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Abnormal placental angiogenesis during gestation resulting from high levels of anti-angiogenic factors, soluble fms-like tyrosine kinase-1 (sFLT1) and soluble endoglin, has been implicated in the progression of preeclampsia (PE). This heterogeneous syndrome (defined by hypertension with or without proteinuria after 20 weeks of pregnancy) remains a major global health burden with long-term consequences for both mothers and child. Previously, we showed that in vivo systemic human (hsFLT1) overexpression led to reduced placental efficiency and PE-like syndrome in mice. Galectins (gal-1, −3 and −9) are critical determinants of vascular adaptation to pregnancy and dysregulation of the galectin-glycan circuits is associated with the development of this life-threatening disease. In this study, we assessed the galectin-glycan networks at the maternal-fetal interface associated with the hsFLT1-induced PE in mice. We observed an increase on the maternal gal-1 expression in the decidua and junctional zone layers of the placenta derived from hs FLT1high pregnancies. In contrast, placental gal-3 and gal-9 expression were not sensitive to the hsFLT1 overexpression. In addition, O- and N-linked glycan expression, poly-LacNAc sequences and terminal sialylation were down-regulated in hsFLT1 high placentas. Thus, the gal-1-glycan axis appear to play an important role counteracting the anti-angiogenic status caused by sFLT1, becoming critical for vascular adaptation at the maternal-fetal interface. • Anti-angiogenic milieu induced by human soluble fms-like tyrosine kinase-1 (hsFLT1) alters the galectin-glycan circuits during pregnancy. • Decidual gal-1 is upregulated in hsFLT1 induced Preeclampsia (PE)-like syndrome in mice. • hsFLT1 exerts a strong influence on the O- and N-linked glycan expression, poly-LacNAc sequences and terminal sialylation at the maternal-fetal interface. [ABSTRACT FROM AUTHOR]

Anaphylactic shock is a severe, acute, generalized, hypersensitivity reaction that appears rarely during pregnancy, but which has significant adverse outcomes on the pregnant woman and the fetus due to hypotension. Herein we present a mini-review about the clinical diagnosis and management in pregnancy, based on cases described in literature. While its etiology is diverse, the most common cases of anaphylactic shock are represented by the administration of antibiotics, especially those for the prophylaxis of group B streptococcal infection, being followed, in the frequency order, by the anesthetic drugs. The maternal consequences of anaphylactic shock are various, besides hypotension, its manifestations being cutaneous, digestive, cardiovascular or respiratory. The fetal implications may include fetal bradycardia, ischemic hypoxic encephalopathy or even death. Adrenaline intramuscularly injected into the vastus lateralis of the quadriceps (anterolateral thigh) is the first-line treatment of anaphylaxis, therefore it should be rapidly available for pregnant women with potential risk of anaphylaxis. Serum tryptase is the only available validated biomarker for anaphylaxis. [ABSTRACT FROM AUTHOR]

One of the promising and quite new directions of non-invasive prenatal diagnostics can be the analysis of extracellular fetal DNA in the blood of pregnant women. Seventeen pregnant women with fetal pathology in the second trimester were examined in the dynamics of gestation in obstetric complex No. 9 in Tashkent. Control group included 29 pregnant women with physiological course of gestation and without pathology. The concentration of fetal DNA in plasma of pregnant women with fetal malformations in the second trimester exceeds the indicators of pregnant women without fetal pathology in 1.8 times. The total concentration associated with the surface of cells of fetal DNA in 2.3 times higher than in women without fetal pathology. The maternal DNA in fetal pathology was significantly decreased (in 3.1 times) in the fraction associated with the surface of blood cells, whereas the level of the mother's DNA in plasma from pregnant women with fetal abnormalities was lower in 1.7 times, in comparison with pregnant women without fetal pathology. The analysis of correlation between fetal and maternal extracellular DNA showed that this relationship is higher in the plasma and in the fraction associated with ionic interactions than in the fraction of extracellular DNA associated with cell surface proteins as in the physiological course of pregnancy, as in fetal abnormalities. The obtained results allow concluding that to increase the informative value of non-invasive diagnosis of fetal pathology at different stages of pregnancy, it seems appropriate to use fractions of fetal and maternal extracellular DNA associated with the surface of blood cells of the mother. [ABSTRACT FROM AUTHOR]

Background: Down syndrome (trisomy 21) is a well-known cause of mental retardation. It can be diagnosed in early pregnancy. Scientists have made great strides in outlining the pathophysiologic mechanisms of mental retardation in Down syndrome. Much less has been published on human therapy. To cur knowledge, these are the first published cases of fetal therapy for Down syndrome. Methodology: Reports of three cases. In all cases, treatment was both biochemical (e.g. nutritional) and educational. In all cases, treatment was both befcre and after birth. Results: All children lacked the characteristic faces usually seen in the children with Down syndrome. This suggests a treatment effect before birth. All children had better than expected development. Discussion: Enhancement of development is preposed as a new therapeutic principle. Developing neurons exchange neurotrophic factors during development when they give or receive stimulation from other neurons. Neurons which receive neurotrophic stimulation survive, and those, which do not, are lost to apoptosis. The developmental therapeutic principle seeks to optimize brain development. Biochemical inputs (neurotransmitters, drugs, hormones, nutrients) and functional stimulation are integrated to optimize the growth and survival of neurons individually; other cells; subcellular organelles; and the brain as a whole. Treatment may be before and after birth, both biochemical and functional. These principles may be applied to Down syndrome, other conditions, and normal fetuses or children. Previously published: Baggot PJ and Baggot RM (2014). Fetal Therapy for Down Syndrome: Report of three cases and review of the literature. J Am Phys Surg 19(l):20-24. [ABSTRACT FROM AUTHOR]

