Search PubMed⌕ Search

Biomedical subjects

S G Gabbe

Publications and source records attributed to S G Gabbe.

At least 55 records · Page 3Linked to original sources
PubMed1992

Financial implications of implementing standards of care for diabetes and pregnancy.

This article examines the financial implications of implementing standards of care for pregnancy among women with diabetes, including both the costs of enhanced treatment and the savings of avoided adverse outcomes. Numerous studies have demonstrated the harmful effects of poor blood glucose control for both mother and fetus. Standards set forth by the American Diabetes Association aim to reduce maternal complications and fetal adverse outcomes, such as congenital malformations. Because the precise configuration of resources required to meet these standards was not outlined in the American Diabetes Association statement, a panel of physicians (all specialists in pregnancy care for women with diabetes) was convened to develop a model program. Implementing such a program during the preconception and prenatal periods will represent an intensification of resource use in the outpatient setting. However, through these preventive measures, medical care costs for maternal and fetal complications can be avoided.

Female↗
PubMed1992

Diabetes mellitus and pregnancy.

Diabetes mellitus represents the most common medical complication of pregnancy. Care programs emphasizing normalization of maternal glucose levels have resulted in perinatal outcome that is nearly equivalent to that observed in normal pregnancies. Reducing the rate of significant congenital anomalies in insulin-dependent women remains a goal for the future.

Diabetes, Gestational↗
PubMed1992

A story of two miracles: the impact of the discovery of insulin on pregnancy in women with diabetes mellitus.

Before the discovery of insulin in 1921, pregnancies in women with diabetes mellitus were a rarity because most reproductive-age patients died soon after diagnosis of this illness. In the limited number of pregnancies reported in the pre-insulin era, both perinatal and maternal mortality were approximately 50%, with stillbirths being the primary cause of perinatal deaths. Insulin treatment restored the fertility of women with diabetes and was associated with a marked reduction in maternal mortality. Women with more severe disease had the opportunity to become pregnant; however, their pregnancies frequently resulted in neonatal death due to prematurity. Therefore, perinatal mortality was not substantially reduced.

Female↗
PubMed1991

Morphologic changes in the human amnion epithelium that accompany labor as seen with scanning and transmission electron microscopy.

Scanning and transmission electron microscopy were used to assess the influence of normal, active labor on the ultrastructure of the human amnion epithelial membrane. Amnion membranes (reflected and placental portions) were obtained from patients either in active labor who were delivered vaginally or by cesarean section after 6 to 12 hours of labor or from patients who underwent elective cesarean section before clinical signs of overt labor. Scanning electron microscopy revealed that reflected amnion membranes that were obtained from patients who were not in labor consisted of a uniform single layer of epithelial cells with numerous microvilli on the apical surface and closely associated cellular borders. In contrast, amnion membranes that were obtained from patients who were in labor consisted of a single layer of epithelial cells, which was interrupted by wide intercellular gaps and extracellular extrusions. Transmission electron microscopy showed that intercellular junctions tended to be less complex in patients who were in labor versus patients who were not in labor. Although lipid droplets were prevalent in both patient groups, specimens that were obtained from patients who were in labor had more lipid droplets per cell than specimens from patients who were not in labor. These results support the theory that the complex biochemical events that culminate in parturition are accompanied and/or preceded by demonstrable morphologic changes in the amnion membrane.

Amnion↗
PubMed1991

Sonographic measurement of fetal humeral soft tissue thickness in pregnancy complicated by GDM.

Sonographic measurement of fetal humeral soft tissue thickness (STT) was performed in 93 women with gestational diabetes mellitus during the third trimester. STT measurements revealed accelerated growth in large for gestational age infants at 31 wk gestation. This new measurement proved to be the most accurate predictor of excessive fetal size compared with other standard ultrasound parameters (sensitivity 82%, specificity 95%, positive predictive value 90%). Asymmetrical growth was more evident in infants with large STT measurements in utero. Humeral STT measurement may distinguish large fetuses with truncal obesity from those that are symmetrically large, thereby allowing prediction of risk for birth trauma before delivery.

