- Email: [email protected]
Fetoscopic neodymium: Yag laser occlusion of placental vessels in severe twin-twin transfusion syndrome
Citations from the Literature
191
cific for IgG. Linear regression revealed a significant increase in antibody with advancing gestational age (r = 0.36, p < 0.01). In addition, placentas from patients in spontaneous term labor revealed a significantly higher antibody level when compared with those of patients at term delivered electively before the onset of labor (mean + SEM 2.6 f 0.2 vs 1.7 f 0.3. p < 0.02). Patients in premature labor failed to demonstrate this increase in antibody staining. One possible explanation for these findings is an enhanced recognition of the fetal trophoblastic tissue by the maternal immune system at term. It also suggests immunologic factors may play an important role in the initiation of normal labor.
injection site. The pharmacodynamics effects of ritodrine were unaffected by injection site, but ritodrine caused a dose-related increase in heart rate and systolic blood pressure and a doserelated decrease in diastolic blood pressure. After a 10 mg injection, the maximal changes in heart rate, systolic, and diastolic blood pressure were 22%, 10070,and 19vo, respectively. However, mean blood pressure was not altered by either the 5 or 10 mg dose. These findings indicate that there are few differences in pharmacokinetic parameters between deltoid and gluteal injection of ritodrine. The single intramuscular injection of 5 or 10 mg ritodrine results in labor-inhibiting concentrations with clinical insignificant cardiovascular effects.
Magnesium tocolysis: Serum levels versus success
Fetoscopic neodymium: Yag laser occlusion of placental vessels in severe twin-twin transfusion syndrome
Madden C; Owen J; Hauth JC Department of Obstetrics and Gynecolo~, University of Alabama at Birmingham, Birmingham, AL 35294, USA AM J OBSTET GYNECOL 1990,162/5 (1177-1180) The relationship between maternal serum magnesium levels and tocolytic success is poorly established. We performed a retrospective analysis of 101 episodes of preterm labor treated with magnesium sulfate and compared the initial, average, and maximum serum magnesium levels with tocolytic success at 48 hours and 7 days. There was no difference in the proportions of tocolytic success when serum levels were < 6 mg/dl compared with levels of > 6 mg/dl. Similar analyses on either side of 5 mg/dl also revealed no significant relationship. Mean serum magnesium levels in patients with successful tocolysis were statistically similar to those of patients in whom tocolysis failed. Multiple logistic regression analysis also failed to establish a positive relationship between serum magnesium levels and tocolytic success. We conclude that serum magnesium levels alone should not serve as an end point of therapy. Pharmecokiaetics and pharmacodyaamics of ritodrine after intramuscular administration to pregnant women
Caritis SN; Venkataramanan R; Cotroneo M; Smith M; Chiago JP; Habucky K Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA AM J OBSTET GYNECOL 1990, 162/5 (1215-1219) To define the pharmacokinetics and pharmacodynamics of ritodrine after intramuscular injection, we administered 5 or 10 mg ritodrine into the gluteus or deltoid muscles of 12 pregnant volunteers. Six women received 5 mg and six received 10 mg into each muscle group on different days. We withdrew blood samples before and 12 times in the 6 hours after ritodrine injection. Blood pressure and heart rate were’iecorded at each time. Ritodrine was measured by high-performance liquid chromatography. Peak ritodrine concentrations (mean f SD) after a single 5 mg injection in the deltoid or gluteus were 38 f 13 and 26 f 8 ng/ml, respectively. After a 10 mg dose in the deltoid or gluteus, peak concentrations were 59 + 30 and 47 + 22 ng/ ml, respectively. Although higher, the peak plasma concentrations after injections into the deltoid were not significantly greater than those after injection into the gluteus. None of the pharmacokinetic parameters differed according to dose or
De Lia JE; Cruikshank DP; Keye WR Jr Department of Obstetrics and Gynecology, 50 North Medical Drive, Salt Lake City, UT 84132, USA OBSTET GYNECOL 1990,75/6 (1046-1053) Most pregnancies with severe twin-twin transfusion syndrome before 27 weeks’ gestation result in perinatal death. Previous attempts at therapy have been generally unsatisfactory and rarely successful. We have developed a technique for intrauterine ablation of the vascular communications between the fetoplacental circulations with a fetoscopically directed neodymium: YAG laser. The operation was performed on three women at risk for pregnancy loss from acute hydramnios at 18.5,22, and 22.5 weeks’ gestation. The first two procedures were uneventful, but the third was complicated by a placental vessel perforation. The first two patients delivered at 27 and 34 weeks after premature rupture of membranes and spontaneous labor, whereas the third woman developed severe preeclampsia at 29 weeks which necessitated delivery. Four of the six infants survived. Clinical and ultrasonographic evidence, as well as pathologic examination of the placentas, suggested that stabilization or resolution of the syndrome was due to photocoagulation of the vascular communications. This initial experience suggests that fetoscopic laser occlusion of placental vessels is feasible and superior to previous therapies because it treats the underlying pathophysiology directly. Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetdc setting
Ludmir J; Samuels P; Brooks S; Mennuti MT Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA OBSTET GYNECOL 1990,75/6 (906-910) During an 8-year period, we managed 42 women with 101 pregnancies with previously diagnosed but uncorrected uterine malformations referred to our institution for high-risk obstetric care. All patients were managed under the same standardized protocol requiring weekly visits and decreased physical activity. The population studied consisted of four groups of pregnancies with the following uterine anomalies: unicornuate (five), bicornuate (61), septate (25), and didelphys (ten). Sixty percent of the pregnancies in the unicomuate and didelphys Int J Gynecoi Obstet 34
191
cific for IgG. Linear regression revealed a significant increase in antibody with advancing gestational age (r = 0.36, p < 0.01). In addition, placentas from patients in spontaneous term labor revealed a significantly higher antibody level when compared with those of patients at term delivered electively before the onset of labor (mean + SEM 2.6 f 0.2 vs 1.7 f 0.3. p < 0.02). Patients in premature labor failed to demonstrate this increase in antibody staining. One possible explanation for these findings is an enhanced recognition of the fetal trophoblastic tissue by the maternal immune system at term. It also suggests immunologic factors may play an important role in the initiation of normal labor.
