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At least 163 records · Page 9Linked to original sources
PubMed2000

Comparison of the Bishop score, ultrasonographically measured cervical length, and fetal fibronectin assay in predicting time until delivery and type of delivery at term.

OBJECTIVE: Our aim was to compare the Bishop score, fetal fibronectin assays, and ultrasonographic measurement of cervical length to determine the best markers for time until spontaneous labor at term and risk of cesarean delivery, especially for the indication of lack of progress of dilatation. STUDY DESIGN: This prospective study included 128 singleton vertex pregnancies with no clinical evidence of membrane rupture or regular contractions and a prenatal consultation between 39 weeks 4 days' gestation and 40 weeks 3 days' gestation. We successively assayed for fetal fibronectin, determined the Bishop score, and measured cervical length by transvaginal ultrasonography. The end points were the percentage of patients with a spontaneous onset of labor in the week after these tests and the type of delivery. RESULTS: The spontaneous onset of labor within a 7-day period was closely associated with a Bishop score > or = 6 and with a cervical length < or = 26 mm but not with a positive result of the fetal fibronectin assay. On the other hand, vaginal delivery was significantly associated with the fibronectin assay result but not with either the Bishop score or cervical length. CONCLUSIONS: The Bishop score and ultrasonographic measurement of cervical length are valuable for predicting the onset of spontaneous labor within 7 days (when these assessments are performed close to term), whereas the fetal fibronectin assay is useful for evaluating the risk of cesarean delivery. These tests thus provide different physiologic data that are useful for different purposes.

Adult↗
PubMed1996

Head entrapment and neonatal outcome by mode of delivery in breech deliveries from 28 to 36 weeks of gestation.

OBJECTIVES: We attempted to determine whether there are differences in the incidence of head entrapment and adverse neonatal outcome by mode of delivery in breech deliveries from 28 to 36 weeks of gestation. STUDY DESIGN: Computerized data and charts of 321 viable consecutive singleton breech deliveries from 28 to 36 weeks' gestation were reviewed. Statistical methods used included chi2, logistic regression, and analysis of variance. RESULTS: Head entrapment occurred in 4 of 52 (7.7%) neonates delivered vaginally and 14 of 269 (5.2%) neonates delivered by cesarean section (p = 0.48). There were no statistically significant associations between head entrapment and adverse neonatal outcomes. CONCLUSIONS: There was no significant difference in the incidence of head entrapment by mode of delivery for breech infants at 28 to 36 weeks' gestation, nor was there an association with adverse neonatal outcomes after entrapment.

Birth Weight↗
PubMed2002

Immersion delivery of plasmid DNA. II. A study of the potentials of a chitosan based delivery system in rainbow trout (Oncorhynchus mykiss) fry.

The possibility of utilising DNA vaccines for aquaculture fish has been of growing interest in recent years and novel methods to deliver DNA to the fish are under investigation. One of the delivery methods of interest is immersion. Due to the favourable properties of chitosan in gene delivery and bioadhesion, chitosan-DNA formulations have been investigated for use for immersion delivery to fish. Initial studies on this system, however, revealed an acute toxic effect of the formulations. In this study, factors important for the acute toxicity of chitosan and chitosan formulations are identified and attempts are made to explain the underlying mechanisms for the toxicity. In vivo methods revealed that the toxicity mainly was dependent on the concentration of chitosan, but also the molecular weight and the degree of acetylation of the chitosans were of importance. Noteworthy, the toxicity of the polymer decreased dramatically when the chitosan was 'decharged' by complexation with DNA. In vitro experiments supported the in vivo observations. Most likely, the observed toxicity is caused by an electrostatic interaction between the cationic polymer and the anionic parts of the gill mucus. The result is obstructed oxygen diffusion over the gills and the fish are killed by acute hypoxia. Careful selection of chitosan type and charge of the particles may result in a potential for chitosan based immersion delivery of plasmid DNA.

Animals↗
PubMed2000

Floating drug delivery systems: an approach to oral controlled drug delivery via gastric retention.

In recent years scientific and technological advancements have been made in the research and development of rate-controlled oral drug delivery systems by overcoming physiological adversities, such as short gastric residence times (GRT) and unpredictable gastric emptying times (GET). Several approaches are currently utilized in the prolongation of the GRT, including floating drug delivery systems (FDDS), also known as hydrodynamically balanced systems (HBS), swelling and expanding systems, polymeric bioadhesive systems, modified-shape systems, high-density systems, and other delayed gastric emptying devices. In this review, the current technological developments of FDDS including patented delivery systems and marketed products, and their advantages and future potential for oral controlled drug delivery are discussed.

