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PubMed1990

[Risk assessment of active obstetrical intervention in relation to delivery time interval in the control of vaginal twin delivery].

In connection with the vaginal delivery of twins, different opinions exist among obstetricians as to whether the time interval between the birth of both twins influences the often reported higher perinatal mortality and morbidity of the second twin. During the period from January 1, 1982, to December 12, 1987, we had 176 twin deliveries (1.5%), among a total number of 11,395, from which, after vaginal birth of twin A, in 96 cases twin B was born alive. In this study group, we analysed retrospectively our active obstetrical management in respect of relations between time interval on the one hand and perinatal mortality, operation frequency and foetal outcome of the second born twin on the other. The perinatal mortality rate, as defined by the WHO was 4.2% and excluding stillborns and children with a birth weight of less than 1,000 g, only 0.3%. We could not identify the influence of the time interval on perinatal mortality, which was equal for both twins. The frequency of surgical interventions rose from 12.8% when twin B was born within 20 min, to 38.8% when it was delivered after this time interval. An adverse foetal outcome judged by APGAR-score could not be proved. Shortening the time interval by active obstetrical management is of value in order to reduce potential risks for the mother and the second born twin, but it should be borne in mind, that the results of our study are positively influenced by the primary selection criteria of mode of delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed2003

Deciding on route of delivery for obese women with a prior cesarean delivery.

OBJECTIVES: This study was undertaken to estimate the vaginal birth after cesarean (VBAC) success rate, compare rates of infections in women attempting VBAC and those undergoing planned repeat cesarean, and compare the cost of these two plans of care for obese women. STUDY DESIGN: We performed a historical cohort analysis of singleton deliveries at >/=36 weeks' gestation in women with a body mass index 40 or greater and one prior cesarean delivery. Outcomes included rates of VBAC success and puerperal infections and mean cost of care. RESULTS: The cohort consisted of 122 mother-infant pairs, 61 each in the VBAC and cesarean groups. In the VBAC group, 57% (95% CI 45-70) of women were delivered vaginally. The VBAC group had higher rates of chorioamnionitis (13.1% vs 1.6%, P=.02), endometritis (6.6% vs 0%, P=.06), and composite puerperal infection (24.6% vs 8.2%, P=.01). Mean cost of care was similar for mothers ($4439 vs $4427, P=.95), infants ($1241 vs $1422, P=.49), and mother-infant pairs ($5680 vs $5851, P=.64). CONCLUSION: Compared with planned cesarean delivery, VBAC trials in obese women are three times as likely to be complicated by infection and do not result in reduced costs.

Adult↗
PubMed1996

Gene delivery to skeletal muscle results in sustained expression and systemic delivery of a therapeutic protein.

Somatic gene therapy has been proposed as a means to achieve systemic delivery of therapeutic proteins. However, there is limited evidence that current methods of gene delivery can practically achieve this goal. In this study, we demonstrate that, following a single intramuscular administration of a recombinant adeno-associated virus (rAAV) vector containing the beta-galactosidase (AAV-lacZ) gene into adult BALB/c mice, protein expression was detected in myofibers for at least 32 weeks. A single intramuscular administration of an AAV vector containing a gene for human erythropoietin (AAV-Epo) into mice resulted in dose-dependent secretion of erythropoietin and corresponding increases in red blood cell production that persisted for up to 40 weeks. Primary human myotubes transduced in vitro with the AAV-Epo vector also showed dose-dependent production of Epo. These results demonstrate that rAAV vectors are able to transduce skeletal muscle and are capable of achieving sustained expression and systemic delivery of a therapeutic protein following a single intramuscular administration. Gene therapy using AAV vectors may provide a practical strategy for the treatment of inherited and acquired protein deficiencies.

Animals↗
PubMed2001

Local intra-arterial drug delivery for prevention of restenosis: comparison of the efficiency of delivery of different radiopharmaceuticals through a porous catheter.

