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Biomedical subjects

F A Manning

Publications and source records attributed to F A Manning.

At least 19 recordsLinked to original sources
PubMed1992

Severe anti-C hemolytic disease of the newborn.

OBJECTIVE: Because of referral of a C-alloimmunized pregnant woman with a previous hydropic death whose fetus survived after four intraperitoneal transfusions, prevalence and severity of anti-C hemolytic disease of the newborn were investigated. STUDY DESIGN: The numbers of C- or Ce-alloimmunized pregnancies in Manitoban women and their outcome for the 28-year period ending Oct. 31, 1990, were reviewed. The literature relating to C or Ce alloimmunization from 1944 to 1990 was surveyed. RESULTS: In Manitoba for the period reviewed there were 120 pregnancies in 80 C- or Ce-alloimmunized women. Twenty-two ended in abortion and two in fetal death unrelated to anti-C or anti-Ce. Of the remaining 96, 33 fetuses of 32 pregnancies were affected but only eight (6.7%) required treatment after birth. None were severely affected. In the literature there are only three other reported deaths from C or Ce hemolytic disease; two of the three may have been the same patient. The prevalence of C or Ce alloimmunization reported in various series, including our own, ranged from 8.7 to 185 per 100,000 pregnancies. CONCLUSIONS: Because on rare occasions, C or Ce alloimmunization can cause severe hemolytic disease, criteria for investigative measures such as amniocentesis or cordocentesis do not differ from the criteria for instituting these measures in Rho (D)-alloimmunized pregnancies.

Erythroblastosis, Fetal↗
PubMed1992

Must macrosomic fetuses be delivered by a caesarean section? A review of outcome for 786 babies greater than or equal to 4,500 g.

Because difficult vaginal delivery is more frequent with macrosomic fetuses, some writers recommend routine Caesarean section for the delivery of fetuses greater than or equal to 4,500 g. The purpose of this study was to evaluate the appropriateness of this recommendation. A retrospective review was undertaken to determine how many fetuses born in our hospital weighing greater than or equal to 4,500 g died or were permanently damaged as a consequence of mechanical difficulties at delivery. During a 10-year period, 590 (75%) of 786 cephalic babies weighing greater than or equal to 4,500 g and alive at the start of labour were born vaginally. No baby died or was permanently damaged as a consequence of mechanical difficulties at delivery. Routine Caesarean section for macrosomic fetuses to prevent death or damage from difficult delivery is not warranted by our results.

Birth Weight↗
PubMed1992

Maternal Kell blood group alloimmunization.

BACKGROUND: Two recent paper have provided conflicting views regarding the severity of Kell hemolytic disease of the newborn. METHODS: We reviewed our experience during 1944-1990 with pregnant Kell-alloimmunized Manitoban women and similar women referred from outside of Manitoba. RESULTS: Between 1944-1990, 311 Kell-immunized Manitoban women had 459 pregnancies, of which 63 ended in abortion or stillbirth unrelated to anti-Kell. Of the infants born, 376 were unaffected and 20 were affected. Twelve did not require treatment; two needed phototherapy, one required a simple transfusion, and one an exchange transfusion. One died of kernicterus and three were hydropic and died; all four deaths occurred between 1948-1954. Fourteen Kell-immunized women with 16 pregnancies were referred from outside Manitoba. Eleven had a history of Kell hydropic fetuses and ten had hydropic fetuses at referral. Five of the hydropic fetuses survived and five died. Five women had Kell-negative infants correctly predicted by amniocentesis (two) and by fetal blood sampling (three). Serial amniotic fluid delta OD 450 readings were 83-89% accurate in predicting the presence and severity of Kell hemolytic disease. Life-threatening inaccuracies occurred, primarily in the early and middle second trimester. CONCLUSIONS: Kell hemolytic disease, although rare, may be as severe as Rh(D) hemolytic disease when it does occur. When there is a history of hydrops or the father is Kell-positive and the maternal anti-Kell indirect antiglobulin titer is 8 or greater, amniocentesis should be performed at 16-20 weeks' gestation. Fetal blood sampling followed by fetal intravascular transfusion is indicated if delta OD 450 readings approach the 65% level in modified zone 2 of Liley or if amniocentesis is precluded because of an anterior placenta and there is a history of hydrops or ultrasound evidence of fetal hemolytic disease.

Amniotic Fluid↗
PubMed1991

Bleeding after intravascular transfusion: experimental and clinical observations.

Characteristics of postpuncture bleeding of umbilical vessels were evaluated with an in vitro cord perfusion model and in vivo by ultrasonographic observation of bleeding duration after intravascular transfusion. Ultrasonographic determination of blood loss in vitro was very sensitive (0.01 ml/sec). In vitro blood loss varied directly with perfusion rate, but there were wide variations between cord specimens. Observed clinical bleeding occurred in 43% of cases; the duration of bleeding varied by vessel punctured, needle size, and fetal platelet count. The combined in vitro and clinical data help define the range of duration of bleeding and the probable volume of loss.

Bleeding Time↗
PubMed1991

Assessment of fetal well-being with ultrasound.

