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PubMed1996

Human erythrocyte CAI and CAII isoenzymes in hypoxemic and anemic fetuses.

OBJECTIVES: The aims of the present study are (1) to determine the erythrocyte CAI and CAII concentrations in SGA and anemic fetuses and to compare them with normal levels, and (2) to examine whether there is any correlation between fetal hypoxia or anemia and isoenzyme concentrations. METHODS: Human erythrocyte CAI and CAII concentrations were measured in SGA (n = 25) and anemic (n = 32) fetuses (20-36 weeks' gestation), using enzyme-linked immunosorbent assays (ELISA). The blood gases and pH were measured with an ABL-2c blood gas analyzer. RESULTS AND CONCLUSION: In the group of SGA fetuses, there was a tendency for CAI and CAII to be higher than for normal fetuses. The CAI/CAII ratio was also significantly higher than the normal ratio. There were significant correlations between blood Delta pH and Delta CAI, Delta CAII, or Delta CAI/CAII ratio in this group of fetuses. The levels of CAI, CAII, and CAI/CAII ratio were the same as for normal fetuses in the group of anemic fetuses from red cell isoimmunized pregnancies before their first intrauterine blood transfusion. However, in the group of anemic fetuses after their first blood transfusion, the levels of both isoenzymes were significantly higher than the normal blood levels. Within the latter group there was a significant negative correlation between the Delta CAI and the percentage of fetal erythrocytes in the circulation.

Anemia↗
PubMed1990

The use of loglinear model to evaluate factors associated with sero-prevalence of Campylobacter fetus in dairy cattle.

Campylobacter fetus is one of the leading infections causing bovine infertility and abortion. In a cross-sectional study, the associations of parity, herd, serological status against Leptospira hardjo and Haemophilus somnus with the sero-prevalence of Campylobacter fetus in dairy cattle were evaluated. Four hundred dairy cows from three herds were included in the study. Blood samples from the cows were collected in December 1986. An enzyme-linked immunosorbant assay (ELISA) was used to determine positive or negative status of cows against Campylobacter fetus , Haemophilus somnus and Leptospira hardjo antigens. Loglinear analysis was used to describe the relationship of four categorical variables with the sero-prevalence of Campylobacter fetus . The final loglinear model was interpreted as a logit model. The final loglinear model included a three-way interaction among Campylobacter fetus , Leptospira hardjo and herd and a two-way interaction between Campylobacter fetus and parity. The adjusted odds of being a positive Campylobacter fetus reading were highest for cows with parity >6 (e.g. 27.8, 95% confidence interval (CI) = 12.9, 60.1); it was next highest for cows in parity <4 (e.g. 18.0, 95% CI = 13.5, 24.2); and it was lowest for cows in parity 4 to 6 (e.g. 13.3, 95% CI 7.3, 24.4). The herd management practice that was associated with the carrier state in early and late parities is identified in the study, and the biological implication of a three-way interaction among Campylobacter fetus , Leptospira hardjo and herd are discussed.

Journal Article↗
PubMed1994

Heart rate changes following habituation testing of the motor response in normal human fetuses.

We examined the heart rate (HR) response immediately following habituation testing in 54 normal human fetuses between 34 and 40 weeks of gestation to determine if cardiac self-regulation was a function of the rate of motor habituation. All fetuses received eight trials of a 1-s vibroacoustic stimulus (VAS) with a 10-s interstimulus interval. A score of 0-10 was assigned for each trial based on subjective assessment of intensity and duration of the fetal motor response. Motor habituation was evaluated in terms of the rate of response decrement over trials. For each fetus the average post-VAS HR was calculated in 1-min blocks for the first 7 min following habituation testing. When subjects were divided into slow and fast motor habituators, we found that fetuses who were slow habituators displayed a significantly greater increase in HR above baseline at each of the first 7 min following habituation testing as compared to fetuses whose motor response habituated more rapidly, F(1,52) = 4.88, P = 0.03. However, there was no difference between slow and fast motor habituators in the rate at which the HR returned toward prestimulus levels. To further examine these results, we divided the 54 fetuses into four groups based on the medians of the slope of the post-VAS HR regression line and the variability in HR about this line. We found that fetuses whose HR decreased slowly after habituation testing displayed significantly greater variability in their cardiac response as compared to fetuses whose HR decreased more rapidly (chi 2 = 4.74, P = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Tetralogy of Fallot, truncus arteriosus, abnormal myocardial architecture and anomalies of the aortic arch system induced by bis-diamine in rat fetuses.

