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Biomedical subjects

V A Barss

Publications and source records attributed to V A Barss.

At least 19 recordsLinked to original sources
PubMed1992

An intravaginal controlled-release prostaglandin E2 pessary for cervical ripening and initiation of labor at term.

The purpose of this randomized, double-blind study was to evaluate the efficacy and safety of a new controlled-release hydrogel pessary for ripening the cervix and initiating labor. Subjects had an entry Bishop score of 4 or less and gestational age of 37 or more weeks. One hundred fourteen women received a placebo pessary and 101 received the hydrogel pessary, containing 10 mg of prostaglandin (PG) E2. Compared with the placebo group, those given the PGE2 pessary were more likely to have an increase in Bishop score of 3 or more (60 or 59% versus 21 or 18%; P less than .0001), change to a Bishop score of 6 or higher (59 or 58% versus 18 or 16%; P less than .0001), and active labor (68 or 67% versus 15 or 13%; P less than .0001). Including the crossover study, uterine hyperstimulation (28 of 182, 15%) and fetal heart rate abnormalities (18 of 182, 10%) in PGE2-treated subjects were reversed on removal of the pessary with no apparent harm to the mother or fetus. These temporary adverse effects appeared while the pessary was in place and after the onset of active labor. Oxytocin was unnecessary in 89 of 182 (49%) of the PGE2-treated cases and was used more often to augment than to induce labor. We conclude that the described controlled-release PGE2 vaginal pessary induces appreciable cervical ripening and frequently initiates active labor with little or no need for oxytocin. The pessary may cause uterine hyperstimulation or fetal heart rate abnormalities, but these would be expected to reverse on removal of the pessary.

Delayed-Action Preparations↗
PubMed1989

Prematurity among insulin-requiring diabetic gravid women.

From Jan. 1, 1983, through Dec. 31, 1987, 420 gravidas with insulin-requiring diabetes antedating pregnancy delivered on the Joslin Clinic service. Among them, 110 pregnancies (26.2% of the total) delivered before 37 completed weeks of gestation compared with a 9.7% incidence (906/9368) for the general population at the Brigham and Women's Hospital during calendar year 1985. Thirty-three percent of all premature deliveries were the result of the development of preeclampsia. The relative risk of prematurity for diabetic patients with any hypertensive complication was 2.0 (95% confidence interval, 1.40 to 2.87) compared with normotensive diabetic subjects. Compared with the general population, most of the excess risk of prematurity was confined to hypertensive diabetics and normotensive patients of more advanced White class. A history of having had a previous premature delivery, increasing duration of diabetes antedating pregnancy, and carrying a male fetus in the index pregnancy were significantly associated with premature delivery. Future efforts to reduce the incidence of prematurity among diabetic gravidas should be directed toward reducing the incidence of preeclampsia.

Diabetes Mellitus, Type 1↗
PubMed1989

Diabetes and pregnancy.

Prior to the introduction of insulin, a vast majority of pregnancies complicated by diabetes ended in perinatal death, with an associated risk of maternal death. Currently, virtually all diabetic women can undergo pregnancy with the expectation of good maternal and fetal outcome. However, many challenges still remain in preventing congenital anomalies and macrosomia.

Counseling↗
PubMed1989

Pregnancy outcome after premature rupture of the membranes at or before 26 weeks' gestation.

Pregnancy outcome was examined in 59 clinically stable patients with rupture of the membranes at or before 26 weeks' gestation. The mean gestational age at rupture of the membranes was 23.2 weeks, and the mean latent period was 21.5 days. Delivery occurred within 7 days in 29 patients (49.2%), chorioamnionitis developed in 27 patients (45.8%), and operative delivery was required in 24 patients (40.7%). Sixty-three infants were delivered, with a perinatal mortality rate of 49.1%. Among survivors, 84% required newborn intensive care during the initial hospitalization, 77% were discharged with minor to moderate reversible sequelae, and 16% were discharged with sequelae that were likely to be of long-term duration. Obstetric factors present at rupture of the membranes were evaluated for their ability to predict maternal and neonatal morbid outcomes; obstetric interventions were evaluated for their ability to modify outcomes. These data suggest that outcomes in this subset of patients may not be uniformly dismal, and support clinical decision-making on an individualized basis.

Adult↗
PubMed1989

Sonographic evaluation of hydrops fetalis.

