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Biomedical subjects

M W Varner

Publications and source records attributed to M W Varner.

At least 91 records · Page 5Linked to original sources
PubMed1983

Diagnosis of maternal cystic fibrosis during pregnancy.

The third and fourth cases of maternal cystic fibrosis diagnosed during pregnancy are presented. Quantitative pilocarpine iontophoresis (sweat chlorides) must be performed to establish the diagnosis. Other important findings include recurrent or persistent respiratory symptoms, chest x-ray abnormalities, abnormal pulmonary function studies, and abnormal arterial blood gases. Gastrointestinal tract dysfunction and a positive family history for respiratory disease also suggest the diagnosis. Pregnant patients with cystic fibrosis require careful and frequent cardiopulmonary and gastrointestinal surveillance. A higher incidence of premature labor is noted and all patients are best managed in tertiary referral centers. Patients should also be monitored carefully during the puerperium because maternal pulmonary decompensation may occur during this time.

Adolescent↗
PubMed1982

Maternal mortality in a major referral hospital, 1926 to 1980.

This review describes the changes in the causes of maternal deaths in a major referral hospital over a span of 55 years. There has been a significant decline in direct maternal deaths from infection, hemorrhage, and toxemia. Continued vigilance is needed since 58% of direct obstetric deaths in our hospital during the last 30 years were considered to have been preventable. Heart disease and nonobstetric infection as indirect causes of maternal deaths have decreased also. Greater effort is necessary to identify those patients with conditions that predispose to indirect deaths and to provide appropriate contraception, sterilization, early pregnancy termination, or optimal multidisciplinary care in a referral hospital.

Adolescent↗
PubMed1981

A prospective evaluation of X-ray pelvimetry.

One hundred four consecutive patients undergoing x-ray pelvimetry were analyzed prospectively in an attempt to evaluate the efficacy of this procedure. Comparison was made between prepelvimetry and post-pelvimetry clinical management plans. Roentgenographic pelvic measurements led to prompt and significant alterations in clinical management plans in only one of 67 patients with vertex presentation and one of 37 with breech presentation. In 98% of patients, no change in immediate clinical management plan was made on the basis of x-ray pelvimetry findings.

Cesarean Section↗
PubMed1981

Conservative management of premature rupture of the membrane.

Management recommendations for pregnancies complicated by premature rupture of the membranes must consider both the neonatal morbidity and mortality of immaturity associated with prompt delivery and the infectious risks to the mother and fetus associated with prolonged observation. Because these considerations are critical in pregnancies with prematurely ruptured membranes and premature but potentially viable infants, 116 pregnancies with this complication between 28 and 36 weeks' gestation were reviewed. All patients received careful in-hospital surveillance. Six patients (5.2%) developed amnionitis prior to labor. Nine infants (7.1%) developed neonatal sepsis, with the predominant pathogen being the group B beta-hemolytic streptococcus. A decrease in the incidence of respiratory distress syndrome (RDS) and patent ductus arteriosus (PDA) with progressive duration of membrane rupture was observed. The perinatal survival in this study was 96.9%. These findings suggest that in similar patient populations an expectant management plan may be employed with minimal infectious risks to mother and fetus.

Adolescent↗
PubMed1980

X-ray pelvimetry in clinical obstetrics.

X-ray pelvimetry has been used in obstetrics for over 80 years, but its clinical usefulness remains uncertain. Review of 101 consecutive x-ray pelvimetries obtained by Brown's modification of the Colcher-Sussman technique demonstrated the anteroposterior measurements to be of no value in predicting the eventual method of delivery. However, a transverse of the inlet of less than 13.0 cm and a transverse of the midpelvis of less than 10.0 cm were each associated with an increased frequency of operative delivery. In 94 cases no new information was obtained by x-ray pelvimetry; in the other 7 patients the information obtained was equally accessible by either ultrasonography or abdominal scout film. The authors conclude that x-ray pelvimetry by the technique used in their institution has very limited usefulness in clinical obstetrics.

Delivery, Obstetric↗
PubMed1979

Human placental lactogen: a predictor of perinatal outcome?

Serial human placental lactogen (hPL) determinations were performed on 806 women with normal and abnormal pregnancies late in the pregnancy. These results were not reported to the clinicians involved. For the study population as a whole, low hPL levels did not effectively predict those adverse perinatal outcome variables evaluated. Further analysis revealed that this was true both for the normal and abnormal pregnancy groups. Our data do not support the routine use of antepartum hPL screening, as advocated by others, as a means of improving perinatal outcome. In certain at-risk patients, there was an association between low hPL values and the presence of 1 or more of the adverse outcome variables. However, these patients had been recognized clinically as having fetuses in jeopardy.

Female↗
PubMed1979

hPL: physiologic and pathophysiologic observations.

Serum human placental lactogen (hPL) levels were studied in 806 women in late pregnancy. The hPL levels were positively correlated with birth weight but were unrelated to maternal age, parity, socioeconomic status, or the sex of the newborn. The hPL levels peaked at 37 weeks' gestation and then declined moderately. An individual's hPL levels in late pregnancy are quite constant week to week. Patients with severe chronic hypertension have low hPL values; those carrying twins have high values.

Birth Weight↗
PubMedDate not supplied

Amniotic fluid epidermal growth factor levels in normal and abnormal pregnancies.

OBJECTIVE: To determine the concentrations of epidermal growth factor (EGF) in amniotic fluid (AF) from women during late pregnancy, with and without pathophysiologic complications. METHODS: All AFs were collected by amniocentesis from the following groups: gestational age at least 38 weeks (n = 15); gestational age 36-37 weeks (n = 10); gestational age 35 weeks (n = 5); labor 34 weeks or less, delivered within 7 days (n = 10); labor 34 weeks or less, undelivered (n = 10); chorioamnionitis (n = 7); gestational age-matched controls (n = 7); term, in labor (n = 8); term, not in labor (n = 8); intrauterine growth restriction (IUGR) 38 weeks or more (n = 8); macrosomia at 38 weeks or more (n = 10). Epidermal growth factor was assayed using a specific radioimmunoassay. RESULTS: Amniotic fluid EGF levels increase rapidly in late pregnancy but are not altered by chorioamnionitis or by term or preterm labor. Intrauterine growth restriction is associated with lower EGF levels in AF, but macrosomia is without effect. CONCLUSIONS: Epidermal growth factor levels in AF are increased near term and decreased in pregnancies complicated by IUGR; they may be an indicator of specific maturational events.

Amniotic Fluid↗
PubMedDate not supplied

Regulation of fetal fibronectin production in human amnion cells.

OBJECTIVE: We evaluated the role of human amnion in the production of fetal fibronectin and assessed the regulation of fetal fibronectin production by inflammatory products and cytokines. METHODS: Human amnion cells were grown in culture. At confluence, the cell were incubated with and without lipopolysaccharide, interleukin-1 beta, tumor necrosis factor-alpha, and interleukin-6. Fetal fibronectin production was measured in the supernatant fluid using an enzyme-linked immunosorbent assay technique. RESULTS: Unstimulated amnion cells produced fetal fibronectin, and production was increased by lipopolysaccharide, interleukin-1 beta, tumor necrosis factor-alpha, and interleukin-6. CONCLUSION: Human amnion cells in vitro produce fetal fibronectin in substantial quantities. This production is stimulated by inflammatory products and mediators that are considered to be important in the initiation of some cases of preterm labor.

Amnion↗