Analysis of factors associated with infantile hemangioma: a multicenter case-control study / 中华皮肤科杂志

Objective:To analyze demographic and clinical characteristics of infantile hemangioma (IH) , and to explore related risk factors for IH.Methods:A multicenter case-control study was conducted. IH patients (case group) and healthy children (control group) were collected from West China Hospital of Sichuan University, West China Second University Hospital of Sichuan University and Yulin Community Central Hospital of Chengdu from October 2018 to December 2020. The data on patients′ demographic characteristics, and risk factors during their mothers′ pre-pregnancy, pregnancy and perinatal period were collected and retrospectively analyzed. Univariate and multivariate analyses were performed using binary logistic regression.Results:A total of 1 479 patients with IH and 1 086 healthy children were included in this study. There were 456 males and 1 023 females in the case group, with the age being 3.74 ± 2.82 months, and there were 359 males and 727 females in the control group, with the age being 3.95 ± 2.77 months. There was no significant difference in the gender ratio, age, ethnic composition, birth weight or birth height between the case group and control group (all P > 0.05) . IH lesions mostly affected the head and face (564 cases, 38.1%) , followed by the trunk (449 cases, 30.6%) and limbs (356 cases, 24.1%) . At the visit, 1 109 (75.0%) patients presented with proliferating IH, 1 059 (71.6%) with superficial IH, and 1 306 (88.3%) with focal IH. The IH lesion area ranged from 0.01 to 168.00 (6.24 ± 12.91) cm 2, and the segmental IH area ranged from 7.50 to 168.00 (32.17 ± 26.94) cm 2. Univariate logistic regression analysis showed some factors influencing the occurrence of IH (all P < 0.05) , including pre-pregnancy factors (delivery history and miscarriage history) , pregnancy factors (fetal distress, cord entanglement, history of threatened abortion, placenta previa, oligohydramnios, gestational hypothyroidism, gestational anemia, history of progesterone supplementation, history of thyroxine drug use, history of uterus myomas) , and perinatal factors (including fetal position, gestational weeks, premature rupture of membranes and preterm premature rupture of membranes) . Multivariate binary logistic regression adjusted analysis showed that fetal breech presentation, preterm birth, cord entanglement and history of thyroxine drug use during pregnancy did not influence the occurrence of IH (all P > 0.05) ; the delivery history was the strongest independent risk factor for IH (adjusted OR = 5.624, 95% CI: 4.275 to 7.398, P < 0.001) , and gestational hypothyroidism and history of uterus myomas were protective factors for IH. Conclusions:In this study, the average age of IH patients at visit was 4 months, skin lesions mostly occurred on the head and face, and most were superficial and focal in the proliferative stage. The occurrence and development of IH may be associated with placental diseases, hypoxia, maternal hormone levels during pregnancy, etc.

Carencias y variabilidad en la calidad de la atención a neonatos hospitalizados en México. Estudio transversal en 28 hospitales públicos / Deficiencies and variability in the quality of care for hospitalized neonates in Mexico. Cross-sectional study in 28 public hospitals

Resumen: Objetivo: Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Material y métodos: Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccionados al azar del Subsistema Automatizado de Egresos Hospitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según muestreo estratificado no proporcional. Resultados: Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la identificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones: La calidad de la atención a neonatos en hospitales es heterogénea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

Abstract: Objective: To evaluate the quality of care to newborns with process indicators, in selected pathologies. Materials and methods: Multi-centric, cross-sectional evaluation of 9 indicators in 28 hospitals in 11 States of Mexico. Lot Quality Assurance Sampling (LQAS) was used for quality standards and sample per hospital. Randomly selected cases from the Automated Hospital Discharge Subsystem. The hospitals are classified as "standard compliance"/"non-compliance" by indicator and, compliance with 95%CI exact binomial, regional and national, according to non-proportional stratified sampling. Results: No indicator meets the standard of 75% in hospitals, with range from 0 to 19 hospitals that meet, according to indicator. Except for timely identification of perinatal asphyxia and onset of correct antibiotics in suspected early sepsis, the compliance is <50% on all other indicators. Conclusions: The quality of care for newborns in hospitals is heterogeneous and poor. Indicators are proposed to monitor improvement initiatives.

Marcadores morfológicos de hipoxia en el riñón fetal con insuficiencia placentaria tratado con neuro-EPO: estudio en ratas / Morphological markers of hypoxia in the fetal kidney with placental insufficiency treated with neuro-EPO: study in rats

RESUMEN Fundamento: la restricción del crecimiento intrauterino constituye una complicación del embarazo. Los recién nacidos con esta condición están expuestos a un mayor riesgo de morbimortalidad perinatal y postnatal. Objetivo: evaluar marcadores morfológicos de hipoxia en el desarrollo fetal y en el riñón, utilizando un modelo de insuficiencia placentaria tratado con eritropoyetina humana con bajo contenido de ácido siálico (neuro-Epo) en ratas. Métodos: se utilizaron tres grupos de ratas gestadas de la línea Wistar. Un grupo control (grupo I) y dos grupos experimentales (grupos II y III) con seis ratas cada uno. A las ratas de los grupos II y III se les realizó ligaduras de arterias uterinas en el día 16 de la gestación (E 16). Al grupo III desde E16 hasta E19 se le administró una dosis de 0,5 mg/kg/día de neuro-Epo por vía subcutánea y al grupo II se les administró placebo. En el día 20 de la gestación se pesaron los fetos y sus placentas. En el feto se midió la talla y los diámetros cefálicos. Las características morfométricas e histológicas en el riñón fetal se estudiaron con tinción de hematoxilina-eosina y PAS. Se realizó un análisis cualitativo histopatológico de sus tipos celulares. Resultados: los fetos con restricción del crecimiento intrauterino no mejoraron los marcadores de crecimiento. Se encontraron lesiones por hipoxia en el riñón fetal del grupo RCIU no tratado que mejoraron al administrar neuro-Epo. Conclusiones: la administración de neuro-Epo solo mostró efectos reparadores y protectores sobre alteraciones histológicas provocadas por la hipoxia en el riñón fetal.

ABSTRACT Foundation: intrauterine growth restriction constitutes a complication of pregnancy. Newborns with this condition are exposed to an increased risk of perinatal and postnatal morbidity and mortality. Objective: to evaluate morphological markers of hypoxia in fetal and kidney development, using a model of placental insufficiency treated with human erythropoietin with low sialic acid content (neuro-Epo) in rats. Methods: three groups of gestated rats from the Wistar line were used. A control group (group I) and two experimental groups (groups II and III) with six rats each. Rats of groups II and III had uterine artery ligation on day 16 of pregnancy (E 16). Group III from E16 to E19 was administered a dose of 0.5 mg / kg / day of neuro-Epo subcutaneously and group II was administered placebo. On the 20th day of gestation the fetuses and their placentas were weighed. The fetuses' size and cephalic diameters were measured. Morphometric and histological features in the fetal kidney were studied with hematoxylin-eosin staining and PAS. A qualitative histopathological analysis of their cell types was performed. Results: fetuses with intrauterine growth restriction did not improve growth markers. Hypoxia lesions were found in the fetal kidney of the untreated RCIU group that improved by administering neuro-Epo. Conclusions: the administration of neuro-Epo only showed reparative and protective effects on histological alterations caused by hypoxia in the fetal kidney.

