Biomedical subjects

Everett F Magann

Publications and source records attributed to Everett F Magann.

At least 19 recordsLinked to original sources

PubMed2006

Does magnesium sulfate reduce the short- and long-term requirements for pain relief after caesarean delivery? A double-blind placebo-controlled trial.

OBJECTIVE: The purpose of this study was to determine whether magnesium sulfate decreases postoperative pain and analgesic consumption. STUDY DESIGN: Women who underwent elective cesarean delivery were randomized into groups according to high-dose magnesium sulfate (50 mg/kg load and 2 g/h), low-dose magnesium sulfate (25 mg/kg load and 1 g/h), or placebo. Before the delivery, the dose of patient-controlled opioid that was used and the visual analogs of pain during the first 48 hours after delivery and at 6 weeks were assessed. RESULTS: Forty-two women were assigned randomly to the high-dose arm; 38 women were assigned to the low-dose magnesium arms, and 40 women were assigned to the control arm. The cumulative opioid use (P = .636); pain scores at 6, 12, 24, and 48 hours at rest (P = .786) and with movement (P = .179); the use of analgesics after hospital discharge (P = .711); and wound pain with movement (P = .429) or pressure (P = .144) after 6 weeks were similar. CONCLUSION: Magnesium sulfate does not reduce the severity of short-term or long-term (6 weeks) pain after cesarean delivery.

Adult↗

PubMed2006

American College of Obstetricians and Gynecologists practice bulletins: an overview.

OBJECTIVE: The purpose of this study was to review the American College of Obstetricians and Gynecologists practices bulletins to quantify the type of recommendations and references and determining whether there are any differences between obstetric and gynecologic bulletins. STUDY DESIGN: All practice bulletins published from June 1998 to December 2004 were reviewed. Odds ratios and 95% confidence intervals were calculated. RESULTS: The 55 practice bulletins contained 438 recommendations of which 29% are level A, 33% level B, and 38% level C. The 55 bulletins cite 3953 references of which 17% are level I, 46% level II, 34% level III, and 3% others. Level A recommendations were significantly more likely among the 23 gynecologic than 32 obstetric bulletins (37% versus 23%, odds ratios 1.95, 95% confidence intervals 1.28, 2.96). The study types referenced in obstetric and gynecologic bulletins were similar (P > .05 for comparison of levels I, II, and III and meta-analysis references). CONCLUSION: Only 29% of the American College of Obstetricians and Gynecologists recommendations are level A, based on good and consistent scientific evidence.

Evidence-Based Medicine↗

PubMed2006

Ludwig's angina in pregnancy.

Ludwig's angina is an infectious process involving the submental, sublingual, and submandibular spaces that can rapidly progress to hemodynamic instability and airway loss. Treatment involves antibiotics, incision, drainage and the placement of extraoral drains. This is the first reported recent case of Ludwig's angina in a pregnant patient.

Adult↗

PubMed2006

Suspicion of intrauterine growth restriction: Use of abdominal circumference alone or estimated fetal weight below 10%.

OBJECTIVE: To determine, among patients at risk for intrauterine growth restriction (IUGR), the peripartum outcomes and predictive accuracy for those with normal abdominal circumference (AC) and estimated fetal weight (EFW) for gestational age (GA; group 1) versus those with AC < or = 10% for GA but EFW>10% (group 2) versus those with AC and EFW < or = 10% for GA (group 3). STUDY DESIGN: We identified, retrospectively, non-anomalous singleton pregnancies with reliable GA, and delivery within 21 days of the examination who were referred for possible IUGR. Odds ratios (OR) and 95% confidence intervals (CI) were calculated, as were likelihood ratios (LR) for detection of small for gestational age (SGA) (birth weight < or = 10% for GA; SGA). RESULTS: Among the 169 consecutive patients who met the inclusion criteria, the prevalence of SGA was significantly higher for group 3 (80%) than group 1 (42%; OR 4.26, 95% CI 1.94-9.16) or group 2 (49%; OR 5.49, 95% CI 2.13-13.85). The rate of admission to the neonatal intensive care unit (67%, 34%, and 36% for groups 3, 2, and 1, respectively) and the combined perinatal morbidity (35%, 23%, and 15%) were different for the three groups. The LR for detection of SGA was 1.2 (95% CI 1.0-1.4) for group 2 and 2.8 (95% CI 1.6-4.9) for group 3. CONCLUSIONS: Among patients suspected for IUGR, the peripartum outcome is poorest for those with AC and EFW < or = 10% for GA, than for those with AC < or = 10% but EFW>10%. The detection of SGA is poor regardless of whether just AC or AC plus EFW are < or = 10%.

