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Biomedical subjects

F G Cunningham

Publications and source records attributed to F G Cunningham.

At least 55 records · Page 3Linked to original sources
PubMed1992

High- versus low-dose oxytocin for labor stimulation.

The number of cesarean births for dystocia has increased dramatically in the United States. Central to the management of dystocia is correction of ineffective labor by oxytocin administration, and contemporary obstetric practice is to stimulate labor with a low-dose oxytocin regimen. We prospectively compared a low-dose oxytocin regimen (1-mU/minute dosage increments) with a high-dose regimen (6-mU/minute dosage increments) in 2788 consecutive singleton cephalic pregnancies. The low-dose regimen was used first for 5 months in 1251 pregnancies, and the high-dose regimen in 1537 pregnancies during the subsequent 5 months. Indications for oxytocin stimulation were divided into augmentation (N = 1676) and induction (N = 1112). Labor stimulation was more than 3 hours shorter (P less than .0001) with the high-dose oxytocin regimen and associated with a reduction in neonatal sepsis (0.2 versus 1.3%; P less than .01). Uterine hyperstimulation was more common (55 versus 42%; P less than .0001) with the high-dose regimen, but no adverse fetal effects were observed. High-dose augmentation resulted in significantly fewer forceps deliveries (12 versus 16%; P = .03) and fewer cesareans for dystocia (9 versus 12%; P = .04). Similarly, failed induction was less frequent with high-dose compared with low-dose oxytocin (14 versus 19%; P = .05). Although the high-dose induction regimen was associated with a significantly increased cesarean incidence for fetal distress (6 versus 3%; P = .05), the incidence of umbilical artery cord blood acidemia was not increased in this subset. Induction of labor with high-dose oxytocin is problematic because of risk-benefit considerations. Although induction failed less frequently with the high-dose regimen, cesarean for fetal distress was performed more frequently. In contrast, high-dose oxytocin to augment ineffective spontaneous labor minimized the number of cesareans done for dystocia.

Adult↗
PubMed1991

On reducing the frequency of severe abruptio placentae.

At Parkland Memorial Hospital the frequency of abruptio placentae so severe as to kill the fetus has decreased from 1 in 420 deliveries during 1956 through 1969 to 1 in 830 during 1974 through 1989. Major factors in this reduction were elimination of very high parity and a marked increase in the percentage of Latin American women, in whom the risk was 1 in 1473 deliveries compared with 1 in 595 for black women and 1 in 876 for white women. Abdominal trauma was encountered rarely, as was fetoplacental-to-maternal hemorrhage sufficient to impair fetal perfusion seriously. Abnormal development of Müllerian ducts and uterine myomas were encountered rarely. Neither red blood cell macrocytosis characteristic of folate deficiency nor iron deficiency could be implicated in the genesis of severe abruptio placentae. Abruptio placentae recurred in 12% of subsequent pregnancies and proved fatal to the fetus in 7%, unchanged from our earlier experience.

Abruptio Placentae↗
PubMed1991

Mechanisms of hemolysis and anemia associated with acute antepartum pyelonephritis.

Anemia develops in about a fourth of women whose pregnancy is complicated by pyelonephritis, although its exact mechanism has not been defined clearly. In this study of 18 women with antepartum pyelonephritis, although only a third had anemia (hematocrit less than 30 vol/dl), there was evidence for hemolysis in all 18. Specifically there was a mean decrease in hematocrit of 5 vol/dl from admission to discharge. With scanning electron microscopy, we compared erythrocyte morphologic aberrations that were found in women with renal infection with those of normally pregnant women, and the former had significantly increased proportions of echinocytes in particular, but schistocytes and spherocytes were increased also (total 10.3% vs 1.4%, p less than 0.0001). These changes, especially echinocytosis, have been induced in vitro by lipopolysaccharide, and they are known to lead to premature red blood cell destruction in vivo. We conclude that hemolysis with subsequent anemia in pregnant women with pyelonephritis is caused by lipopolysaccharide-induced red blood cell membrane damage.

Acute Disease↗
PubMed1991

Computed tomography for evaluation of puerperal infections.

