Biomedical subjects
Publications and source records attributed to H E Fox.
Adverse pregnancy outcome in diethylstilbestrol-exposed progeny has been described by many authors. These three cases demonstrate many of the features discussed in the literature as well as a previously unreported cause of antepartum and intrapartum bleeding: a cervical vascular malformation.
Transvaginal collection of amniotic fluid and the use of a reliable test for fetal lung maturity will provide information needed in the management of patients with premature rupture of the membranes.
Hypoplasia of the fetal lung is found in association with long-standing oligohydramnios. In animal models, interference with fetal breathing activity has led to lung hypoplasia. It has been suggested that lung hypoplasia associated with oligohydramnios is due to inhibition of fetal breathing. Observations of seven patients with prolonged oligohydramnios, three of whom had lung hypoplasia, indicate that fetal breathing does occur in these cases and that is unlikely that lung hypoplasia is merely the result of absent fetal breathing activity. In fact, when compared to the four patients with oligohydramnios and presumably normal lungs, the three patients with oligohydramnios and lung hypoplasia spent more time breathing and did so at higher rates.
We measured serum concentrations of calcium and parathyroid hormone in seven pregnant women who were receiving intravenous magnesium sulfate for the suppression of premature labor. After administration of magnesium sulfate, the mean (+/- S.E.M.) serum magnesium level rose rapidly from the normal base-line level of 2.0 +/- 0.2 mg per deciliter to 6.1 +/- 0.4 mg per deciliter (0.8 +/- 0.1 to 2.5 +/- 0.2 mmol per liter) (P less than 0.001) at 30 minutes and remained markedly elevated. Concentrations of total and ionized calcium fell gradually in all subjects from normal base-line concentrations, 8.6 +/- 0.2 and 4.4 +/- 0.1 mg per deciliter (2.2 +/- 0.1 and 1.1 +/- 0.03 mmol per liter), respectively, into the hypocalcemic range, reaching a nadir of 7.6 +/- 0.2 and 3.9 +/- 0.1 mg per deciliter (1.9 +/- 0.1 and 0.98 +/- 0.03 mmol per liter), respectively, at three hours (P less than 0.001). Parathyroid hormone levels fell rapidly in response to magnesium infusion, from 13.1 +/- 2.5 to 7.8 +/- 0.7 pg per milliliter at 30 minutes, and were significantly below base-line levels for two hours despite frank hypocalcemia. These results suggest that hypermagnesemia rapidly decreases the secretion of parathyroid hormone in vivo in human subjects and that parathyroid hormone levels remain depressed despite concomitant hypocalcemia. The results also suggest that the hypocalcemia associated with hypermagnesemia may be due in part to the suppressive effects of hypermagnesemia on parathyroid hormone secretion.
We have reviewed the outcome for low birth weight infants in a designated Level 2 hospital. In New York City, hospitals are classified as Level 1, Level 2 and Level 3; the latter being the large tertiary center. St. Luke's-Roosevelt Hospital Center, Roosevelt Division is a Level 2 institution modified by components of Level 3 expertise. The data presented spans 10 years comparing results before (Level 2) and after (Level 2+) upgrading of services. The survival of very low birth weight infants improved as a result of the change and is comparable to the tertiary center. The factors are discussed. It is concluded that an institution can decide on the lowest gestational age and/or birth weight to be managed within its perinatal service.
