Hyperbaric oxygenation and glucose/amino acids substitution in human severe placental insufficiency.

In the first case, the AA and glucose were infused through a perinatal port system into the umbilical vein at 30 weeks' gestation due to severe IUGR. The patient received daily hyperbaric oxygenation (HBO, 100% O2 ) with 1.4 atmospheres absolute for 50 min for 7 days. At 31+4  weeks' gestation, the patient gave birth spontaneously to a newborn weighing 1378 g, pH 7.33, APGAR score 4/6/intubation. In follow-up examinations at 5 years of age, the boy was doing well without any neurological disturbance or developmental delay. In the second case, the patient presented at 25/5  weeks' gestation suffering from severe IUGR received HBO and maternal AA infusions. The cardiotocography was monitored continuously during HBO treatment. The short-time variations improved during HBO from 2.9 to 9 msec. The patient developed pathologic CTG and uterine contractions 1 day later and gave birth to a hypotrophic newborn weighing 420 g. After initial adequate stabilization, the extremely preterm newborn unfortunately died 6 days later. Fetal nutrition combined with HBO is technically possible and may allow the prolongation of the pregnancy. Fetal-specific amino-acid composition would facilitate the treatment options of IUGR fetuses and extremely preterm newborn.

Effects of transcutaneous electrical nerve stimulation on fetal and placental development in an experimental model of placental insufficiency.

OBJECTIVE: To elucidate the effects of transcutaneous electrical nerve stimulation (TENS) in pregnancies with placental insufficiency. METHODS: Pregnant rats were subjected to uterine artery ligation and to TENS according to the following groups: ligated stimulated (LS); ligated non-stimulated (LN), control stimulated (CS); and control non-stimulated (CN). Fetal external measurements, such as crown-rump length (CRL), fronto-occipital distance (FOD), thoracic ventral-dorsal (TVDD) and abdominal ventral-dorsal (AVDD) distances were analyzed together with the area occupied by fetal internal organs. Glucose transporter 1 (GLUT-1) expression was evaluated by immunohistochemistry in fetal organs. Thickness of junctional, labyrinth and intermediate placental zones was analyzed by morphometric evaluation in HE-stained slides, and placental hypoxia-inducible factor 1 alfa expression was measured by real-time polymerase chain reaction. RESULTS: In LN and CS groups compared to the CN group, CRL was reduced (27.51/28.95 versus 30.16 mm), as well as FOD (6.63/6.63 versus 7.36 mm), AVDD (7.38/8.00 versus 8.61 mm) and TVDD (6.46/6.87 versus 7.23 mm). Brain GLUT-1 expression was higher in LS (1.3%) and CS (1.8%). The area occupied by placental vessels in the labyrinth zone (29.67 ± 3.51 versus 20.83 ± 7.63) and intermediate zone (26.46 ± 10.21 versus 10.86 ± 8.94) was larger in the LS group than in the LN group. CONCLUSIONS: Our results suggest a negative effect of TENS on placental development, thus compromising the maintenance of adequate blood flow to the fetus.

Transcutaneous electrical nerve stimulation and placental vascularization in cases of uterine blood flow restriction.

Studies report transcutaneous electrical nerve stimulation (TENS) as a treatment for placental insufficiency. To induce utero-placental insufficiency in rats, the uterine artery was ligated. Transcutaneous electrical nerve stimulation was applied with a frequency of 80 Hz, pulse duration of 200 µs, and low intensity. Placental blood vessels were analyzed after immunohistochemistry. The number, caliber and area occupied by placental vessels, fetal weight and length, and placental volume were lower in cases stimulated by TENS. The interaction between ligation and stimulation by TENS was associated with reduction of all these measurements, suggesting that TENS use during pregnancy may have harmful effects on intra-uterine development.

Transcutaneous electrostimulation for suspected placental insufficiency (diagnosed by Doppler studies).

BACKGROUND: Transcutaneous electrostimulation is thought to be able to improve blood flow and so it has been suggested that it may help to promote fetal growth. OBJECTIVES: The objective was to assess the effects of transcutaneous electrostimulation in suspected placental insufficiency on the promotion of fetal growth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials Register. Date of last search: December 1999. SELECTION CRITERIA: Acceptably controlled trials of transcutaneous electrostimulation compared with placebo or no treatment in women with suspected impaired fetal growth or placental insufficiency. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: No studies were included. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of transcutaneous electrostimulation in the management of women with suspected placental insufficiency.

[Experimental validation of the efficacy of laser-magnetic therapy for chronic placental insufficiency]. / Eksperimental'noe obosnovanie lazeromagnitoterapii khronicheskoi platsentarnoi nedostatochnosti.

A new pathogenetically based non-medicamentous method for correction of uteroplacental bloodflow disturbances has been developed on the model of chronic placental insufficiency in rats. A single 5 min laser-magnetic exposure on day 21 of normal pregnancy resulted in a vasodilating effect with reduction of the peripheral resistance in the uterine horn vessels and with improvement of their blood supply. A new LAMA laser magneto-therapeutic device was employed. Daily 5 min sessions of laser magnetic therapy administered to rats with chronic placental insufficiency from pregnancy days 15-16 to 21 normalized uterine horn contractility and resulted in positive morphofunctional changes in the components of the uterine horns and placenta, being associated with a noticeable improvement of fetal functions. Hence, laser magnetic therapy may be regarded as an effective non-drug method for therapy of chronic placental insufficiency.

