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Biomedical subjects

B Kirshon

Publications and source records attributed to B Kirshon.

At least 37 records · Page 2Linked to original sources
PubMed1991

Long-term indomethacin therapy decreases fetal urine output and results in oligohydramnios.

Four quadrant quantitative amniotic fluid volume (length, width, and depth) was performed in six fetuses prior to and during indomethacin therapy for preterm labor in patients with normal amniotic fluid volume prior to therapy. The dose of indomethacin was 25 mg orally every 6 hours. One patient had to have the dose reduced to 25 mg every 12 hours due to constriction of the ductus arteriosus. Fetal urine output was determined prior to and during indomethacin therapy. The mean pretherapy amniotic fluid volume of 341.5 +/- 43.2 mm declined to 97 +/- 9.3 mm at the time of discontinuation of indomethacin for oligohydramnios. This occurred after 15 days of 25 mg indomethacin orally every 6 hours in four patients and after 28 days at 25 mg indomethacin every 12 hours in the remaining patient. Fetal urine output prior to and following indomethacin was 4.93 +/- 14 ml and 1.73 +/- 0.6 ml/hr, respectively. Prolonged indomethacin therapy results in decreased fetal urine output with resultant oligohydramnios and appears to be the major limiting factor aside from ductal constriction to long-term indomethacin therapy.

Adult↗
PubMed1991

Should continuous hydralazine infusions be utilized in severe pregnancy-induced hypertension?

Intravenous hydralazine therapy in severe preeclampsia-eclampsia may be administered by either continuous intravenous infusion or intermittent bolus therapy. We studied the hemodynamic effects of continuous intravenous hydralazine infusion in seven patients with severe pregnancy-induced hypertension. The starting infusion dose was 5 mg/hr and was increased every 15 to 20 minutes by 1 to 2 mg/hr to obtain a 20% reduction in mean arterial blood pressure. The initial mean systolic and diastolic blood pressures were 208.3 +/- 24.8 and 124.3 +/- 11.6 mmHg, respectively. The comparable mean levels following hydralazine therapy was 144 +/- 13.6 and 87 +/- 11.6 mmHg. This decline was obtained at a mean hydralazine dose of 16.04 +/- 3.65 mg/hr. Despite an increase in cardiac output, the rapid uncontrolled decline in blood pressure resulted in five of the seven patients developing fetal distress requiring cesarean delivery. If hydralazine therapy is to be used in severe preeclampsia-eclampsia, we advocate avoidance of continuous intravenous therapy.

Apgar Score↗
PubMed1991

Respiratory function in severe gestational proteinuric hypertension: the effects of rapid volume expansion and subsequent vasodilatation with verapamil.

OBJECTIVES: (1) To define the baseline respiratory function in untreated severe gestational proteinuric hypertension (GPH) and (2) to assess the effects of volume expansion with dextran (MW = 70,000 Dalton) and subsequent vasodilatation with the calcium antagonist verapamil on the baseline respiratory function in severe GPH. DESIGN: Prospective descriptive study. SETTING: Reproductive Research Unit, Groote Schuur Hospital, Cape Town, South Africa. SUBJECTS: Six women with severe GPH undergoing stabilization and delivery. INTERVENTIONS: Baseline haemodynamic and respiratory function was assessed using invasive monitoring. Patients then underwent volume expansion to a pulmonary capillary wedge pressure of 16 mmHg with dextran-70, followed by vasodilatation with the calcium antagonist verapamil. Haemodynamic and respiratory variables were measured, before and after both the fluid load and the reduction (20%) in the mean arterial pressure. MAIN OUTCOME MEASURES: Mean arterial pressure, heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac index, systemic vascular resistance, pulmonary vascular resistance, respiratory rate, blood gases, alveolar arterial oxygen difference, oxygen availability, oxygen consumption, pulmonary shunt fraction. RESULTS: Baseline oxygen availability/delivery and oxygen consumption indices were consistent with severe tissue ischaemia. Volume loading with 400 +/- 114 ml dextran-70 normalized these variables, and subsequent vasodilatation with verapamil did not reduce these indices below the normal limits for pregnancy. CONCLUSIONS: These data support the theory that some of the complications of severe GPH may follow organ damage due to prolonged tissue ischaemia. They also support the appropriateness of controlled volume expansion in the management of this condition. We suggest, from these data, that the combination of volume expansion and verapamil vasodilatation lowers the blood pressure without compromising the maternal respiratory function.

