Normal values for human umbilical venous and amniotic fluid pressures and their alteration by fetal disease.

Umbilical venous and amniotic fluid pressures were measured in 68 human pregnancies at the time that cordocentesis was performed. Normal umbilical venous pressure was unrelated to gestational age and remained within a tight range (5.3 +/- 2.3 mm Hg, mean +/- SD). Fetuses with an elevated umbilical venous pressure had disorders consistent with either hepatomegaly or congestive heart failure. Umbilical venous pressure was significantly increased before treatment in two fetuses with immune hydrops; it rapidly declined with treatment. Neither gestational age nor umbilical venous pressure was significantly different in the groups that received and did not receive pancuronium. There was a strong relationship between amniotic fluid pressure and gestational age in normal pregnancy (r = 0.54, p less than 0.0001). Women with hydramnios had amniotic fluid pressures greater than control subjects (p = 0.0007). This investigation documents normal human amniotic fluid and fetal umbilical venous pressures. These measurements are altered by disease and may prove to be of diagnostic and therapeutic value in the future.

[Oligo-amnios]. / L'oligo-amnios.

The amniotic fluid shares closely in the well-being of the future child and volume abnormalities represent a valuable factor in the screening of fetal pathology. Many publications have recently reminded of the importance of oligo-amnios as a prognosis factor in prenatal monitoring. Through an incomplete review of the literature, the author reminds of the physiology of amniotic fluid, diagnosis methods of oligo-amnios (essentially sonography), its causes and consequences, and finally its practical use as a monitoring parameter. A few possibilities of treatment are also discussed.

Diagnosis and treatment of twin to twin transfusion in the mid-second trimester of pregnancy.

Acute hydramnios in the second trimester of pregnancy associated with twin to twin transfusion is a rare and usually disastrous complication. Few infants survive the neonatal period. We report a case of acute hydramnios prior to 20 weeks of gestation secondary to twin to twin transfusion documented by fetal blood samples obtained using cordocentesis. Selective fetacide was performed using a new procedure after a pericardial effusion had failed. The hydramnios resolved and the surviving co-twin was delivered at term.

Intra-uterine shunting procedures.

Modern realtime ultrasound equipment and interpretation have presented physicians with a new type of patient, i.e. the fetus. The fetus suffers all the diseases we know as birth defects, but in their formative stages. Two conditions, namely obstructive uropathy and obstructive hydrocephalus, appear to be amenable in some cases to treatment in utero. Animal models for these conditions have been developed and the first attempts to treat the disorders in humans have been made. While many questions remain unanswered, some initial observations and conclusions can be drawn from this experience.

Biochemical investigations of cultured amniotic fluid cells in mucolipidosis type IV.

Biochemical abnormalities similar to those observed in cultured fibroblasts of patients with mucolipidosis type IV were demonstrated in cultured amniotic fluid cells of two fetuses affected with mucolipidosis IV. Increased gangliosides and acid mucopolysaccharides were observed in the affected cultures when compared to two normal controls. Both GM3 (monosialo) and GD3 (disialo) gangliosides accumulated in the affected cells: the latter showing a three-fold and the former a two-fold increase over controls. The major mucopolysaccharide components were dermatan sulfate and heparan sulfate, both increased approximately four-fold. A partial, but significant deficiency of soluble ganglioside sialidase was observed in the two affected cultures, while this activity was normal in a culture of a non-affected fetus of the same mother in a third pregnancy. Non-soluble membrane-bound and neuraminlactose sialidase was not affected.