Chronic Fetal Distress Research Articles

Umbilical cord constriction as a cause of intrauterine fetal death

ABSTRACT The umbilical cord constriction (UCC) is an uncommon condition and an important etiology for stillborn fetuses. The main goal of this study was to verify the UCC occurrence as the cause of intrauterine fetal death, the associated etiology and its pathological characteristics. Therefore, a descriptive retrospective cross-sectional study was developed using the database from a Pathology Institute, in Brazil, from 1995 to 2017. The results presented a total of 1,359 embryo/fetus deaths – 69 (5.07%) due to UCC, 60.9% males and 39.1% females. The average age of pregnant women was 27.5 years ± 7.2 years of standard deviation (SD). The majority of deaths occurred during the second trimester (76.5%), followed by the first (14.7%) and third (8.8%) trimesters, respectively. One constriction alone was found in 87% of cases, 11% had two constrictions and only 1% had three or more. The presence of congenital malformations was detected in 20.2% of necropsies, the identification of chronic fetal distress was described in 71% of the technical reports and 17% of the cases had obstructive vasculopathy characteristics in microscopy analysis. Regarding the anatomopathological characteristics between the male and female sexes, no significant difference was found (p > 0.05) correlating gestational age, weight or congenital malformations. UCC was a cause of fetal death found in 5% of the cases, and it was linked to congenital malformations, fetal distress and obliterative vasculopathy.

MAJOR OBSTETRICAL COMPLICATIONS IN AN ELDERLY PRIMIPAROUS WITH A MULTITUDE OF PRE-EXISTING PATHOLOGIES

The number of primiparous pregnant women, over the age of 35, has increased considerably in the past few years, because of the elevated level of education and also because the multitude of contraceptive methods. Such a patient suits the category of elderly primiparous and it represents a real obstetrical challenge, due to the numerous complications related to pregnancy and the immediate postpartum, as well as those related to the neonatal prognosis. We present a 35 old years patient, second gestation, primiparous, a partially monitored pregnancy, known with essential hypertension grade III ESC / ESA, insufficiently controlled therapeutically, with target organ damage (exudative retinal detachment, hypertensive choroidopathy), morbid obesity and also with the suspicion of a renal tumor. The rate of complications occurring in the case of an elderly primiparous was increased in the present case. Obstetrical complications occurred: preeclampsia, HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, placental abnormalities (placenta accreta), intrauterine growth restriction, chronic fetal distress and finally fetal death in utero. The evolution of the patient in postpartum was burdened by the decompensation of the pre-existing pathology. In conclusion, elderly primiparous is susceptible to obstetrical complications during pregnancy and childbirth, such as premature birth, fetal acute distress, which may result in fetal death, placental abruption, placental abnormalities, preeclampsia, eclampsia, therefore following up the pregnancy requires increased attention and is also a real challenge for the obstetrician.

Neonatal Outcome of Induced Prematurity for Severe Preeclampsia in Four Great Kinshasa Maternities

Severe preeclampsia (SPE) is associated with fetal complications including intrauterine growth retardation (IUGR), prematurity and in utero fetal death. Its treatment remains child birth that often is planned before term. However, this attitude can lead to fetal complications related to prematurity. Several studies on preeclampsia have already been studied in the DRC and several aspects have already been realized, but to date, the neonatal outcome has not yet been addressed. Methods: This is cross-sectional study performed in four public hospitals in Kinshasa (Democratic Republic of Congo). We included 400 cases of induced prematurity (IP) for SPE; the analysis compared pregnant women who gave birth before 34 weeks of amenorrhea (WA) and those after 34 WA. The comparison of the proportions was made by the Chi-square test and the calculation of Means by the Student’s test. The significance level was set at P Objective: To determine the frequency of induced prematurity for severe preeclampsia (SPE), to identify the indications and to evaluate neonatal outcome. Results: The IP frequency for SPE was 46.2%. The retro placental hematoma was the most indication in pregnancies before 34 WA 24.9%, while high blood pressure 54.5% in the after 34 WA group. In utero death was more common in pregnant women who gave birth before 34 weeks 25.4%; chronic fetal distress was elevated in the after 34 WA group 19.5%. Neonatal infection was more common in the group after 34 WA 49.4%, while respiratory distress 39.6%, intra and periventricular hemorrhage 19.5% and neonatal death 39.6% were more in group before 34 WA. Conclusion: Prematurity induced for SPE is related to a poor neonatal prognosis.

