Fetal Hemodynamic Parameters in Low Risk Pregnancies: Doppler Velocimetry of Uterine, Umbilical, and Middle Cerebral Artery

Objective. To elaborate curves of longitudinal reference intervals of pulsatility index (PI) and systolic velocity (SV) for uterine (UtA), umbilical (UA), and middle cerebral arteries (MCA), in low risk pregnancies. Methods. Doppler velocimetric measurements of PI and SV from 63 low risk pregnant women between 16 and 41 weeks of gestational age. Means (±SD) for intervals of gestational age and percentiles 5, 50, and 95 were calculated for each parameter. The Intraclass Correlation Coefficients (ICC) were also estimated for assessing intra-and intervariability of measurements. Results. Mean PI of UtA showed decreasing values during pregnancy, but no regular pattern was identified for mean SV. For UA, PI decreased and SV increased along gestation. MCA presented PI increasing values until 32-35 weeks. SV showed higher levels with increasing gestation. High ICC values indicated good reproducibility. Conclusions. Reference intervals for the assessment of SV and PI of UtA, UA, and MCA were established. These reference intervals showed how a normal pregnancy is expected to progress regarding these Doppler velocimetric parameters and are useful to follow high risk pregnancies. The comparison between results using different curves may provide insights about the best patterns to be used

Endoscopic Laser Dichorionization of the Placenta in the Treatment of Severe Twin-Twin Transfusion Syndrome

Objectives: To describe the results of a technique of laser ablation of placental vessels in the treatment of severe twin-twin transfusion syndrome (TTTS), which is characterized by separation of the fetoplacental vascular territories and dichorionization of the placenta. Patients and Methods: Descriptive analysis of TTTS cases treated with the endoscopic laser dichorionization of the placenta (ELDP) procedure. The variables evaluated were the occurrence of reversal of the donor-recipient phenotype, persistence of TTTS or twin anemia-polycythemia sequence (TAPS); gestational age at delivery; discharge from the hospital of at least 1 or 2 live neonates, and incidence of neurological alterations among survivors. Results: 67 patients were treated with the ELDP procedure. There was no persistence of TITS, reversal of the donor-recipient phenotype or TAPS. The median gestational age at delivery was 33.0 (23.6-37.7) weeks. The rate of discharge from the hospital of at least 1 or 2 live neonates was 88.2% (67/76) and 71.1% (54/76), respectively. Among survivors, 17 (17/121 = 14.0%) children presented with neurodevelopmental alterations during clinical follow-up. Conclusions: The major contribution of this study was the demonstration that the ELDP technique appears to be associated with a low risk of persistence or recurrence of TTTS and TAPS. (C) 2013 S. Karger AG, Basel34420621

Normal insulin sensitivity in lean offspring of obese parents

Objective: Offspring of diabetic or hypertensive patients are insulin resistant at a prediabetic/prehypertensive stage. We tested the hypothesis that insulin action may be impaired in the offspring of obese nondiabetic parents. Research Methods and Procedures: Twenty-one lean offspring of nonobese subjects [(OL) 22+/-3 years of age] were matched to 23 lean offspring of obese subjects (OOb) by gender distribution, age, BMI, and waist circumference. Anthropometry, oral glucose tolerance, in vivo insulin sensitivity [by a euglycemic insulin clamp (6 pmol/min per kilogram(FFM); where FFM represents fat-free mass)], and thermogenesis (by indirect calorimetry) were measured in each subject. The study subjects were from a population of 267 nuclear families (one offspring and both his/her parents) in which there was statistically significant (chi(2)=30.2, p=0.001) concordance of BMI between parents and offspring. Results: In comparing OOb with OL, no statistically significant difference or trend toward a difference was detected in fasting plasma glucose and insulin concentrations, glucose and insulin responses to oral glucose, insulin sensitivity [metabolism value=45+/-12 (OOb) vs. 47+/-17 mumol/min per kilogram(FFM) (OL)], insulin-induced inhibition of protein and lipid oxidation, stimulation of glucose oxidation and nonoxidative glucose disposal, respiratory quotient, resting energy expenditure, and glucose-induced thermogenesis. Discussion: The metabolic similarity between lean offspring of obese parents and those of nonobese parents Suggests that insulin resistance and its correlates are not co-inherited with the predisposition to develop obesity

Longitudinal reference intervals for doppler velocimetric parameters of the fetal renal artery correlated with amniotic fluid index among low‐risk pregnancies

To establish longitudinal reference intervals for pulsatility index (PI) and systolic velocity (SV) of the fetal renal artery, and to evaluate their correlation with the amniotic fluid index (AFI). Methods A prospective longitudinal study was conducted among women with low‐risk pregnancies who attended outpatient clinics at the University of Campinas Medical School, Brazil, at 16–19 weeks of pregnancy between April 1, 2008, and March 31, 2010. Doppler velocimetric measurements of the fetal renal artery and assessments of the AFI were undertaken at 4‐week intervals to 36 weeks, and every 2 weeks thereafter until delivery. Results A total of 63 women were enrolled. The PI of the fetal renal artery showed little variation during pregnancy, whereas SV values increased to 36–37 weeks of pregnancy and decreased thereafter. No correlations were found between the AFI and the fetal renal artery Doppler velocimetric parameters (P > 0.05 for all). The intraclass correlation coefficients for intra‐observer and inter‐observer variability indicated good reproducibility of SV, but the reproducibility of PI was lower. Conclusions The AFI did not correlate with fetal renal artery Doppler velocimetric measures among low‐risk pregnancies. However, investigations are needed among high‐risk pregnancies1311454