Objective According to the classification system used, 15–60% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (FGR) as a cause of death. Distinguishing small-for-gestational age (SGA) from pathological FGR is a challenge at postmortem examination. This study uses data from a large, well-characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight. Methods Autopsy findings from intrauterine death investigations (2005–2013 inclusive, from Great Ormond Street Hospital and St George’s Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born ≥24 weeks’ gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated. Results There were 1064 intrauterine deaths, including 533 stillbirths ≥24 weeks’ gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10th centile and were defined as SGA. The majority (86%) of stillborn SGA fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the SGA population compared with the non-SGA population (P=0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (P<0.0001 for both), with an average artifactual reduction in birth weight of around −0.8 SD of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (P=0.0001). Conclusion Based on birth weight alone, 36% of stillbirths are classified as SGA. However, fetuses lose weight in utero with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of FGR. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction ( IUGR) is interconnected with developmental programming of lifelong pathophysiology. IUGR is seen in human multifetal pregnancies, with stepwise rises in fetal numbers interfering with placental nutrient delivery. It remains unknown whether fetal blood analyses would reflect fetal nutrition, liver, and excretory function in the last trimester of human or ovine IUGR. In an ovine model, we hypothesized that fetal plasma biochemical values would reflect progressive placental, fetal liver, and fetal kidney dysfunction as the number of fetuses per gestation rose. To determine fetal plasma biochemical values in singleton, twin, triplet, and quadruplet/quintuplet ovine gestation, we investigated morphometric measures and comprehensive metabolic panels with nutritional measures, liver enzymes, and placental and fetal kidney excretory measures at gestational day ( GD) 130 (90% gestation). As anticipated, placental dysfunction was supported by a stepwise fall in fetal weight, fetal plasma glucose, and triglyceride levels as fetal number per ewe rose. Fetal glucose and triglycerides were directly related to fetal weight. Plasma creatinine, reflecting fetal renal excretory function, and plasma cholesterol, reflecting placental excretory function, were inversely correlated with fetal weight. Progressive biochemical disturbances and growth restriction accompanied the rise in fetal number. Understanding the compensatory and adaptive responses of growth-restricted fetuses at the biochemical level may help explain how metabolic pathways in growth restriction can be predetermined at birth. This physiological understanding is important for clinical care and generating interventional strategies to prevent altered developmental programming in multifetal gestation. [ABSTRACT FROM AUTHOR]

Objective: To establish a reference range for the fetal intracranial translucency (IT) measurement between 11 and 14 + 2 weeks in a Brazilian population. Methods: A retrospective cross-sectional study was performed with 199 low-risk singleton pregnancies during the first trimester ultrasound exam. The IT (fourth ventricle width) measurement was performed in a mid-sagittal view of fetal profile defined by two echogenic borders – the dorsal part of the brain stem anteriorly and the choroid plexus of the fourth ventricle posteriorly. Polynomial regression was used to obtain the best fit using fetal IT measurements and crown-rump length (CRL). Percentiles 5th, 50th and 95th were determined for each gestational age. Results: The mean of fetal IT ranged from 1.6 mm at CRL 45 to 2.0 mm at CRL 84 mm. A best fit curve was a first-degree polynomial regression: IT measurement = 1.001 + 0.0124 × CRL (R2=0.09). Conclusion: Reference range for the fetal IT measurement between 11 and 14 + 2 weeks of gestation in a Brazilian population was established. [ABSTRACT FROM PUBLISHER]

Ultrasound prenatal examination enables one to assess the facial skeleton and the neck from the first weeks of gestation. Cervicofacial tumors detected via prenatal ultrasound are very rarely reported fetal pathologies. They include cystic hygromas, teratomas, epulides, vascular tumors, and thyroid tumors. The tumor category, its location and vascularization pattern allow one to accurately establish a diagnosis which is usually confirmed by clinical examination of the neonate or a pathological examination (surgical specimen, biopsy, autopsy). The prenatal ultrasound diagnosis of cervicofacial tumor in the fetus allows planning of pregnancy management and fetal therapy, preparation of the delivery, and perinatal as well as neonatal treatment. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia, traditionally characterized by high blood pressure and proteinuria, is a common pregnancy complication, which affects 2-8% of all pregnancies. Although children born to women with preeclampsia have a higher risk of hypertension in later life, the mechanism of this increased risk is unknown. DNA methylation is an epigenetic modification that has been studied as a mediator of cellular memory of adverse exposures in utero. Since each cell type in the body has a unique DNA profile, cell subtype composition is a major confounding factor in studies of tissues with heterogeneous cell types. The best way to avoid this confounding effect is by using purified cell types. However, using purified cell types in large cohort translational studies is difficult. The amnion, the inner layer of the fetal membranes of the placenta, is derived from the epiblast and consists of two cell types, which are easy to isolate from the delivered placenta. In this study, we demonstrate the value of using amnion samples for DNA methylation studies, revealing distinctive patterns between fetuses exposed to proteinuria or hypertension and fetuses from normal pregnancies. Results: We performed a genome-wide DNA methylation analysis, HpaII tiny fragment Enrichment by Ligation-mediated PCR (HELP)-tagging, on 62 amnion samples from the placentas of uncomplicated, normal pregnancies and from those with complications of preeclampsia or hypertension. Using a regression model approach, we found 123, 85, and 99 loci with high-confidence hypertension-associated, proteinuria-associated, and hypertension- and proteinuria-associated DNA methylation changes, respectively. A gene ontology analysis showed DNA methylation changes to be selecting genes with different biological processes in exposure status. We also found that these differentially methylated regions overlap loci previously reported as differentially methylated regions in preeclampsia. Conclusions: Our findings support prior observations that preeclampsia is associated with changes of DNA methylation near genes that have previously been found to be dysregulated in preeclampsia. We propose that amniotic membranes represent a valuable surrogate fetal tissue on which to perform epigenome-wide association studies of adverse intrauterine conditions. [ABSTRACT FROM AUTHOR]

