Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography （CTG） has been a major driv...Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography （CTG） has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about signifcant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [defnitions of fetal heart rate （FHR） parameters, CTG recording speed, 3-tier systems, etc .] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefning the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography （ECG） is discussed. The FHR decelerations are often deterministic （center-stage） in CTG interpretation and 3-tier categorization. It is discussed if their scientifc and physiological classifcation （avoiding framing and confirmation biases） may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG （STAN） have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable （overcome human factors） and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often diffcult and resource-intensive.展开更多
BACKGROUND Mesenchymal stem cells,found in various tissues,possess significant healing and immunomodulatory properties,influencing macrophage polarization,which is essential for wound repair.However,chronic wounds pre...BACKGROUND Mesenchymal stem cells,found in various tissues,possess significant healing and immunomodulatory properties,influencing macrophage polarization,which is essential for wound repair.However,chronic wounds present significant therapeutic challenges,requiring novel strategies to improve healing outcomes.AIM To investigate the potential of fetal dermal mesenchymal stem cells(FDMSCs)in enhancing wound healing through modulation of macrophage polarization,specifically by promoting the M2 phenotype to address inflammatory responses in chronic wounds.METHODS FDMSCs were isolated from BalB/C mice and co-cultured with RAW264.7 macrophages to assess their effects on macrophage polarization.Flow cytometry,quantitative reverse transcriptase polymerase chain reaction,and histological analyses were employed to evaluate shifts in macrophage phenotype and wound healing in a mouse model.Statistical analysis was performed using GraphPad Prism.RESULTS FDMSCs induced macrophage polarization from the M1 to M2 phenotype,as demonstrated by a reduction in proinflammatory markers(inducible nitric oxide synthase,interleukin-6)and an increase in anti-inflammatory markers[mannose receptor(CD206),arginase-1]in co-cultured RAW264.7 macrophages.These shifts were confirmed by flow cytometry.In an acute skin wound model,FDMSC-treated mice exhibited faster wound healing,enhanced collagen deposition,and improved vascular regeneration compared to controls.Significantly higher expression of arginase-1 further indicated an enriched M2 macrophage environment.CONCLUSION FDMSCs effectively modulate macrophage polarization from M1 to M2,reduce inflammation,and enhance tissue repair,demonstrating their potential as an immunomodulatory strategy in wound healing.These findings highlight the promising therapeutic application of FDMSCs in managing chronic wounds.展开更多
Background:Magnetic resonance spectroscopy(MRS)represents a significant advancement in the noninvasive assessment of brain metabolism.MRS can provide valuable metabolic information and facilitate more accurate diagnos...Background:Magnetic resonance spectroscopy(MRS)represents a significant advancement in the noninvasive assessment of brain metabolism.MRS can provide valuable metabolic information and facilitate more accurate diagnoses of intrauterine fetal brain development than was previously possible.To obtain information regarding normal intrauterine fetal brain metabolism and to establish gestational age-specific reference values for normal fetal brain metabolites for subsequent use in MRS,we conducted MRS scans of normal fetal brains during mid-to late-term pregnancies,along with related processing.Methods:In this prospective study,MRS scans were conducted on 109 fetuses,with a total of 54 normal fetal brains enrolled on the basis of specific inclusion and exclusion criteria.We analyzed metabolic ratios,including the sum of N-acetylaspartate(NAA)and total N-acetylaspartate(tNAA),total choline(tCho),inositol(Ins),and total creatine(tCr),in relation to gestational age.Results:Gestational age was significantly correlated with specific metabolic ratios(Ins/tCr:r=-0.75,p<0.0001;tCho/tCr:r=-0.50,p<0.0001),especially tNAA/tCho(tNAA/tCho:r=0.54,p<0.0001)and tNAA/Ins(r=0.56,p<0.0001),providing a baseline for fetal brain metabolic assessment.Linear regression analysis was used to calculate regression lines for fetal brain metabolite ratios.Slopes were tested at p of 0.05.Conclusions:The current findings confirmed a significant correlation between fetal brain metabolites and gestational age,supporting the feasibility of establishing standard values for these metabolites in fetal brain assessment.展开更多
Advances in fetal surgery techniques have enabled the treatment of certain congenital defects before birth.A critical area of focus is the role of perinatal imaging in optimizing prenatal interventions within the prec...Advances in fetal surgery techniques have enabled the treatment of certain congenital defects before birth.A critical area of focus is the role of perinatal imaging in optimizing prenatal interventions within the precision medicine framework.Magnetic resonance imaging(MRI)is emerging as an indispensable tool for guiding these intricate procedures with the potential to significantly enhance the standard of care and outcomes for affected fetuses.This review begins with an overview of the classification and indications for fetal surgical interventions.It then explores the detailed applications of prenatal MRI scanning and diagnostic techniques across various categories of fetal surgery.A key focus is how fetal MRI provides critical insights into specific lesion characteristics and tissue involvement,thereby aiding healthcare professionals in selecting the optimal surgical strategies for prenatal and postnatal interventions.Fetal MRI offers detailed visualizations that complement traditional ultra-sound findings,enhancing the precision of radiological planning for fetal surgery.Finally,the review highlights how integration of fetal MRI into the decision-making process enables healthcare providers to make well-informed choices,ultimately improving the prognosis and outcomes for both the mother and fetus.展开更多
A pregnant woman underwent fetal brain magnetic resonance imaging(MRI)following ultrasound detection of a posterior fossa cyst at 29 weeks'gestation.She presented with no relevant medical history and underwent a r...A pregnant woman underwent fetal brain magnetic resonance imaging(MRI)following ultrasound detection of a posterior fossa cyst at 29 weeks'gestation.She presented with no relevant medical history and underwent a routine obstetric examination during pregnancy.The fetal head position,fetal cranial development,and limb development remained normal until 29 weeks.展开更多
BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subs...BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.展开更多
