PubMed Health⌕ Search

Biomedical subjects

S A Friedman

Publications and source records attributed to S A Friedman.

At least 55 records · Page 3Linked to original sources
PubMed1993

Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)

OBJECTIVE: Our purpose was to describe the incidence and effects of serious obstetric complications on maternal outcome in pregnancies complicated by HELLP syndrome. STUDY DESIGN: A prospective cohort study was performed on 442 pregnancies with HELLP syndrome managed at this center from August 1977 through July 1992. RESULTS: Of 437 women who had 442 pregnancies with HELLP syndrome; 309 (70%) of the cases occurred ante partum and 133 (30%) post partum; 149 (11%) developed at < 27 weeks and 80 (18%) at term. Maternal mortality was 1.1% (five patients). Serious maternal morbidity included disseminated intravascular coagulation (21%), abruptio placentae (16%), acute renal failure (7.7%), pulmonary edema (6%), subcapsular liver hematoma (0.9%), and retinal detachment (0.9%). Fifty-five percent of patients required transfusions with blood or blood products, and 2% required laparotomies for major intraabdominal bleeding. Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p < 0.0001), acute renal failure (p < 0.001), and pulmonary edema (p < 0.01). Moreover, there was a strong association between pulmonary edema and acute renal failure (p < 0.0001). There were no differences in laboratory findings between HELLP syndrome before and after delivery; however, women with postpartum HELLP syndrome had significantly higher incidences of pulmonary edema and renal failure. CONCLUSION: HELLP syndrome is associated with serious maternal morbidity, especially when it arises in the postpartum period.

Abruptio Placentae↗
PubMed1993

Currently recommended oral regimens for ritodrine tocolysis result in extremely low plasma levels.

OBJECTIVE: Our aim was to compare plasma drug levels in patients receiving ritodrine intravenously with those in patients receiving ritodrine orally at recommended dosages. STUDY DESIGN: Plasma samples from 20 pregnant patients treated with intravenous ritodrine (50 to 300 micrograms/min), 9 patients treated with oral ritodrine only (60 to 120 mg per 24 hours), and 9 patients treated first with intravenous and subsequently with oral ritodrine were analyzed for ritodrine concentration with the use of high-performance liquid chromatography. RESULTS: Average plasma ritodrine levels of patients receiving different intravenous dosages ranged from 27.8 +/- 3.5 to 113.3 +/- 38.8 ng/ml. Levels during oral therapy ranged between 9.8 +/- 3.2 and 13.8 +/- 4.4 ng/ml. In both modes of drug delivery, concentrations were significantly correlated with doses. In patients treated first with intravenous ritodrine and subsequently with the oral form, plasma concentrations during oral therapy averaged 27.7% +/- 18.8% of those obtained during intravenous infusion. CONCLUSION: Subtherapeutic plasma concentrations might be responsible for the failure to demonstrate clinical benefits of oral ritodrine in prevention of recurrent preterm labor. A twofold to threefold increase in the maximum recommended oral dosage of ritodrine should be considered, especially for patients who had previously required relatively high intravenous infusion rates (> 100 micrograms/min).

Administration, Oral↗
PubMed1993

Fetal lung maturity is not accelerated in preeclamptic pregnancies.

