Antenatal Diagnosis of Fetal Retinoid Syndrome at 20 Weeks of Gestation: A Case Report

INTRODUCTION

Isotretinoin, a synthetic derivative of vitamin A, is one of the most potent human teratogens, and is mainly utilized for the treatment of severe recalcitrant nodular acne. Retinoic acid embryopathy is well defined in the literature.

CASE REPORT

The mother was referred for a fetal posterior fossa abnormality, first detected at 20 weeks of gestation. The mother used isotretinoin until 18 weeks gestation. Ultrasound examination revealed hypertelorism, cerebellar hypoplasia, vermian agenesis, truncus arteriosus, anotia, thymic aplasia, corpus callosum hypoplasia. An intrauterine diagnosis of fetal retinoid syndrome was confirmed by fetopsy after termination of pregnancy.

CONCLUSION

The typical findings of fetal retinoid syndrome can be visualized with ultrasound in early second trimester.

Early active motion after rigid internal fixation of unstable extra-articular fractures of the proximal phalanx

The purpose of this study is to describe active early rehabilitation in proximal phalanx fractures treated with rigid internal fixation. A total of 22 consecutive patients presenting with spiral, oblique or comminuted extra-articular fractures of the proximal phalanx were included in the study. All fractures were rigidly stabilized with plate and screws or screws alone and subsequently entered an active early rehabilitation programme. The mean follow-up period was 15.4 months (SD 10.1). Mean visual analogue scale pain score was 0.3 (SD 0.5) and Disability of the Arm, Shoulder and Hand score was 9.2 (SD 4.1). Mean total active motion was 241.9° (SD 18.3). According to the digital functional assessment, 86.3% of the patients had excellent results. Extension lags of the proximal interphalangeal joint were observed in seven fingers (mean lag, 3.4° (SD 5.5)). The results of this study demonstrated high patient satisfaction and good outcomes after the surgical technique and postoperative rehabilitation protocol described in open reduction and rigid internal fixation of proximal phalangeal fractures.

LEVEL OF EVIDENCE

IV.

Maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in gestational diabetes mellitus

OBJECTIVE

The aim of the study is to evaluate maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in patients with getational diabetes mellitus compared with a control group.

METHODS

We have measured maternal serum ANP and BNP levels in 35 otherwise healthy and 45 gestational diabetic women between gestational week 24 and 28 referred to our unit in a cross-sectional study. Independent samples t-test or the Mann-Whitney U-test was used for comparison of two groups where appropriate.

RESULTS

Mean maternal serum homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, fasting glucose and insulin levels in gestational diabetes mellitus (GDM) group were significantly higher than the control group (p < 0.01). Mean maternal serum ANP and BNP levels of women with GDM were significantly lower than the control group (12.9 ± 9.9 versus 34.8 ± 16.9 pg/ml, p < 0.001; 416.6 ± 209.7 versus 629.7 ± 162.2 mg/dl, p < 0.001, respectively). Maternal serum ANP and BNP levels were negatively correlated with insulin levels, HbA1c and HOMA-IR values (p < 0.05).

CONCLUSIONS

Maternal serum ANP and BNP levels are significantly lower in patients with GDM. These biomarkers might be valuable in clinical setting for identifying high-risk women for developing diabetes during pregnancy.

Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb

The aim of this study was to investigate the radiological and functional results of anatomical reduction and stable fixation followed by an early rehabilitation programme in the treatment of fractures of the base of the thumb metacarpal. Sixteen consecutive patients (11 men and five women; mean age: 36.4 years) with intra-articular fractures of the thumb metacarpal base were treated with plate and/or screw fixation between April 2002 and March 2011 at our department. Patients were followed-up for an average period of 15.62 months. Bony healing was achieved in all cases and all patients were able to return to pre-trauma activity levels 12 weeks following surgery. Open reduction with stable internal fixation and an early active rehabilitation programme appears to be an efficient method in the treatment of trapeziometacarpal joint fractures with satisfactory functional and radiological results.

A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre

The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers' education to change this attitude should be implemented.

Women's Preferences of Method of Delivery and Influencing Factors

Background

Currently, the rate of caesarean section has been substantially increased in developing and developed countries. To determine the factors causing such an increase, it is important to determine reasons for women to refuse vaginal delivery and preferring caesarean section.

