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The most important advancement in perinatology during the past few years has been the possibility to selectively establish a criterion to judge high risk pregnancies, which still represent the great majority of cases of materno-infant morbimortality. Social, economic, and cultural factors, age, biological antecedents of the mother, previous pregnancies, and medical history, have all a great influence in the evaluation of gestation. Through the years several models have been constructed to evaluate high perinatal risks; excluding complications due to danger of congenital abnormalities only 19% of women are exposed to high risk pregnancy. Among prenatal risk factors the most common are toxemia, chronic hypertension, severe cardiopathy, and diabetes; risk factors that may become more evident during delivery or shortly before it are toxemia again, premature rupture of membranes, meconial amniotic fluid, and abnormal presentation.
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PMID:[Perinatal medicine. Medico-social implications. I. Technics used in the identification of high risk pregnancy]. 45 11

142 determinations of leucocyte alkaline phosphatase (LAP) activity have been done in 103 cases of high risk pregnancy. A statistically significant elevation of LAP score has been found in high risk pregnancies due to diabetes mellitus, toxaemia, renal diseases and third trimester haemorrhage, but not in pregnancies complicated by cardiac disease, chronic hypertension, Rh sensitization or anaemia.
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PMID:Leucocyte alkaline phosphatase activity during high risk pregnancies. 67 79

The introduction deals with the main characteristics of two representatives of high risk pregnancies: diabetes mellitus and EPH gestoses. Particular interest was shown in risks that may occur in pregnant diabetics, with which they must be acquainted. Some theories are given on the pathogenesis of EPH gestoses. The aim of our investigation was to determine the concentration at which immunoglobulins G, M and A pass in cord blood, amniotic fluid and urine, and whether there is a significant difference between control group and among pregnant diabetics or those with EPH gestoses. The investigation was performed by the nephelometric technique on the Immunochemistry Analyzer. Each group consisted of 20 women, with a total of 60. Immunoglobulins A, M and G were determined in the mothers' sera, cord blood or amniotic fluid. IgG was obtained in urine in measurable concentrations. A significant increase of IgG was found in the urine of pregnant diabetics. IgM was significantly increased in the sera of diabetic mothers. IgA was significantly increased in pregnant diabetics, while both high risk pregnancy groups had an increased IgA in cord blood. The values of IgA in amniotic fluid were decreased in the EPH gestoses group in comparison to the group of diabetics. The authors find these variations interesting and feel they should be followed in other high risk pregnancy groups.
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PMID:[Laboratory study of patients with endemic nephropathy]. 191 48

Orthotopic liver transplantation was performed in a 29-year-old woman because of increasing decompensation of HBs-antigen positive post-hepatitic cirrhosis. Postoperatively she developed a mild rejection reaction and diabetes mellitus. Thirteen months after the transplant she conceived twins. This high risk pregnancy was complicated by a febrile viral infection with purulent tracheobronchitis at 9 weeks and a threatened abortion at 11 weeks. At 33 weeks there was a sudden drop in haemoglobin due to a minor uterine rupture which necessitated cesarean section. The female infants--of development in keeping with the dates--showed no clinical or ultrasound evidence of any malformations. Apart from initial difficulties--asphyxia (second twin), fluctuating glucose and calcium levels, an episode of neonatal jaundice which required phototherapy, reluctance to suck and hypotonia--the further development of both twins proceeded normally. The maternal diabetes disappeared after delivery, HBs-antigen remained negative and the HBs-antibody titre rose. The patient has remained in good condition, both mentally and physically.
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PMID:[Twin pregnancy after liver transplantation]. 235 62

For women whose health cannot support pregnancy, the author's obstetrics department has formed a multidisciplinary team to counsel couples on psychological and practical aspects of contraception and abortion. High risk pregnancies are those occuring in women with such disorders as cardiopathy, nephropathy, hypertension, diabetes, cancer, Rhesus isoimmunization and psychosis. Two approaches are used: to prevent or terminate pregnancy. Contraception must be explained concretely, addressing the couples' particular situation and personality. Pills are often contraindicated, in high risk patients as are IUDs in nulliparas and those taking anticoagulants. Many couples used to careful medical surveillance can adjust to temperature rhythm or diaphragms. For women who must have Tubal ligation, the decision is made jointly by the couple, obstetrician, psychotherapist and specialist. Counseling is usually necessary to prevent psychological or sexual dysfunction, particularly in those sterilized during caesarean section if the infant's survival is also at risk. A similar multidisciplinary team is consulted for therapeutic abortion alone or combined with tubal ligation.
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PMID:[Fecundity and high risk pregnancy]. 507 55

PP12 is one of the recently discovered soluble tissue antigens of the placenta. During normal pregnancy maternal serum PP12 levels rise during the first 18 weeks reaching a mean peak value of 139.9 +/- 40.26 micrograms/l; after that there is a fall to a mean value of 111.9 +/- 42.39 micrograms/l between 28 and 40 weeks. Significantly higher mean serum PP12 levels were found in the third trimester in two high risk pregnancy groups (281.09 +/- 117.08 micrograms/l in pre-eclamptic toxaemia and 203.71 +/- 73.77 micrograms/l in diabetes) while serum PP12 levels remained normal (114.94 +/- 58.06 micrograms/l) in twin pregnancy. The increase of serum PP12 concentration in toxaemia and in diabetes may be of considerable diagnostic significance.
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PMID:Serum levels of placenta-specific tissue protein 12 (PP12) in pregnancies complicated by pre-eclampsia, diabetes or twins. 650 61

