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Biomedical subjects

C L Cetrulo

Publications and source records attributed to C L Cetrulo.

At least 37 records · Page 2Linked to original sources
PubMed1986

Serial amniocenteses in the treatment of twin to twin transfusion complicated with acute polyhydramnios.

Twin to twin transfusion, complicated by acute polyhydramnios in a monozygous twin pregnancy, is a difficult clinical problem. A precipitous course usually results in termination of the pregnancy within a few days and often is associated with a high perinatal mortality rate. Two cases are presented that were treated with repeated amniocenteses for the relief of extreme abdominal discomfort and to prevent imminent premature labor. The amount of amniotic fluid removed each time varied from 300 cc to 1200 cc, which was enough to relieve symptoms but not enough to induce uncontrolled uterine activity. A total of 3500 cc and 4750 cc of amniotic fluid were removed from the first and the second patient, respectively. The procedure was found to be safe and resulted in prolonging the pregnancies by 14 and 11 days, respectively. This management, with the addition of tocolysis and close fetal surveillance can offer some hope in an otherwise hopeless situation.

Adult↗
PubMed1986

Acute polyhydramnios complicating monozygous twin pregnancies--case report.

Two cases of acute polyhydramnios complicating twin pregnancies were treated with repeated amniocentesis for the relief of extreme abdominal discomfort and to prevent imminent premature labor. The procedure was found to be safe and resulted in prolonging the pregnancies by 14 to 11 days respectively. This management, with the addition of tocolysis and close fetal surveillance (which resulted in 2/4 living children) can offer some hope in an otherwise hopeless situation.

Adult↗
PubMed1986

Effect of mode of delivery on morbidity and mortality of infants at early gestational age.

The effect of mode of delivery on the mortality and morbidity of 26- to 32-week neonates was studied. Five hundred six consecutive deliveries at 26 to 32 weeks' gestation were reviewed. The populations were divided into high-risk and low-risk neonates by evaluation of antepartum variables known to increase neonatal risk, ie, abruptio placenta. One hundred ninety-six infants were classified as low risk. In this group, 124 vaginal and 72 cesarean section deliveries were compared using demographic, peripartum, and neonatal variables. Cesarean delivery was associated with highly significant maternal morbidity, including a 30% incidence of vertical uterine incision. No difference in neonatal mortality was shown. Cesarean delivery was associated with lower one-minute Apgar scores and a greater incidence and severity of hyaline membrane disease. No neonatal differences were shown in the incidence of trauma, intraventricular hemorrhage, or seizures. This study does not support cesarean delivery of all tiny neonates.

Apgar Score↗
PubMed1985

Infection and phagocytosis as possible mechanisms of rupture in premature rupture of the membranes.

The concept that premature rupture of the membranes is due to an infectious process is well accepted. However, no definitive data implicating a particular microorganism or a mechanism of action have been advanced. By the use of our recently developed experimental in vitro amnion-chorion reaction vessel model we have studied the effect of the peroxidase-hydrogen peroxide-halide antimicrobial system on these membranes. We have noted that amnion, chorion, decidua, and placental macrophages all possess peroxidase activity. Tissues collected from deliveries following labor (vaginal) are significantly higher in activity than those collected from deliveries with no labor (cesarean section). A mobilization of enzyme from macrophages to amnion appears to occur in the laboring patient. Increased protein hydrolysis is noted in membranes collected from patients without labor subjected to the peroxidase-hydrogen peroxide-halide cytotoxic system when compared with membranes from laboring patients. Bursting pressures of membranes collected from patients without labor are shown to be decreased when the membranes were incubated in the presence of lysolecithin or in the presence of amniotic fluid and phospholipase A2.

Amnion↗
PubMed1985

Pregnant women's absorption of iron from prenatal supplements.

A randomized, double-blind, crossover study was carried out on iron absorption from three prenatal supplements by women in the first trimester of pregnancy. The supplements were given to fasting subjects as a single pill early in the morning, and iron absorption was determined from measurements of serum iron performed during the course of the day. Iron absorption from two of the supplements was substantially less than the 3.5 mg recommended for the prevention of iron deficiency during pregnancy. The third supplement, containing reduced amounts of calcium and magnesium, provided on the average 3.6 mg of absorbed iron to the subjects. These results support previous findings in nonpregnant subjects that the availability of iron in a prenatal supplement is affected by the overall composition of the supplement.

