Physiology and management of intrauterine growth retardation: A biologic approach with fetal blood sampling

Cox, Wendy L.; Daffos, F.; Forestier, F.; Descombey, D.; Aufrant, C; Auger, Marie-Claire; Gaschard, Jean-Claude

doi:10.1016/0002-9378(88)90490-5

Cited by 62 publications

(24 citation statements)

References 7 publications

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“…The presence of fetal hypoxia in the context of intrauterine growth restriction, but not in PTL, has been studied extensively in the past using cordocentesis [146,147,151–153]. In one of the largest studies, Nicolaides et al [146] compared the umbilical arterial and venous pH, PaO 2 , PaCO 2 and LDH in small for gestational age (SGA) fetuses with appropriate for gestational age (AGA) fetuses.…”

Section: Discussionmentioning

confidence: 99%

Blood pH and gases in fetuses in preterm labor with and without systemic inflammatory response syndrome

Romero¹,

Soto²,

Berry³

et al. 2011

The Journal of Maternal-Fetal & Neonatal Medicine

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OBJECTIVE Fetal hypoxemia has been proposed to be one of the mechanisms of preterm labor (PTL) and delivery. This may have clinical implications since it may alter: 1) the method/frequency of fetal surveillance; and 2) the indications and duration of tocolysis to an already compromised fetus. The aim of this study was to examine whether there is a difference in the fetal blood gas analysis [pH, PaO2 and base excess (BE)] and in the prevalence of fetal acidemia and hypoxia between: 1) patients in PTL who delivered within 72 hours vs. those who delivered more than 72 hours after cordocentesis; and 2) patients with Fetal Inflammatory Response Syndrome (FIRS) vs. those without this condition. STUDY DESIGN Patients admitted with PTL underwent amniocentesis and cordocentesis. Ninety women with singleton pregnancies and PTL were classified according to 1) those who delivered within 72 hours (n = 30) and after 72 hours of the cordocentesis (n = 60); and 2) with and without FIRS. FIRS was defined as a fetal plasma concentration of IL-6 >11 pg/mL. Fetal blood gases were determined. Acidemia and hypoxemia were defined as fetal pH and PaO2 below the 5th percentile for gestational age, respectively. For comparisons between the two study groups, ΔpH and ΔPaO2 were calculated by adjusting for gestational age (Δ = observed value-mean for gestational age). Non-parametric statistics were employed. RESULTS No differences in the median Δ pH (−0.026 vs. −0.016), ΔPaO2 (0.25 mmHg vs. 5.9 mmHg) or BE (−2.4 mEq/L vs. −2.6 mEq/L) were found between patients with PTL who delivered within 72 hours and those who delivered 72 hours after the cordocentesis (p>0.05 for all comparisons). Fetal plasma IL-6 concentration was determined in 63% (57/90) of fetuses and the prevalence of FIRS was 28% (16/57). There was no difference in fetal pH, PaO2 and BE between fetuses with and without FIRS (p>0.05 for all comparisons). Moreover, there was no difference in the rate of fetal acidemia between fetuses with and without FIRS (6.3% vs. 9.8%; p>0.05) and fetal hypoxia between fetuses with or without FIRS (12.5% vs. 19.5%; p>0.05). CONCLUSIONS Our data do not support a role for acute fetal hypoxemia and metabolic acidemia in the etiology of preterm labor and delivery.

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Section: Discussionmentioning

confidence: 99%

Blood pH and gases in fetuses in preterm labor with and without systemic inflammatory response syndrome

Romero¹,

Soto²,

Berry³

et al. 2011

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Vergleichbar sind unsere Daten mit den Ergebnissen von Nicolaides et al [6], Dagegen fanden andere Autoren [7][8][9] keine gestationsabhängigen pH-Wert-Veränderun-gen in ihren Untersuchungen. Als Ursache für den gesta tionsabhängigen pH-Abfall wird eine steigende Produk tion von Laktat durch die Plazenta angenommen.…”

Section: Diskussionunclassified

“…Andere Autoren [6,7] fanden eben falls sinkende pCF-Werte im Verlauf der Schwanger schaft, mit dem Unterschied, dass der pCF-Abfall in ihren Untersuchungen steiler ist. Die Ausgangs-pCFWerte dieser Arbeitsgruppen sind insgesamt auch etwas höher als in unserer Studie.…”

