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Biomedical subjects

L I Burd

Publications and source records attributed to L I Burd.

At least 19 recordsLinked to original sources
PubMed1998

A randomized trial of misoprostol and extra-amniotic saline infusion for cervical ripening and labor induction.

OBJECTIVE: To compare the cesarean rates in women undergoing induction of labor with unfavorable cervices who receive either misoprostol or extra-amniotic saline infusion. METHODS: We assigned 250 women undergoing indicated induction of labor randomly to misoprostol (50 microg every 4 hours for three doses with or without oxytocin) or extra-amniotic saline infusion and oxytocin. Each eligible subject had a singleton gestation, vertex presentation, intact membranes, cervical dilation no more than 2 cm, and effacement no more than 50%. RESULTS: Two hundred forty-eight women were studied after two exclusions; 120 were assigned to misoprostol, and 128 to extra-amniotic saline infusion. This sample size ensured an 80% chance of detecting an intergroup difference in cesarean rates of at least two-fold. The groups were similar in age, race, parity, indication for induction, and gestational age. The extra-amniotic saline infusion group had a significantly lower median initial dilation; however, at 12 hours, this group was significantly more dilated. The groups also were similar in epidural use, chorioamnionitis rates, endometritis rates, birth weights, and neonatal outcomes. Overall, 23% of women underwent cesarean deliveries, 18% and 27% for the misoprostol and extra-amniotic saline infusion groups, respectively (P = .12). There were no significant differences in the median time to either vaginal or cesarean delivery between the two groups. Eighty-one percent of women were delivered in less than 24 hours from initiation of induction; 78% in the misoprostol group, and 84% in the extra-amniotic saline infusion group (P = .19). CONCLUSION: Both methods of labor induction appear to be equally effective in this group of women at high risk for cesarean delivery and prolonged induction of labor.

Adult↗
PubMed1996

Pregnancy outcome in women with low midtrimester maternal serum unconjugated estriol.

OBJECTIVE: To determine if unexplained low second-trimester maternal serum unconjugated estriol (MSuE3) is a useful predictor of complications of pregnancy. STUDY DESIGN: Between February 1, 1990, and January 3, 1993, 10,492 patients underwent prenatal screening using second-trimester maternal serum alpha-fetoprotein (MSAFP), maternal serum human chorionic gonadotropin (MShCG) and MSuE3. One hundred ninety-five patients with complete obstetric history/delivery records and with < 0.4 multiples of the median (MoM) second-trimester MSuE3 values were matched with 261 controls with complete obstetric history/delivery records and normal second-trimester MSAFP, MSuE3 and MShCG. RESULTS: The relative risk of pregnancy loss, as compared to that in controls, was 3.7 (1.4-9.1 confidence interval [CI], P < .0001) in patients with 0.2-0.4 MoM MSuE3 and 19.3 (6.1-60.5 CI, P < .0001) in patients with < 0.2 MoM MSuE3. After exclusion of patients with low and high MSAFP and MShCG, the relative risk of pregnancy loss for the remaining patients with low MSuE3 was 3.3 (1.3-8.5 CI, P < .008). CONCLUSION: The data suggest that patients with unexplained low second-trimester MSuE3 have an increased risk of pregnancy loss that may not be associated with a high or low MSAFP, MShCG or higher incidence of pregnancy-induced hypertension, gestational diabetes, premature rupture of membranes or premature onset of labor.

Adult↗
PubMed1995

An increased incidence of haemangiomas in infants born following chorionic villus sampling (CVS).

The incidence of haemangiomas was ascertained by questionnaire in infants born to 578 consecutive CVS patients and 445 consecutive mid-trimester amniocentesis patients seen at a single institution between 1 January 1989 and 31 May 1991. The incidence of 7.4 per cent reported in the amniocentesis group was comparable to previous estimates of the incidence of haemangiomas in the general population. In contrast, a 21.1 per cent incidence, three-fold higher than that observed in the amniocentesis group, was observed among CVS-exposed infants (P < 0.001). This increased incidence was largely confined to patients undergoing a transcervical procedure. No correlation was observed between the incidence of haemangiomas and gestational age at sampling, sample size, number of sampling attempts, or a history of bleeding following the procedure.

Abdomen↗
PubMed1992

Limb anomalies associated with chorionic villus sampling.

Data on outcome of pregnancy were obtained in 436 (94%) of 463 patients undergoing chorionic villus sampling (CVS) at Humana Hospital-Michael Reese between January 1, 1989 and November 30, 1990. There were 18 elective abortions, 27 fetal and neonatal losses, and 391 surviving infants. Of the 394 fetuses and infants who were adequately evaluated, a total of 13 (3.3%) had major congenital anomalies, including four with transverse limb reduction deformities, three with cleft lip with or without cleft palate, and one each with a nasal encephalocele, large port-wine stain, craniosynostosis, omphalocele with associated defects, ambiguous genitalia, and undescended testes. The limb malformations in the four affected infants were all very similar and were comparable to those described by others in association with CVS. Three of the cases of limb malformations followed transcervical CVS; one followed a transabdominal procedure. The procedures were performed at 9.5, 9.5, 10.5, and 11 weeks' gestation. An adequate sample was obtained with a single attempt in each case. These observations, in conjunction with others in the literature, suggest that there is an increased risk of limb anomalies associated with CVS. A vascular etiology, related to either decreased fetal perfusion or thrombosis of the sampling site with subsequent embolization, is suggested.

