Biomedical subjects

I R Merkatz

Publications and source records attributed to I R Merkatz.

At least 37 records · Page 2Linked to original sources

PubMed1991

Intrapartum ultrasonographic estimates of fetal weight by the house staff.

In spite of the widespread use of ultrasonographic estimates of fetal weight, a paucity of data exists with regard to its use in patients who are in labor. The purpose of this study was to evaluate the accuracy of ultrasonographic estimates of fetal weight in a busy labor and delivery suite by the house staff. Measurements of biparietal diameter, abdominal circumference, and femur length were prospectively obtained in 109 patients in labor in whom this information was expected to be contributory in making delivery plans. All patients were delivered within 48 hours of ultrasonographic evaluation. Measurements of abdominal circumference were obtained in all cases. Biparietal diameter and femur length were obtained in 85% and 92% of cases, respectively. Overall, the mean absolute errors were 9.3% and 9.2% for estimated fetal weight by biparietal diameter/abdominal circumference and abdominal circumference/femur length ratios, respectively. Estimated fetal weight by biparietal/diameter/abdominal circumference ratio was not significantly different from that by femur length/abdominal circumference ratio. In conclusion, the accuracy of intrapartum estimates of fetal weight performed by the house staff in a busy labor and delivery unit is comparable to that reported for estimates obtained during the antepartum period by professional users of ultrasonography in a controlled setting.

Abdomen↗

PubMed1991

The effect of fetal movement counting on maternal attachment to fetus.

The effect of fetal movement counting on maternal attachment to fetus was investigated in 213 women with uncomplicated singleton pregnancies at 28 to 32 weeks' gestation. Women were randomized into those who counted fetal movements using the Sadovsky (n = 63) or Cardiff (n = 62) charts and controls (n = 88). After 1 month of fetal movement counting, the Cranley 24-item scale with five subscales was used as a measure of maternal-fetal attachment. Univariate analysis revealed a statistically significant increase in total attachment scores and in each of the five attachment subscales among women who counted fetal movements (p less than 0.0001). Turkey's studentized range test confirmed significant differences between each of the Sadovsky and Cardiff groups compared with controls (p less than 0.05). Our study suggests that fetal movement counting may enhance the maternal-fetal attachment process.

Adolescent↗

PubMed1991

Antepartum fetal surveillance tests during sickle cell crisis.

A study was conducted to evaluate the characteristics of antepartum fetal assessment tests for women with sickle cell disease during crisis. A total of 24 women with 39 episodes of crisis after 34 weeks of pregnancy were studied. All subjects were evaluated with nonstress tests, biophysical profile score, and uterine and umbilical artery systolic/diastolic ratios during and after sickle cell crisis. Results revealed that the incidence of nonreactive nonstress tests was significantly higher during crisis compared with the period after crisis (58.9% vs 10.3%, p less than 0.05). The frequency of biophysical profile score less than 8 was significantly higher during crisis compared with after crisis (33.3% vs 7.7%, p less than 0.05). All subjects had an increase in uterine systolic/diastolic ratio during crisis. The average uterine systolic/diastolic ratio was 3.92 (range, 2.16 to 4.24) during crisis and 2.54 (range, 1.98 to 3.23) after crisis (p less than 0.05). In contrast, there was no significant change in the mean umbilical systolic/diastolic ratios during and after crisis (2.58 and 2.62, respectively). We conclude that, although sickle cell disease crisis is associated with a higher incidence of abnormal biophysical test results, in most patients these results will revert to normal after crisis. The increase in uterine vascular resistance without a concordant increase in umbilical vascular resistance suggests that the transient effects of sickling during crisis may not compromise umbilical blood flow.

Adult↗

PubMed1991

The contributions of the nurse and the machine in home uterine activity monitoring systems.

The relative contributions of home tokodynamometry and daily nursing telephone contact to the success of preterm birth prevention programs remains a subject of debate. Because investigators have obtained conflicting data, a reinterpretation of published results was undertaken by proposing a dynamic interface between the nurse and the machine. Experience gained from the technology and the development of nursing expertise with assessment of patient symptoms are presented as interdependent factors, both of which are critical to a therapeutic nurse-patient relationship. It is proposed that this combined interactive expertise increases sensitivity to the early recognition of preterm labor. The nurse's role in providing social support to high-risk pregnant women is then identified as a potential additional independent contributing factor to reported observed reductions in preterm births. Discussion focuses on future research, public policy issues, and the need for expanding nurse-patient interactions into the home.

Female↗

PubMed1991

Third-trimester prediction of small-for-gestational-age infants in pregnant women with sickle cell disease. Development of the ultradop index.

