Fetal development

Latinoamérica reporta en las gestantes un consumo de alcohol del 44%, cigarrillo 51.8%, anfetaminas 8.3%, cocaína 2.5% y marihuana 2%. Las gestantes consumidoras representan un problema para las instituciones prestadoras de salud que exige intervenciones intersectoriales e interdisciplinarias por las consecuencias físicas, psicológicas, familiares y sociales que conlleva para la madre, el neonato y el infante. En esta revisión se describen las complicaciones físicas y conductuales en la madre, el feto y el neonato, que surgen por el consumo de cocaína y sus derivados durante la gestación. Se realizó una revisión narrativa a partir de la búsqueda de información científica indexada en las bases de datos Pubmed, Lilacs, Ovid, Science Direct entre el 2000 y el 2015, se utilizaron palabras clave con el fin de realizar una búsqueda estandarizada de información y se incluyeron artículos como productos de investigaciones, revisiones sistemáticas, metaanálisis. Las gestantes consumidoras de cocaína entrañan un factor de riesgo para la salud pública, con consecuencias físicas, psicológicas, familiares, sociales para la madre, el neonato y el infante, tales como hipertensión gestacional, desprendimiento de placenta, retardo del crecimiento intrauterino y síndrome de abstinencia neonatal. Es necesario que los profesionales de salud, las instituciones hospitalarias y Secretarías locales de salud elaboren, adapten y adopten algún protocolo de notificación, manejo y seguimiento a las madres consumidoras y de sus hijos para promover hábitos saludables, prevención de complicaciones obstétricas, neonatales y seguimiento de repercusiones en el desarrollo y crecimiento de los hijos.
ABSTRACT
Latin America reported the following data regarding substance abuse in pregnant women: 44% alcohol, 51.8% tobacco, 8.3% amphetamines, 2.5% cocaine and 2% cannabis. Pregnant women using these substances are a risk factor for health institutions due to the physical, psychological, social, and family consequences for the mother and the
newborn infant. Thus, intersectoral and interdisciplinary interventions are necessary to treat this problem. This review describes the physical and behavioral complications in the mother, fetus, and neonate as a result of the use of cocaine and its derivatives during pregnancy. A narrative review was performed by means of a search of journals indexed in PubMed, Lilacs, Ovid, Science Direct from 2000 to 2015. Keywords were used in order to perform a standardized literature search, and data from research articles, systematic reviews, meta-analyses were included. Pregnant consumers of cocaine involve a risk factor for public health due to the physical, psychological, family, and social consequences
for the mother, the newborn, and infant, such as high blood pressure, abruption, intrauterine growth retardation, and neonatal abstinence syndrome. It is necessary for local health departments to develop, adopt, and adapt reporting, management, and monitoring protocols for consuming mothers and their children in order to promote healthy habits, prevention of obstetrics and neonatal complications and to monitor the impact on growth and development in children.
RESUMO
Latino-américa reporta nas gestantes um consumo de álcool de 44%, cigarro 51.8%, anfetaminas 8.3%, cocaína 2.5% e maconha 2%. As gestantes consumidoras representam um problema para as instituições prestadoras de saúde que exige intervenções inter-setoriais e interdisciplinares pelas consequências físicas, psicológicas, familiares e sociais que implica para a mãe, o neonato e o infante. Nesta revisão se descrevem as complicações físicas e de condutas na mãe, o feto e o neonato, que surgem pelo consumo de cocaína e seus derivados durante a gestação. Se realizou uma revisão narrativa a partir da busca
de informação científica indexada nas bases de dados Pubmed, Lilacs, Ovid, Science Direct entre 2000 e 2015, se utilizaram palavras chave com o fim de realizar uma busca padrão de informação e se incluíram artigos como produtos de investigações, revisões sistemáticas, meta-análise. As gestantes consumidoras de cocaína entranham um fator
de risco para a saúde pública, com consequências físicas, psicológicas, familiares, sociais para a mãe, o neonato e o infante, tais como hipertensão gestacional, desprendimento de placenta, retardo do crescimento intrauterino e síndrome de abstinência neonatal. É necessário que os profissionais de saúde, as instituições hospitalares e Secretarias locais de saúde elaborem, adaptem e adotem algum protocolo de notificação, manejo e seguimento às mães consumidoras e de seus filhos para promover hábitos saudáveis, prevenção de complicações obstétricas, neonatais e seguimento de repercussões no
desenvolvimento e crescimento dos filhos.

