Biomedical subjects
Publications and source records attributed to G J Gilson.
Female circumcision is a problem unfamiliar to most Western obstetrician-gynecologists. We present a case illustrative of the unique management problems posed by these patients during labor. A method of releasing the anterior vulvar scar tissue to allow vaginal delivery is described. Sensitivity and a nonjudgmental approach as to what is culturally appropriate care for these women are of paramount importance.
We investigated the effect of preinduction cervical ripening with the intracervical instillation of dinoprostone (prostaglandin E2 gel, 0.5 mg) on the results of labor induced with intravenous oxytocin. We randomly allocated 79 pregnant women to receive either the intracervial application of dinoprostone gel or placebo gel. Compared with control subjects, the group who received dinoprostone had no difference in induction-to-delivery interval or in cesarean section rate. The dinoprostone group had fewer failed inductions, but there was no difference between the two groups in the number who delivered spontaneously within 24 hours. From review of the literature and a meta-analysis, it was likewise revealed that dinoprostone did not favorably affect the cesarean section rate. Contrary to current opinion, intracervical dinoprostone gel does not appreciably lower the cesarean section rate when used at this dose and route before labor is induced.
There are no absolute objective diagnostic criteria for cervical incompetence. Abdominal and endovaginal ultrasonographic assessment of endocervical length, both of which have been associated with technical problems, have been used to establish the diagnosis. Cervical cerclage may be useful in preventing silent cervical dilatation; however, no prospective trials with and without cerclage have been performed when endocervical shortening has been demonstrated by ultrasonography.
Fetal trauma resulting in acute anemia after maternal blunt abdominal trauma is a rare but potentially lethal condition. We recently managed such a case with the use of fetal intravascular transfusion.
Knowledge about possible alterations in cardiac output (CO), total peripheral vascular resistance (TPVR), and their time course and magnitude of change is conspicuously lacking for the conscious gravid rat. Therefore, we assessed CO using Fick methodology in unrestrained, chronically instrumented, conscious rats. The rats were studied during early (day 7), mid (day 13), or late gestation (day 18) along with nonpregnant control rats matched with respect to age and days postsurgery. Significant differences between pregnant and nonpregnant rats were observed during midgestation, when CO was increased by 26 +/- 12% and TPVR was decreased by 23 +/- 9% in the pregnant animals. These changes were accompanied by a narrowed arterial-mixed venous oxygen content difference (AVD; P < 0.05 vs. nonpregnant). In late gravid rats, CO was higher than nonpregnant values by 49 +/- 8%, and TPVR was lower by 34 +/- 7% (both P < 0.05). Oxygen consumption and carbon dioxide production were significantly increased, and AVD further narrowed when compared with the nonpregnant control group. With the exception of absent chronic respiratory alkalosis in pregnant rats, we conclude that cardiovascular and respiratory changes in conscious, gravid rats and in pregnant women are comparable. We speculate that the ultimate purpose of many of these adaptations is to increase CO so that oxygen delivery and the supply of nutrients to the uteroplacental units are sufficient or more than sufficient to meet oxygen and nutrient demands. At midgestation, the rise in CO seems to anticipate the oxygen needs of the nascent uteroplacental units.
An infant was born to a woman who received intravenous esmolol for intrapartum supraventricular tachyarrhythmia. Despite the very short acting and cardio-selective beta-1 adrenergic blockade induced by that agent, neonatal effects can occur up to 48 hours after delivery.
Fetal triploidy can be suspected but not diagnosed based on ultrasonographic findings. A patient was diagnosed with fetal triploidy in the second trimester.
Sixty-eight women admitted with the diagnosis of preterm premature rupture of membranes (PROM) and a latency period of at least 48 hours were followed expectantly. Fetal surveillance consisted of daily kick counts, daily nonstress test (NST), and fetal biophysical profile every 48-72 hours. Patients were delivered as a result of spontaneous labor, clinical chorioamnionitis, fetal distress, or attainment of 37 weeks' gestation. No corticosteroids, tocolytics, or prophylactic antibiotics were used. The last biophysical profile and the last NST before delivery were evaluated for each patient. There was no statistically significant association between chorioamnionitis or fetal infection and the following: 1) a low biophysical profile (score of 6 or lower), 2) a low biophysical profile that included a nonreactive NST and absent fetal breathing movements, or 3) a nonreactive NST. We conclude that the biophysical profile and the NST are poor predictors of perinatal infectious complications.
To assess the reliability of early biometric measurements in pregnancy, transvaginal sonography was performed in 92 pregnancies in the first trimester in a cross-sectional fashion. Measurements included crown-to-rump length (CRL), biparietal diameter (BPD), head and abdominal circumference (HC and AC), and femur length (FL). Stepwise regression analysis of the gestational age was performed. CRL maintained the highest correlation with gestational age (r = 0.99, p less than 0.001). BPD, HC, AC also correlated well. FL showed a less strong correlation with gestational age (r = 0.76, p less than 0.001). CRL remains the standard for early sonography measurements.
