RESUMEN
OBJECTIVE: To investigate whether steroids that induce lung maturation have acute effects on higher cortical function in the human fetus. METHODS: Cortical auditory-evoked responses (CAERs) were recorded from 10 singleton fetuses between 29 and 34 gestational weeks by fetal magnetoencephalography (fMEG) using transabdominal auditory stimulation prior to and within 3 hours after administering 2 × 12 mg of betamethasone, at an interval of 18 and 24 hours. RESULTS: The components of the CAER complex were categorized according to their latency: P2pm (186 + 20 ms, 90%), N2pm (260 + 34 ms, 50%), P3pm (474 + 36, 50%). In almost all of these cases the peak latencies of the fetal P2pm (P = .042) and P3pm (P = .043) were delayed after exposure to betamethasone (Wilcoxon rank test). The trend was also observable in N2pm (P = .08). CONCLUSION: Administration of betamethasone to expectant mothers was associated with acute change in higher cortical functions in the exposed fetuses. Implications regarding functional brain development need further evaluation.
Asunto(s)
Betametasona/efectos adversos , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/embriología , Glucocorticoides/efectos adversos , Magnetoencefalografía , Adolescente , Adulto , Corteza Cerebral/fisiología , Contraindicaciones , Potenciales Evocados Auditivos , Femenino , Madurez de los Órganos Fetales , Edad Gestacional , Humanos , Pulmón/embriología , Masculino , Intercambio Materno-Fetal , Trabajo de Parto Prematuro , Embarazo , Resultado del EmbarazoRESUMEN
Reproduction is indispensable to evolution and, thus, life. Nonetheless, it overcomes common rules known to established life. Immunology of reproduction, and especially the tolerance of two genetically distinct organisms and their fruitful symbiosis, is one of the most imposing paradox of life. Mechanisms, which are physiologically used for induction of said tolerance, are frequently abused by pathogens or tumors intending to escape the host's immune response. Understanding the regulation of immune responses in pregnancy and the invasion of allogeneic fetus-derived trophoblast cells into the decidua may lead to new therapeutic concepts. In transplantation, knowledge concerning local physiological immunotolerance may be useful for the development of new therapies, which do not require a general immune suppression of the patient. In immunological disorders, such as autoimmune diseases or allergies, immune deviations occur which are either prevented during pregnancy or have parallels to pregnancy. Vice versa, lessons from other fields of immunology may also offer new notions for the comprehension of reproductive immunology and may lead to new therapies for the treatment of pregnancy-related problems.
Asunto(s)
Alergia e Inmunología , Reproducción/inmunología , Animales , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/terapia , Femenino , Humanos , Hipersensibilidad/inmunología , Hipersensibilidad/terapia , Tolerancia Inmunológica , Neoplasias/inmunología , Parásitos/inmunología , Embarazo/inmunología , Inmunología del Trasplante , Virus/inmunologíaRESUMEN
Auditory evoked responses between right- and left-hemispheric derivations were investigated in 53 recordings from fetuses in the third trimester using fetal magnetoencephalography (fMEG). The side-different latency development of the component P2pm suggests an earlier maturation of certain right than homologous left hemispheric brain areas during fetal brain development.
Asunto(s)
Dominancia Cerebral/fisiología , Potenciales Evocados Auditivos/fisiología , Magnetoencefalografía/métodos , Diagnóstico Prenatal , Adulto , Encéfalo/embriología , Encéfalo/fisiología , Femenino , Edad Gestacional , Humanos , Embarazo , Tercer Trimestre del EmbarazoRESUMEN
OBJECTIVE: To investigate fetal and uteroplacental blood flow after transdermal administration of glyceroltrinitrate (GTN) in pregnancies at risk for preterm delivery. STUDY DESIGN: Twenty-five pregnant women who received GTN patches (Nitroderm TTS 10) with a dosage of 0.8 mg/h, because of risk for preterm delivery, were included in the prospective study. Doppler measurements (resistance index, RI) of the umbilical artery (UA), the middle cerebral artery (MCA) and the uterine arteries of the placental (UTA-P) and the non-placental (UTA-NP) side, with calculation of the mean-RI (UTA-mean), were performed before and after 24, 48 and 72 h of the 1st GTN application. Wilcoxon test and Holm correction were used for statistical analysis. RESULTS: The initial RI values were in the normal range. Significant decreases of the RI of UTA-NP ( P = 0.02 ) and UTA-mean ( P = 0.03) were observed 24h after GTN application. The other RI values did not show significant changes. CONCLUSION: Transdermal nitroglycerine used for the treatment of preterm labour does only reduce uterine vascular impedance at the non-placental side with primary higher resistance. It does not affect fetal perfusion and uterine perfusion at the placental side with normal blood flow resistance.
Asunto(s)
Donantes de Óxido Nítrico/efectos adversos , Nitroglicerina/efectos adversos , Circulación Placentaria/efectos de los fármacos , Tocolíticos/efectos adversos , Arterias/efectos de los fármacos , Arterias/fisiología , Femenino , Feto/irrigación sanguínea , Edad Gestacional , Humanos , Trabajo de Parto Prematuro/tratamiento farmacológico , Embarazo , Estudios Prospectivos , Útero/irrigación sanguínea , Resistencia Vascular/efectos de los fármacosRESUMEN
The body stalk anomaly is described as a maldevelopment during embryonic folding in the third week after conception, resulting in a severe defect of the fetal abdominal wall. The extra-embryonic coelom fails to obliterate and parts of the fetal body remain in an exo-coelomic situation. Reports on its occurrence in multiple pregnancies have in the past focused on concordance between monozygotic twins. We report on a case of a twin pregnancy after fertility treatment that was complicated by a Body Stalk Anomaly in one of the fetuses with a positive neonatal outcome of the unaffected twin.
