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PubMed1997

Splenic artery velocity waveforms in small-for-gestational-age fetuses: relationship with pH and blood gases measured in umbilical blood at cordocentesis.

OBJECTIVE: Our purpose was to relate velocity waveforms from the splenic artery with pH and blood gas levels measured at cordocentesis in small-for-gestational-age fetuses and to compare the diagnostic efficiency of splenic artery waveforms with that of other fetal arterial and venous vessels in predicting acid-base status. STUDY DESIGN: Cross-sectional recordings from the splenic artery were obtained by color and pulsed Doppler techniques in 316 appropriately grown fetuses, 12 small-for-gestational-age fetuses with normal umbilical artery velocity waveforms (group 1), and 30 small-for-gestational-age fetuses with abnormal umbilical artery velocity waveforms (group 2). Measurements of splenic artery pulsatility index values in small-for-gestational-age fetuses were compared with those of appropriate-for-gestational-age fetuses. Associations of splenic artery pulsatility index with Po2, Pco2, and pH values measured at cordocentesis were examined and compared with those of umbilical artery, middle cerebral artery, and inferior vena cava. RESULTS: In appropriately grown fetuses pulsatility index values from the splenic artery decrease with advancing gestation (r = 0.51, p < 0.0001). Splenic artery pulsatility index values are lower in group 2 (p < 0.001) but not in group 1 small-for-gestational-age fetuses (p = 0.211). The amplitude of the decrease in the pulsatility index is significantly associated with fetal hypoxemia (r = 0.646, p < 0.001), acidemia (r = 0.593, p < 0.001) and hypercapnia (r = 0.577, p < 0.001). However, logistic regression demonstrates that hypoxia is better predicted by middle cerebral artery pulsatility index, whereas hypercapnia and acidosis are more closely associated with the percent of reverse flow in inferior vena cava. CONCLUSION: A decrease in the splenic artery pulsatility index occurs in small-for-gestational-age fetuses in the presence of abnormal pH and blood gas values, but a more accurate assessment of acid-base status may be obtained with the study of the middle cerebral artery and inferior vena cava.

Blood Flow Velocity↗
PubMed2002

Prenatal course and pregnancy outcome of fetuses with a transient nuchal translucency.

OBJECTIVES: This study was designed to correlate fetuses in a normal prenatal population who exhibited transient nuchal translucency (NT) with both prenatal course and pregnancy outcome. METHODS: The fetuses with abnormal NT were followed by ultrasonography at 1-2-week intervals during their prenatal course. Fetuses with NT who exhibited no detectable congenital malformations were defined as the NTO group; fetuses with abnormal NT and structural malformations but no chromosomal abnormalities were placed in the SM group; and fetuses with abnormal NT, structural malformations, and chromosomal abnormalities were categorized as the CA group. The groups were compared by: maternal age, weeks of gestation by ultrasound and the NT value at the initial exam, the maximum NT value, and the duration of abnormal NT. RESULTS: During the study period, 92 fetuses with abnormal NT were found, monochorionic twins excluded. Of the 92 fetuses, 80 were in the NTO group, 10 were in the SM group, and two were in the CA group. The maternal age and the gestational weeks at the initial diagnosis were not significantly different in the NTO and the SM groups. However, the NT value at the initial diagnosis, maximum NT value, and the duration of abnormal NT were significantly greater in the SM group than those values in the NTO group. CONCLUSIONS: Fetuses with transient nuchal translucency commonly had structural malformations, particularly fetuses with significant and large persistent NT.

Adult↗
PubMed1998

Detection and assessment of pyelectasis in the fetus: relationship to postnatal renal function.

