Search PubMed⌕ Search

Biomedical subjects

G R DeVore

Publications and source records attributed to G R DeVore.

At least 37 records · Page 2Linked to original sources
PubMed1993

Circulating intercellular adhesion molecule-1 in amniotic fluid, maternal serum alpha-fetoprotein levels, and intrauterine growth retardation.

OBJECTIVE: Our purpose was to determine if circulating intercellular adhesion molecule-1, a marker of chronic inflammation, is present in amniotic fluid in midtrimester, is increased in patients with elevated maternal serum alpha-fetoprotein level, and is associated with intrauterine growth retardation. STUDY DESIGN: Amniotic fluid circulating intercellular adhesion molecule-1 levels were assayed by enzyme-linked immunoassay in 273 samples obtained by midtrimester amniocentesis in gestations involving a single, structurally normal fetus. The control group consisted of 108 patients with normal maternal serum alpha-fetoprotein levels and 165 patients with elevated levels. Intrauterine growth retardation was diagnosed if birth weight was < 10th percentile for the clinically estimated gestational age. RESULTS: Circulating intercellular adhesion molecule-1 was detectable in amniotic fluid in 105 of 273 samples (38%). In the control group it was detectable in amniotic fluid in seven of 108 (6%). In patients with elevated maternal serum alpha-fetoprotein 97 of 164 (59%) had detectable levels (p < 0.001). Of the 273 cases 38 (14%) had intrauterine growth retardation. Of these 23 (59%) had detectable circulating intercellular adhesion molecule-1 levels (p < 0.001). Of the seven cases of intrauterine growth retardation with normal maternal serum alpha-fetoprotein levels, one (14%) had detectable circulating intercellular adhesion molecule-1. Of the 31 cases of intrauterine growth retardation with elevated maternal serum alpha-fetoprotein 22 (71%) had detectable circulating intercellular adhesion molecule-1. When circulating intercellular adhesion molecule-1 was detectable in amniotic fluid, increasing levels was significantly related to decreasing gestational age at delivery (p < 0.005). CONCLUSIONS: Midtrimester amniotic fluid from normal pregnancies does not generally contain detectable circulating intercellular adhesion molecule-1. Detectable amniotic fluid levels are significantly related to a birth weight < 10th percentile at delivery and to elevated midtrimester maternal serum alpha-fetoprotein levels. Increasing circulating intercellular adhesion molecule-1 levels are related to shortened length of gestation. This test may contribute to risk assessment for intrauterine growth retardation and prematurity. Circulating intercellular adhesion molecule-1 is a known marker of inflammatory processes; its further study may also improve understanding of the pathophysiologic mechanisms of certain cases of intrauterine growth retardation and prematurity.

Amniotic Fluid↗
PubMed1993

Fetal echocardiography: factors that influence imaging of the fetal heart during the second trimester of pregnancy.

OBJECTIVE: The four-chamber view of the heart is an important component of the ultrasonographic examination of the fetus. However, during the second trimester of pregnancy the fetal heart cannot always be imaged in every patient. The purpose of this study was to ascertain the rate of successful imaging of the fetal heart during the second trimester and to determine factors that may influence imaging. METHODS: Seven hundred and nine second trimester fetuses were examined and an attempt was made to obtain the four-chamber and outflow tract views of the heart. Analysis included multiple logistic regression models of the main effects and interactions of ten candidate variables. RESULTS: The four chambers and outflow tracts were imaged in 643 fetuses (90.7%) and not imaged in 66 (9.3%). Fifty-two of 709 patients (7.3%) had had previous surgery. In the 52 patients with a history of previous surgery, the heart could not be imaged in 18 (34%). Six hundred and fifty-seven patients (92.7%) did not have previous surgery. Of this group, the fetal heart could not be imaged in 48 (7.3%). In only one fetus in which the heart could not be imaged was it because of fetal position. Three independent risk factors that influenced imaging of the fetal heart were gestational age, maternal adipose tissue thickness, and previous lower abdominal surgery. Increasing gestational age increased the probability of imaging the heart, whereas increasing adipose tissue thickness and a history of previous surgery decreased the probability of imaging the heart. COMMENTS: When the fetal heart cannot be imaged during the second trimester, these factors should be identified. Using data from this study, the gestational age at which the highest probability of imaging the heart can be determined if the thickness of the adipose tissue and a history of lower abdominal surgery are known.

