K. Marsál - Academia.edu (original) (raw)

Papers by K. Marsál

Acta Obstetricia et Gynecologica Scandinavica, 2000

The hypothesis was that low cerebral perfusion pressure is more common in women with mild preecla... more The hypothesis was that low cerebral perfusion pressure is more common in women with mild preeclampsia as compared to those with severe preeclampsia, while high cerebral perfusion pressure is more common in women with severe preeclampsia than in women with mild preeclampsia. Prospective, observational study. University teaching hospitals. Transcranial Doppler ultrasound was used to measure the blood velocity in the middle cerebral arteries of 54 patients with mild preeclampsia and 44 patients with severe preeclampsia. Blood pressure was measured simultaneously. Cerebral perfusion pressure was calculated and plotted on the same axes as data from 63 normal pregnant women. Data outside of the 95% prediction limits were regarded as abnormal. All studies were prior to labor, and before volume expansion or treatment. Student's t-test, Mann Whitney U test, and Fisher's exact test as appropriate with two-tailed p<0.05. The number of patients in each group with cerebral perfusion pressure values outside the normal 95% prediction limits. Almost the same number of women with mild (21/54=39%) and severe (15/44=34%) preeclampsia had measurements within the normal range (p=0.78). Mild preeclamptic women were more likely to have low (28/54=52%) rather than high cerebral perfusion pressure (p<0.001), while severe preeclamptics were more likely to have high cerebral perfusion pressure (26/44=59%) than low (p<0.001). In preeclampsia the brain can be normally perfused, underperfused and over-perfused. Although many women with mild preeclampsia will have underperfusion (52%), and a significant number of women with severe preeclampsia will have overperfusion (59%), many preeclamptic women have cerebral perfusion within the normal range.

Contributions to gynecology and obstetrics, 1979

Seminars in perinatology, 1987

Doppler estimation of the blood flow in the descending aorta of the fetus and waveform analysis o... more Doppler estimation of the blood flow in the descending aorta of the fetus and waveform analysis of the maximum aortic velocity provide valuable information on fetal circulation. When estimating fetal aortic flow, it is important to consider possible sources of error; even when recording the maximum aortic velocity for waveform analysis, to obtain reproducible results it is important to use a low high-pass filter, a well-defined angle of insonation, and a standardized site of measurement and to avoid periods of fetal breathing and activity. In normal pregnancy the time-averaged mean velocity in the descending aorta is stable throughout the third trimester. The weight-related flow is stable until 37 weeks, after which it falls slightly. The placental proportion of the flow in the thoracic descending aorta decreases toward term. In the aorta of normal fetuses there is positive flow throughout the whole heart cycle, which is due to the low vascular resistance in the placental circulatio...

Contributions to gynecology and obstetrics, 1982

Clinics in Obstetrics and Gynaecology, 1983

Modern ultrasound techniques enable dynamic studies of fetal activity in utero to be studied and ... more Modern ultrasound techniques enable dynamic studies of fetal activity in utero to be studied and quantified. Real-time B-mode scanning has become the method of choice for this purpose because of its ease of use and precision. Fetal movements can be visualized as early as in the seventh week of pregnancy and the development of the movement patterns can be followed throughout the pregnancy. Up to 16 types of movements have been described by several research groups. In early pregnancy, the finding of normal fetal movements is a good prognostic sign in cases of threatened abortion. A decrease in the movement incidence or a qualitative change of the movements are associated with poor outcome. In late pregnancy, the mean incidence of general fetal movements has been found on average to be 9 to 18 per cent of observation time. Fetal breathing movements, mainly with typical "see-saw' configurative changes of the fetal trunk, occur episodically: both long-term and short-term periodicity have been revealed. For recognition of the time incidence pattern of fetal movements or breathing, a sufficiently long observation time (80 to 100 minutes) is necessary. The incidence of fetal breathing movements increases with gestational age and breathing movements become more regular in mature fetuses. Fetal motor activity is subject to several external influences: glucose given to the mother causes an increase in the fetal breathing movement incidence; maternal hypercarbia stimulates the fetal breathing movements; alcohol administered to the mother abolishes fetal breathing; maternal smoking changes the time spacing of breathing and increases the fetal breathing rate; and exposure of the fetus to sound causes an increase in the number of movements. Real-time ultrasonography enables detection and recording of several other fetal activities: hiccups, swallowing and changes in the stomach volume, micturition, and fetal eye movements. The latter fetal activity is used together with fetal movements, fetal mouth movements and fetal heart rate for the identification of the fetal behavioural states. Quantification of fetal activity as a clinical test of fetal well-being was expected to give an alarm signal in cases of fetal hypoxia and imminent asphyxia. In general, the predictive value of a negative result (i.e., a finding of normal fetal activity) was high; the predictive value of decreased or abnormal fetal activity was found to be much less predictive of fetal compromise.(ABSTRACT TRUNCATED AT 400 WORDS)

