Amniotic fluid volume estimation in the postdate pregnancy: a comparison of techniques.
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Amniotic Fluid↗
Biomedical subjects
J C Morrison
Publications and source records attributed to J C Morrison.
Noninvasive measurement of rat intraocular pressure with the Tono-Pen.
PURPOSE: The purpose of this study was to evaluate the Tono-Pen 2 tonometer for measuring intraocular pressure (IOP) in the living rat eye. METHODS: One eye from each of 20 adult, anesthetized brown Norway rats (group 1) was cannulated and simultaneously connected to a syringe and a pressure transducer with a chart recorder. We increased IOP from 15 to 45 mmHg in 5-mmHg increments and obtained 15 consecutive readings (ignoring instrument-generated averages) at each pressure increment with a Tono-Pen 2 tonometer. To test the tonopen's ability to measure unknown IOP, transducer pressures were varied randomly in 20 additional animals (group 2), and tonopen readings were obtained in masked fashion. RESULTS: Plotting the mean tonopen readings for each animal against transducer IOP produced a regression formula of y = 4.54 + 0.79x (r = 0.98). Mean group 2 tonopen values plotted against transducer IOP yielded a regression formula of y = 4.75 + 0.78x (r = 0.94). A method comparison analysis showed that the tonopen significantly overestimates pressures at low IOP (< or = 15 mmHg), and it significantly underestimates pressures at high IOP (> or = 30 mmHg). Using two-way analysis of variance, it was determined that the group 2 data did not differ significantly from the group 1 data (P > or = 0.76). Because of this consistency, we generated a correction factor with 95% prediction intervals for Tono-Pen readings. CONCLUSIONS: The Tono-Pen 2 can be used reliably to measure IOP in the normal rat eye.
Animals↗
Comparison of cytobrush and cotton swab for Papanicolaou smears in pregnancy.
Papanicolaou smears obtained using cytobrush or cotton swabs were compared in 222 pregnant women. There were no complications attributable to the cytobrush. Endocervical cell yields obtained with the brush were 70.9% compared to 41.9% with the swab (P = .0001). There was no difference between use of the swab and the brush in the prevalence of dysplasia (19 cases) nor was there any difference in the prevalence of dysplasia in the smears that contained endocervical and/or metaplastic cells (17/181 = 8.6%) compared to those not containing these cell types (2/24 = 8.3%). This study suggests that use of the cytobrush in pregnancy warrants further study because of the frequency with which smears are reported as inadequate because they lack endocervical and/or metaplastic cells.
Analysis of Variance↗
Intrapartum prediction of birth weight: clinical versus sonographic estimation based on femur length alone.
OBJECTIVE: To determine the relative accuracy of predicting birth weight by clinical estimate versus sonographic mensuration of femur length (FL) alone. METHODS: Two hundred pregnant women at term and in early labor had the weight of their fetuses estimated by clinical and sonographic methods. RESULTS: Clinical assessment of birth weight had a significantly lower mean standardized absolute error (90.6 g/kg) than sonographic estimate based on FL alone (106.7 g/kg) (P < .05). Clinical estimates were significantly more often within 5% (35%) of actual birth weight than were those derived sonographically (29%) (P = .005). CONCLUSION: Using FL alone to predict birth weight has no advantage over a clinical estimate among term patients in labor.
Birth Weight↗
Maternal mortality in Mississippi: 1987-1991.
OBJECTIVE: To characterize the maternal mortality in the state of Mississippi for 1987-1991 and compare the maternal mortality from 1977-1986 with that of the last 5 years. STUDY DESIGN: Factors associated with maternal mortality were obtained from death certificates, replies to questionnaires, medical records, and autopsy reports. RESULTS: The maternal mortality rate in Mississippi for 1987-1991 (14.1/100,000) was not significantly different than for 1977-1986 (11.8/1000,000; P = 0.45). Over the last 5 years there was an increased incidence of direct obstetric deaths (50% vs 73%). During 1987-1991, toxemia as a cause of death for parturients decreased, while hemorrhage as a cause of maternal death increased. There was a rise in the incidence of patient related factors which were avoidable and which led to several deaths during 1987-1991. CONCLUSION: The state's maternal mortality rate remains stable. Improved patient and health care provider's education are necessary to further decrease the incidence of maternal death in Mississippi.
