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Biomedical subjects

S G Gabbe

Publications and source records attributed to S G Gabbe.

At least 91 records · Page 5Linked to original sources
PubMed1986

Pregnancy following renal transplantation in class T diabetes mellitus.

Nine cases of pregnancy complicated by diabetes and prior renal transplantation are reviewed. Maternal and fetal death occurred in a patient with foot and leg ulcers associated with preexisting peripheral vascular disease. Pregnancy-induced hypertension occurred in six cases. Spontaneous weight-bearing fractures occurred in two patients. No episodes of renal allograft rejection occurred. Evidence of fetal compromise was present in six cases. All fetuses were delivered by cesarean section prior to term, with live births occurring from 31 1/2 to 36 weeks' gestation. A single case of hypospadias was the only congenital defect. Prepregnancy screening for complications of diabetes and renal transplantation is advised and euglycemia should be achieved before and during pregnancy. Advanced diabetic vascular disease puts these gestations at significant risk.

Adult↗
PubMed1986

Capillary blood glucose screening for gestational diabetes: a preliminary investigation.

Home glucose monitoring with the use of reflectance meters is an important adjunct in the care of pregnant women with insulin-dependent diabetes. The accuracy of reflectance meters for the assay of capillary glucose specimens has been well documented. The present preliminary study was undertaken to determine the utility of outpatient screening for gestational diabetes mellitus with the use of a reflectance meter (Accu-Chek, Boehringer Mannheim Co.). One hundred twenty-five patients in our high-risk practice had a standard 50 gm glucose load at 26 to 28 weeks' gestation. Capillary glucose values were measured on site with the Accu-Chek. Venous plasma glucose levels were measured by the central laboratory chemistry analyzer. While the laboratory (x) and meter (y) glucose determinations between the two sets of values were highly correlated (R = 0.89, p less than 0.001), there was a significant difference in their average values (x = 111.74, y = 136.35, p less than 0.0001). With the use of a receiver operator characteristic curve, a meter value of 160 mg/dl was determined as the optimal threshold for performing a 3-hour glucose tolerance test. The sensitivity and specificity with the use of a meter value of 160 mg/dl were 93% and 96%, respectively, for detecting an abnormal screening test in venous plasma (greater than or equal to 135 mg/dl). A total of 32 glucose tolerance tests were performed, with four patients included who had venous values less than 135 mg/dl. All eight patients with gestational diabetes mellitus were correctly identified. These data suggest that a glucose reflectance meter can be used for accurate outpatient screening of gestational diabetes mellitus. The potential advantages of capillary blood glucose screening include both cost and efficiency. Patients with abnormal screening values can be promptly identified and scheduled for a follow-up 3-hour glucose tolerance test.

Blood Glucose↗
PubMed1986

An evaluation of the relative risks of a trial of labor versus elective repeat cesarean section.

A retrospective study of a trial of labor (TOL) after prior cesarean section was conducted over 18 months in a patient population that is homogeneous with regard to race, socioeconomic class, gestational age, and medical complications. Of 171 women who had undergone previous cesarean sections, 75 were offered a TOL. Thirty-five of these patients had an elective repeat cesarean section, while 40 agreed to a TOL. Thirty-two of the latter patients delivered vaginally (80%). The criteria for offering a TOL and a protocol for TOL are presented. A comparison of the maternal and neonatal morbidity associated with repeat cesarean section versus TOL do not strongly favor either method of delivery in our population. The patients who had undergone cesarean section for cephalopelvic disproportion (CPD) had the lowest acceptance and the lowest success rate of a TOL. The hospital charges and hospital stay of the two groups are presented. The financial aspects of the two methods of delivery and the impact of Diagnosis Related Groups (DRGs) on the management of these patients are discussed. Careful selection of patients for a TOL is essential to maintain the quality of medical care while responding to pressures to reduce the cesarean section rate and to reduce the costs of medical care.

Adolescent↗
PubMed1986

Maternal acetaminophen overdose at 15 weeks of gestation.

Acetaminophen is a common drug used in pregnancy. A 32-year-old woman ingested 64 g of acetaminophen at 15 weeks of gestation. Treatment with N-acetylcysteine was given within 24 hours. The patient nonetheless developed severe hepatic necrosis and her hospital course was complicated by adult respiratory distress syndrome. With aggressive supportive treatment, the mother survived and delivered a viable infant at 32 weeks' gestation. The possible mechanisms of acetaminophen toxicity in the mother and the fetus are discussed.

Acetaminophen↗
PubMed1986

Total parenteral nutrition during pregnancy.

