A management strategy for fetal immune-mediated atrioventricular block

Introduction.?The purpose of this study is to describe an in utero management strategy for fetuses with immune-mediated 2° or 3° atrioventricular (AV) block.

Methods and results.?The management strategy as applied to 29 fetuses consisted of three parts. First, using fetal echocardiography and obstetrical ultrasound, we assessed fetal heart rate (FHR), heart failure, growth and a modified biophysical profile score (BPS) assessing fetal movement, breathing and tone. Second, we treated all fetuses with transplacental dexamethasone, adding terbutaline if the FHR was?<56 bpm. Digoxin and/or intravenous immune globulin (IVIG) was added for progressive fetal heart failure. Third, we delivered fetuses by cesarean section for specific indications that included abnormal BPS, maternal/fetal conditions, progression of heart failure, or term pregnancy. We assessed perinatal survival, predictors of delivery and maternal/fetal complications in 29 fetuses with 3° (n?=?23) or 2° (n?=?6) AV block. There were no fetal deaths. In utero therapy included dexamethasone (n?=?29), terbutaline (n?=?13), digoxin (n?=?3) and/or IVIG (n?=?1). Delivery indications included term gestation (66%), fetal/maternal condition (14%), low BPS (10%) and progression of fetal heart failure (10%). An abnormal BPS correlated with urgent delivery.

Conclusion.?These results suggest that applying this specific management strategy that begins in utero can improve perinatal outcome of immune-mediated AV block.     

Fetal heart rate response to cordocentesis and pregnancy outcome: A prospective cohort

Objective.?To evaluate fetal cardiac response to cordocentesis and whether such changes may affect pregnancy outcome.

Methods.?117 singleton pregnant women requiring percutaneous trans-abdominal cordocentesis were prospectively included. Fetal heart rate was continuously evaluated by ultrasound for 1?min after completion of cordocentesis and intermittently for 20?min more. Fetal and pregnancy outcomes were analyzed by grouping fetal cardiac response to cordocentesis into bradycardia, normal heart rate and tachycardia groups.

Results.?Women included in the study were 30.5?±?4.0 years old and had a gestational age of 23.7?±?2.0 weeks. Fetal blood sample obtained by cordocentesis was 3.1?±?0.8?ml. Fetal heart rate before cordocentesis was 149?±?8 beats per minute (bpm), ranging from 130 to 169 bpm. Fetal heart rate post-cordocentesis was 145?±?30 bpm (from 32 to 175 bpm). The incidence of bradycardia and tachycardia was 10.3% (n?= 12) and 6.0% (n?= 7), respectively. Fetal heart rate returned to normal levels in all cases at ??5 minutes post-cordocentesis. In the tachycardia group, 6 cases had normal pregnancy outcome and one patient was lost to follow-up. In the bradycardia group, we observed two pregnancy terminations, one patient was lost to follow-up and nine were normal outcomes. In the group with normal heart rate (n?=?98), we observed one intrauterine fetal death, nine adverse fetal outcomes, eight pregnancy terminations and nine patients were lost to follow-up.

Conclusions.?Transient fetal tachycardia and bradycardia were uncommon and were not associated with adverse fetal or pregnancy outcomes.     

Successful prenatal treatment of congenital heart block with ritodrine administered transplacentally

Congenital heart block (CHB) is rather rare, and a poorer prognosis has been documented in fetuses with a ventricular rate <55 beats per minutes (bpm), in which therapeutic interventions during pregnancy have been warranted. We present a case of CHB associated with maternal anti-SSA/Ro antibody, diagnosed at 28 weeks’ gestation. Fetal echocardiography revealed atrioventricular dissociation, with an atrial rate of 170 bpm and a ventricular rate of 54 bpm. To increase the fetal heart rate, maternal intravenous ritodrine infusion was undertaken, fetal ventricular rate was rapidly increased to 65 bpm. The pregnancy successfully continued until term, and a female infant weighing 2919 g was delivered by cesarean section with Apgar scores of 8 and 8 and 1 and 5 min. The infant is now 12 months of age and growing normally on oral terbutaline without pacing. In a case of fetal heart block, maternal administration of ritodrine may be a therapeutic intervention to improve the fetal and neonatal prognosis. Received: 27 May 2001 / Accepted: 20 August 2001 Correspondence to H. Matsushita     

Reference intervals of embryos/fetuses heart rate between 6 and 14 weeks of pregnancy

Abstract

Objective: To determine reference intervals for the embryos/fetuses heart rate (HR) between 6 and 14 weeks of pregnancy.

