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Biomedical subjects

K J Moise

Publications and source records attributed to K J Moise.

At least 145 records · Page 8Linked to original sources
PubMed1987

Prenatal diagnosis and postnatal management of critical aortic stenosis.

Fetal echocardiography has yet to have an impact on the treatment of congenital heart disease. Critical aortic valve stenosis was diagnosed by echocardiography before birth in a 35 week gestation fetus. The risks to the fetus and mother associated with prolonged rupture of membranes prompted their transport to a hospital with cardiac surgical and high-risk perinatal facilities. Prenatal and postnatal echocardiographic findings agreed regarding the diagnostic criteria for critical aortic stenosis and primary forms of cardiomyopathy were excluded. Results of fetal Doppler examination were consistent with valvular aortic stenosis and excluded mitral regurgitation. Determination of the left ventricular size excluded ventricular hypoplasia. The infant was delivered by cesarean section and underwent successful emergency aortic valvotomy at 12 h of age. Fetal echocardiography, in combination with a multidisciplinary postnatal approach, can be used in the successful treatment of a severe form of congenital heart disease.

Aortic Valve Stenosis↗
PubMed1987

Acute fatty liver of pregnancy: etiology of fetal distress and fetal wastage.

Acute fatty liver is a rare complication of pregnancy occurring in approximately one in 13,000 deliveries. This disease has been associated with high maternal and fetal mortality rates in the past. Advances in medical care and early recognition and delivery are credited with recent reductions in the maternal and fetal loss seen with this disease. Maternal death is associated with hypoglycemia, hepatic failure, or coagulopathy. The etiology of fetal mortality is not well delineated. Reported is a patient with histologically proved acute fatty liver who developed fetal distress during therapy for coagulopathy. Review of the fetal monitor tracing in conjunction with examination of the placenta have led us to propose that uteroplacental insufficiency may be the cause for fetal distress and fetal wastage in fatty liver of pregnancy.

Acute Disease↗
PubMed1986

The use of colloid osmotic pressure in pregnancy.

The intravascular and interstitial colloid osmotic pressure represent two important Starling forces. Pregnancy, betamimetic therapy, preeclampsia, and a variety of other factors can affect these forces. Although controversial, the normalization of colloid osmotic pressure in various disease states may prove beneficial to the patient.

Blood Specimen Collection↗
PubMed1985

Colorectal carcinoma in pregnancy.

Colorectal carcinoma in pregnancy is rare. The symptoms frequently are masked by the symptoms associated with normal pregnancy, resulting in delayed diagnosis. Based on our experience with five patients and review of the literature, we developed a management regimen that takes an aggressive approach to tumor excision, yet maintains the pregnancy and fertility if possible. The prognosis is poor for most patients because the stage of the tumor is usually advanced at the time of diagnosis. The key to improved survival, as with all cancers, is early diagnosis and treatment.

Adult↗
PubMed1984

Anaphylaxis in pregnancy.

The intrauterine anoxic insult to the fetus of a woman who suffered anaphylactic shock raises concern about supporting uteroplacental perfusion during maternal therapy. We propose ephedrine as an appropriate first-line medication.

Anaphylaxis↗
PubMedDate not supplied

Atraumatic subdural hematoma associated with pre-eclampsia.

A patient with pre-eclampsia at 31.7 weeks' gestation developed focal neurologic signs. Computerized tomography revealed a large cranial subdural hematoma. A subdural hematoma should be considered in any pre-eclamptic patient demonstrating lateralizing neurologic symptoms. Despite adequate treatment, an atraumatic subdural hematoma associated with pre-eclampsia carries a poor maternal prognosis.

Adult↗
PubMedDate not supplied

Candida chorioamnionitis: a report of two cases.

Intra-amniotic infection (IAI) across intact membranes by Candida albicans is a rare occurrence. We report two cases of preterm labor and Candida chorioamnionitis that were diagnosed by intrapartum amniocentesis. The diverse maternal and neonatal outcomes observed indicate that Candida IAI is associated with significant, unpredictable maternal and neonatal morbidity.

Adult↗
PubMedDate not supplied

Fetal heart rate influence on the pulsatility index in the middle cerebral artery.

In 1300 Doppler assessments performed on the fetal cerebral arteries, 5 cases of heart rate deceleration were recorded while studying the middle cerebral artery. There were 3 normal fetuses (mean menstrual age +/- standard deviation: 28.6 +/- 2.1 weeks), one growth-retarded fetus (34 weeks, menstrual age) and 1 fetus with red cell alloimmunization (27 weeks, menstrual age). The magnitude of decline in the heart rate during the deceleration ranged from 44 to 93 bpm (67 +/- 18 bpm). Pulsatility index values were calculated on 44 waveforms and correlated with the heart rate. Linear regression analysis showed a statistically significant inverse correlation between the heart rate and the pulsatility index in the middle cerebral artery of 4 fetuses. These results indicate that heart rate will affect the pulsatility index of the middle cerebral artery.

