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Biomedical subjects

N A Beischer

Publications and source records attributed to N A Beischer.

At least 73 records · Page 4Linked to original sources
PubMed1986

The long-term follow-up of women with gestational diabetes.

Four hundred and forty-seven women who had gestational diabetes have been retested at intervals from 1 to 12 years following diagnosis; 49 (11%) were found to be diabetic and 35 (7.8%) had impaired glucose tolerance using the WHO criteria. An abnormal glucose tolerance test in the puerperium and obesity at the time of retesting had significant associations with abnormal glucose tolerance at follow-up. However, the best predictive factor of the likelihood of the development of significant hyperglycaemia was the recurrence of gestational diabetes in a subsequent pregnancy, since 28% of these women were diabetic and a further 4% had impaired glucose tolerance at the time of follow-up. These findings indicate that the criteria used for the diagnosis of gestational diabetes at the Mercy Maternity Hospital, Melbourne (1-hour greater than or equal to 9 mmol/l together with a 2-hour greater than or equal to 7 mmol/l) are appropriate for an Australian population.

Adult↗
PubMed1986

Unexplained intrauterine death near term.

In Victoria, in 1984, intrauterine hypoxia of unknown aetiology accounted for 59 of the 252 perinatal deaths of infants with a birth-weight of 2,500 g or more. These unexplained deaths occur in approximately 1 in 1,000 pregnancies near term, and in more than 90% of cases the infants are neither small nor large for dates (tables 1 and 2). In 27 of the 59 cases, a fetoplacental function test (oestriol assay, cardiotocography) had been performed, and in 6 glucose tolerance had been tested either before or after the fetal death occurred. We endorse recent recommendations that all pregnant women should be screened for gestational diabetes at approximately 24-28 weeks' gestation as a possible means of reduction in the number of intrauterine deaths of mature infants. Consideration of these cases indicates that induction of labour should not be deferred after 37-38 weeks' gestation in high risk pregnancies, merely because tests of fetoplacental function are normal--i.e. laboratory tests should not outweigh clinical judgment especially in high risk pregnancies! It is considered that the cost of identification of these infants at risk of 'unexplained death', if possible, is likely to be justified by the fact that they are mature and apparently normal.

Australia↗
PubMed1986

Timely diagnosis by cardiotocography of critical fetal reserve due to fetofetal transfusion syndrome.

In a review of 90 twin pregnancies monitored by antenatal cardiotocography there were 8 cases of subsequently proven fetofetal transfusion syndrome. In 2 of these evidence of severe fetal stress had indicated immediate delivery; the 4 babies survived in circumstances that were perilous. In 1 case there was no evidence of critical fetal reserve but the recipient twin died, this probably representing an acute fetofetal transfusion during labour. In the 5 milder cases with no evidence of stress on cardiotocography, all babies survived and they required minimal or no treatment for problems relating to the fetofetal transfusion. In multiple pregnancy the cardiotocograph offers the additional bonus of detection of fetal compromise due to fetofetal transfusion.

Adult↗
PubMed1985

Nonstressed antepartum cardiotocography in patients undergoing elective cesarean section--fetal outcome.

In a prospective study of 409 patients monitored with nonstressed antepartum cardiotocography and delivered by elective cesarean section, cardiotocography was requested for 170 because of clinical indications. This group had higher incidences of abnormal cardiotocography (p less than 0.001), fetal growth retardation (p less than 0.001) and neonatal deaths (p less than 0.025) than had the group without such requests, suggesting that clinicians effectively selected the high-risk pregnancy for testing of fetal well-being. Cardiotocographic evidence of critical reserve was found in 17 of 170 patients (10%) tested for a clinical indication and in none of the 239 patients in the control group. Patients with abnormal cardiotocography results had significantly higher incidences of cord arterial blood pH less than 7.26 (p less than 0.05) and Apgar scores of less than 6 at 1 minute (p less than 0.001), showing that an abnormal cardiotocogram is indicative of a fetus at risk of having hypoxia.

Apgar Score↗
PubMed1985

Primary malignant fibrous histiocytoma of the uterus--ultrastructural and immunocytochemical studies of two cases.

The clinical and pathological features, including ultrastructural and immunocytochemical findings, of 2 cases of primary malignant fibrous histiocytoma of the uterus are reported. One patient had pulmonary metastases at the time of hysterectomy: she developed pelvic recurrence and died 3 mth after operation. The other patient was well and apparently free of disease 6 mth after hysterectomy. Histologically both tumours resembled pleomorphic leiomyosarcoma, and the diagnosis of a malignant fibrous histiocytoma was confirmed only after electron microscopic and immunocytochemical studies. Hormone receptor assay for estrogen and progesterone was positive in both tumours. Anti-estrogen treatment was started in one case but was ineffective.

Aged↗
PubMed1984

The outcome of pregnancies complicated by narcotic drug addiction.