Female↗
Preoperative skin preparation and intraoperative pelvic irrigation: impact on post-cesarean endometritis and wound infection.
OBJECTIVE: To determine the impact of two skin preparation methods and two techniques of pelvic irrigation on the incidence of post-cesarean endometritis and wound infection in an indigent patient population. METHODS: A randomized study was performed in 100 cesarean patients. Subjects were assigned to one of four groups, involving either standard skin preparation (povidone-iodine [7.5%] scrub followed by povidone-iodine [10%] solution) or special skin preparation (5-minute scrub with parachlorometaxylenol followed by povidone scrub and solution), and either normal saline or antibiotic (cefazolin sodium, 1 g in 500 mL normal saline) irrigation of the pelvis and subcutaneous tissue at uterine and fascial closure. Four groups of patients were formed: standard skin preparation plus normal saline irrigation, standard preparation plus antibiotic irrigation, special preparation plus normal saline irrigation, and special preparation plus antibiotic irrigation. RESULTS: Endometritis occurred significantly more often in the combined groups that did not include antibiotic irrigation than in the combined groups involving antibiotic irrigation (P < .001). In contrast, comparison of skin preparation methods between povidone-iodine alone versus preparation including parachlorometaxylenol indicated no significant difference (P = .22). CONCLUSION: Skin preparation with an antibacterial scrub in addition to standard povidone-iodine scrub and solution does not appear to play as significant a role in the reduction of post-cesarean endometritis or wound infection as does intraoperative pelvic irrigation with antibiotic solution.
Adult↗
An assessment of obstetric services in Mississippi.
Seven hundred and six (80.6% response rate) obstetricians, family physicians, and general practitioners responded to a survey designed to elicit information regarding their obstetric practice. Results of the study were compared to a similar survey conducted in 1985. The proportion of obstetricians offering obstetric care has remained relatively constant since 1985. Among family physicians and general practitioners, however, there was a significant decrease in the proportion who practice obstetrics (p < .01), and a significant increase in the proportion who have discontinued obstetric practice in the last five years (p < .01) and who plan to discontinue obstetric care in the next five years (p < .05). Consistent with the 1985 data, cost of malpractice insurance, threat of litigation, and time demand were the three most frequently reasons for discontinuing obstetric care. Without changes in the current system, the provision of obstetric care in rural areas will continue its current dramatic decline.
Adult↗
Rapid estimation of birth weights: ask the mother.
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Birth Weight↗
Home monitoring of uterine activity.
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Female↗
Vaginal birth after cesarean delivery: are there useful and valid predictors of success or failure?
OBJECTIVE: Before parturition are there useful and valid predictors of successful or unsuccessful vaginal birth after previous cesarean birth that could be used to enhance the obstetric care of a patient and her pregnancy? STUDY DESIGN: The clinical course and outcome of all patients who attempted vaginal birth after cesarean delivery at one level III center during 1989 were evaluated to identify factors prognostic of a successful or unsuccessful patient group; use of this information in stepwise logistic regression and cluster analysis was disappointing. RESULTS: No single criterion or optimal clusters of factors were found and no equation achieved greater than 75% predictability of outcome with acceptable sensitivity and specificity. CONCLUSIONS: Before parturition prediction of outcome of vaginal birth after cesarean delivery is tenuous regardless of past obstetric history or recent clinical parameters. Thus it seems appropriate to encourage a trial of labor in almost all patients with a prior low-segment uterine incision (transverse or vertical) unless there is a strong physician or patient-derived contraindication to such an undertaking.
Body Weight↗
Measurement of amniotic fluid volume: accuracy of ultrasonography techniques.
OBJECTIVE: Our purpose was to determine amniotic fluid volume by the dye-dilution technique and compare it with the amniotic fluid index, largest vertical pocket, and two-diameter pocket (defined as vertical x horizontal of the largest vertical pocket). STUDY DESIGN: This prospective study involved 40 women undergoing amniocentesis in late pregnancy to detect fetal lung maturity or evidence of chorioamnionitis. The amniotic fluid volume was quantified ultrasonographically by means of the amniotic fluid index, largest vertical pocket, and two-diameter pocket. During amniocentesis the fluid volume was calculated by the dye-dilution technique of Charles and Jacoby. RESULTS: Ultrasonographic measurements by amniotic fluid index, largest vertical pocket, and two-diameter pocket correctly predicted normal amniotic fluid and hydramnios (74%). A new measurement, two-diameter pocket, gave a significantly more accurate estimate of oligohydramnios than did amniotic fluid index (p < 0.002) or largest vertical pocket (p < 0.0003). CONCLUSION: All three indices are moderately accurate in identifying normal amniotic fluid volume and hydramnios. Two-diameter pocket is the most accurate test to predict oligohydramnios.
