RESUMEN
OBJECTIVE: To assess hematologic and biochemical blood variables in growth-restricted fetuses and relate them to biophysical measurements. METHODS: Blood was sampled from 22 growth-restricted fetuses. All had normal karyotypes and no congenital infections. Venous pH, partial pressure of oxygen, hematocrit, glucose, uric acid, urea, creatinine, total protein, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase, creatinine kinase, triglycerides, and cholesterol were measured and compared with our reference range. RESULTS: Ultrasound measurements of abdominal circumference correlated with fetal pH (r = 0.64), partial pressure of oxygen (r = 0.52), glucose (r = 0.67), total bilirubin (r = -0.54), lactic dehydrogenase (r = -0.48), and triglyceride levels (r = -0.65). Compared with fetuses with present end-diastolic velocities in the umbilical artery, the eight with absent end-diastolic velocities had lower pH (median z score -4.31), partial pressure of oxygen (median z score = -2.39), glucose (median z score = -2.01), and cholesterol (median z score = -2.34), and higher gamma-glutamyltransferase (median z score = 2.43), lactic dehydrogenase (median z score = 3.75), urea (median z score = 1.33), creatinine (median z score = 1.23), and triglyceride levels (median z score = 1.71). Only triglycerides correlated with abdominal circumference, independent of Doppler results. CONCLUSION: Growth-restricted fetuses with absent end-diastolic velocities in the umbilical artery had more marked acidemia, hypoxemia, hypoglycemia, and abnormal liver function than those with end-diastolic velocities. Triglyceride levels were inversely related to fetal size independent of Doppler results. High triglyceride levels might reset fetal homeostatic mechanisms, leading to disturbances of lipid metabolism in later life.
Asunto(s)
Retardo del Crecimiento Fetal/metabolismo , Glucosa/metabolismo , Metabolismo de los Lípidos , Hígado/metabolismo , Equilibrio Ácido-Base , Sangre Fetal/química , HumanosRESUMEN
Diagnostic advances have made it possible to use ultrasonograph to assess placentation and therefore zygosity in utero in the case of monochorionic-monozygotic twins. Foetal behaviour of 15 monozygotic and 15 unlike-sexed dizygotic twin pairs was studied serially with ultrasounds from 10 to 22 weeks gestational age. Each twin, regardless of its zygosity, showed individualised behavioural styles. One twin was found to be 'dominant' in the sense of being more active, but less reactive, possibly due to the fewer stimuli being generated by its co-twin. Monozygotic twins, as opposed to dizygotic twins, showed greater similarities in activity and reactivity levels, but were never behaviourally identical and decreased in likeness with increasing age. Our data suggest that so-called identical twins are very similar, but not behaviourally identical, from very early in pregnancy. The unequally shared intrauterine environment contributes to putting each monozygotic twin on a progressively distinct behavioural path.
Asunto(s)
Movimiento Fetal , Gemelos Dicigóticos , Gemelos Monocigóticos , Ultrasonografía Prenatal , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Masculino , Embarazo , Factores SexualesRESUMEN
OBJECTIVES: To establish a reference range of insulinlike growth factor 1 (IGF-1) values in normal fetuses and to assess whether intrauterine growth retardation is associated with increased or decreased IGF-1 levels. METHODS: Retrospective analysis of blood samples collected from 64 fetuses who underwent blood sampling at 18-38 weeks' gestation was performed: 40 fetuses, who were considered controls, were appropriately grown for gestational age and were found unaffected by the condition for which they were tested; the remainder (n = 24) underwent fetal blood sampling to assess fetal karyotype and acid-base balance following ultrasonic diagnosis of intrauterine growth retardation. (In this group, 8 survived, and 16 died during the perinatal period). IGF-1 was measured using a radioimmunoassay after acid-ethanol extraction in order to avoid interference by the binding proteins. All samples from controls and growth-retarded fetuses were measured using the same batch, and the intra-assay coefficient of variation of the test ranged from 4.1 to 6.1%. RESULTS: In control fetuses, IGF-1 serum levels increased linearly with gestational age. In growth-retarded fetuses, IGF-1 levels were not significantly different from the reference range (median Z-score -0.3; range -4.4 to 291) and did not correlate with fetal size, hematocrit, and acid-base balance values. There was a significant difference in IGF-1 and pH values when the fetuses were divided into two groups based on the perinatal outcome: those who survived had values of IGF-1 mostly within the normal range, whereas the fetuses who died in utero or postnatally had significantly decreased pH and elevated IGF-1 values (median Z-score 2.1; 95% confidence interval 0.4-13.9; p = 0.04). CONCLUSIONS: This study confirms previous observations that IGF-1 levels parallel the increase in fetal size which occurs with advancing gestation. Increased levels of IGF-1 may indicate a terminal process in the fetal adaptation to placental failure.