Labor Admission Test And Neonatal Outcome

Purpose: Purpose of the study is to study the Mode of Delivery and Perinatal outcome in relation to the admission test in the study group . Method: All women in latent phase of labor were subjected to admission test with CTG machine and tracing recorded. Any complication arising during labor and the perinatal out come were recorded. Results: Incidence of fetal distress, need for operative delivery, low apgar scores, low birth weight, admission to NICU and perinatal deaths are significantly more in non reactive admission test group. Conclusion: Admission test is economical, non invasive, and readily available screening test. Non reactive patterns predicts well the incidence of perinatal complications and Neonatal mortality.

Antropometría neonatal a término en una población rural y urbana a 3 400 metros de altura / Anthropometry in at-term neonates in a rural and an urban population at 3 400 meters altitude / Antropometria de recém-nascidos a termo em uma população da zona rural e da zona urbana a uma altitude de 3 400 metros

RESUMEN Objetivo Averiguar si hay diferencias en las medidas antropométricas de neonatos a término en una población rural y urbana a 3 400 m de altura. Material y métodos Estudio descriptivo poblacional de neonatos a término sin enfermedades en el Hospital Nacional Adolfo Guevara Velasco del Cusco (HNAGV) y el Centro de Salud de Huanoquite (CSH), entre 2005 y 2010. Se calcularon medidas de tendencia central, las medias se compararon con la prueba t de Student, el modelo final se ajustó por sexo neonatal y se calcularon las odds ratios (OR) y sus IC95% para estimar la fuerza de la asociación entre tener un neonato pequeño para la edad gestacional (PEG) según el P10 del peso y del índice ponderal (IP) en los recién nacidos de madres que viven en el distrito de Huanoquite y cuyo parto fue atendido en el CSH. Resultados En el HNAGV y el CSH se estudiaron 372 y 368 los neonatos, respectivamente. Las medias de la edad materna fueron 31,7 y 27,0 años, las gestaciones previas, 2,4 y 3,4, los abortos, 0,4 y 0,0, los hijos nacidos vivos, 1,0 y 2,3 (p < 0,001), y el peso, la talla y el IP, 3 311,8 g, 49,5 cm, 2,73 y 3 008,9 g, 48,4 cm, 2,66, respectivamente (p < 0,001). Tras ajustar por sexo, el peso, la talla y el IP por categoría edad gestacional para los dos centros fueron: (37-38 semanas) 3 185,1 g, 49,18 cm, 2,67, y 3 009,8 g, 48,5 cm, 2,64; (39-40 semanas) 3 385,9 g, 49,9, 2,73, y 3 051,8 g, 48,6 cm, 2,66; (41-42 semanas) 3 461, 6 g, 50,2 cm, 2,73, y 3 072,2 g, 49,1 cm, y 2,6, respectivamente (p < 0,001). La OR de nacer PEG en el CSH fue 3,52 (2,4-5,1) según el peso y 2,05 (1,3-3,1) según el IP respecto a nacer en el HNAGV. Conclusión El peso, la talla y el IP de los neonatos del CSH fueron menores que los del HNAGV y las OR de tener un neonato PEG fueron 3,52 según el peso y 2,05 según el IP, respectivamente.

Objective Ascertain whether there are differences in the anthropometric measurements of at-term neonates in a rural population and an urban population at 3 400 m altitude. Material and methods Descriptive population study of healthy at-term neonates in the Adolfo Guevara Velasco National Hospital (HNAGV) in Cusco and in the Huanoquite Health Center (CSH), [both at 3 400 m altitude in Peru], between 2005 and 2010. Measures of central tendency were calculated, the averages were compared with a Student's t-test, the final model was adjusted by neonatal sex, and the odds ratios (OR) and corresponding confidence intervals (CI95%) were calculated to estimate the strength of association between small for gestational age (SGA) infants (according to weight under P10 and ponderal index [PI]) in mothers who live in the Huanoquite district and those who gave birth in the CSH. Results In the HNAGV and the CSH, 372 and 368 neonates were studied, respectively. The average maternal age was 31.7 and 27.0 years; previous pregnancies, 2.4 and 3.4; miscarriages, 0.4 and 0.0; live births, 1.0 and 2.3 (p<0.001); and weight, height and PI, 3 311.8 g, 49.5 cm, 2.73, and 3,008.9 g, 48.4 cm, 2.66, respectively (p<0.001). The weight, height, and PI for the two centers were, after adjusting for sex and by gestational age bracket: (37-38 weeks) 3,185.1 g, 49.18 cm, 2.67, and 3,009.8 g, 48.5 cm, 2.64; (39-40 weeks) 3 385.9 g, 49.9, 2.73, and 3 051.8 g, 48.6 cm, 2.66; (41-42 weeks) 3 461, 6 g, 50.2 cm, 2.73, and 3,072.2 g, 49.1 cm, and 2.6, respectively (p<0.001). The OR of SGA births in the CSH was 3.52 (2.4-5.1) according to weight and 2.05 (1.3-3.1) according to PI, compared to birth in the HNAGV. Conclusion The weight, height, and PI of infants born in the CSH were lower than those born in the HNAGV, and the OR of SGA births was 3,52 according to weight and 2,05 according to PI, respectively.

