妊娠期高血压对脐血脂联素水平影响及其与胰岛素的关系

目的 探讨妊娠期高血压(妊高征,PIH)对胎儿脐血脂联素水平的影响及脂联素与胰岛素之间的关系.方法 妊高征母亲所生新生儿60例,分为3组:妊娠期高血压组(PIH 1)23例、子(癎)前期轻度组(PIH 2)22例、子(癎)前期重度组(PIH 3)15例,正常对照组40例,采用放射免疫分析法(RIA)测定脐血脂联素、胰岛素水平,并分析两者相关性.结果 ①PIH组脐血脂联素水平低于正常对照组,且随母亲PIH程度的加重呈进行性的下降,组间比较差异有统计学意义(P＜0.05);②PIH组脐血胰岛素水平低于正常对照组,且随母亲PIH程度的加重呈进行性的下降,组间比较差异无统计学意义(P＞0.05);③PIH组脐血脂联素水平与胰岛素水平呈正相关(r=0.293,P＜0.05).结论 妊高征时宫内不利环境影响胎儿内分泌代谢的调节,且随母亲妊高征程度的加重而加重.     

妊娠期高血压对新生儿脐血脂联素水平的影响

目的 探讨妊娠期高血压综合征(妊高征)对新生儿脐血脂联素水平的影响及脂联素与出生体质量、体质量指数(BMI)的关系.方法 选择妊高征母亲所生新生儿60例,分为3组:妊娠期高血压组23例、子癎前期轻度组22例、子癎前期重度组15例,健康对照组(孕母体健.除外高血压病、糖尿病、甲状腺功能亢进、心血管疾病等)40例.抽取其脐动脉血5 mL,常温3 000 r/min离心10 min,提取血清1 mL,置-80℃冰箱待测.严格测量新生儿出生净体质量,精确至1 g,身长精确至0.1 cm,计算BMI,BMI=体质量/身长2(kg/m2).放射免疫法测定各组脐血脂联素水平,并分析脂联素与出生体质量、BMI的相关性.采用SPSS 11.5软件进行统计学分析.结果 妊娠期高血压组、子痫前期轻度组、子癎前期重度组新生儿脐血脂联素水平、出生体质量、BMI均低于健康对照组,且随母亲妊高征程度的加重呈进行性下降,组间比较有显著性差异(F=3.984,6.262,2.772 Pa<0.05).妊高征组新生儿脐血脂联素水平与出生体质量、BMI呈显著正相关(r=0.320,0.338 Pa<0.01).结论 妊高征时宫内不利环境影响胎儿内分泌代谢的凋节,且随母亲妊高征程度的加重而加重;脂联素可以作为衡量胎儿生长发育状态的重要指标之一.     

新生儿缺氧性肺动脉高压对左室舒张功能的影响及其与血浆脑利钠肽相关性研究

评估缺氧新生儿肺动脉高压（PAH）的发生及其对左室形态及功能的影响,探讨缺氧性PAH新生儿血浆脑利钠肽（BNP）水平与左室舒张功能的关系。方法　选择2003年11月至2008年11月解放军总医院和北京军区总医院附属八一儿童医院新生儿重症监护室（NICU）收治的缺氧新生儿52例,根据彩色多普勒超声检查是否存在PAH分为PAH组（34例）与对照组（18例）,比较2组患儿彩色多普勒超声心动图资料及其与左室舒张功能、血浆BNP水平的关系。结果　（1） 与对照组相比,PAH组左室舒张末内径（LVDd）、右室内径（RV）、肺动脉内径（PA）明显增大（P < 0.05）;三尖瓣反流峰值（VTR）流速增快及肺动脉收缩压（PASP）升高（P < 0.05）,室间隔增厚不明显（P > 0.05）。（2）PAH组二尖瓣口血流多普勒频谱A峰流速（AV）、舒张早期充盈时间速度积分（AVTI）及A峰流速与E峰流速比值（AV/EV）、左房充盈分数（AVTI /EVTI）均较对照组显著增加（P < 0.01）;PAH组的左室等容舒张时间（LIVRT） 延长,但与对照组相比差异无统计学意义（P > 0.05）,EV、舒张末期充盈时间速度积分（EVTI）及E峰减速时间（DT）较对照组亦无明显改变（P > 0.05）。（3） PAH组血浆BNP水平较对照组显著升高（P < 0.05）。（4）相关分析表明,PASP与AV/EV比值呈正相关（r = 0.4126, P < 0.01）;PAH组AV/EV比值与血浆BNP水平呈正相关 （r =0.4326,P < 0.01）。 结论　缺氧新生儿PAH已引起左室心肌重塑表现及左室舒张功能减低, 监测血浆BNP水平对新生儿缺氧性PAH伴左心功能受损的早期诊断具有十分重要的临床意义。     

