1/2. Placental lakes, absent umbilical artery diastolic flow and poor fetal growth in early pregnancy.Uteroplacental insufficiency is a common cause of intrauterine growth retardation in the third trimester of pregnancy. We report a case in which placental vascular lesions, absent end-diastolic frequencies in the umbilical artery and high maternal serum levels of alpha-fetoprotein and human chorionic gonadotropin were observed from the beginning of the second trimester in a patient with a history of recurrent first- and second-trimester miscarriages. Fetal growth started to slow down from 14 weeks of gestation and no end-diastolic phase was found in the umbilical artery until 18 weeks of gestation, when the pregnancy was terminated. In apparently healthy women with or without a history of fetal death during the first half of pregnancy, the discovery of placental vascular lesions together with a high resistance to blood flow in the umbilical circulation should prompt early antepartum surveillance.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/2. A novel approach to the management of pregnancies complicated by uteroplacental insufficiency and previous stillbirth.To our knowledge, this is the first time that a combination of aspirin and glyceryl trinitrate (GTN) has been used in the prophylaxis of preeclampsia and fetal growth retardation, and their use associated with not only Doppler screening of the uterine arteries but also regular Doppler follow-up of the fetal arterial and venous circulation. Whilst future trials are needed to prove whether screening, prophylaxis and Doppler management are individually beneficial, we propose that this combination of management strategies contributed to a good outcome in the cases described. Furthermore, randomized trials are required to determine the safety and efficacy of prophylactic low-dose aspirin combined with GTN treatment in pregnancies affected by an impaired uteroplacental circulation.- - - - - - - - - - ranking = 2keywords = circulation (Clic here for more details about this article) |