Biomedical subjects

M L Druzin

Publications and source records attributed to M L Druzin.

At least 55 records · Page 3Linked to original sources

PubMed1989

Maternity shelter care for adolescents: its effect on incidence of low birth weight.

A group of 112 pregnant adolescents residing in a maternity shelter was compared with a group of 113 pregnant adolescents residing in their own homes but receiving identical medical care. The sheltered group was made up of a particularly high-risk group: they were more likely to be black, unmarried, receiving public assistance, and registered later for prenatal care than the group living at home. Despite these differences, the sheltered group delivered significantly fewer infants of low birth weight and preterm gestation than the control group. Variables assessed in this study fail to explain this difference. It is concluded that the services offered in a maternity shelter can have a positive impact on the reduction of low birth weight deliveries in a group of high-risk patients. These results indicate that the social and behavioral correlates of low birth weight remain to be fully defined and understood.

Adolescent↗

PubMed1989

The effect of vibroacoustic stimulation on the nonstress test at gestational ages of thirty-two weeks or less.

The effect of vibroacoustic stimulation on the nonstress test at gestational ages of less than or equal to 32 weeks was studied in 15 patients who underwent a total of 316 nonstress tests starting at 20 to 25 weeks' gestation. There were 168 nonreactive nonstress tests that were followed by 3 seconds of vibroacoustic stimulation. The incidence of reactive nonstress tests after vibroacoustic stimulation was significantly increased after 26 weeks' gestation. This may have clinical applicability and may be related to functional maturation of the fetal auditory system.

Acoustic Stimulation↗

PubMed1989

Expectant management of abruptio placentae before 35 weeks gestation.

Forty-three patients with abruptio placentae before 35 weeks of pregnancy were managed expectantly with observation or with tocolytic therapy when contractions were present. Mean time to delivery was 12.4 days. Twenty-three patients were delivered within 1 week of admission. In the remaining 20 patients, the mean time to delivery was 26.8 days. There were no intrauterine deaths. In properly selected patients with preterm gestation and low-grade abruptio it is reasonable to defer delivery. These patients must be followed closely with antepartum fetal heart rate monitoring, serial hematologic and coagulation profiles, and serial sonograms when indicated.

Abruptio Placentae↗

PubMed1989

Early prediction of antepartum hypertension.

We validated a mid-pregnancy screening mean arterial pressure (MAP2) of 85 mmHg or higher as a significant predictor of hypertension in pregnancy. During the 17-month period from October 1984 through February 1986, 730 women, or 16% of all women cared for and delivered at our institution, were screened at or near 20 weeks of amenorrhea. Of the 139 women with a MAP2 of 85 mmHg or higher, 21.6% developed antepartum hypertension, compared with only 0.7% of the 591 women with a MAP2 below 85 mmHg. The screening MAP2 level of 85 mmHg was the optimal cutoff for MAP2 as a screening test. Controlling for the value of the screening MAP2, the only other important predictors of antepartum hypertension were chronic hypertension and diabetes mellitus. Using these three variables, the probability that an individual pregnant woman will develop antepartum hypertension can be assessed with a high degree of accuracy (84.5%) by 20 weeks of amenorrhea. This assessment is noninvasive and simple to use. Three distinct levels of risk have been defined; the moderate- and high-risk groups warrant careful surveillance during pregnancy and may be reasonable groups in which to test preventive interventions.

Adult↗

PubMed1989

Antepartum fetal heart rate monitoring. State of the art.

1. AFHRT remains one of the most widely used methods of assessing fetal condition. 2. The actual types of tests used as primary surveillance tests are unimportant. Both the NST and CST have been successfully used. 3. The clinician should adopt a scheme in which they have all the data necessary to determine whether this will fit in with their practice. 4. Characteristics other than reactivity or nonreactivity are important. a. Abnormal baseline fetal heart rate or beat-to-beat variability b. Fetal heart rate decelerations 5. Amniotic fluid volume assessment is important particularly in cases of postdates and intrauterine growth retardation. 6. Condition-specific AFHRT (i.e., modifications of schemes to fit clinical circumstances) is an important concept. 7. Testing at gestational ages of 26 to 28 weeks may be appropriate in certain situations. After 28 weeks, AFHRT can be used reliably. 8. The integration of an AFHRT scheme into the total clinical picture is the key to success.