Twenty-seven women with homozygous sickle cell disease were followed from the third trimester until delivery. All the subjects underwent both Doppler and sonographic assessment at two points in pregnancy, periods I (28-30 weeks) and II (34-36 weeks). Estimated fetal weight (EFW) was calculated. Using a continuous wave Doppler instrument, mean systolic:end diastolic (S:D) ratios were calculated to characterize the umbilical waveforms. S:D ratios greater than or equal to 3 were designated abnormal. An index, the ultra-dop, was developed that combined ultrasound EFW less than or equal to 25th percentile and S:D greater than or equal to 3. Nine of 27 infants (33%) were small for their gestational age, with a mean gestational age of 38 +/- 2 weeks. The sensitivity, specificity and predictive values were calculated for smallness for gestational age utilizing ultrasound, Doppler velocimetry and the ultradop index for periods I and II. For period I, the highest sensitivity was obtained with the ultradop index--88.9% as compared to 77.8% with Doppler scanning and 11.1% with ultrasound. The ultradop also provided the highest positive predictive value, 88.9%; it was followed by Doppler at 77.8% and ultrasound at 50.0%. In period II the ultradop index and Doppler had the same sensitivity, 88.9%, which was much higher than for ultrasound (55.6%). As for period I, the ultradop had the highest positive predictive value, 88.9%. Our data suggest that the ultradop index provides a key assessment of women with sickle cell disease at 28-30 weeks' gestation with reference to the likelihood of their giving birth to small-for-gestational-age infants.

Adult↗

PubMed1991

Caring for our future: a report by the expert panel on the content of prenatal care.

The report of the Expert Panel on Prenatal Care entitled Caring for Our Future: The Content of Prenatal Care was presented to the Assistant Secretary for Health, James Mason, MD, on October 2, 1989. The Panel noted the need for attention not only to the mother and fetus, but also to the infant and family. Besides traditional medical care concerns, the importance of psychosocial and environmental patient and family needs was emphasized. The Panel felt that the addition of the pre-conception visit to routine prenatal care made care more effective. Suggestions as to visit timing and content were made. The Panel noted the need for further understanding of many of the activities performed routinely in prenatal care.

Female↗

PubMed1990

Ovarian conservation in placental site trophoblastic tumor.

While isolated reports on the management and natural biology of placental site trophoblastic tumor (PSTT) continue to accumulate, little attention has been given to ovarian conservation in the surgical management of this disease. Review of the literature reveals ovarian involvement by this tumor to be infrequent and, when present, grossly apparent at laparotomy. In the reported cases, grossly normal ovaries did not contain pathologic evidence of tumor. This study reports two additional cases in which at least one ovary was preserved. Until more reliable criteria are available for predicting which cases of PSTT will pursue a malignant course, the option of ovarian conservation should be available to young patients requiring abdominal surgery, if the disease remains confined to the uterus.

Adult↗

PubMed1990

Sonographic estimates of fetal weight in the intrauterine growth retardation population.

The efficacy of different methods of fetal weight estimation using sonographic measurements of the abdominal circumference (AC), biparietal diameter (BPD), and femur length (FL), either alone or in combination, was evaluated in the fetus with intrauterine growth retardation (IUGR). Eighty-one patients, referred with a clinical suspicion of IUGR, were studied. All patients had sonographic measurements within 7 days of delivery. Four regression equations were used to estimate fetal weight: AC (Hadlock), BPD-AC (Shepard), AC-FL (Hadlock), BPD-AC-FL (Hadlock). For the total study group, as well as for the infants who were found to be IUGR at birth, 75% of the estimates of fetal weight using the BPD-AC-FL method were within 10% of the actual birthweight. Nearly comparable results were obtained using the AC-FL method. In the fetus with IUGR, estimates of fetal weight that incorporated the FL correlated best with the actual birthweight.

Anthropometry↗

PubMed1990

Lifestyle modification as an intervention for inner city women at high risk for preterm birth.

This study details a programme which emphasized nursing interventions for women at high risk for preterm birth. Preterm birth continues to be a major health problem, with ongoing research being conducted both in the United States and internationally in an effort to find causative factors. Programmes designed to prevent preterm birth have been described often in the literature, with lifestyle factors being implicated in the incidence of preterm birth by many researchers. The purpose of this study was to determine the lifestyle factors most often associated with preterm birth in a high risk population of inner city women, and to examine the effect of change in lifestyle when change was possible. Women at high risk for preterm birth were interviewed extensively for prevalence of 12 lifestyle factors most often cited in the literature as being associated with preterm birth. Counselling and education were offered to each woman, with emphasis on symptom recognition and modification of lifestyle activities. Comprehensive prenatal care was administered by programme personnel. A profile of the women's reported lifestyle activities and stress factors is presented along with the relationship to outcome. The data suggested that, when change in lifestyle activity or stress was possible, women who decreased the activity or stressor were more likely to deliver at term. This study represents one of the first efforts in the United States to produce a prospective database to quantify risk and analyse the impact of change in activities associated with symptoms of preterm labour in high risk women.(ABSTRACT TRUNCATED AT 250 WORDS)

Counseling↗

PubMed1990

Prevention of preterm birth: clinical opinion.

