This review discusses the use of antihypertensive drugs in acute and long term treatment of hypertensive disorders of pregnancy, including their placental transfer and adverse effects on the fetus. All antihypertensive agents cross the placental barrier and are present in varying concentrations in the fetal circulation, with varying resultant effects on fetal metabolism.

Effects of antihypertensive drugs on the unborn child: what is known, and how should this influence prescribing?

Liver volume (LIVV) is very important in determining the status of fetal growth. However, to measure human fetal LIVV in utero precisely and noninvasively is not an easy task. With the recent advancement of three-dimensional (3-D) ultrasound (US), the limitation in assessing fetal LIVV by 2-D US can be overcome. The purpose of this study was to establish a normal reference chart of fetal LIVV for clinical use. A prospective and cross-sectional study using 3-D US was undertaken to assess the fetal LIVV in normal pregnancy. In total, 226 singleton fetuses ranging between 20 and 40 weeks of gestation and fitting the criteria of normal pregnancies were enrolled in this study. Our results showed that fetal LIVV is highly correlated with the gestational age (GA). Furthermore, using GA as the independent variable and fetal LIVV as the dependent variable, the best-fit regression equation was LIVV (mL) = -398.26 + 46.199 xGA - 1.7567 x GA(2) + 0.0236 x GA(3) (r = 0.97, n = 226, p < 0.0001), with SD of LIVV (mL) = 1.2533 x (0.77956 + 0.17267 x GA). These common indexes of fetal biometry, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HCi), abdominal circumference (ACi), femur length (FL), and estimated fetal weight (EFW), were all highly correlated with fetal LIVV (all p < 0.0001). In conclusion, our data of fetal LIVV assessed by 3-D US can serve as a useful reference in evaluating fetal growth status during normal gestation.

The assessment of normal fetal liver volume by three-dimensional ultrasound.

It is well-documented that fetal growth restriction (FGR) may have increased risks of perinatal morbidity and mortality. Early detection of FGR is crucial in prenatal care and daily practice. We undertook a prospective and cross-sectional study using quantitative 3-D ultrasound (US) to assess the efficacy of fetal liver volume (LV) in predicting FGR. During the study period, 42 fetuses with FGR and 375 fetuses without FGR were included for the LV assessment in utero by 3-D US. All the fetuses were singletons and had follow-up to delivery to ensure whether they were complicated with FGR or not. Our results revealed that fetal LV assessed by 3-D US can differentiate well fetuses with FGR from those without FGR. The sensitivity of fetal LV in predicting FGR was 97.6%, with specificity 93.6%, predictive value of positive test 63%, predictive value of negative test 99.7% and accuracy 94%. In conclusion, fetal LV assessed by quantitative 3-D US can be used to predict fetuses with FGR antenatally. Our data support that fetal LV assessment by 3-D US would be a useful test in detecting fetuses with FGR.

Predicting fetal growth restriction with liver volume by three-dimensional ultrasound: Efficacy evaluation

Limited pharmacokinetic data for cefoperazone are available from the parturient. Because cefoperazone has a dual excretory pattern, primarily via the biliary system and secondarily via the kidney, pregnancy-induced physiologic alterations can influence its deposition and clearance. Twelve term parturients receiving cefoperazone prophylaxis after cesarean section were selected for study. After 2 g of cefoperazone was administered for 1 h intravenously, serial blood samples were assayed by high-pressure liquid chromatography. Plasma protein binding of cefoperazone was studied in vitro. The mean peak cefoperazone concentration +/- standard deviation was 169.9 +/- 60.4 micrograms/ml. The mean half-life was 152 min. Total serum clearance was 80.8 +/- 30.8 ml/min. The steady-state volume of distribution was 14.2 +/- 6.0 liters. All subjects had detectable trough levels at the end of the dosage interval, with a mean value of 6.5 +/- 5.2 micrograms/ml. Protein binding of cefoperazone for parturients was 74.3 +/- 10.9%, compared with 87.7 +/- 3.2% in nonpregnant controls (P less than 0.05). These data suggest that cefoperazone deposition can be greatly influenced by pregnancy. However, unlike several other new antimicrobial agents whose excretions are mainly renal, the cefoperazone half-life and thus trough concentration for the parturient more closely resemble that for the nonpregnant subject.

Pharmacokinetics of cefoperazone in the parturient.

母子垂直感染による新生児 early-onset sepsis 予防に対するcefazolinの有効性に関する薬物動態学的評価

The pharmacokinetics of certain drugs were studied in the following patient groups: in women in stage III of pregnancy, in women in labor, and in non-pregnant women as a control group. In late gravidity several parameters of distribution and elimination change. Nevertheless, it is not necessary to modify the usual dose schedule. However, sulfonamides and antibiotics should be administered in the upper range of dosage. In contrast to late pregnancy, we found elimination of drugs to be always retarded during labor. Attention must be paid to accumulation, which may occur.

Pharmacokinetics during pregnancy and delivery.

Pharmacokinetics during Pregnancy and Delivery

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Pharmacokinetics during pregnancy and delivery.

Pharmacokinetics during Pregnancy and Delivery