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PubMed1994

[Premature rupture of fetal membranes in the midtrimester (II): Antibiotic treatment in a case of intraamniotic infection prior to fetal viability].

A case of a 33 year old woman G7P6A1, with preterm premature rupture of membranes at 20 weeks of gestation and asymptomatic intramniotic infection is reported. At admission, the presence of Klebsiella oxytoca in amniotic fluid was demonstrated by amniocentesis. Parenteral antibiotics were administered with a following demonstration of aseptic fluid. The patient delivered at 29 1/2 weeks of pregnancy. A newborn weighing 1520 with an Apgar score of 8-8 was obtained. The mother had a normal puerperal period without any evidence of infectious morbidity. A clinical sepsis was demonstrated in the newborn with appropriate response to antibiotic therapy. No further complications were observed.

Adult↗
PubMed1990

Can pregnancy-associated plasma protein A (PAPP-A) predict the outcome of pregnancy in women with threatened abortion and confirmed fetal viability?

Depressed pregnancy-associated plasma protein A (PAPP-A) concentrations have been found in patients with threatened abortion, often weeks before spontaneous abortion while the fetus was still alive. In order to extend these findings we have developed a highly sensitive PAPP-A radio-immunoassay and have established a reference range in early pregnancy for PAPP-A between week 7 and week 20 of pregnancy, based on blood samples from 240 pregnant women. The gestational age was determined by ultrasound. PAPP-A was measured in 128 women admitted to hospital because of vaginal bleeding in the 7th to 20th gestational week. The viability of the fetus was confirmed by ultrasonography. The serum values of PAPP-A were significantly lower (p = 0.002) in the group of women with vaginal bleeding than in the group of normally pregnant women. However, with regard to abortion later on, the predictive value of an abnormal blood test on admission was only 18.7%. Serial determinations showed increased PAPP-A values corresponding to the centile expected in the 12 women who aborted, as well as in the 116 women who gave birth. Consequently, the test is of no clinical value in the assessment of the prognosis in patients with symptoms of threatened abortion.

Abortion, Threatened↗
PubMed1992

Fetal viability does not affect the onset of stretch-induced labor and the increase in amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite levels.

The role of the fetus in the onset and progress of stretch-induced labor and in the change in amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite levels was evaluated in six normal pregnant women (group 1) and six women whose fetuses had been dead for more than one week (group 2). The uterus was distended by a balloon inflated with physiologic saline. Regular uterine contractions occurred, and increased in all patients. Within 21 hours, all patients delivered a normal baby in group 1 and a macerated fetus in group 2. There was no significant difference in induction-delivery interval between the two groups. Both groups showed a significant and similar range of increases in the levels of amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite during treatment (P less than 0.001). Thus, the fetus has no functional role in the onset and progress of stretch-induced labor or in the rise of amniotic fluid prostaglandin F2 alpha and plasma prostaglandin F2 alpha metabolite levels.

Adult↗
PubMed2003

[Obstetrical considerations regarding marginal fetal viability of very early premature infants].

As a result of the impressive progress in perinatal medicine the frontier of extrauterine viability has been shifted to a continuously decreasing gestational age. Optimal results require a close collaboration between obstetrician and neonatologist following well defined protocols. The quality of interdisciplinary efforts in perinatal medicine is not only measured by survival rates but by the number of survivors with good chances of normal development. Before 24 weeks survival rate drops below 10% and more than half of the few survivors show signs of more or less severe handicaps. Interventional medicine, be it prenatally, during or after birth, is not recommended. Comfort care and support is given to the parents as well as the infant after birth. Beyond 26 weeks chances of survival rapidly increase above 50% while the rate of handicapped among the survivors drops below 50%. Starting with 26 weeks full monitoring of the fetus and operative interventions for delivery of the fetus together with expert neonatal treatment to assure optimal survival are recommended. In the grey zone of 24 and 25 weeks management must be individualized considering the special circumstances of the individual case and taking into account the basic expectations of the parents. Prenatally the most common clinical scenarios can be assigned to one of three categories, which are described in some detail.

