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PubMed1984

Effects of ethanol and/or caffeine on fetal development and placental amino acid uptake in rats.

The effects of ethanol alone or in combination with caffeine on fetal viability, growth and placental amino acid uptake function in the rat were examined. Compared to pair-fed control values, chronic ethanol exposure reduced fetal survival by 24%, fetal weight by 17%, along with weight decreases of fetal brain (16%), heart (31%), and kidney (48%) as compared to pair-fed control values. Placental weight was significantly increased by 17%. Concomitant caffeine intake generally exacerbated these effects with a further reduction in fetal survival, fetal body and visceral weights. Caffeine intake alone had no consistent effect on these parameters. Acute in vitro (3 mg/ml) and chronic in vivo ethanol exposure reduced placental net uptake of alpha-aminoisobutyric acid (AIB) by 32 and 45%, respectively. Neither acute in vitro (10 micrograms/ml) nor prior chronic caffeine exposure altered villous AIB uptake. Concomitant ethanol and caffeine treatment increased AIB uptake as compared to ethanol alone. However, AIB uptake continued to be reduced (by 22%) as compared to pair-fed control values.

Amino Acids↗
PubMedDate not supplied

Fetal salvage with maternal total parenteral nutrition: the pregnant mother as her own control.

Hyperemesis gravidarum affects both maternal and fetal well-being by reducing maternal vascular volume (normally increased with pregnancy) and depleting maternal nutritional stores. Severe intractable hyperemesis may result in fetal demise. This report documents the ability to maintain maternal fluid and nutritional requirements during first trimester pregnancy in a female with intractable hyperemesis gravidarum. Additionally, this patient is unique in that her five prior pregnancies were complicated by hyperemesis with the last three resulting in fetal demise. Speculation regarding the relative importance of inadequate hydration and nutrition in first trimester fetal viability is given. When hyperemesis is unresponsive to conventional management, intravenous hydration should be instituted without delay to preserve maternal intravascular blood volume and thus placental blood flow. Consideration for total parenteral nutrition can then be given which, after adequate in-hospital instruction, may in most cases be continued in the home.

Adult↗
PubMed1996

Vaginal bleeding and early pregnancy outcome in an infertile population.

OBJECTIVE: Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding. STUDY DESIGN: This was a cohort study of pregnancies obtained using either assisted reproductive technology (ART) or routine infertility treatment (RIT). Two hundred twenty-eight pregnant women were divided into two groups based on the presence or absence of vaginal bleeding. Successive measurements of beta-hCG levels were obtained every 2 days, starting on day 14 after ovulation or embryo transfer. All pregnancies underwent weekly transvaginal ultrasound (UTZ) examinations beginning on day 21. The occurrence of vaginal bleeding was monitored weekly. RESULTS: Seventy of the 228 patients (31%) had bleeding in early pregnancy, resulting in 31 (44%) pregnancy losses. Only 22 pregnancy losses (14%) were observed in 158 patients who did not have bleeding (P < 0.001). The abortion rate for the bleeding versus nonbleeding groups was 35 and 9%, respectively (P < 0.001). Vaginal bleeding was associated with a higher abortion rate in pregnancies following RIT than ART (51 vs 8%; P < 0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleeding was also associated with a higher abortion rate than that in the nonbleeding group (17 vs 4%; P < 0.001). However this higher incidence was observed only in pregnancies following RIT, not ART (28 vs 5%; P < 0.001). CONCLUSIONS: Although bleeding significantly decreased the chance of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. However, the predictive value of fetal cardiac activity was reduced in the presence of vaginal bleeding in an infertile population treated with RIT.

Abortion, Spontaneous↗
PubMed1999

The use of pulsatile perfusion during aortic valve replacement in pregnancy.

