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Biomedical subjects

Dev Maulik

Publications and source records attributed to Dev Maulik.

At least 19 recordsLinked to original sources
PubMed2006

United States multicenter clinical usage study of the STAN 21 electronic fetal monitoring system.

OBJECTIVE: The fetal electrocardiogram system for electronic fetal monitoring (EFM) (STAN S21, Neoventa Medical, Moelndal, Sweden) has led to improved perinatal outcomes in other countries. We aimed to assess the ability of United States (US) obstetricians to use this system appropriately for intrapartum care. STUDY DESIGN: A prospective nonrandomized trial was conducted in 6 sites. Enrollment required a singleton vertex fetus, >36 weeks' gestation, with indications for direct fetal monitoring during first stage of labor. Appropriate use was measured by negative predictive value (NPV) of nonintervention for fetuses with nonreassuring fetal heart rate (FHR) patterns, normal STAN readings, and normal neonatal outcomes with umbilical cord arterial pH >7.12; and percent agreement (PA) for intervention decisions with 3 STAN experts who conducted retrospective case reviews blinded to outcome. RESULTS: Five hundred and thirty patients were enrolled. An NPV of 95.2% was achieved while PA between investigators and STAN experts was 84%, and 90%, for intervention and nonintervention, respectively. No fetus with metabolic acidosis requiring intervention was missed by US clinicians. CONCLUSION: US clinicians used the STAN system appropriately in a manner similar to that of experienced STAN users.

Acidosis↗
PubMed2006

Fetal growth compromise: definitions, standards, and classification.

Fetal growth compromise is mostly defined by gestational age specific threshold value of birth weight or ultrasonically estimated fetal weight. The most frequently used threshold is the 10th centile. However, this approach can not differentiate fetal constitutional smallness from fetal growth failure. The most common descriptor terms are fetal growth restriction (FGR), intrauterine growth restriction and small for gestational age. It is recommended to restrict the use of the first two terms to prenatal assessment of growth and the last term to assessment of the birth weight. Growth reference charts are affected by physiological and methodological variables. There is controversy on whether the reference charts should be customized by multiple variables or inclusive of the whole population. Symmetric FGR is more common and has better outcome than asymmetric FGR. However, such a classification may not be clinically relevant.

Birth Weight↗
PubMed2006

Fetal growth restriction: pathogenic mechanisms.

Complex genetic and environmental mechanisms of maternal, fetal and placental origin regulate fetal growth and may contribute to fetal growth restriction (FGR). The somatotrophic regulatory factors include IGF-I, IGF-II, the IGF binding proteins (IGFBP) 1-6, IGF receptors 1 and 2, and the IGFBP specific proteases. Abnormal remodeling of utero-placental arteries and abnormal fetal-placental angiogenesis has also been implicated in FGR. The underlying molecular mediators include vascular endothelial growth factor (VEGF), placental growth factor (PlGF), VEGF receptors, VEGF binding proteins, and numerous other agents working through multiple pathways many of which still remain unknown. Expression of these major angiogenic factors appears to be regulated by local oxygen partial pressure. Future investigations may resolve many of these issues not only adding to the clarity of our understanding of the mechanisms of growth restriction but also improving clinical management.

Female↗
PubMed2006

Fetal growth restriction: the etiology.

Fetal growth restriction (FGR) is etiologically associated with various maternal, fetal and placental factors, although such an association may not be present in many cases. Maternal factors include hypertensive diseases, autoimmune disorders, certain medications, severe malnutrition, and maternal lifestyle including smoking, alcohol and cocaine use. Fetal etiologies include aneuploidy, malformations, syndromes related to abnormal genomic imprinting, perinatal viral or protozoan infections, preterm birth, and multiple gestation. Placental factors may involve many conditions including anatomical, vascular, chromosomal and morphological abnormalities. Better understanding of these etiologic conditions may lead to improved prediction, prevention and management of FGR.

Aneuploidy↗
PubMed2006

Prenatal therapy for fetal growth restriction.

The choice of therapy for fetal growth restriction (FGR) depends on the nature of the insult that led to the development of FGR. Many etiologic factors are either not amenable to therapy or fetal growth has not been improved by treatments that benefit the mother. Many therapeutic approaches have been used to improve fetal condition. None of the approaches have been of value in a consistent manner. We present the numerous approaches, and their rationale for their use, that have been tried to treat the growth impaired fetus. The evidence from the randomized clinical trials is summarized and their conclusions given.

