Biomedical subjects

D D McIntire

Publications and source records attributed to D D McIntire.

At least 19 recordsLinked to original sources

PubMed2005

A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function.

OBJECTIVE: The purpose of this study was to determine if refraining from coached pushing during the second stage of labor affects postpartum urogynecologic measures of pelvic floor structure and function. STUDY DESIGN: Nulliparous women at term were randomized to coached (n = 67) vs uncoached (n = 61) pushing. At 3 months' postpartum women underwent urodynamic testing, pelvic organ prolapse examination (POPQ), and pelvic floor neuromuscular assessment. RESULTS: Urodynamic testing revealed decreased bladder capacity (427 mL vs 482 mL, P = .051) and decreased first urge to void (160 mL vs 202 mL, P = .025) in the coached group. Detrusor overactivity increased 2-fold in the coached group (16% vs 8%), although this difference was not statistically significant (P = .17). Urodynamic stress incontinence was diagnosed in the coached group in 11/67 (16%) vs 7/61 (12%) in the uncoached group (P = .42). CONCLUSION: Coached pushing in the second stage of labor significantly affected urodynamic indices, and was associated with a trend towards increased detrusor overactivity.

Delivery, Obstetric↗

PubMed2004

Association of maternal serum alpha-fetoprotein with persistent placenta previa.

OBJECTIVE: To evaluate the relationship between maternal serum alpha-fetoprotein (MSAFP) and the risk of persistent placenta previa. METHODS: We conducted a retrospective cohort study of singleton pregnancies with sonographic evidence of placenta previa at 15-20 weeks' gestation, between October 1991 and August 2000. Only pregnancies with MSAFP determination at 15-20 weeks' gestation and non-anomalous live-born infants > or =24 weeks' gestation were included. Pregnancies in which Cesarean delivery was performed for placenta previa were considered persistent; this was the primary outcome. RESULTS: Of 275 women with previa at 15-20 weeks' gestation, 33 (12%) had previa at delivery. Trend analysis revealed a greater likelihood of persistent previa with increasing MSAFP values (p=0.01). Mid-trimester MSAFP <1 multiple of the median (MoM) was associated with a decreased incidence of persistence of 4%, significantly less than the risk at > or =1 MoM (16%; p=0.01). CONCLUSIONS: There is an association between increasing MSAFP values and greater likelihood of persistent placenta previa. An MSAFP value <1 MoM is associated with a reduction in the risk of persistence of previa to delivery.

Epidemiologic Methods↗

PubMed2003

Maternal and fetal artery Doppler findings in women with chronic hypertension who subsequently develop superimposed pre-eclampsia.

OBJECTIVE: To carry out a prospective study of Doppler velocimetry of the fetomaternal circulation in women with chronic hypertension, to evaluate whether the subsequent development of superimposed pre-eclampsia can be predicted. STUDY DESIGN: Serial Doppler studies of the maternal uterine and renal arteries, and fetal middle cerebral and umbilical arteries, were performed at 16-20 and at 28-32 weeks' gestation in 56 women with chronic hypertension. Pulsatility indices were compared using the Wilcoxon rank sum method. A p value of < 0.05 was considered significant. RESULTS: Uterine artery impedance was significantly elevated as early as 16-20 and at 28-32 weeks' gestation, while the cerebroplacental ratio was lower at 28-32 weeks' gestation, in the 14 women who developed superimposed pre-eclampsia. The maternal renal artery impedance remained constant throughout gestation, regardless of the development of pre-eclampsia. CONCLUSIONS: Uterine artery Doppler velocimetry at 16-20 and at 28-32 weeks' gestation showing increased impedance is predictive for the development of superimposed pre-eclampsia in women with chronic hypertension. The cerebroplacental ratio suggested early fetal brain sparing at 28-32 weeks' gestation in these women.

Adult↗

PubMed2001

The continuing value of the Apgar score for the assessment of newborn infants.

