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Biomedical subjects

L Iffy

Publications and source records attributed to L Iffy.

At least 37 records · Page 2Linked to original sources
PubMed1996

Bromocriptine related atypical vascular accidents postpartum identified through medicolegal reviews.

Recent literary case reports indicate that bromocriptine mesylate, when used for the suppression of lactation in the puerperium, can cause serious and even lethal side effects. The untoward sequelae are attributed to generalized or focal vasospasm affecting the cardiac and/or cerebral bold vessels. Apart from pre-existing hypertension and use in association with other ergot derivatives, the factors predisposing to such complications have not been elucidated, The authors present three atypical bromocriptine related postpartum accidents which may expand the understanding both of the predisposing factors and the potential consequences of bromocriptine related severe side effects. One of the cases raises the suspicion that the manifestations of hyperthyroidism may be aggravated by this method of pharmacologic ablactation. Another observation appears to imply that the drug may trigger the onset of chronic hypertension in women so predisposed. The development of cerebral infarcts, identified by MRI, in a clinically asymptomatic woman, exemplifies the threat of recurrent seizure activity in cases of bromocriptine related stroke.

Adult↗
PubMed1996

Intracerebral hemorrhage in normotensive mothers using bromocriptine postpartum.

Three cases of cerebral hemorrhage that occurred in the puerperium in normotensive women who used bromocriptine for milk suppression postpartum are described. Unlike in some other instances reported in the past, the extent of the bleeding was limited in these patients and the long range outcome was relatively benign. All episodes were associated with the development of hypertension. These incidents occurred between the 10th and 17th days postpartum; somewhat later than the usually observed peak time period (6th to 8th day) for the development of severe bromocriptine related side effects.

Adult↗
PubMed1996

The role of medico-legal reviews in medical research.

Serial malpractice reviews offer an opportunity for the study of the effects of various practice patterns. In the specialty of obstetrics, the usefulness of this approach has been demonstrated repeatedly: (a) Much of the data indicating that bromocriptine, when given postpartum for milk suppression, has life endangering propensities have derived from medico-legal reviews. (b) Important new information about factors predisposing to or associated with neonatal brachial plexus injuries have emerged from critical analysis of malpractice claims. There is reason to anticipate that objective evaluation of the background of other prenatal birth injuries can provide more useful clinical information than traditional randomized prospective studies.

Brachial Plexus↗
PubMed1995

Lethal cardiovascular complications in patients receiving bromocriptine for ablactation.

Three cases, involving lethal circulatory collapse in patients who received bromocriptine mesylate (Parlodel) for the suppression of lactation, are reported. These accidents expand the scope of severe side-effects that appear to be attributable to a widely used pharmacological approach to ablactation during puerperium. The circumstances that surrounded the maternal deaths in these instances are consistent with previous clinical observations and epidemiological research, suggesting that pregnancy induced hypertension increases the risks for severe untoward effects from bromocriptine. The common denominator in these side-effects appears to be vasospasm; a paradoxical reaction to a drug, the primary pharmacological effect of which is vasodilation. The reported cases came to the attention of the author through medicolegal inquiries. This underlines the potential value of malpractice reviews, as a research tool, for the critical analysis of rare adverse occurrences and unsuspected complications in the clinical practice of medicine.

Adult↗
PubMed1994

Rates of cesarean section and perinatal outcome. Perinatal mortality.

A comparison of relevant statistics from National Maternity Hospital, Dublin, Ireland and University Hospital, Newark, New Jersey, USA, for the years 1983-1989, revealed that after removal of major confounding factors, such as a fourfold difference in < 2500 gram births and an about tenfold discrepancy in the frequency of lethal congenital defects, the perinatal survival rates in all weight categories were significantly higher in the American center. The findings suggest that optimum perinatal results could not be achieved in an American high risk center with the approximately 6% abdominal delivery rate favored in Dublin. The same data also suggest, however, that the 17.5% rate of abdominal deliveries in Newark was unnecessarily high. The favorable impact of the relatively liberal use of cesarean section might have been derived in this study from a marked reduction of in utero losses, in the absence of an identifiable effect upon the rate of neonatal mortality.

