Biomedical subjects

B A Brindley

Publications and source records attributed to B A Brindley.

5 recordsLinked to original sources

PubMed1990

Combined ultrasonography and amniocentesis for pregnant women with elevated serum alpha-fetoprotein. Revising the risk estimate.

A combination of ultrasound and amniocentesis for alpha-fetoprotein (AFP) and acetylcholinesterase (ACHE) identified 36 anomalous fetuses among 331 pregnant women evaluated at our center for "true" elevated maternal serum alpha-fetoprotein (MSAFP). In six cases the diagnosis of fetal anomalies was missed on initial ultrasonography. In addition, placental pathology was identified in 12 cases and adverse outcome (fetal demise, intrauterine growth retardation, severe oligohydramnios) in 15. When grouped by multiples of the median (MOM), a significant linear correlation was observed between increasing MSAFP and the rate of fetal anomalies or adverse outcome. The frequency of fetal anomalies increased from 0.93% when MSAFP was less than 3.0 MOM to 56% when MSAFP was greater than 7.5 MOM. No differences were observed in the frequency of placental pathology between the groups. A normal ultrasound study in these patients will decrease considerably, but not eliminate, the risk estimate for undetected fetal anomalies. From our 83% ultrasound sensitivity we calculate that with MSAFP greater than 3.0 MOM the risk of anomalies despite a reassuring scan is greater than 1% and clearly warrants offering amniocentesis for amniotic fluid AFP and ACHE. Between 2.5 and 3.0 MOM the risk is relatively low. Amniocentesis should be offered routinely to patients with MSAFP greater than 3.0 MOM and normal ultrasonography. In patients with MSAFP of 2.5-2.9 MOM and satisfactory ultrasonography the risk of amniocentesis may outweigh its benefits.

Acetylcholinesterase↗

PubMed1989

Bromocriptine mesylate for lactation suppression: a risk for postpartum hypertension?

The etiology of postpartum eclampsia and hypertension remains controversial. Recent reports have suggested a possible idiosyncratic hypertensive reaction associated with the use of bromocriptine mesylate. The purpose of this study was to determine whether bromocriptine, used for lactation suppression, is a risk factor for postpartum hypertension. In 1813 consecutively delivered staff patients, blood pressures at three separate home visits were obtained between 3-21 days postpartum. Postpartum hypertension, defined for the purposes of this study as systolic pressure of 140 mmHg or greater and/or diastolic pressure of 90 mmHg or greater on any of the three home visits, was the dependent variable; bromocriptine exposure was the independent variable. Covariates included age, race, chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication. Discriminant analysis, including the first-order interactions, revealed that race, history of chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication contributed significantly to postpartum hypertension (F (7, 1803) = 107.9; P less than .001, explained variance 30%). Of all the interaction terms, only the bromocriptine by pregnancy-induced hypertension interaction was significant. These findings support the contention that patients with antepartum pregnancy-induced hypertension who receive bromocriptine for lactation suppression are at increased risk for postpartum hypertension. Avoiding the elective use of this drug in patients with pregnancy-induced hypertension might constitute a reasonable clinical response to these findings.

Adult↗

PubMed1989

Interpretation of chorionic villus sampling laboratory results is just as reliable as amniocentesis.

Karyotypes of chorionic villi have been said to be less accurate than karyotypes of amniocytes. Karyotypic differences between placental and fetal tissue and maternal-cell contamination could potentially complicate clinical management. We compared cytogenetic results obtained by chorionic villus sampling and amniotic fluid cells in our center during a 2-year period (1986-1987). Chorionic villus sampling material was processed for direct analysis and backed up when indicated (now routinely) with tissue cultures. The incidence of inconclusive results requiring additional studies was 1.2% for chorionic villus sampling and 0.75% for amniotic fluid cells. Mosaicism was the most common problem for both chorionic villus sampling and amniotic fluid cells. Failure of growth was more frequent in amniocentesis material (0.35 versus 0.09%), but polyploidy and atypical aneuploidies were greater with chorionic villus sampling. The accuracy of cytogenetic evaluation by chorionic villus sampling and amniotic fluid cells and the need for additional invasive procedures appear to be equal in our laboratory.

Amniocentesis↗

PubMed1988

Induction and augmentation of labor: basis and methods for current practice.

Medical control of labor is often necessary in modern obstetrics. The status of the cervix may dictate the method of induction and influence its success. Four milligrams of prostaglandin (PGE2) gel applied intravaginally has been shown to be a safe, efficacious, and extremely well-tolerated agent to promote cervical ripening. The patient should be monitored before and at least 4 hours after PGE2 gel application, since the incidence of uterine activity is high after this treatment and many of these pregnancies are at risk. The rare case of hyperstimulation may be treated with a tocolytic agent. The start of oxytocin may be individually tailored, but we do not recommend its use in less than 4 hours after gel insertion. Oxytocin should be used with great caution if the patient continues to have uterine activity from the PGE2 gel. Because, in part, the use of the PGE2 gel for cervical ripening is not approved by the Food and Drug Administration in the United States, it is prudent to discuss its use with the patient, document carefully, and use this medication only if there is clear indication. Protocols for the use of oxytocin currently used in many hospitals seem to be based on outdated pharmacologic data. Relatively new information on the pharmacology and clinical effects of oxytocin are reviewed to provide a rational approach to its clinical use in accordance with recently published guidelines from the American College of Obstetricians and Gynecologists (ACOG). The current data overwhelmingly indicate that oxytocin should be started at a low dose (0.5-1 mU/min) with a slow, arithmetical increase every 30 to 60 minutes. Previous reports of a high incidence of fetal distress, uterine dysfunction, and hyperstimulation in induced labor may be related to use of oxytocin at doses higher than currently appear appropriate. The risks of induction and augmentation can be reduced by careful patient selection and preparation. Oxytocin is safe and effective with expert medical management which provides careful monitoring, controlled infusion, persistence, and the knowledge of when to stop.

Cervix Uteri↗

PubMed1988

Nomograms for ultrasound visualization of fetal organs.

Although there is extensive literature regarding ultrasonic biometric evaluation of the fetus, our goal is to establish nomograms for the visualization of fetal organs, as they have not previously been reported. Data from the first complete ultrasound examination of 2,389 consecutive gravidas at greater than or equal to 14 weeks gestation were analyzed. The examinations were performed by three registered sonographers during a 20-month period. Fetal cerebral ventricles, heart, stomach, kidneys, intestines, bladder, diaphragm, spinal column, extremities, and umbilical cord were examined routinely and classified as normal, abnormal, or suboptimally visualized. Ultrasound visualization of these organs varied with gestational age (P less than 0.0001) and patterns of visualization varied markedly by organ. These nomograms could be useful in the timing of ultrasound examinations, the timing and method of delivery, detection of anomalies amenable to in utero therapy, parental counseling, quality assurance programs, and medicolegal liability defense.

Fetus↗