Occurrence of onchocerciasis in subjects coming from non-endemic areas and migrating to a hyperendemic area

The diurnal change in baseline fetal heart rate (FHR) of four anencephalic fetuses at 20, 23, 24 and 30 weeks of gestation were examined. The mean baseline FHR in 00.00-06.00 h, 06.00-12.00 h, 12.00-18.00 h and 18.00-24.00 h were compared by one-factor ANOVA and Scheffe's test in each case. The diurnal variations in baseline FHR were recognized in all subjects (P < 0.01). In 3/4 subjects, the lowest values were at 00.00-06.00 h. The diurnal variation in baseline FHR might be caused by maternal factors because it was present even in the anencephalic fetuses that had no central nervous system having the oscillators of the circadian rhythm.     

Fetal heart rate characteristics at 25 to 28 weeks' gestation

The objective of this article is to define normative fetal heart rate (FHR) tracing characteristics between 25-28 weeks' gestation in a low-risk population with normal pregnancy outcomes and to determine which criteria best determine FHR reactivity. Continuous FHR tracings were reviewed from 188 low-risk women participating in a trial of the Mammary Stimulation Test (MST) at 25-28 weeks' gestation. A reactive tracing required the presence of > or =two accelerations in 20 min. Different acceleration criteria were evaluated based upon the width of the acceleration (short vs. long) and the amplitude of the acceleration (10 vs. 15 bpm). Seventy-one percent of the FHR tracings were reactive using the higher amplitude (15 bpm), short criteria. This number increased significantly to 92% when the lower amplitude (10 bpm), short criteria were used (p <0.01). As gestational age advanced, there was a trend toward increased reactivity irrespective of which criteria were used, but these differences were not significant. Reducing the acceleration amplitude criteria to 10 bpm in preterm pregnancies will maximize the number of reactive nonstress tests. This is advantageous because it would improve test specificity and decrease the false-positive rate. Our findings need to be prospectively validated in a high-risk population.     

Fetal Neurobehavioral Development: A Tale of Two Cities.

Longitudinal neurobehavioral development was examined in 237 fetuses of low-risk pregnancies from 2 distinct populations-Baltimore, Maryland, and Lima. Peru-at 20. 24. 28. 32, 36. and 38 weeks gestation. Data were based on digitized Doppler-based fetal heart rate (FHR) and fetal movement (FM). In both groups. FHR declined while variability, episodic accelerations, and FM-FHR coupling increased, with discontinuities evident between 28 and 32 weeks gestation. Fetuses in Lima had higher FHR and lower variability, accelerations, and FM-FHR coupling. Declines in trajectories were typically observed 1 month sooner in Lima, which magnified these disparities. Motor activity differences were less consistent. No sex differences in fetal neurobehaviors were detected. It is concluded that population factors can influence the developmental niche of the fetus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Doppler study of the fetal cardiac function in prolonged pregnancies

OBJECTIVE: To evaluate the association between fetal cardiac function and amniotic fluid index (AFI) in postterm fetuses, and to determine if changes in fetal cardiac function precede the occurrence of nonreassuring intrapartum fetal heart rate (FHR) patterns. METHODS: Forty-five otherwise low-risk pregnant women between 41 and 43 weeks' gestation were studied longitudinally. Gestational age was confirmed in all patients by ultrasound before 20 weeks' gestation. Each subject had two or three tests performed every 3-4 days, including a non-stress test, a biophysical profile, and Doppler studies of the aortic and pulmonic outflow tracts. Aortic and pulmonic artery flow velocity waveforms were recorded slightly distal to the valves. Peak velocity, velocity time integral, and heart rate were calculated from the flow velocity waveforms we obtained. The change in AFI and aortic and pulmonic peak velocity and [velocity time integral] x [heart rate] were calculated for each fetus. RESULTS: Labor was induced at 42 weeks' gestation in 20 patients, and 17 entered labor spontaneously. Changes in AFI, observed during the follow-up period, correlated significantly with changes in aortic peak velocity (r = 0.54, P < .01) and with aortic outflow [velocity time integral] x [heart rate] (r = 0.60, P < .001) but not with pulmonic peak velocity and [velocity time integral] x [heart rate]. The decrease in aortic peak velocity and aortic and pulmonic [velocity time integral] x [heart rate] was significantly higher (P < .01) in eight fetuses that developed a nonreassuring intrapartum FHR (reduced FHR variability, late decelerations, and severe variable decelerations) than in those who had an uneventful labor. CONCLUSION: In prolonged pregnancies, cardiac function deteriorates in fetuses that develop a nonreassuring intrapartum FHR, and the changes in the left cardiac function correlate with changes in AFI.     

