[Morphological characteristics of fetal testes in chronic intrauterine hypoxia in different gestation periods]. / Morfologicheskie osobennosti iaichek ploda pri khronicheskoi vnutriutrobnoi gipoksii na raznykh srokakh gestatsii.

OBJECTIVE: To study the morphological characteristics and expression of vascular endothelial growth factor (VEGF) in the fetal testes exposed to chronic intrauterine hypoxia during pathological pregnancy in different gestation periods. MATERIAL AND METHODS: The testes from 48 male fetuses that had died in the antenatal or early neonatal period in mothers with pathological pregnancy were morphologically evaluated. RESULTS: Chronic intrauterine hypoxia was shown to be a powerful damaging factor and leads to delayed gonadal development. Histological examination of testicular tissue showed a significant reduction in the number of tubular cells per vision field, a decrease in tubular diameter and area, with the simultaneously increased area of the stroma and a larger number of vessels. Immunohistochemical study revealed the pronounced cytoplasmic expression of VEGF in testicular tissue in different gestation periods in the spermatogenic epitheliocytes, vessels, Leydig interstitial cells, while the maximal expression of this receptor was observed at 19-25 weeks' gestation, the degree of expression decreased at 26-29 weeks' gestation. CONCLUSION: Intrauterine hypoxia has a destabilizing effect on the processes of proliferation and differentiation of the spermatogenic epithelium, interstitial endocrinocytes, activates the processes of angiogenesis and the growth of connective tissue. All this can involve not only gonadal dysgenesis, but also future reproductive dysfunction. Hypoxia stimulates the expression of VEGF, whose receptors are present in almost all testicular cell populations. It can be assumed that VEGF can act as a paracrine regulator of Leydig cell activity, also as an inducer of angiogenesis, and thus play a certain role in the development of male fertility.

Creatine supplementation during pregnancy: summary of experimental studies suggesting a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy.

While the use of creatine in human pregnancy is yet to be fully evaluated, its long-term use in healthy adults appears to be safe, and its well documented neuroprotective properties have recently been extended by demonstrations that creatine improves cognitive function in normal and elderly people, and motor skills in sleep-deprived subjects. Creatine has many actions likely to benefit the fetus and newborn, because pregnancy is a state of heightened metabolic activity, and the placenta is a key source of free radicals of oxygen and nitrogen. The multiple benefits of supplementary creatine arise from the fact that the creatine-phosphocreatine [PCr] system has physiologically important roles that include maintenance of intracellular ATP and acid-base balance, post-ischaemic recovery of protein synthesis, cerebral vasodilation, antioxidant actions, and stabilisation of lipid membranes. In the brain, creatine not only reduces lipid peroxidation and improves cerebral perfusion, its interaction with the benzodiazepine site of the GABAA receptor is likely to counteract the effects of glutamate excitotoxicity - actions that may protect the preterm and term fetal brain from the effects of birth hypoxia. In this review we discuss the development of creatine synthesis during fetal life, the transfer of creatine from mother to fetus, and propose that creatine supplementation during pregnancy may have benefits for the fetus and neonate whenever oxidative stress or feto-placental hypoxia arise, as in cases of fetal growth restriction, premature birth, or when parturition is delayed or complicated by oxygen deprivation of the newborn.

[Maternal diabetes and fetal hypoxia]. / Aidin diabetes ja sikiötä uhkaava hapenpuute.

Perinatal mortality has not decreased in type 1 diabetic pregnancies during the last 30 years. Fetal deaths are five times and neonatal deaths three times higher compared with the general population. Chronic intrauterine hypoxia caused by maternal diabetes is the most likely cause of stillbirths during the last weeks of pregnancy. Both fetal hyperglycemia and hyperinsulinemia can independently cause fetal chronic hypoxia by increasing fetal oxygen consumption. Fetal chronic hypoxia can be detected antenatally by measuring amniotic fluid erythropoietin concentration. Prepregnancy visits for advice and glycemic control should be increased among diabetic women. Furthermore, pregnancy surveillance should be enhanced and therapeutic strategies changed in order to improve perinatal outcome among diabetic pregnancies.

Pulmonary innate immune response and melatonin receptors in the perinatal stress.

