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Biomedical subjects

P J Reuwer

Publications and source records attributed to P J Reuwer.

14 recordsLinked to original sources
PubMed2000

[Embolization as treatment for postpartum hemorrhage].

A 33-year-old woman suffered from an early postpartum bleeding (15 hours after delivery) and a 29-year-old patient from a late one (nine days postpartum). Both women were treated with conservative methods including curettage and surgical evacuation of the haematoma in one case. However, blood loss didn't stop. Instead of hysterectomy it was decided to embolize the appropriate cervicouterine branch of the A. uterina in these young women, which appeared to be effective. In case of non-effective treatment of postpartum bleeding, hysterectomy is not the only remaining therapy. Gynaecologists and radiologists together may consider embolization therapy. This has proved to be a minimally invasive and successful treatment. Unlike hysterectomy, the uterus will be preserved, making an additional pregnancy possible.

Adult↗
PubMed1994

A randomized controlled trial on the clinical value of umbilical Doppler velocimetry in antenatal care.

OBJECTIVE: Our aim was to assess the clinical value of umbilical Doppler velocimetry with regard to maternal hospitalization policy, obstetric management, and perinatal outcome. STUDY DESIGN: We conducted a randomized controlled trial in a university hospital population. A total of 1598 women participated, of whom 809 were allocated to the Doppler group and 789 to the control group. In the Doppler group umbilical Doppler studies were performed only when indicated. Abnormal pulsatility index values prompted intensified (clinical) fetal monitoring. In the control group Doppler velocimetry was not available. RESULTS: The use of umbilical Doppler velocimetry did not show any clinical or economical benefit with regard to maternal admission rate and duration or neonatal admission policy and requirements of ventilatory support. Neither did the use of Doppler have any beneficial effect on obstetric management during labor and the occurrence of fetal distress during labor. In the control group a higher perinatal mortality rate was observed. In the Doppler group the risk ratio of perinatal mortality of fetuses and infants weighing > or = 500 gm was 0.45 (95% confidence interval 0.21 to 0.94), as compared with the control group. Neonatal mortality was equal in both groups; therefore the reduction in perinatal mortality was not the result of a delay in timing of fetal death. CONCLUSION: Selective use of umbilical Doppler velocimetry in pregnancies "at fetal risk" may be of benefit in antenatal care by a reduction of perinatal mortality and especially late fetal mortality.

Adult↗
PubMed1990

Normal umbilical artery Doppler sonography does not exclude fetal distress.

Umbilical artery Doppler sonography is advocated as a method for fetal surveillance. Two cases of fetal distress caused by fetal anemia of non-immune origin are presented. In both cases a normal pulsatility index of the umbilical artery was found. It is emphasized that normal umbilical artery Doppler sonography does not exclude fetal distress.

Adult↗
PubMed1989

The validity of screening for small-for-gestational-age and low-weight-for-length infants by Doppler ultrasound.

A prospective blind study assessed the efficacy of Doppler examination of the umbilical arteries (pulsatility index) as a screening procedure for predicting small-for-gestational-age and low-weight-for-length (low ponderal index) infants. Birthweight below the 2.3rd and 10th centile and ponderal index below the 3rd and 10th centile were chosen as 'cut-off' levels. Of pregnant women from our university hospital population, 400 were examined at 28 and 34 weeks gestation. The sensitivity of the test was low, ranging from 16.9 to 41.7% for the different indices. The predictive value of a negative screening test also was unsatisfactory, ranging from 79.6% to 97.9%. It is concluded that a single umbilical artery Doppler examination at 28 or 34 weeks does not satisfy the need in obstetrics for a simple and accurate technique to screen for small-for-gestational-age and low-weight-for-length infants in an unselected obstetric population.

Embryonic and Fetal Development↗
PubMed1989

The performance of a simple scoring system screening for low birthweight infants for gestation in an unselected pregnant population.