Several years ago, most obstetricians would have thought that any disease severe enough to require parenteral nutrition would also lead to infertility or early pregnancy loss. Women with many complex disease states have now been successfully treated by TPN during pregnancy, resulting in favorable outcomes for both mother and fetus. Theoretically, these patients, if not supplied with an adequate amount of essential nutrients by TPN, might have experienced excessive perinatal morbidity and mortality. The difficulties involved with studying maternal-fetal exchange processes in humans leave considerable gaps in our current knowledge about nutritional requirements during normal pregnancy. Some have suggested that subtle degrees of malnutrition may jeopardize normal growth and development. In states of severe protein calorie malnutrition, there remains little doubt that intrauterine growth is diminished. In such cases in which there is poor maternal weight gain, it may be critical to initiate some method of nutritional support. Whereas TPN during pregnancy has been sporadically employed in the treatment of cases of suspected fetal growth retardation, limited experience with this therapy suggests that at present we primarily direct treatment toward patients with specific disease states that are accompanied by overt malnutrition. Parenteral nutrition support should begin only after a period of adequate nutritional assessment and monitoring. If such support is necessary, TPN should be administered by a team of qualified knowledgeable individuals who are very familiar with the techniques. The relatively high rate of premature delivery associated with patients requiring TPN during pregnancy requires the presence of an intensive care nursery in the institution.

Female↗
PubMed1986

Estimation of human fetal-placental unit metabolic rate by application of the Bohr principle.

The Bohr Principle via continuous indirect calorimetry was used to estimate human fetal-placental unit metabolic rate in 12 normal women undergoing elective caesarean section under continuous lumbar epidural anaesthesia. Maternal oxygen consumption decreased after umbilical cord clamping and after placental removal. Fetal-placental unit oxygen consumption was 10.7 +/- 1.3 ml/min per kg (mean +/- SEM). Fetal oxygen consumption was 6.8 +/- 1.4 ml/min per kg. Placental oxygen consumption was 37 +/- 12 ml/min per kg. Fetal-placental unit carbon dioxide production was 9.2 +/- 1.2 ml/min per kg. These mean values agree favourably with measurements of uterine and fetal metabolism from other mammalian species. Maternal minute ventilation decreased with removal of the fetal-placental unit, and this decrease was found to be linearly related to the fetal-placental unit carbon dioxide production.

Adult↗
PubMed1986

Definition, detection, and management of gestational diabetes.

The Second International Workshop-Conference on Gestational Diabetes was held in Chicago, IL on October 25-27, 1984 as an invitational meeting sponsored by the American Diabetes Association with the cooperation of the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Diabetic Pregnancy Study Group of the European Association for the Study of Diabetes. The meeting was convened to collate existing information about gestational diabetes mellitus and to use state-of-the-art appraisals to achieve consensus about definitions, prognoses, and strategies for success, diagnosis, and intervention. The invited presentations documented that gestational diabetes mellitus is a heterogeneous disorder with varying incidence in various parts of the world. The increased obstetric and perinatal risk of undetected gestational diabetes was supported. The reports clearly established that more than half of the women with gestational diabetes mellitus ultimately develop permanent diabetes. Mounting evidence also suggests the possibility of long-range complications such as increased obesity and diabetes in the offspring. The available experiences with a variety of therapies such as diet and insulin were reviewed. The meeting highlighted the importance of gestational diabetes mellitus as a distinct entity deserving of increased recognition, treatment, long-range follow-up, and research.

Birth Weight↗
PubMed1985

Management of diabetes mellitus in pregnancy.

During the past decade, our major objective in the management of pregnancies complicated by diabetes mellitus has become normalization of maternal and, therefore, fetal glucose levels. For most women with insulin-dependent diabetes, this goal may be achieved through the use of multiple insulin injections combined with an appropriate dietary intake. The results of such therapy can now be accurately assessed by means of home glucose monitoring. Patients with gestational diabetes can be properly treated only if they are first identified. Therefore, all pregnant women should be tested for this disorder because screening based on past obstetric history or clinical criteria alone may miss up to 50% of patients with gestational diabetes. Between 1980 and 1984, the perinatal mortality rate reported in the American literature for more than 800 insulin-dependent patients was 21 per 1000, with more than 50% of these deaths resulting from major malformations. Such data emphasize the need to achieve maternal euglycemia before conception, as poor maternal control has been associated with teratogenesis. Prepregnancy assessment should also include a thorough evaluation of maternal vasculopathy.

Ambulatory Care↗
PubMed1985

The effect of oral ritodrine therapy on glucose tolerance in pregnancy.

