Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
The refinements of modern ultrasound techniques permit a renewed examination of old concepts of fetal circulation. The concept of preferential streaming of umbilical blood through the foramen ovale is verified by animal experiments, and ultrasound studies have confirmed that a similar mechanism operates in human fetuses. However, the normalized umbilical flow appears to be less in the human than in fetal sheep, and decreases with advancing gestational age (115 ml min −1 kg −1 at 20 and 64 mL min −1 kg −1 at 40 weeks). Compared to the 50% shunting of umbilical blood through the ductus venosus found in animal experiments, the degree of shunting in the human fetus under physiological conditions is considerably less, 30% at 20 weeks, which decreases to 18% at 32 weeks, suggesting a higher priority of the fetal liver than previously realized. Augmented pulsatility in the precordial veins, ductus venosus, and umbilical vein is an important clinical sign that is poorly understood. Recent fluid dynamic studies show that, apart from the pressure generated in the atria, it is the stiffness of the vessel wall, compliance, and notably, impedance which modify these waves. Particularly the substantial shift in impedance at the ductus venosus-umbilical vein junction causes wave reflection and reduced transmission of waves, the result being diminished or absent pulsation in the umbilical vein.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
In order to find a reliable early marker of infection in newborns a study with simultaneous determination of soluble Intercellular Adhesion Molecule-1 (sICAM-1) and C-Reactive Protein (CRP) was planned. Prospectively 90 babies < 5 days of age suspect of infection were included. Retrospectively this population was classified into an “infected” group ( n = 45) and a “non-infected” group ( n = 45). For each of these two groups we calculated the sensitivity, specificity and predictive values of sICAM-1 and CRP as early markers of infection. We determined the best cut-off level for sICAM-1 to be 300 μg/l and for CRP 5 mg/l. As a biochemical test for infection in the newborns the sensitivity and negative predictive value for CRP were 0.69 and 0.73 respectively. When sICAM-1 was added and CRP and s-ICAM-1 were used in combination the sensitivity improved significantly to 0.93, p < 0.01 and the negative predictive value improved to 0.92, p < 0.05. In normal 5–8 days old babies' sICAM-1 was significantly higher than at birth (cord blood), p < 0.0001. In conclusion, sICAM-1 and CRP in combination are better than CRP as a primary test for identification of infection in babies < 5 days of age.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Aims: In our study we determined possible risk factors for intraventricular hemorrhage grade III to IV (IVH) based on a regional German neonatal data base and tried to build a logistic-regression model to predict the risk of IVH according to gestational age. Materials: We identified 3721 premature infants, 22 to 36 completed weeks of gestational age, born from 1994 through 1997. 136 (3.7%) IVH were diagnosed sonographically. 60 (44%) infants with IVH died. We examined the following variables as risk factors for IVH: gestational age, sex, blood pH of 7.2 or less, body temperature of 35°C or less, multiple birth, small-for-gestational age, intubation after birth, transport to another hospital. Results: In the full logistic regression model sex, blood pH of 7.2 or less, multiple birth, and small-for-gestational age were not associated with a significant risk of IVH. Body temperature of 35°C or less was associated with an increased risk of IVH (adjusted odds ratio, 1.92; 95% confidence interval, 1.09 to 3.40). Intubation after birth increased the risk of IVH in neonates under 28 weeks of gestational age (OR, 3.72; 95% CI, 1,65 to 8.38) only to a moderate extent, but significantly in neonates 32 to 36 weeks of gestational age (OR, 16.51; 95% CI: 7.35 to 36.18). The risk of IVH was mainly related to gestational age. Neonates delivered before 28 weeks of gestation (OR, 75.72; 95% CI, 46.14 to 124.30) faced the highest risk of IVH. Transport to another hospital was connected with an increased risk of IVH regardless of gestational age (adjusted OR, 1.95; 95% CI, 1.07 to 2.56). Conclusion: The frequency of IVH could be reduced significantly, if extremely premature infants, the vast majority of patients suffering from IVH, did not have to be transferred postnatally to another hospital.