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Biomedical subjects

L C Gilstrap

Publications and source records attributed to L C Gilstrap.

At least 109 records · Page 6Linked to original sources
PubMed1986

Early repair of an external sphincter ani muscle and rectal mucosal dehiscence.

Little information is available to assist in the management of a dehiscence subsequent to a fourth degree episiotomy repair. Delayed repair of the external sphincter ani muscle and rectal mucosa may result in weeks or months of disability and inconvenience for these women. A series of eight women is presented whose fourth degree episiotomy repair dehiscence was managed by early puerperal repair. The details of wound and bowel preparation, the operative technique, and postoperative care are described. Because all eight women had a successful repair, the authors believe that early surgical correction is an acceptable treatment for this puerperal complication.

Anal Canal↗
PubMed1986

Uterine contraction pressures with oxytocin induction/augmentation.

Uterine contraction pressures were quantified (in Montetevideo units) in 109 women at term gestation who received oxytocin for induction or augmentation of labor and whose labor resulted in a spontaneous vaginal delivery. Newborn five-minute Apgar scores were greater than or equal to 8 in 108 of the 109 neonates, and no immediate neonatal morbidity was attributable to the oxytocin stimulation of labor. Women undergoing oxytocin induction had significantly greater uterine contraction pressures than those with oxytocin augmentation. During oxytocin induction 91% of women achieved at least 200 to 224 Montevideo Units and 40% at least 300 Montevideo units versus 77 and 7.7%, respectively, during augmentation of labor. With concurrent fetal monitoring these levels of uterine activity should be sought before consideration of a cesarean delivery because of presumed cephalopelvic disproportion or failure to progress.

Drug Administration Schedule↗
PubMed1986

Women's G tolerance.

G tolerances of 102 women and 139 men subjected to Standard Medical Evaluation (Medeval) G Profiles were compared. Unpaired t-tests revealed no significant difference between the women and men in either relaxed or straining G tolerance. Covariance analysis controlling for differences in tolerance due to age, height, weight, and activity status revealed the women to have marginally lower tolerance; the analysis also identified height as a factor having a strong negative influence on G tolerance, and weight as having a positive influence. When the women were matched only by height to the men in the comparison group, the women's mean G tolerances were significantly lower than the men's. On Standard Training G Profiles 88% of 24 women and 80% of 213 men completed the runs, but this difference was not significant. G tolerances of 47 women were measured on the Medeval Profiles both during and between menses, but no significant differences related to menstruation were found. No important differences between women and men in signs or symptoms of G stress were observed, except for two instances of urinary stress incontinence in women during the Training Profiles. We conclude that women should not categorically be excluded from aircrew duties for reasons of G intolerance.

Adult↗
PubMed1985

Umbilical cord pH, PCO2, and bicarbonate following uncomplicated term vaginal deliveries.

Normal values for umbilical arterial and venous pH, PCO2, PO2, and bicarbonate must be known before these parameters can be used for assistance in clinical decisions. We evaluated the cord blood from 146 infants born after uncomplicated labor and vaginal deliveries at 37 to 42 weeks' gestation. All infants had a normal baseline fetal heart rate and normal beat-to-beat variability for at least 10 minutes preceding expulsion. The cord blood of infants born to women with pregnancy complications such as diabetes mellitus, preeclampsia, twins, meconium-stained amniotic fluid, or fetal growth retardation was not included. Mean umbilical arterial values +/- 1 SD for the parameters studied were: pH, 7.28 +/- 0.05; PCO2, 49.2 +/- 8.4 mm Hg; PO2, 18.0 +/- 6.2 mm Hg; bicarbonate, 22.3 +/- 2.5 mEq/L. Umbilical venous values were: pH, 7.35 +/- 0.05; PCO2, 38.2 +/- 5.6 mm Hg; PO2, 29.2 +/- 5.9 mm Hg; bicarbonate, 20.4 +/- 4.1 mEq/L.

