Methodological and clinical studies of Doppler ultrasound indices and their relation to fetal haemoglobin concentration, acid-base status, and blood gas values.
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Acid-Base Equilibrium↗
Biomedical subjects
J Legarth
Publications and source records attributed to J Legarth.
Umbilical artery Doppler flow-velocity waveforms and fetal acid-base balance in Rhesus-isoimmunized pregnancies.
Pulsed Doppler blood-flow velocity waveforms in the umbilical arteries, as well as blood gases, hematocrit, and lactate concentration in umbilical venous blood, were examined in 21 patients undergoing 49 cordocentesis, 34 of which were followed by fetal blood transfusion into the umbilical vein. The aim of the study was to evaluate the correlations, if any, between the Doppler indices from the umbilical artery (pulsatility index, resistance index, systolic/diastolic ratio) and the blood gas values (pO2, pCO2, O2 content, pH) and lactate content in the umbilical vein. The only correlation confirmed in this study was in the subgroup of anemic fetuses undergoing fetal blood transfusion, where correlation existed between A/B and the initial O2 content (r = -0.41, p < 0.02). We conclude that, in Rhesus-isoimmunized pregnancies, in contrast to other pregnancies, a close correlation does not exist between the Doppler indices in the umbilical artery and the fetal blood gas values.
Acid-Base Equilibrium↗
Umbilical artery Doppler flow-velocity waveforms in Rhesus-isoimmunized fetuses before and after fetal blood sampling or transfusion.
Pulsed-Doppler examinations of blood-flow velocities in the umbilical artery were carried out before and after 15 diagnostic cordocenteses and 34 fetal blood transfusions into the umbilical vein. There were decreases in the systolic/diastolic ratio (A/B) (p < 0.01), the pulsatility index (PI) (p < 0.05), and the resistance index (RI) (p < 0.01) after cordocentesis but not after fetal blood transfusion. There were no correlations between the initial hematocrit and the umbilical artery Doppler indices in the sample nor in the fetal blood sampling group. In the fetal blood transfusion group, on the other hand, there was a negative correlation between the initial hematocrit and A/B (r = -0.44; p < 0.01) and the RI (r = -0.35; p < 0.05). The umbilical artery Doppler flow-velocity indices did not predict the fetal hematocrit.
Blood Flow Velocity↗
[The antiprogesterone preparation mifepristone (RU 486). Should this "abortion pill" be introduced in Denmark?].
The antiprogesterone mifepristone (RU 486) was synthesized in 1980 by Roussel-Uclaf (Paris). Since 1982 several studies have examined the ability of the drug to interrupt early pregnancies. 600 mg of mifepristone given by mouth to pregnant women with an amenorrhea of less than 50 days will lead to vaginal bleeding in more than 97% of the cases. The bleeding will be followed by moderate (menstruation-like) pain, and complete abortion will occur in 75% of the cases. A success rate of 75% is not sufficient for clinical use. The treatment should therefore consist of a combination of mifepristone and prostaglandin. The prostaglandin can be administered either by i.m. injections or as a vaginal suppository given 38-48 hours after the patient has received 600 mg of mifepristone by mouth. Such a combination of mifepristone and prostaglandin results in a complete abortion rate of more than 95%. Pelvic inflammatory disease (P.I.D.) after these abortions is extremely rare (below 0.5%), and other serious side effects are also uncommon. We find that mifepristone in combination with prostaglandin should be offered to Danish women seeking abortion as an alternative to the traditional method of vacuum aspiration.
Abortifacient Agents, Steroidal↗
Placenta previa-percreta: magnetic resonance imaging findings and methotrexate therapy after hysterectomy.
A case is reported of a 42-year-old woman with placenta previa-percreta and multiple previous cesarean sections. Preoperative magnetic resonance imaging findings are described. Management included a cesarean supracervical hysterectomy, bilateral hypogastric arterial ligation, and intraoperative methotrexate administration. The placental portion that invaded the urinary bladder wall was left in place, without attempt to remove it surgically.
Adult↗
Prediction of mode of delivery and 'DisFIL score' following induction of labor by local PGE2.
