摘要:

The value of fetal haematological indices in the prediction of intrauterine infection in 91 cases of preterm prelabour amniorrhexis was examined. Cordocentesis and amniocentesis were performed for the diagnosis of intrauterine infection. The patients were subsequently divided into three groups, depending on the results of fetal blood and amniotic fluid cultures. In group 1 there were 53 patients with negative fetal blood and amniotic fluid cultures, group 2 consisted of 22 patients with negative fetal blood, but positive amniotic fluid cultures, and in group 3 there were 16 patients with positive fetal blood cultures. The mean leucocyte and neutrophil counts in all three groups were significantly higher than normal, and in group 3 the values were significantly higher than in group 1. The leucocyte and neutrophil counts were above the 95th centile of the normal range in 58% (22 cases) and 66% (25 cases), respectively, of the 38 cases with positive fetal blood and/or amniotic fluid cultures and in only 15% (8 cases) and 13% (7 cases), respectively, of the 53 patients with no infection. There were no significant differences between the groups, between the patients with amniorrhexis or for normal haemoglobin concentration, platelet count, or lymphocyte count. In the majority of the cases with positive fetal blood and/or amniotic fluid cultures, there is fetal leucocytosis. Since the results of the fetal leucocyte and neutrophil counts are available within a few minutes after cordocentesis, it would be reasonable to give antibiotics to all patients with a fetal leucocyte count above the 95th centile.

ISSN:1015-3837    

DOI:10.1159/000264244

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The development of multiple-marker biochemical screening has increased the percentage of aneuploidies detected for all age groups and has also increased the abnormality/amniocentesis ratio from about 1 in 85 for maternal serum α-fetoprotein alone (single screening) to about 1 in 50 for either maternal serum α-fetoprotein plus human chorionic gonadotropin (double screening) or maternal serum α-fetoprotein combined with human chorionic gonadotropin and unconjugated estriol (triple screening). We evaluated the decisions to have or decline amniocentesis of 985 patients ‘at risk’ by either single, double, or triple screening, as multiple markers were phased in over a 3-year period. The patient acceptance of the procedure did not change (approximately 80%) either by actual risk or type of biochemical screening. The labeling of ‘at risk’ status is more important than actual numerical risks, and the patient perception of risk status must be considered in

ISSN:1015-3837    

DOI:10.1159/000264245

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The objective of this study was to evaluate maternal temperature, heart rate, leukocyte count and C-reactive protein in the prediction of fetal bacteraemia and positive amniotic fluid cultures in 75 pregnancies complicated by preterm prelabor amniorrhexis. Cordocentesis and amniocentesis were performed and fetal blood and amniotic fluid were cultured for aerobic and anaerobic bacteria. Amniotic fluid was also cultured for Ureaplasma urealyticum and Mycoplasma hominis. Patients were classified into 3 groups: negative fetal blood and amniotic fluid cultures (group 1, n = 45); negative fetal blood but positive amniotic fluid cultures (group 2, n = 18), and positive fetal blood cultures (group 3, n = 12). In the groups with intrauterine infection compared to the non infected group, the median maternal temperature, leukocyte count and C-reactive protein were significantly higher. In groups 1, 2 and 3 the respective incidences of maternal pyrexia were 0, 7 and 16% and raised C-reactive protein 13, 28 and 33%. In pregnancies complicated by preterm prelabor amniorrhexis, maternal temperature, heart rate, leukocyte count and C-reactive protein do not provide sensitive prediction of intrauterine infection.

ISSN:1015-3837    

DOI:10.1159/000264246

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Fetal and maternal serum ferritin and cobalamin concentrations were examined in 40 red blood cell-isoimmunised pregnancies undergoing cordocentesis at 18–38 weeks of gestation and the values were compared to those of normal pregnancies. In the red blood cell-isoimmunised pregnancies, the fetal serum ferritin concentration was increased and the cobalamin concentration was decreased, whereas maternal serum ferritin was decreased and cobalamin was not significantly different from normals. There was a significant association between the degree of fetal anaemia and the increase in fetal serum ferritin concentration, but not with fetal serum cobalamin. This study suggests that fetal haemolytic anaemia is associated with iron overload and cobalamin deficienc

