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Biomedical subjects

P Duff

Publications and source records attributed to P Duff.

At least 91 records · Page 5Linked to original sources
PubMed1989

Hydrops fetalis and premature closure of the ductus arteriosus: a review.

The purpose of this report is to describe a case of nonimmune hydrops fetalis that resulted from an unusual congenital heart defect, premature closure of the ductus arteriosus. In this fetus, the ductal closure was not associated with other heart defects such as tetralogy of Fallot or truncus arteriosus, nor was it related to maternal use of nonsteroidal antiinflammatory agents. Despite adequate digitalization of the mother, the fetus died of congestive heart failure at 29 weeks of gestation. Autopsy confirmed stricture of the ductus in association with enlargement of the foramen ovale and marked dilation of the right atrium and main pulmonary artery.

Adult↗
PubMed1989

Reliability of fetal buttock blood sampling in assessing the acid-base balance of the breech fetus.

This prospective investigation was undertaken to compare fetal buttock capillary blood pH and umbilical artery and vein pH in fetuses presenting by the breech. The study group comprised ten term patients with singleton fetuses in the frank breech presentation who met established criteria for vaginal breech delivery. All patients had a normal labor pattern. Eight fetuses had a normal fetal heart rate tracing and two had severe variable decelerations during the second stage of labor. We obtained capillary blood for pH measurement from the fetal buttock within 15 minutes of delivery. Immediately after delivery, we collected arterial and venous blood samples from the umbilical cord for measurement of pH. In all fetuses, there was a highly significant correlation between fetal buttock capillary blood pH and umbilical artery pH (r = 0.96; P less than .001) and umbilical vein pH (r = 0.88; P less than .001). We conclude that measurement of pH in capillary blood obtained from the fetal buttock provides accurate assessment of the acid-base status of the breech fetus.

Blood Specimen Collection↗
PubMed1989

Reliability of a rapid latex fixation test for detecting group B streptococci in the genital tract of parturients at term.

The purpose of this prospective investigation was to determine the reliability of a rapid latex particle agglutination test in detecting group B streptococci in the lower genital tract of laboring women. Five hundred asymptomatic patients with intact membranes who were in labor at term underwent sterile speculum examination. Secretions from the endocervix and vagina were collected with sterile swabs. One swab was inoculated directly onto a blood agar plate for culture. The other was initially placed into a Culturette transport system and then transferred into a test tube containing an enzyme extraction reagent. After a 60-minute incubation at 37C, the latex fixation test was performed on the residual liquid in the tube. The frequency of positive cultures in our population was 5.0%. The sensitivity and specificity of the rapid slide test were 88 and 99.6%, respectively. The positive and negative predictive values were 91.7 and 99.4%, respectively. The group B streptococci latex fixation test appears to be a rapid and reliable means of detecting group B streptococci in the lower genital tract of term patients with intact membranes. Use of this method should permit a more selective approach to the intrapartum chemoprophylaxis of women colonized with group B streptococci.

Female↗
PubMed1989

Randomized comparison of oral terbutaline and ritodrine for preventing recurrent preterm labor.

We compared oral ritodrine and terbutaline for the prevention of recurrent preterm labor. Women between 20 and 35 weeks' gestation who successfully completed a course of intravenous tocolysis were eligible for inclusion. One hundred two patients were randomized to oral ritodrine (20 mg every four hours) or oral terbutaline (5 mg every four hours). The groups showed no significant differences with respect to recognized risk factors for preterm labor or prognostic factors for the failure of tocolysis. Initial treatment failures occurred more frequently in the ritodrine group (nine vs. two, P = .0527). There were no statistically significant differences in the treatment results or frequency of side effects. We conclude that ritodrine appears to be less effective than terbutaline upon the initiation of oral therapy and that oral ritodrine and terbutaline are equivalent in safety and efficacy when used on a long-term basis for preventing recurrent preterm labor.

Administration, Oral↗
PubMed1989

The effect of bacteriostatic lubricant on group B streptococcal cultures of the female genital tract.

