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Biomedical subjects

L C Gilstrap

Publications and source records attributed to L C Gilstrap.

At least 37 records · Page 2Linked to original sources
PubMed1995

Management of disseminated intravascular coagulopathy.

Disseminated intravascular coagulopathy is a process in which aberrant activation of the clotting mechanism results in defective coagulation. Although infrequently encountered during pregnancy, disseminated intravascular coagulopathy is associated with several clinical situations unique to obstetrics. Management consists of treating the underlying cause, restoring and maintaining the circulating blood volume, and replacing deficient clotting factors as indicated.

Abortion, Induced↗
PubMed1994

The transfer of the nucleoside analog ganciclovir across the perfused human placenta.

OBJECTIVE: The purpose of this study was to compare the maternal-fetal placental transfer of the antiviral nucleoside analog ganciclovir to that of acyclovir and to investigate the mechanism of transport. STUDY DESIGN: The ex vivo human placental cotyledon model was used. Carbon 14-labeled antipyrine was used as the reference compound to determine the clearance index of both antiviral agents. Dinitrobenzylthioinosine was used as a nucleoside transport inhibitor to help determine the transfer mechanism of each agent. RESULTS: The clearance index for ganciclovir was 0.17 +/- 0.08 and 0.20 +/- 0.10 at 1 and 10 micrograms/ml maternal concentrations. This was similar to the clearance index for acyclovir, which was 0.17 +/- 0.06 and 0.18 +/- 0.12, respectively. The clearance index for ganciclovir was not significantly affected by the addition of 5 mumol/L dinitrobenzylthionosine to the perfusate (0.25 +/- 0.09 vs 0.20 +/- 0.05). The same was true for acyclovir (0.29 +/- 0.06 vs 0.22 +/- 0.07). When the closed system and maternal ganciclovir concentrations of 1.0, 10.0, and 100 micrograms/ml were used, the percent fetal levels compared with maternal levels at 1 hour were 17.2%, 19.2%, and 17.3%, respectively. For acyclovir the fetal levels were 15.6%, 9.1%, and 8.9% compared with maternal levels. CONCLUSION: The antiviral agents ganciclovir and acyclovir appear to cross the placenta by simple diffusion, at least at therapeutic levels, and this transfer is not affected by the nucleoside transport inhibitor dinitrobenzylthioinosine.

Acyclovir↗
PubMed1994

Management of mild pregnancy-induced hypertension remote from term.

The goal in the management of patients with pregnancy-induced hypertension is delivery of infants who will thrive physically and mentally without compromising maternal health in the process. Many therapeutic approaches have been recommended; however, none except delivery are curative. In the interest of maternal health, delivery is essential regardless of gestational age when severe preeclampsia or eclampsia is diagnosed. Conversely, women with mild pregnancy-induced hypertension remote from term may be managed conservatively with efforts directed toward prolonging gestation in order to maximize perinatal outcome. The regimen used at Parkland Memorial Hospital has proven to be safe and effective. We will continue to use this method of inpatient management until well-controlled studies are designed and conducted and yield comparably safe and efficacious outcomes.

Adult↗
PubMed1993

Prediction of the severity of meconium aspiration syndrome.