Section: Diskussionunclassified

“…Die Differenzen zwischen den Untersuchungsergebnissen sind durch die verschie denen Grössen der Untersuchungskollektive und durch die unterschiedlichen Gerätetypen zur Blutgasmessung erklärbar. Einen mit zunehmendem Gestationsalter an steigenden pCOi-Verlauf, der bereits in einigen Untersu chungen [6][7][8] [11,12] und neuerdings auch des venösen Systems [13] zuverlässige Informationen über den unmittelbaren Zustand geben. Einige Autoren empfehlen bei solch pa thologischen Schwangerschaften eine Nabelschnurpunk tion, die nicht nur zum Ausschluss einer Chromosomen aberration dienen kann, sondern auch zur Bestimmung des Blutgas-und Säure-Basen-Haushalts [14][15][16], In eini gen Fällen kann somit die Einleitung der Geburt abgewar tet werden.…”

Section: Diskussionunclassified

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Normwertkurven für intrauterine fetale Blutgas- und Säure-Basen-Parameter im 2. und 3. Trimenon

Schröter

Chaoui

Glatzel

et al. 1997

Gynäkol Geburtshilfliche Rundsch

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Fragestellung: Ziel der Arbeit war die Erstellung gestationsabhängiger Referenzkurven für fetale Blutgas- und Säure-Basen-Parameter während der 2. Schwangerschaftshälfte. Methoden: Bei 155 zeitgerecht entwickelten Feten wurde zwischen der 18. und der 39. Schwangerschaftswoche eine diagnostische Nabelschnurpunktion durchgeführt und aus dem Nabelvenenblut zusätzlich der Blutgas- und Säure-Basen-Status bestimmt. Im einzelnen wurden der pH-Wert, der Sauerstoffpartialdruck und der Kohlendioxidpartialdruck mit einem pH-Blut-gasanalysator AVL 995 gemessen und die Sauerstoffsättigung, die Bikarbonat-Ionen-Kon-zentration und der Base excess errechnet. Danach wurden eine lineare Regression bezogen auf das Gestationsalter errechnet und das 95%ige Konfidenzintervall gebildet. Ergebnisse: Mit zunehmender Dauer der Schwangerschaft zeigte der Kurvenverlauf von pH-Wert, Sauerstoffpartialdruck und Sauerstoffsättigung einen signifikanten Abfall, während der Kohlendioxidpartialdruck signifikant anstieg. Die Bikarbonat-Ionen-Konzentration und der Base excess blieben dagegen konstant. Schlussfolgerungen: Die Ergebnisse geben einen Einblick in die Physiologie der fetalen Regulation des Säure-Basen-Haushalts und sollen als Referenzkurven zur Beurteilung antenataler Blutgasanalysen hypoxisch gefáhrdeter Feten dienen.

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“…Therefore catecholamines detected in fetal blood are considered to be released into the blood from fetal organs: increased catecholamines imply fetal stress. Recently fetal blood sampling using ultrasoundguided cordocentesis has enabled us to eval uate fetal well-being on hematological and biochemical bases [1,2], In this study we determined the catecholamine concentration in fetal blood and made an effort to deter mine which biochemical parameters could better correlate with the catecholamine con centration values in order to precisely evalu ate the degree of fetal compromise. …”

mentioning

confidence: 99%

Catecholamine Levels and Their Correlation to Blood Gases in Umbilical Venous Blood Obtained by Cordocentesis

Okamura

Watanabe²,

Tanigawara³

et al. 1990

Fetal Diagn Ther

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The plasma catecholamine concentration was evaluated in umbilical venous blood obtained by cordocentesis performed in 77 fetuses for indications including: nonimmune hydrops; Rh incompatibility; intrauterine growth retardation; polyhydramnios; anomalies; immunological disorders, and possible viral infection. The pH as well as pO₂ of the umbilical venous blood showed a notably significant negative correlation with the norepinephrine concentration (r = ––0.5607, r = ––0.4467); while pCO₂ was also significantly correlated with the norepinephrine concentration (r = 0.4955). When the pCO₂/pO₂ ratio was tentatively put up for comparison, the ratio was undoubtedly better correlated (r = 0.60442) with the fetal norepinephrine concentration than any other biochemical variable. Moreover, the ratio over 2.0 suggests that fetal catecholamine values have reached abnormal levels.

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Physiology and management of intrauterine growth retardation: A biologic approach with fetal blood sampling

Cited by 62 publications

References 7 publications

Blood pH and gases in fetuses in preterm labor with and without systemic inflammatory response syndrome

Blood pH and gases in fetuses in preterm labor with and without systemic inflammatory response syndrome

Normwertkurven für intrauterine fetale Blutgas- und Säure-Basen-Parameter im 2. und 3. Trimenon

Catecholamine Levels and Their Correlation to Blood Gases in Umbilical Venous Blood Obtained by Cordocentesis

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