Search PubMed⌕ Search

Biomedical subjects

P Samuels

Publications and source records attributed to P Samuels.

53 records · Page 3Linked to original sources
PubMed1990

Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura.

BACKGROUND AND METHODS: The optimal management of immune thrombocytopenic purpura during pregnancy remains controversial because the risk of severe neonatal thrombocytopenia remains uncertain. We studied the outcome of the index pregnancy in 162 women with a presumptive diagnosis of immune thrombocytopenic purpura to determine the frequency of neonatal thrombocytopenia and to determine whether neonatal risk could be predicted antenatally by history or platelet-antibody testing. RESULTS: Two maternal characteristics were identified as predicting a low risk of severe neonatal thrombocytopenia: the absence of a history of immune thrombocytopenic purpura before pregnancy, and the absence of circulating platelet antibodies in the women who did have a history of the condition. Eighteen of 88 neonates (20 percent; 95 percent confidence interval, 13 to 30 percent) born to women with a history of immune thrombocytopenic purpura had severe thrombocytopenia (platelet count less than 50 x 10(9) per liter at birth), as compared with 0 of 74 (0 percent; 95 percent confidence interval, 0 to 5 percent) born to women first noted to have thrombocytopenia during pregnancy (P less than 0.0001). Among the women with a history of immune thrombocytopenic purpura, 18 of 70 neonates (26 percent; 95 percent confidence interval, 16 to 38 percent) born to those with circulating platelet antibodies had severe thrombocytopenia, as compared with 0 of 18 infants (0 percent; 95 percent confidence interval, 0 to 18.5 percent) born to those without circulating antibodies (P less than 0.02). Thus, the risk of severe neonatal thrombocytopenia in the offspring of women without a history of immune thrombocytopenic purpura before pregnancy and of women with a history of the condition in whom circulating platelet antibodies are not detected was 0 percent (95 percent confidence intervals, 0 to 5 and 0 to 18.5 percent, respectively). CONCLUSIONS: The absence of a history of immune thrombocytopenic purpura or the presence of negative results on circulating-antibody testing in pregnant women indicates a minimal risk of severe neonatal thrombocytopenia in their offspring.

Autoantibodies↗
PubMed1990

Anesthetic considerations in premature birth.

Premature birth still accounts for about 75% of perinatal mortality. Although great strides have been made in the care of premature babies over the past two decades, markedly decreasing mortality, the prevention of premature birth has not been greatly improved. Although tocolysis, particularly with the beta-2 agonists and magnesium sulfate, may delay birth and allow fetal maturation, it poses several risks which, if not recognized, can cause serious morbidity and even mortality. The use of these drugs and other less widely used tocolytics has important implications for the anesthesiologist. The premature infant itself is subjected to such risks as RDS, IVH, NEC, asphyxia, hypothermia, increased incidence of breech presentation, metabolic disturbances, and predisposition for trauma. To ensure safe delivery, premature babies should be delivered in a tertiary care center equipped and ready to attend to their needs. Major conduction block, particularly continuous lumbar epidural analgesia, is an ideal form of analgesia for the delivery of most premature neonates. Properly administered, it maintains maternal physiology, is not associated with drug depression in the newborn, enables a controlled, atraumatic vaginal delivery, and has little interaction with tocolytics (and indeed may protect against some of their side effects). It is ideal for a trial of labor and, if initiated early, allows for an emergency cesarean section. Continuous lumbar epidural block and subarachnoid block are both superb for elective or urgent cesarean section. However, when their use is contraindicated, inhalation analgesia for vaginal delivery or general anesthesia for cesarean section can be safely administered from the standpoint of both mother and child. Expertly administered anesthesia is not a luxury but is indeed indispensable for successful premature delivery.

Adrenergic beta-Agonists↗
PubMed1990

Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetric setting.

