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Biomedical subjects

R K Laros

Publications and source records attributed to R K Laros.

At least 55 records · Page 3Linked to original sources
PubMed1987

Evaluation of the weekly cervical examination in a preterm birth prevention program.

The efficacy of regular cervical examinations in detecting preterm labor, as well as possible risks, was studied for 133 preterm labor patients who had received regular cervical examinations as part of a preterm birth prevention program. When compared to all other patients experiencing preterm labor during the study period, the rates of preterm premature rupture of the membranes, chorioamnionitis, and postpartum endomyometritis were not increased. For 95 patients with preterm labor within 7 days of a routine cervical examination, labor onset was not temporally associated with the preceding examination. Preterm labor was diagnosed in 18 asymptomatic patients (18.2%) when the weekly examination revealed cervical change. Routine cervical exams, therefore, did not increase morbidity, and for some patients identified preterm labor before symptoms appeared.

Cervix Uteri↗
PubMed1987

Objective method of diagnosing oligohydramnios in postterm pregnancies.

Oligohydramnios is an important factor influencing the management of postterm pregnancies. However, sonographic assessment of oligohydramnios has been based largely on the subjective judgement of the sonologist. From January 1982 to December 1984, 54 patients had articulated-arm B-scan ultrasound examinations and were identified as postterm. Of these patients, 25 were subjectively diagnosed as having oligohydramnios. Five patients were considered to have low normal amounts of amniotic fluid. The remainder were considered to have normal or greater than normal quantities of amniotic fluid. From this population, an amniotic fluid index was determined for each patient by finding the product of the length, width, and depth of the largest amniotic fluid pocket. Patients with a fluid index less than 60 showed a strong association with the postmaturity syndrome. Indeed, all but one postmature infant was born of a pregnancy with a fluid index less than 60. No other fetal or perinatal complications were statistically correlated with oligohydramnios in this small patient series.

Amniotic Fluid↗
PubMed1986

Prepregnancy weight, weight gain, and birth weight.

The effect of maternal weight gain on birth weight in 2946 live births with delivery after 37 weeks' gestation was studied at Moffitt Hospital, University of California (San Francisco), between September, 1980, and December, 1983. The sample was stratified into four categories according to prepregnancy weight for height with use of a body mass index. To study the effect of maternal weight gain on infant birth weight, multiple regression analysis, controlled for selected covariables, was carried out on the entire sample and on each prepregnancy weight group. For the entire sample, both pregravid body mass and weight gain significantly influenced birth weight. For the underweight, ideal weight, and moderately overweight women, each kilogram of maternal weight gain significantly increased birth weight. This study supports recent evidence for the association between maternal weight gain and birth weight, but only for women whose prepregnancy weights are 135% of ideal or less. These results suggest that recommendations for a minimum weight gain for obese women are unnecessary.

Adolescent↗
PubMed1986

Ultrasound evaluation of polyhydramnios and twin pregnancy.

We analyzed the ultrasound examinations and medical records of 75 pairs of twins who were delivered between January, 1983, and December, 1984, to study the relationship between increased amniotic fluid volume, fetal abnormalities, and preterm labor. Ten of these 75 twin pregnancies demonstrated elevated amniotic fluid volume that persisted throughout pregnancy. Total intrauterine volumes were elevated in these cases, and nine of the ten pregnancies were abnormal. In addition, it was noted that elevation of the amniotic fluid volume alone did not explain the high rate of preterm labor and delivery in twin gestations.

Congenital Abnormalities↗
PubMed1986

Short-term neonatal morbidity associated with prematurity and the effect of a prematurity prevention program on expected incidence of morbidity.

