Substance abuse services for pregnant women: a medical approach.
Explore the source record for details and available documents.
Delivery of Health Care, Integrated↗
Biomedical subjects
J M Thorp
Publications and source records attributed to J M Thorp.
Pregnancy-induced hypertension: genesis of and response to endothelial injury and the role of endothelin 1.
This paper discusses the spectrum of pregnancy-induced hypertension and presents a theory for its etiology. Endothelial injury is the purported precursor to pregnancy-induced hypertensive disorders, and this discussion expands on a possible mechanism by which injury could occur as a result of incomplete trophoblastic invasion. We review endothelin physiology and compare and contrast the evidence surrounding endothelin 1 as a putative mediator of PIH. An approach to treatment utilizing antagonists to the endothelin 1 receptor is introduced.
Animals↗
Magnetic resonance imaging of the pelvic floor in the postpartum patient.
Magnetic resonance imaging (MRI) was used to assess anatomical changes in the pelvic floor after childbirth. Six women underwent serial MRI examination within 30 hours and at 1 week, 2 weeks, 6 weeks and 6 months after delivery; 8 additional women were studied only within 30 hours of delivery. T-1 and T-2-weighted images of the pelvis in the transverse and sagittal planes with a 1.5-T MR imager were obtained. In the sagittal section we assessed the urethrovesical angle, urethral length, distance from the symphysis to the proximal and distal vagina, vaginal length, width and length of the sphincters, and the presence of sphincter defects. Axial sections were assessed for sphincter defects for the distance between the symphysis and midurethra, vagina and rectum. Only one parameter (distance between symphysis and distal vagina) changed significantly over time, without a clear trend in direction. Interobserver variation was reasonable (<15%) except for anal canal length, urethral length and distance between symphysis and anus. There were no significant correlations between birthweight and MRI parameters. There was a non-significant association (P = 0.09) between the sole combined sphincter defect and rectal injury, but not with episiotomy or parity. We concluded that it is feasible to determine multiple measurements on MR images to evaluate structures of the pelvic floor.
Adult↗
Assessment of pelvic floor function: a series of simple tests in nulliparous women.
The aim of the study was to assess normal ranges, variations, test-retest reliability and correlations between tests for a battery of simple, minimally invasive tests of pelvic floor function in nulliparous asymptomatic women. Women were recruited by advertisement and underwent dipstick urinalysis, simple cystometrics, provocative tests for incontinence, Q-tip test and surface electromyography with acrylic plug electrodes. Subjects were retested at a later date. Nineteen subjects underwent initial testing and 12 were retested. A wide range of normal values was obtained. Cystometric measures of first and strong urge to void the maximum bladder capacity, Q-tip test and rectal perineometry had significant correlations between the two visits. There were no significant between-test correlation coefficients. It was concluded that the simple tests used demonstrate a mixed ability to follow pelvic floor function longitudinally.
Adolescent↗
A randomized controlled trial of smoking cessation intervention in pregnancy in an academic clinic.
To evaluate the effectiveness of a physician-based intervention to promote smoking cessation during pregnancy, we conducted this randomized controlled trial in the resident-staffed prenatal clinics at the University of North Carolina Women's Hospital . Two hundred fifty prenatal patients who smoked were enrolled at their first visit and randomly assigned to the intervention or the usual-care group. Resident physicians provided self-help materials to intervention subjects and used a script to set goals with them at each prenatal visit. Subjects who set quit dates were contacted by volunteer cessation counselors. To verify smoking status, subjects provided a self-report and breath carbon monoxide (CO) sample at each visit. Controls were similarly assessed at enrollment and at three additional predetermined intervals. Twenty percent of intervention subjects and 10% of controls reported cessation, which was verified by CO level (P = .052). Fifty-one percent of subjects reduced their consumption by half or more, compared with 30% of controls (P = .002). The intervention is effective in promoting smoking cessation and reduction. In addition, this technique is inexpensive, readily accepted by staff, and efficient.
Adult↗
Central hemodynamic effects of recombinant human relaxin in the isolated, perfused rat heart model.
OBJECTIVE: To determine the cardiac effects of relaxin in the isolated, perfused rat heart model, and to see if pregnancy modifies the hormone's actions. METHODS: Hearts were excised from 18 female Sprague-Dawley rats (ten pregnant, eight nonpregnant) and attached to a Langendorff apparatus. Left ventricular systolic pressure, heart rate, and contractility were measured. Hearts were exposed serially to 0.5, 1.0, 2.0, 4.0, 8.0, and 16.0 ng/mL concentrations of recombinant human relaxin. RESULTS: Hearts from pregnant rats had lower heart rates than those from nonpregnant animals. Relaxin increased heart rate, left ventricular systolic pressure, and contractility in a dose-dependent fashion. Pregnancy did not modify this response. CONCLUSION: Recombinant human relaxin is a potent inotropic and chronotropic agent. The effects coupled with the physiologic increase of relaxin during human pregnancy indicate that relaxin may be involved in the cardiovascular changes of pregnancy.