OBJECTIVES: The aim of this study was to analyze the relation between anomalies of the heart and aortic arch arteries in near-term rat fetuses exposed to the chemical bis-diamine. BACKGROUND: Bis-diamine is known to induce cardiovascular anomalies. METHODS: Bis-diamine was given orally to normal pregnant rats, and the 65 fetuses were examined under a dissecting microscope after formalin fixation. RESULTS: There were 26 rat fetuses (40%) with a ventricular septal defect in the perimembranous portion, of which 14 (22%) had tetralogy of Fallot, 4 (6%) had truncus arteriosus and 8 (12%) had a relatively small defect with no other major anomalies. In 44 fetuses (68%) the middle latitudinal muscle bundle of the ventricular septum was continuous with the right ventricular free wall. There were, isolated or in association, a double- or right aortic arch in 6 fetuses (9%), aberrant subclavian arteries in 9 (14%), right ductus arteriosus in 12 (18%) and agenetic ductus in 4 (6%). The cross-sectional area of the ductus, as corrected by that of the aortic isthmus, was abnormally small in 47 rats (72%). The rat fetuses with a septal defect or abnormal myocardial architecture, or both, usually had a small ductus; it was very small or absent in those fetuses with tetralogy of Fallot. Of the four fetuses with truncus arteriosus, two had a vestigial vasculature on the truncus root and three had a rudimentary infundibulum. CONCLUSIONS: The cardinal defect may be the anomalous and reduced development of the sixth arch arteries, which by imposing pressure overload on the fetal right ventricle, may have led to either or both the persistence of ventricular septal defect as a vent or the formation of myocardial architecture favorable for the generation of pressure in the right ventricle.

Abnormalities, Drug-Induced↗
PubMed2000

Sonographic prognostic factors in fetuses with sacrococcygeal teratoma.

BACKGROUND: A subset of fetuses with sacrococcygeal teratoma (SCT) develops hydrops caused by high-output heart failure. Identification of fetuses at risk for hydrops is important because fetal intervention may reverse the pathophysiology of the disease. To date, no reliable sonographic prognostic factors have been identified. METHODS: An experienced sonologist reviewed the sonographic records of 17 fetuses with SCT referred to the authors' institution. Size of the tumor was measured and corrected for fetal size. The appearance of the tumor (solid versus cystic) and its vascularity were graded on a subjective scale of 1 to 5. RESULTS: Only 4 of 12 fetuses that had hydrops survived; of the survivors, 3 had undergone fetal intervention. All nonhydropic fetuses survived. Fetuses with hydrops had tumors that were mainly solid and highly vascular, whereas nonhydropic fetuses had predominantly cystic tumors with comparatively less vascularity. There was no significant difference in tumor size between these 2 groups. CONCLUSIONS: Fetuses with SCT that are mainly solid in appearance and are highly vascularized have a higher risk of getting hydrops in utero. Tumor size is not an independent prognostic factor.

Coccyx↗
PubMed1985

Management of the fetus with congenital hydronephrosis II: Prognostic criteria and selection for treatment.