Diabetes, Gestational↗
PubMed1991

Fetal surveillance in the pregnancy complicated by diabetes mellitus.

During the last decade, outpatient protocols have been developed for antepartum fetal assessment in pregnancies complicated by diabetes mellitus. This approach has been associated with a markedly reduced cost of health care and emotional stress for patients and their families attributable to lengthy hospitalization. These programs have used primarily biophysical testing, with twice weekly NSTs followed by a CST or biophysical profile when necessary. Most recently, Doppler studies have been investigated as a method for identifying fetal compromise. Maternal assessment of fetal activity can be used as a screening test in most surveillance programs. Essential to the success of these protocols has been our ability to monitor maternal glycemia and to maintain glucose levels in the physiologic range through aggressive therapy with insulin and diet. Reassuring tests of fetal condition are present in most diabetic women and therefore permit fetal maturation to take place before delivery.

Delivery, Obstetric↗
PubMed1990

Evidence of a role for protein kinase C in epidermal growth factor-induced prostaglandin E2 synthesis in amnion cells.

Human amnion cells synthesize and release prostaglandin E2 in response to epidermal growth factor. The protein kinase C activator, phorbol 12-myristate, 13-acetate also stimulates amnion cell prostaglandin E2 synthesis. We used a human amnion cell line (WISH) to conduct in vitro experiments to investigate a potential role of protein kinase C in the signal transduction pathway leading to epidermal growth factor-induced prostaglandin E2 production. Pretreatment of cultured amnion cells with a low, nonstimulating dose of phorbol 12-myristate, 13-acetate potentiated the action of epidermal growth factor in causing prostaglandin E2 production as measured by radioimmunoassay. The protein kinase C-selective inhibitor staurosporine inhibited epidermal growth factor-induced prostaglandin E2 production, further suggesting a role for protein kinase C in epidermal growth factor action. Experiments were conducted in which amnion cells were rendered protein kinase C-deficient by chronic exposure to phorbol ester, which has been shown to down-regulate the enzyme. In these cells, epidermal growth factor caused prostaglandin E2 synthesis at levels comparable to native (non-protein kinase C-deficient) cells. We conclude that protein kinase C plays a more modulatory than direct role in the epidermal growth factor signal transduction cascade that leads to prostaglandin E2 production by amnion cells. We propose a bifurcating transduction scheme in which, under conditions of protein kinase C inactivation, epidermal growth factor alone causes prostaglandin E2 synthesis. When protein kinase C is activated by as yet unknown endogenous substances, the epidermal growth factor responsiveness of the amnion cells is greatly enhanced. This pathway could have important implications in a feed-forward mechanism regulating the level of prostaglandin E2 production during the onset of labor.

Alkaloids↗
PubMed1990

Antenatal diagnosis of sacral agenesis syndrome in a pregnancy complicated by diabetes mellitus.

The sacral agenesis syndrome is a severe congenital abnormality consisting of agenesis of the lumbar spine, sacrum, and coccyx, as well as hypoplasia of the lower extremities. It is considered the most characteristic of all congenital anomalies associated with maternal diabetes mellitus. We describe the sonographic and radiologic findings of agenesis of the lumbosacrococcygeal spine with lower limb and genital hypoplasia in the offspring of a woman with both diabetic retinopathy and nephropathy. The diagnosis was established at 25 weeks' gestation and was confirmed by radiologic evaluation of the neonate.

Abnormalities, Multiple↗
PubMed1990

Risk factors for preterm premature rupture of the fetal membranes.

