Change in amniotic fluid index after amniotomy during first stage of labor.
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Amniotic Fluid↗
Biomedical subjects
J C Morrison
Publications and source records attributed to J C Morrison.
Risk of preterm delivery from preterm labor in high-risk patients.
This study aimed to determine the incidence of preterm labor and birth (< 37 weeks' gestation) in patients at high risk for early delivery. In this retrospective, descriptive study, 17,186 women with high-risk factors for early delivery were studied over a five-year period (1986-1990). Study groups included women with prior preterm delivery, multifetal gestations, uterine abnormalities and cervical factors. The rate of preterm labor for all patients averaged 40% (range, 30-46%). The rate of preterm delivery in the four groups ranged from 14% to 30% and averaged 19.7%. In those who experienced preterm delivery, only 32% of cases were due to preterm labor with advanced cervical dilatation, failed tocolysis or preterm premature rupture of membranes. The majority of early deliveries were due to medical or obstetric disorders as well as to patient/physician factors. The incidence of preterm labor remains significant when women have high-risk factors for preterm delivery. However, the incidence of preterm delivery, particularly that due to avoidable factors, such as failed tocolysis and preterm rupture of the membranes, is considerably lower than that quoted in the literature.
Adult↗
Limbal microvasculature of the rat eye.
PURPOSE: To define the microvascular anatomy of anterior segment blood supply and aqueous drainage in the rat eye. METHODS: External limbal blood vessels were studied by direct inspection of normal, living rat eyes and eyes injected intracamerally with fluorescein dye. Intraocular connections of these vessels were then documented with scanning electron microscopy of methylmethacrylate microvascular luminal castings. RESULTS: The rat limbus possesses a circumferential vascular ring consisting of a single artery and a venous plexus. The limbal artery communicates with radial anterior ciliary arteries and with perforating arterioles arising from the long posterior ciliary arteries. The venous plexus is connected to a circumferential Schlemm's canal by numerous transcleral, aqueous-containing collector channels and drains into multiple radial veins located within the episclera. CONCLUSIONS: These findings illustrate anatomic similarities between rats and primates, both in anterior segment blood supply and aqueous humor drainage. The rat limbal artery provides collateral perfusion of the anterior segment from anterior and long posterior ciliary systems. The direct communications between identifiable external aqueous-containing veins, a circumferential episcleral venous plexus, and an internal Schlemm's canal provides the anatomic basis for producing chronically elevated intraocular pressure in rats using retrograde injection of mild sclerosing agents into the aqueous humor outflow pathways, and for administering drugs and other agents to the entire trabecular meshwork and Schlemm's canal.
Animals↗
Epithelial ingrowth and apparent filtering bleb encapsulation.
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Corneal Diseases↗
Plasma exchange for preeclampsia: II. Unsuccessful antepartum utilization for severe preeclampsia with or without HELLP syndrome.
OBJECTIVE: To explore the efficacy of plasmapheresis/plasma exchange as the primary therapy to arrest and reverse the progression of severe preeclampsia with or without HELLP syndrome in order to postpone delivery and improve perinatal outcome in very preterm pregnancies. STUDY DESIGN: In this case series of patients managed over a 4-year period from 1984 to 1987, seven gravidas with severe preterm preeclampsia underwent 1-2 plasmaphereses/plasma exchange procedures using the IBM 2997 Cell Separator with continuous electronic fetal heart rate monitoring (n = 7 patients) and central cardiovascular monitoring (n = 3 patients). RESULTS: The seven patients (one with HELLP syndrome, six without HELLP) presented between 24 and 30 weeks gestation and, despite plasmapheresis/plasma exchange, the severity of each study subject's preeclampsia persisted without clinically significant improvement. Maternal-fetal deterioration required cesarean delivery in all cases within 48 (in four patients within < 36) hours of therapy. No clinically significant adverse effect of plasma exchange therapy was recorded during cardiovascular and laboratory monitoring; two fetuses developed repetitive late decelerations during exchange despite adequate maternal fluid preload. The only patient with HELLP syndrome developed eclampsia as her third plasma exchange within 25 hours was being initiated. Significant problems with fluid retention and displacement (variable amounts of pulmonary edema, pleural effusions, large volume ascites) were encountered in all patients. Four neonates died (24-27 weeks/438-820 g) and three survived intact (740, 950, and 1,280 g). One mother (case 5) developed end-stage renal disease 21 months postpartum. CONCLUSIONS: The application of plasmapheresis/plasma exchange therapy as described in order to prolong very preterm pregnancies in the undelivered patient with severe preeclampsia/eclampsia with or without HELLP syndrome did not produced encouraging results. Patients in general were exposed to additional medical and surgical risk without a corresponding improvement in perinatal outcome.