Resumo Objetivo Examinar se existem diferenças antropométricas em recém-nascidos a termo em uma população da zona rural e da zona urbana vivendo a uma altitude de 3.400 m. Materiais e métodos Estudo descritivo populacional de recém-nascidos a termo sem doenças associadas realizado no Hospital Nacional Adolfo Guevara Velasco, em Cusco (HNAGV), e no Centro de Saúde, em Huanoquite (CSH), entre 2005 e 2010. Foram calculadas as medidas de tendência central e as médias comparadas com o teste t de Student. O modelo final foi ajustado por sexo do recém-nascido e calculados os odds ratios (OR) e seus respectivos intervalos de confiança de 95% (IC95%) para estimar a força da associação entre ser pequeno para idade gestacional (PIG) segundo o percentil 10 (P10) do peso e o índice ponderal (IP) nos recém-nascidos de mães que vivem no distrito de Huanoquite cujo parto foi assistido no CSH. Resultados Foram estudados 372 e 368 recém-nascidos no HNAGV e no CSH, respectivamente. A idade média materna foi de 31,7 e 27,0 anos, as mães tiveram em média 2,4 e 3,4 gestações anteriores, 0,4 e 0,0 abortos, 1,0 e 2,3 nascidos vivos (p < 0,001) com peso, comprimento e IP foi de 3 311,8 g, 49,5 cm e 2,73 e 3 008,9 g, 48,4 cm e 2,66, respectivamente (p < 0,001). Após ajuste para o sexo, o peso, o comprimento e o IP por categoria de idade gestacional nos dois centros estudados foram: (37-38 semanas) 3 185,1 g, 49,18 cm e 2,67 e 3 009,8 g, 48,5 cm e 2,64; (39-40 semanas) 3 385,9 g, 49,9 e 2,73 e 3 051,8 g, 48,6 cm e 2,66; (41-42 semanas) 3 461,6 g, 50,2 cm e 2,73 e 3 072,2 g, 49,1 cm e 2,6, respectivamente (p < 0,001). Os OR dos recém-nascidos PIG no CSH foram de 3,52 (2,4-5,1) segundo o peso e 2,04 (1,3-3,1) segundo o IP ao nascimento no HNAGV. Conclusão O peso, o comprimento e o IP dos recém-nascidos no CSH foram menores que os dos recém-nascidos no HNAGV e o OR de ser PIG foi de 3,52 segundo o peso e 2,05 segundo o IP, respectivamente.

Effects of prenatal hypoxia on vascular functions of fetal rats / 中华围产医学杂志

Objective To explore the effects and mechanisms of prenatal hypoxia on vasomotor functions of fetal rats.Methods Sixteen pregnant Sprague-Dawley rats were randomly divided into two groups:control and hypoxia groups (eight in each group).Rats in the hypoxia group were provided with 10.5％ of oxygen from gestation day 5 to 21,while those in the control group were exposed to normoxic condition.Fetuses were removed from the pregnant rats by cesarean section on gestational day 21.Fetal body weight,blood gas and electrolyte levels were measured.Thoracic aorta rings were separated from fetal rats and used in different vascular function tests.Effects of hypoxia during pregnancy on angiotensin Ⅱ (Ang Ⅱ)-mediated vasoconstrictions and acetylcholine (Ach)-mediated vasodilatations in fetal thoracic aortas were measured.Changes in vasomotor functions were observed after both endothelial nitric oxide synthase (eNOS) inhibitor NG-nitro-L-arginine methyl ester (L-Name) and L-type calcium channel (LTCC) inhibitor nifedipine were administered.T-test and two-way analysis of variance were used for statistical analysis.Results (1) Compared with the control group,fetal body weight [(4.40±0.23) vs (3.33±0.42) g,t=2.871],blood partial pressure of oxygen [(50.64±2.17) vs (42.50-±-2.32) mmHg (1 mmHg=0.133 kPa),t=-2.618] and blood oxygen saturation [(58.95±1.97)％ vs (47.73±2.24)％,t=3.564] in the hypoxia group were significantly reduced (all P＜0.05).(2) Compared with the control group,Ang Ⅱ-mediated vasoconstrictions increased,but Ach-mediated vasodilatations in fetal thoracic aortas decreased in the hypoxia group (both P＜0.05).L Name induced stronger Ang Ⅱ-mediated contractions in thoracic aortas in the control group than that in the hypoxia group (P＜0.05).However,nifedipine decreased Ang Ⅱ-induced contractions,especially in the hypoxia group (P＜0.05).Conclusions Maternal hypoxia during pregnancy not only affects the growth and development of fetuses but also changes their blood vessel functions,which may be related to the change of LTCC and the impairment of eNOS.

Preventable causes of death and factors associated with newborn survival at a university hospital in Curitiba, Paraná, Brazil / Causas evitáveis de morte e fatores associados à sobrevida de recém-nascidos em um hospital universitário da cidade de Curitiba, Paraná, Brasil

ABSTRACT Introduction: The analysis of deaths occurred in the neonatal period and the association of these data to necropsy data are crucial to reduce infant mortality rate worldwide. Objective: To analyze the preventable causes of death and the factors associated with a higher risk of early newborn death. Methods: A cross-sectional and descriptive study was performed with data about newborns that died during the neonatal period at a university hospital located in Curitiba; 314 cases of pediatric necropsies were selected, and preventable causes of death, survival time, sex, weight, gestational age, first- and fifth-minute Apgar score, cyanosis, acidosis, meconium aspiration, the need for oxygen resuscitation, cause of death and baseline disease were analyzed. Results: When considering only the cause of death, 300 cases (95.54%) would have preventable causes, but when analyzing the underlying disease, the number of cases decreased to 209 (66.56%). The most frequent cause of death was hypoxia (85%), and the main baseline disease was diffuse alveolar damage (52.9%). There was a positive association between these variables with survival time: cyanosis (p = 0.02), gestational age (p = 0.012), cause of death (p < 0.001), Apgar score < 6 (p < 0.001) and pH value (p < 0.001). Conclusion: The incidence of preventable causes of death is probably lower when analyzed concurrently with the underlying disease. Cyanosis, gestational age, cause of death, Apgar < 6 and arterial blood pH are associated with survival time of newborns.

RESUMO Introdução: A análise de óbitos ocorridos no período neonatal e a associação desses dados aos de necrópsias são fundamentais no auxílio à redução da taxa de mortalidade infantil no mundo. Objetivos: Observar as causas evitáveis de morte e os fatores associados ao maior risco de óbito neonatal precoce. Métodos: Foi realizado estudo transversal e descritivo de recémnascidos que foram a óbito em um hospital da Universidade Federal do Paraná (UFPR). Foram selecionados 314 casos de necrópsias e analisadas as causas evitáveis de morte, tempo de sobrevida, gênero, peso, idade gestacional, índice de Apgar do primeiro e do quinto minuto, cianose, acidose, aspiração meconial, necessidade de reanimação com oxigênio, causa de morte e doença básica. Resultados: Quando se analisa apenas a causa de morte, 300 casos (95,54%) seriam de causas evitáveis, porém, quando se analisa a doença básica, o número de casos diminui para 209 (66,56%). A causa de morte mais frequente foi hipóxia (85%), e a doença básica principal foi dano alveolar difuso (52,9%). Houve associação positiva das seguintes variáveis com o tempo de sobrevida: cianose (p = 0,02), idade gestacional (p = 0,012), causa do óbito (p < 0,001), valor de Apgar < 6 (p < 0,001) e valor do pH (p < 0,001). Conclusão: A incidência de causa evitável de morte é provavelmente menor quando analisada concomitantemente com a doença básica. A cianose, a idade gestacional, a causa do óbito, o Apgar < 6 e o valor do pH do sangue arterial estão associados ao tempo de sobrevida de recém-nascidos.

