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PubMed1976

Lymphopoiesis and lymphocyte recirculation in the sheep fetus.

The production and the circulation of lymphocytes has been examined in the sheep fetus where neither foreign antigen nor immunoglobulins occur. It was found that as the lymphoid organs increased in size during fetal life, the numbers and the output of lymphocytes in the thoracic duct lymph increased. The recirculating pool of lymphocytes was estimated to be 5.5 +/- 1.5 X 10(8) cells in fetal lambs 95-100 days of age, 5.7 +/- 1.2 X 10(9) cells in fetuses 130-135 days of age, and 1.2 +/0 9.3 X 10(10) cells in fetuses near to term. The rate of addition of lymphocytes to the recirculating pool was 3.2 +/- 1.9 X 10(6) cells/h in fetuses of 100 days and 3.4 +/- 0.9 X 10(7) cells/h in fetuses of 130 days of age. Lymphocytes recirculated from blood to lymph in fetuses; labeled cells injected into the blood stream reappeared in the thoracic duct lymph promptly and reached maximum levels around 12-18 h after they were injected. Labeled lymphocytes were detected subsequently in greatest numbers in the lymph nodes, particularly in the mesenteric lymph nodes and in the interfollicular areas of the Peyer's patches. Chronic drainage of thoracic duct lymph from fetuses in utero for periods of up to 36 days had no obvious effects on the growth or development of the fetus and only minimal effects on the content of lymphocytes in the various lymphoid tissues even though the number of cells in the blood and lymph were reduced to between 20-30% of normal levels. Thymectomy done in fetuses about 2 mo befor cannulation of the thoracic duct reduced the output of cells in the thoracic duct to about 25% of normal levels and caused a significant reduction in the content of lymphocytes in the various lymphoid tissues. Thymectomized fetal lambs subjected to thoracic duct drainage for periods up to 2 wk in utero had a similar complement of lymphocytes in their lymphoid tissues to intact thymectomized fetal lambs. Lymphocytes obtained from the thoracic duct lymph of lambs thymectomized 2 mo previously recirculated from blood to lymph when they were injected intravenously, although they did this at a significantly slower rate than did lymphocytes from normal lambs.

Animals↗
PubMed1988

Doppler echocardiographic assessment of atrioventricular velocity waveforms in normal and small-for-gestational-age fetuses.

A prospective longitudinal study determined the physiological patterns of blood flow velocity waveforms in normal and in small-for-gestational-age (SGA) fetuses. Using a Pulsed Doppler Duplex system, 125 normally grown fetuses and 35 SGA fetuses were studied longitudinally at between 27 and 42 weeks gestation. In normal fetuses the ratio between the E velocity (early passive ventricular filling) and the A velocity (active ventricular filling during atrial contraction) increased progressively during pregnancy in both transmitral and transtricuspid waveforms, approaching 1 at term. In SGA fetuses, the E/A ratios did not increase during pregnancy and the values obtained were significantly lower than in normal fetuses. The ratio between the transtricuspid and transmitral mean temporal velocities remained almost constant throughout pregnancy in the normal fetuses with transtricuspid velocity slightly exceeding the transmitral velocity. On the other hand, in SGA fetuses the ratio between the mean temporal velocities was inversed with the transmitral velocity progressively greater than the transtricuspid velocity suggesting the existence of intracardiac haemodynamic changes in these fetuses.

Blood Flow Velocity↗
PubMed2004

Non-protein-bound iron and free radical damage in fetuses with rhesus haemolytic disease: influence of intrauterine transfusions.