Abdomen↗

PubMed2006

The 80-hour workweek restriction: How are OB/GYN resident procedure numbers affected?

OBJECTIVE: To evaluate the surgical caseload in a military obstetrics and gynecology residency program, prior to and after implementation of an 80-hour workweek. METHODS: A retrospective cohort study evaluating data submitted to the Accreditation Council for Graduate Medical Education (ACGME) for cumulative resident procedures in obstetrics and gynecology for the years before (July 2001-June 2002) and after (July 2002-June 2003) 80-hour workweek implementation. Total obstetric and gynecology procedures were examined using both the Student's paired t-test and a two-way mixed factor analysis of variance. RESULTS: Between July 2001 and June 2002 there were 822 gynecological cases and 3958 deliveries done by 17 OB/GYN residents; these were compared with 827 cases and 3504 deliveries done by 18 OB/GYN residents between July 2002 and June 2003 (p=0.189). The total numbers of obstetric and gynecology cases pre- and post-80-hour workweek intervention were similar when evaluated by month (July through June of 2001/2 vs. 2002/3; p=0.908). There was a significantly greater number of obstetrics cases compared with gynecological cases (p < 0.001) in the pre- vs. post-80-hour workweek groups; the number of gynecological cases remained constant in the post-80-hour workweek group while the obstetric numbers dropped (p=0.001). CONCLUSION: The 80-hour workweek restriction resulted in similar total numbers of obstetrics and gynecology cases, although the total number of obstetric cases per resident declined after implementation.

Cohort Studies↗

PubMed2006

Screening for fetal growth restriction.

Since antenatal detection of fetal growth restriction, defined as birth weight <10% for gestational age, can reduce perinatal morbidity with antepartum testing and use of Doppler, it is imperative that there be a greater effort to detect the growth abnormality. According to a well-conducted randomized clinical trial, all uncomplicated pregnancies should have sonographic assessment of birth weight at 30-32 weeks and at 36-37 weeks. An increased awareness not only of the risk factors but also of the associated probability of abnormal growth can identify the cohorts that would benefit from uterine artery Doppler in 2nd trimester. Among patients at risk for suboptimal growth, Doppler of the umbilical artery improves the detection rate.

Birth Weight↗

PubMed2006

Milk-alkali syndrome presenting as acute renal insufficiency during pregnancy.

BACKGROUND: Gastroesophageal reflux is common during pregnancy. Hypercalcemia from overuse of antacids can lead to complications, including the milk-alkali syndrome. CASE: A multiparous patient, at 35 weeks of gestation, was admitted to evaluate an unexplained increase in her serum creatinine (0.6 mg/dL to 1.4 mg/dL). She was normotensive and asymptomatic. Her serum calcium was 16.2 mg/dL. She reported significant gastric reflux symptoms and was taking a calcium-based antacid at high doses. She was treated with aggressive hydration. Her calcium and renal function normalized with no further complications. CONCLUSION: Overuse of calcium-containing medications can cause milk-alkali syndrome. Vigorous hydration is generally adequate treatment, and education regarding calcium intake is important to prevent occurrence.

Antacids↗

PubMed2006

Timing of placental delivery to prevent post-partum haemorrhage: lessons learned from an abandoned randomised clinical trial.

It has been recognised that, if the length of the third stage of labour exceeds 30 min, then there is an increased risk of a post-partum haemorrhage. Recent information has suggested that 18 min is the optimal time for removal of the undelivered placenta to prevent a post-partum haemorrhage. A randomised trial comparing 20 vs. 30 min was stopped after an interim analysis because only eight of 1607 patients' placentas had not delivered by 20 min. A third stage of labour that exceeded 10 min was observed to be significantly correlated with an increased risk of post-partum haemorrhage.

Adult↗

PubMed2005

Suspicion and treatment of the macrosomic fetus: a review.

OBJECTIVE: To review the prevalence of and our ability to identify macrosomic (birthweight >4000 g) fetuses. Additionally, based on the current evidence, propose an algorithm for treatment of suspected macrosomia. STUDY DESIGN: A review. RESULTS: According to the National Vital Statistics, in the United States, the prevalence of newborns weighing at least 4000 g has decreased by 10% in seven years (10.2% in 1996 and 9.2% in 2002) and 19% for newborns with weights >5000 g (0.16% and 0.13%, respectively). Bayesian calculations indicates that the posttest probability of detecting a macrosomic fetus in an uncomplicated pregnancy is variable, ranging from 15% to 79% with sonographic estimates of birth weight, and 40 to 52% with clinical estimates. Among diabetic patients the post-test probability of identifying a newborn weighing >4000 g clinically and sonographically is over 60%. Among uncomplicated pregnancies, there is sufficient evidence that suspected macrosomia is not an indication for induction or for primary cesarean delivery. For pregnancies complicated by diabetes, with a prior cesarean delivery or shoulder dystocia, delivery of a macrosomic fetus increases the rate of complications, but there is insufficient evidence about the threshold of estimated fetal weight that should prompt cesarean delivery. CONCLUSION: Due to the inaccuracies, among uncomplicated pregnancies suspicion of macrosomia is not an indication for induction or for primary cesarean delivery.

