Search PubMed⌕ Search

Biomedical subjects

R B Newman

Publications and source records attributed to R B Newman.

At least 55 records · Page 3Linked to original sources
PubMed1993

Randomized trial of oral indomethacin and terbutaline sulfate for the long-term suppression of preterm labor.

OBJECTIVE: Our purpose was to determine the efficacy and safety of long-term oral tocolysis with indomethacin or terbutaline sulfate. STUDY DESIGN: Seventy-one patients at 26 to 32 weeks' gestation admitted for preterm labor were prospectively randomized to receive oral indomethacin or terbutaline sulfate after successful intravenous tocolysis. Patients were monitored weekly for cervical change, maternal side effects, amniotic fluid volume, and constriction of the fetal ductus arteriosus. Patients receiving indomethacin were converted to terbutaline at 34 weeks or with the occurrence of fetal ductal constriction or oligohydramnios. RESULTS: Of 71 patients randomized six were excluded after randomization. Thirty-three patients were randomized to indomethacin and thirty-two to terbutaline. There were no differences in the percentage of patients achieving 34 weeks of gestation. No differences in neonatal outcome were noted. Nine (27%) fetuses receiving indomethacin had constriction of the fetal ductus arteriosus, and 13 (38%) had oligohydramnios. Most patients on terbutaline reported beta-mimetic side effects (53%), but only one required discontinuation of therapy. CONCLUSION: Both indomethacin and terbutaline sulfate are effective tocolytics, but major fetal side effects are common with long-term indomethacin use.

Adult↗
PubMed1993

Randomized trial of intraumbilical vein oxytocin in midtrimester pregnancy losses.

OBJECTIVE: The purpose of this double-blind prospective randomized trial was to determine whether high-dose intraumbilical vein oxytocin injection shortens the third stage of labor in midtrimester pregnancy losses. STUDY DESIGN: Patients (n = 50) with spontaneous or induced midtrimester pregnancy losses (14 to 26 weeks' gestation) were randomized to receive either 100 IU of oxytocin in 20 ml of normal saline solution or 20 ml of normal saline solution alone as a placebo. The umbilical vein was injected as soon as the cord was clamped. Outcome data were collected. RESULTS: Of the 50 patients randomized, 45 completed the study. Five were excluded after randomization because of either cesarean delivery (1 patient) or en caul delivery (4 patients). Twenty-one patients received oxytocin, and 14 received placebo. Ten patients who were not injected because of technical failure were evaluated separately. There were no differences between the three groups with regard to gestational age, fetal weight, length of the third stage, blood loss, or need for operative removal of the placenta. CONCLUSION: Injection of high-dose oxytocin into the umbilical vein in second-trimester pregnancy losses does not shorten the third stage of labor or decrease the need for surgical intervention because of retained placenta.

Abortion, Spontaneous↗
PubMed1993

Predicting success of external cephalic version.

OBJECTIVE: Many authors have identified prognostic factors for external cephalic version success, but there has not been an attempt to integrate these factors into a simple, quantitative scoring system for predicting version success. Nor have any prognostic factors been prospectively tested. STUDY DESIGN: We examined the clinical characteristics of 108 consecutive breech versions performed between 1984 and 1986. These characteristics were evaluated by stepwise linear regression and discriminate analysis to identify those factors associated with success. Five factors explained the majority of the variability in outcome (parity, placental location, dilation, station, and estimated fetal weight). A model was developed to incorporate the trends identified among these five variables to create a scoring system similar to that of Bishop. This scoring system was then applied to 286 women undergoing external cephalic version since October 1986. RESULTS: There was a positive relationship between a rising version score and the likelihood of successful breech version. No versions were successful with a score < or = 2, and all breech versions were successful with a score of 9 or 10. The results of the version score may have significantly altered physician recommendations in more than one third of cases. CONCLUSION: We believe that this simple, quantifiable scoring system is a refinement in our ability to predict the likelihood of external cephalic version success.

Body Weight↗
PubMed1993

Risks of antepartum cervical examination in multifetal gestations.

OBJECTIVE: This study was performed to determine the risks associated with antepartum cervical examination in women with multifetal gestations attending a specialized antepartum Twin Clinic. STUDY DESIGN: Patients followed up in a specialized Twin Clinic from 1988 through 1991 (N = 89) received extensive preterm birth prevention education and routine cervical examination at each clinic visit. Obstetric outcome was compared between these patients and 288 other twin gestations followed up in the high-risk obstetric clinics between 1981 and 1991. In these control twin gestations cervical examination was done for obstetric indications only. RESULTS: Comparisons between the 89 Twin Clinic attendees and the 288 controls followed up in the high-risk obstetric clinic revealed no significant differences in patient demographics, medical complications, or infectious morbidity. Importantly, premature rupture of membranes was significantly less frequent in the Twin Clinic group, who had 7.6 +/- 3.2 (mean +/- SD) cervical examinations per patient. CONCLUSION: Routine cervical examination in multifetal gestations is not associated with increased rates of premature rupture of membranes or other obstetric complications.