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Sangre Fetal/química , Retardo del Crecimiento Fetal/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Estudios de Casos y Controles , Muerte Fetal/sangre , Edad Gestacional , Humanos , Mortalidad Infantil , Recién Nacido , Valores de Referencia , Estudios RetrospectivosRESUMEN
Unilateral absence of a uterine tube is an extremely rare finding, for which there are two possible etiopathogenic causes: in some cases it is due to haemorrhage filling of the cavity and its reabsorption as a result of asymptomatic torsion of the uterine tube during adult life, in pediatric age or even during intrauterine life; alternatively, the absence may be congenital, associated with developmental alterations of the mesonephric and paramesonephric ducts. The article presents two cases of fallopian tube absence: a congenital monolateral absence and a tubal torsion during pregnancy. The symptomatology of the torsion of the fallopian tube in pregnancy can be milder than in the classic description with peritoneal reaction and severe clinical alteration. The main risk factors for tubal torsion are: adhesions and inflammatory processes, ovarian cysts, usually of dermoid type, menstrual period, pregnancy, abnormal long mesosalpinx and/or mesovarium, pelvic congestion induced by constipation and disturbed venous blood flow from the adnexa. A congenital defect of the mesonephric duct is followed by a homolateral defect of the paramesonephric duct. The resulting anomaly is characterized by the absence of the uterine tube, uterus-tube angle, kidney and ureter. Partial or total unilateral defects of a paramesonephric duct are more common than aplasia of both ducts. Some authors have suggested that an inadequate blood supply during the descent into the pelvis of the caudal part of the paramesonephric duct might feasibly lead to incomplete tube development.
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Trompas Uterinas/anomalías , Complicaciones del Embarazo/diagnóstico , Adulto , Enfermedades de las Trompas Uterinas/diagnóstico , Enfermedades de las Trompas Uterinas/cirugía , Trompas Uterinas/cirugía , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/cirugía , Anomalía TorsionalRESUMEN
OBJECTIVE: Because individuals with Down syndrome appear to be protected from the development of atherosclerosis, we aimed to assess whether blood lipid and lipoprotein concentrations are different from controls in fetuses with trisomy 21. STUDY DESIGN: Eighteen fetuses with trisomy 21 and seven with trisomy 18 undergoing blood sampling at 18 to 36 weeks' gestation were matched by gestational age and size with an equal number of controls. Cholesterol and triglycerides were assayed in all fetuses and compared with the reference range constructed from 157 normal fetuses. High-density lipoproteins and apoproteins A and B were assayed in eight fetuses with trisomy 21, four with trisomy 18, and an equivalent number of controls. RESULTS: When compared with the reference range, fetuses with trisomy 21 had significantly increased cholesterol levels (median Z score 2.31, 95% confidence interval 1.57 to 3.08, p = 0.0001). Cholesterol and apoprotein A concentrations were also significantly higher than in fetuses with normal karyotypes matched by gestational age and size at sampling, whereas other lipids and lipoproteins were similar. There were no differences between fetuses with trisomy 18 and their matched controls. A value of fetal cholesterol > or = 85 mg/dl had a sensitivity of 72% and specificity of 95% in detecting fetuses with trisomy 21. CONCLUSIONS: Fetuses with trisomy 21 have abnormalities of lipid metabolism that are specific and may be genetically determined. The finding of high cholesterol levels in fetuses undergoing blood sampling for indications other than karyotyping should prompt investigation of fetal chromosomes because of the increased risk of trisomy 21. The mechanism through which high levels of cholesterol during prenatal life are not leading to increased risk of atherosclerosis remains to be elucidated.
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Colesterol/sangre , Síndrome de Down/sangre , Sangre Fetal/química , Apolipoproteínas/sangre , Aberraciones Cromosómicas/sangre , Trastornos de los Cromosomas , Cromosomas Humanos Par 18 , Humanos , Curva ROC , Valores de Referencia , Triglicéridos/sangre , TrisomíaRESUMEN
The objective of this work was to investigate the emergence of intrapair stimulation between twin fetuses and the presence of possible changes in types and percentage of evoked patterns with advancing gestational age. The existence of intrapair stimulation would indicate the functioning of fetal tactile and proprioceptive sensibility. This was studied from video recordings of 30 min ultrasonographic observations of 8 twin pregnancies at 8, 9 and 10 weeks gestational age, of 20 twin pregnancies at 11, 12 and 13 weeks and of 20 twin pregnancies studied with 60 min observations at 15-16, 18-19 and 21-22 weeks. All age groups were subdivided in Monochorionic (Mc) and Dichorionic (Dc) pregnancies. Intrapair stimulation before 11 weeks gestational age is an exceptional event. Due to greater spatial contiguity and thinness of the membrane dividing the two amniotic sacs in Mc pregnancies, it was noted only in these. From 12 weeks onwards, evoked movements began to be observed in Dc pregnancies as well. After the 15th week, intrapair stimulation is a constant and increasing feature of all twin gestations. Movements vary from generalized bodily activity to being progressively localized. No specific evoked movement patterns were observed.
