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Biomedical subjects

J C Morrison

Publications and source records attributed to J C Morrison.

411 records · Page 23Linked to original sources
PubMedDate not supplied

Parous patients' estimate of birth weight in postterm pregnancy.

Our objective was to determine among postterm gestations (gestational age > or = 41 weeks) the accuracy of a parous patient's (n = 70) estimate of her newborn's birth weight and to compare the accuracy of clinical prediction with the assessment by the parturient (n = 40). During early labor 70 postterm parous subjects were asked to predict the birth weight of their neonate on the basis of their prior obstetric experiences. For comparison, a concurrent clinical estimate of the birth weight by the provider was also obtained in 40 of these patients. The incidence of macrosomia (birth weight > or = 4000 gm) among postterm parous mothers was 25.7%. The mean standardized error of the maternal estimate of birth weight was 85 +/- 76 gm/kg and 71.4% of their estimates were within +/- 10% of actual birth weight. Maternal estimate of birth weight > or = 4000 gm had a 94% specificity and 77% positive predictive value for a macrosomic fetus. Among 40 postterm parous women the clinical estimate had a mean standardized error (75 +/- 71 gm/kg) comparable to that of the maternal prediction (92 +/- 81 gm/kg) of birth weight (p = not significant). The mean standardized error among estimates for 11 macrosomic newborn infants who underwent both methods of estimation of birth weight was not significantly different. In conclusion, postterm parous women are at risk for delivery of a macrosomic fetus. Among these parturients, an estimate of birth weight by parous women is comparable to the clinical prediction of newborn weight by their providers.

Adult↗
PubMedDate not supplied

Guidelines for management of shoulder dystocia.

Shoulder dystocia is an unpredictable obstetric emergency that occurs in approximately 0.5% of all vaginal deliveries. It appears to result from size discrepancy between the shoulder girdle and the maternal pelvis, abnormal labor mechanics, or both. Many maneuvers have been suggested to free the impacted anterior shoulder, but no specific maneuver or sequence of manipulations has been proved superior. This represents a difficult clinical problem for the obstetrician because it occurs without warning and can result in serious consequences for the infant and increased morbidity in the parturient. This report offers a descriptive review of the various maneuvers that can be used to resolve shoulder dystocia and outlines a suggested sequence that has been successful for these manipulations.

Delivery, Obstetric↗
PubMedDate not supplied

Obstetric challenges of massive obesity complicating pregnancy.

This study examined the effects of massive maternal obesity on medical complications, mode of delivery, postpartum complications, and hospital confinement. In this retrospective case control study, women weighing > 300 pounds delivering from January 1, 1986, to November 1, 1991, were matched for age, race, parity, and height with lean parturient women (mean weight 160 +/- 21 pounds). Among massively obese women there was a greater incidence of chronic hypertension (p < 0.05) and diabetes (p < 0.05) than in the control group. Primary cesarean section was more frequent (p < 0.05), as was the postoperative complication of endometritis when obese patients were compared with lean women (p < 0.05). Cephalopelvic disproportion was the only indication for primary cesarean section, which occurred with greater frequency in the obese group. The postpartum hospital confinement was also significantly longer in the obese study group (p < 0.05). The gestation of a massively obese parturient woman is more frequently complicated by chronic hypertension and diabetes. Abdominal delivery for cephalopelvic disproportion is more likely, and this mode of birth is more often followed by endometritis, which results in longer hospital stays.

Adult↗
PubMedDate not supplied

Neonatal morbidity between 34 and 37 weeks' gestation.

The objective of this study was to determine the risk of significant neonatal morbidity in women with preterm labor who deliver between 34 and 37 weeks' gestation. A total of 101 women between 34 and 37 weeks' gestation with documented preterm labor met inclusion and exclusion criteria; 90 gave informed consent and were randomly assigned to receive either intravenous magnesium tocolysis (treatment group) or conservative management with hydration, sedation, and observation (control group). Of the 90 women entering the study (45 in the treatment group and 45 in the control group), 2 discontinued tocolytic therapy because of gastrointestinal side effects. The gestational age on admission, cervical dilatation at diagnosis of preterm labor, interval to delivery, and birth weight were not significantly different between the treatment and control groups. There were no serious neonatal complications. In each group, three women had transient tachypnea and one had respiratory distress syndrome. We conclude that neonatal morbidity after delivery between 34 and 37 weeks' gestation is unchanged whether or not attempts to arrest labor are unsuccessful. The extra expense and maternal risk of tocolysis are not justified by beneficial results in the infant.

