AGA fetuses at 17-41 weeks' gestation. The pulsatility index (PI) was used to quantify the waveforms. Superior cerebellar artery velocity waveforms were also obtained from 30 SGA fetuses divided into group A (n = 15), with a normal umbilical artery PI, and group B (n = 15), with an abnormal umbilical artery PI. The transverse cerebellar diameter was measured in all SGA fetuses. RESULTS: The superior cerebellar artery PI was best represented by a second-order polynomial equation [PI = 0.145 + 0.101 x (gestational age) - 0.00197 (gestational age)2]. Small-for-gestational-age fetuses of group A had a superior cerebellar artery PI in the normal range, whereas 13 of 15 fetuses of group B (86.7%) had a PI value less than the individual 95% confidence interval. The transverse cerebellar diameter in group A fetuses was in the normal range in ten of 15 cases, whereas it was in the normal range for all group B fetuses. CONCLUSION: Small-for-gestational-age fetuses with an abnormal umbilical artery PI have "cerebellar-sparing effect," as suggested by a superior cerebellar artery PI less than the normal range and a normal transverse cerebellar diameter.

Arteries↗
PubMed1985

Behavioural states in the fetuses of nulliparous women.

Behavioural state observations were carried out serially on the fetuses of 14 low risk nulliparae. They were observed serially at 2-weekly intervals between 32 weeks gestational age and delivery at term. Two real-time ultrasound B-scanners were used to visualize fetal body, eye and breathing movements. Fetal heart rate patterns were recorded simultaneously by means of a clinical fetal monitor. States appeared to be present transiently in three fetuses at 34 weeks. States were definitely present in five of 13 fetuses studied at 38 weeks and six of seven observed at 40 weeks. In comparison to the fetuses of low risk multiparae studied earlier, the fetuses in the present study showed a somewhat lower proportion of quiescence (coincidence 1F) and higher percentage of activity (coincidence 2F); however, most of these differences were not statistically significant. In the fetuses which showed states, the distribution and durations of the states at 38 and 40 weeks were not different from those found previously in the fetuses of multiparae. We conclude that the development of behavioural states is generally similar in the fetuses of low risk nulliparae and multiparae, but that states appear at a somewhat later gestational age in the fetuses of nulliparae.

Eye Movements↗
PubMed1993

The intercostal-to-phrenic-inhibitory reflex (IPIR) in normal and intra-uterine growth-retarded (IUGR) human fetuses from 26 to 40 weeks of gestation.

The existence of an IPIR in the healthy fetus between 37 and 40 weeks of gestation has already been demonstrated: compression of the fetal thoracic wall during an epoch of fetal breathing movements (FBM) consistently caused a fetal apnea (> or = 4 s). The apnea durations were similar in fetal behavioural states 1F and 2F, with a wide inter- and intrafetal variability. We therefore hypothesized that the duration of the IPIR-apnea would increase during gestation and would be increased in IUGR-fetuses as compared to healthy fetuses of the same age. Twenty-six healthy fetuses between 28 and 40 weeks (mean 34.3 weeks) and 14 IUGR-fetuses between 26 and 38 weeks (mean 33.5 weeks) were studied. If FBM were present, the caudolateral part of the fetal thoracic wall was shortly compressed manually and the duration of the resulting apnea was measured. In a random order a sham-compression was also carried out on the fetal head. In normal fetuses 21/28 real compressions were followed by an apnea in 1F, while this was only the case in 3/21 sham-compressions (P < 10(-4)). For 2F these results were 47/57 and 7/51, respectively (P < 10(-4)). In IUGR-fetuses 43/51 real compressions (1F and 2F together) and 7/46 sham-procedures provoked an apnea (P < 10(-4)). These results prove the existence of the IPIR in normal and IUGR-fetuses. The mean (+/- S.D.) duration of apnea in the IUGR-fetuses was 15.8 s (+/- 4.0) (range 4-80 s) and 15.2 s (+/- 4.3) (range 4-106 s) in the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)

Apnea↗
PubMed2004

Sonographic morphology and hyaluronan content of umbilical cords of healthy and Down syndrome fetuses in early gestation.

OBJECTIVE: To explore the sonographic vascular architecture and the hyaluronan amount and distribution of umbilical cords of healthy and trisomy 21 fetuses in early gestation. MATERIAL AND METHODS: Umbilical cord sonographic morphology and morphometry of 112 consecutive normal fetuses and 11 trisomy 21 fetuses were assessed between 10 and 15 weeks of gestation. The umbilical coiling index was defined as the reciprocal of the length of one complete coil measured in a longitudinal section of the umbilical cord. The umbilical coiling angle was defined as the maximum angle between the long axis of the umbilical cord and that of the umbilical arteries. Three umbilical cord samples obtained from Down syndrome fetuses and one from a healthy fetus after voluntary termination of pregnancy at 13 weeks of gestation were used for biochemical analysis. Quantitative hyualuronan content and tissue distribution was studied using fluorophore-assisted carbohydrate electrophoresis (FACE) analysis and staining methods using biotin-labeled hyaluronan-binding protein (bHABP), respectively. RESULTS: A significant correlation was present between gestational age and both the umbilical coiling index (r=-0.56, p<0.001) and the umbilical coiling angle (r=-0.43, p<0.001). The proportion of uncoiled umbilical cords was significantly higher in Down syndrome fetuses than in healthy fetuses [8/112 (7.1%) vs. 4/11 (36.4%), p<0.05]. Biochemical analysis demonstrated a higher amount and a different distribution of hyaluronan in trisomy 21 umbilical cords compared to healthy fetuses. CONCLUSION: The umbilical cord of Down syndrome fetuses in early gestation shows peculiar sonographic vascular features and quantitative alterations of the Wharton's jelly hyaluronan.

