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Biomedical subjects

E Kestler

Publications and source records attributed to E Kestler.

17 recordsLinked to original sources
PubMed2003

FIGO Save the Mothers Initiative: the Central America and USA collaboration.

The American College of Obstetricians and Gynecologists (ACOG) and the Central American Federation of Associations and Societies of Obstetrics and Gynecology (FECASOG), as a part of the FIGO Save the Mothers Initiative, undertook a pilot project to improve provision of basic emergency obstetric care in selected departments in four Central American countries. This article describes the process of the development and implementation of the project. Preliminary results suggest that the capacity to provide this care has been improved by the training of healthcare personnel.

Central America↗
PubMed2001

Maternal height and newborn size relative to risk of intrapartum caesarean delivery and perinatal distress.

OBJECTIVE: To estimate the changes, in risk of intrapartum caesalrean delivery and perinatal distress that may be introduced through increased birth size, resulting from interventions such as improving nutrition of the mother; and to characterise delivery risk relative to maternal stature by birth size. DESIGN: Model these risks using data from the Guatemalan Perinatal Study. SETTING: The antenatal clinic of the Gynaecology and Obstetrics Hospital of the Guatemalan Social Security Institute in Guatemala City serving predominantly working class women. POPULATION: Women who had their first prenatal visit between April 1984 and January 1986. METHODS: Multivariate logistic regression models were developed to estimate incidence of intrapartum caesarean delivery and perinatal distress and used to calculate changes in risk associated with changes in size. MAIN OUTCOME MEASURES: Incidences of intrapartum caesarean delivery and perinatal distress. RESULTS: A woman of 146cm height (-1 SD) relative to another of 160 cm (+1 SD) has a 2.5 times higher risk of intrapartum caesarean delivery. An increase in newborn head circumference and weight (from -1 SD to +1 SD) are each independently associated with an increase in risk of intrapartum caesarean delivery (2.0 times and 1.5 times. respectively). An increase in birthweight from 2,450 g to 2,550 g is associated with a decrease in risk of perinatal distress of 34/1,000 cases and an increase in risk of intrapartum caesarean delivery of 8/1,000 cases. CONCLUSIONS: Increases in fetal growth comparable to those attributable to improved nutrition during pregnancy are associated with a larger decrease in risk of perinatal distress relative to the increase in risk of intrapartum caesarean delivery for the mother. Greater maternal stature is associated with lower risk of intrapartum caesarean delivery.

Adult↗
PubMed2000

Pregnancy-related mortality in Guatemala, 1993-1996.

To select the proper interventions that could prevent maternal mortality, adequate and appropriate maternal mortality data are needed. Nevertheless, the quality and quantity of information and the scope of maternal health- and death-related data are inadequate in many countries, particularly in the developing world. From January 1993 to December 1996 a surveillance program in maternal mortality was developed to conduct surveillance studies in the department of Guatemala, Guatemala. With an active surveillance system, our approach gave a more complete picture of maternal death and produced information on the specific causes of maternal mortality. Using multiple sources of information, we reviewed and analyzed all deaths of women of childbearing age (10 to 49 years). Each death was investigated to determine whether it was pregnancy-related or not. The maternal mortality ratio for the four-year study period was 156.2 deaths per 100,000 live births. Women 35 and older had a higher risk of maternal death than women under that age. Women who were 35-39 years old had a maternal death risk almost three times as high as women aged 20-24. For women who were 40 or older the risk was more than double that of women 20-24 years old. Overall, the two leading causes of maternal mortality were infection and hemorrhage. Vaginal deliveries where there was medical assistance had the highest rate of delivery-related maternal death from general infection. In deliveries attended by nonmedical personnel, delivery-related maternal deaths from hemorrhage were most frequently associated with retained placenta. Developing countries are called on to implement systems that can provide continuous and systematic data collection so that policymakers and health managers have adequate information to design proper interventions to save women's lives.

Adolescent↗
PubMed1993

Modeling maternal weight and height in studies of pregnancy outcome among Hispanic women.

