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Biomedical subjects

F K Lotgering

Publications and source records attributed to F K Lotgering.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Sports during pregnancy].

The aim of this article is to investigate to what extent physical exercise and pregnancy affect each other. Despite an increase in metabolism at rest, the amount of oxygen available for exercise is virtually unaffected by pregnancy. The capability to perform exercise (in W) is equally unaffected, but body weight increases. As a result the maximal running speed and/or distance decreases during pregnancy. The fetus needs a constant supply of oxygen and nutrients. During exercise uterine blood flow decreases. This decrease is linearly correlated with the intensity and the duration of exercise and the maximal reduction averages approximately 25%. Nonetheless, uterine oxygen consumption is maintained. This is the result of compensation through hemoconcentration, redistribution of blood flow within the uterus, and increased oxygen extraction. A harmful effect of physical exercise on the child in utero, such as abortion, hypoxia, or growth retardation, has not been demonstrated so far. Although exercise does not seem to be harmful during normal gestation, one should be careful in case of pregnancy complications such as pregnancy-induced hypertension or premature contractions.

Embryonic and Fetal Development↗
PubMed1989

Pregnancy in a patient with diffuse cavernous hemangioma of the uterus.

This is the first reported case of successful conservative treatment of a pregnant woman with a diffuse cavernous hemangioma of the uterus. Marked autotransfusion from the hemangioma during labor contractions was clinically apparent and was confirmed by invasive hemodynamic monitoring.

Adult↗
PubMed1989

Oral glucose tolerance test is a poor predictor of hyperglycemia during pregnancy.

In an effort to assess the efficacy of the oral glucose tolerance test to detect patients with gestational diabetes mellitus who require therapeutic measures to maintain normoglycemia, we compared the results of an oral glucose tolerance test with those of a home glucose profile consisting of three postprandial glucose values in 250 pregnant women. The OGTT overestimated the occurrence of hyperglycemia by 28%, while the home glucose profile underestimated the occurrence of hyperglycemia by 5%. Pregnancy outcome was not significantly different between spontaneously normoglycemic women and those who required therapy. One cannot effectively identify the ten percent largest infants in the population by screening for gestational diabetes.

Adult↗
PubMed1987

Transabdominal cerclage for closure of the incompetent cervix.

In addition to the limited published experience with transabdominal cervical cerclage (TCC) we report the use of this procedure in 14 women with a diagnosis of cervical incompetence, and a cervical deformity or defect precluding the usual transvaginal approach. In 13 pregnant patients and in one nonpregnant woman a band was placed transabdominally around the cervix at the level of the isthmus. No significant perioperative complications occurred. Two women had two consecutive pregnancies following TCC, so we report the outcome of 16 pregnancies. Fetal salvage increased from 16% before to 94% after TCC. Our experience and an analysis of the available literature support the view that TCC may be a beneficial procedure in women with cervical incompetence due to a severely traumatized cervix.

Adult↗
PubMed1987

Fetal blood flow velocity waveforms in relation to changing peripheral vascular resistance.

In an acute experiment in Texel ewes, Doppler flow velocity waveforms from the fetal descending aorta were related to peripheral vascular resistance as calculated from perfusion pressure divided by electromagnetically measured volume flow in the descending aorta. Vascular resistance was increased by stepwise embolization of the peripheral circulation via repeated bolus administration of Sephadex G-25 microspheres. A rise in peripheral vascular resistance was associated with a reduction in peak and end-diastolic flow velocity and an increase in Pulsatility Index. Clinically, if similar changes are observed in growth retarded fetuses, the findings are usually interpreted to represent 'uteroplacental insufficiency'. Present data provide direct evidence that raised peripheral vascular resistance does indeed produce such waveform changes.

Animals↗
PubMed1986

Hemodynamic effects of caval and uterine venous occlusion in pregnant sheep.

In chronically instrumented pregnant ewes we studied the systemic, uterine, and fetal effects of increased uterine venous pressure with and without simultaneous changes in cardiac output, by occluding either the inferior vena cava or both uterine veins. Increased uterine venous pressure with no reduction in venous return of blood to the heart resulted in a reflex increase in arterial blood pressure. Infrarenal obstruction of the inferior vena cava resulted in a moderate reduction in venous return and cardiac output with no change in arterial blood pressure, while suprarenal obstruction of the inferior vena cava caused a major decrease in cardiac output as well as in arterial pressure. Uterine blood flow varied in proportion with perfusion pressure at all levels of obstruction. Uterine oxygen consumption and fetal oxygenation only decreased with suprarenal obstruction of the inferior vena cava, when uterine blood flow fell more than 50%.

