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Biomedical subjects

K J Moise

Publications and source records attributed to K J Moise.

At least 127 records · Page 7Linked to original sources
PubMed1989

Doppler assessment of the pulsatility index of the middle cerebral artery during constriction of the fetal ductus arteriosus after indomethacin therapy.

To investigate the effects of constriction of the ductus arteriosus on the pulsatility index of the middle cerebral artery, maximum velocity waveforms were obtained in 13 fetuses (one set of twins) whose mothers were treated with indomethacin for preterm labor (n = 9) or polyhydramnios (n = 3). Eleven of the fetuses manifested ductal constriction within 48 hours of therapy, whereas two fetuses had constriction after 1 week of therapy. Six of the 13 fetuses also manifested tricuspid insufficiency in association with constriction of the ductus arteriosus. All abnormal cardiac changes resolved in utero after discontinuation of indomethacin. No difference in the pulsatility index values of the middle cerebral artery was observed in the fetuses with ductal constriction but without tricuspid regurgitation (n = 7) when the values were compared with those obtained in absence of ductal constriction (1.87 +/- 0.37 vs. 1.88 +/- 0.33). In the fetuses that manifested both ductal constriction and tricuspid insufficiency (n = 6), the pulsatility index values in the middle cerebral artery were significantly lower in the presence of ductal constriction when compared with the values obtained in the absence of ductal constriction (2.22 +/- 0.26 vs. 1.57 +/- 0.34). These results indicate that a response to indomethacin sufficient to cause both ductal constriction and tricuspid insufficiency decreases the pulsatility index of the middle cerebral artery.

Blood Circulation↗
PubMed1989

Doppler assessment of the pulsatility index in the cerebral circulation of the human fetus.

To determine whether the pulsatility index was similar in all cerebral vessels, 30 fetuses at 23 to 37 weeks' gestation were studied. There were 12 normal fetuses, 14 growth-retarded fetuses, and 4 fetuses that were transfused in utero because of Rh isoimmunization. The middle cerebral artery and the internal carotid artery were studied in all fetuses. The proximal anterior cerebral artery was also studied in addition to the other two vessels in 12 fetuses from the three groups. The pulsatility index was significantly higher in the middle cerebral artery than in the internal carotid artery in all three groups. The pulsatility index of the proximal anterior cerebral artery was between the values shown for the middle cerebral artery and the internal carotid artery. The pulsatility index of the proximal anterior cerebral artery was significantly different from the index for the middle cerebral artery and not significantly different from the index for the internal carotid artery. These data indicate the importance of knowing exactly which cerebral vessel is being insonated, so that the Doppler waveform can be interpreted correctly.

Carotid Artery, Internal↗
PubMed1989

Maternal malignancy metastatic to the products of conception: a review.

Documented reports of maternal malignancy metastatic to the placenta and fetus are rare. From 1866 until the present there have been 52 cases reported in the Western literature. We report a case of maternal large-cell carcinoma of the lung metastatic to the maternal brain and the placenta without fetal involvement.

Adult↗
PubMed1989

Comparison of four types of intrauterine transfusion: effect on fetal hematocrit.

The advent of cordocentesis has made it possible to treat fetuses affected by severe red cell alloimmunization by infusing red cells into umbilical vessels. In addition, serial hematocrits can be followed between transfusions. Twenty fetuses underwent a total of 118 intrauterine procedures. Four transfusion techniques were compared to assess the effect of each method on the stability of the fetal hematocrit between procedures. The change in hematocrit per day for direct intravascular transfusion was -1.06 +/- 0.68%, for intraperitoneal transfusion: +0.03 +/- 0.6%, for combined exchange intravascular and intraperitoneal transfusion: +0.02 +/- 0.3% and for combined direct intravascular and intraperitoneal technique: -0.01 +/- 0.4%. The greatest fall in hematocrit was noted with the use of the direct intravascular technique alone (p less than 0.001). The combined direct intravascular/intraperitoneal approach produces a stable hematocrit between procedures and offers the possibility of performing intrauterine transfusions at less frequent intervals.

Blood Transfusion, Intrauterine↗
PubMed1989

Intravenous pancuronium bromide for fetal neuromuscular blockade during intrauterine transfusion for red-cell alloimmunization.