Cardiotocography↗

PubMed1989

Fetal bradycardia during antepartum testing. Further observations.

One hundred twenty-one cases of antepartum fetal bradycardia, occurring at 36 weeks' gestation or greater, were prospectively managed by active intervention and delivery. There were no fetal deaths. Intrapartum complications were similar at all gestational ages, regardless of whether the bradycardia was associated with a reactive or nonreactive nonstress test. Only the incidence of low five-minute Apgar scores was significantly higher in the nonreactive group. The incidence of cord compression patterns (variable decelerations) in labor was higher than that of uteroplacental insufficiency patterns (late decelerations). Intervention with delivery in the presence of fetal bradycardia should be considered in all cases with evidence of fetal lung maturity.

Bradycardia↗

PubMed1989

Uterine incision and maternal morbidity after cesarean section for delivery of the very low birthweight fetus.

The maternal morbidity associated with the type of uterine incision used for the delivery of the very low birthweight (VLBW) fetus was examined. Maternal morbidity factors evaluated included the incidence of infection, bleeding, wound complications, estimated blood loss, blood transfusions, fever and days in hospital. Cesarean section was performed in 115 of 197 VLBW infants, with 31 low transverse and 84 vertical cesarean sections. There were no significant differences in antepartum, intrapartum or postpartum data between these two groups. Short term maternal morbidity was not increased with the use of vertical compared with low transverse cesarean section for the delivery of the VLBW fetus.

Cesarean Section↗

PubMed1989

Total complement activity in maternal sera, amniotic fluids and cord sera in women with premature labor, premature rupture of membranes or chorioamnionitis.

Total hemolytic complement activity (CH50) was determined in maternal sera, amniotic fluids or cord sera, or all, from 119 patients with preterm uterine contractions, premature rupture of membranes or chorioamnionitis, or all, at 24 to 40 weeks of gestation. The mean CH50 of maternal sera exceeded the mean CH50 of both amniotic fluids and cord sera. The mean CH50 of amniotic fluids exceeded that of cord sera and increased significantly at 32 weeks. This rise preceded that of the mean CH50 of cord sera, which occurred at a fetal weight of approximately 2,500 grams. The mean CH50 of amniotic fluids varied significantly and inversely with that of cord sera. The levels of CH50 in these three fluids did not distinguish between patients with preterm uterine contractions who delivered prematurely and those who delivered at term. The CH50 in patients with premature rupture of membranes did not differ from a control population of women with uncomplicated pregnancies. The mean CH50 of maternal sera was increased in patients with chorioamnionitis but was not predictive of chorioamnionitis. The mean CH50 of maternal sera was decreased in patients who smoked cigarettes and in patients who received intravenous ritodrine.

Amniotic Fluid↗

PubMed1989

Packing of lower uterine segment for control of postcesarean bleeding in instances of placenta previa.

Hemorrhage remains a serious obstetric complication with uterine atony as its most common cause. Postpartum atony is controlled with oxytocics and prostaglandins. Uterine arterial ligation is used to decrease the degree of postpartum hemorrhage. Hypogastric arterial ligation and hysterectomy are used when conservative measures fail. With placenta previa accreta, the aforementioned techniques are often not successful in the control of bleeding in the lower segment. The technique of packing of the lower uterine segment is described for use when local control of bleeding points is unsuccessful and hysterectomy is contemplated. Preservation of reproductive potential may be accomplished with this technique with minimal maternal morbidity.

Cervix Uteri↗

PubMed1989

Intrapartum uterine rupture.

The association between diethylstilbestrol (DES) exposure in utero and uterine malformations resulting in poor reproductive performance is well established. A case is presented of uterine rupture in a patient exposed to DES in utero who had no known predisposing factors for uterine rupture.

Adult↗

PubMed1988

Neonatal lupus risk to newborns of mothers with systemic lupus erythematosus.