Adrenergic beta-Agonists↗
PubMed2006

Management of fetal growth restriction: an evidence-based approach.

This review provides an evidence-based approach to the management of fetal growth restriction (FGR). The management consists of the following components: appropriate fetal surveillance, timely intervention, and selective etiological management. Umbilical arterial (UA) Doppler sonography is the primary test. Supplementary tests include nonstress test (NST), amniotic fluid assessment, biophysical profile (BPP), and selective venous Doppler sonography. Ominous signs include UA absent or reverse end-diastolic flow, non-assuring NST, low BPP, and abnormal fetal venous flow patterns. An evidence-based clinical management guideline is included and individualization of care is recommended.

Amniotic Fluid↗
PubMed2005

Effect of post-hypoxic MgSO(4) administration in utero on Ca(2+)-influx and Ca(2+)/calmodulin kinase IV activity in cortical neuronal nuclei.

Previously we have demonstrated that in utero hypoxia results in increased nuclear Ca(2+)-influx and increased CaM kinase IV activity in neuronal nuclei of the guinea pig fetus. The present study tests the hypothesis that maternal treatment with magnesium sulfate (MgSO(4)) following in utero hypoxia will attenuate the hypoxia-induced increase in Ca(2+)-influx and CaM kinase IV activity in neuronal nuclei of the fetal guinea pig brain during recovery. Pregnant guinea pigs at 60 days of gestation were divided into four groups: normoxic (Nx=5), hypoxic (Hx, n=4), untreated post-hypoxic 24h recovery (Rec, n=8) and Mg(2+)-treated post-hypoxic 24h recovery (Mg(2+)-Rec, n=8). Maternal hypoxia was induced by decreasing FiO(2) to 8% for 1h. Recovery groups received either saline or 300 mg/kg MgSO(4) (i.p.) followed by 100mg/kg/h i.p. for 4h. Fetal cerebral tissue hypoxia was documented by ATP and phosphcreatine (PCr) levels. Neuronal nuclei were isolated and nuclear Ca(2+)-influx as well as CaM kinase activity was determined. Nuclear Ca(2+) influx (pmol/mg protein) was 4.84+/-0.83 in Nx, 12.50+/-2.97 (p<0.05) in Hx, 7.83+/-1.78 in Rec group (p<0.05 versus Nx and Hx) and 5.02+/-1.77 in Mg(2+)-Rec group (p<0.05 versus Rec group, p<0.05 versus Hx, p=NS versus Nx). CaM kinase IV activity (pmol/mg protein/min) was 1197+/-62 in Nx, 2524+/-132 (p<0.05 versus Nx) in Hx, 1830+/-141 (p<0.05 versus Nx and Hx) in Rec and 1938+/-118 in Mg(2+)-Rec group (p<0.05 versus Hx and Nx, p=n.s. versus Rec). The data show that MgSO(4) administration following in utero hypoxia prevents hypoxia-induced increase in neuronal nuclear Ca(2+)-influx but has no effect on CaM kinase activity in the guinea pig fetus during recovery. We conclude that post-hypoxic administration of Mg(2+) prevents hypoxia-induced modification of neuronal nuclear membrane function.

Animals↗
PubMed2005

Computer analysis of three-dimensional power angiography images of foetal cerebral, lung and placental circulation in normal and high-risk pregnancy.

Three-dimensional (3-D) ultrasound (US) has greatly improved evaluation of organ circulation. The aim of this study was to explore the possible use of this new technique in normal and high-risk pregnancies. Fetal brain, lung and placenta 3-D power Doppler signal intensity were recorded in 115 normal singleton pregnancies (24 to 42 weeks gestation) and in 67 high-risk pregnancies. Mean image pixel signal intensity was calculated for each organ and a brain-lung ratio. In normal pregnancy, placental and lung signal intensity increased until 33, with a rapid decrease after 38, weeks of gestation. Fetal cerebral signal intensity increased with gestational age. Placental and fetal lung signal intensity was significantly lower in high-risk pregnancies than in the control group, with increased fetal brain and brain-lung ratios. The present results suggest a reduction of placental perfusion after 38 weeks of gestation in normal pregnancy, with redistribution of fetal circulation. Lung signal intensity increased abruptly at 32 weeks of gestation, which might reflect lung maturity. The new method showed signs of centralization of fetal circulation at the end of gestation. The results might suggest a possible clinical use for fetal surveillance in high-risk pregnancies.

Brain↗
PubMed2005

Massive luteinized follicular cyst of pregnancy.

