Absent maternofetal potassium gradient at term

Mean (SE) umbilical venous plasma potassium concentrations at 5.5, 10, 20, and 30 minutes after the start of laparotomy at term were 4.75 (0.15), 5.95 (0.26), 6.81 (0.23), and 7.59 (0.81) mmol/kg plasma water. Maternal peripheral venous plasma concentrations were 4.30 (0.13) before and 4.26 (0.23) mmol/kg plasma water after laparotomy. Plasma calcium concentration in maternal and cord blood did not change significantly.

Bioactive parathyroid hormone in pregnant rats and fetuses

Parathyroid function at the end of gestation (day 21) was investigated by measuring plasma calcium (PCa), immunoreactive parathyroid hormone (iPTH), bioactive parathyroid hormone (bioPTH; cytochemical bioassay), and bone histology in intact and thyroparathyroidectomized (TPTX; day 12, ether anesthesia) rats and their fetuses. In pregnant intact rats, PCa was significantly lower, and iPTH, bioPTH, and osteoclast number were higher than in nonpregnant rats. In fetuses, PCa was higher than maternal PCa and correlated with fetal bioPTH. TPTX suppressed maternal bioPTH and decreased iPTH and osteoclast number, whereas fetal iPTH and bioPTH were decreased with no change in osteoclast number. Fetal PCa was near normal and was correlated with maternal PCa but not with fetal bioPTH. The fetomaternal calcium gradient was maintained and even increased. This study shows that there is maternal physiological hyperparathyroidism and functional fetal parathyroid glands at the end of gestation in the rat. Parathyroid hormone does not seem to be responsible for maintaining the high fetomaternal calcium gradient in TPTX animals.

Alphafetoprotein in midtrimester Down's syndrome fetal serum

Serum alphafetoprotein was estimated in fetuses with and without Down's syndrome or with other chromosome abnormalities from the 17th to the 28th week of pregnancy. In normal fetuses, the AFP level declines steadily during this period. Before 20 weeks, there was no difference in the serum AFP levels of the three groups of fetuses. After 20 weeks, the serum AFP level in cases of Down's syndrome declined more rapidly than normal. This was not observed in fetuses with other chromosome abnormalities. This suggests that low maternal serum alphafetoprotein levels used for prenatal screening for Down's syndrome in the early second trimester cannot be explained by low levels in the Down's fetuses themselves.

Maternal and fetal catecholamines and uterine incision-to-delivery interval during elective cesarean

The fetal sympathoadrenal system is activated during periods of intrauterine stress such as inadequate uterine perfusion. During cesarean, the period of interruption of utero-placental blood flow is extended as the time interval from uterine incision to delivery increases. An increasing uterine incision-to-delivery interval with spinal or general anesthesia has been associated with a poorer neonatal outcome. This association has not been demonstrated previously in patients undergoing cesarean delivery under epidural anesthesia. We investigated the correlation between prolonged uterine incision-to-delivery intervals, fetal catecholamine concentrations, and fetal blood gas values at delivery in 25 parturients undergoing cesarean under epidural anesthesia and in 28 under spinal anesthesia. Infants delivered after prolonged uterine incision-to-delivery intervals had significantly lower pH values in both the epidural and spinal groups. With longer uterine incision-to-delivery intervals, umbilical arterial norepinephrine concentrations were increased significantly. Umbilical arterial pH values were significantly lower in infants with higher umbilical arterial catecholamine concentrations. The importance of minimizing the uterine incision-to-delivery interval, regardless of the type of anesthetic selected, is demonstrated.

Reduction of embryonic intracellular pH: a potential mechanism of acetazolamide-induced limb malformations

The effects of acetazolamide on the developing rodent limb bud were postulated to result from a reduction of intracellular pH (pHi). Embryonic intracellular pH was calculated from transplacental distribution of the weak acid, 5,5'-dimethyloxazolidine-2,4-dione, in teratogenically sensitive (C57BL/6) and resistant (SWV) inbred mice. pHi was reduced by acetazolamide treatment in C57 embryos and limb buds but not in SWV samples. Acetazolamide teratogenesis can be exacerbated by coadministration of amiloride, presumably through inhibition of Na+/H+ exchange attributable to the latter agent. pHi reduction after such treatment was more profound than after acetazolamide alone, providing further support for the central hypothesis. pH was also reduced in other embryonic (embryo plasma) and extraembryonic compartments (exocoelomic fluid, amniotic fluid). pH changes in these compartments could also lead or contribute to abnormal development.

Serum level of 19-hydroxyandrostenedione during pregnancy and at delivery determined by gas chromatography/mass spectrometry

19-Hydroxyandrostenedione (19-OHA) is secreted from the adrenal glands in men and women and also from the placenta during pregnancy. It has been found to cause hypertension in animal models. We have synthesized [7,7-2H2]-19-OHA with high deuterium content and, together with [7,7-2H2]A and [9,11-2H2]estrone (E1), have developed a quantitative assay of serum level 19-OHA, A, and E1 using the gas chromatography/mass spectrometry-mass fragmentography method to monitor individual subjects throughout pregnancy. The labeled 19-OHA, used as internal standard, showed only 6.73% of unlabeled compound. Recovery of standard 19-OHA, A, and E1 (5,000 pg each) added to male plasma was 97.4 +/- 2.3%, 96.3 +/- 2.1%, and 100.1 +/- 4.1% (mean +/- SD), respectively; the intraassay coefficient of variation was 2.1%, 3.5%, and 3.8%, respectively. Ten pregnant subjects without complications and 10 pregnant subjects near term with hypertension were selected (with informed consent). The 19-OHA and E1 serum concentrations of maternal venous blood from uncomplicated pregnancies increased significantly as gestation progressed (19-OHA: first trimester, 225 +/- 72; second trimester, 656 +/- 325; third trimester, 1,518 +/- 544 pg/ml), reaching the highest level at delivery (19-OHA: 1,735 +/- 684 pg/ml). Whereas a positive correlation was found between the level of 19-OHA and E1, no apparent change of the A level was observed during pregnancy. Levels of the three steroid hormones in pregnancy complicated by hypertension in the second and third trimester were not found to be significantly different from those of normal pregnancy (19-OHA of hypertensive subjects: second trimester, 762 +/- 349; third trimester, 1,473 +/- 491 pg/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Response to corticotropin-releasing hormone during pregnancy in the baboon

