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Biomedical subjects

R A Kinch

Publications and source records attributed to R A Kinch.

At least 19 recordsLinked to original sources
PubMed1996

Use of the protein/creatinine ratio of a single voided urine specimen in the evaluation of suspected pregnancy-induced hypertension.

BACKGROUND: The use of a 24-hour urine collection to evaluate protein excretion in a woman with suspected pregnancy-induced hypertension (PIH) is cumbersome, time consuming, and subject to improper collection. Our purpose was to determine the correlation of the protein/creatinine ratio of a single voided urine specimen to the 24-hour urine collection for total protein in the range of zero to 1000 mg protein per 24 hours. METHODS: Single voided urine specimens and 24-hour total urine protein collections were ordered for 66 consecutive women admitted to an antepartum unit for suspected PIH. The correlation of the protein/creatinine ratio of the single voided specimen with the 24-hour urine protein excretion was calculated. RESULTS: Forty-one sets of data with a 24-hour urine protein less than 1000 mg per 24 hours were obtained. The correlation of the single voided protein/creatinine ratio to the 24-hour total protein was 0.80 (P<.001), with a regression equation of (protein/creatinine)=0.81X(24-hour protein)-0.011. No single protein/creatinine ratio cutoff was ideal to distinguish between significant and insignificant proteinuria; however, a ratio less than .15 efficiently ruled out significant proteinuria [corrected]. CONCLUSIONS: We conclude that the protein/creatinine ratio of a single voided urine specimen may have a role in the management of ambulatory women with suspected PIH, although further study is needed. The main potential benefit of this method is that in institutions where women with suspected PIH are hospitalized, women with insignificant proteinuria may be identified within a matter of hours and their follow-up care handled on an outpatient basis.

Creatinine↗
PubMed1996

Prevalence of HIV in a largely indigent obstetric population of Tarrant County, Texas.

To establish the seroprevalence of the human immunodeficiency virus (HIV) in our county hospital obstetric patients, and to assess the predictive value of screening questionnaires for high-risk behaviors attributing to HIV infection, we conducted written surveys and blinded HIV testing over a 4-month period ending February 1993. Blinded HIV antibody testing was performed on 1348 patients upon admission to labor and delivery. The coded blood samples were matched to similarly coded surveys of patient demographics and behaviors implicated in HIV transmission. The overall HIV prevalence in our regional population remains virtually unchanged at a rate of 0.22% (2.2 per 1000 patients). Questionnaires regarding health history were not predictive for HIV infection in our patients. Universal screening questionnaires cannot predict HIV infection. Similarly, routine mandatory testing for HIV performed on obstetric patients on the day of delivery are not cost-effective and do not provide clinically meaningful information needed to alter management protocols.

Adult↗
PubMed1994

Trial of labor following cesarean delivery.

OBJECTIVE: To examine several variables that may affect the success rate for a trial of labor after previous cesarean delivery, as well as those affecting the rate of uterine rupture. METHODS: Between June 1, 1990 and December 31, 1991, we performed a consecutive, prospective study of 593 pregnant women who had had at least one abdominal delivery in the past, and attempted a trial of labor in each. Particular attention was given to the success rate of vaginal delivery, the type of previous uterine incision, use of oxytocin, estimated maternal blood loss, 5-minute Apgar scores, and reason for the previous cesarean operation. RESULTS: Four hundred seventy-eight patients (81%) had a successful vaginal delivery. Oxytocin induction or augmentation was successful in 46 of 67 (69%) and 117 of 167 cases (70%), respectively. Estimated maternal blood loss was less than 500 mL in 453 cases (95%). Five patients (0.8%) experienced true uterine rupture, resulting in severe neurologic sequelae in one infant. The only consistent indication of uterine rupture was an abrupt and prolonged fetal bradycardia. The majority (463; 97%) of infants who were delivered vaginally had 5-minute Apgar scores of 8 or greater. CONCLUSION: Our success rate of 81% suggests that a trial of labor after previous cesarean delivery is a safe and desirable option, but only after thorough patient counseling. An abrupt and persistent fetal bradycardia may be the only indication that uterine rupture has occurred.

Apgar Score↗
PubMed1994

Management of the third stage of labor: a survey of practice among Texas obstetricians.

Available evidence shows that the benefits of routine oxytocic administration in the third stage of labor far outweigh the potential risks. In 1990, T.F. Baskett, MD, reviewed the routine use of oxytocic drugs by Canadian obstetricians in the management of the third stage of labor. With Dr Baskett's permission, we sent a similar questionnaire to 1500 obstetricians in Texas: 1000 practiced in urban areas and 500 practiced in rural areas of the state. Ninety-four percent of Texas obstetricians answering the survey used oxytocics routinely in managing the third stage of labor. However, only 14.9% administered the oxytocics before delivery of the placenta, in contrast to 92.1% who gave oxytocics after the delivery of the placenta. Oxytocin was the chosen oxytocic drug for routine third-stage management (95%) as well as for postpartum hemorrhage (73.3%). Of the physicians surveyed, 55.9% used 15-methyl prostaglandin F2a (Hemabate) to treat postpartum hemorrhage refractory to other drugs within the past year. Of the respondents, 14.3% had managed acute uterine inversion during the past year. Thus, Texas obstetricians use Oxytocin routinely in the management of the third stage of labor, but few are converted to active management.

Attitude of Health Personnel↗
PubMed1992

Vaginal birth after cesarean section at the University of Texas.

Vaginal delivery was successful in 76% of the 242 women who underwent a trial of labor after cesarean section in a prior pregnancy. Separation of the uterine scar occurred in four women (1.7%). Women whose prior cesarean section was for breech presentation had the highest rate of successful vaginal delivery (86%). The vaginal delivery rates were similar in women who delivered infants with birth weights > or = 4,000 g (73%) and < 4,000 g (76%). The use of epidural anesthesia and oxytocin may enhance the success of vaginal delivery in women undergoing a trial of labor following an earlier cesarean section.

