RESUMEN
Magnetic resonance imaging requested for a potentially serious indication, provided a unique opportunity to explore the intervillous circulation of placentas from pregnancies complicated by Intra Uterine Growth Restriction (IUGR) and to compare them to normal cases. This allowed an innovative characterization of in vivo utero-placental blood flow, correlating a compromised intervillous circulation in IUGR to the deterioration of fetal condition. MR imaging was requested to rule out suspected posterior placental adhesive disorders in 26 patients. Twelve patients had fetuses appropriate for gestational age, while in 14 patients fetuses were affected by severe IUGR. Multiphasic dynamic contrast-enhanced sagittal sequences were acquired and a quantitative analysis of signal intensity and enhancement kinetics was performed for both the entire placenta and for selected regions. Images disclosed a homogeneous perfusion overall the placenta in normal cases, while IUGR placentas displayed a slow intervillous blood flow, along with many patchy unperfused areas. Intermittent stops worsen the perfusion dynamics of the intervillous mostly in IUGR cases with an elevated ductus venosus pulsatility index. In conclusion, we proved that in IUGR placenta maternal placental blood flow is extremely compromised and that superimposed dynamic phenomena concur to worsen the intervillous circulation leading to an end-stage fetal decompensation.
Asunto(s)
Retardo del Crecimiento Fetal/fisiopatología , Circulación Placentaria , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Placenta/fisiopatología , Embarazo , Estudios Retrospectivos , Adulto JovenAsunto(s)
Betametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Nacimiento Vivo , Pulmón/crecimiento & desarrollo , Trombocitopenia/tratamiento farmacológico , Adulto , Femenino , Desarrollo Fetal/efectos de los fármacos , Edad Gestacional , Humanos , Recuento de Plaquetas , Embarazo , Complicaciones Hematológicas del Embarazo , Primer Trimestre del Embarazo/sangre , Primer Trimestre del Embarazo/efectos de los fármacos , Trombocitopenia/sangreRESUMEN
The aim of the study was to investigate on a possible association between maternal mean platelet volume (MPV) and oxygen-metabolic changes in pregnancies affected by altered maternal-fetal Doppler velocimetry. We considered the altered maternal-fetal Doppler velocimetry group (n = 57) pregnant women admitted to our Institution for a pregnancy complication associated to the event Pre-eclampsia (PE) and intrauterine growth retardation (IUGR), with altered Doppler velocimetry in the umbilical artery ( UA) (high pulsatility index, absence or reverse end diastolic flow (ARED), blood flow cephalisation) and/or bilateral increased resistance in uterine arteries. Out of these cases, 25 pregnancies were complicated by PE and 32 pregnancies were complicated by IUGR. We included 145 normotensive third trimester pregnant women as a normal maternal-fetal Doppler velocimetry control group. From all women, 20 ml of whole venous blood was obtained from the antecubital vein soon after Doppler velocimetry evaluation. MPV was significantly higher in women with abnormal Doppler velocimetry compared to those with normal Doppler velocimetry (8.0 fl [7.0-8.7] vs. 9.1 fl [8.0-10.6], <0.001. Values are median [interquartiles]). We performed a ROC curve in order to find an MPV cut-off able to predict an uneventful event in Doppler velocimetry compromised fetuses (neonatal O(2) support > 48 hrs or intubation and/or pH < 7.2 at umbilical blood gas analysis (UBGA)). An MPV > or = 10 fl was significantly related to the former diagnostic endpoints compared to that of non-compromised fetuses (sensitivity: 45%, specificity: 89.7%, 95 CI: 18.8-66, p < 0.01). Our study suggests that pregnancies affected by Doppler velocimetry alterations, an MPV value > or = 10 fl may be associated with severe oxygen support and/or low UA ph at birth.
