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R Figueroa

Publications and source records attributed to R Figueroa.

At least 37 records · Page 2Linked to original sources
PubMed2000

Use of castor oil in pregnancies at term.

CONTEXT: Despite wide use of castor oil to initiate labor, the obstetric literature contains few references to this botanical laxative. Derived from the castor plant Ricinus communis, castor oil may possess properties that are useful in post-term pregnancies. OBJECTIVE: To evaluate the relationship between the use of castor oil and the onset of labor. DESIGN: Prospective evaluation. SETTING: A community hospital in Brooklyn, NY. PATIENTS: A total of 103 singleton pregnancies with intact membranes at 40 to 42 weeks referred for antepartum testing. Inclusion criteria included cervical examination, Bishop score of 4 or less, and no evidence of regular uterine contractions. INTERVENTION: Patients were alternately assigned to 1 of 2 study groups: a single oral dose of castor oil (60 mL) or no treatment. MAIN OUTCOME MEASURES: Castor oil was considered successful if labor began within 24 hours after dosing. Groups were compared for onset of labor in 24 hours, method of delivery, presence of meconium-stained amniotic fluid, Apgar score, and birth weight. RESULTS: Fifty-two women received castor oil and 48 were assigned no treatment. Following administration of castor oil, 30 of 52 women (57.7%) began active labor compared to 2 of 48 (4.2%) receiving no treatment. When castor oil was successful, 83.3% (25/30) of the women delivered vaginally. CONCLUSIONS: Women who receive castor oil have an increased likelihood of initiation of labor within 24 hours compared to women who receive no treatment. Castor oil use in pregnancy is underreported worldwide. This small series represents the first attempt to evaluate the medication.

Administration, Oral↗
PubMed1999

Differential regulation of mu-opioid receptor mRNA in the nucleus accumbens shell and core accompanying amphetamine behavioral sensitization.

Repeated amphetamine (AMPH) administration results in behavioral sensitization. To investigate the participation of the opioid system in this phenomenon, we examined the effects of acute and repeated AMPH administration on mu-opioid receptor (MOR) mRNA levels in the nucleus accumbens (NAc) and striatum (STR) of rats, by quantitative non-radioactive in situ hybridization. Five injections of d-AMPH (1.5 mg kg-1, i.p., once every other day), resulted in a sensitization response profile and a significant down-regulation of MOR mRNA levels in the NAc shell, whereas no change was observed in MOR mRNA levels in the NAc core compared to the saline controls. Conversely, MOR mRNA levels were up-regulated in the rostral STR of AMPH-sensitized rats compared to saline controls. No changes in MOR mRNA levels were observed after acute AMPH treatment in any of the brain regions studied. These results suggest that the opioid system participates in the neurobiological underpinnings of behavioral sensitization and that opioid receptor (OR) expression in the STR and NAc shell and core is differentially modulated by repeated AMPH exposure.

Amphetamine↗
PubMed1999

Maternal magnesium sulfate and the development of neonatal periventricular leucomalacia and intraventricular hemorrhage.

