Biomedical subjects

L D Devoe

Publications and source records attributed to L D Devoe.

123 records · Page 7Linked to original sources

PubMed1984

Clinical features of the reactive positive contraction stress test.

During a five-year period, 2815 patients undergoing 5685 fetal heart rate (FHR) tests produced 147 positive contraction stress tests. Baseline FHR patterns were considered reactive if three or more accelerations occurred during 30 minutes of the contraction stress test and nonreactive if fewer or no accelerations were noted. There were 75 reactive positive contraction stress tests and 72 nonreactive positive contraction stress tests. Both groups were promptly delivered, generally (91%) within 24 hours of the last test. Fetuses producing reactive positive patterns tended to be more mature, larger, and most frequently tested for postmaturity. Fetuses with nonreactive positive patterns had significantly higher rates of perinatal mortality and morbidity, growth retardation, and cesarean deliveries; they were frequently carried by hypertensive mothers. Each group was analyzed according to deceleration: contraction ratio, and deceleration: contraction ratio deciles from 30 to 100% were examined. Perinatal complications increased progressively with higher deceleration: contraction ratios, irrespective of baseline reactivity; however, nonreactive fetuses in any deceleration: contraction ratio decile had more frequent perinatal compromise than their reactive counterparts. The lack of specificity (26 poor outcomes in 75 cases) associated with the reactive positive contraction stress tests encourages more frequent attempts at vaginal delivery; in this group, 64 of 71 patients had successful vaginal deliveries. Furthermore, the high incidence of good fetal outcome in the reactive positive group suggests that the urgency of delivery in such circumstances be reassessed and that other fetal-maternal indicators be considered in delivery decisions.

Apgar Score↗

PubMed1984

Serum complement levels and perinatal outcome in pregnancies complicated by systemic lupus erythematosus.

Previous reports suggest an association between maternal serum complement component (C3 and C4) levels and perinatal outcome. Eighteen women with systemic lupus erythematosus (21 pregnancies) were prospectively studied. C3 and C4 levels were measured monthly unless more frequent data were needed for acute medical management. Perinatal outcome was then correlated with both maternal clinical and serologic status before and during pregnancy. Twelve pregnancies were carried to term, 11 of which began in clinical remission. Eight of these 12 had normal C3 and C4 levels at the onset of pregnancy, and 11 were normal at delivery. Four pregnancies were delivered prematurely (with one neonatal death from septic meningitis); all began pregnancy in clinical remission but three had low C3 and C4 levels before delivery. Three pregnancies beginning in clinical remission ended in spontaneous first- or early second-trimester abortions; all had low C3 and C4 levels before aborting. Normal complement component levels were observed in the remaining two pregnancies that were terminated electively; they had no evidence of fetal or placental abnormality. The correlation of maternal serum complement levels and pregnancy outcome in this series suggests that these parameters may help in the assessment of fetal as well as maternal prognosis in lupus-complicated gestations.

Abortion, Spontaneous↗

PubMed1983

Renal histology and pregnancy performance in systemic lupus erythematosus.

Previous reports indicate that maternal and fetal outcome in pregnancies complicated by systemic lupus erythematosus (SLE) may be strongly influenced by the presence of renal disease. As the relationship between renal histology and clinical function in SLE is not consistent, prospective data on the outcomes of such pregnancies would aid patient counselling. Fifteen women with SLE had 18 pregnancies subsequent to renal biopsies, performed from 3 months to 8 years prior to conception. Their renal function was evaluated before, during and after pregnancy. Fourteen of 15 patients had evidence of renal involvement, based on by light and electron microscopic sections: 7 had mesangial involvement (WHO Class II); 5 had active focal or diffuse glomerulonephritis (Classes III and IV); two had membranous involvement (Class V); 1, no evident disease. Perinatal outcome was similar whether lesions were milder (8 continuing pregnancies, 4 term deliveries) or more severe (6 continuing pregnancies, 3 term deliveries). Clinical renal function was normal in all but 3 cases at the beginning of pregnancy; 2 additional patients experienced moderate deteriorations in renal function during pregnancy but recovered normal function in the puerperium. Fetal outcome was abnormal (3 premature deliveries, 1 neonatal death, 1 spontaneous abortion) in all cases where renal function was decreased, while 10 of 13 pregnancies in patients with normal renal function ended in term deliveries. The data suggest that currently preconceptual renal histology provides a less accurate basis for perinatal counselling than does the assessment of clinical renal function.

