Essential fatty acids in pregnancies complicated by intrauterine growth retardation.

The relative fatty acid composition of lecithin was measured in maternal and cord blood serum in human pregnancies at risk for intrauterine growth retardation (IUGR) (n = 28) as compared to controls (n = 20). In the IUGR cases (n = 13) linoleic acid was lower in maternal samples but higher in cord blood, oleic acid was elevated in both whereas docosohexaenoic acid was lower. Essential fatty acid composition of lecithin was found to be different in IUGR.     

Fetal blood flow in pregnancies complicated by intrauterine growth retardation

A noninvasive pulsed Doppler ultrasound technique was used to characterize blood flow in the descending thoracic aorta and the intra-abdominal part of the umbilical vein in 159 fetuses suspected of intrauterine growth retardation (IUGR) on the basis of ultrasound fetometry. From this group, 74 infants with IUGR (defined as gestational age-related birth weight of 2 standard deviations [SD] or more below the population mean) were born. The blood flow results were not available to the clinicians managing the pregnancies. Blood flow mean velocity in the fetal aorta was lower, pulsatility index and rising slope higher, and umbilical volume flow and umbilical flow per 100 g placental tissue were lower in the pregnancies with IUGR than in 21 normal pregnancies. The waveform of the maximum aortic velocity envelope was related to operative delivery for fetal distress, Apgar score, and umbilical cord blood pH. The pulsatility index and the configurational assessment of the diastolic part of the waveform were combined to form a new concept, the blood flow class. The blood flow class was abnormal in 57% of the fetuses classified as having IUGR at birth and in 93% of those growth-retarded fetuses who subsequently developed signs of fetal distress requiring operative delivery. Waveform analysis, in terms of blood flow class, seems to be a useful tool in the surveillance of fetuses when IUGR is suspected. Abnormal blood flow class is a marker of fetal distress and probably gives an earlier indication than antenatal nonstressed cardiotocography. The results of this study point to a strong association between IUGR and impaired fetal blood flow. The aortic volume blood flow, unlike waveform analysis, does not seem to be a variable sensitive enough to predict fetal outcome in the individual pregnancy.     

Comparative analysis of the maternal and umbilical interleukin-8 levels in normal pregnancies and in pregnancies complicated by preeclampsia with intrauterine normal growth and intrauterine growth retardation.

OBJECTIVES: The aim of this study was to determine the maternal and umbilical cord serum levels of interleukin-8 (IL-8) in pregnancies complicated by preeclampsia with intrauterine normal growth and intrauterine growth retardation (IUGR), and in normotensive pregnancies. PATIENTS AND METHODS: The study was carried out on 15 patients with singleton pregnancies complicated by preeclampsia with appropriate for gestational age weight infants and 12 pregnant patients with preeclampsia complicated by IUGR. The control group consisted of 10 healthy normotensive delivering patients with singleton uncomplicated pregnancies. Maternal and umbilical serum IL-8 concentrations were estimated using the ELISA method. RESULTS: There were no statistically significant differences in patient profiles between the groups. Systolic and diastolic blood pressure and mean arterial blood pressure were higher in the study groups in comparison with the control group. Lower birth weight and lower gestational age at birth were observed in the group of patients with preeclampsia complicated by IUGR. Increased maternal and umbilical serum levels of IL-8 were found in both preeclamptic patient groups in comparison with the control group. The umbilical cord blood concentrations of IL-8 in all groups of patients tended to be higher in comparison with the maternal blood. CONCLUSIONS: It seems that these higher IL-8 concentrations may be associated with apoptosis, inflammation, neutrophil activation, endothelial cell damage and dysfunction, and increased endothelial permeability. They may also participate in an attempt to compensate for the imbalanced apoptosis and vascular resistance. Our findings suggest a possible significant role of IL-8 in the pathogenesis and sequelae of preeclampsia, especially in preeclamptic pregnancies complicated by IUGR.     