OBJECTIVE: Neonatal periventricular leucomalacia and intraventricular hemorrhage are strong correlates of cerebral palsy. Our objective was to evaluate the effect of maternal magnesium sulfate exposure on the incidence and severity of periventricular leucomalacia and intraventricular hemorrhage in preterm neonates. METHODS: Nine hundred eighteen consecutive inborn neonates with birth weights from 500 to 1750 g were divided primarily into two groups on the basis of maternal exposure to magnesium sulfate. The groups were divided secondarily into two clinical groups, a physician-initiated group, which consisted of neonates delivered for maternal or fetal indications, and a preterm delivery group, which included neonates delivered as a result of preterm labor or preterm premature rupture of membranes. These clinical groups were stratified further into magnesium sulfate-exposed and -unexposed subgroups. Neonatal neurosonograms were performed on days 3 and 7 of life and described as normal or abnormal. Abnormal sonograms included any periventricular leucomalacia or intraventricular hemorrhage. Severe lesions included periventricular leucomalacia, periventricular leucomalacia with intraventricular hemorrhage, or grades 3 or 4 intraventricular hemorrhage. The magnesium sulfate groups and the clinical groups with their magnesium sulfate strata were compared for the incidence and severity of abnormal sonograms. They also were compared for maternal and neonatal characteristics. RESULTS: Maternal magnesium sulfate exposure was not associated with reduction in the incidence of abnormal sonograms when compared with the unexposed group (27% compared with 33%, P = .06). However, fewer severe lesions were observed in the exposed group (14% compared with 21%, P = .004). When clinical groups were examined, magnesium sulfate was not associated with a decrease in abnormal sonograms (adjusted odds ratio [OR] 1.09, 95% confidence interval [CI] 0.78, 1.52, P = .40) or severe lesions (adjusted OR 1.11, 95% CI 0.73, 1.68, P = .42). Logistic regression analyses of magnesium sulfate exposure within clinical groups controlling for the confounding effects of maternal and neonatal characteristics revealed no protective effect of magnesium sulfate exposure on the incidence of abnormal sonograms (adjusted OR 1.01, 95% CI 0.70, 1.44, P = .97) or severe lesions (adjusted OR 1.01, 95% CI 0.70, 1.74, P = .69). Within clinical groups, the preterm delivery group exhibited an increased risk for abnormal sonograms (adjusted OR 1.63, 95% CI 1.01, 2.67, P = .05) and severe lesions (adjusted OR 9.79, 95% CI 3.27, 29.29, P = .001) when compared with the physician-initiated delivery group, independent of maternal magnesium sulfate exposure. CONCLUSION: Maternal magnesium sulfate exposure had no protective effect on the incidence or severity of periventricular leucomalacia and intraventricular hemorrhage in preterm neonates. The prevalence of these lesions was correlated better with the clinical group of origin and indication for its use.

Anticonvulsants↗
PubMed1998

Rubella and pregnancy: failed prevention policies.

Objective: Postpartum rubella immunization can prevent 33-50% of all cases of congenital rubella. Our purpose was to assess missed opportunities for postpartum rubella vaccination.Methods: A retrospective prenatal record review of 304 women attending a high risk obstetrics clinic was done. The rubella status on the first prenatal visit was recorded. Rubella status was determined by immunoassay (ELISA) and reported as immune, uncertain, or nonimmune. For rubella nonimmune women their ethnicity, age, parity, and place of delivery were recorded.Results: Fifteen (4.9%) of the 304 women were nonimmune to rubella. Of the 15 women, 6 were white, 4 were Afro-American, and 5 were Hispanic. The mean age was 30.1 +/- 6.2 y (range 20-42 y). Thirteen had given birth at least once (range 1-4), while two were nulliparous. Eleven of the 13 women gave birth in the USA, while two gave birth in South America. These eleven women gave birth 20 times without receiving rubella counseling or vaccination.Conclusion: Recommendation for postpartum rubella vaccination of nonimmune women should be adhered to in order to decrease the risk of congenital rubella syndrome.

Journal Article↗
PubMed1998

Perinatal outcome of triplet gestation: does prophylactic cerclage make a difference?

Objective: To compare the perinatal outcome of triplet gestations with and without prophylactic cerclage.Methods: A retrospective chart review of all triplet gestations delivered between January 1988 and June 1997 was performed. Only women initiating prenatal care before 15 weeks gestation were included. Management guidelines for triplets were uniform with the exception of use of prophylactic cerclage placed at 14 +/- 1 weeks gestation. Hospitalization was reserved for maternal medical and obstetric conditions, or fetal indications. Tocolytics were initiated only for persistent uterine contractions with intact membranes. All deliveries were effected by cesarean section at 37 weeks or less for maternal or fetal indications. All neonates were cared for at our institution. The cerclage group was compared to the no cerclage group for gestational age at delivery and maternal and neonatal complications. Descriptive statistics, Student t test, and Mann-Whitney U test were used for analysis.Results: Fourteen of the 51 (27.4%) sets of triplets had cerclage. There were no differences between groups when compared for maternal age, length of hospital stay, preterm labor rate, steroid use, histologic or clinical chorioamnionitis, and postoperative complications. In addition, there were no differences in mean birth weight, Apgar scores, respiratory distress syndrome, intraventricular hemorrhage/periventricular leucomalacia, NICU stay, and neonatal mortality. Although the mean gestational age at delivery for the cerclage group (33.1 +/- 2.7 weeks) was not different from the no cerclage group (31.7 +/- 3.7 weeks), the proportion of pregnancies delivered at 31 weeks or more was significantly higher in the cerclage group (13/14 vs 23/37, P =.03).Conclusions: Prophylactic cerclage may influence the proportion of triplet gestations delivered at 31 weeks or more. Lack of differences in the other parameters may be reflective of the small sample size.

