Prenatal diagnosis of enterolithiasis: a sign of fetal large bowel obstruction.
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Adult↗
Biomedical subjects
D B Cotton
Publications and source records attributed to D B Cotton.
Amnioinfusion: does the choice of solution adversely affect neonatal electrolyte balance?
OBJECTIVE: To determine whether various solutions commonly used in amnioinfusion during labor affect neonatal electrolyte and blood gas values. METHODS: Amnioinfusion for thick meconium or severe variable fetal heart rate decelerations is used at our institution according to a standardized protocol. During alternating 3-week periods, the only solution made available for amnioinfusion was either normal saline or Ringer's lactate. Bolus volume, rate, and duration of infusion were determined by the individual physicians. At delivery, cord blood was collected for electrolyte and blood gas determination. These values were compared between the two solution groups and to a non-infused control group. RESULTS: Complete data on neonatal electrolytes and blood gas values were available on 53 infusion patients (20 Ringer's lactate, 33 normal saline) and 39 non-infusion patients. Comparing infusion to non-infusion patients and those infused with Ringer's lactate to those with normal saline, we found no significant difference in demographics, neonatal outcome variables, duration of labor, neonatal electrolytes, and cord blood gas values. Infusion variables (bolus volume, infusion rate, hours infused, and total volume infused) did not differ between solutions. Total volume and hours of infusion were closely correlated with each other (r = 0.93, P < .001); both were correlated with neonatal chloride (r = 0.38 and r = 0.36, respectively; P < .005). No cases of hypernatremia or hyperchloremia were found in any of the groups. The type of solution used had no effect on the neonatal chloride trend. CONCLUSION: The use of both normal saline and Ringer's lactate for indicated amnioinfusion in labor appears to have no clinically significant effect on neonatal electrolytes.
Adult↗
[Emergency postpartum hysterectomy. A study over 5 years].
A retrospective review was conducted of 34 women who underwent emergency peripartum hysterectomy at Hutzel Hospital--Wayne State University, Detroit from January 1986 to December 1991. Indications for hysterectomy were placenta accreta, uterine rupture, uterine atony and unspecified uterine bleeding. The median age of the patients was 33 years (20-40 years). The median hospital stay was 6 days (4-26 days) and median blood loss was 2000 ml (1000-6000 ml), with a median blood replacement of 4 units of packed cells (0-16 RPC). Postoperative complications included urinary tract infection (2), vaginal cuff cellulitis (3), wound infections (2), septic thrombophlebitis (2), acute tubular necrosis (1) and wound hematoma (1). No patient died.
Adult↗
A comparison of cardiac index in normal term pregnancy using thoracic electrical bio-impedance and oxygen extraction (Fick) techniques.
OBJECTIVE: To correlate cardiac index in normal late third-trimester pregnancy using the thoracic electrical bio-impedance technique with that obtained from the oxygen extraction technique. METHODS: Eight carefully screened normal pregnant women underwent assessment of cardiac index using both the thoracic electrical bio-impedance technique and the oxygen extraction technique. Measurements were obtained in various positions. RESULTS: The correlation was good between the thoracic electrical bio-impedance and oxygen extraction techniques in the left lateral (r = 0.915) and right lateral (r = 0.863) positions, and the intercepts at the midpoints of the oxygen extraction data in these positions suggested good absolute correlation as well. Correlation between thoracic electrical bio-impedance and the Fick cardiac index was poor in all other positions. CONCLUSIONS: Thoracic electrical bio-impedance cardiac index assessment is influenced by maternal position and must be used with caution in clinical research protocols. This technique appears to be inappropriate for general clinical use during pregnancy.
Adult↗
Effects of chronic exercise on blood volume expansion and hematologic indices during pregnancy.
