Hemodynamic, hematological and hemorrheological evaluation of post-term pregnancy.

OBJECTIVE: To evaluate the hemorrheological modifications in post-term pregnant women. METHODS: Pregnant women (n = 48) at > 280 days' gestation, were tested on alternate days by nonstress test; ultrasound assessment of amniotic fluid volume, placental grading, hourly measurement of fetal urine production, and maternal fetal Doppler analysis. We further recorded maternal: plasma viscosimetry, red blood cells, hemoglobin, hematocrit, platelet count, mean platelet volume, fibrinogen, antithrombin III, creatinine, uric acid, plasma calcium, hPL, and estriol. We analyzed the last values obtained within 48 hours prior to delivery. RESULTS: The subjects were divided into Group I (40 wks to 40 wks+3 days; n = 16); Group II (40 wks+4 days to 41 wks; n = 16); Group III (> 41 wks; n = 16). The time-averaged maximum velocity of the fetal descending thoracic aorta was lower at Doppler analysis in Group III (29.0 +/- 3.5 cm/s) than in Group I (34.0 +/- 4.3 cm/s; p < 0.05). A decrease of the middle cerebral/umbilical pulsatility index ratio (1.75 in the Group I vs 1.52 in the Group III; p < 0.05) was shown. Furthermore, the incidence of oligohydramnios; Grannum placental grade III; plasma viscosity and coagulation parameters were significantly higher in Group III patients. The plasma viscosity resulted positively correlated with uric acid, and inversely correlated with fibrinogen, antithrombin III and platelet number values. CONCLUSIONS: From the present data we conclude that post-term pregnancy may mimic a mild 'fetal growth restriction'.

Maternal hyperoxygenation in the treatment of mild intrauterine growth retardation: a pilot study.

The aim of this study was to determine the efficacy of long-term maternal hyperoxygenation in comparison with bed rest in the management of mildly growth-retarded fetuses (5-10th centile).Thirty-eight patients with intrauterine growth retardation were studied. The patients were divided into oxygen-treated (n = 18) and untreated (n = 20) groups. Ultrasound assessment of amniotic fluid volume was performed on alternate days, and the fetal abdominal circumference was evaluated weekly. Doppler analysis of fetal/maternal circulation was performed upon the patient's arrival at hospital, after 12 h, and thereafter on alternate days until parturition. Fetal blood was sampled by cordocentesis for immediate blood gas analysis at the start of the study and on the day of delivery. Although in the treated patients there was significant improvement in Doppler flow pat tern and blood gas indices, no significant differences in type of delivery and perinatal outcome were noted between the groups. Maternal hyperoxygenation in mild intrauterine growth retardation did not improve perinatal outcome.

Uterine and ovarian blood flow measurement. Does the full bladder modify the flow resistance?

Doppler ultrasound is a non-invasive technique for investigating artery blood flow variations. In 39 normoovulatory patients we investigated the correlation between bladder distension and uterine/ovarian blood flow resistance. The patients were scanned transabdominally or transvaginally both with full and emptied bladders. Pulsatility Index was significantly higher in patients with a full bladder than in the same group after they had emptied their bladders. The present study showed that the full bladder modifying pelvic anatomy and/or increasing sympathetic tone is responsible of a high blood flow resistance in the uterine artery.

Absent or reversed end-diastolic flow in umbilical artery and severe intrauterine growth retardation. An ominous association.

Uteroplacental insufficiency is a major cause of perinatal mortality and postnatal morbidity. Doppler velocimetry has been used to assess well-being of the fetus for several years. In the present study we evaluated the perinatal outcome of growth retarded fetuses with presence or absence of diastolic flow in umbilical artery at Doppler analysis. Forty-six pregnant women with intra-uterine-growth-retardation were studied. Ultrasound assessment of amniotic fluid was performed on alternate days until parturition. A weekly ultrasound measurement of fetal abdominal circumference was done. Doppler analysis of fetal/maternal circulation was performed upon arrival of the patient in hospital and thereafter on alternate days until delivery. Fetal blood was sampled by cordocentesis for immediate blood-gas analysis. In the group (n = 26) with absent or reversed diastolic flow in the umbilical artery, we observed a correspondingly worse blood-gas analysis; a reduced time interposed between the diagnosis and the delivery; a reduced birth weight associated with an increased fetal risk and with a perinatal mortality approaching 60%. Our data suggest that absent or reversed diastolic flow in umbilical artery of growth-retarded fetuses, associated with alterations in other vessels, are ominous signs of serious fetal compromise.

Maternal hyperoxygenation in the treatment of intrauterine growth retardation.

OBJECTIVE: In the current study the efficacy of maternal hyperoxygenation on growth-retarded fetuses was evaluated. STUDY DESIGN: Thirty-six pregnant women with intrauterine growth retardation were studied. The patients were divided in oxygen-treated (n = 17) and untreated (n = 19) groups. Doppler analysis of the fetal circulation was performed on the arrival to the hospital, after 12 hours, and thereafter on alternate days until delivery. Fetal blood was sampled by cordocentesis for immediate blood gas analysis at entrance to the study and the day of delivery. RESULTS: Significant improvement in Doppler flow patterns in treated patients were found when compared with untreated women. The Doppler variations were associated with complementary modifications in fetal blood gas. These differences resulted in a significant modification in perinatal mortality with an incidence of 29% and 68% (p less than 0.01) in treated and untreated groups, respectively. CONCLUSION: Our data suggest a benefit of maternal hyperoxygenation in the treatment of fetal growth retardation.

Lack of beta-endorphin plasma level rise in oxytocin-induced labor.

beta-Endorphin (beta-EP), beta-lipotropin (beta-LPH) and cortisol plasma levels were measured during labor in 18 pregnant women. In 7 cases labor progressed spontaneously and in 11 cases oxytocin (5 mIU/min) was administered to stimulate uterine contractions. In control and oxytocin-treated subjects hourly blood samples were taken until delivery. In spontaneous labor all three hormones showed a progressive and significant increase until parturition. In oxytocin-treated patients, however, both beta-EP and beta-LPH remained constant until parturition. Cortisol levels in oxytocin-treated patients presented a significant increase but reached values significantly lower than in control patients. These results indicate that women with uterine hypocontractility during labor requiring oxytocin showed no rise in their plasma beta-EP and beta-LPH and a blunted cortisol rise during oxytocin administration.

Pemphigus and pregnancy. Review of the literature and description of a case.

PIP: Pemphigus during pregnancy is discussed as an indication for therapeutic abortion. The case of a 46-year-old woman, suffering from pemphigus for 2 years, who had a therapeutic abortion in the 17-18th week of pregnancy, is described. Pemphigus had been aggravated by pregnancy, and the patient was treated with corticosteroids, since maternal prognosis depends upon early and massive cortisone treatment. Abortion was indicated because of the fetal deformities and pregnancy complications ascribed to corticosteroids by many authors. Incomplete abortion was induced by saline injection followed by oxytocin slow drip infusion, and instrumental emptying of the uterine cavity. The patient died 1 month later of bronchopulmonary complications of pemphigus. Pemphigus in pregnancy is compared with cervical cancer in the discussion of indications for therapeutic abortion.^ieng