Biomedical subjects

E F Magann

Publications and source records attributed to E F Magann.

At least 55 records · Page 3Linked to original sources

PubMed1999

Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis.

OBJECTIVE: Our purpose was to perform a meta-analysis of studies on the risks of cesarean delivery for fetal distress, 5-minute Apgar score <7, and umbilical arterial pH <7.00 in patients with antepartum or intrapartum amniotic fluid index >5.0 or <5.0 cm. STUDY DESIGN: Using a MEDLINE search, we reviewed all studies published between 1987 and 1997 that correlated antepartum or intrapartum amniotic fluid index with adverse peripartum outcomes. The inclusion criteria were studies in English that associated at least one of the selected adverse outcomes with an amniotic fluid index of </=5.0 cm versus >5.0 cm. Contingency tables were constructed for each study, and relative risks and standard errors of their logs were calculated. Fixed-effects pooled relative risks were calculated for groups of studies that were homogeneous, whereas random-effects pooled relative risks were calculated for significantly heterogeneous groups of studies. RESULTS: Eighteen reports describing 10,551 patients met our inclusion criteria. An antepartum amniotic fluid index of </=5.0 cm, in comparison with >5.0 cm, is associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 2.2; 95% confidence interval, 1.5-3.4) and an Apgar score of <7 at 5 minutes (pooled relative risk, 5.2; 95% confidence interval, 2.4-11.3). An intrapartum amniotic fluid index of </=5.0 cm is also associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 1.7; 95% confidence interval, 1.1-2.6) and an Apgar score <7 at 5 minutes (pooled relative risk, 1.8; 95% confidence interval, 1.2-2.7). A poor correlation between the amniotic fluid index and neonatal acidosis was noted in the only study that examined this end point. More than 23,000 patients are necessary to demonstrate that the incidence of umbilical arterial pH <7.00 is 1.5 times higher among those with oligohydramnios in labor than among those with adequate amniotic fluid index (alpha = 0.05; beta = 0.2) CONCLUSIONS: An antepartum or intrapartum amniotic fluid index of </=5.0 cm is associated with a significantly increased risk of cesarean delivery for fetal distress and a low Apgar score at 5 minutes. There are few reports linking amniotic fluid index and neonatal acidosis, the only objective assessment of fetal well-being. A multicenter study with sufficient power should be undertaken to demonstrate that a low amniotic fluid index is associated with an umbilical arterial pH <7.00.

Acidosis↗

PubMed1999

Risk factors for secondary arrest of labor among women >41 weeks' gestation with an unfavorable cervix undergoing membrane sweeping for cervical ripening.

OBJECTIVE: To identify the risk factor(s) for secondary arrest of labor among women with an unfavorable cervix at > 41 weeks' gestation. METHODS: Prospectively all gravid women with a Bishop score of < or = 4 and no contraindication to a vaginal delivery were candidates for this study. Univariate analysis followed by logistic regression modeling were used to identify variables with a significant association. RESULTS: Over a 9-month period, 115 women entered into the study. In univariate analysis, variables with a significant association with cesarean delivery: (1) non-Caucasian race (P = 0.007), Bishop score < 7 at hospitalization; P = 0.001, and reason for admission (P = 0.017). Logistic regression analysis yielded OR 4.7 (1.6, 15) non-Caucasian race and 9.5 (3.2, 30.8) Bishop < 7 on admission. CONCLUSION: Pregnancies > 41 weeks with an unfavorable cervix, non-Caucasian race and a failure to achieve a Bishop score of > or = 7 prior to hospitalization were significant risk factors for abdominal delivery.

Cervical Ripening↗

PubMed1999

Detection of growth-restricted fetuses in preeclampsia: a case-control study.

