Biomedical subjects
Publications and source records attributed to R A Chez.
The role of fetal surveillance in pregnancies complicated by insulin-dependent diabetes mellitus without evidence of hypertension, microvascular disease, or fetopathy is questioned.
We tested the hypotheses that fetal heart rate decelerations are present during the third trimester in most low risk pregnant women, the prevalence of decelerations is a function of the length of time fetal heart rate monitoring occurs and their presence is not associated with an adverse prognosis. We performed a retrospective chart review of 114 self-referred low-risk pregnant patients who presented to the labor and delivery triage area of a tertiary care hospital at 26-41 weeks gestation. None required admission to the hospital. The control group consisted of patients who delivered immediately before and after the delivery of the study patient. Normal long-term variability and fetal baseline heart rate were found in all electronic fetal monitoring tracings. Accelerations were present in 91% and decelerations in 65% of patients. There was no correlation between length of time of monitoring and the incidence of decelerations. At delivery, there were no differences in birthweight, gestational age, 5-min Apgar scores or cord pH between the control and study patients. Variable decelerations were a common finding in the third trimester of low-risk pregnant patients who self referred to labor and delivery triage. They were not prognostic of an adverse perinatal outcome.
We describe the maternal, obstetric, and neonatal outcomes of patients undergoing elective, empiric, and emergency cervical cerclage at our institution in an attempt to determine predictive factors for adverse perinatal and maternal outcomes. A retrospective chart review was conducted on patients who underwent cervical cerclage placement over a 7-year time span. Of 55 charts, 40 contained complete peripartum data satisfactory for review; 7 elective, 15 empiric, and 18 emergency cerclages were analyzed. There was no perinatal mortality in the elective group, and 5/7 patients delivered at term. The empiric population experienced a 20% neonatal mortality; 6/15 gestations progressed to term. The perinatal mortality was 44% in the emergency group and 2/18 patients delivered at term. Relative to neonatal outcome, elective cerclage was statistically significantly better than emergent cerclage; there was no statistically significant difference between the elective and empiric groups nor between the empiric and emergent groups. This relatively small series with a large number of variables appeared to favor an elective procedure rather than an empiric one. Although emergent cerclage was associated with only a 56% neonatal survival, it did have value in some patients.
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Several authors of standard obstetric texts state that engagement occurs before the onset of labor in a majority of nulliparas at term, and failure of the fetal head to engage in early labor is a greater indicator for operative birth. A pilot clinical descriptive study was done at University Hospital, University of Medicine and Dentistry of New Jersey, in Newark to examine the birth outcomes of nulliparous women who arrived in early labor with an unengaged vertex presentation at term. For the study, 146 births were reviewed, and data from 101 vertex deliveries that met the study's criteria were compiled to test this hypothesis. The study results showed that in approximately 31% of the nulliparas, the fetal head was engaged. The incidence of the unengaged vertex in early labor in nulliparous women who met the study's criteria was found to be 69%. This factor alone did not predict birth outcome.
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Five 20-minute nonstress-test strips were mailed to 1,000 members of NAACOG--the organization for obstetric, gynecologic, and neonatal nurses. The individuals were selected systematically from NAACOG's 10 districts. For the 412 (41%) respondents, at least 84% of the answers concurred on each of the five strips. The majority opinion was taken to be the correct answer. Concurrence with the majority was independent of clinical experience, clinical training, and the extent of present nonstress-test responsibilities. The same five strips were interpreted by obstetricians in a previously reported survey. On a two-point, reactive-nonreactive scale, the sample of obstetric nurses' degree of agreement differed significantly from the sample of physicians' degree of agreement (92 versus 98%) on only one strip.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.