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Biomedical subjects

John M O'Brien

Publications and source records attributed to John M O'Brien.

11 recordsLinked to original sources
PubMed2005

Modifiable risk factors for growth restriction in twin pregnancies.

OBJECTIVE: This study was undertaken to evaluate modifiable risk factors for adverse fetal growth in twin pregnancies. STUDY DESIGN: A large cohort study from a database of women with twin gestations identified at risk for preterm labor was performed. Examining each infant's birth weight and gestational age at delivery, infants were classified as being average (AGA), large (LGA), or small (SGA) for gestational age, using the Alexander reference curve. Clinical and demographic factors were compared between patients delivering at least 1 SGA infant and AGA pairs using Pearson's chi2 Student t test statistics and logistic regression. RESULTS: There were 11,827 twin pregnancies evaluated. Risk factors associated with SGA deliveries included tobacco abuse, poor weight gain, lean prepregnancy body mass index, African American race, and nonmarried. The logistic regression identified tobacco abuse as the single greatest risk for poor fetal growth, (odds ratio [OR] 1.95; 95% CI [1.68, 2.27]). Weight gain of less than one-half lb/wk also increased SGA risk (OR 1.35; 95% CI [1.16, 1.68]), whereas weight gain greater than 1 lb/wk decreased SGA risk (OR 0.77; 95% CI [0.68, 0.86]). CONCLUSION: Tobacco abuse and weight gain are the modifiable risk factors, which require intervention during a twin pregnancy. Patients should be encouraged to stop tobacco abuse and gain a minimum of one-half lb/wk in the later half of pregnancy to minimize the risk for growth restriction.

Adult↗
PubMed2005

Does an obese prepregnancy body mass index influence outcome in pregnancies complicated by mild gestational hypertension remote from term?

OBJECTIVES: This study was undertaken to determine the influence of increased prepregnancy body mass index (BMI) on pregnancy outcome in women with mild gestational hypertension remote from term. STUDY DESIGN: A matched cohort design was used. A total of 365 pregnant women with mild gestational hypertension and a normal prepregnancy BMI (20-25 kg/m2) were matched 1:1 for gestational age at diagnosis, race and parity to 365 women with mild gestational hypertension, but an obese prepregnancy BMI (> or = 30 kg/m2). RESULTS: Matched characteristics were distributed as follows: gestational age at diagnosis 32.2 +/- 2.4 weeks; race 80.8% white; parity 59.7% nulliparous. The rate of progression to preeclampsia was the primary endpoint of the study and was similar between the prepregnancy normal and obese BMI groups (37.8% vs 41.1%, P = .352). Birth weight at delivery (3033 +/- 747 g vs 2833 +/- 659 g, P < .001) and cesarean delivery rate (56.7% vs 40.3%, P < .001) were greater in the obese prepregnancy BMI group. CONCLUSION: In patients with mild gestational hypertension remote from term, an obese prepregnancy BMI was associated with similar rates of progression to preeclampsia. Secondarily, an obese prepregnancy BMI was associated with higher birth weights and an increased incidence of cesarean delivery.

Adult↗
PubMed2005

The effect of fetal number on the development of hypertensive conditions of pregnancy.

OBJECTIVE: To estimate the incidence and effect of pregnancy-related hypertensive conditions on multiple gestations. METHODS: Women with 1-4 fetuses enrolled in an outpatient perinatal services program at 28 or more weeks of gestation were identified. Those without a prior diagnosis of hypertension at enrollment and who delivered at more than 28 weeks of gestation were included in the analysis. The incidence of all pregnancy-related hypertensive conditions, diagnosis of severe hypertensive conditions (hemolysis, elevated liver enzymes and low platelets syndrome; disseminated intravascular coagulation; eclampsia; low platelets; renal failure; and abruption), and interventional delivery related to hypertension were estimated, and compared according to fetal number. RESULTS: Data were analyzed for 34,374 singleton, twin, triplet, and quadruplet gestations. The incidence of pregnancy-related hypertensive conditions increased with multifetal gestations as compared with singletons (12.7-19.6% for multifetal gestations compared with 6.5% for singletons, P < .001). The incidence of severe pregnancy-related hypertensive conditions was significantly increased in twin (1.6%) and triplet (3.1%) gestations as compared with singletons (0.5%, P < .001). Quadruplet pregnancies were not significantly higher than triplet gestations for these complications. The need for early delivery related to hypertension was greater with increasing fetal number through triplet gestations. By logistic regression, higher fetal number, nulliparity, and advanced maternal age were each independently associated with the development of pregnancy-related hypertensive conditions. CONCLUSION: Mild and severe pregnancy-related hypertensive disease increases progressively with advancing fetal number from singleton to triplets but is not further increased in quadruplet pregnancies. Multifetal pregnancies should be observed closely for onset of gestational hypertensive disease. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2004

Measuring outpatient outcomes of emesis and nausea management in pregnant women.

