Fetal and maternal non-glucose carbohydrates and polyols concentrations in normal human pregnancies at term

The objective of the present investigation was to determine fetal and maternal plasma concentrations of nonglucose carbohydrates and polyols in normal human pregnancies at term. Uncomplicated human pregnancies (n = 50) were studied at > or =37 wk gestation. Blood samples were obtained from umbilical artery, umbilical vein, and maternal peripheral blood at the time of elective cesarean section. Plasma concentrations of inositol, glycerol, erythritol, sorbitol, and mannose were determined by HPLC analysis. Differences between umbilical venous, umbilical arterial, and maternal concentration were tested by the two-tailed t test for paired samples. Correlations between umbilical and maternal concentration and between umbilical venoarterial concentration difference and umbilical arterial concentration were assessed by Pearson's correlation and multiple regression analysis. All newborns were appropriate for gestational age, and oxygenation and acid-base balance were within the normal range for all fetuses studied. For most of the polyols (inositol, sorbitol, and erythritol), the fetal concentration was significantly higher than the maternal concentration. The umbilical venoarterial concentration difference for inositol was -10.5 +/- 3.6 microM, for glycerol was 10 +/- 1.7 microM, for sorbitol was 3.8 +/- 0.5 microM (p < 0.001), and for mannose was 7.6 +/- 0.7 microM. There was a significant correlation between maternal concentration and umbilical venous concentration of mannose (UV(MAN) = 15.38 + 0.69 M(MAN); R(2) = 0.46; p < 0.001). These results indicate that in normal human pregnancies at term, inositol is produced by the fetus, sorbitol is produced by the placenta, and there is a significant umbilical uptake of mannose from the maternal circulation

Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy

OBJECTIVE: The objective of the study was to determine the feasibility of detecting fetal brain lactate, a marker of fetal metabolic acidemia, using a noninvasive technique, proton magnetic resonance spectroscopy (1H MRS), in intrauterine growth-restricted (IUGR) fetuses. STUDY DESIGN: In vivo human fetal brain lactate detection was determined by 1H MRS in 5 fetuses with IUGR. Oxygenation and acid-base balance data were obtained at birth. RESULTS: 1H MRS analysis showed the presence of a lactate peak in the brain of the most severely affected IUGR fetus, with abnormal umbilical artery Doppler and fetal heart rate tracing. This finding was consistent with the low oxygen content and high lactic acid concentration observed in umbilical blood obtained at delivery. CONCLUSION: 1H MRS allows the noninvasive detection of cerebral lactate in IUGR fetuses. Lactate detected by 1H MRS may represent a possible marker of in utero cerebral injury or underperfusion

Patologie materno-fetali nei parti tra 22-25 settimane

The survival rate for infants born preterm at the threshold of viability has improved over the past two decades. However, the incidence of moderate or severe, neurodevelopmental disability in surviving children is still high. Approximately 20-40% of preterm birth are the result of physician's decision for maternal or fetal indications, and the remainder follow spontaneous onset of labor or rupture of the membranes. Iatrogenic delivery is mainly due to preeclampsia and IUGR which share the common pathway of impaired placenta implantation. Intrauterine infection is present in most cases of extremely spontaneous preterm birth. Bacteria may reach the uterus by migrating from the abdominal cavity, through hematogenous spread, or from the vagina through the cervix. Inhibition of contractions has been the focus of therapeutic approaches. Tocolysis has allowed to delay delivery long enough to administer corticosteroids which improve neonatal outcome, but has proven ineffective in preventing preterm delivery. Future efforts to prevent prematurity should focus on primary and secondary prevention

Clinical relationship and psychological experience of hospitalization in \u201chigh-risk\u201d pregnancy

