Fetal lung maturation in diabetic pregnancy

1986 ◽  
Vol 113 (3_Suppl) ◽  
pp. S101-S106 ◽  
Author(s):  
Olof Tydén ◽  
Ulf J. Eriksson ◽  
Christian Berne
Keyword(s):  
Amniotic Fluid ◽  
Metabolic Control ◽  
Preterm Delivery ◽  
Experimental Studies ◽  
Fetal Lung ◽  
Diabetic Pregnancy ◽  
Phosphatidyl Glycerol ◽  
Lung Maturation ◽  
Metabolic Derangement ◽  
Lung Maturity

Abstract. The increased incidence of the idiopathic respiratory distress syndrome (IRDS) in infants of diabetic mothers may be explained by preterm delivery and asphyxia but the metabolic derangement per se may also be responsible for the inadequate production of surfactant. Experimental studies of the underlying mechanisms in the lungs of fetuses of pregnant diabetic rats have shown a decreased formation of the two major surfactant phospholipids disaturated phosphatidyl choline and phosphatidyl glycerol. In addition, the activities of key enzymes responsible for the production of these phospholipids are decreased in the fetal lung tissue. Inadequate utilization of pulmonary glycogen for surfactant biosynthesis has also been observed. Furthermore, experimental studies support that other changes than fetal hyperinsulinaemia are needed to produce a state of disturbed surfactant production. In human diabetic pregnancy strict metabolic control allows the fetal lungs to mature in a near-normal fashion. The presence of phosphatidyl glycerol in the amniotic fluid seems to be the best available predictor of lung maturity in diabetic pregnancy, in which both the lecithin/sphingomyelin ratio and amniotic fluid cytology may result in false-positive and false-negative values. The trend towards extension of delivery to term will undoubtedly diminish the need for estimation of fetal lung maturity by amniocentesis. Avoiding preterm delivery and adhering to strict metabolic control of the maternal diabetes would be expected to decrease the neonatal respiratory problems in diabetic pregnancy.

Fetal lung maturity in complicated pregnancy, as predicted from microviscosity of amniotic fluid.

1982 ◽  
Vol 28 (8) ◽  
pp. 1754-1757 ◽  
Author(s):  
N V Simon ◽  
W A Hohman ◽  
R C Elser ◽  
J S Levisky ◽  
M J Carp ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Lung Maturation ◽  
Class D ◽  
Hyaline Membrane ◽  
Induced Hypertension ◽  
Complicated Pregnancy ◽  
Fetal Lung Maturation ◽  
Lung Maturity

Abstract We measured the microviscosity of amniotic fluid between 28 and 40 weeks of gestation in 252 normal pregnancies and in 172 pregnancies complicated by factors known to influence fetal lung maturation, including chronic high blood pressure, pregnancy-induced hypertension, diabetes mellitus, and therapy with betamethasone. Comparison of the microviscosity value distributions and regression analysis indicated significantly lower microviscosity values in hypertensive disorders, in Class D and Classes F or R diabetes, and after 48 h of treatment with betamethasone. Few changes were observed in Classes A, B, or C diabetes. These observations are consistent with the accelerated maturation of surfactant observed in chronic intrauterine stress and the lower incidence of hyaline membrane disease reported after glucocorticoids.

Improved thin-layer chromatography of disaturated phosphatidylcholine in amniotic fluid.

1981 ◽  
Vol 27 (2) ◽  
pp. 239-242 ◽  
Author(s):  
M Y Tsai ◽  
M Cain ◽  
M W Josephson
Keyword(s):  
Respiratory Distress ◽  
Thin Layer ◽  
Amniotic Fluid ◽  
Thin Layer Chromatography ◽  
Fetal Lung ◽  
Dipalmitoyl Phosphatidylcholine ◽  
Fetal Lung Maturity ◽  
Coefficients Of Variation ◽  
Layer Chromatography ◽  
Lung Maturity