BACKGROUND: The 10-point Apgar score has been used to assess the condition and prognosis of newborn infants throughout the world for almost 50 years. Some investigators have proposed that measurement of pH in umbilical-artery blood is a more objective method of assessing newborn infants. METHODS: We carried out a retrospective cohort analysis of 151,891 live-born singleton infants without malformations who were delivered at 26 weeks of gestation or later at an inner-city public hospital between January 1988 and December 1998. Paired Apgar scores and umbilical-artery blood pH values were determined for 145,627 infants to assess which test best predicted neonatal death during the first 28 days after birth. RESULTS: For 13,399 infants born before term (at 26 to 36 weeks of gestation), the neonatal mortality rate was 315 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 5 per 1000 for infants with five-minute Apgar scores of 7 to 10. For 132,228 infants born at term (37 weeks of gestation or later), the mortality rate was 244 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 0.2 per 1000 for infants with five-minute Apgar scores of 7 to 10. The risk of neonatal death in term infants with five-minute Apgar scores of 0 to 3 (relative risk, 1460; 95 percent confidence interval, 835 to 2555) was eight times the risk in term infants with umbilical-artery blood pH values of 7.0 or less (180; 95 percent confidence interval, 97 to 334). CONCLUSIONS: The Apgar scoring system remains as relevant for the prediction of neonatal survival today as it was almost 50 years ago.

Apgar Score↗

PubMed2001

Antenatal dexamethasone and decreased birth weight.

OBJECTIVE: To test the hypothesis that antenatal dexamethasone treatment to promote fetal lung maturation results in decreased birth weight corrected for gestational age. METHODS: The birth weights of all dexamethasone-treated, singleton, live-born infants delivered at our hospital were compared with our overall obstetric population; a group of untreated infants frequency matched approximately 3:1 according to maternal race, infant sex, and gestational age at delivery; and an historical cohort of infants with an indication for dexamethasone but delivered in the 12 months before the introduction of corticosteroid therapy at our hospital. RESULTS: Dexamethasone-treated infants (n = 961), when compared with either the overall population (n = 122,629) or matched controls (n = 2808), had significantly lower birth weights after adjustment for week of gestation (P <.001). Compared with the historical cohort of infants, the average birth weight of dexamethasone-treated infants was smaller by 12 g at 24-26 weeks, 63 g at 27-29 weeks, 161 g at 30-32 weeks, and 80 g at 33-34 weeks' gestation. CONCLUSION: Antenatal dexamethasone administered to promote fetal maturation is associated with diminished birth weight.

Birth Weight↗

PubMed2001

Recurrence of preterm birth in singleton and twin pregnancies.

OBJECTIVE: To assess recurrence of preterm birth and its impact on an obstetric population. METHODS: Women with consecutive births at our hospital beginning with their first pregnancy were identified (n = 15,945). The first pregnancy was categorized as delivered between 24 and 34 weeks' gestation or 35 weeks or beyond, singleton or twin, and spontaneous or induced. The risk of preterm delivery in these same women during subsequent pregnancies was then analyzed. RESULTS: Compared with women who delivered a singleton at or beyond 35 weeks' gestation in their first pregnancy, those who delivered a singleton before 35 weeks were at a significant increased risk for recurrence (odds ratio [OR] 5.6, 95% confidence interval [CI] 4.5, 7.0), whereas those who delivered twins were not (OR 1.9, 95% CI 0.46, 8.14). The OR for recurrent spontaneous preterm birth presenting with intact membranes was 7.9 (95% CI 5.6, 11.3) compared with 5.5 (95% CI 3.2, 9.4) with ruptured membranes. Of those women with a recurrent preterm birth, 49% delivered within 1 week of the gestational age of their first delivery and 70% delivered within 2 weeks. Among 15,863 nulliparous women with singleton births at their first delivery, a history of preterm birth in that pregnancy could predict only 10% of the preterm births that ultimately occurred in the entire obstetric population. CONCLUSION: In a population-based study at our hospital, women who initially delivered preterm and thus were identified to be at risk for recurrence ultimately accounted for only 10% of the prematurity problem in the cohort.