OBJECTIVE: Meconium aspiration syndrome is associated with increased neonatal morbidity and mortality. We sought to determine whether the need for neonatal mechanical ventilation or prolonged ventilation (> or = 3 days) was predictable from antepartum, intrapartum, and immediate neonatal events. STUDY DESIGN: Between 1987 and 1989, 8003 of 43,906 (18%) live infants had meconium-stained amniotic fluid; 82 of these infants had clinical and radiographic evidence of meconium aspiration, and of these 82, 39 (48%) required mechanical ventilation. Predictors of ventilation or prolonged ventilation were determined by means of stepwise logistic regression. RESULTS: Predictors of neonatal ventilation included fetal tachycardia, interval from meconium detection to delivery, low 5-minute Apgar score, respiratory distress necessitating intubation in the delivery suite, and delivery by cesarean section. Sensitivity was 72%, and specificity was 64%; the model was incorrect in 32% of the cases. Predictors of prolonged ventilation were ominous fetal heart rate tracing, umbilical arterial pH < 7.20, birth weight > 90th percentile, nulliparity, and Apgar score > 4 at 1 minute and < or = 6 at 5 minutes. Sensitivity was 67%, and specificity was 91%; prolonged ventilation was incorrectly predicted in 17% of the cases. CONCLUSIONS: Use of these models to determine the need for mechanical ventilation or prolonged ventilatory assistance will enhance identification of infants at risk of severe meconium aspiration and will lead to early transfer to the neonatal intensive care unit for intense observation and management.

Apgar Score↗
PubMed1993

Acid-base significance of meconium discovered prior to labor.

Although the significance of meconium in the amniotic fluid diagnosed during labor remains problematic, there is little information regarding the significance of meconium discovered prior to labor. The present study consisted of 40 term pregnancies with meconium found at amniocentesis for lung maturity (n = 7) or elective cesarean section (n = 33) and 40 uncomplicated, control pregnancies with clear amniotic fluid at elective cesarean section. The mean umbilical artery (UA) blood pH was 7.26 in the meconium group and 7.28 in the control group. Overall, the frequency of fetal acidemia (UA pH < 7.20) was 15% (6 of 40) of the infants in the meconium group versus 8% (3 of 40) in the control group (p = 0.24). All nine of these infants had a respiratory acidosis defined as a UA blood pH less than 7.20 with normal bicarbonate and elevated carbon dioxide pressure. Importantly, none of the neonates had metabolic acidemia and all had uncomplicated hospital courses. All of the pregnancies reported were promptly delivered because of meconium and we therefore cannot recommend nonintervention when meconium is diagnosed in the antepartum period. Meconium discovered prior to labor is not necessarily a marker of immediate or chronic fetal compromise.

Acid-Base Equilibrium↗
PubMed1993

Correlations between obstetric clinical events and umbilical cord blood acid-base and blood gas values.

Umbilical cord blood acid-base analysis may be used to assess the condition of fetus and newborn more objectively. Newborn acid-base status is an important criterion when we attempt to define perinatal asphyxia. It also has medicolegal ramifications because it enables the documentation of the presence of a biochemical milieu that is not related to the later development of cerebral palsy. We anticipate future research will focus on the redefinition of acidemia and its relationship to fetal and new-born outcomes.

Acid-Base Equilibrium↗
PubMed1993

Survey of forceps delivery in North America in 1990.

OBJECTIVE: To determine whether opinions and practice patterns have markedly changed over the past decade and whether clinicians are cognizant of the new ACOG definitions for forceps deliveries. METHODS: Two hundred ninety-five United States and Canadian residency programs were surveyed via a questionnaire; 203 (69%) responded. Statistical analysis was performed using the chi 2 test, Yates correction factor, and the extended Mantel-Haenszel test. RESULTS: All but two program directors (99%) were familiar with the new definitions, which were being used by 162 (80%) of the programs. All institutions used outlet and low forceps, although 14% no longer performed midforceps deliveries. Attending faculty were the primary instructors in 67% of United States and 100% of Canadian programs. Simpson forceps were the most commonly used for outlet (46%) and low (43%) forceps deliveries. Kielland (27%) and Simpson (24%) instruments were most commonly used for midforceps deliveries. CONCLUSION: Although the rate of midforceps use decreased, operative vaginal delivery was still commonly taught in residency programs in North America in 1990.

Canada↗
PubMed1992

Early repair of episiotomy dehiscence associated with infection.

