Experts In Obstetrics Research Articles

Gaucher disease. Current issues in diagnosis and treatment. NIH Technology Assessment Panel on Gaucher Disease

To provide physicians with a responsible assessment of the diagnosis and treatment of Gaucher disease.A nonfederal, nonadvocate, 14-member panel representing the fields of pediatrics, obstetrics and gynecology, genetics, endocrinology, molecular biology, internal medicine, and biostatistics. In addition, 30 experts in genetics, pediatrics, neurology, obstetrics and gynecology, orthopedics, hematology, genetic counseling, clinical pathology, and epidemiology presented data to the panel and a conference audience of 230 during a 1 1/2 public session. Questions and statements from conference attendees were considered during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third.The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and on the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.Despite the success of enzyme therapy, treatment is limited by the cost of the agent. This makes it imperative to determine the lowest effective initial and maintenance doses, to define the appropriate clinical indications for treatment, and to establish uniform methods for optimize outcome assessment. The value of treatment for asymptomatic individuals has not been determined. General population screening for affected individuals and for carriers is not appropriate at this time. As a prototype for all rare diseases, the plight of patients with Gaucher disease raises difficult financial and ethical issues, which we as a society must address.

Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

<h3>Objective.</h3> —To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants. <h3>Participants.</h3> —A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500. <h3>Evidence.</h3> —An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force. <h3>Consensus.</h3> —The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. <h3>Consensus Statement.</h3> —The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference. <h3>Conclusions.</h3> —Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health. (<i>JAMA</i>. 1995;273:413-418)

Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

To develop a consensus on the use of antenatal corticosteroids for fetal maturation in preterm infants.A nonfederal, nonadvocate, 16-member consensus panel including representatives from neonatology, obstetrics, family medicine, behavioral medicine, psychology, biostatistics, and the public; 19 experts in neonatology, obstetrics, and pharmacology presented data to the consensus panel and a conference audience of approximately 500.An extensive bibliography of references was produced for the consensus panel and the conference audience using a variety of on-line databases including MEDLINE. The consensus panel met several times prior to the conference to review the literature. It also commissioned an updated meta-analysis, a neonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evidence using the grading system developed by the Canadian Task Force on the Periodic Health Examination and adapted by the US Preventive Services Task Force.The consensus panel, answering predefined consensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature.The consensus panel composed a draft statement that was read in its entirety at the conference for comment. The panel released a revised statement at the end of the conference and finalized the revisions a few weeks after the conference.Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.

Neutrophil chemotaxis and adhesion in preterm babies.

<h3>Background and aims:</h3> As an essential part of antenatal care, pregnant women of all ages should be offered screening for chromosomal abnormalities before 20 weeks gestation. This study was aimed to evaluate the type and frequency of chromosomal abnormalities following pregnancy screening tests so that we can compare the actual pregnancy outcomes with test results, this will help us in decision making whether the tests are reliable to use in practice or not. <h3>Methods:</h3> A “cross-sectional” study was conducted on 557 pregnant patients, presenting for prenatal diagnostic amniocentesis for chromosomal abnormalities, to Tabriz Al-Zahra Hospital since 2008 to 2011. Amniocentesis was conducted by an expert obstetrician at second trimester between 16 and 22 weeks of gestation. 15 to 20 ml of amniotic fluid was aspirated for chromosomal study. An interview was set for pregnancy outcomes to assess the test results. <h3>Results:</h3> Of 557 cases, the mean maternal age in amniocentesis was 31.84±6.92 y (range, 15-47y). Amniocentesis revealed the presence of chromosomal abnormalities in 32 cases (5.74%) including 18 girls (56.25%) and 16 boys (43.75%). The most common diagnosed chromosomal abnormality in studying cases was Down syndrome (50%) followed by other chromosomal abnormalities. Following up the patients, 92.4% of newborns did not have any congenital abnormality, but the remaining 7.6% had both chromosomal and non-chromosomal abnormalities. No fetal loss was reported in this study. So the effectiveness of this test was evaluated 75.52%. Assessment of total costs revealed that $US100 had been spent for hospitalization, and about $US500 for genetic tests. Also, the cost of three days hospitalization for pregnancy termination was evaluated as about $US1000. <h3>Conclusion:</h3> Several studies have evaluated the cost-effectiveness of each diagnostic method for detecting chromosomal anomalies. There is still no consensus on the most cost-effective strategy that should be implemented to diagnose chromosomal anomalies. So we didn9t have an actual gold standard to compare with amniocentesis. More studies analyzing natural outcome after prenatal diagnosis of these chromosomal abnormalities are needed.

