Biomedical subjects

L D Devoe

Publications and source records attributed to L D Devoe.

At least 91 records · Page 5Linked to original sources

PubMed1989

Monitoring intrauterine pressure during active labor. A prospective comparison of two methods.

Conventional recording of intrapartum uterine activity uses fluid-filled internal catheter systems requiring periodic maintenance. An intrauterine pressure catheter system, the INTRAN, uses an electronic pressure sensor and theoretically could obtain satisfactory uterine recordings with less maintenance. Simultaneous recordings with the INTRAN and standard fluid-filled systems were made in 40 third-trimester patients using comparably calibrated electronic monitoring systems. Comparisons of the recordings from each patient showed similar mean baseline uterine tone, contraction interval and duration. Mean peak uterine pressures were significantly higher with the INTRAN system (63 vs. 56 mm Hg). Coefficients of correlation for contraction interval, duration, peak intrauterine pressure and resting tone were .99, .87, .84 and .34, respectively. Both systems detected abnormal uterine activity equally well. Major technical failures were equally frequent with both systems; however, the fluid-filled catheters required more frequent readjustment.

Adolescent↗

PubMed1988

Prognostic components of computerized fetal biophysical testing.

Fetal biophysical testing with arbitrary scores for fetal heart rate (FHR), breathing movements, body movements, tone, and amniotic fluid volume has not proved to be highly sensitive or significantly better than FHR testing alone. Using a computerized analysis system for simultaneously acquired biophysical variables, we studied 200 high-risk fetuses near term. The dynamic parameters obtained for each fetus were compared with established nomograms, and overall test results correlated with the presence or absence of perinatal mortality, fetal distress, a 5-minute Apgar score less than 7, and intrauterine growth retardation for those delivered within 7 days of the last test. A test was considered abnormal if two or more parameters fell more than 2 standard deviations from the population mean. A decreased incidence of fetal body movements, amniotic fluid volume, and frequency of FHR acceleration were the most common individual test abnormalities. Test sensitivity (86%), specificity (89%), positive predictive value (75%), and negative predictive value (93%) exceeded those of the "standard" scoring approach and correctly identified all fetuses with malformation, perinatal death, and 19 of 22 fetuses with intrauterine growth retardation.

Amniotic Fluid↗

PubMed1988

Does the onset of spontaneous labor at term influence fetal biophysical test parameters?

Recent data suggest that fetal breathing movement incidence declines while fetal heart rate (FHR) and body movement incidence do not change within 72 hours of spontaneous term labor. We conducted a retrospective study to determine whether the length of time from testing to spontaneous labor onset could influence these biophysical test parameters. Eighty-one normal term fetuses underwent 60-minute tests 1-40 days before the onset of spontaneous labor: 41 were tested within 7 days of labor (19 within 3 days and 22 within 4-7 days) and 40 were tested more than 7 days before labor. We simultaneously acquired and analyzed FHR baseline, frequency of accelerations between ten to 14 beats per minute and more than 15 beats per minute in amplitude, percent of time spent in breathing and moving, and fetal breath rate. These biophysical parameters were not significantly different between the groups, implying that they may continue to provide clinically useful information in the prelabor period.

Female↗

PubMed1988

Computerized analysis of resting fetal heart rate tracings.

Previous attempts to computerize the analysis of fetal heart rate (FHR) using mainframe or minicomputers were not accepted in routine clinical practice because of their complexity, cost, and lack of validation. We describe the first practical, inexpensive system integrated into a clinical protocol that analyzes and documents FHR baseline, long-term variability, and episodic events using a standard microcomputer. A comparison of computerized and manual analyses of 284 nonstress tests (NSTs) of high-risk patients revealed no significant differences in determining the number of acceleration and deceleration events and mean FHR baseline. Long-term variability and other reported data could not be compared for lack of manual techniques. The combination of standardized analysis and quantified data may improve the predictive value of the computerized NST compared with the visually analyzed NST. Other benefits include computerized archiving, data transmission by telephone, and linkage to a perinatal data base.

Diagnosis, Computer-Assisted↗

PubMed1987

Evidence for histidyl and carboxy groups at the active site of the human placental Na+-H+ exchanger.

