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Biomedical subjects

H E Fadel

Publications and source records attributed to H E Fadel.

At least 19 recordsLinked to original sources
PubMed1989

Effect of fetal sex and race on amniotic fluid lecithin concentration.

Amniotic fluid lecithin phosphorus concentration (AF-Lec) was measured in 209 healthy women at 31.7-42.7 weeks gestation. The patients were divided into four groups according to race and fetal sex. No differences in AF-Lec between black and white nor between male and female fetuses were found. The relationship of AF-Lec to gestational age and the incidence of "mature" AF-Lec was not different among the four groups. We conclude that there is no effect of fetal sex, race, or the interaction between them on fetal lung development as measured by AF-Lec.

Adult↗
PubMed1989

Antenatal diagnosis of fetal intracranial anomalies.

Defects in the central nervous system (CNS) are the most devastating of the various fetal malformations that can be sonographically diagnosed. The sonographer often initiates a decision-making process that presents the patient with difficult options. An accurate and reliable sonographic diagnosis becomes an essential part of this evolving aspect of obstetric care. In this paper, some of the major defects of the CNS that have been diagnosed sonographically are presented with a brief outline of the pathologic features, diagnostic features, the prognosis, as well as management options. Most of these malformations are serious enough so that termination of pregnancy is usually offered if the diagnosis is made prior to the age of viability and, for some malformations (ie, hydranencephaly, alobar holoprosencephaly), even later. Intrauterine treatment, principally ventriculoamniotic shunting, remains an investigational procedure. A diagnosis of a serious or lethal malformation allows the obstetrician to choose not to perform a cesarean section because of fetal distress or dystocia due to macrocephaly in such "doomed" fetuses. On the other hand, cesarean section may be the preferred route of delivery for fetuses with other malformations (eg, meningomyelocele).

Abnormalities, Multiple↗
PubMed1989

Factor VII deficiency and pregnancy.

Hereditary factor VII deficiency is very rare in pregnancy (one in 500,000). However, obstetricians should consider this diagnosis whenever the prothrombin time is prolonged while the activated partial thromboplastin time is normal. The factor VII level increases in normal pregnancy, but the effect of pregnancy upon the factor VII level in deficient individuals is unknown. We report two cases of factor VII deficiency in pregnancy. In both, factor VII levels were 15% or less in the third trimester and were lower postpartum, suggesting that pregnancy does elevate factor VII in deficient individuals as well. Fresh frozen plasma is the treatment of choice. If the level is very low, fresh frozen plasma can be given prophylactically; otherwise, it should be given if blood loss becomes excessive.

Adolescent↗
PubMed1988

Fetal lung maturity in diabetic pregnancies: relation among amniotic fluid insulin, prolactin, and lecithin.

Insulin, prolactin, and lecithin phosphorus levels were measured in 97, 62, and 44 amniotic fluid samples from third trimester normal, gestational diabetic, and insulin-dependent diabetic patients, respectively. There was no difference in lecithin phosphorus concentration (index of fetal lung maturity) among the three groups. The amniotic fluid insulin level was significantly higher in insulin-dependent diabetic patients, whereas there was no difference in amniotic fluid prolactin levels among the groups. Correlations of amniotic fluid prolactin levels with both lecithin phosphorus and insulin levels were not statistically significant in any of the groups. This is probably because amniotic fluid prolactin is decidual, rather than fetal, in origin. Even though amniotic fluid insulin levels, which reflect fetal levels, were significantly higher in insulin-dependent diabetic patients, there was no difference in the amniotic fluid lecithin phosphorus concentration in diabetic pregnancies compared with that in normal pregnancies. Moreover, there was a positive, and not a negative, correlation between amniotic fluid insulin and amniotic fluid lecithin phosphorus levels in diabetic pregnancies. These results do not support the theory that fetal hyperinsulinemia results in delayed pulmonic maturation in diabetic pregnancies.

Adult↗
PubMed1988

Intrauterine resolution of nonimmune hydrops associated with cytomegalovirus infection.

Intrauterine resolution of a case of nonimmune hydrops fetalis associated with cytomegalovirus infection occurred during conservative antenatal management. Although the etiology for a case of nonimmune hydrops diagnosed antenatally is often obscure, a systematic investigation provided an antenatal diagnosis of cytomegalovirus infection, permitting expectant management and eventual vaginal delivery at term.

Adult↗
PubMed1988

Anaphylaxis to human serum albumin.

