Dyre Trolle

Ultrasound-guided fetal intravenous transfusion for severe rhesus haemolytic disease.

Intrauterine, intraperitoneal transfusion is associated with a poor survival rate in fetuses with hydrops and low gestational age. A method of direct fetal intravenous transfusion was used in two fetuses. One fetus with severe rhesus haemolytic disease was given transfusions in the 29th and 30th weeks of gestation, using an ultrasound-guided needle through the hepatic part of the umbilical vein without fetoscopy. In another fetus, an experimental cannulation of the umbilical vein succeeded in the 23rd week of gestation. Ultrasound-guided fetal intravenous transfusion avoids the use of fetoscopy, which has limitations, and may improve the prognosis for rhesus-sensitised fetuses.

PLACENTAL TRANSFER OF PHENOBARBITONE IN EPILEPTIC WOMEN, AND ELIMINATION IN NEWBORNS

Abstract The concentration of phenobarbitone in human umbilical-cord serum was 95% of the concentration in the maternal serum, whether this was derived from phenobarbitone or, by metabolic transformation, from primidone. The rate of elimination of the drug from the blood of the newborn was slower than or equal to that in adults.

The prognostic and diagnostic value of total estriol in urine and in serum and of human placental lactogen hormone in serum in the last part of pregnancy

The benefit to the antenatal care from using estriol and human placental lactogen (hPL) determinations is emphasized and likewise that special attention must be paid to values below the reference intervals. Referring to biosynthesis and place of production, a survey is given of the various causes of low estriol and/or low hPL values, and a number of clinical cases illustrate the matter. A follow-up study of children from pregnancies with low estriol values has disclosed an alarming number of cases of severe handicaps.

Familial male hermaphroditism with delayed and partial masculinization.

Abstract Seven cases of male hermaphroditism, five of them members of one family, are presented. All these patients exhibit the same clinical picture: female phenotype with testes, absence of Mullerian structures, enlarged clitoris in childhood, masculinization during puberty with further growth of the clitoris, hair growth, deepening of the voice, broad shoulders and long arms, and breast development. They have 46 chromosomes with an XY sex-chromosome constitution. They show high urinary excretion of 17-ketosteroids, especially of the androsterone and etiocholanolone fractions. For the reasons discussed in this paper they are believed to represent a syndrome with a specific etiology among the heterogeneous group of male hermaphrodites with incomplete testicular feminization. The name familial male hermaphroditism caused by delayed and partial masculinization is suggested.

ABO and Rh phenotyping of foetal blood obtained by foetoscopy

Blood samples taken from the foetus by foetoscopy early in the 2nd trimester of pregnancy can be used for reliable blood grouping. However, the sampling technique is not perfect. In 5 out of 15 pregnant women, no foetal blood was obtained, although between 1 and 10 samples were taken on each occasion. One‐third of 56 samples from the 10 women contained foetal blood.

Decrease in the Mortality Rates for Low-Birth-Weight Infants After Phenobarbitone Treatment

Abstract. A daily dosage of 100 mg phenobarbitone administered orally to pregnant women for three days or more immediately before delivery has reduced the various mortality rates for low‐birth‐weight infants by 50% or more. Since it is hardly possible to treat all pregnant women in this way it is recommended to administer phenobarbitone to women with high‐risk pregnancies such as former stillborn infant, former premature delivery, pregnancy complications, and planned induction of premature labour before the 37th week and until delivery takes place. If the mothers of low‐birth‐weight infants have not been adequately treated it is recommended that the newborn infant be given phenobarbitone injections immediately after birth and at 8‐hour intervals, 10 injections in all.

Patterns of Bilirubin Conjugation in the Newborn

Concentrations of unconjugated bilirubin and bilirubin diglucuronide (measured as alkali-hydrolyzable bilirubin conjugate) have been determined in serum from umbilical cord blood and capillary blood, taken daily during the first five days after birth, in 47 healthy mature infants. Three of these showed an aberrant pattern.Bilirubin diglucuronide concentrations were higher than adult values in all the infants, probably indicating an inhibition of the excretion of this pigment.In the main group of infants unconjugated bilirubin concentrations were high. This may be the result of slow irreversible conjugation. An alternative explanation is possible. If an equilibrium of conjugation is present, the high concentrations of unconjugated bilirubin may result from the elevated concentration of conjugate. In the 3 aberrant cases unconjugated bilirubin was lower than in the main group, about adult level. This may be explained by an early development of the conjugating enzyme or by a high uridine diphosphate glucuron...

Alpha-fetoprotein in amniotic fluid and serum from pregnant women with severe rhesus isoimmunization.

Abstract. In 12 pregnant women with severe rhesusisoimmunization the AFP concentration in amniotic fluid (50 samples), maternal serum (212 samples) and cord blood (5 samples) were determined by immuno‐electrophoresis. With surviving infants (9 patients) the initial values in amniotic fluid before intrauterine transfusion (IUT) lie evenly distributed within the 90% reference interval. In serum the initial values are within the 90% reference interval, but above the mean level for AFP concentration for gestational age. A similar pattern is seen in the period up to delivery. In 3 cases of intrauterine/neonatal death the initial concentrations of AFP in maternal serum were significantly above the upper limit of normal range, whereas all the initial amniotic fluid concentrations were close to 95% fractile. Intrauterine transfusions do not influence the AFP profiles in a uniform way. The AFP concentration in maternal serum may be used in evaluation of severe rhesus‐isoimmunized pregnancies.

Do newborns of epileptics on anticonvulsants develop biochemical signs of osteomalacia

In a controlled prospective study performed in 16 pregnant epileptics and nine normal pregnant controls, biochemical indices of calcium homeostasis (serum calcium, serum magnesium, serum phosphate, and serum alkaline phosphatases) were determined after 18 weeks pregnancy, at birth, 8 days and 6 months after birth. Furthermore, the same indices were measured in their newborns in the first 6 months of life. In both groups of mothers the serum alkaline phosphatase rose significantly during the pregnancy (P < 0.001), followed by a significant fall after the births (epileptics: P < 0.05, controls: P < 0.001), but the epileptic mothers had significantly higher initial serum alkaline phosphatase levels than the controls (P < 0.05). In both groups of newborns a dramatical fall in serum calcium was observed in the first day of life (P < 0.001), followed by a normalization after 1 month. The serum alkaline phosphatases doubled between day 8 and day 30 in both groups (P < 0.001).

BONE MINERAL CONTENT DURING PREGNANCY IN EPILEPTICS ON ANTICONVULSANT DRUGS AND IN THEIR NEWBORNS

Abstract. Bone mineral content (BMC) in the long bones was measured by photon absorptiometry in epileptic pregnant and normal pregnant women an in their newborns. The BMC (highly related to total body calcium) was completely unchanged during pregnancy in both groups. The BMC was of virtually the same order in the newborns of the epileptic mothers as in the newborns of the normal mothers. Furthermore, the development state, estimated from BMC, weight and length, was identical in the two groups of newborns. These results show that anticonvulsant osteomalacia can be held at a constant level during pregnancy, and infants born to epileptic mothers have no demonstrable demineralization of bone.