OBJECTIVE: To determine iron-induced free radical damage in fetal rhesus haemolytic disease (RHD) before and after repeated intrauterine red blood cell transfusions and its relation to hydrops fetalis. DESIGN: Prospective, observational study. SETTING: Department of Obstetrics, Leiden University Medical Centre, the Netherlands. POPULATION: Fifty anaemic fetuses, including 13 hydropic ones, 9 preterm and 12 term neonates and 8 female non-pregnant adults. METHODS: Venous blood plasma samples were collected from 50 fetuses suffering from RHD preliminary to the first, and if appropriate, subsequent intrauterine red blood cell transfusions for determination of iron status including non-protein-bound iron (NPBI) and iron-binding primary antioxidant proteins, total plasma anti-oxidant capacity and its contributing secondary antioxidants (e.g. vitamin C, uric acid, sulphydryl groups and peroxidation products). Results were compared with values of healthy preterm and term neonates directly at birth and adult controls. Within the fetal haemolytic group, 13 hydropic fetuses were analysed as a separate group. MAIN OUTCOME MEASURES: Non-protein-bound iron, antioxidants, total antioxidant capacity and peroxidation products. Sub analysis of the outcome measures of the hydropic fetuses. RESULTS: RHD fetuses had at initial cordocentesis a significantly higher NPBI level and a significantly lower total plasma antioxidant capacity than control babies and adults. Their vitamin C tended to be more oxidised but lipid peroxidation had not increased, when compared with preterm babies. The repeated intrauterine red blood cell transfusions had a positive effect on the total antioxidant capacity of plasma and did not increase the concentration of NPBI. The hydropic fetuses, who had higher NPBI concentrations and lower plasma protein concentrations and total antioxidant capacity, did not show more peroxidation products in plasma than the non-hydropic fetuses. Fetuses without reversal of hydrops despite intrauterine transfusions showed decreasing levels of proteins with subsequent transfusions but peroxidation products remained constant. CONCLUSION: Repeated intrauterine red blood cell transfusions do not lead to free radical damage in the fetus in utero. Iron-induced free radical activity does not appear to play a causative role in the proceeding of hydrops fetalis in RHD.

Adult↗
PubMed1992

Isolated choroid plexus cysts in the second-trimester fetus: is amniocentesis really indicated?

Choroid plexus (CP) cysts have been associated with trisomy 18, although most fetuses with CP cysts are normal. Since many fetuses with trisomy 18 have other sonographic abnormalities, the necessity of obtaining a karyotype for all fetuses with isolated CP cysts remains controversial. The authors prospectively studied 234 second-trimester fetuses with sonographically discovered CP cysts. Two hundred twenty of them had no other sonographic findings. None of these 220 normal fetuses had evidence of aneuploidy at amniocentesis or an anomaly at birth. Fourteen fetuses had major anomalies detected in utero: 11 had trisomy 18, one had triploidy, and two had normal karyotypes but were structurally abnormal. While size and bilaterality of the CP cysts were not helpful in predicting aneuploidy, the meticulous anatomic survey of fetuses with CP cysts allowed successful identification of all aneuploid fetuses. These data show that the yield of abnormal karyotypes in fetuses with isolated CP cysts is low and may not justify the risk of amniocentesis.

Amniocentesis↗
PubMed1999

Iliac angle as a marker for Down syndrome in second-trimester fetuses: CT measurement.

PURPOSE: To determine if the iliac angle is greater in second-trimester fetuses with trisomy 21 than in euploid fetuses and to establish the best level and plane for measuring this angle by using three-dimensional computed tomography (CT). MATERIALS AND METHODS: CT was performed in 18 formalin-preserved fetuses (eight trisomy 21, 10 euploid control fetuses), and the pelvic bone anatomy was reconstructed three-dimensionally. Iliac angles were measured in axial views at three levels in two planes. Data were analyzed nonparametrically with the Mann-Whitney test. RESULTS: The mean gestational ages for trisomy 21 and control fetuses were 17.0 and 16.7 weeks, respectively. The external plane was the easiest to measure and the most reproducible. The mean iliac angles were significantly greater (P < .05) in the trisomy 21 fetuses than in the control fetuses and were as follows: superior level, 95.6 degrees vs 76.4 degrees; middle level, 84.5 degrees vs 62.5 degrees; and lower level, 78.1 degrees vs 57.5 degrees. With a 90 degrees threshold, the superior iliac angle measurement had a sensitivity of 75%, a specificity of 89%, and an odds ratio of 24 for Down syndrome. CONCLUSION: Second-trimester fetuses with trisomy 21 have a significantly greater iliac angle than euploid fetuses have. The iliac angle varies with the axial level, with the widest angle at the most superior level. Measurement of the iliac angle at the most superior level is supported as a potential marker for Down syndrome at prenatal ultrasonography.