The objective of this study was to evaluate methods of using maternal weight and height in studies of pregnancy outcome for Hispanic women. Reference anthropometric data came from 1166 Mexican-American women in the Hispanic Health and Nutrition Examination Survey (HHANES). Prospective data on maternal anthropometry and infant birth weight came from 1362 Hispanic women in the Kaiser-Permanente Contraceptive Drug Study and 12,786 women in the Guatemalan Cooperative Perinatal Study. Five methods of standardizing weight for height were evaluated, including power-type indexes and weights relative to HHANES reference data. In linear- and logistic-regression analyses, these methods were practically interchangeable, with no evident advantage of Hispanic reference data. However, if weight was not height-standardized the effect of height was underestimated; if height was omitted and weight was not height-standardized the effects of weight were exaggerated. Therefore, analyses of pregnancy outcome should include both height and height-standardized weight.

Adult↗
PubMed1993

Wanted: better care for pregnant women.

In three prenatal clinics in Latin America the average attendance time by pregnant women was 129 minutes but the average time spent with a doctor was only 8-10 minutes. In order to improve prenatal care, providers should analyse what happens during visits. Assessments should be made of the usefulness of the services offered and some thought should be given as to who might best provide them.

Appointments and Schedules↗
PubMed1992

Effect of fat and fat-free mass deposition during pregnancy on birth weight.

OBJECTIVES: The purposes of our study were to describe the patterns and location of fat and fat-free mass deposition during pregnancy and to evaluate their effects on fetal growth. STUDY DESIGN: Our study is a prospective follow-up of 105 healthy pregnant women who were delivered of term infants. Body composition was evaluated eight times during gestation with anthropometric measures and bioimpedance techniques. Body fat and fat-free mass were calculated with equations specifically developed for this population. RESULTS: Total weight gain was 10.0 +/- 3.5 kg; net weight gain was 3.7 +/- 0.31 kg; birth weight was 3211 +/- 467 gm (values are mean +/- SEM). In these women fat was deposited mostly in the thigh and subscapular region for a total of 6.23 +/- 0.19 kg at term. The period of pregnancy of the largest maternal fat deposition per week is between the twentieth and thirtieth weeks. After adjusting by prepregnancy weight, birth weight is associated with maternal changes in thigh skin folds and fat gain before the thirtieth week of gestation. Infants born to mothers with low fat gain before the thirtieth week were 204 gm lighter than infants born to mothers with fat gain > or = 25th percentile of this population. CONCLUSION: Maternal nutritional status at the beginning of gestation and the rate of fat gain early in pregnancy are the two nutritional indicators most strongly associated with fetal growth in this population.

Adipose Tissue↗
PubMed1991

Epidemiologic identification of infants with low birth weight in urban areas of Latin America: II. A simplified risk score for early prenatal identification in Guatemala City.

A simple, empirically derived instrument is needed in developing countries to identify mothers at risk of delivering low birth weight (LBW) infants, in order to help reduce the incidence of LBW deliveries and provide mothers at high risk with appropriate health care. The study reported here was devoted to developing an instrument of this kind using data obtained before the twenty-sixth week of gestation from an urban study population of 17,135 Guatemalan women. It appears that this instrument could be appropriately applied to urban populations in other developing countries.

Adolescent↗
PubMed1990

The differential neonatal morbidity of the intrauterine growth retardation syndrome.

This is a prospective study of differential morbidity among subgroups of intrauterine growth retardation. Cases of intrauterine growth retardation (N = 3450) (greater than or equal to 37 weeks, less than 10th percentile birth weight for gestational age) were classified by their ponderal index (weight/length3) in four subgroups using the 10th, 25th, and 90th percentiles of the Lubchenco's ponderal index-gestational age distribution. There were 432 cases (12.5%) with low ponderal index or disproportionate intrauterine growth retardation, 936 (27.1%) with intermediate ponderal index, 2030 (58.8%) with adequate ponderal index or proportionate intrauterine growth retardation, and 52 (1.5%) with high ponderal index. The low ponderal index group or disproportionate intrauterine growth retardation group had a statistically significant higher risk (between 1.6 and 12.5 times) for low 1- and 5-minute Apgar scores, aspiration syndrome, hypoglycemia, and perinatal asphyxia than the adequate ponderal index group. The low ponderal index group also had an increased risk (relative risk = 2.0 [95% confidence interval, 1.0 to 3.8]) for hospital stay of more than 1 week. These differences persist after a stratified analysis by birth weight and in a multiple logistic regression analysis. Similarly, higher neonatal morbidity is observed among infants with normal birth weights but with low ponderal index. These data provide further evidence of the heterogeneity of the intrauterine growth retardation syndrome and of the independent effect of body disproportion on neonatal morbidity, even among infants with normal birth weights. Because there are significant clinical implications attributed to the low ponderal index group, this subgroup should be identified as early as possible.