Cardiac operations are occasionally required during pregnancy. Despite a low maternal mortality, fetal mortality remains high. Previous reports have suggested maintenance of high perfusion pressure and flow rate as protective measures to maintain fetal viability. Recent experimental data suggest pulsatile perfusion may help preserve placental hemodynamic function. The successful use of pulsatile bypass to replace the aortic valve in a 25-year-old female at 14 weeks gestation, with both maternal and fetal survival, is presented.

Adult↗
PubMed1977

Effect on pregnancy and plasma progesterone of exogenous steroid maintenance in ovariectomised pregnant rabbits.

Pregnancy was maintained in ovariectomised does with 1 to 4 mg/day of exogenous progesterone with or without 0.2 microgram/day of estradiol. Progesterone doses were designed to give similar plasma progesterone levels in treated groups to those found in normal pregnancy, and were measured and compared with normals since this comparison does not appear to have been published previously. In normal pregnancy mean progesterone levels reached 10 ng/ml on day 7 and then plateaued at 14 ng/ml between day 10 and 20 before falling to very low levels at parturition. In treated groups progesterone levels reached 10 ng/ml on day 6 and remained between 10 and 13 ng/ml until day 20 before declining. The difference between treated and control plasma progesterone plateau levels was tested using the t-test and was found not be significant. The differences in progesterone levels between treated groups with or without estradiol, whether pregnant or not, were also not significant. Mean litter sizes (alive or dead) were not significantly different. However, fetal viability in the group maintained on progesterone alone was significantly lower than in the normal controls.

Animals↗
PubMed1986

Blood transfusion and Jehovah's Witnesses: medical and legal issues in obstetrics and gynecology.

Jehovah's Witnesses are members of a religious denomination whose beliefs prohibit the use of blood or blood products. Plasma volume expanders and extracorporeal hemodilution of the patient's own blood are theologically acceptable. Acute massive hemorrhage in which only blood is lifesaving may be encountered in obstetrics and gynecology. Either withholding or administering blood in such circumstances may have legal consequences for the physician and hospital. Factors to be considered include fetal viability, the presence of dependent children, and rules of informed consent. Whenever possible, the potential for transfusion should be anticipated and clearly discussed with the patient. When appropriate, the physician and hospital should move rapidly to obtain judicial resolution.

Blood Transfusion↗
PubMedDate not supplied

Successful preterm delivery in a patient with severe mitral stenosis.

We present the case of a 36-year-old woman who was diagnosed with severe mitral stenosis in the 30th week of a pregnancy that was complicated by complete placenta previa and placenta percreta. With medical management, she successfully carried the pregnancy to fetal viability and was delivered by cesarean section before undergoing percutaneous balloon mitral valvuloplasty.

Adult↗
PubMed1998

Cryopreservation of activated mouse oocytes and zygote reconstitution after thaw.

A new approach to cryopreservation of unfertilized oocytes is proposed using techniques of artificial egg activation combined with nuclear transplantation. Matured mouse oocytes were released from metaphase II arrest by brief exposure to alcohol, allowed to progress to the pronuclear stage and then frozen according to a standard freezing protocol in propandiol. After thaw the female pronuclei were enucleated and fused with a male karyoplasts that were divided from in-vivo fertilized zygotes. Reconstituted zygotes, fresh and cryopreserved culture control zygotes were cultured to the blastocyst stage and transferred to pseudopregnant recipients. The rate of blastocyst formation was 75.8, 91.6 and 44.1% respectively. A total of 110, 215 and 70 blastocysts were transferred to pseudopregnant females respectively. The implantation rates were 36.4, 72.0 and 75.7% while the rates of fetal viability at mid-gestation were 15.5 (P < 0.0001), 51.1 and 37.1% respectively.

Animals↗
PubMed1995

Developmental toxicity of N-methylformamide administered by gavage to CD rats and New Zealand white rabbits.

