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Biomedical subjects

N K Kochenour

Publications and source records attributed to N K Kochenour.

At least 37 records · Page 2Linked to original sources
PubMed1986

Maternal-fetal pH difference and fetal scalp pH as predictors of neonatal outcome.

The purpose of this study was to determine if interpretation of fetal scalp pH values would be enhanced by concurrent measurement of maternal venous pH. The last fetal capillary pH obtained before delivery was compared with simultaneous maternal-fetal pH difference as predictors of neonatal outcome assessed by five-minute Apgar scores. Fetal scalp pH and maternal-fetal pH difference were significantly correlated with r = -0.72 (P less than .0001). The acidotic fetuses born to acidotic mothers had low maternal-fetal pH differences, and all were nondepressed at birth. A 33% reduction in false negatives was found using maternal-fetal pH difference instead of scalp pH alone. Errors in interpretation of fetal scalp pH can be reduced by the use of maternal-fetal pH difference.

Apgar Score↗
PubMed1985

Obstetric complications associated with the lupus anticoagulant.

We identified eight patients with the lupus anticoagulant (an autoantibody acquired by some patients with systemic lupus erythematosus), by observation of an increased activated partial thromboplastin time and abnormal results on a tissue thromboplastin-inhibition test. The patients had experienced a total of 30 spontaneous abortions and fetal deaths in 31 previous pregnancies (96.8 per cent). During their next pregnancy, the patients were treated with 40 to 50 mg of prednisone per day and 81 mg of aspirin per day. The therapy shortened their activated partial thromboplastin times, produced normal values for tissue thromboplastin inhibition, and reduced the rate of pregnancy loss to 37.5 per cent. However, preeclampsia developed in the five patients who gave birth to live infants, and fetal growth retardation occurred in three cases. The corticosteroid and low-dose aspirin regimen appears to improve perinatal outcome in cases in which the mother has the lupus anticoagulant, but such practices as careful fetal surveillance and preterm delivery when appropriate are also important to successful obstetric management of such cases.

Abortion, Spontaneous↗
PubMed1984

Changes in the management of severely Rh-immunized patients.

Since July 1, 1978, we have instituted the following changes in the management of severely Rh-immunized patients: (1) serial amniotic fluid optical density (delta OD450 ) values and real-time ultrasound scanning beginning at 21 weeks' gestation, (2) fetal transfusions as early as the twenty-third week, (3) ultrasound surveillance during and after intrauterine transfusions, and (4) planned premature delivery with neonatal exchange transfusions for selected cases between 29 to 32 weeks and for all patients after 32 weeks' gestation. The perinatal survival rate (83.8%) in 37 isoimmunized pregnancies managed with this regimen was significantly higher (p less than 0.05) than in 34 such pregnancies (55.9%) managed according to the protocol utilized during the previous four years.

Adult↗
PubMed1984

Infant adiposity and maternal energy consumption in well-controlled diabetics.

This study was designed to determine the relationship of maternal diet and infant adiposity in well-controlled diabetics. The relationship between the fat consumption pattern of the pregnant diabetic and the adiposity of her infant was investigated. Length, weight, and head circumference; triceps, subscapular, and anterior thigh skinfolds; and subcutaneous fat layer were obtained on ten infants of diabetic mothers and ten infants of nondiabetic mothers. Measurements were taken at 48 h, 2 weeks, and 1 month postpartum. Maternal dietary intakes were recorded for 6 days during the third trimester of pregnancy. Infants of diabetic mothers and infants of nondiabetic mothers exhibited differences in birth length, 2-week and 1-month head circumference, 2-week triceps skinfold thickness, and fat layer. However, measurements differing at birth were not consistant with those differing at repeated measurements throughout the first month of life. Only the dietary intake of linoleic acid as a percentage of energy intake differed between the two groups of women. The diabetic women consumed more linoleic acid. The fat consumption pattern in the pregnant diabetic was unrelated to the subsequent anthropometric measurements of her infant. The well-controlled diabetics in this study did not have large-for-gestational-age infants.

Adipose Tissue↗
PubMed1984

Adverse pregnancy outcome: sensitive periods, types of adverse outcomes, and relationships with critical exposure periods.