During an 8-year period, we managed 42 women with 101 pregnancies with previously diagnosed but uncorrected uterine malformations referred to our institution for high-risk obstetric care. All patients were managed under the same standardized protocol requiring weekly visits and decreased physical activity. The population studied consisted of four groups of pregnancies with the following uterine anomalies: unicornuate (five), bicornuate (61), septate (25), and didelphys (ten). Sixty percent of the pregnancies in the unicornuate and didelphys group reached term, 39% in the bicornuate group, and 48% in the septate group. Preterm labor requiring tocolysis occurred in 21% of the pregnancies in the bicornuate group and 15% of the pregnancies in the septate group. Cerclage was placed in 5% of the pregnancies in the bicornuate group. Before our care, the fetal survival rate for pregnancies in the bicornuate and septate groups was 52 and 53%, respectively; with our management protocol, it was 58 and 65%, differences that were not statistically significant. Our experience suggests that high-risk obstetric intervention does not obviate the potential benefit of metroplasty, especially for patients with a bicornuate or septate uterus. We believe that traditional indications for metroplasty should continue to be used.

Abortion, Spontaneous↗
PubMed1989

Spontaneous small bowel obstruction associated with a spontaneous triplet gestation. A case report.

Spontaneous bowel obstruction in pregnancy is a rare event and usually associated with a prior history of surgical procedures or infection. Its symptoms can mimic physiologic changes in pregnancy or preterm labor. We treated a woman who had a triplet gestation and whose lack of predisposing factors delayed the diagnosis of obstruction. The patient delivered prematurely at 22 weeks and required surgery to alleviate the obstruction. The possibility of intestinal obstruction should be entertained in any pregnant woman presenting with nausea, vomiting and an overdistended uterus.

Adult↗
PubMed1989

Autoimmune diseases in pregnancy. The obstetrician's view.

Pregnancy in the patient with an autoimmune disease is a high-risk situation often resulting in preterm delivery or pregnancy loss. Pregnancy loss can occur in any trimester. These patients require special maternal and fetal surveillance by the obstetrician. Patients with normal renal function and blood pressure are associated with the best outcome. Cooperation between the obstetrician, rheumatologist, and pediatrician usually result in a good outcome for both mother and infant.

Anti-Inflammatory Agents↗
PubMed1988

Cerebrospinal fluid shunts in pregnancy. Report of two cases and review of the literature.

With the introduction of silicone indwelling cerebrospinal fluid (CSF) shunts in the 1960s, the prognosis for children with hydrocephalus changed dramatically. These individuals are leading normal and productive lives today. Many women with CSF shunts are not entering the childbearing years. Previously, only 13 cases of pregnancy occurring in patients with CSF shunts have been reported. We present two cases here and review the complications and outcome of the other reported cases. Shunt malfunction appears to be common in pregnancy due to increased intraperitoneal pressure and the enlarging uterus. Rarely is surgical correction or premature delivery necessary. A successful pregnancy ending in the vaginal delivery of a term infant can be expected in the majority of these patients.

Adult↗
PubMed1988

Ultrasound in the management of the twin gestation.

In summary, ultrasound plays an important role in a twin gestation from the time of diagnosis of the pregnancy until the time the second fetus is delivered. Although it has never been quantitated, ultrasound has made a large impact on the safe management of the twin gestation. As techniques are refined and technology is improved, ultrasound will become even more sensitive in detecting chorionicity and congenital anomalies. Doppler assessment of uterine and umbilical blood flows may also become an important tool in assessing fetal well-being in the multiple gestation.

Amniocentesis↗
PubMed1987

Management of the diethylstilbestrol-exposed pregnant patient: a prospective study.

Over a 5-year period we have managed 63 diethylstilbestrol-exposed pregnant patients with a standardized protocol requiring weekly cervical examination and decreased physical activity of the patient. Twenty-six patients (42%) underwent a prophylactic cerclage for a history of second-trimester loss or a hypoplastic cervix on initial clinical examination (group I). Thirty-six patients (58%) were followed expectantly (group II). Sixteen patients (44%) in group II demonstrated cervical change and required an emergency cerclage. Twenty-one patients were managed expectantly with no cerclage. The gestational age at delivery for group I was 37.7 +/- 2.80 versus 34.5 +/- 6.9 weeks for patients without a cerclage (p = 0.04). There were no perinatal deaths if a cerclage was performed, whereas there were five deaths (24%) in the group without cerclage. The five deaths occurred at a mean gestational age of 24.40 +/- 4.0 weeks and a mean birth weight of 614.00 +/- 441.73 gm. Patients with a hypoplastic cervix or prior reproductive loss had a better outcome with early cerclage than patients with a normal cervix followed expectantly. We presently lack a reliable method to detect the diethylstilbestrol-exposed patient at greatest risk for perinatal loss. Based on our experience we believe that placement of a cerclage early in pregnancy should be a strong consideration.

