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Biomedical subjects

J D Blanco

Publications and source records attributed to J D Blanco.

At least 37 records · Page 2Linked to original sources
PubMed1993

Association of clinical intra-amniotic infection and meconium.

The objective of this study was to determine the rate of intra-amniotic infection in patients with meconium-stained amniotic fluid compared to controls. With a retrospective case-controlled study design, we compared 100 pregnant women with meconium to 100 pregnant women without meconium for the development of intra-amniotic infection. Patients delivered between September 1 and December 31, 1990. Exclusion criteria were active infection prior to labor or antibiotic use within the 7 days prior to delivery. We diagnosed clinical intra-amniotic infection in patients with ruptured membranes by a maternal temperature 100.4 degrees F or higher and any two of the following: maternal or fetal tachycardia, uterine tenderness, white blood cell count 10,500 mm3 or more, or foul-smelling amniotic fluid. Demographic variables, labor characteristics, maternal infectious morbidity, and neonatal outcome were analyzed using the Wilcoxin rank test, chi-square test, or Fisher's exact test as appropriate. The rate of clinical intra-amniotic infection was significantly higher in women with meconium-stained amniotic fluid (8%) compared with women with no meconium (2%) (p = 0.05).

Adult↗
PubMed1993

Disseminated herpes zoster in a pregnant woman positive for human immunodeficiency virus.

We report a case of disseminated herpes zoster in a pregnant patient positive for the human immunodeficiency virus (HIV). Disseminated zoster was the first manifestation of HIV infection in this patient. In HIV-positive patients, zoster may be complicated by cutaneous dissemination, visceral involvement, and death. Intravenous acyclovir may prevent serious sequelae in both mother and fetus.

AIDS-Related Opportunistic Infections↗
PubMed1993

Massive septic pelvic thrombophlebitis.

BACKGROUND: Septic pelvic thrombophlebitis is a major complication of endometritis. The thrombi commonly occur in the uterine and/or ovarian veins and may extend into the inferior vena cava. CASE: Following vaginal delivery, a 19-year-old woman, gravida 2, developed postpartum septic pelvic thrombophlebitis extending from the right ovarian vein up to the diaphragm and down to the femoral vein. The patient was treated successfully with heparin and antibiotics, and eventually was discharged on oral anticoagulants for an extended period. Follow-up revealed complete resolution of the thrombus. CONCLUSION: Septic pelvic thrombophlebitis is not limited to the pelvis and lower abdominal vessels.

Adult↗
PubMed1993

Single-dose ampicillin prophylaxis does not eradicate enterococcus from the lower genital tract.

OBJECTIVES: To determine the carriage rate of enterococcus in the lower genital tract of women having a cesarean delivery and to determine whether a single 2-g intraoperative dose of ampicillin eradicates enterococcus from the lower genital tract. METHODS: Lower genital tract cultures were taken in 84 women who were in labor or had ruptured membranes and who were about to have an indicated cesarean delivery. The subjects were randomized to receive either a single 2-g dose of ampicillin or a cephalosporin as prophylaxis. Cultures were repeated 24 hours postpartum. RESULTS: Enterococcus was isolated preoperatively in 33 subjects (39.3%) and postoperatively in 36 (42.9%). The enterococcus was eradicated in five of 17 women (29.5%) who received ampicillin. CONCLUSION: These results suggest that a single 2-g dose of ampicillin does not eradicate enterococcus from the lower genital tract.

Adult↗
PubMed1993

Cervical dilation: accuracy of visual and digital examinations.

OBJECTIVE: To determine the accuracy of visually versus digitally determined cervical dilation. METHODS: We studied 64 pregnant women with rupture of the amniotic membranes. One of two residents performed a speculum examination, estimated the dilation and effacement visually, and noted whether fetal parts or amniotic membranes were present. The same examiner then determined digitally the cervical dilation and effacement and station of the presenting part. RESULTS: There was a statistically significant correlation between visually and digitally determined cervical dilation (r = 0.78, P < .001). CONCLUSION: Visual estimation of cervical dilation correlates well with digital examination.

