Effect of maternal isoxsuprine on fetal rabbit lung biochemical maturation.

Isoxsuprine was given intramuscularly for 24 hours to pregnant rabbits at 26 to 27 days' gestation. There was no effect on fetal weight within one day of the last injection. Fetuses of isoxsuprine-treated mothers had higher lung lecithin (6.67 micron per gram +/- 2.81) and higher tracheal wash lecithin/sphingomyelin (L/S) ratios (5.85 +/- 4.5) than did untreated fetuses--lung lecithin (5.35 micron per gram 1.23) and tracheal wash L/S (4.08 +/- 2.3). In contrast, phosphorylcholine glyceride transferase activity of the fetal lung was less in isoxsuprine-treated fetal lung tissue.     

Diabetes mellitus and pregnancy.

Diabetes mellitus represents the most common medical complication of pregnancy. Care programs emphasizing normalization of maternal glucose levels have resulted in perinatal outcome that is nearly equivalent to that observed in normal pregnancies. Reducing the rate of significant congenital anomalies in insulin-dependent women remains a goal for the future.     

Effect of aminophylline on lung maturation in preterm rabbit fetuses

Pregnant rabbit does were treated intravenously with aminophylline (6 mg/kg/day) from the twenty-fifth day after the day of mating, and the fetuses were delivered by hysterotomy on the twenty-eighth day. One group of neonates was breathing air, and another group 100% oxygen. Lung mechanics were evaluated in the newborn animals during spontaneous or artificial ventilation, and the lungs were studied histologically with particular reference to the alveolar volume density. In one series of experiments, the lungs were washed and the lavage fluid was analyzed for phosphatidylcholine and phosphatidylglycerol. Aminophylline-treated litters had greater body weights, an improved survival rate, and an increased amount of phosphatidylglycerol in lung lavage fluid. Respiratory frequency was increased in aminophylline-treated animals breathing air, but data on lung compliance showed no significant difference between treated and control animals. In the present model, the beneficial effect of aminophylline can be attributed largely to a combination of accelerated fetal growth and improved postnatal regulation of breathing and less to a specific influence on the biochemical and functional maturation of the lung.     

Attitudes of maternal-fetal specialists concerning maternal-fetal surgery.

OBJECTIVE: We examined the attitudes of members of the Society for Maternal-Fetal Medicine regarding the clinical, scientific, ethical, and policy issues in maternal-fetal surgery. STUDY DESIGN: A 43-question survey was distributed to all members of the Society for Maternal-Fetal Medicine. Two mailings and one electronic mail reminder were sent, each with instructions to submit the survey either via US mail or the Internet. The survey included questions in six categories: physician demographic data, experience with maternal-fetal surgery, views on innovative therapies, scientific validation of currently used and proposed procedures, ethical issues, and future directions in public policy. RESULTS: Of the 1639 United States members sent questionnaires, 943 replied (response rate = 59%). Forty-seven percent had referred patients for open fetal surgery for nonlethal conditions, and 69% believed physicians were obligated to inform patients of this option. Seventy-eight percent believed that innovative therapies should be performed only under institutional review board-approved protocols. Although the majority of respondents believed that certain proposed benefits of open fetal surgery for myelomeningocele could offset the risks, the majority (56%) also indicated that the procedure has not been validated. Fifty-seven percent believed that a moratorium should be imposed on open fetal surgery for nonlethal conditions, such as myelomeningocele, until a multicenter-controlled clinical trial is completed. CONCLUSIONS: The use of maternal-fetal surgery for nonlethal conditions is highly controversial. The majority of maternal-fetal specialists we surveyed support further research before such procedures are integrated into clinical practice.     

Effect of dexamethasone, triiodothyronine and dimethyl-isopropyl-thyronine on lung maturation of the fetal rat lung

Our purpose was to elucidate why clinical studies have up to now failed to demonstrate a positive effect of TRH combined with glucocorticosteroids on fetal lung maturity. Morphological and biochemical lung maturation were determined by electron microscopy, choline incorporation, and surfactant-protein-A m-RNA synthesis in rat lung organoid cultures after exposure with a series of concentrations of dexamethasone, triiodothyronine, and dimethyl-isopropyl-thyronine. Thyroid hormones improved morphogenesis of lung histotypic structures but had a negative effect on surfactant synthesis whereas glucocorticosteroids had a positive effect on the surfactant synthesis but a negative effect on morphogenesis. The combination of both substances even had the most negative effect on morphogenesis. Since morphogenesis of lung histotypic structures is prerequisite for surfactant synthesis and secretion, we hypothesize that a sequential treatment of thyroid hormones to improve morphogenesis followed by the application of glucocorticosteroids might be an option to improve neonatal lung function.     

