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At least 19 recordsLinked to original sources

PubMed2000

Elective versus selective caesarean section for delivery of the small baby.

BACKGROUND: Elective caesarean delivery for women in preterm labour might reduce the chances of fetal or neonatal death, but it might also increase the risk of maternal morbidity. OBJECTIVES: The objective of this review was to assess the effects of a policy of elective caesarean delivery versus selective caesarean delivery for women in preterm labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Randomised trials comparing a policy of elective caesarean delivery with expectant management with recourse to caesarean section. DATA COLLECTION AND ANALYSIS: One reviewer assessed eligibility and trial quality. MAIN RESULTS: Five studies involving 104 women were included. All trials reported recruiting difficulties. No significant differences between elective and selective policies for caesarean delivery were found for fetal, neonatal or maternal outcomes. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of a policy for elective caesarean delivery for small babies. Randomised trials in this area are likely to continue to experience recruitment problems. However it still may be possible to investigate elective caesarean delivery in preterm babies presenting cephalically.

Cesarean Section↗

PubMed2000

Planned caesarean section for term breech delivery.

BACKGROUND: Routine use of caesarean section for breech presentation is widespread. However poor outcomes after breech birth may be the result of underlying conditions causing breech presentation rather than damage during delivery. OBJECTIVES: The objective of this review was to assess the effects of planned caesarean section for breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials register. Date of last search: October 1997. SELECTION CRITERIA: Randomised trials comparing planned caesarean section for breech presentation with planned vaginal delivery. DATA COLLECTION AND ANALYSIS: Reviewers assessed trial eligibility and quality. MAIN RESULTS: Two studies involving 313 women were included. Caesarean section was done in 93% (119/128) of women allocated to planned caesarean section and 54% (99/185) of women in the planned vaginal delivery groups. The policy of planned caesarean section was associated with significantly increased maternal morbidity (relative risk 1.31, 95% confidence interval 1.02 to 1.68) and reduced short term neonatal morbidity (relative risk 0.26, 95% confidence interval 0.08 to 0.88). The studies were unable to detect differences in brachial plexus injuries, low Apgar scores or perinatal mortality. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of a policy of planned caesarean section for breech presentation. A large Canadian trial addressing this question is currently underway.

Breech Presentation↗

PubMed2002

Differences in postpartum morbidity in women who are infected with the human immunodeficiency virus after elective cesarean delivery, emergency cesarean delivery, or vaginal delivery.

OBJECTIVE: The aim of this study was to assess the impact of elective cesarean delivery on postpartum morbidity in women who are infected with the human immunodeficiency virus (HIV). STUDY DESIGN: We performed a retrospective study of 401 women who were infected with HIV who were delivered in a single reference center from 1989 through 1999. Women who had cesarean deliveries (n = 201), of which 109 were elective and 92 were emergency, were compared with a group of women who were delivered vaginally (n = 200), composed of the women who were infected with HIV preceding each cesarean delivery. RESULTS: One or more serious complications occurred after 12% of emergency cesarean deliveries, after 6.4% of elective cesarean deliveries, and after 4% of vaginal deliveries (P =.04). In a multivariate analysis, which was adjusted for maternal CD4 lymphocyte count and antepartum hemorrhage, the relative risk of any postpartum complication (serious or minor) was increased by 1.85 (range, 1.00-3.39) after elective cesarean delivery and 4.17 (range, 2.32-7.49) after emergency cesarean delivery, compared with vaginal deliveries (P =.0001). CONCLUSION: Postpartum morbidity in women who are infected with HIV was highest after emergency, rather than elective, cesarean deliveries.

Adult↗

PubMed2001

Transdermal delivery of methotrexate: iontophoretic delivery from hydrogels and passive delivery from microemulsions.

