Recurrent adverse pregnancy outcome and antiphospholipid antibodies

Article Abstract:

There are many causes of early pregnancy loss, spontaneous abortion and intrauterine growth retardation. Although some of these losses are caused by an abnormal chromosome (genetic), others cannot be explained (idiopathic). It has been hypothesized that antibodies produced erroneously against the body's own tissues are involved in reproductive failure and fetal loss. Two antibodies have been studied, lupus-like anticoagulants and anticardiolipin. These antiphospholipid antibodies are thought to interfere with the prothrombin blood clotting complex, which in turn causes thrombosis (clot formation) and fetal loss. Some studies have demonstrated an association between the antiphospholipid antibody cardiolipin (immunoglobulin G, IgG) and poor pregnancy outcome. The lupus-like antiphospholipid antibody, originally found in patients with the autoimmune disease lupus erythematosus, is also found in the blood of patients with other immunologic disorders. Although the mechanisms of thrombosis are poorly understood, one theory involves the inhibition of prostaglandins, hormone-like substances with antithrombotic properties, which are released by the cells lining blood vessels. Since the organ of fetal nutrition, the placenta, is a mass network of blood vessels, the interruption of the blood supply by generalized thrombosis causes infarction and tissue death. Cardiolipin is present in some patients experiencing adverse pregnancy outcome, and screening for the antibody may help identify women at risk for reproductive failure and fetal loss. Aspirin, corticosteroids or heparin, agents that affect various phases of the clotting process, may be useful in treating pregnancies affected by antiphospholipid antibodies. Optimum therapeutic protocols await extensive studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Autoantibodies, Physiological aspects, Miscarriage, Anticardiolipin antibodies, Fetal death

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Fetal breathing movements after preterm premature rupture of membranes

Article Abstract:

Premature membrane rupture before 24 weeks of pregnancy is associated with a high fetal mortality rate, due to complications of prematurity, infection, and pulmonary hypoplasia (poor growth of lung tissue). The cause of pulmonary hypoplasia is unclear, but has been attributed to loss of lung fluid and decreases in fetal breathing. As part of a study to determine the relationship between fetal breathing movements and pulmonary hypoplasia, the effect of ruptured membranes on fetal breathing was evaluated in 43 patients. The results were compared with those of 31 healthy patients. Membrane rupture had occurred between 24 and 34 weeks, and uterine infections, a possible complicating factor, were not present. Significantly less time was spent in breathing by fetuses with ruptured membranes at any age. However, as the duration of time after membrane rupture increased, frequency of breathing increased. The amount of breathing time differed significantly in the first two weeks after membrane rupture, but not thereafter. In contrast, no differences in fetal trunk movement were observed. These results indicate that membrane rupture is associated with a specific decrease in fetal breathing movements, but not a general depression in motor activity. The direct cause is still unclear, but reduced breathing associated with ruptured membranes very likely contributes to pulmonary hypoplasia in fetuses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Complications and side effects, Fetus, Premature rupture of membranes, Premature rupture of the membrane

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Estimating gestational age in the term pregnancy with a model based on multiple indices of fetal maturity

Article Abstract:

Pregnancies continuing past the normal 40 weeks gestational period occur in three to 12 percent of all pregnancies. Post-date pregnancies can be associated with poor fetal outcome. Ascertaining the correct gestational age of a fetus is essential for the diagnosis of a post-date pregnancy. Current methods, which use biometric measurements of organ size, are not accurate near the end of pregnancy. To determine the most accurate assessment of fetal age, ultrasound, or the use of high frequency sound to visualize internal structures, in combination with other methods of estimating gestational age were studied. In 100 pregnancies, the growth plate of the upper arm bone, the humerus ossification center, and colonic grade, a method which grades the age of a placenta, offered the best predictability of gestational age. A table developed from standard measurements can be used to predict the gestational age of a fetus late in pregnancy.

Measurement, Gestational age

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