Administration, Oral↗
PubMed2006

[First breech twin pregnancy: Can we still accept a vaginal delivery? Comparative study of perinatal outcome with attempt of vaginal delivery versus planned cesarean: 166 cases].

OBJECTIVES: To evaluate practices and perinatal outcome in planned routes of delivery for first breech twins. MATERIALS AND METHODS: A retrospective study in first breech twin pregnancies with a gestational age of at least 35 weeks at onset of labor. Maternofetal pathologies known to be associated with a poor neonatal outcome were excluded. A low neonatal outcome was defined by at least one of the following criteria: neonatal death, 5-minute Agar Score < 7, cord blood pH < 7.10, traumatic neurological injuries, admission in neonatal intensive unit care. Neonatal and maternal outcomes were compared between attempt of vaginal delivery (AVD) and planned cesarean section (PCS). RESULTS: Among 166 included patients, an AVD has been performed in 105 cases (63.3%) and a PCS in 61 (36.8%). In AVD group, 46 women (43.8%) delivered vaginally. Low neonatal outcome was not significantly different in AVD group compared with PCS group (9 (8.6%) versus 6 (9.8%); p = 0.78 for the first twin and 7 (6.7%) versus 2 (3.3%); p = 0.49 for the second twin). There was no significant difference in maternal morbidity between the two groups. As a general rule, established practices for deciding route of delivery and labor have been applied in our department. CONCLUSION: No excess of neonatal risk in AVD group compared with PCS was observed. These results could be extrapolated to centers applying a careful protocol to decide the route of delivery and labor practices.

Adult↗
PubMed2002

Mode of delivery and outcome of 699 term singleton breech deliveries at a single center.

OBJECTIVE: Elective cesarean delivery has been postulated to improve the outcome of term fetuses in breech presentation. We retrospectively compared the short- and long-term outcomes of term infants who were delivered from a breech presentation at a single center. STUDY DESIGN: We reviewed 699 consecutive term breech presentations according to the intended mode of delivery at a single center between January 1993 and December 1999. The short-term outcome measures were perinatal death, neonatal death, or serious neonatal morbidity; the long-term outcome measures were developmental delay and spasticity. RESULTS: The rate of serious perinatal morbidity in the trial-of-labor and cesarean delivery groups was 2.3% and 0.5%, respectively (P =.12). There was no perinatal or neonatal death in either group. With a median follow-up period of 57 months (range, 13-100 months), the rate of developmental delay was 1.9% and 0.5%, respectively (P =.29). Spasticity was not noted in any of the children. CONCLUSION: Our data suggest that planned vaginal delivery remains an option for selected term breech presentations.

Adult↗
PubMed2005

Colon targeted delivery systems: review of polysaccharides for encapsulation and delivery.

Colon-targeted delivery of bioactives has recently gained importance in addressing specific needs in the therapy of colon-based diseases. Many approaches have been attempted for the development of colon-specific delivery systems, with not much success in the past. Recent research into the utilization of the metabolic activity and the colonic microenvironment in the lower gastrointestinal tract has attained great value in the design of novel colon-targeted delivery systems based on natural biodegradable polymers. In the current article, special emphasis has been placed on polysaccharide systems, with minimal chemical modification, that have been exploitedfor colon targeting. These polysaccharide based encapsulation and targeted delivery systems are envisaged to have an immense potential for the development of food/nutraceutical formulations for colon-based diseases, including colorectal cancer.

Alginates↗
PubMed1993

Feasibility and drug delivery efficiency of a new balloon angioplasty catheter capable of performing simultaneous local drug delivery.

