Search PubMed⌕ Search

Biomedical subjects

Everett F Magann

Publications and source records attributed to Everett F Magann.

At least 55 records · Page 3Linked to original sources
PubMed2004

Does the frequency of outpatient visits in addition to the regularly scheduled prenatal visits identify a poor pregnancy outcome?

Do extra outpatient visits, in addition to regularly scheduled visits, identify a pregnancy at risk of an adverse outcome? This prospective investigation analysed additional outpatient visits, by low-risk obstetric patients. One hundred and sixty-two women were evaluated with one to two additional visits and 66 had three or more visits. Antepartum and intrapartum pregnancy complications between groups was similar suggesting that frequency of additional visits does not identify a pregnancy at risk for an adverse outcome.

Adolescent↗
PubMed2004

Diagnosis of postpartum infections: clinical criteria are better than laboratory parameter.

BACKGROUND: Physiologic increases in the leukocyte count and segmental neutrophil percentage during pregnancy alter the ability of these indices to predict infection. METHODS: Women with cesarean deliveries were assessed by leukocyte counts and segmented neutrophil percentage as well as clinical signs to detect postoperative infection. RESULTS: In 157 consecutive patients undergoing cesarean deliveries there was a significant physiologic increase between the preoperative and postoperative leukocyte count (12.4 +/- 3.9/uL vs. 14.8 +/- 3.4/uL, P < 0.001). The leukocyte count after delivery did not discriminate whether or not the patient would develop a postpartum infection or have significant hyperpyrexia. CONCLUSION: Due to physiologic changes associated with pregnancy, the leukocyte count and segmented neutrophil percentage do not predict infection. Therefore clinical findings are most important in diagnosing postpartum infections.

Adult↗
PubMed2004

Detecting fetal growth restriction or discordant growth in twin gestations stratified by placental chorionicity.

OBJECTIVE: To use recommendations made by the Evidence-Based Medicine Working Group to determine the accuracy of sonographically estimated fetal weight to diagnose fetal growth restriction (FGR) (estimated or actual birth weight < 10% for gestational age [GA]) or discordancy in dichorionic and monochiorionic twin gestations. STUDY DESIGN: The inclusion criteria for this retrospective analysis were nonanomalous twins, reliable GA and sonographic estimate of fetal weight within 21 days of live births of both fetuses beyond 26 weeks. For likelihood ratio (LR) and odds ratio (OR), 95% confidence intervals (CIs) were calculated. RESULTS: Over 52 months, 126 twin gestations met the inclusion criteria; 29% were monochorionic and 71% dichorionic. The incidence of FGR in 1 of monochorionic twin fetuses (46%) was twice as high as in dichorionic (26%; OR 2.01; 95% CI 1.00, 4.03), but the rates of discordance > or = 20% were similar (21% vs. 18%, respectively; OR 1.26; 95% CI 0.64, 2.47). The LR (95% CI) of detecting discordant growth > or = 20% was 6.1 (2.5, 15.1) for dichorionic twins and 6.0 (1.8, 20.0) for monochorionic. The LR of identifying FGR in twin A and B in dichorionic twins was 6.3 (2.0, 19.7) and 8.7 (2.9, 26.9), respectively; the corresponding LR for monochorionic twins was 14.5 (1.9, 112.3) and 18.7 (2.6, 135.1). To determine the number of twins required for a tight confidence interval around an LR of 10, post hoc sample size calculations indicated: (1) regardless of chorionicity, attaining LR > 10 is not feasible; (2) in dichorionic twins, detection of FGR with twin A or B is not possible; and (3) about 500 monochorionic pregnancies are necessary to ensure that estimated fetal weight can accurately identify FGR. CONCLUSION: Using guidelines proposed by the Evidence-Based Medicine Working Group, at present it may not befeasible to identify aberrant growth in twins.

Adult↗
PubMed2004

Acute colonic pseudo-obstruction following cesarean delivery.

