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Biomedical subjects

E Mueller-Heubach

Publications and source records attributed to E Mueller-Heubach.

At least 19 recordsLinked to original sources
PubMed1992

Validation of noninvasive fetal renal artery flow measurement by pulsed Doppler in the lamb.

OBJECTIVE: Our objective was to evaluate the accuracy of quantitative measurement of blood flow of the left renal artery in the fetal lamb by means of range-gated, two-dimensional pulsed Doppler ultrasonography. STUDY DESIGN: Doppler measurements were compared with invasive measurements obtained with a perivascular flow probe (Transonic) placed on the fetal renal artery. Renal blood flow was manipulated acutely either by volume expansion or depletion or by means of pharmacologic agents. With each manipulation values of the left fetal renal artery blood flow were obtained with both methods. The size of the fetal renal artery was determined by postmortem examination. RESULTS: A total of 36 paired flow measurements were obtained on five fetuses. One fetus had only Transonic determination of renal blood flow. Pulsed Doppler ultrasonography blood flow and transit-time ultrasonography blood flow estimations were correlated (F = 82.4, R2 = 0.73, p < 0.001). CONCLUSION: This study suggests that two-dimensional pulsed Doppler can reliably estimate renal blood flow in the fetal lamb.

Animals↗
PubMed1991

Low incidence of positive amnionic fluid cultures in preterm labor at 27-32 weeks in the absence of clinical evidence of chorioamnionitis.

In order to determine the utility of amniocentesis for detecting subclinical chorioamnionitis in asymptomatic afebrile women in preterm labor with intact membranes, we enrolled 47 women between 27-32 weeks' gestation in a prospective study. After enrollment, 38 women fulfilled all clinical and laboratory criteria for the study; nine women were excluded because they had a leukocyte count exceeding 15,000/microL. None of the 38 asymptomatic afebrile women had a positive culture from the amnionic fluid for bacteria, fungi, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, or any viruses. Sepsis was not proved in any of the 38 infants delivered to these patients. There was a clear relationship between histologic evidence of chorioamnionitis and failure of tocolytic therapy. Fetal lung profiles were mature in 29% of the amnionic fluid samples from 30-32 weeks' gestation, but in none of the amnionic fluid samples before 30 weeks. Amniocentesis does not seem useful to detect chorioamnionitis in asymptomatic afebrile women with preterm labor and intact membranes at 27-32 weeks' gestation, and should be reserved for those cases in which information about fetal lung maturity would be helpful.

Adolescent↗
PubMed1991

Pregnancy outcome following ultrasound diagnosis of macrosomia.

Both elective cesarean and early induction have been proposed for pregnancies in which the fetus is suspected to be macrosomic by ultrasound examination. We studied 242 nondiabetic women with estimated fetal weights (EFWs) by ultrasound of at least 4000 g or the 90th percentile for gestational age at 36 or more weeks' gestation. In 66 of 86 women (77%) delivering within 3 days of ultrasound examination, EFW exceeded birth weight. In only 41 of these 86 women (48%) were the EFWs within the corresponding 500-g category of birth weight. A trial of labor resulted in vaginal delivery in 76 of 106 women (72%). There were five cases of shoulder dystocia but no birth trauma. Estimated fetal weights and birth weights were not significantly different between the women who had a trial of labor and those who did not. Our results do not support cesarean delivery or early induction as a means of preventing infant morbidity when fetal macrosomia (weight of 4000 g or more or the 90th percentile for gestational age) is diagnosed by ultrasound.

Birth Injuries↗
PubMed1990

Histologic chorioamnionitis and preterm delivery in different patient populations.

The placentas of 1843 deliveries were examined for the presence of histologic chorioamnionitis, which was classified as mild, moderate, or severe. Chorioamnionitis was present in 7.5% of patients who underwent cesarean before labor and in 18 and 32% of those delivering at term and preterm, respectively. Chorioamnionitis was severe in 74% of preterm but in only 15% of term deliveries. Premature rupture of membranes (PROM) was more frequent with preterm than with term delivery, with chorioamnionitis present in 42 and 15% of patients, respectively. Although chorioamnionitis was equally frequent in women with intact membranes delivering preterm and term, chorioamnionitis was severe in 63% of preterm and 14% of term deliveries (P less than .001). The frequency and severity of chorioamnionitis were related inversely to gestational age at preterm birth. Preterm delivery was more frequent in black than in white patients (19 versus 9%) and in indigent clinic versus private patients (13 versus 7.5%). However, there was no significant difference in frequency and severity of chorioamnionitis between black and white or between indigent clinic and private patients who delivered preterm. Among term births, chorioamnionitis was more often severe in black than in white patients. Chorioamnionitis in term deliveries was more frequent in clinic than in private patients; however, this was not true when only severe chorioamnionitis was considered. There were no differences in PROM between these patient populations. Thus, higher preterm birth rates in black and indigent clinic populations are not due to the more frequent occurrence of chorioamnionitis.

Black People↗
PubMed1989

Preterm birth prevention: evaluation of a prospective controlled randomized trial.