BACKGROUND: Local drug delivery at angioplasty treatment sites may improve acute and long-term results after angioplasty. A new dual-purpose balloon angioplasty catheter containing intramural channels and exterior pores ('channeled balloon') was designed to allow local drug delivery at low pressure without jet streams during simultaneous balloon angioplasty. METHODS: Acute feasibility studies were performed in normal ex-vivo and in-vivo arteries (three canine arteries and three rabbits with normal iliac arteries), in which 2 ml of marker agents were locally infused at 2 atm during simultaneous angioplasty at 6 atm with the channeled balloon. Histology, radioactive counting, and autoradiography were performed to determine the intramural localization of the delivered markers. The in-vitro efficiency of acute local drug delivery was estimated in seven normal canine arteries by infusing 3H-heparin and radioactive counting. RESULTS: Histology revealed the presence of markers in the inner third of the media in all ex-vivo samples, and markers in all in-vivo iliac arteries except for one, whereas control segments had no intramural staining. Autoradiography documented transmural radioactive granules. Radioactive counts were 40- to 263-fold higher in those locally treated with the radioactive marker agent. Efficiency of the acute local delivery was estimated by dividing the actual counts by the expected counts; it ranged from 24 to 48%. CONCLUSION: This study demonstrates that the channeled balloon is capable of delivering drugs locally at low pressure in adequate concentrations during simultaneous high-pressure balloon angioplasty in normal arteries.

Angioplasty, Balloon, Coronary↗
PubMed1983

A comparison of low-risk pregnant women booked for delivery in two systems of care: shared-care (consultant) and integrated general practice unit. II. Labour and delivery management and neonatal outcome.

A random sample of low-risk pregnant women were equally divided into four groups of 63 nulliparae and multiparae each booked for care in a integrated general practice unit (GPU) and a shared-care (consultant) system. Selection criteria included only women who were admitted because they were in spontaneous labour or thought they were. Nulliparous women booked for shared-care came into hospital at a less advanced state of cervical dilatation than those booked for the GPU and spent longer (11 compared with 8 h) in hospital before delivery; the comparable durations in multiparae were 6 and 4 h. Both the first and second stages of labour were longer in the GPU-booked women but they received less pethidine and fewer had epidural analgesia; they received less electronic fetal monitoring, augmentation and forceps delivery, and fetal distress was diagnosed less often. The 1-min Apgar score was less than or equal to 6 in 17.5% of infants of nulliparae booked for the shared-care system compared with 1.6% of those booked for the GPU. The intubation rate of infants of nulliparae was 11% in the shared-care system compared with no intubations in the GPU. These comparisons demonstrate the simplicity and safety of delivery of low-risk women in the GPU as compared with deliveries of similar women in a shared-care (consultant) unit.

Adolescent↗
PubMed1999

Vaginal delivery compared with caesarean section in early preterm breech delivery: a comparison of long term outcome.

OBJECTIVE: To determine the optimum mode of delivery of the early preterm fetus in breech presentation. DESIGN: Retrospective comparison of two cohorts of preterm breech fetus. SETTING: Two tertiary care centres: at one centre the preferred management for preterm breech presentation was vaginal delivery; at the other centre, the preferred method was caesarean section. POPULATION: All singleton infants delivered after breech presentation from 1984 through 1989, at a gestational age of 26 to 31 weeks. Those with lethal congenital abnormalities, placenta praevia, placental abruption, fetal death or fetal distress before the onset of labour were excluded. MAIN OUTCOME MEASURES: Survival without disability or handicap documented at two years corrected age. The influence of a number of relevant variables on this outcome was assessed by logistic regression analysis. RESULTS: There was no difference in survival without disability or handicap between the centres (odds ratio 1.5, 95% CI 0.6-3.9 vaginal delivery compared with caesarean section). Survival without disability or handicap was positively influenced by increasing birthweight and corticosteroids > 24 h before birth, and negatively influenced by footling presentation. CONCLUSION: A policy of caesarean section for early preterm (26-31 weeks) breech delivery is not associated with increased survival without disability or handicap.

Adult↗
PubMed2006

Novel drug delivery systems: potential in improving topical delivery of antiacne agents.

Acne is the most common cutaneous disorder of multifactorial origin with a prevalence of 70-85% in adolescents. The majority of the acne sufferers exhibit mild to moderate acne initially, which progresses to the severe form in certain cases. Topical therapy is employed as first-line treatment in mild acne, whereas for moderate and severe acne, systemic therapy is required in addition to topical therapy. Currently, several topical agents are available that affect at least one of the main pathogenetic factors responsible for the development of acne. Although topical therapy has an important position in acne treatment, side effects associated with various topical antiacne agents and the undesirable physicochemical characteristics of certain important agents like tretinoin and benzoyl peroxide affect their utility and patient compliance. Novel drug delivery strategies can play a pivotal role in improving the topical delivery of antiacne agents by enhancing their dermal localization with a concomitant reduction in their side effects. The current review emphasizes the potential of various novel drug delivery strategies like liposomes, niosomes, aspasomes, microsponges, microemulsions, hydrogels and solid lipid nanoparticles in optimizing and enhancing the topical delivery of antiacne agents.