Archives of Gynecology, 1982

A hand-held real-time ultrasound scanner was used for the estimation of bladder volume in the hop... more A hand-held real-time ultrasound scanner was used for the estimation of bladder volume in the hope of eliminating unnecessary postoperative catheterizations. In 11 women, the bladder was filled stepwise and scans were done at volumes of 0, 50, 100, 150, and 200 ml, 50 ml being chosen as the minimum volume for clinically significant residual urine. The method was then used in 43 examinations on 26 patients, 24 of whom had had a gynecological operation. There were only three mistakes: once a residual urine volume of more than 50 ml was missed, and twice the scan wrongly suggested a residual urine volume of more than 50 ml.

Journal of Ultrasound in Medicine, 1995

To evaluate the ability of transvaginal Doppler examination to discriminate between different typ... more To evaluate the ability of transvaginal Doppler examination to discriminate between different types of solid pelvic tumors, 55 women scheduled for laparotomy because of a solid pelvic mass underwent transvaginal sonographic examination, including color and spectral Doppler techniques. Arteries in the wall and core of each mass were examined. The histological diagnoses were as follows: uterine myoma (n = 28), malignant ovarian tumor (n 19), and benign ovarian tumor (n m 8). Pulsatility index values tended to be highest in the malignant ovarian tumors, albeit with considerable overlap with respect M ost uterine myomas have a characteristic appearance at gray scale ultrasonography, and the sonographic diagnosis of myomas seldom entails problems of differential diagnosis. However, in rare cases, it may be difficult to discriminate between a uterine myoma and a solid ABBREVIATIONS PI, Pulsatility index; TAMXV; lime-averaged maximum velocity

Placenta, 2004

Pre-eclampsia is one of the most common causes of perinatal and maternal morbidity and mortality.... more Pre-eclampsia is one of the most common causes of perinatal and maternal morbidity and mortality. High blood pressure and proteinuria are important clinical signs of pre-eclampsia. Sympathetic overactivity and elevated level of circulating vaso active substances, such as monoamines has been shown. Extracellular concentrations of monoamines are normally kept low by specific transporter proteins of which many are expressed in the placenta. In this study we used in situ hybridization and real-time PCR to study the gene expression of monoamine transporters, such as NET, SERT, VMAT2, EMT and OCT1/2, in normal as well as in pre-eclamptic placentae. We demonstrated high expression of NET mRNA in the trophoblast cells of the anchoring villi and a lower expression intensity in the chorionic villi. SERT mRNA was mainly detected in chorionic villi. VMAT2 mRNA was not detected in the central part of the placenta but was present in the spiral arteries of placenta bed biopsies, in cytokeratin positive cells. EMT mRNA was mainly detected in the intra lobular septa and together with OCT1 and OCT2 mRNAs also expressed in scattered cells of placental vessel adventitias. Moreover, quantitative analysis showed a significant lower expression of NET and EMT mRNAs in pre-eclamptic placentae as compared to the control group. A defective gene expression or function of these monoamines transporters might explain the elevated concentrations of monoamines in pre-eclamptic patients. Monoamine transporters may serve as a protective mechanism preventing vasoconstriction in the placental vascular bed and thereby securing a stable blood flow to the fetus.

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Ceská gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne, 1997

Journal of perinatal medicine, 1994

Doppler ultrasound velocimetry of uteroplacental, umbilical and fetal vessels provides the clinic... more Doppler ultrasound velocimetry of uteroplacental, umbilical and fetal vessels provides the clinician with important information on the hemodynamics of respective vascular area. Gestational age-related reference values have been established for maternal uterine and arcuate artery, umbilical artery, fetal descending aorta, and fetal cerebral, renal and femoral arteries. Recently, velocimetry of the fetal central venous system gained increasing attention. In growth-retarded fetuses and fetuses developing intrauterine distress, the umbilical artery blood velocity waveform changes in a typical way: the diastolic velocity of the waveform decreases and eventually disappears. The absent or reverse end-diastolic flow (ARED flow) is associated with high risk of intrauterine demise and adverse perinatal outcome. Applied as a screening test in an unselected pregnant population, umbilical artery velocimetry has not been found useful. In a preselected population of high-risk pregnancies, especial...

