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Biomedical subjects

M Blott

Publications and source records attributed to M Blott.

At least 19 recordsLinked to original sources
PubMed2001

Guidelines for the management of HIV infection in pregnant women and the prevention of mother-to-child transmission.

AIMS OF THE GUIDELINES: These guidelines, drawn up by a multidisciplinary group of clinicians and lay workers active in the management of pregnant women infected with HIV, aim to give up-to-date information on interventions to reduce the risk of mother to child transmission of the virus. The evidence on the use of interventions to prevent mother to child transmission of HIV has been graded according to the strength of the data as per the definitions of the US Agency for Health Care Policy and Research [1]. Weighted evidence on the use of combination antiretroviral therapy (ART) for the treatment of HIV infection per se is presented in the BHIVA guidelines for adults [2,3]. The highest level evidence (i.e. randomised controlled trials (RCTs) or large, well conducted meta-analyses) is only available for formula feeding, prelabour caesarean section and zidovudine monotherapy. The need to treat mothers for HIV infection has led to the widespread use of ART in pregnancy which in turn results in new questions such as how to deliver when the mother, on therapy, has no detectable plasma viraemia with the most sensitive assays. In addressing many common and/or difficult clinical scenarios in the absence of 'best evidence' the guidelines rely heavily on 'expert opinion'. Recommendations for management are given in the section on clinical scenarios, and summarized in Table 3. An expanded version of these guidelines with an appendix on safety and toxicity data is available on the BHIVA website http://www.bhiva.org. The authors are available to discuss individual cases.

Adult↗
PubMed2001

Acceleration of diabetic retinopathy in pregnancy: a case report.

AIMS: Diabetic retinopathy can deteriorate during pregnancy. This usually manifests itself as an increase in the number of background retinopathy lesions, notably the appearance of new cotton wool spots, predominantly during the first trimester. The changes are usually attributed to the rapid attainment of tight glycaemic control during pregnancy. We present a case report of catastrophic deterioration in retinopathy during a period of stable glycaemic control. RESULTS: J.P. had normal fundoscopic appearance at booking and during the early part of pregnancy. She experienced rapid deterioration in visual acuity secondary to cystoid macular oedema and vitreous haemorrhage during the third trimester of pregnancy. Her glycaemic control was stable at that stage and had not changed when compared with earlier stages of pregnancy. She required three sessions of intrapartum laser therapy and postpartum vitrectomy. CONCLUSIONS: The case highlights the importance of regular retinal surveillance in a diabetic pregnancy, even in the absence of sudden improvements in glycaemic control.

Adult↗
PubMed1995

Preterm prelabor amniorrhexis: outcome of live births.

OBJECTIVE: To investigate the risk of postnatal death in pregnancies with preterm prelabor amniorrhexis in relation to gestational age at both amniorrhexis and delivery. METHODS: In 172 singleton pregnancies with preterm prelabor amniorrhexis resulting in live births, postnatal survival and cause of death were examined in relation to gestational age at both amniorrhexis and delivery. In 108 of the patients, the amniotic fluid index (AFI) and fetal breathing movements were determined, and in 98, the internal thoracic circumference and cardiothoracic ratio were also measured. The value of these indices in the prediction of pulmonary hypoplasia was examined. RESULTS: There were 30 (17%) deaths, 18 of which were due to pulmonary hypoplasia and 12 to prematurity-related complications. Survival was related to both gestational age at amniorrhexis (50% for amniorrhexis before 20 weeks' gestation and 98% when amniorrhexis occurred after 25 weeks) and gestational age at delivery (57% for those born at 24-28 weeks' gestation and 96% for those born after 32 weeks). Pulmonary hypoplasia was also related to both gestational age at amniorrhexis (causing 92% of deaths in the group with amniorrhexis at less than 20 weeks' gestation but none of those with amniorrhexis after 23 weeks) and gestational age at delivery (causing 50% of deaths in the group delivered at 24-28 weeks' gestation and 87% of deaths in infants delivered after 28 weeks). Fetal breathing movements were present in 33 and 63% of cases with and without pulmonary hypoplasia, respectively. The corresponding values for internal thoracic circumference below the 2.5 percentile were 33 and 9%, respectively. There were no significant differences in the AFI or cardiothoracic ratio between the cases with and without pulmonary hypoplasia. Multivariate analysis demonstrated that the only characteristic that contributed significantly in distinguishing between cases with and without pulmonary hypoplasia was gestational age at amniorrhexis. CONCLUSION: In pregnancies with preterm prelabor amniorrhexis, postnatal survival is related to both gestational age at amniorrhexis and gestational age at delivery. Prediction of pulmonary hypoplasia is primarily dependent on gestational age at amniorrhexis.

