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Biomedical subjects

D Chelmow

Publications and source records attributed to D Chelmow.

27 records · Page 2Linked to original sources
PubMed1995

Costs of triplet pregnancy.

OBJECTIVE: Our purpose was to describe the total costs involved in the delivery, prenatal, and neonatal care for triplet pregnancies. STUDY DESIGN: Twenty triplet pregnancies were born at our institution over the 1-year period between July 1, 1992, and June 30, 1993. Total charges for prenatal care, physician fees, antepartum admissions, delivery, postpartum inpatient and outpatient care, and neonatal inpatient and outpatient care were extracted from the hospital billing computers. RESULTS: Our 20 triplet pregnancies were delivered of 54 live born infants at an average gestation of 30.2 weeks. Mothers averaged 16.7 inpatient hospital days. Total cost of prenatal care, outpatient laboratories and ultrasonography, delivery, and maternal inpatient care averaged $27,491. Neonates averaged 13.7 hospital days. Total neonatal costs for the inpatient stay and short term-postpartum (< 6 week) outpatient period was $36,856 per family. Total average cost per family was $64,347. CONCLUSION: Combined maternal and neonatal costs per individual baby delivered was approximately $21,000. Although expensive, this cost is far from prohibitive, even in times of close attention to health care expenditures.

Boston↗
PubMed1994

Laparoscopic diagnosis and methotrexate treatment of an ovarian pregnancy: a case report.

This report suggests an alternative for dealing with the diagnostic dilemma of differentiating an ovarian pregnancy from a ruptured CL cyst and suggests a conservative management approach that will possibly minimize adhesion formation and optimize future fertility. This new approach is based on a single case reported here, and therefore needs further verification. However, use of this revised set of diagnostic criteria, combined with the judicious use of MTX, may be an alternative therapy for selected ovarian pregnancies.

Adult↗
PubMed1993

Maternal and neonatal outcomes after prolonged latent phase.

OBJECTIVE: To examine the association of prolonged latent phase with cesarean risk, subsequent labor abnormalities, and other adverse maternal and neonatal outcomes. METHODS: Patients with prolonged latent phase were compared to patients with normal latent phase. We studied 10,979 singleton vertex deliveries of at least 37 weeks' gestation. Patients with risk factors for adverse outcome known before labor were excluded from the analysis. RESULTS: Seven hundred thirteen patients (6.5%) had prolonged latent phase. Subsequent labor abnormalities were more frequent among patients with prolonged latent phase (42.9 versus 16.3%; P < .05), as was cesarean delivery (24.4 versus 6.9%; P < .05). Need for neonatal resuscitation, thick meconium, maternal fever, low 5-minute Apgar score, intensive care nursery admission, lengthened maternal and newborn hospital stays, and higher estimated blood loss were all significantly more frequent in patients with prolonged latent phase after controlling for mode of delivery. Multivariate linear logistic regression models were created to determine whether these risks actually reflected the prolonged latent phase. The first model controlled for other labor abnormalities, parity, epidural use, and macrosomia and showed prolonged latent phase to be associated with an increased risk for cesarean delivery (relative risk [RR] 1.65, 95% confidence interval [CI] 1.32-2.06). The second model controlled for other labor abnormalities, postdates, thick meconium, mode of delivery, and prolonged rupture of membranes and showed that both the need for newborn resuscitation and 5-minute Apgar scores less than 7 were significantly more frequent in association with a prolonged latent phase (RR 1.37 and 1.97, 95% CI 1.15-1.64 and 1.23-3.16, respectively). CONCLUSIONS: Prolonged latent phase is independently associated with an increased incidence of subsequent labor abnormalities, need for cesarean delivery, depressed Apgar scores, and need for newborn resuscitation. The presence of prolonged latent phase should alert the clinician to an increased risk for further problems during the labor.

Adult↗
PubMed1992

Maternal and neonatal outcomes after oxytocin augmentation in patients undergoing a trial of labor after prior cesarean delivery.

OBJECTIVE: To study the safety of oxytocin augmentation in patients having abnormal labors after a prior cesarean delivery. METHODS: We retrospectively analyzed a case series of women undergoing a trial of labor after a previous cesarean delivery from the University of California San Francisco perinatal data base. Women whose labors were augmented with oxytocin were compared to women with labor abnormalities managed without the use of oxytocin. A wide range of maternal and neonatal outcomes was compared. Only vertex singleton term deliveries were studied. RESULTS: From 1975-1990 there were 504 trials of labor, of which 185 (37%) had labor abnormalities; 62 of these 185 (34%) were augmented with oxytocin. Fifty-eight percent of the trials of labor ended in vaginal delivery. In patients since 1982, 73% delivered vaginally. Forty-six (74%) of augmented patients delivered vaginally. There were no maternal deaths, uterine ruptures, or hysterectomies. Estimated blood loss was slightly greater among augmented patients after controlling for mode of delivery (P < .05), but only by 50-100 mL on average. There was no difference in the need for maternal transfusion. Fetal trauma and fetal scalp blood sampling occurred more frequently (P < .05) in the augmented labors, but only in the subgroup delivered by cesarean. No increased risk was demonstrated by a comparison between patients receiving oxytocin and epidural anesthesia and patients with labor abnormalities receiving neither. CONCLUSION: Retrospective analysis supports the use of oxytocin and epidural anesthesia to augment abnormal trials of labor after prior cesarean.