Adult↗
PubMed1992

Prostaglandin E2 gel induction of patients with a prior low transverse cesarean section.

To determine safety and efficacy of induction with prostaglandin E2 gel, we compared the outcome of 25 patients (study group) with an unfavorable cervix, a medical indication for delivery, and one prior low cervical transverse cesarean section to 56 patients (comparison group) with one prior low cervical transverse cesarean section and spontaneous labor. We placed 1 mg of prostaglandin E2 in gel intracervically in the 25 study patients. Common indications for delivery were: diabetes, post dates, and preeclampsia. Although most labor and delivery variables were similar, the study group had a longer mean latent phase (14.2 +/- 13.8 versus 7.3 +/- 3.7 hours: p less than 0.002), but had a shorter mean length of active phase (4.0 +/- 3.5 versus 5.7 +/- 3.0 hours; p less than 0.02). None of the patients in either group had a dehiscence of the uterine scar, nor rupture of the uterus. Both groups had a similar cesarean section rate. Since from the few reported, nonrandomized studies it appears that prostaglandin E2 gel use in patients with a prior low cervical transverse cesarean section may be useful and relatively safe, it may be time to attempt randomized trials of prostaglandin E2 gel versus oxytocin for induction of patients with a prior low cervical transverse cesarean section, unfavorable cervix, and a medical indication for delivery.

Adult↗
PubMed1992

Screening for hepatitis B among pregnant patients in a rural population.

From February 1988 to April 1990, we collected blood for hepatitis B surface antigen (HBsAg) from all women coming to the Texas Tech University Health Science Center in Lubbock for prenatal care. These patients were from rural western Texas and eastern New Mexico. They were also screened for hepatitis B risk factors, as outlined by the Centers for Disease Control. We reviewed the prenatal records of all HBsAg-positive women. Six of 4452 women (0.13%) had a positive HBsAg test. Four of the six women had identifiable risk factors and two did not; two were non-Hispanic caucasian (Anglo), two were Hispanic, and two were black. Anglos comprised 49.5% of the rural population, Hispanics 34.9%, blacks 12.8%, and Asians 2.8%. No Asian women were positive for HBsAg. The prevalence of HBsAg positivity was lower in this rural population than in previously reported urban populations. While the prevalence in the studied blacks and Hispanics was similar to that in previous reports, the prevalence in the rural Anglos was lower.

Black or African American↗
PubMed1992

Limited-spectrum (first-generation) cephalosporins.

Except in the treatment of pyelonephritis, the first-generation cephalosporins are rarely the first line drug of choice for any suspected infection in obstetrics. Other antibiotics have a narrower spectrum of antimicrobial coverage and are cheaper. Unless culture dictates the use of cephalosporins for main-line therapy, the use of first-generation cephalosporins should be limited to the treatment of pyelonephritis in pregnancy and for prophylaxis at the time of surgery.

Bacterial Infections↗
PubMed1992

Extended-spectrum (second- and third-generation) cephalosporins.

The extended-spectrum cephalosporins provide better activity against gram-negative bacilli and anaerobes than first-generation agents. Cefoxitin and cefotetan (second-generation) and ceftriaxone (third-generation) have excellent activity against B. fragilis and are useful in the treatment of postoperative infections and pelvic inflammatory disease. The extended-spectrum cephalosporins are as efficacious as first-generation agents for prophylaxis of cesarean section and hysterectomy. The first-generation drugs, such as cefazolin, are considerably less expensive than these newer compounds, however, making first-generation agents the drugs of choice when used for prophylaxis. The majority of the third-generation agents should be reserved for the treatment of meningitis and resistant nosocomial infections.

Bacterial Infections↗
PubMed1992

Roseola infantum in pregnancy. A case report.

