- Email: [email protected]
61 Cocaine: Postpartum Hypertension Not a Risk with Bromocriptine Use
298
SPO Abstracts
61 COCAINE: POSTPARTUM HYPERTENSION NOT A RISK
January 1992
Am J Obstet Gynecol
63
ECLAMPSIA·-TYPICAL FINDINGS WITH MRI. MA DaJunu......JRBartonX, BM Sibai. University of TN, Memphis. Purpose: To study the MRI findings in patients with eclampsia, and to determine the clinical utility of this imaging modality. Methods: 25 patients with a diagnosis of eclampsia received cerebral magnetic resonance imaging. The scans were obtained from 0 to 18 days after the first seizure (median 6.6 days). The scan at 18 days was 8 rescheduled exam secondary to claustrophobia during the first study one week earlier.Results: Fourteen scans were normal (median of 5.5 days after the first seizure). One additional scan could not be completed due to claustrophobia, and was not rescheduled. The T2-weighted images were the most useful. Only 2 of the patients had abnormalities on the T1 weighted scans. No cerebral hemorrhage or atrophy was noted. Cortical edema in the posterior hemispheres (posterior parietal and occipital lobes) was the single most common fmding--seen in all II abnormal scans. Infratentorial abnormalities were noted in two cases-edema in the midbrain and brain stem in I case. and cerebellar edema in the other case. Five patients had edema of the cortex and white matter. Three of the patients had focal neurologic deficits at admission. but one patient recovered before the time of scanning. The patient with normalization of neurologic function had only cortical edema on her scan (obtained at 18 days secondary to claustrophobia). The other 2 patients. who also had residual focal neurologic deficits at discharge. had both white matter edema and cortical edema, and one also had changes consistent with infarction. Three of the 7 patients who had scans more than one week after the first seizure activity had abnormal studies. These 3 patients had the most abnormal neurologic exams of all 26 patients. Patient management was not changed by MRI results, but the studies helped to exclude certain pathology (tumor, aneurysm, stroke) for which specific intervention might be useful. Conclusion: Cortical edema is the most common abnormality in eclamptic patients receiving cerebral MRI studies. We recommend limiting the use of MRI to patients with focal neurologic deficits, prolonged coma, or intractable seizures in order to exclude serious pathology for which specific therapy might be indicated.
64
PROSTAGLANDIN PRODUCTION BY TROPHOBLAST OF NORMOTENSIVE AND PREECLAMPTIC PREG'IA'ICIES M Morgan S. Silavin x , D. Rice x , Dept Ob/Gyn. Univ. of California Irvine, Orange, CA and Dept Ob/Gyn. Univ. of Oklahoma Health Sciences Center, Oklahoma City. OK Preeclampsia. is hypothesized to have an alteration in placental production of thromboxane and prostacyc1in. The purpose of this study was to determine if trophoblasts from preeclamptic (PIH) patients produce differential amounts of thromboxane and prostacyclin compared to normotensives (NORM). Placentae from PIH (n=7) and NORM(n=9) pregnancies were utilized to isolate cytotrophoblasts via the method of Kliman et. al. (Endocrinol 118:1567;1986). These cells were incubated for 24 hours in culture media with (S) or without (NS) 10% calf serum. Media were assayed for the stable metabolites of thromboxane (TBX2) and prostacyclin (6.ketoPGFla) via specific RIA. Separate cultures were incubated with indomethacin 50!lM (IND) or arachidonic acid JOO!lM (AA) to confirm trophoblast prostanoid production. Both TBX2 and 6-ketoPGF1 a concentrations were reduced with IND added and increased with AA added. The prostanoid concentrations are in pg/mg protein. Results: The mean ±SEM concentration of TBX2 and 6·ketoPGFla of trophoblasts from PlH patients was less than NORM women. TBX2 PCF1a ratio
WITH BROMOCRIPTINE USE. YR Renfroe" RK Bhatia, SF Bottoms, DL Watson, and RJ SokoL Wayne State Univ., Hutzel Hospital, Detroit, MI. On the basis of two case reports of severe postpartum hypertension (PPH) and secondary cortical blindness, seizures, or pulmonary edema, it has been recommended that bromocriptine should not be used for lactation suppression in cocaine abusers. A postulated mechanism for cocaine to potentiate the dopaminergic effects of bromocriptine could be reuptake inhibition of both dopamine and norepinephrine at the presynaptic receptors. However, severe hypertension and its sequelae have also been reported with bromocriptine alone, especially in patients with preeclampsia. To investigate the relationship, if any, between bromocriptine, cocaine abuse, and postpartum hypertension, we studied 1069 patients, excluding those with antepartum hypertension. All patients had blood pressure determinations during 2 home visits by a nurse within 3 weeks postpartum. PPH (n = 178) was defined as persistent elevation 2': 140/90 at either visit. Stepwise discriminant analysis with PPH as the dependent variable revealed that a history of preeclampsia (p < 0.(01), obesity (p < 0.01), and parity (p < 0.05) were significant risk factors for PPH. Neither bromocriptine use (n = 773), cocaine abuse (n = 52), or their combination (n = 46) was significantly associated with PPH. None of the studied patients developed serious sequelae of PPH. We conclude that cocaine abuse is not a contraindication for the use of bromocriptine to suppress lactation.
