Search PubMed⌕ Search

Biomedical subjects

L C Gilstrap

Publications and source records attributed to L C Gilstrap.

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

Intrapartum treatment of acute chorioamnionitis: impact on neonatal sepsis.

In a study of 312 women with acute chorioamnionitis, 152 women received antibiotics before delivery, 90 received antibiotics after cord clamping, and 70 did not receive antibiotics. Antibiotics were administered during labor rather than after cord clamping if delivery was not imminent. Although endometritis developed more frequently in the patients receiving antibiotics after cord clamping, the difference was not statistically significant (5.6% versus 3.9%, difference not significant). There were two cases of verified sepsis in the group of infants (35 weeks) born to mothers receiving intrapartum antibiotics and there were eight cases in the no antibiotics group (p = 0.06). More importantly, in neonates greater than or equal to 35 weeks' gestational age, there was a significant difference in the frequency of positive blood cultures for group B streptococci (0/133 versus 8/140, p less than 0.05). We conclude that administration of antibiotics to the mother during labor may result in a decreased incidence of neonatal sepsis.

Acute Disease↗
PubMed1988

Cocaine use in pregnant women in a large public hospital.

Cocaine has been reported to be associated with several pregnancy complications such as abruptio placentae, an increase in the incidence of low birthweight infants, and congenital malformations in the newborn. With the increasing frequency of cocaine abuse of women of childbearing age in the United States, clinicians can reasonably be expected to encounter increasing numbers of pregnant women who use cocaine. The exact prevalence of cocaine use during pregnancy is not known. In the present series of 102 pregnant women, the prevalence of cocaine use was 9.8%, with a 95% confidence interval of 3.9 to 15.7%. There was one mother who had an abruptio placentae and there was one infant who had a congenital malformation among the ten women with a history of cocaine use during pregnancy. The mean birthweight was 3180 +/- 380 gm for infants born to mothers who used cocaine compared with 3250 +/- 422 gm (p = NS) for the infants born to mothers who did not use cocaine. A significant number of pregnant women in our population use cocaine during pregnancy.

Adult↗
PubMed1988

Prevention and treatment of preterm labor in twins.

It is well established that mothers with twin gestations are at a significant risk of giving birth to a premature infant and, compared to singletons, the perinatal mortality and morbidity are significantly increased. Unfortunately, it is clear that little progress has been made over the past two decades in either the prevention or the treatment of premature labor in twins. The clinician is left with more questions than answers. This latter aspect needs to be recognized by the legal profession. Obviously, more studies regarding the possible beneficial effect of either bedrest or prophylactic beta-sympathomimetics are needed before meaningful recommendations can be made on a universal basis. It is also obvious that more potent tocolytic agents are needed to actually treat premature labor once it occurs. Taking all of these facts into consideration, the authors would recommend the protocol outlined in Table 3 for the general management of twins with regard to premature labor.

Adrenergic Agonists↗
PubMed1988

Prophylactic antibiotics for cesarean section and surgical procedures.

Although prophylactic antibiotics are used frequently on women undergoing pelvic surgery, including cesarean section, they should be reserved for patients who have a significant risk of infection. Among such patients are those who have undergone vaginal hysterectomy or cesarean section after having been in labor with ruptured membranes. Prophylaxis should be limited to one to three doses of antibiotic, with the newer broad-spectrum antibiotics and combination antimicrobial agents reserved for more serious, established infections.

Anti-Bacterial Agents↗
PubMed1988

Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis.

Levels of five antibiotics used in treating chorioamnionitis were measured in maternal and cord blood and placenta. Ampicillin provided the highest ratio of cord to maternal blood (0.71). Gentamicin was also relatively high in this respect and also had the highest placenta to maternal blood ratio (3.97). Based on these findings, the commonly used combination of ampicillin and gentamicin seems appropriate, although additional anaerobic coverage may be needed.

Acute Disease↗
PubMed1988

Methamphetamine abuse during pregnancy: outcome and fetal effects.

Methamphetamines are a popular class of recreational drugs sometimes abused by women of childbearing age. The effects of methamphetamine abuse on pregnancy outcome and embryofetal development are not known. In this study, we compared pregnancy and fetal outcome in 52 women who abused methamphetamines with a randomly selected control group of 52 non-drug-abusing women. Body weight, length, and head circumference were significantly decreased in neonates born to mothers who abused methamphetamines during pregnancy. However, the frequency of congenital anomalies was not significantly increased in this group.