Adolescent↗
Plasma exchange for preeclampsia: III. Immediate peripartal utilization for selected patients with HELLP syndrome.
OBJECTIVE: To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after delivery in the patient with severe preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN: Two gravidas with complicated severe preeclampsia/eclampsia/HELLP syndrome were treated emergently in the immediate peripartal period with single-volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite multiple platelet unit infusions, one primigravida in active labor at 5 cm cervical dilation and 39 weeks' gestation remained at a platelet count of 14,000/microL and began to ooze from her guns. A second primigravida remained obtunded, oliguric, and thrombocytopenic with epistaxis and hematuria following cesarean delivery and platelet transfusions. A single expedited 3-liter plasma exchange procedure reversed the rapidly deteriorating clinical situation for each patient and accelerated recovery from HELLP syndrome. Both patients and progeny suffered no permanent sequelae. CONCLUSION: Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can be employed effectively for the pregnant patient with severe atypical HELLP syndrome that progressively worsens during labor or the early puerperium despite the use of conventional transfusion therapy.
Adolescent↗
Effect of blood transfusion in patients with gynecologic malignancy.
OBJECTIVES: To determine the effect of blood transfusion on long-term outcome (disease-free interval, recurrence of disease after treatment, and survival) in women with invasive gynecologic malignancy. METHODS: In this retrospective study, 125 patients with gynecologic malignancy were assessed over a 36-month period. The variable of whether patients received blood transfusion during therapy was used to divide the sample into two groups. RESULTS: There were no differences in the age, ethnicity, and site-stage of tumor of the two groups. Treatments (surgery, radiotherapy, chemotherapy, or multimodal) were similar between the two groups, as were initial hematocrits. The disease-free interval was significantly better in women who did not receive homologous blood (P < 0.001). Life table analysis illustrated that more patients were alive and free of disease if they did not receive blood (P < 0.001). Likewise, persistence-recurrence of cancer was more common in the transfusion group (P < 0.001). Finally, overall survival time was adversely affected by transfusion (P = 0.045). CONCLUSIONS: The use of blood products in patients with invasive gynecologic cancer is associated with enhanced recurrence or persistence of malignancy, a decrease in the disease-free interval, and reduction in the probability of survival without evidence of disease.
Adult↗
Invalid equation to describe the amniotic fluid index in normal pregnancy.
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Amniotic Fluid↗
Resident research projects: frequency of presentation and publication in a national forum.
OBJECTIVE: Our aim was to determine the fate of mandatory resident research projects with regard to subsequent presentation and publication. STUDY DESIGN: In this retrospective descriptive study required research projects were assessed for frequency of presentation at regional and national meetings or publication in medical journals, or both, over a 10-year period (1983 through 1992). Rising second-year house officers elected to initiate their own study with departmental support under the guidance of a faculty advisor or selected a research project from a list of potential investigations offered by departmental faculty. Projects were presented at the annual alumni meeting in April of the junior and senior years. The faculty advisor assisted in research design, protocol development, obtaining human investigation committee approval, data collection, statistical analysis, manuscript preparation, and coaching for the oral presentation. After local presentation these projects were evaluated for submission to regional and national meetings and prepared for peer-review publication. RESULTS: During a 10-year period 104 resident research projects resulted in 72 regional or national presentations and 52 peer-review publications. There was a significant increase in the proportion of projects presented at national meetings over time (r = 0.99; p < 0.0001). There was also an increase in the number of projects published in peer-review journals during the decade-long study period (r = 0.96, p = 0.0001). CONCLUSIONS: Required completion of two research studies during residency bolstered by early selection of prospective projects and departmental fiscal support, as well as intensive faculty advisor direction and assistance, has resulted in resident projects with increasingly frequent national recognition.
