摘要:

The discovery of a ‘stuck twin’ during an ultrasound examination has often been equated with twin-to-twin transfusion based to a great extent on postnatal confirmation of discordant fetal size and hemoglobin concentration. However, the diagnosis of twin-to-twin transfusion cannot be made with certainty after birth since virtually all monochorionic gestations have placental anastomoses and there are many causes of growth deficiency and abnormal hemoglobin concentration. The purpose of this study is to investigate the pathophysiology of chronic twin-to-twin transfusion syndrome and apply the findings to the development of a anagement algorithm. In 42 twin gestations with stuck twin associated with acute hydramnios, we performed targeted ultrasound cordocentesis in each fetus and therapeutic amniocentesis. The diagnosis of chronic twin-to-twin transfusion syndrome required: sonographic evidence of monochorionicity; rapid reaccumulation of fluid after amniocentesis; discordant fetal size, and divergent fetal hematocrit measurements with at least one above or below the 95% confidence interval for gestational age. These criteria were met in 20 of 42 (48%) pregnancies. The mean gestation was 23.8 ± 2 weeks (range 21-27 weeks). In 4 pregnancies, the transfer of adult RBCs from the donor to the recipient was documented. Monochorionicity was confirmed in all postnatally. All recipients had polycythemia and hyperproteinemia. Hydrops developed only in the recipient twin (6 of 20) and was associated with an elevated umbilical venous pressure. All pregnancies were treated with aggressive serial therapeutic amniocenteses. There was no objective evidence that amniocentesis altered the magnitude of the shunt. In addition, 1 patient chose pregnancy termination, 3 a selective fetocide of the donor twin, and 4 transfusion therapy. The mean gestation at delivery was 29 + 4 weeks and the perinatal mortality rate 58% (23 of 40 fetuses). Survival was significantly lower when symptoms appeared < 25 weeks (10 of 30 vs. 7 of 10, p = 0.04). The presumptive diagnosis of twin-to-twin transfusion is frequently erroneous and an accurate diagnosis required antenatal evaluation. Hydrops results from heart failure secondary to a combination of polycythemia and hyperproteinemia. Because no antenatal therapy is clearly effective and the likelihood of neonatal survival is greater when symptoms first appear ≥ 24 weeks, an invasive evaluation should be limited to those pregnancies which either present < 25 or ≥ 25 weeks with a hydrop

ISSN:1015-3837    

DOI:10.1159/000263949

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The presence of nucleated erythrocytes was studied before and after enrichment with immunomagnetic beads and monoclonal antiglycophorin A (anti-GPA) antibody in the peripheral venous blood of 11 pregnant women at 10–16 weeks of gestation. Nucleated erythrocytes were identified by alkaline phosphatase antialkaline phosphatase immunostaining by means of anti-GPA antibody. In the unenriched cell samples, nucleated erythrocytes were found at frequencies of 1/2,800–1/83,000 in 6 cases. The frequency of nucleated erythrocytes was increased up to 6 times by the enrichm

ISSN:1015-3837    

DOI:10.1159/000263950

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.

ISSN:1015-3837    

DOI:10.1159/000263951

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In an attempt to locate biochemical markers specific for fetal distress we measured the amniotic concentrations of β-endorphin, ACTH, cortisol, dopamine, norepinephrine and epinephrine with its major metabolite metanephrine (MN) in pregnancies with documented fetal well-being and pregnancies complicated by hypertension and fetal distress. While higher levels of cortisol and MN were found only in a selected subgroup of highly compromised subjects (p < 0.001 and p < 0.005, respectively), β-endorphin increased significantly under conditions of moderate or severe intrauterine sufferance (p < 0.001 in both cases). Due to higher levels of the opioid even during the initial stage of fetal discomfort we evaluated its characteristics as a possible clinical marker. Specificity was 88.5%, whereas the sensitivity of 65.6% in the moderately compromised subgroup increased to 88.9% in severely suffering fetuses. Although more accurate and mainly real-time information on the fetal health status is obtained by means of biophysical methods, the determination of amniotic fluid β-endorphin might be of clinical usefulness in prenatal diagnos

