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Biomedical subjects

R B Newman

Publications and source records attributed to R B Newman.

At least 73 records · Page 4Linked to original sources
PubMed1989

Eclampsia as a possible risk factor for persistent trophoblastic disease.

Twenty cases of hydatidiform mole complicated by eclampsia with adequate postevacuation follow-up are identified in a review of the literature since 1866. The clinical presentation of each of these patients is reviewed with particular attention to the existence of known risk factors for persistent trophoblastic disease. After excluding 3 women with coexisting fetus and 2 others who were treated initially with a total abdominal hysterectomy, it was discovered that 14 of the remaining 15 women developed persistent trophoblastic disease. This frequency of persistent trophoblastic disease is greater than can be explained based on previously described risk factors and suggests that the occurrence of eclampsia may be an independent risk factor for persistent trophoblastic disease.

Adult↗
PubMed1989

The influence of fetal number on antepartum uterine activity.

Home uterine activity monitoring was performed by 54 women with singleton, 30 with twin, and 34 with triplet gestations. Data were analyzed to determine the relationship between antepartum uterine activity, preterm labor, and fetal number. Preterm labor in singleton and twin gestations was preceded by significant increases in pre-labor contraction frequency (P less than .01). However, in triplets, preterm labor was not preceded by increased pre-labor contractions. Triplet and twin gestations with term labor were associated with higher baseline contraction frequencies than were high-risk singleton gestations with term labor (P less than .05). Fetal number had no impact on pre-labor contraction intensity, although triplet gestations had a significantly greater proportion of uterine activity occupied by low-amplitude, high-frequency contractility.

Female↗
PubMed1988

Association of eclampsia and hydatidiform mole: case report and review of the literature.

A patient with a hydatidiform mole complicated by eclampsia is presented. The findings from 57 other cases discovered in a review of the literature since 1866 are summarized to define the clinical characteristics of women experiencing eclampsia as a manifestation of their hydatidiform mole. Eclampsia complicating a molar pregnancy is generally preceded by typical preeclamptic symptomatology and uniformly by severely elevated blood pressure. Neurological or visual symptoms also commonly warn of impending eclampsia. Although the reported cases of eclampsia complicating molar pregnancies are rare, this risk argues for the liberal use of prophylactic antiseizure medication when caring for women with a hydatidiform mole and hypertension, neurological complaints, or other preeclamptic symptoms.

Adult↗
PubMed1987

Antepartum ambulatory tocodynamometry: the significance of low-amplitude, high-frequency contractions.

The clinical significance of low-amplitude, high-frequency contractions was examined during pregnancy in 142 women who underwent daily ambulatory tocodynamometry between 23-36 weeks' gestation. The results indicate that patients destined to develop preterm labor had this contractility pattern significantly more often than did their counterparts who delivered at term (13.5 versus 9.2%; P less than .01). Parity and gestational age had no effect on the occurrence of low-amplitude, high-frequency contractility, but this pattern was also significantly more prevalent in the presence of multifetal gestations, independent of the occurrence of preterm labor. The institution of tocolytic therapy was accompanied by a 50% decrease in the proportion of time occupied by low-amplitude, high-frequency contractions. Although this contraction pattern occurred significantly more often among patients who later developed preterm labor, calculations of its predictive values, specificity, and sensitivity indicate that its presence has relatively limited clinical significance.

Female↗
PubMed1987

Measurement of fetal shoulder width with computed tomography in diabetic women.

We conducted a feasibility study of the use of computed tomography (CT) to measure the width of the fetal shoulders and to predict large birth weight in infants of diabetic mothers. Computed tomography pelvimetry using low-dose digital radiographs was performed before delivery at term in 22 diabetic women. Shoulder width was estimated by direct electronic measurement on a single axial section through the shoulders of the fetus, and by orthopedic calipers within 48 hours of birth. Shoulder width by CT was 11.4-16.5 cm, and correlated significantly with postnatal measurements (r = 0.66, P = .01). Shoulder width by CT also correlated well with birth weight (r = 0.84, P less than .01), and measured more than 14 cm in all seven infants with birth weights more than 4200 g. Using 14 cm as a positive test and birth weight 4200 g as an abnormal result, the predictive value of a positive test was 78% and the predictive value of a negative test was 100%. This technique deserves further evaluation in assessing the risk of shoulder dystocia in potentially macrosomic infants.

Birth Weight↗
PubMed1986

Assessment of uterine activity in ambulatory patients at high risk of preterm labor and delivery.

