Biomedical subjects
Publications and source records attributed to M L Druzin.
A technique to assist in the atraumatic delivery of the very low birth weight fetus in cases of malpresentation at cesarean section is described; the technique minimizes potential trauma associated with version and/or extraction techniques. Use of uterine relaxing anesthetic agents and subsequent risk of hemorrhage are avoided.
A study of 37 patients who underwent 365 antepartum fetal heart rate tests showed a significant difference in heart rate between 19 to 24 weeks' and 36 to 40 weeks' gestation. Baseline heart rate remained within the normal range, suggesting that an abnormal heart rate at any gestational age should prompt further fetal assessment. Baseline fetal heart rate was not significantly different between male and female fetuses.
Ninety-three nonstress tests were performed on 57 nondiabetic patients at greater than 34 weeks' gestation. Maternal whole blood glucose levels were measured before beginning the nonstress test and within five minutes of the second fetal heart rate acceleration. There was a significant rise in maternal whole blood glucose levels in the maternal glucose ingestion group but not in the maternal water ingestion group. There was no significant difference in the mean time to reactivity between the two groups. These results suggest that maternal glucose ingestion does not affect time to reactivity or the incidence of reactive nonstress tests.
The success of the Shirodkar cerclage procedure described herein lies in the use of the medium curve White tonsil forceps. The use of this curved tonsil clamp allows compression of the vaginal mucosa laterally, thereby making it relatively simple to place the Mersilene band accurately submucosally and avoiding blind advancement of an aneurysm needle.
Plasma renin activity (PRA) was measured in the late third trimester in 26 hypertensive pregnant women and correlated with their infants' birth weights. Seven pre-eclamptics, six chronic hypertensives and 13 chronic hypertensives with superimposed pre-eclampsia were studied. Plasma renin activity was lower in 13 mothers with small for gestational age (SGA) infants (5.2 +/- 0.89 ng/ml per h, compared with 13 mothers with appropriate for gestational age (AGA) infants (16.65 +/- 2.37 ng/ml per h, P less than 0.001. The mean PRA was also lower in mothers with babies weighing less that 2500 g, regardless of gestational age, compared with 11 mothers with babies weighing more than 2500 g, (7.58 +/- 1.61 versus 15.86 +/- 2.73 ng/ml per h, P less than 0.050. Mean PRA was not significantly different in the different hypertensive groups, although women with chronic hypertension appeared to have lower PRA than pre-eclamptics. Our data suggest that in gestational hypertension, low PRA is associated with low infant birth weight, and that late third trimester PRA may therefore identify those at risk for poor fetal outcome.
One hundred and forty-one instances of premature rupture of the amniotic membranes (PROM), between 25 and 36 weeks gestation and with duration of PROM greater than six hours, were managed by bedrest, observation and no obstetric intervention. Delivery was allowed if the patient had spontaneous labor develop, and delivery was initiated for chorioamnionitis or fetal distress. The perinatal mortality was 25 of 148 infants delivered (168 of 1,000 births). The majority of neonatal deaths (64 per cent) were attributable to complications of prematurity. Neonatal sepsis was uncommon as a cause of death (0.16 per cent). Results indicate that the natural history of PROM is associated with a low incidence of serious maternal and fetal infections and that prematurity is the most serious problem.
Hemorrhage was the major complication of a serious vaginal injury. Failure to control such a hemorrhage with local suturing should prompt an exploratory celiotomy and ligation of the visible bleeding points. Hypogastric artery ligation is indicated in cases of intractable bleeding.
Prorenin and human chorionic gonadotropin are both synthesized in chorionic cells. The relationship of changes in maternal plasma prorenin to changes in human chorionic gonadotropin were therefore evaluated during the first trimester. In samples submitted to the routine chemistry laboratory for detection of pregnancy a positive relationship was observed between prorenin and beta human chorionic gonadotropin during the 5 weeks following conception. Subsequently human chorionic gonadotropin continued to rise but prorenin had reached a plateau. Serial studies in one subject demonstrated that prorenin had increased to 65% of maximum by the thirteenth day following conception whereas human chorionic gonadotropin had risen to only 0.2% of maximum. By 3 to 5 days post partum, beta human chorionic gonadotropin had fallen by 98% but prorenin had fallen by only 50%. The early rise in prorenin following conception and the relatively slow fall post partum suggest that pregnancy-related changes in maternal plasma prorenin are of maternal, not fetal, origin.
