摘要:

The addition of maternal serum intact hCG (MShCG) to routine maternal serum α-fetoprotein screening for Down’s syndrome is expected to yield a detection efficiency around 60% for an amniocentesis rate approximating 5%. We compared the detection rate using intact MShCG and free-beta hCG in 480 normal pregnancies and 48 with chromosome defects (Down’s syndrome 31, other chromosome defects 17). No significant difference in detection efficiency was determined. However, since the false-positive rate with free-beta hCG was almost twice that found with intact hCG, and the detection rate for other chromosome defects was more than double, the intact MShCG assay is currently preferred. Free-beta hCG earlier in gestation may, however, ultimately prove superior in maternal screening for chromosome def

ISSN:1015-3837    

DOI:10.1159/000263830

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Glucose, insulin, glucagon and fructosamine were measured in the plasma of control (n = 34) and of Rh fetuses (n = 22) before the first and subsequent transfusion. Prior to treatment, Rh fetuses, compared to controls, had raised concentrations of glucose (p = 0.01), glucagon (p = 0.04) and fructosamine (p = 0.004). Fetal insulin levels were not significantly different. Before subsequent transfusion, despite correction of anemia, Rh fetuses were clearly hyperinsulinemic even after correction for gestation (p = 0.002) and had low glucagon concentrations (p = 0.01) when compared with values at the first transfusion. This metabolic milieu appears similar to that of fetuses of diabetic mothers which have increased plasma glucose and insulin during most of the last third of gestation.

ISSN:1015-3837    

DOI:10.1159/000263831

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The aim of the study was to investigate changes with gestation of fetal plasma tumor necrosis factor alpha (TNF-α) concentration. In a cross-sectional study, enzyme-linked immunoassay was used to measure plasma TNF-α concentration in 40 fetal blood samples obtained by cordocentesis (n = 25), cardio-centesis (n = 5) or at elective caesarean section (n = 10) at 12-38 weeks gestation. The fetal plasma concentration of TNF-α increased from a mean of 13.5 pg/ml at 12 weeks gestation to 37.5 pg/ml at 38 weeks (r= 0.59, p < 0.0001), and was significantly associated with the monocyte count (r = 0.56, p < 0.001). TNF-α is present in the fetal circulation from at least 12 weeks and the changes in plasma TNF-α concentration with gestation coincide with the development of the fetal monocyte-macrophage sy

ISSN:1015-3837    

DOI:10.1159/000263832

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

One hundred and three intrauterine growth retardation (IUGR) pregnancies were scheduled for pulsed Doppler ultrasound of the common carotid and the umbilical artery, non-stress and contraction stress tests (NST/CST) as well as vibroacoustic stimulation tests (VAST). The last examinations < 3 days before birth were compared by receiver-operator characteristics: Results of the resistance indices of fetal common carotid/umbilical artery and NST were more predictive of later fetal distress during labour, compared to CST and VAST (p < 0.001/ < 0.01). Similar results were found for the prediction of low pH and Apgar values, though differences were less pronounced. Our results suggest that stressful examinations should be abolished from mother and fetus in the supervision of IUGR.

ISSN:1015-3837    

DOI:10.1159/000263833

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

In this prospective study conducted from 1984 through 1987, the ability to correctly predict growth discordancy in twin gestations by ultrasonic estimated fetal weights is examined. Discordancy was defined as an intertwin birth weight difference of 25% or greater. This method resulted in a sensitivity rate of 77% and a specificity rate of 92%. The positive predictive value of an abnormal test (i.e. discordant growth) was 67% and the negative predictive value of a normal test (i.e. concordant growth) was 95%. The perinatal mortality rate of 217/1,000 in discordant twin fetuses was significantly higher than 29/1,000 in the concordant twins in this study population (p < 0.01) and even more of a contrast to the rate of 10/1,000 in our singleton population. Accurate prediction of discordant twin pregnancies which are at high risk for poor outcome opens the opportunity for potential in utero treatment modalities.

