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Biomedical subjects

J C Morrison

Publications and source records attributed to J C Morrison.

At least 163 records · Page 9Linked to original sources
PubMed1993

The effect of provider education on blood utilization practices.

OBJECTIVE: Our aim was to determine prospectively if a process of provider education and subsequent audit of transfusion criteria can reduce inappropriate blood product infusion. STUDY DESIGN: Beginning in December 1990, a year-long process of provider education and quality assurance audit, with the use of guidelines based on National Institutes of Health blood product consensus conferences, was instituted. After this orientation and education period, the medical records were reviewed for patients on the obstetrics and gynecology service from Dec. 1, 1990, through Sept. 30, 1991, who received blood products (packed red blood cells, fresh-frozen plasma, cryoprecipitate). This group was compared with patients cared for by our service over a similar period before the institution of these guidelines. The incidence of cesarean birth and operative intervention for gynecologic malignancies, as well as the number of major operative gynecologic procedures, was found to be unchanged during the total study period (Dec. 1, 1988, through Sept. 30, 1991). RESULTS: In 1989 there were 1236 units of blood products transfused; in contrast, in 1991 428 units of blood were transfused. In 1989, 107.9 +/- 59.9 units of packed cells per month were used in 33.6 +/- 16.8 patients (3.2 units per patient). In contrast, in 1991, 14.4 +/- 5.8 patients per month received transfusions (2.82 units per patient) with 40.7 +/- 17.2 units of packed cells (p < 0.0001). This represents a 75% decrease in the total number of packed cells and a 60% decrease in the number of patients undergoing transfusion per month. Similar reductions in the usage of cryoprecipitate and fresh-frozen plasma were noted (p = 0.024 and 0.002, respectively). Acute operative blood loss was the most common indication for transfusion. Abdominal hysterectomy was the most common procedure followed by exploratory laparotomy and cesarean section. No patients in whom blood was not used had untoward effects. CONCLUSION: Education as to appropriate blood utilization and concurrent quality assurance audit techniques can safely reduce blood usage on a busy obstetrics and gynecology service in a tertiary care center.

Anesthesia↗
PubMed1993

Oncofetal fibronectin in patients with false labor as a predictor of preterm delivery.

OBJECTIVE: Our objective was to determine whether fetal fibronectin is a discriminator for preterm labor and early delivery in women who have intact membranes and uterine activity. STUDY DESIGN: In our prospective study 28 women between 24 and 34 weeks' gestation with regular, persistent uterine contractions (> 10/hr) and intact membranes were assessed for presence of fetal fibronectin. A Dacron swab was applied to the external os for 10 seconds. The cervix was < or = 1 cm, and all patients were diagnosed as having false labor. The assay was performed by using monoclonal antibody FDC-6 to bind fetal fibronectin. RESULTS: Of the 28 patients with false labor, 14 had a positive fetal fibronectin, and all had preterm labor (specificity and positive predictive value 100%). Of these, nine delivered preterm, yielding a specificity and positive predictive value of 72% and 64%, respectively. Among the 14 women with a negative fetal fibronectin, only four developed preterm labor (sensitivity 78%, negative predictive value 71%). One patient delivered preterm at 34 weeks (sensitivity 90% and negative predictive value 93%). CONCLUSIONS: A positive fetal fibronectin in women who have false labor indicates a significant risk for preterm labor and early delivery. A negative fetal fibronectin is a reassuring sign.

Adult↗
PubMed1993

Intrapartum fetal heart rate assessment: monitoring by auscultation or electronic means.

OBJECTIVE: Our purpose was to assess the frequency with which auscultation could be used as the primary mode of fetal assessment during labor in a busy labor and delivery suite by means of published criteria. STUDY DESIGN: During a 3-month period, 862 patients in labor with live fetuses between 24 and 43 weeks of gestation were available for auscultation in the prospective study. Auscultation was initiated during a contraction and extended for 30 seconds after uterine activity ceased. It was repeated every 15 minutes in the first stage and every 5 minutes in the second stage of labor. RESULTS: In 420 patients this modality was not begun because of inability of the nurses to meet 1:1 staffing requirements. In 19 patients auscultation was not performed because of obesity (12) or patient refusal (7). Of the 423 assessed by auscultation 392 were unable to complete monitoring caused by the frequency requirement (n = 212) or the recording criteria (n = 163). Of the 31 patients where auscultation was successfully completed, there was a 1:1 nurse ratio during the entire labor. CONCLUSIONS: Auscultation with stringent evaluation and recording frequency is not feasible under normal labor and delivery room conditions unless 1:1 nursing care is always available.

Adult↗
PubMed1993

The efficacy of brimonidine in decreasing elevations in intraocular pressure after laser trabeculoplasty.