Asunto(s)
Pared Abdominal/anomalías , Anomalías Múltiples/diagnóstico por imagen , Gemelos , Ultrasonografía Prenatal , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/embriología , Adulto , Parto Obstétrico , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Resultado del EmbarazoRESUMEN
OBJECTIVE: To compare the maternal and fetal side effects of transdermal nitroglycerin and intravenous fenoterol combined with magnesium sulfate in a prospective randomised study. STUDY DESIGN: Fifty pregnant women between 27 and 35 weeks of gestation with preterm labour were treated with either nitroglycerin (0.4-0.8 mg/h) or fenoterol (60 - 120 microg/h). Outcome parameters were (1) the effects on fetal and maternal heart frequency (FHF/MHF) and blood pressure, and (2) subjective experiences of adverse effects assessed by utilising a questionnaire. RESULTS: In the fenoterol group, elevated mean MHF, FHF and systolic blood pressure were recorded compared to nitroglycerin. Fewer maternal side effects were reported in the nitroglycerin group. Palpitations (82%), tremor (68%) and restlessness (64%) were most common in the fenoterol group (two drop-outs), whereas nitroglycerin caused headaches in 71% of the cases (four drop-outs). CONCLUSION: Transdermal nitroglycerin appears to be a safe therapy for the mother and fetus and is a promising new option for the treatment of preterm labour.
Asunto(s)
Fenoterol/efectos adversos , Feto/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Nitroglicerina/efectos adversos , Encuestas y Cuestionarios , Tocólisis/efectos adversos , Tocolíticos/efectos adversos , Administración Cutánea , Adolescente , Adulto , Presión Sanguínea/efectos de los fármacos , Quimioterapia Combinada , Femenino , Fenoterol/administración & dosificación , Alemania , Cefalea/inducido químicamente , Frecuencia Cardíaca Fetal/efectos de los fármacos , Humanos , Inyecciones Intravenosas , Sulfato de Magnesio/administración & dosificación , Sulfato de Magnesio/efectos adversos , Nitroglicerina/administración & dosificación , Trabajo de Parto Prematuro/tratamiento farmacológico , Embarazo , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Tocólisis/métodos , Tocólisis/psicología , Tocolíticos/administración & dosificación , Temblor/inducido químicamenteRESUMEN
OBJECTIVES: To investigate the changes of the fetal magnetocardiography (FMCG), a new noninvasive diagnostic tool in the analysis of electrophysiologic changes of the heart, in cases of congenital heart defect (CHD). METHODS: The FMCG was analysed and compared to the postnatal ECG in eight cases of CHD: atrial septal defect ASDII (three cases), a combination of atrioventricular-septal-defect (AVSD) and Tetralogy of Fallot (TOF) (one case ), complete transposition of great arteries (d-TGA) (two cases), coarctation of aorta (COA) (one case), stenosis of the pulmonary artery (PS) and right ventricular hypoplasia (one case). RESULTS: (1) The following FMCG changes were observed: a split R-wave (AVSD/TOF, ASDII), prolongation of QRS complex (COA, PS). (2) The notch of the R-wave could not be observed in the newborn with AVSD/TOF. (3) Neither the fetal FMCG nor the neonatal ECG revealed any changes in the cases of d-TGA. (4) All other neonatal ECGs were corresponding to the FMCG. CONCLUSIONS: The FMCG can unearth changes of the cardiac electrophysiologic activity in the case of CHD. The method provides additional information concerning the effect of a CHD on the cardiac conductory system. As in the neonate, the FMCG changes do not reflect the severity of the CHD. FMCG cannot serve as a primary diagnostic tool in the case of CHD as compared to echocardiography.
Asunto(s)
Arritmias Cardíacas/diagnóstico , Electrocardiografía/métodos , Enfermedades Fetales/diagnóstico , Cardiopatías Congénitas/diagnóstico , Diagnóstico Prenatal , Adulto , Femenino , Humanos , Magnetismo , Embarazo , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: To assess the joints of the pelvic ring postpartum and to discern normal postpartum findings and pathologic lesions using MRI. MATERIALS AND METHODS: MR images were obtained in six women with severe pelvic ring pain after delivery, in 13 women after uncomplicated vaginal delivery, and in 11 healthy, nulliparous non-pregnant volunteers. Distances of the pubic gap, signal intensities of the pubic cartilage, and signal changes of the pelvic ring bones were determined and evaluated. RESULTS: Both postpartum groups had significantly larger distances of the interpubic gap compared to the nulliparous group (P = 0.0002). The mean signal intensity of cartilage of the symphysis pubis was significantly different on the T1-weighted and T2-weighted MR images in postpartum women compared to nulliparous women (P = 0.001), indicating a higher water content of the pubic cartilage. 13 of all 19 postpartum women had bruises of parasymphyseal pubic bones. One pubic symphysis rupture and one sacral stress fracture were detected in two symptomatic women. CONCLUSION: MR imaging is a useful adjunct to clinical examination to identify patients with lesions of the pelvic ring postpartum. MRI of the pelvic ring of asymptomatic postpartum women can demonstrate signal changes of the pubic cartilage and small bruises of the pubic bones.