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Biomedical subjects

I Z Mackenzie

Publications and source records attributed to I Z Mackenzie.

34 records · Page 2Linked to original sources
PubMed1989

Production of additional atypical alloantibodies in Rh(D)-sensitized pregnancies managed by intrauterine investigation methods.

The production of additional atypical alloantibodies by previously Rh(D)-alloimmunized antenatal patients can complicate the clinical management of both mother and fetus. The relative risks of stimulating additional antibodies following the use of intrauterine investigation methods currently used for the management of haemolytic disease of the newborn have been assessed. A significantly (P less than 0.05, X2) greater number of additional antibodies were detected during pregnancy in the group of pregnancies managed by intrauterine transfusion (IUT) (3/29) than in those managed without recourse to intrauterine investigation (0/50), although one of the patients in the IUT group produced a further antibody following a fetal blood sample but before an IUT had been carried out. The number of additional antibodies detected post-delivery was significantly greater (P less than 0.02) in pregnancies managed by intrauterine transfusion (2/10) than in those managed by fetal haematocrit determination alone (0/28).

Blood Specimen Collection↗
PubMed1987

In-utero intravascular transfusion of the fetus for the management of severe Rhesus isoimmunization--a reappraisal.

Ten fetuses, severely affected by Rhesus (D) haemolytic disease, received one to three intravascular blood transfusions at between 18 and 30 weeks gestation, with the use of fetoscopically guided needles into one of the umbilical cord vessels. Although the technique was successfully accomplished in all cases, the fetal response to the procedure was varied. Only two fetuses survived beyond the neonatal period, and one child subsequently died principally because of the problems resulting from premature delivery. The reason for the low rate of survival has been explored and the continued use of the method described is now questioned.

Blood Transfusion, Intrauterine↗
PubMed1987

Progesterone inhibition in mid-trimester termination of pregnancy: physiological and clinical effects.

A double-blind, placebo controlled clinical trial was conducted to assess the clinical and physiological effects of 'epostane', a progesterone synthesis inhibitor, in mid-trimester prostaglandin termination of pregnancy. Mean peripheral progesterone levels had fallen by 74% after 72 h in the patients treated wtih epostane. The mean induction-abortion interval in the treatment group was 490 (SD 271) min, compared with 1432 (SD 640) min in the control group. Intrauterine pressure recording demonstrated increased sensitivity to prostaglandin E2 after epostane treatment but no change in oxytocin sensitivity. The clinical implications of facilitated induction of abortion are discussed.

Abortifacient Agents↗
PubMed1985

The metabolic and endocrine milieu of the human fetus at 18-21 weeks of gestation. II. Blood glucose, lactate, pyruvate and ketone body concentrations.

Blood levels of glucose, lactate, pyruvate and total ketone bodies were measured in 16 conscious mothers and their minimally stressed fetuses at 18-21 weeks gestation. Blood samples were taken from the maternal antecubital vein and from the fetal umbilical vein and artery during fetoscopy prior to termination of pregnancy. The mean concentrations of blood glucose, lactate and pyruvate were similar in maternal and fetal venous blood; no significant difference was found between the fetal umbilical artery and vein concentrations. Maternal total blood ketone body levels were significantly higher than fetal levels with no detectable umbilical venous arterial concentration difference. There was a significant inverse relationship between the umbilical artery levels and the umbilical venous-arterial concentration differences for blood glucose and lactate.

Blood Glucose↗
PubMed1985

The metabolic and endocrine milieu of the human fetus and mother at 18-21 weeks of gestation. I. Plasma amino acid concentrations.

Plasma levels of 17 amino acids were measured in 10 conscious mothers and their minimally stressed fetuses (mean body weight 302 g) at 18-21 wk gestation. Simultaneous blood samples were taken from the maternal antecubital vein, and from the fetal umbilical vein and artery by fetoscopy prior to termination of pregnancy. The mean concentrations of all amino acids were significantly higher in the fetal (2.26 mmol/liter) than in the maternal (0.96 mmol/liter) circulation, the total molar concentration of amino acids was 2.4 times greater in fetal than in maternal plasma. There was a significant positive relationship between maternal and fetal levels for most amino acids; the mean umbilical concentration difference was significantly positive for glycine, alanine, isoleucine, leucine, phenylalanine, and histidine.

Abortion, Induced↗
PubMed1978

Very early abortion by prostaglandins.

