High total cholesterol and triglycerides levels increase arginases metabolism, impairing nitric oxide signaling and worsening fetoplacental endothelial dysfunction in gestational diabetes mellitus pregnancies.

Maternal physiological dyslipidemia (MPD) supports fetal development in human pregnancy. However, some women develop maternal supraphysiological dyslipidemia (MSPD: increased total cholesterol (TC) and triglycerides (TG) levels). MSPH is present in normal and also in gestational diabetes mellitus (GDM) pregnancies. MSPD and GDM associate with fetoplacental endothelial dysfunction, producing alterations in nitric oxide (NO)-L-arginine/arginase metabolism. Nevertheless, the effect of MSPD on GDM, and how this synergy alters fetoplacental endothelial function is unknown. Therefore, the aim of this study was to evaluate in human umbilical vein endothelial cells, the effects of MSPD in GDM and how these pathologies together affect the fetoplacental endothelial function. 123 women at term of pregnancy were classified as MPD (n = 40), MSPD (n = 35), GDM with normal lipids (GDM-MPD, n = 23) and with increased lipids (GDM-MSPD, n = 25). TC ≥291 mg/dL and TG ≥275 mg/dL were considered as MSPD. Endothelial NO synthase (eNOS), human cationic amino acid transporter 1 (hCat1), and arginase II protein abundance and activity, were assayed in umbilical vein endothelial cells. In MSPD and GDM-MSPD, TC and TG increased respect to MPD and GDM-MPD. eNOS activity was reduced in MSPD and GDM-MSPD, but increased in GDM-MPD compared with MPD. However, decreased tetrahydrobiopterin levels were observed in all groups compared with MPD. Increased hCat1 protein and L-arginine transport were observed in both GDM groups compared with MPD. However, the transport was higher in GDM-MSPD compared to GDM-MPD. Higher Arginase II protein and activity were observed in GDM-MSPD compared with MPD. Thus, MSPD in GDM pregnancies alters fetal endothelial function associated with NO metabolism.

First-trimester placental function in levothyroxine-using pregnant women: a case-control study.

We aimed to compare the pregnancy-associated plasma protein-A (PAPP-A) and the uterine artery pulsatility index (UtA PI) levels of euthyroid pregnant women using levothyroxine vs. a control group of uncomplicated pregnancies and to evaluate the effects of different levothyroxine dosages on pregnancy outcomes. We retrospectively evaluated 206 levothyroxine-using pregnant women by looking at their basic placental function markers and obstetric outcomes. A sample of 449 women whose pregnancies concluded with uncomplicated term deliveries composed of our control group. To examine the relationship between the levothyroxine dosages and the frequency of pregnancy complications, levothyroxine users were divided into different groups according to the 75, 100, and 150 mcg cutoffs. The median PAPP-A MoM levels of levothyroxine users were significantly lower at 0.94 vs. 1.11 (p < .001) and the median mean UtA PI was significantly higher than the control group at 2.08 vs. 1.74 (p < .0001). The median birth weight was significantly lower for the levothyroxine users' group at 3292 g vs. 3427 g (p < .0001). Using 75, 100, and 150 mcg dose cutoffs, PAPP-A MoM, mean UtA PI and obstetric complication frequencies were not significantly different among levothyroxine users. Significant changes in placental function markers have been observed in euthyroid levothyroxine-using pregnant women during the first trimester. However, the frequency of obstetric complications does not appear to be dose dependent.

Idiopathic Purpura With Gray Platelets: an Acquired Form of Gray Platelet Syndrome.

An acquired, transient bleeding disorder that predominantly affects children in Southeast Asia has been reported for the last 4 decades. The condition has been named idiopathic purpura with gray platelets (IPGP) or acquired platelet dysfunction with eosinophilia. In a retrospective review from a private pediatric clinic over an 8-year period, 10 consecutive children were diagnosed as IPGP with a mean age of 8.4 (3.7 to 16.2) years. Eosinophilia (>0.5×10/L) was absent in 1, while gray platelets were consistently found in all cases with a mean proportion of 64.5% (40% to 80%). Platelet aggregation tests were performed in 9 patients with abnormal responses consistent with platelet storage pool defect. All children recovered completely and spontaneously from 1 to 4 months after diagnosis without specific therapy. In an otherwise well child who presents abruptly with easy bruising and a platelet count >100×10/L, IPGP can be readily recognized as an acquired form of gray platelet syndrome. Eosinophilia is common but not mandatory for diagnosis.