Sampling in social gerontology: a method of locating specialized populations

This study reviews 27 patients with positive OCTs who were subsequently allowed a trial of directly monitored labor. Of these, 19 patients (70%) developed FHR signs of fetal distress and 8 (30%) tolerated labor without late decelerations. These patients were evaluated for signs of fetal reactivity (acceleration of the FHR associated with fetal movement of contractions) during the OCT. Those with a reactive pattern during the OCT (15 patients) uniformly had a good fetal outcome (unless there was birth trauma or premature delivery), but 8 of these 15 patients showed fetal distress during monitored labor. If the positive OCT was associated with a nonreactive baseline FHR recording, a trial of labor uniformly resulted in FHR signs of fetal distress. It is therefore concluded that a patient with a nonreactive positive OCT is unlikely to tolerate subsequent labor without fetal distress.     

Plasma exchange in myasthenia gravis

OBJECTIVE: To evaluate whether fetal heart rate (FHR) patterns obtained in nonstress testing within 24 hours of delivery in patients with preterm delivery were associated with histologic acute infection, and if so, whether the associations are with maternal as opposed to fetal acute inflammation (acute amnionitis versus acute umbilical vasculitis). METHODS: The data set included 351 consecutive patients delivering from 22 to 32 weeks' gestation (excluding cases of preeclampsia; nonhypertensive abruption; stillbirth; fetal structural and karyotypic anomalies; Rh isoimmunization and hydrops fetalis; and maternal diabetes and hypertension). Severe variable decelerations were defined as FHR < 70 beats per minute lasting > 60 seconds, and decreased fetal heart variability included both reduced beat-to-beat variability and long-term heart rate cyclicity. Amniotic fluid volume was graded sonographically as part of a fetal biophysical profile. Acute inflammation of amnion (indicative of maternal inflammation) and umbilical cord (fetal inflammation) were scored by a single pathologist blinded to clinical data. RESULTS: Severe FHR variable decelerations were directly related to acute amnionitis (P = .012) and acute umbilical vasculitis (P = .0013). In preterm labor, decreased FHR variability was related to acute amnionitis (P = .005). All observations were independent of amniotic fluid volume or use of tocolytic agents. CONCLUSIONS: Severe variable decelerations and decreased FHR variability at < 32 weeks' gestation are related to histologic evidence of acute inflammation.     

Neuronal responses in monkey anterior putamen during operant bar-press behavior

OBJECTIVE: To determine whether computer assisted fetal heart rate analysis or the biophysical profile score can provide noninvasive prediction of fetal acidaemia. DESIGN: Cross sectional study. SETTING: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital School of Medicine, London. SUBJECTS: Forty-one women with pregnancies complicated by diabetes mellitus. INTERVENTIONS: Fetal heart rate (FHR) monitoring with computer assisted analysis, biophysical profile score (BPS) and cordocentesis for measurement of umbilical venous blood glucose concentration and blood gases, up to 24 h before delivery at 27 to 39 weeks gestation. RESULTS: The mean umbilical venous blood pH was significantly lower than the normal mean for gestation, and was below the 5th centile in 18 pregnancies, including all six cases where the mother had nephropathy and hypertension. The mean pO2 was not significantly different from the normal mean for gestation. There were significant associations between fetal acidaemia and both the BPS (r = 0.46, P < 0.01) and FHR variation (r = 0.42, P < 0.01). However, of the 12 acidaemic fetuses of non-nephropathic mothers, nine had normal BPS and six had normal FHR variation. CONCLUSIONS: In pregnancies complicated by maternal diabetes mellitus, BPS and FHR variation are of limited value in the prediction of fetal blood pH.     

Behavioral responses of the chronically instrumented sheep fetus to chemosensory stimuli presented in utero.

