Publications by authors named "Christine Kovac"

6 Publications

  • Page 1 of 1

Uterine Rupture with Cesarean Scar Heterotopic Pregnancy with Survival of the Intrauterine Twin.

Case Rep Obstet Gynecol 2016 26;2016:6832094. Epub 2016 Dec 26.

Perinatal Partners, Miami Valley Hospital, Dayton, OH, USA.

. Heterotopic pregnancy is a multiple gestation with both intrauterine and ectopic fetuses. A cesarean scar ectopic pregnancy is when the fetus has implanted over the previous hysterotomy site. A known complication of cesarean scar ectopic pregnancy is uterine rupture, which can cause great morbidity and mortality. . 28-year-old G5P3105 at 10 weeks with a dichorionic diamniotic gestation was found to have a ruptured uterus with expulsion of a cesarean scar ectopic pregnancy and retention of the intrauterine fetus. After uterine repair, the singleton gestation reached viability was delivered by emergent cesarean section for placental abruption. . Safe management of cesarean ectopic pregnancy requires early diagnosis by ultrasonography. With early detection, management can focus on preventing maternal morbidity of uterine rupture and life-threatening hemorrhage.
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http://dx.doi.org/10.1155/2016/6832094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220436PMC
December 2016

Lethal fetal anomalies: why the big void?

Obstet Gynecol 2011 Dec;118(6):1377-1378

From Perinatal Partners, LLC, Dayton, Ohio.

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http://dx.doi.org/10.1097/AOG.0b013e318234d990DOI Listing
December 2011

Fetoplacental vascular tone is modified by magnesium sulfate in the preeclamptic ex vivo human placental cotyledon.

Am J Obstet Gynecol 2003 Sep;189(3):839-42

Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Tacoma, Wash., USA.

Objective: The purpose of this study was to evaluate fetoplacental vascular tone and response to a vasoconstrictor in placentas of preeclamptic and normotensive pregnancies with and without the presence of magnesium sulfate.

Study Design: Two cotyledons from each placenta were selected from preeclamptic (n=8) and normotensive (n=7) pregnancies. In one cotyledon from each pair, the maternal circuit was perfused with magnesium sulfate. The fetal arteries were injected sequentially with angiotensin II (10(-10)mol and 10(-11.5) mol). Perfusion pressures and response to angiotensin II were compared, with regard to preeclampsia and exposure to magnesium sulfate.

Results: Perfusion pressure was higher in preeclamptic placentas, compared with normotensive placentas (30.4 mm Hg vs 24.4 mm Hg, P=.02). There was a decrease in perfusion pressure with exposure to magnesium sulfate in preeclamptic placentas (22.5 mm Hg, P<.01), but not in normotensive placentas. Fetoplacental vascular response to angiotensin II was not affected by preeclampsia or magnesium sulfate.

Conclusion: In placentas from preeclamptic pregnancies there is increased fetoplacental perfusion pressure, which decreases with exposure to sulfate.
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http://dx.doi.org/10.1067/s0002-9378(03)00851-2DOI Listing
September 2003

The effects of a cyclo-oxygenase II inhibitor on placental artery production of thromboxane and prostacyclin.

Am J Obstet Gynecol 2003 Sep;189(3):835-8

Madigan Army Medical Center, Tacoma, WA 98431, USA.

Objective: The study was undertaken to determine the effects of a cyclo-oxygenase II inhibitor on fetoplacental artery production of prostacyclin and thromboxane A(2).

Study Design: Eight placentas were obtained from normal parturients at delivery and four chorionic plate arteries were dissected from each placenta. Arteries were incubated in media alone, media plus angiotensin II (1x10(-10) mol), media plus rofecoxib (300 ng/mL), or media plus angiotensin II and rofecoxib. Serial samples were assayed for metabolites of thromboxane B(2) and prostacyclin by enzyme-linked immunosorbent assay. Results were compared by analysis of variance, and P<.05 was considered significant.