Cardiac Problems in Pregnancy: Diagnosis and Management of Maternal and Fetal Disease

The multiauthor textbook has become the most convenient way of collating a comprehensive body of new information. Elkayam and Gleicher state that their purpose is to acquaint the adult and pediatric cardiologist with the developing field of fetal cardiology and to offer the obstetrician an understanding of maternal cardiology. The two editors, a cardiologist and an obstetrician, have accomplished both goals in their collaborative effort. They have written, either alone or together, about one third of the 49 chapters of the text and delegated the remainder to about 60 of their colleagues with established expertise in cardiology, pediatrics, obstetrics, surgery, anesthesiology, and pertinent basic sciences. The second edition has maintained the original organization, which combines in a single volume two loosely related surveys of maternal and fetal cardiology. Several chapters have been added, and some of the older ones have been updated or rewritten, but only a few of the

Midwifery, 1977

On January 1, 1974, an autonomous midwifery service was formed at Roosevelt Hospital in New York City to provide an obstetric service to “private” patients. While the autonomy was complete, physician consultation and participation provided by the “full-time or senior resident” staff were always available. We are now aware that this plan as opposed to any other, provided the ingredient of consumer-desired empathy of the midwife coupled with instant obstetric expertise that assured every patient the availability of modern obstetric practice. Four hundred and fifty-four patients cared for by midwives were compared to a random sample of 500 patients cared for by attending obstetricians. A striking similarity in the two groups was evident. Certain items, such as operative deliveries, were higher in the private patient group. The midwifery group had a low incidence of complications, but the incidence of acute complications made it apparent that an operating room suite must be immediately available. It is eminently clear that a low-risk group can be identified but there is no possible way to identify a “no risk” population.

Toxoplasmose: Praktische Fragen und Ergebnisse.

Although only infrequently recognized, Toxoplasma gondii (Nicolle and Manceaux, 1908) probably invades at least as many people as tuberculosis. Kirchhoff and Kraeubig have tapped the pooled knowledge of German and Austrian experts in parasitology, pathology, immunology, pediatrics, gynecology and obstetrics, ophthalmology, and public health and they have condensed their combined knowledge of toxoplasmosis in a little volume. It should help the clinician recognize it more frequently. Since most internists are likely to recognize toxoplasmosis only among cases resembling infectious mononucleosis with negative heterophil reactions, the thoroughgoing descriptions presented of the clinical manifestations may be particularly interesting: manifestations of the acute disease include lymphadenitis particularly in the neck, severe persistent headache particularly in the forehead, nonspecific fever, meningismus, splenomegaly, hepatomegaly rarely with hepatitis, transient exanthemata, retinitis, conjunctivitis, vesicular pharyngitis, endometritis, and miscarriage or stillbirth. Manifestations of the chronic disease include intermittent fever often preceded or accompanied by peripheral muscular or articular

Evaluation of placentography in late bleeding of pregnancy.

Placenta praevia is present when the placenta is implanted within the zone of the internal os, so as to cover it in whole or in part. Painless bleeding in the last trimester of pregnancy produces fear in the most expert obstetrician. Although less than one-third of such cases of staining or bleeding are due to placenta praevia, its implications and potentialities for morbidity and mortality in both infant and mother make its diagnosis or exclusion most important. Soft-tissue radiography is a simple, safe, and accurate procedure that requires no special preparation of the patient, no pelvic manipulation, and no injection of an opaque medium. Interpretation of the films requires only understanding, diligence, and observation of all the shadows which are present. Stallworthy (10, 11) states that in no branch of obstetrics has there been such a dramatic reduction in fetal mortality as in the expectant treatment of placenta praevia. The aim is to reduce fetal mortality due to this cause to below 10 per cent (combined stillbirths and neonatal deaths). It is now in general higher, due to intervention and prematurity. Bleeding in the last trimester is frequently considered sufficient cause for vaginal examination. The internal os is invaded, with the attendant risks of infection, precipitation of severe hemorrhage, and induction of premature labor. Furthermore, a marginal placenta may be beyond the examining finger and still cause severe bleeding. Also, the cervix is not always patulous and it would not appear justifiable to dilate for diagnosis, especially if simple roentgen methods can be relied upon with confidence (4). Early diagnosis is important, first because the patient is placed in a position favorable for dealing with an emergency prior to its occurrence; second, because the cause may be dealt with by an elective procedure, with minimal risk to mother and child. Frequently a diagnosis can be made by films alone and without hospitalization (8). Anatomically the uterus at term is a flat, pear-shaped organ with the widest diameter at the cornua. Within it the fetus, which is movable, attempts to assume a position to the best advantage, with the back convex and the ventral surface concave. In addition, the uterus contains the amniotic fluid, which amounts to about a quart, and the placenta, which is fixed in position soon after conception, normally above the equator or in the corpus. The lower uterine segment and cervical areas are not adapted for placentation. These constitute the inactive passage zone between the contractile corpus above and the vagina below. The lower segment is composed largely of elastic tissue and few muscle fibers. It is designed to withstand considerable pressure. The added vascularity with placental attachment in this segment interferes with its normal integrity. The cause of low implantation is not known, but it is definitely associated with multiparity and probably with endometrial disease.

Note on the Estimation of the Bi-Spinous Diameter in Pelvimetry

It is agreed that the bi-spinous diameter in obstetrics is important, for although it is usually easy for the radiologist and the expert obstetrician to say at once, from routine pregnancy radiographs, that it is adequate, yet if there is doubt as to its adequacy, it has been no easy matter to measure it accurately. Tomography provides the method of choice for measuring this diameter simply and easily. It also produces information which will enable those who have no tomographic facilities to measure the bispinous diameter readily from a routine antero-posterior view of the pregnancy—that is to say, an antero-posterior view taken with the pregnant woman lying supine with her legs flat along the table, a F.F.D. of 36 inches, tube centred 2 inches above the pubic symphysis, and technical conditions adequate to ensure clear bony detail in the resultant film. (No. 1 routine film for pregnancy—any stage.) Experience—as well as actual measurements on dried pelves—shows that the bi-spinous diameter should lie abo...