PubMed Health⌕ Search

Biomedical subjects

D A Davey

Publications and source records attributed to D A Davey.

At least 19 recordsLinked to original sources
PubMed1992

The variability of urinary protein and creatinine excretion in patients with gestational proteinuric hypertension.

OBJECTIVE: To determine the variability of protein excretion in patients with proteinuric hypertension and the accuracy of either a urinary protein/creatinine ratio or a Multistix examination for the estimation of a 24 h protein excretion. DESIGN: An indwelling urinary catheter was placed for 24 h and successive 8 h specimens examined. SETTING: A tertiary referral hospital in Cape Town, South Africa. SUBJECTS: 22 women with significant proteinuria in pregnancy were studied. MAIN OUTCOME MEASURES: The urine volume, protein excretion and creatinine excretion in eight hourly periods were measured. Multistix examination of each specimen was recorded. RESULTS: A large coefficient of variation in urine volume (41%), amount of protein excreted (44%) and the amount of creatinine excreted (22%) in the eight hourly specimens were noted. The protein creatinine ratio did not accurately predict the 24 h protein excretion. The Multistix examination was less accurate with increasing amounts of proteinuria. The amount of creatinine excreted correlated with the volume of urine passed (r = 0.43). CONCLUSION: The analysis of a 24 h specimen or urine for protein excretion remains the best method of monitoring proteinuria in pregnancy. The amount of creatinine excreted in 24 h cannot be used as an index of completeness of collection of the 24 h specimen.

Circadian Rhythm↗
PubMed1991

Platelet count and liver function tests in proteinuric and chronic hypertension in pregnancy.

Platelet counts and plasma enzyme estimations were performed in 207 pregnant patients with proteinuric hypertension and in 60 patients with chronic hypertension. Patients with abruptio placentae were excluded. In the proteinuric hypertensive patients a low platelet count (less than 150,000/mm3) was found in 63 (30%) and elevated transaminase levels in 50 (24%) and both abnormalities were present in 47 patients (23%). The serum lactate dehydrogenase (LDH) value was mildly elevated in most proteinuric hypertensive women, but a markedly elevated LDH level (greater than 400 IU/l) was usually associated with other evidence of liver necrosis. Raised plasma alkaline phosphatase and gamma-glutamyltransferase levels were not related to the occurrence or severity of liver necrosis. In proteinuric hypertensive patients a low platelet count or elevated transaminase level was associated with deteriorating renal function, increased maternal morbidity, increased incidence of low-birth-weight babies and a raised perinatal mortality rate (149/1,000). In patients with chronic hypertension, 1 had a low platelet count but none had elevated transaminase, LDH or other enzyme levels and there was no recorded perinatal mortality.

Adolescent↗
PubMed1991

Placental bed spiral arteries in the hypertensive disorders of pregnancy.

OBJECTIVE: The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura. DESIGN: An observational study, based on women having caesarean sections for clinical reasons. SUBJECTS: 17 normal pregnant women, 43 with gestational hypertension, of whom 39 had proteinuria, 17 with chronic hypertension, of whom 6 had proteinuria, and 5 with unclassified hypertension. INTERVENTIONS: Placental bed biopsies obtained during caesarean section. MAIN OUTCOME MEASURES: Histological appearance of sections stained with haematoxylin and eosin PAS and Lendrum's MSB. RESULTS: Biopsies containing spiral arteries were obtained from 6 normotensive and 44 hypertensive women. Trophoblastic invasion was present in 5 of the 6 normotensive biopsies but absent in the majority of those with hypertension. Subintimal proliferation was seen in all the normotensive biopsies but in only 8 of 28 from those with gestational hypertension and proteinuria. Other features seen predominantly or only in the hypertensive biopsies, in order of frequency, were medial hyperplasia, fibrin deposits, acute atherosis, endothelial vacuolation and thrombosis. CONCLUSION: Absence of physiological changes may not be peculiar to preeclampsia but may be associated or even a result of various forms of hypertension in pregnancy. Spiral arteries show a spectrum of changes in hypertensive pregnancies that do not appear to bear a clear-cut relation to the clinical signs.

Arteries↗
PubMed1990

Indoramin in the treatment of pregnancy hypertension. A placebo-controlled trial comparing the efficacy of indoramin with alpha-methyldopa.

A placebo-controlled trial was used to assess the antihypertensive efficacy of indoramin in the management of pregnancy hypertension. Sixty patients were recruited into the study and only 17 attained satisfactory blood pressure control. In the doses of drugs administered indoramin was not shown to be more effective than alpha-methyldopa.

Drug Therapy, Combination↗
PubMed1990

The effect of plasma volume expansion on uteroplacental blood flow in hypertensive pregnancies.

The effect of plasma volume expansion on uteroplacental blood flow was investigated in 20 hypertensive women in the 3rd trimester of pregnancy by measuring the radioactivity in the region of the placenta with a gamma camera after an intravenous injection of indium-113. Despite a significant increase in plasma volume there was no change in maternal blood pressure or in uteroplacental blood flow. This suggests an autoregulation of both blood pressure and uteroplacental blood flow.

Adult↗
PubMed1990

Hemodynamic changes associated with intravenous infusion of the calcium antagonist verapamil in the treatment of severe gestational proteinuric hypertension.

