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Biomedical subjects

W F O'Brien

Publications and source records attributed to W F O'Brien.

At least 19 recordsLinked to original sources
PubMed1992

Carbohydrate metabolism after three months of using a gestodene-containing monophasic oral contraceptive.

Carbohydrate metabolism was prospectively evaluated in twenty-one normal women prior to and during their use for three months of a monophasic oral contraceptive containing the progestin gestodene plus ethinyl estradiol. The women had a three-hour oral glucose tolerance test using a 75 gram glucose load, measuring serum glucose and insulin levels. The results demonstrate no significant changes in either of the carbohydrate metabolic indices between the two tests. These data support the safety of this new progestin-containing contraceptive.

Adult↗
PubMed1992

Effect of magnesium sulfate on plasma endothelin-1 levels in normal and preeclamptic pregnancies.

OBJECTIVE: We attempted to determine the effects of magnesium sulfate on: (1) endothelin-1 concentration in preeclampsia, preterm labor, and term pregnancy and (2) endothelin-1 release from human umbilical cord endothelial cells. STUDY DESIGN: Plasma samples were prospectively collected from eight women with preeclampsia, six preterm labor patients, and eight term patients undergoing external cephalic version before and 2 hours after magnesium sulfate infusion. Supernatants were collected from human umbilical cord endothelial cells exposed to magnesium sulfate and controls. All samples were assayed with a specific radioimmunoassay for endothelin-1. Paired Student t test and analysis of variance were used for statistical analysis. RESULTS: Magnesium sulfate infusion in preeclampsia lowered endothelin-1 levels compared with preinfusion values (6.6 +/- 3.81 before and 4.75 +/- 2.28 after infusion, p < 0.02). Magnesium sulfate did not have an effect on endothelin-1 concentration in preterm and term pregnancies. Magnesium sulfate did not alter the endothelin-1 release from human umbilical cord endothelial cells. CONCLUSION: A significant reduction of endothelin-1 plasma levels after magnesium sulfate therapy is limited to preeclampsia. In contrast, this lowering effect was not exhibited in women without preeclampsia or in normal endothelial cells.

Adult↗
PubMed1992

Six-month carbohydrate metabolism studies in women using oral contraceptives containing gestodene and ethinyl estradiol.

Twenty-five women had their carbohydrate metabolism prospectively evaluated during the six months that they used a gestodene and ethinyl estradiol monophasic oral contraceptive. Serum glucose and insulin levels were measured during a 75-gram three-hour oral glucose tolerance test. At the six-month test, the three-hour glucose and the fasting and three-hour insulin values were significantly elevated. The literature on carbohydrate metabolism during gestodene oral contraceptive use is also reviewed.

Adult↗
PubMed1992

Cystic degeneration of a leiomyoma masquerading as a postoperative abscess.

Leiomyomas are common tumors that usually have a typical sonographic appearance. With degeneration, however, the sonographic findings may be completely uncharacteristic. We report a case of a multicystic anterior uterine wall mass detected at antenatal sonography in an asymptomatic patient. Differential diagnosis included myoma, varicosity, hematoma, abscess, uterine anomaly, and pelvic neoplasm. At cesarean section, the mass was confirmed to be a myoma. Postoperatively, an ultrasound was performed by the radiology service during evaluation of suspected endometritis and the mass was interpreted as an endometrial abscess. This case illustrates that myomas can present with sonographic features consistent with a number of pathologic disorders. This variable pattern of echogenicity may sometimes create difficulty in establishing a correct diagnosis. The case also demonstrates the importance of communication between services and the need for not only antenatal but also postpartum and gynecologic ultrasound studies to be performed by physicians trained in sonographic findings of the abnormal uterus.

Abscess↗
PubMed1992

Comparison of cord purine metabolites to maternal and neonatal variables of hypoxia.

