Search PubMed⌕ Search

Biomedical subjects

J N Martin

Publications and source records attributed to J N Martin.

At least 73 records · Page 4Linked to original sources
PubMed1998

Medical practices of past graduates from one obstetric/gynecologic training program.

BACKGROUND: We sought to assess the practice patterns of former obstetric-gynecologic residents and to solicit their opinions regarding their educational experience and its clinical relevance to primary care. METHOD: In response to a Residency Review Committee mandate regarding past residents, a questionnaire was sent to all graduates from our residency program over a 17-year period (1979 to 1995). RESULTS: Of the 90 subjects who received the survey, 86 responded. Their ages ranged from 29 years to 49 years; 79 were married and 7 were single. Of the 75 in clinical practice, 71 practiced both obstetrics and gynecology and 13 had subspecialized. Most of the respondents (77/80) practiced in the mid-South. Of all graduates, 93% routinely provided primary care. In rating 20 major resident education categories, respondents gave high grades to training in surgically related areas. Only 4% rated their experience as fair or poor in the operative categories. CONCLUSION: Our graduates indicate satisfaction with their training, and their practices include primary care.

Adult↗
PubMed1998

Bishop score: a poor diagnostic test to predict failed induction versus vaginal delivery.

BACKGROUND: We evaluated the accuracy of the Bishop score in predicting the likelihood of successful labor induction (entry into active phase) in nulliparous and multiparous women. METHODS: During an index year, all patients having induction of labor and a preinduction Bishop score were included in a standard protocol for cervical ripening and use of oxytocin. Receiver-operating characteristic (ROC) curves were constructed for Bishop scores (0 to 11) to predict abdominal delivery for failed induction (final cervical dilation <4 cm) versus vaginal delivery. RESULTS: Parturients who had vaginal delivery (n = 253) and those in whom attempted induction failed (n = 38) did not differ significantly with respect to maternal demographics, length of gestation, Bishop score and its distribution, and infant birth weight. The area under the ROC curve did not differ significantly from the area under the nondiagnostic line. CONCLUSION: The Bishop score appears to be a poor predictor of the outcome of labor induction.

Adult↗
PubMed1998

Maternal mortality associated with adult respiratory distress syndrome.

BACKGROUND: Pregnancy-related adult respiratory distress syndrome (ARDS) can lead to maternal mortality and morbidity. METHODS: Records of all pregnant patients diagnosed with ARDS over a 14-year period were reviewed and the cases were stratified into survivors and nonsurvivors. RESULTS: Forty-one cases were identified and 31 survived (maternal mortality rate of 24.4%). Adult respiratory distress syndrome was diagnosed in the antepartum period in 23 (56.1%) of the patients and the majority of these cases occurred in the third trimester (73.9%). There was no statistically significant difference in demographic characteristics, preexisting diseases, or probable precipitating cause for the development of ARDS between the two groups. The cause of death among the nonsurvivors included multisystem organ failure, sepsis, cardiac arrest, and disseminated intravascular coagulopathy. CONCLUSION: Pregnancy-related ARDS continues to be associated with a high maternal mortality rate (25%). Unfortunately, the etiology for ARDS during pregnancy is not predictive of maternal outcome.

Adolescent↗
PubMed1998

Absence of seasonal variation on the frequency of HELLP syndrome.

BACKGROUND: We wanted to determine the relationship between weather/seasonal conditions and the incidence/severity of HELLP syndrome. METHODS: We retrospectively reviewed medical records of all patients with class 1 (platelet nadir < or = 50,000/microL), class 2 (platelet nadir > 50,000/microL but < or = 100,000/microL), and class 3 (platelet nadir > 100,000/microL but < or = 150,000/microL) HELLP syndrome, who had been treated at the University of Mississippi Medical Center between January 1, 1980, and December 31, 1992. RESULTS: No seasonal differences were observed in the incidence or severity of pregnancies complicated by HELLP syndrome. CONCLUSION: HELLP syndrome appears to occur throughout the year without any seasonal variation.

Female↗
PubMed1998

Oral magnesium for tocolysis: a comparison of magnesium gluconate and enteric-coated magnesium chloride.

