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Biomedical subjects

M L Socol

Publications and source records attributed to M L Socol.

At least 55 records · Page 3Linked to original sources
PubMed1990

Severe acidosis and subsequent neurologic status.

To examine the relationship between severe acidosis at birth and evidence of subsequent neurologic dysfunction, a 4-year review was performed encompassing 15,528 neonates. One hundred forty-two (0.91%) of these neonates had an umbilical cord arterial pH less than or equal to 7.05 with a base deficit greater than or equal to mEq/L. Neurologic assessments found 101 of 110 term neonates (91.8%) and 17 of 32 preterm neonates (53.1%) with severe acidosis to be free of neurologic deficits at the time of hospital discharge. Follow-up developmental evaluation data were available for 7 of 9 term neonates and 8 of 15 preterm neonates with abnormal examinations. Although 5 term and 6 preterm infants demonstrated mild developmental delays or mild tone abnormalities in the first year of life, none exhibited a major motor or cognitive abnormality at 12 to 24 months of age. Consequently, acidosis in umbilical cord blood, even when severe, is a poor predictor of subsequent neurologic dysfunction.

Acid-Base Equilibrium↗
PubMed1990

Awaiting cervical change for the diagnosis of preterm labor does not compromise the efficacy of ritodrine tocolysis.

We retrospectively studied 209 patients treated with ritodrine hydrochloride to determine whether change in cervical effacement or dilatation during a period of observation before therapy would result in decreased efficacy of ritodrine, as measured by delivery delays of 48 hours, 1 week, or until greater than or equal to 37 weeks' gestation; neonatal intensive care unit admission; and neonatal respiratory distress syndrome. Patients who were greater than or equal to 3 cm dilated on admission were at high risk of therapy failure by all outcome measures compared with patients less than 3 cm dilated. For patients less than 3 cm dilated on admission, there was no difference in outcome when patients treated for contractions only were compared with those treated after change in effacement or dilatation had been documented. We conclude that awaiting change in cervical effacement or dilatation to be more certain of the diagnosis of preterm labor will not compromise the efficacy of ritodrine tocolysis.

Adult↗
PubMed1990

Effects of intravascular, intrauterine transfusion on prenatal and postnatal hemolysis and erythropoiesis in severe fetal isoimmunization.

In an investigation of the effects of intrauterine, intravascular transfusions (IUT) on fetal and neonatal hemolysis and erythropoiesis, 12 fetuses who received IUT for treatment of severe isoimmunization had serial measurements of hemoglobin concentration, Kleihauer-Betke stains to detect fetal hemoglobin-containing erythrocytes, and determination of plasma erythropoietin (EPO) concentration before each IUT, at birth, and postnatally. Reticulocyte counts and sensitizing antibody titers were measured in five fetuses. Mean values before the first IUT, before the final IUT, and at birth were as follows: hemoglobin level, 6.1, 9.1, and 11.3 gm/dl; reticulocyte count, 22.7%, 0.5%, and 0.9%; fetal hemoglobin-containing erythrocytes, 100%, 1.6%, and 1.5%; and EPO level, 12, 56, and 756 mU/ml, respectively. Only one neonate required exchange transfusion. In the first month postnatally, all infants had a profound anemia. All but one infant required simple blood transfusions postnatally. Before the first postnatal transfusion, mean hemoglobin concentration was 6.2 gm/dl, mean reticulocyte count was 0.8%, mean erythropoietin concentration was 23 mU/ml, and the sensitizing antibody titer remained markedly elevated. Except for the surge of EPO at birth, EPO levels did not rise prenatally or postnatally unless marked anemia (hemoglobin level less than 5 gm/dl) occurred. These observations suggest that the intrauterine and postnatal anemia in fetuses who receive IUTs may be explained both by hemolysis of newly formed erythrocytes by circulating antibody, which typically persisted for more than a month after birth, and by suppressed erythropoiesis.

Anemia, Neonatal↗
PubMed1989

Factors influencing hemostasis after umbilical vein puncture in vitro.

Bleeding from the site of cordocentesis can be detected by ultrasound examination, but significant hemorrhage into the amniotic fluid rarely occurs. To evaluate the relative contribution of amniotic fluid thromboplastins and the quantity of Wharton's jelly in facilitating coagulation at the puncture site, amniotic fluid samples and umbilical cord segments were obtained at cesarean section from 20 patients. After puncture of the umbilical vein, bleeding times were measured in amniotic fluid and 0.9% sodium chloride. The quantity of Wharton's jelly was assessed by measuring umbilical cord circumference. Mean bleeding times were significantly shorter in amniotic fluid compared with saline solution, but there was no consistent relationship between bleeding times and umbilical cord circumference. We conclude that properties of amniotic fluid facilitate coagulation at the site of umbilical vein puncture.