Roseola infantum (exanthem subitum) was first described as a specific syndrome by Zahorsky in 1913. It is a benign disease that occurs almost exclusively in infants and young children (six months to three years of age). We report a case of roseola in a pregnant woman. We were unable to find any prior reports of roseola in pregnancy. The classic presentation of roseola is characterized by high temperatures (103-105 degrees F) that last 3-5 days and resolve by crisis followed by the appearance of a morbilliform rash that lasts a few hours to a few days. The infectious agent is human herpesvirus-6. We recommend the addition of roseola to the differential diagnosis of rashes that occur in pregnancy. The potential danger to the fetus from this virus is unknown.

Adult↗
PubMed1992

The Zavanelli maneuver: a different perspective.

Some obstetricians recommend the Zavanelli maneuver to resolve shoulder dystocia. Descriptions in the literature report an almost automatic ease in performance of the maneuver. We report a case of severe shoulder dystocia in which management with the Zavanelli maneuver and immediate cesarean was extremely difficult. The procedure involved exact reversal of all the cardinal movements of labor, and the delivery required terbutaline, general anesthesia, and added personnel to ensure successful extraction of the fetus. A delivery requiring the Zavanelli maneuver can be difficult to perform and may be worsened by insufficient personnel and inexact reversal of all the cardinal movements of labor.

Adolescent↗
PubMed1991

Patient attitudes toward testing for maternal serum alpha-fetoprotein values when results are false-positive or true-negative.

We investigated the attitudes toward the maternal serum alpha-fetoprotein (MSAFP) test of patients whose results from MSAFP testing were either false-positive or true-negative. Forty-six women who had previous false-positive results from MSAFP testing and 46 who had previous true-negative values participated. Patients were matched for age and socioeconomic status, and all were delivered of normal neonates. A significantly larger number of patients in the group with false-positive results believed they had not understood the MSAFP test than in the group with true-negative results (19.6% vs 0%). Significantly more women in the "false-positive" group felt that the test caused anxiety than in the "true-negative" group (65.2% vs 17.4%). Fewer women in the false-positive group than in the true-negative group said they would have MSAFP testing in a subsequent pregnancy (58.7% vs 91.3%). Further, the women in the false-positive group were less likely than those in the true-negative group to recommend MSAFP testing to a friend (52.1% vs 80.4%). In patients whose results were false-positive, there was a significant relationship between the patient's perception of understanding the MSAFP test and her attitude toward MSAFP testing.

Adult↗
PubMed1990

Chlamydial infections.

Chlamydia causes many human infections and should be treated aggressively. Tetracycline or doxycycline are the drugs of choice, but erythromycin can be used if a drug allergy is present or if tetracyclines are contraindicated. In the pregnant woman, aggressive treatment can improve neonatal outcome. In the United States, each year 155,000 infants are exposed to Chlamydia trachomatis during the birth process, and more than 100,000 will be infected. Of these, 75,000 will get conjunctivitis, and 30,000 will get pneumonia. In pregnancy, erythromycin is the drug of choice, with treatment recommended after initial culture and at term if repeat cultures are positive. If erythromycin is not tolerated, or the patient has an allergy to it, ampicillin or clindamycin may be effective alternatives.

Anti-Bacterial Agents↗
PubMed1990

The nonstress test. Criteria for the duration of fetal heart rate acceleration.

Although the most common definition of a reactive nonstress test is an acceleration in the fetal heart rate of 15 beats per minute (bpm) for 15 seconds, some investigators require that the fetal heart rate acceleration be maintained at 15 bpm above the baseline for the entire 15 seconds (long criterion), and others require simply that the acceleration be 15 seconds from the beginning until the return to the baseline (short criterion). In 1,241 nonstress tests (NSTs) there was a statistically significant difference in the number of reactive tests between the short and long criteria (1,108 [89%] vs. 985 [79%], P less than .001). This difference in percentage of reactivity may be important when comparing studies performed by various investigators. In comparing cesarean section deliveries for fetal distress we were unable to find a difference in the ability to predict a poor outcome between use of the short and long criteria. However, a type II error is possible since the number of poor outcomes was small. We now use the short criterion for NST interpretation.

Female↗