OBJECTIVE: To analyze the cytokines of the innate immune pulmonary response and the capacity for local response to melatonin according to the perinatal stress. METHODS: 49 cases of pediatric autopsies were evaluated, divided according to cause of death, perinatal stress, gestational age, and birth weight. The percentages of IL-6, C-reactive protein (CRP), IL-1ß, TNF-α, and melatonin receptor were evaluated by immunohistochemistry. RESULTS: The IL-6 expression was higher in the children showing chronic stress, anoxia, and infection. The IL-6 expression showed a progressive increase according to the relation between weight and GA. There was no significant difference in the expression of IL-1ß and TNF-α. The CRP expression was higher in the cases showing chronic stress and premature cases. The expression of melatonin receptors was significantly higher in the cases showing chronic stress, being more evident in the cases showing infection. CONCLUSION: The cause of death and the type of stress influence the expression in situ of melatonin and cytokines of the innate immune pulmonary response. The evaluation of IL-6 and CRP may contribute to the understanding of the evolution of neonates with chronic stress. The greater sensitivity of the lung to melatonin in these cases may indicate an attempt at controlling the immunological response, in an attempt to diminish the harmful effects of stress.

An international delphi study of the causes of death and the criteria used to assign cause of death in bovine perinatal mortality.

The objective of the present study was to elicit opinion from two groups of veterinarians [subject matter experts and non-subject matter experts] about the causes of bovine perinatal mortality and the criteria used to assign such causes. The subject matter experts were selected on the basis of their scientific publications or experience of working in a veterinary diagnostic or research laboratory in the area of bovine perinatal mortality. The non-subject matter experts were self-selected as cattle veterinarians without particular expertise in bovine perinatology. A total of 74 veterinarians (46 subject matter experts and 28 non-subject matter experts) from 23 countries responded. The study was conducted using Delphi methodology over seven rounds. Respondents were asked to agree the causes of bovine perinatal mortality and for each cause to agree the supporting diagnostic criteria. There was a close agreement between groups on 16 causes of death apart from intra-uterine growth retardation (IUGR) and micronutrient imbalances which were accepted by fewer subject matter experts. There was inter-group consensus on the criteria to diagnose accidents, congenital defects, dystocia, hyperthermia, infections, premature placental separation, prematurity and prolonged calving. There was inter-group consensus on the criteria to diagnose anoxia, apart from gingival cyanosis; on haemorrhage, apart from haemorrhagic anaemia; on IUGR, apart from organ weights; and on iodine imbalance, apart from goitre and thyroid iodine content. The results from this study highlighted the current lack of standardization of the criteria used to define the cause of death for bovine perinatal mortality and the need for such standardization.

Morphologic analysis of fetal stress organsin different causes of perinatal death.

Complications act as stress-inducers during pregnancy so the fetus can develop functional compensatory mechanisms or morphologic changes. The cases analyzed are with congenital malformations or acute stress; chronic included cases with ascending infection (AI) and perinatal hypoxia/anoxia (PHA). The hematoxylin-eosin (H&E) was done to analyze the vacuolization, and the immunohistochemistry to the phagocytosis. The discreet standard of vacuolization was observed in 52.6% of the cases, 22.1% moderate, and 25.3% severe. The number of macrophages was higher in PHA. Changes in these organs are closely related to the cause of death and to the period during which the harmful agent.

Advanced maternal age and the risk of perinatal death due to intrapartum anoxia at term.

BACKGROUND: Advanced maternal age is associated with higher risks of intrapartum complications. However, the effect of maternal age on the risk of perinatal death due to these complications is unclear. The aim of the present study was to determine the association between maternal age and delivery-related perinatal death at term. METHODS: In this retrospective cohort study, birth records of 1,043,002 singleton term infants with cephalic presentation were analysed excluding anomalous and antepartum losses in Scotland between 1985 and 2004. Linked Scottish national registries of pregnancy outcome data and perinatal death data were used. The event was delivery-related perinatal death (ie, intrauterine fetal death during labour or death of the infant in the first 4 weeks of life), plus a subgroup ascribed to intrapartum anoxia. RESULTS: There were 803 delivery-related perinatal deaths, with 490 due to intrapartum anoxia (4.7 per 10,000 births) and 313 (3.0 per 10,000 births) due to non-anoxic causes. Compared to women aged 25-34, women aged 40 and above had a twofold risk of delivery-related perinatal death at term (adjusted OR 2.20, 95% CI 1.42 to 3.40). The excess was explained by increased risk of death due to intrapartum anoxia. Among women in labour at term, age greater than 40 was independently associated with risk of anoxic death among primiparous (adjusted OR 5.34, 95% CI 2.34 to 12.20) and multiparous women (adjusted OR 2.14, 95% CI 0.99 to 4.60). CONCLUSIONS: Advanced maternal age is associated with an increased risk of death due to intrapartum anoxia at term.