Blood Volume↗
PubMed1990

Placental transfer of indomethacin in the human pregnancy.

Little is known about the placental transfer of indomethacin in the human pregnancy. Twenty-six pregnant patients (gestational age, 29.4 +/- 0.5 weeks) were given a 50 mg oral dose of indomethacin 6.08 +/- 0.07 hours before 42 cordocenteses undertaken for standard indications. Maternal serum, fetal serum, and amniotic fluid levels were measured at the time of each procedure. Maternal indomethacin levels were not significantly different from corresponding fetal levels (218 +/- 21 vs 219 +/- 13 ng/ml). The maternal/fetal serum ratio (0.97 +/- 0.07) was not found to vary with gestational age (R = -0.07, p = 0.66). Fetal serum levels were significantly higher than corresponding amniotic fluid levels (219 +/- 16 vs. 21 +/- 2 ng/ml; p less than 0.001). The fetal/amniotic fluid ratio (10.0 +/- 1.2) did not vary with gestational age (R = 0.33, p = 0.11). Indomethacin crosses the human placenta easily throughout gestation; only small amounts of the unchanged drug are found in the amniotic fluid.

Amniotic Fluid↗
PubMed1990

The effect of indomethacin on the pulsatility index of the umbilical artery in human fetuses.

Pulsed and continuous-wave Doppler ultrasonography was used to assess blood velocities in the ductus arteriosus and the pulsatility index of the umbilical artery in 20 fetuses (1 pair of twins and 18 singletons) at 23 to 33 weeks' gestation during maternal indomethacin therapy for preterm labor or polyhydramnios. There was no statistically significant difference in the pulsatility index of the umbilical artery during maternal indomethacin treatment (mean +/- SD, 1.11 +/- 0.20) when compared with baseline values (1.12 +/- 0.19) in all 20 fetuses studied. An increase in the peak systolic and diastolic blood velocities in the ductus arteriosus consistent with ductal constriction was noted in 9 fetuses. Analysis of the umbilical artery pulsatility index values before and during indomethacin in this subgroup of fetuses failed to reveal a statistically significant change (1.12 +/- 0.19 vs. 1.11 +/- 0.20). Indomethacin therapy does not influence the pulsatility index of the umbilical artery at the gestational ages studied.

Blood Flow Velocity↗
PubMed1990

Flow velocity waveforms of the vascular system in the anemic fetus before and after intravascular transfusion for severe red blood cell alloimmunization.

Sixteen intravascular transfusions were performed in 16 anemic human fetuses. To investigate the status of the vascular system with Doppler ultrasonography before and after correction of anemia, pulsatility index values were obtained for the flow velocity waveforms of the middle cerebral artery, internal carotid artery, anterior cerebral artery, thoracic aorta, abdominal aorta, renal artery, femoral artery, and umbilical artery before and the day after the correction of anemia. The fetuses were divided into two groups: (1) fetuses with a hematocrit level between 2 and 4 SDs below the normal mean value for gestational age and (2) fetuses with a hematocrit value less than 4 SDs below the normal mean value for gestational age. No significant differences were observed in the pulsatility index values of the vessels studied before and after correction of anemia in both groups of fetuses. These data suggest that the pulsatility index cannot be used as an indicator of fetal anemia at the hematocrit values studied.

Anemia, Hemolytic, Autoimmune↗
PubMed1990

Postpartum cardiovascular complications after bromocriptine and cocaine use.

A case is presented of a postpartum woman in whom hypertension and pulmonary edema developed after administration of bromocriptine mesylate. Caution is advised when there is additional recent use of cocaine because of a suggested potentiating action of cocaine on the development of adverse cardiovascular and cerebral sequelae in postpartum patients who take bromocriptine.

Adult↗
PubMed1990

In utero resolution of hydrops fetalis following the death of one twin in twin-twin transfusion.