Pelvic computed tomography was used to evaluate 74 women with persistent puerperal infection. There was at least one abnormal roentgenographic finding in 57, and these are correlated with clinical and surgical findings. In 16 women, a palpable pelvic mass was seen on tomography, however, masses not appreciated clinically were visualized in another 29 women, and in five, a clinically palpable mass was not visualized by tomography. In 12 women who had a normal pelvic examination, septic pelvic thrombophlebitis was diagnosed by tomography. Over-all, there was poor correlation with roentgenographic findings and uterine incisional necrosis and dehiscence. We conclude that pelvic tomography is useful to evaluate some women with persistent puerperal infection, but that these studies must be correlated with clinical findings.

Adolescent↗
PubMed1991

Cerebrovascular accidents complicating pregnancy and the puerperium.

The decreasing incidence of direct causes of maternal death over the past half century has led to a heightened awareness of nonobstetric factors responsible for maternal mortality. For example, cerebrovascular accidents are an important nonobstetric cause of maternal morbidity and mortality. During the 6.5-year period from 1984 to mid-1990, we encountered 15 women in whom pregnancy or the puerperium was complicated by an acute cerebrovascular accident. Six of these women had hemorrhagic strokes and nine had ischemic strokes. During this same time, approximately 90,000 women were delivered at Parkland Memorial Hospital, and thus the incidence of stroke was about one in 6000 pregnancies. Chronic hypertension or preeclampsia was causative in three cases of hemorrhagic stroke. It is important that 20% of the women died as a result of stroke, and of the 12 survivors, 40% have residual neurologic deficits. An aggressive work-up to define the etiology of stroke is necessary in order to implement cause-specific management, with subsequent reduction in morbidity and mortality.

Cerebrovascular Disorders↗
PubMed1990

Liver histopathologic findings in women with sickle cell disease given prophylactic transfusion during pregnancy.

Forty women with a major sickle hemoglobinopathy (hemoglobin SS, SC, or S-beta-thalassemia) were given red blood cell transfusions prophylactically during pregnancy. A mean of 13.6 units of erythrocytes per woman was given and none received more than 28 units. Direct-vision needle biopsy of the liver was performed in conjunction with cesarean section or puerperal sterilization. Although iron deposition in hepatocytes and Kupffer cells was identified commonly, neither cirrhosis nor widespread hepatocellular necrosis was found. We conclude that the risk of irreversible hepatic damage is negligible in women with sickle hemoglobinopathies who are given erythrocytes prophylactically during one pregnancy.

Anemia, Sickle Cell↗
PubMed1990

Chronic renal disease and pregnancy outcome.

During the 18-year period from 1971 through 1988, 37 women whose pregnancies were complicated by moderate or severe renal insufficiency were managed at Parkland Memorial Hospital. Common maternal complications included anemia, chronic hypertension, and preeclampsia. Perinatal complications included midpregnancy losses and low birth weight from preterm delivery, fetal growth retardation, or both. Despite the high incidence of maternal morbidity, 85% of pregnancies in the 26 women with moderate renal insufficiency resulted in a live-born infant; there was one stillbirth and no neonatal deaths. Of the 11 women with severe disease, seven were delivered of live-born infants after greater than or equal to 26 weeks' gestation. Although six of these 37 women had worsening renal function during pregnancy, it seems unlikely that pregnancy per se caused this. More importantly, in four of these six women and in four others who had stable function throughout pregnancy, end-stage renal disease developed within a mean of 4 years after delivery. In 14 women blood volume was determined during pregnancy, and whereas those with moderate disease had normal volume expansion, women with severe disease had significantly attenuated expansion. Finally, serial creatinine clearances did not increase during pregnancy in half the women with moderate insufficiency and none with severe dysfunction.

Anemia↗
PubMed1990

Eclampsia.

Early detection and hospitalization in women with mild preeclampsia may prevent eclampsia. In the event of severe preeclampsia or eclampsia, delivery is indicated for the benefit of both mother and fetus. Thereafter, pathologic changes of preeclampsia and eclampsia, including major multiple organ system dysfunction, undergo complete reversal.

Anticonvulsants↗
PubMed1990

Ticarcillin/clavulanate in the treatment of pelvic infections.