Identification of poor fetal growth is an important objective of antenatal care. We evaluated the validity of the Wennergren score to predict small for gestational age and/or underweight for length infants (low ponderal index). To 405 randomly chosen pregnant women from our university hospital population, this numerical scoring system was applied at 28 and 34 weeks of gestation. Birthweights below the 2.3rd and 10th centile and ponderal indexes below the 3rd and 10th centile were used as outcome standards. The sensitivity of predicting SGA infants ranged from 28.4% for infants below the 10th birthweight centile at 28 weeks, to 66.7% for infants below the 2.3rd centile at 34 weeks. Figures for low ponderal indices ranged from 25.0% to 50.0%. In contrast to the promising performance of the Wennergren score as described in the Scandinavian literature, this score was not useful as a screening test for SGA or underweight for length infants in a Dutch hospital population.

Female↗
PubMed1989

Clinical value of screening for fetal growth retardation by Doppler ultrasound.

A representative sample of 405 pregnant women from one university hospital population was examined by Doppler ultrasound of the umbilical arteries to evaluate the validity of this method as a screening procedure for fetal growth retardation (IUGR) in the 28th and 34th week of pregnancy. Birthweight percentile and ponderal index were used as standards for fetal growth. The sensitivity of predicting impaired fetal growth varied between 17% and 33%, depending on the week of pregnancy and the standards used to define growth retardation. It was concluded that this method is too insensitive as a screening tool for the prediction of fetal growth retardation.

Blood Flow Velocity↗
PubMed1987

Intrauterine growth retardation: prediction of perinatal distress by Doppler ultrasound.

To investigate the ability of umbilical artery Doppler findings to identify true cases at risk of fetal distress among 51 pregnancies clinically judged to be compromised by intrauterine growth retardation (IUGR) Doppler data were related to pregnancy outcome, which was classified into three groups-group 1, healthy babies with normal placental function (16 fetuses), group 2, fetuses with definite signs of placental failure (30), and group 3, non-classifiable pregnancies (5). Group 2 was subdivided into 2A, placental failure with manifest perinatal distress (19), and 2B, placental failure without perinatal distress (11). All 19 compromised and distressed fetuses (group 2A) had extremely pathological Doppler findings, even several weeks before fetal distress became apparent by cardiotocography. The Doppler findings in the 11 small-for-dates fetuses without perinatal distress (group 2B) were inconsistently normal or slightly pathological. All 16 normal infants (group 1) had normal antenatal Doppler data. The Doppler technique thus allows accurate and early recognition of those fetuses who will become distressed perinatally. It also helps to identify which fetuses clinically suspected of IUGR have an adequate placental circulation.

Evaluation Studies as Topic↗
PubMed1986

Feto-placental circulatory competence.

Doppler assessment of the pulsatility index (PI) of umbilical artery blood velocities offers promise as a simple, non-invasive method for early diagnosis of placental failure. The present report identifies the hemodynamic factors determining this PI, based on current knowledge of feto-placental physiology. It is postulated that the umbilical artery PI is mainly determined by the ratio of capillary to arterial resistances in the fetal placental circulation. However, the biological PI variations on a minute by minute basis are caused by short-term variations in blood pressure pulsatility. The ratio of resistances declines markedly with advancing pregnancy, indicating that the site of predominant resistance determining the volume of placental blood flow gradually migrates from the peripheral capillary to the arterial compartment. After 28 wk of gestation, umbilical artery PI values decrease below 1, reflecting the normal reserve capacity of the functional capillary bed of the placenta. PI values above 1 in the last trimester reflect a critical enhancement of placental capillary resistance, which must impede blood flow to functional chorionic villi. It is concluded that this Doppler technique may provide a simple method for clinical assessment of placental circulatory competence.

Aorta↗
PubMed1985

Antidiuretic effect of ritodrine with and without beta-adrenergic blockade.

Dose-related effects of ritodrine and ritodrine combined with metoprolol on urinary excretion rate were studied in anesthetized dogs. Urine production was abruptly reduced after a total dose of 4 micrograms.kg-1 of ritodrine. This effect could not be antagonized by metoprolol, although the ritodrine-induced decrease of mean arterial pressure and renal arterial blood flow was significantly inhibited. The possible role of fluid retention during tocolytic treatment, even with beta-adrenergic blockade, in the etiology of pulmonary edema is discussed with a review on recent literature.