Humans↗
Prediction of hemorrhage at cesarean delivery.
OBJECTIVE: To identify and quantitate the risk factors that might be predictive of hemorrhage during abdominal delivery. METHODS: Over a 2-year period, 1610 women underwent cesarean delivery and 127 (7.9%) had hemorrhage, defined as a decrease in hematocrit of 10% or greater, estimated blood loss greater than 1500 mL, or packed red blood cell administration. These women were compared through a case-control study design with the next abdominal birth without hemorrhage that could be matched for age, parity, indication for cesarean delivery, type of anesthesia, type of skin incision, and antepartum hematocrit. RESULTS: Preeclampsia (odds ratio 3.6, 95% confidence interval [CI] 1.8-7.4), disorders of active labor (odds ratio 4.4, 95% CI 1.4-13.7), Native American ethnicity (odds ratio 6.4, 95% CI 1.8-22.4), previous postpartum hemorrhage (odds ratio 8.4, 95% CI 1.9-37.4), and obesity of greater than 250 lb (odds ratio 13.1, 95% CI 1.7-102.7) were all statistically associated with significant bleeding during abdominal delivery. Combinations of two or more of these factors were associated with a markedly increased risk for hemorrhage, with odds ratios of 18.4 or greater. CONCLUSIONS: Patients undergoing cesarean delivery who have factors exposing them to increased risk of hemorrhage can be identified prospectively. These women will benefit greatly from extended preoperative counseling when possible, effective utilization of blood bank technology through type and cross-match requests, and preventive measures during abdominal delivery to minimize blood loss.
Blood Loss, Surgical↗
Comparative efficacy of two sonographic measurements for the detection of aberrations in the amniotic fluid volume and the effect of amniotic fluid volume on pregnancy outcome.
OBJECTIVE: To determine in pregnant women with preterm labor the relative efficacy of the amniotic fluid index (AFI) and the two-diameter pocket to detect abnormalities in amniotic fluid volume (AFV), and to relate these findings to pregnancy outcome. METHODS: Fifty-seven healthy women with preterm labor underwent amniocentesis in the third trimester to detect subclinical chorioamnionitis and assess fetal lung maturity. The AFV was estimated by the AFI and two-diameter-pocket methods, then confirmed by a dye (aminohippurate sodium)-dilution technique. Each labor was evaluated for severe variable decelerations requiring amnioinfusion, fetal distress resulting in cesarean delivery, and a 5-minute Apgar score below 7. RESULTS: Using fluid volume confirmed by dye dilution, the AFI correctly diagnosed AFV as low (less than 500 mL) in only two of 23 (8.7%) patients, compared to 14 of 23 (61%) for the two-diameter pocket (P < .001). Fetal distress requiring cesarean delivery occurred significantly more often in the hydramnios group (three of six) compared to those with normal AFV (one of 23) (P < .03), and approached significance in the oligohydramnios group (two of 21) (P = .056). There were no significant differences among the three patient groups regarding the need for amnioinfusion for severe variable decelerations or the occurrence of 5-minute Apgar scores below 7. CONCLUSIONS: Compared to the AFI, the two-diameter pocket is a superior sonographic measurement for the detection of oligohydramnios. In an otherwise low-risk pregnancy with preterm labor, oligohydramnios is associated with no greater risk for an adverse outcome than is a normal AFV.
Adult↗
Postnatal penicillin prophylaxis and the incidence of group B streptococcal sepsis in neonates.
