The vasculosyncytial membrane (VSM), primary site of fetomaternal exchange is formed when syncytiotrophoblast surrounds the terminal villi and make a close contact with capillaries. Some syncytiotrophoblast forms thin single layer of villous and some syncytial nuclei become piled up to form the syncytial knots (SKs). Undoubtedly there is a clear-cut inverse relation between villous VSM and fetal hypoxia. In preeclampsia (PE) the hypoxia injury disrupts the syncytial architecture which in turn initiates other complications of PE. Present study was designed to observe the morphological and histomorphometric features of 84 placentas from control and PE (42 each) collected from Department of Obstetrics and Gynecology. Neonatal weight and placental weight were reduced in PE than the controls but the feto-placental index did not differ. The SK density and VSM thickness was found to be increased and was statistically significant in PE cases. In relation to SKs, the VSM thickness was twofold increased than the controls and was statistically significant. The SKs in the present study were classified as type-1, 2a, 2b, and 3. Type 1 was found to be 62% in control and 47% in PE, type 2a and 2b were 38% in control and 37% in PE, and type 3 was in 8% of PE cases. All the parameters of present study reveal the adverse effects of PE influencing on both morphological and microscopical features of the placenta resulting in fetal hypoxia.
Anoxia ; Capillaries ; Fetal Hypoxia ; Gynecology ; Membranes ; Obstetrics ; Placenta ; Pre-Eclampsia ; Trophoblasts

The vasculosyncytial membrane (VSM), primary site of fetomaternal exchange is formed when syncytiotrophoblast surrounds the terminal villi and make a close contact with capillaries. Some syncytiotrophoblast forms thin single layer of villous and some syncytial nuclei become piled up to form the syncytial knots (SKs). Undoubtedly there is a clear-cut inverse relation between villous VSM and fetal hypoxia. In preeclampsia (PE) the hypoxia injury disrupts the syncytial architecture which in turn initiates other complications of PE. Present study was designed to observe the morphological and histomorphometric features of 84 placentas from control and PE (42 each) collected from Department of Obstetrics and Gynecology. Neonatal weight and placental weight were reduced in PE than the controls but the feto-placental index did not differ. The SK density and VSM thickness was found to be increased and was statistically significant in PE cases. In relation to SKs, the VSM thickness was twofold increased than the controls and was statistically significant. The SKs in the present study were classified as type-1, 2a, 2b, and 3. Type 1 was found to be 62% in control and 47% in PE, type 2a and 2b were 38% in control and 37% in PE, and type 3 was in 8% of PE cases. All the parameters of present study reveal the adverse effects of PE influencing on both morphological and microscopical features of the placenta resulting in fetal hypoxia.
Anoxia ; Capillaries ; Fetal Hypoxia ; Gynecology ; Membranes ; Obstetrics ; Placenta ; Pre-Eclampsia ; Trophoblasts

BACKGROUND: The aim of the present study was to investigate the changes in the patterns of power spectrum of R-R interval variability on fetal lamb EKG during acute fetal hypoxia. METHODS: Acutely instrumented six fetal lambs during the third trimester of gestation(115 to 145 days) was subjected to reproducible hypoxia by reduction of maternal placental blood flow with complete obstruction of maternal abdominal aorta for 60 seconds. RESULTS: Power spectral density of low, middle and high frequency increased significantly on hypoxia compared to that of baseline state. Power density of high frequency was significantly higher than that of low and middle frequency in baseline state. And the power density of low and high frequency was significantly higher than that of middle frequency in hypoxic state and 1 minute of recovery. CONCLUSIONS: The conclusion is that an increase in power density of low frequency during hypoxia suggested increased sympathetic activity and increased power density of high frequency throughout the experimental procedures suggested active respiratory movements of fetal lambs close to term and increased parasympathetic activity, reflecting rapidly the autonomic nervous system changes of the fetal lambs.
Anoxia* ; Aorta, Abdominal ; Autonomic Nervous System ; Electrocardiography ; Female ; Fetal Hypoxia ; Heart Rate* ; Heart* ; Humans ; Pregnancy ; Pregnancy Trimester, Third

