Clarel Antoine, M.D.

Pathology and human immunodeficiency virus expression in placentas of seropositive women
Chandwani S; Greco MA; Mittal K; Antoine C; Krasinski K; Borkowsky W
1991 May;163(5):1134-1138, Journal of infectious diseases
The pathology of term placentas from seropositive human immunodeficiency virus (HIV)-infected and seronegative women was investigated by routine histologic, immunocytochemical, and in situ hybridization techniques. Placentas were evaluated for evidence of villitis, chorioamnionitis, and funisitis. Membranes, trophoblast, and decidua were also examined by immunohistochemistry using monoclonal HIV p24 antibody. Twenty placentas were evaluated by combined immunochemical and in situ hybridization techniques, using a 35S-labeled RNA probe complementary to the 3' long terminal repeat and envelope region of HIV-1. HIV-seropositive placentas did not show significant villitis; however, the incidence of chorioamnionitis increased (P less than .01). HIV antigens and nucleic acids were identified in the trophoblast of 10% of the placentas that also showed chorionitis. Term HIV-positive placentas may show histologic changes that may or may not be directly related to the virus. Analysis of tissues from earlier gestational placentas may prove more informative in clarifying the mechanism of maternal-fetal HIV transmission
— id: 14042, year: 1991, vol: 163, page: 1134, stat: Journal Article,

PATHOLOGY AND HIV EXPRESSION IN TERM PLACENTAS FROM SEROPOSITIVE WOMEN
Chandwani, S; Greco, MA; Mittal, K; Antoine, C; Krasinski, K; Borkowsky, W
1990 ;62(Suppl 1):A17-A17, Laboratory investigation
— id: 32016, year: 1990, vol: 62, page: A17, stat: Journal Article,

Pregnancy post-Stevens-Johnson syndrome: case report and review of the literature
Kratzert K; Marks F; Antoine C; Brescia RJ; Parodneck L; Young BK
1988 Sep;72(3 Pt 2):447-450, Obstetrics & gynecology
A pregnancy complicated by vaginal stenosis six years after diagnosis of Stevens-Johnson syndrome is described. The pathologic changes in the vagina have not previously been reported. The basic pathology of severe mucosal erythema multiforme was present, as well as ectasia of the superficial capillaries and small venules. The effect of the vaginal scars on the mode of delivery is discussed
— id: 10982, year: 1988, vol: 72, page: 447, stat: Journal Article,

POSTNATAL OVERESTIMATION OF GESTATIONAL-AGE IN PRETERM INFANTS
SHUKLA, H; ATAKENT, YS; FERRARA, A; TOPSIS, J; ANTOINE, C
1987 OCT ;141(10):1106-1107, American journal of diseases of children
— id: 41673, year: 1987, vol: 141, page: 1106, stat: Journal Article,

Biochemical differences related to birth order in triplets
Antoine C; Kirshenbaum NW; Young BK
1986 May;31(5):330-332, Journal of reproductive medicine
This is the first report to date on biochemical parameters in triplets. Umbilical artery and venous pH, PO2, PCO2, lactate and base deficit were measured in seven sets of triplets. Other parameters compared were route of delivery, one- and five-minute Apgar score, birth weight, relative birth order and sex. Twenty-one viable infants were born from three induced and four spontaneous pregnancies. Female: male sex ratio was 1.6:1.0. All triplets within a set were delivered by the same route--six sets by cesarean section and one set vaginally. There were no significant differences, according to Student's t-test, in birth weight, Apgar scores and biochemical parameters related to birth order. Comparison of umbilical artery and umbilical venous pH, PO2, PCO2, lactate and base deficit differences did not demonstrate evidence of acidosis or significant base deficit in the third triplet when compared with the first two, suggesting that the duration in utero after deliver of the firstborn is not associated with metabolic acidosis or hypoxia in the absence of any obstetric complication or anesthetic problem
— id: 66856, year: 1986, vol: 31, page: 330, stat: Journal Article,

MATERNAL AND FETAL MORTALITY IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME
ANTOINE, C; MORRIS, M; DOUGLAS, G
1986 AUG ;86(8):443-445, New York state journal of medicine
— id: 51156, year: 1986, vol: 86, page: 443, stat: Journal Article,

THE FETUS AS THE FINAL ARBITER OF INTRAUTERINE STRESS DISTRESS
REECE, EA; ANTOINE, C; MONTGOMERY, J
1986 MAR ;29(1):23-32, Clinical obstetrics & gynecology
— id: 41305, year: 1986, vol: 29, page: 23, stat: Journal Article,

OVERESTIMATION OF GESTATION AGE (GA) IN PRETERM INFANTS
Shukla, H; Ferrara, A; Atakent, Y; Topsis, J; Antoine, C
1986 Apr;20(4):A361-A361, Pediatric research
— id: 31071, year: 1986, vol: 20, page: A361, stat: Journal Article,

