Re: Early Cardiac Function Predicts Miscarriage Risk
From: Terry J DuBose (tjdubose@juno.com)
Sun Dec 7 14:28:43 2003
That is an impressive display of the tenaciousness to life, and is
interesting. Wolfgang, do you have the in vivo images of the ectopic
prior to salpingotomy, that would add to the case. Also, what was the
heart rate before removal?
Thanks, Terry
On Sun, 7 Dec 2003 14:56:36 -0600 wolfgang.moroder@tin.it (Wolfgang
Moroder, M.D.) writes:
> 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:
> >
> >This message is in MIME format. Since your mail reader does not
> understand
> >this format, some or all of this message may not be legible.
> >
> >----__JNP_000_2e2d.11ee.491b
> >Content-Type: text/plain; charset=iso-8859-1
> >Content-Transfer-Encoding: 8bit
> >
> >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
> >------------------------------------------Art, I saw this,... it i
> >interesting. The bit about lack ofoxygen in the
> >------------------------------------------Art, I saw this,... it i
> embryonic > >------------------------------------------Art, I saw this,... it i
> very
> >------------------------------------------Art, I saw this,... it i
> >period=20
> >------------------------------------------Art, I saw this,... it i
> >------------------------------------------Art, I saw this,... it i
> very
> >------------------------------------------Art, I saw this,... it i
> >is new, I think:"The cause of embryonic congestive heart failure
> – not
> >enough oxygenreaching the heart – is much the same in embryos
> as it is in
> >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
>
