Haemodynamic changes during the early puerperium.
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Blood Flow Velocity↗
Biomedical subjects
W Dunlop
Publications and source records attributed to W Dunlop.
Renal haemodynamics and tubular function in human pregnancy.
In human pregnancy, effective renal plasma flow and glomerular filtration rate increase to levels 50-80% above non-pregnant values. The increments occur shortly after conception, persist throughout the second trimester and reduce slightly in late pregnancy. The hyperfiltration of pregnancy does not seem to be a potentially damaging process. The increased excretion of glucose and other nutrients, as well as uric acid and protein, is related in part to altered tubular function. Renal physiology is altered so much in pregnancy that non-pregnant norms cannot be used in antenatal care.
Female↗
Combined Doppler and echocardiographic measurement of cardiac output: theory and application in pregnancy.
A non-invasive technique for the measurement of cardiac output in pregnancy by combined cross-sectional and Doppler echocardiography at three intracardiac sites is described. The validity of the technique for use during pregnancy is reviewed. Comparison with cardiac output determined simultaneously by the direct Fick technique in 15 non-pregnant subjects showed close agreement for all three measurement sites. Acceptable measurements were obtained from the aortic and pulmonary valves in all pregnant subjects and from the mitral valve in 84% of pregnant subjects. The within-patient intra-observer and hour-to-hour variabilities of cardiac output in pregnant and non-pregnant subjects were less than 5% of the mean for all three valves studied. Flow measurements at each of the three intracardiac sites correlated closely. The advantages and limitations of the technique for use during pregnancy are discussed.
Adolescent↗
Haemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study.
Serial haemodynamic investigations were performed in 15 women at 38 weeks gestation and then 2, 6, 12 and 24 weeks after delivery. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic, pulmonary and mitral valves. Cardiac chamber size and ventricular function were investigated by M-mode echocardiography. Flow measurements at the three intracardiac sites correlated closely. Cardiac output fell from a mean of 7.42 l/min at 38 weeks to 4.96 l/min at 24 weeks after delivery, a fall of 33%. Most of this decrease (28%) had occurred by 2 weeks. This was associated with a 20% reduction in heart rate and an 18% reduction in stroke volume. By 2 weeks after delivery there was a significant decrease in left atrial dimension and left ventricular end-diastolic dimension. Left ventricular wall thickness and mass declined throughout the period of study as did aortic, pulmonary and mitral valve areas. M-mode derived indices of myocardial contractility were all significantly reduced by 2 weeks and thereafter showed no further change. No haemodynamic differences were found between lactating and non-lactating mothers.
Adult↗
A multiple pregnancy after in-vitro fertilization. Case report.
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Adult↗
Treatment of hirsutism in polycystic ovary syndrome with bromocriptine.
The value of bromocriptine in the treatment of hirsutism in polycystic ovary syndrome (PCO) was assessed subjectively and photographically in a double-blind trial in 22 women studied for 1 year. Menstrual frequency was recorded. Circulating concentrations of oestradiol, oestrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG) were determined before treatment and after 6 and 12 months therapy. On the same occasions gonadotrophin concentrations (mean of 24 samples) and their response to 100 micrograms LHRH were determined. No evidence was found to support a therapeutic role for bromocriptine in the treatment of hirsutism or menstrual regulation in PCO. No biochemical changes were seen specific to bromocriptine therapy.
Adolescent↗
Studies of prolactin secretion in polycystic ovary syndrome.
In order to investigate the postulated relationship between hyperprolactinaemia and polycystic ovary syndrome (PCOS) we have studied 62 patients with PCOS. Only two patients had persistent prolactin (PRL) concentrations greater than the normal range on both random sampling and after blood sampling from intravenous cannula over 2 hours. Twenty-eight of the remaining patients had basal PRL secretion studied in more detail. Samples were collected at 15 min intervals during a 6 h period in all 28 patients and hourly samples were collected overnight from four patients. Results failed to demonstrate differences from control subjects in mean basal PRL concentrations, in spontaneous fluctuations or in increments related to stress, food or sleep. Lactotroph response to thyrotrophin releasing hormone, luteinising hormone releasing hormone and insulin stress testing in PCOS were determined. Results confirm a previous observation that normal PRL increments occur after ovulation and a blunted response follows a period of anovulation. This study has failed to find a consistent abnormality of lactotroph function in patients with PCOS other than that associated with anovulation.
Adolescent↗
Determination of the frequency of pulsatile luteinizing hormone secretion by time series analysis.
Statistical methods of time series analysis, in particular, spectral analysis, have been used to determine the pulse frequency of LH secretion. This method can detect significant harmonic variation within the data. Six normal women in the early follicular phase of the menstrual cycle were studied at 5 and 15 min sampling intervals and significant dominant pulse frequencies were revealed in five subjects (51-120 min). In addition, a low frequency variation (greater than 6 h) was revealed in four subjects and more rapid frequencies (20 and 13.3 min) were seen clearly in one subject. Comparison of repeat studies on four individuals at the same stage of different menstrual cycles and on two individuals in the same cycle failed to demonstrate differences in five of the six subjects. This method of analysis offers a new approach to the analysis of LH pulse frequency. Realistic comparisons of this frequency between and within individuals can now be made. A new observation of superimposed harmonic components of LH pulsatility has also been recorded.