Key points The fetus responds to decreases in arterial partial pressure of oxygen by redirecting the blood flow mainly to the brain and the heart, at a cost to other peripheral organs like the kidneys., Renal hypoxia and ischaemia stimulate inflammatory and apoptotic responses., Ketamine, an NMDA receptor antagonist, is able to reduce renal immune and inflammatory gene expressions stimulated by hypoxia., Ketamine may have therapeutic potential for protection against ischaemic renal damage in fetuses subjected to acute hypoxia., Abstract Acute fetal hypoxia is a form of fetal stress that stimulates renal vasoconstriction and ischaemia as a consequence of the physiological redistribution of combined ventricular output. Because of the potential ischaemia-reperfusion injury to the kidney, we hypothesized that it would respond to hypoxia with an increase in the expression of inflammatory genes, and that ketamine (an N-methyl- d-aspartate receptor antagonist) would reduce or block this response. Hypoxia was induced for 30 min in chronically catheterized fetal sheep (125 ± 3 days), with or without ketamine (3 mg kg−1) administered intravenously to the fetus 10 min prior to hypoxia. Gene expression in fetal kidney cortex collected 24 h after the onset of hypoxia was analysed using ovine Agilent 15.5k array and validated with qPCR and immunohistochemistry in four groups of ewes: normoxic control, normoxia + ketamine, hypoxic control and hypoxia + ketamine ( n = 3-4 per group). Significant differences in gene expression between groups were determined with t-statistics using the limma package for R ( P ≤ 0.05). Enriched biological processes for the 427 upregulated genes were immune and inflammatory responses and for the 946 downregulated genes were metabolic processes. Ketamine countered the effects of hypoxia on upregulated immune/inflammatory responses as well as the downregulated metabolic responses. We conclude that our transcriptomics modelling predicts that hypoxia activates inflammatory pathways and reduces metabolism in the fetal kidney cortex, and ketamine blocks or ameliorates this response. The results suggest that ketamine may have therapeutic potential for protection from ischaemic renal damage. [ABSTRACT FROM AUTHOR]

Fetal exposure to five parabens was investigated due to their endocrine-disrupting potential and possible impact on fetal development. Body burdens occurring from real-world exposures were determined typically as total concentrations after conjugate hydrolysis in 181 maternal urine and 38 umbilical cord blood plasma samples from a multiethnic cohort of 185 predominantly-black, pregnant women recruited in Brooklyn, New York between 2007/9. For 33 participants, both sample types (maternal urine and cord blood) were available. Methyl- (MePB), ethyl- (EtPB), propyl- (PrPB), butyl- (BuPB), and benzylparaben (BePB) were detected in 100, 73.5, 100, 66.3 and 0.0% of the urine samples at median concentrations of 279, 1.44, 75.3, 0.39, and < 0.02 μg/L, respectively. Median concentrations of MePB and PrPB were, respectively 4.4- and 8.7-fold higher compared to those reported previously for the general U.S. population (NHANES, 2005/6). Listed in the order above, the five parabens were detected in 97.4, 94.7, 47.4, 47.4, and 44.7% of cord blood plasma samples at median total concentrations of 25.0, 0.36, < 0.27, < 0.09, and < 0.10 μg/L, respectively. Free MePB, EtPB, and PrPB were detected in a subset of cord blood plasma samples at, respectively, 3.9, 71.7, and 6.4% of their total concentrations, whereas free BuPB and BePB were not detected. Literature data and those reported here show the urban community studied here to rank highest in the world for MePB and PrPB exposure in pregnant women, whereas it ranks among the lowest for EtPB and BuPB. This study is the first to report the occurrence of parabens in human umbilical cord blood. Maternal exposure to parabens is widespread, and substantial differences were found to exist between communities and countries both in the spectrum and degree of paraben exposures. [ABSTRACT FROM AUTHOR]

Fetal Alcohol Spectrum Disorder (FASD) is a non-diagnostic umbrella term that describes a range of effects that can occur as a result of a mother consuming alcohol during pregnancy (SAMSHA, 2014). Awareness of the need for professionals to become educated on FASD has emerged as a critical topic in the field of social work and child welfare practice specifically. The social work practice response to children and families, in order to be effective, must develop and emerge from an FASD Informed Practice lens - which implies particular knowledge and competencies in practice. This article will highlight the need to recognize FASD as a disabling condition and identify why training and knowledge is essential in order to work effectively with children and families. Further, an educational pathway to FASD informed practice in relation to a broad array of interventions and enabling/supportive approaches relevant to social work theory will be identified. The focus of this paper is to identifying why knowledge and education on FASD is important to social work practice. [ABSTRACT FROM AUTHOR]

Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To compare left myocardial performance index ( MPI) values and reproducibility using different settings and ultrasound equipment in order to standardize optimal machine settings. Methods Left MPI was prospectively evaluated by one observer performing conventional Doppler in 62 fetuses (28-36 weeks of gestational age) using different settings (changing sweep speed, gain and wall motion filter ( WMF)) and two different ultrasound devices (Siemens Antares, Siemens; Voluson 730 Expert, GE Medical Systems). Intraclass coefficients of agreement ( ICCs) were calculated using Bland-Altman analysis. Results Using baseline settings on the Siemens, mean ( SD) MPI was 0.44 (0.05) with an ICC of 0.81. Decreasing the sweep speed resulted in decreasing average MPI values (0.43) and decreasing ICC (0.61). Lowering gain also influenced average MPI values (0.46) and ICC (0.76). Raising gain resulted in similar MPI values (0.45) with better ICC (0.90) compared with baseline settings. Raising wall motion filter ( WMF) provided the best ICC (0.94) compared with the other settings. Changing the ultrasound equipment resulted in an ICC of 0.64. The optimal settings to achieve the highest reproducibility in measurement of MPI were sweep speed 8, gain 60 dB and WMF 281 Hz for Siemens Antares and sweep speed 5, gain −10 dB and WMF 210 Hz for Voluson 730 Expert. Conclusion Changing ultrasound settings or equipment may affect the calculation and repeatability of measurement of MPI values. Strict standardization of methods decreases the variability of this parameter for fetal cardiac function assessment. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

We hypothesize that prenatal exposure to glucocorticoids (GCs) negatively alters the insulin signal transduction pathway and has differing effects on the fetus according to gestational age (GA) at exposure. Twenty-three fetal baboons were delivered from 23 healthy, nondiabetic mothers. Twelve preterm (0.67 GA) and 11 near-term (0.95 GA) baboons were killed immediately after delivery. Half of the pregnant baboons at each gestation received two doses of i.m. betamethasone 24 h apart (170 μg/kg) before delivery, while the other half received no intervention. Vastus lateralis muscle was obtained from postnatal animals tomeasure the protein content andgene expressionof insulin receptor β (IRβ; INSR), IRβ Tyr 1361 phosphorylation (pIRβ), IR substrate 1 (IRS1), IRS1 tyrosine phosphorylation (pIRS1), p85 subunit of PI3-kinase, AKT (protein kinase B), phospho-AKT Ser473 (pAKT), AKT1, AKT2, and glucose transporters (GLUT1 and GLUT4). Skeletal muscle from preterm baboons exposed to GCs had markedly reduced protein content of AKTand AKT1 (respectively, 73 and 72% from 0.67 GA control, P<0.001); IRb and pIRb were also decreased (respectively, 94 and 85%, P<0.01) in themuscle of premature GCexposedfetusesbut not intermfetuses.GLUT1andGLUT4tendedto increasewithGCexposure in preterm animals (PZ0.09), while GLUT4 increased sixfold in term animals after exposure to GC (P<0.05). In conclusion, exposure to a single course of antenatal GCs during fetal life alters the insulin signaling pathway in fetal muscle in a manner dependent on the stage of gestation. [ABSTRACT FROM AUTHOR]

