Re: Early Cardiac Function Predicts Miscarriage Risk
From: Wolfgang Moroder, M.D. (wolfgang.moroder@tin.it)
Sun Dec 7 13:55:33 2003
There is a tentative proof of how little oxygen the embryonic heart
needs.
One night I was on call in my ward and I diagnosed a tubal pregnancy at
8 weeks post mens. I took the patient to the OR, did a salpingotomy and
gave the intact embryo to the nurse to put it in saline. After surgery
I was still busy with some other urgent work and after some 60-80
minutes I took the embryo to the ultrasound room to do some in vitro
scanning. What I sow was quite impressive and you can see it if you
download the ultrasound clip invitro.avi from here:
http://mio.discoremoto.virgilio.it/moroder/invitro.avi
please click on "salva" which means download in Italian. It will take
some time since the clip is 1.5 MB.
Well after the embryo of 8 weeks was kept more than an our in saline the
heart was still beating.
Maybe Terry you could publish this as a experimental case?
Best regards
Wolfgang
At Thu, 4 Dec 2003, Terry J DuBose wrote:
>
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>For some reason I can no longer respond to messages from my office... had
>to forward this response home and send from there. Terry
>------------------------------------------
>Art, I saw this,... it is very interesting. The bit about lack of
>------------------------------------------
>------------------------------------------
>------------------------------------------
>oxygen in the embryonic period is new, I think:
>------------------------------------------
>
>------------------------------------------
>"The cause of embryonic congestive heart failure – not enough oxygen
>------------------------------------------
>reaching the heart – is much the same in embryos as it is in the
>elderly," Dr. Birnholz said. "I suspect that if the blood vessels that
>feed the placenta do not properly form or are slightly delayed in
>development, the heart does not get the support required."
>
>Because the embryonic heart rate (EHR) acceleration and deceleration
>curve has the shape of a classic “damping feedback curve” ( see:
>http://www.obgyn.net/us/cotm/0001/ehr2000b.htm ), we have always thought
>that there were probably 3 or more variables that control the shape of
>the curve. In addition, because the curve peaks (9.2 LMP weeks) at about
>the same time as the hCG and when the ventricular septum closes, we
>assumed that the variables may include electrical (bundle of His & 2
>branches
>completion), hydraulic (VS closure), or hormonal (hCG curve), but did not
>consider the oxygen. Of course, the oxygen might influence one or more
>of the variables, including normal ventricular closure or other
>development.
>
>I will be anxious to see the published research… both for the new
>information, as well as to see if our work will be referenced.
>DuBose TJ, Cunyus JA, Johnson LF; Embryonic Heart Rate and Age; J of
>Diagnostic Medical Sonography; 6:151-157, 1990, May/June
>
>Peace, Terry J. DuBose, M.S., RDMS
>Little Rock, Arkansas USA
>
>At Wed, 3 Dec 2003, art fougner, md wrote:
>
> Radiological Society of North America 03.12.2003
>
> Doppler ultrasound predicts risk of miscarriage
>
>Doppler ultrasound performed in early pregnancy can accurately identify
>embryonic congestive heart failure and subsequent risk of miscarriage,
>according to research being presented today at the 89th Scientific
>Assembly and Annual Meeting of the Radiological Society of North America
>(RSNA).
>
>"The chances the pregnancy will continue are very high, about 95
>percent, when Doppler ultrasound confirms normal embryonic heart
>function at six weeks," said the study’s author Jason C. Birnholz,
>M.D., president of Diagnostic Ultrasound Consultants in Oak Brook, Ill.
>"Over 99 percent of pregnancies with an abnormal Doppler pattern do not
>continue." The Doppler test measures the speed of red blood cells moving
>through vessels to determine pressure dynamics within the embryo’s
>heart.
