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Biomedical subjects

T R Easterling

Publications and source records attributed to T R Easterling.

At least 19 recordsLinked to original sources
PubMed1992

Breech extraction of low-birth-weight second twins: can cesarean section be justified?

The outcomes of 54 breech-extracted second twins weighing between 750 and 2000 gm were compared with the outcomes of their siblings and of 43 sets of twins delivered by cesarean section for malpresentation. Vaginally delivered first twins had fewer days of mechanical ventilation and oxygen therapy than their breech-extracted siblings (p = 0.004). There were no significant differences in any measures of neonatal outcome when breech-extracted twins were compared with second twins delivered by cesarean section. We conclude that routine cesarean section is not justified for nonvertex second twins expected to weigh less than 2000 gm.

Breech Presentation↗
PubMed1992

Effect of orthostatic stress on umbilical Doppler waveforms in normal and hypertensive pregnancies.

OBJECTIVE: Our study examined the effects of orthostatic stress and maternal hemodynamics on umbilical systolic/diastolic ratios in normal and hypertensive pregnancies. STUDY DESIGN: Eighteen normal and 20 hypertensive third-trimester pregnancies were examined in the left lateral recumbent, sitting, and standing positions. Measurements included umbilical systolic/diastolic ratio, maternal blood pressure, maternal cardiac output, and maternal total peripheral resistance. RESULTS: All patients demonstrated a fall in cardiac output and a rise in total peripheral resistance with standing. No change in systolic/diastolic ratio occurred with change to the upright position in patients with normotension. Patients with hypertension exhibited a significant increase in umbilical systolic/diastolic ratio with postural change. The increase was more marked in women who had hypertension with elevated peripheral resistance. CONCLUSION: Patients with hypertension are at increased risk of elevation of systolic/diastolic ratio with postural change; women with high-resistance hypertension may be at highest risk.

Diastole↗
PubMed1992

Pregnancy loss and thrombosis with protein C deficiency.

OBJECTIVES: Protein C inhibits coagulation and promotes fibrinolysis. This study investigates the association between protein C deficiency and pregnancy loss, thrombosis in pregnancy, and thrombosis with oral contraception. STUDY DESIGN: Fifteen protein C--deficient patients and 37 controls from a single kindred were studied. An obstetric history was obtained by telephone. Data were analyzed by logistic regression, Fisher's exact test, and Student t test. RESULTS: Protein C--deficient women experienced a 33% pregnancy loss versus 19% in the controls (not significant). Thromboembolism during pregnancy in protein C--deficient women was 33% (45% in those not receiving prophylactic anticoagulation) versus 5% in controls (odds ratio 7.37, p = 0.026). Five of 12 protein C--deficient women using oral contraception developed thrombosis versus 0 of 33 controls. The risk of thrombosis for protein C--deficient women using oral contraception is increased (p < 0.001). CONCLUSIONS: Perinatal outcome is not statistically different with protein C deficiency. Protein C deficiency increases the risk of thrombosis during pregnancy and with oral contraception. Prophylactic heparin is suggested during pregnancy for protein C--deficient women with personal or family histories of thrombosis. Oral contraception is not advised.

Adult↗
PubMed1992

The maternal hemodynamic effect of indomethacin in normal pregnancy.

The vasodilation of pregnancy is thought by many to be due to increased endothelial production of prostacyclin, a vasodilatory prostanoid. Indomethacin, a potent inhibitor of prostaglandin synthesis, is known to increase the maternal blood pressure response to angiotensin II infusion. We sought to measure directly the hemodynamic effects of a short course of indomethacin. Twenty-three healthy pregnant women with uncomplicated pregnancies between 26-32 weeks' gestation completed the study. Using Doppler technology, we determined cardiac output, stroke volume, and total peripheral resistance before and after three 25-mg doses of indomethacin. Although blood pressure did not change, peripheral resistance rose and stroke volume fell following indomethacin administration. Our findings support the hypothesis that indomethacin interferes with tonic prostaglandin-induced vasodilation in pregnancy. However, the increase in vascular resistance was very slight, suggesting that other vasodilators are also at work in pregnancy. We recommend that indomethacin be used judiciously in hypertensive pregnant patients until more information concerning possible adverse hemodynamic effects becomes available.

Blood Pressure↗
PubMed1991

Duplication (6q) syndrome diagnosed in utero.

We report on a case of partial duplication 6q detected ultrasonographically. The clinical picture noted in utero is consistent with the adult phenotype previously reported in the literature.

