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Biomedical subjects

E D Hobart

Publications and source records attributed to E D Hobart.

6 recordsLinked to original sources
PubMed1993

Antenatal steroid therapy before 33 weeks' gestation.

OBJECTIVE: The purpose of this study was to determine those factors influencing contemporary antenatal steroid use in pregnancies delivered prior to 33 weeks of gestation. METHOD: We analyzed the clinical circumstances of 86 consecutive patients who delivered prior to 33 weeks of gestation and compared to 20 women who received dexamethasone prior to delivery with the remaining 66 untreated cases. RESULT: Known risk factors for preterm delivery (e.g. prior preterm birth, n = 17; prior admission and tocolysis during the index pregnancy, n = 15) did not discriminate between treated and untreated subsets. Premature membrane rupture (3/20 vs. 34/66; P < 0.01) and documented preterm labor (1/20 vs. 23/66 P < 0.01) were more common in the untreated cohort and a shorter mean interval from admission to delivery was also observed (2.8 vs 11.2 days). However, a full course of steroids would have been possible in 22/66 untreated women, since delivery was delayed for at least 36 h in these patients. CONCLUSION: These observations reflect the fact that many preterm births cannot be anticipated, even among hospitalized patients. We would therefore suggest that universal steroid treatment be considered for all women with documented preterm labor prior to 33 weeks of gestation. Initiation of steroid therapy at the referral center, (prior to maternal transport) should also be considered. Since both premature membrane rupture and early gestational age (24-28 weeks') confounded many of these cases, steroid use in patients with these circumstances should be reevaluated.

Cohort Studies↗
PubMed1992

Factors associated with multiple-pass procedures during chorionic villus sampling: a video analysis.

Multiple placental passes during chorionic villus sampling (CVS) increase the risk of fetal loss; however, specific factors that predispose to repeat aspiration have not been delineated. To identify anatomic and technical variables associated with multiple-pass procedures, a detailed review of 205 videotaped CVS procedures (single pass = 163; multiple pass = 42) was performed, blinded to pregnancy outcome. The route of sampling did not influence the need for multiple aspiration attempts (transabdominal--30/135; transcervical--12/70), nor was placental location alone discriminatory. However, the combination of a posterior placenta and uterine retroversion was observed more frequently in the multiple-pass cohort (8/42 vs. 9/163; p less than 0.05). In transabdominal cases, suboptimal needle placement (e.g., perpendicular to the placental long axis) was more common in the initial aspiration of a multiple-pass procedure (21/30 vs. 38/105; p less than 0.01), while limited penetration of the catheter tip (e.g., just inside the placental edge) characterized a majority of multiple-pass cases in the transcervical subset (7/12 vs. 3/58; p less than 0.0001). A case-control cohort was constructed to evaluate the impact of these technical variables on sampling efficacy, independent of the influence of uterine position and placental site. In that analysis, suboptimal location and/or orientation of the sampling device remained characteristic of multiple-pass cases. We conclude that further reduction in the frequency of multiple-pass procedures might be achieved by consistent placement of the device tip in the central placental mass. Unlike amniocentesis, where any point of amnion entry will suffice, this technical nuance should be emphasized with CVS to maximize the single-pass success rate.

Case-Control Studies↗
PubMed1990

An evaluation of the chorionic villus sampling learning curve.

Prior studies have identified a correlation between the rate of fetal loss (subsequent to chorionic villus sampling) and the operator's level of experience. However, centers performing only modest numbers of procedures during the initial phase of their programs have reported loss rates similar to those of the more active diagnostic units. Our personal experience would suggest that a "learning curve" for chorionic villus sampling does exist but that fetal loss may be an insensitive end point with which to evaluate the impact of cumulative performance. In an attempt to quantify the learning curve that we have appreciated subjectively, a detailed analysis of our initial experience with chorionic villus sampling was undertaken. Between May 1988 and August 1989, a total of 185 procedures were accomplished consecutively by one operator and form the basis for this analysis. Transcervical (n = 82) and transabdominal (n = 103) techniques were used for posterior and anterior-fundal placental locations, respectively. Three pregnancy losses occurred and insufficient material for analysis was retrieved in five patients. We observed a significant reduction in the required number of placental aspirations during the study interval (p less than 0.001). When analyzed separately, consecutive performances of the transabdominal technique demonstrated a significant reduction in the mean number of placental passes (p less than 0.00001) along with more efficient sampling (increased sample weight/aspiration attempt; p less than 0.01). Although the fetal loss rate is a critical measure of safety and may directly be related to operator experience, other measures of expertise (e.g., single-pass success rate) may be more appropriate indicators of competence and may be useful to centers wishing to initiate their own chorionic villus sampling programs.

Abortion, Spontaneous↗
PubMed1990

An optimized antibody-chelator conjugate for imaging of carcinoembryonic antigen with indium-111.

A monoclonal antibody to carcinoembryonic antigen showing minimal cross-reactivity with blood cells and normal tissues was derivatized with benzylisothiocyanate derivatives of EDTA and DTPA. Seven chelators per immunoglobulin could be incorporated without loss of immunoreactivity. The resulting conjugates, labeled with indium-111, showed low liver uptake in animals. A cold kit, comprising the DTPA conjugate at a molarity of antibody bound chelator exceeding 1 x 10(-4) M, gave radiochemical yields of indium labeled antibody of greater than or equal to 95% and was stable for 1 yr.

Animals↗
PubMed1989

Impact of residual amniotic fluid volume in patients receiving parenteral tocolysis after premature rupture of the membranes.

The inhibition of labor subsequent to premature rupture of the membranes remains controversial. To evaluate the possibility that diminished amniotic fluid volume impacts on the latent period in patients receiving tocolytic therapy after premature rupture of the membranes, we reviewed our recent clinical experience with premature rupture of the membranes and the use of tocolytic agents. Between January 1985 and June 1988, 70 singleton pregnancies with premature rupture of the membranes between 25 and 34 weeks of gestation without prior tocolytic therapy were included. Ritodrine (n = 22), magnesium sulfate (n = 37), or both agents (n = 11) were administered and followed by oral terbutaline if tocolysis was achieved. Ultrasonographic examination was performed after admission and patients were grouped on the basis of estimates of residual amniotic fluid volume. Fourteen patients had adequate fluid volume; 20 had diminished fluid volume, and 36 had oligohydramnios. Patients with adequate fluid volume had a significantly longer interval between tocolytic therapy and delivery when compared with the other two categories (analysis of variance, p less than 0.001), and proportionately more patients remained undelivered for greater than 1 week (adequate 8 of 14 vs. diminished 3 of 20 and oligohydramnios 3 of 36; p less than 0.001). In the 18 patients with premature rupture of the membranes before 30 weeks' gestation, adequate fluid volume was associated with the longest latent period (adequate 14.0 days; diminished 12.6 days, and oligohydramnios 2.8 days; analysis of variance, p less than 0.05). We conclude that tocolytic therapy is of little benefit in the presence of oligohydramnios. If additional prospective studies of tocolytic efficacy in pregnancies complicated by premature rupture of the membranes are undertaken, inclusion of residual amniotic fluid volume as an independent variable before randomization should be considered.

Amniotic Fluid↗