Acute colonic pseudo-obstruction remains an uncommon complication in obstetric practice, but when it occurs, it is most frequently noted after cesarean delivery. Acute colonic pseudo-obstruction is characterized by the findings consistent with large bowel obstruction in the absence of a demonstrable mechanical cause as noted in this case report. We report the occurrence of acute colonic pseudo-obstruction post-cesarean delivery in which prompt recognition of impending cecal perforation allowed appropriate management by tube cecostomy. Although acute colonic pseudo-obstruction is uncommon, it is important that obstetric practitioners recognize this clinical entity as the potentially fatal consequences of cecal perforation can be prevented by tube cecostomy.

Acute Disease↗
PubMed2003

Postpartum seizure prophylaxis: using maternal clinical parameters to guide therapy.

OBJECTIVE: To use individual patient clinical parameters to signal cessation of postpartum magnesium sulfate seizure prophylaxis for the spectrum of pregnancy-related hypertensive disorders. METHODS: This was a prospective study using clinical symptoms (absence of headache, visual changes, epigastric pain) and signs (sustained blood pressure less than 150/100 without need for acute antihypertensive therapy, spontaneous diuresis more than 100 mL per hour for no less than 2 hours) to signal cessation of intravenous magnesium sulfate postpartum in gravidas diagnosed with preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome. Laboratory assessments (including proteinuria) were not used as criteria for drug discontinuation. RESULTS: Five hundred three patients were enrolled and classified according to American College of Obstetricians and Gynecologists criteria (mild preeclampsia, severe preeclampsia, chronic hypertension with superimposed preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelets syndrome). Maternal age, gestational age, and hours of magnesium therapy before delivery were not statistically different among groups. There was no significant difference in the duration of postpartum magnesium sulfate therapy among groups with the median duration of therapy 4 hours (range 2-77 hours). No eclamptic seizures occurred after magnesium discontinuation. Thirty-eight patients (7.6%) required reinstitution of magnesium therapy for 24 hours because of exacerbation of blood pressure (sustained blood pressure more than 160/110) associated with headache or visual changes. CONCLUSION: Clinical criteria, when compared with arbitrary protocols, can be used successfully to shorten the duration of postpartum magnesium sulfate administration for seizure prophylaxis in patients with pregnancy-related hypertensive disorders.

Adult↗
PubMed2003

Effect of maternal hydration on amniotic fluid volume.

OBJECTIVE: To estimate the effects of maternal intravenous hydration on amniotic fluid volume in normal pregnancies. METHODS: Women undergoing an amniocentesis for the evaluation of fetal lung maturity before an elective cesarean delivery were eligible to participate. An amniotic fluid index (AFI) was obtained before the amniocentesis, and at the time of the amniocentesis the amniotic fluid (AF) volume was determined by diazo-dye reaction with subsequent spectrophotometric analysis of AF samples. If the AF sample drawn for fetal maturity studies was mature, the patient was hydrated with 1000 mL of balanced salt solution 30 minutes before her cesarean delivery. Amniotic fluid volume was subsequently estimated after the hydration by a repeat AFI. Amniotic fluid volume was directly measured at cesarean delivery and compared with the dye-determined volume. The pre- and posthydration AFI were also compared. RESULTS: A total of 17 women participated in the study between January 2001 and June 2001. Statistically significant increases in the AF volume and AFI were found. The prehydration median AF volume was 450 mL (range 250-953), and the median increase in AF volume was 188 mL (95% confidence interval [CI] 60, 254 mL; P <.001). Median AFI was 8.6 (range 5.8-17.8) with a median change in AFI of 1.7 cm (95% CI 1.1, 3.0; P <.001). CONCLUSION: Maternal intravenous hydration appears to increase both the actual and ultrasound-estimated AF volumes in normal third-trimester pregnancies.

Adult↗
PubMed2003

Comparability of the amniotic fluid index and single deepest pocket measurements in clinical practice.

Two ultrasound techniques, the amniotic fluid index (AFI) and the single deepest pocket (SDP), are currently used to detect oligohydramnios, predict variable decelerations, risk of Caesarean delivery for fetal distress, Apgar scores, umbilical cord artery pH, perinatal mortality, and cerebral palsy. Both techniques poorly identify oligohydramnios. Both techniques identify pregnancies at risk for variable decelerations, low Apgar scores, and Caesarean delivery for fetal distress. Only the SDP is predictive of a compromised fetus-umbilical artery pH, as a stand-alone test, has been correlated with perinatal mortality, and as part of the biophysical profile has been linked to cerebral palsy. This brief communication reviews the comparability of these two techniques and which method, if either, is superior in the identification of oligohydramnios, the predictability of these techniques to identify an adverse pregnancy outcome, and the ability to predict cerebral palsy and perinatal mortality.