Comparative analysis of the maternal and umbilical interleukin-8 levels in normal pregnancies and in pregnancies complicated by preeclampsia with intrauterine normal growth and intrauterine growth retardation

Objectives.?The aim of this study was to determine the maternal and umbilical cord serum levels of interleukin-8 (IL-8) in pregnancies complicated by preeclampsia with intrauterine normal growth and intrauterine growth retardation (IUGR), and in normotensive pregnancies.

Patients and methods.?The study was carried out on 15 patients with singleton pregnancies complicated by preeclampsia with appropriate for gestational age weight infants and 12 pregnant patients with preeclampsia complicated by IUGR. The control group consisted of 10 healthy normotensive delivering patients with singleton uncomplicated pregnancies. Maternal and umbilical serum IL-8 concentrations were estimated using the ELISA method.

Results.?There were no statistically significant differences in patient profiles between the groups. Systolic and diastolic blood pressure and mean arterial blood pressure were higher in the study groups in comparison with the control group. Lower birth weight and lower gestational age at birth were observed in the group of patients with preeclampsia complicated by IUGR. Increased maternal and umbilical serum levels of IL-8 were found in both preeclamptic patient groups in comparison with the control group. The umbilical cord blood concentrations of IL-8 in all groups of patients tended to be higher in comparison with the maternal blood.

Conclusions.?It seems that these higher IL-8 concentrations may be associated with apoptosis, inflammation, neutrophil activation, endothelial cell damage and dysfunction, and increased endothelial permeability. They may also participate in an attempt to compensate for the imbalanced apoptosis and vascular resistance. Our findings suggest a possible significant role of IL-8 in the pathogenesis and sequelae of preeclampsia, especially in preeclamptic pregnancies complicated by IUGR.     

Lectin histochemistry in the human placenta of pregnancies complicated by intrauterine growth retardation based on absent or reversed diastolic flow

The oligosaccharide distribution of the glycoconjugates was investigated in placental tissue of pregnancies complicated by intrauterine growth retardation (IUGR) with absent or reversed flow in the umbilical artery (ARED), between the 29 and the 37 weeks of pregnancy. Placentae of a gestational age-matched group of normally grown pregnancies was also selected as control group. For this purpose a battery of seven HRP-conjugated lectins was used (DBA, SBA, PNA, ConA, WGA, LTA and UEA I). Our data showed that alpha-D-mannose (ConA), N-acetyl-D-glucosamine (WGA), beta-N-acetyl-D-galactosamine (SBA), alpha-L-fucose (LTA and UEA I) were present in less amount or were not present in the trophoblast and/or in the endothelial cells of the pathological group compared to the control one. The trophoblast basement membrane and/or basal plasma membrane of the pathological placentae were characterized by the presence of alpha-D-mannose (ConA), N-acetyl-D-glucosamine (WGA), sialic acid and D-galactose-(beta1-->3)-N-acetyl-D-galactosamine (neuraminidase-PNA), only in some tracts, in all the weeks of gestation. In the control placentae these sugar residues were present in the whole basement membrane and/or basal plasma membrane from 31 or 35 weeks. The Hofbauer cells of the pathological placental tissue showed a less amount or lack of alpha-D-mannose (ConA), beta-N-acetyl-D-galactosamine (SBA) and alpha-L-fucose (UEA I) compared to the control ones.These results suggest that a less amount or lack of some sugar residues may contribute to restricted placenta growth and development and thus reduced efficiency in maternal-fetal exchanges of gases and metabolites.     

Unstressed antepartum cardiotocography in the management of pregnancies complicated by intrauterine growth retardation

A study of antenatal cardiotocographs (CTG) in 250 patients with fetal growth retardation showed that nonreactive tracings were associated with a significant increase in operative deliveries for fetal distress in labour, a high perinatal mortality rate, and fetal anomalies, and a low Apgar score of the infant, both at one and five minutes after delivery. A "ten-point" scoring system was used to evaluate the CTG tracing. A score of 6 or less was associated with a significantly higher perinatal morbidity and mortality rate compared with those who had a score of 7 or more (p less than 0.01).     

