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Biomedical subjects

L Baxi

Publications and source records attributed to L Baxi.

At least 19 recordsLinked to original sources
PubMed2002

Transcranial Doppler blood flow measurement during cesarean section in two patients with cerebral vascular disease.

We present two cases of neurovascular disease in pregnancy in which transcranial Doppler was used to assess the status of the cerebral circulation during cesarean section under regional anesthesia. One woman had been found to have moyamoya disease, following a series of transient ischemic attacks during her first pregnancy, which ended in spontaneous abortion. On this occasion she was delivered by cesarean section under slowly-induced epidural anesthesia, using ephedrine to maintain the blood pressure, and transcranial Doppler revealed no change in signal in her left middle cerebral artery. Both mother and baby had an uneventful post natal course. The second case involved a primiparous woman with a large arteriovenous malformation that had been detected following generalized seizures, which were treated with valproic acid. Her cesarean section was conducted under spinal anesthesia, and her blood pressure maintained with ephedrine. Again transcranial Doppler revealed no change in signal in her middle cerebral artery during the procedure. We believe this is a potentially useful technique to monitor the cerebral circulation intraoperatively in the presence of cerebrovascular disease.

Journal Article↗
PubMed2002

Perinatal mortality in diabetic patients undergoing antepartum fetal evaluation: a case-control study.

OBJECTIVE: To identify changing trends, if any, of fetal loss in diabetic patients undergoing antepartum fetal evaluation in a case-control study. METHODS: Fetal assessment (non-stress test and/or biophysical profile) logbooks from January 1981 to June 1998 were reviewed and the patients with diabetes were identified. The study group comprised patients with pregnancy loss. Each case was matched by year of delivery and class of diabetes with four randomly selected controls with no pregnancy loss. All patients in both groups were at > 26 weeks' gestation. RESULTS: Thirteen stillbirths and four neonatal deaths occurred in 1,935 diabetic patients who underwent fetal evaluation. There was no significant difference in age, race, gravidity, parity, clinic or private service, or the type of delivery in the two groups. Losses were more likely (p < 0.001) to occur before 32 weeks, with birth weights < 2,500 g, with a greater time interval from their last fetal evaluation, with poor glycemic control and with congenital malformations (six of seven occurred before 1990). In this study, perinatal losses were associated with non-compliance and other associated problems in the mother. Overall perinatal mortality in these patients was 17 per 1935 and corrected 11 per 1935 or 5.6 per 1,000. CONCLUSION: In the 1980s suboptimal glycemic control with major fetal malformations emerged as the major contributory factor to perinatal loss and, in the 1990s, this was associated medical problems. With a better awareness of the adverse effect of suboptimal glycemic control at the time of organogenesis and advances in fetal diagnosis and evaluation, fetal loss due to diabetes has become a rarity. Patients with associated medical problems and those at risk for abruptio placentae should be managed more aggressively.

Adult↗
PubMed1998

Attempted vaginal birth after cesarean section: a multicenter comparison of outpatient prostaglandin E(2) gel with expectant management.

Objective: To compare the clinical effectiveness and safety of outpatient administration of an intracervical prostaglandin (PG) E(2) gel with expectant management for women with an unfavorable cervix who wish to attempt a vaginal birth after cesarean section.Study Design: This outpatient study was a randomized, multicenter investigation involving pregnant women at term with one previous low transverse cesarean section. Each had an unfavorable cervix (Bishop score </=4) and was a candidate for vaginal delivery. Those randomly assigned to receive the gel, rather than expectant management, were given a 0.5 mg dose of PGE(2) (Prepidil) intracervically at 39 weeks gestation. This cervical ripening treatment was repeated at weekly office visits for up to 3 doses.Results: Of the 294 cases, 143 received the gel while 151 underwent expectant management. No differences between the two groups were found for maternal demographics, race, parity, or predose Bishop score. The rates of repeat cesarean section did not differ (P =.68) with use of the gel (61, 42%) or with expectant therapy (48, 45%). The onset of active labor, the duration of labor among those delivering vaginally, and the 1-minute and 5-minute Apgar scores were not different between the two groups. No uterine rupture was apparent, and adverse effects during labor were as likely to occur in the two groups.Conclusions: Although its safety was confirmed for outpatient use and for persons with a prior cesarean delivery, intracervical prostaglandin E(2) gel did not improve the chance of a vaginal birth after a cesarean delivery.

Journal Article↗
PubMed1998

Is induction of labor with continuous release dinoprostone vaginal pessary a viable option in patients with preeclampsia?