Objectives

To determine Turkish women’s attitudes and basal knowledge regarding vaginal delivery and caesarean section, as well as factors causing women to prefer caesarean section even when a medical indication does not exist.

Patients and Methods

This descriptive study consisted of 840 women, completing the questionnaire developed by the researchers.

Results

Mean age rate of participants was 39.8 ± 11.8 years. The most significant reasons of vaginal delivery preferred by participants (n = 685) were determined to be healthy and swift recovery period after delivery, whereas those preferred by participants (n=155) for caesarean section were being safer for babies, easier than vaginal delivery and a less painful method. Higher educational status, pregnancy after infertility treatment and undergoing caesarean section for the last delivery were determined to be among important factors affecting to choose caesarean section.

Conclusions

Information gained misleadingly and fears related to vaginal delivery were seen as factors affecting women’s preferences for delivery. Thus, midwives are required to train both pregnant women during antenatal care and all women in society about methods of delivery and to give effective counseling.

Intraabdominal extrapulmonary sequestration diagnosed by color doppler ultrasound at 22 weeks' gestation

Intraabdominal extrapulmonary sequestration is seen very rarely. When a left suprarenal mass is detected in prenatal sonography, vascularization of the lesion should be evaluated with color Doppler sonography. We present a case of intraabdominal extrapulmonary sequestration that was diagnosed by color Doppler ultrasound at 22 weeks' gestation.

The effect of gestational age on sonographic screening of the hip in term infants

Several authors have suggested that the final five weeks of gestation are a critical period for the development of the hip. In order to test the hypothesis that gestational age at birth may influence the development of the hip joint, we analysed the sonographic findings in 1992 hips (in 996 term newborns) with no risk factor for developmental dysplasia of the hip. The 996 infants were born at a mean gestational age of 39 weeks (37 to 41).

The mean bony roof angle (α), cartilage roof angle (β) and the distribution of the type of hip were compared between the 37th, 38th, 39th, 40th and 41st birth week groups. There was a significant difference in the distribution of type of hip between the different birth week groups (p < 0.001), but no significant difference between the α angles of all groups (p = 0.32). There was no correlation between birth week and roof angle (p = 0.407 and p = 0.291, respectively) and no significant correlation between birth weight and roof angle (p = 0.735 and p = 0.132, respectively).

The maturity of the infant hip, as assessed sonographically, does not appear to be affected by gestational age, and the fetal development of the acetabular roof appears to plateau from 37 weeks.

Cite this article: Bone Joint J 2013;95-B:266–70.

Acromegaly is associated with higher frequency of female sexual dysfunction: experience of a single center

The aim of the study was to assess female sexual dysfunction (FSD), quality of life and depression status in female patients with acromegaly. Fifty-seven sexually active female patients with acromegaly disease (21 controlled, 36 uncontrolled) monitored by Cerrahpasa Medical School, Endocrinology and Metabolism out-patient clinic and age and body mass index-matched 46 healthy female subjects were included in the study. Sexual functions and status of depression in both patient and control groups were evaluated by using the Female Sexual Function Index Form (FSFI) and the Beck Depression Inventory (BDI), respectively. Quality of life was evaluated by using the Acromegaly Quality of Life (AcroQoL) Scale. Hormone levels were studied in the groups. The FSFI total score and desire, arousal, orgasm, and satisfaction domains in patients with acromegaly were significantly lower than in the healthy controls (p ≤ 0.0001). There was no difference between biochemically controlled and uncontrolled patients with acromegaly with respect to FSFI scores (p = 0.7). AcroQoL total score in female patients with controlled acromegaly and uncontrolled acromegaly were 46.33 ± 16.5% and 50.13 ± 18.21%, respectively (p = 0.53). The difference in BDI scores between controlled and uncontrolled acromegaly patients was not significant but they were significantly higher in the control group (p ≤ 0.0001). In the correlation analysis, a negative correlation was found between FSFI total and BDI score (r = -0.69, p< 0.001), age (r = -0.45, p< 0.001), and IGF-I (r = -0.28, p = 0.006). This study showed that sexual dysfunction and depression rates in female patients with acromegaly are higher than in healthy females.

