Treatment of Fetal Premature Ventricular Contractions by Administering Propranolol Hydrochloride Orally to the Mother.

> Frequent fetal premature ventricular contractions were diagnosed at 39 weeks of gestation. To avoid unnecessary cesarean section, the mother was administered propranolol hydrochloride orally. The tococardiography became feasible and permitted us to evaluate fetal well-being. The patient successfully delivered transvaginally a male infant at 40 weeks of gestation.

Blood flow velocity waveforms of the fetal middle cerebral artery in pregnancies complicated by diabetes mellitus.

Fetal blood flow velocity waveforms of the middle cerebral artery were measured by pulsed Doppler ultrasound in 43 pregnant women with diabetes mellitus (33 class B, 3 class C, 6 class D and 1 class R). The recordings were performed between 24 and 38 weeks of gestation. A total of 122 recordings were analyzed prior to establishing the resistance index (RI = peak systolic velocity minus diastolic velocity/peak systolic velocity). The mean maternal serum glucose was 124.3 mg/dl (range: 72.7 to 281.5 mg/dl), the mean hemoglobin A1c was 6.03% (range: 3.3 to 11.0%) and the mean fructosamine level was 255.97 mumol/L (range: 205 to 397 mumol/L). The resistance index did not differ between the fetuses of the diabetic mothers in our study population. Additionally, no significant correlation was noted between RI values and serum glucose levels (r = 0.03), hemoglobin A1c levels (r = 0.13) or fructosamine levels (r = 0.04) during the period of 26 to 34 gestational weeks. These data indicate that the RI within the fetal cerebral artery is unaffected by the maternal glycemic control when mean serum glucose levels are below 280 mg/dl.

Polyhydramnios: ultrasonic detection of fetal and maternal conditions.

Estimation of amniotic fluid volume is an important part of routine obstetric sonography. A relationship between polyhydramnios and poor perinatal outcome has been reported. This study correlates the severity of polyhydramnios with perinatal morbidity and mortality. Among 67 cases of polyhydramnios detected in singleton pregnancies, 8 were associated with maternal conditions including noninsulin-dependent diabetes (5 cases), insulin-dependent diabetes (1 case) and gestational diabetes (2 cases). Forty-four were associated with fetal conditions, including fetal anomalies (31 cases), fetal chromosomal disorders (10 cases) and fetal functional disorders (3 cases). Fifteen of the 67 cases had no apparent underlying fetal or maternal cause. Perinatal death occurred in 19 cases (28%) and was associated with fetal anomalies (12 cases), chromosome disorders (6 cases) and a functional fetal abnormality (1 case). Severe polyhydramnios with amniotic pocket dimensions > or = 120 mm (91%) or with a need for amniocentesis (91%) were associated with fetal abnormalities in most cases. The rate of perinatal death was not increased, indicating that severe polyhydramnios does not always result in lethal abnormalities.

Color and pulsed Doppler ultrasonography of reversed umbilical blood flow in an acardiac twin.

Prenatal diagnosis of an acardiac twin pregnancy was performed. At 30 gestational weeks, pulsed color Doppler ultrasound revealed polyhydramnios, reversed-pulsatile blood flow in the umbilical artery and vein of the acardiac twin, and artery-artery anastomosis on the placental surface. The total cardiac dimension, maximum blood flow velocity of the ascending aorta and the pulmonary artery in the alive twin were in the normal range.

Ultrasonography and Doppler studies in twin-to-twin transfusion syndrome.

In 40 twin pregnancies, the evaluation of hemodynamics by ultrasound was performed during the period January 1986 through September 1991. The blood flow velocities' waveforms in the umbilical artery, umbilical vein and tricuspid valve, and the total cardiac dimension, were obtained by ultrasonography in conjunction with 3.5 MHz pulsed Doppler ultrasound. Six patients with twin pregnancies were identified as having twin-to-twin transfusion syndrome (TTS), on the basis of like-sex twins with monochorionic diamniotic placentation, vascular anastomosis in the placenta, and umbilical cord venous blood hemoglobin difference exceeding 5 g/dl at delivery. No distinctive findings for TTS were revealed by the measurement of umbilical artery blood flow velocity waveforms. However, cardiomegaly in 5 recipient fetuses and tricuspid regurgitation and biphasic umbilical vein waveforms in 3 recipient fetuses constituted characteristic features of TTS. Ultrasonography and a Doppler study might be beneficial in diagnosing TTS and evaluating the hemodynamics in a recipient fetus.