Selecting appropriate management for the fetus with bilateral congenital hydronephrosis depends on our ability to accurately assess the severity of existing renal damage and to predict the potential for recovery of renal and pulmonary function if the obstruction is relieved. We reviewed our experience with 20 fetuses with congenital bilateral hydronephrosis to determine the prognostic value of various criteria used to assess functional potential, including temporary catheter exteriorization to measure fetal urine output and composition. Based on autopsy, biopsy, or clinical outcome, ten fetuses were classified retrospectively as "poor function," and ten fetuses as "good function." The good function group could be distinguished from the poor function group by the following criteria: Amniotic fluid (AF) status at presentation (P less than .001), ultrasound appearance of the fetal kidneys (P less than .05), fetal urine sodium and chloride concentration and osmolarity (P less than .001), and hourly urine output (P less than .02), but not by fetal urine iothalamate excretion or potassium and creatinine concentrations (P greater than .05). Based on these results, we have identified prognostic criteria that accurately identify the fetus with "good function" from the fetus with "poor function." We also reviewed the clinical management of our last 12 unreported cases. Ten fetuses had undergone diagnostic catheter placement and in utero renal function testing. This led to placement of a therapeutic indwelling catheter-shunt in seven fetuses (three required multiple shunts) and a suprapubic vesicostomy in another. Catheter related complications, including three cases of chorioamnionitis, emphasize the need for better methods of in utero decompression in selected cases. Our ability to select appropriate management has improved markedly.

Biopsy↗
PubMed1998

Collagen type VI gene expression in the skin of trisomy 21 fetuses.

OBJECTIVE: To determine whether the mechanism for the retention of interstitial fluid in trisomy 21 fetuses presenting with nuchal translucency at 10-14 weeks' gestation is an alteration in the composition of collagen type VI, which is normally a triple helix formed of three single chains, alpha1, alpha2, and alpha3. The genes responsible for the alpha1 and alpha2 chains, COL6A1 and COL6A2, are located on chromosome 21 and therefore may be overexpressed in trisomy 21, whereas COL6A3 is located in chromosome 2. METHODS: Skin tissue was obtained after termination of pregnancy at 11-16 weeks' gestation in five fetuses with trisomy 21 and five normal controls. Total RNA was extracted and the steady-state levels of COL6A1 and COL6A3 mRNA expression of the gene transcripts were determined. Additionally, the distribution of collagen type VI in the skin of trisomy 21 and normal fetuses was analyzed using an immunohistochemical method. RESULTS: The ratio of the normalized densitometric scores for the mRNA expression of COL6A1 to COL6A3 in the skin of trisomy 21 fetuses was twice as high as in normal fetuses. Immunohistochemistry demonstrated that in trisomy 21 fetuses collagen type VI formed a dense network extending from the epidermal basement membrane to the subcutis, whereas in normal fetuses dense staining was confined to the upper region of the dermis. CONCLUSION: The distribution for collagen type VI is different from normal in the skin of trisomy 21 fetuses, and there is overexpression of COL6A1 compared with COL6A3.

Adult↗
PubMed2000

Fetal heart rate in relation to its variation in normal and growth retarded fetuses.

OBJECTIVES: (1) to assess the relationship of basal fetal heart rate (FHR) with both long term (LTV) and short term (STV) FHR variation in low-risk pregnancies, longitudinally from 24 weeks gestation onwards and (2) to investigate the relationship of FHR with LTV and STV in intrauterine growth retarded (IUGR) fetuses. STUDY DESIGN: Computerised FHR recordings were made in twenty-nine uncomplicated pregnancies (n=224) and in twenty-seven IUGR fetuses who were selected retrospectively from three databases (n=135). Nomograms of FHR variation with FHR and GA were constructed using multilevel analysis. RESULTS AND CONCLUSIONS: There was a strong negative relationship of FHR with both LTV and STV in the control group (R2=53% and 52%, respectively). In the IUGR fetuses, FHR was generally higher than in normal fetuses whereas LTV and STV were lower. The relationship of FHR with LTV and STV in the IUGR group was less strong (for both: R2=18%). Correction of FHR variation for basal FHR in the IUGR fetuses only resulted in a slight reduction in the number of recordings with a variation below the normal range. As it does not improve the recognition of fetuses being considered at the highest risk, such a correction of FHR variation for basal FHR is therefore not necessary. Intrafetal consistency, known to be present in healthy fetuses, was also present in the IUGR fetuses with a low FHR variation.

Female↗
PubMed1999

Accuracy of prenatal echocardiographic diagnosis and prognosis of fetuses with conotruncal anomalies.

