Edward J. Wolf

Relationship between fetal biophysical activities and umbilical cord blood gas values

In a prospective study of 62 patients undergoing cesarean section before the onset of labor a fetal biophysical profile assessment was performed within 3 hours before the cesarean section. The presence or absence of the individual fetal biophysical activities (fetal heart rate reactivity, fetal breathing movements, fetal body movements, and fetal tone) were correlated with umbilical cord blood gas and acid-base measurements (artery and vein). Fetuses with nonreactive nonstress test results or the absence of breathing had significantly lower cord artery pH, PO2 bicarbonate, and base excess measurements but not a significantly different PCO2 level as compared with fetuses that had these activities present. Fetuses with the absence of movements or tone had lower pH, PO2 bicarbonate, and base excess levels and higher PCO2 levels as compared with fetuses with the presence of movements or tone, respectively. These blood gas and acid-base differences were observed in both umbilical cord artery and vein. Subsequent analysis of the blood gas and acid-base measurements of the fetuses with compromised biophysical activities revealed that there are different levels of acidemia, hypoxemia, and hypercapnia at which the individual biophysical activities are compromised. These data suggest that the first manifestations of fetal hypoxemia and acidemia are nonreactive nonstress test results and loss of fetal breathing; in advanced acidemia, hypoxemia, and hypercapnia fetal movements and fetal tone are compromised.

The Principal Pregnancy Complications Resulting in Preterm Birth in Singleton and Twin Gestations

Preterm birth is the major cause of perinatal mortality for both singleton and twin gestations in the United States; most preterm birth prevention programs are primarily structured to detect and treat preterm labor. Most of these programs have had limited success, and the preterm birth rate for twins has remained well above that for singletons. Little attention has been paid to the question of whether the frequency of conditions that result in preterm twin delivery differs from those that result in the delivery of preterm singletons. Delivery records were reviewed for all 1,976 preterm (24–36 completed gestational weeks) singleton pregnancies and 221 preterm twin pregnancies delivered at the University of Connecticut Health Center, 1980–1989, to determine the primary complication that resulted in preterm delivery. Premature rupture of membranes was responsible for 46% of these singleton preterm deliveries, while the other causes were preterm labor with intact membranes (20%), pregnancy-induced hypertensio...

Correlation of Uterine Fundal Height with Ultrasonic Measurements in Twin Gestations

Owing to the lack of fundal height (FH) nomograms for normal twin gestations, it has been a standard recommendation to use frequent ultrasound examinations in order to diagnose discordant fetal growth. The validity of such a practice, however, has not been established. The purpose of this study was to establish a nomogram for FH measurements in normal twin gestations and to evaluate it as a means of detecting discordant growth in twins.This is a prospective cross-sectional study of 160 twin pregnancies between 16 and 36 weeks presenting for an ultrasound. FH measurements were obtained by both the Division of Maternal-Fetal Medicine attending physician and fellow. Maternal age, gravidity, parity, height and weight, gestational age (GA), fetal presentation, placentation, amniotic fluid volume, estimated fetal weight, and percent discordance were also recorded. A nomogram for FH in normal twin gestations (n = 143) was developed and it was used to see if FH can detect discordant growth in twins (n = 17).The 1...

Maternal Blood Pressure Adaptation in the First Trimester of Pregnancy

Normal changes in blood pressure during pregnancy are well documented in the second and third trimesters. Little is known about first-trimester changes, particularly compared with preconceptional values. This knowledge might allow for early prediction of conditions such as preeclampsia or intrauterine growth restriction. Prior studies utilized a laboratory setting. We conducted this retrospective study to compare blood pressure readings in early pregnancy with preconceptional values in the clinical setting. The records of 44 healthy normotensive nonsmoking women with a body mass index <30 and an uncomplicated appropriately grown singleton term delivery were reviewed. Preconceptional blood pressures values were compared with values at five periods (weeks 1 to 8, 9 to 16, 17 to 23, 24 to 32, 33 to 40). There was no difference in blood pressure parameters when comparing preconceptional values with period 1. The mean and systolic arterial pressures decreased significantly in periods 2 and 3. We were unable to demonstrate significant change in any blood pressure parameter in the first 8 weeks of pregnancy. This work should be repeated in patients who subsequently develop preeclampsia, spontaneous abortion, or intrauterine growth restriction to determine if early changes might be evident in early pregnancy to identify patients destined to develop pregnancy complications.

Case Report of Placement of a Bird's Nest Filter During Pregnancy

Anticoagulant therapy is the standard treatment of thrombotic disease to prevent embolic complications. In some circumstances, anticoagulation is not feasible, such as in the presence of heparin-induced thrombocytopenia or at the time of delivery. The case of a patient who developed deep vein thrombosis and heparin-induced thrombocytopenia is presented. A birds nest inferior vena caval filter was successfully placed prior to delivery in order to prevent peripartum thromboembolic complications.

Obstetrical Factors Associated with Nuchal Cord in a High-Risk Population

The obstetrical factors associated with nuchal cord at birth were retrospectively studied in 520 high-risk patients with gestational ages ranging from 24 to 42 weeks. The overall frequency of nuchal cord at birth was 16.7% (87 of 520). The frequencies of nuchal cord in preterm and term gestations were 14.7 and 22%, respectively. Factors associated with increased incidence of nuchal cord at birth were vertex presentation, vaginal birth, and term gestation. When the data were analyzed according to route of delivery and gestational age, it was found that the group of neonates born vaginally at term had the highest incidence of nuchal cord (17 of 51 or 33.3%, P <. 05) as compared to infants born at term by cesarean section (14 of 90 or 15.5%), preterm born vaginally (24 of 140 or 17.1%), and preterm born by cesarean section (32 of 239 or 13.3%). These data suggest that vaginal birth at term is the most significant factor associated with increased frequency of nuchal cord. Although a lower mean cord artery pH ...

Intravenous Adenosine for the Treatment of Maternal Paroxysmal Supraventricular Tachycardia

Intravenous adenosine is being used for the treatment of paroxysmal supraventricular tachycardia and paroxysmal junctional tachyarrhythmia in nonpregnant patients. In the cases presented here, intravenous adenosine rapidly terminated maternal paroxysmal supraventricular tachycardia in pregnant patients without maternal or fetal complications. Its potential advantages over other antiarrhythmics are discussed.