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Biomedical subjects

L B Curet

Publications and source records attributed to L B Curet.

At least 37 records · Page 2Linked to original sources
PubMed1996

Comparison of absorbable uterine staples and traditional hysterotomy during cesarean delivery.

OBJECTIVE: To evaluate the use of the Auto Suture Poly CS-57 disposable surgical stapler to determine if the device offers any advantages over suture closure of the uterus. METHODS: A matched case-control study design was used. Operative time, estimated blood loss, change in hematocrit, incidence of postoperative endometritis, length of stay, and total patient costs were compared. Patients were recruited from a university hospital setting and a private practice. RESULTS: There were 288 patients in the study, 144 in the staple group and 144 matched patients in the standard hysterotomy control group. Patients did not differ in age, parity, gestational age, number of primary or repeat operations, anesthesia, infant weights, or outcomes. Comparing the patients in the staple group and the control group, there was no significant difference in operative time (63.7 +/- 22.9 versus 62.0 +/- 22.3 minutes, staple group versus controls, respectively), estimated blood loss (822 +/- 338 versus 879 +/- 318 mL), change in hematocrit (-5.9 versus -6.5 volume percent), incidence of postoperative endometritis (15 versus 20%), length of stay (4.1 +/-1.3 versus 4.0 +/- 2.2 days), or total cost ($4490 +/- 1544 versus $3997 +/- 1117). Comparing patients operated upon by residents in the university to those operated upon by the private attending physicians, there were no significant differences noted in the above-mentioned variables between stapled and sutured patients. CONCLUSION: Compared with the usual suture technique for cesarean delivery, the uterine stapling device used in this study was not associated with a significant decrease in the incidence of postoperative anemia, infection, length of hospital stay, or cost. This device appears to offer no advantage over traditional hysterotomy and repair.

Case-Control Studies↗
PubMed1996

Postoperative management of cesarean patients: the effect of immediate feeding on the incidence of ileus.

OBJECTIVE: To evaluate the effect of immediate feeding on gastrointestinal function in patients undergoing cesarean delivery. METHODS: A prospective study was conducted in which patients were randomized to one of two groups, either early feeding or delayed feeding, ie, feeding according to the institution's current protocol. Questionnaires were filled out by the subjects on the day of discharge. Fisher exact test was used to compare the two groups with respect to the type of anesthetic used and to compare the incidence of gastrointestinal symptoms. A one-sided exact binomial confidence interval was used to determine the upper bound of the likelihood of paralytic ileus. Logistic regression analysis was used to evaluate the presence of ileus symptoms when controlling for the type of anesthetic used. RESULTS: There were no significant differences between the control and study groups. There was no significant difference in the number of gastrointestinal symptoms between the two groups. The incidence of postoperative paralytic ileus was zero in both the study and control groups. CONCLUSION: Routine early feeding of subjects undergoing cesarean delivery can be implemented without an increase in gastrointestinal symptoms or paralytic ileus.

Anesthesia, Obstetrical↗
PubMed1996

A prospective randomized evaluation of a hygroscopic cervical dilator, Dilapan, in the preinduction ripening of patients undergoing induction of labor.

OBJECTIVE: Our purpose was to investigate the safety and efficacy of a synthetic intracervical hygroscopic dilator, Dilapan (Gynotech, Inc., Middlesex, N.J.), on ripening the cervix before medically indicated induction of labor. STUDY DESIGN: Two hundred forty patients with a Bishop score of < or = 4 were prospectively randomized to receive either preinduction synthetic hygroscopic dilators (n = 112) or no pretreatment (n = 128) before oxytocin induction. RESULTS: Compared with controls, the dilator group exhibited a significant change in median Bishop score, but there was no significant difference in length of labor (dilator 18.8 +/- 12.8 hours vs control 21.7 +/- 14.8 hours) or in the cesarean section rate (dilator 41/112 [36.6%] vs control 49/128 [38.3%]). Relative proportions of nulliparous and multiparous patients, infant weights, and cervical dilation at the time of cesarean section were not significantly different between groups. No adverse maternal or fetal effects could be attributed to use of the device. CONCLUSIONS: Preinduction cervical ripening with hygroscopic dilators does not shorten the length of labor or lower the cesarean section rate in patients undergoing induction of labor.

Abortifacient Agents↗
PubMed1995

Chagas disease in pregnancy.