OBJECTIVES: The purpose of the study was to determine the accuracy of the prenatal echocardiographic diagnosis and prognosis of fetuses with conotruncal anomalies. BACKGROUND: The accuracy of prenatal echocardiographic diagnoses of cardiac lesions has been reported, but no previous reports specifically address fetal conotruncal anomalies. METHODS: Medical records of 61 fetuses, in which a fetal diagnosis of a conotruncal anomaly was made, were reviewed. Disease entities included were tetralogy of Fallot (TOF), double outlet right ventricle (DORV), transposition of the great arteries (TGA), and truncus arteriosus (TA). RESULTS: Fetal diagnosis was established at a median of 24.5 weeks' gestation. Termination of pregnancy was chosen in 31% (19/61) of cases. Postnatal assessment of the diagnosis was not obtained in 12 cases. Excluding two sets of conjoined twins, accurate prenatal diagnosis including definition of the great artery orientation was achieved in 36 of 47 cases (77%). Seven of 17 fetuses with DORV anatomy, of which 6 were thought to have a subpulmonary ventricular septal defect (VSD), had incorrect prenatal assessment of the great artery relationships. One fetus thought to show features of TA had aortic atresia with VSD and normal-sized left ventricle. Of the 42 pregnancies that continued, 15 had major extracardiac malformations and/or chromosomal abnormalities of which one died in utero with trisomy-13 and TA. A further nine died within the neonatal period. Among the 27 fetuses without a documented chromosomal or major extracardiac anomaly, 13 (48%) died. Overall, the survival rate beyond 28 days of life was 52% (22/42). In contrast, 75% (6/8) of fetuses with TOF, excluding the absent pulmonary valve syndrome, survived. CONCLUSIONS: Conotruncal anomalies can be diagnosed by prenatal echocardiography with a high degree of accuracy. Defining the exact spatial relationship of the great arteries is problematic in some fetuses. The overall prognosis for fetuses with a conotruncal anomaly is poor, with the exception of uncomplicated TOF.

Abnormalities, Multiple↗
PubMedDate not supplied

Ventricular volume overload in the human fetus: observations from fetal echocardiography.

We examined two groups of fetuses in which echocardiography had been performed and in which ventricular volume overload eventually led to fetal hydrops. The first group (18 fetuses) had atrioventricular valve regurgitation and almost all of the fetuses had structural heart disease. No fetus in this group survived the neonatal period; only two of the pregnancies in this first group were terminated. A second group of three fetuses had ventricular volume overload from sacrococcygeal teratomas at 21 to 24 weeks' gestation. These fetuses also had nonimmune hydrops (or it developed), but they did not have structural heart disease or atrioventricular valve regurgitation. Combined ventricular output in this group was calculated by Doppler ultrasound to be greater than twice the normal output for fetuses of the expected gestational weight. The proportion of the combined output to the lower body and the placenta was increased with the increase to the teratoma, exceeding the increase to the placenta. In one fetus, serial study demonstrated increasing output and the development of hydrops. Intrauterine surgery was undertaken to control the high output failure. The abnormal variables tended to revert to normal after replacement of blood loss, and the hydrops disappeared. The pregnancy continued until the spontaneous rupture of membranes at 26 weeks' gestation forced delivery by cesarean section. The infant died from severe hyaline membrane disease. These findings suggest that, in some circumstances, fetal hydrops is a late sign of cardiac failure and heralds incipient death.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1994

Ductus venosus blood velocity and the umbilical circulation in the seriously growth-retarded fetus.

Based on the assumption that the ductus venosus is regulator of oxygenated blood in the fetus, the present study investigated the blood flow velocity of the ductus venosus in relation to the umbilical circulation in the that seriously growth-retarded fetus. The study group of 38 fetuses (gestational week 17-39) had no chromosomal aberrations or structural malformations and had an ultrasonographic biometry of < 2.5th centile and birth weight of <or= 2.5th centile. Of the 38 fetuses seven died in utero and four died postnatally. The ultrasonographic examination included pulsed Doppler measurement of the umbilical artery pulsatility index (PI), the umbilical vein dimension and blood flow velocity, and the peak and maximum blood flow velocities of the ductus venosus. The majority of fetuses had a raised PI in the umbilical artery (26/38) and reduced blood flow in the umbilical vein (25/33). Despite such changes in the umbilical circulation, a normal peak velocity in the ductus venosus was maintained in all fetuses. During the atrial contraction, however, 13 fetuses had reduced or reversed blood velocity in the ductus venosus. Reduced ductus venosus velocity during atrial contraction seemed to be a serious finding linked to raised PI and absent or reversed end-diastolic flow in the umbilical artery, and umbilical vein pulsation. The results support the assumption that the blood flow of the ductus venosus is a preferential bloodstream in the human fetus that is maintained within normal ranges as long as possible during placental hemodynamic compromise.

