James A Thorp

James A Thorp
SSM HEALTH · Maternal Fetal Medicine

Doctor of Medicine

About

99
Publications
10,624
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3,728
Citations
Citations since 2016
14 Research Items
778 Citations
2016201720182019202020212022020406080100120
2016201720182019202020212022020406080100120
2016201720182019202020212022020406080100120
2016201720182019202020212022020406080100120

Publications

Publications (99)
Preprint
Objectives to assess COVID-19 mortality rates per country population. To determine what if any independent country-specific variables from 9 different databases were correlated. Design population based retrospective cohort study. Setting analysis of global COVID-19 treatment and containment strategies using data from 9 worldwide websites. Participa...
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The recent recognition of intravascular amyloid formation with deposition of insoluble microthrombi throughout the circulatory system in primary COVID-19 infection or following administration of mRNA vaccines is a pivotal discovery that alters conventional notions about the nature of the underlying pathologic process at play in SARS-CoV-2 infection...
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In this three-part series we examine the extent to which disaster capitalism and the medical-industrial complex turned the pandemic into a 'golden' opportunity to enhance corporate profits which took place, in large part, at the taxpayer's expense through appropriation of public resources. In the first part we examine the rise of this predatory soc...
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In this third part we examine the path not taken: a handful of cheap, widely available, home-based therapies—ozone preconditioning, hydroxychloroquine, and light/vitamin treatment—which, had they been implemented early in the pandemic could have reduced morbidity and mortality by 80% or more.
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In the second part of our trilogy, we begin by examining social policies sponsored by the science community and enacted by policy-makers to curtail the dynamics of the COVID-19 pandemic. Containment /mitigation strategies such as lockdowns came at great social and economic costs and yet failed to meaningfully impact the spread and evolution of the...
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Two years into the pandemic, with the number of deaths over five million globally and vaccine-resistant variants continuing to multiply, scientists are in the midst of the most dangerous and ill-conceived experiment in the history of medicine. Pinning their hopes on the success of new mRNA-based vaccines that stretch all conventional notions of a v...
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Fundamental to the aether concept is seamless unity, a dynamic continuum of cause and effect, mediated by the opposing conjoined force fields that form the basis of action-at-a-distance and simultaneity. All action and reaction, from the macrocosmic level downward into the subatomic domain, is mediated through interactions between the aether-derive...
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In this article, we examine dynamics of the three primary aether modalities in the water-body: first, the magnetic, which takes origin in the cardiovascular system; secondly, the radiant, related to ambient light-fall upon the body from the outside or that generated internally, and flows as organized currents in interstitial water; and the dielectr...
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At the turn of the 20th century medicine and physics seemed to be heading in two opposing if not mutually exclusive directions: medical science had asserted the primacy of the cell and had set out to integrate known chemical principles into cellular functioning; physics, on the other hand, had broken through the barriers of classical Newtonian mech...
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Introduction & Background: In recent months unexpected reports have surfaced claiming the presence of magnetic attraction in the shoulder regions of subjects who had recently received the COVID-19 vaccination. Purpose: To determine if such claims are legitimate or spurious. Methods: A prospective observational study was performed utilizing standard...
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Internal Medicine comprehensive review of ozone, its mechanism of action, and its safety and efficacy in a wide variety of acute and chronic disease states. We posit that ozone is the most powerful preconditioning agent yet discovered. We conclude that ozone mechanism of action is by an organized, hierarchical blood energetic field.
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Introduction: Adjunctive ozone therapy for COVID-19 is being used successfully in China, Spain, Italy, and South America. One proposed mechanism is by improving blood / tissue oxygenation thus averting multiorgan system failure due to hypoxia. The purpose of this study was to determine if ozonated-saline administered intravenously affects the oxyge...
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Objective: Tocolysis with the NSAID indomethacin has been associated with unfavorable antenatal and neonatal outcomes. Data on tocolysis with the NSAIDS ketorolac and ibuprofen are sparse. Our study examines: 1) fetal effects of acute ketorolac, followed by chronic ibuprofen tocolysis 2) neonatal outcomes at our facility. Methods: A retrospective o...
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Background Spontaneous triplets in a uterus didelphys is an extremely rare finding. Only four other cases are reported in the literature. Case A 24 year old gravida 3 para 2-0-0-2 conceived spontaneous triplets in a uterine didelphys. She developed cervical insufficiency and underwent cerclage placement at 17 weeks. After spontaneous rupture of me...
