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Biomedical subjects

L Cousins

Publications and source records attributed to L Cousins.

At least 19 recordsLinked to original sources
PubMed2005

Targeted mid-trimester ultrasound examination: how does fetal anatomic visualization depend upon the duration of the scan?

OBJECTIVE: To determine the relationship between visualization of key fetal anatomic structures during mid-trimester ultrasound examination with gestational age and duration of examination. METHODS: One hundred ultrasound examinations at 16-22 weeks' gestation were reviewed to determine the times at which key fetal anatomic features were seen. Scans were terminated at 30 min or when a comprehensive anatomic survey was complete. Exclusion criteria included multiple gestation, maternal weight>77 kg, abdominal wall scarring, and suspected fetal anomalies. RESULTS: Visualization of cranial anatomy including lips, face, midline, ventricles, choroid plexus, and cerebellum was achieved in 98% of patients within 30 min. The corresponding figures for spine, cardiac screening (four-chamber, aortic, and pulmonary outflow views) and for abdominal anatomy (stomach, kidneys, bladder, ventral wall, and three-vessel cord) were 91%, 91%, and 99%, respectively. A complete anatomic survey including each of the above elements was obtained by 10, 15, 20, 25, and 30 min in 8%, 31%, 53%, 72% and 81% of the subjects. Rates of complete anatomic surveys within 30 min improved by gestational age interval, from 20/30 (67%) at 16-18 weeks, to 36/44 (82%) at 18-20 weeks, and 25/26 (96%) at 20-22 weeks; this rise was primarily due to improvements in visualization of the spine and heart. CONCLUSIONS: A comprehensive anatomical survey can be completed in 10 min or less in a minority of patients. For each 5-min time increment up to 30 min, the rate of complete surveys improves. Rates of completed anatomic surveys rise with gestational age.

Aortic Valve↗
PubMed2001

Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses, and outcomes.

OBJECTIVE: To describe causes, courses, complications, and outcomes of patients with pregnancy-associated acute respiratory distress syndrome (RDS). METHODS: Twenty-eight women with ARDS during pregnancy or within a week postpartum formed the study population. Eight cases had been reported previously. Charts were abstracted for maternal demographics, etiology, and treatment of acute RDS, and maternal outcomes. For antepartum acute RDS, newborn charts were also reviewed. RESULTS: The incidence of acute RDS, excluding maternal transports, was one per 6277 deliveries or 0.016% (95% confidence interval [CI] 0, 0.027%). Leading causes were infection (12 cases), preeclampsia or eclampsia (seven cases), and aspiration (three cases). Eleven mothers died, a maternal mortality rate of 39.3% (CI 21.5%, 59.4%). Six of eight women who were ventilated for over 14 days survived. Nine of the acute RDS cases might have been preventable. Ten mothers with living fetuses were ventilated during the third trimester; nine delivered within 4 days. Among six infants delivered because of fetal heart rate abnormalities, one died and at least three had evidence of asphyxia. CONCLUSIONS: Acute RDS occurs more frequently in pregnancy than the 1.5 cases per 100,000 per year reported for the general population. Prolonged ventilator support is warranted. The high rate of perinatal asphyxia in infants who have fetal heart rate abnormalities supports a strategy of expeditious delivery during the third trimester.

Adolescent↗
PubMed2001

Olanzapine as alternative therapy for patients with haloperidol-induced extrapyramidal symptoms: results of a multicenter, collaborative trial in Latin America.

Conventional antipsychotic agents can induce extrapyramidal symptoms (EPS) that may be alleviated by switching patients to novel agents such as olanzapine. Patients with schizophrenia and related disorders (ICD-10) who were taking haloperidol (N = 94; mean dose = 12.7 mg/day) and had EPS (Simpson-Angus Scale [SAS] > 3) were directly switched to 6 weeks of open-label olanzapine treatment (mean dose = 11.4 mg/day). There were significant mean improvements (p <0.001 for all measurements) from baseline to endpoint on the SAS (-9.69+/-5.33; percentage change, 87.2%), the Barnes Akathisia Scale (-1.00+/-1.19; percentage change, 82.5%), and the Abnormal Involuntary Movement Scale (-1.48+/-2.89; percentage change, 81.1%), and anticholinergic use decreased from 47.9% to 12.8% (mean baseline to endpoint change: -1.52+/-1.91-mg equivalents of benztropine; p < 0.001). Significant mean baseline to endpoint improvements (p < 0.001 for all measurements) were observed on the Positive and Negative Syndrome Scale (PANSS; -25.28+/-18.67; percentage change, 30.3%), the PANSS-extracted Brief Psychiatric Rating Scale (0-6 scale, -13.41+/-10.16; percentage change, 54.4%), and the Clinical Global Impressions Severity scale (-1.16+/-1.19; percentage change, 26.4%). Spontaneously reported treatment- emergent adverse events with a greater than 5% incidence were somnolence (16.0%), increased appetite (14.9%), weight gain (11.7%), headache (8.5%), anxiety (7.4%), dizziness (6.4%), and insomnia (5.3%). Criteria for a successful switch were met by 90.5% of patients. Psychotic symptom exacerbation was experienced by 30.9% of patients at any time during the study and by 11.7% of patients at endpoint. Results suggest that a direct switch to olanzapine is a therapeutic option when patients with haloperidol-induced EPS are unable to tolerate a more gradual switch.