Journal Article↗
PubMed1994

Color Doppler identification of a pericardial effusion in the fetus.

The aim of the study was to determine whether color Doppler identifies abnormal fluid within the pericardial space of the fetal were referred for heart. Second- and third-trimester fetuses diagnostic ultrasound. The four-chamber view of the fetal heart was imaged with real-time ultrasonography and examined for the presence or absence of separation of the pericardium from the epicardium, which extended from the atrioventricular junction toward the apex of the ventricle. To examine the pericardial space, the color Doppler maximal velocity was set at low Nyquist limits (0.08-0.24 m/s). In each fetus the transducer was angled so that the axis of the interventricular septum was parallel or tangential to the ultrasound beam to optimize the color Doppler recording. The control group consisted of 50 fetuses (16-38 weeks of gestation) who did not demonstrate evidence of pericardial effusion when examined with real-time ultrasound. Second- and third-trimester fetuses were selected from our database who demonstrated a pericardial effusion identified with real-time ultrasound. Color Doppler signals were not identified within the pericardial space in the 50 control fetuses. Fetuses with a pericardial effusion identified with real-time ultrasound demonstrated color Doppler within the pericardial space which was opposite to the direction of blood entering and exiting the ventricles. Color Doppler enhanced the detection of a pericardial effusion in the second-trimester fetus when the axis of the heart was and third-parallel or tangential to the ultrasound beam, which is suboptimal for real-time imaging. Color Doppler provides a new method to identify a pericardial effusion in the fetus during the second and third trimesters of pregnancy and complements the real-time examination.

Journal Article↗
PubMed1996

Single umbilical artery: analysis of Doppler flow indices and arterial diameters in normal and small-for-gestational age fetuses.

In this study we examined the value of Doppler flow measurements of the umbilical artery in distinguishing normal fetuses from those with single umbilical artery, and studied the Doppler flow differences and the compensatory arterial dilatation in appropriate (AGA) and small-for-gestational-age (SGA) fetuses with single umbilical artery. The Doppler flow indices (pulsatility index, S/D ratio) and the arterial diameters were prospectively and serially measured in 26 and 15 fetuses with single umbilical artery and without congenital malformations, respectively. Longitudinal changes in Doppler flow indices in normal and SGA fetuses with single umbilical artery are comparable, and are within normal reference ranges for three-vessel cords; there is a fairly constant widening of the single umbilical artery throughout gestation and a mean increase in size of about 1 mm over that found in normal cords from 20 weeks onward. In fetuses with single umbilical artery at mid-gestation, an umbilical artery diameter of more than 4 mm occurred in only 5/15 cases and is therefore not a reliable criterion for single umbilical artery screening prior to 26 weeks of gestation. Doppler flow measurements in normal and SGA fetuses with single umbilical artery are not significantly different from normal fetuses. Compensatory arterial dilatation may prevent fetuses with single umbilical artery from becoming growth retarded.

Blood Flow Velocity↗
PubMed1997

Computerized analysis of behavior in fetuses with congenital abnormalities.

