摘要:

Objectives. We questioned whether race-specific databases for maternal serum alphafetoprotein (MSAFP) screening should be added to those already available for African-American and white patients. Study design. We analyzed 138,272 MSAFP samples. The geographic origin of the samples was New York metropolitan area. Patients were classified as white, African-American, Hispanic or Asian. The usual adjustments were made and groups compared. Statistical analysis included ANOVA and multiple comparison test. Results. MSAFP values are highest (p < 0.05) for Asians, followed by African-Americans, Hispanics, and whites, although the difference between Hispanic and white was not significant. Conclusions. Four separate databases are definable if specimen quantity is sufficient. Race/ethnic specific databases are more likely to yield the most accurate detection of abnormal MSAFP values, and therefore, fetal anomalies.

ISSN:1015-3837    

DOI:10.1159/000263854

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

An evaluation of nephrogenesis according to fetal age was performed by quantifying the state of the nephrogenic blastema (NB) and the number of glomeruli (GN) on frontal renal sections in 99 control fetuses (gestational age ranging from 9 to 40 weeks) and in 17 aborted fetuses with low urinary tract obstruction (gestational age ranging from 14 to 36 weeks). In the control group, GN increases slowly from the 10th to the 18th week, then abruptly from the 18th to the 32nd week, reaching an upper limit with NB disappearance by the 32nd week. In the uropathy group, the renal changes show a wide range of severity clearly accounted for by the impairment of both NB and GN. The dysplastic effect of urinary backpressure is the more consistent pathogeny with the spectrum of observed renal changes. It is likely, from GN used as a time-dependent marker of renal development, that the most severe dysplasia is the result of early obstruction with abnormal disappearance of NB and subsequent arrest of nephrogenesis.

ISSN:1015-3837    

DOI:10.1159/000263855

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

To determine if there are any specific monitoring patterns associated with chromosomal abnormalities the intrapartum tracings of 17 postnatally diagnosed karyotypically abnormal infants were obtained. Controls were randomly selected from infants born on the same day at the same gestational age. The tracings from these two groups were independently evaluated. Comparison of the monitor interpretations showed: (1) the karyotypically abnormal group was more likely to have decreased or absent short- (p < 0.001) and long-term (p < 0.01) variability; (2) accelerations were more likely to be represented in the control group (p < 0.001); (3) no significant differences were found in the baseline heart rates or in the presence or frequency of mild, moderate, or severe variable or late decelerations. These findings may reflect underlying central nervous system abnormalities as opposed to uteroplacental insufficiency, but are not specific to karyotypically abnormal infants.

ISSN:1015-3837    

DOI:10.1159/000263856

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

We herein reviewed 630 malformed fetuses delivered from 24 weeks of gestation onwards in our institute over the past 22 years. These fetuses were divided into 2 groups: 210 from 1970 to 1982 (group 1) and 420 from 1983 to 1991 (group 2). Twenty-two varieties of congenital malformations were diagnosed antenatally in group 1, whereas 55 additional malformations became diagnosable in group 2. Thirty-four varieties of congenital malformations still remained undiagnosed throughout the 22-year study period. Cases receiving ‘fetal therapy’ and ‘close obstetric care’ increased, with statistical significance, from 1.8 to 15.7%, and from 22.9 to 55.7% in groups 1 and 2, respectively. A significant increase was also noted in the survival rate from group 1 (63.3%: 105/166) to group 2 (75.5%: 259/343). This study has revealed that the steady advancement in antenatal diagnosis of congenital malformations, along with great efforts in terms of intensive care, has contributed to improved fetal

ISSN:1015-3837    

DOI:10.1159/000263857

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

The objective of this study was to determine the rate of ultrasound-detected free-floating particles in amniotic fluid during the early second trimester and their relationship with maternal serum α-fetoprotein (MSAFP) in patients with normal amniotic fluid α-fetoprotein (AFAFP). Ninetyeight consecutive patients undergoing second trimester amniocentesis for various indications were prospectively studied. Before undergoing amniocentesis, each patient had a level II ultrasound examination and evaluation of the presence of free floating particles. A subjective estimate of the particle amount and measurement of the size of the largest particle seen were made. Patients were stratified into three groups according to their MSAFP level (low, normal, high). Statistical significance of results was assessed by analysis of variance and multiple comparison procedure, and by nonparametric procedures, as appropriate. MSAFPs (mean ± 1 SD) were 0.41 ± 0.18 and 4.88 ± 2.22 multiples of the median for the low and the high groups, respectively. All AFAFPs were within normal limits. Ninety four percent of patients with high MSAFP had free-floating particles in amniotic fluid as compared to 43% in the low and normal groups (p < 0.01). Patients with high MSAFP had significantly greater density and size of particles. The presence of ultrasound-detected free-floating particles in amniotic fluid of normal patients during the early second trimester may preclude its use as a reliable indicator for fetal lung maturity, or suggest that the source of these particles may differ by trimester. High MSAFP is significantly correlated hith the ultrasonographic appearance of free-floating particles, as well as with larger size and higher am