N-Methylformamide (NMF) is a metabolite of dimethylformamide (DMF), a solvent with wide applications in the chemical industry. The potential developmental toxicity of NMF was evaluated in CD rats and New Zealand white rabbits. Pregnant rats and rabbits were dosed once daily by gavage on Gestation Days 6-15 and 6-18, respectively. Doses for rats were 0, 1, 5, 10, or 75 mg/kg; doses for rabbits were 0, 5, 10, or 50 mg/kg. Cesarean sections were performed on rats and rabbits on Gestation Days 20 and 29, respectively. No treatment-related maternal deaths or clinical signs occurred in either species. Body weight gain and food consumption were depressed in rats given 75 mg/kg and rabbits given 50 mg/kg. Fetal viability was reduced at 75 mg/kg in rats and at 50 mg/kg in rabbits. In rats, a significant increase in the incidence of malformations including cephalocele and sternoschisis was observed in fetuses from the 75 mg/kg group. In addition, a developmental delay was indicated by reduction of fetal weight and by a significant increase in the occurrence of incomplete ossification of various skeletal structures. In the rabbit, fetal body weight was reduced at 50 mg/kg. Malformations observed at 50 mg/kg included gastroschisis, cephalocele, domed head, flexed paw, and skull and sternum anomalies. The lowest-observed-adverse-effect levels for maternal and developmental toxicity in the rat and rabbit were 75 and 50 mg/kg, respectively. The no-observed-adverse-effect level for maternal and developmental toxicity in the rat and rabbit was 10 mg/kg.

Abnormalities, Drug-Induced↗
PubMed2001

Surgical resolution of an ectopic pregnancy in a captive gerenuk (Litocranius walleri walleri).

A full-term ectopic pregnancy was diagnosed in a multiparous, captive gerenuk (Litocranius walleri walleri) following prolonged gestation without parturition. Until 213 days of gestation, fetal viability was determined by transabdominal ultrasound of fetal heartbeat, physical palpation, and visual observations of fetal movements. Survey abdominal radiographs obtained at day 229 of gestation revealed a fully mineralized fetal skeleton in an inappropriate position for parturition. Surgical exploration revealed a full-term, nonviable, male calf contained within fetal membranes attached to the omentum. Histologic examination of the fetal membranes identified lesions compatible with placenta-cotyledon separation occurring prior to surgical removal. No congenital fetal abnormalities or infectious processes were identified. Visual observation of the reproductive tract at the time of surgery revealed no abnormalities or evidence of concurrent pregnancy.

Animals↗
PubMed1991

Host genetic influences on fetal susceptibility to murine cytomegalovirus after maternal or fetal infection.

Genetically determined resistance to murine cytomegalovirus is observed in adult mice and is mediated in part by genes of the H-2 complex, with the H-2k haplotype conferring resistance. This model was used to examine the effect of primary maternal infection on fetal outcome. The severity of fetal growth retardation and death after primary maternal infection on day 8 of pregnancy was found to be genetically determined. Fetal viability and weight were significantly lower in infected BALB/c mothers (H-2d) than in CBA(H-2k) and BALB.K(H-2k) mothers. However, fetal infection was not detected, suggesting that the resistance mechanisms operate at the level of the mother or placenta. By directly inoculating fetuses in utero, it was shown that genetic factors in the fetus can influence the level of fetal infection and viability. These results point to the possibility that host genetic factors may modulate maternal and fetal cytomegalovirus infections in humans.

Animals↗
PubMed1979

Postpartum survival of mice exposed in utero to ultrasound.

We found no credible enhancement of neonatal mortality in mice exposed in utero on Day 8 of gestation to ultrasound at 0.44 W/cm2 (+/- 20%) spatial average intensity, 2 MHz, continuous wave, for 60--180 s in a 37 degrees C water bath. This result is compared with the adverse effect on neonatal survival reported by Curto [in Ultrasound in Medicine (Plenum, New York, 1976), Vol. 2, pp. 535--536] for exposure on Day 14 of gestation at about 0.125 to 0.5 W/cm2, 1MHz, continuous wave, for 180 s in a 30 degrees C bath. It is concluded that a temporary reduction in fetal viability, lasting from 4 days to less than 10 days after exposure, could account for both sets of data. It is also evident from these data that improved methods of determining intensities within mammalian tissues are highly desirable.

