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Biomedical subjects

L C Gilstrap

Publications and source records attributed to L C Gilstrap.

At least 19 recordsLinked to original sources
PubMed1992

Early repair of episiotomy dehiscence associated with infection.

OBJECTIVE: The purpose of our study was to examine early repair of episiotomy dehiscences in a large urban hospital setting serving a predominantly indigent population. STUDY DESIGN: Since September 1, 1989, we have proceeded with early repair in the immediate postpartum period. The medical records of 34 of 35 patients who underwent early repair were reviewed. RESULTS: Of the 34 patients, 21 (62%) had midline and 13 (38%) had mediolateral episiotomies. Dehiscence was associated with episiotomy infection in 27 (79%) of the 34 patients: 18 (86%) in the midline group and 9 (69%) in the mediolateral group. Repair was accomplished from 3 to 13 days (mean = 6.4) after dehiscence. Successful repairs were accomplished in 32 (94%) of 34 patients. Two (6%) patients with initial third-degree episiotomies had a subsequent breakdown of their repairs and were allowed to heal by secondary intention. CONCLUSIONS: Although most dehiscences in our population were associated with infection, early repair in this population is associated with a satisfactory outcome in the vast majority.

Adult↗
PubMed1992

Expectant management of preterm ruptured membranes: effects of antimicrobial therapy.

OBJECTIVE: To determine whether the addition of broad-spectrum antimicrobial therapy to traditional expectant management improves pregnancy outcome in patients with premature rupture of membranes (PROM) remote from term. METHODS: Patients with preterm PROM before 34 weeks' gestation who were not in labor and had no signs of infection or fetal distress were randomized to one of two study groups: 1) expectant management alone and 2) expectant management plus antimicrobial therapy. Women in the latter group received intravenous ampicillin, gentamicin, and clindamycin for 24 hours, followed by amoxicillin plus clavulanic acid orally for 7 days. Other than antibiotic use, management of the two groups was identical. RESULTS: Significantly more women (P < .01) treated with antibiotics (20 of 48, 42%) remained undelivered 7 days after admission compared with those managed expectantly without antibiotics (seven of 46, 15%). In addition, more neonates in the group managed with antibiotics were admitted to the routine nursery (nine of 48 versus two of 45; P = .03). However, there was no difference between the groups in the frequency of serious maternal or neonatal morbidity. CONCLUSIONS: The addition of broad-spectrum antimicrobial therapy to traditional expectant management of pregnancy complicated by preterm PROM may increase the number of gestations undelivered 7 days after admission. It may also decrease the proportion of infants admitted to special care nurseries. Whether these effects result in significant short- or long-term maternal or neonatal benefit remains to be determined.

Anti-Bacterial Agents↗
PubMed1992

Esophageal achalasia in late pregnancy.

Esophageal achalasia is a rare disorder that may mimic nausea and vomiting of pregnancy. Presentation or persistence of these symptoms in the latter half of pregnancy is unusual. We describe a case of third-trimester weight loss due to the nausea and vomiting of achalasia. Pneumatic dilation of the esophagus is often necessary to improve oral intake. However, advances in nutritional supplementation may prevent malnutrition and allow treatment and its complications to be delayed until after delivery.

Adult↗
PubMed1991

Balanced translocation 12/13 and situs abnormalities: homology of early pattern formation in man and lower organisms?

Studies in "lower" organisms have identified a set of homologous sequences expressed in oocytes and early embryos that is critical for pattern formation. Mutations in such genes may exhibit maternal effect--they cause abnormalities in the fetus only when present in the mother. We report on a mother and child with identical, apparently balanced translocations having the breakpoints 12q13.1 and 13p13. The fetus had multiple anomalies including bilateral trilobar lungs, complex heart defect, malrotation of the gut, and asplenia, while the mother was entirely normal. Several hypotheses are advanced to explain this variable expression including transection of a gene with maternal effect--lateral asymmetry in the fetus is influenced by the maternal genotype. This explanation would account for the higher transmission of congenital heart disease to offspring by affected females noted in several studies. The human counterparts of 2 loci (int-1 and HOX 3) involved in Drosophila early pattern formation are located near the translocation breakpoint 12q13.1. If one of these genes is responsible for situs abnormality, then university of positional code (but not of embryologic mechanism) is suggested for higher metazoans.

