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Biomedical subjects

J A Copel

Publications and source records attributed to J A Copel.

At least 109 records · Page 6Linked to original sources
PubMed1991

Perinatal outcome of fetal complete atrioventricular block: a multicenter experience.

The clinical course and outcome of 55 fetuses with complete atrioventricular (AV) block detected prenatally were studied to identify factors that affect the natural history of this lesion. In 29 fetuses (53%) complete AV block was associated with complex structural heart defects, usually left atrial isomerism (n = 17) or discordant AV connection (n = 7). The other 26 fetuses had normal cardiac anatomy; in 19 cases the mother had connective tissue disease or tested positive for antinuclear antibodies. Six fetuses showed progression from sinus rhythm or second degree block to complete AV block. Of the 55 pregnancies, 5 were terminated and 24 fetuses or neonates died; at the end of the neonatal period 26 fetuses were still alive. Fetal or neonatal death correlated significantly with the presence of structural heart defects (4 of 29 surviving, p less than 0.001), hydrops (0 of 22 surviving, p less than 0.001), an atrial rate less than or equal to 120 beats/min (1 of 12 surviving, p less than 0.005) or a ventricular rate less than or equal to 55 beats/min (3 of 21 surviving, p less than 0.001). Mean atrial and ventricular rates were higher in surviving than in nonsurviving fetuses (142 +/- 8 vs. 127 +/- 21 beats/min, p less than 0.002; 64 +/- 8 vs. 52 +/- 8 beats/min, p less than 0.001, respectively). A slow atrial rate, however, was frequently associated with left atrial isomerism.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed1991

Congenital heart disease and fetal thoracoabdominal anomalies: associations in utero and the importance of cytogenetic analysis.

We examined the frequency with which congenital heart disease (CHD) and cytogenetic abnormalities were found associated with omphalocele, gastroschisis, duodenal atresia and posterior diaphragmatic hernias. We performed fetal echocardiograms on 80 patients with these diagnoses and found congenital heart disease in 13 of 37 with omphalocele (35%), 2 of 17 with gastroschisis (12%), 4 of 15 with duodenal atresia (27%), and 2 of 11 with posterior diaphragmatic hernia (18%). Karyotypes were obtained in 74 and were abnormal in 24 (32%). Although most fetuses with these extracardiac malformations and abnormal karyotypes had associated CHD, many did not. Normal karyotypes were found in 69% of fetuses with CHD and omphalocele, and 50% of fetuses with CHD and duodenal atresia. We conclude that CHD may be present in fetuses with extracardiac malformations whether or not the karyotype is normal and that the prenatal evaluation of fetuses with these lesions should include both karyotype and fetal echocardiography. Although karyotypes play an important role in prenatal diagnosis, they are not predictive of normal cardiac structure when normal in the abnormalities studied. Even when the karyotype is normal in the presence of these abnormalities, fetal echocardiography is indicated.

Abdominal Muscles↗
PubMed1991

Can umbilical artery pulsatility index predict the outcome of fetuses with structural heart disease?

Umbilical artery Doppler waveforms have been suggested to demonstrate diminished end-diastolic velocities in anomalous fetuses. We evaluated 11 fetuses with antenatally diagnosed congenital heart disease (CHD) and compared them to a normal population. Fetuses with CHD were studied once each and ranged in age from 19 to 32 weeks gestation. Eight had normal chromosomes, and three were aneuploid. The pulsatility index (PI) was elevated (above the 90th percentile for gestational age) in 3/11 CHD fetuses (P = NS). Elevated PI did not discriminate well between those with fatal and nonfatal lesions. Although all three fetuses with elevated PI had fatal disease, five of eight fetuses with fatal anomalies had normal PI values. We conclude that, while umbilical artery PI values were elevated in a subgroup of affected fetuses, this was not clinically helpful.

Female↗
PubMed1991

Introduction to Doppler velocimetry in obstetrics.

Doppler velocimetry of the fetal and maternal circulation can provide important diagnostic and prognostic information. However, the precise role of this technology in screening, diagnosis, and management of perinatal complications is still evolving. This article discusses some principles of physics, techniques, clinical applications, and limitations of Doppler velocimetry in obstetrics.

Female↗
PubMed1991

Doppler echocardiography and color flow mapping.

Doppler color flow mapping permits real-time integration of structural and functional information. Flow through fetal and maternal vessels can be examined. Evaluation of fetal cardiac function can be enhanced, and structural abnormalities can be thoroughly studied. Other important applications include improved diagnoses of ectopic pregnancy and ovarian cancer.

