OBJECTIVE: Our goal was to evaluate the cerebral vasculature in postpartum normotensive and preeclamptic women. STUDY DESIGN: Nineteen previously preeclamptic women and 19 matched normotensive controls were studied at 6 weeks, and 8 preeclamptic women and 28 normotensive controls were studied at 12 weeks post partum. Systolic, diastolic, and mean velocities, as well as resistance and pulsatility indexes, of the middle cerebral, ophthalmic, and central retinal arteries were recorded. Data are presented as median and range. Statistical significance was set at p < 0.05. RESULTS: There were no differences in maternal age, parity, heart rate, mean arterial pressure, and proteinuria between the two groups at 6 and 12 weeks post partum. At 6 weeks post partum the preeclamptic group had higher ophthalmic artery diastolic velocity (9.0 cm/sec, 3.1 to 22.3, vs 5.4 cm/sec, 3.0 to 20.1; p = 0.008), ophthalmic artery mean velocity (6.0 cm/sec, 8.8 to 34.8, vs 12.5 cm/sec, 6.8 to 35.4; p = 0.03), and central retinal artery systolic velocity (10.0 cm/sec, 7.6 to 28.0, vs 8.4 cm/sec, 5.2 to 18.3; p = 0.02). The ophthalmic artery resistance index (0.72, 0.43 to 0.88, vs 0.79, 0.66 to 0.90; p = 0.03) and ophthalmic artery pulsatility index (1.56, 0.94 to 2.82, vs 2.03, vs 1.13 to 3.10; p = 0.04) were lower in the preeclamptic group. At 12 weeks post partum the preeclamptic group had elevated ophthalmic artery mean velocity (14.5 cm/sec, 7.9 to 20.2, vs 10.9 cm/sec, 5.5 to 15.4 p = 0.01), central retinal artery systolic velocity (11.1 cm/sec, 6.8 to 15.9, vs 8.5, 5.1 to 15.3; p = 0.02), and central retinal artery diastolic velocity (3.9 cm/sec, 1.2 to 5.2, vs 3.0, 1.4 to 5.8; p < 0.05). CONCLUSION: In the postpartum period preeclamptic women show persistently elevated central retinal artery systolic velocity, which suggests distal vasoconstriction.

Adolescent↗

PubMed1997

Comparison of intraocular pressure between normotensive and preeclamptic women in the peripartum period.

OBJECTIVE: Our purpose was to determine whether intraocular pressure differs between preeclamptic and normotensive women in the peripartum period. STUDY DESIGN: Eighteen preeclamptic (defined as blood pressure > 140/90 mm Hg and > or = 1+ proteinuria) and 18 normotensive women were studied. Intraocular pressure was determined with a handheld tonometer. Each intraocular pressure determination was obtained by repeatedly touching the cornea until signal averaging produced a single measurement with a variance < 5%. Right and left intraocular pressure, heart rate, and blood pressure were obtained intrapartum and 24 hours post partum with the patient in the seated, supine, and left lateral positions. Data are reported as mean +/- SD or median (range) as appropriate. Significance was set at p < 0.05. RESULTS: No differences existed in race, age, weight, gravidity, parity, cervical dilatation, and heart rate between the preeclamptic and normotensive groups. Gestational age was lower (39 [34 to 42] vs 41 [34 to 42] weeks, p = 0.003), and intrapartum mean arterial pressure (100.2 +/- 9.8 vs 81.0 +/- 8.3 mm Hg, p < 0.001) and degree of proteinuria (3 [1 to 4] vs 0, p < 0.001) were higher in the preeclamptic group. There was no effect of position or delivery on intraocular pressure in either group. Intraocular pressure was higher in the preeclamptic group in the intrapartum (18.8 +/- 3.0 vs 15.3 +/- 2.7 mm Hg, p < 0.001) and postpartum periods (20.2 +/- 4.5 vs 15.7 +/- 3.6 mm Hg, p = 0.002). CONCLUSION: Compared with normotensive women, preeclamptic women have increased intraocular pressure in the peripartum period.

Adult↗

PubMed1995

Comparison of the effects of meperidine and nalbuphine on intrapartum fetal heart rate tracings.