Pregnancy presents an immunological conundrum because two genetically different individuals coexist. The maternal lymphocytes at the uterine maternal-fetal interface that can recognize mismatched placental cells are T cells and abundant distinctive uterine NK (uNK) cells. Multiple mechanisms exist that avoid damaging T cell responses to the fetus, whereas activation of uNK cells is probably physiological. Indeed, genetic epidemiological data suggest that the variability of NK cell receptors and their MHC ligands define pregnancy success; however, exactly how uNK cells function in normal and pathological pregnancy is still unclear, and any therapies aimed at suppressing NK cells must be viewed with caution. Allorecognition of fetal placental cells by uNK cells is emerging as the key maternalfetal immune mechanism that regulates placentation. [ABSTRACT FROM AUTHOR]

Adverse intrauterine environments have been associated with increased risk of later cardiovascular disease and hypertension. In an animal model using diverse developmental toxicants, we measured blood pressure (BP), renal nephron endowment, renal glucocorticoid receptor (GR) gene expression, and serum aldosterone in offspring of pregnant Sprague Dawley rats exposed to dexamethasone (Dex), perfluorooctane sulfonate (PFOS), atrazine, perfluorononanoic acid (PFNA), arsenic, or nicotine. BP was assessed by tail cuff photoplethysmography, nephron endowment by confocal microscopy, and renal GR mRNA by qPCR. BP was also measured by telemetry, and corticosterone (CORT) was measured in resting or restrained Dex and atrazine offspring. Treated dams gained less weight during treatment in all groups except arsenic. There were chemical- and sex-specific effects on birth weight, but offspring body weights were similar by weaning. BP was higher in Dex, PFOS, atrazine, and PFNA male offspring by 7–10 weeks. Female offspring exhibited elevated BP at 10 weeks for PFNA and arsenic, and at 37 weeks for Dex, PFOS, and atrazine. Dex, PFOS, and atrazine offspring still exhibited elevated BP at 52–65 weeks of age; others did not. Elevated BP was associated with lower nephron counts. Dex, PFOS, and atrazine offspring had elevated renal GR gene expression. Elevations in BP were also observed in Dex and atrazine offspring by radiotelemetry. Atrazine offspring exhibited enhanced CORT response to restraint. Elevated offspring BP was induced by maternal exposure to toxicants. Because all treatments affected maternal gestational weight gain, maternal stress may be a common underlying factor in these observations. [ABSTRACT FROM AUTHOR]

Negative factors, such as the 'magnificent' five that includes alcoholism, smoking, unhealthy food, lack of movement, and negative emotions, accompany a person almost from birth and trigger powerful internal biochemical reactions leading to disastrous consequences. Those new deleterious reactions force the organism to mobilize all of its internal reserves to neutralize, at least temporarily, the destructive effects of these negative factors. As a result of this continuous struggle for survival, body parts degenerate, starting from connective tissue protein molecules to entire newly formed organs (such as adipose tissue). Today we can state with certainty that the reason for the majority of widespread pathologies causing premature aging and death, such as atherosclerosis and arterial hypertension, is exactly those external negative factors that a person voluntary introduces into their life. However, the margin of safety that Nature enclosed in the human body is really amazing, allowing light-minded and self-destructive people to live up to 60 years and longer. It is quite possible that the lifespan will increase up to 100 years and more if a person stops destroying themself with negative emotions and bad habits, including unhealthy food and overeating. This article examines possible interconnection between unhealthy overeating and the theory of programmed aging and phenoptosis. [ABSTRACT FROM AUTHOR]

Abstract: Cases of spina bifida alone and in association with ventriculomegaly represent important but different malformations according to clinical characteristics. In our study, we analyzed the data on pregancies terminated because of isolated cases (n =307) and ventriculomegaly-associated cases (n =372) of spina bifida. In spina bifida cases in association with hydrocephalus, positive obstetric history was found approximately 1.5 times more frequently than in the isolated ones. The incidence of positive genetic history was nearly two-fold in the latter cases. In isolated cases of spina bifida, associated malformations were more common than in cases of spina bifida and ventriculomegaly together. The most frequent associated malformations were those of the urogenital system (in cases of spina bifida: 11.1%; in cases of SB+V: 9.14%). The risk of recurrence of SB+V is significantly higher than that of isolated SB (8.9% vs. 2.1%). It can be concluded that positive genetic history is more common in cases of isolated spina bifida. Malformations out of the nervous system are more commonly observed in cases of isolated spina bifida. During the prenatal diagnostics of spina bifida, sonography must focus on malformations of the urogenital system. [Copyright &y& Elsevier]

The objective of this study was to investigate, retrospectively, the frequencies of fetal chromosomal abnormalities identified in 4176 prenatal cytogenetic examinations at the Xiamen Maternity and Child Health Care Hospital over the 5-year period from October 2005 to September 2010. The frequency of abnormal fetal karyotypes was 4.6%. Numerical chromosome abnormalities were identified in 150 cases. The frequency of trisomy 21 was by far the highest, followed by trisomy 18. Structural aberrations of chromosomes were identified in 43 cases, including 21 cases with balanced and 22 cases with unbalanced chromosomal aberrations. In addition, 16 cases of apparently de novo chromosomal aberrations and 27 cases of familial inheritances were observed. Increased awareness of the frequencies of fetal chromosome abnormalities is important for the improvement of prenatal care and providing the options of termination or continuation of the pregnancy. Data obtained in this study provide the basis of a database for genetic counseling. [ABSTRACT FROM AUTHOR]