Background: Neurodevelopmental abnormalities in experimental fetal alcohol spectrum disorder (FASD) are associated with impaired signaling through complex pathways that mediate neuronal survival, growth, migration, en...Background: Neurodevelopmental abnormalities in experimental fetal alcohol spectrum disorder (FASD) are associated with impaired signaling through complex pathways that mediate neuronal survival, growth, migration, energy metabolism, and plasticity. Gestational dietary soy prevents alcohol-related impairments in placentation and FASD-associated fetal anomalies. Objective: This study was designed to determine if gestational dietary soy would be sufficient to normalize cognitive function in young adolescent offspring after chronic in utero exposure to alcohol. In addition, efforts were made to characterize the mechanisms of FASD prevention by maternal dietary soy. Methods: Pregnant Long Evans rats were fed isocaloric liquid diets containing 0% or 26% caloric ethanol with casein or soy isolate as the protein source from gestation day 6 through delivery/postnatal day 0 (P0). From P24 - P28, the offspring were subjected to Morris water maze (MWM) testing, and on P35, they were sacrificed to harvest temporal lobes for histopathologic and molecular studies. Results: The in-utero ethanol-exposed offspring exhibited significant performance impairments on the MWM test, and they had a significantly reduced mean brain weight with neuronal loss in the CA1 hippocampal region and evidence of white matter myelin loss. Gestational dietary soy nearly normalized MWM performance and preserved brain weight, hippocampal CA1 architecture, and white matter myelin staining in alcohol-exposed offspring. Mechanistically, the main positive effects of soy included increased temporal lobe expression of HES-1 and HIF-1α, reflecting enhanced Notch signaling, and broadly increased expression of GnRH network molecules, including Erb1, Gper1, GnRH, GnRH-R, KiSS, and KiSS-R, irrespective of gestational ethanol exposure. Conclusions: Dietary soy intervention early in pregnancy may reduce FASD-associated cognitive deficits. The findings suggest that targeting Notch and GnRH-related networks may help reduce long-term disability with FASD. Additional mechanistic and experimental research is needed to determine if longer-duration, postnatal dietary soy could prevent the adverse neurobehavioral effects of FASD.展开更多
Background The creatine-creatine kinase-phosphocreatine(Cr-CK-PCr)system maintains intracellular ratios of ATP/ADP for support of cellular functions and has been characterized at the placental-uterine interface of rod...Background The creatine-creatine kinase-phosphocreatine(Cr-CK-PCr)system maintains intracellular ratios of ATP/ADP for support of cellular functions and has been characterized at the placental-uterine interface of rodents,primates,swine and sheep,and thus may support fetal development.This study determined effects of dietary supplementation of creatine(Cr)to gestating gilts on fetal development,the number and ratio of primary and secondary muscle fibers,and on protein expression in endometrium and fetal biceps-femoris muscle,respectively in fetal pigs on d 60 and d 90 of gestation.Methods Reproductively mature gilts were synchronized to estrus using Matrix,observed for estrus(d 0),and artificially inseminated 12 h and 36 h later.Gilts were individually housed and fed 0.86 kg of 14%crude protein diet twice daily that meets nutritional requirements for pregnant gilts.Gilts were assigned to either basal diet control(CON)group,or Cr supplemented group(provided 30 g Cr monohydrate daily)from d 10 to either d 60 or d 90 of gestation.Gilts were euthanized and hysterectomized on either d 60 or d 90 of gestation.These protocols were completed in two replicates,as gilts were bred in spring and euthanized in summer or bred in fall and euthanized in winter(n=20 gilts/replicate).Litter size,crown-rump length,sex,and fetal weight was recorded.Three female and male fetuses closest to mean litter weight were selected to assess effects of treatment on weight of fetal brain,kidney,liver,spleen,and biceps-femoris muscle.Data were analyzed to determine effects of treatment,days of gestation,replicate,and sex on litter size,fetal measurements,and incidence of intrauterine growth restriction.Results Dietary Cr supplementation increased fetal brain weight to body weight ratios on d 90 of gestation(P<0.05)and fetal kidney weight to body weight ratios on d 60 of gestation(P<0.01),while days of gestation had significant effect on expression of mitochondrial CK isoform in gilt endometria(P<0.05).Conclusions Results suggest that dietary supplementation of Cr in gestating gilts enhanced development of select fetal organs and contribute to understanding roles of the Cr-CK-PCr system in pregnancy.展开更多
Objective Sleep is fundamental to the physical and mental health of both the general population and pregnant women.Most studies have focused on the impact of certain trimester sleep behaviors on gestational complicati...Objective Sleep is fundamental to the physical and mental health of both the general population and pregnant women.Most studies have focused on the impact of certain trimester sleep behaviors on gestational complications and birth outcomes.This study aimed to explore the association between maternal sleep duration and fetal growth development from as early as 23 gestational weeks to birth.Methods A total of 803 pregnant women were prospectively enrolled.The self-reported maternal nocturnal sleep duration during all 3 trimesters was recorded.The outcome measures were reference-population-based Z-scores of fetal biometric measurements obtained through routine ultrasonographic examination.Results Using multiple linear regression,a marginally significant negative association was observed between second-trimester sleep duration and second-trimester fetal head circumference(HC)and third-trimester fetal biparietal diameter(BPD).Then the associations of long sleep duration in each trimester with fetal biometry extreme values were evaluated.A significant impact of second-trimester long sleep duration on the second-trimester BPD below the 10th percentile of the reference population was observed.Longitudinal analysis reported similar results for BPD and HC.Conclusions Overall,a negative association between sleep duration and fetal biometric measurements was observed.Long sleep durations in the second trimester might negatively impact fetal growth,particularly brain parameters,including BPD and HC.展开更多
Objective Placental dysfunction induced by fetal cardiopulmonary bypass(CPB)imposes limitations on the clinical application of this procedure.The potential impact of microRNA-mediated autophagy in placental endothelia...Objective Placental dysfunction induced by fetal cardiopulmonary bypass(CPB)imposes limitations on the clinical application of this procedure.The potential impact of microRNA-mediated autophagy in placental endothelial cells on overall placental function remains elusive,necessitating a comprehensive exploration of the underlying mechanisms involved.Methods We established fetal sheep CPB models and employed immunohistochemistry to assess the placental expression of ATG7.Bioinformatic analysis,coupled with dual-luciferase reporter assays,was used to elucidate the intricate relationship between miR-320a and ATG7.Changes in ATG7 expression were further investigated through Western blotting and quantitative polymerase chain reaction(qPCR).Human umbilical vein endothelial cells(HUVECs)were cultured,and in vitro experiments were conducted to evaluate their regulatory effects on endothelial function.Immunoblotting was used to measure the expression levels of ATG7,endothelin-1(ET-1),SIRT1,and FOXO1,whereas enzyme-linked immunosorbent assay(ELISA)was used to quantify nitric oxide(NO)production.Results Sixty minutes after CPB,a substantial decrease in ATG7 expression in placental tissue was observed.The downregulation of ATG7 expression led to increased ET-1 production in HUVECs,concomitant with decreased NO production.miR-320a was identified as a specific regulator of ATG7 expression,with subsequent experiments demonstrating a significant reduction in placental ATG7 levels upon injection of the miR-320a agomir compared with the miR-320a antagomir during fetal sheep CPB.In HUVECs,miR-320a downregulated ATG7,resulting in increased ET-1 production and diminished NO production.Treatment with the miR-320a mimic/miR-320a inhibitor revealed that miR-320a inhibited the SIRT1/FOXO1 pathway in HUVECs by downregulating ATG7 expression,culminating in increased ET-1 production and reduced NO levels.Conclusion The observed downregulation of placental ATG7 expression subsequent to fetal CPB is intricately associated with endothelial dysfunction.Furthermore,our findings underscore the specific regulatory role of miR-320a in modulating ATG7 expression within the placenta.At the cellular level,increasing the level of miR-320a has emerged as a potential strategy for modulating endothelial function through the inhibition of ATG7 and the SIRT1/FOXO1 pathway.展开更多
