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Ficarola F, Svelato A, Angioli R, Rossi R, D'Avino S, DE Luca C, Rinaldo D, Ragusa A. Reduced fetal movements: the case of Fetomaternal Hemorrhage. Case series and proposal of a management protocol. Minerva Obstet Gynecol 2021; 74:386-392. [PMID: 34904586 DOI: 10.23736/s2724-606x.21.04972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fetomaternal hemorrhage (FMH) was reported more than 60 years ago for the first time defined by the transfer or transfusion of fetal blood into the maternal circulation before or during delivery. The transfused volume is usually very small but when this value exceeds, it may be clinically significant. Antenatal diagnosis of severe FMH is difficult and it can be suspected in case of reduction of fetal movements, abnormal cardiotocography and ultrasound. FMH is associated to different adverse outcomes and admission to neonatal intensive care. The low incidence of FMH limits the studies, thus being able to rely only on diagnosis and retrospective studies. We present case series of FMH and analyze the steps with the purpose of defining a flow-chart for early diagnosis and management of FMH.
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Affiliation(s)
- Fernando Ficarola
- Department of Obstetrics and Gynecology, Policlinico Campus Bio-Medico, Rome, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy -
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Policlinico Campus Bio-Medico, Rome, Italy
| | - Rita Rossi
- Department of Obstetrics and Gynecology, Massa Carrara General Hospital, Massa Carrara, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Caterina DE Luca
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Denise Rinaldo
- Department of Obstetrics and Gynecology, Bolognini General Hospital, Seriate, Bergamo, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
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2
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Maged AM, Waly M, AbdelHak A, Eissa TS, Osman NK. Correlation of Doppler Velocimetry of Uterine and Umbilical Arteries with Placental Pathology in Pregnancy Associated with Intrauterine Growth Restriction. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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3
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Jawad AK, Alalaf SK, Ali MS, Bawadikji AA. Bemiparin as a Prophylaxis After an Unexplained Stillbirth: Open-Label Interventional Prospective Study. Clin Appl Thromb Hemost 2019; 25:1076029619896629. [PMID: 31880168 PMCID: PMC7019397 DOI: 10.1177/1076029619896629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
Stillbirth is a devastating event to the parents, relatives, friends, and families. The role of anticoagulants in the prevention of unexplained stillbirths is uncertain. An open-label interventional prospective cohort study was conducted on 144 women with a history of unexplained stillbirths. The intervention group had a high umbilical artery resistance index (RI) and received bemiparin. The nonintervention group had a normal RI and did not receive any intervention. We measured the adjusted odds ratio (OR) and 95% confidence interval (CI) of the main outcome for these variables using logistic regression analysis. Fresh stillbirth and early neonatal death rates were lower (P = .005, OR = 11.949 and 95% CI = 2.099-68.014) and newborn weight was higher (P = .015, OR = 0.048, 95% CI = 0.004-0.549) in the group that received bemiparin. Bemiparin is effective in decreasing the rate of stillbirth in women with a history of previous unexplained stillbirths.
