Search PubMed⌕ Search

Biomedical subjects

O Langer

Publications and source records attributed to O Langer.

At least 109 records · Page 6Linked to original sources
PubMed1989

Clinical management of the fetus with markedly diminished umbilical artery end-diastolic flow.

This study was conducted to evaluate prospectively a management protocol for fetuses with a markedly abnormal umbilical artery velocity waveform. The study population consisted of fetuses whose systolic/diastolic ratio was greater than 2 SD above the mean for gestational age. The matched control population consisted of fetuses with similar gestational ages, indications for testing, and estimated fetal weights with normal systolic/diastolic ratios. Abnormal Doppler results were used only to determine the frequency of fetal testing. Biophysical profile testing was performed semiweekly on all patients. Patients with absent or reversed end-diastolic flow were admitted for daily testing. The following criteria were used as indications for delivery: (1) worsening maternal condition, (2) oligohydramnios, (3) intrauterine growth retardation with lung maturity, and (4) biophysical profile score less than or equal to 4. Fifty-one patients (7%) had abnormal Doppler blood flow velocity studies. When the study population was compared with the control population at the time of delivery, there were no differences in umbilical artery pH, Apgar score, or incidence of intrauterine growth retardation. However, study patients were delivered at a significantly lower gestational age and lower birth weight and experienced a higher likelihood of neonatal intensive care unit admission. When study patients with documented end-diastolic flow were compared with study patients with no end-diastolic flow, there were no differences in umbilical artery pH, Apgar score, or incidence of intrauterine growth retardation. However, fetuses with no end-diastolic flow had a significantly shorter test-to-delivery interval, lower gestational age, lower birth weight, and more neonatal intensive care unit admissions. There were no perinatal deaths among the study patients. The range of systolic/diastolic ratios for the five patients who failed to follow our protocol for intensive maternal-fetal surveillance was 4.3 to infinity; all experienced fetal death within 18 days. These results suggest that immediate delivery of the fetus with diminished end-diastolic flow may not be mandatory. The combined use of fetal biophysical testing and commonly used criteria for delivery results in acceptable fetal outcome and prolongation of gestational age.

Blood Flow Velocity↗
PubMed1989

Changes in the pattern of uterine contractility in relationship to coitus during pregnancies at low and high risk for preterm labor.

This is a preliminary, prospective study of uterine contractility in response to sexual intercourse. The study population consisted of 30 pregnant subjects. Group I included 15 women treated for an episode of preterm labor with intravenous and oral tocolysis in this pregnancy, and group II was a matched control group of low-risk volunteers. The availability of home uterine tocodynamometric systems permitted monitoring of uterine contractility for three 60-minute time periods related to coitus. A significant increase in uterine contractility in the immediate postcoital period was observed for the high-risk women, but not for the controls. This increased uterine activity subsided spontaneously within 2-3 hours, returning to baseline. These initial preliminary observations of uterine response to coitus in a home environment are interesting; however, further research is suggested to establish their clinical implications.

Adult↗
PubMed1988

The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes.

In this prospective study 246 women with gestational diabetes were followed up to determine the characteristics of metabolic control associated with large-for-gestational-age infants. Memory-based reflectance meters were used for self-monitoring blood glucose. Ambulatory glucose profiles were produced to characterize glycemic control levels throughout pregnancy. With these novel approaches to the collection and representation of glucose data, the severity of glucose intolerance (hyperglycemia) was found to be associated with both maternal and neonatal morbidity in terms of infant size and cesarean section rate. By use of hierarchical cluster analysis to identify three groups on the basis of control levels (low less than 87 mg/dl, mid 87 to 105 mg/dl, high greater than 105 mg/dl) we were able to show a positive outcome in the low group with reduced rates of large-for-gestational-age (2%) and macrosomatic (0%) infants. Furthermore, we showed that as mean blood glucose levels and instability in glycemic control increased from group to group, incidence of large-for-gestational-age and macrosomatic infants increased. Whereas obesity increased the relative risk of adverse neonatal outcome, type of treatment (insulin versus diet) did not appear to be significant. Appropriately monitored toward stability within a narrow range to achieve tight metabolic control, ambulatory glycemia in pregnancy is associated with a decreased risk of maternal and fetal complications.