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Objective . To evaluate the perception of “Defensive Medicine” by hospital based obstetricians and the influence of this attitude on the choice of cesarean delivery. Subjects and Methods . Questionnaire sent by mail to a sample (76) of obstetricians of general district, teaching and university hospitals in a region of southern Italy (Puglia). Doctors were selected as the head, the most senior and the most junior specialist of each department. Independent variables of the study were considered as demographic data of the subjects, years of service, interest in private practice, size of the hospital, background cesarean section rate, personal and site of work exposure to legal claims. Outcome measures were experience and confidence in training for operative vaginal and breech delivery, use of the partogram in labor, opinion about a trial of labor after a previous cesarean section and about cesarean section on request, personal perception of defensive medicine. Univariate and multivariate analysis of data were performed. Results . The response rate was 83%. According to our data, seniority in service meant confidence in and request of more teaching of obstetrics manoeuvres, size of hospitals was positively related to amore rationale approach of the diagnosis of dystocia, heads of units were keener to accept the patient's wish for a cesarean section. Doctors with large private practices were less likely to be sued and the perception of legal pressure was directly related to the rate of cesarean section in each unit. Discussion . Defensive Medicine is a reality that encompasses all categories of doctors in this survey. The only differences were in the rate of perception of legal pressure. We believe that residential programs should be modified in order to improve specialists' understanding of malpractice problems and that the patient-doctor relationship should be ameliorated in public hospitals.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
C-type natriuretic peptide (CNP) belongs to the natriuretic peptide family that plays an important role in the control of blood pressure, renal function and volume homeostasis. In contrast to the atrial natriuretic peptide and brain natriuretic peptide, CNP acts in an autocrine/ paracrine fashion and is considered to be the endothelial component of the natriuretic peptide system. CNP has a high expression and tissue-specific regulation in reproductive organs. Using a radio-immunoassy for CNP-22 we measured for the first time CNP in fetal blood. Samples were taken by cordocentesis in a group of fetuses with rhesus isoimmunisation (10.74 ± 2.81 pg/ml), fetuses with rhesus isoimmunisation after intravascular transfusion (10.03 ± 4.01 pg/ml) and a group with structural anomalies (12.9 ± 5.67 pg/ml). A group of healthy fetuses was used as controls (11.64 ± 4.32 pg/ml). In contrast to ANP, the fetal CNP-plasma concentrations remain stable in the investigated fetal diseases and after volume load during intravascular transfusion. Moreover, fetal CNP-plasma levels are higher than previously measured maternal concentrations in normal pregnancies. Therefore, the fetus expresses CNP independently of the maternal circulation.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Objectives: Reservation of dedicated series of pedipacks, consisting of 3 to 4 units of 70 ml filtered red cell concentrate in additive solution SAGM from 1 donor, may reduce donor exposure. In this prospective efficacy study the benefits, release and expiration of pedipacks (PP) assigned to preterm infants requiring neonatal intensive care are analyzed. Methods: On the basis of clinical assessment of the need for multiple transfusions, 96 preterm neonates (gestational age < 32 wks and/or birth weight <1500 g) were assigned to either the high risk group (HRG), who were to receive dedicated donor blood units, or the low risk group (LRG). Inclusion criteria for HRG were 1) estimated time of admission > 21 days and 2) expected need for multiple transfusions due to clinical cardiorespiratory instability, prolonged parental feeding or frequent blood sampling. To reduce wastage of donor blood, dedication of donor blood units was limited to 21 days. Results: 50 series (192 PP) were assigned to 42 HRG infants. Two HRG infants received 3 series, 4 received 2 series and 36 received 1 series of PP. Mean transfusion rate was 3.1 PP in the HRG and 0.4 in the LRG. In the LRG 35 of 54 were not transfused, 19 received 1 to 2 PP. In both groups transfused newborns were exposed to 1.1 donors in average. In the HRG of 192 PP, 137 PP (71%) were used within 21 days, and another 30 (16%) before the expiration date < 35 days. Twenty five PP (13%) expired, mainly because of logistical problems in the introduction phase. Conclusion: Assignment of dedicated PP on the basis of clinical parameters at entry considerably reduces donor exposure in HRG. Wastage of dedicated blood transfusions was reduced by limitation of the dedicated period (21 days). In terms of efficacy, reservation and use of PP can be optimized by standardized administrative measures.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
This study was performed to correlate cervicovaginal fluid and umbilical cord plasma level of IL-6 and IL-8 in patients with premature rupture of the membranes (PROM) and to see the effect of antibiotics on those concentrations. As a part of a randomized controlled trial of treatment in PROM with antibiotics, cervicovaginal fluid was sampled before delivery for measurement of IL-6 and IL-8 and for bacteria from 36 patients less than 36 weeks of gestation. Umbilical cord plasma was also collected. Concentrations of IL-6 and IL-8 were measured by an ELISA. Neonatal infections were noted in a total of 9 cases, including bacteria detection (Escherichia coli 2 cases, GBS and Streptococcus constellata) in 4 cases. Correlation between IL-6 in cervicovaginal fluid and in cord plasma (r = 0.881, p < 0.0001) was stronger than that of IL-8 (r = 0.469, p < 0.01). The difference of concentrations in IL-6 and IL-8 was not significant between cases with (n = 20) and without (n = 16) ampicillin. Our observation indicates that the measurement of IL-6 concentrations in cervicovaginal fluid is a useful marker for PROM patients who are more likely to develop neonatal infection and the antibiotic treatment does not necessarily produce their beneficial effects on fetuses at the risk of infection.