Cerebral Arteries↗
PubMedDate not supplied

Antibody-induced anemia in fetal sheep: model for hemolytic disease of the fetus and newborn.

OBJECTIVE: Our purpose was to produce a condition analogous to alloimmune hemolytic disease of the fetus and newborn by infusing antierythrocyte antibodies in fetal sheep. METHODS: Antierythrocyte antibodies were infused intravascularly into late-gestation ovine fetuses over a 10-day period. Fetal blood was sampled daily for complete blood cell counts, blood gases, iron, erythropoietin (EPO), and electrolyte concentrations. Red cell mass (RCM) and blood volume were determined every other day using indicator dilution techniques. Results were compared with eight similarly aged control animals. Statistical analysis included Student t test, three-factor analysis of variance, and least squares regression. RESULTS: The hematocrit in seven fetal sheep receiving antibody infusion declined significantly by 10.3 +/- 1.7%, whereas it increased in control animals 2.3 +/- 0.6% (P <.001). RCM was reduced by 18.9 +/- 3.2% over the 10-day protocol while increasing 34.1 +/- 4.2% in control animals, representing more than a 50% difference in RCM (P <.001). Fetal EPO was significantly increased with lower hematocrit and lower PO(2) (P <.001). As fetal hematocrit declined below 25%, lactate and reticulocytes also increased (P <.001). Plasma iron concentration was not significantly altered (P =.47). CONCLUSIONS: The chronically catheterized fetal sheep is a viable model for studying immunologically induced fetal anemia as hematocrit can be titrated and the fall in RCM and hematocrit are associated with fetal hypoxia and elevated EPO as occurs in the anemic human fetus. Furthermore, there appears to be a threshold degree of anemia required to elicit responses as the fetal EPO, PO(2), and lactate appeared unresponsive until hematocrit fell below 25%.

Anemia↗
PubMedDate not supplied

Noninvasive determination of fetal RhD status using fetal DNA in maternal serum and PCR.

OBJECTIVE: Because prenatal testing of fetal RhD status by amniocentesis carries small yet finite risks to the fetus and mother, this study sought to determine whether fetal DNA in maternal serum could be used to detect fetal RhD status by polymerase chain reaction (PCR). METHODS: A retrospective analysis was made of frozen serum specimens from 20 sensitized RhD-negative pregnant women (ranging from 15.0 to 36.0 weeks' gestation) who were confirmed by serology at birth to have been carrying RhD-positive fetuses. Eleven serum specimens from RhD-negative individuals served as controls. DNA was isolated from serum and used in two PCR-based methods to detect a 99 base pair (bp) DNA fragment specific for the RhD gene and a 113 bp fragment specific for the RhCE gene as control. RESULTS: Overall, in 14 (70%) of 20 RhD-positive fetuses the 99 base pair RhD-specific PCR product was detected. There was no false positive detection among the 11 control serum specimens. CONCLUSION: The results illustrate the ability to detect fetal RhD sequences in maternal serum of sensitized women. Moreover, the findings demonstrate that fetal single-gene disorders can be detected prenatally by using DNA isolated only from maternal serum.

Blood Grouping and Crossmatching↗
PubMedDate not supplied

The treatment of preterm labor using a portable subcutaneous terbutaline pump.

The perinatal mortality rate related to preterm delivery has led researchers to investigate new methods of tocolysis. A new concept in managing preterm labor uses continuous administration of terbutaline sulfate via a portable subcutaneous infusion pump. Use of the terbutaline pump to treat 13 preterm labor patients at the Baylor College of Medicine demonstrated an efficacy rate of 9 for a population failing all other methods of tocolysis. This unique treatment modality offers new hope for patients experiencing recalcitrant preterm labor.

Female↗
PubMedDate not supplied

Maternal blood donation for intrauterine transfusion.

Pregnancy affected by erythrocyte alloimmunization often requires intrauterine transfusion for fetal survival. Because blood donated by a random donor has been associated with an increased risk of disease transmission, maternal blood donation has been advocated as an alternative blood source for intrauterine transfusion. Collaboration between medical, nursing, laboratory, and nutrition personnel optimizes the safety and success of the procedure. This article describes the collaborative care of the woman participating in maternal blood donation for intrauterine transfusion.

Blood Donors↗
PubMedDate not supplied

Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence.