CRH is secreted by the placenta into human maternal and fetal plasma during gestation. In the present study plasma CRH was measured in the plasma of five pregnant baboons and their fetuses to ascertain whether the baboon is a suitable model for study of placental CRH. Studies were performed in chronically catheterized animals that exhibited no behavioral or endocrinological signs of stress; maternal animals moved freely about the cage. Mean maternal plasma CRH was 620 +/- 110 pmol/L (2970 pg/mL) at 146 +/- 11 days gestation, and mean fetal plasma CRH was 133 +/- 29 pmol/L (640 pg/mL) at delivery in four animals. Plasma CRH was undetectable (less than 8.5 pmol/L; less than 41 pg/mL) in nonpregnant animals and in animals 8 h after delivery. Maternal and fetal plasma CRH levels in the chronically catheterized baboon were very similar to human maternal and umbilical cord CRH levels at comparable gestational ages. In addition, the majority of maternal plasma CRH eluted in the same position as synthetic human CRH by gel filtration. CRH stimulation tests were performed in the chronically catheterized maternal baboon to investigate whether pituitary-adrenal function during pregnancy is similar to that observed after chronic CRH infusion; blunted ACTH and cortisol responses to acute injections of CRH are observed after chronic CRH infusion. The administration of 0.5 micrograms/kg ovine CRH (oCRH) failed to result in an ACTH or cortisol rise in four pregnant baboons. Baseline ACTH levels were 5.2 +/- 0.4 pmol/L (23.5 pg/mL), and baseline cortisol levels were 800 +/- 55 nmol/L (29.1 micrograms/dL); neither rose after CRH administration. In contrast, 0.5 micrograms/kg oCRH did result in significant ACTH and cortisol elevations in five nonpregnant baboons [ACTH: baseline, 5.9 +/- 1.4; peak, 16 +/- 4.8 pmol/L (P less than 0.05); cortisol: baseline, 430 +/- 55 nmol/L; peak, 960 +/- 200 nmol/L (P less than 0.05)]. In contrast, the administration of a larger dose of oCRH (5.0 micrograms/kg) led to stimulation of ACTH release in five pregnant baboons (baseline, 6.6 +/- 1.3 pmol/L; peak, 34.1 +/- 6.4; P less than 0.001). After this dose cortisol levels also rose in the pregnant animals (baseline = 1040 +/- 30 nmol/L; peak, 1620 +/- 130); however, this response was blunted compared to that in the nonpregnant animals (P less than 0.05). CRH (5.0 micrograms/kg) significantly stimulated both ACTH and cortisol in the nonpregnant animals.(ABSTRACT TRUNCATED AT 400 WORDS)

DNA polymorphism and globin chain analysis in the prenatal diagnosis of beta-thalassaemia major in Taiwan

Thirty-six pregnancies in 25 families at risk of beta-thalassaemia major received prenatal diagnosis. Chorionic villus sampling or amniocentesis was done in 35 pregnancies to obtain fetal cells for DNA linkage study, for which Southern blotting and DNA hybridization were used to detect seven restriction fragment length polymorphisms (RFLPs) within the beta-globin gene cluster: epsilon-HincII, G gamma-HindIII, A gamma-HindIII, phi beta-HincII, 3' phi beta-HincII, beta-AvaII, and 3' beta-BamHI. beta-Thalassaemia major was diagnosed in seven and excluded in 22 pregnancies. In the remaining six cases, beta-thalassaemia major could not be excluded. In these six pregnancies and another one with late booking, ultrasound-guided cordocentesis was performed at the 22nd to 27th week of gestation. Globin chain composition was determined with urea-acetic acid-Triton X-100-12 per cent polyacrylamide gel electrophoresis. beta-Thalassaemia major was diagnosed in two fetuses and excluded in the other five. Eleven fetuses (in which beta-thalassaemia major was excluded) have been delivered and are healthy at more than 5 months old. DNA linkage analysis coupled with globin chain electrophoresis provides an effective way for prenatal diagnosis of beta-thalassaemia major, although these methods are being replaced by more direct detection techniques using oligonucleotide probes.

Concentration of placental protein 19 in body fluid and placental tissues

Placental protein 19 (PP19) is one of the new placental tissue proteins identified in extracts from human term placenta by Bohn and Winkler. We measured the PP19 concentration in body fluids and placental tissue by radioimmunoassay; the minimum detectable dose of standard was 1.5 ng/ml. Although ethylene diamine tetraacetic acid (EDTA-2K) inhibited the immunoreaction between PP19 (225/242) and anti-PP19 antibody (632 ZA), the PP19 concentration did not differ between serum and heparin and sodium citrate plasmas. The serum PP19 concentration was increased by hemolysis. In blood cell fractions separated by the Ficoll-Paque/Macrodex method, polymorphonuclear leukocyte fraction contained the highest PP19 concentration. The circulating serum PP19 concentration was 4.5 +/- 1.1 ng/ml (mean +/- standard deviation) in the proliferative phase (n = 8) and 5.1 +/- 1.6 ng/ml in the secretory phase (n = 7) for nonpregnant women, and 4.6 +/- 2.2 ng/ml from men (n = 12). Seminal plasma (n = 8) contained 212.2 +/- 99.7 ng/ml. The maternal serum PP19 concentration in 291 normal pregnancies increased from 6.2 ng/ml (median) at 6-7 weeks of gestation to 34.1 ng/ml at 38-39 weeks. The mean PP19 concentration was higher in amniotic fluid and retroplacental blood, but lower in umbilical cord blood than that in circulating maternal serum. In hydatidiform mole, vesicular fluid contained high PP19 concentration (1154.6 +/- 659.5 ng/ml), although these maternal serum concentration was not statistically higher than normal range. The chorionic villous trophoblast contained more PP19 than decidua, chorion, and amnion. These results suggest that PP19 has an extraplacental source, even though the chorionic villous trophoblast may be the main source throughout pregnancy.

