Bruce Kenneth Young, M.D.

Stem cell markers in amniotic fluid derived cells
Jadhav A.; Basch R.; Chan M.; Strelchenko N.; Chen Z.; Young B.
2012 ;206(1 SUPPL 1):S186-S187, American journal of obstetrics & gynecology
OBJECTIVE: We sought to characterize markers of pluripotency in amniotic fluid derived cells as a non-controversial and readily available source of potentially therapeutic stem cells. STUDY DESIGN: Amniotic fluid stem cells (AFSC) express stem cell surface markers as well as transcription factors. Isolation and enrichment of the stem cell population is essential to their therapeutic potential. We studied expression of stem cell surface markers CD 117, CD 133, SSEA3, SSEA4, TRA 160, TRA 181 and CD90; as well as transcription factors OCT4, SOX2, NANOG and REX 1 by magnetic bead separation, flow cytometry analysis and PCR for transcription factors. Samples were obtained after cytogenetic analysis following routine amniocentesis for age or maternal anxiety in 10 normal patients. Cells were cultured for up to seven passages with analysis after confluence. RESULTS: There was great variation in different samples ability to express the different markers. The most prevalent marker was CD90, a mesenchymal stem cell factor; followed by SSEA4 and TRA160, both embryonic stem cell markers. The other markers were significantly present as well (SSEA3, TRA 160, TRA 181,CD90,OCT4, SOX2, NANOG and REX 1), however CD 117 and CD 133 were often undetectable or present in small amounts. CONCLUSION: There was considerable variation among samples, possibly gestational age related. In Amniotic fluid derived cells, stem cell markers CD90, SSEA4 and TRA160 are expressed in the largest amount with CD90 being the most abundantly expressed marker. Therefore these markers might be used for identification, isolation and enrichment of amniotic fluid stem cells for potential clinical use, since amniotic fluid is widely available and non-controversial as a source of multipotent stem cells.(Table persented)
— id: 149828, year: 2012, vol: 206, page: S186, stat: Journal Article,

Co-ordinate expression of Th1/Th2 phenotypes in maternal and fetal blood: Evidence for a transplacental nexus
Jadhav A.; Young B.; Tse D.
2012 ;206(1 SUPPL 1):S93-S93, American journal of obstetrics & gynecology
OBJECTIVE: To study if maternal atopy and environmental exposure might affect fetal immune response. STUDY DESIGN: We studied paired maternal and neonatal blood samples from 38 unlabored normal mothers delivered by cesarean section, without recent infection as evidenced by total serum IgE<300 IU/ml. At delivery, 10 ml of fetal blood (FB) was withdrawn from the umbilical cord. At the same time, 10 ml of maternal blood (MB) was obtained by venipuncture. Specimens were processed and analyzed sideby- side within 12 hours. The samples were incubated with 10mcg/ml Staphylococcal Enterotoxin B (SEB). Th phenotypes were analyzed by flow cytometry. Cytokines were assayed by multiplex analysis (Luminex 200) RESULTS: Basal levels of IFN-, IL-4, and eotaxin in paired maternal and fetal sera were tightly correlated. Polyclonal T cell activation in vitro induced co-ordinate IFN- production from paired maternal and fetal mononuclear cells, accompanied by co-ordinate increases in activated CD4+CD69+ cells that display the CCR4+ Th2 and CXCR3+Th1 phenotypes. Maternal and fetalCD4+CXCR3+Tcells were subsequently identified as the major producers of IFN-. CONCLUSION: The data established that a transplacental nexus exists during normal pregnancy such that fetal Th responses to an immune stimulus are biased by the maternal immune system. (Table Presented)
— id: 149830, year: 2012, vol: 206, page: S93, stat: Journal Article,

Identification and Isolation of Putative Stem Cells from Mouse Placenta
Proudfit, Christine L.; Chan, Michael K.; Basch, Ross S.; Young, Bruce K.
2011 MAR ;18(3):261A-261A, Reproductive sciences (Thousand Oaks, Calif.)
— id: 134893, year: 2011, vol: 18, page: 261A, stat: Journal Article,

Novel Technique for Injection of Fetal and Neonatal Murine Kidneys Using Ultrasound Biomicroscopy
Proudfit, Christine L.; Chan, Michael K.; Basch, Ross S.; Young, Bruce K.
2011 MAR ;18(3):367A-368A, Reproductive sciences (Thousand Oaks, Calif.)
— id: 134894, year: 2011, vol: 18, page: 367A, stat: Journal Article,

Temporal Expression of Renal Markers in Mouse Placenta
Proudfit, Christine L.; Chan, Michael K.; Basch, Ross S.; Young, Bruce K.
2011 MAR ;18(3):187A-187A, Reproductive sciences (Thousand Oaks, Calif.)
— id: 134892, year: 2011, vol: 18, page: 187A, stat: Journal Article,

Parallel maternal and fetal immune activation by bacterial toxins in vitro*
Young BK; Li X; Arslan AA
2011 Aug 11;:?-? #, Journal of perinatal medicine
Abstract This study evaluated in vitro immune responses to Escherichia coli lipopolysaccharide in maternal and fetal blood. Samples were concurrently obtained from maternal venipuncture and umbilical cord blood samples and cultured with the E. coli endotoxin, and cytokines were assayed. There were statistically significant correlations between maternal and fetal samples. This demonstrates maternal and fetal immune communication and mutual programming during pregnancy. Subclinical infection, which predisposes to premature labor, could be detectable from a maternal blood sample even if derived only from the fetal compartment. A maternal blood panel test might serve as a diagnostic screen for subclinical infection in patients at risk for preterm labor
— id: 150006, year: 2011, vol: , page: ?, stat: Journal Article,

The intellectual devotional health : revive your mind, complete your education, and digest a daily dose of wellness wisdom [Emmaus PA] : Rodale, 2009
Kidder, David S; Oppenheim, Noah D; Young, Bruce K
intellectual devotional health : revive your mind, complete your education, and digest a daily dose of wellness wisdom [Emmaus PA] : Rodale, 2009,
— id: 2115, year: 2009, vol: , page: , stat: ,

Practice patterns in the management of isolated oligohydramnios: a survey of perinatologists
Schwartz, Nadav; Sweeting, Raeshell; Young, Bruce K
2009 Apr;22(4):357-361, Journal of maternal-fetal & neonatal medicine
OBJECTIVE: Optimal management of isolated oligohydramnios (IO) remains debatable. We surveyed Society for Maternal-Fetal Medicine (SMFM) members regarding their opinions and practice patterns. STUDY DESIGN: Questionnaires were mailed to perinatologists across the US. IO was defined as sonographic low fluid (per the practitioner's definition) in the absence of intrauterine growth restriction, fetal anomaly or significant maternal comorbidity. RESULTS: The overall response rate was 35% (n = 632). Ninety-two percent of respondents consider IO to be a risk factor for various adverse outcomes. With a favourable cervix, 34% and 82% would consider inducing labour without documented lung maturity prior to 37 and 39 weeks, respectively. When asked whether induction of labour in cases of IO reduces perinatal morbidity, 45% were unsure and 21.4% thought it would not. Only 33% believe induction could decrease adverse outcomes. Newer members of SMFM (<10 years) and those of private practice were more likely to believe that induction is efficacious in decreasing morbidity. CONCLUSION: There is significant divergence regarding the management of IO. Despite being unsure of its benefit, most practitioners lean towards intervention. The available literature is insufficient to make firm recommendations supporting intervention for IO
— id: 101294, year: 2009, vol: 22, page: 357, stat: Journal Article,

Practice patterns of intrapartum fetal blood sampling in the United States
Schwartz, N; Wilson, R; Young, BK
2008 APR ;111(4):40S-40S, Obstetrics & gynecology
— id: 78720, year: 2008, vol: 111, page: 40S, stat: Journal Article,

Miscarriage, medicine & miracles : everything you need to know about miscarriage
Young, Bruce; Zavatto, Amy
New York, N.Y. : Bantam Books, 2008,
— id: 1442, year: 2008, vol: , page: , stat: ,

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome
Crombleholme, Timothy M; Shera, David; Lee, Hanmin; Johnson, Mark; D'Alton, Mary; Porter, Flint; Chyu, Jacquelyn; Silver, Richard; Abuhamad, Alfred; Saade, George; Shields, Laurence; Kauffman, David; Stone, Joanne; Albanese, Craig T; Bahado-Singh, Ray; Ball, Robert H; Bilaniuk, Larissa; Coleman, Beverly; Farmer, Diana; Feldstein, Vickie; Harrison, Michael R; Hedrick, Holly; Livingston, Jeffrey; Lorenz, Robert P; Miller, David A; Norton, Mary E; Polzin, William J; Robinson, Julian N; Rychik, Jack; Sandberg, Per L; Seri, Istvan; Simon, Erin; Simpson, Lynn L; Yedigarova, Larisa; Wilson, R Douglas; Young, Bruce
2007 Oct;197(4):396.e1-396.e9, American journal of obstetrics & gynecology
OBJECTIVE: The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS). STUDY DESIGN: This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients. RESULTS: There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis. CONCLUSION: The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS
— id: 131926, year: 2007, vol: 197, page: 396.e1, stat: Journal Article,

Isolated oligohydramnios presents clinical scenarios for which optimal management is debatable
Schwartz, N; Sweeting, R; Young, B
2007 DEC ;197(6):S180-S180, American journal of obstetrics & gynecology
— id: 87166, year: 2007, vol: 197, page: S180, stat: Journal Article,

Intrapartum fetal monitoring today
Schwartz, Nadav; Young, Bruce K
2006 ;34(2):99-107, Journal of perinatal medicine
The literature on intrapartum fetal monitoring is reviewed emphasizing the pathophysiology, and current practice guidelines are discussed. FHR monitoring, ancillary tests, and investigational modalities are considered
— id: 66854, year: 2006, vol: 34, page: 99, stat: Journal Article,

Vaginal birth after cesarean section: X-ray pelvimetry at term is informative
Young, Bruce K
2006 ;34(3):216-216, Journal of perinatal medicine
— id: 66853, year: 2006, vol: 34, page: 216, stat: Journal Article,

Heterogeneity in fetal immunocompetence during the second trimester of gestation. Implications for treatment of nonimmune genetic disorders by in utero transplantation
Tse, Doris B; Ching, Elbert; Yousefzadeh, Nora; Roque, Hank; Young, Bruce K
2005 May-Jun;20(3):175-181, Fetal diagnosis & therapy
OBJECTIVE: To address the role that alloreactivity may play and better define the window for histoincompatible stem cell transplantation in utero. SUBJECTS, MATERIAL AND METHODS: We studied 9 fetal blood specimens obtained by cardiocentesis during elective abortions in the second trimester by multicolor flow cytometry and in vitro stimulation. RESULTS: Lymphocytes ranged from adult levels (3/9) to >90% leukocytes. Six specimens had T cells within adult range. T cells in the other specimens were reduced, while B cells were conversely elevated. This variability did not correlate with gestational age, or leukocyte composition. Following 4 h of mitogenesis, fetal CD4+ and CD8+ T cells from 1 of 5 specimens showed a response similar to that of maternal T cells, while the other 4 specimens showed a diminished response (0.3 +/- 0.2-fold). This heterogeneity did not correlate with gestational age, or lymphocyte subset distribution. Following 18 h of in vitro mitogenesis, fetal T cells from 2 specimens showed a response similar to that of maternal T cells (0.8 +/- 0.2-fold). Despite that, one specimen gave a 3-fold greater response in a one-way mixed lymphocyte reaction vs. maternal cells compared to the other specimen. CONCLUSION: We determine that fetal immunocompetence differs greatly during the second trimester and assessment of host vs. donor reactivity prior to in utero transplantation is likely to potentiate more favorable outcomes
— id: 56179, year: 2005, vol: 20, page: 175, stat: Journal Article,

Combined sonographic and endoscopic umbilical cord occlusion in twin and triplet gestations
Young, Bruce K; Stephenson, Courtney D; Mackenzie, Andrew P; Roman, Ashley S; Rebarber, Andrei; Minior, Victoria K; Mayberry, Patricia; Timor-Tritsch, Ilan E
2005 ;33(6):530-533, Journal of perinatal medicine
OBJECTIVE: To review our experience with a minimally invasive technique for umbilical cord occlusion as a method of selective feticide in monochorionic sets. STUDY DESIGN: Umbilical cord occlusion was completed using 3 mm bipolar cautery under ultrasound guidance (3D/4D, n = 6; 2D, n = 6) with pre and post ligation endoscopic evaluation. RESULTS: 12 cases of monochorionic sets where selective feticide was performed were identified during the period 2000 to present. There were four triplet and eight twin gestations in the study cohort. Median interval from intervention to delivery was 16 weeks (range, 5-19). All co-twins survived the procedure and 15 of 16 were delivered after 33 weeks. CONCLUSIONS: Umbilical cord occlusion in monochorionic sets can be accomplished in a minimally invasive manner with combined endoscopic and ultrasound guidance in both twin and triplet pregnancies
— id: 62605, year: 2005, vol: 33, page: 530, stat: Journal Article,

Endoscopic closure of fetal membrane defects: comparing iatrogenic versus spontaneous rupture cases
Young, B K; Mackenzie, A P; Roman, A S; Stephenson, C D; Minior, V; Rebarber, A; Timor-Tritsch, I
2004 Oct;16(4):235-240, Journal of maternal-fetal & neonatal medicine
OBJECTIVE: Currently, physicians manage preterm premature rupture of membranes (PPROM) by expectant management or termination of the gestation. A therapy aimed at sealing membranes would be optimal to maintain the pregnancy and achieve a normal neonate. Our objective was to compare an endoscopic technique for intrauterine closure of fetal membrane defects after both iatrogenic and spontaneous rupture of membranes. METHODS: Our technique was performed on four patients experiencing PPROM spontaneously and four patients after genetic amniocentesis. Intrauterine endoscopy allowed direct visualization of membrane defects. Rapid sequential injections of platelets, fibrin glue and powdered collagen slurry were administered at the site of the defect and of trocar placement. Sonography for amniotic fluid index, nitrazine and fern testing and pad count were performed after each procedure at three intervals: immediately post-procedure, and after 24 and 48 h. RESULTS: Eight patients underwent endoscopic intrauterine sealing of ruptured membranes between 16 and 24 weeks of gestation: four were spontaneous ruptures and four were ruptures post-amniocentesis. In the post-amniocentesis group, three patients delivered viable infants at 26, 32 and 34 weeks. In one patient, the membranes ruptured again 12 h after the sealing procedure and she decided to undergo termination of pregnancy. Of the four spontaneous rupture patients, two experienced preterm labor and delivery within 2 days of the procedure. One patient was diagnosed with fetal demise 12 h post-procedure, and one patient delivered a neonate at 31 weeks of gestation with severe respiratory distress syndrome. CONCLUSIONS: This technique for sealing ruptured membranes is effective after amniocentesis, but may not be of benefit with spontaneous rupture
— id: 55599, year: 2004, vol: 16, page: 235, stat: Journal Article,