Down Syndrome↗
PubMed2006

The assessment of fetal behavior of growth restricted fetuses by 4D sonography.

AIM: To find out whether the quantity of fetal facial expression and quality of body movements can be used as an additional diagnostic criterion for prenatal brain impairment in fetuses with growth restriction. SUBJECT AND METHODS: A prospective study was conducted in 50 uncomplicated healthy women as control group with reliably dated pregnancies and 50 pregnant women with a growth restricted fetus as study group in the third trimester of pregnancy. 4D ultrasound observation is specially designed to assess whether functional brain impairment and fetal growth restriction had prenatally occurred by the utilization of several behavioral patterns. RESULTS: The median value of all movement patterns in the normal fetuses differed from fetuses with intrauterine growth restriction (IUGR). Statistical evaluation revealed significant differences in the distribution of the movements between these groups (P<0.05). We noted a tendency that IUGR fetuses have less behavioral activity than normal fetuses in all observed movement patterns. Correlation reached statistical significance between normal and IUGR fetuses in the third trimester in hand to head, hand to face and head retroflexion. Statistically significant differences could be shown in the distribution of the median values of observation over the five qualitative categories of head and hand movements (P<0.05). CONCLUSIONS: Recent data on IUGR fetuses obtained by 4D sonography are stimulating and might result in a more effective strategy to assess development before birth. The results of this study may encourage future use of 4D ultrasound for quantitative and qualitative assessment of fetal behavior as possible indicators of the neurological condition in IUGR fetuses.

Facial Expression↗
PubMed2004

Pulmonary vein pulsatility in fetuses of diabetic mothers: prenatal Doppler echocardiographic study.

OBJECTIVE: To verify the hypothesis that the pulmonary vein pulsatility index is higher in fetuses of diabetic mothers than it is in normal fetuses of nondiabetic mothers. METHODS: Twenty-four fetuses of mothers with either gestational or previous diabetes (cases), and 25 normal fetuses of mothers without systemic disease (control) were examined. Fetuses were examined through prenatal Doppler and color flow mapping. The pulmonary vein pulsatility index was obtained by placing the pulsed Doppler sample volume over the right superior pulmonary vein and applying the formula (systolic velocity - presystolic velocity)/mean velocity. RESULTS: The mean gestational age of the study fetuses was 30.3 2.7 weeks, and gestational age of the controls was 29 3.3 weeks, with no significant difference in gestational age between groups (p=0.14). Fetuses of diabetic mothers had a mean pulmonary vein pulsatility index of 1.6 1, and those of the control group had an index of 0.86 0.27. CONCLUSION: Fetuses of diabetic mothers had pulmonary vein pulsatility indexes (parameter easily obtained through Doppler echocardiography that may be related to fetal diastolic function) higher than those in fetuses of mothers with normal glycemia.

Blood Flow Velocity↗
PubMed1994

Choroid plexus-ventricular wall separation in fetuses with normal-sized cerebral ventricles at sonography: postnatal outcome.

OBJECTIVE: The choroid plexus typically fills the atrium of the lateral ventricles of the brain in normal fetuses, but separates from the medial ventricular wall with increasing ventriculomegaly. Sonographic depiction of choroid plexus-ventricular wall separation has been associated with a high frequency of unfavorable outcomes in fetuses with mild ventricular dilatation. This separation, however, is also observed in a small subgroup of fetuses with normal ventricular measurements. The objective of this study was to ascertain the prognosis for fetuses when choroid plexus-ventricular wall separation and normal-sized lateral ventricles are seen on antenatal sonograms. MATERIALS AND METHODS: Postnatal follow-up was reviewed for 74 fetuses showing a 3 mm or greater separation between the choroid plexus and the medial ventricular wall and normal-sized (< or = 10 mm) ventricles on antenatal sonograms. Fetuses were divided into normal and abnormal outcome groups, and the data were analyzed to determine if the amount of separation, the ventricular atrial diameter, or the evolution of these findings on follow-up sonograms was predictive of outcome. RESULTS: Fifty-nine patients (80%) had normal outcomes (defined as no congenital anomalies and no significant subsequent medical history apart from usual infant and childhood illnesses) and 15 patients (20%) had abnormal outcomes. The severity of the abnormalities varied widely, ranging from relatively inconsequential, such as isolated polydactyly, to complex congenital malformation syndromes resulting in neonatal death. No consistent pattern of malformation was evident. Although we found a statistically significant difference in the degree of choroid plexus-ventricular wall separation when fetuses were separated into normal and abnormal outcome groups, the range of measurements obtained in these two populations overlapped considerably. Outcomes were normal in all 13 patients in whom the choroid plexus-ventricular wall separation had returned to normal by the time of the last antenatal sonogram. CONCLUSION: A separation of 3 mm or greater between the choroid plexus and the medial ventricular wall is an important finding that is associated with an increased risk of an abnormal outcome even in the subpopulation of fetuses with normal-sized ventricles. Although the outcome will be normal in the majority (80%) of such fetuses, identification of choroid plexus-ventricular wall separation mandates a meticulous examination of fetal anatomy.

