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Biomedical subjects

M G Rosen

Publications and source records attributed to M G Rosen.

At least 19 recordsLinked to original sources
PubMed1992

Abnormal labor and infant brain damage.

OBJECTIVE: To determine whether arrest disorders result in increased neurologic abnormalities in infancy or childhood. METHODS: Four hundred thirteen infants with arrest disorders as defined by Friedman criteria were matched to a similar population without arrest disorders. The median length of follow-up was 6 years for the study infants and 5.07 years for the controls. The numbers of children with abnormalities in the groups with and without arrest disorders, as well as the specific abnormalities encountered, were stratified by method of delivery. RESULTS: Thirty neurologic abnormalities were found in the arrest group and 37 in the control group; thus, the null hypotheses could not be rejected. In addition, although the control group was not followed as long as the study population, the diagnosis of abnormalities was more frequent in the later years in the controls. This suggests that had the follow-ups been equal, there would have been stronger proof that arrest by itself was not associated with infant brain damage. CONCLUSION: Our study confirms that labor diagnoses of prolonged active phase, protractions or arrests, and failure to descend are not associated with increased neurologic abnormalities. Delivery by cesarean or vaginal birth and use of oxytocin are not factors in the etiology of major brain damage.

Brain Damage, Chronic↗
PubMed1992

Obstetric care and cesarean birth rates: a program to monitor quality of care.

OBJECTIVE: To study the quality of obstetric care in relation to rising cesarean rates, a Task Force was formed in New York state by the Department of Health and ACOG District II. The Task Force also included the Organization of Obstetric, Gynecologic, and Neonatal Nurses and the Hospital Association of New York State. The goals were to enhance hospitals' in-house review processes, standardize terminology, and improve the quality of care. A premise of the program was that if quality of care improved, cesarean rates would fall. METHODS: A Dictionary of Terms was developed to standardize clinical and diagnostic terminology. A two-tiered review process was instituted, using internal and external hospital reviews. A format for in-house review of obstetric care was developed and recommended to hospitals. External reviews were conducted at 24 hospitals during 1989-1990. Review teams, composed of obstetrician-gynecologists and obstetric nurses in active obstetric practice, assessed obstetric facilities, staffing, medical care, and the in-house review process. Contacts continued with the hospitals after site visits to follow up on implementation of recommendations. General recommendations to improve care, based on the overall program experience, were distributed to hospitals and physicians as part of educational efforts to improve quality of care. RESULTS: The state cesarean rate reversed. Statistics for 1989 and 1990 showed a stronger downward trend in reviewed hospitals than in non-reviewed hospitals. A survey of reviewed hospitals reported a positive response to the review process. CONCLUSION: A successful quality assurance program can be jointly developed by a state regulatory agency and a medical specialty society.

Cesarean Section↗
PubMed1979

Human fetal respiratory movements: a technique for noninvasive monitoring with the use of a tocodynamometer.

A tocodynamometer applied to the maternal abdomen is used for monitoring human fetal respiratory movements (FRM). This provides a recording of fetal chest wall movements from which observations and measurements relating to fetal respiratory physiology may be made. The FRM must be differentiated from materanal vascular and respiratory movements, as well as fetal movements and cardiac pulsations. The technique lends itself to extended periods of observation, since it does not transmit energy to the fetus as in other techniques. The simplicity of the technique, combined with the use of monitoring devices already available in most hospitals, warrants further observation of this method of respiratory movement monitoring in the developing fetus.

Female↗
PubMed1978

Use of computers in the labor and delivery suite: an overview.

Some simple computers for fetal monitoring are already commercially available. These systems are designed to alarm when abnormalities reflected by the fetal heart are detected during labor. Unfortunately, the problems of fetal heart rate/intrauterine pressure data analysis have been oversimplified. An "ideal" obstetric computer-based data management system would begin, as the clinician should, with the assessment of risk from the patient's past history, pregnancy course, and labor progress as a basis for analyzing the condition of the fetus during labor. Systems available now are of limited scope, expensive, and of unproved clinical value. Premature attempts at clinical computerization will accomplish little, except to give computers a bad name. Let the buyer beware!

Computers↗
PubMed1978

Clinical estimation of gestational age: rules for avoiding preterm delivery.

Reliable knowledge of the duration of pregnancy prior to birth is often of crucial importance in making obstetric care decisions. Laboratory methods for estimating fetal maturity have received considerable attention, but the usefulness of historical information has only rarely been addressed. In order to examine the value of clinical estimators of fetal gestational age (GA) in 690 pregnancies, the correlations of menstrual history (LMP), first unamplified audible fetal heart tones (FFH), and quickening (Q), with GA, based on the modified Dubowitz examination at birth, were examined. Evaluation of each of the data sets used alone reveals that in order to be 90% certain that an infant will be mature at delivery (greater than or equal to 38 weeks), a reliable LMP must have been noted for 42 weeks prior to birth, the FFH heard for 21 weeks, and Q felt for 25 weeks. These findings suggest that carefully obtained historical and physical examination information remains a cornerstone of appropriate obstetric care.

Delivery, Obstetric↗
PubMed1978

Fetal movements associated with fetal heart rate accelerations and decelerations.

In normal pregnant women, the relationship between the FHR and fetal movements (FM) was evaluated during 1,541 consecutive observed FM of at least 1 second's duration. Two observed FHR changes were: (1) accelerations and (2) accelerations followed by decelerations. An acceleration in FHR was observed in association with 91.2 per cent of all FM of 1 to 3 seconds' duration and with 99.8 per cent of FM of longer than 3 seconds' duration. FM were associated with an acceleration followed by a deceleration 66.7 per cent of the time. FM lasting longer than 1 second and associated with neither accelerations nor decelerations were seen 1.8 per cent of the time.

Female↗
PubMed1977

Clinical application of high-risk scoring on an obstetric service.

Obstetric risk scoring is a formalized way of recognizing, documenting, and cumulating antepartum and intrapartum factors to predict later complications for mother, fetus, and infant. If simple, practical, and reliable, risk scoring can be clinically useful in determining appropriate levels of care. In this prospective study, antepartum and intrapartum risk scales were integrated into the clinical record, and the relationship of risk scores to outcome was evaluated for 1,275 consecutively delivered gravid women. The forms could be simply and quickly filled out by the staff. Increased risk on both scales was significantly related to lowered one- and five-minute Apgar scores. The perinatal mortality rate increased from 0 to 93.4 per thousand from the lowest to the highest risk group. More than 80% of all perinatal deaths occurred in the one quarter of patients in the highest risk group. These results suggest that this risk scoring system can be used effectively in a clinical setting to identify patients at increased risk for neonatal depression and perinatal death.

Apgar Score↗
PubMed1977

Human fetal respiratory arrhythmia.

The association of human fetal respiration with the fetal heart rate was studied in 13 pregnant patients between Weeks 34 and 41 of pregnancy. Fetal respiration was recorded with the use of a tocodynamometer. Fetal heart rate was recorded with the use of ultrasound and abdominal fetal electrocardiogram monitoring devices. The results documented the presence of human fetal respiratory arrhythmia. An increase in fetal heart rate was seen during fetal "inspiration" followed by a decrease during "expiration." The possible mechanisms of the respiratory arrhythmia are discussed.

Blood Pressure↗