Time of birth and risk of neonatal death at term: retrospective cohort study.

OBJECTIVE: To determine the effect of time and day of birth on the risk of neonatal death at term. DESIGN: Population based retrospective cohort study. SETTING: Data from the linked Scottish morbidity records, Stillbirth and Infant Death Survey, and birth certificate database of live births in Scotland, 1985-2004. SUBJECTS: Liveborn term singletons with cephalic presentation. Perinatal deaths from congenital anomalies excluded. Final sample comprised 1,039,560 live births. MAIN OUTCOME MEASURE: All neonatal deaths (in the first four weeks of life) unrelated to congenital abnormality, plus a subgroup of deaths ascribed to intrapartum anoxia. RESULTS: The risk of neonatal death was 4.2 per 10,000 during the normal working week (Monday to Friday, 0900-1700) and 5.6 per 10 000 at all other times (out of hours) (unadjusted odds ratio 1.3, 95% confidence interval 1.1 to 1.6). Adjustment for maternal characteristics had no material effect. The higher rate of death out of hours was because of an increased risk of death ascribed to intrapartum anoxia (adjusted odds ratio 1.7, 1.2 to 2.3). Though exclusion of elective caesarean deliveries attenuated the association between death ascribed to anoxia and delivery out of hours, a significant association persisted (adjusted odds ratio 1.5, 1.1 to 2.0). The attributable fraction of neonatal deaths ascribed to intrapartum anoxia associated with delivery out of hours was 26% (95% confidence interval 5% to 42%). CONCLUSIONS: Delivering an infant outside the normal working week was associated with an increased risk of neonatal death at term ascribed to intrapartum anoxia.

Rates of and factors associated with delivery-related perinatal death among term infants in Scotland.

CONTEXT: Rates of obstetric intervention in labor, including cesarean delivery, have increased significantly in most developed countries. It is, however, unclear if this has been paralleled by decreased rates of perinatal and neonatal death associated with complications of labor at term. OBJECTIVES: To determine whether rates of perinatal death at term, either during labor or in the neonatal period, have changed in Scotland during the last 20 years and whether this was associated with a reduction in deaths ascribed to intrapartum anoxia. DESIGN, SETTING, AND PARTICIPANTS: A population-based, retrospective cohort study of linked data from a registry of births (Scottish Morbidity Record 02) and a registry of perinatal deaths (Scottish Stillbirth and Infant Death Survey) between 1988 and 2007. Participants included all births of a singleton infant in a cephalic presentation at term (N = 1,012,266), excluding those with perinatal death due to congenital anomaly or antepartum stillbirth. MAIN OUTCOME MEASURE: Delivery-related perinatal death, defined as intrapartum stillbirth or neonatal death unrelated to congenital abnormality. These events were also subdivided into those events ascribed to intrapartum anoxia and all other causes. The risk of death was modeled using logistic regression and analyses were adjusted for maternal age, height, parity, socioeconomic deprivation status, gestational age, birth weight percentile, fetal sex, onset of labor, and the annual number of births per hospital. RESULTS: During the study period, the risk of delivery-related perinatal death decreased from 8.8 to 5.5 per 10,000 births (unadjusted change, -38%; 95% confidence interval [CI], -51% to -21%). When analyzed by the cause of death, there was a significant decrease in the risk of death ascribed to intrapartum anoxia (5.7 to 3.0 per 10,000 births; unadjusted change, -48%; 95% CI, -62% to -29%), but no significant change in the risk of death ascribed to other causes. When deaths ascribed to intrapartum anoxia were analyzed by the time of death in relation to delivery, the reduction was similar comparing intrapartum stillbirths (2.6 to 1.1 per 10,000 births; unadjusted change, -60%; 95% CI, -75% to -34%) and neonatal deaths (3.1 to 1.9 per 10,000 births; unadjusted change, -38%; 95% CI, -59% to -7%). Adjustment for maternal, fetal, and obstetric factors was without material effect. CONCLUSION: Rates of intrapartum stillbirth and neonatal death at term decreased in Scotland between 1988 and 2007. This decrease was only significant for deaths ascribed to intrapartum anoxia.

Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term.

BACKGROUND: To determine the factors associated with the risk of delivery-related perinatal and neonatal death among term infants presenting by the breech and the effect of changes in the mode of delivery on the overall rates of perinatal and neonatal mortality associated with breech presentation. METHODS: We studied 32,776 singleton term infants presenting breech excluding anomalous and antepartum losses in Scotland between 1985 and 2004, using linked Scottish national registries of pregnancy outcome data and perinatal death data. The event was delivery-related perinatal and neonatal death (i.e. intrauterine fetal death during labour or death of infant in the first 4 weeks of life), subdivided according to intrapartum anoxia or mechanical cause of death. Analysis was by multivariate logistic regression. RESULTS: During the study period, the risk of delivery-related perinatal and neonatal death decreased by 72% (95% CI -1% to 93%), due to a 90% (95% CI 33-99%) reduction in anoxic or mechanical deaths. Both intrapartum (OR 0.16, 95% CI 0.02-0.75) and planned (OR 0.01, 95% CI 0.00-0.09) caesarean delivery were protective against anoxic or mechanical deaths and increased use of planned caesarean delivery accounted for 16% of the decline in anoxic and mechanical deaths over the study period. CONCLUSION: Increased use of planned caesarean delivery only partly explains the decline in delivery-related perinatal and neonatal death between 1985 and 2004 in Scotland.

[Definition of intrapartum asphyxia and effects on outcome]. / Définition de l'asphyxie intrapartum et conséquences sur le devenir.

Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH less than 7.00 and base deficit greater or equal to 12 mmol/l. Neonatal complications of intrapartum asphyxia include multiorgan failure and neonatal encephalopathy. Most severe consequences are death and neurological or sensorial impairment. Cause of permanent neurological impairment can be attributed to intrapartum asphyxia if three criteria are met: intrapartum history of a threatening event with acute fetal heart rate deterioration, biological markers of asphyxia, neonatal encephalopathy. Moderate to severe neonatal encephalopathy in asphyxiated term infants is associated with a high risk of cerebral palsy (especially quadriplegic or dyskinetic type) and/or cognitive disorders. Prognosis of neonatal encephalopathy can be accurately assessed by MR imaging.

Avaliação dos recém-nascidos a termo com índice de apgar baixo de um Hospital Geral Terciário, público e de ensino no Ceará, em 2005 / Evaluation of newborn term infants with low Apgar score in a Hospital Geral Terciário, and public education in Ceará in 2005

INTRODUÇÃO: A asfixia intra-uterina e a intraparto, o baixo peso ao nascer, asinfecções e a prematuridade constituem as principais causas de óbitos neonatais do recémnascido. O índice de Apgar é um dos critérios usados para diagnosticar asfixia. OBJETIVO: Analisar o perfil dos recém-nascidos a termo com índice de Apgar baixo (...) e índice de Apgar maior ou igual a 7, que nasceram em um Hospital Público no município de Fortaleza-Ce, no ano de 2005. METODOLOGIA: Trata-se de um estudoanalítico, retrospectivo, do tipo caso-controle, de base hospitalar. A população do estudo foi constituída pela coorte da pesquisa Tendências e Diferenciais na Saúde Perinatal noMunicípio de Fortaleza, Ceará: Comparação entre 1995 e 2005. Foram selecionados recém-nascidos (RNs) com idade gestacional maior ou igual a 37 semanas. Os que apresentaram índice de Apgar (...) 6 foram definidos como casos enquanto aqueles com índice de Apgar maior ou igual a 7 constituíram o grupo controle, ficando a amostracomposta por 626 RNs, sendo 313 casos e 313 controles. Empregou-se um questionário estruturado, adaptado do instrumento de coleta de dados da pesquisa, com variáveissociodemográficas, obstétricas, clínicas. RESULTADOS: Na amostra 62,5 por cento eram filhos de mulheres na faixa etária de 20-34 anos. Na análise multivariada foi considerado comofator de risco para índice de Apgar baixo as variáveis: baixa escolaridade da mãe (OR=2,48 IC95 por cento: 1,22- 5,06), tempo de trabalho de parto (OR=1,79 IC95 por cento: 1,03-3,11), peso aonascer (OR=3,25 IC95 por cento:1,15 -3,25), tipo de parto (OR=1,83 IC95 por cento: 1,33-2,51) e SHG (OR = 2,07, IC95 por cento: 1,34 -3,16). As variáveis idade materna, situação conjugal, ocupação, consulta pré-natal, sexo do RN e dia do nascimento não apresentaram associação com avariável desfecho. CONCLUSÃO: as mães dos recém-nascidos eram na sua maioria jovens, pertencentes às classes sociais menos favorecidas. O índice de Apgar baixo pode ser decorrente de fatores clínicos, obstétricos, perinatais, de organização da atenção ao binômio parturiente-feto e do contexto socioeconômico.