Adult↗
PubMedDate not supplied

Intrapartum hydramnios at term and perinatal outcome.

The objective of this study was to compare the intrapartum outcome among laboring patients with hydramnios (amniotic fluid index > or = 24.0 cm) versus those with adequate fluid (amniotic fluid index > 5.0 and < 24.0 cm). Prospectively, during a 2-year period, 341 patients in early labor underwent four-quadrant measurement of amniotic fluid volume. Forty-two patients had intrapartum oligohydramnios (amniotic fluid index < or = 5.0 cm) and were excluded from further analysis. The study compares the outcome between 277 subjects with adequate fluid and 22 with hydramnios. The intrapartum amniotic fluid index, birth weight, incidence of macrosomia (birth weight > or = 4000 gm), shoulder dystocia, cesarean section for fetal distress or cephalopelvic disproportion, Apgar score, and neonatal malformations were noted in each of the 299 subjects. Umbilical arterial blood gas was analyzed in 189 patients. In this study, 22 women with hydramnios had a significantly higher risk of delivering a macrosomic fetus than the 277 patients with a normal index (36.3% vs 13.7%; p = 0.01). There was no significant difference in the incidence of shoulder dystocia, cesarean section for cephalopelvic disproportion, or fetal distress, Apgar scores < 7 at 1 and 5 minutes, fetal acidosis, or neonatal anomalies. We conclude that hydramnios during the intrapartum period in patients at term is significantly associated with delivery of a macrosomic fetus, but not with delivery of a compromised neonate.

Adult↗
PubMedDate not supplied

Treatment for hyperemesis gravidarum in the home: an alternative to hospitalization.

Our objective was to determine whether medical therapy in the home for patients with hyperemesis gravidarum is safe, efficacious, and cost effective compared with hospitalization. In this retrospective, matched control study 50 women with hyperemesis were treated in the home and were matched for gravidity, gestational age, and weight loss from prepregnancy weight with 47 patients who were hospitalized for traditional treatment. Both groups had similar intravenous fluid and medical support until they could tolerate adequate oral intake. Women in the home had 9.7 +/- 8.0 days of intravenous therapy compared with 9.5 +/- 6.2 days in hospitalized patients (not significant). The mean percent of weight loss at initiation of therapy was similar in both groups (4.6% +/- 5.7% vs 4.5% +/- 6.1%, not significant). The mean weight change during therapy in the home group was + 1.0 +/- 4.3 pounds compared with +1.2 +/- 8.6 pounds in the hospitalized group (not significant). The only complication was infiltration of the intravenous site, the occurrence of which was similar in the two groups (40% vs 57%, not significant). At discontinuation of therapy 90% of the home patients no longer required any supportive therapy; 10% (n = 5) required hospitalization because of relapse. The cost of therapy was significantly lower for patients in the home group ($708 +/- $533 vs $2701 +/- $1717, p < 0.001). These data show that management of hyperemesis in the home is both safe and efficacious. Furthermore, successful therapy can be achieved in the home at a significantly reduced cost.

Adult↗
PubMedDate not supplied

Martial status and military occupational specialty: neither factor has a selective adverse effect on pregnancy outcome.

This investigation was undertaken to determine whether there is a relationship between martial status or military occupational specialty (MOS) and pregnancy outcome in and active-duty population. In this prospective, descriptive study 312 active-duty women were identified as married or single and stratified into four groups on the basis of MOS: group I (n = 144), mild to moderate mental stress; group II (n = 43), intensive mental stress; group III (n = 72), exposure to hazardous material; and group IV (n = 53), physical stress. Each patient group was evaluated to determine the incidence of medical complications. One hundred ninety-three of the service women were married and 70 were single. There was no significant difference between pregnancy complications and martial status. In spite of considerable stress and hazardous exposure the incidence of medical complications of pregnancy observed among groups (group I = 67%, group II = 58%, group III = 48% and group IV = 53%) was not significantly different. On the basis of the findings of this study we conclude that martial status and MOS did not significantly influence military pregnancy outcome.

