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Biomedical subjects

P R Meier

Publications and source records attributed to P R Meier.

At least 19 recordsLinked to original sources
PubMed1995

The value of urine screening for glucose at each prenatal visit.

OBJECTIVE: To determine whether chemical (dipstick) urinalysis for glucose at each prenatal visit predicts gestational outcomes such as gestational diabetes, abruptio placentae, preterm delivery, fetal heart rate abnormality, cesarean delivery for dystocia, fetal macrosomia, and shoulder dystocia. METHODS: We retrospectively evaluated each of the 3217 women who were delivered at St. Joseph's Hospital between July 1, 1990, and September 1, 1993, and who had received all prenatal care at Marshfield Clinic. Study subjects had complete urinalyses at the first prenatal visit, blood glucose diabetes screening at 24-28 weeks, and dipstick urinalysis for glucose at each prenatal visit. Women were excluded because of preexisting diabetes, multiple gestation, glucosuria at the first prenatal visit, or failure to complete the recommended blood screening at 24-28 weeks. The remaining 2965 women were grouped according to whether their dipstick urine tests were positive for glucose. Then the two groups were compared with regard to relevant pregnancy outcomes. RESULTS: Women with glucosuria in the first two trimesters had a significantly higher incidence of gestational diabetes (12.8 versus 2.9%, P = .003). For women without evidence of gestational diabetes, there were no clinically important differences in the measured pregnancy outcomes between the two groups. CONCLUSION: Routine dipstick urinalysis for glucose can identify gravidas at increased risk for gestational diabetes, possibly allowing certain women with gestational diabetes to be diagnosed earlier than 24-28 weeks. However, most glucosuria testing is performed after a patient has completed routine blood screening for gestational diabetes. This third-trimester testing is not predictive of any clinically important pregnancy outcome.

Diabetes, Gestational↗
PubMed1991

Effect of epidural analgesia on the primary cesarean rate.

There is some concern that providing parturients with epidural analgesia increases the likelihood of cesarean delivery. Because of the widespread interest in cesarean rates and the expanding use of epidural analgesia, we believed that this contention should be assessed. Hospital records were reviewed to determine the primary cesarean rate for 1084 parturients who delivered at our institution during 15 months in which there was a 24-hour "on demand" epidural service. This was compared with our primary cesarean rate during 15 months in which epidural analgesia was not available, even on physician request. Because of the characteristics of our institution, this control group consisted of patients from the same population base managed by the same eight obstetricians using the same management techniques. For patients in labor, the primary cesarean rate overall was 9.0% before and 8.2% after the epidural service began (P = .626). When subpopulations based on parity and indication for cesarean delivery were studied, there were no significant changes in the cesarean rate. These results demonstrate that the availability of on-demand epidural analgesia for patients in labor did not increase the primary cesarean rate, either in the aggregate or for any of the subpopulations studied.

Analgesia, Epidural↗
PubMed1990

Thyroid function and treatment in premenstrual syndrome.

In 1986 it was reported that a high percentage of women with premenstrual syndrome (PMS) were found to have thyroid hypofunction (TH), mostly subclinical hypothyroidism, as defined by an augmented response of TSH to TRH, and that all affected women had complete relief of PMS symptoms with L-T4 therapy. We studied baseline thyroid function (T4, T3 uptake, T3, TSH, and TSH response to TRH) in 15 normal women (group 1) and 44 women with PMS and treated 22 of the PMS women with L-T4 (group 2; 1.6 micrograms L-T4/kg dose) and the other half with placebo (group 3) for 2 months in a double blinded protocol. We found no evidence of thyroid dysfunction in group 2 or 3, except for 1 subject with slightly elevated TSH (6.2 microIU/mL) and moderate augmented response to TRH (change in TSH, 65 microIU/mL). During the treatment phase we found a complete relief of symptoms in 6 (27%), a partial relief of symptoms in 6 (27%), and some relief of symptoms in 12 (54%) in group 2. Whereas in group 3, 10 (45%) had complete relief, 5 (23%) had partial relief, and 15 (68%) had some relief of symptoms. These results show that 1) there is no significant thyroid disease in PMS; and 2) L-T4 is no better than placebo in treatment of PMS. We conclude that the high incidence of thyroid hypofunction previously reported in PMS is due to an unusually low TSH level for the limit of the normal range for the TRH stimulation test.

Adult↗
PubMed1989

HIV among pregnant women: north central Wisconsin.

The incidence of infection by the human immunodeficiency virus (HIV) among pregnant women in north central Wisconsin is unknown. We devised and used an anonymous screening protocol to determine both the incidence of HIV infection and the rate of infection spread in this population. Our data demonstrate an extremely low incidence of HIV infection. Further, over the time periods studied, no clear evidence of an increase in the incidence of this severe infection could be demonstrated.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Accuracy of ultrasound diagnoses in pregnancies complicated by suspected fetal anomalies.

Referral of pregnancies complicated by suspected fetal anomalies to level III perinatal centres for further evaluation and management is increasing as use of real-time ultrasound spreads, but the sensitivity and specificity of the prenatal diagnoses made in this population are unknown. We undertook a prospective study that followed pregnancies referred to a designated programme dealing with suspected fetal abnormalities. Follow-up of 257 pregnancies revealed that 282 separate anomalies were accurately diagnosed in 212 cases. Normal anatomy was correctly predicted in 42 cases, 16 per cent of the referred population. False-positive and false-negative rates were 1.5 per cent (4/257) and 2 per cent (1/46), respectively. However, 37 per cent of those infants born with anomalies had additional problems not prenatally detected by ultrasound. These results indicate that prenatal ultrasound diagnoses are remarkably accurate overall but that they may be insensitive to associated anomalies in individual cases.