Admission test in detecting fetal asphyxia at the time of admission in labour

Introduction: The intrapartum assessment of fetal well being has become an integral part of the management of labour. Aim: The objective of this study was to evaluate the predictive value of admission test in detecting fetal asphyxia at the time of admission in labour and to correlate the results of admission test with perinatal outcome in high risk obstetric cases compared with low risk obstetric cases. Materials and methods: This was a prospective observational study conducted in the labour and maternity ward of Govt. Gandhi hospital in Secunderabad, during the period 2012 to 2013 with a sample size 50 high risk obstetric cases and 50 low risk obstetric cases. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions. Results: The majority of women were primigravida in the 18-23 years age group in both high risk and low risk groups. Admission test was reactive in 35 cases (70%) in high risk group, 42 cases (84%) in low risk group where as non reactive in 15 cases (30%) in high risk group and 8 cases (16%) in low risk group. In cases with reactive admission test spontaneous vaginal deliveries were more in low risk group than in high risk group. Operative deliveries were more in high risk group than in low risk group in both reactive and non reactive admission test. Indication for caesarean section in both reactive and non reactive admission test was more in high risk group i.e. 1 case (25%) and 6 cases (66%) respectively. Perinatal outcome was abnormal in high risk groups in both reactive and non B. Rekha, J. Rajeshwari. Admission test in detecting fetal asphyxia at the time of admission in labour. IAIM, 2016; 3(10): 146-152. Page 147 reactive admission test. Specificity and Negative predictive value in high risk group is less than that in low risk group. Conclusion: The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in both high-risk and low risk obstetric patients with significant results.

Relation Between Absoute Nucelated Red Blood Cell Count at Birth and Retinopathy of Prematurity

PURPOSE: The aim of this study is to prove the association between potential fetal hypoxia and retinopathy of prematurity (ROP) development and absolute nucleated red blood cell (aNRBC) is used to evaluate it in premature infants without any hypoxic or ischemic history. METHODS: Medical records of 43 premature infants with ROP who were admitted to the neonatal intensive care unit at Wonkwang University Hospital from January 2004 to December 2014 were analyzed retrospectively. We excluded 15 infants who had a confounding medical condition that could have increased the aNRBC count. Finally, 28 premature infants affected by ROP were enrolled and compared with 28 pair-matched controls. The aNRBC counts at birth in these infants were compared. Statistical analysis was performed with a paired t-test for continuous data, and a Fisher's exact test for categorical data. P24 hours), prenatal betamethasone, surfactant or respiratory distress syndrome between the ROP and the control infants. In addition, neither group differed in major morbidities such as patent ductus arteriosus, periventricular leukomalacia, intraventricular hemorrhage (> or =Grade 2), or bronchopulmonary dysplasia. Regardless of the severity of ROP, the aNRBC counts at birth in premature infants with ROP were not higher than in the control infants. CONCLUSION: The aNRBC counts at birth may not be related directly to the development of ROP.

Relação entre a contagem de eritroblastos no sangue do cordão umbilical e os resultados obstétricos e neonatais em fetos pequenos para a idade gestacional e com Doppler de artéria umbilical normal / Relation between nucleated red blood cell count in umbilical cord and the obstetric and neonatal outcomes in small for gestational age fetuses and with normal dopplervelocimetry of umbilical artery

OBJETIVO: Avaliar resultados obstétricos e neonatais em gestantes com fetos pequenos para a idade gestacional após 35 semanas segundo a contagem de eritroblastos (EB) no sangue de cordão umbilical.MÉTODOS: A contagem de EB por 100 leucócitos no sangue do cordão umbilical foi obtida de 61 gestantes com fetos pequenos para a idade gestacional e Doppler umbilical normal. Estas foram divididas em 2 grupos: EB≥10 (grupo estudo, n=18) e EB<10 (grupo controle, n=43). Resultados obstétricos e neonatais foram comparados entre os grupos. Para a análise estatística, foram utilizados teste do χ2e t de Student, com nível de significância adotado de 5%.RESULTADOS: A média±desvio padrão de EB por 100 leucócitos foi de 25,0±13,5 para o grupo estudo e de 3,9±2,2 para o grupo controle. Os grupos EB≥10 e EB<10 não diferiram estatisticamente em relação à idade materna (24,0 versus 26,0 anos), primiparidade (55,8 versus 50%), comorbidades (39,5 versus 55,6%) e idade gestacional no parto (37,4 versus 37,0 semanas). O grupo EB≥10 apresentou maior taxa de cesárea (83,3 versus 48,8%, p=0,02), sofrimento fetal (60 versus 0%, p<0,001) e pH<7,20 (42,9 versus11,8%, p<0,001). O peso de nascimento e o percentil de peso para a idade gestacional foram significativamente menores no grupo EB≥10 (2.013 versus 2.309 g; p<0,001 e 3,8 versus 5,1; p=0,004; respectivamente). Não houve nenhum caso de Apgar de 5º minuto abaixo de 7.CONCLUSÃO: A contagem de EB acima de 10 por 100 leucócitos no sangue do cordão umbilical foi capaz de identificar maior risco de parto cesárea, sofrimento fetal e acidose de nascimento em fetos pequenos para a idade gestacional com dopplervelocimetria de artéria umbilical normal.

PURPOSE: To analyze the obstetrical and neonatal outcomes of pregnancies with small for gestation age fetuses after 35 weeks based on umbilical cord nucleated red blood cells count (NRBC).METHODS: NRBC per 100 white blood cells were analyzed in 61 pregnancies with small for gestation age fetuses and normal Doppler findings for the umbilical artery. The pregnancies were assigned to 2 groups: NRBC≥10 (study group, n=18) and NRBC<10 (control group, n=43). Obstetrical and neonatal outcomes were compared between these groups. The χ2 test or Student's t-test was applied for statistical analysis. The level of significance was set at 5%.RESULTS: The mean±standard deviation for NRBC per 100 white blood cells was 25.0±13.5 for the study group and 3.9±2.2 for the control group. The NRBC≥10 group and NRBC<10 group were not significantly different in relation to maternal age (24.0 versus 26.0), primiparity (55.8 versus 50%), comorbidities (39.5 versus55.6%) and gestational age at birth (37.4 versus 37.0 weeks). The NRBC≥10 group showed higher rate of caesarean delivery (83.3 versus 48.8%, p=0.02), fetal distress (60 versus 0%, p<0.001) and pH<7.20 (42.9 versus11.8%, p<0.001). The birth weight and percentile of birth weight for gestational age were significantly lower on NRBC≥10 group (2,013 versus 2,309 g; p<0.001 and 3.8 versus 5.1; p=0.004; respectively). There was no case described of 5th minute Apgar score below 7.CONCLUSION: An NRBC higher than 10 per 100 white blood cells in umbilical cord was able to identify higher risk for caesarean delivery, fetal distress and acidosis on birth in small for gestational age fetuses with normal Doppler findings.