Sonographic criteria were developed to aid in determining the cause of hydrops fetalis in 26 consecutive cases diagnosed antenatally. This enabled us to predict whether the hydrops was due to anemia-related causes (isoimmunization, fetomaternal hemorrhage, alpha-thalassemia) or non-anemia-related causes. Fetuses without anemia as the cause of hydrops most often exhibited pleural effusions (87%) or marked edema (62.5%). A combination of pleural effusions and marked edema was evident in fetuses without anemia 56.3% of the time. Those with anemia as the cause of hydrops were significantly less likely to exhibit pleural effusions (20%), marked edema (10%), or pleural effusions and marked edema (10%). A thickened placenta occurred significantly more frequently (80 versus 37%) in anemia-associated hydrops. With the use of cordocentesis and intravascular in utero transfusion, the early recognition and treatment of hydrops fetalis due to anemia should lead to improved outcome in fetuses so affected.

Anemia↗
PubMed1988

The cost of irregular antibody screening.

The cost of irregular antibody screening in the third trimester exceeds +600,000.00 per perinatal death averted. This cost appears prohibitive compared with the clinical impact of the disease and costs of other screening tests.

Antibodies↗
PubMed1988

Management of isoimmunized pregnancy by use of intravascular techniques.

Twenty-two patients who had 23 pregnancies complicated by isoimmunization were managed by the use of intravascular methods on an outpatient basis. Nine patients underwent 30 percutaneous fetal blood sampling procedures to determine fetal blood type or hematocrit, without complication. Thirteen patients underwent 45 intrauterine fetal transfusions via the umbilical vessels and 16 intraperitoneal fetal transfusions. The overall survival rate in this series was 85.7%. Survival among fetuses that were hydropic at initial evaluation was 83.3%. The procedure-related perinatal mortality rate for intravascular intrauterine transfusions was 2.2%. Knowledge of fetal blood type and hematocrit allowed treatment individualized to the specific needs of each patient. In particular, the ability to transfuse blood directly into the vascular system of the hydropic fetus proved to be lifesaving in those patients.

Blood Grouping and Crossmatching↗
PubMed1988

Fetal abnormalities: diagnosis or treatment with percutaneous umbilical blood sampling under continuous US guidance.

Percutaneous umbilical blood sampling has become an important tool in maternal-fetal medicine and allows direct access to fetal blood. In 52 patients, 100 successful consecutive blood sampling procedures were done for a variety of indications, including 20 intravascular intrauterine fetal transfusions for isoimmune disease. Indications, technique, and complications in this series of percutaneous umbilical blood sampling procedures are described.

Blood Specimen Collection↗
PubMed1988

Early amniocentesis for prenatal cytogenetic evaluation.

Early amniocentesis at 11-14 weeks gestation was evaluated in 100 consecutive patients to see how this technique compares with later amniocentesis. There were no complications as a consequence of the procedure or related pregnancy losses of chromosomally normal fetuses. Samples obtained from three (3%) patients showed insufficient cell growth; two of these patients elected a repeat procedure, which yielded a normal karyotype in each case. There were five abnormal karyotypes, one of which was a culture artifact; in the latter case, repeat amniocentesis at 15 weeks yielded a normal result. Of the 95 pregnancies with normal karyotypes, 94 were progressing normally at follow-up, and one patient elected pregnancy termination because of maternal indications. It appears that early amniocentesis may be an attractive alternative to traditional amniocentesis, in that it provides results at an earlier gestational age and may avoid certain disadvantages of chorionic villus sampling.

Amniocentesis↗
PubMed1988

Effects of prazosin and indomethacin on the alpha-adrenergic stimulation of rabbit myometrium.

The effect of norepinephrine (NE) stimulation of near-term pregnant rabbit myometrium was studied by comparing cumulative dose-response curves for NE and NE with prazosin or indomethacin. Prazosin blocked the stimulatory effects of NE. Indomethacin pretreatment resulted in attenuation, but not suppression of contractile activity. Myometrial activity was associated with a progressive increase in the synthesis of prostaglandin (PG) F2 alpha. Our observations suggest that alpha-adrenergic agonists have some myometrial stimulating effect independent of PG production.

Animals↗
PubMed1987

Acute fetal distress associated with percutaneous umbilical blood sampling.

