Biomedical subjects

A Anyaegbunam

Publications and source records attributed to A Anyaegbunam.

At least 37 records · Page 2Linked to original sources

PubMed1991

Intrapartum ultrasonographic estimates of fetal weight by the house staff.

In spite of the widespread use of ultrasonographic estimates of fetal weight, a paucity of data exists with regard to its use in patients who are in labor. The purpose of this study was to evaluate the accuracy of ultrasonographic estimates of fetal weight in a busy labor and delivery suite by the house staff. Measurements of biparietal diameter, abdominal circumference, and femur length were prospectively obtained in 109 patients in labor in whom this information was expected to be contributory in making delivery plans. All patients were delivered within 48 hours of ultrasonographic evaluation. Measurements of abdominal circumference were obtained in all cases. Biparietal diameter and femur length were obtained in 85% and 92% of cases, respectively. Overall, the mean absolute errors were 9.3% and 9.2% for estimated fetal weight by biparietal diameter/abdominal circumference and abdominal circumference/femur length ratios, respectively. Estimated fetal weight by biparietal/diameter/abdominal circumference ratio was not significantly different from that by femur length/abdominal circumference ratio. In conclusion, the accuracy of intrapartum estimates of fetal weight performed by the house staff in a busy labor and delivery unit is comparable to that reported for estimates obtained during the antepartum period by professional users of ultrasonography in a controlled setting.

Abdomen↗

PubMed1991

Antepartum fetal surveillance tests during sickle cell crisis.

A study was conducted to evaluate the characteristics of antepartum fetal assessment tests for women with sickle cell disease during crisis. A total of 24 women with 39 episodes of crisis after 34 weeks of pregnancy were studied. All subjects were evaluated with nonstress tests, biophysical profile score, and uterine and umbilical artery systolic/diastolic ratios during and after sickle cell crisis. Results revealed that the incidence of nonreactive nonstress tests was significantly higher during crisis compared with the period after crisis (58.9% vs 10.3%, p less than 0.05). The frequency of biophysical profile score less than 8 was significantly higher during crisis compared with after crisis (33.3% vs 7.7%, p less than 0.05). All subjects had an increase in uterine systolic/diastolic ratio during crisis. The average uterine systolic/diastolic ratio was 3.92 (range, 2.16 to 4.24) during crisis and 2.54 (range, 1.98 to 3.23) after crisis (p less than 0.05). In contrast, there was no significant change in the mean umbilical systolic/diastolic ratios during and after crisis (2.58 and 2.62, respectively). We conclude that, although sickle cell disease crisis is associated with a higher incidence of abnormal biophysical test results, in most patients these results will revert to normal after crisis. The increase in uterine vascular resistance without a concordant increase in umbilical vascular resistance suggests that the transient effects of sickling during crisis may not compromise umbilical blood flow.

Adult↗

PubMed1991

A longitudinal evaluation of the efficacy of umbilical Doppler velocimetry in the diagnosis of intrauterine growth retardation.

In a prospective study of 149 patients, the interrelationship among abnormal umbilical artery systolic/diastolic (S/D) ratios, maternal hypertension and IUGR was examined. Abnormal S/D ratio was defined as a value greater than or equal to 3 in the third trimester. Results suggest that the incidence of abnormal S/D ratios are significantly higher in hypertensive as compared to normotensive pregnancies, as well as in small for gestational age (SGA) compared to appropriate for gestational age (AGA) deliveries. Although umbilical artery velocimetry was more predictive of IUGR in hypertensive than normotensive pregnancies, overall 45% of SGA births were not identified by this technique. Further classification of potential etiologies and mechanisms of IUGR based on maternal factors should improve the positive predictive value of the abnormal S/D ratio in subgroups of pregnant women. In the interim the results strongly suggest that abnormal S/D ratio in a hypertensive pregnancy should alert the obstetrician to the probability of IUGR.

Blood Flow Velocity↗

PubMed1991

Association between umbilical artery cord pH, five-minute Apgar scores and neonatal outcome.