Echocardiography, Doppler↗
PubMed1991

The antenatal diagnosis of congenital heart disease using fetal echocardiography: is color flow mapping necessary?

Doppler color flow mapping is widely used in fetal echocardiography. We studied the impact of color flow mapping on fetal cardiac diagnosess. Between January 1, 1989 and June 30, 1990, we performed 854 fetal echocardiograms on 776 fetuses. Color flow mapping was used in 45 of 48 fetuses diagnosed as having cardiac abnormalities. Scans were reviewed to assess how color flow mapping influenced the ultimate diagnoses. Color flow mapping was essential to the correct anatomical diagnoses in 13 fetuses (29%), helpful but not essential in 21 (47%), and added little to two-dimensional examination alone in 11 (24%). It was essential in determining the course and flow direction in the great vessels when outflow obstruction was present or with transposition, and it was helpful but not essential in locating small jets of atrioventricular valve regurgitation. It was not helpful when the anatomical abnormalities were clearly identified from two-dimensional examination alone. We conclude that color flow mapping is helpful in the delineation of anatomical diagnoses in three-quarters of cases of fetal heart disease, particularly when the great vessels are abnormal. It may speed examinations by directing pulsed Doppler sampling. We did not find it essential to the proper recognition of anatomically abnormal hearts.

Echocardiography, Doppler↗
PubMed1990

Does the umbilical artery systolic/diastolic ratio reflect flow or acidosis? An umbilical artery Doppler study of fetal sheep.

We studied four fetal sheep at 114 to 139 days' gestation to evaluate the effect of acute placental embolization on placental perfusion, fetal oxygenation and acid-base status, and the umbilical artery systolic/diastolic ratio. Studies were performed after maternal anesthesia was induced in an acute model, with serial umbilical artery embolizations performed at 20 to 30 minute intervals. Fetal umbilical flow, systolic/diastolic ratio, and arterial blood gas levels were followed up. One animal maintained a normal systolic/diastolic ratio despite a 50% drop in flow after the first injection and pH of 6.91, and died after the second injection. The remaining three animals showed significantly decreased flow after the third injection (p less than 0.02), with no change in the systolic/diastolic ratio. The systolic/diastolic ratio increased significantly after the fourth injection (p less than 0.05) when flow had dropped even further. Corresponding decreases in PO2 and pH did not achieve statistical significance. The magnitude of all changes increased with subsequent embolizations. We conclude that in this model significant reductions in flow result in small increases in the systolic/diastolic ratio and that greater magnitude changes in the systolic/diastolic ratio appear only with severely diminished flow and PO2, when acidosis develops.

Acidosis↗
PubMed1990

Invasive fetal assessment in the antepartum period.

Access to the fetus as a true patient is a recent development in maternal-fetal medicine. We review the major invasive techniques currently available for establishing diagnoses and providing treatments to the fetus. These include fetoscopy, fetal blood sampling, fetal transfusions, and fetal shunts. Indications, techniques, and complications are discussed.

Biopsy↗
PubMed1990

Invasive fetal procedures.

The development of the subspecialty of maternal-fetal medicine has been hampered by the inability to gain direct access to the fetus. With the development and improvement of high-resolution real-time ultrasound, access to the fetus and its intravascular compartment has become a reality. This article presents a description of the invasive procedures used in the prenatal diagnosis and treatment of fetal medical and surgical conditions.

Biopsy↗
PubMed1989

Pulsed Doppler flow-velocity waveforms in the prediction of fetal hematocrit of the severely isoimmunized pregnancy.

We previously reported a significant relationship between the hematocrit levels of anemic fetuses and information derived from ultrasonographic and Doppler flow-velocity waveforms. In this study we prospectively tested two formulas for the prediction of hematocrit values, by use of gestational age, presence or absence of hydrops, and Doppler indices. Although one of the two formulas predicted hematocrit values significantly, the only component of the formula that made a significant contribution was fetal hydrops. We conclude that currently available fetal Doppler measurements are unable to be applied in the prospective prediction of hematocrit values in anemic fetuses of isoimmunized pregnancies.

Blood Flow Velocity↗
PubMed1989

Fetal cardiac output in the isoimmunized pregnancy: a pulsed Doppler-echocardiographic study of patients undergoing intravascular intrauterine transfusion.