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Objective: To evaluate the diagnostic value of maternal serum interleukin 6 (IL-6), C-reactive protein (CRP) levels and white blood cell (WBC) count for the prediction of preterm labor and length of admission-to-delivery interval in patients with preterm labor. Methods: Maternal serum IL-6, CRP and WBC count were prospectively determined in eighty-two patients in preterm labor and 21 controls. Data was analyzed in study and control groups, and for the assessment of clinical and laboratory risk factors in the prediction of admission-to-delivery interval in the study group. Results: Maternal serum IL-6 levels were significantly higher in the study group than controls. The IL-6 value associated with the highest percent of true positives and true negatives for the prediction of preterm labor was 5 pg/ml. The area under curve of maternal IL-6 was significantly higher than the area under curve of of CRP and WBC count. In the study group maternal serum IL-6 levels were significantly higher in patients delivered within 2 and 7 days than the nondelivering ones and a cut off value of 8.3 pg/ml was determined for estimation of preterm delivery. Conclusion: Maternal serum IL-6 is a reliable marker in the prediction and management of preterm labor and delivery.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Pre-eclampsia — edema, proteinuria, hypertension (EPH-gestosis) is one of the more common complications observed during pregnancy. The umbilical cord vein walls were taken from newborns delivered by healthy mothers (control material) and by mothers with polysymptomatic pre-eclampsia (investigated material). Normal saphenous vein walls were collected from adult subjects undergoing varicose vein surgery. The collagen content was measured by the assay of hydroxyproline. Elastin was determined according to Fastin Elastin Assay and gravimetrically. Glycosaminoglycans content was determined by uronic acids assay. The collagen content decreased in the pre-eclampsia material. The amount of soluble elastin increased in the investigated material. The insoluble elastin content decreased in the umbilical cord veins of newborns delivered by mothers with pre-eclampsia. Reconstructing the umbilical cord vein wall may disturb fetal blood flow and affect the vascular system in adulthood.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Objective: Legionnaire's disease complicating pregnancy is an unusual event that can seriously compromise both the mother and the fetus. Case report: We describe one case of such association, with an unfavourable intrauterine fetal outcome, secondary to acute placental insufficiency, related to infection. Discussion: It is important in these high risk pregnancies complicated by acute pneumonia to take into consideration the diagnosis, as early as possible, and the appropriate treatment or the careful monitoring of fetal wellbeing.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Ultrasonography is used for the prenatal diagnosis of hypoplastic lungs. However, ultrasound poses problems because of difficulties in getting the entire lung in perspective and the results depend on the skill of the examiner. When the alveolar formation of the fetal lung is retarded, the fetus is predicted to show an altered density on MRI using an SSFSE sequence due to a varied amount of alveolar lung fluid. We present a case of twins who showed a marked difference in signal intensity of the lung on MRI, which was useful for predicting the fetal pathophysiology. Intrauterine MRI provides the possibility of diagnosing hypoplastic lungs prenatally.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Twins born with congenital lobar emphysema are reported. This has not previously been described. Diagnosis, surgical management and subsequent course is highlighted. These twins may well be the smallest to have operative treatment.
Unable to retrieve citations for this document
Retrieving citations for document...
Requires Authentication
Unlicensed
Licensed
June 1, 2005
Abstract
Reported herein are the cases of three infants who were born with serious intrathoracic injuries, apparently sustained at the time of the mother's involvement in a motor vehicle accident. The accidents occurred at 26th, 29th and 36th weeks of pregnancy and resulted in minimal injuries to the mothers themselves. The infants were born four weeks, three hours and two days later, respectively. Their injuries were manifested (singly) by hemothorax, pneumothorax and contusion of lung, the latter in a setting of multi-organ trauma. We suggest that chest x-ray, in addition to brain ultrasound, be routinely included in the evaluation of neonates whose mothers were involved in a motor vehicle accident during pregnancy, not excluding cases wherein the mother's injuries were negligible or inapparent and regardless of the time elapsed between accident and delivery.