N端脑钠肽前体及Tei指数对新生儿缺氧性肺动脉高压右心室功能评价的意义

目的 探讨血浆N端脑钠肽前体(NT-proBNP)及Tei指数评价新生儿缺氧性肺动脉高压(HPH)患儿右心室功能的意义.方法 选择2012年6月至2013年11月本院新生儿重症监护病房收治的缺氧性新生儿为观察组,根据生后第1天是否合并肺动脉高压分为HPH组与非HPH组.HPH组依据其生后第7天的肺动脉压力(PASP)是否恢复正常分为HPH恢复组和HPH未恢复组.选择同期入院无缺氧病史的新生儿为对照组.所有研究对象均于生后第1天、HPH组于生后第7天测定PASP、右室Tei指数、右室射血分数(RVEF)、E/A比值;所有对象于超声检查后1h内采集静脉血,测定血浆NT-proBNP水平.结果 研究期间共收治有缺氧史的新生儿72例,合并肺动脉高压46例,其中轻度HPH组20例,中度HPH组18例,重度HPH组8例,非HPH组26例;共纳入对照组22例.生后第1天各组RVEF、E/A比值比较,中度及重度HPH组均低于对照组、非HPH组及轻度HPH组,重度HPH组低于中度组,差异有统计学意义(P＜0.05).生后第1天各组Tei指数及血浆NT-proBNP比较,HPH组和非HPH组均高于对照组,中度及重度HPH组高于非HPH组和轻度HPH组,重度HPH组高于中度HPH组,差异有统计学意义(P＜0.05).生后第7天HPH恢复组RVEF、E/A比值高于第1天,Tei指数及血浆NT-proBNP低于第1天,差异有统计学意义(P＜0.05);HPH未恢复组Tei指数及血浆NT-proBNP低于第1天,差异有统计学意义(P＜0.05),RVEF、E/A比值与第1天差异无统计学意义(P＞0.05).生后第1天Tei指数与血浆NT-proBNP呈正相关(r=0.826,P＜0.001),并且二者均与PASP正相关(r分别为0.555,0.504,P＜0.001).结论 新生儿HPH患儿存在右心功能障碍,其血浆NT-proBNP水平、右室Tei指数与PASP高低密切相关,有助于右心功能障碍的诊断.     

应用二维斑点追踪成像技术监测急性淋巴细胞白血病柔红霉素化疗患儿左室扭转功能探讨

探讨应用二维斑点追踪成像技术监测柔红霉素化疗对急性淋巴细胞白血病（急淋）患儿左心室短轴心肌扭转功能的影响,分析心脏功能损伤与柔红霉素不同累积剂量的关系。方法　研究对象为2007年1月至2009年12月深圳市儿童医院诊断的急淋患儿60例,均接受柔红霉素化疗,按治疗程序分为A组（化疗前）、B组（柔红霉素化疗累积剂量达120 mg/m2）和C组（柔红霉素化疗累积剂量达240 mg/m2）。对照组为同期体检正常儿童60名。检测每组常规超声心动图指标左室射血分数（EF）、二尖瓣口舒张期血流比值（E/A）,并应用超声二维斑点追踪成像技术（two-dimensional speckle tracking imaging,2DSI）检测对照组及A、B、C组的左室短轴基底段和心尖段的心肌节段收缩期峰值旋转度,计算左室心肌收缩期峰值扭转角度。结果　心率、EF、二尖瓣口舒张期E/A比值在对照组、A、B、C各组间比较,差别无统计学意义（P > 0.05）。A、B组与对照组比较,基底段和心尖段的峰值旋转角度差异无统计学意义（P > 0.05）;C组与对照组比较心尖段峰值旋转角度,差异无统计学意义（P > 0.05）; C组与对照组、A组、B组比较,基底段峰值旋转角度差异有统计学意义（F＝5.23, P < 0.05）。A、B组与对照组比较,左室扭转角度差异无统计学意义（P > 0.05）,但C组小于对照组、A组、B组,差异有统计学意义（F＝4.51, P < 0.05）。结论　急淋患儿柔红霉素化疗累积剂量达120 mg/m2时未发现心脏扭转功能损伤,当达到240 mg/m2时,心脏扭转功能出现显著损伤,2DSI可无创性定量监测患儿心脏功能的变化,对临床评价柔红霉素的心脏毒性、预防化疗后遗症的发生有重要意义。     