Adult β-cell dysfunction, a hallmark of type 2 diabetes, can be programmed by adverse fetal environment. We have shown that fetal glucocorticoids (GCs) participate in this programming through inhibition of β-cell development. Here we have investigated the molecular mechanisms underlying this regulation. We showed that GCs stimulate the expression of peroxisome proliferator--activated receptor-γ coactivator-1α (PGC-1α), a coregulator of the GCs receptor (GR), and that the overexpression of PGC-1α represses genes important for β-cell development and function. More precisely, PGC-1α inhibited the expression of the key β-cell transcription factor pancreatic duodenal homeobox 1 (Pdx1). This repression required the GR and was mediated through binding of a GR/PGC-1α complex to the Pdx1 promoter. To explore PGC-1α function, we generated mice with inducible β-cell PGC-1α overexpression. Mice overexpressing PGC-1α exhibited at adult age impaired glucose tolerance associated with reduced insulin secretion, decreased β-cell mass, and β-cell hypotrophy. Interestingly, PGC-1α expression in fetal life only was sufficient to impair adult β-cell function whereas β-cell PGC-1α overexpression from adult age had no consequence on β-cell function. Altogether, our results demonstrate that the GR and PGC-1α participate in the fetal programming of adult β-cell function through inhibition of Pdx1 expression. [ABSTRACT FROM AUTHOR]

Objective: Prenatal cytogenetic diagnostic methods for the diagnosis of fetal chromosomal anomalies have been used reliably over the last 40 years. Advanced maternal age has become a basic indication for amniocentesis. Methods: We examined the results of the chromosome analyses of 3485 women that had amniocentesis for any reason during their antenatal care in our perinatology clinic in 2007-2009. Amniocentesis was performed for advanced maternal age in 1456 women (41.8%) and for other reasons in the remaining 2029 women (58.2%). Chromosomal anomalies were examined numerically and structurally. Results: When the amniocentesis results of the patients were reviewed as numerically normal or abnormal; 40 (2.7%) of 1456 amniocentesis procedures performed for advanced maternal age, 5 (0.9%) of 531 procedures performed for an increased double-test risk and 14 (1.3%) of 1095 procedures performed for an increased triple test risk were found to have chromosomal aneuploidy. Conclusions: Maternal age is still the most prevalent indication for genetic amniocentesis other than positive prenatal screening tests. Among women with advanced maternal age, prenatal ultrasonography for soft markers of chromosomal aneuploidy accompanied with maternal serum biochemical screening tests should be evaluated during the decision making process of genetic amniocentesis. [ABSTRACT FROM AUTHOR]

Abstract: Multiple pregnancy with its wide array of medical consequences poses an important condition during pregnancy. We performed perinatal autopsy in 49 cases of spontaneous abortion resulting from multiple pregnancies during the study period. Twenty-seven of the 44 twin pregnancies ending in miscarriage were conceived naturally, whereas 17 were conceived through assisted reproductive techniques. Each of the 5 triplet pregnancies ending in miscarriage was conceived through assisted reproductive techniques. There was a positive history of miscarriage in 22.4% of the cases. Monochorial placentation occurred more commonly in multiple pregnancies terminating with miscarriage than in multiple pregnancies without miscarriage. A fetal congenital malformation was found in 8 cases. Three of these cases were conceived through assisted reproductive techniques, and 5 were conceived naturally. Miscarriage was due to intrauterine infection in 36% of the cases. Our study confirms that spontaneous abortion is more common in multiple than in singleton pregnancies. Monochorial placentation predicted a higher fetal morbidity and mortality. In pregnancies where all fetuses were of male gender, miscarriage was more common than in pregnancies where all fetuses were female. Assisted reproductive techniques do not predispose to the development of fetal malformations. [Copyright &y& Elsevier]

Objective. To determine the factors affecting the accuracy of ultrasonographic weight estimation in twins. Methods. 152 sets of twins delivered vaginally, were included. Effects of fetal weights, inter-twin weight discordance, chorionicity, early rupture of membranes, intrauterine growth restriction, and presentations of twins on errors of estimated fetal weights were evaluated. The primary measures of estimated fetal weight accuracy compared were mean-percentage-error and the standart deviation (SD) of percentage errors. Results. Mean percentage errors for the first fetus (8.13 ± 6.82) and the second fetus (8.07 ± 6.88) were similar ( p == 0.64). Random errors of both fetuses were also similar ( p == 0.78). If one of the fetuses had IUGR, the percentage error and also the random error of that fetus would increase significantly. Different presentations and fetal gender combinations were similar for both types of errors of fetal weight estimation. A weak negative lineer relationship was found between the weight of the first fetus and its percentage error ( r == −0.27, p == 0.04). A similar relation was present between the weight and percentage error of the second fetus ( r == −0.29, p == 0.03). Percentage errors and also random errors of both fetuses were significantly higher if severe discordance was present between twins ( p == 0.01 and p == 0.02, respectively). Conclusions. IUGR, fetal weights, and inter-twin discordence are the factors affecting the accuracy of weight estimation by ultrasonography. [ABSTRACT FROM AUTHOR]

El artículo presenta información sobre tres drogas auxiliares en la obstetricia. Se incluyen los detalles del origen, la fisiopatogenia y los efectos de las drogas Flaxedil, Nisentil y Largactil, además de la historia de las drogas e información sobre la efectividad y la investigación referida a las drogas.

Abstract: Hydrops fetalis (HF) is characterized by an accumulation of fluid in the extracellular compartments and in body cavities. Non-immune HF (NIHF) is caused by a wide variety of disorders and overall, 20–25% of NIHF remain unexplained. Inborn errors of metabolism, mostly lysosomal storage diseases have been estimated to account for 1–2% of cases, leading to HF by anemia or liver failure. Very few cases of NIHF and Congenital Disorder of Glycosylation (CDG) have been reported. We present here a case of recurrence of HF in a non-related couple in which the diagnosis of CDG type I was suspected at fetal pathological examination then confirmed at the enzymatic and molecular levels, as well as on a characteristic CDG I serum transferrin profile at 30weeks of gestation. We also provide a systematic review of reported cases with CDG type I and NIHF reported thus far. When NIHF remains unexplained despite exhaustive obstetrical screening, analysis of PMM activity in the parents'' leucocytes is possible and might be performed easily during pregnancy. The accurate diagnosis is important in terms of counseling during pregnancy or later, in order to allow an early molecular prenatal diagnosis for the following pregnancies. [Copyright &y& Elsevier]

