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Biomedical subjects

N A Beischer

Publications and source records attributed to N A Beischer.

At least 37 records · Page 2Linked to original sources
PubMed1994

Value of cardiotocography in women with antepartum haemorrhage--is it too late for caesarean section when the cardiotocograph shows ominous features?

Caesarean section is thought to be indicated by an ominous antepartum cardiotocograph (CTG). However, the fear remains that infants delivered for this indication in the presence of antepartum haemorrhage, especially when premature, are destined to have severe hypoxic neurological damage. We therefore reviewed our experience of cardiotocography in women with antepartum haemorrhage (APH) from 1989 to 1992. There were 472 women with APH who had a CTG performed. Of them, 68 had abruptio placentae and 317 had an APH of undetermined cause. For the group with abruptio placentae, the perinatal mortality rate (PMR) was 230.7 per 1,000 when the CTG was abnormal, but only 18.2 per 1,000 if the CTG was normal (odds ratio 16.2, 95% confidence interval [CI] 1.53-171.9, p = 0.02). For APH of undetermined cause, the corresponding rates were 90.9 per 1,000 and 9.8 per 1,000 (odds ratio 10.1, 95% CI 0.96-105.8, p = 0.13). There were no perinatal losses in women with APH due to placenta praevia (87 cases). There were 6 cases of critical fetal reserve identified on a CTG in women with abruptio or APH of undetermined cause. All were delivered by Caesarean section, with 4 surviving infants, 3 with normal neurological outcome and 1 lost to follow-up. There were 3 cases of APH resulting in an infant with cerebral palsy, all of whom had had a normal antepartum CTG. Our data suggest that cardiotocography allows pregnancy to be safely prolonged in pregnancies complicated by abruptio placentae or APH of undetermined cause, and that Caesarean section is an appropriate form of delivery when the CTG becomes abnormal in these cases.

Abruptio Placentae↗
PubMed1994

Maternal glucose tolerance and obstetric complications in pregnancies in which the offspring developed type I diabetes.

OBJECTIVE: To identify possible in utero risk factors in children who develop type I diabetes and to determine the risk of development of type I diabetes in the children of women with gestational diabetes. RESEARCH DESIGN AND METHODS: All known children with type I diabetes born at the Mercy Hospital for Women whose mothers had glucose tolerance tests (GTTs) performed during pregnancy were identified. The results of the mothers' GTTs were compared with those of the hospital population, as were their obstetric complications. RESULTS: We identified 38 children with type I diabetes born at this hospital whose mothers had GTTs performed during pregnancy. Only one of these mothers had gestational diabetes, compared with 5.6% in the overall hospital population (adjusted odds ratio 0.69, 95% confidence interval 0.12-3.84, P = 0.99). There were no differences in the blood glucose levels between the mothers of the children who developed diabetes and the general hospital population. The birth weights of the children destined to develop diabetes also showed no deviation from the expected distribution, and there were no outstanding features of the mothers' obstetric histories. CONCLUSIONS: Maternal blood glucose level is not an important determinant of the child's risk of developing type I diabetes.

Birth Weight↗
PubMed1993

Value of early glucose tolerance testing in women who had gestational diabetes in their previous pregnancy.

The patterns of glucose tolerance, clinical characteristics, and follow-up results of 1,027 pregnant women who had gestational diabetes diagnosed in their previous pregnancy, were analyzed. Glucose tolerance testing was performed before 24 weeks (mean 16.6 +/- 4.5 weeks) in 180 women (group 1); when the result was normal the test was repeated at 26-30 weeks' gestation. In this group the incidence of recurrent gestational diabetes was 49.4%, and early testing diagnosed 61.8% of cases. Group 2 consisted of 685 women in whom glucose tolerance was tested only at 26-30 weeks' gestation. In this group the incidence of recurrent gestational diabetes was 34.0%. Group 3 consisted of 162 women in whom glucose tolerance was not tested in the subsequent pregnancy. Perinatal mortality rates in Groups 1 to 3 were 2.2%, 0.6% and 3.1% respectively in the pregnancy subsequent to that in which gestational diabetes was first diagnosed. The risk of emerging diabetes mellitus on follow-up was greater in women in whom gestational diabetes was diagnosed early than in those diagnosed at the usual time (33.3% versus 12.5%, p < 0.05). Analysis of the 13 perinatal deaths in Groups 1-3 revealed 5 that were potentially avoidable; none of the 3 women with recurrent gestational diabetes in the early tested group who had perinatal deaths received insulin in their subsequent pregnancies. Although perinatal deaths are unavoidable in some high-risk pregnancies associated with gestational diabetes, this study suggests that early diagnosis of gestational diabetes may allow further reduction of perinatal mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

Gestational diabetes and follow-up among immigrant Vietnam-born women.

