Abruptio placentae: Clinical management in nonacute cases

Sholl, John S.

doi:10.1016/0002-9378(87)90200-6

Cited by 93 publications

(29 citation statements)

References 8 publications

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“…Although there are some notable differences in the impact on the divers pathways, there is a consistent overall pattern: combined exposure produces a worsened outcome, through either additive, or as seen here, synergistic effects and furthermore, neural circuits show global increases in indices of presynaptic activity, regardless of transmitter type. Given the increased incidence of preterm delivery in women who smoke during pregnancy [24,35,42,60,62], and the consensus use of glucocorticoids in preterm infants [13], our results are relevant to a substantial human population, especially in light of our use of treatment paradigms that closely mimic both the timing and plasma levels of corresponding human fetal exposures to nicotine and dexamethasone [13,34,47,48]. The findings reported here and in our earlier work [53,54] point to the likelihood of greater long-term liabilities in this group.…”

Section: Discussionmentioning

confidence: 99%

Mimicking maternal smoking and pharmacotherapy of preterm labor: Fetal nicotine exposure enhances the effect of late gestational dexamethasone treatment on noradrenergic circuits

Slotkin

Seidler

2011

Brain Research Bulletin

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Smoking during pregnancy increases the risk of preterm delivery, which in turn necessitates the common use of glucocorticoids to prevent respiratory distress syndrome. Accordingly, there is a substantial population exposed conjointly to fetal nicotine and glucocorticoids (typically dexamethasone). We administered nicotine to pregnant rats throughout gestation, using a regimen (3 mg/kg/day by osmotic minipump) that maintains plasma nicotine levels within the range seen in smokers; on gestational days 17, 18 and 19, we gave 0.2 mg/kg of dexamethasone. We assessed norepinephrine levels in three brain regions (frontal/parietal cortex, brainstem, cerebellum) throughout adolescence, young adulthood and later adulthood, and contrasted the persistent effects with comparable measures in peripheral tissues (heart, liver). In adolescence, males showed initial deficits in the frontal/parietal cortex with either dexamethasone alone or the combined treatment, with resolution to normal by young adulthood; the group exposed to both nicotine + dexamethasone showed subsequent elevations that emerged in full adulthood and persisted through five months of age, an effect not seen with either agent separately. In females, the combined exposure produced an initial deficit that resolved by young adulthood, without any late-emerging changes. We did not see comparable effects in the other brain regions or peripheral tissues. This indicates that nicotine exposure sensitizes the developing brain to the adverse effects of dexamethasone treatment, producing sex-selective changes in innervation and/or activity of specific noradrenergic circuits. The fact that the combined treatment produced greater effects points to potentially worsened neurobehavioral outcomes after pharmacotherapy of preterm labor in the offspring of smokers.

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Section: Discussionmentioning

confidence: 99%

Mimicking maternal smoking and pharmacotherapy of preterm labor: Fetal nicotine exposure enhances the effect of late gestational dexamethasone treatment on noradrenergic circuits

Slotkin

Seidler

2011

Brain Research Bulletin

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“…The US diagnostic performance for the diagnosis of abruption is low [49, 50]; in fact 25–50 % of haematomas, mostly retroplacental, remain undetected [51–53] because the echotexture of recent haemorrhage is similar to that of the placenta [49] or because of the small dimensions; moreover clots resulting from chronic abruption may drain through the cervix [53]. The most accurate ultrasound criteria for placenta abruption (sensitivity 80 %, specificity 92 %) are the detection of pre-/retroplacental collections, evidence of marginal subchorionic or intra-amniotic haematomas, increased placental thickness (>5 cm) and jelly-like movements of the chorionic plate [51, 53].…”

Section: Obstetric Causesmentioning

confidence: 99%

Imaging for acute pelvic pain in pregnancy

et al. 2014

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Acute pelvic pain in pregnancy presents diagnostic and therapeutic challenges. Standard imaging techniques need to be adapted to reduce harm to the foetus from X-rays because of their teratogenic and carcinogenic potential. Ultrasound remains the primary imaging investigation of the pregnant abdomen. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of gynaecological and obstetric problems during pregnancy and in the setting of acute abdomen during pregnancy. MRI overcomes some of the limitations of ultrasound, mainly the size of the gravid uterus. MRI poses theoretical risks to the foetus and care must be taken to minimise these with the avoidance of contrast agents.Teaching Points• Ultrasound and MRI are the preferred investigations for acute pelvic pain during pregnancy.• Ultrasound remains the primary imaging investigation because of availability and portability.• MRI helps differentiate causes of acute pelvic pain when ultrasound is inconclusive.

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“…In selected patients with mild (grade 1) abruption, with no evidence of maternal or fetal compromise, expectant management may allow time for glucocorticoid administration and appears to be a safe option (1,9,47). Antepartum testing should be frequent, and at least initially continuous.…”

Section: General Principlesmentioning

confidence: 99%

“…Antepartum testing should be frequent, and at least initially continuous. There does not appear to be any increased morbidity or mortality associated with tocolytic use in selected patients (9,48). In this setting, magnesium sulfate is the tocolytic agent used most frequently in the United States due to its cardiovascular side effect profile, but its effectiveness has not been sufficiently studied (48).…”

Section: General Principlesmentioning

confidence: 99%