Algorithms↗

PubMed2005

Use of fetal pulse oximetry among high-risk women in labor: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to determine the clinical role of fetal pulse oximetry to reduce cesarean delivery for a nonreassuring fetal heart rate tracing. STUDY DESIGN: Singletons > or =28 weeks were randomized to fetal pulse oximetry plus electronic fetal heart rate monitoring (monitoring + fetal pulse oximetry) or monitoring alone. RESULTS: Overall, 360 women in labor were recruited: 150 cases with monitoring+fetal pulse oximetry and 177 cases with monitoring alone were analyzed. Most demographic, obstetric, and neonatal characteristics were similar. Specifically, the gestational age, cervical dilation, and station of the fetal head were not differential factors. In addition, cesarean delivery for nonreassuring fetal heart rate tracing was not different between the group with monitoring+fetal pulse oximetry (29%) and the group with monitoring alone (32%; relative risk, 0.95; 95% CI, 0.75, 1.22). Likewise, cesarean delivery for arrest disorder was similar between the group with monitoring+fetal pulse oximetry (22%) and the group with monitoring alone (23%; relative risk, 1.05; 95% CI, 0.79, 1.44). However, the decision-to-incision time was shorter for the group with monitoring+fetal pulse oximetry (17.8 +/- 8.2 min) than for the group with monitoring alone (27.7 +/- 13.9 min; P < .0001). CONCLUSION: The use of fetal pulse oximetry with electronic fetal heart rate monitoring does not decrease the rate of cesarean delivery, although it does alter the decision-to-incision time.

Adult↗

PubMed2005

Professional liability claims and Central Association of Obstetricians and Gynecologists members: myth versus reality.

OBJECTIVE: The purpose of this study was to survey members of the Central Association of Obstetricians and Gynecologists about professional liability claims. STUDY DESIGN: A survey was mailed to Central Association of Obstetricians and Gynecologists members regarding medical liability experience. RESULTS: Of the 897 surveys mailed, 73% were completed. The responding 658 clinicians had been in practice for 17,136 years and had 1507 closed claims. The respondents had a claim every 11 years of practice and a trial every 69 years. Matched for years of practice, a case control comparison indicated that the litigation is significantly lower for female physicians (1.5 +/- 1.8) than for male physicians (2.2 +/- 2.0; P = .019) although the mean cases that were dropped or dismissed were higher for men (1.3 +/- 1.7 vs 0.8 +/- 1.4; P = .022). However, the mean number of trials, defense trial verdicts, and the settlement amounts were similar for both genders. CONCLUSION: We found that professional liability claims are uncommon and that the gender of the obstetrician-gynecologist influences the litigation profile.

Adult↗

PubMed2005

Brachial plexus injury: a 23-year experience from a tertiary center.

OBJECTIVE: The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. STUDY DESIGN: A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. RESULTS: During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. CONCLUSION: A case of brachial plexus injury occurs 1 time in every 1000 births, is permanent in 1 of every 10,000 deliveries, and is litigated 1 time for every 45,000 deliveries. The infrequent nature of injury may preclude prevention.

Adult↗

PubMed2005

Third stage of labor.

All staff involved in obstetric care should be competent in performing active management of the third stage of labor. Active management has been shown to be clearly superior to physiologic or expectant management. Comparison of the various uterotonic agents has pointed to misoprostol as a potential first-line agent in treating obstetric hemorrhage. Its cost, routes of delivery, and efficacy make it an appealing drug in urban and rural settings. By being facile with the active management of labor and the prompt recognition and treatment of postpartum hemorrhage, the morbidity from significant blood loss and subsequent surgery can be reduced significantly.

Female↗

PubMed2005

Does maternal hypoglycemia during screening glucose assessment identify a pregnancy at-risk for adverse perinatal outcome?

