Search PubMed⌕ Search

Biomedical subjects

W C Mabie

Publications and source records attributed to W C Mabie.

At least 19 recordsLinked to original sources
PubMed1992

Adult respiratory distress syndrome in pregnancy.

OBJECTIVE: Our objective was to determine the causes of adult respiratory distress syndrome in pregnancy, the treatment required, and maternal and perinatal outcomes. STUDY DESIGN: We examined a case series of 16 patients with adult respiratory distress syndrome initially treated in an obstetric intensive care unit. Criteria for the diagnosis were respiratory distress requiring mechanical ventilation and a lung injury score > 2.5. RESULTS: The incidence of adult respiratory distress syndrome in pregnancy was 1 per 2893 deliveries, occurring primarily in the third trimester. The causes were infection (n = 8), preeclampsia/eclampsia (n = 4), hemorrhage (n = 2), thrombotic thrombocytopenic purpura (n = 1), and smoke inhalation (n = 1). Most patients (69%) were delivered before or soon after admission to our hospital. Multiple organ failure developed in 12 patients (75%). Complications of mechanical ventilation occurred in 81% of cases. Other complications of intensive care unit support were endocarditis, superior vena cava thrombosis, line sepsis, and bacteremia. Maternal mortality was 44%; perinatal mortality was 20%. CONCLUSIONS: Adult respiratory distress syndrome in pregnancy is associated with a maternal mortality similar to that of studies in the nonpregnant patient. The main causes in pregnancy are hemorrhage, infection, and toxemia. All maternal deaths occurred in patients with multiorgan failure.

Critical Care↗
PubMed1992

Obstetric management of gastroenterologic complications of pregnancy.

Key elements in the management of gastroenterologic complications during pregnancy are knowledge of the natural history of the disease process, understanding the effects of pregnancy on the disease and of the disease on pregnancy, concern about fetal effects of medications, careful antepartum fetal assessment, and appropriate timing of the delivery. Vaginal delivery is preferred in most pregnancies complicated by gastrointestinal disease.

Acute Disease↗
PubMed1992

Placenta previa.

Placenta previa occurs in approximately one in 200 pregnancies. The cause is unknown, but endometrial damage due to prior pregnancy, cesarean section, and other factors predispose to it. Diagnosis is usually made by transabdominal ultrasonography. False-positive diagnoses are common in the second trimester and the term "potential placenta previa" has been proposed to describe this situation. Bleeding with placenta previa is usually associated with uterine contractions, thus the introduction of tocolysis. Placenta accreta is common in the patient with one or more previous cesarean sections and placenta previa in the current pregnancy. Management of placenta previa is expectant and involves avoidance of digital vaginal examination, delay of delivery until 36 weeks' gestation and/or documented fetal lung maturity, transfusion support to maintain maternal hematocrit greater than or equal to 30%, serial ultrasonography, antepartum fetal heart rate monitoring, glucocorticoids, tocolytic therapy, and elective delivery by cesarean section. Maternal mortality is rare with placenta previa. Perinatal mortality is currently 4% to 8% primarily related to complications of prematurity.

Amniocentesis↗
PubMed1991

Herpes simplex virus hepatitis in pregnancy. Two patients successfully treated with acyclovir.

Two cases of herpes simplex virus hepatitis in pregnancy are presented. Each case was characterized by extremely high serum aminotransferase levels with minimal bilirubin elevation. In both cases, liver biopsy was instrumental in arriving at the diagnosis. In addition, computed tomography showed a radiographic appearance of the liver not characteristically seen in other hepatic disorders of pregnancy. A high index of suspicion in the second case led to early recognition and treatment. Despite the presence of fulminant liver failure and evidence of herpes encephalitis in the other case, institution of therapy with acyclovir was associated with complete recovery in both patients. The present cases are compared and contrasted with the literature. The incidence of two cases within a 6-month period suggests that herpes simplex virus hepatitis in pregnancy may occur more frequently than previously reported.

Acyclovir↗
PubMed1991

Acute fatty liver of pregnancy.

