Maternal and neonatal hemostatic correlation.
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Antithrombins↗
Biomedical subjects
S F Bottoms
Publications and source records attributed to S F Bottoms.
Markers for endothelial injury, clotting and platelet activation in preeclampsia.
The etiology of disseminated intravascular coagulation (DIC) in preeclampsia is not well understood. We measured plasma levels of fibronectin (FN), which may reflect endothelial cell injury, fibrinopeptide A (FPA), a specific marker of clotting, platelet counts (PLC) and mean platelet volumes (MPV), as well as beta-thromboglobulin (beta TG) and platelet factor 4 (Pf4), products of irreversible platelet activation in 24 preeclamptic patients and 24 controls matched for age, gestational age, labor status, and parity. In preeclampsia, FN and FPA were significantly elevated while PLC were significantly decreased (P less than 0.0001, less than 0.05 and less than 0.01, respectively). beta TG, Pf4, and MPV values did not show significant differences. These findings support the hypothesis that endothelial injury, clotting activation and platelet consumption are increased in preeclampsia. However, the much closer association of preeclampsia with FN levels as compared to FPA, beta TG, Pf4, suggests that endothelial injury is a more basic mechanism of preeclampsia than clotting or platelet activation.
Adolescent↗
Low-dose-aspirin: treatment of the imbalance of increased thromboxane and decreased prostacyclin in preeclampsia.
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Aspirin↗
Prognostic factors and complication rates for cervical cerclage: a review of 482 cases.
Charts from 482 singleton pregnancies undergoing cerclage placement in patients over a 6-year period were reviewed. Cervical dilatation at time of surgery, number of previous spontaneous losses, and gestational age at placement were key determinants of outcome. The most frequent complication, premature rupture of the membranes, ultimately occurred in 38% of patients. The 6.6% infection rate was increased in patients undergoing emergent versus elective surgery (12.7% vs 4.7%, p less than 0.005) and in patients at increased dilatation at time of surgery (5.7% for less than or equal to 2 cm vs 41.7% for greater than 2 cm, p less than 0.005). McDonald and Shirodkar procedures had similar obstetric outcomes in patients undergoing their first cerclage. The subgroup of patients with prior cerclage surgery showed improved birth weight when the Shirodkar procedure was performed instead of the McDonald cerclage (mean birth weight 3020 vs 2470 gm, p less than 0.005). An increased rate of primary cesarean section was found in the Shirodkar group (31% vs 17%, p less than 0.005). Complication rates and pregnancy outcome appear to reflect cervical dilatation more than gestational age at time of surgery.
Adolescent↗
Attitudes on the ethics of abortion, sex selection, and selective pregnancy termination among health care professionals, ethicists, and clergy likely to encounter such situations.
The ethical attitudes of health care providers toward abortion, sex selection, and selective termination of normal and anomalous fetuses in singleton or multiple pregnancies were evaluated by questionnaires distributed to members of the American Society of Human Genetics, the International Fetal Medicine and Surgery Society, the Society of Perinatal Obstetricians, ethicists, and clergy. Demographic characteristics of respondents exhibited a preponderance of men (76%), age greater than 40 (68%), and of United States residents (82%). Seventy-nine percent of respondents were in the medical profession. Approximately half of the respondents were Protestant, the rest being evenly distributed among Catholic, Jewish, and other religions. Acceptance of abortion for social indication varied by religion and gestational age but not by religious conviction, age, country, or gender of respondent. First-trimester abortion of a normal singleton pregnancy was considered more acceptable than selective termination of normal fetuses in multifetal gestations. Sex selection was considered unethical by most respondents. Selective termination was deemed ethically appropriate in quadruplets or multifetal gestations of more than five fetuses and in multiple pregnancies bearing one anomalous fetus. In the latter situation, acceptance increased with the severity of fetal anomalies and decreased from the first to the third trimester. The medical specialty of respondents was the only independent factor strongly associated with acceptance of selective termination by trimester, indication, and number of fetuses. Acceptance of selective termination among health care professionals appears to reflect not only perceptions of procedure-related risks and benefits in the index pregnancy but also individual training and religious beliefs.