[Use of fentanyl for anesthesia induction in cesarean section. Pharmacokinetics and pharmacodynamics in mother and child]

A group of 36 patients in the last trimester of pregnancy and scheduled for cesarean section were examined during the induction of standardized general anesthesia (methohexitone 1.5 mg/kg, succinylcholine 1.5 mg/kg). No other inhalation anesthetics than N2O/O2 (50%:50%) were administered. In addition, 18 of the women received 0.005 mg/kg fentanyl prior to intubation. The remaining 18 patients served as a control group. In the study group maternal fentanyl plasma levels were determined 1 min after injection and again at the time of omphalotomy (radioimmunoassay). Immediately after clamping of the umbilical cord the fetal fentanyl plasma levels and the pH, pCO2 and pO2 values in both umbilical vein and artery were measured. The feto-maternal ratio and the fetal uptake were calculated. RESULTS. Maternal fentanyl plasma levels decreased significantly, from 7.84 (3.55-17.24) ng/ml 1 min after injection to 5.92 (2.01-14.15) ng/ml during omphalotomy. The corresponding fentanyl plasma levels in the umbilical vein were 2.08 (0.88-3.42) ng/ml. The feto-maternal ratio was 0.44 (0.08-1.00). The induction-delivery time ranged from 2 to 8 min. There was a significant correlation between umbilical-venous fentanyl concentration and the induction-delivery time: the longer the induction-delivery time the lower the fentanyl concentration in the umbilical vein. The 1-min Apgar score was 8 (5-9), the 5-min Apgar score 9 (8-10) and the 10-min Apgar score 10 (9-10) in neonates born to the fentanyl group. Only the 1-min Apgar score was significantly lower than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

[The first case of prenatal diagnosis of sickle cell anemia in the USSR]

A married couple with a risk to have a child with sickle-cell anemia has been detected as a result of mass screening of pregnant women in Baku. The prenatal diagnosis was made on the 26th week of pregnancy by means of chordocentesis and biosynthesis of globin chains that revealed the absence of normal beta-globin chain synthesis in the presence of beta S. The diagnosis of sickle-cell anemia was confirmed after abortion in the fetal blood material obtained from the heart by isoelectro-focussing. The family has received a recommendation on the prenatal DNA-diagnosis in the first trimester on the next pregnancy.

Evaluation of fetal and neonatal acid-base status

Determination of fetal acid-base status, either at birth, intrapartum, or antepartum, is the gold standard for the diagnosis of fetal asphyxia. Indirect methods such as Apgar scores and fetal heart rate monitoring show at best only minimal correlation. It is evident that intrauterine hypoxia is a rare cause of central nervous system injury, and the finding of a normal acid-base status at birth should lead the clinician to search for other causes of central nervous system injury or birth depression. A combination of techniques including fetal acid-base assessment, electronic fetal heart rate monitoring, and thorough neonatal evaluation probably provides the best predictor of long-term outcome. Newer methods of umbilical cord sampling and acid-base determinations in the intrauterine growth retarded fetus hold some hope for the future.

Fetal cystic hygromata: insights gained from fetal blood sampling

Twelve second-trimester fetuses with cystic hygroma underwent fetal blood sampling for rapid karyotyping, haematologic evaluation, and blood gas analysis. An abnormal karyotype was found in seven cases: monosomy X in five, trisomy 21 in one, and trisomy 13 in the other. Eight of ten fetuses undergoing blood gas analysis showed hypoxaemia, five of which were growth-retarded. Nine pregnancies were terminated. Of the remaining three, only one fetus survived the perinatal period.

Placental transfer of vitamin K1 in preterm pregnancy

Seventy-eight women at earlier than 35 weeks' gestation with premature rupture of membranes and/or preterm labor were randomly assigned to receive either 10 mg vitamin K1 intramuscularly (IM) or no treatment. If delivery did not occur within 4 days, the dose of vitamin K1 was repeated. Women whose pregnancies continued beyond 8 days received 20 mg of vitamin K1 orally every day until the end of the 34th week or until delivery, whichever occurred earlier. The median maternal plasma vitamin K1 level was significantly higher in treated than in untreated subjects (11.592 versus 0.102 ng/mL; P less than .001). The median cord plasma levels were 0.024 ng/mL in the treated group and 0.010 ng/mL in the controls, a significant difference (P = .046). Median plasma vitamin K1 levels were comparable in mothers receiving the drug by the IM route only and by both the IM and oral routes (10.533 versus 11.928 ng/mL; P = .460). The infants of the latter group, however, had significantly higher median cord plasma levels (0.42 versus 0.017 ng/mL; P less than .001). There was no correlation between cord plasma vitamin K1 levels and gestational age or duration of maternal supplementation with vitamin K1. We conclude that, in preterm pregnancies, vitamin K1 crosses the placenta slowly and to a limited degree.

Prenatal effects of maternal caffeine intake and dietary high protein on mandibular development in fetal rats

The purpose of the present study was to determine the effects of caffeine on the mandibles of newborn rats whose dams were given a normal diet (200 g protein/kg diet) compared with those given a high-protein diet (400 g protein/kg diet) during gestation. A total of twenty pregnant Sprague-Dawley rats were randomly divided into four groups of five each. Starting on day 7 of gestation, groups 1 and 2 were fed on control and high-protein diets respectively, and groups 3 and 4 were pair-fed with groups 1 and 2 respectively, but with caffeine added to their diets. The caffeine supplement was 20 mg/kg body-weight. At birth, pups were killed and various measurements of their mandibles were made. The mandibular weights, calcium contents, and alkaline (EC 3.1.3.1) and acid (EC 3.1.3.2) phosphatase activities of the group given the caffeine-supplemented control diet were significantly lower than those of the corresponding unsupplemented group. Alkaline and acid phosphatase activities, collagen synthesis and hydroxyproline contents of the caffeine-supplemented high-protein group were greater than those of the corresponding unsupplemented group, whereas Ca and protein contents of the caffeine-supplemented high-protein group were lower than those of the corresponding unsupplemented group. There were no significant differences in plasma caffeine levels for either dams or pups between the caffeine-supplemented control and high-protein groups. The effects of caffeine on the development of fetal mandibles are apparently modified by different levels of maternal dietary protein.

