Patrizia Bozzetti - Academia.edu (original) (raw)
Papers by Patrizia Bozzetti
Biology of the Neonate, Feb 1, 1987
Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in ... more Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in 14 fetal blood samples between 17 and 21 weeks of gestation. The samples were obtained at the time of fetoscopy performed for prenatal diagnosis. Results have been compared with two reference groups: (a) 4 patients in whom fetal cord blood sampling was performed at 32-36 weeks of gestation, and (b) 10 patients at the time of elective cesarean section, 35-39 weeks. PO2 and oxygen saturations were significantly higher and hemoglobin concentration lower in the mid-gestation fetus. Acid-base balance was not significantly different. There was a significant correlation between maternal and fetal hemoglobin concentrations. The oxygen affinity of fetal blood was not significantly different from that described for term fetuses with a oxygen saturation of less than 90%.
Contributions to nephrology, 1984
American Journal of Obstetrics and Gynecology, 1987
Journal of Maternal-Fetal and Neonatal Medicine, 1996
A 31-year-old pregnant woman at 20 weeks' gestation was sent to our hospi... more A 31-year-old pregnant woman at 20 weeks' gestation was sent to our hospital for fever, anemia, and arthralgias. As she was known to be a double heterozygote for beta-thalassemia and hemoglobin S, a diagnosis of hemolytic anemia caused by sickled red cells vasocclusive crises was made. The patient was submitted to partial exchange transfusion (PET) with a complete recovery. A second PET was performed at 36 weeks' gestation, and elective cesarean section was performed at 37 weeks, with the birth of a normal female neonate.
Reproductive Sciences, 2009
The objective of this work was to determine whether the prenatal determinates of clinical severit... more The objective of this work was to determine whether the prenatal determinates of clinical severity in intrauterine growth restricted pregnancies, established by abdominal circumference measures, correlates with neonatal morbidity and mortality. A total of 336 singleton pregnancies with intrauterine growth restriction were subdivided into group 1 (normal fetal heart rate and pulsatility index of the umbilical artery: 251 cases), group 2 (normal fetal heart rate and abnormal pulsatility index: 50 cases), and group 3 (abnormal fetal heart rate and pulsatility index: 35 cases). Gestational age, birth weight, body mass index, placental weight, and Apgar score were significantly related to the severity of intrauterine growth restriction (P < .001). Neonatal survival was 100%, 96%, and 57% in the 3 groups, respectively (P < .001). Greater than 80% of neonates of group 1 had no complications when compared to group 2 (54%) and group 3 (10%); P < .001. Gestational age was the only independent variable significantly associated with neonatal outcomes. The data confirm that the classification of clinical severity of intrauterine growth restriction based on biophysical parameters is clinically relevant to predict neonatal outcome.
Obstetrics & Gynecology, 2008
To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatili... more To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatility index of the umbilical artery according to the neonatal birth weight/gestational age standards and the intrauterine growth charts.
New England Journal of Medicine, 1993
Fetuses with intrauterine growth retardation are delivered if they have evidence of distress, as ... more Fetuses with intrauterine growth retardation are delivered if they have evidence of distress, as manifested by abnormalities in the fetal heart rate and umbilical-artery blood flow. We studied whether umbilical-blood sampling might provide further information useful for management. We measured hemoglobin and lactate concentrations, oxygen content, pH, blood gas levels, and base deficit in umbilical-vein blood and correlated these measurements with the heart rate and umbilical-artery wave forms recorded by Doppler velocimetry in 56 fetuses with growth retardation. Twenty-one fetuses had normal heart rates and normal results of velocimetry, 24 had normal heart rates and abnormal results of velocimetry (indicative of decreased diastolic flow), and 11 had abnormal heart rates and abnormal results of velocimetry. None of the 21 fetuses with normal heart rates and velocimetry had hypoxia or acidemia. Of the 24 fetuses with normal heart rates and abnormal velocimetry, 4 (17 percent) had moderate lactic acidosis, 1 (4 percent) had a low pH value, and 3 (12 percent) had hypoxia. Of the 11 fetuses with abnormal heart rates and velocimetry, 7 (64 percent) had lactic acidosis, low blood oxygen content, and low pH values. The absence of end-diastolic flow increased the risk of hypoxia and acidemia. The proportion of fetuses with elevated hemoglobin concentrations was similar among the three groups. Assessment of fetal oxygenation and acid-base balance is not indicated in fetuses with growth retardation if their heart rates and the results of velocimetry are normal. If the results of velocimetry are abnormal, fetal-blood sampling can distinguish fetuses that have growth retardation alone from those that also have hypoxia and acidosis, and thus may aid in determining the optimal time of delivery.
