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1.
Obstet Gynecol ; 83(5 Pt 1): 643-6, 1994 May.
Article in English | MEDLINE | ID: mdl-8164917

ABSTRACT

OBJECTIVE: To determine the relation between the obstetric management of fetal distress and cerebral palsy. METHODS: The obstetric details of all 78 children with cerebral palsy born in a geographically defined area between 1975-1980 were compared with those of 591 control children. RESULTS: Fetal distress was identified more frequently in children with cerebral palsy who were born at term (24%) than among controls (11%). There was an inappropriate response to fetal distress in 12% of children with cerebral palsy but in only 3% of controls. CONCLUSIONS: If fetal distress in some way causes subsequent cerebral palsy, then the data in this study suggest that its complete elimination might be expected to reduce the birth prevalence of cerebral palsy by 15.6%. "Perfect" obstetric management of fetal distress might reduce the birth prevalence of cerebral palsy by 9% in term infants or 6% overall.


Subject(s)
Cerebral Palsy/epidemiology , Fetal Distress/complications , Case-Control Studies , Cerebral Palsy/etiology , Cerebral Palsy/prevention & control , Fetal Distress/therapy , Humans , Incidence , Infant, Newborn , Odds Ratio , Prevalence
3.
Br J Obstet Gynaecol ; 94(5): 431-9, 1987 May.
Article in English | MEDLINE | ID: mdl-3580326

ABSTRACT

Recent experimentally derived evidence has confirmed earlier suggestions that seizures which occur within 48 h of birth in babies born at or later than 37 completed weeks gestation are particularly likely to reflect intrapartum asphyxia. We have compared 54 cases of such seizures with 41,090 controls in a geographically defined population. Nulliparity, hydramnios, post-term pregnancy, oxytocin augmentation of labour, abnormalities of fetal heart rate and/or meconium-stained amniotic fluid, prolonged second stage of labour, emergency caesarean section, assisted vaginal delivery, low Apgar score and resuscitation at delivery and subsequent ventilatory support were all statistically significantly more common among cases than among controls. Five of the 54 babies who developed seizures died within 28 days of birth and 11 of the 49 survivors had an impairment diagnosed by 3 years of age which was usually associated with some degree of cerebral palsy. Comparison of the frequency of antecedent perinatal risk factors in the seizure babies who died, those who survived with disabilities and normal survivors failed to reveal any clear pattern.


Subject(s)
Cerebral Palsy/etiology , Fetal Hypoxia/complications , Seizures/etiology , Female , Follow-Up Studies , Humans , Infant, Newborn , Male , Obstetric Labor Complications , Pregnancy , Risk
4.
Postgrad Med ; 78(8): 57-60, 62, 64, 1985 Dec.
Article in English | MEDLINE | ID: mdl-4070102

ABSTRACT

Whether a relationship exists between the quality of obstetric care and poor fetal outcome, notably cerebral palsy, remains uncertain. We herein report a study which suggests that substandard obstetric care bears little relationship to the etiology of cerebral palsy. In none of our 34 cases of cerebral palsy was there any recognized delay on the physician's part in reacting to evidence of fetal asphyxia.


Subject(s)
Cerebral Palsy/epidemiology , Fetal Hypoxia/epidemiology , Obstetrics/standards , Quality of Health Care , Cerebral Palsy/etiology , Female , Fetal Hypoxia/complications , Fetal Monitoring , Humans , Infant, Newborn , Pregnancy
5.
Lancet ; 2(8407): 827-31, 1984 Oct 13.
Article in English | MEDLINE | ID: mdl-6148570

ABSTRACT

The case-control method was used to study the relation between four possibly preventable adverse outcomes of pregnancy and suboptimal antepartum and intrapartum obstetric care defined by clinical consensus. Fetuses whose deaths were ascribed to asphyxia or trauma, and babies born at term who had seizures within 48 h of delivery, were significantly more likely than controls to have received suboptimal care during pregnancy. Babies with seizures, as well as those with terminal apnoea, were also substantially more likely than controls to have been born after a failure to react appropriately to signs of severe fetal distress during labour. Most of the babies who received suboptimal obstetric care, however, did not have any of these adverse outcomes. In addition, most babies with these adverse outcomes had apparently received satisfactory obstetric care. No relation was detected between cerebral palsy and suboptimal obstetric care.


