Speciality
Spotlight

 




 


Obstetric & Gynaecology


 

 




Fetal Therapy

      

  • JP Newnham, SF Evans, M Godfrey, et al (Univ. of Western Australia, Perth; Children’s Hosp. Med. Ctr. Cincinnati, Ohio)


    Maternal, but not fetal, administration of corticosteroids restricts fetal growth: 


    J Matern Fetal Med. 8:81-87, 1999

        


    Repeated maternal doses of betamethasone resulted in decreases in birth weight as well as in lower weights of the placenta and major organs. However, injection directly into the fetus did not affect birth weight, placental weight, placental to birth weight ratio, or the weights of the major organs, except for the liver.

        


    Maternal administration of corticosteroids certainly results in improved new born lung function in immature fetuses born of human and a variety of other mammals. In the human, evidence of fetal growth retardation on exposure to multiple maternal corticosteroid dosages, although not entirely conclusive, does appear to exist in some cases. 

        


    No effects on fetal growth was seen among fetuses injected transdermally with either single or multiple doses.

       

  • NP French et al ( King Edward Mem Hosp. Perth, Western Australia)

    Repeated antenatal corticosteroids: Size at Birth and Subsequent Development 

    Am J Obstet Gynecol, 180:114-121, 1999.

        


    In terms of perinatal mortality and morbidity, recipients of steroids showed the favourable effects expected on pulmonary maturation, but no impact could be noted based on the number of steroid doses.

        

  • Long-term Somatic Follow-up of Prenatally Treated Children with Congenital Adrenal Hyperplasia.

    Lajic S, Wedell A, Bui T-H, et al ((Karolinksa Hosp., Stockholm)

    J Clin Endocrinol Metab 83:3872-3880, 1998.

         


    The Authors have selected 44 mothers at risk and were treated with dexamethasone (DEX ) (20mg/kg/day) administered orally in 3 divided doses before the seventh gestational week. When the sex of the fetus was determined, treatment was discontinued if the fetus was unaffected or an affected boy and continued if the fetus was a girl.

         


    Conclusion : Although prenatal DEX treatment of children with CAH limits virilization of female fetuses, more research is needed to limit side effects for mother and fetus.

        


    The failure of negative cortisol feedback on the pituitary, CAH results in virilization and external abnormalities in genitalia of female infants. Fetal diagnosis rests mainly with the family histories of prior affected infants. When both parents are known carriers, the chance for an affected infant is 1 out of 4 and for an affected female infant, it is 1 out of 8.

         


    During the interval 1985 to 1995, the fetal diagnosis was made by amniotic fluid steroid analysis and by genetic linkage studies. Currently, the diagnosis can be made by genome analysis after amplification of DNA obtained by chorion villus biopsy, because primers for satisfactory amplification of the CAH gene site are now known.

         


    The impact of steroid therapy on mothers as revealed by questionnaire studies, was not great. But in the newborns 4 of the 5 affected female infants were spared the effects of virilization. But it was found that 6 of the 37 fetuses that did not prove to have CAH demonstrated a wide range of newborn complications newborn neonatal growth retardation, hydrocephalus, hypospadius, hepatic fat infiltration, behavioral abnormalities, mitochondrial based carbohydrate metabolic abnormality, and failure of normal speech development. 

         


    Clearly genetic analysis of the fetus before therapy is warranted for what must, at this point, be viewed as an experimental approach to the prevention of the fetal effects of
    CAH.

       

  • Joshua A. Copel, Ren-Ing Liang, et al [From the Departments of Obstetrics and Gynecology, Pediatrics [Cardiology], and Diagnostic Radiology, Yale University School of Medicine]

    The Clinical Significance of the Irregular Fetal Heart Rhythm

    Am J. Obstet Gynecol April 2000, Volume 182, Number 4, Pgs. 813-819



    Objective – Irregular fetal heart rhythms are common in clinical practice , but there is little information available on their significance or appropriate management. 



    Study Design – This was a retrospective review of fetuses seen during 10 years that either were referred for fetal echocardiography because of a fetal arrhythmia or were found incidentally to have an arrhythmia during fetal echocardiography for other indications. 



