Benefits of placental biopsies for rapid karyotyping in the second and third trimesters (late chorionic villus sampling) in high-risk pregnancies

In a total of 301 placental biopsies in the second and third trimesters, 225 were performed because of suspicious ultrasonographic findings. In this group there was a high rate of aneuploidies (20%). As opposed to the alternative methods for rapid karyotyping, placental biopsies can easily be performed even in pregnancies with abnormal amounts of amniotic fluid. Oligohydramnios and polyhydramnios were key ultrasonographic findings in 38% of cases and were found to be associated with 22% of abnormal chromosomal findings. Suggestive ultrasonographic findings seem to justify the exclusive use of direct preparation.     

Placental biopsy for rapid fetal karyotyping in the second and third trimesters of pregnancy

Summary Rapid chromosomal analysis in the 2nd and 3rd trimester of gestation is desirable in cases of suspected or proven fetal malformation. The presence of any chromosomal aberration of the fetus influences the further prenatal and perinatal management of the pregnancy. Placental biopsy and preparation of trophoblast tissue after short term culture offers the possibility of getting satisfactory results within 2 to 3 days of biopsy. Fifty-seven patients underwent placental biopsy between the 16th and 36th weeks of gestation because of sonographically suspected or proven fetal malformation. In 51 of 57 cases fetal karyotyping was successful and no severe complications after biopsy were seen. Eight pathologic karyotypes were found. In 3 cases the chromosomal analysis yielded unsatisfactory results because of the inadequate quality of metaphases. In another 3 cases not enough chorionic tissue was aspirated in 2 biopsy attempts. In all other cases normal fetal karyotypes were found. Sonographically guided placental biopsy represents a simple method for fetal karyotyping and is a useful tool for the management of pregnancies with suspected or proven fetal malformation in the 2nd and 3rd trimester.     

Ultrasonography during the second and third trimesters

This second atlas of ultrasonography, devoted to the second and third trimesters of pregnancy, gives a better idea of the normal fetal anatomy and the most frequent variations.     

Transabdominal placental biopsy in the second and third trimester of pregnancy.

Transabdominal placental biopsy under ultrasound guidance was carried out in 260 cases in the second trimester and 50 cases in the third trimester of pregnancy. Placental tissue was aspirated using an 18 or 20 gauge needle. In a total of 310 placental biopsies in the second and third trimester, 100 were performed because of suspicious ultrasonographic findings. Placental biopsy is simple in the presence of severe oligohydramnios where fetal blood sampling is usually more difficult. Oligohydramnios and polyhydramnios were the ultrasonographic findings in 50% of cases and were found to be associated with 30% of abnormal chromosomal findings. There was one (0.3%) abortion within two weeks following placental biopsy. Placental biopsy did not affect the outcome of the pregnancy.     

Circulating levels of Elabela and Apelin in the second and third trimesters of pregnancies with gestational diabetes mellitus

Abstract

We design this study to detect levels of Elabela (ELA) and Apelin (APLN) in women with and without gestational diabetes mellitus (GDM) in the second and third trimesters, and to identify whether there is any association between ELA, APLN, and metabolic parameters. Seventy-nine GDM and 80 control subjects in the second trimester and 87 GDM and 88 healthy subjects in the third trimester were included. In the second trimester, lower ELA levels [(14.1 versus 16.9) ng/ml, p?=?.025] and higher APLN levels [(1021.8 versus 923.5) pg/ml, p?=?.046] were observed in GDM patients compared to controls. ELA levels were positively correlated with fasting plasma glucose (FPG) (r?=?0.423, p?<?.001) in the control group, and APLN levels were negatively correlated with triglycerides (TG) (r?=??0.251, p?=?.025) in the control group and total cholesterol (TC) (r?=??0.227, p?=?.044) in the GDM group. ELA appeared to be related to glucose metabolism and APLN is involved in lipid metabolism during pregnancy. The expression of ELA is significantly downregulated from the second trimester to the third trimester.     

