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C V Towers

Publications and source records attributed to C V Towers.

14 recordsLinked to original sources
PubMed1992

A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation.

Previous randomized controlled studies of corticosteroids for the reduction of respiratory distress syndrome have failed to demonstrate benefit in very early premature gestational age groups. A randomized, double-blind, placebo-controlled clinical trial of betamethasone given to mothers with intact membranes and threatened premature delivery between 24 and 28 weeks of pregnancy was conducted. Thirty-six patients were randomized to receive betamethasone, two doses of 12 mg, 24 hours apart, and 41 received placebo. No difference was found in the overall incidence of respiratory distress syndrome between the two groups (betamethasone vs placebo 0.55 vs 0.66) or in the incidence of respiratory distress syndrome in babies delivered between 1 and 7 days after the first dose of drug (betamethasone vs placebo 0.78 vs 0.88). Nor were there any differences observed in any measure of severity of respiratory distress syndrome between the groups. The neonatal death rates were also similar (betamethasone vs placebo 0.25 vs 0.24). The only difference seen was an unexpected reduction in the betamethasone group in the incidence of grades 3 and 4 intraventricular hemorrhage (betamethasone vs placebo 1/31 vs 9/36, p = 0.01). Therefore this study was unable to demonstrate any beneficial effect of corticosteroids in reducing respiratory distress syndrome at less than 28 weeks' gestation in spite of a sample size that had an 80% likelihood of detecting a 50% reduction in the incidence of respiratory distress syndrome with p = 0.05, which is the minimum reduction seen in virtually all randomized trials in other gestational age groups.

Adult↗
PubMed1992

Perinatal outcome in pregnancy complicated by massive obesity.

OBJECTIVE: Our objective was to determine the impact of massive obesity during pregnancy, defined as maternal weight > 300 pounds, on perinatal outcome. STUDY DESIGN: A case-controlled study was conducted. Between Jan. 1, 1986, and Dec. 31, 1990, 111 pregnant women weighing > 300 pounds who were delivered at Long Beach Memorial Women's Hospital were identified with a perinatal data base search. A control group matched for maternal age and parity was selected, and perinatal variables were compared between groups. To control for potential confounding medical complications, massively obese patients with diabetes and/or chronic hypertension antedating the index pregnancy were excluded from the obese group, and the data were reanalyzed. The Student t test chi 2, and Fisher's exact statistical analysis were used where appropriate. RESULTS: Massively obese pregnant women are significantly more likely to have a multitude of adverse perinatal outcomes, including primary cesarean section (32.4% vs 14.3%, p = 0.002), macrosomia (30.2% vs 11.6%, p = 0.0001), intrauterine growth retardation (8.1% vs 0.9%, p = 0.03), and neonatal admission to the intensive care unit (15.6% vs 4.5%, p = 0.01). They also are significantly more likely to have chronic hypertension (27.0% vs 0.9%, p < 0.0001) and insulin-dependent diabetes mellitus (19.8% vs 2.7%, p = 0.0001). However, when those massively obese pregnant women with diabetes and/or hypertension antedating pregnancy are excluded from analysis, no statistically significant differences in perinatal outcome persisted. CONCLUSION: Massively obese pregnant women are at high risk for adverse perinatal outcome; however, this risk appears to be related to medical complications of obesity.

Adult↗
PubMed1992

Severity of asthma and perinatal outcome.