OBJECTIVE: Our purpose was to determine whether there is an increased incidence of pulmonary maturity in premature fetuses of preeclamptic women compared with fetuses of matched controls. STUDY DESIGN: A matched cohort study design was used. One hundred twenty-seven strictly defined preeclamptic women who had undergone amniocentesis for pulmonary maturity assessment were matched for gestational age, race, and infant gender to nonhypertensive women with preterm labor who had undergone the same procedure. Patients with multiple gestation, ruptured membranes, diabetes, or prior glucocorticoid treatment were excluded. Lung maturity was assessed with the Lumadex foam stability index test, the lecithin/sphingomyelin ratio, and the TDx fetal lung maturity assay. In addition, the occurrence of respiratory distress syndrome was assessed in 69 of the 127 matched pairs who were also matched for mode of delivery and amniocentesis-to-delivery interval. RESULTS: There was no significant difference in the incidence of an immature result between the preeclamptic and matched control groups (39.4% vs 38.6%). Likewise, women with mild (n = 63) and severe (n = 64) preeclampsia or with small-for-gestational-age (n = 26) and appropriate-for-gestational-age (n = 101) infants, when analyzed separately, showed no differences in comparison with their matched controls. When analyzed by gestational age subgroups, no specific gestational age range was associated with accelerated maturity. The incidence of respiratory distress syndrome in the 69 matched pairs was slightly, but not significantly, higher in the preeclampsia group (relative risk 1.43, 95% confidence interval 0.94 to 2.37). CONCLUSION: This study does not support the contention that fetuses of preeclamptic women exhibit accelerated lung maturation.

Adult↗
PubMed1993

Phenytoin versus magnesium sulfate in preeclampsia: a pilot study.

A randomized clinical trial was designed to determine whether there are clinically demonstrable advantages of phenytoin over magnesium sulfate in preeclamptic patients because of the latter drug's uterine relaxant properties. An intravenous infusion, immediately after randomization, of either phenytoin or magnesium sulfate, with subsequent measurement of serum concentrations and maintenance of therapeutic levels was given to 103 preeclamptic and two eclamptic women. Observed were the rate of cervical dilation during active labor and change in hematocrit between predelivery and 24-hour postdelivery values and the incidence of side effects ascertained by interview. Compared with those receiving magnesium sulfate, patients receiving phenytoin had more rapid cervical dilation (3.3 cm/hr versus 1.5 cm/hr, p = 0.016) and a smaller fall in hematocrit after delivery (-4.7% versus -7.6%, p = 0.034). A significantly lower incidence of hot flushes (15% versus 46%, p < 0.005) and a trend toward less dyspnea and weakness were reported by phenytoin-treated patients. Our phenytoin regimen produced acceptable serum phenytoin levels (10 to 25 micrograms/ml) in 96% of patients.

Adult↗
PubMed1993

Fetal circulatory endothelin-1,2 in the midtrimester.

Umbilical-vein blood from eight fetuses who underwent cordocentesis for rapid karyotyping at 19-22 gestational weeks was tested for immunoreactive endothelin-1,2 by means of radioimmunoassay. Endothelin was detected in the serum of all but one of these fetuses. Levels of endothelin-1,2 ranged from 8.5 to 19.2 fmol/ml (mean 13.4 fmol/ml). We speculate that endothelin in the fetoplacental circulation may play a role in the regulation of fetal hemodynamics in utero.

Cordocentesis↗
PubMed1993

Amniotic fluid index in hospitalized hypertensive patients managed expectantly.

OBJECTIVE: To determine the relationship between low amniotic fluid (AF) index and fetal growth retardation (FGR), fetal distress, and cesarean delivery in patients hospitalized for hypertensive disease, and to describe changes in AF status in relation to the severity of maternal disease. METHODS: The AF index in 142 hospitalized hypertensive patients was followed per an inpatient protocol with semi-weekly testing; medical records were reviewed to obtain delivery data. RESULTS: Fetal growth retardation was significantly associated with an AF index of 5.0 cm or less or 7.0 cm or less (P < .001) at initial assessment, with positive predictive values of 86 and 52%, respectively. However, the sensitivity of an AF index of 5.0 cm or less or 7.0 cm or less to detect FGR was limited (21 and 46%, respectively). Fetal distress and cesarean delivery were not associated with an AF index of 5.0 cm or less or 7.0 cm or less throughout observation in this cohort. Based upon a definition of oligohydramnios as an AF index of 7.0 cm or less, the AF status worsened from an initial normal value in 39% of patients whose final diagnosis was severe preeclampsia, versus only 14% of patients who were diagnosed as having mild disease. The AF index also normalized in ten patients who were originally diagnosed with oligohydramnios and admitted for expectant management. Only one of these women was diagnosed with severe preeclampsia. CONCLUSIONS: 1) Depending on the definition, the incidence of oligohydramnios ranges from 10-30% in hypertensive patients requiring hospitalization; 2) an AF index of 5.0 cm or less at initial evaluation predicts FGR but lacks sensitivity; 3) the AF status frequently changes with serial assessment, and these changes appear to be related to the severity of hypertensive disease; and 4) the frequency of the obstetric complications studied depends more upon the severity of hypertensive disease than on its potential effect of inducing oligohydramnios.

