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Biomedical subjects

P Duff

Publications and source records attributed to P Duff.

At least 73 records · Page 4Linked to original sources
PubMed1991

Intraamniotic infection in patients with intact membranes and preterm labor.

The purpose of this review was to determine the frequency of intraamniotic infection in women with preterm labor and intact membranes and to assess the need for amniocentesis in these patients. We reviewed reports in the English language literature from the past 10 years in which the frequency of intraamniotic infection was determined by transabdominal amniocentesis. The 16 studies reviewed demonstrated frequencies of positive cultures that varied from 0 to 61 per cent. This extreme variability seems to be the result of diverse patient populations, dissimilar microbiologic techniques, and different definitions of preterm labor. Advanced cervical dilation and poor response to tocolytic agents were two factors associated with a higher frequency of intraamniotic infection. We conclude that each institution must determine the frequency of intraamniotic infection associated with preterm labor in their patient population. In populations with a high frequency of infection, amniocentesis for microbiologic evaluation is recommended for management of preterm labor, especially in patients who have advanced cervical dilatation or who are unresponsive to tocolytic therapy.

Amniocentesis↗
PubMed1991

The effect of double gloving on frequency of glove perforations.

OBJECTIVE: The purposes of this prospective investigation were to determine the frequency of glove perforation during obstetric and gynecologic procedures and to assess the value of double gloving in preventing damage to the inner glove. METHODS: During a 2-month period, surgeons in the Department of Obstetrics and Gynecology were asked to double glove during all operative procedures. At the conclusion of surgery, the gloves were collected and the surgeons noted the type of procedure and their role as primary surgeon or first assistant. They also indicated whether a perforation was recognized intraoperatively. The gloves were tested for damage by first filling them with air and immersing them in water and then by directly filling them with water. RESULTS: Four hundred forty-one sets of double gloves were evaluated. Of these, 61 sets (14%, 95% confidence interval 10.8-17.2%) had holes in at least one of the four gloves and six sets had more than one perforation, for a total of 67 holes. Fifty-two holes (78%) penetrated only the outer glove and nine (13%) were only in the inner glove. Penetration of both gloves at identical sites occurred in only six of the total glove sets (1.4%, 95% confidence interval 0.3-2.5%). The two most common sites of perforation were the thumb and index finger of the nondominant hand. Glove perforation occurred in 15% of cesarean deliveries and 11% of vaginal deliveries, a nonsignificant difference. In contrast, penetration occurred in 28% of major gynecologic procedures (P less than .05 compared with cesarean or vaginal delivery). Chief and third-year residents were significantly more likely to sustain perforation than were attending physicians or junior residents (P less than .01). Perforation to the gloves of chief residents typically occurred while they were serving as assistants for first- and second-year residents. Third-year residents usually sustained perforations while functioning as primary surgeons. CONCLUSIONS: Glove perforations occur with relatively high frequency during pelvic surgery, particularly abdominal procedures. Double gloving offers a measure of protection against damage to the inner glove and may prevent subsequent exposure of the surgeon to blood and other body fluids.

Gloves, Surgical↗
PubMed1991

Amoxicillin treatment of bacterial vaginosis during pregnancy.

The purpose of this investigation was to evaluate the efficacy of amoxicillin for treatment of bacterial vaginosis during pregnancy. The diagnosis of bacterial vaginosis was established by clinical examination and microscopic examination of a Gram stain and saline preparation of vaginal secretions. In a double-blind, randomized manner, 108 patients at 15-25 weeks' gestation were assigned to treatment with oral amoxicillin, 500 mg three times daily for 14 days, or placebo. Patients were evaluated 2 weeks after treatment, at 34-36 weeks' gestation, and at delivery. There were no significant differences between the two groups with respect to any clinical or microbiologic measure of treatment outcome. There were also no significant differences in the frequency of obstetric complications. We conclude that amoxicillin is not effective therapy for bacterial vaginosis in pregnant women.

Amoxicillin↗
PubMed1991

Pulmonary function of preeclamptic women receiving intravenous magnesium sulfate seizure prophylaxis.

