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1.
J Reprod Med ; 45(2): 149-52, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10710749

ABSTRACT

BACKGROUND: Pregnancy associated with primary pulmonary hypertension is an uncommon observation, with maternal mortality > 50%. Experience treating this condition is limited. Past reports have emphasized the need for pregnancy termination. In the last few years there has been considerable interest in long-term intravenous use of epoprostenol (prostacyclin) in patients with primary pulmonary hypertension. CASE: A woman with severe primary pulmonary hypertension who was on long-term epoprostenol therapy became pregnant with twins and was treated with high doses of epoprostenol and nitric oxide during delivery and the postpartum period. She was well six months later on continuous epoprostenol therapy. The one viable infant was alive and still hospitalized at this writing. CONCLUSION: Epoprostenol therapy may be continued during pregnancy in patients with severe primary pulmonary hypertension for long-term pulmonary vasodilatation.


Subject(s)
Abnormalities, Drug-Induced , Antihypertensive Agents/therapeutic use , Bronchodilator Agents/therapeutic use , Epoprostenol/therapeutic use , Hydrocephalus/chemically induced , Hypertension, Pulmonary/drug therapy , Nitric Oxide/therapeutic use , Pregnancy Complications, Cardiovascular/drug therapy , Pregnancy, Multiple , Adult , Anticoagulants/adverse effects , Antihypertensive Agents/adverse effects , Epoprostenol/adverse effects , Face/abnormalities , Female , Humans , Hypertension, Pulmonary/complications , Pregnancy , Pregnancy Outcome , Syndrome , Twins , Warfarin/adverse effects
2.
Am J Epidemiol ; 146(11): 961-5, 1997 Dec 01.
Article in English | MEDLINE | ID: mdl-9400338

ABSTRACT

Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. Women with GDM are at elevated for numerous maternal health complications, and their infants are at elevated risk for death and morbidity. Management of GDM has traditionally been through diet and close monitoring of glucose levels, with initiation of insulin therapy when diet alone fails to maintain euglycemia. Recently, however, it has been suggested that alternative treatment modalities, such as exercise, may overcome a peripheral resistance to insulin, thus preventing GDM or controlling hyperglycemia in women with GDM. In this study, conducted from October 1995 to July 1996, the authors used a population-based birth registry to determine whether exercise has a preventive role in the development of GDM in women living in central New York State. They used contingency tables and chi-square statistics to examine bivariate differences among maternal and demographic variables and the occurrence of GDM. When stratified by prepregnancy body mass index category, exercise was associated with reduced rates of GDM only among women with a body mass index greater than 33 (odds ratio = 1.9, 95% confidence interval 1.2-3.1). The effect of exercise in obese women was further complicated by insurance status. When the data were stratified by insurance status, it appeared that women of higher socioeconomic status who were obese and did not exercise were at a significantly elevated risk of GDM compared with their counterparts of lower socioeconomic status. The results of this study suggest that for some women exercise may play a role in reducing the risk that they will develop GDM during pregnancy.


Subject(s)
Diabetes Mellitus/epidemiology , Diabetes, Gestational/epidemiology , Exercise , Obesity , Adult , Body Mass Index , Diabetes Mellitus/prevention & control , Diabetes, Gestational/prevention & control , Female , Humans , New York/epidemiology , Pregnancy , Prevalence , Retrospective Studies , Risk Factors , Social Class
3.
Am J Public Health ; 87(10): 1709-11, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9357361

ABSTRACT

OBJECTIVES: This study assessed the effect of unintended pregnancy on breast-feeding behavior. METHODS: All women delivering a live birth between January 1, 1995, and July 31, 1996 (n = 33,735), in the 15-county central New York region were asked whether they had intended to become pregnant and their breast-feeding plans. RESULTS: Women with mistimed pregnancies, and pregnancies that were not wanted were significantly less likely to breast-feed than were women whose pregnancies were planned. After adjustment for confounding variables and contraindications for breast-feeding, the odds ratios of not breast-feeding remained significant. CONCLUSIONS: Promoting breast-feeding among women with unintended pregnancies is important to improve health status.