The closure of iatrogenic membrane defects after amniocentesis and endoscopic intrauterine procedures
Young, Bruce K; Roman, Ashley S; MacKenzie, Andrew P; Stephenson, Courtney D; Minior, Victoria; Rebarber, Andrei; Timor-Tritsch, Ilan
2004 May-Jun;19(3):296-300, Fetal diagnosis & therapy
OBJECTIVE: To describe a new technique for wound closure after endoscopic intrauterine procedures which prevents amniotic fluid leakage after the procedure. STUDY DESIGN: This is an observational study which reviews a new technique under an IRB-approved protocol. The rationale for this study was the increasing frequency of intrauterine endoscopic procedures. The most common complication of these procedures is persistent leakage of amniotic fluid from puncture sites, which can result in preterm labor and preterm delivery. Thus, these procedures carry a high morbidity rate that may overcome the benefit of the intervention. We have employed a new technique, which has successfully prevented amniotic fluid leakage following the procedure. The instruments used for the endoscopic procedures were no larger than 3.5 mm for all cases. A sealant of platelets was rapidly injected followed by injection of fibrin glue and powdered collagen slurry at each puncture site. Sonography for modified AFI, clinical examination for nitrazine and ferning, and pad count were performed after each procedure at three intervals: immediately after the procedure, 24 h and 48 h. RESULTS: Eight patients undergoing an endoscopic intrauterine procedure (either cord ligation for twin-twin transfusion syndrome or sealing of ruptured membranes after amniocentesis) were included. All patients were treated between 18 and 24 weeks of gestation. Sonography, clinical examination and pad count revealed no evidence of amniotic fluid leakage either intra-abdominally or vaginally in any of the patients. There was 1 patient who ruptured membranes 12 h after the procedure due to severe vomiting. Another patient elected to terminate the pregnancy 48 h after the procedure without evidence of leakage. The remaining patients continued for 8 weeks or more without fluid leakage. CONCLUSION: The technique described, immediate sealing of puncture wounds following endoscopic intrauterine procedures, is effective in preventing amniotic fluid loss after the procedure
— id: 46087, year: 2004, vol: 19, page: 296, stat: Journal Article,

Perinatal outcomes in monoamniotic gestations
Roque, H; Gillen-Goldstein, J; Funai, E; Young, B K; Lockwood, C J
2003 Jun;13(6):414-421, Journal of maternal-fetal & neonatal medicine
OBJECTIVE: A comprehensive review of monoamniotic twin gestations reported between 1990 and 2002 was performed to estimate current perinatal mortality and morbidity rates, as well as the predictive value of an antenatal diagnosis of cord entanglement for poor obstetric outcomes. METHOD: A Medline literature review using the search term 'monoamniotic' and limited to articles published in the English language between 1990 and 2002 was performed. RESULTS: A total of 133 continuing, non-conjoined twin monoamniotic pregnancies with delivery information were identified. Perinatal loss per 2-week interval was relatively constant at 2-4% from 15 to 32 weeks. However, of the 131 fetuses reaching 33 weeks, the percentage loss significantly increased to 11.0% at 33-35 weeks and 21.9% at 36-38 weeks compared to that at 30-32 weeks. Overall perinatal mortality was 23.3%. Of all losses, 61.2% involved both twins and 38.8% involved only one fetus. Cord entanglements were documented antenatally in 22.6% of reports. There was a statistically significant decrease in the average number of neonatal intensive care unit days for non-anomalous neonates (10.6 +/- 7.7 vs. 32.6 +/- 32.0), average gestational age at the time of delivery (30.4 +/- 7.6 vs. 32.6 +/- 4.1), as well as a decrease in the prevalence of total (8.3% vs. 27.7%) and non-anomalous (7.0% vs. 21.6%) perinatal mortality in pregnancies with an antenatal diagnosis of cord entanglement compared to those without the antenatal diagnosis of cord entanglement. The presence of fetal anomalies was associated with a 42.9% perinatal mortality rate. CONCLUSIONS: Contrary to previous reports, there is a significant increase in the incidence of perinatal loss beyond 32 weeks among monoamniotic twins, suggesting that delivery after corticosteroid therapy should be strongly considered at this gestational age
— id: 66855, year: 2003, vol: 13, page: 414, stat: Journal Article,

Four-dimensional real-time sonographically guided cauterization of the umbilical cord in a case of twin-twin transfusion syndrome
Timor-Tritsch, Ilan E; Rebarber, Andrei; MacKenzie, Andrew; Caglione, Christopher F; Young, Bruce K
2003 Jul;22(7):741-746, Journal of ultrasound in medicine
In the past decade, three-dimensional (3D) sonographic technology has matured from a static imaging modality to near-real-time imaging. One of the more notable improvements in this technology has been the speed with which the imaged volume is acquired and displayed. This has enabled the birth of the near-real-time or four-dimensional (4D) sonographic concept. Using the 4D feature of the current 3D sonography machines allows us to follow moving structures, such as fetal motion, in almost real time. Shortly after the emergence of 3D and 4D technology as a clinical imaging tool, its use in guiding needles into structures was explored by other investigators. We present a case in which we used the 4D feature of our sonographic equipment to follow the course and motion of an instrument inserted into the uterus to occlude the umbilical cord of a fetus in a case of twin-twin transfusion syndrome
— id: 39141, year: 2003, vol: 22, page: 741, stat: Journal Article,

Steroidogenesis patterns in common trisomies
Gillen-Goldstein, Jonathan; Roque, Henry; Young, Bruce K
2002 ;30(2):132-136, Journal of perinatal medicine
OBJECTIVE: By determining the early patterns of steroidogenesis in the most common aneuploidies, we have shown that there are differences between aneuploid and euploid pregnancy steroidogenesis patterns. We hypothesize that there are differences in steroidogenesis between specific trisomies, as well. METHODS: The records of all patients with a cytogenetic diagnosis of aneuploidy were studied. Serial data on progesterone(P), estradiol(E2) and beta-HCG(bHCG) was collected in the first trimester of aneuploid pregnancies. A matched group of normals at the same gestational ages was used as a control group. The specific trisomies of the above group were catalogued. RESULTS: 31 aneuploid pregnancies were reviewed for progesterone, estradiol and beta-HCG in the first trimester. Data was available for three or more patients with trisomy 16, 18, 21 and 22. Serial measurements between 5 and 10 weeks of pregnancy were obtained for P, E2, and bHCG. Gestational age was determined by LMP and serial sonograms. The progesterone, estradiol and beta-HCG levels were evaluated by calculating the rates of change between 5 and 10 weeks, rather than threshold values. The natural log of the values was used to plot serial data and reduce scatter due to the large natural variation in values between patients. The rates of change of P, E2 and b-HCG in the trisomic pregnancy groups were compared to matched normal pregnancies. The slopes of the curves for the trisomies and euploid pregnancies were calculated and compared. We determined that the rate of change of HCG for each of the trisomies was no different from euploid pregnancies, which is consistent with earlier data. In examining estradiol, trisomy 22 did not have a statistically different pattern of steroidogenesis, where trisomies 16, 18 and 21 were different than euploid (p < 0.05). With progesterone, trisomies 16, 18 and 22 had statistically different rates of change (p < 0.05), however trisomy 21 did not. CONCLUSIONS: As we have shown, in pregnancies with aneuploidy, there is a different pattern of steroidogenesis from euploid pregnancies. The difference is detectable in the first trimester by serial measurements of P and E2. In determining steroidogenesis in trisomies 16, 18, 21, and 22, we demonstrate that there is a difference in progesterone and estradiol levels over 5 to 10 weeks among the trisomies that can assist in the diagnosing of abnormal pregnancies in the first trimester. Furthermore, by looking at the rates of change of the individual steroids, the specific aneuploidy may be suspected. A large prospective study may reveal the clinical utility of these observations for early prenatal diagnosis of aneuploidy or probable spontaneous abortion
— id: 39644, year: 2002, vol: 30, page: 132, stat: Journal Article,

A weighted risk index for antenatal prediction of perinatal outcome
Gomez, Jorge L; Young, Bruce K
2002 ;30(2):137-142, Journal of perinatal medicine
OBJECTIVE: The hypothesis is that a risk score derived from the risk index (RI) is correlated with perinatal outcomes. STUDY DESIGN: The RI is a weighted numerical score based on gestational risk factors applied to 782 gravidas antepartum. Management was independent of the score. Birth weight, Apgar scores, and cesarean birth were correlated with risk score. RESULTS: The break point score in this non-Gaussian cohort was 6. Using 6, 80.2% were low and 19.8% high risk. Birth weight < 2500 gm was inversely correlated (p < .001) and occurred in 13% of the high risk ((3)6) and 4.9% of the low risk (< 6) group, relative risk (RR) 2.7. C-section correlated (p < .001), and occurred in 51% of the high and 23% of the low risk group, RR 2.4. risk score inversely correlated with 5 minute Apgar (RR 4.7 p < .002) but not the 1 minute Apgar score. CONCLUSION: The RI identified gravidas at risk for low birth weight, low 5 minute Apgar score, and cesarean birth
— id: 39643, year: 2002, vol: 30, page: 137, stat: Journal Article,

Paraplegia
Young, Bruce K
2002 ;90(3):271-276, Advances in neurology
— id: 39624, year: 2002, vol: 90, page: 271, stat: Journal Article,

Review of monoamniotic gestations reported in English language literature from 1988 to 1999
Roque H; Goldstein J; Abdelhak Y; Roshanfekr D; Lockwood C; Young B
2001 ;184(1):?-? #0605, American journal of obstetrics & gynecology
— id: 73667, year: 2001, vol: 184, page: ?, stat: Journal Article,

Endoscopic ligation of umbilical cord at 19 week's gestation in monoamniotic monochorionic twins discordant for hypoplastic left heart syndrome
Young BK; Roque H; Abdelhak Y; Timor-Tristch I; Rebarber A; Rosen R
2001 Jan-Feb;16(1):61-64, Fetal diagnosis & therapy
We report the first attempt of reduction of monoamniotic twins, discordant for hypoplastic left heart syndrome, using a new fetoscopic technique. Employing sonographic guidance and endoscopic visualization, cord ligation was accomplished, but significant cord entanglement, not previously appreciated, resulted in the ligation of the umbilical cord of the normal fetus. Cord entanglement may frustrate endoscopic techniques in monoamniotic twins
— id: 26825, year: 2001, vol: 16, page: 61, stat: Journal Article,

Management of cervical cerclage at term: remove the suture in labor?
Abdelhak YE; Aronov R; Roque H; Young BK
2000 ;28(6):453-457, Journal of perinatal medicine
OBJECTIVE: To assess the risks and benefits to patients who carry to term after undergoing a Shirodkar cerclage where the cerclage is not removed until the patient presents in labor. METHODS: A retrospective analysis was conducted examining all patients who underwent a Shirodkar cerclage employing a 5 mm Mersilene band. All the cerclages were placed by a single operator over a twenty five year span, from 1/01/74 till 10/01/98. Only patients who delivered vaginally or were allowed a trial of labor were included. In all cases, the cerclage was removed under regional anesthesia after the patient presented to the hospital in labor. RESULTS: Ninety six cerclage procedures were performed over that period. Eighty two pregnancies qualified for review. Sixty two patients delivered vaginally (76%). Nine cesareans were indicated for failure to progress in labor (11%) with cervical dystocia possibly implicated in one. There were no cases of ruptured uteri or the development of uterine windows. Of the 82 pregnancies there were five cases (6%) of minor cervical laceration. CONCLUSION: Allowing patients to proceed to labor with a Shirodkar, cerclage in place, does not increase the risks of cervical dystocia, cervical laceration, or uterine rupture above the reported incidence for these complications in patients in whom the cerclage is removed prophylactically
— id: 39494, year: 2000, vol: 28, page: 453, stat: Journal Article,

Change in cervical length after cerclage as a predictor of preterm delivery
Dijkstra K; Funai EF; O'Neill L; Rebarber A; Paidas MJ; Young BK
2000 Sep;96(3):346-350, Obstetrics & gynecology
OBJECTIVE: To determine whether the degree of cervical lengthening after cerclage and whether serial follow-up measurements of cervical length after cerclage are predictive of pregnancy outcome. METHODS: Eighty women whose primary physician determined that a prophylactic (n = 50) or urgent cerclage (n = 30) was indicated had transvaginal ultrasonographic evaluation before and after cerclage. Thereafter, most women had three additional transvaginal ultrasound examinations until 32 weeks' gestation. At each examination, the mean of three measurements was calculated. Statistical analyses were done by t test, analysis of variance, and logistic regression, with significance set at P <.05. RESULTS: The mean +/- standard deviation precerclage cervical length was 27.2 +/- 10.3 mm and after cerclage was 34.1 +/- 9.9 mm (n = 80, P <.001, paired t test). No significant association was found (r = -0.26) between the difference in cervical length (postcerclage - precerclage lengths) and pregnancy outcome. Patients with a prophylactic cerclage had a mean cervical length that was consistently longer in patients delivering at term compared with those who delivered preterm at 20 to 32 weeks' gestation. In the urgent cerclage group a significant difference in cervical length between those who delivered at term compared with preterm was evident only at 28 to 32 weeks. CONCLUSION: The increase in cervical length after cerclage is not predictive of term delivery. Serial cervical length measurements in the late second or early third trimester predict preterm birth but could provide earlier warning in patients with a prophylactic cerclage than in patients with urgent cerclage
— id: 23505, year: 2000, vol: 96, page: 346, stat: Journal Article,

Minimally invasive endoscopy in the treatment of preterm premature rupture of membranes by application of fibrin sealant
Young, B K; Roque, H; Abdelhak, Y E; Poiolek, D; Demopulos, R; Lockwood, C J
2000 ;28(4):326-330, Journal of perinatal medicine
We report only the 3rd case of closure of amniorrhexis following genetic amniocentesis. Our technique is the first to use endoscopic visualization of the rupture site and apply maternal platelets and fibrinogen/thrombin (Hemaseel Haemacure Corp Sarasota F1). The patient underwent repair at 20.6 weeks, 26 days after spontaneous rupture of membranes post-amniocentesis. At the time of the procedure the amniotic fluid index was 1 cm. Patient was delivered at 32.3 weeks secondary to complications of diabetes and severe preeclampsia. The neonate had APGARS of 7 at 1 min and 8 at 5 min and was discharged home on Day 21 of life
— id: 130984, year: 2000, vol: 28, page: 326, stat: Journal Article,