Neonatology, 1987
Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in ... more Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in 14 fetal blood samples between 17 and 21 weeks of gestation. The samples were obtained at the time of fetoscopy performed for prenatal diagnosis. Results have been compared with two reference groups: (a) 4 patients in whom fetal cord blood sampling was performed at 32-36 weeks of gestation, and (b) 10 patients at the time of elective cesarean section, 35-39 weeks. PO2 and oxygen saturations were significantly higher and hemoglobin concentration lower in the mid-gestation fetus. Acid-base balance was not significantly different. There was a significant correlation between maternal and fetal hemoglobin concentrations. The oxygen affinity of fetal blood was not significantly different from that described for term fetuses with a oxygen saturation of less than 90%.
Metabolism, 1988
The relationship between maternal and fetal glucose concentrations was investigated in pregnant w... more The relationship between maternal and fetal glucose concentrations was investigated in pregnant women at different gestational ages. Maternal and fetal blood samples were obtained during 14 fetoscopies (17 to 21 weeks), four umbilical cord samples (32 to 36 weeks), nine elective cesarean sections with appropriate for gestational age (AGA) fetuses (35 to 39 weeks) and nine elective cesarean sections with small for gestational age (SGA) fetuses (34 to 37 weeks). A significant linear relationship between maternal and fetal glucose concentrations was demonstrated at midgestation (P less than .001) and at late gestation (P less than .001). At equal maternal concentrations there were no significant differences in fetal glucose concentration between the cord samples obtained in late gestation and those obtained at cesarean section. At midgestation fetal glucose concentration is independent of and may exceed maternal concentration at maternal glucose levels less than 4.44 mmol/L. Furthermore, the relationship between maternal and fetal concentrations at maternal glucose concentrations greater than 4.44 mmol/L is significantly different at midgestation from that at late gestation (P less than .01); at equal maternal concentrations there were higher glucose concentrations in the mid trimester fetus. In late gestation as the maternal glucose concentration increases there is an increase in the maternal arterial-umbilical arterial glucose concentration difference and the umbilical glucose/oxygen quotient (P less than .003) reflecting increased glucose utilization by the fetus. There were no significant differences between AGA and SGA babies with respect to these relationships.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2008
To compare dinoprostone gel and insert in achieving successful vaginal delivery in nulliparous an... more To compare dinoprostone gel and insert in achieving successful vaginal delivery in nulliparous and multiparous women. 220 nulliparous and 100 multiparous with a Bishop score < or =7 were randomized to receive dinoprostone either gel or insert for cervical ripening. The main outcome measures were the rate and latency of vaginal delivery. In nulliparous women no significant differences were found between the gel and insert groups in the rate of vaginal delivery (85.6% vs. 80.7%) delivery < or =12 (36.8% vs. 32.9%) and < or =24h (85.3% vs. 93.4%) regardless of the preinduction Bishop score. Nulliparous with Bishop score < or =4 treated with the insert had a decreased risk (p<0.05) of post partum hemorrhage (4.8%) when compared with nulliparous treated with gel (16.7%). On the contrary, in multiparous the time to delivery interval was significantly shorter in the gel treated group (9.9+/-4.9h vs. 13.1+/-5h; p<0.001) with more patients delivering vaginally < or =12h (75% vs. 37.5%, p<0.001), regardless of the preinduction Bishop score. Both dinoprostone gel and insert are efficient in achieving cervical ripening and successful labor in nulliparous and multiparous. In multiparous, however, the gel significantly reduces the time to vaginal delivery with more patients delivering vaginally < or =12h, regardless of the Bishop score.
American Journal of Obstetrics and Gynecology, 1990
Fetal plasma amino acid concentrations were obtained by cordocentesis at midgestation in 11 norma... more Fetal plasma amino acid concentrations were obtained by cordocentesis at midgestation in 11 normal (appropriate for gestational age) fetuses and at late gestation in 12 small-for-gestational-age fetuses, and at cesarean section in 14 normal term infants. In normal fetuses total molar amino acid concentrations and fetal/maternal total molar concentration ratios did not change significantly between the second and third trimesters. Fetal and maternal concentrations of most amino acids were significantly correlated at both midgestation and late gestation. Small-for-gestational-age fetuses had significantly lower concentrations of total alpha-aminonitrogen; this was mainly because of a reduction of the branched chain amino acids valine, leucine, and isoleucine, and of lysine and serine. Maternal arterial concentrations of phenylalanine, arginine, histidine, and alanine were elevated in small-for-gestational-age pregnancies. Thus there are only minor changes in amino acid concentrations between midgestation and late gestation in normal fetuses with a constant fetal/maternal ratio. In small-for-gestational-age infants a significant reduction in alpha-aminonitrogen and in most essential amino acids was demonstrable in utero weeks before delivery.