OBJECTIVE: To assess the relationship between fetal pyelectasis determined by ultrasonography and postnatal renal function. METHODS: We first established normal values for anteroposterior, transverse, and longitudinal diameters of the renal pelvis sonographically in 68 normal fetuses at 30-40 weeks' gestation. We also evaluated prospectively the relationship between the severity of pyelectasis (diameter at least two standard deviations above the normal mean) in 36 fetuses at 30-40 weeks' gestation and postnatal renal function. Fetal renal function also was evaluated through measurement of the hourly urine production rate, whereas postnatal renal function was assessed by technetium 99m-diethylenetriamine penta-acetic acid renography and excretory urography. RESULTS: Fetal pyelectasis was diagnosed when renal pelvic diameters were at least 8 mm (anteroposterior), 11 mm (transverse), and 14 mm (longitudinal), all upper limits of normal diameters of 68 normal fetuses as determined in the first part of the study. Pyelectasis was associated with a normal urine production rate in all fetuses, but in six fetuses it was associated with a normal urine production rate in all fetuses, but in six fetuses it was associated with a progressive deterioration of renal function within the 1st month of life, requiring neonatal surgery. In the other 30 fetuses with pyelectasis, who did not require neonatal surgery, pyelectasis decreased gradually or totally disappeared within 2 years. Renal pelvic anteroposterior, transverse, and longitudinal pelvic diameters were at least 20, 25, and 26 mm, respectively, during late fetal life in those neonates at the time of corrective surgery. The mean anteroposterior diameter in those fetuses who did not require surgery at infancy (11 +/- 6 mm) was significantly less than in those requiring surgery (33 +/- 14 mm, P < .01). Likewise, the transverse diameters were 17 +/- 10 mm and 38 +/- 16 mm (P < .01) and the longitudinal diameters were 20 +/- 10 mm and 48 +/- 22 mm (P < .01). CONCLUSION: Neonatal surgery is recommended when the anteroposterior, transverse, and longitudinal renal pelvic diameters during the prenatal period are at least 20, 25, and 26 mm, respectively. Surgery is not necessary when the diameters are less than 20 mm.

Dilatation, Pathologic↗
PubMed1999

Increased platelet-activating factor-acetylhydrolase activity in the umbilical venous plasma of growth-restricted fetuses.

OBJECTIVE: To determine whether platelet-activating factor-acetylhydrolase activity in fetal plasma obtained at birth from umbilical vessels is different from that in maternal plasma, and (2) to compare platelet-activating factor-acetylhydrolase activity in cord plasma from fetuses with fetal growth restriction (FGR) and those with appropriate growth for gestational age (AGA). METHODS: Platelet-activating factor-acetylhydrolase activity was measured in the plasma of 22 nonpregnant healthy women, 16 pregnant women at term during labor, 28 fetuses exhibiting AGA, and seven fetuses with FGR. RESULTS: Plasma platelet-activating factor-acetylhydrolase activity in normotensive pregnant women at 37-41 weeks' gestation was 28.1+/-16.6 nmol/mL per minute, which was not statistically different from the activity in nonpregnant women (30.8+/-11.1 nmol/mL per minute). Platelet-activating factor-acetylhydrolase activity in venous cord plasma from AGA fetuses was significantly (P < .01) lower than that in maternal plasma (6.3+/-2.6 nmol/mL per minute), and there was no difference between the activities found in arterial and venous cord samples. In FGR fetuses, venous cord platelet-activating factor-acetylhydrolase activity was significantly (P < .01) higher (12.1+/-1.4 nmol/mL per minute), than the activity seen in AGA fetuses, and when the data from AGA and FGR fetuses were considered together, there was a negative correlation between cord plasma platelet-activating factor-acetylhydrolase activity and neonatal body weight (r = .46, P = .006). CONCLUSION: Platelet-activating factor hydrolysis is significantly lower in fetuses than adults. Further, the comparatively high platelet-activating factor-acetylhydrolase activity in FGR fetuses suggests the existence of a compensatory mechanism to maintain microcirculation within the placenta.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗
PubMed1999

Relationship of amniotic fluid index and cord blood erythropoietin levels in small for and appropriate for gestational age fetuses.

