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Biomedical subjects

S G Gabbe

Publications and source records attributed to S G Gabbe.

At least 19 recordsLinked to original sources
PubMed2002

A planned randomized clinical trial of treatment for mild gestational diabetes mellitus.

OBJECTIVE: A planned study is described which will determine whether a benefit exists for the treatment of mild carbohydrate intolerance during pregnancy. METHODS: A randomized clinical trial of women with mild gestational diabetes will compare perinatal outcomes in those receiving diet therapy and insulin as required versus those randomized to no specific treatment. RESULTS: The primary outcome of this study will be a composite of neonatal morbidity in the treatment and control groups. CONCLUSIONS: A randomized treatment trial of mild gestational diabetes mellitus will clarify whether identification and treatment of mild gestational diabetes mellitus reduces perinatal morbidity. This information will aid in selecting appropriate thresholds for the treatment of gestational diabetes mellitus.

Cohort Studies↗
PubMed2000

Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus.

OBJECTIVE: Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n = 24), were treated with multiple insulin injections (group 2, n = 24), or were already using an insulin pump before pregnancy (group 3, n = 12). Patient satisfaction and continuation of pump therapy post partum were assessed. STUDY DESIGN: A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, White class, and date of delivery. RESULTS: No differences in glycosylated hemoglobin A levels were observed among groups 1, 2 or 3 in the first, second, or third trimester. Patients in group 1 started pump therapy at a mean of 16.8 weeks' gestation, and 17 (70.8%) began therapy as outpatients. No deterioration in glycemic control was noted during the 2- to 4-week period after the start of pump treatment. Among the women in group 1 eight had at least one episode of severe hypoglycemia before starting pump therapy, but only one had such an episode after this treatment was begun. Two episodes of ketoacidosis occurred in group 1, and no episodes occurred in groups 2 and 3. No significant differences in perinatal outcomes or health care costs were observed among groups 1, 2, and 3. After delivery 94. 7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle. Postpartum glycosylated hemoglobin A values were 7.2% in group 1 and 9.1% in group 2, a significant difference. CONCLUSIONS: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed.

Adult↗
PubMed1999

Restructuring residency training in obstetrics and gynecology.

This essay presents a brief review of the history advocating a restructuring of residency training to increase the flexibility of the experience. The advantages for both the general obstetrician-gynecologist and the subspecialist are reviewed.

Education, Medical, Graduate↗
PubMed1999

The microbiologic effect of digital cervical examination.

OBJECTIVE: The purpose of this study was to determine whether digital examination introduces vaginal organisms into the cervix. STUDY DESIGN: Thirty-five women with reported ruptured membranes at >/=34 weeks' gestation underwent a sterile speculum examination and a standardized semiqualitative, semiquantitative endocervical culture before and immediately after digital cervical examination. RESULTS: Cultures taken before digital examination demonstrated a mean of 2.8 +/- 1.7 different types of organisms, whereas cultures taken after digital examination demonstrated a mean of 4.4 +/- 1.5 different types of organisms (P <.0001). Twenty-eight patients (80%) had heavier growth or a greater number of different organisms in the postexamination culture than in the pre-examination culture. The state of the fetal membranes (ruptured as opposed to intact) did not alter these relationships. CONCLUSION: An immediate effect of digital examination is the introduction of vaginal organisms into the cervical canal.

Adolescent↗
PubMed1998

Management of infants of diabetic mothers.