BACKGROUND: Chagas disease is a tropical disease now making its appearance in the United States as more immigration from Latin America occurs. Pregnant women with chronic infection with Trypanosoma cruzi may present with cardiac or gastrointestinal symptoms and transmit the infection to their fetuses. CASE: A 32-year-old Mexican woman presented with cardiac symptoms at 16 weeks' gestation. She was found to have a left anterior hemiblock on her electrocardiogram. Her indirect immunofluorescent antibody titer for T cruzi was positive at greater than 1:2048. Subsequently, she had a normal pregnancy and delivery. The infant's T cruzi immunofluorescent antibody titer was 1:256 at birth and had not declined at his 6-week follow-up. CONCLUSION: Obstetric care providers in the United States need to be familiar with American trypanosomiasis because it may present during pregnancy. Serious maternal disease is possible, and perinatal transmission may be seen in 2-10% of cases.

Adult↗
PubMed1995

Acute spinal cord injury and neurogenic shock in pregnancy.

A case of a pregnant woman with a subluxation of C-6 on C-7 with acute quadriplegia and sensory loss to the T-10 dermatome is described. Hemodynamic and fetal monitoring during the 3-week period of neurogenic shock resulted in good maternal and fetal outcomes. Pulmonary complications and anesthetic issues are important aspects of the care of these critically ill patients. Major trauma is a common cause of death and disability in young adults and may contribute to as much as 15 percent of nonobstetric maternal deaths. Spinal cord injuries involve young women in 15 percent of cases. The literature is replete with information on the obstetric management of patients with preexisting spinal cord injury (1-4) but there is little on the management and special problems of the pregnant patient with acute spinal cord trauma. We report here the management of a case of acute cord transection accompanied by spinal shock and discuss the specific maternal as well as fetal considerations in this syndrome.

Acute Disease↗
PubMed1995

Transvaginal sonographic measurement of cervical length. Evaluation of twin pregnancies.

Twin gestations continue to contribute significantly to perinatal morbidity and mortality. The increased perinatal risks associated with twin gestations are directly related to prematurity. Thus, further characterization of the risks of prematurity may yield useful information in managing these patients. We investigated transvaginal ultrasound measurement of the cervix throughout twin gestations and compared these findings to those in singleton pregnancies. Twenty-five patients with twin gestations underwent 53 cervical length measurements. As compared to cervical length in singleton pregnancies, that in twins was significantly shorter for matched gestational age groups.

Adolescent↗
PubMed1995

Doppler velocimetry and fetal heart rate pattern observations in acute cocaine intoxication. A case report.

While the use of cocaine in pregnancy continues to be a significant contributor to adverse maternal and perinatal outcomes, systematic study of the physiologic effects of cocaine in human gestation remains difficult. In a case of acute cocaine intoxication in the third trimester, Doppler velocimetry suggested a physiologic response from the uterine artery but not the umbilical artery. Furthermore, the abnormal uterine artery velocimetry was associated with a positive nonreactive contraction stress test, which became negative and reactive as the effects of the cocaine wore off and the velocimetry returned to normal. These observations suggest that the uterine arteries are more sensitive to cocaine than are the umbilical arteries and that abnormal fetal heart rate patterns during acute cocaine intoxication may be transitory.

Adult↗
PubMed1994

Hantavirus pulmonary syndrome complicating pregnancy.

OBJECTIVE: The purpose of this report is to bring to the attention of obstetric care providers the occurrence in pregnancy of a threatening pulmonary syndrome caused by hantavirus infection. STUDY DESIGN: Two recent cases of hantavirus pneumonitis in pregnancy, one complicated by adult respiratory distress syndrome, are presented. The clinical characteristics and epidemiology of the illness, which has now been reported in 12 western states, are detailed. RESULTS: Hantavirus pulmonary syndrome is characterized by pneumonitis, often progressing to adult respiratory distress syndrome, which is accompanied by thrombocytopenia, lactacidemia, and leukocytosis with a marked left shift. Severe hypoxemia and lactacidemia were associated with a poor perinatal outcome. CONCLUSION: The hantavirus pulmonary syndrome occurring during pregnancy may be life-threatening and may result in fetal hypoxemic damage.

Adult↗
PubMed1994

Amnioinfusion: an update.

Amnioinfusion is one of the most innovative techniques of the decade. The authors reviewed current literature, research indications, and nursing implications for amnioinfusion. Current technology has simplified the amnioinfusion procedure. This technique provides both therapeutic and prophylactic regimens for the intrapartum mother and her fetus, and it has many clinical implications for nursing.

Amniotic Fluid↗
PubMed1993

Female circumcision: obstetric issues.

