PubMed Health⌕ Search

Biomedical subjects

J A Thorp

Publications and source records attributed to J A Thorp.

At least 19 recordsLinked to original sources
PubMed2001

The effect of multidose antenatal betamethasone on maternal and infant outcomes.

OBJECTIVE: This study was undertaken to determine whether prolonged betamethasone therapy is, as has been suggested, associated with adverse maternal or neonatal outcomes. STUDY DESIGN: A secondary multivariate analysis of a randomized controlled trial was performed to determine whether duration of betamethasone therapy was associated with adverse maternal or neonatal outcomes. RESULTS: There were 414 fetuses whose mothers were randomly assigned to trial groups. Final models included only valid cases without missing or averaged data (N = 367 to N = 412, depending on the model). Three or more sets of weekly betamethasone injections were given in 21.3% of cases and > or =4 sets were given in 12.3% of cases. Prolonged antenatal betamethasone therapy was not associated with increases in incidences of antenatal fever, chorioamnionitis, reduced birth weight, suppressed neonatal adrenal function, neonatal sepsis, or neonatal death. It was associated with larger birth weights (P <.05). CONCLUSION: Prolonged antenatal betamethasone therapy was not associated with higher risks of antenatal maternal fever, chorioamnionitis, reduced birth weight, neonatal adrenal suppression, neonatal sepsis, and neonatal death.

Adrenal Insufficiency↗
PubMed2001

Perinatal factors associated with severe intracranial hemorrhage.

OBJECTIVE: The purpose of this study was to assess the incidence of perinatal factors that are associated with severe intracranial hemorrhage in a large and recent multicenter experience. STUDY DESIGN: Retrospective analyses of nonanomalous newborns who were admitted to 100 neonatal intensive care units from 23 to 34 6/7 weeks' gestation were analyzed by multiple regression. RESULTS: There were 12,578 premature newborns with a mean (+/- SD) gestational age of 31.3 +/- 2.9 weeks and a birth weight of 1685 +/- 571 g, respectively. The overall incidence of severe intracranial hemorrhage was 2.9%; in 4575 newborns who weighed < or = 1500 g the incidences of intracranial hemorrhage was 7.1%. Factors with positive and negative associations with severe intracranial hemorrhage are listed in order of decreasing statistical significance: gestational age (negative), surfactant (positive), antenatal indomethacin (positive), neonatal transport (positive), cesarean birth (negative), poor prenatal care (positive), 5-minute Apgar score of < 7 (positive), chorioamnionitis (positive), antenatal terbutaline (negative), preterm premature rupture of fetal membranes (negative), and abruption (positive). CONCLUSION: The incidence of severe intracranial hemorrhage has dramatically declined over the past 2 decades. Antenatal steroids were not associated with reductions in severe intracranial hemorrhage.

Birth Weight↗
PubMed2001

Antenatal magnesium exposure and neonatal demise.

OBJECTIVE: To assess the effect of antenatal magnesium sulfate exposure on neonatal demise. STUDY DESIGN: A retrospective analysis of prospectively captured data from 100 tertiary centers between May 1997 and January 2000 was performed. Included were nonanomalous newborns who were admitted to the neonatal intensive care unit between 23 and 34 completed weeks' gestation. Predictors of neonatal demise were determined from a pool of 24 candidate variables in a univariate analysis. A multivariate predictive model for mortality was constructed by using the variables that had significant interactions with the rate of demise (P < or = .1). RESULTS: A total of 12,876 cases were available for analysis. When these cases were stratified according to gestational age, magnesium was associated with a significant reduction in neonatal demise (OR, 0.67; 95% CI, 0.54 to 0.84; P =.0005). The effect remained when controlling for both gestational age and indication for therapy (adjusted OR, 0.70; 95% CI, 0.56 to 0.89; P =.003). The effect was similar in direction and magnitude in the final model after controlling for additional antenatal factors (OR, 0.82; 95% CI, 0.65 to 1.04; P =.108). CONCLUSION: Antenatal magnesium exposure is not associated with neonatal death, regardless of indication for therapy.

Adult↗
PubMed2000

Decompression of fetal cardiac tamponade caused by congenital capillary hemangioma of the pericardium.