The objective of the study was to evaluate pre-induction risk factors for (i) assisted vaginal delivery (forceps or vacuum extraction), (ii) caesarean section, (iii) failed induction followed by caesarean section, and from these to evaluate a score of the 'Disadvantages Following Induction of Labour' (the DisFIL score). The study was a case-control study applied on a prospective cohort of 336 pregnant women induced by local PGE2. Assisted vaginal delivery was associated with primiparity (OR (odds ratio) = 10.7; CI, 3.6-32.0) and higher pelvic scores (Bishop score: OR = 1.9; CI, 1.4-2.6). Caesarean section was related to higher maternal age (P < 0.001) and lower pelvic scores (Bishop score: OR = 0.7; CI, 0.5-1.0, P < 0.05). When performed because of fetal distress, assisted vaginal delivery and caesarean section were both associated with lower fetal weights (P < 0.05). Failed induction followed by caesarean section was related to primiparity (P < 0.0001, Fisher's test) and lower pelvic scores (Bishop score: OR = 0.6; CI, 0.4-0.9). A higher 'DisFIL score' was associated with primiparity (OR = 4.7; CI, 2.8-8.0), higher maternal age (P < 0.01), lower pelvic scores (P < 0.01, chi 2 test) and PGE2 in intracervical gel rather than in vaginal pessaries (OR = 2.1; CI, 1.4-3.2). It is concluded that the major predictors of 'Disadvantages Following Induction of Labor' by local PGE2 are primiparity, high maternal age, low pelvic scores and the method of.
Adult↗
Hypoxanthine in fetal umbilical venous blood and amniotic fluid from pregnancies complicated by rhesus isoimmunization.
Concentrations of hypoxanthine (HX) was determined in umbilical venous blood and amniotic fluid obtained at 74 instances in 36 rhesus immunized patients before the onset of labor. HX concentrations were related to gestational age, concentrations of hemoglobin and lactate, pH, and partial oxygen pressure in umbilical venous blood. Multiple regression analysis revealed hemoglobin concentration to be the only variable that had any explanatory power to HX in amniotic fluid. No one of the studied variables gave any significant contribution to a regression model to explain HX in umbilical venous blood. We conclude that HX levels in umbilical venous blood and in amniotic fluid from rhesus immunized patients were not associated with fetal blood gases before the onset of labor.
Amniocentesis↗
Erythropoietin concentrations in amniotic fluid and umbilical venous blood from Rh-immunized pregnancies.
We set out to investigate prospectively the levels of erythropoietin in amniotic fluid and umbilical venous blood, and to attempt to relate these to fetal haemoglobin and lactate concentrations and to pCO2 and PO2 in Rh immunised patients studied before the onset of labor. Fetal blood was obtained by cordocentesis, and amniotic fluid by amniocentesis from a consecutive series of 36 Rh immunized patients at the time of fetal blood sampling. There was a close correlation (tau = 0.357, P = 0.0001) between the concentrations of erythropoietin in umbilical venous blood and those in amniotic fluid. Erythropoietin in umbilical venous blood correlated inversely with hemoglobin (tau = 0.453, P = 0.0001), and directly with lactate concentrations (tau = 0.450, P = 0.0005). When all other variables were considered, multiple regression analysis demonstrated hemoglobin concentration to be the only variable to be related to the level of erythropoietin in umbilical venous blood taken before transfusion. When the same analysis was performed on the same variables, adding erythropoietin concentration in amniotic fluid as the dependent variable, only erythropoietin in umbilical venous blood was found to be related to the level of erythropoietin in amniotic fluid. We conclude that the erythropoietin concentration in umbilical venous blood from Rh-immunized patients before the onset of labor, is related to fetal anemia. We also conclude that erythropoietin concentration in amniotic fluid is related to that in fetal blood, thereby indicating that the fetus is an important source of amniotic fluid erythropoietin in non laboring patients.
Amniotic Fluid↗
Predictive value of pelvic scores for induction of labor by local PGE2.