The practice of medicine is undergoing marked changes fueled by the infusion of vast amounts of new information concerning the etiology, the progressive pathophysiology, and the complexity of host response to disease states. It is only recently that we have begun to examine the present extent of fetal disease and to determine the characteristics of its advancements. This information now permits new and rational approaches to the management of fetal disease. Clinical significance, both real and potential, of this new wealth of information in reducing perinatal mortality and morbidity is difficult to overestimate. Cumulative experience with fetal biophysical scoring as a method for antepartum fetal risk assessment is now extensive. The cumulative data indicate that the method is sensitive for recognizing both the normal and the compromised fetus. Moreover, the method appears to offer the advantage of grading various degrees of fetal compromise. The additional information gained by real-time ultrasound scanning (gestational age determination, fetal morphometrics, and fetal anomaly screening), although not an integral part of the fetal biophysical profile score, nevertheless remains a critical aspect of antepartum fetal assessment. These data are collected simultaneously with fetal biophysical profile scoring. It is impossible to separate cleanly the advantage of fetal biophysical profile scoring in isolation of this additional information. It would, however, seem that such attempt at separation is artificial because the data in combination provide the key information that the physician needs to guide fetal management. It seems more reasonable to expect that continued modification and improvement of the existing fetal biophysical profile scoring method with inclusion of new testing techniques will be the steps that will occur to improve testing accuracy (Fig. 3). In medical schools in the 1960s, it was generally taught that the concept of "irreducible" perinatal mortality existed and that this figure was usually set at a perinatal mortality of around 8 per 1000. Now in the 1990s that perinatal mortality has already fallen below this irreducible level and continues to fall. We now observe perinatal mortality among tested fetuses of less than 7 per 1000 and corrected perinatal mortalities of less than 2 per 1000. These remarkable results strongly underscore the advantages obtained by ultrasound assessment of the fetus.

Amniotic Fluid↗
PubMed1990

Maternal serum alpha-fetoprotein in twin pregnancy.

Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 138 twin pregnancies. All patients had at least one ultrasonographic examination (86% before 20 weeks' gestation). Two pregnancies were discordant for open fetal defects (one anencephaly, one gastroschisis). The median serum alpha-fetoprotein value in the remaining 136 twin pregnancies paralleled a curve 2.5 times the median curve for singleton pregnancies over the gestational range studied. Higher serum alpha-fetoprotein values correlated significantly with increasing incidence of fetal and neonatal death, premature delivery (less than 35 weeks' gestation), and twin-to-twin birth discordance (greater than 20%), most pronounced at greater than 4 multiples of the singleton median level. A significant negative correlation between alpha-fetoprotein and birth weight was observed (p less than 0.001), but was related more to prematurity than to poor fetal growth. Theoretically, serum alpha-fetoprotein screening detected 56.5% of the twins in this study when a cutoff level of 2.5 multiples of the median was used, enhancing twin detection in the study population by 40%. These data indicate that maternal serum alpha-fetoprotein screening has a valuable role in the management of twin pregnancy, both in the detection of twins and in the prediction of perinatal outcome in twin pregnancy.

Female↗
PubMed1990

Intrauterine transfusion--intraperitoneal versus intravascular approach: a case-control comparison.

Intravascular fetal transfusion has gained widespread acceptance and has supplanted the use of intraperitoneal fetal transfusion in management of severe alloimmune disease in many centers. This study compares the two methods with regard to multiple objective end points of performance, therapy, and outcome in a highly matched case-control fashion. The intravascular approach is better on almost every level. More surviving infants who are in better condition at a mature gestation and whose mothers have fewer complications and sequelae are the result. Whereas intraperitoneal transfusion should not be abandoned altogether, it is a second-line procedure used only in very limited circumstances. Intravascular fetal transfusion offers realistic prognosis for intact survival at virtually any extreme of alloimmune disease.

Blood Group Incompatibility↗
PubMed1979

Amniotic fluid phosphatidylglycerol and real-time ultrasonic cephalometry.

The fetal biparietal diameter (BPD) was measured at the time of real-time ultrasound-directed amniocentesis in 159 cases and a phospholipid profile was obtained from the amniotic fluid. BPD measurements of 9.0, 8.7, and 9.2 cm were then compared with a lecithin/sphingomyelin (L/S) ratio greater than or equal to 2.0 for the ability to predict the presence of phosphatidylglycerol (PG) in the profile. The data from the diabetic and nondiabetic patients were analyzed separately. The results demonstrated that in the presence of a L/S ratio greater than or equal to 2.0 the BPD does not aid in the identification of amniotic fluid samples which contain PG in either the diabetic or nondiabetic groups. The data also confirmed previous findings that the BPD is not a reliable predictor of the L/S ratio. It is concluded that for the detection of PG in amniotic fluid, the use of real-time ultrasonic cephalometry cannot substitute for the performance of the phospholipid profile.

Amniotic Fluid↗
PubMed1979

Immediate effect of amniocentesis on fetal breathing and gross body movements.