Abdomen↗
PubMed1993

Simultaneous Doppler recording of the pulmonary artery and vein: a new technique for the evaluation of a fetal arrhythmia.

We describe a new technique to evaluate cardiac rhythm using color and pulsed Doppler ultrasonography to identify and record pulmonary arterial and venous waveforms. Fifty fetuses were examined during the second and third trimesters of pregnancy. Simultaneous pulsed Doppler recording of the pulmonary artery and vein was obtained in 100% of fetuses between 15 and 40 weeks' gestation. Atrial systole was identified from the pulmonary vein and was manifested by an interruption of venous flow. Ventricular systole was manifested by a sharp peak that returned toward the baseline before it continued through the duration of systole as a lower-velocity waveform. This technique has the following advantages: (1) the lung parenchyma is easily accessible, irrespective of fetal position; (2) the pulmonary arteries and veins are adjacent to each other as they enter and exit the lung, thus making it easy to simultaneously obtain Doppler recordings of these vessels; (3) the pulsed Doppler waveform has an appearance similar to an electrocardiogram.

Adult↗
PubMed1992

Screening for Down syndrome with the femur length/biparietal diameter ratio: a new twist of the data.

OBJECTIVE: The purpose of this study was to determine the value of discordant morphometric measurements as identifiers of Down syndrome by evaluating the relationship of biparietal diameter, femur length, biparietal diameter/femur length ratio, and cephalic index between a group of fetuses with trisomy 21 and a control population. STUDY DESIGN: Biometric measurements from 48 fetuses with trisomy were reviewed and compared with 107 normal fetuses of similar gestational age. Data were analyzed in 2-week gestational age intervals to determine the effect of gestational age on ultrasonographic detection of Down syndrome. Outcome measures were subject to least-squares linear regression and the t test for analysis. RESULTS: A positive relationship between abnormal morphometric measurements and fetuses with Down syndrome was detected but only during specific weeks of pregnancy. CONCLUSION: Although it appears that biometric measurements may be useful for Down syndrome, further study is needed before its widespread introduction into clinical practice.

Down Syndrome↗
PubMed1992

The effect of altitude on the umbilical artery Doppler resistance.

This study examined whether there were differences between the umbilical artery systolic-diastolic (S/D) ratio and resistance index (RI) in patients with normal fetuses living at sea level (group I) and those living between 4,200 and 4,500 feet above sea level (group II). Linear regression demonstrated a significant association (P less than 0.001) between gestational age and the S/D ratio and RI for groups I (n = 100) and II (n = 128). Least-squares regression analysis demonstrated no significant differences in slopes or intercepts between groups I and II. The results would suggest that altitude, up to 4,500 feet above sea level, does not affect umbilical artery Doppler resistance in normal fetuses.

Altitude↗
PubMed1992

The aortic and pulmonary outflow tract screening examination in the human fetus.

Imaging of the aortic and pulmonic outflow tracts in the fetus may be difficult owing to fetal position. This study describes two screening methods for imaging the outflow tracts, depending on whether the interventricular septum was tangential (group I) or perpendicular (group II) to the ultrasonic beam. We performed 170 examinations during the second and third trimesters of pregnancy. The outflow tracts were imaged in 166 (97.6%). Fetuses in group I were identified much less frequently (13.2%) than fetuses in group II (86.8%). This study would suggest that for the outflow tracts to be imaged during a screening examination, the sonographer should become familiar with the sonographic anatomy of the outflow tracts when the interventricular septum is perpendicular to the ultrasound beam.

Aorta↗
PubMed1991

The use of fetal echocardiography for predicting intrapartum fetal heart rate patterns in the post-term pregnancy.