OBJECTIVE: To determine the perinatal outcome in pregnancies with maternal hypoglycemia following a second trimester oral glucose challenge test (GCT). STUDY DESIGN: Retrospective case-control study of pregnancies undergoing a second trimester 1-hour oral glucose challenge test (GCT). Hypoglycemic pregnancies (<88 mg/dl) were matched with pregnancies with 1-hour glucoses of >88 mg/dl. Antepartum, intrapartum, and neonatal outcomes were assessed. RESULTS: Over 29 months, 334 hypoglycemic singleton pregnancies were matched with 334 controls. A greater number of special/neonatal intensive care unit (SCN/NICU) admissions occurred in the hypoglycemic group (48/334 (14.4%) vs 29/334 (8.7%) in the control group) (p=0.02). The SCN/NICU admission rate remained after controlling for maternal hypertension, smoking, and preterm birth (p=0.037). The development of pregnancy-induced hypertension in women with hypoglycemia 24/334 (7.2%) compared with euglycemic women 13/334 (3.9%, p<0.06) was not significant. CONCLUSION: Admission to SCN/NICU is increased in pregnant women with hypoglycemia following a GCT.

Adolescent↗

PubMed2005

Neonatal organ dysfunction among newborns at gestational age 34 weeks and umbilical arterial pH<7.00.

PURPOSE: Among newborns at 34 weeks or more with umbilical arterial pH<7.00, we endeavoured to determine the pH threshold and risk factors for neonatal organ injury within 72 hours of birth. STUDY DESIGN: Retrospectively, all non-anomalous newborns delivered over 6 years near term with a low pH were identified. Each case of a newborn with injury was compared with the next four neonates with a pH below 7.00 and no injury. A receiver-operating characteristic (ROC) curve and unconditional logistic regression was used. RESULTS: Of the 87 newborns with pathologic acidosis, 16% had neonatal organ system injury. Inspection of the ROC curve indicates that a pH of 6.92 is the threshold that identifies newborns who will have damage to organs. Unconditional logistic regression analysis indicates that the significant risk factors for morbidity were an Apgar score or=37 weeks, pH <or=6.92 is the threshold linked with neonatal organ dysfunction.

Acid-Base Imbalance↗

PubMed2005

A review of sonographic estimate of fetal weight: vagaries of accuracy.

PURPOSE: To determine the factors that might influence the accuracy of sonographic estimated fetal weight. STUDY DESIGN: A PubMed search (Jan 1975 to Jan 2003) of articles published in the English language was carried out and the inclusion criterion was that estimates were within 10% of birth weight. A Chi-square test for trend was used and odds ratio (OR) with 95% confidence intervals (CI) was calculated. RESULTS: Over 28 years, 175 articles were identified but only 54 (31%) met the inclusion criterion. Overall 62% (8895/14 384) of the predictions were within 10% of the actual weight. The accuracy was significantly different in articles where <7 vs. >7 days were allowed to lapse between examination and delivery (OR 2.17, 95% CI 1.93, 2.45); where examinations were done by registered diagnostic medical sonographers (RDMS; 65%) versus physicians (59%) or residents (57%; p < 0.0001); in term vs. preterm patients (OR 1.97, 95% CI 1.67, 2.13); and in studies with >1000 vs. <1000 cohorts (OR 1.62; 95% CI 1.51, 1.74). CONCLUSIONS: If feasible the sonographic examination should be done by RDMS and within a week of delivery.

Birth Weight↗

PubMed2005

The effects of standing, lifting and noise exposure on preterm birth, growth restriction, and perinatal death in healthy low-risk working military women.

OBJECTIVE: The effects of standing, lifting and noise in low-risk, healthy pregnant women are uncertain. In the past, the heterogeneity of the populations studied, the limitations of the designs of the retrospective and case control studies, and a failure of some of the larger investigations to evaluate all the potential confounding variables has hampered many studies. The purpose of this investigation was to evaluate, throughout pregnancy, the effects of standing, repetitive lifting, and noise in the workplace compared with no standing, lifting or noise exposure, on maternal and perinatal outcomes in a large prospective study of a low-risk healthy population of working women cared for by a single group of health providers. METHODS: This prospective observational study used an extensive questionnaire to collect antepartum, intrapartum, and postpartum information. Information was collected on the initial visit, each subsequent visit, and immediately after delivery. The participating women were divided into groups based on the amount of time spent standing, the amount and extent of repetitive lifting, and noise exposure in the workplace. RESULTS: Eight hundred and fourteen low-risk active duty women participated in this investigation over a 4-year period. Multivariate analysis with non-exposure compared with exposure reinforced the effect of standing on preterm labor (OR 1.80, 95% CI 1.05, 3.16) and preterm birth (OR 1.69, 95% CI 1.03, 2.80) and showed a trend toward an effect of noise exposure on preterm labor (OR 1.76, 95% CI 0.78, 3.39) after controlling for other exposures. CONCLUSIONS: This investigation suggests an association of occupational standing with preterm labor and preterm birth.

Adult↗

PubMed2005

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↗