Amniotic Fluid↗
PubMed1989

Prediction of hematocrit decline after intravascular fetal transfusion.

Fetal blood sampling and intravascular transfusion via cordocentesis allow more precise fetal evaluation and treatment in isoimmunized pregnancies. However, the timing of repeat transfusion has remained empiric. In this report we review our experience with fetal transfusions in isoimmunized pregnancies to evaluate the ability to predict fetal hematocrit decline and thereby determine the optimum timing for repeat transfusions. Between March 1986 and March 1988, 60 intravascular fetal transfusions were performed in 20 patients. Fetal transfusions were excluded from analysis if blood samples were unable to be obtained before and after transfusion, as well as at the beginning of the next transfusion or birth. Fifty-three procedures were analyzed. Two equations were used to predict the fetal hematocrit at the subsequent transfusion. The difference between observed and predicted hematocrits at the beginning of a subsequent transfusion or birth was -0.9% +/- 5.8% with equation 2, which was the more accurate formula in the majority of fetuses. Prediction of fetal hematocrit decline may be used to determine the optimum timing of repeat transfusion.

Blood Transfusion, Intrauterine↗
PubMed1988

Prediction of fetoplacental blood volume in isoimmunized pregnancy.

Direct intravascular fetal transfusion under ultrasound guidance allows precise evaluation of both fetal anemia and adequacy of therapy. In addition, the change in hematocrit after transfusion may be used to estimate the circulatory fetoplacental blood volume. In this study we present the estimates of fetoplacental blood volume calculated at the time of intravascular fetal transfusions. Between March 1986 and March 1988, 60 intravascular fetal transfusions were performed in 20 patients. The 56 procedures in which fetal hematocrits were obtained both before and after transfusion were analyzed. The mean fetoplacental blood volume before transfusion was 94.0 ml/kg. Furthermore, the fetoplacental blood volume per kilogram fetal weight decreased with advancing gestation. These estimates of fetoplacental blood volume and changes relative to gestational age may be useful in the treatment of the severely isoimmunized fetus. Reliance on the more recently generated fetoplacental blood volumes may allow more accurate predictions of transfusion volumes and estimation of the hematocrit after transfusion.

Blood Transfusion, Intrauterine↗
PubMed1988

Cordocentesis: an appraisal of risks.

Fetal blood sampling via cordocentesis is being used with increasing frequency. Between March 1986 and February 1988, we performed 58 intravascular transfusions (64 attempts) and 27 fetal blood samplings (28 attempts) guided by ultrasonography. The complication rates for intravascular transfusion and fetal blood sampling were 9.4% (6 of 64) and 7.1% (2 of 28), respectively. The procedure-related mortality rates were 4.7% (3 of 64) and 0%. We caution that the potential complications be seriously considered when appropriate patients are selected for cordocentesis. Additionally, we recommend that cordocentesis be performed only in tertiary care centers by personnel skilled in both ultrasonography and prenatal diagnosis.

Blood Specimen Collection↗
PubMed1988

Apgar scores and umbilical cord arterial pH in the breech neonate.

Apgar scores and umbilical cord arterial pH measurements of 449 singleton breech deliveries are compared retrospectively to those of 1425 singleton vertex neonates. In the vaginal deliveries the Apgar scores and umbilical arterial pH were higher for the vertex neonates. There were no differences in either Apgar scores or umbilical arterial pH between the breech and vertex neonates delivered by cesarean section. Whereas Apgar scores in the less than 1000 g and greater than or equal to 2500 g weight groups were lower in the breech neonates delivered vaginally compared to cesarean section, umbilical arterial pH measurements were similar. The data suggest that liberal use of cesarean section may improve the Apgar scores but will probably not appreciably improve the acid-base status of the breech neonate.

Apgar Score↗
PubMed1988

Vaginal birth after cesarean section for arrest of labor: is success determined by maximum cervical dilatation during the prior labor?

The charts of 229 patients who attempted a vaginal birth after a cesarean section were reviewed. A total of 103 patients had a prior cesarean section for either failure to progress or cephalopelvic disproportion. On the basis of the maximum cervical dilatation in the prior labor, the patients were categorized into three groups: 0 to 5 cm, 6 to 9 cm, and 10 cm. The success rates for vaginal delivery of 61%, 80%, and 69%, respectively, were not significantly different among groups (p = 0.31). When arrest of labor was not the indication for primary cesarean section, 78% of the patients were subsequently delivered of their infants vaginally. This was not significantly different from the 70% overall success rate achieved by the group with failure to progress or cephalopelvic disproportion (p = 0.17). Similarly, when the success rate for a trial of labor was plotted against neonatal birth weight, the trends were comparable in the groups with and without failure to progress or cephalopelvic disproportion. These data suggest that patients with a prior cesarean section for arrest of labor are good candidates for a trial of labor and that the cervical dilatation previously reached does not determine the likelihood of success.