Low Soluble Fms-Like Tyrosine Kinase-1, Endoglin, and Endothelin-1 Levels in Women With Confirmed or Suspected Preeclampsia Using Proton Pump Inhibitors.

Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and endoglin levels and decreased placental growth factor levels. Proton pump inhibitors (PPIs) decrease trophoblast sFlt-1 and endoglin secretion in vitro. PPIs are used during pregnancy to combat reflux disease. Here, we investigated whether PPIs affect sFlt-1 in women with confirmed/suspected preeclampsia, making use of a prospective cohort study involving 430 women. Of these women, 40 took PPIs (6 esomeprazole, 32 omeprazole, and 2 pantoprazole) for 8 to 45 (median 29) days before sFlt-1 measurement. Measurements were only made once, at study entry between weeks 20 and 41 (median 33 weeks). PPI use was associated with lower sFlt-1 levels, with no change in placental growth factor levels, both when compared with all non-PPI users and with 80 gestational age-matched controls selected from the non-PPI users. No sFlt-1/placental growth factor alterations were observed in women using ferrous fumarate or macrogol while, as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower placental growth factor levels. The PPI use-associated decrease in sFlt-1 was independent of the application of antihypertensive drugs and also occurred when restricting our analysis to patients with hypertensive disease of pregnancy at study entry. PPI users displayed more cases with preexisting proteinuria, less gestational hypertension, and a lower number of neonatal sepsis cases. Finally, their plasma endoglin and endothelin-1 levels were lower while sFlt-1 levels correlated positively with both. In conclusion, PPI use associates with low sFlt-1, endoglin, and endothelin-1 levels, warranting prospective trials to investigate the therapeutic potential of PPIs in preeclampsia.

Use of a bayesian hierarchical model to study the allometric scaling of the fetoplacental weight ratio / Utilização de modelo hierárquico bayesiano para estudar a relação alométrica entre o peso placentário e peso ao nascer

Objectives: to propose the use of a Bayesian hierarchical model to study the allometric scaling of the fetoplacental weight ratio, including possible confounders. Methods: data from 26 singleton pregnancies with gestational age at birth between 37 and 42 weeks were analyzed. The placentas were collected immediately after delivery and stored under refrigeration until the time of analysis, which occurred within up to 12 hours. Maternal data were collected from medical records. A Bayesian hierarchical model was proposed and Markov chain Monte Carlo simulation methods were used to obtain samples from distribution a posteriori. Results: the model developed showed a reasonable fit, even allowing for the incorporation of variables and a priori information on the parameters used. Conclusions: new variables can be added to the modelfrom the available code, allowing many possibilities for data analysis and indicating the potential for use in research on the subject.

Objetivos: propor a utilização de um modelo Hierárquico Bayesiano para estudar a relação alométrica existente entre o peso ao nascer e o peso placentário, incluindo possíveis fatores interferentes. Métodos: foram analisados os dados de 26 gestações únicas, com idade gestacional entre 37 e 42 semanas. As placentas foram coletadas imediatamente após o parto e conservadas sob refrigeração até o momento da análise, o que ocorreu em até 12 horas. Os dados maternos foram obtidos de prontuários médicos. Finalmente, foi elaborado um modelo hierárquico bayesiano e, para obter amostras da distribuição a posteriori, foram utilizados métodos de simulação Markov Chain Monte Carlo. Resultados: o modelo obtido apresentou um ajuste razoável, permitindo ainda a incorporação de variáveis e informações a priori, sobre os parâmetros utilizados. Conclusões: a partir da disponibilização do código, novas variáveis podem ser adicionadas ao modelo, permitindo muitas possibilidades para a análise dos dados, mostrando potencial para ser utilizado em pesquisas na área.

Insulin therapy and fetoplacental vascular function in gestational diabetes mellitus.