Methods: A retrospective cross-sectional study was carried in a single center with singleton pregnancies of embryos/fetuses with a crown-rump length (CRL) between 5 and 85?mm. The HR was assessed by real time M-mode or spectrum Doppler ultrasound. To evaluate the correlation between embryo/fetal HR and CRL, polynomial equations were calculated, with adjustment by the determination coefficient (R²).

Results: A total of 5867 pregnancies were assessed. The mean gestational age was 10.37?±?2.12 weeks. The mean maternal age was 26.41?±?6.78 years. The mean embryo/fetal HR (bpm) for the CRL (mm) intervals 5├15; 15├25; 25├35; 35├45; 45├55; 55├65; 65├75; 75├85 was 145.1?±?18.7; 167.2?±?10.1; 166.9?±?8.7; 165.5?±?6.9; 162.2?±?6.8; 159.2?±?6.4; 157.1?±?6.4; 154.9?±?7.3; respectively. The following third-order equation best represented the correlation between embryo/fetal HR and CRL: HR?=?119.25?+?3.596*CRL-0.07954*CRL^2?+?0.00051*CRL³ (R^2?=?0.36).

Conclusion: Reference intervals of HR in embryos/fetuses in a large sample were determined. These reference intervals can be used in high-risk early pregnancy losses.     

Computerized analysis of heart rate in fetuses from mothers under levothyroxin treatment

Objective. To investigate fetal heart rate (FHR) of fetuses whose mothers are under levothyroxin treatment for chronic hypothyroidism.

Study design. Sixty women under chronic therapy with levothyroxin and 180 controls at 37–39 weeks' gestation were studied by Sonycaid Sistem 8002® computerized cardiotocography (cCTG) for 30 min. cCTG parameters were expressed as mean and SD and the differences tested for statistics by Student t-test. Furthermore, cCTG parameters were related to levothyroxin dose by regression analysis. Significance was assessed at p < 0.05.

Results. Computerized cardiotocographic tracings of fetuses from mothers under levothyroxin treatment revealed: significant reduction of baseline FHR (130.1 ± 9.47 vs. 134.9 ± 4.68 bpm); increased number of FHR decelerations greater than 20 bpm (0.2 ± 0.41 vs. 0.05 ± 0.22); reduction of body movements per hour (6.68 ± 11.72 vs. 10.65 ± 11.74); and increased uterine contraction peaks (5.15 ± 4.69 vs. 2.7 ± 2.57). Those fetuses also showed significantly reduced neonatal weight (2668.2 ± 766.65 vs. 3215.44 + 523.88 g) and lower 1-min Apgar score (8.6 ± 0.95 vs. 9.3 ± 1.11). Regression analysis showed a significant correlation between levothyroxin dose and baseline FHR (r = 0.60; p < 0.0001) and fetal body movements per hour (r = 0.52; p < 0.0001), and an inverse relationship with uterine contraction peaks (r = ?0.35; p < 0.006), whilst no correlation was found with the number of FHR decelerations greater than 20 bpm.

Conclusions. Maternal hypothyroidism and levothyroxin treatment influence FHR and cCTG is a sensible tool to reveal that influence.     

Prediction of postnatal arrhythmia in fetuses with cardiac rhabdomyoma

Objectives: Fetal cardiac rhabdomyomas are rare but well-known to be associated with arrhythmia or conduction abnormalities. However, since in utero electrophysiological information is quite limited, it remains unclear which type of rhabdomyoma will develop arrhythmia after birth. The aim of this study is to identify factors that predict postnatal arrhythmia requiring therapy in fetuses with cardiac rhabdomyoma.

