Intrauterine fetal demise and hemostatic failure: the fetal death syndrome.
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Blood Coagulation Disorders↗
Biomedical subjects
J A Copel
Publications and source records attributed to J A Copel.
Fetal atrioventricular valve insufficiency associated with nonimmune hydrops: a two-dimensional echocardiographic and pulsed Doppler ultrasound study.
Of 466 fetuses who underwent cardiac ultrasound examination with cross-sectional and M mode echocardiography and pulsed Doppler ultrasound and in whom we were able to follow the natural history, 12 were found to have atrioventricular valve insufficiency and nonimmune hydrops. Eleven fetuses (all of whom had structural heart disease) died either in utero or during the early postnatal period. In the one surviving hydropic fetus with supraventricular tachyarrhythmia and atrioventricular valve regurgitation but without structural heart disease, all the abnormalities disappeared on treatment with digoxin and verapamil. Seven fetuses who had atrioventricular valve insufficiency but did not develop nonimmune hydrops all survived pregnancy and the early neonatal period. The syndrome of atrioventricular valve insufficiency, nonimmune hydrops, and structural heart disease has a poor prognosis. The hydrops in this instance reflects fetal cardiac failure related to venous hypertension and low colloid oncotic pressure.
Echocardiography↗
Diagnosis of ectopic pregnancy: value of the discriminatory human chorionic gonadotropin zone.
A prospective study was conducted to test the hypothesis that the absence of an intrauterine gestational sac when the serum level of human chorionic gonadotropin (hCG) is above 6500 mIU/mL is indicative of ectopic pregnancy. A total of 383 patients who were clinically suspected to have ectopic pregnancies had pelvic ultrasound examinations with serum hCG determinations on the day of the scan. There were 217 (57%) intrauterine gestations, 104 (27%) ectopic pregnancies, and 62 (16%) spontaneous abortions. Forty-one percent of patients had an hCG level above 6500 mIU/mL. The absence of an intrauterine gestational sac at an hCG concentration above this level had a sensitivity of 100%, a specificity of 96%, a positive predictive value of 86%, a negative predictive value of 100%, and was 98% efficient, based on a 19.4% prevalence of ectopic pregnancies among this group.
Abortion, Spontaneous↗
Value of culdocentesis in the diagnosis of ectopic pregnancy.
The diagnostic value of culdocentesis was examined in all patients admitted with hemoperitoneum during a three-year period. There was a total of 158 women with positive culdocentesis, of whom 132 (83.5%) had tubal ectopic pregnancies and 26 had other diagnoses. Of the 132 patients with ectopic gestations, the majority (62%) had unruptured tubes. A nondiagnostic culdocentesis should not be used either to raise or to lower the clinician's suspicion of ectopic pregnancy as 16% of patients with an ectopic pregnancy had a nondiagnostic culdocentesis, of which one-quarter were ruptured and three-quarters had hemoperitoneum diagnosed at the time of surgery. A positive culdocentesis along with a positive serum human chorionic assay was associated with an ectopic pregnancy in 99.2% of cases. This procedure should not be limited to the evaluation of patients with classic peritoneal signs, as 45% of the authors' patients with a positive culdocentesis did not have such findings.
Biopsy, Needle↗
Contraction stress testing with nipple stimulation.
The contraction stress test (CST) is used widely as a measure of fetoplacental respiratory reserve. With contractions traditionally induced by intravenous oxytocin, the test has been limited in its use by time, expense and patient discomfort. In a prospective evaluation of the effectiveness of nipple stimulation for the production of uterine contractions, a successful CST was obtained in 94% of the attempts, with a mean total test time of 12 minutes.
Adolescent↗
In utero diagnosis and treatment of fetal supraventricular tachycardia.
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Anti-Arrhythmia Agents↗
Intestinal parasites and other infections during pregnancy in Southeast Asian refugees.