PURPOSE: Following parenteral magnesium tocolysis for patients in preterm labor. The choice of oral tocolytic medications is controversial. METHODS: Over a six-month period, 47 patients who were inpreterm labor were randomized after parenteral magnesium tocolysis to receive magnesium gluconate ([Mg-g] 648 mg elemental magnesium/day) or magnesium chloride ([Mg-c] 640 mg elemental magnesium/ day). A serum magnesium was obtained 24 hours after the initiation of oral therapy. RESULTS: In the 25 patients were treated with Mg-g and 22 with Mg-c there were no differences in patient demographics, initial cervical dilatation hours on parenteral magnesium sulfate, recurrent contractions, or side effects between the two groups. The cost was also similar (Mg-c, $1.40/d; Mg-g, $2.11/d). The serum magnesium levels were higher in the Mg-c group (1.80 +/- 0.28 mg/dl) compared to the Mg-g group (1.63 +/- 0.30 mg/dl) but the difference was not significant. CONCLUSION: These two preparations of magnesium are similar in their effects on uterine activity and serum levels when used at these dosages.

Administration, Oral↗
PubMed1997

Better maternal outcomes are achieved with dexamethasone therapy for postpartum HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome.

OBJECTIVE: Our purpose was to determine whether the routine initiation of dexamethasone therapy in patients with postpartum HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome produces specific and general therapeutic benefits. STUDY DESIGN: In this retrospective, analytic study the puerperal courses of 43 women with postpartum HELLP syndrome who were treated with dexamethasone were compared with those of 237 similar patients who did not receive corticosteroids. Dexamethasone 10 mg intravenously at 12-hour intervals was given until disease remission was noted in treated patients, at which time up to two additional 5 mg intravenous doses were given at 12-hour intervals. RESULTS: The two patient groups were similar in regard to mode of delivery, gestational age, parity, and frequency of eclampsia. Compared with control subjects, dexamethasone-treated postpartum patients were more ill with significantly higher (p < 0.05) admission mean arterial blood pressure, higher serum uric acid level, and severe proteinuria. Dexamethasone administration was associated with a more rapid normalization of platelet counts and lactic dehydrogenase values. Most impressive was a clinically significant reduction of indicated transfusion and respiratory therapy, invasive hemodynamic monitoring, infectious or bleeding-related morbidity, and length of postpartum hospital course. CONCLUSIONS: Patients who received dexamethasone for postpartum-onset HELLP syndrome experienced a shorter disease course, faster recovery, less morbidity, and less need for other interventionist therapy compared with patients with HELLP syndrome who did not receive dexamethasone.

Adult↗
PubMed1997

Are obstetric interventions such as cervical ripening, induction of labor, amnioinfusion, or amniotomy associated with umbilical cord prolapse?

OBJECTIVE: Our purpose was to determine whether intrapartum obstetric interventions are associated with umbilical cord prolapse. STUDY DESIGN: A computer search identified patients who had intrapartum umbilical cord prolapse. Thirty-seven cases were identified between 1990 and 1994 (incidence of 1.85 per 1000). These women were randomly matched to control patients with intact membranes. RESULTS: Patients with umbilical cord prolapse were delivered earlier (34.8 vs 37.1 weeks, p = 0.05). Otherwise, there were no differences between groups regarding the use of cervical ripening, incidence of labor induction, or the use of amnioinfusion and amniotomy. Although cervical dilatation and station were similar between groups at the time of admission, women with umbilical cord prolapse did not have as much descent of the presenting part associated with cervical dilatation and progressive labor compared with control patients. CONCLUSION: By themselves, obstetric interventions of cervical ripening, labor induction, amnioinfusion, and amniotomy do not increase the likelihood that a patient will have umbilical cord prolapse.

Adolescent↗
PubMed1997

The case for trial of labor in the patient with a prior low-segment vertical cesarean incision.

OBJECTIVE: Our purpose was to review recent obstetric literature detailing the subsequent delivery experience of patients with a prior low-segment vertical cesarean incision and to derive recommendations for practice on the basis of this information. STUDY DESIGN: Ten studies that included information about pregnancy outcome in patients with prior low-segment vertical cesarean operations were retrieved and reviewed from the American obstetric literature since 1981 and from a review of all abstracts presented annually since 1981 to the Society of Perinatal Obstetricians. RESULTS: Altogether, information about subsequent pregnancy outcome for 382 patients with prior low-segment vertical cesarean delivery was available for analysis. Among the 372 patients with complete patient population information, vaginal delivery was safely accomplished in 306 (82%). Four uterine ruptures (1.05%) have been reported, only one of which occurred after a single prior unextended low-segment vertical cesarean incision. Two ruptures occurred elsewhere on the lateral or posterior aspect of the uterus in subsequent pregnancies, and the fourth rupture occurred at the juncture of prior low vertical and transverse incisions. No perinatal mortality or permanent perinatal morbidity was encountered with these pregnancies. CONCLUSIONS: In the otherwise uncomplicated pregnancy the patient with one previous nonextended low-segment vertical cesarean incision should be considered to have a prior low-segment scar and as such be a candidate for trial of labor in her current singleton pregnancy. The same care, counseling, and caution should be exercised for this patient as for one with a prior low-segment transverse incision.

