Use of verapamil for paroxysmal supraventricular tachycardia during epidural anesthesia for cesarean section.
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Adult↗
Biomedical subjects
J E Ferguson
Publications and source records attributed to J E Ferguson.
Effect of bupivacaine hydrochloride on bilirubin production in neonatal rats.
The rate of bilirubin production was studied in 12-hour-old rats exposed to bupivacaine HCl by subcutaneous injection. The bilirubin production was estimated by measuring the excretion rate of carbon monoxide (VeCO) using an open flow-through system. No significant difference was found between the VeCO of bupivacaine HCl-treated and control animals, or between the levels of bilirubin in the pooled blood of treated (0.92 +/- 0.32 SE mg/dl) and control (1.0 +/- 0.28 SE mg/dl) animals. These negative findings support the clinical studies which have not demonstrated an association between epidural anesthesia with bupivacaine HCl and neonatal jaundice.
Animals↗
Oxytocin-induced labor characteristics and uterine activity after preinduction cervical priming with prostaglandin E2 intracervical gel.
Labor characteristics and quantitation of uterine activity resulting from oxytocin induction of labor after intracervical prostaglandin E2 (PGE2) gel priming have not been previously reported. Forty-seven women with modified Bishop scores of 5 or less received preinduction priming with 0.5 mg of intracervical PGE2 gel. Oxytocin was used to induce labor after priming, and uterine activity was quantitated. A matched group of control patients was managed identically but did not receive PGE2 gel. In the gel group, modified Bishop scores improved significantly and in two patients (4%), priming alone induced labor. No uterine hyperstimulation or fetal heart rate abnormalities occurred during priming. Cesarean sections for all indications and those for failed induction were less common in the gel group. The length of the active phase and the second stage of labor were significantly shorter in the gel group. Uterine activity was similar in both groups. The data suggest a primary cervical action of the gel.
Adult↗
Biamnial elevated alpha-fetoprotein and positive acetylcholinesterase in twins, one with anencephaly.
Anencephaly in twin B was accompanied by elevated amniotic fluid alpha-fetoprotein (AFP) and a positive acetylcholinesterase (AChE) band on gel electrophoresis in both twin sacs, although twin A was normal. AChE results did not help distinguish the false positive AFP in this set of twins, implying that AChE may diffuse transamniotically as has been previously postulated for AFP. In light of the low concordance rate for neural tube defects in twins, patient counselling in this situation must include the information that AFP and AChE may be falsely elevated in normal twin when the other twin has a neural tube defect.
Acetylcholinesterase↗
Adjunctive magnesium sulfate infusion does not alter metabolic changes associated with ritodrine tocolysis.
Magnesium sulfate, an agent whose cellular actions might cause metabolic disturbances, has been used concomitantly with ritodrine hydrochloride for preterm labor tocolysis. Although the profound metabolic effects of beta-adrenergic agents have been well described, the possibility that adjunctive magnesium might cause further or unexpected alterations in maternal metabolic parameters has not been fully evaluated. To investigate this question, we prospectively randomized patients, in a blinded fashion, to receive ritodrine plus placebo or ritodrine plus adjunctive magnesium sulfate for preterm labor tocolysis. Serial measurements of potassium, glucose, blood urea nitrogen, and hematocrit were obtained and compared between tocolytic treatment groups. The metabolic changes found were similar in each group and appear to result predominantly from beta-adrenergic stimulation with no apparent perturbations caused by the direct cellular actions of magnesium sulfate. From the metabolic standpoint, it appears that the clinician may use adjunctive magnesium sulfate without fear of accentuating or obscuring the expected beta-adrenergic-induced alterations in the above-mentioned maternal metabolic parameters.
Adult↗
Elevation of bilirubin production in neonatal rats treated with nicardipine hydrochloride.
Administration of nicardipine hydrochloride, a dihydropyridine calcium entry blocker, caused a 30% rise in the rate of bilirubin formation in neonatal rats. Plasma bilirubin concentrations also increased from 0.83 +/- 0.05 to 1.06 +/- 0.10 mg/100 ml (p less than 0.05). We conclude that maternal administration of nicardipine hydrochloride for tocolysis could affect bilirubin production in the neonate.
Animals↗
Effect of epidural analgesia with bupivacaine hydrochloride on neonatal bilirubin production.
