Late gestation fetal magnetic resonance imaging-derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia

Purpose

Magnetic resonance imaging (MRI) has been used as an imaging modality to assess pulmonary hypoplasia in congenital diaphragmatic hernias (CDHs). The objective of this study was to determine if there is a correlation between late gestational fetal MRI-derived total lung volumes (TLVs) and CDH outcomes.

Methods

From 2006 to 2009, 44 patients met criteria of an isolated CDH with a late gestational MRI evaluation. The prenatal TLV (in milliliters) was obtained between 32 and 34 weeks gestation. The measured study outcomes included survival, need for extracorporeal membrane oxygenation (ECMO), and length of stay.

Results

There were 39 left and 5 right CDH patients. The average TLV was significantly lower for nonsurvivors (P = .01), and there was a significant association between lower TLV and the need for ECMO (P = .0001). When stratified by TLV, patients with a TLV of greater than 40 mL had a 90% survival vs 35% survival for a TLV of less than 20 mL. Furthermore, patients with a TLV greater than 40 mL had a lower rate of ECMO use (10%) than patients with a TLV of less than 20 mL (86%). Shorter length of stay was found to correlate with increasing TLV (P = .022).

Conclusion

Late gestation fetal MRI-derived TLV significantly correlates with postnatal survival and need for ECMO. Fetal MRI may be useful for the evaluation of patients who present late in gestation with a CDH.     

Tumor volume to fetal weight ratio as an early prognostic classification for fetal sacrococcygeal teratoma

Purpose

This study was designed to develop a prognostic factor for fetuses with sacrococcygeal teratoma (SCT) that may be useful to predict outcome and guide counseling early in pregnancy. We hypothesize that, in fetuses with SCT, the ratio of tumor size to estimated fetal weight in the second trimester predicts outcome.

Methods

We retrospectively reviewed charts of all patients evaluated at our Fetal Center for SCT between 2004 and 2009. Estimated fetal weight and tumor volume were calculated based on prenatal ultrasound or fetal magnetic resonance imaging. Patients were stratified based on tumor volume to fetal weight ratio (TFR), and their outcomes were analyzed by Fisher's Exact test.

Results

Tumor volume to fetal weight ratio before 24 weeks' gestation was predictive of outcome. Those with a TFR less than or equal to 0.12 (n = 5) had a significantly better outcome than patients with a TFR greater than 0.12 (n = 5, P < .05). All patients with poor outcomes had a TFR greater than 0.12 by 24 weeks' gestation. A TFR greater than 0.12 predicted poor outcome with 100% sensitivity and 83% specificity. All 4 patients who developed hydrops had a TFR greater than 0.12.

Conclusion

In our series of fetuses with SCT, TFR before 24 weeks' gestation correlates with outcome. This novel, prenatal diagnostic tool may be useful in prenatal counseling and for early identification of high-risk fetuses.     

Apelin/APJ在胎儿生长受限胎盘组织中的表达及其临床意义

目的检测Apelin/APJ在胎儿生长受限(FGR)患者与正常孕妇胎盘组织中的表达差异。方法选取FGR患者20例(研究组),正常妊娠妇女20例(对照组),分娩时收集其胎盘组织,通过免疫组化方法检测各组胎盘组织中Apelin/APJ的表达水平;比较两组新生儿出生体重。结果 Apelin/APJ在FGR患者的胎盘组织中表达显著降低,与新生儿出生体重呈正相关。结论 Apelin/APJ的表达异常可能参与了FGR的发生和病理生理过程。     

Zinc restriction during different periods of life: influence in renal and cardiovascular diseases

Micronutrient undernutrition during critical periods of growth has become an important health issue in developing and developed countries, particularly among pregnant women and children having an imbalanced diet. Zinc is a widely studied microelement in infant feeding because it is a component of several enzymes involved in intermediary metabolism ranging from growth to cell differentiation and metabolism of proteins, carbohydrates, and lipids.Human and experimental studies have reported an association between zinc deficiency and the etiopathogenesis of cardiovascular and renal diseases like hypertension, atherosclerosis, congestive heart failure, coronary heart disease, and diabetes. The main links between the development of these pathologies and zinc deficiency are multiple mechanisms involving oxidative stress damage, apoptosis, and inflammation.A substantial body of evidence suggests that a poor in utero environment elicited by maternal dietary or placental insufficiency may “programme” susceptibility in the fetus to later development of cardiovascular, renal, metabolic, and endocrine diseases. Zinc deficiency in rats during intrauterine and postnatal growth can also be considered a model of fetal programming of cardiovascular and renal diseases in adult life. Dietary zinc restriction during fetal life, lactation, and/or postweaning induces an increase in arterial blood pressure and impairs renal function in adult life.This review focuses on the contributions of experimental and clinical studies to current knowledge of the physiologic role of zinc in the cardiovascular and renal systems. Moreover, this review examines the relationship between zinc deficiency during different periods of life and the development of cardiovascular and renal diseases in adult life.     