Trophoblast apoptosis in human term placentas from pregnancies complicated with idiopathic intrauterine growth retardation

Objective.?To investigate proliferative, apoptotic, and antiapoptotic activity of placental trophoblast in pregnancies complicated with idiopathic intrauterine growth retardation (IUGR).

Methods.?Study group included data and placentas from 52 normal singleton term pregnancies with idiopathic IUGR. Records and placentas from 69 singleton pregnancies with normal fetal growth served as a control group. IUGR was defined by birth weight less than 10th percentile of standard values. Children with congenital malformations and those born with the signs of hypoxia, laboratory or clinical signs of preeclampsia or infection, children born to anemic mothers and those born from pregnancies with an increased coagulation system activity were excluded.

Results.?There was no statistically significant difference in the cytotrophoblast proliferation index value (Z?=?0.24; P?=?0.553), trophoblast expression of the Bcl-2 antiapoptotic factor (Z?=?0.47; P?=?0.634), and trophoblast apoptotic index (Z?=?0.51; P?=?0.613) between the idiopathic IUGR and control group.

Conclusion.?The proliferative and apoptotic events in the trophoblast of placentas with idiopathic IUGR did not differ from physiologic ones. Study results suggest the IUGR syndrome to have no uniform etiology or even underlying pathophysiology that would determine the possible fetal risk and subsequent long-term consequences for fetal health and life. This imposes the need of a more precise definition and unambiguous distinction between the idiopathic and other forms of IUGR.     

Maternal-fetal glucose gradient in normal pregnancies and in pregnancies complicated by alloimmunization and fetal growth retardation

Maternal and fetal glucose concentrations were measured simultaneously in 54 pregnancies in which fetal blood sampling was conducted between 18 and 34 weeks gestation. Twenty-five pregnancies were normal (group 1), 13 were complicated by fetomaternal alloimmunization (group 2), and 16 by intrauterine growth retardation (group 3). The maternal glucose concentration was similar in the three groups. The fetal glucose level was significantly lower in growth-retarded (mean = 2.7 mmol/L) than in normal pregnancies (mean = 3.5 mmol/L). There was a statistically significant gradient between maternal and fetal glucose concentrations in groups 1 and 3, but no gradient was found in group 2. Maternal and fetal glucose concentrations were significantly correlated in all groups, but the correlations were distinct. For a given maternal glucose concentration, fetal glucose was higher in patients with alloimmunization and lower in patients with intrauterine growth retardation than in normal pregnancies. In patients with intrauterine growth retardation, fetal PO2 correlated positively with fetal glucose and inversely with maternal fetal glucose gradient.     

The usefulness of color doppler placenta mapping in the prediction of the condition of neonate in pregnancies complicated by intrauterine growth retardation

OBJECTIVE: The aim of the study was to assess usefulness of placenta mapping as a screening method for early detection of the state of emergency of fetus and neonate in pregnancies complicated with intrauterine growth retardation (IUGR). MATERIALS AND METHODS: We investigated 48 pregnant women with intrauterine growth retardation detected by ultrasound screening. RESULTS: Color Doppler placenta mapping as a method of early detection of intrauterine growth retardation has sufficient sensitiveness and specificness. CONCLUSIONS: Changes arising in spiral arteries of the placenta cause vanishing of Color Doppler signal in the area of intervillous circulation. Lack of Doppler signal from spiral arteries correlates with bad condition of neonate after delivery.     

Coagulation and fibrinolysis in pregnancies complicated by fetal growth retardation.

Saline extracts were made from portions of 17 normal placentae and from 8 placentae from pregnancies complicated by fetal growth retardation, but not hypertension. The ability of these extracts to inhibit urokinase-induced fibrinolysis was measured using a fibrin plate technique. Placental extracts from pregnancies complicated by fetal growth retardation exhibited greater inhibition of urokinase-induced fibrinolysis. There was no evidence of disseminated intravascular coagulation in these patients, but certain coagulation factors in the peripheral blood were raised.     