The Na+-H+ exchanger of the human placental brush-border membrane was inhibited by pretreatment of the membrane vesicles with a histidyl-group-specific reagent, diethyl pyrocarbonate and with a carboxy-group-specific reagent, N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline. In both cases the inhibition was irreversible and non-competitive in nature. But, if the membrane vesicles were treated with these reagents in the presence of amiloride, cimetidine or clonidine, there was no inhibition. Since amiloride, cimetidine and clonidine all interact with the active site of the exchanger in a mutually exclusive manner, the findings provide evidence for the presence of essential histidyl and carboxy groups at or near the active site of the human placental Na+-H+ exchanger. This conclusion was further substantiated by the findings that Rose Bengal-catalysed photo-oxidation of histidine residues as well as covalent modification of carboxy residues with NN'-dicyclohexylcarbodi-imide irreversibly inhibited the Na+-H+ exchanger and that amiloride protected the exchanger from inhibition caused by NN'-dicyclohexylcarbodi-imide.

Amiloride↗

PubMed1987

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy.

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31% in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.

Adolescent↗

PubMed1987

A prospective comparative study of the extended nonstress test and the nipple stimulation contraction stress test.

The nonstress test and the nipple stimulation contraction stress test were performed at the Medical College of Georgia and the University of Mississippi Medical Center, with the use of common maternal state protocols, minimum criteria for baseline fetal heart rate reactivity, and follow-up of abnormal test results. At the Medical College of Georgia, 656 patients were studied with nonstress tests used as the primary test, whereas at the University of Mississippi Medical Center, 614 patients were managed with the nipple stimulation contraction stress test used as the primary test. Both populations were comparable in regard to pregnancy complications, gestational age, birth weight, perinatal outcomes, cesarean section rates, and the incidence of positive contraction stress tests. Specificity and positive and negative predictive values were similar for both tests. The extended nonstress test had higher sensitivity but also required significantly longer mean duration of testing. The corrected perinatal mortality rate for a reactive nonstress test or negative nipple stimulation contraction stress test was zero within one week of the last test. We conclude that both tests provide excellent primary methods of fetal surveillance and that the decision to use one test rather than the other should be made on the basis of considerations of cost, convenience, time availability, and the presence of specific test contraindications or pregnancy complications.

Breast↗

PubMed1987

The effects of long- and short-term maternal caffeine ingestion on human fetal breathing and body movements in term gestations.

The possible effects of long- and short-term maternal ingestion of caffeine during normal human pregnancy on the breathing and body movements of third-trimester fetuses were studied in 14 patients, selected by a dietary questionnaire, and divided into two equal groups: high consumers (greater than 500 mg/day) (group 1) and low consumers (less than 250 mg/day) (group 2). All mothers followed a standard study protocol and underwent overnight fasting; studies began with a 30-minute control period, followed by oral administration of 200 mg caffeine, and a 180-minute subsequent observation period with continued maternal fasting. Blood samples for glucose and caffeine were obtained every 30 minutes and continuous recording of fetal breathing and body movements were entered on a microcomputer for off-line analysis. The two groups were similar for all obstetric outcome features. Plasma glucose levels were similar and constant in both groups whereas caffeine levels increased significantly at 60 minutes after administration; mean plasma caffeine levels were significantly higher in group 1 than in group 2 at all intervals. Fetal breathing rates and body movement incidences were similar in both groups before and after caffeine administration. Fetal breathing movement incidence decreased significantly in group 2 but was sustained at baseline levels in group 1 throughout the study. High long-term ingestion of caffeine during pregnancy is associated with higher maternal plasma caffeine levels and fetal breathing activity when compared with low caffeine ingestion. Short-term administration of 200 mg caffeine does not appear to have a significant physiologic impact on these activities.

Caffeine↗

PubMed1987

The effects of maternal ambulation on the nonstress test.

Using a recently developed noninvasive telemetry device (model 8240A, Hewlett-Packard Co., Palo Alto, California), we studied, under controlled conditions, the effects of maternal ambulation on the nonstress test patterns of 100 near-term high-risk pregnancies, randomly divided into two equal groups who underwent three alternating 30-minute periods of ambulation and bed rest, beginning either with ambulation (group 1) or bed rest (group 2). Fetal heart rate data were captured and analyzed by a programmed microcomputer for group mean 30-minute fetal heart rate baseline rates and variability and incidences and dimensions of fetal heart rate accelerations and decelerations. Both groups were similar for the maternal and perinatal data examined. The fetal heart rate parameters analyzed were similar within and between each group during each 30-minute testing segment. No episodes of sustained tachycardia or bradycardia were observed. Although 13 fetuses in each group exhibited variable or late decelerations, the incidence of decelerations was no different during periods of rest or ambulation. Maternal ambulation does not elicit abnormal fetal heart rate responses in most high-risk fetuses and may be an acceptable alternative to conventional nonstress test conditions.

Female↗

PubMed1987

Pleural effusions and pulmonary hypoplasia.

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Adult↗

PubMed1987

Fetal biophysical testing. The effects of prolonged maternal fasting and the oral glucose tolerance test.