Asunto(s)
Velocidad del Flujo Sanguíneo , Plaquetas/citología , Sangre Fetal , Circulación Placentaria/fisiología , Embarazo de Alto Riesgo/sangre , Arterias Umbilicales/diagnóstico por imagen , Estudios de Casos y Controles , Estudios Transversales , Femenino , Retardo del Crecimiento Fetal/sangre , Retardo del Crecimiento Fetal/metabolismo , Hipoxia Fetal/fisiopatología , Hipoxia Fetal/terapia , Edad Gestacional , Humanos , Recién Nacido , Flujometría por Láser-Doppler , Terapia por Inhalación de Oxígeno , Preeclampsia/sangre , Preeclampsia/metabolismo , Valor Predictivo de las Pruebas , Embarazo , Tercer Trimestre del Embarazo , Embarazo de Alto Riesgo/metabolismo , Ultrasonografía , Arterias Umbilicales/patologíaRESUMEN
BACKGROUND: Thickened nuchal translucency (NT) has been related to fetal genetic syndromes, structural abnormalities, and other diseases. The aim of this research was to evaluate the association of NT with adverse pregnancy outcomes. STUDY DESIGN: In the period 2002-2004 in 2104 pregnant women between 10+6 and 13+5 weeks' gestation, NT was evaluated as a parameter for aneuploidy screening: out of these, 734 singleton pregnant women that underwent 2nd trimester amniocentesis and whose pregnancy outcome were known were selected. NT was statistically correlated to pregnancy and neonatal outcome. RESULTS: Median gestational age (GA) at NT evaluation was 11+2 weeks' gestation. NT median was 1.1 mm (0.9-1.4 mm, 25th-75th centile, range 0.5-4.0 mm). After multiple logistic regressions, the variables significantly associated to NT values were: threatened preterm labor (p<0.008) and preterm labor (p<0.02). The best diagnostic accuracy point was NT>95th centile and >1.5 MoM for the prediction of threatened preterm labor. CONCLUSION: In this series, increased NT values were associated to threatened preterm labor and preterm labor in euploid fetuses: this finding may have clinical consequences in the management of such pregnancies.
Asunto(s)
Medida de Translucencia Nucal , Complicaciones del Embarazo/diagnóstico , Resultado del Embarazo , Diagnóstico Prenatal/métodos , Adulto , Bases de Datos Factuales , Femenino , Edad Gestacional , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Modelos Logísticos , Trabajo de Parto Prematuro , Valor Predictivo de las Pruebas , Embarazo , Complicaciones del Embarazo/patología , Embarazo de Alto Riesgo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To study the utility of Doppler velocimetry and computerized cardiotocography in the management of intrauterine growth restriction and prediction of neonatal outcome. PATIENTS AND METHODS: Seventy-two pregnant women with fetuses showing growth restriction and delivered within 48 h of their last Doppler velocimetry evaluation. The last computerized cardiotocographic trace from these fetuses was used for statistical analysis, and the last trace from the healthy fetuses of 93 consecutive women undergoing cesarean section was used as control. Umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), UA PI/MCA PI ratio, and uterine artery resistance index (Ut RI) were assessed. RESULTS: Among women with growth-restricted fetuses, all parameters were significantly higher in those who had hypertension; and in those who had diabetes, only the UA PI/MCA ratio was significantly higher. Umbilical artery PI values and the UA PI/MCA ratio were higher in those who had a nonreassuring result to computerized nonstress test immediately before delivery. A multiple logistic analysis showed that the UA PI/MCA ratio was the only Doppler velocimetry parameter predicting cardiotocographic nonreactivity; furthermore, the predictivity of extended newborn hospitalization (longer than 15 days) was verified, with a sensitivity of 56% and a specificity of 92% when the ratio was higher than 1.26. CONCLUSION: The MCA PI of fetuses with growth restriction should be assessed. The UA PI/MCA ratio is predictive of a nonreactive computerized cardiotocography trace and of prolonged neonatal hospitalization.