The Apgar score: is it enough?
Silverman F; Suidan J; Wasserman J; Antoine C; Young BK
1985 Sep;66(3):331-336, Obstetrics & gynecology
One thousand thirty-two neonates were evaluated with umbilical venous and arterial blood samples drawn at delivery for assessment of pH, PO2, PCO2, and base deficit. These values were statistically correlated with Apgar scores in all of the neonates studied. Infants were divided into Apgar groupings (group A, greater than or equal to 7 at one and five minutes; group B, less than 7 at one minute, greater than or equal to 7 at five minutes; group C, less than or equal to 7 at both one and five minutes). Generally, umbilical artery and umbilical venous data were parallel. The differences in means for pH, PO2, PCO2, and base deficit was significant when group A was compared with group B in both umbilical artery and umbilical venous data. However, a severe degree of biochemical disturbance must take place before significant association with neonatal depression can be made. It appears that umbilical blood biochemical data are related to fetal metabolic status before birth but only modestly influence the one-minute Apgar score
— id: 66858, year: 1985, vol: 66, page: 331, stat: Journal Article,

Differences in twins: the importance of birth order
Young BK; Suidan J; Antoine C; Silverman F; Lustig I; Wasserman J
1985 Apr 1;151(7):915-921, American journal of obstetrics & gynecology
Despite the clinical impression that firstborn twins do better than second-born twins, recent reports have shown no difference in perinatal mortality between them. In order to evaluate differences in twins, more sensitive means than perinatal deaths are necessary. This study examines differences between 80 firstborn and second-born twin pairs with respect to Apgar score, umbilical venous and arterial blood gas, and acid-base data. The umbilical venous and arterial blood PO2, PCO2, base deficit, pH, and lactic acid concentration were measured in paired samples and compared with the paired t test and chi 2 when applicable. Statistically significant differences favoring twin A, the firstborn, were found in 1-minute Apgar score, umbilical venous pH, PO2, and PCO2, and umbilical arterial PO2. The other factors in umbilical venous and arterial blood did not show statistically significant differences. When these parameters were examined with respect to route of delivery, monochorionic and dichorionic twins, interval between twins, and vertex twins only, with the possible effects of malpresentation eliminated, the results persistently favored the firstborn twin. Thus it is unequivocally demonstrated that there are substantial differences at birth favoring the first twin, despite similar perinatal mortality for both. The data suggest that the second-born twin has potentially greater susceptibility to hypoxia and trauma
— id: 66861, year: 1985, vol: 151, page: 915, stat: Journal Article,

Simultaneous measurement of fetal tissue pH and transcutaneous pO2 during labor
Antoine C; Young BK; Silverman F
1984 May;17(2-3):69-76, European journal of obstetrics, gynecology & reproductive biology
Simultaneous measurement of fetal heart rate (FHR), uterine contractions (UC), continuous fetal tissue pH (TpH) and transcutaneous pO2 (tcpO2) was attempted in 40 high-risk parturients monitored for an average duration of 117 +/- 74 min. There were only two failures (9%) in the last 23 cases, with satisfactory recording of all parameters in 78% of the total. At present, the feasibility of simultaneous biochemical monitoring is limited to the active phase of labor. Fetal scalp and umbilical arterial blood pH and pO2 were obtained as well. The biochemical data showed a good correlation between tcpO2, scalp capillary pO2 and umbilical artery pO2 (P less than 0.02). The correlation was not significant between similar pH comparisons, although an average difference of 0.04 pH units was observed between the final tpH and umbilical artery pH. Both fetal TpH and tcpO2 fell progressively during labor. Preliminary findings comparing TpH, tcpO2 and FHR suggest that changes in tcpO2 rapidly reflect changing maternal and fetal conditions, while TpH responds more slowly and less sensitively
— id: 66867, year: 1984, vol: 17, page: 69, stat: Journal Article,