母亲妊娠糖尿病及妊高征对新生儿内分泌水平影响的研究

探讨母亲妊娠合并糖尿病及妊高征对高危儿血糖、胰岛素、皮质醇、胰岛素样生长因子1水平（IGF－1）的影响，检测糖尿病组42例，妊高征组144例，健康对照组23例，均于出生24－48小时内采取股静脉血，测定有关内分泌水平。结果显示：（1）糖尿病组胰岛素，皮质醇水平较对照组显著增高，P＜0．05；（2）妊高征组皮质醇水平明显高于对照组，P＜0．05；（3）糖尿病与妊高征二组比较，IGF－1有显著性差异，P＜0．05。结论，妊娠合并糖尿病及妊高均对围产儿内分泌产生影响，可引起血皮质醇水平明显升高，尤其以前者为甚，可以发生高胰岛素血症及血中IGF－1水平升高，胎儿柯兴氏面容、RDS及巨大的发生显著增高，影响围产儿的质量，应引起重视。     

重度妊娠高血压综合征对早产儿心率及QTLc的影响

目的观察重度妊娠高血压综合征(重度妊高征)患者早产儿心电图心率及经心率较正后的QT间期(QTLc)特点,为早产儿心电图诊断提供科学依据。方法将胎龄30～36周的早产儿155例根据其母妊娠期是否有妊高征分为2组:重度妊高征组和非妊高征组(对照组),测量心率及经心率校正后的QT间期(QTLc)。结果重度妊高征组早产儿心率较对照组快,两组间比较差异有统计学意义;重度妊高征组早产儿QTLc较对照组长,两组间比较差异有统计学意义。结论重度妊高征对其早产儿心电图时限参数心率及QTLc有影响。     

Tei指数评价缺氧新生儿左心室功能障碍的作用研究

目的：探讨Tei指数在评价缺氧新生儿左心室功能障碍中的作用。方法：52例低氧血症新生儿（轻度20例,中重度各16例）和40例正常新生儿作为研究对象,于生后1、3、7 d用多普勒超声心动图测定反映心脏收缩及舒张功能的指标：左心室射血分数（LVEF）、二尖瓣口E/A值;左心室Tei指数（LV-Tei）。结果：（1）中度低氧血症组生后1、3 d LVEF、左室E/A值明显低于对照组（P<0.01）;重度低氧血症组生后1、3、7 d LVEF、左室 E/A 值均明显低于对照组（P<0.01或0.05）。（2）轻度低氧血症组生后1 d、中度及重度低氧血症组生后1 d、3 d LV-Tei 值明显高于对照组（P<0.01）。（3）低氧血症组生后1 d、3 d PaO2与LV-Tei呈负相关(r=-0.50, P<0.05; r=-0.71, P<0.01)。结论：LV-Tei可敏感地发现低氧血症患儿左心室功能下降,对临床的诊治有重要的指导作用。     

