Biomedical subjects
Publications and source records attributed to E L Capeless.
Lipoatrophic diabetes mellitus is a rare syndrome characterized by lipoatrophy and insulin-resistant diabetes mellitus. Partial lipodystrophy without clinical diabetes mellitus has been associated with intrauterine growth retardation and fetal death. We report successful pregnancy outcomes in two women with lipoatrophic diabetes mellitus.
To assess the magnitude and timing of cardiovascular changes in pregnancy, eight subjects were serially studied before conception and at 8, 16, and 24 weeks' gestation. With the use of M-mode echocardiography, cardiac output, ejection fraction, stroke volume, and end-diastolic volume were calculated from left ventricular dimensions with subjects in the left lateral position. Systemic vascular resistance was calculated with the use of cardiac output and simultaneously obtained measurements of arterial pressure. Cardiac output increased 1 L/min at 8 weeks' gestation, which represented greater than 50% of the total change seen. Cardiac output increased primarily because of stroke volume rather than heart rate. By 8 weeks' gestation, systemic vascular resistance had fallen to 70% of its preconceptional value. Thus when subjects are studied before conception and during the early phase of pregnancy, the majority of the pregnancy-induced changes in these parameters occur during the embryonic period.
A woman was referred at 19 weeks' gestation for genetic counseling regarding elevated maternal serum alpha-fetoprotein levels. Sonography identified fetal hydrops and fetal death. Fetal tissue specimens showed evidence of human parvovirus infection by DNA probe analysis.
Thirty women who were seen at our institution between 1984 and 1988 for pruritic urticarial papules and plaques of pregnancy (PUPPP) were retrospectively evaluated and interviewed. We found a significantly increased maternal weight gain and newborn birth weight in patients with PUPPP, compared with age and parity-matched controls. The average weight gain during pregnancy was 18.1 +/- 0.9 (SEM) kg for the patients with PUPPP (excluding twin gestations) and 14.6 +/- 1.0 kg for the controls. The mean newborn birth weight was 3.6 +/- 0.09 kg for the PUPPP group and 3.3 +/- 0.08 kg for the control group. There were three twin pregnancies (10%), compared with the twin gestation rate at our institution of 1.6%. Therefore, based on our findings of an increased maternal weight gain and neonatal birth weight, an increased twin rate, and an abdominal eruption that occurs in primigravidas in their third trimester of pregnancy, we suggest that abdominal distention or a reaction to it may play a role in the development of PUPPP.
A questionnaire concerning the management of women with preterm premature rupture of membranes was sent to the members of the Society of Perinatal Obstetricians. Expectant management was recommended by 97% of the respondents. There was no consensus about the role and frequency of steroids, blood work, ultrasound examination, and fetal monitoring in the follow-up of these patients.
Ball pelvimetry has been utilized at the Medical Center Hospital of Vermont to evaluate infants with breech presentation for vaginal delivery. That technique provided measurements of both the fetal head volume and maternal pelvic capacity so that relative fetomaternal relationships could be established. Between January 1979 and December 1981, 107 patients in spontaneous labor with term pregnancy were evaluated with the protocol. Inadequate pelvimetry and hyperextension of the fetal head occurred in 21 patients (20%). Of the 86 patients who were allowed to labor, 51 (59%) had a vaginal delivery. The total cesarean section rate was 52%. Vaginal delivery in our highly selected patient population did not increase neonatal morbidity. There were no neonatal deaths.
Glycohemoglobins (GH), minor variants of hemoglobin A, are elevated in patients with diabetes mellitus. We examined the clinical usefulness of GH levels in human pregnancy. There was no correlation between GH levels and gestational age or neonatal birth weight. Insulin-dependent diabetics had higher GH levels than did normal controls (greater than or equal to 33 weeks' gestation). There was a significant correlation between fasting plasma glucose concentration and GH levels in insulin-dependent diabetics, especially when the former was determined six to 12 weeks before GH determination. Because of the wide scatter of data and the a posteriori relationship, however, we were unable to use this information at the clinical level.
Bilateral breast stimulation was used to evoke a spontaneous contraction stress test. The success rate and incidence of abnormal uterine activity using the stimulus was compared with patients tested by the authors' standard oxytocin stress test protocol. Bilateral breast stimulation was initially used for 346 tests between 32 and 43 weeks of gestational age. A satisfactory test, or three contractions within ten minutes, was obtained in 239 (69%) patients. The testing time was reduced with successful breast stimulation. The incidence of abnormal uterine activity after breast stimulation was not statistically different from that observed with oxytocin administration alone. However, when oxytocin was administered after breast stimulation, there was a significant increase in the incidence of prolonged contractions.
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Since our institution has a low cesarean rate (14%), it was our hypothesis that the rate of cesarean delivery in patients who underwent induction for macrosomia would be similar to the cesarean rate in patients with similar birth weights who entered labor spontaneously. A retrospective analysis of cases seen from December 1993 to July 1995 revealed 53 nondiabetic patients who underwent induction for fetal macrosomia. These study patients were matched to the next nondiabetic patient delivering a child of equal or greater birth weight who entered labor spontaneously. Maternal demographics, labor characteristics, and neonatal outcome data were reviewed. There were no differences between the induction and spontaneous labor groups in maternal age, gestational age, rate of nulliparity, incidence of shoulder dystocia, Apgar scores, or vaginal birth after prior cesarean delivery. The cesarean delivery rate was higher in the induction group when compared to the spontaneous labor group (36% vs. 17%, P < 0.05) despite a lower birth weight in the induction group (4,102 +/- 374 g vs. 349 g, P < 0.05). Regional analgesia was administered more frequently in the induction group (38% vs. 53%, P < 0.05). An increased risk of cesarean delivery was observed in subjects undergoing induction for the indication of fetal macrosomia. These data support a plan of expectant management when fetal macrosomia is suspected.