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Biomedical subjects

J P Lavin

Publications and source records attributed to J P Lavin.

28 records · Page 2Linked to original sources
PubMed1982

Effect of maternal ketoacidemia on the pregnant ewe and the fetus.

Poorly controlled diabetic pregnancies are associated with hyperglycemia and elevated ketones. While glucose is known to cross the placenta, there is limited information regarding the placental transfer of ketones and their associated cardiovascular and metabolic effects in the fetus. Thus, the present study was undertaken to evaluate the transfer of the ketoacid beta hydroxybutyrate across the ovine placenta and to determine the effects of this ketoacid on maternal and fetal physiologic and metabolic parameters. Pregnant ewes (110 to 120 days' gestation) were instrumented with catheters in the lateral branch of both uterine arteries, uterine veins, femoral artery, and femoral vein, and electromagnetic flow probes were placed on both middle uterine arteries. Catheters were placed in the fetal carotid artery and jugular vein, and a catheter and balloon were placed in the amniotic fluid. Beta hydroxybutyrate (0.39 mmole/100 ml of uterine blood flow) and antipyrine (00.27 mmole/100 ml of uterine blood flow) as a second reference marker, were infused simultaneously into the uterine arteries for a period of 2 hours. The beta hydroxybutyrate concentrations in the uterine vein increased to 5.93 +/- 1.32 mmoles/L, and were associated with a significant increase in maternal heart rate and a slight but significant reduction in uterine blood flow. No changes in maternal arterial blood gas values were noted. The concentration of beta hydroxybutyrate in the fetal carotid arteries increased from 0.01 +/- 0.01 mmole/l to 0.15 +/- 0.03 mmole/L, and were associated with a significant reduction in fetal PaO2 (24.2 +/- 0.9 to 17.9 +/- 1.9 mm Hg) and an elevation of fetal lactate levels (1.86 +/- 0.17 to 5.07 +/- 1.56 mmoles/L).

3-Hydroxybutyric Acid↗
PubMed1982

Cardiovascular and biochemical effects of infusion of beta hydroxybutyrate into the fetal lamb.

Previous studies from our laboratory have shown that beta hydroxybutyrate crosses the ovine placenta in small amounts during maternal hyperketonemia and produces significant reductions in fetal PaO2 and increased fetal lactate levels. The present study evaluates the effects of fetal hyperketonemia on fetal and maternal cardiovascular and biochemical parameters. Pregnant ewes (110 to 120 days' gestation) were instrumented with catheters in the femoral artery, femoral vein, and uterine veins, and electromagnetic flow probes were placed on the middle uterine arteries. The fetal carotid artery and jugular vein were catheterized, and a catheter and balloon were placed in the amniotic fluid. Beta hydroxybutyrate (0.44 mmole/min) and antipyrine (0.03 mmole/min) were simultaneously infused directly into the fetal jugular vein for 90 minutes. The fetal beta hydroxybutyrate level increased from a baseline of 0.12 +/- 0.08 to 6.80 +/- 0.46 mmoles/L and was associated with a significant decrease in fetal PaO2 (23.7 +/- 2.4 to 16.0 +/- 0.4 mm Hg) and a large increase in the fetal lactate (1.85 +/- 0.27 to 5.43 +/- 0.92 mmoles/L) at 90 minutes. The present results suggest that during fetal hyperketonemia fetal oxygenation is significantly reduced and may contribute to the increased perinatal mortality in the pregnant diabetic patient.

3-Hydroxybutyric Acid↗
PubMed1982

Total parenteral nutrition in a pregnant insulin-requiring diabetic.

A 28-year-old class F diabetic woman whose pregnancy was complicated by gastroparesis, hemorrhagic gastritis, narcotic addiction, intrauterine fetal growth retardation, and severe preeclampsia was supported with total parenteral nutrition (TPN) from the 27th to the 29th week or pregnancy. During this period there was adequate control of serum glucose, a positive nitrogen balance, and a normal amino acid profile. Unfortunately, a rapid deterioration in renal function and hypertensive disease occurred, requiring cesarean section at the 29th gestational week. TPN was continued for an additional 30 days postoperatively until the gastritis resolved and adequate oral nutrition could be reestablished. Wound healing was satisfactory.