Spontaneous preterm delivery continues to be the most significant problem facing clinicians as we enter the 1990s. Prevention of preterm labor still awaits needed improvements in prediction. At present, most preterm birth prevention programs are based upon the early recognition of preterm labor followed by prompt tocolysis. Programs based upon patient education and support, daily contact by trained nurses, intermittent cervical assessment, and daily sampling of uterine activity have been associated with a decrease in preterm birth. The exact contribution of each component to reduce preterm birth remains to be defined and, at present, a combination of the components is still suggested.

Female↗

PubMed1990

A "PROPP" for the Bronx: preterm birth prevention education in the inner city.

As one component of the multifaceted community-wide preterm prevention program known as "A PROPP for the Bronx" (Program to Reduce Obstetric Problems and Prematurity), a prenatal education videotape in both English and Spanish was developed. Its impact was evaluated in 615 high-risk patients at the Bronx Municipal Hospital Center. The 12-minute videotape focused on the implications of preterm birth, the signs and symptoms of preterm labor, and behavioral modification to reduce life-style risk factors. An instrument was constructed to examine baseline knowledge, information transfer, and knowledge retention, and was validated and tested for reliability (r = 0.95). The results demonstrated a statistically significant knowledge transfer for patients viewing the videotape (P less than .0001) and significant knowledge retention through the postpartum period (P less than .0001) for Spanish-speaking as well as English-speaking parturients. These data emphasize the importance of the educational component of a preterm prevention program in an impoverished population at risk for early delivery.

Adolescent↗

PubMed1990

Education does not improve patient perception of preterm uterine contractility.

In this prospective study, we sought to compare pregnant women's self-perception of their preterm uterine contractility versus electronically obtained data and to evaluate the impact of intensive patient education on increasing awareness of the presence of uterine contractions. Thirty-eight women each monitored their uterine activity at home for two 60-minute periods daily during a 21-day sequence. An event marker was used to document perceived contractions and after a 3-day baseline interval, an intensive nursing-service educational intervention was initiated for all subjects. Thirty-five percent of women underreported uterine contractions, whereas only 5% overreported their uterine activity during the study. Derived patient scores of underreporting and overreporting of contractions did not vary among seven consecutive 3-day study intervals. Analysis of the data revealed that patients perceived fewer than 10% of all contractions documented electronically. No improvement in the reliability of patient perception of preterm uterine contractility was obtained after the educational intervention.

Adult↗

PubMed1990

Uterine contractility patterns after an episode of preterm labor.

Uterine contractility patterns were studied in an attempt to identify those women on tocolytic therapy at risk for preterm delivery. One hundred sixteen women treated successfully after an episode of preterm labor were followed with an ambulatory tocodynamometer system. Contractions were monitored twice daily for 1 hour until delivery or until 36 completed weeks of gestation. In this group, 52 women (45%) delivered preterm and 64 (55%) delivered at term. The analysis revealed that 1) from 24-29 weeks' gestation, there was no significant difference in the uterine activity between the two groups; and 2) beginning at 30 weeks' gestation and continuing until the end of the 36th week of gestation, uterine activity was significantly greater in women destined to deliver preterm. These observations suggest that the patterns of daily uterine contractility observed in patients after an episode of preterm labor can identify those at greater risk for a preterm delivery.

Adult↗

PubMed1989

Maternal hemoglobin F levels may have an adverse effect on neonatal birth weight in pregnancies with sickle cell disease.

A total of 26 patients with sickle cell disease were followed up through 32 pregnancies. There was no correlation between days in hospital or number of painful crises and either birth weight or birth weight percentile. The number of dense irreversibly sickled and least deformable cells was negatively correlated with birth weight percentile (r = -0.63, p less than 0.01). Patients' initial hemoglobin levels were positively correlated with birth weight percentile (r = 0.52, p less than 0.004). Hemoglobin F, on the other hand, was significantly inversely correlated with birth weight percentile. Nine pregnancies with small-for-gestational-age infants had an average hemoglobin level of 9.1% +/- 4.5%. In contrast, patients who were delivered of appropriate-for-gestational-age infants (23 pregnancies) had an average hemoglobin F level of 3.6% +/- 2.9% (p less than 0.01). We conclude that total hemoglobin levels and dense cells are correlated with birth weight percentile; moreover, the higher the maternal hemoglobin F levels the higher the risk of small-for-gestational-age infants. We speculate that although high hemoglobin levels may be beneficial to the fetus, high maternal hemoglobin F levels could increase the desaturation of non-F cells and induce placental obstruction.

