Biomedical subjects

Terry Hyslop

Publications and source records attributed to Terry Hyslop.

6 recordsLinked to original sources

PubMed2003

Variation in the HLA-G promoter region influences miscarriage rates.

The HLA-G gene is primarily expressed in placental cells that invade the maternal decidua during pregnancy. This gene encodes multiple isoforms that fulfill a variety of functions at the maternal-fetal interface throughout gestation. Recently, a null allele for the most abundant HLA-G isoform was associated with recurrent miscarriage in two independent studies, suggesting that reduced levels of the HLA-G1 protein may compromise successful pregnancy. We initiated the present study to determine whether other polymorphisms that could affect expression levels of HLA-G were associated with fetal loss in women participating in a 15-year prospective study of pregnancy outcome. We genotyped these subjects for 18 single-nucleotide polymorphisms in the 1,300 bp upstream of exon 1, 13 of which were identified as part of this study, as well as for an insertion/deletion (in/del) polymorphism in the 3' untranslated region. The 18 SNPs defined eight unique haplotypes. One polymorphism, -725C/G, was associated with fetal loss, with an increased risk for miscarriage in couples in which both partners carried the -725G allele, compared with couples not carrying this allele (odds ratio 2.76, 95% confidence interval 1.08-7.09; P=.035). Further, the G at nucleotide -725 creates a CpG dinucleotide, and we demonstrate that this CpG site is methylated on -725G alleles. Overall, this study identified extraordinary levels of variation in the 5'-upstream regulatory region of HLA-G and provides evidence for an association between a promoter-region SNP and fetal loss rates, further attesting to the novel features and critical role of this gene in pregnancy.

Abortion, Spontaneous↗

PubMed2003

Physician and patient factors associated with ordering a colon evaluation after a positive fecal occult blood test.

OBJECTIVE: Successful colorectal cancer screening relies in part on physicians ordering a complete diagnostic evaluation of the colon (CDE) with colonoscopy or barium enema plus sigmoidoscopy after a positive screening fecal occult blood test (FOBT). DESIGN: We surveyed primary care physicians about colorectal cancer screening practices, beliefs, and intentions. At least 1 physician responded in 318 of 413 (77%) primary care practices that were affiliated with a managed care organization offering a mailed FOBT program for patients aged >/=50 years. Of these 318 practices, 212 (67%) had 602 FOBT+ patients from August through November 1998. We studied 184 (87%) of these 212 practices with 490 FOBT+ patients after excluding those judged ineligible for a CDE or without demographic data. Three months after notification of the FOBT+ result, physicians were asked on audit forms if they had ordered CDEs for study patients. Patient- and physician-predictors of ordering CDEs were identified using logistic regression. MEASUREMENTS AND MAIN RESULTS: A CDE was ordered for only 69.5% of 490 FOBT+ patients. After adjustment, women were less likely to have had CDE initiated than men (adjusted odds, 0.66; confidence interval, 0.44 to 0.97). Physician survey responses indicating intermediate or high intention to evaluate a FOBT+ patient with a CDE were associated with nearly 2-fold greater adjusted odds of actually initiating a CDE in this circumstance versus physicians with a low intention. CONCLUSIONS: Primary care physicians often fail to order CDE for FOBT+ patients. A CDE was less likely to be ordered for women and was influenced by physician's beliefs about CDEs.

Adult↗

PubMed2003

Racial differences in severe perineal lacerations after vaginal delivery.

OBJECTIVE: The purpose of this study was to determine the relationship between maternal race and rates of third- and fourth-degree laceration after vaginal delivery. STUDY DESIGN: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 through 2000 was completed. Univariate and multivariable models were computed with the use of logistic regression models. RESULTS: From the database, 34,048 vaginal deliveries were identified, with 3487 deliveries resulting in third- or fourth-degree laceration (10.2%). Overall severe laceration rates by race with all vaginal deliveries for patients without and with episiotomy were as follows: white, 4.3% and 15.1%; black, 2.0% and 19.3%; Asian 9.1% and 32.3%; Hispanic, 3.4% and 17.0%, respectively. After being controled for other variables with multivariable logistic regression in all vaginal deliveries, Asian race (odds ratio, 2.04; 95% CI, 1.43-2.92), forceps (odds ratio, 3.71; 95% CI, 3.39-4.05), vacuum-assisted delivery (odds ratio, 1.86; 95% CI, 1.64-2.10), large size for gestational age (odds ratio, 1.94; 95% CI, 1.21-3.09), and episiotomy (odds ratio, 3.09; 95% CI, 2.66-3.59) were associated significantly with severe lacerations. CONCLUSION: Race is an independent risk factor for severe perineal lacerations after vaginal delivery, with Asian women at highest risk. Asian women who undergo episiotomy and operative vaginal delivery are especially at high risk for rectal sphincter injury.

Adult↗

PubMed2002

Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000.

OBJECTIVE: To determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy. METHODS: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models. RESULTS: Overall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86, 0.87), black race (OR 0.29, 95% CI 0.28, 0.31), and spontaneous vaginal delivery (OR 0.40, 95% CI 0.36, 0.45). Increased association with episiotomy was seen in forceps deliveries (OR 4.04, 95% CI 3.46, 4.72), and with third- or fourth-degree lacerations (OR 4.87, 95% CI 4.38, 5.41). In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk (OR 0.59, 95% CI 0.54, 0.64). CONCLUSION: There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

Adult↗

PubMed2002

Patients with prior second-trimester loss: prophylactic cerclage or serial transvaginal sonograms?

OBJECTIVE: To compare management with prophylactic cerclage versus serial transvaginal sonograms of the cervix in patients with prior second-trimester loss. STUDY DESIGN: Singleton pregnancies with prior second-trimester spontaneous loss between 14 and 24 weeks' gestation were retrospectively reviewed. At the obstetricians' discretion, some were managed with prophylactic cerclage and some with serial transvaginal sonograms of the cervix, starting at 14 weeks, and cerclage only if cervical length was <25 mm or funneling was >25% before 24 weeks. All cerclages were McDonald. Primary outcome was preterm delivery at <35 weeks. RESULTS: Of 177 patients with singleton pregnancies who had prior second-trimester loss identified, 66 received prophylactic cerclage and 111 were followed up with transvaginal sonography, of which 36% (40/111) had therapeutic cerclage because of cervical changes. The two management groups of prophylactic cerclage versus transvaginal sonography of the cervix did not differ in any measure of obstetric outcome, including preterm delivery at <35 weeks (23% vs 30%; P =.3), preterm delivery at <33 weeks (21% vs 26%; P =.5), or gestational age at delivery (34.6 +/- 6.8 weeks vs 34.4 +/- 6.8 weeks; P =.8). CONCLUSION: In patients with prior second-trimester loss, serial transvaginal sonography of the cervix, with cerclage only if indicated by cervical changes, is a valuable alternative to a policy of uniform prophylactic cerclage.

Abortion, Spontaneous↗

PubMed1999

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