PURPOSE: The authors explored the empirical dosing requirement for administration of an alpha 2-adrenoceptor agonist, brimonidine, and determined its efficacy in decreasing elevations in intraocular pressure (IOP) after 360 degrees argon laser trabeculoplasty (ALT). METHODS: This vehicle-controlled, double-masked, multicenter trial evaluated three dosing regimens of brimonidine. Two hundred thirty-two patients for whom 360 degrees ALT was indicated were randomized into one of four treatment groups: 0.5% brimonidine both before and after ALT; brimonidine before but vehicle after ALT; vehicle before but brimonidine after ALT; or vehicle at both times. RESULTS: During the first 3 hours after 360 degrees ALT, the overall incidence of IOP elevations of 5 mmHg or greater was 38% (23 of 60 eyes) in the group receiving vehicle only, and it ranged from 3% to 9% (2 of 62 to 5 of 53 eyes) in the groups receiving any brimonidine treatment. There was little difference in efficacy between the three dosing regimens of brimonidine. Brimonidine was well tolerated by the patients. CONCLUSION: Based on this large, controlled, multicenter study, 0.5% brimonidine was an effective agent for reducing elevations in IOP after 360 degrees ALT. Only one dose, administered either before or after 360 degrees ALT, was required.

Adrenergic alpha-Agonists↗
PubMed1993

Cytobrush versus swab endocervical sampling for the detection of obstetric chlamydial infection.

Timely detection and treatment of chlamydial infections during pregnancy is an important public health issue. Exfoliated, infected cells must be present for successful detection of endocervical infection. We compared samples obtained using a cytobrush versus a Dacron-tipped applicator swab for tissue culture isolation of Chlamydia trachomatis from the cervices of 605 pregnant women. The prevalence of chlamydial infection was 5.1%. Cytobrush and Dacron-tipped swab sampling were equally accurate; each detected 80% of all chlamydial infections identified. There were no clinically significant obstetric complications following cytobrush sampling. Bacterial contamination was present in one third more samples obtained using the cytobrush than those obtained using the swab (p = .0001). Culture-independent diagnostic methods such as immunoassays may be preferable for diagnosis of chlamydial infection when cytobrush samples are processed from such clinical specimens.

Cervix Uteri↗
PubMed1993

Placenta praevia: does uterine activity cause bleeding?

Twenty-two women > 24 weeks' gestation with a central placenta praevia were monitored to determine if an increase in uterine activity precedes bleeding in patients with central praevias. Monitoring of all subjects began at 26.3 +/- 4.4 weeks and continued until 37 weeks (or delivery if preterm). All subjects had at least one haemorrhage, 7 women had 2, and 4 subjects had 3 episodes of bleeding. Only 3 patients delivered at term while the remainder (86%) delivered preterm. The gestational age at first episode of bleeding was 29.1 +/- 3.6 weeks and at delivery was 34.3 +/- 3.3 weeks. Nine women (41%) had an increase in uterine activity above baseline the day or the day preceding the first haemorrhage. The increase in uterine activity was not statistically significant when compared to the 6 days prior to bleeding when all 22 patients were considered.

Adult↗
PubMed1993

Acute tocolysis for fetal distress: terbutaline versus magnesium sulphate.

Forty-six women in active labour who developed fetal distress requiring abdominal delivery were randomized to receive 0.25 mg of terbutaline (subcutaneously) or magnesium sulphate as a 4-g bolus (intravenously) to decrease uterine activity. The terbutaline-treated group in contrast to the magnesium sulphate-treated group had reduced uterine activity as measured by Montevideo units (p < 0.002). This decrease in uterine activity was noted more rapidly in all 23 patients who received terbutaline, 1.8 +/- 0.74 minutes compared to 7.5 +/- 2.1 minutes in the 16 of 23 patients (magnesium sulphate-treated women) in whom a decrease in uterine activity occurred (p < 0.001). Umbilical cord arterial blood pH at delivery was less than 7.20 in only 2 of the 23 patients treated with terbutaline versus 7 of the 23 in the magnesium sulphate-treated group. We conclude that terbutaline is an effective and more rapid-acting tocolytic agent to arrest uterine activity prior to delivery for fetal distress.

Adult↗
PubMed1993

Clinical estimate of birth-weight in labour: factors influencing its accuracy.

Clinical assessments of birth-weight were made among 88 parturients at term, to determine what maternal and neonatal factors influence the accuracy of predicting neonatal weight. An estimate within +/- 10% of actual weight was considered accurate, while a prediction off by more than 10% was classified as inaccurate. Seventy-one per cent (63 of 88) of the estimates were considered accurate and 28% (25 of 88) inaccurate. Among these 2 groups of patients, univariate analysis did not identify maternal age, gravidity, parity, gestational age, maternal height, prepregnancy weight and maternal body mass index, maternal weight and maternal body mass index at the time of delivery, change in body mass index during pregnancy, intrapartum amniotic fluid index, newborn's weight, length, and ponderal index as being significant correlates of an accurate clinical estimate of the birth-weight. Over 2 years, as the provider gained experience in predicting the neonatal weight, the accuracy of the clinical estimate of birth-weight did not improve.

