Miguel Margulies

Uric acid levels: a useful index of the severity of preeclampsia and perinatal prognosis

Maximum serum uric acid (SUA) levels during the third trimester of pregnancy were selected in 215 hypertensive pregnant women: 100 with mild preeclampsia (PE), 25 with severe PE, 70 with essential hypertension (EH) and 20 with EH with superimposed PE (EH + PE). The increase in SUA levels was statistically significant in women with severe PE (6.22 mg% +/- 1.30 mg%) and with EH + PE (6.09 mg% +/- 1.53 mg%) when compared with values in mild PE and EH women (4.85 mg% +/- 1.34 mg% and 4.95 mg% +/- 1.22 mg%, respectively). A significant decrease in average gestational age at delivery and a greater percentage of small-for-gestational age newborns were observed in women with severe PE and EH + PE, compared with patients with mild PE and EH. No correlation within the groups was found between SUA levels and fetal weight. To conclude, the determination of SUA concentration for the clinical screening of a pregnancy complicated by hypertension is an easy and inexpensive method for the prediction of perinatal results associated with severe PE.

Neonatal administration of high-dose intravenous immunoglobulin in rhesus hemolytic disease

Our aim was to assess the effectiveness of neonatal treatment of Rh hemolytic disease with high-dose intravenous immunoglobulin (HDIVIG), in reducing neonatal hemolysis. A total of 40 neonates born to isoimmunized Rh negative women were studied. The population was randomized into 2 groups: Group 1 received IVIG 800 mg/kg/day for 3 days, plus phototherapy; and Group 2 received only phototherapy. No significant difference was observed between the groups in the severity of either the antenatal and neonatal disease, mode of delivery, mean birthweight, gestational age at delivery, proportion of preterm deliveries, 1 minute Apgar Score, days of phototherapy, and presence of neonatal cholestasis. Group 1 babies showed a significantly decreased duration of hospitalization, less hemolysis, and a less marked increase in bilirubin levels on the first day of life than Group 2 newborns. Therefore, Group 1 neonates received less treatment with transfusions (exchange-transfusions and/or simple blood treatment with transfusions) than those in Group 2. Our data suggest that the frequency of transfusional therapy can be reduced by combining conventional phototherapy with HDIVIG. Further studies are needed to determine the optimum timing and dosages of neonatal HDIVIG treatment.

Two-dimensional and M-mode echocardiographic findings in hypertensive pregnant women

Two-dimensional and M-mode echocardiograms were obtained during the thirty-second week of gestation from 69 women classified as follows: group I, 22 normotensive primigravid women; group II, 16 primigravid women with pregnancy-induced hypertension; group III, 21 percent women with essential hypertension; and group IV, 10 normotensive nonpregnant control subjects. Systolic, diastolic, and mean arterial pressures were higher in groups II and III than in groups I and IV (p less than 0.001). Echocardiographic dimensions were significantly increased in group III compared with the other groups (p less than 0.01). No significant differences were observed among the other groups in the echocardiographic parameters or in the indices of ventricular performance studied. In echocardiographic studies, chronic hypertensive pregnant women are distinguished from patients with pregnancy-induced hypertension because the former have ventricular hypertrophy resulting from the pressure overload exerted for a long period of time. Our patients with essential hypertension experienced no changes in left ventricular performance because of the early stage of their hypertensive disease.

Ketanserin versus alpha-methyldopa in the treatment of hypertension during pregnancy: a preliminary report.

The antihypertensive efficacy of acute treatment with the serotonin receptor antagonist, ketanserin, in women with preeclampsia has been recently documented. The purpose of this study was to determine the safety and efficacy of chronic ketanserin treatment in a group of 20 hypertensive pregnant women: 10 received daily oral doses of ketanserin (20-80 mg), and 10 were treated with oral alpha-methyldopa (500-2000 mg). This study includes (a) patients with a sustained elevation of systolic blood pressure higher than 159 mm Hg and/or diastolic blood pressure higher than 99 mm Hg at bed rest, and (b) hypertensive patients with systolic blood pressure higher than 140 mm Hg or diastolic blood pressure higher than 90 mm Hg with superimposed symptoms such as headaches, stomach aches, and neurological disturbances. A significant and comparable decrease in blood pressure was noted in both groups, in relation with pretreatment levels; no adverse affects were observed in mother or fetus from the ketanserin and alpha-methyldopa groups.