A prospective study was conducted of 270 intrapartum patients admitted in labor to investigate the independent and combined relationships between umbilical arterial cord pH and Apgar scores and neonatal outcome. The results revealed that when assessed independently, a low 5-min Apgar score (less than 7) was associated with both NICU admission and neonatal sepsis. When categorized by both cord pH and 5-min Apgar, the majority of patients (75.9%) had both parameters normal, 20.7% had an abnormal pH (less than 7.20) and normal Apgar (greater than or equal to 7) and few patients had either both normal or an abnormal Apgar given a normal pH. Given a normal 5-min Apgar score, additional information about the cord pH did not enhance the predictability for either NICU admission or neonatal sepsis. Neonates with both an abnormal pH and 5-min Apgar had the highest incidence of NICU admission. For all neonates, the presence of meconium greatly increased the likelihood of being admitted to the NICU.

Acidosis↗

PubMed1991

Rationale for insulin management in gestational diabetes mellitus.

A prospective study was undertaken to test the hypothesis that insulin treatment in patients with gestational diabetes mellitus (GDM) with fasting plasma glucose (FPG) greater than 5.3 mM significantly reduces adverse perinatal outcome. Assigned to insulin or diet treatment based on FPG were 471 GDM women. Four factors believed to be associated with infants large for gestational age (LGA) were evaluated: FPG, overall glycemic control, maternal weight, and treatment regimen. We found that when glycemic control was optimized, the key factors related to large infants were FPG and treatment modality. In the low-FPG group (less than 5.3 mM), diet therapy achieved an incidence of 5.3% LGA. When insulin therapy was used to optimize control, an incidence of 3.5% LGA was found. Patients in the mid-FPG group (5.3-5.8 mM) had a higher increased rate of LGA (28.6%) for diet-treated versus insulin-treated women (10.3%). In addition, a fourfold increased risk for LGA was found in the diet-treated obese subjects in the mid-FPG group compared with insulin-treated obese women. Finally, treatment with insulin resulted in similar incidence of LGA within all FPG groups. We concluded that FPG greater than 5.3 mM can be the basis for initiation of insulin treatment in GDM subjects with optimization of glycemic control as the goal. This approach may contribute significantly to reduced neonatal risk and may foster a standardized method for rapid and effective assignment to treatment.

Adult↗

PubMed1991

Third-trimester prediction of small-for-gestational-age infants in pregnant women with sickle cell disease. Development of the ultradop index.

Twenty-seven women with homozygous sickle cell disease were followed from the third trimester until delivery. All the subjects underwent both Doppler and sonographic assessment at two points in pregnancy, periods I (28-30 weeks) and II (34-36 weeks). Estimated fetal weight (EFW) was calculated. Using a continuous wave Doppler instrument, mean systolic:end diastolic (S:D) ratios were calculated to characterize the umbilical waveforms. S:D ratios greater than or equal to 3 were designated abnormal. An index, the ultra-dop, was developed that combined ultrasound EFW less than or equal to 25th percentile and S:D greater than or equal to 3. Nine of 27 infants (33%) were small for their gestational age, with a mean gestational age of 38 +/- 2 weeks. The sensitivity, specificity and predictive values were calculated for smallness for gestational age utilizing ultrasound, Doppler velocimetry and the ultradop index for periods I and II. For period I, the highest sensitivity was obtained with the ultradop index--88.9% as compared to 77.8% with Doppler scanning and 11.1% with ultrasound. The ultradop also provided the highest positive predictive value, 88.9%; it was followed by Doppler at 77.8% and ultrasound at 50.0%. In period II the ultradop index and Doppler had the same sensitivity, 88.9%, which was much higher than for ultrasound (55.6%). As for period I, the ultradop had the highest positive predictive value, 88.9%. Our data suggest that the ultradop index provides a key assessment of women with sickle cell disease at 28-30 weeks' gestation with reference to the likelihood of their giving birth to small-for-gestational-age infants.

Adult↗

PubMed1990

Effects of epidural block with lignocaine and lignocaine-adrenaline on umbilical artery velocity wave ratios.