OBJECTIVE: To describe the clinical outcome of infants born to mothers with gestational diabetes mellitus (GDM) and preexisting insulin-dependent diabetes mellitus (IDDM). SETTING: A tertiary care regional perinatal center with a specialized diabetes-in-pregnancy program. DESIGN: Case series. RESULTS: Five hundred thirty infants were born to 332 women with GDM and 177 women with IDDM. Thirty-six percent of these 530 newborns were large for gestational age, 62% were appropriate for gestational age, and only 2% were small for gestational age. Seventy-six (14%) of all infants were born before 34 weeks' gestation, 115 (22%) between 34 and 37 weeks of gestation, and 339 (64%) at term. Two hundred thirty-three infants (47%) were admitted to the neonatal intensive care unit due to respiratory distress syndrome (RDS), prematurity, hypoglycemia, or congenital malformation. Hypoglycemia (more common among infants of maternal diabetic classes C through D-R) was documented in 137 (27%) of all newborns. One hundred eighty-two infants (34%) had RDS of varying severity. Polycythemia (5% of infants), hyperbilirubinemia (25%), and hypocalcemia (4%) were other morbidities present. Two hundred forty-four infants were admitted for routine care and enteral feedings. Forty-three of these newborns required subsequent transfer to the neonatal intensive care unit for treatment of hypoglycemia (16 cases), RDS (19 cases), or both (8 cases). Routine care failures were more common among infants whose mothers had advanced diabetes, but less frequent among breast-fed infants. CONCLUSIONS: With modern management, fewer morbidities can be expected in infants of diabetic mothers. Those infants born to women with IDDM remain at risk for hypoglycemia, which can be treated in one half of the cases by enteral feedings alone. The majority of cases of RDS are mild and require short admissions to special care nurseries. Optimal care of infants of diabetic mothers is based on prevention, early recognition, and treatment of common conditions. Severe congenital malformations, significant prematurity, RDS, recurrent hypoglycemic episodes, and asymptomatic infants of women with advanced IDDM should be admitted to special care nurseries. Breast-feeding among women with GDM and IDDM should be encouraged.

Adult↗
PubMed1998

A blueprint for academic obstetrics and gynecology.

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.

Consensus Statements as Topic↗
PubMed1998

The gestational diabetes mellitus conferences. Three are history: focus on the fourth.

This study reviews the summary and recommendations of the first three International Workshops Conferences on Gestational Diabetes Mellitus (GDM) and highlights areas of controversy requiring further research and discussion. The International Workshop Conferences on GDM held in 1979, 1984, and 1990 established a definition of GDM, confirmed the value of universal screening with a 50-g oral glucose load, recommended use of the 100-g oral glucose tolerance test with interpretation according to the diagnostic criteria of O'Sullivan and Mahan, and emphasized the importance of classification after pregnancy with a 75-g oral glucose tolerance test with classification according to the criteria of the National Diabetes Data Group or the World Health Organization. Recommendations for management have included nutritional counseling with limitation of the intake of concentrated sweets, monitoring maternal glucose levels to maintain the fasting plasma glucose < 105 mg/dl and the 2-h postprandial plasma glucose < 120 mg/dl, initiating insulin therapy if treatment with diet fails, and prohibiting the use of oral hypoglycemic agents. Antepartum fetal surveillance with emphasis on the evaluation of fetal growth using clinical and ultrasonographic techniques to detect macrosomia were also proposed. Although much has been accomplished in the first three conferences, areas of continued controversy include establishing a definition and method of detection for GDM that can be agreed on worldwide; defining the appropriate glucose levels to initiate dietary and/or insulin therapy; preventing macrosomia, as well as detecting and managing it, to reduce the cesarean delivery rate; and determining the long-term consequences for the mother with GDM and her infant through further studies.

Blood Glucose↗
PubMed1997

Reproductive hazards of the American lifestyle: work during pregnancy.

OBJECTIVE: The purpose of this study was to review the literature relating to the impact of work and workplace hazards on pregnancy, as well as to provide suggestions to practitioners caring for working women. STUDY DESIGN: This study is a review of the literature to date. RESULTS: Studies examining the impact of work during pregnancy on perinatal outcome have failed to yield consistent findings. An increase in preterm births and low-birth-weight infants has been observed in women who work in adverse conditions or in jobs with known hazardous exposures. No adverse outcomes are seen in women with less strenuous jobs or in women who are able to modify their work activity. CONCLUSION: A careful workplace history should be taken by the obstetrician-gynecologist including level of activity, hazardous exposures, and ease of workplace modification. Women whose work requires prolonged standing or walking should be monitored carefully throughout pregnancy for evidence of intrauterine growth restriction or symptoms of preterm labor. The ultimate decision on continuation of employment during pregnancy should be made by the patient after careful counseling by her physician and discussions with her employer.