During her 26th week of pregnancy a 20-year-old woman developed generalized pruritus, urticaria, flushing, tinnitus, and tachycardia during plasmapheresis with 5% human serum albumin (HSA) as adjunctive treatment for anti-Kell isoimmunization. The reaction was controlled with intravenous diphenhydramine. Despite pretreatment with diphenhydramine and betamethasone a subsequent attempt to perform plasmapheresis with infusion of 5% HSA resulted in a more severe reaction which progressed to respiratory distress. Intradermal skin testing with 5% HSA produced a 9 x 11-mm wheal and 17 x 21-mm erythema at 15 minutes. An enzyme-linked immunoassay was positive for IgE antibody to 5% HSA before and after dialysis for removal of Na caprylate. These results are consistent with an IgE-mediated basis for this patient's reaction to HSA.

Adult↗
PubMed1987

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy.

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31% in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.

Adolescent↗
PubMed1987

The reliability and clinical use of a rapid phosphatidylglycerol assay in normal and diabetic pregnancies.

Lecithin phosphorus concentration, the standard fetal lung maturity test in our institution, and phosphatidylglyercol were assayed in 69, 29, and 45 amniotic fluid samples from normal (GI), gestational (GII), and insulin-dependent diabetic (GIII) women by means of thin layer chromatography and Amniostat-FLM, respectively. Lecithin phosphorus concentration greater than or equal to 0.1 mg/dl and positive or strong positive Amniostat-FLM results were considered mature. The results of both assays were concordant in 79% of the samples. The discordance rate was highest in GIII patients. In our experience, respiratory distress syndrome did not develop in neonate infants of diabetic women delivered after a mature lecithin result. With lecithin phosphorus concentration as the reference standard, the predictive value of a mature Amniostat-FLM result was 96.2%, whereas that of an immature result was 58.5%. Respiratory distress syndrome occurred in only two GIII neonates who were delivered within 72 hours of both immature lecithin and Amniostat-FLM results. These findings support the use of Aminostat-FLM as a screening test for fetal lung maturity in both normal and diabetic pregnancies. Additional tests will be necessary to evaluate further fetal lung maturity only if the results are negative.

Adult↗
PubMed1987

Pleural effusions and pulmonary hypoplasia.

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Adult↗
PubMed1987

Cardiovascular effects of ritodrine tocolysis: a new noninvasive method to measure pulmonary capillary pressure during pregnancy.

The cardiovascular effects of ritodrine tocolytic therapy were assessed by noninvasive simultaneous recordings of indirect carotid pulse, electrocardiogram (ECG), phonocardiogram, and M-mode echocardiogram in 12 patients in preterm labor. The study was performed before and during infusion, and afterward when the patient was on oral drug therapy. Ritodrine therapy increased heart rate, left ventricular fractional shortening, pre-ejection period/left ventricular ejection time ratio, and cardiac index. A progressive rise in pulmonary capillary pressure was observed in all patients, exceeding 18 mmHg (the threshold for the development of pulmonary congestion) in six patients. Systolic arterial pressure, left ventricular end-diastolic dimension, and plasma protein oncotic pressure remained unchanged during therapy. Ritodrine therapy resulted in a significant drop in diastolic blood pressure and peripheral vascular resistance. This noninvasive means of measuring cardiovascular parameters, including pulmonary capillary pressure, may be useful in monitoring patients who develop significant cardiovascular side effects during tocolytic therapy.

Echocardiography↗
PubMed1986

Effect of maternal-fetal disorders on lung maturation. I. Diabetes mellitus.

Amniotic fluid for fetal lung maturity studies was obtained from 287 healthy and 198 diabetic women. Classes of diabetes were as follows: Class A, 111; Class B, 58; Class C, 13; Class D, 11; Class F, 4; and Class R, 1. The regression lines representing the relationship of amniotic fluid lecithin phosphorus concentration to gestational age at amniocentesis in each of the groups of diabetic patients were not statistically different from those of the control subjects. Each of the diabetic patients was then matched with a control subject of the same race, sex of newborn infant, and gestational age at amniocentesis. The regression lines of the nonhypertensive, hypertensive, and all diabetics were not different from those of their respective matched control subjects. Also there was no difference in the proportion of mature lecithin phosphorus concentrations at different weeks between diabetic and normal women. The absence of a significant influence of diabetes on fetal lung maturation is probably due to improvement in diabetic control resulting in normalization of the fetal metabolic environment.

Amniocentesis↗
PubMed1986

Indirect antiglobulin test and anti-D prophylaxis in hereditary persistence of fetal hemoglobin.

