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Biomedical subjects

J C Hauth

Publications and source records attributed to J C Hauth.

At least 145 records · Page 8Linked to original sources
PubMed1984

Cesarean section: changing incidence and indications.

There were 19,419 deliveries at Wilford Hall USAF Medical Center from 1970 through 1981. Of these, 1847 (9.5%) were by primary cesarean section and 800 (4%) by repeat operations. The most common indications for cesarean section (dystocia, breech presentation, repeat operation, and fetal distress) remained the same during this period. However, within these four indications and also between the three time periods of 1970 to 1973, 1974 to 1977, and 1978 to 1981, significant trends were apparent. From the periods of 1970 to 1973 through 1974 to 1977, the primary rate increased from 5.6% to 12.8% (P less than .0001). Dystocia (P less than .0001), breech presentation (P less than .0001), and fetal distress (P less than .0001) were responsible for this increase. However, from 1974 to 1977 through 1978 to 1981, the primary rate decreased to 9.6% (P less than .0001). This was related to significantly decreased rates for dystocia (P less than .0001) and fetal distress (P less than .0001). This decrease was temporally related to an initiation of various means to decrease the authors' overall cesarean section rate that approached 20% in 1976.

Breech Presentation↗
PubMed1984

Second stage fetal heart rate abnormalities and neonatal acidosis.

Of 403 newborns with either fetal heart rate (FHR) bradycardia or tachycardia during the last ten minutes of the second stage of labor, 20% had an umbilical cord pH of less than 7.20 at birth compared with only 4% of newborns who had a normal FHR during the last ten minutes of labor (P less than .0001). Thirty (18%) of 165 neonates with mild bradycardia and 33 (27%) of 121 neonates with moderate to marked bradycardia had cord pH values of less than 7.20 at birth (P less than .0001). Of the 117 neonates with tachycardia during the last ten minutes of the second stage, 17 (15%) had a pH of less than 7.20 (P less than .0001). There was a significant increase in low cord pH values when FHR variability was absent when compared with normal variability (P less than .0001).

Acidosis↗
PubMed1984

Passive smoking and thiocyanate concentrations in pregnant women and newborns.

Serum thiocyanate concentrations have been used as a marker of cigarette exposure in both smokers and nonsmokers. The authors used this measure to estimate passive exposure in low-risk healthy pregnant women at term. Three groups were compared: smokers, passive smokers, and nonsmokers. The mean thiocyanate concentration (95 mumol/L) was significantly higher (P less than .001) in smokers than in passive smokers (35.9 mumol/L) or nonsmokers (32.3 mumol/L). The maternal and umbilical mean cord thiocyanate concentrations were similar in the smoking group (95 versus 72 mumol/L). Although the umbilical cord levels in the infants of passive smokers and nonsmokers were similar (26 versus 23 mumol/L), both levels were significantly lower than those of smokers. Most important, there was an inverse relationship between umbilical cord thiocyanate concentration and birth weight (P less than .001). The authors found no evidence that passive cigarette smoke exposure resulted in higher maternal or umbilical cord thiocyanate concentrations than found in nonsmokers.

Adult↗
PubMed1984

Changes in thyroid function and serum iodine levels after prepartum use of a povidone-iodine vaginal lubricant.

To determine if application of iodide to vaginal mucosa of pregnant women results in significant iodide absorption or changes in thyroid function, we studied 18 intrapartum women for whose examinations during labor povidone-iodine gel was used as a lubricant and 16 for whose examinations an iodine-free lubricant was used. Both serum inorganic iodine and total serum iodine increased significantly (p less than 0.001) after iodide exposure and fell (p = 0.003) to near baseline within two days. In both groups, serum thyroxine and triiodothyronine fell during labor and delivery; differences between groups were not significant. In the iodine-treated group, however, there was a significant increase in thyroid-stimulating hormone at two days postpartum (p less than 0.001). Iodide applied to vaginal mucosa of pregnant women is absorbed and affects the maternal pituitary-thyroid axis.

Administration, Topical↗
PubMed1984

Neonatal acidosis and method of delivery.