NEW FINDINGS: What is the topic of this review? This review focuses on the effects of insulin therapy on fetoplacental vasculature in gestational diabetes mellitus and the potentiating effects of adenosine on this therapy. What advances does it highlight? This review highlights recent studies exploring a potential functional link between insulin receptors and their dependence on adenosine receptor activation (insulin-adenosine axis) to restore placental endothelial function in gestational diabetes mellitus. Gestational diabetes mellitus (GDM) is a disease that occurs during pregnancy and is associated with maternal and fetal hyperglycaemia. Women with GDM are treated via diet to control their glycaemia; however, a proportion of these patients do not achieve the recommended values of glycaemia and are subjected to insulin therapy until delivery. Even if a diet-treated GDM pregnancy leads to normal maternal and newborn glucose levels, fetoplacental vascular dysfunction remains evident. Thus, control of glycaemia via diet does not prevent GDM-associated fetoplacental vascular and metabolic alterations. We review the available information regarding insulin therapy in the context of its potential consequences for fetoplacental vascular function in GDM. We propose the possibility that insulin therapy to produce normoglycaemia in the mother and newborn may require additional therapeutic measures to restore the normal metabolic condition of the vascular network in GDM. A role for A1 and A2A adenosine receptors and insulin receptors A and B as well as a potential functional link in the cell signalling associated with the activation of these receptors is proposed. This possibility could be helpful for the planning of strategies, including adenosine receptor-improved insulin therapy, for the treatment of GDM patients, thereby promoting the wellbeing of the growing fetus, newborn and mother.

Efeito da enrofloxacina sobre a interação blastocisto endométrio e seu reflexo no desenvolvimento placentário e fetal em ratas / Effect of enrofloxacin on the blastocyst endometrial interactions and their impact on placental and fetal development in rats

Estudos têm mostrado efeitos tóxicos da enrofloxacina em diversos tecidos. Assim, testou-se a hipótese de que a enrofloxacina pode interferir no desenvolvimento placentário e gerar efeitos adversos ao feto. A enrofloxacina (Baytril(r)) foi administrada em ratas, na dose de 5mg/kg, diariamente, IM, durante toda a gestação. As placentas foram analisadas morfologicamente, morfometricamente e imuno-histoquimicamente aos sete, 14 e 21 dias de prenhez. Os resultados mostraram que a enrofloxacina reduziu o número de sítios de implantação, o peso e a área total do disco placentário aos 14 e 21 dias de desenvolvimento, além dos elementos constituintes da placenta. A análise histoquímica não revelou alterações significativas no teor de fibras colágenas, elásticas e reticulares. O teste de Tunel mostrou atividade apoptótica apenas nas placentas com 14 dias de desenvolvimento de ambos os grupos, sendo mais intensa no grupo tratado. Não foi observado nenhum indício de malformação na cabeça, no tronco e nos membros dos neonatos. No entanto, houve uma redução significativa no número e no peso dos neonatos no grupo tratado, porém sem afetar o seu comprimento. Assim, concluiu-se que a enrofloxacina administrada na dosagem de 5mg/kg durante prenhez em ratas interfere no número de embriões implantados e no desenvolvimento placentário. Isto sugere cautela na administração da enrofloxacina durante a gestação, pois a exposição contínua a esse antibiótico pode ter reflexos na redução do número e do peso da prole...

Some studies have shown the toxic effects of enrofloxacin in various tissues. Thus, the hypothesis that enrofloxacin could interfere with placental development and generate adverse effects to the fetus was tested in this study. Enrofloxacin (Baytril(r)) was administered in the dose of 5mg/kg daily, i.m., throughout gestation in rats. The placentas were analyzed morphologically, morphometrically, and immunohistochemically on the 7, 14, and 20th days of pregnancy. The results showed that enrofloxacin reduced the number of implantation sites, weight, and placental disk total area at 14 and 20 days of development, in addition to the element components of the placenta. The histochemical analysis did not reveal significant changes in the content of collagen, reticular, and elastic fibers. The TUNEL test showed apoptosis only in placenta development at 14 days in both groups and more intense in the treated group. Head, trunk, and limb malformations were not observed in the neonates. A significant reduction in the number and weight of neonates were observed in the treated group, however, without affecting their length. Thus, it was concluded that the administration of enrofloxacin, at the dosage of 5 mg/kg during pregnancy in rats, interferes in the number of implanted embryos and placental development. This suggests caution in the administration of enrofloxacin during pregnancy because continuous exposure to this antibiotic may have adverse effects, reducing the number and weight of the offspring...

Cytofluorimetric platelet analysis.

Blood platelets are highly specialized cells that drive hemostatic events and tissue repair mechanisms at the site of vascular injury. Their peculiar morphology and certain functional characteristics can be analyzed by flow cytometry (FCM). Specifically, platelet activation, a hallmark of prothrombotic states and inflammatory conditions, is associated with changes in expression of both surface and intracellular antigens that are recognized by specific monoclonal antibodies. Assessment of platelet activation status as ex vivo or in vitro reactivity to specific agonists has become relevant in particular conditions (namely, cardiovascular diseases, hematological malignancies, monitoring of pharmacological antiaggregation). In addition, aberrant surface marker expression that characterizes inherited and acquired platelet function disorders is also detected by FCM. This review discusses the main applications of FCM in platelet analyses, which are relevant for both research and clinical settings.

