Search PubMed⌕ Search

Biomedical subjects

L H Nelson

Publications and source records attributed to L H Nelson.

At least 37 records · Page 2Linked to original sources
PubMed1987

C-reactive protein: a limited test for managing patients with preterm labor or preterm rupture of membranes?

C-reactive protein has been used to identify patients at high risk for infectious morbidity with preterm labor or preterm rupture of membranes. In this article we report on 104 patients with preterm labor symptoms (n = 45) or preterm rupture of the membranes (n = 59) and serial evaluations of C-reactive protein measured by latex agglutination and laser nephelometry. The simple, inexpensive latex method appears comparable to the laser method in predicting infectious morbidity and can be used clinically. Elevated C-reactive protein values before delivery predict infectious morbidity in only 8% to 29% of patients, and up to 18% of patients with serious infections may be misdiagnosed as having normal C-reactive protein values before delivery.

C-Reactive Protein↗
PubMed1987

Outcomes in patients with unusually high maternal serum alpha-fetoprotein levels.

In a study group of 166 patients with unusually high maternal serum alpha-fetoprotein values greater than or equal to 5 multiples of the median, 110 (66%) patients had a condition affecting obstetric care compared with 14% in the 2.5 to 2.9 range, 26% in the 3.0 to 3.9 range, and 30% in the 4 to 4.9 range of multiples of median. Fetal anomalies composed a significantly greater proportion (p less than 0.0001) of positive findings in the study group than the group with maternal serum alpha-fetoprotein values of greater than or equal to 2.5 to 4.9 multiples of the median. Fetal death either before 20 weeks or of one twin occurred significantly more often in the study group (p less than 0.0001). Neural tube defects (21%) and fetal death before 20 weeks (19%) were the most common findings in the study group. There was not a statistically significant difference (p less than 0.53) in pregnancy complications or in late complications between the two groups although oligohydramnios and abdominal pregnancies occurred more often in the study group (p less than 0.029 and less than 0.011). Diagnosticians evaluating patients with unusually elevated maternal serum alpha-fetoprotein values must be aware of the usual differential diagnosis as well as rarer causes. One must recognize that finding an unaffected fetus does not preclude the subsequent development of a pregnancy complication.

Female↗
PubMed1987

Elevated maternal serum alpha-fetoprotein levels and oligohydramnios: poor prognosis for pregnancy outcome.

The outcome of 21 pregnancies with elevated maternal serum alpha-fetoprotein levels associated with oligohydramnios was studied. Seven of the 21 pregnancies ended in spontaneous abortion or intrauterine fetal death before week 24 of pregnancy. Five patients experienced premature labor between 24 and 26 weeks of gestation; each fetus was either stillborn or died in the immediate neonatal period. Four patients were delivered of infants after 32 weeks of gestation; each infant was either stillborn or died in the immediate neonatal period. Four patients electively had their pregnancies terminated. One patient was delivered at term of a healthy, growth retarded male infant who on follow-up at age 17 months was developmentally normal. Only three cases were associated with a fetal defect. Patients should be counseled that, even in the absence of a demonstrable cause for diminished amniotic fluid on ultrasonography, raised maternal serum alpha-fetoprotein levels coupled with oligohydramnios seem to carry a poor prognosis.

Amniotic Fluid↗
PubMed1987

Ultrasonography in patients with low maternal serum alpha-fetoprotein.

In previous reports on the use of maternal serum alpha-fetoprotein (MSAFP), emphasis was placed on the significance of elevated MSAFP values. The purpose of this paper is to stress the importance of low MSAFP values based on data from 28,285 pregnancies screened. The cutoff value used to define low MSAFP is less than 5 ngm/ml or 0.2 multiples of the median at 16 weeks. In the low group, which comprised 1.3% of the total screened, the findings at ultrasonography were incorrect gestational age, fetal demise, hydatid mole, nonpregnancy, and a grossly normal live fetus. The overall incidence of a positive finding (exclusive of a normal fetus) in the low MSAFP group was 83% compared to an incidence of 38% of the patients offered ultrasonography in the group with elevated MSAFP. The low MSAFP group is more likely to yield a finding that could affect obstetrical management than the high MSAFP group.

Amniotic Fluid↗
PubMed1987

Efficacy of combined administration of magnesium sulfate and ritodrine in the treatment of premature labor.

