Fetal facial expressions in small-for-gestational-age and growth-restricted fetuses

Objective: To evaluate the frequencies of fetal facial expressions among appropriate-for-gestational-age (AGA), small-for-gestational-age (SGA), and growth-restricted (FGR) fetuses.

Methods: Four-dimensional (4D) ultrasound was used to examine the facial expressions of 50 AGA, 25 SGA, and six FGR fetuses between 28 and 35 weeks of gestation. The frequencies of seven facial expressions during 15-minute recordings were assessed. Comparison of facial expressions among the three groups was performed.

Results: Mouthing was the commonest facial expression at 28–35 weeks, and the frequency of mouthing was significantly higher than those of the other six facial expressions in AGA fetuses. Mouthing was the most frequent facial expression, but there was no significant difference in the frequency among mouthing, smiling and blinking in SGA fetuses. Moreover, mouthing displayed a significantly higher frequency than the other facial expressions, except for yawning, smiling, and blinking in FGR fetuses. However, there was no significant difference in the frequency of each facial expression among the three groups.

Conclusions: Our results suggest that the frequencies of fetal facial expressions are not decreased in either SGA or FGR pregnancies. The absence of a decrease in the frequency of each fetal expression in FGR fetuses may be due to increased brain blood flow because of the brain-sparing effect. Moreover, accelerated maturation and development of the brain function, especially the central dopamine system, might be suspected in SGA and FGR fetuses.     

Learning from the STRIDER trial

The STRIDER is an international consortium of five randomised trials of the use of sildenafil to treat fetal growth restriction. We describe the scientific rationale and processes undertaken to take advantage of such a joint approach to studying new interventions in pregnancy. We also describe the challenges faced during recruitment and the further challenges faced after initial publication. We discuss concerns about fetal wellbeing identified in the Netherlands STRIDER trial and the implications of this on other studies and the wider maternity research community.     

Combination of hand-held probe and microscopy for fluorescence guided surgery in the brain tumor marginal zone

BackgroundVisualization of the tumor is crucial for differentiating malignant tissue from healthy brain during surgery, especially in the tumor marginal zone. The aim of the study was to introduce a fluorescence spectroscopy-based hand-held probe (HHF-probe) for tumor identification in combination with the fluorescence guided resection surgical microscope (FGR-microscope), and evaluate them in terms of diagnostic performance and practical aspects of fluorescence detection.Material and MethodsEighteen operations were performed on 16 patients with suspected high-grade glioma. The HHF-probe and the FGR-microscope were used for detection of protoporphyrin (PpIX) fluorescence induced by 5-aminolevulinic acid (5-ALA) and evaluated against histopathological analysis and visual grading done through the FGR-microscope by the surgeon. A ratio of PpIX fluorescence intensity to the autofluorescence intensity (fluorescence ratio) was used to quantify the spectra detected by the probe.ResultsFluorescence ratio medians (range 0 – 40) measured by the probe were related to the intensity of the fluorescence in the FGR-microscope, categorized as “none” (0.3, n = 131), “weak” (1.6, n = 34) and “strong” (5.4, n = 28). Of 131 “none” points in the FGR-microscope, 88 (67%) exhibited fluorescence with the HHF-probe. For the tumor marginal zone, the area under the receiver operator characteristics (ROC) curve was 0.49 for the FGR-microscope and 0.65 for the HHF-probe.ConclusionsThe probe was integrated in the established routine of tumor resection using the FGR-microscope. The HHF-probe was superior to the FGR-microscope in sensitivity; it detected tumor remnants after debulking under the FGR-microscope. The combination of the HHF-probe and the FGR-microscope was beneficial especially in the tumor marginal zone.     

重度子痫前期与孕晚期S/D升高对FGR形成的交互作用探讨

目的 探讨重度子痫前期与S/D升高对FGR形成的交互作用。方法 选择2009年1月-2010年12月在本院分娩的被确诊为子痫前期,孕晚期行产科多普勒检查能够得到孕晚期S/D值,并排除其他妊娠期合并症和并发症的患者204例作为本次研究的研究对象;用Logistic 回归的方法分析重度子痫前期和孕晚期S/D升高（具体指S/...     