The incidence of known narcotic drug addiction at 2 Maternity Hospitals in Melbourne was 0.06% (45 of 80,950 confinements). The obstetric results of these 45 pregnancies were unexpectedly favourable, the main complications being fetal growth retardation (27%) and premature birth before 37 weeks (27%). There were no fetal malformations and only 1 perinatal death. Follow-up information is necessary to ascertain if the main hazard to these infants lies in the environment to which they return.

Adolescent↗
PubMed1983

Quality of survival of infants with critical fetal reserve detected by antenatal cardiotocography.

During the 8-year period 1973 to 1980, antenatal cardiotocographic monitoring was performed on 3,006 high-risk pregnancies selected from a total obstetric population of 37,856 patients. A critical fetal reserve was detected in 72 patients (2.3%) whose pregnancies resulted in 20 perinatal deaths and 52 infants who survived the neonatal period; 45 of these infants have been assessed at ages ranging from 2 months to 8 years, 9 months. Growth was below the tenth percentile in 25.0% for weight, 23.3% for length, and 22.5% for head circumference at the review examination. Neurological abnormalities were detected in 12 infants but the abnormality was major in only four, including one who has familial interstitial polyneuropathy. The quality of survival of infants delivered of pregnancies complicated by critical fetal reserve is satisfactory; 93.2% had no neurological impairment likely to interfere with quality of life and indeed 13.5% had superior intelligence. Cardiotocographic evidence of critical fetal reserve does not signify that the fetus is doomed; delivery by cesarean section is indicated if the fetus is viable and has no ultrasonic evidence of untreatable major malformation.

Adult↗
PubMed1983

Non-immune hydrops fetalis: changing contribution to perinatal mortality.

During the decade to 1979, 203 hydropic infants died in the State of Victoria, Australia. Non-immune hydrops fetalis (NIHF) became more common than immune hydrops fetalis as a cause of fetal hydrops, and its contribution to the total perinatal mortality increased from 0.1% to 3%. The perinatal mortality rate of infants with NIHF was virtually 100%. The most consistent finding at post-mortem was pulmonary hypoplasia which was probably due to compression from serous cavity effusions. Survival may be improved by early diagnosis and termination of the pregnancy in selected patients with viable infants before the development of gross serous cavity effusions. The most constant clinical sign associated with hydrops fetalis was polyhydramnios which is an indication for ultrasonography and cardiotocography to detect cases of NIHF and to select the optimum time for delivery.

Australia↗
PubMed1983

Prospective follow-up of growth retarded infants and of those from pregnancies complicated by low oestriol excretion--7 years.

Growth and neurological outcome to 7 years of age were determined in 273 growth retarded infants, 341 infants from pregnancies complicated by subnormal urinary oestriol excretion and 72 control infants. By 1 year of age 80.6% of growth retarded infants were above the 10th percentile for weight. Growth continued so that after 2 years of age only 10.6% were beneath the 10th percentile. A neurological abnormality was detected in 9.5% of growth retarded infants and 8.3% of control infants (P = NS). Only 6 (2.2%) of the growth retarded infants were severely handicapped. A neurological abnormality was detected in 16.4% of infants from pregnancies with low oestriol excretion and although this incidence was higher than that of the control infants (8.3%), the difference failed to achieve statistical significance. The neurological abnormality was severe in only 7 infants (2.1%). The intelligence quotient (IQ) was the same in infants from pregnancies complicated by chronically low oestriol excretion whether hypertonic dextrose (mean IQ 103) had been administered to the mother or not (mean IQ 105). It is concluded that the pregnancy complicated by low oestriol excretion and/or fetal growth retardation should be treated with optimism.

Child↗
PubMed1983

Intrauterine growth retardation.

Fetal growth retardation ranks third after prematurity and malformations as a cause of perinatal deaths. Antenatal fetal monitoring (biochemical testing of fetoplacental function plus cardiotocography) has emerged as the most important means of reduction in the number of stillbirths and improvement in the quality of survival of infants who are born alive. Clinical acumen combined with biochemical and/or ultrasonographic testing will identify no more than 70% of growth retarded fetuses. However, not all small for dates fetuses are at risk, and many doomed to die in utero are not by definition, growth retarded. It should be the obstetrician's aim to identify the fetus at risk of death from hypoxia whether growth retarded or not. Biochemical and ultrasonographic methods of testing are not truly comparable, since some aim to identify the growth retarded fetus, irrespective of his state of health, whereas others aim to detect fetoplacental dysfunction, irrespective of whether or not the fetus is growth retarded. With present methods of antenatal diagnosis and treatment and timing of delivery determined by nonstressed cardiotocography, the physical and intellectual prognosis of growth retarded infants is most satisfactory; follow-up studies have shown that only about 2% of these infants are severely handicapped.

Delivery, Obstetric↗