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Biomedical subjects

A M Kaunitz

Publications and source records attributed to A M Kaunitz.

At least 55 records · Page 3Linked to original sources
PubMed1996

Randomized trial of oxytocin alone and with propranolol in the management of dysfunctional labor.

OBJECTIVE: To compare oxytocin infusion alone and with intravenous (i.v.) propranolol in the management of dysfunctional labor. METHODS: Ninety-six parturients with abnormalities of the active phase of labor were randomly assigned to either propranolol 2 mg IV or an identical placebo, in addition to continuous infusion of oxytocin. Administration of propranolol or placebo was repeated in 1 hour if there was no change in cervical dilation. Patients not responding to this second administration of propranolol or placebo were delivered by cesarean. RESULTS: Among 96 subjects enrolled, 49 were allocated to the propranolol group and 47 to the placebo group; 13 (26.5%) of the former were delivered by cesarean, compared with 24 (51.1%) of the latter (relative risk 0.58, 95% confidence interval 0.35-0.93; P = .02). Between the two groups, no differences were observed in low Apgar scores, cord arterial pH, or incidence of admissions to the neonatal intensive care nursery. Maternal morbidity was similar in both groups. After logistic regression analysis controlling for nulliparity, birth weight, and epidural anesthetic use, the significant reduction in the cesarean rate associated with use of propranolol persisted. Propranolol administration was associated with a markedly reduced cesarean rate among patients with inadequate uterine contractility. CONCLUSION: Low-dose administration of IV propranolol in patients with dysfunctional labor augmented with oxytocin safely reduced the need for cesarean delivery, particularly among patients with inadequate uterine contractility.

Adrenergic beta-Antagonists↗
PubMed1996

Depot medroxyprogesterone acetate contraception and the risk of breast and gynecologic cancer.

As the use of depot medroxyprogesterone acetate (DMPA) contraception increases in the United States and worldwide, assessing any impact on the risk of breast and gynecologic cancers becomes increasingly important. Overall, use of DMPA does not affect breast cancer risk. An elevated risk of this disease, however, has been noted in recent or current users. Hence, the association between DMPA use and breast cancer risk appears similar to that observed with oral contraceptives. Use of DMPA is associated with an 80% risk reduction of endometrial adenocarcinoma, a level of protection even greater than that noted with oral contraceptives. The risk of epithelial ovarian cancer and cervical neoplasia does not appear to be affected by DMPA use. Except for a substantial reduction in the risk of endometrial adenocarcinoma, use of DMPA does not appear to influence reproductive tract cancer risks.

Breast Neoplasms↗
PubMed1995

Pyelonephritis in pregnancy: once-a-day ceftriaxone versus multiple doses of cefazolin. A randomized, double-blind trial.

OBJECTIVE: The purpose of this study was to compare the efficacy of a single daily dose of intravenous ceftriaxone with that of multiple-dose cefazolin in the treatment of acute pyelonephritis in pregnancy. STUDY DESIGN: This was a double-blind, randomized, clinical trial. Patients admitted to the hospital with the diagnosis of acute pyelonephritis in pregnancy were enrolled and randomized according to a computer-generated randomization schedule. The study group received a single daily 1 gm dose of ceftriaxone intravenously along with two additional doses of normal saline solution. The comparison group received three daily 2 gm doses of cefazolin intravenously. All infusions were given on an 8-hour schedule. Treatments were continued until the patient became afebrile. Each patient was discharged from the hospital on a regimen of appropriate oral antibiotics as directed by urine culture and sensitivities. At follow-up visits test-of-cure cultures were obtained. RESULTS: During the 2-year study period, 178 patients were randomized: 88 received cefazolin and 90 ceftriaxone. Patient demographics and presenting signs and symptoms were similar in both groups. No differences were noted between the groups regarding days of febrile morbidity, length of hospital stay, or treatment failures. CONCLUSIONS: Daily single-dose intravenous ceftriaxone is as effective as multiple-dose cefazolin in the treatment of patients with acute pyelonephritis during pregnancy.

Adult↗
PubMed1995

Preinduction cervical ripening with commercially available prostaglandin E2 gel: a randomized, double-blind comparison with a hospital-compounded preparation.

