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Notes: Objective To examine whether in women who are delivered of an extremely small for gestational age infant, raised levels of second trimester maternal serum alpha-fetoprotein (MSAFP) or human chorionic gonadotrophin (MShCG) levels are related to the presence of placental pathology detected at birth.Design Retrospective cross-sectional study.Setting Department of Obstetrics and Gynaecology, Antenatal Diagnosis Unit, Groningen University Hospital, The Netherlands.Participants Eighty-four women who were delivered of an extremely SGA infant (〈 2.3rd centile) in whom the MSAFP and the MShCG levels were known and placental pathology reports were available (study group), and 8692 women in whom the MSAFP and MShCG levels were known and the pregnancy outcome was normal (control group). Pregnancies with congenital anomalies were excluded. Analyte levels were expressed in multiples of the median (MOM) for gestational age. Statistical analysis between groups was performed by ANOVA, after logarithmic transformation of the MOMS, to normalise their distribution.Main outcome measures 1. The means of the MSAFP and MShCG concentrations in the study group with and without placental lesions were compared with those in the control population. 2. The means of the MSAFP and MShCG levels in the study group with placental lesions were compared with those in the study group without placental lesions.Results 1. Comparison of study groups with controls: in the study group without placental lesions, the mean log MSAFP MOM (0.062), as well as the mean log MShCG MOM (–0.033), was not significantly different (P= 0.11 and P= 0.68, respectively) from the mean analyte levels in the control population (0.002 and 0.006, respectively). The mean logs of these analytes in the study group with placental lesions (0.162 and 0.129, respectively) were significantly higher compared with the MSAFP and MShCG levels in the control population (P 〈 0.001 for both analytes). 2. Comparison of study groups with each other: the mean log of the MSAFP level of 0.162 in the group with placental lesions was significantly different from the mean of 0.062 of the study group without placental lesions (P 〈 0.025). The higher mean log MShCG MOM of 0.129 in the group with placental lesions was significantly different from the mean log MShCG MOM of −0.033 in the study group without placental lesions (P 〈 0.025).Conclusions Raised levels of second trimester MSAFP and MShCG in women who are subsequently delivered of an extremely small for gestational age infant are related to the presence of pathological changes in the placenta, detectable at birth. It is speculated that these placental pathological changes, which frequently accompany small for gestational age pregnancies, have their origin in the second trimester, when the normal physiological changes of the placenta occur.

Notes: Summary. The histopathological appearance of conception products from 44 women with recurrent miscarriage was compared with those obtained from 105 women with sporadic miscarriage. Abnormal villi, suggesting fetal chromosomal abnormalities, were found in 62% of women with a recurrent miscarriage and in 58% of those with sporadic miscarriage. This difference is not statistically significant.

Notes: Objective To review the use of a membrane-free haemolysate prepared from maternal blood to distinguish the amniotic sacs at amniocentesis in twin gestation.Setting University Hospital, Groningen.Method Haemoglobin solution prepared from maternal blood.Subjects 63 twin pregnancies having amniocentesis.Results The fetal loss before 28 weeks was 4%. There was no perinatal mortality. Dye was detected in the second sac in 9 of 24 women tested before 1985 and none of the 39 women since, no malformations could be ascribed to the use of the haemolysate.Conclusion The use of the membrane-free haemolysate is safe, but the technique will probably gradually become redundant because of improved ultrasound.

Notes: Objective To investigate normal fetal heart rate in early pregnancy and assess the hypothesis that abnormal fetal heart rate is associated with fetal chromosomal abnormalities.Design Prospective descriptive cross-sectional study.Setting Antenatal clinic associated to the University Clinic of Obstetrics, University Hospital Groningen, The Netherlands.Subjects 424 pregnant women who attended for prenatal counselling.Interventions Measurements of fetal heart rate from 6–16 weeks gestation, cross-sectional study.Main outcome measures Fetal heart rate expressed as beats/min.Results Karyotyping showed a normal chromosomal pattern in 414 fetuses. The median fetal heart rate increased from 138 beats/min at 6 weeks to 177 beats/min at 9 weeks, thereafter, fetal heart rate gradually decreased to 150 beats/min at 16 weeks. Karyotyping showed 10 abnormalities: five trisomies 21, three trisomies 18, and two mosaic patterns in chorionic villi. Fetal heart rate of the trisomic fetuses was distributed around the median with that of all Down's syndrome fetuses within the normal range. In one fetus with trisomy 18, the heart rate exceeded the 90th centile, in another it fell under the 10th centile. The two fetuses with a mosaic pattern in chorionic villi had heart rates outside the normal range.Conclusion Fetal heart rate in chromosomally abnormal fetuses in early pregnancy do not appear to be consistently different from that in normal fetuses. The use of a single measurement of fetal heart rate is not valuable for screening purposes. Chromosomal mosaicism in chorionic villi may be associated with abnormal fetal heart rate.