Objective: To evaluate the utility of an interdisciplinary clinic in improving perinatal outcomes... more Objective: To evaluate the utility of an interdisciplinary clinic in improving perinatal outcomes for all pregnant patients of junior enlisted rank (E4 and below) in response to previous reports that this group is at higher risk for adverse outcomes. Methods: The study population included all junior enlisted active duty patients (E4and below)delivering between January 1, 1993, and June 30, 1996. Outcomes for patients receiving care in a focused active duty obstetrical clinic were compared with outcomes in similar cohorts of senior active duty patients (E5 and above) and non-active duty pregnant patients. Evaluation was based on perinatal outcomes, including chorioamnionitis, postpartum hemorrhage, intrauterine growth retardation, cesarean delivery, preterm delivery rates «37 weeks), postterm delivery rates (>41 weeks), postpartum days, mean gestational age at delivery, mean delivery weights, Apgar scores at 1 and 5 minutes, preeclampsia, and premature labor. Variables with potential to confound perinatal outcomes were also studied. Confounding variables included tobacco use, gestational diabetes, chronic hypertension, thyroid disease, history of substance abuse, and alcohol use. Power analysis accomplished before initiation of the study showed adequate sample size (>240 patients in each group) to demonstrate statistically different rates of preterm delivery. Statistical analysis was done using the X 2 test for categorical variables and Student's t test for continuous variables. Results: There were no statistical differences between junior active duty patients, senior active duty patients, and non-active duty patients in preterm delivery and other outcome variables. Conclusion: The focused obstetrical clinic, conducted for junior enlisted soldiers by a senior nurse practitioner, appears to provide an intervention that ensures perinatal outcomes equal to those of both the non-active duty and the senior active duty population.
Journal of Steroid Biochemistry and Molecular Biology, 1991
We examined the extent to which supraphysiological doses of androgen can modify body composition ... more We examined the extent to which supraphysiological doses of androgen can modify body composition and strength in normally virilized men. In doubly blind tests, 30 healthy young men received testosterone enanthate (TE) or 19-nortestosterone decanoate (ND), at 100mg/wk or 300mg/wk for 6 weeks. The TE-100mg/wk group served as replacement dose comparison, maintaining pretreatment serum testosterone levels, while keeping all subjects blinded to treatment, particularly through reduction in testicular volumes. Isokinetic strength measurements were made for the biceps brachii and quadriceps femoris muscle groups before treatment and 2-3 days after the 6th injection. Small improvements were noted in all groups but the changes were highly variable; a trend to greater and more consistent strength gain occurred in the TE-300mg/wk group. There was no change in weight for TE-100 mg/wk but an average gain of 3 kg in each of the other groups. No changes in 4 skinfold thicknesses or in estimated percent body fat were observed. Of 15 circumferences, significant increases were observed only for men receiving TE-300 mg/wk (shoulders) and ND-300 mg/wk (shoulders and chest). The data suggest that high dose androgens increase body mass and may increase strength in normal men but, except for a consistent weight gain with greater than replacement doses, the detectable changes were highly variable and relatively small, especially in comparison to the significant alterations which were observed for other markers of androgen action.
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: Endothelial nitric oxide synthase (eNOS) modulates blood flow and is upregulated by hy... more OBJECTIVE: Endothelial nitric oxide synthase (eNOS) modulates blood flow and is upregulated by hypoxia. Hypothesis: eNOS is upregulated in the uterine artery (UtA), umbilical artery (UmA) and umbilical vein (UmV) in an ovine model of IUGR.
Australian & New Zealand Journal of Obstetrics & Gynaecology, 1998
Summary: We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving... more Summary: We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving perinatal outcomes. The study population included all delivering unmarried teenagers (13–19 years) from January 1, 1993 to December 31, 1995 attending the focussed adolescent obstetrical clinic compared to a similar cohort of married teenagers (13–19 years), married 20–24 year-old patients, and unmarried 20–24 year-old patients. There were no statistical differences in chorioamnionitis, intrauterine growth retardation (IUGR), postpartum haemorrhage, maternal weight gain, mean gestational age at delivery, preterm delivery rates (<37 weeks), low birth-weight (<2,500 g), Caesarean delivery, postterm delivery rates (>41 weeks), macrosomia (<4,000 g), placental abruption, chronic hypertension, alcohol use, Apgar scores or stillbirth rates or neonatal death rates among the 4 groups studied. Statistical differences were noted in mean delivery weights (p < 0.05), preeclampsia (p < 0.004), gestational diabetes (p < 0.01), history of substance abuse (p < 0.0001), tobacco use (p < 0.0001), and forceps delivery rates (p < 0.004). However, in the teen cohort none of these differences appeared to adversely affect perinatal outcomes in our patients. The focussed, adolescent obstetrical clinic appears to provide perinatal morbidities equal to a low-risk, general population generating better than expected outcomes for pregnant teenagers.
