The effect of maternal oxygen inhalation upon fetal oxygenation.

In eight sheep, uterine and umbilical blood flows and oxygen uptakes, the transplacental flow-limited clearance of an inert molecule, pH values, and oxygen pressures, saturations, and capacities in the main placental vessels have been measured during maternal air breathing and oxygen inhalation. The mean +/-SEM percentage changes during oxygen inhalation were +4.6 +/-8.4 for the umbilical flow, +2.8 +/-8.7 for the uterine flow, and +4.6 +/-6.2 for the clearance. None of these changes are statistically significant. Oxygen uptake rose slightly in two cases and remained unchanged in the others. In all cases the oxygen pressures, saturations, and contents rose significantly in the uterine and umbilical vessels with oxygen inhalation.

An evaluation of fetal renal function in a chronic sheep preparation.

Fetal renal function in the sheep was investigated in a chronic preparation which permitted repeated evaluations of urine flow and osmolality as well as renal clearances in animals which were unanesthetized and remote from acute surgical stress. Measurements of fetal blood pressure, pH, osmolality, fetal growth in utero, and final outcome did not indicate an adverse effect of the experimental procedure on the fetus. Fetal urine flow and osmolality were highly variable during the early postoperative period. They did not stabilize until 3-6 days after surgery, when urine osmolality became markedly hypotonic (range 65-160 mOsm/kg H(2)O) and urine flow rose to approximately 0.14 ml/min.kg. Fluctuations in urine flow and osmolality in the early postoperative period were the result of tubular reabsorption of water rather than a change in the glomerular filtration rate. The inulin-(14)C clearance, used as a measure of the glomerular filtration rate, was 1.05 +/-0.05 ml/min.kg (mean +/-sem) for all animals studied. Urea, fructose, sodium, and chloride were partially reabsorbed by the fetal kidney, while creatinine was secreted. Continuous drainage of fetal urine for 18 days in one animal demonstrated that the fetus was able to excrete large amounts of water, sodium, and fructose without apparent detrimental effects.

Mammary blood flow and endocrine changes during parturition in the ewe.

The temporal relationship between changes in mammary blood flow (MBF) and changes in the concentration of plasma prolactin, progesterone, estradiol-17beta, and cortisol, was examined in chronic sheep preparations undergoing spontaneous labor (Group I) or labor induced by an infusion of dexamethasone (1 mg/24 h) to the fetus (Group II). In Group I, an increase in prolactin (45 to 489 ng/ml), a decrease in progesterone (15 to 4 ng/ml), and an increase in MBF (97 to 365 ml/min) occurred at about the same time, whereas increases in estradiol-17beta (80 to 211 pg/ml) and cortisol (9 to 39 ng/ml) followed the change in MBF. A similar pattern of changes in MBF and hormonal concentrations occurred over a shorter period when premature labor was induced in the animals in Group II. These findings suggest that changes in plasma prolactin and progesterone concentrations play an important role in the regulation of MBF at the time of parturition.

The relationship of maternal and fetal glucose concentrations in the human from midgestation until term.

The relationship between maternal and fetal glucose concentrations was investigated in pregnant women at different gestational ages. Maternal and fetal blood samples were obtained during 14 fetoscopies (17 to 21 weeks), four umbilical cord samples (32 to 36 weeks), nine elective cesarean sections with appropriate for gestational age (AGA) fetuses (35 to 39 weeks) and nine elective cesarean sections with small for gestational age (SGA) fetuses (34 to 37 weeks). A significant linear relationship between maternal and fetal glucose concentrations was demonstrated at midgestation (P less than .001) and at late gestation (P less than .001). At equal maternal concentrations there were no significant differences in fetal glucose concentration between the cord samples obtained in late gestation and those obtained at cesarean section. At midgestation fetal glucose concentration is independent of and may exceed maternal concentration at maternal glucose levels less than 4.44 mmol/L. Furthermore, the relationship between maternal and fetal concentrations at maternal glucose concentrations greater than 4.44 mmol/L is significantly different at midgestation from that at late gestation (P less than .01); at equal maternal concentrations there were higher glucose concentrations in the mid trimester fetus. In late gestation as the maternal glucose concentration increases there is an increase in the maternal arterial-umbilical arterial glucose concentration difference and the umbilical glucose/oxygen quotient (P less than .003) reflecting increased glucose utilization by the fetus. There were no significant differences between AGA and SGA babies with respect to these relationships.

Endometrial carcinoma in young women taking oral contraceptive agents.

The first 21 cases recorded in the Registry for Endometrial Carcinoma in Young Women Taking Oral Contraceptive Agents are reported. We have found no other such cases in the literature, and indeed several authors have stated that these agents, because of their predominantly progestional action, would be expected to be protective against this disease. In 8 of the 21 patients, factors were present which militated against a close relation between oral contraceptives and carcinoma, and 5 of these 8 patients had taken only or predominantly combined agents. On the other hand, 11 of the remaining 13 patients took sequential agents, a ratio directly opposite that of the usage of combined and sequential agents in the American population. The possible reasons for the excess of sequential agents, chiefly Oracon, are discussed, and directions for future study are suggested.

Umbilical cord prolapse.

Umbilical cord prolapse complicated one of 385 pregnancies occurring at the University of Colorado Health Science Center between 1969 and 1982. Whereas malpresentation of the fetus is frequently associated with prolapse of the funis, nearly 50% of all cases occurred in vertex presentations. Obstetric intervention is associated with nearly one in five cases of cord prolapse and represents a readily preventable cause of maternal and perinatal morbidity.