Over a 3-year period 5457 indigent patients were scored for risk of preterm birth and 4595 women were delivered at greater than or equal to 20 weeks' gestation. Patients at high risk (18.1%) were randomized into control and intervention groups. The latter group received weekly cervical examinations and instruction regarding subtle symptoms and signs of preterm labor. Medical providers received similar instruction. There was no difference in preterm births between control and intervention groups (20.8% vs. 22.1%). Medical providers, convinced of preterm birth prevention during year 1 of the study, defeated the study design by giving preterm birth precautions to all patients. In turn, preterm births decreased from 13.7% (year 1) to 9.3% (year 2, p less than 0.001) and remained stable in year 3 (8.7%). Preterm births during year 1 and the 8 months preceding year 1 were not different. Significant differences in preterm births between private and indigent study patients during these two periods (p less than 0.001) disappeared during years 2 and 3 of the study.

Clinical Trials as Topic↗
PubMed1989

Evaluation of risk scoring in a preterm birth prevention study of indigent patients.

A total of 4591 indigent patients were scored for risk of preterm labor and birth by the Creasy et al. scoring system and delivered at greater than or equal to 20 weeks' gestation. Of 462 preterm deliveries (less than 37 weeks), only 39.6% were contributed by the 18.1% of patients who scored at high risk (score greater than or equal to 10). Of the 44 risk factors in the scoring system, 25 were not statistically significant by univariate chi 2 analysis. The spontaneous preterm birth rate was 8.0%. The positive predictive value of the Creasy et al. system was 18.3%. With multiple logistic analyses we excluded infrequent risk factors and identified five factors that remained significant (prepregnancy weight less than 45.5 kg, black race, single marital status, one preterm labor and delivery, preterm labor, and delivery greater than or equal to 2). With these five risk factors we created an equation that allowed identification of 12% of patients at high risk of preterm delivery with a positive predictive value of 21.9%. Because of the importance of previous preterm delivery, risk scoring of primigravid patients is of limited value.

Black or African American↗
PubMed1988

The clinical significance of hemorrhagic endovasculitis of the placenta.

Hemorrhagic endovasculitis of the placenta has been reported to correlate with intrauterine growth retardation, perinatal morbidity and mortality, and long-term developmental delay. At a regional obstetric hospital we identified 13 cases of hemorrhagic endovasculitis among 1938 placentas from singleton pregnancies of greater than or equal to 20 weeks' gestation over a 3-month period, an incidence of 0.67% of unselected pregnancies. All cases were live-births without intrauterine growth retardation. Associated clinical features were pregnancy-induced hypertension, nuchal cord at delivery, and postterm gestation. One infant had severe perinatal asphyxia with long-term psychomotor retardation. In the placenta, hemorrhagic endovasculitis was associated with infarction, fetal vessel thrombosis, and villitis of unknown cause. Interference with umbilical blood flow or regional compromise of villous perfusion may be an initiating event in the development of this lesion.

Endothelium, Vascular↗
PubMed1986

Kell sensitization in pregnancy.

Maternal anti-Kell antibody was found in 127 of 127,076 pregnancies during a 16-year period (0.1%). Thirteen Kell-sensitized pregnancies ended with a Kell-positive newborn infant, five of these had a poor perinatal outcome (hydrops, intrauterine or neonatal death, hemoglobin less than 7.9 gm, congestive heart failure). Mothers with Kell-positive infants and poor outcome had anti-Kell titers greater than or equal to 1:128 at delivery. With a maternal anti-Kell titer less than 1:32 at delivery, only one baby was Kell positive and mildly affected by hemolytic disease. Spectrophotometric analysis of amniotic fluid (delta optical density at 450 nm) in three of four pregnancies with poor perinatal outcomes revealed values of delta optical density at 450 nm in the high midzone of Liley within 1 week of delivery. Therefore, Kell-sensitized patients have to be managed differently from patients with rhesus sensitization. A management scheme to optimize perinatal outcome in Kell-sensitized pregnancy is described on the basis of this largest reported series of Kell-sensitized pregnancies.

Adolescent↗
PubMed1979

Pharmacologic inhibition of preterm labor.

Preterm labor is responsible for a majority of cases of perinatal morbidity and deaths. Prevention of preterm labor is not usually possible; thus pharmacologic treatment is the only recourse available. Numerous agents have been used to treat preterm labor, but none has proved to be superior. This report reviews the current information available about the pharmacology of labor-inhibiting drugs and discusses the clinical approach to the management of preterm labor.

Adrenergic beta-Agonists↗
PubMed1978

Use of supine pressor test to prevent gestational hypertension in primigravid women.

The supine pressor (roll-over) test was performed on 62 nulliparous patients under 20 years of age at conception. The 28 patients (45%) with positive tests were treated to prevent the development of gestational hypertension. Four of those with a positive test and two of those with a negative test developed gestational hypertension. Compared with a composite of other reported studies of this test in which the patients were not treated, our results indicated a statistically significant reduction in the incidence of gestational hypertension. The supine pressor test appears to be useful clinically in young nulliparous women.