A wide variety of agents has been demonstrated to be capable of affecting the fetus in utero. Certain generalizations can be made concerning these teratogens. Two of the most important of these principles are the specificity of the agent and the time during gestation of the exposure. Although noticeable adverse effects are structural malformations, there are numerous functional malformations, such as lower intelligence and poor reproductive outcome, that may follow exposure to these agents. There is some evidence that future behavior may be affected by in utero teratogen exposure; however, this field has been infrequently investigated and no firm conclusions can be drawn.

Abnormalities, Drug-Induced↗
PubMed1982

Effect of plasma exchange and immunosuppression on Rho(D), viral, and bacterial antibody titers in Rh-immunized women.

Pharmacologic immunosuppression and plasmapheresis have both been advocated as adjunctive methods of treatment for Rh immunization, but a combined regimen of the two has not been attempted. We treated four nonpregnant, severely Rh-sensitized female volunteers with intensive plasma exchange and either promethazine 150 mg or prednisone 60 mg per day in an attempt to remove circulating anti-Rho(D) and prevent further synthesis of the antibody. Each patient received three or four exchanges. The Rho(D) antibody titer decreased by at least one dilution immediately following 11 of 14 plasma exchanges and was ultimately lowered at least two dilutions in all patients. In one case the titer was reduced from 1:512 to 1:16, and a low titer was maintained for the duration of treatment. However, this regimen could increase the risk of infection for a mother and/or infant, as evidenced by the concomitant lowering of viral and bacterial antibody titers in these women.

Antibodies, Bacterial↗
PubMed1982

Effect of pregnancy on diabetic retinopathy.

The incidence of progression of diabetic retinopathy during pregnancy is unknown and its proper management uncertain. In this study, 55 insulin-dependent diabetic patients under strict glucose control were followed throughout pregnancy with serial retinal examinations by ophthalmoscopy and photographs. Nineteen patients had minimal or background retinopathy and 7 had untreated proliferative changes. Six patients had been treated before pregnancy with photocoagulation for proliferative retinopathy. A positive correlation was found between progressive proliferative diabetic retinopathy and the duration of diabetes mellitus independent of glucose control. During gestation 3 of 19 patients (16%) with minimal or background retinopathy and 6 of 7 patients (86%) with untreated proliferative retinopathy experienced deterioration of their eye disease. In 4 patients with proliferative retinopathy, progression of retinal disease was arrested with photocoagulation during pregnancy. Only 1 of 6 who had received laser treatment prior to pregnancy experienced progression of her retinopathy. These results suggest that photocoagulation prior to pregnancy may protect against rapidly progressive proliferative retinopathy and that aggressive treatment during pregnancy can prevent progression of proliferative retinopathy and visual impairment.

Acute Disease↗
PubMed1981

Air as a contrast marker for ultrasound-guided fetal transfusions.

The authors describe a new air contrast technique for B-scan ultrasound to confirm the correct intra-abdominal placement of transfused blood after nine intrauterine transfusions in four patients. Such confirmation by this method is neither dependent on the amount of blood introduced nor masked by fetal ascites.

Air↗
PubMed1981

Antepartum diagnosis and intrapartum management of lethal renal defects.

Bilateral renal agenesis (Potter syndrome) in the neonate is incompatible with life. Unfortunately, these infants are often delivered by cesarean section, as premature labor and breech presentation are commonly associated with the condition. In reviewing the obstetric course of 6 women who recently delivered such babies, the authors have found that antepartum diagnosis is possible in most cases. specifically, vaginal delivery should be strongly considered for patients in premature labor with intact membranes and breech presentation when there is ultrasound evidence of an abnormally shaped fetal head, absence of the fetal bladder, and severe oligohydramnios.

Breech Presentation↗
PubMed1981

Ultrasound air contrast transfusion technique: an aid to managing the Rh-affected fetus with ascites.

The successful management of an Rh-sensitized pregnant patient is reported in whom fetal intrauterine transfusions were utilized despite the presence of fetal ascites before the 26th week of gestation. A new ultrasound air contrast technique is described that confirms the correct intraabdominal placement of the transfused blood. The technique is not dependent on the amount of blood introduced, nor is it masked by fetal ascites.