Asunto(s)
Retardo del Crecimiento Fetal/diagnóstico , Arteria Cerebral Media/fisiología , Resultado del Embarazo , Flujo Pulsátil/fisiología , Ultrasonografía Prenatal , Arterias Umbilicales/fisiología , Adulto , Velocidad del Flujo Sanguíneo , Cardiotocografía , Femenino , Humanos , Hipertensión Inducida en el Embarazo , Recién Nacido , Embarazo , Tercer Trimestre del Embarazo , Embarazo en Diabéticas , Ultrasonografía DopplerRESUMEN
OBJECTIVE: To describe antenatal corticosteroid policies in Italy in comparison with other European countries, as inferred by the published data of the EURAIL Study Group (1999). METHODS: The results of a mail survey of departmental policies in Italy and Europe were compared. RESULTS: The survey response rate was similar in Italy and Europe (86% and 81%, respectively); 70.7% of the respondents in Italy and 84% in Europe started antenatal corticosteroids from 24 to 28 weeks' gestation; however, 5% of respondents in Italy started at a gestational age of >34 weeks. The use of multiple antenatal corticosteroid courses was observed in 81% of the units in Italy and 87% in Europe. Betamethasone was the more frequently used drug in Italy. CONCLUSIONS: Antenatal corticosteroids are used frequently in Italy and Europe in accordance with international recommendations, although many differences exist in the mode of administration. In 1999 almost all units used multiple courses, although this may not represent the rule 5 years later, following the publication of a prospective randomized trial that questioned the benefits of multiple courses of antenatal corticosteroids.
Asunto(s)
Betametasona/administración & dosificación , Utilización de Medicamentos/estadística & datos numéricos , Glucocorticoides/administración & dosificación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Prenatal/normas , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Betametasona/uso terapéutico , Europa (Continente) , Femenino , Madurez de los Órganos Fetales , Edad Gestacional , Glucocorticoides/uso terapéutico , Humanos , Recién Nacido , Italia , Pulmón/embriología , Política Organizacional , Guías de Práctica Clínica como Asunto , Embarazo , Encuestas y CuestionariosAsunto(s)
Acidosis/diagnóstico , Sufrimiento Fetal/diagnóstico , Adulto , Velocidad del Flujo Sanguíneo , Análisis de los Gases de la Sangre , Cardiotocografía , Cesárea , Femenino , Sangre Fetal/química , Frecuencia Cardíaca Fetal/fisiología , Humanos , Recién Nacido , Flujometría por Láser-Doppler , Masculino , Embarazo , Flujo Pulsátil/fisiología , Arterias Umbilicales/fisiopatologíaRESUMEN
AIM: To describe antenatal corticosteroids (ANCs) policies in European obstetric units and to determine factors that influence the use of multiple courses. METHODS: 641 obstetricians from obstetric departments covering a geographical area in 14 European countries responded to a questionnaire on ANCs policies. Logistic regression was used to identify factors that were related to the use of multiple ANCs courses. RESULTS: The survey response rate was 76% (inter-country range 33-94%): 11% (0-50%) of the respondents started ANCs from 23 to 24 wk gestation, 82% from 24 to 28 wk (50-100%) and 7% from 28 to 36 wk (0-32%). Eighty-five percent of the units (63-100%) used multiple ANCs courses. After adjustment for country, number of infants delivered at 24-32 wk annually in the unit, NICU and maternal hypertension, maternal hypertension tended to be an explicative factor (OR 1.97; 95% CI: 0.75-5.17). CONCLUSIONS: The high proportion of departments that initiated ANCs between 24 and 28 wk of gestation is consistent with the high incidence of neonatal morbidity and mortality in that age range. Multiple courses are overwhelmingly prescribed in Europe, although their risk/benefit ratio compared with a single dose is not yet known. The likelihood of using repeated courses of ANCs may be related to the presence of maternal hypertension, and this highlights the importance of closely monitoring women at risk of premature delivery.