Abnormalities, Multiple↗
PubMedDate not supplied

Ear dysmorphism associated with cystic hygroma colli in second-trimester fetuses.

To investigate if fetuses with cystic hygroma colli have ear article dysmorphism, we studied 16 fetuses with cystic hygroma colli, all of which had 45,X karyotype, and 107 normal fetuses. All the specimens were second-trimester formalin-preserved human fetuses. The ear lengths and widths were measured and ear indices (length/width) calculated. There were no significant differences in the ear measurements of age-matched normal male and female fetuses (P > .05). Ear growth was less linear in the cystic hygroma colli group than in the normal fetuses; Pearson's coefficient .45 vs. .87 for ear length, and r = .77 vs. .88 for ear width. The mean (+/- SD) ear index of the normal fetuses was 1.56 +/- 0.22 compared to 2.10 +/- 0.36 of the cystic hygroma colli fetuses, P < .001. The ear dysmorphism (> 2 SD of gestational age norm) was observed in 6.3% (1/16) of the ear widths, 56.3% (9/16) of the ear lengths, and 62.5% (10/16) of the ear indices. We conclude that cystic hygroma colli fetuses with 45,X have unique ear auricle morphology.

Aneuploidy↗
PubMed2003

Changes in nuchal translucency thickness in normal and abnormal karyotype fetuses.

OBJECTIVE: To investigate the dynamic trend of the nuchal translucency thickness between fetuses with normal and abnormal karyotype. DESIGN: Prospective observational study. SETTING: Ospedale Microcitemico, Cagliari, Italy. POPULATION: A cohort of 305 first trimester fetuses. METHODS: Fetuses with a nuchal translucency greater than or equal to the 95th centile were invited for a second nuchal translucency measurement. The finding of an 'increased or unchanged' or 'diminished' thickness was compared in fetuses with normal and abnormal karyotype. MAIN OUTCOME MEASURES: Nuchal translucency and karyotype. Median maternal age was 35 years (min 17, max 44) and median crown-rump length at first visit was 50 mm (min 38, max 80). A second nuchal translucency measurement was carried out in 292 fetuses, resulting in increased or unchanged values in 95 cases and decreased nuchal translucency in 197 cases. Two hundred and twenty-six (77.4%) fetuses had normal karyotype and 66 (22.6%) had abnormal karyotype (44 trisomies 21, 10 trisomies 18, 5 trisomies 13, 4 cases of 45 X0, 1 case of 47,XXY, 1 case of 47,XXX and 1 translocation). In the 66 chromosomally abnormal fetuses, the second nuchal translucency measurement was enlarged or unchanged in 37 (56%), and diminished in 29 (44%), while in the 226 normal fetuses the second nuchal translucency measurement was enlarged or unchanged in 58 cases (25%) and diminished in 168 (75%) (relative risk 2.6, 95% confidence interval 1.7-4.0). CONCLUSION: In fetuses with abnormal karyotype, the second nuchal translucency measurement tends to be increased or unchanged, while in normal cases the size of nuchal translucency is generally reduced.

Adolescent↗
PubMed1992

Estimating the time of death in stillborn fetuses: I. Histologic evaluation of fetal organs; an autopsy study of 150 stillborns.

