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PubMed2003

A randomised controlled trial of admission electronic fetal monitoring in normal labour.

AIM: To test the hypothesis that the use of admission Electronic Fetal Monitoring (EFM) for healthy pregnant women in spontaneous labour would result in an increase in continuous EFM when compared to women who have had no admission EFM. DESIGN: A randomised controlled trial. SETTING: The Midwives Birth Unit in Glasgow Royal Maternity Hospital, a major urban teaching hospital with approximately 5000 births per year. PARTICIPANTS: Healthy pregnant women admitted in normal labour, deemed low risk based on the midwives' birth unit admission criteria. INTERVENTION: Women were randomly allocated either to receive a routine 20-minute period of EFM at the time of admission (control group), or to receive no routine admission EFM (study group). OUTCOME MEASURES: Primary study outcomes, use of continuous EFM; and use of EFM additional to the admission test. SECONDARY OUTCOMES: artificial rupture of membranes, use of fetal scalp electrode, fetal blood sample, syntocinon, epidural analgesia, number of vaginal examinations, rate of transfer to labour ward, and reason for transfer. KEY FINDINGS: There was no statistically significant difference between the groups for use of continuous monitoring, but significantly more women in the control group did receive additional EFM. There was no statistically significant difference between groups for any of the interventions studied. CONCLUSION: The use of admission EFM did not in itself lead to a cascade of intervention. Other factors including setting of care and philosophy of caregivers may have an effect on the rate of intervention in labour.

Adolescent↗
PubMed1996

Factors influencing the development of melatonin rhythmicity in humans.

The emergence of melatonin rhythmicity was studied in 163 infants between 46-55 weeks postconception by monitoring the excretion of the urinary melatonin metabolite 6-sulfatoxymelatonin (aMT.6S). From this population, we examined the effects of gender, season, multiple birth, home birth, previous sudden infant death syndrome in the family, premature labor, spontaneous rupture of membranes, preeclampsia, intrauterine growth restriction, and nursery lighting on pineal rhythmicity. As previously reported, rhythmic excretion of aMT.6S appeared between 49-55 weeks postconception (9-15 weeks of age) in singleton babies born at term in the hospital. Full-term infants who had a sibling die of sudden infant death syndrome had a pattern of melatonin rhythm development no different from that of the control full-term infants. In contrast, full-term infants born at home and full-term twins born in the hospital had significantly lower aMT.6S excretion than hospital-born singleton infants at the same ages despite similar body weights (e.g. at 52 weeks postconception; 1.8 +/- 0.4, 1.1 +/- 0.3, and 3.6 +/ -0.5 nmol/day, respectively). In full-term infants, there was no difference in the development of melatonin rhythmicity between the sexes, with season or method of delivery (vaginal vs. caesarean). The premature infants were divided into 5 groups (babies born after premature labor, premature rupture of membranes, preeclampsia, intrauterine growth restriction, and fetal distress). All premature infants had a delay in the appearance of aMT.6S rhythms in the urine in relation to chronological age. When the infants were compared on the basis of weeks since conception, those infants born after spontaneous premature labor excreted amounts of aMT.6S no different from those of full-term singleton infants during the period of study. In contrast, the premature rupture of membranes, preeclampsia, and fetal distressed infants excreted 50% less aMT.6S, and intrauterine growth restricted infants excreted 67% less at the same postconceptional ages. These differences were due to reduced nocturnal excretion of the metabolite. In an attempt to accelerate the development of melatonin rhythmicity, premature labor and premature rupture of membranes infants were randomly assigned to be totally deprived of light (using phototherapy eye shields) or partially deprived of light by moving them to a dimly lit room each night for the last 3-8 weeks of their stay in the hospital nursery. Babies born after premature labor produced normal amounts of aMT.6S between 46-52 weeks postconception, and this pattern was not affected by the nocturnal light deprivation. Infants born after premature rupture of membranes and totally deprived of light at night had aMT.6S excretion rhythms at 52 weeks postconception no different from those of full-term hospital-born infants or premature labor infants, whereas those in infants placed in dim light were similar to those in untreated premature rupture of membranes infants. These results suggest that premature birth alone is not the sole cause of altered rhythm development; other factors, such as preeclampsia, growth restriction, and nursery lighting, play an important role. The consequences of the delayed appearance of melatonin in infants are not known, but deserve further study.

