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Biomedical subjects

O Langer

Publications and source records attributed to O Langer.

126 records · Page 7Linked to original sources
PubMed1985

The heightened significance of prolonged bradycardia associated with intrauterine growth retardation.

The significance and management of prepartum bradycardia is not well established in prepartum fetal assessment. The incidence of prolonged bradycardia was 3.5% (45 per 1284), defined as a decrease of greater than or equal to 40 beats per minute of the fetal heart rate (FHR) below the baseline for at least 2 minutes. Thirty-two maternal, fetal, and FHR tracing characteristics were examined to study correlations between the variables, the presence of the bradycardia, and neonatal outcome. Neonatal outcome was evaluated by dividing the population into two groups. Group 1 consisted of infants with 1-minute Apgar scores less than 6 and NICU admissions greater than 24 hours. Group 2 comprised infants with 1-minute Apgar scores greater than 6 and no NICU admission or less than 24 hours NICU admission. IUGR was diagnosed in 40% of the patients. Statistically significant associations were found for correlations between Group 1 infants and IUGR (P less than .05), oligohydramnios (P less than .05), cesarean section rate (P less than .04), and the presence of meconium (P less than .01). There were no fetal heart rate characteristics found to be significantly associated with IUGR or neonatal outcome. The data do not support the need for immediate delivery in patients with prolonged prepartum bradycardia, but its presence does warrant a workup for intrauterine growth retardation.

Amniotic Fluid↗
PubMed1985

Terminal pattern: characteristics and management.

Terminal prepartum patterns from 31 patients were associated with 39% perinatal mortality rate and major degrees of perinatal asphyxia among survivors. Conditions most commonly associated with these patterns were intrauterine growth retardation, preeclampsia, and prolonged pregnancy. NST patterns in which there was absence of accelerations, absent or reduced variability, with or without variable or shallow late decelerations, portended very omnious outcomes when accompanied by absent fetal movements and/or oligohydramnios. Perinatal mortality was 39% under these circumstances. Immediate cesarean section is warranted when this situation is encountered.

Asphyxia Neonatorum↗
PubMed1983

Prolactin, cortisol and thyroxine levels and the premature infant.

The relationship of prolactin, cortisol and thyroxine values in cord and maternal plasma to fetal age and weight and to the incidence of hyaline membrane disease (HMD) was investigated in 80 neonates of whom 40 were born at more than 37 weeks' gestation. Of the 40 born at less than 36 weeks 11 developed HMD. Serum cortisol has been shown to be a differentiating factor for HMD, but cord thyroxine and prolactin levels seem to be related more to age and weight than to the occurrence of HMD.

Fetal Blood↗
PubMed1982

Obstetrics in the very young black South African teenager.

A group of 200 14-16-year-old Black obstetric patients was compared with controls aged 20-23 years. We found a significantly higher incidence of occipitoposterior presentations in the former group, resulting in higher caesarean section and assisted delivery rates. Decreases i the incidence of pre-eclamptic toxaemia and in perinatal mortality are evident in comparison with a similar study 10 years age.

Adolescent↗
PubMed1982

Characteristics and management of intrapartum prolonged fetal bradycardia.

Twenty-five patients had intrapartum prolonged fetal bradycardia, defined as a drop of the fetal heart rate (FHR) by greater than or equal to 50 beats/min maintained for greater than or equal to 3 min; 10 were delivered by caesarean section and 15 vaginally. The only neonatal death occurred in the group delivered abdominally. Statistical analysis showed no difference in amplitude or duration of deceleration in the two groups but the 1 and 5 min Apgar scores were higher in the group delivered vaginally (P less than 0.01), whereas the onset of deceleration to delivery interval was shorter in the group delivered by caesarean section (p less than 0.005). Appropriate management of prolonged bradycardia is outlined and the characteristics of the FHR tracings are identified that are of prognostic value in determining whether or not immediate delivery is indicated.

Adolescent↗
PubMed1980

Effect of addition of 10% Amberlite XAD-2 to the diet on serum cholesterol and atherogenesis in rabbits.