Preterm premature rupture of the membranes (PPROM) is a significant cause of prematurity, accounting for approximately one third of preterm births in the United States. PPROM occurs in approximately 0.7-2% of all pregnancies nationally, and has a reported recurrence rate of 21%. The elucidation of potential risk factors for PPROM could contribute to a better understanding of its etiology. To study the contributions of 20 potential risk factors, we undertook a case-control study in our clinic population, which has a 5-6% incidence of PPROM. One hundred and thirty-three patients experiencing PPROM were matched for race, age, parity and gestational age with undelivered patients. Studies performed included ultrasonographic examinations, blood levels of ascorbic acid and zinc, microbiologic assays, patient questionnaires, and chart reviews. After stratification of both groups into subgroups based on matching criteria, summary tests of significance and Mantel-Haenszel tests of odds ratios were performed. On univariate analysis the following factors achieved significance at the p less than 0.05 level with 95% confidence intervals: 1) previous history of PPROM 2) smoking (dose related) 3) fundal location of the placenta in the present pregnancy. 4) a prior history of cerclage. After regression analysis, we concluded that smoking and history of previous PPROM were found to be risk factors for PPROM in our inner city black population.

Analysis of Variance↗
PubMed1990

Management of diabetes mellitus and pregnancy: a survey of obstetricians and maternal-fetal specialists.

To ascertain current practice trends among obstetricians and maternal-fetal subspecialists regarding the care of pregnancies complicated by diabetes mellitus, a questionnaire was sent to all members of the Society of Perinatal Obstetricians (SPO) and a randomly selected group of American College of Obstetricians and Gynecologists (ACOG) Fellows. A total of 273 of 356 SPO members (77%) and 198 of 504 ACOG Fellows (39%) responded. When divided according to years post-residency (ACOGa, less than 15 years; ACOGb, 15 years or more), significant differences in practice patterns were observed for ACOG Fellows. The SPO responses were similar among these subgroups. Despite current ACOG recommendations, most clinicians practice universal screening for gestational diabetes. Significant discrepancies appear to exist between ACOGb versus ACOGa and SPO with regard to methods of glucose surveillance and the threshold for initiating insulin therapy in gestational diabetes. Intensive fetal surveillance, elective delivery, and high cesarean rates are common in pregnancies complicated by insulin-dependent diabetes mellitus, which is most often managed by a perinatologist or by an obstetrician in consultation with an internist. Few insulin-dependent patients seek preconceptional care.

Adult↗
PubMed1989

Sonographic evaluation of fetal abdominal growth: predictor of the large-for-gestational-age infant in pregnancies complicated by diabetes mellitus.

Serial ultrasound examinations were performed during the third trimester in 79 pregnant women with diabetes to establish the onset of accelerated fetal growth. At least three ultrasound examinations were performed, with a minimum scan interval of 2 weeks. Growth curves constructed for femur length and head circumference were similar for fetuses appropriate for gestational age (n = 48) and fetuses large for gestational age (n = 31). The mean changes in femur length and head circumference (expressed as centimeters per week during the early and late third trimesters) did not differ statistically between these two groups. Abdominal circumference growth was clearly accelerated at 32 weeks' gestation in the large for gestational age group (mean +/- SD, 1.36 +/- 0.16 cm/wk) compared with the appropriate for gestational age group (0.901 +/- 0.21 cm/wk, p less than 0.001). With use of a receiver operator characteristic curve, a change in abdominal circumference of 1.2 cm/wk over the period of 32 to 39 weeks' gestation was determined to be an optimal cutoff for detecting excessive fetal growth (sensitivity 84%, specificity 85%). A change in abdominal circumference 1.2 cm/wk was present in 4/4 large-for-gestational age fetuses (less than 4000 gm), in 17/21 (81%) of fetuses with birth weights 4000 to 4499 gm, and in 5/6 (83%) whose weight exceeded 4500 gm. It appears that improved detection of the fetus large for gestational age in diabetic pregnancies may be accomplished by the use of serial ultrasonography during the third trimester.

Birth Weight↗
PubMed1989

Shoulder soft tissue width as a predictor of macrosomia in diabetic pregnancies.