OBJECTIVE: To determine whether the autopsy histology of fetal tissues can determine the time of death of stillborn fetuses. METHODS: Hematoxylin and eosin slides from autopsies of 150 stillborn fetuses with well-timed deaths were evaluated retrospectively. Fetuses were divided into a learning set (100 fetuses) and a test set (50 fetuses). RESULTS: From assessment of the 100 fetuses in the learning set, 23 histologic features were identified with possible temporal associations with fetal death. When those histologic features were randomly and blindly assessed in the 50 test fetuses, ten features performed well as diagnostic tests (sensitivity, specificity, and positive predictive values at or above 0.875), correctly classifying 43 of 50 fetuses (86%) with respect to the time of death. The ten histologic features and their predicted death-to-delivery intervals were: loss of nuclear basophilia in individual cells in renal cortical tubules (4 hours), liver (24 hours), inner half of the myocardium (24 hours), outer half of the myocardium (48 hours), bronchial epithelium (96 hours), and tracheal cartilage (1 week); and loss of nuclear basophilia of all cells in the liver (96 hours), gastrointestinal tract (1 week), adrenal (1 week), and kidney (4 weeks). The development of these histologic changes appeared to be accelerated by fetal hydrops and a delivery-to-autopsy interval exceeding 24 hours and decelerated by fetal gestational age under 25 weeks. CONCLUSION: Histologic changes identifiable in hematoxylin and eosin-stained fetal tissue may be useful for estimating the time of death in many stillborn fetuses.

Autopsy↗
PubMed1989

Lymphocyte blastogenesis and cellular cytotoxicity in a congenital infection of bovine fetuses related to epizootic bovine abortion.

The disease referred to as epizootic bovine abortion (EBA) was experimentally induced in bovine fetuses. Dark-field microscopy was used to detect congenital infection with an unclassified spirochaete-like organism. Some of the fetuses collected at abattoirs were also found to be naturally infected with a morphologically similar microorganism. Blood counts and organ weights were correlated with the presence of the microorganism. Lymphocyte blastogenesis increased, the result of in vivo stimulation among the infected fetuses. Phytomitogens (phytohaemagglutinin, concanavalin A and lipopolysaccharide) also stimulated greater responses in infected fetuses when compared to results in normal fetuses. Cellular cytotoxicity was examined by the single cell assay and results indicated that there were fewer cytotoxic lymphocytes among the diseased fetuses. The infected abattoir-collected specimens were obtained from clinically normal adult cattle, and the immunological changes in these fetuses were closely characterised with those of the EBA diseased fetuses. These naturally infected fetuses showed signs of a mild infectious disease.

Abortion, Veterinary↗
PubMed1984

[Topography of the serotonin neurons in the brain stem of human fetus: an immunohistochemical study].

The distribution of serotonin neurons in the central nervous system (CNS) has been intensively examined in mammals, such as rats, cats and monkeys. However, the details of serotonin neuron system have been remained uncertain in human CNS, although two fluorescence histochemical studies were reported in human fetus. In this study, we performed immunohistochemical examination on the distribution of serotonin neurons in the brain stem of human fetuses. The brain stems from five human fetuses (CRL: 120-275 mm, GA: 15-27 wks) were fixed with 4% paraformaldehyde, dehydrated with graded ethanol, and embedded in paraffin. Serial sections, 6 micron in thickness, were cut from seven different levels of the brain stem of each fetus. The initial several sections were used for usual histological observations. The following serial ones were stained by peroxidase-antiperoxidase (PAP) technique using anti-serotonin sera. The anti-serotonin sera used were raised in rabbits by the methods of Ranadive and Sehon (1967), Grota and Brown (1974), and Steinbusch et al (1978). Before the use, the specificity of the antisera was confirmed by the immunohistochemical examination of the CNS of rat embryos and adults. Positively stained serotonin neurons were clearly demonstrated in the brain stems of all cases examined (Figs. 1A-1H). They were small to medium in size, 10 X 20 micron to 20 X 40 micron, and varied in shape, showing round to oval cell somata with unipolar, bipolar and multipolar processes. The distribution of serotonin neurons in the brain stems was almost the same among five human fetuses (Figs. 2A-2K). A large number of serotonin neurons were located in the midline raphe nuclei. In addition, numerous serotonin neurons were observed widely in the other tegmental area. The nuclei containing serotonin neurons were listed in Table 2 according to the terminology by Olszewski and Baxter (1982). The distribution of the serotonin neurons in the raphe nuclei of human fetuses was fundamentally similar to those of many mammals reported previously. However, the lateral extension of serotonin neurons to the other tegmental area beyond the midline raphe nuclei in human fetuses was much greater than in any other mammals. This distribution pattern of serotonin neurons was considered to be peculiar to human fetus. Since the histological architecture of the brain stems of five fetuses examined was very similar to that of human adults, the distribution of serotonin neurons demonstrated here may also represent that of human adults.