The effects of addition of the polystyrene resin XAD-2 to the diet of rabbits on serum cholesterol, on hepatic enzyme of cholesterol synthesis (HMG-CoA reductase), and on atherogenesis was determined. Feeding of XAD-2 caused substantial decrease of total serum cholesterol and of the cholesterol of the apo B-containing lipoproteins (50%). Atherogenesis, which was induced by mechanical injury to the arterial wall, greatly decreased (p < 0.01) in animals fed with 10% XAD-2 supplement in their diet. Average lesions volume of 4.2 +/- 2.0 mm3 per aorta was observed in animals maintained on XAD-2 diet, in comparison to 15.42 +/- 3.3 mm3 in animals maintained on regular diet. The animals maintained on XAD-2 showed elevated activity of hepatic HMG-CoA reductase. The activity of this enzyme was 3.2 fold that obtained from livers of control animals.

Animals↗
PubMedDate not supplied

Delayed appearance of pulmonary maturation markers is associated with poor glucose control in diabetic pregnancies.

Fetuses born after pregnancies complicated by diabetes display delayed pulmonary maturation as measured by the delayed appearance of biochemical indicators of pulmonary maturity (phosphatidylglycerol, lecithin/sphingomyelin ratio) and by the occurrence of hyaline membrane disease even in term gestations. We tested the hypothesis that poor maternal glycemic control is associated with delayed appearance of the biochemical markers of fetal pulmonary maturation. Consecutive diabetic pregnancies with documentation of maternal glycemic control and amniotic fluid analysis for PG were analyzed. Maternal glycemic control was defined as good if the mean blood glucose was < or = 5.8 mmol/L (105 mg/dl) and poor if > 5.8 mmol/L. The presence of amniotic fluid phosphatidylglycerol was considered an indicator of lung maturity. Hyaline membrane disease was defined by the criteria of Corbet et al. [J Pediatr 118:277-284, 1991]. A total of 621 diabetic pregnancies were analyzed (261 good glycemic control, 360 poor glycemic control). Phosphatidylglycerol was absent in 21% of good glycemic control vs. 31% of poor glycemic control pregnancies (P < 0.05). When stratified by gestational age, the risk of absence of phosphatidylglycerol was significantly higher in the poor glycemic control group (O.R. 1.83, 1.19-2.84). At 36-37.9 weeks, poor glycemic control pregnancies had significantly higher rates of absent phosphatidylglycerol (37% vs. 22%, O.R. 2.04, 1.1-3.9). All cases of hyaline membrane disease beyond 32 weeks gestation occurred in poor glycemic control pregnancies. There were no cases of hyaline membrane disease beyond 37.0 weeks gestation. We conclude that poorly controlled maternal glucose levels are associated with delayed appearance of phosphatidylglycerol in diabetic pregnancies. However, after 37.0 weeks of gestation, no significant neonatal pulmonary disease occurred.

Biomarkers↗
PubMedDate not supplied

Isolated oligohydramnios in the term pregnancy: is it a clinical entity?

The aim of this study was to test the hypothesis that isolated oligohydramnios in the otherwise normal term pregnancy does not indicate fetal compromise. Women undergoing labor induction for isolated oligohydramnios between 37 and 41-6/7 weeks gestation were matched by gestational age and parity to women with normal amniotic fluid index measurements who presented in spontaneous labor. Pregnancies complicated by hypertension, diabetes, fetal anomalies, or suspected fetal growth restriction were excluded. The primary outcome variable was route of delivery. Secondary outcomes examined included presence of meconium, acidosis, low Apgar score, and NICU admission. A total of 183 women underwent induction for isolated oligohydramnios. When compared to the control group, neonatal outcome measures did not differ in the group induced for oligohydramnios. However, the women who were induced had significantly more cesarean deliveries (15.8% vs. 6.6%, P < 0.01, odds ratio 2.7). The increased need for operative delivery was not attributable to more fetal distress in the oligohydramnios group. We conclude that isolated oligohydramnios in the otherwise normal term pregnancy may not be a marker for fetal compromise, and induction of labor may not be warranted in most cases.

Adult↗
PubMedDate not supplied

Pre-existing diabetics: relationship between glycemic control and emotional status in pregnancy.