Prenatal diagnosis by transabdominal chorionic villus sampling in the second and third trimesters

From October 1989 through December 1993, 124 pregnant women (114 in the second trimester and 10 in the third trimester) underwent transabdominal chorionic villus sampling (CVS) for prenatal molecular or cytogenetic diagnosis. The mean gestational age was 18.2 weeks. Indications for CVS comprised single gene disease (72%), fetal anomalies detected by ultrasound (17%), advanced maternal age (6%), and previous siblings with chromosomal aberration (5%). Among the 89 fetuses at risk for single gene disease, 20 were diagnosed as affected by DNA analysis. Among the 35 fetuses at risk for chromosomal anomaly, 4 had trisomy, 3 had a 45, XO karyotype and 2 had a structural chromosomal abnormality. The miscarriage rate was 1.8% (2/114) and the spontaneous preterm birth rate was 2.4% (3/124). No maternal or other fetal complications occurred. This study suggested that second- and third trimester CVS is a safe and useful method for prenatal diagnosis.     

中晚期妊娠胎盘植入患者的临床分析

目的 探讨中晚期妊娠发生胎盘植入的高危因素、诊断和治疗方法.方法 对北京协和医院1997年5月至2007年5月收治的中晚期妊娠发生胎盘植入的47例患者的临床资料进行回顾性分析.结果 (1)发生率:北京协和医院1997年5月至2007年5月的10年间,胎盘植入的总发生率为0.262%(47/17 918).(2)高危因素:有子宫手术史者占81%(38/47),本次妊娠合并前置胎盘者占30%(14/47),合并子宫肌瘤者占11%(5/47),有产后出血史者占11%(5/47).(3)诊断:47例胎盘植入患者中,发生在中孕期17例,其中产后B超确诊胎盘植入12例,临床确诊5例;发生在晚孕期30例,其中病理确诊8例,产后B超确诊2例,临床确诊20例.(4)治疗:中孕期患者刮宫术治疗有效率为43%(6/14),子宫动脉栓塞术治疗有效率为100%(11/11);晚孕期患者刮宫术治疗有效率为21%(6/29),宫腔纱布填塞术治疗有效率为87%(13/15),子宫动脉栓塞术治疗有效率为4/4.结论 胎盘植入发生的高危因素主要有子宫手术史,其次是前置胎盘、合并子宫肌瘤及产后出血史;胎盘植入的诊断以临床诊断为主,B超对产后诊断有重要价值;子宫动脉栓塞术是治疗胎盘植入的一种行之有效的方法.     

Blood chemistry of human fetuses in the second and third trimesters

Six biochemical parameters and four enzyme activities were determined from the serum of 76 healthy and 56 pathological human fetuses between the 20th and 38th week of pregnancy. In the normal fetuses studied within that period, creatinine, immunoglobulin M, lactate dehydrogenase, and gamma-glutamyltransferase increased; haemoglobin F and glucose progressively decreased; and alkaline phosphatase was at a peak around the 26th week; cholesterol and triglycerides were always low. The same parameters were also measured in some of the pathological fetuses and compared with their normal counterparts.     

妊娠中晚期合并重症急性呼吸综合征的临床分析

目的 探讨与分析妊娠中晚期合并重症急性呼吸综合征(SARS)患者的临床特点及母婴预后。方法 对我院2003年2月4日—3月17日收治的妊娠中晚期合并SARS5例患者的临床资料进行回顾性分析。结果 (1)5例妊娠中晚期合并SARS(其中双胎妊娠2例)患者均为初产妇,孕中期发病2例,孕晚期发病3例;院内感染3例,社区感染2例。(2)5例患者均有发热(5／5),其中高热3例、低热2例,畏寒或寒战3例,咳嗽4例。(3)外周血淋巴细胞减少2例,血小板减少2例,肝酶升高3例,低蛋白血症4例,X线胸片阴影5例。(4)5例患者经对症治疗均已痊愈出院。(5)剖宫产3例、阴道产1例,共分娩新生儿5例(包括双胎1例),新生儿随访至今无SARS感染。1例双胎妊娠患者,一胎宫内死亡,另一胎儿现在观察中,情况尚稳定。结论 妊娠中晚期合并SARS患者的母婴预后尚好,但应注意妊娠期特殊的生理变化与SARS的相互影响。重症者宜适当放宽剖宫产指征,对降低母婴死亡率十分重要。     

