Intraamniotic instillation of surfactant for prevention of neonatal respiratory distress syndrome (RDS): A preliminary report

Supplementary natural surfactant (SS) was administered intra-amniotically (80 mg in 1 ml) under ultrasound guidance in the proximity of the fetal mouth in 5 pregnant women at 28 to 32 wks gestation, with immature amniotic fluid indexes of fetal lung maturity, and whose delivery was imminent because of severe fetal distress as indicated by cardiotocography and Doppler velocimetry of maternal and fetal arteries. The administration of SS was preceded by TV aminophylline to the mother (a bolus of 240 mg over 10 min, and a maintenance dose of 0,02-0,1 mg/kg/min) in order to elicit sustained fetal breathing movements. Following delivery by cesarean section the clinical conditions of four newborn infants were good with no respiratory problems, along with an uneventful clinical course. However, the newborn infant not exposed in utero to aminophylline showed some respiratory problems which required two extra doses of SS after birth. It is suggested that this prophylactic approach has a great potential for becoming a reliable option for the antenatal prevention of RDS

Association between maternal-fetal Doppler velocimetry and fetal lung maturity

Aims: To correlate maternalfetal Doppler velocimetry parameters to indices of fetal lung maturity (FLM). Methods: Fiftyfive consecutive third trimester pregnancies in which a pulsedwave Doppler study, including uterine resistance index (Ut RI), umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and the UA/MCA ratio was performed within 24 hours before amniocentesis and within a week from birth. FLM was determined by amniotic fluid lamellar bodies count (LBs). Results: A positive correlation between MCA PI and LBs (p 0.64 was correlated to delayed FLM (LBs < 20,000/l; sensitivity: 90.9%, specificity: 90.3%; positive predictive value: 76.9%, negative predictive value: 96.6%). Comment: In third trimester pregnancies abnormal uterine artery waveforms may be associated to a delayed FLM, as expressed by decreased amniotic fluid LBs

Improvement of uterine artery Doppler velocimetry indices after metroplasty in arcuate uteri

Our study aimed to evaluate the effect of metroplasty performed in arcuate uteri on uterine artery Doppler velocimetry. We performed uterine artery Doppler velocimetry transvaginally before and after metroplasty in 36 women with arcuate uteri. Pulsatility indexes (PI) of uterine arteries were calculated and the presence or absence of a protodiastolic notch was evaluated. Comparing Doppler indexes before and after metroplasty, we found that uterine artery impedance improves as assessed by lower mean PI. We observed that PI after intervention was significantly lower compared with indexes before for mean Doppler index evaluations (mean uterine PI pre: 2.07+/-0.61 and post: 1.49+/-0.24 [p<0.03]). No differences were observed as regards bilateral protodiastolic notch absence or presence. A protodiastolic notch was present in 22 out of 36 women before metroplasty (61%), and a notch was observed in 19 out of 36 (52%) after metroplasty. Our results suggest that, metroplasty, as well as making the uterine cavity wider, leads to better uterine perfusion