[Changes in various parameters of humoral immunity and the sympathetico-adrenal system in newborn infants after transcutaneous electric nerve stimulation in premature labor]

Transcutaneous electric neurostimulation (TENS) as a mode of reflex therapy acts on the hypothalamic-pituitary control via the neuromediator system to modulate the activity of endocrine glands, metabolism and the immune status. Immunoglobulin and catecholamine levels and the activity of tumor necrosis factor have been assayed in umbilical blood sera of 25 preterm newborns who were delivered using TENS (n = 10) and spontaneously (n = 15). Comparison of clinical data and the findings of catecholamine and immune factor assays suggested that TENS in premature delivery improved fetal and neonatal adaptations to perinatal stresses and infection.

Fetal uptake of intraamniotic digoxin in sheep

To explore the possibility that intraamniotic administration of digoxin is an effective treatment regimen for fetal tachyarrhythmia, we injected digoxin into the amniotic fluid cavity of pregnant sheep and examined the time course of digoxin distribution to the fetal and maternal plasma compartments. Animals were studied in two groups according to digoxin dosage: 0.7-1.8 nmol/kg fetal body wt in the high-dose group (n = 6) and 0.1-0.6 nmol/kg fetal body wt in the low-dose group (n = 14). Within 1 h, plasma digoxin concentrations in the high-dose and low-dose groups were 18.2 +/- 15.0 nmol/L and 2.7 +/- 0.8 nmol/L, respectively (values are expressed as mean +/- SD). At 6 h digoxin concentrations were 13.8 +/- 7.0 and 3.1 +/- 0.9 nmol/L, and at 24 h they were 2.3 nmol/L (n = 1) and 1.8 +/- 1.2 nmol/L, respectively. Peak maternal digoxin levels were about one-tenth fetal values in the high-dose group and undetectable in the low-dose group. Fetal digoxin concentrations were significantly greater in the descending aorta than in the umbilical vein (p less than 0.02). Fetal arterial blood pressure and heart rate were not significantly different from control at any time after digoxin administration. These results demonstrate that digoxin is rapidly taken up into the fetal circulation from the maternal amniotic cavity. The exact mechanism whereby this occurs is unknown, but transplacental transfer from the maternal circulation is not involved. Our findings suggest that intraamniotic administration of digoxin may be an alternative treatment for fetal tachyarrhythmias when direct administration of antiarrhythmic agents is ineffective or produces maternal toxicity.

Chronic fetal malnutrition and vitamin A in cord serum

The relationship between type I IUGR (chronic fetal malnutrition) and cord serum levels of vitamin A was studied in 269 infants from Guatemala. Of the newborns in the sample, 28 per cent were type I IUGR, 8 per cent were type III UGR (acute fetal malnutrition), and 64 per cent were of normal weight for gestational age. A trend of increasing birthweight with increasing vitamin A levels was found. Also, vitamin A levels in the cord blood of the smallest type I IUGR babies were significantly lower than levels in the smallest type II IUGR babies. Vitamin A levels and birthweight were positively associated only among type I IUGR neonates. Significantly more type I IUGR babies had vitamin A levels in the lowest quartile than did babies of normal birthweight.

Growth hormone, insulin and glucose concentrations in bovine fetal and maternal plasmas at several stages of gestation

For cows on d 137 (n = 6), 180 (n = 8), 226 (n = 9) and 250 (n = 5) of gestation (Exp. 1), concentrations of insulin and glucose were two- to three-fold less (P less than .01) in fetal venous plasma than in uterine arterial plasma. Concentrations of growth hormone, conversely, were 10- to 20-fold greater (P less than .01) in fetal venous than in uterine arterial plasma. Concentrations of insulin and glucose in maternal and fetal plasmas and concentrations of growth hormone in maternal plasma did not vary with stage of gestation. Concentrations of growth hormone in fetal venous plasma, however, were greater on d 226 and 250 than on d 137 and 180. For cows (n = 6) on d 198 of gestation (Exp. 2), concentrations of insulin and glucose in maternal and fetal plasmas and of growth hormone in maternal plasma remained relatively constant in samples collected every 30 min for 3 h. In contrast, growth hormone concentrations in fetal venous plasma were highly variable and appeared to be episodic, with pulses of 10 to 60 ng/ml in amplitude. No significant correlations were found among concentrations of insulin, glucose and growth hormone in fetal venous plasma. When samples were collected every 15 min for 4 h from cows (n = 5) on d 198 of gestation (Exp. 3), episodes of growth hormone in fetal venous plasma were irregular in amplitude and frequency.(ABSTRACT TRUNCATED AT 250 WORDS)

Radioimmunoassay of digoxin in serum using monoclonal antibodies and assessment of interference by digoxin-like immunoreactive substances

We used 7 monoclonal antibodies (MoAbs) and one polyclonal antibody to develop radioimmunoassays (RIAs) for digoxin in serum or plasma. These RIAs were tested for measuring apparent digoxin concentrations in serum from patients receiving the drug, from normal individuals, and in cord blood plasma. We found that two MoAbs cross-reacted significantly with substances in cord blood. The magnitude of cross-reactivity was dependent on the incubation time and temperature. Under equilibrium conditions, one antibody gave apparent digoxin values in cord blood plasma averaging 2.15 ng/ml. We suggest that this cross-reactivity is partially due to progesterone and 17-hydroxyprogesterone in cord blood plasma. The antibody that shows high cross-reactivity with digoxin-like immunoreactive substances may prove a useful tool for studies dealing with characterization of the cross-reacting compounds.

Evaluation of variable decelerations of fetal heart rate with the deceleration index: influence of associated abnormal parameters and their relation to the state and evolution of the newborn

The deceleration index of the Fetal heart rate (FHR) (Acién P. et al. (1979) J. Perinat Med 7, 7-18) was used to analyze 157 cardiotocographic registers that displayed variable deceleration during labor. We have related the deceleration index value to perinatal results and to other abnormal parameters of FHR. An increase in neonatal pathology was observed in the deceleration group compared to a group of 50 controls with normal FHR, when the deceleration index was greater than 150 and specially if it was greater than 200. The association of other abnormal parameters of FHR (especially absence of variability between or during decelerations, absence of transitory ascents, presence of tachycardia and, of less importance, absence of ascents at the beginning of deceleration or presence of overshoot acceleration following deceleration) yields a worse prognosis for the fetus than does an increased deceleration index alone. The deceleration index is a good method for evaluation of variable decelerations of FHR, and is well correlated to the condition of the newborn.