Cesarean Section↗
PubMed1990

[Rate of spontaneous abortion in relation to the time of fetal viability assessment].

For the first time, the rate of spontaneous abortion is reported in a multicenter study of three different gynecological centers. In 1987 und 1988, the average spontaneous abortion rate in 315 pregnancies was 3.3%, after foetal heart actions had been verified by ultrasonic examination between the 7th and 12th week of gestation. A statistical significance has been calculated between the spontaneous abortion rate of 6.3%, if foetal heart beats were seen between the 7th and 9th week, and the spontaneous abortion rate of 1.0% with an evidence of foetal life (p less than 0.01) between the 10th to 12th week of gestation. The rate of spontaneous abortion of women above 34 years of age (8.9%) is statistically different (p less than 0.01) to that of women under 35 (1.9%). In women older than 34, the spontaneous abortion rate before the 10th week of gestation is 22.2% in contrast to 3.2% of women younger than 35 (p less than 0.01). Considering the evidence of foetal heart actions between the 10th and 12th week, the spontaneous abortion rate of women above the age of 34 is 1.9%, compared to 0.8% of women younger than 35. The statistical higher spontaneous abortion rate of women above the age of 34 before the 10th week of gestation and the lack of statistical difference of the abortion rate in this defined age group for foetal life to be proven from the 10th week on, should be an argument in favour of the 10th week of gestation as the earliest date of prenatal diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1992

The role of obstetric factors in determining fetal viability.

OBJECTIVE: To study the influence of primary obstetric complications on the survival and short-term morbidity rates of very-low-birth-weight (VLBW) babies. DESIGN: A 1-year retrospective, descriptive study. SETTING: Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. STUDY POPULATION: 257 women admitted with live singleton fetuses and who eventually delivered babies with birth weights ranging from 750 to 1,499 g. MANAGEMENT: Primary obstetric complications responsible for the delivery of the VLBW babies were clinically diagnosed. Active management was undertaken if the fetus was viable and obstetric and neonatal resuscitation were applied. Management was conservative when the fetus was considered non-viable. This decision on the initial treatment option was taken by the obstetrician who managed the case. MAIN OUTCOME MEASUREMENTS: Survival and short-term morbidity rates of the babies. RESULTS: Spontaneous preterm labour (45%) and hypertensive disorders (39%) were equally responsible for delivery of VLBW babies at Tygerberg Hospital. The only obstetric factor influencing the babies' outcome, however, was the initial management decision by the obstetrician. There was a survival rate of 160/213 (75.1%) in the actively managed group compared with only 1/44 (2.3%) in the conservatively managed group. Other factors that significantly influenced neonatal survival of VLBW babies were: birth weight, gestational age, Apgar score at 5 minutes and length of time between admission to hospital and the delivery. CONCLUSION: The obstetric complication responsible for delivery of the VLBW baby did not influence the survival rate. The major determinant of neonatal survival was the obstetrician's decision to manage the fetus either actively or conservatively. It seems that the outcome of VLBW babies is influenced primarily by the intrinsic characteristics of the neonates' gestational age, birth weight and condition at birth, and not the reason for delivery.

Delivery, Obstetric↗
PubMed1990

Implantation potential and fetal viability of mouse embryos cultured in media supplemented with platelet-activating factor.

Supplementation of culture media with PAF failed to increase the proportion of 2-cell mouse embryos which developed through to the expanded blastocyst stage after 72 h of culture in vitro. Culture of embryos with 1.86 microM-PAF, however, significantly increased the number of cells in expanded blastocysts. Culture in vitro with 0.186 or 1.86 microM-PAF significantly increased the ability of embryos to implant upon transfer to pseudopregnant recipients. The specificity of this effect was demonstrated by its inhibition by the specific PAF-receptor antagonist, SRI 63-441. Of the embryos which implanted, there was no difference in the proportions of PAF-treated or control embryos which resorbed nor was there any effect of PAF on fetal weight or crown-rump length measurements. Embryos cultured with 1.86 microM-PAF did have slightly heavier placentae than their respective controls. These results demonstrate the ability of exogenous PAF to enhance the viability of preimplantation mouse embryos cultured in vitro and support the hypothesis that a major site of the action of PAF during early pregnancy is the embryo itself.