Subject(s)
Pregnancy Complications , Prenatal Care/standards , Quality of Health Care , Adolescent , Apnea/etiology , Asphyxia Neonatorum/mortality , Birth Injuries/mortality , Cerebral Palsy/diagnosis , Clinical Trials as Topic , England , Evaluation Studies as Topic , Female , Fetal Distress/physiopathology , Fetal Monitoring , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/mortality , Labor, Obstetric , Pregnancy , Pregnancy Complications/etiology , Prospective Studies , Risk , Seizures/etiology
7.
Am J Obstet Gynecol ; 137(2): 245-53, 1980 May 15.
Article in English | MEDLINE | ID: mdl-7377244

ABSTRACT

A diagnosis of fetal distress was made in 75 term obstetrical patients from a population of 3,972 term deliveries. Twenty-three percent of the infants were scored 6 or less on the 5-minute Apgar rating. One or more determinations of fetal scalp pH were available in 27 of these patients. The scalp pH improved the accuracy of the diagnosis of fetal distress modestly. Follow-up evaluation to at least 1 month of age was available in 75% of the infants. Six infants were not neurologically normal; in four of them this was of major importance, and in the other two it was of minor importance. In one, the condition was almost certainly unrelated to prenatal or perintal factors, whereas in the other five, evidence of chronic fetal asphyxia as well as perinatal asphyxia was elicited. An additional 10 term infants with a 5-minute Apgar score of 6 or less had entirely normal electronic fetal monitoring tracings.


Subject(s)
Fetal Distress/diagnosis , Fetal Monitoring , Apgar Score , Brain Damage, Chronic/etiology , Congenital Abnormalities , Delivery, Obstetric/methods , Female , Fetal Distress/physiopathology , Fetal Heart/physiopathology , Fetal Hypoxia/complications , Fetal Hypoxia/diagnosis , Follow-Up Studies , Heart Rate , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Pregnancy , Risk , Time Factors
8.
Am J Obstet Gynecol ; 133(4): 358-61, 1979 Feb 15.
Article in English | MEDLINE | ID: mdl-433995

ABSTRACT

In the current legal climate, the recognition of cerebral palsy or other major brain dysfunction in a child is likely to lead to a malpractice action against the obstetrician who delivered the child. Perinatal asphyxia is usually considered the most likely cause of the brain damage, and the obstetrician is presumed by the lawyer either to have failed to recognize the fetal asphyxia or to have ignored it. In this essay, the illogic in this reasoning is discussed. While fetal asphyxia clearly can cause fetal brain damage, the infrequency of this relationship is stressed. The dilemma faced by the obstetrician as a result of modern perinatal care is discussed.


Subject(s)
Cerebral Palsy/etiology , Fetal Hypoxia/complications , Malpractice , Obstetrics , Female , Fetal Hypoxia/diagnosis , Fetal Hypoxia/etiology , Humans , Iatrogenic Disease/etiology , Infant, Newborn , Jurisprudence , Obstetric Labor Complications/complications , Pregnancy
9.
Am J Hematol ; 7(3): 245-54, 1979.
Article in English | MEDLINE | ID: mdl-94976

ABSTRACT

Late diabetic complications are often related to vascular changes and formation of thrombi in the altered vasculature. Contributing factors to thrombosis susceptibility of diabetic patients include changes in clotting factors, platelets, and inhibition of fibrinolysis. We have measured various fibrinolytic inhibitors in the blood of diabetic children, diabetic pregnant women and their offspring, and healthy controls. Inhibitors studied included 1) fast (immediate) antiplasmin, 2) slow (progressive) antiplasmin, 3) alpha-2-macroglobulin, and 4) alpha-1-antitrypsin. It appears from our study that high fast-antiplasmin levels, and low or missing slow-antiplasmin levels are characteristic of diabetic patients and of newborn of diabetic mothers. The reason for high fast-antiplasmin levels is not clear: Levels are not connected with the age of the patient or duration of diabetes, and are not elevated in response to a fibrinolytic process (fibrin decomposition products could not be shown to be present in the serum of diabetic children). Alpha-2-macroglobulin was significantly higher and alpha-1-antitrypsin significantly lower in diabetic women than in controls. In the other groups of patients studied differences in these inhibitors from the appropriate control groups were not statistically significant.