Ultrasound Probe Pressure on the Maternal Abdominal Wall and the Effect on Fetal Middle Cerebral Artery Doppler Indices.

Background and Objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall—needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner’s hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).

CASE-REPORT Low-level trisomy 14 mosaicism in a male newborn with ectrodactyly

Complete trisomy 14 mosaicism is a rare chromosome disorder and was first reported in 1970. We describe a case of a male neonate who presented complete trisomy 14 mosaicism in only 4% of the cells from peripheral blood. A nineteen-day-old male neonate was born as result of the second pregnancy. The infant was delivered by cesarean section due to gestational hypertension and chronic fetal distress. The length of the term pregnancy was 37 weeks, the birth weight was 3.105 g, the length was 48 cm, and the head circumference was 35.5 cm. The baby remained hospitalized for 19 days in the neonatal intensive care unit due to respiratory distress syndrome and congenital malformations. Physical examination revealed a toned and normal activity, followed by phenotypic changes such as a broader forehead, formation of a cleft palate, hypertelorism, low-set ears, bilateral cryptorchidism, absence of the second toe of the left foot (ectrodactyly), and fusion of third and fourth toes in the right foot (bilateral syndactyly). Cytogenetic analysis was performed on peripheral blood cultures after hospitalization in the neonatal intensive care unit. Analysis of 200 G-banded metaphases showed that 192 (96%) had normal karyotype 46,XY and only 8 (4%) presented trisomy 47,XY,+14. It was not possible to perform cytogenetic analysis on the patient's parents. Our patient represents the first case of trisomy 14 disorder to present ectrodactyly.

Diagnóstico ecográfico del retardo del crecimiento intrauterino

En los últimos años asistimos a un movimiento de interés general respecto a los fetos con dificultades en el crecimiento intrauterino. El llamado de atención que significa el Retardo del Crecimiento Intrauterino (R.C.I.U.), para los obstetras, pediatras, y perinatólogos, se encuentra altamente justificado, ya que éste representa una alta mortalidad perinatal (8 veces mayor que los de peso normal). El frecuente sufrimiento fetal agudo y crónico, los numerosos peligros en el periodo neonatal, y la posible subnormalidad posterior, se ven contemplados en las crecientes investigaciones sobre este tópico.

Complicaciones fetales en gestantes con paludismo

OBJETIVO: Determinar las complicaciones fetales en pacientes gestantes con malaria. DISEÑO: Estudio prospectivo. PACIENTES Y MÉTODOS: Diez fetos de gestantes con malaria por Plasmodium vivax fallciparum controlados clínica y ecográficamente y atendidos en el hospital MINSA-Tumbes. RESULTADOS: La complicación más frecuente fue el sufrimiento fetal agudo o crónico (80%) y en un sólo caso hubo óbito.

129-POS

Objectives To determine risk factors for cesarean section in women with severe preeclampsia. Methods A prospective cohort study was conducted including women with severe preeclampsia treated at IMIP, Northeast of Brazil, from August 2009 to December 2010. Exclusion criteria were eclampsia, hemorrhagic emergencies, coma and other clinical conditions associated. Statistical analysis included determination of Risk Ratio and multiple logistic regression to determine the adjusted risk of cesarean section after controlling potential confounders. Results A total of 500 women with severe preeclampsia were included. Labor was spontaneous in 110 patients (22%) and induced in 141 (28.2%), 95 of whom went on to have vaginal deliveries (67.4%). The total Cesarean section rate was 68%; with 249 patients (50%) having elective and 92 (18.4%) intrapartum Cesarean sections. The Cesarean section rate following spontaneous labor was 42% The indications for cesarean were: severe preeclampsia (57%), chronic fetal distress (15%), breech presentation (5.6%), dystocias and/or cephalopelvic disproportion (6%), nonreassuring fetal heart rate (4.4%), macrosomia (4%) and having had two or more previous Cesarean sections (3.5%) When multiple logistic regression was performed, the main risk factors associated with cesarean section were hypertension without control during pregnancy (OR = 4.86; 95% CI = 1.30–20.42) and birthing from 7:00am to 10:00pm (OR = 6.52; 95% CI = 1.98–29.8). Labor induction (OR = 0.02; 95% CI = 0.01–0.16) and spontaneous labor (OR = 0.002; 95% CI = 0.0001–0.016) were associated with reduced risk of cesarean section. There was no association between cesarean section and maternal age, parity, gestational age, clinical presentation of preeclampsia, HELLP syndrome and proteinuria. Conclusions Cesarean section is frequently performed in patients with severe preeclampsia but real indications remain unclear. Labor induction is associated with a reasonable rate of success and should be tried in more cases. Disclosures L. Katz: None. M.M. Amorim: None. A.S. Souza: None. S.B. Maia: None. A.H. Franca Neto: None. N.V. Leal: None. A. Faundes: None.