Amniotic Fluid↗
PubMed2003

Is amniotic fluid volume status predictive of fetal acidosis at delivery?

OBJECTIVE: To ascertain if dye-determined amniotic fluid volume just prior to delivery correlates with fetal acidosis at delivery. DESIGN: The present was a prospective observational study. SETTING: The study took place at the University of Mississippi Medical Center, Jackson MS, USA. POPULATION: The population included 100 unlaboured women undergoing an amniocentesis for the assessment of fetal lung maturity before an elective Caesarean delivery between January 1997 and December 2000. MAIN OUTCOMES MEASURED: The amniotic fluid volume was estimated by ultrasound measurement and quantified by dye-determined methodology immediately prior to Caesarean delivery. Umbilical cord artery pH was collected at the time of Caesarean delivery. RESULTS: The predictive accuracy of an amniotic fluid index < or = versus > 5 to identify an umbilical artery pH of < 7.20 had a sensitivity of 0%, a specificity of 84%, and a likelihood ratio of zero. None of the dye-determined low amniotic fluid volumes were identified using the single deepest pocket technique. Dye-determined low, normal, and high amniotic fluid volume groups contained a similar number of fetuses with umbilical cord arterial pH < 7.20 (P = 0.371), < 7.10 (P = 0.460), and < 7.00 (P = 0.614). Receiver-operating characteristic curves could not identify any amniotic fluid index from 0 to 18, single deepest pocket from 0 to 12, or dye-determined amniotic fluid volume 100-1900 mL to differentiate between the two newborns with an umbilical cord artery pH < 7 from 98 babies with cord pH > or = 7.0. CONCLUSIONS: Neither ultrasound estimates nor dye-determined amniotic fluid volumes are predictive of a low umbilical artery pH at delivery.

Acidosis↗
PubMed2003

Predictability of intrapartum and neonatal outcomes with the amniotic fluid volume distribution: a reassessment using the amniotic fluid index, single deepest pocket, and a dye-determined amniotic fluid volume.

OBJECTIVE: The purpose of this study was to establish whether ultrasound-estimated or dye-determined amniotic fluid distribution (upper compared with lower quadrant) is predictive of perinatal outcome. STUDY DESIGN: Amniotic fluid distribution as measured by the amniotic fluid index, single deepest pocket, and dye-determined volumes was ascertained and correlated with intrapartum and neonatal outcomes. RESULTS: Between January 1997 and January 2001, 135 women (70 upper-greater and 65 lower-greater) participated in this prospective observational study. The sum of the amniotic fluid index (P =.309), single deepest pocket (P =.168), and dye-determined amniotic fluid volume (P =.368) for the upper-greater compared with the lower-greater groups were similar. Decelerations in labor (P =.597), late decelerations (P =.999), cesarean deliveries for fetal distress (P =.413), and umbilical cord pH < 7.2 were similar (P =.647) CONCLUSION: Ultrasound-estimated and dye-determined amniotic fluid volumes are similar between upper-greater and lower-greater groups, and intrapartum/neonatal outcomes are not affected by the amniotic fluid distribution.

Adult↗
PubMed2003

Continuous subcutaneous terbutaline administration prolongs pregnancy after recurrent preterm labor.