Congenital heart disease(CHD)is the most common congenital anomaly and a major cause of death among fetal malformations,but prenatal diagnosis is considered to be low.The development of artificial intelligence(AI)in f...Congenital heart disease(CHD)is the most common congenital anomaly and a major cause of death among fetal malformations,but prenatal diagnosis is considered to be low.The development of artificial intelligence(AI)in fetal echocardiography has made it possible to automate and standardise the examination,improving the variation in CHD detection rates between different regions and reducing the reliance on operator experience.AI includes any computer program(algorithms and models)that mimics human logic and intelligence,and its use in fetal echocardiography is mainly to acquire and optimise images,perform automatic measurements,identify discrepant values,and diagnose and classify pathologies.In this review,we will look at the different practical applications of AI in fetal echocardiography.展开更多
BACKGROUND Fetal hydrops is a serious condition difficult to manage,often with a poor prognosis,and it is characterized by the collection of fluid in the extravascular compartments.Before 1968,the most frequent cause ...BACKGROUND Fetal hydrops is a serious condition difficult to manage,often with a poor prognosis,and it is characterized by the collection of fluid in the extravascular compartments.Before 1968,the most frequent cause was the maternal-fetal Rh incompatibility.Today,90%of the cases are non-immune hydrops fetalis.Multiple fetal anatomic and functional disorders can cause non-immune hydrops fetalis and the pathogenesis is incompletely understood.Etiology varies from viral infections to heart disease,chromosomal abnormalities,hematological and autoimmune causes.CASE SUMMARY A 38-year-old pregnant woman has neck lymphoadenomegaly,fever,cough,tonsillar plaques at 14 wk of amenorrhea and a rash with widespread itching.At 27.5 wk a fetal ultrasound shows signs of severe anemia and hydrops.Cordocentesis is performed with confirmation of severe fetal anemia and subsequent fetal transfusion.The karyotype is 46,XX,array-comparative genome hybridization(CGH)negative,and infectious tests are not conclusive.In the following days there is a progressive improvement of the indirect signs of fetal anemia.At 33.6 wk,for relapse of severe fetal anemia,further fetal transfusions are necessary and an urgent cesarean section is performed.On the day 12 of life,for the detection of anemia,the newborn is subjected to transfusion of concentrated red blood cells and begins treatment with erythropoietin.Later there is a normalization of blood chemistry values and the baby does not need new transfusions.A 29-year-old pregnant woman,with Sjogren's syndrome and positive Anti-Ro/SSA antibodies,is subjected to serial fetal ecocardio for branch block.At 26.5 wk there is a finding of fetal ascites.Infectious disease tests on amniotic fluid are negative as well as quantitative fluorescent polymerase chain reaction,Array CGH.At cordocentesis Hb is 1.3 mmol/L,consequently fetal transfusion is performed.Also in this case,due to continuous episodes of relapse of fetal anemia with consequent transfusions,at 29.4 wk a cesarean section is performed.On day 9 of life,a treatment with erythropoietin is started in the newborn,but the baby needs three blood transfusions.The search for autoantibodies in the baby found SS-A Ro60 positive,SSA-Ro52 positive and SS-B negative.The hemoglobin values normalized after the disappearance of maternal autoantibodies.CONCLUSION An attempt to determine the etiology of hydrops should be made at the time of diagnosis because the goal is to treat underlying cause,whenever possible.Even if the infectious examinations are not conclusive,but the pregnancy history is strongly suggestive of infection as in the first case,the infectious etiology must not be excluded.In the second case,instead,transplacental passage of maternal autoantibodies caused hydrops fetalis and severe anemia.Finally,obstetric management must be aimed at fetal support up to an optimal timing for delivery by evaluating risks and benefits to increase the chances of survival without sequelae.展开更多
Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Dep...Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.展开更多
Background: Fetal weight estimation by ultrasound is an important factor in obstetrics;it is directly related to the gestational age which helps to plan the mode of delivery and labor management. Objective: to compare...Background: Fetal weight estimation by ultrasound is an important factor in obstetrics;it is directly related to the gestational age which helps to plan the mode of delivery and labor management. Objective: to compare between fetal thigh circumference (TC) and abdominal subcutaneous tissue thickness (SCT) in estimating birthweight in term pregnant women. Patients and Methods: This prospective cohort study was conducted at outpatient clinic or emergency room, Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from March 2022 until May 2023. During this study, 100 term pregnant females with gestational age 37 - 40 weeks attended El Demerdash Maternity Hospital and scheduled for delivery either at outpatient clinic or emergency room were enrolled, after consenting each of them. Basic fetal biometry was performed by an expert and professional medical personnel to ensure the accuracy of examination results. Fetal abdominal subcutaneous thickness and fetal thigh circumference were measured for assessment of gestational age and correlated with actual fetal body weight. In the current study, three formulas;Hadlock, Vintzileos’ and SCT formula were correlated with actual fetal body weight after birth. Results: The present study revealed that TC formula is closer to the actual birth weight, followed by Hadlock formula, while the SCT formula is the furthest from it. Conclusion: To increase the accuracy of birth estimations, regular ultrasound examinations should include fetal thigh circumference measurement.展开更多
[Objective]The aim was to study the differential expression ofAPOEgene in different generations of porcine fetal fibroblasts cells.[Method]The first,tenth,fifteenth,twentieth,twenty-fifth,fiftieth generations of porci...[Objective]The aim was to study the differential expression ofAPOEgene in different generations of porcine fetal fibroblasts cells.[Method]The first,tenth,fifteenth,twentieth,twenty-fifth,fiftieth generations of porcine fetal fibroblast cells,which were normally grown and passed,were collected before total RNA was extracted respectively.The expression ofAPOEgene in different generations of porcine fetal fibro-blast cells was detected by RT-PCR technique.[Result]The expression level of porcine APOE mRNA in the first generation of porcine fetal fi-broblast cells was the highest,and then it gradually decreased with the increase of cell generations and was the lowest in the fiftieth generation.[Conclusion]The expression ofAPOEgene had the selective trend in different generations of porcine fetal fibroblast cells.展开更多
Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. Th...Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. This study investigated vascular morphology and expression of these angiogenic factors in rat placenta on the day 15, 18, 21 of gestation （D 15, D 18 and D21）. The rats were randomly assigned into 3 groups： normal group, model group [fetal growth restriction （FGR） model], and Bushen Tqi Huoxue （BYHR） recipe treatment group （BYHR group, the pregnant rats with FGR were treated with BYHR recipe）. Morphological analysis indicated that during initial villous formation, fetal nucle- ated erythrocytes （FNEs） appeared in maternal blood sinus （MBS）. Subsequently, FNEs were sur- rounded by endothelial cells to form fetal capillary （FC） and then by trophoblast cells to form villi. As pregnancy proceeded, FC density increased progressively with increasing endothelial identification staining （EIS） in normal and BYHR groups. Whereas, villous formation was suppressed, normal in- crease in FC density was impaired and EIS was weakened in model group. Quantitative PCR analysis showed that VEGF and Flkl mRNA increased over gestation in all groups, indicating that VEGF might play a pivotal role in FC growth during late gestation. VEGF mRNA was increased on D15, while de- creased on D21 in model group as compared with normal group and BYHR group. Immunohistochemi- cally, Ang-2 protein was highly expressed in FNEs, gradually disappeared as villi matured, and decreased over gestation in all groups, indicating that Ang-2 might play a pivotal role in villous formation, which was further supported by decreased Ang-2 mRNA and protein expression in model group on D 15. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio increased from D15 to D18 in all groups as placenta matured. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio were decreased on D18 in model group as compared with normal and BYHR groups, indicating delayed maturity of FGR placenta. Alterations in angiogenic factors may result in altered placental vasculature and cause placental insufficiency. BYHR recipe could balance the angiogenic factors to promote the formation and maturation of FGR placental vasculature.展开更多
The pathology of fetal alcohol syndrome and the less severe fetal alcohol spectrum disorders includes brain dysmyelination.Recent studies have shed light on the molecular mechanisms underlying these white matter abnor...The pathology of fetal alcohol syndrome and the less severe fetal alcohol spectrum disorders includes brain dysmyelination.Recent studies have shed light on the molecular mechanisms underlying these white matter abnormalities.Rodent models of fetal alcohol syndrome and human studies have shown suppressed oligodendrocyte differentiation and apoptosis of oligodendrocyte precursor cells.Ethanol exposure led to reduced expression of myelin basic protein and delayed myelin basic protein expression in rat and mouse models of fetal alcohol syndrome and in human histopathological specimens.Several studies have reported increased expression of many chemokines in dysmyelinating disorders in central nervous system,including multiple sclerosis and fetal alcohol syndrome.Acute ethanol exposure reduced levels of the neuroprotective insulin-like growth factor-1 in fetal and maternal sheep and in human fetal brain tissues,while ethanol increased the expression of tumor necrosis factor α in mouse and human neurons.White matter lesions have been induced in the developing sheep brain by alcohol exposure in early gestation.Rat fetal alcohol syndrome models have shown reduced axon diameters,with thinner myelin sheaths,as well as reduced numbers of oligodendrocytes,which were also morphologically aberrant oligodendrocytes.Expressions of markers for mature myelination,including myelin basic protein,also were reduced.The accumulating knowledge concerning the mechanisms of ethanol-induced dysmyelination could lead to the development of strategies to prevent dysmyelination in children exposed to ethanol during fetal development.Future studies using fetal oligodendrocyte-and oligodendrocyte precursor cell-derived exosomes isolated from the mother's blood may identify biomarkers for fetal alcohol syndrome and even implicate epigenetic changes in early development that affect oligodendrocyte precursor cell and oligodendrocyte function in adulthood.By combining various imaging modalities with molecular studies,it may be possible to determine which fetuses are at risk and to intervene therapeutically early in the pregnancy.展开更多
Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August...Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.展开更多
<div style="text-align:justify;"> The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. Th...<div style="text-align:justify;"> The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. The amniocentesis has been used in clinics to evaluate the maturity of the fetal lung, which is invasive, expensive and time-consuming. Ultrasonography has been developed to examine the fetal lung quantitatively in the past decades as a non-invasive method. However, the contour of the fetal lung required by existing studies was delineated in manual. An automated segmentation approach could not only improve the objectiveness of those studies, but also offer a quantitative way to monitor the development of the fetal lung in terms of morphological parameters based on the segmentation. In view of this, we proposed a deep learning model for automated fetal lung segmentation and measurement. The model was constructed based on the U-Net. It was trained by 3500 data sets augmented from 250 ultrasound images with both the fetal lung and heart manually delineated, and then tested on 50 ultrasound data sets. With the proposed method, the fetal lung and cardiac area were automatically segmented with the accuracy, average IoU, sensitivity and precision being 0.98, 0.79, 0.881 and 0.886, respectively. </div>展开更多
Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period i...Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Results Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks’ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were per-formed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conclusion The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.展开更多
文摘Intrapartum fetal monitoring has been criticized for the lack of evidence of improvement in fetal outcome despite causing increased operative intervention. Paradoxically, cardiotocography （CTG） has been a major driver for litigation for neonatal neurological injury. This analytical review tries to explore why extensive clinical studies and trials over 50 years have failed to demonstrate or bring about signifcant improvement in intrapartum fetal monitoring. There seems a need for significant reform. International congruence on most aspects of CTG interpretation [defnitions of fetal heart rate （FHR） parameters, CTG recording speed, 3-tier systems, etc .] is highly desirable to facilitate future meaningful clinical studies, evaluation and progress in this field. The FHR changes are non-specific and poor surrogate for fetal well-being. As a compromise for maintaining low false-negative results for fetal acidemia, a high false-positive value may have to be accepted. The need for redefning the place of adjuvant tests of fetal well-being like fetal blood sampling or fetal electrocardiography （ECG） is discussed. The FHR decelerations are often deterministic （center-stage） in CTG interpretation and 3-tier categorization. It is discussed if their scientifc and physiological classifcation （avoiding framing and confirmation biases） may be best based on time relationship to uterine contractions alone. This may provide a more sound foundation which could improve the reliability and further evolution of 3-tier systems. Results of several trials of fetal ECG （STAN） have been inconclusive and a need for a fresh approach or strategy is considered. It is hoped that the long anticipated Computer-aided analysis of CTG will be more objective and reliable （overcome human factors） and will offer valuable support or may eventually replace visual CTG interpretation. In any case, the recording and archiving all CTGs digitally and testing cord blood gases routinely in every delivery would be highly desirable for future research. This would facilitate well designed retrospective studies which can be very informative especially when prospective randomised controlled trials are often diffcult and resource-intensive.
基金National Natural Science Foundation of China,No.81873934and Jinan Science and Technology Planning Project,No.202225065.