Blood Glucose↗
PubMed1988

The application of uterine and umbilical artery velocimetry to the antenatal supervision of pregnancies complicated by maternal sickle hemoglobinopathies.

To assess the efficacy of Doppler flow velocimetry in predicting fetal compromise and neonatal outcome in pregnant women with sickle cell hemoglobinopathies, a prospective study was conducted of 96 patients, 48 with sickle cell hemoglobinopathy (8 with SS and 40 with AS hemoglobin) and 48 low-risk AA hemoglobin controls. All subjects were followed biweekly from the third trimester of pregnancy through delivery with uterine and umbilical artery velocimetry, nonstress, tests, and hematocrit and blood pressure measurements. An abnormal systolic/diastolic ratio was defined as a value greater than or equal to 3. The incidence of abnormal systolic/diastolic ratios for uterine or umbilical arteries was significantly higher in pregnant women with SS hemoglobin (88%) when compared with patients with AS (7%) and AA (4%) hemoglobin. In addition, the abnormal systolic/diastolic ratios for both umbilical and uterine arteries are correlated with abnormal nonstress test results. The nonstress test results became abnormal on average 3 weeks after the systolic/diastolic ratios did. The presence of abnormal systolic/diastolic ratios for umbilical and uterine arteries is predictive of fetal distress and infants small for gestational age. The high incidence of concordant uterine and umbilical artery abnormal systolic/diastolic ratios in pregnant women with SS hemoglobinopathy, which were identified earlier than were abnormal nonstress results, suggests an important parameter in the monitoring of these high-risk pregnancies.

Adult↗
PubMed1988

Pregestational diabetes: insulin requirements throughout pregnancy.

The management of pregestational diabetes requires tight metabolic control to reduce maternal and perinatal morbidity and mortality. It has been suggested that type I diabetes is a disorder characterized by insulin deficiency and type II diabetes is characterized by insulin resistance; however, it may be hypothesized that a difference in insulin requirements should emerge throughout pregnancy to reflect the dissimilarities in these two metabolic disturbances. The current investigation of 103 women with pregestational diabetes used a novel approach (reflectance meters with onboard memories) to uncover the actual insulin dosages required to reach and maintain optimum metabolic control throughout pregnancy. It was found that both type I and type II diabetes appear to have a triphasic insulin pattern, with the patient having type II diabetes requiring significantly higher doses of insulin during each trimester. This seems to suggest that the hormonal changes in pregnancy may have a similar effect on both type I and type II diabetes but to a different degree. Thus this should be considered in the treatment of pregestational diabetes and in the development of an algorithm for diabetes management.

Adult↗
PubMed1988

An association between hyperinsulinemia and hypertension during the third trimester of pregnancy.

We studied 43 women in their third trimester of pregnancy whose fetuses were at significant risk of intrauterine growth retardation. To define metabolic subtypes for intrauterine growth retardation, a 100 gm glucose load was administered after an overnight fast. Twenty-seven women were normotensive and 16 had hypertension. The glucose tolerance of the hypertensive group was essentially the same as that of the normotensive group. However, 8 of the 16 women with hypertension had marked hyperinsulinemia in response to an oral glucose load. Of the five women with hypertension who gave birth to offspring of low birth weight, three had hyperinsulinemia.

Blood Glucose↗
PubMed1988

Primary, secondary, and tertiary prevention. Program for diabetes in pregnancy.

Over the past 2 yr the effectiveness of a program in primary, secondary, and tertiary prevention of diabetes in pregnancy was studied. The purpose of the program was to determine the degree to which preventive medicine in terms of early screening and diagnosis, rapid initiation of treatment, and close follow-up surveillance could reduce the morbidity and mortality associated with pregestational and gestational diabetes. The study compared the program in prevention with previous programs, and its results were measured against national criteria established by the Centers for Disease Control. A significant increase in early identification of gestational diabetes and a decrease in fetal and maternal complications were detected.

Female↗
PubMed1988

Intrauterine growth retardation--a prospective study of the diagnostic value of real-time sonography combined with umbilical artery flow velocimetry.