Study design: A retrospective review of infants prenatally diagnosed with cardiac rhabdomyoma was performed at our tertiary pediatric cardiac center between 1990 and 2016. Fetal arrhythmia was diagnosed using fetal echocardiography and magnetocardiography. We compared the characteristics of cases with and without antiarrhythmic therapy after birth. Cases without antiarrhythmic therapy after birth consisted of those who had postnatal arrhythmia but did not require antiarrhythmic therapy and those who had no postnatal arrhythmia.

Results: A total of 20 fetuses with cardiac rhabdomyoma were included in this study. Ten cases (50%) were confirmed as having tuberous sclerosis after birth. The mean gestational week at diagnosis and delivery were 32.1?±?2.7 and 37.6?±?2.8 weeks, respectively. Mean cardiac tumor size in utero was 21?±?11?mm (range, 7–54?mm) in diameter. Fetal arrhythmia was found in six cases; three resolved in utero with transplacental antiarrhythmic therapy. Postnatal arrhythmia or conduction abnormalities were found in 12 cases; 7 required antiarrhythmic therapy. Cases with antiarrhythmic therapy after birth had larger cardiac tumor in utero than those without therapy (29.6?±?12.8?mm versus 16.3?±?5.8?mm, p?30?mm in diameter predicted postnatal arrhythmia requiring therapy with sensitivity of 57.1% and specificity of 100%. Location and number of cardiac tumor and presence of arrhythmia or conduction abnormalities in utero were similar between the two groups.

Conclusions: Cardiac rhabdomyomas >30?mm in diameter are associated with postnatal arrhythmia requiring therapy regardless of number and location.     

Maternal steroid therapy for fetuses with immune-mediated complete atrioventricular block: a systematic review and meta-analysis

Introduction: To explore the effect of maternal fluorinated steroid therapy on fetuses affected by immune-mediated complete atrio-ventricular block (CAVB) in utero.

Material and methods: Pubmed, Embase, Cinahl, and ClinicalTrials.gov databases were searched. Only studies reporting the outcome of fetuses with immune CAVB diagnosed on prenatal ultrasound without any cardiac malformations and treated with fluorinated steroids compared to those not treated were included. The primary outcome observed was the regression of CAVB; secondary outcomes were need for pacemaker insertion, overall mortality, defined as the occurrence of either intrauterine (IUD) or neonatal (NND) death, IUD, NND, termination of pregnancy (TOP). Furthermore, we assessed the occurrence of all these outcomes in hydropic fetuses compared to those without hydrops at diagnosis. Meta-analyses of proportions using random effect model and meta-analyses using individual data random-effect logistic regression were used to combine data.

Results: Eight studies (162 fetuses) were included. The rate of regression was 3.0% (95%CI 0.2–9.1) in fetuses treated and 4.3% (95%CI 0.4–11.8) in those not treated, with no difference between the two groups (odds ratio (OR): 0.9, 95%CI 0.1–15.1). Pacemaker at birth was required in 71.5% (95%CI 56.0–84.7) of fetuses-treated and 57.8% (95%CI 40.3–74.3) of those not treated (OR: 9, 95%CI 0.4–3.4). There was no difference in the overall mortality rate (OR: 0.5, 95%CI 0.9–2.7) between the two groups; in hydropic fetuses, mortality occurred in 76.2% (95%CI 48.0–95.5) of the treated and in 23.8% (95%CI 1.2–62.3) of the untreated group, while in those without hydrops the corresponding figures were 8.9% (95%CI 2.0–20.3) and 12% (95%CI 8.7–42.2), respectively. Improvement or resolution of hydrops during pregnancy occurred in 76.2% (95%CI 48.0–95.5) of cases treated and in 23.3% (95%CI 1.2–62.3) of those nontreated with fluorinated steroids.

Conclusions: The findings from this systematic review do not suggest a potential positive contribution of antenatal steroid therapy in improving the outcome of fetuses with immune CAVB.     

Evolución y manejo intrauterino de las taquicardias fetales

Objective

To review the intrauterine management and outcome of fetal tachycardia.

Methods

A total of 23 fetuses with distinct types of tachycardia, diagnosed at a median gestational age of 30.2 weeks, were included. The inclusion criteria were fetal tachycardia diagnosed prenatally, and complete, long-term follow-up in utero and after birth in the Obstetrics Department, La Fe University Hospital, Valencia, Spain from 2002 to 2010. Data from included pregnancies were collected from a review of the patients’ medical records.