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Prostaglandins play a key role in uterine contractions. Term and preterm myometrium has increased expression of prostaglandin receptors. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the cyclooxygenase receptor and thereby decrease uterine contractions during preterm labor. The NSAID indomethacin has been most extensively studied. Its use h...
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Obstet Gynecol. 2013 Feb;121(2 Pt 2 Suppl 1):452-4. doi: http://10.1097/AOG.0b013e31827566ca. Intra-amniotic fluconazole therapy for Candida albicans intra-amniotic infection. Bean LM1, Jackson JR, Dobak WJ, Beiswenger TR, Thorp JA. Author information Abstract BACKGROUND: The consequences of intra-amniotic Candida infection can be devastating. Curr...
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Venous thromboembolism and adverse pregnancy outcomes are potential complications of pregnancy. Numerous studies have evaluated both the risk factors for and the prevention and management of these outcomes in pregnant patients. This consensus group was convened to provide concise recommendations, based on the currently available literature, regardi...
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The effects of epidural analgesia on first labors have been studied by Thorp and colleagues (1,2). One study has been published (3) and is the subject of a question-and-answer discussion, presented here. In this study 711 consecutive nulliparous women at term, with spontaneous onset of labor and cephalic presentation, were divided into one group (n...
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We report a maternal death after a second-trimester amniocentesis. An uncomplicated amniocentesis was performed using sterile technique and ultrasound guidance. A refrigerated amniotic fluid specimen demonstrated negative leukocyte esterase activity, negative Gram stain for bacteria and white blood cells, and normal glucose and interleukin-6. The p...
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Information on outcome by gestational age from large numbers of twins and triplets is limited and is important for counseling and decision-making in obstetric practice. We reviewed one of the largest available neonatal databases to describe mortality and morbidity rates and growth in newborn infants from multiple gestations and compared these data...
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Objective: Intrauterine growth restriction (IUGR) is an important reason for premature delivery and has been reported to be associated with increased mortality, but in some studies paradoxically, improved morbidities. Data on neonatal outcomes for infants with IUGR at each viable gestational age at birth from large numbers of deliveries are lackin...
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Full-text available
Prior studies have identified individual risk factors that are associated with necrotizing enterocolitis (NEC); however, the small sample sizes of these previous studies have not allowed the analysis of potential interaction between multiple variables and NEC. Our purpose was to describe the incidence and risk factors for NEC in premature neonates...
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To determine the effects of phenobarbital and repeated antenatal steroid use on the primary outcome (intelligence and achievement) and secondary outcomes (behavior and head circumference) at age 7 years. This study was a secondary analysis of a double-blind clinical trial (phenobarbital-vitamin K versus placebo). Intelligence (Wechsler Intelligence...
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Fetal hypoxia can lead to severe morbidity and even mortality in newborns. The determination of fetal acid-base status by the clinician is therefore of utmost importance. Umbilical cord gases should always be obtained at high-risk deliveries, and the argument can be made for universal sampling, given the inaccuracy of the APGAR scoring in defining...
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To determine whether antenatal corticosteroid use is associated with weight and head circumference at birth. We conducted a retrospective analysis of nonanomalous newborns admitted to 100 neonatal intensive care units from 23 to 34 6/7 weeks of gestation using multivariable analysis of variance that controlled for several potentially confounding va...
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To assess the effect of antenatal and postnatal corticosteroids on head circumference growth and weight gain from birth to discharge. We conducted a retrospective analysis of nonanomalous newborns admitted to the neonatal intensive care unit from 23 to 34 6/7 weeks of gestation. Independent variables included maternal age, race, nulliparity, poor p...
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The purpose of this study was to assess the incidence of perinatal factors that are associated with severe intracranial hemorrhage in a large and recent multicenter experience. Retrospective analyses of nonanomalous newborns who were admitted to 100 neonatal intensive care units from 23 to 34 6/7 weeks' gestation were analyzed by multiple regressio...
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To assess the effect of antenatal magnesium sulfate exposure on neonatal demise. A retrospective analysis of prospectively captured data from 100 tertiary centers between May 1997 and January 2000 was performed. Included were nonanomalous newborns who were admitted to the neonatal intensive care unit between 23 and 34 completed weeks' gestation. Pr...
