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Biomedical subjects

E Amon

Publications and source records attributed to E Amon.

At least 19 recordsLinked to original sources
PubMed2001

Intrapartum management of nonvertex second-born twins: a critical analysis.

OBJECTIVE: Our purpose was to assess the impact of the mode of delivery--vaginal delivery versus cesarean section--on the perinatal outcomes of the second-born breech twins. STUDY DESIGN: This study was a retrospective analysis of second-born breech twins with a gestational age of > or =24 weeks at the onset of labor. The patients are divided into three groups: cesarean section without labor (group I), cesarean section after labor (group II), and vaginal breech delivery (group III). RESULTS: There were 141 patients: 40 in group I, 66 in group II, and 35 in group III. There was no birth injury or neonatal death. Group II had one fetus with grade II intraventricular hemorrhage. There was no significant difference among the groups with regard to gestational age, birth weight, hyaline membrane disease, Apgar scores at 1 and 5 minutes, and cord blood gas indices, except venous pH in infants with birth weights <1500 g. CONCLUSIONS: Vaginal delivery of breech second-born twins, with gestational ages of at least 24 weeks, especially those with birth weights of > or =1500 g, appears to be a safe alternative to cesarean section.

Birth Weight↗
PubMed2000

Tocolysis with advanced cervical dilatation.

OBJECTIVE: To assess the feasibility and potential benefit of delaying delivery in women with advanced preterm labor. METHODS: Two hundred fifty-seven gravidas with intact membranes and preterm labor at cervical dilatations of at least 3 cm were studied. Women were excluded if they had premature rupture of membranes, gestational age less than 24 or more than 35.9 weeks, complete cervical dilatation, severe hemorrhage, chorioamnionitis, and triplets or higher-order gestations. Management consisted of tocolysis with intravenous magnesium sulfate as the primary agent, antenatal steroids, antibiotics, and amniocentesis. The primary endpoint was delay to delivery interval. Statistical analyses by cervical dilatation were performed using the Pearson chi2 test and a nonparametric test of trend. RESULTS: Eighty-one percent of pregnancies were referrals in utero from outlying hospitals. Delivery was delayed 24 hours or longer in 74% and beyond 48 hours in 60% of cases. Among 229 women who delivered at our center, 21% remained undelivered after 1 week. Evaluating delay as a function of cervical dilatation, trend analysis found a highly significant inverse relationship (P < .001). Among women dilated 5 cm, 46% delivered beyond 48 hours. Among those dilated 6 cm or more, 19% delivered beyond 48 hours. Mild pulmonary edema developed in five percent, and all responded promptly to medical interventions. Chorioamnionitis developed in eight percent. CONCLUSION: Delaying delivery 24-48 hours to allow antenatal steroid use or other interventions is possible in women with advanced preterm labor.

Cervix Uteri↗
PubMed2000

Haplogroup-associated differences in neonatal death and incidence of low birth weight at elevation: a preliminary assessment.

OBJECTIVE: We sought to assess reproductive fitness differences between mitochondrial deoxyribonucleic acid haplogroups at high altitude. STUDY DESIGN: This study considers differences in outcomes of conception, birth weight, and neonatal mortality rates for 62 women classified according to haplogroups (B or non-B). RESULTS: The number of low-weight births (<2500 g) for the non-B group was significant (P =.019). Mothers in the non-B group reported more spontaneous abortions (P =.171) and stillbirths (P =.301). The difference in conceptions per woman between groups was significant (P =.036). However, no difference in infants alive at 1 month of age was evident. Neonatal death was significant (P =.017). The odds of an unsuccessful outcome among mothers in the B group was compared with mothers in the non-B group and was significant (P =.029). The chance of an adverse outcome, that is, fetal or infant death before 1 month, for mothers in the B group was between 11.1% and 88.7% lower than for mothers in the non-B group. CONCLUSIONS: The neonatal mortality rate for the non-B group was significantly elevated relative to the B group. The molecular basis for these observations is not clear.

Abortion, Habitual↗
PubMed2000

Neonatal pulmonary hypoplasia and perinatal mortality in patients with midtrimester rupture of amniotic membranes--a critical analysis.