OBJECTIVE: To compare blood volumes and hematologic indices between nine aerobically trained, physically active pregnant women who continued to exercise throughout gestation and five healthy yet sedentary gravidas. METHODS: Subjects were tested on three occasions: 25 and 36 weeks of pregnancy and 12 weeks postpartum. Plasma volumes were estimated by dye dilution with Evans blue. Blood samples were taken from the antecubital vein with the subjects resting in a seated, semirecumbent position. In addition to plasma volume estimations, blood samples were analyzed for hematocrit ratio, hemoglobin concentration, red cell count, and plasma protein concentration. Blood volumes and red cell volumes were calculated from plasma volume estimates and hematocrit ratios. RESULTS: Average birth weight and length of gestation did not differ between the subject groups. Analysis of variance indicated that absolute blood volume measures were significantly greater (P < .01) in the physically active compared to sedentary subjects at all three test times. Similar results were found for plasma and red cell volumes (P < .01). Blood volumes relative to body weight were significantly higher in physically active subjects (P < .01) than in their sedentary counterparts at 25 weeks (88.5 versus 75.5 mL/kg) and at 36 weeks (88.4 versus 70.9 mL/kg), as well as at 12 weeks postpartum (72.2 versus 57.6 mL/kg). All vascular volumes were significantly (P < .001) lower at 12 weeks postpartum compared to those seen during pregnancy in both subject groups. Hematologic indices of hematocrit ratio, hemoglobin concentration, red cell count, and plasma protein concentration were all greater (P < .001) at 12 weeks postpartum than during pregnancy. CONCLUSIONS: Physically active women possessed significantly greater vascular volumes than their sedentary counterparts. Although this difference was maintained throughout gestation as the active gravidas continued to exercise, there was no apparent effect on pregnancy outcome.
Adult↗
A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes.
OBJECTIVE: Our aim was to compare the value of amniotic fluid tests for the detection of microbial invasion of the amniotic cavity and in the prediction of the amniocentesis-to-delivery interval and neonatal complications in patients with preterm premature rupture of membranes. STUDY DESIGN: Amniotic fluid was obtained by transabdominal amniocentesis from 110 consecutive patients with preterm premature rupture of membranes. Fluid was cultured for aerobic and anaerobic bacteria, as well as mycoplasmas. Amniotic fluid analysis included a Gram stain examination, white blood cell count, and glucose and interleukin-6 determinations. Logistic regression and survival techniques (proportional hazards model) were used for statistical analysis. RESULTS: (1) The prevalence of positive amniotic fluid cultures in patients with preterm premature rupture of membranes was 38% (42/110); (2) patients with microbial invasion had a shorter amniocentesis-to-delivery interval and a higher neonatal complication rate than patients with negative cultures; (3) the most sensitive test for the detection of microbial invasion of the amniotic cavity was amniotic fluid interleukin-6 determinations (cutoff 7.9 ng/ml) (sensitivity: for IL-6 80.9%; for white blood cell count 57.1%; for glucose 57.1%; for Gram stain 23.8%; p < 0.05 for all comparisons); (4) the most specific test for the detection of microbial invasion was the Gram stain of amniotic fluid (specificity: for Gram stain 98.5%; for white blood cell count 77.9%; for interleukin-6 75%; for glucose 73.5%; p < 0.01 for all); (5) of all amniotic fluid tests, interleukin-6 determination was the only test that had significant clinical value in the prediction of the amniocentesis-to-delivery interval and neonatal complications. CONCLUSION: Interleukin-6 concentrations in amniotic fluid are a better predictor of microbial invasion of the amniotic cavity, amniocentesis-to-delivery interval and neonatal complications than the amniotic fluid Gram stain, glucose, or white blood cell count in patients with preterm premature rupture of membranes.
Amniocentesis↗
Effects of hydralazine on pregnant rats and their fetuses.
OBJECTIVE: We conducted this study to assess potential teratogenic or fetotoxic effects of in utero hydralazine exposure in the rat. STUDY DESIGN: Pregnant rats were treated with hydralazine (0, 15, or 30 mg/kg/day) by either gavage or subcutaneous injection during gestation days 8 through 19, inclusively. Surviving animals were killed, uterine contents examined, and fetuses evaluated by Wilson's method for teratologic examination. RESULTS: Oral administration did not affect maternal weight gain or fetal or placental weights. Subcutaneous administration decreased fetal and placental weights but only in dams given the highest dose subcutaneously; significantly increased maternal mortality and reduced maternal weight gain were also observed. There was no increased incidence of fetal anomalies in any group. CONCLUSION: Hydralazine does not have teratogenic or fetopathic effects when given to rats in dosages that are nontoxic to the mother.
Abnormalities, Drug-Induced↗
Transfer of maternally administered magnesium sulfate into the fetal compartment of the rat: assessment of amniotic fluid, blood, and brain concentrations.