Adolescent↗

PubMed2001

Adverse cardiac events after surgery: assessing risk in a veteran population.

OBJECTIVE: To establish rates of and risk factors for cardiac complications after noncardiac surgery in veterans. DESIGN: Prospective cohort study. SETTING: A large urban veterans affairs hospital. PARTICIPANTS: One thousand patients with known or suspected cardiac problems undergoing 1,121 noncardiac procedures. MEASUREMENTS: Patients were assessed preoperatively for important clinical variables. Postoperative evaluation was done by an assessor blinded to preoperative status with a daily physical examination, electrocardiogram, and creatine kinase with MB fraction until postoperative day 6, day of discharge, death, or reoperation (whichever occurred earliest). Serial electrocardiograms, enzymes, and chest radiographs were obtained as indicated. Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema. Serious cardiac complications included the above, heart failure, and unstable angina. MAIN RESULTS: Severe and serious complications were seen in 24% and 32% of aortic, 8.3% and 10% of carotid, 11.8% and 14.7% of peripheral vascular, 9.0% and 13.1% of intraabdominal/intrathoracic, 2.9% and 3.3% of intermediate-risk (head and neck and major orthopedic procedures), and 0.27% and 1.1% of low-risk procedures respectively. The five associated patient-specific risk factors identified by logistic regression are: myocardial infarction < 6 months (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.9 to 12.9), emergency surgery (OR, 2.6; 95% CI, 1.2 to 5.6), myocardial infarction > 6 months (OR, 2.2; 95% CI, 1.4 to 3.5), heart failure ever (OR, 1.9; 95% CI, 1.2 to 3.0), and rhythm other than sinus (OR, 1.7; 95% CI, 0.9 to 3.2). Inclusion of the planned operative procedure significantly improves the predictive ability of our risk model. CONCLUSIONS: Five patient-specific risk factors are associated with high risk for cardiac complications in the perioperative period of noncardiac surgery in veterans. Inclusion of the operative procedure significantly improves the predictive ability of the risk model. Overall cardiac complication rates (pretest probabilities) are established for these patients. A simple nomogram is presented for calculation of post-test probabilities by incorporating the operative procedure.

Adult↗

PubMed2001

Outcomes among term infants when two-hour postnatal pH is compared with pH at delivery.

OBJECTIVE: This study was undertaken to measure infant outcomes when pH at birth was compared with neonatal pH determined within 2 hours of age. STUDY DESIGN: We retrospectively studied term infants born between January 1, 1988, and August 31, 1998, who had umbilical artery blood pH measured at birth and again from the radial artery or umbilical artery within 2 hours after birth. Statistical significance was determined with the chi2 test. Odds ratios and 95% confidence intervals were calculated by means of the Mantel-Haenszel method. RESULTS: Data from a total of 1691 infants were analyzed: 178 (11%) had acidemia at birth (pH of <7.20) that persisted through the first 2 hours after birth; 110 (6%) had development of acidemia after birth; and 594 (35%) were born with a cord pH of <7.20 that improved after delivery. The remaining 809 infants (48%) did not have acidemia either at birth or during the neonatal period, and these served as the reference group. Seizures during the first 24 hours after birth were more likely among those infants with persistent acidemia (odds ratio, 13.0; 95% confidence interval, 6.3-26.7). The odds ratio for seizures among infants in whom acidemia developed after birth was 5.7 (95% confidence interval, 2.2-14.5). Other than the reference group, the infants who were born with acidemia that was corrected by 2 hours after birth had the lowest risk of seizures (odds ratio, 2.5; 95% confidence interval, 1.2-5.3). Significant differences in neonatal outcomes persisted after correction for anomalies. CONCLUSION: The direction of pH change from birth to the immediate neonatal period was significantly related to morbidity and mortality among term infants who were ill at birth or became ill shortly thereafter.