Neuronal apoptosis in the neonates born to preeclamptic mothers

Objective: Preeclampsia may result in uteroplacental insufficiency and chronic intrauterine fetal distress. The aim of this study is to address this issue investigating neuronal apoptosis in an experimental model of preeclampsia and to evaluate the neurological outcome of the perinatal asphyxia in the neonates born to preeclamptic mother.Materials and methods: Two out of four pregnant Sprague–Dawley rats (preeclamptic group) were given water containing 1.8% NaCl on gestation day 15 and 22 in order to establish the model of preeclampsia whereas other two (non-preeclamptic group) received normal diet. A model of perinatal asphyxia was established on the postnatal 7th day to one preeclamptic and one non-preeclamptic dam. Overall 23 pups born to overall four dams were decapitated to assess neuronal apoptosis by the TUNEL assay.Results: The number of apoptotic neuronal cells was significantly higher in the preeclampsia groups in comparison with the control group (p = 0.006 and p = 0.006, respectively). It was also significantly higher in the asphyctic/non-preeclamptic group than the count in the control group (p = 0.01). There was also significant difference between both asphyctic groups (p = 0.003).Conclusion: We conclude that preeclampsia causes small babies for the gestational age and cerebral hypoplasia. Both preeclampsia and perinatal asphyxia can cause increased neuronal apoptosis in the neonatal brains. However, the prognosis for neurological outcome is much worse when the perinatal asphyxia occurs in newborns born to preeclamptic mothers.

Protection of Neuronal Diversity at the Expense of Neuronal Numbers during Nutrient Restriction in the Drosophila Visual System

SummarySystemic signals provided by nutrients and hormones are known to coordinate the growth and proliferation of different organs during development. However, within the brain, it is unclear how these signals influence neural progenitor divisions and neuronal diversity. Here, in the Drosophila visual system, we identify two developmental phases with different sensitivities to dietary nutrients. During early larval stages, nutrients regulate the size of the neural progenitor pool via insulin/PI3K/TOR-dependent symmetric neuroepithelial divisions. During late larval stages, neural proliferation becomes insensitive to dietary nutrients, and the steroid hormone ecdysone acts on Delta/Notch signaling to promote the switch from symmetric mitoses to asymmetric neurogenic divisions. This mechanism accounts for why sustained undernourishment during visual system development restricts neuronal numbers while protecting neuronal diversity. These studies reveal an adaptive mechanism that helps to retain a functional visual system over a range of different brain sizes in the face of suboptimal nutrition.

Quels arguments pour déterminer l’origine infectieuse d’un retard de croissance intra-utérin ?

Intra-uterine growth retardation (IUGR) is a frequent cause of consultation in antenatal care unit. The prognosis relies on the etiology: vascular, chromosomic, genetic, or infectious. Because of chronic fetal distress, hypotrophy increase morbidity, mortality and neurosensorial long term effect. Usually, infection is involved in 5 to 15% of the IUGR, mainly by Cytomegalovirus (CMV), Varicella Zoster virus, rubella, toxoplasmosis, herpes and syphilis. Maternal sera and amniotic liquid analysis make the diagnosis possible but fetal ultrasound scan is used to find other features. Most of the abnormalities are unspecific but their combination can worsen fetal prognosis. Infection should always be ruled out in the assessment of IUGR.