We prospectively studied 91 infants born to women with systemic lupus erythematosus (SLE) or with SLE-like disease. Thirty-eight infants, including 3 sets of twins, were born to women who had anti-Ro, anti-La, or anti-RNP antibodies. Four infants had definite neonatal lupus, and 4 had possible neonatal lupus. No prospectively studied infant had congenital heart block. The presence of neonatal lupus did not correlate with the titer of anti-Ro antibodies. During the same time period, 2 additional babies with neonatal lupus and congenital heart block were born to mothers not previously known to have SLE. Taken together, these findings confirm the association of anti-Ro antibody with neonatal lupus, but indicate that life-threatening neonatal lupus is rare in children born to mothers who are known to have SLE, even when antibodies to Ro, La, or RNP are present. Prophylactic therapy is therefore not indicated for these women. An important proportion of mothers bearing children with neonatal lupus do not have recognized SLE and, currently, cannot be prospectively identified.

Antibodies↗

PubMed1988

Donation of blood by the pregnant patient for autologous transfusion.

A study was conducted to determine the safety and utility of autologous blood donation in third trimester pregnancy. Thirty-seven obstetric patients, 32 with an obstetric risk factor, donated an average of 485 ml of blood. Twenty-one of the 37 patients were expected to undergo cesarean section. Nonstress testing was performed before and after phlebotomy. Continuous fetal heart rate monitoring was maintained throughout the donation, which lasted an average of 9 minutes. All nonstress test results were normal before and after the phlebotomy except in one case. All fetal heart rates remained stable during phlebotomy and premature labor was not precipitated. All fetal outcomes were normal. One patient delivered on the day of phlebotomy, 6 hours after the procedure. Only one of the autologous units was used, in a patient who had a pelvic infection and moderate anemia. The incidence of primary cesarean section was 35%. Phlebotomy of the mother appears to be safe for the fetus at term. Further investigation is needed to determine the safety of removal of more than 1 unit of blood and blood donation at earlier gestational ages.

Adult↗

PubMed1988

Development and validation of a multivariate predictor of mortality in very low birth weight.

Accurate prognosis is critical to the design of all prospective research aimed at improving survival. Predictions based on birth weight, gestational age, or any other single variable, fail to take into account the potentially important contribution of other factors. In order to develop a practical and accurate multivariate model, we studied all singleton pregnancies resulting in viable liveborn infants who weighed less than or equal to 1500 g at birth during 1984 and 1985 at the New York Hospital-Cornell Medical Center. When gestational age, birth weight, and/or crown-heel length were considered, no maternal characteristics were significant predictors of mortality. The model with the maximal predictive accuracy (84.5%) used birth weight and 5-minute Apgar score to calculate a probability of mortality. This prognostic model was then validated in a separate cohort of singletons born in 1986. We conclude that clinical trials should require stratification before randomization, using the calculated probability of mortality, rather than birth weight or gestational age alone. Given the ability of models, such as the one presented here, to generate reasonable estimates of mortality, this information might also be used in the clinical setting to assist parents and physicians in individualized decision-making processes for a given infant.

Adult↗

PubMed1987

Hypocalciuria in preeclampsia.

We studied 40 women in the third trimester of pregnancy to determine whether alterations in serum calcium levels or in urinary calcium excretion would distinguish patients with preeclampsia from normal pregnant women or women with other forms of gestational hypertension. Our population included 10 normal pregnant women, 5 pregnant women with transient hypertension, 6 with chronic hypertension, 7 with chronic hypertension and superimposed preeclampsia, and 12 with preeclampsia. The serum levels of ionized calcium, phosphate, and 1,25-dihydroxyvitamin D were not different among the various groups. In contrast, the mean (+/- SD) 24-hour urinary calcium excretion in the patients with preeclampsia or hypertension with superimposed preeclampsia was significantly lower (42 +/- 29 and 78 +/- 49 mg) than that in normal pregnant women (313 +/- 140 mg per 24 hours), women with transient hypertension (248 +/- 139 mg per 24 hours), or women with chronic hypertension (223 +/- 41 mg per 24 hours) (P less than 0.0001). The hypocalciuria in the women with preeclampsia was associated with a decreased fractional excretion of calcium. Although the mean creatinine clearance was reduced in the women with preeclampsia, the range of values overlapped with those in the other groups. In contrast, we observed little or no overlap with respect to calcium excretion. We conclude that preeclampsia is associated with hypocalciuria due to increased tubular reabsorption of calcium. Measurement of calcium excretion may be useful in distinguishing preeclampsia from other forms of gestational hypertension.

