Maternal-fetal transfer of aminophylline

Ten women with normal pregnancies who underwent an elective cesarean section received orally 200 mg of aminophylline every 6 hours for 24 - 36 hours prior to surgery. The levels of aminophylline and caffeine were measured in maternal and cord sera and in amniotic fluids. The mean level of aminophylline (+/- SD) in maternal serum was 10.4 +/- 1.74 micrograms/ml, and in cord serum 11.2 +/- 1.25 micrograms/ml. The mean aminophylline level in amniotic fluids was 8.2 +/- 1.42 micrograms/ml. The serum aminophylline levels were within the therapeutic level range. Caffeine levels in those specimens ranged between traces to 6 micrograms/ml which correspond to the normal dietary range.     

Maternal blood pressure response to the intravenous administration of pethidine-promethazine during labor

A double blind study on the effect of an intravenous injection of a combination of 75 mg pethidine and 25 mg promethazine was conducted on 200 women during normal deliveries. Four groups of 50 women each received injections of pethidine and promethazine, promethazine alone, pethidine alone and normal saline. In the pethidine-promethazine group there was a significant elevation in blood pressure in the first 10 min following the injection as compared with the other groups. The mean (+/- S.D.) systolic blood pressure after the injection was 143.2 +/- 14.3 mmHg as compared with 118.9 +/- 8.4 mmHg before the injection, and the mean diastolic blood pressure as 96.9 +/- 8.4 mmHg after the injection as compared with 77.7 +/- 9.3 mmHg before the injection. 25 mg promethazine alone caused slight elevation in blood pressure which was further increased by combination with pethidine. The clinical significance of these observations is discussed.     

Pharmacokinetics of raloxifene and its clinical application.

Hormone replacement therapy (HRT) administered to postmenopausal women relieves climacteric symptoms, prevents loss of bone mass, and counteracts the development of coronary artery disease. However, whereas all the benefits associated with HRT are achieved only following long-term therapy, the long-term compliance to the regimen is poor. The most common reasons for discontinuance are uterine bleeding, breast pains, and a fear of breast cancer. Long-term HRT may be associated with an increased risk of breast cancer. Consequently, there is a need for an "ideal estrogen", designed to pinpoint desired target tissues for estrogen, such as the bone and liver, while acting as an antiestrogen in uterus and breast tissues. Raloxifene belongs to a new class of compounds, selective estrogen receptor modulators (SERMs). It binds to and interacts with estrogen receptors, acting as an estrogen agonist in bone and liver, but as an estrogen antagonist in breast and uterus. Therefore, raloxifene represents a potentially important alternative to HRT in postmenopausal women for the prevention and treatment of osteoporosis and cardiovascular disease. Clinical studies regarding the drug's long term benefits are still required.     

Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety study

OBJECTIVE: This study was undertaken to compare the efficacy and safety of intravenous administration of atosiban versus ritodrine for the treatment of preterm labor.Study Design: Women with preterm labor and intact membranes diagnosed at 23 to 33 gestational weeks (n = 247) were randomly assigned to treatment arms and received atosiban (6.75 mg intravenous bolus, 300 microg/min for 3 hours, then 100 microg/min intravenously) or ritodrine (0.10-0.35 mg/min intravenously) for as long as 18 hours. Tocolytic effectiveness was assessed in terms of the numbers of women who had not been delivered after 48 hours and after 7 days. Safety was assessed in terms of maternal side effects and neonatal morbidity. Secondary outcomes included mean gestational age at delivery and mean birth weight. An intent-to-treat analysis was performed with the Cochran-Mantel-Haenszel test. RESULTS: The proportion of women who had not been delivered at 48 hours was 84.9% (n = 107) in the atosiban group and 86.8% (n = 105) in the ritodrine group. At 7 days 92 women had still not been delivered in both the atosiban (73.0%) and ritodrine (76.0%) groups. Neither of these differences was statistically significant. The incidence of maternal cardiovascular side effects was substantially lower in the atosiban group (4.0% vs 84.3%, P <.001). In addition, intravenous therapy was terminated more frequently as a result of maternal adverse events in the ritodrine group (29.8%) than in the atosiban group (0.8%). The overall occurrences of fetal adverse events in the two treatment groups were comparable. Neonatal morbidity was similar between the treatment groups after adjustment for unbalanced enrollment of women with multiple pregnancies and for gestational ages within treatment groups. CONCLUSION: Atosiban was comparable in clinical effectiveness to conventional ritodrine therapy but was better tolerated than ritodrine, with no evidence of significant maternal or fetal adverse events. Neonatal morbidity, which was similar between the two treatment arms, was apparently related to the gestational age of the infant rather than to the exposure to either tocolytic agent.     

Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode.

OBJECTIVE: Quantification of fetal heart ventricle volume can aid in the evaluation of functional and anatomical aspects of congenital heart disease. The aim of this study was to establish nomograms for ventricular volume using three-dimensional (3D) inversion mode ultrasonography with the spatio-temporal image correlation (STIC) modality and to calculate ejection fraction and stroke volume. METHODS: The fetal heart was scanned using the STIC modality, during fetal quiescence with abdomen uppermost, at an angle of 30-50 degrees , without color Doppler flow mapping. In post-processing, starting with the classic four-chamber view plane in the A-frame, the reference point was moved to the center of the ventricle. The operator used the edit volume followed by Virtual Organ Computer-aided AnaLysis (VOCAL) mode options; in manual trace the VOCAL settings were set to 15 degrees . The trace was drawn and included the myocardium; inversion mode thresholding provided the volume of the intraventricular (anechoic) voxels within the region of interest. The total volume and the intraventricular volume were displayed. The process was repeated for right (R) and left (L) ventricles at end diastole (EDV) and end systole (ESV). The stroke volume (SV = EDV - ESV) and ejection fraction (EF = SV/EDV) were calculated from these measurements. Intraclass correlation was used to evaluate intra- and interobserver agreement. RESULTS: One hundred fetuses ranging from 20 + 5 to 40 + 0 gestational weeks were included in the study. In addition, six fetuses diagnosed during the study period with a cardiac anomaly were examined and their ventricular volumes compared with those of the main study group. LEDV ranged from a mean of 0.53 cm(3) at midgestation to a mean of 3.96 cm(3) at term. LESV ranged from a mean of 0.17 cm(3) at midgestation to 1.56 cm(3) at term. REDV ranged from a mean of 0.68 cm(3) at midgestation to a mean of 5.44 cm(3) at term. RESV ranged from a mean of 0.26 cm(3) at midgestation to 2.29 cm(3) at term. Total stroke volume ranged from a mean of 0.78 cm(3) at midgestation to a mean of 5.5 cm(3) at term. The mean right : left ventricle ratio was 1.4, and left ejection fraction ranged from 42.5 to 86% in these fetuses. Nomograms were created for RESV, LESV, REDV, LEDV and total stroke volumes vs. estimated fetal weight and gestational age. Intra- and interobserver agreement reached 96%. CONCLUSIONS: 3D inversion mode sonography combined with STIC represents a simple and reproducible method for estimating fetal cardiac ventricle volume. This innovative methodology may add to overall evaluation of cardiac volume and function, and improve our understanding of normal and abnormal cardiac structure, as well as the severity and prognosis of cardiac lesions.