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Affiliation(s)
- Ariana Khalis Jawad
- Department of Obstetrics and Gynecology, Kurdistan Board of Medical
Specialty, Erbil, Kurdistan, Iraq
| | - Shahla Kareem Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical
University, Erbil, Kurdistan, Iraq
| | - Mahabad Salih Ali
- Department of Obstetrics and Gynecology, Ministry of Health, Maternity
Teaching Hospital, Erbil, Kurdistan, Iraq
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Doro GF, Senra JC, Rodrigues AS, Miyadahira S, Ribeiro RL, Francisco RPV, Bernardes LS. Renal vascularization indexes and fetal hemodynamics in fetuses with growth restriction. Prenat Diagn 2017. [DOI: 10.1002/pd.5099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giovana Farina Doro
- Department of Obstetrics and Gynecology, Clinics Hospital; University of São Paulo; São Paulo Brazil
| | - Janaína Campos Senra
- Department of Obstetrics and Gynecology, Clinics Hospital; University of São Paulo; São Paulo Brazil
| | - Agatha Sacramento Rodrigues
- Statistician at the Department of Obstetrics and Gynecology, Clinics Hospital; University of São Paulo; São Paulo Brazil
| | - Seizo Miyadahira
- Department of Obstetrics and Gynecology, Clinics Hospital; University of São Paulo; São Paulo Brazil
| | - Renata Lopes Ribeiro
- Department of Obstetrics and Gynecology, Clinics Hospital; University of São Paulo; São Paulo Brazil
| | | | - Lisandra Stein Bernardes
- Department of Obstetrics and Gynecology, Clinics Hospital; University of São Paulo; São Paulo Brazil
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Smolich JJ, Kenna KR, Mynard JP. Retrograde lower body arterial reservoir discharge underlies rapid reversal of ductus arteriosus shunting after early cord clamping at birth in preterm lambs. J Appl Physiol (1985) 2016; 120:399-407. [DOI: 10.1152/japplphysiol.00794.2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/25/2015] [Indexed: 11/22/2022] Open
Abstract
Arterial reservoir (“windkessel”) function, whereby a part of left ventricular (LV) output is stored in elastic arteries during systole and discharged in diastole, is a well-established physiological phenomenon. However, its role in rapid reversal (to left-to-right) and a systolic-to-diastolic shift of shunting across the ductus arteriosus after birth is unknown. To address this question, ductal and aortic isthmus flows were measured with high-fidelity transit-time probes in six anesthetized preterm fetal lambs before and after cord clamping and subsequent early mechanical ventilation and for 30 min postbirth. Descending aortic flow was calculated as the sum of isthmus and ductal flows. Left-to-right ductal flow profiles were related to those of the isthmus and descending aorta, with upper body arterial reservoir discharge indicated by forward diastolic isthmus flow, and retrograde lower body arterial reservoir discharge by negative diastolic descending aortic flow. Left-to-right ductal shunting appeared immediately after cord clamping ( P < 0.001), due entirely to newly emergent retrograde lower body reservoir discharge, and rose with ventilation via increased lower body reservoir discharge ( P < 0.005), supplemented by upper body reservoir discharge after 45 s ( P < 0.025) and LV systolic flow after 3 min ( P = 0.025). The contribution of lower body reservoir discharge to left-to-right ductal shunting fell to 55 ± 8% at ≥15 min ( P < 0.001) but remained higher ( P < 0.002) than LV systolic flow (33 ± 8%) or upper body reservoir discharge (12 ± 5%). These results suggest that retrograde lower body arterial reservoir discharge plays a key role in rapid reversal and a systolic-to-diastolic shift of ductal shunting after cord clamping and early ventilation at birth.