This study was undertaken to evaluate the role of umbilical artery flow velocimetry combined with sonographic estimation of fetal weight, head circumference to abdominal circumference ratio, femur length to abdominal circumference ratio, and qualitative determination of amniotic fluid volume as a comprehensive test for the detection of intrauterine growth retardation (IUGR). The following cutoff values were used to indicate abnormal test results: 1) umbilical artery peak systolic to end-diastolic ratio (S/D) above 3, 2) estimated fetal weight below the tenth percentile for gestational age, 3) head circumference to abdominal circumference ratio more than 2 SD above the mean for gestational age, 4) femur length to abdominal circumference ratio above 23.5%, and 5) qualitative amniotic fluid volume less than 2 cm. The study population consisted of 127 patients referred with a clinical suspicion of IUGR. Forty-five infants (35%) were small for gestational age. None of these five tests were uniformly successful in identifying growth-retarded infants. Overall, the best predictor appeared to be estimated fetal weight below the tenth percentile for gestational age, which correctly identified 39 of the 45 IUGR infants (sensitivity 87%, specificity 87%). The sensitivity of this test was nearly twice that of any other test. All indices performed similarly in predicting the non-IUGR infant (range of specificities 87-98%).

Blood Flow Velocity↗
PubMed1987

Gestational diabetes: insulin requirements in pregnancy.

A prospective study of 57 women with gestational diabetes mellitus was undertaken to determine actual insulin requirements throughout pregnancy. Women were placed on a multiple injection, mixed insulin regimen and monitored their blood glucose level 6.5 +/- 1 times per day using a memory-based reflectance meter to obtain verified data. A significant (p less than 0.01) increase in total insulin dose was found during the initial treatment period (7 +/- 2 days) until the target glucose range was achieved. Insulin requirements continued to significantly (p less than 0.01) rise until 30 +/- 1 gestational weeks, despite a stabilization of glucose level. Thereafter, there was no significant change (3%) in insulin requirement. A correlation of r = 0.58 (p less than 0.001) for the relationship between insulin dose at the 24 and 32 weeks' gestation, and an r = 0.99 (p less than 0.0001) for the relationship between insulin dose at 32 and 39 weeks' gestation was found. We concluded that an emphasis on ambulatory blood glucose control and insulin adjustments should occur in the early treatment phase of gestational diabetes.

Adult↗
PubMed1987

Verified self-monitored blood glucose data versus glycosylated hemoglobin and glycosylated serum protein as a means of predicting short- and long-term metabolic control in gestational diabetes.

Glycosylated hemoglobin and glycosylated serum protein have been suggested as tools for evaluation of long- and short-term glycemic control, respectively. Twenty-six patients with gestational diabetes were prospectively studied to determine the relationship of glycosylated hemoglobin and glycosylated serum protein to metabolic control. To verify the accuracy of blood glucose data, a memory-based reflectance meter was used for subjects with gestational diabetes who tested 6.5 +/- 1 times per day. Our analysis revealed that despite a statistically positive correlation between glycosylated hemoglobin, glycosylated serum protein, and verified data, their use as a clinical tool is limited because of their poor predictability.

Adult↗
PubMed1987

The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy.

A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p less than 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p less than 0.01) and gestational diabetes mellitus group (34% versus 12%; p less than 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3%). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome.

Adult↗
PubMed1987

Intrapartum vibratory acoustic stimulation of the human fetus during episodes of decreased heart rate variability.

The effects of intrapartum vibratory acoustic stimulation during periods of decreased fetal heart rate variability were studied in 25 healthy term fetuses. Fetal monitoring and real-time ultrasound scanning were used simultaneously to detect fetal response. Vibratory acoustic stimulation was provided by an artificial larynx generating a signal at 85 dB and 85 Hz. This stimulus was applied for 5 seconds on the maternal abdomen over the fetal head after a 20-minute period of decreased fetal heart rate variability. All fetuses reacted with an immediate fetal heart rate acceleration of at least 10 bpm (range: 10 to 35 bpm, mean +/- SD = 18.4 +/- 7.0), and 19 fetuses also had sudden fetal body movement. A deceleration of the fetal heart rate after the initial acceleration was observed in nine fetuses (range: 15 to 70 bpm, mean +/- SD = 45.5 +/- 16.5). The implications of these findings are discussed in relation to the possible use of fetal vibratory acoustic stimulation for intrapartum surveillance.