Subject(s)
Breast Feeding/psychology , Pregnancy, Unwanted/psychology , Pregnancy/psychology , Female , Humans , New York
4.
Obstet Gynecol ; 89(2): 213-6, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9015022

ABSTRACT

OBJECTIVE: To explore the relationship between pre-pregnancy obesity and the risk for cesarean delivery. METHODS: The population studied included 20,130 women with live births after 20 weeks' gestation in central New York state between June 1, 1994, and May 31, 1995. Women who were obese before pregnancy were compared with nonobese women with regard to mode of delivery. Obesity was defined as body mass index (BMI) greater than 29. Separate analyses were conducted on the entire sample and on a subset of women with singleton pregnancies and no prior cesarean deliveries, as an estimate of the risk of primary cesarean delivery in obese women. Statistical analyses included chi 2 test, crude odds ratio (OR) with 95% confidence interval (CI), and adjusted OR with 95% CI, using logistic regression to control for confounding variables. RESULTS: The adjusted OR was 1.64 (95% CI 1.46, 1.83) for obese women with singleton pregnancies and no prior cesarean deliveries to undergo cesarean delivery. The adjusted OR was 1.66 (95% CI 1.51, 1.82) for obese women in the entire sample to undergo cesarean delivery. In addition, increasing BMI was associated with increased risk for cesarean delivery. CONCLUSION: Compared with nonobese women, women who are obese before pregnancy are at increased risk for cesarean delivery. Preconceptional counseling regarding dietary and life-style modifications may alter this pattern.


Subject(s)
Cesarean Section/statistics & numerical data , Obesity , Pregnancy Complications , Adult , Confidence Intervals , Female , Humans , Odds Ratio , Pregnancy , Risk Factors
5.
J Public Health Manag Pract ; 3(2): 37-40, 1997 Mar.
Article in English | MEDLINE | ID: mdl-10186710

ABSTRACT

We evaluated the cost impact of implementing a perinatal data system (PDS) on birth certificate (BC) processing and perinatal quality improvement (QI) reporting. Relevant staff in all birthing hospitals in the 15-county Central New York region (N = 23) were interviewed at baseline prior to implementation of the PDS and one year after implementation of the PDS to ascertain the time and costs of BC processing and of QI report generation. The average time and cost to collect and complete BCs did not change significantly from baseline to year 1. The time and costs to complete QI reports decreased significantly by 70 percent during this same period. Hospitals fully using the PDS for QI reporting purposes took, on average, six percent of the time it took other hospitals to generate comparable QI reports. The PDS significantly reduced the time and cost of generating perinatal reports from a consolidated database over what hospitals had done previously. Given the richness of the reports and the efficiency with which they are produced, hospitals are encouraged to adopt electronic means of BC processing and accessing these data for QI reporting purposes.


Subject(s)
Automation/economics , Birth Certificates , Hospital Information Systems/economics , Perinatal Care/organization & administration , Quality Assurance, Health Care/organization & administration , Cost-Benefit Analysis , Female , Humans , Infant, Newborn , New York , Perinatal Care/economics , Pregnancy
6.
J Reprod Med ; 35(6): 658-60, 1990 Jun.
Article in English | MEDLINE | ID: mdl-2193155

ABSTRACT

A small, cystic structure was identified on a routine ultrasound scan performed for dating at 15 weeks' gestation. Originally it was thought to be an omphalocele, but further examination confirmed its origin in the cord several centimeters distal to the fetus. Close scrutiny of ultrasonograms is important since technical capabilities permit high-resolution scans during early gestation.


Subject(s)
Hernia, Umbilical/diagnosis , Ultrasonography , Urachal Cyst/diagnosis , Diagnosis, Differential , Female , Humans , Pregnancy , Pregnancy Trimester, Second
8.
Infection ; 13(6): 263-6, 1985.
Article in English | MEDLINE | ID: mdl-4077268

ABSTRACT

Routine cervical cultures for chlamydia were obtained during the third trimester of pregnancy to identify infected mothers whose infants may also be infected. The effectiveness of maternal erythromycin therapy in preventing disease due to chlamydia among infants born to these women was also assessed. Clinical outcome of treated mothers and infants was compared to that of untreated subjects. Of 1082 women who were cultured, 85 (7.8%) were positive for chlamydia. Erythromycin therapy was prescribed for 38 of these women. Nasopharyngeal/conjunctival chlamydia cultures were obtained from 16 infants of culture-positive, treated mothers and 21 infants of culture-positive, untreated mothers. None of the infants born to culture-positive, treated mothers developed infection with chlamydia, while five of 21 infants of untreated mothers (p less than 0.04) were culture-positive and symptomatic (four with conjunctivitis, one with pneumonia). On follow-up of the infants born to chlamydia-positive mothers, there was no evidence that chlamydia-infected infants had more frequent episodes of upper respiratory infection and otitis media during the first six months of life. This study demonstrated that diagnosis and treatment of cervical chlamydia infection during the third trimester of pregnancy provides a practical approach to the prevention of infection in the newborn.


