Amniotic fluid glucose concentration as a marker for intra-amniotic infection

Article Abstract:

Because intra-amniotic infection (within the amniotic sac in which the fetus is suspended) is a significant cause of complications in both mother and fetus, including fetal death, a sensitive, specific, and inexpensive diagnostic test is highly desirable. The use of a test that measures amniotic fluid (AF) glucose levels is described in 86 pregnancies involving 84 women. The AF samples were obtained during amniocentesis for premature labor (43 samples) or evaluation of lung maturity near term (38), or via intrauterine catheter during labor (5). The presence of intra-amniotic infection was determined by culture of tissues from the placenta and amniotic sac. Results showed that 14 cultures were positive for infection and that the average AF glucose concentration in these cases was 7.1 milligrams per deciliter. Seventy-two cultures were negative, with an average AF glucose concentration of 30.4 milligrams per deciliter. These differences were statistically significant. AF glucose values equal to or less than 5 milligrams per deciliter was 90 percent predictive of a positive culture; a value greater than 5 milligrams per deciliter had a negative predictive value of 93 percent. A criterion of 5 milligrams per deciliter or less had a sensitivity of 63 percent (percent of correct positive diagnoses) and a specificity of 99 percent (percent of correct negative diagnoses). The test was particularly useful in ruling out infection, since no woman with an AF glucose level higher than 20 milligrams per deciliter had an intra-amniotic infection. Used with other tests, measuring the AF glucose is valuable for diagnosing intra-amniotic infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Infection, Diagnosis, Measurement, Amniotic fluid, Glucose, Prenatal diagnosis, Chorioamnionitis

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Fetal blood sampling in the management of intrauterine thyrotoxicosis

Article Abstract:

Graves disease is an autoimmune condition (in which the body makes antibodies against its own tissues) that can result in damage to the fetus of a pregnant woman afflicted with it. In this disease, antibodies that stimulate the thyroid can cross over to the fetus, where they may damage it because of excess thyroid activity. The case report of a 33-year-old pregnant woman with Graves disease is presented. The patient was under treatment and had normal levels of thyroid hormone when first seen in the twenty-first week of pregnancy. Her pregnancy history was complicated, and included the birth of an infant with growth retardation. Tests performed on fetal blood sampled from the umbilical cord (obtained by funipuncture) showed that the infant in this case report was suffering from thyrotoxicosis (a hyperactive thyroid gland), and treatment with propylthiouracil (an antithyroid drug) was started. After some dosage adjustments, therapy continued until the infant boy was born after 38 weeks' gestation. He did well, but required additional treatment with propylthiouracil. Subsequently, he appeared normal, with no symptoms of thyroid dysfunction. A discussion of the problem of determining normal levels of fetal thyroid hormones is provided. The fetuses of women with Graves disease who manufacture high levels of thyroid-stimulating antibodies should be evaluated by ultrasound and heart rate assessment at an age of 20 to 24 weeks, since they can respond to circulating maternal antibodies by that time. Early diagnosis and treatment are essential to prevent complications of this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Fetus, Physiological aspects, Autoimmune diseases, Pregnancy, Graves' disease, Hyperthyroidism, Autoimmune diseases in pregnancy

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Selective embryocide in the nonsurgical management of combined intrauterine-extrauterine pregnancy

Article Abstract:

An ectopic pregnancy occurs when the products of conception implant in areas outside of the uterus. In vitro fertilization techniques require more than one embryo to be transferred at a time. A 32-year-old woman had four embryos transferred during an in vitro fertilization trial. Transvaginal ultrasound, the use of high-frequency sound transmitted through a probe inserted into the vagina, was used to visualize the fetus. A viable gestational sac was located within the uterus. However, another embryo was detected in the right fallopian tube. In an effort to save the viable intrauterine pregnancy, selective termination of the tubal pregnancy was performed using conservative methods. A salt solution was injected into the gestational sac of the tubal embryo which caused the fetal heart to cease. Transvaginal ultrasound verified a viable uterine pregnancy and a smaller, nonviable ectopic pregnancy. The remainder of the pregnancy was uneventful except for an incident of early labor that began at 32 weeks of pregnancy. A healthy infant was delivered by cesarean section at 38 weeks gestation. The tube containing the ectopic pregnancy that was visualized during the cesarean was removed at delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Evaluation, Ultrasound imaging, Pregnancy, Ectopic, Ectopic pregnancy, Fertilization in vitro, Human, Human fertilization in vitro, Prenatal ultrasonography, Ultrasonics in obstetrics

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