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Biomedical subjects

R C Cefalo

Publications and source records attributed to R C Cefalo.

At least 55 records · Page 3Linked to original sources

Effects of terbutaline sulfate on fetal cardiac function.

An isolated heart preparation was used to study the effects of terbutaline sulfate (Brethine) on fetal cardiac function. Pregnant guinea pigs received daily subcutaneous injections of terbutaline for 10 day, whereas a control group received placebo injections. Fetal guinea pig hearts were evaluated for cariodynamic and pathologic differences. Fetuses exposed to terbutaline demonstrated a higher mean heart rate (p less than 0.01), a higher mean heart weight (p less than 0.05), a higher mean heart weight/body weight ratio (p less than 0.01), and a trend toward higher left ventricular systolic pressure levels (p less than 0.1). These hemodynamic responses in fetuses exposed to terbutaline may result in increased functional demands that may predispose myocardial tissue to damage.

Animals↗

Hypersensitivity to magnesium sulfate.

Two patients who were labor and delivery nurses were treated with intravenous magnesium sulfate because of preterm labor. Both patients had a rapid and sudden onset of an urticarial eruption. The eruption cleared when magnesium sulfate was discontinued. The reactions did not affect the mothers or fetuses, but other therapies to stop labor were necessary.

Adult↗

Maternal death from carotid artery thrombosis associated with the syndrome of hemolysis, elevated liver function, and low platelets.

A case is presented of cerebral infarction secondary to carotid artery thrombosis in a patient with hemolysis, elevated liver function, and low platelets (HELLP) syndrome. The patient's rebound thrombocytosis may have contributed to a hypercoagulable state. Severe preeclamptic patients with HELLP syndrome who experience a reactive thrombocytosis may represent a subset of women who have postpartum thrombosis.

Adult↗

Pseudotumor cerebri and pregnancy.

We reviewed 11 pregnancies complicated by pseudotumor cerebri over a 6-year period for an incidence of approximately 1 in 870 births. No pregnancy was adversely affected, but symptoms of pseudotumor increased in 9 of 11 pregnancies. All patients were managed medically, 9 of 11 with analgesics and diuretics. Two cases required steroid therapy.

Acetaminophen↗

The use of fetal and anencephalic tissue for transplantation.

Advances in transplantation have extended the life and relieved the suffering of thousands of individuals. The prospect of being able to use tissues from embryos, as well as from anencephalic newborns, offers the promise of further relief of suffering. However, these possibilities raise significant moral and public policy issues. The question arises of the extent to which those who disapprove of abortion may make use of tissues derived from abortion in order to treat serious diseases. This essay argues that, with proper safeguards, such tissue can be used without cooperating in abortion. That is, even those who oppose abortion can benefit from the use of tissue procured during abortion. Questions also arise regarding the probity of maintaining a pregnancy in order to produce an anencephalic newborn whose biological existence will be maintained so as better to secure organs once death is declared. It is argued that, since no harm can be done to a being that has neither a sense of self or the capacity to feel pain, and since women have a right to forego abortions, there is no legitimate ground for opposing women's seeking meaning in their pregnancy through maximizing the opportunity of others to use the organs of their anencephalic newborn once death has been declared. Finally, it is argued that, since the capacities for sentience, a minimal condition for personhood, are never realized by an anencephalic, the entity has never been alive as a person. Therefore, there should be no opposition in principle to aborting anencephalics nor, after proper declaration, to making their organs available as one would after whole-brain death, despite the continued functioning of the brain stem.

Aborted Fetus↗

The zygote: to be or not be a person.

It is no longer possible to claim that the biological characteristics of the future adult are already determined at conception. After all, a zygote may develop into a hydatidiform mole rather than into a human being. The development of an individual human person is determined by genetically and non-genetically coded molecules within the embryo, together with the influence of the maternal environment. Consequently, it is an error to regard the zygote's chromosomal (and other) DNA as sufficient to determine the uniqueness of the future individual.

Abortion, Legal↗

Pregnancies among physicians. A historical cohort study.

Sixty-seven pregnancies in practicing physicians were compared with 201 pregnancies in nonphysicians in a historical cohort study. All subjects were cared for and delivered by the same obstetricians. Physician and nonphysician pregnancies of similar socioeconomic status were matched for age, race and parity. After statistically controlling for alcohol and tobacco use and adequacy of prenatal care, physicians had a 1.86 (1.00, 3.46) relative risk of an adverse pregnancy outcome. Physicians were at a 4.0 (1.58, 10.1) and 2.33 (0.93, 5.8) times higher risk for preterm labor and delivery than were nonphysicians. Pregnancies in physicians were found to be similar to those in nonphysicians in the use of obstetric technology except for an increased number of ultrasound examinations among physicians. These results suggest that physicians are at increased risk for an adverse pregnancy outcome and should be considered and treated as a high-risk obstetric group.