Five hundred ninety-three nonstress tests were performed on 41 obstetric patients, at gestational ages ranging from 20 to 40 weeks. Diagnoses included 10 cases of prematurity, six cases of diabetes mellitus, five cases of collagen-vascular disease, five cases of poor obstetric history, three cases of cardiac arrhythmia, and one case each of asthma, polyhydramnios, leukemia, nonimmune fetal hydrops; and eight volunteers were without high-risk factors. All neonates had a 5-minute Apgar score greater than 8; 29 neonates weighed greater than or equal to 2500 gm, 12 weighed less than 2500 gm, and four weighed less than 1500 gm. One neonate died of prematurity, and one was small for gestational age. There were no congenital anomalies. There was a significant difference in the number of reactive nonstress tests and nonreactive nonstress tests between the 20- to 24-week, 24- to 28-week, 28- to 32-week, and 32- to 36-week gestational age groups. The increased incidence of nonreactive nonstress tests at earlier gestational ages may have clinical implications.
During a prospective study of pregnancies in women with systemic lupus erythematosus, we examined the relation between antibody to cardiolipin, measured by the enzyme-linked immunosorbent assay, and midpregnancy fetal distress, identified by abnormal results of antepartum fetal heart-rate testing or by fetal death. All of nine patients with lupus and this complication had abnormally high antibody levels (mean, 212.3 +/- 55.3 units), as compared with values in normal nonpregnant women (28.2 +/- 10.1 units). None of 12 pregnant patients with lupus but without this complication had antibody levels above 50 units (mean, 27.5 +/- 3.4 units; P less than 0.005 vs. women with lupus and fetal distress); 4 of 12 pregnant subjects without lupus had antibody levels above 50 units (mean, 42.5 +/- 11.0), and fetal death occurred in the subject with the highest level. The mean antibody level in 12 nonpregnant patients with lupus was 117.4 +/- 35.0 units. Two patients who had lupus anticoagulant but not clinical lupus, both with histories of prior fetal death, also had high antibody levels; fetal death occurred in one, and spontaneous fetal bradycardia in the other. Antibody to cardiolipin was loosely linked to a history, but not the simultaneous presence, of demonstrable lupus anticoagulant or thrombocytopenia, and could be detected as early in pregnancy as either anticoagulant or thrombocytopenia. We conclude that measurement of antibody to cardiolipin is the most sensitive assay to predict fetal distress or death in patients with systemic lupus erythematosus and may be of pathogenetic importance in this syndrome.
A prospective study of 790 patients was performed in order to examine the role of manual manipulation of the fetus in the nonstress test. The patients were assigned randomly to two groups based on the last two digits of their hospital number. The odd-numbered patients underwent manual manipulation of the fetus prior to the onset of the nonstress test; the even-numbered patients did not. There was no significant difference between the two groups with respect to the indications for testing and the total number of tests. There was no statistically significant difference between the two groups with respect to the ratio of reactive to nonreactive nonstress tests and the mean duration of testing. Simple manual manipulation of the fetus does not seem to change the outcome in antepartum fetal heart rate testing when the nonstress test is the primary one.
