Marker Of Fetal Maturity Research Articles

The distal femoral epiphysis used as a fetal maturity marker: Implications of extant medical data for bioarcheological analysis

AbstractThe distal epiphysis of the femur is classically reported as a marker of fetal maturity and is thus identified in a bioarcheological context as an indicator that an individual died at or around the time of birth; it thus provides crucial information in the creation of the biological profile and associated burial practices. The aim of the present study was to re‐evaluate this use by investigating an extant sample to assess (i) the age‐related frequencies of both distal femoral and proximal tibial epiphyses and (ii) the influence of factors such as sex, vitality, and morbidity on the maturation of both epiphyses. The study was conducted on medical CT scans acquired in utero and ex utero between 2008 and 2017 in the hospital of Marseille (France). The final sample included 248 individuals aged between 26 and 42 completed gestational weeks (GW). Based on the results obtained in this study, 11% of the individuals from the sample aged between 26 and 33 completed GW had already developed a distal femoral epiphysis, whereas individuals aged between 38 and 42 GW had already developed both femoral and tibial epiphyses. According to these observations and current obstetrical practice, this maturation indicator cannot therefore be considered a precise estimator of whether a fetus is at term or not in an archeological context. Similarly, no delayed ossification was found among individuals who did not survive to 42 GW, or among those with severe developmental abnormalities, which does not support the hypothesis that delayed epiphysis maturation of the distal femur may be a morbidity marker for this age group in past populations.

Perinatal outcome of pregnancies with intrauterine passage of meconium at 37-39 compared with 40-42 weeks' gestation

MECONIUM AT 37-39 COMPARED WITH 40-42 WEEKS’ GESTATION SHARON MASLOVITZ, ISHAI LEVIN, BENNY ALMOG, KUPFERMINC MICHAEL, DAVID PAUZNER, ARIEL MANY, Tel-Aviv Sorasky medical center., 0bstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: Meconium staining of amniotic fluid is considered by some as a marker of fetal maturity but others relate to it as fetal gastro-intestinal (GI) tract response to hypoxia. We sought to assess whether detection of antenatal meconium during earlier gestation (37-39w) is associated with adverse perinatal outcome compared with later appearance of intrauterine meconium (4042w). STUDY DESIGN: All patients delivering at Lis maternity hospital between June 2000 and June 2004 were reviewed for the presence of meconium and divided into two groups by gestational age at delivery (group I: 37-39 weeks, group II: 40-42 weeks). Maternal demographics and birth outcomes including mode of delivery, Apgar scores, NICU (neonatal intensive care unit) admission rate and neonatal complications and mortality were collected. Exclusion criteria included multiple gestations, breech presentations and fetal anomalies. RESULTS: 32428 women delivered at our hospital during the study period and 4798 of them were complicated by antenatal meconium (14.8%). After excluding multiple pregnancies, elective cesareans, induced deliveries and malformed fetuses we reviewed the computerized medical files of 2991 women, 1281 of them delivered spontaneously at 37-39 weeks’ (group I) gestation and 1710 at 40-42 weeks(group II). Cesarean rate was 22.2% and 16.8% (for group I and II respectively, P!0.05), while overall non-elective cesarean rate was 12.6% during that period (p!0.05). Neonates of group I were at higher risk for 5’ Apgar score!7 compared with neonates from group II (4.7% vs 2.8%, respectively, p!0.05) and at higher risk for NICU admission as well (9% VS 6.3%, respectively, p!0.05). No differences were detected with regards to meconium aspiration syndrome, respiratory distress syndrome, intraventricular hemorrhage and neonatal mortality. CONCLUSION: antenatal passage of meconium is associated with less favorable perinatal outcome when detected at 37-39 weeks’ gestation as compared with 40-42 weeks’ gestation in terms of non-elective cesarean rate, low 5’ Apgar scores and NICU admission rate.

Cord Blood TGFα Concentrations Increase with Advancing Gestational Age.† 1099

Transforming growth factor-alpha (TGFα) is a polypeptide that plays an important role in the growth and differentiation of a variety of ectodermal and mesodermal cells both during fetal and postnatal life. Epidermal growth factor (EGF), a growth factor that acts similarly to TGFα through binding of the EGF receptor, is associated with fetal growth and maturation: EGF cord blood concentrations correlate significantly with birth weight and placental weight (Biol Neonate, 1992:61). It is unknown if a similar relationship exists between cord blood TGFα concentration and advancing gestational age. We sought to determine if such an association exists. Eighty newborns ranging in age from 26 to 42 weeks gestation were enrolled in the study, and clinical data collected prospectively. At delivery, a cord blood sample was collected from each placenta and processed within 4 hours for serum separation. Serum samples were then frozen at -80°C until later analysis. Each sample was analyzed for TGFα concentration (pg/mL) by a commercially available RIA (RDI; sensitivity 1 pg/100 μL; cross-reactivity with EGF of 0%). The concentration of cord serum TGFα was expressed as the mean ± S.D. There was a strong association between TGFα cord serum concentration and gestational age (p<0.0002): the cord serum TGFα mean ± S.D. of infants <35 weeks was 16.5± 6.0 while the mean ± S.D. TGFα concentration of those infants ≥ 35 weeks was 26.0 ± 9.4. TGFα concentration increased with advancing gestational age to 36 weeks; thereafter, a concentration plateau was reached. Post-hoc analysis for unequal cell size was significant at p<0.05 (set a priori) with a critical difference of 3.7 (F=15.4). A similar association was demonstrated with birth weight. Those indicators of a premature birth, such as use of tocolysis, administration of celestone to mother prior to delivery, and respiratory distress, also were associated with TGFα cord serum concentrations. These results suggest that TGFα, like EGF, may play a role in fetal growth, and may be a marker of fetal maturity.

Fetal pepsinogens in human amniotic fluid.

The presence of group I (Pg I) and group II (Pg II) pepsinogens was determined in 59 samples of human amniotic fluid between 11 and 40 weeks of gestation. Pg I was present in all of the samples, while Pg II was present only in samples of gestational age 32 weeks or older. No differential pattern of the fractions was present, although the first fraction of Pg I was not present in any of the samples. The sequential appearance of Pg I and Pg II suggests their fetal origin and that the synthesis of Pg I by fetal gastric mucosa may precede that of Pg II, thus serving as a potential marker of fetal maturity.