OBJECTIVE: To report our experience with intentional puncture of the intervening membrane ('septostomy') for the treatment of the twin oligohydramnios-polyhydramnios sequence (TOPS). METHODS: 12 patients were diagnosed with TOPS based on ultrasonographic findings. A 20- to 22-gauge spinal needle was used to puncture the membrane between the twins without any attempt at amnioreduction in 9 patients, while the procedure was combined with amnioreductions in 3 patients. RESULTS: Gestational age was 23.1 +/- 3.3 weeks at the time of septostomy and 31.1 +/- 4.4 weeks at delivery. Rapid accumulation of fluid around the 'stuck' fetus occurred in all cases following a single procedure. Three of the 24 fetuses died in utero and 1 died on the fifth day of life, for a combined survival of 83.3%. In the survivors, the septostomy to delivery interval ranged between 0.6 and 13 weeks (mean +/- SD 8.3 +/- 4.8). CONCLUSION: Amniotic septostomy is a promising new method for the management of TOPS and is associated with survival rates that are better than, or comparable to, more invasive modalities. A multicenter trial comparing septostomy to other modalities is warranted.

Amnion↗
PubMedDate not supplied

A simple method to estimate volume for fetal intravascular transfusions.

We derived a constant termed the transfusion coefficient to simplify the estimation of the fetal intravascular transfusion volume. The product of the estimated fetal weight (g) and 0.02 (transfusion coefficient), estimates the transfusion volume (ml) required to increase the fetal hematocrit by approximately 10 percentage points. Our estimation was comparable to Mandelbrot's technique and better than Plecas' method for estimating fetal transfusion volumes. Utilizing the transfusion coefficient to estimate the intravascular transfusion volume for an anemic fetus is simple, rapid and accurate.

Adult↗
PubMedDate not supplied

Fetal and neonatal hematologic parameters in red cell alloimmunization: predicting the need for late neonatal transfusions.

The purpose of this study was to determine whether the need for late neonatal transfusion can be predicted in fetuses who received intrauterine transfusions. The records of 36 patients who underwent intrauterine transfusion were reviewed. Newborns who required late transfusions had a lower reticulocyte count at their last intrauterine transfusion, a longer duration between their lowest fetal reticulocyte count and delivery, and a higher umbilical cord blood hemoglobin and percent adult red cells on Kleihauer-Betke stain at delivery. The need for late transfusions appears to be related to the extent and duration of fetal bone marrow suppression.

Bilirubin↗
PubMedDate not supplied

Ultrasound-guided cardiac blood sampling of the rabbit fetus.

The object of the study was to determine whether cardiac sampling of the rabbit fetus could be successfully accomplished with minimal procedure-related loss. Pregnant rabbit dams were randomized to undergo ultrasound-guided fetal cardiac sampling in either the left or right uterine horn at 27 days of gestation; cesarean delivery was performed the following day. Liveborn pups from unsampled uterine horns underwent cardiac puncture immediately after birth. Fetal hematologic parameters were then compared to neonatal parameters. The acute fetal mortality from the sampled uterine horns was similar to that of the unsampled horns (3.6 vs. 4.5%). Fetal hematologic values were significantly higher than neonatal values with the exception of the reticulocyte count. This rabbit model offers a new approach for the evaluation of novel treatment modalities for hemolytic disease of the human fetus.

Animals↗
PubMedDate not supplied

Effects of intravascular transfusion for red cell alloimmunization on fetal arterial blood pressure.

OBJECTIVE: To evaluate the effects of intravascular transfusion (IVT) on the fetal umbilical arterial pressure (UAP) in pregnancies complicated by red cell alloimmunization. STUDY DESIGN: UAP and amniotic fluid pressures (AFP) were measured immediately before and after IVT. Mean UAP was calculated by computing 1/3 (systolic blood pressure - diastolic blood pressure) + diastolic blood pressure. The fractional increase in fetoplacental blood volume with transfusion was calculated by dividing the net volume of blood transfused by the sum of the net volume transfused and the fetoplacental volume based on the estimated fetal weight by ultrasound. Statistical techniques included paired t-test, and the Pearson product correlation. Significance was defined as p < 0.05. RESULTS: The fetal umbilical artery was punctured during a total of 27 procedures in 21 patients. Pre- and posttransfusion mean UAPs were recorded in 16 of these procedures. Mean UAP increased from 34.0 +/- 14.2 mm Hg pretransfusion to 38.6 +/- 12.8 mm Hg posttransfusion (p = 0.34). There was no correlation between the fractional change in fetoplacental blood volume and the calculated difference between pre- and posttransfusion blood pressure. Bradycardia occurred during 5 procedures (31.2%). Fetal demise occurred after 2 procedures (12.5%). CONCLUSION: IVT appears to have a minimal effect on the fetal UAP. Fetal bradycardia occurs in a significant percentage of these cases.

Blood Pressure↗