The best management of respiratory distress syndrome (RDS) is prevention. Prenatal administration of Cortico-steroids has been proved to be a valuable way for accelerating fetal lung maturation. In case of high risk pregnancy, however, where acceleration of lung maturation is most needed, there may be a relative contraindication for using steroids. According to the theory that the increase in the phospholipid component of surfactant may be mediated by intra-amniotic thyroxin administration, its use for accelerating human fetal lung maturation has been tested. Seven samples of amniotic fluid were obtained in order to determine the lung maturity in seven pathological pregnancies (pre-eclamptic toxemia, diabetes, infection, hypertension, placental insufficiency) prior to elective caesarean section. Since thyroxin does not cross the placenta, it has to be injected directly into the amniotic sac. 20 ml of clear fluid were obtained by amniocentesis prior to each injection of 250 micrograms of Levothyroxin through the same needle. Each of the infants was delivered before 34 weeks. Birth weights of the premature infants were between 1220-1870 grams. In all cases the Lecithin/Sphingomyelin Ratio (L/S) in amniotic fluid analysis was immature. After thyroxin administration L/S Ratio was mature in pharyngeal aspirate examination after delivery in 6 cases. RDS was seen in only one infant. The interval between intraamniotic administration of T4 and delivery ranged from 72 hours to 2 weeks in 6 cases. In one case with clinical and radiological signs of RDS the injection-delivery interval was less than 48 hours: the L/S Ratio in pharyngeal aspirate was immature 2,8 (normal greater than 3).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention of hyaline membrane disease by intraamniotic administration of thyroxine]. 653 84

Gestational diabetes is defined as glucose intolerance recognized during pregnancy. Research is necessary to achieve more accurate diagnosis, precise definition of outcome criteria and assessment of their significance, correlation of outcomes with maternal variables, and more effective therapies to control glucose levels. Until such information is available, the following guidelines are proposed. All pregnant women should be screened for glucose intolerance between the 24th and 28th weeks of pregnancy. The diagnosis should be based on O'Sullivan's oral glucose tolerance procedure. Management should include high risk pregnancy surveillance and nutritional counseling. Some centers advocate insulin administration if dietary management does not consistently maintain the fasting plasma glucose below 105 mg/dl and the 2-h postprandial glucose below 120 mg/dl. However, the point at which insulin therapy should be instituted remains to be established. All agree that close control of plasma glucose is importance in reducing fetal and perinatal morbidity and mortality.
Diabetes Care
PMID:American Diabetes Association Workshop-Conference on gestational diabetes: summary and recommendations. 738 68

The diagnosis of congenital heart disease by means of echocardiography is already a real fact. The use of this technique for diagnosis in utero currently allows the detection of these malformations during the early stages of pregnancy and to determine the prognosis of the fetal cardiopathies, as well as to establish a medical or surgical treatment of the neonate. The prenatal echocardiographic study of 126 pregnant women, previously having had children with heart disease, has allowed s to prove the greater incidence of cardiopathy in this population (6.4%), compared to the results obtained from a group of pregnant women previously having normal children and without a high risk pregnancy (0.8%). These findings support the theory that genetic factors are the primary cause of congenital cardiac malformations, although the existence of teratogen factors (rubella, diabetes, etc.) in some cases cannot be excluded.
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PMID:[Congenital familial cardiopathies. Prenatal diagnosis]. 846 Aug 38

Insulin dependent diabetes (IDD) is considered to be an immune endocrinopathy as in such patients a disorder of the immune system is involved; however, up to now no data are available on the occurrence of antiphospholipid antibodies (aPL) in IDD pregnant women and on possible correlation between the presence of aPL and the high fetomaternal morbidity reported in these patients. The presence of lupus anticoagulant (LA) and of anticardiolipin antibodies (ACA) was monthly evaluated. In 35 IDD pregnant women referring within the 7 degrees week of pregnancy to the High Risk Pregnancy Medical Unit. Levels of D-dimer, fibrin degradation product, were also assayed. Twelve IDD pregnant women resulted to be aPL positive with a markedly high prevalence of positivity (34%). aPL positive did not significantly differ from aPL negative women in age, duration and severity of diabetes and in metabolic control throughout pregnancy. Pregnancy induced hypertension (PIH) and intrauterin growth retard (IUGR) were observed in 6/12 aPL positive and in only 2/23 aPL negative patients (p < 0.02). A pathological increase in D-dimer levels occurred in 6/12 aPL positive patients and in none aPL negative (p < 0.03). The high frequency of aPL positivity and its strict relation to pregnancy complications strongly support a major role for an autoimmune pathogenetic mechanism in the occurrence of feto-maternal morbidity in IDD pregnant women. The identification of this subgroup at risk for complications may be clinically relevant.
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PMID:Antiphospholipid antibodies and pregnancy disorders in women with insulin dependent diabetes. 873 24


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