Aida Salihagić

Doppler cerebro-umbilical ratio and fetal biophysical profile in the assessment of peripartal cardiotocography in growth-retarded fetuses.

Objective: The aim of the study was to examine the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of peripartal cardiotocography (CTG) in growth-retarded fetuses. Methods: The prospective study included 58 pregnant women with singleton pregnancy from 28 to 42 weeks of gestation with clinically and ultrasonically verified late intrauterine growth retardation (IUGR). After assessment of the FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and the FBP were assessed twice a week. The last peripartal CTG was used as an outcome parameter. Results: The FBP score was statistically significant when associated with peripartal CTG (p < 0.001). The mean value of the FBP was 7.77 ± 0.28 for infants with a normal peripartal CTG, 6.13 ± 0.41 for infants with a prepathological CTG and 4.40 ± 0.60 for infants with a pathological peripartal CTG. There was also a statistically significant association between the C/U ratio ≧1 and normal CTG (p < 0.005), but there was no statistically significant difference between prepathological and pathological CTG in relation to C/U ratio values (p > 0.05). Normal and pathological peripartal CTG was correlated with the perinatal outcome, but prepathological CTG was not correlated with results of the perinatal outcome (p > 0.05). Conclusions: Our results showed that both methods of fetal monitoring need to be used in perinatal monitoring of growth-retarded fetuses. The two methods can be used as important parameters in deciding to end pregnancies with IUGR when pathological values occur.

Short-term and long-term stimulation of Na+−H+ exchange in cortical brush-border membranes during compensatory growth of the rat kidney

The effect of unilateral nephrectomy on Na+−H+ exchange in rat renal cortical brush-border membrane vesicles (BBMV) was studied by the method of acridine orange fluorescence quenching. The exchanger activity in BBMV from remnant kidney increased rapidly by 70–75% within first 30 min following uninephrectomy. Only a slight further increase was found in later stages of renal growth, i.e. 30 min to 7 days following uninephrectomy. The changes in antiporter activity were restricted toVmax, whereas theKm for Na+ was similar in control and compensatory growing kidney. The increase of Na+−H+ exchange at 15 min was not affected by actinomycin D in vivo, whereas the increase at 48 h was completely abolished indicating that protein synthesis could be involved in the late, but not in the initial stimulation of renal Na+−H+ exchange. The late, but not the initial stimulations of Na+−H+ exchange were associated with elevated activities of cortical (Na++K+)-ATPase indicating that changes in antiporter activity precede those in the (Na++K+)-pump. The early stimulation of Na+−H+ exchange in BBMV in one kidney was induced also by the occlusion of blood flow through the contralateral kidney for 15 min, without removing it. Thirty min after the occlusion was removed and the reflow established, the Na+−H+ exchange in BBMV from the intact kidney decreased to the control values. The observed modulations in renal Na+−H+ exchanger may be regulated by phosphorylation-dephosphorylation events. In support, the concentration of a well known protein kinase C activator, 1,2-diacylglycerol, in the cortical tissue of the remnant kidney increased up to 100% within 5 min following unilateral nephrectomy and preceded the increase in Na+−H+ exchange. The early stimulation of Na+−H+ exchange may be a “trigger” in initiating the kidney growth.

Fetal Biophysical Profile and Cerebro-Umbilical Ratio in Assessment of Perinatal Outcome in Growth-Restricted Fetuses

Aim: To examine the value of the fetal biophysical profile (FBP) and the Doppler cerebro-umbilical ratio (C/U) in the assessment of perinatal outcome in growth-restricted and hypoxic fetuses. Study Design: The prospective clinical study included 87 pregnant women with singleton pregnancies at 28–42 weeks of gestation with clinically verified intrauterine growth restriction (IUGR). After assessment of FBP, flow velocity waveforms from the umbilical and middle cerebral arteries were recorded and the C/U ratio was calculated. The C/U ratio and FBP were assessed twice a week. At delivery, umbilical arterial pH, the occurrence of meconium-stained amniotic fluid (MAF), Apgar score at 5 min and the incidence of cesarean sections were used as outcome parameters. Results: The mean FBP value was 5.5 ± 0.96 in cases with MAF, and 6.88 ± 0.26 in cases without MAF. Also, there was no statistical significance in the relation between the C/U ratio and the appearance of MAF. At pH >7.2, the mean FBP value was 7.11 ± 0.23, while it was 2.83 ± 0.79 in newborns with acidosis. Both FBP and C/U values were statistically correlated with pH (p < 0.01). The mean umbilical arterial pH was 7.31 ± 0.0 at a C/U ratio of ≧1 and 7.21 ± 0.03 at a C/U ratio of <1. In cases with Apgar scores of 8–10, the mean FBP value was 7.28 ± 0.23, at Apgar scores of 5–7 it was 3.9 ± 0.52, while at Apgar scores of 0–4 the mean FBP value was 1.5 ± 0.5. The mean Apgar score at 5 min was 9.54 ± 0.09 at a C/U ratio of ≧1, and 8.12 ± 0.49 at a C/U ratio of <1. The mean FBP value in cases of vaginal delivery was 7.55 ± 0.31. In cesarean section deliveries, the mean FBP value was 5.97 ± 0.37. Also, there was a high frequency of cesarean sections in growth-restricted fetuses with a C/U ratio of <1 (p < 0.05), i.e. slightly less than FBP. Conclusions: FBP and C/U ratio were associated with low arterial pH, low Apgar score and the rate of cesarean sections (p < 0.05), but there was no association between FBP or C/U ratio and the appearance of MAF (p > 0.5). Due to their good predictive value the FBP and C/U ratio could be used in the prenatal monitoring of growth-retarded and hypoxic fetuses. These two methods can be used as important parameters in the decision to end pregnancies with IUGR, when pathological values occur. Thus a reduction in perinatal morbidity, mortality and the incidence of infants with poor neurologic outcome can be expected.