Gestational diabetes is associated with an increased risk of fetal macrosomia and perinatal death. Immigrant mothers from Vietnam who delivered in the Mercy Hospital for Women between January 1, 1979 and December 31, 1990 were investigated to assess their risk of gestational diabetes, the factors that were associated with gestational diabetes, and the prevalence of diabetes mellitus on follow-up. These mothers were compared with Australian-born mothers attending the same hospital and who delivered in the same period. Using a logistic regression model, gestational diabetes was found to be more common in Vietnam-born mothers who were older, who were primigravidas, or were underweight and the risk of gestational diabetes increased over the time period of the study. The adjusted relative risk of gestational diabetes for Vietnam-born women was 1.43 (95% confidence limits 1.10, 1.86) compared with Australian-born women. The incidence of gestational diabetes was 7.8% (144 of 1,839) in Vietnam-born mothers and 4.3% (1,173 of 27,086) in Australian-born mothers. Vietnam-born mothers also had a greater risk of diabetes mellitus on follow-up; 25% (17 of 68) of those with follow-up testing had developed diabetes mellitus within 9 years of diagnosis of gestational diabetes, in comparison with an incidence of 9% (52 of 581) of Australian-born mothers with follow-up testing. Vietnam-born mothers should have glucose tolerance testing performed during pregnancy to detect gestational diabetes and those diagnosed should have long-term follow-up to detect the development of diabetes mellitus.

Adult↗
PubMed1993

Why do Asian-born women have a higher incidence of gestational diabetes? An analysis of racial differences in body habitus, lipid metabolism and the serum insulin response to an oral glucose load.

We have observed a higher incidence of gestational diabetes (GDM) in Asian-born than in Caucasian women. Body habitus, serum lipid levels and the serum insulin response to a glucose load in pregnancy were compared in 15 women with normal glucose tolerance, 16 Caucasian women with GDM and 19 Asian-born women with GDM. Caucasian women with GDM, unlike Asian-born women with GDM, were obese compared with control women as measured by body mass index (p = 0.022). Both groups of GDM women had similar patterns of insulin response to oral glucose with a delayed insulin peak and an elevated 2-hour insulin level (p = 0.0021). In addition, the insulin response per unit of glycaemic stimulus (incremental insulin area/incremental glucose area at 1 hour) was reduced in both GDM groups (p = 0.035). Fasting serum triglyceride levels were higher in women with GDM although this was only significant in the Caucasian group (p = 0.014). Asian-born women with GDM had significantly lower (p = 0.041) serum cholesterol levels than Caucasian women with GDM. There was a significant correlation (p = 0.025) between glucose tolerance (area under the curve) and fasting serum triglyceride values. The relationship between lipid and carbohydrate metabolism in Asian-born and Caucasian women in pregnancy requires further investigation.

Adult↗
PubMed1992

The treatment of gynaecological malignancy in a general public hospital.

OBJECTIVE: To assess the adequacy of treatment of gynaecological cancer in a public hospital and to determine the influence of referral patterns on patient outcome. DESIGN: A retrospective analysis of clinical histories. SETTING: A tertiary-level general public hospital. PATIENTS: 89 patients admitted between 1 January 1979 and 31 December 1987 for primary treatment of a gynaecological malignancy. MAIN OUTCOME MEASURES: The primary study parameter was patient survival. During data analysis, the study parameters were altered to include the adequacy of initial surgery and survival time in relation to the involvement of the Gynaecology Unit. RESULTS: Initial presenting symptoms had a major influence on the referral patterns of patients with a gynaecological malignancy. All patients who presented with abnormal vaginal bleeding were managed by the Gynaecology Unit. Patients with ovarian cancer who presented with non-specific abdominal symptoms and ascites were often managed by other units. There was a statistically significant difference in the adequacy of initial surgery depending on whether the patient was managed by the Gynaecology or the Surgical Unit (P < 0.05). The median survival time of patients managed by the Gynaecology Unit was 20 months; this was considerably longer than the figure of 14 months for other units (P < 0.05). CONCLUSIONS: Patients with ovarian cancer who are managed by a specialised gynaecology unit are more likely to have adequate initial surgery and a longer median survival time. Female patients presenting with non-specific abdominal symptoms, ascites and other signs of intra-abdominal malignancy should be reviewed by a gynaecology unit before initial surgery.

Endometrial Neoplasms↗
PubMed1992

Prospective study of the quality of survival of infants with critical fetal reserve detected by antenatal cardiotocography.

