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Biomedical subjects

F Gardeil

Publications and source records attributed to F Gardeil.

17 recordsLinked to original sources
PubMed2001

Is fetal abdominal subcutaneous fat comparable with established indices of growth restriction?

The purpose of this study was to determine if measurement of the abdominal subcutaneous fat antenatally using ultrasound is comparable to other established indices of fetal growth restriction (FGR). One hundred women with singleton pregnancies had an ultrasound scan within 1 week of delivery at term. Ultrasound measurements included abdominal circumference (AC), liquor assessment by amniotic fluid index (AFI) and abdominal subcutaneous fat thickness (FAB). After delivery,infants were weighed and skinfold thickness at triceps and subscapular sites measured. Ponderal index was also calculated. Infants with an abdominal subcutaneous fat measurement antenatally of 5 mm or less (n = 41) were more likely than those with a fat measurement of more than 5 mm (n = 59) to have an AFI < 8 cm (P < 0.001) and to have an AC < 10th centile (P < 0.001). Decreased antenatal fat thickness was associated postnatally with a lower mean ponderal index (24.2 kg/m3 vs. 25.5 kg/m3, P < 0.02) and a decreased skinfold thickness (4.84 vs. 5.55 mm, P < 0.003 and 3.88 vs. 4.37, P < 0.03 for triceps and subscapular, respectively). This study shows that fetal abdominal subcutaneous fat measurement correlates with established predictors of fetal nutrition such as liquor volume, abdominal circumference, ponderal index, triceps and subscapular skinfold thickness.

Journal Article↗
PubMed2001

Beta-3 versus beta-2 adrenergic agonists and preterm labour: in vitro uterine relaxation effects.

OBJECTIVE: 1. To investigate the effects of the selective beta-3 adrenoreceptor agonist, BRL 37344, on human pregnant myometrial contractility in vitro. 2. to compare these effects with those of the beta-2 adrenoreceptor agonist, ritodrine. METHODS: Isometric tension recording was performed under physiological conditions in isolated myometrial strips from biopsies obtained at elective caesarean section. Following pre-incubation with oxytocin (10(-9) M), the effects of cumulative additions of BRL 37344 or ritodrine (10(-8)-10(-3.5) M) on myometrial contractility were investigated. Results were expressed as -log EC50 (pD2) and mean maximal inhibition achieved for both drug compounds. RESULTS: BRL 37344 exerted a concentration dependant relaxant effect on myometrial contractions in all strips exposed [pD2, 7.26 (0.48) (SEM); mean maximal inhibition 61.98 (4.89%); n = 6]. Similarly, ritodrine exerted a concentration dependant inhibition of myometrial contractility in all strips exposed [pD2 = 7.40 (0.28); mean maximal inhibition 59.49 (3.97%); n = 6]. There was no significant difference between calculated pD2 values (P = 0.65) or mean maximal inhibition achieved (P = 0.79). CONCLUSIONS: The beta-3 adrenoreceptor agonist BRL 37344 induced relaxation of human myometrial contractions with similar potency to that of the most commonly used tocolytic agent ritodrine. This raises the possibility that the novel beta-3 adrenoreceptor agonists may have potential as therapeutic agents for human preterm labour. In view of their reported reduced cardiovascular side effects their potential clinical use requires further evaluation.

Adrenergic beta-Agonists↗
PubMed2001

Severe HELLP syndrome remote from term.

A 27 year-old nulliparous woman was admitted to University College Hospital Galway with severe preeclampsia at 21 weeks 'gestation. In addition, there was evidence of HELLP syndrome with renal failure. A decision was made to end the pregnancy to save the mother's life. Labour was induced with misoprostol and vaginal delivery of a male stillborn fetus weighing 250 g was achieved after 19 hours. The condition of the patient improved gradually following delivery. Renal impairment, however, persisted postpartum. HELLP syndrome is a life-threatening complication of pregnancy which can only be cured by delivery. Other therapeutic modalities are only palliative but may improve the outcome for the very premature viable fetus. Conservative management is not an option when HELLP syndrome occurs long before fetal viability has been reached.

Abortifacient Agents, Nonsteroidal↗
PubMed2000

Are the immediate complications of conisation with the large loop similar to those with the knife?

One hundred patients underwent conisation with large loop excision of the transformation zone. The overall immediate complication rate was 6%. There were no preoperative complications. Three patients were treated with antibiotics for infection and three patients had a secondary haemorrhage. No patient required a blood transfusion or cervical suturing and no patient returned to the operating theatre.

Journal Article↗
PubMed1999

Subcutaneous fat in the fetal abdomen as a predictor of growth restriction.

OBJECTIVE: To determine if measuring fetal abdominal fat antenatally using ultrasound can predict fetal growth restriction (FGR). METHODS: One hundred thirty-seven unselected women with singleton pregnancies had serial ultrasound scans at 20, 26, 31, and 38 weeks' gestation. Subcutaneous fat in the fetal abdomen was measured using the same section as the abdominal circumference (AC). Outcome measures were birth weight, neonatal morbidity, and ponderal index. RESULTS: Infants with subcutaneous fat less than 5 mm at 38 weeks (n = 51) were almost five times more likely to have a birth weight below the 10th centile than those with subcutaneous fat of 5 mm or more (n = 75). The incidence of neonatal morbidity was significantly higher in infants with subcutaneous fat less than 5 mm, compared with those with subcutaneous fat of 5 mm or more (20% versus 8%, P < .05). Decreased subcutaneous fat was also associated with a high prevalence of low ponderal index, regardless of birth weight category. CONCLUSION: Measurement of fat in the abdominal wall is a simple technique with a sensitivity for predicting low birth weight similar to that of conventional sonography and might potentially predict FGR irrespective of fetal weight.