Results

Of 23 fetuses with fetal tachycardia diagnosed in utero, 18 (78.26%) had supraventricular tachycardia, two (8.69%) had atrial flutter and three (13.04%) had tachycardia of unknown origin. Six fetuses (26.08%) developed hydrops. Of the 23 fetuses, 13 (56.52%) received digoxin, one (4.34%) digoxin with amiodarone, two (8.69%) digoxin with flecainide and one (4.34%) received flecainide alone. The initial treatment was adjusted in 15 fetuses (65.21%). The tachycardia was reverted in nine fetuses. Eleven pregnancies (47.82%) ended at full term by vaginal delivery. A cesarean section was performed in 12 women (52.17%).

Conclusion

Our data are consistent with current evidence that a significant proportion of fetal tachycardias can be treated successfully by transplacental administration of antiarrhythmic drugs. The first-line treatment is digoxin, which can be associated with flecainide. The long-term prognosis for fetuses diagnosed with tachycardia is excellent, with the abnormal rhythm resolving spontaneously during pregnancy in a high percentage of cases.     

Fetus with heart failure due to congenital atrioventricular block treated by maternally administered ritodrine

BACKGROUND: The efficacy of maternal administration of ritodrine in cases of congenital atrioventricular block (CAVB), especially with fetal heart failure, is not yet determined. CASE: At 21 2/7 weeks of gestation, isolated CAVB with a ventricular/atrial rate of 55-70/130-140 bpm was found in a fetus from a 30-year-old Japanese nulliparous woman with anti-SSA antibody. Cardiothoracic area ratio (CTAR) was 40% and no fetal hydrops was observed. At 30 2/7 weeks, the ventricular rate decreased to 49 bpm with an atrial rate of 125 bpm. CTAR increased to 53.8% and ascites appeared. Maternal continuous ritodrine infusion was started with rapid improvement of fetal cardiac function; increment in the ventricular rate to 57 bpm and atrial rate to 137 bpm, with a decrement in CTAR to 44.6%. Ascites also gradually decreased and by the fourth day, it had completely disappeared with CTAR of 40.2%. On the 12th day after ritodrine treatment (32 1/7), amniotic fluid volume decreased and fetal weight gain stopped, which led us to assume a worsening intrauterine environment, and cesarean section was performed. A 1,178 g male infant was born with a 5-min Apgar score of 8. Continuous isoproterenol infusion was started, increasing the ventricular rate from 71 to 80 bpm. Pacemaker implantation is under consideration to treat this infant. CONCLUSION: Maternal administration of ritodrine not only increased the fetal heart rate but also ameliorated the signs of fetal heart failure, and thus is considered one treatment of choice in CAVB.     

Our Experience of Immune Fetal Hydrops: its Clinical Characteristics and Perinatal Outcome

IntroductionFetal hydrops is a serious condition which has high morbidity and mortality. Incidences of immune hydrops have decreased by manifold after introduction of anti-D immunoglobulin. Intra-uterine fetal blood transfusion revolutionized the treatment of these affected fetuses after diagnosis of immune fetal hydrops. In this study we aim to evaluate the clinical characteristics of immune hydropic fetuses and perinatal outcome after institution of intra-uterine transfusions. Materials and methodsA retrospective study was carried out in pregnant women with immune fetal hydrops from October 2004 to December 2019 in our tertiary care hospital. After diagnosis of fetal hydrops, all the fetuses received intra-uterine transfusions. All the newborns were followed up till 3 months postdelivery. All the fetuses were divided in two groups: hydrops diagnosed below 32 weeks (Group A) and in second group hydrops diagnosed after 32 weeks gestation (Group B). ResultsTotal 63 patients were diagnosed to have hydrops during the study period. Group A had 48 fetuses and Group B had 15 fetuses. Average gestational age of diagnosis of hydrops in group A was 24.2 weeks and in group B it was 32.5 weeks. All the fetuses received intra-vascular intra-uterine transfusion. Pericardial effusion was found to be significantly associated with group A. Successful perinatal outcome was seen in 92% fetuses. 87% fetuses had complete resolution of hydrops before delivery. All the fetuses received phototherapy and intra-venous immunoglobulin after delivery, and 5 fetuses underwent exchange transfusion. ConclusionFavourable perinatal outcome was achieved in hydropic fetuses with intra-uterine blood transfusions. Complete resolution of hydrops before delivery increases the chances of perinatal survival.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13224-020-01423-4.     