One of the shortcomings of antepartum testing in the post-term pregnancy is that it does not identify the majority of fetuses who develop abnormal intrapartum fetal heart rate changes. The purpose of this study was to determine whether antenatal cardiovascular evaluation could aid in the identification of post-term fetuses at risk for intrapartum heart rate abnormalities. Seventy-five patients with a gestational age greater than 41 weeks underwent a non-stress test, amniotic fluid index and real-time assessment of the heart for the presence or absence of a pericardial effusion. M-mode measurements of the right ventricular inner dimension (RVID), left ventricular inner dimension (LVID), biventricular outer dimension (BVOD) and Doppler velocimetry of the umbilical artery (S/D) were performed. Group I (n = 32) had normal intrapartum heart rate tracings. Group II (n = 20) had abnormal intrapartum fetal heart rate tracings but did not undergo emergency delivery. Group III (n = 23) had abnormal intrapartum fetal heart rate tracings but underwent emergency delivery. When comparing Group I with Group II, the latter had significant differences for abnormal RVID, RVID/LVID ratio, and pericardial effusion. When comparing Groups I and III, there were significant differences for RVID, RVID/LVID ratio, pericardial effusion, BVOD, LVID and amniotic fluid index. Neither the non-stress test nor S/D predicted abnormal intrapartum fetal heart rate patterns. For prediction of abnormal intrapartum heart rate patterns, the sensitivities of the RVID (0.79), LVID (0.33), RVID/LVID ratio (0.72) and BVOD (0.63) were 1.7-4 times greater than the non-stress test (0.19) and the sensitivities of the RVID, RVID/LVID ratio and BVOD were 2 times greater than the amniotic fluid index (0.28). The positive (0.50-0.86) and negative (0.42-0.68) predictive values were similar for all groups. To predict emergency delivery associated with abnormal heart rate tracings, the sensitivities of the RVID (0.83), RVID/LVID ratio (0.70) and BVOD (0.65) were 2.5-3 times greater than the non-stress test (0.26) and 1.5 times greater than the amniotic fluid index (0.39). The positive (0.36-0.56) and negative (0.70-0.86) predictive values were similar. The presence of pericardial effusion had a higher sensitivity than the non-stress test and amniotic fluid index for predicting abnormal intrapartum heart rate patterns but not emergency delivery. Doppler velocimetry of the umbilical artery had a lower sensitivity than the non-stress test and amniotic fluid index for predicting intrapartum heart rate patterns as well as identifying the fetus needing emergency delivery. The results of this study would suggest that there is initially dilatation of the right ventricle which may be associated with abnormal intrapartum fetal heart rate patterns. However, when the left ventricle dilates, leading to cardiomegaly, there is a greater incidence of abnormal intrapartum fetal heart rate changes and associated emergency delivery. The amniotic fluid index appears to be a later finding for predicting abnormal intrapartum fetal heart rate changes.

Journal Article↗
PubMed1990

Performing cytogenetic studies on ascitic, amniotic and hygroma fluid.

The importance of obtaining cytogenetic studies on antenatally diagnosed structural malformations is well recognized. In two cases, three fetal compartments were sampled, each resulting in successful cytogenetic studies. Fluid was obtained under ultrasound guidance from amniotic fluid, fetal ascites and cystic hygroma fluid. Fluid from the hygroma itself may be the easiest compartment to analyze.

Amniocentesis↗
PubMed1989

Fetal heart rate transmission with the facsimile telecopier in rural areas.

Over a 30-month period, 24 portable facsimile telecopiers were placed in rural hospitals with delivery services, allowing 24-hour direct transmission of fetal heart rate tracings for consultation. An analysis of the first 209 intrapartum fetal heart rate strips is presented. Variable decelerations were the most frequent indication for consultation, but they were less commonly interpreted as indicating fetal distress. Such units have major advantages in terms of both cost and versatility over previously described systems and have proved extremely valuable to the rural practitioner of obstetrics.

Electrocardiography↗
PubMed1989

A comparative study of fetal umbilical velocimetry with continuous- and pulsed-wave Doppler ultrasonography in high-risk pregnancies: relationship to outcome.

