Biomedical subjects

J Minogue

Publications and source records attributed to J Minogue.

9 recordsLinked to original sources

PubMed1995

The association between occupational factors and preterm birth: a United States nurses' study. Research Committee of the Association of Women's Health, Obstetric, and Neonatal Nurses.

OBJECTIVE: Our purpose was to evaluate factors associated with preterm birth among a national sample of U.S. nurses. STUDY DESIGN: We conducted a case-control study of 210 nurses whose infants were delivered prematurely (< 37 weeks) (cases) and 1260 nurses whose infants were delivered at term (> or = 37 weeks) (controls). An occupational fatigue score was constructed from four sources and varied from 0 to 4. The relation between occupational activity (including hours working and fatigue score) and preterm birth was analyzed with the use of Pearson chi 2 tests, estimates of odds ratios with 95% confidence intervals, and multivariate logistic regression; we controlled for confounding factors. RESULTS: Factors significantly associated with preterm birth included hours worked per week (p < 0.002), per shift (p < 0.001), and while standing (p < 0.001); noise (p = 0.005); physical exertion (p = 0.01); and occupational fatigue score (p < 0.002). The adjusted odds ratios were 1.6 (p = 0.006) for hours worked per week (< or = 36 vs > 36) and 1.4 (p = 0.02) for fatigue score < 3 vs > or = 3. CONCLUSIONS: Preterm birth among working women may be related to hours worked per day or week and to adverse working conditions.

Case-Control Studies↗

PubMed1993

The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation.

OBJECTIVE: Our purpose was to evaluate factors associated with the best intrauterine growth and lowest morbidity among twins ("ideal twin pregnancy"). STUDY DESIGN: A historic prospective study of 163 twin births was performed. Ten models were formulated with multiple regression and multivariate logistic regression. RESULTS: In the models of birth weight, gestations of 28 to 36 and 39 to 41 weeks, black race, > or = 15% discordancy, and smoking were all significant negative factors. The pattern of early low weight gain (< 0.85 pounds per week before 24 weeks) and late low weight gain (< 1.0 pound per week after 24 weeks) was negatively associated with all eight models of intrauterine growth. CONCLUSIONS: The best intrauterine growth and lowest morbidity is achieved earlier for twins than for singletons. Using length of stay and growth retardation criteria, nearly 70% of "ideal" twin pregnancies were between 35 and 38 weeks. In addition, poor weight gain and poor patterns of weight gain were associated with all measures of intrauterine growth and adverse pregnancy outcomes.

Baltimore↗

PubMed1993

The changing pattern of infant mortality in the US: the role of prenatal factors and their obstetrical implications.

Infant mortality is one of the leading public health problems in the United States today. During the first half of this century the decline in infant mortality resulted largely from a reduction in postneonatal deaths (2-11 months after birth). Since 1950, two-thirds of all infant deaths have occurred in the neonatal period (1st month after birth). Since 1981, the rate of decline in the infant mortality rate has slowed due to a deterioration in the distribution of birthweights and a slowed improvement in birthweight-specific mortality rates. The role of birthweight is central to this issue, because low birthweight (LBW, < 2500 g) is a major determinant of death in the first year of life, particularly during the neonatal period. Stated another way, less than 0.5% of infants with birthweights > 2500 g die during the first year of life compared to 10.2% of infants with birthweights < 2500 g and 45.3% with birthweights < 1500 g (very low birthweight, VLBW). These effects are magnified when evaluated on a race-specific basis: the rate of LBW is twice as high and the rate of VLBW is three times as high for black infants compared to white infants. Reducing the rates of VLBW and LBW, particularly among blacks, holds the greatest potential for future reductions in infant mortality in the United States. The important role of maternal factors in the antecedents of infant mortality (VLBW, LBW, intrauterine growth retardation, preterm birth) have been clearly and repeatedly demonstrated. Some of these factors, such as maternal race, adverse obstetrical history and low level of education, are not amenable to change during pregnancy. Other factors, such as cessation of smoking, higher maternal weight gain and the initiation of early prenatal care have been shown to improve the course and outcome of pregnancy and subsequently result in reduced infant mortality.

Black People↗

PubMed1993

The role of fetal growth restriction and gestational age on length of hospital stay in twin infants.

OBJECTIVE: To evaluate the association between length of gestation and fetal growth restriction (FGR) and the role of FGR in neonatal morbidity as determined by length of hospital stay among newborn twins. METHODS: Using a race-, gender-, and gestational age-specific birth weight and length of hospital stay singleton standard, 490 twin infants were classified as FGR (at or below the tenth percentile) or non-FGR (above the tenth percentile). Length of stay and length-of-stay ratio (twin stay divided by the 50th percentile singleton stay) were calculated for each twin. Analysis included stepwise multiple regression for length of stay and length-of-stay ratio, and analysis of variance with main effects and second-order interactions for the length-of-stay measures using factors significant in the multiple regression models. RESULTS: For length of stay, significant factors in the multiple regression model included respiratory distress syndrome (RDS), gestation category, FGR, sepsis, time of birth (1979-1984 versus 1985-1989), and cesarean delivery. For length-of-stay ratio, significant factors included FGR, gestation category, sepsis, period of birth, cesarean delivery, and hyperbilirubinemia. The analysis of variance showed that RDS had the greatest effect on length of stay, whereas FGR had the greatest effect on length-of-stay ratio. For both dependent variables, the effect of FGR was magnified when compounded by significant neonatal complications (RDS, sepsis, hyperbilirubinemia) or gestation category. CONCLUSIONS: Fetal growth restriction is a major factor in the neonatal morbidity of twins. Early recognition of and interventions for FGR in twin gestations should be a primary goal for reducing both immediate and long-term adverse outcomes.