Adult↗

PubMed1987

Second-trimester fetal monitoring and preterm delivery in pregnancies with systemic lupus erythematosus and/or circulating anticoagulant.

Antepartum fetal monitoring was initiated at 19 to 26 weeks' gestation in 15 pregnancies: six (five with systemic lupus erythematosus, one with circulating anticoagulant) with a complicated antepartum course (group 1); three, all systemic lupus erythematosus, with a normal antepartum course (group 2); and six normal control pregnancies (group 3). Group 1 all exhibited nonperiodic fetal heart rate decelerations, without the classical appearance of early, late, or variable decelerations, and four of the six had fetal bradycardia. In three group 1 cases, there was no active intervention because of early gestational age, and fetal death occurred at 23, 27, and 27 weeks, respectively. The other three patients in group 1 received betamethasone and were delivered by cesarean section at 28 to 30 weeks. There were no cases of respiratory distress syndrome or neonatal death. Five of the six infants in group 1 were small for gestational age. The nonperiodic fetal heart rate decelerations were absent in both groups 2 and 3 who all had normal fetal outcomes at term. The abnormal finding of women with nonperiodic fetal heart rate decelerations at 20 to 28 weeks may detect the fetus at risk for intrauterine death in pregnancies complicated by systemic lupus erythematosus or circulating anticoagulant. Continued surveillance, steroid induction of lung maturity, and delivery should be considered in these cases.

Adult↗

PubMed1987

Fetal heart rate response to vibratory acoustic stimulation predicts fetal pH in labor.

Vibratory acoustic stimulation was performed during labor in 188 instances 60 seconds before fetal scalp puncture was done to determine fetal scalp blood pH. The fetal heart rate response was recorded for both vibratory acoustic stimulation and fetal scalp puncture. No instance of fetal acidosis occurred in the presence of an acceleration to either vibratory acoustic stimulation or fetal scalp puncture. Vibratory acoustic stimulation was more likely to elicit an acceleration than fetal scalp puncture in the nonacidotic fetus. Vibratory acoustic stimulation is less invasive and may be used in some instances in which fetal scalp blood puncture for pH determination is technically impossible.

Acoustic Stimulation↗

PubMed1987

Antibody to cardiolipin, lupus anticoagulant, and fetal death.

We compared the concordance and predictive powers of activated partial thromboplastin time (APTT) and of IgG and IgM antibody to cardiolipin (aCL), for predicting fetal death in 50 pregnant women with systemic lupus erythematosus (SLE) and/or lupus anticoagulant. Overall concordance of any abnormal determination of aCL during pregnancy with any abnormal determination of APTT was 76% (0.05 less than p less than 0.10). Fetal death occurred in 6/12 (50%) of patients with high APTT compared to 5/20 (16%) of patients with low APTT; fetal death occurred in 10/13 (77%) of patients with abnormal aCL and in 2/37 (5%) of patients with normal aCL. Sensitivity for predicting fetal death was .55 for APTT and .85 for aCL; specificity was .81 for APTT and .92 for aCL. Abnormalities of APTT and aCL are sufficiently frequently discordant to prevent equation of the 2 assays. ACL is the better assay for predicting fetal death.

Antibodies↗

PubMed1987

Hazards of lupus pregnancy.

Fetal death occurs in about 1/3 of pregnancies in patients with systemic lupus erythematosus (SLE). It is largely predicted by lupus anticoagulant (estimated by activated partial thromboplastin time) and/or antibody to cardiolipin. These antibodies are not synonymous. Neonatal lupus appears in a minority of infants born to women with antibody to the Ro/La antigens. Hypocomplementemia is common in SLE pregnancies, as in pregnancy induced hypertension. Lupus exacerbation is uncommon either during or after pregnancy. Prematurity and fetal death are the greatest hazards.

Autoantibodies↗