Systolic/diastolic ratios of umbilical velocimetry obtained with either continuous-wave or pulsed-wave Doppler ultrasonography have been used to assess downstream placental vascular resistance and fetal well-being. The purpose of this study is to compare the efficacy of systolic/diastolic ratios obtained by continuous-wave and pulsed-wave Doppler ultrasonography in the prediction of poor pregnancy outcome. Continuous-wave and pulsed-wave umbilical velocimetry was performed and systolic/diastolic ratios were measured in 200 high-risk pregnancies in the third trimester by use of Angioscan III and a General Electric RT 3600 scanner, respectively. A total of 165 study participants had normal systolic/diastolic ratios and 35 participants had elevated ratios (greater than 3.0) with both continuous-wave and pulsed-wave Doppler ultrasonography. Both methods identified 35 participants with abnormal ratios, and none of the women was misclassified by either method. The pulsed-wave and continuous-wave values for 35 participants with elevated ratios were 6.35 +/- 1.52 and 6.23 +/- 1.58, respectively; values for 165 participants with normal ratios were 1.95 +/- 0.40 and 1.96 +/- 0.41, respectively (not significantly different). Participants with elevated systolic/diastolic ratios within 7 days of delivery had significantly higher incidence of adverse pregnancy outcome as judged by small-for-gestational-age fetuses, presence of meconium at delivery, fetal distress in labor, cesarean sections and 5-minute Apgar scores less than 7. Fetuses with elevated ratios were delivered at an earlier gestational age (34 +/- 1.2 weeks), had lower birth weights (1422 +/- 151 gm), and spent more time in the neonatal intensive care unit (17.1 +/- 5.2 days), compared with fetuses with normal ratios (delivered at 38.5 weeks +/- 0.9 weeks, 3100 +/- 210 gm birth weights, and 2 +/- 0.2 days spent in neonatal intensive care units, respectively, p less than 0.05). We therefore conclude that continuous-wave and pulsed-wave Doppler ultrasonography produce similar results with regard to systolic/diastolic ratios in high-risk pregnancies, and either method appears to be a valuable adjunct in the surveillance of high-risk pregnancies.

Apgar Score↗
PubMed1989

Central hemodynamic assessment of normal term pregnancy.

Ten carefully screened primiparous patients between 36 and 38 weeks' gestation underwent pulmonary artery catheterization, arterial line placement, and central hemodynamic assessment in the left lateral recumbent position. Studies were repeated in the same patients between 11 and 13 weeks post partum. Compared with the nonpregnant state, there was a significant fall in systemic vascular resistance, pulmonary vascular resistance, colloid oncotic pressure, and colloid oncotic pressure-pulmonary capillary wedge pressure gradient by the late phase of the third trimester (p less than 0.05). Pregnancy was associated with a significant rise in cardiac output and pulse in all patients (p less than 0.05). There was no significant change in pulmonary capillary wedge pressure, central venous pressure, left ventricular stroke work index, or mean arterial pressure. Normally the late phase of the third trimester is not associated with hyperdynamic left ventricular function as assessed by the left ventricular stroke work index/pulmonary capillary wedge pressure ratio.

Adult↗
PubMed1988

Qualitative assessment of maternal uterine and fetal umbilical artery blood flow and resistance in laboring patients by Doppler velocimetry.

The purpose of this study is to evaluate the effect of uterine contractions during labor on both the uterine and the umbilical circulations. Twenty-seven patients in active labor were studied by continuous-wave Doppler velocimetry. Umbilical, left uterine, and right uterine arterial waveforms were obtained before, during, and after peak uterine contractions, and the ratio of maximum systolic and minimum diastolic velocities was calculated. Fifteen patients showed absent flow in end diastole on the uterine artery waveform and had significantly higher intra-amniotic pressures (64.5 +/- 3.5 mm Hg) during the peak amplitude of the uterine contraction compared with the 12 patients with maintained end diastolic flow (46.5 +/- 2.6 mm Hg; p less than 0.05). During the peak amplitude of the uterine contractions the 12 patients maintaining end-diastolic flow had significantly higher systolic/diastolic ratios in the uterine artery (6.5 +/- 1.5) compared with either before or after a contraction (2.1 +/- 0.15 and 2.0 +/- 0.2, respectively; p less than 0.05). Also, these 12 patients showed a linear relationship between the systolic/diastolic ratio and the intrauterine pressure. However, no differences were observed in the umbilical artery systolic/diastolic ratios before, during, or after a contraction in the intensity range studied. On the contrary, during contractions an increase in uterine artery resistance occurs with decreased or absent end-diastolic flow, which bears an inverse linear relationship to the intensity of the contraction. This suggests that during uterine contractions the human fetus continues to have uninterrupted fetoplacental blood flow, whereas the degree of interruption or reduction in uteroplacental blood flow is dependent on the intensity of uterine contraction.