In vitro assays were performed to investigate the effectiveness of transdermal administration of methotrexate (MTX) by iontophoretic delivery from two types of hydrogel and passive delivery from two types of microemulsion. Both iontophoretic delivery of MTX from hydrogels and passive delivery from microemulsions were more effective than passive delivery from aqueous solutions of the drug. In the iontophoretic delivery assays, the type of hydrogel used and the concentration of the drug in the loading solution had little influence on effectiveness of delivery. In the passive delivery assays, we used both water/oil (w/o) and oil/water (o/w) microemulsions: effectiveness of delivery was higher from o/w systems. At the end of all assays, significant amounts of MTX were detected in the skin. These results suggest that both hydrogels and microemulsions may be of value for the topical administration of MTX in the treatment of psoriasis.

Administration, Cutaneous↗

PubMed1985

Mode of delivery in the low birth weight fetus. Delivery by cesarean section independent of fetal lie versus vaginal delivery in vertex presentation. A study with long-term follow-up.

In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow-up until 18-24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p less than 0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.

Adult↗

PubMed2002

"Bronchial artery delivery of viral vectors for gene delivery in cystic fibrosis; superior to airway delivery?".

BACKGROUND: Attempts at gene therapy for the pulmonary manifestations of Cystic Fibrosis have relied mainly on airway delivery. However the efficiency of gene transfer and expression in the airway epithelia has not reached therapeutic levels. Access to epithelial cells is not homogenous for a number of reasons and the submucosal glands cannot be reached via the airways. PRESENTATION: We propose to inject gene delivery vectors directly into bronchial arteries combined with pre-delivery of vascular endothelial growth factor to increase vascular endothelial permeability and post-delivery flow reduction by balloon occlusion. Thus it may be possible to reach mucous secreting cells of the bronchial luminal epithelium and the submucosal glands in an increased and homogenous fashion. TESTING: This combination of techniques to the best of our knowledge has not previously been investigated, and may enable us to overcome some of the current limitations to gene therapy for Cystic Fibrosis.

Journal Article↗

PubMed1983

Improved delivery through biological membranes. 11. A redox chemical drug-delivery system and its use for brain-specific delivery of phenylethylamine.

A dihydropyridine in equilibrium pyridinium salt type redox system is described as a general and flexible method for site-specific and sustained delivery of drugs to the brain. According to this, a biologically active compound linked to a lipoidal dihydropyridine carrier easily penetrates the blood-brain barrier. Oxidation of the carrier part in vivo to the ionic pyridinium salt prevents its elimination from the brain, while elimination from the general circulation is accelerated. Subsequent cleavage of the quaternary carrier-drug species results in sustained delivery of the drug in the brain and facile elimination of the carrier part. The concept is illustrated with phenethylamine as the drug and trigonelline as the quaternary carrier. One injection to rats of 1-methyl-3-(N-phenethylcarbamoyl)-1,4-dihydropyridine resulted in continuous build up in the brain of the corresponding 1-methyl-3-(N-phenethylcarbamoyl)pyridinium salt, reaching a maximum at about 80 min. At this time, the general circulation was practically void of either compound, while the accumulated carrier-drug species provided a source for sustained drug delivery only in the brain.

Alkaloids↗

PubMed2000

Exploring the role nurses play at different stages of the birthing process. Developing strong and long-term relationships with women by examining relationship-building stages prior to delivery, during delivery, and after delivery.

The health care community is becoming increasingly aware of the need to develop strong and long-term relationships with the women who make up the majority of the health care market. The perceived quality of obstetric care positively impacts future revenue streams by creating "family" loyalty for an umbrella of other health services offered by the provider organization. This article examines the differential impact that various service performance dimensions have on women's perceptions of quality for different stages of the birthing process, and how relationship-marketing principles can be utilized to develop loyal partnerships. The three distinct relationship-building stages are examined--birthing experiences prior to delivery, during delivery, and after delivery--along with their implications for perceptions of quality analyzed.

Female↗

PubMed1987

Improved delivery through biological membranes XXV. Enhanced and sustained delivery of trifluorothymidine to the brain using a dihydropyridine in equilibrium pyridinium salt type redox delivery system.