Adult↗
PubMed1993

Reduction in very low birth weight deliveries and perinatal mortality in a specialized, multidisciplinary twin clinic.

OBJECTIVE: To determine whether a specialized, multidisciplinary twin clinic could reduce rates of very low birth weight (VLBW) and perinatal mortality. Multifetal gestations account for only 1% of all pregnancies, yet are responsible for nearly 10% of all perinatal mortality. Very low birth weight (less than 1500 g) infants are the major contributors to this increased perinatal mortality rate. METHODS: Eighty-nine twin pairs followed in the Twin Clinic since 1988 were compared with 51 contemporary twin pairs who did not attend the Twin Clinic. Patients not attending the Twin Clinic were attended in the high-risk clinic by the obstetric residents and faculty. All maternal transports were excluded. Aspects of prenatal care emphasized in the Twin Clinic that differed from the high-risk clinic included consistent evaluation of maternal symptoms and cervical status by a single certified nurse-midwife, intensive preterm birth prevention education, individualized modification of maternal activity, increased attention to nutrition, and tracking of clinic non-attenders. RESULTS: There were no differences between the groups in demographic characteristics, adequacy of prenatal care, or antepartum complications. However, Twin Clinic attenders had lower rates of VLBW infants, neonatal intensive care unit admission, and perinatal mortality. CONCLUSIONS: These improvements in perinatal outcome for twin gestations are attributed to intensive preterm birth prevention education, individualization of prenatal care, and frequent maternal assessment by a consistent care provider. This approach reduced the rate of very early preterm delivery and its neonatal sequelae.

Adult↗
PubMed1992

The effect of maternal intravenous glucose administration on fetal activity.

OBJECTIVE: The study was designed to objectively evaluate the effect of maternal intravenous glucose infusion on fetal activity. STUDY DESIGN: Twenty-one volunteers at 30.7 +/- 3.0 weeks' gestation were objectively evaluated for fetal activity with a Doppler monitor before and during an intravenous glucose test. Baseline fetal activity monitoring began 10 minutes before a fasting blood glucose level was obtained. A standard 1-hour intravenous glucose tolerance test was then performed, and fetal activity monitoring was continued for the duration of the test. Twenty-one women at 29.8 +/- 3.0 weeks' gestation volunteered to serve as controls and were continuously monitored for fetal activity. The control patients did not receive intravenous glucose. RESULTS: Linear regression analysis revealed an increase in fetal activity in both groups; however, the increase in the glucose infusion group was significantly greater than in the control group. CONCLUSIONS: Maternal glucose infusion causes short-term stimulation of fetal activity; however, some other factor in the monitoring process also stimulates fetal activity.

Blood Glucose↗
PubMed1992

Position of the vibroacoustic stimulator does not affect fetal response.

OBJECTIVE: This study was designed to compare the fetal response to the vibroacoustic stimulation test when applied alternately over the fetal vertex or breech. STUDY DESIGN: Two hundred five patients with a nonreactive nonstress test after 10 minutes were prospectively randomized to receive the vibroacoustic stimulation test over the fetal vertex (n = 115) or the fetal breech (n = 90). Fetal heart rate reactivity was evaluated. Two patient subsets were evaluated for fetal movement (n = 37) and the fetal startle response (n = 20) after the vibroacoustic stimulation test. RESULTS: Virtually identical fetal heart rate responses and increases in fetal movement were observed after vibroacoustic stimulation over the fetal vertex or breech. The fetal startle response was uniformly observed in both groups. CONCLUSION: Vibroacoustic stimulation over the fetal breech elicits an identical short-term fetal response compared with stimulation over the fetal vertex, potentially reducing the intensity of sound exposure at the fetal ear.

Acoustic Stimulation↗
PubMed1992

Impact of a pharmacist/physician cooperative target drug monitoring program on prophylactic antibiotic prescribing in obstetrics and gynecology.