Birth Weight↗
PubMed1994

Cerebral palsy following cutting of the nuchal cord before delivery.

Five cases identified in the course of medicolegal reviews are described where the umbilical cord wrapped around the neck of the foetus once was cut intentionally, or broken, prior to the extraction of the body. Delivery was delayed on account of shoulder dystocia for a period of time varying from three to seven minutes. All of these infants were born with a low APGAR score. Subsequently, they displayed manifestations of cerebral palsy and two of them also had permanent brachial plexus lesion. This series of incidents indicates that an unexpected arrest of the shoulders may inadvertently compound the problem that the severing of the cord prior to the delivery of the body entails. If, as in the cases presented here, hypoxic brain damage ensues, the severing of the cord may become a suspected causative factor. Our literary review has revealed no reference to severing of the cord having been followed by shoulder dystocia. Along with other instances where similar reviews drew attention to as yet unrecognized clinical phenomena, this unusual cluster of a previously unconsidered type of accident at birth underlines the value of carefully conducted medicolegal reviews as a potential clinical research tool in medicine.

Adult↗
PubMed1994

Common intrapartum denominators of shoulder dystocia related birth injuries.

The intrapartum background of fetal injuries associated with shoulder dystocia was studied retrospectively on the basis of 107 relevant medical records. Intrapartum use of oxytocin and protraction-arrest disorders, the latter particularly during the second stage of labor, were frequent findings. Delivery was effected by forceps or vacuum extraction in almost one-half of the cases. Shoulder dystocia related permanent fetal impairments were closely connected to macrosomia. The fetal weight was > or = 4,000 grams in about 75% and > or = 4,500 grams in approximately 40% of the instances. Permanent hypoxic or traumatic cerebral damage was documented in almost one-third of the cases. The data indicate that in connection with coincidental neonatal afflictions, the birth weights of the fetuses are higher and instrumental extractions are more frequent than in relation to all clinically diagnosed cases of shoulder dystocia.

Adolescent↗
PubMed1993

Rates of cesarean section and perinatal outcome: stillbirths.

Based on their yearly clinical statistics for 1983-1989, the cesarean section and stillbirth rates at National Maternity Hospital (Dublin), where the patients are generally white, and University Hospital (Newark), where the patients are predominantly black, were compared. After adjusting for confounding factors, such as unregistered mothers admitted subsequent to fetal demise, differing rates of < 2500 g births and lethal congenital defects, the overall rates of intrauterine fetal demise were identical. When analyzed according to birth weights, in all weight groups, the stillbirth rates were significantly lower in Newark than in Dublin. However, for every 1000 births, more < or = 2500 g fetuses died in utero in Newark than in Dublin. This trend was reversed in the > 2500 g group, where the respective rate at National Maternity Hospital exceeded that of University Hospital more than twice. The latter result largely derived from an almost 7-fold higher rate of intrapartum deaths in the > 2500 g weight group at National Maternity Hospital as compared to University Hospital. When projected against prevailing American statistics, which reflect a stillbirth rate about twice as high among blacks than among whites, the results suggest that the management patterns favored in Newark, including a relatively liberal cesarean section rate (17.5% versus 5.8%), affected the rate of in utero losses favorably.

Black or African American↗
PubMed1993

A study of early fetal growth patterns in twin pairs.

The relationships of sitting heights and body weights of fetal twin pairs were analyzed in comparison with established growth rate standards of singleton fetuses. The apparent rate of growth of individual twins scattered around the average growth curve in the same manner as singletons. In contrast, members of 12 twin pairs with < 125 mm sitting heights, were closely similar in terms of bodily dimensions. Among the 7 pairs with crown-rump lengths of > 125 mm, 4 were discordant, suggesting a deceleration of growth in one of the twin fetuses, starting after the 18th week of gestation.

Body Height↗