Factores maternos que influyen en la mortalidad fetal tardía

Con la finalidad de identificar algunos factores maternos perinatales que se relacionan con la mortalidad fetal tardía (MFT), se realizó una investigación retrospectiva, transversal y analítica, en el Hospital Abel Santamaría Cuadrado, que comprendió el período desde mayo del 2001 hasta mayo del 2003. El universo estudiado estuvo constituido por todas las gestantes que tuvieron su parto en la etapa anteriormente mencionada. Como grupo estudio se tomaron a todas las pacientes que tuvieron una muerte fetal tardía, y para la comparación se escogió un grupo control integrado por gestantes cuyos recién nacidos fueron vivos. Las variables analizadas estuvieron relacionadas con la madre, el embarazo, el feto y el nacimiento, así como las causas directas de la muerte. El análisis estadístico se realizó a través del por ciento, la media, la desviación estándar, el test de diferencia de proporciones (Z), y se empleó también el Odds Ratio (OR). Se obtuvo una elevada significación estadística entre la muerte fetal tardía y la gestante añosa, multípara, multigesta con antecedentes de enfermedades tanto asociadas como propias del embarazo, y el bajo peso materno al inicio del embarazo. Se concluye que es necesario identificar las gestantes con factores de riesgo de muerte fetal tardía y profundizar en su atención obstétrica...(AU)

Beta1-adrenergic receptors maintain fetal heart rate and survival.

Beta-adrenergic receptor (betaAR) activation has been shown to maintain heart rate during hypoxia and to rescue the fetus from the fetal lethality that occurs in the absence of norepinephrine. This study examines whether the same subtype of betaAR is responsible for survival and heart rate regulation. It also investigates which betaARs are located on the early fetal heart and whether they can be directly activated during hypoxia. Cultured E12.5 mouse fetuses were treated with subtype-specific betaAR antagonists to pharmacologically block betaARs during a hypoxic insult. Hypoxia alone reduced heart rate by 35-40% compared to prehypoxic levels. During hypoxia, heart rate was further reduced by 31% in the presence of a beta(1)AR antagonist, CGP20712A, at 100 nM, but not with a beta2 (ICI118551)- or a beta3 (SR59230A)-specific antagonist at 100 nM. Survival in utero was also mediated by beta1ARs. A beta1 partial agonist, xamoterol, rescued 74% of catecholamine-deficient (tyrosine-hydroxylase-null) pups to birth, a survival rate equivalent to that with a nonspecific betaAR agonist, isoproterenol (87%). Receptor autoradiography showed that beta1ARs were only found on the mouse heart at E12.5, while beta2ARs were localized to the liver and vasculature. To determine if the response to hypoxia was intrinsic to the heart, isolated fetal hearts were incubated under hypoxic conditions in the presence of a betaAR agonist. Heart rate was reduced to 25-30% by hypoxia alone, but was restored to 63% of prehypoxic levels with 100 nM isoproterenol. Restoration was completely prevented if beta1ARs were blocked with CGP20712A at 300 nM, a concentration that blocks beta1ARs, but not beta2- or beta3ARs. Our results demonstrate that beta1ARs are located on the heart of early fetal mice and that beta1AR stimulation maintains fetal heart rate during hypoxia and mediates survival in vivo.