Perfluorinated compounds (PFCs) are a group of chemicals widely used for many applications. In this study PFCs were investigated in maternal blood during pregnancy (at two time points) (n = 40 and 38) and 6 months after delivery (n = 47), in cord blood (n = 33) and in blood of infants six (n = 40) and nineteen months (n = 24) after birth, and monthly in breast milk samples in Germany. Concentrations in maternal serum ranged from 0.5 to 9.4 μg/L for perfluorooctane sulfonate (PFOS) and 0.7 to 8.7 μg/L for perfluorooctanoic acid (PFOA). In cord serum, the values ranged from 0.3 to 2.8 μg/L and from 0.5 to 4.2 μg/L for PFOS and PFOA, respectively. The median results from serum at six and nineteen months of age were 3.0 and 1.9 μg/L for PFOS and 6.9 and 4.6 μg/L for PFOA, respectively. In breast milk samples, PFOS ranged from <0.03 to 0.11 μg/L (median: 0.04 μg/L), while PFOA was detected only in some samples as were all other PFCs. Overall, we found low levels of PFCs in cord sera and an increase in concentrations through the first months of infant life. Although the concentrations in breast milk were low, this intake led to a body burden at the age of six months similar to (PFOS) or higher than (PFOA) that found in adults. [ABSTRACT FROM AUTHOR]

The article analyzes aspects of the ultrasound evaluation of the malformations in the human fetal venous system. It states that an abnormal development in the system can be based from any of its embryonic systems including umbilical and cardinal systems. It presents several abnormalities in the system which include heterotaxy syndromes and primary failure to create critical anastomoses. It concludes that fetal system anomalies can be diagnosed by recognition of their sonographic appearance.

Objective: To determine whether the prenatal ultrasound (US) score can effectively differentiate fetal physiological and pathological hydronephrosis. Study Design: 158 fetuses (198 kidneys) with hydronephrosis (PAPD>or=10mm) were diagnosed by prenatal US in the third trimester. We measured and recorded three US parameters: renal pelvic anterior posterior diameter (PAPD), renal parenchyma thickness and pelvicaliceal morphology. They were graded with a score from 0 to 3 on the basis of severity of hydronephrosis, and the total US score of each kidney was obtained. According to the postnatal US and clinical diagnosis and management, all the cases were divided into two groups: physiological and pathological hydronephrosis. Using receiver operating characteristic curves analysis, we researched whether the US score was more accurate than each parameter and which was the best cut-off value for differential diagnosis of physiological and pathological hydronephrosis. Results: Of all the 198 hydronephrosis, 139 (70.20%) were physiological and 59 (29.80%) were pathological confirmed postnatally. Area under the curve of US score was 0.982, which was significantly larger than that of each parameter (P<0.05). The higher the score, the higher the possibility of pathological hydronephrosis was. Score 6 was the best cut-off value: the sensitivity, specificity, positive predictive value, negative predictive value, consistency rate and Youden's index were 89.83%, 94.24%, 86.89%, 95.62%, 92.93% and 0.8407, respectively. Conclusion: Prenatal US score is easy to obtain by measuring some data of the kidney and can effectively differentiate fetal physiological and pathological hydronephrosis. It can also be used as a new quantitative method to evaluate the prognosis of fetal hydronephrosis so as to provide reference for prenatal intervention and more accurate information for the family of the fetus. [ABSTRACT FROM AUTHOR]

Prune-belly syndrome is a rare congenital disorder characterized by musculature deficiency in the abdominal wall, lower urinary tract obstruction, other urinary tract anomalies, and bilateral cryptorchidism. The syndrome is commonly associated with pulmonary, skeletal, cardiac, and gastrointestinal defects. Over 95% of patients are male. Urinary tract disease is the major prognostic factor with the complications of pulmonary hypoplasia and end stage renal disease. The aim of this study was to determine phenotypic and pathological features of fetuses with this syndrome. Six fetuses with prune-belly syndrome were evaluated by postmortem pathological investigation. Characteristic features of the fetuses with this syndrome as well as additional anomalies were evaluated. Five fetuses were male while one was female. Gestational age ranged from 15 to 22 weeks. A urethral pathology that prevented urinary outflow from the bladder was present in all cases. Marked bladder distension with atrophy of the bladder smooth muscle and abdominal distension with muscular atrophy were also seen in all. Crypto-orchidism, Potter face, pes equinovarus, pulmonary hypoplasia and obstructive renal dysplasia were among the additional noteworthy anomalies. The pathogenesis of prune-belly syndrome is controversial. More studies are required on the inheritance, etiology and pathogenesis of the prune belly syndrome. Factors affecting the bilaminar and trilaminar germ layer during early 2-3. embryonic week may be considered to explain the pathogenesis of the anomalies seen with this syndrome. [ABSTRACT FROM AUTHOR]

The article focuses on diagnosis and risk factors of fetomaternal hemorrhage. It states that fetomaternal hemorrhage is a pathophysiological condition wherein a considerable volume of fetal blood enters the maternal circulation. It also notes that disruption of the trophoblast leads to the condition, however, the cause of such event remains unknown. Moreover, it emphasizes that understanding of fetomaternal hemorrhage is not complete and that diagnostic methods are still needed to be improved.

This article summarizes the essentials of studies on the craniofacial skeleton performed over 17 years. It presents data from research into foetal pathology resulting in new views on craniofacial patterning and/or fields for further discussion. [ABSTRACT FROM PUBLISHER]

Background: Malnutrition in fetal life and during suckling have in some animal studies resulted in adaptive changes related to the fat and glucose metabolism, which in the long term might predispose the offspring for metabolic disorders such as obesity later in life. The objective was to study the effect of fetal life malnutrition in male mink on the gene expression of leptin and adiponectin in different adipose tissue sites. Results: Thirty-two male mink, strict carnivore species, exposed to low (FL) or adequate (FA) protein provision the last 16.3 ± 1.8 days of fetal life and randomly assigned to a low (LP) or adequate (AP) protein diet from 7 to 9.5 weeks of age were used. Adipose tissues (subcutaneous, perirenal and mesenteric) were analyzed using qPCR. Fetal life or postweaning protein provision did not affect the relative abundances of leptin and adiponectin mRNAs in adipose tissue at 9.5 weeks of age. Relative abundances of leptin and adiponectin mRNAs were different between adipose tissue sites and were significantly higher in subcutaneous than in perirenal and mesenteric tissues. Conclusion: Fetal life protein malnutrition in male mink, did not result in adaptive changes in the gene expression of leptin and adiponectin mRNAs in adipose tissue at 9.5 weeks of age as found in rodents. However, both leptin and adiponectin mRNAs were significantly differently expressed between tissue sites. [ABSTRACT FROM AUTHOR]

