Biomedical subjects

M Y Divon

Publications and source records attributed to M Y Divon.

At least 73 records · Page 4Linked to original sources

PubMed1992

Ritodrine therapy in the presence of chronic abruptio placentae.

BACKGROUND: Betamimetic therapy is usually contraindicated for the treatment of premature labor associated with abruptio placentae. We report prolongation of a pregnancy for 7 weeks using ritodrine despite the presence of placental abruption. CASE: A 33-year-old primigravid woman presented at 25 weeks' gestation with irregular uterine contractions, vaginal bleeding, and sonographic evidence of abruptio placentae. Port wine-colored amniotic fluid was found during amniocentesis, and serial hematocrits decreased from 36 to 25%. A diagnosis of abruptio placentae was made, and because the maternal cardiovascular and fetal biophysical indices were normal, tocolytic therapy was started. Before the administration of ritodrine, the patient and her husband were given an extensive review of the risks, including blood transfusion, adult respiratory distress syndrome, disseminated intravascular coagulopathy, and maternal or fetal death. CONCLUSION: Although clinical suspicion of abruptio placentae remains a contraindication to betamimetic therapy, exceptions may be made if fetal and maternal well-being can be monitored and if a fully staffed operating room is always available for immediate cesarean delivery. The benefits of this management may outweigh the associated risks for carefully chosen, very preterm gestations.

Abruptio Placentae↗

PubMed1992

Sudden fetal death in women with well-controlled, intensively monitored gestational diabetes.

An intensive antepartum monitoring system for women with gestational diabetes mellitus was evaluated over a 5-year period. Early diagnosis and liberal treatment with insulin was concomitantly followed with non-stress testing: weekly from 28 to 34 weeks' gestation and semi-weekly thereafter. Despite maternal euglycemia and satisfactory antepartum assessment, three fetal deaths occurred within 72 hours of reassuring fetal monitoring. Additionally, 24 (7%) fetuses were delivered on the basis of a low biophysical profile score (less than 6) at term. The stillbirth rate for women with gestational diabetes was 7.7/1000, whereas the stillbirth rate for nondiabetic low-risk patients was 4.8/1000. Women with gestational diabetes continue to be in a high-risk category for antepartum fetal death, requiring intensive monitoring with consideration for timely delivery.

Adult↗

PubMed1992

Longitudinal study of the amniotic fluid index in post-dates pregnancy.

Amniotic fluid (AF) was measured in 511 post-dates pregnancies (at least 41 weeks of gestational age) with the use of the AF index. Ultrasonographic evaluations were conducted on a semiweekly basis. Only patients with reliable gestational ages calculated from certain last menstrual period and confirmed by early sonographic estimates participated in the study. Oligohydramnios (AF index of 5.0 cm or less) was detected in 11.5% of the study population. Longitudinal data were available from 121 patients who demonstrated a mean 25% decrease in AF index per week beyond 41 weeks' gestation. The longitudinal change in AF index was statistically significant (P less than .0005). Amniotic fluid index measurements ranged from 1.7-24.6 cm, with a mean of 12.4 at 41 weeks' gestation. Compared with previous cross-sectional studies, this longitudinal study provides a more accurate estimate of changes in AF levels as a function of gestational age.

Amniotic Fluid↗

PubMed1991

Intrapartum ultrasonographic estimates of fetal weight by the house staff.

In spite of the widespread use of ultrasonographic estimates of fetal weight, a paucity of data exists with regard to its use in patients who are in labor. The purpose of this study was to evaluate the accuracy of ultrasonographic estimates of fetal weight in a busy labor and delivery suite by the house staff. Measurements of biparietal diameter, abdominal circumference, and femur length were prospectively obtained in 109 patients in labor in whom this information was expected to be contributory in making delivery plans. All patients were delivered within 48 hours of ultrasonographic evaluation. Measurements of abdominal circumference were obtained in all cases. Biparietal diameter and femur length were obtained in 85% and 92% of cases, respectively. Overall, the mean absolute errors were 9.3% and 9.2% for estimated fetal weight by biparietal diameter/abdominal circumference and abdominal circumference/femur length ratios, respectively. Estimated fetal weight by biparietal/diameter/abdominal circumference ratio was not significantly different from that by femur length/abdominal circumference ratio. In conclusion, the accuracy of intrapartum estimates of fetal weight performed by the house staff in a busy labor and delivery unit is comparable to that reported for estimates obtained during the antepartum period by professional users of ultrasonography in a controlled setting.

Abdomen↗

PubMed1991

Maternal perception of decreased fetal movement as an indication for antepartum testing in a low-risk population.