Animals↗
PubMed1989

Effects of oral copper administration to pregnant heterozygous brindled mice on fetal viability and copper levels.

Copper (6 ppm) was administered to pregnant heterozygous brindled and normal mice from 13 to 18 days gestation. The copper and zinc concentrations in the cerebrum, cerebellum, liver, and kidneys of mothers and their fetuses were determined. The placental concentrations in fetuses of heterozygous mothers administered copper were also determined. The heterozygous mothers had smaller numbers of live fetuses than the normal mothers, but had the same number as normal mothers when copper was administered. The hepatic copper concentration in the heterozygous mothers was lower than that in the normal mothers and was not increased by the administration. The body and tissue wet weights of all fetuses were unaffected by the maternal genotype or drinking fluid. The cerebral copper concentrations in hemizygous and heterozygous fetuses were increased by the copper administration but did not reach normal levels. The hepatic and renal concentrations remained unchanged. The cerebral copper concentrations in normal fetuses of both heterozygous and normal mothers were increased by the copper administration. The copper administration increased the copper concentrations in liver of normal fetuses of heterozygous mothers and in kidneys of normal fetuses of normal mothers. The placental copper concentration in hemizygous fetuses was higher than those in heterozygous and normal fetuses. These results suggested that oral copper administration to pregnant females could improve an abnormal copper distribution in hemizygous and heterozygous fetuses without affecting fetal growth.

Animals↗
PubMed1992

The effects of ultrasound-guided shock waves during early pregnancy in Sprague-Dawley rats.

Pregnancy is a contraindication to extracorporeal shock wave lithotripsy (ESWL) because of its possible harm to the embryo or fetus caused by shock waves or ionizing radiation. In this study timed-pregnant rats were subjected to shock waves early in gestation using a lithotriptor having ultrasound imaging. In a pilot group undergoing immediate laparotomy, it was determined to what extent the pelvic structures were effected. Then a test group was exposed to shock waves and carried to near term pregnancy along with an identical group of pregnant, sham procedure rats. A laparotomy all were inspected for fetal viability, fetal abnormalities, and maternal organ damage. Fetuses located nearest the focal area of maximum shock wave energy showed lower mean weight than controls. There was no recognizable gross or microscopic fetal damage.

Animals↗
PubMed1986

Bilateral maintenance of rabbit corpora lutea by the feto-placental unit.

The present study was undertaken to determine whether the rabbit feto-placental unit maintains corpora lutea systematically and/or locally and the interrelationships between conceptus number, luteal weight, luteal progesterone concentrations and serum progesterone levels. Thirty-three does were divided into the following treatment groups: (I) bilaterally pregnant, two ovaries; (II) unilaterally pregnant, two ovaries; (III) bilaterally pregnant, one ovary; (IV) unilaterally pregnant, one ovary, contralateral and (V) unilaterally pregnant, one ovary, ipsilateral. Blood samples were obtained from all rabbits on days 6, 9, 12, 15, 18 and 21 post coitum. Does were killed on day 21, and the percentage of viable fetuses, fetal weights, and luteal weights recorded. Blood samples and corpora lutea were analysed for progesterone. Serum progesterone levels were similar for all groups until day 9 post coitum. Levels in groups III, IV and V declined significantly between days 9 and 12 following removal of one ovary at day 9. Fetal viability, fetal weights and luteal progesterone concentrations did not differ among any of the groups. Luteal weights did not differ among groups I, III, IV and V, but luteal weights of animals in group II were lower than those of group I (P less than 0.05). Ratios of viable fetuses to number of corpora lutea ranged from 1:11-10:5. No differences were observed in serum progesterone, luteal weights or luteal progesterone concentrations among animals with two conceptuses and those with seven or more, but serum progesterone levels in does with only one conceptus were lower than those in does with more (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