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Objective: Ascertain whether there are differences in the anthropometric measurements of at-term neonates in a rural population and an urban population at 3 400 m altitude. Material and methods: Descriptive population study of healthy at-term neonates in the Adolfo Guevara Velasco National Hospital (HNAGV) in Cusco and in the Huanoquite Health Center (CSH), [both at 3 400 m altitude in Peru], between 2005 and 2010. Measures of central tendency were calculated, the averages were compared with a Student's t-test, the final model was adjusted by neonatal sex, and the odds ratios (OR) and corresponding confidence intervals (CI95%) were calculated to estimate the strength of association between small for gestational age (SGA) infants (according to weight under P10 and ponderal index [PI]) in mothers who live in the Huanoquite district and those who gave birth in the CSH. Results: In the HNAGV and the CSH, 372 and 368 neonates were studied, respectively. The average maternal age was 31.7 and 27.0 years; previous pregnancies, 2.4 and 3.4; miscarriages, 0.4 and 0.0; live births, 1.0 and 2.3 (p<0.001); and weight, height and PI, 3 311.8 g, 49.5 cm, 2.73, and 3,008.9 g, 48.4 cm, 2.66, respectively (p<0.001). The weight, height, and PI for the two centers were, after adjusting for sex and by gestational age bracket: (37-38 weeks) 3,185.1 g, 49.18 cm, 2.67, and 3,009.8 g, 48.5 cm, 2.64; (39-40 weeks) 3 385.9 g, 49.9, 2.73, and 3 051.8 g, 48.6 cm, 2.66; (41-42 weeks) 3 461, 6 g, 50.2 cm, 2.73, and 3,072.2 g, 49.1 cm, and 2.6, respectively (p<0.001). The OR of SGA births in the CSH was 3.52 (2.4-5.1) according to weight and 2.05 (1.3-3.1) according to PI, compared to birth in the HNAGV. Conclusion: The weight, height, and PI of infants born in the CSH were lower than those born in the HNAGV, and the OR of SGA births was 3,52 according to weight and 2,05 according to PI, respectively. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether the magnitude of change in the cerebroplacental ratio (CPR) after 30 weeks' gestation is a better predictor of adverse pregnancy outcome compared with a single CPR measurement at 35-37 weeks. A secondary aim was to evaluate whether the utility of CPR at 35-37 weeks was enhanced after adjusting for change in gestational age.Methods: This was a retrospective cohort study of women who had at least two ultrasound scans between 30 and 37 weeks' gestation, with the final scan at 35-37 weeks. Exclusion criteria were major congenital abnormality, aneuploidy, multiple pregnancy and unknown middle cerebral artery pulsatility index or umbilical artery pulsatility index. A normal reference range for CPR was derived from a separate cohort of women with normal outcome and a Generalised Additive Model for Location, Scale and Shape was fitted to derive standardized centiles. These reference centiles were then used to calculate Z-scores for the study cohort. Logistic regression models and receiver-operating characteristics (ROC) curves were used to evaluate the predictive utility of CPR Z-score at last CPR measurement and the change in CPR on mode of delivery, neonatal outcome and composite neonatal outcome. The area under the ROC curve (AUC) for each model was compared before and after adjustment for parity, hypertension, diabetes, body mass index and smoking status.Results: A total of 1860 women met the inclusion criteria. There was no association between the magnitude of change in CPR and composite adverse pregnancy outcome (P = 0.92). Of the outcomes that made up the composite, an increase in CPR Z-score over time was associated with a lower risk for emergency Cesarean delivery (P < 0.001) and emergency Cesarean delivery for non-reassuring fetal status (P = 0.02). It was also associated with a lower risk of birth weight < 10th centile (P = 0.01) and hypoglycemia (P = 0.001). There was no significant difference between the AUCs of last CPR Z-score and last CPR Z-score adjusted for the change in gestational age in predicting pregnancies at risk for adverse outcome.Conclusions: Our results suggest that both the individual CPR Z-score and the magnitude and direction of change in CPR Z-score can identify pregnancies at risk of various adverse perinatal outcomes. However, the CPR Z-score at 35-37 weeks' gestation appears to be a better predictor. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between the cerebroplacental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM).Methods: This was a retrospective cohort study of women with a non-anomalous singleton pregnancy diagnosed with GDM who delivered at Mater Mothers' Hospital between 2007 and 2015. CPR was measured in 1089 cases between 34 + 0 and 36 + 6 weeks' gestation. CPR values were compared between groups categorized according to GDM treatment (by diet, oral hypoglycemic agent (OHA) or insulin). The association between CPR and intrapartum and perinatal outcomes was evaluated.Results: No difference in CPR was observed between treatment groups. Fetuses with CPR < 10th centile were significantly more likely to have adverse composite perinatal outcome (odds ratio (OR) = 2.93 (95% CI, 1.95-4.40)), preterm delivery and low birth weight than fetuses with CPR ≥ 10th centile (all P < 0.001). These associations were present regardless of the type of GDM treatment. Fetuses of women with insulin-controlled GDM had poorer neonatal outcomes than did fetuses of women treated with OHA or dietary control alone. The risk of adverse outcome was significantly increased in the insulin-treated group (OR = 1.75 (95% CI, 1.34-2.28); P < 0.001), which also had higher rates of preterm delivery and higher birth weight.Conclusion: Regardless of the type of treatment, a low CPR is associated with poorer neonatal outcome in women with GDM. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: Villous immaturity for gestational age is a multifactorial developmental deviation associated with unexpected placental insufficiency, fetal hypoxia and term fetal death. In our previous work we have shown that immature CD15+/CD31+/CD34+ endothelial cells were an important indicator of placental villous immaturity and chronic insufficiency. The aim of this study was to perform a comparative analysis of CD15-marked immaturity in the vessel walls between normal and pathological term placentas of clinically and structurally heterogenous groups with normal, low and high weight.Study Design: 165 clinically normal and pathological placentas of gestational age 39-42 with normal weight (25-75 percentile), low weight (<10 percentile) and high weight (>90 percentile) were structurally and immunohistochemically analyzed. Excluded were placentas with a severe form of placental insufficiency associated with intrauterine fetal death, low APGAR-score, genetic and chromosomal diseases or placental inflammations. The distribution patterns of CD15, CD31 and CD34 were assessed separately in the macrovasculature, microvasculature and placental barrier (PB) - associated capillaries.Results: All placental groups with normal weight, low weight and high weight include normal, accelerated villous maturation or villous immaturity independent of their weight. However, a significant increase of immature CD15+/CD31+/CD34+ endothelial cells was detected in microvasculature and PB -associated capillaries in high weight-placentas (63.5%/52.2%), compared to those of normal weight (13.8%/8.2%) and low weight (16.1%/17.8%). The distribution of macrovascular immature CD15+/CD31+/CD34+ endothelial cells did not show such marked differences.Conclusion: We have identified the immaturity of microvasculature and PB -associated capillaries with a pathological persistency of immature CD15+/CD31+/CD34+ endothelial cells and a reduction of terminally differentiated CD15-/CD31+/CD34+ endothelial cells in a structurally and clinically heterogeneous group of high weight-placentas. We assume that immaturity of placental vessels are part of prenatal adaptational processes that can be recruited in different emergency situations and may provide potential targets of therapeutic correction of placental growth and chronic insufficiency. We therefore recommend the use of CD15-based immunophenotyping as a method to identify latent unfavorable conditions of fetal development in the intrauterine life and individual risk of disease in the postnatal period. [ABSTRACT FROM AUTHOR]

Objective: Each pregravidic, gestational or intrapartum complication may, per se, have a different impact on the operative delivery rate, regardless of which fetal monitoring system was adopted. We wanted to verify if CTG plus ST interval analysis (STAN) of fetal ECG might be able to reduce the number of operative delivery for fetal distress in high-risk pregnancies compared to low-risk women monitored with CTG alone.Materials and Methods: In this cohort study, we evaluated 100 high-risk pregnancies consecutively with STAN® S31 (Neoventa Medical, Gotenburg, Sweden) and 160 low-risk pregnancies consecutively with continuous CTG (Hewlett Packard, 50 IP, Palo Alto, CA).Results: We found that STAN monitoring, although associated with a higher total operativity rate, both vaginal (11% versus 3.12%, p = 0.015) and cesarean (17% versus 4.37%, p = 0.001), reduced the cesarean section rate performed for fetal distress (29.41% versus 85.71%, p = 0.023) compared with low-risk CTG monitoring group.Conclusion: CTG plus ST interval analysis of fetal ECG reduced the risk of operative cesarean delivery for fetal distress in high-risk gestations. [ABSTRACT FROM AUTHOR]

