Biomedical subjects
Publications and source records attributed to M Thiery.
Echographic measurement of the early postpartum uterus was performed, mainly to investigate whether involution patterns correlate with parity, the administration of oxytocin during labor, and lactation. Our findings suggest that these factors do not have a marked effect on uterine involution.
A gel containing 0.5 mg prostaglandin E2 (PGE2) was extra-amniotically instilled 90 clinically normal gravidae at term, for ripening of the cervix before elective induction of labor by amniotomy and intravenous PGE2. An acceptable increase in the Bishop score was noted to have occurred in 87/90 women, when assessed eight hours after administration of the gel; 14 of these women were then in established labor, which progressed uneventfully. Four of the 90 subjects required cesarean section for cephalopelvic disproportion. No adverse maternal or fetal effects of the procedure were detected under careful clinical, electronic and biochemical monitoring. However, epidural anesthesia adversely influenced the acid-base equilibrium of the fetus.
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Leucocyte and lymphocyte counts, the distribution of erythrocyte rosette-forming cells (E-RFC), erythrocyte-antibody-complement rosette-forming cells (EAC-RFC), cells bearing surface membrane immunoglobulin (SMIg), latex-ingesting cells and the PHA stimulation index of lymphocytes were evaluated in both pregnant and non-pregnant women. In the gravid female leucocytosis due to neutrophilia is seen, and the PHA-induced transformation of maternal lymphocytes in the absence of autologous plasma remains unaltered. There was a rise in the percentage of EAC-RFC and cells bearing SMIg during a pregnancy, but after monocyte adsorption on plastic dishes of the mononuclear cells, obtained after Ficoll-Hypapue centrifugation, this increase is abolished. There is a significant increase of the number of latex-ingesting cells during pregnancy. These findings indicate a significant increase of the monocytes during pregnancy.
In 22 normal term gravidas with unfavorable cervix, 5 mg PGF2alpha in Tylose gel was instilled into the extra-amniotic space. The treatment improved the cervical state so much that the women could be successfully induced by conventional methods. The procedure was well tolerated by the mother and it appeared to be perinatally safe.
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Pre-induction ripening of the unfavorable cervix was attempted in 104 normal term gravidas by means of a single extra-amniotic instillation of a viscous gel containing 0.5 mg prostaglandin E2. The procedure was highly successful and no adverse effect on mother or fetus was observed.
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Epidural analgesia (bupivacaine) was administered during labor after amniotomy, in some cases supplemented by intravenous oxytocin. A higher incidence of transient uterine hypertonus was seen after blocking. Fetal heart rate changes mainly took the form of bradycardia (in association with uterine hypertonus). At birth, the maternal biochemical condition was characterized by a lower degree of metabolic acidosis, compared to normal unanesthetized controls. The fetuses displayed a slight degree of hypoxia and hypercapnia. The mechanisms underlying these modifications are discussed. Epidural blockade in combination with elective induction of labor, whether or not supplemented by intravenous oxytocin, may carry a risk. Its magnitude is considered acceptable for both mother and fetus provided they are constantly under close surveillance, limited amounts of bupivacaine are administered and the second stage of labor is kept short. However, some warnings against epidural analgesia apply to patients with placental insufficiency and very active labor.
Labor was electively induced at term in 117 clinically normal nulliparae and parous women by combining low amniotomy with intravenous administration of prostaglandin F2 alpha (n = 64) or prostaglandin E2 (n = 53). Analgesia was obtained by continuous lumbar epidural block with bupivacaine. The procedure was very effective in producing vaginal delivery within 24 h after prostaglandin infusion (n = 115), but it was accompanied by an extremely high incidence of uterine hypertonus. Tentative explanations for the transient uterine hyperstimulation are a direct stimulatory effect of the local anesthetic on the contractility of the myometrial fiber and/or a temporarily higher amount of circulating oxytocic compound reaching the myometrium due to local vasodilatation as a result of sympathetic nerve blockade. In some cases uterine hypertonus was associated with slowing of the basal fetal heart rate and, when severe, with the appearance of late deceleration patterns and fetal acidosis. In other cases the fetal heart rate deceleration is explained by the toxic effect of bupivacaine on the myocard. Since both the myometrial hyperactivity and the FHR alterations were temporary, fetal biochemical parameters were unaffected at completion of the first stage of labor. Because with intravenous prostaglandin uterine hyperstimulation is more difficult to avoid and regional analgesia further increases the hazard of both hypertonus and fetal heart rate deceleration, the combined application of an intravenous prostaglandin and continuous epidural analgesia should not be introduced into obstetrical practice.
The placental transfer of thiamphenicol was studied in 21 subjects at term after an intravenous bolus injection of 1000 mg of the drug. Detectable antibiotic levels were present in umbilical blood and amniotic fluid within 15 min of maternal administration. With the dosage applied, minimum concentrations required for the inhibition of many Gram-positive and Gram-negative organisms causing intrauterine infections were attained in maternal plasma, cord plasma and amniotic fluid. The value of thiamphenicol for the treatment of intrauterine infections is discussed.
In 100 clinically-normal women, labor was induced at term by low amniotomy and PGE2. The drug was administered by either the oral or the oromucosal route, the same incremental dose scheme (initial dose of 0.5 mg; hourly increment of 0.5 mg until adequate uterine stimulation or a maximum single dose of 3.0 mg) being applied. Both routes of administration had comparable efficacy and were equally safe. The incidence of abnormal monitoring findings (uterine hypertonus, transient bradycardia and dips II during the first stage; late decelerations, progressive and transient bradycardia during the second stage of labor) and of low Apgar scores were similar. Acid-base and lactate-pyruvate equilibria in mother and fetus were not influenced by the route of drug administration in parous women. In nulliparae treated with PGE2 by the oromucosal route, higher values were found for the fetal-maternal difference in excess lactate than in those given oral PGE2; however, this is probably of little clinical importance.
Ripening of the unfavorable cervix (Bishop score less than or equal to 4) was obtained in 92 clinically normal gravidae at term (68 nulliparae and 24 parous women), not in labor and with intact membranes, by injecting one or two doses (250 to 500 mug each) of prostaglandin (PG)E2 suspended in a viscous gel (5% Tylose) into the extra-ovular space. On average 7 to 8 hours after the injection the mean increase of the cervical score was 3.7 and 4.1 in the nulliparous and parous women, respectively. Complications associated with placement of the catheter were few. The method is simple, well tolerated and no untoward maternal or perinatal effects could be directly attributed to it. However, suitable criteria for predicting both the effect of the procedure and the optimal PG dose to be administered are still needed.
The data of this follow-up study fail to prove that elective induction of labor at term by amniotomy and intravenously or orally administered PGF2alpha or PGE2 has an untoward effect on reproductive performance. If, however, the procedure is complicated by a serious degree of sustained uterine hyperstimulation, permanent damage to the internal cervical os may ensue, as illustrated by one of our patients.
An insulinoma was excised during pregnancy. The tumor was located by radiography and severe hypoglycaemia made it necessary to administer diazoxide to the mother. The out come in the pregnancy was satisfactory. The rationale and risks of giving diazoxide in pregnancy are discussed.
Serum HCG and HPL levels were determined in 154 samples derived from 39 twin and one triplet pregnancies. Compared with singleton gestations, these levels were respectively 2.5 and 1.5 times higher throughout gestation. Analysis of these data in terms of predictive accuracy for the existence of a twin indicates that neither assay can serve for screening purposes though simultaneous determination of HCG and HPL may provide a fair index of suspicion.