Adolescent↗
PubMed1999

Fetal oxygenation, assessment of fetal well-being, and obstetric management of the pregnant patient with asthma.

Asthma is the most common chronic respiratory disease affecting pregnant women. To provide the best obstetric care, it is necessary to understand fetal oxygenation and how it can be affected by maternal asthma. During pregnancy, fetal well-being should be closely monitored, and asthma care should be carefully integrated with obstetric care. Optimal fetal assessment includes establishing gestational age, assessment of fetal growth, and monitoring fetal activity. Evaluation for high-risk patients may include the non-stress test, contraction stress test, or biophysical profile.

Asthma↗
PubMed1995

Prenatal diagnosis of the two-vessel cord: implications for patient counselling and obstetric management.

The study was designed to investigate the implications of the sonographic diagnosis of the two-vessel umbilical cord for patient counselling and pregnancy management. Retrospective analysis was carried out of prenatal findings and pregnancy outcomes when a two-vessel cord was diagnosed in utero. Eighty-two fetuses each with a single umbilical artery were diagnosed by ultrasound. Ten were aneuploid, including nine with visible structural defects and one with early onset intrauterine growth retardation. Of the remaining 72, 31 had other anomalies diagnosed postnatally; 27 of these had structural defects detected on ultrasound examination. However, in nine of these 27 sonographically abnormal fetuses, one or more major structural defects were missed by ultrasound examination. Among the 45 chromosomally normal fetuses with no visible defects on scan, four had anomalies diagnosed after birth. Among the chromosomally normal singletons, six of 22 with other anomalies seen on scan and seven of 38 with no other visible defects on scan had intrauterine growth retardation. Among chromosomally normal twins, one of two with other anomalies seen and two of five appearing otherwise normal had intrauterine growth retardation; one twin set was delivered at 23 weeks after the demise of both twins. Karyotyping is recommended whenever a two-vessel cord is seen in association with symmetric intrauterine growth retardation or any other defect. The fetus diagnosed with a two-vessel cord and any other anomaly by ultrasound often has additional structural defects not seen on scan. The fetus with an isolated two-vessel cord on scan seldom has unrecognized major anomalies, but is at risk for intrauterine growth retardation.

Abnormalities, Multiple↗
PubMed1992

The California Diabetes and Pregnancy Program: implementation of a multicenter experience with diabetic pregnancies.

The California Diabetes and Pregnancy Program (CDAPP) began in 1984 as a multicenter, collaborative project with support provided by the state Department of Health Services, Maternal and Child Health Branch. Between its inception and 1988, it expanded from three to eight perinatal regions, making the CDAPP model of care available to patients in 19 clinical affiliate sites. The care was provided by a multidisciplinary team composed of physicians, a diabetes educator, a registered dietician, a social worker, and appropriate consultants. The elements of this model of care included comprehensive patient education, active patient participation in care, maternal and perinatal medical assessment, and collection of standardized patient information adequate to allow a programmatic and medical evaluation of the CDAPP. Despite impressive growth of the program by December 1988, statewide implementation of CDAPP is incomplete.

Adolescent↗
PubMed1991

Screening recommendations for gestational diabetes mellitus.

As a result of extensive experiences in multiple centers and a review of the current literature, we conclude that a plasma glucose level obtained 1 hour after a 50 gm oral glucose challenge is the "best" gestational diabetes mellitus screening test. This universal screening is performed at least once during pregnancy. The screening threshold should be no higher than 140 mg/dl, or an unacceptable loss in sensitivity occurs. Universal screening for gestational diabetes mellitus is justified by morbidity reduction, cost, and protocol simplicity and ease.

