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Biomedical subjects

D M Okada

Publications and source records attributed to D M Okada.

At least 19 recordsLinked to original sources
PubMed1987

Clinical and microbiologic risk evaluation for post-cesarean section endometritis by multivariate discriminant analysis: role of intraoperative mycoplasma, aerobes, and anaerobes.

The clinical and microbiologic risk factors for postpartum endometritis were studied prospectively in 77 patients undergoing cesarean section without antibiotic prophylaxis at Harbor-University of California at Los Angeles Medical Center. Intraoperative cultures were obtained from the amniotic fluid, lower uterine segment, and abdominal wound for isolation of genital mycoplasmas, aerobes, and anaerobes. Postsection endometritis developed in 21 (27%) patients and was significantly associated with presence of either high-virulence bacteria (predominantly, coliforms, streptococci, anaerobic cocci, and bacteroides) (35% to 60% versus 10% to 24%; p less than 0.05) or Ureaplasma urealyticum (15% to 42% versus 0% to 10%; p less than 0.05) at any site compared with afebrile women. Multivariate analysis identified primary cesarean section, younger maternal age, presence of ruptured membranes, and presence of Ureaplasma as significant risk factors independent of other confounding variables (p less than 0.01). It is suggested that genital mycoplasmas could play a primary role in some cases of postsection endometritis or that they are cofactors or markers for the presence of other high-virulence aerobic and anaerobic bacteria.

Anti-Bacterial Agents↗
PubMed1983

Neonatal metabolic effects of oral ritodrine hydrochloride administration.

Neonatal hypoglycemia and hyperinsulinemia have been reported following maternal ritodrine administration, but no prospective controlled study of the neonatal metabolic and cardiovascular effects of maternal ritodrine is available. We conducted a double-blind prospective study in 35 patients with preterm labor and/or ruptured membranes. Patients in premature labor received ritodrine (max dose, 350 mcg/min) or a placebo intravenously for 12 hours, and then orally (20 mg every 4 hours) until labor ensued. Patients with ruptured membranes received only oral therapy. Only patients who were maintained on oral therapy for a minimum of 12 hours and who were within 6 hours of their last dose of oral therapy were included in the analysis. Glucose and insulin values in cord blood at 6 and 12 hours of age were not significantly different between the ritodrine and placebo groups. There were no hypoglycemic infants in the ritodrine group. Mean systolic and diastolic blood pressure, heart rate and blood volume were similar for ritodrine and control infants. Although premature infants are at high risk for hypoglycemia it appears from this study that chronic oral ritodrine therapy does not significantly affect neonatal glucose homeostasis.

Adult↗
PubMed1979

Epidemiology of the group B streptococcus: maternal and nosocomial sources for infant acquisitions.

Repeated bacteriologic observations were made in 462 newborn infants and correlated with similar data from their mothers to evaluate the relative contributions of the birth canal and the hospital environment to acquisition of group B streptococci in the first few days of life. Fifty-eight percent of infants whose mothers were intrapartum carriers acquired streptococci in comparison with 12% of those whose mothers were noncarriers. Acquisitions from the birth canal were not influenced by the route of delivery or the time between membrane rupture and birth, but could be related to the quantity of streptococci in maternal cultures. Observations in ten cohorts of infants, including serotyping and bacteriophage susceptibility of group B isolates, demonstrated clear-cut streptococcal spread among infants in two cohorts. Infants appeared to harbor larger numbers of streptococci at more body sites following acquisition from the birth canal than after acquisition from the hospital environment.

Carrier State↗
PubMed1979

Antibody response to monovalent A/New Jersey/8/76 influenza vaccine in pregnant women.

The decision to implement a mass immunization program with A/New Jersey/8/76 (Hsw1N1) influenza vaccine provided a unique opportunity to evaluate immunological responses during pregnancy. Fifty-nine pregnant and 27 nonpregnant women participated in this study. Influenza virus hemagglutination-inhhibition antibody titers were determined to A/New Jersey/8/76 (Hsw1N1), A/Japan/305/57 (H2N2), and A/Hong Kong/8/68 (H3N2) before and after a single dose of monovalent (200 chick cell agglutination units) influenza A/New Jersey/8/76 (Hsw1N1) vaccine. The difference in titers between pregnant and nonpregnant women was insignificant. Treatment of the sera with 2-mercaptoethanol disclosed a similar immunoglobulin M response to the vaccine in both groups. The mean fold rise in heterologous antibody titer was similar in pregnant and nonpregnant women. This study demonstrated that pregnant women were able to respond to an original myxovirus antigen, influenza A/New Jersey/8/76, in a manner equivalent to nonpregnant, age-matched controls.

