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Biomedical subjects

S H Golde

Publications and source records attributed to S H Golde.

At least 19 recordsLinked to original sources
PubMed1993

Outcome of pregnancy in diabetic ketoacidosis.

To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during gestation, 20 consecutive cases of ketoacidosis in type I diabetic pregnant women were studied. They were divided into two groups for comparison: Group 1, 13 patients (65%), had a live fetus and group 2, seven patients (35%), had a fetal death on admission. Both groups were similar in age, gravidity, parity, abortions, height, weight, serum sodium and potassium, arterial pH, carbon dioxide tension, bicarbonate, base excess, and anion gap. Significantly different between groups 1 and 2 were: gestational age (24 versus 31 weeks; p < 0.05), serum glucose (374 versus 830 mg/dl; p < 0.005), blood urea nitrogen (14 versus 23 mg/dl; p < 0.025), osmolality (295 versus 311 mmol/kg; p < 0.025), insulin requirements (127 versus 202 U; p < 0.05), and length of resolution (28 versus 38 hours; p < 0.05). Two patients had serum glucoses less than 200 mg/dl despite profound ketoacidosis. Precipitating factors included infections, poor compliance, and very importantly, unrecognized new onset of diabetes (6 patients). All stillborns were grossly normal and those autopsied had no discernible cause of death. There were no maternal deaths. A high fetal mortality (35%) was found but there were no fetal losses once therapy was initiated. The unrecognized new onset diabetics accounted for almost a third (30%) of the cases of ketoacidosis and for 57% of the fetal deaths. Attentiveness to the symptoms of uncontrolled diabetes and appropriate screening can be effective preventive measures.

Adult↗
PubMed1991

Use of femur length measured by ultrasonography to predict fetal maturity.

The ultrasonographic criteria of biparietal diameter greater than or equal to 9.2 cm and a grade III placenta have been shown to correlate with fetal maturity in the fetus of a nondiabetic mother in our population. These two criteria have helped reduce the incidence of third-trimester amniocenteses by 66.6% at our institution. Occasionally, however, because of fetal position, we are unable to obtain an accurate biparietal diameter. We therefore carried out a prospective study of 120 patients to evaluate the relationship between femur length of greater than or equal to 7.3 cm and fetal maturity. In this study, the addition of the femur length criterion increased the specificity of the ultrasonographic criteria for fetal maturity from 66.6% to 85%. The data suggest that femur length could be used along with the biparietal diameter and placental grade as an alternative to amniocentesis in term nondiabetic pregnancies.

Female↗
PubMed1987

Tuberculosis presenting as puerperal fever.

Two cases of unusual postpartum fever in foreign nationals are presented. Prolonged work-up led to the diagnosis of pulmonary tuberculosis as a cause of postpartum fever that responded well to antituberculous drugs. The signs and symptoms illustrated by these cases should alert physicians to consider tuberculosis in their differential diagnosis when caring for pregnant immigrants. The changing patterns and diagnostic and therapeutic problems are discussed.

Adult↗
PubMed1986

Ruptured intracranial aneurysms during pregnancy. A report of four cases.

Four patients presented with ruptured intracranial aneurysms during pregnancy. Problems encountered during the management of these cases included delayed diagnosis, obstructive hydrocephalus, cerebral ischemia due to vasospasm and recurrent subarachnoid hemorrhage. Recent advances in the management of ruptured intracranial aneurysms, including early computerized tomographic scanning, intravascular volume expansion and induced hypertension for the management of cerebral vasospasm, and the timely obliteration of the aneurysm are applicable to the subarachnoid hemorrhage patient even if her condition is complicated by pregnancy.

Adolescent↗
PubMed1985

Lung profiles in the isoimmunized pregnancy.

The management of an isoimmunized pregnancy, although not commonly seen today, represents a challenging obstetric problem. The knowledge of fetal lung maturity status is essential in deciding when to perform an intrauterine transfusion, give steroids, or deliver an infant. The interpretation of the fetal lung profile in these patients has been questioned. Charts were reviewed from 99 isoimmunized patients cared for at Los Angeles County/University of Southern California Medical Center, Women's Hospital, from March, 1981, through December, 1983. There were 77 patients who underwent 260 amniocenteses. The lecithin-sphingomyelin ratio, dipalmitoyl phosphatidylcholine, phosphatidylinositol, and phosphatidylglycerol from the amniotic fluid did not differ from the values expected in normal gestations. There were a total of six patients who underwent intrauterine transfusions and the lung profile data were consistent with anticipated values. We conclude that lung maturation is neither delayed nor accelerated in the isoimmunized pregnancy.

Amniotic Fluid↗
PubMed1984

The role of nonstress tests, fetal biophysical profile, and contraction stress tests in the outpatient management of insulin-requiring diabetic pregnancies.