Effects of amniotic and maternal CD-146, TGF-β1, IL-12, IL-18 and IFN-γ, on adverse pregnancy outcome

OBJECTIVE

Our aim was to determine the effects of maternal serum and amniotic fluid levels of cluster of differentiation 146 (CD-146), transforming growth factor (TGF)-β1, interleukin (IL)-12, IL-18, and interferon (IFN)-γ on intrauterine growth restriction and preterm labor.

METHODS

In this retrospective cohort study, we included pregnant women who underwent amniocentesis at Istanbul University Cerrahpasa Medical School. Women were followed up to labor. The study group comprised 23 women with adverse pregnancy outcomes (intrauterine growth restriction and preterm labor), and the control group comprised 105 women with normal pregnancy outcome.

RESULTS

The study group was further divided into two subgroups of preterm labor and intrauterine growth restriction. No significant differences were found for IL-12, IFN-γ, TGF-β1, or CD-146 levels in either plasma or amniotic fluid between the study and control groups. Serum IL-18 levels were similar, but the amniotic fluid level of IL-18 was significantly higher in the intrauterine growth restriction subgroup than that in the preterm labor subgroup and that in the control group (p < 0.01).

CONCLUSIONS

Increased IL-18 level in amniotic fluid may be a predictor for intrauterine growth restriction. IL-12, IFN-γ, TGF-β1, and CD-146 were not related to adverse pregnancy outcome.

Bladder exstrophy

Bladder exstrophy is a very rare congenital malformation in which the anterior wall of the bladder is absent, and the posterior wall is exposed externally. The differential diagnosis includes omphalocele, gastroschisis, and cloacal exstrophy. Ultrasound and Doppler examinations are the main diagnostic tools. Although mortality is low, termination of pregnancy should be discussed due to serious morbidities.

Multiple fetal anomalies in association with topiramate and oxcarbezepine treatment

We present a case of a woman who used topiramate (100 mg) and oxcarbazepine (300 mg) continuously during pregnancy. Multiple fetal anomalies including limp defects of the lower extremities, pericardiac fluid collection, cardiomegaly, cleft lip and palate, absent right kidney, and dysplastic left kidney were found by ultrasonography. Labor was induced and anomalies were confirmed by autopsy. The malformation rate after exposure to oxcarbazepine in utero as a monotherapy was calculated to be 2.4%, which is compatible with the malformation rate seen in the general population. Topiramate is teratogenic in mice, rats, and rabbits, but there are very few reports about its teratogenicity in humans.

Protein oxidation markers in women with and without gestational diabetes mellitus: a possible relation with paraoxonase activity

AIMS

To clarify the levels of protein oxidation markers such as protein carbonyl (PCO), protein hydroperoxides (P-OOH), advanced oxidation protein products (AOPP) and nitrotyrosine (NT), as well as antioxidative enzymes such as paraoxonase (PON-1) in women with and without gestational diabetes mellitus (GDM).

METHODS

The study was conducted on 23 women with GDM and 22 women without GDM. The levels of the P-OOH, AOPP, and PON-1 were determined by colorimetric methods; whereas NT and PCO levels were measured by ELISA.

RESULTS

The concentrations of protein oxidation markers were significantly increased and PON1 activity was significantly decreased in GDM group compared to those of normal pregnant women. The control group showed a significant negative correlation between PON-1 and PCO (r=-0.451, p=0.027); whereas in GDM group, there was a significant positive correlation between P-OOH and HbA1c (r=0.89, p=0.001). There was no significant correlation between AOPP, PON-1, P-OOH, PCO, and HbA1c in either group.

CONCLUSIONS

There is evidence of a possible association between protein oxidation and decreased PON1 activity in GDM. The increase in protein oxidation parameters in the GDM group leading to decreased PON1 activity might, we think, create a predisposition for clinical complications in GDM group.

Comparison of complications in second trimester amniocentesis performed with 20G, 21G and 22G needles

AIM

to compare short- and long-term complications of amniocentesis performed with 20G, 21G, and 22G needles.

METHODS

this observational study included 793 pregnant women who underwent amniocentesis in the Perinatology Department of Cerrahpasa Medical Faculty, Istanbul University, Turkey. The patients were divided into three groups according to the needle size used for the procedure: 20G (Group 1), 21G (Group 2), and 22G (Group 3). The incidences of early and late complications were compared among groups.