We evaluated the rate of bilirubin production in vivo in newborns whose mothers received an epidural block with bupivacaine hydrochloride during labor and delivery. Bilirubin production was estimated in 23 full-term newborns whose mothers were treated with bupivacaine and in 20 controls by determining the end-tidal carbon monoxide concentration and the blood carboxyhemoglobin level corrected for ambient carbon monoxide. No significant difference was found between the mean end-tidal carbon monoxide concentrations for the bupivacaine-treated and the control groups (1.3 +/- 0.5 and 1.4 +/- 0.7 microL/kg/hour, respectively), or between the mean blood carboxyhemoglobin levels corrected for ambient carbon monoxide (0.54 +/- 0.17 and 0.52 +/- 0.18% saturation, respectively). These negative findings support the clinical studies, which have failed to demonstrate a causative connection between bupivacaine and neonatal jaundice.
Anesthesia, Epidural↗
Social support in improving perinatal outcome: the Resource Mothers Program.
This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy. Each Resource Mother is assigned to a pregnant teenage primigravida and serves as part of her support system throughout pregnancy and until the infant's first birthday. We studied 565 matched pairs (case/control) of rural teenage primigravidas with single pregnancies with and without the social support of the Resource Mother. There were significantly more patients with adequate prenatal care in the program group (P less than .000001). The frequency of low birth weight infants was significantly less (P = .006), as was the small-for-gestational-age rate (P = .002).
Adolescent↗
Maternal and fetal factors affecting success of antepartum external cephalic version.
We studied 172 patients who were considered for external cephalic version with tocolysis at term. Before a single attempt at version, a variety of maternal and fetal factors considered likely to affect success were coded for each patient. Maternal age, height, and Quetelet index did not affect success. However, successful version was more likely in parous women than in nulliparous women, and less likely with cornual than with other placentations. Amniotic fluid volume, fetal abdominal circumference, type of breech, and the specific nature of the maternal-fetal spatial relation were also important determinants of success. Fetal biparietal diameter, gestational age, and estimated fetal weight were not. All of these factors can be evaluated before attempting version and can be used when counseling candidates for version.
Adolescent↗
Preterm labor in the quadriplegic parturient.
The occurrence of preterm labor is not uncommon in the pregnant quadriplegic. Early diagnosis is hampered by the inability of most quadriplegics to sense uterine contractions in the usual way. A patient we recently treated for preterm labor learned to recognize contractions by the associated symptoms of autonomic hyper-reflexia: flushing, headache, and piloerection. Tocolytic therapy was successful and a favorable neonatal outcome occurred. Increased awareness by the physician and the pregnant quadriplegic patient is encouraged so that symptoms of autonomic hyper-reflexia may be recognized as potentially indicative of uterine contractions.
Adult↗
The effect of ritodrine hydrochloride on bilirubin production in neonatal rats.
The effect of ritodrine hydrochloride (RH) on bilirubin metabolism in newborn Wistar rats was studied. Wistar rat pups were given two 35-mg/kg injections of RH, and total bilirubin formation (TBF) was determined from the whole body excretion rate of carbon monoxide (VeCO). Early labeled bilirubin formation (ELB), plasma bilirubin levels, and hepatic heme oxygenase (HO) activity were also determined. We found significant increases in TBF, ELB, and HO in the RH-treated animals over the control animals. These increases, however, were small, considering the high doses of RH administered. Our findings suggest that at clinically administered doses, the potential for RH to exacerbate neonatal jaundice is minimal.
Animals↗
Antepartum external cephalic version under tocolysis.
Reported are 172 patients considered for external cephalic version at gestational age greater than 37 weeks. Their outcome was compared with 40 similar patients in whom external version was not attempted. One hundred fifty-eight patients had attempted version, and success was achieved in 122 (77%). Intrapartum vertex presentation occurred in 12% of the control population and in 77% of the version patients. Cesarean section was performed in 80% of the control patients and in 32% of the version patients. There were no maternal or fetal complications directly attributable to external cephalic version. Antepartum external cephalic version under tocolysis is associated with a high success rate, an acceptably low rate of complications, and a decreased incidence of cesarean section for breech presentation at term.
Adult↗
Increased immunoreactive erythropoietin in cord plasma and neonatal bilirubin production in normal term infants after labor.
