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Fetal lung maturity

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https://www.readbyqxmd.com/read/29900526/transplacental-versus-direct-fetal-corticosteroid-treatment-for-accelerating-fetal-lung-maturation-where-there-is-a-risk-of-preterm-birth
#1
REVIEW
Debby P Utama, Caroline A Crowther
BACKGROUND: Despite major advances in medical technology, the incidence of preterm birth remains high. The use of antenatal corticosteroid administered transplacentally, by intramuscular injection to women at risk of preterm birth, has reduced the incidence of respiratory distress syndrome and increased the survival rates of preterm infants. However, this intervention also comes with its own risks and side effects. Animal studies and early studies in pregnant women at risk of preterm birth have reported the use of an alternative route of administration, by direct intramuscular injection of corticosteroid into the fetus under ultrasound guidance, in an attempt to minimise the side-effect profile...
June 14, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29894780/the-rate-of-neonatal-respiratory-distress-syndrome-transient-tachypnea-in-the-newborn-and-the-amniotic-lamellar-body-count-in-twin-pregnancies-compared-with-singleton-pregnancies
#2
Hiroyuki Tsuda, Tomomi Kotani, Tomoko Nakano, Kenji Imai, Takafumi Ushida, Akihiro Hirakawa, Fumie Kinoshita, Yuichiro Takahashi, Shigenori Iwagaki, Fumitaka Kikkawa
BACKGROUND: Whether or not the period of fetal lung maturity differs between twin and singleton pregnancies has not been clarified. We examined whether or not fetal lung maturity and fetal lung absorption are achieved earlier in twin fetuses than in singleton fetuses. METHODS: We registered 454 singleton pregnancies and 398 twin pregnancies with no congenital abnormalities affecting the respiratory function or neonatal deaths. All patients were delivered by Caesarean section without labor between 24 and 38 gestational weeks...
June 9, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/29874660/the-hypothalamic-pituitary-adrenal-axis-and-the-fetus
#3
Amr Morsi, Donald DeFranco, Selma Witchel
Glucocorticoids (GCs), cortisol in humans, influence multiple essential maturational events during gestation. In the human fetus, fetal hypothalamic-pituitary-adrenal (HPA) axis function, fetal adrenal steroidogenesis, placental 11β- hydroxysteroid dehydrogenase type 2 activity, maternal cortisol concentrations, and environmental factors impact fetal cortisol exposure. The beneficial effects of synthetic glucocorticoids (sGCs), such as dexamethasone and betamethasone, on fetal lung maturation have significantly shifted the management of preterm labor and threatened preterm birth...
June 6, 2018: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/29871548/antenatal-synthetic-glucocorticoid-exposure-at-human-therapeutic-equivalent-doses-predisposes-middle-age-male-offspring-baboons-to-an-obese-phenotype-that-emerges-with-aging
#4
Hillary F Huber, Anderson H Kuo, Cun Li, Susan L Jenkins, Kenneth G Gerow, Geoffrey D Clarke, Peter W Nathanielsz
INTRODUCTION: Women threatening premature delivery receive synthetic glucocorticoids (sGC) to accelerate fetal lung maturation, reducing neonatal mortality and morbidity. Few investigations have explored potential long-term offspring side effects. We previously reported increased pericardial fat and liver lipids in 10-year-old (human equivalent 40 years) male baboons exposed to 3 antenatal sGC courses. We hypothesized middle-aged sGC male offspring show obesity-related morphometric changes...
January 1, 2018: Reproductive Sciences
https://www.readbyqxmd.com/read/29800541/neonatal-outcomes-of-elective-early-term-births-after-demonstrated-fetal-lung-maturity
#5
Alan T N Tita, Kathleen A Jablonski, Jennifer L Bailit, William A Grobman, Ronald J Wapner, Uma M Reddy, Michael W Varner, John M Thorp, Kenneth J Leveno, Steve N Caritis, Jay D Iams, George Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
BACKGROUND: Studies of early term birth after demonstrated fetal lung maturity show that respiratory and other outcomes are worse with early term birth (370 -386 ) even after demonstrated fetal lung maturity when compared with full term birth (390 -406 ). However these studies included medically indicated births and are therefore potentially limited by confounding by the indication for delivery. Thus the increase in adverse outcomes might be due to the indication for early term birth rather than the early term birth itself...