Journal Article↗
PubMed1998

Amniotic fluid complement C3 as a marker of intra-amniotic infection.

OBJECTIVE: To determine the value of amniotic fluid (AF) complement C3 as a marker of intra-amniotic infection and to compare complement C3 with other rapid markers of intra-amniotic infection. METHODS: One hundred four women with singleton gestations, in preterm labor with intact membranes, at 23-35 weeks' gestation underwent transabdominal amniocentesis. Amniotic fluid was analyzed for white blood cell (WBC) count, lactate dehydrogenase (LDH), glucose, Gram stain, and complement C3. Cultures for aerobes, anaerobes, and mycoplasma species also were performed. The median values of complement C3, WBC, LDH, and glucose were compared between the culture-positive and -negative groups. Complement C3 was compared with WBC count, LDH, glucose, and Gram stain for sensitivity, specificity, positive and negative predictive values, and accuracy in the prediction of a positive AF culture. Descriptive statistics, receiver operating characteristic curve, Fisher exact test, and Wilcoxon rank-sum test were used for analysis. RESULTS: The prevalence of positive cultures was 11.5% (12 of 104). The culture-positive group had a significantly higher median C3 (7.0 mg/dL) than the median C3 (3.0 mg/dL) of the culture-negative group (P < .001). Also, the median values of WBC (1120.5 cells/mm3) and LDH (2697 U/L) were significantly higher and the median glucose (6.5 mg/dL) was significantly lower among women with positive AF cultures than among women with negative AF cultures (WBC=1 cell/mm3; LDH=165 U/L; glucose=45 mg/dL; P < .001). Eleven of the 12 culture-positive cases had a C3 of 5 mg/dL or more, whereas four of the 92 culture-negative cases had a C3 of 5 mg/dL (P < .001). Nine of the 12 culture-positive cases but none of the 92 culture-negative cases had a C3 of 6 mg/dL or more (P < .001). The relative risks of a positive AF culture were 65.27 (95% confidence interval [CI] 9.08, 469.27) and 31.67 (95% CI 10.40, 96.43) times greater among women with AF complement C3 levels of 5 and 6 mg/dL or more, respectively. Depending on the cutoff point used, complement C3 had similar or higher sensitivity, specificity, positive predictive value, and negative predictive value for intra-amniotic infection when compared with WBC count, LDH, glucose and Gram stain. CONCLUSION: Amniotic fluid complement C3 has value in the diagnosis of intra-amniotic infection in preterm labor with intact membranes. Complement C3 is available readily and compares favorably with other rapid markers of AF infection. This study supports the general concept of fetal inflammatory response to microbial invasion of AF.

Adult↗
PubMed1998

Amniotic fluid neuron-specific enolase: a role in predicting neonatal neurologic injury?

OBJECTIVE: To determine the relationship between amniotic fluid (AF) neuron-specific enolase and the development of neonatal intraventricular hemorrhage and periventricular leucomalacia. METHODS: Thirty-nine AF samples, obtained from women in preterm labor between 24 and 32 weeks' gestation, were analyzed for neuron-specific enolase. All women delivered preterm neonates who had neurosonograms on the 3rd and 7th days of life. The results of the neurosonograms were used to divide the study population first into normal and abnormal groups, then into normal, minor, and major brain lesion groups. The groups were compared for the median neuron-specific enolase, proportion with values of 6 microg/L or more, and other demographic characteristics. RESULTS: There were no differences between the groups' maternal and neonatal characteristics. However, the abnormal group had significantly higher median value of neuron-specific enolase than the normal group (9.5 microg/L and 2.0 microg/L, respectively; P < .001). The median neuron-specific enolase levels for the major, minor, and normal groups were 9.75 microg/L, 6.5 microg/L and 2.0 microg/L, respectively (P < .001). The optimum cutoff point, with a sensitivity of 89% and specificity of 100%, was 6 microg/L; 89% of the abnormals had values of 6 microg/L or more, compared with none of the normals (P < .001). The risk of developing intraventricular hemorrhage or periventricular leucomalacia was 11.5 times greater when AF neuron-specific enolase levels were 6 microg/L or more. CONCLUSION: Amniotic fluid neuron-specific enolase is a useful marker of neonatal neurologic injury.