An influx of Indochinese refugees into the Philadelphia area prompted a review of their reproductive performance as related to parasitic diseases and other infectious complications. A total of 100 infants were delivered of 97 women over an 18-month period (41 Vietnamese, 28 Laotian, 26 Cambodian, 2 Thai). Intestinal parasites were present in 65% of the mothers. Additional infections included 1 case of malaria, 1 of gonorrhea, 4 of syphilis, 5 of hepatitis B surface antigen and 12 of positive tuberculin (5-tuberculin-unit) skin tests. When comparing Southeast Asian gravidas with and without parasites, there were no significant differences between mean hemoglobin values, mean gestational age at delivery and mean birth weights of their infants. Although the Southeast Asian refugees had a high rate of infectious complications, they proved to have favorable pregnancy and neonatal outcomes.
Adolescent↗
Carbon monoxide intoxication in early pregnancy.
Carbon monoxide exposure has been described as having both acute and chronic effects; acute intoxication early in pregnancy has not been previously reported, however. A case of carbon monoxide poisoning at 8 weeks' menstrual age is described with good fetal outcome. Appropriate literature is briefly reviewed.
Adult↗
Increase of fetal hematocrit decreases the middle cerebral artery peak systolic velocity in pregnancies complicated by rhesus alloimmunization.
Our hypothesis for this study was that an increase in fetal hematocrit would decrease the middle cerebral artery peak systolic velocity. Seventeen pregnancies complicated by Rh alloimmunization were included in this study. Middle cerebral artery peak systolic velocity was studied by Doppler ultrasound before and after intrauterine transfusion with adult packed red blood cells (hematocrit = 80-85%). Mean gestational age at time of study was 27 weeks. Paired t-test was used for statistical comparison. A P value of < 0.05 was considered statistically significant. The fetal hematocrit ranged from 5.9% to 30% prior to the procedure, and it was 24.8-53.4%, following the procedure. Mean middle cerebral artery peak systolic velocity was 46.2 +/- 10.7 cm/s prior to the procedure, and it decreased to 31.7 +/- 9.5 cm/s following the procedure (P < 0.01). The increase of fetal hematocrit significantly decreases the middle cerebral artery peak systolic velocity supporting data that this Doppler measurement may be useful for the diagnosis of fetal anemia.
Anemia↗
Gestational age standardized nuchal thickness values for estimating mid-trimester Down's syndrome risk.
OBJECTIVE: Our aim was to develop gestational age standardized indices of fetal nuchal thickening. In addition, we wanted to develop a method for combining nuchal thickness data with maternal age for calculating individual Down's syndrome risk. METHODS: Nuchal thickness was measured prospectively in pregnancies undergoing genetic amniocentesis. A regression equation for expected median nuchal thickness based on the biparietal diameter (BPD) was developed. Nuchal thickness values were expressed as multiples of the median (MoM). Additionally, a new parameter, percentage increase in nuchal thickness (PIN) (measured minus expected nuchal thickness) X100/expected nuchal thickness, was used. Receiver operator characteristics curves for Down's syndrome detection based on nuchal thickness values expressed as MoM, PIN, and in mm were compared. Log10 transformation of MoM data resulted in a Gaussian distribution, and the Down's syndrome likelihood ratios were calculated based on the heights of the Gaussian curves. Likelihood ratios were also calculated based on PIN values. The screening efficiency of maternal age alone was compared to age plus MoM, and age plus PIN values by multiplying age-related risk by the likelihood ratio corresponding to the given nuchal thickness MoM or PIN values. RESULTS: There were 3,574 chromosomally normal and 50 Down's syndrome fetuses in the study. Both PIN and MoM values for nuchal thickness were closely correlated (R = 1.00, P<0.001) and each was poorly correlated with gestational age (R = 0.018, P = 0.28). The Down's syndrome screening efficiency of PIN, MoM, and nuchal thickness values in mm were not significantly different. The addition of nuchal thickness data to maternal age-related risk significantly improved the Down's syndrome screening efficiency: Area under the ROC curve for maternal age risk = 0.58, maternal age + PIN area = 0.79 (P<0.001 compared to maternal age alone) and for maternal age + MoM = 0.77 (P<0.005 compared to maternal age alone). CONCLUSIONS: The development of gestational age standardized nuchal thickness indices makes it possible to combine ultrasound and maternal age-related risk to derive individual Down's syndrome odds.
Amniocentesis↗
Indications for fetal echocardiography.