Umbilical arterial concentrations of purine metabolites were evaluated prospectively as markers of hypoxia. The results suggest that hypoxanthine accumulates in association with fetal acidosis and reduced levels of buffer base (P less than .01). Acute hypoxemia defined by umbilical arterial oxygen pressure was accompanied by elevation of uric acid concentrations (P less than .01). Fetal heart rate tracings with characteristics classically associated with fetal stress correlated with increased concentrations of hypoxanthine and xanthine (P less than .01). Therefore, intrapartum events may occur that are not documented by standard markers of perinatal hypoxia at delivery.

Asphyxia Neonatorum↗
PubMed1992

Evaluation of oxygen desaturation events in singleton pregnancies.

Previous investigators have demonstrated that oxygen desaturation may occur in laboring women. The purposes of this study were to identify groups at risk for desaturation and to seek correlation with newborn outcome. Volunteers in labor were evaluated for oxygen desaturation, analgesic exposure, magnesium sulfate administration, and various medical illnesses. Desaturations were noted more frequently in women exposed to narcotic analgesics, sedatives, and magnesium sulfate. A trend toward more desaturations in the women with preeclampsia was noted. Although desaturations related to narcotic analgesics and sedatives are most likely due to hypoventilation, the mechanism in women treated with magnesium sulfate is uncertain. Maternal peripartum desaturations did not result in unfavorable neonatal Apgar scores, cord blood gas measurements, or neonatal oxygen desaturation values, but the staff was aware of the events and prompt treatment was instituted.

Apgar Score↗
PubMed1992

Clitoral size in normal women.

OBJECTIVE: We sought to determine clitoral size in normal women and the possible effect of age, height, weight, parity, and oral contraceptive (OC) use. METHODS: Prospective measurement was made of clitoral dimensions in 200 consecutive normal women at routine gynecologic examination in an office setting. RESULTS: The mean (+/- standard deviation) transverse diameter of the glans clitoris was 3.4 +/- 1.0 mm. The longitudinal diameter of the glans was 5.1 +/- 1.4 mm. Total clitoral length including glans and body was 16.0 +/- 4.3 mm. The mean clitoral index was 18.5 mm2. Measurements of all diameters were normally distributed. Age, height, weight, or current use of OCs did not influence clitoral size, but parous women had significantly larger measurements. CONCLUSIONS: It is possible to obtain useful clitoral measurements in the office setting. Parity influences clitoral size, but age, height, weight, and OC use do not.

Adolescent↗
PubMed1992

Randomized comparative trial of indomethacin and sulindac for the treatment of refractory preterm labor.

This study was designed to investigate the efficacy and safety of sulindac in the treatment of preterm labor. Thirty-six women in preterm labor who had failed initial attempts at tocolysis with magnesium sulfate were randomized to receive either oral indomethacin or oral sulindac for 48 hours. The mean gestational ages at admission were 29 and 30 weeks for the sulindac and indomethacin groups, respectively. There was a significantly greater hourly fetal urine output, deepest amniotic fluid pocket, and amniotic fluid index in the sulindac group. A trend toward higher fetal ductus arteriosus flow velocities noted in the indomethacin group was not seen in the sulindac group. The drugs had similar success in delaying delivery for 48 hours or 7 days. The mean birth weights were 2000 and 2323 g for the sulindac and indomethacin groups, respectively. Sulindac appears to be as effective as indomethacin for refractory preterm labor but with fewer fetal side effects.

Adult↗
PubMed1991

Potential role of endothelin-1 in normal and hypertensive pregnancies.

Endothelins are the most potent naturally occurring vasoconstrictors yet discovered. Both normal and abnormal pregnancies are associated with significant changes in vascular smooth muscle; therefore the potential role of endothelin in pregnancy was investigated. Plasma immunoreactive endothelin-1 concentration was measured by radioimmunoassay in blood from women with normal pregnancy and preeclampsia and in cord blood from normal pregnancies. Endothelin-1 levels were elevated in pregnant women during labor when compared with levels in nonpregnant women and patients with normal pregnancies before labor. Preeclampsia in nonlaboring women before treatment was associated with higher endothelin values when compared with values in normal nonlaboring patients and women with preeclampsia after magnesium sulfate infusion. The umbilical venous concentration of endothelin was 10 times higher than normal pregnant levels and four times higher than levels in laboring patients.

