摘要:

In 29 pregnancies complicated by maternal diabetes mellitus paired samples of umbilical venous blood were obtained at cordocentesis and delivery to investigate the effect of delivery on indices of fetal oxygenation. After delivery by elective Caesarean section the median umbilical venous blood pH was significantly lower than predelivery, however, there was no significant change in the median umbilical venous blood pO2 or plasma erythropoietin concentration. In those delivered after labour the median umbilical venous blood pH and pO2 were significantly lower and the median plasma erythopoietin concentration was significantly higher than predelivery. The data of this study demonstrate that umbilical venous blood pH and pO2 and plasma erythropoietin are influenced by the mode of delivery and results obtained at delivery may not accurately reflect in utero homeostasis.

ISSN:1015-3837    

DOI:10.1159/000264224

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The main interest in our study was to find out if advice given to facilitate mourning after perinatal child loss (looking at the dead child, picture, burial) could be used to help parents terminating pregnancies for fetopathic reasons. To evaluate the acceptance and to compare the outcome in grief reactions we interviewed women undergoing termination of pregnancy for fetopathic reasons 1–2 days after the loss of the child and they answered a mailed questionnaire 8 weeks later. For comparison we assessed data from women with spontaneous child losses within the 12th to 24th week of pregnancy in a similar way. No difference in the extent of creating memories between the two groups of child losses could be assessed (44% of women after termination and 55% after spontaneous loss looked at their dead child). Making the dead baby a tangible person led to stronger grief reactions immediately after the loss without significant difference due to the kind of loss. But 8 weeks later women after spontaneous child losses reported significantly more mourning than those after termination. It could be shown that women do mourn after termination of pregnancy, that creating memories leads to more intense grief reactions shortly after the loss and that grief diminishes over time. The advice given to facilitate mourning after perinatal child loss can be transferred to parents dealing with termination of pregnancy for fetopathic reasons although coping seems to be more complicated in the latter situatio

ISSN:1015-3837    

DOI:10.1159/000264225

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The expected utility theory suggests eliminating an age-specific criterion for recommending prenatal diagnosis to patients. We isolate the factors which patients and physicians need to consider intelligently in prenatal diagnosis, and show that the sole use of a threshold age as a screening device is inadequate. Such a threshold fails to consider adequately patients’ attitudes regarding many of the possible outcomes of prenatal diagnosis; in particular, the birth of a chromosomally abnormal child and procedural related miscarriages. It also precludes testing younger women and encourages testing in patients who do not necessarily require or desire it. All pregnant women should be informed about their prenatal diagnosis options, screening techniques, and diagnostic procedures, including their respective limitations, risks, and benefit

ISSN:1015-3837    

DOI:10.1159/000264226

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Direct endoscopic visualization of in utero fetal muscle biopsy was performed in 2 cases for which the primary guidance for the procedure remained real time ultrasound. Direct visualization aids in the precise placement of the biopsy gun which may enable the procedure to be done at earlier gestational ages. At the currently used gestational ages (i.e. 18+ weeks), it does not substantially improve the procedure.

ISSN:1015-3837    

DOI:10.1159/000264227

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The purpose of this investigation is to determine whether fetal thrombocytopenia is a risk factor for puncture site bleeding. Three groups of fetuses either with or at known risk for thrombocytopenia were identified from a prospectively maintained data base of 1,100 procedures: alloimmune thrombocytopenia (ATP, 29 cordocenteses); unexpected thrombocytopenia (53 cordoncenteses), and intravascular transfusion for fetal hemolytic anemia (194 transfusions). A fourth group (58 cordocenteses) included as a normal control consisted of all appropriately grown fetuses tested within the same gestational age range as those with ATP. In total, 276 fetal blood sampling procedures were included, of which 134 (49%) yielded a platelet count of < 120 × 103/μl and 38 (14%) a platelet count of < 50 × 103/μl. The first platelet count obtained from fetuses with ATP ranged from 1 × 103 to 159 × 103/μl. There was no correlation between the platelet count and bleeding time whether the analysis was limited to only pretreatment procedures or included all. Each fetus with unexpected thrombocytopenia was systemically ill. There was no correlation between platelet count and the duration of bleeding from the cord puncture site. Intravascular transfusion produced a significant decline in the platelet count (238 ± 66 × 103vs. 153 ± 56 × 103/μl, p < 0.001). Twenty-nine percent of the post transfusion platelet counts were below 120 × 103/μl. There was a significant negative correlation between the final platelet count and the duration of puncture site bleeding (r = ––0.178, p = 0.03) independent of either the presence of hydrops, the initial or the increase in the umbilical venous pressure during transfusion. None of the 58 control fetuses had a platelet count below 120 × 103/μl. There was no correlation between platelet number and the duration of bleeding from the puncture site in this group. Thrombocytopenia is not an independent risk factor for umbilical cord bleeding after a cordocentesis per