Cesarean Section↗
PubMed1993

Hypertension in pregnancy.

Selected articles on hypertensive diseases in pregnancy from the past year are highlighted. The concept that endothelial cell dysfunction plays an important role in the pathogenesis of preeclampsia has been strengthened. The initial inciting event is still unclear, but inadequate implantation and decreased antioxidant activity may play a role. Magnesium sulfate is still the anticonvulsant of choice for seizure prophylaxis, but the exact mechanism of its action remains controversial. The ideal screening test to identify those patients likely to develop preeclampsia is still lacking, and the side effects and risks of aspirin prophylaxis are not yet known. The results from the National Institutes of Health-sponsored multicenter trial on this subject should be forthcoming.

Female↗
PubMed1992

Circulating concentrations of fetal fibronectin do not reflect reduced trophoblastic invasion in preeclamptic pregnancies.

This prospective, nested, case-control study investigated whether maternal plasma fetal fibronectin reflects reduced trophoblastic invasion at 16 to 20 weeks in women who later have preeclampsia. Concentrations of fetal fibronectin were 8.7 +/- 2.6 micrograms/ml in women with preeclampsia and 8.1 +/- 2.5 micrograms/ml in matched controls (p greater than 0.5). These results are discussed.

Case-Control Studies↗
PubMed1992

Venous occlusion secondary to subluxation of the shoulder--a case report.

This is the case report of an eighty-seven-year-old woman who was seen because of swelling of her left upper extremity and breast of one week's duration. She had a history of severe arthritis of the knees and had been wheelchair-bound for seven years. Venography showed compression of the cephalic vein and thrombosis of the distal basilic vein with extension into the axillary and subclavian veins. To the author's knowledge, this is the first case report of venous thrombosis in association with subluxation of the shoulder.

Aged↗
PubMed1992

Prophylaxis of eclamptic seizures: current controversies.

Treatment of this pathophysiologically poorly understood disease is controversial. Despite this uncertainty, the goals of management of the patient with preeclampsia and eclampsia are diagnosis, stabilization, and delivery of the baby. Stabilization refers to both mother and fetus and should include the prevention of eclampsia or the recurrence of eclamptic seizures. There are empiric data supporting the use of magnesium sulfate for the management of preeclampsia and eclampsia in North America, but there are few data to support its efficacy as a classic anticonvulsant. Until controlled trials are completed, we suggest that magnesium sulfate continue to be used in preeclampsia, with the addition of established anticonvulsant medications when eclampsia occurs. Data on established antiepileptic drugs such as diazepam and phenytoin support their use in treating patients with eclamptic seizures. As stated in an earlier review, "in treating preeclampsia, magnesium sulfate therapy may have a role and may moderate factors leading to eclampsia. Whether magnesium sulfate therapy may have some as yet unproved effect on epileptogenic foci or seizure propagation is not the important issue for the physician caring for the eclamptic patient. Until adequately designed therapeutic trials are available, it is our opinion that treatment should be based on the use of anticonvulsant drugs of established efficacy in seizure control and prophylaxis (p. 1363)."