Subject(s)
Cervix Uteri/microbiology , Chlamydia Infections/prevention & control , Infant, Newborn, Diseases/prevention & control , Adult , Chlamydia trachomatis , Conjunctivitis/microbiology , Erythromycin/therapeutic use , Female , Humans , Infant , Infant, Newborn , Pneumonia/microbiology , Pregnancy , Pregnancy Trimester, Third , Uterine Cervicitis/drug therapy , Uterine Cervicitis/microbiology
10.
JAMA ; 251(7): 935, 1984 Feb 17.
Article in English | MEDLINE | ID: mdl-6694297
14.
Am J Obstet Gynecol ; 139(8): 937-8, 1981 Apr 15.
Article in English | MEDLINE | ID: mdl-6261581

ABSTRACT

A case is presented in which cytomegalovirus was isolated from the amniotic fluid at 36 weeks' gestation in a pregnancy complicated by cytomegalovirus hepatitis at 10 weeks of gestation. Abnormalities noted in the newborn infant included an undescended testis, right equinovarus, and hypotonia. All cultures revealed cytomegalovirus. Subsequent immunoglobulin studies, chest x-ray film, and bone films were all normal.


Subject(s)
Amniotic Fluid/microbiology , Cytomegalovirus Infections/microbiology , Cytomegalovirus/isolation & purification , Pregnancy Complications, Infectious/microbiology , Adolescent , Female , Hepatitis, Viral, Human/microbiology , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Trimester, Third
15.
J Reprod Med ; 22(4): 213-6, 1979 Apr.
Article in English | MEDLINE | ID: mdl-458765

ABSTRACT

Persistent fetal bradycardia may have multiple etiologies. The following represents a case of persistent fetal bradycardia due to congenital heart block in the infant of a woman with suspected collagen vascular disease. A review of the literature and a discussion of the association of maternal collagen vascular disease and congenital heart block is presented. The prognosis of infants with congenital heart block is reviewed and the possible association with growth retardation discussed.


Subject(s)
Collagen Diseases/complications , Heart Block/congenital , Pregnancy Complications, Cardiovascular , Adult , Electrocardiography , Female , Fetal Heart/physiopathology , Heart Block/diagnosis , Heart Block/therapy , Heart Rate , Humans , Infant , Infant, Newborn , Infant, Small for Gestational Age , Pacemaker, Artificial , Pregnancy , Prenatal Diagnosis , Ultrasonography
17.
Obstet Gynecol ; 47(1): 21-7, 1976 Jan.
Article in English | MEDLINE | ID: mdl-813162

ABSTRACT

An experience with the lecithin/sphingomyelin (L/S) ratio in a population of high-risk obstetric patients is presented. A wide range of values in ralation to gestational age was found. A delayed rise in L/S ratio was found in Class A diabetes and Rh sensitization but was most striking in Class B through F diabetes. Chronic hypertension alone or in combination with diabetes is associated with an earlier rise in L/S ratio. A poor correlation of L/S ratio and neonatal pulmonary outcome with birthweight and gestational age was found. However, a good correlation between L/S ratio and neonatal pulmonary outcome was apparent. An L/S ratio of over 2 was universally associated with absence of serious RDS, but a low L/S ratio was less precisely predictive.


Subject(s)
Amniotic Fluid/analysis , Phosphatidylcholines/analysis , Pregnancy Complications/diagnosis , Sphingomyelins/analysis , Birth Weight , Diabetes Mellitus/diagnosis , Female , Humans , Hypertension/diagnosis , Infant, Newborn , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Hematologic/diagnosis , Pregnancy in Diabetics/diagnosis , Respiratory Distress Syndrome, Newborn/diagnosis , Rh-Hr Blood-Group System
18.
Clin Perinatol ; 2(2): 207-19, 1975 Sep.
Article in English | MEDLINE | ID: mdl-1183135

ABSTRACT

The assessment of maternal nutrition is a very important task that should become a more integral part of clinical obstetrical care. It is not simple but neither is it overly complex for the practical office or clinic setting or personnel. This is especially critical for the groups at nutritional risk. Normal pregnancy physiology complicates the interpretation of traditional physical and laboratory techniques and, therefore, must be thoroughly understood. The dietician and/or nutritionist should be involved where available. The physician and nursing component of maternity care must, however, be increasingly aware of and involved with assessment techniques if maternity patients are to achieve adequate nutrition in practical clinical terms.


Subject(s)
Nutritional Physiological Phenomena , Pregnancy , Prenatal Care , Diet , Female , Humans , Medical History Taking , Physical Examination , Risk
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