Adult↗
PubMed1993

Standard parameters of preeclampsia: can the clinician depend upon them to reliably identify the patient with the HELLP syndrome?

Four hundred and fifty-four gravid women were identified with the HELLP syndrome from January, 1980 to May, 1992. The peak systolic and diastolic blood pressures, proteinuria, and uric acid were recorded for each patient during the peripartal course. Patients were classified according to disease severity with, in addition to elevated lactate dehydrogenase (LDH) values, laboratory evidence of haemolysis and hepatic dysfunction, a peripartal platelet count < or = 50,000/microliters was depicted Class I, Class II as a platelet count > 50,000 and < or = 100,000/microliters and Class III as > 100,000 and < or = 150,000/microliters. Patients with Class I HELLP syndrome had peak antepartum systolic blood pressures < 150 mm Hg significantly more often than the Class II (p < 0.0091) or Class III (p < 0.04) HELLP syndrome. Class I HELLP syndrome had significantly more patients with 1+ to 2+ proteinuria than Class II (p < 0.02) and Class III HELLP syndrome (p < 0.009). Uric acid levels were not different among nor proportionately related to increasing severity of the HELLP syndrome.

Adolescent↗
PubMed1993

Corticosteroids for the enhancement of fetal lung maturity: impact on the gravida with preeclampsia and the HELLP syndrome.

This study was undertaken to determine maternal impact of corticosteroids administered for the promotion of fetal lung maturity in mothers with the HELLP syndrome. Twenty-seven of 427 women with the HELLP syndrome treated between 1980-1991 received a full course of steroids prior to preterm delivery. This group was compared to 27 matched control patients with the HELLP syndrome who received no corticosteroids. Subjects were matched for maternal age, race, sex of the fetus, and severity of the HELLP syndrome. The antepartum platelet count stabilized or increased in 25 of 27 steroid-treated women in contrast to 0 of 15 control women (p < 0.00001). In comparison to control patients, LDH serum concentrations in steroid-treated patients stabilized or decreased and the SGOT/AST and SGPT/ALT stabilized or decreased during therapy (p < 0.005). The interval from delivery to platelet nadir in patients with Class III HELLP syndrome was shorter in the steroid-treated group (p < 0.008) than in untreated patients.

Adolescent↗
PubMed1993

Corticosteroids for enhanced fetal lung maturation in patients with HELLP syndrome: impact on neonates.

This study was undertaken to determine retrospectively, in women with the HELLP syndrome, the perinatal effects of corticosteroid administration for promotion of fetal lung maturity. Twenty-seven of 427 women with the HELLP syndrome treated between 1980 and 1991 received a full course of steroids prior to preterm delivery. They were compared to 27 control patients with the HELLP syndrome matched for maternal age, severity of disease, gestational age, race, and sex of the fetus. Respiratory distress requiring mechanical ventilation occurred in 13 of 27 neonates who received steroid administration and in 23 of 27 who did not receive steroids (p < 0.001). The average stay in the neonatal intensive care unit was 29.8 +/- 50.6 days for the steroid-treated group and 45.2 +/- 35.3 days for the group without steroid use (p = NS). The incidence of neonatal deaths, intraventricular haemorrhage type III and IV, necrotizing enterocolitis, and retrolental fibroplasia was greater in the control group but the difference was not statistically significant.

Dexamethasone↗
PubMed1993

Clinical application of the Kleihauer-Betke test.

A prospective study was performed to investigate the benefit of serial quantitation of fetomaternal hemorrhage with the Kleihauer-Betke test for the prediction of neonatal/maternal outcome in pregnancies at risk for such bleeding. Of 65 patients, 14 (22%) had a positive Kleihauer test. Six of these women (43%) had evidence of placental abruption. Neonatal anemia (hematocrit < 48%) was present in only 2 of the 14 patients with a positive Kleihauer test (14%). Morbidity in the newborn correlated with gestational age at delivery, not with neonatal hematocrit. Maternal morbidity was not associated with a positive test. We conclude that Kleihauer-Betke testing is of limited value in patients at risk for fetomaternal hemorrhage.

Erythrocytes↗
PubMed1993

Blood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision.