Introduction Neonates born prematurely or small for gestational age (SGA) as a consequence of intrauterine growth restriction (IUGR) have a higher risk of neurological injury due to fetal hypoxia. Hypoxic ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) are the main clinical forms of brain injury. The patterns and underlying mechanisms of neurological injury are interrelated. Aim of the study The purpose of the study was to evaluate the neurological outcome of SGA newborns versus neonates born preterm. Materials and methods A 3 year randomized case - control study was conducted between the 1st of January 2014 and the 31th of December 2016, at the Emergency County Hospital, Timisoara. 170 SGA newborns and 170 AGA newborns matched 1:1 for gestational age and birth month were included in the study. Patients were divided in 4 subgroups according to gestational age: 101 SGA newborns born at term (SGATerm) and 69 SGA newborns born preterm (SGA-Preterm), 101 AGA neonates born at term (AGA-Term) and 69 AGA neonates born preterm (AGA-Preterm). Results and discussions Preterm neonates had difficulties of early neonatal adaptation, as indicated by a low APGAR score. Preterm neonates irrespective of birth weight, had a higher incidence of both HIE (26.1% SGA Preterm versus 11.8% SGA Term and 11.5% AGA Preterm compared to 0.0% AGA Term) and IVH (20.3% SGA Preterm versus 7.9% SGA Term and 15.9% AGA Preterm compared to 0.0% AGA Term ). Conclusions Neonates born preterm have a poorer neurological outcome compared to term newborns, regardless of birth weight. SGA is an additional, aggravating factor for neurological injury. More extensive studies on the different subgroups of SGA newborns are required in order understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between duration of fetal hypoxia, nucleated red blood cell (NRBC) count, and fetal growth. Methods: Pregnant rats were exposed to a severe hypoxia (9.5%-10% O2) for varying time intervals (2, 6, 12, 24, 48, and 120 hours; n=4 for each time interval) immediately prior to delivery at term. Normoxic controls were exposed to room air (21% O2) and matched for all other study variables (n=4 rats for each time interval). Pups were delivered via hysterotomy while maintaining exposure gas concentrations. Blood gas analysis and NRBC counts were performed, and fetal body and liver weights were recorded. Student's t test and simple regression were used for statistical analysis. Results: As the duration of hypoxia increased, fetal weight, liver weight, blood bicarbonate, and base excess levels decreased significantly; concomitantly, NRBC counts increased. This increase in NRBCs became statistically significant after 24 hours of exposure. After 48 hours of hypoxia there was a 2.5-fold rise in NRBC count, and after 120 hours of hypoxia there was a 4.5-fold rise in NRBC count over control levels. After 12 or more hours of hypoxia, fetal body weights were significantly reduced; 120 hours of hypoxia resulted in a 35% reduction in fetal body weight, a 34% reduction in fetal liver weight, and 356% increase in NRBC count. Conclusion: In a pregnant rat model, chronic maternal hypoxia (≥24 hours) results in a significant increase in fetal NRBC counts as well as reduced fetal body weight and organ growth. [ABSTRACT FROM AUTHOR]

Objective: Lactate Pro™ (LP1) is the only lactate meter evaluated for fetal scalp blood sampling (FBS) in intrapartum use. The reference values for this meter are: normal value < 4.2 mmol/L, preacidemia 4.2-4.8 mmol/L, and acidemia > 4.8 mmol/L. The production of this meter has been discontinued. An updated version, Lactate Pro 2TM (LP2), has been launched and is shown to be differently calibrated. The aims of the study were to retrieve a conversion equation to convert lactate values in FBS measured with LP2 to an estimated value if using LP1 and to define reference values for clinical management when using LP2. Study design: A cross-sectional study was conducted at a university hospital in Sweden. A total of 113 laboring women with fetal heart rate abnormalities on cardiotocography (CTG) had FBS carried out. Lactate concentration was measured bedside with both LP1 and LP2 from the same blood sample capillary. A linear regression model was constructed to retrieve a conversion equation to convert LP2 values to LP1 values. Results: LP2 measured higher values than LP1 in all analyses. We found that 4.2 mmol/L with LP1 corresponded to 6.4 mmol/L with LP2. Likewise, 4.8 mmol/L with LP1 corresponded to 7.3 mmol/L with LP2. The correlation between the analyses was excellent (Spearman's rank correlation, r = 0.97). Conclusion: We recommend the following guidelines when interpreting lactate concentration in FBS with LP2: < 6.4 mmol/L to be interpreted as normal, 6.4-7.3 mmol/L as preacidemia indicating a follow-up FBS within 20-30 min, and > 7.3 mmol/L as acidemia indicating intervention. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the relationship between the cerebro-placental ratio (CPR) and intrapartum and perinatal outcomes in pregnancies complicated by pre-existing insulin dependent diabetes (pT1DM) mellitus, pre-existing non-insulin dependent diabetes mellitus (pT2DM) and gestational diabetes mellitus (GDM).Study Design: This was a retrospective cohort study of 1281 women with diabetes mellitus birthing at the Mater Mothers' Hospital in Brisbane between 2007 and 2015. The CPR in non-anomalous singleton fetuses was measured between 34+0 and 36+6 weeks gestation and compared between types of DM treatment groups and correlated with intrapartum and perinatal outcomes.Results: Of the study cohort, 9.7% (124/1281) had pT1DM, 5.3% (68/1281) had pT2DM and 85.0% (1089/1281) had GDM. Of women with pT2DM and GDM, 61.8% (42/68) and 28.9% (315/1089) respectively, required insulin during pregnancy. Women with pT1DM had an increased odds of having a CPR <5th centile (OR 3.73, 95%CI: 1.90-6.96, p=0.0001) or a CPR <10th centile (OR 3.01, 95% CI: 1.80-4.91, p<0.0001) respectively. The odds of a UA PI >90th centile (OR 2.69, 95% CI: 1.60-4.39, p=0.0001) was higher in the pT1DM cohort. There was however no significant difference in the mean MCA PI between the three groups. Stratification by CPR centiles (<10th centile vs. ≥10th centile) demonstrated a lower birth weight in the CPR <10th centile cohort for all DM categories. The proportion of neonates with birth weights <10th centile were higher in the CPR <10th centile cohort with the GDM cohort having an odds ratio of 8.28 (95% CI 4.22-16.13, p<0.0001) of this complication. The CPR <10th centile cohort also had a greater proportion of adverse composite neonatal outcome regardless of type of DM.Conclusions: Regardless of the type of DM, a low CPR was associated with poorer neonatal outcomes. Women with pT1DM also had the highest mean UA PI and lowest mean CPR despite no difference in the mean MCA PI between the three groups. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal, cord blood erythropoietin (EPO), and copeptin levels in low-risk term deliveries which are complicated by meconium-stained amniotic fluid (MSAF) to those with clear amniotic fluid. Also, to evaluate the relations between these markers and cord blood pH values. Methods: Low-risk term pregnant women with MSAF at an active phase of labor were defined as the study group (n = 39). Pregnant women with clear amniotic fluid were selected for the control group (n = 41). The two groups were matched for age, body mass index and gestational age. Maternal, cord blood EPO and copeptin levels with cord blood pH values were also measured. Results: Maternal, cord blood EPO, and copeptin levels of study and control groups were 42.6 ± 9.0 versus 40.7 ± 9.2, 134.2 (20.5–834.6) versus 38.4 (10.3–114.2), 4.9 (0.1–31.1) versus 4.0 (3.1–28.4), and 4.7 (2.6–25.5) versus 3.6 (2.0–23.2), respectively. The differences were statistically significant for cord blood EPO, maternal and cord blood copeptin levels (p < 0.001,p = 0.004,p < 0.001, respectively). The study group had a statistically and significantly lower cord blood pH values (7.25 ± 0.05 versus 7.34 ± 0.04,p < 0.001). Moreover, cord blood EPO and maternal and cord blood copeptin levels were inversely correlated with cord blood pH values in the study group (p < 0.001,p = 0.005, andp = 0.009, respectively). Conclusion: We suggest that higher cord blood EPO and maternal and cord blood copeptin levels may be an indicator of fetal acidosis in low-risk term deliveries complicated by MSAF. [ABSTRACT FROM PUBLISHER]