Adult↗
PubMed1980

Fetal platelet counts in the obstetric management of immunologic thrombocytopenic purpura.

The optimal method of infant delivery for gravida women with immunologic thrombocytopenic purpura (ITP) is controversial because of the unpredictability of the fetus developing thrombocytopenia and the uncertainty of the relation between vaginal birth and intracranial hemorrhage in thrombocytopenic infants. We have employed the technique of platelet counts on fetal scalp blood obtained prior to or early in the course of labor in 12 patients with ITP. A count of 50,000/cu mm, selected on the basis of literature review and retrospective analysis of our own experience, was used to define fetal thrombocytopenia. Three thrombocytopenic fetuses were delivered by cesarean section. Trial labor was permitted in the other nine cases in which fetal scalp platelet count exceeded 50,000/cu mm. The outcome was good in all instances. If cesarean section is to be employed in ITP patients to obviate the potential danger of fetal hemorrhage with vaginal delivery, the use of platelet counts of fetal scalp blood seems to provide the most rational basis for management at present.

Blood Platelets↗
PubMed1980

Lactation suppression.

In spite of a very recent upsurge in breast-feeding in industrialized countries, approximately one-half of parturients are candidates for postpartum lactation suppression. The mechanisms controlling lactation are complex and involve preparation of the breast during pregnancy, stimulation of secretion of milk in the immediate postpartum period, ejection of milk from the alveolar cells, and maintenance of milk production during the period od lactation. The local effects of estrogen and progesterone in the breast prevent milk secretion during pregnancy. With their withdrawal in the postpartum period, the stimulating effect of the anterior pituitary hormone prolactin dominates and milk secretion is initiated and maintained. Milk ejection is accomplished by a neurohormonal reflex resulting in stimulation of the myoepithelial cells of the breast by the posterior pituitary hormone oxytocin. Local stimulation of the breast by suckling is important in initiating the release of oxytocin and also the secretion of prolactin. The suppression of lactation in the postpartum period can be accomplished in approximately 60--70% of females by the use of a tight brassiere and avoidance of stimulation of the nipples. An additional 10% or so of females can be helped with the use of estrogens during the postpartum period. The addition of an androgen to the estrogen increases the success rate of lactation suppression to about 90%. Unfortunately, the use of estrogen alone or in combination with an androgen is accompanied by rebound lactation in a significant number of patients and has been associated with an increased incidence of postpartum thromboembolic disease. Lactation suppression by inhibiting prolactin secretion with synthetic ergot alkaloids such as bromocriptine has been shown to be safe and highly effective both immediately post partum and after lactation has been established. The 2 week period of therapy required with this drug may be unsatisfactory for some patients. If given immediately at delivery, a single injection of testosterone enanthate and estradiol valerate is equally effective in suppressing lactation and, in the young patient who has delivered vaginally, is not associated with significant risk.

Androgens↗
PubMed1980

Intrapartum fetomaternal bleeding in Rh-negative women.

In a series of 1206 consecutive Rh-negative women who delivered Rh-positive infants, fetal erythrocytes were found in the maternal blood of 175 (14.5%) during the postpartum period. In 12 (1.0%) there was evidence of a larger fetomaternal hamorrhage than would be neutralized by a single 300-microgram dose of Rh-immune globulin. Except for manual removal of the placenta, no correlation was found between large fetomaternal hemorrhages and obstetric manipulations, complications, or surgery. Thus, the authors believe that all Rh-negative patients should be screened post partum to ascertain the adequacy of Rh-immune globulin prophylaxis.

Adolescent↗
PubMed1980

Irradiation-induced constrictive pericarditis requiring pericardiectomy during pregnancy.

Constrictive pericarditis is a rare but potentially life-threatening complication of pregnancy. This is a case report of irradiation-induced constrictive pericarditis requiring pericardiectomy during pregnancy. It is hoped that our team approach to this particular problem can serve as a model for the management of similar medical and surgical complications of pregnancy.

Adult↗