Biomedical subjects

R C Cefalo

Publications and source records attributed to R C Cefalo.

At least 19 recordsLinked to original sources

PubMed1995

Breast-feeding education of obstetrics-gynecology residents and practitioners.

OBJECTIVE: Our purpose was to assess breast-feeding education, knowledge, attitudes, and practices among resident and practicing obstetrician-gynecologists. STUDY DESIGN: A mailed survey was administered to a national sample of resident and practicing obstetrician-gynecologists. RESULTS: Response rates were 64% for residents and 69% for practitioners. Residency training included limited opportunity for direct patient interaction regarding breast-feeding; 60% of practitioners recommended that training devote more time to breast-feeding counseling skills. Only 38% of residents reported that obstetric faculty presented breast-feeding topics; more common sources were nursing staff and other residents. Practitioners rated themselves as more effective in meeting the needs of breast-feeding patients than were residents; prior personal breast-feeding experience was a significant influence on perceived effectiveness. Almost all respondents agreed that obstretician-gynecologists have a role in breast-feeding promotion, but significant deficits in knowledge of breast-feeding benefits and clinical management were found. CONCLUSION: Residency training and continuing education programs should create opportunities to practice breast-feeding promotion skills and emphasize management of common lactation problems.

Breast Feeding↗

PubMed1994

Group B streptococci: results of a protocol of antepartum screening and intrapartum treatment.

OBJECTIVE: Our purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers. STUDY DESIGN: In 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals. Cultures were obtained from the lower third of the vagina and rectum at 24 to 28 weeks' gestation. Women with positive cultures were treated with intravenous antibiotics in labor. Women with signs of chorioamnionitis (through intrapartum assessment) were also treated in labor, regardless of carrier status. RESULTS: During the first 2 years of this protocol 1681 women were delivered. Forty percent of the women were from the private practice, 32% were black, and 62% were married. The group B streptococcal carriage rate was 14%. During the period of evaluation there were no infants infected with group B streptococci and no adverse reactions or complications among women who were treated with antibiotics. CONCLUSION: We found antepartum screening and intrapartum chemoprophylaxis of all group B streptococcal carriers to be an acceptable and effective protocol for reducing perinatal group B streptococcal infections.

Ampicillin↗

PubMed1994

Estrogen mediates the pregnancy-enhanced cardiotoxicity of cocaine in the isolated perfused rat heart.

OBJECTIVE: To determine whether pregnancy enhances cocaine toxicity in the isolated perfused whole rat heart model and whether this enhanced toxicity can be simulated by pre-treatment with either estrogen or progesterone. METHODS: Hearts excised from 65 female Sprague-Dawley rats were attached to a Langendorff apparatus for measurement of left ventricular systolic pressure, heart rate, and contractility. Before excision, the animals were assigned to one of five groups: 1) nonpregnant, 2) pregnant, 3) nonpregnant pretreated with progesterone, 4) nonpregnant pretreated with estrogen, and 5) nonpregnant pretreated with estrogen and progesterone. Each group was exposed serially to the following cocaine concentrations: 5 x 10(-6), 1 x 10(-5), and 6 x 10(-5) mol/L. RESULTS: Heart rate declined at all doses of cocaine (9.2, 6.9, and 31.0%, respectively). The lowest dose of cocaine had positive inotropic effects, with a 23.2% increase in left ventricular pressure and a 15.3% increase in contractility. Exposure to the two higher doses resulted in negative inotropic effects (a 24.8% decrease in left ventricular pressure and a 39.7% decrease in contractility for the highest dose). Although pre-treatment with estrogen, alone or with progesterone, resulted in responses similar to those seen in pregnant animals, progesterone pre-treatment alone failed to do so. CONCLUSIONS: Cocaine displayed cardiotoxicity in isolated rat hearts similar to that in other animal models. This toxicity was enhanced by pregnancy. We were able to simulate changes by pretreating the animals with estrogen. Perhaps the enhanced cardiotoxicity of cocaine in pregnancy is partially mediated by estrogen.

Animals↗

PubMed1994

Pregnancy in a patient with eosinophilic granulomatosis of the lung: a case report.