Introduction: This systematic review evaluates maternal tolerance and obstetric and perinatal outcomes following sildenafil citrate (SC) use in human pregnancy.Data Sources: Scopus, PubMed, Cochrane Library, Web of Science, Embase, and Google Scholar were searched. Relevant full-text studies including case series and reports in English were included. Publications were excluded if the pregnancy was terminated or if SC was used only at conception.Results: Sixteen studies were included (n = 165). Indications for use and outcomes were variably reported. Maternal outcomes reported were headache (45.8%, 49/107), visual disturbances (17.3%, 14/81), dyspepsia/epigastric pain (15.8%, 15/95), and hypotension (0%, 0/39). There were more caesarean (83.3%, 55/66) than vaginal deliveries (16.7%, 11/66) and postpartum haemorrhage occurred in 3.9% (3/76) of women exposed to SC. Neonatal outcomes including nursery admission (67.3%, 35/52), Apgar scores <7 at 5 min (7.1%, 4/56), and cord arterial pH <7.1 (0%, 0/17) were reported. Stillbirths (4.3%, 3/69) and neonatal deaths (3.9%, 5/129) were comparable to SC-naïve groups. There were no congenital malformations (0%, 0/35).Conclusions: Despite limited data, overall there does not appear to be any severe adverse maternal side effects nor any increase in the rate of stillbirths, neonatal deaths, or congenital anomalies attributed to SC. [ABSTRACT FROM AUTHOR]

Background: Anemia is a commonly diagnosed comorbidity in pregnancy that is associated with increased risk of maternal and neonatal complications. Recent data demonstrate that maternal anemia is associated with higher umbilical artery and umbilical vein O 2 content at the time of delivery., Objective: This study aimed to examine the relationship between maternal anemia and electronic fetal monitoring patterns associated with fetal hypoxia., Study Design: This is a secondary analysis of a prospective cohort study of singleton term deliveries with cord gases and universal complete blood count collected on admission between 2010 and 2014. Maternal anemia was defined as hemoglobin ≤11.0 g/dL on admission. The primary outcome was a composite of high-risk category 2 electronic fetal monitoring features in the last 60 minutes before delivery (recurrent late and/or variable decelerations, minimal variability, tachycardia, or >1 prolonged deceleration); secondary outcomes were total deceleration area and total deceleration area >90th percentile. Of the 8580 patients in the original study, 8196 were included in the analysis. Outcomes were compared between patients with and without anemia. Multivariable logistic regression was used to adjust for potentially confounding factors, including hypertensive disorders of pregnancy and induction of labor., Results: Of the 8196 patients with complete blood count on admission and fetal monitoring data, 2672 (32.6%; 2672/8196) were anemic and 5524 (67.4%; 5524/8196) were not. Patients with anemia were significantly less likely to have composite high-risk category 2 features on electronic fetal monitoring (34.2% vs 32.0%; adjusted risk ratio, 0.93; 95% confidence interval, 0.86-0.99). Women with anemia also had decreased total deceleration area and were less likely to have total deceleration area >90th percentile (18.7% vs 16.2%; adjusted risk ratio, 0.85; 95% confidence interval, 0.77-0.94)., Conclusion: Patients with anemia are less likely to have high-risk category 2 electronic fetal monitoring features associated with fetal hypoxia. This finding is consistent with the association between maternal anemia and increased umbilical cord O 2 content, and suggests that maternal anemia may be protective against intrapartum fetal hypoxia., (Copyright © 2023 Elsevier Inc. All rights reserved.)

As the incidence of Alzheimer's disease (AD) increases year by year, more people begin to study this disease. In recent years, many studies on reactive oxygen species (ROS), neuroinflammation, autophagy, and other fields have confirmed that hypoxia is closely related to AD. However, no researchers have used bioinformatics methods to study the relationship between AD and hypoxia. Therefore, our study aimed to screen the role of hypoxia-related genes in AD and clarify their diagnostic significance. A total of 7681 differentially expressed genes (DEGs) were identified in GSE33000 by differential expression analysis and cluster analysis. Weighted gene co-expression network analysis (WGCNA) was used to detect 9 modules and 205 hub genes with high correlation coefficients. Next, machine learning algorithms were applied to 205 hub genes and four key genes were selected. Through the verification of external dataset and quantitative real-time PCR (qRT-PCR), the AD diagnostic model was established by ANTXR2, BDNF and NFKBIA. The bioinformatics analysis results suggest that hypoxia-related genes may increase the risk of AD. However, more in-depth studies are still needed to investigate their association, this article would guide the insights and directions for further research., (© 2023. The Author(s).)