Abnormalities, Multiple↗
PubMed1991

"Meconiumcrit" and birth asphyxia.

Determination of the percent by volume of the solid component of meconium (the "meconiumcrit") provides a more objective method of characterizing the type of meconium. In a study of 106 women with meconium-stained amniotic fluid, 61 (58%) had thin meconium, 36 (34%) had moderate meconium, and nine (8%) had thick meconium. There was no correlation between the type of meconium and newborn acidemia (umbilical artery pH, less than 7.20)--13%, 19%, and 11%, respectively. None of the newborns with either thin or thick meconium had 1-minute Apgar scores of less than or equal to 3 and only two with moderate meconium had such Apgar scores; none had an Apgar score of less than or equal to 3 at 5 minutes. None of the newborns with thin or moderate meconium had meconium aspiration syndrome, although two of nine infants with thick meconium did have meconium aspiration syndrome. All newborns subsequently did well and left the hospital in good condition. There would appear to be no correlation between the consistency of meconium and recently reported criteria for defining birth asphyxia.

Apgar Score↗
PubMed1991

Is hyperthermia teratogenic in the human?

Maternal hyperthermia during embryogenesis has been postulated to cause a variety of major congenital anomalies in exposed offspring. Although the literature regarding human exposures is not conclusive, studies using animal models support the contention that major structural anomalies may be produced. In the present study, pregnancy outcome of a cohort of women who reported having a temperature of 101 degrees F or higher for 24 hours or more during the first trimester was compared to a control group of women (matched on last menstrual period, parity, and age) who denied having a fever. A statistically significant increased frequency of a specific type of congenital anomaly, abdominal wall defects, was found in offspring whose mothers had sustained high temperatures during embryogenesis. Although an increased risk of this type of congenital anomaly is not consistent with previous epidemiologic studies, similar defects of this organ system have been reported in offspring of pregnant nonhuman primates (monkeys) and rodents (guinea pigs) who experienced hyperthermia during pregnancy.

Adult↗
PubMed1991

Anaerobic coverage for intra-amnionic infection: maternal and perinatal impact.

Although intrapartum antibiotics are beneficial to both the mother and newborn, there is no consensus as to the most efficacious antibiotic regimen in the treatment of intra-amnionic infection, especially with regard to anaerobic coverage. We randomized pregnant women with intra-amnionic infection to receive either dual agent therapy (ampicillin and gentamicin) or triple agent therapy (ampicillin, gentamicin, and clindamycin). The frequency of vaginal and cesarean delivery was similar in both groups. There was no significant difference in the incidence of endometritis between the two groups (10 of 69 versus 5 of 64; p = NS). There were no significant differences in either neonatal morbidity or mortality. The addition of clindamycin to provide anaerobic coverage for intra-amnionic infection does not significantly alter the incidence of endometritis in women delivered by cesarean section, although it may have an impact on women delivering vaginally.

Ampicillin↗
PubMed1991

Intrapartum antibiotic therapy for suspected intraamniotic infection: impact on the fetus and neonate.

Acute chorioamnionitis occurs relatively frequently in pregnancy and may result in significant fetal and neonatal morbidity. Although there is no unanimity of opinion regarding the most efficacious antibiotic regimen for the treatment of this complication, there is a consensus, at least among obstetricians, that maternal treatment may have an impact on neonatal outcome. It appears that the fetus and neonate benefit from "intrauterine" treatment. Virtually all antibiotics cross the placenta, and fortunately most are relatively safe for use during pregnancy.

Anti-Bacterial Agents↗
PubMed1991

Trimethoprim and sulfamethoxazole transfer in the in vitro perfused human cotyledon.

