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Biomedical subjects

A A Compton

Publications and source records attributed to A A Compton.

15 recordsLinked to original sources
PubMed1988

Sonographic evaluation of cervical length in pregnancy: diagnosis and management of preterm cervical effacement in patients at risk for premature delivery.

Sonographic measurement of cervical length during pregnancy can provide an objective, noninvasive assessment of anatomical shortening associated with premature labor and delivery. One hundred fifty normal women underwent serial sonographic cervical length measurements during uncomplicated pregnancy. The mean cervical length was 52 +/- 12 mm until 34 weeks' gestation, when gradual effacement and cervical length shortening began. Using these data, we managed 88 pregnant women with previous second-trimester pregnancy losses by a combination of cerclage placement for cervical length less than 40 mm and aggressive therapy for premature uterine contractions. The results showed the following: 1) 97% of women with diethylstilbestrol exposure and 80% of women with müllerian abnormalities exhibited cervical length shortening; 2) only 60% of women with a normal uterine cavity showed cervical lengths of less than 40 mm; and 3) all three groups of high-risk patients, independent of cervical length, showed significant premature uterine activity. These observations suggest that sonographic cervical length measurement may be a useful adjunct in the assessment of anatomical cervical integrity and the decision for cerclage placement. Furthermore, the presence of both premature cervical length shortening and preterm uterine activity in 65% of high-risk patients suggests that "cervical incompetence" and premature labor may not be distinct entities, but common symptoms associated with an increased risk of preterm delivery.

Cervix Uteri↗
PubMed1987

The presence or absence of fetal breathing movements as a predictor of outcome in preterm labor.

The presence or absence of fetal breathing movements may be helpful in differentiating between true and false preterm labor. We attempted to demonstrate the clinical utility of this simple ultrasonic observation in predicting short-term delivery outcome during suspected preterm labor. A total of 50 pregnancies between 26 and 34 weeks' gestation with presumed preterm labor were observed in a prospective manner. During 20 minutes of observation with real-time ultrasound at the time of admission, fetal breathing movements were observed in 33 patients and considered absent in the remaining 17 patients. In those pregnancies with absent fetal breathing movements, true labor with subsequent delivery occurred in 16 patients. Of the 33 pregnancies with fetal breathing movements present, 29 continued for greater than 48 hours. It appears that the absence of fetal breathing movement is a reliable indicator of imminent preterm delivery, irrespective of fetal membrane status (p less than 0.0001). The observed mean sensitivity and specificity of this phenomenon in predicting short-term delivery outcome are 96.6% +/- 3.3% (mean +/- SD) and 80.0% +/- 8.9%, respectively. A multivariant statistical model based on the frequency of contractions, white blood cell counts, initial cervical examination results, and premature rupture of membranes could successfully predict delivery outcome in 40% to 75% of cases. The addition of fetal breathing movement analysis to the model allowed for the correct prediction of outcome in 90% of the cases.

Delivery, Obstetric↗
PubMed1987

Soft tissue and pelvic dystocia.

This article has considered the subject of bony pelvic dystocia and soft tissue dystocia. Dystocia most often results from a combination of fetal and pelvic factors. However, on many occasions the size and shape of the pelvis is the initial problem, which encourages the fetus to take up a malposition such as occiput-posterior, and this in turn results in a dysfunctional contraction pattern that may or may not be corrected by oxytocin augmentation--a vicious circle that can only be broken by performance of a cesarean section. With minor degrees of pelvic dystocia, asynclitism and molding of the fetal head can often make a safe vaginal delivery possible. Clinically all pelvises can be categorized into adequate, questionable, and too small. The latter group is the least common and generally includes the congenitally or developmentally abnormal pelvises, and in most cases primary cesarean section should be the mode of delivery. In all other pelvises with a vertex presentation, a trial of labor is indicated because the fetal head is an excellent pelvimeter. With proper fetal monitoring with an intrauterine pressure catheter, with the use of a partograph to assist in the diagnosis of an active-phase arrest, followed by a cesarean section at the appropriate time, there is no increase in fetal or maternal morbidity. If the breech is the presenting part, then there are only two types of pelvis--very adequate and inadequate--and x-ray pelvimetry should be used to help in the classification.(ABSTRACT TRUNCATED AT 250 WORDS)

Contracture↗
PubMed1987

A large meningioma presenting as a neurologic emergency in late pregnancy.

A case is described of a large meningioma presenting as an acute neurologic emergency in late pregnancy. The diagnosis was made by a head computed axial tomography scan and an immediate cesarean section was performed, followed by a craniotomy and dissection of the tumor, with excellent outcome both for mother and infant.

Adult↗
PubMed1986

Salivary estriol as an index to fetal wellbeing.