Umbilical artery blood flow velocity waveforms in pregnancy complicated by diabetes mellitus.

Umbilical artery blood velocity waveforms were recorded by a pulsed Doppler system in the third trimester of pregnancy in 16 diabetic women (12 class B, 1 class C, 3 class D) and the waveforms were analysed for resistance index (RI = peak systolic velocity minus end diastolic velocity/peak systolic velocity). There was no significant correlation between the RI values and either serum glucose (r = 0.385) or fructosamine levels (r = 0.380). However, the RI values were raised in two cases with serum glucose levels of over 300 mg/dl. With a fall in serum glucose levels, the RI values returned to the normal range. No abnormal umbilical artery velocity waveforms were found when the serum glucose level was below 200 mg/dl.

Serum levels of 1,5-anhydro-D-glucitol during the normal and diabetic pregnancy and puerperium.

In 25 normally non-pregnant women, 543 normally pregnant women and 75 pregnant women with diabetes mellitus or gestational diabetes mellitus, the relationship between the serum concentration of 1,5-anhydro-D-glucitol (1-deoxy-glucose) and carbohydrate metabolism was studied. The concentration of 1,5-anhydro-D-glucitol was estimated by means of gas-liquid chromatography. In normally non-pregnant women the concentration was found to be 18.6 +/- 5.2 mg/l (mean +/- SD). During the normal pregnancy, from 9 weeks of gestation, a steadily decreasing concentration was observed as the pregnancy progressed and the lowest value (10.2 +/- 4.6 mg/l) was found in the third trimester. After 5 days of puerperium the concentrations were found to be 10.8 +/- 3.7 mg/l. On the 30th day postpartum, the level was within the range for non-pregnant subjects. The values in pregnant women with diabetes mellitus and gestational diabetes mellitus were mostly below 10 mg/l throughout the entire pregnant period. The 1,5-anhydro-D-glucitol concentration was not affected by meals or oral glucose loading. A concentration below 10 mg/l was found in 36% of the normally pregnant women, where oral glucose tolerance tests and measurement of glycohemoglobin were shown to be within the normal range. The present study suggests that a change of 1,5-anhydro-D-glucitol level during pregnancy may reflect a mild alteration of carbohydrate metabolism that goes undetected by all the other diabetic indicators.

Congenital cytomegalovirus infection associated with fetal ascites and intrahepatic calcifications.

A fetus at 20 weeks' gestation was shown by ultrasonography to have ascites and intrahepatic calcifications. We aspirated the fetal ascites at 29 and 30 weeks' gestation to decompress the fetal lungs due to the progression of the ascites and the concomitant compression in the fetal lungs. The newborn had neither hypoplasia of the lungs nor any respiratory complication, though congenital cytomegalovirus infection was present. This is the first report of such congenital cytomegalovirus infection associated with fetal ascites and intrahepatic calcifications. Careful monitoring and early intervention is necessary for a good prognosis.

Cerebral artery blood flow velocity waveforms in normal and small for dates fetuses.

Middle cerebral artery (MCA) blood flow velocity waveforms were recorded by a pulsed Doppler system in normal and small for dates (SFD) fetuses. Eighty four normal growth fetuses and 15 SFD fetuses were studied between the 28th and 40th gestational week. The flow velocity waveforms were analysed to determine the resistance index (RI = peak systolic velocity minus end diastolic velocity/peak systolic velocity). The results obtained were as follows: 1. The mean values of RI in the MCA had a peak of 0.802 +/- 0.049 at 32-33 gestational weeks and decreased gradually to a level of 0.686 +/- 0.087 at 40 gestational weeks. 2. In 8 asymmetrical SFD fetuses, the RI values for the MCA were below the normal range (mean -1.5 SD) in 6 cases and normal in 2 cases. 3. The RI values for MCA in all 7 symmetrical SFD fetuses were in the normal range.