Adult↗
PubMed1987

The origin of increased serum iron in pregnancy-induced hypertension.

Serum iron was measured in 30 patients with pregnancy-induced hypertension and 24 normal pregnant women. The mean iron concentration was significantly higher in the group with pregnancy-induced hypertension (111 +/- 26 micrograms/ml) than in the controls (69 +/- 17 micrograms/ml) (p less than 0.0001). Readily available laboratory variables were used to determine whether the increased serum iron was the result of (1) hemolysis, (2) hepatocellular injury, or (3) intravascular volume contraction leading to hemoconcentration. It appears that a clinically silent, ongoing hemolytic reaction is responsible for the increase in serum iron seen in patients with pregnancy-induced hypertension.

Adult↗
PubMed1987

Abnormalities in platelet antiglobulin tests in preeclamptic mothers and their neonates.

We prospectively studied 40 women with preeclampsia and 26 women with normal pregnancy for the presence of platelet-bound and circulating platelet-bindable immunoglobulin and complement. Although only 12 patients with preeclampsia had a platelet count less than 150,000/mm3, 36 of 40 demonstrated an abnormal direct antiglobulin test, compared with only three of 26 control subjects (p less than 10(-8]. An abnormal indirect test was also detected in 30 of 40 patients with preeclampsia compared with five of 26 healthy pregnant control women (p = 9.3 X 10(-6]. Abnormal antiglobulin tests persisted for 2 to 6 weeks after delivery. Although each neonate had a platelet count greater than 200,000/mm3 at the time of delivery, 10 of 18 had an abnormal direct antiglobulin test compared with one of 14 control subjects (p = 0.0049). The high frequency of abnormal platelet antiglobulin tests in women with preeclampsia and their neonates may indicate an immune cause of certain aspects of the syndrome or may reflect the extent of platelet activation.

Adolescent↗
PubMed1980

Vibrio parahaemolyticus in Brazilian coastal waters.

Vibrio parahaemolyticus has been increasingly recognized as an important cause of acute diarrheal illness in Asia, Europe, Africa, Australia, and North America. We investigated whether this pathogen was also present in Brazil and found that 10% of the fish samples studied were contaminated with this halophilic vibrio. Positive cultures were obtained in three of 64 fish (5%) and in seven of 36 shell fish (19%).

Animals↗
PubMedDate not supplied

Interleukin-1 alpha, epidermal growth factor, and transforming growth factor-beta exhibit differential kinetics on endothelin-1 synthesis in amnion cells.

OBJECTIVE: To investigate the effects of three cytokines, interleukin-1 alpha (IL-1 alpha), epidermal growth factor (EGF), and transforming growth factor-beta (TGF-beta), on the regulation of endothelin-1 (ET-1) mRNA and protein production in human amnion cells. METHODS: Human amnion cells were harvested from uncomplicated pregnancies undergoing elective cesarean delivery at term and grown in primary monolayer culture. Cells were treated with IL-1 alpha, EGF, and TGF-beta for dose-response and time course experiments. Northern analysis was used to determine ET-1 mRNA expression, and enzyme-linked immunosorbent assay was used for ET-1 peptide determination. RESULTS: Interleukin-1 alpha, EGF, and TGF-beta induced the expression of ET-1 mRNA and protein in a dose- and time-dependent fashion. The kinetics of ET-1 mRNA production did not differ markedly with respect to the inducing cytokine, but the kinetics of ET-1 protein production was quite different. Interleukin-1 alpha and EGF stimulated a rapid increase in ET-1 that peaked by 24 hours, and the levels declined to just above the detection limit by 72 hours. In contrast, TGF-beta-stimulated cells showed modest ET-1 production at early times (4-24 hours) and then gradually increased and peaked at 72 hours. CONCLUSIONS: Cytokines modulate the expression of ET-1 mRNA and its cognate protein in human amnion cells. The differential kinetics of ET-1 peptide expression in amnion cells suggests that ET metabolism as well as synthesis contribute to the net expression of endothelin in amnion.

Amnion↗
PubMedDate not supplied

A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.

In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of $13,327 was realized for each mother-infant dyad discharged early from the hospital.

Adult↗