The purpose of this investigation was to compare immunoreactive erythropoietin levels in umbilical cord plasma and neonatal bilirubin production in infants born of normal women who delivered with or without labor. Two groups of term (38 to 42 weeks) singleton pregnancies were compared: 1) those delivered by repeat elective cesarean section without prior labor (N = 17), and 2) those delivered vaginally or by cesarean section after labor (N = 24). None of the infants was asphyxiated, and there was no difference in Apgar scores between the no-labor and labor groups. The cord plasma erythropoietin levels were lower in the infants of women who had repeat elective cesarean section without labor than in those whose mothers had labor before delivery (Wilcoxon rank sum test, P less than .025). The median erythropoietin for the no-labor group was 22.9 mU/mL compared with 38.8 mU/mL for the labor group. The pulmonary excretion rate of carbon monoxide (VeCO), an index of bilirubin production, for the no-labor group was 14.3 +/- 6.2 SD microL/kg per hour compared with 18.0 +/- 4.9 SD microL/kg per hour for the labor group (P less than .05). The hemoglobin concentration for the no-labor group was 16.0 +/- 1.5 SD g/dL compared with 17.7 +/- 2.2 SD g/dL for the labor group (P less than .05). The VeCO correlated with the hemoglobin concentration (N = 32, r = 0.37, P less than .05). The results of the present study suggest that labor is normally associated with increases in the cord plasma erythropoietin level.(ABSTRACT TRUNCATED AT 250 WORDS)
Bilirubin↗
Intrapartum external cephalic version.
Intrapartum external cephalic version at term was employed in 15 patients with intact membranes and breech presentations; successful version occurred in 11 patients. There were no untoward maternal or fetal outcomes.
Breech Presentation↗
Inositol 1,4,5-trisphosphate is not effective in releasing calcium from skeletal sarcoplasmic reticulum microsomes.
Regulation of many cell systems has been shown to be mediated by Inositol 1,4,5-trisphosphate which causes a release of calcium from intracellular sites. We have shown that release of Ca2+ from sarcoplasmic reticulum microsomes was not stimulated by IP3. The phorbol ester, TPA, also had no effect on Ca2+ release or Ca2+ ATPase activity. Thus, it is unlikely that the breakdown of polyphosphatidylinositides serves as a second messenger to mediate release of Ca2+ in skeletal muscle.
Animals↗
Activation of frog (Xenopus laevis) eggs by inositol trisphosphate. I. Characterization of Ca2+ release from intracellular stores.
Iontophoresis of inositol 1, 4, 5-triphosphate into frog (Xenopus laevis) eggs activated early developmental events such as membrane depolarization, cortical contraction, cortical granule exocytosis, and abortive cleavage furrow formation (pseudocleavage). Inositol 1, 4-bisphosphate also triggered these events, but only at doses approximately 100-fold higher, whereas no level of fructose-1, 6-bisphosphate tested activated eggs. Using Ca2+-selective microelectrodes, we observed that activating doses of inositol 1, 4, 5-trisphosphate triggered a Ca2+ release from intracellular stores that was indistinguishable from that previously observed at fertilization (Busa, W. B., and R. Nuccitelli, 1985, J. Cell Biol., 100:1325-1329), whereas subthreshold doses triggered only a localized Ca2+ release at the site of injection. The subthreshold IP3 response could be distinguished from the major Ca2+ release at activation with respect to their dose-response characteristics, relative timing, sensitivity to external Ca2+ levels, additivity, and behavior in the activated egg, suggesting that the Xenopus egg may possess two functionally distinct Ca2+ pools mobilized by different effectors. In light of these differences, we suggest a model for intracellular Ca2+ mobilization by sperm-egg interaction.
Animals↗
Diabetes and pregnancy in South Carolina.
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Cross-Sectional Studies↗
Nonimmune hydrops fetalis in association with hemangioma of the umbilical cord.
Nonimmune hydrops fetalis is becoming the predominant form of fetal hydrops due to the declining frequency of Rh isoimmunization. Reported is the preterm delivery of a hydropic twin with umbilical cord and cutaneous hemangiomata. The unusual umbilical angiomatous malformation was associated with marked edema of the cord. This produced an ultrasonographic abnormality detected antenatally as a multicystic mass in close approximation to the fetal abdomen. The hydropic twin responded to aggressive neonatal management. It appears that hemangiomata of the umbilical cord may be causally related to fetal hydrops and may represent another entry in the differential diagnosis of this disorder.
Adult↗