Adrenergic beta-Antagonists↗
PubMed1985

Cardiovascular effects of ritodrine are blocked by metoprolol in the anesthetized dog.

Inhibition of ritodrine-induced cardiac and peripheral vascular effects by the beta 1-adrenergic blocker metoprolol, was studied by electromagnetic flow measurements in anesthetized dogs. As expected, metoprolol inhibited the ritodrine-induced/increased cardiac workload and heart rate. Metoprolol also inhibited ritodrine-induced peripheral vasodilation. This leads to questions about the cardiac beta 1-adrenergic selectivity of metoprolol. Regarding earlier studies showing no interference in labor inhibition, the combination of ritodrine and metoprolol might be useful in treatment of preterm labor, while economizing cardiovascular performance centrally as well as peripherally.

Anesthesia↗
PubMed1984

Characteristics of flow velocities in the umbilical arteries, assessed by Doppler ultrasound.

Measuring blood velocities by Doppler ultrasound has introduced a new noninvasive technique into obstetrical diagnostics. This study evaluates the information about fetoplacental hemodynamics that can be extracted from Doppler signals obtained from umbilical arteries. The most significant blood flow characteristic is blood flow pulsatility expressed as pulsatility index (PI). The PI is the difference between systolic and diastolic velocity, divided by the mean velocity. The PI strongly correlates with downstream impedance to flow. It is demonstrated that sophisticated spectral analysis of the Doppler signals has no practical advantages over the simple zero-crossing technique for establishing PI values, since blood flow in umbilical arteries has a blunt-to-flat profile. This study shows that the PI is a gestational-age-related, intra- and inter-observer-reproducible variable. The significant decrease of PI values with advancing gestational age reflects a progressive reduction of placental vascular resistance to umbilical blood flow. The PI holds promise as a simple method for early diagnosis of impaired umbilical circulation.

Blood Flow Velocity↗
PubMed1984

Doppler assessment of the fetoplacental circulation in normal and growth-retarded fetuses.

The Pulsatility Index (PI) of Doppler flow signals from umbilical arteries was used to study flow resistance of the placental villous circulation. A preliminary reference curve of PI values in normal pregnancy was composed from 23 healthy women examined every 2 wk from the 16th postmenstrual week until delivery. The gestational age-related decrease of PI values reflects a reduction of flow resistance in the placental villous circulation. In small-for-date fetuses significantly increased PI values were found, indicating that this simple technique may permit an early diagnosis of compromised fetoplacental circulation, even several weeks to months before fetal growth retardation is clinically presumed.

Blood Flow Velocity↗
PubMedDate not supplied

Dose-related effects of fenoterol and ritodrine in 10 peripheral vascular beds of the anesthetized dog.

Dose-response curves of the uterine relaxants fenoterol and ritodrine were established for vascular conductance in 10 peripheral arterial beds in anesthetized dogs. Vascular sensitivity was expressed as (E)D50 of conductance response. Fenoterol induced strong vasodilation in all arterial beds except in the kidneys. The gastrointestinal vessels are significantly more sensitive to fenoterol than are muscle and brain vessels. Ritodrine induced strong vasodilation in all arterial beds except in the kidneys and the liver. The vascular sensitivity spectrum of ritodrine differs from that of fenoterol. On a molecular basis fenoterol was 66 times as potent as ritodrine if arterial pressure reduction was used as criterion. When (E)D50 values of vascular conductances of both drugs were plotted against arterial pressure reduction as reference, the gastrointestinal vessels (left gastric, splenic, gastroduodenal, proper hepatic, and superior mesenteric arteries) appeared to be significantly more sensitive to fenoterol than to ritodrine. In contrast, vascular sensitivity in the myocardium, striated muscles, and brain (left coronary, common carotid, femoral, and vertebral arteries) was not statistically different for the two drugs.

Anesthesia↗