A series of alpha,alpha,alpha-trifluorothymidine (TFT) derivatives was designed and studied for brain-enhanced/specific delivery of this antiviral drug. The derivatives were esters involving one or both of TFT's hydroxy functions and N-methyl-dihydronicotinic acid. Such esters are subject to oxidative (to trigonelline) and hydrolytic metabolic transformations. Thymidine (T) was used as a model compound and the kinetics of the oxidative and hydrolytic conversion of some 16 derivatives of T and TFT were studied in various biological fluids. One compound, 3'-[O-(N-methyl-1,4-dihydronicotinoyl)]-5'-[O-(pivaloyl)]-TFT (14), was selected for in vivo studies. The compound appeared to cross the blood-brain barrier and to be converted in the brain by successive oxidative and hydrolytic processes to the 3'-[O-(N-methyl nicotinoyl)]TFT (17); this quaternary pyridinium salt was 'locked in' the brain and then further hydrolyzed in a sustained manner to release TFT, detected in measurable levels at least until 18 hours following the i.v. injection of 14. TFT was also identified as an in vitro degradation product in the different biological tissues and fluids. The results suggest that the dihydropyridine in equilibrium pyridinium salt redox delivery system can be successfully used for the brain delivery of antiviral agents that would not otherwise cross the blood-brain barrier.

Animals↗

PubMed1984

Improved delivery through biological membranes XIV: Brain-specific, sustained delivery of testosterone using a redox chemical delivery system.

The dihydropyridine in equilibrium pyridinium salt redox delivery system was used for the specific delivery and sustained release of testosterone in the brain. Administration of the N-methyl-1,4-dihydro nicotinate ester of testosterone in female rats gave high and sustained brain levels of the corresponding quaternary ester, testosterone trigonellinate. This contrasted with rapid elimination from the general circulation. Release of testosterone "locked into" brain as the quaternary salt was sustained, t1/2 = 20 h.

Animals↗

PubMed1983

Improved delivery through biological membranes. 13. Brain-specific delivery of dopamine with a dihydropyridine in equilibrium with pyridinium salt type redox delivery system.

The dihydropyridine in equilibrium with pyridinium salt type redox delivery system was used for the brain-specific delivery of dopamine. In vivo administration of the catechol-protected dopamine coupled with 1,4-dihydrotrigonelline as the carrier resulted in brain-specific, high and sustained concentrations of the 1-methyl-3-[N-[beta-(3,4-dihydroxyphenyl)ethyl]carbamoyl]pyridinium salt, the direct dopamine precursor, locked in the brain for many hours, while systemic concentration decreased fast, with a t 1/2 of less than 30 min. Significant dopaminergic activity was observed in the brain, which was sustained for hours.

Animals↗

PubMed2002

Cancer gene therapy: 'delivery, delivery, delivery' .

Gene therapy for cancer treatment represents a promising approach that has shown selectivity and efficacy in experimental systems as well as clinical trials. Some major problems remain to be solved before this strategy becomes routinely adopted in the clinic, one of the main challenges being the improvement of gene delivery. Namely, the development of DNA vectors characterized by maximum efficiency and minimal toxicity will define the success of gene therapy and its chances of being accepted by public and clinicians. A number of issues need to be considered. The "magic" vector should be targeted, protected from degradation and immune attack, and safe for the recipient and the environment. Moreover, it should express the therapeutic gene for as long as required, in an appropriately regulated fashion. Vehicles such as retroviruses, adenoviruses and liposomes have been adopted in clinical studies, with varying results. New therapeutic modalities are also being explored in order to overcome the limitation of poor gene transfer and patient toxicity, including bacteria, adeno-associated and herpes simplex viruses, lentiviruses, cationic polymer-DNA complexes and electroporation. Some of the delivery systems tested in preclinical and clinical models are reviewed in this article, with particular attention to the targeting of the tumor environment.

Animals↗

PubMed1998

Trial of labor after cesarean delivery: the effect of previous vaginal delivery.

