Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition.

AIMS: This case-control study was conducted to identify maternal and placental risk factors of small-for-gestational-age (SGA) and fetal malnutrition. METHODS: Cases comprised 104 consecutively delivered SGA neonates (determined as per INTERGROWTH- 21st standard). An equal number of next-born gestation and gender-matched appropriatefor- gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate logistic regression analysis was done to identify the maternal and placental risk factors. RESULTS: The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ratio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncytial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1- 8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regression analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnourished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory support, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were comparable among well-nourished, malnourished SGA and AGA groups. CONCLUSION: Maternal fever, placental syncytial knots, and calcifications were independent risk factors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.

Non-reassuring foetal status and neonatal irritability in the Japan Environment and Children's Study: A cohort study.

The aim of this study was to investigate whether non-reassuring foetal status (NRFS) affected an infant's temperament, or if the temperament formed prenatally resulted in an excessive heart rate reaction that was diagnosed as NRFS. We examined the correlation between NRFS and difficulty in holding a baby, and the amount of crying in the one month after birth, which was considered an indicator of the newborn's temperament. We divided the cases with NRFS into positive NRFS and false positive NRFS. NRFS was associated with bad mood, frequent crying for a long duration, and intense crying. After adjustment for other covariates, NRFS was associated with bad mood (odds ratio, OR = 1.15, 95% confidence interval, CI = 1.00-1.33), and intense crying (1.12, 1.02-1.24). In the multi-variable model, positive and false positive NRFS were not clearly associated with neonatal irritability. When stratified by parity, NRFS and false positive NRFS were likely to be positively associated with neonatal irritability in parous women. The clear association between NRFS and intense crying was observed in parous women (multi-variable adjusted OR = 1.46, 95% CI = 1.16-1.83), but not in nulliparae (1.01, 0.91-1.12) (p for effect modification <0.01). Similarly, increased odds of intense crying associated with false positive NRFS were only found in parous women (multi-variable adjusted OR = 1.40, 95% CI = 1.09-1.81) (p for effect modification = 0.03). There was no association observed between positive NRFS and irritability; therefore, NRFS has no effect on an infant's temperament.

Cord blood TNF-α and IL-6 levels as diagnostic indicators of brain damage in neonates with non-asphyxia fetal distress.

PURPOSE: We investigated prospectively cord blood TNF-α and IL-6 levels as diagnostic indicators of brain damage in neonates with non-asphyxia fetal distress. METHODS: Eighty neonates delivered by cesarean section from January 2013 to December 2014 were enrolled. Magnetic resonance imaging was conducted to determine brain damage. Neonates were assigned to a healthy control group (n = 30) or, with fetal distress, apportioned to groups with or without brain damage (n = 20 and 30, respectively). After delivery, the umbilical arterial blood of all neonates was harvested. Serum tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) levels were evaluated to investigate a correlation between cord blood TNF-α and IL-6 levels and brain damage caused by non-asphyxia fetal distress. RESULTS: The TNF-α and IL-6 levels in the cord blood of brain-damaged neonates with fetal distress (75.63 ± 7.68 and 217.95 ± 25.15 pg/mL, respectively) were significantly higher than that of neonates with fetal distress without brain damage (43.67 ± 5.54, 119.08 ± 12.30 pg/mL) or the healthy neonates (42.35 ± 6.63, 128.46 ± 16.15 pg/mL); the latter two groups were comparable for both TNF-α and IL-6. The receiver operating characteristic curve showed that when TNF-α (IL-6) reached 53.23 pg/mL (156.23 pg/mL), the specificity and sensitivity for diagnosis of brain damage was 80.3% (82.5%) and 90.1% (81.5%), respectively. CONCLUSION: Monitoring TNF-α and IL-6 levels in umbilical cord blood may assist early diagnosis of brain damage in neonates with non-asphyxia fetal distress.

A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise.

