Hamid A. Hadi

Serial noninvasive evaluation of cardiovascular hemodynamics during pregnancy

M-mode echocardiography, in combination with electrocardiography and phonocardiography, has been used to measure pulmonary capillary pressure as well as other cardiac functions. Serial hemodynamic evaluations by use of this technique were performed in seven healthy pregnant women in the recumbent position. Each patient had five studies: four antenatal studies and one postpartum study that served as a control. Mean pulmonary capillary pressure was within normal limits throughout pregnancy and the puerperium. Cardiac output did not increase significantly by the end of the first or second trimester but became elevated by 31% in the early third trimester. This elevation in cardiac output persisted until delivery and resulted from a comparable increase in heart rate. Stroke volume and ejection fraction did not change significantly, while peripheral vascular resistance fell, although not significantly, reaching a nadir at approximately 28 weeks of gestation. Our findings indicate that maternal cardiac output increases due to an increased heart rate and reduced afterload.

Nonimmune hydrops fetalis: Clinical experience and factors related to a poor outcome

Twenty-one cases of nonimmune hydrops fetalis diagnosed at the Medical College of Georgia during a 2-year period are presented. All fetuses satisfied strict diagnostic criteria and were evaluated according to a standard protocol. The corrected mortality rate was 95% with pulmonary hypoplasia being the most common cause of perinatal death. The mean gestational age at diagnosis was 24.8 weeks; in 57% of the cases the cause of nonimmune hydrops fetalis was identified. Fifteen fetuses had serial ultrasound assessment and in 19 cases postnatal evaluation was performed. Two factors that consistently conveyed a poor perinatal outcome were ultrasonographic evidence of malformation and/or the presence of persistent pleural effusions. A method for the quantification of fetal pleural effusions is presented and its clinical relevance is discussed.

Pleural effusions and pulmonary hypoplasia

Nine cases of fetuses with pleural effusions are presented in which the diagnosis was made by ultrasound before the thirtieth week of gestation. A ratio of lung span to hemithorax diameter was calculated and ranged from 0.44 to 0.77 (mean 0.60). At autopsy, pulmonary hypoplasia was confirmed in all cases by criteria based on the ratio of lung weight to total body weight. Because pleural effusions occurring in the midtrimester can be detected and may lead to pulmonary hypoplasia, consideration should be given to definitive in utero therapy when no other major fetal abnormality is detected.

Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach.

Four cases of benign intracranial hypertension (BIH) in pregnancy are presented. Literature regarding this rare entity is reviewed. Various diagnostic and therapeutic approaches in the management of BIH are described, with special emphasis on the newer neurodiagnostic and neurosurgical approaches. Guidelines have been suggested in diagnosing and managing this syndrome in pregnancy.

Alcohol and reproductive function: a review.

This article reviews the effects of alcohol on male and female gonads and hormonal levels; it further discusses the use of ethanol during pregnancy and its teratogenic effect on the fetus. Impotence is a common result of acute alcoholism, and testicular atrophy, infertility, and decreased libido are associated with alcoholism 70-80% of the time. In addition, alcohol consumption produces significant spermatozoal morphological changes involving breakage of the sperm head, distention of the midsection, and curling of its tail. Seminiferous tubules are filled mostly with spermatids that undergo degeneration and result in aspermia. Acute ethanol intoxication is accompanied by decreased plasma testosterone levels and a surge of luteinizing hormone. Ethanol appears to have a dual effect: locally on the gonads and centrally on the hypothalamus-pituitary axis, causing an adverse effect on spermatogenesis. Less is known about the effects of alcohol on the female reproductive function; however, inhibition of ovulation and a significant reduction of plasma estradiol and progesterone levels has been noted in rats following ethanol administration. Alcohol consumption during pregnancy is the most frequent known teratogenic cause of mental retardation. Infants most severely affected by maternal alcohol abuse during gestation possess a number of dysmorphic anomalies termed fetal alcohol syndrome. The abnormalities most typically associated with alcohol teratogenicity can be grouped into 4 categories: growth deficiencies, central nervous system dysfunctions, craniofacial abnormalities, and other major and minor malformations. The effects of maternal alcohol consumption on the fetus are independent of maternal nutritional status and smoking history. Alcohol abuse during pregnancy occurs in 2-13% of US women, and these women have a 50-70% chance of delivering an infant with a serious abnormality.

Pregnancy in renal transplant recipients: a review.

Although pregnancy in renal transplant patients was looked upon with skepticism in the past, it is no longer an insurmountable barrier to successful pregnancy. Gestation in these patients, once quite rare, is increasing markedly and obstetricians expect to encounter problems such as immunologic, genetic, teratogenic, and infectious disease during the course of pregnancy in these patients. The purpose of this paper is to review various maternal and fetal aspects of pregnancy in renal transplant recipients.

Cardiac isoenzymes and electrocardiographic changes during ritodrine tocolysis

To investigate the potential myocardial ischemic effects of ritodrine, we studied 36 singleton and four twin preterm pregnancies during ritodrine therapy. We serially determined serum creatinine phosphokinase (CPK-MB fraction) and lactic dehydrogenase isoenzymes and performed electrocardiography before and during ritodrine infusion and again within the first 24 hours of oral drug therapy. We observed that serum CPK-MB and lactic dehydrogenase isoenzymes remained within the normal range during therapy periods. The incidence of sinus tachycardia and non-specific T wave changes were 100% and 25%, respectively. In three of four twin pregnancies, ST-T segment depression in leads I, V4, V5, and V6 of the electrocardiogram was noted. Our study suggests that (1) the recommended ritodrine regimen does not produce direct myocardial damage, and (2) ritodrine may cause cardiac ischemia as determined by electrocardiography, which theoretically would progress to myocardial damage if not treated properly.

Spontaneous in Utero Rupture of Fetal Meningomyelocele Sac: A Case Report

DOI: http://dx.doi.org/10.5915/22-2-13561 Route of delivery in cases of intact fetal meningomyelocele is controversial. Currently, many obstetricians are concerned about rupture of the meningomyelocele during vaginal delivery and elect to perform caesarean section. We present a case of meningomyelocele in which the sac was spontaneously ruptured two days prior to cesarean section, suggesting that in some cases vaginal delivery may not be responsible for rupture of the sac.