Birth Weight↗
PubMed1997

Sulfated polysaccharides extracted from sea algae as potential antiviral drugs.

The inhibitory effects of polyanionic substances on the replication of herpes simplex virus (HSV) and other viruses were reported almost four decades ago. However, these observations did not generate much interest, because the antiviral action of the compounds was considered to be largely nonspecific. Shortly after the identification of human immunodeficiency virus (HIV) as the causative agent of the acquired immune deficiency syndrome (AIDS) in 1984, heparin and other sulfated polysaccharides were found to be potent and selective inhibitors of HIV-1 replication in cell culture. Since 1988, the activity spectrum of the sulfated polysaccharides has been shown to extend to various enveloped viruses, including viruses that emerge as opportunistic pathogens (e.g., herpes simplex virus [HSV] and cytomegalovirus [CMV]) in immunosuppressed (e.g., AIDS) patients. As potential anti-HIV drug candidates, sulfated polysaccharides offer a number of promising features. They are able to block HIV replication in cell culture at concentrations as low as 0.1 to 0.01 microgram ml-1 without toxicity to the host cells at concentrations up to 2.5 mg ml-1. We noted that some polysulfates show a differential inhibitory activity against different HIV strains, suggesting that marked differences exist in the target molecules with which polysulfates interact. They not only inhibit the cytopathic effect of HIV, but also prevent HIV-induced syncytium (giant cell) formation. Furthermore, experiments carried out with dextran sulfate samples of increasing molecular weight and with sulfated cyclodextrins of different degrees of sulfation have shown that antiviral activity increases with increasing molecular weight and degree of sulfation. A sugar backbone is not strictly needed for the anti-HIV activity of polysulfates because sulfated polymers composed of a carbon-carbon backbone have also proved to be highly efficient anti-HIV agents in vitro. Other, yet to be defined, structural features may also play an important role. Sulfated polysaccharides may act synergistically with other anti-HIV drugs (e.g., azidothymidine [AZT]). They are known to lead very slowly to virus-drug resistance development and they show activity against HIV mutants that have become resistant to reverse transcriptase inhibitors, such as AZT, tetrahydro-imidazo [4,5,l-jk] [1,4]-benzodiazepin-2(1H)-thione (TIBO) and others. From studies on their mechanism of action we concluded that polysulfates exert their anti-HIV activity by shielding off the positively charged sites in the V3 loop of the viral envelope glycoprotein (gp120). The V3 loop is necessary for virus attachment to cell surface heparan sulfate, a primary binding site, before more specific binding occurs to the CD4 receptor of CD4+ cells. This general mechanism also explains the broad antiviral activity of polysulfates against enveloped viruses. Variations in the viral envelope glycoprotein region may result in differences in the susceptibility of different enveloped viruses to compounds that interact with their envelope glycoproteins. The efficacy of polysulfates in the therapy and/or prophylaxis of retroviral infections and opportunistic infections remains to be demonstrated both in animal models and humans. It is important to consider not only treatment of patients who are already infected with HIV, but also prophylaxis and protection from HIV and/or other virus infections. Because (i) sexual transmission is responsible for the large majority of HIV infections worldwide; (ii) this transmission is mostly mediated via mononuclear cells that infect epithelial cells of the genital tract; and because (iii) polysulfates effectively inhibit cell-cell adhesion, polysulfates may be considered as potentially effective in a vaginal formulation to protect against HIV infection.

Animals↗
PubMed1998

Postpartum sleep in the hospital. Relationship to taking-in and taking-hold.

This descriptive, correlational study examined the relationship of sleep in the hospital to the new mother's progression through Rubin's phases of taking-in and taking-hold in 120 women who had delivered vaginally. The Martell and Mitchell Postpartum Questionnaire, which measured taking-in and taking-hold, was completed the evening of delivery and the following two mornings. The Verran and Snyder-Halpern Visual Analog Sleep Scale was completed each morning. Both taking-in and taking-hold were present on the evening of delivery. There were small decreases in taking-in and small increases in taking-hold between the evening of delivery and the first morning. Sleep disturbance was high, and sleep effectiveness was low, on the first evening. Neither sleep measure was a predictor of change in taking-in or taking-hold. Findings indicate that taking-in and taking-hold are both present on the day of delivery and that increases in taking-hold take place despite high levels of sleep disturbance.