BACKGROUND: A large luteinized follicular cyst can rupture or twist during pregnancy. However, in the absence of those complications a simple ovarian cyst can often be managed conservatively, provided that sonographic evaluation of the cyst is benign. Rapid growth of a simple follicular cyst is rare but may occasionally complicate pregnancy. CASE: A 25-year-old primigravida had a simple-appearing adnexal mass detected by sonogram early in pregnancy. She was followed with serial sonograms. Because of the clear sonolucent appearance of the mass and the patient's preference, a conservative management was elected. The cyst grew in size as her pregnancy progressed, became symptomatic, and necessitated surgical intervention. Cystectomy and cesarean delivery at 36+ weeks relieved the symptoms and achieved delivery of a healthy infant. CONCLUSION: Solitary luteinized follicular cysts of pregnancy have the potential to grow to a very large size and create complications related to their size alone. Conservative management of simple adnexal cysts in pregnancy, based on their sonographic appearance, can avoid risks of abdominal surgery in the second trimester of pregnancy, but in the third trimester, a large cyst can create significant complications requiring surgical intervention.

Adult↗
PubMed2004

Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries.

OBJECTIVE: To estimate the differences in immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. METHODS: We conducted a medical record review of all forceps and vacuum-assisted deliveries that occurred from January 1, 1998, to August 30, 1999, at Winthrop-University Hospital. Maternal demographics and delivery characteristics were recorded. Maternal outcomes, such as use of episiotomy and presence of lacerations, were studied. Neonatal outcomes evaluated were Apgar scores, neonatal intensive care unit admissions, cephalohematomas, instrument marks and bruising, and caput and molding. RESULTS: Of 508 operative vaginal deliveries, 200 were forceps and 308 were vacuum assisted. Forceps were used more often than vacuum for prolonged second stage of labor (P =.001). There was a higher rate of epidural (P =.02) and pudendal (P <.001) anesthesia, episiotomies (P =.01), maternal third- and fourth-degree perineal (P <.001) and vaginal lacerations (P =.004) with the use of forceps, whereas periurethral lacerations were more common in vacuum-assisted (P =.026) deliveries. More instrument marks and bruising (P <.001) were found in the neonates delivered by forceps, whereas there was a greater incidence of cephalohematomas (P =.03) and caput and molding (P <.001) in the neonates delivered with vacuum. Multivariable logistic regression analysis showed that forceps use was associated with an increase in major perineal and vaginal tears (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.27, 2.69; P =.001), an increase in instrument marks and bruising (OR 4.63; 95% CI 2.90, 7.41; P <.001) and a decrease in cephalohematomas (OR 0.49; 95% CI 0.29, 0.83; P =.007) compared with the vacuum. CONCLUSIONS: Maternal injuries are more common with the use of forceps. Neonates delivered with forceps have more facial injuries, whereas neonates delivered with vacuum have more cephalohematomas. LEVEL OF EVIDENCE: II-3

Adult↗
PubMed2003

The usefulness of the TDx/TDxFLx fetal lung maturity II assay in the initial evaluation of fetal lung maturity.

OBJECTIVE: This study was undertaken to evaluate the usefulness of the TDx/TDxFLx Fetal Lung Maturity II (FLM II) assay (Abbot Laboratories, Abbot Park, Ill) in the initial evaluation of fetal lung maturity. STUDY DESIGN: One hundred twenty-seven women who underwent amniotic fluid collection through amniocentesis or vaginal pool for fetal lung maturity studies were evaluated for inclusion. The uncontaminated amniotic fluid specimens were analyzed within 24 hours with the use of the TDx/TDxFLx FLM II assay with values 55 mg/g or greater considered mature, values between 40 and 54 mg/g considered intermediate, and values 39 mg/g or less considered immature. Eighty-two women with singleton gestations who were delivered within 72 hours were included in the final analysis. We compared the TDX/TDxFLx FLM II test with the presence of neonatal respiratory distress syndrome (RDS). RESULTS: Seven of the 82 (8.5%) neonates had RDS develop. None of the 60 neonates with mature values had RDS develop. Two of 10 (20%) neonates with intermediate values and 5 of 12 (42%) neonates with immature values had RDS develop. With the use of a cutoff value of 55 mg/g, the TDx/TDxFLx FLM II assay had sensitivity and a negative predictive value of 100%, a specificity of 80%, and a positive predictive value of 31.8%. CONCLUSION: The TDx/TDxFLx FLM II assay is a useful tool in determining fetal lung maturity by using a cutoff value of 55 mg/g.

Adult↗