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555 Development of a computer data base for perinatal monitoring
Volume Hi4 r\umh{,l I, P.lrt
SPO Abstracts
554B CHARACTERIZATION OF SIGMA BINDING SITES IN HUMAN PLACENTA: EFFECT OF PERINATAL COCAINE EXPOSURE. Luis Sanchez·Ramos MD D. D.
Flynn, A.Ax. Vaishnay, yx. ttzhak, D.Cx Mash PhDx. Departments of Obstetrics and Gynecology, University of Florida, JacksonVille and. Pharmacology, Neurology and Biochemistry, University of Miami School of Medicine, Miami, FL
Recent studies suggest that the psychotropic actions of opiate benzomorphans are mediated by sigma receptors. In addition, putative sigma receptors have been characterized in peripheral tissues and cells including the ovary, spleen and lymphocytes. We report the characterization of a high affinity sigma binding site in the human placenta. Placental tissue was obtained from patients admitted for delivery. Cocaine users were identified by urine screens for cocaine metabolites. Sigma receptors were labeled in placental membranes with R(+) [3H]-3-3-hydroxy[phenyl]-N-(1-propyl) piperidine ([3H]-PPP). Saturation analysis revealed an apparent single class of sites (Kd=80 nM; Bmax= 20-30 pmol/gram tissue). Haloperidol, pentazocine, 1,3 di (2tolyl)guanidine, and (+) SKF 10,437 displaced [3H]-PPP binding in placental membranes. The rank order of potency and stereo selectivity demonstrated in competition assays with [3H]-PPP were identical in human cerebellum and placenta. Progesterone competitively displaced [3H)-PPP binding in the placenta (KI = 0.2 uM). Cocaine was equipotent at sigma bindmg sites labeled in placental and cerebellar membranes. The density of sigma binding sites in the placentas taken from mothers who tested positive for urinary cocaine metabolites was significantly reduced compared to control values matched for gestational age. These preliminary findings suggest that peripheral sigma receptors may be regulated by cocaine exposure.
555 DEVELOPMENT
OF A COMPUTER PERINATAL MONITORING.
Authors:
399
~
DATA
BASE
FOR
Paul C. Browne. MD, Suzanne Robinson, RN', Diane Kelly, RN' Emory School of Medicine, Grady Memorial Hospital, Atlanta, Georgia
556 CARBETOCIN
TO PRODUCE UTERINE CONTRACTION DURING CESAREAN SECTION - A DOSE-RANGING STUDY. Marc Boucher, F Durocher', PA Schultz', W Wassenaar'. University of Montreal, SainteJustine Hospital, Montreal, Canada. After delivery of the infant at cesarean section (CIS), intravenous (IV) oxytocin (OT) is given for a variable amount of time to effect adequate uterine contraction (UC) and prevent hemorrhage. Carbetocin (CBT) is a synthetic analogue of OT with a half-life of 40 minutes and 1/10. the activity of OT. Our study was aimed at determining the IV CBT dose required to obtain adequate UC after CIS, its duration of action and its effect on maternal vital signs. After obtaining informed consent, 13 patients undergoing elective CIS under epidural anesthesia received one or more incremental doses of CBT (after manual removal of the placenta) until adequate UC was achieved. UC, amount of lochia and vital signs were monitored constantly up to 7 hours post-injection. All but one patient responded to doses :$ lOOlLg. None of these 12 responders needed additional OT during their postpartum stay and all had sustained adequate UC and normal 10chias. No significant change in vital signs was observed. CBT was well tolerated by all patients. Our results suggest that a single CBT dose of lOOlLg is a safe and well tolerated alternative to regular OT to prevent excessive blood loss after CIS.
557 A TIME COURSE OF TRANSPLACENTAL DIGOXIN THERAPY FOR FETAL SUPRAVENTRICULAR TACHYARRHYTHMIA: AN OVERVIEW AND GUIDELINES. Daniel M. Lasser, M~; Laxmi Baxi, HD; Fredrick Bierman, H~. College of Physicians and Surgeons Columbia University New York, New York.
A perinatal data base has been developed to organize demographic information, maternal historical information, incorporation of
obstetrical ultrasound parameters, antepartum
testing, and peripartum mon1toring. The ini tial development of the data base proved most useful as a form of word processing to print consistent reports on patients undergoing common antepartum tests such as ultrasound and non-stress testing. Subsequent versions have proven the need for a core amount of information on each patient against which outcome variables can be compared. The use of International Classification of Diseases of Medicine (ICDM-9) codes and Classification of Physician Therapy (CPT) codes has standardized information gathering in different hospitals which have used this data base. Resident clinical performance has improved markedly when on line access of data base information has become available. The use of a clinical application for a commercially available data base program has been found superior to the use of a commerc1ally written specific data base program, since reprogramming can be performed on site and application to other perinatal services has required minimum reprogramming.
The efficacy of maternally administered d~goxin in the treatment of fetal tachycardia (SVT) is currently being scrutinized. Treatment failures have been encountered while successful direct fetal drug injections are being performed, albeit at greater risk. Guidelines for the appropriate duration of attempted therapy with digoxin should be established. Therapeutic failures could then be correctly identified and alternative management initiated. To this end we have analyzed all published reports of fetal transplacental digoxin therapy for SVT. 30 cases of firmly diagnosed fetal SVT were identified in which data was provided on the duration of therapy. In all cases maternal serum drug levels were kept within the accepted normal peak for digoxin. Our analysis revealed that the median time interval for establishment of complete control of SVT was 8 days and that reported failures have been treated for significantly less time (median of 3 days, p
supraventr~cular
SPO Abstracts
554B CHARACTERIZATION OF SIGMA BINDING SITES IN HUMAN PLACENTA: EFFECT OF PERINATAL COCAINE EXPOSURE. Luis Sanchez·Ramos MD D. D.