Adolescent↗
Oral magnesium and the prevention of preterm labor in a high-risk group of patients.
OBJECTIVE: The null hypothesis of this study is that treatment with oral magnesium gluconate 1 gm four times daily will not decrease the rate of preterm labor and delivery in a high-risk group of pregnant women. STUDY DESIGN: Fifty-four women at risk for preterm delivery were selected randomly to receive magnesium gluconate 1 gm orally four times daily or placebo. These women were monitored prospectively for signs and symptoms of preterm labor. A subgroup of 31 women also received a home uterine activity monitor. The serum magnesium level was measured initially and again 2 weeks after study enrollment. The data were analyzed with Fisher's exact test and analysis of variance. RESULTS: Preterm labor developed in 15 women in the placebo group and in 16 women in the magnesium group. There were no differences in birth weight or gestational age at delivery. The mean increase in serum magnesium level while the patients were taking magnesium gluconate was 0.10 mg/dl (p = not significant). Five women did not have an increase in serum magnesium level and preterm labor developed in all of them. CONCLUSION: Magnesium gluconate in a dose of 1 gm four times daily is not effective for preventing preterm delivery in a high-risk group of patients.
Administration, Oral↗
Interval to delivery in high-risk patients: do tocolytic agents really work?
Some question whether tocolytic drugs reduce uterine activity and prolong gestation. The interval from discontinuance of tocolytics until spontaneous labor and delivery in patients (n = 69) with documented preterm labor (PTL) versus subjects receiving prophylactic tocolytic therapy (n = 41) was studied. Women with documented PTL delivered sooner after cessation of tocolytics (6.1 +/- 6.9 days) than control (C) patients (14.7 +/- 10.8 days, P less than 0.001). Also, 28 of the 69 (41%) patients in the PTL group delivered within 24 h of discontinuation of tocolysis compared to 4 (10%) in the C group (P less than 0.0004). We conclude that tocolytic therapy for documented preterm labor suppresses uterine activity and when these agents are discontinued, contractions return and labor ensues.
Adult↗
Adjunctive antibiotic treatment of women with preterm rupture of membranes or preterm labor.
Subclinical infection is associated with preterm rupture of the membranes (PROM) and preterm labor (PTL) in many cases. It was hypothesized that antibiotic treatment might delay delivery and/or decrease infectious morbidity in those with PROM or PTL. Patients from 19 to 34 weeks with PROM and no labor or PTL with intact membranes (but not both) were separately randomized to receive ampicillin versus placebo in addition to usual therapy. There were 36 women with PTL (21 ampicillin/15 placebo) and 84 with preterm PROM (41 ampicillin/43 placebo). Demographically, the treatment and placebo groups were similar. Outcome variables analyzed included delivery delay after treatment, maternal chorioamnionitis/endometritis, Apgar score, neonatal infection, or respiratory distress, and hospital stay. There were no significant differences between the ampicillin and placebo groups in those with PTL or preterm PROM as it concerned outcome parameters. Adjunctive ampicillin used for treatment of idiopathic PTL or preterm PROM was not beneficial in this study.
Adult↗
Subcutaneous tocolytic infusion therapy for patients at very high risk for preterm birth.
Patients with multiple gestations or recalcitrant preterm labor are at very high risk for preterm birth in spite of adequate tocolysis. Subcutaneous infusion of tocolytic medications on an ambulatory basis has been used in several small series and has effectively prolonged gestation. This retrospective analysis presents data from 992 patients at very high risk for preterm delivery who were prescribed this therapy. The amount of tocolytic medication was individualized by utilizing the patient's volume of distribution and clearance. Pharmacists adjusted the dosage based on uterine activity strips received by nursing personnel. The average basal rate was .073 +/- .020 mg/h. Patients received an average of seven scheduled boluses per day and 1.54 +/- .93 unscheduled boluses per week (.25 +/- .03 mg each). The therapy extended the gestation a mean of 38 +/- 23 days and average gestational age at delivery was 36.3 +/- 2.6 weeks with a mean birthweight of 2759 +/- 681 g. This study, utilizing a large number of patients, confirms earlier reports that for women at very high risk for preterm delivery subcutaneous tocolytic infusion therapy is beneficial. Prospective studies evaluating such treatment on a randomized basis are indicated.