Birth Weight↗
PubMed1997

Sonographic examination does not predict twin growth discordance accurately.

OBJECTIVE: To assess the accuracy of estimating birth weight among twins with discordancy (intra-pair difference in actual birth weight of more than 25%) and to determine the relative accuracy of an intra-pair difference in abdominal circumference (delta AC) of 20 mm or more or in estimated fetal weight (delta EFW) of 25% or more for the identification of discordant growth in twins. METHODS: Over a 6-year period, we identified all non-anomalous twin pairs with gestational ages greater than 23 weeks and sonographic examinations within 3 weeks of birth. Ultrasonographic biometry of both twins included AC, head circumference, and femur length; these indices were used to estimate fetal weight by Hadlock's formula. Likelihood ratios, receiver-operating characteristic curves, and prediction limits were applied to assess the accuracy of the two diagnostic methods to predict an abnormal outcome. RESULTS: A total of 242 twin pairs were studied. The mean gestational age among the 21 twins with abnormal growth (30.6 +/- 4.6 weeks) was significantly less than among the 221 twins with normal growth (33.2 +/- 4.0 weeks) (P < .005). The biometric measurements of fetal parts, sonographic estimate of fetal weight, and actual birth weight for both fetuses were significantly less for discordant twin pairs (P < .05). The accuracy of predicting birth weight, as determined by mean error and percentage of the estimate within 10% of the actual weight, was similar between the groups. Receiver-operating characteristic curves showed that both diagnostic tests yielded areas under the two curves not significantly different from the area under the nondiagnostic line (P > .05). Most important, prediction limit calculations indicated that a 90% certainty that the actual birth weight discordance was at least 25% was achievable only if delta AC was 172 mm or greater or delta EFW was 112% or more. CONCLUSION: The most popular current methods (difference in AC or EFW) for predicting discordant growth in twin gestations have limited accuracy when held to a standard for discordance that requires a birth weight difference of at least 25%.

Birth Weight↗
PubMed1997

The origin of endothelin-1 in patients with severe preeclampsia.

OBJECTIVE: To determine the site of origin of increased concentrations of plasma endothelin-1 in patients with severe preeclampsia. METHODS: Twelve patients with severe preeclampsia undergoing an indicated abdominal delivery had endothelin-1 levels measured from plasma specimens drawn from right and left uterine and antecubital veins before delivery and after placenta removal with uterine curettage. Twelve uncomplicated control patients undergoing abdominal delivery had endothelin-1 concentrations drawn by an identical protocol. Clinical staff members were blinded to endothelin-1 results and laboratory staff were blinded to patient group assignment and sample source. Endothelin-1 plasma concentrations were determined by radioimmunoassay and data were analyzed by paired t test. RESULTS: No difference in endothelin-1 concentration was noted with respect to placental location, central versus peripheral, or predelivery versus postdelivery sampling procedures. Overall, patients with preeclampsia had higher plasma concentrations of endothelin-1 (mean 11.0 +/- 6.6 pg/mL) compared with normotensive patients (mean 8.4 +/- 6.7 pg/mL, P < .005). CONCLUSION: The decidual-placental interface does not appear to be the source of increased plasma endothelin-1 concentrations found in severe preeclampsia. The origin of this increase remains uncertain.

Adult↗
PubMed1997

Remote umbilical arterial blood pH analysis: accuracy, utility, and limitations.

It is not always possible or feasible to perform routine umbilical artery blood sampling at birth. This study was undertaken to assess the accuracy of selective remote umbilical arterial blood analysis to retrospectively predict the original birth pH of any newborn. Umbilical arterial blood samples were obtained in two preheparinized syringes immediately following 1007 deliveries. One sample was analyzed within 60 minutes of delivery. The other was placed on ice and later analyzed at variable time intervals up to 180 hours postpartum. The results of each remote analysis were adjusted using a previously published regression equation to accurately identify which newborns had pH values < 7.00, < or = 7.10, or < 7.20 at birth. Among the 1007 newborns, there were 14 (1.3%), 44 (4.3%), and 187 (18.5%) who had pH values < 7.00, < or = 7.10, and < 7.20, respectively, at birth. Remote umbilical arterial samples analyzed within 72 hours of delivery correctly identified newborns with an original pH < 7.00, < or = 7.10, or < 7.20 with: (1) a sensitivity of 100, 82, and 84%, respectively; (2) positive predictive values of 100, 93, and 66%, respectively; and (3) a test efficiency of 100, 99, and 89%, respectively. Up to 72 hours after delivery, remote umbilical arterial blood pH analysis can be reliably used to accurately identify the newborn that was acidotic at birth.