Birth Weight↗
PubMed1988

Fetal heart rate changes after fetal intravascular treatment with pancuronium bromide.

Because of recurrent needle dislodgement secondary to fetal movement, we have altered our intravascular transfusion technique by replacing maternal premedication (meperidine and diazepam [group 1]) with fetal intravascular infusion of pancuronium bromide (Pavulon [group 2]), a nondepolarizing neuromuscular blocking agent. Baseline fetal heart rate, number of accelerations, and variability were assessed before and after transfusion in both groups. Whereas there were no changes after transfusion in the former group, those fetuses who received pancuronium bromide demonstrated a dramatic abolishment of accelerations and decrease in variability, with the heart rate pattern often appearing "sinusoidal-like." These alterations in fetal heart rate were temporary changes that reverted to normal once the fetus "awakened" from the neuromuscular blockade. We speculate that these changes in fetal heart rate are secondary to the interaction of the reported hypertensive and vagolytic effects of pancuronium bromide.

Blood Transfusion, Intrauterine↗
PubMed1987

Percutaneous umbilical transfusion in severe rhesus isoimmunization: resolution of fetal hydrops.

The rhesus-sensitized fetus with the worst prognosis is one with early onset of hydropic changes. Percutaneous umbilical blood sampling now enables access to the fetal circulation and thereby allows more precise evaluation of fetal anemia and direct intravascular transfusion. A variation of this technique was used in three pregnancies complicated by fetal pericardial effusion, scalp edema, and abdominal ascites before 26 weeks' gestation. Twelve ultrasound-guided percutaneous transfusions of 30 to 85 ml packed red blood cells were administered into the umbilical cord at its placental insertion. In each fetus the hydropic changes completely resolved and pregnancy outcome was successful. Neither adjunctive therapy with digoxin or Lasix nor exchange transfusions were used. Percutaneous umbilical transfusions appear to have the potential to improve the prognosis for the severely isoimmunized fetus.

Adult↗
PubMed1986

Diabetic macrosomia: accuracy of third trimester ultrasound.

Sonar biparietal diameter, head circumference, and abdominal circumference percentile values obtained late in the third trimester were compared with birth weight percentile (relative to dates) in 147 diabetic mothers and 40 control fetuses of nondiabetics. Estimates of fetal weight by the method of Shepard et al were also calculated from these sonar data and compared with birth weight percentile. Abdominal circumference values greater than the 90th percentile correctly predicted macrosomia (defined as birth weight greater than 90th percentile) in 78% of cases. Biparietal diameter and head circumference percentiles were significantly less predictive of macrosomia. When analyzed in a similar manner, estimated fetal weights greater than the 90th percentile correctly predicted macrosomia at birth in 74% of cases. However, when both the abdominal circumference and the estimated fetal weight exceeded the 90th percentile, macrosomia was correctly diagnosed in 88.8% of pregnant women with diabetes mellitus.

Abdomen↗
PubMed1985

Meconium below the vocal cords at delivery: correlation with intrapartum events.

Intrapartum events were studied in 272 patients with meconium-stained amniotic fluid. All infants underwent DeLee suction followed by intubation and 58 of 272 had meconium present below the vocal cords at delivery. Neither the total duration of variable fetal heart rate decelerations or a continuous saltatory pattern nor the presence or absence of late decelerations could be related to an increased risk of meconium below the vocal cords. When a rising baseline fetal heart rate and decreased variability were present as well, a significantly greater proportion of patients had meconium below the vocal cords. Routine obstetric and pediatric suctioning did not prevent the single death that occurred in a fetus who had deep meconium aspiration in utero.

Amniotic Fluid↗
PubMed1985

Real-time ultrasound estimations of weight in fetuses of diabetic gravid women.

