Auswahl der wissenschaftlichen Literatur zum Thema „Hypoxie foetale – diagnostic“

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Pregnancy is a physiological state associated with many alterations in biochemical, physiological, hematological & immunological processes. Preeclampsia and eclampsia complicate 6-8% of all pregnancies and lead to various maternal and fetal complications. The aim of the present study was to evaluate serum LDH levels in the normal pregnant women and pregnant women with preeclampsia and eclampsia in ante-partum period and to study the correlation of maternal and perinatal outcomes with serum LDH levels.This prospective study was conducted among ANC mothers from 18-35 years with term singleton pregnancy attending OBG OPD and labour room at Navodaya Medical College Hospital & Research Centre, Raichur. After taking informed consent & detailed clinical examination, relevant laboratory investigations were performed. The serum LDH estimated using fully automated ERBA biochemical analyser.In the present study, a total of 200 pregnant women were included, out of which 100 were normal pregnant women which served as control group; remaining 34 (17%) cases were included in pregnancy with eclampsia and 66 (33%) were pregnancy with pre-eclampsia. In 29 cases of study group with Serum LDH in the range of 600-800 IU/L, 08 (27.6%) had severe pre-eclampsia and 18 (62.0%) had eclampsia. Of 34 eclampsia cases, 18(52.9%) had Serum LDH range 600-800IU/L and 14 (41.2%) had serum LDH >800IU/L. The mean Serum LDH in study group was 570.5 IU/L and in control group was 201.5 IU/L. The patients had maternal complications like abruption, PPH, DIC, eclampsia with LDH>600. Neonatal complications like IUGR, fetal distress, neonatal death, LBW, premature birth, IUD were increased with raised LDH. Serum LDH is the earliest marker in blood during hypoxia and oxidative stress. It is raised in cases of pre-eclampsia and eclampsia. Detection of high-risk patients with increased levels of LDH mandates close monitoring, prompt and correct management to decrease both maternal and foetal morbidity and mortality. Estimation of serum Lactate Dehydrogenase can be used as a prognostic marker for preeclampsia and eclampsia.

Abstract Breech presentation, i.e. the abnormal lie of a foetus longitudinally with the buttocks closest to the mother’s cervix, is a common issue affecting up to 5% of women during delivery resulting in poor outcomes such as traumatic labour, infection and increased neonatal mortality. Currently, abdominal palpation is the screening method of choice for breech presentation; however, 15,000 breech presentations remain undiagnosed across England annually. While routine ultrasonography has been suggested, its cost-effectiveness and scalability remain concerning, especially in low/middle-income countries. Various algorithms have been applied to maternal trans-abdominal ECGs to obtain foetal ECGs, but current applications only allow heart rates, congenital heart defects, hypoxia, and foetal distress to be identified. The use of ECG is proposed to determine foetal position as breech foetuses tend to display QRS complexes in a similar pattern to the maternal trace, whereas cephalic foetuses would demonstrate inverted QRS complexes. ECGs are cost-effective, safe and do not require highly skilled technicians to operate, which makes it an ideal starting platform for the development of a device with high sensitivity and reasonable diagnostic speeds to identify breech foetuses. Future considerations include the use of artificial intelligence to increase diagnostic accuracy and development of a patient-facing mobile application.

BACKGROUND Early diagnosis of sepsis in neonates is cardinal. The isolation of the organism from the body fluids is time-consuming and does not reliably exclude the infection even if it is negative. Nucleated red blood cells (NRBCs) are immature erythrocytes that are elevated in association with foetal distress, hypoxia, and inflammation. The purpose of the study was to evaluate the diagnostic efficacy of nucleated red blood cells (NRBCs) in the detection of neonatal sepsis. METHODS This was a prospective study which was conducted in the section of haematology, Department of Pathology of Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun, Uttarakhand. A total of 92 term neonates admitted to NICU with clinical features and risk factors of sepsis from October 2020 to March 2021 were included in the study. All study neonates were classified into proven sepsis, probable clinical sepsis and no sepsis groups. The NRBC count and haematological parameters were obtained by a fully automated analyzer SYSMEX XN1000 and corroborated with a peripheral blood smear. The data obtained were analyzed using one-way ANOVA with Fisher’s LSD multiple comparison tests or t-test using GraphPad Prism 7 software. A P-value of 0.001 was taken to be statistically significant. RESULTS Among the 92 cases studied, 23 were culture-positive sepsis, 31 were of probable clinical sepsis or were culture-negative and the rest 38 cases had no sepsis. In the present study, the difference in NRBC count between the sepsis and no sepsis group was statistically significant (P-value < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of NRBC count for sepsis were found to be 77. 78 %, 60.52 %, 73.68 % and 65.71 % respectively. The average NRBC count in the mortality group was higher than in live neonates. CONCLUSIONS The NRBC count showed comparable or higher sensitivity than haematological parameters. Higher NRBC counts in the mortality group correlated with adverse neonatal outcomes, hence carrying a prognostic value.

