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Biomedical subjects

E F Magann

Publications and source records attributed to E F Magann.

At least 19 recordsLinked to original sources
PubMed2003

Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome.

OBJECTIVES: To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. METHODS: A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. RESULTS: Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (-15.3+/-1.4 mmHg vs. -7.5+/-1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). CONCLUSION: This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.

Adrenal Cortex Hormones↗
PubMed2003

Application of learning theory to obstetric maloccurrence.

The average fellow of the American College of Obstetricians and Gynecologists performs approximately 140 deliveries per year. Based on this estimation and the established prevalence of three commonly litigated maloccurrences, we calculated the number of years of clinical experience required to encounter one case. Permanent brachial plexus palsy complicates only 1 per 4553 deliveries so a clinician would encounter such a case in 33 years of practice. For every 6667 deliveries, there is a case of cerebral palsy attributable to intrapartum hypoxia, so a practioner would see only one case every 48 years. Since the rate of asphyxia with uterine rupture is 1 per 2819 vaginal births after Cesarean section and the average provider performs seven vaginal births after Cesarean deliveries per year, a clinician would have a case in 403 years of practice. Adverse outcomes expressed as an absolute percentage or as the number of cases per number of deliveries are statistically accurate. Expression of these maloccurrences in terms of the number of years of clinical experience permits the generation of a clinically relevant data point and also allows insight into why their prevalence has not decreased.

Birth Injuries↗
PubMed2003

Effectiveness and safety of a structured swimming program in previously sedentary women during pregnancy.

OBJECTIVE: To determine whether undertaking a swimming program in sedentary women during pregnancy would improve maternal fitness without adverse fetal consequences. METHODS: Prospective observational investigation of healthy sedentary pregnant women participating in a monitored swimming program. RESULTS: Twenty-three women attended swimming sessions from 16 to 28 weeks of gestation resulting in increasing distances swum and improved aerobic fitness as measured by physical work capacity (PWC170) (p = 0.003). Resting maternal heart rate decreased (p = 0.041) and resting systolic (p = 0.092) and diastolic (p = 0.971) blood pressures remained unchanged over gestation. The mean fetal heart rates decreased with advancing gestational age (p = 0.001), consistent with normal physiology. Non-stress tests and umbilical artery systolic/diastolic ratios were similar before and after swimming sessions, providing evidence that fetal well-being was unchanged. CONCLUSIONS: A structured swimming program in sedentary pregnant women increases maternal fitness without any alteration in maternal and fetal well-being.

Adult↗
PubMed2003

Detection of fetal growth restriction in patients with chronic hypertension: is it feasible?

OBJECTIVE: To determine the utility of sonographic estimated fetal weight (EFW) in diagnosing intrauterine growth restriction (IUGR, birth weight < 10% for gestational age) in patients with chronic hypertension. METHODS: All pregnant patients with hypertension delivered during a 5-year period at three centers were identified retrospectively. Patients with gestational hypertension, pre-eclampsia, diabetes mellitus, fetal anomalies and absence of a sonographic examination within 3 weeks of delivery were excluded. Likelihood ratio (LR) and guidelines established by the Evidence-Based Medicine Working Group were used to determine whether sonographic EFW is a reliable diagnostic test to detect IUGR. RESULTS: At the three centers, there were 264 patients with chronic hypertension (122, 77 and 65 at centers I, II and III, respectively). The incidence of IUGR ranged from 13% to 27% but was similar at the three locations (p = 0.064). The LR (with 95% confidence interval (CI)) of detecting IUGR was 4.4 (95% CI 2.5, 7.7), 2.3 (95% CI 1.4, 3.7) and 6.1 (95% CI 2.7, 13.7) at centers I, II and III, respectively. Based on the proportions of abnormal growth, we required 253 and 71 newborns with fetal growth restriction at centers I and II, respectively, to have narrow confidence intervals around the clinically important LR of 10. The extremely low incidence of IUGR at center III (13%) precluded the estimation of required sample size. CONCLUSION: Use of Evidence-Based Medicine Working Group guidelines indicates that sonographic EFW is slightly to moderately useful in detecting fetal growth restriction in patients with chronic hypertension.