RESULTS

fetal loss rates did not differ among groups (Group 1=1.57%, Group 2=1.47%, Group 3=1.61%). Rates of vaginal bleeding (1.57%, 1.10%, and 0.81%, respectively), bloody amniotic fluid (2.32%, 6.23%, and 2.67%, respectively) and amniotic fluid leakage (1.57%, 1.10%, and 1.61%, respectively) were also similar among the three groups.

CONCLUSION

short- and long-term complications did not differ among amniocenteses performed with 20G, 21G, and 22G needles.

Increased maternal serum and cord blood fibronectin concentrations in preeclampsia are associated with higher placental hyaluronic acid and hydroxyproline content

BACKGROUND

Total or cellular fibronectin (FN) determinations have been used to differentiate between normal and preeclamptic pregnants. The purpose of this study was to examine the relationship between maternal serum FN levels and the extracellular matrix molecule contents of placental tissue, such as FN, hyaluronic acid (HA) and hydroxyproline (HP) levels.

MATERIAL AND METHODS

We obtained maternal blood samples and placental tissue samples from healthy (n = 17, controls) and preeclamptic pregnants (n = 29). We also obtained cord blood samples for FN and HA determination from the same patients. FN and HA concentrations in the placenta and maternal and cord blood were measured by and enzyme-linked immunosorbent assay and HP contents in the placenta were measured by a colorimetric assay.

RESULTS

FN levels in maternal serum, cord blood, and placenta were significantly higher in preeclamptics than in controls (p<0.001, p<0.001 and p<0.05, respectively). HA concentrations in the cord blood and placenta were found to be elevated in preeclamptics (p<0.05 and p<0.01). Preeclamptics had significantly higher placental HP levels than controls (p<0.001). Similar statistically significant results were obtained when the pregnant subjects classified as nulliparous and multiparous. There was no difference in ECM molecule levels between nulliporous and multiparous women in preeclamptic pregnant group. In regression analysis maternal serum FN levels were correlated with placental HA and HP levels (p<0.01 and p<0.01). There was a positive correlation between cord blood FN and both placental HP (p<001) and HA levels (p<0.01). FN levels in maternal serum, cord blood, and placenta were also negative correlated with fetal birth weight (p<0.01, p<0.05 and p<0.05, respectively).

CONCLUSION

FN in maternal serum, cord blood, and placenta is increased with elevated placental HA and HP levels, probably reflecting placental basement membrane alterations during preeclampsia.

Expression and comparison of gap junction protein connexin 37 in granulosa cells aspirates from follicles of poor responder and nonpoor responder patients

OBJECTIVE

To localize gap junction protein connexin 37 (Cx37) in granulosa cells obtained from aspiration of follicles, and to compare differences between poor responder and nonpoor responder patients in assisted reproductive technology.

DESIGN

Prospective clinical study.

SETTING

IVF unit of a university hospital.

PATIENT(S)

Seventy patients with various causes of infertility, undergoing an IVF treatment.

INTERVENTION(S)

Controlled ovarian hyperstimulation, serum hormone level measurements, ultrasonography scanning of ovarian follicles, oocyte retrieval after hCG administration and embryo transfer.

MAIN OUTCOME MEASURE(S)

Outcome of the IVF treatment and expression rate of Cx37 in granulosa cells.

RESULT(S)

Connexin 37 was expressed in the granulosa cells of all the patients. Connexin 37 rate in granulosa cells in the poor responder group was 81.32 +/- 35.86% (distribution: 2.95%-99.9%), while it was 88.98 +/- 23.73% (distribution: 6.30%-100.00%) in the nonpoor responder group. Connexin 37 rates between the two groups were not significantly different.

CONCLUSION(S)

Connexin 37 is expressed in the granulosa layer of follicles in the human ovary, and expression of Cx37 in granulosa cells was not different between poor responder and nonpoor responder patients.

The incidence of placental abnormalities, maternal and cord plasma malondialdehyde and vascular endothelial growth factor levels in women with gestational diabetes mellitus and nondiabetic controls

BACKGROUND/AIMS

To evaluate the incidence of placental abnormalities, cord plasma erythropoietin (EPO) levels and nucleated red blood cell (NRBC) counts, maternal and cord plasma malondialdehyde (MDA) and vascular endothelial growth factor (VEGF) levels in women with gestational diabetes mellitus (GDM) and nondiabetic controls.