Acute Kidney Injury↗
PubMed1982

The effects of epidural anesthesia on electronic fetal heart rate monitoring.

A variety of changes of FHR monitoring parameters have been attributed to epidural anesthesia. Epidural anesthesia with lidocaine may cause tachycardia in a small percentage of patients and decreased FHR variability in other patients. No changes in baseline FHR have been observed after epidural anesthesia with bupivacaine or chloroprocaine. Chloroprocaine causes no significant change in FHR variability. Bupivacaine is associated with a statistically significant increase in FHR variability when group data are compared. However, this response does not occur in every patient, nor is it predictable in any given patient. Several studies have shown high incidences of pathologic periodic changes in FHR in women receiving epidural anesthesia with lidocaine. These changes appear to be strongly related to both maternal hypotension secondary to anesthesia-induced sympathetic blockade and to maternal uterine hypertonus. Studies in which bupivacaine or chloroprocaine were employed, and in which hypotension was avoided, indicate that observed pathologic periodic changes are not related to drug injection but rather to sporadic nonanesthesia-induced changes in uterine activity. Epidural anesthesia employing anesthetic solutions to which epinephrine has been added lead to decreased uterine activity. Epidural anesthesia without epinephrine appears to have no effect on uterine activity. In general, epidural anesthesia in the absence of maternal hypotension or uterine hypertonus causes minimal changes in the FHR parameters. Those changes that do occur are neither universal or predictable. Therefore, any alteration in FHR monitoring parameters occurring in a patient receiving epidural anesthesia should be evaluated and acted upon in the same fashion and by the same methods one would employ if the patient were not receiving epidural anesthesia.

Anesthesia, Epidural↗
PubMed1982

Vaginal delivery in patients with a prior cesarean section.

To assess the risks and benefits of vaginal delivery in patients with prior cesarean section, the English literature on this subject from 1950 to 1980 was reviewed. The following conclusions were reached: 1) Properly conducted vaginal delivery after cesarean section is relatively safe, with a 0.7% incidence of uterine rupture, 0.93 perinatal mortality, and no maternal deaths due to uterine rupture. 2) Of those patients allowed a trial of labor, 66.7% were successfully delivered vaginally. Successful vaginal delivery occurred in 74.2% of those patients with a nonrecurrent indication for their previous cesarean section and in 33.3% of those patients whose indication for previous cesarean section was cephalopelvic disproportion. Sixty-seven percent of those patients with a prior vaginal delivery versus 47.1% of those patients without a prior vaginal delivery subsequently delivered vaginally. 3) A classic uterine scar clearly increases the probability of uterine rupture. However, the precise magnitude of the increased risk cannot be accurately determined. 4) Certain basic safety requirements such as available operating room facilities and adequate personnel for careful observation are mandatory, but other management policies that remain controversial include use of regional anesthesia, oxytocin administration, timing of hospital admission, artificial rupture of membranes, mode of delivery, proper method to evaluate the uterine scar, and delivery of fetuses in breech presentation and twins. 5) A policy of selective vaginal deliveries among patients with prior cesarean sections will result in cost reductions due to decreased postpartum hospitalization.

Cesarean Section↗
PubMed1982

The use of amniotic fluid 3-methyl histidine to creatinine molar ratio for the diagnosis of intrauterine growth retardation.