Fetal biophysical testing incorporates observations of the fetal heart rate (FHR), fetal breathing movements (FBMs) and fetal trunkal movements (FTMs). These parameters were examined during maternal fasting and glucose loading. Thirty normal term gravidas were studied during a 210-minute session, of which the first 30 minutes served as a fasting control period, following which 20 (group G) received 100 g oral glucose, while 10 (group F) continued fasting. Serum glucose levels in both groups were determined every 30 minutes. FHR, FBMs and FTMs were recorded concurrently using abdominal electrocardiography and real-time ultrasonography and entered on line into a microcomputer. Offline data analysis provided mean 30-minute baseline FHRs, acceleration counts, FBM incidences, FBM rates and FTM incidences. Both groups were similar for gestational age, birth weight and perinatal outcomes. Mean 30-minute FHR baseline was unchanged and similar in both groups. Mean 30-minute FHR acceleration counts and FTM incidences were significantly higher in group F, while FBM incidences and rates were significantly higher in group G. While biophysical testing can be conducted under either set of maternal conditions, different normal standards must be employed, test length must be sufficient to account for normal biologic variations, and biophysical parameters must be monitored concurrently.

Electrocardiography↗

PubMed1987

Outcome of fetal meningomyelocele after vaginal delivery.

Eight neonates with meningomyelocele were delivered vaginally. Diagnosis of meningomyelocele was made by ultrasonography during the latter half of pregnancy in three patients. The remaining five did not have ultrasound examination during the antenatal period. None of the meningomyelocele sacs (less than or equal to 4 cm in diameter) was ruptured at the time of delivery. Cesarean section may not be necessary for all fetuses with meningomyelocele.

Adult↗

PubMed1987

Clinical significance of fetal tachypnea during antepartum biophysical testing.

Fetal tachypnea has been regarded as a rare finding with a poor perinatal prognosis. Eighteen cases of fetal tachypnea were noted during the biophysical tests of 200 patients. Biophysical testing consisted of concurrent ultrasound observations of fetal breathing and body movements and electronic monitoring of fetal heart rate, coupled with determinations of fetal tone and amniotic fluid volume. Fetal breathing movement frequency and rate, fetal trunkal movement frequency, and baseline fetal heart rate were analyzed on a programmed microcomputer. The mean (+/- SD) breathing rate was 68.2 +/- 6.4 breaths per minute; mean breathing frequency, 55 +/- 22.6%; mean baseline heart rate, 141 +/- 8 beats per minute; mean trunkal movement incidence, 5.5 +/- 2.6%; and mean acceleration frequency, 14.6 +/- 9.8 per hour. No fetus was apneic for more than eight minutes, and there were no significant correlations between fetal breath rates and the other biophysical parameters. There were no perinatal deaths. Seven fetuses experienced perinatal morbidity, of whom five had other abnormalities on biophysical testing. This study indicates that fetal tachypnea occurs more often than previously believed and does not generally signify fetal compromise unless other biophysical abnormalities are also present.

Female↗

PubMed1987

Comparison of uterine activity induced by nipple stimulation and oxytocin.

Intermittent nipple stimulation has been proposed as a substitute for exogenous oxytocin infusion in the performance of contraction stress tests. To compare the uterine activity produced by these two methods, we studied a group of 45 term pregnant women undergoing indicated inductions of labor. Twenty-five patients had nipple stimulation and 20 patients received oxytocin infusions according to a study protocol. The two groups were similar in all obstetric parameters. Pre- and posttest uterine activity was measured by internal tocodynamometry and quantified in Montevideo units. A significant increase in uterine activity occurred in both groups (P less than .01). Regular uterine activity (three contractions in ten minutes) was achieved more rapidly (P less than .005), but at a lower level (P less than .001) in the nipple stimulation group. Pre- and posttest tonus did not change significantly in either group. In the nipple stimulation group, five patients (20%) did not achieve adequate contraction patterns after 15 stimulation-rest cycles (a total of 110 minutes) and three subjects (12%) experienced uterine hyperstimulation. These observations suggest that exogenous oxytocin and intermittent nipple stimulation may not have equivalent effects on uterine contractility. Therefore, it may not be justified to substitute one technique for the other or to use the same criteria for interpretation of contraction stress tests produced by both techniques.

Adult↗

PubMed1986

Interaction of clonidine with human placental Na+ -H+ exchanger.