Acidosis↗

PubMed2001

A randomized trial of labor analgesia in women with pregnancy-induced hypertension.

OBJECTIVE: The purpose of this study was to compare the peripartum and perinatal effects of epidural with intravenous labor analgesia in women with pregnancy-induced hypertension. STUDY DESIGN: Women with pregnancy-induced hypertension who had consented to participate were randomized to receive either epidural or intravenous analgesia for labor pain. Both methods were given according to standardized protocols. All women received magnesium sulfate seizure prophylaxis. Obstetric and neonatal outcomes were compared according to intent-to-treat allocation. RESULTS: Seven hundred thirty-eight women were randomized: 372 women were given epidural analgesia, and 366 women were given intravenous analgesia. Maternal characteristics were similar, including the severity of hypertension. Epidural analgesia was associated with a significantly prolonged second-stage labor, an increase in forceps deliveries, and an increase in chorioamnionitis. Cesarean delivery rates and neonatal outcomes were similar. Pain relief was superior with the epidural method. Hypotension required treatment in 11% of women in the epidural group. CONCLUSION: Epidural labor analgesia provides superior pain relief but no additional therapeutic benefit to women with pregnancy-induced hypertension.

Adolescent↗

PubMed2001

Intensity of labor pain and cesarean delivery.

Some authors have suggested that the intensity of labor pain may be related to labor dystocia. We performed a secondary analysis of a previously published randomized investigation of the effects of epidural analgesia during labor compared with patient-controlled IV meperidine on cesarean delivery. Two-hundred-fifty-nine women who received patient-controlled IV meperidine were identified for analysis. All women were in spontaneous labor with a singleton, term gestation. Women requiring 50 mg or more of meperidine per hour during labor were compared with those who required <50 mg/h. In addition, their pain scores (visual analog scale) were compared before and after analgesia administration. Pain scores were significantly higher in women requiring 50 mg/h of meperidine (8.7 vs 8.0, P = 0.05), and their labors tended to be longer (9 vs 5 h, P = 0.09). More cesarean deliveries for obstructed labor were performed in women requiring >50 mg/h of meperidine (14% vs 1.4%, P = 0.001). Neonatal outcomes were similar in the two groups.

Adult↗

PubMed2000

Correlation between amniotic fluid glucose concentration and amniotic fluid volume in pregnancy complicated by diabetes.

OBJECTIVE: Pregnancies complicated by diabetes are frequently characterized by an increased volume of amniotic fluid, and the pathophysiologic mechanism of this increase is not known. Our goal was to evaluate the relationship between amniotic fluid glucose concentration and the amniotic fluid index in pregnancies complicated by insulin-treated diabetes and to compare it with that seen in normal pregnancies. STUDY DESIGN: Amniotic fluid index and amniotic fluid glucose levels were measured before elective repeated cesarean delivery in 41 women with insulin-treated diabetes and in 35 women without diabetes. Only singleton gestations without anomalous fetuses were included. Women with diabetes were hospitalized for approximately 4 weeks before delivery, during which time glycemic control was optimized. Amniotic fluid index and amniotic fluid glucose concentration were correlated with each other and were compared between the groups with and without diabetes. RESULTS: The mean amniotic fluid index was significantly increased in the diabetes group (16.6 +/- 5.0 cm in the diabetes group vs 13.4 +/- 3.5 cm in the control group; P =.002). The amniotic fluid glucose concentration was also significantly greater in the diabetes group than in the control group (39 +/- 17 mg/dL in the diabetes group vs 24 +/- 11 mg/dL in the control group; P <.001). Among women with diabetes the amniotic fluid glucose concentration was significantly correlated with the amniotic fluid index (r = 0.32; P =.04), a correlation not found among the control women. The mean fasting blood glucose concentration among the women with diabetes for the week before amniocentesis was 82 +/- 11 mg/dL. CONCLUSION: The amniotic fluid index parallels the amniotic fluid glucose level among women with diabetes. This finding raises the possibility that the hydramnios associated with diabetes is a result of increased amniotic fluid glucose concentration.