Animals↗
Management of leiomyoma causing myocardial infarction.
Although most myocardial infarctions are caused by either obstruction or spasm of the coronary arteries, severe anemia can lower oxygen carrying capacity and damage the myocardium. We report a case of leiomyoma-induced menorrhagia of such severity that myocardial infarction ensued. Hysterectomy was indicated to avoid further anemia. While delaying elective surgery until the heart has had time to recover from infarction is the usual practice, the fact that myoma-induced menorrhagia contributed to ischemia in this patient prompted us to perform hysterectomy shortly after infarction.
Adult↗
Statewide assessment of a behavioral intervention to reduce cigarette smoking by pregnant women.
OBJECTIVE: Smoking in pregnancy is the foremost cause of preventable perinatal mortality. We have demonstrated that a behavioral intervention can alter smoking in pregnant women. We tested the utility of this intervention at multiple sites in varied settings across a suburban-rural state. STUDY DESIGN: We performed a prospective cohort study at 10 prenatal care sites across North Carolina. Carbon monoxide manometry was used to verify cessation; self-report confirmed reduction. Each site enrolled smokers for 1 year. Four outcome predictor variables were studied: clinic volume, prevalence of smoking, physician versus nonphysician intervenors, and public versus private clinics. RESULTS: Smoking prevalence varied from 4% to 85%. Biologically confirmed quit rates ranged from 0% to 45%. The prevalence of smoking within a clinic's population was able to explain differences in reduction (p < 0.01) of smoking between sites. CONCLUSION: We have demonstrated the effectiveness of an intervention to alter smoking behavior in pregnancy. It appears that this technique has the greatest utility in clinics with a high prevalence of smoking.
Behavior Therapy↗
Pregnancy in a patient with Goodpasture syndrome and renal transplantation.
Patients with Goodpasture syndrome have classically had decreased fertility and associated pregnancy wastage. Renal transplantation can increase the likelihood of successful pregnancy. We describe a patient who carried a pregnancy into the third trimester and had a good neonatal outcome. However, she developed superimposed preeclampsia with subsequent graft rejection.
Adult↗
Effects of maternal smoking on amniotic fluid volume and fetal urine output.
The purpose of this study was to assess the effects of maternal smoking on amniotic fluid volume and fetal urine output. Seventeen women (10 smokers and 7 non-smokers) were serially assessed through pregnancy. Smoking status was determined by self-report and carbon monoxide manometry. Amniotic fluid volume was assessed by sonographically measuring the maximum vertical pocket, the amniotic fluid index, and the two dimensions of the largest pockets. The coronal area formula was used to calculate bladder volume at 5-minute intervals for 20 minutes. Urine output was calculated from serial measurements of bladder volume. The mean gestational age of the first session was 26.8 (2.7) weeks, of the second session 32.4 (1.6) weeks, and of the last session 36.9 (2.1) weeks. In the univariate analysis there were no differences between smokers and non-smokers at any of the three visits for gestational age, fetal weight, maximum vertical pocket, amniotic fluid index, two-dimensional maximum pocket, and urine output. In the regression model, while controlling for gestational age, smoking status could not predict significant differences in any parameter. Maternal smoking does not appear to affect either amniotic fluid volume or fetal urine output.
Amniotic Fluid↗
Utility of antibiotic therapy in preterm premature rupture of membranes: a meta-analysis.
The optimal management of preterm premature rupture of membranes (PROM) is controversial. Maternal risks must be weighed against fetal benefit when expectant management is considered. Despite concerns about maternal harm, protocols of expectant management seem to afford the best perinatal outcomes. Given that infection often is the common pathway for delivery in preterm PROM, recent reports have explored the utility of maternal administration of antibiotics. In this paper we will summarize these results using meta-analytic techniques and assess the impact of antibiotic therapy on maternal and perinatal outcomes.
Anti-Bacterial Agents↗
Cohort study of twinning in an academic health center: changes in management and outcome over forty years.
OBJECTIVE: Our purpose was to explore the management and outcomes of twin pregnancies over 40 years (1952 to 1993) within a single academic health center. STUDY DESIGN: According to a retrospective cohort design, twin pregnancies were collected and the following variables were analyzed: maternal age, parity, gestational age, birth weight, twin gender, presentation, delivery route, intervals between births, Apgar scores, and perinatal outcome. Information was broken into approximately decade-long epochs (1952 to 1962, 1963 to 1972, 1973 to 1982, 1983 to 1993) to compare trends over time. RESULTS: A total of 814 twin pregnancies were delivered. Median birth weight and gestational age decreased over time. The prevalence of > 20% birth weight discordancy was 23% and did not increase. Nulliparity increased over time but maternal age did not. Same-sex pairs were constant, as was presentation. Use of abdominal delivery and the abdominal delivery of a nonvertex second twin after vaginal delivery of the first increased in the last two epochs. Both the interval between births and the Apgar score of the second twin increased over time. Perinatal mortality of very-low-birth-weight and normal-birth-weight twins decreased over time. CONCLUSIONS: The maternal demographics of twinning changed little over 40 years. Gestational age and birth weight decreased over time because of the regionalization of perinatal care. Birth weight-specific perinatal mortality improved over time.
