The nonpredictive value of fetal urinary electrolytes: preliminary report of outcomes and correlations with pathologic diagnosis

Fetal urine was sampled 12 times in nine fetuses with sonographically diagnosed urinary tract obstruction to assess renal function. By previously proposed criteria, four fetuses were predicted to have poor renal function. Two of these fetuses were found to have renal dysplasia on autopsy after elective termination. The other two died in the neonatal period but only one of these had histologic evidence of renal dysplasia. Five fetuses were predicted to have good renal function. Three of these developed renal failure after birth, one was found to have renal dysplasia on autopsy after elective termination, and one is alive and well. We conclude that fetal urine electrolytes are not necessarily an accurate predictor of neonatal renal function.     

五种不同止孕剂对小白鼠止孕演变过程的研究

本实验应用五种化学性质截然不同的止孕剂,揭示了小白鼠在妊娠各期药物止孕情况的变化过程。这个变化过程不因药物更改而改变,而是取决于小白鼠自身的止孕生理特性。小白鼠妊娠各期止孕变化过程可分为三个阶段。第一阶段,约在怀孕10天之内,药物杀死胚胎之后,胚胎无排出现象而留在子宫中吸收。第二阶段是在怀孕的第11—13天,在此期药物杀死胚胎后,胚胎仍留在子宫中被吸收,在胎仔死亡过程中,子宫有出血现象,个别的死胎在吸收过程中流出。第三阶段是在怀孕14天之后直至足月,各种流产剂的作用都导致活胎流产。这一止孕特点告诉我们在筛选计划生育药物时,若是为了观察药物杀死早期胚胎的效果,则应用怀孕10天之内的小白鼠;若是为了观察流产(排出)效果,则应用怀孕14天之后的小白鼠。而人的早期止孕是有排出特点的,所以用小白鼠筛选抗早孕药物时,既观察早期胚胎的杀死效果,同时也观察排出效果,这种筛选方法我们称谓“小白鼠比较止孕生理模型”筛选法。只有当观察到这两个指标的成功率都很高时,才可作进一步筛选。     

Application of the assays for progesterone and estradiol in saliva in family planning research]

A clinical study has been conducted on the radioimmuno assays of progesterone and estradiol in saliva to analyze the effect of norethindrone visiting pills and levonorgestrel post coital contraceptives on ovarian function and to monitor the resumption of ovarian function after the termination of early pregnancy using sulprostone. Two cases were recruited for the study of norethindrone, 5 cases for the study of levonorgestrel, and 4 cases for sulprostone. The studies showed that the levels of the 2 steroids in saliva were correlated with those observed in serum. The determination of the hormone level in saliva after termination of pregnancy using sulprostone provided information on the length of time between abortion and resumption of ovarian function. Analysis of hormones in saliva is a useful and convenient procedure in family planning research. Since the concentration of hormone in saliva is much lower than in serum, highly sensitive assays are needed, and more samples have to be collected due to the large variance of hormone levels in saliva.     

Rare manifestations of sirenomelia syndrome: a report of five cases

Five cases of sirenomelia presented with rare manifestations are discussed. Three neonates were born alive and died within 2 to 12 hours after birth. One case was the offspring of a triple in vitro fertilization pregnancy with history of early intrauterine death of one of the triplets. The main features included fusion of lower extremities (five of five), renal agenesis (three of five), polycystic renal dysplasia (two of five), anal atresia with large bowel hypoplasia (three of five), pulmonary hypoplasia (four of five), and single umbilical artery (five of five). Other features that have only rarely been associated with sirenomelia included concurrence of congenital heart disease and neuroblastoma, gallbladder agenesis, and upper extremity defects.     