OBJECTIVE: To determine the diagnostic accuracy of detecting growth-restricted fetuses in women with and without preeclampsia. METHODS: Over 2 years, parturients with reliable gestational ages, preeclampsia, and sonographic estimates of birth weights were matched (1:1) for gestational age with women without preeclampsia. Paired and unpaired t tests were used; P < .05 was significant. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Two hundred eighty-seven preeclamptic women were identified and matched. In each group, mean (+/- standard deviation [SD]) gestational age was 34.9 +/- 4.2 weeks, and 166 (57.8%) infants were born preterm. Fetal growth restriction (FGR) was significantly more common among women with preeclampsia (14.9%) than among controls (5.6%; OR 2.98, 95% CI 1.64, 5.44). The percentage of sonographic estimates within 10% of actual birth weight (57.5% versus 53.6%) was similar in the two groups (OR 1.16; 95% CI 0.84,1.62). Compared with normal growth, the mean (+/- SD) standardized absolute error was significantly higher among those with FGR regardless of group (preeclampsia 109 +/- 100 versus 158 +/- 152 g/kg; P = .009; control 117 +/- 103 versus 233 +/- 206 g/kg; P < .001). Fetal growth restriction was detected more commonly among preeclamptic women than among controls (11.6% versus 0%; OR 4.74 95% CI 0.25, 90.31). The sensitivity and positive predictive value of FGR detection were 10% and 50%, respectively, among women with preeclampsia and 0% each among controls. CONCLUSION: Although FGR was detected more frequently in fetuses of women with preeclampsia than in those of controls, the ability to predict it with sonography remained poor.

Adult↗

PubMed1999

Amniotic fluid volume assessment in singleton and twin pregnancies.

The best method of ultrasonic mensuration to identify abnormal AFV reliably in singletons and the individual sacs of diamniotic twins remains elusive. With respect to twins, localization of the dividing membrane seems to be necessary for AFV assessments of each amniotic cavity. The relationship of ultrasonic estimates, actual AFV, and pregnancy outcome remains undetermined. In the authors' opinion, the subjective assessment in twin gestation may be as accurate as semiquantitative ultrasonic estimates of AFV, similar to the situation in singleton pregnancies. The authors propose that further prospective research address the following questions: (1) What is the appropriate threshold for intervention when AFI decreases to lower ranges? (2) What other factors (e.g., cervical examination, fetal heart rate patterns, underlying obstetric conditions, fetal growth pattern) are important when the AFI falls to low values in making clinical decisions?

Amniotic Fluid↗

PubMed1999

Membrane sweeping versus dinoprostone vaginal insert in the management of pregnancies beyond 41 weeks with an unfavorable cervix.

OBJECTIVE: To determine the best method of cervical ripening to prevent postdate inductions in women with an unfavorable cervix at 41 weeks' gestation. STUDY DESIGN: Women presenting at 41 weeks' gestation with a Bishop score of < or = 4 received daily dinoprostone (Cervidil) vaginal inserts (group I) or daily membrane sweeping (group II). RESULTS: One-hundred and eighty-two women were prospectively randomized with 91 women in each arm. The women in group II, membrane sweeping, had Bishop scores significantly greater on admission for delivery (p < 0.001), had less time elapsed from admission to delivery (p = 0.018), and had fewer labor inductions at 42 weeks (p = 0.04) than the women in group I, the dinoprostone group. In addition, a greater number of women in group II were admitted in spontaneous labor (p = 0.006) than in group I. Total antenatal costs for the membrane sweeping group was $15,120 versus $59,540 for the dinoprostone group. CONCLUSION: Daily membrane sweeping was more effective than dinoprostone administration with fewer postdate inductions at one-fourth the cost.

Adult↗

PubMed1999

Twelve steps to optimal management of HELLP syndrome.

The early diagnosis and treatment of HELLP syndrome remains problematic for the obstetric health care provider. The nonspecific signs and symptoms of this disorder early in the disease process make the accurate diagnosis difficult and delays early treatment, which has the best prognosis for both maternal and perinatal outcome. The introduction of high-dose nonmineralocorticosteriods to assist in the treatment of these patients is an exciting new development. Use of the 12-step approach to the diagnosis and management of pregnancies complicated by HELLP syndrome has proven to be a successful tool to help us achieve the best possible maternal and perinatal outcome.

Anticonvulsants↗

PubMed1999

Preeclampsia-associated hepatic hemorrhage and rupture: mode of management related to maternal and perinatal outcome.

This article is a critical review of the obstetric literature concerning preeclampsia-associated hepatic hemorrhage to develop guidelines conducive to optimal maternal and perinatal outcomes. An English literature search was performed for reports of hepatic hemorrhage or hepatic rupture in pregnancy during 1960 to 1997. Data were analyzed by Statmost packages using ANOVA, Chi-square, and Fisher's exact tests. One hundred forty-one patients with hepatic rupture/hemorrhage were reported. The three most common presenting findings were epigastric pain, hypertension, and shock. With rare exception, patients had evidence of preeclampsia. Diagnosis was elusive and most frequently accomplished at laparotomy. When utilized, ultrasound and computed tomography (CT) were helpful diagnostic modalities. Maternal survival was highest in the arterial embolization treatment group. Maternal and perinatal survival improved considerably during the study interval. Route of delivery did not seem to impact survival rates. It was concluded that the application of ultrasound and CT for diagnosis and the use of hepatic artery embolization for treatment of hepatic hemorrhage/rupture seem to be beneficial management options for this rare event.