Prediction of the development of atopic symptoms in early childhood by cord IgE-binding factors (soluble Fc epsilon R2)

The relationship of cord serum sFc epsilon R2 levels to the development of atopic symptoms in early childhood was studied. Cord sFc epsilon R2 was 444.2 +/- 235.1 pg/ml (n = 77), which was not significantly different from maternal serum sFc epsilon R2 (541.7 +/- 346.9 pg/ml, n = 42). However, there was no correlation between cord and maternal serum sFc epsilon R2, suggesting that most, if not all, of cord serum sFc epsilon R2 was produced by the fetus itself. Cord serum sFc epsilon R2 in infants who developed atopic symptoms later was significantly higher than that in infants who were free of atopic symptoms (P less than 0.01 at 7 and 13 months of age). The incidence of the development of atopic symptoms increased with the increase of cord serum sFc epsilon R2. These results suggest that sFc epsilon R2 is related to the development of atopic disorders and that the measurement of cord serum sFc epsilon R2 may be of value in predicting the development of atopic disorders in early childhood.

Perinatal outcome after a prolonged second stage of labor

It is commonly held that the second stage of labor should last no more than two hours because of an apparently increased risk of morbidity. The purpose of this investigation was to determine whether this commonly held notion is true in this era of close fetal monitoring and umbilical blood gas determination. Between May 1987 and October 1988, 50 (3.5%) of 1,432 uncomplicated term pregnancies ended in delivery after a second stage of labor lasting greater than 120 minutes. A prolonged second stage was associated more commonly with nulliparity, occiput posterior positioning, epidural anesthesia and a need for operative delivery but not birth weight greater than 4,000 g or a short umbilical cord. Infants born after a prolonged second stage did not have an increased incidence of umbilical artery pH less than 7.20 or of five-minute Apgar scores less than 7, nor did they need intensive care nursery admission. A prolonged second stage of labor appears not to impose an increased hazard on the fetus but does require close fetal monitoring and increases the possibility of operative delivery.

A double-blind comparison of epidural bupivacaine and bupivacaine-fentanyl for caesarean section

The effect of adding fentanyl 100 mcg to bupivacaine 0.5% plain to establish epidural anaesthesia for elective caesarean section was investigated in a randomised, double-blind study of sixty healthy women. The quality of intraoperative analgesia as assessed by both patients and anaesthetists was significantly improved with fentanyl. The onset and duration of sensory anaesthesia, degree and duration of motor block, and other characteristics of epidural anaesthesia were unaltered. No adverse maternal side-effects (except mild pruritus) were noted and neonatal outcome was unaffected. The pharmacokinetics of epidural fentanyl administration were investigated by plasma fentanyl assays from maternal and cord blood taken at delivery. Epidural bupivacaine-fentanyl combination is a valuable therapeutic approach to the conduct of epidural anaesthesia for caesarean section in healthy women and foetuses. Further neonatal evaluation of the premature or compromised foetus is suggested before the universal application of this technique.

Fetal breathing, sleep state, and cardiovascular responses to adenosine in sheep

The possibility that adenosine mediates hypoxic inhibition of fetal breathing and eye movements was tested in nine chronically catheterized fetal sheep (0.8 term). Intracarotid infusion of adenosine (0.25 +/- 0.03 mg.min-1.kg-1) for 1 h to the fetus increased heart rate and hemoglobin concentration but did not significantly affect mean arterial pressure or blood gases. As with hypoxia, adenosine decreased the incidence of rapid eye movements by 55% and the incidence of breathing by 77% without significantly affecting the incidence of low-voltage electrocortical activity. However, with longer (9 h) administration, the incidence of breathing and eye movements returned to normal during the adenosine infusion. Intravenous infusion of theophylline, an adenosine receptor antagonist, prevented most of the reduction in the incidence of breathing and eye movements normally seen during severe hypoxia (delta arterial PO2 = -10 Torr). It is concluded that 1) adenosine likely depresses fetal breathing and eye movements during hypoxia and 2) downregulation of adenosine receptors may contribute to the adaptation of breathing and eye movements during prolonged hypoxia.

[Amniocentesis versus choriocentesis (chorionic villi sampling) and cordocentesis (fetal blood sampling)]

Opinions are still divergent regarding the respective place of amniocentesis and choriocentesis in the scheduled prenatal diagnosis. Amniocentesis (PLA) is the oldest method. This technique is perfectly mastered as well as its results, complications; its follow-up is 17-18 years in the world and over 16 years in Lyon. The rate of technical failures is inferior to 0.5 p. cent under ultrasonographic control. Its results are quite reliable (one error in 4 to 5,000 amniocentesis for the karyotype). The culture failures are under 1 p. cent. The titration of tracers, such as alpha-feto-protein or acetyl-cholinesterase is possible, favoring PLA over choriocentesis when there is a risk of neural dysraphias. PLA may be performed at any time during the pregnancy. Its main drawback seems to be its lateness: currently, the ideal time is 15-16 weeks. PLA performed earlier may result in more technical and culture failures. When performed at 12-13 weeks, it enters in competition with the choriocentesis although its theoretical risk of abortion is lower. Therefore, PLA and choriocentesis may be competitors, according to the risk factors and the indications, especially regarding cytogenetics.

Androgens in fetal pigs in relation to sex of neighbour(s)

Concentrations of androgens in blood and/or fetal fluids were determined in pig fetuses 35, 56/58 and 115 days of age. For each fetus the sex of its neighbour(s) in utero was determined. Irrespective of the sex of neighbour(s), no significant differences in testosterone levels were found between the different groups of females, or between the different groups of males. When females and males were compared, significant differences were found. At a fetal age of 35 days testosterone concentrations (mean and SD) in amniotic fluid were 0.17 +/- 0.06 and 0.26 +/- 0.05 nmol/l in females and males, respectively (p less than 0.01). At a fetal age of 56/58 days, the corresponding values were 0.14 +/- 0.04 and 0.21 +/- 0.07 nmol/l (p less than 0.01). At this age testosterone concentrations in mixed umbilical blood plasma were 0.22 +/- 0.08 in females and 1.12 +/- 0.64 nmol/l in males (p less than 0.001). At term the mean concentrations of testosterone were 2.4 and 2.5 nmol/l in mixed umbilical blood plasma and 1.6 and 1.7 nmol/l in fetal fluid in females and males, respectively. The levels of dehydroepiandrosterone in fetal fluid at this stage were 1.6 nmol/l in females and 1.7 nmol/l in males. Concentrations of dihydrotestosterone were below the sensitivity level of the method (less than 0.09 nmol/l) in all samples tested. It is concluded that male neighbours do not influence the androgen levels in blood plasma and fetal fluids of the females.