The calcium antagonist verapamil was intravenously infused after plasma volume expansion with dextran-70 in nine patients with severe gestational proteinuric hypertension. The hemodynamic response of these patients was monitored using a flow-directed pulmonary artery catheter. Verapamil produced a statistically significant reduction in mean arterial pressure and systemic vascular resistance without adversely affecting the cardiac output. The decrease in blood pressure was smooth and controlled and was associated with an insignificant increase in heart rate. There were no adverse fetal effects as evidenced by cardiotocographic monitoring. The apparent efficacy of verapamil in this study justifies further investigation.

Adult↗
PubMed1989

Haemodynamic changes in gestational proteinuric hypertension: the effects of rapid volume expansion and vasodilator therapy.

Ten patients with gestational proteinuric hypertension were studied with a Swan-Ganz thermodilution haemodynamic catheter before, during and after plasma volume expansion. Five patients were treated with dihydralazine before volume expansion and five after volume expansion. Before treatment all patients had a low pulmonary capillary wedge pressure (PCWP), low cardiac index (CI) and high systemic vascular resistance (SVR). Following volume expansion the PCWP and CI increased, the SVR decreased but the blood pressure (BP) was unchanged. Administration of dihydralazine following volume expansion led to a decrease in PCWP, an increase in CI and a decrease in SVR and BP. Dihydralazine alone caused an increase in heart rate, PCWP, and CI, and a decrease in SVR and BP. Volume expansion, by increasing CI and decreasing SVR, may be of therapeutic benefit in the severely hypertensive pregnant patient with a low cardiac index.

Adult↗
PubMed1989

The right to be born.

The right to be born embodies several different rights: the right to be conceived, the right to be implanted in the uterus, and the right to live (or not be aborted). The right to be conceived, or the right of parents to reproduce, may depend upon circumstances. Do couples have the right to have children to whom they cannot offer an adequate upbringing? Do couples have the right to have as many children as they wish if in this way they will reduce the amount of food available to other families? Is the right to have children coupled with a responsibility not to have more children than a community, a country or the world can support? Fertilisation occurs in the fallopian tube, but only about 30% of fertilised ova normally become successfully implanted in the uterus. Fertilisation can also be achieved in a test tube and the resultant embryo then implanted in the mother's uterus to grow into a "test tube baby". Is it ethical to allow the use of donor sperm or ova, a surrogate mother, experimentation on embryos, and what should be done with "spare" embryos? The British Unborn Child (Protection) Bill 1986 prohibits anyone from possessing a fertilised embryo unless it is for the purpose of enabling a specific women to have a child. The right to live and not be aborted may involve a conflict of interests between a mother and her unborn child. A mother may claim absolute rights over her own body, including the right to have an abortion if she desires.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed1988

Plasma volume expansion in pregnancy hypertension.

Stabilised human serum 500 ml was infused intravenously over 90 minutes in 14 hypertensive women in late pregnancy, and the haemodynamic changes were investigated and compared with those in 7 similar women who were not treated. There was a significant mean increase of 1,85 l in plasma volume, a decrease in diastolic and systolic blood pressure, and an increase in central venous pressure (CVP), pulse pressure and pulse rate in the treated group at 2 hours but not in the control group. After 24 hours most of the observations were not significantly different from the pretreatment levels except the CVP and pulse rate measurements which were still significantly raised. The CVP measurements in the hypertensive women before treatment were relatively low compared with those reported in normal women in late pregnancy. It is suggested that there may be an under-filling of the circulation in pregnancy hypertension and that plasma volume expansion may have an important therapeutic effect by increasing cardiac output and renal and uterine blood flow.

Blood Pressure↗
PubMed1988

The classification and definition of the hypertensive disorders of pregnancy.

Hypertension and proteinuria in pregnancy may be the result of a number of different disorders with different etiologies and pathologic characteristics. As the causes of hypertension and proteinuria in pregnancy are largely unknown, a new clinical classification of the hypertensive disorders is proposed and is based solely on the physical signs of hypertension and proteinuria. The classification is intended to define meaningful clinical categories by which all cases of hypertension and proteinuria occurring in pregnancy, labor, or the puerperium may be classified. New definitions of hypertension and proteinuria are also proposed; they are based on standardized methods of measurement and simple criteria of abnormality. It is hoped that this clinical classification and associated definitions will find general acceptance so that the incidence and outcome of the hypertensive disorders of pregnancy and the results of research in different centers may be compared and mutual understanding achieved.

Diagnosis, Differential↗
PubMed1988

The effect of sublingual nifedipine on uteroplacental blood flow in hypertensive pregnancy.

The effect of nifedipine on uteroplacental blood flow was investigated in nine hypertensive women in the trimester of pregnancy and compared with the effects of a placebo in nine similar hypertensive women. An index of uteroplacental blood flow was obtained, twice before treatment and once after treatment, by measuring the increase in radioactivity in the region of the placenta with a gamma camera following an intravenous injection of indium-113m. There was no significant change in the blood flow index in either the nifedipine- or the placebo-treated groups despite a significant fall in blood pressure with nifedipine. Nifedipine lowers the blood pressure without any apparent reduction in uteroplacental blood flow.

Adult↗
PubMed1984

The value of an auditory stimulatory test in antenatal fetal cardiotocography.

One hundred auditory stimulatory antenatal fetal cardiotocographic tests were compared to standard non-stress tests in patients with pregnancy hypertension. The incidence of equivocal tests was significantly reduced. The A.S.T. is a simple and reliable test for assessing fetal heart reactivity in hypertensive pregnancy.

Acoustic Stimulation↗