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Biomedical subjects

F F Broekhuizen

Publications and source records attributed to F F Broekhuizen.

30 records · Page 2Linked to original sources
PubMed1987

Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984.

Two hundred fifty-six vacuum extractions and 300 randomly chosen forceps deliveries were analyzed retrospectively. Vacuum extraction use increased from 0.3 to 3.1%, while forceps use declined from 10.1 to 4.9% over a five-year period. No differences were found in indications for vacuum extraction and forceps, but the preapplication position differed (occiput posterior or transverse in 81.2% in the vacuum group and 27% in forceps patients). Preapplication station also differed, with 59.8% of vacuum extraction at +1 or higher stations, compared with 9% of forceps. Under these conditions we found less maternal trauma, similar failure rates (3.9 versus 2%), and no difference in maternal morbidity. There was a higher incidence of shoulder dystocia and neonatal jaundice in the vacuum group, but cephalohematoma frequency did not differ significantly (3.9% vacuum extraction, 4.3% forceps). Cosmetic injuries (ecchymoses, abrasions) were more likely with vacuum extraction than with forceps (44.1 versus 29.5%). One death occurred in each group. Vacuum extraction replaced midforceps in our institution in the study period. We consider vacuum extraction a useful technique to teach house staff in view of today's decreasing instrumental delivery rate.

Birth Injuries↗
PubMed1985

Computerized labor and delivery logbook. A first step to a perinatal database in a university-affiliated community hospital.

In response to rapidly expanding data collection and retrieval needs, a modest perinatal database was initiated. This database combines the ease of entry and retrieval and the continuous accessibility of a microsystem with the storage and back-up advantages of a minicomputer with programming and troubleshooting support. The described system requires no change in medical record keeping, permits data entry by nursing personnel, requires little editing and is reasonably priced.

Costs and Cost Analysis↗
PubMed1985

Amniocentesis for gram stain and culture in preterm premature rupture of the membranes.

A retrospective study was conducted to assess the predictive value and clinical usefulness of amniotic fluid Gram stain and culture in the management of preterm premature rupture of the membranes (PROM). Amniocentesis was attempted in 79 patients and was successful in 53 patients for a success rate of 67%. The complication rate was 1.8%. Fifty-three patients from whom amniotic fluid was obtained after preterm PROM were studied. Patients were managed expectantly unless clinical chorioamnioitis developed, a positive Gram stain or culture was found, or a mature lung profile after 34 weeks' gestation was established. A low incidence of chorioamnionitis (5.5%), postpartum endometritis (11%), and neonatal sepsis (3.5%) was found with expectant management. A statistically significant association between Gram stain and antepartum infection, postpartum infection, and neonatal infection was noted. Gram stain had a 100% sensitivity and 82% specificity as predictor of chorioamnionitis. Amniotic fluid culture had a 100% sensitivity and 76% specificity as predictor of chorioamnionitis. As predictor of a positive culture result, Gram stain had a sensitivity of 60% and specificity of 92%. No patient with a negative Gram stain or culture developed infectious sequelae regardless of the timing of amniocentesis. All positive Gram stains and cultures were found within 48 hours of rupture of membranes. Amniocentesis for Gram stain and culture has clinical usefulness in preterm PROM and, despite false-positive tests, the authors' data support intervention on the basis of a positive Gram stain.

Amniotic Fluid↗
PubMed1984

Comparison of lecithin: sphingomyelin ratio, fluorescence polarization, and phosphatidylglycerol in the amniotic fluid in the prediction of respiratory distress syndrome.

The significance of the lecithin sphingomyelin (L:S) ratio as a determining factor in fetal lung maturity is well established. An L:S ratio of greater than 2.0 to 2.5 is indicative of fetal lung maturity in most assays. The fluorescence polarization method (fluorescence polarization less than 0.320) has been associated with fetal lung maturity. The presence of phosphatidylglycerol in amniotic fluid has been related to fetal lung maturity and the absence of respiratory distress syndrome. Amniotic fluid samples from 235 amniocentesis procedures and vaginal pool collection at varying gestational ages were analyzed for L:S ratio, fluorescence polarization, and phosphatidylglycerol. All samples with meconium or hemolyzed blood contamination and selected complications of pregnancy were removed from the study. A positive result will predict the absence of respiratory distress syndrome, and a negative result will predict the presence of respiratory distress syndrome. Correlation of L:S ratio, fluorescence polarization, and phosphatidylglycerol were favorable. False-positive results in three (3.3%) fluorescence polarization samples were noted, whereas there were none (0%) in the L:S ratio sample and one (1%) in the phosphatidylglycerol sample. Twenty-four (77.4%), 28 (73.7%), and 37 (77%) were the number of false-negatives in the fluorescent polarization, L:S ratio, and phosphatidylglycerol samples. Fluorescence polarization, L:S ratio, and presence of phosphatidylglycerol compare favorably as fetal lung maturity tests. The prediction of respiratory distress syndrome is as sensitive with the three modalities. The specificity and the predictive value of a positive test is more favorable with L:S ratio and phosphatidylglycerol.

