An intrauterine umbilical coiling index can be determined by ultrasound and correlates well with the actual index at birth. The sonographic umbilical coiling index is related to Doppler flow characteristics in the umbilical vein.

No abstract

No abstract

Third-trimester pregnancy is characterized by sympathetic overactivity. When complicated by preeclampsia, sympathetic overreactivity to cardiovascular reflex testing is observed. Our data support the notion that the pathophysiologic phenomena that characterize preeclampsia are mediated not only by circulating or locally acting vasoactive substances, but also, at least in part, by an increase in sympathetic nervous tone.

ABSTRACT. Using the conductance catheter technique, assessing fetal status during labor. The diagnosis of fetal comprowe measured the effects of hypoxic acidemia on left ven-mise is based upon the recognition of different fetal heart rate tricular end-systolic elastance in anesthetized, 133-d ges-patterns, several of which are nonspecific and often lead to the tation, in utero fetal sheep (n = 7). Conductance and Millar overdiagnosis of fetal distress. Our aim, as clinicians, is to corcatheters were introduced into the left ventricle through a rectly identify those cases in which hypoxic acidemia is the carotid artery cutdown. Fetuses were rendered progres-underlying cause for the heart rate changes. Metabolic acidemia sively hypoxic and acidemic by placental embolization with and changes in intracellular pH have been shown to affect repeated injections of 5.10' 50-pm plastic spheres every myocardial function (1). Indices of cardiac function with the 15 min via a catheter placed in the fetal abdominal aorta. potential to reflect fetal distress more accurately should therefore We recorded pressure-volume data and arterial blood gases be investigated. at 15-min intervals. End-systolic elastance was computedThe present study was devised to examine the effects of hyusing a single-beat method of extrapolating maximum iso-poxic acidemia on myocardial function in in urero fetal sheep. volumic pressure. A mean of five boluses was required to The conductance catheter technique, which has little effect on cause fetal death. Placental embolization caused progres-cardiac mechanics, was used to measure fetal LV volume. E,,, sive fetal acidemia. Mean baseline fetal arterial pH was the slope of the ESPVR, was measured to assess ventricular 7.32 f 0.06 (mean f SD) and gradually decreased with contractility. It is a relatively load-and heart rate-insensitive embolization (p < 0.0001). A linear relationship was found measure of the intrinsic contractile properties ofthe myocardium to exist between elastance and pH with a mean decrease (2, 3). This technique has previously been used in the human of 0.46 kPa/mL per 0.1-unit drop in pH ( r = 0.96; p < adult as well as in numerous animal models and age groups (4-0.0001). Despite the decrease in end-systolic elastance, 6), but this, to our knowledge, is the first application in the fetus. stroke volume and left-ventricular output were maintained Other more traditional indices of cardiac performance were also due to a parallel decrease in afterload. The decrease in correlated with the deteriorating fetal acid-base status induced end-systolic elastance was gradual and extended over the by progressive placental embolization. entire clinically important range of pH, rather than being a terminal event. This study, which, to our knowledge, is MATERIALS AND METHODS the first to use the conductance catheter to measure fetal left ventricular function demonstrates that hypoxic acideStirgical procedzire. Surgery was performed on seven pregnant mia adversely affects myocardial contractility asses...

A case of fetal gastroschisis associated with 45,XY,-22/46,XY mosaicism and absent cerebral diastolic flow is described. This is the third case reported of monosomy 22 mosaicism, and the first one to be diagnosed antenatally.

Echocardiographic hemodynamic and left ventricular parameters were determined in 14 normotensive and 18 hypertensive women during the last trimester of pregnancy. The hypertensive patients had significantly higher mean values of total peripheral resistance (p < 0.001), maximum velocity of posterior wall motion (p < 0.05), mean velocity of circumferential fiber shortening (p < 0.01) and percent fiber shortening of left ventricular diameter (p < 0.05). The mean values for heart rate, stroke volume, cardiac output, cardiac index, left ventricular posterior wall thickness and septal thickness did not differ significantly in both groups. These results reflect increased cardiac contractility related to elevated peripheral vascular resistance in subjects with pregnancy-induced hypertension.

The effect of ventriculomegaly on pulsatile flow in the internal carotid arteries has been studied by Doppler ultrasound in four hydrocephalic fetuses. The pulsatility index showed progressive elevation proportional to the developing ventriculomegaly and thus may be a valuable index for the study of the mechanism of brain injury and for the determination of optimal timing of intervention.