Abstract: Maternal undernutrition during pregnancy alters the physiology, behaviour and cognitive abilities of the offspring in sheep. Undernutrition restricted to the time around conception alters the physiology of the offspring, but effects on the behaviour and cognitive abilities are unknown. We studied the effects of mild periconceptional undernutrition in sheep on side preference and cognitive flexibility in the offspring. Ewes were well fed (controls) or mildly undernourished from 60 days before until 30 days after mating (PCUN; 10–15% body weight reduction). Offspring were evaluated at 4 and 18 months of age in a left–right choice maze using social and feeding motivation as rewards. We determined side preference, and assessed cognitive flexibility as the ability to improve runs required to reach criterion during two reversal learning episodes. Side preference in the PCUN offspring was close to neutrality in singleton males (p ≤0.05) and twin females (p ≤0.05) at 4 but not 18 months of age. Twin offspring tended to be more likely to change side preference between 4 and 18 months (p =0.07). Performance on reversal learning was similar in PCUN and control offspring, but speed of learning improved faster in female than in male lambs (p ≤0.05) at 4 but not 18 months of age. These findings suggest that mild periconceptional undernutrition in sheep can alter behavioural laterality of the offspring, and that singleton/twin status, sex and postnatal age are all important factors to consider in evaluating the effects of prenatal insults on postnatal behaviour. [Copyright &y& Elsevier]

Embryo implantation consists of a series of events promoting the invasion of the endometrium and then the uterine arterial system by the extra-embryonic trophoblast. In order for this semi-heterologous implantation to succeed, the endometrium has to first undergo a number of structural and biochemical changes (decidualization). The decidua's various constituents subsequently play a role in the embryonic implantation. The third step is the transformation of the uterine vascular system and the growth of the placenta, which will provide the foetoplacental unit with nutrients. Several physiopathological aspects will be discussed: 1) the implantation window, regulated by maternal and embryonic hormonal secretions and thus influenced by any defects in the latter: dysharmonic luteal phase, 21-hydroxylase block, abnormal integrin expression, 2) the successive trophoblast invasions of uterine vessels which, when defective, lead to early embryo loss or late-onset vascular pathologies, as preeclampsia, 3) the pregnancy's immunological equilibrium, with a spontaneously tolerated semi-allogeneic implant, 4) the impact of pro-coagulant factors (thrombophilia) on the pregnancy's progression, 5) the environment of the uterus, ranging from hydrosalpinx to uterine contractions. In summary, the least anatomical or physiological perturbation can interfere with human embryonic implantation - a very particular phenomenon and a true biological paradox. [ABSTRACT FROM AUTHOR]

In this article the authors discuss the pathophysiology of the conditions to identify the causes of stillbirth. It states that stillbirth is a leading complication in obstetrics, and identifying the cause of death and developing interventions to prevent stillbirth are necessary. The authors urge to investigate the effects of a disease process in the maternal, fetal and placental conditions. Among the conditions causing stillbirth include antiphospholipid syndrome and chromosomal abnormalities.

Chiari I malformation is associated with a small posterior fossa which cannot accommodate a growing hindbrain. Pseudotumor cerebri has been linked to developmental posterior fossa malformations. The authors present two cases of early-deterioration post-Chiari I malformation surgery in a young and an adult patient, which were linked to raised intracranial pressure and had a stormy post-operative period. The pathophysiology of pseudotumor cerebri in early post-operative complications of Chiari malformation surgery is addressed along with arguments favoring its association. Potential clinical risk factors and red flags linking pseudotumor cerebri and Chiari malformation patients are discussed. The management of post-operative complications produced by the association is addressed. [ABSTRACT FROM AUTHOR]

Background: Previous studies have linked prenatal influenza exposure to increased risk of schizophrenia; however, no study has examined the neurodevelopmental sequelae of this prenatal insult before the onset of psychotic symptoms using serological evidence of infection. This study sought to examine the contribution of prenatal influenza A and B exposure to cognitive performance among children who developed psychoses in adulthood versus nonpsychiatric control children. Methods: Subjects were 111 cases (70 with schizophrenia and 41 with affective psychoses) and 333 matched control subjects followed from gestation until age 7 through the Collaborative Perinatal Project. The Wechsler Intelligence Scale for Children (age 7) was administered and adult psychiatric morbidity was assessed by medical records review and confirmed by a validation study. Assays were conducted from archived prenatal maternal sera collected at birth, and influenza infection was determined by immunoglobulin G (IgG) antibody titers >75th percentile. Results: Significant decreases in verbal IQ and the information subtest, as well as similar nonsignificant reductions in full scale IQ scores and vocabulary, comprehension, digit span, and picture arrangement subtests were found among cases who were prenatally exposed to influenza B versus cases who were not exposed. Fetal exposure to influenza B did not lead to any significant differences in cognitive performance among control children. Conclusions: Cumulatively, these findings suggest that a genetic and/or an environmental factor associated with psychosis rendered the fetal brain particularly vulnerable to the effects of influenza B, leading to poorer cognitive performance even before symptom onset. [Copyright &y& Elsevier]

Abstract: Cyclic guanosine 3'',5''-monophosphate (cGMP) mediates a wide spectrum of physiologic processes in multiple cell types within the cardiovascular system. Dysfunctional signaling at any step of the cascade — cGMP synthesis, effector activation, or catabolism — have been implicated in numerous cardiovascular diseases, ranging from hypertension to atherosclerosis to cardiac hypertrophy and heart failure. In this review, we outline each step of the cGMP signaling cascade and discuss its regulation and physiologic effects within the cardiovascular system. In addition, we illustrate how cGMP signaling becomes dysregulated in specific cardiovascular disease states. The ubiquitous role cGMP plays in cardiac physiology and pathophysiology presents great opportunities for pharmacologic modulation of the cGMP signal in the treatment of cardiovascular diseases. We detail the various therapeutic interventional strategies that have been developed or are in development, summarizing relevant preclinical and clinical studies. [Copyright &y& Elsevier]

