Genetic factors and fetal growth sex constitution and birthweight in twins.

Fetal growth is considered a multifactorially-influenced characteristic. Genetic factors were found to play the main role in fetal growth determination, and it is the polygenic inheritance. The paper reviews the birthweights of 360 unlike-sexed two-egg twins, born at the Clinic of Gynecology and Obstetrics, Faculty of Medicine in Beograd, from January 1, 1970 through June 30, 1984. The mean birthweight differences between the male (2954.94 +/- 704.28 g) and female (2313.19 +/- 651.32 g) fetuses, amounted to 141.75 g. The difference is highly significant (P less than 0.01); variation coefficient shows that the examined groups were homogenous (VC was below 30%). The results were discussed from the genetic point of view, and particularly from the point of view of sex constitution, with special respect to the effect of Y chromosome on fetal growth. It has been known that human somatic development, body weight, bone maturation and teeth development are influenced by variety of factors. In addition to nutritional and other factors of the external environment, genetic and humoral factors are leading. The fact that fetuses with XY male constitution are heavier at birth than female fetuses with XX constitution, made us consider the correlation between genotype-phenotype, and the mentioned characteristics. This study was aimed at finding out the role of genetic factors in fetal growth, with respect to sex constitution, particularly to chromosome effect on fetal growth in unlike-sexed two-egg twins.

[Non-surgically corrected congenital cardiac malformations in pregnant women]. / Les malformations cardiaques congénitales non corrigées chirurgicalement de la femme enceinte.

The authors have studied 787 women with cardiac disease out of 78,594 pregnant women between 1971 and 1980. They found 133 women who had congenital heart disease who were delivered in their service, and they compared these with 260 pregnant women who were normal. They used the classification of the Cardiological Society of New York to grade the functional state of the patients. Five pregnancies had to be terminated before the 16th week because of a worsening of the cardiovascular state of the patient. The majority (79%) of the patients delivered vaginally and 21% had caesarean operations. 20.5% babies were born prematurely (p less than 0.005). 13.4% of the infants weighed less than 2,000 g at birth. Perinatal mortality was 62.9 per 1,000. Maternal mortality was 23.6 per 1,000. The authors conclude that these pregnancies are high-risk pregnancies where the prognosis is only favourable if the heart disease is moderate. This becomes worse when there is cardiac decompensation or cyanosis due to heart disease.

[New aspects in the diagnosis of fetal malformations using ultrasound]. / Noviji aspekt dijagnostike fetalnih malformacija ultrazvukom.

The article deals with new ultrasound diagnostic aspects of foetal malformations. The frequency of such events in Yugoslav population is described and importance of their early detection is emphasized. The following features of foetal malformations are discussed: systems, characteristics, possible aetiopathogenesis, ultrasound detection and sonographic signs. Some congenital malformations are illustrated by original ultrasound and postnatal pictures. Their postnatal and intrauterine corrections are examined. Consequently, the optimal possible abortion is discussed. The analysis concerns the practical classification of congenital malformations into serious, incorrectable, incompatible with life, recommendation for abortion, and into light, correctible anomalies. Exclusion of pathologic events in risk-groups and during routine practice is emphasized. Possible errors (false-positive and false-negative diagnosis) and difficulties in the definition of small structural anomalies are presented. Complementary diagnostical methods are also enumerated.

[Occurrence of triplet births]. / Ucestalost radjanja trojki.

The authors studied all cases of triplets who were born at the Department of Gynaecology and Obstetrics of University Clinical Centre in Belgrade, over a twenty-year period (1970-1989). Thirty sets of triplets were born in this period. This means that one set of triplets was born per 5845 births. Preterm deliveries occurred in 19 cases. Liveborn children had lower Apgar score. Common birthweight was slightly below 1800 grams. In more than one half of the foetuses malpresentation was found. More than one fourth of sets were delivered by Cesarean section. Total foetal loss reached 23.33% and purified perinatal mortality rate reached 11.11%. The triplet diagnosis on time is important because of the necessary prevention measures and appropriate therapy.

[A case report of collision in twin pregnancy]. / Prikaz kolizije u toku porodaja blizanaca.

A parturient who had never been examined during pregnancy was admitted to the maternity ward at the end of the first phase of labour. Owing to a stoppage in the expulsion of the regularly rotated head, the forceps was applied. The extraction of the head was followed by the collision of the shoulders. Behind the fetus's neck, in the uterine canal, there was the head of the other fetus. The attempt of the reposition of the head of the other twin in general anesthesia was a failure. Since auscultation revealed no heart tones in any of the twins, the perforation of the head of the other fetus was performed, and in this way the extraction of the first and then of the second fetus was possible. The authors emphasize the importance of the echographic detection of the position and site of the fetuses in twin pregnancy.

[Treatment of ectopic pregnancy using methotrexate]. / Lecenje ektopicne trudnoce primenom metotreksata.