BACKGROUND: Isolated fetal pericardial effusion is rare but has been associated with various cardiac masses. Decompression in utero might prolong the pregnancy. CASE: In a 34-year-old white woman, gravida 3, para 0-1-1-1, at 34 5/7 weeks' gestation, ultrasound detected massive fetal pericardial effusion that progressed rapidly to hydrops. The fetal heart was structurally normal. We decompressed the fetal cardiac tamponade by pericardiocentesis, removing 52 mL of straw-colored fluid, which improved fetal movement and hydrops. We did pericardiocentesis at 6 weeks postpartum for a large pericardial effusion. Two weeks later the effusion recurred and we did thoracotomy with pericardial window placement. Pathologic diagnosis of pericardial biopsy was congenital capillary hemangioma of the pericardium. CONCLUSION: Isolated fetal pericardial effusion can be caused by capillary hemangioma of the pericardium despite lack of any mass on ultrasound. Decompression of pericardial effusion in utero might relieve fetal cardiac tamponade and extend pregnancy.

Adult↗
PubMed1999

Severe early onset preeclampsia secondary to bilateral ureteral obstruction reversed by stenting.

BACKGROUND: Severe early onset preeclampsia might be reversed by correction of an underlying pathophysiologic condition. CASE: A 22-year-old nullipara with a history of antivesicoureteral reflux surgery in childhood presented at 23 weeks' gestation with severe headaches, hypertension, proteinuria, edema, and acute renal failure. Severe preeclampsia was diagnosed, and bilateral distal ureteral obstruction was documented by cystoscopy, fluoroscopy, and retrograde pyelography. Bilateral ureteral stent placement completely resolved the preeclampsia and prolonged pregnancy until term. CONCLUSION: Pregnant women with a history of antireflux surgery in childhood might be at risk for acute renal failure and severe preeclampsia caused by bilateral ureteral obstruction. Ureteral stent placement might reverse obstruction, renal failure, and preeclampsia.

Adult↗
PubMed1999

Umbilical cord blood gas analysis.

Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful umbilical cord blood parameter is arterial pH. Sampling umbilical venous blood alone is not recommended because arterial blood is more representative of the fetal metabolic condition and because arterial acidemia may occur with a normal venous pH. A complete blood gas analysis may provide important information regarding the type and cause of acidemia and sampling the artery and vein may provide a more clear assessment. The sampling technique is simple and easily mastered by any treatment person in the delivery room. Preheparinized syringes ensure a consistent dose and amount of heparin. Depending on how normality is defined and on the population studied, normal ranges for umbilical cord blood gas values vary (see Table 1). In general, the lower range for normal arterial pH extends to at least 7.10 and that for venous pH to at least 7.20. Many different factors during pregnancy, labor, and delivery can affect cord blood gases. Umbilical blood sampling for acid-base status at all deliveries cannot be universally recommended because many facilities do not have the capabilities to support such a practice and in doing so may impose an excessive financial burden. Considering the costs, the accumulated published data, and the nonspecificity of electronic fetal monitoring in the evaluation of fetal oxygenation, it may be more rational to implement universal cord blood gas analysis. Care providers and institutions with the logistical capabilities in place should consider the cost efficacy of routine cord blood gas analysis because it is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth.

Acid-Base Equilibrium↗
PubMed1999

Does perinatal phenobarbital exposure affect developmental outcome at age 2?

The objective of this paper is to determine if phenobarbital exposure during pregnancy affects developmental outcome at age 2 years. Between 1991 and 1994, 401 pregnant patients at risk for delivery prior to 34 weeks' gestation were invited to participate; 48 mothers declined entry. Before delivery, pharmacy randomized the pregnant women to receive phenobarbital and vitamin K or identically appearing placebo in a blinded fashion. Developmental follow-up at age 2 years was performed. Children from the treatment group scored significantly lower on the Bayley Mental Developmental Index (mean MDI +/- 1 SD) than children whose mothers were randomized to the placebo group [104 +/- 21 (n = 59) vs. 113 +/- 22 (n = 62), p = 0.023]. Of 36 independent variables, randomization group was one of five that individually contributed to the prediction of the Bayley MDI score (p < 0.05). It was concluded that perinatal phenobarbital therapy may impair developmental outcome.

Adult↗
PubMed1998

Epidural and other labor analgesic methods.

This article focuses on methods of pain relief during labor, reviewing the current state of the art including risks and benefits. Regional techniques such as epidural or combined spinal/epidural techniques are discussed. A limited review of the effects of epidural analgesia on labor and delivery is presented. Other pharmacologic methods for labor pain relief are discussed including intravenous narcotics, paracervical block and inhalational analgesia. The following nonpharmacologic methods are also discussed: hypnosis, supportive care, transcutaneous electronic nerve stimulation (TENS), acupuncture/acupressure, subcutaneous water blocks and hydrotherapy.

Journal Article↗
PubMed1997

Maternal oxygen desaturation with intravenous magnesium therapy.