Female↗

PubMed1983

Pregnancy complicated by extrahepatic biliary tract carcinoma. A case report.

Carcinoma of the extrahepatic biliary tract rarely coexists with pregnancy. Survival of both mother and infant beyond the early puerperium has not been reported previously in such instances. We treated a patient for pregnancy complicated by cholangiocarcinoma, with a successful maternal and fetal outcome.

Adenoma, Bile Duct↗

PubMed1983

Postdates pregnancy. Assessment of fetal risk and obstetric management.

Two hundred forty-eight well-dated pregnancies that exceeded their expected dates of confinement were followed with serial maternal urinary or plasma estriol determinations and weekly fetal heart rate tests. Most pregnancies (176) delivered after spontaneous labor, while 72 had labor induced for abnormal test results or electively. Perinatal mortality (8.1/1,000) was comparable to that of our term (37-40-week) population; the two deaths occurred in the 43rd week. Intrapartum fetal distress, meconium staining, postmaturity syndrome and primary cesarean section rates all increased with gestational age beyond the 40th week. Induced labors, irrespective of indication, were significantly longer than spontaneous ones and were associated with higher rates of fetal distress and primary cesarean section. In the study group, fetal distress often arose during labor and was not anticipated by the antenatal testing.

Female↗

PubMed1982

Antepartum fetal heart rate testing in preterm pregnancy.

The nonstress test (NST) and the contraction stress test (CST) have had wide application to term pregnancies, but little has been reported of use in the management of preterm fetuses. Seventy-two of 438 high-risk gravidas, receiving both tests between 25 and 34 weeks' gestation, delivered singleton infants before completion of their 34th week. On the basis of the last NST and CST preceding delivery, the 72 fetuses could be divided into reactive-negative and nonreactive-positive groups. Nonreactive-positive fetuses experienced greater perinatal mortality and significantly higher rates of intrapartum fetal distress, neonatal depression, respiratory distress syndrome (RDS), intrauterine growth retardation, and cesarean section. Pulmonary complications in nonreactive-positive fetuses, regardless of the lecithin: sphingomyelin ratio, were significantly increased if intrapartum fetal distress had preceded delivery. Most neonatal deaths stemmed from RDS-related complications, 86% preceding the 31st week of gestation; however, nearly half of the perinatal deaths before the 30th week followed reactive NSTs. The data suggest that for clinical management of preterm pregnancy, fetal heart rate testing should be initiated after the 29th week; earlier, test significance is less clear and infant survival less likely. Maternal estriol determinations aid little in the management of nonreactive-positive fetuses. Rather, the care of these selected pregnancies should be temporized through the 30th week; when delivery is then elected, intrapartum fetal distress should be avoided through liberal use of cesarean section in the nonreactive-positive group.

Estriol↗

PubMed1981

Oxytocin challenge test and intrauterine growth retardation.

On the basis of analyses of the nonstressed fetal heart rate test (NST) and the oxytocin challenge test (OCT) in 85 fetuses with intrauterine growth retardation (IUGR), the predictive power of NST/OCT on fetal outcome and the mechanism of a positive OCT in IUGR were investigated. These fetuses with IUGR exhibited high incidences of nonreactive NSTs (35.3%) and positive OCTs (40%) attributable to a combination of compromised placental function and diminished fetal reserve. Adverse fetal prognosis is most accurately predicted by the joint occurrence of a nonreactive NST and a positive OCT (92%). In such cases, when IUGR is strongly suspected, liberal use of cesarean section is recommended to assure good fetal outcome.

Cesarean Section↗

PubMed1981

The application of multiple-parameter scoring to antepartum fetal heart rate testing.