OBJECTIVE: To determine whether low amniotic fluid index (AFI) reflects an increase in cord blood erythropoietin levels and is a marker of antenatal fetal hypoxia in small for gestational age (SGA) and appropriate for gestational age (AGA) fetuses in the third trimester. METHODS: Erythropoietin levels in cord blood were measured in 134 high-risk obstetric patients, including 40 with low AFI (7 cm or less) and 94 with normal AFI (greater than 7 cm), which were sampled at elective cesarean delivery of fetuses with a gestational age of 32 to 39 weeks. The infants were divided into the SGA and AGA groups based on birth weight. Partial correlations of AFI with cord blood erythropoietin levels were evaluated by Pearson correlation coefficient after logarithmic transformation of erythropoietin levels in each group. RESULTS: Cord blood erythropoietin levels in SGA fetuses with low AFI (n = 24) were significantly higher than those in SGA fetuses with normal fluid volume (n = 16) (171.6 +/- 207.4 mIU/dL compared with 36.1 +/- 24.1 mIU/dL, P < .001). Conversely, cord blood erythropoietin levels in AGA fetuses with low AFI (n = 16) were not significantly different than those in AGA fetuses with normal fluid volume (n = 78) (32.1 +/- 18.7 mIU/dL compared with 29.5 +/- 15.3 mIU/dL). A significant partial correlation between AFI and erythropoietin levels was demonstrated only within the SGA group (P < .001, r = -.67). CONCLUSION: Low AFI could indicate the degree of antenatal fetal hypoxia in SGA fetuses. The impact of a reduced amniotic fluid volume on antenatal fetal condition might be less severe in AGA fetuses than in SGA fetuses.

Adult↗
PubMed1999

Clinical and pathologic features of cloned transgenic calves and fetuses (13 case studies).

The neonatal abnormalities, treatments and outcomes in a group of 13 cloned transgenic calves and fetuses that progressed into the third trimester of pregnancy are described. From these 13 fetuses, 8 calves were born live, 4 stillborn fetuses were recovered from 3 cows that died 7 d to 2 mo before term, and 1 aborted fetus was recovered at 8 mo gestation. All fetuses and calves were derived from the same male fetal Holstein fibroblast cell line transfected with a beta-galactosidase marker gene. Six calves were delivered by Cesarian section and two by vaginal delivery between 278 and 288 d of gestation. Birth weights ranged from 44 to 58.6 kg. Five of the 8 live born calves were judged to be normal within 4 h of birth based on clinical signs and blood gas measurements. One of these 5 calves died at 6 wk of age from a suspected dilated cardiomyopathy. Three of the 8 calves were diagnosed with neonatal respiratory distress immediately following birth, one of which died (at 4 d of age) as a result of pulmonary surfactant deficiency coupled with pulmonary hypertension and elevated systemic venous pressures. Similar findings of chronic pulmonary hypertension were also observed in 2 of 5 fetuses. Placental edema was present in both calves that later died and in the 2 fetuses with cardiopulmonary abnormalities. Hydrallantois occurred with or without placental edema in 6 cows, and only 1 calf from this group survived. The 6 cows without hydrallantois or placental edema produced 5 live calves and 1 aborted fetus. The cardiopulmonary abnormalities observed in the calves and fetuses occurred in utero in conjunction with placental abnormalities, and it is likely that the cloning technique and/or in vitro embryo culture conditions contributed to these abnormalities, although the mechanism remains to be determined.

Animals↗
PubMed2001

Alterations in irregular and fractal heart rate behavior in growth restricted fetuses.

OBJECTIVES: To determine whether irregularity, and short- and long-term fractal correlation reflecting smoothness of heart rate behavior are changed in intrauterine growth restricted fetuses. STUDY DESIGN: Fetal heart rate data of 192 normal fetuses and 86 intrauterine growth restricted fetuses between 31 and 42 weeks of gestation were studied. Approximate entropy to quantify irregularity, and short-term (< or =80 beats, alpha1) and long-term (>80 beats, alpha2) fractal scaling exponents to quantify the short- and long-term fractal correlation were calculated. RESULTS: In the intrauterine growth restricted fetuses, the approximate entropy was significantly lower (P<0.001). The alpha2 value was significantly higher (P=0.0001) than in the normal fetuses, which performed better (F=34.2, P<0.0001) than other heart rate variability indexes in differentiating the intrauterine growth restricted fetuses from the normal fetuses in stepwise discriminant analysis. CONCLUSIONS: Compared to normal fetuses, intrauterine growth restricted fetuses show a difference in that the irregularity of the fetal heart is decreased. A more apparent difference is that the long-term fractal correlation of the fetal heart is increased and the fetal heart is smoother in the long-term scale.

Adult↗
PubMed1999

Computerised analysis of unstimulated and stimulated behaviour in fetuses with intrauterine growth restriction.

