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  • 1
    ISSN: 1432-0568
    Keywords: Key words Nuchal translucency ; Trisomy 16 ; Trisomy 21 ; Trisomy 18 ; Trisomy 13
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  An increase in the nuchal translucency that can be detected at 10–14 weeks of gestation by ultrasound forms the basis for a screening test for chromosomal abnormality. Several mechanisms leading to this increase in skin thickness have been proposed, including changes of the extracellular matrix, cardiac defects and abnormalities of the large vessels. This study examines the composition of the extracellular matrix of the skin in gestational age-matched fetuses with trisomy 21, 18 and 13 from 12–18 weeks. Immunohistochemistry was applied with monoclonal and polyclonal antibodies against collagen type I, III, IV, V and VI and against laminin and fibronectin. Collagen type VI gene expression was further studied by in situ hybridization to detect differences in expression patterns of COL6A1, COL6A3 and COL1A1 between normal fetuses and those with trisomy 21. The ultrastructure of tissue samples was studied by transmission electron microscopy (TEM) and additionally by immunogold TEM. Further, we examined the morphology of the skin in an animal model for Down’s syndrome, the murine trisomy 16, by light and TEM. The dermis of trisomy 21 fetuses was richer in collagen type VI than that of normal fetuses and other trisomies, and COL6A1, located on chromosome 21, was expressed in a wider area than COL6A3, which is located on chromosome 2. Collagen type I was less abundant in the skin of trisomy 18 fetuses, while the skin of all three trisomies contained a dense network of collagen type III and V in comparison with normal fetuses. Collagen type IV, of which two genes are located on chromosome 13, was expressed in the basement membranes of the skin in all fetuses and additionally in the dermal fibroblasts only of trisomy 13 fetuses. Likewise, laminin was present in all basement membranes of normal and trisomic fetuses as well as in dermal fibroblasts of fetuses with trisomy 18. LAMA1 and LAMA3 genes are located on chromosome 18. Dermal cysts were found in the skin of trisomy 18 and 13, but not in trisomy 21 and normal fetuses. Ultrastructural findings showed that an extracellular precipitate containing glycosaminoglycans was regularly present in the skin of trisomy 21 fetuses and murine trisomy 16 embryos. In conclusion, this study suggests that the skin edema in fetal trisomies is characterized by specific alterations of the extracellular matrix that may be attributed to gene dosage effects as a result of a genetic imbalance due to the condition of fetal trisomy.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1076
    Keywords: Pulmonary hypoplasia ; Functional residual capacity ; Prematurity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Serial measurements of functional residual capacity (FRC) were made in 22 infants (median gestational age at delivery 32 weeks, range 25–40) during the first 2 years of life. All infants had been delivered from pregnancies complicated by prolonged and preterm rupture of the membranes (PPROM) of at least 1 week in duration. The onset of membrane rupture was at a median of 26 weeks (range 15–32) with a median duration of 5.5 weeks (range 1–21). The mean FRC at all postnatal ages studied: 25 ml/kg at 6 and 12 months and 24ml/kg at 18 and 24 months did not differ significantly from the control population (mean 24ml/kg). There was, however, a wider scatter of results in the study population: four infants born very preterm consistently had FRC results above the 95% confidence limits of the controls but only two infants had FRCs consistently below this range. These results suggest PPROM may not be an invariable association of abnormal antenatal lung growth.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 156 (1997), S. 550-552 
    ISSN: 1432-1076
    Keywords: Key words Amniocentesis ; chorion villus sampling ; Neonatal intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neonatal respiratory difficulties are increased following second trimester amniocentesis. In preterm, prolonged rupture of the membranes, respiratory outcome is particularly poor when rupture occurs in the first trimester. It therefore seems likely that first trimester/early amniocentesis (EA) would be associated with severe respiratory problems necessitating a high neonatal intensive care unit (NICU) admission rate. To test that hypothesis, the requirement for admission to the NICU of 278 infants whose mothers had undergone EA, 262 whose mothers had undergone chorion villus sampling (CVS group) and 264 controls whose mothers had undergone no invasive procedures were reviewed as were their diagnoses if they needed admission. There was no significant difference in the mode of delivery, gestational age or gender distribution of the three groups and the median maternal age of the EA and CVS groups was similar. Nineteen EA, eight CVS and five control infants required admission to the NICU (EA versus controls, P 〈 0.01; EA versus CVS plus controls, P 〈 0.005). Nine EA, one CVS and four control infants had suffered respiratory problems (EA versus CVS P 〈 0.05). Logistic regression analysis demonstrated that immaturity and EA were significantly associated with a requirement for NICU admission. We conclude infants whose mothers have undergone EA may be at increased risk for NICU admission, this is partly due to respiratory problems but the association is uncommon.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 151 (1992), S. 528-531 
