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Effect of magnesium sulfate on plasma endothelin-1 levels in normal and preeclamptic pregnancies
218
Citations from the Literature
The smaller thao expected fmt-trimester for chromosome anomalies
fetus is at increased risk
Drugan A.; Johnson M.P.; Isada N.B.; Holzgreve W.; Zador I.E.; Dombrowski M.P.; Sokol R.J.; Hallak M.; Evans MI. USA
AM J OBSTET GYNECOL 1992 167/6 (1525-1528) OBJECTIVE: Intrauterine growth retardation associated with fetal chromosome anomalies is usually documented on ultrasonography late in the second trimester. However, we believe and attempt to document here that the impact of aneuploidy on fetal growth is evident much earlier (i.e., the aneuploid fetus may appear smaller than dates on ultrasonography even in the first trimester). STUDY DESIGN: For the population referred to our center for chorionic villus sampling from January 1988 to July 1991, we compared gestational age as calculated from the last menstrual period to that derived from fetal size as measured by crown-rump length. A cutoff of 7 days was chosen to select the study group. The remainder of our chorionic villus sampling population in which fetal size was expected was used as controls. We also divided those chorionic villus sampling patients by when a fetal death was observed by size. RESULTS: In the study period 3194 chorionic villus sampling procedures were performed and in 277 (8.7%) fetal length was smaller than expected by at least 7 days. Sixty (1.9%) chromosome anomalies were diagnosed by first trimester chorionic villus sampling in the study period. The frequency of chromosome anomalies was 4.3% in the study group and 1.7% in controls (P < 0.004). The more aberrant the karyotype on ‘postmortem chorionic villus sampling,’ the greater the growth retardation tended to be. CONCLUSIONS: In our chorionic villus sampling population a fetal crown-rump length smaller than dates is associated with a significant increase in risk of chromosome anomalies. Moreover, the larger the size-dates discrepancy, the higher the possibility that the aneuploidy affecting that pregnancy is of the severe or lethal type. Asphyxial complications in the term newborn with severe ombilical acidemia
Goodwin T.M.; Belai I.; Hemandez P.; Durand M.; Paul R.H. USA
AM J OBSTET GYNECOL 1992 167/6 (1506-1512) OBJECTIVE: Our purpose was to determine the relationship of umbilical acid-base status and Apgar score to neonatal asphyxial sequelae in infants with severe acidemia (pH < 7.00). STUDY DESIGN: The obstetric and neonatal course of 129 term, nonanomalous singleton infants with umbilical pH < 7.00 was reviewed. RESULTS: There were three stillbirths (failed resuscitation). Seventy-two of 126 (57%) were admitted to the neonatal intensive care unit. Thirty-eight percent had pulmonary dysfunction, 26% renal dysfunction, 31% cardiac dysfunction, and 31% hypoxic ischemic encephalopathy (seizures and hypotonia, n = 29; seizures only, n = 3; hypotonia only, n = 10). There were five neonatal deaths. In 109 cases umbilical arterial values were available, and among these infants there was a significant increase in the incidence of seizures with declining pH from 9% (5/57), with a pH of 6.90 to 6.99, to 80% (8/10), with a pH of 6.61 to 6.70. Respiratory acidemia (Pco~ > 65, base deficit c 10) was identified in 28 of 109 (26%), all
Int J Gynecol Obstet 42
but six occurring in the pH range above 6.90. Compared with infants with comparable umbilical artery pH, infants with respiratory acidemia did not differ significantly with respect to asphyxial end-organ injury in general (8/35 vs. 6/22), but there was a trend toward a lower incidence of hypoxic ischemic encephalopathy (6/35 vs. l/22, p = 0.06). All infants with definite abnormal outcome (five neonatal deaths and 10 severe neurologic deficit) had seizures, hypotonia, and at least one other organ system dysfunction. Twenty-four of 29 infants (83%) who developed seizures had a 5-min Apgar score < 7, but only 12 of 29 (41%) had a 5-min Apgar score of 5 3. Two infants with Apgar scores of 6 and 7 at 5 min and no evidence of nonasphyxial comorbidity subsequently manifested profound neurologic deficit. CONCLUSIONS: Infants with severe umbilical acidemia can be separated with regard to risk of hypoxic ischemic encephalopathy and abnormal neurologic outcome by consideration of the severity and composition of the acidemia and evidence of other end-organ dysfunction. Even in this pH range the Apgar score is not highly predictive of asphyxial complications. Effect of magnesium sulfate on plasma endothelin-1 levels in normal and preeclamptic pregnancies Mastrogiannis D.S.; Kalter C.S.; O’Brien W.F.; Carlan S.J.; Reece E.A. USA