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This study was undertaken to determine whether prolonged betamethasone therapy is, as has been suggested, associated with adverse maternal or neonatal outcomes. A secondary multivariate analysis of a randomized controlled trial was performed to determine whether duration of betamethasone therapy was associated with adverse maternal or neonatal outc...
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Isolated fetal pericardial effusion is rare but has been associated with various cardiac masses. Decompression in utero might prolong the pregnancy. In a 34-year-old white woman, gravida 3, para 0-1-1-1, at 34 5/7 weeks' gestation, ultrasound detected massive fetal pericardial effusion that progressed rapidly to hydrops. The fetal heart was structu...
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Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful u...
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Severe early onset preeclampsia might be reversed by correction of an underlying pathophysiologic condition. A 22-year-old nullipara with a history of antivesicoureteral reflux surgery in childhood presented at 23 weeks' gestation with severe headaches, hypertension, proteinuria, edema, and acute renal failure. Severe preeclampsia was diagnosed, an...
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Prematurity is the most important risk factor for intracranial haemorrhage (ICH). Many aetiological factors contribute to ICH in neonates, including trauma with labour, mode of delivery, acidemia, hypoxia, hypercarbia, immaturity of the coagulation system, change in newborn blood pressure, and newborn stress from resuscitation. Antenatal initiative...
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The objective of this paper is to determine if phenobarbital exposure during pregnancy affects developmental outcome at age 2 years. Between 1991 and 1994, 401 pregnant patients at risk for delivery prior to 34 weeks' gestation were invited to participate; 48 mothers declined entry. Before delivery, pharmacy randomized the pregnant women to receive...
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An acardiac parabiotic fetus is a rare anomaly that occurs almost exclusively in twin gestations. Although extremely rare, this phenomenon also has been reported in singleton gestations in association with an intra-amniotic tumor. It occurs when there is shunting of blood through arterial-to-arterial and venous-to venous anastomoses within the plac...
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This article focuses on methods of pain relief during labor, reviewing the current state of the art including risks and benefits. Regional techniques such as epidural or combined spinal/epidural techniques are discussed. A limited review of the effects of epidural analgesia on labor and delivery is presented. Other pharmacologic methods for labor p...
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Normal values for maternal oxygen saturation (SpO2 measured by the pulse oximeter) are not well defined during pregnancy. Oxygen desaturation (low SpO2 values) occurs more frequently during pregnancy than in the nonpregnant state. This is caused in part by the physiological and anatomical changes of pregnancy. Low SpO2 values may occur more frequen...
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The objective of this paper is to determine the importance of perinatal factors predicting occurrence of severe intracranial hemorrhage (ICH) in premature newborns. A post-hoc analysis of a previously published randomized, double-blinded, prospective trial was performed. Logistic regression analysis was used to assess the importance of obstetrical...
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To describe the occurrence, treatment, and outcome of maternal oxygen desaturation during magnesium sulfate therapy. A post hoc analysis of a randomized double-blind trial, designed to determine if mothers at risk for premature delivery treated with phenobarbital and vitamin K had less frequent intracranial hemorrhage in their newborns, was done. A...
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Objective: Although preeclampsia complicates 5-10% of all pregnancies, its etiology is unknown. It has been hypothesized that preeclampsia may have a single gene inheritance pattern and result from a pathologic interaction between the coagulation system, platelet, endothelial cell, and the placenta. The factor V Leiden gene mutation was recently di...
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Fetal acid-base status is the end point that all antepartum and intrapartum surveillance tools are designed to assess, either directly or indirectly. Umbilical arterial blood pH is normal in 80% of depressed newborns, thereby proving the absence of birth asphyxia both in the delivery room and in the courtroom. The technique, normal ranges, and risk...
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Our purpose was to evaluate the relationship between umbilical arterial blood oxygen saturation determined by hemoximetry (Sao2) and umbilical arterial blood pH and base excess determined by blood gas analysis to establish a "critical threshold" for fetal preductal arterial oxygen saturation determined by reflectance pulse oximetry (Spo2). Umbilica...
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We should anticipate a continued slow fall in cesarean birth rates over time as initiatives for health care improvement help us focus on strategies to avoid interference in the normal process of labor and vaginal birth. (Am J Obstet Gynecol 1996;175:369-74.)