Adult↗
PubMed1991

Peritoneal closure or non-closure at cesarean.

The value of peritoneal closure at the time of cesarean birth was evaluated prospectively. Two hundred forty-eight women undergoing low transverse cesarean through a Pfannenstiel skin incision were assigned to one of two groups: peritoneum open (N = 127) or peritoneum closed (N = 121). The mean (+/- SEM) surgical time in the open group (48.1 +/- 1.2 minutes) was significantly less than for the closed group (53.2 +/- 1.4 minutes) (P less than .005). There were no postoperative differences between the groups in the incidence of wound infection, dehiscence, endometritis, ileus, and length of hospital stay. Our study suggests that leaving the parietal peritoneum unsutured is an acceptable way to manage patients at cesarean delivery.

Adult↗
PubMed1991

Use of TRH in the fetus to advance lung maturity.

Maturation of the fetal lung is a complex process involving interactions between intrinsic biologic development of several cell types and hormonal triggering of biochemical and functional alterations. Catecholamines, corticosteroids, thyroid hormones and perhaps prolactin, all influence the transition from non-functional to functional pulmonary tissue, the most critical component necessary for extrauterine existence. The assimilation of clinical observation, in vitro experimentation, and animal studies has led to the potential of therapeutic intervention in a manner with minimal hazard to the fetus. The use of maternally administered TRH to reduce the incidence and severity of RDS, although still in the early stages of clinical application, appears to justify the long years of careful research in this area.

Adrenal Cortex Hormones↗
PubMed1991

Cocaine and indomethacin: fetal anuria, neonatal edema, and gastrointestinal bleeding.

A case is reported in which exposure to cocaine and indomethacin was associated with development of fetal anuria, anasarca, and neonatal gastrointestinal hemorrhage. Cocaine and indomethacin may act synergistically to adversely affect renal, cardiovascular, and platelet function. It may be prudent to obtain a drug history and urine screen for cocaine before instituting indomethacin therapy for preterm labor or polyhydramnios.

Adult↗
PubMed1991

Finapres: a noninvasive device to monitor blood pressure.

Often, obstetric patients are not evaluated in preliminary studies during the development of new medical devices. The purpose of this study was to compare the Finapres digital probe with oscillometric and arterial line devices for recording blood pressures in low- and high-risk pregnant women. A total of 38 women were studied, including 24 with pregnancy-induced hypertension, two with chronic hypertension, two with cardiac disease, and ten who had no risk factors but requested epidural catheter placement. The comparison of Finapres or oscillometric recordings with direct arterial values confirmed that systolic recordings were imprecise for both devices (r = 0.80 and r = 0.64, respectively). Diastolic recordings (Korotkoff sound, phase 4) from the Finapres were accurate compared with the arterial values (r = 0.84). The Finapres performed at least as reliably as the oscillometric monitor in assessing blood pressure in our pregnant population and provided continuous measurements. When very accurate systolic recordings are needed, arterial catheter placement may be necessary.

Adult↗
PubMed1991

Cervical cerclage in early pregnancy.

A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed. For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage: group 1 less than or equal to 13 weeks; group 2 greater than 13 weeks, but less than 18 weeks; group 3 greater than or equal to 18 weeks. There was no difference among groups in mean age, gravidity, history of diethylstilbestrol exposure (DES), prior pregnancy loss at or before 20 weeks, or prior dilation and curettage procedure. There were 24 modified McDonald and 14 modified Shrodkar procedures performed. The mean gestational age of cerclage placement in group 1 was earlier than in group 2 and group 3 by 3.5 and 10.5 weeks, respectively. There were no major surgical complications in any of the three groups. The overall incidence of preterm labor and preterm birth were 48.6% and 37.8%, respectively. Analysis of variance demonstrated a trend toward differences in the incidence of preterm labor, preterm birth, and estimated gestational age at delivery, with the earlier group favored. None of these, however, reached the level of statistical significance. Estimated blood loss, obstetric complications, mean birthweight, and mean gestational age at delivery were not statistically different for the three study groups. The above data are discussed and support given for the safety and efficacy of cervical cerclage placement in early pregnancy when compared with the more standard recommendations of placement at from 14 to 17 weeks' gestational age.