A case of massive hydramnios involving a twin-twin transfusion syndrome is presented with death of the larger twin and the development of hydrops fetalis in the surviving smaller twin. The amniotic fluid volume of the surviving twin became normal and the hydrops fetalis resolved spontaneously in utero. Concomitant with the resolution of the hydrops fetalis, the umbilical cord systolic to diastolic ratio improved. At the time of delivery, the hydrops had resolved. The liveborn infant died 11 days later secondary to pulmonary hypertension and cardiorespiratory failure. Although the fetal status improved in utero, the pulmonary hypertension postdelivery resulted in neonatal death.

Adult↗
PubMed1990

Effect of indomethacin on the fetal ductus arteriosus during treatment of symptomatic polyhydramnios.

Ten pregnancies with 13 fetuses complicated by symptomatic polyhydramnios were treated with indomethacin. A baseline fetal echocardiogram was obtained before therapy, repeated 24 hours after the initiation of indomethacin and then performed weekly provided that the ductus arteriosus remained patent. The mean duration of indomethacin therapy was 28.3 +/- 18.9 days. The starting dose in all patients was 25 mg orally every six hours. The ductus arteriosus was noted to constrict in four patients, with the development of tricuspid regurgitation in one. One of the constrictions occurred after 23 days of therapy. In one patient with constriction a reduction of the indomethacin dosage was not associated with constriction, while in the other three, constriction was still evident at a reduced dosage. All constrictions and the tricuspid regurgitation resolved in utero within 24 hours after discontinuation of the indomethacin. We recommend careful monitoring of the fetal ductus arteriosus when treating symptomatic polyhydramnios with indomethacin.

Ductus Arteriosus↗
PubMed1990

Uterine blood flow velocity waveforms in pregnant women during indomethacin therapy.

Continuous-wave Doppler ultrasound was used to assess blood flow velocities and determine the pulsatility index of the uterine arteries in ten pregnant women at 23-33 weeks' gestation during indomethacin therapy for preterm labor or polyhydramnios. There was no statistically significant difference in the pulsatility index of the uterine arteries during maternal indomethacin treatment (mean +/- SD 0.85 +/- 0.29) compared with pre-treatment values (0.85 +/- 0.23). Although studies in animals have reported that indomethacin increases uterine impedance to flow, it appears that it does not affect the uterine impedance in humans.

Blood Flow Velocity↗
PubMed1990

Maternal mortality in a maternal-fetal medicine intensive care unit.

Maternal mortality in a large, tertiary-care, intensive care, referral center was reviewed for a six-year period. The first three years of the review were prior to the institution of a maternal-fetal medicine intensive care unit, located in the labor-and-delivery suite. The subsequent three years encompassed a period during which an intensive care unit staffed by maternal-fetal medicine specialists and obstetric anesthesiologists was established in the labor-and-delivery suite. The maternal mortality rate was 21.7/100,000, or 10 maternal deaths in 45,984 deliveries, prior to establishment of the unit and 22.1/100,000, or 11 maternal deaths in 49,700 deliveries, after establishment of the unit. The major causes of maternal mortality were pregnancy-induced hypertension, hemorrhage and infection. It appears that a multi-disciplinary team composed of maternal-fetal medicine specialists and obstetric anesthesiologists can provide the same level of care for critically ill obstetric patients that traditionally would be provided by medical intensive care specialists.

Adolescent↗
PubMed1990

Intrathecal morphine analgesia and low-dose dopamine for oliguria in severe maternal pulmonary hypertension. A case report.

Maternal pulmonary hypertension can be life threatening, and many problems and complications can occur during labor and delivery as well as postpartum. A case of severe maternal pulmonary hypertension was monitored with a pulmonary artery catheter. Intrathecal morphine was administered for labor analgesia, and low-dose dopamine was utilized for maternal oliguria. Neither the morphine nor the dopamine resulted in adverse maternal hemodynamic effects. Both analgesia and resolution of the oliguria were accomplished.

Adult↗
PubMed1990

Incidence of gestational diabetes: effects of race.