The accumulation in large amounts of bisnucleoside polyphosphates (Ap4X) after heat shock in Xenopus laevis oocytes or cultured hepatoma cells (HTC cells) is observed after exposure to temperatures of 45 degrees C or higher. The accumulation is a transient phenomenon, with the collapse in cellular ATP concentration severely affecting the rate of synthesis of Ap4X, allowing degrading activities to empty the pool of these compounds under prolonged heat shock. This accumulation of Ap4X to high levels, compared to the basic content, is only observed under conditions leading to irreversible damage, ultimately resulting in the death of the cell. It is shown that the increase in Ap4X after hyperthermia is due to the partial or almost complete inhibition of their degradation pathways, rather than to a stimulation of their rate of synthesis. Finally, the synthesis of heat-shock proteins could be observed under conditions which do not lead to important accumulation of Ap4X, therefore ruling out the possibility that these adenylylated nucleotides would behave as chemical signals ("alarmones") triggering the synthesis of heat-shock proteins. Nevertheless, on the basis of our earlier results (Guédon, G., Sovia, D., Ebel, J. P., Befort, D., and Remy, P. (1985) Embo J. 4, 3743-3749), it cannot be excluded that Ap4X might play a role in the regulation of the heat-shock response; this would, however, rely on variations in Ap4X concentrations which do not exceed a factor of 2.
Explore the source record for details and available documents.
The objective of this study was to determine if the 2 h value of the glucose tolerance test (GTT) is as reliable as the complete GTT in identifying risk for excessive fetal growth. Five hundred eighty-eight patients underwent a 3 h oral GTT at 26-28 weeks' gestation. The 2 h value of the test was compared to the results of the GTT. The incidence of large for gestational age (LGA) infants was compared for patients who had an abnormal GTT or an abnormal 2 h value only. A normal 2 h value was associated with a normal GTT in 98.5% of cases, while an abnormal 2 h value was associated with an abnormal GTT in 70% of cases. An abnormal GTT was associated with a 22% incidence of LGA, while a 2 h value > or = 165 mgm/dl was associated with a 20% incidence of LGA. This difference was not statistically significant. A single 2 h value GTT is more cost-effective and as predictive as a complete 3 h GTT in identifying risk for excessive fetal growth.
We investigated whether use of labetalol, a beta adrenoreceptor blocking antihypertensive agent commonly employed as an alternative to hydralazine, is independently associated with pulmonary edema in women with severe preeclampsia. We retrospectively evaluated women with severe preeclampsia who were given labetalol by intravenous bolus for MAP > 120 mm Hg. Outcome variables included: achieving MAP < 120 mm Hg with < 300 mg of labetalol, incidence of adverse effects of the drug, including pulmonary edema, hypotension, and maternal bradycardia. Total intravenous fluid intake exceeding output (+ delta I/O) and presence or absence of preeclamptic liver involvement were noted. Statistical analysis included unpaired t-tests and Fisher's exact test. Fifty-one women were studied, 7 (13.7%) of whom developed pulmonary edema. Demographic and pregnancy characteristics were not different between patients who did or did not develop pulmonary edema. No patient had detectable underlying heart disease. Patients with or without pulmonary edema did not differ as regards entry MAP (130 +/- 14 vs. 129 +/- 18 mm Hg), total dose of labetalol (209 +/- 83 vs. 193 +/- 39 mg/24 hours), incidence of bradycardia or hypotension (0/7 vs. 8/44), or presence of hepatic involvement (1/7 vs. 9/44). However, there was a significant difference in degree of positive fluid balance. Patients developing pulmonary edema had a net gain of 1,466 +/- 429 mL of fluid in the 24 hours in which they received labetalol than those who did not (659 +/- 1152 mL, P = .003). Initial central hemodynamic monitoring data revealed no impairment of cardiac performance (mean cardiac output 7.7 +/- 1.8 L/min, cardiac index 4.0 +/- 0.8 L/min/m2, left ventricular stroke work index 73 +/- 9 g.m.m-2) despite high pulmonary capillary wedge pressures (22 +/- 4 mm Hg). We conclude that the incidence of pulmonary edema in patients with severe preeclampsia who are treated with labetalol appears to be a result of an increase in third space fluid accumulation as a manifestation of the severity of their disease, not a direct effect of the drug on cardiac performance.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: The objective of this study was to compare the relative effects of both antepartum and intrapartum maternal plasma glucose concentrations on neonatal plasma glucose levels. STUDY DESIGN: This was a prospective, nonrandomized study. Two hundred thirty-three pregnant insulin-requiring patients with diabetes received intensive diabetic treatment aimed at maintaining the 2-hour postprandial plasma glucose level < 150 mg/dl and the intrapartum plasma glucose level < 100 mg/dl. The neonatal plasma glucose level was monitored during the first 48 hours of life and the incidence of neonatal hypoglycemia was compared with the average antepartum and intrapartum maternal plasma glucose concentrations. RESULTS: The lowest incidence of neonatal hypoglycemia occurred, as expected, among infants of patients who had the lowest mean antepartum and intrapartum plasma glucose levels. However, the intrapartum plasma glucose concentration had a stronger association with decreased neonatal hypoglycemia than the antepartum plasma glucose levels. CONCLUSIONS: Even in the presence of poor antepartum diabetic control tight regulation of the intrapartum plasma glucose levels will significantly reduce the incidence of neonatal hypoglycemia.