Search PubMed⌕ Search

Biomedical subjects

H Minkoff

Publications and source records attributed to H Minkoff.

At least 91 records · Page 5Linked to original sources
PubMed1988

Avoidable causes of perinatal death at or after term pregnancy in an inner-city hospital: medical versus social.

A retrospective analysis of 174 consecutive singleton perinatal deaths at or after term pregnancy in an inner-city hospital was undertaken to determine avoidable causes of death. Adequate material was available in 161 cases. Twenty-eight infants with major malformations were excluded. The remaining 133 infants (95 stillbirths and 38 neonatal deaths) constituted the study population. An avoidable cause was defined as departure from the recognized standards of perinatal care that contributed to the deaths. Avoidable factors were present in 69 of 95 (73%) stillbirths. Contributing maternal/social and obstetric factors were present in 40 of 69 (58%) and 29 of 69 (42%) cases, respectively. Avoidable factors were found in 34 of 38 (89%) neonatal deaths. Contributing obstetric, maternal/social, and pediatric factors were present in 20 of 34 (59%), 12 of 34 (35%), and 2 of 34 (6%) cases, respectively. These results suggest that maternal/social causes were present more often than medical causes as a contributing factor in avoidable perinatal deaths at or after term pregnancy.

Adult↗
PubMed1988

A cohort study of alkaloidal cocaine ("crack") in pregnancy.

The recent dramatic increase in the use of alkaloidal cocaine ("crack") has led to concern about possible deleterious fetal effects associated with its use during pregnancy. Crack, which is not destroyed by heating, can be smoked, and delivers a large quantity of cocaine to the vascular bed of the lung, producing an effect similar to that from intravenous injection. To describe the association of crack use with pregnancy outcome, we conducted a retrospective matched cohort study of 55 women who admitted to the use of crack during pregnancy and 55 non-drug-using women who delivered during the same period. The groups were matched for age, parity, socioeconomic status, alcohol use, and presence or absence of prenatal care. A significantly larger number of women using crack delivered at 37 weeks or earlier (50.9 versus 16.4%; P = .001). Crack-exposed infants were 3.6 times more likely to have intrauterine growth retardation (P less than .006) and 2.8 times more likely to have a head circumference less than the tenth percentile for gestational age (P less than .007). Premature rupture of the membranes was 1.8 times more common in the crack group (P less than .03). Sixty percent of crack-using mothers received no prenatal care. Abnormal neurobehavioral symptoms were present in a minority of infants and were usually mild.

Adult↗
PubMed1987

Serosurvey of human immunodeficiency virus infection in parturients. Implications for human immunodeficiency virus testing programs of pregnant women.

Although perinatal transmission of the human immunodeficiency virus (HIV) is well documented, seroprevalence rates of HIV in populations of women of reproductive age have not yet been reported. To determine the seroprevalence of HIV in childbearing women from a population with a high incidence of acquired immunodeficiency syndrome, cord blood samples were collected from 602 infants delivered at an inner-city municipal hospital in New York. Demographic and HIV risk factor information was also collected from mothers of these infants. Twelve (2%) of 602 samples (95% confidence interval, 1% to 4%) were positive for HIV on enzyme-linked immunosorbent assay and Western blot analysis. In interviews, seven of 12 seropositive women had risk factors as defined by the Centers for Disease Control, Atlanta; the remaining five seropositive women had no self-identified risk factors. The HIV seroprevalence rate in our hospital (2.0%) is several times higher than that of many other diseases for which screening is already routine. This serosurvey indicates that HIV infection of inner-city parturients is a significant problem that warrants broadly implemented health strategies. Furthermore, the data also suggest that if risk factor information elicited by physicians is used to initiate HIV antibody counseling and testing of pregnant women, a significant number of seropositive parturients is missed. In areas with significant seroprevalence rates of HIV infection, a broader counseling and testing program may be needed.

Enzyme-Linked Immunosorbent Assay↗
PubMed1987

Relationship of vaginal pH and Papanicolaou smear results to vaginal flora and pregnancy outcome.

Prematurity is a major cause of perinatal morbidity. Studies have implicated components of the vaginal flora in the etiology of some cases of preterm birth. Current scoring systems do not include factors which directly reflect the vaginal flora. Since Papanicolaou smears and the vaginal pH may be affected by the vaginal flora and are easy tests to perform, we studied their relationship to vaginal flora and pregnancy outcome. Among 231 patients, those with a vaginal pH greater than or equal to 4.4 were significantly more likely to carry Trichomonas vaginalis (P less than 0.03); Bacteroides species (P less than 0.01), and Mycoplasma hominis (P less than 0.001), and to have premature rupture of the membranes (P less than 0.01), and preterm rupture of the membranes (P less than 0.05). Patients with atypia reported on Papanicolaou smear more frequently carried M. hominis (P less than 0.01), and had premature rupture of the membranes (P less than 0.01). Although the high sensitivity and negative predictive value of those tests may make them useful additions to current scoring systems, their low specificity prevents them from being independent predictors of risk.

