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Biomedical subjects

Joseph A Spinnato

Publications and source records attributed to Joseph A Spinnato.

7 recordsLinked to original sources
PubMed2006

Tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks of gestation: a randomized controlled pilot study.

OBJECTIVE: The purpose of this study was to determine whether intravenous magnesium sulfate (MgSO4) followed by oral nifidepine tocolysis in women with preterm labor between 32 0/7 and 34 6/7 weeks' gestation reduces neonatal hospital stay. STUDY DESIGN: Fifty-four women between 32 0/7 and 34 6/7 weeks with preterm labor were randomized to receive either MgSO4 and oral nifidepine (n = 24) or no tocolysis (n = 30). All women received betamethasone and prophylactic antibiotics. The primary outcome was total neonatal hospital stay. Data were analyzed using Chi-square and Mann Whitney U test. RESULTS: The 2 groups had similar mean cervical dilation and gestational age at enrollment. There were no statistically significant differences in total neonatal hospital stay (5.8 +/- 7.2 days; median of 3 days in the no tocolysis vs. 7.5 +/- 8.6 days; median of 3 days in the tocolysis group), rate of preterm delivery (57% vs. 75%) or need for oxygen supplementation (7% vs. 21%, p < 0.23). The neonatal complications were similar in each group. CONCLUSION: Tocolysis after 32 weeks gestation does not reduce neonatal hospital stay.

Adult↗
PubMed2006

New therapies in the prevention of preeclampsia.

PURPOSE OF REVIEW: The review summarizes the results of recent randomized clinical trials whose primary purpose was to prevent preeclampsia and explores safety concerns that have been raised by these trials. Preeclampsia remains one the most common causes of perinatal and maternal mortality, particularly in resource-poor developing countries where its impact on morbidity and mortality is 20 to 100-fold greater than that in developed countries. The potential benefit of antioxidant vitamins and calcium continue to be explored, and are the subject of this review. RECENT FINDINGS: Two large, prospective, randomized trials involving more than 4000 low and high-risk subjects, respectively, compared vitamin C/E to placebo. There were no differences noted in the frequency of preeclampsia between groups. Additionally, potential adverse influences of supplementation on low birthweight, late stillbirth, and severity and timing of preeclampsia and neonatal acidosis were noted. A large, multicenter calcium vs. placebo trial sponsored by the World Health Organization in locations known to have dietary calcium deficiency failed to reduce preeclampsia or low birthweight rates. SUMMARY: These negative trials have reduced the likelihood that antioxidant or calcium supplementation will significantly impact the incidence of this disease. The safety concerns regarding antioxidants must be carefully explored.

Antioxidants↗
PubMed2004

Prevention and management of RhD isoimmunization.

An Rh-negative woman is at risk for developing Rh isoimmunization upon exposure to RhD antigens from her Rh-positive baby through fetal-maternal hemorrhage. The incidence of Rh isoimmunization and fetal hemolytic disease has decreased substantially since Rh immune globulin was introduced in 1968. When RhD sensitization does occur, careful follow-up of these mothers and judicious intervention can result in good outcomes for most pregnancies. Both Doppler assessment of middle cerebral artery peak systolic velocity and spectral analysis of amniotic fluid at 450 nm (DeltaOD 450) are useful in the diagnosis and management of fetal anemia.

Female↗
PubMed2002

The pattern of change in the lecithin/sphingomyelin ratio in patients with preterm premature rupture of membranes between 24 and 34 weeks' gestation.

OBJECTIVE: To report the pattern of change in the lecithin/sphingomyelin (L/S) ratio in patients with preterm premature rupture of membranes (PPROM) between 24 and 34 weeks' gestation. STUDY DESIGN: L/S was determined prospectively using transvaginally and transabdominally collected amniotic fluid from patients with PPROM between 24 and 34 weeks' gestation. Samples were collected prospectively on admission and every 48 to 96 hours until L/S was > or =2.0. All patients received intramuscular betamethasone weekly. RESULTS: Fifty-five patients were included in the study. One hundred twenty-seven samples were collected transvaginally and nine were collected transabdominally. Cox regression analysis showed that a higher initial L/S value and more advanced gestational age were associated with accelerated lung maturation. Among patients at > or =29 weeks' gestation with an initial L/S of > or =1.5 and <2.0 (n=17), 15 of 17 (88%) reached L/S > or = 2 at a mean of 3.1 +/- 1.7 days (range 1.0 to 7.0 days). With an initial L/S of > or =1.0 and <1.5 (n=16), 14 of 16 (88%) patients reached L/S > or =2 at a mean of 4.1 +/- 1.9 days (range 1.7 to 7.0 days). With an initial L/S of <1.0 (n=11), 6 of 11 (54%) patients reached L/S > or =2 at a mean of 5.0 +/- 1.6 days (range 4.7 to 6.8 days). CONCLUSION: Our data document a dramatic acceleration of fetal lung maturation among patients with PPROM at > or = 29 weeks.

Amniotic Fluid↗
PubMed1986

Pain and discomfort thresholds in late pregnancy.

Gintzler found an abrupt increase in pain thresholds in rats during the last days of gestation. While some data suggest a similar increase in pain thresholds for pregnant women, Goolkasian and Rimer have found, using signal detection procedures, that women are increasingly likely to report stimuli as painful during the last 2 weeks of pregnancy. The present studies were carried out to assess pain and discomfort thresholds in the last weeks of women's pregnancies. In the first study, daily measures of the pressure-induced pain thresholds of 6 women who had spontaneous, vaginal births increased during the last 16 days of pregnancy and exceeded the 300 mm Hg maximum stimulus pressure for the last 9 days of pregnancy. In the second study, the discomfort thresholds of 6 women were measured each day during the last 11 days of pregnancy before spontaneous vaginal births. The discomfort thresholds of the pregnant women were higher than those of 6 non-pregnant women whose discomfort thresholds were also measured each day. Pregnant women's thresholds increased before the onset of labor, while the discomfort thresholds of the non-pregnant women were unchanged during the course of the study. These results extend Gintzler's findings of reduced sensitivity to pain shortly before parturition.

Adult↗