The current study was undertaken to determine if blood loss at the time of cesarean section is affected by method of placental removal (spontaneous versus extracted) or uterine position for repair (in situ versus exteriorized). This prospective randomized study involved 100 women who were undergoing a cesarean section. The patients were placed into one of four groups--1, spontaneous placenta detachment, in situ uterine repair; 2, spontaneous placental detachment, exteriorized uterine repair; 3, manual placental removal, in situ uterine repair, and 4, manual placental removal, exteriorized uterine repair. Patients with spontaneous placental separation (groups 1 and 2) compared with manual removal (groups 3 and 4) revealed a significant decrease in blood loss (p < 0.001). Uterine position did not significantly affect blood loss in the spontaneous group (1 and 2; p = 0.971) or the manual placental removal groups (3 and 4; p = 0.061). The hematocrit values for all groups were similar preoperatively, but postoperatively, were significantly lower in the manual removal groups when compared with the spontaneous placental separation groups (p < 0.001). The method of placental removal and not the position of the uterus at the time of its repair has a significant role in blood loss during cesarean birth.

Adult↗
PubMed1993

The University of Mississippi Medical Center's Antenatal Diagnostic Unit: on the cutting edge of tomorrow.

Prenatal diagnosis is a rapidly expanding field in the specialty of obstetrics. Modern providers of perinatal care must understand the fundamentals of inherited disease and keep abreast of advances in antenatal diagnosis. Pivotal in providing appropriate evaluation in this area is a referral center that is capable of affording the necessary evaluation, documentation and consultation. Although pregnancy termination is an option for some couples, many will use the information provided to prepare emotionally and financially for the birth of a child with special problems and needs. Some diagnoses will change obstetric management during the remainder of pregnancy or will lead to a recommendation for delivery at a tertiary medical facility. Other women with medical conditions warrant preconception counseling regarding pregnancy management and likelihood of a successful outcome. Patients with genetic disorders within their families may desire carrier detection through DNA analysis. Finally, women on medications at or near the time of conception frequently have concerns regarding potential teratogenesis. The ADU represents a commitment by both the Department of Obstetrics and Gynecology and the University of Mississippi Medical Center to furnish these services to providers and patients of the State of Mississippi.

Academic Medical Centers↗
PubMed1993

Prompt visualization of the gallbladder with a rim sign--acute or subacute cholecystitis?

An immunosuppressed, neutropenic patient developed symptoms and signs of acute cholecystitis. Gallbladder ultrasound was consistent with acute cholecystitis. Technetium-99m-diisopropyl iminodiacetic acid (DISIDA) scan showed a rim sign, but with normal gallbladder visualization. On restudy 72 hr later when the patient's WBC count was recovering, the 99mTc-DISIDA scan again showed a persistent rim sign, but now there was no gallbladder visualization at 1 hr, a pattern strongly predictive for acute complicated cholecystitis. Biliary drainage was performed by percutaneous cholecystotomy with clinical improvement. Semielective cholecystectomy performed 8 wk later confirmed both acute and chronic cholecystitis. We describe the rim sign and its variants, mechanisms of causation, prognostic importance and correlate our report with a review of the literature.

Acute Disease↗
PubMed1993

Intrapartum assessment by house staff of birth weight among twins.

OBJECTIVE: To determine among twins in labor: 1) the relative accuracy of an intrapartum sonographic estimate of the birth weight for both fetuses using biparietal diameter and abdominal circumference, 2) the accuracy of detecting discordant growth (difference in actual birth weights greater than or equal to 15%), and 3) the estimate of fetal weight for nonvertex twin B that would reliably avoid breech extraction of infants less than 1500 g. METHODS: Retrospectively, we identified and analyzed parturients with twins who had an intrapartum sonogram performed by a house officer assigned to the labor and delivery suite. RESULTS: The mean birth weight (+/- standard deviation) for the twin A group was 1910 +/- 628 g and for twin B was 1869 +/- 668 g. The mean standardized absolute errors for the twin A group (121 +/- 118 g/kg) and the twin B group (92 +/- 67 g/kg) were not significantly different (P = .06). Analysis of variance revealed that regardless of the presentation of the fetuses, the mean standardized absolute error was not significantly different (P = .10). Using a difference in the estimates of birth weight of 15% or greater, the positive and negative predictive values of detecting discordant growth within a twin pair were 53 and 83%, respectively. Among 30 vertex-nonvertex twin pairs, 12 of the second fetuses had actual birth weights of 1500 g or less, and all were estimated to weigh less than 1700 g. CONCLUSIONS: The intrapartum sonographic estimate of fetal weight in twin pregnancy by house staff appears reliable, and the accuracy of prediction is similar regardless of presentation, discordance, or actual birth weight greater or less than 1500 g. To avoid vaginal delivery of a persistent nonvertex twin B with a birth weight of 1500 g or less, a sonographic estimate of 1700 g for the second fetus may be adequate.

Adult↗