Antibodies, Monoclonal↗

PubMed1999

Low amniotic fluid volume is poorly identified in singleton and twin pregnancies using the 2 x 2 cm pocket technique of the biophysical profile.

BACKGROUND: This study was done to determine the accuracy of the 2 x 2 cm pocket identifying low amniotic fluid (AF) volume in singleton and twin pregnancies. METHODS: The AF volume was evaluated by ultrasonography for the presence of a 2 x 2 cm pocket before amniocentesis. The actual AF volume was then determined by a diazo-dye reaction with subsequent spectrophotometric analysis using paraminohippurate. RESULTS: The AF volume was low in 21 of the 79 singleton pregnancies and normal in 47; hydramnios was present in 11. Among amniotic sacs of the 60 twin pairs, oligohydramnios was found in 33 amniotic sacs. normal AF volume in 80 sacs, and high volume in 7. An AF pocket smaller than 2 x 2 cm was identified in only 3 of the 79 singleton pregnancies and in only 2 of the 120 twin amniotic sacs. CONCLUSIONS: Judging AF volume on the basis of a 2 x 2 cm pocket misses more than 90% of cases of oligohydramnios in singletons and twins.

Adolescent↗

PubMed1999

Amniotic fluid index in normal pregnancy: a longitudinal study.

OBJECTIVE: This longitudinal study was undertaken to characterize the change in the amniotic fluid volume in normal pregnancy. METHODS: Prospectively, patients with uncomplicated gestations underwent serial amniotic fluid index by a single sonographer. RESULTS: Fifty-six patients underwent a total of 378 determinations of amniotic fluid volume (6.8 +/- 2.5 examinations per patient). The variation in mean amniotic fluid index between 24 and 40(+6) weeks was not significantly different (p = 0.381). Among the 42 patients who delivered at term there was no significant decrease in the amniotic fluid index between their first and last measurement (p = 0.86). However, in the 14 patients who delivered after 41 weeks, there was a significant decrease in the index over time (p = 0.04). CONCLUSION: The longitudinal study on amniotic fluid volume in normal pregnancy reveals that amniotic fluid index does not change significantly with gestational age.

Adult↗

PubMed1999

Dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets.

OBJECTIVE: Patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial. METHOD: A single case report and review of the literature. RESULT: We report a patient with HELLP syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum. CONCLUSION: Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with HELLP syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.

Adult↗

PubMed1999

May-Hegglin anomaly in a pregnancy complicated by intrauterine growth restriction and ambiguous genitalia.

OBJECTIVE: Thrombocytopenia as a hematologic disorder complicates up to 4% of all pregnancies. May-Hegglin anomaly is a rare cause of low platelets in pregnancy. METHODS: A case of May-Hegglin anomaly complicating pregnancy and intrauterine growth restriction in a fetus with ambiguous genitalia is described. RESULTS: The antepartum and intrapartum diagnosis and management of a patient diagnosed with May-Hegglin anomaly is discussed. The involvement and consultation of a perinatologist, neonatologist, internist, and anesthesiologist is reviewed, with emphasis on the mode of delivery. CONCLUSION: The potential maternal and fetal complications associated with May-Hegglin anomaly warrant early pregnancy diagnosis and access to a tertiary care facility.

Disorders of Sex Development↗

PubMed1999

Accuracy of sonographically estimated fetal weight with and without oligohydramnios. A case-control study.