Maternal perception of decreased fetal movement has traditionally been used as an indication for fetal testing in high-risk patients. Two hundred ninety-two low-risk patients who presented with a complaint of decreased fetal movement were studied to determine the incidence of adverse outcome and need for further testing. Initial testing included a nonstress test and ultrasonographic examination. Five (1.7%) of the study group had fetal death on initial examination and 4.4% of patients required immediate delivery because of abnormal maternal or fetal evaluation. An additional 5.8% had abnormal fetal heart rate tracings that necessitated follow-up. Fifty-two percent of patients with normal initial evaluations underwent additional testing. There were no significant differences between patients undergoing additional testing, patients having no additional testing, and a low-risk nontested group with regard to adverse outcome. Fetal surveillance is indicated in low-risk patients with decreased fetal movement. Additional testing of patients with a normal initial evaluation and no further complaint of decreased fetal movement may not be necessary.

Adolescent↗

PubMed1990

Sonographic estimates of fetal weight in the intrauterine growth retardation population.

The efficacy of different methods of fetal weight estimation using sonographic measurements of the abdominal circumference (AC), biparietal diameter (BPD), and femur length (FL), either alone or in combination, was evaluated in the fetus with intrauterine growth retardation (IUGR). Eighty-one patients, referred with a clinical suspicion of IUGR, were studied. All patients had sonographic measurements within 7 days of delivery. Four regression equations were used to estimate fetal weight: AC (Hadlock), BPD-AC (Shepard), AC-FL (Hadlock), BPD-AC-FL (Hadlock). For the total study group, as well as for the infants who were found to be IUGR at birth, 75% of the estimates of fetal weight using the BPD-AC-FL method were within 10% of the actual birthweight. Nearly comparable results were obtained using the AC-FL method. In the fetus with IUGR, estimates of fetal weight that incorporated the FL correlated best with the actual birthweight.

Anthropometry↗

PubMed1989

Postdate fetal surveillance: is 41 weeks too early?

During an 18-month period, 293 patients had a nonstress test and ultrasonographic evaluation of amniotic fluid volume twice weekly beginning at 41 weeks' gestation. Patients were admitted for induction of labor for either an abnormal nonstress test result or oligohydramnios. A control population consisted of 59 low-risk patients who were delivered between 39 and 41 weeks' gestation and had antepartum testing within 4 days of delivery. Study patients who were delivered between 41 and 42 weeks' gestation had a significantly increased incidence of abnormal nonstress tests, oligohydramnios, cesarean sections for fetal distress, and admissions to the neonatal intensive care unit compared with control patients. The abnormal fetal testing and adverse perinatal outcome associated with pregnancies over 42 weeks were also found in pregnancies between 41 and 42 weeks' gestation. These data support the concept that postdate fetal testing should begin at 41 weeks of gestation.

Evaluation Studies as Topic↗

PubMed1989

Macrosomia in the postdate pregnancy: is routine ultrasonographic screening indicated?

Macrosomia is a potential but often overlooked consequence of the postdate pregnancy. A total of 317 consecutive patients with well-dated pregnancies who were seen because of fetal surveillance at greater than 41 weeks' gestation had an estimation of the fetal weight based on femur length and abdominal circumference at the initial visit. The incidence of macrosomia at 41 weeks' gestation was 25.5%. There was a higher incidence of cesarean section because of arrest and protraction disorders in the postdate pregnancies in which the infant was macrosomic (22%) versus those in which the infant was not macrosomic (10%, p less than 0.01). In a control group of 100 consecutive women delivered between 38 and 40 weeks' gestation, the incidence of macrosomia was 4%, significantly lower than the rate in the postdate patients (p less than 0.01). Incidence of cesarean section because of arrest and protraction disorders was significantly lower in this group (6%, p less than 0.05). The sensitivity and specificity of an estimated fetal weight greater than 4000 gm to predict a birth weight greater than 4000 gm were 60.5% and 90.7%, respectively, with a positive predictive value of 70% and a negative predictive value of 87%. We conclude that routine ultrasonographic screening for macrosomia may be a valuable adjunct to current fetal surveillance protocols used in the postdate pregnancy.

Cesarean Section↗

PubMed1989

Discordant twins--a prospective study of the diagnostic value of real-time ultrasonography combined with umbilical artery velocimetry.