    ISSN: 1432-1076
    Keywords: Respiratory distress syndrome ; Prematurity ; Small for gestational age ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neonatal ventilatory requirements and outcome were examined in 135 very preterm, small-for-gestational age (SGA) infants to determine whether fetal growth retardation protects against severe respiratory distress syndrome (RDS) in very immature infants. Their results were compared to those from gestational age-and gender-matched controls. Although there was no significant difference in the median duration of mechanical ventilation between the two groups, more SGA infants required ventilation and were ventilated because of RDS. In a subgroup also matched for mode of delivery, there was no significant difference between the proportion of SGA infants requiring mechanical ventilation for RDS compared to their matched controls. The mortality was greater in the SGA group. We conclude that fetal growth retardation does not protect against severe RDS.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In singleton pregnancies at 10 to 14 weeks of gestation the prevalence of missed abortion is about 2%. In an ultrasound screening study at 10 to 14 weeks of gestation involving 492 twin pregnancies the prevalence of missed abortion was about twice as high as in singletons. The risk of subsequent miscarriage in twin pregnancies with one missed abortion was about ten times higher than in normal twin pregnancies. These findings may have important implications both in terms of counselling and for future research into the causes of miscarriage.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To examine the potential value of maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) and pregnancy-specific βl-glycoprotein (SP1) in the detection of fetal trisomy.Design Cross-sectional study.Setting The Harris Birthright Research Centre For Fetal Medicine, King's College Hospital Medical School, London, UK and Division of Maternal-Fetal Medicine, Jefferson Medical College, Philadelphia, USA. Subjects and methods Maternal serum PAPP-A and SP1 concentrations were measured at 10 to 13 weeks gestation in samples from 42 pregnancies with fetal trisomy (trisomy 21, n= 29; trisomy 18, n= 9; trisomy 13, n= 4) and in samples from 210 matched controls.Results In controls, both maternal serum PAPP-A and SP1 increased significantly with gestation and in trisomic fetuses levels of both hormones were reduced. However, discriminant analysis demonstrated that SP1 did not contribute significantly in the distinction between trisomic and control pregnancies. Although levels of PAPP-A were reduced throughout the gestational range examined (10 to 13 weeks), especially in cases with fetal trisomy 21, the deviation was more pronounced at 10 to 11 weeks than at 12 to 13 weeks gestation. In 45% of pregnancies with fetal trisomy 21 and 70% of pregnancies with trisomies 18 or 13 maternal serum PAPP-A levels at 10 to 11 weeks gestation were below the 5th centile of the normal range.Conclusion Maternal serum PAPP-A concentration in the first trimester of pregnancy may prove to be useful in the prediction of risk for fetal trisomies.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To assess the ability of noninvasive tests of fetal wellbeing to predict hypoxic morbidity independent of fetal size.Design A prospectively planned, longitudinal, observational study.Setting Fetal Surveillance Unit, King's College Hospital, London.Subjects One hundred and ninety-one pregnant women with singleton pregnancies who were delivered after 32 weeks' gestation who were seen in the Fetal Surveillance Unit within seven days of delivery.Interventions Fetal surveillance by fetal abdominal circumference, heart rate variability (mean range), biophysical profile score and umbilical artery pulsatility index measurements.Main outcome measures Birthweight was classified as 〈 or ≤2.5th centile (AGA or SGA) for gestational age and sex. Morbidity was defined as at least one of the following at birth: delivery by emergency caesarean section for fetal distress, umbilical venous blood pH less than 7.15, 5 min Apgar score less than 7 or admission to the Special Care Baby Unit (SCBU).Results Fetal abdominal circumference was the best indicator of which fetuses (n = 30) would be SGA. Fourteen of the 30 (47%) SGA fetuses had morbidity at birth and abnormal umbilical Doppler studies significantly predicted this (χ2= 2.93, P= 0.003). By contrast, fetal heart rate variability and the biophysical profile score did not. Twenty-seven of the 161 (17%) AGA fetuses had morbidity at birth, but this was not significantly predicted by heart rate variability, biophysical profile score or umbilical Doppler studies.Conclusions None of the antenatal testing techniques studied predicted morbidity in normally grown fetuses but Doppler studies indicated whether a small fetus was ‘sick small’ or ‘normal small’.