May 22, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29789058/prevention-and-treatment-of-respiratory-distress-syndrome-in-preterm-neonates
#6
Christopher McPherson, Jennifer A Wambach
Respiratory distress syndrome (RDS) impacts a high proportion of preterm neonates, resulting in significant morbidity and mortality. Advances in pharmacotherapy, specifically antenatal corticosteroids and postnatal surfactant therapy, have significantly reduced the incidence and impact of neonatal RDS. Antenatal corticosteroids accelerate fetal lung maturation by increasing the activity of enzymes responsible for surfactant biosynthesis, resulting in improved lung compliance. Maternal antenatal corticosteroid treatment has improved survival of preterm neonates and lowered the incidence of brain injury...
May 1, 2018: Neonatal Network: NN
https://www.readbyqxmd.com/read/29770109/fetoscopic-endoluminal-tracheal-occlusion-and-reestablishment-of-fetal-airways-for-congenital-diaphragmatic-hernia
#7
Lennart Van der Veeken, Francesca Maria Russo, Luc De Catte, Eduard Gratacos, Alexandra Benachi, Yves Ville, Kypros Nicolaides, Christoph Berg, Glenn Gardener, Nicola Persico, Pietro Bagolan, Greg Ryan, Michael A Belfort, Jan Deprest
Background: Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and morbidity mainly due to pulmonary hypoplasia and hypertension. Temporary fetal tracheal occlusion to promote prenatal lung growth may improve survival. Entrapment of lung fluid stretches the airways, leading to lung growth. Methods: Fetal endoluminal tracheal occlusion (FETO) is performed by percutaneous sono-endoscopic insertion of a balloon developed for interventional radiology...
2018: Gynecological Surgery
https://www.readbyqxmd.com/read/29767297/magnetic-resonance-assessment-of-fetal-lung-maturity-comparison-between-signal-intensity-and-volume-measurement
#8
Ryo Ogawa, Tomoyuki Kido, Masashi Nakamura, Teruhito Kido, Teruhito Mochizuki, Takashi Sugiyama
PURPOSE: We evaluated the associations between gestational age (GA) and lung-to-liver signal intensity ratio (LLSIR) and fetal lung volume (FLV) using magnetic resonance imaging (MRI). Moreover, we evaluated the reproducibility of these measurements. MATERIALS AND METHODS: LLSIR and FLV were measured using single-shot fast spin-echo MRI in 88 consecutive fetuses. The Spearman test was used to assess the relationships between (1) LLSIR and GA, and (2) FLV and GA in 81 fetuses without lung abnormalities...
May 16, 2018: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/29766152/undesired-effect-of-excessive-betamethasone-administration-during-pregnancy-a-rare-case
#9
Alireza Mirzaei, Solmaz Piri, Kaveh Gharanizadeh, Mozhdeh Zabihiyeganeh
Background: Postpartum bilateral femoral neck fracture (BFNF) is a rare condition. We here report a case of BFNF due to excessive corticosteroid consumption, twin pregnancy, immobility, and vitamin D deficiency. Case: This is a report of a 32-yr-old woman with bilateral femoral insufficiency fracture five days after emergency cesarean section due to preterm labor, twin pregnancy, and the history of a previous cesarean section at 33 wk. Antenatal repeated courses of betamethasone injections for fetal lung maturity, daily oral use of prednisolone for the history of miscarriage, immobilization, and vitamin D deficiency were the important contributing factors in her past medical history and lab investigations...
March 2018: International Journal of Reproductive Biomedicine (Yazd, Iran)
https://www.readbyqxmd.com/read/29758177/the-efficacy-of-antenatal-steroid-therapy-is-dependent-on-the-duration-of-low-concentration-fetal-exposure-evidence-from-a-sheep-model-of-pregnancy
#10
Matthew W Kemp, Masatoshi Saito, Haruo Usuda, Shimpei Watanabe, Shinichi Sato, Takushi Hanita, Yusaku Kumagai, Timothy J Molloy, Michael Clarke, Peter J Eddershaw, Gabrielle C Musk, Augusto Schmidt, Demelza Ireland, Lucy Furfaro, Matthew S Payne, John P Newnham, Alan H Jobe
OBJECTIVE: Antenatal corticosteroids (ANS) are among the most important and widely used interventions to improve outcomes for preterm infants. ANS dosing regimens remain un-optimized and without maternal weight-adjusted dosing. We, and others, have hypothesised that once a low concentration of materno-fetal steroid exposure is achieved and maintained, the duration of the steroid exposure determines treatment efficacy. Using a sheep model of pregnancy, we tested the relationship between steroid dose, and duration of exposure, and treatment efficacy...