RATIONALE AND OBJECTIVES: Several radiopharmaceuticals were administered through a porous balloon catheter to compare the absolute amount deposited and the retention in the vessel wall. The reported efficiency of local drug delivery ranges from 0.001% to 0.1%, with poor retention after 24 hours. METHODS: An endothelin derivative (n = 6), pertechnetate (n = 6), hexamethylpropylene amineoxime (HMPAO) (n = 5), ethyl cysteinate dimer (ECD) (n = 5), and tin colloid (n = 5) were labeled with 185 MBq/mL 99m-technetium. After balloon denudation of the infrarenal aorta in 27 New Zealand White rabbits, 100 microL of each agent was administered through a porous balloon at a pressure of 4 bar. Dynamic and static whole-body scintigrams were obtained for 24 hours. The infrarenal aorta was excised and the activity calculated in a gamma counter. RESULTS: Apart from their retention in the region of local administration, the radiopharmaceuticals showed different distribution patterns. The highest regional tracer retention was observed with HMPAO. After administration of HMPAO, a significant difference between regional (vessel wall plus surrounding tissue: 14.5% of injected dose [ID]/24 hours) and local (vessel wall: 1.8% ID/24 hours) delivery was found. In contrast, ECD was eliminated quickly (local retention after 24 hours = 0% ID). The retention efficiencies were HMPAO > endothelin derivative > tin colloid > pertechnetate > ECD. CONCLUSIONS: The different physicochemical and pharmacokinetic properties of radiopharmaceuticals resulted in different delivery efficiencies after local application.

Animals↗
PubMed2001

Remote adenoviral gene delivery to the spinal cord: contralateral delivery and reinjection.

OBJECTIVE: This study characterizes the distribution of adenoviral genes in the spinal cord after viral vector injection into the sciatic nerve. It also evaluates the ability of repeated adenoviral sciatic nerve injections to prolong gene expression in the spinal cord. METHODS: Rat sciatic nerves were unilaterally coinjected with the retrograde tracer Fluoro-Gold (Fluorochrome, Inc., Denver, CO) and the adenoviral vector Ad5RSVntLacZ. The distribution of adenoviral gene expression in the spinal cord was compared with that of Fluoro-Gold. Next, levels of gene expression in the sciatic nerve and spinal cord were compared after single and repeated injections of Ad5RSVntLacZ. Finally, remote spinal cord gene expression in naive animals was compared with expression in animals that had been pretreated with subcutaneous Ad5RSVntLacZ inoculation. RESULTS: Viral gene expression was detected in all quadrants of the spinal cord gray matter, whereas Fluoro-Gold was detected only in the ipsilateral ventral horn (n = 5). This remote delivery was blocked by sciatic nerve transection (n = 10). Viral gene expression occurred in the sciatic nerve after both initial and repeated injections, whereas remote gene expression in the spinal cord was observed only after primary sciatic nerve injection (n = 24; P < 0.003). As with repeated sciatic nerve injections, subcutaneous inoculation with Ad5RSVntLacZ blocked subsequent remote spinal cord gene delivery (n = 8; P < 0.05). CONCLUSION: Remote viral gene delivery occurs in neurons without direct sciatic nerve projections but is dependent on intact peripheral nerves. Repeated injections fail to boost spinal cord gene expression, because of immune recognition of reinjected virus.

Adenoviridae↗
PubMed1983

Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery.

A total of 304 women, for whom operative delivery was considered necessary in the second stage of labour, were randomly assigned to delivery by vacuum extraction or forceps. Of those allocated to forceps a higher proportion of babies were actually delivered with the allocated instrument; however, the caesarean section rate was also higher in this group. Maternal trauma, use of analgesia and blood loss at delivery were significantly less in the group allocated to vacuum extraction. Vacuum extraction did, however, appear to predispose to an increase in mild neonatal jaundice. More serious neonatal morbidity was rare in both groups and the trial was of insufficient size to rule out a clinically important differential effect of the two instruments on these measures of outcome. Another trial is now needed to address this still open question more rigorously.

Adult↗
PubMed2001

Multiple immediate-early gene-deficient herpes simplex virus vectors allowing efficient gene delivery to neurons in culture and widespread gene delivery to the central nervous system in vivo.

