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Biomedical subjects

J C Veille

Publications and source records attributed to J C Veille.

At least 19 recordsLinked to original sources
PubMed1995

Fetal fibronectin, interleukin-6, and C-reactive protein are useful in establishing prognostic subcategories of idiopathic preterm labor.

OBJECTIVE: Our purpose was to evaluate fetal fibronectin, interleukin-6, and C-reactive protein from patients with preterm labor to establish prognostic subcategories. STUDY DESIGN: Thirty-seven patients with preterm labor had cervical fetal fibronectin and plasma C-reactive protein sampled. Eighteen of these patients had amniotic fluid interleukin-6 levels measured. Outcome variables were (1) delivery before 34 weeks and (2) delivery within 48 hours. RESULTS: Detectable cervical fetal fibronectin identified 89% of patients who were delivered before 34 weeks' gestation. Interleukin-6 > 1500 pg/ml identified 88% of patients who were delivered within 48 hours. C-reactive protein > 1.5 mg/dl correlated with elevated interleukin-6 levels (p < 0.001). CONCLUSIONS: Three subcategories of idiopathic preterm labor were evident: (1) fetal fibronectin nondetectable (37% likely to be delivered before 34 weeks), (2) fetal fibronectin detectable but interleukin-6 < 1500 pg/ml (79% likely to be delivered before 34 weeks but 85% with > 48 hours' latency), and (3) fetal fibronectin present and interleukin-6 > 1500 pg/ml (91% likely to be delivered with < 48 hours' latency).

Amniotic Fluid↗
PubMed1994

Obesity, pregnancy, and left ventricular functioning during the third trimester.

OBJECTIVE: Our purpose was to determine left ventricular size and function in obese pregnant patients during the third trimester. STUDY DESIGN: Eight morbidly obese pregnant patients had M-mode echocardiography. None were hypertensive or diabetic at the time of study. A group of 36 normal patients were used as controls. RESULTS: Left ventricular end-diastolic dimension, fractional shortening, and cardiac index were not significantly different between the two groups. Left atrial size, left ventricular wall thickness, interventricular septal thickness, and left ventricular mass were greater in the obese group. The radius-to-wall thickness ratio was significantly smaller in the obese group. CONCLUSIONS: (1) Left ventricular dimension and function in obese patients was similar to that of nonobese patients. (2) The left ventricle was found to be significantly hypertrophied in obese patients. Left ventricular reconfiguration appears to be important in preserving left ventricular function. Whether these changes are specific to pregnancy or secondary to maternal obesity remains to be determined.

Adult↗
PubMed1994

The predictive value of intrapartum fetal heart rate abnormalities in the extremely premature infant.

OBJECTIVE: Our purpose was to evaluate the validity of intrapartum fetal heart rate tracings in predicting short- and long-term outcomes of infants delivered between 24 and 26 weeks. STUDY DESIGN: Fetal heart rate tracings obtained during the last hour before delivery of fetuses delivered at 24 to 26 weeks' gestation were reviewed. Two perinatologists blinded to neonatal outcome evaluated the tracings for the following attributes: baseline rate and variability, presence and severity of decelerations, and overall impression (reassuring, nonreassuring, or ominous). Measured outcomes were cord blood pH; Apgar scores; intraventricular hemorrhage; duration of assisted ventilation; and hospitalization, survival, and developmental status at 1 year. RESULTS: The fetal heart rate attribute that was found to be predictive of neonatal outcome was the presence of any bradycardia or tachycardia found in any 10-minute window (designated "baseline rate abnormality"). This correlated with neonatal death (p < 0.007). None of the other fetal heart rate attributes were associated with any neonatal outcome. Intraobserver agreement was "fair to good" (kappa 0.5). CONCLUSION: Fetal baseline rate abnormalities (either tachycardia or bradycardia) were predictive of neonatal death in extremely premature fetuses.

Bradycardia↗
PubMed1994

Fetal cardiovascular hemodynamics in the presence of complete atrioventricular block.