Human maternal-fetal lactate relationships
Suidan JS; Antoine C; Silverman F; Lustig ID; Wasserman JF; Young BK
1984 ;12(4):211-217, Journal of perinatal medicine
This study attempts to determine the major source of lactate in the normal and in the depressed human fetus, in order to assess the applicability of fetal blood lactate measurement for the evaluation of fetal stress during labor. We obtained umbilical arterial and venous blood samples at delivery in 132 liveborn infants, together with simultaneous maternal radial arterial samples. All samples were analyzed immediately for pH, blood gases, and lactate. In vigorous newborns (1-minute Apgar score greater than or equal to 7), umbilical arterial and venous lactate levels were lowest with elective cesarean section done before the onset of labor, higher with cesarean section performed during labor, and highest at the time of vaginal delivery (p less than 0.001, Tab. I). Fetal lactate levels were also significantly higher than maternal levels in vigorous newborns (p less than 0.01), the lactate difference between umbilical artery and maternal artery being lowest with elective cesarean section, higher with cesarean section performed during labor, and highest with vaginal delivery (p less than 0.02, Tab. II). Depressed newborns (1-minute Apgar score less than 7) had higher umbilical lactates and higher fetal-maternal lactate differences than vigorous newborns (p less than 0.01, Tab. III). Our results indicate that the blood lactate levels in both mother and fetus increase with labor and reach their highest values at the time of vaginal delivery. The lactate levels are highest in the umbilical artery, lower in the umbilical vein, and lowest in the maternal artery before the onset of labor.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 66868, year: 1984, vol: 12, page: 211, stat: Journal Article,

Current status of continuous fetal pH monitoring
Antoine C; Silverman F; Young BK
1982 Jun;9(2):409-422, Clinics in perinatology
— id: 66875, year: 1982, vol: 9, page: 409, stat: Journal Article,

Fetal lactic acidosis with epidural anesthesia
Antoine C; Young BK
1982 Jan 1;142(1):55-59, American journal of obstetrics & gynecology
Three hundred thirty-six consecutive cesarean deliveries performed under epidural anesthesia were reviewed. Twenty per cent of mothers suffered at least a 20% fall in blood pressure following administration of epidural anesthesia. An additional 24% required ephedrine, a vasopressor with predominantly beta activity, when other corrective measures failed. Thus, 44% of these patients suffered significant hypotension. Forty-one percent of all elective repeat cesarean sections were treated wih ephedrine because of maternal hypotension. Fifty-one patients delivered by scheduled repeat cesarean section were divided into ephedrine-treated and untreated groups. There were no differences in Apgar scores among infants of both groups. Fetal acidosis was proportional to the severity of hypotension and the ephedrine dose. The metabolic abnormalities were most pronounced when severe hypotension, requiring over 15 mg of ephedrine, was present. Following restoration of blood pressure with conventional measures and ephedrine therapy, lactic acidosis persisted until delivery, whereas PO2 and PCO2 reverted toward normal values. The hypoperfusion of the intervillous space was the most likely cause of the observed significant umbilical venous and arterial lactic acidosis. Maternal hypotension remains a significant problem complicating conduction anesthesia
— id: 66879, year: 1982, vol: 142, page: 55, stat: Journal Article,

Sinusoidal fetal heart rate pattern with vasa previa in twin pregnancy
Antoine C; Young BK; Silverman F; Greco MA; Alvarez SP
1982 May;27(5):295-300, Journal of reproductive medicine
A case of vasa previa in twin pregnancy associated with a sinusoidal heart rate was observed. A review of the world literature revealed eight previously reported cases of vasa previa in twins. No first twin survived, and 62.5% of second twins eventually died from partial or complete exsanguination. This is the first reported case of sinusoidal fetal heart rate in association with vasa previa. Continuous fetal monitoring suggested the diagnosis of funic presentation and of fetal bleeding. A high index of suspicion, use of amnioscopy, ability to detect fetal blood in the vaginal pool, continuous fetal heart rate monitoring and ultrasonography may help in reducing the high perinatal mortality associated with vasa previa
— id: 66876, year: 1982, vol: 27, page: 295, stat: Journal Article,

Fetal blood analysis. I. Effect of delayed collection
Silverman F; Antoine C; Young BK
1982 Summer;4(2):87-91, Diagnostic gynecology & obstetrics
Umbilical blood was analyzed for pH, pO2, pCO2, HCO3-, base excess, and plasma lactate to evaluate possible errors of fetal scalp blood analysis. Two studies to determine the effect of delayed collection and exposure to air on fetal blood acid-base measurement analyzed anaerobically collected umbilical blood in syringe and capillary samples. In the first study, 37 samples were analyzed and then placed in small droplets on a glass slide and exposed for 30 seconds and 60 seconds respectively. These samples were then collected and reanalyzed. No significant change was noted through 1 minute of exposure in any of the acid-base parameters measured. In the second study, 34 samples were again analyzed and then exposed in droplets for a full 5 minutes. Differences in measurement of pO2, base excess, and plasma lactate remained insignifiicant even up to 5 minutes. The results of this study demonstrate that the occasional slow scalp blood collection or admixture with air do not present a significant obstacle to proper use of fetal acid-base analysis
— id: 66878, year: 1982, vol: 4, page: 87, stat: Journal Article,

Comparison of tissue pH monitor with a standard blood pH meter
Antoine C; Silverman F; Young BK
1981 Dec;27(12):2070-2071, Clinical chemistry
— id: 66880, year: 1981, vol: 27, page: 2070, stat: Journal Article,