Asunto(s)
Corticoesteroides/administración & dosificación , Feto/efectos de los fármacos , Complicaciones del Embarazo/tratamiento farmacológico , Corticoesteroides/efectos adversos , Estudios Transversales , Europa (Continente) , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Logísticos , Embarazo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To verify the reliability of computerized cardiotocography (cCTG) in the prediction of the oxygen metabolism status of fetuses with growth restriction and Doppler velocimetry alterations. METHODS: From 24 third-trimester cesarean section performed because of intrauterine growth restriction (IUGR) and Doppler velocimetry alterations, there were 11 cases of fetal heart rate alterations (Dawes-Redman criteria were not satisfied) and 13 cases of reactive cCTG. Fetal lung maturity was detected by amniocentesis and blood samples for umbilical blood gas analysis (UBGA) were collected before the first neonatal breath from the umbilical artery in a double-clamped segment of the cord. RESULTS: Umbilical cord gas analysis showed arterial cord blood pH to be 7.20 or less in 11 newborns (45.8%), 7.10 or less in 6 (25%), and 7.00 or less in 3 (12.5%). Linear regression analysis showed short-term variation (STV) in the fetal heart rate to be significantly correlated with umbilical artery pH (r = 0.49; P = 0.01) and pCO2 (r = -0.50; P = 0.01). There were no significant correlations between cCTG and the other UBGA parameters considered. Receiver operator curves permitted to calculate the STV values at which pathological neonatal UBGA values can be expected (pH < 7.00 and pCO2 > 80 mmHg). A short-term variation less than 4.5 ms was found to predict acidemia with a sensitivity of 100% and a specificity of 70% (positive predictive value, 33%; negative predictive value, 100%), and hypercarbia with a sensitivity of 100% and a specificity of 77.8% (positive predictive value, 55.6%; negative predictive value, 100%). CONCLUSION: In view of the results of this study, 4.5 ms for STV may be a threshold below which timing of delivery should be decided in cases of fetal growth restriction.
Asunto(s)
Acidosis/diagnóstico , Cardiotocografía/métodos , Retardo del Crecimiento Fetal/fisiopatología , Feto/metabolismo , Frecuencia Cardíaca Fetal , Acidosis/embriología , Amniocentesis , Análisis de los Gases de la Sangre , Dióxido de Carbono/sangre , Cesárea , Femenino , Sangre Fetal/metabolismo , Retardo del Crecimiento Fetal/complicaciones , Retardo del Crecimiento Fetal/metabolismo , Madurez de los Órganos Fetales , Edad Gestacional , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Flujometría por Láser-Doppler , Modelos Lineales , Pulmón/embriología , Masculino , Oxígeno/sangre , Oxígeno/metabolismo , Valor Predictivo de las Pruebas , Embarazo , Tercer Trimestre del Embarazo , Sensibilidad y EspecificidadRESUMEN
We report on an infant with multi-system disease including liver fibrosis, right microphthalmia with cataract, interstitial pneumonitis, and hyperechoic lesions in the basal ganglia and in the periventricular and thalamic regions. Prenatal ascites with hepatomegaly concomitantly with detection of cytomegalovirus (CMV) DNA in the amniotic fluid, following recurrent maternal CMV infection, had been shown. Although CMV culture and DNA detection were negative in the urine, the infant was given foscarnet because CMV infection was demonstrated in the liver by DNA detection and immunohistochemical staining. Favorable clinical outcome and absence of CMV in the liver were subsequently shown. Our case suggests that congenital CMV disease following maternal recurrence may not be associated with disseminated infection but only with intracellular infection. The diagnosis should therefore be based on CMV detection in the involved organs. Moreover, this is the first report on the possible efficacy and safety of foscarnet for therapy of immunocompetent infants with congenital CMV disease.
Asunto(s)
Antivirales/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , Foscarnet/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Antivirales/administración & dosificación , Citomegalovirus/genética , Citomegalovirus/aislamiento & purificación , Citomegalovirus/ultraestructura , Infecciones por Citomegalovirus/diagnóstico por imagen , Infecciones por Citomegalovirus/transmisión , ADN Viral/análisis , Diagnóstico Diferencial , Femenino , Foscarnet/administración & dosificación , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Cirrosis Hepática/embriología , Masculino , Reacción en Cadena de la Polimerasa , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Ultrasonografía PrenatalRESUMEN
AIM: To study the efficacy and safety of controlled release dinoprostone (PGE2) for the induction of labour. METHODS: From March 2001 to August 2002, a total of 173 patients hospitalized for postdate pregnancy, maternal hypertension, intrauterine delayed growth, reduction of amniotic fluid, were studied. In 33 of these patients, a hydrogel strip containing 10 mg dinoprostone, inserted into the posterior fornix of the vagina and release PGE2 at constant rate of 0.3-0.4 mg/h was used. RESULTS: Indications for induction, mode and time of delivery, maternal, fetal and neonatal parameters anomalies are evaluated. In 23 patients dinoprostone was used for postdate pregnancy, in 4 for maternal hypertension, in 4 for oligohydramnios and in 2 for intrauterine delayed growth. In 2 cases, the vaginal insert was removed for hyperstimulation in 1 case and for abnormal fetal heart rate in the other case. After vaginal delivery, Apgar scores and umbilical artery pH values were evaluated without anomalies. Vaginal delivery within 24 hours occurred in 51.6% of patients and medium time to delivery was 17.5 (nulliparous) and 12.3 (multiparous) hours. Only one case of uterine hyperstimulation to PGE2 was recorded, and the induction was suspended. The cesarean section rate was 12% and vaginal delivery after 24 hours was 38.7%. CONCLUSION: The continuous release of PGE2 from the vaginal insert permits a controlled and safe induction of labour, minimal risk of hyperstimulation, fast and easy removal of drugs in cases of fetal or maternal anomalies, easy accetability for patients, but high cost.
