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Biomedical subjects

F J Zlatnik

Publications and source records attributed to F J Zlatnik.

At least 19 recordsLinked to original sources
PubMed1992

Management of premature rupture of membranes at term.

Although prelabor rupture of membranes at term is common, in most cases, the spontaneous onset of labor relieves the obstetrician of the need for making management decisions. The standard practice in the United States has been to induce labor with intravenous oxytocin in that minority of patients who fail to labor spontaneously. Controlled trials suggest that this practice is associated with higher rates of both chorioamnionitis and the need for cesarean delivery than is expectancy. Expectancy, however, has not been demonstrated to be safer for the perinate.

Chorioamnionitis↗
PubMed1992

Frequency, distribution, and theoretical mechanisms of hematologic and weight discordance in monochorionic twins.

OBJECTIVE: The purpose of this study was to determine the frequency, distribution, and most likely etiology of hematologic and weight discordance in pathologically proven monochorionic twins, and to use this information to reevaluate the neonatally derived definition of the twin-twin transfusion syndrome. METHODS: We reviewed our experience with 97 pathologically proven monochorionic twin pregnancies. The frequency and distribution of weight and hemoglobin-hematocrit (hb-hct) discordance were determined for all twin pairs. Factors that may have contributed to the discordance were identified, and theoretical mechanisms were proposed. RESULTS: All combinations of weight and hb-hct discordance were observed. Thirty-four twin pairs (35%) were discordant for weight. In half of these (17 of 34), the hb and hct were concordant. In 18% (six of 34), the smaller twin had the higher hb-hct, and in 32% (11 of 34), the smaller twin had the lower hb-hct. Twenty-three of 63 size-concordant pairs (36%) were discordant for hb-hct. Ten infants were infected at birth, eight had malformations, and 25 likely suffered an acute transfusion event. CONCLUSIONS: Any combination of weight and hb-hct discordance can occur in monochorionic twins. Acute and chronic twin-twin transfusion, uteroplacental insufficiency, infection, malformations, or other factors may have accounted for the discordance observed. Thorough antenatal evaluation with invasive testing and marker studies (to identify a physiologically unbalanced placental anastomosis) may be necessary to establish an accurate diagnosis. We conclude that weight and/or hb-hct discordance is relatively common in monochorionic twins and in itself is not sufficient to diagnose twin-twin transfusion.

Birth Weight↗
PubMed1991

Monoamniotic twins: a retrospective controlled study.

Monoamniotic twins are uncommon but are at high risk (reportedly 50%) for perinatal death, commonly from cord accidents. Until recently the diagnosis of monoamniotic twinning was seldom made before delivery, but modern ultrasound technology permits diagnosis during prenatal care, creating a management dilemma. This is a report of the experience with monoamniotic twins of 20 or more weeks' gestation at the University of Iowa Hospitals from 1961-1989. Twenty monoamniotic twin pregnancies were compared with 40 monochorionic, diamniotic controls regarding antepartum and intrapartum complications. Overall, monoamniotic twins were delivered earlier, were more likely to die in utero, and had lower birth weights than diamniotic twins. When only live-born twins were considered, however, there were no differences in gestational age at delivery, birth weight, or 5-minute Apgar scores. No fetal death occurred after 32 weeks, suggesting that prophylactic preterm delivery may not be indicated in all cases. Labor and vaginal delivery were not associated with an increased risk of fetal death.

Amnion↗
PubMed1990

Histologic chorioamnionitis, microbial infection, and prematurity.

The purpose of this study was to relate histologic chorioamnionitis to the isolation of microorganisms from the freshly separated chorioamnion in women who had early preterm delivery (before 35 weeks' gestation) following spontaneous labor. Histologic chorioamnionitis was identified in 51 of 95 study subjects. It was more common in the second trimester (72%) than from 27-34 weeks' gestation (33%) (P less than .001). Culture specimens were obtained for aerobic and anaerobic bacteria, yeasts, mycoplasmas, and Chlamydia. Microorganisms were recovered from 38 subjects; all culture reports were negative in 36. A statistically significant association was demonstrated between histologic chorioamnionitis and positive culture results. If any microorganism was recovered, 68% of the subjects had histologic chorioamnionitis, versus 39% if all cultures were negative. Of cases of histologic chorioamnionitis in the third trimester, 92% were associated with positive cultures, compared with 54% in the second trimester. Our results suggest that histologic chorioamnionitis is not synonymous with infection, especially in the second trimester.

Adolescent↗
PubMed1989

Radiologic appearance of the upper cervical canal in women with a history of premature delivery. II. Relationship to clinical presentation and to tests of cervical compliance.

Two hundred twelve women with histories of spontaneous second-trimester abortions or early preterm births (less than 34 weeks) were evaluated with hysterography in the nonpregnant state. The canal:cannula (C:CN) ratio, a representation of the width of the upper cervical canal, was related to the clinical characterization of the early delivery. Narrow canals were associated with bleeding or premature rupture of the membranes (PROM) preceding preterm labor. Wide canals were found in association with the clinical diagnosis of cervical incompetence. Those patients in whom preterm labor occurred in the absence of preceding bleeding or PROM had intermediate values. The results of two tests of cervical compliance, Hegar dilator passage and catheter balloon traction, were concordant and varied with the C:CN ratio.