OBJECTIVE: This study examined the effects of order of previous modes of delivery on the rate of cesarean delivery and duration of a trial of labor among women with a history of 1 previous cesarean delivery and 1 previous vaginal delivery. STUDY DESIGN: The medical records of 4393 women at our institution who were seen June 1984-July 1996 for a trial of labor after a previous cesarean delivery were abstracted. The 800 women with a history of 1 previous cesarean and 1 previous vaginal delivery were included in this analysis. They were split into 2 groups by obstetric history: (1) 1 cesarean delivery followed by 1 vaginal delivery (vaginal last) and (2) 1 vaginal delivery followed by 1 cesarean delivery (cesarean last). Patient characteristics, durations of labor, and rates of cesarean delivery were compared with chi2 analysis, the Student t test, and the Wilcoxon rank sum test. Possible confounding variables were controlled for with multivariate logistic regression. RESULTS: The rates of cesarean delivery for the vaginal last and cesarean last groups were 7.2% and 14.7%, respectively (P = .002). The median durations of labor for the vaginal last and cesarean last groups were 5.6 and 7.0 hours, respectively (P = .01). The differences in cesarean rates and durations of labor were seen regardless of the indication for the previous cesarean delivery. CONCLUSIONS: Among women with 1 previous cesarean and 1 previous vaginal delivery, those whose most recent delivery was vaginal had a lower rate of cesarean delivery and shorter duration of labor than did those whose most recent delivery was cesarean.

Adult↗

PubMed1998

The impact of treatment complexity and computer-control delivery technology on treatment delivery errors.

PURPOSE: To analyze treatment delivery errors for three-dimensional (3D) conformal therapy performed at various levels of treatment delivery automation and complexity, ranging from manual field setup to virtually complete computer-controlled treatment delivery using a computer-controlled conformal radiotherapy system (CCRS). METHODS AND MATERIALS: All treatment delivery errors which occurred in our department during a 15-month period were analyzed. Approximately 34,000 treatment sessions (114,000 individual treatment segments [ports]) on four treatment machines were studied. All treatment delivery errors logged by treatment therapists or quality assurance reviews (152 in all) were analyzed. Machines "M1" and "M2" were operated in a standard manual setup mode, with no record and verify system (R/V). MLC machines "M3" and "M4" treated patients under the control of the CCRS system, which (1) downloads the treatment delivery plan from the planning system; (2) performs some (or all) of the machine set up and treatment delivery for each field; (3) monitors treatment delivery; (4) records all treatment parameters; and (5) notes exceptions to the electronically-prescribed plan. Complete external computer control is not available on M3; therefore, it uses as many CCRS features as possible, while M4 operates completely under CCRS control and performs semi-automated and automated multi-segment intensity modulated treatments. Analysis of treatment complexity was based on numbers of fields, individual segments, nonaxial and noncoplanar plans, multisegment intensity modulation, and pseudoisocentric treatments studied for a 6-month period (505 patients) concurrent with the period in which the delivery errors were obtained. Treatment delivery time was obtained from the computerized scheduling system (for manual treatments) or from CCRS system logs. Treatment therapists rotate among the machines; therefore, this analysis does not depend on fixed therapist staff on particular machines. RESULTS: The overall reported error rate (all treatments, machines) was 0.13% per segment, or 0.44% per treatment session. The rate (per machine) depended on automation and plan complexity. The error rates per segment for machines M1 through M4 were 0.16%, 0.27%, 0.12%, 0.05%, respectively, while plan complexity increased from M1 up to machine M4. Machine M4 (the most complex plans and automation) had the lowest error rate. The error rate decreased with increasing automation in spite of increasing plan complexity, while for the manual machines, the error rate increased with complexity. Note that the real error rates on the two manual machines are likely to be higher than shown here (due to unnoticed and/or unreported errors), while (particularly on M4) virtually all random treatment delivery errors were noted by the CCRS system and related QA checks (including routine checks of machine and table readouts for each treatment). Treatment delivery times averaged from 14 min to 23 min per plan, and depended on the number of segments/plan, although this analysis is complicated by other factors. CONCLUSION: Use of a sophisticated computer-controlled delivery system for routine patient treatments with complex 3D conformal plans has led to a decrease in treatment delivery errors, while at the same time allowing delivery of increasingly complex and sophisticated conformal plans with little increase in treatment time. With renewed vigilance for the possibility of systematic problems, it is clear that use of complete and integrated computer-controlled delivery systems can provide improvements in treatment delivery, since more complex plans can be delivered with fewer errors, and without increasing treatment time.