Abnormalities, Drug-Induced↗
PubMed1987

The effect of oxytocin infusion on the pharmacokinetics of intramuscular magnesium sulfate therapy.

The effect of oxytocin infusion on the pharmacokinetics of standard intramuscular magnesium sulfate therapy was determined in 18 women with preeclampsia; the results were compared with those in seven women with preeclampsia who did not receive oxytocin. Oxytocin had no significant effects on the maternal serum magnesium and calcium ion concentrations, nor did oxytocin appear to affect the magnesium or calcium concentrations in fetal umbilical cord blood. Urinary excretion of magnesium rose 21-fold and calcium excretion rose threefold in patients receiving intramuscular magnesium sulfate in both the oxytocin and the nonoxytocin groups. Sixty-five percent of the administered magnesium was excreted during the treatment period, again with no significant differences between the oxytocin and the nonoxytocin groups. These results indicate that oxytocin does not affect the pharmacokinetics of intramuscular magnesium sulfate and no dosage adjustment of magnesium sulfate is required when oxytocin is used to induce or augment labor or when it is given during the postpartum period.

Calcium↗
PubMed1987

Second-stage fetal heart rate abnormalities and type of neonatal acidemia.

The type of acidemia (umbilical arterial pH less than 7.2) occurring in newborns with second-stage baseline fetal heart rate (FHR) abnormalities was evaluated in 277 term gestations. Umbilical arterial acidemia occurred in 40% of the neonates with moderate to severe bradycardia (25 of 63), in 30% with mild bradycardia (16 of 53), and in 22% with tachycardia (seven of 32), compared with only 6% (eight of 129) of those with a normal FHR (P less than .05 in each of the three comparisons). The majority (31 of 56, 55%) of the acidemic neonates had a mixed respiratory-metabolic pattern, whereas 13 of 56 (23%) had a respiratory pattern and 12 of 56 (21%) had a metabolic pattern. The mean umbilical arterial buffer deficit (mEq/L) was significantly greater (P less than .0005) in newborns with metabolic acidemia (-15.9 +/- 2.8) than in those with either mixed (-9.6 +/- 2.5) or respiratory (-6.4 +/- 1.9) acidemia. We conclude that baseline second-stage FHR abnormalities can predict which newborns are at increased risk of having umbilical arterial pH below 7.2 at birth. Selective determination of umbilical arterial pH and blood gas analysis may be useful in assessing intrapartum management retrospectively.

Acidosis↗
PubMed1987

Pulmonary edema as a delayed complication of ritodrine therapy. A case report.

Pulmonary edema occurred 24 hours after intravenous ritodrine therapy and 10 hours after subcutaneous terbutaline therapy. Standard therapy directed at volume overload quickly cleared the pulmonary congestion, and the pregnancy progressed uneventfully to term. A retrospective review incriminated transfusion therapy and volume overload as the etiology.

Adolescent↗
PubMed1987

Nuchal cords and neonatal outcome.

To assess the significance of nuchal cords, 110 affected woman-infant pairs at term gestation were compared with 110 control pairs. Newborns with a nuchal cord had an increased prevalence of umbilical artery acidemia (22 of 110 versus 13 of 110; P less than .05) and more variable fetal heart rate (FHR) decelerations in the first stage of labor (mild = 41 versus 20; P less than .0001; moderate-severe = 21 versus 5; P less than .0001) and the second stage of labor (moderate-severe = 46 versus 21; P less than .0001). In newborns with a nuchal cord, the umbilical artery acidemia was usually mixed (68%) or respiratory (23%) in origin, and pure metabolic acidemia was infrequent (9%). We conclude that nuchal cords are associated with an increased prevalence of variable FHR decelerations in the first and second stages of labor and with an increased incidence of umbilical artery acidemia.

Acidosis, Respiratory↗
PubMed1987

Effect of type of anesthesia on blood loss at cesarean section.

Halogenated anesthetic agents have been used to supplement nitrous oxide during balanced general anesthesia for cesarean delivery to decrease maternal awareness. However, these agents can interfere with uterine contractility and hence have the potential to increase blood loss at the time of cesarean section. To ascertain the effect of the addition of halogenated anesthetic agents for cesarean section anesthesia versus conduction or a simple balanced general anesthetic, we retrospectively assessed three aspects that may reflect operative blood loss at the time of cesarean section. Significantly more women whose balanced general anesthesia for cesarean section was supplemented with a halogenated agent (usually 0.5% halothane) versus those with a conduction or balanced general anesthetic required transfusion therapy, had a postpartum hematocrit less than 30 vol% and had a decrease in the pre- to postdelivery hematocrit of at least 8 vol %. The addition of halogenated anesthetic agents to a balanced nitrous oxide anesthesia for the purpose of decreased maternal awareness must be weighed against the risk incurred from the increased requirement for blood replacement and/or from postpartum anemia.

