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Biomedical subjects

D R Coustan

Publications and source records attributed to D R Coustan.

70 records · Page 4Linked to original sources
PubMed1985

Correlation of the interpretation of fetal heart rate records with cord plasma erythropoietin levels.

On the basis that fetal levels of plasma erythropoietin (Ep) may reflect fetal oxygenation the primary purpose of the present study was to assess the relation between Ep measured in cord plasma at delivery and the intrapartum fetal heart rate (FHR) record. A scoring system for interpreting FHR recordings blindly was prospectively utilized in 41 selected human pregnancies during the 4 h immediately preceding birth. The correlation of the overall mean FHR score for each individual patient with cord plasma Ep was significant such that the highest Ep levels were observed in those infants with the most abnormal FHR scores. Furthermore, when the birthweights of the infants were adjusted for gestational age, sex, and birth order, birthweight centile was negatively correlated with cord plasma Ep. When both FHR score and birthweight were simultaneously correlated with cord plasma Ep using multiple regression, the combined effect of these two factors improved the association of either alone with both contributing approximately equally.

Birth Weight↗
PubMed1985

Neonatal morbidities in infants of mothers with glucose intolerance in pregnancy.

Of 1839 pregnant women screened prospectively, 52 were identified to have glucose intolerance. Ten additional pregnant women identified as having glucose intolerance before the universal screening were also included in the study cohort. These 62 patients were followed in a perinatal high-risk clinic with weekly plasma glucose determinations. The patients were treated with diet and, in addition, 21 of 62 were treated with insulin therapeutically. By observational cohort design, the infants and a comparable number of matched controls were evaluated for evidence of neonatal morbidities and classified into percentile for birth weight. Compared with the control group, the operative mode of delivery, the mean birth weight, the birth-weight percentile, the male/female ratio, the frequency of low Apgar score (less than or equal to 6 at 1 min), and the number of infants with congenital anomalies were significantly higher in the infants born to the glucose-intolerant mothers. Although the mean maternal blood sugar was maintained within a reasonably euglycemic range, the usual neonatal morbidities were not eliminated entirely. Further understanding and management of glucose intolerance in pregnancy is necessary to further diminish or eliminate neonatal morbidities.

Apgar Score↗
PubMed1984

Prophylactic insulin treatment of gestational diabetes reduces the incidence of macrosomia, operative delivery, and birth trauma.

Four hundred and forty-five gestational diabetic women who were delivered over a 5-year period were evaluated. One hundred and fifteen were treated with insulin and diet, 184 with diet alone, and 146 with neither insulin nor dietary manipulation. The incidence of babies weighing more than 4000 gm was 7% in the insulin-treated group, 18.5% in the diet-treated group, and 17.8% in the untreated group (p less than 0.05). The incidence of operative delivery (midforceps, midcavity vacuum extraction, or primary cesarean section) was 16.3% in the insulin-treated group, 30.4% in the diet-treated group, and 28.5% in the untreated group (p less than 0.05). The incidence of birth trauma (shoulder dystocia, Erb's palsy, cephalhematoma, soft tissue injury) was 4.8% in the insulin-treated group, 13.4% in the diet-treated group, and 20.4% in the untreated group (p less than 0.05). These data suggest that prophylactic insulin treatment prevents not only macrosomia but also its sequel of traumatic delivery.

Adult↗
PubMed1982

Criteria for screening tests for gestational diabetes.

A 50 gm, 1-hour glucose screening test was given to 381 gravid women 25 years of age or older. All women with plasma glucose values greater than or equal to 130 mg/dl (119 mg/dl, whole blood) were given a 100 gm, 3-hour glucose tolerance test to diagnose gestational glucose intolerance using O'Sullivan's diagnostic criteria. On the basis of the distribution of screening test values, three diagnostic zones could be identified: a zone below 135 mg/dl plasma glucose, with less than 1% probability of diabetes; a zone above 182 mg/dl plasma glucose, with more than 95% probability of diabetes; and a central zone of uncertainty (135 to 182 mg/dl, plasma glucose), where further testing is required. These test results suggest that thresholds for further testing be lowered from 143 to 135 mg/dl of plasma glucose.

Adult↗
PubMed1981

Efficacy of the insulin pump in the home treatment of pregnant diabetics.

The efficacy and feasibility of the insulin infusion pump in pregnancy were examined in seven class D to FR diabetics, maintained on the pump at home from 10 to 29 wk gestation until delivery. An improvement in glucose control was achieved within the first month and sustained to term. Home monitoring demonstrated a fall in mean blood glucose levels from 135 mg/dl range 98-175, prepump) to 104 mg/dl (range 84-120) and a 25-30% reduction in standard deviations during pump treatment. Furthermore, glycosylated hemoglobin levels were normalized in each patient. During periodic inpatient evaluations, mean 24-h plasma glucose levels were slightly, but not significantly, lower after pump treatment (97 vs 86 mg/dl). However, glycemic excursions were strikingly diminished; MAGE values and standard deviations fell by 45% and 34%, respectively. The total daily insulin dose required at the start of pump treatment was 31% less than the conventional dose used before the pump (P less than 0.002). Thereafter the insulin dose increased by approximately 2.5 U/wk, with the basal infusion remaining at 40% of the total dose throughout the pregnancy. All infants were born at term, had no macrosomia or neonatal problems, and had normal intravenous glucose tolerance tests at 2 h of age. We conclude that the insulin infusion pump, managed at home, is a highly efficient way to achieve normal or near-normal glucose levels in the pregnant diabetic.

Adult↗
PubMed1980

Tight metabolic control of overt diabetes in pregnancy.