[Improvement of Doppler ultrasonography findings following transcutaneous electrostimulation in women with placental insufficiency]. / Zur Verbesserung der Doppler-Sonographiebefunde nach transkutaner Elektrostimulation bei Frauen mit Plazentainsuffizienz.

Previous perinatal trials using Doppler ultrasound have demonstrated a favorable correlation between abnormal blood flow spectra and feto-maternal problems. 33 patients with manifest placental unsufficiency were subject to daily transcutaneous nerve stimulation in a 2-week therapeutic course. 23 patients of the control group were treated by bed rest over 2 weeks. The patient group with transcutaneous nerve stimulation (TNS) showed significant improvement of the investigated blood flow parameters (A/B ratio) of the umbilical artery and fetal aorta (p less than 0.01). In the placebo group there were no significant alterations of blood flow parameters. The clinical findings (improved flow parameters and perinatal outcome) are not expected to yield any significant improvement when placental insufficiency is treated with bed rest alone.

[Physico-chemical characteristics of the plasma membrane of the human placenta in placental insufficiency]. / Fiziko-khimicheskaia kharakteristika plazmaticheskikh membran platsenty zhenshchin pri platsentarnoi nedostatochnosti.

Lipid peroxidation, microviscosity, lipid fraction ratios and glycoprotein carbohydrate metabolism were investigated in syncytiotrophoblastic plasmatic membranes of patients with placental insufficiency. Changes are demonstrated in the above parameters, as compared to normal values, indicative of profound structural transformations of placental membranes. Hyperbaric oxygenation is shown to have a favorable effect on structure and properties of placental membranes.

[Sonographic detection of increased perfusion in placental insufficiency following TNS therapy using pulsed Doppler ultrasound]. / Sonographischer Nachweis der Durchblutungssteigerung bei Plazentainsuffizienz nach TNS-Therapie mit Hilfe des gepulsten Doppler-Ultraschalls.

In the last years transcutaneous electric nerve stimulation (TNS) has been used at the first Department of Gynaecology and Obstetrics in Vienna for the therapy of placental insufficiency. With the new method of Doppler Ultrasonography a direct measurement of blood flow in the Arteriae umbilicales is possible. In 16 patients with reduced placental perfusion between 34 to 38 weeks of pregnancy TNS-therapy has been monitored by Doppler Ultrasonography. In 14 patients an impressive improvement to normal values of perfusion could be observed. Only 2 patients with morphological changes in the placenta were resistant to therapy. A control group of 16 patients with normal values of perfusion did not show any response to TNS-therapy as expected. Therefore this safe and simple method of TNS is recommended for the therapy of functional placental insufficiency.

[Transcutaneous electrical nerve stimulation in the treatment of placental insufficiency. II. Results of treatment compared to special infusion treatment]. / Die transkutane elektrische Nervenstimulation zur Behandlung der Plazentainsuffizienz. II. Mitteilung: Ergebnisse der Behandlung im Vergleich mit einer speziellen Infusionsbehandlung.

Results of treatment of placental insufficiency by transcutaneous electric nerve stimulation (TNS) in 101 patients are demonstrated and compared with a treatment of a special infusion therapy. While TNS-therapy a significant rise of Fischer-Score was observed. In both groups the urinary estrogen excretion was increased.

[Hemodynamic placental insufficiency and its therapeutic modification in threatened premature labor]. / Hämodynamische Plazentainsuffizienz und ihre therapeutische Beeinflussung bei drohender Frühgeburt.

The authors are involved in a study in the field of nuclear medicine aimed at further clarifying the connection between premature delivery and placental insufficiency. They are particularly concerned with uteroplacental perfusion at the time when a trend is emerging toward premature birth, and with ways of treating this by exclusive therapy using betamimetics and/or additional maternal oxygen inhalation/additional maternal transcutaneous dorsal nerve stimulation (TNS). The significantly longer half-life periods of activity increase found at the time of hospitalization similar to pregnancies with intra-uterine fetal retardation, as compared with a normal control group, are interpreted as expressing a hemodynamic placental insufficiency and a risk of premature delivery. In contrast to exclusive betamimetic therapy, additional O2 inhalation/additional TNS significantly shorten the half-life period both in short-time and long-time tests. The better therapeutic effect on uteroplacental perfusion in cases of imminent premature delivery which is thus demonstrated can be seen also in an improved respiratory condition of the fetus as shown in a cardiotocogram. From a clinical point of view, the authors call attention to the clearly prolonged pregnancy periods regardless of the duration of gestation, at the time when a trend is emerging toward premature birth, as compared with exclusive betamimetic therapy, the duration of tocolysis/amount of betamimetic applied being the same.