Adult↗
PubMed1998

Elevated Amniotic Fluid Interleukin-6 as a Predictor of Neonatal Periventricular Leukomalacia and Intraventricular Hemorrhage.

> Objective: To investigate the relationship between amniotic fluid interleukin-6 levels and the development of periventricular leukomalacia and intraventricular hemorrhage in the preterm neonate and to compare the value of amniotic fluid interleukin-6 with amniotic fluid culture and histologic chorioamnionitis in the prediction of periventricular leukomalacia and intraventricular hemorrhage. Methods: 119 women, between 20 and 34 weeks gestation, in preterm labor with intact membranes, underwent transabdominal amniocentesis. Amniotic fluid was cultured for aerobic and anaerobic bacteria, Ureaplasma urealyticum and Mycoplasma hominis. Amniotic fluid interleukin-6 levels were determined by enzyme-linked immunosorbent assay. The placentas were examined for histopathologic evidence of inflammation. Where the birth weight was <2,000 g, transfontanelle cranial sonography was performed on the 3rd and 7th days of life for diagnosis of periventricular leukomalacia and intraventricular hemorrhage. Student's t test, the Mann-Whitney U test, likelihood ratio chi2, logistic regression, and receiver-operator characteristic curve were used for analysis. Results: 33 women were excluded from the analysis because they delivered at other institutions. The neonates of 33 women did not have sonography because they weighed >2,000 g at birth. Two neonates died before sonography was performed; four neonates who weighed <2,000 g at birth did not have sonography. In the definitive study group of 47 women, those with neonates who developed periventricular leukomalacia and intraventricular hemorrhage (n = 14) had higher median amniotic fluid interleukin-6 levels (42,795 pg/ml versus 8,020 pg/ml; P = 0.009), more positive amniotic fluid cultures (64% vesus 21%; P < 0.003), and a shorter median amniocentesis-to-delivery interval (16 h versus 24 h; P = 0.045) than women (n = 33) who delivered neonates without periventricular leukomalacia or intraventricular hemorrhage. The groups did not differ in gestational age at admission (P = 0.15), birth weight (P = 0.09), or histologic chorioamnionitis (P = 0.37). An amniotic fluid interleukin-6 level >/=20,000 pg/ml had a sensitivity of 71% and a specificity of 70% compared with a sensitivity of 69% and specificity of 79% for amniotic fluid culture, and a sensitivity of 71% and specificity of 42% for histologic chorioamnionitis in the prediction of periventricular leukomalacia and intraventricular hemorrhage. Women with amniotic fluid interleukin-6 levels >/=20,000 pg/ml (n = 20) had more neonates with periventricular leukomalacia or intraventricular hemorrhage than women with amniotic fluid interleukin-6 levels <20,000 pg/ml (n = 27) (50% versus 15%; P = 0.009). They also were of lower birth weight (P = 0.02), had more neonatal morbidity (P = 0.01), had more positive amniotic fluid cultures (P = 0.01), and more histologic chorioamnionitis (P = 0.02). Logistic regression analysis demonstrated that amniotic fluid interleukin-6 was an independent risk factor for the development of periventricular leukomalacia and intraventricular hemorrhage (odds ratio, 5.81; 95% confidence interval, 1.02-33.16; P = 0.05) after controlling for gestational age, birth weight, histologic chorioamnionitis, and amniotic fluid culture (odds ratio, 7.94; 95% confidence interval 1.22-51.77; P = 0.03). Conclusions: In women in preterm labor with intact membranes amniotic fluid interleukin-6 is useful in predicting neonatal periventricular leukomalacia and intraventricular hemorrhage.

