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Biomedical subjects

S G Sunderji

Publications and source records attributed to S G Sunderji.

13 recordsLinked to original sources
PubMed1996

Multicenter randomized clinical trial of home uterine activity monitoring: pregnancy outcomes for all women randomized.

OBJECTIVE: Our purpose was to evaluate the impact of home uterine activity monitoring on pregnancy outcomes among women at high risk for preterm labor and delivery. STUDY DESIGN: Women at high risk for preterm labor at three centers were randomly assigned to receive high-risk prenatal care alone (not monitored) or to receive the same care with twice-daily home uterine activity monitoring without increased nursing support (monitored). There were 339 women with singleton gestations randomized with caregivers blinded to group assignment. The two groups were medically and demographically similar at entry into the study. RESULTS: Women in the monitored group had prolonged pregnancy survival (p = 0.02) and were less likely to experience a preterm delivery (relative risk 0.59; p = 0.04). Infants born to monitored women with singleton gestations were less likely to be of low birth weight (< 2500 gm; relative risk 0.47, p = 0.003), and were less likely to be admitted to a neonatal intensive care unit (relative risk 0.5, p = 0.01). CONCLUSION: These data show, among women with singleton gestations at high risk for preterm delivery, that the use of home uterine activity monitoring alone, without additional intensive nursing care, results in improved pregnancy outcomes, including prolonged gestation, decreased risk for preterm delivery, larger-birth-weight infants, and a decreased need for neonatal intensive care.

Adult↗
PubMed1991

Multicenter randomized clinical trial of home uterine activity monitoring for detection of preterm labor.

Home uterine activity monitoring has been described as an effective means of detecting uterine contractions, but controversy exists whether it is home uterine activity monitoring or increased nursing support in conjunction with it that contributes to earlier detection of preterm labor. In this study 377 women at risk for preterm labor from three centers were prospectively, randomly assigned to high-risk prenatal care alone (not monitored) or to the same care with twice-daily home uterine activity monitoring without increased nursing support (monitored). The two groups were medically and demographically similar at entry into the study. Routine visits, nonroutine visits, and gestational age at diagnosis of preterm labor were similar in both groups. Preterm labor occurred in 41 of 198 monitored and 39 of 179 not monitored patients. Mean cervical dilatation was 1.4 cm in 41 monitored compared with 2.5 cm for 37 not monitored (p = 0.0006); 73.1% of monitored and 27.5% of not monitored had preterm labor detected before 2 cm dilatation (p = 0.00009). Neonatal outcome of singleton pregnancies showed greater birth weight, fewer days in the neonatal intensive care unit, and fewer babies requiring oxygen therapy and mechanical ventilation in the monitored group. The better outcomes are probably due to the increased likelihood of diagnosis of preterm labor before advanced cervical dilatation with home uterine activity monitoring, thus providing the clinician with a better chance to initiate tocolytic therapy directed at improving pregnancy outcome.

Birth Weight↗
PubMed1990

Maternal serum Down syndrome screening: unconjugated estriol is not useful.

Study of 41 known Down syndrome cases and 441 matched controls did not confirm earlier reports that low unconjugated estriol levels can be used to detect fetal Down syndrome. Hence the obstetric community should exercise caution in using unconjugated estriol levels as a marker in prenatal Down syndrome screening.

Down Syndrome↗
PubMed1985

Abnormalities in vascular arachidonic acid metabolism in the infant of the diabetic mother.

The infant of the diabetic mother has an increased incidence of thromboses in utero and in the neonatal period. In the adult with diabetes a decrease in prostacyclin formation has been suggested as a cause for the atherothrombotic tendency. We therefore evaluated arachidonic acid metabolism in infants of diabetic mothers. Endogenous radioimmunoassayable 6-keto prostaglandin F1 alpha (PGF1 alpha) was normal in umbilical vessels obtained from the infants of diabetic mothers whose glucose homoeostasis was maintained when compared with control values. Nevertheless, a significant inhibition of vascular production of 6-keto PGF1 alpha was observed in infants born to mothers with raised HbA1C concentrations. A decrease in the concentration of plasma 6-keto PGF1 alpha was also seen in the infants of diabetic mothers when compared with control neonates. The correlation observed between plasma 6-keto PGF1 alpha concentrations and endogenous vascular prostacyclin formation in the infants of diabetic mothers indicates that the in vitro deficiency of prostacyclin formation reflects a concomitant in vivo abnormality.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

Hypertrophic cardiomyopathy and pregnancy: report of a maternal mortality and review of literature.

The first case of maternal mortality with hypertrophic obstructive cardiomyopathy is reported. An additional successfully managed case of hypertrophic obstructive cardiomyopathy and pregnancy is reported. Systemic arterial embolization, which has not been previously reported in hypertrophic obstructive cardiomyopathy with pregnancy is discussed. English language literature on hypertrophic obstructive cardiomyopathy and pregnancy is reviewed, and a management plan has been outlined.