Congenital Abnormalities↗
PubMed1986

Perinatal autopsy: its clinical value.

The clinical value of the routine autopsy was studied in 172 sequential cases of perinatal deaths. Of these cases 139 (81%) were autopsied including 52 fetal deaths and 87 neonatal deaths. The clinically assigned cause of death was compared with the cause of death as identified by the autopsy. In 26% (nine fetal and 27 neonatal deaths) the autopsy was the sole means of establishing the cause of death. A need for specific genetic counseling or evaluation was identified in 62 of the 139 perinatal deaths. In 30 (48%) cases the autopsy was the sole source of information highlighting this need. The autopsy is an important clinical tool providing useful information to the perinatal clinician. Besides providing specific causes of death, it can correct clinical impressions and identify genetic factors that require further assessment and counseling.

Autopsy↗
PubMed1985

Clinical course of fetal hydrocephalus: 40 cases.

The clinical course and outcome of hydrocephalus diagnosed in utero is not well understood. To approach this problem 40 cases were reviewed of intrauterine fetal hydrocephalus diagnosed with sonography, and follow-up information was obtained regarding them. Sonograms were evaluated for cerebral dimensions, biparietal diameter, brain mantle size, ventricular ratio, amount of amniotic fluid, and associated abnormalities. Neonatal brain sonograms and computed tomographic (CT) scans were reviewed also. Clinical charts were reviewed for maternal age and parity, referral source, family history, fetal age at diagnosis and delivery, mode of delivery, physical examination and/or autopsy findings, karyotype, amniotic alpha 1 fetoprotein level, cause of death, shunt placement after birth, and status of live infants. The observations indicate that the prognosis for fetal hydrocephalus is poor. Only six infants (15%) were alive after an average follow-up of 13 months. Three children were normal and the other three had neurologic abnormalities ranging from severe (paralysis and incontinence) to minimal (2-3 months delayed motor development). Thirty-four fetuses or neonates died. Nine families elected to terminate pregnancy. Ten opted for decompression at delivery for progressive hydrocephalus. Neural tube defects were present in 12 of 23 infants at delivery. Fourteen other infants had additional significant congenital abnormalities. Other abnormal sonographic findings included polyhydramnios (13 of 38), oligohydramnios or decreased fluid (nine of 38), neural tube defect (nine of 40), and other congenital abnormalities (nine of 40). These findings indicate that hydrocephalus diagnosed in utero by sonography is caused by a heterogeneous group of disorders. In general, the prognosis for normal development is poor. Individual prognoses, however, depend on the specific malformations and the interventions used.

Female↗
PubMed1984

Umbilical cord prolapse.

Umbilical cord prolapse complicated one of 385 pregnancies occurring at the University of Colorado Health Science Center between 1969 and 1982. Whereas malpresentation of the fetus is frequently associated with prolapse of the funis, nearly 50% of all cases occurred in vertex presentations. Obstetric intervention is associated with nearly one in five cases of cord prolapse and represents a readily preventable cause of maternal and perinatal morbidity.

Breech Presentation↗
PubMed1983

Fetal heart rate in relation to body mass.

In contrast to the inverse relation of heart rate to body mass in adult mammals, the heart rate of immature fetuses is unrelated to body mass and approximately constant among different species. With maturation, fetal heart rate decreases in a large mammal but tends to increase in a small mammal. These maturational changes reduce the difference between the heart rate of a term fetus and the heart rate which is "appropriate for body mass" as calculated by means of the allometric equation for adults. The comparative physiology of fetal heart rate supports the hypothesis that immature fetuses of small and large mammals have similar oxygen consumption rates per unit body mass.

Aging↗
PubMed1983

Trial of labor in patients with multiple previous cesarean sections.

Trial of labor (TOL) in patients with multiple previous low transverse cesarean sections has not been investigated extensively, and information regarding the risks and benefits of this kind of management is largely unavailable. A combined series of patients experienced a TOL after two or more previous cesarean deliveries; the rate of vaginal delivery was 66%, and there was virtually no morbidity. Though a larger number of patients is necessary to document the desirability of a TOL in these circumstances, the evidence available now suggests that this management approach is both reasonable and safe.

Cesarean Section↗
PubMed1983

Amniotic fluid embolus-like syndrome presenting in the second trimester of pregnancy.

Two cases of sudden cardiopulmonary embarrassment and profound disseminated intravascular coagulation occurring in the second trimester of pregnancy are described and a third from the literature is reviewed. All 3 pregnancies were complicated by persistent uterine bleeding. With supportive care, all mothers survived with rapid and spontaneous resolution of the clotting abnormalities. It is speculated that the pathophysiology of this event involves an amniotic fluid embolus. At this time no specific recommendations for prevention or treatment can be made. Vigorous support of the mother appears to offer the best chance for a successful outcome.

Abortion, Therapeutic↗
PubMed1983

The antepartum assessment of fetal well-being.

Modern obstetrics is concerned with the health and well-being of both the mother and the unborn child. During the first two thirds of this century there was a pronounced decrease in maternal mortality and morbidity related to pregnancy. More recently, using the techniques of amniocentesis, antepartum fetal heart rate testing and ultrasound, obstetricians have been able to more accurately assess the health of a fetus. This knowledge has resulted in decreased perinatal mortality and morbidity and, when rigorously applied, a decrease in fetal loss.

Amniocentesis↗