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H L Minkoff

Publications and source records attributed to H L Minkoff.

47 records · Page 3Linked to original sources
PubMed1987

Care of pregnant women infected with human immunodeficiency virus.

The Centers for Disease Control and the American College of Obstetricians and Gynecologists have recommended that pregnant women who are at increased risk for acquired immunodeficiency syndrome be tested for antibodies to human immunodeficiency virus. When this recommendation is implemented, some clinicians who undoubtedly have had limited experience with patients infected with human immunodeficiency virus will be responsible for the care of pregnant women found to be asymptomatically infected with human immunodeficiency virus. There is, therefore, a need for information that will ensure that adequate counseling is provided and that appropriate medical and infection control measures are instituted. This article will review issues related to counseling and antepartum, intrapartum, and postpartum care of seropositive pregnant women.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Relation of private or clinic care to the cesarean birth rate.

The rising rate of cesarean births in the United States has been the focus of academic attention as well as attention from the media during the past decade. Although there is a consensus about the indications for cesarean delivery that have led to the increased rate (dystocia, malpresentation, fetal distress, and previous cesarean delivery), the influence of other key factors, such as whether the patient received care from a private physician or through a hospital clinic, has not been established. In a review of 65,647 deliveries in four Brooklyn hospitals between 1977 and 1982, we found that private physicians performed significantly more cesarean sections than house officers and attending physicians. Private patients giving birth to their first child were significantly more likely than clinic patients to undergo cesarean delivery if dystocia, malpresentation, or fetal distress was diagnosed, and private patients with one or more previous deliveries were significantly more likely to undergo cesarean delivery if dystocia or malpresentation was diagnosed. Private patients had fewer perinatal deaths, which were concentrated among infants with birth weights under 2000 g, but the infants of private patients had a significantly higher rate of low Apgar scores and birth injuries than the infants of clinic patients.

Adult↗
PubMed1984

The physician's role in prenatal counseling.

Malformations occur in 3 percent of all live-born infants in the United States. A successful effort to reduce this incidence depends on understanding the factors that cause malformations and taking steps to eliminate them. Often these steps must be taken before conception, and the responsibility falls on the physician who regularly sees the patient. The patient's history and the acronym DIRE --drugs, infections, radiation and environment--are useful in assessing reproductive risk.

Abnormalities, Drug-Induced↗
PubMed1983

Cervical cerclage: an aggressive approach to threatened or recurrent pregnancy wastage.

Patients at high risk for recurrent pregnancy wastage may not always provide a typical history of cervical incompetence. Seventy-five pregnancies were managed with a cervical cerclage, with tocolytic agents used adjunctively in some. The pregnancies were divided into three groups on the basis of past obstetric history and statistically analyzed with respect to outcome. Patients in categories 1 and 2 showed significant improvement in mean birth weight and maximum gestational age attained with a shift in the ratio of term to premature births after intervention. In category 3, a trend of improvement in mean birth weight and maximum gestational age was seen but fetal salvage was not improved. Maternal morbidity was low with a cerclage-related cesarean section rate of 6.8% and only 8% infectious morbidity. It is concluded that cervical cerclage should be considered in the management of recurrent pregnancy wastage even if the obstetric history is atypical.

Abortion, Habitual↗
PubMed1982

The relationship of amniotic fluid phosphate-to-zinc ratios to post-cesarean section infection.

Although many reports concerning risk factors for post-cesarean section febrile morbidity have been published, few have considered the antibacterial activity of amniotic fluid. This study, in which the amniotic fluid phosphate-to-zinc ratios were used as a reflection of antibacterial activity, demonstrates that, among 85 patients who underwent elective repeat cesarean sections, less febrile morbidity was present when the patient's amniotic fluid had greater antibacterial activity. There was less standard fever, use of antibiotics, and endometritis among patients whose amniotic fluid had lower phosphate-to-zinc ratios.

Amniotic Fluid↗
PubMed1982

Vaginal colonization with Group B beta-hemolytic streptococcus as a risk factor for post-cesarean section febrile morbidity.