The indirect antiglobulin test was used to assess the efficacy of anti-D prophylaxis in two Rh negative women with hereditary persistence of fetal hemoglobin. Saturation of all D sites by passive antibody should be followed by indirect antiglobulin positivity due to excess administered anti-D. In hereditary persistence of fetal hemoglobin, all red cells have fetal hemoglobin making the acid elution test (Kleihauer-Betke smear) to detect feto-maternal hemorrhage useless. The indirect antiglobulin test is recommended in patients with hereditary persistence of fetal hemoglobin.

Adult↗
PubMed1986

Blood loss at vaginal delivery.

Although the accurate assessment of blood loss at vaginal delivery is clinically important in terms of maternal morbidity and mortality, the quantity is usually underestimated. We present a simple, practical, and convenient method of quantitating blood loss at vaginal delivery. The method of vaginal delivery (spontaneous versus forceps) does not significantly affect blood loss; an episiotomy, a laceration, or both may.

Amniotic Fluid↗
PubMed1986

Detection and quantitation of fetomaternal hemorrhage.

Failure to administer additional doses of Rh immune globulin (RhIG) to patients with excessive fetomaternal hemorrhage (FMH) is one of the causes of continued Rh isoimmunization. We compared the fetal cell ratio (FCR) with the other laboratory methods currently used at our hospital to quantitate FMH, ie, fetal cell preparation (FCP), RhIG cross-match with maternal serum, and indirect Coombs' testing 24 to 48 hours after administration of RhIG. The incidence of excessive FMH as detected by the various methods was 3.6% (cross-match), 9.6% (Coombs'), 18% (FCP), and 66% (FCR). The methods currently used do not accurately quantify FMH. The FCR is the most sensitive test but it has a high false-positive rate and thus does not appear to be clinically useful. We suggest that repeating the indirect Coombs' test may provide a practical alternative for determining the need for additional doses of RhIG.

Adolescent↗
PubMed1986

Pregnancy outcome in renal transplant recipients: experience at the Medical College of Georgia and review of the literature.

Between 1970 and 1982, 13 renal transplant recipients had 17 pregnancies with follow-up at the Medical College of Georgia (MCG). Nine patients received related donor grafts and four received cadaver kidneys; 11 mothers survived their pregnancies. Preeclampsia, urinary tract infections, and preterm labor were frequent complications. complications. Perinatal complications were rare, and 12 of 13 continuing pregnancies produced surviving infants. Only one infant had congenital abnormalities (premature closure of the fontanelles and umbilical hernia). We present maternal and neonatal details, with prognostic considerations for pregnancy in such patients.

Abnormalities, Multiple↗
PubMed1986

Glycosylated hemoglobin and protein levels in normal and diabetic pregnancies: relation to birth weight.

Glycosylated hemoglobin and protein were measured in maternal and cord blood of 24 normal, 19 class A, and ten insulin-treated diabetics using an affinity chromatographic technique. Maternal (intrapartum) glycohemoglobin and glycoprotein levels in the diabetics were not significantly different from those in normal controls, suggesting "tight" metabolic control in these patients. Compared with controls, cord blood glycohemoglobin and glycoprotein levels were significantly higher in insulin-treated, but not in class A, diabetics. The birth weight ratio correlated significantly only with maternal glycohemoglobin in insulin-treated diabetics. The results suggest that: even in well-controlled insulin-treated diabetics, the fetuses are hyperglycemic; maternal glycohemoglobin correlates with birth weight in insulin-treated diabetics; maternal glycoprotein determinations cannot be used to predict birth weight; hyperglycemia cannot be the sole determinant of fetal overgrowth in diabetic pregnancies; factors influencing fetal overgrowth in class A and insulin-treated diabetics may be different.

Adult↗
PubMed1985

Indications for and timing of delivery in diabetic pregnancies.

The management of 430 diabetic pregnancies is presented. Our protocol emphasized "tight" metabolic control and assessment of fetal well-being by antepartum fetal heart rate testings and estriol levels. Spontaneous labor was allowed in uncomplicated Class A diabetic patients. Labor in complicated cases and insulin-dependent diabetic pregnancies was induced after establishing fetal lung maturity, except when a maternal or fetal complication dictated otherwise. A significant drop in estriol was observed in 4% of Class A diabetic patients and 10.2% of insulin-dependent diabetic patients. None developed a positive contraction stress test. Abnormal fetal well-being tests contributed minimally to the indications for induction of labor. The incidence of induced preterm delivery was 2.8% in Class A diabetic patients and 18.4% in insulin-dependent diabetic ones. The perinatal mortality was 5.6:1000 and 13:1000, respectively. The incidence of respiratory distress syndrome was very low, and none of the cases were associated with a "mature" amniotic fluid lecithin phosphorus measurement.

Adult↗