A total of 2,435 pregnant women underwent glucose screening during the late second trimester or early third trimester. Of those screens, 548 (22.5%) were abnormal; from these, 154 abnormal glucose tolerance tests were recorded. This gave an overall 6.3% incidence of gestational diabetes at our institution. Eighty-two of the abnormal glucose tolerance tests were in Hispanic females, but this was not significantly higher than in other racial groups. Patients with a negative glucose tolerance test after a positive diabetic screen and obese gravidas had an 11.3% incidence of macrosomia. Of all the macrosomic infants (greater than 4,000 g) 38% of mothers weighed 200 lb (90 kg) or more.

Female↗
PubMed1990

Doppler assessment of the renal blood flow velocity waveform during indomethacin therapy for preterm labor and polyhydramnios.

To investigate the effects of indomethacin on the human fetal renal blood flow velocity waveform, 17 fetuses whose mothers were treated for preterm labor (N = 8) or polyhydramnios (N = 9) were studied. There were five growth-retarded fetuses (all in the group with polyhydramnios), 11 normal fetuses, and one fetus with red-cell alloimmunization. The indomethacin dose in all patients was 25 mg orally every 6 hours. The gestational age of the fetuses studied varied between 24-35 weeks (mean +/- SD 29.6 +/- 2.8). The fetal renal artery was studied at its origin from the aorta before and during the first 24 hours of indomethacin therapy. Seven fetuses manifested ductal constriction. Three fetuses also manifested tricuspid regurgitation. All ductal constrictions and the tricuspid regurgitations resolved in utero after discontinuation of indomethacin. There were no significant differences in the pulsatility index values of the renal artery before and during indomethacin therapy. These results suggest that there is no change in fetal renovascular parameters detectable with pulsatility index measurements during the first 24 hours of maternal indomethacin therapy.

Ductus Arteriosus↗
PubMed1990

Indomethacin therapy in the treatment of symptomatic polyhydramnios.

Eight gravidas with symptomatic polyhydramnios were managed with maternal indomethacin therapy. The mean gestational age at presentation was 28.6 +/- 3.5 weeks. Only patients requiring serial amniotic fluid decompressions for rapid amniotic fluid reaccumulation were enrolled in the study. An initial amniotic fluid decompression was performed and, when a second decompression was required, indomethacin was initiated. Amniotic fluid volume was measured with a para-amino hippuric acid dilution technique before and during indomethacin therapy. Fetal urine output, studied by serial bladder dimension ultrasonography, declined significantly during indomethacin therapy (P less than .05). Only one patient required further amniotic fluid decompression while on indomethacin. The mean (+/- SD) amniotic fluid volume was 1529 +/- 1070 mL after the initial amniocentesis, and was 2355 +/- 820 mL at the second amniocentesis just before indomethacin therapy. The mean amniotic fluid volume during indomethacin therapy was 1608 +/- 914 mL. We recommend initial amniotic fluid decompression followed by indomethacin therapy for the management of symptomatic polyhydramnios as an alternative to serial amniotic fluid decompressions.

Adult↗
PubMed1990

Outcome of twin-twin transfusion diagnosed before 28 weeks of gestation.

To develop prognostic indicators for those patients diagnosed with twin-twin transfusion before 28 weeks' gestation, we conducted a retrospective analysis of all cases diagnosed at Baylor College of Medicine from January 1985 through April 1989. Twenty-seven cases of twin-twin transfusion were diagnosed by ultrasound; the criteria for diagnosis were polyhydramnios in one amniotic cavity and oligohydramnios in the other cavity. The mean (+/- SD) age at diagnosis was 21.9 +/- 2.9 weeks and the mean age at delivery was 26.8 +/- 4.9 weeks. Gestational age at diagnosis was similar in survivors and non-survivors (21.7 +/- 3.7 versus 22.2 +/- 2.8 weeks; P = .35); however, surviving infants were delivered later in gestation (31.9 +/- 3.5 versus 25.9 +/- 3.4 weeks; P = .000008). The overall survival rate was 21%. Fetal hydrops correlated with poor survival. Amniocentesis for decompression and tocolysis failed to decrease perinatal mortality.

Adult↗