Abdomen↗
PubMed1998

Does increased resistance on umbilical artery Doppler preclude a trial of labour?

OBJECTIVE: To determine whether patients with increased resistance on umbilical artery Doppler velocimetry could be safely allowed a trial of labour. DESIGN: The Coombe Womens' Hospital is a university teaching hospital which takes tertiary referrals. All singleton pregnancies found to have increased resistance (>2 SD above the mean for gestational age) on umbilical artery Doppler ultrasound between 1993 and 1995 inclusively were identified from the ultrasound database and reviewed, retrospectively. Cases where the umbilical artery waveform reverted to normal or deteriorated to absent end diastolic flow on a subsequent scan were excluded. The 118 cases identified were divided into two groups, those that were delivered by elective caesarean section and those that laboured. RESULTS: Forty-five patients were delivered by elective caesarean section and 73 were allowed to labour. In the group that laboured over 90% delivered vaginally and 9.8% were delivered by emergency caesarean section. Three babies had a cord pH less than 7.20 in the group that laboured. Two babies had an Apgar score of less than 7 at 5 min in the group that were delivered electively. There were no neonatal seizures or perinatal deaths in either of the two groups. CONCLUSIONS: This study shows that patients with increased resistance on umbilical artery Doppler can be allowed a trial of labour without compromising the fetal outcome. We would suggest that consideration be given to induction of labour in selected patients as an alternative to elective section.

Adult↗
PubMed1997

Persistent intraepithelial neoplasia after excision for cervical intraepithelial neoplasia grade III.

OBJECTIVE: To determine the factors associated with subsequent intraepithelial neoplasia among patients who had cervical intraepithelial neoplasia grade III (CIN III) diagnosed on a specimen from previous large-loop excision of the transformation zone. METHODS: We studied all large-loop excisions of the transformation zone performed between May 1991 and December 1993, inclusive. All cases of CIN III were identified. We followed up patients with cytology and colposcopy for 2 years after treatment for high-grade CIN. Findings at follow-up were analyzed. RESULTS: A histologic diagnosis of CIN III was made in 225 patients. The lesion appeared incompletely excised in 105 patients (48.2%). In 76 cases (34.9%), CIN III was found at the endocervical margin. Of the 211 patients reviewed at 6 months, 18 (8.5%) had histologically proven CIN. The incidence of CIN was 16.5% after a report of incomplete excision, compared with 1.9% after a report of complete excision (P < .001). Furthermore, there was no subsequent CIN III in the complete-excision group. Of the 183 patients reviewed at 24 months, seven (3.8%) had histologically proven CIN. All cases of subsequent CIN were associated with dyskaryosis on follow-up cervical cytology. CONCLUSIONS: Positive margins increase the risk of treatment failure. Cytology alone may be adequate for follow-up when CIN III is completely excised.

Adult↗
PubMed1995

[Peripartum hysterectomy. Report of eleven cases].

A series of hysterectomies performed during labor or shortly after delivery, all as emergencies is reported. The study covered the ten years 1982-1991, during which 65,488 deliveries resulted in infants with a birth weight of 500 g or more. There were no hysterectomies among the 21,998 primipara, the incidence in multipara being 1 per 3,954 deliveries. Five operations were performed for rupture of the uterus and six for cataclysmic bleeding. Seven of the 11 patients had history of caesarean section. In multipara, the existence of a caesarean scar multiplied the risk of emergency hysterectomy by a factor of 18. There were no maternal deaths but all patients required transfusion with more than 6 units of packed cells. These results emphasize the fact that a history of caesarean is the principal etiologic factor in patients experiencing complications of pregnancy which require emergency peri-partum hysterectomy.

Blood Transfusion↗
PubMed1994

Uterine rupture in pregnancy reviewed.

Uterine rupture is associated with maternal and fetal mortality and morbidity. In developed countries there have been many recent advances in the management of labour. This study, therefore, reviewed this Hospital's experience of uterine rupture in the decade 1982 to 1991. Excluding cases of asymptomatic scar dehiscence, there were 15 cases of uterine rupture in 65,488 deliveries, giving an overall incidence of 1 in 4,366. There was no case of rupture in 21,998 primigravidas. Of the 15 cases, only two occurred in 39,529 multigravidas without a previous uterine scar (1 in 19,765), and 13 cases occurred in the 3,961 multigravidas with a previous caesarean section scar (1 in 304). Twelve of the 13 ruptures after caesarean section occurred in the delivery immediately after the section. There were no maternal deaths but five (33%) patients required a hysterectomy. Three of the five perinatal deaths were attributable to the rupture. Ten of the 15 patients had labour induced, and a total of 13 patients received an oxytocic agent. Of the 15 cases, 8 were diagnosed during labour and 7 postpartum. Compared with earlier reports from Dublin, the incidence of uterine rupture was low due to a decrease in the number of ruptures associated with trauma or obstetric manipulation. The main associated feature was previous caesarean section. This review highlights the risk of uterine rupture when an oxytocic agent is administered to a multigravid patient with a previous caesarean section scar.

Female↗