Adolescent↗
PubMed1978

Epidemiology of group B Streptococcus: longitudinal observations during pregnancy.

A longitudinal, three-year study of the epidemiology of group B Streptococcus was conducted with repeated (four to 11) observations of 382 patients followed through pregnancy, delivery, and the postpartum period. Group B streptococci (2.3% of which were nonhemolytic) were isolated from the birth canal at first visit from 15% of the patients and from 28% with repeated cultures. Overall, group B streptococci were isolated at 12% of culture visits. Streptococcal carriage was significantly less common among patients who were Mexican-American, 20 years old or older, or in a fourth or later pregnancy. Multivariate analysis indicated that each of these three factors had a significant, independent bearing upon carriage of group B streptococci. Of 108 patients harboring these organisms in the birth canal, 36% could be classified as chronic, 20% as transient, and 15% as intermittent carriers. The relationship of infant colonization to the presence of streptococci in the birth canal at delivery and not to previous or subsequent carriage by the mother was consistent with the observation that maternal colonization was often inconstant.

Adult↗
PubMed1977

Neonatal scalp abscess and fetal monitoring: factors associated with infection.

Forty-two of 929 (4.5 per cent) newborn infants prospectively studied following continuous, direct fetal heart rate monitoring during labor developed a scalp abscess at the site of electrode application during the neonatal period. Factors associated with infection with the use of a multivariate analysis were duration of monitoring (p less than 0.01) and high-risk indications for monitoring (p less than 0.01). Of the 42 infected neonates, 33 had complete bacteriologic studies. Microorganisms were isolated from all the infection tended to be polymicrobial, most commonly containing both aerobes and anaerobes. Staphylococcus epidermidis, Streptococcus, Peptostreptococcus, and Peptococcus were the predominant isolates. These data indicate that scalp abscess complicating intrapartum fetal monitoring may be nosocomial importance, and infants monitored should be closely observed in order to prevent more serious infectious complications.

Abscess↗
PubMed1977

Neonatal scalp abscess following intrapartum fetal monitoring: prospective comparison of two spiral electrodes.

During a six-month period, 929 newborn infants had continuous, direct fetal heart rate monitoring during labor. Of these, 481 were monitored with the Berkeley Bio-Electronics spiral electrode and 448 were monitored with the Corometrics spiral electrode. The over-all incidence of scalp abscess complicating fetal monitoring was 4.5 per cent. In the group monitored with the Berkeley electrode, 25 newborn infants (5.2 per cent) developed a scalp abscess; in the group with the Corometrics electrode, 17 newborn infants (3.8 per cent) developed scalp abscess. The incidence of scalp abscess was not significantly different in the two groups.

Abscess↗
PubMed1977

Serum progesterone and estradiol-17beta levels in premature and term labor.

A total of 30 to 50 per cent of premature labors occur without identifiable predisposing conditions. To evaluate the hormonal status of these pregnancies, serum progesterone (P) and estradiol (E2) were measured by radioimmunoassay singly in 60 premature labor patients and serially in 19 normal pregnancies. Premature labor patients as a group have significantly lower P and E2 levels than controls. Pregnancies complcated by idiopathic premature labor (IPL) (p less than 0.01), premature labor secondary to abruptio-marginal separation (A-MS) (p less than 0.05), and premature rupture of membranes (PROM) (p less than 0.05) have significantly lower P levels than controls. Patients with IPL and A-MS have significantly lower P levels (p less than 0.01) than PROM patients. No significant change in P or E2 occurs immediately prior to normal term labor. Conclusions are that (1) premature labor patients have significantly lower Pand E2 levels than controls, (2) the degree of P depression varies according to the type of premature labor and (3) IPL is characterized by premature labor with no identifiable predisposing factors.

Estradiol↗
PubMed1977

The incompetent cervix and accelerated fetal lung maturation.