BACKGROUND: Previous evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies. METHODS: Ninety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2.5mg/min or phenylephrine 30µg/min. Systolic blood pressure was targeted between 90% and 110% of baseline. Incidence of fetal acidosis (UA pH <7.2 and/or base deficit >12mmol/L) was recorded. Other parameters of cord gases, Apgar score, need for immediate resuscitation, maternal hemodynamics, and adverse events were also compared. RESULTS: Number of neonates showing acidosis with ephedrine or phenylephrine was comparable (P=.22). Of these, newborns with base deficit >12mmol had low 1-minute Apgar scores (n=15/23). The ephedrine group had higher oxygen content in UA (P=.03). There was no adverse neonatal outcome during the period of observation. Incidence of maternal nausea and vomiting was higher with ephedrine than with phenylephrine (22.2% vs 4.4%; P=.02). Maternal bradycardia was observed with phenylephrine (P=.02). CONCLUSION: Our data report similar fetal acidosis with either phenylephrine or ephedrine administered during spinal anesthesia for treating maternal hypotension in cases of emergency CD.

Fetal distress and in utero pneumonia in perinatal dolphins during the Northern Gulf of Mexico unusual mortality event.

An unusual mortality event (UME) involving primarily common bottlenose dolphins Tursiops truncatus of all size classes stranding along coastal Louisiana, Mississippi, and Alabama, USA, started in early 2010 and continued into 2014. During this northern Gulf of Mexico UME, a distinct cluster of perinatal dolphins (total body length <115 cm) stranded in Mississippi and Alabama during 2011. The proportion of annual dolphin strandings that were perinates between 2009 and 2013 were compared to baseline strandings (2000-2005). A case-reference study was conducted to compare demographics, histologic lesions, and Brucella sp. infection prevalence in 69 UME perinatal dolphins to findings from 26 reference perinates stranded in South Carolina and Florida outside of the UME area. Compared to reference perinates, UME perinates were more likely to have died in utero or very soon after birth (presence of atelectasis in 88 vs. 15%, p < 0.0001), have fetal distress (87 vs. 27%, p < 0.0001), and have pneumonia not associated with lungworm infection (65 vs. 19%, p = 0.0001). The percentage of perinates with Brucella sp. infections identified via lung PCR was higher among UME perinates stranding in Mississippi and Alabama compared to reference perinates (61 vs. 24%, p = 0.01), and multiple different Brucella omp genetic sequences were identified in UME perinates. These results support that from 2011 to 2013, during the northern Gulf of Mexico UME, bottlenose dolphins were particularly susceptible to late-term pregnancy failures and development of in utero infections including brucellosis.

Intraoperative findings, placental assessment and neonatal outcome in emergent cesarean deliveries for non-reassuring fetal heart rate.

OBJECTIVE: To correlate between intraoperative findings, placental histopathology and neonatal outcome in emergent cesarean deliveries (ECD) for non-reassuring fetal heart rate (NRFHR). STUDY DESIGN: Data on ECD for NRFHR were reviewed for labor, documented intraoperative findings, neonatal outcome parameters and placental histopathology reports. Results were compared between those with and without intraoperative findings. Placental lesions were classified to those related to maternal underperfusion or fetal thrombo-occlusive disease, and those related to maternal (MIR) and fetal (FIR) inflammatory responses. Neonatal outcome consisted of low Apgar score (≤7 at 5 min), cord blood pH<7.0, and evidence of respiratory distress, necrotizing enterocolitis, sepsis, transfusion, ventilation, seizure, hypoxic-ischemic encephalopathy, phototherapy, or death. RESULTS: Intraoperative findings were observed in 49.5% of 543 women, mostly cord complications (77%). Placental lesions were more common in those without intraoperative findings as compared to those with intraoperative findings: placental lesions related to maternal under-perfusion, vascular lesions, 9.1% vs. 4.1%, p=0.024, and villous changes, 39.2% vs. 30.7%, p=0.047, lesions consistent with fetal thrombo-occlusive disease, 13.6% vs. 7.4%, p=0.024, and inflammatory lesions, MIR and FIR, p=0.033, p=0.001, respectively. By using multivariate logistic regression analysis, adverse neonatal outcome was found to be dependent on maternal age, gestational age, preeclampsia placental weight <10th%, and MIR. CONCLUSION: NRFHR necessitating ECD may originate from different underlying mechanisms. In about half, the insult is probably acute and can be identified intraoperatively. In the remaining half, underlying placental compromise may be involved.