Amnion↗
PubMed1990

Fetal breathing movements in pregnancies complicated by premature membrane rupture in the second trimester.

Forty pregnancies complicated by oligohydramnios in the second trimester due to prolonged and premature membrane rupture (PPROM) were followed prospectively to determine factors influencing fetal breathing activity and the relationship of fetal breathing movements (FBM) to outcome. The patients were retrospectively divided into three groups according to the presence or absence of FBM. Membrane rupture occurred at a significantly earlier gestation in those pregnancies in which FBM were absent. Duration of membrane rupture only differed significantly between pregnancies in which FBM were intermittent or consistently present. In the group in which FBM were always absent (N = 12) all the infants died in utero or in the neonatal period due to pulmonary hypoplasia. In the group with FBM always present (N = 17) all infants survived. In the third group FBM were observed in some, but not all, ultrasound examinations (N = 11). Some infants survived (N = 6), while others died either due to pulmonary hypoplasia or neonatal sepsis. These results show the necessity for several serial ultrasound examinations, all demonstrating the absence of fetal breathing movements, before pulmonary hypoplasia in PPROM can be predicted confidently.

Amniotic Fluid↗
PubMed1990

The ultrasonographic assessment of the fetal thorax and fetal breathing movements in the prediction of pulmonary hypoplasia.

Comparison was made of fetal breathing movements (FBM) and thoracic measurements in the prenatal diagnosis of pulmonary hypoplasia. In 20 pregnancies with oligohydramnios due to premature and prolonged rupture of the membranes (PROM) the presence or absence of FBM was assessed, the internal thoracic and cardiac circumferences were measured and the internal thoracic and lung areas calculated. All 5 infants with absent FBM died from pulmonary hypoplasia in the neonatal period and all 15 with FBM present survived. The internal thoracic circumference of 3 of the fetuses that developed pulmonary hypoplasia and 1 of those that did not were below the 2.5th centile of a reference range constructed from 76 normal pregnancies. Similarly, the lung areas were below the 2.5th centile of our reference range in 3 fetuses who developed pulmonary hypoplasia and 2 of those that survived. The absence of FBM was found to be the most accurate predictor of pulmonary hypoplasia in pregnancies complicated by oligohydramnios due to PROM.

Amniotic Fluid↗
PubMed1989

Premature membrane rupture in pregnancies of less than 34 weeks gestation.

The outcome of pregnancies complicated by premature membrane rupture (PROM) at gestations of less than 34 weeks during a one-year period was reviewed. At presentation, infection was suspected in 12 of the 56 mothers, but confirmed in only three. All non-infected patients were then admitted to the ward and managed expectantly. Despite membrane rupture of up to 3-weeks duration, there were no episodes of proven maternal infection amongst the inpatients. Following delivery, seven babies had positive blood cultures; antenatal infection had been suspected, but not proven, in one case only. Four mothers developed postpartum infection which responded to antibiotic therapy. All mothers with infection, presenting either antenatally or postnatally, delivered within 48 h of membrane rupture and in all infected neonates the duration of membrane rupture was 72 h or less. The occurrence of sepsis was not related to the gestational age at onset of the membrane rupture. We conclude that patients with rupture of the membranes of 72 h duration or longer may be admitted for expectant management, even if presenting early in the second trimester, without an increased risk of infection.

Female↗