Change in cervical length after prophylactic cerclage
Funai EF; Paidas MJ; Rebarber A; O'Neill L; Rosen TJ; Young BK
1999 Jul;94(1):117-119, Obstetrics & gynecology
OBJECTIVE: To determine changes in length of incompetent cervices after cerclage, using transvaginal ultrasound. METHODS: Patients were enrolled in a prospective, observational study under an Institutional Review Board-approved protocol. McDonald or Shirodkar sutures were placed according to physician preference. Pre- and postcerclage cervical lengths were measured within 72 hours of the procedure. At each examination, the first measurement was discarded, and a mean of the subsequent three measurements was calculated. RESULTS: Twenty-one Shirodkar and ten McDonald operations were done. The mean (+/- standard deviation) precerclage cervical length was 2.7+/-0.9 cm and the postcerclage cervical length was 3.6+/-0.9 cm (P<.001, paired t test). CONCLUSION: Prophylactic cerclage results in measurable increases in cervical length, which might contribute to the success of the procedure. Further study is needed to determine whether the degree of cervical lengthening after cerclage predicts term delivery
— id: 8501, year: 1999, vol: 94, page: 117, stat: Journal Article,

Intra amniotic candidiasis. Case report and meta-analysis of 54 cases
Roque H; Abdelhak Y; Young BK
1999 ;27(4):253-262, Journal of perinatal medicine
We present a case of mid pregnancy loss with retained intrauterine contraceptive device associated with fetal Candida infection. Review of English literature identified 53 additional cases of fetal candidal infection, with 17 associated with an IUCD in situ. The presence of an IUCD was associated with delivery at a statistically significant earlier gestational age when compared to cases not associated with an IUCD (23.3 +/- 4.9 vs 31.6 +/- 7.0, p < 0.001). Seventy-seven percent of fetal candidal infections associated with an IUCD were systemic (heart, brain, liver, gastrointestinal, lung) compared to 33% of cases not associated with an IUCD. In contrast to bacterial intraamniotic infections there was a low incidence of maternal febrile morbidity. An hypothesis as to the pathogenesis of Candidal infections in the presence and absence of an IUCD is offered as well as a paradigm for the management of the gravid patient with an IUCD in situ
— id: 6237, year: 1999, vol: 27, page: 253, stat: Journal Article,

Effects of tocolytics on the fetal heart
Blackstone, J; Friedman, D; Hoskins, IA; Young, BK
1996 ;6(3):158-162 SUM, Journal of maternal-fetal investigation
Objective: Tn order to determine if tocolytic agents affect fetal ventricular function, we used the combined ventricular shortening fraction, an echocardiographic index of fetal cardiac function to evaluate fetuses whose mothers were being treated for preterm labor. Study design: A group of 30 patients diagnosed with preterm labor and eligible for tocolytic therapy were the subjects of this prospective non-randomized cohort study. Sixteen patients were treated initially with subcutaneous terbutaline, five with intravenous ritodrine, and nine with intravenous magnesium sulfate. All were later maintained on oral therapy with either terbutaline or ritodrine. Each fetus acted as its own control. Each was studied before treatment, while on a clinically therapeutic intravenous or subcutaneous regimen, during oral therapy, and after birth. The in utero evaluations included a biophysical profile, umbilical artery Doppler waveform study, and an M-mode tracing of ventricular wall motion generated from a four-chamber view of the heart to assess the end diastolic and the end systolic dimensions. The combined ventricular shortening fraction was then calculated as (end diastolic - end systolic)/end diastolic x 100%. Multiple analysis of variance was used to compare means over time for each variable. Means between groups were compared using the two-tailed Student's t test; P = 0.05 was utilized. Results: No significant change was noted in the mean combined ventricular shortening fraction of fetuses who had been exposed to tocolytic agents, all of whom had normal studies. The mean combined ventricular shortening fraction pretreatment was 34.8%, as compared with 33.9% in patients treated with beta-mimetics. Those treated with MgSO4 had an improved mean combined ventricular shortening fraction of 37.9%. This change was not statistically significant. Doppler and biophysical profiles were normal, and preterm labor was successfully arrested in all cases. Conclusion: In this small pilot study short ten treatment with commonly utilized tocolytic agents did not appear to affect fetal ventricular function
— id: 52851, year: 1996, vol: 6, page: 158, stat: Journal Article,

Tachycardia as the sole fetal heart rate abnormality after funipuncture
Seligman SP; Young BK
1996 May;87(5 Pt 2):833-834, Obstetrics & gynecology
BACKGROUND: Fetal bradycardia is a common complication of funipuncture. We present a case of fetal exsanguination in which fetal tachycardia was the sole fetal heart rate abnormality. CASE: Funipuncture was performed at 32 weeks' gestation for evaluation of Rh isoimmunization. A persistent fetal tachycardia ensued and, although there was no immediate ultrasound evidence of bleeding, repeat ultrasonography revealed active bleeding at the puncture site. A neonate with an initial hematocrit of 42% was delivered by cesarean. Despite aggressive replacement of blood products, a repeat hematocrit was only 35% and a severe, persistent coagulopathy ensued. The newborn died 18 hours after delivery. Autopsy findings were consistent with neonatal coagulopathy. CONCLUSION: Although fetal bleeding is usually a common, relatively benign complication of funipuncture, streaming may not always be detected on ultrasonographic examination. Our case demonstrates that fetal tachycardia may be the only sign of fetal hemorrhage
— id: 12617, year: 1996, vol: 87, page: 833, stat: Journal Article,

Fetal cardiac effects of oral ritodrine tocolysis
Friedman DM; Blackstone J; Young BK; Hoskins IA
1994 Mar;11(2):109-112, American journal of perinatology
The beta-sympathomimetic oral tocolytic ritodrine can cause maternal tachycardia and hypotension, and may cross the placenta. A new echocardiographic technique has been developed to explore fetal and placental ritodrine effects. Values in 76 healthy historic controls were compared to 18 studies in 16 patients performed while receiving stable oral ritodrine therapy, measured both at baseline and 30 minutes after a dose. Data collected included maternal pulse and blood pressure (BP), fetal cerebral and umbilical Doppler waveforms, and fetal heart rate. A new index of fetal myocardial contractility, combined ventricular shortening fraction, was derived from two-dimensionally directed M-mode. Maternal pulse and BP, fetal heart rate and heart size, and all Doppler indices were normal, without demonstrable dose-response effects. In the control subjects, combined ventricular shortening fraction fell with increasing gestational age (combined ventricular shortening fraction = -0.27 estimated gestational age + 49; r = 0.27; P < or = 0.02; standard error of the estimate, 11%). However, combined ventricular shortening fraction in ritodrine patients was abnormally decreased in 72% of cases. The mean index in normal subjects was 43 +/- 5%, but in ritodrine patients it was only 31%. We conclude that a history of premature labor or oral ritodrine, or both, is associated with reduced shortening fraction. Since there was no change in placental resistance, cerebral hypoxia, fetal heart rate, or heart size (preload), then low shortening fraction may be due to increased fetal systemic vascular resistance (BP) or decreased myocardial contractility
— id: 6375, year: 1994, vol: 11, page: 109, stat: Journal Article,

The role of nitric oxide in the pathogenesis of preeclampsia
Seligman SP; Buyon JP; Clancy RM; Young BK; Abramson SB
1994 Oct;171(4):944-948, American journal of obstetrics & gynecology
OBJECTIVE: Nitric oxide, a potent vasodilator released by endothelial cells, inhibits platelet aggregation and adhesion to vascular endothelial surfaces. Because endothelial cell damage is considered pivotal in the pathogenesis of preeclampsia, this study was initiated to determine whether nitric oxide production is decreased in patients with preeclampsia. STUDY DESIGN: Twenty-six patients with preeclampsia (as defined by a blood pressure > or = 140 mm Hg systolic or 90 mm Hg diastolic plus proteinuria, > or = 300 mg per 24 hours or > or = 2+ by dipstick, both occurring on two occasions > or = 4 hours apart) and 26 normotensive women with singleton gestations in the third trimester were studied. Because nitric oxide is spontaneously oxidized to both nitrite and nitrate, two analytic assays were used serially. Serum nitrite levels were initially determined with the Greiss reagent and subsequently analyzed with Escherichia coli nitrate reductase. RESULTS: With the Greiss reagent alone the mean +/- SEM of serum nitrite level in 26 patients with preeclampsia was significantly decreased compared with 26 normotensive patients (3.46 +/- 1.43 mumol/L vs 4.65 +/- 0.85 mumol/L, p = 0.02). With the addition of the nitrate reductase enzyme of Escherichia coli the mean +/- SEM of serum nitrite level in 26 preeclamptic patients was again significantly decreased compared with 26 normotensive patients (20.04 +/- 1.25 mumol/L vs 27.38 +/- 2.23 mumol/L, p = 0.02). One patient with the syndrome of hemolysis, elevated liver enzymes, and low platelets demonstrated a concurrent decrease in serum nitrite over a 2-week period, emphasizing the relationship of nitric oxide to the pathophysiologic features of the syndrome. CONCLUSIONS: Circulating levels of nitrite are decreased in patients with preeclampsia. These data support the concept that diminished nitric oxide synthesis contributes to the pathophysiologic changes seen in preeclampsia
— id: 6747, year: 1994, vol: 171, page: 944, stat: Journal Article,

Pregnancy in women with paraplegia
Young BK
1994 ;64:209-214, Advances in neurology
— id: 13010, year: 1994, vol: 64, page: 209, stat: Journal Article,

Synthesis of alpha 1-antichymotrypsin and alpha 1-antitrypsin by human trophoblast
Bergman D; Kadner SS; Cruz MR; Esterman AL; Tahery MM; Young BK; Finlay TH
1993 Sep;34(3):312-317, Pediatric research
alpha 1-Antichymotrypsin (alpha 1-ACHY) and alpha 1-antitrypsin (alpha 1-AT) are closely related glycoprotein protease inhibitors, present in plasma and other extracellular fluids, that neutralize proteases released by leukocytes in response to trauma and inflammatory stimuli. Both inhibitors are synthesized primarily by hepatocytes, although lower levels of synthesis by monocytes and breast and intestinal epithelial cells have been demonstrated. Recently, the immunohistochemical localization of alpha 1-AT and alpha 1-ACHY in intrauterine and extrauterine human trophoblastic tissue has been reported. In the present study, we have sought to determine whether human trophoblast is also able to synthesize alpha 1-AT and alpha 1-ACHY. Messenger RNA for both inhibitors was found by Northern blotting in chorionic villi obtained from first trimester and term placenta. Substantial differences in messenger levels for both inhibitors among individual placentas were noted. alpha 1-ACHY and alpha 1-AT messenger was also present in trophoblast cells in primary culture. Synthesis of alpha 1-AT and alpha 1-ACHY protein was demonstrated by SDS-PAGE after immunoprecipitation of [35S]-labeled alpha 1-AT and alpha 1-ACHY from conditioned media of trophoblast cells in culture metabolically labeled with [35S]-methionine. It is of some interest that the M(r) of the alpha 1-AT and alpha 1-ACHY secreted by trophoblast were 50,000 and 49,000, respectively, compared with 54,000 and 68,000 for these proteins in plasma (or secreted by HepG2 human hepatoma and MCF-7 human breast cancer cells).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 56499, year: 1993, vol: 34, page: 312, stat: Journal Article,

Umbilical cord blood acid-base values and other descriptors of fetal condition
Blackstone J; Young BK
1993 Mar;36(1):33-46, Clinical obstetrics & gynecology
— id: 13235, year: 1993, vol: 36, page: 33, stat: Journal Article,

Osler-Weber-Rendu disease. Diagnosis and management of spontaneous hemothorax during pregnancy [see comments]
Bevelaqua FA; Ordorica SA; Lefleur R; Young B
1992 Dec;92(12):551-552, New York state journal of medicine
— id: 13345, year: 1992, vol: 92, page: 551, stat: Journal Article,

Activation of the alternative complement pathway accompanies disease flares in systemic lupus erythematosus during pregnancy
Buyon JP; Tamerius J; Ordorica S; Young B; Abramson SB
1992 Jan;35(1):55-61, Arthritis & rheumatism
OBJECTIVE. To assess the activity of systemic lupus erythematosus (SLE) during pregnancy and to distinguish it from preeclampsia. METHODS. We prospectively measured the complement activation products Ba, Bb, SC5b-9, and C4d, as well as the conventional complement determinants C3, C4, and CH50, during pregnancy in 14 patients with SLE and 10 women with preeclampsia. RESULTS. Four of the 14 SLE patients were considered to have disease flares, 3 occurring in the second trimester and 1 postpartum. In these patients, significant abnormalities of Ba, Bb, SC5b-9, and CH50 were noted. In contrast, measures of C4d did not distinguish between pregnant patients who had flares and those whose SLE remained stable. Although decreased values of C3 were rarely seen in the patients with stable disease, normal values of C3 during lupus pregnancy were not reliably associated with stable disease. Three of 10 non-SLE patients with preeclampsia had elevated levels of Ba; however, in each case, the CH50 level was close to or within the normal range. This was in sharp contrast to the findings observed in the 4 patients with active SLE, in whom high levels of plasma Ba were always associated with low CH50 values. Moreover, the ratio of CH50 to Ba was significantly lower in the patients with lupus flares than in the non-SLE patients with preeclampsia. CONCLUSION. While a decline in the CH50 level alone could otherwise be attributed to decreased synthesis of complement components, these data demonstrate that ongoing activation of the alternative complement pathway can accompany disease flares in pregnant women with SLE
— id: 9752, year: 1992, vol: 35, page: 55, stat: Journal Article,

Use of esterase inhibitors and zone electrophoresis to define bacterial esterases in amniotic fluid
Hoskins IA; Katz J; Kadner SS; Young BK; Finlay T
1992 Dec;167(6):1579-1582, American journal of obstetrics & gynecology
OBJECTIVE: The purpose of our study was to define further the role of bacterial esterases in amniotic fluid obtained from women with chorioamnionitis. STUDY DESIGN: Amniotic fluid samples from 39 patients with chorioamnionitis were submitted for bacterial cultures and in vitro assay. Esterase inhibitors diisopropyl fluorophosphate and iodoacetic acid were added and the degree of inhibition calculated. These results were compared with the amniotic fluid culture results. Chi square analysis was performed to compare the results of the esterase assay and the inhibition assay between the uninfected and infected amniotic fluid samples. RESULTS: Thirty-one patients had positive bacterial cultures, with 21 being infected with gram-negative organisms. All samples showed significant inhibition (range 55% to 82%) with diisopropyl fluorophosphate. There was partial inhibition with iodoacetic acid (range 10% to 30%) in the gram-negative samples but no inhibition in the gram-positive and uninfected samples. Six infected and two uninfected samples were analyzed by using zone electrophoresis with human plasma as a control. Minimal esterase motility was noted in the amniotic fluid samples as compared with that in plasma. CONCLUSION: The esterases in amniotic fluid appeared to be of bacterial, not human, origin. Furthermore, different groups of bacteria appeared to produce different esterases in infected amniotic fluid
— id: 13348, year: 1992, vol: 167, page: 1579, stat: Journal Article,