BACKGROUND: There are three syndromes of histiocytosis X: eosinophilic granulomatosis of the lungs, Hand-Schüller-Christian disease, and Letterer-Siwe disease. Although there have been five case reports of Hand-Schüller-Christian disease in pregnancy, we found none describing pregnancy in patients with eosinophilic granulomatosis. CASE: We present a report of eosinophilic granulomatosis of the lungs in pregnancy. The patient's pregnancy was complicated by fetal growth retardation (FGR) and oligohydramnios, but resulted in the delivery of a healthy infant. Her pulmonary disease remained stable. CONCLUSION: Pregnancy does not appear to exacerbate pulmonary eosinophilic granulomatosis. In this patient, pregnancy was complicated by FGR and oligohydramnios. This case report may be valuable in counseling patients with eosinophilic granulomatosis who are currently pregnant or contemplating pregnancy.

Adult↗

PubMed1992

Prenatal diagnosis and caring.

Although the science of prenatal diagnosis is rapidly expanding, the art of caring for these patients is poorly understood and taught. Prenatal diagnosis programs must acknowledge the psychosocial consequences of electing to undergo prenatal testing, receiving either normal or abnormal test results, and choosing to continue or terminate a pregnancy with an identified fetal defect. There are suggestions from the literature of interventions to assist families under these circumstances (Table 3). Prospective studies of patient adaptation are needed; however, on the basis of the retrospective studies and common sense, a reasonable plan for patient support and care can be established. Prenatal diagnosis programs must demand not only excellent medical knowledge and technical expertise but also compassionate and continued care for the patient, her partner, and family.

Adaptation, Psychological↗

PubMed1992

Effect of daily immersion on the edema of pregnancy.

To evaluate whether pregnant women become refractory to the effects of immersion, we studied 11 healthy women from 26 to 38 weeks' gestation, immersed in 34 degrees C shoulder-deep water for 4 or 5 consecutive days. The daily immersion diuresis showed no change throughout the study (p = 0.98: mean, 145 ml, 159 ml, 159 ml, 173 ml, 184 ml, day 1 through day 5, respectively). The range of urine volumes was broad, 35 to 675 ml, depending on the subject's degree of edema. Immersion produced a significantly larger diuresis compared with preimmersion values, 162 ml versus 110 ml. Maternal blood pressure and heart rate consistently fell during immersion, and this effect was maintained for each day studied. The subjects' hematocrit, hemoglobin, and total protein were unchanged from a preimmersion sample on day 1 to a postimmersion sample on the last day of the study. The results of this study indicate that pregnant women do not become refractory to the hemodynamic and diuretic effects of immersion.

Adult↗

PubMed1992

Elemental mercury exposure in early pregnancy.

We present a case of first-trimester elemental mercury exposure and review the literature to demonstrate that the reproductive toxicity of mercury varies depending on the form of mercury to which one is exposed. It appears that elemental mercury exposure poses less of a reproductive threat than the well-known hazards of exposure to organic mercurials. It is critical to determine the form of exposure when counseling patients at risk.

Adult↗

PubMed1991

Characteristics of neonatal intensive care unit patients in North Carolina: a cross-sectional survey.

A shortage of neonatal intensive care facilities has been encountered in some areas of the country including North Carolina. To examine possible solutions to this health care delivery problem, a cross-sectional survey of all the neonatal intensive care units in North Carolina was performed to examine characteristics of patients occupying the beds in these facilities. It was found that a substantial amount of chronic care is now occurring in neonatal intensive care beds, with 38% of occupants of neonatal intensive care beds being 31 days of age or older and 3% being mechanically ventilated at 91 days of age or older. In addition, according to criteria established for this study, a substantial number of "convalescent" patients (32%) were occupying beds in neonatal intensive care units. It is concluded that an increase in both intermediate/convalescent care beds and establishment of chronic care facilities in North Carolina, rather than an increase in intensive care beds in these units, would alleviate the shortage of neonatal intensive care facilities. Further, the characteristics of the population occupying neonatal intensive care unit beds should be considered by health planners in addition to occupancy rate, when new facilities are being established.

Bed Occupancy↗

PubMed1991

Immune thrombocytopenic purpura in pregnancy: a reappraisal of management.

