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Biomedical subjects

E Papiernik

Publications and source records attributed to E Papiernik.

At least 145 records · Page 8Linked to original sources
PubMed1989

[An example of research and actions related to perinatal mortality in Guadeloupe. Factors and profiles of sociodemographic risk].

Perinatal risk factors in Guadeloupe (French West Indies) have been analysed from a community-based case-control survey. Two hundred and sixty four perinatal deaths were involved along with 605 controls. Principal component factor analysis of individual risk characteristics was used to identify risk group profiles. These risk profiles were: "single women of low socio-economical status" (17% of the variability), "traditional Caribbean housewives" (14%), "single adolescents" (7%), and "immigrant women" (10%). Only the three first were significantly associated with a poor outcome for the current pregnancy. This approach may be fruitful in planning for public health interventions to prevent perinatal risk. Also, risk profile concepts may be well-accepted by physicians and care providers, in routine practice, for screening of individual at-risk patients.

Community Health Services↗
PubMed1989

[Management of triple pregnancies].

A retrospective study of triplet pregnancies is presented. Data concerning 24 triplet pregnancies which were followed up to delivery and for a period of 11 years afterwards at the Maternity Center of the Antoine Beclere Hospital, are analysed. Early diagnosis of triplet pregnancy leads to a strong prognostic indication for prematurity. This allows time to institute preventive measures principally by reducing maternal physical activity. Because of the establishment of specific prenatal surveillance of the mothers, the rate of prematurity in triplet pregnancies be notably lowered. The mean gestational age at delivery was 33.9 weeks. The use of corticosteroid therapy between 28 and 34 weeks of gestation seems to helps prevent hyaline membrane diseases. Delivery is performed by elective cesarean section. The perinatal mortality rate was 6%.

Adult↗
PubMed1989

[Tetraplegia and pregnancy].

A report is given of pregnancy in a tetraplegic patient. The main complications that patients who are suffering from tetraplegia have in pregnancy are urinary tract infection, anaemia, and complications of bed rest, as well as premature delivery and autonomic hyperreflexia. Autonomic hyperreflexia is provoked by stimuli such as distension of the bladder or of the rectum or stimulation of the cervix. In this syndrome bradycardia, arterial hypertension and headaches are associated. The major risk is of intra-ventricular haemorrhage in labour. The care of the pregnant tetraplegic patient requires the cooperation of the obstetrician, the anaesthetist and the nursing staff, as well as of the patient.

Adult↗
PubMed1989

[Ambulatory practice of breast surgery].

Breast surgery on an outpatient basis has been indicated by control trials to investigate the efficacy of mass screening with single-view mammography in reducing mortality. These trials have also increased surgery in benign breast pathology. Sixty patients were investigated and forty-seven answered a questionnaire. Ninety-two per cent of those who answered were satisfied with this short-stay hospitalisation and ninety-four per cent would be willing to do the same again if necessary. Seventeen per cent of the patients would have preferred to stay in the hospital the night after surgery. All patients preferred to be admitted the morning of surgery. Forty-three per cent of patients had local or regional anaesthesia and were satisfied to know the diagnosis during surgery. All personnel of the health service concerned find a benefit of this outpatient arrangement, that is, both patients and hospital authorities. This has been found to be a cost-saving measure as well as an effective way of diagnosing and treating benign breast tumors.

Ambulatory Surgical Procedures↗
PubMed1989

[Social acceptability of screening for HIV seropositivity in pregnant women. An inquiry in the Paris region].

Current debate about screening strategies for HIV during pregnancy is not limited to clinical and epidemiologic arguments; ethical and social concerns about the risk of stigmatization against HIV carriers are also taken into account. Therefore, data on public perception of AIDS and attitudes toward preventive measures against the disease can be of interest. In December 1987, a survey was carried out, through personal interview, in a representative sample (900 individuals selected by the quota method) of the 10.5 million inhabitants 18 years of age and over, in the Paris region. 9.8% of the women declared having been tested for HIV, at least once, during 1987, and 20% of these tests were part of prenatal care. Mandatory screening for HIV among pregnant women is supported by 78.6% of the respondents while only 64% support screening during premarital examinations and a minority (37.8%) is in favour of mandatory screening for the whole population. 48.5% of respondents share the misperception that transmission from mother to fetus always happens, and 70% think that women who are HIV carriers should renounce pregnancy: willingness to support mandatory screening for pregnant women is significantly higher among individuals who share these two beliefs.

Adult↗
PubMed1988

Pregnancy and paroxysmal nocturnal hemoglobinuria.