ISSN:1015-3837    

DOI:10.1159/000264228

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Single-needle insertion as an alternative technique for genetic amniocentesis in twin gestation has been evaluated in 27 pregnancies. A 22-gauge needle was inserted into the most proximal sac and amniotic fluid was aspirated. The needle was then traversed through the dividing membrane to enter the second sac and amniotic fluid was aspirated. This technique avoids the use of dye and ensures tapping of both sacs. No fetal losses attributable to the procedure occurred during the trial. In comparison with the double-needle insertion, it is a swift and easy procedure and reduces discomfort to the patient.

ISSN:1015-3837    

DOI:10.1159/000264229

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The objective of this report was to evaluate the effect of ultrasonographic (US) findings on pregnancy management in patients with marker chromosome (MC) aneuploidy ascertained through prenatal diagnosis. From 1989 throughJune 1993,15,522 prenatal diagnostic procedures were performed for accepted indications. Charts of patients with MC on amniocentesis or chorionic villus sampling (CVS) karyotype were evaluated with respect to US anomalies, pregnancy complications, and outcome. Nineteen cases of MC were identified. The prevalence of MC in our study was 0.12% (1:816 procedures). No significant difference between CVS and amniocentesis was found: 5/19 (26%) were CVS specimens, which is comparable to our CVS (3,259/15,522) case distribution. Three cases with incomplete records were excluded from the analysis. Four inherited MC cases were identified; 1 case had anencephaly. Of the 12 de novo MC cases 4 (33%) had abnormal US findings, and an additional 4 were found to have cytogenetic evidence for partial trisomy. Seven of these 8 abnormal de novo MC cases were terminated. MC aneuploidy is more common in pregnancies sampled for usual genetic indications than previously reported in pediatric series. Highresolution US may identify a major malformation not etiologically related to a MC inherited from a normal phenotypic parent. The association of the novo MC with US anomalies confers a poor prognosis, suggesting the expression of genetic imbalance from the accessory chromatin (partial trisomy). However, when US appears normal on initial and follow-up examinations, the chances for a normal-phenotypic newborn are high.

ISSN:1015-3837    

DOI:10.1159/000264230

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Second trimester selective termination has been used for 15 years to prevent the birth of children with fetal abnormalities. We have managed a twin pregnancy in which one twin had spontaneous rupture of membranes at 15 weeks, with continued fluid leakage and oligohydramnios. There was a high risk for infection, and selective termination was performed at 18 weeks of gestation, followed by the term delivery of the remaining twin. Selective termination may preserve the viability of the second twin therwise considered at high risk for fetal loss.

ISSN:1015-3837    

DOI:10.1159/000264231

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The authors report the case of a women who took retinoids (Roaccutan®, isotretinoin) during the first trimester of pregnancy, and a therapeutic abortion was carried out. The interest in this case report lies in the determination of the concentration of isotretinoin and its metabolites (4-oxoisotretinoin, and tretinoin) in fetal tissues, using high performance liquid chromatography. The findings show the significant transplacental crossing of isotretinoin, an accumulation of 4-oxo-isotretinoin in the liver, and a low concentration of retinoids in the brain of this 4-month-old fetus. The authors emphasize that contraception must be used during retinoid treatment, and 4 weeks after retinoids have been stopped

ISSN:1015-3837    

DOI:10.1159/000264234

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Between October 1985 and December 1993, 421 patients underwent fetal blood sampling for rapid karyotyping (426 samplings, 5 twin pregnancies). The aim of the study was to evaluate cordocentesis in terms of results, complications and additional information in this specific indication especially in case of abnormal pregnancy sonogram. The fetal loss rate possibly related to fetal blood sampling was 1.9%. Abnormal sonograms represented 91% of rapid karyotype indications. Chromosomal abnormalities were found in 9.5% of abnormal sonograms and in 16.9% of fetal structural anomalies (37 cases). The commonest chromosomal abnormality was trisomy 21 (11 cases). In conclusion, cordocentesis is a safe and reliable method for rapid karyotyping although it is associated with more risks than in other indications (congenital infections). The high rate of chromosomal abnormalities pleaded for ultrasonographic screening in a population usually not investigated by cytogenetic studies.

ISSN:1015-3837    

DOI:10.1159/000264235

出版商:S. Karger AG    

年代:1995

数据来源: Karger