Kevin P. Magee

Coarctation of the abdominal aorta in pregnancy: Diagnosis by magnetic resonance imaging

Background Coarctation of the aorta is rare, affecting one per 2000–3000 women. Abdominal coarctation is more commonly identified in women than in men, but only two cases have been reported in pregnancy. Case A 26-year-old woman was diagnosed with hypertension at 15 years of age. Her blood pressure was controlled adequately with beta-blockers. During her pregnancy, she was found to have coarctation of the abdominal aorta by magnetic resonance imaging. Conclusion Magnetic resonance imaging is a safe, reliable means by which to confirm clinically suspected coarctation of the aorta during pregnancy.

Massive septic pelvic thrombophlebitis

Background: Septic pelvic thrombophlebitis is a major complication of endometritis. The thrombi commonly occur in the uterine and/or ovarian veins and may extend into the inferior vena cava. Case: Following vaginal delivery, a 19‐year‐old woman, gravida 2, developed postpartum septic pelvic thrombophlebitis extending from the right ovarian vein up to the diaphragm and down to the femoral vein. The patient was treated successfully with heparin and antibiotics, and eventually was discharged on oral anticoagulants for an extended period. Follow‐up revealed complete resolution of the thrombus. Conclusion: Septic pelvic thrombophlebitis is not limited to the pelvis and lower abdominal vessels. (Obstet Gynecol 1993;82:662‐4)

Ex vivo human placental transfer and the vasoactive properties of hydralazine

OBJECTIVE The purpose of this study was to determine the placental transfer and fetal vascular effects of hydralazine in an ex vivo human placental system. STUDY DESIGN Nine placentas from uncomplicated term vaginal or cesarean deliveries were studied by means of the ex vivo single-cotyledon perfusion system. Antipyrine was used for the reference compound in the determination of the clearance index of hydralazine. Fetal vascular effects of hydralazine were determined by the effects on the perfusion pressure of the fetal artery in a constant-flow open system. Variations in fetal pressure were analyzed with the 1-sample Student t test. RESULTS The clearance index of hydralazine ranged from 0.61 +/- 0. 18 to 0.73 +/- 0.14. The accumulation of hydralazine in the recirculated fetal compartment was linear in relationship to the maternal concentration. Fetal pressure changes were noted in 6 of the 9 placentas, or 66.6%. The mean change in pressure was -4.1 +/- 4.4 mm Hg (P =.0231). CONCLUSIONS Hydralazine readily crosses the ex vivo human placental perfusion system.

Ex vivo human placental transfer of rifampin and rifabutin.

Objective: The purpose of this study was to determine the ex vivo human placental transfer of rifampin and rifabutin. Methods: Seven placentas from uncomplicated term vaginal or cesarean deliveries were studied utilizing the ex vivo single cotyledon perfusion system. Antipyrine was used for the reference compound in the determination of the clearance indices of rifampin and rifabutin. Results: The clearance indices of rifampin at maternal concentrations of 1.0 and 10.0 μg/ml were 0.12 ± 0.05 and 0.12 ± 0.11, respectively. The clearance indices of rifabutin at maternal concentrations of 1.0 and 10.0 μg/ml were 0.44 ± 0.11 and 0.37 ± 0.15, respectively. Conclusions: Because of its greater lipophilicity, rifabutin was found to have a greater clearance than rifampin. However, because of rifabutins trend toward greater deposition in tissue, there was proportionately less accumulation of rifabutin in the fetal circulation when compared to rifampin.