文摘BACKGROUND Mesenchymal stem cells,found in various tissues,possess significant healing and immunomodulatory properties,influencing macrophage polarization,which is essential for wound repair.However,chronic wounds present significant therapeutic challenges,requiring novel strategies to improve healing outcomes.AIM To investigate the potential of fetal dermal mesenchymal stem cells(FDMSCs)in enhancing wound healing through modulation of macrophage polarization,specifically by promoting the M2 phenotype to address inflammatory responses in chronic wounds.METHODS FDMSCs were isolated from BalB/C mice and co-cultured with RAW264.7 macrophages to assess their effects on macrophage polarization.Flow cytometry,quantitative reverse transcriptase polymerase chain reaction,and histological analyses were employed to evaluate shifts in macrophage phenotype and wound healing in a mouse model.Statistical analysis was performed using GraphPad Prism.RESULTS FDMSCs induced macrophage polarization from the M1 to M2 phenotype,as demonstrated by a reduction in proinflammatory markers(inducible nitric oxide synthase,interleukin-6)and an increase in anti-inflammatory markers[mannose receptor(CD206),arginase-1]in co-cultured RAW264.7 macrophages.These shifts were confirmed by flow cytometry.In an acute skin wound model,FDMSC-treated mice exhibited faster wound healing,enhanced collagen deposition,and improved vascular regeneration compared to controls.Significantly higher expression of arginase-1 further indicated an enriched M2 macrophage environment.CONCLUSION FDMSCs effectively modulate macrophage polarization from M1 to M2,reduce inflammation,and enhance tissue repair,demonstrating their potential as an immunomodulatory strategy in wound healing.These findings highlight the promising therapeutic application of FDMSCs in managing chronic wounds.
基金supported by China Society for Maternal and Child Health Research(Gant/Award Number:2023CAMCHS003A17).
文摘Background:Magnetic resonance spectroscopy(MRS)represents a significant advancement in the noninvasive assessment of brain metabolism.MRS can provide valuable metabolic information and facilitate more accurate diagnoses of intrauterine fetal brain development than was previously possible.To obtain information regarding normal intrauterine fetal brain metabolism and to establish gestational age-specific reference values for normal fetal brain metabolites for subsequent use in MRS,we conducted MRS scans of normal fetal brains during mid-to late-term pregnancies,along with related processing.Methods:In this prospective study,MRS scans were conducted on 109 fetuses,with a total of 54 normal fetal brains enrolled on the basis of specific inclusion and exclusion criteria.We analyzed metabolic ratios,including the sum of N-acetylaspartate(NAA)and total N-acetylaspartate(tNAA),total choline(tCho),inositol(Ins),and total creatine(tCr),in relation to gestational age.Results:Gestational age was significantly correlated with specific metabolic ratios(Ins/tCr:r=-0.75,p<0.0001;tCho/tCr:r=-0.50,p<0.0001),especially tNAA/tCho(tNAA/tCho:r=0.54,p<0.0001)and tNAA/Ins(r=0.56,p<0.0001),providing a baseline for fetal brain metabolic assessment.Linear regression analysis was used to calculate regression lines for fetal brain metabolite ratios.Slopes were tested at p of 0.05.Conclusions:The current findings confirmed a significant correlation between fetal brain metabolites and gestational age,supporting the feasibility of establishing standard values for these metabolites in fetal brain assessment.
基金supported by Zhejiang Provincial Natural Science Foundation of China(Grant No.ZCLTGY24H0401)Technology Program of Jiaxing(Grant No.2024AD30125).
文摘Advances in fetal surgery techniques have enabled the treatment of certain congenital defects before birth.A critical area of focus is the role of perinatal imaging in optimizing prenatal interventions within the precision medicine framework.Magnetic resonance imaging(MRI)is emerging as an indispensable tool for guiding these intricate procedures with the potential to significantly enhance the standard of care and outcomes for affected fetuses.This review begins with an overview of the classification and indications for fetal surgical interventions.It then explores the detailed applications of prenatal MRI scanning and diagnostic techniques across various categories of fetal surgery.A key focus is how fetal MRI provides critical insights into specific lesion characteristics and tissue involvement,thereby aiding healthcare professionals in selecting the optimal surgical strategies for prenatal and postnatal interventions.Fetal MRI offers detailed visualizations that complement traditional ultra-sound findings,enhancing the precision of radiological planning for fetal surgery.Finally,the review highlights how integration of fetal MRI into the decision-making process enables healthcare providers to make well-informed choices,ultimately improving the prognosis and outcomes for both the mother and fetus.
基金supported by China Society for Maternal and Child Health Research(Grant/Award Number:2023CAMCHS003A17).
文摘A pregnant woman underwent fetal brain magnetic resonance imaging(MRI)following ultrasound detection of a posterior fossa cyst at 29 weeks'gestation.She presented with no relevant medical history and underwent a routine obstetric examination during pregnancy.The fetal head position,fetal cranial development,and limb development remained normal until 29 weeks.
文摘BACKGROUND Acute pancreatitis in pregnancy is a rare but serious condition that can lead to high maternal mortality and fetal loss.Instances of pregnancy complicated by severe acute pancreatitis,particularly with subsequent respiratory and cardiac arrest,are rarely reported.CASE SUMMARY We present the case of a 35-year-old woman,at 36+5 weeks of gestation,who presented with paroxysmal epigastric pain accompanied by low back pain,nausea,and vomiting.According to the clinical symptoms,B-ultrasound imaging and biochemical indicators,the patient was diagnosed with acute pancreatitis and initially managed conservatively.However,3 hours after admission,the patient experienced respiratory and cardiac arrest,and the fetus died.In this case,the adverse outcomes occurred due to the lack of aggressive fluid resuscitation and an active surgical intervention.CONCLUSION Implementing aggressive fluid resuscitation to sustain tissue perfusion,alongside the proactive evaluation of pharmacological agents that suppress gastric acid secretion and inhibit pancreatic enzyme activity,may be beneficial in mitigating the risk of a severely adverse prognosis.Effective management of acute pancreatitis during pregnancy requires careful timing of surgical intervention,a thorough evaluation of the risks and benefits regarding the continuation or termination of pregnancy,and a focus on safeguarding both maternal and fetal health.