Intravenous pancuronium bromide was administered into the umbilical cord by funipuncture to effect temporary fetal paralysis. Neuromuscular blockade was achieved in 12 fetuses undergoing a total of 34 intrauterine procedures for the treatment of severe red-cell alloimmunization. The same initial dose of 0.2 mg/kg fetal weight estimated by ultrasound was used in all cases, but anemic fetuses did not resume movement for prolonged periods. A relationship among fetal hematocrit, adjusted dose, and duration of paralysis was described by the equation: Duration (hours) = 5.24 + 10.30 adjusted dose (mg/kg) - 0.16 hematocrit (%) (R2 = 0.49; P less than .001). Intravenous pancuronium was found to be a safe and effective method for cessation of fetal movement during intrauterine procedures.

Blood Transfusion, Intrauterine↗
PubMed1989

Effect of acetaminophen on fetal acid-base balance in chorioamnionitis.

The effect of antipyretic treatment with acetaminophen on fetal status was examined in eight laboring women febrile with chorioamnionitis. After a fetal heart rate tracing and scalp blood gas level were obtained near maximum maternal fever, a 650-mg acetaminophen suppository was administered. If the temperature remained greater than 101 degrees F, the dose was repeated in one to two hours. The fetal heart rate tracing was analyzed again after the mother's fever was reduced by acetaminophen. All patients delivered within four hours of the first dose. Umbilical artery blood gases were obtained at delivery. Significant improvements in the bicarbonate concentration and base deficit were noted at the time of delivery as compared to the scalp gas at the height of the maternal fever. The fetal heart rate tracings at the height of the maternal fever, characterized by tachycardia, poor variability and late decelerations, changed to a normal heart rate pattern without decelerations when the mother's fever was reduced. Hence, in the laboring gravida with chorioamnionitis, reducing maternal fever with acetaminophen improves fetal status and thereby may reduce the probability of cesarean section for fetal distress.

Acetaminophen↗
PubMed1989

Effect of heparin on umbilical arterial blood gases.

Arterial blood gas analysis was performed utilizing different heparin volumes and concentrations on 20 umbilical cord blood samples. A significant decrease in the bicarbonate concentration and base excess was found when 10,000 instead of 1,000 U/mL heparin was used to coat the syringe. When 0.2 mL of 1,000 U/mL heparin was added to 0.8 mL of blood, significant decline in the PCO2, base excess and bicarbonate concentration occurred. When 0.2 mL of 10,000 U/mL heparin was added to 0.8 mL of blood, a significant decline in the pH, PCO2, bicarbonate concentration and base excess was noted. Increasing the dilution and/or quantity of heparin in an umbilical arterial blood specimen may result in a significant misinterpretation of the fetal acid-base status by indicating a more significant chronic metabolic acidosis component than really exists.

Blood Gas Analysis↗
PubMed1989

Implications of sino-aortic baroreceptor reflex dysfunction in severe preeclampsia.

Loss of sino-aortic baroreceptor reflex sensitivity has been associated with various forms of hypertension. Baroreflexive dysfunction antedates elevation of blood pressure (BP) in some forms of hypertension, and may play a role in their pathogenesis. We studied baroreflex function in seven women with severe preeclampsia being treated with intravenous hydralazine. As indices of baroreflex sensitivity and hemodynamic competence, we measured the reflexive elevations in heart rate (HR) (delta HR/delta BP) and cardiac index (CI) (delta CI/delta BP) in response to hydralazine-induced falls in blood pressure. The change in cardiac index per unit change in systemic vascular resistance index (SVRI) (delta CI/delta SVRI) served as an additional measure of hemodynamic competence. The results indicated that a higher baseline blood pressure was associated with a dramatic reduction in baroreflex sensitivity (delta HR/delta BP) and baroreflex control of blood pressure (delta CI/delta BP and delta CI/delta SVRI). In patients with higher baseline blood pressures, the severe impairment of baroreflex function eliminated the normal circulatory buffer against vasodilator-induced hypotension. Abrupt and profound reductions in blood pressure and the development of fetal distress in response to hydralazine occurred in the patients with higher initial blood pressures. In addition, the present results suggest that phenomena such as the blood pressure lability and increased responsiveness to angiotensin that characterize preeclampsia are, at least in part, reflections of baroreflex dysfunction.

Adult↗
PubMed1989

Quantitative hemodynamic effects of acute volume expansion in severe preeclampsia.