OBJECTIVE: To determine the accuracy of sonographically estimated fetal weight among women with and without oligohydramnios (amniotic fluid index [AFI] < or = 5.0 cm) and to ascertain the ability to detect fetal growth restriction (FGR) (estimated birth weight < 10th percentile for gestational age [GA]) among patients in two groups. STUDY DESIGN: Assuming that 50% of sonographic predictions are within 10% of the birth weight in the study group, 300 parturients are necessary to show a difference of 15% among controls (alpha = .05, beta = .02). The study group consisted of parturients with a reliable GA of > or = 24, no known anomalies and known AFI of < or = 5.0 cm. The control (1:1) was the next patient with the same GA but AFI between 5.1 and 23.9 cm. The paired t test was used, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. P < .05 was considered significant. RESULTS: Among the study and control groups (N = 162 each), maternal demographics, mean estimate (P = .078) and actual birth weight (P = .091) were similar. Sonographic estimates within 10% of weight were not significantly different among those with (57%) and without oligohydramnios (59%; OR 0.92; 95% CI 0.59, 1.44). The frequency of FGR was higher among those with inadequate fluid (18%) than controls (9%; OR 2.13; 95% CI 1.10, 4.16). Sensitivity, positive predictive value and likelihood ratio were higher among those with oligohydramnios (76%, 78% and 16) than controls (53%, 42% and 7). CONCLUSION: The accuracy of sonographic estimates of fetal weight is not influenced by whether the parturient has oligohydramnios. Moreover, the accuracy of identifying FGR is not diminished among those with AFI < or = 5.0 versus > 5.0 cm.

Adult↗

PubMed1998

Can we decrease postdatism in women with an unfavorable cervix and a negative fetal fibronectin test result at term by serial membrane sweeping?

OBJECTIVE: Our purpose was to determine whether the risk for postdatism can be reduced by serial membrane sweeping in women with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin test result. STUDY DESIGN: Women with uncomplicated pregnancies, who were candidates for a vaginal delivery with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin test result were asked to participate in this investigation. Patients were chosen at random and assigned to a group for membrane sweeping every 3 days or to a control group who received gentle examinations every 3 days. RESULTS: Sixty-five women were selected at random for serial membrane sweeping (n = 33) or for the control group (n = 32). Although gestational age and Bishop score at study entry were similar, the gestational age on admission for delivery was earlier in the membrane sweeping group (39.9 +/- 0.3) versus the control group (41.5 +/- 0.6, P < .0001). The Bishop score on admission to labor and delivery was greater (8.8 +/- 2.1) in the membrane sweeping group than in the control group (6.2 +/- 2.7, P < .0001). The number of women admitted for labor inductions at 42 weeks' gestation was 18 of 32 (56%) in the control group versus none (0 of 24) in the membrane-sweeping group (P < .0001). CONCLUSIONS: Women with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin test result are at risk for not being delivered by 41 completed weeks and thus may require postdates induction or antenatal testing. Serial membrane sweeping significantly reduces the risk of postdatism and induction of labor.

Cervical Ripening↗

PubMed1998

Management of pregnancies beyond forty-one weeks' gestation with an unfavorable cervix.

OBJECTIVE: Our purpose was to determine the optimal management of pregnancies beyond 41 weeks' gestation with a cervix unfavorable for induction. STUDY DESIGN: All uncomplicated pregnancies that reached 41 weeks' gestation with a Bishop score of < or = 4 were randomly assigned to one of three groups: (1) daily cervical examinations, (2) daily membrane stripping, or (3) daily placement of prostaglandin gel until 42 weeks. RESULTS: In 105 pregnancies the Bishop score on admission to labor and delivery was significantly greater in the groups receiving prostaglandin or stripping of the membranes versus the control group, whereas the converse was time of gestational age at delivery (p = 0.0001). Fewer patients required induction in the two treatment groups (20%, 17%) versus the control (69%) patients (p < 0.0001). CONCLUSIONS: Daily membrane stripping or daily placement of prostaglandin gel is successful in reducing the number of inductions at 42 weeks for postdatism.

Administration, Intravaginal↗

PubMed1998

Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients.

