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Biomedical subjects

L B Curet

Publications and source records attributed to L B Curet.

At least 73 records · Page 4Linked to original sources
PubMed1983

Maternal and fetal responses to a maternal aerobic exercise program.

To investigate the effects of exercise on the pregnant woman and her fetus, 20 pregnant women were studied during the second and third trimesters. Twelve of the women participated in an aerobic exercise program while eight women did not perform any regular exercise and served as a control group. On the basis of submaximal exercise test results, an 18% improvement and a 4% decline in absolute aerobic capacity (liters of oxygen per minute) were observed in the exercise and control groups, respectively. Functional aerobic capacity (milliliters of oxygen per kilogram per minute) rose 8% in the exercise group and declined 10% in the control group. A small but significant rise in fetal heart rate was measured during the exercise sessions. A comparison of pregnancy outcome of the two groups showed no differences in labor duration, Apgar scores, or fetal growth.

Exercise Test↗
PubMed1983

Amniotic fluid phospholipids after maternal administration of dexamethasone.

The administration of corticosteroids to pregnant women in premature labor can accelerate fetal lung development and potentially prevent neonatal respiratory distress syndrome (RDS). Controversy exists, however, as to whether amniotic fluid phospholipid indices of lung maturation are influenced by such treatment. Without a suitable test for evaluating the fetal response to corticosteroids, there is no method of recognizing whether and when lung development has been stimulated. In an attempt to resolve this issue, we carried out a study of amniotic fluid phospholipids as part of the National Institutes of Health multicenter trial of prenatal corticosteroids. Amniocenteses were performed before the administration of either steroid hormone or placebo and approximately 1 week after a series of four injections was initiated. Analysis of the ratio of lecithin (phosphatidylcholine) to sphingomyelin (L/S ratio) revealed nearly identical values initially and no significant difference in the posttreatment means when 25 steroid-treated pregnancies were compared to 20 control pregnancies. Although there were significant increases in both groups during the interval between amniocenteses, no statistical difference was found in the extent of change in L/S ratios between the two groups, when pretreatment values were compared with those obtained an average of 1 week later. In addition to evaluating L/S ratios, we performed an assessment of phospholipid concentrations in 17 pregnancies before and after administration of dexamethasone. This revealed no detectable phosphatidylglycerol. There were increases in the absolute concentrations of phosphatidylcholine and disaturated phosphatidylcholine, but these changes were relatively modest in magnitude and could be attributable to either advanced gestational age or dexamethasone. Our results demonstrate that current tests of fetal lung maturity do not provide a routine means for prenatal detection of pulmonary maturational responses to corticosteroids.

Amniotic Fluid↗
PubMed1983

Interrelationships among human chorionic gonadotropin (hCG), 17 beta-estradiol, progesterone, and estriol in maternal serum: evidence for an inhibitory effect of the fetal adrenal on secretion of hCG.

In normal pregnancy, maternal serum hCG reaches a maximum concentration about 8-10 weeks after the last menstrual period and then decreases. To investigate the possibility that this decrease in hCG is produced by an inhibitory effect of steroids originating in the feto-placental unit, hCG, progesterone, 17 beta-estradiol, and estriol were determined by specific RIAs in 341 serum specimens obtained from 229 different pregnancies. Expressions for predicted hCG as a function of estimated trophoblastic mass and percent predicted hCG were determined to correct for the increase in hCG with increasing trophoblastic mass. The relationships between hCG and progesterone, 17 beta-estradiol, estriol, or estimated trophoblastic mass were not linear. Expression of the hCG data as percent predicted hCG produced linear relationships between hCG and each of the above steroids. Both hCG itself and percent predicted hCG were shown to have a negative regression on estriol (P less than 0.001) and a positive regression on progesterone (P less than 0.001), but not on 17 beta-estradiol (P greater than 0.05), in a multiple linear regression on all three steroids. These data suggest that hCG production is inhibited by a steroid originating in the fetal adrenal. This inhibitory effect plateaus in late pregnancy, allowing a minor late increase in hCG due to increasing trophoblastic mass.

Adrenal Glands↗
PubMed1980

Oxytocin challenge tests and urinary estriols in the management of high-risk pregnancies.

Three hundred sixty-two pregnant patients at risk for placental insufficiency were evaluated with the oxytocin challenge test (OCT) and urinary estriol determinations. The perinatal mortality in patients with positive tests was 6 times higher than the perinatal mortality in patients with negative tests. Expectant treatment of patients with a positive OCT was associated with a perinatal mortality 6 times higher than if immediate delivery was accomplished. A negative stress test was reassuring, as the risk of death in utero within a week of a negative test was only 0.3%. The combination of low estriol levels and positive OCT was quite ominous, while the presence of normal estriol levels provided reassurance of good perinatal outcome when expectant treatment of a patient with a positive OCT was undertaken. The overall perinatal mortality of the patients in this study was not different from that in the general obstetric population.

Cesarean Section↗
PubMed1980

Temporary submucosal cervical cerclage.