Humans↗

PubMed1987

Improved delivery through biological membranes. XXX. Synthesis and biological aspects of a 1,4-dihydropyridine based chemical delivery system for brain-sustained delivery of hydroxy CCNU.

A redox chemical delivery system based on the NADH in equilibrium NAD+ model was applied to an active metabolite (D) of 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), i.e. CCNU-OH. The 1,4-dihydrotrigonelline ester of CCNU-OH, N-(2-chloro ethyl)-N'-[trans-4-(1,4-dihydro-1-methyl-3-pyridinecarbonyloxy)cyc lohexyl]- N-nitrosourea (D-CDS) was prepared by a direct hydride transfer reaction of the corresponding pyridinium precursor (D-Q+) with a highly reactive 1-benzyl-1,2-dihydroisonicotinamide. The in vitro kinetics in biological fluids indicated facile oxidative conversion of D-CDS to D-Q+. An in vivo study showed that one intravenous injection to rats of D-CDS resulted in rapid brain accumulation of D-Q+, followed by a sustained release of CCNU-OH, while D-Q+ was rapidly eliminated from systemic circulation. The ratio of brain/blood concentration of D-Q+ was found to increase progressively with time. At an equimolar dose of CCNU-OH, the ratio of brain/blood concentration for CCNU-OH was found to be close to unity.

Animals↗

PubMed2002

A state-wide assessment of the obstetric, anesthesia, and operative team personnel who are available to manage the labors and deliveries and to treat the complications of women who attempt vaginal birth after cesarean delivery.

OBJECTIVE: The purpose of this study was to determine on a state-wide basis the range of obstetric, anesthesia, and surgical team personnel who were available immediately to manage the labors and deliveries of women who attempted vaginal birth after cesarean delivery. Additionally, we tried to determine whether hospitals had stopped performing vaginal births after cesarean delivery or made changes in their policies regarding vaginal birth after cesarean delivery as a result of recent American College of Obstetricians and Gynecologists recommendations. STUDY DESIGN: Available immediately was defined as "being present in the hospital." All hospitals that provided obstetric care in the State of Ohio were surveyed to determine whether an obstetrician with cesarean privileges, an anesthesiologist, or an anesthetist capable of independently administering anesthesia for a cesarean section, and a surgical team were available immediately when women attempted vaginal birth after cesarean delivery. The hospitals were also asked whether they had stopped allowing vaginal births after cesarean delivery or had made changes in their vaginal birth after cesarean delivery policies in response to the recent recommendations of the American College of Obstetricians and Gynecologists. Data were computerized and analyzed by the chi(2) test. RESULTS: Seventy-seven (93.9%), 35 (100%), and 13 (100%) of level I, II, and III hospitals performed vaginal births after cesarean delivery. An obstetrician was immediately available in 27.3%, 62.9%, and 100% of level I, II, and III institutions, respectively (P <or=.001). Anesthesia availability was 39%, 100%, and 100% of level I, II, and III institutions, respectively (P <or=.001). A surgical team was available in 35.1%, 97.1%, and 100% of level I, II, and III hospitals, respectively (P <or=.001). A complete complement was available in 15.6%, 62.9%, and 100% of level I, II and III institutions, respectively (P <or=.001). Two hospitals had stopped the performance of vaginal births after cesarean delivery, and 10 additional hospitals were considering stopping the performance of vaginal births after cesarean delivery. Policy changes had been adopted in 15 institutions, and 4 other institutions were considering changes. CONCLUSION: Most level I and many level II hospitals provide less than optimum staffing when women are attempting vaginal birth after cesarean delivery. Because vaginal births after cesarean delivery are equally distributed among level I, II, and III institutions in this state, many women may be attempting vaginal birth after cesarean delivery under less than optimal conditions. The data suggest the need for changes in staffing or referral patterns to safely meet the Healthy People 2010 goal of increasing the vaginal birth after cesarean delivery rate nationally.