Little is known about the anatomic and physiologic changes in the pelvic floor that occur during... more Little is known about the anatomic and physiologic changes in the pelvic floor that occur during pregnancy. The purpose of this study was to prospectively document pelvic organ support throughout pregnancy using the standardized system of the International Continence Society, also known as the Pelvic Organ Prolapse Quantification (POPQ) Staging System. Pelvic organ support evaluations were performed in nulliparous pregnant women presenting for routine obstetric care during each trimester. POPQ stage assignments and POPQ component measurements were compared for first-, second- and third-trimester examinations. Overall POPQ stage was significantly higher in the third trimester than in the first (P=0.001). Individual POPQ points which showed significant differences between the first and third trimesters include Aa, PB, Ap, Ba, Bp, TVL and GH. These findings probably represent normal physiologic changes of the pelvic floor during pregnancy, but suggest that significant changes may be objectively demonstrated prior to delivery.
To determine whether current methods for detecting Down syndrome based on fetal femur length calc... more To determine whether current methods for detecting Down syndrome based on fetal femur length calculations are influenced by ethnicity. Methods. The study population consisted of all fetuses scanned between 14 and 20 completed weeks' gestation from April 1, 1997, to January 1, 2000. The expected femur length was calculated from the biparietal diameter. The variance from the expected femur length, compared with the biparietal diameter, was calculated, and the mean variations were compared by maternal race. Ethnic-specific formulas for expected femur length were derived by simple regression. Results. There was a statistically significant difference in femur length in the Asian group compared with all other groups, as well as the white group compared with the black and Asian groups (P < .05). However, there was no significant difference between the black and Hispanic groups or the white and Hispanic groups. The Asian group had the largest variation, with the measured femur length being less than the expected femur length. All groups studied had a mean expected femur length less than the mean measured femur length. On the basis of the ethnic-specific formulas for femur length, there was a significant decrease in patients that would undergo further evaluation for Down syndrome. Conclusions. There is a significant difference in the mean expected femur length by biparietal diameter among fetuses in the second trimester with regard to ethnicity. Using ethnic-specific formulas for expected femur length can have a considerable impact on the use of sonographic risk factors for Down syndrome screening. Further data are required for use of femur length as a screening tool in the genetic sonogram.
Objective: To evaluate the utility of an interdisciplinary clinic in improving perinatal outcomes... more Objective: To evaluate the utility of an interdisciplinary clinic in improving perinatal outcomes for all pregnant patients of junior enlisted rank (E4 and below) in response to previous reports that this group is at higher risk for adverse outcomes. Methods: The study population included all junior enlisted active duty patients (E4and below)delivering between January 1, 1993, and June 30, 1996. Outcomes for patients receiving care in a focused active duty obstetrical clinic were compared with outcomes in similar cohorts of senior active duty patients (E5 and above) and non-active duty pregnant patients. Evaluation was based on perinatal outcomes, including chorioamnionitis, postpartum hemorrhage, intrauterine growth retardation, cesarean delivery, preterm delivery rates «37 weeks), postterm delivery rates (>41 weeks), postpartum days, mean gestational age at delivery, mean delivery weights, Apgar scores at 1 and 5 minutes, preeclampsia, and premature labor. Variables with potential to confound perinatal outcomes were also studied. Confounding variables included tobacco use, gestational diabetes, chronic hypertension, thyroid disease, history of substance abuse, and alcohol use. Power analysis accomplished before initiation of the study showed adequate sample size (>240 patients in each group) to demonstrate statistically different rates of preterm delivery. Statistical analysis was done using the X 2 test for categorical variables and Student's t test for continuous variables. Results: There were no statistical differences between junior active duty patients, senior active duty patients, and non-active duty patients in preterm delivery and other outcome variables. Conclusion: The focused obstetrical clinic, conducted for junior enlisted soldiers by a senior nurse practitioner, appears to provide an intervention that ensures perinatal outcomes equal to those of both the non-active duty and the senior active duty population.