OBJECTIVE: This study was undertaken to study the effectiveness of continuous subcutaneous terbutaline (SQT) in the home after recurrent preterm labor (RPTL). STUDY DESIGN: Women with RPTL at less than 32 weeks' gestation were treated with continuous SQT administered in the home compared with matched control patients. RESULTS: Fifteen SQT patients were compared with 45 women (3:1) treated with no tocolytic therapy after hospitalization. Gestational age at delivery more than 37 weeks (53% vs 4%), percentage delivered at less than 32 weeks (0% vs 47%), overall and pregnancy prolongation (49.8 +/- 19.2 days vs 24.5 +/- 12.8 days) were all significantly better in the study group (P <.001). The total number of maternal hospital days (9.8 +/- 2.1 vs 15.9 +/- 7.4, P <.0001), duration of NICU stay (1.9 +/- 4.9 vs 19.8 +/- 29.3 days, P <.001), and total cost for newborn care (6,995 +/- 14,822 US dollars vs 62,033 +/- 89,978 US dollars, P <.002) favored the study patients. For every dollar spent on SQT, there was a savings of 4.67 US dollars in newborn hospital costs for control patients. CONCLUSION: In this small study, the use of SQT significantly prolongs pregnancy, decreases serious neonatal complications, and reduces the duration of hospitalization for both mother and infant, as well as neonatal costs.

Adult↗
PubMed2003

Vaginal birth after cesarean section versus elective repeat cesarean delivery: Weight-based outcomes.

OBJECTIVE: The study was undertaken to compare infectious morbidity and trial of labor (TOL) success stratified by weight in women. STUDY DESIGN: Vaginal birth after cesarean section (VBAC) candidates were divided into groups based on prepregnancy weight: group I, 70 (<200 pounds); group II, 70 (200-300 pounds); and group III, 69 (>300 pounds). RESULTS: The TOL success rate was 81.8% in group I compared with 57.1% in group II and 13.3% in group III (P =.001). The overall infectious morbidity was significantly greater in the obese women 39% (P =.001) compared with the average women at 11.4% and the lean women at 5.7%. CONCLUSION: Infectious morbidity is increased and VBAC success is reduced in patients who weigh more than 300 pounds.

Adult↗
PubMed2003

Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature.

OBJECTIVE: The purpose of this study was to determine the rate of uterine rupture and its complications as the result of trial of labor after previous cesarean delivery. STUDY DESIGN: PubMed was searched from 1989 to 2001, with the terms "VBAC, uterine rupture," "trial of labor, uterine rupture," "cesarean delivery, uterine rupture," and "scarred uterus, rupture." For inclusion, reports had to contain data from at least 100 patients with trials of labor that included a description of adverse outcomes. Duplicate reporting from a single institution was excluded. Odds ratios and 95% CIs were calculated. RESULTS: Seventy-two of the 361 articles (20%) that were identified met the inclusion criteria. A 6.2 per 1000 trial of labor rate of uterine rupture (total=880 uterine ruptures in 142,075 trials of labor) was determined. For every 1000 trials of labor the uterine rupture-related complication rate was 1.8 for packed red blood cell transfusion, 1.5 for pathologic fetal acidosis (cord pH<7.00), 0.9 for hysterectomy, 0.8 for genitourinary injury, 0.4 for perinatal death, and 0.02 for maternal death. The perinatal mortality rate was significantly lower among studies from the United States versus other countries (0.3 vs 0.6; odds ratio, 0.50; 95% CI, 0.26-0.94) and in series that exceeded 1000 patients (0.2 vs 1.7; odds ratio, 7.34; 95% CI, 3.94-13.69). CONCLUSION: Although relatively uncommon, uterine rupture is associated with several adverse outcomes, depending on the time of the publication and the site and size of the population that was studied.

Female↗
PubMed2003

The importance of parity to major maternal morbidity in the eclamptic mother with HELLP syndrome.

OBJECTIVE: To determine if the rate of major morbidity from severe preeclampsia with/without hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome differs by parity. METHODS: Retrospective investigation of 970 gravidas with severe preeclampsia with and without HELLP syndrome analyzed according to parity. RESULTS: Altogether 609 (63%) patients were nulliparous and 361 (37%) parous. Between groups there was no significant difference in the incidence of overall major morbidity (21% vs. 19%, p=0.467), or specific morbidities including hematologic/coagulopathic (13.6% vs. 11.9%, p=0.442), cardiopulmonary (8.9% vs. 7.2%, p=0.362), CNS/visual (1.8% vs. 2.8%, p=0.319), or hepatorenal (0.8% vs. 2.2%, p=0.068). Although eclampsia was significantly more common in nulliparous (10.2%) than in parous patients (5.5%, p=0.012), the later significantly more often demonstrated major maternal morbidity associated with eclampsia (50%) than did nulliparous patients (25%, p=0.043). CONCLUSIONS: Unless parous patients with severe preeclampsia with or without HELLP syndrome develop eclampsia, their disease acuity does not differ significantly from their nulliparous counterparts.

