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Biomedical subjects

F A Manning

Publications and source records attributed to F A Manning.

At least 73 records · Page 4Linked to original sources
PubMed1985

Ovine fetal urine production following maternal intravenous furosemide administration.

The response of the ovine fetus to maternal furosemide administration was studied in six chronically catheterized fetal lamb preparations. These studies indicate that in the chronic sheep model maternally administered diuretics do not augment fetal urine production. Additionally, passage of the drug from the maternal intravascular compartment to the fetal intravascular compartment could not be demonstrated. It is suggested that on the basis of these data, the results of the "Lasix challenge test" should be interpreted with caution when they are used to evaluate human fetal renal function.

Amniotic Fluid↗
PubMed1985

Fetal assessment based on fetal biophysical profile scoring: experience in 12,620 referred high-risk pregnancies. I. Perinatal mortality by frequency and etiology.

Fetal biophysical profile scoring was used as a method for antepartum fetal risk assessment in 12,620 high-risk patients referred in a 55-month interval. A total of 26,257 tests were performed on these patients (range, one to 18 tests per patient). Ninety-three perinatal deaths occurred (gross perinatal mortality rate, 7.37 per 1000) of which 62 (66.6%) were due to a major anomaly, seven were due to Rh disease (7.5%), and the remaining 24 deaths (25.8%) occurred in structurally normal fetuses. The corrected perinatal mortality rate was 1.90 per 1000. Eight structurally normal fetuses died within 1 week of a normal test result (corrected false negative rate, 0.634 per 1000). These data suggest fetal biophysical profile scoring is an accurate method for identification of the fetus at risk for perinatal death.

Amniotic Fluid↗
PubMed1985

Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases.

Most babies born with congenital diaphragmatic hernia (CDH) die after birth. The natural course of CDH in the human fetus is not known. We found 94 cases of fetal CDH in the records of surgeons and obstetricians surveyed in the United States and Canada. We found the following: (1) prenatal diagnosis of CDH is accurate and current techniques can detect lethal nonpulmonary anomalies and prevent diagnostic errors; (2) despite optimal conventional therapy, most fetuses with detectable CDH will die in the neonatal period (80% mortality); (3) polyhydramnios is both a common prenatal marker for CDH (present in 76% of fetuses) and a predictor for poor clinical outcome (only 11% survived); (4) fetal CDH is a dynamic process--nonsurvivors have larger defects and may have more viscera displaced into the chest at an earlier stage of development. Surgical intervention before birth may be necessary to improve survival of the fetus with CDH and polyhydramnios.

Congenital Abnormalities↗
PubMed1985

Intrauterine transfusion in an Rh-immunized twin pregnancy: a case report of successful outcome and a review of the literature.

Fifteen sets of twins have been reported among 2331 pregnancies complicated by Rh alloimmunization of sufficient severity to warrant intrauterine transfusions. Four of the 15 sets were managed in Winnipeg, Canada. One of the four is described in detail in the present report. Serial amniocenteses (N = 15) and intrauterine transfusions (N = 8) were used in the management of the dizygous affected twin fetuses with a favorable outcome. Factors contributing to the survival of the twins are described.

Adult↗
PubMed1984

Ultrasound evaluation of amniotic fluid volume. I. The relationship of marginal and decreased amniotic fluid volumes to perinatal outcome.

Qualitative amniotic fluid volume determination is a routine part of fetal biophysical profile score testing. The relationship between oligohydramnios and poor perinatal outcome has been previously documented. We have undertaken a retrospective chart review relating qualitative amniotic fluid volume as determined at the time of last biophysical profile score assessment to perinatal outcome in 7582 referred high-risk obstetric patients. Gross and corrected perinatal mortality in association with normal qualitative amniotic fluid volume ranged from 4.65/1000 and 1.97/1000, respectively, to 187.5/1000 and 109.4/1000 in association with decreased qualitative amniotic fluid volume, respectively. The incidences of major congenital anomaly and intrauterine growth retardation were significantly related to qualitative amniotic fluid volume.

Amniotic Fluid↗
PubMed1984

Ultrasound evaluation of amniotic fluid volume. II. The relationship of increased amniotic fluid volume to perinatal outcome.

Qualitative amniotic fluid volume determination is a routine part of fetal biophysical profile score testing. The relationship between polyhydramnios and poor perinatal outcome has been previously documented. We have undertaken a retrospective chart review which relates qualitative amniotic fluid volume as determined at the time of last biophysical profile score assessment to perinatal outcome in 7562 referred high-risk obstetric patients. Gross and corrected perinatal mortality in association with normal qualitative amniotic fluid volume ranged from 4.65/1000 and 1.97/1000, respectively, to 32.9/1000 and 4.12/1000 in association with increased qualitative amniotic fluid volume, respectively. The incidences of major congenital anomaly and fetal macrosomia were significantly related to qualitative amniotic fluid volume.