Anesthesia, Epidural↗
PubMed1986

Effect of guanfacine, an alpha-adrenergic agonist, on menopausal flushing.

The effect of guanfacine (0.5 mg/day), an alpha-adrenergic agonist, on menopausal flushing, was studied in a double-blind, placebo-controlled crossover study in 11 patients. Both guanfacine and placebo significantly decreased the total number of flushes from baseline values. There was, however, no significant difference between placebo and guanfacine. Larger doses of guanfacine may be required to exert a therapeutic effect similar to that reported in the literature with the alpha-adrenergic agents, clonidine and alpha-methyldopa.

Climacteric↗
PubMed1985

Thyroid function in epileptic mothers and their infants at birth.

It has been suggested that patients receiving anticonvulsant therapy have depressed thyroid function. Thyroid function was studied in 16 pregnant epileptic women who were receiving various anticonvulsants; 20 nonepileptic pregnant women served as controls. Maternal and umbilical cord blood was collected at delivery and serum thyrotropin, total thyroxine, triiodothyronine, triiodothyronine resin uptake, and free thyroxine levels were measured. The free thyroxine index was calculated from the thyroxine and triiodothyronine resin uptake data. There were no significant differences in any of the maternal parameters. In cord serum, the thyroxine level was significantly lower (p less than 0.001) in the infants of the epileptic mothers. The triiodothyronine resin uptake was slightly increased in the epileptic group (p less than 0.05) so that the free thyroxine index largely compensated for this. The thyrotropin, free thyroxine, and triiodothyronine levels did not differ between the two groups. Thus the low thyroxine values in cord blood of infants of epileptic mothers receiving anticonvulsants probably reflect an alteration in protein binding rather than a true alteration in thyroid function.

Anticonvulsants↗
PubMed1985

Effect of naloxone on menopausal flushes, skin temperature, and luteinizing hormone secretion.

The effect of naloxone (1.4 mg/hr for 3 hours) on subjectively experienced menopausal flushes, skin temperature, and luteinizing hormone secretion was investigated in seven women in a double-blind, saline-controlled, crossover study. Naloxone had no effect on the number of subjective flushes, episodic skin temperature elevation, luteinizing hormone pulses, variability of luteinizing hormone secretion, or total luteinizing hormone secretion. This study suggests that a naloxone-sensitive opioid mechanism is not active in modulating luteinizing hormone secretion in the postmenopausal woman and that opioid receptor blockade is not effective in altering the frequency of menopausal flushes.

Climacteric↗
PubMed1984

Effect of methyldopa on menopausal flushes, skin temperature, and luteinizing hormone secretion.

The effect of methyldopa (100 mg intravenously), the precursor of the alpha-receptor agonist alpha-methylnorepinephrine, on subjectively experienced menopausal flushes, skin temperature, and luteinizing hormone secretion was investigated in seven women in a double-blind, saline-controlled, crossover study. Subjects were monitored over a 3-hour period. Methyldopa significantly decreased the number of subjective flushes (p less than 0.05) and the number of cutaneous temperature peaks (p less than 0.05) but had no effect on the number of luteinizing hormone secretory pulses, variability of luteinizing hormone secretion, or total luteinizing hormone secretion. These studies indicate that alpha-adrenergic mechanisms (central and/or peripheral) play a role in the pathophysiology of menopausal flushes.

Climacteric↗
PubMed1983

Effect of intravenous clonidine on menopausal flushing and luteinizing hormone secretion.

The effect of clonidine (0.075 mg given intravenously) on subjectively experienced menopausal flushes, skin temperature and luteinizing hormone (LH) secretion was investigated in eight women in a double-blind, saline-controlled cross over study. Subjects were monitored over a 5-hour period. The number and magnitude of temperature peaks (increment greater than 1 degree C) was unaffected by clonidine. Clonidine significantly decreased the number of subjectively experienced flushes as well as the intensity of the flushes. Clonidine had no effect on the number of LH secretory pulses or on total LH secretion. These results indicate that the therapeutic effect of clonidine is independent of factors responsible for episodic skin temperature changes or factors regulating LH secretion.

Climacteric↗
PubMed1981

Labour is still painful after prepared childbirth training.

Labour pain was measured with the McGill Pain Questionnaire in 87 primiparas and 54 multiparas. The average intensity of labour pain ranked among the most intense pains recorded with the questionnaire. However, the pain scores had a wide range and were influenced by several medical and social variables. They were significantly higher for the primiparas than for the multiparas. Moreover, high pain levels were associated with a history of menstrual difficulties and lower socioeconomic status. The primiparas who had received prepared childbirth training had lower pain scores than those who had received no such training. Nevertheless, the effects of prepared childbirth training were relatively small, and most patients (81%) who received it requested epidural anesthesia. Because many women who received training suffered severe pain during labour, prepared childbirth training and epidural anesthesia should be regarded as compatible, complementary procedures.

Adolescent↗
PubMed1981

Premature ovarian failure.

Premature ovarian failure remains a multifactorial syndrome in which genetic, immune, and environmental factors may play a role. The possible etiology and pathophysiology of premature ovarian failure is reviewed. A scheme of the management of premature ovarian failure is illustrated. This allows a logical approach in which the final diagnosis has to be made with laparotomy ovarian biopsy. It is hoped that future research can be directed to the solution of the etiology of premature menopause and insensitive ovary syndrome, as well as the management of patients with insensitive ovary syndrome, so that either by estrogen replacement or stimulation with hypothalamic/pituitary hormone these primordial follicles can be induced to develop normally.

Adult↗