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Biomedical subjects

K J Moise

Publications and source records attributed to K J Moise.

At least 73 records · Page 4Linked to original sources
PubMed1993

The use of color flow Doppler ultrasonography to diagnose umbilical cord entanglement in monoamniotic twin gestations.

OBJECTIVE: Our purpose was to investigate the use of color flow Doppler ultrasonography to identify umbilical cord entanglement. STUDY DESIGN: Our case series consisted of three monoamniotic twin gestations. Color flow Doppler was used prospectively to study the umbilical cords. RESULTS: Apparent "branching" of the umbilical artery, with evidence of two different heart rates in the two segments of the branch, was seen in all cases. Compression of the umbilical vein was identified by extremely high blood velocity. CONCLUSIONS: Color flow Doppler is useful in the identification of umbilical cord entanglement in monoamniotic twin pregnancies and may provide a method of monitoring the fetuses for evidence of cord compression.

Adolescent↗
PubMed1993

Effect of advancing gestational age on the frequency of fetal ductal constriction in association with maternal indomethacin use.

OBJECTIVE: The objective of this study was to determine whether indomethacin is associated with an increased incidence of constriction of the human fetal ductus arteriosus with advancing gestational age. STUDY DESIGN: A retrospective analysis of fetal echocardiograms performed in 44 patients with premature labor or hydramnios treated with indomethacin (25 mg orally every 6 hours) was undertaken. Fisher's exact test, Kaplan-Meier survival analysis, and log-rank techniques were used; a value of p < 0.05 was considered statistically significant. RESULTS: The frequency of ductal constriction was similar for fetuses of singleton and multiple gestations. A dramatic increase in constriction was noted at 32 weeks' gestation when the rate of compromise approached 50%. CONCLUSIONS: The use of indomethacin should be restricted to gestational ages of < 32 weeks. In multiple gestations each fetus should be evaluated by echocardiography, because the ductal response may vary between individual fetuses.

Constriction, Pathologic↗
PubMed1993

The effects of indomethacin and terbutaline on human fetal umbilical artery velocimetry: a randomized, double-blind study.

OBJECTIVE: Our purpose was to study the effects of indomethacin and terbutaline on umbilical artery impedance as measured by the systolic/diastolic ratio. STUDY DESIGN: Normal, low-risk patients at 26 to 32 weeks' gestation were enrolled. A baseline evaluation of the umbilical artery systolic/diastolic ratio was performed. The patients were then randomized to one of three groups and received a coded capsule that contained either terbutaline (5 mg), indomethacin (50 mg), or placebo. Repeat evaluation of the umbilical artery systolic/diastolic ratio was performed 4 hours later. The ratios before and after administration of the medication were compared in the control and study groups. Analysis of variance and paired Student t test were applied. RESULTS: Fifteen patients received indomethacin, 14 placebo, and 12 terbutaline. Pretreatment and posttreatment systolic/diastolic ratios were 3.2 and 3.1 for the indomethacin group, 3.2 and 3.3 for the placebo group, 3.0 and 2.8 for the terbutaline group, respectively. The changes in the systolic/diastolic ratio in the indomethacin and terbutaline groups, as compared with the placebo group, were not found to be significant. CONCLUSION: Terbutaline and indomethacin do not have a significant effect on the human umbilical artery impedance as measured by the systolic/diastolic ratio.

Diastole↗
PubMed1993

Prostaglandin synthetase inhibitors in pregnancy.

The use of indomethacin as a tocolytic agent in patients with premature labor was first reported by Zuckerman in 1974. Since then, prostaglandin synthetase inhibitors (PSI) have been used in pregnancy for a variety of indications. However, serious fetal side effects of this category of drugs continue to be reported. We present a review of the literature and the experience at our institution on the use of indomethacin, the most commonly prescribed antiprostaglandin in pregnancy. Therapeutic guidelines and surveillance recommendations for the use of PSI in pregnancy are proposed. The role of newer PSI in pregnancy and their side effect profile are also presented.