Adult↗
PubMed1985

Positive correlation between mature amniotic fluid optical density readings and the absence of neonatal hyaline membrane disease.

Fetal pulmonary maturity is generally determined by analyzing amniotic fluid for surfactants. This task is accomplished by lipid extraction of the fluid and resolution, identification and quantitation of the isolated lipids with thin-layer chromatography. These methods are lengthy, cumbersome and often not available on demand. A quick, simple, reliable and economical test therefore would be highly desirable. We have been able to correlate an optical density (OD) reading of amniotic fluid at 650 nm greater than or equal to 0.15 with the absence of hyaline membrane disease (HMD). For 428 fluids in which an OD reading of greater than or equal to 0.15 was found and delivery occurred within 48 hours, HMD was present in only two infants. The accuracy of the test was 99.53% , with a false-positive rate of 0.47%. With the use of this simple and accurate test one can satisfy the requirement of an on-demand test to determine fetal pulmonary maturity.

Amniotic Fluid↗
PubMed1984

Correlation of amniotic fluid optical density at 650 nm and lecithin/sphingomyelin ratios with phosphatidylglycerol.

In this study we have attempted to correlate amniotic fluid optical density measurements and lecithin/sphingomyelin (L/S) ratios with the presence of phosphatidylglycerol. An 85% correlation (126 of 148) of all three parameters was noted. When the assumption was made that phosphatidylglycerol is indicative of fetal pulmonary maturity, 93 of 94 fluid samples having an optical density at 650 nm greater than or equal to 0.15 had demonstrable phosphatidylglycerol for a 1% false positive rate. In 53 fluid samples having an optical density at 650 nm less than 0.15, phosphatidylglycerol was present in 11 and absent in 42, a 21% false negative rate. The same analyses with lecithin/sphingomyelin ratios showed a 5% false positive rate and a 31% false negative rate.

Amniotic Fluid↗
PubMed1984

The epidemiology and clinical history of asymptomatic midtrimester placenta previa.

The current case-controlled study examines the epidemiologic factors and subsequent clinical history in 139 patients with asymptomatic low placentation and 137 patients with normal placental position diagnosed in the second and third trimesters by gray-scale ultrasonography. Increased maternal age or parity and previous endometrial or myometrial damage were significantly associated with asymptomatic midtrimester low implantation. Three percent of early low implantations persisted as instances of placenta previa at term. However, in low implantation, the antepartum course was associated with perinatal complications in 45% of patients. Statistically significant increases in third-trimester bleeding, abruptio placentae, and suspected intrauterine growth retardation were shown in the patients with low implantation, when compared to the control patients. Forty-two percent of the patients with low implantation were delivered by cesarean section. The need for cesarean delivery, loss of blood, and prolonged hospitalization were statistically increased in the patients with low implantation. Infants born to mothers with low implantation showed statistically significant increases in prematurity, low birth weight, and perinatal mortality when compared to infants born to control patients.

Adult↗
PubMed1984

Intrauterine fetal demise in multiple gestation.

Fifteen cases were reviewed over a five-year period at a perinatal centre with intrauterine demise of one member of a multiple gestation. Nine cases were monozygotic twin pairs, two were dizygotic, and two were triples . Gestational age ranged from 27 to 39 weeks. The management protocol consisted of delivery in all cases after confirmation of the diagnosis. In 4 cases delivery was immediate because of spontaneous labor. In the other cases elective delivery was performed if the gestational age was 37 weeks or greater or there was evidence of preeclampsia or if amniocentesis revealed a mature lecithinsphingomyelin (L/S) ratio. Steroids were given if the L/S was immature or the attempt at amniocentesis was unsuccessful and delivery was performed 48 hours after initiation of steroid therapy. Cesarean section was the mode of delivery in 14 of the 15 cases. All of the cotwins and cotriplets survived. One survivor of a monozygous twin pair has multicystic encephalomalacia possibly implicating perinatal arterial occlusion or in utero disseminated intravascular coagulation (DIC). The intrauterine deaths are categorized into possibly avoidable deaths (2/15), unavoidable due to congenital anomalies (3/15), and unknown or unavoidable deaths (8/15).