Adult↗

PubMed2000

Pregnancy outcomes after antepartum diagnosis of oligohydramnios at or beyond 34 weeks' gestation.

OBJECTIVE: Our purpose was to assess whether antepartum oligohydramnios is associated with adverse perinatal outcomes. STUDY DESIGN: Women delivered between July 1, 1991, and September 30, 1996, who underwent ultrasonography at >/=34 weeks' gestation were analyzed. Oligohydramnios was defined as an amniotic fluid index </=50 mm. Perinatal outcomes in pregnancies with oligohydramnios were compared with those with an amniotic fluid index of >50 mm. RESULTS: In our analysis of 6423 pregnancies, 147 (2.3%) were complicated by oligohydramnios. This complication was associated with increased labor induction (42% vs 18%; P <.001), stillbirth (1. 4% vs 0.3%; P <.03), nonreassuring fetal heart rate (48% vs 39%; P <. 03), admission to the neonatal intensive care nursery (7% vs 2%; P <. 001), meconium aspiration syndrome (1% vs 0.1%; P <.001), and neonatal death (5% vs 0.3%; P <.001). CONCLUSION: Antepartum oligohydramnios is associated with increased perinatal morbidity and mortality.

Adult↗

PubMed2000

Forty weeks and beyond: pregnancy outcomes by week of gestation.

OBJECTIVE: To assess pregnancy outcomes at 40, 41, and 42 weeks' gestation when labor induction is done routinely at 42 but not 41 weeks. METHODS: We reviewed all singleton pregnancies delivered at 40 or more weeks' gestation between 1988 and 1998 at Parkland Memorial Hospital, Dallas, Texas. We excluded women with hypertension, prior cesarean, diabetes, malformations, breech presentation, and placenta previa. Labor characteristics and neonatal outcomes of pregnancies at 41 and 42 weeks' gestation were compared with pregnancies that ended at 40 weeks. Women with certain dating criteria had induction of labor at 42 weeks. Gestational age was calculated from the last menstrual period (LMP), sonography when available, and clinical examination. If the fundal height between 18 and 30 weeks was within 2 cm of gestational age, the reported LMP was accepted as correct. Sonogram was used to calculate gestational age if a discrepancy was identified. Statistical analysis consisted of chi(2) and analysis of variance. RESULTS: We studied 56,317 pregnancies: 29,136 at 40 weeks, 16,386 at 41 weeks, and 10,795 at 42 weeks. Labor complications increased from 40 to 42 weeks, including oxytocin induction (2% versus 35%, P <.001), length of labor (5.5 +/- 4.9 versus 8.8 +/- 6. 5 hours, P <.001), prolonged second stage of labor (2% versus 4%, P <.001), forceps use (6% versus 9%, P <.001), and cesarean delivery (7% versus 14%, P <.001). Neonatal outcomes were similar in the three groups, including 5-minute Apgar score less than 4, admission to the neonatal intensive care unit (NICU), umbilical artery pH less than 7, seizures, and perinatal mortality. Sepsis was more frequent in the 42-week group than the other groups (0.1 versus 0.3%, P =. 001), as was admission to the NICU (0.4 versus 0.6%, P =.008). CONCLUSION: Routine labor induction at 41 weeks likely increases labor complications and operative delivery without significantly improving neonatal outcomes.

Adult↗

PubMed2000

Effects of symmetric and asymmetric fetal growth on pregnancy outcomes.