OBJECTIVE: Our objective was to determine the impact of asthma and its severity, as determined by medication requirements, on perinatal outcome. STUDY DESIGN: A case-controlled study was conducted. Among 30,940 live births at Long Beach Memorial Medical Center Women's Hospital, 183 deliveries occurred between Jan. 1, 1985, and Dec. 31, 1990, that were coded for the diagnosis of asthma. Eighty-one that required the chronic use of medications to control their disease were identified. Thirty-one patients were steroid dependent and 50 were non-steroid-medication dependent. A control group was randomly selected (excluding maternal transports), and selected perinatal variables were compared between groups. RESULTS: When compared with controls, steroid-dependent asthmatics were at significantly increased risk for gestational (1.5% vs 12.9%) and insulin-requiring diabetes (0% vs 9.7%). Preterm delivery and preterm premature ruptured membranes occurred significantly more often in both asthmatic groups. Overall cesarean section rate was significantly increased in the non-steroid-medication-dependent asthmatic group when compared with controls (56.0% vs 30.0%). Delivery by primary cesarean section was significantly more common in the steroid-dependent group (38.7% vs 19.2%), and a strong trend was noted among the non-steroid-medication-dependent patients (34.0% vs 19.2%). Cesarean delivery for fetal distress was also more common in these two asthmatic groups. Neonates born to both groups of asthmatic pregnant women were significantly more likely to be of birth weight < 2500 gm but did not have an increased frequency of intrauterine growth restriction. No significant differences in low 5-minute Apgar scores were found; however, neonates born to both steroid-dependent and non-steroid-medication-dependent asthmatics were significantly more likely to be admitted to the neonatal intensive care unit (39.0% and 22.0% vs 7.7%). Preterm delivery and low birth weight were complications observed significantly more often in the steroid-dependent asthma group when compared with the non-steroid-medication-dependent group (54.8% vs 14.0% and 45.2% vs 14.0%). CONCLUSIONS: Perinatal outcome is compromised in the pregnancy complicated by chronic medication-dependent asthma. The extent is variable and is associated with disease severity, as measured by medication requirements.

Asthma↗
PubMed1992

Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes.

OBJECTIVE: To compare the clinical outcome in patients with preterm premature rupture of membranes (PROM) who had a sterile speculum examination with those having a digital vaginal examination. METHODS: We studied 271 singleton pregnancies complicated by preterm PROM from the Memorial Medical Center of Long Beach Perinatal Outreach program that met the criteria for expectant treatment from January 1986 to April 1990. Patients were not included in the study if they had multiple gestations, cerclage, advanced labor, or any indication for delivery on admission (eg, mature lung profile, chorioamnionitis). All subjects were maternal transports to our tertiary care facility and were managed similarly by our perinatal group. The women were questioned as to whether a digital vaginal examination had been performed before transport. Latency period and other obstetric characteristics were then compared. The latency period, defined as days from rupture of membranes until active intervention was initiated or labor began spontaneously, was also stratified by gestational age. RESULTS: One hundred twenty-seven subjects had a digital vaginal examination and 144 had a sterile speculum examination. A significantly (P less than .0001) shorter mean latency period (2.1 +/- 4.0 versus 11.3 +/- 13.4 days) was found in those who had a digital vaginal examination. In addition, a shorter latency period was noted for each gestational age. No difference in uterine activity or cervical dilatation and effacement was noted between the groups on admission. CONCLUSION: Digital vaginal examinations performed on patients whose pregnancies are complicated by preterm PROM appear to shorten significantly the latency period.

Chorioamnionitis↗
PubMed1991

Rate of recurrence of preterm premature rupture of membranes in consecutive pregnancies.

The reported incidence of preterm premature rupture of membranes ranges between 1% and 2% of all pregnancies. The rate of recurrence is poorly defined. The goal of this study was to establish the frequency of recurrence in a high-risk referral practice. Over a 5-year period we identified 121 patients with preterm premature rupture of membranes who had a minimum of two consecutive pregnancies under our care, resulting in a total of 255 pregnancies for analysis. Recurrent preterm premature rupture of membranes occurred in 39 of 121 patients, for a rate of 32.2% (95% confidence interval, 23.9 +/- 40.5). We were unable to demonstrate an association between the estimated gestational age at the time of rupture in the index pregnancy, latency period, interval between pregnancies, and the probability of repeat preterm premature rupture of membranes in the next pregnancy. We conclude that patients with preterm premature rupture of membranes should be counseled regarding the significant risk of recurrence and need to have close follow-up in their subsequent pregnancies.

Adult↗
PubMed1991

Pulmonary injury associated with antepartum pyelonephritis: can patients at risk be identified?

