Fetal growth restriction (FGR) occurs due to various reasons and is associated with increased fetal and neonatal mortality and morbidity. FGR has been defined as having birth weight less than the 10th centile. The first clinically relevant step is the detection of true FGR, pathological small fetuses, associated with signs of abnormal placental insufficiency and poorer perinatal outcome. The role of obstetric management is to identify growth restricted fetuses at risk of chronic hypoxia in uterus, to monitor their wellbeing, and to deliver when the adverse outcome is imminent. The purpose of this document is to review the FGR with diagnosis, antenatal surveillance tools, and guidance for management and timing of delivery.
Anoxia ; Birth Weight ; Fetal Development* ; Fetus ; Humans ; Infant ; Infant Mortality ; Placental Insufficiency ; Prenatal Diagnosis ; Uterus

Impetigo herpetiformis (IH) is an extremely rare pustular disorder and potentially life-threatening condition for both mother and fetus. Intrauterine growth retardation, fetal abnormalities, and even fetal/neonatal death can occur with worsening maternal disease and are probably related to placental insufficiency. Maternal risk is linked to fluid and electrolyte abnormalities, in particular, hypocalcemia- induced convulsions and sepsis. Therefore, early recognition is crucial to reduce both maternal and fetal morbidities, and a patient with IH may require emergency caesarean delivery. Here, we report a case of a 34-year-old pregnant woman with IH who underwent successful urgent general anesthesia for caesarean section.
Adult ; Anesthesia ; Anesthesia, General ; Cesarean Section* ; Emergencies ; Female ; Fetal Growth Retardation ; Fetus ; Humans ; Impetigo* ; Mothers ; Placental Insufficiency ; Pregnancy ; Pregnant Women ; Psoriasis ; Seizures ; Sepsis

Gestational diabetes mellitus (GDM) is traditionally defined as newly onset or detected carbohydrate intolerance during pregnancy. Unprotected exposure to high glucose levels during pregnancy is related to adverse pregnancy outcomes including fetal demise and intrauterine growth restriction associated with placental insufficiency. The most common complications related to GDM comprise macrosomia, shoulder dystocia, brachial plexus palsy, intrauterine fetal death and preeclampsia, polyhydramnios, preterm delivery, and increased cesarean section rate. Moreover, GDM may increase the chance of GDM recurrence in a subsequent pregnancy, impaired glucose tolerance or type 2 DM, and obesity or impaired glucose tolerance in the offspring. Therefore, proper obstetrical management and glucose control are always challenging and important. The aim of this article is to discern: 1) obstetric complications related to GDM diagnosed after pregnancy, 2) various methods of fetal surveillance, 3) proper timing for delivery and mode of delivery, 4) postpartum management for GDM patients and neonates, and 5) preconceptional counseling prior to a possible subsequent pregnancy.
Brachial Plexus ; Cesarean Section ; Counseling ; Diabetes, Gestational* ; Dystocia ; Female ; Fetal Death ; Glucose ; Humans ; Infant, Newborn ; Obesity ; Obstetrics ; Paralysis ; Placental Insufficiency ; Polyhydramnios ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Recurrence ; Shoulder

The development of the kidneys and other organs of the urinary tract follows the natural rule of gene-environment-lifestyle interaction. Both intrinsic and extrinsic factors may be associated with the etiology of various kinds of urinary malformations, but the environmental factor is an extrinsic factor. Related literatures were reviewed in this paper, which focuses on the association of congenital urinary malformations with possible environmental factors. It is concluded that urinary malformation is associated with low birth weight, maternal disease, placental insufficiency, maternal drug exposure, and maternal exposure to environmental pesticides. Living environment and socioeconomic factors may also influence the incidence of urinary malformation.
Female ; Fetus ; drug effects ; Gene-Environment Interaction ; Humans ; Infant, Low Birth Weight ; Pesticides ; toxicity ; Placental Insufficiency ; Pregnancy ; Socioeconomic Factors ; Urinary Tract ; abnormalities