Asunto(s)
Dinoprostona/administración & dosificación , Trabajo de Parto Inducido , Oxitócicos/administración & dosificación , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , VaginaRESUMEN
OBJECTIVE: To assess through pregnancy fetal breathing movements (FBMs) patterns detected by M-mode and Doppler velocimetry technology. METHODS: In this cross-sectional study FBMs were investigated in 1882 uncomplicated pregnancies over a 4-year period. Abdominal and thoracic wall movements of fetuses between 14 and 40 weeks of gestation were studied by M-Mode scan, and color Doppler velocimetry with spectral imaging analysis was used to investigate the presence of FBMs associated with nasal fluid flow velocity waveforms (NFFVWs). RESULTS: Abdominal movements were observed in 19% of cases when gestation was less than 20 weeks and in 61% of cases when it was between 21 and 25 weeks; chest movements were significant after 21 weeks; and NFFVWs were detected at 22 weeks and increased progressively to 93% of cases at term. CONCLUSIONS: Fetal breathing movements are a complex phenomenon with a composite, progressive pattern of development during gestation.
Asunto(s)
Movimiento Fetal/fisiología , Embarazo/fisiología , Respiración , Ultrasonografía Prenatal , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/fisiología , Adulto , Estudios de Cohortes , Estudios Transversales , Desarrollo Embrionario y Fetal/fisiología , Femenino , Edad Gestacional , Humanos , Atención Prenatal , Valores de Referencia , Mecánica Respiratoria/fisiología , Pared Torácica/diagnóstico por imagen , Pared Torácica/fisiología , Ultrasonografía Doppler en ColorAsunto(s)
Enfermedades Fetales/diagnóstico , Hipertensión/diagnóstico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Ácido Úrico/sangre , Femenino , Enfermedades Fetales/fisiopatología , Humanos , Hipertensión/fisiopatología , Modelos Lineales , Circulación Placentaria , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Ultrasonografía PrenatalRESUMEN
OBJECTIVE: To study the combination of computerized cardiotocography (cCTG) and the amniotic fluid index (AFI) in the prediction of neonatal acidemia at birth. METHODS: A total of 89 singleton third-trimester high-risk pregnancies delivered by Cesarean section, with an AFI evaluated within 24 h from birth, and an antepartum cCTG performed within 6 h from delivery, were studied. The score was the sum of values for AFI (oligo/anhydramnios = 1, normal = 0) and cCTG (Dawes-Redman criteria, not met = 1, met = 0). The endpoint was to predict an abnormal neonatal outcome as defined by an umbilical artery pH of < or = 7.2. RESULTS: Fifteen neonates had an umbilical artery pH of < 7.2. The combination of cCTG + AFI score was able to predict pH values (< or = 7.20) with an OR = 2.83 (p < 0.02). The diagnostic accuracy of the combination of cCTG + AFI was as follows: sensitivity 80%, specificity 58%, positive predictive value 28%, negative predictive value 83%. COMMENT: We suggest that the cCTG + AFI score may be of value in the prediction of neonatal acidemia and help in the management of third-trimester high-risk pregnancies.
