Mechanical ventilation during pregnancy using a helium-oxygen mixture in a patient with respiratory failure due to status asthmaticus.

The authors present a 15-year-old with a second trimester intrauterine pregnancy who developed respiratory failure as the result of status asthmaticus and the development of the adult respiratory distress syndrome. Mechanical ventilation was provided with a combination of oxygen and helium to facilitate gas exchange and limit peak inflating pressures. The physiologic basis for helium's potential beneficial effects on gas exchange are reviewed. Previous reports concerning the use of helium during mechanical ventilation as well as the techniques of delivery are discussed.

Inhibin-A and pro-alpha C are elevated in preeclamptic pregnancy and correlate with human chorionic gonadotropin.

PROBLEM: Serum concentrations of the heterodimeric glycoprotein inhibin-A (alpha-beta A) and its alpha-subunit increase during pregnancy. The placenta is the predominant source of inhibin during pregnancy, and a paracrine role in the trophoblast has been suggested. Elevated serum concentrations of inhibin alpha-subunit as well as the glycoprotein human chorionic gonadotropin (hCG) have been described in preeclamptic pregnancy. The objectives of this investigation were to compare serum concentrations of inhibin-A and inhibin pro-alpha C in preeclamptic and normotensive pregnancy, and to examine the relationship of hCG and inhibin-A in those pregnancies. METHOD OF STUDY: A case-control design using 32 patients with preeclampsia with a single fetus at 32-40 weeks of gestation and 34 gestation age-matched normotensive control subjects was used for this investigation. Solid-phase enzyme-linked immunosorbent assays were used to measure inhibin-A and inhibin pro-alpha C in sera. An immunoradiometric assay was used to measure intact hCG. RESULTS: Inhibin-A and inhibin pro-alpha C concentrations were significantly elevated in the sera of women with preeclampsia compared with those concentrations in normotensive control subjects (P < 0.05). A relationship of inhibin-A or pro-alpha C with severity of preeclampsia was not observed. There was a significant positive correlation of serum hCG with both inhibin-A and pro-alpha C (P < 0.05). CONCLUSIONS: Levels of inhibin-A and the subunit pro-alpha C are increased in pregnancies complicated by preeclampsia. These findings are potentially the effect of a paracrine role of inhibin-A in the development and proliferation of the trophoblast.

Obtaining the four-chamber view to diagnose fetal cardiac anomalies.

Four-chamber view screening of the fetal heart was greeted with significant optimism in the mid-1980s. This screening technique was initially expected to detect most congenital heart disease in utero; however, recent studies demonstrate a 4% to 40% sensitivity of four-chamber view screening. It is therefore probable that the dream of antepartum diagnosis of most congenital heart disease in utero will remain unfulfilled. This is particularly true with increasing funding constraints for health care provision imposed by both the federal government and third-party payors.