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Biomedical subjects

K J Moise

Publications and source records attributed to K J Moise.

At least 91 records · Page 5Linked to original sources
PubMed1992

Imported malaria in pregnancy: report of four cases and review of management.

Malaria is a common infection worldwide. Increased travel by pregnant women makes it likely that physicians in the United States will see cases of malaria in this population. We observed four cases of malaria during pregnancy over an 8-month period at a general hospital in the United States. These cases illustrate the association between pregnancy and severe malaria in the mother and congenital infection in the newborn. We also noted delays in diagnosis because malaria was mistaken for other common illnesses. Therapy was complicated by concerns about the safety of antimalarial agents for the fetus and newborn as well as drug resistance. While chloroquine is safe for use in pregnancy, drug resistance is now common, especially when the etiologic organism is Plasmodium falciparum. There are concerns about the safety of administering other antimalarial agents during pregnancy (e.g., mefloquine). Concerns about the safety and availability of these agents limit options for prophylaxis.

Adult↗
PubMed1992

Continuous subcutaneous terbutaline pump therapy for premature labor: safety and efficacy.

To assess the usefulness of a continuous subcutaneous pump infusion of terbutaline for long-term tocolysis, we used this modality in 13 patients in whom other tocolytic regimens had failed. The mean (+/- standard deviation) maternal age was 29.9 +/- 3.8 years. The study population included 10 singleton gestations, two sets of triplets, and one twin pregnancy. In three cases, the terbutaline pump was thought to have been successful (duration of pump therapy, 52.7 +/- 20.9 days; gestational age at delivery, 37.1 +/- 1.3 weeks), whereas in six cases marginal success was achieved (duration, 42.2 +/- 27.7 days; gestational age at delivery, 33.8 +/- 2.6 weeks). In the remaining four patients, pump therapy was discontinued after 2 to 23 days because of maternal complications. In contrast to previous reports, we achieved only limited success with the subcutaneous terbutaline pump in the small number of patients studied.

Adult↗
PubMed1992

Ultrasound-guided blood sampling of rabbit fetuses.

A rabbit animal model for hemolytic disease of the newborn has been previously described. However, evaluating the effects of this disease was limited to histologic and hematologic examinations of liveborn kitlings. To assess the feasibility of in utero blood sampling, we performed ultrasound-guided cardiac sampling of 50 fetuses in 16 New Zealand White does on days 26 and 27 of gestation. The overall rate of successful sampling was 80%. The procedure-related mortality declined to 35% by the third phase of the study. The mean (+/- SD) hematocrit (%) and reticulocyte values (#/100 RBCs) on day 26 were 26.3 +/- 3.3 and 35.6 +/- 5.1, respectively; values on day 27 were 31.3 +/- 4.9 and 27.5 +/- 7.6. The results of this study suggest that hematologic data can be obtained from rabbit fetuses in the majority of cases with only moderate fetal loss.

Animals↗
PubMed1992

Termination of supraventricular tachycardia with intravenous adenosine in a pregnant woman with Wolff-Parkinson-White syndrome.

BACKGROUND: Pregnancy is associated with an increased frequency of arrhythmias in women with Wolff-Parkinson-White syndrome. We describe the use of intravenous (IV) adenosine for the acute termination of a narrow complex tachycardia in a pregnant patient with this syndrome. CASE: A 26-year-old woman with known Wolff-Parkinson-White syndrome presented with dizziness, palpitations, and a narrow complex supraventricular tachycardia. We used IV adenosine to convert the arrhythmia to a normal sinus rhythm. During labor, the patient again developed a narrow complex supraventricular tachycardia, and fetal monitoring revealed recurrent deep variable decelerations. Intravenous adenosine resulted in conversion to sinus rhythm and restoration of the fetal heart rate to normal. Cesarean delivery produced a healthy male infant. CONCLUSIONS: Adenosine is effective in rapidly terminating maternal narrow complex tachyarrhythmias before and during delivery in women with Wolff-Parkinson-White syndrome. It can also treat fetal bradycardia resulting from the maternal arrhythmia.

Adenosine↗
PubMed1992

Intravascular transfusion of fetuses with rhesus incompatibility: prediction of fetal outcome by changes in umbilical venous pressure.

OBJECTIVE: We examined whether abnormal elevations in umbilical venous pressure during intravascular transfusion predict post-transfusion mortality. METHODS: Umbilical venous pressures were measured during intravascular transfusion of human fetuses with Rhesus incompatibility. Five fetuses died within 24 hours after transfusion and nine fetuses survived the procedure. RESULTS: Survivors and non-survivors were similar in demographic and clinical data, as well as in transfusion characteristics. The only difference between the groups was the change in umbilical venous pressure during the transfusion: 5.0 +/- 6.3 mmHg for survivors versus 18.1 +/- 10.4 mmHg for non-survivors (P = .01). An increase in the umbilical venous pressure of 10 mmHg or more predicted fetal death with a sensitivity of 80% and specificity of 89%. CONCLUSION: Based on these results, we have modified our transfusion technique. If the change in umbilical venous pressure during intravascular transfusion approaches 10 mmHg, we discontinue the procedure. If the change in pressure exceeds 10 mmHg during transfusion, we remove blood and replace it with an equal volume of saline.