Obstetrics and gynecology, 1978

Ultrasonic real-time B-mode technique was used to record fetal breathing movements (FBM) in 100 c... more Ultrasonic real-time B-mode technique was used to record fetal breathing movements (FBM) in 100 consecutively examined women in late pregnancy. During the "inspiratory" phase of the FBM cycle, the diaphragm of the fetus contracts and moves in caudal direction. The diaphragmatic movement is accompanied by a retraction of the thorax with maximum inward movement of the lower sternum and by an expansion of the fetal abdomen. During "expiration" all structures return to their initial position. The incidence of FBM found in 24 pregnancies with various disorders was significantly lower than that in the 76 uncomplicated pregnancies (P less than 0.001). In 92% of the observations in which FBM were present for more than 5 minutes within 30-minute recording, this finding indicated an unaffected pregnancy at the time of the examination. No correlation was found between the FBM results and the subsequent course and outcome of the pregnancies.

Fetal Growth, 1989

In animal experiments, uteroplacental blood flow has been shown to be one of the most important d... more In animal experiments, uteroplacental blood flow has been shown to be one of the most important determinants of fetal growth.(1) Experimentally induced reduction of the blood flow to the uterus results in intrauterine growth retardation (IUGR).(2) Certain complications of human pregnancy, e.g. pre-eclampsia, restrict the blood flow through the placental vascular bed and predispose to IUGR.(3) In growth retarded fetal lambs the umbilical blood flow is reduced.(4) During intrauterine hypoxia, which is more likely to occur in growth retarded than in normal fetuses, fetal blood flow is redistributed to ensure preferential blood supply to vital organs.(5,6) This phenomenon has been named the brain-sparing effect.

Ultrasound in Obstetrics and Gynecology, 1992

Ultrasound in Obstetrics and Gynecology, 2008

Objectives: To compare two-dimensional (2D) and threedimensional (3D) ultrasound techniques, incl... more Objectives: To compare two-dimensional (2D) and threedimensional (3D) ultrasound techniques, including volumetry of fetal thigh, for weight estimation of large fetuses, and to develop a new fetal weight (FW) estimation formula. Methods: In a prospective comparative study FW estimation was done on 176 pregnant women at ≥ 287 days of gestation ≤ 4 days before delivery. Fetal head (BPD or HC), abdomen (AD) and femur were measured with 2D ultrasound technique and the volume of fetal thigh (Tvol) was estimated with 3D technique. The 2D formula of Persson and Weldner (1) was compared with the 3D formula of Lee et al(2). A new formula was developed in a subgroup of 63 fetuses where volumetry of abdomen (Abdvol) was done and the formula (FW = 2088.4904 + 81.0519 × HC − 0.1214 × HC × HC − 69.0966 × AD + 0.4741 × AD × AD + 6.4044 × Tvol + 0.0534 × Abdvol) was tested on another 50 women. Results: Standard deviation (SD) of the mean percent error (MPE) was 6.3% for both the 2D and 3D formulas, and 5.6% for the new formula. Significantly more FW estimated by the 2D formula and the new formula than by the 3D formulas were within both ±5% and ±10% of the birth weight, 50 and 86% (Persson and Weldner), 52 and 86% (new formula), 41 and 73% (Lee), respectively. In the independent Test group the SD of MPE was similar for the 2D, 3D and new formulas, 7.02, 7.04 and 7.09%, respectively. Conclusion: FW of large fetuses was estimated using 2D ultrasound method with same accuracy as with 3D ultrasound. 3D ultrasound technique requires technically advanced and expensive equipment, special operator training and skills, and it is time consuming. At present, to abandon the 2D ultrasound method in favour of 3D ultrasound for FW estimation seems not reasonable.

Ultrasound in Obstetrics and Gynecology, 1996

Our objective was to study uterine and umbilical artery flow resistance during the oxytocin chall... more Our objective was to study uterine and umbilical artery flow resistance during the oxytocin challenge test (OCT). The study population was 21 women with suspected placental insufficiency; one woman was excluded because of a positive OCT with reactive fetal heart rate pattern. We carried out simultaneous electronic fetal heart rate monitoring and Doppler velocimetry of uterine and umbilical artery flow during the OCT. The uterine artery flow resistance increased significantly during contractions in both OCT-positive (n = 5) and OCT-negative (n = 15) cases compared with basal values, but the increase was significantly higher in positive cases. The umbilical artery flow resistance increased significantly during contractions in OCT-positive cases, but was almost unchanged in negative cases. During uterine inactivity, there were no differences between the groups for any vessel. This study showed that fetal heart rate decelerations during the OCT are associated with rapid and exaggerated increases of vascular resistance in both uterine and umbilical arteries. The causal relationship is unknown, but the findings indicate pathophysiological mechanisms revealed only during uterine contractions.