Harmonization of terminology in developmental toxicology: The quest for a more precise description and a harmonized classification of fetal observations ଝ a r t i c l e i n f o a b s t r a c t Harmonization of terminology in developmental toxicology is a prerequisite to ensure a better risk assessment of chemicals. As part of an international effort of the International Programme on Chemical Safety (IPCS) to harmonize terminology in developmental toxicology, workshops have taken place in Berlin since 1995. This publication reports the main outcomes of the Fifth and Sixth Berlin Workshops held in 2005 and 2007, respectively. The objective of the Fifth workshop was to discuss a draft international proposal for updating the glossary of descriptive terms for fetal abnormalities put forward by Wise et al. [Wise LD, et al. Terminology of developmental abnormalities in common laboratory mammals (version 1). Teratology 1997;55:249-92].

Somatic nuclear transfer (NT) in cattle is often accompanied by severe placental anomalies, hypertrophy, and hydrallantois, which induce a high rate of pregnancy losses throughout gestation. These placental deficits are associated with an abnormal increase of the maternal plasma levels of pregnancy-associated glycoprotein (PAG), produced by the trophoblastic binucleate cells (BNC) of the placenta. The objective of this study was to analyze the origin of the abnormally elevated PAG concentrations in the peripheral circulation of NT recipients during pathological pregnancies. Concentrations of PAG were measured both in maternal blood, in chorionic and cotyledonary tissular extracts from control recipients (after artificial insemination, AI, or in vitro fertilization, IVF) and clone recipients on Day 32, Day 62, and during the third trimester of gestation. Three different radioimmunoassay (RIA) systems were used. One homologous RIA for PSP60, similar to bovine PAG-1 (PAG 67kDa ), and two heterologous RIA with PAG 67kDa as standard and tracer, and antisera anti-caprine PAG (AS#706 and AS#708). Circulating and tissular concentrations of bovine placental lactogen (bPL), a glycoprotein also produced by BNC, were determined by RIA at the same stages. The number of BNC in the placental tissues was determined by cell counting after immunostaining with anti PSP60 antibody on tissue sections from control and NT pregnancies. Maternal plasma PAG concentrations were not different among groups on Day 32, but they were significantly higher in NT than in control pregnancies on Day 62 with all three RIA and during the third trimester with two RIA (RIA-PSP60 and RIA with AS#708). Circulating bPL concentrations were undetectable on Days 32 and 62 and were not different in the third trimester between NT and control pregnancies. Tissular amounts of PAG on total proteins were not different between the two groups at all stages studied. No difference was determined in the percentage of PSP60-positive BNC in placental tissues between controls and NT on Day 62 and during the third trimester of pregnancy. Western blots of tissular extracts from placenta showed no major molecular weight changes of PAG in NT pregnancies compared to controls. No differences in maternal circulation concentrations or tissular content of bPL were observed between control and NT pregnancies. In conclusion, the specific increase of PAG in maternal plasma concentrations during abnormal NT pregnancies do not result from a higher proportion of BNC, or an increased protein expression of PAG and could be due to changes in the composition of terminal glycosylation which result into a clearance decrease of PAG from the circulation.