Bicarbonates↗
PubMed1985

Survival and short-term morbidity of the premature neonate.

Obstetric decisions regarding premature (23 to 32 weeks' gestation) infants must be based on gestational age. However, most reports of the survival of premature infants are based on birth weight. The present report relates the perinatal survival and morbidity of 105 newborns to the obstetric gestational dating criteria between 23 and 32 weeks' gestation. Gestational age was determined from at least four obstetric criteria including the first day of the last menstrual period, early pelvic examination, the earliest auscultation of fetal heart tones with a fetoscope, fundal height measurements in centimeters between 20 and 30 weeks' gestation, and sonographic gestational age measurements. At 23 to 26 weeks' gestational age, nine (39%) of 23 neonates survived. Five of nine survivors had moderate to severe intracranial hemorrhage, three had moderate to severe bronchopulmonary dysplasia, and three had moderate to severe retrolental fibroplasia. At 27 to 29 weeks' gestational age, 25 (93%) of 27 neonates survived. Of the 25 survivors, three had moderate to severe intracranial hemorrhage, one had moderate to severe bronchopulmonary dysplasia, and one had severe retrolental fibroplasia. At 30 to 32 weeks' gestational age, 52 (95%) of 55 neonates survived. Three of the 52 (6%) survivors had serious neonatal morbidity consisting of moderate to severe intracranial hemorrhage (three neonates) and moderate to severe bronchopulmonary dysplasia (one neonate). Thus, ten of 34 (29%) survivors between gestational ages of 24 to 29 weeks had a serious morbidity versus only three of 52 (6%) survivors between 30 to 32 weeks' gestation (P less than .01).

Bronchopulmonary Dysplasia↗
PubMed1985

Term maternal and neonatal complications of acute chorioamnionitis.

One hundred and three women who developed acute chorioamnionitis at 37 weeks' gestation or beyond were studied retrospectively. Clinical findings included fever (99.2%), fetal (82%) and maternal (19.4%) tachycardia, uterine tenderness (16.5%), and foul-smelling amniotic fluid (8.7%). Three of the 46 women who underwent cesarean section subsequently required addition of a second or third antibiotic for serious pelvic infection, whereas two had a subcutaneous wound infection requiring open drainage. Importantly, between zero and ten hours of the diagnosis of chorioamnionitis, a critical time interval where delivery impacted on neonatal infectious morbidity was not identified. Additionally, in the initial 24 hours after rupture of the fetal membranes there was no association between fetal, neonatal, or maternal complications versus duration of membrane rupture. These data suggest that immediate operative delivery of term gestations complicated by acute chorioamnionitis will not reduce neonatal morbidity.

Acute Disease↗
PubMed1984

Second-stage fetal tachycardia and neonatal infection.

Forty fetuses who had mild or marked tachycardia during the final 10 minutes of the second stage of labor were evaluated for neonatal infection. Prolonged sepsis/pneumonia occurred in 10 of the 40 infants (25%), three of eight (38%) with marked tachycardia, seven of 32 (22%) with mild tachycardia, and in only one of 167 control infants who had a normal second-stage fetal heart rate (0.6%). None of the 40 women with fetal tachycardia or the 167 control subjects had any intrapartum fever or other evidence of acute chorioamnionitis. Persistent fetal tachycardia during the second stage of labor defines a population at increased risk for subsequent neonatal sepsis/pneumonia. This population will require prolonged, expert neonatal care.

Bacterial Infections↗
PubMed1984

Umbilical cord pH and PCO2: effect of interval from delivery to determination.

