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T R Easterling

Publications and source records attributed to T R Easterling.

50 records · Page 3Linked to original sources
PubMed1989

Preeclampsia: a hyperdynamic disease model.

Preeclampsia is a common disease and as such is a significant contributor to maternal and neonatal morbidity and mortality. Despite the ubiquity of the disease and its public health impact, no comprehensive mechanism has been established. Therapy has been limited to bed rest and premature delivery. The purpose of this article is to examine preeclampsia from a hemodynamic point of view and to advance a hypothesis of disease mechanism.

Adrenergic beta-Antagonists↗
PubMed1989

Fetal and maternal considerations in the management of stage I-B cervical cancer during pregnancy.

The timing of treatment for stage I-B cervical carcinoma diagnosed during pregnancy is complicated by conflicting concerns for fetal survival and control of malignancy. There were 11 pregnant women with stage I-B cervical carcinoma diagnosed prior to fetal viability since 1969. Six patients were managed with termination of pregnancy and radical hysterectomy with pelvic lymphadenectomy. In 5 patients, treatment was delayed for 6 to 17 weeks and then delivery was accomplished by cesarean section followed directly by radical hysterectomy and pelvic lymphadenectomy. Two of the infants experienced complicated neonatal courses and would have benefited from additional delay. Benefits that could be achieved by delaying delivery for the fetus were calculated from a review of 600 inborn infants without congenital anomalies admitted to the neonatal intensive care (NICU) during 1984 and 1985. Neonatal mortality decreased from 32.8% at 26-27 weeks to 2.7% at 34-35 weeks gestation. Similar improvements in neonatal morbidity were demonstrated. Although adverse maternal outcomes were not associated with delay, an evaluation of risk cannot be derived from this series. Significant fetal benefit can accrue from relatively short delays in planned delivery dates. When stage I-B cervical carcinoma is diagnosed during pregnancy and when fetal survival is desired, delivery should be delayed to achieve fetal maturity, rather than only potential viability.

Adult↗
PubMed1989

Antihypertensive therapy in pregnancy directed by noninvasive hemodynamic monitoring.

Invasive and noninvasive investigations suggest that the hemodynamics of pregnant hypertensive patients are heterogeneous. Nineteen pregnant patients were evaluated before changes in antihypertensive therapy. Cardiac output was measured by Doppler technique. Blood pressure was measured by automated cuff. Systemic vascular resistance was calculated. Two distinct groups were identified on the basis of differences in cardiac output (p less than 0.0001) and systemic vascular resistance (p less than 0.0001). Those with high resistances were treated with hydralazine. A modest antihypertensive effect was achieved (-6.9 mmHg, p = 0.01), but systemic vascular resistance was dramatically reduced, (-534 dyne.sec.cm-5, p less than 0.0001) and was associated with a compensatory increase in cardiac output (2.0 liters/min, p less than 0.0001). Those with a high cardiac output were treated with atenolol. An antihypertensive effect was achieved, (-17.0 mm Hg, p = 0.008), which was associated with a reduction in cardiac output (-2.8 liters/min, p less than 0.0001).

Atenolol↗
PubMed1989

Measurement of cardiac output in pregnancy by thermodilution and impedance techniques.

To assess the value of impedance cardiography in pregnancy, simultaneous measurements of cardiac output were made with impedance and thermodilution techniques in 10 patients who required pulmonary artery catheterization. The methods correlated poorly (r = 0.17). The discrepancy between methods was particularly pronounced in hypertensive patients. Impedance cardiography does not measure cardiac output accurately in hypertensive pregnant women.

Cardiac Output↗
PubMed1989

Hemodynamic observations during paroxysmal hypertension in a pregnancy with pheochromocytoma.

A patient with pheochromocytoma diagnosed at 17 weeks' gestation was studied at rest, during an episode of paroxysmal hypertension, and during phenoxybenzamine treatment. Cardiac output was estimated noninvasively by Doppler technique. During paroxysmal hypertension, the mean blood pressure was 102 mmHg, cardiac output fell by 40%, and systemic vascular resistance rose by 250%. Phenoxybenzamine treatment did not change the resting cardiac output or systemic vascular resistance. These observations suggest that serious fetal compromise might occur even with mild episodes of hypertension associated with pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1988

Intraperitoneal fetal transfusion under direct ultrasound guidance.

