- Email: [email protected]
61 The effect of exercise on norepinephrine and epinephrine levels in pregnant and non-pregnant patients
266
SPO Abstracts Am
Januarv 199 1
J Ob,tet Gynecol
61 THE EFFECT OF EXERCISE ON NOREPINEPHRINE AND EPINEPHRINE LEVELS IN PREGNANT AND NON-PREGNANT PATIENTS. Richard M. Farmer x , M.D., PhD, Raul Artal, M.D., University of Southern California, L.A., CA The catacholamines norepinephrine (NE) and epinephrine (E) are closely involved in regulating blood flow and thus play an essential role during exercise. The effect of mild, moderate, and strenuous exercise levels on the hormones norepinephrine (NE) and epinephrine (E) were compared in 100 pregnant and 43 non-pregnant subjects immediately after the exercise routine. The data were analyzed using a Wilcoxon non-parametric software program (CRUNCH, version 3.13). The median values for NE and E, expressed as a percent change from baseline levels, are shown in the table below for each exercise level. Non-pregnant values are in parenthesis. NE E mild 160(170) 140(150) moderate 200(220) 150(180) strenuous 440(1000) 300(1100) The levels of NE and E are not statistically different between pregnant and non-pregnant subjects with mild and moderate exercise. However, there was a signigicantly (p<0.05) blunted response in the pregnant subject during strenuous exercise when compared to the non-pregnant levels. As NE can cause uterine irritability, this blunted response may have a protective effect on the pregnancy during strenuous exercise.
63
PULMONARY METABOLISM OF PROSTANOIDS DURING PREGNANCY Murray D. Mitchell, D. Phil', Steven L. Clark, M.D. UnIVersity of Utah and IHC Perinatal Center, Salt Lake City, Utah The pulmonary metabolism of select prostanoids was assessed in late third trimester pregnancy and compared to that in the nonpregnant state. Paired blood samples were simultaneously obtamed from the pulmonary artery and radial artery of 6 carefully selected normotensive nuUiparous patients between 35-38 weeks gestation and again 11-13 weeks postpartum. PGE" 6-keto PGF,a and TxB, were measured. Results: In nongravid patients, a net increase in PGE, of 419±344 pg/ml was observed during passage through the pulmonary arterial bed (p<0.05). Net increases III concentrations of 6-keto PGF,a and TxB, were also observed, but did not reach statistical Significance. During pregnancy, a net decrease in PGE, of 257±220 pg/ml and a decrease in TxB, of 13±8 pg/ml was observed during pulmonary passage (p<0.05). 6-keto PGF,a concentratIOns also decreased but did not reach statistical significance. The changes in PGE, and TxB, during pulmonary passage were significantly different in the pregnant as compared to the nonpregnant state (P <0.05). ConClusions: 1. The pulmonary arterial bed is a site of significant production/metabolism of select prostanoids. 2. Baseline values for pulmonary metabolism of these prostanoids and the effects of pregnancy on this metabolism have been established. 3. Pregnancy mduces profound changes in the pulmonary metabolism of these prostanoids, with resultant net degradation, as opposed to production of certain compounds. Such metabolic capacity may account for the well documented lack of change in pUlmonary, as opposed to systemiC vascular resistance in preeclampsia. 4. Future comparison of these results with data collected in patients with preeclampsia may yield valuable information regarding the role of prostanoid metabolism in the pathogenesis of thIS condition.
62 THE USE OF A NEURAL NETWORK FOR THE ULTRASONOGRAPHIC ESTIMATION OF FETAL WEIGHT IN THE MACROSOMIC FETUS. Richard M. Farmer MD, PhDx, Arnold L. Medearis, MD., GreIgh I. HIrata, MO, Lawrence D. PIatt, MD, University of Southern California, L.A., CA The estimation offetal weight by ultrasound has traditionally relied on formulas derived from regression analysis, both linear and non-linear, of morphometric parameters such as the biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). An estimated fetal weight (EFW) within 10% of the actual birthweight may be considered acceptable. However, in the macrosomic fetus (estimated fetal weight> 4000 grams), a 10% error can yield results that differ from the actual birthweight by 400 - 500 grams (~) . Traditional regression analysis relied on the recognitIon of a pattern between morphometric parameters and fetal weight. An emerging technique which specializes in pattern recognition is the biologically simulated intelligence (BSI), or neural network. The current study was undertaken to determine the applicability of the BSI in the estimation offetal weight in the macrosomic fetus. The BSI network was developed using retrospective data on 114 patients with an EFW > 4000 g. The BPD, head circumference, AC, FL, amniotic fluid index, and an assessment of subcutaneous tissue, as well as maternal age, gravity, parity, height, gestational age, and fundal height were used as variables in the BSI model. The network model was optimized with respect to network size, training tolerance, and neuron gain by successive interation. The network was then validated prospectively with 90 patients identified as having a macrosomic fetus. The percent error (from actual birth weight) was compared to the results obtained from published linear re~ession formulas by Hadlock and our own institution, both USIng the AC and FL. Thl' BSI yielded an average error of 5.1 %, which was statistically better than the two other methods (p<0.025). We conclude that the BSI network performed better than standard regression models in this study. The BSI is an emerging technique for data interpretation which offers great potential, but needs prospective evaluation.
