Search PubMed⌕ Search

Biomedical subjects

J C Morrison

Publications and source records attributed to J C Morrison.

At least 217 records · Page 12Linked to original sources
PubMed1990

Cost/health effectiveness of home uterine activity monitoring in a Medicaid population.

It has been shown that an intensive system of preterm birth prevention using home uterine activity monitoring can decrease the number of early births. Such a system was employed in 130 public assistance (Medicaid) patients who were at high risk for preterm birth. A retrospective review of the pregnancy outcome in these subjects was conducted and their data exposed to a model for projected patient care cost. The incidence of preterm labor in the at-risk group was 46%, with an average prolongation of pregnancy of 4.9 weeks. The occurrence of preterm delivery for failed tocolysis or advanced cervical dilatation was less than 10%. Based on a cost-analysis model that considered newborn charges and monitoring expenses, nearly [corrected] $3 million (an average of $21,813 [corrected] per patient) was saved using this system.

Cost-Benefit Analysis↗
PubMed1990

The diagnosis and management of hemoglobinopathies during pregnancy.

Patients with hemoglobinopathies can be at risk for significant maternal and fetal morbidity during pregnancy. This is especially true for those gravidas with SCD or certain thalassemia disorders. With intensive management, pregnancy outcome for these women has improved dramatically, and approximates that of the general population. Criteria for diagnosis for many of these conditions are well established. Appropriate therapeutic interventions are more controversial, but, regardless, emphasize the need for a heightened awareness of these disorders and their potential complications.

Chemical Phenomena↗
PubMed1990

Antenatal fetal assessment: an overview.

In the past two decades there have been dramatic changes in antenatal fetal assessment. As experience has been gained with new modalities, it has been possible to further decrease perinatal morbidity and mortality by modifying the indications and the frequency of testing, as well as the time of initiation. More antepartum assessment is performed today than ever before with the advent of new procedures. With the increasing complexity of multiple modalities and confounding risk factors it has become necessary to individualize the management of each high-risk pregnancy. The clinician should attempt to identify which test or group of tests will insure the lowest perinatal mortality for a given risk factor. The specific test(s) utilized will depend on the population, the expertise of the personnel administering the test, and the manpower and equipment available. Antenatal fetal assessment is usually not performed unless one is prepared to modify obstetric management or expedite delivery when significant abnormalities are identified. The risks of delivery (maternal and neonatal) must then be weighed against the potential adverse effects of continuing the pregnancy. It should be recognized that there is no single "best test" for all clinical situations. It is important for the practicing physician to keep abreast of new developments in antenatal assessment and to be aware of recommended modifications in older applications.

Congenital Abnormalities↗
PubMed1990

Uterine activity compared with symptomatology in the detection of preterm labor.

The relative contribution of uterine activity obtained by home monitoring with a guard ring tocodynamometer compared with seven specific signs and symptoms reported during patient/nurse contact as an aid in detecting preterm labor has not been studied. In this prospective, multicenter study, patients at risk for developing early labor who were randomized to receive home uterine activity monitoring and perinatal nursing support were assessed. The initiator of provider contact (uterine activity detected on routine transmission, patient-perceived signs and symptoms of preterm labor during perinatal nurse contact, or both) resulting in a diagnosis of preterm labor was recorded. Contraction data were then analyzed for an association with preterm labor. There was a strong association of increased uterine activity (four or more contractions per hour) on a repeat monitoring strip with preterm labor (P less than .001). Among patients diagnosed with preterm labor, 31% had increased uterine activity detected on a routine transmission without patient-reported signs and symptoms, compared with 24% who were diagnosed as the result of patient-reported symptoms without increased uterine activity. Daily objective uterine activity data alone have greater incremental value over and above other signs and symptoms as an aid to the physician in diagnosing preterm labor.

Female↗
PubMed1990

The contribution of symptomatology and/or uterine activity to the incidence of unscheduled visits.