Female↗
PubMedDate not supplied

Diabetic ketoacidosis complicating pregnancy.

OBJECTIVE: This report describes the physiologic alterations that predispose pregnant women to diabetic ketoacidosis and the experience in a tertiary center after adoption of aggressive management of diabetics. STUDY DESIGN: In 1982 a protocol for strict surveillance of glucose homeostasis for pregnant diabetic patients and the early recognition and aggressive treatment of patients who do have diabetic ketoacidosis was initiated and has resulted in improved maternal and neonatal outcomes. RESULTS: From 1986 through 1991 the incidence of diabetic ketoacidosis was 3% compared with an incidence of 22% from 1976 to 1981. During this same time the incidence of fetal death associated with diabetic ketoacidosis decreased from 35% to 10%. CONCLUSION: Diabetic ketoacidosis and fetal morbidity/mortality can be reduced by aggressive management during pregnancy.

Adult↗
PubMedDate not supplied

Intrapartum amniotic fluid index and two-diameter pocket are poor predictors of adverse neonatal outcome.

OBJECTIVE: The objective of this study was to determine whether amniotic fluid index < or = 5.0 cm or two-diameter pocket volume < or = 15 cm2 is a predictor of abdominal delivery because of fetal distress or of Apgar score < 7 at 1 or 5 minutes. STUDY DESIGN: The study was prospective and involved 209 parturients in early labor who had ultrasonographic assessment of amniotic fluid volume by both methods. RESULTS: The incidences of cesarean delivery because of fetal distress and of Apgar scores < 7 at 1 and 5 minutes were 8.1%, 9.0%, and 1.9%, respectively. Only Apgar scores < 7 at 1 minute were significantly higher among patients with a two-diameter pocket < 15 cm2 (16/114) as compared with > 15(2) (3/95, p = 0.007). Oligohydramnios by either method was a poor predictor of adverse outcomes (p values ranging from 0.06 to 0.21). Receiver-operating characteristic curves generated for the amniotic fluid index or two-diameter pocket to predict abdominal delivery because of fetal distress or Apgar scores < 7 at 1 minute indicate that both methods are poor diagnostic tests to predict these complications. CONCLUSION: Intrapartum assessment of amniotic fluid volume, by amniotic fluid index or the two-diameter pocket technique, is a poor predictor of adverse neonatal outcome.

Amniotic Fluid↗
PubMedDate not supplied

Comparison of intra-amniotic (15S)-15-methyl-PGF2 alpha and intravaginal prostaglandin E2 for second-trimester uterine evacuation.

OBJECTIVE: To compare the efficacy, safety, and side effects of intra-amniotic (15S)-15-methyl prostaglandin F2 alpha (15-M-PGF2 alpha) and intravaginal prostaglandin E2 (PGE2) for midtrimester uterine evacuation. STUDY DESIGN: Ninety-three patients underwent therapeutic midtrimester pregnancy termination by the use of laminaria placement and intra-amniotic injection of 15-M-PGF2 alpha. A matched control group underwent uterine evacuation by laminaria placement and insertion of PGE2 intravaginal suppositories. The main outcomes studied were time to delivery, side effects, and complications. RESULTS: The 15-M-PGF2 alpha group had a shorter time to delivery (12.3 +/- 6.4 hours) compared with the PGE2 group (16.2 +/- 6.6 hours, p < 0.0001). The evacuation rate over time was significantly greater in the 15-M-PGF2 alpha group (p = 0.001). The PGE2 group had a significantly higher incidence of side effects. CONCLUSIONS: The use of intra-amniotic 15-M-PGF2 alpha for therapeutic second-trimester pregnancy termination is safe and is associated with a more rapid evacuation of the uterus and fewer side effects than intravaginal PGF2 suppositories.

Abortifacient Agents, Nonsteroidal↗
PubMedDate not supplied

Two-hour postprandial test versus one-hour, fifty-gram glucola test as screening tools for gestational diabetes: a critical analysis.