injection site. The pharmacodynamics effects of ritodrine were unaffected by injection site, but ritodrine caused a dose-related increase in heart rate and systolic blood pressure and a doserelated decrease in diastolic blood pressure. After a 10 mg injection, the maximal changes in heart rate, systolic, and diastolic blood pressure were 22%, 10070,and 19vo, respectively. However, mean blood pressure was not altered by either the 5 or 10 mg dose. These findings indicate that there are few differences in pharmacokinetic parameters between deltoid and gluteal injection of ritodrine. The single intramuscular injection of 5 or 10 mg ritodrine results in labor-inhibiting concentrations with clinical insignificant cardiovascular effects.
Magnesium tocolysis: Serum levels versus success
Fetoscopic neodymium: Yag laser occlusion of placental vessels in severe twin-twin transfusion syndrome
Madden C; Owen J; Hauth JC Department of Obstetrics and Gynecolo~, University of Alabama at Birmingham, Birmingham, AL 35294, USA AM J OBSTET GYNECOL 1990,162/5 (1177-1180) The relationship between maternal serum magnesium levels and tocolytic success is poorly established. We performed a retrospective analysis of 101 episodes of preterm labor treated with magnesium sulfate and compared the initial, average, and maximum serum magnesium levels with tocolytic success at 48 hours and 7 days. There was no difference in the proportions of tocolytic success when serum levels were < 6 mg/dl compared with levels of > 6 mg/dl. Similar analyses on either side of 5 mg/dl also revealed no significant relationship. Mean serum magnesium levels in patients with successful tocolysis were statistically similar to those of patients in whom tocolysis failed. Multiple logistic regression analysis also failed to establish a positive relationship between serum magnesium levels and tocolytic success. We conclude that serum magnesium levels alone should not serve as an end point of therapy. Pharmecokiaetics and pharmacodyaamics of ritodrine after intramuscular administration to pregnant women
Caritis SN; Venkataramanan R; Cotroneo M; Smith M; Chiago JP; Habucky K Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA AM J OBSTET GYNECOL 1990, 162/5 (1215-1219) To define the pharmacokinetics and pharmacodynamics of ritodrine after intramuscular injection, we administered 5 or 10 mg ritodrine into the gluteus or deltoid muscles of 12 pregnant volunteers. Six women received 5 mg and six received 10 mg into each muscle group on different days. We withdrew blood samples before and 12 times in the 6 hours after ritodrine injection. Blood pressure and heart rate were’iecorded at each time. Ritodrine was measured by high-performance liquid chromatography. Peak ritodrine concentrations (mean f SD) after a single 5 mg injection in the deltoid or gluteus were 38 f 13 and 26 f 8 ng/ml, respectively. After a 10 mg dose in the deltoid or gluteus, peak concentrations were 59 + 30 and 47 + 22 ng/ ml, respectively. Although higher, the peak plasma concentrations after injections into the deltoid were not significantly greater than those after injection into the gluteus. None of the pharmacokinetic parameters differed according to dose or
De Lia JE; Cruikshank DP; Keye WR Jr Department of Obstetrics and Gynecology, 50 North Medical Drive, Salt Lake City, UT 84132, USA OBSTET GYNECOL 1990,75/6 (1046-1053) Most pregnancies with severe twin-twin transfusion syndrome before 27 weeks’ gestation result in perinatal death. Previous attempts at therapy have been generally unsatisfactory and rarely successful. We have developed a technique for intrauterine ablation of the vascular communications between the fetoplacental circulations with a fetoscopically directed neodymium: YAG laser. The operation was performed on three women at risk for pregnancy loss from acute hydramnios at 18.5,22, and 22.5 weeks’ gestation. The first two procedures were uneventful, but the third was complicated by a placental vessel perforation. The first two patients delivered at 27 and 34 weeks after premature rupture of membranes and spontaneous labor, whereas the third woman developed severe preeclampsia at 29 weeks which necessitated delivery. Four of the six infants survived. Clinical and ultrasonographic evidence, as well as pathologic examination of the placentas, suggested that stabilization or resolution of the syndrome was due to photocoagulation of the vascular communications. This initial experience suggests that fetoscopic laser occlusion of placental vessels is feasible and superior to previous therapies because it treats the underlying pathophysiology directly. Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetdc setting
Ludmir J; Samuels P; Brooks S; Mennuti MT Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA OBSTET GYNECOL 1990,75/6 (906-910) During an 8-year period, we managed 42 women with 101 pregnancies with previously diagnosed but uncorrected uterine malformations referred to our institution for high-risk obstetric care. All patients were managed under the same standardized protocol requiring weekly visits and decreased physical activity. The population studied consisted of four groups of pregnancies with the following uterine anomalies: unicornuate (five), bicornuate (61), septate (25), and didelphys (ten). Sixty percent of the pregnancies in the unicomuate and didelphys Int J Gynecoi Obstet 34