OBJECTIVE: Our purpose was to follow serially the hemodynamic adaptation to a congenital complete heart block in a human fetus. STUDY DESIGN: Longitudinal and serial M-mode and Doppler echocardiography over a 10-week span were performed on a fetus affected by complete heart block. Ventricular fractional shortening, size, and flow across the atrioventricualr valves and outflow tracts were determined starting at 20 weeks up to the time of delivery. Neonatal Doppler follow-up was performed at 2 days of life after implantation of a temporary pacemaker. RESULTS: The right and left ventricles were able to adapt to sustained bradycardia by increasing their size. This ventricular dilatation was also associated with an increase in fractional shortening, which was associated with ventricualr free wall hypertrophy. When ventricualr heart rate decreased to 38 beats/min, fractional shortening decreased, this was associated with the rapid onset of ascites and pericardial effusion. CONCLUSION: In the presence of sustained bradycardia ventricular output can increase, because this fetus was able to increase ventricular size and fractional shortening and wall thickness.

Adult↗
PubMed1993

Fetal renal pulsed Doppler waveform in prolonged pregnancies.

OBJECTIVE: Our purpose was to determine Doppler waveforms of the fetal human renal artery in prolonged pregnancy in the presence or absence of oligohydramnios. STUDY DESIGN: Fifty patients at or after 40 weeks were studied. Ultrasonography was performed to determine the amniotic fluid index by the four-quadrants technique. Two groups of patients were obtained on the basis of the amniotic fluid index. Group 1 had an amniotic fluid index > 5 (normal) (n = 33); group 2 had amniotic fluid index < or = 5 (oligohydramnios) (n = 17). Umbilical artery and fetal renal pulsed Doppler waveforms were determined and analyzed. The fetal renal artery systolic-to-diastolic ratio of the two groups was compared. RESULTS: Fetuses with a low amniotic fluid index had a significantly higher ratio. A significant negative correlation coefficient between amniotic fluid index and fetal renal systolic/diastolic ratio was found (r = -0.435 and p < 0.01). CONCLUSIONS: In prolonged pregnancies there is a significant relationship between the amniotic fluid index and the fetal renal systolic/diastolic ratio. In pregnancies associated with oligohydramnios the systolic/diastolic ratio is significantly higher than in those with normal amniotic fluid volume. These data suggest that intrarenal flow in prolonged pregnancies complicated with oligohydramnios is significantly different.

Adult↗
PubMed1992

Validation of noninvasive fetal renal artery flow measurement by pulsed Doppler in the lamb.

OBJECTIVE: Our objective was to evaluate the accuracy of quantitative measurement of blood flow of the left renal artery in the fetal lamb by means of range-gated, two-dimensional pulsed Doppler ultrasonography. STUDY DESIGN: Doppler measurements were compared with invasive measurements obtained with a perivascular flow probe (Transonic) placed on the fetal renal artery. Renal blood flow was manipulated acutely either by volume expansion or depletion or by means of pharmacologic agents. With each manipulation values of the left fetal renal artery blood flow were obtained with both methods. The size of the fetal renal artery was determined by postmortem examination. RESULTS: A total of 36 paired flow measurements were obtained on five fetuses. One fetus had only Transonic determination of renal blood flow. Pulsed Doppler ultrasonography blood flow and transit-time ultrasonography blood flow estimations were correlated (F = 82.4, R2 = 0.73, p < 0.001). CONCLUSION: This study suggests that two-dimensional pulsed Doppler can reliably estimate renal blood flow in the fetal lamb.

Animals↗
PubMed1992

Effects of maternal administration of 3% carbon dioxide on umbilical artery and fetal renal and middle cerebral artery Doppler waveforms.