Birth Weight↗
PubMed1990

The effect of maternal work on fetal growth and duration of pregnancy: a prospective study.

The effect on birth outcome of work requiring different degrees of physical exertion was examined among 15,786 pregnant women who were followed through the Guatemalan Social Security Institute's hospital. Work inside and outside the home was ascertained through a questionnaire administered to each women before delivery. Odds ratios were adjusted for household income, maternal height and age, and birthweight of previous infant. Women with three or more children and no household help were at increased risk for small-for-gestational-age (SGA) births compared with women with family (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.31, 2.47) or hired help (OR 2.0; 95% CI 1.16 to 3.33). Compared with office work, manual work increased the risk for an SGA (OR 1.32; 95% CI 1.12 to 1.56) and SGA/preterm birth (OR 2.56; 95% CI 1.10 to 5.96). Work in a standing compared with sitting position significantly increased the risk for a preterm birth (OR 1.56; 95% CI 1.04 to 2.60). There was a significant positive trend in frequency of SGA and SGA/preterm birth with an increase in the physical demands at work, as measured by an activity score. These data suggest that interventions to reduce physical exertion among pregnant women could improve birth outcome.

Adult↗
PubMed1989

Measurement error in clinical perinatal data.

The error measurement of clinical perinatal variables obtained during the standardization and data-collection periods of a large prospective epidemiologic study is presented. The error is considerably larger during the data-collection period, particularly with regard to uterine height, birth weight, and blood pressure values. This information strongly supports the need to continuously supervise and monitor perinatal data collection systems, even after standardization.

Data Collection↗
PubMed1989

The effect on fetal growth of protozoan and helminthic infection during pregnancy.

This is a prospective study of 14,914 pregnant women conducted in Guatemala City, Guatemala. Stool samples were obtained from the studied patients before the first prenatal visit (mean gestational age 21.6 +/- 8.4 weeks) for the diagnosis of parasitic infections during pregnancy. Forty-four percent had at least one parasite detected, and 24% were infected with helminths. Ascaris lumbricoides was the most prevalent (14.5%). Infected mothers were less educated, had less adequate water and sanitary conditions, and had lower nutritional status. The incidence of intrauterine growth retardation (IUGR) increased with the number of parasitic species detected (up to two or more species, P less than .01). High levels of infection (greater than or equal to + +) were associated with an increased risk of IUGR for protozoa and helminths, except for Strongyloides stercoralis and Hymenolepis nana. Chronically malnourished women of short stature had significantly higher IUGR rates when infected with one or two or more species (P less than .01). Up to 10% of the IUGR rates may be attributed to parasitic infections among the malnourished women.

Adult↗
PubMed1988

Perinatal data reliability in a large teaching obstetric unit.

In this inter-rater agreement study of antenatal and neonatal variables collected in a large teaching obstetric unit, information routinely collected by hospital staff was compared with that collected by a specially trained physician and a social worker. Agreement between the two sources of data was evaluated using kappa statistics and intraclass correlation coefficients. Excellent agreement was observed for some variables such as maternal and newborn anthropometric measures, and previous birthweight, but there was poor agreement for others such as indicators of physical activity, work during pregnancy and blood pressure measures. Some of the limitations are due to problems in phrasing questions, patients' recall, interviewer bias and abstracting data. We recommend that epidemiological studies should always include a reliability component, proper standardization of personnel and instruments and include, when published, validity data and examples of questions used.

Adult↗
PubMed1988

Improved lactose digestion during pregnancy: a case of physiologic adaptation?

Loss of intestinal lactase activity among adults could theoretically limit milk consumption and hence dietary availability of calcium during pregnancy. The present study sought to define, using breath hydrogen (H2) production as an index of incomplete carbohydrate absorption, the prevalence during pregnancy of lactose maldigestion of 360 mL of milk (18 g of lactose), and to determine whether lactose digestion improved as pregnancy advanced. The prevalence of lactose maldigestion among 114 pregnant women tested before the 15th week of gestation was 54%. By term, 44% of those originally classified as maldigesters had become digesters. There was a significant reduction in the four-hour sum of the changes in breath H2 concentration from the period before 15 weeks (116.6 +/- 9.6 ppm) to the time after 36 weeks (54.4 +/- 7.3 ppm; P less than .01). This apparent adaptive improvement in intestinal handling of milk lactose during gestation has implications for calcium intake and absorption.

Acidosis, Respiratory↗