In modern conditions much attention is paid to prenatal (antepartum) diagnostics in antenatal clinics, on the activities of which the success of prevention of obstetric pathology, early diagnosis and treatment of pregnancy complications depends. Treatment and prevention work of antenatal clinics reduces the number of complications in childbirth, perinatal pathology and postnatal morbidity. The level of gynecological morbidity is largely depends on the quality of obstetric care. This paper deals with literature and own data of the authors on the problem of prevention of fetal hypoxia in antenatal clinics. We found differences in the results of researches. They, probavly, may be explained by a small number of observations, assessment of intracardiac blood flow in specific groups of fetuses with different degrees of severity of functional status disorders, the lack of a comprehensive study of intracardiac hemodynamics in general. All of the above dictates the need for research in this area.

Introducción: la transfusión fetomaterna masiva (TFM) es una entidad con una elevada morbilidad y mortalidad fetal, suele cursar con una disminución en la percepción de los movimientos fetales por parte de la madre, y la presencia de un patrón cardiotocográfico sinusoidal fetal, asociado a la anemia fetal. No obstante, ambas situaciones tienen muy baja especificidad. Se presenta un caso clínico con el objetivo de revisar la exactitud del patrón sinusoidal en el diagnóstico de anemia fetal. Materiales y metodos: se presenta el caso de una gestante de 36 semanas que fue atendida en el Hospital Universitario La Paz (complejo hospitalario de tercer nivel que forma parte del conjunto de hospitales públicos en España), en la que tras presentarse un patrón cardiotocográfico no tranquilizador, se realizó una inducción del parto en el que las pruebas habituales de bienestar fetal resultaron insuficientes para el diagnóstico de sufrimiento fetal. Tras un parto eutócico se comprobó la presencia de una anemia neonatal grave, comprobándose la presencia de un gran volumen de sangre fetal en la sangre materna mediante el test de Kleihauer Betke. Se hace una revisión de los artículos publicados en los últimos 10 años en las base de datos Medline vía PubMed, en español e inglés. Conclusión: la monitorización fetal intraparto podría ser útil en el diagnóstico de la hemorragia fetomaterna masiva, aunque se deben hacer estudios más amplios para determinar la exactitud diagnóstica.Introduction: massive fetomaternal transfusion (MFT) is an entity having high fetal morbidity and mortality; it usually involves the mother’s reduced perception of fetal movements and the presence of a cardiotocographic fetal sinusoidal rhythm, associated with fetal anemia. However, both situations have very low specificity. A clinical case is presented here to arouse interest in reviewing the precision of the sinusoidal rhythm when diagnosing fetal anemia. Materials and methods: the case of a 36-weeks pregnant mother is presented; she attended La Paz teaching hospital (a third-level hospital forming part of the Spanish public hospital system). After presenting a non-reassuring cardiotocographic heart rate pattern, birth was induced in which the usual fetal wellbeing tests proved insufficient for diagnosing fetal suffering. The presence of serious neonatal anemia was shown following a eutocic delivery, the Kleihauer-Betke test proving the presence of a large volume of fetal blood in the mother’s blood. Articles published in both Spanish and English during the last 10 years in the Medline database were reviewed via PubMed. Conclusion: intradelivery fetal monitoring could be useful in diagnosing massive fetal-maternal hemorrhage, even though broader studies should be carried out for determining diagnostic precision.

