Biomedical subjects

Everett F Magann

Publications and source records attributed to Everett F Magann.

63 records · Page 4Linked to original sources

PubMed2003

Emergency cesarean delivery for nonreassuring fetal heart rate tracings. Compliance with ACOG guidelines.

OBJECTIVE: To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal distress" and assess compliance with American College of Obstetricians and Gynecologists (ACOG) guidelines. STUDY DESIGN: A PubMed search with the search items cesarean, fetal distress, cesarean, nonreassuring fetal heart rate, cesarean, neonatal acidosis and cesarean, umbilical arterial pH was undertaken. Excluded from the search were case reports, letters to the editor, focus on fetal anomaly, combinations with other reasons for operative delivery (either abdominally or vaginally) or absence of pertinent information. RESULTS: Among 392 articles from the search, 169 met the inclusion criteria. Three reports provided detailed information on use of scalp pH; use occurred in 5% (60/1,128) of emergency cesareans. Three reports provided data on the use of tocolytics for intrauterine resuscitation; the combined result was 16% (201/1,261). Five reports assessed the decision-to-incision interval within 30 minutes; in 59% (262/446) of cases it was achieved. Five reports contained cord pH information on 340 emergency cesarean deliveries; umbilical arterial pH was < 7.00 in 10%. CONCLUSION: Physician use of, and compliance with, ACOG guidelines for emergency cesarean deliveries is difficult to assess, and incomplete compliance appears commonplace.

Acidosis↗

PubMed2002

Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women.

OBJECTIVE: To evaluate the influence of exercise on maternal and perinatal outcome in a low-risk healthy obstetric population. METHODS: We conducted a prospective observational study of low-risk healthy women exercising during their pregnancy. An extensive questionnaire collected antepartum, intrapartum, and postpartum patient information on 750 women. The women were divided into four groups based on exercise level during pregnancy. RESULTS: There were no differences among groups for maternal demographic characteristics, antenatal illnesses, stress, social support, or smoking. Heavily exercising women were older (P =.042), had higher incomes (P =.001), and were exercising more at conception (P =.001). Women who did more exercise were more likely to need an induction of labor (P =.033, relative risk 1.84, 95% confidence interval 1.05, 3.20), induction or augmentation with oxytocin (P =.015, relative risk 1.53, 95% confidence interval 1.19, 1.97), and had longer first-stage labors (P =.032) resulting in longer total labors (P =.011). The difference in the length of first-stage labor was even greater if the no-exercise group was compared with the strongly exercising group (P =.009, relative risk 1.38, 95% confidence interval 0.16, 2.60). Fewer umbilical cord abnormalities (P =.034) were observed with exercise, but exercising women had more colds and flu (P =.008). Heavily exercising women had smaller infants (mean difference 86.5 g) compared with sedentary women. CONCLUSION: Exercise in working women is associated with smaller babies, increased number of inductions and augmentations of labor, and longer labors. Colds and flu are more frequent in exercising women.

Adult↗

PubMed2002

Markedly elevated beta-hCG levels in a normal singleton gestation with hyperreactio luteinalis.

BACKGROUND: Human chorionic gonadotropin (hCG) is produced by the trophoblast early in pregnancy and peaks at a level of approximately 100,000 IU/liter around the ninth week of gestation. Abnormally high levels are usually noted in association with multiple gestation, molar gestation, and specific ovarian or gestational malignancies. CASES: A multiparous patient in the second trimester was referred for evaluation after a maternal triple marker screen was incalculable due to a beta-hCG level of 2.1 million IU/L. Targeted sonography revealed bilateral complex adnexal masses with a solid component of the left ovary, a normal fetus, and normal placenta. The patient underwent an exploratory laparotomy at 18 weeks' gestational age. A left oophorectomy was performed. Pathology confirmed hyperreactio luteinalis. The remainder of the pregnancy was remarkable for preterm labor and delivery at 35 weeks' gestational age. At delivery, the hCG level was noted to be 24,210 IU/L, and the fetus and placenta were normal. CONCLUSION: Markedly elevated hCG levels rarely occur in normal singleton pregnancy and can be associated with hyperreactio luteinalis. When noted, a work-up to evaluate possible malignancy, molar gestation, and multiple gestation should be pursued.

Adult↗

PubMed2002

Pregnancy after classic cesarean delivery.

OBJECTIVE: To describe maternal and perinatal outcomes after a prior classic cesarean delivery. METHODS: A retrospective review was performed including all patients from 1990-2000 whose most recent pregnancy was preceded by classic cesarean delivery. RESULTS: During the 11-year period, there were 37,863 deliveries and 157 patients (0.4%) underwent classic cesarean operations. In the next pregnancy, one case of uterine rupture (0.6%, 95% confidence interval 0.1, 3.5) occurred at 29 weeks without preterm labor and resulted in fetal death. The prevalence of asymptomatic dehiscence was 9% (95% confidence interval 5, 15). There was no significant difference between patients with uterine dehiscence (n = 15) and patients with intact uteri (n = 141) with regard to maternal demographics, duration of labor, cervical dilatation at time of surgery, transfusion of packed red cells, bowel injury, postpartum endometritis, wound breakdown, thrombophlebitis, or umbilical arterial pH less than 7.00 (P >.05). Duration of labor, cervical dilatation, and gestational age at repeat cesarean delivery were poor predictors for uterine rupture or dehiscence. CONCLUSION: Among patients with prior classic cesarean delivery, uterine rupture and dehiscence are neither predictable nor preventable. One in four patients will experience some form of maternal morbidity. Uterine rupture, although infrequent, can be fatal to the fetus. Uterine dehiscence, however, does not increase neonatal or peripartum maternal morbidity.

