Biomedical subjects

T Easterling

Publications and source records attributed to T Easterling.

7 recordsLinked to original sources

PubMed2001

Breast-feeding by a cyclosporine-treated mother.

BACKGROUND: Cyclosporine is known to be excreted in breast milk, but levels in infants are not known. Post-transplant breast-feeding has been contraindicated in mothers treated with calcineurin inhibitors such as cyclosporine. CASE: A 35-year-old woman exclusively breast-fed her infant during the first 10.5 months of life while she was being treated with cyclosporine. Cyclosporine measurements in infant and maternal blood and breast milk revealed a mean breast milk/maternal blood level ratio of 84%, but undetectable levels in the infant. The infant grew and developed normally. CONCLUSION: The infant of a cyclosporine-treated mother was breast-fed exclusively during the first 10.5 months of life and did not absorb a detectable amount of the drug. Fetal growth and development were normal.

Adult↗

PubMed1995

Recent changes in delivery site of low-birth-weight infants in Washington: impact on birth weight-specific mortality.

OBJECTIVES: Our purpose was to ascertain whether the proportion of low-birth-weight infants delivered in Washington at tertiary hospitals changed between 1980 and 1991 and whether mortality differed by level of birth hospital. STUDY DESIGN: A retrospective cohort study was performed of 500 to 2499 gm infants born to Washington residents between 1980 and 1991 (n = 43,228). RESULTS: Overall, the percentage of low-birth-weight infants born at tertiary centers rose from 1980 to 1982 through 1986 to 1988 and subsequently declined significantly. Among infants weighing < 2000 gm nontertiary delivery was associated with greater potentially preventable mortality (500 to 999 gm, relative risk 1.5, 95% confidence interval 1.3 to 1.8; 1000 to 1499 gm, relative risk 2.1, 95% confidence interval 1.3 to 3.3; 1500 to 1999 gm, relative risk 1.6, 95% confidence interval 1.0 to 2.6). Nontertiary delivery of 2000 to 2499 gm infants was associated with lower overall mortality (relative risk 0.5, 95% confidence interval 0.3 to 0.8), but higher-risk deliveries in this birth weight range were apparently concentrated at tertiary hospitals. CONCLUSIONS: In light of the apparent benefit of tertiary center birth for infants weighing < 2000 gm, the possible erosion of effective regionalized perinatal care networks should be monitored closely.

Adult↗

PubMed1993

Fetal Doppler echocardiography in pulmonary atresia.

The prenatal diagnosis of pulmonary atresia is of particular importance because the affected neonate may be dependent on ductal blood flow to the lung, requiring urgent administration of prostaglandins. We review eight cases studied by ultrasonography in utero. Severe tricuspid regurgitation was present in six fetuses. Right ventricular size varied among cases. Right atrial enlargement was present in seven, usually with tricuspid regurgitation. Failure to identify the main pulmonary artery or valve on a single examination was not specific. Doppler flow studies were most reliable for the diagnosis by establishing the existence of retrograde flow in the ductus arteriosus from the aorta.

Blood Flow Velocity↗

PubMed1992

Maternal and fetal hemodynamic effects of autologous blood donation during pregnancy.

OBJECTIVES: Our objectives were to describe the maternal and fetal hemodynamic impact of a 1 U acute blood loss during pregnancy and to compare the hemodynamic responses of pregnant women with those of nonpregnant controls. STUDY DESIGN: With Doppler techniques cardiac output and total peripheral vascular resistance were determined in 16 pregnant women in the third trimester and in 16 nonpregnant volunteers before and during orthostatic stress, before and after donation of 450 ml of whole blood. In pregnant women the fetal umbilical artery systolic/diastolic ratio was also determined. Data were subjected to multiple logistic regression analysis. RESULTS: In both groups orthostasis provoked significant decreases in cardiac output and increases in total peripheral vascular resistance. The hemodynamic effects of blood loss were less pronounced and did not significantly change the hemodynamic response to orthostasis in either group. Neither orthostasis nor blood loss caused significant changes in the umbilical systolic/diastolic ratio. CONCLUSION: These data support the hemodynamic safety of uncomplicated autologous blood donation during late pregnancy.

Blood Donors↗

PubMed1991

Anesthetic concerns in the patient with preeclampsia.

Preeclampsia is a disease of unknown etiology and a major contributor to maternal and neonatal morbidity and mortality. With severe preeclampsia, numerous factors including intravascular volume depletion and susceptibility of developing pulmonary edema complicate anesthetic management. Invasive monitors such as CVP or PA pressure measurements are often required for guiding fluid management. When possible, lumbar epidural blockade is the preferred method for providing analgesia and anesthesia. Under all circumstances, a collegial and collaborative approach between obstetrician and anesthesiologist facilitates optimum patient care.

Anesthesia, Obstetrical↗

PubMed1988

Antepartum testing in postterm pregnancy.

Antepartum testing in postdate pregnancy was reviewed. No method of testing has been uniformly found to prevent all antepartum deaths in pregnancies with confirmed dates greater than 42 weeks. Perinatal mortality varies according to both the test and the institution. When comparing results according to the method of testing, perinatal mortality appears to be lowest (1.8/1,000) with the use of a 3-cm vertical pocket on ultrasound. Nearly as good is the use of a contraction stress test (2.5/1,000) on a weekly basis. Ultrasound using a 1-cm pocket and a biweekly non-stress test (NST) resulted in slightly worse perinatal mortality (5/1,000 and 6/1,000, respectively). If variable decelerations during the NST are not interpreted as abnormal, the perinatal mortality using a biweekly NST is 15/1,000. Induction of labor at 41-42 weeks with a favorable Bishop score will obviate the need for antepartum testing in some patients.

Amniotic Fluid↗

PubMedDate not supplied

Induction of fetal demise in advanced pregnancy terminations: report on a funic potassium chloride protocol.

Advanced pregnancy termination with uterotonic agents with their inherent risk for occurrence of a live birth and surgical evacuation of a fetus perceived to be vigorous can both be sources of emotional anguish for women. They argue for offering women an option for induction of fetal demise prior to uterine evacuation. We report on our experience with 60 pregnancies in which lethal fetal administration of potassium chloride was performed prior to evacuation of the uterus. We describe a double-bolus technique for funic intravascular injection of potassium chloride to arrest the fetal heart. There were no maternal complications and the procedure was successful in 86.7% (n = 52) of the cases; of the remaining 8 cases, 7 had demise induced by direct fetal cardiac injection, and a live birth occurred in 1 case.

Abortion, Induced↗