OBJECTIVE: To examine the effects of meperidine and nalbuphine on intrapartum fetal heart rate (FHR) tracings using computer analysis. METHODS: We studied 28 women with uncomplicated pregnancies in early labor at term with reactive FHR tracings. The women were randomized to receive either meperidine 50 mg or nalbuphine 10 mg intravenously on request. One-hour FHR recordings were obtained before and immediately after administration of the medications. RESULTS: There were no significant differences in the FHR characteristics of the two groups during the pre-treatment period. Nalbuphine significantly decreased the number of accelerations of 10 beats per minute (17 versus 4, P = .003) and 15 beats per minute (10 versus 1.5, P = .001), time spent in episodes of high variation (35.5 versus 10 minutes, P = .004), long-term variation (47 versus 29.8 milliseconds, P = .002), and short-term variation (8.4 versus 6.4 milliseconds, P = .03). Meperidine had no significant effect on any FHR characteristic. CONCLUSION: In the early intrapartum period of normal term pregnancies and at commonly used dosages, nalbuphine had a significant effect on FHR tracings, whereas meperidine had no effect, as determined by computer analysis.

Adolescent↗

PubMedDate not supplied

Atraumatic subdural hematoma associated with pre-eclampsia.

A patient with pre-eclampsia at 31.7 weeks' gestation developed focal neurologic signs. Computerized tomography revealed a large cranial subdural hematoma. A subdural hematoma should be considered in any pre-eclamptic patient demonstrating lateralizing neurologic symptoms. Despite adequate treatment, an atraumatic subdural hematoma associated with pre-eclampsia carries a poor maternal prognosis.

Adult↗

PubMedDate not supplied

Histopathologic effects of meconium on human umbilical artery and vein: in vitro study.

OBJECTIVE: To determine the histopathologic effects of meconium on human umbilical artery and vein. METHODS: Umbilical cords from six patients with uncomplicated, singleton, term gestations were obtained immediately after delivery. One centimeter segments from each cord were flushed, isolated, placed in either modified Krebs solution alone or modified Krebs solution with various concentrations (1%, 10%, or 25%) of fresh meconium, and then incubated at pH 7.2, temperature 37 degrees C, PCO2 50-55 mmHg, PO2 40-45 mmHg for 1, 6, 12, or 24 h. The specimens were then fixed, stained, and examined under light microscopy. RESULTS: Umbilical arteries exhibited focal vacuolation of the endothelium after exposure of the cord to meconium. Umbilical veins revealed: 1) endothelial loss proportionate to the meconium concentration at all intervals (P < 0.05), 2) increased density or focal absence of the internal elastic lamina, and 3) focal loss of myocyte nuclei. Rare nonpigmented macrophages and increased mast cells were identified in the Wharton's jelly. CONCLUSIONS: Exposure to meconium in vitro results in histopathologic changes in the umbilical artery and vein.

Cell Nucleus↗

PubMedDate not supplied

Effects of placental delivery method and intraoperative glove changing on postcesarean febrile morbidity.

This study was designed to evaluate the effects of the placental delivery methods and intraoperative glove changing on postcesarean febrile morbidity. In this randomized controlled trial, consenting patients were randomized to one of four management protocols: Group A (n = 26)--no glove change with manual placental delivery; Group B (n = 27)--no glove change with expressed placental delivery; Group C (n = 27)--glove change with manual placental delivery; and Group D (n = 28)--glove change with expressed placental delivery. Glove change was performed by removal of a second glove after delivery of the fetal head. Variables examined included febrile morbidity, endometritis, maximums and durations of elevated temperatures, as well as other demographic, intrapartum, and postpartum variables. Febrile morbidity and endometritis rates were not significantly different between the four groups. When the groups were combined so as to compare no glove change versus glove change (Groups A and B vs. C and D) and manual versus expressed placental delivery (Groups A and C vs. B and D), there were no significant differences in either febrile morbidity (relative risk: 0.7, 95% CI: 0.3-1.4 and relative risk: 1.4, 95% CI: 0.6-3.5) or endometritis (relative risk: 1.2, 95% CI: 0.5-2.8 and relative risk: 1.5, 95% CI: 0.6-3.6), respectively. There were no statistically significant differences in measures of postcesarean febrile morbidity based on placental delivery method or intraoperative glove change.

Cesarean Section↗

PubMedDate not supplied

A simple method to estimate volume for fetal intravascular transfusions.

We derived a constant termed the transfusion coefficient to simplify the estimation of the fetal intravascular transfusion volume. The product of the estimated fetal weight (g) and 0.02 (transfusion coefficient), estimates the transfusion volume (ml) required to increase the fetal hematocrit by approximately 10 percentage points. Our estimation was comparable to Mandelbrot's technique and better than Plecas' method for estimating fetal transfusion volumes. Utilizing the transfusion coefficient to estimate the intravascular transfusion volume for an anemic fetus is simple, rapid and accurate.

Adult↗