Chronic Disease↗
PubMed2002

Ultrasound estimation of amniotic fluid volume using the largest vertical pocket containing umbilical cord: measure to or through the cord?

OBJECTIVES: The purpose of this investigation was to determine the preferable method, either measuring to the umbilical cord or through the umbilical cord to the base of the pocket, of ultrasonically estimating amniotic fluid volume. SUBJECT AND METHODS: This was a prospective study carried out in singleton pregnancies undergoing a third-trimester amniocentesis. The amniotic fluid index (AFI) and single deepest pocket (SDP) were measured prior to amniocentesis. If measured spaces contained umbilical cord, measurements were made to and through the cord. Actual amniotic fluid volume was determined by the dye-dilution technique. RESULTS: One-hundred pregnancies were evaluated. Low dye-determined volume was identified in a significantly greater number of pregnancies using the AFI to the cord (7/28, 25%) compared to through the cord (2/28, 7%) (P = 0.025). The SDP technique to the cord was superior in low volumes (2/28, 7%) vs. (0/28, 0%) through the cord (although statistical significance could not be determined because there were no low through-the-cord measurements). CONCLUSIONS: For the detection of low amniotic fluid volumes, the AFI to the cord is better than through the cord. Measurement to the cord and through the cord had similar accuracy for both the AFI and SDP techniques in normal and high dye-determined amniotic fluid volumes.

Adolescent↗
PubMed2002

Outpatient cervical ripening with prostaglandin E2 and estradiol.

OBJECTIVE: To determine whether weekly outpatient administration of prostaglandin gel or estrogen cream initiated labor in women with an unfavorable cervix. METHODS: All uncomplicated pregnancies at term gestation who were candidates for a vaginal delivery with a Bishop score of < or = 6 were randomly assigned to receive on a weekly basis: prostaglandin E2 gel (n = 41); estrogen cream (n = 44); or inert lubricant jelly (n = 43). RESULTS: In the three groups no differences were observed among 128 subjects in the weekly Bishop scores, cervical dilatation or gestational age upon admission to the labor and delivery suite, the percentage of patients presenting with spontaneous labor or ruptured membranes, the number of post-date inductions or neonatal outcome. CONCLUSIONS: Weekly out-patient cervical ripening using either prostaglandin gel or estrogen in women with an unfavorable cervix at 37 weeks' gestation was no more effective than a placebo in Bishop score improvement or in preventing post-date inductions.

Ambulatory Care↗
PubMed2002

Repeat postpartum magnesium sulfate administration for seizure prophylaxis: is there a patient profile predictive of need for additional therapy?

OBJECTIVE: To profile patients with hypertensive disorders of pregnancy who require reinstitution of magnesium sulfate therapy for disease exacerbation. STUDY DESIGN: A prospective clinical trial enrolling gravidas with pre-eclampsia. The length of postpartum magnesium sulfate seizure prophylaxis was determined by individual patient characteristics. Patients with exacerbation of their disease after discontinuation of magnesium sulfate received a second course of magnesium sulfate lasting 24 h. RESULTS: Of a total of 503 patients, 38 (7.6%) required reinstitution of postpartum magnesium sulfate therapy for an additional 24-h period. Patients with chronic hypertension complicated by superimposed pre-eclampsia were most likely to require further therapy (11/61, 18.0%), when compared with other hypertensive disorders. Additionally, patients who required reinstitution of magnesium therapy had significantly shorter gestations (32.4 +/- 4.2 weeks versus 36.3 +/- 4.2 weeks, respectively; p < 0.001), and higher mean arterial pressure during the initial magnesium course (113.2 +/- 11.2 versus 105.6 +/- 11.3 mmHg; p < 0.001). CONCLUSION: Patients with chronic hypertension complicated by superimposed pre-eclampsia, patients delivered prior to 35 weeks' gestation and patients requiring a longer initial magnesium prophylaxis are at higher risk for the need of reinstitution of seizure prophylaxis postpartum.

Anticonvulsants↗
PubMed2002

Dye-dilution techniques using aminohippurate sodium: do they accurately reflect amniotic fluid volume?