测定脐血脑钠肽对血糖异常孕妇的胎儿心功能评价

目的：探讨脐血脑钠肽（BNP）评价血糖异常孕妇胎儿心功能的可行性及高血糖对胎儿心功能的影响。方法：妊娠期血糖异常孕妇24例,包括妊娠期糖尿病18例和糖耐量受损6例,按分娩前血糖值的高低分为控制欠佳组（7例）和控制较好组（17例）,孕末期行胎儿超声心动图测量心脏相关指标;正常妊娠孕妇25例为对照组。于胎儿分娩时留脐血,测定BNP浓度。结果：血糖异常组胎儿脐血BNP值明显高于对照组,分别为（114.0±39.0）和（80.6±13.7） pg/mL（P<0.01）,其中血糖控制欠佳组高于控制较好组（142.1±44.1 pg/mL vs 102.4±31.2 pg/mL;P<0.01）。脐血BNP在妊娠期糖尿病和糖耐量受损两组间差异无显著性,与孕末期胎儿左室壁厚度呈正相关,与二尖瓣A峰、E/A比值分别呈正、负相关（r值分别为0.715,0.491和-0.507,P<0.05）。结论：妊娠期高血糖时脐血BNP水平明显升高,与孕妇血糖控制情况及胎儿心功能变化相关联,可反映胎儿心功能的潜在损害。良好血糖控制可能减轻这一影响。［中国当代儿科杂志,2009,11（10）：805-808］     

新生儿脐血一氧化氮与妊高征关系的探讨

娃高征是人类妊娠期主要并发症，也是导致婴儿死亡率升高的主要原因，目前其病因不明。研究表明，一氧化氮（nitricoxide，NO）在妊高征发病机理中发挥重要作用‘”。至今有关临床研究报道不多。我们测定了正常孕妇及妊高征患者所分娩新生儿脐血NO水平，以了解它在妊高征中的病理生理意义。一、对象与方法：1．对象：均为我院妇产科的孕妇及其新生儿。妊高征组新生儿26例，其中男14例，女12例，胎龄36～42周，出生体重2．1～3．5kg，母孕期除妊高征外无其它疾病；对照组新生儿30例，为健康孕妇所生，其性别、服龄、出生体重及分娩方式与妊…     

Overgrowth and Enlarged Heart in Mouse Fetuses with Maternally Inherited ThP and twLub2: An Example of Genomic Imprinting in Animals

ABSTRACT T^hp/+ mouse is known to have differing phenotypes depending on gender of the T^hP parent. In the present study, fetuses with maternally [Group A (until day 18 of pregnancy) and Group C (day 19)] and paternally [Group B] inherited T^hP were examined with particular reference to the developmental abnormalities of hearts. In addition, a small number of fetuses with maternally inherited t^wLub2 on day 19 were compared with T^hp. Group A T^hP fetuses had greater body weight, possibly larger body size, generalized edema (100%), marked enlargement of the hearts (100%) and hypoplastic pulmonary trunk (73.7%). There were no such malformations in Group B T^hP fetuses or in the controls (+/+) for both groups. The bilaterally thickened ventricular wall of fetal hearts in Group A and C T^hP fetuses bulged into ventricular cavity. The pulmonary valve was also thickened. The labeling indices of the ventricular myocardial cells by BrdU were inclined to be higher in Group A T^hP than in the control (+/+) fetuses. Fetuses of t^wLub2 had abnormalities of the cardiovascular system similar to Group C T^hp. The results suggest that cardiac lesions in fetuses with maternally inherited T^hP and t^wLub2 correspond to cardiomyopathy. Overgrowth and enlarged heart indicate the possibility of T^hP as an animal model for Wiedemann-Beckwith syndrome.     