Results: At 24 hours, 6-keto-prostaglandin F(1alpha) levels in the rofecoxib group (1.74+/-1.39 ng/mg tissue, P<.01) and the rofecoxib plus angiotensin II group (2.15+/-1.85 ng/mg tissue, P<.01) were significantly lower than levels in the control group (4.25+/-2.03 ng/mg tissue). Thromboxane B(2) levels were lower in the angiotensin II group (0.65+/-0.33 ng/mg tissue) than the control group (1.22+/-0.70 ng/mg tissue, P<.05).

Conclusion: Cyclo-oxygenase II inhibition decreases the production of prostacyclin in fetoplacental arteries and alters the normal ratio of thromboxane A(2) to prostacyclin.
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http://dx.doi.org/10.1067/s0002-9378(03)00844-5DOI Listing
September 2003

The effect of fetal acidemia on fetal-placental vascular tone and production of the inflammatory cytokines interleukin-6 and tumor necrosis factor-alpha.

Am J Obstet Gynecol 2002 Oct;187(4):894-7

Division of Maternal-Fetal Medicine, Madigan Army Medical Center, Ft. Lewis, WA, USA.

Objective: Our purpose was to determine the effects of fetal acidemia on placental vascular tone and production of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha).

Study Design: With use of an ex vivo placental perfusion model, the maternal and fetal circulation of two cotyledons from five human placentas were perfused for 4 hours. The fetal circulation of one cotyledon was perfused with acidemic (pH 6.90) Hanks' balanced salt solution (HBSS), whereas the fetal circulation of the other cotyledon was perfused with physiologic (pH 7.35) HBSS. Fetal venous effluents were collected hourly, and IL-6 and TNF-alpha concentrations were determined by enzyme-linked immunosorbent assay. Cotyledon perfusion pressures were recorded every 10 minutes. Paired t tests were used to compare differences in cytokine production and perfusion pressure between the cotyledons.

Results: Fetal-placental vascular perfusion pressure was consistently reduced from baseline under acidemic, but not physiologic, conditions with statistical significance achieved from 20 minutes onward (P <.05). IL-6 and TNF-alpha increased exponentially over time for both conditions (P <.05). There was no difference in cytokine production when acidemic conditions were compared with physiologic conditions (P <.05).

Conclusion: Fetal-placental vasodilation may be a compensatory mechanism to improve acidemic conditions. Unlike fetal hypoperfusion or fetal hyperoxia, fetal acidemia does not result in elevated placental cytokine levels.
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http://dx.doi.org/10.1067/mob.2002.127455DOI Listing
October 2002

Maternal ethnicity and variation of fetal femur length calculations when screening for Down syndrome.

J Ultrasound Med 2002 Jul;21(7):719-22; quiz 724-5

Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington 98431, USA.

Objective: To determine whether current methods for detecting Down syndrome based on fetal femur length calculations are influenced by ethnicity.

Methods: The study population consisted of all fetuses scanned between 14 and 20 completed weeks' gestation from April 1, 1997, to January 1, 2000. The expected femur length was calculated from the biparietal diameter. The variance from the expected femur length, compared with the biparietal diameter, was calculated, and the mean variations were compared by maternal race. Ethnic-specific formulas for expected femur length were derived by simple regression.

Results: There was a statistically significant difference in femur length in the Asian group compared with all other groups, as well as the white group compared with the black and Asian groups (P < .05). However, there was no significant difference between the black and Hispanic groups or the white and Hispanic groups. The Asian group had the largest variation, with the measured femur length being less than the expected femur length. All groups studied had a mean expected femur length less than the mean measured femur length. On the basis of the ethnic-specific formulas for femur length, there was a significant decrease in patients that would undergo further evaluation for Down syndrome.

Conclusions: There is a significant difference in the mean expected femur length by biparietal diameter among fetuses in the second trimester with regard to ethnicity. Using ethnic-specific formulas for expected femur length can have a considerable impact on the use of sonographic risk factors for Down syndrome screening. Further data are required for use of femur length as a screening tool in the genetic sonogram.
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http://dx.doi.org/10.7863/jum.2002.21.7.719DOI Listing
July 2002