The purpose of this prospective investigation was to determine the effect of bacteriostatic lubricant on group B streptococcal cultures obtained from the lower genital tract of pregnant women. Fifty pregnant women with intact membranes who recently had genital tract cultures for group B streptococci were evaluated. The study group consisted of 25 women who had positive cultures, and the control group comprised 25 women who had negative cultures. All patients underwent examination with a sterile nonlubricated speculum within 7 days of the previously obtained cultures. Secretions from the endocervix and from the posterior vaginal wall near the introitus were collected with a sterile cotton-tipped applicator and inoculated directly onto a selective blood agar culture plate. The sterile speculum was removed and a digital examination performed using bacteriostatic lubricant. A second sterile speculum was then inserted into the vagina and another group B streptococcal culture was obtained. There was 100% correlation between the cultures obtained before and after the vaginal examination. We conclude that use of bacteriostatic lubricant does not alter the recovery of group B streptococci from the genital tract of pregnant women with intact membranes.

Chlorhexidine↗
PubMed1989

Is universal screening for hepatitis B infection warranted in all prenatal populations?

The purpose of this prospective study was to determine the prevalence of asymptomatic hepatitis B infection in a low-risk, closely monitored population. At the time of their first prenatal evaluation, a cohort of active-duty military personnel and their dependents underwent screening for hepatitis B surface antigen. Ten of 1520 women (0.66%) tested positive. All of these women were Asians and would have been identified under a selective screening protocol. None of the ten seropositive patients had other risk factors for hepatitis B infection. We conclude that in this type of population, universal screening for hepatitis B is not cost-effective. Selective screening for high-risk patients would appear to be more appropriate.

Adolescent↗
PubMed1988

The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients.

The purpose of this investigation was to compare the reliability of a urine dipstick evaluation for nitrites and leukocyte esterase activity with that of a urine culture in diagnosing asymptomatic bacteriuria in obstetric patients. A clean-catch midstream urine specimen was obtained from 750 consecutive obstetric patients presenting for initial evaluation. One portion of the specimen was tested for nitrites and leukocyte esterase activity with Chemstrip LN dipsticks. A second aliquot of urine was plated on blood and MacConkey agar and incubated aerobically. The cost of the nitrite and leukocyte esterase test was $0.35. The per patient charge for the urine cultures would have been $28. Sixty-two women (8.3%) had urine cultures of 100,000 or more colony-forming units of a uropathogen per milliliter. The sensitivities of the nitrite and leukocyte esterase test in identifying patients with positive cultures were 43 and 77%, respectively, and the specificities were 99 and 96%, respectively. The sensitivity and specificity for the two tests combined (either test abnormal) were 92 and 95%, respectively. Five patients had negative screening tests but positive urine cultures; all five isolates were gram-positive organisms, three group B streptococci and two enterococci. We conclude that neither the nitrite test nor the leukocyte esterase test alone is a sensitive enough screening test to detect asymptomatic bacteriuria in obstetric patients. The combination of the two tests, however, may provide an acceptable cost-effective alternative to screening all asymptomatic obstetric patients with urine cultures.

Bacteriuria↗
PubMed1988

Outcome of trial of labor in patients with a single previous low transverse cesarean section for dystocia.

The purpose of this prospective investigation was to evaluate the outcome of trial of labor in women with a history of a single low transverse cesarean section for dystocia in comparison with the outcome in women with a history of cesarean delivery for a reason other than dystocia. During the study period, 89 of 131 patients (68%) with a history of dystocia had a successful trial of labor, compared with 78 of 96 women (81%) who had cesarean delivery for a reason other than dystocia (P less than .025). Within the former group, 79% of women who originally had surgery while still in the latent phase of labor had a successful trial of labor, compared with 61% (.05 less than P less than .10) of patients who had an arrest of dilation in the active phase of labor and 65% (not significant) of those who had an arrest of descent. The only serious complication among study patients was a single instance of uterine scar dehiscence (0.5%). We conclude that approximately two-thirds of patients with a previous cesarean delivery for dystocia will have a successful trial of labor. Of these women, those individuals whose initial operation was performed in the latent phase of labor appear to have the best prognosis for subsequent vaginal delivery.

Abdomen↗
PubMed1987

Prophylactic antibiotics for cesarean delivery: a simple cost-effective strategy for prevention of postoperative morbidity.

Postoperative endomyometritis is the most common complication associated with cesarean delivery. The frequency of endomyometritis varies from 5% to 85% (mean 35% to 40%), depending on the socioeconomic characteristics of the patient population and the indication for abdominal delivery. In women undergoing cesarean section after extended duration of labor and ruptured membranes, the use of prophylactic antibiotics has been consistently effective in decreasing the frequency of endomyometritis. A single dose of antibiotic administered after the umbilical cord is clamped provides a degree of prophylaxis comparable to that achieved with two- and three-dose regimens. There is no evidence that the newer extended-spectrum cephalosporins or penicillins are better for prophylaxis than ampicillin or a first-generation cephalosporin. Administration of antibiotics by intraoperative irrigation is an acceptable, but not superior, alternative to systemic antibiotic administration. Prophylactic antibiotics alter the vaginal flora after operation, but to date harmful clinical effects have not occurred as a result of such alteration.