Description of response to aspirin and clopidogrel in outpatients with coronary artery disease using multiple electrode impedance aggregometry.

Identification of outpatients with high platelet reactivity (HPR) on antiplatelet treatment is an unmet need. The present study was conducted in healthy individuals (n = 50) and in outpatients with coronary artery disease (CAD) at a distance from the acute ischemic episode (aspirin group, n = 71; aspirin/clopidogrel group, n = 106). We studied the feasibility and the precision of whole blood multiple electrode aggregometry (MEA) after triggering platelet aggregation by arachidonic acid or adenosine diphospate (ADP). The MEA can be performed on whole blood within 2 hours after sample venipuncture. The threshold for the diagnosis of HPR is situated at 55 and 50 U for the arachidonic acid and ADP test, respectively. Frequency of HPR was 7% and 20% in aspirin and aspirin/clopidogrel groups, respectively. In 3.8% of patients in aspirin/clopidogrel group, combined HPR on aspirin and clopidogrel was found. In outpatients with CAD, use of MEA is feasible for the diagnosis of HPR.

Relationship between placental alkaline phosphatase activity and cord blood glucose, albumin and neonatal birth weight at term

It has been observed that placental alkaline phosphatase (PAP) activity progressively rises as pregnancy advances, possibly, because of its increasing synthesis by placental tissue. The present investigation therefore, examines the relationship between placental alkaline phosphatase activity and the biochemical indices of foetal nutrition (cord blood glucose, albumin) and growth (neonatal birth weight). Placental and umbilical cord blood samples were collected from one hundred and five deliveries and prepared for both, placental alkaline phosphatase assay, and glucose and albumin estimations using standard procedures. The birth weights of the neonates at term were taken and recorded. Correlation analyses of the data obtained show significant positive relationships between PAP and cord blood glucose (r² = 0.86, p<0.05), albumin (r² = 0.71, p < 0.05) and birth weight (r² = 0.68, p<0.05), but no significant relationship with gestational age. PAP may be essential in nutrient mobilization to the foetus. However, further studies involving more subjects and an intrauterine growth retardation control group (IUGR) are required to fully document the present report.

Se ha observado que la actividad de la fosfatasa alcalina placentaria (PAP) aumenta progresivamente a medida que avanza el embarazo, posiblemente debido al incremento de su síntesis a través del tejido placentario. Por lo tanto, la presente investigación estudia la relación entre la actividad de la fosfatasa alcalina placentaria y los índices bioquímicos de la nutrición fetal (glucosa sanguínea de cordón umbilical, albúmina) y crecimiento (peso neonatal). Se recolectaron muestran placentarias y sanguíneas provenientes de 105 partos y preparadas tanto para el ensayo de fosfatasa alcalina placentaria como para estimaciones de glucosa y albúmina utilizando los procedimientos estándar. Se tomaron y registraron los pesos de los recién nacidos a término. El análisis y la correlación de los datos obtenidos muestran una relación significativamente positiva entre el PAP y la glucosa en sangre del cordón umbilical (r² = 0,86, P < 0,05), albúmina (r² = 0,71, P < 0,05) y peso al nacer (r² = 0,68, P < 0,05), pero no relación significativa con la edad gestacional. PAP puede ser esencial en la movilización de nutrientes para el feto. Sin embargo, se requieren estudios posteriores que incluyan más sujetos y un grupo control con retardo en el crecimiento intrauterino, para completar el presente reporte.

Perfil biofísico fetal: actualización de sus fundamentos e indicaciones / Biophysical fetal profile: update of rationale and indications

1. PBF 8 o 10 /10 es signo de bienestar fetal. 2. PBF 6/10 es considerado equívoco en la predicción de asfixia fetal. 3. PBF 0 a 4/10 sugiere alto riesgo de asfixia fetal severa si no se interviene en una semana. 4. PBF se indica en embarazo con riesgos de compromiso fetal hipóxico-isquémico. 5. Se puede realizar una o más veces a la semana si la condición clínica lo requiere. 6.- El PBF es no invasivo; es fácil de aprender y de realizar. Bien indicado tiene un alto rendimiento. 7. Debe efectuarse siempre en período post prandial. Al completar esta actualización, hemos podido reenfocar nuestro estudio de la Unidad Feto-placentaria y con ello definir las indicaciones del perfil biofísico fetal en nuestra Unidad de Perinatología.