    Results – From 1988 through 1997 authors performed 5566 fetal echocardiograms on 4838 different fetuses. There were 614 fetuses with irregular fetal heart rhythms. Among 595 referred for arrhythmias, extrasystoles were found in 255 [42.9%], normal rhythms were seen in 330 [55.4%], and hemodynamically significant arrhythmias were seen in 10. There were 2 fetuses with arrhythmias and structural heart disease. Nine of 10 fetuses with hemodynamically significant arrhythmias survived. An additional five neonates were found to have hemodynamically significant arrhythmias only postnatally. A total of 15 fetuses [2.4%] among those referred for irregular rhythms had significant arrhythmias.



    Conclusions – Irregular fetal heart rhythms signify hemodynamically significant arrhythmias in a small but important proportion of fetuses. Those without persistent irregularities on evaluation can be followed up with routine prenatal care

        

  • Embroyonic
    Stem Cell Lines Derived From Blastocysts

    Thomson JA, Itskovitz J, Shapiro SS, et al (Univ
    of Wisconsin, Madison)

    Science 282 : 1145 – 1147, 1998.

        

    Purpose. – Embryonic cell (ES) are embryo-derived,
    pluripotent mammalian cells that are capable of
    prolonged, undifferentiated proliferation and have
    the potential to form derivatives of all 3
    embroyonic germ layers, even after prolonged
    culture. Studies of mouse ES cells suggest that they
    can contribute to wide range of adult tissues,
    including germ cells. Thus, ES cells may represent a
    new approach to introducing specific genetic changes
    into the germ line. 

       

    The pluripotent human ES cells were derived form
    human blastocysts. The resulting cell line was
    karyotypically normal, even after extended culture.
    They expressed high levels of telomerase activity.

      

    Editorial comment : The possibilities for in utero
    repair of neural tissue lost through injury, for
    replacing islet cells in embryos destined otherwise
    to become juvenile diabetics, or for repair of
    cardiomyopathy in utero become realizable.

        

      



 

 

Speciality Spotlight

 

 

Fetal Therapy
      

  • JP Newnham, SF Evans, M Godfrey, et al (Univ. of Western Australia, Perth; Children’s Hosp. Med. Ctr. Cincinnati, Ohio)
    Maternal, but not fetal, administration of corticosteroids restricts fetal growth: 
    J Matern Fetal Med. 8:81-87, 1999
        
    Repeated maternal doses of betamethasone resulted in decreases in birth weight as well as in lower weights of the placenta and major organs. However, injection directly into the fetus did not affect birth weight, placental weight, placental to birth weight ratio, or the weights of the major organs, except for the liver.
        
    Maternal administration of corticosteroids certainly results in improved new born lung function in immature fetuses born of human and a variety of other mammals. In the human, evidence of fetal growth retardation on exposure to multiple maternal corticosteroid dosages, although not entirely conclusive, does appear to exist in some cases. 
        
    No effects on fetal growth was seen among fetuses injected transdermally with either single or multiple doses.
       

  • NP French et al ( King Edward Mem Hosp. Perth, Western Australia)
    Repeated antenatal corticosteroids: Size at Birth and Subsequent Development 
    Am J Obstet Gynecol, 180:114-121, 1999.
        
    In terms of perinatal mortality and morbidity, recipients of steroids showed the favourable effects expected on pulmonary maturation, but no impact could be noted based on the number of steroid doses.
        

  • Long-term Somatic Follow-up of Prenatally Treated Children with Congenital Adrenal Hyperplasia.
    Lajic S, Wedell A, Bui T-H, et al ((Karolinksa Hosp., Stockholm)
    J Clin Endocrinol Metab 83:3872-3880, 1998.
         
    The Authors have selected 44 mothers at risk and were treated with dexamethasone (DEX ) (20mg/kg/day) administered orally in 3 divided doses before the seventh gestational week. When the sex of the fetus was determined, treatment was discontinued if the fetus was unaffected or an affected boy and continued if the fetus was a girl.
         