64
A NOVEL TEST OF FETAL LUNG MATURITY Raml Almog*, John Goldkrand, and Reglna Saulsbery* NYS Health Department, WCLR, Albany, New York and Memorial Medical Center, Savannah, Georgia. A simple, rapld and reliabl e colorimetric method for antenatal assessment of fetal lung matur1ty as a test for predlct ing respiratory dlstress syndrome (RDS) has been developed. The method lS based on spec lfic associat10ns of amniotic fluld phospholipids w1th an insoluble dye complex . Three different diagnostic 1nd1ces: anionic (phosphatidylglycerol) phospholip1d index (A 'I), leclthln index (L'I), and total phosphol1pid index (T'I) are obta1ned simultaneously. The performance of the test was evaluated by analyz1ng 101 amniotlc fluid specimens that were obtained wlthin three days of delivery , For 85 of these spec lmens, conventional determinatlon of the L/ S ratlo was obtained_ There were 22 RDS cases, The new test demonstrated hlgher diagnostic efficiency (percentage of true results) than the L/S ratio in predictlng RDS particularly when cutoff pOlnts of both A'I and L'I used in the diagnosis. The efficiency of this combined index (AL'I) was 91% while that of the L/ S ratio (L/S>2:1) was just 76%. The percentage of false positives (immature result wlthout RDS) was Just 6% with the AL'I and 24% with L/S . More important, the percentage of false posi tives was at least three-fold lower (P
SPO Abstracts Am
Januarv 199 1
J Ob,tet Gynecol
61 THE EFFECT OF EXERCISE ON NOREPINEPHRINE AND EPINEPHRINE LEVELS IN PREGNANT AND NON-PREGNANT PATIENTS. Richard M. Farmer x , M.D., PhD, Raul Artal, M.D., University of Southern California, L.A., CA The catacholamines norepinephrine (NE) and epinephrine (E) are closely involved in regulating blood flow and thus play an essential role during exercise. The effect of mild, moderate, and strenuous exercise levels on the hormones norepinephrine (NE) and epinephrine (E) were compared in 100 pregnant and 43 non-pregnant subjects immediately after the exercise routine. The data were analyzed using a Wilcoxon non-parametric software program (CRUNCH, version 3.13). The median values for NE and E, expressed as a percent change from baseline levels, are shown in the table below for each exercise level. Non-pregnant values are in parenthesis. NE E mild 160(170) 140(150) moderate 200(220) 150(180) strenuous 440(1000) 300(1100) The levels of NE and E are not statistically different between pregnant and non-pregnant subjects with mild and moderate exercise. However, there was a signigicantly (p<0.05) blunted response in the pregnant subject during strenuous exercise when compared to the non-pregnant levels. As NE can cause uterine irritability, this blunted response may have a protective effect on the pregnancy during strenuous exercise.