May 9, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29720513/glucocorticoids-antenatal-corticosteroid-therapy-and-fetal-heart-maturation
#11
Emma Agnew, Jessica Ivy, Sarah Stock, Karen Chapman
Glucocorticoids are essential in mammals to mature fetal organs and tissues in order to survive after birth. Hence, antenatal glucocorticoid treatment (termed antenatal corticosteroid therapy) can be life-saving in preterm babies and is commonly used in women at risk of preterm birth. Whilst the effects of glucocorticoids on lung maturation have been well described, the effects on the fetal heart remain less clear. Experiments in mice have shown that endogenous glucocorticoid action is required to mature the fetal heart...
May 2, 2018: Journal of Molecular Endocrinology
https://www.readbyqxmd.com/read/29684311/tfam-is-required-for-maturation-of-the-fetal-and-adult-intestinal-epithelium
#12
Manasa Srivillibhuthur, Bailey N Warder, Natalie H Toke, Pooja P Shah, Qiang Feng, Nan Gao, Edward M Bonder, Michael P Verzi
During development, the embryo transitions from a metabolism favoring glycolysis to a metabolism favoring mitochondrial respiration. How metabolic shifts regulate developmental processes, or how developmental processes regulate metabolic shifts, remains unclear. To test the requirement of mitochondrial function in developing endoderm-derived tissues, we genetically inactivated the mitochondrial transcription factor, Tfam, using the Shh-Cre driver. Tfam mutants did not survive postnatally, exhibiting defects in lung development...
July 15, 2018: Developmental Biology
https://www.readbyqxmd.com/read/29681180/amniocentesis-compared-with-antenatal-corticosteroids-prior-to-early-term-scheduled-cesarean-delivery
#13
Kelly B Zafman, Nathan S Fox
OBJECTIVE: There are a variety of maternal or fetal conditions that require late preterm or early term delivery. In cases where early delivery is indicated, optimal management is not always clear. Historically, obstetricians used amniocentesis to document fetal lung maturity, but recently, many have transitioned to administration of antenatal corticosteroids (ACS). The objective of this study was to compare neonatal outcomes between women undergoing amniocentesis or receiving ACS prior to scheduled cesarean delivery (CD) less than 39 weeks...
May 6, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29671605/effects-of-budesonide-and-surfactant-in-preterm-fetal-sheep
#14
T Brett Kothe, Emily Royse, Matthew W Kemp, Augusto F Schmidt, Fabrizio Salomone, Masatoshi Saito, Haruo Usuda, Shimpei Watanabe, Gabrielle C Musk, Alan H Jobe, Noah H Hillman
BACKGROUND: Mechanical ventilation causes lung injury and systemic inflammatory responses in preterm sheep, and is associated with bronchopulmonary dysplasia (BPD) in preterm infants. Budesonide added to surfactant decreased BPD by 20% in infants. OBJECTIVE: Determine the effects of budesonide and surfactant on injury from high tidal volume (VT) ventilation in preterm lambs. METHODS: Ewes at 125 {plus minus} 1 day GA had fetal surgery to expose fetal head and chest with placental circulation intact...
April 19, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/29505915/the-influence-of-betamethasone-on-fetal-heart-rate-variability-obtained-by-non-invasive-fetal-electrocardiogram-recordings
#15
Kim M J Verdurmen, Guy J J Warmerdam, Carlijn Lempersz, Alexandra D J Hulsenboom, Joris Renckens, Jeanne P Dieleman, Rik Vullings, Judith O E H van Laar, S Guid Oei
BACKGROUND: Betamethasone is widely used to enhance fetal lung maturation in case of threatened preterm labour. Fetal heart rate variability is one of the most important parameters to assess in fetal monitoring, since it is a reliable indicator for fetal distress. AIM: To describe the effect of betamethasone on fetal heart rate variability, by applying spectral analysis on non-invasive fetal electrocardiogram recordings. STUDY DESIGN: Prospective cohort study...