Cesarean Section↗
PubMed1984

Discordant anencephaly in a set of triplets.

A 38-year-old woman, gravida 5, para 3, with a triplet pregnancy discordant for anencephaly, is reported. The diagnosis was made prenatally by ultrasound. Autopsy of the anencephalic member revealed small adrenal glands with absent fetal cortex, and a coincidental tetralogy of Fallot. Studies of the histocompatible lymphocyte antigens of both parents were performed and they failed to demonstrate HLA B-27. The literature on anencephaly in triplets is summarized. The association of congenital heart disease and HLA B-27 with anencephaly is discussed.

Adult↗
PubMed1983

Phagocytosis and onset of human labor.

An in vitro experimental model has been developed which allows the study of amnion lysosomal enzyme release under controlled conditions. Briefly, a layer of human amnion membrane mounted on a specially designed reaction vessel serves as the reaction surface. We have noted that the addition of particulate material to these membranes incubating in pseudoamniotic fluid results in an increased release of the lysosomal marker enzyme N-acetylglucosaminidase when compared to the release in the absence of particles. This release is completely inhibited by iodoacetate and slightly by azide. A similar increased release is also noted with the use of term amniotic fluid as incubation medium when compared to centrifuged (30,000 g/20 min) amniotic fluid. Lecithin and lysolecithin were effective in releasing increasing amounts of enzyme. This increased release was noted only from membranes of placentas collected from subjects who had undergone cesarean section prior to labor. Membranes collected from vaginal deliveries after labor showed a baseline increased release but no further stimulation upon the addition of any of the substances. These results suggest that the release of lysosomal enzymes from amnion membranes is brought about by substance(s) present in amniotic fluid. Very probably, these are surfactants. The interaction of these substances with amnion cells would eventually result in an exponential burst of prostaglandin synthesis, which would result in labor.

Acetylglucosaminidase↗
PubMed1983

Management of a nonreactive nonstress test in a twin gestation. A case report.

The increased risk associated with multiple gestation requires antepartum fetal surveillance with electronic fetal heart rate monitoring. Occasionally the nonstress test is abnormal in one fetus. We reviewed such a case for the pertinent questions about management of a nonreactive nonstress test in a twin gestation. From the case and the literature we formulated a protocol for management.

Adult↗
PubMed1983

Biparietal diameter as a predictor of fetal lung maturity.

A correlation has been established between fetal biparietal diameter (BPD), amniotic fluid lecithin/sphingomyelin (L/S) ratio and optical density at 650 nm (O.D. 650). We have noted that if the BPD is greater than 9.2 cm, the L/S ratio and O.D. 650 will be greater than 2.0 and 0.15, respectively, in 90% of cases. We reviewed the literature on the complication rate of third-trimester amniocentesis under ultrasonic guidance and concluded that in the absence of good dating, a reliably obtained BPD greater than 9.2 cm indicates fetal lung maturity in cases where amniotic fluid studies cannot be performed.

Amniocentesis↗
PubMed1982

Surfactants, L/S ratio, amniotic fluid optical density and fetal pulmonary maturity.

Optical density readings of amniotic fluids of 0.15 or greater at 650 nm have been noted to correlate with fetal pulmonary maturity. The amniotic fluid absorbance has been shown to be due not only to lecithin and sphingomyelin but also to other surfactants, including phosphatidyl glycerol and inositol. The addition of lecithin and sphingomyelin to previously centrifuged amniotic fluid (i.e., optical) density less than 0.001: L/S ratio, nondetectable) results in an increase in absorbance. At any simulated L/S ratio, the addition of phosphatidyl glycerol and/or phosphatidyl inositol results in a further increase in optical density. It is suggested that optical density readings represent more closely the surfactant composition of amniotic fluid than L/S ratios; therefore, it appears that optical density measurements are a better predictor of fetal pulmonary development than are L/S ratios.

Amniotic Fluid↗