Vaginal colonization of mothers with Group B beta-hemolytic streptococcus (GBS) has been recognized as a risk factor for neonatal morbidity. The relationship of GBS colonization to risks for the mother who undergoes cesarean section has not been defined. In this study, we found that, among patients who underwent cesarean section, the 19% of them who were colonized with GBS had a higher incidence of standard fever (66.6% vs. 30.5%), clinical diagnosis of endomyometritis (61.1% vs. 12.5%), and use of antibiotics (61.1% vs. 26.3%) in relationship to a significantly increased frequency of premature rupture of the membranes (50.0% vs. 14.8%). Reasons for the association between vaginal colonization and increased morbidity are discussed.

Anti-Bacterial Agents↗
PubMed1980

The rising cesarean section rate: can it safely be reversed?

Reports from the United States and around the world have marked a steadily rising cesarean section rate. Although the indications that account for the increase are generally agreed upon (previous cesarean section, dystocia, fetal distress, and malpresentation), the benefits derived from the liberalized use of cesarean section to deal with these diagnoses have not been carefully documented. In an attempt to determine if the cesarean section rate could be lowered with no adverse effect on neonatal outcome, 105,848 deliveries at Downstate-Kings County Hospital from 1961 through 1977 were reviewed. The 9727 cesarean sections performed were evaluated to determine the reasons for the increasing rates and the effect on perinatal outcome. It was concluded that by the use of fetal scalp blood sampling in cases of fetal distress, the use of internal pressure transducers in patients who fail to progress in labor, and allowing selected patients with previous sections to labor, the cesarean section rate might be substantially lowered. The maternal morbidity and mortality were also analyzed.

Cesarean Section↗
PubMedDate not supplied

Neurobehavioral and pregnancy effects of prenatal zidovudine exposure in Sprague-Dawley rats: preliminary findings.

In 1994, the Public Health Service made prenatal zidovudine (ZDV, AZT) the standard of care to prevent mother-to-child transmission of HIV. The current study was undertaken to determine if prenatal exposure to ZDV has an impact on pregnancy outcomes, birth anomalies, or offspring behavior in an animal model using Sprague-Dawley (SD) rats. Thirty-one virgin female SD rats were mated and randomly assigned to receive either ZDV at 150 mg/kg/day or vehicle via gastric intubation for 22 days starting on gestation day (G) 1. On G 22, teratologic examination of 12 litters showed no gross structural malformations. There were no significant differences between the groups for maternal food and water consumption or maternal weight gain across pregnancy. However, ZDV treatment significantly reduced litter size and increased birth weights for both male and female pups. One developmental milestone, pinna detachment, occurred significantly earlier in the ZDV-exposed male pups compared to the vehicle-intubated male controls. On day 21-22 of life, pups in each litter were injected with one of four doses of amphetamine and were observed for behavioral activity in a photobeam-based activity monitor for 1 h. Overall amphetamine increased activity and decreased thigmotaxis or wall-hugging behavior. ZDV treatment increased the locomotor response to amphetamine in females only and dampened the action of amphetamine to decrease thigmotaxis in both genders. Further studies are warranted to determine the threshold dose at which these changes occur, the duration of the effects, as well as the neurochemical system(s) responsible for the altered amphetamine responses.

Amphetamine↗
PubMedDate not supplied

Care of women infected with the human immunodeficiency virus.

OBJECTIVE: --To review current knowledge regarding human immunodeficiency virus (HIV) infection in women and to derive from that data standards of care. DATA SOURCES: --Selective review of pertinent articles addressing cervical disease, pelvic inflammatory disease, sexually transmitted diseases, contraception, and pregnancy in HIV-infected women. A computer-assisted search was used to identify relevant articles on pharmacokinetics of drugs in women and oral contraceptive--drug interactions. DATA EXTRACTION: --Pertinent data were abstracted from case-control, cohort studies, clinical trials, and pharmacokinetic studies. DATA SYNTHESIS: --Few studies have been performed to define the clinical course of HIV infection in women. Gender-specific manifestations, such as cervical neoplasia, pelvic inflammatory disease, and vaginal moniliasis, appear to pursue a more aggressive course in HIV-infected women. Little is known about the pharmacokinetics of drugs for HIV and related infections. Oral contraceptives may alter the metabolism of some drugs used in HIV-infected women. An approach to the routine treatment of HIV-infected women is summarized. CONCLUSIONS: --Little is currently known regarding the natural course of HIV infection in women. Women infected with HIV should be followed up frequently with specific attention paid to the reproductive system. Additional studies should be conducted to determine the impact of HIV on gender-specific diseases.

Contraception↗