Unstimulated (passive) and stimulated behaviour, in the form of fetal heart rate (FHR) and activity (FA)) was studied in 32 normal fetuses and 14 fetuses with intrauterine growth restriction (IUGR). FHR and FA were recorded using a single 1.5 MHz ultrasound transducer and analysed by computer. A 5 s vibroacoustic stimulus (VAS) (electronic artificial larynx) was used for the stimulation studies. The IUGR fetuses had significantly different patterns of both unstimulated and stimulated behaviour compared to normally grown fetuses. When unstimulated they had lower FA rates than the normally grown fetuses but this was only statistically significant at 28-31 weeks. They also spent a significantly lower proportion of time exhibiting high FHR variation at 28-31 weeks. Following VAS the IUGR fetuses had lower FA responses at all gestations and lower FHR responses from 32 weeks, though only the differences in FA response at 28-31 weeks were statistically significant. Of the 14 fetuses with IUGR, all but one exhibited passive behaviour (ERR and/or FA) that was outside the 10-90th range, for normally grown fetuses, whilst 6 of the 14 had responses to VAS that were within the normal range. We do not feel that computerised assessment of stimulated behaviour in preterm IUGR fetuses confers any advantage over passive observations.

Acoustic Stimulation↗
PubMed1998

Phosphoisoforms of insulin-like growth factor binding protein-1 in appropriate-for-gestational-age and small-for-gestational-age fetuses.

We analysed phosphoisoforms of insulin-like growth factor binding protein-1 (IGFBP-1) in maternal and cord sera from preterm and term fetus with different growth status. Phosphoisoforms were separated by non-SDS-polyacrylamide gel electrophoresis and detected by immunoblot. Phosphoisoforms were also analysed by anion exchange chromatography on HPLC. The proportion of non-phosphorylated IGFBP-1 to total IGFBP-1 was significantly higher in preterm fetus than in their mothers, however, the relative amounts of each IGFBP-1 isoforms were similar between preterm and term fetus. The levels of non-phosphorylated IGFBP-1 were similar between appropriate for gestational age (AGA) and small for gestational age (SGA) fetus at term, however, phosphorylated isoforms of IGFBP-1 were increased in SGA fetus compared to those of AGA fetus and the proportion of non-phosphorylated IGFBP-1 to total IGFBP-1 was lower in SGA fetus than those in AGA fetus. Thus, the profiles of non-phosphorylated and phosphorylated IGFBP-1 in the fetus varies corresponding to fetal growth suggesting that not only total amounts of IGFBP-1 but also the proportion of phosphoisoforms of IGFBP-1 is important for fetal growth.

Biomarkers↗
PubMed1993

Biometric measurements in fetuses of different race and gender.

Sonographic fetal biometric measurements on 6082 low-risk patients were compared in the second and third trimesters of pregnancy with respect to fetal race and gender. Ultrasonic measurements were obtained from fetuses of women participating in the Routine Antenatal Diagnostic Imaging with Ultrasound Study (RADIUS), who underwent both an early sonographic evaluation between 15 and 22 weeks' gestation and a later scan between 31 and 35 weeks' gestation. In the 16-21-week scans, male fetuses had significantly larger biparietal diameter measurements compared to female fetuses (estimated difference 0.852 mm, 95% CI 0.737-0.967). There was only minimal difference in biparietal diameter between Black and White fetuses. Femur length was similar in both female and male fetuses, but longer in Black compared to White fetuses (estimated difference 0.808 mm, 95% CI 0.539-1.078). During the 31-35-week scans, male fetuses continued to have larger biparietal diameter measurements compared to female fetuses (estimated difference 1.22 mm, 95% CI 1.04-1.40), and femur lengths were persistently longer in Black compared to White fetuses (estimated difference 0.563 mm, 95% CI 0.234-0.893). Further investigation is necessary to evaluate the effect of these slight differences in morphometric fetal measurements between races and genders, so that we can determine how best to use them for optimizing prenatal care.

Journal Article↗
PubMed1996

Blood flow velocity waveforms from peripheral pulmonary arteries in normally grown and growth-retarded fetuses.