Percutaneous umbilical blood sampling is emerging as an important procedure in the armamentarium of the obstetrician involved with prenatal diagnosis. It has apparent low morbidity and can be accomplished with relative ease by the experienced operator. We report a series of 42 successful percutaneous umbilical blood sampling procedures in 22 patients and describe the indications and gestational ages of the fetuses undergoing the blood-sampling procedures. Nine of the procedures involved intravascular transfusions. In one of our 42 cases, acute fetal distress developed in a manner similar to that of a previously reported case that was likewise associated with a compromised fetus and ended in death. Because of prompt and immediate delivery, the infant described in this series survived and, although this procedure appears to be relatively safe in experienced hands, it is imperative that the associated complications be duly recorded.

Blood Specimen Collection↗
PubMed1987

Cardiac output in a fetus with erythroblastosis fetalis: assessment using pulsed Doppler.

Pulsed Doppler studies of left and right ventricular outputs were obtained over time in a hydropic fetus with erythroblastosis fetalis. Despite severe anemia, cardiac outputs were within the normal range and remained normal after in utero percutaneous intravascular transfusions, which reversed the hydrops. The measurement of cardiac output in utero provides direct evidence that high-output failure due to anemia is not the mechanism for hydrops in erythroblastosis fetalis.

Adult↗
PubMed1986

Ultrasonographic fetal surveillance in the management of the isoimmunized pregnancy.

During the past 20 years the management of pregnancies involving rhesus sensitization has been based on determinations of the optical density of amniotic fluid as an index of the bilirubin concentration and the degree of hemolysis. High values have dictated intervention in the form of delivery or intrauterine transfusion, depending on the gestational age. Since 1982 intensive surveillance with ultrasound imaging and electronic monitoring of the fetal heart rate have become useful in decisions about the timing of intervention. Using these tools, we followed 11 fetuses who would previously have been treated by multiple intrauterine transfusions or early delivery, for 8 to 63 days without treatment. All were born alive, in good condition and without hydrops, at gestational ages of 30.5 to 36.0 weeks. The lengths of stay for the neonates ranged from 8 to 48 days, and all were discharged alive. We conclude that rhesus sensitization in a select group of fetuses, who according to former standards would have been candidates for earlier delivery or intrauterine transfusion, can be managed expectantly for longer periods by careful observation with modern techniques of surveillance.

Cesarean Section↗
PubMed1986

Use of a small-gauge needle for intrauterine fetal transfusions.

Intraperitoneal intrauterine fetal transfusions have generally been performed with large-gauge Tuohy needles, which increase the risk of traumatic fetal complications. We feel that this technique can be improved by use of a small-gauge needle and continuous ultrasound visualization. A series of 20 transfusions is presented.

Blood Transfusion, Intrauterine↗
PubMed1986

Prenatal sonographic diagnosis of congenital hemivertebra.

The prenatal sonographic diagnosis of spinal abnormalities associated with neural tube element malformations has been well described; however, the diagnosis of fetal skeletal anomalies of the vertebral bodies with a neurologically intact spine has received little attention. Three cases of congenital hemivertebra should alert the sonographer to search for other congenital defects and for orthopedic complications of vertebral body malformations in childhood. Prior knowledge of the presence of an abnormal vertebral body can alert the pediatrician to watch for early signs of problems such as scoliosis or kyphoscoliosis, and to plan surgery if necessary.

Adult↗
PubMed1985

Antenatal sonographic diagnosis of fetal gastrointestinal malformations.

Fetal gastrointestinal abnormalities are readily detected by ultrasonography. The presentation, management, and outcome of 17 cases of fetal gastrointestinal and associated anomalies are presented. Antenatal knowledge of these abnormalities can potentially decrease neonatal morbidity and mortality because the appropriate preparations can be made in advance of delivery.

Adult↗
PubMed1985

Ultrasonographic determination of chorion type in twin gestation.

Reported are sonographic criteria for distinguishing the chorionic type of twin pregnancies prenatally. Thirty-four twin pregnancies were prospectively evaluated with correct assignment of chorionic type in 33 cases. The ability to determine the chorionic type of twin gestation facilitated the prenatal diagnosis and management in eight of the studied cases. Knowledge of the type of twinning antenatally is important in the management of twin pregnancies.

Amnion↗