In a study of eight patients with severe preeclampsia, cumulative rapid infusions of 500 mL (set of eight patients) and 1000 mL (subset of five patients) of 5% albumin in normal saline were followed with invasive hemodynamic measurements at 5 and 30 minutes. Pulmonary capillary wedge pressure and central venous pressure rose. Cardiac index rose 23 and 34% at 5 minutes after the 500-mL and 1000-mL infusions, respectively; at 30 minutes, it remained at 17 and 34%, respectively, above control. The systemic vascular resistance index fell 24 and 29% below control values at 5 minutes after the respective infusions; at 30 minutes, it remained at 15 and 25%, respectively, below control. Mean systemic arterial pressure was unchanged, except for a small reduction shortly after the initial 500-mL infusion. In contrast, mean pulmonary arterial pressure rose significantly. Hence, the dominant effects of acute volume expansion in severe preeclampsia include an unchanged (or slightly reduced) mean systemic arterial pressure, resulting from marked elevations in cardiac index and concomitant, proportionate declines in systemic vascular resistance index.

Adult↗
PubMed1988

Indomethacin in the treatment of premature labor. Effects on the fetal ductus arteriosus.

Indomethacin is a potent agent in the treatment of premature labor, but its use has been limited because of concern about its constrictive effects on the fetal ductus arteriosus. To study these effects we used serial fetal echocardiography in 13 pregnant women in premature labor who received indomethacin according to three different dose schedules, ranging from 100 to 175 mg per day, for a maximum of 72 hours. The gestational ages of the fetuses ranged from 26.5 to 31.0 weeks. The detection of ductal constriction in 7 of the 14 fetuses by echocardiography led to the discontinuation of indomethacin. Three fetuses also had tricuspid regurgitation. There was no statistically significant difference between the mean (+/- SEM) gestational age of the fetuses with ductal constriction and that of those without constriction (29.3 +/- 0.59 and 28.4 +/- 0.52, respectively). There was no relation between serum indomethacin levels in the mothers and ductal constriction. In all seven fetuses affected, ductal constriction had resolved by the time they were restudied 24 hours after the discontinuation of indomethacin. Persistent fetal circulation was not detected in any of the 11 neonates studied after delivery. Indomethacin used to treat premature labor appears to cause transient constriction of the ductus arteriosus in some fetuses, even after short-term use.

Adolescent↗
PubMed1988

Role of volume expansion in severe pre-eclampsia.

Fifteen primigravid patients with severe pregnancy-induced hypertension were studied by catheterization of the right side of the heart. A hemodynamic protocol was implemented that required maintaining colloid osmotic pressure above 17 millimeters of mercury, pulmonary capillary wedge pressure below 15 millimeters of mercury and the mean arterial pressure in a very narrow range throughout labor and delivery and for 48 hours postpartum. The initial colloid osmotic pressures and pulmonary capillary wedge pressures were 18.0 +/- 2.6 and 10.5 +/- 4.0 millimeters of mercury, respectively, and remained essentially unchanged throughout the post partum period. The only benefit derived from volume expansion in these patients appeared to be the absence of acute fetal distress after the initiation of antihypertensive therapy. Six of 15 patients had late fetal stress develop during labor, suggesting that aggressive volume repletion and colloid osmotic pressure correction in pregnancy-induced hypertension does not effect the over-all incidence of fetal distress. We recommend that correction of colloid osmotic pressure be restricted to instances in which extremely low values (less than 12 millimeters of mercury) or a prolonged negative colloid osmotic pressure to pulmonary capillary wedge pressure gradient are identified. Finally, the benefit of volume expansion in pregnancy-induced hypertension appears to be the prevention of sudden and profound drops in blood pressure with antihypertensive therapy--not the prevention of fetal distress during labor.

Antihypertensive Agents↗
PubMed1988

Methylergonovine-induced hypertonus in term pregnancy. A case report.

The administration of methylergonovine maleate to a patient at term is rare. A patient received the drug at 36 weeks' gestation, with subsequent development of fetal distress secondary to uterine tetany. Treatment with terbutaline and magnesium sulfate was unsuccessful in alleviating the uterine hypertonus, necessitating cesarean section.

Adolescent↗
PubMed1988

Influence of short-term indomethacin therapy on fetal urine output.

Eight pregnancies ranging from 27-32 weeks' gestation were treated for preterm labor with oral indomethacin. The dosage regimen was 25 mg every four hours in four patients and 25 mg every six hours in the other four patients. The maximum duration of indomethacin therapy was 72 hours. In three patients, fetal ductus arteriosus constriction mandated discontinuation of indomethacin at 24 hours. Sonographic assessment of hourly fetal urine output was performed before therapy, at multiple regular intervals during therapy, and 24 hours after the last dose of indomethacin. A dramatic decline was noted from the mean baseline fetal urine output of 11.2 mL/hour. The mean fetal urine output at five, 12, and 24 hours during therapy was 2.2, 1.8, and 1.8 mL/hour, respectively (P less than .05). Twenty-four hours after completion of indomethacin therapy, the mean fetal urine output was 13.5 mL/hour. Poor correlation (r = 0.14, P less than .05) was noted between maternal serum indomethacin levels and hourly fetal urine output. This significant decline in urine output is consistent with other results in neonatal and adult animals and humans. Furthermore, it implies a role for prostaglandins in controlling urine output during fetal life.