Antepartum fetal surveillance methods applicable in a home glucose-monitored population of pregnant diabetic women have been evaluated. A testing sequence of nonstress heart rate testing, backed up by either the fetal biophysical profile or contraction stress testing employed at a twice weekly interval, in 107 outpatients was compared with the management of 140 historic control patients by weekly nonstress tests and daily plasma estriols. There were 617 of 672 (91.8%) reactive nonstress tests in outpatients compared to 566 of 626 (90.4%) reactive tests in hospitalized control patients. Of 13 contraction stress tests performed in the outpatient group, only one was positive. Although 2,670 estriol determinations were done on hospitalized control patients, none was used for outpatients. No losses were attributed to unexplained antenatal stillbirth in either group. A fetal biophysical score of 8 was found to be at least as reliable as a reactive nonstress test. Antenatal surveillance in the well-controlled, insulin-requiring diabetic woman can be safely achieved with a testing sequence that consists of twice weekly nonstress tests backed up by the fetal biophysical profile and contraction stress tests.

Diabetes Mellitus, Type 1↗
PubMed1984

The use of ultrasound in the diagnosis of fetal lung maturity.

We have shown that there is a relationship between a BPD of at least 9.2 cm and the presence of lung maturity in the fetus of a nondiabetic pregnancy. The presence of a grade III placenta in the late third trimester appears to be a reliable predictor of maturity, but more data need to be assessed before the utility of this method at any gestational age can be properly evaluated. We have discussed a scheme incorporating ultrasonographic observations and laboratory analysis in reducing the risk of iatrogenic hyaline membrane disease and reducing the need for amniocentesis.

Amniocentesis↗
PubMed1983

The effect of plasma glucose variability on neonatal outcome in the pregnant diabetic patient.

Maternal glucose variability was studied in 154 pregnant diabetic patients hospitalized during the last month of their pregnancies. By means of several statistical analyses of the coefficient of variation for within-day plasma glucose variability, we found as follows. (1) There was a significant association between maternal glucose variability and neonatal outcome. (2) Patients with greater glucose variability had more episodes of hyperglycemia, but not hypoglycemia. (3) There was no correlation between maternal glucose variability and the birth weight of the infant. We are proposing the use of an index for glucose variability to monitor glucose control in pregnancy and predict neonatal outcome. Although absence of glucose variability will not ensure prevention of neonatal complications, there is a clear association between greater glucose variability and neonatal complications.

Birth Weight↗
PubMed1982

The use of ultrasound in the prediction of fetal pulmonary maturity.

Previous studies suggest that ultrasound criteria of biparietal diameter (BPD) and/or placental grade permit elimination of amniocentesis for pregnancy dating. To evaluate the potential risks and benefits of such a modified approach to determining fetal maturity, this prospective study, in which a BPD of greater than or equal to 9.2 cm or a Grade III placenta was used instead of amniotic fluid analysis, was undertaken. One hundred fifty-three infants were delivered electively between March, 1981, and January, 1982, on the basis of ultrasound parameters of pulmonary maturity. None of the electively delivered infants developed respiratory distress syndrome. We conclude from these preliminary results that the ultrasonically determined BPD of greater than or equal to 9.2 cm Grade III placenta is at least as sensitive as the lecithin/sphingomyelin ratio in predicting pulmonary maturity in our patient population.

Cesarean Section↗
PubMed1982

Insulin requirements during labor: a reappraisal.

Continuous insulin infusion has been advocated for strict glucose control during labor in insulin-requiring diabetic patients. We studied 33 insulin-dependent diabetic patients who were at term and undergoing induction of labor with oxytocin. Each patient received a glucose infusion (6 gm/hr), and the blood glucose level was determined hourly. Blood glucose levels did not rise above 100 mg/dl in 16 patients (48.4%) despite continuous intravenous glucose infusion. No differences were found in the following parameters between these patients and those requiring insulin infusion: maternal age, weight, diabetic class, gravidity, and prior insulin requirement. Birth weights and the incidence of neonatal morbidity were similar between groups and occurred despite euglycemia during labor. We found that euglycemia during labor did not prevent infant morbidity irrespective of the use of continuous low-dose insulin infusion. Additionally, 48% of patients did not require any insulin during induction of labor despite large antenatal insulin requirements.

Blood Glucose↗
PubMed1982

Sympathoadrenal activity in infants of diabetic mothers.

We assessed the activity of the sympathoadrenal system in infants of diabetic mothers. Concentrations of metanephrine in the amniotic fluid were correlated to amniotic fluid lung profiles. At the time of delivery, the levels of umbilical artery and vein plasma catecholamines were compared to the incidence of neonatal complications. Mature lung profiles correlated significantly with progressively rising metanephrine concentrations. Infants who had a higher incidence of neonatal complications at delivery had significantly higher plasma catecholamine levels as well. It is concluded that in infants of diabetic mothers there is a higher significant association between the sympathoadrenal activity and lung maturation. The majority of infants of diabetic mothers have excessive sympathoadrenal activity at birth, which could potentially lead toward catecholamine depletion and related complications in the first days of life.

Adrenal Glands↗