American Journal of Obstetrics and Gynecology, 1992
OBJECTIVE: To determine respiratory gas relationships between the uterine veins and umbilical vei... more OBJECTIVE: To determine respiratory gas relationships between the uterine veins and umbilical vein in normal and pregnancies complicated by intrauterine growth retardation. STUDY DESIGN: Respiratory gases were measured in both uterine veins and the umbilical vein in eight normal and 13 pregnancies with intrauterine growth retardation. RESULTS: No significant differences were found in the placental versus nonplacental uterine veins. There was a significant correlation for umbilical and uterine venous values of P0 2 (p < 0.002) and Peo 2 (p < 0.004) in appropriate-for-gestational-age pregnancies, umbilical venous P0 2 was always less than uterine venous Po2, and Peo2 always greater than uterine. The transplacental gradient was significantly higher in intrauterine growth retarded than appropriate-for-gestational-age pregnancies for both P0 2 and Peo 2 • There was a lower uterine oxygen extraction in intrauterine growth retarded pregnancies (p < 0.05).
American Journal of Nephrology, 1986
We describe 19 pregnancies in 18 women with chronic renal disease and plasma creatinine greater t... more We describe 19 pregnancies in 18 women with chronic renal disease and plasma creatinine greater than or equal to 1.6 mg/dl before pregnancy. There were 2 spontaneous abortions (11th and 21st week), 2 therapeutic abortions (18th and 19th week), 1 stillbirth (30th week), 1 neonatal death (31st week) and 13 live births, 7 of them were preterm. Nine cesarean sections were done. Serial determinations of plasma creatinine during pregnancy showed a trend to decrease during the first half and to increase during the second half of pregnancy. The effect of pregnancy on the progression of renal failure was evaluated in 14 patients by comparing the linear regression lines of reciprocal plasma creatinine versus time before and after pregnancy. In 5 patients the rate of progression worsened after pregnancy. Our data indicate that women with chronic renal failure may have a successful pregnancy, but one third of them will have an accelerated rate of progression of the disease.
American Journal of Obstetrics and Gynecology, 1988
Plasma amino acid concentrations were determined in 28 pregnant women and their infants at term. ... more Plasma amino acid concentrations were determined in 28 pregnant women and their infants at term. Samples were obtained from 17 appropriate for gestational age and eight small for gestational age infants at cesarean section, while three small for gestational age fetuses were studied in utero by transabdominal cord sampling by means of ultrasonic guidance. Small for gestational age fetuses have significantly lower concentrations of a-aminonitrogen, compared with those of appropriate for gestational age fetuses, in both the umbilical artery and vein. Most of the difference is accounted for by the branched chain amino acids valine, leucine, and isoleucine. In contrast, hydroxyproline concentration is significantly higher in both the umbilical artery and vein of small for gestational age fetuses. The sum of the branched chain amino acid concentrations in the umbilical vein is directly related to maternal arterial values in both appropriate for gestational age and small for gestational age fetuses. Maternal arterial concentrations were slightly lower in small for gestational age fetuses and the regression analysis of umbilical venous versus maternal arterial branched chain amino acid concentrations was significantly different for small for gestational age and appropriate for gestational age infants. Umbilical venoarterial concentration differences in normal fetuses are significantly positive for most essential amino acids and for total a-aminonitrogen. In contrast, these differences were significant only for four essential amino acids in small for gestational age infants, while the total a-aminonitrogen venoarterial difference was not significant. The data obtained by · transabdominal cord sampling from relatively undisturbed fetuses were in agreement with the data obtained at cesarean section; this information suggests that these differences between small for gestational age and appropriate for gestational age infants reflected steady-state conditions. (AM J OesTET GYNECOL 1988;158:120-6.)