[Transcutaneous electric nerve stimulation in the treatment of placental insufficiency. 1. Methodologic principle and set of instruments]. / Die transkutane elektrische Nervenstimulation zur Behandlung der Plazentainsuffizienz. 1. Mitteilung: Methodenprinzip und Gerätekombination.

Presentation of a set of generators for the transcutaneous electric nerve stimulation serving the treatment of placental insufficiency. First experiences confirm the proper practibility of the method in the variant of our generator set.

[Therapeutic efforts and prenatal modification of selected disordered fetomaternal relations]. / Therapeutische Bemühungen um präpartale Beeinflussung ausgewählter gestörter fetomaternaler Beziehungen.

Based on the current view about disturbances of the feto-materno-placental unit we examined 37 women with suspected intrauterine fetal growth retardation and 12 women with threatened premature labor and looked for possibilities of antenatal therapeutic influence of nutritive, respiratory, endocrine and hemodynamic insufficiency. In a randomized study we can prove a normal increase of the distance between symphysis pubis and fundus as well, as the biparietal diameter not only following bedrest but also following bedrest with additional intravenous infusion of glucose respectively oral application of galactose. The high rate of hypotrophic babies is no argument against a positive influence on nutritive insufficiency, but the acquired retardation can not be compensated totally. Neither a positive influence on the endocrine insufficiency nor the moderate respiratory one could be found. As well by maternal transcutaneous nerval stimulation as by maternal oxygen inhalation an oral long-term tocolysis we can demonstrate a considerable improvement of the uteroplacental perfusion measured with isotopes. These positive aspects are basis for further investigations. An important supposition to a successful therapy remains an early diagnosis.

[Fractional composition of membrane proteins of the placenta in feto-placental insufficiency after hyperbaric oxygenation]. / Fraktsionnyi sostav membrannykh belkov platsenty v usloviiakh feto-platsentarnoi nedostatochnosti posle giperbarooksigenatsii.

Electrophoretic properties of syntrophoblast membrane proteins, solubilized by detergents, were distinctly altered under conditions of feto-placental insufficiency of endocrine genesis. Treatment of women with feto-placental insufficiency by means of hyperbaric oxygenation prevented the impairment of membrane protein composition.

[The influence of transcutaneous nerve stimulation (TNS) on hormonal parameters of placental function in cases of placental insufficiency (author's transl)]. / Der Einfluss der transkutanen Nervenstimulation (TNS) auf hormonelle Funktionsparameter bei Plazentainsuffizienz.

The influence of transcutaneous nerve stimulation (TNS) on the hormonal parameters of placental function (HPL and Estriol) in the serum of 39 patients between the 28th and 39th week of pregnancy was investigated. In this patients placental insufficiency was suspected because of low hormonal parameters or a diminished radioisotope placental perfusion test. During a hospitalization of 2 weeks these patients underwent a daily TNS-therapy for 2-3 hours. 2 or 3 hormonal values before these two-weeks therapy and 2 or 3 values after the therapy were compared. A significant difference (p less than 0.05; t-test) was found. HPL and Estriol mean values raised absolutely, but also in comparison to a group of patients of our clinic without placental insufficiency. A correlation between the onset of therapy at a certain week of gestation and it's effect could not be proved. The use of this riskless method as a therapy of placental insufficiency is recommended.

[Improvement of utero-placental perfusion by transcutaneous nerve stimulation (author's transl)]. / Verbesserung der plazentaren Durchströmung durch transkutane Nervenstimulation.

A report is given on 37 patients with a diminished utero-placental perfusion. 12 patients underwent only once, 25 patients daily over 2 to 3 weeks a transcutaneous lumbo-sacral electric nerve stimulation. Both, the 12 patients stimulated only once and the 25 patients with daily stimulation, showed a significant increase of utero-placental perfusion measured by the method of radioisotope placental perfusion. Transcutaneous nerve stimulation (TNS) therefore could be used for therapeutic purpose in cases of placental dysfunction.

[Improvement of the antepartal CTG by transcutaneous electric stimulation (author's transl)]. / Optimierung des antepartalen CTG durch transkutane Elektrostimulation.

37 gravid patients with diagnosed symptoms and signs of placental insufficiency underwent during 10 days a treatment of transcutaneous electric stimulation. Fetal CTG showed compared to the situation before treatment a distinct increase in the amplitude of the oscillation pattern and a rise in the number of accelerations, which means an improvement of the fetal situation. In 10 cases Fischer-Score went up from 7 to 10, in other 10 cases from 8 to 10.

[The influence of TNS (transcutaneous nerve stimulation) on placental flow (author's transl)]. / DER Einfluss der TNS (transkutane Nervenstimulation) auf die plazentare Durchströmung.

A report about 12. gravid patients with a diminished uteroplacental flow is given. To increase their placental perfusion a transcutaneus lumbo-sacral electric nerve stimulation was performed. In all 12 cases a distinet increase war measured by the method of radioisotope placenta-perfusion. The mean values showed a high significant difference (p less than 0,001). The reasons for this results and the possibilities of this findings for the therapy of funcitonal placental insufficiency are discussed.