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Affiliation(s)
- Joseph J. Smolich
- Heart Research Group, Murdoch Childrens Research Institute, Victoria, Australia; and
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Kelly R. Kenna
- Heart Research Group, Murdoch Childrens Research Institute, Victoria, Australia; and
| | - Jonathan P. Mynard
- Heart Research Group, Murdoch Childrens Research Institute, Victoria, Australia; and
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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6
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Arias-Ortega R, Echeverría JC, Guzmán-Huerta M, Camargo-Marín L, Gaitán-González MJ, Borboa-Olivares H, Portilla-Islas E, Camal-Ugarte S, Vargas-García C, Ortiz MR, González-Camarena R. Respiratory sinus arrhythmia in growth restricted fetuses with normal Doppler hemodynamic indices. Early Hum Dev 2016; 93:17-23. [PMID: 26709133 DOI: 10.1016/j.earlhumdev.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The autonomic behavior of growth-restricted fetuses at different evolving hemodynamic stages has not been fully elicited. AIM To analyze the respiratory sinus arrhythmia (RSA) of growth-restricted fetuses that despite this severe condition show normal Doppler hemodynamics. SUBJECTS 10 growth-restricted fetuses (FGR group) with normal arterial pulsatility indices (umbilical, uterine, middle cerebral, ductus venosus and aortic isthmus), and 10 healthy fetuses (Control group), 32-37weeks of gestation. METHOD B-mode ultrasound images for visualizing fetal breathing movements (FBM) or breathing akinesis (FBA), and the simultaneous RR-interval time series from maternal abdominal ECG recordings were obtained. The root-mean-square of successive differences of RR-intervals (RMSSD) was considered as a RSA-related parameter among the instantaneous amplitude of the high-frequency component (AMPHF) and its corresponding instantaneous frequency (IFHF), both computed by using empirical mode decomposition. Mean fetal heart-periods and RSA-related parameters were assessed during episodes of FBM and FBA in 30s length windows. RESULTS FGR and Control groups presented RSA-related fluctuations during FBM and FBA. Also, both groups showed significant higher (p<0.001) values for the mean heart-period, RMSSD and AMPHF during FBM. No-significant differences (p>0.05) were found for the IFHF regardless of breathing activity (FBM vs. FBA). CONCLUSION Growth-restricted fetuses without evident hemodynamic compromise exhibit a preserved autonomic cardiovascular regulation, characterized by higher values of RSA and mean heart-period in the presence of FBM. This physiological response reflects a compensatory strategy that may contribute to preserve blood flow redistribution to vital organs.
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Affiliation(s)
- R Arias-Ortega
- Laboratorio de Investigación en Fisiología Humana (LIFH), Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), 09340 México D.F., México; Programa de Doctorado en Ingeniería Biomédica, División de Ciencias Básicas e Ingeniería, UAM-I, 09340 México D.F., México.
| | - J C Echeverría
- Ingeniería de Fenómenos Fisiológicos Perinatales, Departamento de Ingeniería Eléctrica, UAM-I, 09340 México D.F., México
| | - M Guzmán-Huerta
- Unidad de Investigación de Medicina Materno Fetal, del Departamento de Medicina Fetal del Instituto Nacional de Perinatología (INPer), 11000 México D.F., México
| | - L Camargo-Marín
- Unidad de Investigación de Medicina Materno Fetal, del Departamento de Medicina Fetal del Instituto Nacional de Perinatología (INPer), 11000 México D.F., México
| | - M J Gaitán-González
- Laboratorio de Investigación en Fisiología Humana (LIFH), Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), 09340 México D.F., México
| | - H Borboa-Olivares
- Unidad de Investigación de Medicina Materno Fetal, del Departamento de Medicina Fetal del Instituto Nacional de Perinatología (INPer), 11000 México D.F., México
| | - E Portilla-Islas
- Programa de Doctorado en Ingeniería Biomédica, División de Ciencias Básicas e Ingeniería, UAM-I, 09340 México D.F., México
| | - S Camal-Ugarte
- Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento (CIMIGen), 09890 México D.F., México
| | - C Vargas-García
- Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento (CIMIGen), 09890 México D.F., México
| | - M R Ortiz
- Ingeniería de Fenómenos Fisiológicos Perinatales, Departamento de Ingeniería Eléctrica, UAM-I, 09340 México D.F., México
| | - R González-Camarena
- Laboratorio de Investigación en Fisiología Humana (LIFH), Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana Unidad Iztapalapa (UAM-I), 09340 México D.F., México.