Home uterine activity monitoring and perinatal nursing support have been shown to be associated with a decrease in preterm births with no increase in the number of unscheduled patient visits. This prospective, randomized multicenter study compared the frequency of unscheduled visits in patients receiving home uterine activity monitoring and perinatal nursing support with that of patients receiving education regarding the detection and reporting of preterm labor symptomatology. The contribution of patient-reported signs and symptoms versus objective uterine activity data to unscheduled visits is assessed. The overall frequency of unscheduled visits was similar in both groups. In the home uterine activity monitoring and perinatal nursing support group, the contributions of uterine activity versus signs and symptoms to the diagnosis of preterm labor were equal, with 36% of patients diagnosed with preterm labor sent to the physician for increased uterine activity and 36% for signs and symptoms. The sensitivity for the group receiving monitoring and nursing support in detecting preterm labor was 93%. The majority of false-positive visits were associated with patient symptoms. These data show that this combination service does not lead to a clinically significant increase in unscheduled visits. Further, the visits resulting from the combination service provide a sensitive predictive method to aid physicians in detecting early labor.

Clinical Trials as Topic↗
PubMed1990

Preterm birth: a puzzle worth solving.

The incidence of preterm birth has not declined in spite of obstetric and neonatal advances. Although results are variable, the majority of preterm birth prevention programs that embody risk assessment, patient education, and frequent provider visits have shown promise in reducing early births compared with those patients receiving standard care. More recently, home uterine activity monitoring has been shown to be accurate in demonstrating contraction frequency. The combination of this assessment method to detect increased uterine activity at the earliest possible time and intensive perinatal nursing support as to symptomatology related to preterm labor has led to an earlier detection of preterm labor. This, when combined with a comprehensive program of preterm birth prevention, has in many studies resulted in a decrease in the number of early deliveries. To achieve reduction in preterm births, however, these programs must be integrated with aggressive physician management of tocolytic therapy of such patients and continued intensive involvement in such gestations.

Cardiotocography↗
PubMed1990

Stripping the fetal membranes at term. Is the procedure safe and efficacious?

A prospective, randomized investigation was undertaken in a low-risk group of pregnant women at term (38-42 weeks' gestation) to determine if stripping the fetal membranes would safely result in earlier delivery. Ninety-nine patients entered the study; 51 underwent stripping of the membranes, and 48 controls did not. Fifty-nine percent of the patients in the stripped group delivered within one week as compared to 21% in the nonstripped group (P less than .0003). Two pregnancies in the stripped group advanced beyond 42 weeks' gestation as compared to six pregnancies in the control group (P = .12). A single gravida in the control group developed chorioamnionitis during labor. There were no other infections or other complications. Stripping the membranes was associated with earlier delivery and was not associated with any complications.

Chorioamnionitis↗
PubMed1990

Stripping membranes at term: can it safely reduce the incidence of post-term pregnancies?

Membrane stripping has been used clinically for many years but has not been well studied. An investigation was undertaken to determine whether weekly membrane stripping beginning at 38 weeks could safely reduce post-term pregnancies. One hundred eighty patients with firm gestational dates were randomized to either a treatment or control group. Control subjects received a gentle cervicovaginal examination each week to assess Bishop scores, whereas the treatment group also underwent weekly stripping of membranes. Women who received treatment had earlier delivery (mean +/- SEM 8.60 +/- 0.74 versus 15.14 +/- 0.83 days; P less than .0001) and fewer post-term deliveries than those in the control group (three versus 14; P less than .004). The reduction of post-term pregnancies was most notable in nulliparous women with unfavorable Bishop scores. Complications were similar in both groups. Membrane stripping was safe and was associated with earlier delivery and a decreased incidence of post-term gestation.

Adult↗
PubMed1990

Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and infection with abdominal pregnancy.

Hemorrhage during or after surgery, pelvic abscess, bowel obstruction, and prolonged febrile morbidity can complicate the puerperal course of the gravida after removal of an extrauterine fetus with nondisturbance of the extrauterine placenta. In this report we describe the successful angiographic arterial gelfoam embolization of the placental vascular bed to control heavy postoperative hemorrhage in a mother suffering adult respiratory distress syndrome after removal of the fetal portion of her abdominal pregnancy. Six weeks later, computed tomography (CT)-directed drainage by catheter of a placental abscess was performed. Selective angiographic transcatheter embolization with gelfoam is a useful tool for the control of hemorrhage in the gravida who is an unfavorable operative candidate or who may present technical hemostasis problems peculiar to the placenta with abdominal pregnancy. Later use of CT-directed catheter drainage of the infected residual placental mass provided a nonoperative means of treatment.