Neurodegenerative tauopathies are marked by their common pathologic feature of aggregates formed of hyperphosphorylated tau protein, which are associated with synapse and neuronal loss. Changes in tau conformation result in both loss of normal function and gain of fibrillogenicity that leads to aggregation. Here, we discuss the pathophysiology of tau and emerging evidence of how changes in this protein might ultimately lead to neuronal death. In particular, based on recent evidence, we propose that a non-apoptotic caspase-associated form of death is occurring in tauopathy. [Copyright &y& Elsevier]

We exploit time reversibility analysis, checking the invariance of statistical features of a series after time reversal, to detect temporal asymmetries of short-term heart period variability series. Reversibility indexes were extracted from 22 healthy fetuses between 16th to 40th wk of gestation and from 17 healthy humans (aged 21 to 54, median = 28) during graded head-up tilt with table inclination angles randomly selected inside the set (15, 30, 45, 60, 75, 90}. Irreversibility analysis showed that nonlinear dynamics observed in short-term heart period variability are mostly due to asymmetric patterns characterized by bradycardic runs shorter than tachycardic ones. These temporal asymmetries were I) more likely over short temporal scales than over longer, dominant ones; 2) more frequent during the late period of pregnancy (from 25th to 40th week of gestation); 3) significantly present in healthy humans at rest in supine position; 4) more numerous during 75 and 90° head-up tilt. Results suggest that asymmetric patterns observable in short-term heart period variability might be the result of a fully developed autonomic regulation and that an important shift of the sympathovagal balance toward sympathetic predominance (and vagal withdrawal) can increase their presence. [ABSTRACT FROM AUTHOR]

Preterm labor leading to preterm delivery (<37 weeks' gestation) affects approximately 5-7% of live births in developed countries, but significantly higher in developing countries. Prematurity due to preterm birth (PTB) accounts for around 28% of neonatal mortality worldwide. Approximately 45-50% of PTBs are idiopathic or spontaneous, 30% are related to preterm rupture of membranes, and another 15-20% are attributed to medically indicated or elective preterm deliveries. The rate of spontaneous PTB is also increasing and the exact cause is still unclear. Generalized approaches in screening for high risk status of preterm labor and interventions have failed to reduce PTB rates. PTB presents a clinical dilemma due to etiologic, pathophysiologic and genetic heterogeneities. Racial disparity in PTB rates observed in the US further complicates its understanding. PTB is a complex phenotype and is not initiated by a single etiologic agent. Etiologic factors operate through multiple pathophysiologic pathways, and these pathways include highly overlapping biomarkers and molecular factors creating pathophysiologic heterogeneities. In this article, the current understanding of PTB pathophysiology is reviewed and the need for a much broader approach in research, analysis and interpretation of data is explained, where environmental and race/ethnicity specific risk factors may dictate specific pathways leading to PTB. Recent data on amniotic fluid biomarkers and maternal and fetal genetic variants, which indicate huge disparity between races in the US, are also reviewed. These data suggest that gene-gene interactions and gene-environmental interactions produce distinct pathophysiologic pathways with respect to an individual's genetic make-up and environmental risk exposure. Current strategies of high risk screening and intervention measures may not be generalized, and a more individualized approach may be required to understand PTB and its prevention. [ABSTRACT FROM AUTHOR]

Preeclampsia is associated with an increased release of factors from the placental syncytium into maternal blood, including the antiangiogenic factors soluble fms-like tyrosine kinase-1 and soluable endoglin, the antifibrinolytic factor plasminogen activator inhibitor-1, prostanoids, lipoperoxides, cytokines, and microparticles. These factors are suggested to promote maternal endothelium dysfunction and are associated with placental damage in pregnancies also complicated with intrauterine growth restriction (IUGR). In this report, we briefly describe the interaction of syncytial factors with hypoxia, reactive oxygen species, and apoptosis in the pathophysiology of preeclampsia and IUGR. Given the critical role of the syncytium in these complications of pregnancy, we also present a novel methodology in which laser capture microdissection followed by Western blotting is used to assess levels of syncytial Fas ligand, a key protein in the apoptotic cascade. [ABSTRACT FROM AUTHOR]

AbstractChronic respiratory morbidity is common following premature birth, particularly if complicated by the development of bronchopulmonary dysplasia (BPD). Affected infants can remain oxygen dependent for many months and frequently require hospital readmission in the first 2 years after birth. Troublesome, recurrent respiratory symptoms requiring treatment are common in prematurely born children, especially those who had BPD. The most severely affected may remain symptomatic and have evidence of airway obstruction even as adults. The studies examining adolescents and adults usually report patients who had ‘classical’ BPD, that is they often had had severe respiratory failure in the neonatal period with chronic pulmonary fibrosis and airway smooth muscle hypertrophy. Nowadays, infants are described as having ‘new’ BPD, developing chronic oxygen dependence despite initially minimal or even no respiratory distress. Affected patients, however, have reduced alveolarisation and experience deterioration in lung function over the 1st year after birth. It is essential to determine if they have ‘catch up’ and identify which strategies impair and most importantly promote lung growth in this very-high-risk population.Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim: To produce a new scoring system for fetal neurobehavior based on prenatal assessment by 3D/4D sonography. We identified severely brain damaged infants and those with optimal neurological findings and compared fetal with neonatal findings. Results: The new scoring system was retrospectively applied in a group of 100 low-risk pregnancies. After delivery, postnatal neurological assessment was performed, and all neonates assessed as normal reached a score between 14 and 20, which we assumed to be a score of optimal neurological development. Subsequently, the same scoring system was applied in the group of 120 high-risk pregnancies in which, based on postnatal neurological findings, three subgroups of newborns were found: normal, mildly or moderately abnormal, and abnormal. Normal neonates had a prenatal score between 14 and 20, mildly or moderately abnormal neonates had a prenatal score of 5–13, whereas those infants who were assigned as neurologically abnormal had a prenatal score from 0–5. Conclusion: A new scoring system for the assessment of neurological status for antenatal application is proposed, similar to the neonatal optimality test of Amiel-Tison. This preliminary work may help in detecting fetal brain and neurodevelopmental alterations due to in utero brain impairment. [ABSTRACT FROM AUTHOR]