Utilizing the in vitro human placental model, we studied the placental transfer of trimethoprim and sulfamethoxazole. At trimethoprim concentrations of 7.2 micrograms/ml, only 1.4 micrograms/ml was transported across the placenta after 1 h, and at concentrations of 1.0 microgram/ml, one half the usual serum level, only 0.08 microgram/ml was transported across the placenta. Maternal concentrations of sulfamethoxazole of 29.6 and 127.7 micrograms/ml resulted in concentrations of 5.1 and 14.8 micrograms/ml on the fetal side, respectively. Thus, it would appear that trimethoprim is slowly transported across the placenta and in low concentrations whereas sulfamethoxazole readily crosses the placenta. The combination of these drugs is useful for treatment of bacteriuria. It may also prove to be especially useful for Pneumocystis carinii infections in pregnant women with AIDS. With a half-life of 13 h for trimethoprim and 6 h for sulfamethoxazole, the drugs are not likely to achieve toxic levels in the fetal compartment. Thus, it would appear that trimethoprim and sulfamethoxazole may be both efficacious and safe for the treatment of both these infections during pregnancy.

Female↗
PubMed1991

Stress hormones and acid-base status of human fetuses at delivery.

The relationship of plasma concentrations of arginine vasopressin (AVP), ACTH, cortisol, and PRL in the human fetus to mode of delivery and acid-base status has been investigated in 91 term pregnancies consisting of 4 groups based on mode of delivery, type of anesthesia, and use of ephedrine prophylaxis for maternal blood pressure control. Infants delivered vaginally after uncomplicated labors had higher umbilical cord plasma concentrations of AVP, ACTH, and cortisol than infants delivered without labor. Use of ephedrine, an alpha-agonist, during regional anesthesia was associated with elevated plasma AVP and ACTH concentrations compared to those in women receiving general anesthesia. At the time of delivery, 12 infants had acidemia (pH less than 7.20), as judged by pH of umbilical arterial blood. Their plasma AVP, ACTH, and cortisol levels did not differ from those of infants delivered by uncomplicated vaginal delivery, but were greater than those of infants delivered by cesarean section under general anesthesia. Moreover, in infants with acidemia, plasma concentrations of AVP and ACTH were significantly correlated, but PRL levels were unaffected by mode of delivery or acidemia. Elevated umbilical cord plasma concentrations of AVP, ACTH, and cortisol characterize term vaginal deliveries and are associated with intrauterine stress, demonstrating activation of the fetal hypothalamic-pituitary-adrenal axis and suggesting that AVP is important in ACTH release in the human fetus; however, PRL does not appear to be an important stress hormone.

Acid-Base Equilibrium↗
PubMed1991

Uterine contraction pressures achieved in parturients with active phase arrest.

An adequate trial of labor preceding cesarean delivery for arrest of cervical dilatation in the active phase of labor has not been defined precisely. We reviewed the records of 85 consecutive women at term who received oxytocin for induction or augmentation of labor and who subsequently delivered by cesarean for arrest of labor in the active phase. The mean duration of oxytocin infusion was 15 hours for induction of labor and 8.9 hours for augmentation. Thirty-four (92%) of the 37 women who received oxytocin induction and 44 (92%) of the 48 who had oxytocin for augmentation achieved at least 200 Montevideo units of uterine pressure. All 85 newborns were vigorous at birth and had no complications during their stay in the hospital nursery. Evaluation of uterine contraction pressure can provide a quantifiable end point for the management of oxytocin induction or augmentation of labor.

Cesarean Section↗
PubMed1991

Pathologic fetal acidemia.