Herpes simplex virus (HSV) has several potential advantages as a vector for delivering genes to the nervous system. The virus naturally infects and remains latent in neurons and has evolved the ability of highly efficient retrograde transport from the site of infection at the periphery to the site of latency in the spinal ganglia. HSV is a large virus, potentially allowing the insertion of multiple or very large transgenes. Furthermore, HSV does not integrate into the host chromosome, removing any potential for insertional activation or inactivation of cellular genes. However, the development of HSV vectors for the central nervous system that exploit these properties has been problematical. This has mainly been due to either vector toxicity or an inability to maintain transgene expression. Here we report the development of highly disabled versions of HSV-1 deleted for ICP27, ICP4, and ICP34.5/open reading frame P and with an inactivating mutation in VP16. These viruses express only minimal levels of any of the immediate-early genes in noncomplementing cells. Transgene expression is maintained for extended periods with promoter systems containing elements from the HSV latency-associated transcript promoter (J. A. Palmer et al., J. Virol. 74:5604-5618, 2000). Unlike less-disabled viruses, these vectors allow highly effective gene delivery both to neurons in culture and to the central nervous system in vivo. Gene delivery in vivo is further enhanced by the retrograde transport capabilities of HSV. Here the vector is efficiently transported from the site of inoculation to connected sites within the nervous system. This is demonstrated by gene delivery to both the striatum and substantia nigra following striatal inoculation; to the spinal cord, spinal ganglia, and brainstem following injection into the spinal cord; and to retinal ganglion neurons following injection into the superior colliculus and thalamus.

Animals↗
PubMed1999

Relation between size of delivery unit and neonatal death in low risk deliveries: population based study.

AIM: To examine risk of neonatal death after low risk pregnancies in relation to size of delivery units. METHODS: A population based study of live born singleton infants in Norway with birthweights of at least 2500 g was carried out. Antenatal risk factors were adjusted for. RESULTS: From 1972 to 1995, 1.25 million births fulfilled the criteria. The neonatal death rate was lowest for maternity units with 2001-3000 annual births and steadily increased with decreasing size of the maternity unit to around twice that for units with less than 100 births a year (odds ratio 2.1; 95 % confidence interval 1.6 to 2.8). Institutions with more than 3000 deliveries a year also had a higher rate (odds ratio 1.7; 95% CI 1.4 to 2.0), but analyses suggest that this rate is overestimated. CONCLUSION: Around 2000 to 3000 annual births are needed to reduce the risk of neonatal deaths after low risk deliveries.

Birth Rate↗
PubMed1997

Synthesis, characterization, biodegradation, and drug delivery application of biodegradable lactic/glycolic acid oligomers: Part II. Biodegradation and drug delivery application.

Previously synthesized lactic/glycolic acid (PLGA) oligomers with different compositions (i.e. different ratio of lactic to glycolic acid in the oligomers) were further studied regarding their biodegradation and drug delivery application. The PLGA oligomers have fast biodegradation characteristics. They degrade to water soluble substances, i.e. lactic and glycolic acids, at a rate of 31.43-40.68 mg day-1 in a medium of constant pH and 28.04-37.87 mg day-1 in a medium of non-constant pH. The biodegradation rate is affected by the composition of the PLGA oligomers and the pH of the incubating medium. The higher the content of glycolic acid moiety in the oligomer, the faster the biodegradation rate. The lower the pH of the incubating medium, the slower the biodegradation of PLGA oligomers. A sustained-release drug delivery system based on the PLGA oligomers was fabricated as injectable microgranules by thermal blending of the PLGA oligomers and drug. Aspirin was used as a model drug. The oligomeric microgranules have advantages of easy fabrication, high drug loading efficiency, easy administration, and fast biodegradation. This thermal blending preparation method has a high loading efficiency of more than 90%. The PLGA oligomeric microgranules can release drug from 9 to 13 days depending on the oligomer composition. Both drug release rate and release duration are influenced by composition of the oligomers. The PLGA oligomeric matrix has the capability of protecting aspirin from hydrolysis. The lactic/glycolic acid oligomeric microgranules have potential use for sustained-release drug delivery.

Aspirin↗
PubMed1996

Pulsed delivery of inhaled nitric oxide to patients with primary pulmonary hypertension: an ambulatory delivery system and initial clinical tests.