Blood Transfusion, Intrauterine↗
PubMed1991

Doppler assessment of renal blood flow velocity waveforms in the anemic fetus before and after intravascular transfusion for severe red cell alloimmunization.

Image-directed pulsed Doppler ultrasonography demonstrated a decrease in the pulsatility index of the renal artery in 9 anemic fetuses (less than 30 weeks, menstrual age) soon after intravascular transfusion. The pulsatility index returned to pretransfusion values the day following the transfusion. End diastolic blood velocity in the renal artery could not be measured before the transfusion, was detectable immediately after the procedure, and was again nonmeasurable one day after the transfusion. These data suggest an increase in renal blood flow in the anemic fetus soon after intravascular transfusion to eliminate excess fluid.

Anemia↗
PubMed1991

Porencephalic cyst: a complication of fetal intravascular transfusion.

A case of unilateral porencephalic cyst as a result of intravascular intrauterine transfusion is reported. Although other factors may have contributed, fetal bradycardia and relative hyperviscosity as a result of increased fetal hematocrit value were considered to be related to this event. Because some authors recommend direct intravascular transfusion to supraphysiologic hematocrits to prolong the interval between procedures, we would caution the use of this approach on the basis of theoretic considerations and the occurrence of this complication.

Adult↗
PubMed1991

Long-term indomethacin therapy decreases fetal urine output and results in oligohydramnios.

Four quadrant quantitative amniotic fluid volume (length, width, and depth) was performed in six fetuses prior to and during indomethacin therapy for preterm labor in patients with normal amniotic fluid volume prior to therapy. The dose of indomethacin was 25 mg orally every 6 hours. One patient had to have the dose reduced to 25 mg every 12 hours due to constriction of the ductus arteriosus. Fetal urine output was determined prior to and during indomethacin therapy. The mean pretherapy amniotic fluid volume of 341.5 +/- 43.2 mm declined to 97 +/- 9.3 mm at the time of discontinuation of indomethacin for oligohydramnios. This occurred after 15 days of 25 mg indomethacin orally every 6 hours in four patients and after 28 days at 25 mg indomethacin every 12 hours in the remaining patient. Fetal urine output prior to and following indomethacin was 4.93 +/- 14 ml and 1.73 +/- 0.6 ml/hr, respectively. Prolonged indomethacin therapy results in decreased fetal urine output with resultant oligohydramnios and appears to be the major limiting factor aside from ductal constriction to long-term indomethacin therapy.

Adult↗
PubMed1991

Indomethacin therapy in the treatment of symptomatic polyhydramnios.

It appears that maternal indomethacin therapy may be a useful adjunct in selected cases of polyhydramnios. Initial evaluation should include glucose tolerance testing and a thorough search for fetal abnormalities by ultrasonography. In the patient with symptoms such as premature labor or respiratory compromise, an initial amniocentesis should be considered for decompression and fetal karotype. Oral indomethacin therapy can then be started. Although the optimal dose is unknown, a 25-mg oral dose every 6 hours appears adequate. Ultrasound assessment of amniotic fluid volume should be done once or twice weekly. If oligohydramnios develops, the indomethacin should be discontinued, and the amniotic fluid volume serially monitored. Fetal echocardiography should be considered in the first 24 hours after therapy has been initiated and weekly thereafter. Evidence of severe constriction of the ductus arteriosus or tricuspid regurgitation warrants discontinuation of the indomethacin; lesser degrees of ductal constriction can be treated by decreasing the dose of the medication.

Female↗
PubMed1991

Spontaneous rupture of liver during pregnancy: current therapy.

Spontaneous hepatic rupture secondary to severe pregnancy-induced hypertension is associated with a high rate of maternal and fetal mortality. Numerous types of surgical management have been described, but a uniform surgical approach has not been accepted. The purpose of this review was to examine modes of surgical therapy reported in the literature since 1976, as well as the 11-year experience at our institution. Twenty-eight cases were extracted from the literature and seven more were identified at our institution. The incidence in our population was one per 45,145 live births. Among 27 cases managed by packing and drainage, an 82% overall survival was achieved, whereas only 25% of eight patients undergoing hepatic lobectomy survived (P = .006). Hepatic hemorrhage with persistent hypotension unresponsive to blood products should be managed by evacuating the hematoma, packing the damaged liver, and draining the operative site. More aggressive surgical techniques, such as hepatic artery ligation or hepatic lobectomy, should be reserved for refractory cases.