Imaging the fetal brain in the second and third trimesters using transvaginal sonography

High-frequency transvaginal probes were used at 20-40 weeks' gestation to develop a systematic examination of the fetal brain. Modeling the procedure after the standard neonatal neurosonographic examination, we attempted to obtain three coronal sections (anterior, midline, posterior) and two sagittal sections (midsagittal, right or left parasagittal). In 70 normal patients, all planes were imaged with a similar frequency (74-76%) except for the posterior coronal plane, which was imaged 59% of the time. Among the first 35 cases, 17% had a complete study, compared with 71% of the second 35 cases. Transvaginal sonography established or changed the diagnosis in five of the 13 cases with central nervous system or other abnormalities. We recommend that a complete fetal neurosonographic examination include transvaginal sonography to complement and enhance the transabdominal examination, especially for cases in which a fetal abnormality is suspected.     

Amniotic fluid beta-endorphin and beta-lipotropin concentrations during the second and third trimesters

Amniotic fluid beta-endorphin (beta-EP) and beta-lipotropin (beta-LPH) were measured by radioimmunoassay after silicic acid extraction and gel chromatographic separation of the two peptides in uncomplicated second-trimester and term pregnancies, in diabetic patients at term, and in pregnancies complicated by Rh-isoimmunization, premature labor, and intrauterine growth retardation. Furthermore, the lecithin/sphingomyelin (L/S) ratios as well as the dehydroepiandrosterone sulfate (DHEA-S) and cortisol levels were determined in most of the amniotic fluid specimens. Both the mean (+/- SE) beta-EP (65.3 +/- 9.1 fmol/ml) and beta-LPH (150 +/- 15.8 fmol/ml) concentrations were significantly higher in the 20 patients with normal pregnancies of 16 to 21 weeks' duration than those found in 21 patients with uncomplicated term pregnancies of 38 weeks' gestation, averaging 42.6 +/- 6.0 and 80.1 +/- 10.7 fmol/ml, respectively. The mean amniotic fluid beta-EP and beta-LPH concentrations measured in the latter subjects were similar to those observed in 23 diabetic patients with otherwise uncomplicated term pregnancies. The mean amniotic fluid beta-EP and beta-LPH levels found in the limited number of patients with Rh-isoimmunization (N = 9), premature labor (n = 8), and intrauterine growth retardation (n = 5) with pregnancies of 24 to 36, 24 to 36, and 34 to 38 weeks' gestation, respectively, were not significantly different from the mean amniotic fluid beta-EP and beta-LPH concentrations of uncomplicated term pregnancies. In all patients but those with Rh-isoimmunization, beta-EP concentrations exhibited a positive correlation with beta-LPH levels. However, the molar beta-LPH:beta-EP ratio was significantly lower at term than during the early second trimester. Neither beta-EP nor beta-LPH correlated with the amniotic fluid L/S ratio and only beta-LPH exhibited a significant inverse correlation with amniotic fluid DHEA-S. The latter was significantly higher in uncomplicated term than second-trimester pregnancies. These results confirm that immunoassayable beta-EP is present in amniotic fluid and declines toward term. These data demonstrate that immunoassayable beta-LPH is present in amniotic fluid and show a more pronounced decrease toward the end of pregnancy than beta-EP. Neither peptide, at least on account of the amniotic fluid levels, appears to be associated with fetal maturation. The physiologic significance of amniotic fluid beta-EP and beta-LPH and their possible role as markers of fetal response to stress remain to be elucidated.     