The predictive value of pelvic scores, parity, age and gestational age for induction of labor by local prostaglandin-E2 (PGE2) was examined in 336 women attempting induction of labor by intracervical or vaginal PGE2. The patient characteristics were correlated to: (1) vaginal delivery within 48 h, (2) the period from induction to onset of labor (latency period), and (3) the duration of labor. The Bishop score (P < 0.01) and even more the Lange score (P < 0.0001) were significantly inversely correlated to both latency period and induction-delivery period. This was caused by cervical dilatation (P < 0.001), fetal station (P < 0.05) and cervical length (P < 0.05), whereas position and consistency of the cervix were of no importance. All three periods studied were significantly (P < 0.0001) shorter in parous women. In primiparous women, gestational age was of no importance for the latency period; however, higher gestational age was associated with longer labor (P < 0.001). We conclude that the predictive value of pelvic scores on induction hardly differs using local PGE2 compared to conventional methods; furthermore, the Bishop score should be substituted, disregarding position and consistency of the cervix, but putting more weight to cervical dilatation. A new pelvic score is proposed.
Adult↗
Intramural pregnancy after in vitro fertilization and embryo transfer.
A case of intramural but not interstitial pregnancy, established after IVF/ET, is described. The etiologic, diagnostic, and therapeutic aspects of this clinical dilemma are discussed.
Adult↗
Lack of relation between fetal blood gases and fetal blood flow velocity waveform indices found in rhesus isoimmunised pregnancies.
OBJECTIVE: To investigate the relation between umbilical vein blood gas components and the vascular resistance in four fetal arteries in Rh-immunised pregnancies. DESIGN: A prospective observational study over a 4-month period. SETTING: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. SUBJECTS: Fifteen Rh-isoimmunised pregnant women. INTERVENTIONS: Pulsed Doppler examinations of the umbilical artery, fetal internal carotid artery, thoracic aorta and abdominal aorta before transabdominal fetal blood sampling from the umbilical vein on 38 occasions. MAIN OUTCOME MEASURES: Doppler flow velocity pulsatility index (PI), systolic/diastolic ratio (A/B) and resistance index (RI) in the four fetal arteries investigated were related to the umbilical vein blood gases and acid-base status (PO2, PCO2, O2-content, CO2-content, HCO3, base excess and lactate concentration). RESULTS: There were no correlations between the Doppler indices in any of the vessels studied and the blood gases components in the umbilical vein. The ratios between the corresponding Doppler indices in the different vessels were also independent of the blood gases and acid-base status and there were no significant differences in the Doppler indices in the same vessel between fetuses with blood gas values over the 75th centile and those with values below the 25th centile. CONCLUSION: This study does not support a reduction in peripheral vascular resistance in the fetal cerebrum in relation to fetal hypoxia in Rh-immunized pregnancies.
Blood Flow Velocity↗
Mifepristone or vacuum aspiration in termination of early pregnancy.
This trial compared the termination of early pregnancy (amenorrhoea less than 43 days) by 600 mg orally of the antiprogesteron Mifepristone to the traditional method of vacuum aspiration. Fifty women were randomly assigned to either of the treatments. All the patients treated with vacuum aspiration had a complete abortion. Three of these patients developed pelvic inflammatory diseasae (PID) after the aspiration. Another patient had the uterus perforated during the procedure, and an emergency laparotomy had to be performed. The patients in the evacuation group spent more days in bed and needed longer sick leave after the treatment than the patients in the Mifepristone group. In the Mifepristone group, six patients had incomplete abortions and all were treated by evacuation. Three of the patients developed PID after the evacuation. A decrease of 40% or more in beta hCG from the initial value to the value 1 week later were invariably associated with complete abortion. In both groups the changes in hemoglobin were insignificant and no patients needed blood transfusion or emergency evacuation. The Mifepristone treatment is a simple and safe alternative to vacuum aspiration for termination of early pregnancies.
Abortion, Incomplete↗
Induction of labour: the effect of vaginal prostaglandin or i.v. oxytocin--a matter of time only?
Ninety-one pregnant women with unfavourable cervix (Bishop score no higher than 6) were randomly allocated to induction of labour with either prostaglandin E2 suppositories 2.5 mg 1-2 a day or i.v. oxytocin 4-32 mU/min. The induction procedure was carried on for 2 days. For statistical comparison of efficacy, life table analysis and the logrank test were used with vaginal delivery as the aimed 'event'. Prostaglandin suppositories were more efficient after 12 h (p less than 0.025) and 24 h (p less than 0.005), whereas no difference in efficacy was observed after 48 h. Vaginal delivery was obtained within 48 h in 74% of the women in the prostaglandin group and in 70% in the oxytocin group. No difference was observed in methods of delivery or neonatal Apgar scores, though, in neonates delivered vaginally within 2 days, lowered umbilical artery blood pH values were found after prostaglandin E2 suppositories (p less than 0.05). The patients attitude toward the method of induction was highly in favour of the prostaglandin suppositories. Prostaglandin E2 suppositories are considered excellent for induction of labour if delivery has to be within 24 h, whereas the two methods are equally effective after 48 h.