OBJECTIVE: To determine whether meconium staining can be the indicator of intrauterine hypoxia by comparing umbilical venous erythropoietin (EPO) concentration and the number of nucleated erythrocytes (NRBC), as a marker of intrauterine hypoxia, between non meconium-stained neonates and meconium-stained neonates of term pregnancy. And to determine correlation between the number of NRBC, EPO levels and interleukin-6 (IL-6), as another mediator of intrauterine hypoxia. METHODS: In 240 neonates with gestational age ranged from 37 to 41 weeks, including 231 cases of nonmeconium-stained neonates and 9 cases of meconium-stained neonates, we performed the measurement of EPO levels by RIA, the number of NRBC per 100 white blood cells (WBC) by blood smear and IL-6 by ELISA in umbilical venous blood at delivery. Statistical analysis was performed by chi-square test, Wilcoxon rank sum test, linear regression analysis using SPSS 11.0 version statistical package. RESULTS: Amniotic fluids of meconium-stained neonates had significantly greater EPO concentrations compared with that of nonmeconium-stained controls (41.3+/-13.0 vs 26.5+/-18.9 mIU/mL, p=0.001). But there were no statistical difference in the number of NRBC, IL-6 levels and hematocrit of umbilical venous blood. The EPO levels in umbilical venous blood was correlated with the number of nucleated erythrocytes (r2=7.7%, p<0.001), and IL-6 in umbilical venous blood was correlated with the number of NRBC. (r2=11.5%, p<0.001). CONCLUSION: These results suggest that meconium-stained amniotic fluid can be associated with fetal hypoxia. And the production of fetal NRBC is thought to be stimulated by EPO and IL-6, but it requires further study of other (yet to be determined) hypoxia-derived mediators.
Amniotic Fluid ; Anoxia ; Enzyme-Linked Immunosorbent Assay ; Erythroblasts ; Erythropoietin* ; Female ; Fetal Hypoxia ; Gestational Age ; Hematocrit ; Humans ; Infant, Newborn* ; Interleukin-6 ; Leukocytes ; Linear Models ; Meconium* ; Pregnancy*

OBJECTIVE: To determine the usefulness of neonatal nucleated red blood cell counts (nRBC) as an independent predictor of fetal hypoxia and perinatal outcome in severe preeclampsia. METHODS: One hundred thirty eight patients with severe preeclampsia were studied. Umbilical artery Dopppler velocimetry was performed in all patients, and were divided into two groups, the control group with present umbilical artery end diastolic velocity, and the case group with absent or reversed velocity. The patients were also separately grouped as another control (n=58), acute (n=19), and chronic hypoxia (n=55) according to abnormal Doppler findings, presence of oligohydramnios, intrauterine growth restriction (IUGR), and pattern of fetal heart rate tracings during labor. At delivery, the umbilical cord blood was collected and the levels of nRBC per 100 WBC were measured from the samples along with blood gas analysis. The results were compared between the control and acute groups, and chronic hypoxic fetus. Correlation with perinatal outcomes was also evaluated. Student's t-test, ANOVA, and regression analysis were performed for statistical analysis. RESULTS: Those with absent or reversed end diastolic velocity did not have significantly greater nRBC counts, but had lower platelet counts (p=0.02), lower pO2 (p=0.005), and higher pCO2 saturation levels (p=0.01). There were no significant differences with regard to nRBC counts among the control, acute, and chronic hypoxia groups. Elevated nRBC counts were significantly associated with neonatal intensive care unit stay of more than 28 days (p=0.013), respiratory distress syndrome (p=0.003), disseminated intravascular coagulopathy, or sepsis (p=0.041). CONCLUSION: nRBC counts did not show significant difference according to umbilical artery Doppler velocity. Also we could not find any difference between the control, acute, and chronic hypoxic group, suggesting that nRBC counts does not correlate with both hypoxic status, or duration of hypoxia. Correlation with elevated nRBC counts and neonatal intensive care unit stay of more than 28 days, respiratory distress syndrome, disseminated intravascular coagulopathy, and sepsis was observed. However, the overlapping results and the wide range of nRBC counts according to the complications limits its role as a predictor of poor perinatal outcome.
Anoxia ; Blood Gas Analysis ; Erythrocyte Count ; Female ; Fetal Blood ; Fetal Hypoxia* ; Fetus ; Heart Rate, Fetal ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Oligohydramnios ; Platelet Count ; Pre-Eclampsia* ; Pregnancy ; Rheology ; Sepsis ; Umbilical Arteries