胎儿肢体畸形的产前超声诊断

目的探讨胎儿肢体畸形的产前二维及三维超声特征,评价二维、三维超声诊断胎儿肢体畸形的价值。方法对行常规产前超声检查者,主要运用二维超声采用连续顺序追踪超声法逐一检查,必要时进行三维及四维超声检查,记录全部畸形胎儿,将产前超声诊断结果与引产或产后结果对照。结果产前超声共检出129例胎儿肢体畸形,其中上肢畸形54例,下肢畸形75例,共分为10类,涉及肢体258处。以足内、外翻、对称性四肢短小、畸形手等最为常见。与引产后或产后结果比较,超声漏诊了3例畸形手,1例少指,1例足内翻,其余产前超声诊断均得到证实。结论胎儿肢体畸形有典型的超声图像特征,目前超声检查已成为产前诊断的常规的、重要的、不可替代的首选方法,且可多次重复,动态观察病变的变化,及时做出诊断为临床治疗方法的选择提供重要的依据,对产前诊断具有重要的临床意义。     

人类微小病毒B19感染的最新进展

人类微小病毒B19主要侵袭人体骨髓造血系统,损害人体多种脏器,是儿科出疹性疾病——传染性红斑的病原。还可使慢性溶血患者发生再障危象、关节病、血管性紫癜和雷诺肢端综合征等。在免疫缺陷患者,可造成持续感染。妊娠期受到病毒侵害,引发宫内感染,可导致流产、胎儿水肿和死胎。此外,还与多种造血系统异常(中性粒细胞减少症和血小板减少症等)有关。     

妊娠期高血压疾病孕妇血液流变学与胎儿血流动力学的相关性分析

目的分析妊娠期高血压疾病孕妇血液流变学与胎儿血流动力学的相关性。方法检测妊娠高血压疾病孕妇全血及血浆黏度,包括全血比黏度高切（BVH）、全血比黏度低切（BVL）、血浆黏度（PV）、红细胞压积（HCT）;应用彩色多普勒监测胎儿脐动脉（UMA）、大脑中动脉（MCA）血流指标。结果重度妊娠期高血压各值明显大于轻度妊娠期高血压;妊娠期高血压孕妇血液流变学各值与胎儿脐动脉血流阻力指标各值呈正相关,与大脑中动脉血流阻力指标各值呈负相关。当孕妇血液流变学各值增高达到以下指标：BVH≥4.63、BVL≥6.23、PV≥1.68、HCT≥0.36时可预测妊娠高血压的发生;当胎儿UMA血流S/D〉3、PI〉1.7、RI〉0.6时,MCA血流S/D≤4、P I≤1.6、R I≤0.6时,可预测胎儿缺氧。结论妊娠期高血压疾病孕妇血液流变学变化与胎儿血流动力学指标相关性分析,可为预测妊娠期高血压的严重程度提供有益的信息。     

不同分娩方式对足月胎儿生长受限孕妇妊娠结局的影响

目的:通过比较不同分娩方式对胎儿生长受限(FGR)孕妇妊娠结局的影响,为胎儿生长受限孕妇选择合适的分娩方式。方法:将2006～2008年在郑州大学第三附属医院分娩的145例足月FGR孕妇作为研究对象,比较不同分娩方式新生儿不良妊娠结局(窒息或羊水污染发生)的比例;比较不同指征行剖宫产的FGR孕妇不良妊娠结局发生比例;比较发生不良妊娠结局组及妊娠结局正常组新生儿的体重。结果:①剖宫产组较阴道分娩组新生儿不良结局的发生率低,但差异没有统计学意义。②以羊水过少或胎窘为指征的FGR孕妇新生儿不良妊娠结局发生率高。③不良妊娠结局组新生儿体重更低。结论:影响生长受限胎儿预后的主要是新生儿的出生体重而不是分娩方式,伴有羊水过少或是疑诊胎窘的FGR病例选择性的剖宫产相对安全。     

胰岛素样生长因子-1、2与胎儿生长受限的相关性

目的:探讨胰岛素生长因子-1(IGF-1)、胰岛素生长因子-2(IGF-2)与胎儿生长受限(FGR)的相关性。方法:采用放射免疫分析法测定12例FGR孕妇(实验组)和24例正常晚期妊娠妇女(对照组)脐血中的IGF-1、IGF-2水平。结果:实验组IGF-1水平为(15.68±6.76)μg/L,明显低于对照组(45.19±11.25)μg/L,二者比较差异有统计学意义(P<0.01);实验组IGF-2水平为(1.52±0.20)μg/L,明显低于对照组(1.97±0.21)μg/L,二者比较差异有统计学意义(P<0.05)。结论:妊娠晚期IGF-1、IGF-2水平降低是导致FGR发生的原因之一。