Abortion, Induced↗
Is placenta previa a determinant of preeclampsia?
Low implantation of the placenta has been reported to be associated with a decreased risk for preeclampsia and this has been attributed to increased placental blood flow. However, placenta previa is known to be associated with separation and bleeding, intrauterine growth retardation, and elevated umbilical blood flow resistance by Doppler studies, suggesting decreased umbilical blood flow. To better evaluate the relationship of placenta previa and preeclampsia, 6576 consecutive patients who had ultrasound examination after 28 weeks gestation and delivery at our institution were studied. The placental location, parity, maternal weight, development of preeclampsia, and gestational age were evaluated by using frequency tables and stepwise discriminant analysis. Results showed that placenta previa is not a significant determinant of the development of preeclampsia, but parity, maternal weight, and gestational age contributed significantly to the development of preeclampsia. The finding of decreased incidence of preeclampsia with previa is explained not by increased placental blood flow but by associated maternal characteristics, and particularly by the strong association of previa with premature delivery.
Body Weight↗
Randomized prospective trial comparing ultrasonography and pelvic examination for preterm labor surveillance.
This study was designed to compare the effectiveness of cervical assessment by either ultrasonography or bimanual pelvic examination in a program for preterm labor surveillance. Patients (n = 57) at risk for preterm birth were seen once a week for patient education, review of symptoms, and cervical evaluation. Cervical evaluation was assigned randomly to either ultrasonographic evaluation or pelvic examination. The groups did not differ in demographic or obstetric factors. The overall rate of prematurity was 18%. Preterm labor was more frequent with ultrasonographic evaluation (52%) than with pelvic examination (25%) (p less than 0.05). The group evaluated by ultrasonography received oral tocolytic agents (55%) more than the group that had pelvic examinations (21%) (p less than 0.02). The groups did not differ in infant birth weights, length of gestation, or neonatal mortality or morbidity. In this prospective randomized study of patients at risk for preterm birth, patients under surveillance by ultrasonographic assessment of the cervix did not fare better than those assigned to bimanual examination.
Adult↗
Parental perceptions of genetic risk: correlation with choice of prenatal diagnostic procedures.
Determinants of patients' decisions to have prenatal diagnosis, and by which test (amniocentesis or chorionic villus sampling), is not well understood. We have administered questionnaires to couples referred for genetic counseling and procedures for advanced maternal age and determined patients' responses, decisions, and attributable determinants of their choice. Differences in perception of risks between partners, and choice of procedure, correlated with socioeconomic, educational status and age.
Adult↗
Decrease in thromboxane A2 levels in maternal blood after intravenous ritodrine infusion.
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Female↗
Perinatal characteristics of the phenotypically and chromosomally abnormal live-born.
Perinatal characteristics of 105 singleton live infants born during the last 5 years and suspected phenotypically of having karyotypic abnormalities were studied; 33 abnormal karyotypes were found. These pregnancies were compared with all pregnancies delivering at our hospital during the same time period. A retrospective analysis using our perinatal data base examined maternal age, gravidity, parity, race, mode of delivery, birth weight, gestational age at delivery, Apgar scores, and size for gestational age. Within the phenotypically abnormal group, karyotypically normal and abnormal infants showed no significant differences in primary cesarean rates, low Apgar scores, mean birth weight, or appropriateness of size for gestational age. Karyotypically abnormal infants were smaller than the general population (P less than .001) and had lower Apgar scores (P less than .05) but were just as likely to be full-term (66.7 versus 70.3%). These chromosomally abnormal pregnancies had a higher primary cesarean rate than the general population (30.3 versus 15.4%; P less than .001). Black infants undergoing genetic studies had a 37% rate of karyotypic abnormalities, which was significantly higher than the 12.5% rate in the white infants tested (P less than .05). The term black infant with phenotypic abnormalities suggestive of karyotypic abnormalities may be less likely to be recognized and appropriately tested. Increased awareness of phenotypic abnormalities with subsequent genetic testing seems warranted.