Prenatal diagnosis and outcome of lymphangiomas and its relationship with fetal chromosomal abnormalities

Objectives: Our aim was to evaluate ultrasound findings and perinatal outcome after prenatal diagnosis of lymphangioma.

Methods: This was a retrospective case series study. We searched the archives of our ultrasound database at our center for cases with the prenatal diagnosis of the lymphangioma in the period between January 2008 and November 2014. We described maternal, fetal and perinatal variables for all cases.

Results: Nine fetuses with lymphangioma were identified. All cases were diagnosed during the second and third trimesters with the average gestational age of 22.6?±?3.9 weeks. The average diameter of lymphangioma was 55.4?±?20.1?mm at the time of diagnosis. Five fetuses (55.6%) had lymphangioma on the neck, and four fetuses (44.4%) had lymphangioma on other localizations. Normal fetal karyotype was detected in all cases. There were a total of six live births, one intrauterine death and two medical terminations of pregnancy following the diagnosis of lymphangioma. No abnormal Doppler finding or hydrops were detected in the antenatal follow-up of remaining six cases.

Conclusion: The risk of chromosomal abnormalities is very low in pregnancies with isolated lymphangioma. The outcome of pregnancies with lymphangioma is generally favorable and prognosis depends on their locations and size.     

Predicting outcome in 259 fetuses with agenesis of ductus venosus – a multicenter experience and systematic review of the literature*

Objective: To evaluate prenatal predictors of postnatal survival in fetuses with agenesis of ductus venosus (ADV).

Methods: This retrospective study reviewed our experience and the literature between 1991 and 2015. Prenatal findings were evaluated and perinatal morbidity and mortality was documented.

Results: A total of 259 cases were included in the present analysis from our centers and 49 published studies (15 patients from our retrospective cohort review and 244 from literature review). The intrahepatic and extrahepatic shunts were present in 32.0% (73/226) and 67.7% (153/226), respectively. Cardiomegaly (n?=?64/259, 24.7%), hydrops (n?=?31/259, 12.0%) and amniotic fluid abnormalities (n?=?22/259, 8.5%) were among the most frequent initial ultrasound findings. One hundred and forty-seven fetuses (56.8%) had ADV without structural anomalies while 112 (43.2%) had associated anomalies (cardiac anomalies (n?=?66), extra-cardiac anomalies (n?=?19) and both cardiac and extra-cardiac anomalies (n?=?27)). The mean gestational age (GA) at ultrasound diagnosis was 22.9?±?6.9 weeks while the mean GA at delivery was 34?±?7.5 weeks. The overall neonatal survival was 57.1% (n?=?148/259). The following factors were associated with survival: advanced maternal age, earlier GA at diagnosis, prematurity, increased nuchal translucency, pericardial effusion, associated cardiac defects (especially AVSD), chromosomal abnormalities, hydrops, hygroma and limb anomalies.

Conclusion: Fetal hydrops, the presence of associated congenital anomalies and premature delivery are associated with poor prognosis in fetuses with ADV.     

Post-mortem high-field magnetic resonance imaging: effect or various factors

Abstract

Purpose: To evaluate image quality and diagnostic accuracy of high-field post-mortem (PM) magnetic resonance imaging (MRI) on fetuses below 20 weeks of gestation before and after the freeze-thaw process.

Materials and methods: Nine fetuses were scanned with three different scanning procedures: “fresh”, just after termination of pregnancy (TOP), “non-fresh short scan” and “non-fresh long scan” after being kept at ?20?°C, followed by a conventional autopsy. The brain, thorax except the heart, heart and abdomen were studied. The qualities of the images for the four different fetal regions and for the three different scanning procedures were reported. Regression analysis was used to investigate the effect on image quality of different factors. Additionally, the diagnostic accuracy was also evaluated.