胰岛素样生长因子-1、2与胎儿生长受限的相关性

目的:探讨胰岛素生长因子-1(IGF-1)、胰岛素生长因子-2(IGF-2)与胎儿生长受限(FGR)的相关性。方法:采用放射免疫分析法测定12例FGR孕妇(实验组)和24例正常晚期妊娠妇女(对照组)脐血中的IGF-1、IGF-2水平。结果:实验组IGF-1水平为(15.68±6.76)μg/L,明显低于对照组(45.19±11.25)μg/L,二者比较差异有统计学意义(P<0.01);实验组IGF-2水平为(1.52±0.20)μg/L,明显低于对照组(1.97±0.21)μg/L,二者比较差异有统计学意义(P<0.05)。结论:妊娠晚期IGF-1、IGF-2水平降低是导致FGR发生的原因之一。     

细胞压积、脐动脉S/D与子痫前期胎儿生长受限的相关性研究

目的探讨细胞压积、脐动脉S/D与子痫前期胎儿生长受限的相关性。方法将2008-2009年在我院住院分娩的子痫前期病例（单胎妊娠）分为轻度及重度子痫前期两组,分析其孕周、红细胞压积（HCT）、脐动脉S/D与胎儿生长受限的相关性。结果重度子痫前期组中的未足月妊娠、HCT≥0.35,脐动脉SD≥3.0的FGR发生明显高于轻度子痫前期组,统计结果有统计学差异（P〈0.05）。轻、重两组子痫前期在HCT〈0.35、脐动脉SD〈3.0情况下FGR发生率无统计学差异（P〉0.05）。结论未足月妊娠、HCT≥0.35及脐动脉SD≥3.0时与子痫前期合并FGR的发生密切相关。加强对这些指标的监测可及时诊治子痫前期中的FGR,避免不良围产儿事件的发生。     

Fetal growth restriction alters hippocampal 17-beta estradiol and estrogen receptor alpha levels in the newborn male rat

Fetal growth restriction (FGR) is associated with impaired neurodevelopmental outcomes in affected newborns. The pathogenesis of FGR-associated neurodevelopmental impairment implicates abnormal hippocampal function. The steroid hormone estrogen and its receptor, estrogen receptor alpha (ERα), are involved in the normal programming of hippocampal development and structure. However, the impact of FGR on hippocampal estrogen and hippocampal ERα is not well characterized. We hypothesized that FGR will reduce hippocampal and serum levels of 17-beta estradiol and its receptor, ERα, in the newborn rat hippocampus. We further hypothesize that FGR will reduce hippocampal ERα levels in a region-specific manner. To test our hypotheses, we used the well characterized rat model of FGR induced by uteroplacental-insufficiency in the pregnant Sprague-Dawley rat. Hippocampi and serum were obtained from FGR and control day 0 rat pups and examined for hippocampal 17-beta estradiol, serum 17-beta estradiol, and ERα mRNA and protein levels. Immunohistochemistry was performed to examine region-specific ERα staining. FGR decreased hippocampal 17-beta estradiol levels in the hippocampi of male newborn rats but not females. Serum 17-beta estradiol levels were not affected by FGR in either gender. FGR decreased hippocampal ERα mRNA levels in males but not females. Hippocampal ERα protein levels by Western blotting were not affected by FGR. However, FGR decreased apparent ERα staining in the cornu ammonis (CA)1, CA3, and dentate gyrus regions in the hippocampi of male newborn rats but not females. We conclude that FGR affects the programming of hippocampal estrogen and hippocampal ERα levels in the newborn rat in a gender-specific manner.     

三维能量多普勒超声指标与FGR关系研究

目的探讨三位能量多普勒超声指标与胎儿生长受限（FGR）关系。方法应用GE公司Voluson 730M三维能量超声诊断仪检测36例FGR患者及68例正常胎儿胎盘的血流指数,血管化指数,血管化-血流指数;对胎儿大脑中动脉PI值、脐动脉S/D值以及孕妇子宫动脉PI值进行分析。同时随访观察孕妇妊娠预后情况。结果 FGR组胎盘VI、胎盘FI、胎盘VFI、大脑中动脉PI分别为（14.34±4.49）、（41.04±4.53）、（6.76±2.08）、（1.56±0.39）,均显著性低于正常组的（20.34±6.48）、（46.04±3.84）、（9.24±1.87）、（1.80±0.28）,差异有统计学意义（P〈0.05）;脐动脉S/D、左子宫动脉PI、右子宫动脉PI值分别为（3.76±0.89）、（0.98±0.31）、（0.93±0.29）,均显著性高于正常组的（2.33±0.29）、（0.69±0.22）、（0.65±0.20）,差异有统计学意义（P〈0.05）。FGR组Apgar评分为（7.34±2.39）,显著性低于正常组的（9.52±1.84）,差异有统计学意义（P〈0.05）。FGR组新生儿窒息、胎儿窘迫发生率显著性大于正常组,差异有统计学意义（P〈0.05）。结论在孕妇及胎儿血流动力学变化方面应用三维能量多普勒超声进行监测,可以判断胎儿在宫内有无缺氧状况,三维多普勒超声指标异常与FGR具有相关性。     

