Biomedical subjects
Publications and source records attributed to R C Goodlin.
Some pregnant patients with toxemia, especially those with thrombocytopenia, liver or renal dysfunction have elevated serum DLF (digoxin like factor). Since antidigoxin serum reduces the hypertension of DOCA hypertensive rats, it is proposed that antidigoxin antibodies be tried in the treatment of these select patients with toxemia of pregnancy.
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Using a hand-held infrared temperature sensor, temperatures were recorded from the abdominal wall in antenatal patients at 35+ weeks' gestation. The inguinal and periumbilical areas appeared to be relative "hot spots" in normal pregnancy. This noninvasive technique may be useful in confirming the diagnosis of chorioamnionitis.
In 408 patients, a blunt dissection technique has been used to approach the abdominal cavity for cesarean section through a transverse incision. Within two and one-half minutes, the fetus can be delivered. The transverse incision is stronger and more cosmetic than a vertical incision and maternal complications were infrequent. This blunt technique for primary cesarean section is preferred except in those with muscular abdominal walls or in the markedly obese patient.
A case of Rh negative, sensitized patient was observed while her amniotic fluid values climbed through zone III of Liley's graph. The fetus was monitored weekly with ultrasound and delivered when it had a mature lung profile. It is not always necessary to proceed with immediate fetal therapy whenever amniotic fluid values are in zone III.
Three full-term infants experienced acute blood loss. The fetuses with profound bradycardia could be resuscitated, while the one with accelerations in its heart rate patterns could not.
The surgical technique of cervical cerclage in patients with bulging membranes prior to the twenty-fourth week of gestation is described. Of the 11 patients, ten had viable births. Ten of the 11 patients had spontaneous rupture of their membranes, lasting from two and one-half to 14 weeks. The only adverse effects of rupture of membranes were preterm labor and fetal growth retardation.
Platelet aggregation was analyzed during normal pregnancy by evaluation of the same patient cohort (n = 19) on two separate prenatal visits and at 4 weeks post partum. To analyze platelet aggregation five different parameters were evaluated in platelet-rich plasma and whole blood (by impedance aggregometry) with the use of four different aggregating agents: adenosine diphosphate, collagen, sodium arachidonate, and epinephrine. Plasma levels of beta-thromboglobulin, thromboxane B2, and 1,6-keto-prostaglandin F1 alpha were also analyzed. Platelet counts rose 19% after delivery. Plasma levels of beta-thromboglobulin and thromboxane B2 were not significantly changed during the two antepartum visits, but B-thromboglobulin levels were modestly elevated post partum. Levels of 1,6-keto-prostaglandin F1 alpha decreased significantly from a mean of 125 pg/ml before delivery to 50 pg/ml post partum. All antepartum parameters on whole blood aggregation that were significantly different from postpartum values showed enhanced antepartum reactivity. In platelet-rich plasma, pregnancy was associated with greater platelet reactivity except for two variables, time to half-maximal aggregation for epinephrine and the extent of aggregation by collagen, both noted during the first antepartum evaluation. When the patient cohort of 19 was subdivided according to smoking status, all aggregation parameters of significance (p less than 0.05) demonstrated increased platelet reactivity during pregnancy compared with postpartum values. Smoking women accounted for a disproportionate number of significantly enhanced reactivity (seven variables versus three).
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In two pregnant women with iatrogenic pulmonary edema, impedance plythsmographic measurements indicated low values for maternal cardiac output and venous resistance (or static pressure). Decreased venous tone could account for the pulmonary edema.
The expanded toxemia syndrome or gestosis refers to polysymptomatic diseases that are associated with pregnancy. This report discusses those cases without initial hypertension or proteinuria that were "cured" by delivery and were associated with maternal and fetal morbidity (usually intrauterine growth retardation). A list of suggested tests is presented to document gestosis in pregnant women with medical illnesses. Unlike preeclampsia, gestosis may occur at almost any time in pregnancy.
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Preliminary evidence suggests that fetal movement in response to vibrotactile stimulation "habituates" with repeated exposure. If demonstrated in fetuses, the habituation paradigm may be useful as a measure of fetal well-being or as a predictor of neonatal outcome. However, the ability of the fetal response decrement phenomenon to meet criteria for habituation which would distinguish it from simple receptor fatigue has not been evaluated. In this study, fetuses were exposed to two different frequencies of vibration applied to the maternal abdomen. Fetal movement was observed on an ultrasound monitor. An inverse relationship between the strength of the stimulus and rapidity of the response decrement was not observed. However, return of the response to presentation of a novel stimulus, response decrement to repetition of the second stimulus, and more rapid response decrement upon re-presentation of the original stimulus suggest that the fetal response decrement phenomenon is true habituation.
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We present seven cases of pubic symphyseal discomfort in pregnancy or parturition. These patients were unable to walk and had other signs and symptoms similar to those of osteitis pubis. We differentiate this condition from classical osteitis pubis by the lack of a prolonged course, symptoms, and clinical findings rather than radiologic criteria. We propose that in patients with symphyseal pain and tenderness, difficulty with ambulation, and a clinical course of less than three weeks, symptomatic symphyseal separation should be considered the diagnosis.
An impedance plethysmograph recording was obtained on at least two occasions from 162 women between their 24 and 36th week of pregnancy; 29 while in labor and 21 at the time of their 6-week postpartum visit. There was a significant increase in venous capacitance and a decline in venous capacitance index during apparently normal pregnancy. Those with pregnancy complications (hypertension, premature labor and fetal growth retardation) appeared to have significantly abnormal venous reactivity. It is proposed that equal consideration be given to abnormal venous activity in the mechanisms and therapy of pregnancy-related cardiovascular abnormalities.