Acidosis↗
PubMed1997

Cesarean section for suspected fetal distress. Does the decision-incision time make a difference?

OBJECTIVE: To compare perinatal outcomes in patients at term (37 weeks) in whom the decision-incision time for cesarean delivery was due to suspected fetal distress. STUDY DESIGN: All parturients who underwent cesarean delivery primarily for possible fetal distress during a three-year period were identified retrospectively. Student's t test and the chi 2 test were utilized, and P < .05 was considered significant. A regression analysis of decision-incision time and umbilical arterial pH was performed. RESULTS: From 1991 to 1993, 1.3% (117/9,137) of term laboring patients underwent emergency cesarean delivery for the primary indication of possible fetal distress. In 61 patients (52%) the decision-incision time was 30 minutes, while it exceeded 30 minutes in the remaining 56 women. The two patient groups were similar in maternal demographics, antepartum complications, oxytocin usage, thick meconium, type of abnormal fetal heart rate tracing prompting surgery, use of amnioinfusion (41% vs. 36%), general anesthesia (97% vs. 93%), mean birth weight and Apgar score < 7 at five minutes. Three adverse outcomes were observed more frequently in association with decision-incision time > 30 minutes: (1) lower mean (+/-SD) umbilical arterial pH (7.16 +/- 0.15 vs. 7.26 +/- 0.06, P = .001), (2) pH < 7.00 (8/61 vs. 0/56, P = .005), and (3) admission to the neonatal intensive care unit (P = .008). When the incision was made longer than 30 minutes after the decision, there was no apparent adverse neonatal or infant outcome. CONCLUSION: Although a cesarean decision-incision time < or = 30 minutes is a desirable goal for the fetus possibly in distress, failure to achieve this goal is not associated with a measurable negative impact on newborn outcome.

Adult↗
PubMed1997

Drug use and physical trauma: risk factors for preterm delivery.

OBJECTIVE: The present investigation was undertaken to determine the incidence of alcohol, cocaine, and marijuana use among pregnant patients who suffered any type of physical trauma and to determine if the combination of substance use and physical trauma in pregnancy has extended perinatal implications. METHODS: In this single institution, prospective patient series undertaken over 18 months, all pregnant patients who suffered any type of physical trauma were considered for study. RESULTS: Among 6828 live births over an 18-month period, there were 157 (2.3%) patients who reported physical trauma (insignificant = 153, minor = 2, severe = 2). Consent to screen for the presence of alcohol, marijuana, and cocaine was obtained from 85 (54%) patients with refusal by the remainder. Screening was positive in 11% for one or more substances. The perinatal morbidity and mortality for the 153 patients with insignificant trauma was 50:1000 and 20:1000, respectively, all associated with preterm labor and delivery which occurred in 21% of the patients. None of the four patients with minor or severe trauma either had a positive drug/alcohol screen or any perinatal morbidity or mortality. No maternal mortality occurred. CONCLUSION: An 11% incidence of positive drug screens was encountered in consenting pregnant trauma victims and a 21% incidence of preterm birth was encountered even in this patient population with so-called insignificant trauma.

Female↗
PubMed1997

Neonatal cephalohematoma from vacuum extraction.

OBJECTIVE: To identify factors involved in the development of fetal cephalohematoma from vacuum extraction. STUDY DESIGN: Patients at > or = 34 weeks' gestation were randomly assigned to delivery by vacuum (n = 322) using the continuous (n = 164) or intermittent (n = 158) technique. Neonatal outcome with cephalohematoma was analyzed subsequently and related to prospectively recorded data. RESULTS: Approximately equal numbers of cephalohematoma were recorded in the two groups (continuous 20, intermittent 17; P = .686). Station at point of application (P = .008), increasing asynclitism (P < .001) and increasing application to delivery time (P = .002) correlated significantly with cephalohematoma. Only the last two factors achieved significance after stepwise multiple logistic regression analysis. Factors that did not achieve statistical significance were gestational age (P = .755), birth weight (P = .982), instrumental rotation (P = .896) and previous vaginal delivery (P = .051). CONCLUSION: In this prospective, randomized, controlled trial of vacuum-assisted delivery, the only predelivery factor found to predispose to neonatal cephalohematoma formation was increasing asynclitism. Although cephalohematoma formation was more likely to develop as the duration of vacuum application increased during delivery, only 28% of neonates exhibited this finding when the time from vacuum application to delivery exceeded five minutes.

