Mitral valve prolapse in pregnancy.
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Female↗
Biomedical subjects
B Gonik
Publications and source records attributed to B Gonik.
Prostacyclin release and cytotoxicity of peritoneal cells are inversely related in pregnant and non-pregnant mice infected with herpes simplex virus.
Cytotoxicity of peritoneal cells in a HSV-infected murine model is attenuated in late pregnancy. Prostacyclin (PGI2) is elevated at this time in reproductive tissues and has been implicated in the regulation of the immune response. The purpose of this study was to estimate PGI2 in the peritoneal wash or culture supernatants of peritoneal cells obtained from uninfected and HSV-infected pregnant and virgin mice using a radioimmunoassay for 6-keto-prostaglandin F1 alpha. The peritoneal wash of uninfected pregnant and virgin mice contained high levels of 6-keto-PGF1 alpha, 505 +/- 51 pg/100 microliters, (mean +/- S.E., n = 15), and 200 +/- 19 pg/100 microliters, (n = 30), ad did peritoneal effector and target cell cultures (1,159 +/- 118 pg/100 microliters, n = 6, and 1,057 +/- 207 pg/100 microliters, n = 7), respectively. HSV-infection induced in vitro cytotoxicity and suppressed the release of 6-keto-PGF 1 alpha (r = -0.897, P less than 0.05, n = 18). Its concentration was significantly higher (14-fold, P less than .05) in the peritoneal wash, but not in the cell culture, of pregnant (212 +/- 29 pg/100 microliters, n = 19) as compared to virgin mice (18.5 +/- 3.4 pg/100 microliters, n = 27). The levels of 6-keto-PGF1 alpha were inversely correlated (P less than .05) with the combined effects of HSV-infection and cytotoxicity.
6-Ketoprostaglandin F1 alpha↗
Clinical evaluation of a new herpes simplex virus ELISA: a rapid diagnostic test for herpes simplex virus.
A new sensitive and rapid enzyme-linked immunosorbent assay (ELISA) test (Du Pont HERPCHEK) for the detection of herpes simplex virus (HSV) antigen was evaluated. A total of 563 clinical samples collected from patients attending obstetrics and gynecology and sexually transmitted disease clinics in two geographic locations were tested by ELISA, and the results were compared with virus isolation in cell culture. The sensitivity and specificity of the ELISA were 97.5 and 98.6%, respectively. When a confirmatory blocking ELISA was used to demonstrate the presence of HSV antigen in culture-negative but ELISA-positive samples, the specificity of the assay increased to 100%. The assay is easy to perform and may be used to diagnose HSV infection rapidly without the need for culture confirmation.
Adult↗
Objective evaluation of the shoulder dystocia phenomenon: effect of maternal pelvic orientation on force reduction.
This report describes the use of maternal pelvic and fetal models, a tactile sensing glove, and a microcomputer data acquisition system to measure fetal shoulder extraction forces. Sixty-nine experiments were carried out in the laboratory setting to simulate vaginal delivery of the aftercoming fetal shoulders. The tests were conducted using a variety of fetal biclavicular diameters (10-13 cm) and maternal pelvic angle positions (McRoberts, 10 degrees; lithotomy, 25 degrees). When comparing lithotomy versus McRoberts positioning, there was a consistent reduction in force needed to extract the fetal shoulders with the latter maneuver. No simulated clavicles were fractured during shoulder delivery until a biclavicular diameter of 12.0 cm was reached. At this point, five of eight clavicles (63%) were fractured at 25 degrees and zero of seven (0%) were fractured at 10 degrees (P less than .025). For all 69 experiments, fetal neck extension readings were consistently lower than the total traction forces recorded by the tactile sensing glove. This suggests that, in addition to the axially oriented fetal neck forces, a component of flexion (lateral force) was also present. As the difficulty of shoulder delivery increased, the impact of these inadvertent flexion forces became most pronounced at the level of the brachial plexus. This is the first study to measure shoulder extraction forces reproducibly using a laboratory model for shoulder dystocia and to describe the pathophysiology of specific neonatal injuries from a force perspective. The results document objectively that McRoberts positioning reduces shoulder extraction forces, brachial plexus stretching, and the incidence of clavicular fracture.