1. BFP 8 or 10/10 means fetal wellbeing. 2. BFP 6/10 is considered ambiguous for prediction of fetal asphyxia. 3. BFP 0 to 4/10 suggests high risk of fetal asphyxia if there's no intervention in a week. 4. BFP is indicated in pregnancies in risk for hypoxic-ischemic fetal damage. 5. BFP may be performed one time or more in a week depending on demand of the clinical condition. 6. BFP is non invasive; is easy to learn and to perform. If properly indicated its performance is high. 7. BFP must be performed always during post prandial periods. When finishing this update, we're able to re-focuse our studies of the feto-placental unit, and through this, to define the indications for biophysical fetal profile in our Perinatology Unit.

Interplay of platelet polymorphisms, risk factors, and von [corrected] Willebrand factor [corrected] in determining collagen-adenosine diphosphate PFA-100 results in patients with coronary artery disease.

Platelets play a pivotal role in thrombus formation in patients with coronary artery disease (CAD), since the high shear generated in the presence of severe coronary stenoses can increase platelet reactivity (PR) and trigger thrombogenesis. Several reports have suggested a functional effect of human platelet antigen (HPA)-1 and HPA-2 gene polymorphisms on PR. However, the true determinants of high-shear PR in CAD patients taking their usual medications are still incompletely understood. In 104 patients with stable CAD we analyzed the possible clinical, biochemical and genetic factors affecting high-shear PR, measured by the ex vivo platelet function analyzer (PFA-100) collagen-adenosine diphosphate method. In univariate analysis, a lower PR was associated with decreased plasma von Willebrand factor-ristocetin cofactor activity, increased blood levels of triglycerides, female sex, use of thienopyridines, lower platelet count, and HPA-1b carriership. All variables, except HPA-1b, remained associated with lower PR in multivariate analysis. However, the introduction in the model of the HPA-1 and HPA-2 genotypes as interaction terms led to a significant improvement in the prediction of PR, although the quantitative effect was small (about 3% improvement, P=0.046).Thus, in CAD patients, there seems to be only a mild effect of the platelet glycoprotein HPA-1 and HPA-2 polymorphisms on collagen-adenosine diphosphate-stimulated PR after the effect of well-established clinical and biochemical determinants are considered.

Neutrophil degranulation and complement activation during fetal cardiac bypass.

BACKGROUND: Fetal cardiac bypass results in dysfunction of the fetoplacental unit (FPU) characterized by increased placental vascular resistance and respiratory acidosis. However the mechanisms of this dysfunction are not completely understood. To test the hypothesis that complement activation and neutrophil degranulation may contribute to the placental dysfunction associated with fetal bypass, we compared placental hemodynamics, complement activation, and neutrophil degranulation among fetuses exposed to cardiac bypass with a miniaturized bypass circuit including an in-line axial flow pump (Hemopump), fetuses undergoing bypass with a conventional roller pump circuit, and control fetuses that were similarly exposed but did not undergo bypass. METHODS: Twenty-six Western Cross sheep fetuses (median 122 days gestation) were randomly assigned to undergo cardiac bypass for 30 minutes with the Hemopump circuit (n = 8), to undergo bypass for 30 minutes with the conventional (roller pump) circuit (n = 10), or to undergo identical exposure and cannulation but not bypass (n = 8, controls). Blood samples were collected to measure white cell count and differential, and C3a and lactoferrin levels prior to bypass, at the end of bypass, and 1 and 2 hours after bypass. Hemodynamics and blood gases were also monitored. RESULTS: There was a fall in white cell count over time that continued after bypass in all groups; neutrophils and lymphocytes were affected similarly. C3a levels rose significantly from prebypass to postbypass in the roller pump group (p<0.0001) but not in either of the other groups. Lactoferrin levels rose significantly from start of bypass in both bypass groups (Hemopump p = 0.01; roller pump p<0.0001) but not in controls. The elevation in lactoferrin level coincided with worsening placental gas exchange and deteriorating cardiac function. CONCLUSIONS: Complement and neutrophil activation occurred with fetal cardiac bypass but only neutrophil activation mirrored the FPU and cardiac dysfunction, suggesting that products of neutrophil activation may be important contributing factors. Improved FPU function with a bypass circuit that has less extracorporeal surface and does not require a large priming volume may be due in part to a reduction in the magnitude of this inflammatory response.