Animals↗
PubMed1986

Primary hyperaldosteronism in pregnancy.

A case is reported of a primigravid woman presenting in midgestation with severe hypertension caused by primary hyperaldosteronism. Symptomatic treatment with an aldosterone blocker, a peripheral vasodilator, and a combined alpha beta-blocker allowed pregnancy to continue to 36 weeks' gestation. Cesarean section for fetal distress resulted in delivery of a dysmature female infant who did well. Further postpartum studies confirmed the presumptive diagnosis made during pregnancy. An adenoma, localized in the right adrenal gland, was surgically removed.

Adenoma↗
PubMed1986

Elevated serum transaminase levels during ritodrine administration.

Two cases are presented of the occurrence of elevated serum transaminase levels during ritodrine administration for the treatment of premature labor. The clinical course of these cases suggests that elevated transaminase levels per se do not require the discontinuation of beta-sympathomimetic tocolytic treatment.

Adult↗
PubMed1985

Maternal and fetal responses to exercise during pregnancy.

Exercise has numerous effects on the pregnant woman, the developing fetus, and the placenta. In turn, pregnancy affects the ability to perform physical activity. During pregnancy, increased metabolism at rest results almost exclusively from the gestational increase in mass. Because of this increase, a higher cardiorespiratory effort is required to perform a given amount of external work. One would expect the result to be some training effect, unless a more sedentary lifestyle is adopted. The possibility that maximal O2 consumption may increase during pregnancy has not been studied extensively, yet it is a most important variable that puts other changes in perspective. The sedentary lifestyle commonly adopted in late pregnancy in most western societies may reflect a cultural rather than a physiological phenomenon. In contrast to the physiological alterations in the mother and despite the reductions in uterine blood flow during maternal exercise, physiological changes in the fetus are small. Relatively minor changes occur in the blood concentrations of O2 and substrates during prolonged exhaustive exercise. In addition, despite a temperature increase of 1 to 2 degrees C, there is little evidence for significant alteration in fetal metabolism, cardiovascular hemodynamics, or blood catecholamine concentrations. These observations suggest that acute exercise normally does not represent a major stress for the fetus. Of course, most of the information concerning the fetus is derived from studies in experimental animals, particularly in sheep. In humans the upright position and increased uterine contractibility may affect the fetal responses differently. Virtually nothing is known about the physiological effects of exercise training on the fetus. The most likely effect may be a relatively small reduction in birth weight in some species, but this needs further investigation. Further studies are also needed for a more complete understanding of the mechanisms involved in the remarkably effective mechanisms that account for the relative homeostasis of the fetus during maternal exercise.

Animals↗
PubMed1984

The interactions of exercise and pregnancy: a review.

Increasing numbers of women engage in relatively strenuous exercise during pregnancy. The interaction of the increased metabolic demands of physical activity with those of pregnancy is poorly understood. We review what is known and what is not known of the extent to which pregnancy affects a woman's ability to perform strenuous activity and the degree to which exercise affects the pregnant woman, the fetus, and the infant.

Body Temperature↗
PubMed1984

Acute embolization of the uteroplacental circulation: uterine blood flow and placental CO diffusing capacity.

In an effort to determine to what extent the fetal sequalae following repeated embolization result from decreased area of placental exchange or from decreased uterine blood flow, we injected microspheres into the uterine circulation of the pregnant ewe. We measured total UBF continuously and sampled fetal blood gases in 6 chronically instrumented ewes following repeated injections of 1 to 2 million 25 mu microspheres into the common internal iliac artery at 30 min intervals. Embolization resulted in an immediate 25 to 30% drop in uterine flow, with partial recovery to about 85% of its control value within 30 min after injection. A linear relation existed between uterine blood flow and fetal O2 tension. A slightly accelerated decrease in O2 content with a more rapid increase in CO2 tension and [H+] was seen when uterine flow decreased below 150 ml X min-1 X kg fetal wt-1. Following repeated injections fetal descending aortic O2 tension and content decreased 34 and 82% respectively, while PCO2 and [H+] increased 28 and 84% respectively. Placental diffusing capacity for CO increased 117% after repeated embolization. Most of this increase could be accounted for by the fetal hypoxia and acidosis, although some of it may have resulted from distension or recruitment of vessels in the placental exchange area, or a more uniform distribution of placental blood flows. These studies suggest that the acute changes in fetal blood gas values following embolization result from a reduction in blood flow rather than from a reduced placental exchange area.