Umbilical artery blood velocity A/B ratios were recorded in term fetuses once before and twice after the maternal epidural injection of either 8 ml of lignocaine plain (15 women) or lignocaine with adrenaline 1:200,000 (40 micrograms) (16 women). The administration of lignocaine plain led to decreases in the ratio of varying degrees in all fetuses regardless of the height of the initial A/B ratio. The injection of lignocaine with adrenaline produced identical results in fetuses with initially normal A/B ratios. In contrast, all six fetuses with initially high A/B ratios (above 2.90) who received the adrenaline-containing anaesthetic reacted with a rise in the ratio, and two of these developed transient heart rate decelerations. Thus, if the initial resistance in umbilical blood flow is high, even the small epidural dose of 40 micrograms of adrenaline produces a further increase which may be associated with clinical implications.

Adult↗

PubMed1990

Education does not improve patient perception of preterm uterine contractility.

In this prospective study, we sought to compare pregnant women's self-perception of their preterm uterine contractility versus electronically obtained data and to evaluate the impact of intensive patient education on increasing awareness of the presence of uterine contractions. Thirty-eight women each monitored their uterine activity at home for two 60-minute periods daily during a 21-day sequence. An event marker was used to document perceived contractions and after a 3-day baseline interval, an intensive nursing-service educational intervention was initiated for all subjects. Thirty-five percent of women underreported uterine contractions, whereas only 5% overreported their uterine activity during the study. Derived patient scores of underreporting and overreporting of contractions did not vary among seven consecutive 3-day study intervals. Analysis of the data revealed that patients perceived fewer than 10% of all contractions documented electronically. No improvement in the reliability of patient perception of preterm uterine contractility was obtained after the educational intervention.

Adult↗

PubMed1990

Uterine contractility patterns after an episode of preterm labor.

Uterine contractility patterns were studied in an attempt to identify those women on tocolytic therapy at risk for preterm delivery. One hundred sixteen women treated successfully after an episode of preterm labor were followed with an ambulatory tocodynamometer system. Contractions were monitored twice daily for 1 hour until delivery or until 36 completed weeks of gestation. In this group, 52 women (45%) delivered preterm and 64 (55%) delivered at term. The analysis revealed that 1) from 24-29 weeks' gestation, there was no significant difference in the uterine activity between the two groups; and 2) beginning at 30 weeks' gestation and continuing until the end of the 36th week of gestation, uterine activity was significantly greater in women destined to deliver preterm. These observations suggest that the patterns of daily uterine contractility observed in patients after an episode of preterm labor can identify those at greater risk for a preterm delivery.

Adult↗

PubMed1989

Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy.

In this study we sought to test the hypothesis that treatment of women with one abnormal oral glucose tolerance test value will result in reduction of adverse outcome. One hundred twenty-six women with one abnormal oral glucose tolerance test value and 146 women in the control group (normal oral glucose tolerance test values) participated in a prospective study during the third trimester of pregnancy. The subjects with one abnormal test result were randomized into treated (group 1) and untreated groups (group II). Group 1 subjects were treated with a strict diabetic protocol to maintain tight glycemic control by means of diet and insulin therapy. Group 2 subjects tested their capillary blood glucose for a baseline period. The study revealed that the level of glycemic control was similar before initiation of therapy (mean capillary blood glucose 118 +/- 14 vs. 119 +/- 15 mg/dl, p = NS) for groups 1 and 2, respectively. There was a significant difference in mean capillary blood glucose (95 +/- 10 vs. 119 +/- 15 mg/dl, p less than 0.0001), preprandial, and postprandial determinations between the treated and untreated groups. The overall incidence of neonatal metabolic complications (4% vs. 14%, p less than 0.05) and large infants (6% vs. 24%, p less than 0.03) was significantly lower in the treated group. Comparison between the control (normal oral glucose tolerance test) and the untreated groups showed a significantly higher incidence of large infants and metabolic complications. No difference was found between the normal and treated groups. Thus we conclude that treatment of individuals with one abnormal oral glucose tolerance test value will result in significant reduction in adverse outcome in pregnancy.

Adult↗

PubMed1989

Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age?