Introduction : L'infection foetale avec syndrome de réponse inflammatoire foetale (SRIF) pendant le travail est associée au risque de développer une septicémie néonatale, des troubles du développement neurologique, une paralysie cérébrale, voire un décès. Lorsque l’acidose se surajoute au SRIF pendant le travail, cela induit une situation à très haut risque pour le foetus. Les méthodes actuelles pour diagnostiquer le SRIF sont insuffisantes. Nous avons émis l'hypothèse que l'analyse de la variabilité de la fréquence cardiaque foetale (VFC) pourrait être utilisée pour détecter le SRIF. Par conséquent, le premier objectif de notre travail était d'explorer si la VFC se modifiait au cours d’un SRIF. Le second objectif était d'étudier les changements de la VFC pendant une hypoxie progressive associée à un SRIF, en comparaison à une hypoxie isolée.Matériel et méthodes : Le modèle de SRIF était obtenu par l’injection de lipopolysaccharide (LPS) par voie intraveineuse à des foetus de brebis instrumentés, proches du terme. Un groupe témoin recevait une injection de sérum physiologique. Les paramètres hémodynamiques, les gaz du sang, le dosage d’interleukine-6 (IL-6) et 14 indices de VFC étaient enregistrés pendant six heures. Des comparaisons étaient faites entre les groupes LPS et le groupe témoin toutes les heures. Pour le second objectif, deux autres groupes ont été comparés : l’un avec une hypoxie isolée, l'autre avec une hypoxie associée à un SRIF. L'hypoxie progressive était induite par des occlusions répétées du cordon ombilical d’une minute pendant trois phases d’occlusions : légères, modérées et sévères. Les paramètres hémodynamiques et gazométriques ainsi que la VFC étaient comparés entre les groupes.Résultats : Concernant le premier objectif, 15 agneaux ont été instrumentés. Dans le groupe LPS (n = 8), l'IL-6 augmentait significativement après l'injection de LPS (p < 0,001), confirmant ainsi le modèle SRIF. La fréquence cardiaque foetale augmentait significativement à partir de H5 (p < 0,01). Cinq mesures de la VFC étaient significativement différentes entre le groupe LPS et le groupe témoin (le SDNN (déviation standard des intervalles NN / Standard Deviation of Normal to Normal), la SD2 (déviation standard 2 / Standard Deviation 2), le DFA (analyse des fluctuations sans tendances / Detrended Fluctuation Analysis) alpha 1 et 2 et la VLT (Variabilité à Long Terme). Concernant le second objectif, la mortalité était plus élevée dans le groupe hypoxie + SRIF (n = 4/9) en comparaison au groupe hypoxie isolée (n = 0/9). L'état gazométrique était modifié plus tôt en cas d’hypoxie associé au SRIF. Après les occlusions légères, le pH était significativement plus bas (7,22 [7,12-7,24] vs 7,28 [7,23-7,34], p = 0,01) et les lactates étaient significativement plus élevés (10,3 mmol/L [9,4-11,0] vs 6,0 mmol/L [4,1-8,2], p <0,001) dans le groupe hypoxie + SRIF. Après les occlusions légères, six indices de VFC étaient significativement augmentés dans le groupe hypoxie + SRIF en comparaison au groupe hypoxie isolée (le SDNN, le RMSSD (racine carrée de la moyenne des carrés des différences entre intervalles NN successif / Root Mean Square of Successive Differences), la VCT (Variabilité à court terme), la VLT, les LF (basses fréquences / Low Frequencies) et les HF (hautes fréquences / High frequencies)). Après les occlusions modérées, le SDNN et le RMSSD restaient significativement augmentés.Conclusion : Au cours d'un SRIF aigu, isolé ou associé à une hypoxie, la VFC est significativement modifiée. Ces changements semblent être médiés par une augmentation de la variabilité globale et une perte de complexité de la VFC. Ainsi, la VFC pourrait être utilisée pour la détection précoce de ces deux situations à risque
Introduction: Fetal infection during labor, accompanied by fetal inflammatory response syndrome (FIRS), is linked to neurodevelopmental impairments, cerebral palsy, neonatal sepsis, and even mortality. Existing diagnostic methods for FIRS remain insufficient. Acidosis associated with FIRS during labor presents a significant risk to the fetus. This study hypothesizes that analysing fetal heart rate variability (HRV) could serve as a tool for detecting FIRS. Therefore, the first study aim was to explore whether fetal HRV change during FIRS and the second aim was to explore how HRV changes during acute FIRS-associated hypoxia, compared to isolated hypoxia. Material and methods: In near-term fetal sheep with chronic instrumentation, lipopolysaccharide (LPS) was administered intravenously to simulate FIRS, while a control group received an injection of saline solution. Hemodynamic parameters, blood gas levels, interleukin-6 (IL-6), and 14 heart rate variability (HRV) indices were recorded during a stability period and for six hours after injection. For these different parameters, hourly comparisons were made between the LPS and control groups. For the second aim, two other groups were compared: one with isolated hypoxia, the other with hypoxia and FIRS. Worsening hypoxia was induced by repeated umbilical cord occlusions in three one-hour phases: mild, moderate, and severe. Hemodynamic, gasometric, and HRV parameters were compared between the groups. Results: For the first aim, a total of 15 lambs were instrumented. In the LPS-treated group (n = 8), IL-6 levels significantly increased following LPS administration (p < 0.001), validating the FIRS model. Additionally, fetal heart rate showed a significant increase after H5 (p < 0.01). Significant differences between LPS and control groups were observed between H2 and H4 for five HRV measures (Standard Deviation of Normal to Normal (SDNN), Standard Deviation 2 (SD2), Detrended Fluctuation Analysis (DFA) alpha 1 and 2 and Long-Term Variability (LTV)). The hypoxia and FIRS group had a higher mortality rate (n = 4/9) compared with isolated hypoxia group (n = 0/9). Gasometric state was altered earlier in the hypoxia and FIRS group after mild occlusions (pH = 7.22 [7.12–7.24] vs 7.28 [7.23–7.34], p = 0.01; lactate = 10.3 mmol/L [9.4–11.0] vs 6.0 mmol/L [4.1–8.2], p <0.001). After mild occlusions, the hypoxia and FIRS group had higher values for six HRV parameters compared with the hypoxia group (SDNN, Root Mean Square of Successive Differences (RMSSD), Short Term Variability (STV), LTV, Low Frequencies (LF) and High frequencies (HF). After moderate occlusions, only SDNN and RMSSD remained significantly higher. Conclusion: During acute FIRS, associated or not with hypoxia, HRV is significantly changed. These changes appear to be mediated by an increase of global variability and a loss of signal complexity. HRV indices may therefore be valuable for early detection in these two situations