We adapted two commercially available kits for measuring serum estriol to use in assaying salivary estriol in the third trimester of pregnancy. Salivary estriol increases during gestation, as does unconjugated estriol in serum. With a meticulous collection protocol, fetal wellbeing can be monitored as successfully with saliva samples as with serum. A fetal demise was charted similarly by the salivary and the serum estriol assay. Inter- and intra-assay reproducibility (CV) of the saliva assay was 6.2%. Day-to-day CV, based on a fasting sample before breakfast but obtained 1 to 3 h after rising, was 14.8% (SD 5.8%). Values for salivary estriol obtained immediately after ingestion of food or drink dropped by 19.0% (SD 17.9%) and 32.1% (SD 21.9%), respectively, as compared with values determined immediately before intake of food or water.

Adolescent↗
PubMed1984

Serum testosterone measurements.

Serum testosterone and especially free testosterone is one of the parameters commonly used to evaluate androgen excess or deficiency. The authors equilibrated serum samples with 14C-labeled testosterone followed by an ammonium sulfate precipitation to compare the "apparent free testosterone concentration" with "total" serum testosterone concentration in the following populations: normal males and females; females presenting with gynecologic problems, particularly hirsutism and/or virilization; and males and females on maintenance hemodialysis. Total serum testosterone for each specimen was assayed with five different commercially available RIA kits encompassing a variety of technics: direct assay technics, assays utilizing extraction procedures prior to RIA; tritium-labeled tracer as well as iodine-labeled tracers. Clinical correlations improve strikingly when apparent free testosterone concentrations rather than total serum testosterone concentrations are used.

Female↗
PubMed1981

Significance of the sinusoidal fetal heart rate pattern.

The sinusoidal fetal heart rate pattern has been reported to be an indication of fetal compromise. In this review of 31 cases, drawn from a total of 559 monitored cases of normal and at-risk women, only one resulted in poor outcome, and this was attributable to a difficult breech delivery. An association with administration of analgesics is confirmed. The sinusoidal fetal heart rate pattern does not appear to be uniformly associated with fetal distress. Its presence should be an indication for meticulous assessment of other electrocardiographic, biochemical, or clinical evidence of fetal status.

Analgesics↗
PubMed1980

Plasma estriol in the evaluation of third-trimester gestational age.

This study attempts to confirm previous reports of a clinically useful serum unconjugated estriol surge at 36 weeks' gestation. Although an apparently physiologic estriol surge occurred at 36 +/- 2.1 weeks in 25 of 32 patients, clinical reality makes weekly plasma sampling difficult. In individual cases, use of the "surge point" predicted gestational age within a 4-week range with only 66% accuracy, and potentially serious errors in dating occurred. Other biochemical (lecithin:sphingomyelin, phosphatidylglycerol) and sonographic methods are superior in resolving problems with dating gestational age in the third trimester.

Estriol↗
PubMed1979

Diurnal variations in unconjugated and total plasma estriol levels in late normal pregnancy.

Diurnal variations in plasma unconjugated and total estriol were assessed in 11 third-trimester subjects with uncomplicated pregnancies. Commercially available 125I-labeled radioimmunoassay kits were used. Total plasma estriols reach a nadir during the hours of sleep (400 and 700 hours) which exceeds the episodic fluctuations seen from day to day or during a given 90-minute period. Plasma unconjugated estriol fluctuations over 24 hours did not significantly exceed our previously reported episodic fluctuation of 15.6 +/- 8.2%. The data are interpreted as showing no circadian rhythm, but reflecting, in the case of total plasma estriols, an effect of improved renal clearance during hours of rest. Plasma unconjugated estriol emerges as the test of choice in the monitoring of high-risk pregnancies.

Adult↗
PubMed1978

Plasma estriol vs. estrogen assays in 24-h urines as an index to fetal status.

Conventionally, urinary estrogens are measured to monitor fetal well-being in the third trimester of pregnancy. There are many theoretical and practical advantages to the use of recently introduced plasma estriol assays; consequently, we undertook to compare the results of a spectrophotometric assay for total urinary estrogen with values for plasma total and free (unconjugated) estriol obtained by radioimmunoassay with commercially available kits. The data correlate well, r = 0.70 for plasma total estriol with urinary estrogen (expressed as milligrams of estrogens per gram of creatinine [E/C]), r = 0.79 for plasma free estriol with E/C, and r = 0.71 between the two plasma values. Minute-to-minute fluctuations during 90 min and day-to-day fluctuations followed during five days suggest that fluctuations of up to +/- 45% are within the normal range (means +/- SD of the day-to-day fluctuations were 16.9 +/- 7.7% and 15.6+/- 8.2%). Turn-around time is a minimum of 29 h for the urinary estrogen assay, 4.5 h for the plasma total estriol, and 3 h for the plasma free estriol.

Estriol↗