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>Assistant Professor & Director, Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP
>4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA
>501-686-6510
>DuBoseTerryJ@UAMS.edu
>http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>----__JNP_000_2e2d.11ee.491b
>Content-Type: text/html; charset=iso-8859-1
>Content-Transfer-Encoding: quoted-printable
>
><!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
>
>For some reason I can no longer respond to messages from my office..
>hadto forward this response home and send from there. Terr
>------------------------------------------Art, I saw this,... it i very
>interesting. The bit about lack ofoxygen in the embryonic =
>------------------------------------------Art, I saw this,... it i very
>------------------------------------------Art, I saw this,... it i very
>------------------------------------------Art, I saw this,... it i very
>period
>------------------------------------------Art, I saw this,... it i very
>is new, I think:"The cause of embryonic congestive heart failure – not
>------------------------------------------Art, I saw this,... it i very
>enough oxygenreaching the heart – is much the same in embryos as it is in
>------------------------------------------Art, I saw this,... it i very
>theelderly," Dr. Birnholz said. "I suspect that if the blood
>vessels that feed the placenta do not properly form or are slightly delayed
>in development, the heart does not get the support required."<BR Because
>the embryonic heart rate (EHR) acceleration and decelerationcurve has the
>shape of a classic “damping feedback curve” ( see:<A
>href="http://www.obgyn.net/us/cotm/0001/ehr2000b.htm">http://www.obgyn net/us/cotm/0001/ehr2000b.htm
>), we have always thoughtthat there were probably 3 or more variables that
>control the shape ofthe curve. In addition, because the curve peaks
>(9.2 LMP weeks) at aboutthe same time as the hCG and when the ventricular
>septum closes, weassumed that the variables may include electrical bundle
>of His & 2branchescompletion), hydraulic (VS closure), or hormonal
>(hCG curve), but did notconsider the oxygen. Of course, th
>oxygen might influence one or moreof the variables, including normal
>ventricular closure or otherdevelopment. I will b
>anxious to see the published research… both for the newinformation, as well
>as to see if our work will be referenced.
>DuBose TJ, Cunyus JA,
>Johnson LF; Embryonic Heart Rate and Age; J of Diagnostic Medical Sonography;
>6:151-157, 1990, May/June Peace, Terry J. DuBose, M. .,
>RDMSLittle Rock, Arkansas USAAt Wed, 3 Dec 2003, ar
>fougner, md wrote: Radiological Society of North America
>03.12.2003 Doppler ultrasound predicts risk of
>miscarriageDoppler ultrasound performed in early pregnancy can
>accurately identify embryonic congestive heart failure and subsequent risk
>of miscarriage, according to research being presented today at the 89t
>Scientific Assembly and Annual Meeting of the Radiological Society of North
>America (RSNA)."The chances the pregnancy will continue are very
>high, about 95 percent, when Doppler ultrasound confirms normal embryonic
>heart function at six weeks," said the study’s author Jason C. 
>Birnholz, M.D., president of Diagnostic Ultrasound Consultants in Oak Brook,
>Ill. "Over 99 percent of pregnancies with an abnormal Doppler pattern do not
>continue." The Doppler test measures the speed of red blood cells moving
>through vessels to determine pressure dynamics within the embryo’s
>heart.Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM<BR Assistant
>Professor & Director, Diagnostic Medical Sonography Program <BR University
>of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA 501-686-6510 <A
>href="mailto:DuBoseTerryJ@UAMS.edu">DuBoseTerryJ@UAMS.edu <A
>href="http://www.io.com/~dubose/">http://www.io.com/~dubose/ <A
>href="http://www.uams.edu/chrp/dms/default.asp">http://www.uams.edu/chrp dms/default.asp<A
>href="http://www.obgyn.net/us/panel/panel.htm">http://www.obgyn.net/us panel/panel.htm
>
>----__JNP_000_2e2d.11ee.491b--
--
Wolfgang Moroder, MD
Prenatal Unit
Bolzano General Hospital Italy