Estudios realizados en neonatos con diagnóstico-clínico de hipoxia neonatal: en el Hospital Samuel Dario Maldonado de San Antonio del Táchira en el período de enero-diciembre 2001 / Studies in neonates with clinical diagnose of neonatal hypoxia in Hospital Samuel Dario Maldonado of San Antonio del Tachira in the period january-december 2001

A partir de las ultimas décadas la hipoxia neonatal representa un gran problema; por la morbilidad tan elevada; y con el propósito de conocer que sucedía con los niños que durante su nacimiento presentaron hipoxia neonatal se realizó un estudio analítico retrospectivo de 100 niños que presentaron diagnóstico clínico de hipoxia neonatal moderada severa durante el período enero-diciembre 2001 en el Hospital Samuel Dario Maldonado San Antonio del Táchira fueron seleccionados 30 casos, presentándose el mayor porcentaje por cesárea segmentaria (23,33 por ciento) seguida de parto eutocico (20 por ciento) y período expulsivo prolongado (16,66 por ciento), parto prematuro (13,33 por ciento). También observamos el test de apgar donde el mayor porcentaje encontrado fue de 6 puntos en 7 casos con (23,33 por ciento) tiempo durante 24-28 horas (16.66 por ciento) siendo el sexo masculino el más predominante (56,66 por ciento) acorde a la edad.

Use of Wigglesworth classification for the assessment of perinatal mortality in Bangladesh--a preliminary study.

The Wigglesworth pathophysiological classification was used to analyse perinatal deaths occurring in 5 health centres in Bangladesh. The aims were to assess the feasibility of this classification, to determine the causes of perinatal deaths and thereby to identify the areas in need of intervention. A total of 8058 births were recorded at 5 centres during the period of 11 months from mid-January to mid-December 2001. There were 1069 deaths in the perinatal period. Stillbirths were slightly more frequent (53.5%) than early neonatal deaths (46.5%). Among the stillbirths, fresh stillbirths predominated over normally formed macerated ones at all centers except BIRDEM, where the majority (52.5%) was macerated. The majority (71.6%) of perinatal deaths were in the groups comprising asphyxial conditions (46.8%), conditions associated with immaturity (13.3%), and normally formed macerated stillbirths (NFMSB, 11.5%). In the group, 'other specific conditions' which was responsible for 9.3% of perinatal deaths, all but one case was attributed to sepsis. When the cases were subdivided by birth groups, asphyxia predominated in all but the <1000g group, in whom immaturity was responsible. Conditions associated with immaturity were second highest in number. The majority of the perinatal deaths (83.4%) was in babies less than 2500g. The study has shown that the Wigglesworth classification can be used in different types of health facilities in Bangladesh by doctors, nurses and midwives. The areas which need intervention are antepartum care, obstetric and newborn care practices, and environmental factors responsible for the high prevalence of prematurity and low birth weight.

Safety of home delivery compared with hospital delivery in The Eastern Region Health Authority in Ireland in the years 1999-2002.

A comparison was made of deaths from intrapartum hypoxia of normally formed babies > 2.5 kg born at home (N = 346) and those born in hospitals (N = 61,215). If the intended place of birth is home the chance of dying due to intrapartum hypoxia is 1:70 (5 in 346). If the intended place of birth is hospital the chance of dying is 1:3600 (17 in 61,215). Although the sample size of home births is smaller, the difference is significant (< 0.01 level of significance). In view of the small number of home births, the need for ongoing monitoring of home births over a longer period is essential.

Role of vascularization in determining the time of hypoxic-ischemic encephalopathy in the neonate.

OBJECTIVE: To examine the role of vascularization in determining the time of hypoxic-ischemic encephalopathy (HIEP). STUDY DESIGN: Brain sections of 126 neonatal autopsy cases were examined for edema, gliosis, congestion, inflammation and ischemia. Capillary vessels were examined with both reticulum stains and antibody against CD34. Vascular surface density (VSD) and number of vessels per stroma (NVES) were calculated by stereologic methods. RESULTS: Among 126 cases, 64 were male (50.8%) and 62 female (49.2%). In 25 cases HIEP was observed; 14 had a pregnancy history of hypertension, eclampsia or diabetes mellitus in the mother, with fetal distress or underdeveloped features. Statistically, NVES was strongly related to primary HIEP. However, the HIEP and non-HIEP cases revealed no differences in NVES and VSD means. CONCLUSION: Vascularization, especially NVES, helps in determining whether an HIEP case is pregnancy related or due to end-stage changes of dying, but is not an indicator of HIEP.