Female circumcision is a problem unfamiliar to most Western obstetrician-gynecologists. We present a case illustrative of the unique management problems posed by these patients during labor. A method of releasing the anterior vulvar scar tissue to allow vaginal delivery is described. Sensitivity and a nonjudgmental approach as to what is culturally appropriate care for these women are of paramount importance.

Adult↗
PubMed1993

Prevention of cesarean section. Does intracervical dinoprostone work?

We investigated the effect of preinduction cervical ripening with the intracervical instillation of dinoprostone (prostaglandin E2 gel, 0.5 mg) on the results of labor induced with intravenous oxytocin. We randomly allocated 79 pregnant women to receive either the intracervial application of dinoprostone gel or placebo gel. Compared with control subjects, the group who received dinoprostone had no difference in induction-to-delivery interval or in cesarean section rate. The dinoprostone group had fewer failed inductions, but there was no difference between the two groups in the number who delivered spontaneously within 24 hours. From review of the literature and a meta-analysis, it was likewise revealed that dinoprostone did not favorably affect the cesarean section rate. Contrary to current opinion, intracervical dinoprostone gel does not appreciably lower the cesarean section rate when used at this dose and route before labor is induced.

Administration, Intravaginal↗
PubMed1992

Diagnosis of cervical change in pregnancy by means of transvaginal ultrasonography.

There are no absolute objective diagnostic criteria for cervical incompetence. Abdominal and endovaginal ultrasonographic assessment of endocervical length, both of which have been associated with technical problems, have been used to establish the diagnosis. Cervical cerclage may be useful in preventing silent cervical dilatation; however, no prospective trials with and without cerclage have been performed when endocervical shortening has been demonstrated by ultrasonography.

Cervix Uteri↗
PubMed1992

Short-acting beta-adrenergic blockade and the fetus. A case report.

An infant was born to a woman who received intravenous esmolol for intrapartum supraventricular tachyarrhythmia. Despite the very short acting and cardio-selective beta-1 adrenergic blockade induced by that agent, neonatal effects can occur up to 48 hours after delivery.

Adrenergic beta-Antagonists↗
PubMed1992

Does closure of Camper fascia reduce the incidence of post-cesarean superficial wound disruption?

OBJECTIVE: To determine whether closure of Camper fascia prevents the development of superficial wound disruption after cesarean delivery. METHODS: During a 1-year period, 438 women undergoing cesarean delivery were randomized into groups with and without approximation of Camper fascia with absorbable suture during closure of the abdominal incision. All women received routine postoperative care following our departmental guidelines. We reviewed charts after the puerperium to identify women with postoperative superficial wound disruption and to obtain demographic and delivery information for analysis. RESULTS: We found a significantly higher incidence of wound disruption in the group without the suture than in those in whom the tissue was approximated (P = .03). Four or more vaginal examinations and higher body mass index were also associated with a higher incidence of wound disruption (P = .05 and P = .04, respectively). Logistic regression correction for covariables that might influence the results of our main analysis revealed no effect of maternal age, parity, indications for cesarean delivery, duration of labor, duration of ruptured membranes, duration of surgery, use of internal monitoring, type of incision, use of antibiotic prophylaxis, surgeon's level of training, or maternal diabetes mellitus and/or hypertension. CONCLUSION: Approximation of Camper fascia with absorbable suture at closure of the abdominal incision during cesarean delivery appears to protect against postoperative superficial wound disruption and is therefore recommended.

Abdomen↗
PubMed1992

The biophysical profile and the nonstress test: poor predictors of chorioamnionitis and fetal infection in prolonged preterm premature rupture of membranes.

Sixty-eight women admitted with the diagnosis of preterm premature rupture of membranes (PROM) and a latency period of at least 48 hours were followed expectantly. Fetal surveillance consisted of daily kick counts, daily nonstress test (NST), and fetal biophysical profile every 48-72 hours. Patients were delivered as a result of spontaneous labor, clinical chorioamnionitis, fetal distress, or attainment of 37 weeks' gestation. No corticosteroids, tocolytics, or prophylactic antibiotics were used. The last biophysical profile and the last NST before delivery were evaluated for each patient. There was no statistically significant association between chorioamnionitis or fetal infection and the following: 1) a low biophysical profile (score of 6 or lower), 2) a low biophysical profile that included a nonreactive NST and absent fetal breathing movements, or 3) a nonreactive NST. We conclude that the biophysical profile and the NST are poor predictors of perinatal infectious complications.

Adolescent↗