Seven hundred and four women who had a forceps termination (177 elective, 293 indicated low, and 234 indicated midforceps) of labor over 24 months were compared with 303 spontaneous and 111 cesarean deliveries over the same time period. There was no significant difference between indicated low or midforceps either for fetal distress or arrest of descent with regard to fetal acidosis (pH less than 7.20), one- or five-minute Apgar scores less than 7, fetal trauma, or neurologic deficit at discharge. Fourteen percent of indicated forceps for arrest of descent had neonatal acidosis, versus 8% of cesarean sections for cephalopelvic disproportion (P = NS), and 23% of indicated forceps for fetal distress had acidosis, versus 33% of cesarean sections (P = not significant). There was no significant difference either in the incidence of acidosis or in low Apgar scores in neonates delivered by elective low forceps compared with those born by spontaneous vaginal delivery. The only significant differences in midforceps versus low forceps were between maternal pre- and postdelivery hematocrits (P less than .0001) and vaginal lacerations (P less than .0001). The authors' data support the continued usage of indicated low and selected midforceps operations.

Acidosis↗
PubMed1983

Ritodrine hydrochloride infusion in pregnant baboons. II. Sodium and water compartment alterations.

To evaluate the effects of intravenously administered ritodrine hydrochloride on sodium and water metabolism, a pregnant baboon model was studied. Animals given ritodrine retained significantly more sodium (p less than 0.001) and administered fluids (p less than 0.002) compared with control animals. Although plasma volume did not change significantly within or between the two groups, extracellular volume increased by a mean of 1,480 ml in those given ritodrine compared with 790 ml in the control animals. There was no significant difference between animals given ritodrine and their controls regarding serial hematocrits, serum sodium, or colloid oncotic pressures. From this we conclude that the retained sodium and water was in the interstitial space. Since plasma volume was unaltered by ritodrine administration it seems unlikely that pure volume overload can explain the pulmonary edema induced by beta-mimetics. Combined with the prior observation that direct pulmonary capillary membrane toxicity does not occur, the likely pathophysiology of beta-agonist-induced pulmonary edema involves left ventricular failure.

Animals↗
PubMed1983

Ritodrine hydrochloride infusion in pregnant baboons. I. Biophysical effects.

Pulmonary edema is a potentially fatal complication of beta-sympathomimetic therapy for premature labor. Isolated case reports have supported either primary pulmonary capillary membrane injury or left ventricular failure as the cause of pulmonary edema. By simultaneously monitoring cardiac function and extravascular lung water in six control and six ritodrine hydrochloride-treated pregnant baboons, we attempted to define this pathophysiology. The pulmonary capillary wedge pressure increased in treated animals, reaching significance at 16 hours of ritodrine treatment (p less than 0.0001) concurrent with the maximum increase in cardiac index (p = 0.02). Treated animals also retained 61% of intravenously administered fluids compared with 23% in untreated control animals (p less than 0.002). There were, however, no significant differences between groups in extravascular lung water, central venous pressure, or pulmonary artery pressure. Chest radiographs and arterial blood gas analysis were also comparable between ritodrine-treated and control animals. Fluid retention and elevated hydrostatic pressure are postulated as the etiology of beta-sympathomimetic-induced pulmonary edema. There was no evidence to support a primary pulmonary capillary membrane injury by ritodrine.

Animals↗
PubMed1983

The effect of 17 alpha-hydroxyprogesterone caproate on pregnancy outcome in an active-duty military population.

A prior report suggested that active-duty pregnant women are at increased risk for low-birth weight infants and a higher perinatal mortality rate. The present double-blind investigation was designed to prospectively evaluate that risk and to test the efficacy of 17 alpha-hydroxyprogesterone caproate to prevent reported complications. Three groups of active-duty women were studied, beginning between 16 and 20 weeks' gestation. They were similar for parity, previous abortion, race, cigarette smoking, and marital status. Of these, 80 were given 17 alpha-hydroxyprogesterone caproate, 88 received placebo, and 78 declined to participate in the protocol. There was no significant differences in the three groups when comparisons were made for low-birth weight infants and for perinatal mortality. However, when comparison was made to a military dependent population, they had a significantly worse outcome with regard to both perinatal mortality (p = 0.001) and infants with a birth weight less than 2,500 gm (p = 0.01). We concluded that pregnant military personnel were at increased risk for adverse pregnancy outcome, but that this risk was not altered by therapy with 17 alpha-hydroxyprogesterone caproate.