Adolescent↗
PubMed2003

Cesarean delivery for fetal distress: rate and risk factors.

UNLABELLED: The objective of this article was to review the recent English language literature on cesarean delivery for fetal distress to determine its incidence, diagnostic tests, and the contributing factors to this obstetric complications. A PubMed search (1990-2000) with items of "cesarean, fetal distress," "cesarean, non-reassuring fetal heart rate," "cesarean, neonatal acidosis," and "cesarean, umbilical arterial pH," was undertaken. Reports, letters to the editor, focus on anomalous fetuses, and papers not specifically focused on this topic were excluded. Of the 392 articles that the search yielded, 169 met the inclusion criteria. Based on 37 reports with more than 1,000 patients each, the overall risk of prompt cesarean delivery for fetal concern was 3.1% (43,340 of 13,989,74). The risk exceeded 20% in patients with moderate/severe asthma, severe hypothyroidism, severe preeclampsia, and postterm or fetal growth restricted fetuses with abnormal Doppler studies. Use of likelihood ratios suggests that Doppler of the umbilical artery is a superior diagnostic test to amniotic fluid index in identifying parturients at risk for cesarean for non-reassuring fetal heart rate tracing. Although several risk factors increase the need for cesarean delivery for fetal distress, in general, most are unpreventable. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to estimate the incidence of cesarean delivery for non-reassuring fetal heart rate tracing, outline potential diagnostic tests that are useful for the detection of fetal distress, and summarize medical and obstetric conditions that place patients at risk for cesarean delivery for fetal distress.

Adult↗
PubMed2003

Clinical and sonographic estimations of uterine weight.

Over a 36 month period, all hysterectomies with clinical assessment, sonographic measurement of uterine length and estimated uterine weight were reviewed. Accuracy of these methods was ascertained by: 1) mean error, 2) mean standardized error, and 3) percentage of estimates within 10% of the actual weight. Among 210 hysterectomies, the mean (+/- standard deviation) of uterine weight was 514.9 gm +/- 647.0 gm (range 54-6700 gm) with 135 specimens (64.3%) being 500 gm and 75 > 500 gm. The receiver-operating curves for clinical assessment (0.82 +/- 0.03), uterine length (0.87 +/- 0.03) and Linear Regression Equation (0.82 +/- 0.04) are not significantly different (P > 0.05), having similar abilities to differentiate uterine weight. The clinical estimate of uterine weight is as accurate as ultrasound in determining a uterus weighing > 500 gm but all three methods poorly predict actual uterine weight.

Adult↗
PubMed2003

Detecting fetal macrosomia with abdominal circumference alone.

OBJECTIVE: To determine if abdominal circumference (AC) can identify macrosomia (> or = 4,000 g) at or beyond 37 weeks. STUDY DESIGN: Prospectively, parturients at term admitted for delivery underwent sonographic mensuration of AC. A receiver-operating characteristic (ROC) curve was constructed to determine if AC can differentiate between normal (birth weight < 3,999 g) and macrosomia. A likelihood ratio was calculated. P < .05 was considered significant. RESULTS: The mean gestational age of the 256 subjects was 39.1 +/- 1.5 weeks, and the prevalence of macrosomia was 8.2% (21/256). Inspection of the ROC curve indicated that AC > or = 350 mm can identify macrosomic fetuses. The area under the ROC curve (0.79 +/- 0.04 for macrosomia) was significantly different than the area under the nondiagnostic line (P < .005). The likelihood ratio for AC to detect macrosomia was 2.9 (95% confidence interval, 2.1-4.0). Based on the proportion of macrosomia in our population, we would require over 1,000,000 newborns for a macrosomia analysis to obtain narrow confidence intervals around a clinically useful likelihood ratio. CONCLUSION: Using the guidelines proposed by the Evidence-Based Medicine Working Group, AC is slightly useful in detecting macrosomia among term parturients.

Abdomen↗