Transvaginal color Doppler assessment of uteroplacental circulation in normal and abnormal early pregnancy.

Transvaginal color Doppler offers the potential to study uteroplacental circulation in early normal pregnancies and pregnancies associated with intrautine fibroids. A total of 62 patients (30 early pregnancies complicated by myoma and 32 normal pregnancies representing the control group) whose gestational age ranged from the 6th to the 14th week were examined. The equipment used was an Aloka color Doppler SSD-680 with 5.0 MHz curve-linear transvaginal transducer. The main uterine, radial and spiral arteries were identified in all patients. Peak systolic velocity and resistance index were measured and automatically calculated. Statistical analysis used was Student t-test. This study documents a physiological decrease in impedance in the uteroplacental circulation in pregnancy associated with fibroids, while the blood velocity of the radial arteries showed a significant increase between the 10th and 14th week of gestation.     

Substance misuse in early pregnancy and relationship to fetal outcome

To establish the frequency of substance misuse in early pregnancy in an urban UK population, 807 consecutive positive pregnancy test urine samples were screened for a range of drugs, including cotinine as an indicator of maternal smoking habits. A positive test for cannabinoids was found in 117 (14.5%) samples. Smaller numbers of samples were positive for other drugs:- opiates (11), benzodiazepines (4), cocaine (3) and one each for amphetamines and methadone. Polydrug use was detected in nine individuals. Only two samples tested positive for ethanol. The proportion with a urine cotinine level indicative of active smoking was 34.3%. The outcome of the pregnancy was traced for 288 subjects. Cannabis use was associated with a lower gestational age at delivery (P < 0.005), an increased risk of prematurity (P < 0.02) and reduction in birth weight (P < 0.002). Whilst maternal smoking was associated with a reduction in infant birth weight (P < 0.05), this was less pronounced than the effect of other substance misuse. Conclusion This study suggests that one in six women in South London are using drugs in early pregnancy and that cannabinoid use is associated with a poorer pregnancy outcome.     

Predicting the intrauterine fetal death of fetuses with cystic hygroma in early pregnancy

We investigated whether it was possible to predict the prognosis of fetuses with cystic hygroma in early pregnancy based on the degree of neck thickening. We retrospectively analyzed 57 singleton pregnancies with fetuses with cystic hygroma who were examined before the 22nd week of pregnancy. The fetuses were categorized according to the outcome, structural abnormalities at birth, and chromosomal abnormalities. Here, we proposed a new sonographic predictor with which we assessed neck thickening by dividing the width of the neck thickening by the biparietal diameter, which is expressed as the cystic hygroma width/biparietal diameter ratio. The median cystic hygroma width/biparietal diameter ratio in the intrauterine fetal death group (0.51) was significantly higher than that in the live birth group (0.27). No significant difference in the median cystic hygroma width/biparietal diameter ratio was found between the structural abnormalities group at birth and the no structural abnormalities group, and no significant difference in the median cystic hygroma width/biparietal diameter ratio was found between the chromosomal abnormality group and the no chromosomal abnormality group. We used receiver operating characteristic analysis to evaluate the cystic hygroma width/biparietal diameter ratio to predict intrauterine fetal death. When the cystic hygroma width/biparietal diameter ratio cut‐off value was 0.5, intrauterine fetal death could be predicted with a sensitivity of 52.9% and a specificity of 100%. It is possible to predict intrauterine fetal death in fetuses with cystic hygroma in early pregnancy if cystic hygroma width/biparietal diameter ratio is measured. However, even if cystic hygroma width/biparietal diameter ratio is measured, predicting the presence or absence of a structural abnormality at birth or a chromosomal abnormality is difficult.     

Transvaginal ultrasound in the first trimester of pregnancy.

Recent improvements in transvaginal ultrasound permit the extremely detailed observation of the morphology of the early conceptus in utero. It is possible to use the term "sonoembryology" for the delineation and observation of features such as brain vesicles and the neural tube as early as at the beginning of the 7th week of gestation. In this paper, sonoembryology from 4 to 11 weeks of gestation is briefly described.     

Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth

Maternal smoking during pregnancy is a significant threat to the fetus. We examined the association between active maternal smoking and smoking cessation during early pregnancy with newborn somatometrics and adverse pregnancy outcomes including preterm delivery, low birth weight, and fetal growth restriction. One thousand four hundred mother–child pairs with extensive questionnaire data were followed up until delivery, within the context of a population-based mother–child cohort study (Rhea study), in Crete, Greece, 2007–2008. Comparing smokers to nonsmokers, the adjusted odds ratio (OR) was 2.8 [95% confidence interval (CI), 1.7, 4.6] for low birth weight and 2.6 (95%CI: 1.6, 4.2) for fetal growth restriction. This corresponded to a 119-g reduction in birth weight, a 0.53-cm reduction in length, and a 0.35-cm reduction in head circumference. Smoking cessation early during pregnancy modified significantly these pregnancy outcomes indicating the necessity for primary smoking prevention.     

妊娠早中期胎儿超声心动图诊断先天性心脏病的临床价值

胎儿超声心动图检查是先天性心脏病产前诊断的最有效方法.妊娠早中期胎儿超声心动图筛查先天性心脏病的敏感性及特异性均较高,有序的分段多切面检查是保证诊断准确性的关键.由产科医生、超声科医生、小儿心脏科医生参与的多学科合作可改善胎儿预后,指导孕妇对妊娠过程进行正确的决策,对胎儿进行必要、合理的干预,对降低新生儿出生缺陷具有重要意义.     

Effects of oxytocin treatment early in pregnancy on fetal growth in ad libitum-fed and food-restricted rats.

The effects of oxytocin on fetal and placental growth and on maternal weight gain and accumulation of body fat were studied in ad libitum-fed and food-restricted (receiving 70% of the food intake of the ad libitum-fed group) pregnant rats. Further, a possible role of the IGF axis in mediating oxytocin-induced changes was assessed. Pregnant rats were injected subcutaneously once a day during gestational d 1-5 with saline or oxytocin (1 mg/kg). Ad libitum-fed oxytocin-treated pregnant rats had higher circulating levels of IGF-I, larger placentas, fetuses, and newborn pups and contained less body fat at the end of pregnancy. In food-restricted dams, oxytocin-treatment had no effect on fetal and placental growth. Additionally, food restriction attenuated the normal increase in IGF binding protein-3 protease proteolysis during pregnancy. The results show that oxytocin may affect maternal adaptations to pregnancy and stimulate fetal growth. We suggest that this effect may be mediated by increased IGF-I in ad libitum-fed animals, whereas food restriction may block this effect by resulting in low levels of circulating IGF-I and by attenuating the pregnancy-associated increase in IGF binding protein-3 protease activity and, thereby, further compromise IGF bioavailability.     

Care in early pregnancy.

This century has seen marked improvement in perinatal outcomes but prematurity remains a problem the world over. To improve these results requires more attention to early pregnancy or even pre-pregnancy care. Control of pre-existing conditions, improved social behavior in nutrition, smoking cessation and other factors are discussed.     

Alcohol in pregnancy and fetal heart damage]

Alcohol abuse and addiction during pregnancy can induce damage of the heart muscle and heart defects in the offspring. Between 1973 and 1991 216 children with fetal alcohol syndrome were diagnosed and examined for congenital heart defects. In 63 children (= 29,1%) heart defects were present, established mainly by heart catheterization and/or echocardiography. Most frequently ventricular septal defects (24/63) and atrial septal defects (23/63) occurred, less frequent were AV-defects (3), PDA (3), Fallots teralogy (5), and other malformations (5). Biopsy during heart surgery in 3 children revealed histological and electron microscopic changes of alcohol-cardiomyopathy. Heart defects are predominantly found in children with higher degree of severity concerning the clinical syndrome, less frequently in alcohol effects (4/38 = 11%). Alcohol in pregnancy, even in the course of so called social drinking, usual drinking and binge drinking has to be considered as an essential and preventable co-factor within the multifactorial etiology of congenital heart defects.     