Subject(s)
Diabetes Mellitus, Type 1/blood , Infant, Newborn , Pregnancy in Diabetics/blood , alpha 1-Antitrypsin/analysis , alpha-2-Antiplasmin/analysis , alpha-Macroglobulins/analysis , Adolescent , Child , Child, Preschool , Diabetes Mellitus, Type 1/drug therapy , Female , Humans , Insulin/therapeutic use , Pregnancy , Pregnancy in Diabetics/drug therapy
11.
Am J Obstet Gynecol ; 125(8): 1057-62, 1976 Aug 15.
Article in English | MEDLINE | ID: mdl-133615

ABSTRACT

During a ten-year period, 348 women were studied for a total of 5,877 patient months in four separate studies relating oral contraceptives to changes in hematologic parameters. Significant increases in certain factors of the blood coagulation and fibrinolysin systems (factors I,II,VII,VIII,IX, and X and plasminogen) were observed in the treated groups. Severe complications developed in four patients. All four had an abnormal blood coagulation profile, suggesting "hypercoagulability" before initiation of therapy. Some of these findings represented the most extreme abnormalities seen in the entire group of patients; some increased further during therapy. One of these patients developed a myocardial infarction before receiving any medication, shortly after the base-line values were obtained. One patient developed retinopathy 19 months after she began therapy, and another developed thrombophlebitis after 27 months of therapy. The fourth patient developed thrombophlebitis 14 days after initiation of contraceptive therapy. All four patients were of the A or AB blood group. Previous studies suggested the possiblility of increased propensity for thromboembolic episodes in patients possessing the A antigen. It appears from these data that hematologic work-ups may be useful in women who are about to start long-term oral contraceptive therapy.


PIP: A summary of a 10-year study on thromboembolic and other complications of oral contraceptive (OC) therapy in relationship to pretreatment levels of blood coagulation is presented. 348 women were studied for a total of 5877 patient months in 4 separate studies. Increases in certain factors of the blood coagulation and fibrinolysin systems (factors 1, 2, 7, 8, 9, and 10 and plasminogen) were observed in treated groups. 4 patients developed severe complications and all 4 had an abnormal blood coagulation profile suggesting "hypercoagulability" be fore initiation of therapy. 1 patient developed retinopathy 19 months after she began therapy and another developed thrombophebitis after 27 months of therapy. The 4th patient developed thrombophlebitis 2 weeks after initiation of therapy. All 4 patients were of the A or AB blood group. These data suggest that hematologic work-ups may be useful in women about to start OC therapy.


Subject(s)
Blood Coagulation Factors/analysis , Contraceptives, Oral, Synthetic/adverse effects , Contraceptives, Oral/adverse effects , Progesterone Congeners/adverse effects , Thromboembolism/chemically induced , Adult , Disease Susceptibility , Drug Combinations , Ethinyl Estradiol/adverse effects , Female , Fibrinolysin/metabolism , Humans , Mestranol/adverse effects , Middle Aged , Norethindrone/adverse effects , Pregnancy , Thrombosis/chemically induced
12.
Res Commun Chem Pathol Pharmacol ; 14(3): 543-9, 1976 Jul.
Article in English | MEDLINE | ID: mdl-959656

ABSTRACT

Antithrombin III levels were determined in 18 normal indiviuals of both sexes, 24 pregnant women (at term), 20 patients treated with oral contraceptives and 21 postmenopausal patients treated with Premarin. There was no sex difference in antithrombin III levels in the untreated control group. Pregnant women at term had the lowest levels of antithrombin III. The second lowest values were exhibited by women on oral contraceptives. Both of these groups differed significantly (p less than 0.05) from the controls. Premarin treated postmenopausal women had somewhat lower levels of antithrombin III than controls but these were statistically not significant.


PIP: Antithrombin 3 levels were determined in 18 normal men and women (co ntrols), at term in 24 pregnant women, 20 women taking combined oral contraceptives (OCs), and 21 postmenopausal women on Premarin therapy. There were no differences in antithrombin 3 levels between men and women controls. Antithrombin 3 levels were lowest in pregnant women at term, and women taking OCs had the 2nd lowest levels. Both of these groups had significantly (p less than .05) lower levels of antithrombin 3 than controls. Antithrombin 3 levels were also depressed in the Premarin group, but were not markedly different from controls.