OBJECTIVE: To determine whether the dye-dilution technique using aminohippurate sodium accurately measures amniotic fluid volume. METHODS: Singleton pregnancies with intact membranes undergoing a Cesarean delivery had their amniotic fluid volume assessed by the dye-dilution technique and direct measurement. RESULTS: Fifteen women were prospectively assessed. Six patients had their amniocentesis on the delivery table and nine patients at 4-24 h prior to the Cesarean delivery. The six women undergoing an amniocentesis just before delivery had good concordance between the dye-determined and direct measurement of amniotic fluid volume (r = 0.99, p = < 0.001). Among the nine women with varying times from amniocentesis to direct measurement, the correlation was not significant (r = 0.36, p = 0.08). The percentage difference between the dye-determined and directly measured amniotic fluid volume was significantly smaller in the women undergoing amniocentesis just prior to delivery (7%) than in the women with varying times from amniocentesis to delivery (37%, P < 0.001). CONCLUSION: Dye-determined amniotic fluid volume accurately reflects actual amniotic fluid volume but the dye-determined concentrations, in vivo, may undergo rapid changes.

Adolescent↗
PubMed2001

Ultrasound estimate of amniotic fluid volume: color Doppler overdiagnosis of oligohydramnios.

OBJECTIVE: To determine if concurrent use of color Doppler affects ultrasound estimates of amniotic fluid (AF) volume. METHODS: Study gravidas underwent ultrasound estimations of AF volume subjectively (visualization without measurements) and objectively (using amniotic fluid index [AFI]) and single-deepest pocket techniques, without and with concurrent color Doppler. Amniocentesis with the dye-dilution technique to measure actual AF volume was utilized for comparison. RESULTS: Sixty-seven women at a mean gestational age of 37.1 +/- 2.5 weeks were entered into this investigation between June 1999 and March 2000. Dye-determined AF volume was classified as low in 18 patients and as high in seven, with the remaining 42 within normal range. Using either ultrasound technique with color Doppler produced significantly lower estimates of AF volume (9.3 +/- 4.9) compared to those without color ([11.6 +/- 5], P <.001) for the AFI and (3.7 +/- 1.5) with color compared to those without color ([4.5 +/- 1.5], P <.003) for the single-deepest pocket. Using AFI without color identified two of 67 (3%) of the pregnancies as having low fluid compared to 14 of 67 ([21%] P =.002) using color. The increased classification of oligohydramnios with color did not accurately identify a greater number of dye-determined low volumes; instead, the AFI with color mislabeled nine pregnancies with normal fluid as low. The diagnosis of dye-determined low and high fluid volumes was not significantly different with or without color. CONCLUSION: Concurrent use of color Doppler with AFI measurements leads to the overdiagnosis of oligohydramnios.

Adolescent↗
PubMed2001

A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

OBJECTIVE: This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficacy end points included laboratory values (platelet count, lactate dehydrogenase activity, aspartate aminotransferase activity) and clinical parameters (mean arterial pressure, urinary output). RESULTS: Forty patients were enrolled in the study, 19 in the dexamethasone arm and 21 in the betamethasone arm. The adjusted time-averaged changes from baseline were significant for aspartate aminotransferase activity (dexamethasone, -20.4 +/- 9.6 U/L; betamethasone, 9.9 +/- 8.9 U/L; P =.029), mean arterial pressure (dexamethasone, -15.6 +/- 1.4 mm Hg; betamethasone, -8.1 +/- 1.4 mm Hg; P <.001), and urinary output (dexamethasone, 12.9 +/- 8.6 mL/h; betamethasone, -11.9 +/- 8.2 mL/h; P =.043). CONCLUSION: Intravenously administered dexamethasone appears to be more effective than intramuscularly administered betamethasone for the antepartum treatment of mothers with HELLP syndrome.

Adult↗
PubMed2001

Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section.