International Journal of Gynecology & Obstetrics, 2000

MONDAY, SEPTEMBER 4 27 preeclampsia and with the control group patients. A statistical significan... more MONDAY, SEPTEMBER 4 27 preeclampsia and with the control group patients. A statistical significant difference (p<O,OOl) of RI a. uterina in the 18-22 week was found. Conclusions: We did not prove that with the patients with clinical signs of preeclampsia in the 2"d half of pregnancy a significant elevation of adhesive molecules ICAM-1, VCAM-1 could be already detected in the 1"' half of pregnancy. With the patients with the late manifestation of preeclampsia, the RI of a. uterina may be proved allready in the 18-20 week of pregnancy. The study was supported by the grant ofIGA Ministery ofHealth NH 5733.3

European Journal of Obstetrics & Gynecology and Reproductive Biology, 1997

Objective: To investigate the association between fetal, umbilical and uterine circulatory change... more Objective: To investigate the association between fetal, umbilical and uterine circulatory changes and adverse perinatal findings in very prolonged pregnancies. Stud), design: 44 women proceeding to 43 completed weeks of gestation with the intention of a trial of vaginal delivery were studied prospectively with ultrasound Doppler velocimetry. An intensified fetal surveillance was routinely commenced at 42 weeks and only uncomplicated pregnancies were allowed to proceed. The endpoint perinatal measures were oligohydramnios, fetal meconium release, fetal distress in labor and birth asphyxia. Flow variables in different groups were compared with the Mann-Whitney U test, Student's unpaired t-test, Wilcoxon signed-rank matched-pairs test. Fisher's exact test and contingency table analysis, and a two-tailed P value <0.05 was considered statistically significant. Results: The umbilical artery pulsatility index was significantly lower in cases of fetal meconium release (n= 12) and fetal distress (n=7). The umbilical venous flow velocity was significantly lower in cases of meconium, and the fetal aortic volume flow significantly higher in cases of fetal distress. No significant flow changes were found in connection with oligohydramnios (n=5) and birth asphyxia (n=2). Uterine flow was not significantly affected in any group. Conclusions: In very prolonged pregnancies, fetal distress in labor was not associated with an increased placental vascular resistance. In contrast to previous reports, the umbilical artery pulsatility index was low in cases of fetal distress and meconium release. The etiology is unknown, but a subclinical fetal hypoxia might have triggered a vasodilation of placental vessels. Vasodilation at an unchanged volume flow could also explain the decrease of umbilical venous flow velocity. The increased aortic volume flow indicates an increase of cardiac output in fetuses later developing distress in labor.

Early Human Development, 1985

Intrauterine motor activity was studied in breech presenting but otherwise normal fetuses. In the... more Intrauterine motor activity was studied in breech presenting but otherwise normal fetuses. In the first part of the study, 48 fetuses were examined in the 33rd gestational week with an objective method using four piezo-electric crystals attached to the maternal abdomen for recording fetal movements. Of the 48 fetuses, 25 remained in breech presentation until delivery, while 23 assumed the vertex presentation before birth. In the second part of the study, 63 pregnant women with breech-presenting fetuses in the 33rd gestational week subjectively recorded perceptible movements every evening. Spontaneous cephalic version occurred in 40 cases, and 23 fetuses persisted in the breech presentation until delivery. Neither in the objective nor in the subjective study were any quantitative differences in motor activity found between fetuses subsequently born in breech presentation and these born in vertex presentation.

Early Human Development, 1997

About half of all fetuses with increased resistance to blood flow, but with stih detectable diast... more About half of all fetuses with increased resistance to blood flow, but with stih detectable diastolic blood velocity in the umbilical artery (UA), show signs of imminent asp&i& &r&g labour indicating a need for operative delivery. Fetal brain-sparing during @pox&a is characterized by an increase in diastolic and mean blood flow velocity in the middle cerebral artery (MCA). The aim of this study was to as with increased resistance to blood flow in development of fetal asphyxia during labour. fete-placental vascular resistance between 31 by Doppler ultrasound and the last examination was correlated to perinatal outcome. The'MCA pulsatiiity index (PI), cerebroplacental PI ratio and mean MCA blood v&city were cakulated and correlated to fetal outcome. Fetal brain-sparing was defined as MCA PI < mean-2 SD., cerebroplacental PI ratio < 1.08 and mean MCA blood velocity > mean f 2 SD. No significant association was found between signs of fetal brain-sparing and the petkatal outcome. Among fetuses with signs of increased resistance to flow in the umbilical artery, velocimetry of the middle cerebral artery did not identify those that would not withstand the strain of labour.