This study was undertaken to evaluate the role of Doppler velocimetry combined with intertwin differences in ultrasonographically derived estimated fetal weight, biparietal diameter, abdominal circumference, and femur length as a comprehensive test for the prediction of discordancy. The following cutoff values were used to indicate abnormal test results: delta biparietal diameter greater than 6 mm, delta abdominal circumference greater than 20 mm, delta femur length greater than 5 mm, delta estimated fetal weight greater than 15%, and delta systolic/diastolic ratio greater than 15%. Discordancy was identified when the birth weight difference exceeded 15%. The study population consisted of 58 consecutively evaluated third-trimester twin gestations. Eighteen sets of twins were discordant. None of these tests was uniformally successful in identifying twin discordancy; in three instances, all test results were normal. The diagnostic accuracy provided by ultrasonography was not significantly different from that provided by Doppler velocimetry. Overall the best predictor appeared to be the presence of either delta systolic/diastolic ratio greater than 15% or delta estimated fetal weights greater than 15%, which correctly identified 14 of the 18 discordant twins and misclassified only five of the 40 concordant pairs. This combination also had the highest positive and negative predictive values (73% and 90%, respectively).

Birth Weight↗

PubMed1989

Clinical management of the fetus with markedly diminished umbilical artery end-diastolic flow.

This study was conducted to evaluate prospectively a management protocol for fetuses with a markedly abnormal umbilical artery velocity waveform. The study population consisted of fetuses whose systolic/diastolic ratio was greater than 2 SD above the mean for gestational age. The matched control population consisted of fetuses with similar gestational ages, indications for testing, and estimated fetal weights with normal systolic/diastolic ratios. Abnormal Doppler results were used only to determine the frequency of fetal testing. Biophysical profile testing was performed semiweekly on all patients. Patients with absent or reversed end-diastolic flow were admitted for daily testing. The following criteria were used as indications for delivery: (1) worsening maternal condition, (2) oligohydramnios, (3) intrauterine growth retardation with lung maturity, and (4) biophysical profile score less than or equal to 4. Fifty-one patients (7%) had abnormal Doppler blood flow velocity studies. When the study population was compared with the control population at the time of delivery, there were no differences in umbilical artery pH, Apgar score, or incidence of intrauterine growth retardation. However, study patients were delivered at a significantly lower gestational age and lower birth weight and experienced a higher likelihood of neonatal intensive care unit admission. When study patients with documented end-diastolic flow were compared with study patients with no end-diastolic flow, there were no differences in umbilical artery pH, Apgar score, or incidence of intrauterine growth retardation. However, fetuses with no end-diastolic flow had a significantly shorter test-to-delivery interval, lower gestational age, lower birth weight, and more neonatal intensive care unit admissions. There were no perinatal deaths among the study patients. The range of systolic/diastolic ratios for the five patients who failed to follow our protocol for intensive maternal-fetal surveillance was 4.3 to infinity; all experienced fetal death within 18 days. These results suggest that immediate delivery of the fetus with diminished end-diastolic flow may not be mandatory. The combined use of fetal biophysical testing and commonly used criteria for delivery results in acceptable fetal outcome and prolongation of gestational age.

Blood Flow Velocity↗

PubMed1989

Prenatal ultrasound diagnosis of intestinal obstruction: a case report.

A case of intrauterine intestinal obstruction diagnosed at 31 weeks' gestation by sonographic examination is presented. Unlike other reported cases, the diagnosis was made early in the third trimester and before the development of polyhydramnios. The patient was managed conservatively until delivery at 33.5 weeks. At exploratory laparotomy, immediately after birth, ileal atresia was found and resected. The infant recovered uneventfully.

Adolescent↗

PubMed1988

Reliability and reproducibility of nonstress test readings.

The nonstress test is commonly used as a test of fetal well-being, despite the fact that both false-positive and false-negative results are known to occur. Although some of the errors are due to biologic variability among fetuses, some may be due to variability of reading the test. The purpose of the present study was to assess the reliability and reproducibility of nonstress test readings. Fifty nonstress test monitor strips were read by five perinatologists on two occasions, for a total of 500 readings. Nonstress tests were read as reactive, equivocal, nonreactive, or technically unsatisfactory. Of the 50 tracings, only 11 had identical readings on all 10 occasions, and readers had different readings for the first and second readings 28% of the time. Estimates of interobserver and intraobserver agreement ranged from 0.41 to 0.55. These results indicate that there is considerable interobserver and intraobserver variability that can be expected to have a serious adverse effect on the sensitivity of the nonstress test.

Female↗

PubMed1988

Influence of meperidine on fetal movements and heart rate beat-to-beat variability in the active phase of labor.

Eleven parturients were studied in the active phase of labor. Fetal movements, fetal heart rate, and short-term beat-to-beat variability as well as uterine contractions were evaluated for two 40-minute recording periods before and after maternal intravenous administration of 50 mg meperidine. Meperidine depressed fetal activity and increased the duration and frequency of uterine contractions. Fetal movements were significantly reduced from 156 to 60 and their relative duration from 8.6 +/- 6.0% to 2.4 +/- 2.6% (p less than 0.01). The short-term fetal heart rate beat-to-beat variability was reduced at the baseline period 5.22 +/- 1.02 versus 4.62 +/- 1.47 (p less than 0.05) but not during uterine contractions or fetal movements. The frequency of uterine contractions increased from 3.1 +/- 0.8 to 3.7 +/- 0.7 per 10 minutes (p less than 0.01), and their relative duration from 35.3 +/- 6.9% to 40.1 +/- 5.9% (p less than 0.05).