Seventy-four patients in preterm labor at 20-35 weeks' gestation were randomly assigned to receive ritodrine (N = 36) or ritodrine plus magnesium sulfate treatment (N = 38) for tocolysis. Ten did not complete therapy and were excluded from analysis. Nineteen of 32 patients (59%) in the ritodrine plus magnesium sulfate group were successfully treated, compared with only 11 of 32 patients (34%) in the ritodrine-only group (P less than .05). Of the 21 patients who failed to respond to the initial ritodrine treatment, 16 received intravenous magnesium sulfate supplemental therapy; 75% of this group were treated successfully. The frequency of adverse maternal and fetal side effects did not differ between the treatment groups. In the combined group compared with the ritodrine group, the dose requirements for ritodrine therapy as well as the total duration of treatment for both ritodrine and magnesium sulfate were reduced significantly. We conclude that concurrent administration of ritodrine and magnesium sulfate is more efficacious than ritodrine alone and does not appear to increase the frequency of adverse side effects.

Drug Therapy, Combination↗
PubMed1986

Effectiveness of the Isaacs cell sampler for endometrial cultures.

Because of encouraging results from a preliminary clinical investigation, a practical method of obtaining uncontaminated endometrial cultures using an endometrial sampling device developed for aspiration of cytologic specimens was investigated. Four groups of patients were studied: 8 nonpregnant women, 22 nonpregnant women having a total abdominal hysterectomy, 6 afebrile postpartum women and 8 women with postpartum clinical endometritis. The cervical flora obtained with a swab and the endometrial flora obtained with the sampling device and by direct culture at hysterectomy were compared. The data showed some degree of cervical contamination with the Isaacs method, suggesting that while the technique may be simple, design modifications of the device are needed for it to be dependable.

Cervix Uteri↗
PubMed1985

Gestational age alters fetal breathing response to intravenous insulin and intravenous glucose administration.

An upward change in human maternal plasma glucose concentration is known to increase the percent of time spent in fetal breathing during the late third trimester of human pregnancy. We examined the fetal breathing effects of upward change in plasma glucose (after intravenous glucose administration) and downward change (after intravenous insulin administration) at two different times of day (8 AM and 4 PM) at both 24 and 36 weeks of gestation. No change in the percent of time spent in fetal breathing was seen after insulin infusion. Fetal breathing increased after glucose infusion at 36 weeks of gestation but not at 24 weeks. Responses did not differ between tests performed at 8 AM and 4 PM.

Blood Glucose↗
PubMed1985

Management of Landry-Guillain-Barré syndrome in pregnancy.

The criteria for Landry-Guillain-Barré syndrome are reviewed and a case of a patient requiring respirator support during pregnancy is presented. Based on a current review of the literature, a total of 29 cases have been reported with an estimated fetal survival rate of 96% (26 of 27). The syndrome is not affected by pregnancy or pregnancy termination. Respirator support has the highest risk of maternal morbidity and mortality but should be minimized with modern pulmonary treatment. Additional management considerations are discussed.

Adult↗
PubMed1985

Premature rupture of membranes: a prospective, randomized evaluation of steroids, latent phase, and expectant management.

A prospective, randomized study was conducted comparing the use of betamethasone and early delivery, early delivery alone, and expectant management in patients in the 28th to 34th week of pregnancy with premature rupture of the membranes (PROM). Tocolytic drugs were used to delay delivery until 24 hours had elapsed after the first dose of steroid or 24 to 48 hours of latent period had elapsed in the second group. There were no significant differences in maternal age, gestation at PROM, maximum maternal temperature, birth weights, maternal hospital days, respiratory distress, maternal sepsis, or delivery routes in the three groups. Comparisons with one other similar prospective, randomized study support the concept that expectant management offers less risk from tocolytic side effects.

Bacterial Infections↗
PubMed1984

Addition of magnesium sulfate improves effectiveness of ritodrine in preventing premature delivery.

From October, 1981, to July, 1983, 225 patients were evaluated for premature labor at Forsyth Memorial Hospital. Sixty-five of these patients were considered to be candidates for intravenous ritodrine treatment. Of this group, 24 patients were successfully treated and had pregnancy prolongation ranging from 1 to 17 weeks. Forty-one patients did not respond to maximal intravenous ritodrine therapy (300 to 350 micrograms/min). Eleven patients subsequently delivered within 24 to 48 hours of treatment initiation. The remaining 30 patients received intravenous magnesium sulfate (1 to 3 gm/hr) in addition to intravenous ritodrine. Eighteen patients responded favorably to this combination treatment and had pregnancy prolongation ranging from 1 to 11 weeks. Twelve patients delivered within 1 week from treatment initiation. In all cases where pregnancy prolongation was achieved, birth weight and neonatal outcome were significantly improved compared to patients who did not respond to either intravenous ritodrine alone or intravenous ritodrine and magnesium sulfate combination. Treatment related maternal/fetal complications were not significantly different in the various groups examined. From the foregoing we conclude that, in a select group of patients in premature labor not responding to conventional ritodrine therapy, magnesium supplementation in pharmacologic doses could have a beneficial effect with respect to pregnancy outcome.

