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Biomedical subjects

J H Harger

Publications and source records attributed to J H Harger.

45 records · Page 3Linked to original sources
PubMed1980

Comparison of success and morbidity in cervical cerclage procedures.

A review of 251 cervical cerclage procedures in 205 women over a 7.5-year period was conducted to compare the success rate and morbidity of the Shirodkar and McDonald techniques. Fetal survival rate was 19% before 139 elective McDonald operations and 20% before 63 elective Shirodkar procedures. Fetal survival was 78% after elective McDonald operations and 87% after elective Shirodkar procedures, a difference that is not statistically significant (P > .05). Fetal survival rate was 53% after 30 emergency McDonald and 68% after 19 emergency Shirodkar procedures, a difference not statistically significant. Major postoperative morbidity occurred in 2.0% of the elective cerclage procedures, and acute chorioamnionitis accounted for half the complications (1.2%). Mean blood loss was 30 ml with McDonald operations and 44 ml with Shirodkar procedures; the maximum blood loss of 150 ml occurred in 2 emergency operations. Cervical laceration at parturition occurred more often with Shirodkar (11%) or McDonald (14%) procedures than with the 55,688 other deliveries (2.18%) during the 7.5-year study period (P < .001). Cervical scarring and elective cesarean section significantly (P < .025) increased the cesarean section rate to 16% after McDonald procedures and 25% after Shirodkar procedures.

Cervix Uteri↗
PubMed1980

Ascending transcervical herpes simplex infection with intact fetal membranes.

A case of herpes simplex infection in the placenta and in an immature infant delivered to a mother with proved genital herpes infection is discussed. Infection occurred without premature rupture of membranes. Viral transmission could be attributed to ascending transcervical infection based on evidence of necrotizing chorioamnionitis in absence of villitis plus extensive and severe involvement of the skin and lungs. Such distinct documentation of transcervical infection in the presence of intact fetal membranes makes it obvious that delivery by cesarean section cannot prevent all cases of neonatal herpes infection.

Adult↗
PubMedDate not supplied

Low-dose aspirin and prednisone treatment of pregnancy loss caused by lupus anticoagulants.

The objective of this study was to ascertain the complications and the efficacy of low-dose aspirin (LDA) and prednisone therapy in women with pregnancy loss and "lupus anticoagulants" (LAC). During the period 1985 to 1993, 255 patients with two or more pregnancy losses (RPL) were tested for LAC with an activated partial thromboplastin time (aPTT) and a tissue thromboplastin inhibition index (TTI, normal value < 1.3). The diagnosis of LAC was established if two TTI values were > or = 1.3 or if a prolonged aPTT was measured in the patient's plasma that did not correct to normal by 1:1 mixing with normal plasma. We excluded patients with RPL who had only anticardiolipin antibodies. We treated 28 pregnancies in 21 women with LDA/prednisone for RPL associated with LAC. Therapy with LDA/prednisone was initiated as soon as a viable pregnancy was diagnosed. Therapy was continued until delivery in all but one case. Prednisone dose was minimized by measuring TTI and aPTT every 2 weeks and adjusting the dosage to maintain a TTI < or = 1.2 and to correct the aPTT to less than 36 seconds. Among the 28 pregnancies there were four (14%) first-trimester spontaneous abortions and four (14%) second-trimester fetal deaths. Of 20 surviving neonates (72%), seven were delivered after 37 weeks and 13 before 37 weeks (mean 35.9 +/- 2.3 weeks, range 31.5 to 40.4 weeks). Pre-term premature rupture of membranes occurred in three pregnancies, hypertensive disorders in six, and four small-for-gestational-age neonates were delivered (two stillborn). Mean birth weight of 20 surviving neonates was 2736 +/- 763 gm (range 900 to 3920 gm). Mean daily prednisone dose in 20 live births was 24.1 +/- 8.5 (SD) mg (range 11.3 to 49.3 mg/day) with mean duration of LDA/prednisone therapy of 185 +/- 40 days (range 97 to 223 days). Maximum prednisone dose was 60 mg/day (mean 36.8 +/- 12.7 mg/day). Only one serious maternal complication of LDA/prednisone therapy was observed. One neonate had talipes equinovarus that resolved without surgical therapy. LDA/prednisone therapy seemed effective and reasonably well tolerated in this population. These findings should be confirmed in a prospective, controlled investigation if such a trial can be organized and performed.

Abortion, Habitual↗