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Biomedical subjects

H Gee

Publications and source records attributed to H Gee.

At least 19 recordsLinked to original sources
PubMed1993

Management of severe, early pre-eclampsia: is conservative management justified?

A retrospective analysis was performed to assess the fetal and maternal benefits of allowing women presenting with severe pre-eclampsia between 24 and 32 weeks to continue their pregnancy following treatment of their hypertension. Cases presenting in Oxford (conservative management) and in Birmingham (stabilisation and early intervention) were compared. Patients were considered to require treatment when their systolic blood pressure was > or = 170 mmHg systolic or > or = 110 mmHg diastolic, associated with at least 1+ proteinuria and hyperuricaemia. We compared gestation at delivery, birth weight and neonatal complications for each group, and any maternal morbidity. There were 28 patients in each group. Gestational age at delivery was significantly less in the group managed by early intervention. Those women managed conservatively gained a mean of 9.5 days (range 2-26 days; P < 0.05), and their birthweight was significantly greater (P < 0.05). There was a significant difference between the length of stay in the neonatal intensive care unit between the 2 groups (P < 0.05), the babies of those women managed conservatively staying a mean of 7.4 days less. There were fewer neonatal complications in those cases managed conservatively, the number of newborns with 1 or more complications in the early intervention group being 18 (64.3%), compared with 8 (28.6%) in the expectant management group (P = 0.0001). All of the women in the group managed by early intervention recovered with no severe complications. However, those women managed conservatively had a higher incidence of HELLP (2 cases) and ELLP syndrome (2 cases), 1 case requiring temporary renal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1993

Heart rate variability in healthy term newborns: the contribution of respiratory sinus arrhythmia.

Cardiorespiratory interactions in healthy full term newborns were investigated. Spectral analysis was used on heart rate and breathing data from 22 neonates 2-5 days old to reveal coincident frequencies in the breathing and heart rate variability (HRV) spectra, thus identifying respiratory sinus arrhythmia (RSA). The spectral description of HRV in healthy term newborns revealed a consistent and distinct RSA feature, with a mean contribution of over 30%. The contribution of RSA to HRV was dependent on breathing frequency and absolute RSA power. The mechanisms that produce this cardiorespiratory interaction are considered to be functionally active in the healthy term neonate.

Arrhythmia, Sinus↗
PubMed1993

Cervical contractions: the response of the cervix to oxytocic stimulation in the latent phase of labour.

OBJECTIVE: To assess the cervical response to myometrial activity in early labour. DESIGN: Prospective observational study. SUBJECTS: Women requiring oxytocin stimulation in induced and spontaneous labours. SETTING: A teaching hospital in Birmingham. MAIN OUTCOME MEASURES: Simultaneous comparison of the cervical response to myometrial contractions was made on a cycle by cycle basis to deduce the properties of the cervix in early labour. RESULTS: Sixty-seven patients have been monitored, of whom 63 had satisfactory cervimetry data. Thirty (47.6%) women exhibited cervical contractions in response to myometrial activity. This response was only observed at dilatations up to 4 cm. The change in behaviour coincides with the transition from latent to active phases of dilatation. The length of the latent phase of labour was significantly longer in those women who exhibited cervical contractions (P < 0.001), although the active phase was similar in the two groups (P > 0.1). The group without cervical contractions exhibited a greater degree of effacement (P < 0.05) and tended to have more dilated cervices (P < 0.01) than those who showed cervical contractions. CONCLUSIONS: It is possible for the cervix to contract in early labour. This response may be the result of incomplete preparation of the cervix for the process of dilatation, and is seen during what is recognised as the latent phase in those women in whom the cervix is unaffected and undilated. These properties of the cervix may explain the poor results obtained from oxytocin stimulation of labour in the latent phase.

Adult↗
PubMed1993

Antibody mediated complete congenital heart block in the fetus.

Complete congenital heart block (CCHB) affects 1:20,000-25,000 live births and is usually an atrioventricular block; 30-50% of fetuses with CCHB will have a structural anomaly, though recently attention has focused on the etiological influence of autoimmune disease, such as systemic lupus-erythematosus. The diagnosis is established by detailed two-dimensional ultrasound scanning of the heart to exclude anomaly coupled with M-mode echocardiography and Doppler blood velocity patterns in the major vessels to detect the uncoupling of atrial and ventricular rhythms. Risk factors for an affected child are discussed. A previously affected child, high titers of anti-Ro antibodies, the presence of anti-Ro (SS-A) and anti-La (SS-B), and maternal HLA DR3 confer high risk. Antibody mediated CCHB is irreversible. Plasmapheresis and immunosuppression have been attempted in affected mothers, with limited success, to reduce the likelihood of the fetus being affected, and steroids have been used to reduce the inflammatory reaction in the heart. In many cases the underlying pathology of the immune system adversely affects utero-placental function requiring careful monitoring of fetal well-being. CCHB renders fetal heart rate monitoring virtually useless, in the antenatal and intrapartum periods. Alternatives are explored.

Antibodies, Antinuclear↗
PubMed1993

Parathyroid hormone-related protein as a tumour marker in humoral hypercalcaemia associated with occult malignancy.

The tumour-derived factor PTH-related protein (PTHRP) is the primary humoral factor responsible for hypercalcaemia in patients with solid tumours. In a woman presenting with anaemia and hypercalcaemia, the finding of raised plasma PTHRP and undetectable serum PTH concentrations led to further investigations and the subsequent identification of a uterine tumour. No evidence of tumour spread was found at operation, and removal of the tumour resulted in normalization of both serum calcium and plasma PTHRP. Expression of PTHRP by the tumour was shown by immunohistochemistry and in situ hybridization. We conclude that the identification of an occult tumour in a patient with hypercalcaemia and raised plasma PTHRP provides evidence of the diagnostic utility of PTHRP immunoassays in the investigation of patients with hypercalcaemia and suspected malignancy.

Biomarkers, Tumor↗