The pharmacist's role in promoting rational, cost-effective use of drugs has been described in the literature. In a target drug monitoring program (TDMP), a single agent or group of agents becomes targeted for review. Antibiotics have been the primary focus of TDMP because of their therapeutic impact and cost considerations. The objectives of this project were to assess the prophylactic antibiotic prescribing habits of OB/GYN physicians and to evaluate the impact of a pharmacist/physician cooperative TDMP on prophylactic antibiotic prescribing and cost. The study was conducted in three phases: 1) a retrospective chart review of 150 patients, 2) an in-service education session, and 3) a concurrent chart review of 107 patients. Patient selection, timing of preoperative dose, and use of single dose prophylaxis were according to criteria in greater than 90% of patients both before and after the in-service training. Compliance with recommended regimens increased from 45 to 73% after the in-service training. A cost savings was not realized because the physicians wished to use a regimen with anti-anaerobic coverage (i.e., cefotetan) rather than a less expensive agent. However, the cost of selection of resistant organisms must be considered when discouraging the use of multiple broad spectrum agents. Active involvement of the medical staff in a pharmacy-based TDMP produces a cooperative atmosphere in which to educate clinicians and promote rational prescribing habits.

Anti-Bacterial Agents↗
PubMed1991

Quantification of cervical change: relationship to preterm delivery in the multifetal gestation.

Prematurity is the major contributor to the very high perinatal morbidity and mortality associated with multifetal gestations. Antepartum cervical evaluation has been suggested as a way to better define the risk of preterm delivery in multifetal gestations. Weekly digital cervical examinations were performed in 86 twin and 7 triplet gestations that were being monitored in a special antepartum clinic. A cervical score was calculated from each examination by subtracting cervical dilatation in centimeters from cervical length in centimeters. Cervical scores decline gradually with advancing gestation and are influenced by parity and subsequent preterm delivery. Intervals until delivery decrease significantly with lower cervical scores. A cervical score less than or equal to 0 on or before 34 weeks' gestation was strongly predictive of preterm delivery (75%). Only 2 of 78 (2.6%) with a score greater than 0 were delivered within 1 week of the examination. Cervical scoring is a simple, quantifiable, reproducible, and safe method of evaluating preterm delivery risk. An understanding of the prognostic significance of specific cervical scores may be of value in determining the need for obstetric intervention.

Adult↗
PubMed1991

Uterine activity after preterm premature rupture of the membranes.

Preterm premature rupture of the membranes complicates few pregnancies but is a major contributor to overall perinatal morbidity and mortality. Although a reduced incidence of preterm premature rupture of fetal membranes has been reported in women who had antepartum uterine activity monitoring, there are few data regarding uterine activity after preterm premature rupture of fetal membranes. Therefore daily uterine activity monitoring was performed in 101 consecutive women with preterm premature rupture of fetal membranes between 26 and 34 weeks' gestation. The mean gestational ages at rupture and delivery were 31.4 +/- 2.3 and 33.7 +/- 4.5 weeks, respectively. A significant increase in contraction frequency was identified within 24 hours of onset of preterm labor (p less than 0.005). A contraction frequency of four or more per hour predicted the onset of labor within 24 hours with a sensitivity of 72%, a specificity of 90%, a positive predictive value of 54%, and a negative predictive value of 95%. These results indicate that most women with preterm premature rupture of fetal membranes exhibit a baseline contraction frequency that is similar to that of women with intact membranes and premature labor. An abrupt increase in contraction frequency is a warning of impending labor.

Adult↗
PubMed1991

Cross-sectional analysis of triplet birth weight.

Parameters of fetal growth in triplet gestations are poorly studied and controversial. A cross-sectional analysis of triplet birth weight was performed to elucidate fetal growth patterns. Birth weight and gestational age data were analyzed on 580 infants in 196 triplet sets (eight stillborn infants excluded) between 1985 and 1988. Ovulation induction was used in approximately one half the gestations and early obstetric and ultrasonographic dating was available in all pregnancies. The mean triplet set and individual triplet weights versus gestational age were calculated with distinctly linear growth displayed between 22 to 38 weeks' gestation. Mean intratriplet differences at all gestational ages were determined. A comparison of singleton and triplet growth curves was constructed to show the distinct growth characteristics of triplets.

Birth Weight↗
PubMed1991

Influence of clinical variables on triplet birth weight.

The small size of most reported triplet series has resulted in conflicting statements about the influence of several clinical variables on triplet birth weight. Therefore, obstetrical and neonatal data were collected on 196 mothers and their 580 infants (8 stillbirths excluded). Gestational age was based on the date of fertilization in 13 IVF triplets and on the date of ovulation in 90 medically induced triplets. Obstetrical and ultrasonic criteria were used to estimate the date of confinement in 93 spontaneous triplets. Birth weight appeared to be higher in males and with higher maternal parity, independent of gestational age. The apparent effect of medical technologies such as ovulation induction or IVF on combined triplet birth weight disappeared when maternal parity and fetal gender were controlled. Preeclampsia, maternal race and zygosity were not significantly associated with birth weight. While birth order did not significantly effect ultimate birth weight, the heaviest triplet did present first more often than would be expected by chance alone. Future evaluation of neonatal outcome data in multifetal gestations should control for gestational age, fetal gender and maternal parity. It appears that triplet birth weight is not affected by etiology, which is important given the significant impact of medical technologies.