Constriction, Pathologic↗
PubMed1988

Percutaneous umbilical cord blood sampling in the evaluation of fetal platelet counts in pregnant patients with autoimmune thrombocytopenia purpura.

Autoimmune thrombocytopenia purpura in pregnancy is associated with fetal thrombocytopenia. Twenty-one patients with autoimmune thrombocytopenia purpura (22 fetuses) underwent 26 umbilical cord punctures to assess the fetal platelet count. Blood could not be obtained from one fetus. Thrombocytopenia (less than 150,000/microL) was found in five cases, but in none was it of sufficient degree to preclude vaginal delivery. Persistent fetal bradycardia necessitating emergency cesarean delivery occurred in two cases. Umbilical cord puncture was found to be technically more difficult in the term fetus than in the second-trimester fetus studied in previous investigations.

Adolescent↗
PubMed1987

The use of fetal neuromuscular blockade during intrauterine procedures.

Advances in fetal therapy have led to the utilization of such techniques as intravascular transfusion of the Rh-affected fetus, bladder shunt placement in the fetus with obstructive uropathy, and percutaneous umbilical blood sampling. Fetal movement makes these procedures technically more difficult while increasing the risk of fetal injury. However, maternal sedation rarely results in adequate suppression of fetal activity. Thus we tested the sedative effects of intramuscular d-tubocurarine (3 or 1.5 mg/kg) or pancuronium bromide (0.3 mg/kg) injected into the fetal gluteal region under ultrasound guidance in conjunction with 70 invasive in utero procedures. Short-term paralysis of the fetus was induced in all cases. No deleterious effects of this technique were noted on initial examination of the neonates. Neuromuscular blockade was found to be a very useful adjunct to both diagnostic and therapeutic procedures involving the fetus.

Adult↗
PubMed1987

Umbilical cord hematoma secondary to in utero intravascular transfusion for Rh isoimmunization.

Direct intravascular transfusion of the fetus with Rhesus isoimmunization is becoming more widespread as the procedure of choice in the treatment of this disease. To date no direct complications of this new procedure have been reported. The authors describe a case of cord hematoma with resulting fetal compromise secondary to venipuncture of the umbilical vein. Doppler studies and review of the fetal heart rate tracings pointed toward umbilical artery vasospasm secondary to the cord hematoma as the etiology of the transient fetal bradycardia.

Adult↗
PubMed1987

Detection and quantitation of constriction of the fetal ductus arteriosus by Doppler echocardiography.

Pulmonary hypertension may occur in the fetus in the presence of constriction of the ductus arteriosus. The feasibility of detection and quantitation of fetal ductal constriction by Doppler echocardiography was assessed in an animal preparation in which ductal constriction was created in the fetal lamb with a variable ligature causing varying degrees of fetal pulmonary hypertension (fetal pulmonary arterial systolic pressure 57 to 97 mm Hg and ductal gradient 9 to 42 mm Hg). Comparison of blinded, continuous-wave peak Doppler velocity (V) measurements of the ductal gradient with the modified Bernoulli assumption (gradient = 4V2) compared well with direct catheter measurements of instantaneous peak systolic gradient (r = .99, catheter = 0.95 X Doppler + 0.6), peak-to-peak gradient (r = .97), and mid-diastolic gradient (r = .85). Ductal constriction was characterized by an increase in the peak systolic and diastolic velocities. The normal human fetal ductus arteriosus blood flow velocity pattern was assessed by pulsed Doppler techniques in 25 normal human fetuses after 20 weeks gestation. The peak systolic flow velocity in the ductus arteriosus measured by image-directed pulsed Doppler echocardiography ranged from 50 to 141 cm/sec (mean 80 cm/sec) and increased with gestational age (r = .50). Diastolic velocity in the ductus arteriosus was consistently directed toward the descending aorta and ranged from 6 to 30 cm/sec. The ductal systolic velocities were the highest blood flow velocities in the fetal cardiovascular system. Application of these techniques to fetuses whose mothers were receiving indomethacin for treatment of premature labor at 30 to 31 weeks gestation confirmed this method to be sensitive for detection of fetal ductal constriction, which developed in three fetuses.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