Brain Mapping↗
PubMed1993

Detection by cultural isolation of bovine virus diarrhoea (BVD) virus following field infections in cattle and their fetuses in Turkey.

Cultural isolation, identification and biotype characterization of BVD virus is based on monolayer tissue culture techniques using mainly organs of, e.g., bovine fetuses. These might have experienced a transplacental transmission and are therefore of no use for tissue cultures produced, e.g., from kidneys of such fetuses. In order to rule out BVD virus infections, fetuses must be tested for BVD virus, viral antigen or specific nucleotide sequences. BVD virus and other ruminant pestiviruses have been detected in Turkey by cultural isolation. In bovine fetuses BVD virus has not been demonstrated so far. Cultural isolation was attempted in the present investigation in 50 randomly selected pregnant cows which were brought to an abattoir. Of these cows serum samples were assayed for neutralizing antibodies to BVD virus and 40 (80%) found positive with titres > or = 1:40. In contrast fetuses 120 days of ontogenic age and therefore supposedly immunocompetent were derived from seropositive dams (n = 16) but did not show any neutralizing antibodies to BVD virus. Leucocyte fractions of peripheral blood samples of the 50 cows as well as 353 fetal blood and organ samples were inoculated and submitted to three passages in fetal calf kidney cell cultures before testing for BVD viral antigen by immunofluorescence technique. BVD virus was thus detected in the fetus of one seropositive cow and also in the leucocyte fraction of one seronegative dam including organs of her fetus. The number of fetuses found positive for BVD virus amongst fetuses collected in abattoirs corresponds well to figures gained by other investigators outside Turkey.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Pathogenesis of porcine reproductive and respiratory syndrome virus infection in mid-gestation sows and fetuses.

Two experiments were undertaken to evaluate whether porcine reproductive and respiratory syndrome (PRRS) virus was able to cross the placenta and infect midgestation fetuses following intranasal inoculation of sows and whether PRRS virus directly infected fetuses following in utero inoculation. In experiment 1, eight sows between 45 and 50 days of gestation were intranasally inoculated with PRRS virus (ATCC VR-2332), and four control sows were inoculated with uninfected cell culture lysate. Virus inoculated sows were viremic on postinoculation (PI) days 1, 3, 5, 7 and 9, shed virus in their feces and nasal secretions, and became leukopenic. Sixty-nine of 71 fetuses from principal sows euthanized on PI day 7, 14 or 21 were alive at necropsy and no virus was isolated from any of the fetuses. Two principal sows that farrowed 65 and 67 days PI delivered 25 live piglets and three stillborn fetuses. The PRRS virus was isolated from two live piglets in one litter. In experiment 2, laparotomies were performed on five sows between 40 and 45 days of gestation and fetuses were inoculated in utero with either PRRS virus alone, PRRS virus plus a swine serum containing PRRS antibodies, or uninfected cell culture lysate. Three sows were euthanized on PI day 4 and two sows on PI day 11. Viral replication occurred in fetuses inoculated with virus alone and was enhanced in fetuses inoculated with virus plus antibody. No virus was isolated from control fetuses.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Non-reactive pattern diagnosed by ultrasonic Doppler fetal actocardiogram and outcome of the fetuses with non-reactive pattern].