Adult↗
PubMed1984

The effect of myometrial contractures on uterine blood flow in the pregnant sheep at 114 to 140 days' gestation measured by the 4-aminoantipyrine equilibrium diffusion technique.

Uterine blood flow, between 114 and 140 days' gestation, measured by the 4-aminoantipyrine equilibrium diffusion technique, was significantly decreased from 1359.1 +/- 84.4 ml X min-1 (mean +/- SE) in the absence of contractures to 1147.4 +/- 71.8 ml X min-1 (mean +/- SE) during a contracture (p less than 0.01). Contractures reduced total uterine blood flow regardless of whether the ewe was standing or lying. These observations are in keeping with the suggestion that changes in total uterine blood flow may be an important mechanism responsible for the previously described temporal relationship between contractures and fetal neurophysiologic function.

Ampyrone↗
PubMed1981

Decrease prostacyclin production: a characteristic of chronic placental insufficiency syndromes.

Prostacyclin production in neonates born at various gestational ages (28 weeks to term) was compared with that in neonates born of pregnancies complicated by various acute and chronic placental insufficiency states. Prostacyclin levels were reflected by the amount of conversion of 14C arachidonic acid to 6-keto-PGF1 alpha (the stable end-product of prostacyclin) by umbilical arteries. The uptake of 14C arachidonic acid by the umbilical arteries was also determined, and since this was similar for all groups it was not the cause of the differences noted in prostacyclin production. Neonates born of normal pregnancies had similar levels of prostacyclin production regardless of gestational age. Prostacyclin production was very low in neonates born of pregnancies complicated by chronic placental insufficiency (intrauterine growth retardation, essential hypertension, and pre-eclampsia), but normal with acute placental insufficiency (abruptio placentae). Hence the decrease in fetal prostacyclin production in pre-eclampsia is not related to gestational age; furthermore, it is also seen in other chronic placental insufficiency states.

6-Ketoprostaglandin F1 alpha↗
PubMed1981

Decreased prostacyclin production in the infant of the diabetic mother.

Maternal diabetes mellitus is recognized to be a predisposing factor to thrombosis in the neonate. In the adult with diabetes, abnormalities in the metabolism of AA by the platelet and vessel wall occur, which result in an increase in proaggregatory platelet thromboxane A2. A decrease in antiaggregatory vascular PGI2 has been demonstrated in the diabetic rat, although conclusive proof of a similar abnormality is lacking in humans. We evaluated vascular AA metabolism in 10 IDM (groups II and III comparison to 20 control neonates of gestational ages 32 to 40 weeks (group I). Mean uptakes of labeled AA into vascular tissue of both controls and IDM were similar. The conversion of [14C] AA to 6-keto-PGF1 alpha was not dependent on gestational age (r = 0.223) in the control neonates, with a mean value of 5.2% +/- 1.3 (1 S.D.). A marked decrease (p less than 0.001) in 6-keto-PGF1 alpha formation to 1.7% +/- 0.3 was found in the group II IDM of mothers with poor diabetic control (HbA1c = 9.3% +/- 0.5). In the group III neonates whose mothers had normal HBA1c levels (6.1% +/- 0.9), 6-keto-PGF1 alpha production was normal at 4.9% +/- 0.8. Although no correlation between maternal fasting blood glucose and neonatal 6-keto-PGF1 alpha was demonstrable, a significant inverse correlation (r = 0.872; p less than 0.02) was observed between maternal HbA1c levels and the conversion of AA to 6-keto-PGF1 alpha in the vascular tissues of the IDM. It appear possible that abnormalities in platelet-vascular AA metabolism may play an etiologic role in the vascular complications present in some IDM.

Adolescent↗
PubMedDate not supplied

Efficacy of maternal screening and therapy in the prevention of chlamydia infection of the newborn.

Routine cervical cultures for chlamydia were obtained during the third trimester of pregnancy to identify infected mothers whose infants may also be infected. The effectiveness of maternal erythromycin therapy in preventing disease due to chlamydia among infants born to these women was also assessed. Clinical outcome of treated mothers and infants was compared to that of untreated subjects. Of 1082 women who were cultured, 85 (7.8%) were positive for chlamydia. Erythromycin therapy was prescribed for 38 of these women. Nasopharyngeal/conjunctival chlamydia cultures were obtained from 16 infants of culture-positive, treated mothers and 21 infants of culture-positive, untreated mothers. None of the infants born to culture-positive, treated mothers developed infection with chlamydia, while five of 21 infants of untreated mothers (p less than 0.04) were culture-positive and symptomatic (four with conjunctivitis, one with pneumonia). On follow-up of the infants born to chlamydia-positive mothers, there was no evidence that chlamydia-infected infants had more frequent episodes of upper respiratory infection and otitis media during the first six months of life. This study demonstrated that diagnosis and treatment of cervical chlamydia infection during the third trimester of pregnancy provides a practical approach to the prevention of infection in the newborn.

Adult↗