METHODS

Twenty-two women with GDM, diagnosed according to the current criteria of the American Diabetes Association, were compared with 22 controls. Maternal and cord blood and placental samples were obtained from all pregnant women. Cord plasma EPO levels and NRBC counts, maternal and cord plasma MDA and VEGF levels were determined. Placental tissues were examined histologically.

RESULTS

Maternal and cord plasma levels of MDA and cord plasma EPO levels and NRBC counts were significantly higher in GDM pregnancies (p < 0.01). The presence of villous immaturity, chorangiosis and ischemia were significantly increased in the placentas of women with GDM (p < 0.05). The maternal and cord plasma levels of MDA increased (p = 0.007 and p = 0.001, respectively), whereas VEGF decreased (p = 0.046 and p = 0.001, respectively) with the presence of villous immaturity.

CONCLUSION

The complex process of villous development and maturity might be influenced by the maternal and fetal oxidative and angiogenetic milieu. The placenta that shows abnormalities in angiogenesis and maturation may lead to fetal hypoxia and compromise.

A comparison of oral and vaginal misoprostol for induction of labor

OBJECTIVE

The aim of the study is to compare the efficacy and safety of oral (100 microg) and vaginal (50 microg) misoprostol for labor induction.

STUDY DESIGN

Ninety-nine patients with indications for labor induction randomly received 100 microg oral misoprostol every 4 h or 50 microg vaginal misoprostol every 4 h, using maximum six doses. Mean induction to delivery interval, mode of delivery, rates of tachysystole, hypertonus and hyperstimulation syndrome, oxytocin use, number of doses used, failed induction rate and neonatal outcomes were compared for the two groups.

RESULTS

Mean dose of misoprostol used for oral and vaginal misoprostol groups were 2.17+/-1.35 and 1.91+/-0.94, respectively (p=0.65). There were two failed inductions in the oral (4%) and one failed induction (2.5%) in the vaginal group after a total of six doses of misoprostol (p=0.58). There was no significant difference for the mean induction to delivery interval, to the beginning of active phase interval, active phase duration, second stage duration and the number of women who received oxytocin for induction or augmentation between the two groups (p>0.05). There were also no significant differences for intrapartum complications and neonatal outcomes between the oral and vaginal misoprostol groups (p>0.05).

CONCLUSION

Our findings indicate that, in a closely supervised hospital setting with adequate monitoring, 100 microg oral misoprostol has the potential to induce labor as safely and effectively as its 50 microg vaginal analogue. As oral use of the drug is easier for both the patient and the doctor, oral misoprostol will probably be more preferable than the vaginal route.

Prediction of preeclampsia with maternal mid-trimester placental growth factor, activin A, fibronectin and uterine artery Doppler velocimetry

OBJECTIVE

To assess whether alterations in the serum levels of placental growth factor, activin A and fibronectin could be detected in patients before they become preeclamptic. And to evaluate and compare the clinical utility of these markers and uterine artery Doppler velocimetry in predicting preeclampsia.

METHODS

One hundred and twenty-two normotensive women were prospectively included in the study. Peripheral venous blood samples were obtained and Doppler examination of the uterine arteries was performed between 21 and 26 weeks' gestation. Serum levels of placental growth factor, activin A and fibronectin were measured by enzyme-linked immunoassay and radial immundiffusion technic.

RESULTS

Mid-trimester maternal serum activin A and fibronectin levels and average S/D ratios were significantly higher whereas placental growth factor levels were significantly lower in women who subsequently developed preeclampsia than remained normotensive (p<0.001). The best cut-off values for predicting preeclampsia of placental growth factor, activin A and fibronectin based on ROC curve analysis were 90 pg/ml, 14 ng/ml and 370 mg/l respectively. The areas under the curve equal to 0.993, 0.972, 0.872 and 0.813 for placental growth factor, activin A, fibronectin and uterine artery Doppler respectively were determined for the prediction of preeclampsia.

CONCLUSION

Placental growth factor, activin A, fibronectin and uterine artery Doppler are all potentially useful as predictors of preeclampsia. Maternal serum midtrimester PGF has the highest predictive value and activin A with a compatible accuracy for early identification of preeclampsia.