Amniotic fluid index: correlation with amniotic fluid volume
Hoskins IA; McGovern PG; Ordorica SA; Frieden FJ; Young BK
1992 Sep-Nov;9(5-6):315-318, American journal of perinatology
We calculated the amniotic fluid indexes (AFIs) of 310 women on 459 occasions. Normative data were analyzed and compared with data in several high-risk groups. In the normal gestations there was a progressive increase in AFI with advancing gestation until 32 weeks, after which there was a decline. The mean AFIs in abnormal gestations varied with the clinical diagnoses. These values were compared to those obtained by assessing amniotic fluid volume (AFV), that is a pocket more than 2 cm. There were 51 patients with abnormal AFVs. Forty-two had decreased fluid, six also had decreased AFIs; nine had increased AFVs and five (all with diabetes) also had increased AFIs. Thus, AFIs in normal pregnancies showed an orderly pattern of change with gestational age, and there was no accurate correlation between AFI and AFV. Thus, using AFV alone may lead to false interpretations of amniotic fluid status
— id: 13459, year: 1992, vol: 9, page: 315, stat: Journal Article,

Surgical treatment of incompetent cervix
Marks F; Hoskins IA; Rosenberg C; Young BK
1992 Sep-Nov;9(5-6):481-483, American journal of perinatology
A comparison of multiple factors in the surgical management of cervical incompetence was carried out in 114 procedures. Factors examined included training level of the operator, gestational age, cervical effacement and dilation at the time of operation, diagnostic evaluation, Shirodkar or McDonald procedure, year of the procedure, and tocolytic therapy. The endpoint for successful outcome was defined as 37 weeks or newborn weighing over 2500 gm rather than neonatal survival, thus differing from previous studies. All patients were delivered vaginally unless there was an obstetric indication for cesarean delivery. The most important determinants of a term birth in patients with incompetent cervix were operator experience and the use of a Shirodkar procedure
— id: 13458, year: 1992, vol: 9, page: 481, stat: Journal Article,

Variable decelerations in reactive nonstress tests with decreased amniotic fluid index predict fetal compromise
Hoskins IA; Frieden FJ; Young BK
1991 Oct;165(4 Pt 1):1094-1098, American journal of obstetrics & gynecology
A total of 3158 patients at greater than or equal to 34 weeks' gestation undergoing nonstress tests and amniotic fluid index determinations were divided into six groups according to the amniotic fluid index and the nature of the decelerations. Fetuses with antepartum decelerations had statistically significantly increased incidences of intrapartum decelerations and operative deliveries because of intrapartum 'distress,' regardless of the amniotic fluid index. They also had significantly increased rates of neonatal acidosis and low Apgar scores when there were 'severe' decelerations and an amniotic fluid index less than 5 in the antepartum period. Thus spontaneous decelerations in reactive nonstress tests with an amniotic fluid index less than 5 may predict fetal compromise
— id: 13869, year: 1991, vol: 165, page: 1094, stat: Journal Article,

Relationship between antepartum cocaine abuse, abnormal umbilical artery Doppler velocimetry, and placental abruption
Hoskins IA; Friedman DM; Frieden FJ; Ordorica SA; Young BK
1991 Aug;78(2):279-282, Obstetrics & gynecology
We performed serial umbilical artery Doppler flow velocimetry studies on 314 women and grouped them according to history of antepartum cocaine abuse, placental abruption with antepartum cocaine abuse, preterm labor with antepartum cocaine abuse, preterm labor without antepartum cocaine abuse, and controls without preterm labor or antepartum cocaine abuse. Analyses excluded twin gestation, diabetes, and hypertension. The overall incidence of deliveries at or before 36 weeks was 28% (31 of 112). Thirteen (12%) of the infants were small for gestational age (SGA) and 33 (29%) were low birth weight (LBW). Almost all subjects with a history of cocaine abuse had normal systolic-diastolic ratios (S/Ds). All patients with abruption had abnormal S/Ds, as did 14 of 64 subjects who had preterm labor and a history of cocaine abuse. No abnormal S/Ds were found in the women with preterm labor or in controls. Among cocaine-abusing women, there was a significant correlation between placental abruption and abnormal S/Ds (P less than .05) and between abnormal S/Ds and the incidence of preterm birth and SGA and LBW infants
— id: 13944, year: 1991, vol: 78, page: 279, stat: Journal Article,

Performance of cesarean section using absorbable staples
Hoskins IA; Ordorica SA; Frieden FJ; Young BK
1991 Feb;172(2):108-112, Surgery, gynecology & obstetrics
Although stapling techniques have gained wide acceptance in general surgery, they are still not commonly used in obstetrics. U.S. Surgical Corporation has introduced a stapling device suitable for use in cesarean sections. The copolymer staples (a blend of polylactic and polyglycolic acids) maintain their tensile strength until healing occurs and absorb without producing granulation tissue. The benefits include minimal trauma to tissue and reduced operating time, blood loss and postoperative morbidity. From July 1988 to February 1989, all patients undergoing low transverse cervical cesarean sections were randomized to either group 1 with the uterine incision performed in a routine manner or group 2 with the uterine incision cut and stapled using the Stapler. The preoperative management, intraoperative technique and postoperative surveillance were similar for both groups. The uterine incision was assessed by pelvic sonography during the postpartum period. Statistical analysis was performed using Fisher's exact test and chi-square analysis. Both groups were comparable for age, race, parity, gestational age and primary diagnosis. The length of the operative procedure was significantly shorter (p less than 0.05) in the stapled group. These patients also had a statistically significantly decreased incidence of uterine incisions and lacerations. All other parameters were not significantly different in the two groups. The stapled uterine incisions were visible by ultrasonography in more patients in the stapled group throughout the postpartum period than in the sutured group. Thus, stapling of the uterine incision was an acceptable alternative to traditional suturing techniques and it was possible to visualize clearly these incisions during the postpartum period
— id: 14148, year: 1991, vol: 172, page: 108, stat: Journal Article,

Discordant twins: acid-base status
Ordorica SA; Frieden FJ; Hoskins IA; Young BK
1991 ;40(3-4):373-381, Acta geneticae medicae & gemellologiae
A prospective study was undertaken to determine the effect of twin birthweight discordancy on Apgar scores and umbilical blood acid-base parameters. Using the paired t-test, small but statistically significant differences were seen in these parameters favoring the heavier twin over its lighter sibling. These differences were also affected by birth order, with the first-born being favored
— id: 14209, year: 1991, vol: 40, page: 373, stat: Journal Article,

Pancreatic enzyme activity in pregnancy
Ordorica SA; Frieden FJ; Marks F; Hoskins IA; Young BK
1991 May;36(5):359-362, Journal of reproductive medicine
Serum amylase activity and the amylase:creatinine clearance ratio (Cam:Ccr%) are two of the most commonly used indicators for the diagnosis of pancreatitis. However, published data on the effect of pregnancy on these indicators are conflicting. Furthermore, there are no published data on the effect of pregnancy on serum lipase activity, which is considered one of the most sensitive and specific indicators of pancreatitis. A study was undertaken to determine the effect of pregnancy and gestational age on serum amylase, serum lipase and Cam:Ccr% levels and to establish a baseline of normal values for use in the diagnosis of pancreatitis in pregnant women. Serum amylase, serum lipase and Cam:Ccr% levels were determined on a sample population consisting of 175 pregnant women with gestational ages ranging from 5 to 40 weeks and on a control group of 44 reproductive-age, nonpregnant women. The study results indicated that there is no significant difference in serum amylase, serum lipase and Cam:Ccr% levels between pregnant and nonpregnant women. Cam:Ccr% showed a small but statistically significant increase in the third trimester of pregnancy
— id: 14055, year: 1991, vol: 36, page: 359, stat: Journal Article,

Acid-base differences in preterm and term twin pregnancy
Ordorica SA; Hoskins IA; Young BK
1991 ;40(3-4):361-372, Acta geneticae medicae & gemellologiae
A prospective study was undertaken which examined 179 sets of twins, 68 premature (less than 36 weeks of gestation) and 111 term. The purpose of this study was to assess differences in the acid-base status between twins related to gestational age, birth order and the time interval between twin births. Although the twin blood-gas data is within the range considered normal, statistically significant differences favoring the first-born were noted for both preterm and term twins. These differences do not depend on gestational age, route of delivery or presentation, and become evident when the interval between twin births exceeds one minute. We postulate that after delivery of the first twin, the reduced uterine size causes a decrease in the intervillous blood flow and consequently a reduction in the respiratory exchange between the second fetus, still in utero, and its placenta
— id: 14210, year: 1991, vol: 40, page: 361, stat: Journal Article,

Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature
Wisoff JH; Kratzert KJ; Handwerker SM; Young BK; Epstein F
1991 Dec;29(6):827-831, Neurosurgery
Hydrocephalic women with cerebrospinal fluid shunts are now surviving to reproductive age. Twenty-one pregnancies in 18 patients with shunts, including 11 from the present series and 10 from previous series, were analyzed for neurological, obstetrical, and perinatal outcome. Fourteen women had preexisting shunts, and 4 had the onset of symptomatic hydrocephalus and the placement of shunts during pregnancy. Neurological complications occurred in 13 of 17 (76%) pregnancies in patients with preexisting shunts, including symptoms of increased intracranial pressure (ICP) in 10 of 17 (59%) pregnancies, exacerbation of seizure disorder in 2 of 17 (12%) pregnancies, and severe headaches without increased ICD in 1 patient. In 7 of 11 (66%) of the symptomatic patients, symptoms spontaneously resolved postpartum. Four of 17 (23%) of these pregnancies were associated with shunt obstruction requiring antepartum or postpartum surgery. Four patients had a primary shunt placement, and one had a shunt revision during pregnancy without complications. There were no unusual obstetrical or perinatal complications in the series. The clinical management of pregnant patients with hydrocephalus should include preconception counseling and magnetic resonance imaging, as well as the use of serial antenatal magnetic resonance images, ICP monitoring, or the judicious use of radioisotope studies of shunt patency if signs of increased ICP appear. A cesarean section is recommended for the delivery of the neurologically unstable patient. For asymptomatic mothers, a vaginal delivery with a shortened second stage and prophylactic antibiotics are advised
— id: 13831, year: 1991, vol: 29, page: 827, stat: Journal Article,

Successful pregnancy with isolated herpes simplex virus encephalitis: case report and review of the literature
Frieden FJ; Ordorica SA; Goodgold AL; Hoskins IA; Silverman F; Young BK
1990 Mar;75(3 Pt 2):511-513, Obstetrics & gynecology
Isolated herpes simplex virus encephalitis in pregnancy is a rare illness with an elusive diagnosis. We describe the second patient to survive this disease and the first to have no sequelae, because of prompt diagnosis and treatment with acyclovir
— id: 18695, year: 1990, vol: 75, page: 511, stat: Journal Article,

The Shirodkar operation: a reappraisal
Frieden FJ; Ordorica SA; Hoskins IA; Young BK
1990 Sep;163(3):830-833, American journal of obstetrics & gynecology
Sixty-six cerclages were performed by one surgeon in 46 patients with documented cervical incompetence. The mean operative blood loss was 25 ml, and the mean operating time was 18 minutes with no postoperative morbidity. Fifty-five of the pregnancies were carried for at least 37 weeks, eight were delivered before 37 weeks, and three are continuing. Six of the eight preterm deliveries were a result of factors unrelated to cervical incompetence. The two remaining preterm births were probably also unrelated because one occurred 8 days after emergent cerclage placement and the other occurred 12 weeks after the procedure, both as a result of premature rupture of membranes. There were no cesarean deliveries related to the Shirodkar suture. The efficacy of the procedure was demonstrated by a corrected perinatal survival rate of 100% and term delivery of 88%. (Since this article was written all three of the undelivered patients were delivered of infants after 37 weeks' gestation for a term delivery rate of 88% with 100% neonatal survival
— id: 18691, year: 1990, vol: 163, page: 830, stat: Journal Article,

In vitro inhibition of esterase activity in amniotic fluid: comparison with bacterial cultures
Hoskins IA; Katz J; Frieden FJ; Ordorica SA; Young BK
1990 Dec;163(6 Pt 1):1944-1947, American journal of obstetrics & gynecology
Assessment of leukocyte esterase activity in amniotic fluid for the rapid and reliable diagnosis of chorioamnionitis has been demonstrated previously. We compared in vitro inhibition of esterase activity in amniotic fluid with bacterial cultures to identify the origins of the specific esterases released by the infecting organisms. One hundred forty-one samples were tested (90 uninfected, 51 infected). Each sample was evaluated for Gram stain, cultures, and an in vitro esterase assay followed by ebelactone inhibition. Forty-two patients had positive amniotic fluid cultures. Ebelactone produced varying degrees of inhibition of esterase activity (range, 20% to 60%) in the uninfected samples and in those infected with gram-negative organisms. There was no inhibition in the samples infected with gram-positive organisms. Thus different groups of bacteria may elicit the production of different and specific esterases in infected amniotic fluid, as shown by the differences in in vitro inhibition
— id: 14251, year: 1990, vol: 163, page: 1944, stat: Journal Article,

Leukocyte esterase activity in amniotic fluid: normal values during pregnancy
Hoskins IA; Marks F; Ordorica SA; Young BK
1990 Apr;7(2):130-132, American journal of perinatology
Chorioamnionitis during pregnancy is a common diagnostic dilemma for the obstetrician. Fast and accurate diagnosis poses the most significant problem. Since leukocytes are known to be released in response to infections, examination of amniotic fluid for their presence is an important part of the evaluation for chorioamnionitis. These neutrophils contain several esterases that are not present in serum, urine, or vaginal secretions. The esterases are not influenced by bacteria or by commonly used drugs. We have previously described the reliability of leukocyte esterase (LE) activity for the detection of chorioamnionitis in term pregnancies uncomplicated by other diseases. A prospective study was performed to assess the presence or absence of LE activity to establish normal values in amniotic fluid at various gestational ages prior to term before its use as a possible predictor for chorioamnionitis. Sterile amniotic fluid specimens were obtained from 13 patients undergoing second trimester genetic amniocentesis (with gestational ages varying from 15 to 19 weeks) and from 11 patients with a wide variety of medical problems, undergoing amniocentesis for Rh sensitization or lung maturation studies (with gestational ages ranging from 25 to 27 weeks). All patients with ruptured membranes or preterm labor were excluded. Each amniotic fluid sample was divided into two parts, one of which was transported to the laboratory for aerobic and anaerobic cultures and the other used for LE activity detection as measured by dipstick. The LE results were retrospectively compared with the results of the cultures. LE activity was always found to be negative when the culture results were negative. negative.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 18694, year: 1990, vol: 7, page: 130, stat: Journal Article,

Aneurysm of the vein of Galen: a new cause for Ballantyne syndrome
Ordorica SA; Marks F; Frieden FJ; Hoskins IA; Young BK
1990 May;162(5):1166-1167, American journal of obstetrics & gynecology
Ballantyne syndrome is a condition of multiple causes and is characterized by maternal, placental, and fetal edema. We describe the first case of Ballantyne syndrome in a patient whose fetus had ultrasonographic demonstration of an aneurysm of Galen's vein
— id: 18693, year: 1990, vol: 162, page: 1166, stat: Journal Article,