Abstract We describe an indirect test of fetal lung maturity: the quantitation of disaturated phosphatidylcholine in amniotic fluid. The lipids in samples of amniotic fluid from 172 patients were reacted with osmium tetroxide, and disaturated phosphatidylcholine was then isolated by thin-layer chromatography. Interfering substances were retained by a pre-adsorbent layer. The charred disaturated phosphatidylcholine, quantitated by densitometry, was compared to standard dipalmitoyl phosphatidylcholine. Both within-run and between-run coefficients of variation were about 10%. Blood and meconium do not interfere. Six infants developed respiratory distress when disaturated phosphatidylcholine concentrations of amniotic fluid drawn within 72 h of delivery were less than 5.5 mg/L. A concurrently determined lecithin/sphingomyelin ratio falsely predicted lung maturity in one of these. In seven other samples for which lecithin/sphingomyelin ratios suggested lung immaturity but disaturated phosphatidyl-choline predicted maturity, none of the infants developed respiratory distress. In normal pregnancies, measurement of disaturated phosphatidylcholine in amniotic fluid appears to be a better predictor of fetal lung maturity than is measurement of the lecithin/sphingomyelin ratio. Further studies are needed to determine if this analysis is a better predictor in diabetic pregnancies.

scholarly journals Successfully delayed delivery of second twin after early second trimester rupture of membranes of the first twin: a case report

2020 ◽  
Vol 12 (2) ◽  
pp. 81-85
Author(s):  
Jadranka Georgievska ◽  
Igor Samardziski ◽  
Ana Daneva ◽  
Goran Kocoski
Keyword(s):  
Preterm Delivery ◽  
Good Condition ◽  
Fetal Lung ◽  
Intrauterine Death ◽  
Lung Maturation ◽  
Uterine Contractions ◽  
Regular Control ◽  
Level Institution ◽  
Twin Pregnancies ◽  
Second Twin

Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin  pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and  she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.

scholarly journals Metabolomic profile of amniotic fluid to evaluate lung maturity: the diaphragmatic hernia lamb model

2014 ◽  
Vol 9 ◽  
Author(s):  
Gloria Pelizzo ◽  
Maurizio Ballico ◽  
Maria Chiara Mimmi ◽  
José Louis Peirò ◽  
Mario Marotta ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Diaphragmatic Hernia ◽  
Control Group ◽  
Metabolomic Profile ◽  
Lung Maturation ◽  
Metabolomic Profiling ◽  
Gestation Age ◽  
Alveolar Tissue ◽  
Global Growth ◽  
Lung Maturity

Background: Tracheal occlusion (TO) stimulates lung growth in fetuses affected with congenital diaphragmatic hernia (CDH) although the processes involved in lung maturation still remain unknown. The objective of this study was to evaluate the metabolomic profile of amniotic fluid (AF) following TO in fetal lamb model in order to obtain an indirect view of mechanisms involved in pulmonary reversal hypoplasia and biochemical maturity in response to fetal TO. Methods: Liquid Chromatography Mass Spectrometry was performed on lamb AF samples at: age I (70 days’gestation); age II (102 days’ gestation); age III (136 days’ gestation). CDH was induced at age I and TO at age II. Results: Betaine, choline, creatinine were found significantly increased during gestation in the control group. The CDH group showed choline (p =0.007) and creatinine (p =0.004) decreases during pregnancy. In the TO group choline and creatinine profiles were restored. Conclusions: Alveolar tissue and fetal global growth ameliorated after TO. Metabolomics provided useful information on biochemical details during lung maturation. Metabolomic profiling would help to identify the best time to perform TO, in order to increase survival of CDH affected patients.

scholarly journals Lamellar Body Phospholipid Content of Amniotic Fluid: A Possible Index of Fetal Lung Maturity

1979 ◽  
Vol 16 (1-6) ◽  
pp. 191-196 ◽  
Author(s):  
Coral G. Duck-Chong
Keyword(s):  
Amniotic Fluid ◽  
Individual Variation ◽  
Lamellar Body ◽  
Alveolar Epithelium ◽  
Fetal Lung ◽  
Phospholipid Content ◽  
Secretory Cells ◽  
Lamellar Bodies ◽  
Fetal Lung Maturity ◽  
Lung Maturity

Lamellar bodies, produced by secretory cells in the alveolar epithelium, are the major source of surfactant phospholipid. As the fetal lung matures, the membranous content of the lamellar bodies is secreted into the alveolar spaces and passes into the amniotic fluid, from which it can be isolated in a morphologically recognisable form. A method is described for the rapid isolation of a lamellar body fraction from amniotic fluid using a small air-driven clinical ultracentrifuge. The lamellar body phospholipid content of amniotic fluid increases towards the end of gestation, but the time of onset and the rate of this increase show wide individual variation. Preliminary results suggest that the lamellar body phospholipid content of amniotic fluid may be a useful index of fetal lung maturity.

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