Biology of the Neonate, Feb 1, 1987
Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in ... more Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in 14 fetal blood samples between 17 and 21 weeks of gestation. The samples were obtained at the time of fetoscopy performed for prenatal diagnosis. Results have been compared with two reference groups: (a) 4 patients in whom fetal cord blood sampling was performed at 32-36 weeks of gestation, and (b) 10 patients at the time of elective cesarean section, 35-39 weeks. PO2 and oxygen saturations were significantly higher and hemoglobin concentration lower in the mid-gestation fetus. Acid-base balance was not significantly different. There was a significant correlation between maternal and fetal hemoglobin concentrations. The oxygen affinity of fetal blood was not significantly different from that described for term fetuses with a oxygen saturation of less than 90%.
Contributions to nephrology, 1984
American Journal of Obstetrics and Gynecology, 1987
Journal of Maternal-Fetal and Neonatal Medicine, 1996
A 31-year-old pregnant woman at 20 weeks&amp;amp;amp;#39; gestation was sent to our hospi... more A 31-year-old pregnant woman at 20 weeks&amp;amp;amp;#39; gestation was sent to our hospital for fever, anemia, and arthralgias. As she was known to be a double heterozygote for beta-thalassemia and hemoglobin S, a diagnosis of hemolytic anemia caused by sickled red cells vasocclusive crises was made. The patient was submitted to partial exchange transfusion (PET) with a complete recovery. A second PET was performed at 36 weeks&amp;amp;amp;#39; gestation, and elective cesarean section was performed at 37 weeks, with the birth of a normal female neonate.
Reproductive Sciences, 2009
The objective of this work was to determine whether the prenatal determinates of clinical severit... more The objective of this work was to determine whether the prenatal determinates of clinical severity in intrauterine growth restricted pregnancies, established by abdominal circumference measures, correlates with neonatal morbidity and mortality. A total of 336 singleton pregnancies with intrauterine growth restriction were subdivided into group 1 (normal fetal heart rate and pulsatility index of the umbilical artery: 251 cases), group 2 (normal fetal heart rate and abnormal pulsatility index: 50 cases), and group 3 (abnormal fetal heart rate and pulsatility index: 35 cases). Gestational age, birth weight, body mass index, placental weight, and Apgar score were significantly related to the severity of intrauterine growth restriction (P &amp;amp;amp;amp;amp;amp;amp;lt; .001). Neonatal survival was 100%, 96%, and 57% in the 3 groups, respectively (P &amp;amp;amp;amp;amp;amp;amp;lt; .001). Greater than 80% of neonates of group 1 had no complications when compared to group 2 (54%) and group 3 (10%); P &amp;amp;amp;amp;amp;amp;amp;lt; .001. Gestational age was the only independent variable significantly associated with neonatal outcomes. The data confirm that the classification of clinical severity of intrauterine growth restriction based on biophysical parameters is clinically relevant to predict neonatal outcome.
Obstetrics & Gynecology, 2008
To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatili... more To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatility index of the umbilical artery according to the neonatal birth weight/gestational age standards and the intrauterine growth charts.
New England Journal of Medicine, 1993
Fetuses with intrauterine growth retardation are delivered if they have evidence of distress, as ... more Fetuses with intrauterine growth retardation are delivered if they have evidence of distress, as manifested by abnormalities in the fetal heart rate and umbilical-artery blood flow. We studied whether umbilical-blood sampling might provide further information useful for management. We measured hemoglobin and lactate concentrations, oxygen content, pH, blood gas levels, and base deficit in umbilical-vein blood and correlated these measurements with the heart rate and umbilical-artery wave forms recorded by Doppler velocimetry in 56 fetuses with growth retardation. Twenty-one fetuses had normal heart rates and normal results of velocimetry, 24 had normal heart rates and abnormal results of velocimetry (indicative of decreased diastolic flow), and 11 had abnormal heart rates and abnormal results of velocimetry. None of the 21 fetuses with normal heart rates and velocimetry had hypoxia or acidemia. Of the 24 fetuses with normal heart rates and abnormal velocimetry, 4 (17 percent) had moderate lactic acidosis, 1 (4 percent) had a low pH value, and 3 (12 percent) had hypoxia. Of the 11 fetuses with abnormal heart rates and velocimetry, 7 (64 percent) had lactic acidosis, low blood oxygen content, and low pH values. The absence of end-diastolic flow increased the risk of hypoxia and acidemia. The proportion of fetuses with elevated hemoglobin concentrations was similar among the three groups. Assessment of fetal oxygenation and acid-base balance is not indicated in fetuses with growth retardation if their heart rates and the results of velocimetry are normal. If the results of velocimetry are abnormal, fetal-blood sampling can distinguish fetuses that have growth retardation alone from those that also have hypoxia and acidosis, and thus may aid in determining the optimal time of delivery.