Anemia, Sickle Cell↗

PubMed1989

Effectiveness of patient education to reduce preterm delivery among ordinary risk patients.

Patient education is an important component of all preterm birth prevention programs, but studies of these programs have not examined the independent contribution of patient education to preterm birth prevention. The Program to Reduce Obstetrical Problems and Prematurity in the Bronx, New York, is a multifaceted preterm birth prevention program that includes a half hour combined videotape and nurse discussion session, which was offered to all patients. In evaluating the outcome of pregnancies in patients not at high risk for preterm delivery (ordinary risk patients) we found that patients who received instruction to recognize early signs of preterm labor had babies with a higher birthweight (3255 +/- 548 gm) than patients who were not so instructed (3200 +/- 599 gm, p = 0.03). Average length of gestation in the instructed and noninstructed patients was 276 +/- 15 days and 275 +/- 18 days (p = 0.12), respectively. The preterm delivery rate among patients receiving the instruction was 9.5% compared with 11.5% among those who did not receive it. We conclude that specific prenatal education about early warning signs of preterm labor is an important component of preterm birth prevention programs that can be demonstrated to have an independent contribution to prenatal care.

Adult↗

PubMed1989

Cardiac screening for pregnant intravenous drug abusers.

We performed screening two-dimensional and M-mode echocardiograms on 23 pregnant intravenous drug abusers who had systolic murmurs that clinically appeared physiologic. Although no patient had symptoms or a history of cardiac disease, all but two of the women were evaluated as having unexpected cardiac valvular changes. The majority of morphologic valvular findings on echocardiography consisted of either a mitral valve prolapse or valvular leaflet thickening. However, two of these 21 women were identified as having a previously undiagnosed aortic or tricuspid vegetation for which they subsequently received prophylactic antibiotic therapy during labor and delivery. Notably, two additional women among the group with morphologic valvular changes ultimately developed subacute bacterial endocarditis. Atypically, the clinical illness occurred antenatally for one of the two women with a mitral valve prolapse and 18 months postpartum for another women with unexplained valvular thickening. On the basis of these observations, a more liberal use of echocardiography in the care of the pregnant intravenous drug abuser population is suggested for evaluation of otherwise seemingly innocuous systolic murmurs.

Adult↗

PubMed1989

Changes in the pattern of uterine contractility in relationship to coitus during pregnancies at low and high risk for preterm labor.

This is a preliminary, prospective study of uterine contractility in response to sexual intercourse. The study population consisted of 30 pregnant subjects. Group I included 15 women treated for an episode of preterm labor with intravenous and oral tocolysis in this pregnancy, and group II was a matched control group of low-risk volunteers. The availability of home uterine tocodynamometric systems permitted monitoring of uterine contractility for three 60-minute time periods related to coitus. A significant increase in uterine contractility in the immediate postcoital period was observed for the high-risk women, but not for the controls. This increased uterine activity subsided spontaneously within 2-3 hours, returning to baseline. These initial preliminary observations of uterine response to coitus in a home environment are interesting; however, further research is suggested to establish their clinical implications.

Adult↗

PubMed1988

The urban community as the client in preterm birth prevention: evaluation of a program component.

Education of communities about preterm birth is essential because preterm birth is a major perinatal health problem, contributing 60-80% of the perinatal mortality in the United States. Preterm birth impacts on the health of the community through the increased morbidity and mortality of the affected children, which leads to higher health care costs and compromised future productivity. The role of early enrollment into prenatal care in the improvement of perinatal outcomes has been established by many investigators. A health education strategy using a communication in the form of a videotaped program was designed in order to increase community awareness about this serious health problem and about the importance of early prenatal care. The purpose of this investigation was to evaluate that strategy by: determining the validity of the communication; analyzing its impact on related behavioral intentions of Community Board members; and assessing the association between behavioral intentions and reported behaviors in those Community Board members. A panel of experts in the fields of prenatal care/preterm birth or health education/communication was used to evaluate the face validity of the communication, using the Communication Rating Scale, an instrument developed by James Malfetti, Ed. D. The Fishbein Linear Regression Model was utilized in ascertaining attitudes and social normative factors predictive of behavioral intentions. A nonequivalant control group design was used to measure the impact of the communication on the behavioral intentions of 10 Community Boards in the Bronx, New York. The findings included high ratings by the expert panel; a positive significant difference between behavioral intentions of Community Board members before and after viewing the communication; and significant correlation between behavioral intentions and reported behaviors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