The incidence of fetal breathing movements (FBMs) has been observed to be significantly reduced at 24 and 48 hours after amniocentesis. The cause is unknown. We studied the immediate effects of amniocentesis on two fetal variables, FBMs and gross body movements (FMs). No effect was observed in the incidence of FBMs but an immediate increase in FMs occurred.

Amniocentesis↗
PubMed1979

Fetal breathing movements and the nonstress test in high-risk pregnancies.

Three hundred ninety-eight observations of fetal breathing movements (FBM) and the nonstress test (NST) were made in 223 patients. The presence of FBM was noted in a significantly higher proportion of tests with a reactive NST (88%) than a nonreactive NST (67%). Conversely, a significantly higher proportion of tests were reactive when FBM were present (82.6%) than when FBM were absent (49%). A significant relationship existed betweeen either test and the outcome of pregnancy as judged by the five minute Apgar score or the incidence of fetal distress in labor. Combining two normal tests did not improve the accuracy in predicting outcome; but the combination of both tests, when abnormal, produced a significant improvement in predicting fetuses likely to have an abnormal outcome. The combination of the normal with the abnormal test had a predictive accuracy similar to a single normal test in predicting a normal five-minute Apgar. This combination was associated with an incidence of fetal distress in labor intermediate between that seen with either the normal or abnormal test when alone. Neither a single test nor the combination of tests was helpful in identifying the small-for-gestational age (SGA) infants. These data indicate antepartum fetal evaluation may be improved when more than one biophysical variable is used.

Apgar Score↗
PubMed1979

Breathing movements before death in the primate fetus (Macaca mulatta).

The incidence and character of fetal breathing movements (FBMs) were determined by analysis of continuous tracheal pressure recordings in a 48 hour period preceeding fetal death in utero in 7 chronic pregnant monkey preparations (Macaca mulatta). All fetuses were judged normal by blood gas tensions, pH, and fetal heart rate within 48 hours of death. In the normal fetus breathing movements were periodic and a circadian distribution in the incidence of FBMs was observed. Four distinct patterns of FBMs were observed in the normal fetuses. In five fetuses death occurred in the intrapartum period; all five fetuses were breathing at the onset of labor. A progressive fall in the incidence of FBMs was observed in labor coincident with the development of fetal acidemia. In the remaining two fetuses death occurred before labor. Apnea and gasping were observed in all fetuses before death. The duration of apnea and gasping appeared dependent upon the nature of the lethal insult.

Animals↗
PubMed1979

Fetal breathing movements and the abnormal contraction stress test.

The presence or absence of fetal breathing movements (FBMs) in a 30 minute observation period was determined in 29 patients with abnormal contraction stress tests (CSTs). The study population included 14 patients with positive CSTs, 11 patients with equivocal CSTs, and four patients with unclassified CSTs. In patients with either an equivocal or a positive CST, the presence of FBMs was associated with a high incidence of false predictive tests. Conversely, the absence of FBMs in a patient with a positive CST was uniformly associated with intrapartum fetal distress. The presence or absence of FBMs was not helpful in assessing the patients with unclassified CSTs. These data suggest FBMs may be a useful means of evaluating the patient with a positive or equivocal CST.

Delivery, Obstetric↗
PubMed1979

Fetal movements in human pregnancies in the third trimester.

Fetal movements (FM) were measured using a real-time B-scan method in 50 women in the third trimester. One hundred ninety-five observations were made. The number of FM per 20-minute observation period was similar in normal, diabetic, and hypertensive pregnancies and in patients with placenta previa, but was significantly lower in patients with Rh isoimmunization and an affected fetus. The number of FM did not vary with gestational age, mode of delivery, or birth weight and was significantly increased in patients either with a reactive nonstress test (NST) or in the presence of fetal breathing movements (FBM). Fetal movements were absent before delivery in 4 patients: In 3, the fetus died in utero and in the other a positive contraction stress test (CST) was observed. Conversely, in 2 other fetuses who died in utero, FM were observed during the last examination before death. In both, the cause of fetal death was related to an acute change. No relationship between FM and neonatal death was observed. These data suggest FM monitoring may be helpful in evaluating antepartum fetal condition.

Antibody Formation↗
PubMed1979

Antenatal detection of fetal A-V dissociation utilizing real-time B-mode ultrasound.

Congenital heart block is an unusual cause of fetal bradycardia. Until recently, the diagnosis could be confirmed only by evaluation of the fetal cardiac electrical activity. Two cases are reported in which the diagnosis of atrio-ventricular (A-V) dissociation was confirmed in the antepartum period by real-time ultrasound evaluation of cardiac mechanical activity.

Adult↗
PubMed1979

Maternal hypoxemia and fetal breathing movements.

Fetal breathing movements (FBM) were observed daily using a real-time B-mode ultrasound method in a patient with sickle cell anemia in crisis. Observations were made on 2 occasions in the presence of maternal hypoxemia (PO2 less than or equal to 40 mmHg), and FBM were noted to be absent. Conversely, when maternal PO2 was 60 mmHg or greater, FBM were present 23--80% of the time. The FBM were reduced or absent within 90 minutes of maternal Demerol injection. These observations suggest that the human fetal response to hypoxemia may be similar to that observed under expermental conditions in the animal fetus.

Adult↗