Female↗
PubMed1996

The changing epidemiology of acquired drug-resistant tuberculosis in San Francisco, USA.

BACKGROUND: The increasing incidence of tuberculosis caused by drug-resistant Mycobacterium tuberculosis is thought in part to reflect inadequate implementation of standard tuberculosis control measures. However, in San Francisco, USA, which has an effective tuberculosis control programme, we have recently observed an increase in cases of acquired drug-resistance. METHODS: To explore further this observation, we analysed the secular trend of acquired drug-resistance and conducted a population-based case-control study of all reported tuberculosis cases in the city of San Francisco between 1985 and 1994. FINDINGS: We identified 14 patients with tuberculosis caused by fully susceptible M tuberculosis who subsequently developed drug-resistance. Of these acquired drug-resistance cases, two occurred between 1985 and 1989, whereas 12 occurred between 1990 and 1994 (p = 0.028). In the case-control study, AIDS (odds ratio 20.2, 95% CI 1.12-363.6), non-compliance with therapy (19.7, 1.66-234.4), and gastrointestinal symptoms (11.5, 1.23-107.0) were independently associated with acquired drug-resistance. Between 1990 and 1994, one in 16 tuberculosis patients with AIDS and either gastrointestinal symptoms or non-compliance developed acquired drug- resistance. INTERPRETATION: The substantial increase in acquired drug- resistance in San Francisco seems to be a product of the increasing prevalence of HIV/M tuberculosis coinfection. Our data suggest that the interface of the HIV and tuberculosis epidemics fosters acquired drug-resistance, and that traditional tuberculosis control measures may not be sufficient in communities with high rates of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1996

Military pregnancies and adverse perinatal outcome.

OBJECTIVE: To identify significant risk factors for an adverse outcome in active-duty military women. METHODS: A prospective study of 105 pregnancies and their outcome. RESULTS: The data revealed that: (1) single women more than married personnel had cesarean births when compared with forceps and vacuum (P < 0.03) or spontaneous vaginal delivery (P < 0.04); and (2) active-duty women who gained < 25 pounds during pregnancy developed preterm labor more often (P < 0.05). CONCLUSIONS: Risk factors for these adverse outcomes remain unknown.

Adult↗
PubMed1996

A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor.

OBJECTIVE: Our purpose was to determine the efficacy of the obstetric forceps versus the M-cup, a new vacuum extractor cup, and maternal-neonatal complication rates. STUDY DESIGN: Over a 10-month period operative vaginal deliveries were randomized between the obstetric forceps and the M-cup vacuum extractor cup. Maternal demographics, indication for intervention, analgesia, position, station, degree of asynclitism, fetal caput-molding, and time from application to delivery were prospectively recorded. Episiotomy and extensions, lacerations, and the reason for abandonment of the randomized instrument were noted in both groups. Fetal weight, Apgar scores, cord arterial gases, hyperbilirubinemia, phototherapy, and any evidence of fetal trauma were documented at delivery or in the nursery. RESULTS: Six hundred thirty-seven women were randomized, 315 in the forceps group and 322 in the M-cup group. There were no differences in maternal demographic variables. The station, position, degree of asynclitism, or requirement for rotation was not different between the groups. The corrected efficacy rates were forceps 92% and M-cup 94% (p = 0.217). The M-cup deliveries were accomplished more rapidly than forceps deliveries (p < 0.001) and were associated with a lower rate of episiotomy (p < 0.001), third-degree (p < 0.001) and fourth-degree (p = 0.002) lacerations, but blood loss as clinically estimated (p = 0.232) or as measured by hemoglobin levels (p = 0.166) was not significantly different. Forceps deliveries were associated with fewer clinically diagnosed cephalhematomas (p = 0.015) than M-cup deliveries were, but there were no differences in the number of neonates diagnosed with hyperbilirubinemia (p = 0.377) or in the number of infants treated with phototherapy (p = 0.660). CONCLUSIONS: The M-cup vacuum extractor cup appears to be as efficient (and faster) than the obstetric forceps but is associated with significantly more fetal cephalhematomas, whereas maternal injuries are more common with the forceps.

Adult↗