A prospective and controlled in vivo study to determine if acute episodes of high glucose concentrations in the extra-embryonic celomic cavity could be related to spontaneous abortion
Objectives: In vitro preparations have provided evidence suggesting that acute and chronic exposure to very high glucose concentrations can lead to embryonic demise via disruption of the extra-celomic membranes and yolk sac. In this study, we sought to determine, in vivo, if an acute increase in extra-embryonic fluid glucose concentration could cause spontaneous abortion. Materials and methods: We employed a pregnant non-human primate model and ultrasound-guided celocentesis at 38-42 days from conception. In three control animals, partial replacement of the extra-embryonic celomic fluid was performed using normal saline containing 0.6 mg/mL of glucose. In four study animals, the extra-celomic fluid was replaced with a similar solution containing high glucose concentrations. All animals were then followed until delivery. Results: Immediately after celocentesis, the estimated celomic fluid glucose concentration in experimental animals ranged between 5 mg/mL and 83.8 mg/mL (8-140 times the physiologic glucose concentration of 0.6 mg/mL). All animals delivered live newborns at term without congenital abnormalities. Conclusions: These findings suggest that transitory increases in the extra-celomic fluid glucose concentration are not likely to cause a spontaneous abortion detectable with the sample size of our study.
Available from: Joaquin Santolaya-Forgas
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ABSTRACT: Abstract Objective: Placental abruption is a clinical term used when premature separation of the placenta from the uterine wall occurs prior to delivery of the fetus. Hypertension, substance abuse, smoking, intrauterine infection and recent trauma are risk factors for placental abruption. In this study we sought for clinical factors that increase the risk for perinatal mortality in patients admitted to the hospital with the clinical diagnosis of placental abruption. Material and Methods: We identified all placental abruption cases managed over the past 6 years at our Center. Those with singleton pregnancies and a diagnosis of abruption based on strict clinical criteria were selected. Eleven clinical variables that had potential for increasing the risk for perinatal mortality were selected, Logistic regression analysis was used to identify variables associated with perinatal death. Results: Sixty-one patients were included in the study with 16 ending in perinatal death (26.2%). Ethnicity, maternal age, gravidity, parity, use of tobacco, use of cocaine, hypertension, asthma, diabetes, hepatitis C, sickle cell disease, and abnormalities of amniotic fluid volume were not the main factors for perinatal mortality. Gestational age at delivery, birthweight and history of recent trauma were significantly associated with perinatal mortality. The perinatal mortality rate was 42% in patients that delivered prior to 30 weeks gestation compared to 15% in patients that delivered after 30 weeks gestation (p<0.05). A 3-fold increase in severe trauma was reported in the group of patients with perinatal mortality than in the group with perinatal survivors (25% vs 7% respectively, p<0.05). Conclusions: In patients admitted to hospital for placental abruption delivery prior to 30 weeks gestation and a history of abdominal trauma are independent risk factors for perinatal death.
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