OBJECTIVE: Our purpose was to compare the efficacy, safety, and cost of commercially available dinoprostone cervical gel 0.5 mg with a hospital-compounded formulation. STUDY DESIGN: One hundred thirty-four patients undergoing labor induction were randomly assigned to one of two cervical ripening groups. Commercially available dinoprostone gel 0.5 mg or a compounded formulation of 0.5 mg of prostaglandin E2 gel was administered endocervically. On the basis of cervical scores, gel was reapplied at 6-hour intervals for a maximum of three doses. Physicians managing labor were blinded as to treatment group allocation. RESULTS: Among 134 patients evaluated, 70 were allocated to the commercially available gel and 64 to the compounded gel. No statistically significant differences were noted between the treatment groups with respect to start-to-delivery interval, number of doses, amount of oxytocin, or neonatal adverse outcomes. However, cesarean delivery was performed less frequently in patients in the group receiving the commercially available gel (12.9%) than in the group receiving the compounded gel (28.1%) (p = 0.03). Because of the higher cesarean delivery rate in the compound group, use of this formulation was not associated with cost savings. CONCLUSIONS: The two prostaglandin E2 formulations appeared equivalent with respect to efficacy. An unexplained higher cesarean section rate, however, was associated with the use of the compounded preparation.

Adolescent↗
PubMed1995

Calcium supplementation in mild preeclampsia remote from term: a randomized double-blind clinical trial.

OBJECTIVE: To determine whether calcium supplementation prevents progression to severe disease in preterm nulliparous women with mild preeclampsia. METHODS: Seventy-five women hospitalized at 24-36 weeks' gestation because of mild preeclampsia were randomized to receive either 2 g/day of elemental calcium (36 women) or placebo (39). Both groups had similar demographic characteristics, initial blood pressure measurements, and amount of proteinuria. Diagnostic criteria and clinical management for severe preeclampsia were applied consistently. RESULTS: Eighteen of 36 calcium-treated subjects (50%, 95% confidence interval [CI] 33-67) developed severe preeclampsia, compared with 19 of 39 (48.7%, 95% CI 32-65) in the placebo group (relative risk 1.03, 95% CI 0.64-1.03; P = 1.00). Blood pressure values, gestational age at delivery, newborn weights, incidence of low Apgar scores, and umbilical arterial blood gases were similar for the two groups. CONCLUSION: Calcium supplementation does not prevent severe preeclampsia in preterm patients with mild disease.

Calcium↗
PubMed1995

Contraception. A clinical review for the internist.

Effective use of contraception allows couples to control their fertility and, in certain instances, is associated with important noncontraceptive benefits. Surgical sterilization offers safe, effective, and permanent contraception for women and men. Low-dose OCPs offer safe, effective contraception for most women able and willing to take pills consistently. In addition, their use confers a variety of important noncontraceptive benefits. The availability of long-acting progestin injectable and implantable methods has made highly effective and convenient birth control available for women who are not good pill takers as well as for those for whom contraceptive doses of estrogen are contraindicated. Barrier methods are readily available and provide protection against STDs; unfortunately, erratic use is all too often associated with inadequate contraceptive efficacy. IUDs offer convenient, highly effective contraception for appropriate candidates.

Contraception↗
PubMed1995

Labor induction in patients with previous cesarean section.

To determine the efficacy and safety of labor induction in patients previously delivered by at least one low transverse cesarean section, a retrospective review was done at a single tertiary perinatal center, the University of Florida Health Science Center, Jacksonville. All patients with a previous cesarean section who required labor induction from 1988 until the end of 1992 were identified. Duration and outcome of labor induction, including mode of delivery, maternal and perinatal morbidity, and birth trauma, were evaluated. Of 160 patients with a previous cesarean, 50 (31.3%) had a repeat operation compared to 18 (11.2%) in the no previous cesarean group (p = 0.001, odds ratio = 3.59; 95% confidence interval, 1.98, 6.49). Women in the cesarean group had a higher incidence of operative vaginal deliveries, prolonged duration of the first and second stages of labor, rate and maximum dose of oxytocin infusion. One patient in the previous cesarean group experienced uterine rupture. There was no difference in the rate of infants with low 5-minute Apgar scores or with cord pH values less than 7.20. Labor induction in women with previous low transverse cesarean sections results in an acceptable rate of vaginal delivery and appears safe for both mother and fetus.

Adult↗
PubMed1995

A trial of labor complicated by uterine rupture following amnioinfusion.

Amnioinfusion has become accepted in the management of intrapartum cord compression, meconium-stained fluid, and oligohydramnios. Limited experience exists regarding amnioinfusion in patients undergoing a trial of labor after cesarean section and its potential complications. We report a case of trial of labor in which uterine rupture occurred following intrapartum amnioinfusion. This case demonstrates the need for careful attention to amnioinfusion volumes and administration in patients with a previous cesarean section.

Adult↗
PubMed1994

Cesarean section rates in teaching hospitals: a national survey.