Apgar Score↗
PubMed1984

The wavering midline: a diagnostic sign of fetal hydrocephalus.

The significance of midline wavering in the central nervous system as a diagnostic sign in hydrocephalus was evaluated prospectively in 27 hydrocephalic fetuses. No normal fetuses in a control group exhibited a wavering midline at three different times in pregnancy. Wavering along the entire length of the midline was seen in all 27 affected infants with hydrocephalus diagnosed from 12 to 42 weeks' gestation, prior to determination of an abnormal lateral ventricular width:hemispheric width ratio in one of 23 cases for which data were available and prior to an increased biparietal diameter in 25 (48%). One fetus, not included in the series, showed wavering of the midline echo and had an abnormal lateral ventricular width:hemispheric width ratio. The neonate was later shown to have trisomy 21 (47,XY,+21) and is suspected to have had a transient ventriculomegaly. Wavering along the complete length of the midline echo appears to be a constant finding in hydrocephalus in the fetus.

Adult↗
PubMed1984

Perforation of the intrapericardial aorta during subclavian catheterization.

We have reported a case of fatal perforation of the intrapericardial aorta during attempted subclavian venipuncture through the infraclavicular route in a patient with a ruptured ectopic pregnancy. The case illustrates the importance of having the procedure done only by personnel experienced in the technique, even in emergency situations.

Adult↗
PubMed1983

Gonococcal ventriculitis associated with ventriculoamniotic shunt placement.

Use of a ventriculoamniotic shunt to control fetal hydrocephalus is a new procedure. Early experience suggests possible benefit to the fetus. Complications have been rare. This report describes the first case of Neisseria gonorrhoeae central nervous system infection associated with a ventriculoamniotic shunt and the third case reported in a neonate. On the basis of this clinical experience, we recommend that the mother be monitored closely for cervical pathogens, that delivery be performed prior to amniorrhexis, and that culturing of the shunt and ventricular fluid be carried out at delivery.

Adult↗
PubMed1983

Maternal serum alpha-fetoprotein screening in North Carolina: experience with more than twelve thousand pregnancies.

A total of 12,084 patients participated in a maternal serum alpha-fetoprotein (AFP) screening program in central North Carolina between July 1, 1978, and June 30, 1982. Fifteen open neural tube defects were detected and three others were missed, resulting in a detection rate of 83%. With a cutoff of 2.5 times the normal median, 3.7% of patients screened had a single maternal serum AFP elevation, 2.1% had two successive elevations, and 1.2% became candidates for amniocentesis. Of those patients offered amniocentesis, one in 10 was found to have a fetus with a neural tube defect. No normal fetuses have been aborted. Patients with maternal serum AFP elevations were shown to have a substantially increased risk of fetal loss. Low maternal serum AFP levels were also a significant finding and led to recognition of less advanced gestational age, fetal death, or molar pregnancy in a number of cases.

Amniocentesis↗
PubMed1982

Real-time diagnostic ultrasound in obstetrics.

Real-time B-scanning is a relatively inexpensive and effective diagnostic technique, applicable with some limitations to obstetrics. It produces images at high rates so that the display appears to change continuously with changes in transducer orientation or with motion of the structures imaged. It can be used in the office setting and rapidly provides information to the properly trained examiner. The ability to detect motion provides an important added dimension to ultrasound.

Amniocentesis↗
PubMed1982

Value of serial sonography in the in utero detection of duodenal atresia.

Duodenal atresia can be fatal unless promptly diagnosed and treated surgically. Death occurs in the newborn secondary to emesis, aspiration, and electrolyte imbalance. Serial ultrasound scans were obtained for 2 patients, but duodenal atresia was not detected until 29 and 32 weeks' gestation, respectively. With prior knowledge of an infant with Down syndrome and duodenal atresia, management of fetal distress with subsequent operative delivery can be altered. Early prenatal diagnosis by ultrasonography and subsequent amniocentesis plays an important role in the antenatal and postpartum counseling and management of these patients and neonates.

Adolescent↗