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Intrapartum epidural analgesia has become increasingly popular because it is the most effective method of providing pain relief during labor. Much attention is given to its safety and efficacy, and many health care providers and consumers are unaware of its potential drawbacks. This article reviews the literature about the effects of epidural analg...
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The use and method of intrapartum obstetric analgesia has remained controversial since the late 16th Century. In 1591, during the reign of James, VI, Eufame MacCalzean (a Scottish midwife) was the first to attempt pain relief during labour and childbirth. At that time, the provision of pain relief during labour was an unacceptable medical practice...
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To determine if antenatal vitamin K and phenobarbital therapy affect coagulation studies in umbilical blood at birth, and to provide 95% reference ranges for umbilical blood coagulation parameters in premature gestations. Patients at imminent risk for spontaneous or indicated premature delivery less than 34 weeks' gestation were randomized to recei...
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Objective: The purpose of this study was to determine whether a nonlinear ultrasound transducer could be used to reliably measure the amniotic fluid index (AFI) compared with a linear transducer. Methods: Two hundred pregnant women between 22 and 41 weeks gestational age had blinded AFI measurements with a linear and a nonlinear transducer. The mea...
Article
Asuspected nosocomial outbreak of parvovirusB19infection in a maternity ward was investigated in February 1994. Questionnaires were administered and sera collected from maternity ward staff (n = 91), other ward staff in the same hospital (n = 101), and maternity ward staff at a nearby hospital (n = 81). Blood donors (n = 265) were used as community...
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ōk--q----_xD-xD whether maternal antenatal therapy with vitamin K and phenobarbital prevents intracranial hemorrhage in premature newborns. Women at high risk for spontaneous or indicated premature delivery before 34 weeks' gestation were randomly assigned to receive either placebo or vitamin K and phenobarbital. All patients received betamethasone...
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To compare heparin sodium (100 United States Pharmacopeia U/mL) with 0.9% sodium chloride for use in the maintenance of intermittent intravenous (IV) devices during pregnancy. Women at 26-34 weeks' gestation who required serial phlebotomy were assigned randomly to heparin or normal saline flush, administered in a double-blind fashion. Catheter site...
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Vitamin K is a fat-soluble vitamin crucial to the production of many proteins involved with the coagulation process. It is integral in the synthesis of coagulants (factors II, VII, IX and X) and anticoagulants (proteins C and S). It is generally recognised that routine administration of vitamin K (phytomenadione) shortly after birth will prevent ma...
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Current management protocols for pregnancies complicated by red blood cell alloimmunization use the maternal antibody titer to predict the need for invasive testing for detection of fetal anemia. We investigated the use of three maternal serum tests to assess their usefulness in predicting fetal disease: indirect Coombs' titer, Marsh score, and mon...
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Our aim was to determine whether supplemental oxygen during the second stage of normal labor affects cord blood gas and cooximetry values. Patients at term pregnancy were prospectively randomized to the control or treatment group at the onset of the second stage of labor. The treatment group received 10 L/min oxygen by face mask, which result in a...
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Published studies assessing the effect of epidural analgesia in nulliparous labor on the frequency of cesarean delivery for dystocia are reviewed. There are at least four retrospective studies and two prospective studies that suggest that epidural analgesia may increase the risk of cesarean delivery for dystocia in first labors. The potential for e...
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To determine whether antepartum phenobarbital and vitamin K reduce the risk of intraventricular hemorrhage in premature newborns. Patients at imminent risk for spontaneous or indicated premature delivery between 24-34 weeks' gestation were randomized to receive either placebo or vitamin K and phenobarbital. All patients received betamethasone and a...
Article
The purposes of this study were to evaluate the effect of magnesium sulfate therapy on colloid osmotic pressure and to determine whether changes in colloid osmotic pressure increased the risk of pulmonary edema. During a 1-year time period 294 patients received parenteral magnesium sulfate for the treatment of preterm labor or preeclampsia. Both ch...
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Severe nonimmune hydrops caused by parvovirus B19 was detected at 23 weeks' gestation in a primary school teacher. Severe symptomatic fetal anemia and thrombocytopenia were treated successfully with transfusion of blood and platelets.
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Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery. Normal term nulliparous women in early spontaneous labor were randomized to receive either narcotic or epidural analgesia. When compared with the group receiving narcotic analgesia (n = 45), the group receiving epidural analgesia (n = 48) had a signific...