The accuracy of diagnosis by means of ultrasonic Doppler fetal actocardiogram in non-stress test (NST) was examined in 100 fetuses at 32 to 42 weeks of gestation. Fourteen fetuses were diagnosed as non-reactive by conventional NST which monitored fetal heart rate, but only 4 of the 14 fetuses were found to be "non-reactive" when the fetal actocardiogram was used. Thus the false positive rate obtained with conventional NST in judging the non-reactive pattern was 71.4% (10/14). We next examined the outcome for 25 fetuses (including 20 IUGR cases) with a "non-reactive pattern" who were diagnosed by fetal actocardiogram. Fetal distress occurred in 19 of these fetuses (76.0%), and mostly developed within 5 days after the diagnosis of "non-reactive pattern". The outcome for 20 IUGR fetuses with a "non-reactive pattern" was compared with that for fetuses with a "reactive pattern". IUGR fetuses which were "non-reactive" had a significantly higher fetal distress morbidity rate, and higher cesarean section rate. The sensitivity and specificity of the prediction of the development of fetal distress in IUGR fetuses with a "non-reactive pattern" were 81.0% and 84.2%, respectively. The present results strongly suggest the need to use the ultrasonic Doppler fetal actocardiogram at the time of NST after 32 weeks of gestation.

Cardiotocography↗
PubMed1996

Surveillance of growth-retarded fetuses with computerized fetal heart rate monitoring combined with Doppler velocimetry of the umbilical and uterine arteries.

OBJECTIVE: To define guidelines for surveillance of growth-retarded fetuses with a computerized fetal heart rate (FHR) monitor and Doppler device. STUDY DESIGN: Eighty-one growth-retarded fetuses with birth weights < 10th percentile and lacking major anomalies were studied. One hundred ninety-two tests (one to six per patient), including computerized FHR monitoring and Doppler studies of the umbilical and uterine arteries, were performed. The relationship between Doppler velocimetry or FHR variation and fetal outcome was examined. RESULTS: Fetuses with an abnormal FHR variation or abnormal Doppler velocimetry had a significantly higher rate of cesarean deliveries for fetal distress and a higher number of admissions to the neonatal intensive care unit (NICU) as compared with fetuses with normal results on both tests. The best distinction was noted when the growth-retarded fetuses were partitioned into four analytic groups based on the presence of normal or abnormal FHR variation or Doppler velocimetry. The group with the poorest results was composed of fetuses with abnormal umbilical flow velocity and reduced FHR variation. These fetuses had significantly lower birth weights (1,250 g) and significantly higher rates of cesarean deliveries for fetal distress (92%) and admission to the NICU (100%). Thirty percent of these fetuses died. CONCLUSION: Fetal surveillance with Doppler and computerized FHR monitoring allows better understanding of the management of fetuses that are small for gestational age.

Adult↗
PubMed1996

[Acardiac fetus].

Acardiac fetus is a rare lethal fetopathy usually encountered in monozygous pregnancies. Ultrasound prenatal diagnosis has enabled an increasing number of observations and raised the need for an adequate therapeutic approach since the spontaneous prognosis for the healthy twin is unfavorable in half of the cases. An acardiac fetus was identified at 12 weeks gestation in a 36-year-old woman. Growth of the healthy fetus was carefully monitored and progressed normally to delivery by cesarean section of a 2.900 kg boy at 36 weeks. At delivery, the acardiac fetus was found to be totally free of any attachment, floating in the remaining fluids. Pathology examination showed a 16 g macerated fetus with a cephalic extremity, a ventral pedicle and a syrenomelic caudal extremity. The caryotype was not significative. Acardiac fetus occurs in less than 1% of multiple pregnancies and can develop in single pregnancies. Twin reversed arterial perfusion has been recognized as necessary for development of the perfused fetus. Genetic and immunologic theories have been proposed to explain the pathogenesis which remains unknown. Clinical management depends on the spontaneous development of the acardiac fetus and the deleterious consequences for the healthy twin resulting from heart failure, anasarca or prematurity. Medical management with digoxin, or selective extraction by hysterotomy may improve prognosis but results have been variable. Echoguided umbilical cord ligation has also been proposed to improve maternal mortality. Therapeutic abstention is no longer indicated at prenatal diagnosis of an acardiac fetus and a healthy twin despite the risk of invasive treatment.

Adult↗