文摘Background: Neurodevelopmental abnormalities in experimental fetal alcohol spectrum disorder (FASD) are associated with impaired signaling through complex pathways that mediate neuronal survival, growth, migration, energy metabolism, and plasticity. Gestational dietary soy prevents alcohol-related impairments in placentation and FASD-associated fetal anomalies. Objective: This study was designed to determine if gestational dietary soy would be sufficient to normalize cognitive function in young adolescent offspring after chronic in utero exposure to alcohol. In addition, efforts were made to characterize the mechanisms of FASD prevention by maternal dietary soy. Methods: Pregnant Long Evans rats were fed isocaloric liquid diets containing 0% or 26% caloric ethanol with casein or soy isolate as the protein source from gestation day 6 through delivery/postnatal day 0 (P0). From P24 - P28, the offspring were subjected to Morris water maze (MWM) testing, and on P35, they were sacrificed to harvest temporal lobes for histopathologic and molecular studies. Results: The in-utero ethanol-exposed offspring exhibited significant performance impairments on the MWM test, and they had a significantly reduced mean brain weight with neuronal loss in the CA1 hippocampal region and evidence of white matter myelin loss. Gestational dietary soy nearly normalized MWM performance and preserved brain weight, hippocampal CA1 architecture, and white matter myelin staining in alcohol-exposed offspring. Mechanistically, the main positive effects of soy included increased temporal lobe expression of HES-1 and HIF-1α, reflecting enhanced Notch signaling, and broadly increased expression of GnRH network molecules, including Erb1, Gper1, GnRH, GnRH-R, KiSS, and KiSS-R, irrespective of gestational ethanol exposure. Conclusions: Dietary soy intervention early in pregnancy may reduce FASD-associated cognitive deficits. The findings suggest that targeting Notch and GnRH-related networks may help reduce long-term disability with FASD. Additional mechanistic and experimental research is needed to determine if longer-duration, postnatal dietary soy could prevent the adverse neurobehavioral effects of FASD.
基金supported by Agriculture and Food Research Initiative Competitive Grant no.2022–67015-36376 from the USDA National Institute of Food and Agriculture.
文摘Background The creatine-creatine kinase-phosphocreatine(Cr-CK-PCr)system maintains intracellular ratios of ATP/ADP for support of cellular functions and has been characterized at the placental-uterine interface of rodents,primates,swine and sheep,and thus may support fetal development.This study determined effects of dietary supplementation of creatine(Cr)to gestating gilts on fetal development,the number and ratio of primary and secondary muscle fibers,and on protein expression in endometrium and fetal biceps-femoris muscle,respectively in fetal pigs on d 60 and d 90 of gestation.Methods Reproductively mature gilts were synchronized to estrus using Matrix,observed for estrus(d 0),and artificially inseminated 12 h and 36 h later.Gilts were individually housed and fed 0.86 kg of 14%crude protein diet twice daily that meets nutritional requirements for pregnant gilts.Gilts were assigned to either basal diet control(CON)group,or Cr supplemented group(provided 30 g Cr monohydrate daily)from d 10 to either d 60 or d 90 of gestation.Gilts were euthanized and hysterectomized on either d 60 or d 90 of gestation.These protocols were completed in two replicates,as gilts were bred in spring and euthanized in summer or bred in fall and euthanized in winter(n=20 gilts/replicate).Litter size,crown-rump length,sex,and fetal weight was recorded.Three female and male fetuses closest to mean litter weight were selected to assess effects of treatment on weight of fetal brain,kidney,liver,spleen,and biceps-femoris muscle.Data were analyzed to determine effects of treatment,days of gestation,replicate,and sex on litter size,fetal measurements,and incidence of intrauterine growth restriction.Results Dietary Cr supplementation increased fetal brain weight to body weight ratios on d 90 of gestation(P<0.05)and fetal kidney weight to body weight ratios on d 60 of gestation(P<0.01),while days of gestation had significant effect on expression of mitochondrial CK isoform in gilt endometria(P<0.05).Conclusions Results suggest that dietary supplementation of Cr in gestating gilts enhanced development of select fetal organs and contribute to understanding roles of the Cr-CK-PCr system in pregnancy.
基金supported by the National Natural Science Foundation of China(No.81873843)the National Science and Technology Pillar Program of China during the Twelfth Five-Year Plan Period(No.2014BAI05B05)the Fundamental Research Funds for the Central Universities(No.2017KFYXJJ102 and 2019KFYXKJC053).
文摘Objective Sleep is fundamental to the physical and mental health of both the general population and pregnant women.Most studies have focused on the impact of certain trimester sleep behaviors on gestational complications and birth outcomes.This study aimed to explore the association between maternal sleep duration and fetal growth development from as early as 23 gestational weeks to birth.Methods A total of 803 pregnant women were prospectively enrolled.The self-reported maternal nocturnal sleep duration during all 3 trimesters was recorded.The outcome measures were reference-population-based Z-scores of fetal biometric measurements obtained through routine ultrasonographic examination.Results Using multiple linear regression,a marginally significant negative association was observed between second-trimester sleep duration and second-trimester fetal head circumference(HC)and third-trimester fetal biparietal diameter(BPD).Then the associations of long sleep duration in each trimester with fetal biometry extreme values were evaluated.A significant impact of second-trimester long sleep duration on the second-trimester BPD below the 10th percentile of the reference population was observed.Longitudinal analysis reported similar results for BPD and HC.Conclusions Overall,a negative association between sleep duration and fetal biometric measurements was observed.Long sleep durations in the second trimester might negatively impact fetal growth,particularly brain parameters,including BPD and HC.
基金supported by the National Key Research and Development Program of China(No.2022YFC2407406)Guangzhou Science and Technology Planning Project(No.2023B03J0596)2023 Stability Support for Innovative Capacity Building of Guangdong Provincial Scientific Research Institutions(No.KD022023019).
文摘Objective Placental dysfunction induced by fetal cardiopulmonary bypass(CPB)imposes limitations on the clinical application of this procedure.The potential impact of microRNA-mediated autophagy in placental endothelial cells on overall placental function remains elusive,necessitating a comprehensive exploration of the underlying mechanisms involved.Methods We established fetal sheep CPB models and employed immunohistochemistry to assess the placental expression of ATG7.Bioinformatic analysis,coupled with dual-luciferase reporter assays,was used to elucidate the intricate relationship between miR-320a and ATG7.Changes in ATG7 expression were further investigated through Western blotting and quantitative polymerase chain reaction(qPCR).Human umbilical vein endothelial cells(HUVECs)were cultured,and in vitro experiments were conducted to evaluate their regulatory effects on endothelial function.Immunoblotting was used to measure the expression levels of ATG7,endothelin-1(ET-1),SIRT1,and FOXO1,whereas enzyme-linked immunosorbent assay(ELISA)was used to quantify nitric oxide(NO)production.Results Sixty minutes after CPB,a substantial decrease in ATG7 expression in placental tissue was observed.The downregulation of ATG7 expression led to increased ET-1 production in HUVECs,concomitant with decreased NO production.miR-320a was identified as a specific regulator of ATG7 expression,with subsequent experiments demonstrating a significant reduction in placental ATG7 levels upon injection of the miR-320a agomir compared with the miR-320a antagomir during fetal sheep CPB.In HUVECs,miR-320a downregulated ATG7,resulting in increased ET-1 production and diminished NO production.Treatment with the miR-320a mimic/miR-320a inhibitor revealed that miR-320a inhibited the SIRT1/FOXO1 pathway in HUVECs by downregulating ATG7 expression,culminating in increased ET-1 production and reduced NO levels.Conclusion The observed downregulation of placental ATG7 expression subsequent to fetal CPB is intricately associated with endothelial dysfunction.Furthermore,our findings underscore the specific regulatory role of miR-320a in modulating ATG7 expression within the placenta.At the cellular level,increasing the level of miR-320a has emerged as a potential strategy for modulating endothelial function through the inhibition of ATG7 and the SIRT1/FOXO1 pathway.