Diurnal rhythms in fetal heart rate baseline and sustained fetal tachycardia in twin pregnancy

OBJECTIVE: To elucidate the synchronization of phases of diurnal rhythms in fetal heart rate (FHR) baseline between twin fetuses and the occurrence of sustained fetal tachycardia. METHODS: FHR was simultaneously recorded in twins for 24 h in 7 monochorionic diamniotic (MD) and 8 dichorionic diamniotic (DD) twin pregnancies at 35 to 38 weeks of gestation. The diurnal rhythms of the hourly mean FHR baseline were tested in each fetus, and the time of occurrence of sustained fetal tachycardia was compared between twins. The correlation coefficients and phase lags of diurnal rhythms between the hourly mean FHR baselines of twins were calculated in each case. RESULTS: There were significant diurnal rhythms in the hourly mean FHR baselines of all twin fetuses (p<0.01). The patterns of diurnal rhythms were similar for each pair of twins, with the exception of the periods of sustained fetal tachycardia. Sustained fetal tachycardia was not coincident between twins. Analysis in which the periods of sustained fetal tachycardia were excluded demonstrated a significant correlation between the hourly mean FHR baselines of twins in all cases (p<0.01). In the case of DD twins, the phase lag between twins was 0; however, phase lags were observed in 4 cases of MD twins. CONCLUSIONS: The results of this study revealed that the diurnal rhythms in the FHR baseline correlated well between twins, and that the occurrences of sustained fetal tachycardia were completely independent.     

Fetal heart rate in early pregnancy

Heart rates were measured by transvaginal sonography twice weekly in ten first trimester fetuses in women who conceived after in-vitro fertilization (IVF) or zygote intra-fallopian transfer (ZIFT). From week 6 to week 9 of menstrual age a rapid increase of the mean heart rate was observed from 113 to 167 beats per min, followed by a slow decrease to 156 beats per min. A close correlation between crown-rump length and heart rate was established.     

Maternal anxiety in late pregnancy: effect on fetal movements and fetal heart rate

AIM: To determine whether maternal state and trait anxiety levels affect fetal movements or fetal heart rate (FHR) in the third trimester. SUBJECTS: Forty-one healthy pregnant nulliparous women not on medication and with a singleton pregnancy. STUDY DESIGN: Maternal anxiety was assessed using the Spielberger State- Trait Anxiety Inventory (Form Y) at 36 gestational weeks. The fetuses of the women were examined at 37-40 gestational weeks with ultrasound observation of fetal movements and cardiotocography (CTG). The results of the fetal examinations were compared between women with low and high anxiety scores (low scores being defined as scores below the median and high scores as scores equal to or above the median of the study population), and correlation analyses between anxiety scores and the outcome variables were performed. OUTCOME MEASURES: The presence and duration (expressed as a percentage of the total examination time) of FHR patterns A, B, C, and D, the percentage duration of fetal movements in each FHR pattern, baseline FHR and FHR variability in each FHR pattern. RESULTS: The presence of FHR patterns A, B, C, and D, the duration of FHR patterns A, B, and C, FHR variability in FHR patterns A, B, and C, baseline FHR and the percentage duration of fetal movements in each FHR pattern did not differ between women with low and high state and trait anxiety scores. In fetuses with FHR pattern D, the duration of FHR pattern D increased with increasing maternal trait anxiety scores, (rho=0.88; p=0.008), and FHR variability in FHR pattern D increased with maternal state and trait anxiety scores (r=0.86, p=0.01; r=0.96, p=0.001). CONCLUSION: Maternal anxiety does not seem to affect fetal movements or baseline FHR in late pregnancy, but there is a possible association between maternal anxiety and the duration of FHR pattern D and FHR variability in FHR pattern D.     

Ultrasonic fetal weight estimation in multiple and singleton pregnancy

Thirty-five multiple and 168 singleton fetal weight estimations were made in an Australian population using the tables of Warsof et a/.,¹ which have been computed from a North American population. The estimated fetal weights were compared to the actual birth weights within 96 h of estimation. Con-elation coefficients of the actual birth weight with the estimated fetal weight for the total group, singleton and multiple pregnancies respectively, were 0.967,0.969 and 0.933. The percentages of estimated fetal weights falling within 10% of the actual birth weight were for the three groups, 79.3%, 77.9% and 85.7% respectively. Individual weight sub-groups, <1500g, 1500–2500g, 2500–4000g and >4000g, showed correlation coefficients of 0.84,0.838. 0.839 and 0.759 respectively, which compare favourably to published studies of North American populations using this method. It is concluded that ultrasonic fetal weight estimation using the North American computerized tables of Warsof et al.¹ is appropriate for an Australian population and is valid for both singleton and multiple pregnancies.