Time domain measurement of blood flow in the human fetal aorta during normal pregnancy

OBJECTIVE

To evaluate blood-volume flow-rate measurement in the fetal descending thoracic aorta using a non-invasive, non-Doppler, ultrasound technique.

METHODS

This was a cross-sectional, observational study. Volume flow measurements were obtained from the descending thoracic aorta in 59 human fetuses between 20 and 40 weeks' gestation. These were uncomplicated pregnancies that resulted in the live births of appropriately grown infants. The measurements were obtained using a time domain processing technique: color velocity imaging quantification (CVI-Q).

RESULTS

The blood-volume flow rate increased consistently from the second trimester until term. The mean values ranged between 100 mL/min at 20 weeks' gestation and approximately 350 mL/min at term. The normalized (weight-adjusted) volume flow rates decreased with increasing gestation, from a maximum of 626 mL/min/kg at 23 weeks to a minimum of 45.6 mL/min/kg at 37 weeks.

CONCLUSIONS

The regular measurement of blood-volume flow in the descending fetal thoracic aorta is feasible using CVI-Q. Although there is a considerable learning curve, with adequate training there are potential clinical applications for this non-Doppler technique. However, limitations exist with the currently available technology for clinical use in fetal vascular studies.

Prevalence of polyhydramnios in the third trimester in a population screened by first and second trimester ultrasonography

AIMS

To determine the prevalence of polyhydramnios in a routine antenatal population, in which first and second trimester ultrasound screening for fetal abnormality had been performed and to examine the outcome in these pregnancies.

METHODS

A retrospective analytical survey of all obstetric ultrasound examinations performed in a university teaching hospital over a thirty-six month period. Polyhydramnios was defined as either the measurement of a single deepest pool of liquor > 8 cm (AFV) or according to the amniotic fluid index, the sum of a four quadrant measurement > 24 cm (AFI). Using the stated definitions, polyhydramnios was diagnosed in 37 women, 16 of whom had a raised AFI. The main outcomes of interest included the mode of onset of labour and mode of delivery (rates of spontaneous and induced labour, cesarean section deliveries), birth weight, presence or absence of fetal anomalies, and the perinatal outcome.

RESULTS

The prevalence of polyhydramnios in this study is lower (0.15% AFI > 24 cm and 0.36% AFV > 8 cm) than in previous studies. The association between polyhydramnios, maternal diabetes mellitus (10.8%), fetal abnormalities (5.4%) and fetal macrosomia (10.8%) was also lower than in past reports. There was a better overall fetal outcome compared with previous studies and no perinatal deaths were seen.

CONCLUSIONS

In this study, the prevalence of polyhydramnios in the third trimester was lower than in previous studies, as well as being associated with a better prognosis. This may have been the result of a combination of several factors. These include the introduction of multi-level ultrasound screening for fetal abnormality, and the improved care of diabetic women, and mothers with rhesus iso-immunisation.

Cryosurgery of eyelid basal cell carcinomas

One hundred and twenty-one patients have been treated for eye lid basal cell carcinomas with cryosurgery during the last 7 years. The condition resolved completely after treatment in all patients with no recurrences observed so far. Most patients have been followed for more than 2 years. Complications were few and minor. In 14 cases conjunctival overgrowth was noted. We conclude that this treatment modality is excellent, cost-effective and easily tolerated as compared with other methods.

Free amino acids in the pre-retinal vitreous space. Effect of high potassium and nipecotic acid

The pre-retinal vitreous space of the eye of albino rabbits was perfused in vivo via a dialysis probe in order to measure the concentration of endogenous amino acids. Studies of isotope concentrations in the vitreal effluent following intracarotid injections of 3HOH and [14C]mannitol demonstrated that entrance of 3HOH into the dialysis probe occurred within a few minutes whereas [14C]mannitol was almost completely excluded. Among the amino acids, analysed with high-pressure liquid chromatography (HPLC), glutamine had a concentration similar to that in plasma and cerebrospinal fluid (CSF). Taurine was four times higher than in the CSF. Perfusion with 125 mM KCl media increased particularly the taurine and phosphoethanolamine content. Nipecotic acid, a potent inhibitor of gamma-aminobutyric acid (GABA) uptake, increased GABA concentration over 60 times. In addition, it increased taurine levels by almost 10 times.