Laparoscopic management of ovarian ectopic pregnancy misdiagnosed at elective surgical termination of pregnancy: a report of two cases and review of the literature

Although ectopic pregnancy diagnosed after elective termination of pregnancy is a very rare event, the incidence is increasing. The risk of mortality among women with ectopic pregnancy undergoing termination of pregnancy is 1.3 times higher than for women with ectopic pregnancy not undergoing a termination of pregnancy. Ovarian pregnancy is one of the rarest forms of ovarian pregnancy, sometimes difficult to diagnose as it can be confused with a tubal ectopic pregnancy or a haemorrhagic ovarian cyst. Early diagnosis of this rare entity is now possible owing to the developments in transvaginal ultrasound and availability of highly specific radioimmunoassay for the human chorionic gonadotrophin. Once the diagnosis has been made and surgical treatment planned, operative laparoscopy is a simple, safe and effective method of treating the majority of cases of ovarian ectopic pregnancy. We report two cases of ovarian ectopic pregnancy diagnosed following surgical termination of first trimester pregnancies and safely managed with operative laparoscopy. Our aim is to highlight the importance of proper ultrasonographic evaluation before termination of pregnancy and that ovarian ectopic pregnancy should be considered in the differential diagnosis of women presenting with abdominal pain after therapeutic termination of pregnancy.     

妊娠高血压综合征型肾病综合征79例临床分析

目的 :探讨妊高征型肾病综合征的临床特点及对母婴的影响。方法 :回顾分析广州市 5所医院 4年 79例妊高征型肾病综合征 (肾病组 )和 160例重度妊高征 (对照组 )的临床资料。结果 :妊高征型肾病综合征占分娩总数的 0 .19% ,占重度妊高征的14.0 1% ,肾病组发病孕周早。 2 4h尿蛋白、血浆白蛋白、腹水、肾功能受损、早产、小于胎龄儿、新生儿并发症 2组的差异均有高度显著性 (P <0 .0 1)。 2组之间最高收缩压、最高舒张压、病程差异无显著性 (P >0 .0 5 )。肾病组围产儿死亡率高于对照组 ,差异有显著性 (P<0 .0 5 )。结论 :妊高征型肾病综合征发病孕周早 ,母婴预后差 ,适时终止妊娠可减少妊娠期并发症及围产儿发病率和死亡率     

Successful pregnancy after renal transplantation in a patient with a urinary diversion.

A successful pregnancy is reported in a patient following renal transplantation and urinary diversion. The second half of pregnancy was complicated by hypertension, impaired renal function and obstruction of the ureter in the 35th wk. The latter complication required early termination of pregnancy by cesarean section. A healthy infant was delivered who survived without complications. Maternal renal function returned to pre-pregnancy levels following delivery.     

Discordance of fetal genotype or phenotype in monozygotic twins: a report of 2 cases

BACKGROUND: Discordance of fetal genotype or phenotype in a monozygotic twin pregnancy is rare. CASE: In case 1, a 28-year-old woman at 15 weeks' gestation was found to have a dichorionic twin pregnancy with 1 fetus affected with hydrop fetalis. The result of chromosomal study showed that the structurally normal fetus was 46,XY and that the hydropic fetus was 45,X. One week after selective termination of the hydropic fetus at 19 weeks' gestation, the cotwin died in utero. In case 2, a 30-year-old woman at 20 weeks' gestation, was found to have a monochorionic twin pregnancy with 1 fetus presenting with omphalocele. The result of chromosomal study showed that both fetuses were 46,XX. The fetus with omphalocele died in utero at 29 weeks' gestation, and the normal cotwin was delivered later due to fetal distress. Analysis by short tandem repeat markers in both cases indicated that they were monozygotic twins. CONCLUSION: These cases emphasize the importance of zygosity/chorionicity identification in twin pregnancy even though discordance of fetal genotype or phenotype was found. In monozygotic monochorionic twins, the normal cotwin is at risk for an adverse fetal outcome after 1 spontaneous intrauterine fetal death or selective termination. In monozygotic dichorionic twins, the risk of intrauterine fetal demise of the cotwin after selective termination still exists.     