Analysis of Variance↗
PubMed1991

Hyperemesis gravidarum. A comparison of single and multiple admissions.

Recurrent hyperemesis gravidarum is a frustrating and poorly studied complication of early pregnancy. Between 1979 and 1987, 140 women with emesis severe enough to require parenteral fluid and electrolyte replacement were admitted to the Medical University of South Carolina Hospital, Charleston, on 220 occasions. Thirty-nine of the 140 women were admitted on multiple occasions. A comparison of clinical characteristics of women with single and multiple admissions revealed no significant differences except that women admitted repeatedly for hyperemesis gravidarum were more likely to be nulliparous (P less than .05). Ptyalism (59% vs. 9%) and persistent vomiting for greater than 24 hours after admission (69% vs. 23%) were significantly more common among women who were admitted repeatedly (P less than .05). Despite published reports that hyperemesis gravidarum has no impact on ultimate perinatal outcome, this study indicated that women admitted repeatedly have a more severe nutritional disturbance, associated with significantly reduced maternal weight gain and neonatal birth weight. These risks argue for more aggressive antenatal treatment and increased fetal surveillance in pregnancies complicated by recurrent hyperemesis gravidarum.

Adult↗
PubMed1990

Objective tocodynamometry identifies labor onset earlier than subjective maternal perception.

The ability of women instructed in self-detection of uterine contractions to identify the abrupt rise in uterine activity known to precede the onset of labor has not been evaluated. This study was designed to assess the temporal relationship between objective uterine activity monitoring, subjective maternal perception of uterine activity above a commonly used threshold value (four or more contractions per hour), and progressive cervical change. Daily tocodynamometry (7-9 AM) was recorded in 79 women with preterm premature rupture of the membranes from admission until the onset of spontaneous labor (5.3 +/- 6.3 days). The subjects were at bed rest, received no tocolytic therapy, and were instructed in the signs of labor and uterine self-palpation. Patients simultaneously provided a subjective assessment of uterine activity (four or more contractions per hour). The majority of uterine activity recordings (78%) revealed fewer than four contractions per hour, and the patients' subjective reports agreed in almost all instances (97.6%). On 91 days, four or more contractions per hour were recorded objectively, but the patients' subjective reports agreed in only 25 instances (27%). On the day of labor onset, significantly more women had an objective assessment (32%) (P less than or equal to .01). Patients subjectively identified labor onset 10.6 +/- 6.7 hours after objective monitoring indicated increased uterine activity, and when subjectively identified, both cervical dilatation (4.9 +/- 2.5 cm) and effacement (85 +/- 30%) were significantly advanced (P less than or equal to .001) compared with the admission examination (1.1 +/- 1.2 cm; 20 +/- 30%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiotocography↗
PubMed1990

Antepartum uterine activity characteristics differentiating true from threatened preterm labor.

Daily antepartum nursing contact and ambulatory uterine activity monitoring have been used for the early detection of preterm labor. However, it may be difficult to separate true labor from false labor. In this study, the uterine activity records of 110 women at risk for preterm birth with excessive contraction frequencies were evaluated by blinded reviewers. Maternal symptomatology and uterine activity characteristics such as low-amplitude high-frequency contractility, contraction amplitude, contraction duration, contraction interval, and contraction rhythmicity were assessed for their ability to differentiate true from threatened preterm labor. Neither maternal symptomatology nor any uterine activity characteristic other than contraction frequency could differentiate true from threatened preterm labor. Antepartum uterine activity monitoring should continue to rely on contraction frequency to identify the woman at risk for premature labor.

Adult↗
PubMed1989

Outpatient triplet management: a contemporary review.

The antepartum management of 198 women who were delivered of triplets between 1985 and 1988 is reviewed. Women were managed with the assistance of ambulatory perinatal nursing to provide outpatient surveillance. Modified bed rest, prophylactic tocolysis, and betamethasone were liberally used and patients were hospitalized only when obstetrically indicated. The most common antepartum complication was preterm labor (66.2%) and the success of therapy with tocolytic agents is described. The mean gestational age and birth weight at delivery were 33.6 +/- 3 weeks (mean +/- SD) and 1871 +/- 555 gm, respectively. Comparison of the gestational age distribution at delivery with previous reviews demonstrates fewer deliveries less than 29 weeks' gestation and significantly more deliveries between 32 and 37 weeks' gestation. Cesarean delivery occurred in 94% of the triplets, which eliminated birth order as a factor that affects survival. The corrected perinatal survival rate was 95% in this contemporary review of outpatient triplet management and represents a major improvement in the expected outcome for triplets.

Adult↗