An observational study was undertaken to evaluate a computerized fetal behavior program in a clinical setting. Behavior of normal fetuses was compared with that of fetuses with a variety of congenital abnormalities. Forty-three fetuses were studied at 28-36 weeks; 26 were normal (49 recordings) and 16 had congenital abnormalities (26 recordings; ten had structural abnormalities of the central nervous system, one had Down's syndrome and five had other abnormalities). Behavior was recorded with the use of Doppler ultrasound. The duration of each recording was 60 min or more in all but two instances. The behavioral criteria studied were (1) the relative percentage of time spent in low and high fetal heart rate (FHR) variation; and (2) the percentage of time fetal activity was detected in low and high FHR variation. Fetuses with abnormalities exhibited varying patterns of behavior: only eight had patterns of FHR variation that were within the 10th and 90th centiles for normal fetuses and only one fetus exhibited a fetal activity pattern that was between the 10th and 90th centiles for the normal group. All the abnormal fetuses had a FHR pattern and/or fetal activity rate outside the 10th or 90th centiles. This study suggests that such a computerized behavioral analysis program may serve as a functional adjunct to the evaluation of a fetus with structural abnormalities.

Abnormalities, Multiple↗
PubMed1997

The prevalence and clinical significance of tricuspid valve regurgitation in normally grown fetuses and those with intrauterine growth retardation.

The aim of this study was to assess the prevalence and clinical significance of fetal tricuspid valve regurgitation. In a cross-sectional study, 289 normally grown singleton fetuses with normal heart anatomy, normal estimated weight for gestational age, normal amniotic fluid volume and normal flow velocity waveforms in the umbilical and middle cerebral arteries and umbilical vein were examined. A further 31 singleton fetuses with intrauterine growth retardation (estimated fetal weight below the 3rd centile) were analyzed. Semiquantification of the tricuspid valve regurgitation by spatial and temporal parameters was performed in the four-chamber view by color Doppler flow imaging and by color Doppler M-mode echocardiography (M-Q mode). The prevalence of fetal tricuspid valve regurgitation among normally grown fetuses was 6.23% (n = 18). In all cases, the tricuspid regurgitation was part-systolic (non-holosystolic, early and mid-systolic tricuspid regurgitation) and showed little spatial expansion of the jet as examined by color Doppler flow imaging (no jet reached the opposite atrial wall, the area of tricuspid regurgitation being less than 25% of the atrial area). The maximum velocity of the regurgitant jets was below 2 m/s with one exception. There was no statistically significant correlation between gestational age and occurrence of tricuspid regurgitation (U test, p > 0.05). Re-examination of 14 of the 18 fetuses with tricuspid regurgitation showed that tricuspid regurgitation was a transient phenomenon in these instances. The fetal outcome in the presence of tricuspid valve regurgitation was normal. Regurgitations of the mitral, pulmonary and aortic valves were excluded in all 289 fetuses. Only two of the 31 fetuses (6.45%) with intrauterine growth retardation showed tricuspid valve regurgitation. In one fetus the tricuspid regurgitation ws only part-systolic. In the other severely compromised fetus with highly abnormal flow velocity waveforms in the arterial and venous side of the fetal circulation, cardiac dilatation with holosystolic tricuspid and holosystolic mitral regurgitation occurred immediately before intrauterine death. Fetal tricuspid valve regurgitation was a frequent finding during Doppler echocardiography. Although it may be a sign of increased preload, afterload or cardiac dysfunction, in most cases tricuspid valve regurgitation is an isolated transient finding with little temporal and spatial expansion, and it may be physiological.

Adult↗
PubMed1999

Prenatal diagnosis of a lean umbilical cord: a simple marker for the fetus at risk of being small for gestational age at birth.

OBJECTIVE: The purpose of this study was to investigate whether the prenatal diagnosis of a 'lean' umbilical cord in otherwise normal fetuses identifies fetuses at risk of being small for gestational age (SGA) at birth and of having distress in labor. The umbilical cord was defined as lean when its cross-sectional area on ultrasound examination was below the 10th centile for gestational age. METHOD: Pregnant women undergoing routine sonographic examination were included in the study. Inclusion criteria were gestational age greater than 20 weeks, intact membranes, and singleton gestation. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. Umbilical artery Doppler waveforms were recorded during fetal apnea and fetal anthropometric parameters were measured. RESULTS: During the study period, 860 patients met the inclusion criteria, of whom 3.6% delivered a SGA infant. The proportion of SGA infants was higher among fetuses who had a lean umbilical cord on ultrasound examination than among those with a normal umbilical cord (11.5% vs. 2.6%, p < 0.05). Fetuses with a lean cord had a risk 4.4-fold higher of being SGA at birth than those with a normal umbilical cord. After 25 weeks of gestation, this risk was 12.4 times higher when the umbilical cord was lean than when it was of normal size. The proportion of fetuses with meconium-stained amniotic fluid at delivery was higher among fetuses with a lean cord than among those with a normal umbilical cord (14.6% vs. 3.1%, p < 0.001). The proportion of infants who had a 5-min Apgar score < 7 was higher among those who had a lean cord than among those with normal umbilical cord (5.2% vs. 1.3%, p < 0.05). Considering only patients admitted in labor with intact membranes and who delivered an appropriate-for-gestational-age infant, the proportion of fetuses who had oligohydramnios at the time of delivery was higher among those who had a lean cord than among those with a normal umbilical cord (17.6% versus 1.3%, p < 0.01). CONCLUSION: We conclude that fetuses with a lean umbilical cord have an increased risk of being small for gestational age at birth and of having signs of distress at the time of delivery.