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1983

The effects of ritodrine on prostaglandin metabolite concentrations in the blood of pregnant baboons.

To investigate the relationship between beta sympathomimetic drugs and prostaglandins, we measured prostaglandin metabolites in the plasma of pregnant baboons that were given the drug ritodrine. Animals were at a mean gestation of 120 days, which is equivalent to 27 weeks in women. Ritodrine was infused i.v. at a rate of 23 micrograms/min or 80 micrograms/min for 4 h. Plasma concentrations of 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM), 11-deoxy-13,14-dihydro-15-keto-11,16-cyclo-prostaglandin E2 (PGEM-11), and 6-keto-prostaglandin-F1 alpha (6-keto-PGF1 alpha) were determined as indicators of the precursors, prostaglandin F2 alpha, prostaglandin E2, and prostacyclin (PGI2), respectively. At the 23 micrograms/min ritodrine infusion rate plasma levels of 6-keto-PGF1 alpha were decreased by 51% (+/- 15%) in the animals receiving the drug (p less than 0.005) whereas corresponding levels in control animals did not differ significantly from pre-infusion levels. At the 80 micrograms/min ritodrine infusion rate, the plasma levels of 6-keto-PGF1 alpha decreased by 66% (+/- 18%) compared with pre-infusion levels (p less than 0.001) but again the levels in control animals were not changed significantly. Plasma levels of PGFM and PGEM-11 in animals during ritodrine treatment did not differ significantly from baseline values.

Animals↗
PubMed1983

Ehlers-Danlos syndrome and pregnancy.

Ehlers-Danlos syndrome is a genetically transmitted disorder of connective tissue characterized by hyperelasticity of the skin, hyperflexibility and looseness of the joints, easy bruisability of the skin, and in the more severe forms of the disease, arterial fragility and tendency to rupture. Pregnant patients with Ehlers-Danlos syndrome are at increased risk for various complications, most serious of which is rupture of a major vessel. The present case report is the second known report of a maternal death from rupture of a major artery in a patient with the severe type IV variant of the syndrome. The advisability of pregnancy and genetic counseling are discussed.

Adult↗
PubMed1982

Fetal heart rate reactivity before and after maternal jogging during the third trimester.

A paucity of data exists concerning the fetal effects of exercise during pregnancy. Seven women who jogged at least 1.5 miles three times per week prior to and during pregnancy were studied during the third trimester of pregnancy (28 to 38 weeks' gestation). Fetal status was evaluated by the nonstress test (NST) before and immediately after maternal jogging of at least 1.5 miles. The seven pregnant women had a total of 30 NSTs--15 prior to and 15 immediately after jogging. All 30 tests were reactive, and there was no significant difference in the monitoring time required to obtain a reactive NST before and after jogging. The prejogging fetal heart rate (FHR) ranged from 140 to 150 bpm, and the postjogging FHR ranged from 180 to 204 in nine of the 15 NSTs. It took a mean of 22 minutes (range, 12 to 30 minutes) for the FHR to return to the prejogging baseline.

Female↗
PubMed1982

Conservative management of patients with premature rupture of fetal membranes.