OBJECTIVE: To compare the accuracy of clinical and sonographic estimates of fetal weight made throughout the third trimester of pregnancy. METHODS: Patients in early labor had fetal weight estimated by two approaches: 1) clinical evaluation and palpation followed by 2) sonographic mensuration of fetal biparietal diameter, abdominal circumference, and femur length applied to Hadlock's formula. The accuracy of these two methods of estimating fetal weight was compared using Student t test, Wilcoxon test, and chi2 tests. P < .05 was considered significant. Prediction limits (50th, 90th, and 95th percentiles) were calculated for both techniques by obtaining the range of actual weights associated for a particular estimated fetal weight (EFW). RESULTS: We enrolled 1034 parturients whose clinical EFWs yielded significantly higher mean (+/- standard deviation) simple error (48.2 +/- 411 g) and standardized absolute error (130 +/- 122 g/kg) than were obtained by use of sonographic formulas for EFW (-6.6 +/- 381 g and 104 +/- 89 g/kg, respectively). When the population was partitioned by gestational age, we found that sonographic EFW was more accurate than clinical EFW in preterm (n = 373) but not in term (n = 460) or post-term (n = 201) pregnancies. Prediction limits indicate that for a given EFW, for example, 800 g, the 90% ranges of actual weight based on clinical and sonographic EFW are 566-1829 g and 469-1667 g, respectively. CONCLUSION: The apparent superiority of sonographic EFW over clinical EFW applies principally to preterm pregnancies. The prediction limitation calculation suggests that either method, for any particular estimate between 500 and 4500 g, has limited value in the estimation of actual birth weight, because this outcome is highly variable and frequently lies outside of the useful bandwidth (+/- 10%) for prospective management.

Adult↗

PubMed1998

Intrapartum amniotic fluid index: a poor predictor of abnormal fetal size.

OBJECTIVE: Using receiver-operating characteristic (ROC) curves, we tried to determine the diagnostic threshold of amniotic fluid index (AFI) that will identify abnormal fetal size (birth weights under 2500 g or at least 4000 g) at 37 weeks or beyond. METHODS: We analyzed prospectively over 2 years all parturients with intact membranes and known AFI in early labor. Patients with the following conditions were excluded: pregestational or gestational diabetes, known anomalies, and preterm labor. Two ROC curves were constructed, and the areas (+/- standard error of the mean [SE]) under the curves were calculated. P < .05 was considered significant. RESULTS: Of the 1038 subjects meeting study criteria, 3.6% and 11.5% gave birth to infants who were small for gestational age (SGA) or macrosomic, respectively. Overall, 28.7% had oligohydramnios (AFI at most 5.0 cm) and 3.6% had hydramnios (AFI at least 24.0 cm). Small for gestational age was more common in patients with AFI at most 5.0 cm (6.4%) than in those with adequate fluid (AFI 5.1-23.9; 2.5%), or hydramnios (2.7%; P = .012). Macrosomic newborns were less likely to be born to women with oligohydramnios (7.7%) than to those with adequate amniotic fluid (13.1%) or hydramnios (13.5%). Areas under ROC curves are not significantly different from the area under the nondiagnostic line, indicating that AFI (0-34 cm) cannot differentiate between newborns under 2500 g and at or over 2500 g or under 4000 and at or more 4000 g. CONCLUSION: Intraparterium AFI appears to be a poor screening test to identify risk for delivery of SGA or macrosomic fetus.

Adult↗

PubMed1998

Bishop score: a poor diagnostic test to predict failed induction versus vaginal delivery.

BACKGROUND: We evaluated the accuracy of the Bishop score in predicting the likelihood of successful labor induction (entry into active phase) in nulliparous and multiparous women. METHODS: During an index year, all patients having induction of labor and a preinduction Bishop score were included in a standard protocol for cervical ripening and use of oxytocin. Receiver-operating characteristic (ROC) curves were constructed for Bishop scores (0 to 11) to predict abdominal delivery for failed induction (final cervical dilation <4 cm) versus vaginal delivery. RESULTS: Parturients who had vaginal delivery (n = 253) and those in whom attempted induction failed (n = 38) did not differ significantly with respect to maternal demographics, length of gestation, Bishop score and its distribution, and infant birth weight. The area under the ROC curve did not differ significantly from the area under the nondiagnostic line. CONCLUSION: The Bishop score appears to be a poor predictor of the outcome of labor induction.

Adult↗

PubMed1998

Absence of seasonal variation on the frequency of HELLP syndrome.

BACKGROUND: We wanted to determine the relationship between weather/seasonal conditions and the incidence/severity of HELLP syndrome. METHODS: We retrospectively reviewed medical records of all patients with class 1 (platelet nadir < or = 50,000/microL), class 2 (platelet nadir > 50,000/microL but < or = 100,000/microL), and class 3 (platelet nadir > 100,000/microL but < or = 150,000/microL) HELLP syndrome, who had been treated at the University of Mississippi Medical Center between January 1, 1980, and December 31, 1992. RESULTS: No seasonal differences were observed in the incidence or severity of pregnancies complicated by HELLP syndrome. CONCLUSION: HELLP syndrome appears to occur throughout the year without any seasonal variation.

Female↗