Fetal sheep were surgically prepared on Days 113–114 of gestation with an array of chronic instruments for recording electromyographic data (EMG) in oral-facial, axial, and limb muscles and heart rate (FHR). Fetuses also were fitted with an intraoral catheter for infusion of chemosensory fluids (isotonic saline, quinine, colostrum, sucrose) onto the surface of the tongue. Individual subjects received chemosensory infusions on Days 134–137. Fetuses showed consistent oral responses to quinine and milk, but did not respond to isotonic saline or sucrose. Different patterns of motor responses suggested that fetuses discriminated among different concentrations of quinine. The expression of tachycardia to quinine and bradycardia to milk also suggested differential responding to chemosensory fluids that differ in hedonic qualities Detailed characterization of fetal responses to these stimuli in utero confirm the functionality of the gustatory system in the sheep fetus near term. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute thoracic inlet obstruction in achalasia of the oesophagus

Eleven women with fetal distress as manifested by a decrease of fetal movements up to cessation underwent amniocentesis for amniotic fluid evaluation under continuous FHR monitoring. All the fetuses showed abnormal heart rate response, manifested by absence of FHR acceleration or early or late deceleration. The pathologic response, or lack of response of fetal heart rate during amniocentesis is suggested as an additional test to evaluate the severity of fetal distress.     

Habituation to chemosensory stimuli in the rat fetus: Effects of endogenous kappa opioid activity.

On Day 21 of gestation, rat fetuses respond to chemosensory stimuli by expressing stereotypic facial wiping behavior. A series of 4 experiments was conducted to investigate (1) the influence of morphine on fetal responsiveness to a single chemosensory infusion, (2) the effect of naloxone blockade of endogenous opioid activity on diminished fetal responsiveness over a series of chemosensory infusions, (3) the effect of endogenous opioids on the recovery of fetal responsiveness to infusion after various dishabituation procedures, and (4) the influence of selective mu and kappa opioid receptor antagonists on fetal habituation. These experiments confirm that fetuses habituate after a brief series of chemosensory infusions and that dishabituation promoted by presentation of a novel stimulus is facilitated by pharmacological blockade of kappa opioid receptors. Endogenous activity in the kappa opioid system may be functional in modulating the sensory environment around the time of birth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prenatal expression of species-typical action patterns in the rat fetus (Rattus norvegicus).

We investigated sensory and behavioral responsiveness of the rat fetus. On Days 19, 20, or 21 of gestation, rat fetuses received intraoral infusions of a biologically important stimulus, milk, or a novel chemical stimulus, lemon. Using a technique to directly observe behavior in utero, we found that rat fetuses discriminate between intraoral infusions of milk and lemon, exhibiting different levels and patterns of overall activity after infusion. Milk was found to evoke a low magnitude, delayed increase in overall fetal activity from Day 19 through Day 21, whereas lemon evoked a high-magnitude, spiked pattern of activity that diminished from Day 19 to Day 21. Late in gestation these two stimuli elicited species-typical action patterns. Milk infusions elicited a stretch response much like the one shown by pups at the nipple; lemon infusions elicited face wiping typical of older pups and adults exposed to aversive gustatory stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term intravenous tocolytic therapy

Eighteen women required continuous intravenous tocolytic therapy with either ritodrine hydrochloride or magnesium sulfate for greater than 48 hours because of repetitively recurrent preterm labor; these were compared with a similar group of women successfully treated in less than 48 hours in a retrospective, case-controlled study. The mean gestational age at the time of diagnosis was 31 weeks for both groups. Tocolytic selection was similar in both groups, although the dosage per hour was significantly greater with long-term therapy. The mean interval from initiation of therapy until delivery was 41 days in the study group, compared with 39 days among controls (not statistically significant). The mean gestational age at delivery was 36 weeks in both groups. There were no significant difference in various measures of fetal outcome between groups. These data demonstrate that long-term intravenous tocolytic therapy can be a safe and effective means of prolonging gestation in those women who fail to respond to conventional treatment.     

Amantadine susceptibility in influenza A virus isolates: determination methods and lack of resistance in a Canadian sample, 1991-94

OBJECTIVES: To learn which fetal heart rate (FHR) parameters change with gestational age and to demonstrate the relation with fetal rest-activity states. STUDY DESIGN: FHR and fetal movements were recorded in 12 uncomplicated pregnancies from 26 weeks gestational age onwards. Seventy-two FHR recordings of 60 min duration were analysed by a computer (Sonicaid System 8000). Statistical analysis of complete 60 min recordings and selective periods of rest and activity comprised Spearman's rank correlation test, regression analysis and Wilcoxon's signed-rank test. RESULTS: The time needed to meet the system's criteria of normality decreased with gestational age. The incidence of accelerations (ACC), overall FHR variation (VAR) and variation during 'episodes of high variation' (VEHV) increased with gestational age in the total population, but statistical significance of these relations could only be demonstrated in a minority of individual fetuses. Most FHR parameters differed significantly for periods of fetal rest and activity. No FHR parameters showed a relation with gestational age during periods of rest. CONCLUSIONS: The increase of ACC, VAR and VEHV with gestational age is primarily due to an increase during fetal activity. The considerable variation within and between fetuses, however, can only be partly explained by fetal rest-activity states.     