Drug Evaluation↗

PubMed1988

Fetal heart rate beat-to-beat variability in uncomplicated labor.

18 healthy parturients were monitored during normal labor in order to determine the influence of uterine contractions and fetal body movements on fetal heart rate beat-to-beat variability (BTBV). The BTBV was 5.37 +/- 1.28 during the baseline period and a significant increase to 6.46 +/- 1.64 was found during uterine contractions (p less than 0.001). The BTBV during fetal movements, 6.21 +/- 2.29, did not differ significantly from the value of the baseline period.

Female↗

PubMed1988

Intrauterine growth retardation--a prospective study of the diagnostic value of real-time sonography combined with umbilical artery flow velocimetry.

This study was undertaken to evaluate the role of umbilical artery flow velocimetry combined with sonographic estimation of fetal weight, head circumference to abdominal circumference ratio, femur length to abdominal circumference ratio, and qualitative determination of amniotic fluid volume as a comprehensive test for the detection of intrauterine growth retardation (IUGR). The following cutoff values were used to indicate abnormal test results: 1) umbilical artery peak systolic to end-diastolic ratio (S/D) above 3, 2) estimated fetal weight below the tenth percentile for gestational age, 3) head circumference to abdominal circumference ratio more than 2 SD above the mean for gestational age, 4) femur length to abdominal circumference ratio above 23.5%, and 5) qualitative amniotic fluid volume less than 2 cm. The study population consisted of 127 patients referred with a clinical suspicion of IUGR. Forty-five infants (35%) were small for gestational age. None of these five tests were uniformly successful in identifying growth-retarded infants. Overall, the best predictor appeared to be estimated fetal weight below the tenth percentile for gestational age, which correctly identified 39 of the 45 IUGR infants (sensitivity 87%, specificity 87%). The sensitivity of this test was nearly twice that of any other test. All indices performed similarly in predicting the non-IUGR infant (range of specificities 87-98%).

Blood Flow Velocity↗

PubMed1988

Association between fetal movements and uterine contractions in the active phase of labor.

Fetal body movements were studied for 40 minutes during the active phase of labor in 15 parturients. The total duration of fetal movements constituted 8.2% of the recording period, with a frequency of 3.8 +/- 2.1 per ten minutes. Of all the movements, 57.3% were associated with uterine contractions, while 40.7% of all uterine contractions were associated with fetal movements. All the fetuses moved in the first 30 minutes of the study period. The fetal movements that were associated with uterine contractions were longer than those not associated with contractions. Similarly, uterine contractions associated with fetal movements were longer than other uterine contractions.

Female↗

PubMed1987

The relationship between uterine contractions, fetal movements and fetal heart rate patterns in the active phase of labor.

The relationship between fetal movements, fetal heart rate and uterine contractions was studied with a computerized system in 18 parturients during the active phase of labor. 80% of FHR accelerations and 39% of uterine contractions were associated with fetal trunk movements. The probability of association was greater in longer movements and larger accelerations. 98% of fetal movements which lasted 10-15 s, 98% of accelerations with an amplitude of 25-30 bpm and 96.4% of accelerations with a duration of 40-50 s were associated with fetal trunk movements.

Female↗

PubMed1987

Intrapartum vibratory acoustic stimulation of the human fetus during episodes of decreased heart rate variability.

The effects of intrapartum vibratory acoustic stimulation during periods of decreased fetal heart rate variability were studied in 25 healthy term fetuses. Fetal monitoring and real-time ultrasound scanning were used simultaneously to detect fetal response. Vibratory acoustic stimulation was provided by an artificial larynx generating a signal at 85 dB and 85 Hz. This stimulus was applied for 5 seconds on the maternal abdomen over the fetal head after a 20-minute period of decreased fetal heart rate variability. All fetuses reacted with an immediate fetal heart rate acceleration of at least 10 bpm (range: 10 to 35 bpm, mean +/- SD = 18.4 +/- 7.0), and 19 fetuses also had sudden fetal body movement. A deceleration of the fetal heart rate after the initial acceleration was observed in nine fetuses (range: 15 to 70 bpm, mean +/- SD = 45.5 +/- 16.5). The implications of these findings are discussed in relation to the possible use of fetal vibratory acoustic stimulation for intrapartum surveillance.

Acoustic Stimulation↗