The morphology of the anterior and posterior internal vertebral venous plexus (IVVP) in human fetuses between 21-25 weeks of gestational age is described. The results are compared to the findings of a previous morphological study of the IVVP in the aged. The morphological pattern of the anterior IVVP in the fetus is very similar with the anterior IVVP in the aged human. In contrast, the posterior IVVP in the fetus lacks the prominent transverse bridging veins that are present in the aged lower thoracic and the lumbar posterior IVVP. The background of these morphological differences is unclear. Maybe the thoracolumbar part of the posterior IVVP is subject to ''developmental delay,'' or the observed differences in the aged may result from functional and age-related factors that trigger this part of the vertebral venous system during (erect) life. The observed age related morphological differences of the posterior IVVP support the concept of the venous origin of the spontaneous spinal epidural hematoma (SSEH). Clin. Anat. 18:000-000, 2005. V V C 2005 Wiley-Liss, Inc.

Fetal movements in the uterus are a natural part of development and are known to play an important role in normal musculoskeletal development. However, very little is known about the biomechanical stimuli that arise during movements in utero, despite these stimuli being crucial to normal bone and joint formation. Therefore, the objective of this study was to create a series of computational steps by which the forces generated during a kick in utero could be predicted from clinically observed fetal movements using novel cine-MRI data of three fetuses, aged 20–22 weeks. A custom tracking software was designed to characterize the movements of joints in utero, and average uterus deflection of 6.95±0.41 mm due to kicking was calculated. These observed displacements provided boundary conditions for a finite element model of the uterine environment, predicting an average reaction force of 0.52±0.15 N generated by a kick against the uterine wall. Finally, these data were applied as inputs for a musculoskeletal model of a fetal kick, resulting in predicted maximum forces in the muscles surrounding the hip joint of approximately 8 N, while higher maximum forces of approximately 21 N were predicted for the muscles surrounding the knee joint. This study provides a novel insight into the closed mechanical environment of the uterus, with an innovative method allowing elucidation of the biomechanical interaction of the developing fetus with its surroundings.

Aim: To discuss corporeal support of the brain-dead pregnant woman and to critically examine important aspects of this complex situation that remain as yet unexplored. Background: When brain death of the woman occurs during pregnancy, the fetus may be kept inside the corporeally supported body for prolonged periods to enable continued fetal growth and development. This has been increasingly reported in medical literature since 1982 and has received considerable media attention in the past few years. Implications for midwives and nurses: Sophisticated advances in medical technologies have altered the boundaries of conception and birth, life and death, Western biomedical and cultural conceptions of women and their bodies, fetal personhood, fetal rights and fetal patienthood, profoundly influencing maternal behaviors, medical decisions and the treatment of pregnant women. This is especially so in the rare, but fraught instance of brain death of the pregnant woman, where nurses and midwives working in High Dependency Care units undertake the daily care of the corporeally supported body that holds a living fetus within it. This discussion enables critical and ethical conversation around the complexities of developing appropriate discourse concerning the woman who suffers brain death during pregnancy and considers the complexities for nurses and midwives caring for the Woman/body/fetus in this context. The potential impact on the fetus of growing and developing inside a 'dead' body is examined, and the absence in the literature of long-term follow up of infants gestated thus is questioned. Problem Case studies in the medical literature reporting prolonged corporeal support of the body of the brain dead (BD) pregnant woman demonstrate the considerable complexity of care, use of resources and cost involved in aiming for the birth of a live viable infant, yet aside from ethical debate, little is written about this fraught and complex situation. What is already known The bodies of BD pregnant women have been corporeally supported since 1982 for prolonged periods (2 days– 107 days) solely to enable fetal growth and development. With 37 cases reported to date, literature has either focussed on the ethics of this act, or detailed the technical aspects and complications of high dependency care used to stabilise a BD body to gestate a fetus with the aim of achieving the birth of a live and viable infant. What this paper adds This article raises compelling questions for further consideration around BD in pregnancy and points to new research areas for exploration of this complex and fraught context. These include: the lack of appropriate terminology/dis-course used to describe the woman/body/fetus, the need for qualitative research that examines nurses' and midwives' experiences of caring for the BD body and the fetus, discussion of potential consequences for fetal growth and development inside a dead body, and the need for detailed long-term follow-up of infants gestated thus.