Histologic changes in the adrenal gland reflect fetal distress in hydrops fetalis.

The distribution of lipid in the fetal adrenal cortex is reported to correlate with the duration of hypoxia and degree of fetal stress. The original studies were based on Oil Red O staining, requiring frozen tissue that is often not available. To investigate the reliability of these observations, the distribution of lipid in the fetal adrenal cortex was studied in hydrops fetalis (HF) of different etiologies, using immunostaining for adipophilin on formalin-fixed material. Twenty cases of HF due to hemoglobin (Hb) Bart were compared to 34 cases of HF due to other causes. In the fetal zone, lipid distribution was more diffuse in Hb Bart HF compared to other causes of HF, including those due to anemia, supporting the concept that increased lipid in the fetal zone is associated with severity of hypoxia. A more diffuse distribution of lipid correlated with adrenal cytomegaly (P < 0.01) and extramedullary hematopoiesis (P < 0.01) but not Hb level (P  =  0.68) nor compact cell change (P  =  0.7) or cystic degeneration (P  =  0.07) in the definitive zone. A greater degree of cystic degeneration correlated with lower gestational age, rather than the specific etiology of HF. Thus, cystic degeneration is more a reflection of the onset of fetal stress than severity. The combined histologic changes in the fetal and definitive zones of the adrenal gland provide complementary information about fetal status in HF. Immnunostaining for adipophilin circumvents the need for frozen tissue for assessing lipid content by Oil Red O staining, facilitating studies based on archival material.

Comparative study of placenta acute fetal distress and diabetes associated with pregnancy.

The authors analyze the main histopathological changes of placentas from pregnancies ended with fetal distress at birth and the tasks associated with diabetes. The parallel between the two types of placentas not trying to prove the existence of pathognomonic lesions. Are set out both the similarities between the two titles of placentas lesions (such as changes in microcirculation and so on) as well as particular aspects. The authors analyze a group of 19 pregnant women hospitalized in Obstetrics and Gynecology Clinics of Emergency County Hospital of Craiova, Romania, in September 2010-September 2011, who were born and who were diagnosed with diabetes. In the same period, were studied 21 pregnant women whose pregnancy ended with the birth of a child with fetal distress. Such were identified as placental lesions suggestive of fetal distress as diverse etiology of placental vascular changes and the placenta in pregnancy associated diabetes as immaturity and vascular edema and fibrinoid changes and glycogen stores. The authors have proposed to highlight some lesions suggestive of two groups of diseases but independent groups were analyzed and conclusions were drawn after discussing results. This study is justified by insufficient knowledge of the causes that lead to fetal distress regardless of its etiology. In conclusion, the authors mention both placenta's common changes as specifically changes of the placenta for each type of disorder.

[Up-regulation of glucose regulated protein 78 induced by 2-deoxyglucose plays a protective role for fetal rat cerebral neuron following intrauterine distress].