Acne Vulgaris↗
PubMed1996

[Delivery from breech presentation with the delivery chair. Initial experiences with a new obstetric method].

OBJECTIVE: To prove safety and practicability of birth from breech presentation on a delivery chair. METHOD: In a retrospective study (1990-1995) all fetuses with breech presentation and those born using a delivery chair were collected. RESULTS: Out of a total of 2,925 fetuses 138 (4.7%) had breech presentation; 82 of them were born on a delivery chair. CONCLUSIONS: Since 1992 all fetuses with breech presentation were born on the delivery chair. The frequency of cesarean sections was roughly the same in both collectives (25.5%). We could not identify any disadvantages with this new technique.

Adult↗
PubMed2000

Improved brain delivery of a nonsteroidal anti-inflammatory drug with a synthetic glyceride ester: a preliminary attempt at a CNS drug delivery system for the therapy of Alzheimer's disease.

1,3-Diacetyl-2-ketoprofen glyceride (DAKG), a prodrug of ketoprofen, was synthesized as a model compound in our attempt to develop a central nervous system (CNS) drug delivery system to treat Alzheimer's disease. The primary purpose of the present study is to test whether DAKG improves the delivery of ketoprofen to the brain and to quantitatively evaluate several factors that influence the brain distribution of this prodrug. ddY mice were injected with either ketoprofen or DAKG at a dose of 40 micromol/kg and then the plasma and brain pharmacokinetics of these agents were assessed. The brain uptake clearance of ketoprofen and DAKG across the BBB was measured by in situ mouse brain perfusion. In addition, the efflux permeability of ketoprofen through the BBB was evaluated using the in vivo mouse brain microdialysis technique. The in vivo metabolism of DAKG in the brain was assessed by a short infusion into the internal carotid artery coupled with the brain metabolism index (BMI) method. Administration of DAKG produced an approximately 3-fold increase in the area under the brain concentration - time curve of ketoprofen, compared with administration of ketoprofen itself. The brain uptake clearance (CL(in) ) of ketoprofen across the BBB was 0.0308 +/- 0.0046 mL/min/g whereas the CL(in) of DAKG was 1.60 +/- 0.16 mL/min/g, suggesting a marked increase in BBB permeability following lipidization of ketoprofen. The BMI method confirmed that DAKG is taken up by the brain to rapidly release ketoprofen in a dose-dependent manner. The in vitro metabolism studies revealed that isolated bovine brain capillaries as well as whole brain homogenate have the hydrolysis activity to DAKG. In addition, the brain concentration of ketoprofen after DAKG administration was maintained for a significant period following co-administration of probenecid. These results suggest that DAKG improves the delivery of ketoprofen to the brain, and this improved delivery is due to avid uptake of DAKG across the BBB followed by rapid hydrolysis to ketoprofen within the brain. The ketoprofen produced in the brain was probably cleared by the active efflux system operating in the BBB. Significant inhibition of this efflux system by co-administration of probenecid could result in a sustained concentration of ketoprofen in the brain following DAKG administration.

Alzheimer Disease↗
PubMedDate not supplied

Collagen shield delivery of tissue plasminogen activator: functional and pharmacokinetic studies of anterior segment delivery.

BACKGROUND: Postoperative fibrin formation remains a major complication associated with intraocular surgery, especially after vitreoretinal surgery for proliferative vitreoretinopathy, proliferative diabetic retinopathy, trauma, or endophthalmitis. Tissue plasminogen activator (tPA) has been shown, both in experimental studies and clinical trials, to specifically dissolve formed intraocular fibrin after intracameral or intravitreal injection. We studied collagen shield delivery of tPA to the anterior segment and vitreous of rabbit eyes to evaluate a noninvasive delivery modality. METHODS: Anterior segment fibrin clots were formed in rabbit eyes by injecting citrated rabbit plasma. The tPA hydrated collagen shields, or control shields, were then placed on the rabbit corneas and the extent of fibrin clot was followed. In other rabbit eyes, tPA hydrated collagen shields were placed on the rabbit corneas and an enzyme-linked immunosorbent assay (ELISA) was utilized to determine aqueous, vitreous, and blood levels of tPA over time. RESULTS: Collagen shield tPA delivery shortened the time to fibrin clot lysis by 50% (mean clearance time = 49 +/- 23 hours; P less than .05). ELISA for tPA levels noted measurable vitreous levels by 2 hours after tPA hydrated collagen shield application with a peak at 24 hours. Aqueous tPA levels were not measurable until 18 hours after tPA collagen shield application and peaked at 36 hours. Vitreous tPA levels were greater than aqueous tPA levels at all time points (P less than .05). No evidence of corneal edema or opacification, hemorrhage, or cataract was seen. CONCLUSIONS: These results document the efficacy and safety of tPA delivery to the aqueous and vitreous via a hydrated collagen shield in this animal model.