Adrenergic beta-Agonists↗
The diagnosis and management of dystocia of the shoulder.
Dystocia of the shoulder is an unpredictable obstetric emergency that may result in injury to the mother or fetus. In an effort to reduce such risks, attempts have been made to identify patients having a fetus who may subsequently develop shoulder dystocia. The literature, however, clearly reflects that even the combination of prenatal historic facts, estimated fetal weight and sequence of intrapartum events is ineffective in prospectively identifying infants whose births are complicated by shoulder dystocia. During a ten year period at the University of Mississippi Medical Center, the incidence of macrosomia, shoulder dystocia and subsequent brachial plexus injury was reviewed. The majority of instances (89 percent) of shoulder dystocia occurred in patients weighing less than 8 pounds 13 ounces at birth. In the current retrospective review, only 11 percent of the women had risk factors for macrosomia or shoulder dystocia and among these, none were identified prospectively. Additionally, 91 percent of patients with brachial plexus injury recovered with no sequelae. One instance of brachial plexus injury occurred at the time of cesarean section. These data reveal that macrosomia and subsequent shoulder dystocia cannot be predicted. Therefore, it is not feasible to prevent brachial plexus injury prospectively by prophylactic cesarean section. Great clinical acumen and technical expertise by the obstetrician using a variety of methods may be useful in avoiding, as much as possible, injury to the mother and fetus when shoulder dystocia does occur.
Birth Weight↗
Prophylactic intrapartum amnioinfusion for patients with oligohydramnios. A prospective randomized study.
This prospective study evaluated whether prophylactic saline amnioinfusion among patients with amniotic fluid index (AFI) < or = 5.0 cm decreases the incidence of adverse fetal outcomes. Randomization of 53 patients with decreased AFI at term, resulted in 21 patients' receiving prophylactic saline amnioinfusion early in labor, prior to development of an abnormal fetal heart rate tracing. For the treatment group the mean AFI on admission was 3.0 cm, and the postamnioinfusion AFI was 8.9 cm. For 32 comparison (noninfusion) patients, the mean AFI was 2.9 cm; the group consisted of 17 patients randomized to receive no amnioinfusion (control group) and 15 patients who refused to participate in the study. There was no statistically significant difference between the amnioinfused and nonamnioinfused patients with regard to age, parity, gestational age, AFI at admission or duration of first or second stage of labor. Amnioinfusion resulted in no statistically significant reduction in the incidence of recurrent variable decelerations/bradycardia (26.3% vs. 46.6%), intrapartum resuscitation with terbutaline (5.2% vs. 10.0%), cesarean section for fetal distress (9.5% vs. 9.3%), fetal-acidosis (10.5% vs. 12.0%) or Apgar scores < 7 at five minutes (5.2% vs. 0%) in patients with oligohydramnios.
Amniotic Fluid↗
Neurologic diseases in pregnancy.
Although most neurologic problems require conservative management, such as headaches and nerve compression syndromes, other demand aggressive treatment, such as plasmapheresis in Guillain-Barré syndrome and prompt surgery in those patients with hemorrhagic strokes secondary to a ruptured aneurysm or arteriovenous malformation. Myasthenia gravis, discussed in the autoimmune disease section, and epilepsy are associated with congenital anomalies, whereas the progeny of patients with multiple sclerosis are at a much greater risk than the general population of contracting this disease. Therefore, knowledge of these risks is essential in providing quality preconceptional counseling. Pregnancy provides many physiologic changes that alter the course of preexisting neurologic conditions as well as increasing the risks and morbidity of other diseases. It is for this reason that a cooperative team effort, including the obstetrician, neurologist, and, if needed, the neurosurgeon, is essential for an optimal outcome.
Cerebrovascular Disorders↗