经胎盘转运地高辛治疗胎儿心力衰竭的非随机对照研究

目的 观察经胎盘转运地高辛治疗胎儿心力衰竭的临床疗效及安全性;探讨心血管整体评分（CVPS）和心室作功指数（Tei指数）对胎儿心力衰竭评估及治疗的指导意义。方法 按照研究设计,纳入2008年5月至2011年12月四川大学华西第二医院（我院）产前诊断的胎儿心力衰竭连续病例,知情同意下根据患胎父母意愿分为地高辛组及病例对照组。地高辛组经多学科会诊确定个体化经胎盘转运地高辛治疗方案。对病例对照组进行临床观察。动态监测两组患胎CVPS及心室 Tei指数并观察妊娠结局。同时纳入同期在我院建卡的健康孕妇及胎儿作为正常组,分别于妊娠20、24、28、32、36周及产前观察CVPS及心室 Tei指数演变。结果 ① 地高辛组共纳入10例胎儿心力衰竭病例,其中4例胎儿心房扑动（AF）、3例胎儿室上性心动过速（SVT）、2例轻型胎儿杂合型地中海贫血（MA）、1例胎儿扩张性心肌病（DCM）。AF、SVT及MA患胎经地高辛治疗后心力衰竭得到控制,治疗后孕期顺利,足月顺产,随访10~55个月,生长发育良好,Bayley婴幼儿发育量表测试显示患儿智力及行为发育均正常;治疗过程中CVPS逐渐上升,达到或接近10分,心室 Tei指数逐渐下降,均接近正常组水平。②病例对照组共纳入9例胎儿心力衰竭病例,其中4例AF、3例SVT、2例MA。其中1例AF、1例SVT分别于观察5及7 d后自然转复为窦性心律,其后转入地高辛组,给予地高辛治疗,孕期顺利,足月顺产。其余病例进行临床观察后,其CVPS逐渐降低,心室 Tei指数逐渐升高,最后终止妊娠。③地高辛组1例观察到胃肠道不良反应,地高辛减量后症状消失。结论 地高辛作为治疗胎儿心力衰竭的一线药物具有重要的临床价值,安全性较好;随胎儿心力衰竭控制,胎儿CVPS逐渐上升,心室 Tei指数下降,两者呈负相关关系;CVPS和心室Tei指数能有效指导经胎盘转运药物产前治疗胎儿心力衰竭;及时有效的产前治疗能明显改善疾病预后。     

血管内皮生长因子在重度子癎痫前期产妇新生儿脐血中的表达

目的 探讨血管内皮生长因子(VEGF)在重度子癎前期产妇分娩的新生儿脐静脉血、脐动脉血中的表达及其意义.方法 采用放射免疫分析法检测26例重度子癎前期产妇所分娩新生儿(重度子癎前期组)与30例健康产妇所分娩新生儿(对照组)的脐静脉血、脐动脉血VEGF水平.重度子癎前期组新生儿按照其出生体质量-胎龄分类分为小于胎龄儿15例(SGA组)和适于胎龄儿11例(AGA组).结果 (1)重度子癎前期组脐静脉血、脐动脉血VEGF水平[(15.26±5.28)pg/ml、(19.334±4.45)pg/ml]均显著高于对照组[(12.78±3.21)pg/ml、(14.55±2.90)pg/ml](t=2.16,P<0.05;t=4.82,P<0.01).(2)对照组和重度子癎前期组的脐动脉血VEGF水平均显著高于脐静脉血VEGF水平(t=2.24,P<0.05;t=3.00,P<0.01).(3)对照组和重度子癎前期组脐静脉血和脐动脉血VEGF水平与新生儿胎龄或出生体质量均无明显相关性.(4)重度子癎前期SGA组的脐动脉血VEGF水平(21.38±3.68pg/ml)显著高于AGA组(16.53±3.96pg/ml)和对照组(t=3.22,P<0.01;t=6.80,P<0.01).结论 重度子癎前期产妇新生儿脐静脉血和脐动脉血VEGF水平均较健康产妇新生儿明显升高;脐动脉血VEGF水平在一定程度上可反映妊娠期高血压疾病产妇的新生儿宫内损伤程度.     