Abortion, Habitual↗
PubMed1986

Preinduction cervical ripening with prostaglandin E2 intracervical gel.

A double-blind, placebo-controlled, dose-ranging study was undertaken to evaluate the efficacy of two doses of intracervical prostaglandin E2 gel in patients with unfavorable Bishop scores. Mean change in Bishop score, success of softening, time to labor, and time to delivery were all significantly different in the two treatment groups as compared with the placebo group. Twenty-three of 30 treated patients had uterine contractions lasting greater than four hours and eight patients delivered during the observation period. Moreover, one case of uterine hyperactivity and five cases of severe fetal heart rate decelerations were noted in the treatment groups. Although efficacious for cervical ripening, caution is warranted when using this technique in patients at risk for placental insufficiency.

Adult↗
PubMed1986

Chorionic mycoplasmas and prematurity.

In this study, recovery of Ureaplasma urealyticum and Mycoplasma hominis from the freshly exposed chorion following delivery was related to labor length but not to the interval between membrane rupture and delivery, to birth weight or to gestational age.

Birth Weight↗
PubMed1985

Comparison of amniotic fluid optical density, L/S ratio and creatinine concentration in predicting fetal pulmonary maturity.

The optical density of amniotic fluid at 650 nm (OD650) has been proposed as a rapid means of assessing fetal pulmonary maturity. Two hundred eighty-two amniotic fluid samples were analyzed for OD650, L/S ratio and creatinine concentration, and those values were related to the infants' pulmonary outcome. Among those infants delivered within 72 hours of amniocentesis, pulmonary maturity was predicted accurately in 98.3% by the OD650, 97.7% by the L/S ratio and 97.6% by the creatinine concentration. All three tests were unreliable in predicting pulmonary complications when the tests revealed pulmonary immaturity. OD650 values were found to vary inversely with centrifugation speed, reaffirming the need for standardized processing techniques to achieve reliable results. Marked discrepancies occurred between the diagnoses given by three neonatologists asked to retrospectively evaluate the likely etiology of pulmonary problems in nine infants suspected of having respiratory distress syndrome.

Adolescent↗
PubMed1985

Radiologic appearance of the upper cervical canal in women with a history of premature delivery.

The aim of this study was to compare the radiologic appearance of the upper cervical canal at hysterography between a group of women with a history of premature delivery and a control group. A standardized technique was used that corrects for the magnification inherent in taking measurements directly from the x-ray films. Some women with a history of premature delivery had abnormally wide upper cervical canals in the nonpregnant state. Premature labor might not have been an acute pregnancy-specific event in those women but might have been a reflection of an underlying abnormality.

Cervix Uteri↗
PubMed1979

Dietary protein and human pregnancy performance.

Low birth weight is an important predictor of neonatal mortality and morbidity. Women of low socioeconomic classes give birth to disproportionate numbers of low-birth-weight infants and eat poorer diets than those of higher classes. Although maternal weight gain in pregnancy is positively associated with birth weight, and although animal studies demonstrate the important effects of protein restricti-n on reproductive performance, the significance or lack thereof of diet in general and of protein intake in particular in pregnant women in generally well-nourished populations has not been established. The conflicting data on human pregnancy performance and diet are critically reviewed.

Animals↗
PubMed1979

Urinary nitrogen excretion as related to dietary protein in pregnant women.

The amount of urea in the urine acutely decreases when dietary protein is restricted. This change in urinary urea nitrogen can be represented satisfactorily by the urea nitrogen/total nitrogen (UN/TN) ratio or the UN/creatinine nitrogen (UN/CN) ratio. These determinations are apparently effective tools for simply and objectively describing the recent protein intake of pregnant women.

Ammonia↗
PubMed1979

Human placental lactogen: a predictor of perinatal outcome?

Serial human placental lactogen (hPL) determinations were performed on 806 women with normal and abnormal pregnancies late in the pregnancy. These results were not reported to the clinicians involved. For the study population as a whole, low hPL levels did not effectively predict those adverse perinatal outcome variables evaluated. Further analysis revealed that this was true both for the normal and abnormal pregnancy groups. Our data do not support the routine use of antepartum hPL screening, as advocated by others, as a means of improving perinatal outcome. In certain at-risk patients, there was an association between low hPL values and the presence of 1 or more of the adverse outcome variables. However, these patients had been recognized clinically as having fetuses in jeopardy.

Female↗
PubMed1979

hPL: physiologic and pathophysiologic observations.

Serum human placental lactogen (hPL) levels were studied in 806 women in late pregnancy. The hPL levels were positively correlated with birth weight but were unrelated to maternal age, parity, socioeconomic status, or the sex of the newborn. The hPL levels peaked at 37 weeks' gestation and then declined moderately. An individual's hPL levels in late pregnancy are quite constant week to week. Patients with severe chronic hypertension have low hPL values; those carrying twins have high values.

Birth Weight↗
PubMed1977

Low 'gynecologic': an obstetric risk factor.

The records of patients who were 17 years of age and younger at delivery were reviewed in order to ascertain whether or not a patient's gynecologic age (GA, defined as chronologic age minus age at menarche) independently relates to pregnancy risk. Low GA in a pregnant adolescent increases the chance of delivery of a low--birth weight infant. However, pre-eclampsia and other pregnancy complications studied were not related GA.

Adolescent↗