Animals↗
PubMed1993

The effect of magnesium sulfate on maternal and fetal blood flow in pregnancy-induced hypertension.

The purpose of this study was to evaluate the effects of magnesium sulfate on maternal and fetal blood flow in pregnancy-induced hypertension. Twelve patients with pregnancy-induced hypertension were prospectively studied with transcranial pulsed Doppler and transabdominal color flow Doppler before and after infusion of a 6 gram intravenous loading dose of magnesium sulfate. The maternal vessels studied included the middle cerebral, common carotid, and internal carotid arteries. The fetal vessels studied included the middle cerebral, renal, and umbilical arteries. In addition the maternal circulation in the placental base plate was imaged. The results of this descriptive study suggest that a 6 gram loading dose of magnesium sulfate significantly vasodilates the vascular bed distal to the maternal middle cerebral artery, and increases blood velocity in this distribution. There was no significant change in pulsatility index or blood velocity in the central large vessels of the head and neck. There were no acute effects noted in the fetal or placental vessels evaluated.

Adult↗
PubMed1993

Fetal platelet counts correlate with the severity of the anemia in red-cell alloimmunization.

OBJECTIVE: To determine whether fetal anemia secondary to maternal red-cell alloimmunization is associated with thrombocytopenia. METHODS: The records of 78 patients undergoing intrauterine transfusion for red-cell alloimmunization were reviewed. Pre-transfusion fetal platelet counts were compared between hydropic and nonhydropic fetuses. A regression analysis was performed between the fetal platelet counts and the fetal bilirubin levels, hematocrits, and reticulocyte counts taken at the initial transfusion. The hematocrits, reticulocyte counts, and bilirubin levels were adjusted for gestational age by calculating the number of standard deviations (SDs) from the mean for that age or the multiples of the mean (MOM). Student t test, Pearson coefficient, and contingency table randomization test were used to analyze the data. P < .05 was considered significant. RESULTS: Thirty-seven fetuses were hydropic and 41 were nonhydropic. Hydropic fetuses had a significantly lower platelet count than nonhydropic fetuses (197.5 +/- 86.4 versus 252.6 +/- 73.7 x 10(3)/microL; P < .01). Platelet counts correlated negatively with the reticulocyte count MOM (r = -0.652; P < .01) and the hematocrit SDs below the mean (r = -0.659; P < .01), but did not correlate with the bilirubin MOM (r = -0.183; P = .2). CONCLUSION: Hydropic and severely anemic fetuses are at increased risk for thrombocytopenia. We suggest that increased erythropoiesis diverts the hematopoietic stem cell away from thrombopoiesis.

Anemia, Hemolytic↗
PubMed1993

Intrauterine transfusion with red cells and platelets.

Having direct access to the fetoplacental circulation by ultrasound-directed needle puncture has led to therapeutic interventions for fetal anemia and thrombocytopenia. Most cases of red cell alloimmunization associated with fetal anemia are caused by the antibody to the D red cell antigen. The intravascular transfusion of red cells to a hydropic fetus in such cases has notably improved survival. Nonimmune hydrops fetalis due to maternal parvovirus infection has also been treated successfully with the intravascular transfusion of red cells, whereas fetomaternal hemorrhage has not proved amenable to such therapy. Sensitization to the PLA-1 platelet antigen is the most common cause of fetal thrombocytopenia in maternal platelet alloimmunization. Fetal platelet transfusions have not proved to be a practical therapeutic modality for this disorder owing to the short half-life of the platelets. Platelets transfusions to the fetus just before delivery may avert the need for cesarean section in cases of severe thrombocytopenia.

Blood Transfusion, Intrauterine↗
PubMed1993

Pheochromocytoma-induced myocardial infarction in pregnancy. A case report and literature review.