Delivery, Obstetric↗
Central hemodynamic alterations in amniotic fluid embolism.
Amniotic fluid embolism is an uncommon but devastating obstetric emergency. We report hemodynamic data derived from pulmonary artery catheterization in four previously unpublished cases of amniotic fluid embolism syndrome. These findings confirm a recently published reinterpretation of the central hemodynamics of this condition.
Blood Pressure↗
Intramuscular versus intravenous ritodrine hydrochloride for preterm labor management.
A prospective, interinstitutional comparative trial was undertaken to examine the efficacy, safety, and pharmacodynamics of different administration routes of ritodrine hydrochloride for the management of preterm labor. Forty-five subjects between 20 and 36 weeks' gestation received either intravenous (n = 24) or intramuscular (n = 21) therapy. Successful tocolysis occurred in 14 of 21 (67%) patients in the group treated intramuscularly and in 16 of 24 (67%) patients in the group treated intravenously. A greater mean dose (8.6 versus 3.3 mg/hour) and a higher mean serum concentration (38.9 versus 24.7 micrograms/ml) were needed to achieve successful tocolysis in the intravenous group as compared with the intramuscular group. Patients who did not respond to tocolytic therapy in both groups had levels of ritodrine in the blood either equivalent to or greater than those of subjects who were successfully treated. Analysis of ritodrine levels in the successfully treated intramuscular group demonstrated significant differences in blood levels depending on muscle group used. These differences can be at least partially attributed to higher mean doses administered to patients receiving vastus lateralis injections as compared with those receiving gluteal muscle injections. The results suggest that intramuscular administration of ritodrine is an efficacious and safe route of drug delivery. Additional studies are needed to better define dose-response curves for the intramuscular administration of ritodrine hydrochloride.
Buttocks↗
Septic shock during pregnancy.
A multiinstitutional review of 10 pregnancies complicated by septic shock was undertaken to identify the clinical characteristics and hemodynamic alterations associated with this condition. Prolonged rupture of membranes with the subsequent development of chorioamnionitis or postpartum endometritis were risk factors that commonly preceded the diagnosis of septic shock. The majority of septic shock cases occurred during the puerperium. There were two maternal deaths in this selected series. Associated complications included pulmonary edema, adult respiratory distress syndrome, disseminated intravascular coagulation, pulmonary emboli, and cardiac arrest. The primary hemodynamic derangements were reduced systemic vascular resistance with depressed myocardial function. The mean initial systemic vascular resistance index in eight surviving women was 885 +/- 253 dyne.sec/cm5.m2. Despite an overall presenting cardiac index of 4.20 +/- 2.01 L/min/m2, five patients (50%) had evidence of myocardial depression based on analysis of their left ventricular function curves. Mean arterial pressure, systemic vascular resistance, and left ventricular stroke work index all showed significant improvement after therapy. A hemodynamic algorithm based on volume therapy, inotropic agents, and peripheral vasoconstrictors is offered. This therapeutic approach is designed to optimize cardiac performance and maintenance of organ perfusion in the critically ill patient with septic hypotension during pregnancy.
Blood Pressure↗
Tactile sensory monitoring of clinician-applied forces during delivery of newborns.
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Birth Injuries↗
Natural killer cytotoxicity and antibody-dependent cell cytotoxicity to herpes simplex virus-infected target cells in murine pregnancy.
