Biomedical subjects
Publications and source records attributed to T M Stubbs.
Although genital condylomata worsen with pregnancy, we are unaware of any reports of fatal maternal laryngeal papillomatosis. A maternal death at 20 weeks' gestation of a patient with chronic laryngeal papillomatosis is described. Pregnant patients with a history of this disorder who have symptoms should be considered candidates for immediate evaluation.
OBJECTIVE: Our objective was to compare the safety and efficacy of two accepted oxytocin induction protocols that differ in oxytocin dose increments. STUDY DESIGN: At the Carolinas Medical Center in Charlotte, North Carolina, 151 women with indications for induction of labor were prospectively randomized into one of two oxytocin induction protocols. Safety and efficacy of the two protocols were analyzed with two-tailed t tests and chi 2. RESULTS: Time from induction to establishment of a regular labor pattern was significantly shorter in the experimental group compared with the traditional group (p = 0.03). However, no significant difference was seen from onset of induction to time of delivery. Incidences of hyperstimulation were not significantly different between the two protocols, but there was a trend toward a higher incidence of fetal heart rate changes in the experimental group (p = 0.08). CONCLUSION: These data suggest that induction with larger dose increments will shorten time to adequate labor without an associated increase in uterine hyperstimulation or poor neonatal outcome. The differences in heart rate changes are concerning and merit further investigation. If confirmed by further studies, an increased risk of cord compression could outweigh the benefit of a faster onset of contractions.
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Fibronectin is a high molecular-weight glycoprotein found in most tissues and body fluids. Maternal plasma fibronectin levels have been shown to be elevated in preeclampsia, but little is known about placental fibronectin in preeclampsia. Fibronectin tissue distribution in placental villi was "blindly" graded by two examiners using placentas from eight nonpreeclamptic and six preeclamptic pregnancies. Selected frozen sections of normal-appearing areas from each placenta were incubated with rabbit antihuman fibronectin antiserum and then stained with fluorescein isothiocyanate-conjugated goat antirabbit immunoglobulin G and examined by fluorescent microscopy. We found less intensity of fetal vessel fibronectin staining in villi from placentas from preeclamptic pregnancies than in those of normal pregnancies (p less than 0.02, Mann-Whitney U test). It is unclear why fetal villous vessels in preeclampsia have decreased tissue fibronectin, but this may reflect an additional vascular abnormality associated with the preeclampsia syndrome.
Some preeclamptic patients have schistocytosis, abnormal liver function tests and thrombocytopenia. To determine how strongly these three abnormalities cluster with each other, a sequential series of 49 preeclamptic or eclamptic patients was analyzed for the presence of schistocytosis, serum aminotransferase elevation and thrombocytopenia. These three abnormalities were found less often together (the HELLP syndrome) than singly or in pairs. These data do not clearly separate HELLP patients from other preeclamptic patients.
The plasma fibronectin concentration was abnormally elevated (greater than 400 micrograms/ml) in 16 of 17 normotensive gravid women who subsequently developed preeclampsia. Of this group, 13 had elevated levels detectable greater than or equal to 4 weeks before the onset of hypertension. Our results indicate that plasma fibronectin levels can be abnormally increased long before the onset of clinical symptoms and that abnormalities of this glycoprotein may be an early indication of this pathologic process.
Platelet size and the distribution of platelet sizes are both increased in preeclamptic patients with normal platelet counts. These changes suggest that accelerated platelet production and consumption are both widespread in preeclampsia.
The accurate prediction and diagnosis of preterm labor continue to frustrate the clinician. This is partly due to a scarcity of cervical data from the early third trimester. A total of 760 prospective, serial, paired, and blinded pelvic examinations were done at 28 to 34 weeks of gestation for 191 patients without a history of preterm labor. If the cervix was dilated greater than or equal to 1 cm (internal os) or effaced greater than 30%, the relative risk of preterm labor was increased to 1.8 to 4.2. Negative predictive values for cervical status were greater than 92%, but positive predictive values were less than or equal to 18%. Change over time was unusual (dilatation increase greater than or equal to 1 cm or effacement increase greater than or equal to 40%), suggesting that a baseline late second-trimester examination could assist in the early but accurate diagnosis of preterm labor should it be suspected later in gestation. These data suggest that even in the low-risk patient, an early cervical examination could be beneficial.
Fibronectin is a plasma glycoprotein which is involved in coagulation, platelet function, tissue repair, and the vascular endothelial basement membrane. We have found plasma fibronectin concentrations to be elevated in a group of preeclamptic patients. This finding is consistent with other evidence for a role of the vascular endothelium in preeclampsia.
It has been suggested that the basis for the marked discordance in factor VIII parameters in preeclampsia is the result of proteolysis of the factor VIII procoagulant component (VIII:C) owing to activation of the coagulation system. To investigate this further, levels were compared of factor VIII:C and VIII:C (Ag), the immunologic equivalent of the procoagulant activity, in a series of preeclamptic patients and patients with uncomplicated pregnancies. No significant difference in the mean (+/- SD) level of factor VIII:C or VIII:C (Ag) could be detected between these groups. Our results do not support proteolysis of factor VIII:C as a mechanism to account for the discordant levels of the factor VIII parameters in preeclampsia.