Cesarean Section↗
The physician factor in cesarean birth rates.
To investigate the influence of physicians' practice styles on the rate of deliveries by cesarean section, we studied 1533 affluent women at low risk of obstetrical complications who were cared for by 11 obstetricians in a single community hospital. The mean rate of delivery by cesarean section was 26.9 percent, but the rate ranged from 19.1 to 42.3 percent, according to the physician. The mean rate of primary cesarean section (i.e., the rate for women without previous cesarean deliveries) was 17.2, with a range of 9.6 to 31.8 percent. A stepwise logistic-regression model of the determinants of primary cesarean section, including the individual physician, parity, birth weight, and maternal age and excluding specific medical indications, showed that only nulliparity (P less than 0.0001) was more important than the identity of the physician (P less than 0.001) in its influence on the rate of cesarean section. Variation in cesarean-section rates among physicians was not attributable to the practice setting, the patient population, the degree of obstetrical risk, or the physician's recent medicolegal experience, and it was not accompanied by corresponding differences in neonatal outcome. We conclude that individual practice style may be an important determinant of the wide variations in the rates of cesarean delivery among obstetricians. Our data do not permit us to say with certainty whether the procedure is overused by some obstetricians or underused by others, but we found no obvious differences in neonatal outcome associated with differences in the cesarean-section rate.
Apgar Score↗
Chemotherapy in a pregnant rat model. 1. Mitomycin-C: pregnancy-specific kinetics and placental transfer.
Although cancer complicates pregnancy infrequently, its occurrence jeopardizes maternal and fetal well-being. Treatment with chemotherapeutic agents may adversely affect rapidly dividing fetal tissue, while physiologic changes in pregnancy may alter maternal drug disposition. Previous work on placental transfer and pregnancy-specific kinetics of antineoplastic agents is limited, making the establishment of treatment guidelines for the pregnant cancer patient difficult. Using a pregnant rat model and sensitive HPLC methodology we quantitated the placental transfer and resulting fetal exposure of mitomycin-C (MMC), an alkylating agent. Following maternal dosing, the relative fetal exposure was 6.4%, indicating that MMC does cross the placenta, although to a limited degree. Significant pregnancy-specific alterations in drug disposition, including higher plasma concentrations and decreased clearances in pregnant animals, highlight the need for drug-level monitoring and possible dosage modification when these agents are used in pregnancy.
Amniotic Fluid↗
Increased neonatal urinary ammonia: a marker for in utero caloric deprivation?
The decline in the urinary urea to ammonia ratio represents a simple measure of nutritional status in the adult. We examined the relationship of this ratio to nutrient-related fetal growth retardation. Levels of ammonia and urea nitrogen were measured in the first voided urine and cord blood from 15 term infants exhibiting a wide range of growth. Analysis by multiple regression with neonatal ponderal index as the primary dependent variable revealed a significant correlation between lowered ponderal index and decreased urinary urea and ammonia. The correlation was primarily a function of increasing ammonia levels, with no relationship between fetal leanness and urinary urea. Comparable cord artery and vein ammonia suggest that placental ammoniagenesis was not a major determinant of observed elevations in urinary ammonia. Confirmation of the striking correlation between increased urinary ammonia and lowered neonatal ponderal index may afford a simple test for the identification of nutrient-related growth retardation.
Adult↗
Seasonal variation in conception does not appear to influence the rate of prenatal diagnosis of nondisjunction.
A seasonal effect on ovulation patterns and conception rates is well documented in animal studies. The etiology of reported variation in human fertility is, however, uncertain. Abnormal ovulation has been implicated in the etiology of aneuploid conceptions, many of which abort spontaneously. To investigate the possibility that the frequency of aneuploidy reflects seasonal variation in ovulation patterns, we analyzed 5,292 consecutive prenatal karyotypes obtained from 1985 to 1987. Karyotypes were logged according to month and year of conception. Results were evaluated for cyclicity using frequency spectrum and time series analysis. Variation in the number of prenatal diagnostic procedures corresponded to known peaks in conception and delivery rates. No significant monthly or quarterly trend in the total rate of trisomies or in the rate of trisomy 21 was demonstrated. Although the sample size in this study may not be adequate to detect minor effects, seasonal variation does not appear to be a major determinant of nondisjunction rates in the population referred for prenatal diagnosis.