The objective of this study was to describe blood flow velocity waveforms of fetal peripheral pulmonary arteries in normally grown and growth-retarded fetuses. Doppler studies were performed in 182 normally grown fetuses (gestational age 18-40 weeks) and in 61 growth-retarded fetuses (gestational age 24-36 weeks) that were free from structural and chromosomal abnormalities and whose umbilical and middle cerebral artery Doppler findings suggested uteroplacental insufficiency as the most likely etiology of the growth defect. The pulsatility index was used to quantify the velocity waveforms. Successful recordings were obtained in 90.1% of the normally grown and 93.4% of the growth-retarded fetuses. In normally grown fetuses the pulsatility index values significantly decreased with advancing gestation. In growth-retarded fetuses the pulsatility index values were significantly elevated compared to those of normal fetuses. A significant relationship was observed between the severity of hypoxia and pulsatility index values from the peripheral pulmonary arteries in 29 fetuses in which Doppler recordings were obtained immediately before cordocentesis. In conclusion, these data show that in normal fetuses the Doppler-measured impedance to flow in the peripheral pulmonary circulation decreases with advancing gestation. Impedance to flow in the lungs is elevated in the presence of growth retardation and this increase is related to the severity of fetal hypoxia.

Acid-Base Equilibrium↗
PubMed1997

Incorporating sonographic cheek-to-cheek diameter, biparietal diameter and abdominal circumference improves weight estimation in the macrosomic fetus.

The objective of this study was to improve the accuracy of sonographic fetal weight estimation in macrosomic (> 4000 g) fetuses by combining the cheek-to-cheek diameter (CCD), an indicator of subcutaneous tissue mass, with the biparietal diameter (BPD) and abdominal circumference (AC) in generating a new weight formula. Three hundred well-dated, uncomplicated singleton pregnancies > 32 weeks' gestational age (GA) were analyzed. Sonographic fetal measurements obtained in every case included BPD, head circumference, AC, femur length and CCD. Sonographic estimation of fetal weight (EFW) was derived by using BPD and AC. Actual birth weights (BW) of fetuses delivered within 7 days of the last sonographic examination and weighing over 1500 g (n = 123) were compared to EFW. A formula was derived by correlating BPD, AC and CCD with BW in these 123 fetuses using multiple regression analysis. A second formula was derived from the data of 39 macrosomic fetuses. The two formulae were then tested for accuracy of prediction of fetal weight in 157 other fetuses delivered within 7 days and grouped by birth weight, 44 of them weighing > 4000 g. The new formula for macrosomic fetuses was: EFW (g) = 1065 + 84.5 BPD (cm) + 41.29 AC (cm) + 111.0 CCD (cm). In the macrosomic fetuses, a difference of < 10% between EFW and BW was demonstrated in 72.7% by the BPD-AC formula and 95.5% when incorporating CCD. In this group, the mean percentage error was significantly smaller: 4.14 vs. 7.97% (p = 0.0005). In the regression analysis, the contributions of BPD, AC and CCD to the variance in BW were 5.5%, 16%, and 18.3%, respectively (p = 0.008). In the non-macrosomic fetuses, CCD improved prediction of BW, but the trend did not reach statistical significance. Our results demonstrate that, in the macrosomic fetus, CCD explains more of the variance in BW than other parameters and incorporating it in the sonographic weight estimation greatly improves its accuracy.

Abdomen↗
PubMed1997

The incorporation of maternal age into the sonographic scoring index for the detection at 14-20 weeks of fetuses with Down's syndrome.

Sonographic markers for Down's syndrome have been useful in the identification of affected fetuses. In this study, we evaluated the accuracy of an expanded scoring index that included recently described sonographic markers as well as maternal age to optimize identification of fetuses with Down's syndrome. Over a 27-month period, we performed 4075 genetic amniocenteses for advanced maternal age or an abnormal triple panel. Prior to each amniocentesis, a complete sonographic assessment of the fetus was performed including a structural survey and fetal biometry. Each patient was assigned a score based on the sonographic markers in a previously reported scoring system, modified by the addition of an echogenic intracardiac focus. The sonographic scoring system was then combined with the assignment of additional points based on maternal age. Karyotypic results were obtained subsequent to the scans, and Down's syndrome fetuses and a control group of normal fetuses were compared. Fifty-three fetuses with Down's syndrome were identified by karyotype and compared to a control group of 177 normal fetuses. A score of > or = 2 as a criterion for a positive test resulted in the identification of 75.4% of fetuses with Down's syndrome, with a 5.7% false-positive rate. A score of > or = 1 increased the sensitivity to 83.0%, with a false-positive rate of 17.5%. The age-adjusted modification resulted in the identification of 86.8% of fetuses with Down's syndrome, with a false-positive rate of 27.1%. It is for the individual patient and her practitioner to weigh the risks and benefits in selecting her options for prenatal diagnosis.