胎儿生长受限大鼠胎盘sFLT-1、PLGF的表达及川芎嗪的干预作用

目的：观察川芎嗪干预下大鼠胎儿生长受限（FGR）胎盘中可溶性血管内皮生长因子受体-1（SFLT-1）、胎盘生长因子（PLGF）的表达及其意义。方法：15只SD大鼠分为川芎嗪（TMP）组（FGR治疗组）、FGR非治疗组、正常对照组,FGR治疗组给予高粱酒灌胃,烟熏3次,每次15min,第13天起每天清晨烟熏灌胃后给予TMP 8mg/kg腹腔注射;FGR非治疗组从妊娠第7天起,每日给予高粱酒灌胃,烟熏3次,每次15min;正常对照组从妊娠第7天起,每天9点9mL/kg生理盐水灌胃,每天3次烟熏箱关15min但不烟熏。3组大鼠均于妊娠第20天解剖,比较各组大鼠胎盘PLGF、sFLt-1的表达。结果：FGR治疗组与FGR非治疗组、正常对照组SFLT-1差异无统计学意义（P〉0.05）;FGR治疗组与FGR非治疗组、正常对照组PLGF差异有统计学意义（P〈0.01）。结论：FGR大鼠胎盘SFLT-1升高、PLGF下降,SFLT-1、PLGF可考虑作为胎儿生长受限的筛查指标;经川芎嗪处理后的大鼠胎盘SFLT-1无显著差异,PLGF升高,川芎嗪可考虑作为胎儿生长受限的治疗药物。     

Placental oxidative DNA damage and its repair in preeclamptic women with fetal growth restriction

Preeclampsia is frequently accompanied by fetal growth restriction (FGR). Preeclampsia increases oxygen free radical production, and the resulting oxidative stress impairs placental blood flow. To determine whether placental oxidative stress is associated with FGR in preeclamptic women, we evaluated placental oxidative DNA damage and its repair in 13 preeclamptic women with FGR, 10 preeclamptic women without FGR, and 11 healthy pregnant women without complications. We measured maternal and umbilical serum derivatives of reactive oxygen metabolites (d-ROMs), as a marker of oxygen free radicals, and pulsatility index (PI) of uterine and umbilical arteries, and performed an immunohistochemical analysis to measure the proportion of nuclei in the placental trophoblast that stained positive for 8-hydroxy-2′-deoxyguanosin (8-OHdG), an indicator of oxidative DNA damage, and redox factor-1 (ref-1), indicative of the repair function towards oxidative DNA damage. D-ROMs were increased in the maternal blood of both preeclamptic groups (with FGR, 687.3 ± 50.4 CARR U, p < 0.01; without FGR, 750.4 ± 87.2 CARR U, p < 0.001) compared with controls (504.7 ± 25.0 CARR U). In contrast, d-ROM levels in the umbilical artery were elevated in preeclamptic women with FGR (134.9 ± 13.3 CARR U, p < 0.01), but not in preeclamptic women without FGR (44.0 ± 7.3 CARR U) compared with controls (38.2 ± 5.0 CARR U). Mean PI for uterine arteries was significantly increased in both preeclamptic groups, and the PI in preeclamptic women with FGR was significantly greater than that in women without FGR (0.94 ± 0.07 vs. 1.31 ± 0.07, p < 0.001). The PI for umbilical arteries was significantly increased in preeclamptic women with FGR (0.90 ± 0.05vs. 1.19 ± 0.07, p < 0.001), but not in preeclamptic women without FGR. The proportion of nuclei positive for 8-OHdG was higher in both groups of preeclamptic women than in the control group, but was higher in preeclamptic women with FGR (0.21 ± 0.05 vs. 0.87 ± 0.01, p < 0.001). The proportion of nuclei positive for ref-1 was higher in preeclamptic women without FGR (0.54 ± 0.06, p < 0.001) than in the control group, whereas the proportion did not differ significantly between normal and preeclamptic women with FGR. Our findings indicate that increased oxidative stress and disrupted compensatory reaction against placental oxidative DNA damage may be associated with FGR in preeclamptic women.