Pulmonary function was studied in ten preeclamptic women in labor (mean gestational age 38.1 +/- 0.9 weeks measured from the last menstrual period) receiving continuous intravenous (IV) infusions of magnesium sulfate. Baseline maximal inspiratory pressure, maximal expiratory pressure, functional vital capacity, and forced expiratory volume at 1 second were measured immediately before a 6-g IV loading dose of magnesium sulfate and 2 hours after the initiation of a continuous 2-g/hour infusion of magnesium sulfate. Serum magnesium levels were measured at the same time pulmonary function tests were performed. All values are reported as the mean +/- standard deviation. The maximal inspiratory pressure, an indicator of generalized respiratory muscle weakness, decreased from a baseline value of 26.2 +/- 7.7 to 19.4 +/- 6.3 cm H2O (P less than .05). The maximal expiratory pressure, an indicator of expiratory muscle strength, decreased from a baseline value of 30.6 +/- 9.2 to 25.2 +/- 7.1 cm H2O (P less than .005). The functional vital capacity decreased from a baseline value of 3.37 +/- 0.49 to 3.19 +/- 0.73 L, and the forced expiratory volume at 1 second decreased from a baseline value of 2.61 +/- 0.58 to 2.36 +/- 0.68 L at 2 hours (P less than .05). The mean serum magnesium level was 1.7 +/- 0.2 mg/dL before the administration of the IV loading dose and 4.51 +/- 0.67 mg/dL 2 hours after initiation of the continuous infusion. Our results demonstrate a significant decrease in pulmonary function tests in term preeclamptic patients receiving magnesium sulfate for seizure prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Microbiology of the lower genital tract and amniotic fluid in asymptomatic preterm patients with intact membranes and moderate to advanced degrees of cervical effacement and dilation.

The purpose of this prospective investigation was to evaluate the microbiology of the lower genital tract and amniotic fluid in asymptomatic women with preterm labor. We limited inclusion in the study to patients at 20 to 36 weeks' gestation whose membranes were intact and whose cervix was at least 50% effaced and 2 cm dilated. At the time of admission, we obtained an endocervical specimen for culture for Neisseria gonorrhoeae and for enzyme-linked immunoabsorbent assay for Chlamydia trachomatis and a vaginal specimen for culture for group B streptococci (GBS). We also performed transabdominal amniocentesis to collect amniotic fluid for Gram's stain, latex fixation test for GBS, and aerobic and anaerobic cultures. All patients received parenteral tocolytics. Women who had an immature lecithin to sphingomyelin ratio also received betamethasone. Only 1 of 72 women (1.4%, 95% confidence interval 0 to 4.1%) had a positive amniotic fluid culture. One patient (1.4%) had a positive Gram's stain, and two (2.8%) had positive latex fixation tests. None of these individuals subsequently had a positive culture. Eight women (11.1%) had positive tests for chlamydia, and four (5.5%) had positive vaginal cultures for GBS. None of the patients developed clinical evidence of chorioamnionitis, and only one had puerperal endometritis. None of the neonates had any complications due to infection. We conclude that, in our population, intra-amniotic infection is not a common cause of preterm labor in asymptomatic patients with intact membranes and that amniocentesis should not be performed routinely to assess the bacteriology of the amniotic fluid.

Amniocentesis↗
PubMed1990

The evaluation of urine pH in screening for asymptomatic bacteriuria in pregnancy.

The purpose of this prospective investigation was to determine whether an alteration in urine pH, either by itself or in combination with other rapid screening tests, could be used to identify asymptomatic bacteriuria in pregnant women. Clean catch urine specimen was used to evaluate 510 asymptomatic obstetric patients. Urine specimens were tested for pH, leukocyte esterase activity, and the presence of nitrites. The pH, leukocyte esterase activity, and nitrite reaction were evaluated singly and in combination to determine if these variables could be used to predict significant bacteriuria. Twenty-four (4.8%) patients had positive cultures for E. coli. The mean pH of the infected population was not significantly different from that of the uninfected population. The performance parameters of pH, singly and in combination with the leukocyte esteras and nitrite status, were poor. We concluded that the identification of urine pH is not of value in detecting asymptomatic bacteriuria.

Bacteriuria↗
PubMed1990

Antibiotic prophylaxis for cesarean delivery: is an extended-spectrum agent necessary?