ISSN:1015-3837    

DOI:10.1159/000264247

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The effects of corticosteroids, given for enhancement of fetal lung maturation, on fetal heart rate (FHR) are controversial and may decrease its variability. FHR patterns were analyzed by computerized cardiotocography in 46 fetuses from 23 normal dichorionic twin pregnancies on days 0, 1 and 4–7 while the mothers received four intramuscular injections of 3 mg betamethasone sodium and 3 mg betamethasone acetate within 48 h to enhance fetal lung maturation. Compared with pretreatment values, FHR showed a decrease in long- and short-term variations; other parameters, e.g. the number of fetal movements, remained unchanged. However, decreased FHR variation was followed by an increase in the acceleration rate after maternal administration of betamethasone. These modifications were transient and should not lead to unnecessary anxiety or intervention in otherwise normal fetuse

ISSN:1015-3837    

DOI:10.1159/000264248

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The diagnosis of a diaphragmatic hernia at 18 weeks gestation by instillation of normal saline into the fetal peritoneal cavity under ultrasound guidance is described. The procedure established the diaphragmatic defect with certainty, outlined the contents of the hernia within the thorax, and demonstrated the degree of secondary lung compression.

ISSN:1015-3837    

DOI:10.1159/000264249

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A case report is presented herein of a 33-year-old woman with a history of congenital adrenal hyperplasia in 2 prior births. At 30 weeks of gestation, a scan of the fetal perineum demonstrated ambiguous genitalia which was confirmed at birth. This case demonstrates that when the fetal perineum is well visualized, the diagnosis of normal and abnormal genital development can be made sonographically. This can assist in perinatal/neonatal management, planning and in some cases, can also serve as an additional tool to monitor the success of prenatal steroid therapy of fetal congenital adrenal hyperplasia.

ISSN:1015-3837    

DOI:10.1159/000264250

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The umbilical artery, aorta, and middle cerebral artery pulsatility indices were investigated by pulsed Doppler ultrasound in 73 fetuses at 18–37 weeks of gestation, before and after fetal blood sampling performed either at the placental cord insertion (n = 46) or at the intrahepatic vein (n = 27). At the end of the procedure, after randomization, 35 fetuses were infused amounts of normal saline equal to the blood volume withdrawn, and 38 fetuses served as controls. Following blood sampling, the umbilical artery pulsatility indices decreased both in controls (p = 0.004) and in the saline group (p = 0.006). The middle cerebral artery velocity waveforms exhibited similar changes only in controls (p = 0.01), and no changes in fetal heart rate and aortic pulsatility indices were recorded in either group. The changes in blood flow velocity waveforms did not correlate with gestational age and the blood volume sampled, and were similar whether the site of sampling was the placental cord insertion or the intrahepatic vein. In 10 acidemic and/or hypoxemic fetuses, pulsatility indices in the umbilical and middle cerebral arteries were not modified by the blood sampling procedure. The release of vasoactive substances is most likely the cause of diminished vascular resistances following fetal blood sampling. Hypoxemic/acidemic fetuses may fail to mount a normal vasodilative response to needle punctur

ISSN:1015-3837    

DOI:10.1159/000264251

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The intervillous space (IVS) is part of the histofunctional unit of the human placenta and by being a fetal-maternal exchange interface is an important subject of study for the understanding of fetal physiology, especially in nutritional investigations. A method developed for the collection of IVS blood has permitted to evaluate the fetalmaternal exchanges in an effective manner. Two disadvantages of this method, however, are the mixing of IVS blood and fetal blood and marked hemolysis. In the present study we introduce and describe some modifications of this method using a single stylet for the perforation of the chorionic plate which simplifies collection and reduces the chance of mixing and hemolysis of the samples obtained.

ISSN:1015-3837    

DOI:10.1159/000264252

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Short-term ultrasound-guided fetal umbilical cord catheterization in humans has been reported. However, before chronic umbilical vein catheterization is attempted in humans the technique must be tested in the non-human primate model. If the fetus was to tolerate this procedure, chronic fetal umbilical vein catheterization could be used for drug administration, parenteral fetal nutrition or to monitor the changes of hematologic parameters during and after open or endoscopic fetal surgery. In this study, 4 pregnant baboons were used to test the feasibility of ultrasound-guided umbilical vein catheterization. Although the umbilical vein was successfully catheterized in all the animals, only 1 fetus survived the postoperative period. The 3 immediate fetal deaths were due to a fetal intra amniotic hemorrhage, while the most likely cause of death of the 4th animal was infection. In the surviving fetus and mother, blood was sampled once a day. Neither fetomaternal hemorrhage nor thrombosis could be documented. We conclude that ultrasound-guided transplacental umbilical vein chronic catheterization is technically difficult but feasible in the baboon model. Further studies in this model are needed to improve the catheterization technique and to monitor the extent of time that the catheter may be tolerated within the umbilical vein.

ISSN:1015-3837    

DOI:10.1159/000264253

出版商:S. Karger AG    

年代:1995

数据来源: Karger