文摘Congenital heart disease(CHD)is the most common congenital anomaly and a major cause of death among fetal malformations,but prenatal diagnosis is considered to be low.The development of artificial intelligence(AI)in fetal echocardiography has made it possible to automate and standardise the examination,improving the variation in CHD detection rates between different regions and reducing the reliance on operator experience.AI includes any computer program(algorithms and models)that mimics human logic and intelligence,and its use in fetal echocardiography is mainly to acquire and optimise images,perform automatic measurements,identify discrepant values,and diagnose and classify pathologies.In this review,we will look at the different practical applications of AI in fetal echocardiography.
文摘BACKGROUND Fetal hydrops is a serious condition difficult to manage,often with a poor prognosis,and it is characterized by the collection of fluid in the extravascular compartments.Before 1968,the most frequent cause was the maternal-fetal Rh incompatibility.Today,90%of the cases are non-immune hydrops fetalis.Multiple fetal anatomic and functional disorders can cause non-immune hydrops fetalis and the pathogenesis is incompletely understood.Etiology varies from viral infections to heart disease,chromosomal abnormalities,hematological and autoimmune causes.CASE SUMMARY A 38-year-old pregnant woman has neck lymphoadenomegaly,fever,cough,tonsillar plaques at 14 wk of amenorrhea and a rash with widespread itching.At 27.5 wk a fetal ultrasound shows signs of severe anemia and hydrops.Cordocentesis is performed with confirmation of severe fetal anemia and subsequent fetal transfusion.The karyotype is 46,XX,array-comparative genome hybridization(CGH)negative,and infectious tests are not conclusive.In the following days there is a progressive improvement of the indirect signs of fetal anemia.At 33.6 wk,for relapse of severe fetal anemia,further fetal transfusions are necessary and an urgent cesarean section is performed.On the day 12 of life,for the detection of anemia,the newborn is subjected to transfusion of concentrated red blood cells and begins treatment with erythropoietin.Later there is a normalization of blood chemistry values and the baby does not need new transfusions.A 29-year-old pregnant woman,with Sjogren's syndrome and positive Anti-Ro/SSA antibodies,is subjected to serial fetal ecocardio for branch block.At 26.5 wk there is a finding of fetal ascites.Infectious disease tests on amniotic fluid are negative as well as quantitative fluorescent polymerase chain reaction,Array CGH.At cordocentesis Hb is 1.3 mmol/L,consequently fetal transfusion is performed.Also in this case,due to continuous episodes of relapse of fetal anemia with consequent transfusions,at 29.4 wk a cesarean section is performed.On day 9 of life,a treatment with erythropoietin is started in the newborn,but the baby needs three blood transfusions.The search for autoantibodies in the baby found SS-A Ro60 positive,SSA-Ro52 positive and SS-B negative.The hemoglobin values normalized after the disappearance of maternal autoantibodies.CONCLUSION An attempt to determine the etiology of hydrops should be made at the time of diagnosis because the goal is to treat underlying cause,whenever possible.Even if the infectious examinations are not conclusive,but the pregnancy history is strongly suggestive of infection as in the first case,the infectious etiology must not be excluded.In the second case,instead,transplacental passage of maternal autoantibodies caused hydrops fetalis and severe anemia.Finally,obstetric management must be aimed at fetal support up to an optimal timing for delivery by evaluating risks and benefits to increase the chances of survival without sequelae.
文摘Goiter is an enlargement of the thyroid gland which can be associated with a number of complications both for the mother and the fetus. A 34-year-old pregnant woman with normal thyroid function was referred to our Department of Obstetrics and Gynecology at Microcitemico Pediatric Hospital, Cagliari, for suspected fetal goiter at 32 gestational weeks. The case was monitored regularly by ultrasound and treated successfully with intra-amniotic levothyroxine (L-T4) administration. Fetal goiter was observed to decrease after this treatment and the thyroid ultrasound findings were also normal both at birth and in subsequent follow-ups. Our case report confirms the feasibility of conservative treatment with L-T4, which can effectively prevent complications related to fetal goiter.
文摘Background: Fetal weight estimation by ultrasound is an important factor in obstetrics;it is directly related to the gestational age which helps to plan the mode of delivery and labor management. Objective: to compare between fetal thigh circumference (TC) and abdominal subcutaneous tissue thickness (SCT) in estimating birthweight in term pregnant women. Patients and Methods: This prospective cohort study was conducted at outpatient clinic or emergency room, Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from March 2022 until May 2023. During this study, 100 term pregnant females with gestational age 37 - 40 weeks attended El Demerdash Maternity Hospital and scheduled for delivery either at outpatient clinic or emergency room were enrolled, after consenting each of them. Basic fetal biometry was performed by an expert and professional medical personnel to ensure the accuracy of examination results. Fetal abdominal subcutaneous thickness and fetal thigh circumference were measured for assessment of gestational age and correlated with actual fetal body weight. In the current study, three formulas;Hadlock, Vintzileos’ and SCT formula were correlated with actual fetal body weight after birth. Results: The present study revealed that TC formula is closer to the actual birth weight, followed by Hadlock formula, while the SCT formula is the furthest from it. Conclusion: To increase the accuracy of birth estimations, regular ultrasound examinations should include fetal thigh circumference measurement.
基金Supported by 863 Program of China(2007AA10Z161)National Natural Science Foundation of China(30771545)~~
文摘[Objective]The aim was to study the differential expression ofAPOEgene in different generations of porcine fetal fibroblasts cells.[Method]The first,tenth,fifteenth,twentieth,twenty-fifth,fiftieth generations of porcine fetal fibroblast cells,which were normally grown and passed,were collected before total RNA was extracted respectively.The expression ofAPOEgene in different generations of porcine fetal fibro-blast cells was detected by RT-PCR technique.[Result]The expression level of porcine APOE mRNA in the first generation of porcine fetal fi-broblast cells was the highest,and then it gradually decreased with the increase of cell generations and was the lowest in the fiftieth generation.[Conclusion]The expression ofAPOEgene had the selective trend in different generations of porcine fetal fibroblast cells.