Esterase activity in second- and third-trimester amniotic fluid: an indicator of chorioamnionitis
Hoskins IA; Katz J; Ordorica SA; Young BK
1989 Dec;161(6 Pt 1):1543-1545, American journal of obstetrics & gynecology
Accurate and rapid diagnosis of chorioamnionitis poses a major diagnostic dilemma. We previously reported that leukocyte esterase activity in amniotic fluid, as measured by dipstick assay, could be used as an aid in the diagnosis of chorioamnionitis. This study examines the effectiveness of an in vitro spectrophotometric assay of esterase activity in amniotic fluid. We define baseline levels of esterase activity in uninfected amniotic fluid and demonstrate a quantitative increase when infection is present. Fifty-seven amniotic fluid samples obtained at second- and third-trimester amniocenteses were divided into three parts, one for culture and two for a comparison of esterase activities by the dipstick and spectrophotometric methods. In this study, the spectrophotometric assay, because of its higher specificity and sensitivity in the determination of elevated esterase activity, was shown to be more reliable for predicting chorioamnionitis than either the dipstick or culture method
— id: 10408, year: 1989, vol: 161, page: 1543, stat: Journal Article,

Spondylothoracic dysplasia. Clinical and sonographic diagnosis
Marks F; Hernanz-Schulman M; Horii S; Greenland VC; Lustig I; Snyder J; Young BK; Greco MA; Subramanyam B; Genieser NB
1989 Jan;8(1):1-5, Journal of ultrasound in medicine
Spondylothoracic dysplasia, also known as short-trunk dwarfism or Jarcho-Levin syndrome, is a fatal autosomal recessive disorder characterized by vertebral and spinal defects with a short thorax. Until recently, in utero diagnosis could only be made radiographically. Sonographic criteria for antenatal diagnosis are discussed in conjunction with a review of the literature
— id: 10801, year: 1989, vol: 8, page: 1, stat: Journal Article,

Congenital hereditary fructose intolerance and pregnancy
Marks F; Ordorica S; Hoskins I; Young BK
1989 Feb;160(2):362-363, American journal of obstetrics & gynecology
Congenital hereditary fructose intolerance is associated with the inability to tolerate fructose and carbohydrates, which are converted into fructose. We describe management of a pregnancy complicated by this disease in the mother and its implications for the neonate
— id: 10723, year: 1989, vol: 160, page: 362, stat: Journal Article,

Diagnosis of adrenal ganglioneuroma in pregnancy with magnetic resonance imaging and ultrasonography. A case report
Marks F; Young BK; Raghavendra BN; Rumancik WM; Tessler AN; Eliasen CA; Valensi QJ
1989 Jan;34(1):59-61, Journal of reproductive medicine
A right adrenal gland mass was found during sonographic examination of the right upper quadrant during a workup for hyperemesis gravidarum. Magnetic resonance imaging was used to clarify the origin of the mass. The tumor was nonfunctional. Because of the possibility of a malignancy, the patient underwent a successful second-trimester exploratory laparatomy with right adrenalectomy. Pathology demonstrated a benign ganglioneuroma
— id: 10797, year: 1989, vol: 34, page: 59, stat: Journal Article,

Pregnancy post-Stevens-Johnson syndrome: case report and review of the literature
Kratzert K; Marks F; Antoine C; Brescia RJ; Parodneck L; Young BK
1988 Sep;72(3 Pt 2):447-450, Obstetrics & gynecology
A pregnancy complicated by vaginal stenosis six years after diagnosis of Stevens-Johnson syndrome is described. The pathologic changes in the vagina have not previously been reported. The basic pathology of severe mucosal erythema multiforme was present, as well as ectasia of the superficial capillaries and small venules. The effect of the vaginal scars on the mode of delivery is discussed
— id: 10982, year: 1988, vol: 72, page: 447, stat: Journal Article,

Pregnancy after traumatic aortic aneurysm repair
Marks F; Schweizer WE; Young BK
1988 Aug;159(2):389-390, American journal of obstetrics & gynecology
Thoracic aortic aneurysm is associated with increased morbidity and mortality in pregnancy. Successful pregnancy with vaginal delivery after repair of a traumatic aortic aneurysm is described
— id: 11023, year: 1988, vol: 159, page: 389, stat: Journal Article,

Riboflavin concentration in maternal and cord blood in human pregnancy
Kirshenbaum NW; Dancis J; Levitz M; Lehanka J; Young BK
1987 Sep;157(3):748-752, American journal of obstetrics & gynecology
Riboflavin concentration was measured in sera of a control population and in a series of paired maternal and cord sera. The assay technique was carefully validated and appears to be specific and reproducible. The mean riboflavin concentration in 12 apparently healthy adults was 116 +/- 46 nmol/L (SD). In 20 uneventful pregnancies the cord serum concentration was generally higher than the maternal concentration (158 +/- 47 nmol/L versus 113 +/- 35 nmol/L; p = 0.001). The cord-to-maternal ratio in paired sera averaged 1.45 +/- 0.44. There was no detectable difference in binding of riboflavin to cord and maternal serum proteins as measured by equilibrium dialysis (59.0% +/- 17% versus 60.8% +/- 16%). Comparison of protein binding by paired cord and maternal sera yielded a ratio of 0.99 +/- 0.13. The transplacental gradient of riboflavin concentration is unrelated to protein binding and is consistent with active transport by the placenta, as previously demonstrated in vitro
— id: 43288, year: 1987, vol: 157, page: 748, stat: Journal Article,

Use of furosemide in pregnancies complicated by oligohydramnios
Raghavendra BN; Young BK; Greco MA; Lustig-Gillman I; Horii SC; Hirsch MA; Yee J
1987 Nov;165(2):455-458, Radiology
To differentiate pregnancies complicated by oligohydramnios due to intrauterine growth retardation from those due to renal agenesis, the authors administered furosemide intravenously to eight pregnant women (19-25 weeks gestation) with oligohydramnios. The fetal abdomen was scanned with ultrasound to demonstrate the fetal urinary bladder. In six fetuses, sonography failed to demonstrate the bladder: two fetuses had growth retardation with normal kidneys and bladder, and four had renal anomalies. It is concluded that administration of furosemide to the mother fails to induce diuresis in growth-retarded fetuses of 19-23 weeks gestation and that failure to see the fetal bladder after furosemide administration does not necessarily indicate absent fetal kidneys
— id: 11334, year: 1987, vol: 165, page: 455, stat: Journal Article,

Biochemical differences related to birth order in triplets
Antoine C; Kirshenbaum NW; Young BK
1986 May;31(5):330-332, Journal of reproductive medicine
This is the first report to date on biochemical parameters in triplets. Umbilical artery and venous pH, PO2, PCO2, lactate and base deficit were measured in seven sets of triplets. Other parameters compared were route of delivery, one- and five-minute Apgar score, birth weight, relative birth order and sex. Twenty-one viable infants were born from three induced and four spontaneous pregnancies. Female: male sex ratio was 1.6:1.0. All triplets within a set were delivered by the same route--six sets by cesarean section and one set vaginally. There were no significant differences, according to Student's t-test, in birth weight, Apgar scores and biochemical parameters related to birth order. Comparison of umbilical artery and umbilical venous pH, PO2, PCO2, lactate and base deficit differences did not demonstrate evidence of acidosis or significant base deficit in the third triplet when compared with the first two, suggesting that the duration in utero after deliver of the firstborn is not associated with metabolic acidosis or hypoxia in the absence of any obstetric complication or anesthetic problem
— id: 66856, year: 1986, vol: 31, page: 330, stat: Journal Article,

Antenatal ultrasound diagnosis of an intracranial neoplasm (craniopharyngioma)
Snyder JR; Lustig-Gillman I; Milio L; Morris M; Pardes JG; Young BK
1986 May;14(4):304-306, Journal of clinical ultrasound
— id: 66857, year: 1986, vol: 14, page: 304, stat: Journal Article,

Hydranencephaly: prenatal and neonatal ultrasonographic appearance
Coady DJ; Snyder JR; Lustig-Gillman I; Suidan J; Hori S; Young BK
1985 Jul;2(3):228-230, American journal of perinatology
The prenatal diagnosis and postpartum confirmation of hydranencephaly is discussed. The need for an adequate knowledge of fetal cranial anatomy when performing obstetric sonography is stressed
— id: 22125, year: 1985, vol: 2, page: 228, stat: Journal Article,

Doppler blood velocity waveforms in the umbilical artery as an indicator of fetal well-being
Friedman DM; Rutkowski M; Snyder JR; Lustig-Gillman I; Young BK
1985 Mar-Apr;13(3):161-165, Journal of clinical ultrasound
Doppler blood velocity waveforms were analyzed from the umbilical artery as an indication of fetal well-being. Since the ratio of systolic to diastolic peak flows (A/B) reflects placental vascular resistance, an abnormality of this value may accurately predict compromised fetuses. Twenty-one studies were performed on 13 patients, using a new duplex system for real-time imaging and range-gated pulsed Doppler analysis, and compared to normal standards. Thirteen studies done in nine uneventful pregnancies were consistently normal. However, abnormal studies were found in the four patients reported as case histories, including women with sickle cell anemia, systemic lupus, diabetes, and growth retardation. The A/B ratio was felt to have predicted potential fetal compromise, including the two fetal deaths. Therefore, with certain cautions, we feel that this rapid, non-invasive technique is useful as a serially applicable reflector of the status of fetoplacental circulation
— id: 66862, year: 1985, vol: 13, page: 161, stat: Journal Article,

The Apgar score: is it enough?
Silverman F; Suidan J; Wasserman J; Antoine C; Young BK
1985 Sep;66(3):331-336, Obstetrics & gynecology
One thousand thirty-two neonates were evaluated with umbilical venous and arterial blood samples drawn at delivery for assessment of pH, PO2, PCO2, and base deficit. These values were statistically correlated with Apgar scores in all of the neonates studied. Infants were divided into Apgar groupings (group A, greater than or equal to 7 at one and five minutes; group B, less than 7 at one minute, greater than or equal to 7 at five minutes; group C, less than or equal to 7 at both one and five minutes). Generally, umbilical artery and umbilical venous data were parallel. The differences in means for pH, PO2, PCO2, and base deficit was significant when group A was compared with group B in both umbilical artery and umbilical venous data. However, a severe degree of biochemical disturbance must take place before significant association with neonatal depression can be made. It appears that umbilical blood biochemical data are related to fetal metabolic status before birth but only modestly influence the one-minute Apgar score
— id: 66858, year: 1985, vol: 66, page: 331, stat: Journal Article,

A case of endometrioid carcinoma of the ovary associated with pregnancy
Sommers GM; Noumoff JS; Bigelow B; Young BK
1985 Jul;21(3):364-368, Gynecologic oncology
This is the second report of endometrioid carcinoma of the ovary associated with an intrauterine pregnancy. The previous report presented six cases, making this the seventh. Characteristics of the tumor are reviewed, as are the guidelines for the management of ovarian carcinoma complicating pregnancy
— id: 66860, year: 1985, vol: 21, page: 364, stat: Journal Article,

Acidosis in the vigorous newborn
Suidan JS; Young BK
1985 Mar;65(3):361-364, Obstetrics & gynecology
Simultaneous measurements of maternal arterial and umbilical cord blood pH, PCO2, and base deficit at delivery were studied in 168 live-born infants and their mothers. The correlations between maternal and umbilical parameters were highly significant (P less than .001) and were greater in vigorous than in depressed newborns. Mothers of vigorous acidotic infants had a lower pH and a higher base deficit than those of vigorous nonacidotic infants (P less than .001). However, the maternal-fetal differences were wider in the vigorous acidotic than in the vigorous nonacidotic newborns for all three parameters, and in both umbilical vein and umbilical artery (P less than .001). The data indicate that maternal acidosis accounts only partially for the acidosis observed at the time of delivery in the apparently normal fetus. With neonatal depression, the degree of acidosis is not dependent on maternal pH but on other factors. These factors may be influenced by maternal acidosis, but they are the major reasons for the neonatal depression, not the maternal acidosis
— id: 66863, year: 1985, vol: 65, page: 361, stat: Journal Article,

Observations on perinatal heart rate monitoring. II. Quantitative unreliability of Doppler fetal heart rate variability
Suidan JS; Young BK; Hochberg HM; George ME
1985 Jul;30(7):519-522, Journal of reproductive medicine
Fifty-three fetal heart rate (FHR) tracings obtained by direct ECG monitoring during labor and 24 simultaneous external Doppler FHR tracings were analyzed for the quantitative assessment of baseline FHR variability. The beat-to-beat difference in FHR subsumed by 90% of all beat-to-beat changes within a tracing was taken as the index of variability of that tracing. This index correlated well with the visual assessment of variability for both internal ECG records (Spearman rank correlation coefficient, rs, = 0.71) and external Doppler records (rs = 0.78). However, there was no correlation between the variability index of the Doppler FHR records and that of simultaneous ECG FHR records (r = 0.11, p greater than 0.6). This finding casts doubt on the use of the presence of 'normal' FHR variability as a sign of fetal well-being during antepartum FHR monitoring with current Doppler equipment
— id: 66859, year: 1985, vol: 30, page: 519, stat: Journal Article,

Fetal stress and distress
Young BK
1985 ;21(5):155-174, Birth defects original articles series
— id: 66864, year: 1985, vol: 21, page: 155, stat: Journal Article,

Differences in twins: the importance of birth order
Young BK; Suidan J; Antoine C; Silverman F; Lustig I; Wasserman J
1985 Apr 1;151(7):915-921, American journal of obstetrics & gynecology
Despite the clinical impression that firstborn twins do better than second-born twins, recent reports have shown no difference in perinatal mortality between them. In order to evaluate differences in twins, more sensitive means than perinatal deaths are necessary. This study examines differences between 80 firstborn and second-born twin pairs with respect to Apgar score, umbilical venous and arterial blood gas, and acid-base data. The umbilical venous and arterial blood PO2, PCO2, base deficit, pH, and lactic acid concentration were measured in paired samples and compared with the paired t test and chi 2 when applicable. Statistically significant differences favoring twin A, the firstborn, were found in 1-minute Apgar score, umbilical venous pH, PO2, and PCO2, and umbilical arterial PO2. The other factors in umbilical venous and arterial blood did not show statistically significant differences. When these parameters were examined with respect to route of delivery, monochorionic and dichorionic twins, interval between twins, and vertex twins only, with the possible effects of malpresentation eliminated, the results persistently favored the firstborn twin. Thus it is unequivocally demonstrated that there are substantial differences at birth favoring the first twin, despite similar perinatal mortality for both. The data suggest that the second-born twin has potentially greater susceptibility to hypoxia and trauma
— id: 66861, year: 1985, vol: 151, page: 915, stat: Journal Article,