Results: Fetuses at 12.0–19.6 weeks were included. Regression analysis showed that better image quality was correlated to advanced gestation at TOP and scan on fresh fetuses. PM-MRI on fresh fetuses was always diagnostic for the brain and in more than half of cases on non-fresh fetuses and was nearly equally diagnostic for thoracic and abdominal structures.

Conclusion: High-field PM-MRI seems to offer a quite reliable alternative to the parents declining conventional PM for fetuses before 20 weeks whether these fetuses are freshly scanned or after being frozen.     

Prenatal control of Hb Bart’s hydrops fetalis: a two-year experience at a mainland Chinese hospital

α-Thalassemia is a common inherited disease in southern China. The severest form is Hb Bart’s hydrops fetalis, in which the affected fetuses almost always die in utero or shortly after birth, and the mothers are at high risk for severe morbidity. Therefore, this condition should be controlled, especially prenatally. In this study, we reported on a two-year experience in prenatal control of Hb Bart’s hydrops fetalis at a mainland Chinese hospital. Totally, 573 pregnancies at risk for Hb Bart’s hydrops fetalis were referred and different prenatal procedures were offered depending on the gestational age at presentation. One hundred fifty-two affected fetuses were diagnosed prenatally; among these, only half presented in early gestation, and were terminated in time. Although our prenatal program has successfully prevented the birth of children with severe thalassemia, it does not show a satisfactory outcome, considering the gestational age when an affected pregnancy is terminated.     

Early treatment of intrapericardial teratoma: a case presentation and systematic literature review

Objective: To present a case of an early treatment of cardiac intraperitoneal teratoma (IPT) in a newborn and its associated systematic literature review.

Methods: We presented a case of a newborn with IPT but without hydrops and having a good perinatal outcome after cardiac surgery. Using the PubMed database, we conducted a systematic literature review of articles regarding cases with cardiac IPT diagnosed and treated in the neonatal period and published in English from 2004 onward. We excluded cases that involved fetal death or interrupted gestation events.

Results: In total, 38 cases of IPT from 31 articles were included. The mean?±?standard deviation of the gestational age at diagnosis and delivery were 27.9?±?5.7 and 33.0?±?3.5 weeks, respectively, and that of birth weight was 2373?±?834.5?g. The majority of fetuses (42.1%) were males. Pericardial effusion was the most common symptom (60.5%) followed by hydrops (42.1%) and respiratory distress (42.1%). Intrauterine procedure was not performed in 63.1% of cases, and 71.0% of newborns were alive.

Conclusions: IPT in newborns is usually associated with a good prognosis without the need for intrauterine procedures. Cases with IPT-related death are associated with hemodynamic impairment in fetuses with hydrops.     

Extremely low ventricular rate in a fetus with an isolated non-autoimmune complete congenital heart block. Case report

Congenital complete heart block (CCHB) is an uncommon disorder with an incidence of about 1/20,000 in liveborn infants. It can occur in the setting of structurally normal heart or with structural disease; it is associated with high mortality and morbidity and requires a high index of suspicion for early diagnosis and therapy. Isolated CCHB in a fetus is usually associated with the presence of autoantibodies to SSA (Ro) and SSB (La) antigens in the maternal circulation. Such antibodies cross into the fetal circulation and cause inflammation of the conduction tissues; the causal mechanism is not known. Although the prognosis for the majority of fetuses is good, it is less favourable in fetuses with a ventricular rate <55 bpm in early pregnancy or with a decrease in the ventricular rate by >5 bpm during pregnancy. It is not known if the same prognostic criteria apply for fetuses with isolated non-autoimmune CCHB. This article reports authors' experience in managing a pregnancy with an extremely low fetal heart rate (47 bpm) in a single fetus with an isolated non-autoimmune CCHB in which the outcome was favorable.     