Adult↗
PubMed2000

Umbilical vein blood flow in growth-restricted fetuses.

OBJECTIVE: To determine whether umbilical blood flow is reduced in a subset of growth-restricted (IUGR) fetuses when expressed as flow per kilogram or flow per unit of specific sonographic fetal measurements. DESIGN: Prospective. SUBJECTS: Thirty-seven IUGR fetuses were examined by Doppler ultrasound within 4 h of the last non-stress test prior to delivery. This population was divided into three groups of varying clinical severity according to the characteristics of umbilical arterial pulsatility index (PI) and heart rate. METHODS: Absolute and weight-specific umbilical vein (UV) flow were calculated from measurements of UV diameter and UV mean velocity. Umbilical vein diameter, velocity and UV flow were calculated also per unit head (HC) or abdominal circumference (AC) and correlated with gestational age. RESULTS: Umbilical vein flow (UVf) per kilogram fetal weight was significantly lower in the more severe IUGR fetuses (abnormal umbilical arterial PI) than in normally grown comparable fetuses (P < 0.001). Umbilical vein flow per unit HC was significantly lower in the three groups (P < 0.001) than in the control population. The UV diameter/HC ratio was normal whereas UV velocity/HC ratio was significantly lower in IUGR fetuses than in comparable controls. CONCLUSIONS: The present study clearly establishes that umbilical venous blood flow is reduced in IUGR fetuses on a weight-specific basis. The sonographic growth parameter which best distinguishes umbilical flow differences of IUGR fetuses from normal fetuses is the head circumference.

Adult↗
PubMed2000

Fetal adrenal artery velocimetry measurements in appropriate-for-gestational age and intrauterine growth-restricted fetuses.

OBJECTIVE: To investigate adrenal artery blood flow in the fetus. DESIGN AND METHOD: Sixty-two appropriate-for-gestational-age (AGA) and 20 intrauterine growth-restricted (IUGR) fetuses were recruited to this cross-sectional study between 22 and 42 weeks of pregnancy in a tertiary referral fetal medicine unit of a university hospital. ENDPOINTS: Doppler velocimetry of the fetal adrenal, umbilical (UA), renal and middle cerebral arteries (MCA). Pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), time-averaged maximum velocity (TAMXV) and cerebroplacental ratio (MCA RI/UA RI; CPR). Obstetric outcome. RESULTS: The adrenal artery was detected in 82% of the fetuses. All flow velocity waveforms obtained from the adrenal artery indicated low impedance blood flow. No significant changes in PI, RI, PSV and TAMXV occurred with advancing gestation. The blood flow parameters of the adrenal artery did not differ between AGA and IUGR fetuses. In five IUGR fetuses with signs of redistribution of cardiac output in favor of the brain, the adrenal artery velocimetry results were unremarkable. The adrenal artery PI, RI, PSV and TAMXV values were higher in female fetuses than in male fetuses (P < 0.05). A relationship was observed between the velocity measurements and the estimated fetal weight (P < 0.01). CONCLUSIONS: The fetal adrenal artery could be readily detected. We observed no redistribution of blood flow in favor of the fetal adrenals in IUGR fetuses which were not severely compromised.

Adrenal Glands↗