Absorption↗
PubMed1989

[The significance of the place of delivery for an uncomplicated delivery].

As part of an extensive prospective consecutive investigation of the course of delivery in the Maternity Clinic and Special Department in Glostrup Hospital, the results of the uncomplicated deliveries in both of these institutions are described in this article. Women who were delivered in the Maternity Clinic were, on the whole, a few years older and belonged to higher social groups than those who were delivered in the Special Department. Electronic monitoring was rarely employed in the Maternity Clinic, the parturient women were mobilized to a greater extent, the administration of analgesics was less and early rupture of the membranes was undertaken on fewer occasions. Patients appeared to be more satisfied with the physical surroundings in the Clinic than in the Special Department. It is not possible to isolate any single factor which was responsible for the differences encountered. However, there can scarcely be any doubt that the physical surroundings and the environment in the Maternity Clinic exerted a positive influence on the course of the delivery. The arrangements in the Maternity Clinic have probably also permitted the midwives to give the individual women more personal attention than is normally possible in a busy Special Department. Finally, differences in attitudes and knowledge in the parturient women may well have contributed to the differences encountered. Only randomized controlled investigations will be capable of revealing the roles played by the individual factors in the course of delivery.

Adult↗
PubMed1989

[Fathers of first infants--preparatory courses about delivery, experience of delivery and paternity leave].

In the Central Hospital in Randers, 233 fathers of first infants replied to a questionnaire which illustrated their attitudes to the preparatory courses about delivery, experience of delivery and attitudes to paternity leave. 65% of the fathers participated in the course and 74% stated that they considered that this had been profitable. Where 77% of the men were concerned, these considered that participation in delivery had been a positive experience. 73% of the men had planned paternity leave around the time of delivery, which emphasizes the need for this arrangement.

Delivery, Obstetric↗
PubMed1983

[Home delivery or hospital delivery--a statement free of ideologies].

Due to the progress in obstetrics during the past 20 years hospital deliveries are becoming considerable less risk for mother and child if compared with prior times. On the other hand, individual emotional needs of mother and child are supposed to be relatively more attainable at home deliveries. From the movement to deliver at home obstetrician should learn how to achieve an emotional atmosphere during hospital delivery. Finally we may suggest as a compromise between home and hospital deliveries, out patient management of the same.

Ambulatory Care↗
PubMed1996

Stress hormones and acid-base status in human fetuses at term delivery: the effect of delivery method.

To evaluate the effect of delivery mode on fetal stress hormones and acid-base status and also to investigate the relationship between fetal acidemia and these hormones. 64 women with term pregnancies were studied. All had singleton, healthy pregnancies. Twenty one women were delivered by spontaneous vaginal route, 23 by vaginal route following oxytocin infusion and 20 by elective caesarean section. Umbilical cord blood samples were obtained immediately following the delivery. Blood gas (pH, pCO2, pO2) and hormonal analysis (Cortisol, dehydroepiandrosterone sulphate, prolactin, androstenedione) were done in arterial and venous cord blood samples respectively. Higher pO2 and prolactin, lower pH levels were found in caesarean section compared to other two groups (p < 0.05). At the time of delivery 11 infants had acidemia (pH < 7.20) as judged by pH of umbilical arterial blood. Acidemic group had higher cortisol and pCO2; lower pH and pO2 levels compared to non-acidemic group (p < 0.05). Method of delivery may affect acid-base and hormonal status of human fetus. Fetal acidemia may alter fetal adrenal steroidogenesis leading to increased fetal cortisol production.

Acidosis↗