PubMed Health⌕ Search

Biomedical subjects

D L Walton

Publications and source records attributed to D L Walton.

6 recordsLinked to original sources
PubMed1999

Second-trimester serum chorionic gonadotropin concentrations and complications and outcome of pregnancy.

BACKGROUND: Maternal serum chorionic gonadotropin is measured to screen for fetal chromosomal abnormalities. Whether the results can also be used to predict the risk of complications or an adverse outcome of pregnancy is not known. METHODS: We reviewed the medical records of 28,743 girls and women in whom chorionic gonadotropin was measured during the second trimester of pregnancy (between July 1, 1995, and January 31, 1997), seeking information about the complications and outcome of their pregnancies. We excluded girls and women who had preexisting risk factors for complications or an adverse outcome of pregnancy. RESULTS: Higher serum chorionic gonadotropin concentrations were associated with higher rates of stillbirth (odds ratio for every increase in chorionic gonadotropin of 1 multiple of the median, 1.4; 95 percent confidence interval, 1.1 to 1.9). There was no relation between higher serum chorionic gonadotropin concentrations and the risk of gestational diabetes, premature rupture of membranes or intrauterine growth retardation or small size for gestational age (odds ratio, 1.1; 95 percent confidence interval, 0.9 to 1.2). Higher serum chorionic gonadotropin concentrations were associated with a risk of placental abnormalities (odds ratio, 1.5; 95 percent confidence interval, 1.3 to 1.7), pregnancy-induced hypertension (odds ratio, 1.4; 95 percent confidence interval, 1.3 to 1.5), and preterm delivery without pregnancy-induced hypertension (odds ratio, 1.1; 95 percent confidence interval, 1.0 to 1.2). Inclusion in certain racial or ethnic categories (black, Filipino or Pacific Islander, unknown race or ethnic group, and "other," which included those of Middle Eastern descent and Native Americans) was a better predictor of the risk of an adverse outcome than serum chorionic gonadotropin values. CONCLUSIONS: Measurements of serum chorionic gonadotropin are of little clinical value for predicting the risk of complications and the outcome of pregnancy.

Adolescent↗
PubMed1998

Monitoring women at risk for preterm labor.

BACKGROUND: Preterm birth is a major cause of perinatal morbidity and mortality. Whether the rate of preterm birth can be reduced by frequent contact between nurses and pregnant women or home monitoring of uterine activity is not known. METHODS: We randomly assigned 2422 pregnant women with known risk factors for preterm labor (including 844 women who were pregnant with twins) to receive education and to have one of the following: weekly contact with a nurse, daily contact with a nurse, or daily contact with a nurse and home monitoring of uterine activity. The nurses elicited the women's own assessments of their symptoms and signs of preterm labor. The primary end point was the incidence of birth at less than 35 weeks' gestation. Secondary end points included cervical status at the time preterm labor was diagnosed and birth weight. RESULTS: There were no significant differences among the groups in the incidence of birth at less than 35 weeks (14 percent in the weekly-contact group, 13 percent in the daily-contact group, and 14 percent in the home-monitoring group), in the mean amount of cervical dilatation at the time preterm labor was diagnosed (1.8 cm, 1.5 cm, and 1.4 cm, respectively), or in such neonatal outcomes as birth weights of less than 1500 g or less than 2500 g. However, daily contact with a nurse increased the mean number of unscheduled visits to obstetricians (1.2 in the weekly-contact group, 1.8 in the daily-contact group, and 2.3 in the home-monitoring group) and the proportion of women who received prophylactic tocolytic drugs (12 percent, 14 percent, and 19 percent, respectively). CONCLUSIONS: Women who have daily contact with a nurse, with or without home monitoring of uterine activity, have no better pregnancy outcomes than women who have weekly contact with a nurse.

Adult↗
PubMed1998

Neonatal group B streptococcal infection in a managed care population. Perinatal Group B Streptococcal Infection Study Group.