Objective: To evaluate the role of dinoprostone vaginal pessary (DVP) for induction of labor in preeclampsia.Methods: This is a prospective review of 94 patients with preeclampsia, who delivered from July 1995 to December 1996 at a university center. Of these, 25 received DVP, 22 oxytocin, 11 intracervical prostaglandin E(2), and 36 received no pharmacologic agents. Patients receiving DVP and oxytocin induction were compared for outcome of pregnancy and cesarean section rate. Statistical analysis was carried out by Student t test, chi(2) test with Yates correction.Results: The two groups were comparable with respect to parity and 5-minute Apgar scores.Three patients in the DVP group developed complications-one episode of seizure, one atonic postpartum hemorrhage, and one cervical laceration. One patient in the oxytocin group developed HELLP syndrome.Conclusion: DVP is at least as effective as oxytocin in achieving vaginal delivery in preeclampsia, despite lower Bishop scores. Future larger studies are needed to better assess DVP in patients with preeclampsia.

Journal Article↗
PubMed1998

Laparoscopic cholecystectomy during pregnancy: a case series and review of the literature.

This study was conducted to evaluate the role of antepartum laparoscopic cholecystectomy (LC). Patients who underwent LC were identified from a hospital database with the use of CPT/ICD codes. Of 2093 cases performed at a major center (October 1991 to November 1997), only six were performed during pregnancy. On reviewing the English literature, gestational age at surgery and delivery and outcome of delivery were provided in only 69 of 105 patients (33 papers with 1-10 cases) and we tabulated different variables from the cases in this review. In this series, two patients who had LC in the first trimester underwent elective termination of pregnancy. Of the seven published cases of first trimester LC followed to delivery, one had preterm delivery. First trimester open cholecystectomy (OC) has a 12 percent spontaneous abortion rate. The four patients who had second trimester LC had normal deliveries at term. Of the 43 published cases of second trimester LC followed to delivery, 39 ended in uncomplicated, full-term deliveries. Three of four second trimester cases at one institution had spontaneous abortions. None of our patients underwent LC in the third trimester. Of the 12 published cases of third trimester LC followed to delivery, one had preterm delivery. Third trimester OC is reported to have a 40 percent rate of preterm delivery. There were no intraoperative cholangiograms (IOC), prophylactic or postoperative use of tocolytics, or intraoperative fetal monitoring in our series. We added six cases of LC during pregnancy to the previously reported 105 cases. The successful outcome in all trimesters suggests that LC is a safe procedure throughout pregnancy; however, surgery in the second trimester is preferable. Compared with OC, there is a decreased risk of spontaneous abortion in the first trimester and preterm labor in the third trimester.

Abortion, Spontaneous↗
PubMed1996

Tamoxifen-induced growth of leiomyomas. A case report.

BACKGROUND: Tamoxifen, a nonsteroidal estrogen agonist-antagonist, is used in the treatment of breast cancer. CASE: A postmenopausal woman, aged 73, while being treated with Tamoxifen, developed continuous growth of her myomatous uterus, became symptomatic and required surgery. CONCLUSION: Tamoxifen at a dose of 40 mg/d has been associated with endometrial carcinoma. The growth of myomas seen with Tamoxifen in this patient seems to be a result of its direct agonist properties.

Aged↗
PubMed1995

Significance of prenatal diagnosis of umbilical cord cyst in a fetus with trisomy 18.

An umbilical cord cyst was detected in a fetus who underwent ultrasonography at 38 weeks' gestation for clinical suspicion of intrauterine growth retardation. Such an association should alert the clinician to the possibility of aneuploidy, thus guiding clinical management. This case represents the second report of a cystic umbilical lesion in a fetus with trisomy 18.

Adult↗
PubMed1993

Alpha-fetoprotein in diabetic pregnancy. A reassessment.

We correlated glycosylated hemoglobin (HbA1) with maternal serum alpha-fetoprotein (MSAFP) in 92 and amniotic fluid AFP (AFAFP) in 27 patients with pregestational and gestational diabetes. MSAFP and AFAFP were measured between 15 and 20 weeks and correlated with HbA1. In group 1, HbA1 was measured at < or = 12 weeks' gestation; in group 2, it was measured 0-6 weeks before MSAFP measurement; and in group 3, it was measured within 6 weeks after MSAFP. Mean MSAFP was 1.02 +/- 0.77 multiples of the median (MOM) (+/- SD) in all diabetics, 1.1 +/- 0.93 MOM in gestational diabetics and 0.89 +/- 0.33 MOM in pregestational diabetics (P = NS). There was no correlation between MSAFP and HbA1 in groups 1-3. Patients with HbA1 > 9 g% had a mean MSAFP of 0.84 MOM as compared to 0.85 MOM in those with HbA1 < 9 g% (P = NS). AFAFP values were within normal limits even in patients with HbA1 > 9 g% in early pregnancy (n = 8). No significant decrease in MSAFP was seen in pregestational diabetics, and no correlation was seen with HbA1 levels. AFAFP levels were unchanged in diabetics.