We conducted a retrospective chart review of infants, born over a 3-year period, who had positive urine latex agglutination and/or positive blood culture for group B streptococci (GBS). Infants routinely received intramuscular aqueous penicillin for the first half of the study period, and no penicillin was given for the subsequent 18 months. Overall, infants who received penicillin prophylaxis had a decreased incidence of clinical sepsis and positive blood culture for GBS (4.8/1,000 versus 8/1,000 and 1.3/1,000 versus 5.4/1,000, respectively). The incidence of GBS sepsis during the time of penicillin prophylaxis was not different from that in previously reported studies. When analyzed by weight groups, no difference in clinical sepsis or positive blood cultures for GBS was seen in the subset of infants weighing < or = 2,500 g at birth. There were fewer positive blood cultures in the infants who received penicillin and met the criteria for clinical sepsis. Mortality from GBS sepsis was unchanged during these two study periods in all weight groups.
Female↗
Tocolysis for recurrent preterm labor using a continuous subcutaneous infusion pump.
This study attempted to determine the best method of treatment for patients with recurrent preterm labor: administration of terbutaline via an automated, programmable, subcutaneous infusion pump or oral terbutaline. In this retrospective, controlled study, 32 patients diagnosed with recurrent preterm labor, as determined by persistent uterine contractions with cervical change, were treated with a programmable infusion pump adjusted to control uterine contraction frequency to < or = 4 contractions per hour. Patients in this group were matched for age, race, parity, gestational age and cervical dilation at diagnosis of recurrent preterm labor in subjects taking oral terbutaline. The patients receiving oral terbutaline were given an average of 6.5 mg every four to six hours to maintain uterine quiescence, while those in the pump group were given basal rates of terbutaline and in addition received four to six boluses per day (< 3 mg/d total dose) to achieve this outcome. Patients using the pump were more likely to reach term and less likely to fail tocolytic therapy than were those taking oral terbutaline. The terbutaline pump appeared to be more successful in prolonging pregnancies to term after the diagnosis of recurrent preterm labor than did oral terbutaline.
Administration, Oral↗
Assessment of fetal well-being using the nonstress test in the home setting.
OBJECTIVE: To determine the feasibility of performing nonstress tests (NSTs) in the home setting instead of the health clinic environment. METHODS: In this prospective study, ten women were tested using a Sonicaid TEAM portable monitor and a Hewlett-Packard device in the health clinic. The women were then instructed on use of the Sonicaid device and were tested once a week in the home as well as in the high-risk clinic. All tests were reviewed independently by two of the authors to assess agreement in interpreting the NST. In the health clinic setting, a nonreactive NST was followed by a nipple stimulation contraction stress test (CST); in the home, a nonreactive NST was followed by maternal voice acoustic stimulation. RESULTS: There was 100% correlation during the concurrent study. Two blinded authors agreed on all tests. During the second phase, eight of the ten subjects had NSTs that were consistently reactive in both the home and office settings. In one woman, a nonreactive NST in the clinic was followed by a negative CST. In the remaining patient, a reactive NST in the health clinic was followed 3 days later by a nonreactive NST in the home, which persisted in the provider's office. CONCLUSION: Nonstress testing in the home appears to be an accurate method of antenatal fetal health assessment that adds convenience and potential cost savings.
Feasibility Studies↗
Chondroitin sulfate proteoglycan distribution in the primate optic nerve head.
PURPOSE: To evaluate the presence and distribution of chondroitin and dermatan sulfate-containing proteoglycans in normal human and monkey optic nerve heads by light microscopic immunohistochemistry. METHODS: Monoclonal antibodies specific for glycosaminoglycan attachment sites remaining after incubation of tissues with chondroitinase ABC and ACII were used to detect proteoglycans containing unsulfated chondroitin (OS), chondroitin-4 and/or dermatan sulfate (4S), and chondroitin-6 sulfate (6S) glycosaminoglycans. RESULTS: 4S antibody labeling after chondroitinase ABC was heavily and evenly distributed within the peripapillary sclera and in the core of laminar beams and optic nerve septa. Preincubation with chondroitinase AC, which exposes only chondroitin sulfate attachment sites, diminished labeling intensity in the lamina cribrosa and sclera and almost completely eliminated it in the retrolaminar optic nerve septa. In contrast, 6S antibodies demonstrated a more intermittent linear distribution throughout the laminar beams and optic nerve septa. No qualitative differences were seen between human and monkey optic nerve heads. CONCLUSION: Chondroitin and dermatan sulfate-containing proteoglycans exist throughout the support tissues of the optic nerve head. The specific distribution patterns demonstrated by these monoclonal antibodies, and, in particular, the unique confinement of one of them to the lamina, indicate the presence of different core proteins or different functional glycosaminoglycan side chains that may influence the behavior of the lamina cribrosa.