Flynn, A.Ax. Vaishnay, yx. ttzhak, D.Cx Mash PhDx. Departments of Obstetrics and Gynecology, University of Florida, JacksonVille and. Pharmacology, Neurology and Biochemistry, University of Miami School of Medicine, Miami, FL
Recent studies suggest that the psychotropic actions of opiate benzomorphans are mediated by sigma receptors. In addition, putative sigma receptors have been characterized in peripheral tissues and cells including the ovary, spleen and lymphocytes. We report the characterization of a high affinity sigma binding site in the human placenta. Placental tissue was obtained from patients admitted for delivery. Cocaine users were identified by urine screens for cocaine metabolites. Sigma receptors were labeled in placental membranes with R(+) [3H]-3-3-hydroxy[phenyl]-N-(1-propyl) piperidine ([3H]-PPP). Saturation analysis revealed an apparent single class of sites (Kd=80 nM; Bmax= 20-30 pmol/gram tissue). Haloperidol, pentazocine, 1,3 di (2tolyl)guanidine, and (+) SKF 10,437 displaced [3H]-PPP binding in placental membranes. The rank order of potency and stereo selectivity demonstrated in competition assays with [3H]-PPP were identical in human cerebellum and placenta. Progesterone competitively displaced [3H)-PPP binding in the placenta (KI = 0.2 uM). Cocaine was equipotent at sigma bindmg sites labeled in placental and cerebellar membranes. The density of sigma binding sites in the placentas taken from mothers who tested positive for urinary cocaine metabolites was significantly reduced compared to control values matched for gestational age. These preliminary findings suggest that peripheral sigma receptors may be regulated by cocaine exposure.
555 DEVELOPMENT
OF A COMPUTER PERINATAL MONITORING.
Authors:
399
~
DATA
BASE
FOR
Paul C. Browne. MD, Suzanne Robinson, RN', Diane Kelly, RN' Emory School of Medicine, Grady Memorial Hospital, Atlanta, Georgia
556 CARBETOCIN
TO PRODUCE UTERINE CONTRACTION DURING CESAREAN SECTION - A DOSE-RANGING STUDY. Marc Boucher, F Durocher', PA Schultz', W Wassenaar'. University of Montreal, SainteJustine Hospital, Montreal, Canada. After delivery of the infant at cesarean section (CIS), intravenous (IV) oxytocin (OT) is given for a variable amount of time to effect adequate uterine contraction (UC) and prevent hemorrhage. Carbetocin (CBT) is a synthetic analogue of OT with a half-life of 40 minutes and 1/10. the activity of OT. Our study was aimed at determining the IV CBT dose required to obtain adequate UC after CIS, its duration of action and its effect on maternal vital signs. After obtaining informed consent, 13 patients undergoing elective CIS under epidural anesthesia received one or more incremental doses of CBT (after manual removal of the placenta) until adequate UC was achieved. UC, amount of lochia and vital signs were monitored constantly up to 7 hours post-injection. All but one patient responded to doses :$ lOOlLg. None of these 12 responders needed additional OT during their postpartum stay and all had sustained adequate UC and normal 10chias. No significant change in vital signs was observed. CBT was well tolerated by all patients. Our results suggest that a single CBT dose of lOOlLg is a safe and well tolerated alternative to regular OT to prevent excessive blood loss after CIS.
557 A TIME COURSE OF TRANSPLACENTAL DIGOXIN THERAPY FOR FETAL SUPRAVENTRICULAR TACHYARRHYTHMIA: AN OVERVIEW AND GUIDELINES. Daniel M. Lasser, M~; Laxmi Baxi, HD; Fredrick Bierman, H~. College of Physicians and Surgeons Columbia University New York, New York.
A perinatal data base has been developed to organize demographic information, maternal historical information, incorporation of
obstetrical ultrasound parameters, antepartum
testing, and peripartum mon1toring. The ini tial development of the data base proved most useful as a form of word processing to print consistent reports on patients undergoing common antepartum tests such as ultrasound and non-stress testing. Subsequent versions have proven the need for a core amount of information on each patient against which outcome variables can be compared. The use of International Classification of Diseases of Medicine (ICDM-9) codes and Classification of Physician Therapy (CPT) codes has standardized information gathering in different hospitals which have used this data base. Resident clinical performance has improved markedly when on line access of data base information has become available. The use of a clinical application for a commercially available data base program has been found superior to the use of a commerc1ally written specific data base program, since reprogramming can be performed on site and application to other perinatal services has required minimum reprogramming.
The efficacy of maternally administered d~goxin in the treatment of fetal tachycardia (SVT) is currently being scrutinized. Treatment failures have been encountered while successful direct fetal drug injections are being performed, albeit at greater risk. Guidelines for the appropriate duration of attempted therapy with digoxin should be established. Therapeutic failures could then be correctly identified and alternative management initiated. To this end we have analyzed all published reports of fetal transplacental digoxin therapy for SVT. 30 cases of firmly diagnosed fetal SVT were identified in which data was provided on the duration of therapy. In all cases maternal serum drug levels were kept within the accepted normal peak for digoxin. Our analysis revealed that the median time interval for establishment of complete control of SVT was 8 days and that reported failures have been treated for significantly less time (median of 3 days, p
supraventr~cular