Biochemical changes in the mother and the fetus during labor and its significance for the management of the second stage

In 69 patients with uneventful pregnancies, term labor was studied prospectively with respect to length of second stage, number of bearing down efforts, maternal and fetal levels of lactate, epinephrine and norepinephrine. Maternal venous blood concentrations were measured in early labor and at the time of delivery while samples from umbilical artery and vein provided fetal blood. There was a significant rise of lactate and catecholamines in maternal blood during labor and at delivery fetal lactate concentration was lower than the maternal level while for epinephrine and norepinephrine fetal levels were higher. For all three compounds umbilical artery concentrations were higher than umbilical venous levels. While there was no correlation between the biochemical parameters in maternal blood and length of second stage maternal lactate and norepinephrine concentration at the time of delivery significantly correlated with the number of bearing down efforts. Umbilical artery lactate correlated with both, length of second stage and number of bearing down efforts.

Safety of cordocentesis under ultrasound guidance for fetal blood sampling

In the present study, we attempted to assess the safety and the risk of cordocentesis under ultrasound guidance for fetal blood sampling. Forty-five cordocenteses in 43 cases were carried out. These forty-three cases included 23 nonimmunologic hydrops fetalis, 12 congenital fetal malformations, 3 chromosome aberrations, 3 Rh isoimmunization, and 2 idiopathic thrombocytopenic purpura. Gestational age when cordocentesis was performed ranged from 17 to 39 weeks of gestation. In 42 (93.3%) out of 45 procedures, pure fetal blood was obtained. Postpuncture bleeding was observed in 17 cases (37.8%). In 12 (70.6%) out of 17 cases, bleeding stopped within 2 minutes. In only one case, bleeding continued for 11 minutes and cesarean section was performed due to fetal distress. Cardiotocogram obtained after cordocentesis revealed no ominous signs in the other 44 procedures. The other complications, including premature rupture of the membranes, premature labor, and intrauterine infection, did not occur during or after this procedure. There were no cases in which any kind of injury to the placenta or umbilical cord was observed.

Pure fetal blood samples obtained by cordocentesis: technical aspects of 322 cases

Three hundred and twenty-two percutaneous umbilical blood samplings were performed over 4 years in our prenatal diagnostic centre. A 3.5 MHz sector ultrasound transducer was used to guide a 22.5-gauge needle under local anaesthesia. Sampling was performed for rapid fetal karyotyping (within 72 h) in 120 cases, for diagnosis of fetal toxoplasmosis in 133 cases, for determination of the severity of Rh immunization in 15 cases, and for diagnosis of congenital rubella in 4 cases. Pure fetal blood was obtained in 98.7 per cent of the cases after two attempts. The approach to the cord was either transamniotic or transplacental. Puncturing was preferentially done at the placental insertion of the cord (72.2 per cent of the cases) and the mean blood sample volume was 3.5 ml. The rate of fetal death in utero was 1.9 per cent, including two cases of amnionitis, one trisomy 18, and one severe bradycardia. The failures were due to sampling at an early stage of pregnancy (before gestation week 18), to maternal obesity, oligohydramnios, and the inexperience of the operator.

Hypertriglyceridemia and hypoxemia in small-for-gestational-age fetuses

Plasma triglyceride concentration and blood oxygen tension were measured in samples obtained by cordocentesis from 35 small- and 54 appropriate-for-gestational-age fetuses at 18 to 36 weeks' gestation. In the appropriate-for-gestational-age fetuses there was an exponential decrease in plasma triglycerides with gestation. Some small-for-gestational age fetuses were hypertriglyceridemic and the degree of this biochemical disturbance was significantly correlated with the degree of fetal hypoxemia.

Relation of rate of urine production to oxygen tension in small-for-gestational-age fetuses

Hourly fetal urine production rate was determined by real-time ultrasonography immediately before cordocentesis for blood gas analysis in 27 small-for-gestational-age fetuses at 20 to 37 weeks' gestation; in 14 cases there was associated oligohydramnios. The values were compared with those of 101 appropriate-for-gestational-age fetuses. The hourly fetal urine production rate was significantly lower in the small-for-gestational-age fetuses than in the appropriate-for-gestational-age fetuses. Furthermore, there was a significant correlation between the degree of decrease in urine production and both the degree of fetal hypoxemia and the degree of fetal smallness. There was no significant difference between the oligohydramnios and nonoligohydramnios groups in either the degree of decrease in urine production or the degree of fetal hypoxemia.

[Chorionic villi sampling. Amniocentesis. Cordocentesis]

For early antenatal diagnosis, chorionic villus sampling (CVS) represents a valid alternative to early amniocentesis. It gives rapid results with minimal increase in risks (miscarriage about 1.5 p. cent). The indications of CVS are therefore likely to broaden. For late antenatal diagnosis, linked to an echographic or clinical anomaly, sampling of fetal blood by funicular puncture is taking precedence over sampling of amniotic fluid. Results can be obtained easily and much more quickly at low risk (about 1 p. cent). These techniques are in no way alternatives, but rather complement one another. It is always advisable to choose with care the technique that offers the greatest information with maximum safety.