OBJECTIVE: The null hypothesis is that umbilical, middle cerebral, and renal artery pulsed Doppler velocity waveforms in the normal term fetus may be affected during short-term maternal inhalation of 3% carbon dioxide gas mixture. STUDY DESIGN: Seventy-two observations were made on 14 term fetuses before and during maternal 3% carbon dioxide gas mixture inhalation. The umbilical, middle cerebral, and renal arteries of these fetuses were sampled with pulsed Doppler velocity waveforms and recorded on a strip chart at a preset speed of 50 mm/sec. Doppler waveforms were analyzed for differences in the systolic peak to end-diastolic velocity ratio for these three vascular beds. Peak flow velocity and time velocity integral were also analyzed for the cerebral and renal vascular beds. The data were analyzed with the paired t test. RESULTS: A significant decrease in the systolic-to-diastolic-velocity ratio of the middle cerebral artery occurred with 3% carbon dioxide inhalation (p < 0.02). The other vascular beds had no demonstrable change. CONCLUSION: Transient maternal breathing of 3% carbon dioxide gas mixture selectively causes a decrease in resistance in the fetal cerebral circulation.

Administration, Inhalation↗
PubMed1992

The effect of presentation and mode of delivery on neonatal outcome in the second twin.

OBJECTIVE: The purpose of this study was to determine if cesarean delivery of the nonvertex second twin improved neonatal outcome. STUDY DESIGN: We examined the maternal and neonatal records from 457 sets of twins delivered from 1985 to 1990. We compared 1- and 5-minute Apgar scores, umbilical artery and vein blood pH values, duration of neonatal hospitalization, the incidence and length of ventilation, intraventricular hemorrhage, birth trauma, and mortality rate between vertex and nonvertex second twins delivered either vaginally or by cesarean section. RESULTS: The presentation and mode of delivery of the second twin was not associated with a significant difference in any of the outcome variables except for the 1-minute Apgar score, which was lower in the nonvertex group delivered vaginally. CONCLUSION: Our data do not support routine cesarean delivery for twins of any birth weight when the second twin is nonvertex.

Apgar Score↗
PubMed1992

Interventricular septal thickness in fetuses of diabetic mothers.

Sixty-four diabetic women had their fetuses studied by M-mode echocardiogram between 20-41 weeks of gestation. The mean septal size during both diastole and systole increased in a linear fashion with advancing gestational age in both the normal and diabetic groups. Ventricular septal hypertrophy (ie, more than 2 standard deviations above the normal mean) was present in 48 of 64 (75%) of the fetuses of diabetic women. The ratio of septal size to the anteroposterior cardiac dimension was significantly greater in the diabetic than in the normal group (12 versus 8%; P less than .05). The anteroposterior cardiac dimension indexed to the estimated fetal weight was also greater in the diabetic group. Because both septum and cardiac dimension are larger with maternal diabetes, there may be a specific diabetic cardiomyopathy that originates in utero.

Echocardiography↗
PubMed1991

Ranged-gated pulsed Doppler of the umbilical artery in human fetuses during normal pregnancies.

Range-gated pulsed Doppler has permitted the study of umbilical artery flow velocity waveforms (FVWs) in human fetuses and is becoming part of the antepartum fetal evaluation. No uniform method of describing such velocity waveforms and no significant body of normal values using pulsed Doppler can be found in the literature. The present study reports on a cohort of 268 patients who had pulsed Doppler umbilical artery FVWs performed during their pregnancy. The gestational age at the time of the study ranged between 16th and 42nd weeks of gestation in normal pregnancies. The systolic to diastolic (S/D) ratio was found progressively to decrease as gestation advanced; however, the range of normal values in this study was found to be quite large at all gestational ages. The present data represent normative data of the umbilical artery FVWs S/D ratio in a large number of normal pregnancies as shown by the follow-up of all the patients to delivery. Before umbilical artery waveform becomes part of the antenatal armamentarium, we advise caution before adopting rigid values that are derived from small groups. Lack of standard values for the 95th percentile may result in a premature delivery of an otherwise normal fetus.

Blood Flow Velocity↗
PubMed1991

Effect of maternal carbon dioxide inhalation on human fetal breathing movements in term and preterm labor.

Induced maternal hypercapnia is a potent stimulus to fetal breathing movements in nonlaboring pregnant women. To determine the effect of maternal CO2 administration on fetal breathing movements during spontaneous labor, 14 healthy pregnant volunteers at term and 34 in preterm labor were recruited. If fetal breathing movements were markedly decreased or absent, the subjects were administered a prepared gas mixture of 3% CO2 in air. In term labor and in true preterm labor, fetal breathing movements were markedly decreased and could not be induced by maternal hypercapnia. Among women with suspected preterm labor, initial absence of fetal breathing movements and failure to evoke this response by maternal hypercapnia predicted delivery within 48 hours with a sensitivity of 80% and specificity of 95.5%. Induced maternal hypercapnia fails to stimulate fetal breathing movements in true term and preterm labor and may assist in distinguishing between true and false preterm labor.