Cesarean delivery at term in low risk pregnancies: effects on neonatal morbidity

The rate of cesarean delivery (CD) has significantly increased over the last years, even in low risk pregnancies. Our objective was to compare the neonatal morbidity rate in low risk term infants delivered by vaginal or CD. Prospective observational and analytical cohort study. Main outcome measures. Incidence of any neonatal morbidity and respiratory morbidity. Population and methods. Infants < or = 37 weeks born at the Hospital Italiano de Buenos Aires between December 2004 and July 2006 were eligible. Exclusion criteria included: any maternal related disorder, acute or chronic fetal distress, breech presentation in primiparous women, multiple pregnancies, intrauterine growth restriction and newborns with major malformations. A total of 2021 infants were included, 1120 born vaginally and 901 by CD. Main indications for CD were failure to progress labor (46%) and previous CD (37%). Only 3% of CD was performed by maternal request. Any neonatal morbidity rate was 9% in infants born by CD and 6.6% in infants born vaginally (RR 1.36; 95%CI 1.01-1.8). Respiratory morbidity rate was 5.3% in infants born by CD and 3.1% in those born vaginally (RR 1.7; 95%CI 1.1-2.6). When stratified by gestational age, respiratory morbidity was higher only for infants < or =38 weeks (7.4% in CD vs. 2.1% in vaginal delivery; RR 3.5; 95%CI 1.5-8.1). Also, respiratory morbidity was higher in infants born < or =38 weeks by CD without labor vs. those with labor 10.5% and 3.9%, respectively (RR 1.35; 95%CI: 1.07-1.70). In a logistic regression analysis, CD and male sex were independently associated with higher respiratory morbidity. There were not significant differences in other morbidities. NICU admission was higher in infants born by CD (9.5% vs. 6.1%; RR 1.5; 95% CI: 1.1-2.1). Sixty-eight percent of the mothers from the CD group refereed having moderate to severe pain in the puerperium vs. 36% in the vaginal group (RR 1.9; 95% CI: 1.7-2.1). Exclusive breastfeeding at discharge was significantly lower in infants born by CD (90% vs. 96%; RR 0.94 95%CI 0.92-0.96). Low risk CD at term was associated with a higher neonatal morbidity, NICU admission and maternal pain in the puerperium. It also reduces exclusive breastfeeding rate at discharge.

Fetal Doppler Sonography in Preeclamptic Pregnancies treated with Antihypertensive and Oncotic Therapy

Purpose: Preeclampsia (PE) is a vasospastic disorder characterized by hyperdynamic circulation with increased peripheral, uterine and umbilical arterial resistance, and decreased circulating blood volume, hemoconcentration and hypovolemia, with a high risk of intravascular thrombosis and consequently poor perinatal outcome. Oncotic with antihypertensive therapy is aimed at improving and maintaining uteroplacental and maternal tissue perfusion, isovolemic hemodilution and thromboprophylaxis, thus reducing the risk of acute and chronic fetal distress.

Prevalence of Elevated Alanine Aminotransferase Among US Adolescents and Associated Factors: NHANES 1999–2004

Nonalcoholic fatty liver disease (NAFLD) is a common cause of liver disease in children and adolescents. The majority of studies of NAFLD in children have been in select populations of the clinically obese. Study aims were to estimate the prevalence of elevated alanine aminotransferase (ALT, as a marker of NAFLD) in a general contemporary adolescent population and to identify leading risk factors for ALT elevation (>30 U/L). We analyzed data of adolescent participants (aged 12-19 years; N = 5586) in the National Health and Nutrition Examination Survey 1999-2004, a representative sample of the civilian noninstitutionalized US population. The prevalence of elevated ALT levels (>30 U/L) was 7.4% among white adolescents, 11.5% among Mexican American adolescents, and 6.0% among black adolescents. Elevated ALT levels were prevalent in 12.4% of male subjects compared with 3.5% of female subjects. Multivariable associations with elevated ALT levels were found for sex (odds ratio [OR] male vs female, 7.7; 95% confidence interval [CI], 3.9-15.1), ethnicity (OR black vs white, 0.6; 95% CI, 0.3-1.3; OR Mexican American vs white, 1.6; 95% CI, 1.0-2.6), waist circumference (OR per 1 SD, 1.4; 95% CI, 1.0-2.0), and fasting insulin level (OR per 1 SD, 1.6; 95% CI, 1.2-2.1). Age, C-reactive protein levels, and triglyceride levels were also positively and socioeconomic position inversely associated with elevated ALT levels. The magnitude of associations were similar across ethnic groups. ALT level is associated with waist circumference and insulin resistance even in a young population. These characteristics could be utilized to identify adolescents who may benefit from screening for NAFLD, offering an opportunity to prevent disease progression at an early age.