With use of an ambulatory tocodynamometer, prelabor uterine activity was recorded daily during pregnancy in 34 patients at increased risk of preterm labor and delivery. The data indicate that the frequency of contractions was significantly greater among women who subsequently developed preterm labor when compared to that observed among women who labored at term. This difference was present up to several weeks before the onset of labor. An additional significant rise in frequency of contractions could be observed within the last 24 hours before the development of clinically apparent preterm labor, as evidenced by progressive cervical dilation and effacement. If these results can be reproduced in a larger sample, intermittent ambulatory monitoring may offer an effective way to better identify patients at risk of preterm labor as well as enhance the early diagnosis of this event.

Adult↗
PubMed1986

Uterine activity during pregnancy in ambulatory patients: comparison of singleton and twin gestations.

Prelabor uterine activity was monitored daily in a group of ambulatory outpatients who were delivered at term. The study included 22 patients with one fetus and 18 with twin gestations. The mean weekly frequency of uterine activity during twin gestations was found to be significantly higher throughout pregnancy than that identified during pregnancies with a single fetus. In twin gestations a gradual significant rise in frequency of contractions could be observed with advancing gestational age. The data presented could help establish the guidelines for evaluation of uterine activity records during pregnancies complicated by a multifetal gestation.

Adult↗
PubMed1986

Detection of preterm labor by ambulatory monitoring of uterine activity for the management of oral tocolysis.

A study to evaluate whether ambulatory tocodynamometry at home could enhance the management of oral tocolysis was performed. On discharge from the hospital, after completing parenteral tocolysis, 60 patients received a lightweight tocodynamometer, designed for storage and transmission of uterine activity data. Sixty additional contemporary patients, who were matched for maternal age, parity, and risk factors, served as a control group. In addition to instructions regarding self-detection of recurrent preterm labor, monitored patients recorded uterine activity for greater than or equal to 200 min/day and then transmitted the data to the study center. Tocolytic dosage was adjusted to maintain mean uterine contraction frequency of less than 4/hr. Persistent uterine contractions of greater than or equal to 4/hr lead to in-hospital evaluation for recurrent preterm labor. The results indicate that the monitored group had a lower incidence of preterm births mostly because of a decrease in the proportion of patients with failed tocolysis. It is suggested that surveillance of uterine activity at home during oral treatment for preterm labor may be instrumental in improving perinatal outcome in high-risk patients.

Adult↗
PubMed1986

Maternal perception of prelabor uterine activity.

Patient perception of uterine activity was assessed objectively in 44 women at risk for preterm labor using a tocodynamometer designed for ambulatory outpatient use. The monitor allowed patient-activated marking of the data whenever contractions were perceived. After instruction in self-detection of uterine activity, tocodynamometry was performed daily for 8.5 weeks per patient. Patients identified an average of 15% of their contractions during the study (range 0-78%). Numerous marks were placed in the absence of any detectable uterine activity. Of multiple obstetric variables analyzed, only multifetal gestation and preterm labor in the current pregnancy had any significant impact on perception. Results suggest that self-detection of uterine activity may not be reliable as the only means for the earliest possible detection of preterm labor.

Female↗
PubMed1986

Detection of preterm labor by ambulatory monitoring of uterine activity: a preliminary report.

Effective tocolytic therapy depends on the ability to make an early diagnosis of preterm labor. This study was designed to assess whether daily ambulatory home monitoring of uterine activity could facilitate early diagnosis of preterm labor. Of 76 patients at high risk for preterm labor who used daily ambulatory tocodynamometry, approximately half developed preterm labor. Evaluation when the diagnosis of preterm labor was first established has shown that in 8% of the patients the cervix was dilated more than 2 cm, shortened to less than 0.5 cm in 23%, and the fetal membranes were intact in all subjects. The same evaluation in 76 nonrandom contemporary controls matched for risk factors, maternal age, and parity has shown that more than 50% had a cervix dilated more than 2 cm, 38% had a cervix shorter than 0.5 cm, and 24% had rupture of the fetal membranes. Ultimately, 88% of the monitored patients and 59% of controls delivered at term. Comparisons between these groups indicate that intermittent home tocodynamometry may indeed be useful in making the early diagnosis of preterm labor.

Ambulatory Care↗
PubMed1970

"Quiet, please".

Explore the source record for details and available documents.

Environmental Exposure↗
PubMedDate not supplied

Prenatal care and multiple pregnancy.

Prenatal care of multiple pregnancy presents a variety of nursing challenges. Specialized care, beginning in early pregnancy, can have a significant impact on the outcome for mothers and neonates. Dramatically increasing roles for advanced technology in the care of multifetal pregnancies must be balanced with families' needs for education and support.

Female↗