Unusual Features of Serous Neoplasms of Low Malignant Potential during Pregnancy

Ten serous neoplasms of low malignant potential (LMP) resected during pregnancy were found in the files of the University of Texas M. D. Anderson Cancer Center (UTMDACC). Microscopically, all tumors had marked epithelial proliferation with abundant eosinophilic cells, and eight had intraluminal mucin. Multiple areas of microinvasion were found in eight cases. Additional unusual features were found in three cases. One patient presented with a serous LMP tumor in a supraclavicular lymph node. After resection of an ovarian serous LMP tumor, she was treated with chemotherapy and is without evidence of disease after 21 years. One patient had tumor resected at 24 weeks of gestation and at 2 months postpartum. Marked regression of the epithelial proliferation, the number of eosinophilic cells, and the amount of mucin was seen in the second specimen. Another patient had multiple peritoneal nodules at cesarean section, one of which was biopsied and diagnosed as a primary serous LMP of the peritoneum with multiple areas of microinvasion. Two months later a diagnostic laparoscopy was performed and no residual disease was found. All patients are alive with no evidence of disease. In summary, serous LMP tumors during pregnancy have microscopic and clinical features suggesting aggressive behavior; however, these features appear to regress at the termination of the pregnancy.     

Acute renal failure in hypertensive disorders of pregnancy. Pregnancy outcome and remote prognosis in thirty-one consecutive cases

The purpose of this study is to report short-term pregnancy outcome, subsequent pregnancy outcome, and remote prognosis (follow-up from 0.3 to 9.8 years) in 31 cases complicated by acute renal failure. Eighteen patients had "pure" preeclampsia and 12 patients (13 pregnancies) had chronic hypertension, parenchymal renal disease, or both before pregnancy. All patients had serial evaluation of renal function, urine microscopy, and electrolyte studies at the onset of acute renal failure and on follow-up. There were three immediate maternal deaths (two in the pure preeclampsia group and one in the other group). Nine patients (50%) in the "pure" group required dialysis during hospitalization and all 18 patients had acute tubular necrosis. Five patients (42%) in the other group required immediate dialysis and three patients had bilateral cortical necrosis. The majority of pregnancies in both groups were complicated by abruptio placentae and hemorrhage. All 16 surviving patients in the pure preeclampsia group had normal renal function on long-term follow-up (average 4.0 +/- 3.1 years). Conversely, nine of the 11 surviving patients in the second group required long-term dialysis on follow-up and four of them ultimately died of end-stage renal disease. We conclude that proper management of acute renal failure in patients with pure preeclampsia-eclampsia does not result in residual function impairment.     

A review on pregnancy after intestinal transplantation

The largest experience of pregnancy after solid organ transplantation is recorded in renal and liver recipients. Intestinal/multivisceral transplantation has shown steady improvements in graft and patient survival over the past 20 years and is rapidly becoming more established: the first pregnancy after this procedure was described 10 years ago, and so far eight cases of pregnancies with 100% successful live births have been reported worldwide. Specifically to this procedure, there are 2 factors to be considered in case of pregnancy: absorptive function of transplanted bowel and higher need of immune-suppressants. Close monitoring of renal function and of the graft by endoscopies and biopsies can be considered during the pregnancy to prevent episodes of rejection or enteritis, preserving the fetus by temporary malnutrition. As more intestinal transplant patients are surviving and regaining reproductive function, it is important to report this option to female recipients and to their health-care professionals.     