Effects of maternal limb ischemic preconditioning on structural and func-tional changes of mitochondria in fetal hippocampal neurons induced by intrauterine distress-reoxygenation in rats / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the effects of maternal limb ischemic preconditioning ( LIP) on the mitochon-drial structures and functions of the hippocampal neurons induced by reoxygenation in the intrauterine distress fetal rats. METHODS:Pregnant rats (n=40) were randomly divided into 4 groups: sham (S) group, LIP group, fetal distress ( FD) group and LIP+FD group.Intrauterine ischemia model was established through the experimental design.The ultra-structure of the mitochondria in CA1 area of the hippocampus was observed .The mitochondrial membrane potential and re-active oxygen species ( ROS) were measured .The content of ATP and MDA in the hippocampus tissue was detected.The activity of Mn-SOD was observed.RESULTS:Compared with sham group, the ultrastructure of mitochondria in CA1 area of the hippocampus was damaged in FD group and LIP+FD group.The mitochondrial membrane potential, the content of ATP and the activity of Mn-SOD were decreased.However, the content of ROS and MDA was increased.Compared with FD group, the ultrastructure of mitochondria in CA1 area of the hippocampus was intact in LIP+FD group.Furthermore, the reduced mitochondrial membrane potential and ATP content were inhibited.The activity of Mn-SOD was increased, but the content of ROS and MDA was decreased in LIP+FD group.CONCLUSION:Limb ischemia preconditioning inhibits the damage the mitochondria of fetal hippocampal neurons induced by reoxygenation in the intrauterine distress fetal rats.

Influence of hypoxia during different pregnancy stages on myocardial remodeling in adult offspring rats / 中华围产医学杂志

Objective To evaluate whether the timing of maternal hypoxia during pregnancy could myocardial remodeling in adult offspring.Methods Twenty-four pregnant rats were assigned to the maternal hypoxia group starting from the early period of pregnancy (G1,day 3 to 21 of pregnancy),the group starting from the middle period of pregnancy (G2,day 9 to 21 of pregnancy),the group starting from the late period of pregnancy (G3,day 15 to 21 of pregnancy),or the control group (G0).Six rats were included in each group.Rats in the maternal hypoxia groups (G1,G2 and G3) were subjected to hypoxia for 3 hours in a low pressure cabin with an oxygen concentration of (10± 1) ％.Systolic blood pressure,wet weight of the left ventricle normalized for body weight (left ventricular weight/body weight,LVW/BW),diameter of cardiomyocytes,and the expression levels of collagen Ⅰ and collagen Ⅲ were measured in adult male offspring at the age of 3 and 5 months.One-way ANOVA and SNK test were used for statistical analysis.Results Maternal hypoxia from day 3 to 21 of pregnancy induced higher systolic blood pressure in male offspring at the age of 3 months and 5 months [3 months:G1 (122.0± 11.7) mmHg,G0 (108.3±9.5) mmHg,F=2.97; 5 months:G1 (128.5±7.9) mmHg,G0 (114.6±-10.0) mmHg,F=3.17,both P＜0.05].Maternal hypoxia also led to a higher LVW/BW ratio (G1 1.99±0.03,G0 1.80±0.02,P＜0.05),and increased collagen Ⅰ and collagen Ⅲ expression (collagen Ⅰ /β-actin:G1 1.76±0.07,G0 0.48±0.04,P＜0.01; collagen Ⅲ /β-actin:G1 0.68±0.05,G0 0.34±0.03,P＜0.01) in adult male offspring at the age of 5 months.Maternal hypoxia from day 9 to 21 of pregnancy induced a higher LVW/BW ratio (3 months:G2 2.15 ± 0.05,G0 1.98 ± 0.02,P＜0.05; 5 months:G2 1.96±±0.05,G0 1.80±0.02,P＜0.05),and increased collagen Ⅰ and collagen Ⅲ expression (3 months:collagen Ⅰ /β-actin G2 0.98±±0.02,G0 0.87±0.02,P＜0.05; collagen Ⅲ /β-actin:G2 0.87±±0.01,G0 0.82±0.01,P＜0.05; 5 months; collagen Ⅰ /β-actin G2 1.61±0.05,G0 0.48±0.04,P＜0.01; collagen Ⅲ / β-actin:G2 0.61 ±0.04,G0 0.34±0.03,P＜0.01) in male offspring at the age of 3 months and 5 months,but did not affect systolic blood pressure.Maternal hypoxia from day 15 to 2l did not have any effect.The diameter of cardiomyocytes in male offspring was not significantly different between the groups.Conclusions Maternal hypoxia during different periods of pregnancy has different effects on cardiac structure in adult rat offspring.Maternal hypoxia started in early or mid-pregnancy leads to cardiac collagen deposition without an increase in myocyte size in adult offspring,which may be independent of the change in blood pressure.

Influence of intrauterine hypoxia on lung blood vessel development in rats and expression of vascular endothelial growth factor in the lungs / 中华围产医学杂志

Objective To observe the impact of intrauterine hypoxia on the development of rat lungs and expression of vascular endothelial growth factor (VEGF) in the lungs as the time of hypoxia was extended.Methods To create a model of intrauterine hypoxia,12 pregnant rats were divided into four groups as follows:air-control group,hypoxic 2-day group,hypoxic 6-day group,and hypoxic 10-day group.At birth,we performed pulmonary vascular morphometry in newborn rats with Nis software,and measured pulmonary arterial diameter,wall thickness and wall thickness/pulmonary arterial diameter.We detected expression of VEGF protein by immunohistochemistry and mRNA by real-time polymerase chain reaction.Changes in pulmonary capillary endothelium under electron microscope were observed.One-way analysis of variance and the Student Newman Keuls q (SNK-q) test were applied for statistical analysis.Results As the hypoxic time was extended,wall thickness and wall thickness/pulmonary arterial diameter increased.Compared with the air-control group,pulmonary vascular wall thickness in the hypoxic 10-day group increased [(16.4 ± 5.9) vs (10.8±2.8) μm; q=-8.04,P＜0.05].Wall thickncss/pulmonary artcrial diameter in the hypoxic 10-day group increased compared with that in the air control group,hypoxic 2-day group and hypoxic 6-day group [(31.3±5.1) ％,(22.2±4.9) ％and (23.6±3.9) ％vs (24.1±3.9) ％;q=-7.08,-4.92 and-5.0,all P＜0.05].Expression of VEGF protein in the lungs increased in the hypoxic 6-day group compared with the air-control group [(13.7±3.9) ％ vs (9.3±3.5) ％; q=-6.83,P＜0.05],while the expression was higher in hypoxic 10-day group than in the air-control group and hypoxic 2-day group [(15.2±4.7) ％,(9.3±3.5) ％ vs (11.8 ± 3.3) ％] (q=-9.16 and-5.19,all P＜0.05).Expression of VEGF mRNA in the lungs increased in the hypoxic 6-day group compared with the air-control group [(1.6±0.2)vs (0.8 ±0.2); q=-5.07,P＜0.05],while the expression was higher in the hypoxic 10 day group than in the air-control group and hypoxic 2-day group [(2.2±0.3),(0.8±0.2) vs (1.3±0.2)] (q=-9.54 and-6.42,all P＜0.05).Electron microscopy showed puhnonary capillary endothelial cell swelling as the hypoxic time was extended.In the air-control group,there was no capillary endothelial cell hyperplasia and swelling; in hypoxic 2-day group,there was mild swelling of the capillary endothelial cells and a small amount of hyperplasia; in hypoxic 6-day group,there was moderate swelling of the capillary endothelial cells; and in hypoxic 10-day group:there was significant swelling of the capillary endothelial cells,and pyknosis.Conclusions Intrauterine hypoxia resulted in higher expression of VEGF protcin and mRNA.VEGF in the lungs of newborn rats was involved in the vascular development process.