From 1981 to 1986 antenatal cardiotocographic monitoring was performed on 9,992 high-risk pregnancies selected from a total obstetrical population of 31,518 patients (31.7%). A critical fetal reserve pattern was detected in 89 patients (0.9%) whose pregnancies resulted in 68 surviving infants, 19 perinatal deaths and 2 sudden infant deaths. Since 47.4% of the infants who died in the perinatal period did so because of a related congenital malformation, such a defect should be excluded in the fetus with critical fetal reserve, by ultrasonography, before delivery (there is usually insufficient time for fetal karyotyping). Sixty-three (92.6%) of the surviving children were assessed at our Growth and Developmental Clinic and disabilities were detected in 16 (25.4%); however, the disability was major in only 5, including 2 children with Down syndrome. The quality of survival of infants born from pregnancies complicated by critical fetal reserve was satisfactory as 60 of 63 children (95.2%) had neither a major disability related to intrauterine hypoxia identified by the cardiotocographic pattern, or had one likely to significantly interfere with their quality of life. Our results suggest that pregnancies can be continued until the cardiotocographic pattern becomes critical in order to gain fetal maturity, without compromise to the fetal brain.

Cardiotocography↗
PubMed1992

Antepartum cardiotocographic surveillance of patients with diminished fetal movements.

Over a 9-year period, 2,601 women had antenatal cardiotocography (CTG) performed after reporting diminished fetal movements. This series represented 5.6% of the total hospital population and 16.1% of those having antenatal CTG performed. The perinatal mortality rate (0.8%) and major fetal malformation rate (2.2%) were lower than in the hospital population (1.1% and 4.5% respectively). The incidence of abnormal CTG tracings was lower in the 1,390 women with diminished movements alone (6.4%) compared with the 1,211 who had additional antenatal complications (10.2%, p less than 0.001). Likewise the incidences of critical fetal reserve CTG and perinatal mortality were significantly lower in the group without additional complications (0.3% and 0.5%) compared with those with additional complications (1.7% and 1.2% respectively). The 24 patients with critical fetal reserve CTG were promptly delivered (19 by Caesarean section) with favourable results in 19, cerebral palsy in 1, and 4 perinatal deaths - 2 of these deaths resulted from intrauterine hypoxia (table 3, Cases 12 and 15). There were 17 perinatal deaths in cases where the CTG was satisfactory (13) or showed reduced reserve (4); 9 of these were unavoidable as a result of major malformations or other lethal conditions. The other 8 deaths resulted from hypoxia, including 4 in pregnancies at or beyond 37 weeks' gestation (table 3, Cases 6-9), illustrating that delivery is warranted in women with diminished fetal movements when conditions are favourable even when the CTG is satisfactory. Cardiotocography is useful in the management of patients with diminished fetal movements.

Cardiotocography↗
PubMed1992

Norethisterone and gestational diabetes.

In a single practice during the 21 years 1971-1991, the incidence of gestational diabetes in pregnancies in which norethisterone was prescribed was 32.4% (22 of 69) in comparison with 7.1% in pregnancies in which the women did not take norethisterone (137 of 1,684) (p < 0.001). Gestational diabetes was no less severe (degree of hyperglycaemia, need for insulin therapy) when associated with norethisterone. However, follow-up revealed that gestational diabetes when associated with norethisterone had a lesser risk of emerging diabetes mellitus and impaired glucose tolerance. Masculinization of a female fetus occurred in 5 of 39 (12.8%) exposed to norethisterone; all were cases of clitoral hypertrophy not requiring surgical treatment. Norethisterone in these 69 pregnancies accounted for 33.3% (5 of 15) cases of clitoral hypertrophy diagnosed in 100,756 consecutive births.

Adult↗
PubMed1992

Excessive birth weight and maternal glucose tolerance--a 19-year review.

The incidence of birth-weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth-weight and maternal glucose tolerance was investigated in the light of these observations. The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth-weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus. Excessive birth-weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth-weight > or = 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow-up testing had diabetes mellitus. Birth-weight > or = 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth-weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth-weight > or = 4,540 g had a poor association with later development of diabetes.

Adult↗
PubMed1992

Gestational diabetes in twin pregnancy: prevalence and long-term implications.