Chorionic Villi Sampling↗
PubMed1983

Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. I. Epidemiologic rationale.

Between 1973 and 1981, 61 cases of neonatal group B streptococcal early-onset disease occurred among 32,384 infants born at Michael Reese Hospital and Medical Center, Chicago. Forty-one (67%) of the 61 affected infants were bacteremic at birth, implying intrapartum acquisition of infection. No significant deviations from the overall attack rate of 1.9 per 1,000 live births were associated with maternal demographic factors, but increased attack rates were associated with birth weights of less than or equal to 2.5 kg (7.9 per 1,000), rupture of amniotic membranes greater than 18 hr before birth (7.6 per 1,000), and intrapartum fever (6.5 per 1,000). Forty-five (74%) of the 61 affected infants and 15 (94%) of the 16 with fatal outcome had one or more of these three perinatal risk factors. Based on an intrapartum vaginal carriage rate of 16.7% among parturients with perinatal risk factors, an attack rate of 45.5 per 1,000 was estimated for infants born to colonized "high-risk" parturients, a subgroup comprising approximately 3% of our obstetric population. These findings provide a compelling epidemiologic rationale for trials of selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease.

Anti-Bacterial Agents↗
PubMed1983

Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. II. Predictive value of prenatal cultures.

To determine the value of prenatal cultures in defining maternal colonization status at delivery, 5,586 pregnant women were screened at prenatal visits for vaginal and rectal carriage of group B streptococci (GBS). GBS were isolated from 1,272 (22.8%). At delivery, semiquantitative cultures were obtained from 393 prenatal carriers, of whom 264 (67.2%) retained carriage at delivery. Seventeen (8.5%) of 200 women with negative prenatal cultures acquired carriage. The predictive value of a positive prenatal culture was highest (72.5%) in women with prenatal vaginal and rectal colonization and lowest (59.7%) in women with only rectal colonization. The predictive value varied inversely with the interval between prenatal sampling and delivery. In mothers with prenatal carriage, density of colonization at parturition was not predicted by the sites of prenatal colonization. Density of colonization, however, strongly influenced rates of vertical transmission to neonates and rates of heavy infant colonization. Ten infants born to prenatally cultured mothers developed group B streptococcal early-onset disease; the mothers of eight (80%) of the 10 had prenatal colonization with the homologous GBS serotype.

Ampicillin↗
PubMed1981

Lack of relationship between prolactin and adrenal steroidogenesis in the ovine fetus.

The role of fetal prolactin (PRL) as a fetal adrenotropic hormone was investigated in eight chronically catheterized fetal lambs. Catheters were placed for measurement of plasma prolactin (PRL), cortisol (F), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione (A). Daily (9 AM) samples were obtained until the onset of labor. In four animals 2-Br-alpha-ergocryptine (BC) was administered subcutaneously (1 mg/12 hours) for 11 to 21 days prior to delivery. Four animals served as controls. No difference between groups was noted in the duration of gestation. PRL increased in the control animals from 8.4 +/- 2.4 to 43.0 +/- 5.6 ng/ml (mean +/- SEM) at the time of delivery whereas in animals that received BC it decreased within 24 hour of administration and remained below 3 ng/ml throughout the study period. No differences were noted in the concentration of F, DHEA, DHEA-S, and A between groups. These results suggest that PRL does not play a role in adrenal steroidogenesis or in the initiation of parturition.

Adrenal Cortex Hormones↗
PubMed1978

The relationship of changes in mammary blood flow and plasma progesterone at the time of parturition in the ewe.

Previous studies indicate that there is a fall in maternal plasma progesterone and a marked increase in mammary blood flow (MBF) at the time of parturition in ewes. In this experiment the role of progesterone as a cause of this increase in MBF was investigated. Progesterone was infused (9.9 mcg. per minute) into a branch of the mammary artery in five sheep during the induction of premature labor by fetal dexamethasone infusion (1 mg. per 24 hours) to prevent the normal fall in concentration of local mammary artery progesterone. Five ewes used as controls received a mammary artery infusion of cholesterol (9.9 mcg. per minute). In the cholesterol-infused group MBF increased significantly from baseline after 13 +/- 4 hours (mean +/- standard error) to a peak flow of 235 +/- 9 ml. per minute. In the group receiving the progesterone the increase in MBF was delayed to 35 +/- 7 hours, reaching only 161 +/- 22 ml. per minute. These results were significantly different from control group results (p less than 0.01). This study suggests that the fall in maternal plasma progesterone which occurs at the time of parturition may play a role in the increase in MBF that occurs prior to the onset of labor, delivery, and lactogenesis.