Adolescent↗
Cytogenetic studies in spontaneous abortuses.
In a series of 450 products of conception received for cytogenetic analysis, tissue culture was attempted on 309, and karyotypes were established using banding techniques in 154 singleton specimens. Abnormalities of karyotype were identified in 19%; of these abnormalities, 48% were autosomal trisomies. Gestational age was decreased in the abnormal specimens, and their developmental age was retarded by comparison with their gestational age. Factors contributing to the relatively low incidence of abnormality are examined. The major factor appears to be the clinical interest of collaborating staff, leading to selection, either intentional or unintentional, of particular phenotypes and hence a non-random series. A negative relationship is suggested between frequency of monosomy X and autosomal trisomy, both being associated with maternal age.
Abortion, Spontaneous↗
The acute effects of a dopamine antagonist (domperidone) on luteinising hormone, follicule stimulating hormone, prolactin and thyrotrophin secretion in polycystic ovarian syndrome: differential effect of ovulation.
An alteration of the hypothalamic dopaminergic regulation of LH secretion has been implicated in the abnormal LH secretion of polycystic ovarian syndrome (PCOS). To investigate this, the acute effect of dopamine (DA) receptor blockade on LH, FSH, PRL and TSH secretion was determined. No effect was observed on either LH or FSH secretion in the PCOS patients or in normal women and LH pulsatility appeared to be maintained. When the PCOS patients were divided into those who ovulated in the preceding cycle and those who were anovulatory, it was observed that the ovulatory patients had a normal PRL and TSH response; whereas in the anovulatory patients, the PRL rise was blunted and the TSH response was absent. We conclude that this study gives no evidence to support the hypothesis of altered hypothalamic DA regulation of LH secretion in PCOS. The lack of LH response to DA blockade suggests that a physiological role of DA in the control of LH secretion seems unlikely as determined under these experimental conditions. The differences in PRL and TRH response may reflect anovulation rather than a fundamental abnormality in PCOS.
Adult↗
The effect of bromocriptine in the polycystic ovary syndrome.
The effect of chronic administration of bromocriptine to 20 patients with the polycystic ovary syndrome (PCOS) was studied. All patients had normal serum prolactin levels. Bromocriptine 7.5 mg daily was administered for up to 1 year and the biochemical and clinical responses assessed at 3-monthly intervals. Over a period of 3 to 12 months significant reductions in serum LH levels, LH/FSH ratios and in plasma testosterone were observed. In 14 patients, blunting of the previously enhanced LH response to LHRH was observed. Clinical improvement also occurred, most notably in menstrual function. In 12 out of 20 patients a monthly cycle was established and in a further three there was an increase in the frequency of menstruation towards normal. Eleven out of 20 patients ultimately noted a subjective improvement in hirsutism. We conclude that bromocriptine, given to patients with polycystic ovarian disease, inhibits LH hypersecretion, leading to restoration of cyclic ovarian function and reduced androgen synthesis.
Adult↗
The 'Go-getters' are checking out.
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Alberta↗
Serial changes in renal haemodynamics during normal human pregnancy.
Effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) were determined at constant intervals during and after the normal pregnancies in 25 healthy women. Compared with non-pregnant values, ERPF increased by 80 percent during early pregnancy but fell significantly from this new level during the third trimester. GFR, however, remained at a level 50 per cent above the non-pregnant throughout pregnancy. Filtration fraction (GFR/ERPF) was significantly reduced during early pregnancy but rose to a value equivalent to the non-pregnant during the third trimester. Comparable data of previous workers are re-interpreted.
Adult↗
Non-postural serial changes in renal function during the third trimester of normal human pregnancy.
Seventeen healthy women were investigated near the beginning and again near the end of the third trimester of their normal pregnancies. Infusion studies were performed in the left lateral position. There was a highly significant decrease in effective renal plasma flow but not in glomerular filtration rate, measured as inulin clearance. Plasma creatinine concentration increased significantly, but the renal handling of creatinine was unchanged; simultaneous 24-hour creatinine clearance showed a tendency to decrease. Serum urate concentration also increased significantly, apparently due to an increase in net tubular reabsorption of urate.
Adult↗
Renal hemodynamics and tubular function normal human pregnancy.
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Female↗
24-hour creatinine clearance during the third trimester of normal pregnancy.
Serial changes in 24-hour creatinine clearance were determined in 10 healthy women during late pregnancy and after the puerperium. A decrease occurred in all subjects during the six weeks preceding delivery, so that mean values for the last three weeks of pregnancy did not differ from the non-pregnant mean. Possible reasons for this phenomenon and its clinical implications are discussed.
Adult↗
Renal physiology in pregnancy.
The changes which occur in renal excretory function during pregnancy are discussed. The relationship between glomerular filtration rate and effective renal plasma flow is examined in the light of new serial data obtained under conditions of saline diuresis. Changes in the renal handling of nutrients and in the excretion of waste products during pregnancy are reviewed.
Female↗