There is no clearly established umbilical artery pH cutoff to be used for defining pathologic fetal acidemia (ie, the threshold associated with major neonatal morbidity or mortality). Classically, a pH cutoff of less than 7.20 has been used. Our goal was to define this pH cutoff more precisely. There were 3506 term newborns (2500 g or greater) with an umbilical artery pH of less than 7.20; these newborns were divided into five pH groups. Eighty-seven (2.5%) had a pH of less than 7.00, 95 (2.7%) a pH of 7.00-7.04, 290 (8.3%) 7.05-7.09, 798 (22.8%) 7.10-7.14, and 2236 (63.8%) 7.15-7.19. Two-thirds (66.7%) of the newborns with an umbilical artery pH less than 7.00 had a metabolic component in their acidemia, compared with 13.7% or less in all other pH groups. Significantly more (P less than .05) newborns in the less-than-7.00 pH group had low (less than 3) 1- and 5-minute Apgar scores compared with the other four pH groups. In addition, neonatal death was significantly more common (P = .03) in newborns with a pH less than 7.00, and seven (50%) of the 14 deaths occurred in this group. The statistically significant pH cutoff for all seizures was less than 7.05 (P = .004), and for unexplained seizures was less than 7.00 (P = .01). Eight (67%) of the 12 unexplained seizures occurred in this latter pH group. Thus, a more realistic pH cutoff for defining pathologic fetal acidemia would appear to be less than 7.00.

Acidosis↗
PubMed1991

Elective hospitalization in the management of twin pregnancies.

We sought to evaluate the effectiveness of a policy of early elective hospitalization on the outcomes of 522 consecutive twin gestations delivered at our institution between 1983-1987. During the first 2 years (1983-1985), 237 twin pregnancies were delivered with a policy of elective hospitalization when twin pregnancy was diagnosed between 24-32 weeks' gestation. When possible, elective hospitalization started at 24 weeks' gestation. Electively admitted women remained hospitalized until 34 weeks' gestation, at which time they were discharged unless complications developed requiring continued hospitalization. During 1985-1987, 285 women with twin gestations were intentionally managed as outpatients unless intercurrent complications required hospitalization. A total of 211 twin pregnancies was excluded from analysis because the women did not present for prenatal care (19%) or were undiagnosed until delivery (22%). Of the remaining 311 pregnancies available for study, 134 were managed when the elective admission policy prevailed and 177 when this policy was not in effect. Although the elective admission policy did result in a small reduction in the incidence of low birth weight among the 58 pregnancies hospitalized electively (mean [+/- SEM] gestational age at elective hospitalization 27.7 +/- 0.3 weeks) compared with outpatient management, this policy did not result in an improvement in prematurity (32 versus 36%; P greater than .05) or perinatal morbidity as reflected by requirement for neonatal intensive care (12 versus 11%; P greater than .05) and mechanical ventilation (8 versus 9%; P greater than .05). Moreover, perinatal mortality was actually higher in the electively hospitalized pregnancies (8 versus 2%; P = .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

HIV prevalence in pregnant intravenous drug users in Dallas, Texas.

Information available regarding the prevalence of human immunodeficiency virus (HIV) in pregnant women indicates that the primary risk factor for infection is intravenous drug use. At Parkland Memorial Hospital in Dallas, Texas, approximately 4.7% of pregnant women reported using intravenous drugs. The estimated prevalence of HIV infection among pregnant intravenous drug users at this hospital was 3.3%. This is similar to the HIV infection rates reported for nonpregnant parenteral drug-using populations in other areas of the southwestern United States, suggesting that there may be a lower rate of endemic infection in this region of the country.

Female↗
PubMed1990

Failure to recognize fetal alcohol syndrome in newborn infants.

A clinically distinct constellation of major and minor anomalies, termed the fetal alcohol syndrome, occurs among infants whose mothers abuse alcohol during pregnancy. In addition, significantly higher rates of pregnancy complications, including perinatal deaths and fetal growth retardation, occur among these women and their offspring. We studied the medical records of 40 infants born to 38 alcohol abusers and the frequency of characteristics associated with fetal alcohol syndrome. Physical examinations of 6 infants revealed primary features consistent with a diagnosis of fetal alcohol syndrome. Postnatal growth and development were very poor in 17 (50%) of 34 liveborn alcohol-exposed infants. The diagnosis of fetal alcohol syndrome did not appear in the medical records of any of these infants despite the fact that the mothers' obstetric records included a history of alcohol abuse during pregnancy. This finding emphasizes the importance of good communication between obstetric and pediatric medical staff at this hospital, particularly when providing care for pregnant women and newborn infants at high risk for complications due to maternal alcohol or other drug abuse.

Adolescent↗