This survey investigated the cesarean section rate in teaching hospitals in the United States and the factors that may influence it. A national survey was performed by mailing a questionnaire to 277 accredited residency programs in obstetrics and gynecology. The estimated cesarean rate in all hospitals with residencies in obstetrics and gynecology in the United States in 1990 was 20.3 percent, compared with an overall national rate of 23.5 percent. Women delivering in teaching hospitals were less likely to have a cesarean section than those delivering in hospitals without residency programs (odds ratio = 0.77, 95% CI 0.77-0.78, p = 0.0001). As centers for training and research, teaching hospitals represent an appropriate setting to begin the process of lowering the United States cesarean section rate.

Cesarean Section↗
PubMed1994

Resident research in obstetrics and gynecology.

Mandatory research in an obstetrics-and-gynecology residency can be an effective tool for teaching physicians the skills needed for them to become intelligent readers of the medical literature. We present our 15-year experience with a resident research program. We discovered that in addition to achieving the primary goal in resident education, structured resident research has many other benefits.

Curriculum↗
PubMed1994

Prevention of pregnancy-induced hypertension by calcium supplementation in angiotensin II-sensitive patients.

OBJECTIVE: To evaluate the efficacy of oral supplemental calcium in reducing the incidence of pregnancy-induced hypertension (gestational hypertension or preeclampsia) in angiotensin-sensitive nulliparas. METHODS: Sensitivity to intravenously infused angiotensin was determined at 24-28 weeks' gestation in 281 nulliparous women who had positive roll-over tests. Angiotensin-sensitive women were given 2 g/day of oral elemental calcium or placebo in a randomized, double-blind clinical trial. The tablets were dispensed by the hospital pharmacy in serially numbered computerized pill bottles so as to assess compliance. Repeat angiotensin sensitivity test was performed at 34-36 weeks' gestation. RESULTS: Sixty-three of 67 angiotensin-sensitive nulliparas were evaluable; 29 received calcium and 34 received placebo tablets. Four of 29 calcium-treated subjects (13.8%, 95% confidence interval [CI] 4-32%) developed preeclampsia, compared to 15 of 34 (44.1%, 95% CI 27-62%) in the placebo group (relative risk [RR] 0.37, 95% CI 0.15-0.92; P = .01). The incidence of any type of hypertension was nine of 29 (31%, 95% CI 15-51%) with calcium treatment, compared to 22 of 34 (64.7%, 95% CI 46-80%) with placebo (RR 0.46, 95% CI 0.25-0.86; P = .01). CONCLUSION: Calcium supplementation given in pregnancy to high-risk nulliparas reduces the incidence of pregnancy-induced hypertension.

Adolescent↗
PubMed1994

Long-acting injectable contraception with depot medroxyprogesterone acetate.

Depot medroxyprogesterone acetate (DMPA) is the only injectable contraceptive available in the United States. After more than 20 years of regulatory review, the Food and Drug Administration approved DMPA for contraceptive use in 1992 after the publication of reassuring data about its possible association with breast cancer. It has been used by 30 million women in more than 90 countries. The recommended dosage, 150 mg intramuscularly every 3 months, has a contraceptive efficacy exceeding 99%. After a 150 mg dose, ovulation is inhibited for at least 14 weeks. Almost all users experience menstrual changes, typically episodes of unpredictable irregular spotting and bleeding, particularly during the first year of use. With continued use, spotting and bleeding decrease, and amenorrhea becomes common. Although ovulation suppression may rarely persist for as long as 18 months after the last injection, DMPA does not permanently affect fertility. Long-term DMPA use reduces menstrual blood loss, has been associated with a decreased incidence of candidal vulvovaginitis and pelvic inflammatory disease, and dramatically lowers the risk of endometrial cancer. Prolonged DMPA use may be associated with reversible reduction in bone density, probably related to suppression of endogenous production of estrogen. The most recently published data suggest that long-term use of DMPA induces moderate changes in lipid metabolism that are unfavorable in terms of risk of atherosclerosis. DMPA should be considered a highly effective, safe, convenient, and reversible contraceptive option for appropriately selected patients.

Delayed-Action Preparations↗
PubMed1993

Combined oral contraception with desogestrel/ethinyl estradiol: tolerability profile.