AFLP is a syndrome that occurs in the last trimester or postpartum, characterized by jaundice, coagulopathy, and central nervous system disturbances. Renal insufficiency is common. Clinical and laboratory findings are nonspecific. Diagnosis is based primarily on histologic examination of the liver. The cause of AFLP is unknown. The illness has been associated with a high maternal and fetal mortality; with increased awareness and more liberal use of liver biopsy, however, milder forms of the disease are now recognized. Some speculate that AFLP is part of the spectrum of preeclampsia. Liver histology shows microvesicular fat and little or no inflammation or hepatocellular necrosis. Treatment consists of expeditious delivery and maximal supportive care, which may include intensive care unit monitoring, blood component therapy, glucose infusion, sodium restriction, diuretic agents, mechanical ventilation, and dialysis. The role of hepatic transplantation in AFLP appears limited. The risk of mortality during AFLP must be compared with the short- and long-term morbidity and mortality associated with liver transplantation.

Adult↗
PubMed1991

Hemodynamics of preeclampsia.

A review of the English literature reveals considerable disagreement regarding the cardiovascular hemodynamics of preeclampsia as measured by both noninvasive and invasive techniques. In the untreated patient, most of the data suggest the presence of low CO, low PCWP, and elevated SVR as compared to normotensive pregnancy. In contrast, in patients receiving treatment prior to the measurements, the majority of the data indicate the presence of normal to elevated CO, PCWP, and SVR. There is general agreement that plasma colloid oncotic pressure is markedly reduced in patients with severe disease, and this reduction is more dramatic in the postpartum period especially in those receiving excessive crystalloid therapy. As a result, these patients are at increased risk for pulmonary edema. Several studies recommended using plasma and plasma substitutes to correct the reduced plasma volume and PCWP prior to the use of vasodilator therapy in such pregnancies. This management requires the use of invasive hemodynamic monitoring, and its benefit is transient and not well established. Finally, the true cardiovascular hemodynamics of preeclampsia remain unknown.

Blood Pressure↗
PubMed1990

Maternal and uteroplacental hemodynamic effects of chronic captopril in the hypertensive, term-pregnant rat.

The chronic effects of captopril on maternal hemodynamics and organ perfusion were investigated in 10 untreated and 10 captopril-treated pregnant spontaneously hypertensive rats by means of the radioactive-labeled microsphere technique. The normal decrease in blood pressure during gestation was prevented by reduction of litter size to two conceptuses on day 7 of gestation. Captopril (approximately 10 mg/kg/day) or drug vehicle (50% ethyl alcohol) was administered intraperitoneally by an osmotic pump from day 7 to 21. At term mean arterial pressure was 23% lower in the captopril-treated group as the result of a 29% decrease in total peripheral resistance without a significant change in cardiac output. The decrease in total peripheral resistance was primarily caused by a decline in splanchnic and skin resistances. Maternal organ and uteroplacental perfusion were not significantly altered. We conclude that administration of captopril during the last 2 weeks of pregnancy in the hypertensive rat effectively lowers maternal blood pressure without adverse effects on organ and uteroplacental perfusion.

Analysis of Variance↗
PubMed1990

Treatment in an obstetric intensive care unit.

A three-bed intensive care unit was opened in the labor and delivery area of a city-county hospital having approximately 7500 deliveries annually. The utilization rate of 0.9% and the severity of illness were sufficient to justify such a unit. Main indications for admission were hypertensive disorders (46%), massive hemorrhage (10%), and medical problems of pregnancy (44%). Identifiable benefits of the unit were as follows: (1) Intensive observation and organization allowed for prevention of early recognition and treatment of complications; (2) familiarity with invasive monitoring permitted personnel to exert prompt, rational treatment of hemodynamically unstable patients; (3) continuity of care was improved before and after delivery; (4) residents and fellows learned a great deal about intensive care and the management of rare medical complications of pregnancy. We conclude not only that critically ill pregnant women can be managed successfully in an obstetric intensive care unit but also that critical care is a bona fide part of obstetric practice and has been incorporated into our training program.

Clinical Competence↗
PubMed1990

Recurrent acute fatty liver of pregnancy.

The first reported case of recurrent acute fatty liver of pregnancy confirmed by biopsy is described. In this case a high index of suspicion led to an early diagnosis and intervention with resultant improved maternal and fetal outcome. Electron microscopic examination of a liver biopsy specimen proved more beneficial in confirmation of the diagnosis compared with routine microscopic examination.