Changes in fetal plasma corticotropin-releasing hormone during androstenedione-induced labor in the rhesus monkey: lack of an effect on the fetal hypothalamo-pituitary-adrenal axis

Androstenedione infusion to pregnant monkeys leads to premature labor and live delivery. Androstenedione-induced labor also increased placental CRH messenger RNA and peptide to concentrations observed at term in pregnant monkeys. Placental CRH may modulate fetal pituitary-adrenal function during pregnancy in primates. This study tested the hypothesis that androstenedione-induced premature delivery in pregnant monkeys results from androstenedione-induced increases in placental CRH, which stimulate premature activation of the fetal pituitary-adrenal axis. The hypothesis was tested by comparing fetal umbilical vein (FUV) plasma CRH, ACTH, dehydroepiandrosterone sulfate, and cortisol concentrations at cesarean section in fetuses from mothers undergoing spontaneous, term labor (group I), with those in fetuses from mothers undergoing androstenedione-induced, premature labor (group II) and with those from mothers not in labor (group III). In addition, gestation-related changes in maternal plasma CRH concentrations were investigated, and CRH immunoactivity was characterized by Sephadex G50 chromatography in pooled maternal plasma extracts. FUV CRH concentrations were similarly elevated in group I and group II fetuses, compared with group III fetuses. Despite similar FUV blood gases in all fetuses, FUV ACTH and dehydroepiandrosterone sulfate concentrations were higher in group I fetuses than in group II or group III fetuses. The majority of CRH immunoactivity coeluted with synthetic human CRH. Maternal plasma CRH concentrations showed a modest increase with gestation in the rhesus monkey. These data: 1) demonstrate that androstenedione treatment of pregnant monkeys at 0.8 of gestation elevates fetal plasma CRH to similar concentrations measured at term; 2) do not support the hypothesis that androstenedione-induced delivery in the monkey results from premature activation of the fetal pituitary-adrenal axis by placental CRH; but 3) do support a role for activation of the fetal hypothalamo-pituitary-adrenal axis in association with spontaneous term labor in the monkey; and 4) demonstrate important interprimate species differences in maternal CRH physiology.     

Discriminant analysis of the Ullrich-Turner syndrome neurocognitive profile

OBJECTIVES: To evaluate the effect of fetal behavioral states on the relationship between fetal heart rate (FHR) and middle cerebral artery resistance index (MCA RI) in normal fetuses. METHODS: The FHR and MCA RI of 10 normal cases from 37 to 40 weeks of gestation were recorded consecutively over a 45-min period. Correlations between the MCA RI and FHR during resting and active phases, classified by an actocardiotocogram, were analyzed by simple regression analysis. RESULTS: The mean FHR and MCA RI were significantly higher during the active phase (140.3 +/- 6.6 bpm, 0.79 +/- 0.06) than those during the resting phase (137.4 +/- 6.8 bpm, 0.75 +/- 0.07, P < 0.01, two sample t-test). There was a significant negative correlation (r = - 0.22, n = 2642, P < 0.01) between RI and FHR during the active phase and a significant positive correlation (r = 0.28, n = 2066, P < 0.001) during the resting phase. CONCLUSIONS: The relationship between FHR and the MCA RI during the resting phase is different from during the active phase.     

Pseudoabscess of the aortic root caused by ectopic seating of an aortic prosthesis

Twenty-one fetuses with an enlarged fourth ventricle were detected by ultrasound at 14-16 weeks' gestation. No other central nervous system anomalies were observed and a normal size fourth ventricle was noted in all cases on follow-up scans at 22-23 weeks' gestation. Five fetuses had associated structural anomalies: a single umbilical artery in two cases, non-septated cystic hygroma in two cases and ventricular septal defect in one fetus. All fetuses had a normal brain sonogram after delivery. Nineteen newborns who were followed up to the age of one year had no developmental problems. It is concluded that an isolated enlarged fourth ventricle might be a physiological variant in early fetal life.     