Amniocentesis↗
PubMed1983

Neonatal myotonic dystrophy as a cause of hydramnios and neonatal death. A case report and literature review.

A woman had three consecutive pregnancies complicated by hydramnios and early neonatal death. The identical prenatal and neonatal course, family history and, ultimately, maternal diagnosis supported the diagnosis of recurrent severe neonatal myotonic dystrophy. Ultrasonographic observation of the last fetus affected suggested and predicted the neonatal features of the disease.

Adult↗
PubMed1983

Early-onset preeclampsia, triploidy and fetal hydrops.

Early-onset preeclampsia (16-24 weeks) is frequently associated with fetal and placental anomalies. Hydatidiform mole, fetoplacental triploidy with partial molar changes and idiopathic hydrops fetalis are commonly associated ones. Two patients had severe, early-onset preeclampsia and ultrasonically documented fetal anomalies, one fetal triploidy, the other idiopathic hydrops with normal karyotype. The management of early-onset preeclampsia benefits from ultrasonography, and an aggressive search for fetal anomalies is recommended. Seventy-two percent of cases of early-onset preeclampsia in our institution were associated with significant fetal and placental malformations. An immunologic basis of the preeclampsia in these cases seems likely but remains unproven.

Adult↗
PubMed1980

Laparoscopic findings in twenty-five failures of artificial insemination.

The laparoscopic findings, treatment, and follow-up of 25 patients who failed artificial insemination donor (AID) were retrospectively evaluated. A high incidence (72%) of abnormal pelvic findings was encountered. Endometriosis was found in 60% and pelvic adhesions in 12% of the patients. The incidence of these two entities was not significantly different from their incidence in patients with unexplained infertility in the same institution (44% for endometriosis and 36% for adhesions). After surgical or medical treatment, a pregnancy rate of 22.2% (16.6% for endometriosis and 66.6% for pelvic adhesions) was achieved in patients with positive pelvic findings; in the group with negative pelvic findings, a pregnancy rate of 20% was achieved. The value of diagnostic laparoscopy in AID failures is discussed in the light of the findings presented and the relatively low rate of post-treatment pregnancy.

Adult↗
PubMedDate not supplied

Two-hour urine collection for evaluating renal function correlates with 24-hour urine collection in pregnant patients.

OBJECTIVE: We sought to determine if 2-h urine collection for the assessment of urine protein excretion and creatinine clearance correlates with 24-h urine collection in pregnant patients with renal disease. METHODS: We enrolled patients of gestational ages ranging from 8-41 weeks, admitted as inpatients and having undergone evaluation for renal function (n = 59). We obtained the following samples: 1) 2-h urine, and 2) 24-h urine. We measured serum creatinine concentration, urinary protein, creatinine concentration, and creatinine clearance. The data was analyzed using descriptive analysis, two-way ANOVA, univariate linear regression analysis, and Bland-Altman plot comparing the efficacy of 2-h urine results with 24-h urine results. RESULTS: We analyzed the data on 51 patients. Total proteinuria calculated by protein/creatinine (P:C) ratio in the 2-h group correlated with the total protein measured in the 24-h group (1,840.8 +/- 786 and 1,944 +/- 1,060 mg [mean +/- SE], respectively, r2 = 0.95, P < 0.0001). Creatinine clearance correlated in the 2- and 24-h groups (111 +/- 42 and 122.5 +/- 50 ml/min, respectively; r2 = 0.73, P < 0.001). CONCLUSION: Two-hour urine sampling offers the same clinical information as 24-h urine collection for the evaluation of renal function. Use of 2-h urine collection reduces the time of evaluation and diagnosis, whereby increasing patient compliance and reducing errors in performance of the tests.

Adult↗
PubMedDate not supplied

Obstetric vacuum extraction.

A brief historical review of vacuum extraction, indications for use, safety considerations, mode of action, delivery technique, and discussion of nursing implications is presented. Safety and effectiveness of vacuum extraction are supported by the results of a comparative study done at Mount Sinai Medical Center in which 256 vacuum extractions and 300 randomly selected forceps deliveries were performed. Indications for use, clinical status before application, maternal complications, and immediate neonatal complications are analyzed and discussed.

Birth Injuries↗
PubMedDate not supplied

Using amnioinfusion for the relief of repetitive variable decelerations during labor.

Amnioinfusion is a method of replacing intrauterine amniotic fluid volume through intrauterine infusion of a saline solution using a pressure catheter. This method simply and effectively relieves variable decelerations not alleviated by the conventional measures of maternal position change and oxygen administration. The mechanisms underlying variable decelerations, the technique for amnioinfusion administration, and two case studies are reported. Nursing responsibilities regarding amnioinfusion include pattern recognition, assisting with or initiation of amnioinfusion, and maintenance and evaluation of this intervention.

Adult↗