OBJECTIVE: To describe the occurrence, treatment, and outcome of maternal oxygen desaturation during magnesium sulfate therapy. METHODS: A post hoc analysis of a randomized double-blind trial, designed to determine if mothers at risk for premature delivery treated with phenobarbital and vitamin K had less frequent intracranial hemorrhage in their newborns, was done. A subset of these patients at imminent risk for delivery received both intravenous magnesium sulfate and intravenous study drug (phenobarbital or placebo) and was monitored with maternal oxygen saturation monitoring. RESULTS: One hundred one women (29%) in the trial had pulse oximetry; 47 were assigned to placebo and 54 to the treatment group. The placebo and treatment groups had the following similarities: mean lowest oxygen saturation by pulse oximeter (93.4% +/- 3.0 compared with 93.1% +/- 3.3). mean highest magnesium levels (6.3 mEq/L +/- 1.5 compared with 6.2 mEq/L +/- 0.9), frequencies of desaturation events defined as oxygen saturation below 90% (11% compared with 11%), gestational age at delivery, birth weight, Apgar scores, and cord arterial pH. Using regression analysis, multiple gestation was the only one of 14 independent variables associated with low maternal oxygen saturation. Preeclampsia was not associated with a greater risk of desaturation. The statistical power of this study is limited by its small sample sizes. CONCLUSION: Maternal oxygen desaturation occurs commonly with intravenous magnesium therapy, does not occur more frequently with simultaneous administration of intravenous phenobarbital, and does not cause decompensation in maternal or fetal status. Multiple gestation may be associated with lower maternal oxygen saturation.

Female↗
PubMed1997

Perinatal factors predicting severe intracranial hemorrhage.

The objective of this paper is to determine the importance of perinatal factors predicting occurrence of severe intracranial hemorrhage (ICH) in premature newborns. A post-hoc analysis of a previously published randomized, double-blinded, prospective trial was performed. Logistic regression analysis was used to assess the importance of obstetrical variables and umbilical cord blood coagulation studies and acid-base status in predicting severe ICH (grades 3 and 4). The trial lasted 42 months; 401 pregnant women were invited to participate and 48 declined. The most important predictors of severe ICH in order of decreasing significance were: gestational age at delivery (p=0.0001), duration of painful labor (p=0.0077), duration of antenatal antibiotic therapy (p=0.0203), maternal age (p=0.0247), and factor X activity in umbilical cord blood (p=0.0302). Mode of delivery, cord blood acid-base, and coagulation status did not correlate with severe ICH. The majority of severe ICHs were late in onset; only two of 31 were known to have occurred in the first 24 hr of life. Gestational age, duration of painful labor, duration of antibiotic therapy, and maternal age were the most important predictors of severe ICH.

Adult↗
PubMed1996

Umbilical cord blood gas analysis at delivery.

Fetal acid-base status is the end point that all antepartum and intrapartum surveillance tools are designed to assess, either directly or indirectly. Umbilical arterial blood pH is normal in 80% of depressed newborns, thereby proving the absence of birth asphyxia both in the delivery room and in the courtroom. The technique, normal ranges, and risks, benefits and cost analysis of routine versus selected umbilical blood sampling are considered. The American College of Obstetricians and Gynecologists recommends performing umbilical blood sampling for acid-base analysis in selected deliveries. However, in our opinion routine umbilical blood sampling at all deliveries has merit.

Acid-Base Equilibrium↗
PubMed1996

The relationship between oxygen saturation and pH in umbilical blood: implications for intrapartum fetal oxygen saturation monitoring.

OBJECTIVE: Our purpose was to evaluate the relationship between umbilical arterial blood oxygen saturation determined by hemoximetry (Sao2) and umbilical arterial blood pH and base excess determined by blood gas analysis to establish a "critical threshold" for fetal preductal arterial oxygen saturation determined by reflectance pulse oximetry (Spo2). STUDY DESIGN: Umbilical artery and vein blood specimens were obtained at delivery. Blood gas analysis and hemoximetry were performed. Polynomial regression analysis and receiver-operator characteristic curves were calculated for umbilical arterial blood Sao2 and theoretic preductal arterial blood Sao2 versus umbilical arterial blood pH and base excess. RESULTS: A total of 1101 paired umbilical artery and vein specimens were obtained. When the umbilical arterial blood Sao2 was > or = 30%, umbilical arterial blood pH was > or = 7.13 in 99.0% (388/392) of cases and < 7.13 in 1.0% (4/392) of cases. When umbilical arterial blood Sao2 was < 30%, umbilical arterial blood pH was > or = 7.13 in 91.4% (648/709) of cases and < 7.13 in 8.6% (61/709) of cases. CONCLUSIONS: From these analyses, it appears that an Spo2 cutoff value of 30% would be reasonable in clinical trials of intrapartum fetal pulse oximetry.

Acid-Base Imbalance↗