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Biomedical subjects

C A Michael

Publications and source records attributed to C A Michael.

17 recordsLinked to original sources
PubMed1990

Subspecialisation in obstetrics and gynaecology--whither (or wither) the generalist.

In 1987, Council of the Royal Australian College of Obstetricians and Gynaecologists (RACOG) established its subspecialisation committee who identified subspecialty groups. It was the belief of the subspecialty committee that specialty training was necessary if haphazard evolution of the subspecialties and fragmentation within the discipline of obstetrics and gynaecology was to be avoided. The major issues of such training are manpower considerations and the time committed to the subspecialty, its effect on research and whether the generalist obstetrician and gynaecologist has been disadvantaged by such an initiative. Research initiatives must not suffer and the subspecialist should be prominent in the respective fields informing colleagues of important clinical and research advances. Undoubtedly the workload of the generalist will be eroded but their importance in the practice of obstetrics and gynaecology must be strengthened. The generalist should be encouraged to assist in the management of the patient in association with the subspecialist and referral should be on a tertiary basis. The limits of subspecialisation must be clearly defined and the availability and distribution of subspecialists determined. The numbers should be carefully monitored and training and accreditation and certification of subspecialists should remain within a central body such as the RACOG.

Gynecology↗
PubMed1989

Metabolism of androstenedione by placental microsomes in pregnancy hypertension.

The metabolism of [19-3H3]androstenedione by human placental microsomes was studied in vitro by radiometric analysis which distinguishes between 19-hydroxylation and elimination of the C-19 carbon. The ratio of the metabolic products tritiated water/tritiated formic acid is significantly greater for microsomes from patients with pregnancy hypertension when compared with normotensive pregnant women. This indicates that aromatization (2-hydroxylation) is deficient in pregnancy hypertension.

Androstenedione↗
PubMed1987

Corticosteroid binding globulin in normotensive and hypertensive human pregnancy.

Corticosteroid binding globulin (CBG) concentrations in maternal plasma have been measured throughout pregnancy in a series of 100 singleton pregnancies in 89 normotensive women. Plasma CBG concentrations were monitored also in 10 women with essential or renovascular hypertension. Plasma albumin, cortisol and oestriol were measured concurrently. Plasma CBG increased two and a half to three times during pregnancy. In those women who developed hypertension in pregnancy (mean arterial pressure greater than 107 mmHg), the plasma CBG concentrations were significantly lower than in those who remained normotensive. In women who developed hypertension, the CBG either failed to increase at the same rate as in normal pregnancies or the level fell before the appearance of hypertension. The earlier the onset of hypertension, the greater the decline in CBG. In all subjects, the CBG concentration at 34-36 weeks gestation was directly related to the birthweight of the infant. Plasma cortisol levels were depressed in hypertension relative to that in the normotensive women. Whilst plasma albumin levels decreased at least 30% in most women during pregnancy, the fall tended to be less in hypertensive women, but there was marked overlap between patient groups. Plasma oestriol concentrations were depressed only in the very severely affected cases. It is suggested the CBG concentration is a further reflection of the metabolic abnormalities associated with hypertension in pregnancy, and that it can be used as a marker to identify and monitor those patients at risk.

Adult↗
PubMed1986

Intravenous labetalol and intravenous diazoxide in severe hypertension complicating pregnancy.

The results of a prospective trial to evaluate the use of diazoxide and labetalol given intravenously in the management of severe hypertensive disease in pregnancy are presented. Both drugs had an efficient hypotensive action. The reduction in blood pressure in the labetalol group was better controlled and this may be a factor influencing perinatal outcome. Because of the freedom of maternal and fetal side-effects, labetalol given by intravenous infusion is a more appropriate drug for use in the management of hypertensive crises occurring in pregnancy and labour.

Adolescent↗
PubMed1979

Genetic screening in Western Australia.

The wider application of genetic screening is described in four Western Australian populations. Counselling with prenatal diagnosis of Down's syndrome was offered to 57 women over the age of 35 years and less than 16 weeks' gestation who attended an antenatal outpatients department. Forty-four women consented to amniocentesis and two affected fetuses were found. Both public and private patients can be screened to detect fetuses with Down's syndrome. In a population of 200 pregnant girls whose infants were intended for adoption, a specially designed family history form aided identification of genetic disorders in 32 families. Counselling was offered to the biological parents, to the adoptive parents, and, prospectively, to the child in later years. The effectiveness of the family history as a screening device is illustrated in this adoption sample. Counselling of parents of 20 decreased malformed infants initiated the genetic counselling clinic in Western Australia and led to subsequent referral of 92 similar cases by the family doctors. It was found that parents who gave birth to malformed infants welcome information and risk figures. Diagnostic screening in a population of 6000 intellectually handicapped individuals yielded 1372 cases (23%) with Mendelian, multifactorial, or chromosomal modes of inheritance. This screening enabled patients with inherited causes for their intellectual handicap to be identified and placed on a register for health planning.

Abortion, Induced↗
PubMed1979

Prolonged labour.

Although prolonged labour may be a decreasing obstetrical problem, the importance of its implications should not be overlooked. This article discusses the causes of arrested labour, its complications and their management.

Female↗
PubMed1979

Use of labetalol in the treatment of severe hypertension during pregnancy.

1 Labetalol, a hypotensive agent combining alpha- and beta-adrenoceptor antagonist properties, was used to treat severe hypertensive disease complicating pregnancy. 2 Effective reduction in BP was achieved in all but 3 of the 25 patients treated. Careful monitoring of feto-placental function was undertaken to ensure the maintenance of fetal well-being. Maternal and fetal side-effects were minimal and it was not necessary to discontinue the drug in any patient. 3 Labetalol was estimated in the cord blood of the fetus at delivery as well as in the breast milk of mothers on day 3 post partum. There were no adverse effects of the drug on the infants and significant hypotension did not occur. 4 The reults suggest that labetalol has a direct action on fetal lung maturation and this, together with its effective hypotensive effect, contributes to the low perinatal mortality (3.5%) observed. 5 Oculotoxicity due to the labetalol was not observed in the infants delivered. 6 It is concluded that the efficient hypotensive action of labetalol, together with apparent freedom from maternal and fetal side-effects, and consequent improved perinatal mortality, suggest that it is a suitable drug for use in pregnancy complicated by hypertension.

Adolescent↗
PubMed1978

The treatment of hypertension in pregnancy.

Hypertensive disease in pregnancy remains a major cause of maternal and perinatal morbidity and mortality. Control of maternal hypertension with antihypertensive therapy improves maternal and foetal outcome. If the blood pressure is elevated in early pregnancy, complications are more likely to occur to both mother and foetus, and the outcome may not be favourable. In labour the threat of severe pre-eclampsia or eclampsia is a constant hazard.

Adolescent↗
PubMed1975

Ultrasonic "B" scanning as a pregnancy test after less than six weeks amenorrhoea.

Sixty patients with less than six weeks amenorrhoea were examined by ultrasonic "B" scanning for the detection of pregnancy. The results were compared with those obtained by histological examination of the aspirate after the patient had undergone menstrual regulation by vacuum aspiration of the uterine contents. The overall accuracy was 79 per cent with 15 per cent false positives. The accuracy after 39 days amenorrhoea was 95 per cent. The technique was compared with an immunological pregnancy test.

Abortion, Induced↗