Our study concerns eight pregnancies, six of which were successful, in four patients with paroxysmal nocturnal hemoglobinuria (PNH). Several complications of PNH during pregnancy were prevented: chronic anemia, folate and iron deficiency, and deep-vein thrombosis. During puerperium, acute hemolytic crises, most probably triggered by delivery, were observed in two patients. Thrombotic complications could be prevented by early initiation of an anticoagulant therapy after delivery. The only neonatal complication, observed in two cases, was isoimmune hemolytic anemia related to the multiple blood transfusions received before and during pregnancy. These results show that successful pregnancies are possible in women with PNH provided that both the obstetricians and physicians in charge monitor the pregnancies closely.

Adult↗
PubMed1988

Preliminary report of an identification mission for safe motherhood, Senegal: putting the M back in M.C.H.

The Government of Senegal, in keeping with the priority given to women and children in its health programs, requested the assistance of the United Nations Development Program (UNDP) in identifying and executing a program to diminish maternal mortality in that country. A UNDP "Mission of Identification" was carried out in response to this initiative. The preliminary results of this mission confirm that the issue of maternal safety is of primary concern not only to the government but also to women in the Republic of Senegal. The methodology employed during this mission allowed the team of national and international experts to confirm the level of this concern and to identify four major potential areas of intervention. Quantitative goals for the program have been set and estimates for the efficacy of each of the intervention areas indicate that intervention through the timely provision of access to emergency surgical services and appropriate prenatal care will yield the largest reduction. The feasibility of providing interventions in each of the four areas was also addressed during the mission. This methodology will be applicable to other settings as Third World countries begin to address the problem of excessive maternal mortality.

Abortion, Illegal↗
PubMed1988

Internal iliac artery ligation in post-partum hemorrhage.

Between 1978 and 1986, internal iliac artery ligation was performed on eight patients undergoing treatment for severe post-partum hemorrhage, and disseminated intra-vascular coagulation (DIVC) combined with causal pathology was detected in five patients. This procedure was effective in controlling bleeding in eight patients and no hysterectomy was necessary. Post-operative follow-up was uncomplicated in six patients. One patient suffered from post-operative occlusion. Another patient suffered from renal failure, due to secondary cortical renal necrosis. Surgery is usually simple and does not pose any technical problems. This technique allows for the conservation of the reproductive functions, and two of the women became pregnant at a later stage. Obstetric hysterectomy can be avoided by using this technique. It is recommended in cases where DIVC does not respond to medical treatment and can furthermore be used by all surgeons.

Adult↗
PubMed1988

Effect of progesterone in long-term endometrial cell culture: study of the synthesis of prostaglandins, thromboxane, prostacyclin and prolactin.

Cultured monolayers of endometrial cells synthesized PGE2, PGF2 alpha, 13,14-dihydro-15-keto-PGF2 alpha (DHKF2 alpha), TXB2 and 6-keto-PGF1 alpha. Synthesis increased with the duration of culture, reaching a maximum at approximately the 20th day for PGF2 alpha and PGE2; PGF2 alpha levels always exceeded those of PGE2. Transformation of PGF2 alpha into DHKF2 alpha was minimal. Maximal levels of TXB2 and 6-keto-PGF1 alpha were noted after 7 and 14 days respectively. After three weeks, traces of DHKF2 alpha, TXB2 and 6-keto-PGF1 alpha were noted, whereas PGF2 alpha levels were marked after 30 days of culture. Addition of progesterone (0.32 ng/ml) reduced PG production, notably for PGF2 alpha, but promoted prolactin synthesis, indicating that this progesterone concentration induced decidualization of endometrial cells during the first days of culture.

6-Ketoprostaglandin F1 alpha↗
PubMed1988

The European Multiple Birth Study (EMBS).

The more that twin and other multiple pregnancies are investigated, the more it becomes mandatory that collaborative studies are set up in order to attain the critical number of cases needed to achieve meaningful and reliable results. The European Multiple Birth Study (EMBS) aims to study two aspects of twin and multiple pregnancy: 1) management of pregnancy and labour, with emphasis on the prevention of preterm delivery; 2) accurate determination of zygosity, a prerequisite for the proper use of the twin method in a variety of fields, eg, congenital malformations, genetics, clinical investigations, etc. The rationale, the methods and the organisation of the study are described and discussed.

Data Collection↗
PubMed1988

Management of triplet pregnancy.

Based on the outcome of 21 triplet pregnancies from Antoine Béclère Hospital, early diagnosis in the major requirement for improving rates of fetal survival in multiple pregnancies. The outcome was better in mothers with spontaneous ovulation than in those with induced ovulations. Elective cesarean section is proposed.