We present the case of a 30-year-old woman, 33 weeks pregnant, whose pregnancy was complicated with the rare condition of pheochromocytoma-induced myocardial infarction. Alpha- and beta-adrenergic blockade was instituted immediately for control of hypertension and arrhythmias. Two weeks after myocardial infarction, fetal maturity was documented, and the patient underwent cesarean section delivery of a 6-lb, 6-oz baby girl. The delivery was followed immediately by excision of a 7- x 6- x 4.5-cm tumor, which was confirmed to be a pheochromocytoma by histologic examination. Her post-operative course was uneventful. Our case study and a review of the literature show that the key to successful fetal and maternal outcome is early diagnosis, which can be confirmed by 24-hour urine testing of catecholamine and metanephrine levels. If the tumor is diagnosed before 20 weeks' gestation, we recommend immediate surgical removal of the tumor and continuation of the pregnancy to term. The management of the patient who presents between 20 and 24 weeks' gestation will depend on the uterine size in terms of tumor access. After 24 weeks, the pregnancy should be carried to term, at which time delivery by cesarean section will be followed by tumor excision. Postoperative care should include appropriate cardiovascular investigation and ongoing serial measurements of urinary catecholamines.

Adrenal Gland Neoplasms↗
PubMed1993

The effect of gestational age and fetal indomethacin levels on the incidence of constriction of the fetal ductus arteriosus.

OBJECTIVE: To determine the effects of gestational age and fetal serum indomethacin levels on constriction of the ductus arteriosus after maternal indomethacin administration. METHODS: Twenty-five pregnant Rh-sensitized patients were given a 50-mg oral dose of indomethacin 6 hours before fetal serum indomethacin levels were determined at the time of 50 diagnostic or therapeutic funipunctures. The ductus arteriosus was evaluated with Doppler ultrasound immediately before 40 of the procedures. Constriction of the ductus arteriosus was defined as a peak diastolic flow greater than 35 cm/second. Least-squares regression and multiple regression were used for statistical analysis. RESULTS: The peak diastolic velocity of the fetal ductus arteriosus after maternal indomethacin ingestion was constant at 25 cm/second before 27 weeks, increased between 27-30 weeks to a mean of 39 cm/second, and was stable thereafter (R2 = 0.35; P < .05). There was no significant correlation between constriction of the ductus and fetal serum indomethacin levels (P = .17). CONCLUSIONS: The constrictive effect of maternal indomethacin ingestion on the fetal ductus arteriosus begins as early as 27 weeks' gestation. Constriction of the ductus arteriosus is independent of fetal serum indomethacin levels.

Blood Flow Velocity↗
PubMed1992

The effect of magnesium sulfate on maternal retinal blood flow in preeclampsia: a randomized placebo-controlled study.

OBJECTIVES: Our purpose was to determine the effect of a 6 gm intravenous bolus of magnesium sulfate on maternal retinal blood flow velocity waveforms in patients with preeclampsia. STUDY DESIGN: Twenty-two patients were randomized to two groups and were studied with color flow Doppler before and immediately after infusion of either 6 gm of magnesium sulfate or placebo. The central retinal and posterior ciliary arteries were studied. RESULTS: Magnesium sulfate significantly reduced the pulsatility index (p < 0.005) in both vessels (change in pulsatility index = 0.26 +/- 0.23 for central retinal and -0.22 +/- 0.15 for posterior ciliary) when compared with placebo (change in pulsatility index = 0.02 +/- 0.10 for central retinal and -0.03 +/- 0.09 for posterior ciliary). CONCLUSIONS: These data suggest that magnesium sulfate dilates the vessels distal to the central retinal and posterior ciliary arteries. Changes in pulsatility index in the retinal arteries may be indicative of similar changes in other cerebral vessels.

Adult↗
PubMed1992

Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized, placebo-controlled study.

