Biomedical subjects
Publications and source records attributed to L V Baxi.
Repeated use of a long-acting sympathomimetic amine in the form of a nasal spray was associated with a nonreactive nonstress test and late decelerations in a patient at 41 weeks of gestation. Six hours after the last dose, these changes gradually disappeared.
Near-term ultrasonograms of 44 diabetic gravid patients and 47 nondiabetic gravid patients were retrospectively analyzed. The mean values of abdominal diameter to femur length ratios and abdominal diameter to biparietal diameter ratios in diabetic gravid patients with large-for-gestational age fetuses were significantly different from those values in diabetic patients with appropriate-for-gestational age fetuses and in nondiabetic patients. Glycosylated hemoglobin values were above 7.4% (mean +/- 2 SD) in 79% of diabetic patients with large-for-gestational age infants and abdominal diameter to femur length ratio exceeding 1.385. Glycosylated hemoglobin values were less than or equal to 7.4% in 69% of diabetic gravid patients with appropriate-for-gestational age fetuses and abdominal diameter to femur length ratio less than 1.385. These findings suggest that large-for-gestational age infants have a different growth characteristic with a disproportionate enlargement of the abdomen. This possibly results from a long period of elevated levels of maternal plasma glucose (as shown by elevated values of glycosylated hemoglobin).
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The role of vasopressin (VP) and the kidney in the maintenance of solute and volume homeostasis was studied in chronically instrumented fetal lambs during the third trimester. Plasma VP, urine and plasma osmolality, and urine output were measured in 74 simultaneous samples. The results show a strong positive nonlinear correlation between plasma VP and osmolality when a latter is higher than 290 mosmol/kg (r = 0.803, P = 0.03) and between plasma VP and urine osmolality (r = 0.806, P = 0.05). No correlation was found between fetal and maternal plasma VP. However, linear correlations were found in plasma osmolality and sodium concentrations between mother and fetus; mean maternal-fetal gradients were 4 mosmol/kg and 3.1 meq/liter, respectively. The highest values for plasma VP and osmolality found in our study were 7.0 pg/ml and 317 mosmol/kg, respectively. There values corresponded to urine output of 0.02 ml.kg-1.min-1 and osmolality of 517 mosmol/kg. In conclusion, there studies demonstrate that the relationship among plasma osmolality, plasma vasopressin concentration, and urine osmolality in the lamb fetus are qualitatively similar to those of the adult. The results suggest that the fetal neurohypophysis and kidney may participate in the maintenance of fetal osmolar and volume homeostasis.
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A double-blind study was performed in 50 patients with the use of low-dose intravenous oxytocin or PGF2 alpha for the induction of labor for elective or high-risk indications. Both agents were equally effective for the induction of labor. No major complications were encountered with either drug in mother or infant. The ability to induce labor with relatively small, infrequently increased doses of either inducing agent was an unexpected finding.
To test the hypothesis that fetal heart rate (FHR) changes following paracervical block may be secondary to fetal hypoxia, human fetal oxygenation was measured continuously using a transcutaneous electrode. Following the block, each fetus demonstrated a decline in oxygen tension (tcPO2) at 5 minutes, which reached its lowest value at a mean of 11.5 minutes and remained at this level for an average of 3 minutes. Following the block, FHR variability increased at 5.2 minutes. reaching its maximal level by a mean of 7.5 minutes. By 11 minutes, a decrease in FHR variability was noted, which lasted for approximately 17 minutes. Decreased variability was not uniformly associated with low tcPO2. On some occasions, fetal tcPO2 declined even in the absence of increased uterine activity, which was noted at times following the block. The severity of the tcPO2 decline appears related to the analgesic effectiveness of the block.
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The purpose of our study was to determine the Doppler ultrasound characteristics of fetal breathing-related nasal fluid flow velocity in pregnancies complicated by diabetes mellitus and to examine any changes in the timing parameters of fetal breath cycle relative to maternal blood glucose level. Fetal nasal fluid flow velocity was studied in 67 women at 30-41 weeks of gestation. In 37 cases, the pregnancy was uncomplicated; in 13 cases, the pregnancy was complicated by type I diabetes mellitus; and in 17 cases, the pregnancy was complicated by gestational diabetes. At the examination, subjects with diabetes mellitus were grouped by glucose control (normoglycemic and hyperglycemic) and by gestational age: 30-36 weeks and 37-41 weeks. Maternal hyperglycemia was defined as a plasma glucose value ranging from 140 to 205 mg per 100 ml. A continuous videotape record of the spectral Doppler imaging of fluid flow velocity in the nose was made during each study session. Based on a sample of 25 consecutive fetal breaths, the timing components of breath cycles were determined: time of inspiration (Ti), time of expiration (Te), breath-to-breath interval (Ttotal), and ratio of Ti and Te (Ti/Te). There was a statistically significant difference between the Ttotal (msec) at 30-36 weeks' gestation in the cases of diabetes mellitus with maternal normoglycemia (1,050 +/- 68 SEM) and uncomplicated pregnancy with maternal normal carbohydrate intolerance (1,221 +/- 52). There was a similar difference in the values of Te (552 +/- 37 and 660 +/- 29, respectively) at 30-36 weeks. In cases of maternal hyperglycemia at 30-36 weeks' gestation, the value of Te (689 +/- 84) was significantly higher than in cases of normoglycemia (552 +/- 37). At 37-41 weeks' gestation, only the fetal Ti/Te ratio in normoglycemic diabetic patients was significantly lower than in an uncomplicated pregnancy. No differences were found in the other timing parameters at this gestational age group in cases of diabetes mellitus relative to maternal blood glucose level. No relationship was found between the value of maternal blood glucose and either fetal Ttotal (r2 = 0.003), or Ti/Te ratio (r2 = 0.0001) in cases of diabetes mellitus. Expiratory phase of fetal breath cycle even in well-controlled normoglycemic diabetic women, is significantly shorter than in uncomplicated pregnancies before 37 weeks of gestation. Maternal hyperglycemia in these cases prolonged the duration of expiratory phase of fetal breath cycle and significantly decreased the Ti/Te ratio more than 15% at 30-36 weeks of gestation. It is suggested that blood glucose level is involved in the regulation of fetal respiratory center in pregnancies complicated by diabetes mellitus.
Prenatal fetal echocardiography studies detected large multiple cardiac rhabdomyomas and led to the diagnosis of tuberous sclerosis. Despite episodes of bradyarrhythmias and severe lung compression in utero, the neonate did well and was discharged home on day 20 of life. On day 30 of life, the infant expired at home from cardiac arrest secondary to arrhythmia.