Betamethasone↗
PubMed1988

Comparison of antihypertensive efficacy and perinatal safety of labetalol and methyldopa in the treatment of hypertension in pregnancy: a randomized controlled trial.

Labetalol was compared with methyldopa in a randomized controlled trial involving 176 pregnant women with mild to moderate hypertension. Diastolic blood pressure below 86 mmHg was obtained in a similar proportion of women given labetalol or methyldopa. Intrauterine death occurred in four women treated with methyldopa, and the one neonatal death on day 1 occurred in the labetalol group. The average birthweight and the proportion of preterm or small-for-gestational-age babies were similar in both groups. Heart rate, blood pressure, blood glucose, respiratory rate, and Silverman score of the babies did not differ between the two treatment groups, whether the comparison was made for all the infants, or only for those that were preterm or small-for-gestational-age. These data indicate that maternal beta-blockade with labetalol is as safe as methyldopa for the fetus and the newborn.

Adult↗
PubMed1988

Secular trend in the rate of small-for-gestational-age infants: Haguenau Study 1971-1985.

Between 1971 and 1985, at the Haguenau Maternity Hospital, a 20% decrease was observed in the rate of small-for-gestational-age infants (birthweight less than 10th centile using figures from all the study births) among 20,101 births between 28 and 42 weeks. This decrease could not be explained by simultaneous changes in socio-demographic and anthropometric characteristics of the pregnant women, nor a recruitment bias. The earliness of prenatal care at the Maternity Hospital may have played a role in the downward trend. Further research is needed to confirm the influence of prenatal care on the rate of small-for-gestational-age babies.

Adult↗
PubMed1988

Longitudinal follow-up of 100 patients at risk of intrauterine growth retardation: comparison of diagnosis in two periods.

The concept of low birth weight includes two different entities: prematurity and intrauterine growth retardation. Both of them are major public health problems, because they increase perinatal morbidity and mortality Early diagnosis of IUGR leads to adequate decisions, making possible a reduction in perinatal morbidity and mortality. In order to make an early diagnosis of IUGR, clinical methods have proven to be insufficient. Ultrasonography is an important aid to this diagnosis, introducing the measurement of fetal diameters and perimeters. This study, designed to compare both methods, was carried out in at the Antoine Béclère Hospital, Clamart, France. Data processing was done in CLAP-PAHO/WHO. In the first period, retrospective analyses of 116 clinical histories with IUGR were performed. In this study, only fetal diameters were used and the accuracy of clinical and ultrasonographic diagnosis was evaluated. In the second period a prospective longitudinal follow-up study of 100 pregnant women at risk of developing IUGR was carried out. Clinical diagnosis was also evaluated, and compared to the ultrasonographic approach. The parameters used were the fetal diameters and perimeters (head and abdominal perimeters, and their relationship). Sensitivity, specificity and predictive values of the ultrasonic parameters were calculated (table I). The clinical and ultrasonographic diagnosis of both periods were compared with the purpose to analyze the effect of the measurement of fetal perimeters in the diagnostic accuracy. Newborns of the 100 patients in the prospective study were classified into two groups according to birth weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1988

[Nul telediastolic flux. Prognostic value].

42 fetuses over a period of 2 1/2 years have presented with absent end-diastolic velocity. In 6 of these cases the measurements that had been carried out before the 22nd week of pregnancy with later normalisation of the Doppler velocities did not constitute a poor prognostic sign. On the other hand, absent end-diastolic velocity after the 22nd week (36 fetuses) was a sign of chronic fetal distress. The fetal mortality was 33.2%. 19.45% of the infants had chromosome abnormalities and only 58% of these children were alive and healthy. 74% of the live infants were delivered by caesarean section. With these results we think that absent end-diastolic velocity is a simple diagnostic sign, but it warns us that we should carry out tests for the fetal karyotype.

Adult↗
PubMed1988

[Ambulatory monitoring and telephone transmission of uterine activity. Preliminary study on the evaluation of the TOKOS system].

The authors compare 100 tracings of uterine contractions, recorded using a mobile monitoring apparatus with telephone output TOKOS System), with 100 tracings recorded using static equipment. The TOKOS system is useful in diagnosis of uterine contraction, being equivalent to the reference system. The TOKOS system is superior to the reference system in that it allows the intensity of the contractions to be evaluated. The TOKOS system is an original approach to maternal perception of uterine activity. Overall, 28% of contractions are identified by the patient. The authors conclude that the tracings produced by the TOKOS system are more reliable than maternal perception of uterine contractions.

Adult↗