Intravenous ritodrine therapy can cause significant deterioration of maternal glucose homeostasis. We investigated the effect of full maintenance oral ritodrine therapy (120 mg/day) on glucose tolerance in the early third trimester with the use of 50 gm 1-hour screens followed by 100 gm 3-hour oral glucose tolerance tests if the screen level was greater than or equal to 140 mg/dl. Four hundred ninety-one patients were studied, 42 of whom were receiving oral ritodrine therapy. Twenty-one percent of the ritodrine-treated women had an abnormal 1-hour screen, which was not different from the 20% observed in women not receiving therapy. None of the treated group and 13% of the untreated group who had abnormal screens had abnormal oral glucose tolerance tests. The probability of an abnormal test after an abnormal 1-hour screen was also determined.

Administration, Oral↗
PubMed1985

Diagnostic tests in obstetrics: a method for improved evaluation.

With the proliferation of diagnostic tests in obstetrics, several recurrent questions arise. How does one determine whether one diagnostic test is superior to another available test? What test cutoff value best separates diseased from nondiseased patients? How much does performance of additional tests assist in arriving at a correct diagnosis? This article reviews a simple yet sophisticated analytic technique, the receiver operating characteristic curve, and demonstrates its application to several obstetric diagnostic tests. Receiver operating characteristic curve analysis is used to select a cutoff value for the 1-hour glucose tolerance test, to compare amniotic fluid tests of fetal lung maturity, and to determine the optimal combinations of factors and overall performance of the fetal biophysical profile. The value of receiver operating characteristic curve analysis lies in providing a clear graphic analysis of the performance of diagnostic tests over their entire range of values. It also provides the starting point for evaluating the costs and benefits of alternative cutoff points in differing clinical settings.

Amniotic Fluid↗
PubMed1985

Can preterm deliveries be prevented?

Our hospital serves poor, inner-city women who have a 17% preterm delivery rate. Middle-class women in San Francisco at high risk for preterm delivery have benefited from an antepartum program which emphasized patient education and close follow-up. Using a controlled, randomized design, we are investigating the impact of similar interventions. Patients determined to be at high risk before 18 weeks' gestation on the basis of the Creasy system are randomly assigned to the Preterm Labor Prevention Clinic or serve as high-risk controls. Sixty-four women assigned to the Preterm Labor Prevention Clinic and 68 high-risk control women have been delivered of their infants. No significant differences were noted for the percentages of preterm infants, mean gestational age, or birth weight. Preterm rupture of the membranes accounted for 40% of preterm deliveries in all high-risk patients. Thirty percent of preterm births were indicated for maternal or fetal reasons. The remaining 30% represented failure of tocolytic therapy.

Birth Weight↗
PubMed1985

Amniostat FLM: a new technique for detection of phosphatidylglycerol in amniotic fluid.

Amniostat-FLM (AFLM) is an immunologic semi-quantitative slide agglutination test for determining the presence of phosphatidylglycerol (PG) in amniotic fluid. We analyzed 178 samples for the presence of PG by both AFLM and our standard thin-layer chromatographic technique (TLC). Both tests agreed in 135 of 178 cases. All fluids with a mature AFLM had PG detected by TLC assay. All of the 43 discordant samples were classified as immature by AFLM although PG was present by TLC. Among the 151 patients who delivered within 72 hours of amniocentesis, 17 cases of respiratory distress syndrome (RDS) occurred. All were correctly predicted by immature tests. However, an immature AFLM was associated with RDS in only 21% of cases (11/53) while 37% of cases (17/46) with an immature TLC test resulted in neonates with RDS. We conclude that the AFLM is a very simple, rapid, and sensitive test for identifying infants who will develop RDS but is less specific than the TLC assay. Though a mature AFLM will predict fetal pulmonary maturity, an immature result should be confirmed by thin-layer chromatographic analysis.

Agglutination Tests↗
PubMed1985

Glucose monitoring and insulin administration in the pregnant diabetic patient.