Sex-specific fetal lung development and müllerian inhibiting substance

Male neonates develop respiratory distress syndrome (RDS) with a greater incidence and mortality than do female neonates; the cause of this male disadvantage remains obscure. Male fetuses are exposed to higher levels of androgens and Müllerian inhibiting substance (MIS). Androgens have been shown to inhibit fetal lung maturation, and recent evidence in vitro indicates that MIS, a Sertoli cell-derived glycoprotein made early in ontogeny of the testis, may also inhibit lung development. To study whether this fetal regressor might inhibit maturation of the fetal lung in vivo, we injected human recombinant MIS (rMIS) into fetal rats, measured serum levels of rMIS using an enzyme-linked immunosorbent assay, and analyzed fetal lung tissue histologically and for protein, glycogen, DNA, and disaturated phosphatidylcholine content. Peak serum levels of recombinant MIS were measured at 6 h, with an apparent elimination half-life of 3 h, and without leakage into adjacent littermates injected with vehicle alone. Female fetal rat lung tissue exposed to recombinant MIS (10(-9) M, 10(-8) M) revealed depressed disaturated phosphatidylcholine content both 48 and 72 h after injection compared with female vehicle-injected littermates. Male lungs of the same gestational age appeared inhibited at a higher (10(-8) M) rMIS dose. These inhibitory effects observed in vivo confirm those previously seen in vitro and suggest that MIS, as well as androgens, may play a causative or important ancillary role in the sexual dimorphism that characterizes the neonatal respiratory distress syndrome.

Induction of parturition in pigs: short term effects of prostaglandin F2 alpha on chronically catheterised fetuses at term

Blood pH and PaO2, and plasma glucose and cortisol concentrations were measured, together with myometrial electromyographic (EMG) activity and fetal heart rate, in eight chronically catheterised gilts and 13 of their fetuses during the induction of parturition with prostaglandin F2 alpha (given as the tromethamine salt). Myometrial EMG activity increased markedly in the first one to two hours after the injection but there was a period of relative quiescence over the next two to three hours. Fetal PaO2 fell significantly after the injection of PGF2 alpha (26.3 vs 21.8 Torr, P less than 0.001) but was unaffected by the injection of saline. Fetal and maternal cortisol concentrations increased significantly (fetal 57.3 vs 92.0 ng/ml, P less than 0.01; maternal 43.1 vs 84.9 ng/ml, P less than 0.001) in response to PGF2 alpha injection. Maternal PaO2 and fetal and maternal pH and plasma glucose concentrations were not altered by the injection of either prostaglandin PGF2 alpha or saline. Mean fetal heart rate increased by 7 to 10 per cent during the first hour after induction but this increase was not significant owing to the wide variations in response. It was concluded that the induction of parturition with prostaglandin F2 alpha resulted in a significant decrease in fetal oxygenation during the period of increased uterine activity but that this effect was transient and would not have an adverse effect in normal pregnancies.

Genetic and environmental influences on cord blood serum IgE and on atopic sensitisation in infancy

It has recently been reported that cord blood serum IgE (CBsIgE) concentrations in a black Third-World cohort were significantly higher than those in a similar cohort of white and coloured newborns, and were not influenced by an atopic family history (aFH). This study reports on the 1-year follow-up of these newborns carried out to determine whether statistical differences in median CBsIgE values at birth could be found between infants in each ethnic group who subsequently developed clinical atopy in the first year of life and those who remained healthy. The infants were seen at 3, 7 and 12 months of age. At each visit a detailed history was taken from the mothers, the infants were examined clinically for the presence of atopic disease and blood was taken for immunological assay (total serum IgE by paper-disc radio-immunosorbent testing, and radio-allergosorbent testing for egg-white, cow's milk and Dermatophygoides pteronyssinus). A combination of clinical and immunological variables was assessed in order to categorise the infants into 'atopic' or 'not atopic' groups at the end of the 1-year follow-up period. The black infants who completed the study had the lowest incidence of aFH (16%), but 64% of them developed atopic disease during infancy. The median CBsIgE values for the black infants who became atopic were lower than, but not statistically different from, those for the group who remained non-atopic (P = 0.57). The white and coloured infants who completed the study had 81.6% and 30.4% incidences of aFH respectively, with 47.4% and 58.7% respectively developing atopic disease during infancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic impairment in fetuses of preeclamptic mothers

Cord blood from preeclamptic and normal gestations were analyzed for the vitamin K-dependent proteins, factors II, VII, IX, X, and protein C, and for fibrinogen and albumin. Factor II, factor IX, protein C, and albumin protein levels were reduced in the preeclamptic group, whereas there was no significant change in the fibrinogen or factor X protein levels. The data suggest that these findings are probably due to decreased synthesis and are not indicative of vitamin K deficiency.

Cis- and trans-isomeric fatty acids in plasma lipids of newborn infants and their mothers

The proportionate fatty acid composition of plasma lipids was determined by high-resolution gas-liquid chromatography in 30 pairs of mothers and their term infants at the time of birth. Trans-fatty acids were found at similar percentage levels in maternal and infantile plasma, evidence for the first time of their placental permeability. In umbilical plasma, linoleic and alpha-linolenic acids contributed markedly smaller portions to total fatty acids, in contrast to clearly higher proportions of their long-chain polyunsaturated metabolites (LCP). Significantly larger percentage values in cord than in maternal plasma were found for those LCP that are structural components of brain lipids, which may reflect a discriminating placental transport mechanism for certain physiologically important LCP.

Clinical features of sickle cell disease in eastern Saudi Arab children

The clinical features of sickle cell disease (SCD) in Saudi Arab children of eastern origin are presented. One hundred and seventy-three children were diagnosed at birth and followed prospectively from 3 months to up to 4 years of age. There were 87 boys and 86 girls. Genotype distribution included 146 sickle cell anemia, 24 sickle beta +-thalassemia, two sickle beta 0-thalassemia, and one sickle hemoglobin C disease. Of our patients, 7% presented in the first 12 months of age and 27% remained asymptomatic at 4 years. Painful crises of bones and joints were the most common initial symptoms, followed by dactylitis, abdominal crises and acute splenic sequestration (ASS), occurring in 60%, 31.6%, 6.7%, and 1.7% of the patients, respectively. None of the patients presented with severe bacterial infections. During this study, 175 sickle cell crises were documented, but only 16 (9.1%) required hospital admissions. There were no deaths in this series. High hemoglobin F levels correlated with delayed clinical presentation and reduced number of crises. We conclude that SCD in children of eastern origin is clinically milder than earlier descriptions from the Eastern Province of Saudi Arabia.