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A double pigtail stent was placed to decompress an obstructed fetal kidney. The stent was dislodged, causing an iatrogenic marsupialization between the renal pelvis omentum and skin. The omentum acted as a drain, decompressing the kidney.
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This case illustrates the sonographic changes seen in and the progression of a fetal adnexal cyst with torsion.
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Clinical recognition of antepartum fetomaternal hemorrhage (FMH) is most often achieved by the observation of characteristic fetal heart rate (FHR) patterns and positive Kleihauer-Betke acid elution staining. Both methods are noted to lack sensitivity and specificity. A case of suspected antepartum FMH occurred with intermittent sinusoidal FHR trac...
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Fetal hydrops at 26 weeks' gestation was diagnosed following a massive fetomaternal hemorrhage. Fetal intravascular transfusion was performed, and the hydrops completely resolved within 72 hours. The fetus required one more transfusion at 27 weeks' gestation. A subsequent percutaneous umbilical blood sampling at 30 weeks' gestation demonstrated a n...
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A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervi...
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A woman with acute congestive heart failure secondary to mitral stenosis and sickle cell crisis was treated successfully with a combination of an exchange transfusion and percutaneous balloon valvuloplasty. That combination provided an alternative to surgical mitral commissurotomy, with its significant risks for both the mother and fetus. The patie...
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Serial erythropoietin and ferritin levels were monitored in a fetus and newborn requiring three intravascular transfusions (in utero) for severe Rh disease. The newborn had a hematocrit of 37% at birth; however a hyporegenerative transfusion-dependent anemia developed and lasted approximately 3 months. The prolonged hyporegenerative anemia may be c...
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We report the effect of high glucose infusion on vascular resistance in isolated human placental cotyledons perfused with Krebs-Ringer-bicarbonate solution containing 80 mg/dl (4.4 mmol/L), 160 mg/dl (8.8 mmol/L), or 320 mg/dl (17.6 mmol/L) D-glucose (n = 6). Placental vascular resistance remained constant during 25-minute perfusion periods with 80...
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Lithium is widely used in the treatment of bipolar affective disorders, and teratogenic effects include cardiovascular abnormalities, notably Ebstein anomaly. The most common side effect in the patient taking lithium is polyuria, a form of nephrogenic diabetes insipidus. We report the case of a manic-depressive gravida on lithium therapy who develo...
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Plasma potassium, calcium, and albumin concentrations in irradiated blood, and in fetal blood before and after transfusion, were measured. Dangerously high plasma potassium levels were observed in some units of irradiated packed red blood cells (range, 13.9 to 66.5 mEq/L; mean, 44.7 mEq/L) and could be one possible explanation for the high incidenc...
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Between 1986 and 1988, 1924 term nulliparous patients with spontaneous onset of labor were studied to assess the importance of obtaining umbilical cord blood gas levels on all deliveries. The umbilical cord arterial and venous pH values (expressed as mean +/- 2 SD) were 7.24 +/- 0.14 (n = 1694) and 7.32 +/- 0.12 (n = 1820), respectively. The incide...
Article
Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, wit...
Article
The biophysical profile has proved to be a valuable tool for the assessment of fetal well-being, independent of gestational age. Magnesium sulfate is commonly used as a tocolytic agent, yet relatively little is known about its effects on the biophysical activities of the fetus. To investigate the effects of magnesium sulfate on the biophysical prof...
Article
Preeclampsia is associated with increased thromboxane and decreased prostacyclin production by the placenta. Low-dose aspirin can selectively inhibit thromboxane production in the adult circulation, but its effects on placental vascular production of thromboxane and prostacyclin are incompletely understood. We therefore studied the effects of low-d...
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Vasoactive effects of leukotrienes and thromboxane mimic were tested in the perfused human placental cotyledon. Tissue viability was demonstrated by oxygen consumption and by carbon dioxide and lactate production. Vasoconstrictive effects of leukotrienes B4, C4, and D4 were compared with those of a known potent vasoconstrictor, thromboxane mimic (U...
Article
Active management of labor for term primigravid women with singleton, vertex presentations is associated with significant decreases in incidence of cesarean section and duration of labor, without adversely affecting major perinatal outcome variables. Concern has been expressed that high-dose oxytocin augmentation may increase the incidence of fetal...

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