Three hundred twenty-nine high-risk obstetric patients, undergoing 1,198 nonstressed tests (NSTs) and 101 subsequent contraction-stress tests (CSTs), were delivered during a 13-month study period. Each test was concurrently evaluated by conventional assessment criteria and by a 12-point multiple-parameter scoring system. The last test performed within one week of delivery was correlated with perinatal outcome, and the predictive accuracy of scoring was compared with conventional grading. Three NST groups were identified: group I (score: 9 to 12) had little perinatal compromise and overlapped extensively with the normally reactive group; group III (score: 0 to 4) were nearly all compromised, nonreactive by standard criteria and consistently followed by abnormal CSTs. Group II (score: 5 to 8) had an intermediate rate of compromise (33%) and was further categorized by subsequent CST outcome into normal, compromised or persistently equivocal subgroups. Scoring improved the sensitivity of CSTs, as well, when abnormal (positive or persistently equivocal). CSTs scoring below 5 were associated with a fetal compromise rate of 86%, approximately twice that of the group scoring in the 5-to-8 range. It was concluded that multiple-parameter scoring was of little benefit in improving test accuracy when the NST was normally reactive; however, scoring clearly delineated the most compromised fetal group from those requiring further evaluation when the NST was nonreactive. By combined NST-CST scoring alone, 90% of fetuses could be assigned to high- or low-risk prognostic groups with confidence; the remainder would require additional fetal data to complete their assessment.

Female↗

PubMed1981

Simultaneous nonstress fetal heart rate testing in twin pregnancy.

Twenty-four sets of twins in the third trimester of pregnancy underwent 120 simultaneously recorded nonstress tests (NSTs). Synchronous patterns of fetal heart rate alterations occurred in 58% of the cases and were associated with single placentas and small weight differences between twins. Reactive NSTs were frequent (77%) and, when they occurred within 1 week of delivery, conferred a good prognosis, ie, no perinatal deaths and low morbidity. Nonreactive NSTs were associated with both fetal deaths and a perinatal morbidity of 28%. simultaneous NSTs for twins are technically feasible in the third trimester. They confer a reliable prognosis when reactive; nonreactive tests are less specific and require further investigation.

Adult↗

PubMed1980

C-reactive protein as a predictor of infectious morbidity with premature rupture of membranes.

The management of patients with premature rupture of membranes (PROM) poses one of the most serious dilemmas in obstetrics since PROM significantly increases the likelihood of prematurity and serious perinatal infection. Early infection is not reliably predicted nor detected by standard laboratory parameters. Serum C-reactive protein (CRP) levels were assayed along with white blood cell count, differential, and temperature course in patients with PROM and controls. Elevated CRP very accurately divided patients with evidence of infectious morbidity from those without such evidence (p < 0.001). In 109 patients there were 11 false negatives and no false positives. In 14 of 20 patients followed with serial comparisons who developed morbidity, CRP became elevated at least 12 hours prior to any other parameter measured. Changes in the other six patients were concurrent. The results suggest that CRP may be a reliable, early predictor of infectious morbidity and thus may be of benefit in the selective management of patients with PROM.

Adolescent↗

PubMed1980

Clinical implications of prospective antepartum fetal heart rate testing.

Nonstressed fetal heart rate testing was evaluated in the prospective management of 441 high-risk pregnancies in which delivery was effected between July 1, 1977 and May 1, 1979. In Group I, 297 patients underwent 668 nonstress tests (NSTs); all had subsequent contraction stress tests (CSTs) which formed the basis of their management. In Group II, 144 women had 293 NSTs; CSTs (99) were performed only when preceding NSTs were nonreactive; antenatal management evolved from the outcome of either nonstress testing or contraction stress testing when applicable. Perinatal outcome was correlated only with tests performed within 1 week of delivery. Both groups had equal frequencies of reactive NSTs; good fetal outcome was usually predicted by normal NST reactivity. Omission of CSTs when preceding NSTs were reactive did not alter perinatal outcome. NST nonreactivity is less specific, although generally associated with a higher incidence of perinatal morbidity and intrauterine growth retardation (IUGR). CSTs more effectively separate the nonreactive fetuses with low risk of compormise (CST = negative) from those most compromised (CST = equivocal or positive).

Female↗

PubMed1979

Systemic lupus erythematosus in pregnancy.

Most literature on pregnancies in patients with systemic lupus erythematosus (SLE) is retrospective and selective. This report is a detailed, prospective analysis of 13 pregnancies in eight women with SLE. Pregnancy was best tolerated by mothers without significant nephropathy or cardiopathy who had been in clinical remission for more than three months prior to conception. Management was aided by serial evaluation of complement (C3 and C4) levels and careful supervision of immunosuppressive therapy when indicated. Although fetal status was closely monitored, premature deliveries and spontaneous abortions occurred frequently. No malformations or adverse sequelae were noted in surviving infants exposed to immunosuppressive agents during gestation.

Abortion, Induced↗

PubMedDate not supplied

Fetal acoustic stimulation in early labor and pathological fetal acidemia: a preliminary report.