OBJECTIVE: To evaluate the influence of up-regulation of glucose regulated protein 78 (GRP 78) induced by 2-deoxyglucose (2DG) on fetal rat cerebral neuron apoptosis following intrauterine distress and the unification of endoplasmic reticulum and mitochondrium. METHODS: (1) Fetal rat intrauterine distress model was established and rats were divided into normal group (N = 10), ischemia- reperfusion(IR) group (n = 40) and treatment group (n = 40, injection of 2DG into pregnant rats' abdomen after operation ). (2) Neuron apoptosis and the influence of 2DG on apoptosis was detected by terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) staining. The expression of GRP78, caspase-9, -12, and cytoron C protein were detected by western blot technique. RESULTS: (1) The number of TUNEL positive neuron in normal group was 4.3 +/- 1.8/mm2. The expression of GRP78, caspase-9, -12, cytoron C in cytoplasm were 0.012 +/- 0.003, 0.004 +/- 0.003, 0.006 +/- 0.002, 0.012 +/- 0.005, respectively. (2) The number of TUNEL positive neuron in the IR group were 43.6 +/- 11.4/mm2 (reperfusion 3 h), 64.4 +/- 9.3/mm2 (reperfusion 6 h), 74.2 +/- 12.1/mm2 (reperfusion 12 h), 97.3 +/- 8.9/ mm2 (reperfusion 24 h), respectively. They were significantly more than that in normal group (P < 0.05). The expression of GRP78 at corresponding times in IR group were 0.092 +/- 0.008 (reperfusion 3 h), 0.078 +/- 0.006 (reperfusion 6 h), 0.054 +/- 0.009 (reperfusion 12 h), 0.038 +/- 0.007 (reperfusion 24 h), respectively. The expression of cytoron C in cytoplasm at corresponding times in IR group were 0.040 +/- 0.006 (reperfusion 3 h), 0.076 +/- 0.009 (reperfusion 6 h), 0.108 +/- 0.005 (reperfusion 12 h), 0.089 +/- 0.008 (reperfusion 24 h), respectively. The expression of caspase-9 at corresponding times in IR group were 0.042 +/- 0.003 ( reperfusion 3 h), 0.086 +/- 0.007 (reperfusion 6 h), 0.142 +/- 0.006 (reperfusion 12 h), 0.112 +/- 0.009 (reperfusion 24 h), respectively. The expression of caspase-12 at corresponding times in IR group were 0.076 +/- 0.006 (reperfusion 3 h), 0.113 +/- 0.010 (reperfusion 6 h), 0.125 +/- 0.005 (reperfusion 12 h), 0.057 +/- 0.008 (reperfusion 24 h), respectively. They were significantly higher than that in normal group (P < 0.05). (3) The number of TUNEL positive neuron in the treatment group were 19.4 +/- 10.6/mm2 (reperfusion 3 h), 26.4 +/- 12.3 /mm2 (reperfusion 6 h), 39.3 +/- 13.3/mm2 (reperfusion 12 h), 49.3 +/- 13.6/mm2 (reperfusion 24 h), respectively. They were significantly lower than that in IR group, but more than that in normal group (P < 0.05). The expression of GRP78 at corresponding times in the treatment group were 0.158 +/- 0.012 (reperfusion 3 h), 0.175 +/- 0.005 (reperfusion 6 h), 0.125 +/- 0.013 (reperfusion 12 h), 0.079 +/- 0.004 (reperfusion 24 h), respectively. They were significantly higher than that in IR group and normal group (P < 0.05) . The expression of cytoron C in cytoplasm at corresponding times in IR group were 0.026 +/- 0.002 (reperfusion 3 h), 0.042 +/- 0.008 (reperfusion 6 h), 0.062 +/- 0.007 (reperfusion 12 h), 0.045 +/- 0.004 (reperfusion 24 h), respectively. The expression of caspase-9 at corresponding times in IR group were 0.033 +/- 0.002 (reperfusion 3 h), 0.063 +/- 0.005 (reperfusion 6 h), 0.092 +/- 0.005 (reperfusion 12 h), 0.068 +/- 0.008 (reperfusion 24 h), respectively. The expression of caspase-12 at corresponding times in IR group were 0.061 +/- 0.004 (reperfusion 3 h), 0.068 +/- 0.009 (reperfusion 6 h), 0.072 +/- 0.007 (reperfusion 12 h), 0.054 +/- 0.005 (reperfusion 24 h), respectively. They were significantly lower than that in IR group, but higher than that in normal group (P < 0.05). CONCLUSIONS: Fetal rat cerebral neuron apoptosis following intrauterine distress is associated with the action of endoplasmic reticulum and mitochondrium. Up-regulation of GRP78 induced by 2DG counteracts primary cellular damage caused by endoplasmic reticulum stress. 2DG plays a protective role for fetal rat cerebral neuron following intrauterine distress.

