Selective magnesium sulfate prophylaxis for the prevention of eclampsia in women with gestational hypertension.
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Adult↗
Biomedical subjects
David M Haas
Publications and source records attributed to David M Haas.
The first 48 hours: Comparing 12-hour and 24-hour betamethasone dosing when preterm deliveries occur rapidly.
OBJECTIVE: To compare neonatal outcomes when dosing betamethasone every 12 hours compared to the standard 24-hour dosing regimen when premature deliveries occur within 48 hours of presentation. METHODS: A retrospective chart review was performed on preterm deliveries from January 1, 1996 to July 1, 2000. Deliveries that occurred less than 48 hours after initiation of antenatal steroids were analyzed for neonatal outcomes. RESULTS: Betamethasone was given to 562 women, of whom 166 delivered less than 48 hours after beginning therapy. There were no statistically significant differences in the rates of respiratory distress syndrome, surfactant use, chronic lung disease, intraventricular hemorrhage, neonatal death, or other outcomes between the two groups. The only statistically significant difference between the two groups was for venous cord blood pH (7.27 vs. 7.32, p = 0.01). Separating the results into delivery from 0-24 and 24-48 hour groups, there were no significant differences between the 12-hour and 24-hour dosing groups, although small sample size limited conclusions. CONCLUSION: Dosing betamethasone in 12-hour intervals may result in similar neonatal outcomes compared to the standard 24-hour regimen when delivery occurs within 48 hours of therapy initiation.
Adult↗
Assessment of breastfeeding practices and reasons for success in a military community hospital.
The authors' objectives were (1) to assess factors associated with breastfeeding rates in the early postpartum period and (2) to assess factors contributing to successful breastfeeding among an active-duty and military-dependent population. In September 2002, a baseline breastfeeding survey was administered to women presenting for infant or postpartum care in a military health care facility. A lactation service was then established, and between May and September 2004, a cross-sectional survey was subsequently conducted. Surveys assessed demographics, breastfeeding history and practices, and perceived reasons for success and discontinuation. A total of 934 surveys were collected. Ninety-two percent of women initiated breastfeeding. Eighty-five percent were breastfeeding at 1 week. The rate was 67.0% at 6 weeks and 61.7% at 6 months. Prior breastfeeding experience predicted continued breast-feeding at 6 weeks (OR 2.04); higher education level predicted breastfeeding at 6 months (OR 2.55). Breastfeeding rates increased after the establishment of a lactation service.
Adolescent↗
A cross-sectional survey of stressors for postpartum women during wartime in a military medical facility.
OBJECTIVE: To determine whether having a partner deployed during wartime increased the stress levels in pregnant women and altered the attitudes toward pregnancy or changed birth outcomes. METHODS: Cross-sectional survey of all postpartum women at Naval Hospital Camp Lejeune. The anonymous survey was administered from May to July 2003. RESULTS: Ninety-five surveys were collected. Fewer patients reported that their partner was deployed (41.1%) than not deployed (58.9%). Women with deployed partners gave birth to larger babies (3526.5 g vs. 3248.7 g, p = 0.016). No difference was seen in the gestational age at delivery, percentage with vaginal delivery, average number of children at home, self-reported stress, or reported weight gain during pregnancy. Women with partners deployed more often reported changed eating habits (56.4% vs. 8.0%, p < 0.001). Those with a deployed partner more often reported that media coverage impacted their stress level (p = 0.003). CONCLUSIONS: Pregnant women with deployed partners gave birth to larger babies. They also more frequently report a change in eating habits and that media coverage impacted their stress level.
Adult↗
Preterm birth.
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Adrenal Cortex Hormones↗
External cephalic version with an amniotic fluid index < or = 10: a systematic review.
OBJECTIVE: To review the literature and evaluate the role of the amniotic fluid index (AFI) on the success of an external cephalic version (ECV). STUDY DESIGN: A computerized search of MEDLINE and Cochrane databases were conducted using 'breech', 'version', 'external cephalic version', 'amniotic fluid', and 'amniotic fluid index'. References from the identified publications were manually searched to identify additional relevant articles. Articles from 1987 to 2004 were included. RESULTS: Of the initial 33 articles discovered, only three remained after exclusions. These articles used different AFI ranges for 'borderline' or 'low-normal' fluid measurements and therefore could not be combined for analysis. All three studies demonstrated a lower success rate of ECV with lower amniotic fluid volume estimates (AFI 5-8, <10, or <8.6), although none reached statistical significance. CONCLUSION: Due to limited and dissimilar data, it is impossible to define the lower AFI threshold for an unsuccessful ECV compared with the success of a normal AFI. Although not statistically significant, an AFI <10 may correlate with lower success rates for an ECV.
Amniotic Fluid↗
Rubella, rubeola, and mumps in pregnant women: susceptibilities and strategies for testing and vaccinating.
OBJECTIVE: To estimate rubella, rubeola, and mumps (MMR) susceptibilities in pregnant women and determine the percentage not immune to rubeola or mumps, depending on rubella immunity status. A secondary objective was to assess costs of vaccination and testing programs aimed at eliminating these viral susceptibilities to determine an optimal strategy. METHODS: This was an observational study of women presenting for prenatal care. All women had MMR antibody titers measured. Viral susceptibilities were compared by age, gravidity, parity, and recall of vaccine booster. A logistic regression was performed to assess for predictors of MMR immunity. A cost comparison of different screening and vaccination strategies was performed. RESULTS: Overall, 91 (9.4%) women were susceptible to rubella, 161 (16.5%) to rubeola, and 159 (16.3%) to mumps. Three hundred seventeen (32.6%) were susceptible to at least 1 virus, whereas only 17 (1.7%) were susceptible to all 3. Of the women who were immune to rubella, a large percentage were not immune to either rubeola or mumps (n = 226, 25.6%). Only 74.2% of women who knew they had a booster vaccine were immune to all components of the MMR vaccine. Receiving a booster was predictive of immunity to all 3 viruses. A cost analysis demonstrated that broader screening strategies are more comprehensive and more expensive. CONCLUSION: The current screening and vaccine program has left many reproductive-aged women susceptible to rubella, rubeola, and mumps infections. Perhaps a more comprehensive viral screening program is needed to ensure immunity.