Transvaginal color Doppler in the assessment of abnormal early pregnancy.

The study groups comprised 61 pregnant women whose gestational age ranged from 7 to 12 weeks from the last menstrual period. All patients apparently had a normal developing pregnancy; there were no clinical symptoms of pathology e.g. bleeding in early pregnancy. Eighty-two patients with a clinically and ultrasonographically normal pregnancy whose gestational age ranged from 7 to 12 weeks, served as a control group. When the anatomical position of investigated area have been obtained clearly, pulsed wave Doppler sample volume was placed on the structures of interest: the both uterine arteries and intervillous space. There is no statistically significant difference between the Resistance Index (RI) in the left or right uterine artery (P greater than 0.01) and among investigated groups of patients (P greater than 0.01). The intervillous blood flow RI in the case of molar pregnancy was 0.38 with SD +/- 0.03; in blighted ovum 0.43 with SD +/- 0.03, and in missed abortion 0.43 with SD +/- 0.02. It should be stressed that in nine (31%) cases of blighted ova and in five (26%) cases of missed abortion, intervillous space flow could not be detected. In the control group, intervillous blood flow was always visualized and the mean RI was 0.45 with SD - 0.04. Statistical analysis showed significantly higher RI in control group in comparison with other groups of patients (P less than 0.01), and significantly lower RI in molar pregnancy in comparison with other groups of patients (P less than 0.01). There was no difference in RI between blighted ova and missed abortions (P greater than 0.01).

Transvaginal color doppler assessment of uteroplacental circulation in normal and abnormal early pregnancy

Transvaginal color Doppler offers the potential to study uteroplacental circulation in early normal pregnancies and pregnancies associated with intrautine fibroids. A total of 62 patients (30 early pregnancies complicated by myoma and 32 normal pregnancies representing the control group) whose gestational age ranged from the 6th to the 14th week were examined. The equipment used was an Aloka color Doppler SSD-680 with 5.0 MHz curve-linear transvaginal transducer. The main uterine, radial and spiral arteries were identified in all patients. Peak systolic velocity and resistance index were measured and automatically calculated. Statistical analysis used was Student t-test. This study documents a physiological decrease in impedance in the uteroplacental circulation in pregnancy associated with fibroids, while the blood velocity of the radial arteries showed a significant increase between the 10th and 14th week of gestation.

Clinical Value of the Assessment of Gynaecological Tumour Angiogenesis by Transvaginal Colour Doppler

Angiogenesis occurs in the body in only a few physiological conditions, but it regularly precedes carcinogenesis. Neovascularisation is a term well known to the pathologist, but with the advent of colour Doppler it is now of interest to those using ultrasonography. Since morphological criteria alone are insufficient to characterise space occupying lesions, visualisation of newly formed vessels and consequently, their blood flow characteristics, seems to provide a clearer distinction in vivo between benign and malignant gynaecological tumours. Very low resistance indices in newly formed vessels, as a predictor of malignancy, have already been established. The most recent area of investigation covering the differences between centrally and peripherally placed vessels offers additional criteria for diagnosing gynecological malignancy.

Absence of increased electroneutral Na+-H+ exchange in renal cortical brush-border membranes from hyperthyroid rats

The fluorescence quenching of acridine orange was used to compare Na+-H+ exchange and ion conductances in renal cortical brush-border membrane vesicles (BBMV) isolated from euthyroid and hyperthyroid rats. In BBMV from euthyroid animals, Na+-H+ exchange was entirely electroneutral. In BBMV from hyperthyroid rats, the total rates of Na+-H+ exchange were about 30% higher than in BBMV from euthyroid animals. However, the electroneutral exchange in these membranes was similar to that in BBMV from euthyroid rats; the observed increase in exchange was due to electrically coupled Na+ and H+ movements through conductive pathways in the membranes. Ion conductances in isolated BBMV were tested with outwardly directed K+ gradients in the presence of carbonyl cyanide m-chlorophenylhydrazone (K+ conductance) or valinomycin (H+ conductance). The K+ conductance was negligible and similar in BBMV from both groups of rats. A significant H+ conductance was present in both kinds of membrane preparations and was by 37% higher in BBMV from hyperthyroid animals. Therefore, our experiments failed to demonstrate an increased electroneutral Na+-H+ exchange in BBMV from hyperthyroid rats. Instead, a finding of a significant electrically BBMV from hyperthyroid rats. Instead, a finding of a significant electrically coupled Na+-H+ antiport in the presence of increased H+ conductance in BBMV from hyperthyroid rats indicates that these membranes may also have increased Na+ conductance.

P94Fetal cerebrovascular response to chronic hypoxia

Objective