Reverse end-diastolic flow in a fetus with a rare liver malformation: a case report

<p>Abstract</p> <p>Introduction</p> <p>We describe a case of early and persistent reverse end-diastolic flow in the middle cerebral artery in a fetus with severe ascites. These features are associated with a rare liver malformation known as ductal plate malformation.</p> <p>Case presentation</p> <p>A 28-year-old Caucasian woman was referred to our high-risk obstetric unit at 24 weeks' gestation for fetal ascites detected during a routine ultrasound examination. During her hospitalization we performed medical investigations, including a fetal paracentesis, to detect the etiology of fetal ascites. The cause of fetal ascites (then considered non-immune or idiopathic) was not evident, but a subsequent ultrasound examination at 27 weeks' gestation showed a reverse end-diastolic flow in the middle cerebral artery without any other Doppler abnormalities. A cesarean section was performed at 28 weeks' gestation because of the compromised fetal condition. An autopsy revealed a rare malformation of intrahepatic bile ducts known as ductal plate malformation.</p> <p>Conclusion</p> <p>Persistent reverse flow in the middle cerebral artery should be considered a marker of adverse pregnancy outcome. We recommend careful ultrasound monitoring in the presence of this ultrasonographic sign to exclude any other cause of increased intracranial pressure. To better understand the nature of these ultrasonographic signs, additional reports are deemed necessary. In fact in our case, as confirmed by histopathological examination, the fetal condition was extremely compromised due to failure of the fetal liver. Ductal plate malformation altered the liver structures causing hypoproteinemia and probably portal hypertension. These two conditions therefore explain the severe hydrops that compromised the fetal situation.</p

The alveolar type II cells as a model for investigating the metabolism of surfactant phospholipids

The use of type II pneumocytes in pure culture allows the investigator to directly define at the cellular level the metabolism of pulmonary surfactant. Surfactant analysis and/or secretion has been shown to be enhanced and depressed by a variety of substances, and the main metabolic pathways of the major components have been elucidated. Type II cells are also important in maintaining the in vivo homeostasis of the pulmonary alveolus, because after lung injury they proliferate and serve as stem cells for type I cells. In view of the increasing therapeutic use of surfactant supplementation in RDS and ARDS, the regulation of surfactant secretion is of particular interest, and presumably involves a receptor mediated mechanism in which surfactant associated apoproteins seem to play a pivotal role. These findings support the view that surfactant secretion is a self regulated phenomenon

Renin activity, aldosterone levels and urinary sodium and potassium excretion under tocolytic therapy with salbutamol

The effects of long-term therapy with salbutamol on renin activity, aldosterone levels and urinary sodium and potassium excretion in pregnant women are studied. Salbutamol was given intravenously in a first group of 18 patients in preterm labor, orally in a second group of 9 patients, whereas a third group of 17 patients was taken as control. No significant changes were observed in renin activity and aldosterone levels between the first and the fifth day of intravenous or oral therapy and in 24-h sodium urinary excretion. Only potassium excretion showed a significant decrease (P<0.01) within 24 h from the start of the intravenous therapy, returning to control levels after 48 h. From these results, no replacement of potassium seems to be necessary in patients undergoing tocolytic therapy with betamimetic drugs

Review and meta-analysis: Benefits and risks of multiple courses of antenatal corticosteroids

Preterm birth causes infant morbidity and mortality. A single course of antenatal corticosteroids (ACS) should be considered routine for preterm delivery. Benefits of therapy before 34 weeks' gestation have been established for infants born between 24 h and 7 days after treatment. It is still unclear whether multiple courses (MC) of ACS should be performed in women at risk of preterm delivery 7 days or more after initial treatment. To determine the risks and benefits of MC of ACS. Search and selection for human randomized controlled trials were conducted in PubMed and The Cochrane Central Register of Controlled Trials. Statistical analysis was performed using the Review Manager 4.3 software. MC of ACS were associated with a statistically decrease in the occurrence of respiratory distress syndrome, patent ductus arteriosus, use of surfactant, ventilation support, and any maternal side effects. This treatment was also associated with a significant reduction in birth weight and head circumference. MC of ACS in women at risk of preterm birth do not offer significant benefits concerning the composite neonatal morbidity. Data on long-term safety are still insufficient. Further evaluations, most by follow-up studies, are required to study the long-term effects