The outcomes of 77 fetal intraperitoneal transfusions in 35 pregnancies managed with direct ultrasound guidance and intensive perinatal management were reviewed. Patients were monitored with amniocentesis, and standard indications were used for timing of transfusions. The mean gestational age at first transfusion was 27.3 weeks (range 22-33). The overall mortality rate was 14% (five of 35). No immediate transfusion-related deaths occurred; all fetuses who were not hydropic at first transfusion survived (26 of 26). The mean gestational age at delivery was 33.6 weeks (range 25-36). One infant developed respiratory distress syndrome (RDS). Transfusion-related complications occurred in five cases (fetal colon infusions in two, fetal retroperitoneal infusion in two, and fetal abdominal wall hematoma in one). None of these infants required urgent delivery or suffered long-term sequelae. In nonhydropic fetuses, intraperitoneal transfusions under direct ultrasound guidance had a low incidence of morbidity and no mortality. These results should provide baseline data against which to compare new techniques, such as direct cord transfusion. With neonatal mortality rates of 10% and significant morbidity rates of 10-20% in infants delivered at 32 weeks who develop RDS, intraperitoneal transfusion should be considered in the 32- to 33-week fetus with marked pulmonary immaturity.

Amniocentesis↗
PubMed1988

Aortic stenosis in pregnancy.

Aortic stenosis is uncommon during pregnancy. Five cases are described in which clinical management was facilitated by the use of Doppler echocardiography to assess the severity of disease and pulmonary artery catheterization to manage maternal hemodynamics. Regional anesthesia was used without complication. In patients with severe stenosis, significant morbidity and mortality were experienced when aortic valve replacement was delayed beyond the postpartum period.

Adolescent↗
PubMed1988

The hemodynamic effects of orthostatic stress during pregnancy.

The effects of orthostatic stress on cardiac output and systemic vascular resistance have not been previously studied in pregnancy. A Doppler technique of measuring cardiac output was used to study 15 nonpregnant women, 14 pregnant women in the first trimester, and 16 pregnant women in the third trimester. Subjects were studied in recumbent, sitting, and standing positions. In each group, the change from recumbent to standing positions resulted in a fall in cardiac output of 1.7-1.8 L/minute (P = .001). Systemic vascular resistance rose in each group (P = .001). The magnitude of the rise was greatest in nonpregnant women and smallest in the third trimester (P = .005). The observed fall in cardiac output and rise in systemic vascular resistance may be clinically significant in pregnancies complicated by uteroplacental insufficiency.

Cardiac Output↗
PubMed1987

Anhydramnios.

Explore the source record for details and available documents.

Amniotic Fluid↗
PubMed1987

Measurement of cardiac output during pregnancy: validation of Doppler technique and clinical observations in preeclampsia.

In 12 patients requiring pulmonary artery catheterization, cardiac output was measured using Doppler and thermodilution techniques. The Doppler technique accurately predicted measurements made by thermodilution (r = 0.91; P less than .001). Eighteen normal patients in the third trimester and 36 preeclamptics who had not been treated with medications other than magnesium sulfate were evaluated with Doppler alone. Of note was the heterogeneity among preeclamptics. Although their mean systemic vascular resistance was elevated, it ranged from 2256-648 dyne X sec X cm-5. Cardiac output ranged from 13.2-3.9 L/minute.

Blood Pressure↗
PubMed1985

Fusobacterium: anaerobic occult amnionitis and premature labor.

Fusobacterium species are well established pathogens. Before the advent of effective anaerobic antimicrobial therapy, they were associated with prolonged, often fatal courses. Previously, fusobacterium had not been identified as a common perinatal pathogen. Three cases of occult amnionitis due to Fusobacterium are presented. Review of five series of occult amnionitis revealed 23 cases. In seven (30.4%), Fusobacterium was isolated. In 14 (60.8%), an anaerobic species was isolated. The average gestational age of patients from whom anaerobes were grown was 29.0 weeks. Of those that grew no anaerobes, the average gestational age was 32.3 weeks (P less than .05). The overall rate of maternal febrile morbidity was 35%. Fusobacterium accounted for 50% of the febrile cases while accounting for only 30.4% of the total cases.

Adult↗
PubMedDate not supplied

Hemodynamics associated with the diagnosis and treatment of pheochromocytoma in pregnancy.

A pregnant woman with an undiagnosed pheochromocytoma is described. Her presentation at 29 weeks' gestation was consistent with preeclampsia. Noninvasive measurement of cardiac output and ambulatory monitoring of blood pressure provided data that facilitated making the appropriate diagnosis and managing the patient until delivery at term.

Adrenal Gland Neoplasms↗