Administration, Intravaginal↗
Doppler blood velocity waveforms and the relation to peripheral resistance in the brachial artery.
The relationship between peripheral resistance and the Doppler blood velocity indices--pulsatility index (PI), A/B ratio, resistance index (RI), and the minimum velocity (Vmin)--was evaluated in the brachial arteries of five young women. All the indices showed a very good correlation with resistance (r greater than 94%); the regression line for both PI and A/B were linear, whereas the relationships between resistance and RI, and resistance and Vmin, were best described by a logarithmic and by power function, respectively. Although the women were carefully selected to be as alike as possible, there were significant differences in the individual slopes of the regression lines.
Adult↗
Lamicel does not promote induction of labour. A randomized controlled study.
Lamicel is a synthetic tent, which, when inserted in the cervical canal, dilates the cervix by osmosis. Lamicel as an adjunct to induction of labour with intravenous oxytocin or vaginal prostaglandin E2 has been examined in a randomized controlled trial. Ninety-one pregnant women with an unripe cervix participated in the study. No improvement in efficacy was observed in the Lamicel groups compared to the control groups, neither when induction of labour was performed with oxytocin nor with vaginal prostaglandin.
Apgar Score↗
Characteristics of Doppler blood-velocity waveforms in a cardiovascular in vitro model. I. The model and the influence of pulse rate.
In order to study the indices describing the flow-velocity curves a cardiovascular in vitro model has been constructed. The model consists of two parts: (i) A heart simulator producing controllable cardiac output, pulse rate and pressure variations, (ii) a circulatory system made of elastic butyl rubber tubes with adjustable peripheral resistance bed. The flow-velocity curves were obtained by a Doppler velocity meter as a function of the pulse rate (PR) when pressure, volumetric flow, and peripheral resistances were constant. The four evaluated indices, pulsatility index (PI), peak velocity (Vpeak), rising slope (RS) and A/B ratio (A/B i.e. maximum/minimum velocity ratio) all showed significant correlation with pulse rate. PI, A/B and Vpeak showed a marked increased at low pulse rate and the inverse relation between these indices and pulse rate were best described by power functions, whereas RS was found to be inversely proportional to pulse rate. The results are in good agreement with the few existing clinical observations, and we suggest that the relations described are taken into consideration in the clinical interpretation of blood velocity indices.
Blood Circulation↗
Albumin transfusion in non-immune fetal hydrops: Doppler ultrasound evaluation of the acute effects on blood circulation in the fetal aorta and the umbilical arteries.
A case of non-immune fetal hydrops, diagnosed as mucopolysaccharidosis VII with hypoalbuminemia, was treated in utero with albumin transfusions via cordocentesis on five occasions. Blood samples were taken for analysis of full blood count and blood gases before and after the transfusions. Pulsed Doppler ultrasound examinations of the arterial waveform were performed in the umbilical arteries and the descending fetal aorta and analyzed for the pulsatility index (PI). The hemoglobin concentration and the hematocrit decreased from 111 +/- 5 g/l and 0.335 +/- 0.008 to 95 +/- 5 g/l and 0.282 +/- 0.023 (mean +/- SD), respectively, after the transfusions. The calculated blood volume increased more than the given volume, indicating an autotransfusion causing additional plasma volume expansion. The blood gases were not significantly changed by transfusion. The PI decreased both in the umbilical arteries (p less than 0.05) and the descending fetal aorta, indicating peripheral vasodilatation. A positive correlation was found between the umbilical artery PI and the hematocrit before and after the albumin transfusion (r = 0.59; p less than 0.05). This relation could be due to covariation with other factors, e.g. peripheral vasodilatation secondary to the increased blood volume and the puncture of the umbilical vein itself. No improvement of the hydrops was seen after the albumin transfusions. The fetus died in utero during spontaneous labor after 30 gestational weeks.
Albumins↗