Journal Article↗
PubMed1997

Long-term stroke risk in children with sickle cell disease screened with transcranial Doppler.

Stroke is an important complication of sickle cell disease. Stroke prediction is clinically important because it offers the possibility of primary prevention. In 1992, transcranial Doppler (TCD) evidence of elevated intracranial internal carotid or middle cerebral artery velocity was demonstrated to be associated strongly with an increased risk of ischemic stroke. This study extends the original study and includes 125 more children, longer follow-up, and intracranial hemorrhage in the stroke-risk model. Elevated time averaged mean maximum blood flow velocity, especially when velocity is 200 cm/sec or greater by TCD, was associated strongly with stroke risk. The cases not predicted by TCD point to the need for more information on the optimal timing of TCD surveillance for stroke risk.

Adolescent↗
PubMed1997

Obstetric antecedents of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate.

OBJECTIVE: Neonatal intraventricular hemorrhage and periventricular leukomalacia have a strong correlation with eventual neurologic deficit. Our objective was to correlate obstetric factors with the development of these lesions. STUDY DESIGN: Seven hundred forty-five consecutive inborn neonates with birth weights from 500 to 1750 gm were divided into three clinical groups: premature rupture of membranes, refractory preterm labor with intact membranes, and delivery initiated by the physician for maternal or fetal indications. Neonatal neurosonography was performed on days 3 and 7 of life and results were described as normal or abnormal. Abnormal scans included intraventricular hemorrhage seen within 3 days and echodense or echolucent periventricular leukomalacia seen within 7 days of life. Major abnormalities included intraventricular hemorrhage grades 3 and 4, intraventricular hemorrhage with periventricular leukomalacia, and echolucent periventricular leukomalacia. Abnormal scans were correlated with groups of origin and clinical and histologic chorioamnionitis. RESULTS: Abnormal scans occurred in 33% of cases of premature rupture of membranes and in 38.9% of cases of preterm labor compared with 17.7% of physician-initiated cases (p < 0.000001). Major lesions occurred in 17.6% of cases of premature rupture of membranes, 21.4% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.0000001). Clinical chorioamnionitis occurred in 19.7% of cases of premature rupture of membranes, 11.9% of cases of preterm labor, and 1.1% of physician-initiated cases (p < 0.001) and was associated with a significant increase in the incidence (p < or = 0.005) and severity (p < or = 0.007) of these lesions. Histologic chorioamnionitis occurred in 59.9% of cases of premature rupture of membranes, 43.2% of cases of preterm labor, and 8% of physician-initiated cases and did not correlate significantly with the incidence or severity of abnormal scans. These findings were independent of gestational age. CONCLUSIONS: The incidence and severity of intraventricular hemorrhage and periventricular leukomalacia were significantly increased in premature rupture of membranes and preterm labor compared with the physician-initiated cases. Clinical chorioamnionitis increased the incidence and severity of these lesions.

Cerebral Hemorrhage↗
PubMed1997

Intrapartum assessment of fetal well-being: a comparison of scalp stimulation with scalp blood pH sampling.

OBJECTIVE: To determine whether the need for fetal scalp pH sampling is decreased by the scalp stimulation test and whether redefinition of reactivity and presence of variability further decrease the need for scalp pH sampling. METHODS: One hundred eight women with fetal heart rate (FHR) patterns suggestive of acidosis underwent fetal scalp blood pH evaluations. Digital scalp stimulation was performed for 15 seconds 1-2 minutes before pH sampling. The study group was subdivided based on reactivity to scalp stimulation and scalp puncture and was correlated with pH values. Reactivity was defined as an acceleration of 15 beats per minute or more lasting at least 15 seconds and redefined as an acceleration of 10 beats per minute or more lasting at least 10 seconds. Nonreactive responses were subdivided based on FHR variability preceding the scalp stimulation and were correlated with pH values. Fisher exact test was used for analysis. RESULTS: All 51 instances of acceleration of 15 beats per minute or more lasting at least 15 seconds following scalp stimulation had a scalp pH of 7.20 or more. Using an acceleration of 10 beats per minute or more lasting at least 10 seconds, seven more reactive responses were obtained after scalp stimulation, all with pH of 7.20 or more. The 15 instances in which the pH was less than 7.20 were nonreactive irrespective of the definition of reactivity (P < .001). Twenty-one of the 50 instances of nonreactive responses (reactive response: acceleration of 10 beats per minute or more lasting at least 10 seconds) had positive variability. Only two of these 21 (9.5%) instances compared to 13 of the 29 (45%) instances with negative variability had pH less than 7.20 (P < .007). CONCLUSIONS: The scalp stimulation test could decrease the need for fetal scalp blood sampling by 47%. Redefinition of reactivity could decrease the need for scalp sampling by 54%. In addition, assessment of FHR variability before scalp stimulation could decrease further the need for scalp blood sampling by 73%.