OBJECTIVE: We sought to critically assess the risk factors for neonatal pulmonary hypoplasia and perinatal death in patients with preterm rupture of the amniotic membranes from 15 to 28 weeks' gestation. STUDY DESIGN: This was a prospective cohort study. The study patients had preterm rupture of the amniotic membranes at 15 to 28 weeks' gestation and were without fetal anomalies, multiple gestation, and oligohydramnios before rupture of the membranes. The amniotic fluid volume index was determined at admission and weekly afterward until delivery. RESULTS: The incidence of pulmonary hypoplasia was 12.9% (21/163). The overall perinatal mortality rate was 54% (88/163). Logistic regression analysis revealed the following: (1) Gestational age at rupture of the membranes, the latency period, and either the initial or the average amniotic fluid index have significant influence on the development of pulmonary hypoplasia; (2) gestational age at rupture of the membranes and latency period are significant factors in predicting perinatal death. CONCLUSIONS: In this large population of patients with rupture of membranes at 15 to 28 weeks' gestation, gestational age at rupture of the membranes, latency period, and amniotic fluid index were important independent predictors of neonatal pulmonary hypoplasia. In addition, gestational age at rupture of the membranes and latency period were important independent determinants of perinatal death. Expectant management of patients with preterm rupture of the amniotic membranes during this gestational age interval was associated with improved perinatal survival, even though it may increase the risk of pulmonary hypoplasia.

Female↗
PubMed2000

Idiopathic megarectum complicating pregnancy: report of a case.

Pregnancy often exacerbates constipation in young women with chronic constipation syndromes. The presence of the fetus presents a challenge in both the diagnosis and treatment of these syndromes. This study was conducted to report a rare case of idiopathic megarectum complicating a pregnancy. An aggressive polyethylene glycol (PEG) regimen allowed the patient to carry the child to term and to have a normal vaginal delivery. Successful proctocolectomy was performed with coloanal anastomosis 3 months postpartum. The patient has been free of constipation for 18 months without the need for cathartics or laxatives. All efforts to avoid operative intervention should be made in constipated patients during pregnancy. This principle holds true even in the setting of dilated large bowel. Idiopathic megarectum and the management of constipation in pregnancy are discussed.

Adult↗
PubMed2000

Does preeclampsia influence fetal lung maturity?

OBJECTIVE: This retrospective study compared the fetal lung maturity biochemical profile of patients having preeclampsia with that of patients having preterm labor. STUDY DESIGN: Amniotic fluid was obtained by transabdominal amniocentesis in 90 patients, 59 patients with preterm labor (PTL) and 31 patients with preeclampsia (PRE). Pregnancies with fetal growth restriction were excluded. Fetal lung maturity was assessed by lecithin/sphingomyelin ratio (L/S) and by a fluorescence polarimetry assay (FLM). Mean values of L/S ratios and FLM were compared between the PTL and the PRE groups, each within two gestational age subgroups (27-32.9 weeks gestation and 33-36 weeks gestation). Student t-test, Chi-square test Fisher's exact test were used for statistical analysis. A p value < 0.05 was considered significant. RESULTS: During the gestational age interval of 33-36 weeks, the mean L/S ratios were significantly lower in pregnancies complicated by PRE than in those complicated by PTL (1.99 +/- 0.26 and 2.4 +/- 0.57, respectively; p = 0.01). Similarly, during this gestational age interval, the FLM values were also lower in PRE than in PTL, although the difference did not reach statistical significance. CONCLUSION: During the gestational age between 33 and 36 weeks of gestation, the biochemical profile of preeclamptic patients without IUGR has a significant lower L/S ratio compared to that of preterm patients.

Amniotic Fluid↗
PubMed1998

Role of fetal echocardiography in the management of isolated fetal heart block with ventricular rate <55 bpm.

Persistent bradycardia is an uncommon cardiac problem in fetuses but carries a high mortality in those with a ventricular rate <55 bpm. Fetal heart block is one of the most common causes of persistent fetal bradycardia (PFB). An optimal method for assessing and monitoring cardiovascular compensation in the setting of PFB due to heart block has not been fully established. We report the application of two-dimensional and Doppler echocardiography in close monitoring of cardiac function and hemodynamics in a third-trimester fetus with a ventricular rate <55 bpm due to heart block, which assisted in successful management of the pregnancy to term. Hemodynamic and cardiac adaptive changes in compromised fetuses, particularly due to heart block, are discussed.

Bradycardia↗
PubMed1997

The neonatal bisacromial diameter: a prenatal sonographic evaluation.