Asunto(s)
Acidosis/diagnóstico , Líquido Amniótico , Cardiotocografía/normas , Diagnóstico por Computador/normas , Análisis de los Gases de la Sangre , Cesárea , Femenino , Sangre Fetal/fisiología , Edad Gestacional , Frecuencia Cardíaca Fetal/fisiología , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo , Tercer Trimestre del Embarazo , Embarazo de Alto Riesgo , Curva ROC , Sensibilidad y EspecificidadRESUMEN
Acetowhitening of the vulva has been related to a subclinical human papillomavirus (HPV) infection. No consense has been reached about undertaking -or not- any therapy for these acetowhite changes. We have observed from our clinical experience and in a 10 years observational follow-up, that acetowhitening of the vulva regarding high risk (16-18) and low risk (6-11) HPV groups (as assessed by PCR analysis) significantly decreased; and acetowhitening areas negative to polymerase chain reaction (PCR), significantly increased from 53% (202/382) to 85% (276/325) (P<0.001). Our findings suggest that independently from HPV type and in the absence of cofactors, there is a statistically significant spontaneous remission of these areas.
Asunto(s)
ADN Viral/análisis , Papillomaviridae/aislamiento & purificación , Vulva/patología , Vulva/virología , Adulto , Colposcopía , Anticoncepción , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Pronóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
Lamellar bodies, concentrically layered "packages" of phospholipid that represent the storage form of surfactant, can be counted in the platelet channel of most electronic cell counters. The lamellar body count has been used for more than a decade and performs as well as traditional phospholipid analysis as an assay for evaluating fetal lung maturity. It is preferable to phospholipid analysis because it is rapid, objective, and inexpensive and can be performed in any hospital laboratory. The current methodologies for specimen preparation vary widely among laboratories, most notably with respect to centrifugation, resulting in differences in maturity cutoffs used. Our goal was to establish a consensus regarding a standardized methodology for the lamellar body count. Institutions that previously had published their results with lamellar body counts were invited to contribute. The consensus of the four participating institutions includes the following: centrifugation is not a necessary step and should be abandoned, maturity is suggested by a count of 50,000/microL or greater, and immaturity is suggested by a count of 15,000/microL or lower. As the lamellar body count gains wider acceptance as a primary assay for assessing fetal lung maturity, the test must be performed uniformly and accurately, given the implications of acting on a falsely negative test resulting from improper methodology.
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Líquido Amniótico/química , Madurez de los Órganos Fetales/fisiología , Cuerpos de Inclusión , Pulmón/embriología , Fosfolípidos/análisis , Femenino , Humanos , Cuerpos de Inclusión/fisiología , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Valores de Referencia , Manejo de EspecímenesRESUMEN
BACKGROUND: The effect of antenatal betamethasone on fetal parameters includes a transient reduction of FHR variation and of fetal body movements. An effect on maternal-fetal blood flow has also been shown, with non-univocal results. AIMS: To evaluate the effect of antenatal betamethasone in third trimester singleton high-risk pregnancies by Doppler technology. SUBJECTS AND METHODS: Thirty-six pregnant women who received a full course of betamethasone (12 mg i.m. two times, 24 h apart) were studied. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI), the middle cerebral artery (MCA PI) and of resistance index of uterine arteries (Ut RI) before treatment, and 48 and 96 h after second dose of betamethasone. RESULTS: No significant variation was noted in UA PI through betamethasone therapy. MCA PI decreased significantly 48 h from the last injection of betamethasone (P=0.002), and returned to basal values at 96 h. No difference was found for the other Doppler parameters examined. When serial Doppler studies were analyzed according to the gestational age, in the group <32 weeks' gestation, MCA PI decreased significantly after 48 h (P<0.006) and returned to pre-treatment values after 96 h from the last betamethasone dose. Conversely, no difference was found in Doppler serial measurements in any of the analyzed districts in the subgroup > or =32 weeks. CONCLUSION: Betamethasone treatment is associated with a significant, although transient, reduction of MCA PI, especially at gestational ages <32 weeks'.
