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Biomedical subjects

E L Capeless

Publications and source records attributed to E L Capeless.

At least 19 recordsLinked to original sources
PubMed1995

Detection of fetal HLA-DQa sequences in maternal blood: a gender-independent technique of fetal cell identification.

The objective of this study was to detect fetal HLA-DQa gene sequences in maternal blood. HLA-DQa genotypes of 70 pregnant women and their partners were determined for type A1. We specifically sought couples where the father, but not the mother, had genotype A1. In 12 women, maternal blood samples were flow-sorted. Candidate fetal cells were isolated and amplified by using PCR primers specific for a paternal HLA-DQa A1 allele. Fetal HLA-DQa A1 genotype was predicted from sorted cells; amniocytes or cheek swabs were used for confirmation. Six of twelve sorted samples had amplification products indicating the presence of the HLA-DQa A1 allele; 6/12 did not. Prediction of the fetal genotype was 100 per cent correct, as determined by subsequent amplification of amniocytes or cheek swabs. We conclude that paternally inherited uniquely fetal HLA-DQa gene sequences can be identified in maternal blood. This system permits the identification of fetal cells independent of fetal gender, and has the potential for non-invasive prenatal diagnosis of paternally inherited conditions.

Base Sequence↗
PubMed1995

Uterine artery Doppler velocimetry in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum alpha-fetoprotein levels.

OBJECTIVE: We hypothesized that in pregnancies complicated by unexplained elevations of maternal serum alpha-fetoprotein, second-trimester uterine artery Doppler findings would detect adverse obstetric outcomes. STUDY DESIGN: One hundred three subjects with unexplained elevations of maternal serum alpha-fetoprotein had uterine artery Doppler velocimetry studies performed at the time of targeted ultrasonographic examination (17 to 22 weeks). A resistance index > 95th percentile or the presence of a uterine notch was considered abnormal. Adverse outcomes included preeclampsia, preterm birth, low birth weight, intrauterine growth restriction, abruptio placentae, and fetal death. Statistical analysis was performed by Student t test, chi 2 analysis, and stepwise logistic regression analysis. RESULTS: An elevated uterine resistance index was associated with an increased relative risk for both preeclampsia (relative risk 41.82, 95% confidence interval 5.36 to 326.13) and low birth weight (relative risk 4.65, 95% confidence interval 1.90 to 11.39). A uterine artery notch was associated with an increased risk of preeclampsia (relative risk 52.22, 95% confidence interval 6.82 to 399.70), preterm birth (relative risk 3.21, 95% confidence interval 1.32 to 7.81), and low birth weight (relative risk 4.18, 95% confidence interval 1.64 to 10.66). When the presence of a uterine notch, vaginal bleeding, and level of maternal serum AFP were analyzed by stepwise logistic regression, the presence of a notch was found to be the only significant factor (odds ratio 6.95, 95% confidence interval 1.24 to 39.10) for the development of an adverse outcome. CONCLUSIONS: Abnormal uterine artery Doppler findings are associated with an increased frequency of adverse obstetric outcomes in women with unexplained elevated maternal serum AFP levels. Abnormal Doppler findings demonstrated high sensitivity for the development of preeclampsia but were less sensitive in predicting other outcomes. The presence of a uterine artery notch is a better independent predictor of adverse outcome than are early vaginal bleeding or maternal serum AFP level.

Adult↗
PubMed1992

Pregnancy loss and thrombosis with protein C deficiency.