The hemodynamic effects of maternal hypo- and hyperoxygenation in healthy term pregnancies

OBJECTIVE: To evaluate the hemodynamic effects of maternal hypo- and hyperoxygenation in normal term pregnancy. METHODS: Ten healthy women between 35-41 weeks' gestation were exposed to 10% oxygen in inspired air for 10 minutes and, after a 5-minute recovery period, to a stepwise increase in oxygenation with 50 and 100% oxygen for 10 minutes. Maternal ventilation, hemodynamics, and oxygenation were assessed noninvasively, and maternal and fetal vascular responses were assessed with pulsed-wave color Doppler velocimetry. Computerized cardiotocography was used for fetal heart rate (FHR) analysis. RESULTS: Substantial maternal hypoxia was achieved and accompanied by a statistically significant rise in the maternal heart rate (from 89 +/- 11 to 104 +/- 16 beats per minute) and systolic blood pressure (from 123 +/- 13 to 131 +/- 13 mmHg). Doppler measurements demonstrated a statistically significant decline in the pulsatility index (PI) of the maternal internal carotid artery (from 1.8 +/- 0.3 to 1.5 +/- 0.4) and an increase in the uterine artery PI (from 0.60 +/- 0.12 to 0.72 +/- 0.13). Baseline FHR, heart rate variability, and Doppler velocimetry in the umbilical artery and the middle cerebral artery showed no statistically significant changes. Hyperoxia did not cause changes in the maternal circulation, but the FHR decreased significantly (from 142 +/- 12 to 133 +/- 11 beats per minute). CONCLUSION: Acute short-term hypoxia modifies the maternal circulation, suggesting redistribution of maternal blood flow, but exerts no detectable effects on the healthy fetus. Maternal hyperoxygenation induces no apparent adverse effects.     

Fetal response to voluntary maternal hyperventilation. A preliminary report

Maternal hyperventilation can cause transient reduction in fetal oxygen tension. Fifty women with normal and high-risk pregnancies, between the 32nd and 43rd week, were voluntarily hyperventilated; in 33, fetal heart rate (FHR) acceleration or transient tachycardia were observed (reactive FHR). Of the 33 pregnancies the outcome was good in 30 (91%) as judged by the absence of perinatal death, no fetal distress in labor and no intrauterine growth retardation (IUGR). In 14 patients in whom there was no FHR response to maternal hyperventilation (non-reactive FHR), the outcome of pregnancy was significantly worse; one infant died neonatally, 10 were either chronically (IUGR), or acutely distressed. Only in 3 was the outcome good (21%). The study showed that there is good correlation between a "reactive" FHR and favorable neonatal outcome, and between a "non-reactive" FHR and an unfavorable neonatal outcome.     

Magnesium, calcium and zinc levels of maternal and fetal tissues in magnesium deficient rats

The interaction of magnesium with two other mineral elements, calcium and zinc, was studied in maternal tissues and fetuses of pregnant rats fed a magnesium deficient diet throughout gestation. Reduction in maternal femur magnesium and a trend for increased kidney calcium reflected the dietary magnesium deficiency. In fetuses, however, total magnesium content was reduced and , in addition, fetal zinc content was also lower than normal in the group most severly deficient in magnesium. The possible interpretation of this magnesium-zinc interaction is discussed.     

Effect of pulsatile oxytocin administration to the pregnant ewe in the last third of gestation on fetal ACTH and cortisol response to acute hypoxemia

OBJECTIVE: The aim of this study was to examine the effect of increased myometrial contractility throughout the last third of pregnancy on the ovine fetal response to short-term hypoxemia. METHODS: Oxytocin (600 microU/kg/minute, n = 5) or saline (n = 7) was infused for 5 minutes every 20 minutes into the maternal jugular vein starting at 95-99 days of gestation and continuing throughout the last third of gestation. Fetuses were subjected to a hypoxemic challenge (1 hour) at 131 days of gestation while fetal plasma ACTH and cortisol levels and nuchal muscle electromyogram activity were monitored. RESULTS: The fetal plasma ACTH concentration before and during the hypoxemic challenge was similar in the control and oxytocin groups. The fetal plasma cortisol concentration in the oxytocin group was significantly lower before and during the hypoxemia than in the controls. During hypoxemia, fetal nuchal muscle activity was significantly reduced only in the control group. CONCLUSION: Increased myometrial contracture frequency throughout the last third of pregnancy alters both the neuroendocrine and behavioral responses of fetal sheep to short-term hypoxemia.