基金supported by the National Natural Science Foundation of China(No.30973833)
文摘Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. This study investigated vascular morphology and expression of these angiogenic factors in rat placenta on the day 15, 18, 21 of gestation （D 15, D 18 and D21）. The rats were randomly assigned into 3 groups： normal group, model group [fetal growth restriction （FGR） model], and Bushen Tqi Huoxue （BYHR） recipe treatment group （BYHR group, the pregnant rats with FGR were treated with BYHR recipe）. Morphological analysis indicated that during initial villous formation, fetal nucle- ated erythrocytes （FNEs） appeared in maternal blood sinus （MBS）. Subsequently, FNEs were sur- rounded by endothelial cells to form fetal capillary （FC） and then by trophoblast cells to form villi. As pregnancy proceeded, FC density increased progressively with increasing endothelial identification staining （EIS） in normal and BYHR groups. Whereas, villous formation was suppressed, normal in- crease in FC density was impaired and EIS was weakened in model group. Quantitative PCR analysis showed that VEGF and Flkl mRNA increased over gestation in all groups, indicating that VEGF might play a pivotal role in FC growth during late gestation. VEGF mRNA was increased on D15, while de- creased on D21 in model group as compared with normal group and BYHR group. Immunohistochemi- cally, Ang-2 protein was highly expressed in FNEs, gradually disappeared as villi matured, and decreased over gestation in all groups, indicating that Ang-2 might play a pivotal role in villous formation, which was further supported by decreased Ang-2 mRNA and protein expression in model group on D 15. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio increased from D15 to D18 in all groups as placenta matured. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio were decreased on D18 in model group as compared with normal and BYHR groups, indicating delayed maturity of FGR placenta. Alterations in angiogenic factors may result in altered placental vasculature and cause placental insufficiency. BYHR recipe could balance the angiogenic factors to promote the formation and maturation of FGR placental vasculature.
基金supported by NIH grants R01NS97846,R01NS097846-02S1 and R01NS092876 awarded to MESShriners research grant SHC-85400 awarded to MESUSA Pennsylvania State Department grant Project 10:420491-04400-02 to ND。
文摘The pathology of fetal alcohol syndrome and the less severe fetal alcohol spectrum disorders includes brain dysmyelination.Recent studies have shed light on the molecular mechanisms underlying these white matter abnormalities.Rodent models of fetal alcohol syndrome and human studies have shown suppressed oligodendrocyte differentiation and apoptosis of oligodendrocyte precursor cells.Ethanol exposure led to reduced expression of myelin basic protein and delayed myelin basic protein expression in rat and mouse models of fetal alcohol syndrome and in human histopathological specimens.Several studies have reported increased expression of many chemokines in dysmyelinating disorders in central nervous system,including multiple sclerosis and fetal alcohol syndrome.Acute ethanol exposure reduced levels of the neuroprotective insulin-like growth factor-1 in fetal and maternal sheep and in human fetal brain tissues,while ethanol increased the expression of tumor necrosis factor α in mouse and human neurons.White matter lesions have been induced in the developing sheep brain by alcohol exposure in early gestation.Rat fetal alcohol syndrome models have shown reduced axon diameters,with thinner myelin sheaths,as well as reduced numbers of oligodendrocytes,which were also morphologically aberrant oligodendrocytes.Expressions of markers for mature myelination,including myelin basic protein,also were reduced.The accumulating knowledge concerning the mechanisms of ethanol-induced dysmyelination could lead to the development of strategies to prevent dysmyelination in children exposed to ethanol during fetal development.Future studies using fetal oligodendrocyte-and oligodendrocyte precursor cell-derived exosomes isolated from the mother's blood may identify biomarkers for fetal alcohol syndrome and even implicate epigenetic changes in early development that affect oligodendrocyte precursor cell and oligodendrocyte function in adulthood.By combining various imaging modalities with molecular studies,it may be possible to determine which fetuses are at risk and to intervene therapeutically early in the pregnancy.
文摘Objective:This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty(FPV)in fetuses with pulmonary atresia with intact ventricular septum(PA/IVS).Methods:From August 31,2018,to May 31,2019,seven fetuses with PA/IVS and hypoplastic right heart were included in this study.All underwent echocardiography by the same specialist and were operated on by the same team.Intervention and echocardiography data were collected,and changes in the associated indices noted during follow-up were analyzed.Results:All seven fetuses successfully underwent FPV.The median gestational age at FPV was 27.54 weeks.The average FPV procedural time was 6 min.Persistent bradycardia requiring treatment occurred in 4/7 procedures.Finally,five pregnancies were successfully delivered,and the other two were aborted.Compared to data before fetal cardiac interventions(FCI),tricuspid valve annulus diameter/mitral valve annulus diameter(TV/MV)and right ventricle diameter/left ventricle diameter(RV/LV)of all fetuses had progressively improved.The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s.The average follow-up time was 30.40±2.05 months.During the follow-up period,the diameter of the tricuspid valve ring in five children continued to improve,and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth.However,the development of the right ventricle after birth was relatively slow.It was discovered that there were individual variations in the development of the right ventricle during follow-up.Conclusion:The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI.Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy.The right ventricle develops rapidly in utero,but the development of tricuspid valve is more apparent after birth than in utero.
文摘<div style="text-align:justify;"> The morbidity and mortality of the fetus is related closely with the neonatal respiratory morbidity, which was caused by the immaturity of the fetal lung primarily. The amniocentesis has been used in clinics to evaluate the maturity of the fetal lung, which is invasive, expensive and time-consuming. Ultrasonography has been developed to examine the fetal lung quantitatively in the past decades as a non-invasive method. However, the contour of the fetal lung required by existing studies was delineated in manual. An automated segmentation approach could not only improve the objectiveness of those studies, but also offer a quantitative way to monitor the development of the fetal lung in terms of morphological parameters based on the segmentation. In view of this, we proposed a deep learning model for automated fetal lung segmentation and measurement. The model was constructed based on the U-Net. It was trained by 3500 data sets augmented from 250 ultrasound images with both the fetal lung and heart manually delineated, and then tested on 50 ultrasound data sets. With the proposed method, the fetal lung and cardiac area were automatically segmented with the accuracy, average IoU, sensitivity and precision being 0.98, 0.79, 0.881 and 0.886, respectively. </div>
文摘Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Results Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks’ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, 1 case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were per-formed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart. All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conclusion The prognosis is well for most of the fetuses with arrhythmias, with low incidence of heart deformation.