Myeloperoxidase in the plasma and placenta of normal pregnant women and women with pregnancies complicated by preeclampsia and intrauterine growth restriction

Myeloperoxidase (MPO) is a heme protein produced and released by activated neutrophils and monocytes, and increased MPO is considered important in the pathophysiology of cardiovascular diseases (CVD). Accumulating evidence suggests that preeclampsia (PE), idiopathic intrauterine growth restriction (IUGR), and CVD share many similar metabolic disturbances, including an enhanced systemic inflammatory response and endothelial dysfunction. We hypothesized that MPO plays an important role in the development of PE and IUGR. Plasma samples were collected mid-gestation and at delivery from women with normal pregnancies (n?=?40) and those who subsequently developed PE (n?=?20), IUGR (n?=?11) or both (PE?+?IUGR, n?=?8). Placental samples were obtained immediately after delivery from 22 women with normal pregnancies, 19 women with PE, 14 women with IUGR, and 14 women with PE?+?IUGR. The MPO concentrations were measured using ELISA. Women with PE?+?IUGR had significantly higher plasma MPO before delivery than normal pregnant women. There was no difference in plasma levels at mid-gestation or the placental concentrations between women with normal pregnancies and those who developed PE, IUGR, or PE?+?IUGR. Using explants prepared from the placentas of 8 women with normal pregnancies and 8 women with PE, we found no difference in the levels of MPO in the tissue homogenates and culture media between these two groups of women. Together, these results indicate that increased maternal circulating MPO in women with PE?+?IUGR is likely a result of enhanced systemic inflammation caused by the established disease rather than a primary pathophysiological factor.     

Secretion of prolactin and insulin-like growth factor I by decidual explant cultures from pregnancies complicated by intrauterine growth retardation.

OBJECTIVES: Prolactin and insulin-like growth factor I secretion elsewhere in the uterus have been shown to decrease when tissue-specific growth is limited. We investigated their secretion by decidual explant cultures from pregnancies complicated by fetal intrauterine growth retardation. STUDY DESIGN: Explant cultures from 13 pregnancies complicated by intrauterine growth retardation and 12 control pregnancies were established in minimal essential medium and media was harvested after 24 hours of culture. Prolactin and insulin-like growth factor I concentrations were determined by radioimmunoassay. Total protein in the media was also measured. Data were analyzed by analyses of variance and linear regression. RESULTS: Decidual prolactin secretion in the pregnancies with intrauterine growth retardation was reduced to 109 +/- 31 ng/100 mg tissue per 24 hours compared with 254 +/- 51 ng in the controls (p = 0.01). Insulin-like growth factor I secretion was reduced to 1.9 +/- 0.6 ng/100 mg tissue per 24 hours from 7.1 +/- 0.9 ng/100 mg in the controls (p < 0.0001). Total protein secretion did not differ between the two groups. Decidual prolactin and insulin-like growth factor I secretion had a highly significant positive correlation (r = 0.71, p = 0.0001). CONCLUSIONS: Our data show that two protein hormones secreted by the maternal decidua are dramatically reduced in intrauterine growth retardation and warrant further investigation into their roles in the intrauterine environment.     

Doppler assessment of the fetal asphyxia in pregnancies complicated by gestational hypertension and intrauterine growth retardation

OBJECTIVES: Gestational hypertension is associated with a high morbidity for both mother and fetus. Doppler ultrasound has allowed the fetal circulation to be examined. Now it is possible to monitor the response of the fetal circulation to hypoxia. DESIGN: The aim of this study was to determine flow patterns in fetal circulation from pregnancies complicated by gestational hypertension and intrauterine growth restriction. MATERIALS AND METHODS: The investigation included 23 fetuses with signs of the gestational hypertension and intrauterine growth restriction. We evaluated cerebral-placental ratio (CPR) and pulsation index (PI) in the middle cerebral artery (MCA) and the umbilical artery (UA). We also evaluated flows in umbilical vein. RESULTS: We observed abnormal flow pattern in all cases of analyzing fetuses. The most common abnormal flow was vein pulsation (48%). CONCLUSIONS: All analyzing fetuses shown signs of the hypoxia. Present of the umbilical vein pulsation or decompensate of the brain sparing effect is closely related o increased perinatal mortality.     