OBJECTIVES: Protein C inhibits coagulation and promotes fibrinolysis. This study investigates the association between protein C deficiency and pregnancy loss, thrombosis in pregnancy, and thrombosis with oral contraception. STUDY DESIGN: Fifteen protein C--deficient patients and 37 controls from a single kindred were studied. An obstetric history was obtained by telephone. Data were analyzed by logistic regression, Fisher's exact test, and Student t test. RESULTS: Protein C--deficient women experienced a 33% pregnancy loss versus 19% in the controls (not significant). Thromboembolism during pregnancy in protein C--deficient women was 33% (45% in those not receiving prophylactic anticoagulation) versus 5% in controls (odds ratio 7.37, p = 0.026). Five of 12 protein C--deficient women using oral contraception developed thrombosis versus 0 of 33 controls. The risk of thrombosis for protein C--deficient women using oral contraception is increased (p < 0.001). CONCLUSIONS: Perinatal outcome is not statistically different with protein C deficiency. Protein C deficiency increases the risk of thrombosis during pregnancy and with oral contraception. Prophylactic heparin is suggested during pregnancy for protein C--deficient women with personal or family histories of thrombosis. Oral contraception is not advised.

Adult↗
PubMed1992

Hepatitis B surface antigen screening in a nonindigent population.

The recommendation for universal screening of all pregnant women for hepatitis B surface antigen (HBsAg) is based on data from publicly funded hospitals. We retrospectively reviewed screening results of 2,696 mothers who delivered between May 1989 and April 1990. Our population was 85% privately funded. Screening for HBsAg was positive in 0.07%, negative in 80.4% and not done in 19.6%. All positive screens would have been identified by screening only patients with recognized risk factors. We conclude that the sensitivity of identifiable risk factors to detect HBsAg carriers may be high in some populations. We speculate that universal screening in these populations is not cost efficient.

Carrier State↗
PubMed1992

Elevated maternal serum alpha-fetoprotein: association with placental sonolucencies, fetomaternal hemorrhage, vaginal bleeding, and pregnancy outcome in the absence of fetal anomalies.

Elevated maternal serum alpha-fetoprotein (MSAFP) levels have been associated with an increased incidence of both placental sonolucencies and pregnancy complications. We designed a prospective study to test the hypothesis that the presence of these sonolucencies or a positive maternal Kleihauer-Betke stain would be associated with an elevated risk of obstetric complications. We enrolled 95 women with singleton pregnancies, elevated MSAFP, and no evidence of fetal anomalies on second-trimester ultrasound evaluation. Placental sonolucencies were documented at the time of ultrasound examination, and a maternal Kleihauer-Betke stain for fetal cells was obtained on the same day. Complications of pregnancy included fetal growth retardation, preterm delivery, late vaginal bleeding (at or after the 20th week of gestation), and fetal death. Women with elevated MSAFP had an increased incidence of placental sonolucencies, positive maternal Kleihauer-Betke stains, first-trimester vaginal bleeding, late vaginal bleeding, preterm delivery, fetal growth retardation, and fetal death compared with controls. Thirty-nine of 95 women with elevated MSAFP (41.1%) had at least one complication. In women with elevated levels, neither the presence of placental sonolucencies nor a positive Kleihauer-Betke stain correlated with first-trimester vaginal bleeding, the MSAFP level, or an increased risk of pregnancy complications. First-trimester vaginal bleeding was associated with an increased risk of preterm delivery in subjects with elevated MSAFP.

Adult↗
PubMed1992

Elevated maternal serum alpha-fetoprotein levels and maternal risk factors. Their association with pregnancy complications.

Maternal serum alpha-fetoprotein (MS-AFP) screening programs identify a population of pregnant women with elevated MS-AFP values. When the levels are unassociated with a fetal anomaly, those women have a high incidence of pregnancy complications. Such patients were compared to a population with normal MS-AFP values to determine the incidence of historical risk factors and to ascertain if their presence affected the rate of pregnancy complications. A total of 358 patients were followed prospectively, 23 with elevated MS-AFP levels and 335 with normal levels (control group). Historical risk factors were more frequent in the patients with elevated MS-AFP levels. There was a fourfold increase in the rate of pregnancy complications when a patient had both risk factors and elevated MS-AFP levels as compared with elevated MS-AFP levels alone. In the control group, patients with known risk factors experienced twice the incidence of pregnancy complications as did patients with no risk factors. Using multiple logistic regression analysis, elevated MS-AFP levels were shown to be an independent variable in the risk assessment. The results of this study have wide application in the counseling and follow-up of patients identified by MS-AFP screening programs.