Subject(s)
Antithrombins/blood , Estrogens/pharmacology , Adolescent , Adult , Contraceptives, Oral/pharmacology , Female , Humans , Male , Middle Aged , Pregnancy
14.
Am J Obstet Gynecol ; 121(7): 892-9, 1975 Apr 01.
Article in English | MEDLINE | ID: mdl-1115179

ABSTRACT

Intrauterine hypoxia/asphyxia is an unchallenged cause of perinatal death, but whether sublethal degrees of hypoxia result frequently in brain damage in surviving infants is less certain. To test this hypothesis, obstetric patients with abruptio placentae, placenta previa, and prolapse of the umbilical cord were computer matched on several factors with normal control patients to determine the degree of risk of lower 4 year Stanford-Binet I. Q. scores or abnormalities on the 4 year fine motor and gross motor testings. The mean I. Q. score of babies born of mothers with one of these complications was no different from that of the normal controls. Similarly negative results were recorded on the 4 year fine motor and gross motor testings. Children of low birth weight in either group experienced lower I. Q. scores and higher risk of abnormal findings on the motor tests at 4 years than the babies of mature birth weight. Intrauterine hypoxia/asphyxia apparently is not a major cause of neurologic dysfunction in the surviving child.


Subject(s)
Brain Damage, Chronic/etiology , Fetal Diseases/complications , Hypoxia/complications , Abruptio Placentae/complications , Apgar Score , Asphyxia/complications , Birth Weight , Child Development , Child, Preschool , Educational Status , Female , Fetal Death/etiology , Follow-Up Studies , Gestational Age , Humans , Infant , Infant Mortality , Infant, Newborn , Labor Presentation , Motor Skills , Parity , Placenta Previa/complications , Pregnancy , Stanford-Binet Test , Umbilical Cord , Uterine Prolapse/complications
15.
Res Commun Chem Pathol Pharmacol ; 10(1): 197-200, 1975 Jan.
Article in English | MEDLINE | ID: mdl-1124318

ABSTRACT

During a ten-year period, 348 women were studied for a total of 5877 patient months for changes in hematologic parameters induced by oral contraceptives. Significant increases were observed in Factors I, II, VII, VIII, IX, X and plasminogen. Severe complications developed in four patients. All four had an abnormal blood coagulation profile, suggesting "hypercoagulability" before initiation of therapy. All four patients were of A or AB blood group. It appears from these data that hematologic workups may be useful in women who are about to embark on long-term oral contraceptive therapy.


Subject(s)
Contraceptives, Oral/adverse effects , Thromboembolism/chemically induced , Blood Cell Count , Blood Coagulation/drug effects , Blood Coagulation Factors/analysis , Blood Group Antigens , Blood Platelets/drug effects , Female , Fibrinogen/analysis , Humans , Plasminogen/analysis , Retinal Diseases/chemically induced , Thrombophlebitis/chemically induced , Time Factors
17.
Am J Obstet Gynecol ; 119(3): 401-5, 1974 Jun 01.
Article in English | MEDLINE | ID: mdl-4275088

ABSTRACT

PIP: Blood coagulation changes induced by sequential oral contraceptive (OC) therapy were studied. 112 healthy women volunteers were monitored over a 2-year period while on a regimen of sequential OC therapy (50 mcg ethinyl estradiol daily from Day 5 through 14 and 50 mcg ethinyl estradiol plus 1 mg morethindrone acetate on Day 15 through 25). The treated group showed marked increases toward hypercoagulability in the Hicks and Pitney thromboplastin generation time screening test at 3 and 9 months, Factor 5 at 9 months, Factor 8 at 3 and 9 months, and fibrinogen at 3 months. Decreases from base lines were seen in antiplasmins at 24 months and in alkaline phosphatase at all intervals (3, 9, and 24 months). It was suggested that the decrease in serum antiplasmin indicates a compensatory tesponse in the fibrinolytic system to the hyperactivity of the coagulation system.^ieng


Subject(s)
Blood Coagulation/drug effects , Contraceptives, Oral/pharmacology , Blood Cell Count , Blood Coagulation Tests , Blood Group Antigens , Blood Platelets/drug effects , Drug Combinations , Ethinyl Estradiol/pharmacology , Factor IX/analysis , Factor V/analysis , Factor VII/analysis , Factor VIII/analysis , Factor X/analysis , Female , Fibrinolysin/antagonists & inhibitors , Humans , Norethindrone/pharmacology , Plasminogen/analysis , Pregnancy , Prothrombin/analysis , Prothrombin Time , Smoking , Thrombelastography
20.
Calif Med ; 119(1): 11-4, 1973 Jul.
Article in English | MEDLINE | ID: mdl-4793156
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