With recent advances in neonatal medicine, the risk of mortality for premature newborns has been markedly reduced. Attention has shifted to the morbidity associated with preterm delivery. Consideration of anticipated neonatal morbidity at a particular gestational age plays an important part in the decision of whether or not to treat preterm labor. We have assessed eight indices of short-term morbidity in 170 liveborn infants delivered between 26 and 35 completed weeks of gestation and calculated the gestational age-specific rates of each measure of morbidity. Five measures of short-term morbidity were significantly reduced by extending the gestation from 34 to 35 weeks. To illustrate the effect of prolonged pregnancy on the incidence of short-term neonatal morbidity, the actual incidence of morbidity from a group of preterm labor patients who were part of a preterm birth prevention program was compared to the anticipated incidence of these same morbidity factors has birth occurred when preterm labor was first diagnosed. There was a significant decrease in the number of observed, as opposed to anticipated, neonatal deaths and in morbidity occurrences in four of the six factors tested. Implications for considering short-term neonatal morbidity in the decision to initiate treatment for preterm labor after 33 weeks gestation are discussed.

California↗
PubMed1984

Route of delivery for patients with immune thrombocytopenic purpura.

Over the past 15 years, we managed 19 pregnancies in 18 women afflicted with immune thrombocytopenic purpura. Our policy has been to treat the mother with corticosteroids if her platelet count was below 100 X 10(9)/L and to use cesarean section only for obstetric indications; 14 patients received corticosteroids. The perinatal outcomes were intrauterine fetal death (two), neonatal death (0), and live birth (17). The methods of delivery for the 17 live-born infants were spontaneous vaginal (seven), low forceps or midforceps (five), cesarean section (five). Although seven of the live-born infants (41%) were thrombocytopenic (less than 100 X 10(9)/L), only two received therapy, and none suffered significant hemorrhagic morbidity. Maternal treatment with corticosteroids did not affect the neonatal platelet count, nor was there a correlation between maternal and neonatal platelet counts. On the basis of our experience, we think that cesarean section is not routinely indicated as the method of delivery for parturient patients with immune thrombocytopenic purpura.

Adolescent↗
PubMed1984

The cost effectiveness of stopping preterm labor with beta-adrenergic treatment.

We retrospectively compared the costs of maternal and neonatal medical care after beta-adrenergic drug treatment, given to arrest preterm labor, with expected costs associated with no gestational delay. The treatment arrested labor for at least three days in 61 per cent of patients; gestation was extended by 14.1 +/- 1.1 weeks (mean +/- S.E.M.) in infants with the earliest gestational age at treatment (20 to 25 weeks) and by 2.3 +/- 0.7 weeks in those with the latest gestational age (36 to 37 weeks). Costs were based on hospital charges and physicians' fees, including high-risk obstetric outpatient charges, obstetric prenatal and delivery inpatient charges, and pediatric inpatient charges. Treatment provided between 26 and 33 weeks of gestation was clearly cost effective, resulting in expected savings of $11,240 (1981 dollars) per birth. After 33 weeks there was no substantial difference in expected costs with or without treatment. Between 20 and 25 weeks of gestation, the expected costs per surviving infant were $39,000 lower with treatment; however, the number of mothers who were not treated at this early stage of gestation (three patients) was too small to permit statistical significance. When the improved survival of infants after prenatal treatment was taken into account, treatment before 25 weeks was also cost effective. Thus, the increased costs of prenatal medical care were offset by decreased costs of neonatal medical care when treatment was given before 34 weeks of gestation.

Adrenergic beta-Agonists↗
PubMed1983

Transplacental transmission of pemphigus.

In a pregnancy complicated by maternal pemphigus vulgaris (PV), pemphigus IgG was found both in the fetal circulation and fixed to fetal epidermis in the characteristic intercellular distribution. Light microscopic examination of fetal skin was diagnostic of PV. These findings indicated transplacental transmission of PV. They also strongly support the pathogenic role of PV antibodies and the concept of PV as a tissue-specific autoimmune disease. The occurrence of intrauterine death despite careful antepartum surveillance underscores the management problems encountered when pemphigus coexists with pregnancy.

Adult↗
PubMed1982

Massive ovarian mucinous cystadenoma of low malignant potential.