The development of pulmonary injury in cases of antepartum pyelonephritis is rare but serious. To date, factors that might identify patients at risk have not been determined. We compared 11 patients with pyelonephritis and pulmonary injury with 119 patients with pyelonephritis only. Pulmonary injury was more likely to occur in the more severe cases; however, the presence of a maternal heart rate greater than 110 beats/min and a fever to 103 degrees F 12 to 24 hours before the occurrence of respiratory symptoms in a gestation greater than 20 weeks was highly predictive of pulmonary injury. The most significant predictive factors associated with pulmonary injury were elements of treatment such as fluid overload, use of tocolytic agents, and, to a lesser extent, choice of antibiotic. Therefore, if tocolytic agents are considered at all in the management of acute pyelonephritis in pregnancy, they should be used only in patients with documented cervical change. In addition, urinary output should be monitored very closely. These data also may suggest a cause of the pulmonary edema that is occasionally seen in the management of premature labor with the use of tocolytic agents and fluids in the presence of a possible occult infection.

Anti-Bacterial Agents↗
PubMed1991

Antepartum testing in the hypertensive patient: when to begin.

Antepartum testing has been recommended for patients whose pregnancies are complicated by hypertension. Although this is considered accepted practice, there are little data available to help the clinician know when to start testing. To help answer this question in patients with chronic hypertension and nonproteinuric pregnancy-induced hypertension, we reviewed the results of all antepartum tests between 1976 and 1987 in patients with these diagnoses. The primary mode of surveillance in the majority of our patients was the contraction stress test. We determined when patients first had positive contraction stress test results and when intervention occurred because of an abnormal antepartum test result. There were a total of 917 patients tested with these diagnoses. Fifty-three (5.8%) of these patients had at least one positive contraction stress test result. Twenty-two patients were delivered of infants before 35 weeks' gestation because of abnormal antepartum test results. Those with early intervention (less than 35 weeks' gestation) could not be differentiated from those with later intervention (greater than or equal to 35 weeks' gestation) by maternal age, diastolic blood pressure, or systolic blood pressure at the time of testing. The majority of patients who were delivered of infants before 35 weeks' gestation had a concomitant diagnosis of systemic lupus erythematosus, intrauterine growth retardation, diabetes mellitus, or superimposed preeclampsia. On the basis of when compromise was evident, patients with these diagnoses may require testing to be started as early as the fetus is considered viable. However, in those without these diagnoses, the clinician may delay the beginning of testing until 33 weeks' gestation without significant risk of pregnancy loss before testing.

Female↗
PubMed1991

Sonographically detected fetal choroid plexus cysts. Frequency and association with aneuploidy.

Over a 22-month period, 1045 second-trimester pregnancies were evaluated with ultrasound for the presence of choroid plexus cysts. The frequency of fetal choroid plexus cysts was 3.6% (38/1045). The outcome of the 38 fetuses possessing choroid plexus cysts was as follows: One fetus had triploidy, an occurrence not previously reported; one fetus had hydrocephalus and a normal karyotype; the other 36 fetuses were born normal. Our data were combined with those of previously reported series of fetal choroid plexus cysts to determine if chromosomal analysis is necessary in all fetuses possessing a choroid plexus cyst.

Adult↗
PubMed1991

Prophylactic amnioinfusion in pregnancies complicated by oligohydramnios: a prospective study.

Prophylactic amnioinfusion was assessed in term and post-dates pregnancies with decreased amniotic fluid volume. Subjects were randomly assigned to one of three groups: amnioinfusion with warmed saline solution, room-temperature saline, or control. Patients receiving prophylactic amnioinfusion had a significant decrease in both the frequency and severity of variable decelerations in the first stage of labor (P = .006) and in the average total number of variable decelerations in the first and second stages of labor (P = .01) compared with controls. There was no observed effect on newborn serum electrolyte levels with amnioinfusion, nor was there any apparent benefit of infusion of warmed saline compared with room-temperature saline. In contrast to premature gestations with oligohydramnios, prophylactic amnioinfusion was not associated with a significant improvement in mean umbilical arterial and venous pH or a significant decrease in cesarean delivery for fetal distress (P = .09). This is perhaps because the term fetus has an enhanced ability to tolerate recurrent episodes of heart rate decelerations without demonstrating the rapid metabolic changes seen in the premature fetus.