Adolescent↗
Neonatal outcomes with different betamethasone dosing regimens: a comparison.
OBJECTIVE: To determine any differences in neonatal outcomes when dosing betamethasone every 12 hours vs. 24 hoursfor anticipated preterm delivery. STUDY DESIGN: A retrospective review of births at <36 weeks' gestation from January 1, 1996, to July 1, January 1, 1996, to July 1, 2000. Maternal and neonatal charts were reviewed. The deliveries were separated into 3 groups: those not receiving antenatal corticosteroids, those who received betamethasone 12 hours apart and those who received 24-hour dosing. Demographic, obstetric and neonatal variables were compared between the groups. RESULTS: There were 909 deliveries analyzed. With the 2 betamethasone groups, a significant difference was found for more maternal antibiotic use (90.4% vs. 83.6%, p=0.03), venous cord blood gas pH (7.31 vs. 7.32, p=0.04) and neonatal surfactant use (39.8% vs. 25.5%, p = 0.001) in the 12-hour group as compared to the 24-hour group. For all other outcomes there was no difference. CONCLUSION: Outcomes using a 12-hour dosing schedule of betamethasone were similar to those using a 24-hour regimen in this retrospective review. Twelvehour dosing could be considered an alternative way to deliver antenatal corticosteroids.
Adult↗
Maternal mortality in the U.S. Department of Defense, 1993-1998.
OBJECTIVE: To determine the maternal mortality ratio (MMR) in Department of Defense medical facilities from 1993 to 1998. STUDY DESIGN: We conducted a retrospective review of birth data from military medical facilities using the Standard Inpatient Data Records from 1993 through 1998. The total number of live births and dispositions due to maternal death were obtained. RESULTS: Twenty-two maternal deaths occurred in the study time out of 398,107 live births, for an MMR of 5.5 per 100,000 live births. The ratiosfor the service branches were: Army 7.0, Navy 5.3 and Air Force 3.6. The leading cause of death was embolic disease. CONCLUSION: The military MMR is closer to the Healthy People 2010 goal of 3.3 than is the national ratio, 13.2. Improved reporting of cases, patient education and treating high-risk conditions may help further decrease pregnancy-related mortality.
Eclampsia↗
Postpartum obturator neurapraxia. A case report.
BACKGROUND: Obturator nerve injury is a rare complication of vaginal delivery. CASE: Postpartum obturator neurapraxia was clinically diagnosed in a 22-year-old woman on the first postpartum day after a vaginal delivery. With physical therapy, the neurologic symptoms resolved by the third postpartum month. CONCLUSION: Maternal nerve injuries are uncommon in obstetrics. The diagnosis of obturator neurapraxia is usually made clinically. The symptoms will resolve with conservative physical therapy alone in the majority of cases.
Adult↗
A cross-sectional survey of the relationship between partner deployment and stress in pregnancy during wartime.
OBJECTIVE: The objective of this study was to determine if having a partner deployed during wartime increased the stress levels in pregnant women and altered their attitudes toward pregnancy. METHODS: We administered a cross-sectional survey of all military and civilian women attending the antenatal clinic at Naval Hospital Camp Lejeune. We collected the anonymous surveys in May 2003. The survey measured demographics, self-reported stress level, and other attitudes toward the pregnancy and deployment; blood pressure was recorded. Data were compared by partner deployment status and reported stress levels using chi-square, t-tests, and logistic regression analysis. RESULTS: Two hundred seventy-nine surveys were returned, representing 93.3% of those distributed. An almost equal number of patients had a partner deployed as nondeployed (49.1% versus 50.9%). Women with deployed partners were older, more had children at home, more often reported both significantly higher stress levels and a severe impact of the deployment on their stress, had a lower systolic blood pressure, more often reported changed eating habits, and reported that media coverage of the war worsened their stress than those whose partners were not deployed. Logistic regression analysis of stress found that partner deployment, having more than one child at home, and being active-duty were associated with reporting higher stress levels (odds ratio [OR] = 2.27, p = .013; OR = 3.11, p = .042; and OR = 4.03, p = .01, respectively). CONCLUSIONS: Pregnant women with deployed partners and those with more than one child already at home report higher stress levels than their peers with partners present. Increased stress in pregnant women with deployed partners may lead to adverse pregnancy outcomes. Further study is warranted to assess the impact of deployment on pregnancy and family life to better support homeland pregnant partners of deployed military members during wartime.
Adult↗
Maternal shoe size and infant birth weight: correlation or fiction?
OBJECTIVE: To determine whether maternal prepregnancy shoe size can be used to reliably predict infant birth weight. METHOD: This is a cross-sectional study of 111 consecutive patients admitted to the maternity care unit of a small community hospital. Data collected included prepregnancy height, maternal weight, maternal shoe size, maternal age, gravidity, parity, ethnicity, and method of delivery. Infant birth weight was recorded within the first 2 hours of life. RESULTS: There was no correlation between maternal shoe size and birth weight (r = 0.01; P = NS). There was no correlation between shoe size and birth weight when corrected for parity and ethnicity. CONCLUSION: There is no correlation between maternal shoe and infant birth weight. This anthropometric measure should not be used to estimate infant birth weight.
Adult↗