In vitro natural killer cytotoxicity (NKC) and antibody-dependent cell cytotoxicity (ADCC) activity against herpes simplex virus (HSV)-infected cells were evaluated in a pregnant murine model (C57Bl6 inbred strain). Virgin (n = 16) and pregnant (late gestation) mice (n = 15) were infected intraperitoneally with HSV, type 1. After 18 hr, a 0.5-ml aliquot of the peritoneal wash was frozen for virus plaque assay, and the cells were cultured in the 51chromium release assay for NKC and ADCC. %NKC (mean +/- S.E.) to HSV-infected targets was significantly suppressed (P less than 0.05) in pregnant mice, 10.3% +/- 1.9, compared to that of virgin mice, 32.5% +/- 2.5. This suppression was abrogated with HSV-specific antisera (%ADCC); 53.9% +/- 4.4 (pregnant) compared to 49.1% +/- 3.6 (virgin). The diminished NKC activity in pregnant mice was reflected in an increased mean number of virus particles in the peritoneal wash, 266 +/- 66 PFU/ml, compared to 38 +/- 11 PFU/ml in virgin mice (P less than 0.05). We concluded that NKC, but not ADCC, to HSV-infected targets was suppressed and that HSV elimination was impaired in pregnant mice.
Animals↗
Urinary diagnostic indices in preeclampsia-associated oliguria: correlation with invasive hemodynamic monitoring.
Seven oliguric women with preeclampsia were identified among patients admitted for obstetric care at Jefferson Davis or Hermann Hospitals in Houston, Texas. Urinary diagnostic indices (including urine-to-plasma ratios of creatinine, urea nitrogen, and osmolality) were generally consistent with a prerenal etiology for the observed oliguria. Conversely, invasive hemodynamic monitoring revealed a volume replete state in five of seven preeclamptic women studied. All patients were observed to have markedly elevated urinary sodium concentrations. The transient oliguria observed in these patients spontaneously resolved without diuretic or hyperosmolar agents. We conclude that oliguria is a poor index of volume status in preeclamptic women. Urinary diagnostic indices may also be misleading if used to guide fluid management in these patients. Finally, the clinical significance and therapeutic alternatives relating to preeclampsia-associated oliguria are discussed.
Adult↗
Growth hormone, somatomedin C, and nonsuppressible insulin-like activity levels compared in premature, small, average birth weight, and large infants.
We have investigated the relationship between growth hormone, somatomedin C, nonsuppressible insulin-like activity, weight, gestational age, and 1-minute Apgar score in newborn infants. The 153 infants were categorized as small for gestational age (n = 19), average for gestational age (n = 59), large for gestational age (n = 60), and premature (gestational age at birth, 36 weeks or less (n = 15). Our study showed that (1) growth hormone levels were elevated in premature infants and correlated with Apgar scores and birth weights; (2) somatomedin C and nonsuppressible insulin-like activity levels were significantly lower in premature than in term infants; and (3) the birth weight of all infants studied had a significant overall effect on both somatomedin C and nonsuppressible insulin-like activity levels, suggesting that these factors may be involved in fetal growth. However, because in small for gestational age infants somatomedin C and nonsuppressible insulin-like activity were similar to levels in average for gestational age infants, it is suggested that other factors may inhibit fetal growth.
Apgar Score↗
The use of urinary diagnostic indices in pre-eclampsia-associated oliguria.
A case is presented of severe pregnancy-induced hypertension that was complicated by oliguria and managed with the aid of a pulmonary artery catheter. This case illustrates that urinary diagnostic indices may be unreliable in predicting the etiology of oliguria. Although urinary diagnostic tests are advocated routinely as reliable in the nonobstetric literature, possible misinterpretation of these values in severe pre-eclampsia with oliguria may require confirmation with hemodynamic data obtained from a pulmonary artery catheter.
Adult↗
Natural killer cell cytotoxicity and antibody-dependent cellular cytotoxicity to herpes simplex virus-infected cells in human pregnancy.