Sonographic evaluation of 43 pregnant women with diabetes mellitus was performed in the third trimester of gestation for evidence of fetal macrosomia. The width of the soft tissues of the shoulder from the skin surface to the proximal humerus was compared with previously reported measurements for their ability to predict fetal macrosomia. The abdominal circumference and shoulder soft tissue measurements were the best individual predictors of macrosomia, but a combination of an abdominal circumference greater than the 90th percentile for gestational age or a shoulder soft tissue width greater than 12 mm was the best predictor with a sensitivity of 96%, specificity of 89%, and accuracy of 93%. The shoulder soft tissue width should be evaluated for evidence of macrosomia in diabetic pregnancies.

Female↗
PubMed1989

Effect of amniotomy on uteroplacental and fetoplacental flow velocity waveforms.

Artificial rupture of fetal amnionic membranes is frequently performed in normally progressing spontaneous labor, although the maternal and fetal effects of the procedure have not been clearly defined. The effect of elective amniotomy on placental impedance to blood flow in the umbilical artery and arcuate branches of the uterine artery was determined by analysis of blood flow velocity waveforms (FVWs) recorded with continuous wave Doppler ultrasound in 15 pregnant women at term. All patients were in spontaneous, normally progressing labor after an uneventful pregnancy. Electronic fetal heart rate monitoring and real-time ultrasound examination of the fetuses were unremarkable. FVWs were obtained immediately before and after amniotomy. Fourteen patients progressed to spontaneous vaginal delivery, and one patient underwent repeat cesarean section for arrest of dilation in the active phase of labor. No maternal, fetal, or neonatal complications were recorded. Calculated mean systolic/diastolic ratios of FVWs obtained before and after amniotomy were compared by means of Wilcoxon's signed rank test, and no significant differences were found. We conclude that early elective amniotomy exerts no demonstrable deleterious effect on impedance to uteroplacental or fetoplacental blood flow in healthy women at term.

Adolescent↗
PubMed1989

Doppler umbilical artery velocimetry in pregnancy complicated by insulin-dependent diabetes mellitus.

The mean peak systolic to end-diastolic (S/D) umbilical artery ratio was measured in 291 Doppler studies performed during pregnancy in 35 insulin-dependent diabetic women. A normal decline was observed in the umbilical artery S/D ratio, from 4.2 +/- 0.21 at 18 weeks to 2.18 +/- 0.22 at 38 weeks. There was no significant correlation between mean third-trimester S/D and either glycosylated hemoglobin (r = 0.25) or mean blood glucose levels (r = 0.15). Fetuses of women with vascular disease (class F/R or chronic hypertension) had a mean third-trimester S/D of 3.0 or higher in five of ten cases, compared with three of 25 in patients with uncomplicated diabetes (P less than .03). Mean second- and third-trimester S/D ratios differed significantly in patients with and without vascular disease: 4.34 +/- 0.7 and 3.2 +/- 0.65 versus 3.72 +/- 0.42 and 2.55 +/- 0.32, respectively (P less than .03). Two of three women without vascular disease who demonstrated an elevated mean S/D ratio developed preeclampsia and delivered appropriate for gestational age infants. In women with vascular disease, four of five with an abnormal mean third-trimester umbilical artery S/D ratio were delivered of growth-retarded infants, whereas all five with normal umbilical artery S/D ratios had appropriate for gestational age infants. In three of the abnormal cases, elevated S/D ratios were present in the second trimester before ultrasound documentation of fetal growth retardation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1989

Controlled trial of a Preterm Labor Detection program: efficacy and costs.

Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.

Clinical Trials as Topic↗
PubMed1988

Failure of ultrasonographic parameters to predict the severity of fetal anemia in rhesus isoimmunization.

Ultrasonographic measurements of placental thickness, extrahepatic and intrahepatic umbilical vein diameters, abdominal circumference, head circumference, head/abdominal circumference ratio, and intraperitoneal volume were made in 50 rhesus-isoimmunized pregnancies at 18 to 26 weeks' gestation. The severity of fetal anemia was assessed by fetal blood sampling. Results in the isoimmunized group were compared with a control population of 410 normal pregnancies at 17 to 32 weeks' gestation. In the absence of fetal hydrops, none of the parameters studied could reliably distinguish mild from severe fetal hemolytic disease.

Edema↗