Impact of the severity of fetal distress on decision-to-delivery intervals for assisted vaginal delivery.

To correlate the severity of fetal distress assessed retrospectively using the Dublin intrapartum fetal monitoring classification, with decision-to-delivery intervals (DDI) and neonatal outcome, a prospective 3-month study of 78 consecutive instrumental deliveries was conducted. There were 66 cardiotocographs (CTGs) with an 83% majority agreement on classification: it was agreed 95% of deliveries should be expedited for the 58 interpretable CTGs. Although the more abnormal CTG patterns resulted in shorter DDIs and greater neonatal acidaemia, there were no significant correlations. Acidosis was present in 14% with a suspicious, or 22% an ominous CTG pattern. Delivery as a trial in theatre doubled the DDI at 41.5 +/- 22.7 (mean +/- SD) min, compared with 18.1 +/- 8.1 min in the labour room (p < 0.0001), with one case of severe acidosis in the former group. The prolonged DDI with a trial of delivery in theatre could adversely compromise the already 'distressed' fetus and should be used only when clearly indicated.

Correlación entre diagnostico clínico de sufrimiento fetal agudo y hallazgos ovulares y neonatales en cesarea de pacientes atendidas en el hospital Materno Infantil Doctor Fernando Velez Paiz, Managua julio a diciebre 2007 / Correlation between clinical diagnosis of fetal distress and acute findings in cesarea ovulares and neonatal patients treated in the hospital Mother and Child Doctor Fernando Velez Paiz

El presente trabajo titulado “CORRELACION ENTRE DIAGNOSTICO CLINICO DESUFRIMIENTO FETAL AGUDO Y HALLAZGOS TRANSOPERATORIOS EN CESAREA DE PACIENTES ATENDIDAS EN EL HOSPITAL MATERNO INFANTIL “DR.FERNANDO VELEZ PAIZ”, MANAGUA, JULIO A DICIEMBRE 2007”. es un estudio descriptivo de corte transversal con 103 pacientes con cesárea indicada por sufrimiento fetal agudo y tomada la muestra no probabilística por conveniencia. Nos planteamos como objetivos conocer la frecuencia de cesárea por sufrimiento fetal agudo, identificando los factores asociados a este diagnóstico, los criterios utilizados para realizar el diagnostico de sufrimiento fetal agudo, el manejo prequirúrgico de las pacientes, la correlacion entre el diagnostico pre y pos quirúrgico e identificar cual era lautilidad de los criterios clínicos utilizados. Los criterios de inclusión fueron: 1. Cesárea en esta Unidad Hospitalaria 2. Diagnóstico de sufrimiento fetal agudo 3. Ausencia de procesos patológicos congénitos incompatibles con la vida extrauterina(cardiopatías, malformaciones congénitas importantes) 4. Embarazo de término Encontrando los siguientes resultados: 1. La indicación y realización de cesárea por sufrimiento fetal agudo se dio en el 4,9 por ciento de casos de todos los nacidos en ese periodo de estudio y representó el 19 por ciento de todas las cesáreas realizadas. 2. Los factores asociados a sufrimiento fetal encontrados fueron las distociasfuniculares con un 43,6 por ciento, sin factor evidente con un 43,6 por ciento y el sufrimiento fetal crónico 7,7 por ciento, el síndrome hipertensivo gestacional 1,9 por ciento, amnioitis ehiperdinamia. 3. Los criterios diagnósticos utilizados fueron las alteraciones de la frecuenciacardiaca fetal, (principalmente la taquicardia fetal sostenida) y la presencia de líquido amniótico meconial (2-3 cruces). los serviciosde vigilancia del parto para discriminar mas adecuadamente los casos para decidir su cirugía...