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7
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Browne VA, Julian CG, Toledo-Jaldin L, Cioffi-Ragan D, Vargas E, Moore LG. Uterine artery blood flow, fetal hypoxia and fetal growth. Philos Trans R Soc Lond B Biol Sci 2015; 370:20140068. [PMID: 25602072 PMCID: PMC4305169 DOI: 10.1098/rstb.2014.0068] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evolutionary trade-offs required for bipedalism and brain expansion influence the pregnancy rise in uterine artery (UtA) blood flow and, in turn, reproductive success. We consider the importance of UtA blood flow by reviewing its determinants and presenting data from 191 normotensive (normal, n = 125) or hypertensive (preeclampsia (PE) or gestational hypertension (GH), n = 29) Andean residents of very high (4100-4300 m) or low altitude (400 m, n = 37). Prior studies show that UtA blood flow is reduced in pregnancies with intrauterine growth restriction (IUGR) but whether the IUGR is due to resultant fetal hypoxia is unclear. We found higher UtA blood flow and Doppler indices of fetal hypoxia in normotensive women at high versus low altitude but similar fetal growth. UtA blood flow was markedly lower in early-onset PE versus normal high-altitude women, and their fetuses more hypoxic as indicated by lower fetal heart rate, Doppler indices and greater IUGR. We concluded that, despite greater fetal hypoxia, fetal growth was well defended by higher UtA blood flows in normal Andeans at high altitude but when compounded by lower UtA blood flow in early-onset PE, exaggerated fetal hypoxia caused the fetus to respond by decreasing cardiac output and redistributing blood flow to help maintain brain development at the expense of growth elsewhere. We speculate that UtA blood flow is not only an important supply line but also a trigger for stimulating the metabolic and other processes regulating feto-placental metabolism and growth. Studies using the natural laboratory of high altitude are valuable for identifying the physiological and genetic mechanisms involved in human reproductive success.
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Affiliation(s)
- Vaughn A Browne
- Department of Emergency Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Colleen G Julian
- Department of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | | | - Darleen Cioffi-Ragan
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
| | - Enrique Vargas
- Instituto Boliviano de Biología de Altura, La Paz, Bolivia
| | - Lorna G Moore
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
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Milnerowicz-Nabzdyk E, Bizoń A. Effect of cigarette smoking on vascular flows in pregnancies complicated by intrauterine growth restriction. Reprod Toxicol 2014; 50:27-35. [PMID: 25461903 DOI: 10.1016/j.reprotox.2014.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 08/15/2014] [Accepted: 10/01/2014] [Indexed: 11/20/2022]
Abstract
Exposure to tobacco smoke during pregnancy may result in intrauterine growth restriction (IUGR). In the study, the effect of tobacco smoke on vascular flows in the middle cerebral artery, umbilical artery, ductus venosus in fetuses and uterine artery in pregnancies complicated by IUGR was investigated. The study subjects were divided into three groups: smoking women with IUGR (n=31), women with idiopathic IUGR (n=28) and healthy controls (n=50). Fetal biometry and flow parameters were measured. Concentration of heavy metals and antioxidants was tested in maternal blood and fetal umbilical cord blood. The Student t test and multiple regression analysis were used. Cotinine and cadmium concentrations were significantly higher in smokers (55.23±54.23, 1.52±0.9), while metallothionein was significantly higher (22.94±8.64) in the idiopathic IUGR group. Strong correlations between cotinine and cadmium concentrations and cerebral-umbilical index were found. Long-term exposure to tobacco smoke deteriorates flows in vital fetal vessels.
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Affiliation(s)
- Ewa Milnerowicz-Nabzdyk
- 2nd Department and Clinic of Obstetrics and Gynaecology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland.