OBJECTIVE: The purpose of our study was to examine early repair of episiotomy dehiscences in a large urban hospital setting serving a predominantly indigent population. STUDY DESIGN: Since September 1, 1989, we have proceeded with early repair in the immediate postpartum period. The medical records of 34 of 35 patients who underwent early repair were reviewed. RESULTS: Of the 34 patients, 21 (62%) had midline and 13 (38%) had mediolateral episiotomies. Dehiscence was associated with episiotomy infection in 27 (79%) of the 34 patients: 18 (86%) in the midline group and 9 (69%) in the mediolateral group. Repair was accomplished from 3 to 13 days (mean = 6.4) after dehiscence. Successful repairs were accomplished in 32 (94%) of 34 patients. Two (6%) patients with initial third-degree episiotomies had a subsequent breakdown of their repairs and were allowed to heal by secondary intention. CONCLUSIONS: Although most dehiscences in our population were associated with infection, early repair in this population is associated with a satisfactory outcome in the vast majority.

Adult↗
PubMed1992

Expectant management of preterm ruptured membranes: effects of antimicrobial therapy.

OBJECTIVE: To determine whether the addition of broad-spectrum antimicrobial therapy to traditional expectant management improves pregnancy outcome in patients with premature rupture of membranes (PROM) remote from term. METHODS: Patients with preterm PROM before 34 weeks' gestation who were not in labor and had no signs of infection or fetal distress were randomized to one of two study groups: 1) expectant management alone and 2) expectant management plus antimicrobial therapy. Women in the latter group received intravenous ampicillin, gentamicin, and clindamycin for 24 hours, followed by amoxicillin plus clavulanic acid orally for 7 days. Other than antibiotic use, management of the two groups was identical. RESULTS: Significantly more women (P < .01) treated with antibiotics (20 of 48, 42%) remained undelivered 7 days after admission compared with those managed expectantly without antibiotics (seven of 46, 15%). In addition, more neonates in the group managed with antibiotics were admitted to the routine nursery (nine of 48 versus two of 45; P = .03). However, there was no difference between the groups in the frequency of serious maternal or neonatal morbidity. CONCLUSIONS: The addition of broad-spectrum antimicrobial therapy to traditional expectant management of pregnancy complicated by preterm PROM may increase the number of gestations undelivered 7 days after admission. It may also decrease the proportion of infants admitted to special care nurseries. Whether these effects result in significant short- or long-term maternal or neonatal benefit remains to be determined.

Anti-Bacterial Agents↗
PubMed1992

Esophageal achalasia in late pregnancy.

Esophageal achalasia is a rare disorder that may mimic nausea and vomiting of pregnancy. Presentation or persistence of these symptoms in the latter half of pregnancy is unusual. We describe a case of third-trimester weight loss due to the nausea and vomiting of achalasia. Pneumatic dilation of the esophagus is often necessary to improve oral intake. However, advances in nutritional supplementation may prevent malnutrition and allow treatment and its complications to be delayed until after delivery.

Adult↗
PubMed1991

Balanced translocation 12/13 and situs abnormalities: homology of early pattern formation in man and lower organisms?

Studies in "lower" organisms have identified a set of homologous sequences expressed in oocytes and early embryos that is critical for pattern formation. Mutations in such genes may exhibit maternal effect--they cause abnormalities in the fetus only when present in the mother. We report on a mother and child with identical, apparently balanced translocations having the breakpoints 12q13.1 and 13p13. The fetus had multiple anomalies including bilateral trilobar lungs, complex heart defect, malrotation of the gut, and asplenia, while the mother was entirely normal. Several hypotheses are advanced to explain this variable expression including transection of a gene with maternal effect--lateral asymmetry in the fetus is influenced by the maternal genotype. This explanation would account for the higher transmission of congenital heart disease to offspring by affected females noted in several studies. The human counterparts of 2 loci (int-1 and HOX 3) involved in Drosophila early pattern formation are located near the translocation breakpoint 12q13.1. If one of these genes is responsible for situs abnormality, then university of positional code (but not of embryologic mechanism) is suggested for higher metazoans.

Abnormalities, Multiple↗