Female↗
PubMed1996

T and J vertical extensions in low transverse cesarean births.

OBJECTIVE: To determine the frequency of T and J extensions in low transverse cesarean births at a regional perinatal center, identify the indications for these incisions, and evaluate the associated complications. METHODS: We reviewed the medical records of 56 patients delivered between January 1988 and November 1994 by low transverse cesarean birth requiring vertical extension of the incision into-the upper uterine segment. Cases of extension were compared with controls matched for gestational age, presentation, and indication for cesarean delivery. Data collected included demographic information, indications for extension, extension type, estimated blood loss, intraoperative complications, and length of hospital stay. Paired Student t test and McNemar test were used for statistical analysis. RESULTS: Vertical extensions were performed in 1.3% (95% confidence interval 0.42-2.26%) of low transverse incisions over a 7-year period. The most common indications were malpresentation (n = 31), poorly developed lower uterine segment (n = 12), and fetal head deeply arrested in the midpelvis (n = 6). Estimated blood loss was greater for patients requiring an extension (990 +/- 310 mL) compared with controls (790 +/- 150 mL), as were differences in preoperative versus postoperative hemoglobin and hematocrit (P < .05). Surgical complications were observed in 28 of 56 (50%) subjects with a uterine extension, including excessive blood loss (n = 20), broad ligament hematomas or extensions (n = 4), cervical lacerations (n = 4), and uterine artery lacerations (n = 4). Patients with vertical extensions also had longer hospital stays (4.6 +/- 1.6 versus 3.8 +/- 1.1 days) (P < .05). CONCLUSIONS: Low transverse uterine incisions may be inadequate for the safe delivery of a fetus in cases of malpresentation, preterm birth, and poor development of the lower uterine segment. Used to complete these difficult deliveries, T and J extensions are often associated with intraoperative complications and prolonged hospital stays compared with controls.

Adult↗
PubMed1996

Perinatal outcome and long-term follow-up associated with modern management of diabetic nephropathy.

OBJECTIVE: To determine outcomes in pregnancies complicated by class F diabetes mellitus cared for at a single center, and to assess renal function in these women. METHODS: A retrospective review (1988-1994) of all pregnant women with class F diabetes was performed, as well as an evaluation of current renal function. RESULTS: Forty-six pregnancies in 45 women reached a mean (+/- standard deviation) gestational age of 35.8 +/- 2.3 weeks, with a mean birth weight of 2623 +/- 818 g. No deliveries occurred before 30 weeks and 39 (84%) were at least 34 weeks. Perinatal survival was 100%. Women with initial serum creatinine exceeding 1.5 mg/dL or more than 3 g/24 hours proteinuria had an increased risk of early delivery, lower birth weight, preeclampsia, and cesarean delivery. Twenty-four individuals (53%) developed preeclampsia and seven met criteria for severe preeclampsia. By the third trimester, 26 women(58%) had greater than a 1 g/24 hour increase in proteinuria and 16 (36%) demonstrated more than a 15% fall in creatinine clearance. Follow-up was obtained in 34 subjects with a mean duration of 2.8 years. Individuals with initial creatinine clearance greater than 90 mL/minute and less than 1 g of protein per 24 hours had less loss of renal function at follow-up, as measured by creatinine clearance. At follow-up, mean protein excretion had decreased 1.9 g/24 hours from third-trimester values, but eight women (24%) maintained protein excretion exceeding 3 g/24 hours. CONCLUSION: Modern management of class F patients can result in good perinatal outcomes. Renal function studies early in pregnancy can be used to define the risk of perinatal morbidity and long-term progression of renal disease.

Adult↗
PubMed1996

The alphabet of academic medicine.

Today, academicians in obstetrics and gynecology are required to assume leadership roles in teaching, patient care, research, and administration. The junior faculty member facing these challenges needs a guide to help him or her adjust to the culture of the academic department. These lessons can be described in an alphabet of academic medicine.