The purpose of this investigation was to determine whether an extended-spectrum antibiotic with a long duration of action was more effective for prophylaxis for cesarean delivery than a limited-spectrum agent with a shorter duration of action. Patients were eligible for the study if they were in labor or had ruptured membranes at the time of surgery. In a randomized, double-blind manner, 377 women were assigned to receive 2 g of cefazolin (192) or 2 g of cefotetan (185) intravenously immediately after the infant's umbilical cord was clamped. There were no significant differences between groups with respect to the frequency of febrile morbidity (22.4 versus 21.6%), the mean fever index (15.8 versus 14.9 degree-hours), the frequency of endometritis (19.3 versus 21.1%), or the mean duration of postoperative hospitalization (3.8 versus 3.9 days). Among patients who became infected despite prophylaxis, enterococcus was isolated with disproportionate frequency. This organism was responsible for 89% of the postoperative urinary tract infections and all three cases of bacteremia. It was also the second most common isolate in women with endometritis. A single dose of cefazolin is comparable in effectiveness to cefotetan. In view of the cost difference between the two antibiotics, there is no justification for use of the more expensive, extended-spectrum agent.

Cefazolin↗
PubMed1990

Prenatal diagnosis of chondrodysplasia punctata by sonography.

The rhizomelic form of chondrodysplasia punctata is a lethal autosomal recessive disorder of unknown cause. It is characterized by marked shortening and bowing of the proximal limbs, vertebral column abnormalities, eye and skin defects, severe mental retardation, and recurrent infection. Previously, antenatal diagnosis of this condition was made by radiography. We describe ultrasonographic findings, specifically stippling of the proximal humerus, which permitted us to identify the condition in a fetus at 28 weeks' gestation.

Adolescent↗
PubMed1990

The duration of labor in primiparas undergoing vaginal birth after cesarean delivery.

The purpose of this retrospective investigation was to evaluate the duration of labor in women having a trial of labor after a previous low transverse cervical cesarean delivery for dystocia. We specifically sought to determine whether these patients experienced a labor similar to that of the nulliparous or multiparous woman. During the study period, 73 women who had previously undergone a cesarean for dystocia had a successful trial of labor. We matched each study patient to two controls. One control was nulliparous and the second was a woman who had undergone a previous uncomplicated vaginal delivery. Thirty-six study patients had had a cesarean in the latent phase of labor (group I), 29 in the active phase of labor (group II), and eight in the second stage of labor (group III). With the exception of group I patients, the first and second stages of labor were similar to those of nulliparous control patients. Patients in group I had a significantly longer first stage of labor than did the nulliparous controls. There was no significant difference in oxytocin requirements among the three groups. We conclude that primiparous women who have had a previous cesarean delivery for dystocia have a duration of labor similar in length or longer than that of nulliparous women.

Cesarean Section↗
PubMed1990

Plasma fibronectin concentrations during normal term labor.

We measured plasma concentrations of fibronectin in 30 normal parturients in early labor and at the time of delivery, using a rapid immunoturbidimetric assay. We compared these values with those of 30 healthy nonpregnant control women. The mean plasma concentrations of fibronectin in women in early labor and at delivery were 400 +/- 104 and 410 +/- 147 micrograms/mL, respectively (not significant). Both of these values were higher than the mean fibronectin concentration in controls, 283 +/- 81 micrograms/mL (P less than .0001). We conclude that plasma concentrations of fibronectin are higher in pregnant women than in nonpregnant controls and that they remain relatively constant during uncomplicated term labor.

Adolescent↗
PubMed1990

Prevalence of antibiotic-resistant uropathogens in obstetric patients with acute pyelonephritis.

The purpose of this investigation was to determine the prevalence of antibiotic-resistant uropathogens in 121 pregnant patients hospitalized with acute pyelonephritis. We obtained urine for culture by catheterization and defined a positive culture as greater than 100 colony-forming units per milliliter of urine. We determined bacterial sensitivities with either the Bauer-Kirby disc diffusion test or the Vitek Auto Microbic System. During the 4 years of the study, the prevalence of ampicillin-resistant organisms was 26% (95% confidence interval 18-34%). However, only 4% (95% confidence interval 0-8%) of the uropathogens were resistant to limited-spectrum, first-generation cephalosporins. This observed difference in antibiotic sensitivity was highly significant (P less than .005). Therefore, we conclude that a limited-spectrum cephalosporin is more appropriate than ampicillin for empirical therapy of pyelonephritis in pregnancy.

Acute Disease↗