The relationship between optimal levels of glycemic control and perinatal outcome was assessed in a prospective study of 334 gestational diabetic women and 334 subjects matched for control of obesity, race, and parity. All women with gestational diabetes mellitus were instructed in the use of a memory-based reflectance meter. They were treated with the same metabolic goal according to a predetermined protocol. Three groups were identified on the basis of mean blood glucose level throughout pregnancy (low, less than or equal to 86 mg/dl; mid, 87 to 104 mg/dl; and high, greater than or equal to 105 mg/dl). The low group had a significantly higher incidence of small-for-gestational-age infants (20%). In contrast, the incidence of large-for-gestational-age infants was 21-fold higher in the mean blood glucose category than in the low mean blood glucose category (24% vs. 1.4%, p less than 0.0001). An overall incidence of 11% small-for-gestational-age and 12% large-for-gestational-age infants was calculated for the control group. A significantly higher incidence of small-for-gestational-age infants (20% vs. 11%, p less than 0.001) was found between the control and the low category. In the high mean blood glucose category an approximate twofold increase was found in the incidence of large-for-gestational-age infants when compared with the control group (p less than 0.03). No significant difference was found between the control and mean blood glucose categories (87 to 104 mg/dl). Our data suggest that a relationship exists between level of glycemic control and neonatal weight. This information is helpful in targeting the level of glycemic control while optimizing pregnancy outcome in gestational diabetes comparable to the general population.

Blood Glucose↗

PubMed1989

Maternal hemoglobin F levels may have an adverse effect on neonatal birth weight in pregnancies with sickle cell disease.

A total of 26 patients with sickle cell disease were followed up through 32 pregnancies. There was no correlation between days in hospital or number of painful crises and either birth weight or birth weight percentile. The number of dense irreversibly sickled and least deformable cells was negatively correlated with birth weight percentile (r = -0.63, p less than 0.01). Patients' initial hemoglobin levels were positively correlated with birth weight percentile (r = 0.52, p less than 0.004). Hemoglobin F, on the other hand, was significantly inversely correlated with birth weight percentile. Nine pregnancies with small-for-gestational-age infants had an average hemoglobin level of 9.1% +/- 4.5%. In contrast, patients who were delivered of appropriate-for-gestational-age infants (23 pregnancies) had an average hemoglobin F level of 3.6% +/- 2.9% (p less than 0.01). We conclude that total hemoglobin levels and dense cells are correlated with birth weight percentile; moreover, the higher the maternal hemoglobin F levels the higher the risk of small-for-gestational-age infants. We speculate that although high hemoglobin levels may be beneficial to the fetus, high maternal hemoglobin F levels could increase the desaturation of non-F cells and induce placental obstruction.

Anemia, Sickle Cell↗

PubMed1989

Changes in the pattern of uterine contractility in relationship to coitus during pregnancies at low and high risk for preterm labor.

This is a preliminary, prospective study of uterine contractility in response to sexual intercourse. The study population consisted of 30 pregnant subjects. Group I included 15 women treated for an episode of preterm labor with intravenous and oral tocolysis in this pregnancy, and group II was a matched control group of low-risk volunteers. The availability of home uterine tocodynamometric systems permitted monitoring of uterine contractility for three 60-minute time periods related to coitus. A significant increase in uterine contractility in the immediate postcoital period was observed for the high-risk women, but not for the controls. This increased uterine activity subsided spontaneously within 2-3 hours, returning to baseline. These initial preliminary observations of uterine response to coitus in a home environment are interesting; however, further research is suggested to establish their clinical implications.

Adult↗

PubMed1988

The application of uterine and umbilical artery velocimetry to the antenatal supervision of pregnancies complicated by maternal sickle hemoglobinopathies.