PURPOSE: Prolonged fetal hypoxia stimulates erythropoiesis in fetal life and induces increased nucleated erythrocytes(NRBC) counts at the early newborn period. To evaluate the relationship between prolonged fetal hypoxia and neonatal intraventricular hemorrhage (IVH), and the prediction of neonatal IVH by neonatal NRBC. METHODS: We compared the daily courses of the absolute NRBC count in preterm new- boms at 34 weeks' gestation or earlier with(n=17) and without(n=20) IVH for 7 days of life. RESULTS: Absolute NRBC counts at birth were higher in neonates with IVH than in control neonates(2,499/mm3+/-3,748 and 412/mm3+/-272, respectively, P=0.0022). The cut-off value of 1,000/mm3 for absolute NRBC counts at birth showed the best parameter estimate of the predictive model for IVH at early newborn period with 100% of positive predictive value and 74.1% of negative predictive value. CONCLUSION: Prolonged fetal hypoxia inducing fetal erythropoiesis near labor is closely related to IVH at early newborn period. Thabsolute NRBC counts at birth is the very important predictable marker for the condition.
Erythroblasts* ; Erythropoiesis ; Fetal Hypoxia ; Hemorrhage* ; Humans ; Infant, Newborn* ; Parturition ; Pregnancy

To analyze the effect of hypoxaemia on heart rate variability (HRV) in fetal lambs by means of power spectrum, the intrauterine surgical operations were performed at 116-125 gestational days in 7 lambs. Arterial catheter was inserted in the fetal femoral artery and sent to aorta abdominalis, and blood pressure was recorded continually on tape recorder. The microspheres were injected via the arterial catheter to block the micrangium of placenta, thus making an animal model of fetal hypoxaemia. The fetal blood sample was drawn through the catheter for blood gas analysis. In terms of the heart beat variability power spectral density, there were four consistent components, namely very low (VL, 0.01-0.025 cycle/beat), low (L, 0.025-0.125 cycle/beat), middle (M, 0.125-0.2 cycle/beat), and high (H, 0.2-0.5 cycle/beat). Integrated peaks in the power spectrum were compared before and after administration of microsphere. The spectral power in the L frequency components was significantly increased (0.07 +/- 0.01 vs. 0.21 +/- 0.03, P<0.01), and the spectral power in the H frequency components was significantly reduced (0.53 +/- 0.1 vs. 0.27 +/- 0.05, P<0.05). There was no significant difference in M and VL. The times of microsphere injection were related to fetal blood pH (r=0.585, p<0.01), PCO2 (r=0.5, p<0.05) and PO2 (r=0.75, P<0.01). The results clearly demonstrate the association between change of power spectrum of heart rate variability and the effect of hypoxia of the fetus in labour.
Animals ; Blood Gas Analysis ; Female ; Fetal Blood ; Fetal Hypoxia ; physiopathology ; Fetal Monitoring ; Heart Rate, Fetal ; physiology ; Pregnancy ; Sheep

INTRODUCTIONIntrapartum fetal monitoring is essential for the identification of fetal hypoxia to reduce perinatal morbidity and mortality. Cardiotocography is associated with low specificity for fetal acidosis and poor perinatal outcome leading to unnecessary operative deliveries. ST waveform analysis of the fetal electrocardiogram has been shown to be a promising adjunctive intrapartum assessment tool. We aim to present the pathophysiology, the role of intrapartum monitoring and the practical usage of this relatively new technology in our review.