Acidosis↗
PubMed1997

Seronegativity to varicella-zoster virus in a tertiary care obstetric population.

OBJECTIVE: To determine the seronegativity rate of varicella-zoster virus in a tertiary care obstetric population. METHODS: At their initial prenatal visit, all obstetric patients at Westchester County Medical Center have a varicella-zoster virus IgG antibody titer (Varicella Stat; Biowhittaker, Inc., Walkersville, MD) performed. A value of 0.99 or greater units is positive. Patients were divided into three groups: seronegative, seropositive, and those with no test results. Mean maternal age was compared among groups using the unpaired two-tailed Student t test, with P < .05 considered significant. RESULTS: From February 1, 1994, to May 30, 1996, 927 women had an initial prenatal visit. Ninety-nine patients were varicella-zoster virus antibody negative (seronegativity 11.6%, which is significantly higher than that reported in other studies); 755 were varicella-zoster virus antibody positive, and 73 had no results. The mean age of the seronegative patients was 27 years and of the seropositive patients 28 years, which was not significantly different. CONCLUSION: Varicella-zoster virus seronegativity is higher in our obstetric population than generally is reported in adults. This may reflect the number of immigrants from tropical countries attending metropolitan hospitals. Mathematic models evaluating the impact of varicella-zoster virus vaccination and decisions regarding screening and postpartum vaccination must be based on accurate epidemiologic data, particularly in view of the effect of varicella-zoster virus on pregnant women, their fetuses, and their neonates.

Adult↗
PubMed1996

A comparison of rapid amniotic fluid markers in the prediction of microbial invasion of the uterine cavity and preterm delivery.

OBJECTIVE: The purpose of this study was to evaluate amniotic fluid lactate dehydrogenase level in comparison with other rapid markers in prediction of microbial invasion of the uterine cavity and preterm delivery < or = 36 hours after amniocentesis. STUDY DESIGN: One hundred thirty-one women in preterm labor with intact membranes underwent transabdominal amniocentesis. Amniotic fluid was analyzed for leukocyte count, glucose level, lactate dehydrogenase level, and Gram stain. Cultures for aerobes, anaerobes, and Mycoplasma sp. were performed. Amniocentesis-to-delivery interval was calculated. The study group was divided and the findings compared according to amniotic fluid culture results and according to amniocentesis-to-delivery interval. Sensitivity, specificity, and positive and negative predictive value were calculated for lactate dehydrogenase, leukocyte count, glucose, and Gram stain in the prediction of positive amniotic fluid culture and preterm delivery < or = 36 hours after amniocentesis. Receiver-operator characteristic curve analysis, logistic regression analysis, t tests, and nonparametric tests were used. RESULTS: The prevalence of positive amniotic fluid cultures was 12% (16 of 131). The median lactate dehydrogenase level (1084 U/L) was significantly greater for women with a positive amniotic fluid culture than for those with a negative culture (median lactate dehydrogenase level 194 U/L; p < 0.0002). The critical values calculated for optimal performance in prediction of a positive amniotic fluid culture were a lactate dehydrogenase level > or = 419 U/L, leukocyte count > or = 50 cells/mm3 (50 x 10(6)/L) and glucose < or = 17 mg/dl (0.94 mmol/L). Lactate dehydrogenase, leukocyte count, glucose, and Gram stain were equally sensitive and specific in prediction of a positive amniotic fluid culture. Thirty-nine women (29.8%) gave birth < or = 36 hours after amniocentesis. The median lactate dehydrogenase level (414 U/L) was significantly greater among women giving birth < or = 36 hours after amniocentesis than among women giving birth > 36 hours after amniocentesis (median lactate dehydrogenase, 173 U/L; p < 0.001). Critical values of lactate dehydrogenase > or = 225 U/L, leukocyte count > or = 10 cells/mm3 (10 x 10(6)/L) and glucose < or = 34 mg/dl (1.9 mmol/L) were selected for optimal performance in prediction of amniocentesis-to-delivery interval < or = 36 hours. Lactate dehydrogenase level had the best sensitivity (74%) in prediction of delivery < or = 36 hours after amniocentesis in contrast to leukocyte count (49%), glucose (62%), and positive Gram stain (26%). Amniotic fluid lactate dehydrogenase values > or = 225 U/L were associated with a fivefold greater risk for delivery < or = 36 hours after amniocentesis (odds ratio 5.46, 95% confidence interval 2.00 to 14.87; p = 0.0006). CONCLUSION: Amniotic fluid lactate dehydrogenase level has diagnostic value in prediction of a positive amniotic fluid culture and delivery < or = 36 hours after amniocentesis. Lactate dehydrogenase is a readily available, inexpensive, rapid amniotic fluid marker that can be measured in any hospital laboratory.