To explore the causes of complications in pregnant women with systemic lupus erythematosus (SLE), we prospectively evaluated 34 pregnancies in 28 SLE patients, and 2 additional pregnancies in patients with lupus anticoagulant and positive antinuclear antibody, but no other manifestations of SLE. Nineteen pregnancies (55%) were complicated by marked proteinuria, thrombocytopenia, and/or lupus anticoagulant. Hypocomplementemia occurred in 18 pregnancies (52%). Neither thrombocytopenia-anticoagulant nor proteinuria was accompanied by an increase in antibody to double-stranded DNA or by clinical signs of active SLE. Antibody to Ro antigen did not predict fetal death. Both thrombocytopenia and proteinuria appeared abruptly during pregnancy and disappeared quickly after delivery. Fetal death was the result in 7 of 9 (77%) pregnancies in patients with anticoagulant, 6 of 10 (60%) in patients with thrombocytopenia, 6 of 18 (33%) in patients with hypocomplementemia, and 3 of 11 (27%) in patients with proteinuria. Twenty of 29 (68%) children were identified as male. The pathogenesis of hypocomplementemia was evaluated by a new assay, C1s-C1 inhibitor complex, which is thought to measure rate of complement activation by the classical pathway. Most pregnant patients with low CH50 levels and proteinuria had normal levels of C1s-C1 inhibitor complex, whereas nonpregnant patients with equivalent proteinuria and hypocomplementemia had high levels, as did pregnant patients with hypocomplementemia who did not have SLE. Pregnant and nonpregnant hypocomplementemic patients with proteinuria had similar levels of C3 and C4. In pregnant patients with SLE, C1s-C1 inhibitor complex was independent of CH50; in nonpregnant patients a linear relationship between C1s-C1 inhibitor complex and CH50 was seen.(ABSTRACT TRUNCATED AT 250 WORDS)
The effect of surgical and experimental manipulations on intrauterine growth of the fetus was investigated in 61 rhesus monkey fetuses in which chronic preparations were attempted. The surgical procedure consisted of hysterotomy and insertion of vascular catheters and included unilateral ligation of the fetal carotid artery. The mother was kept in a restraining chair after the operation for the duration of the preparation (0 to 39 days). Thirty-four fetuses who died within 48 hours after operation served as the control group for the growth parameters. The remaining fetuses that survived 7 days or more after the operation were included in the experimental group. Body weight, crown-rump length, crown-heel length, and foot length of the fetus and placental weight were measured at the termination of the preparation. There were significant linear correlations between all parameters and gestational age. Comparison between the control and experimental groups revealed that none of the parameters from the experimental group differed significantly from those of the control group. No relationships were found between the duration of the preparation and any of the parameters. Total brain weights from 19 fetuses exhibited a significant increase with gestational age and these values were within the normal range reported previously. There were no significant differences in weight between right and left cerebral hemispheres. No evidence of unequal blood flow to the cerebral hemispheres was found with the radioactive microsphere technique. The data suggest that the surgery performed on both the mother and the fetus and prolonged maternal restraint did not alter intrauterine fetal development.
To assess whether pregnancy is associated with exacerbation of systemic lupus erythematosus (SLE), a variety of clinical markers of disease activity in 28 pregnant patients with SLE (33 pregnancies) were compared with the same markers in age-, race-, organ system-, and disease severity-matched nonpregnant women with SLE. Both groups were followed up for periods of up to one year after delivery. Eight patients elected abortion for nonmedical reasons. In all patient groups, there were no differences between pregnant and nonpregnant patient groups in frequency of any disease activity marker studied including therapy. However, new proteinuria occurred in four pregnant patients compared with one nonpregnant patient, and thrombocytopenia attributable to SLE occurred in five pregnant patients and one nonpregnant patient. Renal disease, when it occurred, more closely resembled pregnancy-induced hypertension than lupus nephritis. It is concluded that pregnancy complications are frequent, but the assertion that pregnancy causes exacerbation of SLE remains unproved.
Ten diabetic pregnant women were studied during the thirty-sixth to fortieth weeks of gestation to determine whether maternal blood glucose levels influence fetal activity. Maternal blood glucose level was monitored and controlled utilizing an artificial pancreas (Biostator) while fetal activity and heart rate were quantitated by continuous ultrasonic and electrocardiac fetal monitoring. Fetal activity was confirmed independently by a maternal controlled event marker. There was no difference in fetal movement with heart rate accelerations between periods of maternal normoglycemia defined as blood glucose levels between 60 and 140 mg/dl (3.3-7.8 mMol/L) and periods of maternal hyperglycemia (blood glucose level greater than 140 mg/dl or 7.8 mMol/L). Maternal blood glucose levels of less than 60 mg/dl (3.3 mMol/L) were accompanied by a significant (p less than 0.001) increase in fetal activity (19.9 +/- 3.9 SEM episodes of fetal movement per 20-minute observation period versus 8.0 +/- 5 episodes during periods of hyperglycemia). These observations indicate that hyperglycemia does not stimulate fetal activity and that the obstetric practice of beverages with high glucose content administered during antepartum testing (in an attempt to increase fetal movement) should be reevaluated in diabetic women.
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Cigarette smoking during pregnancy has been related to poor perinatal outcome. To investigate the changes in maternal and fetal arterial blood gases associated with smoking, five chronically catheterized pregnant rhesus monkeys were exposed to standard cigarette smoking (N = 5) and nicotine-free herbal cigarette smoke (N = 3). The only consistently reproducible and significant finding was a drop in fetal PO2. The timing of the decline in PO2 and the similar responses to standard and nicotine-free cigarette smoke make carboxyhemoglobin the most likely causative factor.