| | - Anna Bizoń
- Department of Biomedical and Environmental Analysis, Wroclaw Medical University, Borowska 211, 50-556 Wrocław, Poland
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9
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Lee SM, Jun JK, Kim SA, Lee EJ, Kim BJ, Park CW, Park JS. Usefulness of fetal urine production measurement for prediction of perinatal outcomes in uteroplacental insufficiency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2165-2171. [PMID: 25425374 DOI: 10.7863/ultra.33.12.2165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate whether fetal urine production measurement is useful for predicting adverse outcomes in patients with uteroplacental insufficiency. METHODS We enrolled patients with uteroplacental insufficiency at 24 to 40 weeks' gestation and normal pregnancies matched for gestational age and divided them into 3 groups according to perinatal outcomes: group 1 (n = 141), a control group of normal pregnancies; group 2 (n = 29), uteroplacental insufficiency without adverse outcomes; and group 3 (n = 18), uteroplacental insufficiency with adverse outcomes. An adverse outcome was defined as 1 or more of the following: (1) cesarean delivery because of fetal distress; (2) admission to the neonatal intensive care unit; (3) cord arterial pH less than 7.15 at birth; and (4) low 5-minute Apgar score (<7). The fetal urine production rate was obtained by serial bladder volume measurement using virtual organ computer-aided analysis. For bladder volume determination, we scanned the bladder in the 3-dimensional mode and defined the bladder surface contour in the reference plane, repeating the rotation of the reference plane with an angle of 30° and determining the surface contour on each plane. Statistical methods, including the Mann-Whitney U test, Fisher exact test, χ(2) test, and Kruskal-Wallis analysis of variance, were used. RESULTS Group 3 had a lower mean fetal urine production rate than groups 1 and 2, whereas the urine production rate was not different between groups 1 and 2 (group 1, 49.0 mL/h; group 2, 59.4 mL/h; group 3, 20.7 mL/h; P < .001 between groups 1 and 3 and between groups 2 and 3). This difference between groups 2 and 3 remained significant after adjusting for the amniotic fluid index, umbilical artery Doppler pulsatility index, and presence of fetal growth restriction. CONCLUSIONS Uteroplacental insufficiency cases with adverse perinatal outcomes had a lower fetal urine production rate than those without adverse outcomes. This difference might be used to predict adverse perinatal outcomes in uteroplacental insufficiency.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.).
| | - Su Ah Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Eun Ja Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (S.M.L., J.K.J., S.A.K., B.J.K., C.-W.P., J.S.P.); Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea (S.M.L., B.J.K.); and Samsung Medison Co, Seoul, Korea (E.J.L.)
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11
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Mortality and morbidity in preterm small-for-gestational-age infants: a population-based study. Am J Obstet Gynecol 2012; 206:150.e1-7. [PMID: 21982023 DOI: 10.1016/j.ajog.2011.08.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/27/2011] [Accepted: 08/23/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to evaluate the impact of severity of growth restriction on mortality and major neonatal morbidity among very-low-birthweight small-for-gestational-age infants. STUDY DESIGN This was a population-based observational study using data collected by the Israel National Very-Low-Birth-Weight Infant Database 1995 through 2007 including infants 24-31 weeks' gestation, with birthweight (BW) ≤ 50th percentile without major malformations. Four BW percentile groups were considered: < 3rd, 3rd-< 10th, 10th-< 25th, and a reference group 25th-50th percentile. Univariate and multivariable logistic regression analyses were performed. RESULTS Infants of BW 3rd-< 10th percentile were at increased risk for grades 3-4 retinopathy of prematurity (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.54-2.78), bronchopulmonary dysplasia (OR, 2.52; 95% CI, 2.03-3.12), necrotizing enterocolitis (OR, 1.32; 95% CI, 1.04-1.68), and mortality (OR, 2.37; 95% CI, 1.94-2.90). The risk was further increased among infants of BW < 3rd percentile. CONCLUSION Growth restriction severity may serve as a clinical marker of degree of risk for neonatal mortality and various morbidities.
