**3.2.7 Other malformations (isolated cases, n=8)**

Hypoglycemia, hyperlactatemia, and a fall in the venous umbilical ketone bodies concentration are found in the case of multicystic hepatic tumour.

Likewise, in the two fetuses presenting anomalies of the extremities, the following are noted: elevated umbilical venous glycemia of 6.8 and 7.1 mmol/l, with maternal glycemia being 7.0 and 7.8 mmol/l respectively.

Lactatemia is significantly increased in the presence of a genital anomaly (left ovarian cyst).

A moderate rise in the lactate and ketone bodies UVB concentrations is observed in the case of familial recurrent chylothorax.


n = number of samples

\* value outside the normality interval for the gestational age

value increased

170 From Preconception to Postpartum

Glycemia is no different, on average, from that of the control group; however, a low umbilical venous glucose concentration, at 2.8 mmol/l, is found in one case of multicystic

Few metabolic anomalies are found, with the exception of an increase in lactatemia in 3

The metabolic balance shows a significant increase in lactatemia, with umbilical venous concentrations lying between 1.4 and 3.1 mmol/l; a small increase in the serum

Hyperlactatemia is present in 6 cases, associated with a diminution in the pO2, with lactate

This sub-group is also characterised by a decrease in the average free fatty acid concentration, and by a significant fall in cholesterolemia. UVB cholesterol is found at a lower level than that

Umbilical venous glucose and cholesterol concentrations are found to be reduced in the 2

The case of ascites with the complication of fetoplacental anasarca shows severe metabolic changes: hyperlactatemia of 5.9 mmol/l, hypoglycemia of 1.7 mmol/l, and

Hypoglycemia, hyperlactatemia, and a fall in the venous umbilical ketone bodies

Likewise, in the two fetuses presenting anomalies of the extremities, the following are noted: elevated umbilical venous glycemia of 6.8 and 7.1 mmol/l, with maternal glycemia being 7.0

of the control group in over 50% of cases, the lowest concentration being 0.93 mmol/l.

The results are within the normal range in the three cases of isolated fetal ascites.

Lactatemia is moderately increased in 4 cases, in relation with a fall in the pO2.

cases, and an increase in ketone bodies, in particular aceto-acetate, in 2 cases.

An increase in UVB free fatty acids level is also observed.

**3.2.1 Renal malformations (n=14)** 

**3.2.2 Digestive malformations (n=8)** 

**3.2.3 Cardiac malformations (n=5)** 

concentration of free fatty acids is also found.

concentrations being between 3 and 5.4 mmol/l.

cases of cystic adenomatoid malformations of the lung.

**3.2.7 Other malformations (isolated cases, n=8)** 

concentration are found in the case of multicystic hepatic tumour.

**3.2.5 Pulmonary malformations (n=3)** 

hypocholesterolemia of 1.05 mmol/l.

and 7.8 mmol/l respectively.

**3.2.6 Ascites (n=4)** 

**3.2.4 Malformations of the central nervous system (n=11)** 

renal dysplasia.

value decreased

Table 5. Metabolic parameters in the umbilical venous blood (n 2).

During its intra-uterine life, the conceptus can be exposed to various agents (physical, chemical and infectious) which may interfere with its development. However, they are responsible for only 5% of the congenital malformations observed, as around 5% are attributable to chromosome anomalies, 10 to 20% to hereditary diseases, and 70% due to indeterminate causes (Gallot, 2002). The fetus' response to an aggression depends mainly on

We have studied 53 pathological pregnancies, for which a fetal blood sampling was performed following confirmation by ultrasound of one or more fetal malformation(s), or a risk of malformation; the population studied is characterised by its heterogeneity, as

In this context, the obstetrical decision as to whether or not to continue the pregnancy,

The acid-base parameters measured allow a state of fetal distress to be diagnosed, the metabolic parameters assessed characterise the level of energy supply to fetus affected by

The fetal origin of the umbilical venous blood taken was carefully checked in our study protocol, in particular with the measurement of hCG serum concentration; reference values

The pH is not significantly different, on average, from that of the control group; however, the analysis of results showed a state of acidemia to be present in 12 fetuses, i.e. 22% of the group; this relates mainly to cases of cardiac malformation, central nervous system malformations, pulmonary malformations, one case of effusion with anasarca, and one case

The plot on a Davenport diagram of the pH and total CO2 shows that acidosis is usually mixed: gaseous and metabolic. However, gaseous acidosis is predominant as the pH is significantly correlated with the pCO2 (r = -0.866, p < 0.001), while the correlation between pH and plasma bicarbonate concentration is less significant (r = 0.402, p = 0.003). The pCO2

In the presence of effusion with fetoplacental anasarca and flooding with amniotic fluid, acidosis is of essentially metabolic origin, due to the high level of lactic acid in the amniotic

The most frequent gasometric anomaly is the fall in the partial oxygen pressure, present in over 40% of observations. The state of hypoxemia is not specific to any pathology; it is found in all types of malformation, with the exception of anomalies of the limbs and extremities.

Strictly fetal causes - anemia or cardiovascular failure - can be the cause of fetal hypoxia,

**4. Discussion** 

its level of maturity.

previously described.

of hepatic tumour.

fluid.

The fetal karyotype was found to be normal in all cases.

**4.1 Acid-base balance and gasometric data** 

is significantly increased in the event of cardiac malformations.

responsible for a deviation in the metabolism towards anaerobia.

depends principally on the prognosis associated with the malformation.

morphological anomalies, some 20% of which also presented growth restriction.

in the fetal blood were established previously for this parameter (Bon et al., 1999).

Fig. 1. Means (circles) and standard deviations (bars) of UVB constituents in pathological group and sub-groups (number of samples 5). Values are expressed as number of standard deviations (SDs) from the mean of control group. Shaded area indicates extent of reference range for the different variables.