OBJECTIVES: The purpose of this study was to determine the effect of a 6 gm intravenous bolus of magnesium sulfate on maternal brain blood flow velocity waveforms in patients with preeclampsia. STUDY DESIGN: Twelve patients with preeclampsia were randomized to two groups and studied with Doppler ultrasonography before and immediately after infusion of either a 6 gm intravenous loading dose of magnesium sulfate or a placebo. The middle cerebral, common carotid, and internal carotid arteries were studied. RESULTS: Magnesium sulfate significantly reduced the pulsatility index in the middle cerebral artery (change in pulsatility index = -0.16 + 0.09) when compared with the placebo (change in pulsatility index = -0.02 + 0.06), p = 0.01. There were no significant changes in the Doppler indexes of the carotid vessels. CONCLUSIONS: These data suggest that magnesium sulfate vasodilates the smaller-diameter intracranial vessels distal to the middle cerebral artery and may exert its main effect in the prophylaxis and treatment of eclampsia by relieving cerebral ischemia.

Adult↗
PubMed1992

Do abnormal Starling forces cause fetal hydrops in red blood cell alloimmunization?

OBJECTIVE: The purpose of the current investigation was to ascertain whether derangements in umbilical venous pressure and plasma colloid osmotic pressure are involved in the pathophysiologic condition of immune hydrops fetalis. STUDY DESIGN: Umbilical venous pressure (corrected for ambient amniotic fluid pressure) and colloid osmotic pressure were measured during intravascular transfusion. Fetal hydrops was defined as the presence of ascites by ultrasonography. The Mann-Whitney test was used for comparison of groups; a value of p < 0.05 was considered statistically significant. RESULTS: Fifteen hydropic fetuses were matched for gestational age with 15 nonhydropic fetuses also undergoing intrauterine transfusion for anemia. On comparison with their nonhydropic counterparts, hydropic fetuses had a statistically lower colloid osmotic pressure. Umbilical venous pressure was higher and the colloid osmotic pressure--umbilical venous pressure gradient was lower in association with fetal hydrops although these differences did not achieve statistical significance. CONCLUSION: Mild abnormalities of intravascular Starling forces may play a role in the formation of hydrops in anemic fetuses.

Blood Transfusion, Intrauterine↗
PubMed1992

Amniotic fluid volume assessment: comparison of ultrasonographic estimates versus direct measurements with a dye-dilution technique in human pregnancy.

OBJECTIVE: The purpose of our study was to compare the accuracy of clinical ultrasonographic techniques of amniotic fluid volume assessment with a dye-dilution technique. STUDY DESIGN: We compared amniotic fluid volume as measured by ultrasonographic techniques with a dye-dilution method in 50 women undergoing amniocentesis during the third trimester. Thirteen separate ultrasonographic techniques, including the amniotic fluid index, were evaluated with regression analysis. RESULTS: Amniotic fluid volumes as determined by dye-dilution ranged between 129 and 4444 ml. The amniotic fluid index overestimated the actual volume by as much as 88.7% at lower volumes and underestimated the actual volume by as much as 53.9% at higher volumes. CONCLUSIONS: Differences in measurement error between the other ultrasonographic methods and the amniotic fluid index did not appear to be sufficient to warrant changes in current clinical practice. A major source of error in ultrasonographic amniotic fluid volume assessment is that one-dimensional measurements are used to estimate the volume of a complex, three-dimensional object.

Amniotic Fluid↗
PubMed1992

Indomethacin for the treatment of symptomatic leiomyoma uteri during pregnancy.

Pain secondary to carneous degeneration is the most common complication of leiomyoma uteri during pregnancy. Conventional therapy utilizing bed rest and parenteral narcotic analgesics may often be ineffective. We retrospectively reviewed seven cases of degenerating fibroids complicating pregnancy where the prostaglandin synthetase inhibitor, indomethacin (25 mg orally every 6 hours), was used to treat symptoms of pain. In all cases, relief of symptoms was achieved within 48 hours of initiation of therapy. Two patients required a second course of therapy, and one patient required a third course. Mean duration of therapy was 12 days. One fetus developed transient constriction of the ductus arteriosus and transient oligohydramnios. Two pregnancies aborted, one at 22.9 and one at 22.3 weeks; however, no perinatal complications were directly attributable to indomethacin. The five term deliveries were of healthy normal infants. These retrospective data suggest that indomethacin may be effective in the treatment of pain associated with degenerating uterine leiomyomas in pregnancy.

Adult↗