Female↗
PubMed1991

The changing glycemic response to exercise during pregnancy.

This study was designed to test the hypothesis that pregnancy reverses the nonpregnant hyperglycemic response to sustained exercise. Serial data were obtained from 75 exercising women. Before pregnancy, exercise produced an intensity-dependent increase in blood glucose that averaged 1.5 mmol/L at high intensities. By the eighth week this response was blunted and blood glucose increased only when exercise intensity exceeded 80% of maximum. At 15 weeks this progressed and was not associated with a change in either the insulin or catecholamine response. By the twenty-third week exercise produced a decrease in blood glucose that was no longer related to exercise intensity. We conclude that the hypothesis is correct and speculate that the early change in the response is related to decreased hepatic glucose release coupled with increased glucose oxidation. In late pregnancy this is probably accentuated by fetoplacental demands.

Adult↗
PubMed1991

When do cardiovascular parameters return to their preconception values?

To determine if the postpartum period is reflective of a woman's cardiovascular status before pregnancy, we performed serial studies of 13 women before conception and at 6 and 12 weeks post partum. All pregnancies were singleton without hypertensive complications. Cardiac output, stroke volume, and end-diastolic volume were calculated with M-mode echocardiography from the left ventricular dimensions with subjects in the left lateral position. Systemic vascular resistance was calculated from cardiac output and simultaneous measurements of blood pressure. Stroke volume and end-diastolic volume remained consistently elevated over preconception values at 6 and 12 weeks. Systemic vascular resistance remained decreased, compared with baseline, at 12 weeks. Thus cardiovascular parameters had not returned to the preconception baseline, and previous studies that have used this time period for comparison have underestimated the contribution of stroke volume to the total change in cardiac output during pregnancy.

Adult↗
PubMed1990

Neonatal morphometrics after endurance exercise during pregnancy.

This study was designed to test the hypothesis that continuation of a regular running and/or aerobics program during late pregnancy at or above 50% of preconceptional levels limits fetal growth. Accordingly, detailed neonatal morphometric data were gathered in the offspring of two groups: 77 well-conditioned recreational runners and aerobic dancers who were delivered at term after continuing their exercise regimen at or above 50% of the preconceptional level throughout pregnancy and 55 matched controls. Daily exercise performance was quantitated before conception and throughout pregnancy. Significant reductions in birth weight (-310 gm), birth weight percentile (-20), ponderal index (-0.24), its percentile (-30), and the fetoplacental weight ratio (-0.7) were seen in the offspring of the exercise group whereas crown-heel length (51.4 cm) and head circumference (35.0) were similar in the two groups. Reductions in two-site skin-fold thickness (-1.5 mm), skin-fold percentile (-30), calculated percent body fat (-5.0%), and fat mass (-220 gm) in the offspring of the exercise group confirmed the asymmetric pattern of growth restriction and indicated that approximately 70% of the difference in birth weight could be explained by the difference in neonatal fat mass. In runners, the relative level of exercise performance in the last 5 months of pregnancy explained 40% of the variability in birth weight over an 1100 gm birth weight range. We conclude that continuation of a regular aerobic or running program at or above a minimal training level during late pregnancy results in an asymmetric pattern of growth restriction that primarily impacts on neonatal fat mass.

Adult↗
PubMed1990

Fetomaternal bleeding as a cause of recurrent fetal morbidity and mortality.

A woman had fetomaternal bleeding of unknown cause during at least three of five pregnancies. Each event was associated with significant fetal morbidity or mortality. Although fetomaternal bleeding has been reported as a cause of unexplained fetal death, its occurrence in subsequent pregnancies has not been described previously.

Adult↗
PubMed1990

Successful pregnancy outcome in association with lipoatrophic diabetes mellitus.

Lipoatrophic diabetes mellitus is a rare syndrome characterized by lipoatrophy and insulin-resistant diabetes mellitus. Partial lipodystrophy without clinical diabetes mellitus has been associated with intrauterine growth retardation and fetal death. We report successful pregnancy outcomes in two women with lipoatrophic diabetes mellitus.

