**1. Introduction**

160 From Preconception to Postpartum

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Congenital malformations can be defined as structural anomalies arising during the periods of embryogenesis and organogenesis (Roux, 2001).

However, during the fetal period, various external factors of infectious, vascular or toxic origin can also interfere with the development of previously formed structures (Gallot, 2002).

The causes of malformations are either endogenous (genetic) or exogenous, and there are probably interactions between the genetic and the exogenous factors (Roux, 2001). The precise cause of the malformation process, however, is most often unknown and the underlying physiopathological mechanisms are not elucidated (Brent, 1986).

The biology of fetal blood has been widely described in cases of isolated intra-uterine growth restriction (Cox et al., 1988; Economides et al., 1989; Weiner et al., 1989; Pardi et al., 1989; Roberts et al., 1999) but few studies have been conducted in fetuses with morphological anomalies (Bocconi, 1997; Lallata, 1998), and their biochemical profile remains little known.

We present the results of a study on 53 pregnancies with the complication of congenital malformations of variable expression and severity, and during which a fetal blood sampling was performed for fetal karyotyping. The gestational age ranged from 21 to 38 weeks of amenorrhea (average age: 28.5 ±4.45 WA). The karyotype proved to be normal for all the fetuses in this group.

The acid-base balance (pH, pCO2, bicarbonate concentration) and the oxygenation level of the fetuses (pO2, SaO2) were evaluated on umbilical venous blood (UVB), taken by cordocentesis. At the same time, the glucose, lactate, free fatty acid, aceto-acetate, betahydroxybutyrate and cholesterol concentrations were measured, being essential biochemical constituents in relation to the nutritional status.

 Renal malformations 14 cases Obstructive uropathy, Prune Belly syndrome 1 case Unilateral obstructive uropathy 4 cases Bilateral obstructive uropathy 3 cases Cystic dysplasia (just 1 cyst) 1 case Unilateral multi-cystic renal dysplasia 3 cases Bilateral multi-cystic renal dysplasia 2 cases Digestive malformations 8 cases Stenosis of the small intestine with hydramnios 4 cases Stenosis of the oesophagus with hydramnios 2 cases Other digestive malformations 2 cases Cardiac malformations 5 cases Complete atrioventricular canal 1 case Interventricular communication 1 case Transposition of the major vessels 1 case

Transposition of the large vessels, interventricular communication,

Table 1. Pathological group. Fetal anomalies observed.

interauricular communication 1 case Abnormal pulmonary venous return 1 case Malformations of the central nervous system 11 cases Hydrocephaly 4 cases Hydrocephaly and microcephaly 1 case Hydrocephaly and agenesis of the corpus callosum 1 case Microcephaly 2 cases Porencephalic cyst 1 case Spina bifida 2 cases Pulmonary malformations 3 cases Type 1 cystic adenomatoid malformation 1 case Type 2 cystic adenomatoid malformation 1 case Pulmonary hypoplasia with amniotic band syndrome 1 case Ascites 4 cases Isolated fetal ascites 3 cases Ascites with fetoplacental anasarca 1 case Multicystic hepatic tumour 1 case Limb reduction anomaly 1 case Anomaly of the extremities (club foot, club hand) 2 cases Genital anomaly (left ovarian cyst) 1 case Polymalformative syndrome 1 case Familial recurrent chylothorax 1 case Microphthalmia 1 case

The aim of the work was to identify cases of fetal suffering and / or malnutrition, and to define the blood chemistry profile of this fetal population.

The results were compared with those of a control group of 73 healthy fetuses, with an average gestational age of 26 ± 5.7 weeks of amenorrhea, the results of which have already been published (Bon et al., 1997, 2007).