Abscess↗
PubMed1990

Correlation of urinary tract infection with urinary screening at the first antepartum visit.

Urinary tract infection contributes to the morbidity of pregnancy since 4-10 percent of antepartum patients have asymptomatic bacteriuria and 20-40 percent of these will result in pyelonephritis. A cost-effective outpatient assessment for asymptomatic bacteriuria in undelivered obstetric patients is described. In this study, 56 patients between 6-24 weeks gestation were assessed over a seven-month period by photometric urinary screening. This assessment was more accurate in identifying those patients with asymptomatic bacteriuria than prior history or symptoms. A 7 percent incidence of asymptomatic bacteriuria was noted with 75 percent being Escherichia coli and the remainder Klebsiella. Single-dose, oral antibiotic therapy was evaluated and resulted in no recurrences. Such screening for asymptomatic bacteriuria was felt to represent preventive and economic medical benefits.

Anti-Bacterial Agents↗
PubMed1990

Successful pregnancy outcome following mid-gestational uterine rupture and repair using Gore-Tex soft tissue patch.

The first reported gestational use of the Gore-Tex soft tissue patch (expanded polytetrafluoroethylene) for uterine repair and support is presented in a pregnant woman whose partially dehisced, congenitally abnormal uterus was operated upon at 19 weeks' gestation. Use of the expanded polytetrafluoroethylene Gore-Tex soft tissue patch for assisted uterine integrity in combination with a program of uterine tocolysis and close maternal/fetal surveillance averted a pregnancy loss.

Abruptio Placentae↗
PubMed1990

Preventing preterm birth in twin gestation: home uterine activity monitoring and perinatal nursing support.

In this investigation, 45 women with twin gestations in four centers were randomly assigned to either daily home uterine activity monitoring and perinatal nursing support (19) or an education group (26). Patients in the home uterine activity monitoring and perinatal nursing support group monitored uterine activity twice daily, transmitted the data each day, and had 24 hour-a-day access to nursing support. Education patients were counseled regarding the common signs and symptoms of preterm labor. Both groups had scheduled prenatal visits at least every 2 weeks. Sixteen (62%) of the education group and 14 (74%) of the home uterine activity monitoring and perinatal nursing support group developed preterm labor, values that were not significantly different. Of the monitored group who experienced preterm labor, all 14 were dilated 3 cm or less at diagnosis of the first preterm labor, compared with ten of 16 in the education group (P = .01; one-tailed Fisher test). The mean cervical dilatation at the first preterm labor episode in the group receiving daily monitoring and contact (1.6 cm) was significantly less (P = .01) than that in the education group (2.9 cm). Thus, fewer preterm births were recorded in the home uterine activity monitoring and perinatal nursing support group and significantly fewer patients delivered because of failed tocolysis (P = .03).

Adult↗
PubMed1990

Uterine activity among a diverse group of patients at high risk for preterm delivery.

In this study, 98 patients with early premature rupture of membranes (PROM), postoperative recuperation, placenta previa, or blunt abdominal trauma were assessed for uterine contractions with an ambulatory uterine activity monitor. Uterine irritability manifested by low-amplitude, high-frequency contractions of 30 seconds' duration or less was prevalent in all groups but decreased as the patients were stabilized and diminished or disappeared in those who did not develop preterm labor. In the 18 women who developed preterm labor, daily uterine activity monitoring detected contractions 24-48 hours before clinical symptoms of preterm labor and/or vaginal bleeding occurred. A number of patients with early PROM and placenta previa had low-amplitude, high-frequency contractions, and the majority occurred in those who subsequently developed preterm labor.