Adult↗
PubMed1996

Confirmation of Borrelia burgdorferi spirochetes by polymerase chain reaction in placentas of women with reactive serology for Lyme antibodies.

The purpose of our study was to determine whether Borrelia burgdorferi spirochetes were present in placentas of asymptomatic women with reactive Lyme serology using a silver stain, and to confirm the identity of the spirochetes by polymerase chain reaction (PCR). Sixty placentas of asymptomatic women with ELISA-positive or-equivocal serology for Lyme antibodies during pregnancy were examined for spirochetes using a silver stain. The results of the ELISA serology were confirmed by Western blot analysis. PCR amplification for B. burgdorferi was performed on placentas identified to have spirochetes and on a group of placentas negative for spirochetes. Spirochetes were identified by silver staining in 3 (5%) of the 60 placentas. PCR confirmed B. burgdorferi nucleotide sequences in 2 of the placentas. The 5 women had equivocal Lyme ELISA and negative syphilis serology. The results of the Western blot analysis were negative in 2 cases and indeterminate in 1 case. Six controls were negative for spirochetes by silver staining and PCR. A normal perinatal outcome was observed in all cases. Spirochetes identified in placental tissue of pregnancies with reactive Lyme serology were confirmed by PCR to be B. burgdorferi. There was no relationship between the presence of placental spirochetes and the results of Lyme serology or the pregnancy outcome.

Blotting, Western↗
PubMed1996

Comparison of umbilical Doppler velocimetry, nonstress testing, and biophysical profile in pregnancies complicated by diabetes.

The purpose of this study was to determine which test is best for predicting adverse outcomes in pregnancies complicated by diabetes: the nonstress test, biophysical profile, or umbilical artery velocimetry. We evaluated 207 singleton pregnancies complicated by diabetes within 1 week of delivery using the afore-mentioned pregnancy surveillance tests. Adverse pregnancy outcome was defined as delivery before 37 weeks of gestation or the occurrence of fetal growth restriction, hypocalcemia, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, or fetal risk requiring cesarean delivery. The prognostic value of each of the three tests was assessed, after controlling for the mothers' White classification and third trimester glycosylated hemoglobin value. Among the 207 pregnancies, 75 (36.2%) had an adverse outcome. In pregnancies in which the umbilical artery systolic to diastolic ratio was > or = 3.0, the relative risk of adverse outcome was 2.6 (95% confidence interval: 1.9-3.5, P < 0.001). For those with a biophysical profile < or = 6 the relative risk was 1.7 (95% confidence interval: 0.9-2.9, P = 0.109). Patients with a nonreactive nonstress test had a relative risk of 1.7 (95% confidence interval: 1.2-2.5, P = 0.009). Umbilical artery Doppler velocimetry was superior to either the nonstress test or the biophysical profile in identifying the subgroup of pregnancies complicated by diabetes that resulted in an adverse outcome.

Female↗