高龄孕妇合并妊娠期高血压疾病妊娠结局的临床分析

目的分析高龄孕妇合并妊娠期高血压疾病的临床特征,为改善其妊娠结局提供临床依据。 方法采用回顾性研究方法,收集和分析2018年1月至2018年12月在中山大学孙逸仙纪念医院住院分娩妊娠期高血压疾病71例患者的临床资料,其中年龄≥35周岁24例(高龄组),年龄<35周岁47例(对照组),比较两组患者发病孕周、入院孕周、分娩孕周、妊娠合并症或并发症、分娩孕周、新生儿出生体重、新生儿窒息、新生儿呼吸窘迫综合征发生情况;正态分布资料使用t检验,非正态分布资料,使用Mann-Whitney U法进行统计分析,计数资料采用χ²检验。 结果高龄组与对照组相比较,尿素(5.49±2.44)mmol/L vs (4.40±1.46)mmol/L, t＝－2.342)、入院孕周(34.86周vs 37.14周,t＝－2.095)、分娩孕周(36.07周vs 37.43周,t＝－2.564)、剖宫产率(70.83% vs 42.55%, χ²＝5.092)、顺产率(8.33% vs 46.81%, χ²＝10.510)、引产率(16.67% vs 2.13%, χ²＝5.130),差异有统计学意义(P<0.05)。两组新生儿体重(2 680 g vs 2 960 g, Z＝－1.876)、新生儿窒息率(8.33% vs 8.51%, χ²＝0.001)、新生儿呼吸窘迫综合征率(4.17% vs 14.89%, χ²＝0.913),差异无统计学意义(P>0.05)。 结论高龄患者合并妊娠期高血压疾病,与35岁以下孕妇发生妊娠期高血压疾病相比,临床特征为发病更早、肾脏功能损害更严重,终止妊娠孕周较早,早产率、剖宫产率升高,顺产率降低。对于高龄孕妇,应在妊娠过程中给予比普通孕妇更严密的母胎监测。     

Cystic adenomatoid malformation of the lung at the fetal stage. Ultrasonographic diagnosis and counseling]

BACKGROUND: The aim of this study was to report the series of cystic malformation of the lung (CAML) detected at the Center for Prenatal Diagnosis of the University of Naples Federico II and compare the data with the current literature. METHODS: In the period 1994-1997, ten cases of CAML have been detected at our unit. For each case, the following parameters were recorded: size of the cysts (according to the Stocker classification), side, presence of mediastinal shift, hydrops. For confirmation, necropsies and post natal files were sought. RESULTS: CAML was type I in 3 cases, type II in 3, and type III in 4 cases. mediastinal shift was present in 7 cases, hydrops in 2 and bilateral renal agenesis in 1. Seven cases underwent termination of pregnancy, 2 are currently alive and thriving after surgery and one pregnancy is ongoing at 36 weeks of gestation. The diagnosis was straightforward in all cases, and there were no problems of differential diagnosis. CONCLUSIONS: From an analysis of the data published in recent literature, it can be affirmed that hydrops but not mediastinal shift have negative prognostic significance. The abortion rate of 70% in our series, including 4 cases with a good prognosis, is somewhat frustrating. This figure underlines the need for a multidisciplinary counseling in which the pediatric surgeon, the psychologist and the sonographer may support the couple in overcoming the stress related to the acknowledgement of the lesion in order to reach the final decision about the outcome of the pregnancy.     

Trauma and grief 2-7 years after termination of pregnancy because of fetal anomalies--a pilot study

The aim of the study was to obtain information on the long-term posttraumatic stress response and grief several years after termination of pregnancy due to fetal malformation. We investigated 83 women who had undergone termination of pregnancy between 1995 and 1999 and compared them with 60 women 14 days after termination of pregnancy and 65 women after the spontaneous delivery of a full-term healthy child. Women 2-7 years after termination of pregnancy were expected to show a significantly lower degree of traumatic experience and grief than women 14 days after termination of pregnancy. Contrary to the hypothesis, however, the results showed no significant intergroup differences with respect to the degree of traumatic experience. With the exception of one subscale (fear of loss), this also applied to the grief reported by the women. However, both groups differed significantly in their posttraumatic stress response from women who had given spontaneous birth to a full-term healthy child. The results indicate that termination of pregnancy is to be seen as an emotionally traumatic major life event which leads to severe posttraumatic stress response and intense grief reactions that are still detectable some years later.     