Neonatology, 1987
Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in ... more Respiratory gases, acid-base balance, and lactate and hemoglobin concentrations were measured in 14 fetal blood samples between 17 and 21 weeks of gestation. The samples were obtained at the time of fetoscopy performed for prenatal diagnosis. Results have been compared with two reference groups: (a) 4 patients in whom fetal cord blood sampling was performed at 32-36 weeks of gestation, and (b) 10 patients at the time of elective cesarean section, 35-39 weeks. PO2 and oxygen saturations were significantly higher and hemoglobin concentration lower in the mid-gestation fetus. Acid-base balance was not significantly different. There was a significant correlation between maternal and fetal hemoglobin concentrations. The oxygen affinity of fetal blood was not significantly different from that described for term fetuses with a oxygen saturation of less than 90%.
Metabolism, 1988
The relationship between maternal and fetal glucose concentrations was investigated in pregnant w... more The relationship between maternal and fetal glucose concentrations was investigated in pregnant women at different gestational ages. Maternal and fetal blood samples were obtained during 14 fetoscopies (17 to 21 weeks), four umbilical cord samples (32 to 36 weeks), nine elective cesarean sections with appropriate for gestational age (AGA) fetuses (35 to 39 weeks) and nine elective cesarean sections with small for gestational age (SGA) fetuses (34 to 37 weeks). A significant linear relationship between maternal and fetal glucose concentrations was demonstrated at midgestation (P less than .001) and at late gestation (P less than .001). At equal maternal concentrations there were no significant differences in fetal glucose concentration between the cord samples obtained in late gestation and those obtained at cesarean section. At midgestation fetal glucose concentration is independent of and may exceed maternal concentration at maternal glucose levels less than 4.44 mmol/L. Furthermore, the relationship between maternal and fetal concentrations at maternal glucose concentrations greater than 4.44 mmol/L is significantly different at midgestation from that at late gestation (P less than .01); at equal maternal concentrations there were higher glucose concentrations in the mid trimester fetus. In late gestation as the maternal glucose concentration increases there is an increase in the maternal arterial-umbilical arterial glucose concentration difference and the umbilical glucose/oxygen quotient (P less than .003) reflecting increased glucose utilization by the fetus. There were no significant differences between AGA and SGA babies with respect to these relationships.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2008
To compare dinoprostone gel and insert in achieving successful vaginal delivery in nulliparous an... more To compare dinoprostone gel and insert in achieving successful vaginal delivery in nulliparous and multiparous women. 220 nulliparous and 100 multiparous with a Bishop score &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =7 were randomized to receive dinoprostone either gel or insert for cervical ripening. The main outcome measures were the rate and latency of vaginal delivery. In nulliparous women no significant differences were found between the gel and insert groups in the rate of vaginal delivery (85.6% vs. 80.7%) delivery &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =12 (36.8% vs. 32.9%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =24h (85.3% vs. 93.4%) regardless of the preinduction Bishop score. Nulliparous with Bishop score &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =4 treated with the insert had a decreased risk (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) of post partum hemorrhage (4.8%) when compared with nulliparous treated with gel (16.7%). On the contrary, in multiparous the time to delivery interval was significantly shorter in the gel treated group (9.9+/-4.9h vs. 13.1+/-5h; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) with more patients delivering vaginally &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =12h (75% vs. 37.5%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), regardless of the preinduction Bishop score. Both dinoprostone gel and insert are efficient in achieving cervical ripening and successful labor in nulliparous and multiparous. In multiparous, however, the gel significantly reduces the time to vaginal delivery with more patients delivering vaginally &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =12h, regardless of the Bishop score.