The effect of clonidine, an alpha 2-adrenergic receptor agonist, on the Na+ -H+ exchanger in human placental brush-border membrane vesicles was examined. The exchanger was inhibited by clonidine. The inhibition was freely reversible, and the apparent inhibition constant for the process was 250 microM. The nature of inhibition was found to be competitive with respect to Na+. The Dixon plot (1/v versus clonidine concentration) was linear (r2 = 0.998), indicating the interaction of the drug with a single site on the exchanger protein. Similar kinetic analyses with amiloride, a potassium-sparing diuretic, and cimetidine, a histamine type II receptor antagonist, revealed that these drugs also inhibited the Na+ -H+ exchanger by interacting with a single site on the protein. The presence of clonidine increased the intercepts without affecting the slopes of the l/v versus amiloride concentration and the l/v versus cimetidine concentration plots. These results demonstrate that all three drugs, amiloride, cimetidine and clonidine, interact with the human placental Na+-H+ exchanger at a single site in a mutually exclusive manner, and the site of interaction is identical with the Na+-binding site on the external surface of the exchanger protein.

Amiloride↗

PubMed1986

Characterization of tryptophan transport in human placental brush-border membrane vesicles.

The characteristics of tryptophan uptake in isolated human placental brush-border membrane vesicles were investigated. Tryptophan uptake in these vesicles was predominantly Na+-independent. Uptake of tryptophan as measured with short incubations occurred exclusively by a carrier-mediated process, but significant binding of this amino acid to the membrane vesicles was observed with longer incubations. The carrier-mediated system obeyed Michaelis-Menten kinetics, with an apparent affinity constant of 12.7 +/- 1.0 microM and a maximal velocity of 91 +/- 5 pmol/15 s per mg of protein. The kinetic constants were similar in the presence and absence of a Na+ gradient. Competition experiments showed that tryptophan uptake was effectively inhibited by many neutral amino acids except proline, hydroxyproline and 2-(methylamino)isobutyric acid. The inhibitory amino acids included aromatic amino acids as well as other system-1-specific amino acids (system 1 refers to the classical L system, according to the most recent nomenclature of amino acid transport systems). The transport system showed very low affinity for D-isomers, was not affected by phloretin or glucose but was inhibited by p-azidophenylalanine and N-ethylmaleimide. The uptake rates were only minimally affected by change in pH over the range 4.5-8.0. Tryptophan uptake markedly responded to trans-stimulation, and the amino acids capable of causing trans-stimulation included all amino acids with system-1-specificity. The patterns of inhibition of uptake of tryptophan and leucine by various amino acids were very similar. We conclude that system t, which is specific for aromatic amino acids, is absent from human placenta and that tryptophan transport in this tissue occurs via system 1, which has very broad specificity.

Amino Acids↗

PubMed1986

Maternal dietary substrates and human fetal biophysical activity. I. The effects of tryptophan and glucose on fetal breathing movements.

To study the effects of L-tryptophan and glucose on fetal breathing activity, we examined 40 women with normal term pregnancies, randomly assigned to four equal groups who either continued fasting (group C), received 1 gm of oral tryptophan (group T), received 100 gm of oral glucose (group G), or received both substrates (group T + G). Studies lasted 210 minutes, during which fetal breathing movements were observed with real-time ultrasonography and entered and analyzed for incidence, rate, and variability on a microcomputer. Plasma glucose and tryptophan levels were determined every 30 minutes. The incidence of fetal breathing movements declined in group C and rose significantly in the other groups. Breathing rates were unchanged in groups C and T but rose significantly in groups G and T + G during peak breathing intervals. Breath interval variability did not change significantly in any study group. Maternal administration of tryptophan is associated with an alteration in fetal breathing activity but to a lesser degree than that observed after maternal glucose loading.

Administration, Oral↗

PubMed1986

Sequential nonstress testing with use of each fetus as its own control.

The sequential nonstress tests of 126 high-risk fetuses were assessed for baseline fetal heart rate, acceleration frequency, amplitude, and duration and the observance of fetal heart rate decelerations. In 108 fetuses (563 tests) with normal perinatal outcomes, no significant trends in these parameters were found. In 18 fetuses (104 tests) with perinatal compromise, 16 had significantly declining acceleration frequencies, 15 had decreasing acceleration duration, four had rising mean baseline rates, and seven, in their last test before delivery, had repetitive late or severe variable decelerations. The last tests of 11 of these 18 fetuses met institutional criteria for reactivity. When the nonstress tests of compromised fetuses were viewed sequentially, acceleration frequency declined by an average of 59% and acceleration duration by an average of 40%. Sequential assessment of the nonstress test, when compared with the use of standard reactivity criteria, improved test sensitivity from 39% to 89% and negative predictive value from 91% to 98%. We conclude that sequential nonstress test assessment in individual fetuses may improve the diagnostic value of this modality and lead to earlier recognition of fetal compromise.

Female↗