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Introduction: In this study, we aimed at quantifying placental concentrations of 22 chemical elements in small fetuses (SGA) as compared with normally grown fetuses (AGA), and to assess the relationship with Doppler markers of placental function.Methods: Prospective cohort study, including 71 SGA fetuses (estimated fetal weight < 10th percentile) and 96 AGA fetuses (estimated fetal weight > 10th percentile), recruited in the third trimester of gestation. The placental concentration of 22 chemical elements was determined by inductively coupled plasma optical emission spectrophotometer (ICP-OES, ICAP 6500 Duo Thermo): aluminum (Al), beryllium (Be), bismuth (Bi), calcium (Ca), cadmium (Cd), cobalt (Co), chrome (Cr), copper (Cu), magnesium (Mg), manganese (Mn), molybdenum (Mo), nickel (Ni), phosphorus (P), lead (Pb), rubidium (Rb), sulfur (S), strontium (Sr), titanium (Ti), thallium (Tl), antimony (Sb), selenium (Se), and zinc (Zn). Placental function was assessed by measuring the following fetal-maternal parameters: Uterine artery Pulsatility Index (UtA PI), Umbilical artery Pulsatility Index (UA PI) and Middle Cerebral artery Pulsatility Index (MCA PI). The association between the chemical elements concentration and study group and the association with Doppler measures were evaluated.Results: SGA was associated with significantly (p < 0.05) lower concentrations of Al (AGA 21.14 vs SGA 0.51 mg/kg), Cr (AGA 0.17 vs SGA 0.12 mg/kg), Cu (AGA 0.89 vs SGA 0.81 mg/kg), Mg (AGA 0.007 vs SGA 0.006 g/100g), Mn (AGA 0.60 vs SGA 0.47 mg/kg), Rb (AGA 1.68 vs SGA 1.47 mg/kg), Se (AGA 0.02 vs SGA 0.01 mg/kg), Ti (AGA 0.75 vs SGA 0.05 mg/kg) and Zn (AGA 9.04 vs SGA 8.22 mg/kg). Lower placental concentrations of Al, Cr, Mn, Se, Ti were associated with abnormal UtA, UA and MCA Doppler.Discussion: Lower placental concentrations of Al, Cr, Cu, Mn, Rb, Se, Ti and Zn are associated with SGA fetuses and abnormal fetal-maternal Doppler results. Additional studies are required to further understand how chemical elements affect fetal growth and potentially find strategies to prevent SGA. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the rate of spontaneous healing in human fetal membranes after fetoscopy. Study design: Membranes from patients that had undergone fetoscopic interventions and delivered in one of the two treatment centers were included in the study. The membranes were examined macroscopically for any remaining defects and if present, the size of the defect in chorion and amnion was measured. Subsequently, the defect was excised and stained with HE for histological evaluation. Additional immunohistochemical staining was performed with Ki-67, cytokeratin and vimentin. The proliferation index (percentage of proliferating cells) was calculated in amnion and chorion. Results: Nineteen membrane defects were included in the study. The median time interval between invasive procedures and delivery was 60 days (range 3–112). All fetoscopic defects (n =19) could be identified in the gestational sac and in none spontaneous closure had occurred. Proliferation indices as measured by inmunohistochemistry were very low (median 2.8%, range 0–7%) in the chorion and 0% in the amnion. Conclusion: No evidence of spontaneous membrane healing was found after fetoscopic procedures, suggesting that the membrane defect normally persists until delivery. Absence of amniotic fluid leakage after invasive procedures may be based on mechanisms other than histologic membrane repair. [Copyright &y& Elsevier]

Objective: We sought to evaluate the agreement between the opinions of specialists in fetal medicine with ex vivo observations on the potential influence of the angle of needle insertion on the fluid leak through the created defect in human fetal membranes.Study Design: Membranes from placentas of women who were delivered by elective cesarean were harvested, cut in pieces, and secured to the bottom of plastic tubes filled with Hartmann solution. They were punctured with 18-, 20-, or 22-gauge needles, with an angle of insertion of 90 degrees (group 1) or 45 degrees (group 2), and the flow rate (in milliliters per minute) through the created defect at a constant pressure of 150 mm H(2)O was measured. Fifty physicians performing amniocentesis at fetal medicine reference centers were interviewed about their impression and clinical attitude with respect to the angle of needle insertion at the time of amniocentesis.Results: In the ex vivo study, puncture with a 45 degrees angle was associated with a significantly lower flow of fluid through the membrane defect for all needle sizes tested. Regarding survey answers, 82% of physicians try to perform amniocentesis with a given angle (ie, 90 degrees in the vast majority of cases). Among the reasons for doing so, minimizing membrane damage was mentioned in more than half of cases.Conclusion: These results provide evidence that the angle of needle insertion influences the type of defect and therefore the flow rate through human membranes. Membrane damage is a concern of a proportion of specialists while performing amniocentesis, but ex vivo observations do not agree with clinical assumptions on the potential influence of the angle of insertion. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacies of various plugging techniques in sealing the membrane defect created by fetoscopy in the rabbit at midgestation.Study Design: Fetoscopy was performed in pregnant rabbits at 23 days' gestation (term, 32 days' gestation). In group 1 fetal sacs were left unclosed (positive control group, n = 24). In group 2 injection with commercially available extracellular matrix (Matrigel; BD Labware, Bedford, Mass) was performed and a myometrial suture was inserted (n = 23). In group 3 the entry site was plugged with collagen (Colgen; Inter-Phar, Paris, France) combined with a myometrial suture (n = 22). At 30 days' gestation the membrane integrity, amniotic fluid presence, and fetal lung/body weight ratios were assessed. The plugging site was examined histologically.Results: The use of suture and collagen plugs (group 3) resulted in functional restoration of membrane integrity with preservation of amniotic fluid and normal fetal lung/body weight ratio at term in 82% of cases, compared with 42% in the positive control group (group 1; P <.05). Histologic examination revealed entrapment of membranes between the plug and the myometrium but no anatomic repair of the membranes. The use of suture and extracellular matrix (group 2) did not achieve better results than those seen in group 1 (positive control group).Conclusion: Collagen plugs achieved functional sealing of fetoscopic access sites in a rabbit model and prevented oligohydramnios and pulmonary hypoplasia. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to determine whether the pregnant rabbit at mid gestation could be used as a suitable in vivo model for the study of membrane defects after invasive procedures.Study Design: Pregnant rabbits at gestational ages of 22 and 18 days (term is 32 days' gestation) underwent needle insertion with different instrument diameters (1.1 mm, 1.35 mm, 2.0 mm, and 2.7 mm). Two different insertion techniques were evaluated, blind amniotic puncture and puncture through surgically exposed amnion. Membrane integrity, presence of amniotic fluid, and fetal lung/body weight ratio were evaluated at 31 days' gestation.Results: Among rabbits operated on at 22 days' gestation the amniotic integrity restoration at 31 days' gestation ranged from 46% to 76% in the different diameter and access technique groups, as compared with 98% in untreated sacs (P <.05 for all groups). Fetuses from sacs with persisting membrane defects had oligohydramnios and significantly lower fetal lung/body weight ratios. Survival rates among fetuses operated on at 18 days' gestation were so poor that appropriate statistical analysis was not possible in this group.Conclusions: The rabbit at mid gestation can be used as a model to reproduce permanent membrane defects after fetoscopy, reproducing oligohydramnios and pulmonary hypoplasia. This may provide a suitable in vivo model for the study of iatrogenic membrane defects. [ABSTRACT FROM AUTHOR]

Objectives: We sought to evaluate the circulating levels of lipid peroxides and vitamin E and the placental levels of lipid peroxides in pregnant women with different types of hypertension.Study Design: Lipid peroxides were measured in serum and placental tissue by the thiobarbituric acid method and high-pressure liquid chromatography, and vitamin E was measured by high-pressure liquid chromatography. The patients studied were 36 healthy pregnant women and 92 women with hypertension classified as having mild gestational hypertension (n = 28), severe gestational hypertension (n = 10), preeclampsia (n = 34), and chronic hypertension (n = 20).Results: Lipid peroxides in serum and placental tissue were significantly increased, and vitamin E levels in serum were significantly decreased in women with severe gestational hypertension and preeclampsia compared with controls. The groups of mild gestational hypertension or chronic hypertension had similar values of lipid peroxides or vitamin E as controls.Conclusions: Our results suggest that the category of gestational hypertension may be composed of at least two entities with different pathophysiology and support the concept of nonproteinuric preeclampsia. [ABSTRACT FROM AUTHOR]