Tuberculosis hematógena tardía / Late tuberculosis

La tuberculosis hematógena tardía es una forma de tuberculosis miliar que se presenta mucho tiempo después de la infección primaria, a partir de un foco extrapulmonar, por lo general silente. Es forma de tuberculosis se produce debido a una disminución de la inmunidad celular y humoral, generada por una causa intercurrente. Entre estas se pueden citar las terapias inmunosupresoras, neoplasias, diabetes, insuficiencia renal crónica y enfermedades virales. Tiene una alta mortalidad, que se estima en un 85 por ciento de los afectados. Se presenta un paciente de sexo masculino, de 56 años de edad que ingresa al Servicio de Clínica Médica para ser estudiado con diagnóstico de síndrome febril prolongado. Se concluye señalando que, para disminuir la alta mortalidad de esta entidad, debe realizarse su diagnóstico y tratamiento en forma precoz, y para ello hay que tenerla presente en el diagnóstico diferencial del síndrome febril prolongado

Genetic regulation of placental function: a quantitative in situ hybridization study of calcium binding protein (calbindin-D9k) and calcium ATPase mRNAs in sheep placenta.

The calcium requirement of the ovine fetus increases progressively throughout pregnancy. The 9-kDa calcium binding protein (calbindin-D9k; 9CBP) is considered to be a reliable marker for epithelia mediating calcium transport. This quantitative in situ hybridization study shows that the levels of 9CBP mRNA show a pregnancy stage-related increase which correlates with fetal calcium demand only in maternal endometrial gland and fetal interplacentomal trophoblast epithelia. Levels of 9CBP mRNA in the placentome, which has by far the greater area of maternofetal contact, show no changes during pregnancy. mRNA for the CaATPase enzyme, a second requirement for calcium transport, is shown to be present in epithelia in interplacentomal and placentomal regions but shows no change in concentration as pregnancy progresses. Results with the 9CBP and CaATPase mRNAs confirm our recent immunocytochemical results with ruminant placenta and indicate the basis for a cellular calcium transport system analogous to that in the enterocyte. The interplacentomal trophoblast system appears to be eminently suitable for investigations of details of the cellular mechanism and control of epithelial calcium transport.

From biochemical to biophysical placental function tests in fetal surveillance.

Radioimmunoassays of human placental lactogen and estriol levels in the maternal plasma, ultrasound biometry of the abdominal diameter (AD), pulsed Doppler measurements of uteroplacental arteries, the common carotid artery (CCA), and the umbilical artery (UA) and fetal heart rate monitoring were simultaneously performed in 219 risk pregnancies from 26 weeks' onward at regular intervals. The prognostic value of all tests to predict small for gestational age infants (SGA) and fetal distress was evaluated simultaneously. Receiver operator characteristic allowed the simultaneous comparison of all methods: The AD was most predictive for early detection of SGA, even more than uteroplacental blood flow. Fetal blood flow redistribution expressed as a ratio of the resistance index of CCA/UA was the most significant test for detection of fetal distress later in pregnancy, even more than antenatal cardiotocography. Considering cutoff levels used in clinical routine, the sensitivity and specificity of the fetal AD in detecting intrauterine growth retardation more than 28 days before birth, were 71 and 81%, respectively. Pulsed Doppler measurements of CCA/UA less than 7 days before the delivery had a sensitivity and specificity of 83 and 90%, respectively. Our results demonstrate the historical change in fetal surveillance within one study group: If accurate routine ultrasound is available, the use of biochemical placental function tests is not justified, a procedure that is already accepted in nearly all perinatal centers. Fetal cerebral versus umbilical blood flow measurements should be applied as a tool to measure fetal blood flow redistribution in small fetuses to predict most precisely the risk for poor outcome and perinatal hypoxia.

[Use of a mathematical model to establish normal serum parameters characterizing the function of the fetoplacental complex]. / Ispol'zovanie matematicheskogo modelirovaniia dlia polucheniia znachenii normy syvorotochnykh pokazatelei, kharakterizuiushchikh funktsiiu feto-platsentarnogo kompleksa.

Based on the author, data on the content of alpha-fetoprotein, trophoblastic beta-1-glycoprotein, and nonconjugated estriol in the blood serum of 278 somatically healthy women in various periods of normal gestation, the author proposes an approach to the definition of normal range of values. Using mathematical simulation methods, the values of normal concentrations of the fetoplacental complex products were calculated for every week of gestation, this permitting a different representation of laboratory findings and a dynamic follow-up of the course of gestation.