Congenital heart disease is one of the most common congenital malformations diagnosed in liveborns. As more women undergo prenatal diagnosis, the need for screening fetal echocadiography increases. The fetal, maternal, and familial indications for fetal echocadiography are outlined in order to improve the identification of women in greatest need for this screening modality.
Echocardiography↗
Antepartum and postpartum thrombomodulin levels in preeclamptic and normotensive pregnancies.
OBJECTIVE: To determine whether changes in plasma levels of thrombomodulin from antepartum to postpartum reflect the postpartum regression of preeclampsia. METHODS: Twenty-four preeclamptic women and 34 healthy, normotensive women with singleton pregnancies were studied in the third trimester. Plasma levels of thrombomodulin in the antepartum and postpartum periods were measured by a two-site immunoenzymatic assay. Two-tailed Student t test and paired-comparison t test were used for statistical analyses. The results were expressed as mean +/- standard error. RESULTS: Antepartum plasma thrombomodulin levels in preeclampsia were significantly higher than postpartum levels (71.3 +/- 8.5 versus 55.5 +/- 5.4 ng/mL; P = .006), which was not seen in the normotensive controls (49.9 +/- 3.1 versus 44.2 +/- 3.8 ng/mL; P > .05). Antepartum plasma levels of thrombomodulin in preeclamptic women were significantly higher than those in the normotensive controls (P = .01). However, postpartum plasma levels of thrombomodulin in preeclamptic women were not significantly higher than those in the normotensive controls (P > .05). CONCLUSION: Significantly decreased postpartum plasma thrombomodulin levels in preeclamptic pregnancies strongly correspond to clinical postpartum regression of preeclampsia.
Adult↗
Elevated amniotic fluid nitric oxide metabolites and interleukin-6 in intra-amniotic infection.
OBJECTIVE: To compare amniotic fluid nitric oxide metabolites and interleukin-6 (IL-6) concentrations in patients with and without intra-amniotic infection. METHODS: Amniotic fluid nitric oxide metabolites, IL-6, Gram stains, glucose, leukocyte counts, leukocyte esterase activity, creatinine, pH, and specific gravity were determined in 14 patients with intra-amniotic infection and 26 patients without intra-amniotic infection. Intra-amniotic infection was defined as the presence of a positive amniotic fluid culture. The nitric oxide metabolites, nitrate and nitrite (NOx), were measured using Greiss reagent after reduction of nitrate to nitrite with aspergillus nitrate reductase. Interleukin-6 was measured by a two-site, enzyme-linked immunosorbent assay. Amniotic fluid nitric oxide metabolites and IL-6 concentrations were normalized by amniotic fluid creatinine levels. The Mann-Whitney U test, contingency table method, and Spearman's rank correlation test were used for statistical analyses. RESULTS: Amniotic fluid NOx and IL-6 levels were significantly higher in patients with intra-amniotic infection than in those without intra-amniotic infection (NOx: median = 2.06 mumol/mg creatinine, range = 0.74-6.81 versus 1.35 mumol/mg creatinine, range = 0.99-1.60, P = .01, IL-6: median = 2.00 micrograms/mg creatinine, range = 0.026-4.07 versus median = 0.04 micrograms/mg creatinine, range = 0.004-3.210, P = .0009, respectively). Patients with intra-amniotic infection had significantly elevated leukocyte counts, leukocyte esterase activity, Gram positive stains, and significantly lower amniotic fluid glucose levels compared with those without intra-amniotic infection. There were no differences in gestational age, maternal age, parity, race, pH, or specific gravity between the two groups. Amniotic fluid NOx was significantly correlated with IL-6 (r = .4, P = .02). Both amniotic fluid NOx and IL-6 were also positively correlated with amniotic fluid leukocyte counts, leukocyte esterase activity and Gram stains, and negatively correlated with glucose levels. CONCLUSIONS: Amniotic fluid NOx and IL-6 are significantly elevated and positively correlated during intra-amniotic infection. Both increased amniotic fluid IL-6 and nitric oxide may exert cytotoxic and cytostatic effects on the target cells. We suggest that measurements of amniotic fluid NOx and IL-6 may serve as useful clinical markers in patients with intra-amniotic infection.
Adolescent↗