Does ephedrine influence newborn neurobehavioural responses and spectral EEG when used to prevent maternal hypotension during caesarean section?

The recovery of 16 infants born by elective caesarean section with spinal anaesthesia, in which either ephedrine or fluid load was used to prevent maternal hypotension, were studied using Scanlon's neurobehavioural tests and a computerized EEG. Neurobehavioural testing showed no differences between the ephedrine and the non-ephedrine groups of infants at ages of 3 h, 1 day, 2 days and 4-5 days, whereas the spectral EEG showed significant differences between the two groups during the first 2 h after delivery, which had disappeared 24 h later. It is suggested that small doses of ephedrine given to the mother i.v. to prevent hypotension during spinal anaesthesia have short-lived effects on the neonate's central nervous system, which will be detected in the spectral EEG, but not in neurobehavioural tests.

[Cordocentesis for prenatal diagnosis]

Cordocentesis for prenatal diagnosis was being performed in the seventies during the process of fetoscopy. Since then the technique has been used as a diagnostic tool for intrauterine infection, hematological and metabolic disorders and metabolic status of the fetus; and for rapid cytogenic analysis. We report our first 207 cordocenteses performed since December 1985. First puncture was successful in half the cases. The procedure resulted in termination of pregnancy in only 0.96% of cases. Though a new technique, cordocentesis is playing a major role in modern perinatology. The possibility of a direct route to fetal blood vessels early in pregnancy would lead to earlier diagnosis and treatment.

Vitamin K1 levels and coagulation factors in healthy term newborns till 4 weeks after birth

Vitamin K1 serum levels were assessed by means of an off-line multidimensional liquid chromatography in 18 mothers, shortly after delivery, and in their healthy term infants. Umbilical cord and venous blood samples were assayed up to 4 weeks of life. Concurrently, levels of coagulation factors II and X, antithrombin III and platelets were established. Although the detection limit of the assay was as low as 22 pg/ml, vitamin K1 concentration appeared to be still beyond that level in cord blood or in newborn serum within 30 min after birth, whereas vitamin-K-dependent coagulation factors are already at a level of 40%, without evidence for the presence of descarboxy prothrombin, in any of the investigated neonates. After 3 days, breast-fed neonates had lower vitamin K1 levels than formula-fed infants (0.76 and 1.44 ng/ml, respectively). The levels of the vitamin-K-dependent coagulation factors II and X, however, were comparable, regardless of the kind of feeding. After 28 days, breast-fed neonates had even lower vitamin K1 levels (0.49 ng/ml, while the formula-fed infants showed higher vitamin K1 levels (4.45 ng/ml). But even then, the levels of vitamin-K-dependent coagulation factors II and X were comparable, regardless of the kind of feeding. From this we conclude that the serum levels of vitamin K1 in formula-fed neonates exceed those of breast-fed infants from the moment of feeding (24 h and later) without a concomitant rise in vitamin-K-dependent coagulation factors. A relationship between vitamin K1 levels and vitamin-K-dependent coagulation factors could not be established in healthy term breast-fed or formula-fed infants.

Temporal fluctuation of the lead level in the cord blood of neonates in Taipei

From August 1985 to September 1987, 9,502 cord blood samples were obtained from the Taipei Municipal Maternal and Child Hospital. A total of 205 cord blood samples chosen randomly from newborns without parental exposure to lead were analyzed by flameless atomic absorption spectrophotometry. The average blood lead level was .36 +/- .11 mumol/l (7.48 +/- 2.25 micrograms/dl). A similar analysis was performed on samples obtained from 160 newborns whose fathers had occupational lead exposure. In both groups, the average concentration of lead in cord blood in the summer was statistically greater than that in the winter. Air lead and total amount of lead in gasoline consumed in Taipei appeared to be associated with this seasonal fluctuation in the average lead level of cord blood. After considering alternative sources, we conclude that the seasonal fluctuation of cord blood lead is probably influenced by air lead produced from the combustion of gasoline.

Counseling and decision dilemmas associated with fetal blood sampling

Counseling before fetal blood sampling via cordocentesis is more difficult than that done before amniocentesis because 1) a fetal anomaly has been detected or is very likely, 2) the cordocentesis procedure may have a higher risk than does amniocentesis, and 3) the gestational age is frequently advanced before referral. These factors result in counseling and decision dilemmas that include that 1) the advanced gestational age may preclude the option of termination, 2) fetal prognosis may be poor despite normal cytogenetic results, and 3) the benefit of a diagnosis to provide indications for various delivery options must be weighed against the psychological burden of documenting a chromosome abnormality far in advance of delivery. Thus, counseling before cordocentesis requires engaging the couple in decision making regarding potential management of the pregnancy as a prerequisite to choosing or declining the procedure.

Maternal and cord serum glycosylated protein in neonatal macrosomia and correlation with birth weight

Maternal glycosylated hemoglobin and glycosylated protein and cord glycosylated protein were measured at delivery in 20 normal mothers of 20 macrosomic neonates over 4000 g (group I) and compared with values in two groups of mother/infant pairs: 20 normal/20 appropriate for gestational age (group II) and nine diabetic mothers/ten neonates (group III). Infants in group I, by design, weighed more (mean +/- SD 4403 +/- 337 g) than those in group II (2902 +/- 278 g) or group III (3365 +/- 898 g) (P less than .001). There was no significant difference in weight between group II and group III infants. Birth weight ratio was greater (P less than .001) in group I than in group II or group III (1.39 +/- 0.1, 0.9 +/- 0.08, and 1.08 +/- 0.25, respectively); group III infants had a higher birth weight ratio (P less than .05) than those in group II. Hematocrit (%) was higher (P less than .05) in group III (62 +/- 3) than in group I (59 +/- 5) or group II (57 +/- 6) infants. Glycosylated hemoglobin values were similar in all three groups. Mean serum glycosylated protein was higher (P less than .001) in group III (13.8 +/- 2%) than in group I (10 +/- 2%) or group II (9.8 +/- 2.5%) mothers. Cord glycosylated protein was also higher (P less than .001) in group III (12.3 +/- 1.9%) than in group I (9 +/- 1.3%) or group II (8.6 +/- 1.7%) neonates.(ABSTRACT TRUNCATED AT 250 WORDS)