Adult↗
PubMed1991

Indomethacin for preterm labor: fetal toxicity in a dizygotic twin gestation.

Indomethacin was given for the treatment of preterm labor in a twin pregnancy at a dosage of 200 mg/day for 7 days beginning at 34 weeks and 5 days' gestation. During treatment, one twin developed closure of the ductus arteriosus, tricuspid regurgitation, right ventricular dysfunction, and pericardial effusion. Severe oligohydramnios in both amniotic sacs appeared as well. All findings resolved within 7 days of discontinuation of the medication. The infants, delivered vaginally at 37 weeks' gestation, were alive and well at a 2-month follow-up visit. We believe that all fetuses of mothers treated with indomethacin should be closely monitored for early evidence of decreased amniotic fluid volume and constriction of the ductus arteriosus.

Abnormalities, Drug-Induced↗
PubMed1991

Transvaginal pressure pack for life-threatening pelvic hemorrhage secondary to placenta accreta.

A patient with placenta previa presented with severe vaginal bleeding. Emergency classical cesarean was followed by hysterectomy for placenta accreta. The patient's hemodynamic status continued to deteriorate and she subsequently developed a consumptive coagulopathy secondary to massive hemorrhage. A mushroom-shaped pack, created from a sterile plastic bag filled with Kerlix gauze, was placed in the pelvis and brought out through the vagina. Traction on the pack produced pressure against the pelvic floor, controlling the bleeding. This pack was prepared quickly and removed without complication in the immediate postoperative period.

Adult↗
PubMed1990

Changes in fetal hemodynamics with terbutaline treatment and premature labor.

The aim of this study was to examine the fetal hemodynamic effects of terbutaline treatment and premature labor. Image-directed pulsed and continuous wave Doppler ultrasound studies, using 3.3-MHz and 5-MHz transducers (GE PASII and ATL echocardiographic machines), were used to assess fetal cardiac blood velocities in three groups of pregnancies matched for menstrual age (MA). Group 1: 13 normal pregnancies, mean MA 31 weeks. Group 2: 7 women in premature labor prior to tocolytic therapy, mean MA 32 weeks. Group 3: 8 women treated with terbutaline, average dose 18.8 mg daily, for previous premature labor, mean MA 31 weeks. Heart rate averaged 150 bpm, 135 bpm, and 127 bpm in the terbutaline, premature labor, and normal groups, respectively, and each were significantly different from each other. Products of time velocity interval and heart rate at the aortic valves were 1603 cm +/- 140 cm, 1413 cm +/- 190 cm and 1238 cm +/- 200 cm, and at the mitral valves 1102 cm +/- 170 cm, 812 cm +/- 110 cm, and 878 cm +/- 150 cm in the terbutaline, premature labor, and the normal groups, respectively. Aortic and mitral blood velocity products of time velocity integrals and heart rates were significantly higher (p = 0.01) in the terbutaline group relative to the normal group. In addition, the terbutaline group was significantly higher than the labor group at the mitral valve (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1990

Resolution of severe thrombocytopenia in a pregnant patient with rhesus-negative blood with autoimmune thrombocytopenic purpura after intravenous rhesus immune globulin.

Treatment with 120 micrograms of intravenous rhesus immune globulin at 29 1/2 weeks' gestation resulted in an elevation of the platelet count from 38,000/mm3 to 73,000/mm3 in a patient with rhesus-negative blood with autoimmune thrombocytopenic purpura. Red blood cell immune blockade of the reticuloendothelial system is probably not the primary mechanism by which rhesus immune globulin elevates the platelet count.

Adult↗
PubMed1990

Placental transfer of indomethacin in the human pregnancy.

Little is known about the placental transfer of indomethacin in the human pregnancy. Twenty-six pregnant patients (gestational age, 29.4 +/- 0.5 weeks) were given a 50 mg oral dose of indomethacin 6.08 +/- 0.07 hours before 42 cordocenteses undertaken for standard indications. Maternal serum, fetal serum, and amniotic fluid levels were measured at the time of each procedure. Maternal indomethacin levels were not significantly different from corresponding fetal levels (218 +/- 21 vs 219 +/- 13 ng/ml). The maternal/fetal serum ratio (0.97 +/- 0.07) was not found to vary with gestational age (R = -0.07, p = 0.66). Fetal serum levels were significantly higher than corresponding amniotic fluid levels (219 +/- 16 vs. 21 +/- 2 ng/ml; p less than 0.001). The fetal/amniotic fluid ratio (10.0 +/- 1.2) did not vary with gestational age (R = 0.33, p = 0.11). Indomethacin crosses the human placenta easily throughout gestation; only small amounts of the unchanged drug are found in the amniotic fluid.

Amniotic Fluid↗