OBJECTIVE: The purpose of this study was to investigate the prenatal hypoxic effect on the fetal brain development. METHODS: We used the guinea pig chronic placental insufficiency model to investigate the effect of hypoxia on fetal brain development. We ligated unilateral uterine artery at 30-32 days of gestation (dg : with term defined as -67 dg). At 50 dg, 60 dg, fetuses were sacrificed and assigned to either the growth-restricted (GR) or control (no ligation) group. After fixation, dissection, and sectioning of cerebral tissue from these animals, immunohistochemistry was performed with NeuN antibody, which is a mature neuronal marker in the cerebral cortex. RESULTS: The number of NeuN-immunoreactive (IR) cells in the cerebral cortex did not differ between the GR and control groups at 50 dg. However, the number of NeuN-IR cells was lesser in GR fetuses than in controls at 60 dg (p<0.05). CONCLUSION: These findings show that chronic prenatal hypoxia affect the number of neuron in the cerebral cortex of guinea pig fetus at 60 dg. The approach used in this study is helpful for extending our understanding of neurogenesis in the cerebral cortex, and the findings may be useful for elucidating the brain injury caused by prenatal hypoxia.
Animals ; Anoxia* ; Brain ; Brain Injuries ; Cerebral Cortex ; Fetus ; Guinea Pigs ; Immunohistochemistry ; Neurogenesis ; Neurons* ; Placental Insufficiency ; Pregnancy ; Uterine Artery

OBJECTIVETo investigate the etiology, pathogenesis, clinicopathologic characteristics, clinical prognosis and treatment of Dandy-Walker syndrome.

METHODSNine cases of Dandy-Walker syndrome were included in the study. The autopsy findings and clinical history were evaluated along with review of the literature. The causes, pathogenetic mechanism, pathologic features and prognosis of Dandy-Walker syndrome were analyzed.

RESULTSAmong 9 Dandy-Walker syndrome cases, six patients presented with variants of Dandy-Walker complex and 3 cases had classic Dandy-Walker malformation. In addition, 4 patients presented with combined lateral ventricle expansion and multiple malformations were seen in 7 cases. Combined umbilical cord abnormality was noted in 4 patients with variant of Dandy-Walker complex and combined placental abnormality was seen in one classic Dandy-Walker syndrome.

CONCLUSIONSDandy-Walker syndrome is a rare disease. In addition to complex pathogenesis with possible genetic and environmental antigenic etiologies, placental and umbilical cord abnormality may be also related to its development.

Abortion, Induced ; Autopsy ; Dandy-Walker Syndrome ; diagnostic imaging ; pathology ; Female ; Fetal Diseases ; diagnostic imaging ; pathology ; Fetus ; pathology ; Gestational Age ; Humans ; Lateral Ventricles ; pathology ; Male ; Placental Insufficiency ; pathology ; Pregnancy ; Retrospective Studies ; Ultrasonography, Prenatal

BACKGROUND: Abnormal umbilical artery Doppler velocimetry is one of the important findings of intrauterine growth restriction (IUGR) and IUGR is associated with high perinatal morbidity and mortality. In addition, this abnormal Doppler velocimetry is correlated with placental insufficiency. The aim of this study was to determine the pathologic differences in the placentas from IUGR pregnancies with and without the absent or reversed end diastolic velocity (AREDV). METHODS: Among the cases that had undergone prenatal follow-up in our institute, a retrospective slide review was conducted for 18 cases of IUGR with AREDV and 17 cases with IUGR that had normal end-diastolic flow of the umbilical artery. RESULTS: The birth weight and the other clinical parameters were not different among the two groups. Grossly, the placental weight percentiles were significantly smaller in AREDV group when they were adjusted according to gestational age. Histologically, chronic deciduitis, mural hypertrophy of the decidual arteries, an intimal fibrin cushion of the large fetal vessels, increased syncytial knots, villous agglutinations, avascular villi, villous stromal-vascular karyorrhexis, and acute atherosis were more frequently found in the AREDV group and their presence showed statistical significance. CONCLUSIONS: These findings suggest that pathologic abnormalities due to fetal and maternal vasculopathies in the placenta may be the cornerstone for inducing AREDV in the umbilical artery.
Arteries ; Birth Weight ; Fetal Growth Retardation ; Fibrin ; Follow-Up Studies ; Gestational Age ; Hypertrophy ; Placenta ; Placental Insufficiency ; Pregnancy ; Retrospective Studies ; Rheology ; Umbilical Arteries