OBJECTIVE: To assess the prevalence of head circumference to abdomen circumference (HC/AC) asymmetry among small for gestational age (SGA) fetuses, and to determine the likelihood of adverse outcomes among asymmetric and symmetric SGA infants compared with their appropriate for gestational age (AGA) counterparts. METHODS: In a retrospective cohort study, we analyzed consecutive live-born singletons of women who had antepartum sonography within 4 weeks of delivery and delivered between January 1, 1989 and September 30, 1996. A gestational age-specific HC/AC nomogram was derived from our sonographic database of 33,740 nonanomalous live-born singletons. Asymmetric HC/AC was defined as greater than or equal to the 95th percentile for gestational age. RESULTS: Among 1364 SGA infants, 20% had asymmetric HC/AC and 80% were symmetric. Asymmetric SGA infants were more likely to have major anomalies than symmetric SGA infants or AGA infants (14% versus 4% versus 3%, respectively; P <.001). After exclusion of anomalous infants, pregnancy-induced hypertension at or before 32 weeks' gestation and cesarean delivery for nonreassuring fetal heart rate were more common in the asymmetric SGA than the AGA group (7% versus 1% and 15% versus 3%, respectively; both P <.001). A neonatal outcome composite, including one or more of respiratory distress, intraventricular hemorrhage, sepsis, or neonatal death, was more frequent among asymmetric SGA than AGA infants (14% versus 5%, P =.001). Symmetric SGA infants were not at increased risk of morbidity compared with AGA infants. CONCLUSION: The minority of SGA fetuses with HC/AC asymmetry are at increased risk for intrapartum and neonatal complications.

Adolescent↗

PubMed2000

Impact of head-to-abdominal circumference asymmetry on outcomes in growth-discordant twins.

OBJECTIVE: Our aim was to evaluate head-to-abdominal circumference asymmetry as a marker for adverse outcomes in growth-discordant twins. STUDY DESIGN: We conducted a retrospective cohort study of asymmetric and symmetric twins with > or =25% growth discordance, comparing their outcomes with those in concordant symmetric twins. Growth was termed asymmetric on the basis of a head circumference/abdominal circumference ratio at > or =95th percentile on ultrasonography performed < or =4 weeks before delivery. RESULTS: We evaluated 572 twin pairs. Asymmetric discordant twins were more likely than symmetric concordant twins to be delivered at < or =34 weeks' gestation (57% vs. 27%), to require intubation (36% vs. 7%), to remain in intensive care >1 week (36% vs 3%), and to have an outcome composite that included respiratory morbidity, intraventricular hemorrhage, sepsis, or neonatal death (29% vs 6%), all P<.05. Symmetric discordant and symmetric concordant twins had similar outcomes. CONCLUSIONS: Discordant twins with head-to-abdominal circumference asymmetry have an increased risk of morbidity. Moreover, in the absence of asymmetry, outcomes are comparable among discordant and concordant twins.

Abdomen↗

PubMed1999

Birth weight in relation to morbidity and mortality among newborn infants.

BACKGROUND: At any given gestational age, infants with low birth weight have relatively high morbidity and mortality. It is not known, however, whether there is a threshold weight below which morbidity and mortality are significantly greater, or whether that threshold varies with gestational age. METHODS: We analyzed the neonatal outcomes of death, five-minute Apgar score, umbilical-artery blood pH, and morbidity due to prematurity for all singleton infants delivered at Parkland Hospital, Dallas, between January 1, 1988, and August 31, 1996. A distribution of birth weights according to week of gestation at birth was created. Infants in the 26th through 75th percentiles for weight served as the reference group. Data on preterm infants (those born at 24 to 36 weeks of gestation) were analyzed separately from data on infants delivered at term (37 or more weeks of gestation). RESULTS: A total of 122,754 women and adolescents delivered singleton live infants without malformations between 24 and 43 weeks of gestation. Among the 12,317 preterm infants who were analyzed, there was no specific birth-weight percentile at which morbidity and mortality increased. Among 82,361 infants who were born at term and whose birth weights were at or below the 75th percentile, however, the rate of neonatal death increased from 0.03 percent in the reference group (26th through 75th percentile for weight) to 0.3 percent for those with birth weights at or below the 3rd percentile (P<0.001). The incidence of five-minute Apgar scores of 3 or less and umbilical-artery blood pH values of 7.0 or less was approximately doubled for infants at or below the 3rd birth-weight percentile (P=0.003 and P<0.001, respectively). The incidence of intubation at birth, seizures during the first day of life, and sepsis was also significantly increased among term infants with birth weights at or below the 3rd percentile. These differences persisted after adjustment for the mother's race and parity and the infant's sex. CONCLUSIONS: Mortality and morbidity are increased among infants born at term whose birth weights are at or below the 3rd percentile for their gestational age.