Determinations of umbilical blood pH and PCO2 can be useful for correlating intrapartum fetal heart rate patterns, intrapartum samples of scalp blood, and Apgar scores, for the retrospective evaluation of the management of a particular labor. Occasionally, such data can indicate and clarify needed resuscitative measures and intensive neonatal observation. Cumbersome techniques have been described for the handling of specimens of cord blood to ensure an accurate determination. This study was performed to determine the effect on cord blood pH and PCO2 of room temperature and time from delivery. One hundred five cord venous or arterial determinations had a linear pH decrease versus time at room temperature. The regression slope was -3.66 X 10(-4) per minute with a standard deviation of 1.37 X 10(-2). The PCO2 showed only a slight increase with time at room temperature, although the scatter was high, with a standard deviation of 3.8 torr. The conclusion is that samples of cord blood drawn for determination of pH and PCO2 can be kept at room temperature in plastic syringes for up to 30 minutes without significant alteration in these values, i.e., pH decrease no greater than 0.04 unit (p less than 0.05).

Apgar Score↗
PubMed1984

Case report of ECT during high-risk pregnancy.

The authors present the case of a depressed woman given ECT during pregnancy and list administrative and monitoring techniques for protection of both fetus and mother when ECT is administered during pregnancy.

Adult↗
PubMed1984

Piperacillin versus clindamycin plus gentamicin for pelvic infections.

Piperacillin, a new semisynthetic penicillin, has broad spectrum activity against most clinically important aerobic and anaerobic bacteria. In the present study, piperacillin was compared with a combination of clindamycin and gentamicin for the treatment of 83 women with pelvic infection (42 with endometritis, 29 with posthysterectomy cuff infections, 11 with acute salpingitis, and one with a wound infection). There were 179 bacterial isolates, 98 (53%) aerobic and 81 (45%) anaerobic. Of the 42 patients treated with piperacillin, there were three (7.1%) clinical failures compared with one (2.4%) in the 41 patients treated with clindamycin-gentamicin. A single drug, piperacillin, was shown to be as safe and effective as the combined clindamycin plus gentamicin therapy for pelvic infections.

Adult↗
PubMed1984

Pregnancy and acute optic disc edema of juvenile-onset diabetes.

Acute optic disc edema is a recently recognized, relatively benign manifestation of juvenile-onset diabetes mellitus. Twenty-three cases have been reported in the ophthalmology literature, two occurring during pregnancy. The authors present an additional case recognized in a pregnant patient and review the literature. The disorder manifests physical findings similar to those of papilledema, proliferative retinopathy with optic disc edema, inflammatory papillitis, and ischemic optic neuropathy, but has a benign course that requires no treatment and is not adversely affected by pregnancy. It is important to recognize this syndrome because failure to make the correct diagnosis in pregnancy may lead to inappropriate treatment, including therapeutic abortion.

Acute Disease↗
PubMed1984

Cesarean section: changing incidence and indications.

There were 19,419 deliveries at Wilford Hall USAF Medical Center from 1970 through 1981. Of these, 1847 (9.5%) were by primary cesarean section and 800 (4%) by repeat operations. The most common indications for cesarean section (dystocia, breech presentation, repeat operation, and fetal distress) remained the same during this period. However, within these four indications and also between the three time periods of 1970 to 1973, 1974 to 1977, and 1978 to 1981, significant trends were apparent. From the periods of 1970 to 1973 through 1974 to 1977, the primary rate increased from 5.6% to 12.8% (P less than .0001). Dystocia (P less than .0001), breech presentation (P less than .0001), and fetal distress (P less than .0001) were responsible for this increase. However, from 1974 to 1977 through 1978 to 1981, the primary rate decreased to 9.6% (P less than .0001). This was related to significantly decreased rates for dystocia (P less than .0001) and fetal distress (P less than .0001). This decrease was temporally related to an initiation of various means to decrease the authors' overall cesarean section rate that approached 20% in 1976.

Breech Presentation↗
PubMed1984

Second stage fetal heart rate abnormalities and neonatal acidosis.