Adult↗
PubMed1978

Effects of dexamethasone on leukocyte counts in pregnant sheep and fetal lambs.

In adult nonpregnant animals and human beings, glucocorticosteroids increase circulating leukocytes (predominantly neutrophils) and decrease lymphocytes, monocytes, and eosinophils. We were interested in studying effects of glucocorticoids on leukocyte counts during pregnancy to determine any differences between responses in the nonpregnant and pregnant states. After general anesthesia was administered, we placed catheters in a carotid artery and a jugular vein in pregnant sheep and in fetal lambs. Six days after surgery, we administered dexamethasone intravenously to the mother (0.2 mg. per kilogram) or to the fetus (0.06 mg. per kilogram) and obtained maternal and fetal jugular venous blood samples immediately before (control) and 3, 6, 12, 24, 48, and 72 hours after steroid injection. Administration of dexamethasone to the mother significantly increased total leukocyte and neutrophil counts (leukocytes per cubic millimeter blood) and decreased lymphocyte and eosinophil counts, but it did not change monocyte counts. Leukocyte counts returned to control values within 48 hours. Administration of dexamsthasone to the fetus rapidly increased total leukocyte and neutrophil counts, decreased monocyte and eosinophil counts, and had not effect on lymphocyte counts. Fetal leukocyte counts returned to control values by 24 hours after dexamethasone injection. Our results suggest that maternal and fetal leukocytes can respond to glucocorticoids as they do in the adult nonpregnant state.

Animals↗
PubMed1978

Lecithin/sphingomyelin ratio in amniotic fluid and its value for the prediction of neonatal respiratory distress syndrome in pregnant diabetic women.

In 101 diabetic pregnant women (Classes A through D) 146 determinations of the lecithin/sphingomyelin (L/S) ratio were carried out. Gestational ages were verified by serial fetal cephalometry. No L/S ratios of more than 2.0 were found before 34-1/2 weeks' gestation; however, in 42 per cent of patients the L/S ratio was below 2.0 at 36 weeks' gestation or later. Respiratory distress syndrome (RDS) was found in 16 neonates of women with L/S ratios of 2.0 or higher; however, RDS incidence varied depending on the mode of delivery. Abdominal delivery was performed before 37 weeks' gestation in 19 patients with L/S ratios of 2.0 or higher and resulted in neonates with RDS in 41 per cent of cases. Vaginal delivery was accomplished below 37 weeks' gestation in 10 patients with L/S ratios of 2.0 or higher and no subsequent neonatal RDS was observed. After 37 weeks' gestation neonatal RDS is rare, irrespective of mode of delivery. The data presented suggest that similar numerical values of the L/S ratio at different gestational ages have a different predictive value for the occurrence of neonatal RDS.

Amniotic Fluid↗
PubMed1978

Sinusoidal fetal heart rate pattern following intrauterine fetal transfusion.

Two patients with severe rhesus isoimmunization had sinusoidal fetal heart rate patterns following intrauterine fetal transfusion. A consistent temporal relationship between fetal transfusion and sinusoidal fetal heart rate pattern was observed. Survival of a fetus who had a sinusoidal fetal heart rate pattern after each of three transfusions suggests that this pattern may not be ominous when observed transiently after fetal transfusion.

Adult↗
PubMed1977

Effects of dexamethasone on maternal and fetal hemodynamic states and fetal oxygenation.

The effects of dexamethasone on maternal and fetal hemodynamic states and fetal oxygenation were determined in chronically instrumented unanesthetized pregnant ewes and fetal lambs. Intravenous injections of pharmacologic doses of dexamethasone to the mother failed to alter maternal blood pressure, heart rate, blood flow in the uterine artery supplying the pregnant horn, or uterine vascular resistance. Direct administration of dexamethasone to the fetus had no effect on fetal blood pressure, heart rate, acid-base state, or oxygenation. Furthermore, direct fetal administration of dexamethasone did not produce premature parturition.

Animals↗
PubMed1977

Evaluation of postterm pregnancies with maternal serum placental lactogen and alpha-fetoprotein concentrations.

Studies of maternal serum placental lactogen (hPL) levels in 70 women delivering beyond 42 weeks of gestation revealed significantly lower levels of hPL when the offspring had one or more of ten signs of postmaturity or distress. A sequential combination of hPL measurements and intrapartum fetal heart rate monitoring (FHRM) (performed in 61 patients) gave a high degree of prognosis (75% of abnormalities detected, 88% with normal tests having no abnormalities). Considered separately, neither maternal serum hPL levels nor FHRM predicted abnormalities in the offspring to the same high degree. On the other hand, hPL could not be correlated with staining, desquamation, and the presence of meconium in the amniotic fluid at delivery, these criteria being considered separately or in combination. Maternal serum alpha-fetoprotein (AFP) levels during late gestation showed considerable variation and did not permit distinction between pregnancies with or without an abnormality in the offspring.

Female↗