Three-dimensional sonographic measurement of normal fetal brain volume during the second half of pregnancy

OBJECTIVES: This study was undertaken to develop a three-dimensional (3D) ultrasound method of measuring fetal brain volume. STUDY DESIGN: Serial 3D sonographic measurements of fetal brain volume were made in 68 normal singleton pregnancies at 18 to 34 weeks of gestation. A comparison was made with fetal brain volume estimates from two-dimensional (2D) sonographic measurement of head circumference and published postmortem fetal brain weights. RESULTS: Coefficient of variation for fetal brain volume (3D) caused by differences between repeated tests was 10.2% and between analyses of the same recorded volume 2.2%. Median brain volume increases from 34 mL at 18 weeks to 316 mL at 34 weeks. Median brain weight represented approximately 15% of total fetal weight. The 3D ultrasound-derived brain weight is larger than postmortem brain weight. However, this is not so for brain weight derived from total fetal weight at autopsy. A good agreement between 3D and 2D brain volume was found. CONCLUSION: Sonographic measurement of fetal brain volume demonstrated an acceptable intraobserver variability and a nearly 10-fold increase during the second half of gestation.     

Use of enzyme replacement therapy for Gaucher disease during pregnancy

OBJECTIVE: To date there has been little published experience with enzyme replacement therapy in pregnant women with symptomatic type I Gaucher disease. STUDY DESIGN: We describe six patients, including three with repeated early pregnancy loss, five of whom successfully carried pregnancies to term; the last pregnancy was terminated because of pulmonary hypertension. RESULTS: All pregnancies were uneventful and five resulted in healthy newborns. CONCLUSION: We concluded that in patients with Gaucher disease of childbearing age,for whom obstetric complications are an important symptom of the disease, pregnancy is not contraindicated (unless there is evidence or suspicion of pulmonary hypertension) and treatment should not be interrupted because the clinical improvement engendered by enzyme replacement therapy is conducive to fewer complications during pregnancy and delivery and post partum.(Am J Obstet Gynecol 1997;177:12)     

In vivoP-MR spectroscopy in normal pregnancy,early and late preeclampsia: A study of placental metabolism

Introduction

Preeclampsia affects about 3% of pregnancies and the placenta is believed to play a major role in its pathophysiology. Lately, the role of the placenta has been hypothesised to be more pronounced in preeclampsia of early (<34 weeks) rather than late (≥34 weeks) onset. ³¹P Magnetic Resonance Spectroscopy (MRS) enables non-invasive, in vivo studies of placental metabolism. Our aim was to study placental energy and membrane metabolism in women with normal pregnancies and those with early and late onset preeclampsia.

Methods

The study population included fourteen women with preeclampsia (five with early onset and nine with late onset preeclampsia) and sixteen women with normal pregnancy (seven with early and nine with late pregnancy). All women underwent a ³¹P-MRS examination of the placenta.

Results

The phosphodiester (PDE) spectral intensity fraction of the total ³¹P signal and the phosphodiester/phosphomonoester (PDE/PME) spectral intensity ratio was higher in early onset preeclampsia than in early normal pregnancy (p = 0.03 and p = 0.02). In normal pregnancy the PDE spectral intensity fraction and the PDE/PME spectral intensity ratio increased with increasing gestational age (p = 0.006 and p = 0.001).

Discussion

Since PDE and PME are related to cell membrane degradation and formation, respectively, our findings indicate increased cell degradation and maybe also decreased cell proliferation in early onset preeclampsia compared to early normal pregnancy, and with increasing gestational age in normal pregnancy.

Conclusions

Our findings could be explained by increased apoptosis due to ischaemia in early onset preeclampsia and also increased apoptosis with increasing gestational age in normal pregnancy.     

Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation?