Dopplervelocimetria da artéria cerebral média fetal e outros parâmetros de vitalidade fetal na sobrevida neonatal em gestações com insuficiência placentária / Doppler velocimetry of the fetal middle cerebral artery and other parameters of fetal well-being in neonatal survival during pregnancies with placental insufficiency

OBJETIVO: Estudar a dopplervelocimetria da artéria cerebral média fetal em gestações complicadas pela insuficiência placentária e verificar o seu papel no prognóstico de sobrevida neonatal. MÉTODOS: Trata-se de estudo prospectivo de 93 gestantes com diagnóstico de insuficiência placentária estabelecida antes da 34ª semana. A insuficiência placentária foi caracterizada pelo Doppler de artéria umbilical (AU) alterado (> p95). Foram analisados os seguintes parâmetros: índice de pulsatilidade (IP) da artéria umbilical (AU), IP da artéria cerebral média (ACM), relação cerebroplacentária -RCP(IP-ACM/IP-AU), pico de velocidade sistólicada ACM (PVS-ACM) e IP para veias (IPV) do ducto venoso (DV). Os parâmetros foram analisados pelos valores absolutos, em escores zeta (desvios padrão a partir da média) ou múltiplos da mediana (MoM). O desfecho investigado foi o óbito neonatal no período de internação após o nascimento. RESULTADOS: Nas 93 gestações analisadas, ocorreram 25 (26,9%) óbitos neonatais. No grupo que evoluiu com óbito neonatal, quando comparado com o grupo com sobrevida, houve associação significativa com o diagnóstico de diástole zero ou reversa (88% vs. 23,6%, p < 0,001), com maior mediana do IP da AU (2,9 vs. 1,7, p < 0,001) e seu escore zeta (10,4 vs. 4,9, p < 0,001); maior valor do PVS-ACM MoM (1,4 vs. 1,1, p = 0,012); menor valor da RCP (0,4 vs. 0,7, p < 0,001); maior valor do IPV-DV (1,2 vs. 0,8, p < 0,001) e no escore zeta do DV (3,6 vs.0,6, p<0,001). Na regressão logística, as variáveis independentes para a prediçãodoóbito neonatal foram a idade gestacional no parto (OR = 0,45; IC95% 0,3 a 0,7, p < 0,001) e o escore zeta do IP-AU (OR 1,14, IC95% 1,0 a 1,3, p = 0,046). CONCLUSÃO: Apesar da associação verificada pela análise univariada entre a morte neonatal e os parâmetros da dopplervelocimetria cerebral fetal, a análise multivariada identificou a prematuridadeeograude insuficiência da circulação placentária como fatores independentes relacionados com o óbito neonatal em gestações complicadas por insuficiência placentária.

OBJECTIVE: To study the Doppler velocimetry of the fetal middle cerebral artery in pregnancies complicated by placental insufficiency, and to verify its role in the prognosis of neonatal survival. METHODS: This was a prospective study of 93 pregnant women with diagnosis of placental insufficiency detected before the 34th week of pregnancy. Placental insufficiency was characterized by abnormal umbilical artery (UA) Doppler (> 95th percentile). The following parameterswere analyzed: umbilical artery (UA) pulsatility index (PI); middle cerebral artery (MCA) PI; brain-placenta ratio - BPR (MCA-PI/UA-PI); MCA peak systolic velocity (MCA-PSV); and PI for veins (PIV) of ductus venosus (DV). The parameters were analyzed in terms of absolute values, z-scores (standard deviations from the mean), or multiples of the median (MoM). The outcome investigatedwas neonatal death during the hospitalization period after birth. RESULTS: Of the 93 pregnancies analyzed, there were 25 (26.9%) neonatal deaths. The group that died, when compared to the survival group, presented a significant association with the diagnosis of absent or reversed end-diastolic flow (88% vs. 23.6%, p < 0.001), with a higher median of UA PI (2.9 vs. 1.7, p < 0.001) and UA PI z-score (10.4 vs. 4.9, p < 0.001); higher MCAPSV MoM (1.4 vs. 1.1, p = 0.012); lower BPR (0.4 vs. 0.7, p < 0.001); higher PIV-DV (1.2 vs. 0.8, p < 0.001) and DV z-score (3.6 vs. 0.6, p < 0.001). In the logistic regression, the independent variables predictive of neonatal death were: gestational age at birth (OR = 0.45; 95% CI: 0.3 to 0.7; p < 0.001) and UA PI z-score (OR = 1.14, 95% CI: 1.0 to 1.3, p = 0.046). CONCLUSION: Despite the association verified by the univariate analysis between neonatal death and the parameters of fetal cerebral Doppler velocimetry, the multivariate analysis identified prematurity and degree of insufficiency of placental circulation as independent factors related to neonatal death in pregnancies complicated by placental insufficiency.