Plasma malondialdehyde, superoxide dismutase, sE-selectin, fibronectin, endothelin-1 and nitric oxide levels in women with preeclampsia

OBJECTIVE

The purpose of this study was to determine plasma malondialdehyde (MDA), superoxide dismutase (SOD), soluble E-selectin (sE-selectin), fibronectin, endothelin-1 (ET-1) and nitric oxide (NO) levels in women with preeclampsia and to find out the relations of diastolic blood pressure with these variables.

STUDY DESIGN

We performed a case-control study consisting of randomly selected 34 healthy pregnant women and 35 patients diagnosed as preeclampsia. Lipoperoxidation was ascertained by the formation of MDA. SOD activity was determined by the method of Sun et al. Plasma concentration of NO was estimated using colorimetric assay. Plasma ET-1 and sE-selectin were measured by enzyme-linked immunosorbent assay (ELISA). A nephelometric method for fibronectin quantitation was used.

RESULTS

The mean plasma level of MDA was significantly higher and SOD was significantly lower in preeclamptic pregnancies (P<0.001). Plasma concentrations of fibronectin, sE-selectin and ET-1 were significantly increased, whereas NO was significantly decreased in women with preeclampsia than normotensive women (P<0.001).

CONCLUSION

Increased plasma levels of MDA, fibronectin, sE-selectin, ET-1, and decreased plasma levels of NO and SOD in preeclamptic patients suggest that poorly perfused fetoplacental unit is the origin of oxygen free radicals and lipid peroxides.

Maternal plasma levels of cytokines in normal and preeclamptic pregnancies and their relationship with diastolic blood pressure and fibronectin levels

BACKGROUND

To determine the plasma concentrations of placental growth factor (PLGF), vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGF-beta1), soluble tumor necrosis factor alpha receptor (sTNFp55), interleukin-2 receptor (IL-2R), and interleukins 6 and 10 (IL-6, IL-10) in normotensive and preeclamptic women, and to evaluate the correlations between these cytokines and the diastolic blood pressure and fibronectin levels.

METHODS

A prospective case-control study. Thirty-five women with preeclampsia were compared with 34 healthy women with uncomplicated pregnancies. Peripheral venous blood samples were obtained and plasma levels of PLGF, VEGF, TGF-beta1, sTNFp55, IL-2R, IL-6 and IL-10 were measured by an enzyme-linked immunoassay and fibronectin by a radial immundiffusion technic.

RESULTS

In preeclampsia PLGF and VEGF levels were significantly lower, and TGF-beta1, sTNFp55, IL-2R, IL-6 and IL-10 levels were significantly higher than in normotensive pregnancy (p < 0.001). The plasma levels of PLGF and VEGF significantly decreased, whereas TGF-beta1, sTNFp55, IL-2R, IL-6 and IL-10 levels significantly increased with the increments in diastolic blood pressure and fibronectin levels (p < 0.001).

CONCLUSIONS

Altered concentrations of various cytokines might explain the shallow placentation and endothelial cell dysfunction described in preeclampsia. The clinical severity of preeclampsia seems to correlate with the severity of the cytokine abnormalities.

Doppler dynamics: their clinical significance and relationship with fetal blood gases and pH measurements

The aim of the study is to demonstrate the ability of abnormal Doppler indices to predict the acid-base status of the fetus. A pulsed Doppler study of umbilical artery, middle cerebral artery and thoracic aorta were assessed on 30 intrauterine growth restricted and 27 appropriate-for-gestational-age fetuses immediately before cordocentesis. All the fetuses with absent end diastolic velocity in the umbilical artery were found to be acidemic by cordocentesis. Thoracic aorta pulsatility index (PI) increased and middle cerebral artery PI decreased significantly with increased umbilical impedance (r = 0.702, r = -0.340, respectively). Umbilical artery and thoracic aorta PI significantly increased, whereas middle cerebral artery PI decreased with a decrease in umbilical blood pH (r = -0.760, r = -0.642, r = 0.292, respectively). Doppler findings have a very strong correlation with the acid-base status of the fetuses. Increased umbilical impedance is associated with progressive impairment of placental gas exchange and that by the time diastolic flow is lost hypoxaemia or acidaemia is usually present.