IntroductionEven though lifelong premature ejaculation (PE) is highly prevalent, few studies have investigated the neural mechanisms underlying PE.AimThis study aimed to investigate whether patients with lifelong PE exhibit macrostructural or microstructural alterations of the parts of the brain involved in the male sexual response.Materials and MethodsWe enrolled 42 healthy participants and 54 lifelong PE patients. Lifelong PE was diagnosed according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT). We compared measures of cortical morphology, such as volumes of gray matter, white matter, cerebellum volumes, and subcortical structures (ie, amygdala, caudate, hippocampus, globus pallidus, putamen, and thalamus) between the groups using a voxel-based morphometry method from whole-brain T1-weighted magnetic resonance imaging. Moreover, we evaluated the relationships between the relevant cerebral alterations and the severity of symptoms obtained from participants via self-reported questionnaires.Main Outcome MeasuresCerebral macrostructural and microstructural alterations were assessed in PE patients and controls, along with the correlation of caudate nucleus changes in PE patients with clinical data (including the PEDT and the IELT).ResultsThe mean volume of the caudate nucleus was significantly larger in the lifelong PE patients compared with healthy controls (P = .048). Moreover, caudate nucleus volume was positively correlated with PEDT score (r = 0.621; P = .0179) and negatively correlated with the IELT (r = ?0.592; P = .0101). However, cortex morphology and the other subcortical volumes were not significantly different between the 2 groups (P > .05).Clinical ImplicationsMicrostructural alterations in deep gray matter nuclei might be a useful parameter for studying the mechanism of the neurobiology underlying PE.Strengths and LimitationsThere are few studies examining microstructural changes in PE patients. This study furthers our understanding of the etiology of PE. Limitations include the small sample, which limits our ability to make an absolute determination as to whether such subcortical changes are the cause or the consequence of lifelong PE.ConclusionsWe found a significant difference in caudate nucleus volume between patients with PE and healthy controls. In addition, the caudate nucleus volume was positively associated with the severity of PE symptoms. More extensive and possibly longitudinal studies are needed to improve our understanding of the mechanism of the neurobiology underlying PE.Atalay HA, Sonkaya AR, Ozbir S, et al. Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation? J Sex Med 2019;16:992–998.     

Pregnancy in Gaucher disease

An 18-year old woman with type I Gaucher disease and two uncomplicated pregnancies is described. Although she experienced one miscarriage and pregnancy was associated with exaggeration of the clinical symptoms, leading to the diagnosis of the disorder, both her 2nd and 3rd pregnancies were uneventful and deterioration of her clinical situation was not observed. The issue of criteria for risk assessment in pregnancy of type I Gaucher disease patients is addressed.     

Diffusion and perfusion quantified by Magnetic Resonance Imaging are markers of human placenta development in normal pregnancy

PurposeTo investigate the potential of bi-exponential model of diffusion-weighted (DW) signal decay to quantify diffusion and perfusion changes in human placenta of normal pregnancies due to its development.Methods26 normal pregnancies at 19–37 weeks of gestation underwent Magnetic Resonance Imaging (MRI) examination at 1.5 T. DW Spin-Echo Echo Planar Imaging with diffusion gradients applied along 3 no-coplanar directions at seven different b-values (0,50,100,150,400,700,1000 s/mm²) was used.Apparent diffusion coefficient (ADC), pseudodiffusion (D*) and perfusion fraction (f) were extracted in selected placenta regions: umbilical (U-ROI), central (C-ROI) and peripheral (P-ROI). The relation between ADC, D*, f and mother age, gestational age (GA), Body-Mass Index (BMI), basal Glycaemia (bG), were evaluated. Pearson correlation with Bonferroni correction was used.ResultsA significant negative correlation was found between ADC and GA, for GA≥30w in P-ROI, while no-dependence of ADC on GA was observed in GA range 19–29 weeks. A positive linear correlation was found between f and GA in the C-ROI and between f and GA in P-ROI for GA≥30 week. No significant correlations were found between ADC, D*, f and age, BMI, bG.ConclusionADC measurements in P-ROI of normal placenta reflects tissue changes occurring in the third trimester of gestation. Specifically, ADC decreases with GA increase. Besides, f increases with the GA increase in the C-ROI and during the third trimester of pregnancy in the P-ROI.These results suggest the potential of diffusion and perfusion parameters extracted by using a biexponential model to provide information about placenta changes during its development.     

Obstetric aspects of Gaucher disease

The medical aspects of 21 pregnancies in 11 women with type I, non-neuronopathic Gaucher disease have been reviewed. One pregnancy ended in a spontaneous abortion at 12 weeks and two pregnancies in one patient resulted in two children with the Hurler syndrome which is unrelated to Gaucher disease. The other 18 pregnancies resulted in the birth of normal infants at full-term, four by caesarean section and the remainder by normal vaginal delivery. Only one patient experienced a significant exacerbation of her Gaucher disease during pregnancy. Fifteen of the pregnancies were associated with mild haematological complications but active intervention was necessary in only two instances. It can be concluded that there are few contraindications to pregnancy in women with Gaucher disease.     