Journal of Steroid Biochemistry and Molecular Biology, 1991
We examined the extent to which supraphysiological doses of androgen can modify body composition ... more We examined the extent to which supraphysiological doses of androgen can modify body composition and strength in normally virilized men. In doubly blind tests, 30 healthy young men received testosterone enanthate (TE) or 19-nortestosterone decanoate (ND), at 100mg/wk or 300mg/wk for 6 weeks. The TE-100mg/wk group served as replacement dose comparison, maintaining pretreatment serum testosterone levels, while keeping all subjects blinded to treatment, particularly through reduction in testicular volumes. Isokinetic strength measurements were made for the biceps brachii and quadriceps femoris muscle groups before treatment and 2-3 days after the 6th injection. Small improvements were noted in all groups but the changes were highly variable; a trend to greater and more consistent strength gain occurred in the TE-300mg/wk group. There was no change in weight for TE-100 mg/wk but an average gain of 3 kg in each of the other groups. No changes in 4 skinfold thicknesses or in estimated percent body fat were observed. Of 15 circumferences, significant increases were observed only for men receiving TE-300 mg/wk (shoulders) and ND-300 mg/wk (shoulders and chest). The data suggest that high dose androgens increase body mass and may increase strength in normal men but, except for a consistent weight gain with greater than replacement doses, the detectable changes were highly variable and relatively small, especially in comparison to the significant alterations which were observed for other markers of androgen action.
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: Endothelial nitric oxide synthase (eNOS) modulates blood flow and is upregulated by hy... more OBJECTIVE: Endothelial nitric oxide synthase (eNOS) modulates blood flow and is upregulated by hypoxia. Hypothesis: eNOS is upregulated in the uterine artery (UtA), umbilical artery (UmA) and umbilical vein (UmV) in an ovine model of IUGR.
Australian & New Zealand Journal of Obstetrics & Gynaecology, 1998
Summary: We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving... more Summary: We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving perinatal outcomes. The study population included all delivering unmarried teenagers (13–19 years) from January 1, 1993 to December 31, 1995 attending the focussed adolescent obstetrical clinic compared to a similar cohort of married teenagers (13–19 years), married 20–24 year-old patients, and unmarried 20–24 year-old patients. There were no statistical differences in chorioamnionitis, intrauterine growth retardation (IUGR), postpartum haemorrhage, maternal weight gain, mean gestational age at delivery, preterm delivery rates (<37 weeks), low birth-weight (<2,500 g), Caesarean delivery, postterm delivery rates (>41 weeks), macrosomia (<4,000 g), placental abruption, chronic hypertension, alcohol use, Apgar scores or stillbirth rates or neonatal death rates among the 4 groups studied. Statistical differences were noted in mean delivery weights (p < 0.05), preeclampsia (p < 0.004), gestational diabetes (p < 0.01), history of substance abuse (p < 0.0001), tobacco use (p < 0.0001), and forceps delivery rates (p < 0.004). However, in the teen cohort none of these differences appeared to adversely affect perinatal outcomes in our patients. The focussed, adolescent obstetrical clinic appears to provide perinatal morbidities equal to a low-risk, general population generating better than expected outcomes for pregnant teenagers.
Little is known about the anatomic and physiologic changes in the pelvic floor that occur during... more Little is known about the anatomic and physiologic changes in the pelvic floor that occur during pregnancy. The purpose of this study was to prospectively document pelvic organ support throughout pregnancy using the standardized system of the International Continence Society, also known as the Pelvic Organ Prolapse Quantification (POPQ) Staging System. Pelvic organ support evaluations were performed in nulliparous pregnant women presenting for routine obstetric care during each trimester. POPQ stage assignments and POPQ component measurements were compared for first-, second- and third-trimester examinations. Overall POPQ stage was significantly higher in the third trimester than in the first (P=0.001). Individual POPQ points which showed significant differences between the first and third trimesters include Aa, PB, Ap, Ba, Bp, TVL and GH. These findings probably represent normal physiologic changes of the pelvic floor during pregnancy, but suggest that significant changes may be objectively demonstrated prior to delivery.
To determine whether current methods for detecting Down syndrome based on fetal femur length calc... more To determine whether current methods for detecting Down syndrome based on fetal femur length calculations are influenced by ethnicity. Methods. The study population consisted of all fetuses scanned between 14 and 20 completed weeks' gestation from April 1, 1997, to January 1, 2000. The expected femur length was calculated from the biparietal diameter. The variance from the expected femur length, compared with the biparietal diameter, was calculated, and the mean variations were compared by maternal race. Ethnic-specific formulas for expected femur length were derived by simple regression. Results. There was a statistically significant difference in femur length in the Asian group compared with all other groups, as well as the white group compared with the black and Asian groups (P < .05). However, there was no significant difference between the black and Hispanic groups or the white and Hispanic groups. The Asian group had the largest variation, with the measured femur length being less than the expected femur length. All groups studied had a mean expected femur length less than the mean measured femur length. On the basis of the ethnic-specific formulas for femur length, there was a significant decrease in patients that would undergo further evaluation for Down syndrome. Conclusions. There is a significant difference in the mean expected femur length by biparietal diameter among fetuses in the second trimester with regard to ethnicity. Using ethnic-specific formulas for expected femur length can have a considerable impact on the use of sonographic risk factors for Down syndrome screening. Further data are required for use of femur length as a screening tool in the genetic sonogram.
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