OBJECTIVE: We sought to describe the peripartum outcome of women weighing >300 pounds (135 kg) who were candidates for trial of labor after a prior cesarean delivery. STUDY DESIGN: All pregnant women who weighed in excess of 300 pounds and had a prior cesarean delivery were included in this prospective investigation. Student t test, chi(2) analysis, or Fisher exact tests were used. Odds ratios and 95% confidence intervals were calculated. P <.05 was considered significant. RESULTS: During a 2-year period, 69 patients met the inclusion criteria; 39 (57%) underwent an elective repeat cesarean delivery, and 30 (43%) women attempted a vaginal delivery after prior cesarean delivery. The demographics of age, race, gravidity, maternal weight, and preexisting medical conditions were similar for the two groups. Vaginal birth after prior cesarean delivery occurred in 13% (4/30). Reasons for failure included a labor arrest disorder in 46%, fetal distress in 38%, and failed induction in 15%. The rates of endometritis and wound breakdown were higher in the women undergoing trial of labor (30% and 23%, respectively) than in those undergoing repeat elective cesarean delivery (20% and 8%). The combined infectious morbidity rate was significantly higher for women attempting trial of labor (53%) than those undergoing elective repeat cesarean delivery (28%; odds ratio 1.78, 95% confidence intervals 1.05, 3.02). CONCLUSION: The success rate for a vaginal delivery in the morbidly obese woman with a prior cesarean delivery is less than 15%, and more than half of the patients undergoing a trial of labor have infectious morbidity.

Adult↗
PubMed2001

Change in platelet count predicts eventual maternal outcome with syndrome of hemolysis, elevated liver enzymes and low platelet count.

OBJECTIVE: To profile the rates of change for platelets and lactate dehydrogenase (LDH) in patients with the syndrome of hemolysis, elevated liver enzymes and low platelet count (HELLP) to reflect and possibly predict disease severity. METHODS: Serial determinations of the platelet count and serum LDH were analyzed retrospectively for 545 patients with HELLP syndrome and 94 severely pre-eclamptic patients. A repeated measures (mixed model) analysis of variance (ANOVA) was utilized to estimate the rates of change for LDH and platelets in each group. RESULTS: Patients who developed class 1 or 2 HELLP syndrome exhibited a rapid deterioration in platelet count of 45-50,000/microl per day compared to 30,000/microl per day for class 3 and non-HELLP severe pre-eclampsia. For LDH, values increased at a rate of approximately 1400 IU/l per day, 600 IU/l per day, 300 IU/l per day and 200 IU/l per day for patients with classes 1, 2 and 3 and for non-HELLP severe pre-eclampsia, respectively. CONCLUSION: The rate of change of platelets and LDH appeared to correlate well with eventual syndrome severity and this can be used to enhance patient assessment beyond the value of a single test for either laboratory parameter.

Adult↗
PubMed2001

Does uterine wiping influence the rate of post-Cesarean endometritis?

OBJECTIVE: To compare two methods of uterine cleansing to remove residual amnion-chorion at the time of Cesarean delivery. METHODS: All consenting uninfected parturients undergoing a non-emergency Cesarean delivery at the university were enrolled. All patients received antibiotic prophylaxis of a 1-g intravenous bolus of a first-generation cephalosporin immediately after cord clamping. Postpartum endometritis was defined as a temperature of > or = 100.4 degrees F (38 degrees C) on two occasions 6 h apart after the first 24 h with uterine tenderness and/or foul-smelling lochia. RESULTS: Between January 1998 and February 2000 there were 1400 patients enrolled in this investigation. A total of 153 women were determined to have chorioamnionitis present at surgery and 17 women refused participation, leaving 614 women in the uterine wipe group and 616 in the no wipe group. Maternal demographics were similar between patient groups (NS). Intrapartum factors including gestational age at time of Cesarean section, type of anesthesia used for the operative delivery, hours of amnion rupture prior to delivery, use of internal monitoring devices, type of skin incision, method of placental removal, total operative time and estimated blood loss were similar between patient groups (NS). An almost identical number of patients in each arm of the study developed post-Cesarean endometritis (65 out of 614, 10.5%, in the uterine wipe group vs. 66 out of 616, 10.7%, in the no wipe group; p = 1). CONCLUSIONS: Both methods of removing residual amnion-chorion membrane tissue and associated debris at surgery were comparably effective, but neither produced a dramatic reduction in the incidence of postoperative endometritis.

Adult↗
PubMed2001

Subjective versus objective evaluation of amniotic fluid volume of pregnancies of less than 24 weeks' gestation: how can we be accurate?