Adult↗
PubMed1991

A randomized comparison of assisted vaginal delivery by obstetric forceps and polyethylene vacuum cup.

The assisted vaginal delivery methods of rigid obstetric forceps and polyethylene vacuum cup extraction were compared in a prospective, randomized study. The 99 women studied had all completed 35 full weeks' gestation, required attempted assisted vaginal delivery, and were randomly assigned to either attempted forceps or vacuum-assisted delivery. All presentations were cephalic, with stations ranging from +1 to +4. Neonates were evaluated at 24 hours by neonatal staff. The infants underwent intracranial ultrasound screening during the first 24 hours of life and ophthalmologic examination within 48 hours. Vaginal delivery was successful with the intended method in 83% of vacuum-assisted deliveries and in 78% of forceps deliveries (not statistically significant). Neonatal retinal hemorrhage was found in 17 and 38% (P less than .043) of the randomized forceps and vacuum deliveries, respectively. No intraventricular hemorrhage was found. Apart from associations between vacuum-assisted delivery and mild hyperbilirubinemia and neonatal retinal hemorrhage (of uncertain clinical significance), and between assisted forceps delivery and an increased potential for facial injury, neonatal outcomes did not differ significantly. Maternal outcomes also did not differ significantly. No significant differences in safety or efficacy were found between polyethylene cup vacuum extraction and rigid obstetric forceps-assisted vaginal delivery in this population of predominantly low-pelvic assisted deliveries. Patients delivered by sequential use of forceps after vacuum or by vacuum after failed forceps application did not suffer significantly increased morbidity relative to those delivered by forceps or vacuum alone. Use of alternate or sequential methods allowed an overall cesarean rate of 3% in this population.

Acid-Base Equilibrium↗
PubMed1991

The effect of magnesium sulfate on the biophysical profile of normal term fetuses.

Forty term pregnant women with singleton breech gestations admitted for external cephalic version underwent biophysical profile testing before any fluid infusion or medication. After magnesium sulfate had been infused for contraction prophylaxis, the maternal serum magnesium level was measured and a second biophysical profile was performed. The mean (+/- SD) serum magnesium was 5.1 +/- 1.0 mg/dL. The biophysical profile score decreased significantly, reflecting a decrease in fetal breathing activity. In patients with therapeutic maternal serum magnesium levels, loss of any component of the biophysical profile other than respiration cannot be attributed to the elevation in magnesium concentration.

Adult↗
PubMed1991

Sequential outpatient application of intravaginal prostaglandin E2 gel in the management of postdates pregnancies.

A randomized blinded investigation was undertaken to determine the efficacy and safety of sequentially applied intravaginal prostaglandin E2 (PGE2) gel for accelerating cervical ripening in an outpatient setting in low-risk prolonged pregnancies. Fifty women with uncomplicated pregnancies at or beyond 41 weeks' gestation and Bishop scores below 9 received twice-weekly outpatient administration of gel containing 2.0 mg of PGE2 or placebo. Thirty nulliparas and 20 multiparas were enrolled. The PGE2 gel failed to improve cervical ripening over placebo, as judged by Bishop scores. There was no difference between the groups in gestational age on admission to the labor and delivery suite, number of gel applications, requirement for oxytocin, incidence of cesarean delivery, or neonatal outcome. Only two patients (4%) experienced regular uterine contractions after gel insertion; these subsided spontaneously in both. None of the subjects experienced labor, tetanic contractions, evidence of fetal distress, or any other side effects related to gel insertion. We conclude that PGE2 gel in this dosage may be used safely in an outpatient setting, but more frequent application or earlier initiation may be required to produce a clinical effect.

Administration, Intravaginal↗