Adult↗
PubMed1988

Fetal echocardiography. VIII. Aortic root dilatation--a marker for tetralogy of Fallot.

Tetralogy of Fallot has increased in incidence during the past decade. Although abnormalities of the four-chamber screening examination of the fetal heart identifies structural anomalies associated with semilunar and atrioventricular valve hypoplasias, the anomalies associated with tetralogy of Fallot are not as readily identifiable from the four-chamber view alone. This study was designed to determine whether aortic root dilatation, commonly observed in the newborn with tetralogy of Fallot, is a marker for tetralogy of Fallot diagnosed in utero. In 45 normal (control) fetuses the biparietal diameter, head circumference, abdominal circumference, and femur length were measured and M-mode measurements were made of the biventricular outer dimension and aortic root dimension. The aortic root dimension from seven fetuses (18, 19, 20, 23, 32, 33, and 34 weeks' gestation) with tetralogy of Fallot was increased in dimension when compared with cardiac (biventricular outer dimension) and noncardiac biparietal diameter, head and abdomen circumferences, and femur length parameters. In conclusion, incorporation of aortic root imaging with the four-chamber view of the fetal heart during a routine screening examination allows for identification of fetuses with tetralogy of Fallot.

Adult↗
PubMed1988

Maternal and fetal blood flow velocity waveforms in patients with preterm labor: prediction of successful tocolysis.

Umbilical and uterine artery velocimetry was performed using continuous-wave Doppler ultrasound (Angioscan III) in 60 patients in preterm labor. Peak-systolic/end-diastolic ratios were calculated according to previously described techniques. All measurements were made before tocolytic therapy was begun: magnesium sulfate (n = 40) or ritodrine (n = 20). The mean gestational age was 33.1 +/- 1.5 weeks (range 29 to 36 weeks). Twelve (20%) patients had elevated (greater than 2.6) pretherapy uterine peak-systolic/end-diastolic ratios, 10 (16.7%) patients had elevated (greater than 3.5) pretherapy umbilical peak-systolic/end-diastolic ratios, and in eight (13.3%) patients both ratios were elevated. In seven (58.4%) of the 12 patients with elevated uterine peak-systolic/end-diastolic ratios, six (60%) of the 10 patients with elevated umbilical peak-systolic/end-diastolic ratios, and five (62.5%) of the eight patients with both ratios elevated tocolytics failed and the women were delivered within 48 hours, compared with seven (14.6%) of 48, eight (16%) of 50, and six (13.0%) of 46 with normal ratios, respectively (p less than 0.05). We conclude that patients in preterm labor with elevated pretherapy uterine and/or umbilical peak-systolic/end-diastolic ratios are more likely to fail tocolysis therapy and be delivered preterm than those with normal ratios. It may therefore be useful to include umbilical and uterine velocimetry in the initial evaluation of preterm labor.

Adult↗
PubMed1988

Prenatal diagnosis of cysts of the fetal choroid plexus.

Over a two-year period, cysts of the fetal choroid plexus were diagnosed prospectively by routine second-trimester ultrasonography in five patients, representing 0.18% of the population scanned for standard obstetric indications. Gestational age at the time of diagnosis ranged from 16-22 weeks. The cysts were located in the posterior portion of the choroid plexus within the lateral ventricle. The maximum diameter ranged from 3-14 mm. In two cases, the cyst was noted to be bilocular. No additional anomalies were detected in any fetus. Follow-up sonography two to five weeks after the initial scan documented disappearance of the cysts in all cases. The course of pregnancy in these patients was otherwise uneventful, and all infants were normal physically and neurologically both at the time of birth and between four and 24 months of follow-up.

Brain Diseases↗