Operative removal of an 80.3-kg ovarian mucinous cystadenoma of low malignant potential is described. The 30-year-old woman from whom the tumor was removed had many medical problems spanning several medical fields, including psychiatry and plastic surgery, as well as gynecology. The team approach to these problems is summarized in this case report.

Adult↗
PubMed1980

Oral ritodrine maintenance in the treatment of preterm labor.

Seventy patients with preterm labor and intact membranes were initially treated with ritodrine hydrochloride to delay preterm delivery. Tocolysis beyond 24 hours was achieved in 59 patients. Fifty-five of the 59 patients were then placed on either oral ritodrine or placebo as maintenance therapy in a randomized double-blind manner. If preterm labor recurred, the sequence of intramuscular and then oral treatment was repeated. The number of days gained after initiation of intramuscular treatment was similar in both groups (oral ritodrine = 34 days, oral placebo = 36 days). In those 55 patients receiving oral treatment, there was a smaller number of relapses requiring repeat intramuscular treatment in the oral ritodrine group (1.11 in the ritodrine patient vs. 2.71 in the placebo patient, p less than 0.05), and the mean interval between beginning oral treatment and the first relapse/delivery was 5.8 days in the oral placebo group and 25.9 in those receiving oral ritodrine (p less than 0.05). Cardiovascular side effects, notably maternal tachycardia and palpitations were frequent but well tolerated. The results suggest that oral ritodrine maintenance will decrease the incidence of recurrent preterm labor in patients who have had initial successful tocolysis.

Administration, Oral↗
PubMed1980

Implications of metric conversion.

The international scientific community is rapidly achieving conversion to the metric system, and the Système International (SI system) has been chosen for use by health scientists. Because the United States remains 1 of only 4 countries not now using part or all of the SI system, there is now a systematic effort toward rapid conversion. Although most of the SI system is not controversial, several SI units are highly so. Examples include joules instead of calories, pascals instead of millimeters of mercury, and moles per liter instead of milligrams per 100 milliliters. Obstetrician-gynecologists need to be familiar with the SI units and to voice their feelings about the various controversial units. There are decisions still to be made, and the time for discussion and advice is now.

International System of Units↗
PubMed1979

Thalassemia and pregnancy: results of an antenatal screening program.

A thalassemia screening program was implemented at our institution using the finding of a mean corpuscular volume less than 80 fl as the index of abnormality. Further evaluation using hemoglobin (Hb) electrophoresis and serum iron studies was carried out according to the scheme detailed below. A diagnosis of thalassemia was made in 33 women (42 pregnancies). Eight patients had alpha-thalassemia trait, 23 beta-thalassemia trait, and two Hb H disease. Thalassemia trait did not have any adverse effect on pregnancy outcome. In two couples the fetuses were at risk for homozygous disease and in one couple the fetus was at risk for sickle cell beta-thalassemia. The screening program described is an effective and inexpensive means of detecting thalassemia in an antenatal population and is applicable to most every clinic or office setting.

Adult↗
PubMed1977

A comparison of methods for quantitating fetal heart rate variability.

Fetal heart rate (FHR) variability is thought to be an important index of fetal health. In the presence of normal variability, the fetus is vigorous, but lack of beat-to-beat variability may be associated with fetal compromise. A distinction between short-term variability (STV) (beat-to-beat changes between successive beats) and long-term variability (LTV) (rhythmic fluctuations in FHR) has not been made to date. We have utilized computer programs to compare three pairs of mathematical indices and one visual index of FHR variability. Among the three pairs of indices designed for detection of STV and LTV, de Haan's short-term and long-term indices exhibited the least interdependence, and the long-term index was completely insensitive to artifically generated pure STV. Yeh's short-term and long-term indices exhibited substantial positive interdependence. Hon's visual index appears to detect LTV primarily rather than STV. When the effect of progression of labor on FHR variability was examined, no conclusions were possible because of inconsistencies between patients. Ultimately, the clinical value of any one of these indices awaits testing of their ability to define fetal well-being or fetal distress.

Analog-Digital Conversion↗