ISSN:1015-3837    

DOI:10.1159/000263858

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Forty-seven fetuses treated with intravenous intrauterine transfusion for rhesus isoimmunization were studied. At the time of first transfusion the fetuses were below average in size with the fetal femur length being directly related to the degree of fetal anemia. Subsequent to transfusion therapy there was increased growth of all fetal parameters measured. Birthweight was similar to a control group of unaffected fetuses. This contrasts with results after intraperitoneal transfusion where birthweights have been reported as being below average.

ISSN:1015-3837    

DOI:10.1159/000263859

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

A retrospective study compared two comparable consecutive groups of nonlaboring primiparas beyond 41 weeks with severe oligohydromanios (no amniotic pocket more than 2 cm deep). Transabdominal amnioinfusions were not done in the historical control group (n = 14) but were done in the second group (n = 11). Fetal heart rate patterns and neonatal outcome were better in the group with amnioinfusion than in controls, and the rate of cesarean delivery was significantly lower (18 vs. 93%, p < 0.001). These results suggest that prepartum transabdominal amnioinfusionmay have obstetrical and perinatal benefits for nonlaboring postdates with oligohydramnios, especially when the cervix is unripe.

ISSN:1015-3837    

DOI:10.1159/000263860

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Homozygous α-thalassaemia Hb Bart is a very rare illness in North America and Western Europe, but is a common cause of NIHF especially in South East Asia. It causes severe hydrops fetalis with lethal outcome and maternal complications as pre-term labour, preeclampsia and retained placenta. A case report of an immigrant from Laos with preterm labour and fetal ascites, but without signs of pre-eclampsia is demonstrated. Fetal heart rate (FHR) trace and biophysical profile were pathological, while umbilical Doppler flow was normal due to hypoxaemia, but with hypervolumina and a high cardiac output. An amniocentesis and puncture of the ascites were performed, but FBS was not successful. Before receiving the results a caesarean section had to be done for deterioration of the FHR trace. A 1,370-g female infant was born who died of cardiovascular failure due to an α-thalassaemia Hb Bart and respiratory distress 5 days post partum. The parents had both an α-0-thalassaemia. α-Thalassaemia is still a very unknown illness in Germany, but with the increasing numbers of immigrants from South East Asia it should be considered at the differential diagnosis of hydrops fetalis. A prenatal diagnosis should be offered to parents with α-0-thalassa

ISSN:1015-3837    

DOI:10.1159/000263861

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Meroanencephaly is a rare form of anencephaly characterized by malformed cranial bones and a median cranial defect, through which protrudes abnormal tissue, called the area cerebrovasculosa. Area cerebrovasculosa denotes abnormal spongy, vascular tissue admixed with glial tissue ranging from a thin membrane to a large pseudoencephalic mass simulating cerebral tissue, that is composed of connective tissue, hemorrhagic vascular channels, glial nodules, and disorganized choroid plexuses. There are three types of anencephaly: (1) meroanencephaly, where there is rudimentary brain tissue and partial formation of the cranium; (2) holoanencephaly, the most common type, in which the brain is completely absent, and (3) craniorachischisis, the most severe, where area cerebrovasculosa and area medullovasculosa fill both cranial defects and the spinal column. In meroanencephaly, there is a median defect present, through which protrudes the area cerebrovasculosa. We present 3 cases of meroanencephaly diagnosed prenatally, along with histopathologic analysis. One case showed ectoptic glial tissue in the lung and adrenal medullary hyperplasia. Two cases were diagnosed in the early second trimester by ultrasound scanning. Meroanencephaly may be mistaken for encephalocele both at the bedside exam and sonographically, and should be included in the differential for protruding anterior cranial masses.

ISSN:1015-3837    

DOI:10.1159/000263862

出版商:S. Karger AG    

年代:1993

数据来源: Karger

ISSN:1015-3837    

DOI:10.1159/000263863

出版商:S. Karger AG    

年代:1993

数据来源: Karger