Female↗
PubMed1987

Short course of antibiotics for post-cesarean section endometritis.

Although post-cesarean section endometritis is a common postoperative complication, little has been reported on the safety of short-course therapy, particularly in indigent populations. Our preliminary data on 25 indigent patients with endometritis treated only until 24 to 36 hours after defervescence suggest that courses of antibiotics need not routinely be continued for 7 to 10 days.

Cesarean Section↗
PubMed1987

Pregnancy among obstetricians: a comparison of births before, during, and after residency.

Questionnaires were sent to 1025 female board-certified obstetricians, and information was retrieved about pregnancy outcome. A total of 454 pregnancies, one third of which occurred during residency, were evaluated, and the relationship between pregnancy outcome and residency was assessed. Children of primiparous women who were delivered during or after residency had significantly lower mean birth weights than those who were delivered before residency (p less than 0.001 and p less than 0.005, respectively), whereas birth weights of infants born to multiparous women were not significantly different. The low birth weight rate (less than 2500 gm) was significantly increased during residency (p less than 0.002), and infants born during residency were 7.5 times more likely to be growth retarded than those born outside residency (p less than 0.002). The incidence of other pregnancy complications was not found to be increased during residency. Our data suggest a potentially negative impact of residency on the birth weights of infants born to female obstetricians in training.

Birth Weight↗
PubMed1987

Percutaneous drainage of fluid collections in the bladder flap of febrile post-cesarean-section patients. A report of seven cases.

Post-cesarean-section infections are a common cause of fevers on obstetric wards. Patients whose fevers are refractory to antibiotics often have pelvic collections. The contents of these collections and course of patients with collections have not been reported on before in detail. The development of sophisticated imaging techniques has led to the frequent use of percutaneous drainage in the management of abdominal collections. We used percutaneous drainage of collections in febrile post-cesarean-section patients. Hematomas were the most common collections associated with post-cesarean-section infection, and percutaneous drainage was a useful technique for obtaining material for culture and for distinguishing hematomas from abscesses. Most patients defervesced shortly after percutaneous drainage.

Abscess↗
PubMed1987

Twin gestation and perinatal follow-up in a woman with severe chronic renal failure managed without dialysis. A case report.

Severe renal insufficiency (serum creatinine greater than 2 mg/dL) during pregnancy has been associated with poor perinatal outcome. Even in the absence of maternal indications, hemodialysis has been suggested for fetal indications, although the influence of maternal renal failure on the newborn's development is unknown. The effects of the abnormal biochemical environment of dialysis on fetal growth and development are also unknown, and the small numbers of reported cases make it difficult to assess the indications for hemodialysis. A 35-year-old woman had a twin gestation and severe chronic renal failure. The pregnancy was managed without hemodialysis, and at 33 weeks' gestation two healthy newborns were delivered with cesarean section. Bailey scales of infant development at 14 months of age showed normal infant development. Hemodialysis is not indicated solely for fetal reasons in the patient with severe but stable renal failure in the absence of severe hypertension, pre-eclampsia, deteriorating renal status or intrauterine growth retardation.

Adult↗
PubMed1987

Pregnancies resulting in infants with acquired immunodeficiency syndrome or AIDS-related complex.

Thirty-four children have been cared for at SUNY-Health Science Center at Brooklyn with diagnoses of either acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Reported here are descriptions of pregnancies resulting in these children. Few of the mothers (four of 32) were symptomatic; however, low birth weight (11 of 34), preterm birth (11 of 34), and premature rupture of membranes (ten of 32) were common. Of 33 patients whose mode of delivery was known, cesarean section was used in ten cases, including one elective repeat. Among mothers who had children before their affected offspring, the average birth weight of the older children significantly exceeded that of the affected (3241 +/- 508 versus 2712 +/- 722 g, P less than .05). The affected child's age at onset of symptoms did not correlate with birth weight, mode of delivery, or status of membranes at the onset of labor.

AIDS-Related Complex↗
PubMed1987

Pregnancies resulting in infants with acquired immunodeficiency syndrome or AIDS-related complex: follow-up of mothers, children, and subsequently born siblings.

Although several hundred cases of acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) in infants have been reported, there is little information available concerning the follow-up of mothers and these children or subsequently born children. Thirty-four children with perinatally acquired AIDS and ARC (19 AIDS; 15 ARC) have been followed at the Downstate Medical Center. Although no mother had AIDS or ARC during her pregnancy, after an average follow-up (+/- SD) of 27.8 +/- 21.6 months, five had AIDS and ten had ARC. For 22 of the mothers, T4/T8 ratios were obtained; 15 of these were less than 1, and five were between 1 and 1.5. Among 11 subsequently born siblings for whom HTLV-III antibody status was known, four were positive; of these, two had ARC and one had AIDS. We conclude that the diagnosis of AIDS or ARC in a child indicates a risk for the development of illness in the mother and subsequently born siblings.