OBJECTIVE: Our purpose was to determine whether parenteral magnesium sulfate crosses the rat placenta and enters the fetal brain. STUDY DESIGN: Twenty-eight pregnant female Long-Evans rats were divided into four groups, seven animals in each group. These groups included the following: single saline solution injection group evaluated after 20 minutes (control), single magnesium sulfate injection (270 mg/kg) evaluated after 20 minutes, and prolonged (2 and 4 hours) serum magnesium elevation (270 mg/kg loading and then 27 mg/kg every 20 minutes for maintenance). Each animal was killed, and maternal and fetal sera, amniotic fluid, and specific brain areas were analyzed for levels of magnesium. Statistical analysis included analysis of variance, multiple comparison procedure, and linear regression analysis. RESULTS: All three regimens of maternal subcutaneous magnesium sulfate resulted in significantly elevated maternal serum magnesium concentrations (p < 0.01). Fetal blood magnesium concentration rose from 3.9 +/- 0.3 to 4.9 +/- 0.1 mg/dl after 2 hours of continuous injections (p < 0.05), and to 5.3 +/- 0.0 mg/dl after 4 hours (p < 0.01). Amniotic fluid magnesium concentrations rose from 4.2 +/- 0.2 to 5.1 +/- 0.1 mg/dl after 4 hours (p < 0.05). Maternal blood magnesium concentrations were significantly correlated with amniotic fluid concentrations (r = 0.59, p < 0.01). Four hours of maternal magnesium sulfate treatment resulted in a 25% increase in magnesium concentrations in the fetal forebrain (38.3 +/- 2.3 to 47.9 +/- 3.5 mg/dl/gm, p < 0.05). No significant changes in magnesium concentrations were detected in hindbrain. CONCLUSION: Magnesium sulfate injected subcutaneously into rats crosses the placenta within 2 hours of sustained magnesium levels, enter the fetal blood-brain barrier, and concentrates in the forebrain.
Amniotic Fluid↗
Thrombosis and hormone replacement therapy in postmenopausal women.
OBJECTIVE: The effects of postmenopausal hormone replacement therapy on thrombosis remain controversial. We tested the hypothesis that estrogen or progesterone has no significant effect on thrombosis by means of newly developed markers of blood clotting, specifically prothrombin fragment 1 + 2, a marker of factor Xa generation, and thrombin-antithrombin III complex, a marker of thrombin generation. STUDY DESIGN: A prospective study that included 106 women, 68 postmenopausal women on hormone replacement therapy and 38 postmenopausal controls, was performed. Plasma levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex were measured by enzyme-linked immunosorbent assay. Multivariate analysis of the covariance was used for statistical analysis, controlling for patient's age because the hormone replacement therapy group was older. RESULTS: There were no statistically significant differences between the hormone replacement therapy and control groups in either of the clotting parameters measured. A comparison of the levels of prothrombin fragment 1 + 2 and thrombin-antithrombin III complex in patients receiving estrogen alone or estrogen plus progestin also revealed no differences. CONCLUSIONS: Current doses of postmenopausal hormone replacement therapy do not appear to enhance in vivo clotting. Thromboembolic complications among postmenopausal women receiving hormone replacement therapy may therefore be secondary to congenital or other acquired coagulation defects.
Adult↗
Prenatal diagnosis of spontaneous rupture of the fetal bladder with color Doppler ultrasonography.
Rupture of the fetal-neonatal bladder that results in urinary ascites has rarely been reported in the literature. In this report we present the first case of spontaneous rupture of the fetal bladder in which the diagnosis was made prenatally by means of color Doppler ultrasonography.
Adult↗
Fetal leg and femur/foot length ratio: a marker for trisomy 21.
OBJECTIVE: Our purpose was to determine whether the femur/foot length ratio is useful in the prenatal detection of trisomy 21. STUDY DESIGN: Direct necropsy measurements were analyzed on 436 midgestational fetuses (391 normal, 45 with trisomy 21). Necropsy leg/foot length ratio versus gestational age was found to be significantly different between normal fetuses and those with trisomy 21. On the basis of the necropsy data, 345 midgestational pregnancies were evaluated ultrasonographically for femur/foot length ratio versus gestation age to identify fetuses at risk for trisomy 21. RESULTS: A leg/foot length ratio versus gestation age < or = 2.3 correctly identified 84% of fetuses with trisomy 21 between 110 to 155 days gestation age at necropsy. An ultrasonographic femur/foot length ratio versus gestational age < or = 0.9 had an 18.3 odds ratio risk for trisomy 21 in our high-risk population and correctly identified 71% of fetuses with trisomy 21 (positive predictive value 0.24, negative predictive value 0.98). CONCLUSION: The femur/foot length ratio is an additional ultrasonographic marker for identification of fetuses at increased risk for trisomy 21.
Adult↗
Stimulation and inhibition of N-methyl-D-aspartate receptors in rats: developing a seizure model.