Objective: To explore, in a systemic view, the reciprocal perceived relationship between hospitalized \u2018\u2018high-risk\u2019\u2019 pregnant women with uncertain fetal prognosis and the multidisciplinary prenatal care team, by the use of specifically developed questionnaires. Study design: A pilot study in a high-risk pregnancy department. We enrolled 52 pregnant hospitalized women and 17 clinical operators and we interviewed them by the use of open-ended and close-ended question questionnaires. Results: We described patients\u2019 perception of doctors and staff communication, patients\u2019 feelings and emotions relating to \u2018\u2018high-risk\u2019\u2019 pregnancy and hospitalization, operators\u2019 emotions, perceived facilitating factors, difficulties and resources. In a \u2018\u2018high-risk\u2019\u2019 pregnancy condition, some difficulties in the relationship between hospitalized women and health operators occur. For inpatients the emotional difficulties were mostly connected to the pathologic situation and the contingent loneliness. Although the majority of women said that they understood staff communication and that they established a basic trust towards the entire clinical staff, there was a request for greater outspokenness. For clinical operators the relational and communication difficulties specifically concerned the overall management of the relationship with the patients studied. In particular, they perceived themselves to be called to a greater clearness and clinical reliability. Conclusions: Overcoming the dyadic model of the doctor\u2013patient relationship (in a systemic view) by incorporating clinical operators\u2019 and inpatients\u2019 points of view, seems a useful tool to highlight critical and facilitating factors about the relationship and communication in \u2018\u2018high-risk\u2019\u2019 conditions. Condensation Overcoming the dyadic vision of the doctor\u2013patient relationship, by crossing clinical operator\u2019s and inpatient\u2019s points of view, seems a useful tool to highlight critical and facilitating factors about the relationship and communication in \u2018\u2018high-risk\u2019\u2019 pregnancy conditions

Upper eyelid reconstruction with forehead galeal flap

Introduction: Upper lid reconstruction depends on the size of the defect, and a general consensus holds that partial-thickness defects can be reconstructed using simple or composite grafts. Full-thickness defects involving up to 30% of the upper lid are repaired easily by direct suturing with or without upper lid sliding flaps. When defects affect more than 50-70% of the upper lid, complex reconstruction is needed. Traditionally, this devolves upon lower lid flaps, as in the Cutler-Beard and Mustard\ue9 techniques. These methods share intrinsic disadvantages, such as donor site morbidity and the need for two surgical sessions to detach the flap pedicle. To our knowledge, upper lid reconstruction with a grafted forehead galeal-pericranial flap has not been previously reported. This proves to be an excellent reconstructive option for extensive upper lip defects. Moreover, it has many advantages over other reconstruction techniques, such as technical ease and very low donor site morbidity. Furthermore, it is a single-stage procedure. We present our experience with five extensive upper lid reconstructions using galeal-pericranial forehead grafted flaps. Materials and methods: Five patients needed major upper lid reconstruction, which consisted of a galeal-pericranial forehead flap grafted with oral mucosa and retroauricular skin. Four of them had had the lid removed surgically for oncological reasons, while one patient suffered from orbital-periorbital fasciitis. Results: All of the flaps and grafts survived. The functional and morphological results were satisfying, and no complications were noted. Conclusions: The forehead galeal-pericranial flap appears to be an excellent instrument for upper lid reconstruction. Compared to other techniques, it has the advantages of simplicity and very minimal donor site morbidity. Moreover, it does not necessitate a two-stage surgical procedure

Management of a case of arhinia

Arhinia is a rare condition characterised by the congenital absence of nasal structures, with different patterns of presentation, and often associated with other craniofacial or somatic anomalies. To date, about 30 surviving cases have been reported. We report the case of a female patient aged 6 years, who underwent internal and external nose reconstruction using a staged procedure: a nasal airway was obtained through maxillary osteotomy and ostectomy, and lined with a local skin flap and split-thickness skin grafts; then the external nose was reconstructed with an expanded frontal flap, armed with an autogenous rib framework

The effect of a patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy

Objective: The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP). Methods: The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 2 1), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP. Both groups were administered a questionnaire at two points in time (before the counseling and 1 month later) which evaluated participants' knowledge, attitudes and use of contraception (the latter was also followed up 3 months later). The counseling intervention lasted 30 min and was carried out by a psychologist and a gynaecologist. Results: It was found that knowledge, favorable attitudes and use of effective contraception increased significantly for the experimental Group, whereas there was no significant change for the control group. Conclusion: The counseling intervention was therefore found to be efficacious in improving understanding and use of contraception in women who have undergone a TOP. The hope is that this will contribute to increased use of effective contraception in the future. Practice implications: Following the principles of patient-centered medicine, this study provides evidence for the importance of exploring woman's feelings, beliefs, wishes and expectations regarding contraception within a contraceptive counseling intervention