OBJECTIVE: The objective of this study was to compare 2-hour postprandial glucose measurements with the standard 1-hour, 50 gm glucola screen as a predictor of gestational diabetes. STUDY DESIGN: In this prospective study, 448 patients were screened for gestational diabetes mellitus after 20 weeks' gestation. Each patient was instructed to ingest a meal containing at least 100 gm of carbohydrate, and 2 hours later a plasma glucose level was obtained. Shortly after, each patient was given 50 gm glucola followed by a 1-hour glucose measurement. If either screen showed a result of 140 mg/dl or more, a formal 3-hour glucose tolerance test was done. Data were analyzed with use of the receiver operating characteristic curve. RESULTS: Of the 448 patients screened, 39 (8.7%) had a screening result of 140 mg/dl or greater and 16 (3.6%) of these had gestational diabetes mellitus. The receiver operating characteristic curve showed that the 1-hour glucose screen was more predictive of gestational diabetes than the postmeal assessment. The area under the receiver operating characteristic curve (plus or minus the SEM) for the 1-hour glucose test was 0.746 +/- 0.086 (p < 0.005) whereas the 2-hour postprandial test produced an area of 0.524 +/- 0.097 (p = NS). The range of optimal 1-hour glucola discriminatory values was 182 to 190 mg/dl. Thus the critical cutoff value of the 1-hour glucola test that minimizes false-positive results and maximizes true-positive screening for gestational diabetes is 182 mg/dl or greater. CONCLUSIONS: The 1-hour glucola test is a reliable screening test for gestational diabetes mellitus whereas the 2-hour post-prandial test is not.

Adult↗
PubMedDate not supplied

Home blood pressure monitoring for pregnant patients with hypertension.

OBJECTIVE: To determine whether automated measurement of blood pressure and pulse in a home setting can be easily accomplished by pregnant women with chronic hypertension. STUDY DESIGN: In this prospective investigation, seven women with chronic hypertension complicating pregnancy recorded their blood pressure at home twice a day. These data were offloaded once daily into a computer at a remote site, and a computerized printout of these data was received by the physician. RESULTS: The patients participated in the study for 12.2 +/- 5.8 weeks (range 4 to 18 weeks) and were between 23 and 42 weeks' gestation. Average mean arterial pressure in the home was 102 +/- 10 mm Hg, and average pulse was 81 +/- 11 beats per minute. In the clinic, the values were 112 +/- 13 mm Hg and 90 +/- 30 beats per minute (p < 0.05). Each patient was easily taught how to use the machine. CONCLUSIONS: The home blood pressure monitoring device was easy to use and correlated well with values recorded by health professionals for this limited number of subjects. It was particularly helpful to patients (n = 5) who lived long distances (more than 60 miles) from the clinic and to women who needed adjustments of antihypertensive medication.

Blood Pressure↗
PubMedDate not supplied

Sleep patterns in pregnancy: a longitudinal study of polysomnography recordings during pregnancy.

OBJECTIVE: To evaluate the differences in sleep of women throughout pregnancy compared with those of nonpregnant control subjects. STUDY DESIGN: Four pregnant women were studied longitudinally during their pregnancy using inpatient polysomnography. Measurements included electroencephalography, electrocardiography, and continuous-pulse oximetry. Four healthy nonpregnant women matched for age and weight were used as control subjects. The total sleep time was recorded, and percentages of each sleep stage were generated. RESULTS: Qualitative differences in sleep between pregnancy patients and control subjects were evident. Control subjects displayed a normal appearance of slow-wave sleep in stages 3 and 4 (delta sleep). When pregnant patients did display delta sleep, it appeared abnormal secondary to extensive alpha-wave intrusion. Even when including this abnormal delta sleep in a quantitative comparison, the pregnant patients had a significantly shorter percentage of total sleep time in delta sleep (4.9+/-1.9% vs 21.9+/-6.0%, p=0.03). CONCLUSION: Sleep in pregnancy is characterized by loss of normal slow-wave sleep. Thus, sleep stages 3 and 4 are shortened during pregnancy. This sleep alteration is persistent when followed longitudinally during pregnancy.

Adult↗