ISSN:1015-3837    

DOI:10.1159/000263834

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The objective of this report was to undertake an overview of the clinical utility of umbilical Doppler ultrasound in the management of high-risk pregnancies. The study is designed as a formal meta-analysis of 6 randomised trial reports selected by predetermined criteria and was performed at the Division of Reproductive Medicine, Newcastle University, Australia. A total of 6 randomised controlled trials amounted to 2,102 patients in the experimental (Doppler) group and 2,133 patients in the control group. All patients had high-risk pregnancies. The management of pregnancies with Doppler was compared to those with standard obstetric management (i.e. excluding Doppler). Main outcome measures were perinatal mortality in the form of intrauterine deaths as well as obstetric performance indicators including caesarean section, elective delivery, fetal distress in labour, antenatal admissions and admissions to Neonatal Intensive Care Unit. The meta-analysis shows a significant reduction in perinatal mortality in the groups in which Doppler was used. Typical odds ratio was 0.5 [95% confidence intervals (CI) 0.34, 0.73]. The specific reduction in perinatal mortality occurred in intrauterine deaths in otherwise normally formed fetuses. The typical odds ratio was 0.54 with 95% CI 0.32, 0.89. This meta-analysis shows a significant reduction in overall perinatal mortality, specifically in the form of intrauterine deaths in otherwise normally formed babies.

ISSN:1015-3837    

DOI:10.1159/000263835

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The purpose of this study was to evaluate the ability to identify abnormalities in amniotic fluid volume by subjective ultrasonographic assessment compared to a semiobjective method. In 886 consecutive ultrasound examinations subjective assessment of the amniotic fluid volume was performed and graded into 3 categories: normal, decreased, and increased. Following that, a four-quadrant sum (amniotic fluid index) was performed by the same experienced ultrasonographer and divided into 3 categories using the 5th and 95th percentiles. The sensitivity of the subjective analysis to diagnose a decreased amniotic fluid volume when compared with the amniotic fluid index was 58% (95% confidence interval, CI: 40–70%), with a false-positive rate of 17% (CI 8–32%). The sensitivity of the subjective analysis to diagnose an increased amniotic fluid volume when compared with the amniotic fluid index was 100% (CI 70–100%). However, the false-positive rate was 74% (CI 55–85%). Diagnosis of a normal amount of amniotic fluid by the subjective technique had a sensitivity of 96% (CI 95–97%) and a false-positive rate of 3% (CI 2–4%). Subjective ultrasonographic assessment of the amniotic fluid volume may serve as a screening test for the experienced ultrasonographer. However, when a decreased or increased amount of amniotic fluid volume is suspected, one may elect to use the amniotic fluid index for confirmation of the subjective

ISSN:1015-3837    

DOI:10.1159/000263836

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

A case is presented in which ultrasonographic examination led to the prenatal detection of a ring 13 chromosome in a fetus. At 18 weeks’ gestation, the fetus presented with holoprosencephaly, an abnormal configuration of the lower extremities, and an atrial septal defect. Although the amount of amniotic fluid was normal, limb movements were never observed throughout pregnancy. The lower extremities were always flexed at the knee and talipes equinovarus was present. Hydrocephaly became apparent during the 2nd trimester. The ultrasonographic findings were confirmed by postpartum autopsy and X-ray examination. The ring chromosome was identified through amniocentesis and later verified in postpartum tissu

ISSN:1015-3837    

DOI:10.1159/000263837

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

A large contained urinoma measuring 12 × 8 × 8 cm3 was diagnosed in the left kidney of a female fetus at 28 weeks gestation. Analysis of fluid from serial punctures of the cyst indicated that renal function on that side was poor, but because ultrasound findings of the thorax suggested lung growth impairment, a shunt was inserted. After 3 weeks the shunt dislocated into the fetal abdominal cavity and urinous ascites developed. The ascites was found to have resolved spontaneously on ultrasonography 3 weeks later. The infant was delivered at 37 weeks gestation and appeared normal except for bilateral pelvi-ureteric obstruction. This was much worse in the left kidney, the renal function of which was only 10% of normal. A left nephrectomy was carried out when the infant was 6 months old, when the inner part of the shunt was discovered in perinephric fibrous tissue. The renal pelvis was greatly enlarged and fibrotic; no site of rupture could be identified. The infant’s respiratory function was normal. This case suggests the use of intrauterine shunting to decompress a large unilateral urinoma resulting in marked elevation of the fetal diaphragm to prevent impairment of fetal lung gro

ISSN:1015-3837    

DOI:10.1159/000263838

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Neonatal hemochromatosis is a rare inherited disorder of iron metabolism in which various tissues contain excessive amounts of iron. Only in a very few cases in which the disease is associated with fetal nonimmune hydrops is there the possibility for prenatal diagnosis. We present a case of fetal nonimmune hydrops fetalis in which severe fetal anemia and elevated liver enzymes were found. Retrospectively, according to pathological examination, these were signs of neonatal hemochromatosis. Only the knowledge of the disease entity allows antenatal diagnosis and rational perinatal management.

ISSN:1015-3837    

DOI:10.1159/000263839

出版商:S. Karger AG    

年代:1993

数据来源: Karger