Aneuploidy↗
Determinants of altered anxiety after abnormal maternal serum alpha-fetoprotein screening.
With maternal serum alpha-fetoprotein testing, large numbers of previously "low-risk" patients are now considered high risk and are offered genetic testing. Anecdotally, these patients have been perceived as more highly anxious than other second-trimester patients referred for genetic testing because of advanced maternal age. Thus we have studied patient demographics, true genetic risks, the perceptions of risk, and state (situational) and trait (constitutional) anxiety for these patients and their partners. Significantly increased state anxiety was noted for mothers as compared with fathers both in the group of women referred for testing because of maternal serum alpha-fetoprotein levels and in those referred due to advanced maternal age. State anxiety was increased in the women referred for maternal serum alpha-fetoprotein levels as compared with women referred for advanced maternal age. True genetic risks were comparable between the groups. Some critics have argued that maternal serum alpha-fetoprotein screening engenders unnecessary anxiety. Our data show that patients undergoing genetic testing due to maternal serum alpha-fetoprotein levels have higher state anxiety than women undergoing testing because of advanced maternal age, but that indication is much less a factor than are partner differences. Therefore, increased anxiety after abnormal maternal serum alpha-fetoprotein testing results cannot be reasonably used as an argument against such testing.
Adult↗
From mainframe to micro: decentralization of perinatal epidemiology.
To evaluate the feasibility of analyzing large perinatal datasets on smaller computers, the 1980 National Natality Survey was downloaded first to a minicomputer and then to a microcomputer. Operating system utilities were used to minimize programming and storage requirements. Accuracy was confirmed by comparing descriptive statistics with published values derived on mainframes. Based on a typical analytic problem, implementation on the microcomputer compared favorably to implementation on the minicomputer. Our results suggest that the microcomputer may be a practical alternative to the mainframe for perinatal epidemiological analysis.
Computers↗
Nomograms for ultrasound visualization of fetal organs.
Although there is extensive literature regarding ultrasonic biometric evaluation of the fetus, our goal is to establish nomograms for the visualization of fetal organs, as they have not previously been reported. Data from the first complete ultrasound examination of 2,389 consecutive gravidas at greater than or equal to 14 weeks gestation were analyzed. The examinations were performed by three registered sonographers during a 20-month period. Fetal cerebral ventricles, heart, stomach, kidneys, intestines, bladder, diaphragm, spinal column, extremities, and umbilical cord were examined routinely and classified as normal, abnormal, or suboptimally visualized. Ultrasound visualization of these organs varied with gestational age (P less than 0.0001) and patterns of visualization varied markedly by organ. These nomograms could be useful in the timing of ultrasound examinations, the timing and method of delivery, detection of anomalies amenable to in utero therapy, parental counseling, quality assurance programs, and medicolegal liability defense.
Fetus↗
Hemostasis in hypertensive disorders of pregnancy.
We studied parameters of hemostasis reported to be altered with "pure" preeclampsia in hypertensive disorders of pregnancy. Plasma fibronectin, antithrombin, and alpha-2 antiplasmin were measured in normal pregnancies (N = 26) and in pregnancies complicated by preeclampsia (N = 19), hypertension (N = 11), and chronic hypertension with superimposed preeclampsia (N = 11). Preeclampsia, both pure and superimposed, was associated with high fibronectin (P less than .001), low antithrombin III (P less than .001), and low alpha-2 antiplasmin (P less than .05) levels, suggesting endothelial injury, clotting, and fibrinolysis, respectively. Alpha-2 antiplasmin was increased with chronic hypertension (P less than .001), regardless of whether there was superimposed preeclampsia. Fibronectin appeared to be more closely linked with preeclampsia than antithrombin III or alpha-2 antiplasmin and may prove valuable in detecting preeclampsia when evaluating hypertension in pregnancy.
Adult↗