ISSN:1015-3837    

DOI:10.1159/000263952

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A method for rapid estimation of fetal blood content during cordocentesis is described. This procedure gives an opportunity to determine the contamination of the fetal sample by maternal blood as soon as possible. The method is based on the ability of fetal hemoglobin to resist denaturation in alkaline conditions, and can be used routinely. Fetal blood samples show a lower degradation rate (range 1.2–8.2%) compared to the maternal samples (range 25.0–52.5%). The method has the capacity to discriminate fetal and maternal samples with regard to their fetal hemoglobin cont

ISSN:1015-3837    

DOI:10.1159/000263953

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In this geographically based study the findings on 158 abnormal fetuses, primarily diagnosed by routine antenatal ultrasound, are correlated with the results of the examinations subsequently carried out by a fetopathologist and a clinical geneticist. Ninety fetuses (57%) had a single malformation, 66 were polymalformed (42%) and 2 had no malformations. In 90% of all these cases, the prenatally and postnatally detected anomalies were identical; in 3% the defect established at necropsy was different from that diagnosed prenatally, and in 7% the predicted anomaly was absent. These values did not depend on whether single or multiple malformations were involved. In 57% of the polymalformed cases, however, the ultrasound examination missed at least one other diagnosable anomaly. On the basis of pathological and clinical genetic expertise, a risk of recurrence of the anomaly was revised in 13% of the single malformed cases and in 53% of the multiple ones, i.e., in 30% of all the cases of malformation on average. This study confirms the need for the fetus to be examined by a pathologist and a clinical geneticist after termination of a not ‘at risk’ pregnancy in order to check the accuracy of the sonographic procedure, to confirm the reasons for terminating the pregnancy to the parents, and to be able to monitor the next pregnancy based on an accurate assessment of the risk of recurre

ISSN:1015-3837    

DOI:10.1159/000263954

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Evaluation of the adequacy of fetal growth by measurements of fetal size required theoretical formulae for the assessment of present size from previous measurements. The various models presented in the literature assume the same mathematical formula for the whole pregnancy. In this study, a model of different polynomial approximations for the early and late stages of the pregnancy is compared to two models which assume a single formula for both stages of the pregnancy. The standard error of estimate is lower for the sectioned model.

ISSN:1015-3837    

DOI:10.1159/000263955

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The strong light sources used in fetoscopy and embryoscopy may cause eye injuries to the fetus. To circumvent this potential hazard, we have successfully used an infrared light source and infrared video camera to perform ‘night vision’ fetoscopy in a fetal lamb mo

ISSN:1015-3837    

DOI:10.1159/000263956

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The object of the study was to determine whether cardiac sampling of the rabbit fetus could be successfully accomplished with minimal procedure-related loss. Pregnant rabbit dams were randomized to undergo ultrasound-guided fetal cardiac sampling in either the left or right uterine horn at 27 days of gestation; cesarean delivery was performed the following day. Liveborn pups from unsampled uterine horns underwent cardiac puncture immediately after birth. Fetal hematologic parameters were then compared to neonatal parameters. The acute fetal mortality from the sampled uterine horns was similar to that of the unsampled horns (3.6 vs. 4.5%). Fetal hematologic values were significantly higher than neonatal values with the exception of the reticulocyte count. This rabbit model offers a new approach for the evaluation of novel treatment modalities for hemolytic disease of the human fetus.

ISSN:1015-3837    

DOI:10.1159/000263957

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The heterozygous state of the sickle cell trait is not known to be a cause of fetal death. This is a report of disseminated placental infarcts associated with thiamine deficiency in a patient with the sickle cell trait. This pathological association suggests an original physiopathological process.

ISSN:1015-3837    

DOI:10.1159/000263958

出版商:S. Karger AG    

年代:1994

数据来源: Karger