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12
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Desoye G, Gauster M, Wadsack C. Placental transport in pregnancy pathologies. Am J Clin Nutr 2011; 94:1896S-1902S. [PMID: 21543540 DOI: 10.3945/ajcn.110.000851] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The placenta is positioned between the maternal and fetal circulation and hence plays a key role in transporting maternal nutrients to the developing fetus. Fetal growth changes in the 2 most frequent pregnancy pathologies, gestational diabetes mellitus and fetal growth restriction, are predominantly characterized by an exaggerated and restricted fat accretion, respectively. Glucose, by its regulating effect on fetal insulin concentrations, and lipids have been strongly implicated in fetal fat deposition. Transplacental glucose flux is highly efficient and limited only by nutrient availability (flow-limited)--ie, driven by the maternal-fetal glucose concentration gradient and blood flow, with little, if any, effect of placental morphology, glucose consumption, and transporter expression. This explains why, despite changes in these determinants in both pathologies, transplacental glucose flux is unaltered.
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Affiliation(s)
- Gernot Desoye
- Department of Obstetrics and Gynaecology, Institute of Cell Biology, Histology and Embryology, Medical University of Graz, Graz, Austria.
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13
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Frisch L, Groisman G, Hallak M. First trimester diagnosis of forked cord in monoamniotic twin pregnancy. Placenta 2011; 32:1057-9. [PMID: 21959059 DOI: 10.1016/j.placenta.2011.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 09/12/2011] [Accepted: 09/14/2011] [Indexed: 11/26/2022]
Abstract
A 29-year-old healthy woman at 10 weeks gestation was suspected for monoamniotic twin pregnancy, thus referred for evaluation and treatment. Ultrasound examination confirmed intrauterine monoamniotic twin gestation with central insertion of both umbilical cords by brief conjoined part (9 mm) - comprising a forked umbilical cord. Early diagnosis, planned prenatal care and close surveillance allowed preventing perinatal mortality.
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Affiliation(s)
- L Frisch
- Ultrasound Unit, Hillel Yaffe Medical Center, Hadera, Israel.
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14
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Schenone MH, Mari G. The MCA Doppler and its role in the evaluation of fetal anemia and fetal growth restriction. Clin Perinatol 2011; 38:83-102, vi. [PMID: 21353091 DOI: 10.1016/j.clp.2010.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Doppler velocimetry of the middle cerebral artery (MCA) has played a major role in fetal medicine for the last 23 years, both in intrauterine growth-restricted (IUGR) and anemic fetuses. Its utility in the diagnosis and management of cases of fetal anemia was initially demonstrated in cases of red cell alloimmunization and later extended to other types of anemia. In addition, MCA Doppler studies are crucial in the evaluation of IUGR fetuses. This article is a review of the role of the MCA in these 2 conditions.
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Affiliation(s)
- Mauro H Schenone
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, 853 Jefferson Avenue, Memphis, TN 38103, USA
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Dix L, Roth-Kleiner M, Osterheld MC. Placental vascular obstructive lesions: risk factor for developing necrotizing enterocolitis. PATHOLOGY RESEARCH INTERNATIONAL 2010; 2010:838917. [PMID: 21151528 PMCID: PMC2989861 DOI: 10.4061/2010/838917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 02/16/2010] [Accepted: 02/18/2010] [Indexed: 11/20/2022]
Abstract
Necrotizing enterocolitis (NEC) is a severe neonatal disease affecting particularly preterm infants. Its exact pathogenesis still remains unknown. In this study, we have compared the prevalence of vascular obstructive lesions in placentae of premature newborns which developed NEC and of a control group. We further compared separately the findings of placentae of infants of less than 30 weeks of gestation, the age group in which NEC occurs most frequently. We found signs of fetal vascular obstructive lesions in 65% of the placentae of preterm patients developing NEC, compared to only 17% of the placentae of preterm patients in the control group. In the age groups below 30 weeks of gestation, 58.5% of placentae of later NEC patients presented such lesions compared to 24.5% in the control group. The significant difference between NEC and control group suggests a strong association between fetal vascular obstructive lesions and NEC. Therefore, we propose that fetal vascular obstructive lesions might be considered as a risk factor for the development of NEC in premature infants.
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Affiliation(s)
- Laure Dix
- Institute of Pathology, University of Lausanne, CH-1011 Lausanne, Switzerland
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