Abnormalities, Multiple↗
PubMed1991

The effect of maternal hemodynamics on fetal growth in hypertensive pregnancies.

Seventy-six pregnancies in which hypertension complicated pregnancy before 28 weeks' gestation were studied. In 36, hemodynamics were characterized by increased cardiac output and low vascular resistance; in 32, hemodynamics were characterized by high resistance; in eight hemodynamics crossed over from high output to high resistance during pregnancy. High-resistance hypertension was associated with a mean birth weight 1058 gm less than that in the low-resistance group (p = 0.001). The reduction in birth weight was due to a 4-week difference in gestational age (p = 0.001) and lower percentile weights for gestational age, 19th versus 39th (p = 0.005). Infants in the crossover group had low percentile weights and a high rate of intrauterine fetal death.

Adult↗
PubMed1991

The effects of oral nifedipine on hepatic blood flow in humans.

Duplex ultrasonography was used to measure changes in hepatic blood flow in 13 healthy volunteers after they received single doses of 10 mg oral nifedipine and placebo. Blood flow was measured in the hepatic artery and branches of the portal and hepatic veins at baseline and 0.3, 0.6, 1, 1.5, 2, 3, 4, and 5 hours after drug administration. Cardiac output was also measured at baseline and 1, 2, and 3 hours after dosing. Blood flow initially increased in all three vessels 0.6 hour after administration of nifedipine (29%, 56%, and 31% in the hepatic artery, hepatic vein, and portal vein, respectively) compared with placebo. Flow rapidly returned to baseline in the hepatic artery and hepatic vein, whereas it appeared to remain elevated through 3 hours in the portal vein. Nifedipine administration resulted in an increase in cardiac output of 26%, 22%, and 14% above placebo at 1, 2, and 3 hours, respectively. No significant differences were detected in the systolic, diastolic, or mean arterial blood pressures after nifedipine or placebo. This study demonstrates that nifedipine increases hepatic blood flow in a transient nature and systemic hemodynamic parameters do not necessarily reflect specific organ responses. The nifedipine-induced change in blood flow should be considered when nifedipine is coadministered with high-clearance drugs, because systemic availability may be increased.

Administration, Oral↗
PubMed1991

Renal vascular hypertension during pregnancy.

We report two women with renal artery stenosis in pregnancy. The first patient presented with severe hypertension in the first and second trimesters characterized by an extremely high vascular resistance (maximum 2455 dyne.second.cm-5). Transluminal angioplasty was performed at 20 weeks' gestation, resulting in resolution of the patient's hypertension. After angioplasty, her vascular resistance fell to 1600 dyne.second.cm-5, but did not reach normal pregnant levels. The pregnancy was carried to term without complication. The second patient's hypertension improved during pregnancy, and she delivered at term without complication. Twelve weeks postpartum, the patient again became severely hypertensive, and transluminal angioplasty was performed.

Adult↗
PubMed1991

Maternal hemodynamics in pregnancies complicated by hyperthyroidism.

The hemodynamics of six pregnant women with hyperthyroidism were studied before and after therapy. Cardiac output was measured by Doppler technique, and blood pressure by automated cuff. When compared with values in euthyroid pregnant women, blood pressure (83.6 mmHg, P less than .001), heart rate (89.2 beats per minute, P less than .001), cardiac output (11.2 L/minute, P less than .001), and stroke volume (123 mL, P less than .001) were significantly elevated. Total peripheral resistance was significantly reduced (609 dyne.second.cm-5, P less than .001). Despite normalization of thyroid indices after therapy, cardiac output remained markedly elevated (9.7 L/minute, P less than .001) and vascular resistance remained reduced (708 dyne.second.cm-5, P = .01). Although the hemodynamics of pregnant thyrotoxic women normalize with therapy, they remain significantly hyperdynamic.

Echocardiography, Doppler↗
PubMed1991

Maternal hemodynamics and aortic diameter in normal and hypertensive pregnancies.

The aortic diameters of 89 normotensive pregnant women were compared with those of nine rigorously defined preeclamptic women and 59 women who required antihypertensive therapy. Over the course of normal pregnancy, the diameter increased significantly; it was larger in preeclamptic than in normotensive women throughout pregnancy. The aortic diameter in women with high-resistance hypertension was smaller than that in normotensive women and in those with high-output, low-resistance hypertension, but it was larger in women with low-resistance hypertension than in normotensive women. The aortic diameter increased after treatment of high-resistance hypertension with hydralazine, but decreased after treatment of high-output, low-resistance hypertension.