Acute Disease↗
PubMed1990

A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy.

Three hundred women with mild chronic hypertension at 6 to 13 weeks' gestation were randomly allocated to receive either methyldopa or labetalol or be in the control group. Thirty-seven women (12%) were excluded for various reasons. Of the remaining 263 patients, 90 received no drug, 87 received methyldopa, and 86 received labetalol. All 263 were followed throughout pregnancy with serial renal function tests and serial assessment of fetal status. There were no differences among the three groups in mean systolic or diastolic blood pressures, mean gestational age, or initial laboratory findings at time of entry. Patients treated with medications had significantly lower (p less than 0.0001) systolic and diastolic blood pressures throughout gestation compared with the no-medication group. Among the control group there was a spontaneously significant lowering (p less than 0.0001) of both systolic and diastolic blood pressures at 14 to 26 weeks' gestation. However, there were no differences among the three groups regarding the incidences of either superimposed preeclampsia (15.6%, 18.4%, and 16.3%, respectively), abruptio placentae (2.2%, 1.1%, and 2.3%, respectively), or preterm delivery (10%, 12.5%, and 11.6%, respectively). In addition, there were no differences among the groups regarding gestational age at delivery, birth weight, incidence of fetal growth retardation, or neonatal head circumference. There was one midtrimester loss in the methyldopa group and one stillbirth in each of the other groups. We conclude that treatment of maternal blood pressure in mild chronic hypertension during pregnancy did not improve perinatal outcome.

Adult↗
PubMed1989

Labetalol does not decrease placental perfusion in the hypertensive term-pregnant rat.

The acute effect of labetalol hydrochloride, a combined nonspecific beta-adrenergic and postsynaptic alpha 1-adrenergic blocker, on maternal hemodynamics and organ perfusion was investigated in 10 hypertensive, term-pregnant, spontaneously hypertensive rats with the use of the radioactive-labeled microsphere technique. The normal fall in blood pressure during pregnancy was prevented by the reduction of litter size to two conceptuses on day 7 of gestation. Labetalol (1 to 6 mg/kg) effectively lowered mean arterial pressure 22% by decreasing cardiac output 16%; total peripheral resistance was not significantly decreased. Thus, the blood pressure lowering effect of labetalol was due primarily to its beta-adrenergic blocking effect. Regional flows to the carcass and splanchnic circulation were decreased 19% and 15%, respectively, after labetalol administration. Uterine wall and ovarian perfusion were significantly reduced, but placental perfusion was not significantly altered. Because labetalol lowers blood pressure without reducing placental perfusion, it may be a useful alternative to hydralazine for the treatment of hypertensive emergencies in pregnancy.

Animals↗
PubMed1989

The central hemodynamics of severe preeclampsia.

Swan-Ganz hemodynamic monitoring in 49 antepartum patients with severe preeclampsia revealed a variable hemodynamic profile. The majority of patients had normal left ventricular filling pressure (8.4 +/- 0.2 mm Hg), normal to high cardiac index (4.4 +/- 0.1 L.min-1.m2), and upper normal to moderately elevated systemic vascular resistance (1226 +/- 37 dynes.sec.cm-5). Eight patients had pulmonary edema and their findings included high wedge pressure (18 +/- 1 mm Hg), upper normal to high cardiac index (4.9 +/- 0.5 L.min-1.m2), and normal systemic vascular resistance (964 +/- 50 dynes.sec.cm-5). Left ventricular function was hyperdynamic in 73% of the 49 patients. Patients with chronic hypertension and superimposed preeclampsia were hemodynamically indistinguishable from patients with preeclampsia alone. We conclude that, in general, preeclampsia is a high cardiac output state associated with an inappropriately high peripheral resistance. The normal wedge and central venous pressures suggest central redistribution of intravascular volume if the generally accepted reports of decreased plasma volume in preeclampsia are correct.

Adolescent↗
PubMed1989

Intrauterine transfusion via umbilical vein in severe Rh isoimmunization.

Although the widespread use of anti-D immune globulin has dramatically reduced the incidence of Rh isoimmunization, an occasional pregnant patient becomes a candidate for intrauterine transfusion because of sensitization to Rh antigens or irregular red blood cell antigens. Current methods of ultrasonography provide needle guidance to the umbilical vein, permitting fetal intravascular transfusion. We have reported a case involving five separate intrauterine transfusions via the umbilical vein.