OBJECTIVE: In a health maintenance organization population, we determined the incidence of early-onset (at less than or equal to 7 days) neonatal group B streptococcal (GBS) disease, the sensitivity and prevalence of labor risk factors, the adherence to a protocol for intrapartum antibiotics, and the costs for care of and outcomes of affected infants. METHODS: Mothers and infants at four health maintenance organization hospitals in northern California in 1989 to 1995 were studied retrospectively using computerized databases and chart review. In 1994, two of the four hospitals had adopted protocols similar to the ACOG recommendations for intrapartum antibiotics for women with labor risk factors (preterm, temperature 100.4F or higher, or rupture of membranes (ROM) 18 hours or more). RESULTS: Among the 79,940 live births, the incidence of early-onset neonatal GBS infection was higher among preterm than among term infants (3.1 compared with 0.9 per 1000). Before protocol adoption, 68% of 65 infants with GBS had mothers with labor risk factors. Approximately 18% of all mothers had labor risk factors: 7.7% had preterm delivery, and 10.6% had term delivery with fever and/or ROM 18 hours or more. At the two hospitals that adopted GBS protocols, GBS incidence was reduced from 1.3 per 1000 in the preprotocol period to 0.8 per 1000 in the postprotocol period (P=.08). Six cases of neonatal GBS occurred after protocol adoption. Of these, four were not preventable under the protocol and two might have been preventable if protocol had been followed. Three of the 19 preterm infants with group B streptococcal disease died. CONCLUSION: Risk factor-based protocols hold some promise to reduce GBS disease, but clinical strategies to promote protocol adherence are needed.

Antibiotic Prophylaxis↗
PubMed1993

Vaginal birth after cesarean section. Acceptance and outcome at a rural hospital.

A retrospective review of all pregnant women with a history of cesarean section was conducted at an isolated military hospital. During the two-year period 1988-1989, 62 patients were initially considered eligible for attempting vaginal birth after cesarean section (VBAC). Seventy-nine percent (49/62) of the patients initially requested a trial of labor, and 14 of them ultimately did not meet American College of Obstetricians and Gynecologists criteria. Three patients reversed their decision late in pregnancy. Eighty-eight percent (28/32) of those undergoing a trial of labor delivered vaginally. The three patients with more than one prior cesarean section all delivered vaginally. The four failures occurred in patients who had a history of well-documented cephalopelvic disproportion. Perinatal morbidity consisted of intrauterine fetal demise prior to the onset of labor at 40 weeks' gestation. Maternal morbidity included postcesarean endometritis (n = 1) and vaginal sidewall laceration (n = 1). These results indicate that in a rural hospital VBAC was well accepted by patients and was safe; however, further study is required.

Decision Making↗
PubMedDate not supplied

Pentoxifylline does not delay bacterially induced preterm delivery in rabbits.

OBJECTIVE: Our purpose was to determine whether pentoxifylline, a potent cytokine inhibitor, would delay bacterially induced preterm delivery in rabbits. STUDY DESIGN: The study was a randomized, blinded, prospective trial. Twenty-seven rabbits underwent laparotomy. Of these, five (shams) received an intrauterine injection of endotoxin-free water, and the remaining 22 received an injection of 10(5) Escherichia coli into the lower uterine segment. Postoperatively the animals that received the Escherichia coli were divided into two groups. The placebo group (n = 11) received subcutaneous injections of saline solution three times a day and the treatment group (n = 11) received pentoxifylline 20 mg/kg/day in three divided doses. The following parameters were evaluated: (1) time until delivery, (2) time until death, and (3) intrauterine pathologic features. RESULTS: All five of the sham rabbits were delivered at term without any evidence of infection. There were no differences in the preterm delivery rates between the placebo group (eight of 11) and the pentoxifylline-treated group (seven to 11). However, there was a trend toward prolonging time until death in the treatment group. There were no differences in intrauterine pathologic feature between the placebo and treatment groups. CONCLUSION: Pentoxifylline does not delay Escherichia coli induced preterm delivery in rabbits.

Animals↗