Faculty Bibliography

Two cases of Takayasu's syndrome in pregnancy are presented. The obstetric courses of these women are compared with those of 7 others described in the literature. Symptoms of this rare condition may respond variably during pregnancy. Of the 9 women, 5 had worsening of their symptoms during gestation while 4 had milder symptoms than they had had prior to pregnancy. The best therapy is rest. Vaginal delivery is recommended and cesarean section should be reserved for obstetric indications

A case of fetal trigeminal cardiac arrhythmia in labor is presented. The literature on fetal cardiac arrhythmias is reviewed. The significance and management of abnormal fetal rhythms in labor is discussed. The majority of fetal arrhythmias in labor do not require therapy

One hundred forty-four toxemic patients were studied by continuous electronic maternal and fetal monitoring. Ninety-seven were treated by intravenous bolus of 2 g MgSO4 every 1-2 hours, and 47 by intravenous drip MgSO4 at a rate of 1 g/hour. Clinical doses of MgSO4 do not affect maternal ECG, temperature, uterine contractions, or fetal heart rate. Intravenous bolus administration is frequently associated with slowing of maternal respirations and hypotension and occasionally with transient apnea

Fetal heart rates in the range of 100 to 119 beats per minute have been defined as moderate bradycardia. Twenty-five of 1,386 patients monitored during a 1 year period have manifested persistent moderate bradycardia. Moderate bradycardia is apparently related to fetal head compression, often in situations of relative cephalopelvic disproportion. It is alleviated by rotation of the vertex and does not appear to adversely affect the newborn infant

In late human pregnancy more than 90 per cent of the total estriol (E3) in body fluids consists of four conjugates, estriol-3-sulfate (E3-3S), estriol-16-glucosiduronate (E3-16G), estriol-3-glucuronide (E3-3G), and estriol-3-sulfate-16-glucosiduronate (E3-3S-16G). Since the relative amounts of E3 in blood and urine would be determined by the kidney, the renal clearance of each conjugate was determined and compared with inulin and p-aminohippuric acid (PAH) clearance, as measures of glomerular filtration rate (GFR) and the effective renal plasma flow. Five women were studied in the lateral decubitus position with inulin and PAH infusion. Samples of blood and urine were collected at 40 minute intervals and analyzed. The method for E3 conjugates involved separation of the four conjugates on Sephadex LH-20, enzyme hydrolysis, and radioimmunoassay. Renal clearances for E3-3S and E3-3S-16G were below inulin. E3-3G approximated inulin; E3-16G exceeded inulin and approached PAH. In plasma E3-3S-16G represented 48.4 +/- 7.2 per cent; in urine E3-16G represented 69.5 +/- 7.3 per cent of total E3. Thus, different conjugates predominate in blood and urine

Fetal heart rate (FHR) monitor records, particularly those derived from external sensors, may contain artifactual information closely resembling true FHR patterns. Additional machine-determined information may be used to help discriminate these data. Present commercial systems for indicating potentially artifactual FHR modify the FHR display, and this tends to cause the physician to ignore the absence of data or annoy him by obliterating some useful as well as potentialy useless information. Therefore, we chose to put the information that the data may be artifactual on another channel and allow the physician, rather than the instrument, to modify the interpretation of the FHR as necessary. A computer study was made of the characteristics of FHR beat-to-beat changes during poor signal to determine the most appropriate criteria for indicating when the FHR record is highly likely to be artifactual. Unphysiologic, erratic FHR changes are easily flagged by the presence of 3 serial beat-to-beat changes greater than 25 beats/min. Clinical testing demonstrated that this system allows the physician to better discriminate between valid and invalid data and increases the amount of usable data, particularly in active patients

A method was developed for the assay of estriol-16-sulfate (E3-16S) and estriol-3, 16-disulfate (E3-3,16-diS) in maternal serum, cord serum and amniotic fluid at delivery in human pregnancy. Tritiated E3-16S and E3-3,16-diS are added to the fluid being analyzed. The conjugates are separated and purified by sequential chromatography on alumina, Celite and Sephadex LH-20. Each conjugate is hydrolyzed with Glusulase and the released estriol is quantified by radioimmmunoassay. E3-3,16-diS was found in each fluid, most concentrated in the cord serum. Small amounts of E3-16S were found in some amniotic fluids, and this conjugate was virtually absent from the sera. These new estriol conjugates comprise less than 1 percent of total, estriol, apparently too low to be of diagnostic value in human pregnancy