Birth Weight↗

PubMed1990

Maternal serum alpha-fetoprotein levels in pregnancies complicated by diabetes: implications for screening programs.

Maternal serum alpha-fetoprotein may be reduced in diabetic pregnancies, but the association with elevated glycosylated hemoglobin has been controversial. We tested the hypothesis that reductions in maternal serum alpha-fetoprotein may reflect the same phenomena that can also impair normal rates of embryo growth in the presence of poorly compensated maternal diabetes. If so, associations would be expected among maternal serum alpha-fetoprotein, embryo rates of growth, and levels of glycosylated hemoglobin reflective of regulation of maternal diabetes during the period of organogenesis. We found maternal serum alpha-fetoprotein levels in 93 pregnant patients with diabetes to be negatively associated with the earliest (4 to 12 weeks) glycosylated hemoglobin determinations. At glycosylated hemoglobin values greater than 9.6% (which approximates the upper quartile), all maternal serum alpha-fetoprotein values fell below the median for patients without diabetes (below 0.8 multiple of the median after weight adjustment). Moreover, there was a trend for pregnancies with lower maternal serum alpha-fetoprotein levels and higher glycosylated hemoglobin values to also demonstrate early fetal growth delay as measured by ultrasonography.

Embryo, Mammalian↗

PubMed1989

Estimation of birth weight by use of ultrasonographic formulas targeted to large-, appropriate-, and small-for-gestational-age fetuses.

This report sought to determine whether estimates of fetal weight are enhanced by using ultrasonographic formulas targeted to the large-, appropriate-, and small-for-gestational-age fetus in both preterm and term pregnancies. Ultrasonographic fetal measurements from 575 singleton pregnancies were obtained within 7 days of delivery. The first 194 fetuses were classified into three groups on the basis of the growth percentile rank of the abdominal circumference (greater than or equal to 90%, greater than 5% and less than 90%, and less than or equal to 5%). Regression analyses were performed to generate three formulas for estimating fetal weight on the basis of the following: Gestational age (weeks) + Head circumference (cm) + 2 x Abdominal circumference (cm) + Femur length (cm). This mathematic model allowed formulation of accurate and concise tables relating the sum of these measurements to estimated birth weight. The accuracy of these formulas was then prospectively compared, first, with the formula published by Hadlock et al. (in 32 large-, 279 appropriate-, and 70 small-for-gestational-age fetuses) and second, with the formula of Weiner et al. (in 82 preterm fetuses). The difference between actual and estimated birth weights generated by the three study formulas had no systemic error (t test, p greater than 0.05). Cumulatively, there was a statistically significant reduction of random error in the birth weight estimates by use of the three study formulas versus the best single formulas of Hadlock et al. (2 SD reduced from 21.6% to 19.8% and absolute 2 SD reduced from 15.6% to 12.2%). Additionally, the three study formulas resulted in a statistically significant reduction in the absolute 2 SD error compared with the best formula by Weiner et al. in fetuses less than or equal to 34 weeks' gestation (2 SD reduced from 19.1% to 13.6%).

Birth Weight↗

PubMed1989

Factors influencing hemostasis after umbilical vein puncture in vitro.

Bleeding from the site of cordocentesis can be detected by ultrasound examination, but significant hemorrhage into the amniotic fluid rarely occurs. To evaluate the relative contribution of amniotic fluid thromboplastins and the quantity of Wharton's jelly in facilitating coagulation at the puncture site, amniotic fluid samples and umbilical cord segments were obtained at cesarean section from 20 patients. After puncture of the umbilical vein, bleeding times were measured in amniotic fluid and 0.9% sodium chloride. The quantity of Wharton's jelly was assessed by measuring umbilical cord circumference. Mean bleeding times were significantly shorter in amniotic fluid compared with saline solution, but there was no consistent relationship between bleeding times and umbilical cord circumference. We conclude that properties of amniotic fluid facilitate coagulation at the site of umbilical vein puncture.

Amniotic Fluid↗

PubMed1988

Fetal heart rate changes after fetal intravascular treatment with pancuronium bromide.

Because of recurrent needle dislodgement secondary to fetal movement, we have altered our intravascular transfusion technique by replacing maternal premedication (meperidine and diazepam [group 1]) with fetal intravascular infusion of pancuronium bromide (Pavulon [group 2]), a nondepolarizing neuromuscular blocking agent. Baseline fetal heart rate, number of accelerations, and variability were assessed before and after transfusion in both groups. Whereas there were no changes after transfusion in the former group, those fetuses who received pancuronium bromide demonstrated a dramatic abolishment of accelerations and decrease in variability, with the heart rate pattern often appearing "sinusoidal-like." These alterations in fetal heart rate were temporary changes that reverted to normal once the fetus "awakened" from the neuromuscular blockade. We speculate that these changes in fetal heart rate are secondary to the interaction of the reported hypertensive and vagolytic effects of pancuronium bromide.

Blood Transfusion, Intrauterine↗

PubMed1987

When does a statistical fact become an ethical imperative?

Trial of labor is a safe and effective management alternative but remains underused in current clinical practice. To explore whether this underuse is justified, decision analysis is developed to compare a trial of labor with elective repeat cesarean section. With the use of available probability estimates and outcome scoring based on a survey of perinatologists, decision analysis identifies trial of labor as superior to elective repeat cesarean section for both the mother and the neonate. Going beyond the simple comparisons of management options and outcomes, the ethical implications of such results are discussed in terms of "utility ethics," "informed consent," and "universal equality." Such considerations suggest that there is a professional (ethical) responsibility to increase the application of trial of labor.

Cesarean Section↗