Clinical studies of IgA nephropathy during pregnancy

We have obtained some new findings from the observation and management of 15 pregnancies and deliveries, all complicated with IgA nephropathy, which was diagnosed by open renal biopsy before each pregnancy. The classification of IgA nephropathy was from Grade I to Grade IV according to Nomoto et al. Clinical and pathological changes during each pregnancy were observed in the appearance and degree of edema, proteinuria and hypertension. The criteria were based on the classification of toxemia of pregnancy of the Committee for Toxemia of Pregnancy. Japan Society of Obstetrics and Gynecology. We referred to laboratory data such as complete blood counts, coagulation tests, blood chemistry tests, urinalysis and renal function tests. We also referred to Amagasaki's criteria which indicate whether the pregnancy and delivery will be normal or not. Three cases with Grade I IgA nephropathy all had normal courses. Nine cases with Grade II satisfied the criteria of Amagasaki for normal delivery, but during the third trimester, proteinuria was recognized in seven cases, edema in one case and hypertension in two cases. Three cases with Grade III were all met the criteria for abnormal pregnancy and delivery. Only one case showed proteinuria from the first trimester, but she had no obstetrical complications or deterioration of renal function during her course. There were 12 vaginal deliveries and three Cesarian sections. All infants were in good condition except for one intrauterine fetal death. In view of the above results, we concluded that patients with Grade II IgA nephropathy could not continue their pregnancies safety. However, some of the patients with Grade III had successful deliveries.(ABSTRACT TRUNCATED AT 250 WORDS)     

Renal disease in pregnancy

Women with kidney disease who become pregnant are at risk of further damage to their kidneys and an adverse pregnancy outcome. In general, women with mild renal dysfunction (Scr<125 μmol/litre) usually pass through pregnancy without adverse impact on their kidneys, although complications such as pre-eclampsia, fetal growth restriction and pre-term delivery are more likely. Women with severe renal impairment (Scr >220 mmol/litre) have a 1:3 risk of an accelerated decline in renal function because of pregnancy and pre-eclampsia, fetal growth restriction and pre-term delivery become common place. Clinical features such as pre-existing hypertension, proteinuria >1 g/24 hour and/or urinary tract infections add to the likelihood of complications. This article discusses important issues for women with kidney disease in pregnancy.     

The risk of complications of diagnostic and therapeutic cordocentesis

OBJECTIVES: Cordocentesis is one of the wide range of invasive diagnostic and therapeutic procedures used during pregnancy. Most common indications for is are suspicion of chromosomal abnormalities, Rh-immunisation or assessment of fetal renal function. Authors report the frequency of complications of this procedure as high as 1.5-5% with pregnancy loss rate up to 3%. DESIGN: The aim of our study was to determine the frequency of complications after cordocentesis. MATERIAL AND METHODS: We analyzed 145 pregnancies, during which 199 cordocentesis were performed. 124 of them were qualified as diagnostic with obtaining fetal blood (during 4 of them furosemidum was administered to the fetus), 22 diagnostic with furosemidum administration only and 53 therapeutic with blood transfusion (52) or pentaglobin administration (1). RESULTS: Complications of the cordocentesis were diagnosed in three cases--it was 1.5% of all of the procedures. Fetal bradycardia was reported in our material--in two cases it was isolated complication, in one case it appeared with retroplacental haematoma. In all three cases cesarean section was performed and alive babies were born. Data about the end of the pregnancy were obtained from 69 patients (47.5%). CONCLUSIONS: Cordocentesis in many case allows to establish proper diagnosis, make up decisions about treatment or termination of pregnancy and introduce management according to the needs and decisions of the patient. Complications are not very frequent and only in 1.5% were the reason of immediate caesarean section. Cordocentesis is safe and very useful tool of diagnosis in management of high risk pregnancies.     