Systemic mastocytosis with diffuse cutaneous involvement and haematological disease presenting in utero treated unsuccessfully with vincristine.

Mastocytosis is a disorder characterised by abnormal mast cell proliferation. The diverse spectrum of clinical presentations is dependent on the tissues and organs involved. We report a rare case of aggressive systemic mastocytosis presenting in utero with diffuse cutaneous involvement, and haematological abnormalities. There is little published evidence to guide treatment.

B-cell lymphoma during pregnancy associated with hemophagocytic syndrome and placental involvement.

We report a case of B-cell lymphoma during pregnancy associated with hemophagocytic syndrome and placental involvement. A 33-year-old Japanese woman developed pancytopenia, hepatosplenomegaly, and a high-grade fever for 2 weeks at 23 weeks of gestation. The demonstration of hemophagocytes in her bone marrow confirmed the diagnosis of hemophagocytic syndrome. She was referred at 25 weeks of gestation for evaluation of hemophagocytic syndrome. The screening for infection and autoimmune disease was negative. Clinical manifestation suggested malignant lymphoma as the underlying cause of hemophagocytic syndrome, but we could not confirm any lymphoma involvement in the bone marrow aspiration. Glucocorticoid therapy did not arrest the hemophagocytic process. Her general status worsened, and reduction of amniotic fluid was noted. At 28 weeks of gestation, we performed a Cesarean section because of fetal distress. Microscopic examination of placental specimen revealed diffuse infiltration of large, atypical lymphoid cells involving the intervillous space. Using immunohistochemical study, we made the diagnosis of B-cell lymphoma. R-CHOP (rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone) chemotherapy was administered on the eighth postpartum day. After 2 cycles of R-CHOP chemotherapy, hematopoiesis became normal and hepatosplenomegaly almost completely disappeared. After 6 cycles of R-CHOP, the patient received autologous peripheral-blood stem cell transplantation, and she is currently in complete remission 1 year after diagnosis. The infant did well, without clinical or laboratory manifestations of malignant lymphoma. In cases with suspected malignancy associated with hemophagocytic syndrome during pregnancy, it is important to verify placental microscopic examination for evaluating the causative disease of hemophagocytic syndrome.

Monochorionic diamniotic infants without twin-to-twin transfusion syndrome.

BACKGROUND: Monochorionic-diamniotic twins (MoDi) occur in 0.3% of all pregnancies. Twin-to-twin transfusion syndrome (TTS) that occurs in 20% of MoDi pregnancies is associated with high perinatal morbidity and mortality. MoDi twins without TTS are more frequent (80%) but have been scarcely reported. OBJECTIVE: To study perinatal morbidity and mortality of 74 MoDi twin sets without TTS and to compare it to that of 38 sets of MoDi twins with TTS. METHODS: Chorionicity was determined by gender and placental examination. Gestational age (GA) was set by sonography and pediatric examination. TTS was diagnosed clinically and by sonography, discordance was defined by twins birth weight difference > or =20%, and fetal growth restriction was determined by using a twin-specific nomogram. RESULTS: MoDi twin pregnancies without and with TTS were similar in demographics, live births, history of preeclampsia, fetal distress and cesarean delivery. They were different (p<0.01) in discordant pregnancies (36 and 79%), GA at delivery (32 and 29 weeks) intrauterine growth restriction (39 and 89%) and neonatal mortality (12 and 36%). Concordant (47 sets) and discordant (27 sets) MoDi twins without TTS were clinically similar. CONCLUSIONS: MoDi twins without TTS have high rates of birth weight discordance, fetal growth restriction, fetal distress, prematurity and cesarean delivery. Although their perinatal mortality is low, the reported occurrence and the short- and long-term impacts of fetal and neonatal morbidities warrants attention.