BACKGROUND: Inhaled nitric oxide (NO) has been shown to be a selective pulmonary vasodilator in certain patients with primary pulmonary hypertension (PPH). OBJECTIVES: The purpose of this study was to design and test a system for delivery of NO to awaken, ambulatory patients with PPH and to evaluate this system in the home setting. METHODS: The ambulatory delivery system consisted of a tank of 80 ppm of NO (balance N2), a modified gas-pulsing device, and nasal cannulas. The pulsing device was set to deliver NO for 0.1 s at the beginning of each inspiration. RESULTS: Using this system, eight patients with PPH were studied with pulmonary artery catheters in place. Inhalation of NO led to significant reductions in both mean pulmonary arterial pressure (PAPm) (51 +/-12 to 43 +/- 10 mm Hg; p=0.001) and pulmonary vascular resistance (PVR) (790 +/- 285 to 620 +/- 208 dyne x s x cm-5; p=0.01). Three of the eight patients had both greater than 20% and greater than 30% decreases in PAPm and PVR, respectively. No exhaled NO or N02 was detectable in any of the eight patients. One patient was discharged home from the hospital on a regimen of inhaled NO. At 9 months, no adverse effects were noted and the system was working well. CONCLUSIONS: Pulsed delivery of inhaled NO to ambulatory patients with PPH, via nasal prongs, is feasible and, in some patients, leads to significant improvement in pulmonary hypertension. Inhaled 09NO, therefore, may have a role in the long-term treatment of patients with PPH.

Administration, Inhalation↗
PubMed2004

Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing.

BACKGROUND: The authors conducted a study to compare administration of local anesthetic using a computer-controlled delivery device with an aspirating syringe for therapeutic scaling and root planing. The anterior middle superior alveolar, or AMSA, injection was compared with other maxillary injections. METHODS: Twenty healthy adults with moderate periodontal disease participated in this single-blind crossover study. Subjects were evaluated by a trained examiner and were treated by experienced dental hygienists. Subjects provided written and verbal pain ratings via a visual analog scale, or VAS, and a verbal rating scale, or VRS. AMSA injections were compared with syringe-delivered injections--greater palatine, or GP, and nasopalatine, or NP, blocks, and anterior superior alveolar and middle superior alveolar injections--in maxillary quadrants. Bleeding and changes in attachment were evaluated after one month. RESULTS: VAS and VRS scores for AMSA were significantly lower for computer-controlled delivery when compared with NP injections and combined maxillary injections (VAS scores) and with GP and combined maxillary injections (VRS scores). Mean injection times were similar for both groups. Mean gains in attachment were equal, 0.19 millimeters for quadrants anesthetized using computer-controlled injections and 0.22 mm for syringe injections. CONCLUSIONS: Subjects reported having less pain with GP and NP injections delivered using the computer-controlled device, and total injection time was similar to that required for syringe injections. Both techniques provided adequate anesthesia for therapeutic scaling and root planing. Clinical Implications. The two anesthetic delivery techniques were therapeutically equivalent for mandibular injections, and the AMSA injection has clinically significant advantages for maxillary injections.

Adult↗
PubMed2006

Vaginal delivery after caesarean delivery in the days of the Talmud (2nd century BCE -6th century CE).

Caesarean delivery was practised for ages, almost always as a postmortem procedure. It is referred to in the myths and folklore of many ancient societies, for some of the infants so delivered survived, although their mothers did not. A fascinating medical situation of vaginal birth after caesarean delivery that may have occurred in the days of the Talmud is described in Mishna, Bechoroth, chapter 2, page 47. Maimonides (1135-1204) suggested that this passage described a vaginal delivery of a second twin during a caesarean section. This paper discusses which of these two possibilities was more likely to occur in the days of the Talmud (roughly 2nd century B.C.E. to 6th century C.E).

Female↗
PubMed1979

Incidence of preterm delivery in patients with previous preterm delivery and/or abortion.

Patients with a history of two or more pregnancies which ended spontaneously before 37 weeks' gestation had an increased risk of spontaneous labour and delivery in subsequent pregnancies. This risk was correlated with previous second trimester abortion and spontaneous preterm delivery but not with previous first trimester abortions. Patients with one or more pregnancies ending in spontaneous second trimester abortion or with preterm labour and delivery had a 38--43% risk of again delivering before term.

Abortion, Spontaneous↗
PubMed1977

[Concerning the administration of pethidine (Dolantin during delivery: discussion to "Analgesia during delivery--delayed effects for the child? by Riegel, Messow and Pielsticker (author's transl)].

The obstetrical problematic of intrapartal infant death following administration of Dolantin were discussed with the help of both of the cases described in the article by Riegel et al. At the same time, the question of analgesia during delivery with pethidine in combination with a respiratory depressant antidote was examined. Lorfalgyl, according to current opinion, cannot compensate the antidepressive effect of pethidine. Instead, the application of pure pethidine is recommended for obstetric analgesia in the first stage of labor. Today, naloxone used as antidote is particularly suitable before delivery or can be injected into the umbilical vein of the child after delivery. A plan of treatment for pathidine therapy during the first stage of labor in combination with the antidepressant was suggested.