Aged↗
Determination of fetal acidemia at birth from a remote umbilical arterial blood gas analysis.
OBJECTIVE: Sampling of the umbilical artery for determination of acid-base status is performed within 60 minutes of birth, but is not feasible in all hospitals on a 24-hour basis. A desirable alternative would be to perform the arterial cord blood gas analysis hours after the sample was obtained at delivery with reliable identification of whether the newborn was acidotic. STUDY DESIGN: After 19 deliveries multiple umbilical arterial blood samples were withdrawn into five preheparinized syringes, and these were analyzed at 0.5, 15, 30, 45, and 60 hours after delivery. On the basis of observed changes in pH and base deficit over 60 hours, two separate regression equations were generated. These two equations permit calculation of the original pH and base deficit if the following are known: (1) the time interval from delivery to blood gas analysis and (2) the values of the remote pH and remote base deficit. The regression models were validated among 23 subsequent deliveries to assess how accurately they identified newborn acid-base status at birth. RESULTS: The original pH and base deficit can be calculated with two separate equations from linear regression models if two variables are known: the results of the remote umbilical arterial blood gas analysis and time intervals from delivery to analysis. Of 23 newborns during the validation phase of the study, 16 were not acidotic, one had respiratory acidosis, and six had metabolic acidosis. The second umbilical arterial blood gas analysis was performed at a mean (+/- SD) interval of 53.8 +/- 41.5 hours (range 7.5 to 138 hours). The remote gas analysis inaccurately identified 68.7% (11/16) of nonacidotic newborns as being acidotic at birth. However, insertion of these data into these equations produced results with none of the newborns predicted to have normal acid-base when they were acidotic at birth or predicted to be acidotic when the cord pH was normal. CONCLUSIONS: Use of these mathematic models allows the clinician to perform an umbilical arterial blood pH analysis < or = 60 hours after delivery yet with accurate estimation of true acid-base status at birth.
Acidosis↗
A clinicopathologic correlative study of noncontact transscleral Nd:YAG cyclophotocoagulation.
We studied the histopathologic changes of three eyes enucleated two weeks, eight weeks, and 17 months, respectively, after noncontact Nd:YAG cyclophotocoagulation. The histologic findings at two weeks were destruction of the nonpigmented and pigmented ciliary body epithelium, occlusion of the capillaries of the ciliary processes, and ciliary body stromal necrosis in the region of the processes. Hyperplasia of the pigmented and nonpigmented epithelium, fibrosis and near total atrophy of the ciliary processes, and partial atrophy of the ciliary muscles were present at eight weeks and 17 months. We concluded that application of treatment 1.0 to 1.5 mm posterior to the corneoscleral limbus selectively destroys the pars plicata, and that, histologically, the mechanism for reducing intraocular pressure appears to be destruction of ciliary processes with reduction of aqueous formation.
Aged↗
Parturitional factors associated with membrane stripping.
OBJECTIVE: Our purpose was to determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated. STUDY DESIGN: Thirty patients were randomly divided among a study population and two control groups to assess uterine contractions and microbiologic, histologic, and biochemical markers associated with parturitional events over a 7-hour time frame. RESULTS: Clinically, an increased frequency of uterine contractile activity was observed among patients in the membrane-stripped group (p < 0.03). There was a significant increase in plasma 13,14-dihydro-15-keto-prostaglandin F2 alpha (p < 0.001) and endocervical phospholipase A2 activity (p < 0.04) among those who underwent membrane stripping. Blood leukocyte counts, sedimentation rates, prostaglandin E2 metabolite concentrations, and fibronectin levels revealed no significant change during the 7-hour study session. CONCLUSION: Membrane stripping was associated with increases in phospholipase A2 activity and prostaglandin F2 alpha concentrations, indicating a possible correlation with initiation of the cascade of parturitional events.
Amnion↗