Since their introduction nearly 30 years ago, oral contraceptives have been widely researched regarding their contraceptive and noncontraceptive effects. With proper usage, oral contraceptives provide highly effective contraception. In addition, oral contraceptives confer significant noncontraceptive health benefits, including prevention of ovarian and endometrial cancer and reduction in the incidence of pelvic inflammatory disease, endometriosis, benign breast disease, and dysmenorrhea, among others. Today's low-dose oral contraceptives have an improved safety profile when contrasted with their early higher dose counterparts. Yet oral contraceptive use continues to be associated with a variety of minor side effects, which range from menstrual changes such as breakthrough bleeding, spotting, or amenorrhea, to androgenic effects, including weight gain and acne. These androgenic effects are important factors in patient discontinuation of oral contraceptives. Progestins with increased selectivity have the potential to cause fewer androgenic side effects while retaining appropriate progestin suppression of the endometrium and hypophyseal-pituitary-ovarian axis. A combination oral contraceptive (30 micrograms of ethinyl estradiol with 150 micrograms of desogestrel) has been evaluated extensively by European investigators. This literature suggests that a low-dose oral contraceptive formulated with the selective progestin desogestrel offers a favorable profile of reduced androgenic side effects while retaining the cycle control associated with low-dose oral contraceptives currently marketed in the United States.

Acne Vulgaris↗
PubMed1993

Labor induction with the prostaglandin E1 methyl analogue misoprostol versus oxytocin: a randomized trial.

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus intravenous (IV) oxytocin infusion for labor induction. METHODS: One hundred thirty patients were randomly assigned to one of two induction groups: 1) intravaginal misoprostol or 2) IV oxytocin by continuous infusion, with prior cervical ripening using prostaglandin (PG) E2 gel if necessary. RESULTS: Among 129 patients evaluated, 64 were allocated to the misoprostol group and 65 to the oxytocin group. Prostaglandin E2 gel was administered to 29 patients (45%) in the oxytocin group with unripe cervices. Uterine tachysystole occurred more frequently in patients in the misoprostol group (34.4%) than in the oxytocin group (13.8%) (P < .05). Nevertheless, no statistically significant differences were noted between the groups in intrapartum complications including uterine hyperstimulation syndrome, mode of delivery, and neonatal or maternal adverse outcomes. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (11 versus 18 hours; P = .004). In 74% of patients in the misoprostol group, only one intravaginal dose was required for successful labor induction. CONCLUSIONS: Intravaginal administration of misoprostol safely and effectively induces labor while minimizing the expense associated with IV oxytocin infusion. The higher frequency of uterine tachysystole associated with the use of misoprostol did not increase the risk of adverse intrapartum or perinatal outcomes. The use of PGE2 gel for cervical ripening contributed to the longer induction-to-vaginal delivery interval noted in the oxytocin group. Clinical trials appear warranted to detail misoprostol's optimal route, dose, and schedule for labor induction and its safety.

Administration, Intravaginal↗
PubMed1992

Detection of cervical Chlamydia trachomatis and Neisseria gonorrhoeae with deoxyribonucleic acid probe assays in obstetric patients.

OBJECTIVE: The Gen-Probe PACE 2 deoxyribonucleic acid probe assays for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae are targeted against the ribosomal ribonucleic acid of each pathogen. Our study compared the performance of the probe assays with culture for Chlamydia trachomatis (246 patients) and Neisseria gonorrhoeae (310 patients) while screening obstetric patients. STUDY DESIGN: Using culture as a gold standard, we assessed the sensitivity, specificity, positive predictive value, and negative predictive value of the chlamydia and gonorrhea probes. RESULTS: The prevalence of chlamydia by culture was 13.4% and gonorrhea 4.8%. Against culture, the chlamydia probe assay performed as follows: sensitivity 93.9%, specificity 99.1%, positive predictive value 93.9%, and negative predictive value 99.1%. Values for the gonorrhea probe assay were 93.3%, 99.0%, 82.4%, and 99.7%, respectively. Additional molecular analysis of probe-positive-culture-negative specimens suggests that the gonorrhea probe-positive predictive value may be even higher. CONCLUSION: The Gen-Probe PACE 2 deoxyribonucleic acid probe assays for chlamydia and gonorrhea appear to be promising as convenient, reliable, and cost-effective alternatives to conventional cultures in screening obstetric patients.

Adult↗
PubMed1992

Oral contraceptives and gynecologic cancer: an update for the 1990s.

The most recent statistical evidence confirms a protective effect of oral contraceptive use against ovarian and endometrial cancers. Studies of the association between oral contraceptive use and cervical cancer continue to be hampered by confounding factors; however, results suggest that the overall risk of invasive cervical neoplasia is not increased. Although the association between oral contraceptive use and breast cancer remains controversial, existing data strongly suggest that overall risk of breast cancer is not increased by the use of oral contraceptives. In most candidates for oral contraceptive use, the benefits greatly outweigh the risks.

Breast Neoplasms↗