Ticarcillin/clavulanate was used to treat 130 women with pelvic infections. The 129 who completed an initial course of treatment with ticarcillin/clavulanate were analyzed according to type and clinical severity of infection, and pretreatment and posttreatment endometrial bacteriology. There were 26 cases of pelvic inflammatory disease and 103 puerperal infections, 61 of which occurred in women who had delivered by cesarean section (46 elective with no antibiotic prophylaxis at the time of surgery). Of the 129 patients treated, 124 were clinically cured, and one improved (97%). There were four treatment failures, all of which were among a total of 20 cases classified as clinically severe. All the patients designated as treatment failures required prolonged treatment with other antibacterials to achieve a clinical cure, but a longer duration of treatment with ticarcillin/clavulanate might have effected a clinical resolution even in these cases. In vitro examination of endometrial isolates revealed a significant reduction of the minimum inhibitory concentrations (MICs) of beta-lactamase-producing bacteria with the addition of clavulanate to ticarcillin. The relationship of non-beta-lactamase-producing enterococci having relatively high MICs to clinical failure was examined.

Bacteria↗
PubMed1990

The national impact of ritodrine hydrochloride for inhibition of preterm labor.

Ritodrine hydrochloride is a beta 2-receptor agonist that relaxes uterine smooth muscle. It was developed specifically for treatment of preterm labor and was approved for this indication in 1980 by the Food and Drug Administration. Estimates of ritodrine usage in the United States were calculated based upon annual sales, and these were examined in relation to the incidence of births in 500-g weight categories less than 2500 g. We estimate that more than 100,000 women with preterm labor are treated with ritodrine annually, but this has had minimal if any impact on the incidence of low birth weight in this country.

Drug Utilization↗
PubMed1990

Pregnancy complicated by hemoglobin CC and C-beta-thalassemia disease.

The outcomes of 72 pregnancies in 20 women with either hemoglobin CC or C-beta-thalassemia are described. Except for mild to moderate hemolytic anemia, maternal complications caused by the hemoglobinopathy were infrequent and perinatal outcomes were generally good. In eight women, blood volume expansion determined by 51chromium-tagged erythrocytes was similar to that for normally pregnant women. Mean red-cell survival was determined 11 times in eight women, and the red-cell half-life of 22 days was significantly shorter than that of 35 days for normally pregnant women.

Black People↗
PubMed1989

Thyrotoxicosis complicating pregnancy.

During the 12-year period from 1974 through 1985, nearly 120,000 women were delivered of infants at Parkland Hospital, and pregnancy was complicated by overt thyrotoxicosis in 60 of them (1:2000). Initial treatment was based on clinical assessment, and propylthiouracil was usually given in doses of 300 to 800 mg daily. In compliant women seen by midpregnancy, euthyroidism was achieved by a mean of 8 weeks; however, the daily dose was decreased to less than or equal to 150 mg by delivery in only 10%. Metabolic status at delivery correlated directly with pregnancy outcome, and women treated earlier in pregnancy were more likely to be euthyroid at delivery and to have good outcomes. Diagnosis of thyrotoxicosis antecedent to pregnancy was associated with earlier treatment, and 80% of 28 such women were euthyroid by delivery. Conversely, 32 women with a first diagnosis during pregnancy had the preponderance of morbidity, including five of six stillbirths and six of seven cases of heart failure. This group was characterized by a relative delay in gestational age at diagnosis. Preterm delivery, perinatal mortality, and maternal heart failure were more common in women who remained thyrotoxic despite treatment and in those who were never treated. Although we infrequently achieved maintenance doses recommended by most, because there were minimal adverse effects from therapy described here and because uncontrolled thyrotoxicosis caused significant maternal and perinatal morbidity, aggressive medical therapy seems appropriate, especially when pregnancy is advanced.

Adult↗
PubMed1989

Cesarean section: the House of Horne revisited.

In 1983, obstetricians from Dublin, Ireland, alleged that the perinatal mortality rate in the United States could be achieved with a cesarean section rate of approximately 5%. We responded in 1985 that population and infant outcome differences precluded such a low rate of cesarean sections at Parkland Memorial Hospital. The Dublin obstetricians responded 3 years later that it was unfair to compare obstetric services for only 1 year (1983). We respond again.

Cesarean Section↗