American Journal of Obstetrics and Gynecology, 1990
Fetal plasma amino acid concentrations were obtained by cordocentesis at midgestation in 11 norma... more Fetal plasma amino acid concentrations were obtained by cordocentesis at midgestation in 11 normal (appropriate for gestational age) fetuses and at late gestation in 12 small-for-gestational-age fetuses, and at cesarean section in 14 normal term infants. In normal fetuses total molar amino acid concentrations and fetal/maternal total molar concentration ratios did not change significantly between the second and third trimesters. Fetal and maternal concentrations of most amino acids were significantly correlated at both midgestation and late gestation. Small-for-gestational-age fetuses had significantly lower concentrations of total alpha-aminonitrogen; this was mainly because of a reduction of the branched chain amino acids valine, leucine, and isoleucine, and of lysine and serine. Maternal arterial concentrations of phenylalanine, arginine, histidine, and alanine were elevated in small-for-gestational-age pregnancies. Thus there are only minor changes in amino acid concentrations between midgestation and late gestation in normal fetuses with a constant fetal/maternal ratio. In small-for-gestational-age infants a significant reduction in alpha-aminonitrogen and in most essential amino acids was demonstrable in utero weeks before delivery.
American Journal of Obstetrics and Gynecology, 1992
OBJECTIVE: To determine respiratory gas relationships between the uterine veins and umbilical vei... more OBJECTIVE: To determine respiratory gas relationships between the uterine veins and umbilical vein in normal and pregnancies complicated by intrauterine growth retardation. STUDY DESIGN: Respiratory gases were measured in both uterine veins and the umbilical vein in eight normal and 13 pregnancies with intrauterine growth retardation. RESULTS: No significant differences were found in the placental versus nonplacental uterine veins. There was a significant correlation for umbilical and uterine venous values of P0 2 (p < 0.002) and Peo 2 (p < 0.004) in appropriate-for-gestational-age pregnancies, umbilical venous P0 2 was always less than uterine venous Po2, and Peo2 always greater than uterine. The transplacental gradient was significantly higher in intrauterine growth retarded than appropriate-for-gestational-age pregnancies for both P0 2 and Peo 2 • There was a lower uterine oxygen extraction in intrauterine growth retarded pregnancies (p < 0.05).
American Journal of Nephrology, 1986
We describe 19 pregnancies in 18 women with chronic renal disease and plasma creatinine greater t... more We describe 19 pregnancies in 18 women with chronic renal disease and plasma creatinine greater than or equal to 1.6 mg/dl before pregnancy. There were 2 spontaneous abortions (11th and 21st week), 2 therapeutic abortions (18th and 19th week), 1 stillbirth (30th week), 1 neonatal death (31st week) and 13 live births, 7 of them were preterm. Nine cesarean sections were done. Serial determinations of plasma creatinine during pregnancy showed a trend to decrease during the first half and to increase during the second half of pregnancy. The effect of pregnancy on the progression of renal failure was evaluated in 14 patients by comparing the linear regression lines of reciprocal plasma creatinine versus time before and after pregnancy. In 5 patients the rate of progression worsened after pregnancy. Our data indicate that women with chronic renal failure may have a successful pregnancy, but one third of them will have an accelerated rate of progression of the disease.
American Journal of Obstetrics and Gynecology, 1988
Plasma amino acid concentrations were determined in 28 pregnant women and their infants at term. ... more Plasma amino acid concentrations were determined in 28 pregnant women and their infants at term. Samples were obtained from 17 appropriate for gestational age and eight small for gestational age infants at cesarean section, while three small for gestational age fetuses were studied in utero by transabdominal cord sampling by means of ultrasonic guidance. Small for gestational age fetuses have significantly lower concentrations of a-aminonitrogen, compared with those of appropriate for gestational age fetuses, in both the umbilical artery and vein. Most of the difference is accounted for by the branched chain amino acids valine, leucine, and isoleucine. In contrast, hydroxyproline concentration is significantly higher in both the umbilical artery and vein of small for gestational age fetuses. The sum of the branched chain amino acid concentrations in the umbilical vein is directly related to maternal arterial values in both appropriate for gestational age and small for gestational age fetuses. Maternal arterial concentrations were slightly lower in small for gestational age fetuses and the regression analysis of umbilical venous versus maternal arterial branched chain amino acid concentrations was significantly different for small for gestational age and appropriate for gestational age infants. Umbilical venoarterial concentration differences in normal fetuses are significantly positive for most essential amino acids and for total a-aminonitrogen. In contrast, these differences were significant only for four essential amino acids in small for gestational age infants, while the total a-aminonitrogen venoarterial difference was not significant. The data obtained by · transabdominal cord sampling from relatively undisturbed fetuses were in agreement with the data obtained at cesarean section; this information suggests that these differences between small for gestational age and appropriate for gestational age infants reflected steady-state conditions. (AM J OesTET GYNECOL 1988;158:120-6.)