Over the past decade, it has been apparent that the degree of glycemic control achieved in the pregnant patient with diabetes mellitus significantly affects perinatal outcome. While several studies have documented excellent perinatal outcome with good glucose control, the incidence of neonatal morbidity still remains substantially greater than that observed in the general population. Physiologic or "tight" control appears to further reduce the incidence of macrosomia, hypoglycemia, and other indices of neonatal morbidity. The application of home glucose-monitoring techniques to pregnancies complicated by diabetes can result in optimal glucose control. While one small comparative series did not document improvement in perinatal morbidity, fewer admissions for diabetic control and decreased patient expense were observed in the group using home monitoring. After pregnancy, most patients continued to use home monitoring. This probably reflects the degree of patient enthusiasm and interest generated by self-care. Programs using home blood glucose monitoring and individualized insulin regimens in the management of diabetes may have their greatest impact if implemented prior to conception. The degree of glucose control during early embryogenesis appears to determine the incidence of congenital malformations in the offspring of insulin-dependent diabetic women. Continued careful assessment of the degree of glycemic control may enable the patient and her physician to plan the optimal time for attempting a pregnancy.

Blood Glucose↗
PubMed1985

Routine fetal genitourinary tract screening.

To evaluate routine fetal genitourinary tract obstetrical ultrasound screening, and to determine what size renal pelvis is indicative of significant renal disease, we reviewed 4,832 examinations, which had been performed over 2 years, of 3,530 consecutive obstetrical patients. Any fetus that had a renal pelvis greater than 5 mm or a definable cystic area was identified for follow-up. The fetuses of 39 patients (1.1%) who underwent 112 examinations fulfilled these criteria and constitute the basis of this report. A variety of examination criteria were recorded and analyzed in relationship to the follow-up, which ranged from 2-3 days to 21 months. The fetuses of the 39 patients were grouped into three categories: those with renal pelves between 5 and 9 mm in size; those with renal pelves larger than 10 mm; and those with cystic abnormalities. Those with renal pelves larger than 10 mm had either an obstructing lesion or exceptional extrarenal pelves. The clinical and pathologic aspects of these three groups are detailed, discussed, and analyzed. Criteria for significant fetal renal hydronephrosis and aspects of a loculated appearance are given.

Dilatation, Pathologic↗
PubMed1985

Antepartum fetal surveillance in gestational diabetes mellitus.

Pregnancy in patients with gestational diabetes mellitus (GDM) is associated with increased perinatal morbidity. Whether the perinatal mortality rate, particularly the fetal death rate, is greater in these patients remains controversial. The present study was undertaken to review the role of antepartum fetal monitoring in 69 patients with GDM controlled by diet only (class A) and 28 women requiring insulin therapy (class AB). Hypertension complicated 21.6% of these pregnancies. Antepartum fetal surveillance included outpatient nonstress testing, urinary estriol assays, maternal assessment of fetal activity, and clinical estimation of fetal weight. All insulin-requiring patients as well as fourteen class A patients with identifiable risk factors underwent testing. No perinatal deaths occurred. Only six patients required intervention for suspected fetal jeopardy and four of these women had hypertension. Macrosomia was correctly identified in only 6 of 16 infants weighing 4000 g or more. This study suggests that, in GDM, an outpatient program of fetal testing, using primarily the nonstress test and maternal assessment of fetal activity, can be employed in patients requiring insulin as well as class A patients with identifiable risk factors. This protocol resulted in a low rate of unnecessary intervention and good perinatal outcome. The risks for abnormal antepartum testing results appear increased in GDM with hypertension and prolonged pregnancy.

Cesarean Section↗
PubMed1985

High-risk obstetrics. The three-year experience of four subspecialists.

The development of maternal-fetal medicine as a subspecialty in obstetrics and gynecology is fairly new. The specialists involved in this area are usually hospital based and involved in multiple activities, including teaching, administration and research. The role of this subspecialist as a provider of primary care to a high-risk obstetric population is important but has not been reported on previously. In this context high-risk obstetrics refers to intercurrent obstetric problems, previous obstetric problems, previous medical problems, infertility and the supposedly high-risk group of physicians and physicians' wives.

Female↗
PubMed1984

Fetal weight/placental weight ratio and perinatal outcome.

The relationship of placental size to perinatal outcome was investigated in a population of low-risk infants. A trimmed and drained placenta was weighed for each of 417 low-risk infants, and for 108 infants whose intrapartum course was complicated only by compression of the umbilical cord. Tracings from intrapartum electronic fetal heart rate monitoring were analyzed by an investigator who was unaware of the fetal weight/placental weight ratio. The incidence of perinatal problems was increased in those infants whose fetal weight/placental weight ratio was greater than 11: intrapartum fetal distress, 20% (p = 0.0046); meconium-stained amniotic fluid, 28.9% (p = 0.0017); Apgar score less than 7, 11.1% (p = 0.04); and hyperbilirubinemia, 24.4% (p = 0.0008). On the basis of these data, the conclusion drawn was that there is a population of presumably low-risk infants who are at increased risk because they have outgrown their placentas.

Amniotic Fluid↗