Anticonvulsants↗
PubMed1991

High plasma cellular fibronectin levels correlate with biochemical and clinical features of preeclampsia but cannot be attributed to hypertension alone.

Current concepts of the pathogenesis of preeclampsia involve the generalized dysfunction of maternal vascular endothelial cells. We measured the endothelial isoform of fibronectin as a marker of endothelial cell injury throughout pregnancy in a prospective, case-control study. Nineteen women met strict criteria for the diagnosis of preeclampsia. Nineteen normal pregnant women, and 19 women with gestational hypertension but without other stigmata of preeclampsia (transient hypertension) were selected from the same cohort and matched according to race, age, nulliparity, and gestational age at delivery. Plasma levels of cellular fibronectin were significantly elevated in women meeting strict clinical and biochemical criteria for preeclampsia but not in women with normal pregnancies or transient hypertension. Moderate but significant elevations in mean levels were found in the second trimester in women destined to have preeclampsia, as compared with matched normal and transient hypertension groups (p less than 0.05). The results indicate that elevated plasma levels of cellular fibronectin are not simply the result of increased blood pressure but reflect a maternal insult specific to the syndrome of preeclampsia. Elevation of the mean concentration during the midtrimester is consistent with the hypothesis that endothelial cell injury is a specific lesion that occurs early in the course of preeclampsia, before clinical signs and symptoms.

Adult↗
PubMed1991

Pathophysiology of preeclampsia.

Preeclampsia is a complex clinical syndrome, with hypertension representing but one manifestation. Pathogenetically important events in the development of preeclampsia include incomplete trophoblastic invasion of the maternal spiral arteries, poor trophoblastic perfusion, elaboration of a putative endothelial cell toxin, and endothelial cell injury with resulting activation of coagulation, impairment of vasodepressor function, and altered endothelial permeability. These changes lead to the clinical signs and symptoms, which occur relatively late in the course of preeclampsia. The primary immunologic, genetic, and biochemical basis of preeclampsia remains speculative.

Endothelium, Vascular↗
PubMed1991

Pregnancy complicated by collagen vascular disease.

Pregnancies complicated by collagen vascular diseases present a challenge to the obstetrician, internist, and other consulting physicians caring for the patient. Although most pregnancies complicated by these disorders result in satisfactory outcomes, a significant number develop manifestations sufficiently serious to require admission to an intensive care unit. Such manifestations include lupus nephritis, CNS lupus, ARDS, massive alveolar hemorrhage, scleroderma renal crisis, pulmonary hypertension, severe myositis, and diffuse vasculitis. Of the numerous therapeutic options available, many may be used to optimize maternal and perinatal outcome.

Autoimmune Diseases↗
PubMed1988

The P1 plasmid-partition system synthesizes two essential proteins from an autoregulated operon.

The P1 partition region contains two large open reading frames that encode the proteins ParA and ParB. It was previously shown that ParA is essential for partition activity. Using a novel assay, we show that ParB protein is also an absolute requirement for partition and that it is active in trans to the partitioning plasmid. Development of complementation tests for parA and parB allowed us to assign a number of partition-defective point mutants of a P1 miniplasmid to the parA and parB cistrons. Using gene fusion techniques, it was shown that parA and parB constitute an operon controlled from a promoter proximal to the start of parA. Transcription from this promoter is autoregulated by a feedback loop that is sensitive to the ParA and ParB proteins in concert. The parB gene also appears to be expressed at a low level from a second promoter at the intercistronic boundary. This results in a low level of expression and tight autoregulation for the ParA protein and slightly less stringent control for ParB synthesis.

Bacteriophages↗
PubMed1988

Computed tomographic features of puerperal ovarian vein thrombosis.

Puerperal ovarian vein thrombosis is a dangerous complication of childbirth and often leads to inferior vena cava thrombosis and multiple pulmonary emboli. Computed tomography of the abdomen is useful in early diagnosis. Two patients with typical computed tomographic features are presented.

Adult↗