During the period 1971-1991 at the Mercy Hospital for Women, gestational diabetes (GDM) was diagnosed in 3,447 of 61,914 tested singleton pregnancies (5.6%) and 59 of 798 tested twin pregnancies (7.4%, p = 0.025). A difference was apparent in the period 1971-1980, when the prevalences of GDM in singleton and twin pregnancies were 3.0% and 5.6% respectively (p = 0.012), but not in the period 1981-1991 when the corresponding prevalences were 7.4% and 8.4% (p = 0.36). Of the 59 patients in whom a diagnosis of GDM in a twin pregnancy was made, 27 attended the follow-up programme. These patients were matched to a control group of 27 patients who had GDM in a singleton pregnancy with similar characteristics for known risk factors for the development of permanent diabetes mellitus. On WHO criteria diabetes mellitus occurred in 5 (18.5%) of the subjects and 2 (7.4%) of the controls (p = 0.21). The difference in prevalence of GDM in twin and singleton pregnancies is less now that the overall prevalence of the disease has more than doubled (1971-1980 versus 1981-1991). Although the increased rate of permanent diabetes mellitus after twin pregnancy is not statistically significant, it would seem wise to make a special effort to enroll these women in the follow-up programme.

Adult↗
PubMed1991

Long-term implications of gestational diabetes for the mother.

Women with GDM have a greater risk of developing diabetes in the future compared with those women who have normal glucose tolerance during pregnancy. Using life table techniques, 17 years after the initial diagnosis of GDM, 40% of women were diabetic compared with 10% in a matched control group of women who had normal glucose tolerance in pregnancy. The incidence of diabetes was higher among women who were older, more obese, of greater parity and with more severe degrees of glucose intolerance during pregnancy. Diabetes also occurred more commonly among women who had a first-degree relative who was diabetic, in women born in Mediterranean and East Asian countries, and in those who had GDM in two or more pregnancies. Despite differing testing techniques and varying criteria for the diagnosis of GDM, follow-up studies from across the world consistently show a higher rate of subsequent diabetes among GDM mothers. NIDDM is associated with increased morbidity and a higher mortality rate, especially in women. Cardiovascular and cerebrovascular diseases are the leading causes of death. High lipid levels, hypertension and obesity are often already present when diabetes is diagnosed and may antedate the development of overt diabetes; treatment of diabetes at this stage may therefore be too late to prevent complications occurring. A follow-up programme for women with GDM facilitates screening of a group known to be at increased risk of developing diabetes so that the diagnosis can be made before associated risk factors for complications develop. Intervention in the form of counselling regarding cigarette smoking, exercise and a healthy, high-residue, unrefined carbohydrate, low cholesterol diet, given together with weight monitoring, may prevent the onset of both diabetes and its associated cerebrovascular and cardiovascular problems.

Adult↗
PubMed1991

Second twin: quality of survival if born by breech extraction following internal podalic version.

The intrapartum management of the vertex-breech and vertex-transverse twin gestation is controversial. The fall in perinatal mortality rate to a low level has resulted in this parameter failing to be an adequate gauge of the safety of breech extraction and the answer lies in the quality of survival of the infants. Fifty-one twin pairs, collected over 12 years at the Mercy Hospital for Women, Melbourne, occurred where twin 2 was born by breech extraction following internal inversion and the control (twin 1) did not have this procedure performed. In 8 pairs either a stillbirth or neonatal death occurred; in one pair childhood death due to an accident (fire) occurred; in 4 pairs the parents refused entrance to the study as they perceived both twins to be similar; in 2 sets the assessment was incomplete; 11 sets were untraceable leaving 25 sets fully assessed as children ranging in age from 2 to 12 years. Growth, and psychological scores were not significantly different between twins 1 and 2 but 2 children had cerebral palsy and both were born by breech extraction following internal version at 29.2 and 30.1 weeks' gestation, respectively. Because of small numbers the results failed to achieve statistical significance and this study was unable to answer the question regarding the safety of breech extraction following internal version but did show that the majority of infants so born do well.

Apgar Score↗
PubMed1991

Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia.

Gestational diabetes mellitus (GDM) was diagnosed in 1928 of 35,253 (5.5%) tested pregnancies at the Mercy Maternity Hospital in Melbourne between 1979 and the end of 1988. Compared with women born in Australia and New Zealand, the incidence of GDM was significantly greater in women born on the Indian subcontinent (15%); in women born in Africa (9.4%), Vietnam (7.3%), Mediterranean countries (7.3%), and Egypt and Arabic countries (7.2%); and in Chinese (13.9%) and other Asian (10.9%) women. There was no significant difference for women born in the United Kingdom and northern Europe (5.2%), Oceania (5.7%), North America (4.0%), or South America (2.2%). With the World Health Organization criteria as a guide to the severity of hyperglycemia, compared with mothers born in Australia and New Zealand, there were significant increases in the incidences of the more severe grades of GDM in parturients born in the Mediterranean region, Asia, the Indian subcontinent, Egypt, and Arabic countries. The incidence of GDM increased significantly in all racial groups, rising from 3.3% during 1979-1983 to 7.5% during 1984-1988.

Africa↗