Fetal therapy最新文献

The authors analyzed the correlations between the presence of anti-HLA antibodies and fetal neonatal problems. There are specific data in the literature on the protective effect of anti-HLA antibodies against abortion. Nevertheless our study shows a significant correlation between their presence and perinatal problems.

In 36 fetuses with congenital diaphragmatic hernia (CDH) diagnosed at 18-36 weeks' gestation, detailed ultrasound examination was performed for the detection of associated malformations and assessment of the likelihood of pulmonary hypoplasia. In all cases karyotyping was undertaken in blood samples obtained by cordocentesis. In 11 (31%) fetuses there were lethal chromosomal abnormalities and in 6 (17%) of the chromosomally normal fetuses there were additional lethal malformations. Of the 17 fetuses with isolated CDH and where the pregnancy was not electively terminated. 9 (60%) survived and 6 (40%) died in the neonatal period due to pulmonary hypoplasia. The presence or absence of polyhydramnios, fetal breathing movements, mediastinal shift and thoracic position of the stomach were not useful in predicting postnatal outcome.

In 402 cases with prenatally diagnosed nonimmune hydrops fetalis, cardiovascular diseases were present in 18%, chromosomal disorders in 11%, and hematologic disorders of the fetus in 10%. In the last 3 years, fetal blood sampling has become a very important part of the differential diagnosis of nonimmune hydrops (chromosomal, hematologic and metabolic disorders, intrauterine infection). Also, transabdominal placental biopsy has been used for rapid karyotyping. A detailed fetal echocardiogram is absolutely necessary in all cases of nonimmune hydrops, in particular spectral and color Doppler flow mapping. Thus, congenital heart diseases can be accurately diagnosed. Further, in other causes of hydrops regurgitation of atrioventricular valves may be present in advanced stage. New important methods of intrauterine therapy are in particular: intravascular blood substitution in anemia, and the intravascular application of antiarrhythmic drugs in tachyarrhythmia. The overall survival rate was 19.4% (78 of 402); 4.0% (6 of 149) before 24 weeks of gestation, and 28.5% (72 of 253) after this age of gestation. The majority of survivors were in the tachyarrhythmia, hematologic disorder, isolated ascites and hydro-/chylothorax groups (53 of 78 survivors, 68%). In the other groups, the survival rate was generally low.

Reference ranges for the various components of fetal heart rate (FHR) patterns with gestation were established from the study of 119 fetuses at 20-39 weeks. These fetuses were proved by cordocentesis to be normoxaemic and nonanaemic. The mean baseline FHR decreased, while the baseline variability, both for amplitude and oscillation frequency, increased with gestation. The number and amplitude of accelerations increased, and the frequency and duration of decelerations decreased with gestation. These data indicate that in the interpretation of FHR patterns adjustments according to the gestational age of the fetus should be made.

There is presently no information concerning the ontogeny and control of arginine vasopressin (AVP) in the human fetus. AVP was measured in 22 nonanemic control fetuses and 7 fetuses with hemolytic anemia undergoing 13 intravascular transfusions. Each transfused fetus received pancuronium (0.3 mg/kg) and furosemide (2 mg/kg). Compared to the control group of nonanemic fetuses with hemolytic disease, AVP was significantly lower in the anemic fetus prior to transfusion (2.6 +/- 0.4 microU/ml versus 10.4 +/- 4.1 microU/ml, p less than 0.05). This suggests that hemolytic anemia is associated with a relative increase in fetal intravascular volume. Intravascular transfusion was associated with a significant increase in AVP (p less than 0.05). These findings could not be explained by changes in either blood pressure, plasma osmolality, or fetal oxygenation.

Models to predict normal fetal growth have been of limited accuracy. Abnormal growth is even more problematic. We have developed a mathematical modeling system based on observed body and brain weights to study fetal growth patterns in midgestational trisomy 18 fetuses. Third-degree polynomial-based analysis using observed fetal body and brain weights to generate predicted weights for various organ systems allows for the comparative study of growth patterns at various fetal weights and gestational ages. Our data suggest that what has been previously called symmetrical intrauterine growth retardation associated with aneuploid fetuses is really an asymmetrical pattern that is dynamic in nature and may change through the course of pregnancy.

This paper discusses the development of the immune system from early gestation throughout postnatal development. The major aspects of immunoregulation and immunocompetence are reviewed. The mechanism(s) of immunologic tolerance, graft rejection reactions, mixed lymphocyte reactions, allogeneic bone marrow transplantation and graft versus host disease are described.