ABSTRACT
We hypothesized that placental resistance was elevated and transfer reduced in cotyledons from intrauterine growth-restricted (IUGR) fetuses. We perfused 10 cotyledons from term, normally grown fetuses, six from preterm, normally grown fetuses with normal umbilical arterial end-diastolic velocities (EDV), and six from preterm IUGR fetuses (<3rd centile) with absent or reversed umbilical arterial EDV. Perfused cotyledons were pressure-fixed, and villi were observed by scanning electron microscopy. The groups did not differ in fetoplacental resistance at baseline; neither did they differ in the change in resistance that followed the administration of nitroglycerin or angiotensin II. The increase in resistance during hypoxia was similar in the two preterm groups but greater in the term than in the preterm normally grown group (p < 0.05). Groups did not differ in net maternofetal transfer of oxygen or glucose, or in clearance of aminoisobutyric acid or antipyrine. However, glucose consumption was doubled in cotyledons of preterm IUGR versus preterm normally grown fetuses (p < 0.05). Terminal villi of perfused cotyledons from preterm IUGR fetuses displayed less terminal villous branching and budding than preterm controls, as anticipated from previous work. IUGR fetuses with absent or reversed umbilical arterial EDV in vivo may have high placental resistance due to a vasoconstrictive rather than anatomic abnormality and an elevated placental glucose consumption that may impair glucose transfer.
Subject(s)
Fetal Growth Retardation , Glucose/metabolism , Maternal-Fetal Exchange , Placenta/metabolism , Vascular Resistance , Female , Humans , Microscopy, Electron, Scanning , Perfusion , Placenta/ultrastructure , PregnancyABSTRACT
A patient with choriocarcinoma presenting with acute abdominal pain due to splenic rupture from secondary deposits is reported. This rare case exhibited several other unusual features including coexisting bilateral ovarian teratomas and the absence of any evidence of a primary lesion. Several hemangiomata in the liver initially confused the clinic picture.
Subject(s)
Choriocarcinoma/diagnosis , Splenic Rupture/etiology , Uterine Neoplasms/diagnosis , Adult , Choriocarcinoma/complications , Choriocarcinoma/pathology , Chorionic Gonadotropin, beta Subunit, Human/blood , Chorionic Gonadotropin, beta Subunit, Human/cerebrospinal fluid , Female , Hemangioma/complications , Hemangioma/diagnostic imaging , Humans , Liver Neoplasms/complications , Liver Neoplasms/diagnostic imaging , Ovarian Neoplasms/complications , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Pregnancy , Splenic Rupture/pathology , Splenic Rupture/surgery , Teratoma/complications , Teratoma/pathology , Teratoma/surgery , Ultrasonography , Uterine Neoplasms/complications , Uterine Neoplasms/pathologyABSTRACT
We report a statistical analysis of 893 high-risk patients who underwent Doppler sonographic estimation of umbilical venous blood flow within 2 weeks of delivery. Patients with red cell isoimmunization were excluded. In a total of 84 patients, the umbilical venous flow rate was above the 95th centile for normal pregnancy. This finding was associated significantly with an increased prevalence of maternal diabetes mellitus, polyhydramnios, fetal abnormalities, premature delivery, low 5 min Apgar scores, and neonatal death. Umbilical venous flow rates per kilogram of fetal weight above the 95th centile were recorded in 93 patients. This finding was associated significantly with an increased rate of antepartum hemorrhage, premature delivery, low 5 min Apgar scores, longer stays in intensive care nursery, and neonatal death. Low umbilical venous blood flow rates have been investigated extensively and associated with impaired perinatal outcome. The work reported in this paper indicates that a percentage of fetuses will have abnormally high umbilical venous flow rates and that this is also indicative of increased risk.