Outcomes of twin gestations at the University of Colorado Health Sciences Center, 1973-1983.

A retrospective study was undertaken of 341 twin pregnancies over a ten-year period at the University of Colorado Health Sciences Center. The perinatal morbidity and mortality were higher than for singleton gestations, but no difference was found between the first and second twins. Bed rest was effective in prolonging gestation and decreasing perinatal mortality (P less than .05). Delivery of the second twin in noncephalic presentation was accomplished vaginally in 46.5%, with external version successful in five of six attempts. The interval between the birth of each twin did not affect outcome.

Utilization of gyniatricians as primary health care providers for women.

The role, functions, activities, educational preparation and relationship with other health professionals of a new type of primary health care provider is described. The name gyniatrician has been applied to this kind of physician, who will be qualified to provide overall primary health care for women from the onset of puberty through adult life.

PIP: The role, functions, activities, educational preparation and relationship with other health professionals of a new type of primary health care provider for women -- a gyniatrician -- is described. The term gyniatrician is applied to this kind of physician who will be qualified to provide overall primary health care for women from the onset of puberty through adult life. Gyniatricians will have a wide range of functions and activities. They will assume responsibility for the provision, coordination, integration and management of the full range of women's health care and services. The care provided by gyniatricians will be based on a firm foundation of integrated knowledge from the medical, biologic, social, psychologic and behavioral sciences. The gyniatricians will be responsible for recognizing and evaluating their patients' total health needs and for teaching women how to enter the health care system. The gyniatrician's specialized education and training will be 5 years in duration, will begin during the 1st year in medical school, and will include a 1-year residence spent primarily in ambulatory settings. All 5 years of gyniatric training will include intensive study of all aspects of primary health care and services for women. Students desiring to become gyniatricians will be selected from those candidates for admission to medical school who have demonstrated special motivation and interest in primary health care for women. A table of the functions and activities of the gyniatrician is included along with a curriculum guide. Gyniatricians will work with obstetrician-gynecologists in giving the improved total health care that women are requesting. As a result of women's increasing awareness that the health care system is failing to provide what they need and want, women are requesting more pertinent, comprehensive, accessible and competent professional health care.

Prenatal diagnosis and management of congenital heart disease.

Thirty-two fetuses were diagnosed as having congenital heart disease (CHD). The major indications for level II echocardiography other than suspected cardiac abnormalities were fetal malformations, nonimmune hydrops and cardiac arrhythmia. Only three patients had a previous history of fetal CHD. No false-abnormal diagnosis of severe CHD was made. Aortic arch anomalies represented the major diagnostic problem among the six correct but incomplete diagnoses. Sixty-one percent of the fetuses were growth retarded, thus confirming the severity of their CHD. Chromosomal anomalies and extracardiac malformations were associated in 19% and 44% of the fetuses, respectively. Obstetric management and fetal prognosis in cases of extracardiac malformations were greatly influenced by the diagnosis of CHD. The poorest perinatal outcome was associated with heart failure. The only intrauterine deaths occurred in that group, and only one neonate survived. The outcome was more favorable in neonates without other malformations or heart failure. Four of ten (40%) of those neonates survived, while the overall perinatal survival rate was 24%.

Fetal endoxins and complications of pregnancy.

Maternal endoxin (digoxinlike substance) is proposed as arising in the fetal area of the fetal adrenal cortex. Its function may be to sensitize the uterus for labor, much as does cortisol in the sheep fetus. Because endoxin is a sodium-potassium-adenosine triphosphatase inhibitor, however, it may also induce maternal vasoconstriction. On our service, normal pregnant women have detectable endoxin after 35 weeks with increasing amounts at term. Specimens of cord blood often have "digoxin" in the therapeutic range. We find that about 40% of women in premature labor and 65% of pregnant women with hypertension have elevated levels of serum endoxin. Postdate gravid women sometimes have very low endoxin levels. Pregnant women with complications and elevated digoxin (endoxin) levels could have specific antidigoxin therapy if endoxin proves to be a modulator of their symptoms. Digoxinlike substances are also sometimes elevated in ill nonpregnant persons, such as those with renal, liver, or heart failure, or hypertension.

The antepartum assessment of fetal well-being.

Modern obstetrics is concerned with the health and well-being of both the mother and the unborn child. During the first two thirds of this century there was a pronounced decrease in maternal mortality and morbidity related to pregnancy. More recently, using the techniques of amniocentesis, antepartum fetal heart rate testing and ultrasound, obstetricians have been able to more accurately assess the health of a fetus. This knowledge has resulted in decreased perinatal mortality and morbidity and, when rigorously applied, a decrease in fetal loss.

Factors affecting radioactive microsphere measurement of blood flow in pregnant guinea pigs.

Comparative blood flow studies were performed in pregnant guinea pigs using radioactive microspheres to test the effects of different sphere sizes on blood flow measurements and the relationship between flows obtained intraoperatively and those performed after 5 days of recovery from anesthesia and surgery. We observed that 1.5% of the cardiac output was shunted through the microcirculation of the carcass, gut, skin and endomyometrium when 15 mu microspheres were used. Intraoperative measurements of heart rate, cardiac output and placental blood flow are significantly lower than measurements made after 5 days recovery. These reductions were ameliorated with the addition of a continuous infusion of isoproterenol and the deletion of atropine from the anesthetic.