Biomedical subjects

M E Norton

Publications and source records attributed to M E Norton.

24 records · Page 2Linked to original sources

PubMed1990

The clinical significance of predictions based on screening second trimester mean arterial pressure: adverse maternal [corrected] and infant outcomes.

The design of a trial of primary prevention of hypertension in pregnancy rests on both the ability to identify women who are at risk and the definition of a clinically important outcome. The risk of developing antepartum hypertension can now be assessed nonivasively by the midpoint of pregnancy. However, maternal hypertension is not always associated with a clinically important adverse outcome for either mother or infant. The purpose of this study was to prospectively assess whether increasing risk of antepartum hypertension is associated with increasing rates of clinically important maternal and/or infant morbidity. We assembled a prospective cohort of 720 women with singleton pregnancies. The proportion of pregnancies complicated by both antepartum hypertension and maternal and/or infant morbidity increased significantly between low, moderate, and high risk groups (0.2, 6 and 58.8%, respectively, p less than 0.0001). We conclude that a trial of primary prevention of hypertension in pregnancy should include a measure of significant morbidity in mother and infant.

Cohort Studies↗

PubMed1989

Changes in functional status during pregnancy.

Changes in self-reported functional status during pregnancy were studied in 100 women. The baseline interview at 20 weeks was used for assessing subsequent change in maximal physical, mental, and emotional function as well as in global function and global sense of health. Although the transition instruments were only tested at three points during pregnancy (30, 35, and 40 weeks), they succeeded in detecting changes. In particular, both maximal physical function and global function tended to deteriorate as pregnancy progressed toward term, although few women considered themselves to be sick. The authors suggest that changes in functional status should be considered an important "outcome" of pregnancy. Patient-specific measures of change in self-reported maximal function might be used in future trials to help assess the impact of interventions on individual patient's maximal function. The timing of the baseline interview and frequency of the transition assessments should depend on the specific clinical problem under study.

Activities of Daily Living↗

PubMed1989

Early prediction of antepartum hypertension.

We validated a mid-pregnancy screening mean arterial pressure (MAP2) of 85 mmHg or higher as a significant predictor of hypertension in pregnancy. During the 17-month period from October 1984 through February 1986, 730 women, or 16% of all women cared for and delivered at our institution, were screened at or near 20 weeks of amenorrhea. Of the 139 women with a MAP2 of 85 mmHg or higher, 21.6% developed antepartum hypertension, compared with only 0.7% of the 591 women with a MAP2 below 85 mmHg. The screening MAP2 level of 85 mmHg was the optimal cutoff for MAP2 as a screening test. Controlling for the value of the screening MAP2, the only other important predictors of antepartum hypertension were chronic hypertension and diabetes mellitus. Using these three variables, the probability that an individual pregnant woman will develop antepartum hypertension can be assessed with a high degree of accuracy (84.5%) by 20 weeks of amenorrhea. This assessment is noninvasive and simple to use. Three distinct levels of risk have been defined; the moderate- and high-risk groups warrant careful surveillance during pregnancy and may be reasonable groups in which to test preventive interventions.

Adult↗

PubMed1986

Ovulation induction with pulsatile gonadotropin-releasing hormone: a study of the subcutaneous route of administration.

The efficacy of ovulation induction with the use of intermittent gonadotropin-releasing hormone (GnRH) therapy was examined in seven infertile women with hypothalamic amenorrhea. GnRH was administered every 90 minutes via the subcutaneous route in doses ranging from 50 to 300 ng/kg. Analysis of the induced gonadotropin pulse pattern revealed normal to modestly increased luteinizing hormone secretory parameters (e.g., pulse amplitude) in six of the seven patients. Six of seven women and 15 of 16 treatment cycles (94%) were ovulatory. The conception rate was 43% per woman and 19% per cycle. However, detailed hormonal analysis of 13 treatment cycles revealed that only 1 cycle was entirely normal in terms of duration and/or steroid secretion.

Adult↗

PubMedDate not supplied

Molecular zygosity studies aid in the management of discordant multiple gestations.

OBJECTIVE: Management of multiple gestations often requires identification of chorionicity. Sonographic evidence of dichorionicity can be present or inconclusive. DNA determination of zygosity can aid in the subsequent management of twins who are discordant for growth or anomalies. STUDY DESIGN: We present four cases in which monochorionicity could not be excluded sonographically. DNA zygosity studies were performed on amniocytes to guide management of the pregnancies. RESULTS: In two cases, one twin was affected with a significant anomaly. DNA zygosity studies provided a greater than 99% likelihood of monozygous twins in both cases. This altered the counseling regarding selective termination options. The other two cases involved severe intrauterine growth restriction and oligohydramnios in one twin, with a normal co-twin. The small twin appeared nonviable, and DNA studies were used to assess risk to the normal twin in the event of the co-twin's demise. We recommended delivery in the event of monozygous twinning and expectant management if the twins were dizygous. CONCLUSION: Diagnosis of chorionicity is important in multiple gestations. When chorionicity is unclear and management decisions would be altered by determination of zygosity, DNA studies should be considered.

Abortion, Eugenic↗

PubMedDate not supplied

Behçet's syndrome associated with intrauterine growth restriction: a case report and review of the literature.

BACKGROUND: Behçet's syndrome is an immune-mediated connective tissue disorder, and its primary manifestations are oral and genital ulcerations. To our knowledge no cases of adverse fetal outcome have been reported in pregnancies complicated by this disease. CASE: A 27-year-old primigravid woman with a diagnosis of Behçet's disease came to our institution during the first trimester. Her pregnancy was complicated by several exacerbations of her disease including vaginal and oral ulcerations and abdominal pain. She was treated with steroids throughout her pregnancy. She had ruptured membranes and evidence of fetal distress at 361/2 weeks and subsequently delivered a severely growth-restricted fetus (< 3rd percentile). CONCLUSION: Pregnancies complicated by Behçet's disease should be monitored closely for evidence of intrauterine growth restriction and fetal compromise, as are pregnancies complicated by similar connective tissue disorders.

Adult↗