Seventy-three patients with overt diabetes were followed during pregnancy with tight control of carbohydrate metabolism and frequent measurement of glucose levels. During the last 12 weeks of pregnancy, mean plasma glucose levels averaged 108 mg/dl. Mean fasting plasma glucose levels averaged 98 mg/dl. Of the 73 patients, 77 per cent had mean plasma glucose levels of less than 120 mg/dl. Perinatal mortality rate was 4 per cent; this was corrected to 1.4 per cent when congenital anomalies incompatible with life were removed from consideration. Patients were allowed to go as close to term as possible, with 51 per cent being delivered at or beyond 38 weeks. Only two babies (2.8 per cent) were delivered because of deterioration of fetoplacental function test results. The results of this suggest that tight metabolic control may prevent some of the fetal morbidity associated with overt diabetes in pregnancy.

Adolescent↗
PubMed1980

Recent advances in the management of diabetic pregnant women.

Recent advances in perinatology, neonatalogy, and metabolism have substantially improved the prognosis for pregnancy in patients with overt diabetes. Perinatal mortality rates are now approaching those in the general population; morbidity is declining. Yet to be conquered is the markedly increased incidence of congenital anomalies. Nevertheless, in 1980, one can give the pregnant diabetic patient more assurance than ever before that the outcome of her pregnancy is likely to be favorable.

Blood Glucose↗
PubMed1978

Insulin therapy for gestational diabetes.

Seventy-two patient with gestational diabetes were randomly treated with insulin (20 units NPH and 10 units regular) and diabetic diet, diet alone, or neither. Of the 27 patients treated with insulin and diet, 2 (7%) had babies weighing more than 8 1/2 pounds. Of the 11 patients treated with diet alone, 4 (36.4%) had babies weighing more than 8 1/2 pounds. Of the 34 patients treated with neither diet nor insulin, 17 (50%) had babies weighing more than 8 1/2 pounds. These data support the hypothesis that treatment of the gestational diabetic with insulin will reduce the incidence of fetal macrosomia.

Adult↗
PubMed1976

Circadian variation of serum glucose, C-peptide immunoreactivity and free insulin normal and insulin-treated diabetic pregnant subjects.

To examine differences among pregnant diabetic and nondiabetic subjects, serum glucose, and immunoreactivity of C-peptide, free and total insulin were measured at hourly intervals during a 24--h third trimester metabolic ward evaluation. Six normals, three mild, and four juvenile-onset type diabetics were studied. Diets were identical for all subjects. Mild diabetics differed from juvenile diabetics by having significant residual pancreatic B-cell function, as measured by C-peptide immunoreactivity. Short and intermediate acting insulins given once or twice daily to diabetics maintained serum glucose levels within the normal range throughout the 24 h. Despite wide variation in serum total insulin levels, peripheral free insulin concentrations in well-controlled diabetics fell within a relatively narrow range that was higher than in controls. Infants of the diabetic subjects were comparable to the offpsring of the control women.

Blood Glucose↗
PubMed1976

Ovarian pregnancies with Dalkon Shield IUCDs in situ: laparoscopic visualization.

Two ovarian pregnancies coexistent with intra-uterine contraceptive devices are described. In one case, the ovary appeared to contain a cyst at laparoscopy and rupture of the cyst and extrusion of the fetus were witnessed. In the second case, a hemorrhagic ovarian cyst bled at laparoscopy and laparotomy resulted in the diagnosis of ovarian pregnancy. These two cases reveal that laparoscopic examination could be misleading and result in inappropriate management if the diagnosis of ovarian pregnancy is not entertained. The cases described add to the growing number of reports of extrauterine pregnancies occurring in patients using intra-uterine contraceptive devices.

Adult↗
PubMed1976

Improved glucose control in nonhospitalized pregnant diabetic patients.

Methods for management of diabetic pregnancy in the outpatient setting require strict glucose control. To assess the effect of diet and injection of short and intermediate acting insulin on glucose, diabetic patients tested their urine daily for glucose and had biweekly serum glucose tests. A brief metabolic ward study in 9 diabetic patients during the third trimester yielded hourly glucose determinations. These results defined the range of serum glucose over a 24-hour period. Glucose data on 6 normal third trimester women also came from hourly glucose values. Glucose results of normal and diabetic subjects were similar. A 16th subject with diabetic eye, renal, and foot complications is included as a case report to illustrate management technics. Infants of the diabetic women had no perinatal mortality, morbidity, or macrosomia and thus differ from an earlier study where glucose was not strictly controlled. The data suggest hospitalization can be short and low perinatal morbidity and mortality are possible with this outpatient method of management of the pregnant diabetic patient.

Birth Weight↗
PubMedDate not supplied

Preeclampsia effect on platelet count.

Thrombocytopenia is well recognized when preeclampsia is complicated by the hemolysis, elevated liver tests, low platelet count (HELLP) syndrome. We studied the effect of preeclampsia on the platelets of women whose platelet count and liver function were within normal range. We prospectively evaluated 67 preeclamptic women, gestational age 30 to 42 weeks, with disease of variable severity. The platelet counts of these patients, obtained within 24 hours preceding delivery, were significantly lower than the platelet counts of 71 control subjects. The platelet counts did not differ significantly between patients with mild and severe preeclampsia. Our findings suggest the existence of subclinical thrombocytopenia in preeclamptic women whose platelet values are within normal range.

Adult↗
PubMedDate not supplied

Screening and diagnosis of gestational diabetes.

The commonly used diagnostic criteria for gestational diabetes are discussed. Various screening strategies are described, and advantages and disadvantages are outlined. Universal screening of pregnant women with a 50-g, 1-h oral glucose challenge test is recommended.

Adult↗