This study was designed to determine which fetal ultrasonographic parameter best correlates with the neonatal bisacromial diameter (BAD). The latter is defined as the distance between the two acromions of the scapulae. The study population included fifty-four uncomplicated singleton pregnant patients whose infants with birth weights of more than 3000 grams were delivered within a week of ultrasound examinations. Six fetal biometric parameters: circumferences of the chest, abdomen, head, arm, and thigh, and estimated fetal weight were obtained by ultrasonography and were compared with the BAD. The best predictor of the neonatal bisacromial diameter was the fetal chest circumference (r = 0.67, p = 0.003) followed by the arm circumference, (r = 0.59, p = 0.03). The fetal chest circumference correlates well with the neonatal shoulder girth as reflected by the neonatal bisacromial diameter.

Dystocia↗
PubMed1992

Catecholamine levels and associated cardiovascular responses in infants with meconium-stained amniotic fluid.

Catecholamine levels and associated cardiovascular responses were determined in 21 control and 30 term infants with meconium-stained amniotic fluid (MSAF). Cord arterial blood was obtained for determination for norepinephrine (NE) and epinephrine (EPI) levels; cardiovascular measurements included heart rate and systolic blood pressure at 30 min. Pregnancy was uncomplicated in all cases. The total length of labor 964 +/- 402 versus 555 +/- 312 min (P < 0.001) and active phase of labor 300 +/- 261 versus 135 +/- 104 min (P < 0.001) were significantly longer in MSAF infants when compared to controls. The 1 min Apgar score was < 7 (range 1-6) in 11 of 30 MSAF infants versus 0 of 21 control infants; these 11 infants required positive pressure ventilation for approximately 60 s secondary to transient respiratory depression (RD). The 5 min Apgar score was > 7 in 49 of the 51 infants. Infants with MSAF exhibited a higher PaCO2 (6.89 +/- 1.17 vs 6.24 +/- 1.17 mmHg; P < 0.02) and lower pH (7.25 +/- 0.06 vs 7.29 +/- 0.05; P < 0.02) compared to controls. Infants with transient RD demonstrated the most marked arterial blood gas differences, i.e., PCO2 7.41 +/- 1.30 mmHg (P < 0.001), pH 7.21 +/- 0.07 (P < 0.001) and base deficit -6 +/- 4 versus -3 +/- 2.8 (P < 0.001) when compared to controls. NE and EPI levels were significantly higher in MSAF versus control infants, i.e., 12600 +/- 3040 versus 3740 +/- 1000 pg/ml (SEM) (P < 0.02) and 1550 +/- 250 versus 620 +/- 130 pg/ml (P < 0.001) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗
PubMed1992

How small is too small and how early is too early? A survey of American obstetricians specializing in high-risk pregnancies.

Four hundred and five Maternal-Fetal Medicine specialists were surveyed to determine their clinical opinions regarding intrapartum management of the severely preterm fetus requiring delivery. Intrapartum fetal heart rate monitoring was initiated at 23, 24, and 25 weeks' gestation by 10%, 43%, and 66% of respondents, respectively. Cesarean section was not performed at less than 24 weeks' gestation or less than 500 gm fetal weight. Ninety percent of respondents were willing to perform cesarean section for fetal distress or breech presentation at 26 weeks' gestation or 750 gm fetal weight. Delivery management prior to 26 weeks' gestation or for fetuses smaller than 750 gm was variable and appeared to be individualized. Due to inherent uncertainty regarding appropriate management and observed variability of response, we conclude that studies be performed to assess objectively safety and efficacy of cesarean section for fetal indications at less than 26 weeks' gestation or less than 750 gm estimated fetal weight.

Attitude of Health Personnel↗
PubMed1989

Acute systemic organ injury in term infants after asphyxia.

The systemic manifestations of "asphyxia" were evaluated prospectively in 35 consecutively intubated term newborn infants. The following systemic organ injuries were identified most often: (1) renal, ie, oliguria less than 1 mL/kg per hour for at lest 24 hours (40%), an elevated urinary beta-2-microglobulin concentration (57%), azotemia (11%), and an elevated serum creatinine level (17%); (2) central nervous system, ie, hypoxic-ischemic encephalopathy (including seizures) (31%) or an abnormal cranial ultrasound scan, ie, diffuse parenchymal echogenicity, slitlike ventricles, and poor visualization of the sulci, and/or intracranial hemorrhage (26%); (3) cardiovascular, ie, an abnormal echocardiogram (25%) or abnormal electrocardiogram (11%); (4) pulmonary complications, including persistent pulmonary hypertension (23%); and (5) gastrointestinal complications, which were rare. Traditional markers of fetal distress were not related to the frequency and/or distribution of systemic organ injury. An important implication of this study relates to the recognition of the extent and distribution of organ injury in the "asphyxiated" infant.