Adult↗
PubMed1990

Fetal gastroschisis and omphalocele: is cesarean section the best mode of delivery?

There has always been controversy regarding the mode of delivery of fetuses with abdominal wall defects. Prior studies may have been biased in this evaluation as a result of the effects of delay in repair, transport of the fetus to level III facilities, and antenatal diagnosis compared with an unsuspected diagnosis. The purpose of this study was to evaluate mode of delivery at level III institutions with access to complete care to determine if cesarean section improved outcome. One hundred eight infants were treated in the study period for abdominal wall defects. Fifty-six infants met all criteria for admission to the study. No difference in neonatal morbidity or mortality was identified. No difference was found in infants who were born by elective cesarean section compared with infants delivered after labor ensued. In conclusion, we found no evidence that cesarean section or avoidance of labor improved outcome in fetuses with uncomplicated abdominal wall defects.

Abdominal Muscles↗
PubMed1990

Comparison of a rapid enzyme-linked immunosorbent assay test and the Gram stain for detection of group B streptococcus in high-risk antepartum patients.

Early-onset neonatal sepsis with group B streptococci is a major problem in the management of high-risk obstetrics. Intrapartum treatment of the colonized mother reduces neonatal acquisition; however, many high-risk patients are delivered before culture results are available. This study prospectively evaluated a new enzyme-linked immunosorbent assay and the Gram stain for their accuracy in rapid detection of group B streptococci in 131 high-risk patients. Twenty positive cultures for group B streptococci were identified in the study population and were used as the control for test comparisons. The enzyme-linked immunosorbent assay test was 60% sensitive, whereas the Gram stain was 45% sensitive. The enzyme-linked immunosorbent assay showed an increase in sensitivity as the colony count increased; however, two cases of severe neonatal sepsis occurred in patients with low colony counts and both had enzyme-linked immunosorbent assay negative results. In conclusion, the need for a rapid sensitive test for group B streptococci detection still exists.

Enzyme-Linked Immunosorbent Assay↗
PubMed1990

Sonographically demonstrated intra-amniotic hemorrhage following transplacental genetic amniocentesis. Frequency, sonographic appearance, and clinical significance.

Over a 9-month period, 11 transplacental amniocenteses were performed. Following completion of amniocentesis, intra-amniotic hemorrhage occurred in all 11 cases. Amniotic masses and intra-amniotic strands occurred in three cases as a result of intra-amniotic hemorrhage. The 11 pregnancies in which transplacental amniocentesis were performed were uncomplicated, and they resulted in normal infants. Transplacental amniocentesis can yield unusual sonographic appearances but does not appear to have an adverse effect on pregnancy outcome.

Adult↗
PubMed1989

Maternal serum alpha-fetoprotein and fetal triploidy.

Fetal triploidy is commonly found in early pregnancy. The majority of these pregnancies spontaneously abort in the first trimester. Occasionally, the pregnancy progresses to the second and third trimesters. We reviewed the maternal serum alpha-fetoprotein (MSAFP), amniotic fluid alpha-fetoprotein (AFP), amniotic fluid acetylcholinesterase (ACHE), fetal pathology, and placental pathology in sex second-trimester pregnancies complicated by fetal triploidy. Four of these patients had MSAFP values greater than 7.5 multiples of the median (MoM). Five of six pregnancies had MSAFP values greater than 2.25 MoM. All five of these patients had a partial mole. Four patients had amniotic fluid AFP values greater than 2.0 MoM. Two fetuses had associated neural tube defects. These were the only patients with positive amniotic fluid ACHE. None of the other patients had fetuses with anomalies that are known to be associated with an elevated MSAFP. The elevated MSAFP appeared to be related to the presence of a partial mole. Two of the five cases with an MSAFP greater than 2.25 MoM did not have sonographic evidence of a significant anomaly. Therefore, karyotyping can be of benefit in evaluating patients with elevated MSAFP.

Acetylcholinesterase↗