Management and, particularly, mode of delivery of the pregnant patient with immune thrombocytopenic purpura (ITP) are controversial. We reviewed our experience with 31 pregnancies in 25 women with ITP over a 10-year period. Fourteen infants were born vaginally and 18 by cesarean. Six major complications occurred among mothers delivered by cesarean, whereas none occurred among those born vaginally (P = .028). Three of 32 infants were born with moderate thrombocytopenia (platelet count 51-100 x 10(9)/L) and two with severe thrombocytopenia (platelet count 50 x 10(9)/L or less); there were no clinically significant complications in these infants. No maternal characteristic could be used to predict the neonatal platelet count. In an analysis of 474 infants of mothers with ITP reported in the literature and including the present series, 10% were born with moderate thrombocytopenia and 15% with severe thrombocytopenia. The overall rate of intracranial hemorrhage in newborns with moderate or severe thrombocytopenia was 3%. No significant association was found between the rate of intracranial hemorrhage and delivery mode for moderately and severely thrombocytopenic neonates together (weighted odds ratio 1.69, 95% confidence interval 0.14-44.6) or for those with severe thrombocytopenia (crude odds ratio 1.38, 95% confidence interval 0.07-84.67). We conclude that the mode of delivery may not affect the rate of intracranial hemorrhage in thrombocytopenic newborns.

Delivery, Obstetric↗

PubMed1990

The thermoregulation of pregnant women during aerobic exercise in the water: a longitudinal approach.

Twelve women early in their pregnancies were recruited to examine thermoregulation during immersion and exercise in the water (30 degrees C). Their responses were compared at 15, 25 and 35 weeks of pregnancy as well as 10-12 weeks post pregnancy to determine whether the responses differ between the gravid and non-gravid woman or were modified during pregnancy. Rectal temperature, mean skin temperature, heat storage, and evaporation were similar during immersion or exercise during the 15th, 25th and 35th weeks of pregnancy. Compared to 10 weeks post partum, pregnancy reduced heat storage, lowered skin temperature and increased evaporative heat loss during immersion and exercise (P less than 0.05). The results suggest that pregnancy causes subtle changes in the mechanism of thermoregulation which tend to increase heat production and improve heat conservation.

Adult↗

PubMed1990

The effects of immersion and exercise on prolactin during pregnancy.

Prolactin is an important hormone during pregnancy, affecting mother, fetus, and amniotic fluid volume. Immersion is known to affect prolactin levels significantly. To determine the effect of immersion and exercise on the prolactin response during pregnancy, we examined serum prolactin levels at 15, 25, and 35 weeks' gestation and 10 weeks post partum. Twelve women completed 20 min land rest, 20 min immersion in 30 degrees C water to the xiphoid, and 20 min exercise in the water at 60% VO2max. Resting prolactin levels were 1.91 +/- 0.32, 4.55 +/- 0.5, and 5.85 +/- 0.27 nmol.l-1 +/- standard error of the mean at 15, 25, and 35 weeks' gestation, respectively. Postpartum lactating women had a resting mean prolactin level of 3.95 +/- 1.6 versus 0.22 +/- 0.4 nmol.l-1 in non-lactating women. Prolactin levels declined significantly during immersion even after correction for dilution by plasma volume shifts. The immersion response was inversely related to the duration of pregnancy with 29%, 22%, and 12% drops during 15-, 25- and 35-week trials, respectively. Compared to rest, exercise prolactin levels remained depressed during the 15th and 25th week trials. We hypothesize that immersion in water caused prolactin levels to decline.

Adult↗

PubMed1990

Epidural analgesia and autonomic hyperreflexia: a case report.

Autonomic hyperreflexia is a serious complication for paraplegic patients. A paraplegic woman in early labor presented with autonomic hyperreflexia. After epidural analgesia was established, hyperreflexia resolved. When the analgesic wore off, hyperreflexia returned. Continuous epidural analgesia may be helpful for pregnant women who are susceptible to autonomic hyperreflexia.

Adult↗

PubMed1990

Nifedipine enhances the cardiac toxicity of magnesium sulfate in the isolated perfused Sprague-Dawley rat heart.

Magnesium sulfate is commonly used in tocolytic regimens and as prophylaxis against seizures. Nifedipine may be used simultaneously in either situation. With the isolated perfused rat heart model (Sprague-Dawley rats), we investigated the effects of these agents on cardiac function. Whereas each agent alone depressed cardiac performance, the two drugs together had maximal depressive effects on the heart.

Animals↗

PubMed1990

Renal responses to immersion and exercise in pregnancy.

Twelve healthy pregnant women were studied at 15, 25, and 35 weeks' gestation and at 8 to 12 weeks postpartum. Women were immersed for 20 minutes at 30 degrees C. They then exercised at 60% maximum oxygen capacity on a modified ergometer. Substantial diuresis and natriuresis occurred without changes in osmolarity or serum sodium. The diuresis was significantly greater during pregnancy than postpartum. The natriuresis was similar. Diuresis and natriuresis were greater than would be expected from investigations in nonpregnant subjects. This study suggests that immersion may be a beneficial therapy for edema without decreasing plasma volume.