OBJECTIVE: The objective of this study was to develop an experimental rat hippocampal seizure model based on the stimulatory effects of N-methyl-D-aspartate and to determine the inhibitory effects of MK-801 on N-methyl-D-aspartate-induced seizures. STUDY DESIGN: Two separate experiments were performed. In the first experiment chemitrode-implanted rats were injected intracranially with increasing doses (5, 10, 20, and 30 micrograms) of N-methyl-D-aspartate into the hippocampus. Various electrophysiologic and behavioral parameters were examined to determine the dose required to reliably elicit hippocampal seizure activity without having toxic effects on the rats. In the second experiment rats were given an intraperitoneal injection of MK-801 (0.5 or 1 mg/kg), followed 20 minutes later by an intracranial injection of N-methyl-D-aspartate (20 or 30 micrograms). The ability of MK-801 to suppress N-methyl-D-aspartate-induced seizure activity was assessed in this experiment. RESULTS: Intrahippocampal injection of 20 micrograms of N-methyl-D-aspartate produced the shortest electrical seizure latency (193 +/- 72 seconds, p < 0.01). At this dose seizure was achieved in 80% (four of five of the animals, and the highest numbers of electrical seizures per animal were produced (2.2 +/- 0.8, p < 0.05). The group that received 30 micrograms of N-methyl-D-aspartate had a shorter latency, a longer duration of behavioral seizure and a higher number of behavioral seizures (p < 0.05). However, this group suffered a 60% (three of five) mortality rate. The addition of MK-801 significantly decreased the number of seizures per animal and the total seizure duration (p < 0.05). MK-801 also reduced the latency period. CONCLUSION: Intracranial injection of 20 micrograms of N-methyl-D-aspartate produced reliable hippocampal seizure activity without mortality. MK-801 at a dose of 1 mg/kg injected intraperitoneally had significant inhibitory effects on this seizure model.
Analysis of Variance↗
The relationship between spontaneous rupture of membranes, labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of prostaglandins and thromboxane B2 in term pregnancy.
OBJECTIVE: The purpose of this study was to examine the relationship between rupture of membranes, labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of eicosanoids in patients with spontaneous rupture of membranes at term. STUDY DESIGN: Amniotic fluid was retrieved by transabdominal amniocentesis from patients with rupture of membranes and patients with intact membranes at term. Studies to determine the microbial state of the amniotic cavity included culture for bacteria and mycoplasmas, Gram stain, amniotic fluid white blood cell count, and Limulus amebocyte lysate. Eicosanoids (prostaglandin E2, prostaglandin F2 alpha and its stable metabolite, 6-keto-prostaglandin F1 alpha, and thromboxane B2) were determined with sensitive and specific radioimmunoassays validated for human amniotic fluid. Statistical inference was conducted with analysis of variance and linear contrast. RESULTS: (1) Spontaneous rupture of membranes at term was associated with a significant increase in amniotic fluid concentrations of all eicosanoids measured in this study except 6-keto-prostaglandin F1 alpha. (2) Early labor in patients with rupture of membranes was associated with a significant increase in the amniotic fluid concentration of all eicosanoids. (3) A significant increase in amniotic fluid eicosanoids in women with microbial invasion of the amniotic cavity could not be documented. CONCLUSIONS: Whereas preterm labor in the absence of microbial invasion of the amniotic cavity is not associated with a significant increase in amniotic fluid concentrations of prostaglandins, a clear increase was documented in women with early labor after spontaneous rupture of membranes. These observations suggest that there are fundamental differences in the biochemistry of term and preterm parturition.
Amnion↗
The effects of indomethacin and terbutaline on human fetal umbilical artery velocimetry: a randomized, double-blind study.
OBJECTIVE: Our purpose was to study the effects of indomethacin and terbutaline on umbilical artery impedance as measured by the systolic/diastolic ratio. STUDY DESIGN: Normal, low-risk patients at 26 to 32 weeks' gestation were enrolled. A baseline evaluation of the umbilical artery systolic/diastolic ratio was performed. The patients were then randomized to one of three groups and received a coded capsule that contained either terbutaline (5 mg), indomethacin (50 mg), or placebo. Repeat evaluation of the umbilical artery systolic/diastolic ratio was performed 4 hours later. The ratios before and after administration of the medication were compared in the control and study groups. Analysis of variance and paired Student t test were applied. RESULTS: Fifteen patients received indomethacin, 14 placebo, and 12 terbutaline. Pretreatment and posttreatment systolic/diastolic ratios were 3.2 and 3.1 for the indomethacin group, 3.2 and 3.3 for the placebo group, 3.0 and 2.8 for the terbutaline group, respectively. The changes in the systolic/diastolic ratio in the indomethacin and terbutaline groups, as compared with the placebo group, were not found to be significant. CONCLUSION: Terbutaline and indomethacin do not have a significant effect on the human umbilical artery impedance as measured by the systolic/diastolic ratio.