Acoustic Stimulation↗
PubMed1987

Fetal umbilical artery flow velocimetry in postdate pregnancies.

This study prospectively examined the use of umbilical artery flow velocimetry for monitoring fetal health in postdate pregnancies. Forty-six patients with well-established dates were evaluated with semiweekly biophysical profiles and umbilical artery flow velocimetry (characterized by the ratio of the peak systolic to end-diastolic velocity). Their labor records were reviewed, and neonates were examined for signs of postmaturity. Twenty neonates had an abnormal test result or outcome (identified as an abnormal nonstress test, oligohydramnios, meconium, intrapartum fetal distress, or a 5-minute Apgar score less than 7). Nine neonates had a physical examination consistent with the postmaturity syndrome. Twenty-one neonates were entirely normal. Comparisons of the mean systolic/diastolic ratios for neonates with and without the complications associated with postdatism showed no significant differences. In addition, all systolic/diastolic ratios were within the normal range. Therefore, umbilical artery flow velocimetry is unlikely to be useful for the routine antenatal assessment of the postdate fetus.

Blood Flow Velocity↗
PubMed1986

Diminished respiratory sinus arrhythmia in asphyxiated term infants.

Spectral analysis techniques were used to quantitate the association between respiration and heart rate variability in eight healthy and eight asphyxiated infants born at term gestation. Respiratory sinus arrhythmia was demonstrated in all healthy infants. This arrhythmia was significantly diminished in asphyxiated newborn infants. We conclude that newborn infants with low Apgar scores have a reduced respiratory sinus arrhythmia and that this reduction could account for the loss of short-term heart rate variability commonly associated with asphyxia.

Apgar Score↗
PubMed1986

The significance of antepartum variable decelerations.

A total of 4886 nonstress tests were reviewed to establish the relationship between antepartum variable decelerations and perinatal outcome. The association between various fetal heart rate components and variable decelerations was also studied. The incidence of variable decelerations, defined as three or more decelerations greater than or equal to 15 bpm lasting at least 15 seconds in a 20-minute period, was 1.3%. The results suggest that in the presence of variable decelerations: there is a higher incidence of fetal distress in labor, low Apgar scores, neonatal intensive care unit admissions, and nuchal cord involvement; the presence of accelerations and normal variability is associated with good neonatal outcome, whereas their absence is associated with adverse outcome; the presence of accelerations or good variability is not independently correlated with neonatal outcome.

Apgar Score↗
PubMed1986

A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation.

Early identification of the intrauterine growth-retarded fetus is a key factor in improving associated perinatal morbidity and mortality. We investigated, in a prospective study of 43 patients at high risk of intrauterine growth retardation, the predictive value of a derived glucose index and whether hypoglycemia accompanied by hypoinsulinemia in normotensive patients is associated with intrauterine growth retardation. Our findings suggest that the glucose index and 2-hour plasma glucose concentration appear to be useful antepartum predictors of intrauterine growth retardation in normotensive high-risk pregnancies. There is an apparent link between selective maternal hypoglycemia, hypoinsulinemia, and being small for gestational age. A "flat" glucose tolerance test should be regarded as an abnormal pattern in normotensive pregnancies as it was associated with a twentyfold increased risk of intrauterine growth retardation in this study.

Blood Glucose↗
PubMed1985

Unusual skeletal metastases in carcinoma of the cervix.

In a series of 1347 patients with carcinoma of the cervix, 62 or 4.6% had metastatic spread to the bones. Bone metastasis correlated with more advanced disease, occurring in 39.1% of patients with Stage II disease. The role of isotope bone scanning and of the radiographic skeletal survey in the investigation of carcinoma of the cervix is considered. Eight patients having unusual radiographic appearances of skeletal metastases are discussed.

Adult↗