Administration, Inhalation↗
PubMed1991

Maternal left ventricular dimension in pregnancies complicated by fetal growth retardation.

Previous studies using two-dimensional chest radiographs have found a significant correlation between prematurity, fetal growth retardation, and the size of the maternal heart. Accordingly, we evaluated maternal left ventricular size and function by M-mode echocardiography near the end of gestation in 42 women with suspected fetal growth retardation and in 79 women whose pregnancies were normal. No significant differences were found between the two groups, implying that maternal left ventricular size and function is adequate in pregnancies complicated by "idiopathic" fetal growth retardation.

Echocardiography↗
PubMed1990

Improved pregnancy outcome following successful treatment of chlamydial infection.

Pregnancy outcomes of 244 women, successfully treated with erythromycin ethylsuccinate for cervical chlamydial infection, were compared with those of 79 chlamydia-positive pregnant women, who failed to respond to treatment, and 244 chlamydia-free control women, who were not treated. The three groups were at high risk for infection with Chlamydia trachomatis. The frequencies of premature rupture of the membranes, premature contractions, and small-for-gestational-age infants were significantly lower in the successfully treated patients when compared with those of the chlamydia-positive patients, but were not significantly different when compared with those of the control patients. These data indicate that in a pregnant population at high risk for infection with C trachomatis, repeated prenatal chlamydial testing, plus successful erythromycin treatment, can significantly reduce certain adverse effects on pregnancy outcome.

Adult↗
PubMed1990

Middle cerebral artery blood flow in normal and growth-retarded fetuses.

Doppler ultrasonography of the middle cerebral artery was performed on 17 fetuses that were small for gestational age at the time of delivery. Results were compared with a group of 25 fetuses that had a normal weight for gestational age at the time of delivery. Despite a significant difference in fetal weight and systolic/diastolic ratio of the umbilical artery between the two groups, no difference was found in either the systolic/diastolic ratio or in the Pourcelot index of the middle cerebral artery. This may reflect a protective effect on the brain circulation in the small-for-gestational-age fetus.

Cerebrovascular Circulation↗
PubMed1990

Evaluation of the human fetal cardiac size and function.

Two-dimensional-directed M-mode echocardiography was done on 80 normal fetuses between the 17th to 42nd weeks of gestation. The M-mode beam transected the ventricles at the level of the chordae tendineae at the tip of atrioventricular valves. Right and left ventricular dimensions and free wall thicknesses correlated well with gestational age. Calculated measurements showed a good correlation of the stroke volume and cardiac output with gestational age. The right ventricular dimension, however, was significantly greater than the left ventricular one. Fractional shortening of the right and left ventricle did not change significantly with advancing gestational age. This study indicates that the human fetal right ventricle dimension, stroke volume, and cardiac output are slightly larger than that of the left ventricle. This study also suggests that the human fetus increases its cardiac output to match its growth and it does so by increasing ventricular size rather than fractional shortening or heart rate.

Cardiac Output↗
PubMed1989

Two-dimensional and M-mode assessment of aortic growth in the normal and growth-retarded (IUGR) human fetuses.

This study compares human fetal aortic dimensions in 128 normal and 30 intrauterine growth-retarded (IUGR) fetuses using two-dimensional (2D) and M-mode echocardiography. We found that the fetal aortic root in the normally grown fetuses is significantly larger than the descending aorta at all gestational ages. Furthermore, IUGR fetuses had smaller descending aortic dimensions then did normally grown fetuses. When the descending aortic dimension in the IUGR fetuses was corrected for estimated fetal weight, it was found to be of comparable size to those of the normal fetuses. The difference in aortic size of growth-retarded fetuses is proportional to growth and therefore probably a secondary phenomenon.

Aorta↗