Measures of acidosis with repetitive umbilical cord occlusions leading to fetal asphyxia in the near-term ovine fetus.

OBJECTIVE: Increasing frequency of severe variable decelerations is associated with acidemia. However, there is little understanding of its development or normalization rate. STUDY DESIGN: To quantify the time course of acidemia, 10 near-term fetal sheep underwent a series of mild (1 minute every 5 minutes), moderate (1 minute every 3 minutes), and severe (1 minute every 2 minutes) umbilical cord occlusions (UCO), lasting 1 hour each or until fetal arterial pH decreased to less than 7.00. RESULTS: Each minute of UCO resulted in base deficit (BD) and lactate increases at rates of 0.56 and 0.35 mmol/L per minute, respectively. During a 2 h recovery, BD and lactate normalized at rates of 0.09 and 0.04 mmol/L per minute. BD correlated highly with lactate (r = 0.95; P < .001). CONCLUSION: Our findings in the near-term ovine fetus suggest that the knowledge of fetal BD deterioration and recovery rates can aid assessing fetal acidemia during labor.

Mechanisms of impaired nephrogenesis with fetal growth restriction: altered renal transcription and growth factor expression.

OBJECTIVE: Maternal food restriction during pregnancy results in growth-restricted newborns and reduced glomerular number, contributing to programmed offspring hypertension. We investigated whether reduced nephrogenesis may be programmed by dysregulation of factors controlling ureteric bud branching and mesenchyme to epithelial transformation. STUDY DESIGN: At 10 to 20 days' gestation, Sprague Dawley pregnant rats (n = 6/group) received ad libitum food; food-restricted rats were 50% food restricted. At embryonic day 20, messenger ribonucleic acid (mRNA) and protein expression of Wilms' tumor 1 gene product (WT1), paired box transcription factor (Pax)-2, fibroblast growth factor (FGF)-2, glial cell line-derived neurotrophic factor (GDNF), cRET, wingless-type mouse mammary tumor virus integration site (WNT)4, WNT11, bone morphogenetic protein (BMP)-4, BMP7, and FGF7 were determined by real-time polymerase chain reaction and Western blotting. RESULTS: Maternal food restriction resulted in up-regulated mRNA expression for WT1, FGF2, and BMP7, whereas Pax2, GDNF, FGF7, BMP4, WNT4, and WNT11 mRNAs were down-regulated. Protein expression was concordant for WT1, GDNF, Pax2, FGF7, BMP4, and WNT4. CONCLUSION: Maternal food restriction altered gene expression of fetal renal transcription and growth factors and likely contributes to development of offspring hypertension.

Gender-specific programmed hepatic lipid dysregulation in intrauterine growth-restricted offspring.

OBJECTIVE: Intrauterine growth restriction demonstrates increased risk of adult metabolic syndrome. The associated hyperlipidemia results from obesity or programmed metabolic abnormalities. Because lipid homeostasis is regulated by the liver, we hypothesized that hepatic structure and lipid content in intrauterine growth restriction would reflect a primary lipid dysfunction. STUDY DESIGN: From 10 days to term gestation, control pregnant rats received ad libitum diet; study rats were 25% food-restricted (FR). All dams received ad libitum diet throughout lactation. At 3 weeks of age, hepatic lobule size and lipid profile of the pups were determined. RESULTS: At 3 weeks of age, body and liver weights of the pups were comparable with controls, although with reduced hepatic lobule size. FR males had increased hepatic triglyceride and cholesterol content with elevated sterol regulatory element-binding protein-1c, fatty acid synthase, and lipoprotein lipase expression; FR females exhibited decreased hepatic cholesterol levels. Plasma lipid levels were unchanged in FR males and females. CONCLUSION: Developmental programming results in sex-dependent altered lipid metabolism with increased risk in males.

Enhanced nephrogenesis in offspring of water-restricted rat dams.

OBJECTIVE: Maternal water restriction (WR) may induce offspring plasma hypertonicity and enhanced vasopressin secretory responses. We determined effects of pregnancy WR on offspring body composition, renal morphology, and blood pressure. STUDY DESIGN: Pregnant Sprague Dawley rats (n = 21) were randomized to WR, pair-fed (PF), and control from embryo day (e) 10 to e21. Offspring body and organ weights and glomerular number and size were measured at birth and at 21 days of age. At 6 and 9 weeks, offspring blood pressure was determined. RESULTS: At 21 days of age, WR offspring glomerular number was increased (17%; P < .05), whereas PF glomerular number was lower (4%), compared with controls. Systolic blood pressures were elevated in both WR and PF at both 6 and 9 weeks. CONCLUSIONS: Pregnancy WR stimulates offspring nephrogenesis, suggesting an adaptive response to future dehydration. Programmed hypertension in WR and PF groups likely occurs via different mechanisms.

Fetal ST segment heart rate analysis in labor: improvement of intervention criteria using interpolated base deficit.

OBJECTIVE: The addition of ST waveform analysis (STAN, Neoventa, Sweden) to fetal heart rate (FHR) tracings has been demonstrated to improve fetal outcome and reduce operative delivery rates, though the actual level of fetal acidosis at which STAN indicates intervention has not been assessed. We sought to determine if FHR ST segment analysis recommends intervention at appropriate levels of fetal acidosis. METHODS: FHR tracings of 10 acidotic and 10 non-acidotic infants with FHR tracings having a minimum of one STAN flag were retrospectively analyzed. Fetal base deficit (BD) was calculated by interpolation throughout the FHR tracing and STAN 'action' and 'ignore' flags assigned a fetal BD value. A secondary analysis was performed with a revised interpretation of FHR reassuring status. RESULTS: The mean (+/-SD) BD of the first STAN action was significantly greater than the first 'ignore' (4.0+/-2.1 vs. 3.0+/-0.8 mmol/L, p<0.05). Clarified STAN criteria for reassuring vs. non-reassuring FHR resulted in a first action BD of 6.0+/-2.0 mmol/L with 90% sensitivity and 100% specificity for prediction of fetal acidosis. CONCLUSION: The STAN monitor discriminates increasing levels of fetal BD. With clarification of the criteria for reassuring FHR, the calculated BDs of action flags are an appropriate threshold for emergent intervention, successfully predict acidotic fetuses, and avoid unnecessary intervention.

Treatment of recurrent inguinal lymphocele by lymphatic leakage mapping and subsequent ligation of lymphatic vessel endings: a case report.

BACKGROUND: Different approaches have been attempted in both prophylaxis and treatment of recurrent inguinal lymphoceles; however, to date none have been consistently effective. We hereby report our preliminary experience with mapping of the lymphatic leakage followed by ligation of these mapped vessels for resolution of a recurrent inguinal lymphocele. CASE: A 73-year-old woman underwent an anterior modified radical vulvectomy with bilateral inguinofemoral lymph node dissection due to squamous cell carcinoma of the vulva. Postoperatively she presented with a recurrent inguinal lymphocele unresponsive to several treatment measures. After 8 weeks, the patient underwent lymphatic leakage mapping and subsequent ligation of lymphatic vessel endings, which resolved her recurrent lymphocele. CONCLUSION: Lymphatic mapping and ligation of afferent lymphatics may be a useful method for treating recurrent lymphoceles after inguinofemoral lymph node dissection. Further studies are warranted to prove the absolute efficacy of this technique.