Adult↗
PubMed1989

Pharmacologic management of acute mania in pregnancy.

Mania is a psychiatric illness that often requires immediate intervention, and the pregnant manic patient presents a therapeutic dilemma. Use of psychotropic medications during pregnancy may cause three complications: teratogenesis, neonatal toxicity, and behavioral toxicity. The literature contains few well-controlled studies for psychotropic medications in bipolar or other psychiatric populations and those often lack a control group or do not consider confounding factors such as other drug use. Pharmacologic alternatives include antipsychotics, lithium, carbamazepine, and benzodiazepines. Although studies and case reports describe fetal malformations in infants exposed in utero to psychotropic medications, the data are conflicting as to the nature of anomalies and risk of their occurrence. Malformations can occur in almost every organ system; however, the cardiovascular type are of major concern after lithium exposure during the first trimester and oral clefts after benzodiazepine exposure. Antipsychotic exposure can produce extrapyramidal symptoms in the neonate and lithium has been associated with neonatal cyanosis, lethargy, flaccidity, and non-toxic goiter. A neonatal abstinence syndrome has occurred after maternal benzodiazepine consumption. Behavioral toxicity is more difficult to assess, as long-term follow-up is needed. To date, evidence for behavioral toxicity in children exposed to lithium or antipsychotics in utero is lacking. Few specific guidelines for using psychotropic medications in an acutely manic pregnant patient exist. Current symptoms, past response, and the stage of gestation all must be considered. Complete elimination of symptoms may not be the goal. A team approach is essential in treatment of such a complex and challenging patient.

Acute Disease↗
PubMed1988

Nifedipine does not adversely affect uteroplacental blood flow in the hypertensive term-pregnant rat.

The short-term effect of the calcium channel blocker, nifedipine, on maternal hemodynamics and organ perfusion was investigated in 12 hypertensive term-pregnant, spontaneously hypertensive rats by means of the radioactive-labeled microsphere technique. The normal fall in blood pressure during pregnancy was prevented by reducing litter size to two conceptuses on day 7 of gestation. Nifedipine (200 micrograms/kg) effectively lowered mean arterial pressure 25% by decreasing total peripheral resistance 38%. Cardiac output was increased 15%. Blood flows to the splanchnic region and the reproductive organs were increased after nifedipine administration. The increase in blood flow to the reproductive organs was the result of increased ovarian and uterine wall perfusion caused by large reductions in vascular resistances. Placental blood flow was not significantly altered, but resistance was decreased. Thus, the use of nifedipine to lower maternal blood pressure in pregnancy complicated by extreme hypertension does not necessarily decrease uteroplacental perfusion.

Animals↗
PubMed1988

Computed tomography in acute fatty liver of pregnancy.

A case of the diagnosis of acute fatty liver of pregnancy proved by biopsy is described. In this case computed tomography showed decreased attenuation over the liver, and this attenuation is compatible with fatty infiltration. Computed tomography may be useful in the differential diagnosis of jaundice in pregnancy.

Acute Disease↗
PubMed1988

The use of labetalol for attenuation of the hypertensive response to endotracheal intubation in preeclampsia.

Twenty-five women with preeclampsia who were scheduled to undergo cesarean section under general anesthesia were randomly assigned to either a labetalol pretreatment group (n = 15) or a control group (n = 10) who did not receive any antihypertensive therapy before the induction of anesthesia. Patients in the labetalol group received 20 mg of labetalol intravenously followed by 10 mg increments up to a total dose of 1 mg/kg, which resulted in moderate reductions in the maternal mean arterial pressure and heart rate with attenuation of the hypertensive and tachycardiac responses to laryngoscopy and endotracheal intubation. In the labetalol group there was no excessive reduction in the mean arterial pressure with the use of isoflurane and the usual amount of blood loss that occurred during cesarean section. The neonatal Apgar scores and umbilical arterial and venous pH and blood gas values were similar in the two groups. Side effects such as hypotension, bradycardia, and hypoglycemia were not seen in the neonates in the labetalol treatment group.

Adolescent↗