309 women whose menstruation was delayed by 3-35 days were treated with intrauterine or vaginal prostaglandins. Of 275 confirmed pregnancies, 229 were successfully terminated without further abortifacient therapy. A successful outcome was often associated with episodes of vomiting, diarrhoea, and uterine cramps in the 24 hours after prostaglandin administration, but the incidence was related to prostaglandin dosage and gastrointestinal side-effects were more common after vaginal administration. The best results were achieved by the analogue 16:16 dimethyl P.G.E2 as a vaginal pessary. 14 patients (6.1%) required uterine curettage for escessive or prolonged bleeding, while 2 patients required blood transfusion. One patient, who had an intrauterine contraceptive device left in situ during treatment, developed acute pelvic sepsis. No deleterious side-effects occurred in 34 patients who were subsequently proven not to be pregnant at the time of treatment. Treatment by intrauterine or vaginal prostaglandins offers promise as a method of pregnancy termination which avoids much of the physical and emotional trauma associated with surgical termination, and has the advantage of not requiring hospital admission in the majority of cases. The present study shows the safety of the method, and its potential as a self-administration technique.

Abortifacient Agents, Nonsteroidal↗
PubMed1978

The influence of pre-induction vaginal prostaglandin E2 gel upon subsequent labour.

Eight hundred and three patients with singleton viable pregnancies and fetal cephalic presentation were given prostaglandin E2 in viscous gel by intravaginal instillation the evening before planned surgical induction. When the cervix was 'ripe', surgical induction was avoided in 65.9 per cent of primigravidae and 87.5 per cent of multigravidae; the administration of epidural analgesia was less frequent, the rate of spontaneous vaginal delivery greater, the Caesarean section rate lower, and the state of the newborn at delivery better than in those patients who required surgical induction. Side effects attributable to the prostaglandin gel were rare as were complications.

Administration, Topical↗
PubMed1977

Prostaglandin-induced abortion and outcome of subsequent pregnancies: a prospective controlled study.

We analysed a prospective series of 204 pregnancies occurring in 168 women after a prostaglandin-induced abortion. The mean (+/-standard error of mean) interval between abortion and first subsequent conception was 10.4 +/- 0.6 months; no patient reported secondary subfertility.Fifty-five of the subsequent pregnancies were terminated, 23 during the second trimester, again using prostaglandins. Of the 149 pregnancies not terminated, 127 were delivered at term, and 19 spontaneously aborted, seven during the second trimester; there was one missed abortion and two ectopic pregnancies. Morbidity in the 127 term pregnancies was infrequent; spontaneous preterm labour occurred in three patients, and four singleton infants weighed less than 2500 g at birth. There was no apparent association between morbidity in the subsequent pregnancies and the period of gestation at the time of the previous abortion, route of prostaglandin administration, or need for post-abortion curettage.The results obtained overall were very similar to a control group of 612 women consecutively admitted for delivery or abortion to the Oxford obstetrical and gynaecological units. There was, however, an increased incidence of spontaneous abortion and placenta praevia after prostaglandin-induced abortion, and the multigravidae in that group had a longer average duration of labour than the control group. Sixty-five per cent of the post-abortion pregnancies were unplanned compared with 36% of the control group.

Abortion, Induced↗
PubMed1977

The kinetics of extraamniotically injected prostaglandins to induce midtrimester abortion.

In an attempt to improve the extraamniotic administration of prostaglandins in effecting abortion, the movement of injected prostaglandins in a high or low viscosity medium has been observed by radiological studies and radioimmunoassy of PGE and PGFalpha in amniotic fluid and maternal plasma in association with intrauterine tocographic responses. Results obtained suggest that the immediate response by the uterus is a reflection of the speed of absorption of prostaglandins from the chorio-decidual space and that this influences the outcome in inducing abortion within 24 hours. By giving the prostaglandins in a viscous medium a slower release of prostaglandins was produced in most cases, which probably accounts for the greater efficacy obtained using single injections of prostaglandins in this vehicle compared with normal saline.

Abortion, Induced↗
PubMed1976

Extra-amniotic 15 (S)-15 methyl PGF2alpha to induce abortion: a study of three administration schedules.

Abortion was induced in 60 patients between 8 and 18 weeks gestation using 15(S)-15 methyl PGF2alpha in one of three extra-amniotic administration schedules: 1.0 mg in viscous medium (Tylose), 1 mg in viscous medium (Hyskon) or 0.5 mg in non-viscous medium repeated at 12 hours. Eighty per cent of patients aborted within 24 hours in each group. The overall mean induction-abortion interval (+/- S.E.) was 17.6 +/- 2.0: there was no significant difference between the three groups. Twenty patients treated with 1.0 mg in viscous medium had the catheter removed immediately following the prostaglandin injection and the success rate was not significantly altered. Gastro-intestinal side effects (vomiting in 50%, diarrhoea in 32.5%) were more frequent in the patients treated with the larger dose though the difference was not statistically significant. No significant haematological or biochemical changes were detected during the 24 hours following the start of treatment in 24 patients investigated. Thirty seven of the 60 patients (61.5%) aborted completely and did not require surgical evacuation, and none lost more than 500 ml of blood, nor required transfusion. It is concluded that abortion can be induced with a single extra-amniotic injection of 1 mg of 15(S)-15 methyl PGF2alpha in viscous medium in a large percentage of patients but that the incidence of side effects is high.