63
PULMONARY METABOLISM OF PROSTANOIDS DURING PREGNANCY Murray D. Mitchell, D. Phil', Steven L. Clark, M.D. UnIVersity of Utah and IHC Perinatal Center, Salt Lake City, Utah The pulmonary metabolism of select prostanoids was assessed in late third trimester pregnancy and compared to that in the nonpregnant state. Paired blood samples were simultaneously obtamed from the pulmonary artery and radial artery of 6 carefully selected normotensive nuUiparous patients between 35-38 weeks gestation and again 11-13 weeks postpartum. PGE" 6-keto PGF,a and TxB, were measured. Results: In nongravid patients, a net increase in PGE, of 419±344 pg/ml was observed during passage through the pulmonary arterial bed (p<0.05). Net increases III concentrations of 6-keto PGF,a and TxB, were also observed, but did not reach statistical Significance. During pregnancy, a net decrease in PGE, of 257±220 pg/ml and a decrease in TxB, of 13±8 pg/ml was observed during pulmonary passage (p<0.05). 6-keto PGF,a concentratIOns also decreased but did not reach statistical significance. The changes in PGE, and TxB, during pulmonary passage were significantly different in the pregnant as compared to the nonpregnant state (P <0.05). ConClusions: 1. The pulmonary arterial bed is a site of significant production/metabolism of select prostanoids. 2. Baseline values for pulmonary metabolism of these prostanoids and the effects of pregnancy on this metabolism have been established. 3. Pregnancy mduces profound changes in the pulmonary metabolism of these prostanoids, with resultant net degradation, as opposed to production of certain compounds. Such metabolic capacity may account for the well documented lack of change in pUlmonary, as opposed to systemiC vascular resistance in preeclampsia. 4. Future comparison of these results with data collected in patients with preeclampsia may yield valuable information regarding the role of prostanoid metabolism in the pathogenesis of thIS condition.
62 THE USE OF A NEURAL NETWORK FOR THE ULTRASONOGRAPHIC ESTIMATION OF FETAL WEIGHT IN THE MACROSOMIC FETUS. Richard M. Farmer MD, PhDx, Arnold L. Medearis, MD., GreIgh I. HIrata, MO, Lawrence D. PIatt, MD, University of Southern California, L.A., CA The estimation offetal weight by ultrasound has traditionally relied on formulas derived from regression analysis, both linear and non-linear, of morphometric parameters such as the biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). An estimated fetal weight (EFW) within 10% of the actual birthweight may be considered acceptable. However, in the macrosomic fetus (estimated fetal weight> 4000 grams), a 10% error can yield results that differ from the actual birthweight by 400 - 500 grams (~) . Traditional regression analysis relied on the recognitIon of a pattern between morphometric parameters and fetal weight. An emerging technique which specializes in pattern recognition is the biologically simulated intelligence (BSI), or neural network. The current study was undertaken to determine the applicability of the BSI in the estimation offetal weight in the macrosomic fetus. The BSI network was developed using retrospective data on 114 patients with an EFW > 4000 g. The BPD, head circumference, AC, FL, amniotic fluid index, and an assessment of subcutaneous tissue, as well as maternal age, gravity, parity, height, gestational age, and fundal height were used as variables in the BSI model. The network model was optimized with respect to network size, training tolerance, and neuron gain by successive interation. The network was then validated prospectively with 90 patients identified as having a macrosomic fetus. The percent error (from actual birth weight) was compared to the results obtained from published linear re~ession formulas by Hadlock and our own institution, both USIng the AC and FL. Thl' BSI yielded an average error of 5.1 %, which was statistically better than the two other methods (p<0.025). We conclude that the BSI network performed better than standard regression models in this study. The BSI is an emerging technique for data interpretation which offers great potential, but needs prospective evaluation.
64
A NOVEL TEST OF FETAL LUNG MATURITY Raml Almog*, John Goldkrand, and Reglna Saulsbery* NYS Health Department, WCLR, Albany, New York and Memorial Medical Center, Savannah, Georgia. A simple, rapld and reliabl e colorimetric method for antenatal assessment of fetal lung matur1ty as a test for predlct ing respiratory dlstress syndrome (RDS) has been developed. The method lS based on spec lfic associat10ns of amniotic fluld phospholipids w1th an insoluble dye complex . Three different diagnostic 1nd1ces: anionic (phosphatidylglycerol) phospholip1d index (A 'I), leclthln index (L'I), and total phosphol1pid index (T'I) are obta1ned simultaneously. The performance of the test was evaluated by analyz1ng 101 amniotlc fluid specimens that were obtained wlthin three days of delivery , For 85 of these spec lmens, conventional determinatlon of the L/ S ratlo was obtained_ There were 22 RDS cases, The new test demonstrated hlgher diagnostic efficiency (percentage of true results) than the L/S ratio in predictlng RDS particularly when cutoff pOlnts of both A'I and L'I used in the diagnosis. The efficiency of this combined index (AL'I) was 91% while that of the L/ S ratio (L/S>2:1) was just 76%. The percentage of false positives (immature result wlthout RDS) was Just 6% with the AL'I and 24% with L/S . More important, the percentage of false posi tives was at least three-fold lower (P