Immunophysiology of normal pregnancy. Part I. Immunoregulatory mechanisms inside the maternal-fetal interface

Contemporary opinions concerning the function of decidual NK cells, T and B lymphocytes as well as macrophages and neutrophils in normal pregnancy were presented in the paper. Maintenance of proper Th1/Th2 balance concerning cytokines produced by trophoblast, decidua and decidual infiltrating immunological cells was also precisely described.     

Orciprenaline and fetal lung maturation in rabbits.

The palmitic and stearic acids and the palmitic/stearic ratio in fetal rabbit lungs were studied after orciprenaline administration to the mother from the 26th to the 31st day of gestation. The results were significantly higher in the treated groups than in the control group for the palmitic acid and palmitic/stearic ratio.     

Diabetes mellitus in pregnancy and periconceptional genetic counseling.

Gestational diabetes constitutes 90% of all pregnant diabetic patients, whereas insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) together account for the remaining 10%. Diabetes is considered a heterogeneous disease with a continuous spectrum between IDDM and NIDDM. It is believed that gestational diabetes is also a heterogeneous disorder representing, at least in part, patients who are destined to develop in later life either IDDM or NIDDM. Studies in identical twins have shown clear-cut differences in the genetic inheritance of IDDM and NIDDM. Nearly 100% of identical twins were found to be concordant for NIDDM; whereas in IDDM the concordance rate ranges between 20 and 50%. This concordant pattern indicates a higher genetic contribution in NIDDM than IDDM. Furthermore, IDDM is an HLA-linked disorder, and NIDDM is not. The exact mechanism of inheritance of IDDM and NIDDM is not known; therefore the information used in genetic counseling is based on empirical risk estimates. Recent information demonstrates that IDDM is transmitted less frequently to the offspring of diabetic mothers than diabetic fathers (1.3% versus 6%). The estimated risk of recurrence of IDDM to offsprings with one already affected sibling and unaffected parents is 5 to 6%. Additionally, the empirical risk of NIDDM first-degree relatives developing diabetes is much higher than the observed in IDDM relatives, 15% for first-degree relatives and 60 to 75% when both parents have NIDDM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diabetes mellitus in pregnancy in an African population.

OBJECTIVES: To compare the pregnancy outcome among diabetic and non-diabetic Nigerian women. METHODS: A retrospective case record review of 200 pregnant diabetic patients and control was carried out over a 10-year period (1990-1999) at the Maternity unit of the University of Nigeria Teaching Hospital Enugu, Nigeria. RESULTS: The prevalence of diabetes mellitus among pregnant mothers was 1.7%. Pre-gestational diabetes mellitus accounted for 39% of cases while gestational diabetes was responsible for 61% of them. Late antenatal booking and poor control of diabetes mellitus were common features, while maternal and fetal morbidity was high. Hypertension, vulvovaginitis, premature labor, polyhydramnios and ketoacidosis were significantly higher among diabetic mothers than controls. The perinatal mortality was also higher among diabetics than controls (12.5% vs. 3.5%) with stillbirth being the major contributor. Patients with gestational diabetes were at increased risk of fetal macrosomia than controls (28.7% vs. 5.5%). The overall cesarean section rate was high (36%) among diabetics with previous cesarean section and cephalopelvic disproportion being the commonest indications. CONCLUSIONS: Health education and provision of modern affordable methods of management of diagnosed cases such as uristix and hemastix will improve maternal and fetal outcome in pregnant diabetics in Africa.     