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine the value of early ultrasound examination for prenatal diagnosis of cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation.Design Prospective audit. Setting Fetal Medicine Centre.Methods Specialist fetal echocardiography was carried out in 398 chromosomally normal fetuses with a nuchal translucency measurement above the 99th centile (2 3.5 mm). In the first 75 pregnancies the cardiac scan was carried out at 17–22 weeks and the next 323 cases had one scan at 13–17 weeks and another at 20–22 weeks. Pregnancy outcome was obtained in all of the cases.Results Major cardiac defects were present in 29 (7.3% of 398) cases and in 28 of these the diagnosis was made by antenatal echocardiography. In 27 of the 29 fetuses with major cardiac defects echocardiography was carried out at 13–17 weeks and an abnormality was suspected in 24 of the cases (88%).Conclusions Increased nuchal translucency in chromosomally normal fetuses is associated with an increased prevalence of major cardiac defects and, as such, is an indication for specialist fetal echocardiography. Most of the cardiac abnormalities are detectable on antenatal fetal echocardiography and many can be excluded by early scanning.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine the relation between maternal serum inhibin-A and free β-hCG concentrations in chromosomally normal pregnancies and to compare the two biochemical markers for their sensitivity in identifying trisomy 21 pregnancies.Sample Inhibin-A and free β-hCG were measured in maternal serum samples from 800 chromosomally normal singleton pregnancies at 10 to 14 weeks of gestation and 76 singleton pregnancies with fetal trisomy 21.Results In the normal group maternal serum inhibin-A was significantly associated with both maternal weight and gestational age (F= 11.2, P 〈 0.0001). In pregnancies with trisomy 21 the maternal serum inhibin-A and free β-hCG concentrations were significantly increased (mean difference inhibin = 0.51 SD, F= 18, P 〈 0.0001 and mean difference free β-hCG = 1.13 SD, F= 80, P 〈 0.0001). For a 5% false positive rate, the sensitivity of maternal serum free β-hCG in identifying pregnancies with trisomy 21 was 28.9% compared with 12.8% for maternal serum inhibin-A. Delta inhibin-A was significantly associated with delta-free β-hCG (r= 0.345, P 〈 0.01) and the deviation from the normal mean for free β-hCG was significantly greater than the deviation for inhibin-A (t= 4.0, P 〈 0.0001). For a 5% false positive rate, the sensitivity achieved by combining information from delta inhibin-A and delta free β-hCG was similar to the sensitivity of free β-hCG alone (30.3% compared with 28.9%)Conclusion At 10 to 14 weeks of gestation fetal trisomy 21 is associated with increased maternal serum inhibin-A and free β-hCG levels. However, the degree of elevation of inhibin-A is less than that of free β-hCG, and there is a significant association between levels of the two proteins. The sensitivity for trisomy 21 achieved with the combination of maternal serum inhibin-A and free β-hCG is not significantly different from that achieved with maternal serum free β-hCG alone.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To examine the usefulness of selecting the appropriate techque for fetal karyotyping in twin pregnancies by using maternal age and fetal nuchal translucency thickness to determine risk for chromosomal defects in each fetus.Setting Fetal Medicine Centre, London, United Kingdom.Subjects Sixty-seven twin pregnancies identified at the time of an ultrasound scan for determination of fetal nuchal translucency thickness, where the parents requested karyotyping.Intervention The risk for chromosomal defects in each fetus was calculated from the maternal age and fetal nuchal translucency thickness at 10 to 14 weeks of gestation. If the estimated risk for either fetus was 1 in 50 or greater, chorion villus sampling was the method of choice, whereas if the risk was less than 1 in 50 second trimester amniocentesis was performed.Results The estimated risk for trisomies was more than 1 in 50 in 34 pregnancies and 23.5% of these fetuses were found to be chromosomally abnormal. In contrast, in the 33 low risk pregnancies chromosomal abnormalities were found in only 1.5% of the fetuses.Conclusions In twin pregnancies the technique for fetal karyotyping may be selected by calculating the risk for chromosomal abnormality based on maternal age and fetal nuchal translucency thickness.
    Type of Medium: Electronic Resource
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