Abdominal Injuries↗
PubMed1990

Correlation of uterine activity using the Term Guard monitor versus standard external tocodynamometry compared with the intrauterine pressure catheter.

Uterine activity monitoring to detect preterm contractions and thus to manage patients in active labor is valuable to the clinician. Uterine activity measured by external devices using the guard ring principle or by standard tocodynamometers has been shown to be accurate concerning the frequency of uterine activity as compared with intrauterine pressure catheter-derived data in the third trimester. In this study, 26 women from 19-34 weeks in documented preterm labor had their uterine activity measured by a standard in-hospital monitor and a Term Guard tocodynamometer simultaneously. The standard monitor reflected 16-91% of the frequency of contractions noted by the Term Guard device, with a reduction in the correlation at gestational ages under 30 weeks. In another 20 patients between 17-36 weeks' gestation, these two methods of external tocodynamometry were compared with a transcervical catheter which measured actual intrauterine pressure and frequency of contractions. There was a good correlation between the Term Guard device and transcervically measured contractions (94.6%). At gestational ages of 28 weeks or less, there was poor performance from standard devices (less than 38% correlation with the intrauterine pressure catheter). These data have important implications for clinicians who monitor preterm patients on an ambulatory basis for early detection of preterm labor and also have clinical impact for the management of patients at early gestational ages in active labor.

Cardiotocography↗
PubMed1990

Characteristics of uterine activity in gestations less than 20 weeks.

Ambulatory tocodynamometry has been used for some time to record uterine activity during pregnancy. Most studies, however, have been performed in the third trimester (more than 24 weeks). The current study was initiated to assess uterine activity at earlier gestational ages. One hundred thirty-seven patients were studied between 14-19 weeks' gestation (inclusive). Seven patients who were being monitored were noted to have preterm labor, and six of these seven were found to have increased uterine activity before the diagnosis of preterm labor. There was no difficulty encountered in the vast majority of cases in recording objective, accurate uterine activity information even at these early gestational ages. There was an increase in the uterine activity (during the 18th and 19th weeks) in patients destined to develop preterm labor later in gestation as compared with the contraction pattern of those who labored at term. This study demonstrates that accurate uterine activity information can be gained at these early gestational ages and that when increased contraction frequency is present, it is related to preterm labor.

Adult↗
PubMed1990

The incidence of preterm labor and specific risk factors.

A retrospective review of patients at high risk for preterm delivery because of twin gestation, uterine malformation, incompetent cervix, or previous preterm delivery was carried out to assess the rates of preterm labor and spontaneous preterm birth. Among the 119 patients with multifetal gestation, 46% had preterm labor and 36% delivered before 37 weeks' gestation. In the 58 patients with an anomalous uterus, the rate of preterm labor was 19%, and 14% had early deliveries. Of those with incompetent cervices (115), one-fourth had preterm labor and 17% had an early birth. When a history of one or more preterm deliveries was present, the preterm labor rate ranged from 41-68%, with an early delivery rate of 30-47%. Prophylactic tocolytic therapy did not prolong gestations significantly. Maternal smoking did not have an adverse effect on the incidence of preterm labor except in twin pregnancies, for which early delivery was more likely. The percentages for preterm delivery are slightly lower than those found in the literature; this may be attributable to improvement in preterm birth prevention efforts including patient education, more frequent examinations, home uterine activity monitoring, and daily nursing contact.

Female↗
PubMed1990

Aging changes of the rhesus monkey optic nerve.

The authors counted axons in one optic nerve from each of 28 juvenile and aged rhesus monkeys using an automated image analysis system. All nerves were fixed immediately after death and treated identically. Animals ranged in age from 1 1/2 to 29 yr, which correlates with a human age range of 4 1/2-87 yr. Mean axonal number for all specimens was 1,117,859. Large variations in axonal numbers were found, even within a subgroup of ten animals aged 1 1/2-2 yr. Although young nerves had generally more fibers than those from old animals, this difference was not quite statistically significant, translating into a yearly loss of 4319 fibers (0.45% of the total). Age did not have any significant effect on mean axonal diameter.

Aging↗