| 1. |
- Akoka, S, et al.
(författare)
-
Cerebral MRI on fetuses submitted to repeated cocaine administration during the gestation: an ovine model
- 1999
-
Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 85:2, s. 185-190
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to determine the role of Magnetic Resonance Imaging (MRI) in investigating fetal cerebral lesions induced by long term exposure to cocaine during sheep pregnancy. Cerebral Magnetic Resonance Imaging was performed on two groups of fetuses at 125 days of gestation (normal gestation: 145 days). The control group consisted of eight fetuses of four pregnant ewes. The study group consisted of eight fetuses of four pregnant ewes receiving daily 140 mg/kg injection of cocaine from day 60 until delivery. The following MR sequences were applied: T1-weighted FLASH, and T2-weighted Fast-Spin-Echo. Cerebral images were evaluated semi quantitatively using the following criteria: Heterogenicity, contrast between grey and white matter, contours irregularity, hyposignal, lateral ventricle sizes. The brightness distribution and homogenicity of the images were analysed by means of edge pair distributions using a new computerized method originally designed for ultrasound images analysis developed by Ultrasight inc (USA). (1) Flash T1: Heterogenic areas and irregular contours were more frequent in cocaine exposed fetuses. The contrast between grey and white matter was more important in the cocaine group. Hyposignal was found only in the cocaine group. Enlarged lateral ventricle occurred more frequently in the cocaine group. (2) Spin echo T2: The contrast between grey and white matter was higher and the contours of the brain more irregular in the cocaine group. Heterogenicity and hyposignal were also more frequent in this group but the difference with the control group was not significant. The computerized analysis of the contrast density on the cerebral images showed that 88% of the areas exceeding the reference level concerned the cocaine group, while only 14% of the areas exceeding the reference level concerned the control group. Long term exposure to cocaine induces cerebral tissue modifications, in favor of an advanced maturation and the development of hypoxic lesions. The histology of the brains confirmed in the cocaine group, the existence of hypoxic lesions with gliosis, perivascular edema and hemorrhages, and neuronal death.
|
|
| 2. |
- Arabin, B, et al.
(författare)
-
Hemodynamic changes with paradoxical blood flow in expectant management of abruptio placentae
- 1998
-
Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 91:5 Pt 2, s. 796-798
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Because the early diagnosis of abruption often is missed or misinterpreted, emergency situations frequently do not permit adequate management. CASE: A woman of 26-weeks' gestation was transferred with symptoms and laboratory findings typical for abruption. Ultrasound, including Doppler, revealed a subchorionic hematoma, pathologic blood flow in the uterine arteries, low pulsatility index values in the fetal cerebral and umbilical arteries (paradoxical blood flow), and high maximal velocities in the fetal aorta. Repeated Doppler and laboratory examinations revealed a gradual restoration to normal of the arterial uterine blood flow pattern, of paradoxical blood flow, aortic maximal velocities, and laboratory values. CONCLUSION: Serial Doppler measurements considering the paradoxical pattern illustrate pathophysiologic mechanisms of abruption that may assist in deciding whether to deliver immediately or to continue intense surveillance.
|
|
| 3. |
- Arabin, B, et al.
(författare)
-
Treatment of twin-twin transfusion syndrome by laser and digoxin. Biophysical and angiographic evaluation
- 1998
-
Ingår i: Fetal Diagnosis and Therapy. - : Karger. - 1015-3837. ; 13:3, s. 141-146
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: A combination of surgical and medical approaches may address both the underlying pathophysiological processes and the most threatening symptoms in twin-twin transfusion syndrome (TTTS). CASE: A primigravida with monochorionic twin pregnancy was referred with signs of TTTS at 16 weeks. One twin was severely hydropic with normal amniotic fluid, the co-twin had anhydramnios. Laser treatment was performed. Nevertheless, signs of severe cardiac decompensation in the recipient remained unchanged. After treatment with digoxin restoration of congestive heart failure and a resolution of the hydrops were achieved. Activity and inter-twin contacts increased significantly. At 37 weeks 2 healthy boys were delivered. Postnatal computerangiography of the placenta revealed no arteriovenous anastomoses. CONCLUSIONS: This case suggests that a combined causal and symptomatic therapy in cases with cardiac decompensation of the recipient can be beneficial as demonstrated by echocardiography, venous Doppler and behavioral analysis. Computer angiography of the placenta may demonstrate the effect of laser treatment.
|
|
| 4. |
- Valentin, Lil, et al.