Effectiveness of Antihypertensive Drugs in the Treatment of Hypertension in Pregnancy

The purpose of this open, prospective, randomized, comparative study was to examine the effectiveness of atenolol, a cardioselective beta1 blocker, alphamethyldopa, an alpha-adrenergic antagonist, and ketanserin, a serotonin receptor antagonist, in the treatment of 90 patients (N–30 each) with severe chronic hypertension (ChH) during pregnancy or severe pregnancy-induced hypertension, with or without proteinuria in either case.Arterial blood pressure (BP) for each drug group was analyzed at the onset of treatment, weekly for three weeks, and at the end of pregnancy. After one week of treatment a significant drop in BP was observed in the three groups of patients. Thereafter BP remained stable until the end of gestation, when a slight increase in BP was observed, especially in the group of patients treated with ketanserin.No significant difference was observed between the groups in mean birthweight and perinatal morbidity and mortality. No adverse effects from the drugs on the fetus or newborn were observe...

In-utero intravascular transfusion of the fetus for the management of severe Rhesus isoimmunization –a reappraisal

Commentary: The safety of diagnostic ultrasound Dear Sir, Dr Meire’s commentary [Br J Obstet Gynaecol (1987) 94,1121-11221 on the safety of diagnostic ultrasound has rightly summarized the difficulties in deciding the potential risks of this useful clinical tool. Despite the present chaos in delineating and controlling exposure conditions and the bewildering range of ultrasound bioeffects described in over 700 publications since 1950, reviewed by Stewart & Moore (1984), some order is emerging. The increased frequency of sister chromid exchanges induced by pulsed ultrasound in human lymphocytes, first described by Liebeskind et al. (1979), has been amply confirmed in reports from four independent laboratones involving studies of pulsed as well as continuous wave ultrasound (Haupt eta!. 1981; Ehlinger et al. 1981; Ozawa et a/. 1984; Stella et al. 1984). Recently, further evidence that sister chromatid exchanges in human lymphocytes are induced by high-intensity pulsed ultrasound has been presented by Barnett el al. (1988), who are now able to confirm the previous results. Free radical production in amniotic fluid and blood plasma by medical ultrasound, probably following gaseous cavitation, has been detected by Crum et a / . (1987). ‘This provides a likely mechanism for the ongin of the DNA damage. Because of these confirmations and a recent report by Ellisman et al. (1987) that diagnostic levels of ultrasound may disrupt myelination in neonatal rats, the need for regulation, guidance, and properly controlled clinical studies is clear. Clinicians ought to have some estimate of the level of risks associated with ultrasound, as with any other clinical modality. Robert Bases Professor of Radiology Chit

Determination of serum estriol levels using a125I-radioimmunoassay

Radiobiology Section Albert Einstein College of Medicine of Yeshiva University 1300 Morris Park Avenue Bronx N Y 10461 U S A

WS15‐07Assessment of a formula using Doppler velocimetry to calculate fetal hemoglobin (Hb)

SummaryA new method of radioimmunoassay (RIA) for serum estriol (E3) which utilizes125I-estriol as a tracer has been developed. This steroid was radioiodinated with chloramine T and purified by Sephadex LH-20 column chromatography. Two hundred and sixty-two samples from 130 normal pregnant patients at different stages of gestation were analysed. From 5 women, blood samples were drawn at 15 min intervals for 1 h. An increase in the circulating levels of E3 was observed throughout normal pregnancy and the results were widely distributed. The episodic fluctuations of E3 showed a variation of 13–20 ng/ml during the same 1-h sampling period. The quality control results showed the viability of this RIA in the determination of serum E3 utilizing the iodinated steroid as a tracer.

Successful maternal and fetal outcome in a pregnant woman with primary pulmonary hypertension

Aim

INTRAUTERINE TREATMENT OF NON-IMMUNOLOGICAL HYDROPS FETALIS. A CASE REPORT.

A 19-year-old pregnant woman with primary pulmonary hypertension (PPH) who refused to undergo elective therapeutic abortion is presented.