AM J OBSTET GYNECOL 1992 167/6 (1554-1559) OBJECTIVE: We attempted to determine the effects of magnesium sulfate on: (1) endothelin-1 concentration in preeclampsia, preterm labor, and term pregnancy and (2) endothelin-I release from human umbilical cord endothelial cells. STUDY DESIGN: Plasma samples were prospectively collected from eight women with preeclampsia, six preterm labor patients, and eight term patients undergoing external cephalic version before and 2 h after magnesium sulfate infusion. Supernatants were collected from human umbilical cord endothelial cells exposed to magnesium sulfate and controls. All samples were assayed with a specific radioimmunoassay for endothelin-1. Paired Student t test and analysis of variance were used for statistical analysis. RESULTS: Magnesium sulfate infusion in preeclampsia lowered endothelin-I levels compared with preinfusion values (6.6 + 3.81 before and 4.75 * 2.28 after infusion, P < 0.02). Magnesium sulfate did not have an effect on endothelin-1 concentration in preterm and term pregnancies. Magnesium sulfate did not alter the endothelin-1 release from human umbilical cord endothelial cells. CONCLUSION: A significant reduction of endothelin-I plasma levels after magnesium sulfate therapy is limited to preeclampsia. In contrast, this lowering effect was not exhibited in women without preeclampsia or in normal endothelial cells. Maternal-fetal hypertension
HLA-DR
relationships
Hoff C.; Peevy K.; Giattina R.D.A.
and pregnancy-induced
K.; Spinnato J.A.; Peterson
USA
OBSTET GYNECOL 1992 8016 (1007-1012) Objective: Some studies have found an increased prevalence
Citations from the Literature
The smaller thao expected fmt-trimester for chromosome anomalies
fetus is at increased risk
Drugan A.; Johnson M.P.; Isada N.B.; Holzgreve W.; Zador I.E.; Dombrowski M.P.; Sokol R.J.; Hallak M.; Evans MI. USA
AM J OBSTET GYNECOL 1992 167/6 (1525-1528) OBJECTIVE: Intrauterine growth retardation associated with fetal chromosome anomalies is usually documented on ultrasonography late in the second trimester. However, we believe and attempt to document here that the impact of aneuploidy on fetal growth is evident much earlier (i.e., the aneuploid fetus may appear smaller than dates on ultrasonography even in the first trimester). STUDY DESIGN: For the population referred to our center for chorionic villus sampling from January 1988 to July 1991, we compared gestational age as calculated from the last menstrual period to that derived from fetal size as measured by crown-rump length. A cutoff of 7 days was chosen to select the study group. The remainder of our chorionic villus sampling population in which fetal size was expected was used as controls. We also divided those chorionic villus sampling patients by when a fetal death was observed by size. RESULTS: In the study period 3194 chorionic villus sampling procedures were performed and in 277 (8.7%) fetal length was smaller than expected by at least 7 days. Sixty (1.9%) chromosome anomalies were diagnosed by first trimester chorionic villus sampling in the study period. The frequency of chromosome anomalies was 4.3% in the study group and 1.7% in controls (P < 0.004). The more aberrant the karyotype on ‘postmortem chorionic villus sampling,’ the greater the growth retardation tended to be. CONCLUSIONS: In our chorionic villus sampling population a fetal crown-rump length smaller than dates is associated with a significant increase in risk of chromosome anomalies. Moreover, the larger the size-dates discrepancy, the higher the possibility that the aneuploidy affecting that pregnancy is of the severe or lethal type. Asphyxial complications in the term newborn with severe ombilical acidemia