Efficacy of melatonin on offspring liver maturation in pinealectomized pregnant rats subjected to experimental epilepsy

In clinical practice, maternal epilepsy is a disabling disease for newborn infants, but current data concerning the effect of epileptic phenomena in pregnant mothers on newborns are still limited. This study was undertaken to investigate the effects of pinealectomy (Px) and melatonin treatments on the morphological changes in the liver tissue of newborn rats following experimental epilepsy during pregnancy. Female Swiss Albino rats were divided into five groups: intact control group; saline control group; epilepsy group; epilepsy plus Px group; and melatonin-treated epilepsy plus Px group. At one month after Px, an acute grand mal epileptic seizure was induced by penicillin-G during their pregnancy in all animals except the control groups. On the neonatal first day, newborn rats were perfused with intracardiac fixative solution, and then livers were removed and processed for toluidine blue, periodic acid-Schiff (PAS) and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) reactivity. Normal migration and hepatic maturation were determined in the postnatal rat liver in the control groups, while the morphological structure of the liver in the epilepsy and epilepsy plus Px groups corresponded to the early embryonic period. In the melatonin-treated epilepsy plus Px group, the number of TUNEL positive cells decreased significantly compared to both epilepsy and epilepsy plus Px groups; however, there was no statistically significant difference from the control groups as a result of melatonin activity. Some histological findings consistent with chronic fetal distress in newborns of mother rats with epilepsy and Px were observed. Melatonin could be a candidate protective drug for the development of liver tissue in pregnant patients with epilepsy.

Physiological modulation of protein kinase G by chronic hypoxia and maturation in adult and fetal ovine common carotid arteries

In ovine carotid arteries, relaxation responses to 8pCPT-cGMP, a cell permeant non-hydrolyzable analogue of cGMP, are strongly influenced by chronic hypoxia and postnatal maturation. Thus, we hypothesized that chronic hypoxia modulates PKG activity and/or abundance in an age-dependent manner. To test this hypothesis, we measured rates of phosphorylation of a specific PKG substrate (BPDEtide) following activation of PKG in crude high-speed (100,000 XG) artery homogenates with 5 μM cGMP in presence of ATP[?32P] and separation on phosphocellulose. Rates of phosphorylation were significantly enhanced by hypoxia but depressed by maturation and averaged 1959±100 (normoxic adult), 2309 ± 76 (hypoxic adult), 2552±78 (normoxic fetus) and 3392 ± 149 (hypoxic fetus) pmol ATP/mg protein/min. Despite greater PKG activity in fetal than adult arteries, quantitative Western blots revealed that PKG abundances were marked greater in adult than fetal arteries under both normoxic and hypoxic conditions. Immunohistochemistry further revealed that PKG was distributed predominantly near the advential-medial border in adult arteries, but near the basal lamina in fetal arteries. These differences suggest that PKG is physiologically upregulated by chronic hypoxia, but downregulated by postnatal maturation. Such changes have important implications for vascular regulation and reactivity to NO in fetuses born following conditions of chronic intrauterine hypoxia and/or fetal distress. Supported by NIH HD31226 and HL64867

Fetal Doppler Hypoxic index for the prediction of abnormal fetal heart rate at delivery in chronic fetal distress