Adaptation, Psychological↗
PubMed1977

Long-term safety and use-effectiveness of intrauterine devices.

The long-term safety and effectiveness of Lippes Loops, A, C, and D, Dalkon Shields, Saf-T-Coils, and Cu 7-200 intrauterine devices (IUDs) were evaluated on the basis of 670 insertions in 588 women. Ten-year life-table rates for the Lippes Loops C (291 first insertions) and D (213 first insertions) were evaluated. The Loop C was consistently associated with a significantly higher expulsion rate but lower pregnancy rate as compared with the Loop D. Over-all, the removal rates for these two IUDs were similar. The incidence of pelvic infection and abnormal Papanicolaou smears, the time from IUD removal to conception, pregnancy outcome, and the need for any surgery post-IUD insertion were evaluated for all IUDs and all segments of use.

Bacterial Infections↗
PubMed1988

Mini-colpostats in the treatment of carcinoma of the uterine cervix.

Between 1976 and 1982, 293 patients were treated for carcinoma of the uterine cervix at Washington University by definitive radiotherapy consisting of external beam therapy and two standard Fletcher-Suit applications (tandem plus vaginal colpostats). In ninety-nine patients (34%) mini-colpostats (MC) were used for one or both of their intracavitary insertions while 194 (66%) patients were treated twice with regular Fletcher-Suit colpostats (RC). The frequency of MC use was related to the age and parity of the patients. The distribution by stage of MC and RC groups was not significantly different. Pelvic failure in the MC group was similar to that of the RC group (21% vs 24%). Five-year disease-free survival was also similar between the two groups: 86% vs 80% Stage IB, 57% vs 61% Stage IIA, 47% vs 52% Stage IIB, and 27% vs 45% Stage III for MC and RC groups, respectively. The rate of major complications (grade 3) was 15% in the MC group and 8% in the RC group (p = 0.08). Careful phantom dosimetric studies in both types of colpostats and correlations of dose distributions at various points in the pelvis with frequency of rectal and bladder complications were carried out. The bladder and rectum received a 5-10% higher mean radiation dose (Gy) in the MC group than in the RC group despite lower overall exposure (milligram-hours). Thermoluminescent dosimetry in a polystyrene phantom demonstrates that approximately 10% higher doses are delivered to the bladder, rectum, and point A with an MC system as compared to an RC system, for constant exposure in mgh. Phantom measurements of a newer MC with bladder and rectal shielding demonstrate no influence on the bladder and rectal point dose at a source separation of 3 cm; midline points of the bladder and rectum are not within the full shadow of the shields even if the colpostats are flush with the tandem. Implications for therapy are discussed.

Brachytherapy↗
PubMed1996

Gynecologic evaluation of the first female soldiers enrolled in the Gulf War Comprehensive Clinical Evaluation Program at Tripler Army Medical Center.

Tripler Army Medical Center initiated the Department of Defense's Persian Gulf Illness Comprehensive Clinical Evaluation Program (CCEP) on June 15, 1994. In the first 5 months, 100 patients enrolled in this program. Sixteen (16%) were women who served in the Persian Gulf during Desert Shield/ Desert Storm, and 1 (1%) was the dependent wife of a Gulf War veteran who is experiencing illness that may be related to the Persian Gulf War. All 17 women enrolled in the CCEP were evaluated in the Tripler Army Medical Center Obstetrics and Gynecology Clinic between June 17 and November 10, 1994. Each patient underwent gynecologic history, pelvic exam, Pap smear, and screen for fecal occult blood. Ten patients underwent baseline mammograms and 13 patients underwent urogenital and cervical cultures for aerobic bacteria, chlamydia and herpes simplex. The 1 patient with an abnormal Pap smear underwent cervical and endocervical biopsies and colposcopy (histology demonstrated no dysplasia or neoplasia). Half of the 16 Gulf War veterans experienced gynecologic problems while serving in the Gulf and 43% admitted gynecologic problems since returning in 1991. Of 6 patients who became pregnant after returning, 5 had normal pregnancies and 1 suffered four miscarriages.

Adult↗