OBJECTIVE: To determine if a nonreactive response to fetal acoustic stimulation in early labor can predict a significantly higher risk of umbilical arterial pH <7.10 or <7.00. METHODS: Fetal acoustic stimulation was applied to the fetuses of term parturients (gestational age > or =37 weeks) with cervical dilation of < or =5 cm. The responses to stimulation were correlated with cesarean delivery for fetal distress and umbilical arterial pH. Student's t-test, Chi-square, and Fisher exact test were used; P < 0.05 was considered significant. Relative risks (RR) and 95% confidence intervals (CI) were calculated. RESULTS: The study population contained 271 subjects, of which 90% (244) had a reactive response following acoustic stimulation and 10% (27) a nonreactive response. The maternal demographics, time interval from stimulation to delivery (8.3 +/- 8.7 vs. 8.3 +/- 8.4 h; P = 1.00) were similar in the two groups. Compared to those with a reactive response, patients with a nonreactive response had a significantly greater risk for: 1) cesarean delivery for fetal distress (2.0% vs. 11.1%; P = 0.03, RR 4.1, 95% Cl 1.5, 60.5), 2) umbilical arterial pH <7.10 (2.0% vs. 14.8%; P = 0.007, RR 5.0, 95% CI 2.2, 11.6), and 3) umbilical arterial pH <7.00 (0.8% vs. 7%; P = 0.05, RR 5.0, 95% CI 1.8, 15.2). CONCLUSION: A nonreactive response to fetal acoustic stimulation in early labor is associated with a significantly increased risk for cesarean delivery for fetal distress and neonatal acidosis. This finding extends the potential value of acoustic stimulation as an intrapartum admission screening test.

Acidosis↗

PubMedDate not supplied

Severe preeclampsia in preterm pregnancy between 26 and 32 weeks' gestation.

Obstetric management of severe preeclampsia between 26 and 32 weeks' gestation presents a significant management dilemma. We examined the antenatal courses and perinatal outcomes of 67 such affected pregnancies and compared them with a group of 134 patients, matched for gestational age, who delivered after preterm rupture of membranes or preterm labor. Although the severe preeclamptic group had more patients with chronic hypertension and renal disease, 67% had no prior medical problems. The obstetric and other medical characteristics of both groups were similar. Neonatal outcomes in the severe preeclampsia group differed from those in the control group: they had lower mean birthweight, 5-minute Apgar score and umbilical arterial pH were lower, and their rates of respiratory distress syndrome and perinatal death were higher. Temporization for more than 72 hours was not possible in 60 of 67 preeclamptic pregnancies due to rapid deterioration of the mother (56 cases) or fetus (4 cases). The rate of poor neonatal outcomes in severe preeclampsia exceeded that expected with preterm delivery alone and may reflect preexisting fetal compromise, served better by early intervention and delivery.

Adult↗

PubMedDate not supplied

Predicting the duration of the first stage of spontaneous labor using a neural network.

To create a neural network that predicts the length of the first stage of term labor. Two hundred patients with gestations > or = 36 weeks, in spontaneous active labor are the study group: 159 for training and 41 for testing; 4 training set patients had second-stage cesarean section for obstructed labor. The network is designed with Brainmaker MacIntosh 1.0 (California Scientific Software). Inputs are uterine activity, estimated fetal weight, position, station, and gestational age; maternal parity, age, height, weight, membrane status, and cervical dilatation. Actual first stages are regressed on those predicted by the network or by a standard partogram set. Differences between actual first stage lengths and those predicted by the neural network or partogram are compared with t-tests; while the proportions of first stages accurately predicted within 1 or 2 h are compared for both methods with chi-square tests. The network trained in 4 h (1388 runs) to a 0.15 tolerance. The network predictions have significantly higher correlation (r = 0.88) than do standard partograms (r = 0.35) with actual first stage durations. Mean differences between predicted and actual first stages are significantly lower for network output than with partograms; these differences increased with first stages exceeding 3 h; 100% of trained network values are within 2 h of actual first stage length. The network performs similarly for a new set of 41 previously unseen labors. This neural network predicts the length of the first stage of spontaneous labor and uses inputs readily available to obstetricians. It outperforms typical partograms for estimating this important feature of normal labor. Future application for intrapartum prognosis could be based on this successful design.

Artificial Intelligence↗