Due to the paucity of information regarding the emotional status of pregnant diabetic women, we sought to determine the impact of pre-existing diabetes on the relation between the level of glycemic control and emotional well-being during pregnancy. English-speaking women with pre-existing diabetes mellitus (N = 100) and nondiabetic controls (N = 132) were compared for maternal characteristics and test results on the Profile of Mood States-Bipolar form. It is a 72-item, self-administered Likert scale measuring six bipolar subjective mood states representing both positive and negative aspects. Patients were stratified according to level of glycemic control. The number of glucose determinations were categorized as: mild and severe hypoglycemia and hyperglycemia, and normoglycemia. An Average Mood Disturbance score was calculated to measure the level of association between the total psychological profile and categories of glucose determinations. In two of the six subscales (hostility and anxiety) of the Profile of Mood States, significantly lower scores indicating greater hostility and anxiety were found in the diabetic group. The level of glycemic control was not adversely associated with the emotional state of pre-existing diabetic pregnant women. The psychological profile was not associated with the severity of the disease as reflected by the diabetes classification. Pregnant women with pre-existing diabetes display greater anxiety and hostility in comparison to nondiabetic women with no association to level of glycemic control. This issue should be addressed in the medical and psychosocial health assessment of these women.

Affect↗
PubMedDate not supplied

Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers.

The objective was to investigate the hypothesis that anthropometric and body composition differences exist between macrosomic infants of diabetic and nondiabetic mothers. Sixteen infants of mothers with diabetes, along with 58 control infants, were studied within 24 hours of delivery. The following measurements were obtained: birthweight, birth length and extremity length; circumferences of the head, chest, shoulders, and extremities; and triceps, subscapular, flank, and thigh skinfolds. Estimation of fat mass and calculation of percent body fat was performed according to the Dauncey method. Macrosomic infants of diabetic mothers were characterized by larger shoulder and extremity circumferences, a decreased head-to-shoulder ratio, significantly higher body fat, and thicker upper extremity skinfolds compared with nondiabetic control infants of similar birthweight and birth length. Differences in body composition and weight distribution may explain the propensity for shoulder dystocia in the diabetic population.

Adult↗
PubMedDate not supplied

Level of glycemia and perinatal outcome in pregestational diabetes.

This article provides the reader with relevant information regarding the association between level of glycemia and perinatal outcome in preexisting diabetes. Although the glycemic profile is a continuum in nature, different thresholds of glucose are associated with fetal complications such as stillbirth, spontaneous abortion, congenital anomalies, fetal macrosomia, and metabolic and respiratory complications. For each complication, a different targeted threshold of normality is required. Thus, although it is not always possible to achieve optimal glycemic control in all patients, any improvement will be beneficial because it will reduce the rate of complications for a given glucose threshold.

Abortion, Spontaneous↗
PubMedDate not supplied

Human placental transfer of the prostaglandin inhibitor sulindac using an in vitro model.

OBJECTIVE: We determined whether the prostaglandin inhibitor sulindac crosses the human placenta. METHODS: The recirculating single-cotyledon placenta model was used to characterize the maternal-to-fetal and fetal-to-maternal transport of 14C-labeled sulindac in normal term placentas perfused immediately after delivery. Antipyrine was added as a standard for simple diffusion. Serial samples were taken from both reservoirs during each 3-hour perfusion. Transport was calculated using liquid scintillation spectrometry for 14C-labeled sulindac and high-performance liquid chromatography for antipyrine. RESULTS: There was significant maternal-to-fetal transfer of sulindac. The mean (+/- SD) transfer at 2 hours was 7.22 +/- 2.57%. The fetal-to-maternal transfer was similar at 10.75 +/- 3.80%. The mean maternal/fetal concentration ratio of sulindac was 0.42 at 3 hours. Placental uptake ranged from 24-45 ng/g of placenta. CONCLUSIONS: Sulindac crosses the human placenta in small but significant amounts. The transport is similar in both directions, implying simple diffusion.

Antipyrine↗
PubMedDate not supplied

Comparison of pregnancy mood profiles in gestational diabetes and preexisting diabetes.

PURPOSE: This study sought to answer the following questions: How does intensified diabetes management affect the patient's mood profile? Is there a relationship between levels of glycemic control and emotional profile? Which factors distinguish the emotional profile of women with pregestational diabetes from women with newly diagnosed gestational diabetes? METHODS: A secondary analysis was conducted of women with newly diagnosed gestational diabetes (GDM), pregestational diabetes (PGDM), and nondiabetic controls. Those with diabetes were treated with an intensified approach. All participants responded to a questionnaire measuring bipolar subjective mood states. The relation between diabetes types, glucose characteristics during pregnancy, and mood were analyzed. RESULTS: The mood profile was significantly associated with level of glycemic control in GDM women (comparable to controls). PGDM women were not affected by either level of glycemic control or diabetes class categories. The number of glucose determinations, marital status, and maternal age were related to mood profile for GDM women. CONCLUSIONS: Because women with GDM and PGDM present different mood profiles in pregnancy, customized medical/behavioral goals may be needed to enhance compliance and optimize perinatal outcome.

