The prediction of preeclampsia.
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Biomarkers↗
Biomedical subjects
W F O'Brien
Publications and source records attributed to W F O'Brien.
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↗
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↗
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↗
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↗
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↗
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↗
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↗
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↗
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↗
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↗
A randomized comparison of umbilical vein and intravenous oxytocin during the puerperium.
Oxytocin was administered in a randomized fashion via either the umbilical or maternal intravenous route. Women who received intraumbilical oxytocin had significantly greater calculated blood loss compared with those who received peripheral administration (P = .01). This greater blood loss was confirmed by a decrease in hematocrit and hemoglobin concentrations after delivery. There was no difference between the groups in the length of the third stage of labor. The incidence of fetomaternal transfusion was higher in the intraumbilical group (P = .07). We conclude that intraumbilical oxytocin is no more beneficial than peripheral administration.
Adult↗
The value of early third-trimester maternal serum alpha-fetoprotein determination.
The value of determination of maternal serum of alpha-fetoprotein (MSAFP) concentration in the second trimester is well established. In addition to open neural tube defects, pregnancies associated with elevated second-trimester MSAFP have been shown to be at increased risk for a variety of problems, including low birth weight, preterm delivery, and pregnancy-induced hypertension (PIH). We evaluated the potential usefulness of MSAFP in the early third trimester. MSAFP concentration was determined in over 200 women at the time of glucose screening. Results were analysed with regard to gestational age at sampling, maternal weight, race, diabetes, and presence of twins. MSAFP was twice as high in twin gestation, but not affected by race or the presence of diabetes. In contrast to levels in early gestation, third-trimester MSAFP does not appear to be predictive of preterm delivery, low birth weight, or PIH.
Female↗
Potential prenatal predictions of Down syndrome: a statistical analysis.
To determine the feasibility of combining several screening tests for the prenatal detection of Down syndrome, we evaluated the potential relationship among three proposed predictors. We determined the concentration of chorionic gonadotropin in frozen serum samples from women of known maternal age and weight, fetal biparietal diameter, and femur length, and alpha-fetoprotein concentration. When corrected for gestational age and maternal weight, the potential predictors were independent, except for a slight correlation (r = 0.10) between maternal serum alpha-fetoprotein and maternal serum human chorionic gonadotropin. Both maternal serum human chorionic gonadotropin and biparietal diameter/femur length demonstrated an approximately log-normal distribution similar to maternal serum alpha-fetoprotein. Therefore it is scientifically sound to use any or all of these variables in combination for the identification of pregnancies at increased risk for Down syndrome.
Body Weight↗
Amniotic fluid alpha 1-antitrypsin concentration in premature rupture of the membranes.
Premature rupture of the membranes is probably a result of a loss in amniotic membrane collagen. A recent report that the concentration of alpha 1-antitrypsin was decreased in patients with premature rupture of the membranes suggested a generalized defect in such pregnancies. In this study we compared the concentration of alpha 1-antitrypsin in samples from pregnancies with premature rupture of the membranes and from pregnancies with preterm labor at similar gestational age. No difference in alpha 1-antitrypsin concentration was noted between these groups or between samples with or without intrauterine infection. These results support a localized inflammation and necrosis of the membranes at the site of rupture.
Amniotic Fluid↗
Effect of maternal-fetal movement on concentration of cells obtained at genetic amniocentesis.
The number of viable amniotic fluid cells in the aliquot obtained at amniocentesis is an important determinant of the success of subsequent cell culture. However, cell concentration and viability are highly variable, even in samples of equivalent gestational age. We studied the effect of prescribed maternal position change or spontaneous fetal movement on the concentration, viability, and subsequent harvest time of amniotic fluid cells removed at genetic amniocentesis. Samples from 108 patients at 15 to 22 weeks' gestation were evaluated. We did not find a relationship between this type of maternal or fetal movement and the retrieval of amniotic fluid cells.
Adult↗
The effect of magnesium sulfate infusion on systemic and renal prostacyclin production.
Recent in vitro studies have suggested that magnesium sulfate (MgSO4) infusions may increase prostacyclin production. We studied the effect of MgSO4 infusion on prostacyclin (PGI2) metabolite excretion in women with either pregnancy induced hypertension or preterm labor. Excretion of renal and systemic metabolites of PGI2 was measured prior to and following the start of MgSO4 infusion in the two groups. An increased in renal PGI2 metabolite preterm labor excretion was noted in the hypertension group but no change was noted in systemic PGI2 excretion in either group. These data fail to support a generalized, short term increase in endothelial cell PGI2 production as the basis for the beneficial effect of MgSO4.
Adult↗
Predicting preeclampsia.
Recent studies suggest that drugs affecting prostacyclin and thromboxane production may be able to affect the development of preeclampsia. In order to use these agents effectively, we must be able to select properly women at high risk. This review evaluates a number of historic and physical factors and laboratory tests that may aid in the prediction of preeclampsia. Family history, parity, and the roll-over test are currently the most efficient methods that are widely available. Two relatively new laboratory tests, plasma fibronectin concentration and urinary calcium/creatinine ratio, hold the greatest promise for the near future.
Angiotensin II↗