Adult↗
PubMed1997

Doppler echocardiographic evaluation of ventricular diastolic filling in fetuses with ductal constriction.

To assess ventricular diastolic filling in fetuses with constriction of ducts arterious, 43 fetuses of pregnant women receiving indomethacin (100 to 150 mg/day) were examined with Doppler echocardiography. Ductal constriction occurred in 21 fetuses, defined as maximal systolic velocity > 140 cm/s and diastolic flow velocity > 30 cm/s. The variables measured to assess diastolic function were peak velocity during early diastole (peak E wave), peak velocity during atrial contraction (peak A wave), and the velocity ratio (peak E/A ratio); these were compared to maximal ductal flow velocity during systole and diastole. The mitral peak E wave, peak A wave, and peak E/A ratio in fetuses with ductal constriction showed no significant difference from those in fetuses without ductal constriction. In fetuses with ductal constriction, the tricuspid A wave increased significantly without changes in the peak E wave (57 +/- 9 vs 50 +/- 6 cm/s, p < 0.01) and the peak E/A ratio was significantly lower than in fetuses without ductal constriction (0.57 +/- 0.10 vs 0.65 +/- 0.08, p < 0.05). In 9 fetuses with ductal constriction, we compared the Doppler tricuspid E wave, A wave, and E/A ratio during indomethacin administration with those after withdrawal of the drug for a mean of 24 hours. Both systolic and diastolic ductal flow velocities in the fetuses returned to normal range after discontinuation of indomethacin. The tricuspid peak A wave decreased (59 +/- 9 vs 50 +/- 11 cm/s) and the E/ A ratio increased significantly (0.56 +/- 0.07 vs 0.69 +/- 0.07) (both p < 0.01) without any significant change in peak E wave after discontinuation of indomethacin. This study suggests that ductal constriction influences Doppler patterns of right ventricular diastolic filling. These changes could be related to the increased afterload presented to the right ventricle which might affect diastolic function.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

Digoxin-like immunoreactive substance in fetuses with and without cardiac pathology.

The concentration of digoxin-like immunoreactive substance was measured by immunoassay in umbilical venous blood from six normal and 19 fetuses with a variety of cardiac and noncardiac disorders. Fetal blood was obtained either by percutaneous umbilical blood sampling (n = 13) or at delivery (n = 12). Three women received digoxin for fetal indications. Healthy control fetuses had significantly less digoxin-like immunoreactive substance measured (mean concentration below the limit of the assay sensitivity) than was found in ill fetuses whose mothers received digoxin (p less than 0.005). However, the fetal concentrations of immunoreactive digoxin in fetuses with a cardiac abnormality were similar whether the mother had (0.93 +/- 0.4 ng/ml) or had not (1.27 +/- 0.4 ng/ml) received digoxin (p = 0.1452). Although there was a significant negative correlation between digoxin concentration and gestational age (R = -0.5079, p less than 0.01), the youngest fetuses examined were generally the sickest. The correlation with gestational age was not significant if the normal control fetuses were excluded. One fetus with a cardiac tachyarrhythmia was examined during and after transplacental therapy. There was no change. It is possible that previously measured "digoxin" in "treated" fetuses represents digoxin-like immunoreactive substance and that only small amounts of maternally administered digoxin actually reach the ill fetus. Our findings suggest that a randomized trial of maternal digitalization for the treatment of fetal supraventricular tachycardia is essential prior to its acceptance as effective therapy.

Blood Proteins↗
PubMed1997

Outcome of twin gestations with a single anomalous fetus.

OBJECTIVE: Our goal was to determine whether the presence of one anomalous fetus in a twin gestation affects pregnancy outcome when compared with twin pregnancies without fetal anomalies. STUDY DESIGN: Maternal and neonatal data from 970 twin pregnancies delivered from 1988 to 1995 were collected. Three groups of twin gestations were identified: one fetus with a major anomaly (n = 18), one fetus with a minor anomaly (n = 38), and both fetuses without anomalies (n = 914). RESULTS: Maternal demographic characteristics (age, race, and antepartum complications) were similar among the groups. There was no difference in neonatal outcome (gestational age at delivery, birth weight, cord pH, sepsis, and death) in the minor anomaly and no anomaly groups. There were significant differences between the major anomaly group and the no anomaly group in gestational age at delivery (32.9 vs 35.6 weeks, p < 0.05), birth weight at delivery (1759 vs 2291 gm, p < 0.05), hospital days (41 vs 13 days, p < 0.05), and perinatal death of the anomalous fetus (278/1000 vs 10/1000). Except for total days in the hospital, there was no difference in neonatal morbidity or mortality for the normal fetus when compared with the minor group or the no anomaly group. CONCLUSION: The presence of a fetus with a major anomaly in a twin gestation increases the risk of preterm delivery. The neonatal outcome of the nonanomalous fetus does not appear to be affected by the anomalous fetus.

Cesarean Section↗