April 2018: Early Human Development
https://www.readbyqxmd.com/read/29497193/use-of-modified-bilateral-electroconvulsive-therapy-during-pregnancy-a-case-series
#16
Sandeep Grover, Pooja Sikka, Shiv Sajan Saini, Neeru Sahni, Subho Chakrabarti, Devakshi Dua, Anisha Aggarwal, Anita Thakur, Shallu Dhiman, Amal Jolly, Swapnajeet Sahoo, Aseem Mehra, Aditya Somani
There is limited literature on the use of electroconvulsive therapy (ECT) during pregnancy. ECT is considered as a treatment of last resort during pregnancy. In this case series, we present the data of five patients who were administered ECT during pregnancy. The use of ECT required multidisciplinary approach involving psychiatrist, gynecologist, anesthetist and neonatologist. Two patients received ECT during the second trimester and three patients received ECT during the third trimester. In all the patients, ECT was administered by placing the patients in the left lateral position, glycopyrrolate was used for premedication, thiopentone was used for induction, and succinylcholine was used for muscle relaxation...
October 2017: Indian Journal of Psychiatry
https://www.readbyqxmd.com/read/29495225/-effects-of-prenatal-tetrandrine-treatment-on-the-expression-of-kruppel-like-factor-5-and-survivin-in-the-lung-of-congenital-diaphragmatic-hernia-rat-model-induced-by-nitrofen
#17
Q Jiang, W Y Liu, W Feng, H H Jia, F Hou
Objective: To investigate the effect of prenatal administration of tetrandrine on the expression of Kruppel-like factors 5 (KLF5) and Survivin in the lung of congenital diaphragmatic hernia (CDH) rat model. Methods: This experiment took simple random group method, 11 pregnant SD rats were randomly divided into three groups: normal control group (group NC, 3), model control group (group MC, 4), model+ tetrandrine group (group MT, 4). The rats in group MC and MT were given gavage administration with 125 mg nitrofen to induce CDH and the rats in group MT were administered with 30 mg/kg tetrandrine for three days (gestational age of 18...
February 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29460323/clinical-guidelines-for-prevention-and-management-of-preterm-birth-a-systematic-review
#18
REVIEW
N Medley, B Poljak, S Mammarella, Z Alfirevic
BACKGROUND: Clinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB). OBJECTIVES: To summarise CPG recommendations for PTB and identify areas of international consensus. SEARCH STRATEGY: In May 2017 we searched for all CPG relevant to PTB without language restrictions. SELECTION CRITERIA: CPG were eligible if the following criteria were met: (1) the guideline was published or current from June 2013; (2) the guideline recommended practices for the prevention or management of PTB relevant to our prespecified clinical questions for screening, medications or surgery and other interventions; (3) publications on methods of guideline development for eligible CPG were included to enable quality assessment...
February 20, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29436664/knockout-of-microrna%C3%A2-26a-promotes-lung-development-and-pulmonary-surfactant-synthesis
#19
Yi-Fan Sun, Qing Kan, Yang Yang, Ying-Hui Zhang, Jin-Xin Shen, Cun Zhang, Xiao-Yu Zhou
Normal formation and function of the lungs are essential for the transition of the fetus to an air‑breathing environment at birth. The synthesis of pulmonary surfactant (PS), which is produced by type II alveolar epithelial cells (AECIIs), is required for proper lung development. Previous in vitro studies have suggested that PS synthesis is regulated by microRNA (miR)‑26a in fetal rat AECIIs. The present study explored the potential role of miR‑26a in lung development and PS synthesis by using a miR‑26a‑1/miR‑26a‑2 double knockout mouse model...
April 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29408744/the-use-of-antenatal-fetal-magnetic-resonance-imaging-in-the-assessment-of-patients-at-high-risk-of-preterm-birth
#20
REVIEW
L Story, J Hutter, T Zhang, A H Shennan, M Rutherford
Preterm birth, defined as birth occurring prior to 37 weeks gestation is a common obstetric complication affecting 8% of pregnancies and is associated with significant morbidity and mortality. Infection/inflammation has been implicated in both the aetiology of preterm birth itself and associated neonatal pulmonary and neurological morbidity. Treatment options are currently limited to prolongation of the pregnancy using cervical cerclage, pessaries or progesterone or administration of drugs including steroids to promote lung maturity and neuroprotective agents such as magnesium sulphate, the timing of which are highly critical...
March 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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