Goodwin T.M.; Belai I.; Hemandez P.; Durand M.; Paul R.H. USA
AM J OBSTET GYNECOL 1992 167/6 (1506-1512) OBJECTIVE: Our purpose was to determine the relationship of umbilical acid-base status and Apgar score to neonatal asphyxial sequelae in infants with severe acidemia (pH < 7.00). STUDY DESIGN: The obstetric and neonatal course of 129 term, nonanomalous singleton infants with umbilical pH < 7.00 was reviewed. RESULTS: There were three stillbirths (failed resuscitation). Seventy-two of 126 (57%) were admitted to the neonatal intensive care unit. Thirty-eight percent had pulmonary dysfunction, 26% renal dysfunction, 31% cardiac dysfunction, and 31% hypoxic ischemic encephalopathy (seizures and hypotonia, n = 29; seizures only, n = 3; hypotonia only, n = 10). There were five neonatal deaths. In 109 cases umbilical arterial values were available, and among these infants there was a significant increase in the incidence of seizures with declining pH from 9% (5/57), with a pH of 6.90 to 6.99, to 80% (8/10), with a pH of 6.61 to 6.70. Respiratory acidemia (Pco~ > 65, base deficit c 10) was identified in 28 of 109 (26%), all
Int J Gynecol Obstet 42
but six occurring in the pH range above 6.90. Compared with infants with comparable umbilical artery pH, infants with respiratory acidemia did not differ significantly with respect to asphyxial end-organ injury in general (8/35 vs. 6/22), but there was a trend toward a lower incidence of hypoxic ischemic encephalopathy (6/35 vs. l/22, p = 0.06). All infants with definite abnormal outcome (five neonatal deaths and 10 severe neurologic deficit) had seizures, hypotonia, and at least one other organ system dysfunction. Twenty-four of 29 infants (83%) who developed seizures had a 5-min Apgar score < 7, but only 12 of 29 (41%) had a 5-min Apgar score of 5 3. Two infants with Apgar scores of 6 and 7 at 5 min and no evidence of nonasphyxial comorbidity subsequently manifested profound neurologic deficit. CONCLUSIONS: Infants with severe umbilical acidemia can be separated with regard to risk of hypoxic ischemic encephalopathy and abnormal neurologic outcome by consideration of the severity and composition of the acidemia and evidence of other end-organ dysfunction. Even in this pH range the Apgar score is not highly predictive of asphyxial complications. Effect of magnesium sulfate on plasma endothelin-1 levels in normal and preeclamptic pregnancies Mastrogiannis D.S.; Kalter C.S.; O’Brien W.F.; Carlan S.J.; Reece E.A. USA
AM J OBSTET GYNECOL 1992 167/6 (1554-1559) OBJECTIVE: We attempted to determine the effects of magnesium sulfate on: (1) endothelin-1 concentration in preeclampsia, preterm labor, and term pregnancy and (2) endothelin-I release from human umbilical cord endothelial cells. STUDY DESIGN: Plasma samples were prospectively collected from eight women with preeclampsia, six preterm labor patients, and eight term patients undergoing external cephalic version before and 2 h after magnesium sulfate infusion. Supernatants were collected from human umbilical cord endothelial cells exposed to magnesium sulfate and controls. All samples were assayed with a specific radioimmunoassay for endothelin-1. Paired Student t test and analysis of variance were used for statistical analysis. RESULTS: Magnesium sulfate infusion in preeclampsia lowered endothelin-I levels compared with preinfusion values (6.6 + 3.81 before and 4.75 * 2.28 after infusion, P < 0.02). Magnesium sulfate did not have an effect on endothelin-1 concentration in preterm and term pregnancies. Magnesium sulfate did not alter the endothelin-1 release from human umbilical cord endothelial cells. CONCLUSION: A significant reduction of endothelin-I plasma levels after magnesium sulfate therapy is limited to preeclampsia. In contrast, this lowering effect was not exhibited in women without preeclampsia or in normal endothelial cells. Maternal-fetal hypertension
HLA-DR
relationships
Hoff C.; Peevy K.; Giattina R.D.A.
and pregnancy-induced
K.; Spinnato J.A.; Peterson
USA
OBSTET GYNECOL 1992 8016 (1007-1012) Objective: Some studies have found an increased prevalence