Animals↗
PubMed1977

The relationship of mammary temperature to parturition in human subjects.

Four hundred and seventy thermography studies were performed on 210 women to measure mammary temperature prior to, during, and immediately following pregnancy. Mean mammary temperature of 33.3 +/- 0.1 degrees C. (S.E.M.) obtained in 14 nonpregnant patients increased to 34.2 +/- 0.1 C. (S.E.M.) by nine weeks of gestation (p less than 0.01). The difference between mammary and sternal temperature was negative in the nonpregnant state and became positive after 18 weeks of pregnancy. Mammary temperature remained significantly higher in the pregnant group than in the nonpregnant group (p less than 0.001) up to term. In six postpartum patients, a further increase from prepartum values to 35.4 +/- 0.6 degrees C. (S.E.M.) occurred. The results suggest that relatively large changes in mammary blood flow and/or metabolic rate take place in human subjects in early pregnancy and on the day following parturition.

Body Temperature↗
PubMed1976

Mammary blood flow and endocrine changes during parturition in the ewe.

The temporal relationship between changes in mammary blood flow (MBF) and changes in the concentration of plasma prolactin, progesterone, estradiol-17beta, and cortisol, was examined in chronic sheep preparations undergoing spontaneous labor (Group I) or labor induced by an infusion of dexamethasone (1 mg/24 h) to the fetus (Group II). In Group I, an increase in prolactin (45 to 489 ng/ml), a decrease in progesterone (15 to 4 ng/ml), and an increase in MBF (97 to 365 ml/min) occurred at about the same time, whereas increases in estradiol-17beta (80 to 211 pg/ml) and cortisol (9 to 39 ng/ml) followed the change in MBF. A similar pattern of changes in MBF and hormonal concentrations occurred over a shorter period when premature labor was induced in the animals in Group II. These findings suggest that changes in plasma prolactin and progesterone concentrations play an important role in the regulation of MBF at the time of parturition.

Animals↗
PubMed1975

Failure of association of premature rupture of membranes with respiratory-distress syndrome.

Records on 16,458 consecutive births were examined to determine associations between the respiratory-distress syndrome of the newborn and cesarean section, maternal diabetes, ante-partum hemorrhage, toxemia of pregnancy, low one-minute Apgar scores and prolonged rupture of fetal membranes. Groups of infants were compared by four-week gestational age blocks. One-minute Apgar scores of less than 5 and of less than 8 were associated with a significant ( less than 0.05) increase in the incidence of respiratory-distress syndrome at gestational ages beyond 30 weeks. Cesarean section was associated with a significant increase after 34 weeks of gestation. There was no association between the syndrome and toxemia of pregnancy, ante-partum hemorrhage or prolonged rupture of fetal membranes. These data do not support the hypothesis that there is a lower incidence of the respiratory-distress syndrome in infants born after prolonged rupture of fetal membranes.

Apgar Score↗
PubMed1975

Cerebral metabolism in sheep: a comparative study of the adult, the lamb, and the fetus.

The cerebral uptakes of glucose, oxygen, lactate, pyruvate, acetoacetate and beta-hydroxybutyrate were compared in the adult, the fetal, and the newborn sheep. Beginning 1-2 days after surgery, we withdrew samples simultaneously from an artery and from the sagittal sinus for up to 2 wk. At all ages glucose was the only substrate taken up in significant quantity relative to oxygen. The glucose-oxygen quotients were 0.98 less than 1.03 less than 1.08 in adults; 0.92 less than 0.99 less than 1.06 in lambs; 0.92 less than 0.98 less than 1.03 in fetuses. These quotients were not significantly different. There was a significant (P less than .05) arteriovenous difference for lactate in the adult (-0.031 mM), but not in the lamb or fetus. A significant (P less than .05) arteriovenous difference pyruvate was found in the adult (-0.013 mM) and in the fetus (-0.020 mM). The findings of a glucose-oxygen quotient of approximately 1 and the lack of significant lactate production in fetal sheep brain are consistent with the hypothesis that anerobic glycolysis is unimportant to the steady-state cerebral metabolism of the fetal sheep.

Acetoacetates↗
PubMed1975

Relationship of mammary blood flow to parturition in the ewe.

Mammary blood flow was measured in conscious, unanesthetized ewes with electromagnetic flow probes prior to spontaneous labor (four animals) or during the induction of premature labor (four animals) by administration of dexamethasone, 1 mg/24 h, to the fetus. In all animals an increase in mammary blood flow was noted prior to delivery. Dexamethasone administered to one mother in the same dose did not induce labor or produce an increase in mammary blood flow. These results suggest that the fetal adrenal gland influences maternal mammary blood flow prior to delivery.

Animals↗