ABSTRACT
A review is made of the main prenatal growth stages and the way they are influenced by social and biological factors pointing out the role of maternal nutrition before and during pregnancy. It is discussed the available evidence on the relation of maternal nutrition and fetal growth through clinical and epidemiological studies performed in animal and humans, analyzing the causal mechanisms of this association, including the role of placenta. Some clinical useful indicators that allow to evaluate maternal nutrition throughout gestation are presented. Emphasis is made on the impact of protein-energy malnutrition as well as on some specific deficiencies, particularly iron and folic acid. At last, the synergic effect of infection and malnutrition on low birth weight and prematurity is analyzed.
Subject(s)
Fetal Development , Health Status , Maternal Nutritional Physiological Phenomena , Anemia/etiology , Anemia/physiopathology , Animals , Female , Fetal Development/physiology , Folic Acid Deficiency/etiology , Folic Acid Deficiency/physiopathology , Humans , Pregnancy , Pregnancy Complications/etiology , Pregnancy Complications/physiopathology , Pregnancy Outcome , Protein-Energy Malnutrition/etiology , Protein-Energy Malnutrition/physiopathologyABSTRACT
During a 3 and 1/2 years, 132 pregnancies were diagnosed as having a wide variety of congenital abnormalities. A high resolution ultrasound and multidisciplinary approach was used. In 95 cases fetal karyotyping was made. In this group the incidence of chromosomal abnormalities diagnosed during the period and phenotypic expression of the different types of chromosomal abnormalities was investigated. 29 abnormal karyotypes were found; 11 trisomy 18, 7 in monosomy X, 4 in trisomy 21, 3 in trisomy 13, 1 with tetraploidy (92XXYY), 1 Turner mosaic (45XO 68% 46XY 32%), 2 inversions of choromosome 9. Of the total abnormal chromosomal diagnosed during the period (N = 57), this group represented 49.2%, compared to 5 to 15% found in other risk groups. 224 congenital abnormalities were found. 43 (19%) isolated, and 181 (81%) associated. Of the 224 congenital abnormalities diagnosed, 80 (36%) were associated with chromosomal abnormalities. The most associated markers were duodenal atresia, heart defect, microcephaly, enlarged posterior fossa, and cystic hygromata. A specific markers pattern was found for each aneuploidy; heart defects for trisomy 18, holoprosencephaly and faciel cleft for trisomy 13, and cystic hygromata for monosomy X. It was concluded that the ultasound can be the most useful method to select the group of pregnant women with a higher risk of abnormal karyotype.
Subject(s)
Chromosome Aberrations/genetics , Congenital Abnormalities/diagnostic imaging , Genetic Markers , Pregnancy Complications/diagnostic imaging , Ultrasonography, Prenatal , Adult , Amniocentesis , Chromosome Aberrations/diagnostic imaging , Chromosome Disorders , Congenital Abnormalities/genetics , Cytogenetics , Female , Humans , Infant, Newborn , PregnancyABSTRACT
The value of antepartum fetal heart rate testing has been debated in the last few years. According to several research works, the fetal sleeping periods lead to falsely nonreactive tests. These increase the risk and costs of obstetric care. A randomized prospective clinical trial was undertaken in high risk pregnancies to compare the standard nonstress test with the fetal vibroacoustic stimulation. Acoustic stimulation during 5 seconds with a 75 Hz frequency and 74 dB intensity device was applied to the patients in the study group. Nonreactive results were obtained in 11% of the control group and 3.4% in the study group (z = 2.07, p = 0.00116). A reduction of 5 minutes in the length of the test was observed in the study group. Fetal acoustic stimulation should be considered an alternative to improve the efficacy of nonstress testing, by reducing falsely nonreactive tests results and the time it takes to perform them.
Subject(s)
Acoustic Stimulation , Fetal Monitoring/methods , Vibration , Chi-Square Distribution , False Positive Reactions , Female , Fetal Monitoring/statistics & numerical data , Gestational Age , Heart Rate, Fetal , Humans , Pregnancy , Pregnancy Trimester, ThirdABSTRACT
Experience with intraperitoneal blood transfusion, using ultrasonographic guide, in 24 patients with severe isoimmunization to Rh factor, is reported. A total of 57 procedures, were done from 24 weeks of gestation. In 66.6% two or more transfusions were done in the same product. There were 71% of alive newborns and in 29% of the cases it was not possible to improve perinatal survival. The analysis of these results were correlated with antecedents: presence of hydrops, gestational age at the time of resolving pregnancy, and main disease status. The usefulness of intraperitoneal transfusion, is commented upon, and new perspectives, as intravascular transfusion in cases with severe hydrops, are considered.
