Biomedical subjects
N A Beischer
Publications and source records attributed to N A Beischer.
Polyhydramnios and associated maternal and fetal complications in singleton pregnancies.
During the 10-year period 1 January 1979 to 31 December 1988, polyhydramnios occurred in 537 patients with singleton pregnancies delivered at the Mercy Maternity Hospital. Associated maternal and fetal complications and the perinatal outcome of these pregnancies with polyhydramnios were analysed. In 248 of the 537 pregnancies (46%) in this group there were no maternal complications or fetal malformations and the perinatal mortality (PNM) rate was 2.4%. The PNM rate increased significantly to 13.1% when there was associated pre-eclampsia, 10% with gestational diabetes, and to 7.6% with miscellaneous complications. When polyhydramnios was associated with a fetal or placental malformation the PNM rate was 61.4%. The commonest malformations were central nervous system (31%), musculoskeletal (12%) and gastrointestinal system anomalies (10%). Placental chorioangioma occurred in two patients (0.4%) and both babies died. In women with low oestriol excretion (18% of the 455 tested) the PNM rate increased five times to 22.7%.
Perinatal mortality in the infants of diabetic women.
The causes of 50 perinatal deaths which occurred over an 18-year period in the infants of women with either established (n = 205) or gestational (n = 2,442) diabetes were studied. The perinatal mortality rate in these groups was 5.4% and 1.6% respectively and the causes of deaths were similar in both groups. Intrauterine hypoxia was found to be the commonest cause of death, followed by congenital malformations and respiratory distress syndrome. The implications of these findings for measures to reduce such deaths are discussed.
Acute and subacute polyhydramnios in singleton pregnancies.
Over a 10-year period when 51,022 singleton infants were delivered, 19 pregnancies (1 in 2,685) were complicated by acute polyhydramnios 17 (1 in 3,000) by subacute polyhydramnios and 501 (1 in 102) by chronic polyhydramnios. The incidence of major congenital malformations in singleton pregnancies associated with acute polyhydramnios was 63% and the perinatal mortality rate was 74%. When subacute polyhydramnios occurred in singleton pregnancies, the incidence of major congenital malformations was 65%, similar to acute polyhydramnios, but the perinatal mortality rate was only 35%. The comparable figures for chronic polyhydramnios in singleton pregnancies were a major malformation incidence of 14% and perinatal mortality rate of 10%. The type of onset of polyhydramnios, acute, subacute or chronic is therefore the most important indicator of prognosis. In patients with gross polyhydramnios, acute renal failure must be specifically excluded.
Acute polyhydramnios in twin pregnancies.
This paper reports the experience with acute polyhydramnios complicating twin pregnancies at the Mercy Maternity Hospital for the 10-year and 2-month period from January, 1979 to February, 1989 during which time there were 13 such cases, an incidence of 1 in 4,044 pregnancies. Acute polyhydramnios complicated 1.7% of all twin pregnancies. The perinatal mortality rate was 88.5% and accounted for 16.7% of the perinatal deaths in twins. No major fetal malformations were found. One case of acute polyhydramnios was successfully managed with ultrasonographically guided serial amniocenteses. The management of this rare condition is considered.
The significance of polyhydramnios diagnosed during labour or at caesarean section.
In the 38 cases of polyhydramnios reported here the diagnosis was made only at the time of artificial rupture of the membranes to induce or augment labour, or at Caesarean section. Usually this was a benign finding often associated with overweight in the mother (60%) or baby (39.4%). However there was an increased incidence of major congenital abnormality (13.1%) resulting in a high perinatal mortality rate (10.5%); the paediatrician should therefore be alerted prior to delivery of these patients.
The persistence of abnormal glucose tolerance after delivery.
In the first 7 days after delivery, 270 women who had gestational diabetes and 100 who had normal prenatal glucose tolerance were retested for glucose intolerance. In the group who had gestational diabetes, glucose tolerance remained abnormal by the Mercy Maternity Hospital criterion in 28% of those who had been delivered vaginally and in 43% of those delivered by cesarean. The only abnormal test in the control group was in one of the two women delivered by cesarean, and this test returned to normal by the seventh postoperative day. By 6 weeks postpartum, the incidence of abnormal glucose tolerance was 24 and 30% for patients having vaginal and abdominal deliveries, respectively. The method of infant feeding had no significant influence on the prevalence of abnormal glucose tolerance. We conclude that if a glucose tolerance test has not been performed prenatally, the test is still worthwhile in the immediate puerperium if the possibility of gestational diabetes has been raised by adverse pregnancy outcome, because about one in three diabetics will be thus identified. However, screening in the puerperium is not a substitute for prenatal screening.