Effect of Oxymorphone Hydrochloride on Ovine Fetal Heart Rate Variability

In order to determine the effect of the narcotic analgesic oxymorphone hydrochloride (Numorphan, DuPont) on fetal heart rate (FHR) variability, mathematical indices of short-term and long-term FHR variability were determined continuously from R–R intervals of the electrocardiogram in eight chronically instrumented ovine fetuses for 60 min before and after a maternal intravenous bolus of 0.04 mg/kg oxymorphone. The index of short-term variability decreased from 12.7 ± 2.0 during control to 9.7 ± 1.7 during the period from 10 to 30 min after oxymorphone administration during periods of low-voltage, high-frequency electrocortical activity (LVHF ECoG) (P < 0.05). Mean FHR was decreased from 169 ± 8 beats per minute (bpm) during control to 155 ± 7 bpm 30 to 50 min after oxymorphone (P < 0.05). Fetal electrocortical activity was also determined and the decrease in FHR short-term variability occurred despite an increase in the percent time spent in LVHF electrocortical activity from 53 ± 4% during the control period to 74 ± 5% after the oxymorphone injection (P < 0.05). Long-term FHR variability was unaffected by the oxymorphone administration. This study indicates that maternal administration of oxymorphone hydrochloride causes decreased short-term fetal heart rate variability in sheep.     

First trimester fetal heart rate as a predictor of newborn sex

Objective: To predict the sex of newborns using first trimester fetal heart rate (FHR).

Methods: This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student’s t-tests while categorical variables were compared using Chi-square test.

Results: We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0?±?9.1?bpm and for male fetuses 167.3?±?10.1?bpm (p?=?0.62). There was no significant difference in crown rump length between female and male fetuses (4.01?±?1.7 versus 3.98?±?1.7?cm; p?=?0.78) or in gestational age at birth (38.01?±?2.1 versus 38.08?±?2.1 weeks; p?=?0.67). The males were significantly heavier than females (3305.3?±?568.3 versus 3127.5?±?579.8?g; p?<?0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants.

Conclusions: We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns.     

The change in sex hormone binding globulin and the influence by gestational diabetes mellitus in fetal period

Objective. To investigate the influence of gestational diabetes mellitus (GDM) on the change of SHBG in fetus.

Method. Forty-eight pregnant women with GDM and 86 women with normal pregnancy were included in the study. The following were measured in the serums of pregnant women, amniotic fluids, and umbilical cord serums: glucose, insulin, peptide-C, SHBG, and sex hormones.

Results. SHBGs in pregnant women's serums were, when compared with the control group: in male fetuses 308.06 ± 55.64 vs. 445.21 ± 50.07 (p < 0.01) and in female fetuses 312.38 ± 56.61 vs. 451.05 ± 52.87 (p < 0.01). When comparing the levels of SHBGs in amniotic fluids, inclusive of the control group, the following were in male fetuses 8.35 ± 1.07 vs. 8.41 ± 1.09 (p = NS) and in female fetuses 8.31 ± 0.97 vs. 8.39 ± 0.94 (p = NS). For the levels of SHBGs in umbilical cord serums and comparison to the control group were: in male fetuses 41.44 ± 8.83 vs. 40.24 ± 7.50 (p = NS) and in female fetuses 39.93 ± 7.04 vs. 39.69 ± 7.16 (p = NS). The concentration of SHBG in amniotic fluid had no significant relationship to glucose, dehydroepiandrosterone (DHEAS), estradiol, and total and free testosterone, but had an extremely negatively correlated to insulin and peptide-C (p < 0.01) in GDM group.

Conclusion. Although the concentration of SHBG does not change in fetus when pregnant woman is complicated with GDM, it is already influenced by the fetal regulation on hyperinsulinemia.     

Fetal Echocardiography: An 8-Year Experience

Over 8 years, 680 fetuses in 521 gestations underwent echocardiography. Indications included genetic or teratogenic risk, arrhythmias, diabetes, collagen vascular disease, hypertension, growth retardation, and hydrops. Most studies were normal. Eight fetuses had structural heart disease, 31 had benign atrial or ventricular premature beats, five had benign unsustained arrhythmias, three had heart block associated with maternal autoantibodies, and one had sustained supraventricular tachycardia with hydrops. Eight had suspected hydrops, fetal demise, or molar pregnancy. There were 19 cases of abnormal umbilical artery Doppler waveforms and three with pathologic cerebral artery waveforms.

Fetal echocardiography is a valuable noninvasive diagnostic tool in selected cases with a high sensitivity and specificity for serious hemodynamic problems.