PURPOSE: Nausea and vomiting during pregnancy (NVP) can create a significant clinical, psychological, and economic burden for patients, health care providers, and payers. The purpose of this analysis is to describe the clinical and economic outcomes of patients diagnosed with NVP utilizing an outpatient program of nursing support and pharmacologic treatment with subcutaneous metoclopramide (SMT). DESIGN: Women with singleton gestations who were experiencing NVP and whose physicians prescribed an outpatient program with SMT between January 2000 and February 2002 were identified from a database. METHODOLOGY: Descriptive and statistical methods were used to analyze and report incidence of treatment failure, hospitalization/emergency room (ER) visits, degree of ketonuria, and Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score at program start/stop. PRINCIPAL FINDINGS: For a treatment duration of 26.9 +/- 20.8 days, 428 women were enrolled for outpatient SMT at 10.9 +/- 3.2 weeks' gestation. Improvement in NVP symptoms was achieved in 382 women with SMT (89.3 percent), while 46 (10.7 percent) required alteration of antiemetic therapy to subcutaneous ondansetron. The PUQE score at the start of SMT was 7.8 +/- 2.9, decreasing to 3.9 +/- 1.7 by therapy completion (P < .001). At treatment initiation, a PUQE score greater than or equal to 7 was reported by 63.1 percent of women versus 9.1 percent at the program's end (P < .001). Patients with ketonuria that was more than or equal to 1+ decreased from 36.2 percent to 1.4 percent (P < .001). The portion of patients with hospital/ER visits decreased from 65.4 percent to 3.3 percent during treatment (P < .001). Oral dietary improvement was noted in 78.7 percent of patients during treatment. CONCLUSION: Outpatient management was effective in controlling NVP and was associated with a reduced need for hospital or emergency room treatment.

Adult↗
PubMed2002

Mild gestational hypertension: differences in ethnicity are associated with altered outcomes in women who undergo outpatient treatment.

OBJECTIVE: The purpose of this study was to evaluate the impact of ethnicity on outcome in women with mild gestational hypertension that is remote from term. STUDY DESIGN: Nulliparous women with mild gestational hypertension who participated in an outpatient monitoring program between January 1995 and December 1999 were candidates. Patients had a singleton pregnancy at <37 weeks of gestation and were followed up for a minimum of 2 days as an outpatient. Maternal and perinatal outcomes were compared between groups by the Student t test, Mann-Whitney U test, and Pearson chi2 analyses. RESULTS: One thousand one hundred eight-two women were included in the analysis. No clinically remarkable differences in gestational age or incidence of proteinuria at the start of observation were noted. Newborn infants of Hispanic and African American women had significantly smaller birth weights compared with those of white women. African American women had a higher incidence of abruptio placentae (n = 5), stillbirths (n = 3), and neonatal deaths (n = 2) versus the other groups (n = 0 for all). The frequency of progression to thrombocytopenia/HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome) and cesarean delivery rates were similar between groups. CONCLUSION: Differences in outcomes are observed between ethnic groups even when the women undergo the same intensive outpatient monitoring for mild gestational hypertension.

Abruptio Placentae↗
PubMed2002

An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging.

OBJECTIVE: This study was performed to evaluate a protocol for treatment of previable premature rupture of membranes (PROM) that includes the administration of gelatin sponge to retard the loss of fluid from the amniotic cavity. STUDY DESIGN: Women with PROM at or=24 weeks, 53%), with six of these newborn infants surviving to hospital discharge (30%) and two suffering intrauterine death. The average gestational age of delivery for survivors was 31.8 +/- 4.3 weeks, range 25 to 36 weeks. Talipes equivarus was observed in three survivors (50%). Bilateral hip dysplasia and torticollis were also diagnosed in two infants. Respiratory distress syndrome was diagnosed in all cases delivered at less than 32 weeks but was not observed thereafter. No adverse sequelae have been attributed to gelatin sponge exposure. CONCLUSION: The observed survival rate with this interventional approach in a population at highest risk for pregnancy loss justifies further study of this treatment strategy. This protocol may not reduce the rate of musculoskeletal abnormalities.

Cervix Uteri↗
PubMedDate not supplied

Gelatin sponge embolization. a method for the management of iatrogenic preterm premature rupture of the membranes.

Despite the morbidity and mortality associated with early midtrimester premature rupture of the membranes (PROM), limited therapeutic options currently exist for its treatment. A new operative approach to this condition termed embolization involves intra-uterine administration of a gelatin sponge which can remarkably reduce or eliminate further loss of amniotic fluid. A successful case of embolization for the treatment of iatrogenic previable PROM complicating therapeutic fetoscopy is described.

Adult↗