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Betametasona/efectos adversos , Flujometría por Láser-Doppler , Arterias , Betametasona/uso terapéutico , Femenino , Edad Gestacional , Humanos , Arteria Cerebral Media/embriología , Arteria Cerebral Media/fisiología , Embarazo , Flujo Pulsátil , Arterias Umbilicales , Útero/irrigación sanguínea , Resistencia VascularRESUMEN
OBJECTIVE: The aim of this study was to correlate antepartum computerized cardiotocography (cCTG) and Doppler velocimetry parameters to umbilical blood gas analysis (UBGA) value and Apgar score 1-5 min as neonatal outcome endpoints. METHODS: Forty-eight third trimester single high risk pregnancies were considered for this study, with a cCTG performed within 24 hrs from delivery, a complete Doppler velocimetry study performed within 48 hrs from delivery and an UBGA evaluation at birth and before the first breath. RESULTS: When we analyzed the backward stepwise regression of each Doppler velocimetry and cCTG parameters versus UBGA parameters as dependent variables, we found that the linear combination of fetal heart rate (FHR) (p < 0.001), high variation episodes in min (HV) (p < 0.01) and low variation episodes in msec (LV) (p < 0.03) was able to predict pO2 values. When performing a logistic regression of data for every single parameter of FHR tracing and Doppler velocimetry against pH < 7.2 and Becf < -4 as endpoints, we found that only umbilical artery pulsatility index (UA PI) was able to predict umbilical artery pH (O.R.: 8.1 [1.07-61.8]) and only fetal movements (FM) from FHR tracing values was able to predict UA pH (O.R.: 0.94 [0.89-0.99]). Further analysis considers a cut-off for the prediction of UA pH < 7.2 at birth a value at > or = 1.35 for UA PI and at < or = 12 for FM/h. The combination of UA PI > 1.35 and FM/h < 12 did not improve the ability to predict acidemia at birth. CONCLUSION: The validity of our data from the clinical point of view suggests that in third trimester high risk pregnancies, an UA PI > or = 1.35 and/or FM/h < or = 12 (in a FHR tracing > or = 40 min) may represent a risk of 70% acidemia in neonates.
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Sangre Fetal/química , Movimiento Fetal , Enfermedades del Recién Nacido/diagnóstico , Diagnóstico Prenatal , Flujo Pulsátil , Arterias Umbilicales/fisiología , Análisis de los Gases de la Sangre , Femenino , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Valor Predictivo de las Pruebas , Embarazo , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: To determine the reliability of prenatal diagnosis of cytomegalovirus infection in women with primary or recurrent infection. METHODS: Amniotic fluid (AF) samples from 117 pregnant women were evaluated for cytomegalovirus culture and cytomegalovirus-DNA detection. Neonatal and postnatal samples also were examined to confirm or exclude transmission of maternal-fetal cytomegalovirus infection. RESULTS: Of 25 women with primary cytomegalovirus infection, 13 (52%) had cytomegalovirus-positive AF samples by polymerase chain reaction (PCR), nine of which also were diagnosed by culture. All eight neonates born to mothers whose AF was cytomegalovirus-positive by PCR and culture were cytomegalovirus infected, and three were symptomatic. One aborted fetus had cytomegalovirus-DNAemia. Of four women with cytomegalovirus-positive AF samples by PCR only, two delivered asymptomatic cytomegalovirus-infected neonates and two aborted (one fetus had cytomegalovirus encephalopathy). Of 45 mothers with recurrent infection, two with AF cytomegalovirus-positive by PCR and culture, and another with cytomegalovirus-positive AF samples by PCR only, aborted cytomegalovirus-DNA-positive fetuses. Of the other seven women with cytomegalovirus-positive AF samples by PCR only, two delivered asymptomatic cytomegalovirus-infected neonates, two delivered neonates cytomegalovirus-positive by PCR only (one was symptomatic), and three delivered infants cytomegalovirus-negative by PCR and culture. All 47 mothers with nonactive cytomegalovirus infection and cytomegalovirus-negative AF samples had uninfected neonates. Polymerase chain reaction was superior to viral culture in sensitivity and negative predictive value (100% compared with 57% and 94%, respectively) but was lower in specificity and positive predictive value (97% and 83%, respectively, compared with 100%). CONCLUSION: Prenatal diagnosis of fetal cytomegalovirus infection should include PCR in addition to viral culture, particularly for congenital cytomegalovirus infections following maternal recurrence.