Faculty, Medical↗
PubMed1996

Review of statistics usage in the American Journal of Obstetrics and Gynecology.

OBJECTIVE: Our purpose was an assessment of statistical analysis in studies published in the American Journal of Obstetrics and Gynecology, as well as documentation of appropriate and inappropriate statistical application. STUDY DESIGN: All papers included in the Clinical Articles section and transactions of societies sections of the January through June 1994 issues of the American Journal of Obstetrics and Gynecology (volume 170, numbers 1 to 6) were reviewed for statistical usage. Each paper was given a rating for the thoroughness of the listing of applied statistics and a rating for the appropriateness of statistical usage, when possible. RESULTS: Of the 190 available articles, 53 consisted of studies void of statistics, 8 of which required statistics or claimed significance without the use of statistics. Therefore 145 articles were included in the final analysis. Because of inappropriate or incomplete descriptions of statistics used within the article (52.6%), the ability to assess the appropriateness of usage was severely limited. However, 44 articles (30.3%) could be classified as having appropriate usage of statistics, whereas 46 articles (31.7%) were deemed to have inappropriate usage of statistics. Furthermore, 27 of these 46 articles were noted to have serious flaws. CONCLUSION: The lack of complete and detailed listings of applied statistics made it difficult to assess the appropriateness of more than half the studies examined, suggesting a need for more detailed guidelines as to the listing of statistical procedures used. Despite this fact, nearly one third of the articles contained examples of statistics used inappropriately. These findings suggest that a policy of statistical review be instituted.

Publishing↗
PubMed1996

Ketoacids attenuate glucose uptake in human trophoblasts isolated from first-trimester chorionic villi.

OBJECTIVE: The objective of this study was to evaluate the hypothesis that ketoacids (acetoacetic acid and beta-hydroxybutyrate) diminish glucose transport in trophoblasts cultured from first-trimester chorionic villi. STUDY DESIGN: First-trimester trophoblasts were obtained by transabdominal chorionic villus sampling for subsequent cytogenetic analysis. The cells were established as a continuous line exhibiting trophoblast characteristics. Trophoblasts were cultured in Ham's F12/Dulbecco's modified Eagle's medium (1:1) supplemented with 15% fetal bovine serum. Experiments were initiated by a 24-hour preincubation in serum-free Ham's F12/Dulbecco's modified Eagle's medium followed by incubation with ketoacids (acetoacetic acid and beta-hydroxybutyrate, 0 to 10 mmol/L) in the presence or absence of insulin-like growth factor-I (100 ng/ml). The cells were challenged with 2-deoxy-[1,2-3H]D-glucose (0.1 mmol/L) for 5 minutes and then cell-associated radioactivity was measured. Total ribonucleic acid was extracted from cells incubated with ketoacids in the presence or absence of insulin-like growth factor-I, and Northern blots were probed with a phosphorus 32-labeled complementary deoxyribonucleic acid fragment encoding the rat GLUT 1. RESULTS: Ketoacids caused a dose-dependent inhibition of glucose transport. At 5 mmol/L acetoacetic acid there was a > 50% reduction in the rate of glucose transport in both control and insulin-like growth factor-I-treated cells. The diminution in glucose uptake by trophoblasts was not due to cellular toxicity of the ketoacids because there was no significant difference in trypan blue exclusion or lactate dehydrogenase release between control and ketoacid-treated cells. Northern analysis revealed that the steady-state expression of GLUT1 messenger ribonucleic acid was diminished in ketone-treated cells, but this effect was overcome by coincubation of cultures with insulin or insulin-like growth factor-I. CONCLUSIONS: These results indicate that ketoacids can suppress the uptake of glucose into first-trimester human trophoblasts. Because ketoacidosis in pregnant women with diabetes mellitus is a frequent clinical consequence of poor metabolic control, it is possible that elevated levels of acetoacetic acid and beta-hydroxybutyrate may impair the transport of glucose across the placental trophoblast and into the fetal circulation.

Acetoacetates↗