The mechanism of development of hydrops fetalis in severe isoimmunization has been subject to speculation. We performed pulsed Doppler assessment of cardiac output in 13 severely isoimmunized fetuses before and after intravascular transfusion and compared the results with 37 control fetuses between 20 and 34 weeks' gestation. The cardiac index of the anemic fetuses was significantly greater than that of the control group. A significant (right ventricle, p less than 0.01; left ventricle, p less than 0.02) increase in indexed output was noted from both ventricles and in the combined ventricular output (mean +/- SEM 644 +/- 35.3 ml/kg/min in control fetuses versus 879 +/- 86.0 ml/kg/min in anemic fetuses, p less than 0.006). An increase in cardiac output was also noted when anemic fetuses were compared with gestational age-specific norms. We conclude that severely anemic fetuses of isoimmunized pregnancies tend to have significantly higher cardiac output than do unaffected fetuses and that this high output state may play a part in the development of hydrops fetalis.

Blood Transfusion, Intrauterine↗
PubMed1989

Fetal behavior in preterm premature rupture of the membranes.

Although the subject has been the focus of a large body of obstetric literature, premature rupture of the membranes and its pathogenesis, management, and incidence of sequelae remain confused and controversial. The origins of this disquieting state of affairs can be traced to the lack of a specific, narrow definition of the condition, and resultant variations both in gestational age and maternal epidemiology in the populations assessed.

Female↗
PubMed1988

Pulsed Doppler flow-velocity waveforms before and after intrauterine intravascular transfusion for severe erythroblastosis fetalis.

Pulsed Doppler studies of the fetal and maternal circulations were carried out before and after 64 intrauterine transfusions performed on 24 fetuses. A model was derived for the prediction of hematocrit before the first transfusion: Hematocrit = 7.778 - (0.088 x peak velocity in descending aorta) + (0.968 x gestational age [weeks]) - (10.911 if hydrops present) (r = 0.876, p less than 0.0001). An alternative formula, excluding hydrops, was slightly less predictive: Hematocrit = 45.312 - (56.261 x umbilical cord Pourcelot index) - (0.128 x peak velocity in descending aorta) + (1.042 x gestational age) r = 0.822, p less than 0.001). Neither model was accurate in the prediction of hematocrit before second or subsequent transfusions. A third model was derived from second-transfusion data: Hematocrit = 40.524 - (0.045 x peak velocity in descending aorta) - (10.693 x pulsatility index of maternal uterine artery) (r = 0.81, p less than 0.003). However, this model was unable to predict hematocrit before third or later transfusions. No changes in Doppler parameters before and after transfusion were found. We conclude that pulsed Doppler ultrasound may be helpful in the evaluation of isoimmunized pregnancies, in differentiating anemic from normal fetuses. It does not appear to be useful in determining the timing of later transfusions. The lack of change before and after transfusions suggests that these vessels will not provide significant information concerning the effect of rapid volume and hematocrit changes in the fetus.

Blood Transfusion, Intrauterine↗
PubMed1988

The reversal of hydrops fetalis by intravascular intrauterine transfusion in severe isoimmune fetal anemia.

Seventy-two intrauterine intravascular transfusions were performed on 26 patients with severe erythroblastosis fetalis. Twenty of the 26 fetuses were hydropic at the time of referral. Of the 20 hydropic fetuses, 16 (80%) survived. Hydrops was completely reversed in 13 of the 16 fetuses (81%). Total protein of less than 3 gm/dl, albumin less than 2 gm/dl, and a hematocrit level of less than 15% were associated with hydrops fetalis. After hydrops was reversed, total protein greater than 3 gm/dl, albumin greater than 2 gm/dl, along with a sustained hematocrit level of greater than 15%, were found. Only three neonates were born with minimal ascites, two of whom had had intraperitoneal transfusions before intravascular treatments. There were 21 survivors of the total group, giving an overall survival rate of 82%. There was one neonatal death from severe respiratory distress syndrome. Thirty-eight percent of the neonates did not require exchange transfusions in the newborn period. Intrauterine intravascular transfusions appear to be an effective mode of therapy in severe erythroblastosis fetalis and not only increase survival rates but also decrease neonatal morbidity and mortality.

Adult↗
PubMed1988

The frequency of aneuploidy in prenatally diagnosed congenital heart disease: an indication for fetal karyotyping.

The frequency of chromosomal abnormalities in infants with congenital heart disease has been estimated from postnatal clinic data to be 5% to 10%. Over an 18-month period we performed fetal echocardiograms on 502 fetuses and found cardiac anomalies in 34. Eleven of these fetuses (32%) had abnormal chromosomes. This marked discrepancy from the data found in the pediatric literature may relate to nonviable fetuses identified in utero, who escape pediatric case identification. We conclude that in cases of fetal heart disease the workup should include either amniocentesis or fetal blood sampling for chromosome analysis. The information can be used for complete parental counseling and for managing delivery and neonatal care.

Aneuploidy↗