The relative effects of 3 stimuli in the release of vasopressin (VP) by the fetus were examined in 19 chronically instrumented fetal lambs, 118-135 days gestational age. The fetus was exposed to: 1) 30-min administration of 10% O2 to the pregnant ewe, 2) 20 min of partial occlusion of the umbilical cord, or 3) 2 min of complete occlusion of the umbilical cord. Twelve studies were conducted for each of these experimental protocols. The rises (mean +/- SE) in plasma VP in the 3 groups were 29.9 +/- 8.9, 48.9 +/- 11.5, and 157.8 +/- 12.5 pg/ml, respectively; the corresponding falls in PaO2 were 9.2 +/- 0.7, 7.7 +/- 0.9, and 12.7 +/- 1.2 mm Hg. pHa did not change in the group receiving 10% O2, fell by 0.11 +/- 0.02 and 0.14 +/- 0.01 after partial and complete occlusion of the umbilical cord. The rises in mean arterial pressure were 6 +/- 2.2, 10 +/- 1.9, and 23 +/- 3.1 mm Hg, respectively, at the end of the 3 procedures. The rise in plasma osmolality ranged from 2-8 mosmol/kg in all 3 groups. Linear regression analyses showed that log VP was negatively correlated with PaO2 (r = -0.827; P less than 0.01) and pHa (r = -0.706; P less than 0.01) and positively correlated to mean arterial pressure (r = 0.607; P = 0.01), but was not significantly correlated to plasma osmolality. Our present findings suggest that hypoxemia and acidemia are associated with and may both be potent stimuli for VP release in the hypoxic fetus. Increased release together with decreased rate of metabolism by the placenta offer an explanation for the very high VP levels found in the neonate after labor and delivery.
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Human fetal breathing movements were observed by means of the linear array real-time B-scan technique in 40 study sessions at 35 to 36 week's gestation. Fasting and nonfasting subjects received water or 75 gm of glucose orally. Fetal breathing activity, observed as movement of the chest wall, was analyzed. The data support conclusions that fetal breathing increased after maternal ingestion of glucose in both fasting and nonfasting subjects, that the absolute increases in fetal breathing were similar for fasting and nonfasting subjects, and that fetal breathing occurred more frequently in nonfasting control subjects than in fasting control subjects in the setting of the study.
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Hyperparathyroidism during pregnancy is an uncommon condition. Several case reports and literature reviews in the last two decades have reported only benign tumors but have demonstrated that this disease is associated with significant neonatal morbidity and mortality as well as maternal morbidity. Parathyroid carcinoma is a rare disease entity associated with a much more severe course and prognosis than parathyroid adenomas; it has not been reported in a pregnant woman. We report here a case of a hyperfunctioning parathyroid carcinoma that presented as acute pancreatitis in pregnancy. The details of the case management and outcome in both the patients and infant are discussed. A summary of the literature on the findings and management of parathyroid carcinoma is also discussed in relation to this case report.
Fetal breathing movements occur in uncomplicated gestations. The relationship of fetal breathing movements recorded in 30 min sessions to gestational age and blood glucose levels is described. A total of 142 recording sessions were obtained from 45 gravid women with uncomplicated pregnancies from 24 to 41 weeks' gestation. There was a significant increase in the proportion of time spent in fetal breathing as gestational age increased. Glucose levels in a normal range (70 to 120 mg/100 ml) at the time of the recording sessions showed no correlation with the proportion of fetal breathing time.
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A radiotelemetry system for the direct monitoring of fetal heart rate and intrauterine pressure during labor has been evaluated at 5 different institutions. A conventional fetal scalp electrode and a special intrauterine pressure sensor are connected to a radio transmitter placed on the patient's thigh. The receiver can be located up to 50 feet away from the transmitter and is either a self-contained monitor or a unit that converts a conventional fetal monitor to a telemetric one. The telemetry recordings are of similar quality to those obtained from conventional monitors. Telemetry allows for greater patient comfort and mobility as well as greater convenience to the clinical staff. Continuous data can be obtained from patients while they are ambulatory or sitting in a chair as well as while they are in bed.
The study of the development of fetal breathing movements in human gestation may provide an increased understanding of maturation of the functional central nervous system (CNS). In seven term pregnancies low maternal blood alcohol levels suppressed fetal breathing movements. No effects on fetal oxygenation or acid-base status were demonstrated at the low blood alcohol level. The suppression is therefore most consistent with a direct effect of alcohol on the fetal CNS. This investigation provides further support of the thesis that fetal breathing movements reflect some components of fetal CNS activity.