Aorta↗
PubMed1990

Measurement of cardiac output in pregnancy by Doppler technique.

Doppler technique of measuring cardiac output was evaluated during pregnancy. In a study of accuracy Doppler technique correlated well with thermodilution, (r = 0.95, y = 1.05x - 0.35). In a study of interoperator variability, the technique was found to be reproducible, (r = 0.92, y = 0.91x + 0.74).

Aorta↗
PubMed1990

Maternal hemodynamics in normal and preeclamptic pregnancies: a longitudinal study.

Preeclampsia is a disease unique to pregnancy that contributes substantially to maternal and fetal morbidity and mortality. The condition has been thought to be one of hypoperfusion in which increased vascular resistance characterizes the associated hypertension. This study was designed to test an alternative hypothesis, that preeclampsia is characterized by high cardiac output. In a blinded longitudinal study of nulliparas with uncomplicated pregnancies, cardiac output was measured serially by Doppler technique. Cardiac output was elevated throughout pregnancy in patients who became preeclamptic (P = .006). Six weeks postpartum, the hypertension of the preeclamptic subjects had resolved but cardiac output remained elevated (P = .001) and peripheral resistance remained lower than in the normotensive subjects (P = .001). This study demonstrates that preeclampsia is not a disease of systemic hypoperfusion and challenges most current models of the disease based on that assumption.

Adult↗
PubMed1989

Preeclampsia: a hyperdynamic disease model.

Preeclampsia is a common disease and as such is a significant contributor to maternal and neonatal morbidity and mortality. Despite the ubiquity of the disease and its public health impact, no comprehensive mechanism has been established. Therapy has been limited to bed rest and premature delivery. The purpose of this article is to examine preeclampsia from a hemodynamic point of view and to advance a hypothesis of disease mechanism.

Adrenergic beta-Antagonists↗
PubMed1989

Fetal and maternal considerations in the management of stage I-B cervical cancer during pregnancy.

The timing of treatment for stage I-B cervical carcinoma diagnosed during pregnancy is complicated by conflicting concerns for fetal survival and control of malignancy. There were 11 pregnant women with stage I-B cervical carcinoma diagnosed prior to fetal viability since 1969. Six patients were managed with termination of pregnancy and radical hysterectomy with pelvic lymphadenectomy. In 5 patients, treatment was delayed for 6 to 17 weeks and then delivery was accomplished by cesarean section followed directly by radical hysterectomy and pelvic lymphadenectomy. Two of the infants experienced complicated neonatal courses and would have benefited from additional delay. Benefits that could be achieved by delaying delivery for the fetus were calculated from a review of 600 inborn infants without congenital anomalies admitted to the neonatal intensive care (NICU) during 1984 and 1985. Neonatal mortality decreased from 32.8% at 26-27 weeks to 2.7% at 34-35 weeks gestation. Similar improvements in neonatal morbidity were demonstrated. Although adverse maternal outcomes were not associated with delay, an evaluation of risk cannot be derived from this series. Significant fetal benefit can accrue from relatively short delays in planned delivery dates. When stage I-B cervical carcinoma is diagnosed during pregnancy and when fetal survival is desired, delivery should be delayed to achieve fetal maturity, rather than only potential viability.

Adult↗
PubMed1989

Antihypertensive therapy in pregnancy directed by noninvasive hemodynamic monitoring.

Invasive and noninvasive investigations suggest that the hemodynamics of pregnant hypertensive patients are heterogeneous. Nineteen pregnant patients were evaluated before changes in antihypertensive therapy. Cardiac output was measured by Doppler technique. Blood pressure was measured by automated cuff. Systemic vascular resistance was calculated. Two distinct groups were identified on the basis of differences in cardiac output (p less than 0.0001) and systemic vascular resistance (p less than 0.0001). Those with high resistances were treated with hydralazine. A modest antihypertensive effect was achieved (-6.9 mmHg, p = 0.01), but systemic vascular resistance was dramatically reduced, (-534 dyne.sec.cm-5, p less than 0.0001) and was associated with a compensatory increase in cardiac output (2.0 liters/min, p less than 0.0001). Those with a high cardiac output were treated with atenolol. An antihypertensive effect was achieved, (-17.0 mm Hg, p = 0.008), which was associated with a reduction in cardiac output (-2.8 liters/min, p less than 0.0001).

Atenolol↗