Avaliação biofísica complementar da vitalidade fetal / Additional biophysical evaluation of fetal surveillance

O nascimento de um feto saudável sempre constituiu um dos principais objetivos da Obstetrícia. Nos dias atuais, vários procedimentos têm sido utilizados com esta finalidade, porém, apesar da evolução dos métodos diagnósticos e da melhor compreensão da fisiopatologia do sofrimento fetal, ainda existem lacunas no conhecimento sobre o comportamento do feto frente à hipóxia. Outro fator complicador na avaliação do sofrimento fetal é o grande número de doenças maternas com diferentes fisiopatologias que podem interferir no bem-estar fetal. Esta revisão tem como objetivo descrever os principais métodos de avaliação biofísica da vitalidade fetal, com base nas melhores evidências científicas correntemente disponíveis na literatura, e incluindo níveis de evidências e graus de recomendação. Será abordada a avaliação da vitalidade fetal nos casos de insuficiência placentária, não sendo estudadas as situações especiais, como diabetes e gestação múltipla. Evidencia-se uma falta de consenso sobre qual procedimento deve ser utilizado na avaliação da vitalidade fetal, na prática clínica diária. As sociedades internacionais recomendam a realização da doplervelocimetria, da cardiotocografia e do perfil biofísico fetal apenas em gestantes de alto risco, com suspeita de insuficiência placentária ou com restrição de crescimento intrauterino

The birth of a healthy baby has always been an important goal of Obstetrics. Nowadays, many procedures have been used for this purpose, but despite great development in diagnostic methods and better understanding of pathophysiology of fetal distress, there are still gaps in knowledge about fetal behavior in situations of hypoxia. Another complicating factor in the assessment of fetal distress is the large number of maternal diseases with different pathophysiology, which can compromise fetal well-being. This review aims at describing the main methods for fetal assessment, based on the best scientific evidence currently available, including levels of evidence and grades of recommendation. Only fetal evaluation in cases of placental insufficiency will be addressed, and special situations such as diabetes and multiple pregnancies will not be studied. Current evidences show a lack of consensus on what is the best procedure to assess fetal well-being in clinical practice. International societies recommend the performance of Doppler velocimetry, cardiotocography, and fetal biophysical profile only in high-risk pregnancies with suspected placental insufficiency or restricted intrauterine growth

Hemorragia fetomaterna masiva con patrón cardiotocográfico sinusoidal: presentación de un caso y revisión de la literatura / Massive fetomaternal hemorrhage with cardiotocographic sinusoidal rhythm: a case presentation and literature review

Introducción: la transfusión fetomaterna masiva (TFM) es una entidad con una elevada morbilidad y mortalidad fetal, suele cursar con una disminución en la percepción de los movimientos fetales por parte de la madre, y la presencia de un patrón cardiotocográfico sinusoidal fetal, asociado a la anemia fetal. No obstante, ambas situaciones tienen muy baja especificidad. Se presenta un caso clínico con el objetivo de revisar la exactitud del patrón sinusoidal en el diagnóstico de anemia fetal. Materiales y metodos: se presenta el caso de una gestante de 36 semanas que fue atendida en el Hospital Universitario La Paz (complejo hospitalario de tercer nivel que forma parte del conjunto de hospitales públicos en España), en la que tras presentarse un patrón cardiotocográfico no tranquilizador, se realizó una inducción del parto en el que las pruebas habituales de bienestar fetal resultaron insuficientes para el diagnóstico de sufrimiento fetal. Tras un parto eutócico se comprobó la presencia de una anemia neonatal grave, comprobándose la presencia de un gran volumen de sangre fetal en la sangre materna mediante el test de Kleihauer Betke. Se hace una revisión de los artículos publicados en los últimos 10 años en las base de datos Medline vía PubMed, en español e inglés.Conclusión: la monitorización fetal intraparto podría ser útil en el diagnóstico de la hemorragia fetomaterna masiva, aunque se deben hacer estudios más amplios para determinar la exactitud diagnóstica...

Introduction: massive fetomaternal transfusion (MFT) is an entity having high fetal morbidity and mortality; it usually involves the mother’s reduced perception of fetal movements and the presence of a cardiotocographic fetal sinusoidal rhythm, associated with fetal anemia. However, both situations have very low specificity. A clinical case is presented here to arouse interest in reviewing the precision of the sinusoidal rhythm when diagnosing fetal anemia. Materials and methods: the case of a 36-weeks pregnant mother is presented; she attended La Paz teaching hospital (a third-level hospital forming part of the Spanish public hospital system). After presenting a non-reassuring cardiotocographic heart rate pattern, birth was induced in which the usual fetal wellbeing tests proved insufficient for diagnosing fetal suffering. The presence of serious neonatal anemia was shown following a eutocic delivery, the Kleihauer-Betke test proving the presence of a large volume of fetal blood in the mother’s blood. Articles published in both Spanish and English during the last 10 years in the Medline database were reviewed via PubMed. Conclusion: intradelivery fetal monitoring could be useful in diagnosing massive fetal-maternal hemorrhage, even though broader studies should be carried out for determining diagnostic precision...

Conduta obstétrica na centralização da circulação fetal / Obstetric management in fetal brain sparing effect

A centralização do fluxo sanguíneo fetal é um fenômeno de compensação vascular bastante estudado na atualidade. Trata-se de alterações na resistência da circulação fetal, caracterizada pela redistribuição hemodinâmica do fluxo sanguíneo, com perfusão preferencial para órgãos nobres (cérebro, coração e glândulas adrenais) em detrimento dos pulmões, rins, baço e esqueleto, o que pode ser diagnosticado pelo estudo dopplervelocimétrico. O momento ideal para intervenção obstétrica ainda não é consenso. Uma das grandes preocupações, em relação à avaliação da vitalidade fetal, diz respeito ao momento ideal para interrupção da gravidez, uma vez que alguns dos métodos utilizados apresentam uma alta frequência de resultado falso-positivos, podendo ocasionar um nascimento prematuro, por vezes, desnecessário. Em fetos muito prematuros a opção pela interrupção da gravidez pode trazer consequências irreversíveis. Na tentativa de minimizar os danos, optou-se pela realização de uma revisão, baseada nas melhores evidências sobre a conduta nos fetos centralizados.

Fetal brain-sparing effect is a vascular compensation phenomenon widely studied today. Diagnosed by Doppler study it consists of changes on resistance in the fetal circulation characterized by hemodynamic redistribution of blood flow, with preferential perfusion to brain, heart and adrenal glands compared to the lungs, kidneys, spleen and skeleton. There is no consensus over ideal time for obstetric intervention. Ideal time for pregnancy termination is of major concern when assessing fetal vitality since methods used today have high false positives rate, leading to unnecessary prematurity. In extreme prematurity the decision to terminate pregnancy can lead to irreversible consequences. In an attempt to minimize damage, it was decided to carry out a review, based on the best evidence regarding conduct in fetal brain sparing effect.