Apgar Score↗
PubMed1989

Prophylactic amnioinfusion during labor complicated by meconium: a preliminary report.

The purpose of this prospective and randomized study is to evaluate the safety and efficacy of prophylactic transcervical amnioinfusion in the management of labor complicated by meconium. A preexisting intrauterine pressure catheter was used for amnioinfusion. The incidence of thick meconium was significantly lower after amnioinfusion, compared with standard management (5% versus 62% p less than 0.0005). This was also demonstrated with spectrophotometry. Significant differences between the amnioinfusion group and the control group were found for the following: arterial cord pH less than 7.20 (16% versus 38%, p less than 0.05); meconium more than trace below the vocal cords at delivery (0% versus 29%, p less than 0.05) and need for positive pressure ventilation at birth (16% versus 48%, p less than 0.05). No complications related to amnioinfusion were observed. We conclude that (1) transcervical amnioinfusion during labor complicated by meconium is a simple and apparently safe procedure, and that (2) amnioinfusion effectively decreases the frequency of thick meconium, the frequency of neonatal acidemia, the frequency of more than trace meconium below the vocal cords, and the need for positive pressure ventilation.

Adult↗
PubMed1989

A national survey on preterm labor.

A national survey was conducted to examine the American obstetricians' approach to management of preterm labor. Multiple-choice questionnaires were mailed to all current members of the Society of Perinatal Obstetricians and 750 randomly selected diplomates of the American College of Obstetricians and Gynecologists. Respondents included 249 members of the Society of Perinatal Obstetricians and 441 fellows of the American College of Obstetricians and Gynecologists. Analysis of the replies reflects wide variations among American obstetricians' criteria to diagnose preterm labor, choice of tocolytic agent, use of amniocentesis, and use of corticosteroids. Significant differences were found between the two groups in many aspects of diagnosis and management of preterm labor. However, the replies reflect a high degree of awareness of and many instances of first hand experience with severe beta-adrenergic therapy complications, including maternal death. These findings emphasize the need for caution in selection of patients for beta-adrenergic tocolytic therapy and judicious use of these agents.

Adrenal Cortex Hormones↗
PubMed1988

Effect of third-trimester premature rupture of membranes on fetal breathing movements: a prospective case-control study.

Fetal breathing movements were examined in 44 women with premature rupture of membranes. All had previously uncomplicated singleton pregnancies (28 to 41 weeks). Of these 44 women, 13 had complications based on later amnionitis/neonatal infection or antepartum fetal distress. Thirty-one normal antepartum patients, matched for gestational age, served as a normal control group. These women had intact membranes and were without any known or suspected maternal, fetal, or neonatal complications. Fetal breathing movements were found in 90% of cases in the control group, compared with 65% in the 31 women with premature rupture of membranes (p less than 0.05). In the group of 13 women with premature rupture of membranes and complications, the incidence of fetal breathing movements was 38%. Therefore, it is possible that the absence of fetal breathing movements can be due to premature rupture of membranes alone. There was a statistically higher incidence of low-birth-weight infants and low Apgar scores in the group of 13 women with premature rupture of membranes and complications compared with the group of 31 women with premature rupture of membranes.

Adult↗
PubMed1988

Ampicillin prophylaxis in preterm premature rupture of the membranes: a prospective randomized study.

It is hypothesized that ampicillin may treat subclinical deciduitis and prolong the "effective" latent period in patients with preterm premature rupture of the membranes. We studied 82 patients with preterm rupture of membranes who were managed expectantly and were randomly assigned either to receive ampicillin prophylaxis (n = 43) or not to receive ampicillin prophylaxis (n = 39). Patients were excluded from study entry on admission if they had suspected or frank chorioamnionitis, active preterm labor, a history of penicillin allergy, multiple gestation, or cervical cerclage. There were no significant differences between the groups in duration of membrane rupture prior to admission, gestational age at membrane rupture, use of steroids and tocolysis, and demographic factors. Life-table analysis showed that the risk of delivery was significantly lower for the group of patients receiving prophylactic ampicillin. The incidence of neonatal infection was significantly lower in the ampicillin group, 1 (2%) versus 6 (17%), p less than 0.04.

Ampicillin↗