Diastole↗
Central anticonvulsant effects of magnesium sulfate on N-methyl-D-aspartate-induced seizures.
OBJECTIVE: The objective of this study was to determine if magnesium sulfate's central anticonvulsant activity is effective against N-methyl-D-aspartate-induced seizures. STUDY DESIGN: In two separate experiments we investigated magnesium sulfate's ability to inhibit N-methyl-D-aspartate-induced hippocampal seizures in rats. In the first experiment magnesium sulfate was administered peripherally before an intracranial injection of 20 micrograms of N-methyl-D-aspartate. In the second experiment magnesium sulfate was injected intracranially concurrently with N-methyl-D-aspartate. The ability of magnesium sulfate to suppress N-methyl-D-aspartate-induced seizure activity under both conditions was assessed. RESULTS: Peripherally administered magnesium sulfate significantly increased the latency from the time of an N-methyl-D-aspartate injection to the first seizure both by acute injection and after 2 hours of sustained elevation of serum magnesium levels when compared with saline solution-injected controls (p < 0.01). The duration of the first seizure was also significantly reduced. Intracranially administered magnesium sulfate significantly (p < 0.01) increased the seizure latency period by 120%. Overall, central magnesium sulfate prevented seizure activity in 40% of the animals (p < 0.01). CONCLUSION: Magnesium sulfate has a central anticonvulsant action on N-methyl-D-aspartate-induced seizures in this rat model of hippocampal seizures.
Animals↗
Prenatal diagnosis of congenital megalourethra.
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Abnormalities, Multiple↗
Fetal hemoglobin quantitations using the Hemocue system are rapid and accurate.
OBJECTIVES: To determine whether hemoglobin quantitations using the Hemocue system, a rapid and portable hemoglobin photometer, on fetal blood obtained via funipuncture were accurate compared to the Coulter S-Plus IV. We also examined whether gestational age or extremes in hemoglobin levels significantly affected the accuracy of the Hemocue system. METHODS: We performed fetal hemoglobin quantitations using both systems on 58 specimens obtained between 18-38 weeks' gestation. Correlation between values by both systems was determined by linear regression analysis. The effects of gestational age and hemoglobin extremes on the accuracy of the Hemocue system were evaluated by stepwise regression. RESULTS: The mean Hemocue value was 12.0 +/- 2.4 g/dL (range 3.3-16.4); the mean Coulter value was 11.7 +/- 2.3 g/dL (range 3.6-16.2). The regression equation for Hemocue (y) versus Coulter (x) values was y = 0.72 + 0.97x; r = 0.94 (P < .0001). Neither gestational age nor hemoglobin extremes significantly affected the accuracy of the Hemocue system. CONCLUSION: The Hemocue system is rapid and accurate for fetal hemoglobin quantitation between 18-38 weeks' gestation regardless of extremes in gestational age or hemoglobin levels.
Evaluation Studies as Topic↗
Effects of maternal aerobic fitness on cardiorespiratory responses to exercise.
We hypothesized that aerobically fit women who continued to exercise throughout pregnancy would have enhanced cardiorespiratory responses to exercise. Physically active (N = 10) and sedentary (N = 6) subjects were compared during steady-state (15 min) semi-recumbent cycle exercise performed at a given heart rate (HR; 140 b.min-1) twice during pregnancy (25 wk, 36 wk) and 12 wk postpartum. Indirect calorimetry was used to measure volumes and fractional concentrations of expired gases. Cardiac output was estimated via CO2 rebreathing. Data were analyzed with repeated measures ANOVA. Caloric expenditure during exercise was significantly (P < 0.001) greater in the physically active (7.2 kcal.min-1) compared with sedentary (4.7 kcal.min-1) subjects. Alveolar ventilation and cardiac output responses to exercise were proportionally greater (P < 0.001) in the aerobically fit subjects. Ventilatory equivalents for O2 and physiological dead space/tidal volume ratios were significantly (P < 0.01) lower in the physically active subjects during exercise. In contrast, ratings of perceived exertion during exercise did not differ between subject groups. It appears that a physically active woman's enhanced cardiorespiratory responses to acute exercise are maintained during pregnancy if she continues her aerobic fitness program throughout gestation.
Adult↗