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Biomedical subjects

C H Rodeck

Publications and source records attributed to C H Rodeck.

317 records · Page 18Linked to original sources
PubMedDate not supplied

Vibroacoustic stimulation is not associated with sudden fetal catecholamine release.

The safety of vibroacoustic stimulation (VAS), which produces marked changes in fetal heart rate, movements and behavioural state, remains unclear. In order to determine whether VAS is associated with catecholamine release, we measured plasma noradrenaline and adrenaline in 13 appropriately grown normoxaemic fetuses between 28 and 40 weeks gestation immediately before and 60 and 75 s after VAS. Over this time interval, VAS is known to increase fetal heart rate. There was no significant change in either noradrenaline (median change = +0.06 ng/ml, P = 0.26) or adrenaline levels (median change = +0.03 ng/ml, P = 0.4). This study suggests that sympathoadrenal activation is not part of the fetal response to VAS. These findings do not support the recent suggestion that VAS may be deleterious to the fetus by provoking sudden release of catecholamines.

Acoustic Stimulation↗
PubMedDate not supplied

Percutaneous ultrasound-guided injection of the trachea in fetal sheep: a novel technique to target the fetal airways.

OBJECTIVE: To access the fetal airways percutaneously using ultrasound-guided injection of the fetal trachea in sheep. METHODS: Adenoviral gene therapy vectors and transduction-enhancing agents were delivered to the trachea via a needle inserted through the thorax or the neck of late-gestation (0.9 term, n = 3) or mid-gestation (0.5-0.8 term, n = 18) fetal sheep using ultrasound guidance. RESULTS: Injection of the trachea in the fetal thorax was successful in 16 out of 18 fetuses and achieved at the first attempt in 9 fetuses within 12 min [mean 7 min and 31 s +/- (SD) 3 min and 4 s]. Survival was 100%. Injecting the trachea in the neck was less successful. CONCLUSIONS: The fetal trachea of the sheep can be safely accessed by percutaneous ultrasound-guided injection to deliver vectors directly to the fetal airways for gene therapy. It may also enable tracheal occlusion for the antenatal treatment of congenital diaphragmatic hernia without the need for endoscopy or open surgery.

Adenoviridae↗
PubMedDate not supplied

Carbohydrate metabolism in fetuses with Rh alloimmunization.

Glucose, insulin, glucagon and fructosamine were measured in the plasma of control (n = 34) and of Rh fetuses (n = 22) before the first and subsequent transfusion. Prior to treatment, Rh fetuses, compared to controls, had raised concentrations of glucose (p = 0.01), glucagon (p = 0.04) and fructosamine (p = 0.004). Fetal insulin levels were not significantly different. Before subsequent transfusion, despite correction of anemia, Rh fetuses were clearly hyperinsulinemic even after correction for gestation (p = 0.002) and had low glucagon concentrations (p = 0.01) when compared with values at the first transfusion. This metabolic milieu appears similar to that of fetuses of diabetic mothers which have increased plasma glucose and insulin during most of the last third of gestation.

Blood Glucose↗
PubMedDate not supplied

Successful treatment of fetal cardiac arrest by left ventricular exchange transfusion.

A 36-year-old pregnant woman with anti-HPA1a antibodies underwent six fetal platelet concentrate transfusions. During the second, at 28 weeks' gestation, fetal asystole occurred in association with a post-transfusion platelet count of 813 x 10(9)/l. Asystole was reversed by an intracardiac partial exchange transfusion of normal saline for fetal blood, simultaneously reducing fetal plasma viscosity and enabling re-commencement of the fetal circulation.

Adult↗
PubMedDate not supplied

Survival in non-immune hydrops fetalis without malformation or chromosomal abnormalities after invasive treatment.

The aim of the study was to determine the outcome of fetuses with non-immune hydrops (NIH) following modern invasive investigation and therapy. This prospectively planned observational study involved 23 women with singleton fetuses in whom a diagnosis of NIH was made in our fetal medicine unit in 1 year. After investigation and counselling 15 of the 23 women opted for termination of pregnancy (10 chromosomal and 5 structural abnormalities) and there was 1 intrauterine fetal death before therapy was attempted. One case with diaphragmatic hernia was treated with shunting which successfully reversed the hydrops, the pregnancy continued to term, the malformation was surgically corrected but the neonate died from pulmonary hypoplasia. In the remaining 6 cases structural and chromosomal abnormalities were excluded. One had amniotic fluid drainage for polyhydramnios but despite this delivered at 30 weeks' gestation and the neonate died on day 5. The remaining 5 cases had fetal therapy between 22 and 32 weeks' gestation (4 shunt insertions, 1 blood transfusion) and in all the hydrops reversed and the pregnancy continued to at least 35 weeks' gestation. All 5 neonates were discharged from hospital alive and well. Fetal therapy in cases of NIH with normal structure and karyotype was associated with a very good outcome. Giving a uniform poor prognosis is no longer justified because if other fetal abnormalities are excluded, in utero treatment, reversal of the hydrops and survival are often possible. We recommend urgent referral of these cases to a fetal medicine unit.

Adolescent↗
PubMedDate not supplied

Internalization of pleuroamniotic shunt causing neonatal demise.

Internalization of a pleuroamniotic shunt previously has not been associated with significant fetal or neonatal problems. We report a case in whom the shunt internalized and compressed the lung hilum. A review of the complications of antenatal pleuroamniotic shunting is also presented.

Adult↗
PubMedDate not supplied

Three-dimensional magnetic resonance imaging of the postmortem fetal heart.

Five postmortem fetuses were scanned by magnetic resonance (MR) imaging. Of eight three-dimensional (3D) data sets reconstructed on an MGI workstation, five sets demonstrated detailed 3D fetal cardiac structures, and one depicted clear information regarding the disposition and compression of the heart and lungs in diaphragmatic hernia. This study has shown the potential of 3D MR imaging in support of postmortem examination and for interactive visual teaching of the fetal cardiac structures. The new technique may eventually be of significance in prenatal detection of cardiac abnormalities with the development of fast real-time MR imaging.

Aorta↗