Adult↗
PubMed2000

Echocardiographic evaluation of the fetus with congenital cystic adenomatoid malformation.

OBJECTIVES: The development of nonimmune hydrops is a known complication of congenital cystic adenomatoid malformation (CCAM) in the fetus. The aim of this study was to investigate the impact of CCAM on hemodynamics in the fetus and to determine whether cardiac dysfunction contributes to the development of hydrops in this patient population. METHODS: The echocardiographic data from 41 consecutive fetuses diagnosed prenatally with CCAM were reviewed. The presence or absence of hydrops was noted in each patient. Two-dimensional ultrasonographic and Doppler data were compared between the two groups (with or without hydrops). RESULTS: The mean gestational age for the study group at the time of imaging was 23.2 +/- 3.0 weeks. Hydrops was noted in 15 of 41 fetuses (36.5%). The fetuses that developed hydrops had a lower cardiac/thoracic ratio than those which did not develop hydrops (0.18 vs. 0.23, P = 0.001). The fetuses with hydrops also demonstrated an increase in early ventricular filling. The ratio of early ventricular filling to atrial contraction (E/A ratio) at both the tricuspid and mitral valves was significantly higher in the fetuses with hydrops (P = 0.005 and P = 0.03, respectively). Doppler interrogation of the inferior vena cava demonstrated a greater degree of reversal with atrial contraction in the hydrops group (29.7% vs. 15.1%, P = 0.003). The development of significant atrioventricular valve insufficiency was rare in the fetuses with hydrops (one of 15 cases). CONCLUSIONS: Cystic adenomatoid malformation can result in significant cardiac compression in the fetus. This alters hemodynamics and may result in hydrops on the basis of elevated central venous pressure.

Case-Control Studies↗
PubMed1996

Release of vasoactive agents during cordocentesis: differences between normally grown and growth-restricted fetuses.

OBJECTIVE: The purpose of this study was to evaluate whether cordocentesis is associated with the release of vasoactive substances and whether there are differences between normally grown and growth-restricted fetuses. STUDY DESIGN: 6-Keto-prostaglandin F1 alpha (the stable metabolite of prostacyclin), endothelin-1, and cyclic guanosine monophosphate were measured in fetal blood at the beginning and closing of cordocentesis in 30 normally grown fetuses and 25 growth-restricted fetuses. This latter group was characterized by abnormal Doppler index values in umbilical artery and middle cerebral artery, suggestive of chronic hypoxemia as the causative factor of the impaired growth. In six growth-restricted fetuses bradycardia occurred at the end of the procedure. Umbilical artery pulsatility index was measured by Doppler ultrasonography immediately before and after the procedure. RESULTS: The median interval between the two blood samples obtained by cordocentesis was 90 seconds (range 60 to 320 seconds). During this interval a significant rise of 6-keto-prostaglandin F1 alpha (p < or = 0.0001) and endothelin-1 (p = 0.03) was evidenced in normally grown fetuses. The increase in 6-keto-prostaglandin F1 alpha was significantly related (r = 0.52, p = 0.002) to the fall of umbilical artery pulsatility index occurring after the procedure. In growth-restricted fetuses cordocentesis induced a marked increase of endothelin-1 (p = 0.0002), which was significantly related to the severity of acidosis (r = 0.52, p = 0.018), whereas no modifications were evidenced for the other agents tested. The increase of endothelin-1 was higher in those growth-restricted fetuses showing bradycardia at the end of the procedure than in growth-restricted fetuses that did not (p = 0.04). The variations of the vasoactive substances assayed were not significantly related to the type of procedure (transamniotic or transplacental), the amount of blood aspirated during the procedure, the interval elapsing between the first and second samples, the gestational age at which the procedure was performed, and the degree of fetal smallness. CONCLUSION: Cordocentesis induces the rapid release of vasoactive substances and the effect differs between normally grown and growth-restricted fetuses. This may explain the different hemodynamic response and the higher rate of complications occurring in the latter group after cordocentesis.