Animals↗
PubMed1983

Exercise responses in pregnant sheep: oxygen consumption, uterine blood flow, and blood volume.

In an attempt to explore the acute maternal responses to exercise we measured oxygen consumption, uterine blood flow, and blood volume in 13 chronically catheterized pregnant sheep at rest and while exercising on a treadmill. With maximal exercise O2 consumption increased 5.6 times, from a resting value of 5.8 +/- 0.3 (SE) to 32.1 +/- 2.8 ml X min -1 X kg -1, cardiac output increased 2.7 times, from 149 +/- 8 to 404 +/- 32 ml X min -1 X kg -1, and arteriovenous oxygen content difference increased 2.1 times, from 3.9 +/- 0.2 to 8.0 +/- 0.4 ml X dl -1. Total uterine blood flow decreased from a mean resting value of 292 +/- 6 to 222 +/- 19 ml X min -1 X kg fetus -1 near exhaustion during prolonged (40 min) exercise at 70% maximal oxygen consumption. Maternal blood volume decreased 14% (P less than 0.01) from 67.5 +/- 3.7 to 57.8 +/- 3.6 ml X kg -1 during this exercise period, with a 20% decrease in plasma volume without a change in red cell volume. We conclude that uterine blood flow decreases during maternal exercise. However, hemoconcentration helps to maintain a relatively constant oxygen delivery to the uterus.

Animals↗
PubMed1983

Exercise responses in pregnant sheep: blood gases, temperatures, and fetal cardiovascular system.

In an effort to examine the effects of maternal exercise on the fetus we measured maternal and fetal temperatures and blood gases and calculated uterine O2 consumption in response to three different treadmill exercise regimens in 12 chronically catheterized near-term sheep. We also measured fetal catecholamine concentrations, heart rate, blood pressure, cardiac output, blood flow distribution, blood volume, and placental diffusing capacity. Maternal and fetal temperatures increased a mean maximum of 1.5 +/- 0.5 (SE) and 1.3 +/- 0.1 degrees C, respectively. We corrected maternal and fetal blood gas values for the temperatures in vivo. Maternal arterial partial pressure of O2 (PO2), near exhaustion during prolonged (40 min) exercise at 70% maximal O2 consumption, increased 13% to a maximum of 116.7 +/- 4.0 Torr, whereas partial pressure of CO2 (PCO2) decreased by 28% to 27.6 +/- 2.2 Torr. Fetal arterial PO2 decreased 11% to a minimum of 23.2 +/- 1.6 Torr, O2 content by 26% to 4.3 +/- 0.6 ml X dl -1, PCO2 by 8% to 49.6 +/- 3.2 Torr, but pH did not change significantly. Recovery was virtually complete within 20 min. During exercise total uterine O2 consumption was maintained despite the reduction in uterine blood flow because of hemoconcentration and increased O2 extraction. The decrease of 3 Torr in fetal arterial PO2 and 1.5 ml X dl -1 in O2 content did not result in major cardiovascular changes or catecholamine release. These findings suggest that maternal exercise does not represent a major stressful or hypoxic event to the fetus.

Animals↗
PubMed1982

Interobserver and intraobserver variation in the assessment of antepartum cardiotocograms.

Five experienced observers assessed 100 antepartum cardiotocograms from 100 pregnant women by means of three different systems: two commonly used scoring systems and a close look at a 1-minute recording period (window). Variation between observers (interobserver) and within one observer (intraobserver) was determined by calculating the weighted kappa coefficients. Weighted kappa coefficients for interobserver variation in the Visser/Huisjes score and the Fischer score were 0.41 and 0.37, respectively. Weighted kappa coefficients for interobserver variation in a close look at a 1-minute window ranged from 0.09 to 0.69. Thus, a low level of agreement between observers was shown to exist for all three systems tested. The level of intraobserver agreement was shown to be much higher for virtually all three systems. Since the level of interobserver agreement is low, the results of different studies that describe visually assessed antepartum cardiotocograms by means of these scoring systems or 1-minute windows are not comparable, and reproducibility will be low.

Apgar Score↗