Animals↗
PubMed1995

Ethical issues in neonatal paediatrics--the Singapore perspective.

In Singapore, formulating ethical guidelines for people who live in a multiracial, multilingual, multicultural and multi-religious community can be difficult. The "individualised prognostic" strategy in the management of critically ill infants has been followed. Our neonatal paediatricians encounter the following ethical problems: extremely premature babies whose viability is doubtful, babies born with severe congenital malformations, babies born with signs of life in legal or therapeutic termination of pregnancy, the asphyxiated babies or babies with severe or extensive brain damage, and babies who are chronically sick and have no chance of recovery or leaving the hospital. Good ethical decisions require medical facts. The infant's diagnosis and prognosis must be accurate. There should also be detailed information that continuation of any form of medical treatment for the infant is futile, will do more harm than good and is inhumane. Ethical decisions should be made in the best interests of the infant. Dating of the infant's gestational age should be accurate and reliable, and there should also be unanimous definitions such as fetal viability, abortions and lethal malformations. Ethical guidelines and the law must also keep pace with changes in medical practice.

Abortion, Legal↗
PubMed1996

Complete hydatidiform mole and surviving coexistent twin.

Twin gestations consisting of a complete hydatidiform mole and coexisting fetus are rare and associated with an increased risk of persistent gestational trophoblastic tumor. Data were abstracted from 25 well-documented cases from the literature to which we added an additional case. Cases were then separated according to whether the pregnancy was evacuated before fetal viability (19 cases) or resulted in a surviving infant (7 cases). The previable and viable groups did not differ with respect to mean age, gravidity, parity, presenting symptoms, accuracy of sonographic diagnosis in identifying the molar component, uterine size at evacuation, or the presence of preeclampsia and theca lutein cysts. Statistically significant differences (P < .05) were detected between the previable and viable groups in estimated gestational age at evacuation (18.6 weeks vs. 33.0 weeks), the discrepancy between uterine size and estimated gestational age at evacuation (8.1 weeks vs. 1.0 weeks), and preevacuation serum hCG level (1,078,416 vs. 167,883 mIU/liter). Persistent GTT developed in 68.4 percent of the previable group patients and 28.6 percent of those in the viable group (P = .09). In patients with complete hydatidiform mole and coexistent fetus, fetal survival is associated with clinical characteristics suggestive of less exuberant molar growth. The advanced gestational age required to produce a viable, surviving fetus is not an independent risk factor for the development of persistent GTT.

Female↗
PubMed2004

Serum concentrations of macrophage inhibitory cytokine 1 (MIC 1) as a predictor of miscarriage.

Macrophage inhibitory cytokine 1 (MIC 1) is thought to have immunomodulatory actions favouring fetal viability. We measured serum concentrations of MIC 1 in asymptomatic women at 6-13 weeks' gestation who subsequently miscarried or who had already miscarried. MIC 1 concentrations in the miscarriage cohort (n=100), were a third of those who had ongoing pregnancies (n=197). Multiples of the median for miscarriage was 0.32 (95% CI 0.23-0.32) versus 1.00 (0.93-1.06) for ongoing pregnancies; p<0.0001. Concentrations were just as low 3 weeks before diagnosis as on the day of diagnosis. That MIC 1 serum concentrations seem to be low weeks before miscarriage suggests possible predictive and causative roles, as well as therapeutic potential.

Abortion, Spontaneous↗
PubMed1990

A rabbit model for bacteria-induced preterm pregnancy loss.