    Conclusion : Although prenatal DEX treatment of children with CAH limits virilization of female fetuses, more research is needed to limit side effects for mother and fetus.
        
    The failure of negative cortisol feedback on the pituitary, CAH results in virilization and external abnormalities in genitalia of female infants. Fetal diagnosis rests mainly with the family histories of prior affected infants. When both parents are known carriers, the chance for an affected infant is 1 out of 4 and for an affected female infant, it is 1 out of 8.
         
    During the interval 1985 to 1995, the fetal diagnosis was made by amniotic fluid steroid analysis and by genetic linkage studies. Currently, the diagnosis can be made by genome analysis after amplification of DNA obtained by chorion villus biopsy, because primers for satisfactory amplification of the CAH gene site are now known.
         
    The impact of steroid therapy on mothers as revealed by questionnaire studies, was not great. But in the newborns 4 of the 5 affected female infants were spared the effects of virilization. But it was found that 6 of the 37 fetuses that did not prove to have CAH demonstrated a wide range of newborn complications newborn neonatal growth retardation, hydrocephalus, hypospadius, hepatic fat infiltration, behavioral abnormalities, mitochondrial based carbohydrate metabolic abnormality, and failure of normal speech development. 
         
    Clearly genetic analysis of the fetus before therapy is warranted for what must, at this point, be viewed as an experimental approach to the prevention of the fetal effects of CAH.
       

  • Joshua A. Copel, Ren-Ing Liang, et al [From the Departments of Obstetrics and Gynecology, Pediatrics [Cardiology], and Diagnostic Radiology, Yale University School of Medicine]
    The Clinical Significance of the Irregular Fetal Heart Rhythm
    Am J. Obstet Gynecol April 2000, Volume 182, Number 4, Pgs. 813-819

    Objective – Irregular fetal heart rhythms are common in clinical practice , but there is little information available on their significance or appropriate management. 

    Study Design – This was a retrospective review of fetuses seen during 10 years that either were referred for fetal echocardiography because of a fetal arrhythmia or were found incidentally to have an arrhythmia during fetal echocardiography for other indications. 

    Results – From 1988 through 1997 authors performed 5566 fetal echocardiograms on 4838 different fetuses. There were 614 fetuses with irregular fetal heart rhythms. Among 595 referred for arrhythmias, extrasystoles were found in 255 [42.9%], normal rhythms were seen in 330 [55.4%], and hemodynamically significant arrhythmias were seen in 10. There were 2 fetuses with arrhythmias and structural heart disease. Nine of 10 fetuses with hemodynamically significant arrhythmias survived. An additional five neonates were found to have hemodynamically significant arrhythmias only postnatally. A total of 15 fetuses [2.4%] among those referred for irregular rhythms had significant arrhythmias.

    Conclusions – Irregular fetal heart rhythms signify hemodynamically significant arrhythmias in a small but important proportion of fetuses. Those without persistent irregularities on evaluation can be followed up with routine prenatal care
        

  • Embroyonic Stem Cell Lines Derived From Blastocysts
    Thomson JA, Itskovitz J, Shapiro SS, et al (Univ of Wisconsin, Madison)
    Science 282 : 1145 – 1147, 1998.
        
    Purpose. – Embryonic cell (ES) are embryo-derived, pluripotent mammalian cells that are capable of prolonged, undifferentiated proliferation and have the potential to form derivatives of all 3 embroyonic germ layers, even after prolonged culture. Studies of mouse ES cells suggest that they can contribute to wide range of adult tissues, including germ cells. Thus, ES cells may represent a new approach to introducing specific genetic changes into the germ line. 
       
    The pluripotent human ES cells were derived form human blastocysts. The resulting cell line was karyotypically normal, even after extended culture. They expressed high levels of telomerase activity.
      
    Editorial comment : The possibilities for in utero repair of neural tissue lost through injury, for replacing islet cells in embryos destined otherwise to become juvenile diabetics, or for repair of cardiomyopathy in utero become realizable.
        

      

 

By |2022-07-20T16:43:07+00:00July 20, 2022|Uncategorized|Comments Off on Fetal Therapy

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