Adult↗
Vaginal endosonography in the assessment of the anorectum.
Endosonography from within the anus has been used to image the anorectum and its associated musculature. A 5.0-MHz endovaginal probe was inserted vaginally, and longitudinal and cross-sectional views of the anorectum were obtained. We were able to measure rectal length and diameter, puborectalis thickness and angle, thickness of internal and external anal sphincter, and the curvature of the anal canal. We visualized defects in the internal and external anal sphincters. Suitable images were obtained from 70 subjects. Muscle thicknesses were within previously published ranges. Twenty-five of 70 subjects (36%) had defects of the internal anal sphincter, and 19 of 65 subjects (29%) had defects of the external anal sphincter.
Adult↗
Electromyography with acrylic plug surface electrodes after delivery.
Pelvic floor neuromuscular function was evaluated with surface electromyography using acrylic plug electrodes and interactions between neuromuscular function and factors pertinent to the delivery process were explored. Fifty-two women who were primiparas participated in this prospective cohort study. Circumvaginal and circumrectal muscles were assessed. Corrected vaginal-rectal flicks and holds were calculated. The results were compared by delivery route, birthweight, race, lactational status, and delivery anesthetic and to a group of nulliparous subjects. The mean interval from delivery was 46.3 days. Birthweight, race, lactational status, and anesthetic technique were not associated with statistically significant changes in electrical activity, although our ability to detect such differences was low due to the small number of subjects. Women who delivered vaginally had lower vaginal flick voltage than those delivering abdominally. Women who delivered vaginally had lower vaginal flick and hold voltages and rectal flick voltage when compared with nulliparous women studied earlier. Abdominally delivered women had values similar to the nulliparous group. Women delivering vaginally had less surface electromyographic activity in the circumvaginal muscles, implying that vaginal delivery impairs the neuromuscular function of the pelvic floor.
Adolescent↗
The monocyte monolayer assay: a noninvasive technique for predicting the severity of in utero hemolysis.
To test the noninvasive monocyte monolayer assay in predicting hemolytic severity in utero, we studied 18 patients from two institutions with significant erythrocyte alloantibodies. Serum samples were obtained from each patient. Each subject donated a serum sample during her pregnancy. Monocytes were harvested from a single healthy donor and grown in monolayer culture. Erythrocytes with the appropriate antigens were sensitized with maternal serum and incubated with the monocyte monolayers. Erythrophagocytosis was scored as a percentage of the positive control. Perinatal outcomes were assessed post hoc and cases were classified as unaffected or mildly, moderately, or severely affected using standard definitions. Prenatal management was conducted without knowledge of the results. Six of the 18 patients had severe disease and one of the 18 had moderately severe disease. At a cutoff level of 20, the assay generated the following results: sensitivity was 7 of 7 (100%), specificity was 10 of 11 (90.9%), positive predictive value was 7 of 8 (87.5%), and negative predictive value was 10 of 10 (100%). The monocyte monolayer assay appears to be a useful, noninvasive modality for predicting the severity of hemolytic disease in utero.
Erythroblastosis, Fetal↗
Management of drug dependency, overdose, and withdrawal in the obstetric patient.
This article discusses the approach to pregnant patients with substance use problems, a growing problem in obstetric practice. Two alternatives used to detect patients with problematic substance use are discussed: (1) historic screening, which depends on the patient to self-report about her substance use; and (2) toxological assays for substances or their metabolites in the patients' body fluids. Management of women using cocaine and alcohol is also discussed.
Cocaine↗
Liposarcoma of the vulva: a case report.
BACKGROUND: Vulvar liposarcoma is rare. Three cases have been reported since 1966. Primary sarcomas of the vulva constitute 1-2% of all vulvar malignancies. Because of their location and appearance, they may be easily misdiagnosed as a more benign process. CASE: A 65-year-old, black woman had a vulvar lesion that appeared clinically to be a Bartholin's gland abscess. The lesion was a soft tissue mass, was excised in toto and was sent for pathologic study with a presumed diagnosis of lipoma. The pathology report indicated pleomorphic liposarcoma. CONCLUSION: Only three prior cases of this disease have been reported. The clinician should heighten his or her awareness in a patient with a vulvar mass. Early diagnosis is imperative for a favorable outcome.
Aged↗
Obstetric damage and faecal incontinence.
Explore the source record for details and available documents.
Episiotomy↗