David A. Nagey

Effect of exogenous dehydroepiandrosterone upon the fetoplacental biosynthesis of estrogens and its effect upon uterine blood flow in the term pregnant ewe

The fetoplacental unit of the ewe is capable of increasing the biosynthesis of estrogens following the exogenous administration of DHEA to the fetus. The maximum concentrations of estrogens appeared approximately 30 minutes after the administration of DHEA. Uterine blood flow in the pregnant ewe increased approximately 90 minutes after the maximum concentrations of estrogens were noted. The administration of DHEA to the nonpregnant, ovariectomized ewe did not elicit estrogen biosynthesis or changes in uterine blood flow. Isotope experiments in the pregnant ewe demonstrated the incorporation of DHEA into urinary estradiol.

Pregnancy complicated by periarteritis nodosa: Induced abortion as an alternative

Reprint requests: Dr. David A. Nagey, Department of Obstetrics and Gynecology, University of Maryland Hospital, 22 South Greene St., Baltimore, Maryland 21201. tion characteristically may involve essentially any organ system. The disease is most common in men in their fifth and sixth decades of life and so is an even more rare complication of pregnancy. Nine cases of classical periarteritis nodosa in pregnancl have been reported.‘. ’

Is manual palpation of uterine contractions accurate

OBJECTIVE The aims of this study were to assess the accuracy of uterine contraction palpation, determine whether the accuracy of palpation improves with experience, determine clinical factors that affect the accuracy of palpation, and evaluate the range of intrauterine pressure present when an observer notes the contraction to be mild, moderate, or strong. STUDY DESIGN A total of 236 observations were obtained by use of intrauterine pressure catheters on 46 laboring patients in the first stage of labor. The blinded observers (obstetrics and gynecology residents, maternal-fetal medicine fellows and faculty, and labor and delivery nurses) were asked to label a contraction as mild, moderate, or strong. Patients height, weight, parity, and gestational age, use of oxytocin, use of epidural anesthesia, and laboring position, and the level of training of the observer were noted. RESULTS Mild, moderate, and strong contractions had intrauterine pressures of 35.2 +/- 33.8 mm Hg (+/- 2 SD), 44.9 +/- 35.4 mm Hg, and 55.5 +/- 28.0 mm Hg, respectively. The observers were accurate in predicting contraction strength 49% of the time. There was no improvement in accuracy with increased physician experience. All physicians as a group were more accurate than nurses (p < 0.05). Accuracy was not affected by clinical variables. CONCLUSION Manual palpation of uterine contractions is an inaccurate means of determining contraction strength.

Isovolumetric partial exchange transfusion in the management of sickle cell disease in pregnancy

A technique that permits isovolumetric partial exchange transfusion is presented, with experience from 10 partial exchange transfusions in five obstetric patients with sickle cell disease. The technique is performed in an outpatient setting and requires less than two hours once blood has been cross matched. A mathematical model of the blood volume is used to predict final hematocrit and final hemoglobulin (Hgb) A percentage and to compare this technique with a previously described algorithm. Once the decision to perform a partial exchange transfusion has been made, this technique affords diminished risk to the patient and economy of time and money by permitting prediction of the hematocrit and percentage normal hemoglobin (% Hgb A) resulting from various transfusion/withdrawal volumes.

A physiologic model of the dehydroepiandrosterone to estrogen conversion system in the fetoplacental unit

A physiologic model of the dynamics of fetoplacental unit dehydroepiandrosterone (HDEA) to estrogen conversion is presented. A mathematical representation of this model is included. The model is used in Part II to determine the rate constant of DHEA to estrogen conversion and to successfully identify those fetuses in jeopardy from placental insufficiency within the population studied. This presentation permits critical comprehension of the model without extensive mathematical background.

The dehydroepiandrosterone loading test: III. A possible placental function test

The dehydroepiandrosterone loading test (DLT) has been used in a small population of normal and high-risk obstetric patients, to date, in an attempt to develop a dynamic test of placental function. In spite of its limited applications, it has shown reliability in discriminating, with statistical significance, between high-risk pregnancies that result in normally grown, undistressed infants, and high-risk pregnancies that result in infants showing signs of placental insufficiency. The present report expands the study population by presenting our data on 40 loading tests performed in 37 high-risk and normal obstetric patients. Results of 19 of these DLTs have been previously reported and are included herein for statistical analysis. The DLT utilizes an excess substrate load of dehydroepiandrosterone to assess the maximum capability of the placenta to convert it to estrogen. Although our previous report did not show false positive or negative results in the conversion rates, the present results (40 DLTs) found two (2 out of 17) false positives (12%) and two (2 out of 19) false negatives (11%). The highly significant correlation between DLT result and pregnancy outcome seen previously was preserved. In addition, the data of another five DLTs in four patients are presented. This group includes a pregnancy with a fetus with multiple congenital malformations, two patients with intrauterine fetal death, and a nonpregnant woman. The results are not included in the statistical analysis, but discussion of these results has interesting pathophysiologic implications.

The Use of Medical Manpower In a Seventh Grade Drug Education Program.

The use of medical and nursing students in an ongoing drug education program for the seventh grade is described. The results of a questionnaire given to the pupils are shown to demonstrate the effectiveness of this program with respect to both information transmission and the influencing of predicted future use. With the methods used, the program is shown to be objective and effective in stimulating rational drug “use-nonuse” decisions.

The dehydroepiandrosterone loading test

The dehydroepiandrosterone loading test (DLT) has been used in a small population of normal and high-risk obstetric patients, to date, in an attempt to develop a dynamic test of placental function. In spite of its limited applications, it has shown reliability in discriminating, with statistical significance, between high-risk pregnancies that result in normally grown, undistressed infants, and high-risk pregnancies that result in infants showing signs of placental insufficiency. The present report expands the study population by presenting our data on 40 loading tests performed in 37 high-risk and normal obstetric patients. Results of 19 of these DLTs have been previously reported and are included herein for statistical analysis. The DLT utilizes an excess substrate load of dehydroepiandrosterone to assess the maximum capability of the placenta to convert it to estrogen. Although our previous report did not show false positive or negative results in the conversion rates, the present results (40 DLTs) found two (2 out of 17) false positives (12%) and two (2 out of 19) false negatives (11%). The highly significant correlation between DLT result and pregnancy outcome seen previously 2 was preserved. In addition, the data of another five DLTs in four patients are presented. This group includes a pregnancy with a fetus with multiple congenital malformations, two patients with intrauterine fetal death, and a nonpregnant woman. The results are not included in the statistical analysis, but discussion of these results has interesting pathophysiologic implications.