Pre-eclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide, but remains unclear about the underlying disease mechanisms. Pre-eclampsia is currently believed to be a two-stage disease. The first stage involves shallow cytotrophoblast invasion of maternal spiral arteriole, resulting in placental insufficiency. The hypoxic placenta release soluble factors, cytokines, and trophoblastic debris into maternal circulation, which induce systemic endothelial damage and dysfunction. This cause the second stage of the disease: maternal syndrome. Epidemiological research has consistently demonstrated a familial predisposition to pre-eclampsia. Intensive research efforts have been made to discover susceptibility genes that will inform our understanding of the pathophysiology of pre-eclampsia and that may provide direction for therapeutic or preventative strategies. In this review, we summarize the current understanding of the role of genetic factors in the pathophysiology of pre-eclampsia and explain the molecular approach to search for genetic clues in pre-eclampsia.
Arterioles ; Cytokines ; Perinatal Mortality ; Placenta ; Placental Insufficiency ; Pre-Eclampsia ; Trophoblasts

Small-for-gestational-age (SGA) is associated with poor perinatal outcomes. The term SGA is descriptive and means that the fetal size and weight at birth are less than expected (in general, 10th percentile using standard curves for gestational age) regardless of the cause. It was estimated that about 50~70% of fetuses born weighing less than the 10th percentile for gestational age are constitutionally small, with fetal growth appropriate for parental size and ethnicity; these are usually associated with normal placental function and have a normal outcome. Fetal growth restriction (FGR) describes a decrease in the fetal growth rate that prevents an infant from obtaining the complete genetic growth potential. It is common with placental dysfunction occurring in about 3% of pregnancies despite advances in obstetric care. In human pregnancies, placental insufficiency is the leading cause of FGR and is usually due to poor utero-placental blood flow and placental infarcts. The reduction of placental supply of nutrients to the fetus has been associated with several adaptive changes taking place in both the placenta and fetus. Adaptive changes can be followed by pathology leading to fetal death, and therefore staging of the disease is fundamental to timing delivery. Thus, it is responsible for the obstetricians to distinguish SGA from intrauterine growth restriction, correct the causes if possible, and if not, accurately stage the disease progress so as to deliver at the most suitable time. In this review, the management of fetal growth restrictions is summarized based on the diagnosis, etiologic factors, antenatal surveillance, and their possible therapeutic approaches.
Constitution and Bylaws ; Fetal Death ; Fetal Development ; Fetus ; Gestational Age ; Humans ; Hypogonadism ; Infant ; Mitochondrial Diseases ; Ophthalmoplegia ; Parents ; Parturition ; Placenta ; Placental Insufficiency ; Pregnancy

PURPOSE:Umbilical artery Doppler study is a commonly used non-invasive tool in high risk pregnancies because of its good correlation with the degree of placental insufficiency. We analyzed hematologic profiles and perinatal outcome of preterm infants with abnormal umbilical artery Doppler results and the risk factors of early onset thrombocytopenia. METHODS:We retrospectively reviewed the medical records of preterm infants under 35 weeks of gestational age at birth who were admitted to the neonatal intensive care unit of Seoul National University Children's Hospital from January 1, 2002 through December 31, 2004, and whose mothers had undergone umbilical artery Doppler studies within 5 days before delivery. Sixty two neonates were divided into three groups; the 1st group was defined as the patients with normal umbilical artery (UA) systolic/diastolic (S/D) ratio, the 2nd group, with increased UA S/D ratio above 95 percentile, and the 3rd, with absent or reversed end-diastolic flow (AREDF). RESULTS:Mean nucleated red blood cell (nRBC) counts per 100 white blood cells (WBCs) were 14.2 (0-150), 91.0 (0-262), 301.4 (6-884) (P<0.001), mean WBC counts were 10.8 (0- 34.1), 9.2(3.4-23.9), 5.9(0.5-15.2) (x1,000/mm(3)) (P=0.007), and mean platelet counts were 215.5+/-69.2, 185.9+/-96.7, 100.2+/-50.3 (x1,000/mL) ( Arteries ; Blood Platelets ; Erythrocytes ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Length of Stay ; Leukocytes ; Medical Records ; Mothers ; Parturition ; Placental Insufficiency ; Platelet Count ; Pregnancy ; Retrospective Studies ; Risk Factors* ; Seoul ; Thrombocytopenia* ; Umbilical Arteries*