Amniotic Fluid↗
PubMed1984

The effect of vaginal prostaglandin E2 pessaries on induction of labor.

In a prospective randomized study, patients with a valid obstetric indication for induction of labor received either 3 mg prostaglandin E2 vaginal pessaries immediately prior to oxytocin (prostaglandin group, n = 99), or oxytocin alone (oxytocin group, n = 103). At the conclusion of the second day of induction, a significant reduction was noted in the incidence of failed induction in the prostaglandin group (4%) as compared to the oxytocin group (13%) (p less than 0.05). Twenty percent of patients in the prostaglandin group experienced successful induction with prostaglandin pessaries only. When oxytocin was required in the prostaglandin group, the maximal concentration of oxytocin infused and the duration at this concentration were significantly less than in the oxytocin group. No perinatal complications were attributed to the use of prostaglandin. Three minor maternal complications that were attributed to vaginal prostaglandin E2 did not require treatment. Our conclusion is that patients who require an induction of labor, when artificial rupture of the membranes is not feasible, benefit from the use of prostaglandin pessaries before the administration of oxytocin.

Cesarean Section↗
PubMed1984

Treatment of the fetus in utero: evolving concepts.

The rapidly evolving ability to detect the presence of major anomalies in the developing fetus and the emerging prospect of intrauterine treatment of some of these disorders are coupled to create an exciting new frontier in care of the high-risk pregnancy. Preliminary reports suggest that in some highly selected instances perinatal death and morbidity may be prevented by intrauterine surgical procedures. The technical ability to treat the disorder as described is at hand and is unlikely to be the limiting factor in the advance of this area of fetal treatment. However, the very fact that treatment is possible cannot be considered as proof of efficacy. The physician faced with the knowledge that a potentially treatable condition is present in a given fetus may feel the necessity of instituting treatment, but the validity of such an approach is far from established. It is our opinion that efforts should be made to set at the earliest point proper controlled scientific studies from which the benefit, if any, of this surgical approach to fetal disease may be established. Such clinical studies should be conducted in concert with studies in appropriate animal models. It should be noted that fetal surgical treatment is not without potentially lethal fetal and maternal complications. Before such risks, however small, are taken, it seems reasonable to determine the long-term benefits of the surgical procedure. To this end, participation in the International Fetal Surgery Registry is encouraged.

Arnold-Chiari Malformation↗
PubMed1984

Fetal biophysical profile score and the nonstress test: a comparative trial.

In this prospective blind study, 735 patients with high-risk pregnancies referred for antepartum testing of fetal well-being were randomly assigned to either a fetal biophysical profile scoring (375 patients) or a nonstress testing scheme (360 patients). Management was based on the results of antepartum tests, but the method of testing used was not disclosed. Fetal biophysical profile scoring resulted in a significantly higher positive predictive value in regards to low Apgar scores. Sensitivity, specificity, and accuracy, although higher with fetal biophysical profile scoring, did not demonstrate significant differences when compared with the nonstress test. The negative predictive value between the two methods was similar. All major anomalies were detected during ultrasound scanning, whereas none of these anomalies were detected by heart rate testing alone.

Apgar Score↗
PubMed1984

Circadian rhythm in bladder volumes in the term human fetus.

Circadian rhythms have been identified in a variety of maternal and fetal biophysical and endocrinologic parameters. The authors have undertaken a 24-hour study to identify the normal variation in fetal bladder volumes in the healthy, term human fetus. A significant decrease in fetal bladder volumes occurred between 2400 hours and 0600 hours when compared with other times of the day. It is suggested that this fall in fetal bladder volumes may be related to fetal cardiovascular or adrenal gland function.

Circadian Rhythm↗
PubMed1983

Antepartum chronic fetal vesicoamniotic shunts for obstructive uropathy: A report of two cases.

Two fetuses with obstructive uropathy characterized by striking oligohydramnios and dilatation of the urinary collecting system were identified by ultrasound and treated by percutaneous insertion of a long-term vesicoamniotic silicone rubber shunt. Both fetuses were less than 16 weeks' gestation at diagnosis and less than 18 weeks at treatment. One fetus was delivered at 35 weeks and is alive and well; the other died early in the neonatal period at 31 weeks with pulmonary hypoplasia.

Adult↗
PubMed1983

Severe Rh disease--poor outcome is not inevitable.

Most centers report only moderate success in the intrauterine treatment of severe Rh-isoimmune hemolytic disease. For the hydropic fetus, the prognosis is poor. Innovations in the assessment, treatment, and follow-up of the severely affected fetus have yielded more encouraging results. Among the 24 fetuses receiving a refined management plan, instituted in June, 1980, survival rates were 100% in the nonhydropic fetus and 75% in the hydropic fetus. Improved fetal evaluation by means of extensive real-time ultrasonography allows more exact assessment of stage of disease, safer performance of intrauterine transfusion, and a direct picture of the fetal response to treatment. The intrauterine transfusion procedure differs in many aspects from those used in other centers and is notable mostly because of the absence of traumatic fetal death since the present program began. This improvement and the absence of neonatal death have resulted in 92% survival rate among the fetuses transfused. The success of this integrated team approach suggests revision of the pessimism toward the fetus with severe Rh disease.