(författare)
-
Effect of a prostaglandin E1 analogue (gemeprost) on uterine and luteal circulation in normal first trimester pregnancies. A Doppler velocimetry study
- 1995
-
Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - 0301-2115. ; 59:1, s. 25-34
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the effects of gemeprost on utero-placental and luteal circulation and on the embryo/fetus in normal first trimester pregnancies. STUDY DESIGN: Sixty-seven women with a normal first trimester pregnancy requesting termination of pregnancy for psychosocial reasons were randomly allocated to pre-operative treatment with vaginal suppositories containing placebo or gemeprost. The women underwent transvaginal color and spectral Doppler ultrasound examination before the application of the suppository, 4 h after the application of the suppository but before the abortion, and on the seventh post-operative day. Blood flow velocities in the uterine and subchorionic arteries, the intrachorionic area and arteries in the wall of the corpus luteum and the embryonic/fetal heart rate were measured. RESULTS: The median value for pulsatility index (PI) in the dominant uterine artery was 2.4 before treatment with gemeprost and 8.5 4 h after treatment (P = 0.0006); the corresponding values for time-averaged maximum velocity (TAMXV) being 27 cm/s and 10 cm/s (P = 0.0006). Four (14%) of 28 embryos/fetuses in the gemeprost group were dead 4 h after treatment with gemeprost and the median heart rate of those still alive was significantly lower than before treatment (130 vs. 163 bpm; P = 0.003). In the placebo group, the results for the uterine arteries and the embryonic/fetal heart rate did not differ significantly between the first and second ultrasound examinations. The median values for PI and TAMXV in the arteries of the corpus luteum wall at the first ultrasound examination were 0.71 and 18 cm/s, respectively, in the placebo group and 0.71 and 20 cm/s, respectively, in the gemeprost group. These values remained almost unchanged at the second and third ultrasound examinations in both groups. CONCLUSION: Gemeprost has profound effects on utero-placental circulation in the first trimester and can induce embryonic/fetal bradycardia and sometimes embryonic/fetal demise. It has no unequivocal effect on luteal circulation.
|
|
| 5. |
- Valentin, Lil, et al.
(författare)
-
Uteroplacental and luteal circulation in normal first-trimester pregnancies: Doppler ultrasonographic and morphologic study
- 1996
-
Ingår i: American Journal of Obstetrics and Gynecology. - 1097-6868. ; 174:2, s. 768-775
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Our purpose was to establish reference data representative of normal findings at transvaginal color and spectral Doppler ultrasonographic examination of the uteroplacental and luteal circulation in the first trimester and to relate the Doppler findings to morphologic data. STUDY DESIGN: A cross-sectional study was performed of 64 uncomplicated pregnancies of 5 to 11 completed gestational weeks terminated by legal abortion for psychosocial reasons. Doppler examinations of the main uterine arteries, subchorionic arteries, intrachorionic area, and corpus luteum were performed. Abortion material was examined morphologically. RESULTS: In the uterine and subchorionic arteries blood flow velocity increased and pulsatility index values decreased with advancing gestation. Arterial or venous Doppler shift spectra were recorded from the intrachorionic area in 91% (58/64) of the pregnancies. Intrachorionic arterial blood flow velocities and pulsatility index values were low and did not change with advancing gestation; the mean time-averaged maximum velocity, peak systolic velocity, and pulsatility index values were 4.6 cm/sec, 6.0 cm/sec, and 0.47, respectively. Morphologic examination showed trophoblast plugs in the spiral arteries to consistently manifest multiple spaces containing red blood cells at the choriodecidual junction. CONCLUSION: Blood flow velocity in the uteroplacental arteries increases and pulsatility index values decrease with advancing gestation, indicating a steady increase in uterine perfusion during the first trimester. Our findings suggest intervillous flow to be present as early as the first trimester.
|
|