The management of pregnant patients with premature rupture of membranes (PROM) prior to 32 weeks' gestation or at 32 to 34 weeks' gestation is controversial. In a retrospective analysis of 109 patients with PROM at or prior to 34 weeks' gestation, 53 (49%) were managed conservatively, and labor was eigher induced or occurred spontaneously within 24 hours in 56 (51%). Patients initially presenting with chorioamnionitis were excluded from this study, as were all patients with evidence of a fetal anomaly or a medical indication for delivery. The 53 patients managed conservatively had a mean pregnancy prolongation of 21 days (range, 2 to 105 days median, 7 days). The infants of patients managed conservatively had a lower incidence of respiratory distress syndrome (P less than .0025), mortality (P less than .05), and intracranial hemorrhage (P less than .03). Sixty-four percent of the conservatively managed group versus 45% of the induced/spontaneous labor group were found to be normal upon physical and neurologic examination when discharged from the hospital (P less than .035). The difference in incidence of neonatal sepsis between these 2 groups was not statistically significant (P = .42). Immediate induction of labor and/or delivery for patients with PROM at less than 32 weeks' gestation resulted in a significant increase in perinatal mortality and morbidity.

Female↗
PubMed1981

Plasmapheresis as an adjunct to management of Rh isoimmunization.

Plasmapheresis as therapy for Rh isoimmunization has gained recent attention in Great Britain; however, this technique has not been widely accepted in the United States. At Wilford Hall USAF Medical Center, separator was beneficial in the management of a patient with Rh isoimmunization. A decrease in the delta optical density (OD) 450 followed the onset of plasmapheresis by 3 and 4 weeks and a correlation between the plasma anti-D concentration and the severity of the delta OD 450 was demonstrated.

Adult↗
PubMed1980

Post-term pregnancy. I.

The perinatal mortality and morbidity of 185 post-term pregnancies managed by weekly trial inductions starting at 42 weeks' gestation were compared to those of 119 post-term pregnancies with spontaneous labor before a trial induction was accomplished. One stillbirth occurred in the spontaneous labor group and one in the induced group. There was no statistical difference in the maternal or fetal morbidity in terms of bradycardia in labor, meconium-stained amniotic fluid, meconium aspiration, 1-minute Apgar scores less than 4, macrosomia (more than 4000 g), neonatal pneumonia, and the incidence of cesarean section. This retrospective analysis suggests that standard clinical management is sufficient to assure optimal perinatal outcome in post-term pregnancies.

Female↗
PubMed1979

Appraisal of "rigid" blood glucose control during pregnancy in the overtly diabetic woman.

The degree of maternal glucose control achieved during the third trimester of pregnancy was evaluated for 120 overtly diabetic women hospitalized on a high-risk pregnancy ward. "Rigid" blood glucose control, defined as a mean preprandial plasma glucose concentration less than 115 mg/dl was achieved in only 14% of these women. Although mean preprandial plasmal glucose concentrations ranged between 115 and 172 mg/dl in 66% of women and exceeded 172 mg/dl in 20%, the perinatal salvage rate was greater than 95%. Pregnancies of those women whose mean plasma glucose levels exceeded 172 mg/dl required earlier intervention for signs of fetal jeopardy, but the degree of glucose control was not significantly related to either perinatal death or neonatal morbidity. These results suggest that maternal hyperglycemia exceeding a mean preprandial glucose concentration of 172 mg/dl is to be avoided, whereas, at the other extreme, mean glucose levels less than 115 mg/dl or "rigid" control is unnecessary for a successful perinatal outcome.

Adult↗
PubMed1978

Infectious morbidity following cesarean section. Comparison of two treatment regimens.

During a 4-month period 265 women delivered by cesarean section were studied to determine what effect membrane rupture has on the incidence and severity of postoperative infection. There was a definite correlation between the duration of ruptured membranes and the incidence as well as severity of postoperative infections. Only 29% of women with intact membranes subsequently developed endometritis with pelvic cellulitis, in contrast to 85% of those whose membranes were ruptured for less than 6 hours. Wound and pelvic abscesses were encountered in less than 1% of women delivered with intact membranes, yet these complications developed in over 30% of women with membranes ruptured for less than 6 hours. The incidence of septicemia was four times greater in those women whose membranes were ruptured for less than 6 hours. Women with endometritis were treated with one of two empirical antimicrobial regimens chosen randomly. Intravenous penicillin and tetracycline was found to be as effective as, and perhaps slightly more effective than, the combination of intravenous penicillin and intramuscular tobramycin.

Abscess↗