Blood Transfusion, Intrauterine↗
PubMed1983

Intrauterine transfusion: kinetics of absorption of donor cells in fetal lambs.

The absorption of red cells from the peritoneal cavity of fetal lambs was studied in 29 pregnant ewes at approximately 120 days' gestation. Onset of absorption was early, absorption was rapid, and virtually complete absorption was shown in 96% of the fetuses by 92 hours after intrauterine transfusion. The mean time to complete 99% absorption was 75.8 hours, about half the time supposed for human fetuses. The rate of absorption and the maximum level of donor cells in the fetal circulation are both directly related to the transfusion volume. The time required to complete absorption does not vary with the volume transfused: The more blood given at intrauterine transfusion, the faster the fetus absorbs it. This study suggests that absorption in the fetus following intrauterine transfusion is very efficient, and may be faster than previously thought.

Absorption↗
PubMed1983

Estimation of volume and weight of the perinate: relationship to morphometric measurement by ultrasonography.

A method of determining fetal weight in utero was developed by use of real-time ultrasonography. A volume model representing trunk and limbs as cylinders with dimensions related to morphometric parameters was tested on 60 neonates. Head volumes in these 60 neonates were determined from equations relating head morphometric measures to head volume in 30 neonatal autopsy specimens. Head density and trunk and limb density were determined separately on the 60 neonates by study of the variation in overall density with body proportions. From these density and volume values, total body mass was estimated. The deviation of neonatal weight estimates from actual weights at three days postpartum was +/- 4.1 per cent (1 SD). The validity of this method for fetal weight determination was tested by in utero ultrasonographic measurement of 31 fetuses before delivery by cesarean section. The deviation of the weight estimate from the actual weight at three days postpartum was +/- 8.1 per cent (1 SD), or +/- 7.4 per cent (absolute mean error).

Biophysical Phenomena↗
PubMed1983

Intrauterine fetal transfusions: Winnipeg 1982.

Perinatal survival after fetal transfusion in Winnipeg from February 1978 to June 1980 (52%-11 of 21 transfused) was worse than in the preceding 12-year period (70%-79 of 113 transfused). The cause was determined to be narrowing of the epidural transfusion catheter side hole opening diameters, which caused donor red cell hemolysis and hydrops fetalis. Catheter-induced red cell hemolysis was directly responsible for three perinatal deaths in this interval and probably contributed to two others. Catheter-induced red cell hemolysis was prevented completely by removal of the catheter tip and side hole openings, allowing donor red fell egress through the open end of the catheter. Following the institution of real-time ultrasound scan surveillance during and after intrauterine transfusion, survival for the interval from July 1980 to June 1982 was 92% (22 of 24 transfused), by far the series' best intrauterine transfusion survival rate. Hydropic fetal survival rate in the same period was 75% (six of eight transfused). With meticulous prenatal care, amniotic fluid delta OD450 measurements beginning at 20.5 weeks' gestation, and intrauterine transfusion carried out under ultrasound guidance, beginning as early as 22.5 weeks' gestation if necessary, the Rh Laboratory has achieved extremely satisfactory perinatal salvage following intrauterine transfusion. Intensive plasma exchange, as an adjunct to the above measures, should be reserved for the pregnant woman with a history of hydropic fetal death before 28 weeks' gestation.

Blood Transfusion, Intrauterine↗
PubMed1982

The correlation of ultrasonic placental grading and fetal pulmonary maturation in five hundred sixty-three pregnancies.

In a previous study, it was suggested that the presence of a grade III placenta correlates 100% with a mature lecithin/sphingomyelin (L/S) ratio and may replace amniocentesis in confirming fetal lung maturity. In this study that hypothesis was tested in 563 pregnancies. All patients underwent amniocentesis and simultaneously had placental grading. The correlations of placental grade with an L/S ration greater than or equal to 2 were: grade 0, 17%; grade I, 68%; grade II, 91%. The correlations of placental grade with the presence of phosphatidylglycerol (PG) were: grade 0, 17; grade 1, 41%; grade II, 79%; grade II, 75%. The false positive rates associated with grade III placenta were, therefore, 7% for mature L/S ratio and 25% for PG present: when combined with a biparietal diameter greater than or equal to 9.0 cm, a grade III placenta incorrectly predicted lung maturity in 8.5%. We conclude that placental grading is not accurate enough to replace amniocentesis as the standard test of fetal pulmonary maturity.

Amniocentesis↗