Adolescent↗

PubMed1999

Use of Crinone vaginal progesterone gel for luteal support in in vitro fertilization cycles.

OBJECTIVE: To investigate the efficacy and safety of intravaginal Crinone 8% (Columbia Research Laboratories, Miami. FL) versus IM progesterone for luteal phase support after IVF-ET. DESIGN: Prospective open trial with comparison to historical controls. SETTING: University hospital. PATIENT(S): Two hundred six women undergoing IVF-ET. INTERVENTION(S): One hundred patients received Crinone vaginal progesterone gel (90 mg once daily) and 106 patients received IM progesterone (50 mg once daily) beginning on the evening of oocyte retrieval. MAIN OUTCOME MEASURE(S): Pregnancy and miscarriage rates, and midluteal serum progesterone levels. RESULT(S): Positive beta-hCG pregnancy rates, clinical pregnancy rates per transfer, and ongoing pregnancy rates were similar for the Crinone and IM progesterone groups. Women who received Crinone had higher rates of biochemical pregnancy loss but lower rates of clinical pregnancy loss (i.e., spontaneous abortion) than women who received IM progesterone. Midluteal serum progesterone concentrations were significantly higher in the IM progesterone group (94.3+/-8.8 ng/mL versus 57.7+/-7.4 ng/mL). Several women who received Crinone had vaginal bleeding 11-13 days after oocyte retrieval. CONCLUSION(S): For all age categories, positive beta-hCG and ongoing pregnancy rates were similar when Crinone or IM progesterone was given for luteal phase support in IVF-ET cycles, despite lower serum progesterone concentrations and higher rates of biochemical pregnancy loss with Crinone. Although the results of this study support the use of Crinone as an acceptable alternative for luteal support after IVF-ET, differences in bleeding patterns and rates of biochemical pregnancy loss demonstrate the need for a prospective randomized study.

Administration, Intravaginal↗

PubMed1999

Epidural analgesia and intrapartum fever: placental findings.

OBJECTIVE: To assess whether epidural analgesia is associated with fever, independent of maternal infection, by evaluating the relationship between epidural analgesia and inflammation of the placenta. METHODS: Placentas collected prospectively from women with singleton gestations, who delivered 6 hours or more after membrane rupture, were evaluated systematically for histologic inflammation by an investigator blinded to all clinical information. Maternal and neonatal markers of infection were assessed in the cohorts who did and did not receive epidural analgesia. RESULTS: One hundred forty-nine consecutive placentas were analyzed, and 80 (54%) of these women received epidural analgesia. On univariate analysis, significant differences between epidural and no epidural groups were found with respect to maternal fever 38C or greater (46% versus 26%, P = .01), placenta inflammation (61% versus 36%, P = .002), and length of labor (11.8 hours versus 9.6 hours, P = .03). The combination of maternal fever plus placental inflammation was significantly more common in the epidural group (35% versus 17% P = .02). However, maternal fever in the absence of supporting evidence of infection, in the form of placental inflammation, was not increased after epidural analgesia (11% versus 9%, P = .61). CONCLUSION: Epidural analgesia is associated with intrapartum fever, but only in the presence of placental inflammation. This suggests that the fever reported with epidural analgesia is due to infection rather than the analgesia itself.

Acute Disease↗