Anesthesia, Conduction↗
PubMed1987

Twins: prophylactic hospitalization and ward rest at early gestational age.

One hundred eighty-nine twin pregnancies were delivered at Wilford Hall United States Air Force Medical Center from July 1977 through December 1985. Among these, 57 were referred from distant bases and were excluded from further analysis. The remaining 132 pregnancies from our local population make up the study group. Sixty-seven women (51%) followed our advice to be hospitalized at or before 28 weeks' gestation for prophylactic ward rest. The remaining 65 women (49%) were not hospitalized until after 28 weeks' gestational age or until a pregnancy complication or labor occurred. Only three of 134 infants (2%) whose mothers were admitted died, versus 11 of 130 infants (8.5%) whose mothers were not admitted (P less than .03). The results suggest that prophylactic ward rest, implemented at or before 28 weeks' gestational age, may reduce perinatal mortality in this condition.

Bed Rest↗
PubMed1986

Intravenous penicillin desensitization and treatment during pregnancy.

Untreated syphilis during pregnancy may result in stillbirth in one fourth of cases, while in infants who survive, there may be serious immediate and delayed manifestations. Penicillin is the drug of choice for treating both mother and fetus. We describe a woman with an allergy against both major and minor determinants of penicillin in whom syphilis was diagnosed on routine obstetric screening. Her obstetric history included one vaginal delivery at term and four subsequent spontaneous abortions at 12 to 16 weeks. The patient underwent desensitization utilizing graduated intravenous doses of penicillin followed by treatment with a constant infusion for eight days. She experienced no serious allergic reactions requiring alteration of therapy. We conclude that antibiotic desensitization may be a safe alternative during pregnancy if performed with careful monitoring. In this case, it allowed use of penicillin rather than less desirable alternatives.

Adult↗
PubMed1986

Magnetic resonance imaging and ultrasonography in the antenatal evaluation of conjoined twins.

Magnetic resonance imaging and sonography were used as diagnostic aids in the antepartum evaluation of two sets of conjoined twins. Magnetic resonance imaging was performed at 20 weeks' estimated gestational age on thoracopagus/omphalopagus twins and on omphalopagus twins at 20 and 30 weeks. Magnetic resonance imaging is a complementary adjunct to ultrasonography and provides additional anatomically precise clinical data. The advantages of this noninvasive technique include a large diagnostic window allowing total fetal imaging with excellent resolution of tissue composition. Unlike computerized tomographic imaging, there is no associated radiation exposure. The principal disadvantages of magnetic resonance imaging at this time are the cost of the equipment and the lack of real-time imaging capability.

Adult↗
PubMed1986

Genital aerobic bacterial flora of women receiving radiotherapy for gynecologic malignancy.

In the present study, genital aerobic bacterial flora was prospectively studied in 12 women receiving radiotherapy for gynecologic malignancy. Gram-positive cocci accounted for 59% and gram-negative bacilli for 27% of the 26 cervical or vaginal isolates preradiation. A similar pattern of recovery was found during external beam, 60CO whole pelvis radiotherapy. The gram-positive cocci and gram-negative bacilli accounted for 42 and 46% of the preradiotherapy rectal isolates, respectively. There was no significant change in the pattern of rectal flora during external beam radiotherapy. Thus, results from this preliminary study would indicate that external beam radiotherapy has little or no influence on the major aerobic pathogens in either the cervix, vagina, or rectum.

Adenocarcinoma↗
PubMed1986

Serial biparietal diameter and femur length measurements in twin gestations.

Biparietal diameter and femur length measurements from 60 twin pairs were used to construct fetal twin growth tables. From 18 through 38 weeks of gestation the biparietal diameter measurements were accurate within +/- 1.9 weeks, and the femur length within +/- 2.1 weeks in the prediction of gestational age. Since this data was obtained from a predominantly white middle class population it may prove more reliable in similar groups for predicting the adequacy of fetal growth and gestational age than prior data obtained using indigent populations.

Adult↗