The incompetent cervix is an infrequent but identifiable cause of late midtrimester pregnancy loss. The early diagnosis and surgical treatment of these patients have resulted in successful outcomes in 70 to 80 per cent of patients treated. However, this closure of the cervix may be only partially successful, in that the pregnancy may continue beyond the age of fetal viability, but the fetus may be born prematurely. There are no reports in the literature of the neonatal respiratory status of these infants delivered between 24 and 33 weeks of gestation. Nineteen preterm infants of less than 3-4 weeks' gestation were born to mothers with an incompetent cervix. The incidence of the respiratory distress syndrome was significantly less in infants of mothers with an incompetent cervix than in control infants of similar gestation (p less than 0.001). The incomplete cervix appears to be related to maternal or fetal conditions which result in accelerated fetal lung maturation.

Female↗
PubMed1976

Simultaneous comparison of delta 5-3beta-hydroxysteroid levels in the fetoplacental circulation of normal pregnancy in labor and not in labor.

Concentrations of pregnenolone (delta5P), dehydroepiandrosterone (DHEA), 16alpha-hydroxydehydroepiandrosterone (16alpha-OH DHEA), pregnenolone sulfate (delta5P-S), and dehydroepiandrosterone sulfate (DHEA-S) were measured simultaneously by radioimmunoassay in individual, paired umbilical artery (UA) and vein (UV) sera from 18 normal term pregnancies, 6 in labor, 12 not in labor. Mean UA and UV levels +/- SEM (ng/ml) were for delta5P: 30.39 +/- 1.69, 35.55 +/- 3.06; DHEA: 12.31 +/- 2.34, 3.66 +/- 0.38; 16alpha-OH DHEA: 7.48 +/- 0.63, 10.59 +/- 0.78; delta5P-S: 1,652 +/- 154, 1,486 +/- 130; DHEA-S: 2,122 +/- 134, +/- 134, 1,906 +/- 134. Umbilical artery delta5P-S, DHEA-S, and DHEA levels were significantly higher than UV levels, whereas the reverse was true for delta5P and 16alpha-OH DHEA. The inverse arterio-venous (A-V) gradient for 16alpha-OH DHEA was contrary to previous published reports using pooled samples. Comparison by linear regression of paired UA and UV steroid concentrations of delta5P, delta5P-S, DHEA, and DHEA-S revealed a significant correlation (P less than 0.01) for each steroid. Labor was associated with a significant increase in UA levels of DHEA-S and a smaller, but not quite significant, increase in UA levels of delta5P-S, while similar changes for unconjugated delta5-3beta-hydroxysteroids were not observed. Mean A-V gradients between the group of patients in labor and those not in labor were not significantly different. These data demonstrate that: 1) a significant difference between UA and UV concentrations exists for delta5P, DHEA, 16alpha-OH DHEA, delta5P-S, and DHEA-S; 2) there is a significant correlation between UA and UV concentrations for delta5P, DHEA, delta5P-S, and DHEA-S, implying that each fetoplacental unit maintains an equilibrium relative to these steroid concentrations in the umbilical circulation; 3) labor is associated with a significant increase in UA levels of DHEA-S and probably of delta5P-S.

Blood↗
PubMed1975

Hormones in human pregnancy. IV. Plasma progesterone.

The plasma concentration of progesterone (P) has been measured by radioimmunoassay in maternal peripheral vein (M.P.V.) at early pregnancy and in M.P.V. umbilical artery (U.A.) and umbilical vein (U.V.) at term pregnancy. In early preganacy marked hour-to-hour fluctuation of plasma progesterone was noted. At term pregnancy plasma P levels of U.V. were higher than those of U.A. and the umbilical venous arterial differences of plasma P did not differ between male and femal fetuses. Administration of hydrocortisone and ACTH to patients scheduled to undergo cesarean section had no effect on M.P.V., U.A., and U.V. plasma P concentration. On the basis of the differences between U.V. and U.A. plasma P concentrations and reported umbilical flow it was estimated that the secretion rate of P into the fetal circulation is approximately 23 mg. per 24 hr. and would amount to approximately 10 per cent of the reported total daily production rate of P at term pregnancy. The fraction of P which is unbound to the plasma proteins was estimeated by equilibrium dialysis at 37 degrees C. The per cent unbound P in M.P.V. plasma of pregnant patients at term was not different from that of nonpregnant patients but was 40 per cent lower than that in umbilical cord plasma (P LESS THAN 0.01), and the ratio between the concentrations of unbound P and estradiol in M.P.V. increased as pregnancy progressed. Plasma P in re-eclamptic patients who subsequently sustained intrauterine fetal death had no value in assessing placental function.

Adrenocorticotropic Hormone↗