Sonographic detection of placenta accreta in the second and third trimesters of pregnancy

OBJECTIVE: The purpose of this study was to determine whether ultrasonography can detect placenta accreta reliably in at-risk patients. STUDY DESIGN: All patients with a previous cesarean delivery and an anterior placenta or placenta previa were evaluated prospectively at each visit for sonographic signs of placenta accreta (interruption of the posterior bladder wall-uterine interface, absence of the retroplacental clear zone, and placental lacunae). RESULTS: This evaluation involved 2002 patients over a 12-year period. Of the 14 patients with a confirmed diagnosis of placenta accreta who had ultrasound examinations between 15 and 20 weeks of gestation, the diagnosis was suspected strongly in 86% of the patients (12/14 patients). There were 18 false-positive cases (54.5%; 18/33 patients), most of which were due to a lack of visualization of the echolucent area between the placenta and the myometrium (obliteration of the 'clear space') during the third trimester. The presence of multiple linear irregular vascular spaces within the placenta (placental lacunae) was the diagnostic sign with the highest positive predictive value for placenta accreta. CONCLUSION: Placenta accreta can be detected as early as 15 to 20 weeks of gestation in most at-risk patients by visualization of irregular vascular spaces within the placenta (placental lacunae). Obliteration of the retroplacental 'clear space' is not a reliable diagnostic sign for placenta accreta.     

Rapid karyotyping for prenatal diagnosis in the second and third trimesters of pregnancy

Direct chromosome preparations were performed on placental villi obtained by ultrasound-guided needle aspiration between 18 and 37 weeks of pregnancy in 53 patients. The sampling yielded a sufficient amount of tissue with a maximum of two, and in most cases one, insertions. Placental biopsy is easily performed in cases of severe oligohydrammnios, where fetal blood sampling is usually more difficult. Direct karyotyping of placental villi is faster than chromosome analysis from fetal blood or application of the pipette method on amniotic fluid cells, and currently represents the most rapid approach to prenatal diagnosis of chromosomal abnormalities from the first to the third trimester of pregnancy.     

Effects of supine exercise on fetal heart rate in the second and third trimesters

The effects of a brief period of supine exercise on fetal heart rate (FHR) was studied in 25 healthy, regularly exercising women, 12 in the late second trimester and 13 in the mid third trimester. Although statistically significant increases in maternal mean arterial pressure and pulse occurred, the exercise intensity was mild, with the average percent maximal pulse being 46 +/- 5% and 49 +/- 5% in the second and third trimester groups, respectively. Small increases in FHR were seen in both groups, which were insignificant statistically and physiologically. No patient experienced significant FHR abnormalities as a result of the supine exercise sequence. The findings suggest that pregnant women may continue submaximal supine exercise of short duration into the mid to late third trimester.     

Effects of preinduction by mifepristone on therapeutic abortions of the second and third trimesters induced by intravenous sulprostone]

The authors investigate the effects of preinduction by administering 600 mg of mifepristone (RU486) per os before medical termination of pregnancy during the third to ninth months of pregnancy by intravenous sulprostone (Nalador). The study included a population of 35 patients treated with RU486 and then Nalador versus a population of 38 patients treated with Nalador only. The characteristics of the two groups did not show any statistically significant differences (medical, surgical and obstetric difference, indication for termination). The gestational age was lower in the RU486-Nalador group (group mean age : 20.9 weeks of amenorrhea versus 23.3, p less than 0.01). The group receiving RU486 significantly demonstrated the following : reduced time for induction of labour to modifications of the cervix (7.2 h versus 10.9 h, p less than 0.05), a higher number of rapid expulsions (within 10 h in 37.1% versus 15.7%, p less than 0.05) and a reduction of side effects (45.7% versus 71.05%, p less than 0.05). The other parameters analysed (duration of termination, total dose of prostaglandin) appeared to be better with RU486, but the values were not significantly different.