Adult↗

The effect of pregnancy on metabolic responses during rest, immersion, and aerobic exercise in the water.

To examine the effects of advancing pregnancy on metabolic responses, 12 women, who were recruited early in pregnancy, were studied during 20 minutes of immersion in 30 degrees C water, followed by 20 minutes of exercise in the water (60% of predicted maximal capacity) and 20 minutes of lateral supine recovery. Each subject completed the trials during the fifteenth, twenty-fifth, and thirty-fifth weeks of pregnancy, as well as a control period 8 to 10 weeks post partum. Resting oxygen uptake increased with advancing pregnancy. Resting oxygen uptake was higher in the water than on land but was not altered by pregnancy. Exercise oxygen uptakes were similar for all trials, but the work load required to elicit the VO2 decreased during the thirty-fifth week of pregnancy. Exercise heart rates followed the same pattern as oxygen uptake. Lactate concentrations declined with advancing pregnancy after exercise. Blood glucose levels were normal for pregnancy but declined slightly during exercise. Blood triglyceride levels were elevated with exercise, with a tendency to increase with advancing pregnancy. Resting plasma cortisol concentrations increased with pregnancy but remained lower during immersion and exercise. These results suggest that pregnancy significantly alters metabolic responses to exercise in the water.

Adult↗

The effect of human amniotic fluid on the isolated perfused rat heart.

To test the hypothesis that amniotic fluid directly affects cardiac function, isolated rat hearts were perfused with varying concentrations of centrifuged and filtered human amniotic fluid. The most consistent change seen was a dose-dependent decrease in coronary flow rate. With 10% concentrations, a wide spectrum of changes was seen in both a positive and a negative direction for left ventricular pressure and change in pressure with respect to time, which were closely correlated with the degree of decrease in coronary flow rate. If amniotic fluid has a direct role in depressing cardiac function in amniotic fluid embolism, it may act by decreasing coronary flow rather than by directly suppressing myocardial activity.

Amniotic Fluid↗

Immunoglobulin levels in fetal anatomic compartments.

Immunoglobulins G, M, and A were found in varying concentrations in four different human fetal anatomic compartments of 17 fetuses in the absence of apparent infection. The highest levels were noted in the thoracic cavity.

Ascites↗

Cardiovascular responses of pregnant women during aerobic exercise in water: a longitudinal study.

To determine the effects of pregnancy on the cardiovascular responses to immersion and exercise in water, 12 women completed 20 min of immersion and 20 min of bicycle ergometry at 60% predicted VO2max in 30 degrees C water during their 15th, 25th, and 35th week of pregnancy as well as 8-10 weeks post partum. Immersion lowered the resting heart rate approximately 8 bts/min (P less than 0.05). Exercise in water also resulted in a lower heart rate as compared with the same level of exercise on land (132 +/- 4 vs 149 +/- 6 bts/min; P less than 0.05). Both the rest and exercise heart rate responses were independent of duration of pregnancy or pregnancy status. Post partum exercise cardiac output averaged 9.9 +/- 0.4 l/min, significantly lower (P less than 0.05) than the 15th (12.7 +/- 0.5), 25th (14.7 +/- 0.5), or 35th week (15.1 +/- 0.7 l/min). Total peripheral resistance was greatest (P less than 0.05) post partum (657 +/- 29 dyn.s/cm5) compared with either the 15th (515 +/- 27), 25th (407 +/- 18), or 35th week (450 +/- 23). The results indicate that exercise in water lowers the heart rate compared with land exercise at the same metabolic rate. The combined effect of exercise, water, and pregnancy may elevate the cardiac output more than expected on land, but the same general pattern of exercise response will be evident throughout the duration of pregnancy. The results further suggest that water alters the heart rate and blood pressure responses such that land-derived exercise target heart rates should not be used to prescribe exercise intensity in water.

Adult↗

Elevated maternal serum alpha-fetoprotein with normal ultrasound: is amniocentesis always appropriate? A review of 26,069 screened patients.

We reviewed our experience with a policy of revising the estimated probability of an open neural tube defect for those cases in which maternal serum alpha-fetoprotein (MSAFP) was elevated and the ultrasound examination was normal. Assuming a sensitivity for the ultrasound diagnosis of neural tube defects of 90%, the risk estimate derived from the MSAFP was reduced by that amount when ultrasound was adequate and normal. When counseled regarding this revised risk estimate, 67% of our patients declined amniocentesis. The sensitivity for the ultrasound diagnosis of anencephaly in our series was 100%; for open spine defects, 80%; and for all open neural tube defects, 91%. The two patients in whom an open spine defect was not detected with ultrasound had elevated revised risk estimates. When appropriate criteria are met, the estimated sensitivity of ultrasound in diagnosing open neural tube defects may be used for counseling patients at risk for a fetus with an open neural tube defect.