Affect↗
PubMedDate not supplied

Ambulatory glucose profile: representation of verified self-monitored blood glucose data.

Sixty-nine individuals with diabetes (23 with type I, 15 with pregestational, and 31 with gestational) used specially modified reflectance meters containing memory chips enabling the instruments to store 440 individual blood glucose values with corresponding time and date. These data were organized into 14-day periods and then collapsed into a graphic depiction, the Ambulatory Glucose Profile (AGP), which was represented as the pattern of the 25th, 50th, and 75th percentiles of blood glucose values. These three curves illustrate the median level of control and provide an index of variability in control at each hour of a "typical day." We observed distinctive AGPs related to the variability in metabolic control and the type of diabetes. Comparisons between diagnostic groups showed consistent differences between groups, independent of level of glycemic control. Review of serial AGPs obtained for sequential 2-wk periods for 23 non-pregnant individuals with type I diabetes and 10 women with gestational diabetes revealed changes in AGP corresponding to alterations in regimen. The AGP provides a new approach to the evaluation of glycemic control, with applications to patient and physician education, clinical investigation, and individual patient care.

Adult↗
PubMedDate not supplied

Abnormal growth patterns in diabetes in pregnancy: a longitudinal study.

In this longitudinal study we sought to investigate the presence of different abnormal fetal growth patterns in the pregnant diabetic. At least three serial ultrasound examinations were performed during the third trimester on 522 diabetic and 93 control subjects. Growth curves were established for femur length, abdominal circumference and head circumference. In addition, daily growth rate was calculated for fetal weight and all morphometric measurements. The study revealed: a) in the gestational diabetes group large-for-gestational age infants, two accelerated growth patterns (early mean blood glucose 107 +/- 16 and late mean blood glucose 116 +/- 18) were identified; b) there was a significantly larger abdominal circumference (expressed as an age-related percentile) in the early than in the late pattern (88 +/- 10 vs. 60 +/- 18, P less than 0.05); c) femur length, head circumference and growth rate were similar for large-for-gestational age and appropriate-for-gestational age fetuses; d) in the control macrosomic infants (n = 57), the percentile of femur length, head circumference and abdominal circumference within 4 days of delivery were 91 +/- 11, 89 +/- 10, 60 +/- 26, respectively; e) analysis for small-for-gestational age infants showed a similarity in the morphometric measurements and growth rate of insulin-dependent diabetes mellitus and hypertensive control subjects; and f) in contrast, a significantly larger abdominal circumference was found in the gestational diabetes small-for-gestational age infants than in the previous small-for-gestational age groups. Recognition of the specific dynamics and characteristics of these patterns will allow for early detection of the fetus at risk, which in turn will improve clinical decision-making.

Abdomen↗
PubMedDate not supplied

Scientific rationale for management of diabetes in pregnancy. Recent approaches with innovative computer-based technology.

A series of recent studies in women with gestational diabetes mellitus is reviewed. During the studies, which were designed to gain a better understanding of the etiology of perinatal morbidity, a novel means of collecting ambulatory blood glucose values was employed. Subjects used specially modified reflectance meters with onboard memories to record each value with corresponding time and date. The data were transmitted to a microcomputer and rapidly analyzed to permit effective follow-up in the study population. The system enabled the investigators to characterize metabolic control, evaluate different treatment modalities, and measure the association between glycemic control and fetal outcome. These studies indicate that patients with one elevated blood glucose value during formal glucose tolerance testings have higher blood glucose values under ambulatory conditions. Furthermore, these elevated ambulatory glucose values were significantly correlated with fetal macrosomia. Treatment regimens designed to lower verified ambulatory blood glucose measurements may help reduce fetal macrosomia in women with milder forms of gestational diabetes or in women with relative glucose intolerance without a substantial increase in severe hypoglycemia.

Blood Glucose Self-Monitoring↗