Incidence and severity of gestational diabetes in Bahrain and Australia.
The incidence and severity of gestational diabetes in a series of 5,199 predominantly Arab patients in Bahrain, and 2,643 of mixed racial origin in Australia were studied. The incidence of gestational diabetes in Bahrain (5.4%) was less than in Australia (7.2%) but the more severe degrees were 3 times more common in Bahrain (p less than 0.001). The incidence of gestational diabetes was significantly increased with increasing maternal age and parity. A notable difference between the 2 populations occurred in the groups weighing less than 70 kg. Although Bahrain had a higher proportion of patients weighing less than 70 kg (64.7% versus 55.9%; p less than 0.001) there was a significantly higher incidence of gestational diabetes in this group in the Australian series (13.9% versus 3.7%, p less than 0.001). Postnatal testing of 165 gestational diabetics in Bahrain and 194 in Australia indicated that although the severe degrees of glucose intolerance were more likely to persist postnatally, it was impossible to predict in the individual patient the change in glucose tolerance that would occur after delivery. All gestational diabetics should therefore have a postnatal glucose tolerance test.
Combined obstetric neonatal and gynaecology reports. Tasmania 1987.
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Cervical incompetence in a pregnancy following a cervical ectopic pregnancy.
A case of cervical incompetence is reported which occurred in a pregnancy which followed soon after treatment of a cervical ectopic pregnancy using a Foley catheter. Very few pregnancies following cervical pregnancy have been reported. Although this isolated case is clouded by other risk factors, cervical incompetence should be considered as a potential complication of such pregnancies.
Massive hypertrophy of the breasts in pregnancy: report of 3 cases and review of the literature, 'never think you have seen everything'.
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Contribution of prematurity and low birth-weight to neonatal death in Chinese and Western populations.
This paper analyses the contribution of low birth-weight (birth-weight between 500 and 2,500 g) and prematurity (gestation less than 37 weeks) to neonatal death in Chinese and Western populations. The incidences of low birth-weight in the Tsan Yuk Hospital, Hong Kong, the State of Victoria, and the Mercy Maternity Hospital, Melbourne, were 4.63%, 4.29% and 5.66% respectively and the incidences of prematurity were 2.08%, 4.89% and 7.42% respectively. The neonatal mortality rate (per 1,000 livebirths) for premature infants born in Victoria was 64, 89 for those born at the Mercy Maternity Hospital and 119 for the Tsan Yuk Hospital. This paper has demonstrated that a striking differences exists in prematurity rates between Chinese and Western populations, and also that the mortality rate of premature infants is lower in Western populations. If the reason for the lower incidence of prematurity in the Chinese population could be determined and the mortality of premature infants maintained in the Western population, a significant lowering of perinatal mortality would result. Studies to determine causes for premature births in Chinese and Western populations should therefore be undertaken.
Cervical pregnancy: hysterectomy avoided with the use of a large Foley catheter balloon.
A case of cervical pregnancy in the late first trimester is reported where hysterectomy was avoided, when it seemed inevitable in the face of heavy uncontrolled haemorrhage. Having read the cases reporting easy control of massive haemorrhage from the expanded cervix in such cases by a Foley catheter, we decided to try this recently reported technique - it was magically effective.
Placenta membranacea. Case reports.
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A reappraisal of urinary oestriol excretion as a screening test in pregnancy.
During the years 1971-1982 urinary oestriol excretion was tested in 38,536 patients (group 1). One or more low oestriol value was found in 11.0% of patients; in this group the stillbirth rate was 8 times higher, the neonatal death rate 4 times higher, and fetal growth retardation rate 4 times higher than in patients with normal oestriol values (all p less than 0.001). During the years 1982-1984 a further 12,887 patients were tested (group 2) and 9.5% had one or more low oestriol value. The perinatal mortality rate in patients with normal oestriol excretion fell from 0.8% in group 1 to 0.5% in group 2 (p less than 0.05), and in patients with low oestriol excretion from 4.7% in group 1 to 2.4% in group 2 (p less than 0.01). However, patients in group 2 with low oestriol values still had significantly unfavourable results, compared to those with normal oestriol values--stillbirth rate 4 times higher, neonatal death rate 5 times higher, and fetal growth retardation rate 4 times higher (all p less than 0.001). Although perinatal results have improved, fetal growth retardation and the risk of perinatal death are still identified by urinary oestriol assay.
How clean are your instruments?
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Who should treat patients with gynaecological cancer?
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