The Patient within the patient : problems in perinatal medicine
Young, Bruce K
New York : Liss, 1985,
— id: 36, year: 1985, vol: , page: , stat: ,

Simultaneous measurement of fetal tissue pH and transcutaneous pO2 during labor
Antoine C; Young BK; Silverman F
1984 May;17(2-3):69-76, European journal of obstetrics, gynecology & reproductive biology
Simultaneous measurement of fetal heart rate (FHR), uterine contractions (UC), continuous fetal tissue pH (TpH) and transcutaneous pO2 (tcpO2) was attempted in 40 high-risk parturients monitored for an average duration of 117 +/- 74 min. There were only two failures (9%) in the last 23 cases, with satisfactory recording of all parameters in 78% of the total. At present, the feasibility of simultaneous biochemical monitoring is limited to the active phase of labor. Fetal scalp and umbilical arterial blood pH and pO2 were obtained as well. The biochemical data showed a good correlation between tcpO2, scalp capillary pO2 and umbilical artery pO2 (P less than 0.02). The correlation was not significant between similar pH comparisons, although an average difference of 0.04 pH units was observed between the final tpH and umbilical artery pH. Both fetal TpH and tcpO2 fell progressively during labor. Preliminary findings comparing TpH, tcpO2 and FHR suggest that changes in tcpO2 rapidly reflect changing maternal and fetal conditions, while TpH responds more slowly and less sensitively
— id: 66867, year: 1984, vol: 17, page: 69, stat: Journal Article,

Primary hyperparathyroidism in pregnancy. Serum calcium levels after parathyroidectomy
Gershberg H; Young BK
1984 Jun;84(6):323-324, New York state journal of medicine
— id: 25575, year: 1984, vol: 84, page: 323, stat: Journal Article,

INTERMEDIARY METABOLISM OF ESTRIOL IN PREGNANCY
LEVITZ, M; KADNER, S; YOUNG, BK
1984 ;20(4B):971-974, Journal of steroid biochemistry & molecular biology
— id: 40796, year: 1984, vol: 20, page: 971, stat: Journal Article,

Sonographic anatomy of the fetal cerebral ventricles, with reference to the early diagnosis of hydrocephaly
Lustig-Gillman I; Snyder JR; Silverman F; Young BK
1984 ;12(4):185-191, Journal of perinatal medicine
Real time ultrasound was used to evaluate the anatomy of the fetal brain at different gestational ages. Anatomical correlation with the gross brain was utilized for more accurate identification of the neuroanatomical structures. The normal growth of the ventricular system was studied. Transaxial measurements of the anterior horn (AH) and maximum ventricular length (MVL) and width (MVW) were made, and enlarged as pregnancy progressed. The ratios of MVW/MVL, MVL/BPD, and MVW/BPD provide guides to the early diagnosis of hydrocephalus and intracranial abnormalities. Specific measurements of the cerebral ventricles at various gestational ages may be made accurately by utilizing the anatomical landmarks. The anterior horn and midbrain measurements are of little value in the early diagnosis of hydrocephaly. Maximum ventricular length and width are the most useful determinants of hydrocephaly, even as early as 20 weeks. A set of discordant twins in which twin B was found to be hydrocephalic by these studies in the twentieth week is presented with serial measurements for both twins. Multiple measurements of the cerebral ventricular system in utero permit early and precise diagnosis of fetal hydrocephaly
— id: 66869, year: 1984, vol: 12, page: 185, stat: Journal Article,

Human maternal-fetal lactate relationships
Suidan JS; Antoine C; Silverman F; Lustig ID; Wasserman JF; Young BK
1984 ;12(4):211-217, Journal of perinatal medicine
This study attempts to determine the major source of lactate in the normal and in the depressed human fetus, in order to assess the applicability of fetal blood lactate measurement for the evaluation of fetal stress during labor. We obtained umbilical arterial and venous blood samples at delivery in 132 liveborn infants, together with simultaneous maternal radial arterial samples. All samples were analyzed immediately for pH, blood gases, and lactate. In vigorous newborns (1-minute Apgar score greater than or equal to 7), umbilical arterial and venous lactate levels were lowest with elective cesarean section done before the onset of labor, higher with cesarean section performed during labor, and highest at the time of vaginal delivery (p less than 0.001, Tab. I). Fetal lactate levels were also significantly higher than maternal levels in vigorous newborns (p less than 0.01), the lactate difference between umbilical artery and maternal artery being lowest with elective cesarean section, higher with cesarean section performed during labor, and highest with vaginal delivery (p less than 0.02, Tab. II). Depressed newborns (1-minute Apgar score less than 7) had higher umbilical lactates and higher fetal-maternal lactate differences than vigorous newborns (p less than 0.01, Tab. III). Our results indicate that the blood lactate levels in both mother and fetus increase with labor and reach their highest values at the time of vaginal delivery. The lactate levels are highest in the umbilical artery, lower in the umbilical vein, and lowest in the maternal artery before the onset of labor.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 66868, year: 1984, vol: 12, page: 211, stat: Journal Article,

Placental contribution to lactate production by the human fetoplacental unit
Suidan JS; Wasserman JF; Young BK
1984 Jul;1(4):306-309, American journal of perinatology
Umbilical cord blood levels of lactate, base deficit, and pH were measured in 452 liveborn infants. In vigorous newborns, the mean umbilical arterial and venous concentrations of lactate were lowest with elective cesarean section, higher with cesarean section performed during labor, and highest with vaginal delivery (P less than .001). This suggests a rise in the fetal lactate level in response to labor. However, there was no concomitant increase in the mean umbilical arteriovenous lactate differences, indicating that both fetus and placenta increase their lactate production proportionately with labor. Depressed newborns had higher umbilical lactate levels than vigorous newborns irrespective of the method of delivery (P less than .001). Depressed newborns also had a higher mean umbilical arteriovenous lactate difference than vigorous newborns (P less than .001). This suggests that, under conditions that lead to neonatal depression, the fetus is the major source of the increased lactate produced, with a smaller contribution from the placenta. The fetal lactate level may be a good indicator of fetal stress in labor
— id: 66866, year: 1984, vol: 1, page: 306, stat: Journal Article,

Outcome of fetuses with lactic acidemia
Suidan JS; Young BK
1984 Sep 1;150(1):33-37, American journal of obstetrics & gynecology
Umbilical arterial lactate, pH, PO2, PCO2, and base deficit were measured at delivery of 468 live-born infants. The correlation between the 1-minute Apgar score and lactate (r = -0.34) was comparable to that between the 1-minute Apgar score and pH (r = 0.30). The multiple correlation coefficient between the 1-minute Apgar score and all five parameters combined (lactate, pH, PO2, PCO2, and base deficit) was 0.36. This was not significantly higher than the simple correlation coefficient for pH alone (0.30). Similar correlation coefficients were noted for the 5-minute Apgar score. The dividing point between normal and pathologic lactate levels was 3.70 mmol/L. A pH less than 7.20 and a lactate level greater than or equal to 3.70 mmol/L had the same sensitivity, specificity, and positive and negative predictive values for low Apgar scores (less than 7). While pH and lactate are equally correlated with fetal outcome, their combination with each other and with other blood gas parameters does not predict outcome better than either pH or lactate alone
— id: 66865, year: 1984, vol: 150, page: 33, stat: Journal Article,

CLINICAL MANAGEMENT OF SPINAL-CORD INJURY - REPLY
YOUNG, BK
1984 ;64(4):599-599, Obstetrics & gynecology
— id: 40899, year: 1984, vol: 64, page: 599, stat: Journal Article,

PARTURIENT WITH SPINAL-CORD TRANSECTION - COMPLICATIONS OF AUTONOMIC HYPERREFLEXIA - REPLY
YOUNG, BK
1984 ;64(1):147-148, Obstetrics & gynecology
— id: 40935, year: 1984, vol: 64, page: 147, stat: Journal Article,

PREGNANCY AFTER SPINAL-CORD INJURY - REPLY
YOUNG, BK
1984 ;63(5):757-758, Obstetrics & gynecology
— id: 40794, year: 1984, vol: 63, page: 757, stat: Journal Article,

Profile of serum estriol and its conjugates at delivery and in the immediate postpartum period in a patient with severe polycystic kidney disease: a comparison with normal pregnancy
Levitz M; Kadner S; Young BK
1983 Feb 15;145(4):465-468, American journal of obstetrics & gynecology
A patient with group C polycystic kidney disease had abnormally high concentrations of total serum estriol (E3) but low-normal urinary levels of E3 throughout the period of study (20 weeks of gestation until delivery by cesarean section at 33 weeks, 5 days). At delivery and at regular intervals until 6 hours thereafter serum specimens were analyzed for unconjugated E3 and its four major conjugates. Comparisons were made with levels in three normal volunteer subjects studied in the same way. In the 6 hours, total E3 declined 37% in the subject with polycystic kidney disease whereas in normal subjects the decline ranged from 84% to 99%. Unconjugated E3 was depleted from the serum in all subjects in about 2 hours. The major difference between the patient with polycystic kidney disease and the normal subjects was in the profile of E3 conjugates. In polycystic kidney disease, E3-3-glucosiduronate (E3-3G) and E3-3-sulfate-16-glucosiduronate (E3-SG) respectively made up 83% and 1.8% of the total serum estriol, whereas in the normal subjects the average values were 13% for E3-3G and 49% for E3-SG. There were no consistent dramatic changes in the percentage contribution of any conjugate to the total E3 level in either the patient with polycystic kidney disease or the normal subjects in the predelivery or postdelivery periods. The E3 profile in polycystic kidney disease is explainable in terms of impaired renal function coupled with normal enterohepatic metabolism of E3
— id: 66873, year: 1983, vol: 145, page: 465, stat: Journal Article,

Fetal intraventricular hemorrhage: sonographic diagnosis and clinical implications
Lustig-Gillman I; Young BK; Silverman F; Raghavendra BN; Wan L; Reitz ME; Aleksic S; Greco A; Snyder JR
1983 Jun-Jul;11(5):277-280, Journal of clinical ultrasound
— id: 66872, year: 1983, vol: 11, page: 277, stat: Journal Article,

Effects of temperature on arterial and cutaneous pO2 in the rabbit
Silverman F; Young BK
1983 ;15(5):283-290, Gynecologic & obstetric investigation
Continuous transcutaneous measurement of pO2 (tcpO2) has been adapted to fetal and neonatal use, utilizing a noninvasive miniaturized modified Clark pO2 electrode attached to the skin by adhesive. The unprepared ear of the adult female Flemish Giant rabbit was used for attachment of the electrode, and blood for arterial pO2 (apO2) was taken from the auricular artery. The rabbits were gently restrained and unanesthetized. The tcpO2 and pO2 were compared at environmental temperatures of 20-23, 50, and 60 degrees C, in separate experiments. The data demonstrated that tcpO2 is not the same as pO2. It is most clearly related to local blood flow. tcpO2 only indirectly reflects apO2, when peripheral flow is comparable to central flow. Proper use of tcpO2 in the fetus and neonate requires cognizance of blood flow conditions for correct interpretation. tcpO2 is not indicative of apO2 when reduced peripheral circulation is present, in the rabbit ear
— id: 66874, year: 1983, vol: 15, page: 283, stat: Journal Article,

pH Measurement with a fiber-optic tissue-pH monitor and a standard blood-pH meter
Suidan JS; Young BK; Hetzel FW; Seal HR
1983 Aug;29(8):1566-1566, Clinical chemistry
— id: 66870, year: 1983, vol: 29, page: 1566, stat: Journal Article,

Pregnancy after spinal cord injury: altered maternal and fetal response to labor
Young BK; Katz M; Klein SA
1983 Jul;62(1):59-63, Obstetrics & gynecology
Four pregnancies in three patients with spinal cord injury are presented. The major complications encountered include anemia, pyelonephritis, decubiti, premature labor, precipitate labor, and autonomic hyperreflexia. Autonomic hyperreflexia, a severe mass autonomic reflex response to labor, is associated with tachycardia, hypertension, headache, diaphoresis, and severe anxiety. It is probably due to increased norepinephrine release, as very high urinary metanephrines were measured in the latter two cases presented. Maternal and fetal physiology in labor are altered. Despite severe maternal and fetal stress responses, no fetal depression was observed
— id: 66871, year: 1983, vol: 62, page: 59, stat: Journal Article,

Current status of continuous fetal pH monitoring
Antoine C; Silverman F; Young BK
1982 Jun;9(2):409-422, Clinics in perinatology
— id: 66875, year: 1982, vol: 9, page: 409, stat: Journal Article,

Fetal lactic acidosis with epidural anesthesia
Antoine C; Young BK
1982 Jan 1;142(1):55-59, American journal of obstetrics & gynecology
Three hundred thirty-six consecutive cesarean deliveries performed under epidural anesthesia were reviewed. Twenty per cent of mothers suffered at least a 20% fall in blood pressure following administration of epidural anesthesia. An additional 24% required ephedrine, a vasopressor with predominantly beta activity, when other corrective measures failed. Thus, 44% of these patients suffered significant hypotension. Forty-one percent of all elective repeat cesarean sections were treated wih ephedrine because of maternal hypotension. Fifty-one patients delivered by scheduled repeat cesarean section were divided into ephedrine-treated and untreated groups. There were no differences in Apgar scores among infants of both groups. Fetal acidosis was proportional to the severity of hypotension and the ephedrine dose. The metabolic abnormalities were most pronounced when severe hypotension, requiring over 15 mg of ephedrine, was present. Following restoration of blood pressure with conventional measures and ephedrine therapy, lactic acidosis persisted until delivery, whereas PO2 and PCO2 reverted toward normal values. The hypoperfusion of the intervillous space was the most likely cause of the observed significant umbilical venous and arterial lactic acidosis. Maternal hypotension remains a significant problem complicating conduction anesthesia
— id: 66879, year: 1982, vol: 142, page: 55, stat: Journal Article,

Sinusoidal fetal heart rate pattern with vasa previa in twin pregnancy
Antoine C; Young BK; Silverman F; Greco MA; Alvarez SP
1982 May;27(5):295-300, Journal of reproductive medicine
A case of vasa previa in twin pregnancy associated with a sinusoidal heart rate was observed. A review of the world literature revealed eight previously reported cases of vasa previa in twins. No first twin survived, and 62.5% of second twins eventually died from partial or complete exsanguination. This is the first reported case of sinusoidal fetal heart rate in association with vasa previa. Continuous fetal monitoring suggested the diagnosis of funic presentation and of fetal bleeding. A high index of suspicion, use of amnioscopy, ability to detect fetal blood in the vaginal pool, continuous fetal heart rate monitoring and ultrasonography may help in reducing the high perinatal mortality associated with vasa previa
— id: 66876, year: 1982, vol: 27, page: 295, stat: Journal Article,