Anesthesia, Obstetrical↗
PubMed1994

A comparison between health centre deliveries and deliveries born before arrival in the Aitape district.

In this survey the obstetric and neonatal data of the admissions to the Obstetric Ward in Raihu Health Centre during 1990, 1991 and the first half of 1992 were analyzed. The emphasis of the survey was on the difference between deliveries born before arrival (BBA) (24%) and health centre (HC) deliveries (76%). The survey shows that there were differences in postnatal complications, postpartum haemorrhage (16% vs 4.3%), retained placenta (21% vs 1.3%) and puerperal sepsis (18% vs 4.3%), and in antenatal attendance (52% vs 90%), average bedstay (6.5 days vs 5.4 days), mean haemoglobin level (7.78 vs 8.77 g/dl) and gonorrhoea (17% vs 8%). For the neonatal data the survey shows differences in stillbirth rate (10.5% vs 2.3%), perinatal death in the first week (4.0% vs 2.5%) and mean birthweight (for male infants 2.75 kg vs 2.88 kg and female infants 2.60 kg vs 2.73 kg).

Birth Weight↗
PubMed2002

Photomechanical delivery of 100-nm microspheres through the stratum corneum: implications for transdermal drug delivery.

BACKGROUND AND OBJECTIVES: Photomechanical waves (PWs) render the stratum corneum permeable and allow molecules to diffuse into the epidermis. The aim of this study was to investigate the probe size that could be delivered through the stratum corneum and into the epidermis. STUDY DESIGN/MATERIALS AND METHODS: A single PW was applied onto the rat skin in vivo. Aqueous suspensions of fluorescent microspheres, 100 nm in diameter, were used as probes for transdermal delivery. The presence of the microspheres in the epidermis was measured by a fiber-based spectrofluorimeter after the stratum corneum was removed by tape-stripping (TS). RESULTS: Exposure of the rat skin to a PW permeabilized the stratum corneum and allowed the fluorescent microspheres to diffuse into the epidermis. CONCLUSIONS: The experiments show that PWs can facilitate the delivery of very large molecules and probes into the epidermis.

Administration, Cutaneous↗
PubMed1997

A new drug delivery system--ciprofloxacine/tricalcium phosphate delivery capsule (CTDC) and its in vitro drug release pattern.

A new drug delivery system (DDS), ciprofloxacine/tricalcium phosphate delivery capsule (CTDC) was developed by loading a broad-spectrum antibiotic ciprofloxacine into the central cylindrical cavity of tricalcium phosphate capsule. The new system showed good biocompatibility and could degrade gradually in our preliminary studies. In vitro study showed that CTDC could maintain high-level and long-term release of ciprofloxacine and that ultrasonic irradiation within the range of physical therapy could increase the drug release amount from CTDC ( P < 0.02), and might become a new technique to achieve the control of drug release from DDS.

Anti-Infective Agents↗
PubMed1979

Breech delivery: evaluation of the method of delivery on perinatal results and maternal morbidity.

A retrospective study of 460 single-gestation infants in breech position was conducted at the University of Colorado Medical Center to assess the impact of a policy for the selection of cases for vaginal delivery. Among infants weighing more than 2,500 grams, there was an increase in the cesarean section rate from 13% to 54%, with an associated increase in maternal morbidity from 7% to 15%. This occurred with no significant reduction in adverse perinatal outcome. However, a case-by-case review suggests that more frequent and timely cesarean sections would have further reduced perinatal morbidity and deaths among term infants. Among the infants weighing 2,500 grams or less there was an increase in cesarean births from 5% to 55% following the introduction of the strict criteria for vaginal delivery. Among the infants weighing 1,501 to 2,500 grams there was no significant difference in survival between the cesarean and vaginally delivered patients. Although infants weighing 501 to 1,500 grams delivered by cesarean section survived more frequently than did those delivered vaginally, the differences in perinatal deaths may have been due to a higher birth weight in the cesarean-delivered infants or an over-all improvement in neonatal intensive care for infants of very low birth weight.

Apgar Score↗