A submucosal, easily removable cervical cerclage was placed in 37 patients with cervical incompetence. The perinatal mortality rate compared favorably with reports using other techniques, and the cesarean section rate was not different from that in the overall obstetric population. In view of the absence of any complications, this technique would seem to be the cerclage of choice.

Adolescent↗
PubMed1980

Ambulatory care of the pregnant diabetic.

One hundred eight pregnancies in 98 insulin-dependent diabetic women were managed according to a strict protocol calling for weekly postprandial blood sugar determinations, frequent prenatal contacts, and placental evaluation. Patients were cared for on an ambulatory basis with an average of 1 hospitalization during pregnancy exclusive of delivery. There were no fetal deaths and only 1 neonatal death related to diabetes, for a corrected perinatal mortality of 0.97%. White's classification was not helpful in identifying perinatal risks. The incidence of both perinatal and maternal morbidity was high; however, complications were not serious and the overall outcome was acceptable. In view of the financial and social benefits to patients, it is recommended, that an ambulatory approach to care of the pregnant diabetic patient be used and when feasible it should be the method of choice.

Adult↗
PubMed1979

Effect of diabetes mellitus on amniotic fluid lecithin/sphingomyelin ratio and respiratory distress syndrome.

Ninety-eight insulin-dependent diabetic patients were cared for during 108 pregnancies following an ambulatory program aimed at close control of blood sugar levels. The incidence of respiratory distress syndrome (RDS) in these patients was not different from that in nondiabetic patients. Fetal pulmonary maturity seemed to progress at a normal rate as evidenced by an equal incidence of mature lecithin/sphingomyelin (L/S) ratios at various stages of gestation in diabetic and nondiabetic patients. There was no evidence that Class B and C diabetic patients have delayed fetal lung maturation or that Class E, F, and R patients have accelerated maturation. It is concluded that careful metabolic control of the pregnant diabetic patient results in a normal process of fetal pulmonary maturation without increased risk of RDS.

Amniotic Fluid↗
PubMed1979

Evaluation of a program of bed rest in the treatment of chronic hypertension in pregnancy.

Sixty-six patients with chronic hypertension were cared for during a total of 72 pregnancies. Patients were treated at home primarily by greater than or equal to 4 hours of bed rest daily in the left recumbent position. Only patients whose diastolic blood pressures remained greater than 110 mmHg were treated with hydralazine (Apresoline, Ciba). With this plan of treatment there were only 3 perinatal deaths for an uncorrected perinatal mortality of 4.1% (1.4% corrected). Twenty-nine percent of the patients had babies that were small for gestational age, 13.8% had positive oxytocin challenge tests, and 36.8% developed superimposed preeclampsia. When compared with the outcome of previous pregnancies, the program of bed rest lowered perinatal mortality from 16.8 to 8.8%. Thus, it is suggested that bed rest together with the avoidance of diuretics and the judicious use of hydralazine results in the most favorable fetal outcome.

Bed Rest↗
PubMed1979

The effect of internal fetal monitoring on cesarean section morbidity.

A retrospective review was made of 179 patients who underwent primary cesarean section after laboring with ruptured membranes. Patients with internal fetal monitoring (IFM) were more likely to have endometritis. Of the patients who had ruptured membranes for more than 12 hours, those with IFM were more likely to have febrile morbidity than those without IFM.

Adult↗
PubMed1979

Smooth muscle within ovarian decidual nodules: a link to leiomyomatosis peritonealis disseminata?

Evidence is presented for the coexistence of smooth muscle and decidual cells in nodules on and within the ovarian tunica albuginea at term. Routine histologic techniques and electron microscopy have been employed in characterizing the morphology of the nodules. Recent literature concerning the frequency of ovarian decidualization during pregnancy is discussed with respect to the possible relationship of such decidualization to the histogenesis of leiomyomatosis peritonealis disseminata (LPD). The hypothesis that LPD may represent "disseminated fibrosing decidua" is discussed in light of finding collagen fibrils, secretory decidual cells, and smooth muscle cells in these nodules. It is concluded that the present case does not represent "fibrosing decidua." The authors agree with others who have proposed that the smooth muscle in ovarian decidua and LPD result from proliferation of stem cells which may reside in the subperitoneal stroma in association with ectopic endometrial stroma and which may respond to the hormones of pregnancy.

Decidua↗
PubMed1978

Screening for fetal and neonatal risk in the postdate pregnancy.

One hundred four postdate pregnancies were managed according to a well-defined protocol calling for weekly oxytocin challenge tests and urinary estriols three times per week. Although the perinatal mortality rate in these patients was not increased there was a significant increase in the incidence of neonatal morbidity and complications. The clinical syndrome of dysmaturity was seen in 20 per cent of the neonates. When meconium was present in the amniotic fluid the incidence of neonatal and fetal complications was higher. The cesarean section rate was twice the normal rate, with nonprogression of labor being the commonest indication. It is recommended that: (1) pregnancies carried beyond 42 weeks do not require termination simply because they are post dates; (2) all postdate patients should be monitored during labor; (3) trained personnel to initiate neonatal resuscitation should be present at each postdate delivery.

Amniocentesis↗