Flujo venoso fetal e índice cerebro placentario como indicadores de hipoxia fetal en gestantes preeclámpticas severas

Antecedentes: La velocimetría Doppler de la circulación uterina y fetoplacentaria es una herramienta importante para evaluar complicaciones asociadas a la restricción del crecimiento intrauterino y otras formas de distrés fetal debidas a hipoxemia o asfixia, como el producido por los trastornos hipertensivos del embarazo. También puede diagnosticarse anomalías cardíacas fetales, otras malformaciones y alteraciones placentarias o del cordón umbilical. Objetivos: Determinar el valor predictivo del índice cerebro placentario y del flujo anormal del ductus venoso de Aranzio, medido por velocimetría Doppler, en pacientes con preeclampsia severa, en relación a un resultado perinatal adverso. Diseño: Estudio prospectivo, no experimental, longitudinal, de tipo correlacional. Lugar: Unidad de Medicina Fetal y Diagnóstico Prenatal, Servicio de Obstetricia de Alto Riesgo, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú. Participantes: Gestantes con diagnóstico de preeclampsia severa y sus fetos. Intervenciones: Se realizó los estudios ultrasonográficos Doppler en los 7 días previos al parto, en 160 pacientes con diagnóstico de preeclampsia severa. El análisis estadístico se realizó mediante la prueba de chi cuadrado (x²) y prueba exacta de Fisher, con un nivel de significancia de 0,05; confiabilidad del 95%. Principales medidas de resultados: Resultado perinatal adverso. Resultados: El 39,4% (63/160) de las pacientes tuvo un resultado de índice cerebro placentario y de flujo del ductus venoso de Aranzio anormal, lo que se asoció significativamente a restricción del crecimiento intrauterino (RCIU), oligohidramnios y cesárea por distrés fetal agudo (p<0,05), y con alta sensibilidad para la ocurrencia de Ápgar < 7 a los 5 minutos, pH en arteria umbilical < 7,2 cesárea por distrés fetal y admisión a UCI. Conclusiones: La alteración del índice cerebro placentario y del flujo del ductus venoso de Aranzio medido por velocimetría Doppler fetal pudo detectar a más de 65% de los recién nacidos con resultado perinatal adverso por hipoxia fetal y fue prueba predictiva estadísticamente significativa de RCIU y oligohidramnios, en pacientes con preeclampsia severa.

Background: Doppler ultrasound of the uterine and fetoplacental circulation is an important tool to determine complications associated with fetal growth restriction and fetal distress due to hypoxemia or asphyxia as occurring with hypertensive disorders of pregnancy. Also fetal cardiac anomalies, placental malformations and umbilical cord alterations can be diagnosed. Objectives: To determine the predictive value of cerebroplacental index and Aranzios venous duct abnormal flow measured by Doppler ultrasound in patients with preeclampsia, in relation to adverse perinatal outcomes. Design: Prospective, non experimental, longitudinal, correlation study. Setting: Fetal Medicine and Prenatal Diagnosis Unit, High Risk Obstetrical Service, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Participants: Pregnant women with diagnosis of severe preeclampsia and their fetuses. Interventions: Doppler ultrasound examinations were done to determine cerebroplacental ratio and Aranzios venous duct abnormal flow within seven days before childbirth in 160 patients with severe preeclampsia. Chi (x ²) square test and Fisher exact test were used for statistical analysis, with 0,05 level of significance, 95% confidence interval. Main outcome measures: Adverse perinatal outcomes. Results: Abnormal both cerebroplacental ratio and Aranzios venous duct flow were found in 39,4% (63/160) of patients. These patients had a high probability of intrauterine growth retardation (IUGR), oligohydramnios and cesarean section (p< 0,05) with high sensitivity for Apgar < 7 at 5 minutes, pH <7,2 in umbilical artery, cesarean section for fetal distress and admission to NICU. Conclusions: Alteration of both ultrasound Doppler cerebroplacental index and Aranzios venous duct flow detected up to 65% of newborns with adverse perinatal results due to fetal hypoxia and was a statistically significant predictive test of severe IUGR and oligohydramnios in patients with severe preeclampsia.

Clinical monitoring of myocardial injury in neonates with intrauterine distress / 中华妇产科杂志

Objective To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. Methods A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score ＞ 7 at 1 and 5 minites were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minites, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. Results(1)pH(7.23±0.07) and BE [(-4.8±3.0)mmol/L] in the study group were significantly lower than pH (7.31 ±0.03) and BE [(-2.1±1.5)mmol/L] in the control group (P＜0.05).The lactic acid of study group [(5.2±2.3)mmol/L] was higher than that of the control group [(2.3±1.1)mmol/L], and the difference was significant (P＜0.01). However, there was no significant difference between the two groups in PaO2[(16.2±7.9)mm Hg(1 mm Hg=0.133 kPa) vs. (17.5±6.7)mm Hg] and PaCO2[(54.0±11.2)mm Hg vs. (48.5±5.4) mm Hg; P＞0. 05]. (2) The level of CK-MB in neonates with fetal distress[(48 ±59) U/L] was significantly higher than that of healthy neonates [(36±27)U/L]. However, no significant difference was found in CK [(194±73)U/L vs. (162±95) U/L]and BNP levels[(519±309)ng/L vs.(481±216)ng/L;P ＞ 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH(r=-0.296, P＜0.05) and BE (r=-0.318,P＜0.05) of umbilical artery blood,while BNP level was positively correlated with umbilical lactic acid (r=0.278, P＜0.05). No correlation was found between other parameters (P＞0.05).Conclusions Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.

Clinical significance of intermittent sinusoidal fetal heart rate at third trimester / 中华妇产科杂志

Objective To investigate clinical significance of intermittent sinusoidal feial heart rate at third trimester.Methods From Jan 2002 to Dec 2010,48 pregnant women at 33 to 41 gestational weeks undergoing electronic fetal heart rate(FHR)monitoring presented with intermittent sinusoidal FHR in Department of Obstetrics and Gynecology,Second School of Clinical Medicine,Jinan University were enrolled in this retrospective study.Twenty-one cases were categorized into continuous group(i.e.with sinusoidal feature and a constant duration≥10 minutes).while the other 27 cases were categorized iuto intermittent group(i.e.with a duration＜10 minutes).In the mean time.76 normal cases were chosen randomly matched as control group.Blood gas and hemoglobin were measured in umbilical artery after fetal head delivery.General neurological system examination were performed in those fetus in hospitalization.The outcome of those fetuses was compared.Results (1)Neonatal complications:the rate of asphyxia,meconium-stained amniotic fluid and fetal anemia were 63%(17/27),33%(9/27)and 63%(17/27)in group of intermittent sinusoidal FHR,which were significantly higher than 1%(1/76),4%(3/76),3%(2/76)in control group(P＜0.05).When compared with 67%(14/21),52%(11/21),76%(16/21)in group of continuous sinusoidal,the statistical difierence were not observed(P＞0.05).(2)Blood gas in neonate:the rates of pH less than 7 were 18%(5/27)in intermittent group,52%(11/21)in continuous group and 0 in control group,which all reached statistical difference among those three groups(P＜0.05).(3)Brain damage and death:the rates of brain damage and death were 48%(13/27)and 11%(3/27)in intermittent group,81%(17/21)and 43%(9/21)in continuous group,and 0 in control group,which all showed significant difference between them(P＜0.05).Conclusion Intermittent and continuous sinusoidal FHR are typical graphics of severe fetal anemia at third trimester.Intermittent sinusoidal FHR is indicative of serious fetal hypoxia.