AIDS-Related Complex↗
PubMed1986

An obstetric approach to the prevention of early-onset group B beta-hemolytic streptococcal sepsis.

Group B beta-hemolytic streptococcus is one of the most common causes of neonatal sepsis. Despite its relationship to neonatal morbidity and mortality, no consensus exists for an approach to its prevention. Several characteristics of the organism such as high maternal carriage rates, the intermittent nature of this carriage, and the failure of antibiotics to permanently eliminate carriage have limited the success of proposed intervention protocols. In this clinical opinion we review characteristics of the organism and previously suggested intervention protocols. Then, based on this review and an analysis of recently published data, a protocol focusing on preterm births is presented. This proposal favors intrapartum treatment of all mothers who are delivered of preterm infants and who are either carriers of group B beta-hemolytic streptococci or whose carriage status is unknown. A comparison of the costs and benefits of this and other approaches is made.

Ampicillin↗
PubMed1986

Pneumocystis carinii pneumonia associated with acquired immunodeficiency syndrome in pregnancy: a report of three maternal deaths.

Acquired immunodeficiency syndrome (AIDS) has become a major public health problem in the United States. Current projections, based on seroepidemiologic data, suggest a large increase in the number of cases over the next several years. Pneumocystis carinii pneumonia is the most common opportunistic infection associated with AIDS and an increase in the frequency of that illness also can be anticipated. Few cases of P carinii pneumonia associated with AIDS during pregnancy have been reported. Reported here are three such patients. All patients had been intravenous drug users and all died during the hospitalization in which the diagnosis was made. The diagnosis and management of P carinii pneumonia associated with AIDS are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Pneumococcal polysaccharide antibody levels in patients with term and preterm pregnancies.

Serum antibody levels against 12 serotypes of pneumococcal polysaccharide were assessed in pregnant women as well as in cord bloods of their infants. Twelve women were evaluated during the first trimester, second trimester, and in labor at term, and eight women were assessed in the first trimester and in preterm labor. Antibody levels significantly decreased from the first trimester to delivery both in patients with term (339 versus 281 ng AbN/mL; P less than .001), and preterm (448 versus 299 ng AbN/mL; P less than .001) deliveries. There was no significant difference in mean antibody levels or their rate of decline between term and preterm pregnancies.

Adult↗
PubMed1985

Effect of Lamaze childbirth preparation on maternal plasma beta-endorphin immunoreactivity in active labor.

Previous studies have documented a reduction in plasma beta-endorphin levels with the use of various analgesic techniques in labor, such as segmental epidural anesthesia or intrathecal morphine. The Lamaze method of childbirth preparation, which has been found to reduce the need for medication during childbirth and to decrease the subjective perception of pain during labor and delivery, has not been studied in this regard. In this study plasma beta-endorphin immunoreactivity levels were measured during the active phase of labor in 26 patients who had Lamaze classes and in 28 patients who did not have Lamaze classes. The Lamaze group had significantly lower plasma beta-endorphin immunoreactivity (37.2 vs. 68.5 pg/ml; P less than 0.001) and significantly shorter first stages of labor (8.28 hrs. vs. 9.86 hrs; P less than 0.02). It can be theorized that both lower beta-endorphin immunoreactivity and shorter labor in patients in the Lamaze group were related to the reduction of fear, tension, and the emotional stress of labor.

Adult↗
PubMed1985

Diagnosis of intracranial hemorrhage in utero after a maternal seizure.

Reported is a patient who noted decreased fetal movements after a seizure at 32 weeks' gestation. Sonography revealed fetal death and findings consistent with an intraventricular hemorrhage. The possible explanations for and the significance of an association between a maternal seizure and fetal intraventricular hemorrhage are discussed.

Adult↗
PubMed1985

Relationship of ultrasound findings after cesarean section to operative morbidity.

Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have noted fluid collections around the incision site. In this report of 100 postcesarean section patients, it is noted that echo-free areas anterior to the incision site, which correspond to the described fluid collections, were present in 29% of patients and were more frequently found in patients with excess blood loss at surgery. Patients whose echo-free areas were greater than or equal to 3.5 cm were significantly more likely to have postoperative morbidity. The significance of these findings and the role of ultrasound in the evaluation of the postcesarean section patient are discussed.

Abscess↗
PubMed1985

Relationship of vaginitis to the sex of conceptuses.

The relative viability of X-bearing and Y-bearing spermatozoa is influenced by factors in the vagina such as pH. The vaginal environment, in turn, is influenced by its flora. This study examined the relationship of the vaginal flora to the sex of conceptuses. It was found that women who carried Trichomonas vaginalis or Bacteroides sp or who had nonspecific vaginitis at first prenatal visit were significantly more likely to deliver females than women who carried none of these organisms (54 versus 37%, P less than .02).

Bacteriological Techniques↗