To test the applicability of equations for fetal weight estimations in a group of fetuses suspected of being large for gestational age, real-time ultrasound measurements of fetal biparietal diameters and abdominal circumferences were obtained for 34 fetuses of diabetic mothers. In the first phase of the study the accuracy in the prediction of weight was assessed with use of two known equations. In the second phase, biparietal diameter, abdominal circumference, and actual birth weight data of the 34 study fetuses were used as independent variables to determine the best-fitting equation for relating estimated fetal weight (EFW) to biparietal diameter (BPD) and abdominal circumference (AC); this equation is log (EFW) = 0.02597 AC + 0.2161 BPD - 0.1999 (AC X BPD2)/1000 + 1.2659. The standard deviation of differences is 322.26 gm and multiple R = 0.781. In the final phase the reliability of this equation was compared to those of Thurnau and Shepard in 34 additional fetuses of diabetic gravid women. The data suggest that in these fetuses suspected of being large for gestational age the weight estimates calculated at or near term may be enhanced if predictive equations are formulated specifically from the data for such fetuses.

Abdomen↗
PubMed1985

Platelet activation in preeclampsia.

Platelet activation was assessed in hospitalized third-trimester patients with preeclampsia (n = 11) or chronic hypertension with superimposed preeclampsia (n = 11) and in healthy outpatient pregnant controls (n = 10) by measuring plasma beta-thromboglobulin, platelet factor 4, the platelet aggregate ratio, and the amount of collagen required to produce half-maximal aggregation velocity (Kd). Only plasma beta-thromboglobulin levels differed significantly between patients with preeclampsia (50.1 +/- 37.9; p less than 0.05) or chronic hypertension with superimposed preeclampsia (47.6 +/- 16.3; p less than 0.01) and the control subjects (22.5 +/- 11.3). beta-Thromboglobulin values in patients with preeclampsia, but not chronic hypertension with superimposed preeclampsia, correlated directly with 24-hour urinary protein loss (r = 0.93, p less than 0.001) and serum creatinine levels (r = 0.62, p less than 0.05) and inversely with creatinine clearance (r = 0.60, p = 0.05). We conclude that (1) beta-thromboglobulin is elevated in patients with preeclampsia or chronic hypertension with superimposed preeclampsia, (2) the normal platelet aggregate ratio and the Kd indicate that the increase in beta-thromboglobulin is not due to an intrinsic change in platelet responsiveness, and (3) the elevation of beta-thromboglobulin in patients with either preeclampsia or chronic hypertension with superimposed preeclampsia appears to be secondary to platelet consumption in the microvasculature, although in patients with preeclampsia altered renal function may be contributory.

Adult↗
PubMed1985

Ultrasonic fetal weight prediction: role of head circumference and femur length.

The accurate sonographic estimate of fetal weight is helpful in those instances when the fetal weight estimate might alter clinical management. Most sonographic weight predicting formulas have been based predominantly on measurements from the term fetus and then applied to the preterm fetus. Yet, the morphology of the preterm and term fetus differs considerably. The authors have examined the predictive accuracy of three published sonographic formulas in 69 preterm fetuses scanned within 48 hours of delivery. The mean birth weight was 1396 g. Thirty-nine of the infants were less than 1500 g. Sixty-two percent were products of pregnancies complicated by premature rupture of membranes. The results were compared with new equations derived from combinations of head and abdominal circumferences, biparietal diameter, and femur length obtained from the first 33 fetuses and then tested on the remaining 36. Whereas each formula correlated highly with birth weight, the selected new formula was more accurate than the published formulas by each criteria examined. In contrast to the latter, the mean error (actual minus predicted weight) of most new equations did not significantly differ from zero when tested prospectively. In addition, it appeared that the accuracy of two new formulas not incorporating femur length could be further enhanced in the group of fetuses whose femur length differed from the mean by at least 2 standard deviations by multiplying the predicted weight by the ratio of actual to mean femur length. The authors conclude that the use of head circumference and femur length coupled with a population restricted to the preterm fetus enhances the accuracy of sonographic weight predictions.

Birth Weight↗
PubMed1984

Perinatal outcome following prior delivery in the late second or early third trimester.

Forty pregnancies in 37 women who were previously delivered of a live-born fetus between 20 and 32 weeks' gestation are reported here. Fourteen pregnancies were treated with cervical cerclage between 14 and 16 weeks. Twenty-six pregnancies were initially managed conservatively, but three of these patients had a McDonald cerclage placed between 18 and 23 weeks because of significant change in cervical effacement or dilatation. The risk of preterm delivery was 36% (5 of 14) in the cerclage group and 38% (10 of 26) in those patients managed conservatively. The perinatal survival rates were 93% (13 of 14) and 88% (23 of 26), respectively. These results are encouraging when it is considered that only 14% (9 of 64) of prior gestations (exclusive of spontaneous abortions and elective terminations) were carried to term and the perinatal survival rate was 28% (18 of 64). Although this study was nonrandom, these results also support the selective use of cervical cerclage on the basis of past history and physical examination.

Birth Weight↗