Fetal blood analysis. I. Effect of delayed collection
Silverman F; Antoine C; Young BK
1982 Summer;4(2):87-91, Diagnostic gynecology & obstetrics
Umbilical blood was analyzed for pH, pO2, pCO2, HCO3-, base excess, and plasma lactate to evaluate possible errors of fetal scalp blood analysis. Two studies to determine the effect of delayed collection and exposure to air on fetal blood acid-base measurement analyzed anaerobically collected umbilical blood in syringe and capillary samples. In the first study, 37 samples were analyzed and then placed in small droplets on a glass slide and exposed for 30 seconds and 60 seconds respectively. These samples were then collected and reanalyzed. No significant change was noted through 1 minute of exposure in any of the acid-base parameters measured. In the second study, 34 samples were again analyzed and then exposed in droplets for a full 5 minutes. Differences in measurement of pO2, base excess, and plasma lactate remained insignifiicant even up to 5 minutes. The results of this study demonstrate that the occasional slow scalp blood collection or admixture with air do not present a significant obstacle to proper use of fetal acid-base analysis
— id: 66878, year: 1982, vol: 4, page: 87, stat: Journal Article,

Fetal blood analysis. II. Effect of delayed assay on pH and lactate
Wilson SJ; Silverman F; Young BK
1982 Summer;4(2):93-96, Diagnostic gynecology & obstetrics
Fetal umbilical artery blood was analyzed for pH and lactate at intervals over a 3-hour period. No significant change occurred in pH over the first 30 minutes, despite a progressive rise in plasma lactate. The pH changes paralleled the lactate in an inverse relationship, but remained within the error of the method for the first hour. Lactate analysis should be considered for clinical use, for confirmation of pH observations. Also pH assays may be used in any hospital with a blood-gas capability, since a 30-minute delay within the assay does not materially alter the results. A laboratory in the delivery room area is not essential to proper use of fetal blood pH analysis
— id: 66877, year: 1982, vol: 4, page: 93, stat: Journal Article,

Comparison of tissue pH monitor with a standard blood pH meter
Antoine C; Silverman F; Young BK
1981 Dec;27(12):2070-2071, Clinical chemistry
— id: 66880, year: 1981, vol: 27, page: 2070, stat: Journal Article,

Continuous fetal monitoring following third-trimester amniocentesis
Klein SA; Young BK; Wilson SJ; Katz M
1981 Oct;58(4):444-449, Obstetrics & gynecology
One hundred forty-six patients were monitored for up to 2 hours after third-trimester amniocentesis. The patterns of uterine and fetal activity, as well as fetal heart rate, were analyzed using the criteria for nonstress and contraction stress testing. There was a clear relationship between these observations and perinatal outcome. Postamniocentesis monitoring was associated with an Apgar score of 6 or less in only 10% of cases with reactive patterns, compared with in 75% of cases with nonreactive patterns and reduced variability and in all cases with late-component deceleration. All cases of immediate fetal jeopardy were detected and there was no fetal loss. Postamniocentesis monitoring appears to offer significant prognostic information for perinatal outcome in high-risk pregnancy
— id: 66881, year: 1981, vol: 58, page: 444, stat: Journal Article,

Continuous fetal tissue pH monitoring in labor
Young BK
1981 ;9(4):189-194, Journal of perinatal medicine
— id: 66883, year: 1981, vol: 9, page: 189, stat: Journal Article,

Effects of prostaglandin F2 alpha or oxytocin on serum estriol and its conjugates during induced labor
Young BK; Noumoff J; Katz M; Kadner S; Levitz M
1981 Mar;6(3):257-265, Prostaglandins & medicine
Twelve patients underwent induction of labor at term, seven by prostaglandin F2 alpha (PGF) and five by oxytocin infusion. Serum samples were drawn before induction and at two hour intervals after infusion was started, throughout labor. The samples were analyzed for estriol (E3) and its principal conjugates, estriol-3-sulfate (E3-3S), estriol-16-glucosiduronate (E3-16G), estriol-3-glucosiduronate (E3-3G), and estriol-3-sulfate-16-glucosiduronate (E3-SG). No significant changes occurred before eight hours of infusion. Two pre-eclamptic patients showed a 100% increase in serum E3 while receiving PGF. The increases correlated best with rising levels of E3-SG. None of the five pre-eclamptic patients given oxytocin showed this striking changes. These observations raise the possibility that PGF may alter the metabolism of estriol in pre-eclamptic patients, during labor
— id: 66882, year: 1981, vol: 6, page: 257, stat: Journal Article,

SINUSOIDAL FETAL HEART-RATE - REPLY
Young, BK
1981 ;139(2):231-231, American journal of obstetrics & gynecology
— id: 30292, year: 1981, vol: 139, page: 231, stat: Journal Article,

SINUSOIDAL FETAL HEART-RATE PATTERN - REPLY
Young, BK
1981 ;139(2):227-230, American journal of obstetrics & gynecology
— id: 30291, year: 1981, vol: 139, page: 227, stat: Journal Article,

Neonatal herpesvirus sepsis following internal monitoring
Katz M; Greco MA; Antony L; Young BK
1980 May-Jun;17(6):631-633, International journal of gynaecology & obstetrics
The use of internal monitoring, in which an electrode is attached to the fetal scalp, may be associated with serious complications. The authors present a case of fetal neonatal sepsis due to herpesvirus arising at the electrode site
— id: 66886, year: 1980, vol: 17, page: 631, stat: Journal Article,

Sinusoidal fetal heart rate. II. Continuous tissue pH studies
Katz M; Wilson SJ; Young BK
1980 Mar 1;136(5):594-596, American journal of obstetrics & gynecology
Two cases of SHR in labor monitored by continuous fetal tissue pH measurements are presented. Both showed onset of the pattern in the absence of fetal acidosis, a fall in TpH following the appearance of the abnormal FHR pattern, and fetal compensation with a good perinatal outcome. These patients demonstrate that the fetus may tolerate a SHR and recover from preacidosis and acidosis. Continuous pH measurement may be helpful in conservative management of patients with abnormal FHR patterns
— id: 66887, year: 1980, vol: 136, page: 594, stat: Journal Article,

A gonadotropin-responsive virilizing granulosa tumor
Wilson SJ; Young BK; Katz M; Kammerman S; Epstein J; Bigelow B
1980 Winter;2(4):275-281, Diagnostic gynecology & obstetrics
A case of a progressive virilizing solid granulosa-theca cell tumor producing high testosterone levels that were suppressed to normal by a course of oral contraceptives is presented. In vitro studies demonstrated significant specific follicle-stimulating hormone (FSH) receptors on the tumor. The studies of the biological response to gonadotropins in terms of cyclic AMP generation also indicate that the tumor is responsive to gonadotropic hormones in vitro, and are consistent with the in vivo clinical response. A discussion of the role of gonadotropins in the etiology or maintenance of ovarian tumors is also presented
— id: 66891, year: 1980, vol: 2, page: 275, stat: Journal Article,

How to read fetal monitoring records
Young BK
1980 ;44:133-149, Progress in clinical & biological research
— id: 66889, year: 1980, vol: 44, page: 133, stat: Journal Article,

Fetal blood and tissue pH with variable deceleration patterns
Young BK; Katz M; Wilson SJ
1980 Aug;56(2):170-175, Obstetrics & gynecology
Continuous tissue pH, scalp blood pH, and umbilical artery pH were studied in 89 patients with variable decelerations and 5 control patients in labor. The characteristics of the variable decelerations were analyzed. The deceleration pattern was classified as variable without late component (V), variable with late onset (VLO), or variable with late recovery (VLR). The patterns with a late component showed a greater incidence of falling pH during the decelerations. The VLR pattern was very likely to show a tendency to fetal acidosis and a high incidence of low Apgar scores. Variable decelerations without a late component were found to be innocuous. The VLO was an intermediate pattern, often progressing to the potentially more hazardous pattern of VLR
— id: 66885, year: 1980, vol: 56, page: 170, stat: Journal Article,

Sinusoidal fetal heart rate. I. Clinical significance
Young BK; Katz M; Wilson SJ
1980 Mar 1;136(5):587-593, American journal of obstetrics & gynecology
Sixteen cases of SHR are analyzed with respect to perinatal outcome, fetal scalp and umbilical arterial pH, and characteristics of the FHR pattern. There were no perinatal deaths in this series. The SHR is defined and a plan for management of the patient with SHR is proposed. A theoretical explanation of the pathophysiology of SHR is presented in terms of a fetal compensatory mechanism for hypoxia, based on these observations as well as a review of the literature. Biochemical data may provide valuable information permitting optimal management of patients with SHR patterns
— id: 66888, year: 1980, vol: 136, page: 587, stat: Journal Article,

Continuous fetal tissue pH monitoring in labor
Young BK; Katz M; Wilson SJ; Klein SA
1980 ;44:123-132, Progress in clinical & biological research
— id: 66890, year: 1980, vol: 44, page: 123, stat: Journal Article,

Intravenous dexamethasone for prevention of neonatal respiratory distress: A prospective controlled study
Young BK; Klein SA; Katz M; Wilson SJ; Douglas GW
1980 Sep 15;138(2):203-209, American journal of obstetrics & gynecology
A trial of intravenous dexamethasone for prevention of neonatal respiratory distress syndrome was carried out prospectively. There were 112 treated and 188 control patients, matched for gestational age, birth weight, rupture of membranes, and antepartum diagnosis. No short-term deleterious effects on mother or infant were demonstrable. There was an increased incidence of cesarean section and puerperal infection in the treated patients. This was not related to the steroid therapy. There was no increased incidence of infection in the treated neonates. At 28 to 33 weeks' gestation, the treated newborn infants had one half the perinatal mortality and one fourth the incidence of severe respiratory distress syndrome seen in the controlls. Under 28 weeks, and from 34 to 36 weeks, no difference between treated and control groups was observed. Intravenous dexamethasone is effective in reducing perinatal mortality from respiratory distress syndrome in premature infants delivered between 28 to 33 weeks' gestation
— id: 66884, year: 1980, vol: 138, page: 203, stat: Journal Article,

DEFINITION OF SINUSOIDAL FETAL HEART-RATE - REPLY
YOUNG, BK
1980 ;138(8):1232-1233, American journal of obstetrics & gynecology
— id: 40278, year: 1980, vol: 138, page: 1232, stat: Journal Article,

Perinatal medicine today
Young, Bruce K
New York NY : A.R. Liss, 1980,
— id: 2116, year: 1980, vol: , page: , stat: ,

Severe polycystic kidney disease in pregnancy. Report of fetal survival
Katz M; Quagliorello J; Young BK
1979 Jan;53(1):119-124, Obstetrics & gynecology
Advanced polycystic renal disease associated with pregnancy is very rare. A severely uremic pregnant patient with Landesman's Group C disease was delivered by cesarean section at 33 weeks' gestation, after dexamethasone treatment for fetal lung maturation. This is the first surviving infant in a case of Group C polycystic kidney disease
— id: 66896, year: 1979, vol: 53, page: 119, stat: Journal Article,

Diagnosis of congenital mitral and aortic stenosis from the fetal electrocardiogram
Katz M; Valdes-Cruz LM; Greco MA; Yanagawa Y; Klein SA; Mufarrij A; Young BK
1979 Sep;54(3):372-374, Obstetrics & gynecology
A case of congenital mitral and aortic stenosis diagnosed from the fetal electrocardiogram (FECG) during labor is presented. Cardiologic work-up and autopsy findings in the neonate confirmed the diagnosis. This is the first case in which prenatal diagnosis of a specific anatomical lesion of the heart was made from the FECG and confirmed clinically as well as at autopsy
— id: 66893, year: 1979, vol: 54, page: 372, stat: Journal Article,

Premature menopause: a reversible entity?
Szlachter BN; Nachtigall LE; Epstein J; Young BK; Weiss G
1979 Sep;54(3):396-398, Obstetrics & gynecology
Secondary hypergonadotropic, hypoestrogenic amenorrhea, or premature menopause, is usually considered an irreversible process. Four patients with this entity were observed to have evidence of ovulation. Three of these patients became pregnant while they were treated with estrogen replacement therapy (ERT) for their hypoestrogenic symptoms. Estrogen replacement may be effective in reversal of this process
— id: 18783, year: 1979, vol: 54, page: 396, stat: Journal Article,

Intrapartum fetal cardiac arrhythmias
Young BK; Katz M; Klein SA
1979 Oct;54(4):427-432, Obstetrics & gynecology
Fifteen cases of fetal cardiac arrhythmia were detected by direct fetal electrocardiogram (FECG) during intrapartum fetal monitoring. The frequency of arrhythmia of 12.4/1000 monitored births. Thirteen of the arrhythmias were supraventricular. Atrial bigeminy was the most commonly observed arrhythmia, followed by atrial trigeminy. Two cases of ventricular arrhythmia were noted, one of which was a case of ventricular tachycardia. Arrhythmias were not related to drug treatment or to stage of labor. Variable decelerations occurred in association with arrhythmias in 73% of the cases. There were no nuchal cords seen at delivery, nor were there any instances of intrapartum fetal distress, fetal acidosis, or low Apgar scores associated with any arrhythmia. All arrhythmias resolved spontaneously without treatment. The neonatal course was uncomplicated in all cases. Intrapartum fetal arrhythmia is best detected by direct FECG. Appropriate management should include close observation for ominous fetal heart rate (FHR) patterns and fetal acid-base-studies. At present, there is no indication for drug treatment of intrapartum arrhythmia
— id: 66892, year: 1979, vol: 54, page: 427, stat: Journal Article,

The relationship of heart rate patterns and tissue pH in the human fetus
Young BK; Katz M; Klein SA
1979 Jul 15;134(6):685-690, American journal of obstetrics & gynecology
The relationship between different FHR patterns and fetal tissue pH in 68 high-risk gravidas in labor was analyzed. A tissue pH electrode was placed in the fetal scalp and tissue pH recorded on a fetal monitor every 15 seconds along with uterine contractions and continuous fetal heart rate. The tissue pH changes correlated with the FHR patterns in a manner consistent with current concepts of fetal stress. Trend monitoring of fetal tissue pH in labor may prove useful in the management of high-risk patients in labor
— id: 66895, year: 1979, vol: 134, page: 685, stat: Journal Article,

Fetal blood and tissue pH with moderate bradycardia
Young BK; Katz M; Klein SA; Silverman F
1979 Sep 1;135(1):45-47, American journal of obstetrics & gynecology
Eleven patients with moderate fetal bradycardia in labor were studied by fetal scalp blood pH, continuous tissue pH, and umbilical arterty pH at delivery. The neonatal outcomes and biochemical data demonstrated that moderate fetal brdycardia does not indicate fetal distress
— id: 66894, year: 1979, vol: 135, page: 45, stat: Journal Article,