Of 403 newborns with either fetal heart rate (FHR) bradycardia or tachycardia during the last ten minutes of the second stage of labor, 20% had an umbilical cord pH of less than 7.20 at birth compared with only 4% of newborns who had a normal FHR during the last ten minutes of labor (P less than .0001). Thirty (18%) of 165 neonates with mild bradycardia and 33 (27%) of 121 neonates with moderate to marked bradycardia had cord pH values of less than 7.20 at birth (P less than .0001). Of the 117 neonates with tachycardia during the last ten minutes of the second stage, 17 (15%) had a pH of less than 7.20 (P less than .0001). There was a significant increase in low cord pH values when FHR variability was absent when compared with normal variability (P less than .0001).

Acidosis↗
PubMed1984

Passive smoking and thiocyanate concentrations in pregnant women and newborns.

Serum thiocyanate concentrations have been used as a marker of cigarette exposure in both smokers and nonsmokers. The authors used this measure to estimate passive exposure in low-risk healthy pregnant women at term. Three groups were compared: smokers, passive smokers, and nonsmokers. The mean thiocyanate concentration (95 mumol/L) was significantly higher (P less than .001) in smokers than in passive smokers (35.9 mumol/L) or nonsmokers (32.3 mumol/L). The maternal and umbilical mean cord thiocyanate concentrations were similar in the smoking group (95 versus 72 mumol/L). Although the umbilical cord levels in the infants of passive smokers and nonsmokers were similar (26 versus 23 mumol/L), both levels were significantly lower than those of smokers. Most important, there was an inverse relationship between umbilical cord thiocyanate concentration and birth weight (P less than .001). The authors found no evidence that passive cigarette smoke exposure resulted in higher maternal or umbilical cord thiocyanate concentrations than found in nonsmokers.

Adult↗
PubMed1984

Neonatal acidosis and method of delivery.

Seven hundred and four women who had a forceps termination (177 elective, 293 indicated low, and 234 indicated midforceps) of labor over 24 months were compared with 303 spontaneous and 111 cesarean deliveries over the same time period. There was no significant difference between indicated low or midforceps either for fetal distress or arrest of descent with regard to fetal acidosis (pH less than 7.20), one- or five-minute Apgar scores less than 7, fetal trauma, or neurologic deficit at discharge. Fourteen percent of indicated forceps for arrest of descent had neonatal acidosis, versus 8% of cesarean sections for cephalopelvic disproportion (P = NS), and 23% of indicated forceps for fetal distress had acidosis, versus 33% of cesarean sections (P = not significant). There was no significant difference either in the incidence of acidosis or in low Apgar scores in neonates delivered by elective low forceps compared with those born by spontaneous vaginal delivery. The only significant differences in midforceps versus low forceps were between maternal pre- and postdelivery hematocrits (P less than .0001) and vaginal lacerations (P less than .0001). The authors' data support the continued usage of indicated low and selected midforceps operations.

Acidosis↗
PubMed1983

The effect of 17 alpha-hydroxyprogesterone caproate on pregnancy outcome in an active-duty military population.

A prior report suggested that active-duty pregnant women are at increased risk for low-birth weight infants and a higher perinatal mortality rate. The present double-blind investigation was designed to prospectively evaluate that risk and to test the efficacy of 17 alpha-hydroxyprogesterone caproate to prevent reported complications. Three groups of active-duty women were studied, beginning between 16 and 20 weeks' gestation. They were similar for parity, previous abortion, race, cigarette smoking, and marital status. Of these, 80 were given 17 alpha-hydroxyprogesterone caproate, 88 received placebo, and 78 declined to participate in the protocol. There was no significant differences in the three groups when comparisons were made for low-birth weight infants and for perinatal mortality. However, when comparison was made to a military dependent population, they had a significantly worse outcome with regard to both perinatal mortality (p = 0.001) and infants with a birth weight less than 2,500 gm (p = 0.01). We concluded that pregnant military personnel were at increased risk for adverse pregnancy outcome, but that this risk was not altered by therapy with 17 alpha-hydroxyprogesterone caproate.

17 alpha-Hydroxyprogesterone Caproate↗