[Effects of nitric oxide synthase inhibitors on cerebral mitochondrial structure and function in fetal rats with intrauterine distress].

OBJECTIVE: To evaluate the effects of different types of nitric oxide synthase (NOS) inhibitors on cerebral mitochondrial structure and function in fetal rats with intrauterine distress. METHODS: Rats were divided into control group, acute ischemia group, treatment group 1 injection of [N omega-nitro-L-arginine (L-NNA) 4 mg/kg into pregnant rats' abdomen before ischemia], reperfusion group, treatment group 2 [injection of L-NNA 4 mg/kg into pregnant rats' abdomen before ischemia followed by injection of aminoguanidine (AG) 500 mg/kg before operation]. Changes of mitochondrial structure were observed by transmission electron microscopy and expression of neuronal nitric oxide synthase (nNOS) mRNA(A) through RT-PCR. Inducible nitric oxide synthase (iNOS) activity and mitochondrial Na(+)K(+)-ATPase and cytochrome oxidase activity were measured. RESULTS: (1) The A of NOS (5 min, 15 min) in acute ischemia group was higher than that of treatment group 1 (P < 0.05). There was no difference between the A of nNOS (30 min) in two groups (P > 0.05). But the A of nNOS in two groups was higher than that in control group (P < 0.05). (2) iNOS activities in reperfusion group were all higher than those in treatment group 2. Both of those in two groups were higher than that in control group (P < 0.05). (3) Mitochondrial Rsv (5 min, 15 min) in acute ischemia group was smaller than those of treatment group 1 (P < 0.05). There was no difference between mitochondrial Rsv (30 min) in two groups (P > 0.05). Mitochondrial Rsv in reperfusion group was all smaller than those in treatment group 2. And mitochondrial Rsv in all the groups was smaller than that in control group (P < 0.05). (4) Na(+)K(+)-ATPase activity in treatment group 2 was higher than those in reperfusion group (P < 0.05). Na(+)K(+)-ATPase activity in two groups was lower than that in control group (P < 0.05). CONCLUSIONS: nNOS and iNOS play a role in cerebral mitochondrial structure and function damage in fetal rats with intrauterine distress. L-NNA has some limited treatment effect on mitochondrial damage when intrauterine distress induces acute fetal hypoxic-ischemic brain damage. AG plays an obvious treatment role in mitochondrial damage during reperfusion following ischemia.

[Pathological changes and apoptosis of brain cells in rat embryo suffering from intrauterine hypoxia-ischemic injury].

OBJECTIVE: To observe the pathological changes of fetal rat brain cells caused by transient intrauterine ischemia in pregnant rats. METHODS: The uterine arteries of the pregnant rats at 17 days of gestation were clamped for 30 min in the experimental group, the samples were collected 24, 48 and 72 hours respectively after the clamping of artery, respectively. In control group, the pregnant rat's abdomens were cut open and closed but the uterine arteries were kept intact; the samples were collected 24, 48 and 72 hours after the sham operation, respectively. The pathological changes of brain tissues were observed under light microscope by HE, Nissl, cholinesterase staining, sequential TUNEL technique, and by electron microscopy as well. RESULTS: The edema, degeneration of neural cells and the hemorrhage of brain were observed in experimental group. The Nissl bodies and the activity of cholinesterase decreased. The apoptosis cells appeared 24 hours after hypoxia-ischemia injury and increased progressively with time. CONCLUSION: Uterine hypoxia and ischemia can cause severe damage to neural cells of fetal rat.

[Empirical report on acute twin-twin transfusion syndrome with single intrauterine death]. / Erfahrungsbericht über ein akutes feto-fetales Transfusionssyndrom mit letalem Ausgang.