Renal Histology and Pregnancy Performance in Systemic Lupus Erythematosus

Previous reports indicate that maternal and fetal outcome in pregnancies complicated by systemic lupus erythematosus (SLE) may be strongly influenced by the presence of renal disease. As the relationship between renal histology and clinical function in SLE is not consistent, prospective data on the outcones of such pregnancies would aid patient counselling. Fifteen women with SLE had 18 pregnancies subsequent to renal biopsies, performed from 3 months to 8 years prior to conception. Their renal function was evaluated before, during and after pregnancy. Fourteen of 15 patients had evidence of renal involvement, based on by light and electron microscopic sections: 7 had mesangial involvement (WHO Class II); 5 had active focal or diffues glomerulonephritis (Classes III and IV); two had membranous involvement (Class V); 1, no evident disease. Perinatal outcome was similar whether lesions were milder (8 continuing pregnancies, 4 term deliveries) or more severe (6 continuing pregnancies, 3 term deliveries). Clinical renal function was normal in all but 3 cases at the beginning of pregnancy; 2 additional patients experienced moderate deteriorations in renal function during pregnancy but recovered normal function in the puerperium. Fetal outcome was abnormal (3 premature deliveries, 1 neonatal death, 1 spontaneous abortion) in all cases where renal function was decreased, while 10 of 13 pregnancies in patients with normal renal function ended in term deliveries. The data suggest that currently preconceptual rena histology provides a less accurate basis for perinatal counselling than does the assessment of clinica renal function.     

Treatment of Severe Pre-Eclampsia by Plasma Exchange

Summary: Three women with pre-existing renal disease developed severe preeclampsia with renal failure during the midtrimester of pregnancy. Plasma exchange was commenced at 23, 26 and 29 weeks of gestation and continued, initially daily then second daily, until delivery at 32, 29 and 32 weeks, respectively. During this period, signs of pre-eclampsia regressed and renal function stabilised or improved. One baby with severe hyaline membrane disease died at 6 days; the other 2, now aged 7 months and 4 months, are in good health. Plasma exchange may offer an alternative to termination of pregnancy in the management of patients with severe pre-eclampsia when fetal maturity is insufficient for viability.     

Acute Renal Insufficiency in Pregnancy: A Review of Thirty Cases

A review of women with acute changes in renal function during pregnancy including cases with only mild or moderate azotemia was performed to determine the etiology, associated disorders and frequency of this problem in an inner-city population. A retrospective review of the clinical and laboratory data of all patients admitted to the Tulane Obstetric Service at Charity Hospital of New Orleans from 1985-1989 that contained a final diagnosis of hypertension, pre-eclampsia/eclampsia or renal disease was performed to determine if acute renal insufficiency or renal failure occurred during that admission. Renal disease was defined as a serum creatinine level of greater than or equal to 1.2 mg/dl with either a rising or falling level during the hospitalization. Thirty cases of either acute renal insufficiency or renal failure during pregnancy were identified with an incidence of one in 450 deliveries. Seventeen women had either pre-eclampsia or eclampsia. Their clinical and biochemical characteristics were reviewed and found to be similar to those of the 13 women who had other causes of acute renal dysfunction complicating their pregnancies. The mean serum creatinine for all patients in this series was 3.4 mg/dl (range: 1.2-16). Four patients required dialysis, two of whom never regained function. There were no cases of cortical necrosis. Most patients still had abnormal renal function at the time of discharge. There were 21 live births and 9 fetal deaths. Fetal death was more likely to occur with shorter gestation, higher serum creatinine, and lower platelet count. Even in cases with mild acute renal insufficiency complicating pregnancy, there was significant maternal morbidity and fetal mortality. Pre-eclampsia/eclampsia was the most common disorder associated with this problem in pregnancy. In an inner-city population, acute renal insufficiency and renal failure in pregnancy occur more frequently than previously reported; recognition of this problem is necessary to provide appropriate follow-up.