Adult↗
PubMed1989

Cardiovascular changes in early phase of pregnancy.

To assess the magnitude and timing of cardiovascular changes in pregnancy, eight subjects were serially studied before conception and at 8, 16, and 24 weeks' gestation. With the use of M-mode echocardiography, cardiac output, ejection fraction, stroke volume, and end-diastolic volume were calculated from left ventricular dimensions with subjects in the left lateral position. Systemic vascular resistance was calculated with the use of cardiac output and simultaneously obtained measurements of arterial pressure. Cardiac output increased 1 L/min at 8 weeks' gestation, which represented greater than 50% of the total change seen. Cardiac output increased primarily because of stroke volume rather than heart rate. By 8 weeks' gestation, systemic vascular resistance had fallen to 70% of its preconceptional value. Thus when subjects are studied before conception and during the early phase of pregnancy, the majority of the pregnancy-induced changes in these parameters occur during the embryonic period.

Adult↗
PubMed1989

Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal-fetal weight gain and twin pregnancy.

Thirty women who were seen at our institution between 1984 and 1988 for pruritic urticarial papules and plaques of pregnancy (PUPPP) were retrospectively evaluated and interviewed. We found a significantly increased maternal weight gain and newborn birth weight in patients with PUPPP, compared with age and parity-matched controls. The average weight gain during pregnancy was 18.1 +/- 0.9 (SEM) kg for the patients with PUPPP (excluding twin gestations) and 14.6 +/- 1.0 kg for the controls. The mean newborn birth weight was 3.6 +/- 0.09 kg for the PUPPP group and 3.3 +/- 0.08 kg for the control group. There were three twin pregnancies (10%), compared with the twin gestation rate at our institution of 1.6%. Therefore, based on our findings of an increased maternal weight gain and neonatal birth weight, an increased twin rate, and an abdominal eruption that occurs in primigravidas in their third trimester of pregnancy, we suggest that abdominal distention or a reaction to it may play a role in the development of PUPPP.

Birth Weight↗
PubMed1987

Management of preterm premature rupture of membranes: lack of a national consensus.

A questionnaire concerning the management of women with preterm premature rupture of membranes was sent to the members of the Society of Perinatal Obstetricians. Expectant management was recommended by 97% of the respondents. There was no consensus about the role and frequency of steroids, blood work, ultrasound examination, and fetal monitoring in the follow-up of these patients.

Betamethasone↗
PubMed1985

A vaginal delivery protocol for the term breech infant utilizing ball pelvimetry.

Ball pelvimetry has been utilized at the Medical Center Hospital of Vermont to evaluate infants with breech presentation for vaginal delivery. That technique provided measurements of both the fetal head volume and maternal pelvic capacity so that relative fetomaternal relationships could be established. Between January 1979 and December 1981, 107 patients in spontaneous labor with term pregnancy were evaluated with the protocol. Inadequate pelvimetry and hyperextension of the fetal head occurred in 21 patients (20%). Of the 86 patients who were allowed to labor, 51 (59%) had a vaginal delivery. The total cesarean section rate was 52%. Vaginal delivery in our highly selected patient population did not increase neonatal morbidity. There were no neonatal deaths.

Adolescent↗
PubMed1984

Glycohemoglobin determinations in pregnant diabetic patients.

Glycohemoglobins (GH), minor variants of hemoglobin A, are elevated in patients with diabetes mellitus. We examined the clinical usefulness of GH levels in human pregnancy. There was no correlation between GH levels and gestational age or neonatal birth weight. Insulin-dependent diabetics had higher GH levels than did normal controls (greater than or equal to 33 weeks' gestation). There was a significant correlation between fasting plasma glucose concentration and GH levels in insulin-dependent diabetics, especially when the former was determined six to 12 weeks before GH determination. Because of the wide scatter of data and the a posteriori relationship, however, we were unable to use this information at the clinical level.

Birth Weight↗