62
TRANSCRANIAL ASSESSMENT OF MATERNAL CEREBRAL BLOOD FLOW VELOCITY IN NORMAL VS PREECLAMmC WOMEN; VARIATION WITH MATERNAL POSTURE K. Wil1iam~ C. McLean~University of British Columbia, Vancouver B.c. Canada. Cerebral blood flow velocity (CBFV) can be extensively evaluated in adults using a 2 mHz transcranial doppler ultrasound. Middle Cerebral Artel)' (MCA) blood flow velocity is lower with the patient in the upright then in the supine position (Ultrashall Med 1986; 7: 248-52). We assessed MCA blood flow using a pulsed wave doppler with a 2 mHz.
probe in five normotensive and five preeclamptic (PEr) pregnant patients in both supine and standing JX>Sitions to evaluate the effect of
change in maternal position on CBFV. The MCA was insonated through a temporal ultrasound window at a depth of 5.2 cm. We assessed maximum systolic, minimum diastolic and mean MCA flow velocity. We found (1) PET women showed higher MCA velocity than nonnolensive women, (2) Normotensive women showed a fall in all aspects of MCA velocity, from supine to standing (5-12%), (3) PEr women showed a significant rise (P<.05) (average 20% increase) in all aspects of MCA velocity from supine to standing. Max. Systolic Max. Diastolic Mean (mm/sec) (mm/sec) 87 + /- 15 31 + /- 6 50 + /- 8 Norma- :supine tensive standing 80 + /- 17 28 + /- 6 47+/-10 PET: supine 80 +/-17 39 +/-12 55 +1-15 standing 94 +/-14' 48 +/-11" 66 +I- 13' 'P <.04, .. P <.01 Conclusions: These data show that maternal cerebral blood vessels react differently in pregnant PEf women. The pathophysiology of this finding and whether clinically it can be used in a predictive fashion requires further investigation.
S NS S NS' S NS 847±301 875±264 17±5 20±2 55±12 41±12 PIH 1204±164 1299±167 28±5 37±5 424:4 ?f:HJ NORM ·p
SPO Abstracts
61 COCAINE: POSTPARTUM HYPERTENSION NOT A RISK
January 1992
Am J Obstet Gynecol
63
ECLAMPSIA·-TYPICAL FINDINGS WITH MRI. MA DaJunu......JRBartonX, BM Sibai. University of TN, Memphis. Purpose: To study the MRI findings in patients with eclampsia, and to determine the clinical utility of this imaging modality. Methods: 25 patients with a diagnosis of eclampsia received cerebral magnetic resonance imaging. The scans were obtained from 0 to 18 days after the first seizure (median 6.6 days). The scan at 18 days was 8 rescheduled exam secondary to claustrophobia during the first study one week earlier.Results: Fourteen scans were normal (median of 5.5 days after the first seizure). One additional scan could not be completed due to claustrophobia, and was not rescheduled. The T2-weighted images were the most useful. Only 2 of the patients had abnormalities on the T1 weighted scans. No cerebral hemorrhage or atrophy was noted. Cortical edema in the posterior hemispheres (posterior parietal and occipital lobes) was the single most common fmding--seen in all II abnormal scans. Infratentorial abnormalities were noted in two cases-edema in the midbrain and brain stem in I case. and cerebellar edema in the other case. Five patients had edema of the cortex and white matter. Three of the patients had focal neurologic deficits at admission. but one patient recovered before the time of scanning. The patient with normalization of neurologic function had only cortical edema on her scan (obtained at 18 days secondary to claustrophobia). The other 2 patients. who also had residual focal neurologic deficits at discharge. had both white matter edema and cortical edema, and one also had changes consistent with infarction. Three of the 7 patients who had scans more than one week after the first seizure activity had abnormal studies. These 3 patients had the most abnormal neurologic exams of all 26 patients. Patient management was not changed by MRI results, but the studies helped to exclude certain pathology (tumor, aneurysm, stroke) for which specific intervention might be useful. Conclusion: Cortical edema is the most common abnormality in eclamptic patients receiving cerebral MRI studies. We recommend limiting the use of MRI to patients with focal neurologic deficits, prolonged coma, or intractable seizures in order to exclude serious pathology for which specific therapy might be indicated.