To determine if the amniotic fluid 3-methyl histidine to creatinine molar ratio (3MH:CR) could prove useful for the antepartum detection of intrauterine growth retardation (IUGR), the 3MH:CR was determined retrospectively in 3 groups of human amniotic fluids. Group A consisted of amniotic fluids from pregnancies yielding IUGR fetuses whose birth weight was less than or equal to the tenth percentile for gestational age; group B consisted of amniotic fluid from pregnancies yielding infants whose birth weight was greater than the tenth but less than or equal to the 25th percentile for gestational age; group C consisted of amniotic fluids from pregnancies yielding infants whose birth weight was greater than the 25th but less than or equal to the 75th percentile for gestational age. The mean 3MH:CR x 10(-3) for groups A, B, and C were 15.9 +/- 1.9, 5.4 +/- 0.8, and 6.2 +/- 0.5, respectively. The mean 3MH:CR x 10(-3) was statistically different between groups A and B (P less than or equal to .001) and between groups A and C (P less than or equal to .001), but not statistically different between the 2 control groups. Employing an upper limit of normal of 8 for the 3MH:CR x 10(-3), 13 of 15 IUGR neonates were correctly identified as IUGR, and 23 of 27 neonates were correctly identified as being of normal birth weight for gestational age (sensitivity 86.7%, specificity 85.2%, incidence of correct diagnosis 85.7%). No consistent relationship was shown to exist between maternal serum and amniotic fluid 3-methyl histidine level. There was no statistically significant relationship between 3MH:CR x 10(-3) and gestational age. The comparison of the data generated in this study to that obtained with previously reported ultrasonic and biochemical techniques suggests that the amniotic fluid 3MH:CR ratio may prove helpful in establishing the antenatal diagnosis of IUGR, particularly in cases where the gestational age is uncertain.

Amniotic Fluid↗
PubMed1981

The effects of bupivacaine and chloroprocaine as local anesthetics for epidural anesthesia of fetal heart rate monitoring parameters.

The effects of saline-induced pressure-volume changes in the epidural space, and bupivacaine and chloroprocaine as local anesthetics for epidural anesthesia, on various fetal heart rate monitor parameters were investigated in 34 low-risk women. Epidural space pressure-volume changes, bupivacaine, and chloroprocaine had no effect on the incidence of pathologic periodic fetal heart rate changes, the level of the baseline fetal heart rate, or the level of uterine activity units. Epidural space pressure-volume changes and chloroprocaine did not affect fetal heart rate variability. The use of bupivacaine was associated with a significant increase in fetal heart rate variability

Adult↗
PubMed1981

Clinical experience with a screening program for gestational diabetes.

Screening for abnormal glucose metabolism was carried out in 2,077 pregnant women. Historical or clinical risk factors for gestational diabetes were present in 959 women (group 1). The remaining 1,118 patients composed group 2. A 50 gm oral glucose load and a 1-hour serum glucose determination with a threshold of 150 mg/dl were used as a glucose challenge screening test (GCT). Patients with an abnormal GCT underwent an oral glucose tolerance test (GTT). Group 1 patients underwent screening at the initial clinic visit or when the clinical risk factor was first recognized, with repeat screening at 28 to 32 weeks if the initial testing was normal. Group 2 patients were screened at 28 to 32 weeks. In group 1, 69 patients (7.2%) exhibited an abnormal GCT and 14 (1.5%) demonstrated an abnormal GTT. In group 2, 68 patients (6.1%) exhibited an abnormal GCT and 16 (1.4%) demonstrated an abnormal GTT. These incidences are not statistically different. The estimated costs per patient screened and per case of gestational diabetes detected were $4.75 and $328.96, respectively.

Blood Glucose↗
PubMed1981

Pulmonary eosinophilic granuloma complicating pregnancy.

The first known case of pregnancy complicated by pulmonary eosinophilic granuloma is reported. The patient developed dyspnea late in pregnancy, but there was no objective evidence of deterioration in arterial blood gases or pulmonary function tests. Cesarean section was required at 36 weeks' gestation because of falling estriol levels in the presence of a breech presentation and an inability to induce cervical dilation. Maternal, postoperative, and neonatal courses were normal. Recommendations are made concerning the treatment of similar patients with similar symptoms.

Adult↗