OBJETIVO: avaliar a hipótese de que a relação cerebroplacentária (RCP) fetal relaciona-se com acidemia no nascimento, em gestações complicadas pela insuficiência placentária detectada antes da 34ª semana de gestação. MÉTODOS: trata-se de coorte prospectiva de 55 pacientes entre a 26ª e a 34ª semanas de gestação, com diagnóstico de insuficiência placentária caracterizada pelo Doppler de artéria umbilical alterado (índice de pulsatilidade >p95). Para cada paciente foi realizada avaliação da vitalidade fetal pela doplervelocimetria de artéria umbilical, artéria cerebral média e ducto venoso, e pelo perfil biofísico fetal. Foi calculada a RCP pela razão entre os valores do índice de pulsatilidade da artéria umbilical e da artéria cerebral média, bem como o cálculo de seu z-score (número de desvios padrão que se afasta da média para a idade gestacional). A acidemia no nascimento foi caracterizada quando pH7,2, apresentou associação significativa com os valores da RCP (mediana 0,47 versus 0,58; p=0,009), índice de pulsatilidade da artéria umbilical (mediana 2,45 versus 1,93; p=0,003), índice de pulsatilidade para veias (IPV) do ducto venoso (mediana 1,08 versus 0,85; p=0,034) e perfil biofísico fetal suspeito ou alterado (37 versus 8%; p=0,031). A análise da RCP pelo seu z-score demonstrou tendência de maior afastamento negativo da média, mas sem atingir valor significativo (p=0,08). Foi constatada correlação significativa entre o pH no nascimento e a RCP (r=0,45; pPURPOSE: to evaluate the hypothesis that the fetal cerebroplacental ratio (CPR) is related to acidemia at birth in pregnancies complicated by placental insufficiency detected before 34 weeks of gestation. METHODS: this is a prospective cohort study of 55 patients between 26 and 34 weeks of gestation with a diagnosis of placental insufficiency characterized by abnormal umbilical artery Doppler (pulsatility index>95p). Fetal assessment was performed for each patient by dopplervelocimetry of the umbilical artery, middle cerebral artery and ductus venosus, and by the fetal biophysical profile. CPR was calculated using the ratio between middle cerebral artery pulsatility index and umbilical artery pulsatility index, and the z-score was obtained (number of standard deviations of the mean value at each gestational age). Acidemia at birth was characterized when pH7.2, a significant association was observed with CPR values (median 0.47 versus 0.58; p=0.009), pulsatility index of the umbilical artery (median 2.45 versus 1.93; p=0.003), ductus venosus pulsatility index for veins (PIV) (median 1.08 versus 0.85; p=0.034) and suspected or abnormal fetal biophysical profile (37 versus 8%; p=0.031). CPR analysis by z-score showed a negative tendency, but was not statistically significant (p=0.080). Significant correlations were found between pH at birth and CPR (r=0.45; p

The correlation between fetal hypoxia degrees according to the data of cardiotocography and status of mother's vegetative nervous system as a result of heart rhythm variability research have been analyzed. It has been revealed that during the increase of fetal hypoxia severity, mother has observed activation of sympathetic section of vegetative nervous system, which has changed by vagotonia in severe and terminal states. These findings can be used both for indirect estimation of fetal hypoxia severity and for its course prognosis

Placental insufficiency represents a syndrome of multifactorial etiology caused by morphological and functional changes in placenta, leading to disturbances in growth rates and development of fetus. Fetoplacental insufficiency is the leading factor in occurrence of fetal hypoxia, arrested development of fetus, traumas during delivery, diseases and complications in postnatal period. Placental insufficiency development is accompanied by disorders in differentiation and extension placental villi. Also processes of angiogenesis are affected. As a result there is a transport, respiratory, trophic, endocrinal and protective dysfunction of placenta. In fetal organism universal adaptative reactions directed on maintenance of homeostasis arise. Application of interval hypoxic therapy is directed on «training» of fetal adaptative mechanisms to hypoxia. Good tolerance of 10% О - gas mix has been revealed. High therapeutic effect is shown by increase in functional reserves of cardio-respiratory system, normalization of acid-base balance, normalization of arterial pressure, mobilization mechanisms of regulation of hypothalamic-pituitary adrenocortical system that results in increase of general resistance of fetus to hypoxia

The hypoxia is the powerful stressful factor, and, presumably, should result not only in rising of erythrocytes counts for the compensatory purpose, but also in rising of other blood cells number, as consequence of mobilization in the answer stress. In article the influence assessment of pregnancy and delivery features, acute and chronic fetal hypoxia on cord blood cell composition of the full-term newborns is shown. Increase of leucocytes count at elongation of the second period of delivery, presence of chronic prenatal hypoxia or acute hypoxia in delivery is revealed. Differences of cord blood cell composition depending on newborn gender and body weight which consist in higher leucocytes count (all subpopulations including hematopoietic stem cells) at boys and at higher body weight are shown. Differences according to gender and to body weight are independent from each other. It is shown, that boys worse adapt for delivery that is expressed in higher concentration of mobilization cytokines and higher leucocytes and hemopoietic progenitors count in cord blood. It is shown, that mobilization cytokine concentration (IL-8, G-CSF, MMP-9) in cord blood of full-term newborns statistically significantly above, than in peripheral blood of healthy donors. Thus IL-8, G-CSF, MMP-9 concentration higher at boys in comparison with girls; at normal delivery in comparison with delivery by planned cesarean sections and at acute fetal hypoxia.