Fetal growth in pregnancies complicated by placenta praevia]

Intrauterine growth of neonates born from 167 pregnancies complicated with placenta praevia has been analysed. Growth in 22,7% of the total neonates was retarded as compared to fetal age. About half of these newborns died (18 out of 38). The authors draw the attention prematures with retarded growth. The total perinatal mortality amounted to 25,7% (purified percentage: 23,5). The placental coefficient value was consistently higher than the values obtained in normal pregnancies. This may be explained with the disturbed function of the placenta owing to its abnormal adherence. The retarded growth of the fetus seems to play an important role in the still high perinatal mortality rate of neonates born from pregnancies complicated with placenta praevia.     

Changes in platelet function in pregnancies complicated by fetal growth retardation.

Platelet function was investigated in three patients with severely decreased fetal growth rates detected by ultrasound scanning. Only one patient had hypertension, which was mild and developed after decreased fetal growth and altered platelet responses had been detected. Much higher concentrations of platelet-activating factor (PAF) (20-500 nM) were required to stimulate maximal platelet aggregation in all three patients compared with the concentrations of PAF (5-10 nM) required in control pregnancies of similar gestational age. In a fourth patient, platelet desensitisation was observed 5 weeks before the detection of decreased fetal growth. These results are similar to those observed in women with hypertensive disorders of pregnancy, and indicate that there may be a similar change in platelet function in gestational hypertension and in fetal growth retardation, although the clinical manifestations are different.     

Useful of cerebral placental ratio in pregnancies complicated by intrauterine growth retardation and it correlation with perinatal outcome

OBJECTIVE: The aim of this study was to asses usefulness of cerebro-placental ratio in the estimation of the intrauterine fetal well being in pregnancies complicated by intrauterine growth retardation and prediction of perinatal outcome. MATERIAL AND METHODS: We investigated 22 pregnant women between 28th and 40th week of pregnancy with IUGR detected by ultrasound examination. 19 pregnant women between 28th and 41st week of pregnancy was control group. We measured parameters blood flow in umbilical arteries and in middle cerebral arteries in both groups. We calculated cerebro placental ratios(CPR, CPP). We divided pregnant women with IUGR int 2 groups depending on correct (CPR, CPP > 1.08) or incorrect (CPR, CPP < 1.08). In both groups we analyzed perinatal outcome. RESULTS: In group pregnancies complicated with IUGR cerebro-placental ratios (CPR and CPP) were statistically significant lower than in control group. (for CPR p < 0.015 and for CPP p < 0.033). Sensitivity of cerebro placental ratio in screening small gestational age fetuses was 59% and specificity 89%. Sensitivity of cerebro placental ratio in predicting adverse perinatal outcome was 85% and specificity was 82%. CONCLUSIONS: Statistically significant decrease of cerebro-placental ratios is observed in pregnancies complicated wit IUGR. Cerebro placental ratio is very useful tool for prediction of adverse perinatal outcome.     

Histomorphometric study of the placenta in intrauterine growth retardation

Histomorphometric study was made in 22 placentas of intrauterine growth retardation by measuring the proportion of the parenchyma to nonparenchymal tissue, villi components as well as their surface areas and also villi capillaries in the placentas. The results were compared with 20 placentas from the control patient with normal fetal weight. The ratios of parenchymal tissue, absolute villi component and surface area values, villi capillaries in the placentas of IUGR were significantly smaller than those in the control group. It shows that quantitative analysis of the morphometry might serve as an important tool to investigate the change of transference function occurring in IUGR placenta. We postulate that the development of IUGR is related to smaller functional structure in the placenta.