Natural killer cell (NKC) cytotoxicity and antibody-dependent cellular cytotoxicity (ADCC) represent the ability of human leukocyte effector cells to destroy target cells in the absence and presence of antibody, respectively. Since these immune systems play a pivotal role in the body's primary lines of defense against a variety of pathogens including herpes simplex virus (HSV), a study was undertaken to evaluate the influence of pregnancy on these systems. Eleven uncomplicated gravidas were followed serially through each trimester and compared to 11 nonpregnant female controls. Mononuclear cells were acquired by Ficoll-Hypaque centrifugation of heparinized blood. Chang liver cells infected with HSV-I were utilized as target cells in a 51Cr release assay. Mean NKC values in the pregnant patients were uniformly lower than in the controls. No similar decreases in ADCC activity were observed in a comparison between the two study populations. These data support previous observations suggesting that pregnancy represents a relatively immunocompromised state. Differences apparently exist between NKC and ADCC effector cell populations with regard to the influence of pregnancy. Although these physiologic alterations in immunoregulation may help support the fetoplacental allograph, detrimental conditions may exist regarding susceptibility to various pathogens such as HSV.
Antibody-Dependent Cell Cytotoxicity↗
Pelvic inflammatory disease in the adolescent.
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Adolescent↗
Preterm labor: its diagnosis and management.
Preterm labor and delivery remain a significant problem in contemporary obstetric practice. Although the exact cause remains unclear, it is most likely to be multifactorial in nature. No satisfactory screening tool or marker currently exists to firmly establish the diagnosis of impending labor. However, epidemiologic and historical variables associated with preterm delivery show some promise in this regard and are currently being evaluated in preterm prevention programs. Appropriate management of preterm labor mandates early recognition of subtle signs and symptoms; successful therapy is dependent on this issue. The approach to the clinical management of the patient in preterm labor used at our institution is described. Therapy with beta-adrenergic receptor agonists is currently the recommended pharmacologic treatment of this disorder. A review of other tocolytic agents and their usefulness in the management of preterm labor are presented.
Adolescent↗
Enhancement of human neonatal natural killer cytotoxicity to herpes simplex virus with use of recombinant human interferons: lack of neonatal response to gamma interferon.
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Adult↗
Pharmacokinetics of cefoperazone in the parturient.
Limited pharmacokinetic data for cefoperazone are available from the parturient. Because cefoperazone has a dual excretory pattern, primarily via the biliary system and secondarily via the kidney, pregnancy-induced physiologic alterations can influence its deposition and clearance. Twelve term parturients receiving cefoperazone prophylaxis after cesarean section were selected for study. After 2 g of cefoperazone was administered for 1 h intravenously, serial blood samples were assayed by high-pressure liquid chromatography. Plasma protein binding of cefoperazone was studied in vitro. The mean peak cefoperazone concentration +/- standard deviation was 169.9 +/- 60.4 micrograms/ml. The mean half-life was 152 min. Total serum clearance was 80.8 +/- 30.8 ml/min. The steady-state volume of distribution was 14.2 +/- 6.0 liters. All subjects had detectable trough levels at the end of the dosage interval, with a mean value of 6.5 +/- 5.2 micrograms/ml. Protein binding of cefoperazone for parturients was 74.3 +/- 10.9%, compared with 87.7 +/- 3.2% in nonpregnant controls (P less than 0.05). These data suggest that cefoperazone deposition can be greatly influenced by pregnancy. However, unlike several other new antimicrobial agents whose excretions are mainly renal, the cefoperazone half-life and thus trough concentration for the parturient more closely resemble that for the nonpregnant subject.
Adult↗
Septic shock in obstetrics.
Septic shock in the obstetric population remains an uncommon yet potentially lethal complication of infection. Effective therapy mandates early recognition and aggressive intervention. Although numerous similarities exist in comparison to the nonobstetric patient, differences in potential pathogens and alterations in physiologic parameters should be kept in mind. In addition, the antepartum subject carries with her another potentially viable human being who deserves consideration. Optimal therapy should be directed at reestablishing an effective intravascular volume, maintaining adequate oxygen delivery to peripheral and central tissues, and the initiation of appropriate broad-spectrum antimicrobial agents to eradicate the causative pathogens.
Anti-Bacterial Agents↗