Bacterial infection has been implicated in premature labor in humans. To elucidate mechanisms and potential intervention strategies, we sought to develop a model of infection-induced pregnancy loss in rabbits. On day 21 (70% of gestation), each uterine horn was inoculated hysteroscopically with 0.2 ml containing saline solution of 10(6) cfu Escherichia coli or Bacteroides bivius or Fusobacterium necrophorum. Fetal viability was assessed. Animals were sacrificed at various times or as delivery occurred. Serum progesterone and amniotic fluid prostaglandins were measured. Cultures and histologic sections were prepared. Compared with the saline solution group, E coli and F. necrophorum-inoculated rabbits were significantly more likely to deliver (16 of 16 and six of seven with mean times of 31.9 +/- 10.7 and 28.3 +/- 11.5 hours, respectively for E. coli and F. necrophorum). Positive amniotic fluid cultures for the E. coli group were found in 11 of 12 (92%) and for the F. necrophorum group in three of three cases (100%). Histologic inflammation was seen heavily in both the E. coli and F. necrophorum groups, whereas it was absent in the saline solution group. Inoculation with B. bivius led to a much lower pregnancy loss rate (eight of 32) and less histologic inflammation despite positive uterine cultures in most animals. This model may provide an opportunity to determine mechanisms of clinical or subclinical intraamniotic infection and to test intervention strategies.

Abortion, Septic↗
PubMedDate not supplied

Court reaffirms Roe but upholds restrictions.

By a 5-4 margin, the U.S. Supreme Court reaffirmed on June 29, 1992, "the essential holding in Roe v. Wade" that prior to fetal viability, a woman has a constitutional right to obtain an abortion. After viability, a state may prohibit abortion, but only if it provides exceptions for endangerment to the woman's life or health. The Court said that both the intimate nature of the decision to terminate a pregnancy and the Court's obligation to follow precedent required it to uphold Roe's central holding. At the same time, however, the Court discarded Roe's trimester framework that severely restricted a state's power to regulate abortion in the early stages of pregnancy, saying that the trimester framework "undervalues" the state's interest in potential life, which exists throughout pregnancy. The Court also adopted a more lenient standard for analyzing the constitutionality of abortion restrictions than was permitted under Roe. It said a state may regulate abortion throughout pregnancy, as long as it does not impose an "undue burden" on a woman's right to terminate her pregnancy. The Court defined "undue burden" as a regulation that "has the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus." Under Roe, the right to abortion was deemed "fundamental" and could not be restricted unless the state could show a "compelling" interest in doing so.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed1991

Progestagen, oestrone sulphate and cortisol concentrations in pregnant mares during medical and surgical disease.

Plasma cortisol, oestrone sulphate and progestagens were measured in 22 stressed pregnant mares (gestation length 17-336 days) as indicators of fetal viability. Mares were bled every 12 h from time of admission, and plasma was stored at -70 degrees C until assayed. Four normal mares were bled twice weekly from Day 270 to parturition to provide baseline endocrine data. Cortisol and progestagen concentrations were measured by radioimmunoassay and oestrone sulphate was measured by enzyme immunoassay. Mares were grouped according to clinical diagnosis: surgical colic (Group 1, n = 11), medical colic (Group 2, n = 7), and uterine torsion (Group 3, n = 4). Of the 16 mares in Groups 1 and 2 that survived to discharge, 12 mares foaled normally and 4 aborted, 3 during hospitalization. Following surgical treatment of uterine torsion, 2 mares aborted and 2 mares carried foals to term. Plasma cortisol was greater than 30 ng/ml in 19 of the 22 stressed mares at presentation and was less than 30 ng/ml in normal mares at all collections. Cortisol concentrations remained elevated in mares during post admission complications. The mean cortisol concentration of mares with colic that subsequently aborted was higher at presentation, but not statistically different, than levels of mares that did not abort (135 +/- 35 ng/ml and 83 +/- 19 ng/ml, respectively; mean +/- s.e.m.). Progestagen concentrations in normal mares ranged from 2-25 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Veterinary↗