Objective: To design a Doppler Hypoxic index (HI), which takes into account both the duration and the intensity of fetal flow redistribution (i.e. hypoxia) for predicting the occurrence of abnormal fetal heart rate (FHR) at delivery. Method: Sixty-six pregnancies with hypertension and/or growth retardation (IUGR) were investigated (age: 23 ± 5 years; primigravidas: 30%, CS 59%; hospitalisation: 10 ± 8 days, IUGR (<10 c) 82%, intensive care 23%, fetal death 1). Umbilical (URI) and cerebral (CRI) Doppler resistance indices, and the C/U ratio (CRI/URI) were measured every 2 days from admission to delivery. HI was calculated by summing the daily %C/U reduction (in % from normal cut-off limit 1.1) over the period of observation (or mean C/U reduction in % from 1.1 × number of days of observation). Doppler C/U and HI were compared with fetal heart rate (FHR) traces, and perinatal data. Results: HI > 160% was associated with abnormal FHR in 80% of the cases (PPV = 87%, NPV = 88%). HI > 160% predicted the occurrence of abnormal FHR 8 ± 6 days before they happened. Conclusion: A combination of intensity and duration of the fetal flow redistribution (i.e. hypoxia) evaluated by Doppler is correlated with the occurrence of abnormal fetal heart rate.

Tumor placentário diagnosticado durante a gravidez: relato de caso

The most frequently nontrophoblastic tumor of the placenta found is chorioangioma, with an incidence of about 1%. When they are small, they do not significantly affect the fetus, but the large ones can cause intrauterine growth restriction, polyhydramnios, premature delivery, congestive heart failure and fetal death. The authors report a case of chorioangioma in a 28-year-old woman, second gestation, whose diagnosis was established at the 32nd week by ultrasound and confirmed by the anatomopathological examination. Ultrasonography evaluations showed chronic fetal distress and the delivery was performed at 36 weeks. The newborn results were satisfactory with Apgar 9-10 and fetal weight 2.460 g.

Intrauterine Growth Restriction

After completing this article, readers should be able to: 1. List the most common identifiable cause of intrauterine growth restriction (IUGR). 2. List maternal conditions that can cause both IUGR and preterm delivery. 3. Characterize the effects of IUGR on fetal water, mineral, nitrogen, protein, glycogen, adipose tissue, total energy balance, and tissue mass. 4. Describe Doppler velocimetry findings suggestive of chronic fetal distress. 5. List potential adult disorders resulting from IUGR. Intrauterine growth restriction (IUGR) is defined as a rate of fetal growth that is less than normal for the growth potential of a specific infant. An enormous number and variety of established and possible causes have been identified. Potentially, any aberration of biological activity in the fetus can lead to growth failure. For example, deficiency or insufficient action of any one of the factors that influence fetal growth (see “Factors Influencing Fetal Growth” in this issue), alone or in combination, could lead to IUGR. The most common identifiable cause is fetal undernutrition due to placental insufficiency. Although most placentas that have insufficient function probably have specific deficits in nutrient transport capacity (eg, decreased placental vasculature with resulting decreased uterine and/or umbilical blood flow, decreased number or function of specific nutrient transporters), a smaller-than-normal placenta alone is sufficient to limit fetal nutrient supply. Small placental size can be natural, pathologic, or simply relative. For example, a small mother generally cannot produce a large placenta because her uterus is small. Similarly, even a normal-size mother can have a relatively small uterus, and, therefore, produce a small placenta if she carries more than one fetus. Experiments of artificially decreased placental growth have shown that any such restriction leads to fetal growth delay, confirming the direct relationship between placental and fetal size and the primary causal role of the placenta in determining fetal growth. However, there is …

Nucleated red blood cells as a marker in acute and chronic fetal asphyxia

Objective: To investigate the variations of nucleated red blood cell (NRBC) counts in acute and chronic fetal hypoxia and to examine if it could be possible to establish a cutoff value for the number of NRBCs for prediction of fetal acidosis. Method: We prospectively studied 77 pregnant women. Patients were grouped as acute ( n=11) and chronic fetal distress ( n=21) and controls ( n=45). At delivery the umbilical cord was double clamped and blood samples were collected. Results: The mean NRBC counts in chronic fetal distress group was higher than acute fetal distress. NRBC counts were found to be correlated with umbilical cord pH ( r=−0.57; P<0.001). The cutoff value predicting fetal acidosis was determined as 14/100 leukocytes (sensitivity 87%, specificity 81%) by using ROC analysis. Conclusion: The duration and the severity of fetal asphyxia may be predicted by the number of NRBCs per leukocyte.