血管内皮生长因子在重度子癎痫前期产妇新生儿脐血中的表达

目的 探讨血管内皮生长因子(VEGF)在重度子癎前期产妇分娩的新生儿脐静脉血、脐动脉血中的表达及其意义.方法 采用放射免疫分析法检测26例重度子癎前期产妇所分娩新生儿(重度子癎前期组)与30例健康产妇所分娩新生儿(对照组)的脐静脉血、脐动脉血VEGF水平.重度子癎前期组新生儿按照其出生体质量-胎龄分类分为小于胎龄儿15例(SGA组)和适于胎龄儿11例(AGA组).结果 (1)重度子癎前期组脐静脉血、脐动脉血VEGF水平[(15.26±5.28)pg/ml、(19.334±4.45)pg/ml]均显著高于对照组[(12.78±3.21)pg/ml、(14.55±2.90)pg/ml](t=2.16,P<0.05;t=4.82,P<0.01).(2)对照组和重度子癎前期组的脐动脉血VEGF水平均显著高于脐静脉血VEGF水平(t=2.24,P<0.05;t=3.00,P<0.01).(3)对照组和重度子癎前期组脐静脉血和脐动脉血VEGF水平与新生儿胎龄或出生体质量均无明显相关性.(4)重度子癎前期SGA组的脐动脉血VEGF水平(21.38±3.68pg/ml)显著高于AGA组(16.53±3.96pg/ml)和对照组(t=3.22,P<0.01;t=6.80,P<0.01).结论 重度子癎前期产妇新生儿脐静脉血和脐动脉血VEGF水平均较健康产妇新生儿明显升高;脐动脉血VEGF水平在一定程度上可反映妊娠期高血压疾病产妇的新生儿宫内损伤程度.     

Toxoplasma gondii infection during pregnancy: T lymphocyte subpopulations in mothers and fetuses

Prenatal diagnosis of fetal toxoplasmosis is possible with the use of fetal blood sampling, amniocentesis and ultrasound examination. The purpose of this study was to describe T lymphocyte subsets (CD3, CD4 and CD8) in mothers and their fetuses when Toxoplasma gondii infection occurred during pregnancy. Maternal and fetal blood samples were obtained in 86 cases and 9 fetuses showed T. gondii infection. Control groups consisted of 30 healthy nonpregnant women and 30 pregnant women. Pregnant women with T. gondii infection showed an increase in the suppressor (CD8) T subpopulation and a significant depression in the total helper (CD4) T cells. These alterations were more important in mothers whose fetus was infected. We showed the progressive maturation of the fetal immune system with a regular increase of all T lymphocyte subsets. Marked alterations were observed in the 9 infected fetuses (depression of CD4 population and lower CD4/CD8 ratio). In the future these differences might be used as a new marker of the severity of fetal lesions and become a useful diagnostic tool.     

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.     

Assessment of Fetal Cardiac Function in Mild Preeclampsia

This study investigated cardiac function in 65 fetuses of mildly preeclamptic mothers and 55 fetuses of healthy mothers at 26–40 weeks of gestation. Fetuses with intrauterine growth restriction were excluded. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, and gestational age. Peak systolic aortic and pulmonary artery velocities were significantly lower in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. The two groups did not differ significantly in terms of shortening fraction or with regard to mitral or tricuspid annular plane systolic excursion. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the preeclamptic mothers. The Ea, Aa, and Ea/Aa ratios in the interventricular septum, left ventricle posterior wall, and right ventricle free wall were lower in the preeclampsia group than in the control group. The E/Ea ratio was higher in the preeclampsia group than in the control group. The isovolumic relaxation time and the right and left myocardial performance indices were higher in the fetuses of the preeclamptic mothers than in the fetuses of the healthy mothers. An increased ductus venosus pulsatility index (PI) and a decreased middle cerebral artery (MCA) PI were found in the fetuses of the preeclamptic mothers. All the fetuses were asymptomatic. The results suggest that the increase in fetal cardiac afterload in mild preeclampsia may have caused early subclinical changes in fetal systolic and diastolic cardiac function. In addition, the decrease in MCA-PI may have been caused by redistribution of fetal cardiac output in favor of the left ventricle, secondary to increased placental vascular resistance.     

Intrapartum management of severe fetal hydrocephaly

The management of pregnant women with advanced hydrocephalic fetuses presents a dilemma for the treating physician. One side of the management scale is represented by termination of the pregnancy once the diagnosis is confirmed. On the other hand, pregnancy may be allowed to continue to term and vaginal delivery is achieved after performing destructive procedures to the baby's head, which may lead to significant maternal morbidity and definite fetal mortality. Three pregnant women with known severe hydrocephalic fetuses were managed by intraoperative ventriculocentesis to reduce the fetal head circumference prior to delivery by cesarean section in order to avoid any intra-partum destructive surgery on the fetal head. Results and follow-up of the three babies and their mothers are described.