Anesthesia, Obstetrical↗

PubMed1999

Pharmacokinetics and consistency of pericardial delivery directed to coronary arteries: direct comparison with endoluminal delivery.

BACKGROUND AND HYPOTHESIS: Pharmacologic modulation of the contents of the pericardial space has been shown to influence the response of coronary arteries to balloon injury. Endoluminal (EL) local delivery of various drugs into coronaries has been found to be limited by short residence time, as well as by highly variable deposited agent concentration. We hypothesized that compounds placed into the pericardial space (P) would penetrate into coronary tissue with greater consistency than seen after EL delivery and provide for prolonged coronary exposure to agents. METHODS AND RESULTS: 125I-labeled basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), albumin, or 131I-labeled diazeniumdiolated albumin (NONO-albumin) were delivered as model/therapeutic proteins into the porcine pericardial space (n = 15 pigs) or into coronaries using an EL delivery catheter (n = 48 arteries). In subjects receiving 125I-labeled proteins, the delivery target or mid-regions of the left anterior descending (LAD) and left circumflex (LCx) arteries were harvested at 1 h or 24 h for gamma-counting and autoradiography, and fractional intramural delivery (FID) or retention measured as percent agent in 100 mg artery/agent in infusate for both time points. In the animals receiving 131I-labeled NONO-albumin, serial gamma imaging was employed to evaluate the rate of redistribution in individual animals following either pericardial or endoluminal delivery. At 1 h, FID values ranged from 0.00064 to 0.0052% for P delivery (median 0.0022%), and from 0.00021 to 6.7 for EL delivery (median 0.27%). At 24 h, FID values ranged from 0.00011 to 0.003 for P delivery (median 0.0013), and from 0.0002 to 1.4 for EL delivery. The estimated T1/2 for bFGF redistribution from the vascular tissue was 22 h (P) and 7 h (EL), respectively, while the directly determined T1/2 values for NONO-albumin redistribution from the delivery region were 22.2 h (P) and 2.5 h (EL). CONCLUSIONS: These data show that pericardial fluid contents can access coronary arteries with intramural concentrations which typically vary by 10-15-fold, while EL delivery results in a remarkably wide intramural concentration range with up to 33,000-fold variability. The apparent redistribution rate is more rapid following EL delivery, possibly due to sustained diffusive tissue loading from the pericardial space. Pericardial delivery appears to offer substantial advantages over EL administration with respect to residence time and reproducibility.

Albumins↗

PubMed2003

Cohort study of maternal views on future mode of delivery after operative delivery in the second stage of labor.

OBJECTIVE: The purpose of this study was to assess maternal views on the future mode of delivery after either previous instrument vaginal delivery or cesarean delivery at full dilatation. STUDY DESIGN: We conducted a prospective cohort study of 393 women with term singleton cephalic pregnancies. RESULTS: More than one half of the cohort intended to have a further pregnancy, with no significant differences between the instrument vaginal delivery and caesarean delivery groups (51% vs 54% before discharge; adjusted odds ratio, 1.04; 95% CI, 0.2, 6.0), and there was little change in maternal views over time. Women were more likely to aim for a future vaginal delivery after an instrument vaginal delivery (79% vs 39% before discharge; adjusted odds ratio, 4.5; 95% CI, 2.2, 9.2), but the proportion decreased over time (68% vs 42% at 1 year; adjusted odds ratio, 3.6; 95% CI, 1.6, 8.1). There were no significant differences in preferred future mode of delivery for women who had a caesarean delivery after a failed instrument delivery and those who were delivered by immediate caesarean delivery. CONCLUSION: A high proportion of women who have had a previous difficult instrument vaginal delivery would still prefer vaginal delivery in a future pregnancy.

Cesarean Section↗