The authors applied the conservative treatment of ectopic pregnancy with methotrexate in a prospective study comprising 22 patients. Out of this number, 14 patients had intact ectopic pregnancy and 8 showed the signs of initial tubal abortion (as proved by the hematocele finding). This group of 8 patients insisted to be given the same therapy, although they were informed of the possible failure in cases of initial tubal abortion. In all these cases methotrexate was administered locally, injected into the gestational sac under ultrasonic monitoring. In addition to the local application, 13 patients systemically received the same drug in pills (2.5 mg). At the same time, all the patients were given the antidote (Citrovorum factor). This method of treatment appeared to be successful in 16 patients (72.7%), four of them also having hematocele. Surgical treatment was applied afterwards in six patients (27.3%).

[Sonographic monitoring of follicular maturation]. / Sonografsko pracenje folikularnog sazrevanja.

In recent years the interest for the evidence of ovulation and its follow-up has increased. This increase is especially evident in the field of out-body insemination. The ultrasound follow-up of ovulations is performed in the case of the growth of the follicle; determination of the ovulation ring; and observation of the Douglas free liquid. The authors present values of the follicular diameter on the 14th day of gestation in 34 patients with spontaneous, stimulated and induced cycles. In their opinion this procedure is a very useful method which, in addition to other parameters, enables a good inspection into the functioning of the ovary.

[Assessment of the state of the fetoplacental unit before induction of labor and its outcome]. / Procena stanja fetoplacentne jedinice pred indukciju porodaja i njen ishod.

By a prospective study the authors tried to assess the state of the fetoplacental unit in pathologic pregnancies. Depending on the given situation, the following analytical procedures were used: oxytocin test (OCT), placental beta-1-glycoprotein (SP-1), amnioscopy, and analysis of the liquor amnii ingredients (L/S relationship). By combining the above quoted procedures and taking into account obstetric factors (pelvic measures, cervical maturity), the assessment was made of the state of the fetus and the placenta, of the maturity grade and gestation age, and of the condition of the fetus for delivery by the planned induction of uterine contractions. Statistical analysis (the kappa 2 test) has shown that there is no difference in the results concerning the parameters observed, which speaks for good agreement between them. In the authors' opinion, none of the methods used is an absolutely valid test but their combination and dynamic observation along with a certain clinical experience, could lead to right conclusions about the state of the fetoplacental unit before induced labour.

[Childbirth in multiparae]. / Porodaj u viserotki.

The authors present problems of multiparity in women with four or more deliveries, by analysing the course of delivery in these women. To this end they made a retrospective study of 299 such deliveries, by comparing them with 100 randomly selected primiparae from the same period. The results have shown as follows: The incidence of multiparae is about 1.04%; multiparae are significantly older than primapare; multiparae have a larger of spontaneous deliveries, whereas directed and induced labour proved more frequent in primiparae; in primiparae there are significantly more interventions in the course of labour (episiotomy and manual revision of the uterine cavity); labour in multiparae lasts less and their offspring has less wight and less vitality (more at risk); stillborns are four times as frequent in multiparae (3.68%) as is the general rate of mortality (0.94%).

[Standard fetal growth curves--current aspects of their utilization]. / Standardne krive fetalnog rasta--savremeni aspekt njihovog koriscenja.

The total 3492 complete measurements were performed in order to make asymptomatic curves of intrauterine foetal development. Of this number 1756 measurements concerned the biparietal diameter (BPD) and 1736 the abdominal diameter (ABD). Measurements of the biparietal diameter were done from the 13th to the 41st week of gestation. The mathematical processing of all serial groups was done according to defined algorithm. On the basis of statistical analysis of distribution frequency and dispersion parameters the necessary findings were obtained. Thanks to these findings asymptomatic curves of intrauterine foetal development were made.

[Cesarean section combined with splenectomy in severely resistant immune thrombocytopenia]. / Carski rez kombinovan sa splenektomijom u teskoj rezistentnoj imunoj trombocitopeniji.

Immune thrombocytopenic purpura (ITP) associated with pregnancy often involves considerable risk both for mother and child, and usually worsens in the third trimester of gestation. Pregnancy and delivery are especially difficult in patients with severe ITP (platelet count below 20 x 10(9)/L), who are resistant to prednisone and high dose intravenous immunoglobulin (IVIgG). In those cases we applied cesarean section (CS), to prevent intracranial haemorrhage due to fetal/neonatal ITP, and splenectomy at the same time as an effective therapeutic strategy for ITP. We present 5 patients (4 with chronic ITP and 1 with ITP associated with HIV infection), aged 21-35 years, with severe ITP (platelet count 2-10 x 109/L), resistant to prednisone (1-2 mg/kg), and 2/3 were resistant to IVIgG (0.4 g/kg x 5 d). Four patients with severe resistant ITP were supported with 1-2 doses of platelets from cell separator before CS and 1-3 dose during splenectomy. One patient increased platelet count to 55 x 109/L after treatment with IVIgG and splenectomy following CS were done without platelet transfusion. Splenectomy was performed immediately after CS in all patients, and two of them were hysterectomised (one with HIV infection). After splenectomy, platelet count was normalised in all patients, and they had no haemorrhage, wound haematoma formation or any adverse events. But ITP relapsed in 2/5 patients after 1-2 months. Two newborns had severe thrombocytopenia, which solved spontaneously after 3 days in one or after treatment with IVIgG in other. We propose that splenectomy following cesarean section should be considered as approach for delivery and treatment option for mothers with severe resistant ITP.