6-Ketoprostaglandin F1 alpha↗
PubMed1993

Diagnostic value of blood sampling in fetuses with growth retardation.

BACKGROUND: Fetuses with intrauterine growth retardation are delivered if they have evidence of distress, as manifested by abnormalities in the fetal heart rate and umbilical-artery blood flow. We studied whether umbilical-blood sampling might provide further information useful for management. METHODS: We measured hemoglobin and lactate concentrations, oxygen content, pH, blood gas levels, and base deficit in umbilical-vein blood and correlated these measurements with the heart rate and umbilical-artery wave forms recorded by Doppler velocimetry in 56 fetuses with growth retardation. Twenty-one fetuses had normal heart rates and normal results of velocimetry, 24 had normal heart rates and abnormal results of velocimetry (indicative of decreased diastolic flow), and 11 had abnormal heart rates and abnormal results of velocimetry. RESULTS: None of the 21 fetuses with normal heart rates and velocimetry had hypoxia or acidemia. Of the 24 fetuses with normal heart rates and abnormal velocimetry, 4 (17 percent) had moderate lactic acidosis, 1 (4 percent) had a low pH value, and 3 (12 percent) had hypoxia. Of the 11 fetuses with abnormal heart rates and velocimetry, 7 (64 percent) had lactic acidosis, low blood oxygen content, and low pH values. The absence of end-diastolic flow increased the risk of hypoxia and acidemia. The proportion of fetuses with elevated hemoglobin concentrations was similar among the three groups. CONCLUSIONS: Assessment of fetal oxygenation and acid-base balance is not indicated in fetuses with growth retardation if their heart rates and the results of velocimetry are normal. If the results of velocimetry are abnormal, fetal-blood sampling can distinguish fetuses that have growth retardation alone from those that also have hypoxia and acidosis, and thus may aid in determining the optimal time of delivery.

Acidosis↗
PubMed2000

Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses.

BACKGROUND: Invasive techniques such as amniocentesis and cordocentesis are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. The purpose of our study was to determine the value of noninvasive measurements of the velocity of blood flow in the fetal middle cerebral artery for the diagnosis of fetal anemia. METHODS: We measured the hemoglobin concentration in blood obtained by cordocentesis and also the peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anemia due to maternal red-cell alloimmunization. Peak systolic velocity was measured by Doppler velocimetry. To identify the fetuses with anemia, the hemoglobin values of those at risk were compared with the values in 265 normal fetuses. RESULTS: Fetal hemoglobin concentrations increased with increasing gestational age in the 265 normal fetuses. Among the 111 fetuses at risk for anemia, 41 fetuses did not have anemia; 35 had mild anemia; 4 had moderate anemia; and 31, including 12 with hydrops, had severe anemia. The sensitivity of an increased peak velocity of systolic blood flow in the middle cerebral artery for the prediction of moderate or severe anemia was 100 percent either in the presence or in the absence of hydrops (95 percent confidence interval, 86 to 100 percent for the 23 fetuses without hydrops), with a false positive rate of 12 percent. CONCLUSIONS: In fetuses without hydrops that are at risk because of maternal red-cell alloimmunization, moderate and severe anemia can be detected noninvasively by Doppler ultrasonography on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery.

Blood Flow Velocity↗
PubMed1992

Habituation in normal and Down's syndrome fetuses.

The ability of ten normal and two Down's syndrome fetuses to habituate to a repeated auditory stimulus was assessed. The normal fetuses were assessed on two separate occasions during the final trimester of pregnancy. The number of trials to habituate and latency to respond were recorded. The results demonstrated that all normal fetuses exhibited a decrement in response to repeated presentations of the stimulus, a 250-Hz sine wave. This was the result of habituation and not fatigue since fetuses recovered responding upon presentation of a new (500 Hz) stimulus and habituated faster on re-presentation of the original stimulus. The performance of fetuses remained stable over the two testing periods. The response of the Down's syndrome fetuses was different to that of normal fetuses rarely overlapping indices of habituation exhibited by normal fetuses. The study concludes that habituation may be a powerful tool to examine the behavioural and sensory development of the fetus and may be of use in the antenatal assessment of the existence and severity of neural abnormality.

Arousal↗