Le but de cette étude était d'explorer, par une approche métabonomique par spectroscopie de résonance magnétique du proton, les fluides biologiques du nouveau-né (modèle porcelet d'hypoxie ischémie cérébrale) et de la mère (modèle rat d'inflammation materno-foetale) afin de rechercher des biomarqueurs précoces de ces deux pathologies. L'étude des fluides biologiques (urine et liquide céphalorachidien) du porcelet nouveau-né n'a pas permis de mettre en évidence un marqueur diagnostic précoce spécifique de la pathologie. L'inflammation, provoquée chez les animaux à dix-huit et dix-neuf jours de gestation, a provoqué des désordres significatifs sur le devenir de la grossesse, sur le nombre moyen de nouveau-nés, ainsi que sur la croissance des petirs suivis pendant les quatorze premiers jours de vie. L'étude métabonomique du plasma sanguin et du liquide amniotique maternels, couplée aux analyses multi-variées a permis de mettre en évidence des biomarqueurs précoces de l'inflammation
A metabonomic approach using high resolution resonance magnetic spectroscopy was investigated on newborn (piglet model of cerebral hypoxia ischemia) and maternal (rat model of maternofetal inflammation induced by E Coli lipopolysaccharid injections) biological fluids. The aim of this study was to evidence an early biomarker of these two pathologies. Neither in the urine and nor in the cerebrospinal fluid of hypoxic ischemic animals, specifi biomarkers of the pathology were evidenced. Metabonomic studies combined with multivaried analysis on the maternal blood plasma and on the amniotic fluid of inflammation-induced animals at day eighteen and nineteen of gestation had evidenced some specific biomarkers. In addition, inflammation impact was demonstrated on pregnancy outcome, on the mean number of newborn per litter and on the newborn growth during the fourteen's days of life