Cesarean Section↗

PubMed2002

Cervical ripening and induction of labor with misoprostol, dinoprostone gel, and a Foley catheter: a randomized trial of 3 techniques.

OBJECTIVE: The purpose of this study was to compare the efficacy of 3 different techniques of cervical ripening and induction. STUDY DESIGN: Patients who required cervical ripening and induction were randomized to one of 3 groups: (1) supracervical Foley catheter and intravaginal dinoprostone gel, (2) supracervical Foley catheter and 100 microg oral doses of misoprostol, or (3) serial 100-microg oral doses of misoprostol. Intravenous oxytocin was administered when a protraction disorder of labor was identified. RESULTS: There were 339 women randomized. There was no significant difference in the time from first intervention to delivery in the 3 groups (P =.546). In each group, a similar percentage of women required oxytocin (P =.103). The rates of cesarean delivery were equivalent among the groups (P =.722). Rates of tachysystole were high but statistically equivalent among the 3 groups. There were no significant differences in Apgar scores or umbilical artery pH. CONCLUSION: Oral 100 microg serial doses of misoprostol, with or without the use of a supracervical Foley catheter, were equivalent to the use of a supracervical Foley catheter and serial 4-mg doses of dinoprostone gel for cervical ripening and the induction of labor.

Adult↗

PubMed2002

Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to compare a subcutaneous stitch closure and subcutaneous drain placement for the risk of wound disruption after cesarean delivery. STUDY DESIGN: This was a prospective randomized clinical trial that evaluated subcutaneous stitch closure, placement of a subcutaneous drain, or no closure for subsequent wound disruption risk in women with subcutaneous depth at >or=2 cm. RESULTS: The maternal demographics and intrapartum risk factors for postoperative wound disruptions were similar among the 964 study subjects, who were divided into 3 groups. Wound disruptions that required opening of the wound, irrigation, debridement, packing, and/or secondary delayed closure occurred in 9.7% of the women with no closure, 10.4% of the women in the stitch closure group, and 10.3% of the women in the closed drain group (P =.834). CONCLUSION: There appears to be no difference in the subsequent risk of wound complications when no closure of the subcutaneous tissue layers occurs versus suture closure or a closed drainage system.

Adult↗

PubMed2002

Intra-operative haemorrhage by blunt versus sharp expansion of the uterine incision at caesarean delivery: a randomised clinical trial.

OBJECTIVE: To determine whether the method used to expand the uterine incision for caesarean delivery affects the incidence of intra-operative haemorrhage. DESIGN: A prospective randomised study of women undergoing a low segment transverse caesarean delivery. Participants were assigned to have their uterine incision either sharply or bluntly expanded. PARTICIPANTS: Between June 1998 and June 2000, 470 women drew assignments to the sharp expansion group and 475 to the blunt group. RESULTS: The maternal demographics of age, race, nulliparity, and body mass index as well as pre-operative haematocrit were similar between groups. Compared with the blunt group, the estimated blood loss (886 versus 843mL, P = 0.001), change in the mean haematocrit (6.1% versus 5.5%, P = 0.003), incidence of postpartum haemorrhage (13% versus 9%; relative risk = 1.23, 95% CI 1.03, 1.46) and need for a transfusion (2% versus 0.4%; relative risk = 1.65, 95% CI 1.25, 2.21) were significantly greater in the sharp group. CONCLUSION: In caesarean delivery, sharply expanding the uterine incision significantly increases intra-operative blood loss and the need for subsequent transfusion.

Adult↗

PubMed2002

Dominant maternal sleep position influences site of placental implantation.

The objective of this study was to determine if maternal sleeping position around the time of implantation influences eventual placental implantation site. Between November 1997 and April 1999, women with singleton pregnancies between gestational ages of 15 and 20 weeks presenting for ultrasound examinations were prospectively queried regarding their usual position of sleep during early gestation. Dominant position of sleep was noted as prone, supine, right side, or left side. At ultrasound examination, placental location was categorized as (1) fundal, (2) left high, (3) right high, (4) anterior high, (5) posterior high, (6) anterior low, (7) posterior low, (8) right low, (9) left low, or (10) central low. During the 18 months of this study, data were obtained from 1,500 patients. At the time of conception, front or prone sleeping was the most common (497 of 1,500, 33.1%), followed by right side (439 of 1,500, 29.3%) and left side (360 of 1,500, 24%), with the back being the least frequent position of sleep (204 of 1,500, 13.6%). Women who usually slept supine at the time of conception and implantation were significantly more likely to have a high or fundal placental location compared with those who usually slept in the prone position (p = 0.041). In addition, women who slept exclusively on their right side early in pregnancy were significantly more likely to have a right-sided placental location compared with women who slept exclusively on their left side (p = 0.025). The data from this investigation indicate that sleeping position early in gestation may influence the ultimate placental implantation site.

Adolescent↗

PubMed2002

HELLP syndrome leading to a diagnosis of pregnancy.

HELLP syndrome (an acronym for hemolysis, elevated liver enzymes, and low platelets) is a life-threatening complication of pregnancy seen in association with either preeclampsia or eclampsia. HELLP syndrome is rarely diagnosed before 24 weeks of gestation. This atypical form of severe preeclampsia is associated with significant fetal and maternal mortality. The only effective treatment is delivery. We report a case of HELLP syndrome that proved to be a diagnostic clue to an early pregnancy.

Abortion, Therapeutic↗