Amniotic Fluid↗
PubMed1993

Subchorionic hematoma: a review.

A review of the English literature on subchorionic hematoma (SCH) is presented. Fourteen studies are reviewed. The incidence of SCH varied greatly among studies from 4 to 48 per cent. Small SCH tend to be more common in the first trimester and appear to pose no added risk to the ongoing pregnancy. Conversely, SCH in the second trimester often are larger and may be associated with an increased risk of preterm delivery. The etiology of these hematomas remains unclear. Pathological changes that might contribute to their formation are reviewed. Larger studies with controls, including data on the incidence of SCH in a population of normal obstetric patients are needed.

Chorion↗
PubMed1991

Screening recommendations for gestational diabetes mellitus.

As a result of extensive experiences in multiple centers and a review of the current literature, we conclude that a plasma glucose level obtained 1 hour after a 50 gm oral glucose challenge is the "best" gestational diabetes mellitus screening test. This universal screening is performed at least once during pregnancy. The screening threshold should be no higher than 140 mg/dl, or an unacceptable loss in sensitivity occurs. Universal screening for gestational diabetes mellitus is justified by morbidity reduction, cost, and protocol simplicity and ease.

Blood Glucose↗
PubMed1990

Mitochondrial myopathy and preeclampsia associated with pregnancy.

Mitochondrial myopathy is characterized by weakness, exercise intolerance, and acidosis. Pregnancy has been reported to accelerate the disease process. This report discusses pregnancy and management of labor complicated by mitochondrial myopathy and the therapeutic dilemmas that arise when preeclampsia is diagnosed.

Female↗
PubMed1990

False-negative syphilis screening: the prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy.

The prevalence of congenital syphilis is rapidly rising in several areas of the United States. Efforts to control the disease depend on the effectiveness of established screening strategies and treatment of infected pregnant women. False-negative test results hinder these efforts and leave the fetus at risk for acquiring congenital syphilis. Recently we encountered four cases of false-negative syphilis serologic results in women who gave birth to infants with congenital syphilis. The false-negative results were caused by the prozone phenomenon. The prozone phenomenon, seen during primary and secondary syphilis, occurs because a higher than optimal amount of antibody in the tested sera prevents the flocculation reaction typifying a positive result in reagin tests. Serum dilution is necessary to make the correct diagnosis. We recommend that for any pregnant woman with apparently negative syphilis serologic results in whom fetal compromise of unknown etiology exists, particularly nonimmune hydrops, nontreponemal testing should be repeated using serum dilutions to prevent a missed diagnosis of syphilis. We further recommend serum dilution as a routine procedure for all pregnant women in areas of high syphilis prevalence.

Adult↗
PubMed1990

Early detection of caudal regression syndrome with transvaginal scanning.

High-resolution transvaginal ultrasonography may recognize structures in the first- and early second-trimester fetus. In a patient with pregestational diabetes, caudal regression syndrome in the fetus was diagnosed using transvaginal ultrasonography. At 9 weeks of gestation, a shortening of the crown-rump length and a protuberance of the lower spine suggested caudal regression syndrome. By 17 weeks of gestation, the diagnosis was made with certainty. The transvaginal approach has changed the role of first-trimester ultrasound in the diabetic pregnancy. We suggest that transvaginal ultrasonography be used for purposes of accurate dating and for early detection of diabetic embryopathy, particularly in patients with poor periconceptional glycemic control.

Adult↗
PubMed1989

Transvaginal salpingocentesis: a new technique for treating ectopic pregnancy.

Transvaginal sonography is an important tool for diagnosing ectopic pregnancy. In this report the transvaginal passage of a needle, with sonographic guidance, into a tubal gestational sac with a live fetus is demonstrated. We injected potassium chloride solution to arrest cardiac activity, terminating the ectopic pregnancy without surgical intervention. The new therapeutic use of transvaginal sonography is an important addition to the treatment of this prevalent disease.

Adult↗
PubMed1988

Bilateral luteomas of pregnancy in a patient with diabetes.

A patient with diabetes and luteomas of the ovaries demonstrated a significant and progressive rise in the serum levels of androstenedione and testosterone during pregnancy. The levels of these hormones were also elevated in cord blood and ovarian fluid. The increased insulin requirement to maintain euglycemia was observed at an earlier date in this pregnancy than in her previous pregnancy.

Adult↗