We report on a case of acute twin-twin transfusion syndrome in a twin pregnancy in the 26 th under primarily unclear conditions. On admission to the hospital, one fetus was not showing signs of life anymore, while the Doppler indices and CTG of the living fetus showed signs of acute distress. On the scan both fetuses showed adequate and symmetric growth as well as symmetric and normal amniotic fluid amounts, indicating a lack of typical signs for chronic twin-twin transfusion syndrome. The emergency cesarean section performed under the assumption of acute twin-twin transfusion syndrome, which unfortunately could not save the second twin, confirmed our suspected diagnosis.

Arthrogryposis and multicystic encephalopathy after acute fetal distress in the end stage of gestation.

The natural history of the rare association "multicystic encephalopathy-arthrogryposis" was traced in a fetus carefully followed after artificial insemination. The fetus exhibited normal viability and brain morphology up to the 32nd week. At 36 weeks, active movements diminished and at 37 weeks, hydramnios and signs of fetal distress led to cesarean section. The infant presented with severe arthrogryposis of the limbs and spine, but not with the other elements of a long-lasting akinesia. US showed multicystic encephalopathy. Both the clinical and the neuropathological findings established that multicystic encephalopathy was neither the cause nor the sequential consequence of the fetal akinesia, but the result of a recent diffuse, acute malacic process that also involved the anterior horn cells. Acute fetal distress, responsible for major ischemic damage to CNS but compatible with fetal survival, remains an obscure condition which allows for the development of severe arthrogryposis in a few weeks.

Pruebas vibroacústicas fetales no reactivas / Vibro acoustic test fetal not reactive

Dada la relación entre hipoxia perinatal y daño feto-neonatal nos propusimos analizar estos resultados en gestantes que han mostrado resultado no reactivo ante el estímulo vibro-acústico fetal, como prueba evaluatoria de salud fetal. Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo, Venezuela. Estudio retrospectivo descriptivo analítico de 55 pacientes. La principal patología materna fue la hipertensiva (60,82 por ciento), se emplearon 85 registros electrónicos, la resolución obstetrica determinante fue por cesárea 53/55 (96,36 por ciento), siendo la primera indicación el compromiso de la salud fetal 43/55 (81,13 por ciento). El resultado perinatal reveló morbilidad en 31/55 (56,36 por ciento), representada en particular por baja puntuación de Apgar y retardo de crecimiento fetal; hubo muerte feto-neonatal en 7/55 (12,72 por ciento), sanos 17/55 (30,90 por ciento). La prueba vibro-acústica fetal no reactiva se relaciona con elevados resultados perinatales adversos. Tal hallazgo implica manejo cuidadosos de emergencia

A study of gamma-aminobutyric acid (GABA) in amniotic fluid.

OBJECTIVE: The purpose of the study was to evaluate the role of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, in amniotic fluid (AF) during fetal distress, because it has been reported that several neurotransmitters, e.g. norepinephrine, are affected by GABA. METHODS: AF was obtained during elective cesarean section (CS, n = 11) and cesarean section due to fetal distress without labor pain (FD, n = 7). Maternal and umbilical-cord blood, as well as the first urine of the neonates, also were collected. GABA, norepinephrine (NE), and epinephrine (EP) concentrations were measured using HPLC. RESULTS: The GABA concentration was higher in the AF than in either maternal or fetal circulation, or in the first urine of neonates. The GABA concentrations in the AF and in the first urine of neonates were significantly higher in the FD group than in the CS group (p < 0.05). Furthermore, significant positive correlations were observed between the NE and GABA concentrations and between the EP and GABA concentrations in the AF. GABA was produced in a time-dependent manner in cultured amnion cells. CONCLUSION: The highest concentration of GABA was found in the AF. The GABA in the AF appeared to be derived from both the amniotic membrane and the fetal urine. The increase in the GABA concentration in cases of fetal distress might be partially derived from the fetus via fetal urine. The positive correlations between the concentrations of GABA and those of NE and EP in the AF, suggest that GABA, NE, and EP might play important roles during fetal distress.