Amniocentesis↗

Fetal and uterine responses to immersion and exercise.

We evaluated the responses of the fetal-maternal unit to immersion and exercise in the water at 15, 25, and 35 weeks' gestation. As seen by underwater ultrasound, fetuses demonstrated body, limb, and breathing movements. Fetal heart rates (FHRs) were normal, and unchanged from those at rest, during maternal exercise in the water at 60% VO2 maximum. In 21 of 23 cases, post-exercise nonstress tests were reactive within ten minutes. There was no uterine activity seen at either 25 or 35 weeks' gestation. Maternal serum alpha-fetoprotein was unaffected at all gestational ages. Neither maternal temperature nor calculated plasma volume changed during exercise. This general lack of effect contrasts with results from other studies involving similar levels of exercise on land. We speculate that the plasma volume expansion with immersion contributes to the normal FHR responses seen in this study.

Adult↗

Elevated maternal serum alpha-fetoprotein with oligohydramnios: ultrasound evaluation and outcome.

Nineteen pregnancies evaluated for elevated maternal serum alpha-fetoprotein levels were found to have moderate to severe oligohydramnios. There were no survivors among six fetuses with ultrasound-diagnosed urinary tract anomalies. We followed 11 of the remaining 13 pregnancies with serial ultrasound examinations. When the second ultrasound examination demonstrated severely decreased amniotic fluid, the outcome was always poor (intrauterine death, perinatal death, or fetal deformations). Of the five cases in which the second ultrasound showed normal to moderately decreased fluid, there were four surviving infants. When no primary malformations are seen on the initial ultrasound examination, serial ultrasound evaluations of amniotic fluid volume help predict the pregnancy outcome.

Abortion, Induced↗

Determinants of fetal heart rate response to vibroacoustic stimulation in labor.

To determine whether the fetal heart accelerates in response to a sound stimulus in labor, 40 women at various stages of labor were chosen at random to receive either a vibroacoustic stimulus or sham stimulus over the fetal head. Subsequent fetal heart rate (FHR) accelerations occurred to a significantly greater extent in study patients. One hundred thirty-two high- and low-risk patients were studied to determine correlations between the acceleration response and other maternal and fetal variables. There was a statistically significant negative correlation between the heart rate response to stimulation and three maternal variables: the degree of cervical dilation, the presence of ruptured membranes, and use of epidural anesthesia. The degree of fetal response did not correlate significantly with fetal distress at delivery or abnormal FHR tracings at the time of stimulation. Fewer than one-fifth of the fetuses manifested variable heart rate decelerations after the stimulation. In light of possible risks, the clinical use of the fetal acoustic stimulation test in labor should wait until its diagnostic value is better defined.

Acoustic Stimulation↗

Atenolol and short umbilical cords.

Umbilical cord length may be a function of fetal movement. Agents that cause decreased fetal movement may cause short umbilical cords. This investigation examined the effect of the beta-blocker atenolol on umbilical cord length in rabbits. Fetuses of rabbits treated with atenolol had significantly shorter cords than control animals (p less than or equal to 0.0005). Since short cords are associated with problems in labor, low Apgar scores, and abruption, we recommend careful surveillance of mothers and fetuses who are given beta-blocking agents in the first 30 weeks of pregnancy.

Animals↗

Effects of plasma on the platelet antiaggregatory action of prostacyclin in pregnancy.

Platelet-poor plasma from 13 nonpregnant, 33 normally pregnant, and eight preeclamptic women was incubated with prostacyclin. The ability of platelet-poor plasma to diminish the antiaggregatory effect of prostacyclin was assessed by measuring this effect on arachidonic acid-induced platelet aggregation. Platelet aggregation greater than 95% in response to arachidonic acid was observed when incubated plasma without exogenous prostacyclin was assayed. When prostacyclin and platelet-poor plasma were preincubated together, subsequent arachidonic acid-induced platelet aggregation measured 9.6% in samples from nonpregnant patients, 40.3% in samples from normally pregnant patients, and 78.2% in samples from patients with preeclampsia. The ability of exogenous prostacyclin to inhibit arachidonic acid-induced platelet aggregation was significantly different in the presence of plasma from nonpregnant, normally pregnant, and preeclamptic women. These observations suggest that a plasma factor may affect the action of prostacyclin during pregnancy.

Arachidonic Acid↗

Preconceptional health promotion: a focus for obstetric care.

Women contemplating pregnancy generally dream of a healthy infant yet are unaware of the critical significance of the weeks of organogenesis that precede entry into prenatal care. Programs of preconceptional health promotion provide women with information on the potential relatedness of prepregnancy lifestyle choices, health status, and pregnancy outcomes. We review the significance of this relationship and offer a framework for exploring preconceptional issues with women contemplating pregnancy.

Environmental Exposure↗