Anti-Bacterial Agents↗
PubMed1987

Subclinical intra-amniotic infection in asymptomatic patients with refractory preterm labor.

The purpose of this prospective investigation was to determine the incidence of subclinical intra-amniotic infection in asymptomatic patients who had intact membranes and refractory preterm labor. Refractory preterm labor was defined as persistent uterine contractions despite maximum recommended doses of parenteral tocolytics, or recurrent preterm labor within three days of successful transition to oral tocolytics. Amniotic fluid was cultured aerobically and anaerobically and prepared for Gram stain and group B streptococci latex fixation test. One of 24 women had a positive latex fixation test, but the culture was negative. One culture was positive for isolated colonies of Corynebacterium sp. None of the patients developed clinical evidence of intra-amniotic infection or postpartum endometritis. The mean prolongation of pregnancy was 31 days (range 1-63). None of the infants had evidence of sepsis in the immediate neonatal period. In this population, subclinical infection was an uncommon cause of refractory preterm labor.

Amniocentesis↗
PubMed1987

Single-dose cefazolin versus cefonicid for antibiotic prophylaxis in cesarean delivery.

The purpose of this prospective investigation was to compare a single intravenous dose of cefazolin to a single dose of cefonicid as prophylaxis for women having unscheduled cesarean delivery. In a double-blind, randomized design, 96 patients were assigned to receive a 1-g dose of cefazolin and 103 patients were designated to receive a 1-g dose of cefonicid. The antibiotics were administered after delivery of the infant. The two groups were comparable with respect to recognized risk factors for postcesarean infection. There were no statistically significant differences between the groups in the incidence of standard febrile morbidity, endomyometritis, urinary tract infection, wound infection, and bacteremia. There were also no significant differences between the groups in the fever index or the duration of hospitalization. We conclude that cefazolin and cefonicid provide a similar degree of prophylaxis against infection in patients having unscheduled cesarean delivery.

Bacterial Infections↗
PubMed1987

External cephalic version at term: is a tocolytic necessary?

This prospective investigation evaluates the benefit of a beta-mimetic tocolytic for external cephalic version. From July 1, 1984 to May 15, 1987, 58 patients who had breech presentations between 37-41 weeks' gestation were considered for external cephalic version. The patients were randomly assigned to one of two groups: tocolytic or no tocolytic. An ultrasound examination, serum alpha-fetoprotein (AFP), Kleihauer-Betke test, and nonstress test (NST) were performed before and after the attempt at version. A version was not attempted if there was evidence of intrauterine growth retardation (IUGR), oligohydramnios, or a nonreactive NST. Patients in the tocolytic group received 200 micrograms/minute of ritodrine hydrochloride for 20 minutes via continuous intravenous infusion before a version was attempted. Twenty of the 30 patients (66.7%) in the tocolytic group and 19 of the 28 patients (67.8%) in the no-tocolytic group had successful versions, a nonsignificant difference. The nine patients with unsuccessful version attempts in the group without a tocolytic then received intravenous ritodrine and underwent a second attempt. Only one of these nine attempts was successful. There were no serious maternal or fetal complications associated with the attempts at version. In our patient population, use of a tocolytic did not significantly increase the probability of a successful version.

Adult↗
PubMed1986

Pathophysiology and management of postcesarean endomyometritis.

Endomyometritis is the most common complication associated with cesarean delivery. The incidence varies from 5 to 85%, depending upon the patient population surveyed. The major risk factors for postcesarean endomyometritis are young age, low socioeconomic status, and extended duration of labor and ruptured membranes. The principal microorganisms responsible for infection are group B streptococci, aerobic gram-negative bacilli, anaerobic gram-positive cocci, and anaerobic gram-negative bacilli. The mean incidence of bacteremia in patients with endomyometritis is 10%. Less than 2% of infected patients develop life-threatening complications such as septic shock, pelvic abscess, or septic pelvic thrombophlebitis. Antibiotics of proved value in treatment of postcesarean endomyometritis include the newer broad-spectrum cephalosporins and ureidopenicillins and the combination regimen of clindamycin plus aminoglycoside.

Adult↗