Biomedical subjects
Publications and source records attributed to W R Cohen.
Plasma 1,25-dihydroxyvitamin D levels are elevated in early pregnancy and continue to increase throughout pregnancy. They remain elevated postpartum in lactating women. The elevated levels probably represent a physiological response to increased calcium requirements.
Analysis of plasma norepinephrine (NE) concentrations in umbilical artery and vein from infants of diabetic and nondiabetic mothers revealed high plasma NE values in those of diabetic mothers. While birth weight and arterial plasma NE did not correlate in infants of nondiabetic mothers (r = 0.07, NS), birth weight and plasma NE were related inversely in infants of diabetic mothers (r = -0.73, P less than 0.05).
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Obstetric data from 4403 nulliparas were analyzed in order to determine whether the duration of the second stage of labor influences perinatal outcome or maternal puerperal morbidity. No significant increase in the frequency of perinatal mortality, neonatal mortality, or low 5-minute Apgar scores was noted with long second stages. An increase in the incidence of low 1-minute Apgar scores was observed only in those infants who were not monitored. An increase in puerperal hemorrhage after more than 3 hours of second stage labor was attributable to those patients delivered by midforceps operations. It appears that it is unwarranted to terminate labor simply because an arbitrary period of time has elapsed in the second stage.
Traditional methods of diagnosing fetal distress have become obsolete. This diagnosis should be suggested by fetal heart rate patterns that demonstrate recurrent late or severe variable decelerations. Based upon our understanding of these patterns, methods of treating fetal distress in utero have evolved. This paper presents several cases in which elevation of the fetal presenting part was employed in an attempt to improve severe variable decelerations. It is suggested that this might be a salutary procedure when other methods of intrauterine resuscitation have failed.
Explants of various tissues obtained from pregnant women at term and from nonpregnant women were maintained in culture and their capacities to synthesize prostaglandin (PGF) were evaluated. Myometrial and decidual tissues from pregnant women produced significantly smaller amounts of PGF than those from nonpregnant women, suggesting that PGF production is inhibited during gestation. Decidual PGF synthesis was also inhibited by the addition of progesterone, estradiol or indomethacin. The PGF synthesis of the chorion of women in labor was lower than that of women not in labor. In the later group, the cohrion, decidua and myometrium produced significant amounts of PGF, but amniotic PGF production was negligible. Our findings show that the decidua and chorion, as well as the myometrium, are potentially important sources of PGF production. PGF synthesis during pregnancy also may be affected by local inhibitory influences.
OBJECTIVE: The study was designed to determine the prevalence of obesity and related pregnancy complications in an inner-city prenatal clinic. STUDY DESIGN: A retrospective review was conducted of the medical records of 281 women with no chronic diseases and who delivered singleton term babies during a 1-year period. The frequencies of various pregnancy complications, including pregnancy-induced hypertension, preeclampsia, gestational diabetes, shoulder dystocia, postpartum hemorrhage, fourth degree laceration, intrauterine growth restriction, and macrosomia, were compared among groups of patients stratified by body mass index (BMI). RESULTS: Thirty-four percent of patients had a reported prepregnancy BMI of > 26 kg/m2. Fifty-two percent of patients were obese (BMI > 26 kg/m2) when they registered for prenatal care, and 82% of patients had a BMI > 26 kg/m2 at the time of delivery. The incidence of birth weights of > 4 kg was significantly higher in women with a registration BMI > 26 kg/m2 (p = 0.026). Most of these macrosomic babies had mothers with a BMI > 29 kg/m2. Patients who required cesarean delivery had significantly higher BMI than those who were delivered vaginally (p < 0.001). CONCLUSION: Obesity was more common in our inner-city population than has previously been reported and was associated with an increased risk of fetal macrosomia and operative delivery.
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OBJECTIVE: We assessed the relation of fetal station in early labor to subsequent patterns of dilation and descent and to the probability of cesarean delivery. STUDY DESIGN: We evaluated 132 nulliparous women who were in spontaneous latent-phase labor with singleton, vertex-presenting, term fetuses. For each participant, pertinent variables relating to labor characteristics and mode of delivery and newborn characteristics were recorded. Labor curves were drawn and analyzed. RESULTS: Of the 132 participants, 29 (22%) presented with an engaged fetal head, and 103 (78%) presented with an unengaged fetal head. In the unengaged group, 15 (11%) presented with a floating fetal head (-3 station or above), and 88 (67%) presented with a dipping fetal head (-2 or -1 station). A floating head in latent-phase labor conferred a longer second stage (p = 0.02), a trend to more active-phase labor disorders (p = 0.06), and a greater risk of cesarean delivery. Overall, 12 patients (9%) underwent primary cesarean section: 2 (6.9%) from the engaged group, 6 (6.8%) from the dipping group, and 4 (27%) from the floating group (p = 0.042). CONCLUSION: Most nulliparous women in this study presented in labor with an unengaged fetal head. Those with a floating fetal head demonstrated higher rates of cesarean section than those with dipping or engaged heads in early labor.