Placental changes in diabetes mellitus with special reference to villi maturation disorders. (Morphological findings and severity of the disease)]

The placentas of 30 cases of diabetes mellitus were examined. The degree of severity of the disease was classified according to the schema of White. Related to the gestation period different degrees of severity of diabetes mellitus revealed nearly the same weight of the placentas. Similar relations were found referred to the height of the placenta-child-index. Implantation lesions occured in 56, 7% of all cases, most of these in cases with strong diabetes mellitus. The greater number of lesions were insertion anomalies of the cord. All placentas-showed disturbed circulation by dominance of disturbed blood supply. A relation to the degree of the severity of the disease wasn't provable. Very often we found villi necrosis and proliferations of the syncytiotrophoblast. Also we could see alterations of the villi vessels and a compensatory angiomatosis. 83,3% of diabetes cases showed disturbed maturation of the villi; the grade of these changes could not be referred to the degree of severity of this disease; it was merely a ramification block. The authors point out that in diabetes mellitus the degree of danger to the pregnancy does not depend on the severity of the maternal disease. It is always necessary to have a sufficient metabolic condition.     

A betamimetic drug and human fetal lung maturation.

In a double-blind and randomized study the administration of a betamimetic drug to the mother from week 33 to 35 produces a significant increase in amniotic fluid palmitic acid levels. We suggest that the administration of a betamimetic drug during pregnancy to the mother can be useful in producing an acceleration of the fetal lung maturation.     

Management of diabetes mellitus and pregnancy: a survey of obstetricians and maternal-fetal specialists

To ascertain current practice trends among obstetricians and maternal-fetal subspecialists regarding the care of pregnancies complicated by diabetes mellitus, a questionnaire was sent to all members of the Society of Perinatal Obstetricians (SPO) and a randomly selected group of American College of Obstetricians and Gynecologists (ACOG) Fellows. A total of 273 of 356 SPO members (77%) and 198 of 504 ACOG Fellows (39%) responded. When divided according to years post-residency (ACOGa, less than 15 years; ACOGb, 15 years or more), significant differences in practice patterns were observed for ACOG Fellows. The SPO responses were similar among these subgroups. Despite current ACOG recommendations, most clinicians practice universal screening for gestational diabetes. Significant discrepancies appear to exist between ACOGb versus ACOGa and SPO with regard to methods of glucose surveillance and the threshold for initiating insulin therapy in gestational diabetes. Intensive fetal surveillance, elective delivery, and high cesarean rates are common in pregnancies complicated by insulin-dependent diabetes mellitus, which is most often managed by a perinatologist or by an obstetrician in consultation with an internist. Few insulin-dependent patients seek preconceptional care.     

Effect of maternal-fetal movement on concentration of cells obtained at genetic amniocentesis

The number of viable amniotic fluid cells in the aliquot obtained at amniocentesis is an important determinant of the success of subsequent cell culture. However, cell concentration and viability are highly variable, even in samples of equivalent gestational age. We studied the effect of prescribed maternal position change or spontaneous fetal movement on the concentration, viability, and subsequent harvest time of amniotic fluid cells removed at genetic amniocentesis. Samples from 108 patients at 15 to 22 weeks' gestation were evaluated. We did not find a relationship between this type of maternal or fetal movement and the retrieval of amniotic fluid cells.     

Fetal cerebral maturation in hypertensive disorders of pregnancy

A retrospective search of the perinatal autopsy files at Magee-Womens Hospital of Pittsburgh from 1977 to 1979 disclosed 38 autopsies of preterm infants (gestational age 27 to 34 weeks) born to women with hypertensive disorders. Of these fetuses, 23 were chosen for the study of factors that lead to accelerated cerebral maturation in the preterm fetus. The sequential developmental changes of the individual fissures, sulci, and gyri of the cerebral hemispheres were used to assess gestational development of the brain. Seventeen infants showed accelerated cerebral maturation two weeks or more in advance of gestational age. Six infants showed gyral maturation appropriate for gestational age. Chronic maternal hypertension and fetal intrauterine growth retardation were found to be significant risk factors in accelerated intrauterine cerebral maturation. The chronicity of hypertension may be more important than its severity in accelerated fetal cerebral maturation.     

Comparison of fetal lung maturation in preterm singleton and twin pregnancies.

Preterm labor or premature rupture of membranes is one of the major complications of twin pregnancies and contributes to the increased maternal and perinatal morbidity and mortality. Forty-seven twin pregnancies and a comparable group of singleton pregnancies constitute the study population. These patients' pregnancies were complicated only by preterm labor. The lecithin to sphingomyelin ratio is used as an index of fetal lung maturation. Analysis of the data reveals that fetal lung maturation is biochemically comparable between twin and singleton pregnancies and among twins for a given gestational age in this clinical setting.