To assess the efficacy of Doppler flow velocimetry in predicting fetal compromise and neonatal outcome in pregnant women with sickle cell hemoglobinopathies, a prospective study was conducted of 96 patients, 48 with sickle cell hemoglobinopathy (8 with SS and 40 with AS hemoglobin) and 48 low-risk AA hemoglobin controls. All subjects were followed biweekly from the third trimester of pregnancy through delivery with uterine and umbilical artery velocimetry, nonstress, tests, and hematocrit and blood pressure measurements. An abnormal systolic/diastolic ratio was defined as a value greater than or equal to 3. The incidence of abnormal systolic/diastolic ratios for uterine or umbilical arteries was significantly higher in pregnant women with SS hemoglobin (88%) when compared with patients with AS (7%) and AA (4%) hemoglobin. In addition, the abnormal systolic/diastolic ratios for both umbilical and uterine arteries are correlated with abnormal nonstress test results. The nonstress test results became abnormal on average 3 weeks after the systolic/diastolic ratios did. The presence of abnormal systolic/diastolic ratios for umbilical and uterine arteries is predictive of fetal distress and infants small for gestational age. The high incidence of concordant uterine and umbilical artery abnormal systolic/diastolic ratios in pregnant women with SS hemoglobinopathy, which were identified earlier than were abnormal nonstress results, suggests an important parameter in the monitoring of these high-risk pregnancies.

Adult↗

PubMed1988

Pregestational diabetes: insulin requirements throughout pregnancy.

The management of pregestational diabetes requires tight metabolic control to reduce maternal and perinatal morbidity and mortality. It has been suggested that type I diabetes is a disorder characterized by insulin deficiency and type II diabetes is characterized by insulin resistance; however, it may be hypothesized that a difference in insulin requirements should emerge throughout pregnancy to reflect the dissimilarities in these two metabolic disturbances. The current investigation of 103 women with pregestational diabetes used a novel approach (reflectance meters with onboard memories) to uncover the actual insulin dosages required to reach and maintain optimum metabolic control throughout pregnancy. It was found that both type I and type II diabetes appear to have a triphasic insulin pattern, with the patient having type II diabetes requiring significantly higher doses of insulin during each trimester. This seems to suggest that the hormonal changes in pregnancy may have a similar effect on both type I and type II diabetes but to a different degree. Thus this should be considered in the treatment of pregestational diabetes and in the development of an algorithm for diabetes management.

Adult↗

PubMed1987

Gestational diabetes: insulin requirements in pregnancy.

A prospective study of 57 women with gestational diabetes mellitus was undertaken to determine actual insulin requirements throughout pregnancy. Women were placed on a multiple injection, mixed insulin regimen and monitored their blood glucose level 6.5 +/- 1 times per day using a memory-based reflectance meter to obtain verified data. A significant (p less than 0.01) increase in total insulin dose was found during the initial treatment period (7 +/- 2 days) until the target glucose range was achieved. Insulin requirements continued to significantly (p less than 0.01) rise until 30 +/- 1 gestational weeks, despite a stabilization of glucose level. Thereafter, there was no significant change (3%) in insulin requirement. A correlation of r = 0.58 (p less than 0.001) for the relationship between insulin dose at the 24 and 32 weeks' gestation, and an r = 0.99 (p less than 0.0001) for the relationship between insulin dose at 32 and 39 weeks' gestation was found. We concluded that an emphasis on ambulatory blood glucose control and insulin adjustments should occur in the early treatment phase of gestational diabetes.

Adult↗

PubMed1987

Verified self-monitored blood glucose data versus glycosylated hemoglobin and glycosylated serum protein as a means of predicting short- and long-term metabolic control in gestational diabetes.

Glycosylated hemoglobin and glycosylated serum protein have been suggested as tools for evaluation of long- and short-term glycemic control, respectively. Twenty-six patients with gestational diabetes were prospectively studied to determine the relationship of glycosylated hemoglobin and glycosylated serum protein to metabolic control. To verify the accuracy of blood glucose data, a memory-based reflectance meter was used for subjects with gestational diabetes who tested 6.5 +/- 1 times per day. Our analysis revealed that despite a statistically positive correlation between glycosylated hemoglobin, glycosylated serum protein, and verified data, their use as a clinical tool is limited because of their poor predictability.

Adult↗

PubMed1987

The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy.

A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p less than 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p less than 0.01) and gestational diabetes mellitus group (34% versus 12%; p less than 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3%). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome.

Adult↗