Diuresis↗

PubMed1990

Magnesium sulfate tocolysis in selected patients with symptomatic placenta previa.

Tocolysis can be used to arrest contractions in selected patients with placenta previa if the maternal condition is stable. Over a 5-year period, 41 patients with symptomatic placenta previa were treated, of whom 18 were given magnesium sulfate therapy for tocolysis. The mean prolongation of gestation was 18.5 days, and tocolysis was successful in 17 of 18 cases. Since betamimetic drugs used for tocolysis may mask or blunt maternal cardiovascular responses to volume depletion, magnesium sulfate is a better choice to inhibit contractions in patients with symptomatic placenta previa whose bleeding is mild or moderate.

Adult↗

PubMed1990

Nonweightbearing exercise during pregnancy on land and during immersion: a comparative study.

Seven women at 25 weeks' gestation exercised on land and in the water at 70% maximum oxygen capacity (VO2max) on a bicycle ergometer. Women had significantly lower heart rates and lower systolic blood pressures during immersion exercise. Women had a mean diuresis of 207 ml (6.5 ml/min) during water exercise compared with 98 ml. (2.4 ml/min) during land exercise. Fetal heart rates showed a tendency toward being higher after land exercise compared with water exercise. Six of seven fetuses displayed tachycardia after land exercise compared to one of seven after water exercise. Exercise on land and during immersion at 70% VO2max was well tolerated. However, exercise during immersion offers several physiologic advantages during pregnancy.

Blood Pressure↗

PubMed1990

Unexplained elevations of maternal serum alpha-fetoprotein.

Alpha-fetoprotein (AFP) is a commonly used prenatal screening test for congenital anomalies. However, when anomalies are excluded after high resolution ultrasound and/or amniocentesis, an elevated maternal serum AFP (MSAFP) has been found to be associated with a 2- to 4-fold increase in low birthweight resulting from both preterm delivery and intrauterine growth retardation. Unexplained MSAFP elevations are also associated with up to 10-fold increase of placental abruption and a 10-fold increase in perinatal mortality. Results from studies of over 225,000 screened pregnancies indicate that 20 and 38 per cent of women with an unexplained MSAFP elevation may have an adverse pregnancy outcome. Twin gestations with MSAFP elevations greater than four multiples of the median are associated with similar constellations of pregnancy complications. Maternal serum AFP elevations in women with pregnancy complications are most likely the result of a leak of AFP across the placenta. Optimum management of women with unexplained elevations has not yet been established; however, evaluation of fetal growth throughout gestation is important in these patients.

Abruptio Placentae↗

PubMed1990

A comparison of bed rest and immersion for treating the edema of pregnancy.

Bed rest and immersion both lead to a mobilization of extravascular fluid and thus reduce edema. This study compared three treatments for edema in healthy pregnant women in the third trimester: lateral supine bed rest at room temperature, sitting in a bathtub of waist-deep water at 32 +/- 0.5C with legs horizontal, and sitting immersed in shoulder-deep water at 32 +/- 0.5C with legs extended downward. Post-treatment diuresis was selected as the indicator of extravascular fluid mobilization. The mean (+/- SD) diuresis was 105 +/- 48, 161 +/- 155, or 242 +/- 161 mL/hour for bed rest, bathtub, and immersion tank, respectively (P less than .008, tank versus bed rest; P less than .05, tank versus bath). In all treatments, mean arterial pressure (MAP) declined from a baseline value of 88 +/- 9 to 77 +/- 10 mmHg 25 minutes into treatment and 77 +/- 11 mmHg at 50 minutes (both P less than .0001 compared with pre-treatment). Shoulder-deep immersion produced the greatest decline in MAP. Sodium clearance increased from 0.7 to 1.0 mEq/minute in all treatments (P less than .01). Serum sodium, potassium, creatinine, osmolarity, total protein, 6-keto prostaglandin F1 alpha, and plasma volume did not change significantly after the treatments. Serum prolactin declined significantly from 137.8 +/- 44 to 124 +/- 31 ng/mL after treatment; there was no difference among treatments. Immersion appears to be a safe and more rapid method than bed rest to mobilize extravascular fluid during pregnancy.

Adult↗