METHODSAn electronic search of Medline and OVID was carried out, followed by a manual search of the references identified by the electronic search.

RESULTSThe incorporation of ST waveform analysis to cardiotocography has been shown to reduce the rates of neonatal metabolic acidosis, moderate and severe neonatal encephalopathy, thus improving perinatal outcome. The reduction in operative delivery rates due to fetal distress is also significant. The pathophysiology and practical usage of this technology were discussed.

CONCLUSIONSWith more accurate identification of fetal hypoxia and reduction of unnecessary intervention rates, incorporation of ST waveform analysis of fetal electrocardiography into cardiotocography can improve the standard of intrapartum fetal monitoring.

Electrocardiography ; utilization ; Female ; Fetal Hypoxia ; diagnosis ; Fetal Monitoring ; instrumentation ; methods ; Humans ; Pregnancy ; Singapore

Anesthesia for Cesarean Section entails many considerations not pertinent to surgical patients. The anesthesiologist is required to provide anesthesia for mother and fetus simultaneously and to perform emergency anesthesia in high risk paturients with no preoperative evaluation. Variable phrsiologic changes in pregnancy in the cardiovascular, respiratory, gastro-intestinal and renal systems entrance the uptake of anesthetic gases and in the apneic status, PaO2 decreases significantly. During general anesthesia, maternal hypoxia, hyperventilation, aortocaval compression of the enlarged uterus and prolonged induction-delivery time may contribute to circulatory changes which may result in fetal hypoxia and acidosis Kalapa et at (1971) and Gibbs (1981) reported that balanced anesthesia is safe for Cesarean section as long as the time from induction to delivery (IDT) is not prolonged. Maternal arterial blood gases after induction and delivery and fetal umbilical arterial and venous blood gases were measured in 30 paturients under going Cesarean section with thiopental-SCC-N2O-O2 anesthesia (general balanced anesthesia). The relationship between IDT and the apgar score was also studied. The results were as follows : 1) Analysis of tole Paturients arterial blood gases after induction arid after delivery, had no statistical significance. 2) Blood gas analysis from the umbilical of the fetus was pH 7.36 +/- 7.04, PCO2 39.8 +/-3.7 torr, PO2 36.8+/-3.4 torr, BE -2.8+/-0.7 mEq/l and oxygen saturation was 72.2+/-5.8%. Umbilical arterial blood from the fetus was 7.31+/-0.03, PCO2 49.1+/-4.8 torr, PO2 25.9+/-4.7 torr, BE -2.6+/-0.6 mEq/I and oxygen saturation was 36.2+/-3.4%. 3) The results of blood gas tension and acid-base status of the paturient according to IDT were not Statistically Significant in any group- 4) The results of' the apgar score according to IDT indicated that the 1 minute apgar score was statistically singinificant but not clinically the 5 minute appear score was not statistically significant.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics, Inhalation ; Anoxia ; Apgar Score ; Balanced Anesthesia ; Blood Gas Analysis ; Cesarean Section* ; Emergencies ; Female ; Fetal Hypoxia ; Fetus* ; Gases ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Mothers ; Oxygen ; Pregnancy ; Uterus

Aspiration of amniotic fluid, whether being meconium-stained or not, can cause a respiratory distress in neonates. This disorder may result in fatal consequence including unexpected death. Fetal hypoxia stimulates fetal gasping respiration, which can provoke massive amniotic fluid aspiration. A new born male-baby was found dead on the next day after vaginal delivery, and according to the statement of care-giver there was no serious event to the baby except for poor feeding. The diagnosis of amniotic fluid aspiration was confirmed at autopsy. The authors present the autopsy findings, clinical features and courses, failing medicolegal system and medical negligence, with literature review.
Amniotic Fluid ; Autopsy ; Female ; Fetal Hypoxia ; Humans ; Infant, Newborn ; Malpractice ; Respiration