Serum vitamin B12 and B12-binding protein levels associated with oral contraceptives
Costanzi JJ; Young BK; Carmel R
1978 ;36:69-77, Texas reports on biology & medicine
PIP: As part of a study of anemia associated with oral contraceptive use, serum vitamin B12 levels, unsaturated B12-binding capacity, and B12 binder fractionation were examined in 67 consecutive mildly anemic (hemoglobin levels below 13 gm%) women using oral contraceptives and 59 such women using other means of birth control. Results were correlated with hematologic parameters such as complete blood counts and evaluation of iron status. Hemoglobin levels were significantly lower (p 0.01) in the non-oral-contraceptive group, while serum iron levels were significantly higher (p 0.05) in the oral contraceptive group and fewer oral contraceptive users demonstrated iron-deficiency anemia. While no B12-deficient subjects were found, serum B12 levels were significantly lower among oral contraceptive users (p 0.05), but differences were more striking between iron-deficient and non-iron deficient subjects, regardless of oral contraceptive status (p 0.02). The role of iron status needs further clarification as the finding of higher serum B12 levels in iron-deficient subjects contrasts with previous reports of lower B12 levels in cases of disease-related iron deficiency. Moreover, the relationship between iron status and serum B12 level was significant only in the oral contraceptive group. Among pill users, iron deficiency was most frequent in those taking sequential rather than combination preparations (67 vs. 39%). Among non-oral-contraceptive subjects, iron deficiency incidence was 96% in IUD users. Serum unsaturated B12 binding capacity was unaffected by pill use, but pill users showed significantly higher transcobalamin I levels, correlating best with white blood cell counts. The assumption that this elevation reflects pill effect on protein synthesis is premature, even though a general increase in alpha 1-globulin has been reported in pill users. Transcobalamin II and 3rd binder levels were not affected and did not correlate with white blood counts. The correlation between UBBC levels and white blood cell counts was significant in both oral contraceptive and non-oral-contraceptive groups. In contrast to previous findings, UBBC could not correlated with any iron parameter. O
— id: 66900, year: 1978, vol: 36, page: 69, stat: Journal Article,

Sudden anuria in a pregnant woman with a solitary kidney
Fox JJ; Katz M; Klein SA; Young BK
1978 Nov 1;132(5):583-585, American journal of obstetrics & gynecology
— id: 66897, year: 1978, vol: 132, page: 583, stat: Journal Article,

Ballantyne's triple edema syndrome: prenatal diagnosis with ultrasound and maternal renal biopsy findings
Quagliarello JR; Passalaqua AM; Greco MA; Zinberg S; Young BK
1978 Nov 1;132(5):580-581, American journal of obstetrics & gynecology
— id: 10045, year: 1978, vol: 132, page: 580, stat: Journal Article,

Continuous fetal tissue pH monitoring in labor with high risk pregnancies
Young BK; Hirschl IT; Klein SH; Katz M
1978 Sep 1;226(1-2):169-174, Archives of gynecology
Continuous tissue pH monitoring was performed in 61 high risk pregnancies in labor. Useful data was obtained in 48 cases, and compared with fetal scalp blood pH and umbilical artery and vein blood pH. The relationshiip of tissue pH and fetal heart rate changes was analyzed. The tissue pH changes occurred within 2--3 min of the fetal heart rate change, and conformed to the expected fetal physiology of their heart rate pattern
— id: 66898, year: 1978, vol: 226, page: 169, stat: Journal Article,

Observations in perinatal heart rate monitoring. I. A quantitative method of describing baseline variability of the fetal heart rate
Young BK; Weinstein HN; Hochberg HM; George ME
1978 Apr;20(4):205-212, Journal of reproductive medicine
Simultaneous magnetic tape recordings of fetal scalp ECG, maternal ECG and uterine contractions were obtained from 23 patients in active labor. Computer-derived distributions of beat-to-beat changes were used to develop a simple numerical and graphical description of the long and short-term variability patterns. The visually observed variability may be described by the R-R interval change (beat-to-beat change), which is greater than 90% of the total number of beat-to-beat changes. Thus, the 90th percentile of R-R interval changes quantitatively describes the baseline variability. The variability may be classified as fixed, minimal, moderate or marked, based on this simple calculation. Graphs of cumulative percentage of R-R interval changes provide additional visual information. The effects of meperidine HCl on the observed variability were easily detected and visualized by these methods
— id: 66899, year: 1978, vol: 20, page: 205, stat: Journal Article,

Intrapartum maternal and fetal monitoring: the obstetric intensive care unit
Young BK; Weinstein HN; Katz M
1978 ;15(6):526-529, International journal of gynaecology & obstetrics
The Obstetric Intensive Care Unit (OBICU) at Bellevue Hospital in New York City has adapted intensive care and coronary care models to the care of patients in labor. During the past 3 years, 519 of the most serious of 2 250 high-risk obstetric patients treated at the hospital were monitored in the OBICU. There were two maternal and six perinatal deaths. The perinatal mortality rate of the very high risk population of the OBICU was 11.6/1 000, compared to 14.7/1 000 for all deliveries performed at the hospital. Our findings indicate that the OBICU system provides the ideal mechanism for the rapid and continuous control of symptoms in very high risk gravidas which is essential for stabilizing the patient, both for prompt delivery and for optimal maternal and fetal survival
— id: 66901, year: 1978, vol: 15, page: 526, stat: Journal Article,

Continuous fetal tissue pH measurement in labor
Young, B K; Noumoff, J; Klein, S A; Katz, M
1978 Nov;52(5):533-538, Obstetrics & gynecology
Fifty-one women in labor had continuous monitoring of fetal scalp tissue pH, fetal heart rate by ECG, and uterine contractions. A miniature pH electrode secured by a double spiral fetal ECG electrode was used for measurement of fetal pH every 15 seconds. The results were correlated with fetal scalp blood pH values obtained simultaneously. Fetal scalp sampling is intermittent, requires repeated scalp incisions, is subject to errors due to air mixing and coagulation of the blood sample, and is uncomfortable for the parturient. Placement of the tissue pH electrode allows continuous data recording with the minimum discomfort to the patient and the least number of fetal scalp incisions. Clinical use of the tissue pH electrode might be a practical alternative to fetal scalp samples, if the data obtained accurately reflect fetal status
— id: 107399, year: 1978, vol: 52, page: 533, stat: Journal Article,

Takayasu's syndrome in pregnancy
Hauth JC; Cunningham FG; Young BK
1977 Sep;50(3):373-375, Obstetrics & gynecology
Two cases of Takayasu's syndrome in pregnancy are presented. The obstetric courses of these women are compared with those of 7 others described in the literature. Symptoms of this rare condition may respond variably during pregnancy. Of the 9 women, 5 had worsening of their symptoms during gestation while 4 had milder symptoms than they had had prior to pregnancy. The best therapy is rest. Vaginal delivery is recommended and cesarean section should be reserved for obstetric indications
— id: 66902, year: 1977, vol: 50, page: 373, stat: Journal Article,

Estrogens in pregnancy
Levitz M; Young BK
1977 ;35:109-147, Vitamines & hormones
— id: 66905, year: 1977, vol: 35, page: 109, stat: Journal Article,

Fetal trigeminal rhythm
Schneider H; Weinstein HM; Young BK
1977 Jul;50(1 Suppl):58s-61s, Obstetrics & gynecology
A case of fetal trigeminal cardiac arrhythmia in labor is presented. The literature on fetal cardiac arrhythmias is reviewed. The significance and management of abnormal fetal rhythms in labor is discussed. The majority of fetal arrhythmias in labor do not require therapy
— id: 66903, year: 1977, vol: 50, page: 58s, stat: Journal Article,

Effects of magnesium sulfate on toxemic patients in labor
Young BK; Weinstein HM
1977 Jun;49(6):681-685, Obstetrics & gynecology
One hundred forty-four toxemic patients were studied by continuous electronic maternal and fetal monitoring. Ninety-seven were treated by intravenous bolus of 2 g MgSO4 every 1-2 hours, and 47 by intravenous drip MgSO4 at a rate of 1 g/hour. Clinical doses of MgSO4 do not affect maternal ECG, temperature, uterine contractions, or fetal heart rate. Intravenous bolus administration is frequently associated with slowing of maternal respirations and hypotension and occasionally with transient apnea
— id: 66904, year: 1977, vol: 49, page: 681, stat: Journal Article,

EFFECTS OF MAGNESIUM-SULFATE ON TOXEMIC PATIENTS IN LABOR
Young, BK; Weinstein, HM
1977 ;8(1-2):72-72, Gynecologic & obstetric investigation
— id: 29627, year: 1977, vol: 8, page: 72, stat: Journal Article,

QUANTITATIVE CLASSIFICATION OF BASELINE VARIABILITY
Young, BK; Weinstein, HM; Hochberg, HM; George, MED
1977 ;8(1-2):71-72, Gynecologic & obstetric investigation
— id: 29625, year: 1977, vol: 8, page: 71, stat: Journal Article,

OBSTETRICAL INTENSIVE-CARE - 3 YEARS RESULTS
Young, BK; Weinstein, HM; Snyder, JR; Hochberg, HM; George, MED
1977 ;8(1-2):72-72, Gynecologic & obstetric investigation
— id: 29626, year: 1977, vol: 8, page: 72, stat: Journal Article,

16-sulfates of estriol in body fluids of human pregnancy at term
Levitz M; Kadner S; Young BK
1976 Feb;27(2):287-294, Steroids
A method was developed for the assay of estriol-16-sulfate (E3-16S) and estriol-3, 16-disulfate (E3-3,16-diS) in maternal serum, cord serum and amniotic fluid at delivery in human pregnancy. Tritiated E3-16S and E3-3,16-diS are added to the fluid being analyzed. The conjugates are separated and purified by sequential chromatography on alumina, Celite and Sephadex LH-20. Each conjugate is hydrolyzed with Glusulase and the released estriol is quantified by radioimmmunoassay. E3-3,16-diS was found in each fluid, most concentrated in the cord serum. Small amounts of E3-16S were found in some amniotic fluids, and this conjugate was virtually absent from the sera. These new estriol conjugates comprise less than 1 percent of total, estriol, apparently too low to be of diagnostic value in human pregnancy
— id: 66909, year: 1976, vol: 27, page: 287, stat: Journal Article,

An improved data display system for fetal heart rate monitoring
Young BK; Hochberg HM; George ME
1976 Apr;47(4):496-501, Obstetrics & gynecology
Fetal heart rate (FHR) monitor records, particularly those derived from external sensors, may contain artifactual information closely resembling true FHR patterns. Additional machine-determined information may be used to help discriminate these data. Present commercial systems for indicating potentially artifactual FHR modify the FHR display, and this tends to cause the physician to ignore the absence of data or annoy him by obliterating some useful as well as potentialy useless information. Therefore, we chose to put the information that the data may be artifactual on another channel and allow the physician, rather than the instrument, to modify the interpretation of the FHR as necessary. A computer study was made of the characteristics of FHR beat-to-beat changes during poor signal to determine the most appropriate criteria for indicating when the FHR record is highly likely to be artifactual. Unphysiologic, erratic FHR changes are easily flagged by the presence of 3 serial beat-to-beat changes greater than 25 beats/min. Clinical testing demonstrated that this system allows the physician to better discriminate between valid and invalid data and increases the amount of usable data, particularly in active patients
— id: 66908, year: 1976, vol: 47, page: 496, stat: Journal Article,

Renal clearances of estriol conjugates in normal human pregnancy at term
Young BK; Jirku H; Kadner S; Levitz M
1976 Sep 1;126(1):38-42, American journal of obstetrics & gynecology
In late human pregnancy more than 90 per cent of the total estriol (E3) in body fluids consists of four conjugates, estriol-3-sulfate (E3-3S), estriol-16-glucosiduronate (E3-16G), estriol-3-glucuronide (E3-3G), and estriol-3-sulfate-16-glucosiduronate (E3-3S-16G). Since the relative amounts of E3 in blood and urine would be determined by the kidney, the renal clearance of each conjugate was determined and compared with inulin and p-aminohippuric acid (PAH) clearance, as measures of glomerular filtration rate (GFR) and the effective renal plasma flow. Five women were studied in the lateral decubitus position with inulin and PAH infusion. Samples of blood and urine were collected at 40 minute intervals and analyzed. The method for E3 conjugates involved separation of the four conjugates on Sephadex LH-20, enzyme hydrolysis, and radioimmunoassay. Renal clearances for E3-3S and E3-3S-16G were below inulin. E3-3G approximated inulin; E3-16G exceeded inulin and approached PAH. In plasma E3-3S-16G represented 48.4 +/- 7.2 per cent; in urine E3-16G represented 69.5 +/- 7.3 per cent of total E3. Thus, different conjugates predominate in blood and urine
— id: 66907, year: 1976, vol: 126, page: 38, stat: Journal Article,

Moderate fetal bradycardia
Young BK; Weinstein HM
1976 Sep 15;126(2):271-275, American journal of obstetrics & gynecology
Fetal heart rates in the range of 100 to 119 beats per minute have been defined as moderate bradycardia. Twenty-five of 1,386 patients monitored during a 1 year period have manifested persistent moderate bradycardia. Moderate bradycardia is apparently related to fetal head compression, often in situations of relative cephalopelvic disproportion. It is alleviated by rotation of the vertex and does not appear to adversely affect the newborn infant
— id: 66906, year: 1976, vol: 126, page: 271, stat: Journal Article,

Estriol conjugates in body fluids in late human pregnancy
Levitz M; Jirku H; Kadner S; Young BK
1975 May;6(5):663-667, Journal of steroid biochemistry
— id: 66910, year: 1975, vol: 6, page: 663, stat: Journal Article,

Estriol conjugates in amniotic fluid of normal and Rh-isoimmunized patients
Young BK; Jirku H; Slyper AJ; Levitz M; Kelly WG; Yaverbaum S
1974 Nov;39(5):842-849, Journal of clinical endocrinology & metabolism
— id: 66911, year: 1974, vol: 39, page: 842, stat: Journal Article,

Estriol conjugates in amniotic fluid at midpregnancy and term
Young BK; Jirku H; Levitz M
1972 Aug;35(2):208-212, Journal of clinical endocrinology & metabolism
— id: 66912, year: 1972, vol: 35, page: 208, stat: Journal Article,

Treatment of pulmonary edema with ethacrynic acid during labor
Young BK; Haft JI
1970 May 15;107(2):330-331, American journal of obstetrics & gynecology
— id: 66913, year: 1970, vol: 107, page: 330, stat: Journal Article,

Plasma acid phosphatase in normal and pre-eclamptic pregnancy
Young BK; Beller FK
1968 Aug 15;101(8):1068-1072, American journal of obstetrics & gynecology
— id: 66914, year: 1968, vol: 101, page: 1068, stat: Journal Article,

Maternal osteogenesis imperfecta
Young BK; Gorstein F
1968 Apr;31(4):461-470, Obstetrics & gynecology
— id: 66915, year: 1968, vol: 31, page: 461, stat: Journal Article,

Ruptured umbilical hernia in pregnancy. Report of a case
Young BK
1965 Oct;26(4):596-598, Obstetrics & gynecology
— id: 66916, year: 1965, vol: 26, page: 596, stat: Journal Article,