Anesthesia, Epidural↗
PubMedDate not supplied

Pregnancy complicated by obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a well-recognized psychiatric disorder often beginning in reproductive age. A case of OCD in pregnancy is presented and its management discussed. A 28-year-old G3P2 woman presented at 8 weeks' gestation for prenatal care. She had been diagnosed with OCD following her prior pregnancy. Her symptoms primarily involved obsessions about infectious disease and compulsive cleaning and organization of household items, both of which greatly distressed her and interfered with caring for her children. She had been managed with clomipramine between pregnancies and was beginning a clinical trial of fluvoxamine when pregnancy was diagnosed. She discontinued medication when she realized she was pregnant. Her symptoms were managed during the pregnancy with frequent appointments with her obstetrician and her psychiatrist. She used a behavioral technique, "thought-stopping", as well. Her symptoms worsened in the last month of pregnancy and immediately after delivery; she delivered a normal infant. The clomipramine was restarted postpartum. She has done well since then, with minimal psychiatric symptoms. OCD is a disabling psychiatric disorder that occurs in women of reproductive age. With careful management, pregnancy without disabling psychiatric symptoms can occur.

Adult↗
PubMedDate not supplied

Impact of gestational age at delivery of the economics of triplet pregnancy.

OBJECTIVE: To establish the charges associated with triplet pregnancies managed at a single tertiary center, over a 5-year time period, and to evaluate the impact of prematurity on these charges. METHODS: All triplet pregnancies that reached at least 20 weeks gestation and received prenatal and neonatal care at our center from 1992 to 1996 were included. Charges for these mothers and neonates were extracted from two separate hospital billing computer systems, encompassing all inpatient, outpatient, technical, and professional charges. Linear regression was used to evaluate the relationship between gestational age at delivery and total charges. RESULTS: Fifty-five triplet pregnancies were included, resulting in the admission of 149 liveborn neonates. The median gestational age at delivery was 32.1 weeks. The mean charges per triplet mother were: $6,899 (professional), $3,959 (hospital outpatient), and $32,686 (hospital inpatient). The mean charges per neonatal sibling set were: $20,107 (professional) and $124,163 (hospital inpatient). The mean charges per complete triplet pregnancy was $187,814 (maternal plus neonatal). There was a significant inverse relationship between gestational age at delivery and total charges per triplet family, with a decrease of $16,584 for each additional gestational week reached (P = 0.006). CONCLUSIONS: Triplet pregnancy charges averaged almost $190,000 each, which does not include charges associated with assisted reproductive technologies. These charges are almost all related to the expense of prolonged neonatal intensive care, and are significantly related to the gestational age at delivery. Efforts at containing these costs should focus on reducing the incidence of multiple gestation and preventing prematurity.

Boston↗
PubMedDate not supplied

Heterogeneous signal intensity in magnetic resonance images of hypertrophied left ventricular myocardium.

Left ventricular hypertrophy is associated with decreased longevity and often leads to congestive heart failure. An exploratory study of magnetic resonance imaging in human left ventricular hypertrophy was performed. First, 13 patients with left ventricular hypertrophy and 7 controls of similar ages were studied using electrocardiogramgated end-diastolic images. Visual inspection suggested that low-intensity zones were frequently found within the hypertrophied myocardium. To verify this observation, the images were processed with semi-automatic edge detection and a derivative-based tissue characterization algorithm, yielding tissue heterogeneity indices (THI-A and THI-V) which objectively measured the low-intensity zones. THI-A and THI-V were both significantly greater in left ventricular hypertrophy patients than in controls (THI-A: 0.111 vs 0.038, p = 0.009). THI was also significantly correlated with duration of disease and electrocardiographic abnormalities. To validate these initial findings prospectively, the same quantitative analysis was applied to magnetic resonance images of an additional 20 left ventricular hypertrophy patients and 12 controls from two institutions, using different imaging systems and different acquisition parameters. Again, THI was significantly greater in patients than in controls. Analysis of end-systolic images yielded similar results. In four dogs with left ventricular hypertrophy induced by aortic banding, THI showed a statistically significant increase as left ventricular hypertrophy developed. Hypertrophied myocardium thus shows reproducible differences from normal tissue with magnetic resonance imaging; hence, quantitative magnetic resonance tissue characterization may be useful in assessing pathologic changes in LVH.

Adult↗
PubMedDate not supplied

Maternal intravenous hydration and amniotic fluid index in patients with preterm ruptured membranes.

OBJECTIVE: To examine the effect of an intravenous (i.v.) fluid bolus on the amniotic fluid index (AFI) in patients with preterm ruptured membranes. METHODS: Nonlaboring patients at 24-37 weeks' gestation with documented ruptured membranes were randomized to either no hydration or to an i.v. fluid bolus with 1 L of normal saline administered over 30 minutes. All patients had a baseline AFI measured. The same blinded examiner repeated the examination 90 minutes later. RESULTS: Six patients were randomized to the hydration group, seven to the control group. The groups were similar in age, gravidity, parity, time since rupture, gestational age, and baseline AFI. In the hydration group, the AFI increased 5.1 cm (95% confidence interval [CI] 2.9-7.3) after the fluid bolus. In the no-hydration group, the change was 0.6 cm (95% CI-1.1 to 2.2). The difference in the change in AFI between groups was 4.5 cm (95% CI 1.3-7.7) (P = .008). CONCLUSION: The AFI is sensitive to maternal hydration in patients with preterm rupture of membranes and can be increased with an i.v. fluid bolus.

Adult↗