64
PROSTAGLANDIN PRODUCTION BY TROPHOBLAST OF NORMOTENSIVE AND PREECLAMPTIC PREG'IA'ICIES M Morgan S. Silavin x , D. Rice x , Dept Ob/Gyn. Univ. of California Irvine, Orange, CA and Dept Ob/Gyn. Univ. of Oklahoma Health Sciences Center, Oklahoma City. OK Preeclampsia. is hypothesized to have an alteration in placental production of thromboxane and prostacyc1in. The purpose of this study was to determine if trophoblasts from preeclamptic (PIH) patients produce differential amounts of thromboxane and prostacyclin compared to normotensives (NORM). Placentae from PIH (n=7) and NORM(n=9) pregnancies were utilized to isolate cytotrophoblasts via the method of Kliman et. al. (Endocrinol 118:1567;1986). These cells were incubated for 24 hours in culture media with (S) or without (NS) 10% calf serum. Media were assayed for the stable metabolites of thromboxane (TBX2) and prostacyclin (6.ketoPGFla) via specific RIA. Separate cultures were incubated with indomethacin 50!lM (IND) or arachidonic acid JOO!lM (AA) to confirm trophoblast prostanoid production. Both TBX2 and 6-ketoPGF1 a concentrations were reduced with IND added and increased with AA added. The prostanoid concentrations are in pg/mg protein. Results: The mean ±SEM concentration of TBX2 and 6·ketoPGFla of trophoblasts from PlH patients was less than NORM women. TBX2 PCF1a ratio
WITH BROMOCRIPTINE USE. YR Renfroe" RK Bhatia, SF Bottoms, DL Watson, and RJ SokoL Wayne State Univ., Hutzel Hospital, Detroit, MI. On the basis of two case reports of severe postpartum hypertension (PPH) and secondary cortical blindness, seizures, or pulmonary edema, it has been recommended that bromocriptine should not be used for lactation suppression in cocaine abusers. A postulated mechanism for cocaine to potentiate the dopaminergic effects of bromocriptine could be reuptake inhibition of both dopamine and norepinephrine at the presynaptic receptors. However, severe hypertension and its sequelae have also been reported with bromocriptine alone, especially in patients with preeclampsia. To investigate the relationship, if any, between bromocriptine, cocaine abuse, and postpartum hypertension, we studied 1069 patients, excluding those with antepartum hypertension. All patients had blood pressure determinations during 2 home visits by a nurse within 3 weeks postpartum. PPH (n = 178) was defined as persistent elevation 2': 140/90 at either visit. Stepwise discriminant analysis with PPH as the dependent variable revealed that a history of preeclampsia (p < 0.(01), obesity (p < 0.01), and parity (p < 0.05) were significant risk factors for PPH. Neither bromocriptine use (n = 773), cocaine abuse (n = 52), or their combination (n = 46) was significantly associated with PPH. None of the studied patients developed serious sequelae of PPH. We conclude that cocaine abuse is not a contraindication for the use of bromocriptine to suppress lactation.
62
TRANSCRANIAL ASSESSMENT OF MATERNAL CEREBRAL BLOOD FLOW VELOCITY IN NORMAL VS PREECLAMmC WOMEN; VARIATION WITH MATERNAL POSTURE K. Wil1iam~ C. McLean~University of British Columbia, Vancouver B.c. Canada. Cerebral blood flow velocity (CBFV) can be extensively evaluated in adults using a 2 mHz transcranial doppler ultrasound. Middle Cerebral Artel)' (MCA) blood flow velocity is lower with the patient in the upright then in the supine position (Ultrashall Med 1986; 7: 248-52). We assessed MCA blood flow using a pulsed wave doppler with a 2 mHz.
probe in five normotensive and five preeclamptic (PEr) pregnant patients in both supine and standing JX>Sitions to evaluate the effect of
change in maternal position on CBFV. The MCA was insonated through a temporal ultrasound window at a depth of 5.2 cm. We assessed maximum systolic, minimum diastolic and mean MCA flow velocity. We found (1) PET women showed higher MCA velocity than nonnolensive women, (2) Normotensive women showed a fall in all aspects of MCA velocity, from supine to standing (5-12%), (3) PEr women showed a significant rise (P<.05) (average 20% increase) in all aspects of MCA velocity from supine to standing. Max. Systolic Max. Diastolic Mean (mm/sec) (mm/sec) 87 + /- 15 31 + /- 6 50 + /- 8 Norma- :supine tensive standing 80 + /- 17 28 + /- 6 47+/-10 PET: supine 80 +/-17 39 +/-12 55 +1-15 standing 94 +/-14' 48 +/-11" 66 +I- 13' 'P <.04, .. P <.01 Conclusions: These data show that maternal cerebral blood vessels react differently in pregnant PEf women. The pathophysiology of this finding and whether clinically it can be used in a predictive fashion requires further investigation.
S NS S NS' S NS 847±301 875±264 17±5 20±2 55±12 41±12 PIH 1204±164 1299±167 28±5 37±5 424:4 ?f:HJ NORM ·p