Blood Glucose↗
PubMed1991

Insulin sensitivity in pregnancy.

Quantitation of insulin sensitivity (SI) with the insulin suppression test, glucose clamp, or the minimal model method has been achieved in various clinical circumstances. The application of these techniques to pregnancy has been limited. It is important to utilize sensitive and reproducible methods to study SI changes in pregnancy to fully understand the normal and pathological metabolic alterations that occur during gestation. These techniques demonstrate that various factors (obesity, body fat distribution, age, dietary manipulation, and exercise) may affect SI measures. The various pregnancy hormones have differential effects on insulin action. There is consensus among the limited in vivo studies in human pregnancy that late gestation is associated with significantly impaired SI compared with the nonpregnant state. Studies with appropriate matching between control and gestational diabetic subjects have failed to demonstrate a significant difference in SI between groups in the third trimester.

Diabetes, Gestational↗
PubMed1989

A population-based study of maternal and perinatal outcome in patients with gestational diabetes.

A prospective population-based study of gestational diabetes mellitus was done with 2272 patients to determine perinatal and maternal outcomes. A large data base was collected on all patients. Patients with gestational diabetes mellitus were older, shorter, heavier, and had more children than did the control group. The higher cesarean section rate in the patients with gestational diabetes mellitus was explained by their increased rate of repeat cesarean section compared with control patients. This was associated with increased infectious complications. Other maternal complication rates were similar in the two groups. Acceptable glucose control did not normalize birth weight percentiles in patients with gestational diabetes mellitus. Maternal weight at delivery was the only significant predictor of birth weight percentile in the group with gestational diabetes mellitus. Plasma glucose levels were a poor predictor of birth weight percentile. Factors associated with maternal obesity in well-controlled gestational diabetes mellitus may be more significant than glucose control in the development of large-for-gestational-age infants.

Adult↗
PubMed1988

Ultrasonographic assessment of early fetal growth in insulin-treated diabetic pregnancies.

Early fetal growth aberrations have been suggested in diabetic gestations. To characterize such aberrations sonographically, longitudinal crown-rump length measurements were made in a group of 20 control and 20 diabetic pregnancies. The study evaluated growth between 40 and 100 days of amenorrhea. The best-fit curve of growth as a function of gestational age was that of a nonlinear polynomial regression curve for both the control and the diabetic groups. The correlation coefficients were 0.997 and 0.887 for the control and diabetic groups, respectively; the standard error of the estimate was 0.054 and 0.19, respectively. A log10 linear transformation was performed successfully on each curve. Comparison of the slopes and the intercepts of the transformed control and diabetic curves revealed no significant differences. To evaluate the possibility of a transient fetal growth delay, interval growths and interval growth velocities were compared between groups. No significant differences were observed. The control and diabetic groups' mean (+/- SD) growth velocities were 0.043 +/- 0.023 and 0.040 +/- 0.022 mm/day/mm total, respectively (p = NS). The growth of two anomalous fetuses in the diabetic group was studied individually. Their growth characteristics could not be distinguished from the control fetuses' growth profiles. The present study fails to confirm the presence of early fetal growth delay in diabetic pregnancies. Moreover, the data suggest that the fetuses' early growth in the mother with poorly controlled diabetes is similar to that of control fetuses.

Congenital Abnormalities↗
PubMed1987

Longitudinal effects of pregnancy on the pharmacokinetics of theophylline.

The effects of pregnancy on the disposition of theophylline were assessed in 10 patients throughout pregnancy and post-partum. The clearance relative to total theophylline concentrations was only slightly affected during the first two trimesters (2.61 +/- 0.63 l/h and 2.85 +/- 1.05 l/h), while a statistically significant reduction was evident late in pregnancy (2.05 +/- 0.49 l/h). Post-partum clearance values (2.16 +/- 2.81 l/h) suggest an ongoing suppression relative to pre-pregnancy levels. A similar pattern was evident with clearance values based on free theophylline plasma concentrations (p = 0.12). Absolute volume of distribution increased in concert with gestation, suggesting that theophylline partitions into the enlarged tissue spaces. In addition, theophylline binding to plasma proteins decreased, albeit insignificantly, during the second (fraction bound = 29%) and third (32%) trimesters compared to post-partum values (41%). Increases in half-life during the third trimester (13.00 +/- 2.31 h vs 9.53 +/- 3.53 h post-partum) were highly significant. This change reflects the net effect of reduced clearance and increased distribution. Breast feeding had no effect on the disposition of theophylline, although the transfer of this compound into breast milk was confirmed.