Asunto(s)
Movimiento Fetal/fisiología , Feto/fisiología , Edad Gestacional , Embarazo Múltiple/fisiología , Gemelos Dicigóticos , Gemelos Monocigóticos , Adulto , Femenino , Humanos , Embarazo , Primer Trimestre del Embarazo , Segundo Trimestre del Embarazo , Propiocepción/fisiología , Tacto/fisiología , Ultrasonografía Prenatal , Grabación de Cinta de VideoRESUMEN
Seventy-one fetal urine samples were taken from the bladder or renal pelvis of 33 fetuses at 13-36 weeks' gestation with a diagnosis of urinary tract anomaly. Severe isolated hydronephrosis in the absence of an enlarged bladder was the indication for sampling in 12/33 fetuses (26 samples), who were retrospectively classified into three groups: normal, intermediate, and dysplastic, based on the evaluation of postnatal renal function or histology. For all samples, urinary sodium (Na+), calcium (Ca2+), creatinine, beta 2-microglobulin, and N-acetyl-beta-D-glucosaminidase (NAG) were measured. Among the 71 fetal urine samples, both beta 2-microglobulin and NAG correlated inversely with gestational age, Na+, and Ca2+, but not with creatinine concentrations. However, the correlation of urinary beta 2-microglobulin with gestational age was dependent on the Na+ and Ca2+ concentrations, whereas urinary NAG correlated significantly with urinary Na+ and Ca2+, and also with gestational age. In fetuses with isolated hydronephrosis, only Na+, and not Ca2+, was significantly related to both beta 2-microglobulin and NAG. Only Na+ and beta 2-microglobulin were significantly, and similarly, higher in both dysplastic and intermediate kidneys when compared with fetuses with normal postnatal function. If only the last urine sampled was considered, there was overlapping of all parameters in the three groups. In isolated hydronephrosis, only the most extreme forms of renal failure might be suggested by elevated levels of Na+, Ca2+, beta 2-microglobulin, and NAG, without an obvious superiority of any of these parameters.
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Acetilglucosaminidasa/orina , Feto/metabolismo , Hidronefrosis/orina , Riñón/fisiopatología , Microglobulina beta-2/orina , Calcio/orina , Femenino , Edad Gestacional , Humanos , Hidronefrosis/fisiopatología , Embarazo , Análisis de Regresión , Sodio/orinaRESUMEN
OBJECTIVE: To construct reference ranges for fetal pH, oxygen pressure (PO2), and hematologic and biochemical blood constituents, which can be used to analyze changes with gestation and differences with maternal values, thus elucidating some aspects of fetal biology and the effects of the maternal and placental environments. METHODS: We assayed venous pH, PO2, hematocrit, glucose, uric acid, urea, creatinine, total protein, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase, creatine kinase, triglycerides, and cholesterol concentrations in 157 fetuses and 134 mothers who underwent fetal blood sampling from 18 to 37 weeks' gestation. None of the fetuses was infected or had chromosomal, hematologic, or hormonal abnormalities. RESULTS: All the variables analyzed were similar in fetuses sampled at the placental cord insertion (n = 125) or at the intrahepatic vein (n = 32). Maternal and fetal concentrations of glucose (r = 0.79, P < .001), urea (r = 0.96, P < .001), creatinine (r = 0.83, P < .001), and uric acid (r = 0.94, P < .001) correlated significantly, and their differences exhibited significant changes: the maternal-fetal differences of glucose and urea increased, whereas those of uric acid and creatinine decreased with advancing gestation. Fetal pH and PO2 decreased with gestational age, whereas hematocrit increased, similar to what has been described previously. All of the other variables, with the exception of amylase and cholesterol, changed significantly during the investigated period of pregnancy. Gestational age explained at least 40% of the variance in values of fetal total protein, pseudocholinesterase, alanine aminotransferase, creatine kinase, and triglycerides, but only 3-25% of the variation in the remainder. Most enzymes were higher in the fetus than in the maternal circulation, and all except alkaline phosphatase increased with gestational age. The maternal-fetal glucose difference correlated significantly with hematocrit, pH, and PO2, independent of gestational age and independent of each other. CONCLUSION: With the exception of aspartate aminotransferase, all of the analyzed fetal variables were different from the maternal values, and most changed with gestational age. The mechanisms leading to these fetal specificities remain mostly uncertain, but the provision of reference ranges for several blood constituents may be useful in the differential diagnosis of fetal disease.