This study was undertaken to compare subjective versus objective ultrasonic evaluation of amniotic fluid volume in pregnancies of less than 24 weeks' gestation. Amniotic fluid volume was subjectively (visualization without ultrasonic measurements) and objectively (visual interpretation with ultrasonic measurements) evaluated in 42 singleton pregnancies undergoing termination. The actual amniotic fluid volume was then determined using a dye-dilution technique. The women evaluated were in their mid-20s, primarily African American, and between 15 and 23 weeks' gestation. There was no significant difference in the total number of correct estimates of amniotic fluid volume when the data were stratified by level of operator experience (P = .34), ultrasonic technique (P = .33), or the combined correct subjective versus combined correct objective estimates (P = .68). We have concluded that the accuracy of amniotic fluid volume assessment in pregnancies of less than 24 weeks is not influenced by the level of operator experience or the type of ultrasonic measurement.

Amniotic Fluid↗
PubMed2001

Maternal morbidity and mortality associated with intrauterine fetal demise: five-year experience in a tertiary referral hospital.

BACKGROUND: Risk factors for and management of intrauterine fetal demise (IUFD) have been investigated, but the maternal morbidity has not been evaluated. METHODS: Over a 60-month interval, all cases of IUFD after 20 weeks' gestation were reviewed for maternal trauma and maternal postpartum complications. RESULTS: In this retrospective analysis, 498 singleton and 24 twin pregnancies with an IUFD were identified. A cervical or perineal laceration requiring surgical repair complicated 9.4% of pregnancies. One uterine dehiscence and one uterine rupture occurred. Endometritis, the most common postpartum complication, occurred in 63 of 522 patients (12%). One maternal death occurred. Total mean hospital stay was 4.9 +/- 5.7 days. CONCLUSION: Maternal morbidity and rarely mortality can follow IUFD, but this morbidity is similar to that observed without IUFD.

Adult↗
PubMed2001

Labor and membrane rupture in twin gestation. Can they affect the ability to estimate fetal weight?

OBJECTIVE: To determine whether labor or fetal membrane rupture adversely affects the ability of ultrasound to accurately estimate fetal weight (EFW) in a twin gestation. STUDY DESIGN: A medical record audit was performed of the two-year experience of women delivering live born twins and undergoing a complete ultrasound examination within 72 hours of delivery. Those patients experiencing labor or membrane rupture at the time of the previous ultrasound examination were compared to those without these factors to determine if there was any detrimental impact on the accuracy of ultrasound to EFW. RESULTS: The overall ability of ultrasound to accurately EFW was in the range of 64-76%. This was not significantly different from the accuracy in women experiencing labor (62-80%) or in women with membrane rupture (63-81%). The ability of ultrasound to detect fetal discordance is this series ranged from 78% to 100%, with specificity that ranged from 84% to 89%. CONCLUSION: The ability of sonography to accurately EFW as well as detect discordant twin gestation is not altered by the presence of labor or membrane rupture.

Adult↗
PubMed2000

Amniotic fluid index and single deepest pocket: weak indicators of abnormal amniotic volumes.

OBJECTIVE: To compare amniotic fluid index (AFI) with the single deepest pocket in the identification of actual abnormal amniotic fluid (AF) volumes. METHODS: One hundred seventy-nine women with singleton pregnancies at the University of Mississippi between March 1994 and June 1999 had ultrasound estimations of AF volume sequentially using the AFI and single deepest pocket techniques. Each woman subsequently had ultrasound-directed amniocentesis with dye-dilution and spectrophotometric calculation of actual AF volume. RESULTS: Actual AF volumes were low (under 5% by volume for gestational age) in 62 women, normal (5-95%) in 100 women, and high (more than 95%) in 17 women. An AFI up to 5 cm (sensitivity 10%, specificity 96%) and a single deepest pocket up to 2 cm (sensitivity 5%, specificity 98%) were similarly inadequate in identifying dye-determined low AF volumes. Likewise, AFI above 20 (sensitivity 29%, specificity 97%) and a single-deepest pocket above 8 cm (sensitivity 29%, specificity 94%) were poor in identifying dye-determined abnormally high volumes. CONCLUSION: There was no difference between AFI and single deepest pocket techniques for identifying truly abnormal AF volumes. Both techniques were unreliable for identifying true AF volumes.

Adult↗