Asthma↗
PubMed1986

Circadian rhythm and diurnal excursion of plasma cortisol in diabetic pregnant women.

The effect of type I and II diabetes in pregnancy on the circadian rhythm and diurnal excursion of plasma cortisol was studied in the second and third trimesters and post partum. Cosignor analysis demonstrated persistence during gestation of the significant circadian rhythm of the nonpregnant state. As previously reported in control pregnancies, plasma cortisol levels (24-hour mean, nadir, peak, and nadir-peak excursion) increased during gestation while the relative excursion of cortisol (expressed as the percent deviation from the 24-hour mean) was blunted. No significant difference was found between diabetic groups or when diabetic groups were compared with control subjects. Nocturnal hypoglycemia was common among diabetic women during pregnancy and post partum. Although these episodes were usually asymptomatic, the mean concomitant cortisol levels were increased over the corresponding cortisol levels of nonhypoglycemic diabetic and control subjects. We conclude that differences between control and type I and II diabetic subjects in carbohydrate tolerance or glycemic excursion are not explained by differences in cortisol levels or rhythm. The pregnancy-associated blunting of the excursion of cortisol is consistent with an autonomous source of adrenocorticotropin. Asymptomatic nocturnal hypoglycemia is common in insulin-requiring diabetic women and is associated with increased cortisol secretion.

Circadian Rhythm↗
PubMed1985

Screening for carbohydrate intolerance in pregnancy: a comparison of two tests and reassessment of a common approach.

The usefulness of glycosylated hemoglobin as a prenatal screening test for carbohydrate intolerance was studied in 806 consecutive subjects by correlating glycosylated hemoglobin to 1-hour post-50 gm Glucola plasma glucose levels, 3-hour oral glucose tolerance tests, and perinatal and maternal outcomes. Sixty-seven subjects whose 1-hour post-50 gm Glucola plasma glucose levels were greater than or equal to 150 mg/100 ml underwent 3-hour oral glucose tolerance tests; 12 were diagnostic of carbohydrate intolerance. Compared to carbohydrate-tolerant control subjects, gravid patients with carbohydrate intolerance were older, more obese, had higher 1-hour post-50 gm Glucola plasma glucose and glycosylated hemoglobin levels, and infants with increased birth weight percentiles, depressed 5-minute Apgar scores, and an increased incidence of shoulder dystocia and perinatal mortality. Three of 10 carbohydrate-intolerant patients who were evaluated post partum were found to have previously undiagnosed diabetes. Division of measurements of 1-hour post-50 gm Glucola plasma glucose and glycosylated hemoglobin into normal, borderline, and suspicious groups demonstrated a reduction in discriminatory capability of glycosylated hemoglobin as compared to the 1-hour post-50 gm Glucola plasma glucose. We conclude that laboratory screening for carbohydrate intolerance should be a standard element of the prenatal evaluation; gravid patients found to have carbohydrate intolerance should be reevaluated post partum to rule out overt diabetes, and the 1-hour post-50 gm Glucola plasma glucose test is the preferred means of routine screening for carbohydrate intolerance in pregnancy.

Adult↗
PubMed1984

Glycosylated hemoglobin as a screening test for carbohydrate intolerance in pregnancy.

The usefulness of glycosylated hemoglobin as a prenatal screening test for carbohydrate intolerance was studied in 806 consecutive subjects by correlating glycosylated hemoglobin to 1-hour post-50 gm Glucola plasma glucose (1 degree G) levels, and 3-hour oral glucose tolerance tests (3 degrees GTT). Sixty-seven subjects whose 1 degree G greater than or equal to 150 mg/100 ml received a 3 degrees GTT; 12 were diagnostic of carbohydrate intolerance. Compared to carbohydrate-tolerant controls, carbohydrate-intolerant gravid patients had higher 1 degree G (p less than 0.001) and glycosylated hemoglobin (p less than 0.05) levels. Linear regression analysis of 1 degree G and glycosylated hemoglobin demonstrated r = 0.35 (p less than 0.0001). Compared to the glycosylated hemoglobin test, the 1 degree G screening test has greater specificity, sensitivity, and predictive value for a positive diagnosis. Consequently, the 1 degree G is a better routine screening test for carbohydrate intolerance than is glycosylated hemoglobin.

Diabetes Mellitus↗