Obstetric aspects of Gaucher disease

Summary. The medical aspects of 21 pregnancies in 11 women with type I, non-neuronopathic Gaucher disease have been reviewed. One pregnancy ended in a spontaneous abortion at 12 weeks and two pregnancies in one patient resulted in two children with the Hurler syndrome which is unrelated to Gaucher disease. The other 18 pregnancies resulted in the birth of normal infants at full-term, four by caesarean section and the remainder by normal vaginal delivery. Only one patient experienced a significant exacerbation of her Gaucher disease during pregnancy. Fifteen of the pregnancies were associated with mild haematological complications but active intervention was necessary in only two instances. It can be concluded that there are few contraindications to pregnancy in women with Gaucher disease.     

The management of epilepsy in pregnancy

While most women with epilepsy can expect a normal pregnancy outcome, epilepsy remains a significant contributor to both maternal and perinatal morbidity. Pre-pregnancy planning must address reliable contraception and optimisation of antiepileptic drug (AED) regimens to minimise teratogenic risk while maintaining seizure control. The most recent data from the AED registries regarding malformations is presented in this review, as is the limited data on the newer AEDs and studies linking neurocognitive outcomes to AED exposure. During pregnancy, important considerations include; therapeutic drug monitoring, surveillance for obstetric complications and vigilance for seizures during the intrapartum and postpartum period.     

The management of hypoparathyroidism in pregnancy

The management of hypoparathyroidism in pregnancy is reviewed, and previously reported cases are discussed. Two new cases are described. Hypoparathyroidism can be successfully managed in pregnancy. With adequate vitamin D supplementation throughout and elevation of calcium intake in the third trimester, this condition constitutes no threat to the mother or fetus.     

妊娠合并心脏病的筛查和管理

妊娠合并心脏病是目前导致孕产妇死亡的主要原因之一,因此在孕前和孕期保健期间,医务人员应严密关注孕产妇的心脏健康状况。对孕产妇严格地进行心脏病筛查并规范管理,对于降低心脏病孕产妇死亡率具有至关重要的作用。因为妊娠期和产褥期心脏病孕产妇的病理生理学特点,所以其与普通心脏病患者的血流动力学有明显的区别,筛查和管理也与一般的孕产妇和心脏病妇女不同,应强调预防在先和多学科合作的综合管理。     

Ultrasonographic patterns of fetal breathing movements in normal pregnancy

Objective: To assess through pregnancy fetal breathing movements (FBMs) patterns detected by M-mode and Doppler velocimetry technology. Methods: In this cross-sectional study FBMs were investigated in 1882 uncomplicated pregnancies over a 4-year period. Abdominal and thoracic wall movements of fetuses between 14 and 40 weeks of gestation were studied by M-Mode scan, and color Doppler velocimetry with spectral imaging analysis was used to investigate the presence of FBMs associated with nasal fluid flow velocity waveforms (NFFVWs). Results: Abdominal movements were observed in 19% of cases when gestation was less than 20 weeks and in 61% of cases when it was between 21 and 25 weeks; chest movements were significant after 21 weeks; and NFFVWs were detected at 22 weeks and increased progressively to 93% of cases at term. Conclusions: Fetal breathing movements are a complex phenomenon with a composite, progressive pattern of development during gestation.     

不同孕期终止妊娠对妊娠期糖尿病围生儿结局的影响

目的探讨不同孕期终止妊娠对妊娠期糖尿病(GDM)围生儿结局的影响。方法采用回顾性分析方法对2001年3月至2004年3月在中国医科大学附属第二医院确诊、住院分娩资料完整的GDM患者共191例的资料进行分析。结果GDM发生率为2.91%。母体并发症以妊娠期高血压疾病(48例,25.13%)为主。有23例(12.04%)未经治疗即终止妊娠,经过孕期单纯饮食控制或饮食控制加胰岛素治疗168例,其中血糖控制满意者78例(40.84%),血糖控制不满意者90例(47.12%)。剖宫产137例(71.73%),阴道自然分娩37例(19.37%),产钳助产11例(5.76%),穿颅术6例(3.14%)。血糖控制满意组中围生儿的患病率、死亡率和巨大儿的发生率均明显低于血糖控制不满意组及未经治疗组(P<0.01)。从孕36周开始即有巨大儿的发生,孕37～39周末终止妊娠除巨大儿外,新生儿并发症相对减少。结论控制血糖使血糖维持在正常水平是GDM治疗的关键,是降低母体并发症和减少围生儿患病率和死亡率的主要因素。孕37～39周是终止妊娠的适宜时机,但应注意有发生巨大儿的可能。