Abortion, Induced↗
PubMed1976

Single extra-amniotic injection of prostaglandins in viscous gel to induce abortion.

A single extra-amniotic injection of prostaglandin (PG) E2 or F2alpha in a highly viscous gel was administered to 230 patients to induce abortion between 9 and 24 weeks gestation. PGE2 doses of 1-0, 1-5, 2-0 or 3-0 mg induced abortion within 24 hours in 30 per cent, 75 per cent, 76 per cent and 70 per cent of patients respectively. The incidence of gastrointestinal side-effects was dose dependent, being 20 per cent, 35 per cent, 45 per cent and 70 per cent in the respective groups. A 10-0 Pmg dose of PGF2alpha induced abortion within 24 hours in 66 per cent of patients and 45 per cent had gastrointestinal side-effects. Abortion was more often complete with PGE2 (76 per cent) than with PGF2alpha (36 per cent). Immediate withdrawal of the catheter following PG administration did not influence induction-abortion intervals or 24-hour abortion success rates. This technique significantly reduced individual patient care and minimized the potential risk of intrauterine sepsis associated with extra-amniotic techniques requiring repeated or continuous PG administration.

Abortion, Induced↗
PubMed1976

Intrauterine (extraamniotic) prostaglandins in the management of unsuccessful pregnancy.

Extraamniotic administration of prostaglandin E2 or prostaglandin F2alpha has been used in the treatment of 72 cases of unsuccessful pregnancy which included 50 of fetal death in utero, 13 of anencephaly and nine of hydatidiform mole. This management is highly effective in achieving abortion or delivery within 24 hours in almost all cases and results in few side effects. Pyrexia occurred during treatment in three patients, but in none was intrauterine infection observed. Blood loss greater than 250 ml occurred in only two patients, and none required transfusion. We advocate the use of extraamniotic prostaglandins as an active approach to the problem of unsuccessful pregnancy to relieve the patient of emotional distress and avoid the hazards of blood coagulopathy and intrauterine infection, both of which increase the longer a dead fetus is retained in utero.

Abortifacient Agents↗
PubMed1976

Intrauterine prostaglandin E2 as an postconceptional abortifacient.

1. Thirty-eight pregnant women, 2 to 33 days overdue with a menstrual period, were treated with a single intrauterine injection of PGE2. 2. Abortion occurred in 7 of 12 patients (58.3%) treated with PGE2 100 mug and in 22 of 26 patients (84.6%) given PGE2 500 mug. 3. The only side effect was uterine pain requiring analgesia in four of the former and 15 of the latter. Four patients required curettage to control bleeding.

Abortifacient Agents↗
PubMed1975

Single extra-amniotic injection of prostaglandin E2 in viscous gel to induce mid-trimester abortion.

In a preliminary study a single extra-amniotic injection of 1.5 mg of prostaglandin E-2 incorporated into an aqueous viscous gel was given to 24 patients aborted within 24 hours, and the mean induction-abortion interval (plus or minus S.E. of mean) was 13.5 plus or minus 1.5 hours. Vomiting occurred in seven patients, and transient severe uterine cramps, pallor, nausea, and shivering occurred in one patient immediately after injection. Complete abortion occurred in 20patients. A delay in the time taken to abort seemed to be associated with an immediate and rapid rise in uterine tone after the injection which required prompt analgesia; this probably reflected rapid decidual absorption and dissolution of the prostaglandins away from their site of action. The degree of distention of the catheter-retaining balloon did not influence abortion times.

Abortion, Induced↗
PubMed1974

Prostaglandin-induced abortion: assessment of operative complications and early morbidity.

A total of 626 patients undergoing a prostaglandin-induced abortion, the majority in the second trimester, have been analysed for complications occurring during inpatient treatment. Of the last 155 consecutive patients 143 were critically assessed six to eight weeks after abortion for morbidity occurring during their early recovery period.Blood loss of 250 ml or more occurred in 68 patients, pyrexia in 34, pelvic infection in three, and readmission in 14 of the 626 patients studied, and a transfusion was required in eight.Bleeding after abortion stopped within six weeks in all 143 of the 155 consecutive patients assessed but three required readmission for uterine curettage. Menstruation was re-established within six weeks of abortion in 106 patients.The incidence of operative morbidity was similar to that reported for first trimester abortion and better than that in most reported series of second trimester abortions.

Abortion, Induced↗